Tagged Medicaid

GOP Health Bill’s Changes Go Far Beyond Preexisting Conditions

The latest GOP effort to “repeal and replace” the Affordable Care Act is getting a lot of attention, even if its passage seems unlikely. But there is far more to the measure than its changes to rules regarding preexisting health conditions.

In fact, the bill proposed by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) would disrupt the existing health system more than any of the measures considered so far this year, according to supporters and critics.

For backers of the bill, that disruption is a good thing. But others are appalled. As insurance industry analyst Robert Laszewski put it in a note to clients this week, “Would you rather lose your Republican Senate seat because you couldn’t pass an Obamacare repeal-and-replace plan or because you blew up the health insurance system?”

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Some of those alterations have generated little discussion but would have major impacts. Here are four unheralded changes:

The Bill Caps Federal Funding To Medicaid

Much focus has been placed on the bill’s funding formula, which would take money from states that expanded the Medicaid program for the poor. Less notice has been paid to the fact that this bill, like some other GOP options over the summer, would, for the first time, cap overall federal Medicaid funding. The federal government has provided an open-ended funding match since the program’s creation in 1965 — meaning the federal government has provided its share of whatever states spend to care for low-income children, pregnant women, seniors and people with disabilities. More than 70 million people are covered by Medicaid, including those added as a result of the ACA.

Republicans have been pushing unsuccessfully to limit the federal government’s funding of Medicaid to states since the 1980s.

State Medicaid directors — including both Republicans and Democrats — are alarmed at the idea that something of such magnitude could be done with so little debate or consideration. “Graham-Cassidy would completely restructure the Medicaid program’s financing, which by itself is three percent of the nation’s Gross Domestic Product and 25 percent of the average state budget,” said a statement from the group.

The Congressional Budget Office estimated in June that an earlier version of the cap would reduce federal Medicaid spending 35 percent by 2036. As a result, said CBO, states would “uneed to … decide whether to commit more of their own resources, cut payments to health care providers and health plans, eliminate optional services, restrict eligibility for enrollment, or adopt some combination of those approaches.”

“There won’t be enough money to do what’s authorized under current law,” said Jessica Schubel of the left-leaning think tank the Center on Budget and Policy Priorities.

— The Bill Gives Unprecedented Power To The Secretary Of Health And Human Services

Republicans complained bitterly about the power delegated by Congress to the secretary of Health and Human Services in the ACA. But conservative analyst Chris Jacobs pointed out that the Graham-Cassidy bill gives the HHS secretary more power still.

The bill creates a dizzyingly complex formula for the funds now being spent on the ACA, which is intended to draw money away from wealthier states (that mostly expanded Medicaid under the health law) toward poorer ones (that mostly did not). But there is a huge loophole, noted Jacobs. The bill gives the HHS secretary authority to change the formula on his or her own.

“That’s a trillion-dollar loophole that leaves HHS bureaucrats with the ultimate say over how much money states will receive,” Jacobs wrote.

And, he said, it’s the opposite of “federalism,” or giving states more authority, which the bill’s sponsors claim to be advancing.

“Draining the swamp shouldn’t involve distributing money from Washington out to states, whether under a simple formula or executive discretion,” he wrote. “It should involve eliminating Washington’s role in doling out money entirely.”

— The Bill Cuts Off All ACA Funding After 2026

The bill would lump together all funds being spent under the health law to help people pay premiums, out-of-pocket health costs and expand Medicaid to non-disabled adults and redistribute those funds to the states in the form of block grants. States could then use that money for almost anything health-related.

What few people have noticed, however, is that those block grants end abruptly after 2026. Originally, many thought this was because of congressional budget rules that limit new programs to no more than 10 years.

In fact, those rules say that a program cannot add to the deficit after 10 years and don’t affect the length of the program. The block grant is paid for by continuing taxes from the ACA, so there is no budget need to cut it off.

The reason seems to be a desire to require Congress to come back and revisit the program. A spokesman for Cassidy said the program “just has to be reauthorized in 2026 just like the CHIP program.” CHIP is the Children’s Health Insurance Program, also created in a budget bill in 1997. Congress was supposed to reauthorize that program by the end of September, although it looks as if lawmakers will miss that deadline, despite bipartisan support.

Others, however, worry that cutting the money off after 2026 means Congress could no longer use the current funding mechanism. Instead, lawmakers would have to come up with massive cuts to other programs or new tax increases if they wanted to continue providing the money for health care.

— The Bill Could Roil The Individual Insurance Market In Some States By Banning Abortion Coverage In Private Health Plans.

In keeping a promise to anti-abortion lawmakers, the bill would prohibit all private insurance plans receiving any federal funds from providing abortion coverage.

As part of a delicate compromise that got the ACA enacted in 2010, states were given the option to ban abortion coverage in plans on their health exchanges. Half of them did.

But some states, notably California, New York and Oregon require plans they regulate to offer coverage of elective abortions.

The problem is that the deadline for insurers to opt into coverage under the ACA is next Wednesday. If Congress were to pass the bill after that, it is unclear what would happen to those plans. In California, the requirement for abortion coverage is based on the state’s Constitution, so it would be possible that no plans could be offered to people who are eligible for federal help.

“There aren’t clear answers” to what would happen if the bill becomes law in its current form and takes effect in January, said Debra Ness, president of the National Partnership for Women and Families, a reproductive rights advocacy group. “I think it’s going to create chaos.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research Roundup: Hospital Transportation; Medicaid Expansion; Obesity Treatment

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

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

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

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

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

Viewpoints: The Promise And Price Tag Of A New Cancer Drug; Medicaid In Indian Country

A selection of opinions on health care from around the country.

