Tagged Medicaid

Perspectives On What Happens Now: Can Obamacare Be Fixed Or Will It Be Left To ‘Explode’?

Opinion writers offer their thoughts on this question, outline ways the health law can be spared and examine the direction in which the political winds could send the ongoing debate.

The Washington Post: Obamacare Is The Law Of The Land. But It’s Still Vulnerable.
House Speaker Paul D. Ryan’s (R-Wis.) decision to pull legislation to reconfigure the nation’s health-care system is a major setback to President Trump and the GOP. For seven years, Republicans promised to repeal and replace Obamacare. Their failure to deliver on this promise exposes intraparty divisions that will not be easily healed. (Eric Patashnik and Jonathan Oberlander, 3/27)

Los Angeles Times: Can Trump Be Stopped From Making Obamacare ‘Explode’?
Supporters of the Affordable Care Act may have celebrated prematurely at the demise last week of the House Republicans’ proposal for its repeal. Yes, the most immediate threat to the future of Obamacare is dead, for now. And in the wake of the House fiasco, President Trump as well as some Senate Republicans have made noises about reaching out to Democrats to shore up the health insurance program. But the Trump White House and congressional Republicans still have it within their power to damage the prospects of health coverage for millions of Americans, whether by actively undermining the Affordable Care Act by administrative fiat or by letting it wither by neglect. (Michael Hiltzik, 3/27)

The Atlantic: Obamacare Won’t Explode Unless Trump Wants It To
The scope of Obamacare’s problems is small, but significant. While health-care costs have been going up less than normal in recent years and premiums for people insured by their employers have also been fairly stable, people who buy their own insurance through the Obamacare marketplaces saw premiums spike by an average of about 25 percent this year. Also, several insurers pulled out of the Obamacare exchanges in the past year, leaving 21 percent of exchange enrollees with just one insurance option and people in Knoxville, Tennessee with potentially no insurers at all. (Olga Khazan, 3/28)

The New York Times: Pushing Obamacare Over The Cliff 
After Republicans pulled their legislation to repeal and replace the Affordable Care Act last Friday, President Trump told The Washington Post, “The best thing politically is to let Obamacare explode.” Or he could light a match. Republicans may have conceded defeat in their legislative effort to get rid of Obamacare, but their guerrilla war to achieve its demise remains underway. (Steven Rattner, 3/28)

The Washington Post: Why Trump Won’t ‘Let Obamacare Explode’
As President Trump licked his wounded ego Friday, he told The Post in an interview, “The best thing politically is to let Obamacare explode.” His Office of Management and Budget director, Mick Mulvaney, echoed that sentiment on “Meet the Press.” (Jennifer Rubin, 3/27)

The Des Moines Register: It’s Time To Embrace And Fix Affordable Care Act
“I have to tell you, it’s an unbelievably complex subject,” President Donald Trump told governors during a meeting last month. “Nobody knew that health care could be so complicated.” Nobody except everyone else. That is why the 2009 Democratic-controlled Congress spent a year debating and ironing out the details of what eventually became the Affordable Care Act. The two-part law and regulations total thousands of pages. Before passage, lawmakers met with insurers, hospitals, physicians and patient advocacy groups to build a consensus for what they all understood was a labyrinthine endeavor. (3/27)

The New York Times: Republicans For Single-Payer Health Care
Without a viable health care agenda of their own, Republicans now face a choice between two options: Obamacare and a gradual shift toward a single-payer system. The early signs suggest they will choose single payer. That would be the height of political irony, of course. Donald Trump, Paul Ryan and Tom Price may succeed where left-wing dreamers have long failed and move the country toward socialized medicine. And they would do it unwittingly, by undermining the most conservative health care system that Americans are willing to accept. (David Leonhardt, 3/28)

Atlanta Journal-Constitution: Post-AHCA, How Health Reform Can Move Forward In Georgia
When Roswell’s Tom Price moved from Congress to the executive branch as secretary of health and human services, he instantly gained the power to reshape much of the way health care works in this country, regardless of what becomes of Obamacare. Ironically, it’s Obamacare that gives him that ability… It also gives Price’s department the authority to grant the states waivers to the law’s requirements for health plans offered on their insurance exchanges, and that’s where this gets interesting. (Kyle Wingfield, 3/27)

WBUR: Can Gov. Charlie Baker Fix Health Care In America?
Republicans have long hyped the need for a replacement bill by sowing the fear that Obamacare is imploding. Yet they hypocritically ignore their own complicity in creating the conditions for failure. Now that their bill has collapsed, the new mantra is to practice saying “I told you so,” in the event their self-fulfilling prophecy comes to fruition. (Lauren Stiller Rikleen, 3/28)

The Washington Post: Why Trump And The GOP Could Fail On Tax Reform, Too
There are many lessons to be learned from the failure of the GOP health-care effort. An important one is that being a businessman, even a successful one, does not prepare you for the complexities of governing, any more than being a successful software engineer means you could easily become a great carpenter. (Paul Waldman, 3/27)

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 On Who’s To Blame For The Demise Of The House GOP Health Plan

Editorial pages across the country offer their thoughts on the blame game as well as the policies and politics that led to last week’s dramatic outcome.

Los Angeles Times: Healthcare Debacle Results From Republicans Believing Their Own Myths
Donald Trump and congressional Republicans created a political debacle for themselves by believing a set of scare stories about Obamacare that came back to haunt them. It is an object lesson in how false realities ultimately pop like soap bubbles when pricked by plain old truth. There are five fatal fibs the GOP sold to supporters and to themselves. (David Horsey, 3/27)

Boston Globe: In Donald Trump’s Oval Office, The Buck Stops Elsewhere
Since US House Speaker Paul Ryan scrapped last week’s vote on the Republican proposal to replace Obamacare, Trump has blamed different people for its demise, depending on the day. From the Oval Office on Friday, Trump blamed Democrats. On Saturday, Trump asked people to watch a Fox News Channel show on which the host proclaimed, “Paul Ryan needs to step down as speaker of the House.” (Pindell, 3/27)

The Wichita Eagle: Trump’s Ego Costs Him Opportunity On Health Care
When President Trump’s first major governing challenge unexpectedly crystallized last week, his failure to meet it was preordained by his personality. Because he considers himself the center of every universe, an opportunity to step toward greatness was invisible to him. His primary failure wasn’t his inability to persuade the hard-liners in his party to go along with a cobbled-together, cynical and desperate attempt to repeal and replace the Affordable Care Act. Solomon could not have salvaged that wreck. (Davis Merritt, 3/28)

Los Angeles Times: Who’s To Blame For Trump’s Failures? Must Be Paul Ryan
Paul Ryan did it. That’s the argument many of the louder voices on the right are shouting. In the story they tell, the speaker of the House is fully responsible for the GOP’s failure to pass an Obamacare repeal-and-replace bill last week. President Trump should walk across a Havana ballroom like Michael Corleone in “The Godfather Part II,” kiss Ryan on the mouth and say, “I know it was you, Paul. You broke my heart.” (Jonah Goldberg, 3/27)

The Washington Post: This Is Why The Freedom Caucus Called The Shots On Trump’s Health-Care Bill
The Republicans’ failed strategy to repeal and replace the Affordable Care Act is puzzling. Knowing that a more conservative health-care bill would be dead on arrival in the Senate, why did President Trump and House Speaker Paul D. Ryan (R-Wis.) seek the votes of the House Freedom Caucus (HFC), a group of about 30 of the chamber’s most conservative members? Desperate to secure a majority, the White House offered significant last-minute policy concessions to the group — turning off the more centrist members of the Tuesday Group, failing to secure Freedom Caucus votes and dooming the bill. (Ruth Bloch Rubin, 3/27)

The Wall Street Journal: The GOP Entitlement Caucus
The full dimensions of the GOP’s self-defeat on health care will emerge over time, but one immediate consequence is giving up block grants for Medicaid. This transformation would have put the program on a budget for the first time since it was created in 1965, and the bill’s opponents ought to be held accountable for the rising spending that they could have prevented. (3/27)

The Washington Post: The Freedom Caucus Blows Its Chance To Govern
A few days before the House Freedom Caucus brought down the American Health Care Act, Rep. Mark Meadows laid out the stakes for his group: “This is a defining moment for our nation, but it’s also a defining moment for the Freedom Caucus.” The North Carolina Republican was right. The vote was indeed a defining moment — a test in which the Freedom Caucus had to decide: Would it remain a minoritarian opposition bloc whose only role was to defend truth without compromise? Or could it become something bigger, transforming itself into a majoritarian governing force that could lead Congress toward achievable conservative victories and have a lasting impact on the direction of our country? (Marc A. Thiessen, 3/27)

Huffington Post: The Death Of Trumpcare Is The Ultimate Proof Of Obamacare’s Historic Accomplishment
Somehow, despite the intense political forces arrayed against it, and the mind-boggling policy problems it tries to solve, the 2010 health care law keeps defying efforts to wipe it out. That says something about the people who wrote it ― and what they have achieved. Obamacare has never been hugely popular, and it has never worked as well as its architects hoped. Millions of Americans don’t like it and, even now, there are parts of the country where the markets are struggling to survive. But the program has provided security and access to care for millions of others. More importantly, it has shifted the expectations of what government should do ― and of what a decent society looks like. (Jonathan Cohn, 3/26)

Los Angeles Times: The Original Mistake That Distorted The Health Insurance System In America
A World War II-era mistake distorted the U.S. health insurance system. Reformers tried to fix the problem with patchwork solutions until Obamacare dumped yet another layer of misguided policy onto what was already a mess. Now the tangle is so perplexing that a Republican Congress, under a Republican president, could not even bring a health-insurance reform bill to a vote last week. But legislators will no doubt try to tackle the issue again, and when they do, they should consider erasing the original error instead of merely papering it over. (Myron Magnet, 3/28)

RealClear Health: Five Lessons From The AHCA’s Demise
While the keyhole of history has had insufficient time to bring the failed launch of the American Health Care Act (AHCA) into focus, it’s not too soon to begin learning some of the lessons it can teach us. Legislative efforts have a lifespan but our health care system does not. So whether we are still rejoicing or recriminating, let’s take a look at some timeless principles we can apply to the ongoing effort to improve health care in the United States. (Billy Wynne, 3/27)

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

Kansas Senate Gives Preliminary Approval To Medicaid Expansion Bill

Moderate Republicans join with Democrats to easily push through the legislation. But Gov. Sam Brownback has criticized the measure and may veto it.

KCUR: KanCare Expansion Bill Now Just One Step Away 
Buoyed by the failure of Republicans in Congress to repeal the Affordable Care Act, the Kansas Senate on Monday gave tentative approval to a Medicaid expansion bill after debating it for nearly three hours. A bipartisan group of 25 senators voted for the bill. All 13 “no” votes were cast by Republicans concerned about the cost of expansion and opposed to covering low-income, non-disabled adults. If it survives a final-action vote Tuesday, the bill would go to Republican Gov. Sam Brownback, whose spokeswoman reaffirmed his opposition to expansion in tweets during the debate but did not say whether he would veto it. (McLean, 3/27)

Wichita (Kan.) Eagle: Kansas Senate Votes To Expand Medicaid
The legislation in the Senate would expand eligibility for the program for people with incomes of up to 133 percent of the federal poverty line, which is $24,600 for a family of four. The federal government covers 90 percent of the cost of expansion, while the states pay the remaining 10 percent. (Shorman, 3/27)

Kansas City Star: Kansas Senate Votes To Expand Medicaid As Gov. Sam Brownback Doubles Down On Opposition
Opponents of the bill have spent much of the 2017 session downplaying the legislation’s chances because of uncertainty over how health care would change under President Donald Trump’s administration. … But the opponents’ argument faded slightly after U.S. House Speaker Paul Ryan, a Wisconsin Republican, canceled a vote on a bill that would have repealed the Affordable Care Act and effectively barred states from expanding Medicaid beyond March 1, due to a lack of GOP support. (Woodall and Lowry, 3/27)

The Associated Press: GOP Failure In Congress Boosts Medicaid Effort In Kansas
Legislators and advocates in Kansas pushing to expand the state’s health coverage for the poor to thousands of adults are buoyed by the failure of Republicans in Washington to repeal former President Barack Obama’s signature health care law. … The effort in Kansas could prove largely symbolic because Republican legislators remain deeply divided and Brownback is a longstanding critic of health care policies championed by Obama, a Democrat. Yet supporters have scored a significant gain by getting a bill so close to passage. (Hanna, 3/27)

Topeka Capital Journal: Senators Back Medicaid Expansion To Aid Vulnerable Hospitals
Financially fragile hospitals in Kansas — especially facilities in rural areas of the state — have a lot to lose in the Kansas Legislature’s debate about expanding Medicaid services. The Alliance for a Healthy Kansas reported 31 of the state’s 107 hospitals are financially vulnerable because each must grapple with costs of providing care to people who are uninsured. The Senate voted 25-13 on Monday to send the Medicaid expansion bill, House Bill 2044, to final action on Tuesday. Expansion would deliver Medicaid services to about 150,000 more Kansans. (Harford, 3/27)

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Federal Government Takes In $22 Billion In Fines Paid By Health Companies Since 2010

Stat looked at data from 39 agencies to analyze which segments of the health care industry have settled with the government. It found that pharmaceutical companies paid the most, accounting for almost 80 percent of penalties.

Stat: Who Paid The Biggest Fines In Health Care?
When you think of business expenses in the health care industry, you probably don’t think about this mostly hidden cost: settlements made with government agencies. From 2010 to 2017, pharmaceutical companies, health care service providers, and producers of medical equipment and supplies paid the federal government more than $22 billion to settle legal cases. STAT analyzed data from 39 federal regulatory agencies that initiated legal actions against health care companies. In some instances, the companies settled cases without acknowledging any wrongdoing. (Bronshtein, 3/27)

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Taking Stock: After The Smoke Clears, The Health Insurance Issues Remain

Premium costs, essential benefits, Medicaid expansion and the fact that the health industry has a huge impact on the financial markets are among the thoughts on which opinion writers continue to focus.

