Tagged Repeal And Replace Watch

Podcast: ‘What The Health?’ Whiplash

The bipartisan leaders of the Senate Health, Education, Labor and Pensions Committee this week agreed on a bill they say could help stabilize the struggling health insurance exchanges. But despite the compromises made by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), it’s still unclear whether Congress can pass the measure, particularly in time for the 2018 open enrollment that begins Nov. 1.

President Donald Trump, who in the past week has taken multiple positions on whether he supports or opposes the bipartisan efforts, is not helping the effort.

In this episode of “What The Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times, and Alice Ollstein of Talking Points Memo discuss these issues, as well as the fate of the Children’s Health Insurance Program, whose funding authorization expired on Oct. 1.

The Senate compromise would appear to be a win-win: Democrats restore Obamacare markets’ stability and Republicans help bring down premium prices. But politics keep getting in the way.

The panelists agreed that the bipartisan bill faces a perilous path to passage, with Republicans in both the House and Senate loath to vote for something that could be seen as shoring up the health law they promised voters they would repeal. Even if it appears “really, really dead,” proposals often come back to life in health care. Keep an eye on end of the year congressional compromises.

But it also seems that Trump’s cutoff last week of subsidies that reimburse insurers for discounts they provide to lower-income enrollees has had less of an impact than many predicted. In some states, insurance regulators had insurers file two separate sets of rates, including a higher one in case the president stopped the payments. In other states, insurers are letting states file new rates, even though the deadline for that has technically passed.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: The Washington Post’s “The Drug Industry’s Triumph Over the DEA,” by Scott Higham and Lenny Bernstein.

Joanne Kenen: The Pacific Standard’s “Doctor and Advocate: One Surgeon’s Global Fight For The Rights Of Rape Survivors,” by Fabiola Ortiz and Megan Clement.

Margot Sanger-Katz: Vox.com’s “Dark chocolate is now a health food. Here’s how that happened,” by Julia Belluz.

Alice Ollstein: Bloomberg News’ “The Health Plans Trump Backs Have a Long History of Disputes,” by Erik Larson and Zachary Tracer.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Categories: Repeal And Replace Watch, The Health Law

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Stunner On Birth Control: Trump’s Moral Exemption Is Geared To Just 2 Groups

Few people were surprised last week when the Trump administration issued a rule to make it easier for some religious employers to opt out of offering no-cost prescription birth control to their female employees under the Affordable Care Act.

But a separate regulation issued at the same time raised eyebrows. It creates a new exemption from the requirement that most employers offer contraceptive coverage. This one is for “non-religious organizations with sincerely held moral convictions inconsistent with providing coverage for some or all contraceptive services.”

So what’s the difference between religious beliefs and moral convictions?

“Theoretically, it would be someone who says ‘I don’t have a belief in God,’ but ‘I oppose contraception for reasons that have nothing to do with religion or God,’ ” said Mark Rienzi, a senior counsel for the Becket Fund for Religious Liberty, which represented many of the organizations that sued the Obama administration over the contraceptive mandate.

Nicholas Bagley, a law professor at the University of Michigan, said it would apply to “an organization that has strong moral convictions but does not associate itself with any particular religion.”

What kind of an organization would that be? It turns out not to be such a mystery, Rienzi and Bagley agreed.

Among the hundreds of organizations that sued over the mandate, two — the Washington, D.C.-based March for Life and the Pennsylvania-based Real Alternatives — are anti-abortion groups that do not qualify for religious exemptions. While their employees may be religious, the groups themselves are not.

March for Life argued that the ACA requirement to cover all contraceptives approved by the Food and Drug Administration includes methods that prevent a fertilized egg from implanting in a woman’s uterus and therefore are a type of abortion. Real Alternatives opposes the use of all contraceptives.

March for Life, which coordinates an annual abortion protest each year, won its suit before a federal district court judge in Washington, D.C.

But a federal appeals court ruled in August that Real Alternatives, which offers counseling services designed to help women choose not to have an abortion, does not qualify as a religious entity and thus cannot claim the exemption. That decision cited a lower-court ruling that “finding a singular moral objection to law on par with a religious objection could very well lead to a flood of similar objections.”

The departments of Treasury, Labor and Health and Human Services, however, suggest that, at least in this case, that will not happen. The regulation issued by those departments says officials “assume the exemption will be used by nine nonprofit entities” and “nine for-profit entities.” Among the latter, it said, “we estimate that 15 women may incur contraceptive costs due to for-profit entities using the expanded exemption provided” in the rules.

The regulation also seeks comments on whether the moral exemption should be extended to publicly traded firms.

Rienzi agrees that the universe for the moral exemption is likely to be small. “The odds that anyone new is going to come up and say ‘Aha, I finally have my way out,’ ” he said, “is crazy.”

Women’s health advocates, however, are not so sure.

“The parameters of what constitutes a moral objection is unclear,” said Mara Gandal-Powers, senior counsel at the National Women’s Law Center, which is preparing to sue to stop both rules. “There is nothing in the regulatory language itself that says what a moral belief is that would rise to the level of making an organization eligible for the exemption.”

Louise Melling, deputy legal director at the ACLU, which has already filed a lawsuit, agreed. “We don’t know how many other entities are out there that would assert a moral objection,” she said. “Not everybody wanted to file a suit,” particularly smaller organizations.

All of that, however, presupposes that the rule laying out the moral objection exemption will stand up in court.

