Tagged The Health Law

Analyzing The Issues: Cadillac Plans, The ‘Single-Payer Trap’, Health Care Appropriations And Medicare’s Future

Opinion writers offer their takes on health policies that operate as context to the current congressional debate.

Bloomberg: Democrats And The Single-Payer Trap
For seven and a half years, Republicans have campaigned and voted to replace the Affordable Health Care Act. When given a real chance at success, with governing control, they were impeded by a president who’s ignorant on the issue. Then, after Republican senators slipped behind closed doors to come up with their own plans, they provided products that voters, even some Trump supporters, overwhelmingly spotted as frauds. (Albert R. Hunt, 7/25)

Huffington Post: A Message For House Republicans: Actions Speak Louder Than Words
Republicans on the House Appropriations Committee offered some promising phrases when describing their fiscal year 2018 Labor-HHS budget: “Invest in essential health,” “focus investments in programs our people need the most,” and “targeting investments in … public health. ”House LHHS Subcommittee Chair Tom Cole concluded, “This bill is one that reflects the priorities that Americans value, and will continue to support the well-being of Americans through funding these vital programs.” (Clare Coleman, 7/24)

The Wall Street Journal: The Deadline To Kill The Death Panel
All eyes are on the Senate as it debates what to do about ObamaCare. But the House has a last chance this week to abolish one of the law’s most dangerous creations: a board with sweeping, unchecked power to ration care. The Independent Payment Advisory Board—what critics call the death panel—would be an unelected, unaccountable body with broad powers to slash Medicare spending. But the law contains a living will for IPAB. If the president signs a congressional resolution extinguishing the panel by Aug. 15, it will never come into existence. (Grace-Marie Turner and Doug Badger, 7/25)

Milwaukee Journal Sentinel: Medicare Cuts Are A Raw Deal For Wisconsin Seniors
Unfortunately, a federal advisory panel is urging lawmakers to cut Medicare Part B, the program that covers chemotherapies, immunotherapies and other advanced drugs that must be administered by doctors. If Congress implements this recommendation, these trends could reverse, as Wisconsin seniors would lose access to life-saving medications. (Sandra Gines and Carrie Riccobono, 7/25)

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

How It’s Playing On the Ground: A ‘Farce’ Not A Plan? Scolding A Senator

News outlets beyond the beltway offer their perspectives on the Senate’s replacement for Obamacare and what lawmakers should be doing.

San Jose Mercury News: Republican Health Care Is No Plan, It’s A Farce
Americans are divided on what to do about health care, but they should be united in this conclusion: Senate Republicans’ manic approach to reforming a sector that represents one-sixth of the U.S. economy and determines life or death for millions of people is utterly craven and irresponsible. …This is how Republicans are going to determine how Americans get their health care? (7/25)

Arizona Republic: ‘Obamacare Lies’ Or Trump Lies: Which Would You Rather Have?
President Donald Trump raged against what he called “Obamacare lies” Monday, urging Senators to move forward on a repeal and replace plan for the Affordable Care Act. …But the proposals put forth so far by Republicans, and backed by Trump, are estimated to leave tens of millions of Americans without health care and put tens of millions more with very limited coverage and at risk for bankruptcy should anyone in the family contract a major illness. (EJ Montini, 7/25)

Cleveland Plain Dealer: Sen. Rob Portman Must Stand Against Rush To Flawed Senate Health Care Vote
As Sen. Susan Collins, a Maine Republican, said Sunday, if the Senate does open floor debate, it’s unclear whether senators would be dealing with Paul Ryan’s House-passed bill, Mitch McConnell’s first, second or (unseen) third plan – or an ACA repeal, with a Senate promise to replace the law, eventually. …That’s also why Sen. Rob Portman, a suburban Cincinnati Republican who has spelled out his own careful stance on protecting Ohioans that he says will guide his vote, must vote “no” on moves by McConnell to force Senate action on an ill-considered, narrowly partisan package that would devastate health care in Ohio. (7/25)

Cleveland Plain Dealer: Sen. Rob Portman, You Just Let Ohio Down
Sen. Rob Portman cast the wrong vote Tuesday in supporting a hasty, politically motivated effort to allow Senate debate and, presumably, a vote on one or a series of ill-considered, narrowly partisan measures likely to devastate health care in Ohio. …As Sen. Susan Collins, a Maine Republican who cast one of only two Republican “nos” on the Senate floor, said before the vote, no one even knew exactly what senators were being asked to debate and maybe vote on. (7/25)

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

Obamacare’s History Littered With Near-Death Experiences

Few laws have defied as many existential threats as the Affordable Care Act. In seven years, it has been to the brink of elimination nearly a dozen times, only to rally back from seemingly impossible odds. Efforts to kill it have come from Congress (including one in 2015 that made it all the way to President Barack Obama’s desk before being vetoed), the White House and the courts. So far, the law continues.