JAMA: FDA Approval of Tisagenlecleucel: Promise and Complexities of a $475 000 Cancer Drug
Unlike most cancer therapies that are identical from patient to patient, CAR-T therapies are made by removing the T cells of a patient, genetically modifying them to respond to certain targets expressed on the patient’s cancer cells, and then reinfusing the cells. When the T cells come into contact with the relevant target (for instance, CD19 in the case of ALL), they proliferate while secreting a number of programmed substances including inflammatory cytokines that destroy the cancerous cells. Targeted killing of tumor cells by lymphocytes was first suggested by the graft-vs-leukemia effect in bone marrow transplantation, but that effect and the infusion of donor T cells more generally has no effect on solid tumor malignancies or most hematologic cancers. The innovation underlying CAR-T involved exploiting the specificity of antibody-mediated recognition of tumor antigens, and then engineering CAR-T cells to have the relevant antibody fragment fused to the T-cell receptor. Thus, the “living drug” infused into the patient is the patient’s own T cells altered to express a receptor that is specific for the target antigen on the tumor. (Peter B. Bach, Sergio A. Giralt and Leonard B. Saltz, 9/20)

High Country News: How Will Medicaid Cuts Affect Health Care In Indian Country?
In the legislation introduced by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., on Sept. 12, federal Medicaid and health insurance subsidy dollars would be given as a lump sum to states, which would have wide discretion in how they were spent. Nowhere would this be more devastating than in Indian Country. … In Medicaid expansion states, from Alaska to Maine, the Affordable Care Act has meant that the Indian Health Service, which provides care to 2.2 million of the nation’s 5.3 million American Indians and Alaska Natives, has been able to provide preventive services. Those include screenings for breast and colon cancer, never before available to non-elderly adult patients. Now IHS can provide those services and get reimbursed by Medicaid, instead of having the cost of the services come out of IHS’s grossly inadequate budget. (Tanya H. Lee, 9/20)

The Charlotte Observer: Protests At Charlotte Abortion Clinic Go Too Far
Our government has a responsibility to protect people’s First Amendment right to assemble and peacefully protest. It is also incumbent on government to enforce people’s right to make their own decisions about their medical care. At A Preferred Women’s Health Center in east Charlotte, these two fundamental rights are clashing. Anti-choice protesters are harassing and obstructing people who attempt to perform and to gain access to abortions. And the city is giving an unfair boost to the protesters, compromising the health and safety of thousands of women. (Lisa Levenstein, 9/20)

Bloomberg: Defying Ethics Norms Flies With Trump
Health and Human Services Secretary Tom Price has been taking fancy charter flights when previous secretaries flew commercial. Well, what do you expect? Just think about the incentives in a normal administration and in this one. Normally, the president sets a reasonable example of good ethics practices. Oh, there are sometimes controversies, but normal presidents avoid conflicts of interest, follow the guidelines of ethics officials and other best practices, and generally act as if they care about the appearance, at least, of playing by the rules. This president has basically ignored ethics laws and norms from the beginning. It must be hard to care about saving the government a few dollars when the president is using his office to, for example, advertise his business interests. (Jonathan Bernstein, 9/20)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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N.M. Officials To Brief Lawmakers Today On Plans To Curb Medicaid Spending

Proposals to cut state spending have included requiring enrollees to pay monthly premiums and copayments. In other Medicaid news, a look at Louisiana’s program, a managed care contract controversy in Mississippi and record backlogs in Oregon.

The Associated Press: New Mexico Presses Forward With Medicaid Premiums, Copays
New Mexico is pressing forward with plans to limit increases in state spending on Medicaid health care for low-income and disabled residents by adding monthly premiums and copays from patients, as Senate Republicans in Washington contemplate fundamental changes to Medicaid. State officials will brief lawmakers Wednesday on an array of proposed changes to the state’s Medicaid health care program designed to keep costs down while improving the delivery of health care for New Mexico’s poorest residents. (9/20)

New Orleans Times-Picayune: Medicaid In Louisiana: Who Gets It? How Does It Work?
Medicaid has been at the center of much of the health care and budget debate this year in Washington and Baton Rouge. Here is a primer on the program. … About 74 million people — 1 in 5 five Americans — are enrolled in Medicaid. Louisiana is more dependent, with 1.6 million — about 1 in 3 residents — using the program. (O’Donoghue, 9/19)

Jackson (Miss.) Clarion-Ledger: $2B Medicaid Contract Moving Forward After Contract Review Board Refuses To Vote
Public Service Contract Review Board members took a passive role on the Medicaid managed care debate Tuesday, refusing to take up the matter after their staff recommended they approve the $2 billion contract. The non-vote means the MississippiCAN contract, the subject of much controversy since the Mississippi Division of Medicaid signed it in June, is effective and will move forward, according to the board and Medicaid’s attorney. (Wolfe, 9/19)

East Oregonian: Eliminating Medicaid Backlog Will Cost Oregon At Least $4.3 Million
An intensive effort to shore up Oregon’s Medicaid enrollment records is expected to cost the state at least $4.3 million. Participants in the Oregon Health Plan, Oregon’s Medicaid program, must have their eligibility for the plan verified annually in a process called redetermination. Oregon had fallen behind on those annual redeterminations, and by late May had an estimated backlog of about 115,000 people whose eligibility for the Oregon Health Plan was in question. (Withycombe, 9/19)

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

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

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

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

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

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

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

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

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

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

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

It would eliminate the tax on medical devices. 