Bagley said he’s doubtful. The legal arguments making the case for the exemption, he said, are “the kind of things that would be laughed out of a [first-year] class on statutory interpretation.”

Specifically, he said, the rule lays out all the times Congress has included provisions in laws for moral objections. But rather than justifying the case, “it suggests that Congress knew a lot about how to craft a moral objection if it wanted to,” and it did not in the health law, he noted.

Bagley said the fact that the moral exemption was laid out in a separate rule from the religious one demonstrates that the administration is concerned the former might not stand up to court proceedings. “The administration must sense this rule is on thin legal ice,” he said.

Which leads to the question of why Trump officials even bothered doing a separate rule. Bagley said he thinks the act was more political than substantive. “The administration is doing something that signals to religious employers … that they are on their sides, that they have their backs.”

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

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Trump actuando solo: lo que debe saber sobre los cambios a la ley de salud

Aparentemente frustrado por la incapacidad del Congreso de “derogar y reemplazar” la Ley de Cuidado de Salud Asequible (ACA), el presidente Donald Trump decidió tomar el asunto en sus manos.

El jueves 12 de octubre por la noche, la Casa Blanca anunció que cortaría pagos clave a las aseguradoras. Trump firmó una orden ejecutiva destinada a brindar a las personas que compran su propio seguro un acceso más fácil a diferentes planes de salud, que han sido fuertemente regulados o desalentados bajo las reglas de ACA establecidas por la administración Obama.

“Esto está promoviendo la elección de la atención médica y la competencia en todos los Estados Unidos”, dijo Trump en la ceremonia de firma. “Esto va a ser algo en lo que millones y millones de personas se inscribirán, y van a estar muy felices”.

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pagos de subsidios, conocidos como “reducciones de costos compartidos”, son pagos a las aseguradoras para reembolsarles por los descuentos que brindan a los asegurados con ingresos inferiores al 250% del nivel federal de pobreza, o alrededor de $30,000 en ingresos anuales para un individuo. Esos descuentos protegen a estos clientes de bajos y medianos ingresos de tener fuertes gastos de bolsillo, como deducibles o copagos. Estos subsidios han sido objeto de una demanda en curso.

Las reducciones de costos compartidos no son lo mismo que los subsidios a través de créditos impositivos, que ayudan a millones de personas a pagar sus primas. Estos no están afectados por la decisión de Trump.

Las acciones de Trump podrían tener un impacto inmediato en la inscripción para tener cobertura a través de ACA en 2018, cuyo período de inscripción comienza el 1 de noviembre. Aquí hay cinco cosas que debe saber.

  1. La orden ejecutiva no genera ningún cambio inmediato.

Técnicamente, Trump ordenó a los departamentos de Trabajo, de Salud y Servicios Humanos, y del Tesoro, dentro de 60 días, “considerar proponer reglamentos o revisar guías, en la medida permitida por la ley” sobre varias opciones diferentes para expandir los tipos de planes que individuos y pequeñas empresas pueden comprar. Entre sus sugerencias están ampliar las reglas para permitir que más pequeños empleadores y otros grupos formen lo que se conoce como “planes de salud de asociaciones” y para vender seguros de bajo costo y de corto plazo. Sin embargo, no hay ninguna garantía de que cualquiera de estos planes se presentará y, en cualquier caso, el proceso para ponerlos a disposición podría demorar meses.

  1. Los cambios en la reducción de costos compartidos SON inmediatos, pero podrían no afectar a tantas personas.

los pagos a las aseguradoras por los descuentos de bolsillo que brindan a los asegurados de ingresos moderados no significa que esas personas ya no recibirán ayuda. La ley y los contratos de las compañías de seguros con el gobierno federal exigen que se otorguen esos descuentos.

Eso significa que las compañías de seguros tendrán que averiguar cómo recuperar el dinero que se les prometió. Podrían (y muchos ya lo están haciendo) aumentar las primas. Para la mayoría de las personas que obtienen los subsidios por separado para ayudar a pagar sus primas, esos aumentos serán solventados por el gobierno federal. Los que se verán más afectados son las aproximadamente 7.5 millones de personas que compran su propio seguro individual, pero ganan demasiado para obtener ayuda federal para pagar por su cobertura.

Las aseguradoras también podrían abandonar ACA por completo. Eso impactaría a todos en el mercado individual y podría dejar algunos condados sin aseguradora para el próximo año. Las aseguradoras también podrían demandar al gobierno, y la mayoría de los expertos creen que eventualmente ganarían.

  1. Esto podría afectar las opciones de seguros para el próximo año. Pero es complicado.

El impacto en las primas para el próximo año variará según el estado y la aseguradora. Por un lado, las aseguradoras tienen una laguna jurídica que les permite salir de los contratos para 2018 dado el cambio en los pagos federales, por lo que algunos podrían decidir salir del mercado. Eso podría dejar áreas con menos aseguradoras, o sin ninguna. En agosto, la Oficina de Presupuesto (CBO) del Congreso estimó que detener los pagos dejaría a cerca del 5% de las personas que compran su propia cobertura a través de los mercados de ACA sin aseguradoras en 2018.

Para todos los demás, la medida daría como resultado primas más altas, dijo la CBO, agregando un promedio de alrededor del 20%. En algunos estados, los reguladores ya han permitido a las aseguradoras aumentar los precios en 2018 previendo esta acción de Trump de frenar los pagos.

