Tagged Insurance

HHS To Close Insurance Exchange For 12 Hours On Sundays During Enrollment

The Trump administration plans to shut down the federal health insurance exchange for 12 hours during all but one Sunday in the upcoming open enrollment season. The shutdown will occur from 12 a.m. to 12 p.m. ET on every Sunday except Dec. 10.

The Department of Health and Human Services will also shut down the federal exchange — healthcare.gov — overnight on the first day of open enrollment, Nov. 1. More than three dozen states use that exchange for their marketplaces.

HHS officials disclosed this information Friday during a webinar with community groups that help people enroll.

The Trump administration has come under attack from critics who say that it is intentionally undermining the Affordable Care Act, through regulatory actions. It shortened the enrollment period, withdrew money for advertising and cut the budget for navigators to help people shop for plans.

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The fact that HHS is now closing the site for a substantial portion of each weekend, supposedly for maintenance, seemed the last straw. Many working patients — the prime target group for ACA insurance — might be shopping at just that time.

“The Department of Health & Human Services is actively trying to prevent people from signing up for healthcare coverage,” Rep. Don Beyer (D-Va.) tweeted. “This is outrageous.”

“Argh” was the reaction of Shelli Quenga, program director at the Palmetto Project in South Carolina, a nonprofit group that received about $1 million to help with outreach and enrollment in the past 12 months. This month, HHS cut her budget in half for this year’s open enrollment.

Open enrollment season this year runs from Nov. 1 to Dec. 15, less than half the time people have had to sign up during the first four years of the exchanges created under the Affordable Care Act.

More than 12 million people enrolled on the state and federal marketplaces for 2017 coverage, including more than 9 million on the federal exchange. Some customers give up coverage over the course of the year.

Advocates were already nervous that fewer people would sign up during the shortened period this time around.

“I could see this really impacting the ability of people to complete an application sign-up in a single sitting, which is so important,” said Jason Stevenson, spokesman for the Utah Health Policy Project, an Obamacare navigator group. He noted that 10 p.m. Mountain Time is often a relatively popular time for people to enroll online.

“Health insurance is complicated, and in the past couple of years we had an administration that made it easier to sign up, but that has really changed in the past six months, with more hurdles not only for consumers but for those whose job it is to help them,” he said.

A spokesman for the federal Centers for Medicare & Medicaid Services, which oversee the exchanges, said the shutdowns should not cause too many problems.

“Maintenance outages are regularly scheduled on healthcare.gov every year during open enrollment. This year is no different,” the official said. “The maintenance schedule was provided in advance this year in order to accommodate requests from certified application assisters. System downtime is planned for the lowest-traffic time periods on HealthCare.gov including Sunday evenings and overnight.”

Categories: Insurance, The Health Law

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Facebook Live: What’s Happening With The Children’s Health Insurance Program?

KHN Chief Washington Correspondent Julie Rovner and Bruce Lesley, a Capitol Hill veteran who heads First Focus, a bipartisan children’s health advocacy group, break down the current state of play on CHIP reauthorization and other congressional issues.

For more in-depth conversations with KHN reporters, check out our Facebook video archive.

KHN’s coverage of children’s health care issues is supported in part by a grant from The Heising-Simons Foundation.

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Policy Implications: The GOP Bill’s Math Problems; The Importance Of Funding CHIP

Editorial pages include policy analysis of the Graham-Cassidy health care bill and examine some of the key policies now in play.

The Washington Post: Tens Of Millions Of Americans Could Lose Obamacare Tax Credits Because Thousands Of Alaskans Won’t
American politics is always a math problem. If you have a group of x people, you need (x/2) + 1 votes to win the most votes. That holds true for most elections pitting two candidates against each other, and it holds true for passing legislation. In the case of Cassidy-Graham, the clumsily named bill that is the latest and last iteration of Republican efforts to gut the Affordable Care Act, also known as Obamacare, the x is 100 — the number of votes in the Senate. Thanks to two quirks of the process, the legislation would pass with just (x/2) votes, with the +1 being added by VPOTUS-ex-machina Mike Pence. (Philip Bump, 9/21)

Los Angeles Times: Believe It Or Not, Graham-Cassidy Socializes The Cost Of Health Insurance
There are plenty of things wrong with the Graham-Cassidy-Heller-Johnson proposal to overhaul Obamacare (and Medicaid, while it’s at it), from its cockamamie approach to helping people not insured by their employers to its blithe indifference to the rising cost of medical care. But give sponsoring Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) credit for doing something remarkable: They got even the most conservative of their Republican colleagues to agree to socialize more of the cost of health insurance. (Jon Healey, 9/21)

The Washington Post: Republicans’ Brave New Strategy For Fixing The U.S. Health-Care System
Republicans have unveiled their brave new strategy for fixing the U.S. health-care system: Make someone else deal with it. Of all the god-awful Obamacare-repeal-and-replace plans that Republicans have proposed, Cassidy-Graham might be the god-awfulest. It’s definitely the most cowardly. Republicans spent nine months fighting over how to repeal Obamacare without shafting the poor and enraging voters, and they failed. So instead they’re passing the buck. (Catherine Rampell, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Political Perspectives: Pleas For Truth Talk Regarding Graham-Cassidy; Does Panic On Left Suggest Progress On Right?

Opinion writers express outrage at the contents of the Senate GOP’s latest attempt to repeal and replace Obamacare and explore the political motivations for pursuing the measure’s passage.

The New York Times: Senator Cassidy, Please Stop Lying About Health Care
Here’s a giveway about how bad the new Senate health care bill is: Bill Cassidy, one of its authors, keeps trying to sell it by telling untruths. “The relatively new phenomenon of just ‘up is down’ lying about your bill’s impacts is jarring,” says Loren Adler of the USC-Brookings-Schaeffer Initiative on Health Policy. Most egregiously, Cassidy is claiming that the bill would not ultimately deprive sick people of health insurance. That’s false, as NPR calmly explained when Cassidy said otherwise. (David Leonhardt, 9/21)

The Wall Street Journal: The Panic Over Graham-Cassidy
Senate Republicans must be making progress on their latest attempt to reform health care, because the opposition is again reaching jet-aircraft decibel levels of outrage. The debate could use a few facts—not least on the claims that the GOP is engaging in an unfair process. Republicans are scrambling to pass Lindsey Graham and Bill Cassidy’s health-care bill before Sept. 30, when the clock expires on the budget procedure that allows the Senate to pass legislation with 51 votes. The bill would devolve ObamaCare funding to the states, which could seek waivers from the feds to experiment within certain regulatory boundaries, and it also repeals the individual and employer mandates and medical-device tax. (9/21)

The New York Times: Cruelty, Incompetence And Lies
Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good. (Paul Krugman, 9/22)

The Washington Post: This Republican Health-Care Bill Is The Most Monstrous Yet
Motivated by the cynical aims of fulfilling a bumper-sticker campaign promise and lavishing tax cuts on the wealthy, Republicans are threatening to pass a health-care bill they know will make millions of Americans sicker and poorer. Do they think we don’t see what they’re doing? Does Sen. Charles E. Grassley (R-Iowa) think we didn’t hear what he said Wednesday? “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” he told reporters. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.” (Eugene Robinson, 9/21)

The Wall Street Journal: The Graham-Cassidy Show Is Like ‘Jaws’—And You’re The Swimmer
If you’ve been following the congressional health-care “debate”—an overly kind word, to be sure—you may now be getting an eerie feeling. It’s sort of like “Jaws.” You thought it was safe to go back into the health-care waters. The poor and the powerless seemed to be out of harm’s way. Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) were reporting progress on a bipartisan compromise. Then the Graham-Cassidy bill came out of nowhere, like a great white shark, accompanied by a bit of ominous music. (Alan S. Blinder, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Hospital Transportation; Medicaid Expansion; Obesity Treatment

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Urban Institute: The Affordable Care Act Medicaid Expansions And Personal Finance 
Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing. (Caswell and Waidmann, 9/17)

Health Affairs: Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care
Using data for 2016 from 531 unique provider networks in the Affordable Care Act Marketplaces, we evaluated how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers. Compared to primary care networks, participation in mental health networks was low, with only 42.7 percent of psychiatrists and 19.3 percent of nonphysician mental health care providers participating in any network. (Zhu, Zhang and Polsky, 9/1)

Pediatrics: Cost-Effectiveness Of Family-Based Obesity Treatment 
We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. … For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group. (Quattrin, Cao, Paluch et. al., 9/1)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: In Calif., Gubernatorial Candidates Try To Prove Health Care Street Cred; Death Toll Rises In Fla. Nursing Home Tradgedy

Media outlets report on news from California, Florida, Texas, Illinois and Pennsylvania.

