Tagged The Health Law

Podcast: KHN’s ‘What The Health?’ Live from Aspen!

With President Donald Trump and Republicans in Congress stymied in their efforts to change the nation’s health care system, individual states are wrangling with public ire over price and coverage.

Two guests this week, Democratic Govs. John Hickenlooper of Colorado and Steve Bullock of Montana, have made health a priority in their states and are among the governors who have signed on to bipartisan efforts to shore up parts of the Affordable Care Act that are not working. Both governors are also among the long list of Democrats mentioned as possible presidential candidates in 2020.

Meanwhile, actions in Washington, including this week’s regulation expanding the availability of association health plans, often leave states scrambling to figure out what it will mean for their own health insurance markets.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s podcast:

  • Both governors said they think health care will be a dominant voting issue in 2018 and 2020. They say governors are among the few who are able to work on the issue on a bipartisan basis.
  • The conservative health plan unveiled this week as a replacement for the Affordable Care Act would give states more flexibility. It also would likely pose an enormous challenge because, over time, it would reduce the amount of federal health care dollars and wouldn’t give states much time to implement their programs.
  • If a federal court in Washington, D.C., opts to throw out Kentucky’s Medicaid work requirement for nondisabled adults, expansion plans in a number of states could be thrown into disarray. Some of them, like Kentucky, say they will not keep the expansion without the work requirement.
  • Montana offered a somewhat different path to work for people who are covered under the Medicaid expansion. Eighty percent of them are working already. Instead of being punitive, Bullock said, the state made a number of support services and employment training options available and, in turn, that raised the number of those working by 9 percent.
  • Hickenlooper said that in Colorado, because the unemployment rate is below 3 percent, most of the nondisabled adults who were covered under Medicaid expansion and not working are instead caring for their children or elder family members.

To hear all our podcasts, click here.

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Must-Reads Of The Week From Brianna Labuskes

A turbulent news week is capped off by a bit of hope arising from Alzheimer’s research. Disappointment and dashed hopes are the norm in the field, but there’s been a tiny breakthrough: Scientists uncovered a link between the disease and common viruses that lay dormant in the brain after childhood. There’s lots of cautionary language being bandied about (like, don’t get association and causation confused!), but it does open new possibilities for research that has been at a standstill for decades.

And now for what you might have missed this week.


Dr. Atul Gawande, who has just been named to head the health initiative formed by Amazon, Berkshire Hathaway and JPMorgan Chase, has said the U.S. health system is like a car built with Porsche brakes, a Ferrari engine and a BMW chassis. “You put it all together and what do you get? A very expensive pile of junk that does not go anywhere.” Now that Gawande is in the driver’s seat, will he actually be able to do anything about high costs? Those in the medical field were quick to praise him as a “luminary,” but many had concerns about his lack of experience managing a large organization — and the fact that he seems to have lots of other big jobs from Harvard to The New Yorker already demanding his time.

Bloomberg: Can This Surgeon Help Buffett, Bezos and Dimon Solve America’s Health-Care Crisis?

Bloomberg: Doctor and Journalist Atul Gawande Picked for Dimon-Bezos-Buffett Health Firm

And, pharma might be breathing a small sigh of relief. Gawande insists that, despite all the headlines, drug costs aren’t what’s driving spending. The No. 1 culprit according to him? Surgery.

Reuters: Head of New U.S. Corporate Health Plan Cites Surgery As Biggest Cost


President Donald Trump ended his policy to separate migrant children from their parents this week, but chaos at the border continues. Mental health experts and physicians are focusing on the lasting psychological and physical toll on the kids — many who remain in detention centers. Other questions are percolating as well, like: Who benefits from the business of separation? Providing care for those who have been detained is expensive and private contractors are lining up for the work.

Modern Healthcare: Immigrant Detention Crisis Could Yield Profit for Some Providers and Payers

Los Angeles Times: ‘Children Must Not Be Abused for Political Purposes’: What Health Groups Say About Family Separation


Back before the health law, “unauthorized or bogus” insurance schemes were thick on the ground. Now that Trump has released his rule on association health plans (which give small businesses access to insurance options like those available to large companies and let them skirt some of the health law’s requirements), fraud experts are worried the era is going to make a return.

Modern Healthcare: Fraud Fears Rise As Feds Expand Access to Association Health Plans

And if you thought repeal-and-replace was a thing of the past, a group of conservatives helmed in part by the Heritage Foundation have released a new “repeal” plan. While it is extremely unlikely any Republicans in Congress will touch it with a 10-foot pole this close to midterms, the blueprint does show that there’s still an appetite to completely upend the health law.

The Hill: Conservative Groups Outline New ObamaCare Repeal Plan


What’s in a name? Well, critics of the administration’s plans to rename HHS — replated as the Department of Health and Public Welfare — says it means quite a lot. As part of a larger shake-up of agencies, Trump wants to tuck all public assistance programs (like SNAP) into HHS and change its name. But while officials say that adding “welfare” to the department’s title would make it clear what services it provides, others say the word brings with it a negative connotation that would make the programs vulnerable to budget cuts. (Spoiler alert: These moves require congressional approval and would strip some lawmakers of authority, so they’re unlikely to actually come to pass.)

