Tagged Insurance

Analyzing The Issues: Cadillac Plans, The ‘Single-Payer Trap’, Health Care Appropriations And Medicare’s Future

Opinion writers offer their takes on health policies that operate as context to the current congressional debate.

Bloomberg: Democrats And The Single-Payer Trap
For seven and a half years, Republicans have campaigned and voted to replace the Affordable Health Care Act. When given a real chance at success, with governing control, they were impeded by a president who’s ignorant on the issue. Then, after Republican senators slipped behind closed doors to come up with their own plans, they provided products that voters, even some Trump supporters, overwhelmingly spotted as frauds. (Albert R. Hunt, 7/25)

Huffington Post: A Message For House Republicans: Actions Speak Louder Than Words
Republicans on the House Appropriations Committee offered some promising phrases when describing their fiscal year 2018 Labor-HHS budget: “Invest in essential health,” “focus investments in programs our people need the most,” and “targeting investments in … public health. ”House LHHS Subcommittee Chair Tom Cole concluded, “This bill is one that reflects the priorities that Americans value, and will continue to support the well-being of Americans through funding these vital programs.” (Clare Coleman, 7/24)

The Wall Street Journal: The Deadline To Kill The Death Panel
All eyes are on the Senate as it debates what to do about ObamaCare. But the House has a last chance this week to abolish one of the law’s most dangerous creations: a board with sweeping, unchecked power to ration care. The Independent Payment Advisory Board—what critics call the death panel—would be an unelected, unaccountable body with broad powers to slash Medicare spending. But the law contains a living will for IPAB. If the president signs a congressional resolution extinguishing the panel by Aug. 15, it will never come into existence. (Grace-Marie Turner and Doug Badger, 7/25)

Milwaukee Journal Sentinel: Medicare Cuts Are A Raw Deal For Wisconsin Seniors
Unfortunately, a federal advisory panel is urging lawmakers to cut Medicare Part B, the program that covers chemotherapies, immunotherapies and other advanced drugs that must be administered by doctors. If Congress implements this recommendation, these trends could reverse, as Wisconsin seniors would lose access to life-saving medications. (Sandra Gines and Carrie Riccobono, 7/25)

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

How It’s Playing On the Ground: A ‘Farce’ Not A Plan? Scolding A Senator

News outlets beyond the beltway offer their perspectives on the Senate’s replacement for Obamacare and what lawmakers should be doing.

San Jose Mercury News: Republican Health Care Is No Plan, It’s A Farce
Americans are divided on what to do about health care, but they should be united in this conclusion: Senate Republicans’ manic approach to reforming a sector that represents one-sixth of the U.S. economy and determines life or death for millions of people is utterly craven and irresponsible. …This is how Republicans are going to determine how Americans get their health care? (7/25)

Arizona Republic: ‘Obamacare Lies’ Or Trump Lies: Which Would You Rather Have?
President Donald Trump raged against what he called “Obamacare lies” Monday, urging Senators to move forward on a repeal and replace plan for the Affordable Care Act. …But the proposals put forth so far by Republicans, and backed by Trump, are estimated to leave tens of millions of Americans without health care and put tens of millions more with very limited coverage and at risk for bankruptcy should anyone in the family contract a major illness. (EJ Montini, 7/25)

Cleveland Plain Dealer: Sen. Rob Portman Must Stand Against Rush To Flawed Senate Health Care Vote
As Sen. Susan Collins, a Maine Republican, said Sunday, if the Senate does open floor debate, it’s unclear whether senators would be dealing with Paul Ryan’s House-passed bill, Mitch McConnell’s first, second or (unseen) third plan – or an ACA repeal, with a Senate promise to replace the law, eventually. …That’s also why Sen. Rob Portman, a suburban Cincinnati Republican who has spelled out his own careful stance on protecting Ohioans that he says will guide his vote, must vote “no” on moves by McConnell to force Senate action on an ill-considered, narrowly partisan package that would devastate health care in Ohio. (7/25)

Cleveland Plain Dealer: Sen. Rob Portman, You Just Let Ohio Down
Sen. Rob Portman cast the wrong vote Tuesday in supporting a hasty, politically motivated effort to allow Senate debate and, presumably, a vote on one or a series of ill-considered, narrowly partisan measures likely to devastate health care in Ohio. …As Sen. Susan Collins, a Maine Republican who cast one of only two Republican “nos” on the Senate floor, said before the vote, no one even knew exactly what senators were being asked to debate and maybe vote on. (7/25)

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State Highlights: Audit Of Colo. Insurance Exchange Still Finds Deficiencies; Indian Reservation Declares Public Emergency Over Opioid Crisis

Media outlets report on news from Colorado, Missouri, Minnesota, California, Florida, Massachusetts, Texas, Kansas and Wisconsin.

Denver Post: Connect For Health Colorado Is Making Progress To Fix Accounting Troubles
Colorado’s health insurance exchange has made progress in addressing repeated accounting troubles but still fails to always follow its own policies when it comes to contracts and purchases, according to a state audit released Tuesday. The audit of the exchange, known as Connect for Health Colorado, found that 11 percent of payments analyzed — which came out to about $50,000 — did not have the proper documentation. The same was true for nearly $4 million in contract costs. In one instance, the audit found that Connect for Health’s general counsel signed off on a nearly $3 million database contract despite not having the authority to do so for contracts that big. (Ingold, 7/25)

The Star Tribune: Red Lake Indian Reservation Declares Public Health Emergency Over Drug Epidemic
A rampant heroin and opiate epidemic on the Red Lake Indian Reservation has prompted tribal leaders to declare a public health emergency, seek outside help in addressing the crisis and consider the extraordinary step of banishing tribal members involved in drug dealing. … Overdoses on the northern Minnesota reservation have increased significantly in the past few months, tribal leaders said, adding that the problem has worsened with the arrival of more heroin and more of it laced with deadly fentanyl. (Smith, 7/26)

Los Angeles Times: Pasadena Officer Who Investigated Overdose Was Skeptical Of USC Med School Dean’s Story, Recording Shows
The police officer who last year questioned the then-dean of USC’s medical school about his role in the drug overdose of a young woman expressed skepticism at Dr. Carmen Puliafito’s account, according to an audio recording that was made by the officer and released Tuesday. Puliafito told the officer he was at the Pasadena hotel room where the overdose occurred as a family friend to help the woman, who was later rushed to Huntington Memorial Hospital. (Elmahrek, Pringle, Parvini and Hamilton, 7/25)

Miami Herald: Jackson Health Proposes $1.9 Billion Spending Plan For 2018
Jackson Health System is counting on growth in its core operations — plus an estimated $442 million from Miami-Dade taxpayers — to break even on a proposed $1.9 billion spending plan for 2018 approved by hospital trustees on Tuesday. Salaries and benefits for Jackson’s 12,000 full-time employees, who will receive an average 2 percent pay raise next year, tops the hospital system’s list of expenses for next year at about $1.1 billion or 59 percent of the total. (Chang, 7/25)

The Star Tribune: Minneapolis Menthol Tobacco Sales Restriction Vote Delayed Until Aug. 2
Opponents of restricting menthol tobacco sales in Minneapolis claimed victory Tuesday after a City Council committee failed to vote on the ordinance and send it to the full council, though members will vote on the proposal Aug. 2. An already-depleted Health, Environment and Community Engagement Committee fell to three members and lost its quorum when Council Member Alondra Cano stepped out near the end of a lengthy public hearing, delaying the vote. (Belz, 7/25)

St. Louis Public Radio: Missouri Doctor Grapples With State’s High Rate Of Deaths In Childbirth
Twice as many United States women are dying in childbirth today as in 1990, even though all other wealthy nations have seen declines in maternal mortality rates. …Dr. Shilpa Babbar, who specializes in high-risk pregnancies at SSM Health St. Mary’s Hospital in St. Louis County, said that rising rates of obesity and women having children later in life may help explain these figures. (Bouscaren, 7/26)

Health News Florida: Nonprofit Group: HIV Infections Up In Florida
A nonprofit that serves Central Florida residents with HIV and AIDS says the rates are going up. …[Joshua] Meyers said the Ryan White figures show 600 new HIV infections in Orlando last year, which made Orlando the city with the sixth highest infection rate in the country – up from No. 8. (Aboraya, 7/25)

KQED: California Decides All Drinking Water Must Be Tested For A Toxin. But Who Pays?
The State Water Resources Control Board on July 18 adopted the strictest possible standard (5 parts per trillion or less) for the contaminant in public drinking water. …Statewide, the tap water of about a million Californians is known to contain TCP at levels higher than that, according to data from the state water board. (O’Neill, 7/25)

Minnesota Public Radio: Threats To Drinking Water Supplies Intensifying, Health Dept. Says
Minnesota’s public drinking water supplies are in good shape, according the state’s Department of Health, but a new report also warns agencies should remain prepared for that to change. …Minnesota also needs to be prepared to address other pollution in the water supply, including nitrate contamination, which the report states is an ongoing concern for a several areas of the state. (Richert, 7/25)

The Star Tribune: Baby Deliveries To End At St. Joseph’s Hospital In St. Paul
Facing changing demographics and a steep dropoff in demand, the state’s oldest hospital will discontinue maternity care this year. HealthEast Care System’s St. Joseph’s Hospital made the move because fewer women are choosing the St. Paul facility for their baby deliveries. Health system leaders announced the decision Tuesday, noting that women will still be admitted for maternity care through Sept. 7 and that babies will still be delivered until Sept. 10 at HealthEast’s flagship hospital — Minnesota’s first hospital when it was founded in 1853. (Olson, 7/25)

Texas Tribune: Texas Senate Approves Teacher Bonuses, Benefits — But Not Pay Raises
The Texas Senate on Tuesday approved legislation to give teachers bonuses and to improve retired teachers’ health benefits — but only after the bill’s author removed a controversial provision requiring school districts to cover the cost of teacher pay raises. The upper chamber voted 28-3 to give initial approval to Senate Bill 19, authored by Sen. Jane Nelson, R-Flower Mound, which would borrow money from the Texas Health and Human Services Commission to pay for $193 million in statewide teacher bonuses and inject $212 million into a faltering state-run health insurance program for retired teachers. (Swaby, 7/25)

Pioneer Press: St. Joseph’s Hospital Plans To Close Maternity Ward
Minnesota’s oldest hospital will no longer be a destination to deliver babies. St. Joseph’s Hospital in downtown St. Paul will close its maternity ward Sept. 10, according to Fairview HealthEast, which operates the 164-year-old downtown hospital. The decision comes after HealthEast merged with Fairview Health Services earlier this year and is the result of mothers choosing to give birth in the suburbs, according to a Fairview HealthEast statement Tuesday. (Orrick, 7/25)

Kansas City Star: Kansas City Chatbot To Help Prescription Filling
A Kansas City team this week won an award from the Robert Wood Johnson Foundation for developing a robotic chat app that could steer you to a place where that prescription won’t break your budget. Project Helix — a collaboration of KC Digital Drive and two consulting outfits — aimed to help patients navigate the dizzying worlds where prescriptions, pharmacy prices and often inscrutable insurance plans overlap. (Canon, 7/25)

Milwaukee Journal Sentinel: Wisconsin DNR Says Milwaukee Industrial Barrel Plants Broke Environmental Laws
Three Milwaukee-area industrial barrel refurbishing plants have been cited by state regulators for violating 19 environmental laws, including misrepresenting information and sending hazardous ash to a landfill not permitted to handle such waste. Inspectors found that the plants handled, stored and shipped hazardous waste without permits, failed to keep numerous required records, and continued to spew putrid odors over neighborhoods three years after similar smells were noted by inspectors. (Diedrich and Barrett, 7/25)

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

Rural Californians Want Price Relief From GOP Health Bill, But Unlikely To Get It

Aaron Albaugh peered out from under the brim of his cowboy hat, surveying the acres of hayfields in front of him. The fourth-generation rancher has raised about 450 cattle this year, in this remote corner of Lassen County, Calif.