Los Angeles Times: The Push For Single-Payer Health Care Just Went National. What Does That Mean For The California Effort?
When Vermont Sen. Bernie Sanders visited Beverly Hills last May, he made a full-throated appeal for California to “lead the country” and pass a pending state proposal to establish single-payer health care. On Friday, he’ll return here for a San Francisco speech trumpeting his own higher-stakes plan — a bill to drastically overhaul the nation’s health-care system by covering everyone through Medicare. (Mason, 9/22)

Los Angeles Times: Two Top Candidates For California Governor Have Been Touting Their Healthcare Wins. Here’S What They Really Did
Gavin Newsom and Antonio Villaraigosa are depicting themselves as Democratic healthcare visionaries as they campaign to become California’s next governor. To prove his healthcare mettle, Newsom points to Healthy San Francisco, a first-of-its-kind universal system adopted while he reigned as the city’s mayor in 2006. Newsom’s work on the program helped him land an endorsement from the influential California Nurses Association, and a boast or two will surely punctuate his speech at their convention on Friday as hyper-partisan politics intensify over efforts to repeal the Affordable Care Act and implement a national single-payer plan. (Willon, 9/22)

Reuters: Death Toll From Overheated Florida Nursing Home Rises To 10
A 10th elderly patient at a Miami-area nursing home has died after she was exposed to sweltering heat in the aftermath of Hurricane Irma, police said on Thursday. The resident of the Rehabilitation Center at Hollywood Hills died on Wednesday, police in Hollywood, Florida, said in a statement, without giving details. (Simpson, 9/21)

Los Angeles Times: Multiple Cases Of West Nile Virus In Glendale Prompt Education Campaign
With eight cases of West Nile virus reported in Glendale so far this year, health officials took part in a door-to-door education campaign Wednesday, informing residents of what they can do to protect themselves from infection. Conducted by the Greater Los Angeles County Vector Control District, the effort informed residents in Glendale, Los Feliz and Atwater Village about the preventive measures they can take to reduce the risk of being bitten by mosquitoes. Levy Sun, a spokesman for vector control, said wearing insect repellent and dumping out any stagnant water near homes are measures people should take regularly. (Nguyen, 9/21)

Houston Chronicle: Residents Near Houston Superfund Site Await Answers After Hurricane Harvey
Bonner and others in Channelview, Baytown and Highlands neighborhoods along this industrial stretch of the river south of the Lake Houston dam worry about the toxicity of murky water, white dust and the foul-smelling sludge covering their properties. The question for dozens of people, who a week after the storm still guard wrecked riverfront properties from marauders seeking scrap, is whether their neighborhoods are now too contaminated to recover. (Olson, 9/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Money-Saving Offer For Medicare’s Late Enrollees Is Expiring. Can They Buy Time?

Many older Americans who have Affordable Care Act insurance policies are going to miss a Sept. 30 deadline to enroll in Medicare, and they need more time to make the change, advocates say.

A lifetime of late enrollment penalties typically await people who don’t sign up for Medicare Part B — which covers doctor visits and other outpatient services — when they first become eligible. That includes people who mistakenly thought that because they had insurance through the ACA marketplaces, they didn’t need to enroll in Medicare.

Medicare officials are offering to waive those penalties under a temporary rule change that began earlier this year, but the deal ends Sept. 30.

On Wednesday, more than 40 groups, including consumer health advocacy organizations and insurers, asked Medicare chief Seema Verma to extend the waiver deadline through at least Dec. 31, because they are worried that many people who could be helped still don’t know about it.

They also say more time is needed because of application delays at some Social Security Administration (SSA) local offices, where beneficiaries request the waiver.

“We know there are people who can still benefit from it,” said Stacy Sanders, the federal policy director at the Medicare Rights Center, a Washington-based advocacy group that coordinated the request to Medicare. “We know there have been delays, and those are good reasons to extend it.”

Counselors at the Medicare Rights Center have helped seniors apply for the waiver in Arizona, California, Florida, Minnesota, Missouri, New Jersey and New York, she said.

Since the marketplaces opened in 2014, the focus has been on getting people enrolled, Sanders added. “There’s no reason to expect that people would understand how to move out of the marketplace into Medicare.”

The waiver offer applies not only to people over 65 who have kept their marketplace plans, but also to younger people who qualify for Medicare through a disability and chose to use marketplace plans.

The waiver also allows Medicare beneficiaries who earlier realized their mistake in keeping a marketplace plan and have switched to ask for a reduction or elimination of the penalty.

In all cases, people had to be eligible for Medicare after April 1, 2013.

Officials at the Centers for Medicare & Medicaid, which runs Medicare, would not provide details about the number of waivers granted or pending applications. Nor would they comment on the likelihood of an extension.

Barbara Davis said that when she initially applied, a Social Security representative didn’t know about the waiver. She eventually contacted the Medicare Rights Center, where a counselor interceded on her behalf in June. A day later, a Social Security representative told her she would not have a penalty.

“My advice would be, find out your rights before you apply,” said Davis, 68, who lives with her husband in rural western New York. “Because they don’t seem to want to give you information to help you, you have to know this on your own.”

A Social Security spokeswoman said the agency is processing waiver applications from “across the country” but does not keep track of the number. She declined to comment on whether SSA employees know about the waiver.

Sanders suggested that people applying for the waiver ask Social Security officials for it by using its official name: “time-limited equitable relief.”

Since Medicare’s Part A hospitalization benefit is usually free, some seniors who liked their marketplace coverage thought — incorrectly — that they had nothing to lose by signing up for Part A and keeping their marketplace plan.

Some people receiving Social Security retirement or disability benefits opted to keep their marketplace plan and drop Part B after the Social Security Administration enrolled them automatically in Medicare when they became eligible.

If the temporary waiver expires, the only other way for beneficiaries to get an exemption is by proving they declined Part B because a government employee misinformed them.

The groups writing Verma argue that keeping the waiver in place past Sept. 30 could also help many beneficiaries who may be surprised by a little-known rule that will affect 2018 marketplace policies.

For the first time, insurers will be prohibited from issuing a marketplace plan if they know the member is eligible for Medicare and the 2018 policy is significantly different.

Those who find themselves without a marketplace plan could be in for another surprise: They won’t have insurance for outpatient care until July 1 because Medicare imposes a waiting period before Part B coverage kicks in for latecomers.

Extending the deadline “would lessen a significant hardship for many people … [who] are unaware of the repercussions that could result from keeping their marketplace coverage,” said Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, an industry group.

For information on how to apply for the time-limited equitable relief waiver, go to the Medicare Rights Center’s Medicare Interactive webpage or call the center’s helpline at 1-800-333-4114.

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation and coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Cost and Quality, Insurance, Medicare, The Health Law

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High On Drugs? Anthem Cites Soaring Drug Costs To Justify 35% Rate Hike in California

Health insurance giant Anthem predicts Californians will pop a lot more pills next year.

To make the case for a hefty premium hike in the state’s individual insurance market, Anthem Blue Cross has forecast a 30 percent jump in prescription drug costs for 2018. Such a sharp increase is nearly double the estimates of two other big insurers, and it runs counter to industry trends nationally.

Prescription drug spending in the U.S. grew 6.1 percent over the 12 months ending in July, according to Altarum, a nonprofit think tank. That’s down from 12.9 percent in 2014, when expensive new hepatitis C drugs sharply lifted overall pharmaceutical spending.

“I can’t understand why Anthem is predicting 30 percent,” said Charles Roehrig, a health economist and founding director of Altarum’s Center for Sustainable Health Spending. “There are examples of egregious price increases for particular drugs that have gotten a lot of well-deserved attention. But those haven’t characterized what’s happening as a whole,” he added.

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The advocacy group Consumers Union also questioned why Anthem’s cost projections are so much higher than its competitors, and it has asked state regulators to demand additional documentation from the nation’s second-largest health insurer.

Overall, Anthem is proposing a 35 percent rate increase for about 135,000 consumers who buy their own insurance in and outside the Covered California exchange. It’s the largest increase statewide and assumes that federal subsidies for copays and deductibles will continue to be paid. The second highest, also assuming the U.S. government will continue paying those subsidies, is 28.6 percent by Molina Healthcare.