Modern Healthcare: White House Proposes HHS Restructuring and Renaming to Consolidate Welfare Programs

The Wall Street Journal: Trump Proposes Combining Workforce Training, Welfare Programs in Agency Revamp


In the miscellaneous file this week: Some disabled veterans are being told they owe the government thousands of dollars because of an insurance program they didn’t even know existed; it’s not often you can all but feel the giddiness radiating off of articles, but these jaw-dropping results from a new therapy for Duchenne muscular dystrophy is getting everyone emotional; a drugmaker rode a nice wave of good PR and marketing for donating anti-overdose injectors to police departments. One little problem — the drugs were almost expired. And remember that NIH alcohol study where scientists courted the industry for funding? It was yanked after an internal investigation revealed that “so many lines” were crossed that “people were frankly shocked.”

The New York Times: Veterans Owe the D.O.D. Thousands for Survivor Benefits. Why Can’t They Opt Out?

Stat: Sarepta’s Gene Therapy for Duchenne Raises Hopes for ‘Real Change’

Stat: Drug Maker’s Donations of Overdose Antidote Were Close to Expiring

The New York Times: It Was Supposed to Be an Unbiased Study of Drinking. They Wanted to Call It ‘Cheers.’


And, as we head into the weekend, a question you can consider: What would you sacrifice for cheaper premiums?

Administration Eases Way For Small Businesses To Buy Insurance In Bulk

Small employers will more easily be able to band together to buy health insurance under rules issued Tuesday by the Trump administration, but the change could raise premiums for plans sold through the Affordable Care Act’s online marketplaces, analysts say.

The move loosens restrictions on so-called association health plans, allowing more businesses, including sole proprietors, to join forces to buy health coverage in bulk for their workers.

By effectively shifting small-business coverage into the large-group market, it exempts such plans from ACA requirements for 10 “essential” health benefits, such as mental health care and prescription drug coverage, prompting warnings of “junk insurance” from consumer advocates.

Supporters say the new Labor Department rules, which the government estimated could create health plans covering as many as 11 million people, will lead to more affordable choices for some employers.

When it comes to health insurance, “the regulatory burden on small businesses should certainly not be more than that on large companies,” Labor Secretary Alexander Acosta told reporters Tuesday.

Existing rules limit association plans to groups of employers in the same industry in the same region.

The new regulations eliminate the geographical restriction for similar employers, allowing, for example, family-owned auto-repair shops in multiple states to offer one big health plan, said Christopher Condeluci, a health benefits lawyer and former Senate Finance Committee aide.

The rules, to be implemented in stages into next year, also allow companies in different industries in the same region to form a group to offer coverage — even if the only reason is to provide health insurance.

Like other coverage under the ACA, association insurance plans will still be required to cover preexisting illnesses.

Analysts warn that because these changes will likely siphon away employers with relatively healthy consumers from ACA coverage into less-expensive trade-association plans, the result could be higher costs in the online marketplaces.

“If you have a group that is healthier than average, you might get a better rate from one of these plans, and your broker is going to come and say, ‘Hey, I can get you a better deal,’” said Dan Mendelson, president of Avalere Health, a consulting firm.

That would mean that, on balance, consumers insured through ACA small-group and individual plans could be older, sicker and more expensive, adding to years of erosion of the ACA marketplaces engineered by Republicans hostile to the law.

Loosening rules for association plans would lead to 3.2 million people leaving the ACA plans by 2022 and raising premiums for those remaining in individual markets by 3.5 percent, Avalere calculated this year.

America’s Health Insurance Plans, the largest medical insurance trade group, issued a statement saying the regulation “may lead to higher premiums” in ACA insurance and “could result in fewer insured Americans.”

Unlike ACA plans, association coverage does not have to include benefits across the broad “essential” categories, including hospitalization and emergency care.

The National Association of Insurance Commissioners previously warned that such plans “threaten the stability of the small group market” and “provide inadequate benefits and insufficient protection to consumers.”

The American Academy of Actuaries has expressed similar concerns.

Business groups praised the change, proposed in draft form earlier this year.

“We’ve been advocating for association health plans for almost 20 years, and we’re pleased to see the department moving aggressively forward,” said David French, senior vice president of government relations for the National Retail Federation.

Association plans have been around for decades, although enrollment has been more limited since the ACA’s passage. While some of the plans have worked well for their members, others have a checkered history.

In April, for example, Massachusetts regulators settled with Kansas-based Unified Life Insurance Company, which agreed to pay $2.8 million to resolve allegations that it engaged in deceptive practices, such as claiming it covered services that it did not.

The coverage “was sold across state lines and was issued through a third-party association,” according to a release from the Massachusetts attorney general’s office.

Administration Eases Way For Small Businesses To Buy Insurance In Bulk

Small employers will more easily be able to band together to buy health insurance under rules issued Tuesday by the Trump administration, but the change could raise premiums for plans sold through the Affordable Care Act’s online marketplaces, analysts say.

