Tagged States

States Attacking ACA Would Hurt Most If Shield On Preexisting Conditions Were Axed

If the Affordable Care Act’s protections for people with preexisting medical conditions are struck down in court, residents of the Republican-led states that are challenging the law have the most to lose.

“These states have been opposed to the ACA from the beginning,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “They’re hurting their most vulnerable citizens.”

Twenty Republican state attorneys general and governors challenged the constitutionality of the ACA in federal court in February. Last month, U.S. Attorney General Jeff Sessions and the Department of Justice made the unusual decision not to defend key portions of the law against this legal challenge.

The states’ lawsuit argues that because Congress eliminated the Obamacare tax penalty for not having insurance coverage, effective next year, the entire law is unconstitutional. By extension, the suit calls on federal courts to find the health law’s protections for people with preexisting conditions unconstitutional — and Sessions agrees.

Nine of the 11 states with the highest rates of preexisting conditions among adults under 65 have signed onto the lawsuit to strike down the ACA, according to data from insurance companies and the U.S. Centers for Disease Control and Prevention. The 2015 data, the most recent available, were analyzed by the Kaiser Family Foundation in 2016. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

Those who support the lawsuit contend that there are other means of protecting people with preexisting conditions.

“If a court strikes down the constitutionality of the ACA, there are ways to repeal and replace without Arizonans with preexisting conditions losing their coverage,” said Katie Conner, a spokeswoman for Arizona Attorney General Mark Brnovich.

Conner said her boss, who is party to the lawsuit, believes preexisting conditions should “always be covered.” In Arizona, more than 1 in 4 adult adults under 65 have a preexisting condition, according to the data.

The state with the highest rate of adults with preexisting conditions is West Virginia — 36 percent of those under age 65. That means that about 1 in 3 of them could have a hard time buying insurance through the individual marketplace without the ACA protections.

The office of West Virginia Attorney General Patrick Morrisey, who joined the legal challenge against the ACA, declined to comment. But a spokesman for Morrisey’s re-election campaign told PolitiFact last month that “help should be provided to those who need it most, including those with preexisting conditions.”

Plaintiffs in the lawsuit “are paying lip service to these critical protections for people, but they are in fact engaged in a strategy that would get rid of those protections,” said Justin Giovannelli, an associate research professor at Georgetown University’s Center on Health Insurance Reforms. “Frankly, it’s hard to square what they’re saying on the one hand and what they’re arguing in the courts on the other.”

According to a poll released in June, also by the Kaiser Family Foundation, three-quarters of Americans say that maintaining protections for people with preexisting conditions is “very important.” This includes majorities of Democratic, Republican and independent voters.

Before the health law was adopted, insurance companies routinely denied coverage to millions of people with preexisting conditions who purchased insurance through the individual marketplace. If they didn’t deny coverage outright, some health plans charged consumers exorbitant premiums, or offered policies that excluded coverage for pricey conditions. (Although many people got insurance through their employers or public plans that covered preexisting conditions, they could have been left vulnerable if their employment status or other circumstances changed.)

The ACA ended those practices.

Common conditions that led insurance companies to deny coverage included high blood pressure, cancer, obesity, diabetes and depression, among many others. Some people were denied for having acne, asthma or for being pregnant.

The KFF analysis estimated that at least 27 percent of adults under 65 — more than 50 million Americans — had at least one preexisting condition that would have jeopardized their coverage pre-ACA. The foundation said its estimates were an undercount because some diseases that insurers cited when declining coverage are not in the survey data. Also, each insurance company set its own rules and conditions for denials, making accurate counts of those who could be affected hard to nail down.

Less precise estimates by other researchers and the Department of Health and Human Services show that up to half of all adults under age 65 have at least one preexisting condition.


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

New York Health Officials Point To Reduction In Opioid Deaths As Reason To Legalize Marijuana

“Studies have found notable associations of reductions in opioid prescribing and opioid deaths with the availability of marijuana products,” the report from New York’s Health Department found. “States with medical marijuana programs have been found to have lower rates of opioid overdose deaths than other states.” More news on the crisis also comes out of Canada, Colorado, New Hampshire and Ohio.

New York Health Officials Point To Reduction In Opioid Deaths As Reason To Legalize Marijuana

“Studies have found notable associations of reductions in opioid prescribing and opioid deaths with the availability of marijuana products,” the report from New York’s Health Department found. “States with medical marijuana programs have been found to have lower rates of opioid overdose deaths than other states.” More news on the crisis also comes out of Canada, Colorado, New Hampshire and Ohio.

In Florida, Midterm Elections Hold Faint Hope For Medicaid Expansion

Can the deep-red Florida Statehouse follow Virginia and expand Medicaid?

Highly unlikely anytime soon, many state political analysts say.