His closest neighbor lives a half-mile away. “And that’s my brother,” Albaugh said.

“If I want to go see a movie, it’s 70 miles, round-trip,” he added. “If I want to go bowling, that’s 100 miles, round-trip.”

Living a half-day’s drive from civilization, you learn to do without, he explained. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.

“Put a Band-Aid on it,” Albaugh said. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”

For people who were already used to doing without health coverage, it was quite a culture shock when the Affordable Care Act came along and they were told they had to buy it. Residents complained that the premiums and deductibles were too high — and with only two insurers selling plans in their area, there wasn’t enough competition to bring down prices.

Many in this Republican corner of California are looking to the GOP majority in Congress to bring some relief. But for most of them, prices would jump even more under the main proposals the party has served up so far, and fewer services would be covered, according to analyses by the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” said Modoc County resident Althia Cline, who decided to forgo Obamacare coverage — and a surgery she needs to help with her asthma — when she couldn’t find a health plan that her doctors accepted.

Just like the movie theater and the bowling alley, most medical specialists are miles away. In Modoc County, there’s no hospital or birthing center where a woman can have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half from home.

Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.

Tessa Anklin says Covered California health plans are too expensive for her family. (April Dembosky/KQED)

Two years ago, they bought a plan through Covered California. Their monthly premium was just $2 a month after the ACA subsidy, but their annual deductible was $10,000.

“We paid for all of our medical services and our prescriptions,” she said. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”

Then, last year, their monthly premium jumped to $600. Anklin said she’s not sure what happened. It’s possible a technical glitch caused them to lose their subsidy. All she knew was that the plan was the same, their household income was the same, and they still faced the same hour-and-a-half drive to see doctors they almost never needed.

Anklin thought of all the other ways they could spend that money.

“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she said. “That’s a big difference, when you think about how little you actually use the health coverage.”

That’s the reason they decided to cancel their health plan this year and go without insurance. But they’ll still have to pay a penalty when the next tax season comes around.

“It basically penalizes us one way or the other because we can’t afford the coverage,” she said. “So, that’s kind of difficult — to be that middle-class person.”

Anklin said she’d be happy to see Republicans get rid of Obamacare.

“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck,” she said, “when they’re already trying to survive with what they have.”

But the Republican “repeal and replace” plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the   U.S. Senate plan, according to a recent analysis from the Kaiser Family Foundation. Anklin could end up paying roughly $2,000 more per year for the cheapest individual plan than under Obamacare, according to Kaiser’s county-by-county projections.

That’s not the kind of fix she had in mind.

“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin said.

With Republican health care plans in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.

Democrats have also said if the Republican repeal effort fails, they’d be willing to work together on solutions. But it’s not clear the parties could agree on one that would help people like Anklin.

If they can’t, Anklin said, she has no choice but to continue to go without coverage. Financially, it makes sense in the short term, but she still worries about an unforeseen surgery, serious illness or accident.

“If I ever have a problem,” she said, “I know I will be paying for the rest of my life.”

This story is part of a partnership that includes KQED, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Categories: Cost and Quality, Insurance, Repeal And Replace Watch, The Health Law

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Senate Votes To Move Ahead With Debate On Obamacare Replacement Bill

Jul 25 2017

Republican leadership secure the needed 50 votes — with Vice President Mike Pence casting the tie-breaking vote to reach 51 — to bring health care legislation to the floor.

Politico: Republicans Vote To Move Ahead On Obamacare Repeal
Senate Republicans voted Tuesday voted to open debate on repealing Obamacare, dramatically reviving an effort that many GOP lawmakers left for dead just a few days ago. The vote is a huge political win and turnaround for Senate Majority Leader Mitch McConnell and Republicans who’ve promised for seven years to repeal Obamacare if voters gave them control of Congress and the White House. (Haberkorn, Kim and Everett, 7/25)

Before the vote —

AP News: Mic Captures GOP Senator Ripping Trump, Mocking Lawmaker
Oh, that dreaded open microphone! Republican Sen. Susan Collins got caught Tuesday at the end of a hearing with a microphone that was still hot — and captured her ripping President Donald Trump and making fun of a fellow lawmaker who had been critical of her on health care. (Kerr, 7/25)

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Ideas About Issues: The Right Answers On Health Policy Are Beyond Politics; Could The Free Market Deliver A Solution?

Columnists offer thoughts on these issues as well as who has gained ground with Obamacare, how self-employed people are bracing for change and the future of single-payer concepts.

The Columbus Dispatch: Cast Aside Politics, Get Health Care Right
If you want to know what’s wrong with the never-ending political battle being fought in Washington to get rid of the Affordable Care Act, look no further than the lives, families, and communities that have been destroyed by opioid addiction all across America. Opioid addiction is a crisis ripping the heart out of our country. And every plan that’s been put forward by the Republican leadership in Congress takes a blow torch to the most important preventive care and treatment that’s currently covered by health insurance for those caught in the grip of addiction. If the Republicans get their way, that coverage goes away, and with it goes the best hope — and maybe the only real hope — that families and communities have to overcome the ravages of this terrible disease. (Joe Biden, 7/25)

Bloomberg: Obamacare’s Big Win: It Helps Some People Be A Little Less Poor
There are some eternal debates that may never be settled. If there is a God, why does God allow evil in the world? Great taste, or less filling? And of course, does Medicaid make people healthier? I’m not going to rehash that last debate here, which I have covered many times. Suffice it to say that while liberals insist that the evidence is clear that health insurance expansions improve physical health, at least modestly, I do not see that the evidence warrants the confidence they exude. The intuitive sense that this ought to be correct seems to me to be doing a lot of heavy lifting in these evaluations. In health care, our intuitions are often wrong. (Megan McArdle, 7/24)

Modern Healthcare: Self-Employed People Weigh Returning To Corporate Jobs If Senate Passes ACA Repeal Bill
Steven DeMaio of New York City has been happily self-employed as a writer and editor since 2008. At that time, he felt comfortable leaving a corporate job with health benefits and going out on his own because the state where he then lived, Massachusetts, had established a system guaranteeing affordable individual-market coverage without regard to health status. But DeMaio, 46, recently decided to look for a corporate job with health benefits because of uncertainty over the future of his health insurance posed by Republican efforts to repeal and replace the Affordable Care Act. As of Aug. 1, he will begin working for a company that offers a group health plan. (Harris Meyer, 7/24)

RealClear Health: Single-Payer Health Care Looms As 2020 Campaign Issue
With 115 co-sponsors, a House bill that calls for single-payer health insurance now enjoys majority Democratic support in the lower chamber. Paired with Bernie Sanders’ presidential campaign, which helped bring national attention to the issue, some observers say that a single-payer push may become part of Democrats’ platform in 2020. (Ford Carson, 7/25)

Los Angeles Times: Single Payer Can’t Happen In California. At Least, Not Right Away
Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is that at the moment a single-payer bill cannot pass. Fighting for one in the immediate term is a waste of time. Financing, first of all, is a heavy lift. In addition to higher state taxes, California would need to channel Medicare and other federal healthcare funding into the single-payer system. Before it can do that, Congress must pass a waiver and the president must sign it — which isn’t going to happen while Donald Trump is in office. (Steve Tarzynski, 7/25)

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

Tough Takes On The GOP’s Health Legislation Strategy: A New Level Of Cynicism; ‘A Tattered Band-Aid’

Opinion writers offer critiques of the GOP health plans, their strategies and how it could all play out for them in the next election.

The Washington Post: Senate Republicans Take Cynicism To A Horrifying New Level
We are hurtling toward a health-care disaster in the next 36 hours or so, for the worst possible reason. Cynicism is seldom completely absent from the operation of politics, but this is truly a unique situation. Republicans are set to remake one-sixth of the American economy, threaten the economic and health security of every one of us and deprive tens of millions of people of health-care coverage, all with a bill they haven’t seen, couldn’t explain and don’t even bother to defend on its merits. (Paul Waldman, 7/24)

The Wall Street Journal: Can Republicans Govern?
Mitch McConnell is scheduling another showdown vote in the Senate—the third attempt—as early as Tuesday on a motion to proceed to debate on health reform. Succeed or fail, the Republican Majority Leader is right to demand this moment of political accountability. (7/24)

The Wall Street Journal: If Mitch McConnell Fails To Repeal Obamacare, He Should Blame Himself First
Few people in America rode into 2017 higher than Senate Majority Leader Mitch McConnell (R-Ky.). After leading Republicans to the Senate majority in 2014 and blocking President Barack Obama from filling the late Justice Antonin Scalia’s Supreme Court seat, McConnell helped the GOP hold the Senate last fall to deliver the first unified Republican control of government in a decade. Just six months later, though, McConnell is staring at a dramatic reversal of fortunes, facing a full-blown rebellion among the Republican senators he leads and serious doubts about his leadership ability. (Adam Jentleson, 7/25)

The New York Times: How The Health Bill Could Cost Senators In The Next Election
One of the health care bills under consideration by Republican leaders would take health insurance away from 32 million people over the next decade, creating a cohort of Americans who could be motivated to vote against senators who approved the measure. The Senate could vote as early as Tuesday, but it is not yet clear which of the two bills in contention that the majority leader, Mitch McConnell, intends to bring up. The plan that would leave 32 million without coverage would repeal some of the most important parts of the Affordable Care Act without any replacement. (Vickas Bajaj and Stuart A Thompson, 7/24)

Los Angeles Times: A Tattered Band-Aid: Senate GOP’s $200-Billion Obamacare Cushion Would Run Out In Two Years
As Senate Republicans rush pell-mell toward a Tuesday vote on an Obamacare repeal bill that most, if not all, still haven’t seen, a new study examines one of the givebacks the GOP leadership has offered anti-repeal senators to bring them on board. The sweetener is a $200-billion fund for the 31 states that expanded Medicaid under the Affordable Care Act, to be paid out starting in 2022. Since the GOP bill would eliminate the Medicaid expansion, the ostensible idea is to help them cushion health insurance costs for those states and their Medicaid enrollees forced to transition to the ACA’s individual insurance exchanges. (Michael Hiltzik, 7/24)

The Washington Post: Every Republican Health-Care Plan So Far Would Cause Great Harm To The Nation
The Senate has been deadlocked on repealing and replacing Obamacare all month, but Majority Leader Mitch McConnell (R-Ky.) announced Monday afternoon that the chamber would vote Tuesday on . . . well, on something. The scrambling reflected a basic fact: Every major Republican proposal put forward so far would mean millions of Americans would lose access to health care. Each plan would theoretically fulfill a GOP campaign promise while inflicting serious harm on the nation. (7/24)

Los Angeles Times: Lessons From The GOP’s Mostly Dead Healthcare Plan
Hill-watchers say the Republicans so badly need to pass something that they might just surprise everyone and pass … something today. Maybe. But whatever the Senate passes will not be an actual repeal of Obamacare, never mind an actual replacement. (It can’t be. Since Senate Majority Leader Mitch McConnell [R-Ky.] and company can’t or won’t work with Democrats — and vice versa — they are trying to pass their bill using the budget reconciliation process, which is rather limited in scope, but only requires a simple majority.) And even if the miracle happens, the immensely unpopular legislation must then go to conference, and after that go back to both chambers for more voting. It will look less like sausage getting made and more like an elaborate, rolling, mortuary makeover. (Jonah Goldberg, 7/25)