The move loosens restrictions on so-called association health plans, allowing more businesses, including sole proprietors, to join forces to buy health coverage in bulk for their workers.

By effectively shifting small-business coverage into the large-group market, it exempts such plans from ACA requirements for 10 “essential” health benefits, such as mental health care and prescription drug coverage, prompting warnings of “junk insurance” from consumer advocates.

Supporters say the new Labor Department rules, which the government estimated could create health plans covering as many as 11 million people, will lead to more affordable choices for some employers.

When it comes to health insurance, “the regulatory burden on small businesses should certainly not be more than that on large companies,” Labor Secretary Alexander Acosta told reporters Tuesday.

Existing rules limit association plans to groups of employers in the same industry in the same region.

The new regulations eliminate the geographical restriction for similar employers, allowing, for example, family-owned auto-repair shops in multiple states to offer one big health plan, said Christopher Condeluci, a health benefits lawyer and former Senate Finance Committee aide.

The rules, to be implemented in stages into next year, also allow companies in different industries in the same region to form a group to offer coverage — even if the only reason is to provide health insurance.

Like other coverage under the ACA, association insurance plans will still be required to cover preexisting illnesses.

Analysts warn that because these changes will likely siphon away employers with relatively healthy consumers from ACA coverage into less-expensive trade-association plans, the result could be higher costs in the online marketplaces.

“If you have a group that is healthier than average, you might get a better rate from one of these plans, and your broker is going to come and say, ‘Hey, I can get you a better deal,’” said Dan Mendelson, president of Avalere Health, a consulting firm.

That would mean that, on balance, consumers insured through ACA small-group and individual plans could be older, sicker and more expensive, adding to years of erosion of the ACA marketplaces engineered by Republicans hostile to the law.

Loosening rules for association plans would lead to 3.2 million people leaving the ACA plans by 2022 and raising premiums for those remaining in individual markets by 3.5 percent, Avalere calculated this year.

America’s Health Insurance Plans, the largest medical insurance trade group, issued a statement saying the regulation “may lead to higher premiums” in ACA insurance and “could result in fewer insured Americans.”

Unlike ACA plans, association coverage does not have to include benefits across the broad “essential” categories, including hospitalization and emergency care.

The National Association of Insurance Commissioners previously warned that such plans “threaten the stability of the small group market” and “provide inadequate benefits and insufficient protection to consumers.”

The American Academy of Actuaries has expressed similar concerns.

Business groups praised the change, proposed in draft form earlier this year.

“We’ve been advocating for association health plans for almost 20 years, and we’re pleased to see the department moving aggressively forward,” said David French, senior vice president of government relations for the National Retail Federation.

Association plans have been around for decades, although enrollment has been more limited since the ACA’s passage. While some of the plans have worked well for their members, others have a checkered history.

In April, for example, Massachusetts regulators settled with Kansas-based Unified Life Insurance Company, which agreed to pay $2.8 million to resolve allegations that it engaged in deceptive practices, such as claiming it covered services that it did not.

The coverage “was sold across state lines and was issued through a third-party association,” according to a release from the Massachusetts attorney general’s office.

Postcard From D.C. Courthouse: Medicaid Work Requirements And Manafort

It’s probably safe to say that the scrum of reporters — noses and lenses pressed up to the glass doors of the E. Barrett Prettyman Federal Courthouse in Washington, D.C., — were not there to cover a hearing regarding Kentucky’s work requirements for some Medicaid recipients.

No, the news satellite trucks parked outside and long queue of spectators stacked up against the building where there to catch a glimpse of Paul Manafort, President Donald Trump’s former campaign chairman, who was appearing that same morning before another judge in another federal courtroom.

But while the hearing for the Stewart v. Azar case might not have generated as much buzz as Manafort’s, it has the potential to impact many more people. Kentucky itself says as many as 95,000 enrollees would likely lose coverage.

Judge James E. Boasberg acknowledged that he wasn’t presiding over the flashiest case in the courthouse.

“I guess the Paul Manafort overflow room was full so you decided to come in here,” he said.

Even so, Boasberg’s courtroom was packed, with about 65 people inside and a few others waiting outside.

People started to line up for entry more than 90 minutes before the hearing’s 11 a.m. start. They huddled in the cream-colored hallway near its marble pillars to discuss health policy — and the Manafort scene. By 10:30 a.m., a security guard arrived on the scene to shush the assembled crowd, complaining that she could hear their chatter from “every level” of the courthouse.

Who knew Medicaid wonks were such a rowdy bunch?

There was a lot at stake, though. The case’s outcome could reverberate across the country and help determine how much authority the Trump administration has to unilaterally change Medicaid.

Medicaid is the federal-state health insurance program for low-income and disabled people. Kentucky expanded Medicaid under the Affordable Care Act, but got approval from the Trump administration this year to require healthy adults who gained that coverage to prove that they are working, volunteering or taking care of family members for at least 80 hours each month.

Three advocacy organizations sued the federal government on behalf of 15 Kentucky Medicaid recipients who said they would lose their coverage if the work requirements, and some other aspects of Kentucky’s plan, were implemented.