Pero cómo se aplican esos aumentos varía. En California, Idaho, Louisiana, Pennsylvania y Carolina del Sur, por ejemplo, los reguladores hicieron que las aseguradoras cargaran los costos solo en un tipo de plan: el de nivel plata. Esto se debe a que la mayoría de las personas que compran planes plata también obtienen un subsidio del gobierno federal para ayudar a pagar su prima, y esos subsidios aumentan junto con el costo de un plan de plata.

Sin embargo, los consumidores que obtienen un subsidio no verán mucho aumento en sus gastos de bolsillo para la cobertura. Los consumidores sin subsidios tendrán los costos adicionales si se quedan en un plan de plata. En esos estados, los consumidores pueden encontrar un mejor negocio en en una franja de planes, incluidos planes de oro de alto nivel. Sin embargo, muchos estados permitieron a las aseguradoras repartir el aumento esperado en todos los niveles de los planes.

  1. El Congreso podría actuar.

Se han renovado las negociaciones bipartidistas entre los senadores Lamar Alexander (republicano de Tennessee) y Patty Murray (demócrata de Washington) para crear una legislación que continúe con los subsidios para compartir costos y otorgue a los estados más flexibilidad para desarrollar y vender planes menos generosos de atención médica que las que actualmente se ofrecen en los mercados. La decisión de Trump de poner fin a los subsidios de participación en los costos puede reforzar esas discusiones.

En un comunicado, Murray llamó a la acción de Trump para retirar los subsidios de participación en los costos “imprudente”, pero dijo que continúa “siendo optimista sobre nuestras negociaciones y creemos que podemos llegar a un acuerdo rápidamente. Insto a los líderes republicanos en el Congreso esta vez hacer lo correcto para las familias apoyando nuestro trabajo”.

El presidente Trump instó el viernes a los demócratas a que trabajen con él para “llegar a un acuerdo” sobre la atención de salud. “Ahora bien, si los demócratas fueran inteligentes, lo que harían sería venir a negociar algo para que las personas realmente pudieran obtener el tipo de atención médica que merecen, siendo ciudadanos de nuestro gran país”, dijo el viernes por la tarde.

El viernes 6, el líder de la mayoría del Senado Chuck Schumer (demócrata de Nueva York) no parecía estar de humor para cerrar un trato.

“Los republicanos han estado haciendo todo lo posible durante los últimos diez meses para inyectar inestabilidad en nuestro sistema de atención médica y forzar el colapso a través del sabotaje”, dijo en un comunicado.

Una encuesta publicada el viernes 13 de octubre por la Kaiser Family Foundation muestra que el 71% del público prefiere que la administración Trump trate de hacer que la ley funcione en lugar de acelerar el reemplazo alentando su fracaso. La encuesta se llevó a cabo antes de que Trump hiciera su anuncio sobre los subsidios. (KHN es un programa editorial independiente de la fundación).

          5. Algunos estados están demandando, pero el resultado es difícil de adivinar.

A pesar que todos los estados regulan sus propios mercados de seguros, los estados tienen opciones limitadas para lidiar con el último movimiento de Trump. Dieciséis estados y el Distrito de Columbia, encabezados por Nueva York y California, están demandando a la administración Trump para defender los subsidios para los costos compartidos. Pero no está claro si un tribunal federal podría decir que la administración Trump está obligada a continuar haciendo los pagos mientras el caso está pendiente.

Diane Webber contribuyó con este informe.

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

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Trump Acting Solo: What You Need To Know About Changes To The Health Law

Apparently frustrated by Congress’ inability to “repeal and replace” the Affordable Care Act, President Donald Trump this week decided to take matters into his own hands.

Late Thursday evening, the White House announced it would cease key payments to insurers. Earlier on Thursday, Trump signed an executive order aimed at giving people who buy their own insurance easier access to different types of health plans that were limited under the ACA rules set by the Obama administration.

“This is promoting health care choice and competition all across the United States,” Trump said at the signing ceremony. “This is going to be something that millions and millions of people will be signing up for, and they’re going to be very happy.”

The subsidy payments, known as “cost-sharing reductions,” are payments to insurers to reimburse them for discounts they give policyholders with incomes under 250 percent of the federal poverty line, or about $30,000 in income a year for an individual. Those discounts shield these lower-income customers from out-of-pocket expenses, such as deductibles or copayments. These subsidies have been the subject of a lawsuit that is ongoing.

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The cost-sharing reductions are separate from the tax credit subsidies that help millions of people pay their premiums. Those are not affected by Trump’s decision.

Some of Trump’s actions could have an immediate effect on the enrollment for 2018 ACA coverage that starts Nov. 1. Here are five things you should know.

1. The executive order does not make any immediate changes.

Technically, Trump ordered the departments of Labor, Health and Human Services and Treasury within 60 days to “consider proposing regulations or revising guidance, to the extent permitted by law,” on several different options for expanding the types of plans individuals and small businesses could purchase. Among his suggestions to the department are broadening rules to allow more small employers and other groups to form what are known as “association health plans” and to sell low-cost, short-term insurance. There is no guarantee, however, that any of these plans will be forthcoming. In any case, the process to make them available could take months.

2. The cost-sharing reduction changes ARE immediate but might not affect the people you expect.

Cutting off payments to insurers for the out-of-pocket discounts they provide to moderate-income policyholders does not mean those people will no longer get help. The law, and insurance company contracts with the federal government, require those discounts be granted.