As the Senate continues its latest effort to remake the law, here is a timeline of the ACA’s “near-death” experiences, which occurred before the bill passed, during its implementation and after benefits began to flow.

Categories: Courts, Multimedia, Repeal And Replace Watch, The Health Law

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Obamacare’s History Littered With Near-Death Experiences

Few laws have defied as many existential threats as the Affordable Care Act. In seven years, it has been to the brink of elimination nearly a dozen times, only to rally back from seemingly impossible odds. Efforts to kill it have come from Congress (including one in 2015 that made it all the way to President Barack Obama’s desk before being vetoed), the White House and the courts. So far, the law continues.

As the Senate continues its latest effort to remake the law, here is a timeline of the ACA’s “near-death” experiences, which occurred before the bill passed, during its implementation and after benefits began to flow.


November 2009 — Abortion Nearly Stalls House Bill

In order to get the Affordable Care Act passed by the House, then-Speaker Nancy Pelosi (D-Calif.), an abortion-rights backer, had to give in to anti-abortion Democrats and include language expanding federal limits on the procedure, over the opposition of a majority of her colleagues.


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December 2009 — Democrats Forced To Drop ‘Public Option’

Independent Sen. Joe Lieberman of Connecticut refused to become the 60th vote needed to break a GOP filibuster unless Democratic leaders eliminated a provision to allow some people younger than 65 to opt in to Medicare rather than buy private health coverage.


January 2010 — Scott Brown Upsets Democrats’ Strategy

Brown, a Republican, unexpectedly won the seat left empty by the 2009 death of Sen. Edward Kennedy, depriving Senate Democrats of 60 votes, the number needed to force a vote on the bill. Backers of the bill moved to a complicated Plan B. That involved requiring the House to pass the Senate bill without any changes. Compromises were worked out through the budget reconciliation process that enabled Senate passage with only 51 votes.


March 2010 — Abortion Again Threatens Passage

House leaders still did not have the numbers needed for passage and had to negotiate with anti-abortion Democrats to gain enough votes. Those members forced more changes to the bill to get it across the finish line.


March 23, 2010 — Milestone: Bill Signed Into Law


June 2012 — High Court Upholds Health Law Mandate

Supreme Court Chief Justice John Roberts wrote in a 5-4 ruling that the requirement for most Americans to either have insurance or pay a fine constitutes a tax — and therefore is constitutional. In a separate decision, however, the justices in a 7-2 ruling said that the expansion of Medicaid had to be voluntary for the states.


November 2012 — Barack Obama Re-Elected President

Obama’s opponent, Republican Mitt Romney, had promised to undo the health law.


October 2013 — Healthcare.gov Fails To Launch

The health insurance enrollment website failed repeatedly in its debut. The technical difficulties made the law’s rollout a laughingstock. Only six people were able to sign up the first day. It took several weeks to make the site useable for large numbers of customers.


Jan. 1, 2014 — Milestone: Most Of Law’s Benefits Take Effect


June 2014 — Supreme Court Saves Health Law Again

The high court ruled that subsidies to help people afford coverage should be available in states that ran their own insurance exchanges and those that had defaulted to using the federal government’s website. The case centered on imprecise language in the law.


December 2015 — Repeal Passes Both Houses Of Congress

The House and Senate pass a bill that would have repealed major parts (although far from all) of the ACA, delaying most of the changes for two years to give themselves time to come up with a replacement plan. This was not really an existential threat to the bill, however, because lawmakers knew President Obama would veto the measure, which he did in January 2016.


March 2017 — House Stumbles In First Repeal Effort

With a president ready to make repeal a reality, the GOP-led House’s first try at an ACA overhaul ends in humiliating defeat when the measure cannot muster support from both conservatives and moderates. A subsequent version, however, designed to bring down premiums by loosening some consumer protections, passed the House in May.