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

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

3. It would fundamentally restructure the Medicaid program.

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

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

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

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

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

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

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

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

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

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

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

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

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

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Different Takes: What To Do With CHIP; Deal With Threats To Obamacare Before Single Payer

News outlets examine a variety of pressing health policy issues, ranging from the reauthorization of the Children’s Health Insurance Program to what’s next for the Affordable Care Act.

Forbes: Children’s Health Insurance Program Demands Quick, Bipartisan Passage
CHIP was a shared vision of Republicans and Democrats alike. It seems like ancient history now, but, in 1997, I joined with members from both sides of the aisle to debate health care policy forcefully but productively. Led by Senators Ted Kennedy (D-MA) and Orrin Hatch (R-UT), we crafted the CHIP language. Bipartisan action, so crucial to the health of the country and the economy, was never more important than when it came to insuring America’s children. Now, two decades later, that progress is in jeopardy. CHIP is set to expire on September 30. (Bill Frist, 9/14)

National Review: Continue To Fund Children’s Health Care, But Coordinate The Programs Better
CHIP, which helps states provide health-care coverage to low-income kids, is better structured than Medicaid to ensure that funds are targeted to those who need assistance most. Now, after the Affordable Care Act has created an entitlement to subsidized coverage through the exchange, CHIP-eligible families are often torn between two programs that fit together poorly. If a few minor flaws in its design are fixed, however, CHIP can fill a gap and enhance the rest of America’s health-care safety net. (Chris Pope, 9/18)

The Washington Post: Before Tackling Single-Payer, Save Obamacare
Before supporters of universal health coverage get all wrapped up debating a single-payer system, they need to focus on a dire threat to the Affordable Care Act likely to come up for a vote in the Senate before the end of the month. The latest repeal bill is an offering from Republican Sens. Lindsey O. Graham (S.C.) and Bill Cassidy (La.) that would tear apart the existing system and replace it with block grants to the states. Block grants — flows of money for broad purposes with few strings attached — are a patented way to evade hard policy choices. All the tough decisions are kicked down to state capitals, usually with too little money to achieve the ends the block grant is supposed to realize. (E.J. Dionne, 9/17)

The New York Times: Complacency Could Kill Health Care
I haven’t yet read Hillary Clinton’s “What Happened,” but it seems pretty clear to me what did, in fact, happen in 2016. These days, America starts from a baseline of extreme tribalism: 47 or 48 percent of the electorate will vote for any Republican, no matter how terrible, and against any Democrat, no matter how good. This means, in turn, that small things — journalists acting like mean kids in high school, ganging up on candidates they consider uncool, events that suggest fresh scandal even when there’s nothing there — can tip the balance in favor of even the worst candidate imaginable. (Paul Krugman, 9/18)

Baltimore Sun: Medicaid Cuts Shift Burdens To States
Thanks to massive grassroots mobilization efforts, our state narrowly averted disaster when Congress failed to pass any version of Affordable Care Act (ACA) repeal that would have restructured Medicaid and left thousands of my constituents without health care coverage. Stopping health care repeal was a huge victory, but the fight is not over yet. Even deeper cuts to Medicaid have been proposed in the 2018 budget resolution, which would slash health care by $1.5 trillion over the next 10 years to pay for billions in tax breaks to the rich and corporations over that same period. (Rep. C.A. “Dutch” Ruppersberger, 9/17)

The New York Times: The Best Health Care System In The World: Which One Would You Pick?
“Medicare for all,” or “single-payer,” is becoming a rallying cry for Democrats. This is often accompanied by calls to match the health care coverage of “the rest of the world.” But this overlooks a crucial fact: The “rest of the world” is not all alike. The commonality is universal coverage, but wealthy nations have taken varying approaches to it, some relying heavily on the government (as with single-payer); some relying more on private insurers; others in between. (Aaron E. Carroll and Austin Frakt, 9/18)

The Washington Post: A Century Ago, Women Fought For Access To Contraception. The Trump Administration Threatens To Undo Their Work.
Trump administration officials vow that they are going to take care of the health of moms and babies. But their pledge to cut funding to Planned Parenthood promises to do the opposite. The proposed cuts have focused not just on the procedure of legal abortion (which is, of course, another column), but also on eliminating access to contraceptives. These proposals ignore a fundamental truth: Access to birth control is central to women’s health. In fact, it always has been. (Lauren MacIvor Thompson, 9/15)

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Ohio House Speaker Surveys Colleagues About Overriding Kasich’s Medicaid Expansion

Last summer, Ohio Gov. John Kasich vetoed the part of the state’s budget bill that would have frozen Medicaid expansion enrollment. Republicans in the House threatened to try to override the veto in July but eventually did not take a vote. Also in Medicaid news, Pennsylvania’s governor says that a cash shortfall is causing Medicaid payments to insurance companies to go out late.