That means insurance companies will have to figure out how to recover the money they were promised. They could raise premiums (and many are raising them already). For the majority of people who get the separate subsidies to help pay their premiums, those increases will be borne by the federal government. Those who will be hit hardest are the roughly 7.5 million people who buy their own individual insurance but earn too much to get federal premium help.

Insurers could also simply drop out of the ACA entirely. That would affect everyone in the individual market and could leave some counties with no insurer for next year. Insurers could also sue the government, and most experts think they would eventually win.

Facebook Live: Trump Ends Payments For Cost-Sharing Reductions. What’s Next?

3. This could affect your insurance choices for next year. But it’s complicated.

The impact on your plan choices and premiums for next year will vary by state and insurer. For one thing, insurers have a loophole that allows them to get out of the contracts for 2018, given the change in federal payments. So, some might decide to bail. That could leave areas with fewer — or no — insurers. The Congressional Budget Office in August estimated that stopping the payments would leave about 5 percent of people who purchase their own coverage through the ACA marketplaces with no insurers in 2018.

For everyone else, the move would result in higher premiums, the CBO said, adding an average of about 20 percent. In some states, regulators have already allowed insurers to price those increases into their 2018 rates in anticipation that the payments would be halted by the Trump administration.

But how those increases are applied varies. In California, Idaho, Louisiana, Pennsylvania and South Carolina, for example, regulators had insurers load the costs only onto one type of plan: silver-level coverage. That’s because most people who buy silver plans also get a subsidy from the federal government to help pay their premium, and those subsidies rise along with the cost of a silver plan.

Consumers getting a premium subsidy, however, won’t see much increase in their out-of-pocket payments for the coverage. Consumers without premium subsidies will bear the additional costs if they stay in a silver plan. In those states, consumers may find a better deal in a different metal-band of insurance, including higher-level gold plans. Many states, however, allowed insurers to spread the expected increase across all levels of plans.

4. Congress could act.

Bipartisan negotiations have been renewed between Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to create legislation that would continue the cost-sharing subsidies and give states more flexibility to develop and sell less generous health care plans than those currently offered on the exchanges. Trump’s move to end the cost-sharing subsidies may bolster those discussions.

In a statement, Murray called Trump’s action to withdraw cost-sharing subsidies “reckless” but said she continues “to be optimistic about our negotiations and believe we can reach a deal quickly — and I urge Republican leaders in Congress to do the right thing for families this time by supporting our work.”

Trump on Friday urged Democrats to work with him to “make a deal” on health care. “Now, if the Democrats were smart, what they’d do is come and negotiate something where people could really get the kind of healthcare that they deserve, being citizens of our great country,” he said Friday afternoon.

Earlier Friday, Senate Minority Leader Chuck Schumer (D-N.Y.) did not sound as if he was in the mood to cut a deal.

“Republicans have been doing everything they can for the last ten months to inject instability into our health care system and to force collapse through sabotage,” he said in a statement. “Republicans in the House and Senate now own the health care system in this country from top to bottom, and their destructive actions, and the actions of the president, are going to fall on their backs. The American people see it, and they know full well which party is doing it.”

A poll released Friday by the Kaiser Family Foundation shows that 71 percent of the public said they preferred that the Trump administration try to make the law work rather than to hasten replacement by encouraging its failure. The poll was conducted before Trump made his announcement about the subsidies. (Kaiser Health News is an editorially independent program of the foundation.)

5. Some states are suing, but the outcome is hard to guess.

Even though all states regulate their own insurance markets, states have limited options for dealing with Trump’s latest move. Eighteen states and the District of Columbia, led by New York and California, are suing the Trump administration to defend the cost-sharing subsidies. But it is unclear whether a federal court could say that the Trump administration is obligated to continue making the payments while that case is pending. 

Diane Webber contributed to this report.

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Facebook Live: Trump Ends Payments For Cost-Sharing Reductions. What’s Next?

President Donald Trump has followed through on a long-standing threat. His administration announced late Thursday it will halt federal payments for the Affordable Care Act’s cost-sharing reductions. This is the latest blow to the stability of the ACA’s insurance marketplaces, and it is triggering significant confusion among consumers and insurers. This live chat features KHN senior correspondent Jay Hancock answering questions about what it might mean for the upcoming open enrollment period and beyond.

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

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While Trump Moves to Dismantle Health Law, Public Favors Repair

President Donald Trump has collided with a wave of public disagreement by moving to strip the Affordable Care Act of provisions intended to keep insurance prices stable.

In a poll conducted before Trump’s Thursday announcement of unilateral changes to the law, 71 percent of the public said they preferred the administration try to make the law work rather than to hasten replacement by encouraging its failure. Even Republicans, by a small margin, favored a more conciliatory approach to the law, according to the poll from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Trump took the opposite tact Thursday, in the wake of Congress’ failure to replace the 2010 law. He announced two actions that are likely to disrupt the insurance markets for people who buy their policies on their own rather than through their employers.

First, he ordered the government to allow associations of small employers or other membership groups to band together and offer their own insurance that would not have to provide all the types of coverage required under the health law. That same executive order also directs officials to loosen rules for low-cost, short-term health insurance.

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Trump argues these changes would give consumers cheaper coverage options, while many health care experts fear it could shift insurance markets back toward their pre-ACA configuration, when healthy people paid less but people with medical conditions often found coverage unaffordable.