Some of Anthem’s rivals aren’t as pessimistic on the outlook for drug costs. Two other large insurers, Blue Shield of California and Health Net, projected drug costs will rise by 16.4 and 15 percent, respectively. Anthem came in even lower than that in its rate filing for Colorado’s individual market, projecting an 11.4 percent increase in prescription drug costs.

The company said it stands by its California cost projections in light of growing market volatility. In documents filed with regulators, the company expressed concern that declining enrollment in the individual market would saddle it with a sicker group of policyholders.

“As it pertains to pharmacy, our rates reflect the increasing utilization and rising cost of prescription drugs we have experienced in this market over the last couple of years,” said company spokesman Colin Manning.

In fact, Anthem emphasizes rising drug utilization over higher drug prices when justifying its rate increase — an argument Consumers Union challenged as unusual. Most other insurers in California have cited rising prices as a bigger factor in filings to state regulators.

“Anthem projects an extraordinary increase in its enrollees’ use of prescription drugs at four or more times the rate of enrollees at other carriers,” said Dena Mendelsohn, a staff attorney for Consumers Union in San Francisco.

The California Department of Managed Health Care said it is scrutinizing Anthem’s “underlying medical costs and trends” as part of its review of 2018 rate increases. The state agency, which expects to finish its review next month, can pressure insurers to reduce their rates, but it doesn’t have the authority to block them.

“We may ask [Anthem] questions and for additional information to support the plan’s proposed rate change,” said Rodger Butler, a spokesman for the Department of Managed Health Care.

Anthem is significantly curtailing its presence in Obamacare marketplaces nationally next year amid ongoing uncertainty from the Trump administration and Congress over whether they will continue the federal subsidies that lower out-of-pocket costs for low-income consumers.

In August, Anthem announced a partial withdrawal from California’s individual market, saying it will sell policies in only about half of the state’s counties.

Anthem’s chief executive, Joseph Swedish, told investors and analysts at a conference this month that the company may re-enter certain ACA markets across the country if Congress and the White House take steps to stabilize them.

Some experts wonder if Anthem made a mistake in its California rate filing. It wouldn’t be the first time.

In 2010, an outside actuary working for California regulators found a critical error in Anthem’s proposal to raise rates by up to 39 percent. President Barack Obama seized on the public outcry over that double-digit increase to help get the Affordable Care Act passed in Congress. Anthem later withdrew the increase after David Axene, an actuary in Murrieta, Calif., discovered problems with the company’s calculations.

Axene said this latest filing for 2018 health plans raises plenty of questions.

The pharmacy estimate “does seem high,” he said. “It’s a more mature marketplace now, so hopefully everybody knows how to price it. But I’m sure stupid mistakes still happen.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Categories: California Healthline, Cost and Quality, Health Industry, Insurance

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Narrow Networks Get Even Tighter When Shopping For Mental Health Specialists

If you’ve got a plan offered on the federal health law’s insurance marketplace and you’re looking for a therapist, you may have to look really hard: The average provider network includes only 11 percent of all the mental health care providers in a given market, according to a recent study.

An average marketplace plan’s network, the study added, includes just under a quarter of all psychiatrists  and 10 percent of all non-physician mental health care providers. Non-physician mental health care providers included psychologists, nurse practitioners and physician assistants, and  behavioral specialists, counselors and therapists with master’s or doctoral degrees.

Michelle AndrewsInsuring Your Health

In addition, the researchers reported that fewer than half of all psychiatrists and a fifth of non-physician providers participated in any marketplace plan.

The problem isn’t unique to marketplace plans, said study co-author Daniel Polsky, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. However, this study, which was published in the September issue of Health Affairs, sheds more light on the challenges insurers face in trying to develop networks of mental health care providers, he said.

At the same time, the narrow networks — those that generally have fewer than 25 percent of participating doctors and other health providers in the area — that many insurers have adopted to help keep marketplace plan premiums lower may exacerbate the problem of finding mental health services, Polsky said.

High demand for services, a shortage of practitioners and low insurance reimbursement rates have all contributed to mental health care providers’ general lack of enthusiasm for joining provider networks, according to the study.

For comparison, the study also analyzed the average network participation of primary care providers in marketplace plans. It found that the average network for ACA plans included 24 percent of all primary care providers in a given market, more than twice the proportion of mental health care providers.

The study examined 2016 data for 531 provider networks offered by 281 insurance carriers in the marketplaces in every state plus the District of Columbia using data from the Robert Wood Johnson Foundation.

The Mental Health Parity and Addiction Equity Act of 2008 requires that health plans’ mental health services be at least as generous as medical/surgical services. That has provided financial protection for consumers, but access to in-network providers remains a problem.

In recent years, primary care physicians have increasingly provided mental health services. The study suggests that enhancing the collaboration between primary care physicians and mental health specialists is vital to improving access to mental health care.

“I would argue that the challenge isn’t necessarily a lack of primary care physicians, it’s a need to reorganize care to meet the needs of the population,” Polsky said. “Team-based care is an opportunity to meet those needs.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Insurance, Insuring Your Health, Mental Health


Thinking About A Single-Payer System: Pros And Cons Of ‘Medicare For All’

Opinion writers offer their ideas about the health care plan advanced by Sen. Bernie Sanders (I-Vt.).

USA Today: Bernie Sanders Medicare-For-All Plan Is All Wrong For America
My 93-year-old father recently came home from the hospital proudly harboring a life-saving $50,000 aortic valve paid for by Medicare, though he rode home in a wheelchair that Medicare didn’t pay for. This gap in services is growing, as Medicare struggles to cover emerging technologies that are not one-size-fits all while at the same time continuing to provide basic care. If Medicare is converted to single-payer or Medicare for all, as Sen. Bernie Sanders of Vermont proposes, tens of millions more patients will be added to an already faltering system, and the gap between the promise of care and actual care delivered will widen. (Marc Siegel, 9/20)

Los Angeles Times: There Are 3 Types Of Single-Payer ‘concern Trolls’ — And They All Want To Undermine Universal Healthcare
Some of the naysayers are conservatives who simply abhor “big government.” Some have perfectly valid reasons to question the merits of single payer in general or Sanders’ methods in particular. Yet others claim they support universal healthcare in theory (one day, perhaps) but cannot do so now because of a “concern.” They are “concern trolls” — broadly defined as “a person who disingenuously expresses concern about an issue with the intention of undermining or derailing genuine discussion.” (Adam H. Johnson, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Perspectives: Outlooks Are Not Rosy Regarding The On-The-Ground Impact Of The Current GOP Repeal Plan

Newspapers offer their members of Congress a bleak picture of what would happen in their states if the Graham-Cassidy proposal were to become law.

The Kansas City Star: No, Sen. Pat Roberts, This Awful Health Care Bill Isn’t The Only Obamacare Alternative
The Category 5 Hurricane known as Graham-Cassidy is a man-made disaster that may yet be avoided. But if you’re asking why even the craziest storm chaser wouldn’t steer clear of the direct hit that this latest health care bill would amount to, well, talk to our own Sen. Jerry Moran, who remains undecided. Or better yet, listen to his fellow Kansas Republican, Sen. Pat Roberts, whose explanation of this final attempt to blow up the Affordable Care Act is daft but highly instructional. (9/20)

The Des Moines Register: Senate’s Latest Health Bill Offers No Lifeline For Iowa
Gov. Kim Reynolds jumped aboard the latest Republican effort to repeal most of Obamacare as if it were the last lifeboat off the Titanic. “You know, this can work and I believe right now, this is the only vehicle we have to address Obamacare, that’s failing,” she said Tuesday. She was talking about legislation co-sponsored by Republican U.S. Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The bill would put states in charge of designing their own health-care systems, with federal money from existing Obamacare taxes. Expansion of the federal program for low-income Americans, Medicaid, would end in 2020 and states would get block grants instead. (Kathie Obradovich, 9/20)

Lexington Herald Leader: Latest GOP Bill Greatest Threat To Ky. Health Care Coverage
The latest attempt to repeal the Affordable Care Act is known as Cassidy-Graham, and it very well may be the greatest threat to Kentucky’s health care. The state’s success in getting people coverage, and even health-care gains achieved decades ago, are at risk of being undone with this legislation. The bill, sponsored by Sens. Bill Cassidy and Lindsey Graham, is perhaps the final attempt at tearing up the ACA and doing permanent damage to Medicaid. It’s being rushed through before policymakers and the public can understand its implications. That’s because after Sept. 30, the Senate can no longer pass a partisan repeal bill with only 51 votes, due to chamber rules. (9/19)

Kansas City Star: Cassidy-Graham Health Care Bill Would Hurt Kansans
Now, in a last ditch effort to repeal the ACA by September 30, the end of the federal fiscal year, Congress is back with another destructive bill. Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina have introduced legislation that, like its failed predecessors, will result in coverage losses, higher costs, and elimination of consumer protections. (Sandy Praeger, 9/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Parsing The Policies: Is This Just Another ‘Lousy’ Bill Or Does It Advance A ‘Great Idea’?