USA Today: GOP Health Bill Pits Freedom Of Choice Against Freedom From Fear
What is the health care debate all about? Freedom. Specifically two different conceptions of freedom. One is freedom to buy what you want. In this view, the country is a collection of 325 million individuals, and freedom is everyone pursuing their lives without interference. The other is freedom from worry. It views America as a community, and freedom is knowing you can get help when you are sick and in need. (EzekielJ. Emanuel, 7/24)

The Kansas City Star: Pat Roberts, Nancy Pelosi And Passing A Health Care Bill To Find Out What’s In It
Kansas Sen. Jerry Moran has been lavished with attention lately. Which is what happens when you buck your party to save Obamacare one day and the very next time the sun comes up, announce that you support a doomed GOP plan to kill the Affordable Care Act and replace it with nothing but hearty best wishes for all Americans. If Moran now sticks with his party after all and green-lights legislation he has said would hurt his constituents, he’s going to wish he hadn’t distinguished himself in the first place. (Melinda Henneberger, 7/24)

Arizona Republic: John McCain Hands Gov. Doug Ducey His Health Care Vote
Until McCain’s tweet, [Doug] Ducey was nothing more than an observer in the health care debate going on in Washington. He could – if he chose to do so – complain about what senators might do in restructuring or abolishing the Affordable Care Act, but he would bear no measure of blame for their work. Now, he has a say. (EJ Montini, 7/24)

New Orleans Times-Picayune: Health Care Speech Might Be Donald Trump’s Most Cynical One Yet
Trump, certainly the most prolific prevaricator who has ever rested his head at the White House, says that the Democrats’ promises regarding the Affordable Care Act all amount to a “big, fat lie.”If the Republicans had presented anything to make it easier for those families Trump trotted out, then maybe it would be fair to accuse the Democrats of overselling the Affordable Care Act.  But the Republicans aren’t really offering much – if anything — to help those who are struggling to pay their medical bills. (Jarvis DeBerry, 7/24)

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

Molina Healthcare To Lay Off About 1,400 Employees, Memo Says

The insurer says the upcoming cuts to 10 percent of its workforce is driven by losses to its Obamacare exchange business.

Reuters: Molina Healthcare To Cut About 1,400 Jobs: Memo
Molina Healthcare, a health insurer that specializes in the Obamacare and Medicaid healthcare programs for low-income and poor people, plans to cut about 1,400 jobs in the next few months, according to an internal company memo reviewed by Reuters. (Humer, 7/24)

Modern Healthcare: Molina To Lay Off 10% Of Its Workforce
Medicaid health plan Molina Healthcare intends to lay off 1,400 employees, or 10% of its workforce, over the coming months to try to offset losses from its Obamacare exchange business, the company said in an internal memo to employees Monday. The cuts will be across-the-board, including senior leadership, interim CEO and Chief Financial Officer Joe White said in the memo. (Barkholz, 7/24)

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

Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors

COLUMBUS, Ohio — Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation.

One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment.

But the law didn’t go into force on Jan. 1 as scheduled. And its troubled odyssey illustrates the political and business forces opposing a common-sense but controversial solution to rein in high health care costs for patients: Let patients see prices.

Many patient advocates say such transparency would be helpful for patients, allowing them to shop around for some services to hold down out-of-pocket costs, as well as adjust their household budgets for upcoming health-related outlays at a time of high-deductible plans.

At the Ohio Statehouse, the law’s greatest champion in state government has been Rep. Jim Butler, a Republican and former Navy fighter pilot whose wife is a physician. He authored the legislation and has beat the drum for it since he got the idea in 2013, as he waited for a garage mechanic to repair his car and absorbed the shop’s posted rates for brake jobs, oil changes and tuneups.

Opposition has been formidable, led by the goliath Ohio Hospital Association. It has filed a court injunction that is currently delaying enactment, peppered local news media with editorials, and lobbied Republican Gov. John Kasich, who has eliminated funding that would allow implementation from the latest state budget.

Joining the hospital association in its legal action are a wide range of provider groups including the Ohio State Medical Association, the Ohio Psychological Association, the Ohio Physical Therapy Association, and the Ohio chapters of the American Academy of Pediatrics, the American College of Surgeons, and the American Osteopathic Association.

These groups say that the law, which applies only to elective procedures, is too broad and that forcing providers to create estimates before procedures would slow down patient care. “The only way to even try to comply with the law is to delay care to patients in order to track down information from insurance companies, who may or may not provide the requested information,” wrote Mike Abrams, the president and CEO of the Ohio Hospital Association, in an op-ed in The Columbus Dispatch in January.

But Jerry Friedman, a retired health policy adviser for the Ohio State University Wexner Medical Center, said the opposition doesn’t stem from genuine concern about patients but from a desire to keep the secret rates that providers have negotiated with insurers under wraps. Transparency would mean explaining to consumers why the hospital charged them $1,000 for a test, he said, adding that providers “don’t want to expose this house of cards they’ve built between hospital physician industry and the insurance industry.”

Ohio State Rep. Jim Butler (Chris Stewart/Courtesy of the Dayton Daily News)

Said Butler on his quest to see the law enacted: “The health care industry has a lot of political power and lots of money. It’s hard to fight on behalf of people against this kind of force.”

The law’s next test will come in August, when the first court hearing on the association’s lawsuit is scheduled. The Kasich administration said it couldn’t comment on the law because of the pending litigation.

Greater price transparency has been a popular policy prescription for America’s high health costs, especially at a time when many patients have high-deductible insurance plans and face larger copayments. Upfront estimates exist in other countries, such as Australia and, for patients facing out-of-pocket expenses, in France.

In Massachusetts, patients can get an estimate within two days of admission if they ask for it. Nebraska requires hospitals and surgical centers to provide a list of the average charges for services. New Hampshire has a website where consumers can compare costs.

Hospitals and doctors often oppose such measures. The American Hospital Association’s position is that health plans — not hospitals — are responsible for telling insured patients about their out-of-pocket costs, according to its website.

Aimee Winteregg, 35, of Troy, Ohio, said she would have liked such information before five miscarriages in four years left her buried in unexpected medical bills. She and her husband became first-time parents in November. Though they are well insured, tests and treatment cost the couple $4,000 out-of-pocket, demanded in bills that were sometimes no more descriptive than for “medical service.”

“We don’t want to deal with this, especially when the doctor tells you stress is bad for the pregnancy,” her husband, J.D., said. But imposing greater transparency has been controversial in both the medical industry and among some health care researchers, who say it puts patients in an untenable position.

The transparency law “was written by someone thinking about health care as a TV, and not as health care,” said Sandra Tanenbaum, a professor of health services management and policy at The Ohio State University College of Public Health.

She said people could not shop for procedures as they would for a TV or car repairs, since they often lack information on the quality of doctors and hospitals, and make health care decisions based on much more than cost.

Consumers are more likely to base their decisions on their doctors’ advice, not on cost alone, according to a report from the Health Policy Institute of Ohio.

Only around 10 percent of health care costs are even “shoppable” expenses — procedures that can be scheduled in advance, like an MRI or elective surgery — according to the HPIO.

Regardless, Butler maintains, the health care industry can give consumers better information upfront. “If you really want patients to be empowered, they really need the information,” he said.

In support of such access, Butler has written letters to the Ohio Hospital Association, the Ohio attorney general and the Dayton Daily News, all in defense of the transparency law.

The Ohio Hospital Association, along with seven other Ohio health organizations, went to court last December to block the law, a month before it was supposed to take effect.

Butler said Gov. Kasich’s administration is helping the hospital association stall by not writing regulations, eliminating funding for the law in the state budget, and declining to meet with Butler to discuss it.

State Rep. Michael Henne, also a Republican, has worked with Butler in the Ohio General Assembly on the transparency law. He called Butler a “driver” on the law, noting: “It’s frustrating. You don’t realize how much [influence] special interests have in the process.”

Categories: Cost and Quality, Health Care Costs, Health Industry, Insurance

Tags: ,

Parsing The Policies: What’s To Become Of Medicaid And Medicare?

Opinion writers offer their thoughts on how the current Affordable Care Act replacement debate impacts Medicaid and how governors should proceed in pursuing Medicaid waivers as well as current Medicare funding issues.

Daily Beast: Medicaid Delivers As Obamacare Survives
Medicaid got a reprieve from the budget axe with the GOP’s failure so far to repeal, let alone replace, Obamacare. Suddenly, the program for the poor that began in 1965 seems less like a scapegoat for politicians looking to score rhetorical points and to shore up state budgets, and like it may join Medicare and Social Security on the third rail in American politics—touch it and you die. (Eleanor Clift, 7/24)

RealClear Health: Republicans Are Tackling Medicaid Wrongly
The high decibel fight in the Senate over Medicaid is one more example–did we need more?–of why lasting changes in social programs require thoughtful legislative deliberation leading to bipartisan consensus. There should be hearings to gather input from all sides and serious debate in committees as well as on the floor. If one party rams through big changes in any program as important as Medicaid, the other party will demonize the result. In the case of Medicaid cuts, arousing public outrage won’t be hard. Individuals and families, state governments, rural hospitals and other health providers will all be vocal about their plight. One wonders why either party would seek such opprobrium when they could be working together on sensible Medicaid reform. (Alice M. Rivlin, 7/24)

Morning Consult: Governors: Avoid Harmful Insurance Practices In Medicaid Waivers
While our nation’s governors recently gathered in Rhode Island for the summer meeting of the National Governors Association, most of the country’s political attention remained focused on the debate in Washington, D.C. over the fate of the Affordable Care Act. Less noticed, but also critically important, is that fact that each governor holds in their hands today the ability to radically reshape Medicaid for their state’s most vulnerable citizens regardless of the outcome of that debate. (Donna Christensen, Scott Mulhauser and Jason Resendez, 7/24)

CBS News: Medicare Funding: Problems And Solutions
Medicare’s funding problems often get overlooked when the Social Security trustees issue their annual report on the funded status of the Social Security and Medicare programs. Yet together they form the twin pillars of financial security for retirees. That’s why it’s important to understand Medicare’s financial situation, so you can be an informed health care planner — and voter. (Steve Vernon, 7/24)

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

The Big Picture: The Health Issues We Should Be Discussing; How To Move The Debate Forward

Even as the heated discourse over the future of the Affordable Care Act continues, some people offer their thoughts on the serious issues that are being overlooked and on how bad manners have soured the process.