The Associated Press: Ohio House Considers Overriding Gov. Kasich’s Medicaid Expansion Veto
The Ohio House is again weighing an override of Republican Gov. John Kasich’s veto protecting Medicaid expansion after scrapping the idea in July. A memo circulating among House Republicans said GOP Speaker Cliff Rosenberger “would just like to see” where his caucus members stand now that efforts to repeal the federal health care law in Washington appear indefinitely stalled. (9/17)

The Philadelphia Inquirer/Philly.com: With Budget Impasse, Gov. Wolf Delays More Than $1B In Medicaid Payments
With the state’s cash running low, Gov. [Tom] Wolf on Friday said he was forced to withhold nearly $1.2 billion in payments to Medicaid program providers. In a short statement, the governor said his administration will be unable for at least a week to make the payments to managed care organizations, the private health insurers that cover many of the state’s neediest children, elderly, and disabled residents. Insurance industry officials said Wolf’s move is unlikely to interrupt services for Medicaid recipients but could affect the business side. (Navratil and Couloumbis, 9/15)

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Policy Points: Three GOP Senators ‘Bedside Miracle;’ Immigration As A Public Health Issue

Columnists offer their opinions on a range of health policy topics, including the Obamacare alternative being advanced by Sens. Lindsay Graham (R-S.C.), Bill Cassidy (R-La.) and Dean Heller (R-Nev.), the impact of immigration policy and how to make sense of issues during the upcoming open enrollment period.

Bloomberg: The Latest (Dim, Distant) Hope For Health-Care Reform
Health-care reform is like one of those ill people in a Victorian novel. They are pronounced close to death, with no possibility of a cure … and then they linger on for hundreds of pages of breathless plotting, while the reader wonders: “Is this it? Could they possibly live after all that suffering?” The latest bedside miracle is the Graham-Cassidy-Heller proposal, which would cut spending, cap spending, and shift spending away from states that expanded Medicaid to those that haven’t. (Megan McArdle, 9/13)

WBUR: Trump’s Aggressive Immigration Policies Have Created A Public Health Disaster
We are seeing only the tip of the iceberg of public health disasters stemming from the Trump administration’s aggressive detention and deportation policies. Lower birth weights have been reported in Latina mothers affected by immigration raids, and a spike in adverse mental health symptoms has been reported in many immigrant communities. (Dr. Sondra S. Crosby, Gilbert E. Benavidez and J. Astrian Horsburgh, 9/14)  

Los Angeles Times: Making Sense Of Covered California And Medicare During Open Enrollment
It’s that time of year when we all have to start thinking about health insurance plans and options. Not only do I need to figure out if my current plan will be offered again next year, and with what changes, but my husband is over 65, so I also have to research the latest Medicare plans as well. As a columnist, research is my thing, but this insurance stuff makes my head spin. (Barbara Venezia, 9/13)

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State Highlights: Mass. Successful In Reining In Health Costs; Ohio Lawmakers Tap Brakes Over Flu Vaccine Bill

Media outlets report on news from Massachusetts, Ohio, Georgia, Louisiana, New Jersey and Tennessee.

Boston Globe: State Makes Headway In Limiting Health Care Spending, Report Shows
Massachusetts made progress in controlling health spending last year, according to a state report issued amid a swirling debate over how best to rein in costs. Total spending on health care grew an estimated 2.8 percent in 2016, more quickly than inflation and wages but well below the state’s goal, set in law, of holding spending increases below 3.6 percent a year. (Dayal McCluskey, 9/13)

Columbus Dispatch: Flu Vaccine Bill Needs More Work, Ohio House Speaker Says
The House speaker is tapping the brakes on a bill that would largely prohibit hospitals and other employers from requiring workers to get a flu vaccine. The bill passed out of committee Tuesday, despite opposition from every major state health-care association and the Ohio Chamber of Commerce. (Siegel, 9/14)

The Associated Press: 5 In Health Care Fraud Case Face Charges In Witness’ Death
A Louisiana man convicted in a multi-million dollar health care fraud scheme in 2013 now faces federal charges — along with four other men — in the 2012 slaying of a witness in the case, federal prosecutors said Wednesday. Louis Age Jr., 68, his son Louis Age III, 47, and three others face multiple charges that include conspiracy to obstruct justice by murder and conspiracy to commit murder for hire. They were charged by a grand jury last month in an indictment that was unsealed Tuesday. (McGill, 9/13)

The Associated Press: A New Jersey Medicaid Fraud Amnesty Program Is Criticized
About three dozen people accused New Jersey officials of going soft on crime after a program was introduced to allow residents who received unwarranted Medicaid benefits to withdraw without prosecution. Authorities had planned a seminar Tuesday night in Toms River for Ocean County residents who would benefit from the program. (9/13)

Nashville Tennessean: VUMC, Bayer Partner On Kidney Disease Research Initiative
Vanderbilt University Medical Center is partnering with Bayer, the life science and pharmaceutical giant, on a five-year project to find two potential treatments for kidney disease, which has few treatment options. Kidney diseases impact more than 30 million Americans, and is more prevalent due to a variety of factors including obesity, hypertension and Type 2 diabetes, said Dr. Ray Harris, director of the Vanderbilt Center for Kidney Disease. Some populations, such as those from Southeast Asia, China and Pacific Islands, are at higher risk. (Fletcher, 9/13)

Georgia Health News: There’s Lead In That?!
[Tamara] Rubin has made it her mission to point out how widespread a poison lead can be and how easily it can be found. Two of her four boys were lead-poisoned when a contractor used an unsafe way to remove lead paint on the outside of their house. (Goodman and Miller, 9/13)

Cincinnati Enquirer: P&G Cuts Health Care Jobs
Procter & Gamble is cutting jobs in its health care division based in Greater Cincinnati. The consumer products giant is “adjusting” jobs in its North American health care business based at the Mason Business Center. (Coolidge, 9/13)