Editorial pages offer a variety of ideas about the Graham-Cassidy bill now pending in the Senate, with some saying it’s “poison” and others praising its intent to give states flexibility.

Los Angeles Times: Graham-Cassidy: Another Day, Another Lousy GOP Healthcare Bill
The latest proposal — by Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) — suffers from the same fundamental problems as all of its predecessors. Aiming to lower insurance costs for the healthy, it would allow states to herd people with preexisting conditions or potentially expensive risks — say, women who might want maternity coverage — into insurance gulags with egregiously high premiums. (9/21)

USA Today: Last-Ditch Obamacare Repeal Would Be Poison
Given up as a lost cause this summer, the Republican effort to repeal and replace Obamacare is back, this time in the form of a last-ditch effort led by GOP Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson. Like previous efforts, this measure would strip tens of millions of people of their health coverage. It would gut Medicaid, the program responsible for funding nearly half of baby deliveries and most of nursing home care. It would allow insurers in some states to deny coverage based on a previous medical condition. And it would allow insurers to skip coverage of essential services, including maternity care. (9/20)

USA Today: Let States Tailor Health Care Plans
Under Obamacare, insurance premiums in the individual market have more than doubled nationally, and without billions of additional taxpayer dollars, many of those markets are at risk of collapse. Obamacare was never designed to be patient-friendly. In fact, one of the key tenets of Obamacare is taking power away from patients and local officials. Obamacare gives this decision-making power to the federal government, allowing bureaucrats to call the shots. (Sen. Ron Johnson, 9/20)

The New York Times: Graham-Cassidy Has One Great Idea
In the timid sense, the proposal would keep much more of Obamacare’s taxes and spending in place than previous Republican plans this year. Yet Graham-Cassidy makes more sweeping changes by turning money currently used on insurance subsidies and the Medicaid expansion into block grants to states. This change would give states more flexibility to design their own health care systems. (Philip Klein, 9/20)

The Washington Post: Cassidy-Graham Is Attractive In Theory. But It Has A Giant Flaw.
A group of Republican senators, led by Bill Cassidy (La.) and Lindsay O. Graham (S.C.), have revived GOP efforts to repeal and replace Obamacare. Their bill has a number of attractive attributes: It would repeal Obamacare’s individual mandate, for example, and make important reforms to Medicaid. But Cassidy-Graham also has an important, albeit fixable, flaw — what we might call “asymmetric federalism.” (Avik Roy, 9/20)

Los Angeles Times: The Disastrous Impact Of The GOP’s Obamacare Repeal Plan, In Three Devastating Charts
The healthcare consulting firm Avalere on Wednesday released the latest in a series of independent analyses of Senate Republicans’ new effort to repeal the Affordable Care Act. The findings are beyond ugly. They show devastating cuts in healthcare funding for adults, children and the disabled — in effect, almost every population category in the U.S. other than seniors enrolled in Medicare. (Michael Hiltzik, 9/20)

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Political Reverberations: How Graham-Cassidy Impacts The Health Care Debate

Editorial pages feature opinions praising this “last-chance” legislation or calling it “nonsense” and “cynical.” They also detail how, regardless of the outcome of the vote planned for next week, the GOP will own it.

The Wall Street Journal: Republicans Get One Last Chance On ObamaCare Reform
For seven years Republicans promised to repeal ObamaCare, and now they have one last chance to deliver. A bill recently introduced by Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson would eliminate some of ObamaCare’s most unpopular provisions and enact reforms that would lower costs, expand choices, promote federal fiscal responsibility, and give power back to states and consumers. … The Graham-Cassidy bill’s biggest strength is the idea that states are uniquely equipped to design and implement health care programs that suit their residents. The bill would consolidate much of the federal funding given to states under ObamaCare’s coverage provisions—including money for its Medicaid expansion and subsidies to help people buy private insurance—into a single block grant, which states could use for a wide variety of health reforms. (Lanhee J. Chen, 9/20)

JAMA Forum: Republicans Will Own Whatever Happens To The ACA And Health Care Reform
As has become clear, “Repeal and Replace” of the Affordable Car Act (ACA), a mantra that provided such a unifying theme for Republicans when Democrats controlled the White House, has been much harder than Republicans expected when they achieved “full control” of the government. Republicans were barely able to pass a health care bill in the House despite their substantial majority over Democrats (240-194) and the Senate fell short of passing the so-called “skinny” repeal bill, HR 1628, which repealed only a limited portion of the ACA. (Gail Wilensky, 9/19)

The Washington Post: Lots Of Vulnerable House Republicans Come From States That Will Lose Under Cassidy-Graham
If the Senate passes Cassidy-Graham, its latest attempt to repeal Obamacare, the legislation will then go to the House for a vote. If that happens, Speaker Paul D. Ryan (R-Wis.) has vowed to engineer its quick passage in the lower chamber, too …. certain states are going to be hit with major losses if this bill becomes law. And it turns out that those states that would lose out happen to be heavy with incumbent House Republicans whose seats are vulnerable in 2018. Will those vulnerable House Republicans vote for a bill that drains their states of huge sums of money that could have been used to cover their own constituents? (Sarah Posner and Greg Sargent, 9/20)

The Wall Street Journal: The Republicans Who May Save ObamaCare
Like Lazarus, the Republican effort to repeal ObamaCare has risen from the dead. Pundits dutifully filled out the toe tag in July, after a repeal-and-replace bill failed to pass the Senate. Now comes new legislation championed by Sens. Lindsey Graham and Bill Cassidy, which just might get the 50 GOP votes needed for Vice President Mike Pence to break the tie and pass the bill. … Senate passage would clear the way to ending the individual and employer mandates, repealing the medical-device tax, and phasing out the ObamaCare exchanges and their highly prescriptive regulations. … The danger is that there are at least four Republican senators at risk of voting “no.” (Karl Rove, 9/20)

Bloomberg: Republicans Peddle Nonsense To Sell Health-Care Plan
Graham and Cassidy have sold this hastily assembled measure as a bipartisan compromise that, rather than cutting coverage, merely gives the states the funds and flexibility to determine their own health-care policies. None of that holds up. The bill is purely partisan—it’s being rushed through for the simple reason that it lacks any Democratic support. Graham, in press conferences, has hailed the plan as a middle-ground compromise between Obamacare and the coverage-slashing Republican proposals that collapsed in July. That’s nonsense. (Albert R. Hunt, 9/20)

Boston Globe: Yet Another Cynical GOP Ploy On Health Care
The latest Republican vehicle for repealing and replacing Obamacare is Graham-Cassidy, a bill that would dramatically cut federal health care spending and block-grant remaining monies to the states while not requiring those states to spend the money on expanding care. (Micheal Cohen, 9/20)

Bloomberg: How The Health-Care Debate Would Change If Graham-Cassidy Passes
What a difference a week makes. Last week, many commentators (including me) saw the Graham-Cassidy bill as a bit of Hail Mary legislating, a last desperate stand against Obamacare. This week, it started to look as if it might actually have some chance of passage. The legislative math remains daunting; the parliamentary obstacles high. But the status of Republican health-care efforts has moved from “flatline” to “still breathing, barely.” (Megan McArdle, 9/20)

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State Highlights: Texas Bill To Curb ‘Surprise Medical Bills’ Now In Effect; Blue Cross Will Continue To Run N.C.’s State Health Plan

Media outlets report on news from Texas, North Carolina, Maine, Florida, California, Nevada, Colorado, Michigan, Missouri, New Hampshire, Louisiana and Minnesota.