Boston Globe: The Health Care Debate We Should Be Having
Most of the life expectancy gains of the last century can be chalked up to what we call public health, a catch-all term for those interventions aimed not at a single patient, but at a whole community or the entire population. …Which helps explain the great riddle of American health care: How come we spend more than everyone else, yet generally have worse outcomes? We overspend on medical care and underinvest in public health. (Horowitz, 7/22)

St. Louis Post-Dispatch: Collapse To Compromise: A Better Way To Health Care Reform
Republicans and Democrats disagree about the role of government; the trade-off between individual freedom and societal good; and about money and taxes. These long-standing disagreements play out repeatedly on the national stage, and today, health care is front and center. On our present course, these disagreements will turn our health care system upside down every time we vote to change party control of the White House and the Congress. (Steven H. Lipstein, 7/23)

The Washington Post: The GOP Cannot Fix Itself — Let Alone American Health Care
The inability of a Republican Congress and a Republican president to repeal Obamacare, or even just dial it back, is yet the latest demonstration that Republicans simply aren’t ready to govern. The facile explanation for this is the unresolved division, within the party, between its radical tea party populist wing and its more moderate, business-friendly establishment wing. But the bigger issue is that the party’s elected politicians are unwilling to make the trade-offs that are the essence of what governing is about. (Steven Pearlstein, 7/23)

The Washington Post: How Health Care Controls Us
If we learned anything from the bitter debate over the Affordable Care Act (Obamacare) — which seems doubtful — it is that we cannot discuss health care in a way that is at once compassionate and rational. This is a significant failure, because providing and financing health care have become, over the past half-century, the principal activity of the federal government. (Robert J. Samuelson, 7/23)

Huffington Post: Former CBO Directors Express ‘Strong Objection’ To GOP Attacks On Agency
Every economist who has previously served as director of the Congressional Budget Office has signed a letter registering “strong objection to recent attacks” on the agency. The letter, sent Friday morning and addressed to congressional leaders, does not specify who has been making those attacks. But only one political party is attacking the CBO right now ― and only one party has so brazenly questioned the agency’s methods to draw this kind of response from such a distinguished, bipartisan group of economists. It’s the Republicans, because they don’t like what the CBO has been saying about GOP proposals to repeal the Affordable Care Act. (Jonathan Cohn, 7/21)

Roll Call: How Bad Political Manners Fomented The Health Care Mess
[I]t’s not surprising that a secretive, churlish and entirely-outside-the-normal-channels approach has, from the start, distinguished [Senate Majority Leader Mitch McConnell’s] balky and now repudiated tackling of the defining legislative battle of Trump’s first year. Straightforward legislative etiquette would have required at least a few hearings and legislative markups on health care where Democrats could have gone on record in opposition and Republican skeptics, on the hard right and in the center, could have vented concerns and offered mollifying language — long before spreading anxieties at both ends of the GOP ideological spectrum crippled the bill. (David Hawkings, 7/24)

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

Perspectives: Despite Senate Difficulties, ACA Is Still At Risk; The Paths Forward For The GOP’s BCRA

Editorial pages analyze the current state of play in Republicans’ push to replace Obamacare.

The New York Times: Health Care Is Still in Danger
Will Senate Republicans try to destroy health care under cover of a constitutional crisis? That’s a serious question, based in part on what happened in the House earlier this year. As you may remember, back in March attempts to repeal and replace the Affordable Care Act seemed dead after the Congressional Budget Office released a devastating assessment, concluding that the House Republican bill would lead to 23 million more uninsured Americans. Faced with intense media scrutiny and an outpouring of public opposition, House leaders pulled their bill, and the debate seemed over. (Paul Krugman, 7/24)

RealClear Health: A Narrow Path Forward For The BCRA
Following a week of high-level negotiations among GOP senators, Republican leadership is planning a Tuesday vote on the motion to proceed to the House-passed American Health Care Act (AHCA) — the vehicle for their health care reform efforts. The process has been shrouded in confusion and uncertainty, as it still remains unclear what legislation Senate leaders ultimately hope to move forward. And while knowing what’s in the Senate bill may be, as Senate Whip John Cornyn said, a “luxury we don’t have,” it’s worth acknowledging that there’s still a narrow path towards passage. (Shea McCarthy, 7/24)

Boston Globe: Republicans Must Challenge Trump On Health Care
But though he [Donald Trump] has browbeaten Republican senators for failing to follow through on repealing the Affordable Care Act, abandoning his own campaign commitments doesn’t seem to bother him at all. Months into the GOP’s repeal-and-replace effort, not one piece of legislation Trump has backed, in either the House or the Senate, would keep all of those promises. (7/23)

The Wall Street Journal: Force Congress’s Hand On Health Care
If President Trump is serious about repealing ObamaCare—about delivering a better policy with more choice and lower costs—there’s a simple move he could make that wouldn’t require congressional approval. It would align the interests of lawmakers and their staffers with the interests of voters. (Heather R. Higgins, 7/23)

The Wall Street Journal: Congress Won’t End ObamaCare, So Here’s How To Mend It
Having so far failed to repeal and replace the Affordable Care Act, the best way forward for Republicans would be to work with Democrats to improve the marketplaces set up by the 2010 law. While legislation could help, all that really is needed for the marketplaces to succeed is for the Trump administration to do no harm. This means continuing to implement the law without actively undermining it. (Jason Furman, 7/23)

Los Angeles Times: Under Senate’s Obamacare Repeal, Some Americans Would Have To Pay More Than Their Total Income For Health Coverage
One of the ostensibly brilliant ideas in Senate Republicans’ plan to repeal the Affordable Care Act is to move low-income families from Medicaid to the private insurance marketplace, allowing them to use the premium subsidies provided by the ACA. But there’s a catch, according to a new analysis of the proposal. For many low-income families, the marketplace premiums and deductibles combined would amount to more than their total income, even after subsidies. Moreover, despite shifting more of these costs to enrollees, the change would cost the federal government more than Medicaid.  (Michael Hiltzik, 7/21)

The Kansas City Star: Sens. Moran And Roberts: Don’t Endanger My Daughter’s Health
My beautiful daughter Hannah turns 26 this Saturday. Her birthdays are particularly special because she was diagnosed with stage 4 cancer at age 13. After successful treatment, her cancer returned when she was 14 and she had a less than 10 percent chance of survival. She wasn’t expected to be alive for her 15th birthday. Burkitt’s Lymphoma is a very aggressive cancer that doubles in size every two hours. We were fortunate to receive amazing care at Children’s Mercy Hosptital. Hannah endured dozens of surgeries, 69 days of intense chemotherapy and spent over 300 days in the hospital. She received hundreds of units of blood and platelets, had 38 spinal taps, 18 bone marrow biopsies, a stem cell transplant and countless other treatments and procedures. (Deedra Miller, 7/22)

Lincoln Journal-Star: Nebraska Needs Health Care Reform
Obamacare is failing in Nebraska. Proponents of the law argued that it would increase choice and lower costs, but the exact opposite has taken place. For instance, earlier this year, Blue Cross Blue Shield announced it would be leaving the state’s Obamacare exchange market. The last remaining Obamacare insurer — Medica Health — also announced it might pull out of the market by the end of the year, which would leave thousands of Nebraskans without health coverage. (Jarrett Stepman, 7/24)

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

5 Ways White House Can Use Its Muscle To Undercut Obamacare

President Donald Trump has vowed to “let Obamacare fail,” after legislative efforts to undo the Affordable Care Act have stalled.

He and congressional Republicans have repeatedly portrayed the Affordable Care Act insurance marketplaces, also known as exchanges, as being in a “death spiral.” But independent analyses have concluded that such spontaneous disintegration isn’t happening.

In a number of ways, the Trump administration’s policies are pushing Obamacare into the vortex.

Reports from Standard & Poor’s, the Congressional Budget Office and the Kaiser Family Foundation all suggest that the exchanges — where people can shop for coverage, often with the help of a government subsidy — are stabilizing. (Kaiser Health News is an editorially independent program of the foundation.)

Use Our Content

But, like every piece of legislation, Obamacare faces a difficult political reality: Its marketplaces require active maintenance and federal support.

The White House can take a number of behind-the-scenes steps to sabotage the exchanges and hasten their undoing. Already, it’s deploying some of those tactics.

“The administration has a lot of power to undermine the markets and make them dysfunctional,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, who specializes in private insurance markets.

Here’s a look at five ways the White House is already working to weaken the health law, and what that means for consumers.

‘Cost-Sharing Reductions’

Under the ACA, when someone’s income falls between 100 and 250 percent of the federal poverty level — up to about $29,000 for an individual or around $61,000 for a family of four — marketplace carriers must offer a plan with “cost-sharing reductions” (CSRs) that reduce consumers’ out-of-pocket expenses.

Reducing cost-sharing — generally copayments and deductibles — makes plans more expensive for the insurers. The Obama administration used its rule-making power to set up direct payments to carriers to help offset this burden. The Trump White House has inherited that responsibility but also has the power to end the payment program.

The nonpartisan Congressional Budget Office estimated CSR subsidies in 2017 would total about $7 billion. Without that money, analysts say, more insurers might choose to exit, limiting options for consumers, and letting the insurers who remain charge higher prices.

Trump has been committedly noncommittal, publicly indicating he would like to halt the subsidies, but so far — on a month-to-month basis — letting them continue.

The uncertainty makes insurance companies skittish about participating, analysts noted. It’s also one reason some plans say they have had to increase their rates, noted Charles Gaba, a Michigan-based blogger who tracks ACA sign-ups. For instance: When filing plans for the 2018 marketplace, carriers on average raised premiums by about 34 percent — with about 20 points stemming from CSR uncertainty, Gaba said, based on an analysis of 21 states’ initial rate filings. Dropping the subsidies altogether would be even more damaging.

Weaken The Mandate

The White House has already signaled it does not want to enforce the individual mandate — the health law’s requirement that all people have coverage. And administration officials have repeated that position.

Meanwhile, in January, it issued an executive order that encouraged U.S. agencies to grant exemptions and waive or defer health law provisions that could put financial strain on companies or individuals — which could also be applied to the individual mandate.

For 2016 tax returns, though, the Internal Revenue Service continued to impose a financial penalty on people who didn’t have health insurance and who didn’t qualify for an exemption.

But enforcement may be waning. This year, the IRS was supposed to reject tax returns if people didn’t indicate whether they had coverage, flagging them for a potential penalty. Instead, it continued processing them, citing Trump’s executive order.

If the IRS has already processed any tax refunds for consumers, then they “don’t have much leverage” when attempting to collect the mandate fee, said Timothy Jost, emeritus law professor at Washington and Lee University in Virginia and an expert on health reform.

Enforcement of the mandate enforcement, economists note, is crucial to ensuring that enough healthy people buy coverage to balance the costs of sicker beneficiaries.

But even with the mandate in effect, the efforts to defang it bring confusion.

“A lot of people believe the Trump administration is not enforcing it,” Jost said.

As a result, healthy people may become less likely to buy insurance, even as sick ones continue seeking it. That means higher prices, and a shakier pool.

“If they don’t think they’re going to get healthy people in the risk pool, they’re going to increase their rates further to protect themselves,” Jost said. “And as they raise their rates further to protect themselves, people … start to drop out.”

Thus, the president’s position on the mandate is leaving insurance carriers and commissioners “apprehensive,” noted Mike Kreidler, Washington state’s insurance commissioner.

A Bare Market

Skittishness on the part of insurers could lead them to drop out of some marketplaces, leaving consumers in some areas with few or no choices. Those “bare markets” are possible under even stable circumstances — and preventing them requires active federal involvement.

Under the Obama administration, high-level officials were “on the phone daily with insurance company executives … trying to get them to participate,” Corlette said. “It was very much an all-hands-on-deck, ‘we’re going to make it work for you guys’ kind of communication.”

And so far Trump’s Department of Health and Human Services doesn’t appear to be emphasizing this kind of essential outreach, both Corlette and Jost suggested. A few months ago, Kreidler agreed, HHS staffers appeared interested in helping states fill their bare counties — but that support has since dwindled.

“This may be sort of under the radar, but it can have real, lasting effects” for consumer choice, Corlette said.