Bloomberg: Market Impact Of Republicans’ Insurance Debacle Far From Clear
Having stiff-armed political risk for quite a while, market participants now have to think a lot more about the issue in general — and specifically, about how much the Trump administration’s legislative agenda will suffer on account of Republicans’ last-minute decision on Friday to pull their health-care bill from an imminent vote on the floor of the House of Representatives. Some may be inclined to predict other failures that would impact forthcoming economic bills, given the erosion of Republicans’ political capital and the Washington blame game that’s sure to play out. But the situation on the ground is a lot more complicated than that. (Mohamed A. El-Erian, 3/24)

RealClear Health: The Root Cause Of Health Care Dysfunction
Before the Affordable Care Act (ACA) passed in March 2010, President Obama repeatedly promised that the typical family’s health premiums would go down by (sometimes “up to” but frequently “on average”) $2,500. That decline did not occur because the ACA strengthened the control that insurance companies—as opposed to patients—have over health care spending. In fact, Americans’ increasing dependence on health insurance over the last seven decades has been a major contributor to exploding health costs. (John R. Graham, 3/27)

Modern Healthcare: Some Insurance Benefits Are Essential
The House of Representatives last week postponed voting to gut Obamacare after new provisions weakening the essential benefits guarantee failed to win the support from right-wing Republicans, who are opposed to any form of subsidized health insurance. Suffice it to say that the last-minute maneuvering clarified how far the modern Republican Party is willing to go in undermining health insurance, and the healthcare system along with it. (Merrill Goozner, 3/25)

Forbes: More States To Expand Medicaid Now That Obamacare Remains Law
More states will pursue expansion of Medicaid health benefits for poor Americans under the Affordable Care Act after Republicans failed to repeal and replace the law. … At least two states – Kansas and North Carolina – are already working toward becoming the 32nd and 33rd states to expand Medicaid under the ACA. (Bruce Japsen, 3/26)

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What Happens Next?: How To Move Forward On Fixing The Nation’s Health Care

Opinion writers speculate on what will happen now for the future of Obamacare.

The New York Times: How To Build On Obamacare
“Nobody knew that health care could be so complicated.” So declared Donald Trump three weeks before wimping out on his promise to repeal Obamacare. Up next: “Nobody knew that tax reform could be so complicated.” Then, perhaps: “Nobody knew that international trade policy could be so complicated.” And so on. (Paul Krugman, 3/27)

USA Today: Here’s The Bipartisan Path Forward On Health Care: Andy Slavitt
The failure of Trumpcare last week can be seen as a rejection of policies that Americans judged would move the country backwards. But it also presents the opportunity to end the divisiveness that hampered the Obamacare era and move forward in a bipartisan direction that focuses not on destructive rhetoric, but squarely on reducing premiums and expanding access for all Americans. (Andy Slavitt, 3/26)

USA Today: Trump’s New Health Care Opportunity: Our View
President Trump says he has a new strategy to address problems with the Affordable Care Act. He is going to wait “to let Obamacare explode” and then wait some more to let the Democrats “come to us” so we can “make one beautiful deal for the people.” (3/26)

Chicago Tribune: Moving On: Who’ll Fix Obamacare Now?
This week in Washington, a staggered president and his party dig out from the rubble of their failed Obamacare replacement effort. As House Speaker Paul Ryan says, there’s no sugarcoating this. The politics of the Republicans’ failure to pass, or even vote on, the American Health Care Act was ugly. House conservatives in the Freedom Caucus sought a full repeal without an effective replacement, guaranteeing the smoldering political debris in Washington. Why be greedy? Millions of Americans gained coverage via Obamacare. You can’t replace something, no matter how gravely flawed, with nothing. (3/26)

USA Today: The Health Care War Is Far From Over
After eight years of fear-mongering and spreading outright lies about the Affordable Care Act, Republicans finally got the chance to step to the plate and give it their best swing. And they whiffed. Hard. (Neera Tanden, 3/27)

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State Reviews Of The GOP’s Health Plan Implosion

Editorial pages examine who dodged the bullets in their states and detail what went wrong with the American Health Care Act.

Kansas City Star: Americans Want Health Care That Works For All 
I continue to believe that most Americans think everyone should have health care. And while the current law is far from perfect and would benefit from some bipartisan improvements, it is by any measure — coverage, cost, continuity of care — vastly superior to the law Republicans proposed and then couldn’t pass last week. (Kathleen Sebelius, 3/25)

Cleveland Plain Dealer: Collapse Of Trumpcare A Victory For Republicans Who Pushed Back To Protect States Like Ohio
The dramatic collapse today of efforts by House Speaker Paul Ryan and President Donald Trump to force House Republicans to pass Ryan’s jury-rigged repeal of Obamacare was a victory not just for common sense but also for those Republicans who stood up to Trump. Among them: Sen. Rob Portman of Ohio, who, along with several other Republican senators, sent a letter to Majority Leader Mitch McConnell earlier this month outlining the plan’s likely harm to the millions of Americans covered by Medicaid expansion, in Ohio and other states — and to the states themselves. (3/24)

Miami Herald: Healthcare Bill, And GOP, Fail Miserably
But, and pardon the tortured mix of metaphor, Republicans had the ball in their court, for seven years now, and fumbled it — most spectacularly on Friday. That’s when their controversial bill to replace the Affordable Care Act, failed to win the necessary 216 votes to pass. House Speaker Paul Ryan recommended pulling it. President Trump, the biggest loser, agreed. The bill, a cornerstone of Trump’s campaign and that of scores of new Republican lawmakers, went down. Obamacare rules — until Republicans get serious. That’s great news for millions of Americans, and Floridians especially. The bill would have left almost 2 million state residents without health insurance and forced many others to pay thousands more for coverage. Republican Rep. Ileana Ros-Lehtinen told her local constituents she would vote No, while her more cowed Miami colleagues kept mumbling about having to study the situation. (3/25)

The Kansas City Star: Congratulations, Republicans. This Health Care Defeat Is Really A Win.
Cheer up, Republicans. Sometimes, what looks and feels like a loss is really a win. Usually it takes a while for the all-for-the-best benefits of a short-term defeat to sink in. But the health care bill that the Republicans pulled at the last minute on Friday would have quickly made the GOP nostalgic for the days when they could take bows for show votes repealing the Affordable Care Act for the umpteenth time. Had the bill passed, Republicans would have lost both politically and in human terms as the bill devastated many of the very voters who believed President Donald Trump’s campaign promise that “everybody’s going to be taken care of much better than they’re taken care of now.” (3/24)

Chicago Tribune: Why Health Care Can’t Be Fixed
Bill Clinton tried to fix America’s health care problems and was shot down by Congress. Barack Obama got his solution enacted only to find most people didn’t like it. Republicans who voted repeatedly to repeal Obamacare and replace it with something far better have found it fiendishly hard to agree on how. (Steve Chapman, 3/24)

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Perspectives From Monday Morning Quarterbacks: How The Health Bill Unraveled

Opinion writers analyze what happened last week in Congress when the House GOP’s health law replacement plan came undone.

The Wall Street Journal: The ObamaCare Republicans
House Republicans pulled their health-care bill shortly before a vote on Friday, and for once the media dirge is right about a GOP defeat. This is a major blow to the Trump Presidency, the GOP majority in Congress, and especially to the cause of reforming and limiting government. (3/24)

The Wall Street Journal: High Anxiety Over Health-Care Reform
What politicians, those hardy folk, don’t understand about health care is how anxious it makes their constituents. Not suspicious, not obstinate, but anxious. Because unlike such policy questions as tax reform, health care can be an immediate life-or-death issue for you. It has to do with whether, when, and where you can get the chemo if you’re sick, and how long they’ll let you stay in the hospital when you have nobody, or nobody reliable and nearby, to care for you. To make it worse, the issue is all hopelessly complicated and complex and pits you as an individual against huge institutions—the insurance company that doesn’t answer the phone, the hospital that says “I’m afraid that’s not covered”—and you have to make the right decisions. (Peggy Noonan, 3/24)

The Washington Post: The Lessons Trump And Ryan Failed To Learn From History
If President Trump and House Speaker Paul D. Ryan (R-Wis.) had paid attention to Mitt Romney, they could have avoided the fiasco of their now dead and unmourned health-care bill. They would not now face a situation in which both of them are being blamed because they both deserve to be. And the Republican Party would not be engulfed in a festival of recriminations. (E.J. Dionne Jr., 3/26)

The New York Times: The G.O.P.’s Existential Crisis
Give Donald Trump this: His travel ban enraged only half the country. The House Republicans’ attempt to replace the Affordable Care Act, meanwhile, has alienated everyone, including members of the Republican Party itself. The bill was supposed to go to a vote on Friday, but the leadership, facing a likely defeat, was forced to pull it when it became clear it didn’t have the necessary support. It was perhaps better off dead: Already a rushed, Rube Goldberg solution in search of a problem, by the time it neared the House floor it had so many compromises woven into it to win votes that, even if it passed, it would have probably gone down in defeat in the Senate. (Corey Robin, 3/24)

The Washington Post: Republicans’ Dangerous Health-Care Delusions
The jaw-dropping spectacle in which their party holds the White House and majorities in both houses of Congress and yet failed on its first, and arguably most significant, agenda item should disabuse Republicans of a number their deeply held, inaccurate beliefs. (Jennifer Rubin, 3/26)

USA Today: Colossal GOP Failure And Not Just On Health
The plan to replace Obamacare with a new bill crafted by House Speaker Paul Ryan has failed, and embarrassingly so. And that failure is part and parcel of a larger failure of the Republican-led Congress to push an agenda in the new administration. (Glenn Harlan Reynolds, 3/26)

Bloomberg: A Republican Fiasco Years In The Making
We should pause and realize what a big deal this is. The number one agenda item for years, the one that most House Republicans campaigned on when first elected, and they couldn’t manage to even get an initial bill out of the House. Not only that, but it was clear this week that even though most of them were willing to vote for it, practically no one was enthusiastic about what they had produced. It also polled terribly, and conservative health care wonks hated the bill. (Jonathan Bernstein, 3/24)

Los Angeles Times: Trump Discovers That Legislating Is Complicated As The GOP Healthcare Bill Goes Down In Flames
Having recently learned that healthcare is complicated, President Trump has now discovered that legislating is complicated too. Trump’s attempt to force a half-baked bill to “repeal and replace” Obamacare down the throats of reluctant House Republicans failed, as House leaders were simply unable to satisfy the conflicting demands from the two wings of their party. In the end, it wasn’t a case of savvy dealmakers coming up with an offer that buyers couldn’t refuse; it was a case of buyers looking at the offer and saying, “No thanks.” (3/24)

Los Angeles Times: Boy, These Washington Big Shots Ate Well While Their Healthcare Bill Was Blowing Up
One can always count on this feature in the aftermath of any great event that has taken place behind closed doors: the journalistic “inside story.” It’s known in the trade as a “tick-tock.” And the implosion of the House Republicans’ Obamacare repeal bill has thrown off its fair share of examples, notably in the New York Times, Politico, the Washington Post and at CNN. They’re full of scenes of heightened drama from the last week, all described in cinematic detail, replete with the interior monologues of participants at the White House, the Capitol and other locations around town. (Michael Hiltzik, 3/26)

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Health Debate Opinions: Crisis Is Not Trump’s Or Ryan’s Fault; GOP Failed Its Voters’ Needs

As consideration of the Republican health bill stalls on Capitol Hill, opinion writers find many faults.

The Wall Street Journal: The Freedom-From-Reality Caucus
The delay is said to be a defeat for President Trump and Speaker Paul Ryan, but both men have done about as much as they can. They’ve listened to different points of view across a diverse coalition of Members and 33 Governors, and the House bill is a realistic compromise …. No one has offered a better policy alternative to the American Health Care Act that could pass the House and Senate. The real obstacle to progress has been the 29 or so Members of the House Freedom Caucus, who have the power to deny Mr. Ryan a majority of 216 with a mere 22-vote margin of error. (3/23)

The New York Times: The Trump Elite. Like The Old Elite, But Worse!
Legislation can be crafted bottom up or top down. In bottom up you ask, What problems do voters have and how can they be addressed. In top down, you ask, What problems do elite politicians have and how can they be addressed? The House Republican health care bill is a pure top-down document. It was not molded to the actual health care needs of regular voters. It does not have support from actual American voters or much interest in those voters. It was written by elites to serve the needs of elites. Donald Trump vowed to drain the swamp, but this bill is pure swamp. (David Brooks, 3/24)

Politico: The Health Care Albatross
The lesson of Obamacare is that passage of a major health care law never puts health care behind you, only in front of you. For Republicans, their replacement bill will — one way or the other, pass or fail — loom large in 2018 and presumably 2020, if not beyond. (Rich Lowry, 3/22)

The Washington Post: A Postponed Health-Care Vote, A Big GOP Embarrassment And No Good Options Ahead
Legislative sausage-making is never pretty, but what has been happening all week with the signature legislative priority of the GOP seems beyond the norms. Faced with possible defeat on the floor, House Republican leaders postponed a scheduled vote until Friday, hoping that another day of negotiations could produce what seven years of talking have failed to produce, which is a consensus bill that all factions of the party can support. The difficulties Republicans are confronting are entirely of their own making. (Dan Balz, 3/23)

The Wall Street Journal: The Big Health Fix Bruises Ryan And Trump
Former President Barack Obama tried the big fix in health care and he came away with the scars to show for it. Now, House Speaker Paul Ryan and President Donald Trump are trying for the big health-care fix, and they are coming away with the scars to show for it. Maybe there is a lesson in there. (Gerald F. Seib, 3/23)

Bloomberg: Paul Ryan Is Trying To Save Himself
The basic problem is that Republicans have spent years building up expectations for repealing Obamacare without coming up with two crucial parts of their solution: An alternative that they agree on, and the votes in the Senate to impose whatever they want– if they could agree on what they want. (Jonathan Bernstein, 3/23)

The New England Journal of Medicine: The Mirage Of Reform — Republicans’ Struggle To Dismantle Obamacare
[A]s its potential demise draws nearer, the popularity of the ACA, now part of the status quo, is growing. In the Republican imagination, Obamacare has been a disaster. The GOP’s problem is that in reality Obamacare has substantially expanded health coverage, with 20 million Americans gaining insurance. Rolling back the ACA means making insurance less affordable for low-income Americans, increasing the uninsured population, and taking vast funds away from states and medical providers. The GOP health plan neither fully repeals the ACA nor provides a compelling replacement. Instead, in my opinion, it offers only a mirage of reform. (Jonathan Oberlander, 3/22)

The Wall Street Journal: Here’s How 51 Senators Can Reduce Premiums
As this week’s jousting between Speaker Paul Ryan and the Freedom Caucus makes clear, the Republican Party’s conservative and pragmatic wings don’t always agree. But there’s consensus on this: The American Health Care Act, the GOP’s bill to repeal and replace ObamaCare, doesn’t do enough to make insurance more affordable. … The trouble is the Senate’s rules. Republican leaders are counting on passing the AHCA through the budget reconciliation process, which requires only 51 votes, bypassing a filibuster. But for a bill to go through reconciliation, every provision must be budget-related, with clear relevance to either taxing or spending. GOP leaders expect the Senate parliamentarian to rule that repealing ObamaCare’s regulations through the AHCA would have only incidental fiscal consequences. (Avik Roy, 3/23)