The Associated Press: Lawsuit Challenges Law That Only Doctors Perform Abortions
The American Civil Liberties Union and Planned Parenthood filed a federal lawsuit Wednesday that challenges a Maine restriction common across most of the U.S. that abortions be performed solely by physicians. The two groups were joined by four nurses and abortion provider Maine Family Planning in challenging the law that prevents advanced practice registered nurses, such as nurse practitioners and nurse midwives, from performing the procedure. (9/20)

Las Vegas Review-Journal: Southern Nevada Medicare Dilemma: Pay More Or Switch Doctors
The recent decision by Southwest Medical Associates to stop covering traditional Medicare patients in Southern Nevada makes 66-year-old Anne Zarate sick to her stomach. That queasy feeling is not just because, as the Las Vegas woman puts it, she’s being “thrown out with 7,000 others in a city where access to medical care is weak at best.” She also sees Southwest’s action as an example of the inability of government to deliver quality health care in the United States. (Harasim, 9/18)

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Policy Points: Looking For Innovation In Medicare And Medicaid; Health Care In Japan

Editorial pages feature an announcement by the head of the Centers for Medicare & Medicaid Services on Trump administration plans, one suggestion for covering more Americans and a look at how Japan handles health care.

The Wall Street Journal: Medicare And Medicaid Need Innovation
More than 130 million Americans are enrolled in Medicare and Medicaid. America’s elderly and most vulnerable citizens depend on these programs. But both face fiscal crises. … The Centers for Medicare and Medicaid Services has a powerful tool for improving quality and reducing costs: the Center for Medicare and Medicaid Innovation. … This administration plans to lead the Innovation Center in a new direction. On Wednesday we are issuing a “request for information” to collect ideas on the path forward. (Seema Verma, 9/19)

New Haven (Conn.) Register: ‘Medicare For All’ Could Be Cheaper Than You Think
Sanders’s plan would come at a steep price: likely more than US$14 trillion over the first decade, based on an estimate I did of a previous version. There is, however, a simpler and less costly path toward single-payer, and it may have a better chance of success: Simply strike the words “who are age 65 or over” from the 1965 amendments to the Social Security Act that created Medicare and, voila, everyone (who wants) would be covered by the existing Medicare program. While this wouldn’t be single-payer – in which the government covers all health care costs – and private insurers would continue to operate alongside Medicare, it would be a substantial improvement over the current system. (Gerald Friedman, 9/20)

Bloomberg: Want A Better Health Care System? Check Out Japan
Senator Bernie Sanders’s new health care plan, called “Medicare for All,” would eliminate private health insurance and have the government pay for 100 percent of all health services. It’s not going to happen, but it does point the way toward a system that could work better: A public-private hybrid akin to what Japan has. (Noah Smith, 9/19)

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Thoughts On Graham-Cassidy: ‘Bad Idea’; ‘Shoddiest’ Repeal Idea Yet; ‘Ideological Crusade’

Opinion writers offer dim views of the current measure being advanced by Senate Republicans to undo the Affordable Care Act.

The Washington Post: Another Execrable Health-Care Bill Proves Bad Ideas Never Die
Over the next week and a half, Republican senators may try one last time to repeal and replace Obamacare. The latest bill, from Sens. Bill Cassidy (La.), Lindsey O. Graham (S.C.), Dean Heller (Nev.) and Ron Johnson (Wis.), is about as execrable as the others that GOP lawmakers previously failed to approve. The process by which Republicans would pass it would be as sloppy and partisan as the one to which senators such as John McCain (R-Ariz.) objected earlier in the summer. The outcome would be no less destructive. The big difference now is the clock; the procedural window for passing a health-care bill along straight party lines will disappear at the end of the month, spurring Republicans to try one last time. That is a sad excuse to rush through — without even an attempt at bipartisanship and without a complete Congressional Budget Office assessment — a half-baked bill that would harm millions. (9/19)

Bloomberg: The Latest Obamacare Repeal Is The Shoddiest Yet
The new version, sponsored by Senators Lindsey Graham of South Carolina and Bill Cassidy from Louisiana, would do a number of things to a health care system that millions rely upon. A main selling point is giving states additional ability to act on their own — which means that virtually all of the popular protections of the Affordable Care Act, including on pre-existing protections, would be at risk — and also slashing health care funding. What exactly would it do? It’s not much clearer than that now and won’t get much clearer until next month. The Congressional Budget Office has announced they “will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.” (Jonathan Bernstein, 9/19)

USA Today: Obamacare Repeal Is An Ideological Crusade Past Its Sell-By Date. Give It Up, GOP
Just when Democrats thought it was safe to either stop paying attention or go full Don Quixote on Medicare For All, Obamacare repeal is back. When an entire political party has campaigned and won for seven years on getting rid of a law that was about as popular as President Trump (as in not very), it’s hard to move on. We get that. And who would have thought the country would change its collective mind, just when Republicans won control of the whole government? (Jill Lawrence, 9/19)

Bloomberg: Graham-Cassidy Is Already Hurting Health Care 
This last-gasp bill — called Graham-Cassidy after the senators leading it — would be extremely disruptive to hospitals and government-focused insurers. The proposal ends individual and employer insurance mandates, gives states a big chunk of money and then largely leaves them to run their own health-care markets. It would likely lead to large cuts to Medicaid, destabilize the individual insurance market, and significantly reduce insurance coverage. (Max Nisen, 9/19)

The Washington Post: The Graham-Cassidy Health-Care Bill Puts Millions Of Americans At Risk
The Senate is on the verge of launching a dangerous experiment. Having failed for months to repeal and replace the Affordable Care Act, Republicans hope to dump onto the states the problem of providing low- and moderate-income Americans with access to health care. So long as they are determined to push forward without meaningful Democratic input, they have until Sept. 30 to act under Senate rules. The Graham-Cassidy bill — their last chance to meet this deadline — would simply hand the states block grants and abandon to them millions of Americans whom the ACA now helps. (Timothy Jost, 9/19)

Los Angeles Times: Repeal And Replace Is Back, And Scarier Than Ever
Like the villain in a slasher movie, Senate Republicans keep coming for the health insurance of tens of millions of Americans. After Sen. John McCain’s dramatic “no” vote seemed to finish off this year’s attempts to repeal the Affordable Care Act, a proposal by two senators with mostly unearned reputations for moderation — Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) — represents the latest threat to the many people who gained access to healthcare under President Obama. The scariest part is that it might just pass. (Scott Lemieux, 9/19)

St. Louis Post-Dispatch: Last-Ditch Graham-Cassidy Health Care Bill Is The Worst One Yet
Under cover of a fog of news, Senate Republicans have been trying to round up enough votes for yet another bid to repeal and replace the Affordable Care Act. The bill they have in mind is in many ways worse than any of the three bills that failed this summer. After a dramatic thumbs-down “no” vote by Sen. John McCain, R-Ariz., killed the GOP’s third ACA replacement bill, Senate Majority Leader Mitch McConnell, R-Ky., said it was time to move on. Congress went into recess until after Labor Day, and the nation’s attention turned to hurricanes, immigration, budget matters and rapprochement between President Donald Trump and Democrats. (9/19)

The New York Times: John McCain Faces A New Test Of His Principles
It looks as if John McCain’s Senate colleagues are going to test him once again. And the health insurance of millions of Americans depends on the outcome. This summer, when his party was trying to force a health bill with unprecedented haste — no hearings, no support from medical experts — McCain stood up for the idea of the Senate. By now, you’ve probably heard a line or two from his July 25 speech, shortly after learning he had aggressive brain cancer. But the full speech is worth reading. It’s McCain at his best, a defense of the imperfect but noble pursuit of democratic politics. (David Leonhardt, 9/19)

Roll Call: The Fatal Flaw For Republicans In Graham-Cassidy
The Republicans’ latest drive to repeal Obamacare is reminiscent of a poetry fragment from Tennyson’s “The Charge of the Light Brigade”: “Theirs not to make reply, theirs not to reason why.” Whatever happens with the bill likely slated to reach the Senate floor next week, it is hard to escape the feeling that this wild charge will end badly for the Republicans. (Walter Shapiro, 9/20)

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Last-Ditch GOP Effort To Replace ACA: 5 Things You Need To Know

Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again.

While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.)

They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.

An earlier attempt to replace the ACA this summer fell just one vote short when Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and John McCain (R-Ariz.) voted against it. The latest push is setting off a massive guessing game on Capitol Hill about where the GOP can pick up the needed vote.

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After Sept. 30, the end of the current fiscal year, Republicans would need 60 votes ­— which means eight Democrats — to pass any such legislation because special budget rules allowing approval with a simple majority will expire.

Unlike previous GOP repeal-and-replace packages that passed the House and nearly passed the Senate, the Graham-Cassidy proposal would leave in place most of the ACA taxes that generated funding to expand coverage for millions of Americans. The plan would simply give those funds as lump sums to each state. States could do almost whatever they please with them. And the Congressional Budget Office has yet to weigh in on the potential impact of the bill, although earlier estimates of similar provisions suggest premiums would go up and coverage down.