Nashville Tennessean: Neighborhood Health’s Bufwack To Be Succeeded By Brian Haile
Brian Haile, a former TennCare official, will be the CEO of Neighborhood Health starting Oct. 1. He succeeds longtime leader Mary Bufwack, who is retiring. Neighborhood Health treats about 30,000, 17,000 of whom have no insurance, and is a leading source of primary care for Nashville’s homeless residents. The private, non-profit clinic system has expanded into counties surrounding Davidson County in the last few years as the population has shifted and grown. (Fletcher, 9/13)

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Arizona High Court To Hear GOP Lawmakers’ Suit Challenging Expansion Of Medicaid

The legislators filed suit in 2013 seeking to stop then Gov. Jan Brewer’s decision to expand Medicaid under the federal health law. In other Medicaid news, Iowa officials are considering moving people with serious disabilities out of the state’s new managed care plan and a federal judge dismissed a lawsuit seeking to move more people out of nursing homes in Washington, D.C.

Des Moines Register: Disabled Iowans Could Be Exempted From Private Medicaid Management
Iowa might resume direct oversight of care for people with serious disabilities instead of having private Medicaid-management companies continue doing it, the state’s human-services director said Wednesday. Many of the most serious complaints about Iowa’s privatized Medicaid system have come from disabled Iowans and their families. Numerous families have reported having their services cut and their hassles multiplied by the management companies. Their plight has sparked a federal lawsuit against the state. (Leys, 9/13)

The Washington Post: Nursing Home Residents Lose Class-Action Suit To Secure Community-Based Services
A U.S. district court judge on Wednesday dismissed a class-action lawsuit that alleged that the District failed to comply with a federal mandate to move eligible and interested Medicaid recipients out of nursing homes and into the community. U.S. District Judge Ellen Segal Huvelle ruled that a single injunction could not remedy the problems experienced by the elderly and disabled nursing home residents because barriers to moving them back into the community extended beyond the system’s shortfalls with transition services. (Chandler, 9/13)

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Viewpoints: At HHS, ‘Waste Scores A Victory’; Home Care Costs; Misreading The Opioid Crisis

A selection of opinions on health care from around the country.

The Washington Post: Tom Price Decides He Doesn’t Want Medicare To Save Money
The coming crisis is as predictable as it is worrying. Nearly a fifth of every dollar spent in this country is spent on health care. Without reform, that number will only rise as the baby boomers retire. Younger generations will suffer, as money is taken from building roads and educating children to paying for Medicare to cover boomers’ health costs. … Yet waste scored a victory when Health and Human Services Secretary Tom Price decided to stop or scale back “bundled payment” experiments the Obama administration had begun. (9/12)

The Wall Street Journal: Why Home Care Costs Too Much
As baby boomers age into long-term care facilities, Medicaid costs will go through the roof. Americans already spend—counting both public and private money—more than $310 billion a year on long-term support services, excluding medical care, for the elderly and the disabled. Medicaid accounts for about 50% of that, according to a 2015 report from the Kaiser Commission on Medicaid and the Uninsured. Other public programs cover an additional 20%. … There’s an urgent need to find ways of providing good long-term care at a lower cost. One fix would be to deregulate important aspects of home care. (Paul Osterman, 9/12)

The Wall Street Journal: The Way We Pay Doctors Is Hurting Health Care
For several decades, specialists in the U.S. have been paid considerably more than primary-care physicians. On average, orthopedic surgeons, cardiologists, radiologists and plastic surgeons make about twice as much as internists, pediatricians and family medicine doctors. True, most specialists train for a longer period of time than primary-care providers, but the degree of divergence in compensation has little to do with market forces or input costs. The difference has consistently been tied to how we pay for care with our emphasis on volume, procedures and technology, rather than prevention, care coordination, evaluation expertise and outcomes. (Howard Forman, 9/12)

Los Angeles Times: The Great Medi-Cal Paper Waste
Remember the telephone book? That giant, multi-thousand-page behemoth that used to land on your doorstep once a year? Well, neither do we, barely. The heyday of the phone book is long gone, and yet communications with friends and businesses is easier than it’s ever been before. Can it be that California officials haven’t noticed that? A new federal rule that took effect in July allows health insurance plans to stop automatically printing and mailing lengthy Medi-Cal provider directories, some of which are the size of phone books, to all new enrollees and make the information available digitally. Anyone without online access or who preferred having a hard copy could still request one. (9/12)

The Washington Post: Poor, Middle Class Saw Solid Gains Last Year, But We’ll Need Better Policy To Keep It Going
Poverty fell, middle-class incomes rose, and the share of Americans without health coverage ticked down to a historical low last year, according to data released Tuesday morning by the Census Bureau. This trifecta of gains for poor and middle-income households, as well as the uninsured, shows that the seven-year expansion, along with the Affordable Care Act, has continued to lift the living standards of many American households. However, last year’s gains were even stronger for those at the top of the income scale, suggesting that the inequality of economic outcomes continues to grow in America. (Jared Bernstein, 9/12)

The Washington Post: The Media Gets The Opioid Crisis Wrong. Here Is The Truth.
Lawmakers and the media have devoted much of their attention recently to deaths from opioid overdoses, as well as to the broader “deaths of despair” that include suicides and deaths from alcoholic liver disease and cirrhosis. But despite the intense focus on the topic, misinformation about the epidemic runs rampant. By conventional wisdom, tackling this crisis would require extending Medicaid and improving how it functions, cracking down on prescription painkillers and getting more health-care resources into rural communities. (Anne Case and Angus Deaton, 9/12)