All Quiet On The Enrollment Front

The administration could further undermine the marketplace by dropping outreach to consumers. It’s already a shorter enrollment period this year — spanning six weeks instead of three months, from Nov. 1 to Dec. 15 — though that change was already slated to eventually take effect.

That shorter period means people may miss the memo on signing up — or at least need an extra push, Corlette said. And that’s another way the administration could undermine the marketplaces: simply choosing not to advertise them.

Last sign-up season, HHS stopped open enrollment advertising in January, pulling ads a few days before the period ended. Enrollment dropped compared with previous years, Jost and Gaba noted, with young, healthy people being more likely not to buy coverage.

The administration also just stopped funding federal contractors that supported efforts by community groups and other organizations in some of the nation’s largest cities to sign up people.

Dropping advertising, shortening open enrollment or simply scaling back on technical maintenance for the marketplace website could all have significant impact, Corlette said. People who are sick and need insurance will likely seek it out, but those who are healthier — for whom health insurance is a less pressing priority — could miss the boat.

Again, Jost said, that affects insurer participation.

“Insurance is a product that need to be sold,” he said. “If the insurers believe they’re not going to get any help at all in marketing their product,” he added, fewer will want to enter the marketplace.

Word of (Bad) Mouth

HHS has taken an active role in criticizing the health law — pushing press releases and videos that argue it has helped more than hurt. That strategy could do a lot of harm, experts said.

If consumers keep hearing the law is failing, Jost noted, some will ultimately believe it, buying coverage only if they need it and thereby skewing the insurance risk pool.

Perceived hostility also has an effect on insurers, steering them away from marketplace participation.

“When you undermine confidence in the marketplace, you don’t need a Ph.D. in economics to know it’s not good long term,” Corlette said.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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

Tags: , ,

5 Ways White House Can Use Its Muscle To Undercut Obamacare

President Donald Trump has vowed to “let Obamacare fail,” after legislative efforts to undo the Affordable Care Act have stalled.

He and congressional Republicans have repeatedly portrayed the Affordable Care Act insurance marketplaces, also known as exchanges, as being in a “death spiral.” But independent analyses have concluded that such spontaneous disintegration isn’t happening.

In a number of ways, the Trump administration’s policies are pushing Obamacare into the vortex.

Reports from Standard & Poor’s, the Congressional Budget Office and the Kaiser Family Foundation all suggest that the exchanges — where people can shop for coverage, often with the help of a government subsidy — are stabilizing. (Kaiser Health News is an editorially independent program of the foundation.)

Use Our Content

But, like every piece of legislation, Obamacare faces a difficult political reality: Its marketplaces require active maintenance and federal support.

The White House can take a number of behind-the-scenes steps to sabotage the exchanges and hasten their undoing. Already, it’s deploying some of those tactics.

“The administration has a lot of power to undermine the markets and make them dysfunctional,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, who specializes in private insurance markets.

Here’s a look at five ways the White House is already working to weaken the health law, and what that means for consumers.

‘Cost-Sharing Reductions’

Under the ACA, when someone’s income falls between 100 and 250 percent of the federal poverty level — up to about $29,000 for an individual or around $61,000 for a family of four — marketplace carriers must offer a plan with “cost-sharing reductions” (CSRs) that reduce consumers’ out-of-pocket expenses.

Reducing cost-sharing — generally copayments and deductibles — makes plans more expensive for the insurers. The Obama administration used its rule-making power to set up direct payments to carriers to help offset this burden. The Trump White House has inherited that responsibility but also has the power to end the payment program.

The nonpartisan Congressional Budget Office estimated CSR subsidies in 2017 would total about $7 billion. Without that money, analysts say, more insurers might choose to exit, limiting options for consumers, and letting the insurers who remain charge higher prices.

Trump has been committedly noncommittal, publicly indicating he would like to halt the subsidies, but so far — on a month-to-month basis — letting them continue.

The uncertainty makes insurance companies skittish about participating, analysts noted. It’s also one reason some plans say they have had to increase their rates, noted Charles Gaba, a Michigan-based blogger who tracks ACA sign-ups. For instance: When filing plans for the 2018 marketplace, carriers on average raised premiums by about 34 percent — with about 20 points stemming from CSR uncertainty, Gaba said, based on an analysis of 21 states’ initial rate filings. Dropping the subsidies altogether would be even more damaging.

Weaken The Mandate

The White House has already signaled it does not want to enforce the individual mandate — the health law’s requirement that all people have coverage. And administration officials have repeated that position.

Meanwhile, in January, it issued an executive order that encouraged U.S. agencies to grant exemptions and waive or defer health law provisions that could put financial strain on companies or individuals — which could also be applied to the individual mandate.

For 2016 tax returns, though, the Internal Revenue Service continued to impose a financial penalty on people who didn’t have health insurance and who didn’t qualify for an exemption.

But enforcement may be waning. This year, the IRS was supposed to reject tax returns if people didn’t indicate whether they had coverage, flagging them for a potential penalty. Instead, it continued processing them, citing Trump’s executive order.

If the IRS has already processed any tax refunds for consumers, then they “don’t have much leverage” when attempting to collect the mandate fee, said Timothy Jost, emeritus law professor at Washington and Lee University in Virginia and an expert on health reform.

Enforcement of the mandate enforcement, economists note, is crucial to ensuring that enough healthy people buy coverage to balance the costs of sicker beneficiaries.

But even with the mandate in effect, the efforts to defang it bring confusion.

“A lot of people believe the Trump administration is not enforcing it,” Jost said.

As a result, healthy people may become less likely to buy insurance, even as sick ones continue seeking it. That means higher prices, and a shakier pool.

“If they don’t think they’re going to get healthy people in the risk pool, they’re going to increase their rates further to protect themselves,” Jost said. “And as they raise their rates further to protect themselves, people … start to drop out.”

Thus, the president’s position on the mandate is leaving insurance carriers and commissioners “apprehensive,” noted Mike Kreidler, Washington state’s insurance commissioner.

A Bare Market

Skittishness on the part of insurers could lead them to drop out of some marketplaces, leaving consumers in some areas with few or no choices. Those “bare markets” are possible under even stable circumstances — and preventing them requires active federal involvement.

Under the Obama administration, high-level officials were “on the phone daily with insurance company executives … trying to get them to participate,” Corlette said. “It was very much an all-hands-on-deck, ‘we’re going to make it work for you guys’ kind of communication.”

And so far Trump’s Department of Health and Human Services doesn’t appear to be emphasizing this kind of essential outreach, both Corlette and Jost suggested. A few months ago, Kreidler agreed, HHS staffers appeared interested in helping states fill their bare counties — but that support has since dwindled.

“This may be sort of under the radar, but it can have real, lasting effects” for consumer choice, Corlette said.

All Quiet On The Enrollment Front

The administration could further undermine the marketplace by dropping outreach to consumers. It’s already a shorter enrollment period this year — spanning six weeks instead of three months, from Nov. 1 to Dec. 15 — though that change was already slated to eventually take effect.

That shorter period means people may miss the memo on signing up — or at least need an extra push, Corlette said. And that’s another way the administration could undermine the marketplaces: simply choosing not to advertise them.

Last sign-up season, HHS stopped open enrollment advertising in January, pulling ads a few days before the period ended. Enrollment dropped compared with previous years, Jost and Gaba noted, with young, healthy people being more likely not to buy coverage.

The administration also just stopped funding federal contractors that supported efforts by community groups and other organizations in some of the nation’s largest cities to sign up people.

Dropping advertising, shortening open enrollment or simply scaling back on technical maintenance for the marketplace website could all have significant impact, Corlette said. People who are sick and need insurance will likely seek it out, but those who are healthier — for whom health insurance is a less pressing priority — could miss the boat.

Again, Jost said, that affects insurer participation.

“Insurance is a product that need to be sold,” he said. “If the insurers believe they’re not going to get any help at all in marketing their product,” he added, fewer will want to enter the marketplace.

Word of (Bad) Mouth

HHS has taken an active role in criticizing the health law — pushing press releases and videos that argue it has helped more than hurt. That strategy could do a lot of harm, experts said.

If consumers keep hearing the law is failing, Jost noted, some will ultimately believe it, buying coverage only if they need it and thereby skewing the insurance risk pool.

Perceived hostility also has an effect on insurers, steering them away from marketplace participation.

“When you undermine confidence in the marketplace, you don’t need a Ph.D. in economics to know it’s not good long term,” Corlette said.

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

Tags: , ,

Policy Positions: Health Spending Is ‘The American Way’; What Becomes Of Medicare; And Does Universal Health Care Equal Freedom?

Media outlets explore important health policy questions.

Bloomberg: Spending A Lot On Health Care Is The American Way
The U.S. has some of the most expensive medicine in the world, with health-care spending now almost 18 percent of gross domestic product. But why? And might we hope to get this spending down? Unfortunately, expensive health care is embedded in the American way of life — more specifically, the American desire to live it up with high consumption. (Tyler Cowen, 7/20)

Forbes: How GOP Will Still Carve Up Medicare
The rehashed House GOP budget blueprint wants to reshape Medicare into more of a Medicare Advantage model, which now covers some 19 million Americans. What does that mean? Funding for the guaranteed part of Medicare would be shifted into the privatized scheme. You’d receive a fixed stipend or “premium support” to buy a private policy on an exchange. (John Wasik, 7/19)

USA Today: Dear America, Universal Health Care Is What Real Freedom Looks Like
In 1991, after nearly 10 years of recurring wracking pain in my lower abdomen, I walked into a hospital in Helsinki, Finland. I wasn’t a Finnish citizen and wasn’t, at that time, married to one. I was an American writer visiting my Finnish boyfriend, working temporarily in Helsinki. An admitting nurse listened to my symptoms and guessed my problem — a diagnosis that received preliminary confirmation by ultrasound within the hour. (Anne Korkeakivi, 7/20)

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

Different Takes: How The Trump Administration Is Sabotaging Obamacare; Fear And Loathing In The Health Policy Debate

Editorial pages offer tough takes on the Trump administration’s executive maneuvers to render the Affordable Care Act powerless, the Republican’s plans to replace it and how this particular legislative fight shows Washington ‘at its worst.’