June 2017 — Senate Stumbles In Effort To Pass Repeal

After Senate leaders had met behind closed doors for weeks to draft a bill, Majority Leader Mitch McConnell (R-Ky.) postpones the vote when it becomes clear he doesn’t have enough support. He had hoped to have it pass before Congress’ July Fourth recess.

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

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Rural Californians Want Price Relief From GOP Health Bill, But Unlikely To Get It

Aaron Albaugh peered out from under the brim of his cowboy hat, surveying the acres of hayfields in front of him. The fourth-generation rancher has raised about 450 cattle this year, in this remote corner of Lassen County, Calif.

His closest neighbor lives a half-mile away. “And that’s my brother,” Albaugh said.

“If I want to go see a movie, it’s 70 miles, round-trip,” he added. “If I want to go bowling, that’s 100 miles, round-trip.”

Living a half-day’s drive from civilization, you learn to do without, he explained. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.

“Put a Band-Aid on it,” Albaugh said. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”

For people who were already used to doing without health coverage, it was quite a culture shock when the Affordable Care Act came along and they were told they had to buy it. Residents complained that the premiums and deductibles were too high — and with only two insurers selling plans in their area, there wasn’t enough competition to bring down prices.

Many in this Republican corner of California are looking to the GOP majority in Congress to bring some relief. But for most of them, prices would jump even more under the main proposals the party has served up so far, and fewer services would be covered, according to analyses by the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” said Modoc County resident Althia Cline, who decided to forgo Obamacare coverage — and a surgery she needs to help with her asthma — when she couldn’t find a health plan that her doctors accepted.

Just like the movie theater and the bowling alley, most medical specialists are miles away. In Modoc County, there’s no hospital or birthing center where a woman can have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half from home.

Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.

Tessa Anklin says Covered California health plans are too expensive for her family. (April Dembosky/KQED)

Two years ago, they bought a plan through Covered California. Their monthly premium was just $2 a month after the ACA subsidy, but their annual deductible was $10,000.

“We paid for all of our medical services and our prescriptions,” she said. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”

Then, last year, their monthly premium jumped to $600. Anklin said she’s not sure what happened. It’s possible a technical glitch caused them to lose their subsidy. All she knew was that the plan was the same, their household income was the same, and they still faced the same hour-and-a-half drive to see doctors they almost never needed.

Anklin thought of all the other ways they could spend that money.

“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she said. “That’s a big difference, when you think about how little you actually use the health coverage.”

That’s the reason they decided to cancel their health plan this year and go without insurance. But they’ll still have to pay a penalty when the next tax season comes around.

“It basically penalizes us one way or the other because we can’t afford the coverage,” she said. “So, that’s kind of difficult — to be that middle-class person.”

Anklin said she’d be happy to see Republicans get rid of Obamacare.

“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck,” she said, “when they’re already trying to survive with what they have.”

But the Republican “repeal and replace” plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the   U.S. Senate plan, according to a recent analysis from the Kaiser Family Foundation. Anklin could end up paying roughly $2,000 more per year for the cheapest individual plan than under Obamacare, according to Kaiser’s county-by-county projections.

That’s not the kind of fix she had in mind.

“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin said.

With Republican health care plans in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.

Democrats have also said if the Republican repeal effort fails, they’d be willing to work together on solutions. But it’s not clear the parties could agree on one that would help people like Anklin.

If they can’t, Anklin said, she has no choice but to continue to go without coverage. Financially, it makes sense in the short term, but she still worries about an unforeseen surgery, serious illness or accident.

“If I ever have a problem,” she said, “I know I will be paying for the rest of my life.”

This story is part of a partnership that includes KQED, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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

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Postcard From Capitol Hill: What YouTube Didn’t Show You In Senate Health Care Vote

You had to be there.

After days of uncertainty about whether Senate Republicans would vote to begin debating a bill to repeal the Affordable Care Act, it boiled down to a few tense minutes on the Senate floor.

As the vote started shortly after 2 p.m. ET, 30 reporters crammed into the small hallway in front of the chamber, waiting for Arizona Republican Sen. John McCain’s dramatic arrival on the elevator. McCain had been out of Washington, D.C., since his recent diagnosis of brain cancer, but returned Tuesday to vote on the health care bill.