USA Today: Obamacare Is Broken, And Republicans Can Fix It
When President Obama signed the Affordable Care Act seven years ago, he saddled Americans with a healthcare system that put the ultra-liberal agenda ahead of our best interests. We were promised that Obamacare would bring down healthcare costs with increased competition between insurance providers. We were promised we could keep our healthcare plans. We were promised that Obamacare would not raise middle class taxes. Instead, the law brought the American people rising premiums, unaffordable deductibles, fewer insurance choices and higher taxes. We were let down. (Ronna McDaniel, 3/23)

The Washington Post: Republicans Have Met The Enemy On Health Care. It’s Them.
The legislation may pass — either Friday or over the weekend. (It almost certainly won’t pass without changes.) But House Republicans had to be feeling a sense of deja vu as it became clear Thursday that despite the efforts of President Trump and Speaker Paul D. Ryan, the votes simply weren’t there to pass the legislation. Republicans — led by then-Speaker John A. Boehner — failed time and time again to rally votes behind proposals, from the fiscal cliff in 2012 to the farm bill in 2013 to the debt ceiling in 2014. (Chris Cillizza, 3/23)

Politico: Trump’s No-Win Health Care Debacle
Now it is Trump who needs wavering members of his party to come to his rescue. … [B]y 2018, the impact of “Trumpcare” will be start to be felt; and if the analyses of the Congressional Budget Office, the Kaiser Family Foundation and others are correct, the impact will be felt most sharply among older, less affluent, working-class Americans … in other words, Trump’s base. If that prospect ripens into reality, what would be celebrated as a legislative triumph may wind up as an epic disaster. (Jeff Greenfield, 3/22)

Georgia Health News: ACA Repeal Is Too Great A Chance To Take 
People in Georgia are relying on the ACA. If it is repealed, Georgia would lose much of the federal funding that helps sustain its health care system, which has struggled to pay for uncompensated care. Additionally, repeal of the ACA would cost many Georgia jobs. Policymakers are rushing to repeal or restrict the ACA even though that could cause many Georgians to lose their coverage. (Karuna Ramachandran, 3/23)

Arizona Republic: Ducey Not (Yet) Deserting 400,000 Arizonans
The House Republican plan to replace the Affordable Care Act would be huge step back, even for those of us who have insurance (for now). It would be a complete disaster, and in some cases, a death sentence, for Arizona’s most needy citizens. Gov. Doug Ducey knows this. (EJ Montini, 3/23)

Des Moines Register: Branstad Cheerfully Ignores Threat To Medicaid Expansion
Health and Human Service Secretary Thomas Price and Centers for Medicare and Medicaid Service Administrator Seema Verma have sent a letter to Branstad and the governors of 30 other states who expanded Medicaid …. They’re also urging the governors to pursue changes in Medicaid, such as charging beneficiaries higher premiums and requiring beneficiaries to pay for emergency-room visits to discourage such visits. … Apparently, the governor’s enthusiasm for Medicaid expansion has been supplanted by his enthusiasm for a CMS director determined to scuttle that effort. Could it be “the health needs of our state” are less of a priority than the president’s political agenda? (3/23)

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Research Roundup: Ads And Testosterone Use; Home Monitoring With Apps; Per Capita Caps

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

JAMA: Association Between Direct-To-Consumer Advertising And Testosterone Testing And Initiation In The United States, 2009-2013
Question: Is there an association between televised direct-to-consumer testosterone advertising and testosterone testing and initiation in the United States? Findings: In this ecological study of 75 US designated market areas, each exposure to a testosterone advertisement was associated with monthly relative increases in rates of new testosterone testing of 0.6%, new initiation of 0.7%, and initiation without a recent baseline test of 0.8%. (Layton et al., 3/21)

JAMA Surgery: Effect Of Home Monitoring Via Mobile App On The Number Of In-Person Visits Following Ambulatory Surgery
Question: For patients undergoing ambulatory surgery, can follow-up care via a mobile app avert in-person visits compared with conventional, in-person follow-up care during the first 30 days after the operation? Findings: In this randomized clinical trial of 65 patients, those who used the mobile app attended fewer in-person visits for follow-up care during the first 30 days after the operation than patients in the in-person follow-up care group. This difference was statistically significant. (Armstrong et al., 3/22)

JAMA Surgery: Costs And Consequences Of Early Hospital Discharge After Major Inpatient Surgery In Older Adults
Question: Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care? Findings: In a cross-sectional cohort study of 639 943 risk and postoperative complication–matched Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting, or total hip replacement, hospitals with shortest routine postoperative length of stay achieved lowest overall surgical episode payments and did not offset shorter hospital stays with greater postdischarge care spending. (Regenbogen et al., 3/22)

JAMA Internal Medicine: Patient Mortality During Unannounced Accreditation Surveys At US Hospitals
Question: What is the effect of heightened vigilance during unannounced hospital accreditation surveys on the quality and safety of inpatient care? Findings: In an observational analysis of 1984 unannounced hospital surveys by The Joint Commission, patients admitted during the week of a survey had significantly lower 30-day mortality than did patients admitted in the 3 weeks before or after the survey. This change was particularly pronounced among major teaching hospitals; no change in secondary safety outcomes was observed. (Barnett, Olenski and Jena, 3/20)

The Kaiser Family Foundation: Health Insurance Premiums Under The ACA Vs. AHCA: County-Level Data
These maps compare county-level estimates of premiums and tax credits under the Affordable Care Act (ACA) in 2020 with what they’d receive under the American Health Care Act as unveiled March 6 by Republican leaders in Congress. The maps were updated on March 21, 2017 to show estimates of how much a person buying their own insurance would have to pay under both the ACA and the House replacement bill. The maps include premium tax credit estimates by county for current ACA marketplace enrollees at age 27, 40, or 60 with an annual income of $20,000, $30,000, $40,000, $50,000, $75,000, or $100,000. (3/22)

Urban Institute: The Impact Of Per Capita Caps On Federal And State Medicaid Spending
In this paper, we analyze the effect of two per capita cap approaches: that in the AHCA and that in Speaker of the House Paul Ryan’s “Better Way” health care plan, released in June 2016. We estimate the effect of each of these per capita caps on federal and state spending from 2019 to 2028. We estimate that between 2019 and 2028, the Better Way proposal would reduce federal Medicaid spending by $841 billion, or 18.1 percent. The AHCA would reduce federal spending by $457 billion, or 9.8 percent. Assuming the bulk of states that expanded coverage under the ACA dropped eligibility for their expansion populations, we estimate that 8 million enrollees would lose Medicaid coverage, and federal savings would increase to $735 billion between 2019 and 2028. (Holahan, Buettgens and Wang Pan, 3/20)

The Kaiser Family Foundation: What Could A Medicaid Per Capita Cap Mean For Low-Income People On Medicare?
Policymakers are giving serious consideration to proposals, such as the American Health Care Act (AHCA), that would fundamentally change the structure and financing of Medicaid – the federal-state program that provides health coverage for 70 million low-income Americans, including one in five people on Medicare. Federal financing for Medicaid would be converted to a per capita cap model (such as under the AHCA) or block grant, both of which aim to limit and make more predictable federal spending on Medicaid and provide states more flexibility in their management of Medicaid spending. Such a change could affect low-income people on Medicare because Medicaid help cover Medicare’s premiums and cost-sharing, and pays for services not covered by Medicare, such as nursing home care. (Jacobson, Neuman and Musumeci, 3/20)

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KanCare Expansion Headed To Full State Senate Vote

Even as uncertainty swirls in Washington, D.C., supporters of the Medicaid expansion say, “we have to move forward as a state.” Media outlets also report on news out of Minnesota, New Hampshire and California.

Kansas City Star: Medicaid Expansion Moves Forward
Kansas state lawmakers advanced a Medicaid expansion proposal on Thursday even as Congress contemplated a bill that could halt states from expanding the program. Supporters of expanding KanCare, the state’s privatized Medicaid program, said the debate in Kansas can’t be dictated by Washington. Opponents urged lawmakers to wait until the federal health care debate progresses. (Shorman, 3/23)

KCUR: KanCare Expansion Bill Heads To Senate For Vote Next Week
Kansas lawmakers are now a step away from what could be a showdown with Republican Gov. Sam Brownback on the political football issue of Medicaid expansion. The Senate Public Health and Welfare Committee on Thursday advanced an expansion bill to the full Senate for a vote supporters say will take place Monday…Since 2013, 31 states and the District of Columbia have expanded Medicaid eligibility. Kansas and Missouri are among 19 that have not. (Mclean, 3/23)

Pioneer Press: New Tax Or Dip Into Savings? Dayton And GOP Differ On How To Stabilize Insurance Market 
Minnesota lawmakers are on the verge of approving as much as $300 million per year to try to stabilize the state’s 2018 individual health insurance market and lower premiums. But before the program, known as reinsurance, gets off the ground, lawmakers and the governor first have to settle an important question: where should the money come from? The idea, which DFL Gov. Mark Dayton supports despite some qualms, is a top priority for lawmakers and some business groups. (Montgomery, 3/24)

Kansas City Star: Effort To Keep Guns Out Of Public Hospitals Revived In Kansas Senate Panel 
Officials with the University of Kansas Health System made another effort Thursday to keep guns out of its buildings before a state law that would allow concealed weapons takes effect July 1. Senate Bill 235, which had a hearing Thursday before the Senate budget committee, would allow Kansas’ state hospitals and public hospitals, like the University of Kansas Hospital in Kansas City, Kan., to keep banning handguns. (Woodall, 3/23)

San Francisco Chronicle: California Passes Nation’s Toughest Methane Emission Regulations 
California air quality officials have approved what are widely considered to be the most rigorous and comprehensive regulations in the country for controlling methane emissions, a move that helps cement the state’s status as a standard-bearer for environmental protection. The new rules, green-lighted Thursday by the state’s Air Resources Board, seek to curb methane emissions at oil and gas production plants by up to 45 percent over the next nine years. (Fracassa, 3/23)

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Clearing The House Is Just The First Step; GOP Plan Faces Significant Hurdles In The Senate

In the upper chamber, Republicans only claim a 52-48 majority, and many senators have already expressed their dismay at parts of the House’s American Health Care Act. Democrats also see opportunities to snag parts of the GOP plan. Meanwhile, Sen. Rand Paul (R-Ky.), who argues that the measure does not go far enough to repeal Obamacare, is among those who has raised constitutional issues.

Politico: Trump’s Obamacare Repeal Concessions Likely Can’t Pass Senate
Democrats say they are certain they can kill any language in the repeal bill that erases Obamacare’s mandate for minimum benefits in insurance plans. And top Republicans are making no promise that the last-ditch changes to win over conservatives will fly in the more centrist Senate, which is beginning to write its own health care plan. (Everett and Haberkorn, 3/23)

The Hill: Senate GOP Hedges On ObamaCare Repeal Timeline 
Senate Republicans are starting to publicly hedge on when they’ll be able to repeal and replace ObamaCare as their House counterparts struggle to find a deal. On Thursday afternoon, the House delayed a vote on the bill that was originally scheduled for later that day. Sen. Bill Cassidy (R-La.), who has been skeptical of the House bill, said after a caucus launch that he was told that senators would have “more time” to consider a repeal and replace bill and that the House might not vote until next week.  (Carney, 3/23)

CQ Magazine: Even If The GOP Passes A Health Care Bill, Some Wonder If It’ll Be Constitutional
If Republicans rescind the Affordable Care Act mandate that everyone buy health insurance, will their bill be constitutional? GOP Sen. Rand Paul of Kentucky is raising that question, citing the reasoning of Chief Justice John G. Roberts Jr., who wrote the 2012 opinion that upheld the individual mandate penalties in the 2010 health care overhaul. In his opinion in NFIB v. Sebelius, Roberts said the health care law essentially violated the Constitution’s Commerce Clause that gives Congress the power to regulate interstate commerce because it forced people to buy health insurance. But he wrote the requirement that individuals pay a penalty for not obtaining health insurance “may be reasonably characterized as a tax” and let it slide. (Lesniewski, 3/27)

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Viewpoints: Ryan Says Vote Will Fulfill GOP Promise; Small Business Sees Relief; Vote No On ‘Skinflint’ Bill

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

The Wall Street Journal: Keeping Our Promise To Repeal ObamaCare
The election of Donald Trump and a Republican Congress provides an opportunity: We can immediately halt the leftward drift of American social policy, while renewing prosperity through market-based, state-driven solutions that empower people instead of bureaucrats. This is the stuff of conservative dreams. But it will become reality only if Republicans keep the promises we have made. (House Speaker Paul Ryan, 3/22)

Los Angeles Times: A Healthcare Test We’re Hoping Republicans Will Flunk
On Thursday, House Republicans and President Trump face their first big test since the election that put the GOP in complete control of the federal government. The House will be voting on a bill to repeal much of the healthcare reform law Democrats pushed through Congress in 2010, replacing it with a skinflint alternative that’s projected to leave 24 million more people uninsured in a decade. It’s a horrible proposal, and the main hope for the country is that dissident Republicans will kill it because it’s not awful enough for them. (3/22)

Huffington Post: Mental Health, Maternity Care Guarantees In Jeopardy As GOP Wrangles For Votes
Someone with bipolar disease might have no way to pay for a psychiatrist to monitor his condition. A couple might have to fork over $15,000 to have a baby. These are just two of the possible consequences of a deal now under discussion in the U.S. House as Republican leaders working with the Trump administration try furiously to round up the votes they need to win approval for their bill to repeal the Affordable Care Act. (Jonathan Cohn, 3/23)

Los Angeles Times: Eliminating Essential Health Insurance Benefits Is A Stupid Idea That Won’t Save Money. Here’s Why.
David Anderson of Duke points us to a recent paper by Milliman, the preeminent cost-analysis firm in healthcare, about how much these essential benefits actually add to the cost of health insurance and the consequences of removing the mandates. The paper finds that eliminating the most vulnerable mandates, such as maternity care, will reduce average premiums somewhat but drive costs for people who need those services sky-high and transfer much of the cost to other public programs. The net gain for society is almost invisible. To put it another way, the savings are an illusion. In fact, eliminating the mandates might even cost the federal government more money. (Michael Hiltzik, 3/22)