It’s been three years since the Florida legislature last debated — and overwhelmingly rejected —Medicaid expansion under the Affordable Care Act.

Republicans — who have controlled the governor’s office and both legislative chambers for nearly all of the past two decades — have shown no interest since then in pursuing the policy that would make about 660,000 uninsured adults eligible for the government insurance program for the poor.

While Democrats are expected to gain Statehouse seats in the midterm election, it’s unlikely they can capture enough to make a difference. That’s especially true in the House, where the GOP holds a 76-41 majority, with three seats vacant. Six GOP House members don’t even face an opponent.

“I don’t see Medicaid expansion having much of a chance,” said Carol Weissert, Florida State University’s chair of civic education and political science. “It’s a combination of the political reality on the ground, and I don’t see a huge push for it around the state.”

While health care is typically a big issue in retiree-heavy Florida, gun laws and education are likely to play heavy on voters’ minds this fall following the February massacre at Marjory Stoneman Douglas High School in Parkland, Fla., where 17 people were killed.

Susan MacManus, a political science professor emeritus at the University of South Florida in Tampa, said one “long shot” for the Democrats’ fall election prospects is a growing percentage of younger voters. They tend to be more supportive of expanding Medicaid, she said.

Although Election Day is still more than three months away, expansion proponents are unlikely to pull off a repeat of what happened in the Virginia House of Delegates election last November, Weissert said. Democrats there captured 15 GOP seats and came within one vote of controlling the assembly.

That shock helped persuade a few GOP lawmakers to join Democrats to push Medicaid expansion through a legislature that had staunchly rebuffed it for four years. Many freshman Virginia Democratic lawmakers campaigned on this issue and other measures that would make health care more accessible.

About 400,000 people in Virginia are expected to gain coverage from expansion.

Florida is one of 17 states that have not expanded Medicaid since 2014, and only Texas has more residents who could benefit. An expansion would drop Florida’s uninsured rate from 15.7 percent to nearly 11, according to the nonpartisan Urban Institute.

Republican leaders in Florida have cited various reasons for opposing this step. They say the state can’t afford it. They assert that Florida can’t trust the federal government to pay for at least 90 percent of costs for the newly eligible. They also argue that Medicaid coverage should not go to nondisabled adults because the state is straining to cover children, pregnant women and people with disabilities.

In looking at the issue in the gubernatorial races, the good news for expansion proponents is that Gov. Rick Scott, a Republican who opposed the health law and briefly supported Medicaid expansion then opposed it, is leaving office.

Scott is running for the U.S. Senate against incumbent Democrat Bill Nelson.

While the leading Democratic candidates for governor back expansion, the top Republican candidates, including state agriculture Commissioner Adam Putnam and U.S. Rep. Ron DeSantis, are firmly against it. The state’s primary election is Aug. 28.

But if a Democrat could gain the governorship, it would at least give Medicaid advocates some negotiating leverage, said MacManus.

“A Democratic governor could have some influence on the legislature down the road,” she said.

Gregory Koger, professor of political science at the University of Miami, said the party not controlling the White House usually does well in midterm elections and expects Florida Democrats to benefit. President Donald Trump’s low approval ratings, he added, should also help them.

Although the odds are long, he said, the GOP’s failure to repeal the health law last year in Congress might sway some Republicans in the state legislature to vote for expansion, particularly if the plan included a work requirement for those gaining coverage.

“That could give Republicans political cover,” Koger said.

Florida voters seeking expansion will not be able to follow Maine’s lead on a voter referendum on Medicaid until at least 2020.

Maine’s successful 2017 voter referendum ignited interest in other states, including Utah, Nebraska and Idaho, where voters are expected to address the measure in the fall.

Jonathan Schleifer, executive director of the Fairness Project, which is directing the ballot initiatives, said there wasn’t enough time this year to launch an effort in Florida.

“It was premature to do in Florida because we needed a larger runway for the work,” he said. “It would have been impossible to put together that many signatures.”

Schleifer said he sees strong public support for expanding Medicaid and hopes that after more states approve the ballot referendum it will make it easier to accomplish in the Sunshine State.

Initiative Targeting Synthetic Opioids Will Hyper-Focus On Counties To Try To Eradicate Every Instance Of Drugs

Attorney General Jeff Sessions announced the project, which is based on a successful model in Manatee County, Florida. The program will provide a new assistant U.S. attorney to districts in New Hampshire, California, Kentucky, Maine, Ohio, Pennsylvania, Tennessee and West Virginia.

Outrageous Or Overblown? HHS Announces Another Round Of ACA Navigator Funding Cuts

The Trump administration’s decision Tuesday to slash funding to nonprofit groups that help Americans buy individual health insurance coverage sparked outrage from advocates of the Affordable Care Act. Using words like “immoral” and “cold-hearted,” they saw it as the Republicans’ latest act of sabotage against the sweeping health law.