Reporters’ heads swiveled toward the doors each time they opened and when they weren’t doing that, they split their attention between watching the Senate floor action live-streamed on their phones and what they could glimpse through the chamber’s doors a few feet away.

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Inside, Health and Human Services Secretary Tom Price watched from near the entrance to the floor, talking with senators as they came over to him. Seema Verma, who heads the Centers for Medicare & Medicaid Services, made a brief appearance too.

When voting started, protesters in the gallery chanted “Kill the bill, not us!” — the sound of their shouts bouncing off marble steps to the floor below. They were dressed in white lab coats or in white clergy collars; all were dragged off by Capitol police.

Some had emergency bail money stashed in their pockets and emergency phone numbers written on their arms, just in case they were taken into custody without their phones. Police blocked reporters from talking to the protesters before their ejection from the gallery.

As “Yes” votes piled up from Republican senators, the outcome looked clear. “That’s it, they have the votes, they have the votes,” reporters murmured.

Then Sen. Lisa Murkowski (R-Alaska) voted no, joining Sen. Susan Collins (R-Maine). One more “No” vote from a Republican could defeat the GOP’s latest effort to repeal Obamacare.

Doubts revived.

Then in rapid succession — bam-bam-bam — Twitter erupted with announcements that Sens. Rob Portman (R-Ohio), Shelley Moore Capito (R-W. Va.), Dean Heller (R-Nev.) and Jerry Moran (R-Kans.) would vote yes.

By 2:45 p.m., the Republicans had 48 votes to proceed and only two senators left to vote. One was McCain. The other was Sen. Ron Johnson, a Wisconsin Republican who had been hesitant about the bill for weeks.

Johnson strode into the chamber after almost everyone else had voted and spent five tense minutes conferencing with Senate Majority Leader Mitch McConnell at the rear of the chamber. Hundreds of pairs of eyes were laser focused on the two men, standing close to one another, waving their hands and bobbing their heads.

Finally McCain appeared, accompanied by his wife, briskly walking 15 feet to the floor. One senator after another shook his hand and hugged him. Within minutes, both Johnson’s and McCain’s votes were known. The Republicans had 50 votes.

Afterward, McCain spoke simply and powerfully from Senate floor about the need for bipartisan cooperation to fix health care. “Our health care insurance system is a mess. We all know it, those who support Obamacare and those who oppose it. Something has to be done,” he said.

Vice President Mike Pence reminded the chamber to keep quiet, seconds before he cast the tie-breaking vote. The gallery, finally empty of protesters, heeded his words.

Categories: Repeal And Replace Watch, The Health Law

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Senate Votes To Move Ahead With Debate On Obamacare Replacement Bill

Jul 25 2017

Republican leadership secure the needed 50 votes — with Vice President Mike Pence casting the tie-breaking vote to reach 51 — to bring health care legislation to the floor.

Politico: Republicans Vote To Move Ahead On Obamacare Repeal
Senate Republicans voted Tuesday voted to open debate on repealing Obamacare, dramatically reviving an effort that many GOP lawmakers left for dead just a few days ago. The vote is a huge political win and turnaround for Senate Majority Leader Mitch McConnell and Republicans who’ve promised for seven years to repeal Obamacare if voters gave them control of Congress and the White House. (Haberkorn, Kim and Everett, 7/25)

Before the vote —

AP News: Mic Captures GOP Senator Ripping Trump, Mocking Lawmaker
Oh, that dreaded open microphone! Republican Sen. Susan Collins got caught Tuesday at the end of a hearing with a microphone that was still hot — and captured her ripping President Donald Trump and making fun of a fellow lawmaker who had been critical of her on health care. (Kerr, 7/25)

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

Who Knew Senate Health Bill Debate Could Be So Complicated?

So the Senate has voted to start debate on a bill to replace the Affordable Care Act. Now what?

Well, it gets wonky.

The rules for budget reconciliation, the process the Senate is using that limits debate and allows a bill to pass with only a simple majority, comes with a set of very specific rules. Here are some of the big ones that could shape whatever final bill emerges:

Matters Of Timing

Unlike most other Senate bills, where deliberation can last for days or weeks, budget reconciliation rules limit debate to 20 hours. While that 20-hour clock starts running as soon as the Senate votes to proceed to the bill, the debate can be paused. In other words, the Senate can recess for the night, then come back the next day and the clock would resume where it left off the day before. The 20 hours does not include time spent voting on amendments.