USA Today: Vote ‘No’ On Ryancare: Our View
During the presidential campaign, Donald Trump repeatedly promised to repeal Obamacare and replace it with “something terrific.” There are many words for the House Republicans’ latest health care plan, embraced by Trump and scheduled for a vote on Thursday. “Terrific” is not among them. (3/22)

USA Today: Repair Damage From Obamacare: Opposing View
For decades, the National Federation of Independent Business (NFIB) has asked small business owners to rank the top challenges. For more than 30 years, their No. 1 problem has been the high cost of health care. Obamacare turned this concern into a crisis for small businesses. It fails to deliver on its main promise to make health care more affordable. For small business owners, the law has made insurance more complicated, more restrictive and more expensive. (Juanita Duggan, 3/22)

Los Angeles Times: The GOP Healthcare Bill Would Be Good For Small Business
The Affordable Care Act, or Obamacare, was perfectly misnamed. It failed entirely to make insurance affordable for small business owners and millions of other Americans. On the contrary, Obamacare has driven up costs for small business owners, who are hit with higher payroll taxes, taxes on health insurance products, the employer and individual mandate penalties, and the so-called Cadillac tax on expensive health insurance plans. (Tom Scott, 3/23)

Richmond Times-Dispatch: Obamacare Stinks. Small Businesses Need Something Better. 
Eight years ago, small-business owners were given many promises about the Affordable Care Act: that it would drive down costs; that small-business owners could take advantage of new tax credits; and that new exchanges would give owners and employees new options to purchase coverage. By the time President Obama signed the bill, it was abundantly clear that the law would do more to harm small businesses than help them. (Nicole Riley, 3/22)

The Washington Post: The GOP’s Health-Care Plan Goes In The Exact Wrong Direction
There’s a lot not to like about America’s fragmented, inefficient health-insurance system. If you had to identify its fundamental flaw, however, it would probably be this: People need medical care whether they have a job or not, yet the U.S. system is built on a linkage between health insurance and employment. (Charles Lane, 3/22)

Los Angeles Times: The GOP’s Tax Cut For Healthcare CEO Pay Is A Bigger Ripoff Of Taxpayers Than It First Seemed
As the House of Representatives prepares to vote Thursday to repeal the Affordable Care Act, there’s a new estimate of the cost of one of its hidden provisions, a rollback of rules designed to restrain executive pay at health insurance companies. Here’s the bottom line: Rolling back the provision will result in an even bigger ripoff of the American taxpayer than previously calculated. (Michael Hiltzik, 3/22)

Boston Globe: Health Bill Isn’t Reform; It’s A Tax Cut For The Wealthy 
Under Barack Obama, the Affordable Care Act adapted the Massachusetts model, and it now covers 22 million formerly uninsured Americans. But congressional Republicans are attacking national health reform and are seeking to destroy the ACA, not reform it. If they succeed, a moderate Republican governor and a liberal state legislature will soon face the choice of undoing coverage or once again leading the country on health reform. (Jon Kingsdale, 3/22)

Boston Globe: Romney’s Health Care Legacy Under Attack, Just Like Obama’s
Romneycare, as it came to be known, provided the conceptual foundation for Obamacare. And President Trump’s commitment to repealing President Obama’s signature accomplishment — the Affordable Care Act — also puts Romney’s signature accomplishment at great risk. Governor Charlie Baker is warning that the Republican plan to repeal the ACA would reduce federal funding to Massachusetts by as much as $1.1 billion to $1.9 billion. (Joan Vennochi, 3/22)

Forbes: In Amended Health Care Bill, GOP Doubles Down On Tax Breaks For The Rich, Reduced Medicaid Funding
Yesterday, the GOP released amendments to its health care bill, and in response to the shortcomings highlighted by the CBO report, the changes to the bill would add more tax breaks for the rich and further slash Medicaid funding. Yup, you read that right. But as counterintuitive as it may seem, there is a method to the GOP’s madness, as yesterday’s changes 1) make it more likely the bill will pass the House and potentially, the Senate, and 2) it brings within reach the bigger prize being sought by Republican leaders: tax reform. (Tony Nitti, 3/22)

The Washington Post: Health-Care Reform Is A Lot Harder Than Tax Cuts. So Why Are The Republicans Trying To Do It First?
Today, the House Republicans are voting on what I consider their awful health-care replacement plan for the Affordable Care Act. I’ve already explained my negativity about the highly regressive American Health Care Act. If you think the problem is that the wealthy don’t have enough after-tax income and the poor have too much health care, this is the plan for you. … Why are Republicans making their lives harder by starting with a complicated health-care replacement plan, one that itself conflates health policy with tax cuts? The answer, as tax analyst Chye Ching Huang points out in a new piece, is that “passing the health package first facilitates deeper tax cuts for the wealthy and corporations in subsequent tax legislation.” (Jared Bernstein, 3/22)

Bloomberg: Republicans Want To Repeal Medicaid, Too 
Under the AHCA, each state would instead be given a capped allowance, and that amount would rise each year with medical inflation. It would not account for any unforeseen expenses. Over time, as the rise in per-patient costs outstripped the rise in general medical inflation — as the Congressional Budget Office assumes they will — the federal share of funding would decline. Hundreds of billions in costs would be shifted from the federal government to the states. In response, states would need to either raise their own spending on Medicaid — or more likely, offer fewer services to fewer people. (3/22)

Seattle Times: Medicaid Is A Lifeline For Our Children
As discussions continue to swirl around the future of our nation’s health-care system and the American Health Care Act (AHCA), it’s vital we do not forget about the well-being of those who represent the future of our nation — our children. Medicaid is the most critical health care program for our country’s youth, and we at Seattle Children’s are deeply alarmed about the proposed changes to Medicaid that would disproportionately impact our children. (Jeff Sperring, 3/22)

The New York Times: Why Medicaid Work Requirements Won’t Work
Paul Ryan’s plan to replace Obamacare is headed to the House floor on Thursday for a vote that, even now, could go either way. That may sound surprising since Republicans have a sizable majority in the House. But if you’ve been following the debate over their replacement plan, the American Health Care Act, you know that, as harsh as it is, it’s not draconian enough for some members of Speaker Ryan’s party. In an attempt to win over those lawmakers, the Republican leadership has offered ideas to restrict coverage even further. One of the worst is a Medicaid work requirement. (Jared Bernstein and Ben Spielberg, 3/22)

Cincinnati Enquirer: America Needs A Clean Repeal Of Obamacare
There is no question that former President Barack Obama’s signature legislation – Obamacare – has been a massive failure with deadly consequences. The law, which requires Americans to buy insurance from private companies, also manages to increase premiums drastically. … Democrats have been stunningly comfortable playing politics with the life and death consequences of health insurance coverage. … Now is the chance to repeal Obamacare, and it is not a minute too soon. (Ken Blackwell, 3/22)

Cincinnati Enquirer: Insurance Has No Place In Medicine
No fiscal conservatives make health care policy or legislation. Nothing about today’s health care system is fiscally conservative. Insurance is a “needless markup” in the healthcare industry. The management and control of the medical/industrial/Congressional complex must be returned to physicians. Doctors receive only 10 percent of the monies that flow through this system, so they are not the cost problem. (James Baker, 3/22)

The Washington Post: Would The GOP Benefit If Its Obamacare Replacement Failed?
House Republicans plan to vote Thursday on an Obamacare replacement plan, called the American Health Care Act. On Tuesday, Post Opinions writer Jennifer Rubin and Alice Stewart, former spokeswoman for Sen. Ted Cruz’s 2016 presidential campaign, discussed how passage of the bill would affect the GOP’s political fortunes. The email discussion was moderated by Post Opinions digital editor James Downie and has been edited for style and clarity. (3/22)

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Opponents Of KanCare Expansion Challenge Supporters’ Claim It Will Pay For Itself

Outlets report on news out of state legislatures in Kansas, Minnesota, Texas, Arkansas and Florida.

KCUR: Cost Of KanCare Expansion Debated Ahead Of Key Vote
A dispute about the cost and potential benefits of expanding Medicaid eligibility is heating up ahead of a Kansas Senate committee vote on a bill. In testimony Monday to the Senate Public Health and Welfare Committee, supporters of expanding eligibility for KanCare, the state’s privatized Medicaid program, said expansion would more than pay for itself. Former Kansas Senate President Dave Kerr, a Hutchinson Republican, said in its first full year, expansion would add about $81 million to the cost of KanCare. But he said it would generate more than $154 million in revenue and savings, enough to cover the costs of expansion with about $73 million to spare. (Mclean, 3/22)

The Star Tribune: Dayton Issues Warning On ‘Reinsurance’ Plans 
Gov. Mark Dayton on Wednesday warned Republican lawmakers he won’t agree to give insurance companies hundreds of millions of dollars to stabilize Minnesota’s individual health insurance market without more information about how the companies would use the money. The House and Senate passed bills last week to spend, respectively, $384 million or $600 million over the next two years on a new “reinsurance” program to protect insurers against unusually high claims. (Golden, 3/22)

Austin American-Statesman: Texas Senate Gives Initial OK To Ban On Abortion Insurance
The Texas Senate, voting 19-10, gave initial approval Wednesday to a bill that would ban insurance coverage for abortions in the state. Senate Bill 20 by Sen. Larry Taylor, R-Friendswood, would prohibit abortion coverage in private plans, under the Affordable Care Act and in state-issued insurance plans, except for medical emergencies. Those interested in abortion coverage would have to purchase supplemental coverage if offered by their insurer. (Lindell, 3/22)

Texas Tribune: Texas Senate Passes Restrictions On Abortion Insurance 
The Texas Senate on Wednesday gave initial approval to a measure that would require women to pay a separate premium if they want their health plan to cover an elective abortion. Under Senate Bill 20, health plans would still be allowed to cover abortions that are deemed medically necessary. The measure does not make exceptions for cases of rape or incest. (Evans, 3/22)

The Associated Press: ‘Sex-Selection’ Abortion Ban Gets Final OK In Arkansas House
A proposal to impose fines and prison time on doctors who perform abortions that are based solely on whether the mother wants to have a boy or girl received final passage from the Arkansas House. The measure was passed Wednesday on a 57-9 vote. The bill’s sponsor, Republican Rep. Charlie Collins previously told lawmakers that having this ban as law is the right thing to do. (Mukunyadzi, 3/22)

Tampa Bay Times: Future Of Medical Pot In Florida Still Cloudy After Senate Discussion 
Lawmakers have put forward competing proposals to implement Amendment 2, which passed with 71 percent of the vote in November and lets patients with debilitating medical conditions such as cancer, HIV/AIDS, epilepsy and post-traumatic stress disorder use cannabis. On Wednesday, the Senate’s Health Policy panel discussed five approaches to implement the voters’ will. Their deliberations, led by Sen. Dana Young, R-Tampa, revealed the first look at what kind of cannabis bill might pass the Senate — as well as early fault lines. (Auslen, 3/22)

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Texas Braces For Medicaid Cuts Under GOP Health Plan

Many in Texas are keeping a close eye on the Republican bid to replace the Affordable Care Act. One of the big changes is how it would affect low-income people, seniors and people with disabilities who all get help from Medicaid. And Texans on both sides of the political spectrum say the Lone Star State is not going to fare well.

As the GOP bill, the American Health Care Act, works its way through Congress, Anne Dunkelberg, with the left-leaning Center for Public Policy Priorities in Austin, said she’s a little stumped.

“I have worked on Medicaid and uninsured and health care access issues in Texas for well over 20 years,” she chuckled. She said this bill leaves the fate of some current funding streams unclear, and there’s one pot of money she’s particularly concerned about. Texas has struck deals with the federal government under something known as a 1115 waiver to help reimburse hospitals for the cost of caring for people who don’t have insurance. And Texas has more uninsured residents than any other state.

“About half of what Texas hospitals get from Medicaid today comes through payments that are outside from the regular Medicaid program,” she said, which adds up to $4 billion in federal funds every year.

But even if Texas gets to keep all that money, there’s another issue — the GOP plan will reduce how much the federal government pays for Medicaid. It will either cap how much money states get for Medicaid from the federal government for every person they cover. That’s called a per-capita cap, and the payments under that formula would start in 2020, but would be based on how much the state spends this year. Or, in line with this week’s modification of the GOP bill, it would let states choose a lump sum, or block grant, also likely to cut the federal support Medicaid gets.

Adriana Kohler with Texans Care for Children, an advocacy group based in Austin, said Texas already leaves too many people without care.

“Last legislative session there were cuts to pediatric therapies for kids with disabilities enrolled in Medicaid,” she said. The cuts caused some providers to shut their doors, which left some children without services, she said. “That’s why these cuts coming down from the ACA repeal bill are very concerning to us.”

In Texas, she said, children, pregnant women, seniors and people with disabilities will bear the brunt of any belt-tightening. These populations make up 96 percent of people on Medicaid in Texas. That’s why, Dunkelberg said, the program as is should not be the baseline for years to come.

“They could lock Texas into a lot of historical decisions that were strictly driven by a desire to write the smallest budget possible,” she said.

Some on the right agree Texas is getting a raw deal. Dr. Deane Waldman, with the right-leaning Texas Public Policy Foundation, said there are things he likes in the bill. But in general, he said, “it’s bad deal for Texas. It’s a bad deal for the American people.”

He said it was the right thing for Texas not to expand Medicaid, but this bill punishes Texas for it. Under the GOP bill, states that expanded Medicaid would get more money. And because the initial Republican bill left the door open for states to expand Medicaid before 2020, he worried more states would do that to get in on the deal.

“It’s going to be a huge rush — an inducement to drag in as many people as they can drag in, because the more they can drag in, the more federal dollars they can get,” he said. The GOP’s latest plan, however, makes it impossible for any new states to expand Medicaid and cuts off funding for Medicaid expansion states earlier.

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

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

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Repeal Of Health Law Could Force Tough Decisions For Arizona Republicans

Connie Dotts is a big fan of her insurance.

“I like that we can choose our own doctors,” said the 60-year-old resident of Mesa, Ariz. “They also have extensive mental health coverage.”

Dotts isn’t on some pricey plan, either. She’s among the nearly 2 million people enrolled in Medicaid in Arizona and one of the more than 400,000 who have signed up since the Republican-led state expanded Medicaid in 2014.

Her eight prescription drugs are cheap, Dotts said, and she has no copays or premiums. The Medicaid benefits have helped her manage her emphysema, depression and osteoarthritis.