“If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen, because everything else has failed,” said Graham in unveiling the bill last week.

Here are five things to know about the latest GOP bill: 

1. It would repeal most of the structure of the ACA.

The Graham-Cassidy proposal would eliminate the federal insurance exchange, healthcare.gov, along with the subsidies and tax credits that help people with low and moderate incomes — and small businesses — pay for health insurance and associated health costs. It would eliminate penalties for individuals who fail to obtain health insurance and employers who fail to provide it.

It would eliminate the tax on medical devices. 

2. It would eliminate many of the popular insurance protections, including those for people with preexisting conditions, in the health law.

Under the proposal, states could “waive” rules in the law requiring insurers to provide a list of specific “essential health benefits” and mandating that premiums be the same for people regardless of their health status. That would once again expose people with preexisting health conditions to unaffordable or unavailable coverage. Republicans have consistently said they wanted to maintain these protections, which polls have shown to be popular among voters.

3. It would fundamentally restructure the Medicaid program.

Medicaid, the joint-federal health program for low-income people, currently covers more than 70 million Americans. The Graham-Cassidy proposal would end the program’s expansion under the ACA and cap funding overall, and it would redistribute the funds that had provided coverage for millions of new Medicaid enrollees. It seeks to equalize payments among states. States that did not expand Medicaid and were getting fewer federal dollars for the program would receive more money and states that did expand would see large cuts, according to the bill’s own sponsors. For example, Oklahoma would see an 88 percent increase from 2020 to 2026, while Massachusetts would see a 10 percent cut.

The proposal would also bar Planned Parenthood from getting any Medicaid funding for family planning and other reproductive health services for one year, the maximum allowed under budget rules governing this bill. 

4. It’s getting mixed reviews from the states.

Sponsors of the proposal hoped for significant support from the nation’s governors as a way to help push the bill through. But, so far, the governors who are publicly supporting the measure, including Scott Walker (R-Wis.) and Doug Ducey (R-Ariz.), are being offset by opponents including Chris Sununu (R-N.H.), John Kasich (R-Ohio) and Bill Walker (I-Alaska).

On Tuesday 10 governors — five Democrats, four Republicans and Walker — sent a letter to Senate leaders urging them to pursue a more bipartisan approach. “Only open, bipartisan approaches can achieve true, lasting reforms,” said the letter.

Bill sponsor Cassidy was even taken to task publicly by his own state’s health secretary. Dr. Rebekah Gee, who was appointed by Louisiana’s Democratic governor, wrote that the bill “uniquely and disproportionately hurts Louisiana due to our recent [Medicaid] expansion and high burden of extreme poverty.”

5. The measure would come to the Senate floor with the most truncated process imaginable.

The Senate is working on its Republican-only plans under a process called “budget reconciliation,” which limits floor debate to 20 hours and prohibits a filibuster. In fact, all the time for floor debate was used up in July, when Republicans failed to advance any of several proposed overhaul plans. Senate Majority Leader Mitch McConnell (R-Ky.) could bring the bill back up anytime, but senators would immediately proceed to votes. Specifically, the next order of business would be a process called “vote-a-rama,” where votes on the bill and amendments can continue, in theory, as long as senators can stay awake to call for them.

Several senators, most notably John McCain, who cast the deciding vote to stop the process in July, have called for “regular order,” in which the bill would first be considered in the relevant committee before coming to the floor. The Senate Finance Committee, which Democrats used to write most of the ACA, has scheduled a hearing for next week. But there is not enough time for full committee consideration and a vote before the end of next week.

Meanwhile, the Congressional Budget Office said in a statement Tuesday that it could come up with an analysis by next week that would determine whether the proposal meets the requirements to be considered under the reconciliation process. But it said that more complicated questions like how many people would lose insurance under the proposal or what would happen to insurance premiums could not be answered “for at least several weeks.”

That has outraged Democrats, who are united in opposition to the measure.

“I don’t know how any senator could go home to their constituents and explain why they voted for a major bill with major consequences to so many of their people without having specific answers about how it would impact their state,” said Senate Minority Leader Chuck Schumer (D-N.Y.) on the Senate floor Tuesday.

Categories: Insurance, Medicaid, Repeal And Replace Watch, The Health Law

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In Stark Contrast To ACA Plans, Premiums For Job-Based Coverage Show Modest Rise

Family health insurance premiums rose an average 3 percent this year for people getting coverage through the workplace, the sixth consecutive year of small increases, according to a study released Tuesday.

The average total cost of family premiums was $18,764 for 2017, according to a survey of employers by the Kaiser Family Foundation and the Health Research & Educational Trust. That cost is generally divided between the employer and workers. (Kaiser Health News is an editorially independent program of the foundation.)

While overall premium increases remain modest, workers are picking up a greater portion of the tab — this year $5,714 for family coverage, about a third of total cost.

Employer-provided coverage for a single person rose on average 4 percent, to $6,690. Those individuals pay $1,213 on average.

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Still, the employer market looks remarkably stable compared to the price increases seen in the Affordable Care Act’s insurance marketplaces for people who buy their own coverage. Premiums on those plans spiked on average about 20 percent this year, and many insurers dropped out because of financial concerns.

For all the media attention and political wrangling over the  Obamacare exchanges, their share of the market is relatively small. They provide coverage to 10 million Americans while 151 million Americans get health insurance through their employer.

The continued slow rise of employer health premiums identified in the Kaiser survey surprised some analysts who have expected the trend to end as the economy picked up steam, leading to a jump in use of health services and health costs.

Drew Altman, CEO of the Kaiser Family Foundation, said it’s “health care’s greatest mystery” why health insurance costs have continued their slow pace even as the economy has picked up the past few years. “We can’t explain it.”

Another unexpected result was that workers’ deductibles — the health bills that workers must pay before their insurance coverage kicks in — remained stable this year at $1,221. Since 2010, as companies sought to keep premiums in check, deductibles have nearly doubled. Higher deductibles can limit premium increases because costs are shifted to workers and it gives them greater incentive to cut spending.

“Increasing deductibles has been a main strategy of employers to keep premiums down and we will have to watch if this plateauing is a one time thing … or if this portends a sharper increase in premiums in future years,” said Altman. “It could be deductibles are reaching their natural limit or could be the tighter labor market” that’s causing employers to back off, he added.

Meanwhile, a second employer survey released Monday by Mercer, a benefits consulting firm, suggests a modest increase in health costs coming next year, too. Employers said they expect their health costs to increase by an average 4.3 percent in 2018, according to the survey.

To deal with higher medical costs — notably big increases in the prices of prescription drugs — employers are using multiple strategies, including continuing to shift more costs to workers and paying doctors and hospitals based on the value of the services rather than just quantity of services.

Jeff Levin-Scherz, a health policy expert with benefits consultant Willis Towers Watson, said there is a limit on how much employers can shift costs to their workers, particularly in a tight labor market. “Single-digit increases doesn’t mean health care costs are no longer a concern for employers,” he said.

The 19th annual Kaiser survey also found that the proportion of employers offering health coverage remained stable last year at 53 percent. But the numbers have fallen over the past two decades.

The survey highlights that the amount workers pay can vary dramatically by employer size. Workers in small firms — those with fewer than 200 employees — pay on average $1,550 more annually for family premiums than those at large firms. The gap occurs because small firms are much more likely than large ones to contribute the same dollar amount toward a worker’s health benefits whether they’re enrolled in individual or family coverage.

More than one-third of workers at small employers pay at least half the total premium, compared with 8 percent at large employers.

That’s the case at Gale Nurseries in Gwynedd Valley, Pa., where health insurance costs rose 7.5 percent this year. Its 25 workers are paying nearly half the cost of the premium — at least $45 a week for those who choose the base coverage plan offered through Aetna. Employees also have deductibles ranging from $1,000 to $2,500.

A decade ago, the nursery paid the full cost of the premium.

“It’s crazy — we keep paying more and getting less,” said comptroller Candy Koons.

At the Westport (Conn.) Weston Family YMCA, health insurance premiums rose about 7 percent this year, leaving its 50 full-time employees to pay a $156 premium for individual coverage.

“It’s not problematic, but it’s one of our bigger costs associated with payroll,” said Joe Query, the human resources director.

Categories: Health Care Costs, Insurance, The Health Law

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Bemoaning Budget Cuts, Navigators Say Feds Don’t Appreciate Scope Of The Job

The Trump administration says many of the organizations that help people enroll in health plans on the federal insurance marketplaces don’t provide enough bang for the buck, sometimes costing thousands of dollars to sign up each customer. So, it is cutting their funding, some by as much as 90 percent, the government told the groups last week.