The crux of the argument boiled down to this: What is the purpose of Medicaid?

Ian Heath Gershengorn, the attorney arguing on behalf of the Medicaid recipients, said the Kentucky plan went too far. Instead of tweaking some things to make Medicaid better or allow it to serve more people, he argued that Kentucky was fundamentally turning it away from a program designed to improve medical access.

The main goal of the Medicaid statute, according to Boasberg, was to furnish “medical assistance” to people. How then could stripping coverage from 95,000 individuals fit that definition, he asked.

Justice Department attorney Ethan Davis said people who lost their coverage because of the work requirement would find it in the private or employer-sponsored market. Plus, the secretary of Health and Human Services had interpreted Kentucky’s plan to be consistent with Medicaid’s, he added.

Davis also said if Kentucky’s work requirements were struck down, it would discourage other states from expanding their Medicaid programs.

Boasberg said he would try to have a decision by the end of June. Kentucky’s work requirements are scheduled to go into effect July 1.

Must-Reads Of The Week From Brianna Labuskes

President Donald Trump’s summit with North Korean leader Kim Jong Un may have stolen a bit of the spotlight from health care this week, but there’s still plenty of news to go around in our corner of the world. Here’s what you may have missed.

Republicans are cringing at the administration’s decision not to defend the health law’s preexisting condition provision. The move is likely to serve as a tailor-made soundbite for Democrats as lawmakers hit the campaign trail for the midterms. In fact, Dems are already going after the decision as “a sick joke,” while Senate Majority Leader Mitch McConnell (R-Ky.) is doing damage control. “Everybody I know in the Senate — everybody — is in favor of maintaining coverage for preexisting conditions,” McConnell told reporters in the Capitol. “There is no difference in opinion about that whatsoever.”

Politico: Trump’s Latest Health Care Move Squeezes Republicans

The New York Times: A ‘Sick Joke’: Democrats Attack Health Secretary On Pre-Existing Conditions

Politico: McConnell: ‘Everybody’ In Senate Likes Pre-Existing Condition Safeguards


Insurers are less than pleased with a court’s decision that they are not owed billions of dollars from the government under the health law’s risk corridors program. The program was designed to entice insurers into the marketplace with promises of covering their financial risk. But the panel said the government doesn’t have to pay insurers the money because Congress had taken action — after the health law’s passage — requiring the program to be budget neutral year after year. Insurers complain the rug was pulled out from under them.

The Wall Street Journal: Federal Government Doesn’t Have To Pay Billions To Health Insurers, Court Rules


The big dogs in the insurance industry are slowly inching toward a model where they could deny emergency room claims — and hospitals, doctors and lawmakers are all livid imagining a world where patients worry about whether their visits are going to be covered before seeking emergency care. The companies, though, argue that unnecessary ER visits are a huge factor in driving up medical costs. They’re not wrong, but the subject has always been taboo before.

Politico: Insurers Spark Blowback By Reducing Emergency Room Coverage


CRISPR is so hot right now it even spawned a (canceled) TV show. But a report that found genes edited by the technology could essentially be cancer “ticking time bombs” sent stocks spiraling this week.

Stat: CRISPR-Edited Cells Might Cause Cancer, Two Studies Find


Lawmakers are gearing up to consider a whopping 57 measures in an opioid package that is sure to win both Democrats and Republicans political points — conveniently just before the midterms. But advocates say the bills may still fall short of what’s needed to battle the country’s epidemic.

Stat: Can Major Opioids Legislation Make A Dent In A National Epidemic?


And in the miscellaneous file this week: A report confirms that sexual harassment is rampant in the academic sciences (“Most of that harassment is not the Harvey Weinstein harassment. It’s the everyday put-downs, and exclusions and belittlings,” said one woman); an ALS scientist who was diagnosed with the disease after he started researching it says he finds reason to live by helping others fight the condition that has ravaged his body; a nationwide survey reports that the kids are not all right, with sadness and hopelessness on the rise in teens (they’re also drinking less milk for what it’s worth); and how being black in America can deeply affect your health.

The Washington Post: Half Of Women In Science Experience Harassment, A Sweeping New Report Finds

The Washington Post: Devastated By ALS, Trying To Save Others

The New York Times: Sex And Drugs Decline Among Teens, But Depression And Suicidal Thoughts Grow

The Atlantic: Being Black In America Can Be Hazardous To Your Health


As you’re planning your weekend, you should probably know the oft-touted Mediterranean diet report has been retracted as flawed. But if you’re a fish, olive oil and nuts person, don’t worry, experts still think the diet is beneficial to heart health. Meanwhile, I’ll be over here worrying about my DNA’s digital footprint.

Most Texans Want State To Expand Medicaid And Help Poor Get Health Care

Texans think the Legislature should expand Medicaid to more low-income people and make health care more affordable, according to a survey released Thursday.

Researchers surveyed 1,367 Texans between March and May of this year about topics ranging from Medicaid, the Affordable Care Act, maternal mortality and the role of government in tackling health care issues.