But taking care of other problems has to be delayed: “I have torn ligaments in my ankles, and I can’t take the time off work to go to physical therapy or surgery.”

Dotts works in retail and lives paycheck to paycheck. Without Medicaid, she said, she wouldn’t be able to afford to see a doctor. “It’s just barely above what they consider livable income. Any extensive medical issues would put an excessive burden on me,” she said.

The replacement health plan the GOP leaders are pushing in Congress would gradually cut off the federal funding for Medicaid that expanded eligibility. The bill also bars any additional states from expanding Medicaid immediately.

Swapna Reddy, a professor at Arizona State University’s School for the Science of Health Care Delivery, said that as Congress overhauls the health care law, a state like Arizona might particularly suffer.

Unlike some states that expanded Medicaid, Arizona saw a rush of people joining the rolls, Reddy says, because it had a “high-need, uninsured” population.

The Republican bill would continue to pay the higher federal rates that the ACA’s Medicaid expansion offered people like Dotts, Reddy said — but only if they’re already enrolled in Medicaid, and their personal income stays about the same.

“What we know about the Medicaid population is that they kind of fall in and out of eligibility on a regular basis,” she said, because the amount of money they earn tends to fluctuate.

“So it has the real potential of eradicating Medicaid expansion over a period of time,” Reddy says.

The states and the federal government share the cost of Medicaid. Instead of an open-ended entitlement, the bill making its way through Congress right now would cap the federal government’s contribution or turn it into a block grant.

Putting a fixed limit on the federal government’s contribution is unlikely to allow Arizona Medicaid to keep up with the growing cost of covering people, Reddy said.

“The states will have to come up with the remaining money to cover these folks,” she said.

The Republican health plan would eventually cost Arizona nearly half a billion dollars a year, according to calculations by the state, to keep the adults with the lowest income in the expansion population insured. It’s a group that Arizona voters actually required the state to cover in 2000 through a ballot initiative. But during the recession in later years, financial pressure led state lawmakers to freeze enrollment for those adults.

Scaling back Medicaid could be a particularly risky proposition for Arizona, according to the state program’s administrators, because Arizona is already one of the most efficient, lean programs in the country.

Getting locked in at the current funding rates would give other states a leg up, said Tom Betlach, who runs Medicaid in Arizona.

“If they are able to achieve improved outcomes and reduced costs, they are able to capture those savings,” Betlach said. “Versus we actually get penalized for being a good steward of taxpayer funds.”

Betlach said Arizona needs more control than it currently has over who and what types of treatments and procedures are covered if the federal government intends to give Arizona only a fixed amount of cash.

The federal fight over health care puts the state’s Republican governor, Doug Ducey, in a tricky situation. Ducey has said he would like the ACA repealed, but he has also said he doesn’t want hundreds of thousands of people to lose coverage. He has expressed concern that the GOP bill doesn’t give the state enough flexibility.

And it wasn’t even on Ducey’s watch that Arizona expanded Medicaid. The expansion happened under Jan Brewer, Arizona’s former governor and an ally of President Donald Trump. To pull that off, Brewer had to band together with Democrats and buck some of her fellow Republicans in the state Legislature, who then sued her over the expansion. In their lawsuit, the legislators claimed that the way the state pays its share — a fee on hospitals — is unconstitutional.

At a recent court hearing for that long-running lawsuit, Brewer defended her controversial decision to accept the ACA’s expansion funding.

“I think it was the right thing to do,” she said in an interview outside the courtroom. “It saved lives. It insured more people. It brought money into the state. It kept rural hospitals from being closed down. And today there are tens of thousands of people that are very, very grateful.”

But some Republicans, like state Sen. Debbie Lesko, who was among the Arizona legislators who sued Brewer, figured the day would come when the feds would try to roll back the funding.

“I voted against Medicaid expansion, not because I don’t want people to get health coverage,” Lesko said, “but because I’m a realist and I know how much we can afford in our budget.”

This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.

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

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GOP Health Plan Aims To Curb Medicaid, Expand State Options

For all its populist design, the House GOP’s latest proposal to overhaul federal Medicaid funding creates financial risks for states and could leave some enrollees worse off.

Dramatic changes in Medicaid are a big part of the House bill to partially repeal the Affordable Care Act that’s steaming toward a floor vote scheduled for Thursday.

Big revisions were made to the legislation this week to appeal to conservatives pushing to reduce federal Medicaid spending and shift more power to states. Advocates for the program fear those measures, if enacted, could lead to cuts in benefits and fewer enrollees in the state-federal health insurance program for low-income people.

“We could see a complete unwinding of the Medicaid program as we know it today,” said Donna Friedsam, a health policy expert at the University of Wisconsin.

One big change in the GOP’s current bill would immediately shut off federal money to allow any more states to expand Medicaid eligibility under the ACA, commonly known as Obamacare. During the past three years, 31 states plus the District of Columbia have taken advantage of the provision, adding about 11 million people to Medicaid, and Kansas is considering the option. States also would gain more latitude to determine Medicaid eligibility and benefits for their populations. And for the first time, states could require some enrollees to work as a condition for getting coverage.

The GOP’s original plan was to begin shifting Medicaid expansion funding away from states in 2020. In the revised bill, states could keep funds after 2020 but only as long as those adults who gained coverage in the expansion stay in the program. When they drop out or lose eligibility, their funding would vanish.

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Because of changes in jobs and incomes, many Medicaid enrollees on average lose eligibility within two years, according to Census data.

Regular Medicaid funding also gets an overhaul in the GOP bill.

Since Medicaid’s creation in 1965, everyone eligible has been guaranteed coverage. The federal government’s commitment to help states deal with costs is open-ended, meaning its costs rise as states spend more. The states’ obligation is to cover certain groups of people and to provide specific benefits. Children and pregnant women who meet a state’s income criteria must be protected, for example.

The GOP bill would end that federal commitment, limiting what the government gives states to fixed amounts per year. States could choose two options.

The first way, called a per-capita allotment, means that federal dollars would be allocated to states based on how many Medicaid enrollees they served in a prior year, with annual adjustments for inflation and enrollment increases.

The second way would be a block grant.

Under the revised GOP bill, the block grant option would be available for Medicaid spending only on children, non-elderly adults without disabilities and pregnant women — groups that account for most enrollees.

All states would cover their disabled and elderly populations under the per-capita system, which would get a higher annual inflation rate adjustment than the block grant system under the GOP bill.

The objective is to ensure that funding keeps pace with rising health care costs and the needs of a growing elderly population.

Children could fare badly in states that choose the block grant option, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

They would no longer be guaranteed access to a standard Medicaid benefit that Congress created in 1967 to ensure that children got access to preventive health care services, treatment and periodic screenings to catch developing health problems early, Alker said.

“That means the governor and/or the state legislature would decide what benefits a child would get, not the child’s pediatrician,” she said.

Of the two funding arrangements, Medicaid block grants also would be financially riskier for states during economic downturns, when unemployment rises and more people seek to enroll in the program. While per-capita caps rise as enrollment grows, block grants do not — and that could leave a state short of federal aid when demand is strongest.

Most states would likely choose a per-capita cap for that reason, said Bill Hammond, director of health policy at the conservative Empire Center for Public Policy in New York.

But some would take a block grant for the freedom they would gain to change benefits and eligibility standards. As a bonus, they would also get to keep any federal money they saved and use it for non-Medicaid spending, he said.

Jason Fichtner, a Medicaid expert at George Mason University in Fairfax, Va., said a block grant would be attractive only for states if they could get more money than under the per-capita option, at least in the short term.

The GOP proposal would allow states to opt out of block-granted funds after 10 years and return to a full per-capita allotment.

Regardless whether the government uses block grants or per-capita caps, the prospects for dramatic changes are already causing shudders among advocates for low-income people.

“Both are really bad options and neither is good for Kentucky and neither is better than what we have now,” said Emily Beauregard, executive director for Kentucky Voices for Health.

Kentucky has a pending request with the Centers for Medicare & Medicaid Services to drastically change its Medicaid program, including adding a requirement that some enrollees work as a condition for enrollment.

The Obama administration consistently rejected states’ requests for a work requirement on the grounds that they would thwart low-income people from getting health care. Studies have found that many Medicaid enrollees who aren’t disabled or elderly already hold jobs, though often in positions that don’t provide health insurance.

The changes in the GOP bill would give states the option starting in October 2017 to add a work requirement for non-disabled adults. Pregnant women and parents of disabled children or children under 6 would be exempt.

Republican leaders said the requirement is modeled on those applied to federal welfare recipients. Under the Kentucky waiver request, people could meet the job requirement by caring for a family member or volunteering.

The work requirement provision is almost certain to face a court challenge if adopted.

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

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A Fact Check Finds Many Misleading Letters From Lawmakers On Health Care

When Louisiana resident Andrea Mongler wrote to her senator, Bill Cassidy, in support of the Affordable Care Act, she wasn’t surprised to get an email back detailing the law’s faults. Cassidy, a Republican who is also a physician, has been a vocal critic.

“Obamacare” he wrote in January, “does not lower costs or improve quality, but rather it raises taxes and allows a presidentially handpicked ‘Health Choices Commissioner’ to determine what coverage and treatments are available to you.”

There’s one problem with Cassidy’s ominous-sounding assertion: It’s false.

The Affordable Care Act, commonly called Obamacare, includes no “Health Choices Commissioner.” Another bill introduced in Congress in 2009 did include such a position, but the bill died — and besides, the job as outlined in that legislation didn’t have the powers Cassidy ascribed to it.

As the debate to repeal the law heats up in Congress, constituents are flooding their representatives with notes of support or concern, and the lawmakers are responding. We decided to take a closer look at these communications after finding misleading statements in an email Sen. Roy Blunt (R-Mo.) sent to his constituents and asked readers to send us communications they had received.

The resulting review of more than 200 such missives by ProPublica and its partners at Kaiser Health News, Stat and Vox found dozens of errors and mischaracterizations about the ACA and its proposed replacement. The legislators have cited wrong statistics, conflated health care terms and made statements that don’t stand up to verification.

It’s not clear if this is intentional, or if the lawmakers and their staffs don’t understand the current law or the proposals to alter it. Either way, the issue of what is wrong — and right — about the current system has become critical as the House prepares to vote on the GOP’s replacement bill Thursday.

“If you get something like that in writing from your U.S. senator, you should be able to just believe that,” said Mongler, 34, a freelance writer and editor who is pursuing a master’s degree in public health. “I hate that people are being fed falsehoods, and a lot of people are buying it and not questioning it. It’s far beyond politics as usual.”

Cassidy’s staff did not respond to questions about Mongler’s letter.

Political debates about complex policy issues are prone to hyperbole and health care is no exception. And to be sure, many of the assertions in the lawmakers’ letters are at least partially based in fact.

Democrats, for instance, have been emphasizing to their constituents that millions of previously uninsured people now have medical coverage thanks to the law. They say insurance companies can no longer discriminate against patients with pre-existing conditions. And they credit the law with allowing adults under age 26 to stay on their parents’ health plans. All true.

For their part, Republicans criticize the law for not living up to its promises. They say former President Barack Obama pledged that people could keep their health plans and doctors, and premiums would go down. Neither has happened. They also say that insurers are dropping out of the market and that monthly premiums and deductibles (the amount people must pay before their coverage kicks in) have gone up. All true.

But elected officials in both parties have distorted evidence and left out important context. Some statements were simply disingenuous. Others were whoppers. And while more Republicans fudged than Democrats, both had their moments.

“Do most people pay that much attention to what their congressman says? Probably not,” said Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, who served as an assistant Health and Human Services secretary from 2010 to 2012. “But I think misinformation or inaccurate information is a bad thing, and not knowing what you’re voting on is a really bad thing.”

We reviewed the emails and letters sent by 51 senators and 134 members of the House within the past few months. Here are some of the most-glaring errors and omissions:

Rep. Pat Tiberi, R-Ohio, incorrectly cited the number of Ohio counties that had only one insurer on the Affordable Care Act insurance exchange.

What he wrote: “In Ohio, almost one third of counties will have only one insurer participating in the exchange.”

What’s misleading: In fact, only 23 percent (less than one quarter) had only one option, according to an analysis by the Kaiser Family Foundation.

His response: A Tiberi spokesperson defended the statement. “The letter says ‘almost’ because only 9 more counties in Ohio need to start offering only 1 plan on the exchanges to be one third.”

Why his response is misleading: Ohio has 88 counties. A 10 percent difference is not “almost.”

Rep. Kevin Yoder, R-Kan., said that the quality of health care in the country has declined because of the ACA, offering no proof.

What he wrote: “Quality of care has decreased as doctors have been burdened with increased regulations on their profession.”

Why it’s misleading: Some data show that health care has improved since the passage of the ACA. Patients are less likely to be readmitted to a hospital within 30 days after they have been discharged, for instance. Also, payments have been increasingly linked to patients’ outcomes rather than just the quantity of services delivered. A 2016 report by the Commonwealth Fund, a health care nonprofit think tank, found that the quality care has improved in many communities following the ACA.

His response: None.

Rep. Anna Eshoo, D-Calif., misstated the percentage of Medicaid spending that covers the cost of long-term care, such as nursing home stays.

What she wrote: “It’s important to note that 60 percent of Medicaid goes to long-term care and with the evisceration of it in the bill, this critical coverage is severely compromised.”

What’s misleading: Medicaid does not spend 60 percent of its budget on long-term care. The figure is closer to a quarter, according to the Center on Budget and Policy Priorities, a liberal think tank. Medicaid does, however, cover more than 60 percent of all nursing home residents.

Her response: Eshoo’s office said the statistic was based on a subset of enrollees who are dually enrolled in Medicaid and Medicare. For this smaller group, 62 percent of Medicaid expenditures were for long-term support services, according to the Kaiser Family Foundation.

What’s misleading about the response: Eshoo’s letter makes no reference to this population, but instead refers to the 75 million Americans on Medicaid.

Rep. Chuck Fleischmann, R-Tenn., pointed to the number of uninsured Americans as a failure of the ACA, without noting that the law had dramatically reduced the number of uninsured.

What he wrote: “According to the U.S. Census Bureau, approximately thirty-three million Americans are still living without health care coverage and many more have coverage that does not adequately meet their health care needs.”

Why it’s misleading: The actual number of uninsured in 2015 was about 29 million, a drop of 4 million from the prior year, the Census Bureau reported in September. Fleischmann’s number was from the previous year.

Beyond that, reducing the number of uninsured by more than 12 million people from 2013 to 2015 has been seen as a success of Obamacare. And the Republican repeal-and-replace bill is projected to increase the number of uninsured.