Second, Trump ordered the government to stop paying insurers subsidies that allowed low-income people to avoid out-of-pocket medical costs that otherwise this year can be as high as $7,150 for individuals and $14,300 for families. Those insurance subsidies, technically known as cost-sharing reductions, or CSRs, had been embroiled in a legal and political battle between former President Barack Obama and Republicans over whether Congress had authorized the president to pay them.

The foundation’s poll, conducted Oct. 5-10, found that 60 percent of the public thought Congress should guarantee that these payments continue. A majority of Republicans, however, considered them bailouts of insurance companies and should cease.

The poll found that 69 percent of the public favored broader bipartisan congressional compromise to continue the payments — as most Democrats desire — in exchange for allowing states to have greater (but unspecified) flexibility in what kind of plans could be sold on their marketplaces, as Republicans generally favor. Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have been trying to forge a deal to stabilize insurance markets that could draw support from both parties. The poll found that support for a compromise was equally strong among independents and members of both political parties.

The poll found no such comity in the views of most other issues relating to the health law. Democrats overwhelmingly want Trump and Congress to work together to stabilize the marketplaces, while Republicans by a narrow margin prefer lawmakers resuscitate efforts to replace the law. A majority of Republicans (56 percent) are confident Trump and Congress can work together on improving health care, while only 1 in 7 Democrats (14 percent) think so. Independents leaned toward the Democrats’ skepticism.

Even before Trump’s actions Thursday, 66 percent of Democrats thought his approach was undermining the insurance markets, but only 12 percent of Republicans thought so. Among independents, 41 percent thought Trump was hurting the markets.

The poll found similar partisan divides on many of the other current debates over the law, including whether the government should fine people who do not obtain insurance and whether the federal government should spend less on advertisements encouraging people to sign up for coverage.

The federal enrollment period for 2018 coverage begins Nov. 1 and runs through Dec. 15.

The telephone poll included 1,215 adults. Its margin of error is plus or minus 3 percentage points for the full sample.

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Facebook Live: Things To Know About Trump’s Directive On Health Insurance

The executive order that President Donald Trump signed Thursday touches on a range of GOP policy approaches — such as association health plans and short-term health insurance policies, among other things. This live chat features KHN senior correspondent Julie Appleby answering questions about how implementing these ideas could alter the current health insurance marketplace.

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

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Facebook Live: Things To Know About Trump’s Directive On Health Insurance

The executive order that President Donald Trump signed Thursday touches on a range of GOP policy approaches — such as association health plans and short-term health insurance policies, among other things. This live chat features KHN senior correspondent Julie Appleby answering questions about how implementing these ideas could alter the current health insurance marketplace.

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

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Trump’s Order Advances GOP Go-To Ideas To Broaden Insurance Choices, Curb Costs

Note: This story was last updated at 12:28 p.m. ET to reflect additional information from administration officials and other comments.

The Trump administration Thursday advanced a wide-ranging executive order aimed at expanding lower-cost insurance options, allowing employers to give workers money to buy their own coverage and slowing consolidation in the insurance and hospital industries.

Critics said that, if implemented, the changes could result in more bare-bones coverage and pull healthier people out of the already struggling insurance markets, leading to higher premiums for those who remain in more-regulated coverage.

President Donald Trump’s action, which will not take effect in time to affect the upcoming open enrollment for coverage in 2018, signals a shift in the administration’s strategy, which relied on Congress to repeal the Affordable Care Act. Trump is now using the force of his executive rule-making authority to implement long-favored GOP policy alternatives.

“With Congress the way it is, I decided to take it upon myself,” Trump said in remarks at the White House earlier in the week. Senate Republicans failed within recent months to pass legislation to overhaul the ACA.

The executive order directs many agencies, including the Department of Labor, to consider proposing rules or new guidance to loosen current restrictions on what are called “association health plans” and on selling low-cost, short-term insurance.

Such rules could potentially exempt such plans for a number of the requirements of the Affordable Care Act.

This order will “help millions of Americans who have been harmed by Obamacare,” said Andrew Bremberg,  director of the Domestic Policy Council, who briefed the press.

The directive also instructs agencies to consider new regulations or guidance to:

  • Permit the practice of providing a tax-free employer contributions through health reimbursement accounts that workers could use to buy individual market plans. The Obama administration had barred that practice. This adjustment might result in more employers dropping job-based coverage and simply giving workers money to buy their own plans.
  • Report on steps federal and state governments could take to “increase choice and reduce consolidation” in the health care market. A senior administration official said Trump is concerned about the growing number of regions served by only one or two insurers or hospital systems.

Facebook Live Explainer: Things To Know About Trump’s Directive On Health Insurance

The Pros And The Cons

Associations are generally membership groups based on a profession or business. Proponents say allowing consumers to buy insurance through these organizations gives them more clout with insurers than they’d have buying their own plan on the individual market — and results in lower premiums.

But the real savings in premiums is likely to come because the policies could offer fewer benefits than more regulated ACA plans, and the associations would have more leeway to set premiums based on the health of the group.

Trump’s order is likely to please some groups, including the National Federation of Independent Business. This organization has long supported association health plans, which it says allow small businesses to buy coverage across state lines.

Not all small businesses back association health plans, though, or the idea that they need help banding together to buy coverage.

“The truth is, that’s how they get insurance today and it’s called the small group market. Every state has one,” said David Chase, spokesman for Small Business Majority, a group that supports the ACA.

“What association plans would do is actually pull people out of those small group pools and start a bunch of new pools. That doesn’t band people together,” he added.