Here are some takeaways from the survey by the Kaiser Family Foundation and the Episcopal Health Foundation. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

1) Almost All Texans See A Role For The Texas Legislature

Texans overwhelmingly agree that the state should have a role in making health systems work. According to the survey, 67 percent of those surveyed said the state should have a “major role” and 28 percent said a “minor role” in health care. Only 5 percent of Texans said the state should have no role.

“A majority of Texans say that the state has an important role to play in health care,” said Elena Marks, the president and chief executive officer of the Episcopal Health Foundation. “The state is not doing enough and the state should spend more. And people also believe that the state has a role to play in increasing access to insurance.”

2) Texans Are Concerned About Maternal Deaths

When asked what the state Legislature should make a top health care priority, 59 percent of Texans said “reducing the number of women who die from causes related to pregnancy and childbirth.”

That response came in a close second to “lowering the amount individuals pay for health care” (61 percent).

Marks says she thinks a lot of this concern is probably related to media coverage around maternal mortality and that the question itself is really a “no-brainer.”

“‘You mean people are dying from pregnancy and childbirth?’” she said. “I think people may just look at that and go, ‘Well, of course you should be doing something about that.’”

3) Medicaid Expansion Is Popular

About two-thirds of Texans (64 percent) said they think Texas should expand Medicaid to cover more low-income people. Texas is 1 of the 17 states that have not expanded Medicaid under the Affordable Care Act.

Even though feelings in the state are still mixed on the ACA, the survey found that Medicaid is quite popular.

“Roughly 4 million people are covered by Medicaid in Texas, nearly three-quarters of whom are children,” according to the survey’s authors. When asked, 6 in 10 Texans said Medicaid is important to their families.

Marks said she thinks the conversation about Medicaid expansion in Texas is limiting for people seeking more insurance coverage here. She says the state should have a conversation about coming up with its own way to expand access to affordable coverage, which is a popular idea across the political spectrum.

“Let’s stop talking about Medicaid expansion and let’s start talking about expanding access to affordable health insurance coverage,” Marks said.

4) Texans Say We Aren’t Helping The Poor Enough

Roughly two-thirds of Texans also say the state is not doing enough to make sure low-income people get the health care they need.

Respondents also think lawmakers could do more to help children (45 percent) and immigrants (41 percent) get coverage. Broken down by party, Republicans were less likely to say that the state is not doing enough to help vulnerable populations get health care services.

5) A Lot Of Texans Don’t Know Basic Facts About Health Care Here

One of the standouts in this survey is how little people know about the state’s health care system. Consistently, however, Republican respondents were more likely to be misinformed.

For example, groups asked Texans whether the state’s uninsured rate is higher compared to other states. According to the survey, 3 in 10 Texans (31 percent) correctly answer that it is higher. Broken down by party, only 24 percent of Republicans knew Texas has a larger than average share of uninsured people, while 38 percent of Democrats did.

Marks says that could explain why Republicans are less likely to say they think there are problems with the state’s health care system.

“If you think we have about the same or lower uninsured rates, then you don’t think there’s a problem unique to us that we need to solve,” she said.

Texans were also asked whether Medicaid had been expanded in the state; 51 percent of those surveyed correctly said the state had not expanded it.

According to the study’s authors, “Democrats are somewhat more likely than Republicans and independents to know that Texas has not expanded its Medicaid program” (62 percent, 43 percent, and 52 percent, respectively).

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


KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.

Podcast: KHN’s ‘What The Health?’ California Here We Come

 

Health care is a big political issue, but no place more than in California. In San Francisco last week, voters overwhelmingly approved a ballot measure upholding a ban on flavored tobacco products — over the vehement objections of the tobacco industry.

And the state’s activist attorney general, Xavier Becerra, is leading a group of Democratic officials from more than a dozen states defending the Affordable Care Act in a case filed in Texas. That is important given that the Trump administration’s Justice Department decided not to defend the law in full from charges that changes made by Congress in last year’s tax law invalidates the health law.

This week’s panelists for KHN’s “What the Health?” are: Julie Rovner of Kaiser Health News, Anna Maria Barry-Jester of FiveThirtyEight.com, Carrie Feibel of KQED San Francisco and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

  • Republicans and Democrats had been gearing up for a midterm election debate on who is responsible for higher health insurance costs. But that shifted last week to an argument over whether consumers with preexisting conditions should be guaranteed coverage following the Justice Department’s brief saying changes to the ACA invalidated those protections.
  • In California, there is widespread support among Democrats for a single-payer health system. But the term is somewhat amorphous. For some officials, it is a catch-all phrase that seems to suggest strong efforts with current programs to get the uninsured rate down to zero, while still keeping much of the current insurance system in place.
  • Becerra has filed a suit against Sutter Health, a giant in the hospital industry in Northern California, alleging that consolidation has resulted in anti-competitive pricing practices.
  • San Francisco’s adoption of a referendum to ban flavored tobacco products could lead other local governments to follow suit. The measure included not only products with flavors allegedly geared to young people, but also menthol cigarettes, which make up about 30 percent of the market.