But as the ACA’s sixth open-enrollment period under the health law approaches in November, the lack of in-person assistance is unlikely to be a disaster for people seeking coverage, insurance and health experts say.

“I think alone it will have a very small impact on enrollment for 2019,” said William Hoagland, a senior vice president with the Bipartisan Policy Center in Washington.

But combined with other recent actions by the Trump administration, the decision sets a negative tone, Hoagland said.

“It does send a signal of course that the administration is not promoting enrollment,” he said.

The Centers for Medicare & Medicaid Services announced it is cutting money to the groups known as navigators from $36 million to $10 million for the upcoming 45-day enrollment period.

This reduction comes a year after the Trump administration decreased navigators’ funding by 40 percent from $62.5 million — and cut advertising and other outreach activities.

CMS Administrator Seema Verma said the navigators that operate in the 34 states that use the federal marketplace — including many health and religious organizations — were ineffective and had outlived their usefulness.

She pointed out that they helped with fewer than 1 percent of enrollments in 2017 — though she counts navigators as “helping” only if consumers sign up in their presence.

CMS also notes that after last year’s navigator funding was reduced, the overall enrollment in Obamacare plans increased slightly (when counting people who paid their first month’s premiums) to 10.6 million people.

Florida Blue, an insurer that enrolls among the largest number of Obamacare consumers nationwide, said it won’t miss the help from the federally funded grass-roots helpers.

“Given our large and unique distribution-channel strategy of utilizing our retail centers along with our telesales efforts, our dedicated field agents and our direct in-market enrollment efforts, we do not depend on navigators to enroll ACA members,” said spokesman Paul Kluding.

Greg Fann, a fellow with the Society of Actuaries, said the role of navigators has been overstated.

“I am a numbers guy, and what really matters to people are the numbers and price of the coverage,” he said. Nearly 9 in 10 people buying coverage on the ACA exchanges qualify for federal subsidies based on their incomes, and the amount those subsidies rose last year because of an increase in silver-plan premiums.

The navigators, Fann added, were needed more in 2013 and 2014 when the marketplaces were in their first years and millions of people who hadn’t bought insurance before were considering the health law’s new options.

Insurers and brokers, Fann said, should step in to make up for navigator funding.

Don’t count on it, said Steve Israel, a Boynton Beach, Fla., insurance agent and past president of the Florida Association of Health Underwriters. He said most independent brokers want nothing to do with ACA plans because insurers have cut their commissions. “We’ve been sending people to navigators,” Israel said.

Some states that operate their own marketplaces, however, are continuing to invest in these grass-roots aides.

Covered California, for example, is holding its navigator funding steady, dedicating $6.5 million to navigators in this year’s budget.

That’s more than half of what healthcare.gov is investing in navigators in 34 states.

California has 1.5 million people in Obamacare plans, second highest in the nation behind Florida, which has 1.6 million.

Death By 1,000 Cuts? 

Trump spent his first year in office trying to repeal the health law and came within one vote in the U.S. Senate of achieving that goal. Immediately after Sen. John McCain (R-Ariz.) cast the deciding vote to block the dramatic repeal effort, Trump implored Republicans to let the law disintegrate.

“Let ObamaCare implode, then deal,” Trump tweeted on July 28, 2017.

But his administration has not stood idly by.

The Republican-controlled Congress in December passed a law that next year will eliminate the requirement that most Americans have insurance, a move likely to drive healthier people out of insurance market and lead to higher prices for those who are left.

Just last week, CMS said because of a pending lawsuit it was suspending a program created by the law to even out the burden on health insurers whose customers are especially unhealthy or sick. That could take millions of dollars away from some insurers, causing them to hike prices or abandon markets.

The Trump administration also issued new rules to try to make it easier for individuals and small businesses to buy health plans that cost less than ACA coverage because they cover fewer medical services. These plans would bypass the law’s protections that prevent companies from charging higher prices to women, older people and those with preexisting medical conditions.

Critics deride such plans as “junk insurance.”

CMS now wants the navigators to promote these policies in addition to steering people toward ACA-compliant plans and Medicaid.

This adds to the concern about the lack of navigator funding.

The availability of such new types of coverage will increase consumer demand for specially trained navigators, said Elizabeth Hagan, a senior consultant with Transform Health, a consulting firm.

She said the problem with reducing consumer assistance is not so much that fewer people will buy coverage but that people will buy policies that don’t fit their needs.

Jodi Ray, who leads the University of South Florida’s navigator program — the largest one in the state — said her staffers do much more than help with enrollment. They also help consumers file appeals with insurers.

“This is how health care disparities are exacerbated — we will be put in the awful position of pitting populations that need assistance against each other in order to prioritize how we can use the resources,” she said.

California Healthline reporter Ana B. Ibarra contributed to this report.