His response: None.

Rep. Joseph P. Kennedy III, D-Mass., overstated the number of young adults who were able to stay on their parents’ health plan as a result of the law.

What he wrote: The ACA “allowed 6.1 million young adults to remain covered by their parents’ insurance plans.”

What’s misleading: A 2016 report by the U.S. Department of Health and Human Services, released during the Obama administration, however, pegged the number at 2.3 million.

Kennedy may have gotten to 6.1 million by including 3.8 million young adults who gained health insurance coverage through insurance marketplaces from October 2013 through early 2016.

His response: A spokeswoman for Kennedy said the office had indeed added those two numbers together and would fix future letters.

Rep. Blaine Luetkemeyer, R-Mo., said that 75 percent of health insurance marketplaces run by states have failed. They have not.

What he said: “Nearly 75 percent of state-run exchanges have already collapsed, forcing more than 800,000 Americans to find new coverage.”

What’s misleading: When the ACA first launched, 16 states and the District of Columbia opted to set up their own exchanges for residents to purchase insurance, instead of using the federal marketplace, known as Healthcare.gov.

Of the 16, four state exchanges, in Oregon, Hawaii, New Mexico, and Nevada, failed, and Kentucky plans to close its exchange this year, according to a report by the House Energy and Commerce Committee.  While the report casts doubt on the viability of other state exchanges, it is clear that three-quarters have not failed.

His response: None.

Rep. Dana Rohrabacher, R-Calif., overstated that the ACA “distorted labor markets,” prompting employers to shift workers from full-time jobs to part-time jobs.

What he said: “It has also, through the requirement that employees that work thirty hours or more be considered full time and thus be offered health insurance by their employer, distorted the labor market.”

What’s misleading: A number of studies have found little to back up that assertion. A 2016 study published by the journal Health Affairs examined data on hours worked, reason for working part time, age, education and health insurance status. “We found only limited evidence to support this speculation” that the law led to an increase in part-time employment, the authors wrote. Another study found much the same.

In addition, PolitiFact labeled as false a statement last June by Donald Trump in which he said, “Because of Obamacare, you have so many part-time jobs.”

His response: Rohrabacher spokesman Ken Grubbs said the congressman’s statement was based on an article that said, “Are Republicans right that employers are capping workers’ hours to avoid offering health insurance? The evidence suggests the answer is ‘yes,’ although the number of workers affected is fairly small.”

We pointed out that “fairly small” was hardly akin to distorting the labor market. To which Grubbs replied, “The congressman’s letter is well within the range of respected interpretations. That employers would react to Obamacare’s impact in such way is so obvious, so nearly axiomatic, that it is pointless to get lost in the weeds,” Grubbs said.

Rep. Mike Bishop, R-Mich., appears to have cited a speculative 2013 report by a GOP-led House committee as evidence of current and future premium increases under the ACA.

What he wrote: “Health insurance premiums are slated to increase significantly. Existing customers can expect an average increase of 73 percent, while the average change due to Obamacare for those purchasing a new plan will be a 96 percent increase in premiums. The average cost for a new customer in the individual market is expected to rise $1,812 per year.”

What’s misleading: The figures seem to have come from a report issued before the Obamacare insurance marketplaces launched and before 2014 premiums had been announced. The letter implies these figures are current. In fact, premium increases by and large have been moderate under Obamacare. The average monthly premium for a benchmark plan, upon which federal subsidies are calculated, increased about 2 percent from 2014 to 2015; 7 percent from 2015 to 2016; and 25 percent this year, for states that take part in the federal insurance marketplace.

His response: None

Rep. Dan Newhouse, R-Wash., misstated the reasons why Medicaid costs per person were higher than expected in 2015.

What he wrote: “A Medicaid actuarial report from August 2016 found that the average cost per enrollee was 49 percent higher than estimated just a year prior — in large part due to beneficiaries seeking care at more expensive hospital emergency rooms due to difficulty finding a doctor and long waits for appointments.”

What’s misleading: The report did not blame the higher costs on the difficulty patients had finding doctors. Among the reasons the report did cite: patients who were sicker than anticipated and required a raft of services after being previously uninsured. The report also noted that costs are expected to decrease in the future.

His response: None

Sen. Dick Durbin, D-Ill., wrongly stated that family premiums are declining under Obamacare.

What he wrote: “Families are seeing lower premiums on their insurance, seniors are saving money on prescription drug costs, and hospital readmission rates are dropping.”

What’s misleading:  Durbin’s second and third points are true. The first, however, is misleading. Family insurance premiums have increased in recent years, although with government subsidies, some low- and middle-income families may be paying less for their health coverage than they once did.

His response:  Durbin’s office said it based its statement on an analysis published in the journal Health Affairs that said that individual health insurance premiums dropped between 2013 and 2014, the year that Obamacare insurance marketplaces began. It also pointed to a Washington Post opinion piece that said that premiums under the law are lower than they would have been without the law.

Why his response is misleading:  The Post piece his office cites states clearly, “Yes, insurance premiums are going up, both in the health-care exchanges and in the employer-based insurance market.”

Rep. Susan Brooks, R-Ind., told constituents that premiums nationwide were slated to jump from 2016 to 2017, but failed to mention that premiums for some plans in her home state actually decreased.

What she wrote: “Since the enactment of the ACA, deductibles are up, on average, 63 percent. To make matters worse, monthly premiums for the “bronze plan” rose 21 percent from 2016 to 2017. … Families and individuals covered through their employer are forced to make the difficult choice: pay their premium each month or pay their bills.”

What’s misleading:  Brooks accurately cited national data from the website HealthPocket, but her statement is misleading. Indiana was one of two states in which the premium for a benchmark health plan — the plan used to calculate federal subsidies — actually went down between 2016 and 2017. Moreover, more than 80 percent of marketplace consumers in Indiana receive subsidies that lowered their premium costs. The HealthPocket figures refer to people who do not qualify for those subsidies.

Her response: Brooks’ office referred to a press release from Indiana’s Department of Insurance, which took issue with an Indianapolis Star story about premiums going down. The release, from October, when Vice President Mike Pence was Indiana’s governor, said that the average premiums would go up more than 18 percent over 2016 rates based on enrollment at that time. In addition, the release noted, 68,000 Indiana residents lost their health plans when their insurers withdrew from the market.

Why her response is misleading: For Indiana consumers who shopped around, which many did, there was an opportunity to find a cheaper plan.

Sen. Ron Wyden, D-Ore., incorrectly said that the Republican bill to repeal Obamacare would cut funding for seniors in nursing homes.

What he wrote: “It’s terrible for seniors. Trumpcare forces older Americans to pay 5 times the amount younger Americans will — an age tax — and slashes Medicaid benefits for nursing home care that two out of three Americans in nursing homes rely on.”

What’s misleading: Wyden is correct that the GOP bill, known as the American Health Care Act, would allow insurance companies to charge older adults five times higher premiums than younger ones, compared to three times higher premiums under the existing law. However, it does not directly slash Medicaid benefits for nursing home residents. It proposes cutting Medicaid funding and giving states a greater say in setting their own priorities. States may, as a result, end up cutting services, jeopardizing nursing home care for poor seniors, advocates say, because it is one of the most-expensive parts of the program.

His response: Taylor Harvey, a spokesman for Wyden, defended the statement, noting that the GOP health bill cuts Medicaid funding by $880 billion over 10 years and places a cap on spending. “Cuts to Medicaid would force states to nickel and dime nursing homes, restricting access to care for older Americans and making it a benefit in name only,” he wrote.

Why his response is misleading: The GOP bill does not spell out how states make such cuts.

Rep. Derek Kilmer, D-Wash., misleadingly said premiums would rise under the Obamacare replacement bill now being considered by the House.

What he wrote: “It’s about the 24 million Americans expected to lose their insurance under the Trumpcare plan and for every person who will see their insurance premiums rise — on average 10-15 percent.”

Why it’s misleading: First, the Congressional Budget Office did estimate that the GOP legislation would cover 24 million fewer Americans by 2026. But not all of those people would “lose their insurance.” Some would choose to drop coverage because the bill would no longer make it mandatory to have health insurance, as is the case now.

Second, the budget office did say that in 2018 and 2019, premiums under the GOP bill would be 15 to 20 percent higher than they would have been under Obamacare because the share of unhealthy patients would increase as some of those who are healthy drop out. But it noted that after that, premiums would be lower than under the ACA.

His response: None.

Have you corresponded with a member of Congress or senator about the Affordable Care Act? We’d love to see the response you received. Please fill out our short form.

Charles Ornstein is a senior reporter at ProPublica, a nonprofit news organization based in New York City.

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

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Policy Thoughts: Much Is At Stake As The House Approaches A Vote On The GOP Health Bill

Editorial pages across the country are full of tough talk for the American Health Care Act and challenges for the Republican Party.

USA Today: The Republican Reckoning On Health Care
Ronald Reagan wanted to shrink the government and Bill Clinton said the era of big government was over. But their talk was premature. There was still one great task for the world’s wealthiest, most powerful nation to accomplish, and that was to make sure all Americans could get health care. The Affordable Care Act has put us closer to that goal than we’ve ever been, yet President Trump and many in the Republican Party appear determined to reverse these gains. Why? It sure seems like it’s because they’re wedded to ideological purity, the fantasy of a skeletal government, and a cruel political tactic (rip out “Obamacare” root and branch) that has outlived its purpose. (Jill Lawrence, 3/21)

The Wall Street Journal: A Defining Health Vote
The House health-care bill is gaining momentum, and on Monday night the GOP posted amendments meant to add fence-sitters to the coalition. Don’t discount the stakes: The vote scheduled for Thursday is a linchpin moment for this Congress, and a test of whether the GOP can deliver on its commitment to voters. (3/21)

The Wall Street Journal: The GOP Is Out Of Excuses On Health Care
Although this week got off to a crackling start with high-profile hearings on Judge Neil Gorsuch’s Supreme Court nomination and potential Russian interference in the 2016 presidential election, the event with the largest consequences for the Trump administration and the Republican congressional majority occurs on Thursday. That’s when the full House takes up legislation to repeal and replace the Affordable Care Act. (William A. Galston, 3/21)

San Francisco Chronicle: Trump’s Orgy Of Unnecessary Cruelty 
Next comes the House Republican plan, which Trump enthusiastically supports, to repeal the Affordable Care Act and replace it with a system that will cause 14 million Americans to lose their health insurance next year, and 24 million by 2026, according to the Congressional Budget Office. How does Trump justify this human hardship? The plan barely makes a dent in the national debt. It cuts the federal budget deficit by only $337 billion over the next 10 years — a small fraction of the national debt. (Robert Reich, 3/21)

Atlanta Journal-Constitution: Trumpcare, A Bullhorn Touting Its Scorn For The Poor
The poor can be safely ignored largely because they allow themselves to be split along tribal lines of creed and color and kept at one another’s throats. Then they are nickled and dimed and robbed damn near blind by monied interests and their political henchmen. The new health care bill is a prime example. (Leonard Pitts, 3/22)

USA Today: GOP Should Slow Down And Rethink Health Bill
Exactly seven years ago Thursday, after decades of effort to make health care available to all Americans, the Affordable Care Act was signed into law. Now, in what House Speaker Paul Ryan calls “an act of mercy,” the House is planning an anniversary vote to repeal it and, in addition, to radically alter the Medicaid program that has been a staple of the national safety net since the 1960s. For members of Congress, this is one of the most consequential votes they might ever face. (Andy Slavitt, 3/22)

Los Angeles Times: House Republicans Are Hoping The Senate Can Save Them From Their Own Ruinous Healthcare Bill
The House GOP leadership has aligned itself so closely with President Trump on healthcare, it’s borrowing his signature sales tactic as it tries to ram through a bill this week to “repeal and replace” Obamacare: the bold but empty promise. Specifically, it’s promising House Republicans a solution to their concerns about drastically increasing insurance premiums for millions of older Americans, but leaving the Senate to figure out how to deliver it. (Jon Healey, 3/21)

The Washington Post: Who Gets Blamed If The House Doesn’t Pass The AHCA
No great political acumen or psychology degree is necessary to conclude that President Trump is highly susceptible to flattery. It’s little wonder then that House Speaker Paul D. Ryan (R-Wis.), desperate to pass GOP health-care reform or at least not be blamed if it fails, keeps talking about what a terrific “closer” Trump is. (Jennifer Rubin, 3/21)

The New York Times: What’s At Stake In A Health Bill That Slashes The Safety Net
What do we lose when social insurance unravels? It is startling to realize just how much the social safety net expanded during Barack Obama’s presidency. In 2016, means-tested entitlements like Medicaid and food stamps absorbed 3.8 percent of the nation’s gross domestic product, almost a full percentage point more than in 2008. (Eduardo Porter, 3/21)

The New York Times: Fewer Americans Would Be Insured With G.O.P. Plan Than With Simple Repeal
The Congressional Budget Office recently said that around 24 million fewer Americans would have health insurance in 2026 under the Republican repeal plan than if the current law stayed in place. That loss was bigger than most experts anticipated, and led to a round of predictable laments from congressional Democrats — and less predictable ones from Republican senators, including Bill Cassidy of Louisiana and John Thune of South Dakota, who told reporters that the bill needed to be “more helpful” to low-income people who wanted insurance. (Margot Sanger-Katz, 3/21)

Axios: Why Deductibles Would Rise Under The GOP Health Care Plan
Health care is complicated, as the president has discovered. But here is one thing that is not so complicated: if people have modest means and limited tax credits, and coverage is expensive, they will mostly buy health plans with lower premiums — and high deductibles. This is what is likely to happen under the GOP health care bill, the American Health Care Act. Only people who need more health care will stretch for more generous coverage. If that happens, those health plans will draw too many sick people, causing insurance companies to stop offering them for fear of losing money. That would leave mostly the low-premium, high-deductible plans. (Drew Altman, 3/22)

The New York Times: A Republican Health Care Bill In Search Of A Problem
Republican leaders in the House have been huddling over the last few days in a frantic search for enough votes to win passage of their proposed revision of Obamacare, in the process making an already flawed bill even worse. One measure of their desperation was a cynical last-minute provision that would shift Medicaid costs from New York’s rural and suburban counties to the state government, pleasing upstate Republicans who represent those counties but reducing coverage provided by the state. (3/21)

The Charlotte Observer: What You Need To Know About Medicaid This Week
Per capita caps on Medicaid beneficiaries? Block-granting Medicaid? Do these wonky and innocuous-sounding proposals really make any difference? They do. The American Health Care Act – the Republicans replacement for Obamacare – is scheduled for a vote this week in the U.S. House. You will hear much discussion about the individual insurance marketplace, tax credits, and promotion of health savings accounts. However, the changes in Medicaid are the most profound in the AHCA. (Jessica Schorr Saxe, 3/21)

Bloomberg: Better Health Care for Less Money? It’s Not Easy
“America spends more on health care than other rich nations, but has lower life expectancy.” If I had a nickel for every time I have been informed this by an email, seen it in a headline, heard it in conversation, or watched it scroll across my social media feed, I would be able to personally fund a single-payer health-care system. (Megan McArdle, 3/21)

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

Medicaid Caps Pitched By GOP Could Shrink Seniors’ Benefits

Before nursing home patient Carmencita Misa became bedridden, she was a veritable “dancing queen,” says her daughter, Charlotte Altieri.