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Critics also warn that such plans, with pared-down coverage and lower premiums, could siphon off the healthiest consumers. Older, sicker people would be left to seek health insurance through more regulated plans available through state and federal insurance marketplaces. That could cause premiums to rise more rapidly for those groups.

The combination of allowing less-regulated association plans, making it easier for employers to send workers to buy their own coverage and making short term plans more broadly available “is a concerted effort to undermine the individual market” by drawing out the healthiest consumers, said Kevin Lucia, a research professor at Georgetown’s Health Policy Institute.

Still, some employers now sitting on the sidelines might end up adding workers to that pool, countered Chris Condeluci, a Washington, D.C., attorney who previously worked for Sen. Chuck Grassley (R-Iowa) and served as counsel to the U.S. Senate Finance Committee during the drafting of the ACA.

“Some will want to give workers a chunk of change to make sure they get coverage, but not be in the game of sponsoring a [group] plan themselves,” said Condeluci.

Administration officials said Thursday that they had not studied the effect of the changes on the marketplace but might do so in the future.

Some consumer advocates also warn that association plans and short-term policies are generally less generous with benefits — and could leave some unwary consumers stuck with large medical bills. Such plans might not cover maternity care, for example, or prescription drugs.

Additionally, short-term plans can exclude paying for any preexisting medical conditions, either upfront or upon renewal, something the ACA bars for all other types of insurance.

Legal challenges to the executive order could result from these issues.

For one thing, policy experts question whether the Trump administration can allow associations broad leeway to sign up individuals, rather than following the Obama administration’s strict definition of “rare instances” in which an association would qualify as an employer offering group coverage.

Trump administration officials said that issue would be studied as part of the consideration around setting new rules, but that the law may allow self-employed individuals to join associations.

Associations want to be designated as a large group because a complex mix of laws cover employment-based insurance coverage, and rules can differ from those governing small-group or individual coverage.

Large-group plans need not cover all 10 of the ACA’s “essential health benefits,” which include things like hospitalization, drug coverage, maternity care and substance abuse treatment.

They would have to follow other rules, however, such as the ban on setting annual or lifetime limits and the rule allowing parents to keep their children on the policy until age 26.

But insurers could vary premiums for large groups based on medical claims history of the overall group, so younger, healthier groups would likely get lower premiums.

In the individual market, insurers cannot base a premium on a policyholder’s health.

A Speckled Past

Association health plans are not new. They’ve been around for decades, and Republicans have traditionally eyed them as a means to make it easier for small businesses and individuals to band together to buy insurance.

In the past, though, some had solvency problems and went bankrupt, leaving consumers on the hook with unpaid medical bills.

In several states, regulators investigated whether the plans were advertising that they had comprehensive coverage when, in fact, they provided little or no coverage for such things as chemotherapy or doctor office visits.

The ACA answered some of those concerns by setting minimum standards for coverage on most insurance policies, including association plans, which prevent them from skimping on such things as doctor visits or prescription drugs.

Their numbers fell after the sweeping law went into effect.

Meanwhile, the Trump proposal also would allow people to buy short-term plans that last up to 364 days, overturning an Obama administration rule limiting short-term policies to 90 days.

Advocates of the change have always argued that this limit simply meant people had to renew more often — and then face their deductibles all over again.

But How Will Associations Plans Fare?

Joe Antos, at the conservative American Enterprise Institute, questions how popular such plans would be with both consumers and insurers.

“The people on the left who say this will doom the exchange marketplace are, as usual, exaggerating the likely effects of this,” said Antos.

That’s because many of the approximately 9 million people who currently buy coverage through federal or state insurance marketplaces get a premium subsidy to help them purchase. They are unlikely to switch from that, he said.

The main group that it would appeal to are the additional 10 million or so who buy coverage because they don’t get it through their jobs, and don’t get a subsidy.

Key will be just what the plans cover — and what they exclude.

“They’ll only be attracted if these association plans actually provide them coverage they want at a price that is better than the exchange plans,” said Antos.

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

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Trump’s Order Advances GOP Go-To Ideas To Broaden Insurance Choice, Hold Down Costs

President Donald Trump planned Thursday to move forward in changing U.S. health care by signing an executive order aimed at expanding low-cost insurance options, which critics say will leave some with skimpy coverage and hurt already-struggling insurance markets.

This step would signal a shift in the administration’s strategy, which relied on Congress to repeal the Affordable Care Act. Trump is now using the force of his executive rule-making authority to implement long-favored GOP policy alternatives.

“With Congress the way it is, I decided to take it upon myself,” Trump said in remarks at the White House earlier in the week. Senate Republicans failed within recent months to bring up legislation to overhaul the ACA.

Use Our Content

In Thursday’s directive, Trump is expected to loosen rules around policies sold through “associations,” which can be for instance, professional-affiliation groups.

While details are sparse, it could effectively exempt more insurance plans from a number of ACA requirements.

The order also will likely instruct regulators to allow insurers greater leeway in selling low-cost, short-term insurance that can exclude coverage of policyholders’ preexisting medical conditions.

“A big percentage of people will be able to get health care,” Trump said, “and it will not cost our country anything, but they’ll have great, great health insurance again.”

The Pros And The Cons

Proponents say allowing small businesses and possibly self-employed people to buy insurance through associations gives them more clout with insurers than buying their own plan on the individual market — and results in lower premiums.