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

Julie Rovner: The New York Times, “Elizabeth Warren And A Scholarly Debate Over Bankruptcy That Won’t Go Away,” by Margot Sanger-Katz.

Anna Maria Barry-Jester: The Atlantic, “Being Black In America Can Be Hazardous To Your Health,” by Olga Khazan.

Carrie Feibel: KQED, “In The Land Of Legal Weed, Drug Education Moves From ‘Don’t’ To ‘Delay,’” by Carrie Feibel.

Joanne Kenen: The Miami Herald, “She Dreamed Of Getting Plastic Surgery In Miami. Three Days Later, She Was Dead,” by Sarah Blaskey, Sonia Osorio, and Daniel Chang.

To hear all our podcasts, click here.

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

California’s Attorney General Vows National Fight To Defend The ACA

California Attorney General Xavier Becerra pledged Friday to redouble his efforts as the Affordable Care Act’s leading defender, saying attacks by the Trump Administration threaten health care for millions of Americans.

Becerra’s pledge came in response to an announcement from the administration Thursday that it would not defend key parts of the Affordable Care Act in court. The administration instead called on federal courts to scuttle the health law’s protection for people with preexisting medical conditions and its requirement that people buy health coverage.

Becerra accused the administration of going “AWOL.” It “has decided to abandon the hundreds of millions of people who depend on” the law, he said in an interview with Kaiser Health News.

“It’s, simply put, an attack on the health care that millions of Americans have come to count on, and California, being the most successful state in implementing the Affordable Care Act, stands to lose perhaps more than anyone else.”

About 1.5 million Californians buy coverage through the state’s ACA exchange, Covered California, and nearly 4 million have joined Medicaid as a result of the program’s expansion under the law.

The state has been at the forefront in resisting many Trump Administration policies, including on health care and immigration.

“This is not a new experience for us under this new Trump era of having to defend Californians,” Becerra said. In the case of health care, “fortunately we have 16 other  [Democratic attorneys general] who are prepared to do it with us. ”

At issue is a lawsuit filed by 20 Republican state attorneys general on Feb. 26, which charged that Congress’ changes to the law in last year’s tax bill rendered the entire ACA unconstitutional. In the tax law, Congress repealed the penalty for people who fail to have health insurance starting in 2019.

Becerra is leading an effort by Democratic attorney generals from others states and the District of Columbia to defend the ACA against that lawsuit. In May, the court allowed them to “intervene” in the case.

The Trump administration filed a brief in the case on Thursday, arguing that without the tax to encourage healthy people to sign up, the parts of the law guaranteeing coverage to people with previous health conditions — without charging them higher rates — should be struck down as well.

In a letter to House Speaker Paul Ryan explaining the administration’s decision, U.S. Attorney General Jeff Sessions cited the Justice Department’s “longstanding tradition” of defending the constitutionality of federal laws “if reasonable arguments can be made in their defense.”

But in this case, he wrote, he could not find those arguments to defend the constitutionality of the provisions and “concluded that this is a rare case where the proper course is to forgo defense.”

The administration called on the court to declare the provisions that guarantee coverage to be invalid beginning on January 1, 2019, when the mandate penalty goes away.

Because the lawsuit could easily go all the way to the U.S. Supreme Court, a process that could take years, the protections for people with preexisting conditions are likely to stay in place during that period.

Lieutenant Governor Gavin Newsom, the Democratic front-runner in the race for California’s next governor, breathed the same fire as Becerra against the federal government on Friday.

“Trump and his cronies can’t unilaterally roll back preexisting protections for millions of Californians,” Newsom said. “California will fight like hell to protect our families and their healthcare.”

A spokesman for his opponent in the race, Republican gubernatorial candidate John Cox, declined to comment.

If the court ultimately declared the provisions targeted by the Trump Administration unconstitutional, California would be temporarily cushioned from the effects because there are laws already on the books should the ACA – or its provisions – go away.

For instance, existing rules would protect people with pre-existing conditions for twelve months if the ACA were struck down.

During that time, “policymakers in California would look really hard at being able to try to do something so we don’t lose those gains,” said Deborah Kelch, director of the Insure the Uninsured Project in Sacramento.

“It’s hard to look at California and imagine just folding it up and starting over.”

Some critics of the administration’s decision said California should go forward with enacting its own mandate for individual coverage, as a few other states have done. No one has pushed that issue forward in the Legislature.

Since he took office in January 2017, Becerra has emerged as a top opponent of the Trump administration, filing more than 30 lawsuits on health care and other issues.

In California’s primary election Tuesday, Becerra, a Democrat, dominated the race with 45 percent of the vote. He will face retired judge Steven Bailey, a Republican, in the November general election.

Bailey’s spokesman Corey Uhden said Friday that he wouldn’t comment on the constitutionality of the ACA provisions. However, he said, Bailey opposes the individual mandate and wants less government regulation of health insurance.

Alex Leeds Matthews contributed to this report.

 


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

Administration Challenges ACA’s Preexisting Conditions Protection In Court

The Trump administration is refusing to defend key parts of the Affordable Care Act, essentially arguing that federal courts should find the health law’s protection for people with preexisting conditions unconstitutional.