“Even though she would work about 60 hours a week, she would make sure to go out dancing once a week — no matter what,” Altieri, 39, said. “She was the life-of-the-party kind of person, the central nervous system for all her friends.”

A massive stroke in March 2014 changed all that. It robbed Misa, 71, of her short-term memory, her eyesight and her mobility — and it left her dependent on a feeding tube for nourishment. Altieri, who has two small children, is unable to provide the 24-hour care her mother now gets at a Long Beach, Calif., nursing home three miles away — all of it paid by Medi-Cal, California’s version of the Medicaid program for low-income people.

But advocates for the elderly now worry that Misa and other low-income seniors who receive long-term care in facilities or at home could see their benefits shrink or disappear under Republican-proposed legislation to cap federal Medicaid contributions to states. The proposal is part of a broader GOP plan to repeal and replace former President Barack Obama’s Affordable Care Act.

“My mom is getting the basic of basic care,” Altieri said. “If they cut it, I don’t know what to do.”

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Nationwide, Medicaid provides long-term care and support to more than 2 million low-income seniors. The program, funded jointly by the federal government and the states, pays more than half of all long-term care in the country — “more than Medicare, private long-term care insurance and out-of-pocket spending combined,” said Matt Salo, executive director of the National Association of Medicaid Directors.

And, he said, it’s the only public program that offers such care on an ongoing basis. The Medicare program — for people 65 and older — provides only limited long-term care to those who need it after being hospitalized.

The GOP bill, scheduled for a vote on the floor of the House on Thursday, would transform Medicaid from an open-ended system, in which the federal government matches state spending, to one in which it provides a fixed amount to each state, either through a lump-sum payment or on a per-capita basis.

In an attempt to overcome opposition to the bill among some Republicans, GOP leaders agreed Monday to add the option of a lump-sum payment, known as a block grant.

They also amended the bill to allocate additional money for elderly and disabled people on Medicaid. But Eric Carlson, a directing attorney in the Los Angeles office of the nonprofit group Justice in Aging, said such an allocation would not offset the wide funding gap created by caps on federal spending.

“It doesn’t matter whether it’s a block grant or per-capita cap,” Carlson said. “Either way the federal government is setting a hard limit on federal funding available, and states are going to be forced to make due with whatever is sent to them, and it’s not going to be enough.”

Carlson is co-author of a paper released by Justice in Aging that says capping federal Medicaid spending, with either per-capita funding or block grants, would harm older Americans, in part by forcing states to cut services for them “to the bone.”

“Federal payment for Medicaid would drop sharply, resulting in fewer services for everyone who relies on Medicaid, including older adults who account for over 22 percent of all Medicaid spending,” the report predicted.

In 2015, Medicaid spending topped $552 billion nationwide, including more than $85 billion spent on Medi-Cal enrollees, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Under the GOP proposal, nursing care in a facility would remain a guaranteed Medicaid benefit, though states could reduce how much they spent on it if they were forced to economize. And Republicans might well attempt to loosen or undo federal program requirements with subsequent legislation that would give states more control.

Such a shift would “decimate Medicaid’s current guarantee of adequate and affordable care,” according to the Justice in Aging paper.

In the meantime, states could do away with benefits not guaranteed under federal law, which include at-home nursing, personal care — which Medi-Cal covers for qualified beneficiaries — and even inpatient and nursing care in mental health facilities for the elderly.

A report released last week by the nonpartisan Congressional Budget Office suggests states might cut provider payments or eliminate some of their optional services to fill the funding gap left by the restricted flow of federal money.

Oren Cass, a senior fellow with the Manhattan Institute who specializes in anti-poverty law, doesn’t believe that means the GOP plan would necessarily harm elderly Medicaid beneficiaries.

“A state that wants to continue the spending it does on the elderly can do that if it would rather make cuts elsewhere,” he said. “Or it can put up more of its own money.”

Cass said that having more flexibility might appeal to California legislators and health care leaders.

“If you ask California today whether it would rather have Donald Trump run its Medicaid program or run it itself, I think most people there, especially liberal people, would say they would rather have the state making the rules,” he said.

For now, however, the debate over the GOP bill is largely speculative, since there may be enough Republicans with serious concerns about the legislation to sink or significantly amend it.

The CBO report shows the bill would reduce federal budget deficits by a cumulative $337 billion over a decade. The CBO also projected that the bill, if passed, would leave 14 million more people uninsured next year than under current law and 24 million more by 2026.

The cost savings may not be enough to overcome the reluctance of many conservative Congress members who call the bill “Obamacare Lite” because it retains some of the most popular features of the Affordable Care Act.

As the debate heats up in Washington, Charlotte Altieri of Long Beach remains hopeful that her mother’s nursing home care will be spared any cuts.

“We’re not at some grandiose nursing home right now,” she said, “Where are we going to find one that costs less than this one?”

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

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

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A Young Man With Parkinson’s Frets Over The Affordability Of GOP Health Plan

Many millennials have their hands full as they launch into adulthood — jobs, homes and partners. But Ford Inbody, 33, already thinks about a time when he won’t be able to work. He has Parkinson’s disease.

Every night after work, he and his wife, Cortney, walk their two dogs through their Overland Park, Kan., neighborhood. For now, going out for an evening’s stroll is easy. But many of their evening conversations revolve around a time they know is coming — when these walks will prove difficult.

Inbody was diagnosed with young-onset Parkinson’s disease three years ago. When he was 25, he started noticing confusing health symptoms like joint stiffness, tremors and loss of smell. He said initially he was relieved to get a definitive diagnosis.

But, he said, “I then started doing more research about it; that’s when it became a little bit scary. There is no cure. There is no way to slow the progression of the disease. There’s nothing really except just symptom management.”

Since the diagnosis, the couple has had to dramatically rethink their future.

“We had to very much start considering life planning,” he said. “We had to make sure, you know, are we going to have enough income?”

They’re not planning to have kids and are bracing for a much more modest lifestyle than they once imagined. They live now with Ford’s grandmother, to save money for the day when the degenerative disease will eventually force him to stop working.

For now he gets health insurance through his job at a law firm, training attorneys on corporate policies. But Ford and Cortney worry about how his condition will progress and how they’ll pay for health care when he can no longer work.

Cortney works in the human resources department for a chocolatier. It is possible Ford could go on her insurance, but when they first ran the numbers, that was prohibitively expensive. So they thought Ford would get private insurance at a reasonable price despite his condition on the Affordable Care Act exchange; then he’d probably transition to Medicaid when his condition gets bad enough. That’s been his plan.

Ford, now 33, was diagnosed with young-onset Parkinson’s disease three years ago. He and Cortney savor his relatively good health today. But the disease is degenerative, which means they’ll likely need an individual health policy one day soon and will eventually turn to Medicaid. (Alex Smith/KCUR)

But ever since the election, he’s been preoccupied with the developments of repeal and replace.

It’s a constant concern, he said — “reading the news every day, checking out all the different stories that are going on.”

Inbody read every word of the original GOP replacement plan, released March 6. He was somewhat relieved to see that, at least so far, it includes the requirement that insurance companies cover preexisting conditions in every plan on the exchange.

“It’s not like a complete ‘all is lost’ situation,” he said. “And I certainly am not jumping from the roof and concerned that Republicans are trying to doom me to a life of no care.”

But he does have questions about how the overhaul of the health law will play out, in terms of his situation. Chris Sloan, a senior manager with the research and consulting firm Avalere Health, said it’s true Inbody would be able to get some sort of insurance policy, regardless. But there’s a big difference between how the new tax credits he’d get under the GOP plan would compare with the ACA subsidies to help pay for insurance costs.

“The changes to the tax credits and to the subsidies available could mean that he’s going to have to pay more,” Sloan said. “Depending on his finances, some of those changes could mean that he has to pay a lot more to get coverage on the individual market.”

Today, the annual ACA subsidies are based on income and the cost of coverage in each region. Under the GOP proposal, Inbody and his wife would, instead, get a flat $5,000 per year to help pay for health insurance coverage for them both. So when Inbody stops working and the couple’s income is much lower, they won’t get extra help in the GOP plan to pay for monthly health insurance premiums.

That’s not all. Sloan explains that, under the GOP plan, some extra help for out-of-pocket costs will disappear.

“With this new proposal, that just doesn’t exist anymore,” he said.

Sloan said there’s also nothing in the new plan to stop another problem — many exchange policies cover fewer medications than employer-based plans, and the networks of doctors and hospitals are getting narrower.

The bill also proposes drastic changes to Medicaid. Inbody could very well end up on Medicaid — it’s the insurance many people with disabilities rely on.

The Republican plan would limit how much money states get for each Medicaid recipient. And though that amount would go up each year, the increase would be based on overall inflation, not the increase in medical costs. So eventually, Sloan said, the federal government would be giving states a lot less money, relative to the cost of health care.

“Then the state has to make a decision. In Kansas’ case, they’ll have to say, ‘How do we make up that difference?’” Sloan said. “They can say, ‘You know what, we’re just going to reduce eligibility. Previously, we gave Medicaid to people up to this income. Now we’re going to take that — a little bit — because we need the money. So we’ll save money by not covering these people.’”

For example, consider Inbody’s case. Restricting eligibility for Medicaid, under the GOP plan, could mean it will be harder for Inbody to get that coverage, Sloan said. Then, “even if he gets Medicaid down the line, how generous are the benefits? Do they cover everything that he needs for his Parkinson’s condition?”

Inbody has hope that whatever legislation is ultimately passed will help him and others with their health problems. But the politics frustrates him.

“The Republicans, they want it their way,” Inbody said. “And the Democrats are going to do everything they can to refuse a Republican victory. And really, what that means in the end is something completely ineffectual that doesn’t really help anybody is going to get passed — and nobody’s really going to be happy about it.”

For now, Inbody said, he’s enjoying the health he has. He and Cortney headed out last weekend on a Colorado road trip.

This story is part of a partnership that includes KCUR, NPR and Kaiser Health News.

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

Health Policy Perspectives: The Risks People Who Enrolled In Obamacare Now Face; What Can Trump, The GOP Deliver?

Opinion writers around the country examine what is at stake for individuals, the health insurance market and the entire health system as the debate over the GOP’s American Health Care Act continues.

The New York Times: How Trump Can Fix Health Care
President Trump has mostly stayed on the sidelines of the messy policy debates regarding health care reform. But amid the war on Capitol Hill among Republican factions, he could seize the opportunity to provide leadership consistent with his campaign message to disrupt existing health policy. Instead of trying to satisfy the free-market wing of his party, Mr. Trump could push for a solution that delivers on his populist promises by proposing universal catastrophic coverage, ending the specter of medical bankruptcy for many Americans. (Benjamin Domenech, 3/21)

The Washington Post: Trumpcare Never Can Deliver
If you watch the Sunday shows you’ll quickly see the GOP’s circular reasoning: To drive down insurance premium costs you have to remove the insurance mandates, but that’s not in the bill. It comes later, they say, but their fellow Republicans candidly acknowledge that later means “never.” (Jennifer Rubin, 3/20)

The Wall Street Journal: Saving Private Health Insurance
The biggest gamble in the House health-care bill is whether it includes enough reform to arrest the current death spiral in the individual insurance market. No one knows for sure, but critics are overlooking important provisions that will help people who are now exposed to ObamaCare’s rapidly rising premiums. (3/20)

RealClear Health: The Little Death Spiral That Couldn’t
Following an exceedingly unfavorable report from the Congressional Budget Office, prospects of the House Obamacare repeal-and-replace bill becoming law in its original form have become bleak. In its wake comes talk of significant changes to the bill, and even the renewal of an old strategy: letting the Affordable Care Act implode on its own accord, then picking up the pieces anew. There’s only one problem. The predicted “death spiral” hasn’t happened yet, and there’s a reason it won’t. (Stan Veuger and Benedic Ippolito, 3/21)

The Washington Post: Republicans’ Arguments Against Obamacare Are In A Death Spiral
“Obamacare is not going to last,” House Speaker Paul D. Ryan (R-Wis.) said Sunday when challenged to explain how he could support a replacement plan that independent experts project would result in millions of people losing health coverage. “There’s no way Obamacare could stick another two or three years, let alone 10 years.” This is the last rhetorical refuge for defenders of a shoddy GOP replacement plan: Practically any system would be better than the “collapsing” status quo. (3/20)

Richmond Times-Dispatch: Maybe You Should Check Out That Other CBO Report, Too 
Last week the Congressional Budget Office made front-page headlines when it reported that the House proposal to replace Obamacare would throw millions of people off the insurance rolls. Apparently the future of the country’s health-care entitlement system is of profound importance. … But the 10-year forecast is just as important, and adds crucial context to the debate over health care. For instance, it shows that the national debt is set to explode, growing from $20 trillion to $30 trillion by 2027. (3/20)

Stat: AHCA Could Increase Insurance Costs For Pregnancy And Addiction
For individual marketplace insurance, the AHCA removes the requirement to cover specified percentages of the expected medical costs. This means that while plans are required to include the full set of benefits, they are free to raise the cost sharing for particular benefits — like mental health services or maternity and newborn care — to potentially prohibitive levels. (Richard G. Frank and Sherry A. Glied, 3/20)

The Wall Street Journal: My Old Kentucky Health Care
It’s not often that a Donald Trump rally is the bottom story in the state he’s visiting. But when the state is Kentucky and it’s March Madness and the University of Kentucky Wildcats have just advanced to the NCAA’s Sweet 16 in college basketball, it’s understandable that local attentions are focused on hoops not politics. (William McGurn, 3/20)

The Wichita Eagle: Without Health Insurance Mandate, All Will Pay For It
Political opportunism and irrational ideology continue to dominate reason in our latest phase of the struggle over health care. Assuming there is an American future, the people living in it will look back in wonderment that in 2017 a few hundred adult, fairly well-informed, decently educated men and women had such difficulty solving a fundamental problem of governance and math. Why, they will ask, did so many people of that era not understand that every one of them had a financial – let alone moral and humanitarian – stake in everyone else’s physical well-being? (Davis Merritt, 3/21)

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

State Highlights: Ga. House Panel Approves Bill To Reduce ‘Surprise’ Medical Bills; Two Anti-Abortion Measures Clear The Texas Senate

Outlets report on news from Georgia, Texas, Colorado, New Jersey, Connecticut, Massachusetts and Ohio.