San Antonio Press-Express: ‘Bad Paper’ Denying Vets Needed Services
Like [Mike] Gerardo, thousands are discharged from the military though the behaviors that got them this attention are service connected. Suffering from PTSD, for instance, often means self-medicating with drugs and alcohol. These service members are deemed problems and are discharged without being provided the services other “wounded” vets are accorded. (9/12)

WBUR: How To Talk To Your College-Age Kids About Depression And Suicide
School’s back in session, and parents ushering kids to college for the first time will undoubtedly deliver some emotional nuggets of advice. But they should also have a potentially life-saving talk with their kids in the first semester of college to avert a possible tragedy — suicide. (Nancy Rappaport, 9/13)

The New York Times: The Nazis’ First Victims Were The Disabled
I sit facing the young German neurologist, across a small table in a theater in Hamburg, Germany. I’m here giving one-on-one talks called “The Unenhanced: What Has Happened to Those Deemed ‘Unfit’,” about my research on Aktion T4, the Nazi “euthanasia” program to exterminate the disabled. “I’m afraid of what you’re going to tell me,” the neurologist says. (Kenny Fries, 9/13)

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Uninsured Rate Falls To A Record Low Of 8.8 Percent

Three years after the Affordable Care Act’s coverage expansion took effect, the number of Americans without health insurance fell to 28.1 million in 2016, down from 29 million in 2015, according to a federal report released Tuesday.

The latest numbers from the U.S. Census Bureau showed the nation’s uninsured rate dropped to 8.8 percent. It had been 9.1 percent in 2015.

Both the overall number of uninsured and the percentage are record lows.

The latest figures from the Census Bureau effectively close the book on President Barack Obama’s record on lowering the number of uninsured. He made that a linchpin of his 2008 campaign, and his administration’s effort to overhaul the nation’s health system through the ACA focused on expanding coverage.

When Obama took office in 2009, during the worst economic recession since the Great Depression, more than 50 million Americans were uninsured, or nearly 17 percent of the population.

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The number of uninsured has fallen from 42 million in 2013 — before the ACA in 2014 allowed states to expand Medicaid, the federal-state program that provides coverage to low-income people, and provided federal subsidies to help lower- and middle-income Americans buy coverage on the insurance marketplaces. The decline also reflected the improving economy, which has put more Americans in jobs that offer health coverage.

The dramatic drop in the uninsured over the past few years played a major role in the congressional debate over the summer about whether to replace the 2010 health law. Advocates pleaded with the Republican-controlled Congress not to take steps to reverse the gains in coverage.

The Census numbers are considered the gold standard for tracking who has insurance because the survey samples are so large.

The uninsured rate has fallen in all 50 states and the District of Columbia since 2013, although the rate has been lower among the 31 states that expanded Medicaid as part of the health law. The lowest uninsured rate last year was 2.5 percent in Massachusetts and the highest is 16.6 percent in Texas, the Census Bureau said. States that expanded Medicaid had an average uninsured rate of 6.5 percent compared with an 11.7 percent average among states that did not expand, the Census Bureau reported.

More than half of Americans — 55.7 percent — get health insurance through their jobs. But government coverage is becoming more common. Medicaid now covers more than 19 percent of the population and Medicare nearly 17 percent.

Categories: Insurance, Medicaid, States, The Health Law, Uninsured

Viewpoints: Bracing For Health Data Breaches; The Economics Of Opioid Abuse And Despair

A selection of opinions on health care from around the country.

RealClear Health: Your Health Data Will Be Breached
Just a couple of weeks ago, NHS Lanarkshire, the third largest health system in Scotland and one that employs over 12,000 staff, fell victim to a malware attack. On the heels of a broad cyberattack affecting much of the National Health Service (NH) in May, medical operations were put on hold, and patients were even told to not go to the hospital unless it was absolutely necessary. Though occurring on the other side of the Atlantic, this event stood as a stark reminder that many hospitals, health systems and other companies in the health care space are vulnerable to a cyberattack. (Cori McKeever Ashford and Kristen Thistle, 9/12)

Bloomberg: Which Came First, The Opioids Or The Despair?
Anne Case and Angus Deaton’s 2015 article on rising mortality among middle-aged white Americans — and the 2017 follow-up that attributed this rise to an increase in suicides, drug overdoses and alcohol-related deaths among those without college educations — was among those rare academic papers that changed public debate. (Justin Fox, 9/11)

Boston Globe: We Can’t Fight The Opioid Crisis Without Adequate Health Care
Health care and social workers, counselors, and law enforcement agencies, as well as policy makers and administrators at the local, state, and federal levels of government are already putting it all on the line to help people overcome addiction. We must give them the tools and support they need so we can win this fight. (Sen. Elizabeth Warren, 9/11)

The New York Times: Blaming Medicaid For The Opioid Crisis: How The Easy Answer Can Be Wrong
The theory has gained such prominence that a United States senator is investigating it. “Medicaid expansion may be fueling the opioid epidemic in communities across the country,” Senator Ron Johnson, Republican of Wisconsin, wrote recently. Some conservative opponents of the Affordable Care Act have been passing around the same theory for months. It’s a politically explosive (and convenient) argument, but is it true? Substantial evidence suggests the answer is no, but let’s give it a fair hearing. (Aaron E. Carroll and Austin Frakt, 9/12)