Near the end of the debate, Senate leaders could offer a substitute bill. It may incorporate some of the earlier amendments or not, and it is likely geared to attracting as many votes as possible.

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At the end of the 20 hours, there is potentially unlimited time for senators to vote on (but not debate) amendments. By tradition, the minority and majority party each gets one or two minutes to announce what the amendment is, and why it is good or bad. Unlike the initial debate, the clock does not pause for what is referred to as the “vote-a-rama.” That means voting goes only until members get too tired to continue. Vote-a-ramas in the past have often stretched for more than 12 hours, but rarely longer than 24.

Amendments

Senate leaders have for the past several weeks talked about starting debate and having an “open amendment process.” But under reconciliation, amendments are more constrained than under almost any other Senate rules.

According a report by the Congressional Research Service (a nonpartisan research group that provides background briefs to Congress), the Budget Act, which sets the reconciliation rules, “requires that all amendments be germane to the provisions in the bill.” What does that mean? Says CRS, “amendments cannot be used to introduce new subjects or expand the scope of the bill.”

Amendments also cannot add to the budget deficit or cause the bill to miss its overall budget targets.

Budget Targets

Reconciliation is designed to be a process to address the federal budget and is governed by the details set in a budget resolution passed by Congress. Even though congressional leaders have often used it to move legislation that has broader intent, the process has strict rules about spending or saving federal dollars. This year’s targets are modest by most budget resolution standards — each of the two health committees in the Senate were instructed to save $1 billion over 10 years.

But the Senate committees did not take up the bill to make changes or meet those targets on their own. As a result, the Senate is working from the bill passed by the House in May. It saved $119 billion, according to the Congressional Budget Office. Although the Senate is certain to make major revisions to the House legislation, any bill it passes must produce at least that much in savings.

And, of course, if the Senate passes a bill, it would have to be approved by the House or the House and Senate would have to work out differences and then pass that bill.

Byrd Rule

Both the underlying ACA replacement bill and its amendments must comply with the “Byrd Rule,” named for former Sen. Robert Byrd (D-W.Va.), which prohibits language that is “extraneous” to the federal budget from being included in the bill. In practice that means language must add to or subtract from federal spending and that the spending must not be “merely incidental” to a broader policy purpose.

Those determinations are made by the Senate parliamentarian. Last Friday, Senate Democrats released a list of initial decisions made by the parliamentarian’s office that found about 10 parts of the Senate- and House-passed health bills run afoul of the Byrd Rule. That list included a temporary defunding of Planned Parenthood and requirements that people with breaks in coverage wait six months before buying individual health insurance.

Republican leaders say they are working to rewrite the problematic provisions. Whether that will pass the Byrd Rule is one of many things no one knows yet in this very tumultuous debate.

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

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Ideas About Issues: The Right Answers On Health Policy Are Beyond Politics; Could The Free Market Deliver A Solution?

Columnists offer thoughts on these issues as well as who has gained ground with Obamacare, how self-employed people are bracing for change and the future of single-payer concepts.

The Columbus Dispatch: Cast Aside Politics, Get Health Care Right
If you want to know what’s wrong with the never-ending political battle being fought in Washington to get rid of the Affordable Care Act, look no further than the lives, families, and communities that have been destroyed by opioid addiction all across America. Opioid addiction is a crisis ripping the heart out of our country. And every plan that’s been put forward by the Republican leadership in Congress takes a blow torch to the most important preventive care and treatment that’s currently covered by health insurance for those caught in the grip of addiction. If the Republicans get their way, that coverage goes away, and with it goes the best hope — and maybe the only real hope — that families and communities have to overcome the ravages of this terrible disease. (Joe Biden, 7/25)

Bloomberg: Obamacare’s Big Win: It Helps Some People Be A Little Less Poor
There are some eternal debates that may never be settled. If there is a God, why does God allow evil in the world? Great taste, or less filling? And of course, does Medicaid make people healthier? I’m not going to rehash that last debate here, which I have covered many times. Suffice it to say that while liberals insist that the evidence is clear that health insurance expansions improve physical health, at least modestly, I do not see that the evidence warrants the confidence they exude. The intuitive sense that this ought to be correct seems to me to be doing a lot of heavy lifting in these evaluations. In health care, our intuitions are often wrong. (Megan McArdle, 7/24)