Georgia Health News: House Panel OKs New Plan To Halt ‘Surprise’ Bills; Doctors Voice Opposition 
The House Insurance Committee on Monday passed revamped legislation to reduce “surprise billing,’’ in which patients using hospitals in their insurance network may still get unexpected bills from doctors who are not in the network. Consumers who have procedures or visit ERs at hospitals in their networks often get separate bills for hundreds or even thousands of dollars from non-network doctors who were involved. These bills can come from ER doctors, anesthesiologists and radiologists, among others. (Miller, 3/20)

Texas Tribune: Texas Senate Passes Two Anti-Abortion Bills
Two GOP-backed anti-abortion bills passed the Texas Senate on Monday — one that would prevent parents from suing doctors if their baby is born with a birth defect and another that would require doctors to make sure a fetus is deceased before performing a certain type of abortion. Sen. Brandon Creighton’s Senate Bill 25, a “wrongful births” bill designed to prevent doctors from encouraging abortions to avoid lawsuits, passed 21-9. Creighton said without it, doctors have “an invitation to be sued for just practicing medicine” and might not want to work in the state. (Evans, 3/20)

Denver Post: Fingerprint-Based Criminal Background Check Legislation For Colorado Health Care Professionals Passes Key Hurdles
Spurred on by concerns that dangerous criminals are getting hired to care for ill, disabled and frail patients, legislation that would require fingerprint-based criminal background checks for health care professionals in Colorado passed key hurdles this month. House Bill 17-1121, sponsored by Rep. Janet Buckner, D-Aurora, recently cleared two key House committees and appears headed to the Senate for final consideration. (Osher, 3/20)

Houston Chronicle: Health Agency Investigating Its Privatization Of Medicaid Transport Program 
The Texas Health and Human Services Commission has opened an internal investigation into the bungled privatization of a program that transports poor Texans to medical appointments. The probe by the commission’s inspector general, Stuart Bowen, will examine why officials gave lucrative contracts for administration of the program to companies and nonprofit organizations that did not provide cost information and, in some cases, scored poorly on the state’s own rating system. (Rosenthal, 3/20)

Houston Chronicle: One Health Care Disparity Appears To Widen In Houston Area 
It takes less time for a new patient to see a doctor in Houston than the national average, but a health care study also finds the percentage of physicians who accept Medicaid and Medicare remains much lower than in other major cities. Taken together, the two measurements could signal a widening disparity in access to health care based on income and insurance availability in Houston, said Phillip Miller, vice president of communications for Merritt Hawkins, a leading national physician search and health care consulting firm. (Deam, 3/20)

The Philadelphia Inquirer: 31 New Jersey Patients Infected After Injections For Knee Pain
New Jersey health officials have identified 31 patients who became infected after receiving injections to treat knee pain at a clinic in Wall Township, Monmouth County. State and local investigators identified “infection control issues” during an inspection of the clinic on March 13, said Donna Leusner, a spokeswoman for the state Department of Health. At least 20 of the patients at Osteo Relief Institute Jersey Shore have needed surgery to treat their infections, said David A. Henry, health officer for the Monmouth County Regional Health Commission. The investigation is ongoing, he said. (Avril, 3/20)

The CT Mirror: The Health Care That Happens Outside The Doctor’s Office 
[Nadia] Lugo was working as a community health worker, a role many people involved in health care in Connecticut see as a key way to improve care for high-need patients. The job involves bridging the medical and social service systems and the many other factors in people’s lives that can have as much or more impact on their health than medical care – things like housing, transportation and food. (Levin Becker, 3/21)

Boston Globe: Lawmakers Wrestle With Changes To Marijuana Law
State revenue officials predicted taxes on marijuana could eventually bring in more than $100 million each year. The attorney general’s office encouraged lawmakers to clarify how cities and towns can prohibit pot stores. And a long bearded man argued that bills to adjust the state’s new marijuana law are “essentially shredding the will of the people.” (Miller, 3/21)

Columbus Dispatch: Should Only Ohio Residents Be Allowed To Grow Medical Marijuana In State?
People who want to grow medical marijuana in Ohio are certain about one thing: they don’t want outsiders coming in to take over. The vast majority of more than two-dozens speakers at a public hearing today on marijuana cultivation rules said there should be a residency requirement for those granted licenses to grow pot legally under a new state law. (Johnson, 3/20)

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

GOP’s Plan For Medicaid ‘Threatens The Ability’ Of People With Disabilities To Live At Home

Home health care services for more than 17 million Americans could be affected by changes in Medicaid, McClatchy reports. Also in the news, a look at some of the changes that are under the radar such as new requirements for enrollees to renew coverage every six months, instead of once a year. State and regional outlets also continue to look at the debate on Medicaid. And House Speaker Paul Ryan says these changes could be the culmination of a long-held hope.

McClatchy: Medicaid Cuts In GOP Health Bill Could Cut Elderly And Disabled Services 
Vital health care services for more than 17 million of the nation’s most vulnerable citizens could be on the chopping block if the Republican health care bill becomes law. If Medicaid home and community-based services are cut for children with special needs and adults and seniors with disabilities, many would either end up in costly nursing homes, require more assistance from struggling family members or simply do without the care that allows them to live independently. (Pugh, 3/20)

California Healthline: GOP Bill’s Unheralded Changes In Rules Could Undermine Health And Prospects Of Neediest
An under-the-radar provision in the Republican proposal to replace the Affordable Care Act would require the millions of Medicaid enrollees who signed up under the Obamacare expansion to renew their coverage every six months — twice as often as under current law. That change would inevitably push many people out of coverage, at least temporarily, experts say, and help GOP leaders phase out Medicaid expansion — a key goal of the pending legislation. (Bazar, 3/20)

California Healthline: Medicaid Caps Pitched By GOP Could Shrink Seniors’ Benefits
Before nursing home patient Carmencita Misa became bedridden, she was a veritable “dancing queen,” says her daughter, Charlotte Altieri. “Even though she would work about 60 hours a week, she would make sure to go out dancing once a week — no matter what,” Altieri, 39, said. “She was the life-of-the-party kind of person, the central nervous system for all her friends.” (O’Neill, 3/21)

The (Columbia, S.C.) State: GOP’s Medicaid Cuts Could Affect Thousands In SC
South Carolina’s must vulnerable citizens could lose access to health care if massive Medicaid cuts proposed by congressional Republicans become law. The American Health Care Act – President Donald Trump and the GOP House leadership’s plan to replace and repeal President Barack Obama’s signature healthcare law – would make big changes to Medicaid, the federal healthcare program for the poor. A quarter of S.C. residents — 1.2 million of 4.8 million — now get their healthcare via Medicaid. (Self, 3/20)

KCUR: As ACA Repeal Vote Nears, Kansas Debates Expanding Medicaid 
For the past three years, Republican Gov. Sam Brownback and legislative leaders were able to block debate on expanding health care for the disabled and working poor via Medicaid, a component of the 2010 Affordable Care Act. Not anymore. In last year’s primary and general elections, Kansas voters — frustrated by chronic budget problems caused in large part by income tax cuts that Brownback pushed through the Legislature — replaced several conservative incumbents with moderate Republicans and Democrats who promised to stabilize the state’s finances, fund public education and push for Medicaid expansion. (McLean, 3/20)

CNBC: Paul Ryan Says He Has Wanted To Reform Medicaid Since He Was ‘Drinking At A Keg’
House Speaker Paul Ryan told the National Review’s Rich Lowry he has been hoping to reform health care for the poor since his frat-party days. “So Medicaid, sending it back to the states, capping its growth rate, we’ve been dreaming of this since I’ve been around — since you and I were drinking at a keg. … I’ve been thinking about this stuff for a long time,” Ryan said. “We’re on the cusp of doing something we’ve long believed in.” … A video of the discussion was posted on YouTube on Friday.(Dahler, 3/20)

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

GOP Bill’s Unheralded Changes In Rules Could Undermine Health Of Neediest

An under-the-radar provision in the Republican proposal to replace the Affordable Care Act would require the millions of Medicaid enrollees who signed up under the Obamacare expansion to renew their coverage every six months — twice as often as under current law.

That change would inevitably push many people out of coverage, at least temporarily, experts say, and help GOP leaders phase out Medicaid expansion — a key goal of the pending legislation.

“That’s designed to move people off those rolls as soon as possible,” said Ken Jacobs, chairman of the University of California, Berkeley, Center for Labor Research and Education.

The proposal to cut renewal time in half is among other changes that seem only procedural but could have a profound effect on Medicaid enrollees’ health, pocketbooks and ability to get — and keep — coverage.

Another proposal would eliminate the ability of new Medicaid enrollees to request retroactive coverage for up to three months before the month they apply, which they can do under the current law — assuming they were eligible during that previous period.

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Health care experts and advocates fear that could potentially saddle people on Medicaid with unaffordable medical bills, shortchange providers and raise costs throughout the health care system.

“These are changes to fundamental pieces of the Medicaid program,” said Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California in Sacramento, which represents human services directors from the state’s 58 counties.

“They could result in people delaying their health care or having to pay out-of-pocket and not having any hope for reimbursement at all,” she said.

But Michael Cannon, director of Health Policy Studies at the libertarian Cato Institute, said some of these changes would prevent fraud and keep ineligible people from obtaining benefits, thus saving taxpayer money.

“It’s so hard to eliminate fraud in Medicaid, because someone always benefits from it,” he said. “They don’t want to give that up.”

The expansion of Medicaid — the federal-state health care program for people with low incomes, known as Medi-Cal in California — would be phased out under the Republicans’ plan starting in 2020.

The expansion, adopted by 31 states and the District of Columbia, added more than 11 million people to the rolls, including about 3.7 million in Medi-Cal. The federal government picks up a much higher proportion of the cost for this population than for traditional Medicaid enrollees.

In the GOP plan, people already covered under the expansion would continue to be funded by the federal government after Jan. 1, 2020, but if states opted to sign up new enrollees under the expansion criteria after that date, they wouldn’t receive the more generous federal funding for them.

And those who remained in the program after 2020 but later lost eligibility would not draw the more generous federal funding for expansion enrollees if they became eligible again and re-enrolled at a later date.

In California, the potential loss of federal dollars caused by the rollback of the expansion would be massive. The state Legislative Analyst’s Office estimated last month that the Golden State is slated to receive more than $17 billion from the federal government for the Medi-Cal expansion in 2017-18.

“We’re talking about a big shift in costs to the state of California and potentially a major loss in coverage,” said UC Berkeley’s Jacobs.

The GOP legislation, which is scheduled for a vote on the House floor on Thursday, would impose the new renewal requirement on expansion enrollees starting Oct. 1.

“They’re saying to states that do the expansion, ‘We’ll cover people who are continuously in the program, but we’ll make it really hard for people to be continuously in the program,’” Jacobs said.

Wolf Faulkins, a resident of Mariposa, Calif., who enrolled in Medi-Cal in 2014 as a result of the expansion, said the proposed rule change regarding renewal would add one more layer to Medi-Cal’s already considerable bureaucratic requirements, none of them logical or simple.

“If I were more of a senior citizen than I am now, I would be overwhelmed” by it, Faulkins, 61, said. “I would not be a happy camper.” But he would complete the extra paperwork, he added, because his Medi-Cal coverage keeps him alive: Among other things, he has a heart condition and high blood pressure as well as knee and hand ailments.

Senderling-McDonald said the new paperwork will lead some enrollees to drop out for two reasons: Either they’re no longer eligible, or they’re eligible but the new bureaucratic hurdle stops them.

Faulkins agreed. Even though he would jump through the necessary hoops to keep his coverage, some others probably wouldn’t, he guessed. “There are people who are just going to say, ‘It’s important, but it’s too overwhelming. There’s no one to advocate for me. There’s no one to help me figure this out, ” he said. “People are just going to get frustrated and say no.”

The new renewal time frame has a precedent in California, which adopted a semiannual reporting requirement in 2003 for some enrollees that lasted about a decade. Though it was less cumbersome than the regular annual renewals, it nonetheless resulted in people dropping from the rolls, Senderling-McDonald said.

But the Cato Institute’s Cannon believes six-month renewals are reasonable. “The savings from removing ineligible people would justify the paperwork involved,” he said.

The paperwork imposed by these changes could be the least of the headaches for Medicaid beneficiaries.

Retroactive benefits, for example, are extremely valuable for new Medicaid enrollees who face medical bills during a gap in coverage, and losing them could cause financial pain.

“If they have had health expenses, like having to pay for a prescription out-of-pocket or a doctor’s visit, or a woman goes into labor uninsured, they can say to the county, ‘I had medical bills. Can you see if I was eligible during that time?’” said Senderling-McDonald.

Pregnant women are among the most frequent beneficiaries because they often don’t know that they’re pregnant right away, she added.

The GOP bill would end this, and would allow coverage to begin only the month in which enrollees apply. This provision would affect all Medicaid applicants and, like the change in renewal time, would begin Oct. 1.

Some experts believe the proposed change would increase medical debt for consumers hit with massive bills, and for providers who ultimately won’t get paid for their services.

The three-month retroactive rule is “a big deal for hospitals as well as people, because it keeps them from being saddled with medical debt,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.

Senderling-McDonald warned that as more consumers racked up medical debt, the cost of it would shift to other people. “If someone has to declare bankruptcy when they are hit with bills they can’t pay, everybody else takes the hit for it,” she said. “They’re going to raise insurance rates or costs of care for everybody. People who have coverage through employers or the private market could see their rates go up.”

Cannon agreed that providers will get hit with more unpaid bills, but said that this provision would save the federal government money. “States have taxing authority and can fund these benefits themselves if they want to,” he said. “If they don’t, that should tell us something — that they don’t value these benefits that much.”

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

Categories: California Healthline, Cost and Quality, Health Industry, Insurance, Medicaid, Repeal And Replace Watch, The Health Law

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