Cincinnati Enquirer: Issue 2 To Give Ohio Power To Cut Drug Prices
Don’t be fooled when pharmaceutical companies argue that their pricing strategy is simply based on supply and demand. We all know that is not true. It’s time that Ohioans demand pharmaceutical companies bring down their outrageously overpriced drugs. (Nina Turner, 9/11)

Stat: Cancer Treatment Should Qualify As A Reason For Student Loan Deferment
Iwas first diagnosed with cancer when I was a senior in college, preparing to get a job and begin paying off my student loans. I was fortunate to have school administrators who advocated for me, and my loans were quickly deferred. But many of the 70,000 young adults diagnosed with cancer each year in the United States aren’t so lucky. They continue to rack up interest as they put their lives on hold to go through lifesaving cancer treatments. That’s why I urge Congress to pass the Deferment for Active Cancer Treatment Act of 2017 this session. This essential but under-the-radar piece of legislation would allow cancer patients to qualify under existing laws for student loan deferments while they undergo treatment. (Samantha Watson, 9/11)

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Montana Lawmakers Put Plan To Cut Medicaid On Ice After About 175 People Protest

The governor ordered the reductions after the legislature cut the health budget. Meanwhile, federal officials say that New York Medicaid officials failed to follow rules when making about $1.4 billion in Medicaid payments.

Montana Public Radio: Montanans Protest $8.6 Million In Proposed Cuts To State Department Of Health
The cuts Montana’s Department of Public Health and Human Services is planning are in response to the Legislature cutting its budget by $8.6 million. They would result in lower payments to health care professionals, and end some case-management services. … The cut in state funding would also mean an even larger loss of federal Medicaid matching funds, of up to $26 million. The federal government pays most of the cost of Medicaid in Montana. (Cates-Carney, 9/11)

MTN/KTVH (Helena, Mont.): MT Legislative Panel Continues To Block Cuts To Services For Poor, Disabled
A legislative committee Monday continued to block more than $20 million in proposed cuts to medical services for the poor and disabled in Montana – although it’s unclear whether the action will ultimately stave off the cuts. The Children, Families, Health and Human Services Interim Committee voted 7-1 to continue until at least November its objection to Bullock administration rules enacting the cuts, which affect services ranging from nursing-home care for the elderly to case management for the mentally ill. … [Sheila Hogan, director of the state Department of Public Health and Human Services] said the state plans to cut rates paid to Medicaid providers by 3 percent, in response to a state law that directs widespread budget cuts because tax revenue didn’t meet a June 30 target. (Dennison, 9/11)

The Associated Press: US Report Finds $1.4B Problem In New York’s Medicaid Program
The state paid out an estimated $1.4 billion in Medicaid funds for long-term care providers who didn’t follow the state’s rules for the program, according to a federal review of the state’s Medicaid system published Tuesday. The report, from the Office of the Inspector General, revealed a large number of providers who failed to document patient assessments, provide community-based services or provide written care plans to patients, all requirements spelled out in their contracts with the state. (9/12)

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Viewpoints: Coal Country Health Study Is ‘No Waste Of Time’; The Fight Against The Opioid Epidemic Continues

A selection of opinions on health care from around the country.

The Washington Post: Trump Says He Cares About People In Coal Country. So Why Halt A Study On Their Health?
One would imagine that the Trump administration, which swept into power claiming to support the people who live in coal country, would prioritize federal spending on those very people’s health. Instead, the Interior Department has halted a study on how so-called mountaintop-removal coal mining affects people who live around these landscape-stripping operations. Ostensibly, the halt is part of a broad budgetary review. If so, Interior should restart the study quickly. It is a worthwhile use of government research money, and it should proceed no matter which constituency the president had promised to support. (9/10)

The New York Times: A Helpful Tool To Combat The Opioid Crisis
The opioid crisis is so complex and so large — drug-related deaths now exceed those caused by cars, H.I.V. or guns — that there is no single solution. Among the partial ones: prescription drug monitoring programs, an approach highlighted in the draft report from President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis. (Austin Frakt, 9/11)

Chicago Tribune: Illinois Vs. The Opioid Epidemic
The epidemic of opioid overdose deaths has been geographically lopsided. West Virginia has the highest rate, followed by New Hampshire, Ohio and Kentucky. Illinois’ rate is one-third of West Virginia’s, but that’s only modest comfort. Last year, 1,889 people died from opioid overdoses in Illinois. … In recent days, a report put together by a group of state agencies mapped out a comprehensive strategy to eliminate one-third of opioid overdose deaths by 2020. And Gov. Bruce Rauner appointed a task force to look for ways to implement the strategy. … A big need is greater access to “medication-assisted treatment” (MAT), which offers methadone and buprenorphine , drugs proven useful helping those with “opioid use disorder” (addiction, in common parlance) beat the habit. (9/11)

Kansas City Star: Medicaid Is Not To Blame For The Opioid Crisis
Saying that Medicaid expansion is fueling the opioid epidemic is kind of like saying that a sump pump can cause flooding in your basement. The iffy underpinning for this argument is the fact that many of the states that expanded Medicaid coverage under the Affordable Care Act do have higher overdose death rates. (9/10)

Topeka Capital Journal: Time To Debate Medicaid Expansion
Considering its significance for 150,000 Kansans — as well as hospitals and businesses around the state — Medicaid should be a major issue during this campaign. We should demand robust debate, and we can’t allow candidates to obscure the facts (for example, those who oppose expansion often cite its costs and ignore the economic benefits mentioned above). Kansans support Medicaid expansion, and we need to remind our future governor of this fact. (9/9)