But the navigators, as they’re called, say the government doesn’t understand the time involved in the effort or the complexity of the enrollment challenge. Nor do federal officials appreciate the variety of tasks that navigators are asked to handle, they say.

Some customers don’t know how to use a computer. Many don’t understand insurance lingo — what’s a deductible, anyway? — or how to pick the best plan for their needs. Consumers get confused about estimating income and determining household size to qualify for premium tax credits that are available for people with incomes up to 400 percent of the poverty level (about $98,000 for a family of four). What if you’re self-employed and have no idea how many hours of work you’ll get next year? If Grandma is a dependent, does she count as part of the household? What about mixed immigrant families, in which one member is undocumented and ineligible for health insurance? These are the types of vexing questions navigators routinely field, they say.

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In addition to helping people sign up, navigators often assist them throughout the year as their income or job status changes and offer community outreach and education services. Marketplace coverage is complicated and so are people’s lives, they argue, and finding the right plan can be tough.

“You can decide on the best policy, but people come from so many different backgrounds and experiences that it’s impossible to have a policy that can be applied uniformly,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. The center has run a technical assistance project for navigators in recent years and produced an online guide that addresses frequently asked questions.

Sandy Dimick is program director for Get Covered Tennessee, part of Family and Children’s Service, the state’s primary navigator grant recipient. She said one of the common issues that navigators there deal with is helping self-employed people estimate their income for the coming year to know if they can qualify for federal subsidies to help pay for their premiums.

“We’re in Nashville, Music City, and lots of musicians are contract workers,” she said. “They think they qualify for subsidized coverage, but by the time they deduct their expenses they may be in the Medicaid gap because we didn’t expand Medicaid here.” She was referring to people whose incomes are below 100 percent of the poverty level, the minimum amount to qualify for marketplace premium tax credits, but earn too much to qualify for Medicaid.

Navigators can also be instrumental in helping clients save money on out-of-pocket costs, she said, because the federal health law offers cost-sharing reduction subsidies for people earning up to 250 percent of the federal poverty level (about $30,000 for an individual in 2018). The subsidies may bring their deductibles down to zero, potentially saving them thousands of dollars in out-of-pocket costs, Dimick said. But many marketplace customers don’t know about the subsidy and don’t realize it’s available only if they buy a silver plan on the marketplace. Unless these people work with a navigator, they may miss out because those who are financially strapped lean toward purchasing the slightly cheaper bronze plan that doesn’t qualify for cost-sharing reductions.

Dimick said her group will lose 15 percent in federal funding on its $1.6 million grant, about the amount they had anticipated.

Helping people understand how the marketplace coverage works is an ongoing challenge, said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, New York’s largest navigator program. New York runs its own marketplace, and Benjamin said she doesn’t expect a funding cut.

“People are still struggling with the metal levels,” Benjamin said, referring to the bronze, silver, gold and platinum plan types offered on the marketplaces that pay from 60 to 90 percent of covered medical expenses. “They don’t understand that if they have premium tax credits and cost-sharing reductions they shouldn’t just lurch to the lowest-cost bronze plan.”

Erinn Garrison, a navigator in Ohio, sometimes travels to meet people at coffee shops or churches in the rural portions of the state.

“A lot of the people I work with have limited technological capability,” said Garrison, the health initiatives manager at the Ohio Association of Foodbanks in Columbus, which leads a statewide consortium of navigators. “They can’t work on a computer.”

The group’s navigator funding was cut by 71 percent for the coming year, to $485,967.

The Trump administration is taking a hard line, it says, because the navigator groups have not shown that they are providing good value. Last year, the groups received $62.5 million and enrolled 81,426 individuals. The administration said the new funding formula is based on how well each group did toward meeting its 2017 enrollment goal, but many navigator groups say there doesn’t appear to be a correlation.

The federal Centers for Medicare & Medicaid Services, which oversees the federal marketplaces, has a toll-free call center. When asked if it plans to increase staffing or undertake other enrollment activities this year, officials said, “CMS will continue to operate our year-round exchange call center to assist consumers with enrollment and as in past years we will ramp up staffing to support the higher call volume anticipated during open enrollment.”

If navigators are thin on the ground this fall, people can opt to sign up directly with insurers or brokers. The federal government plans to launch a “help on demand” tool on healthcare.gov that will connect consumers directly with agents and brokers, according to a blog post on the Health Affairs website by Timothy Jost, an emeritus professor at Washington and Lee University in Virginia and an expert on the health law. But advocates have expressed concerns that consumers may not get impartial advice from vendors who receive sales commissions for specific insurance products.

In addition to healthcare.gov, some groups have published detailed information aimed at navigators that may help intrepid consumers get answers to enrollment questions. The Georgetown navigator guide is available online, as is information from the Center on Budget and Policy Priorities.

The published CBPP information may be helpful to some individuals, but it’s not a substitute for navigators who help people one-on-one, said Judith Solomon, the center’s vice president for health policy. “It’s not boots on the ground,” she said.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Insurance, Insuring Your Health, The Health Law

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Perspectives: All About Bernie’s ‘Medicare-For-All’ Plan

Editorial writers offer a variety of opinions on the single-payer health plan proposal advanced by Sen. Bernie Sanders (I-Vt.).

Los Angeles Times: Does Bernie Sanders’ Single-Payer Plan Have A Shot?
Sen. Bernie Sanders’ “Medicare for All” plan, unveiled last week, is an ambitious and (to many) enticing idea: a single, government-run health plan with generous benefits for everyone — just like most industrialized countries have enjoyed for decades. If only it were feasible in today’s United States. (Doyle McManus, 9/17)

Chicago Tribune: Bernie Sanders’ Medicare For All Is A Delusional Promise
Bernie Sanders has a health care plan he calls Medicare for all. He’s underselling it. His proposal really should be called Medicare for all and a pony. It’s everything you could want and then some. … It’s not clear that we as a country can afford Medicare as it currently exists. Merely preserving it without significant cuts would eventually require a tax increase that working people would resent. But instead of looking for ways to economize, the Vermont senator wants to expand the program in a way that the term “vast” barely begins to capture. (Steve Chapman, 9/15)

The New York Times: Buried Inside Bernie Sanders’s Bill: A Fallback Plan
The Bernie Sanders “Medicare for All” plan promises rapid, sweeping change to the American health care system, with the elimination of all private insurance and the creation of a costly new government insurance program that will cover everyone and nearly every medical service. But deep in its back pages is a more modest fallback plan. … During that interim, some younger Americans would be able to buy access to the traditional Medicare program, which is now mainly for those 65 and up. The provisions would also establish an option for Americans to buy access to a Medicare-like government plan that would be sold on the Obamacare exchanges. (Margot Sanger-Katz, 9/15)

WBUR: Bernie Sanders’s Single-Payer Swoon
Bernie Sanders filed his “Medicare for All” bill to erect a single-payer system, plugging his plan from a prime perch on The New York Times op-ed page. … Normally, this is where we’d cue the pitfalls-of-single payer part. But first, we need to hose down the fevered scaremongers on the right who oppose single payer for dumb reasons, insisting that would turn us into a goose-stepping Amerika. (Rich Barlow, 9/18)

The Washington Post: The Democrats Have Become Socialists
When Bernie Sanders launched his bid for the Democratic nomination, he was often asked whether he, a democratic socialist, would actually become a Democrat. Now, more than a year after he ignited a movement with his unsuccessful bid, that question is moot. The Democrats have become socialists. (Dana Milbank, 9/13)

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Different Takes: Sanders And Single-Payer; One Last Try On Obamacare Repeal; Building On Victory

Opinion writers across the country examine the health proposal offered by Sen. Bernie Sanders (I-Vt.), where things stand for congressional Democrats and Republicans, how the Trump administration is quietly moving against the Affordable Care Act and why it’s time for politicians to get real.