The federal lawsuit hinges on the ACA’s individual mandate, or the requirement to get health coverage or pay a penalty. The mandate has long been a sticking point for conservatives, who argue that the government should not be telling individuals what coverage they must have.

But that mandate was crucial to persuading insurers to offer plans under the ACA. It helped expand their risk pools while the law forced them to guarantee coverage to any customer. Insurers were not allowed to raise costs for people with preexisting conditions. The administration’s brief, filed Thursday in federal district court in Fort Worth, Texas, takes aim at those links.

Twenty Republican state attorneys general filed suit on Feb. 26, charging that Congress’ changes to the law in last year’s tax bill rendered the entire ACA unconstitutional. In the tax law, Congress repealed the penalty for people who fail to have health insurance starting in 2019.

The attorneys general argue that a Supreme Court decision in 2012 saved the ACA from being declared an unconstitutional overreach of congressional power by declaring the penalty a tax and pointing out that Congress has the power to levy taxes. Without the tax penalty, they argue, “the Court should hold that the ACA is unlawful and enjoin its operation.”

The Trump administration Thursday did not go that far. Rather, it argued that without the tax to encourage healthy people to sign up, the parts of the law guaranteeing coverage to people with health conditions and charging them the same rates should be struck down as well.

The administration called on the court to declare the provisions that guarantee coverage to be “invalid beginning on January 1, 2019,” when the mandate penalty goes away.

Here are five things to know about this latest in a long line of challenges to the health law:

If This Lawsuit Succeeds, Who Would Be Affected?

People who buy their own insurance because they are self-employed or don’t get coverage through their jobs or the government. There are about 21 million people who do so, buying either through brokers or from a state or federal Affordable Care Act marketplace.

But it’s not clear how many Americans have preexisting conditions and could be affected. Estimates vary widely because there is not a standard definition of what counts as a preexisting condition. Before the ACA passed, insurers commonly rejected people with cancer, heart failure, diabetes, arthritis and even less serious conditions.

Based on those pre-ACA examples, the Kaiser Family Foundation estimates that 27 percent of people under age 65 have a preexisting condition. Of course, not all of them buy coverage on their own. (Kaiser Health News is an editorially independent program of the foundation.)

America’s Health Insurance Plans, an industry trade group, Friday criticized the federal government’s filing.

“Zeroing out the individual mandate penalty should not result in striking important consumer protections” that help guarantee coverage to people with preexisting conditions, the statement said. “Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019.”

Is Anything Going To Change Right Away? What About Next Year?

Don’t look for big changes yet.

The lawsuit could easily go all the way to the Supreme Court before there is a resolution, which could take years. So, the preexisting conditions protection is likely to stay in place during that period.

More immediately, there might be some effect on premiums for next year. Health insurers are currently deciding whether to sell coverage in the individual market in 2019 — and what they’re going to charge.

“The more uncertainty there is, the more the actuaries are going to be plugging into their projections for premium rates,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute.

But others say the legal brief may have minimal impact next year on premiums. That’s because insurers already expected the Trump administration would not defend the ACA — and they know that a resolution of the case will be years away, said industry consultant Robert Laszewski.

A bigger effect on premiums, according to both Corlette and Laszewski, are factors already in play that are expected to draw younger and healthier people out of the ACA marketplace. Those include Congress’ decision to repeal the individual mandate penalty and rules expected soon from the administration that will expand the market for lower cost and short-term policies that won’t have to follow all the ACA rules.

How Is This Lawsuit Different From Previous Challenges To The ACA?

The Supreme Court has twice upheld the constitutionality of the health law. Most famously, in 2012, a narrow majority led by Chief Justice John Roberts turned back a challenge that was also filed by Republican attorneys general, along with the National Federation of Independent Business. Roberts wrote in a 5-4 ruling that the requirement for most Americans to either have insurance or pay a fine constitutes a tax — even though Democrats had gone to great lengths to not call it a tax — and was therefore constitutional.

In 2015, the court ruled that Congress did not intend to provide financial aid exclusively for premiums to individuals in states that operated their own insurance exchanges.

This current lawsuit, led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, argues that since Congress has changed the law to remove the penalty forcing individuals to get insurance, it has inadvertently rendered the rest of it impermissible under the 2012 Supreme Court ruling.

“Texans have known all along that Obamacare is unlawful and a divided Supreme Court’s approval rested solely on the flimsy support of Congress’s authority to tax,” said Paxton when the suit was filed. “Congress has now kicked that flimsy support from beneath the law.”

Other legal observers point out that’s not how it works.

“Congress is always free to amend its statutes, even to omit what it previously thought was essential,” wrote Nick Bagley, a law professor at the University of Michigan, in a blog. “That’s what Congress did when it zeroed out the mandate. So we don’t have to speculate what Congress would’ve done if it had a choice between invalidating the ACA’s insurance reforms or just invalidating the mandate. Congress made that choice.”

If The Trump Administration Isn’t Going To Defend The Health Law In This Lawsuit, Who Will?