But the real savings in premiums is likely to come because the policies could offer fewer benefits than more regulated ACA plans, and the associations would have more leeway to set premiums based on the health of the group.

Trump’s order is likely to please some groups, including the National Federation of Independent Business. This organization has long supported association health plans, which they say allows small businesses to buy coverage across state lines.

Critics warn that such plans, with pared-down coverage and lower premiums, could siphon off the healthiest consumers. Older, sicker people would be left to seek health insurance through more regulated plans available through state and federal insurance marketplaces. That could cause premiums to rise more rapidly for those groups.

Some consumer advocates also warn that association plans and short-term policies are generally less generous with benefits – and could leave some unwary consumers stuck with large medical bills. Such plans might not cover maternity care, for example, or prescription drugs.

Additionally, short-term plans can exclude paying for any preexisting medical conditions, either upfront or upon renewal, something the ACA bars for all other types of insurance.

Legal challenges to the executive order could result from these issues.

For one thing, policy experts question whether the Trump administration can allow associations broad leeway to sign up individuals, rather than following the Obama administration’s strict definition of “rare instances” in which an association would qualify as an employer offering group coverage.

That distinction is important because a complex mix of laws cover employment-based insurance coverage, and rules can differ from those governing small-group or individual coverage.

It could be challenging “for them to extend [this coverage] to individuals who are not associated with an employer group,” said Kevin Lucia, a research professor at Georgetown’s Health Policy Institute.

Associations prefer to be viewed as employers offering large-group coverage because then their polices need not cover all 10 of the ACA’s “essential health benefits,” which include things like hospitalization, drug coverage, maternity care and substance abuse treatment.

Insurers can also vary premiums for large groups based on medical claims history of the overall group, so younger, healthier groups would likely get lower premiums.

In the individual market, insurers cannot base a premium on a policyholder’s health.

A Speckled Past

Association health plans are not new. They’ve been around for decades, and Republicans have traditionally eyed them as a means to make it easier for small businesses and individuals to band together to buy insurance.

In the past, though, some had solvency problems and went bankrupt, leaving consumers on the hook with unpaid medical bills.

In several states, regulators investigated whether the plans were advertising that they had comprehensive coverage when, in fact, they provided little or no coverage for such things as chemotherapy or doctor office visits.

The ACA answered some of those concerns by setting minimum standards for coverage on most insurance policies, including association plans, which prevents them from skimping on such things as doctor visits or prescription drugs.

Their numbers fell after the sweeping law went into effect.

Meanwhile, the Trump proposal also would allow people to buy short-term plans that last up to 364 days, overturning an Obama administration rule limiting short-term policies to 90 days.

Advocates of the change have always argued that this limit just meant people had to renew more often — and then face their deductibles all over again.

But How Will Associations Plans Fare?

Joe Antos, at the conservative American Enterprise Institute, questions how popular such plans would be with both consumers and insurers.

“The people on the left who say this will doom the exchange marketplace are, as usual, exaggerating the likely effects of this,” said Antos.

That’s because many of the approximately 9 million people who currently buy coverage through federal or state insurance marketplaces get a premium subsidy to help them purchase. They are unlikely to switch from that, he said.

The main group that it would appeal to are the additional 10 million or so who buy coverage because they don’t get it through their jobs, and don’t get a subsidy.

Key will be just what the plans cover — and what they exclude.

“They’ll only be attracted if these association plans actually provide them coverage they want at a price that is better than the exchange plans,” said Antos.

Critics of ACA rules requiring policies to cover maternity care or mental health conditions have always cited these dictates as a reason for high premiums. Antos noted, though, that those costs pale when compared with the expense of what most people want, such as coverage for hospitalization.

“That’s really expensive,” said Antos. “But no one wants coverage that excludes hospitalization.”

So, insurers — if they even want to back association coverage — may end up offering coverage “that will look a lot like the exchange plans,” Antos said.

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

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Longer Looks: Puerto Rico’s Health Care; Cancer Drugs In Africa & Undermining Obamacare

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

FiveThirtyEight: If Puerto Rico Were A State, Its Health Care System Would Recover Faster From Maria
Nearly three weeks after Hurricane Maria landed in Puerto Rico as a Category 4 hurricane, health care providers are still struggling. Almost all of the community health centers — which are a lifeline for the poorest people — on the western half of the island were still closed Friday or operating at partial capacity. There are serious concerns about how they and other health service providers will begin even basic recovery in many places where diesel is still scarce and communication almost nonexistent. (Anna Maria Barry-Jester, 10/9)

The New York Times: As Cancer Tears Through Africa, Drug Makers Draw Up A Battle Plan
In a remarkable initiative modeled on the campaign against AIDS in Africa, two major pharmaceutical companies, working with the American Cancer Society, will steeply discount the prices of cancer medicines in Africa. Under the new agreement, the companies — Pfizer, based in New York, and Cipla, based in Mumbai — have promised to charge rock-bottom prices for 16 common chemotherapy drugs. The deal, initially offered to a half-dozen countries, is expected to bring lifesaving treatment to tens of thousands who would otherwise die. (Donald G. McNeil, 10/7)

WIRED: The Speculum Finally Gets A Modern Redesign
That the speculum is old is not, on its face, a problem. It’s that the design is neither optimal for patients nor physicians. Doctors have to stretch the speculum’s bills wide in order to see as far back as the cervix, and even then, it’s not always possible to get a good look inside. (Some specula come with built-in lights, but the problem has more to do with tissue falling in than the darkness of the vaginal canal.) All of that pressure causes discomfort; one review of the medical literature found that some women even avoid the gynecologist because of the dreaded device. (Arielle Pardes, 10/5)