The Washington Post: The Biggest Thing Single-Payer Has Going For It
The smartest, savviest people in Washington will tell you Bernie Sanders’s “Medicare for all” idea is dead on arrival, a waste of time and energy. But since those same smart, savvy people told you Donald Trump didn’t have a prayer of becoming president, I’d advise keeping an open mind. What the Vermont senator’s bill has going for it is simple: It’s the right thing to do. (Eugene Robinson, 9/14)

The Wall Street Journal: One Last ObamaCare Try
Senator Lindsey Graham admits that when a defense specialist like him feels compelled to roll out a health-care bill, something has gone wrong—and that’s an understatement for the Republican failure to repeal the Affordable Care Act. The question is whether a last-ditch effort by Sen. Graham and a few colleagues represents an improvement over the Obama Care status quo. The answer is yes. (9/14)

Bloomberg: Democrats Can Build On Their Health-Care Victory
The Republicans’ failure to repeal Obamacare has created a political opening. The American public, threatened with the withdrawal of health insurance from millions of people, has largely come to embrace the idea of universal coverage. At such a moment, Democrats are right to advance ideas for building on the gains accomplished by the Affordable Care Act. (9/14)

The Washington Post: How Trump Is Sabotaging The Affordable Care Act In Virginia
Since President Trump took office, he and his administration have expressed their intention to sabotage the Affordable Care Act by creating instability in state insurance markets. As governors and other leaders across the nation warned, the Trump administration’s actions could threaten the health care and indeed the lives of millions of people across our nation. Unfortunately, here in Virginia, we have seen many of those fears come to fruition. (Gov. Terry McAuliffe, 9/14)

The New York Times: Bernie’s Secret G.O.P. Allies
Bernie Sanders’s biggest ally in his push for single-payer health insurance may well be the Republican Party. Yes, Republicans criticized and mocked the “Medicare for all” bill that Sanders released yesterday, and I doubt any Congressional Republicans will support the bill in the foreseeable future. But I do think they are unwittingly helping his cause. (David Leonhardt, 9/14)

The Washington Post: Sanderscare Is All Cheap Politics And Magic Math
But the lesson the Democrats seem to have taken from the 2016 electoral trouncing is that they need to become more like Republicans. Meaning: Abandon thoughtful, detail-oriented bean-counting and attempts to come up with workable solutions grounded in (occasionally unpopular) reality, and instead chant virtue-signaling catchphrases. (Rampell, 9/14)

Milwaukee Journal Sentinel: The Magical Mystery Of Medicare For All
It’s admirable to stand up for what you believe and to try to persuade voters that the nation would be better off with single payer, a $15-an-hour minimum wage and free college. There are reasonable arguments for all three. But all three are political losers outside the liberal base — at least right now. (David D. Haynes, 9/14)

The Guardian: Universal Healthcare In America? Not A Taboo Now, Thanks To Bernie Sanders
Once radical and taboo in mainstream Democratic circles, endorsing universal healthcare coverage is now de rigueur for anyone who seriously wants to run for president on the Democratic side in 2020. Kamala Harris, the California senator who seemed to be taking the Clinton route to the nomination by courting her Hamptons donors, is now co-sponsoring Sanders’ Medicare for All bill. (Ross Barkan, 9/14)

The Charlotte Observer: Medicare For All? First, Some Big Questions
The United States has long needed a real debate about the possibility of the kind of universal healthcare system that has led to some better outcomes in other developed countries. Sen. Bernie Sanders effectively kicked off that debate Wednesday by revealing a “Medicare for All” plan, backed by 15 Democratic Senate colleagues. (9/14)

The New York Times: Politicians, Promises, And Getting Real
On Wednesday Donald Trump demanded that Congress move quickly to enact his tax reform plan. But so far he has not, in fact, offered any such plan. Not only is there no detailed legislative proposal, his administration hasn’t even settled on the basic outlines of what it wants. Meanwhile, 17 Senate Democrats — more than a third of the caucus — have signed on to Bernie Sanders’s call for expanding Medicare to cover the whole population. So far, however, Sanders hasn’t produced either an estimate of how much that would cost or a specific proposal about how to pay for it. I don’t mean to suggest that these cases are comparable: The distinctive Trumpian mix of ignorance and fraudulence has no counterpart among Democrats. Still, both stories raise the question of how much, if at all, policy clarity matters for politicians’ ability to win elections and, maybe more important, to govern. (Paul Krugman, 9/15)

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State Highlights: U.S. House Votes To Block Reproductive Health Rule, Repeal Death-With-Dignity Law

Media outlets report on news from the District of Columbia, California, Iowa, New Hampshire, Massachusetts, Missouri, Pennsylvania, Minnesota, Oregon and Texas.

The Hill: House Votes To Block DC Reproductive Health Law 
The House voted on Thursday to prevent D.C. from receiving funding to implement a local law making it illegal for employers to discriminate against workers based on reproductive health decisions. An amendment offered by Rep. Gary Palmer (R-Ala.) to a 2018 government-spending package would prohibit the use of funds for the District to implement the law, which bans employers from punishing workers for obtaining contraception, family planning services or abortions. (Marcos, 9/14)

The Washington Post: House Votes To Repeal D.C.’s Death With Dignity Law; Senate Has Yet To Act
The U.S. House on Thursday passed a spending bill that would block five laws affecting the District of Columbia, including the city’s new assisted-suicide law. The bill would also block the District from spending money to subsidize abortion for low-income residents; regulate the sale of marijuana; or carry out a law that says employers cannot discriminate against workers based on their reproductive decisions, such as whether to take birth control or seek an abortion. (Portnoy, 9/14)

Los Angeles Times: California Lawmakers Back Bill To Protect Workers’ Reproductive Health Choices Over Opposition From Religious Groups
Employees would not risk losing their jobs for reproductive health choices, including having an abortion, in-vitro fertilization or a child out of wedlock, under a bill that passed the Legislature on Thursday. The measure, by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego), takes aim at employer codes of conduct, particularly at religious institutions, that could cost workers their jobs for making such health decisions. (Mason, 9/14)

New Hampshire Union Leader: Hospital Executives Discuss Merging Challenges
The president and CEO of Wentworth-Douglass Hospital joined a senior vice president from Massachusetts General Hospital on Thursday to talk about their merger during the first CEO Forum of the academic year at the University of New Hampshire. On Jan. 1, Wentworth-Douglass was officially acquired by Massachusetts General Hospital. Tony James, senior vice president of network development and integration for Massachusetts General, told the crowd in Durham that now people who receive treatment in Boston can get the follow-up care they need in Dover. James said they have always catered to the Seacoast population. (Haas, 9/14)

Boston Globe: Hospital Industry Group Taps Ex-Lawmaker As New Chief
The Massachusetts hospital industry’s largest trade group Thursday named former state representative Steven Walsh as its new chief executive. Walsh, 44, will head the Massachusetts Health & Hospital Association beginning in November, replacing Lynn Nicholas, 63, who announced her retirement several months ago. (Dayal McCluskey, 9/14)

St. Louis Post Dispatch: SSM Consolidates Hospital Foundations, Looks To Spur Greater Change 
For decades, many of SSM’s local hospitals have had an associated foundation, a group led by a volunteer board that raises money to improve facilities and programs. But gone are the days of marrying a charitable foundation to nearly every SSM hospital in the region. Instead, Creve Coeur-based SSM Health is deliberately constructing a larger, more influential philanthropic entity to serve the entire region. (Liss, 9/15)

The Philadelphia Inquirer/Philly.com: Union Prevails At Philly LGBTQ Mazzoni Health Center
Workers at Philadelphia’s scandal-ridden LGBT health-care provider, Mazzoni Center, have won a vote to unionize. Mazzoni leaders have been scrambling to restore order to the health center, which provides vital services in particular to low-income, HIV-positive, and transgender clients, since the medical director, chief executive, and several board members all departed the agency this year. That shake-up followed allegations of sexual misconduct by former medical director Rob Winn. (Melamed, 9/14)

The Oregonian: At Least 43 Kids Reported Sick After Insecticide Exposure At Day Care 
At least 50 people – 43 children and seven adults – reported health problems after being exposed to a powerful insecticide at an Oregon day care, according to newly disclosed state records and information obtained by The Oregonian/OregonLive. The statistics reveal publicly for the first time the scope of reported ailments at a Coos Bay childcare center, which the newsroom uncovered in May. (Schmidt, 9/14)

The Philadelphia Inquirer/Philly.com: Bucks County Pharmacist Charged With Trying To Kill Her Mom With Insulin Injection
After Donna Horger injected her chronically ill mother with insulin, she would later tell authorities that she hoped the 74-year-old “would not wake up and just pass.” But Mary Horger, who suffers from dementia and osteoporosis, did not die. Instead, her daughter, a licensed pharmacist, was arrested for attempted murder. Authorities say the 50-year-old resident of Feasterville, Bucks County, surreptitiously gave her immobile mother the injections at least three times last month in an attempt to lower her blood sugar to a fatal level. (McCarthy, 9/14)

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