In May, the court allowed more than a dozen Democratic attorneys general to “intervene” in the case and defend the law.

“The goal of Texas’ lawsuit is to leave Americans without health insurance, forcing them to choose between their health and other needs,” said California Attorney General Xavier Becerra. Allowing the Democratic officials to join the suit “allows us to protect the health and well-being of these Americans by defending affordable access to healthcare.”

If Nothing Is Going To Happen Right Away, Why Is This Such A Big Deal?

The guarantees for coverage for people with preexisting conditions are among those most valued by the public. Even if the lawsuit stands little chance of success, putting those provisions back in play can create uncertainty for insurers and patients. It could also possibly provide Democrats another talking point for the coming midterm elections in November.

Legal experts also point out that the Trump administration’s failure to defend the law could have long-lasting implications for the rule of law in the nation.

“If the Justice Department can just throw in the towel whenever a law is challenged in court, it can effectively pick and choose which laws should remain on the books,” wrote Bagley. “That’s as flagrant a violation of the President’s constitutional duty to take care that the laws are faithfully executed as you can imagine.”

Must Reads Of The Week From Brianna Labuskes

A distinctly sad and sobering week: days of suicide stories follow the deaths of Anthony Bourdain and Kate Spade. The events, and a devastating report about spiking suicide rates across the country, threw self-harm and mental health awareness into the spotlight. Advocates took to social media to spread the message: Depression “doesn’t discriminate.”

Here’s what else you may have missed this week.

The Justice Department is refusing to defend the health law in court, leaving a coalition of blue-state attorneys general to do the heavy lifting. It’s a political gamble for the administration as it could rattle an already unstable marketplace as the midterm elections creep up on us.

“Of all the things the Trump administration has done to destabilize the market, this may be the most major,” said Timothy Jost, a professor emeritus at Washington and Lee University and a health law supporter. Also, meet the Texas plaintiffs at the heart of the case who feel compelled to follow the letter of the law, despite the lack of penalty.

In a compelling profile, they’re likened to people who don’t “take a tag off of their mattress” because of the legal warning.

The New York Times: Justice Dept. Says Crucial Provisions of Obamacare Are Unconstitutional

Politico: Texas Plaintiffs Personalize Uphill Legal Challenge to Overturn Obamacare

And, these insurers say they don’t expect to lose customers next year, but they’re still planning on raising premiums by the double digits. At first that might warrant a “huh?” moment, but it all comes down to a business calculation. The insurers know when one company loses customers that can have a ripple effect though the marketplace. So, they’re all in a defensive crouch.

Modern Healthcare: Insurers Downplay Mandate Repeal’s Effect, But Still Raise Premiums


Other big news is the grim outlook for Medicare’s trust fund — it’s now expected to be depleted in 2026 instead of 2029, as was projected last year. To be clear, though, the money that’s running out is used to pay for hospital visits. Other services are supported primarily through general funds.

The New York Times: Medicare’s Trust Fund Is Set to Run Out in 8 Years. Social Security, 16.


Single-payer, single-payer, single-payer. You’ve probably heard that phrase a lot in the past year or so, especially this week when the California gubernatorial race was at center stage. But Democrats are being warned not to actually utter those words on the trail, leadership being worried that it could divide the party and make progressive candidates vulnerable to attacks from the GOP. That doesn’t mean talk about universal coverage is verboten, it’s just that the hot buzzword won’t be on too many candidates’ lips this summer and fall.

Politico: The 2 Words You Can’t Say in a Democratic Ad

The New York Times: In Fight for California Governor, Candidates Head to Ideological Corners


Thanks, but no thanks: Pharma companies aren’t all that interested in taking advantage of the relaxed provisions included in the “Right-to-Try” legislation that lawmakers passed recently after a series of fits and starts. It turns out, Big Pharma likes to go through the FDA anyway … which opponents have been saying all along.

The Wall Street Journal: The ‘Right to Try’ Law Says Yes, The Drug Company Says No

And, you think it’s hard to control drug prices for popular, lifesaving medications? What about when the treatment is for a problem no one wants to talk about?

The New York Times: Prices Keep Rising for Drugs Treating Painful Sex in Women


In our miscellaneous file for the week: In somewhat-rare good news, a study found that many women with a common form of breast cancer can skip chemotherapy; a court is weighing whether punishing an offender for having a drug relapse counts as “cruel and unusual punishment”; marijuana addiction is surging, but experts are having a hard time convincing people it even exists; and remember Brazil’s Zika babies? They’re growing up.

The Associated Press: Many Breast Cancer Patients Can Skip Chemo, Big Study Finds

The New York Times: She Went to Jail for a Drug Relapse. Tough Love or Too Harsh?

Stateline: Yes, You Can Become Addicted to Marijuana. and the Problem Is Growing.

The Associated Press: From Shrieks in Bucket to Laughs, Brazil Zika Baby Improves


I also feel duty-bound to point out that the U.S. has now issued a health alert over the unexplained brain injuries that have cropped up in diplomats serving in China. The mystery — make of it what you will — continues! Lots to read this weekend!