Modern Healthcare: Self-Employed People Weigh Returning To Corporate Jobs If Senate Passes ACA Repeal Bill
Steven DeMaio of New York City has been happily self-employed as a writer and editor since 2008. At that time, he felt comfortable leaving a corporate job with health benefits and going out on his own because the state where he then lived, Massachusetts, had established a system guaranteeing affordable individual-market coverage without regard to health status. But DeMaio, 46, recently decided to look for a corporate job with health benefits because of uncertainty over the future of his health insurance posed by Republican efforts to repeal and replace the Affordable Care Act. As of Aug. 1, he will begin working for a company that offers a group health plan. (Harris Meyer, 7/24)

RealClear Health: Single-Payer Health Care Looms As 2020 Campaign Issue
With 115 co-sponsors, a House bill that calls for single-payer health insurance now enjoys majority Democratic support in the lower chamber. Paired with Bernie Sanders’ presidential campaign, which helped bring national attention to the issue, some observers say that a single-payer push may become part of Democrats’ platform in 2020. (Ford Carson, 7/25)

Los Angeles Times: Single Payer Can’t Happen In California. At Least, Not Right Away
Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is that at the moment a single-payer bill cannot pass. Fighting for one in the immediate term is a waste of time. Financing, first of all, is a heavy lift. In addition to higher state taxes, California would need to channel Medicare and other federal healthcare funding into the single-payer system. Before it can do that, Congress must pass a waiver and the president must sign it — which isn’t going to happen while Donald Trump is in office. (Steve Tarzynski, 7/25)

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

Tough Takes On The GOP’s Health Legislation Strategy: A New Level Of Cynicism; ‘A Tattered Band-Aid’

Opinion writers offer critiques of the GOP health plans, their strategies and how it could all play out for them in the next election.

The Washington Post: Senate Republicans Take Cynicism To A Horrifying New Level
We are hurtling toward a health-care disaster in the next 36 hours or so, for the worst possible reason. Cynicism is seldom completely absent from the operation of politics, but this is truly a unique situation. Republicans are set to remake one-sixth of the American economy, threaten the economic and health security of every one of us and deprive tens of millions of people of health-care coverage, all with a bill they haven’t seen, couldn’t explain and don’t even bother to defend on its merits. (Paul Waldman, 7/24)

The Wall Street Journal: Can Republicans Govern?
Mitch McConnell is scheduling another showdown vote in the Senate—the third attempt—as early as Tuesday on a motion to proceed to debate on health reform. Succeed or fail, the Republican Majority Leader is right to demand this moment of political accountability. (7/24)

The Wall Street Journal: If Mitch McConnell Fails To Repeal Obamacare, He Should Blame Himself First
Few people in America rode into 2017 higher than Senate Majority Leader Mitch McConnell (R-Ky.). After leading Republicans to the Senate majority in 2014 and blocking President Barack Obama from filling the late Justice Antonin Scalia’s Supreme Court seat, McConnell helped the GOP hold the Senate last fall to deliver the first unified Republican control of government in a decade. Just six months later, though, McConnell is staring at a dramatic reversal of fortunes, facing a full-blown rebellion among the Republican senators he leads and serious doubts about his leadership ability. (Adam Jentleson, 7/25)

The New York Times: How The Health Bill Could Cost Senators In The Next Election
One of the health care bills under consideration by Republican leaders would take health insurance away from 32 million people over the next decade, creating a cohort of Americans who could be motivated to vote against senators who approved the measure. The Senate could vote as early as Tuesday, but it is not yet clear which of the two bills in contention that the majority leader, Mitch McConnell, intends to bring up. The plan that would leave 32 million without coverage would repeal some of the most important parts of the Affordable Care Act without any replacement. (Vickas Bajaj and Stuart A Thompson, 7/24)

Los Angeles Times: A Tattered Band-Aid: Senate GOP’s $200-Billion Obamacare Cushion Would Run Out In Two Years
As Senate Republicans rush pell-mell toward a Tuesday vote on an Obamacare repeal bill that most, if not all, still haven’t seen, a new study examines one of the givebacks the GOP leadership has offered anti-repeal senators to bring them on board. The sweetener is a $200-billion fund for the 31 states that expanded Medicaid under the Affordable Care Act, to be paid out starting in 2022. Since the GOP bill would eliminate the Medicaid expansion, the ostensible idea is to help them cushion health insurance costs for those states and their Medicaid enrollees forced to transition to the ACA’s individual insurance exchanges. (Michael Hiltzik, 7/24)