Stat: How Good Is A Doctor At The End Of A 28-Hour Shift?
It isn’t terribly reassuring to know that doctors who might need to make life or death decisions about your health could be doing so after having been awake for so long. Would they be on top of their game at hour 16? What about hour 22? In medicine, the devil can be in the details — what if the doctor was too tired to notice something small that might not actually be that small? But according to the organization that sets the rules on how long resident physicians like me are allowed to work, the Accreditation Council for Graduate Medical Education (ACGME), this is OK. (Christopher Bennett, 9/8)

The Columbus Dispatch: Better Care For The Vulnerable
When it comes to caring for the most vulnerable elderly and mentally ill, Franklin County can take pride in the Guardianship Service Board. It has helped remake a system that once permitted shameful exploitation of wards into one of the state’s best. A new agreement between the board and Ohio State University’s Wexner Medical Center demonstrates how its impact can grow even more. (9/11)

Los Angeles Times: Trump And Sessions Are Ignoring Voters’ Overwhelming Support For Medical Marijuana. Will Congress Listen?
Never mind what President Trump said on the campaign trail. His administration and GOP leaders appear determined to eliminate protections for medical marijuana growers, sellers and users. Every year since 2014, Rep. Dana Rohrabacher (R-Costa Mesa) has inserted an amendment into a federal spending bill to prevent the Justice Department from prosecuting medical marijuana businesses that comply with their state’s laws. It’s been a temporary but necessary fix to address a fundamental contradiction: that even though 26 states have legalized medical marijuana, the drug is still prohibited under federal law. … But last week, the House Rules Committee killed the amendment at the urging of Atty. Gen. Jeff Sessions, a hard-line marijuana prohibitionist. (9/9)

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Perspectives: On Obamacare, Is Trump ‘Throwing In The Towel’ Or Using ‘Bureaucratic Sabotage’?

Editorial writers take on a variety of health policy issues, ranging from what’s next for the Affordable Care Act, to whether bipartisan reforms are possible and even who is really to blame.

The Washington Post: Are Trump And Republicans Finally Throwing In The Towel On Obamacare?
The single biggest win that President Trump has scored for his economically struggling supporters thus far is his failure to repeal Obamacare. This fact is sitting right at the center of one of the biggest and most-discussed stories in Washington right now — the possibility that Trump may be in the midst of rethinking his approach, and pivoting toward a more sustained effort to make bipartisan deals with Democrats — yet the centrality of it is largely passing unnoticed. (Greg Sargent, 9/8)

USA Today: Trump Shows GOP How It’s Done: Scrap Absolutism, Deal With Reality
Turns out as well that repealing the Affordable Care Act, aka Obamacare, is not popular either — especially when the Congressional Budget Office has found that every variation on a replacement would cost people more, take away consumer protections, and insure far fewer — up to 24 million fewer in one case. Those protesting repeal at town meetings included conservatives and Trump voters as well as liberal Democrats. Those seeking a bipartisan compromise to stabilize markets and improve the law include more than a few Republican senators and governors. Those trying to get Congress to abandon repeal and move on include … Trump. At least as of Friday. (Jill Lawrence, 9/10)

The Washington Post: Obamacare Doesn’t Deserve A Bailout
Those who cheered for Senate Republicans to fail have been celebrating ever since, and we’re now hearing calls for bipartisan solutions. While most reasonable people would welcome a bipartisan outcome to this mess, the solutions proffered thus far would do little more than shore up the bad policies already in place with another slate of bad policies. We need legitimate, long-term reforms. (Sen. Orrin Hatch, 9/8)

Sacramento Bee: Is Bipartisan Health Reform Possible?
As a doctor, I know many Americans are concerned about the future of health care. Nobody should have to worry that an unexpected medical bill could threaten their family’s financial security. … As Congress returns from summer recess, we have a clear decision to make: Can we work together to fix health care? … But in order for Congress to make improvements, both sides need to honestly discuss the law’s shortcomings. (Rep. Ami Bera, 9/8)

St. Louis Post-Dispatch: Trump Administration Tries Bureaucratic Sabotage To Kill Obamacare
While attention was focused last week on President Donald Trump’s move to end the Deferred Action for Childhood Arrivals program, his administration was moving to sabotage another, much-larger Obama-era achievement: the Affordable Care Act. The Department of Health and Human Services is cutting the budget for outreach programs intended to help Americans sign up for health insurance coverage in 2018. In addition, HHS has cut the sign-up period that begins Nov. 1 from 90 to 45 days. (9/10)

The Washington Post: The ‘Progressives’ Are To Blame, Too, For Mismanaging Our Government
As I have written countless times, the semi-automatic expansion of programs for the elderly (mainly Social Security, Medicare and long-term care under Medicaid) is slowly crowding out many other government programs, from defense to the Centers for Disease Control and Prevention. The paradoxical result is that government spending will grow larger even while it grows less effective. The conventional wisdom in Washington is that the Republicans are responsible for this mess. Their fixation with sizable tax cuts leaves government perpetually dependent on massive borrowing. There is much truth to this. … The other half is the refusal of Democrats — “liberals” and “progressives” — to cut almost any Social Security and Medicare benefits. They’re essentially off-limits, even though life expectancy has increased and many elderly are well-off. (Robert J. Samuelson, 9/10)

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