The New York Times: Health Care In A Time Of Sabotage
Is Trumpcare finally dead? Even now, it’s hard to be sure, especially given Republican moderates’ long track record of caving in to extremists at crucial moments. But it does look as if the frontal assault on the Affordable Care Act has failed. And let’s be clear: The reason this assault failed wasn’t that Donald Trump did a poor selling job, or that Mitch McConnell mishandled the legislative strategy. Obamacare survived because it has worked — because it brought about a dramatic reduction in the number of Americans without health insurance, and voters didn’t and don’t want to lose those gains. (Paul Krugman, 7/21)

Los Angeles Times: The Trump Administration Is Using Obamacare Marketing Dollars To Attack Obamacare
President Trump keeps saying Obamacare will fail on its own. So why is his administration trying so hard to kill it? The latest effort was uncovered by the Daily Beast website, which reported Thursday that Trump’s Department of Health and Human Services was dipping into its “consumer information and outreach” budget — money Congress provided to encourage people to obtain insurance through Obamacare — to produce nearly two dozen YouTube videos blasting the law as burdensome and harmful. (7/21)

The Washington Post: The GOP’s Repeal-And-Replace Plan Should Stay Dead
Republican senators have been huddling in hopes of reviving their Obamacare repeal-and-replace bill. The Congressional Budget Office (CBO) reminded them Thursday of why the bill should, on the contrary, stay dead. Congress’s scorekeepers found that the latest version of the Senate bill would result in 22 million more people without health coverage by 2026. That is true even after the CBO accounted for $70 billion in new funds meant to stabilize health-insurance markets by driving down premiums and other costs. (7/20)

The New York Times: A Republican Health Care Fix
Imagine a young father stepping into the street. He is alert and conscientious. Then, a government truck speeds around the corner. The man lunges out of the way, but it’s too late: The truck runs him over, causing serious injury. Absent government misconduct, the man would have been just fine. While the primary effect of the government’s conduct is an injured man, there are significant secondary consequences. His children will lose his emotional comfort and financial support. His neighborhood loses a valued contributor to its social fabric. His employer must find at least a temporary replacement for the man’s labor. (J.D. Vance, 7/21)

Fortune: Where The Republican Health Care Bill Stands After A Chaotic 72 Hours
It’s been a topsy turvy three days for health care reform (please consider hugging a health care reporter). The Senate’s original Better Care Reconciliation Act (BCRA), which was largely considered to be dead just two days ago, has been revived and somewhat tweaked as of this morning. And the Congressional Budget Office (CBO) is already out with an analysis of that new legislation: 15 million more uninsured Americans next year relative to Obamacare and 22 million more uninsured by 2026. It would also reduce federal deficits by $420 billion over the next decade, according to CBO. (Sy Mukherjee, 7/20)

The Wall Street Journal: Trump, ObamaCare And The Art Of The Fail
It was a political drubbing of the first order. A new Republican president and a Republican Senate and House put everything they had into a bill to repeal and replace ObamaCare, and couldn’t do it. The leadership is rocked. The president looks confused and hapless, while publicly enacting determination and a scolding tone toward those who’d let him down. He rarely showed signs of fully understanding the details or even the essentials of the plan he backed. His public remarks were all over the place: He’ll let ObamaCare collapse of its own weight; he’ll replace it with something big and beautiful; just repeal it; no, let it collapse. He criticized Hill Republicans: They “never discuss how good their healthcare bill is.” But neither did he, not in a persuasive way. (Peggy Noonan, 7/20)

San Francisco Chronicle: Health Care Fight Shows Washington At Its Worst
I like partisan fights when those fights are about something real. The Medicaid fight was at least about something real. But most of this nonsense is a battle of liars trying to protect past lies in the hope of being able to make new lies seem just plausible enough for the liars to keep repeating them. (Jonah Goldberg, 7/21)

Cleveland Plain Dealer: Republicans Trip Over Health Care: Editorial Board Roundtable
It was supposed to be a sprint to the finish line — Republican leadership of the GOP-dominated U.S. Senate planned to repeal speedily the long-hated Obamacare, replace it with the Better Care Reconciliation Act and ride off into the sunset. Instead, it’s been an Army crawl under withering fire for Senate Majority Leader Mitch McConnell, whose initial health care bill was too harsh for moderate Republicans who found it would leave 22 million more people without health insurance, and too generous for conservative Republicans who wanted to strip it bare. (7/20)

Lexington Herald Leader: Ky. Lawmakers Offer Us Hypocrisy, Selfishness In Health-Care Bills
The implosion of the Republican effort to repeal and replace the Affordable Care Act brought to mind the iconic scene in Tennessee Williams “A Cat on a Hot Tin Roof.” There, egged on by his son (Paul Newman) Big Daddy (played by Burl Ives) goes on a verbal rampage about the state of his world, which he characterizes as one of mendacity, lies and hypocrisy. (Ernie Yanarella, 7/20)

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Research Roundup: Early Hospice Discharges Turn Profits; Integrating Mental Health Care

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

Health Affairs: A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death
Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices’ desire to maximize profits drives them to inappropriately discharge patients… Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. (Dolin et. al., 7/1)

Health Affairs: Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions
We compared racial disparities in thirty-day readmissions between traditional Medicare and Medicare Advantage beneficiaries who underwent one of six major surgeries in New York State in 2013. We found that Medicare Advantage was associated with greater racial disparity, compared to traditional Medicare. After controlling for patient, hospital, and geographic characteristics in a propensity score based approach, we found that in traditional Medicare, black patients were 33 percent more likely than white patients to be readmitted, whereas in Medicare Advantage, black patients were 64 percent more likely than white patients to be readmitted. (Li et. al., 7/1)

RAND: Possible Legal Barriers For PCP Access To Mental Health Treatment Records
Provider and payer groups have endorsed the goal of improving the integration of primary care and behavioral health across a variety of programs and settings… Preliminary investigation found that in almost one third of the states (including large-population states such as Florida, Georgia, Massachusetts, New York, and Texas), primary care physicians (PCPs) may have difficulty accessing mental health treatment records without the patient’s (or his/her guardian/conservator’s) written consent. If a comprehensive legal analysis supports this conclusion, then those advocating integration of behavioral and primary care may need to consider seeking appropriate state legislative solutions. (Rothenberg et. al., 7/19)

New England Journal of Medicine: Implementation Of Medical Homes In Federally Qualified Health Centers 
We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients’ experiences, and Medicare expenditures in demonstration sites versus comparison sites… Demonstration sites had higher rates of medical-home recognition and smaller decreases in the number of patients’ visits to federally qualified health centers than did comparison sites, findings that may reflect better access to primary care relative to comparison sites. (Timbie et. al., 7/20)

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Trump Plan Might Cut Expenses For Some Insured Patients With Chronic Needs

Erin Corbelli takes three medications to treat high blood pressure, depression and an anxiety disorder. Her health plan covers her drugs and specialist visits, but Corbelli and her family must pay a $3,000 annual deductible before the plan starts picking up any of that tab.

Corbelli’s insurance is linked to a health savings account so that she and her husband can put aside money tax-free to help cover their family’s drug and medical expenses. But there’s a hitch: Plans like theirs can’t cover any care for chronic conditions until the deductible is satisfied.

Those out-of-pocket expenses could shrink under a Trump administration draft executive order that would change Internal Revenue Service rules about what care can be covered before the deductible is met in plans linked to health savings accounts, or HSAs.

“It would save us a lot of money,” said Corbelli, 41, who lives in Orlando with her husband and their two children, ages 3 and 5.

Michelle AndrewsInsuring Your Health

Health plans with deductibles of thousands of dollars have become increasingly commonplace. Plans often cover services like generic drugs or doctor visits before consumers have satisfied their deductibles, typically requiring a copayment or coinsurance rather than demanding that consumers pony up the entire amount.

But plans that link to health savings accounts have more restrictions than other high-deductible plans. In addition to minimum deductibles and maximum HSA contribution limits, the plans can’t pay for anything but preventive care before consumers meet a deductible. Under current IRS rules, such preventive care is limited to services such as cancer screenings and immunizations that prevent a disease or condition, called “primary prevention.” With HSA-eligible plans, medical services or medications that prevent an existing chronic condition from getting worse or prevent complications from occurring — called “secondary prevention” — can’t be covered before the deductible is paid.

The Trump administration’s draft executive order, which was first obtained last month by The New York Times and has yet to be issued, would allow such secondary preventive services to be covered.

Under the Affordable Care Act, most health plans, including HSA-eligible plans, are required to cover services recommended by the U.S. Preventive Services Task Force without charging consumers anything for them. That requirement is generally limited to primary prevention.

“We know health savings accounts are here to stay and we’d like to make them better,” said Dr. A. Mark Fendrick, an internist who is director of the University of Michigan’s Center for Value-Based Insurance Design and who has advocated for the change.

If people have diabetes, for example, they need regular eye and foot exams to prevent complications such as blindness and amputations down the road. But HSA plans can’t pay anything toward that care until people satisfy their deductible. “The executive order gives plans the flexibility to do that,” he said.

Similarly, it’s critical to remove obstacles to treatment for people like Corbelli with high blood pressure or heart disease, said Sue Nelson, vice president for federal advocacy at the American Heart Association.

“For people with cardiovascular disease, affordability is their No. 1 concern,” Nelson said.

The draft executive order is short on details, and administration officials would have to determine which new preventive services should be covered pre-deductible. Guidelines from medical specialty boards and quality metrics that many physicians are already being measured against could be used, said Roy Ramthun, president and founder of HSA Consulting Services who led the Treasury Department’s implementation of the HSA program in the early 2000s.

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Back then, they took a conservative approach. “We said we can be more flexible later, but we can’t put the genie back in the bottle,” said Ramthun, who supports expanding preventive services coverage.

Many more employers would offer HSA-eligible plans if the list of services that could be covered pre-deductible were expanded, said Tracy Watts, a senior partner at human resources consultant Mercer. Fifty-three percent of employers with 500 or more workers offer HSA-eligible plans, according to Mercer survey data. Three-quarters of employers put money into their employees’ HSA accounts, she said.

Erin Corbelli’s husband’s employer contributes up to $1,500 every year to their health savings account, which can help cover their pre-deductible costs.

Not everyone is so fortunate. “You’re kind of at the mercy of what your employer can offer and what your disposable income is,” she said.

Republicans have long advocated for the expanded use of health savings accounts as a tax-advantaged way for consumers to get more financial “skin in the game.”

Consumer advocates have been much less enthusiastic, noting that the accounts typically benefit higher-income consumers who have cash to spare.

Still, given the reality of the growing prevalence of high-deductible plans, with or without health savings accounts, it’s a sensible proposal, many say.

“This is not a silver bullet or a solution to the problems that high-deductible plans can pose,” said Lydia Mitts, associate director of affordability initiatives at Families USA, an advocacy group. “But this is a good step in thinking about how we offer access to treatment people need in a timely and affordable way.”

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

Categories: Cost and Quality, Insurance, Insuring Your Health

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Perspectives From Across The Country: Placing Blame For Senate GOP Health Bill’s Implosion; The Local Damage Repeal Could Do

Opinion writers examine how repealing Obamacare would play out in their states and towns.

The Kansas City Star: Blame Donald Trump For The Collapse Of Health Care Reform
Let’s be clear and up front: President Donald Trump is primarily responsible for this week’s collapse of Obamacare reform. There are other suspects: Sen. Rand Paul, who demanded full repeal and would not compromise. And Senate Majority Leader Mitch McConnell, who cloaked reform efforts in single-party secrecy. Moderates such as Sen. Susan Collins played a role, as did Sens. Mike Lee of Utah and Jerry Moran of Kansas, who drove stakes into the heart of the preferred reform bill Monday night. And, of course, the liberal mainstream media. Might as well throw us in. But the failure is Trump’s. (Dave Helling, 7/19)

Lexington Herald Leader: My Mistake: I Thought GOP Really Wanted To Pass Obamacare Repeal
I owe my liberal Democratic friends an apology. For years they have been saying the congressional GOP was just passing Obamacare repeals for show, and that they didn’t have a valid replacement bill. I defended them, thinking, naively perhaps, that they really did want to repeal the Affordable Care Act, popularly known as Obamacare, and that one of the many bills they had proposed would unify the party and it would pass with a Republican majority in Congress and become law with a Republican president’s signature. (J. Brandon Thompson, 7/19)

WBUR: Who Killed The GOP Health Care Bill? The American People
After eight years of promising voters fix for the ACA’s high deductibles and paltry provider networks, the Republican House and Senate delivered a bill that would have worsened nearly everything that most people hate about health insurance. Their failure is our calling to envision something better and unite behind it. (Miles Howard, 7/20)

Kansas City Star: Repealing Obamacare Outright Would Hurt Kansans
Without enough votes to pass the U.S. Senate’s proposed health reform bill, we’re still hearing calls to simply repeal the Affordable Care Act — including from President Donald Trump. If successful, an outright repeal would greatly harm Kansans and create instability in our insurance markets. (Michael Munger, 7/19)

Lexington Herald Leader: Kentuckians Must Advocate For Their Health Care
Physicians, like our nation, have strong, diverse opinions about the Affordable Care Act and efforts underway to repeal it. As a physician, dean and president of the American Osteopathic Association, which represents more than 129,000 osteopathic physicians (DOs) and medical students, my mandate is to support policies that will ensure patients are better off in the future than they are today. (Boyd R. Buser, 7/19)

Lincoln Journal-Star: Time Ripe For Bipartisan Health Care Revisions
The American Health Care Act is dead. So are the Better Care Reconciliation Act and a repeal of Obamacare without a replacement, as both have sufficient opposition to be dead on arrival. With the Republicans’ efforts for health care reform reduced to smoldering ruins, now what? (7/20)

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Different Takes: A Win For Obamacare?; Women Senators Flex Muscles In Health Care Debate

Editorial writers offer a range of views on how the push to replace the Affordable Care Act reached its current state of collapse and what it means going forward.