The Washington Post: Every Republican Health-Care Plan So Far Would Cause Great Harm To The Nation
The Senate has been deadlocked on repealing and replacing Obamacare all month, but Majority Leader Mitch McConnell (R-Ky.) announced Monday afternoon that the chamber would vote Tuesday on . . . well, on something. The scrambling reflected a basic fact: Every major Republican proposal put forward so far would mean millions of Americans would lose access to health care. Each plan would theoretically fulfill a GOP campaign promise while inflicting serious harm on the nation. (7/24)

Los Angeles Times: Lessons From The GOP’s Mostly Dead Healthcare Plan
Hill-watchers say the Republicans so badly need to pass something that they might just surprise everyone and pass … something today. Maybe. But whatever the Senate passes will not be an actual repeal of Obamacare, never mind an actual replacement. (It can’t be. Since Senate Majority Leader Mitch McConnell [R-Ky.] and company can’t or won’t work with Democrats — and vice versa — they are trying to pass their bill using the budget reconciliation process, which is rather limited in scope, but only requires a simple majority.) And even if the miracle happens, the immensely unpopular legislation must then go to conference, and after that go back to both chambers for more voting. It will look less like sausage getting made and more like an elaborate, rolling, mortuary makeover. (Jonah Goldberg, 7/25)

USA Today: GOP Health Bill Pits Freedom Of Choice Against Freedom From Fear
What is the health care debate all about? Freedom. Specifically two different conceptions of freedom. One is freedom to buy what you want. In this view, the country is a collection of 325 million individuals, and freedom is everyone pursuing their lives without interference. The other is freedom from worry. It views America as a community, and freedom is knowing you can get help when you are sick and in need. (EzekielJ. Emanuel, 7/24)

The Kansas City Star: Pat Roberts, Nancy Pelosi And Passing A Health Care Bill To Find Out What’s In It
Kansas Sen. Jerry Moran has been lavished with attention lately. Which is what happens when you buck your party to save Obamacare one day and the very next time the sun comes up, announce that you support a doomed GOP plan to kill the Affordable Care Act and replace it with nothing but hearty best wishes for all Americans. If Moran now sticks with his party after all and green-lights legislation he has said would hurt his constituents, he’s going to wish he hadn’t distinguished himself in the first place. (Melinda Henneberger, 7/24)

Arizona Republic: John McCain Hands Gov. Doug Ducey His Health Care Vote
Until McCain’s tweet, [Doug] Ducey was nothing more than an observer in the health care debate going on in Washington. He could – if he chose to do so – complain about what senators might do in restructuring or abolishing the Affordable Care Act, but he would bear no measure of blame for their work. Now, he has a say. (EJ Montini, 7/24)

New Orleans Times-Picayune: Health Care Speech Might Be Donald Trump’s Most Cynical One Yet
Trump, certainly the most prolific prevaricator who has ever rested his head at the White House, says that the Democrats’ promises regarding the Affordable Care Act all amount to a “big, fat lie.”If the Republicans had presented anything to make it easier for those families Trump trotted out, then maybe it would be fair to accuse the Democrats of overselling the Affordable Care Act.  But the Republicans aren’t really offering much – if anything — to help those who are struggling to pay their medical bills. (Jarvis DeBerry, 7/24)

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

Molina Healthcare To Lay Off About 1,400 Employees, Memo Says

The insurer says the upcoming cuts to 10 percent of its workforce is driven by losses to its Obamacare exchange business.

Reuters: Molina Healthcare To Cut About 1,400 Jobs: Memo
Molina Healthcare, a health insurer that specializes in the Obamacare and Medicaid healthcare programs for low-income and poor people, plans to cut about 1,400 jobs in the next few months, according to an internal company memo reviewed by Reuters. (Humer, 7/24)

Modern Healthcare: Molina To Lay Off 10% Of Its Workforce
Medicaid health plan Molina Healthcare intends to lay off 1,400 employees, or 10% of its workforce, over the coming months to try to offset losses from its Obamacare exchange business, the company said in an internal memo to employees Monday. The cuts will be across-the-board, including senior leadership, interim CEO and Chief Financial Officer Joe White said in the memo. (Barkholz, 7/24)

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

Democrats Probe Whether HHS Videos Panning Health Law Veered Too Close To Advocacy

Administration officials are defending the posts saying they are pointing out problems with the current health law to the public.