Vox: I’m An OB-GYN Who Had A 2nd-Trimester Abortion. The 20-Week Ban Bill Is Dangerous.
For women who choose to end a pregnancy in the second trimester — medically defined as between the 13th and the 27th week of gestation — the reasons often involve medical complications. As an obstetrician and a woman who has had a second-trimester abortion, I must emphasize the damaging effects of this bill. Without my procedure, I would have been condemned to carry to term a baby doomed to suffer and die — even as I continued to see patients and delivered other people’s healthy babies. (Cheryl Axelrod, 10/9)

The New York Times: Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?
The disintegration of Jake’s life took him by surprise. It happened early in his junior year of high school, while he was taking three Advanced Placement classes, running on his school’s cross-country team and traveling to Model United Nations conferences. It was a lot to handle, but Jake — the likable, hard-working oldest sibling in a suburban North Carolina family — was the kind of teenager who handled things. Though he was not prone to boastfulness, the fact was he had never really failed at anything. Not coincidentally, failure was one of Jake’s biggest fears. He worried about it privately; maybe he couldn’t keep up with his peers, maybe he wouldn’t succeed in life. The relentless drive to avoid such a fate seemed to come from deep inside him. He considered it a strength. (Benoit Denizet-Lewis, 10/11)

Huffington Post: Trump Has A New Plan To Undermine Obamacare And It Doesn’t Need Congress 
President Donald Trump has already done a lot to sabotage the Affordable Care Act, whether it’s slashing the program’s advertising budget or threatening to cut off some payments that insurers need to cover their costs.Now Trump is thinking about using his executive authority to do something that could be even more damaging to the law ― and, arguably, more threatening to people who depend on it for coverage. (Jonathan Cohn, 10/9)

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

Longer Looks: Puerto Rico’s Health Care; Cancer Drugs In Africa & Undermining Obamacare

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

FiveThirtyEight: If Puerto Rico Were A State, Its Health Care System Would Recover Faster From Maria
Nearly three weeks after Hurricane Maria landed in Puerto Rico as a Category 4 hurricane, health care providers are still struggling. Almost all of the community health centers — which are a lifeline for the poorest people — on the western half of the island were still closed Friday or operating at partial capacity. There are serious concerns about how they and other health service providers will begin even basic recovery in many places where diesel is still scarce and communication almost nonexistent. (Anna Maria Barry-Jester, 10/9)

The New York Times: As Cancer Tears Through Africa, Drug Makers Draw Up A Battle Plan
In a remarkable initiative modeled on the campaign against AIDS in Africa, two major pharmaceutical companies, working with the American Cancer Society, will steeply discount the prices of cancer medicines in Africa. Under the new agreement, the companies — Pfizer, based in New York, and Cipla, based in Mumbai — have promised to charge rock-bottom prices for 16 common chemotherapy drugs. The deal, initially offered to a half-dozen countries, is expected to bring lifesaving treatment to tens of thousands who would otherwise die. (McNeil, 10/7)

WIRED: The Speculum Finally Gets A Modern Redesign
That the speculum is old is not, on its face, a problem. It’s that the design is neither optimal for patients nor physicians. Doctors have to stretch the speculum’s bills wide in order to see as far back as the cervix, and even then, it’s not always possible to get a good look inside. (Some specula come with built-in lights, but the problem has more to do with tissue falling in than the darkness of the vaginal canal.) All of that pressure causes discomfort; one review of the medical literature found that some women even avoid the gynecologist because of the dreaded device. (Arielle Pardes, 10/5)

Vox: I’m An OB-GYN Who Had A 2nd-Trimester Abortion. The 20-Week Ban Bill Is Dangerous.
For women who choose to end a pregnancy in the second trimester — medically defined as between the 13th and the 27th week of gestation — the reasons often involve medical complications. As an obstetrician and a woman who has had a second-trimester abortion, I must emphasize the damaging effects of this bill. Without my procedure, I would have been condemned to carry to term a baby doomed to suffer and die — even as I continued to see patients and delivered other people’s healthy babies. (Cheryl Axelrod, 10/9)

The New York Times: Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?
The disintegration of Jake’s life took him by surprise. It happened early in his junior year of high school, while he was taking three Advanced Placement classes, running on his school’s cross-country team and traveling to Model United Nations conferences. It was a lot to handle, but Jake — the likable, hard-working oldest sibling in a suburban North Carolina family — was the kind of teenager who handled things. Though he was not prone to boastfulness, the fact was he had never really failed at anything. Not coincidentally, failure was one of Jake’s biggest fears. He worried about it privately; maybe he couldn’t keep up with his peers, maybe he wouldn’t succeed in life. The relentless drive to avoid such a fate seemed to come from deep inside him. He considered it a strength. (Denizet-Lewis, 10/11)

Huffington Post: Trump Has A New Plan To Undermine Obamacare And It Doesn’t Need Congress 
President Donald Trump has already done a lot to sabotage the Affordable Care Act, whether it’s slashing the program’s advertising budget or threatening to cut off some payments that insurers need to cover their costs.Now Trump is thinking about using his executive authority to do something that could be even more damaging to the law ― and, arguably, more threatening to people who depend on it for coverage. (Jonathan Cohn, 10/9)

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