The Washington Post: Why Obamacare Won And Trump Lost
The collapse of the Republican effort to repeal the Affordable Care Act is a monumental political defeat wrought by a party and a president that never took health-care policy or the need to bring coverage to millions of Americans seriously. But their bungling also demonstrates that the intense attention to Obamacare over the past six months has fundamentally altered our nation’s health-care debate. (E.J. Dionne, 7/19)

The Wall Street Journal: Obama’s Last Laugh
Like pop-up dolls, across the length of Barack Obama’s presidency, Republicans voted to “repeal” the law that bears his name—ObamaCare. He laughed at them then, and he’s laughing now. No repeal and no replace. They can’t even do repeal and punt. For Democrats, this doesn’t quite make up for losing the election to Donald Trump, but it has to help. Schadenfreude can’t get much better than watching the Republican Party self-humiliate with an abject inability to win while controlling the House, Senate and White House. (Daniel Henninger, 7/19)

Bloomberg: Health-Care Debacle Exposes The Monster In Trump
Let’s put aside for now the extent to which the Affordable Care Act would “fail” without active measures by the White House and the Republican Congress to undermine the state marketplaces; for that matter, ignore the extent to which active Republican resistance, such as the various lawsuits against the law and the decision by many Republican governors to not expand Medicaid, is responsible for a fair number of problems in the first place. Let’s just stipulate for the sake of argument that Trump is correct and the law is doomed if his administration and Republicans in Congress adopt a passive stance of watching and waiting. (Jonathan Bernstein, 7/19)

Bloomberg: Letting Obamacare Fail Would Break Trump’s Oath
Having failed to repeal the Affordable Care Act, President Donald Trump is now stating openly that his plan is to let Obamacare fail instead. 1 Although the end result may be the same, there’s a vast difference between these two options, constitutionally speaking. Repeal is a normal legislative initiative, completely within the power of Congress and the president. But intentionally killing a validly enacted law violates the Constitution’s order that the president “shall take care that the laws be faithfully executed.” (Noah Feldman, 7/19)

Boston Globe: Protecting The Affordable Care Act Was In Trump’s Oath Of Office
At a minimum, if Trump lives up to his threat not to enforce the Affordable Care Act, it will lead to yet more lawsuits against him and his administration like those that have led federal courts to find his Muslim ban unconstitutional. Shirking his constitutional obligation to faithfully execute the laws, and thereby imperiling the health care market and the well-being of millions of Americans, will only bring the nation closer to a constitutional crisis. (Edward Markey, 7/19)

Los Angeles Times: As The Healthcare Bill Goes Down, It’s Another Bad Week For Male Separatists
It’s been a bad week for male separatists. In Washington, D.C., the all-male Republican Senate leadership, which chose not to invite any female senators to their working-group meetings on repealing the Affordable Care Act, watched in frustration as their bill fizzled after those women declined to support it. Sen. Majority Leader Mitch McConnell, demonstrating that overconfidence and sexism often go hand-in-hand, had insisted the bill could succeed without women senators’ input. “Nobody’s being excluded based upon gender,” he said. “Everybody’s at the table.” Sure, if your definition of everybody is “13 middle-aged guys in ill-fitting suits.” (Ann Friedman, 7/20)

The Washington Post: No Women, No Health Care Bill
After Senate Republicans’ second version of a health-care bill collapsed Monday under the weight of more than a dozen senators (male and female) who had concerns, Senate Majority Leader Mitch McConnell decided to just vote on repealing Obamacare without a replacement… And it was Senate Republican women who killed it. (Amber Phillips, 7/19)

The New York Times: If Dr. Trump Were Your Surgeon …
It’s a dark and stormy night, and the hospital corridor is eerily illuminated by lightning flashes as Dr. Trump and Dr. McConnell enter a patient’s room and approach the bed of a young woman, Janet. “We have the best health care plan ever for you!” Dr. Trump says exultantly, to a thunderclap outside. “Tremendous! I’m the best! I take care of everybody.” He uses his stethoscope to listen to Janet’s heart, and frowns slightly. “Er, doctor?” Janet says. “I think my heart is on my left side, not the right.” (Nicholas Kristof, 7/20)

The Hill: How Medicaid Brought Down TrumpCare
Republican efforts to repeal and replace the Affordable Care Act have failed, largely because their legislation did so much more. In their hubris they sought to also dismantle the traditional Medicaid that predated the law by 45 years, something Speaker Paul Ryan had admitted was a dream since his fraternity kegger days. And it was the Medicaid cuts that forced Republicans into their worst public contortions. (Brendan Williams, 7/19)

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Obamacare Exchanges In Limbo

California’s Obamacare exchange scrubbed its annual rate announcement this week, the latest sign of how the ongoing political drama over the Affordable Care Act is roiling insurance markets nationwide.

The exchange, Covered California, might not wrap up negotiations with insurers and announce 2018 premiums for its 1.4 million customers until mid-August — about a month later than usual. Similar scenarios are playing out across the country as state officials and insurers demand clarity on health care rules and funding, with deadlines fast approaching for the start of open enrollment this fall.

“It’s insane,” said John Baackes, CEO of L.A. Care Health Plan, which has about 26,000 customers on the California exchange. “Here we are in the middle of July and we don’t even know what rules we will be operating under for open enrollment. It is not how you want to run a business.”

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Consumers could face sharply higher premiums and fewer choices if more health insurers leave the insurance marketplaces due to lingering uncertainty. State and industry officials around the United States are concerned that the federal government could stop funding so-called cost-sharing subsidies that reduce out-of-pocket costs for low-income consumers. And they worry the Trump administration won’t enforce the individual mandate that requires people to purchase health coverage or pay a penalty.

Amid those concerns, there was a sense of relief Tuesday among many exchange officials and insurers after the U.S. Senate’s latest attempt to replace the Affordable Care Act failed.

Two large insurer trade groups bluntly warned last week that parts of the Senate plan were “unworkable” and could plunge the market into chaos. In a letter to the Senate, America’s Health Insurance Plans and the Blue Cross Blue Shield Association particularly objected to an amendment by Sen. Ted Cruz (R-Texas) that would have allowed insurers to sell bare-bones health plans to people who wanted cheaper premiums. That provision, the insurers said, would split the market between the healthy and the sick, driving up costs for people with preexisting conditions.

However, the Republicans’ failure to pass that ACA replacement plan did not resolve questions swirling around the current health law.

Tuesday, President Donald Trump expressed disappointment at the outcome in the Senate, telling reporters, “We’ll let Obamacare fail and then the Democrats are going to come to us and they’re going to say, ‘How do we fix it?’”

Some Senate Republicans struck a more conciliatory tone, suggesting that lawmakers should work on a bipartisan measure that would help stabilize the individual insurance markets.

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Committee on Health, Education, Labor and Pensions, said he plans to hold hearings in the coming weeks on ways to shore up the individual insurance market. Lawmakers may look at creating a new stabilization fund that helps compensate insurers for higher-cost patients. Such a fund would be similar to one that existed during the first three years of the ACA exchanges.

Some insurance industry executives welcomed the talk of bipartisanship, but they said action must be taken quickly to resolve key issues affecting consumers.

“We are running out of time and we need a resolution on what we are charging for 2018,” said Gary Cohen, vice president of public affairs at Blue Shield of California in San Francisco, the largest Covered California insurer by enrollment.

Cohen, who helped launch the exchanges in 2014 as an official in the Obama administration, noted that the Republican bills in both the House and Senate included money for reinsurance that can help lower premiums industrywide. Those provisions are among the “immediate steps Congress and the Trump administration need to take in order for markets to provide coverage that is affordable.”

A federal reinsurance program helps compensate insurers for the high costs incurred by the sickest patients. That, in turn, allows health plans to keep their overall premiums lower and attract healthier customers into the insurance pool.

Lawmakers could also appropriate federal funds for the cost-sharing subsidies, which have a price tag of about $7 billion a year. Those payments, made directly to insurers, help reduce deductibles and other out-of-pocket costs for policyholders who earn up to 250 percent of the federal poverty level. This year, that’s up to about $29,000 for an individual or around $61,000 for a family of four. More than half of the people enrolled on exchanges nationwide qualify for this financial assistance.

Without it, many consumers would face annual deductibles of $2,000 or more when visiting the doctor or undergoing medical tests. That would make people far less likely to sign up with participating insurers.

Conservatives generally oppose the subsidies, calling them a bailout of the insurance industry and arguing that the Obama administration didn’t have the authority to pay them. Trump has repeatedly threatened to cut off those cost-sharing subsidies as well.

With their future up in the air, some states, including California and Pennsylvania, allowed insurers to submit two sets of proposed premiums. One filing reflects continued federal funding of those subsidies, and a separate one assumes they are eliminated and their cost is included in health plan premiums.

In Pennsylvania, premiums next year without the subsidies would increase by an average of 20 percent, compared with 9 percent if they remained intact.

Pennsylvania Insurance Commissioner Teresa Miller said the market in her state would be in good shape without the uncertainty over federal policy. “The only thing right now keeping everyone on edge is what’s going to happen in Washington, D.C.,” Miller said. “If things calm down in D.C. and if we don’t see further changes, then Pennsylvania’s market really is stabilizing.”

On Tuesday, Covered California said the two different rate filings its health plans submitted will be released Aug. 1. The exchange may announce that same day what the final premiums are, or it could postpone the decision for several more weeks if Congress has begun to pursue fixes to the ACA.

“This decision is based on the ongoing federal uncertainty around the repeal and replacement attempts of the Affordable Care Act and the dramatic potential impacts such uncertainty has on the rates and on California consumers,” the exchange said in a statement.

A recent analysis commissioned by Covered California estimated that premiums for silver-tier plans would jump by 16.6 percent if the federal government stopped paying for the cost-sharing subsidies. That would be in addition to normal increases meant to cover rising medical costs. An exchange spokeswoman declined to comment further Tuesday, citing the ongoing developments in Washington.

In the Florida exchange market, health insurers have sought an average rate increase of nearly 18 percent. But Florida Blue, the state’s largest health insurer, said those rates would go even higher if the cost-sharing reduction payments disappeared.

Robert Laszewski, an industry consultant in Virginia and a frequent ACA critic, said the exchange markets aren’t imploding, despite what the Trump administration has often said. But their premiums will continue to rise unless more young and healthy people are persuaded to buy coverage, he said.

“I think most insurance companies will at least break even, or even make a profit, in 2018,” Laszewski said. “Coverage will be ‘stable,’ but it will stabilize at a horrific premium rate level.”

Eric Whitney, Abe Aboraya and Ben Allen contributed to this story.

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

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Sizing Up Other Key Players: ‘Obamacare Republicans,’ An ‘Unhappy White House’ And, Of Course, Voters

Editorial pages feature different takes on how a range of people — from moderate GOP lawmakers and arch conservatives like Sen. Rand Paul (R-Ky.) — have been center stage in this ongoing health policy debate.

The Wall Street Journal: The ObamaCare Republicans
Senate Republicans killed their own health-care bill on Monday evening, and some are quietly expressing relief: The nightmare of a hard decision is finally over, and now on to supposedly more crowd-pleasing items like tax reform. But this self-inflicted fiasco is one of the great political failures in recent U.S. history, and the damage will echo for years. (7/18)

The Washington Post: Don’t Blame The Moderates For The Health-Care Debacle
With the announcement from Sen. Shelley Moore Capito (R-W.Va.) that she would not vote for repeal (at least as defined by the 2015 reconciliation bill that would leave 32 million more Americans uninsured) with no replacement, the whole dreary episode of Republican hypocrisy on Obamacare can come to an end. (Jennifer Rubin, 7/18)

The Washington Post: Raging Over The Health Bill’s Failure, Trump Will Soon Make An Even Crueler Move
Now that the GOP health bill has imploded in the Senate, it’s fitting, in a way, that President Trump is now demanding in a rage that Senate Republicans vote on straight repeal only. If that play fails, as many analysts seem to expect, it will neatly capture just how saturated in cruelty, dishonesty and bad faith the Republican approach — and, more recently, that of Trump — has been all along. (Greg Sargent, 7/18)

Boston Globe: The Human Cost Of Trump’s Health Care Tantrum
Donald Trump’s tantrum on Tuesday, when he said his administration would let the law fail after a Senate replacement plan collapsed, marks an astonishing abdication of responsibility. If the president follows through on his implicit threat to intentionally sabotage the health care market, Trump will inflict a needless burden on millions of consumers. (7/18)

The New York Times: Obamacare’s Future Now Depends On An Unhappy White House
The congressional effort to overhaul the health care system appears to be in shambles. But the current health care system lives on. And decisions the Trump administration makes about how to manage it could have big effects on who has coverage next year, and what it costs them. The Department of Health and Human Services is in charge of administering Obamacare, and so far the department’s staff has given many public indications that it does not enjoy such duties. (Margot Sanger-Katz, 7/18)

Chicago Tribune: The Future Of Obamacare? Voters, Over To You.
The Senate Republican bill to repeal and replace the health law lies in a smoldering heap. Some GOP lawmakers back a loopy repeal-now, replace-later-maybe effort that as of Tuesday already looked to be political toast. You can’t replace something with nothing, or the promise of something later that you’ve failed to deliver today. (7/18)

USA Today: Rand Paul: Time To Repeal Obamacare
There are those who insist Republicans must act as a team to repeal Obamacare. I agree — if the topic is repeal. Every Republican has run on repealing Obamacare for seven years, and all but one voted for clean repeal in 2015. Now we have a president who will sign it and is asking for us to send the same repeal bill to his desk, one that repeals with a two-year window to work with. We also have a majority leader who has said he will bring this vote to the Senate floor. (Sen. Rand Paul, 7/18)

The Wichita Eagle: Sen. Jerry Moran’s Interesting 24 Hours
Jerry Moran began Tuesday as a hero to Kansas moderates, the Sunflower State Republican who took a stand against a second Senate health care bill by criticizing “the closed-door process.” He listened to his constituents, they figured, being one of the few senators to have a town-hall meeting during the July 4 recess. Which makes the rest of the Tuesday so oddly interesting. (7/18)

The New York Times: John Kasich: The Way Forward On Health Care
Columbus — Washington’s approach to health care over the past decade is yet another example of our lawmakers’ increasing distance from the rest of America. First one party rams through a rigid, convoluted plan that drives up costs though unsustainable mechanisms that are now unraveling. Then the other party pursues fixes that go too far the other way — and again ignores ideas from the other side. (Gov. John Kasich, 7/18)

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Analyzing McConnell’s Health Plan Strategery: A Hail Mary Pass? Is The Game Over?

Opinion writers across the country take a hard look at the legislative tactics employed this week by Senate Majority Leader Mitch McConnell (R-Ky.) as his party’s health plan unraveled.

Bloomberg: A Chance For A New Beginning On Health Care
They may have avoided the ditch, but Republicans have driven themselves into a cul-de-sac. After the failure in the Senate of their disastrous plan to replace Obamacare, Majority Leader Mitch McConnell now promises to make his colleagues vote instead on just a repeal of the Affordable Care Act. (7/18)

The Washington Post: McConnell’s Health-Care Hail Mary
To paraphrase Mark Twain, reports of the death of Republican health-care reform are greatly exaggerated. Far from throwing in the towel, as some have reported, Senate Majority Leader Mitch McConnell is actually throwing a final Hail Mary pass in an effort to pass the Senate Republicans’ Better Care Reconciliation Act (BCRA). And he’s found an extremely clever way to do it. (Marc A. Thiessen, 7/18)

San Jose Mercury News: The Game Is Not Over For Mitch McConnell
McConnell’s biggest challenge was getting 50 Republican senators to agree to vote for a “motion to proceed” on a bill that they disagreed with — knowing that it was unlikely to be amended in ways that would make a difference to their final votes given the split between Republican conservatives and moderates and given the Democrats’ refusal to cooperate. Instead of cooperation, Republicans would have to endure an onslaught of politically toxic Democratic amendments, as Senate Democrats forced them to cast one vote after another designed to make them look like monsters come Election Day. (Marc Thiessen, 7/18)

Los Angeles Times: Uh-Oh, The GOP Has No Choice But To Work With Democrats On Healthcare Reform
The sudden collapse of Kentucky Sen. Mitch McConnell’s healthcare bill on Monday was much more than a tactical setback for the Senate Republican leader once considered an unbeatable legislative wizard. It was a catastrophic failure for the GOP’s attempt to make one-party government work. It’s one thing to produce gridlock when control of Congress is divided. When one party manages to produce gridlock all by itself, something is seriously wrong. The setback means that Obamacare will almost certainly survive for the foreseeable future, despite seven years of GOP promises to repeal it. (Doyle McManus, 7/19)

Miami Herald: Suddenly, A Defeated McConnell Sees The Value Of A Bipartisan Healthcare Plan
This is what happens when you try to muscle through in six months — and in secret — what you could have done over seven years. You bear the brunt of the responsibility for the GOP’s disaster of a healthcare plan getting flushed down the tubes. This is what happens when you do anything, short of crawling under a rock, to avoid having to look your scared and angry constituents in the eye at town hall meetings. When you emerge from wherever you’ve been hiding, those constituents are still scared, still angry, having flooded your offices on the Hill with phone calls and emails to make sure you get the message. (7/18)

The Charlotte Observer: The Last Big Republican Lie On Health Care
Moments after the latest Republican health care bill died Monday night, Senate Majority Leader Mitch McConnell proposed that Republicans instead repeal the Affordable Care Act immediately, but let it live for two years while they come up with a replacement. President Trump, at least initially, agreed in a tweet. (7/18)

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Next Directions On Health Policy: Fixes Should Be Bipartisan; Improve The Health Law Or Move On

Opinion writers offer advice to lawmakers about what to do now that efforts to repeal and replace Obamacare seem to have stalled.

The Washington Post: The Bipartisan Way To Strengthen Health Care
You’d think that Republican leaders would have learned their lesson after a second failed attempt to pass the Better Care Reconciliation Act (BCRA) — the Senate GOP’s replacement for the Affordable Care Act. It should come as no surprise that a bill drafted in secret — without holding a single public hearing or garnering the support of a single health-care stakeholder — would face widespread condemnation. (Neera Tanden and Topher Spiro, 7/18)

Los Angeles Times: With Obamacare Repeal Off The Table, Will Republicans Start Trying To Actually Improve Healthcare?
Miillions of Americans whose healthcare coverage was imperiled can breathe a sigh of relief now that congressional Republicans’ reckless efforts to dismantle the Affordable Care Act have foundered. They can thank a handful of courageous moderates in the Senate Republican Caucus for being unwilling to repeal the ACA without having a replacement ready that wouldn’t make matters worse for their constituents. (7/19)

Lexington Herald Leader: Health-Care Fix Must Be Bipartisan
If the Affordable Care Act is the failure that Republicans Mitch McConnell and Donald Trump insist, then getting Congress to repeal and replace it wouldn’t be so difficult. In reality, the law, signed by Barack Obama in 2010, is not a failure, quite the opposite. It has brought security to millions of Americans for whom sickness previously meant bankruptcy or premature death. It has brought greater financial certainty to the hospitals and clinics that care for them. (7/18)

Los Angeles Times: Democrats And Republicans Should Now Agree On These Real Fixes For Obamacare
With Monday’s collapse of the Senate Republicans’ latest effort to repeal the Affordable Care Act, the GOP and the Trump White House are confronted with the question of what to do next, if anything, on healthcare. But that’s a question for Democrats, too. Although there’s a general perception that Democrats consider Obamacare to be the last word on healthcare policy, that’s never been true. The ACA was the product of compromise from its inception, and also something of an experiment. No one was sure how all its moving parts would work. (Michael Hiltzik, 7/18)

Milwaukee Journal Sentinel: On Health Care, Republicans Should Work With Democrats
Now that the plan to “repeal and replace” Obamacare is dead and the plan to “repeal now, replace later” has expired ignominiously, what’s the next treatment noted health care specialists Donald Trump, Paul Ryan and Mitch McConnell will try?… But instead of sabotaging the Affordable Care Act, Republicans should work with Democrats to shore up the insurance exchanges that are at the heart of the ACA. (David Haynes, 7/18)

The Des Moines Register: To Congress: Improve Obamacare Or Move On
Republican leaders in U.S Congress are the epitome of lost and dysfunctional. When it comes to health insurance, it is painfully clear they have no idea what they’re doing or seeking. The Affordable Care Act needs to be improved, and that should be lawmakers’ goal. But that seems impossible for this group of elected officials. Americans are tired of the shenanigans. (7/18)

The Kansas City Star: Republicans Should Move On From Obamacare Repeal
The Republican Party’s effort to repeal the Affordable Care Act and replace it with something — maybe now, maybe a few years from now — stumbled to a predictable stalemate Tuesday. The GOP hates Obamacare. But after seven years of debate, Republicans still can’t agree on how to make it better. (7/18)

The Wall Street Journal: Medicaid’s Potemkin Health Coverage
If ObamaCare’s expansion of Medicaid were measured merely by growth in enrollment and spending, California’s Medi-Cal program would rank as a huge success. Since 2012, Medi-Cal has added six million beneficiaries, primarily able-bodied adults of working age. Covering them last year brought California nearly $20 billion in additional federal funds. If Medi-Cal were a state, its population of 14 million would make it the fifth-largest in the U.S. The program’s $103 billion budget is about three times the size of Illinois’s general fund. (Allysia Finley, 7/18)

Arizona Republic: Will Trumpcare 2.0 Pay For An Operation Like McCain’s?
Now that the Senate replacement for the Affordable Care Act has gone down the toilet, where it belongs, perhaps President Donald Trump will fashion something that lives up to his campaign promises – a plan where every American will get the kind of care received recently by Sen. John McCain.T he Republican plan wasn’t close. (EJ Montini, 7/18)

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