The Wall Street Journal: Democrats Accuse HHS Of Using Improper Tactics In Health-Law Battle
Health and Human Services Secretary Tom Price and his department have been publicly panning the Affordable Care Act. Democrats call the campaign an improper use of federal resources to undermine the health law. The disagreement amounts to a low-profile skirmish on health care unfolding in the shadows of the attention-grabbing battle playing out on Capitol Hill. If Republicans in Congress fail to enact a sweeping health-care overhaul, Dr. Price’s battle with Democrats will take on far greater importance as the primary arena for the partisan back-and-forth on health care. (Armour and Hackman, 7/24)

The CT Mirror: Murphy Demands Answers From Price On Anti-Obamacare Videos
Sen. Chris Murphy and two of his Democratic colleagues in the Senate, are questioning whether Health and Human Services Secretary Tom Price misused taxpayer money through advertising and public relations efforts aimed at undermining the Affordable Care Act. In a letter that was also signed by Sens. Brian Schatz, D-Hawaii, and Cory Booker, D-N.J., Murphy asked Price to detail how much money HHS is spending to produce and distribute dozens of anti-Obamacare videos available on the department’s official social media accounts. (Radelat, 7/24)

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Parsing The Policies: What’s To Become Of Medicaid And Medicare?

Opinion writers offer their thoughts on how the current Affordable Care Act replacement debate impacts Medicaid and how governors should proceed in pursuing Medicaid waivers as well as current Medicare funding issues.

Daily Beast: Medicaid Delivers As Obamacare Survives
Medicaid got a reprieve from the budget axe with the GOP’s failure so far to repeal, let alone replace, Obamacare. Suddenly, the program for the poor that began in 1965 seems less like a scapegoat for politicians looking to score rhetorical points and to shore up state budgets, and like it may join Medicare and Social Security on the third rail in American politics—touch it and you die. (Eleanor Clift, 7/24)

RealClear Health: Republicans Are Tackling Medicaid Wrongly
The high decibel fight in the Senate over Medicaid is one more example–did we need more?–of why lasting changes in social programs require thoughtful legislative deliberation leading to bipartisan consensus. There should be hearings to gather input from all sides and serious debate in committees as well as on the floor. If one party rams through big changes in any program as important as Medicaid, the other party will demonize the result. In the case of Medicaid cuts, arousing public outrage won’t be hard. Individuals and families, state governments, rural hospitals and other health providers will all be vocal about their plight. One wonders why either party would seek such opprobrium when they could be working together on sensible Medicaid reform. (Alice M. Rivlin, 7/24)

Morning Consult: Governors: Avoid Harmful Insurance Practices In Medicaid Waivers
While our nation’s governors recently gathered in Rhode Island for the summer meeting of the National Governors Association, most of the country’s political attention remained focused on the debate in Washington, D.C. over the fate of the Affordable Care Act. Less noticed, but also critically important, is that fact that each governor holds in their hands today the ability to radically reshape Medicaid for their state’s most vulnerable citizens regardless of the outcome of that debate. (Donna Christensen, Scott Mulhauser and Jason Resendez, 7/24)

CBS News: Medicare Funding: Problems And Solutions
Medicare’s funding problems often get overlooked when the Social Security trustees issue their annual report on the funded status of the Social Security and Medicare programs. Yet together they form the twin pillars of financial security for retirees. That’s why it’s important to understand Medicare’s financial situation, so you can be an informed health care planner — and voter. (Steve Vernon, 7/24)

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The Big Picture: The Health Issues We Should Be Discussing; How To Move The Debate Forward

Even as the heated discourse over the future of the Affordable Care Act continues, some people offer their thoughts on the serious issues that are being overlooked and on how bad manners have soured the process.

Boston Globe: The Health Care Debate We Should Be Having
Most of the life expectancy gains of the last century can be chalked up to what we call public health, a catch-all term for those interventions aimed not at a single patient, but at a whole community or the entire population. …Which helps explain the great riddle of American health care: How come we spend more than everyone else, yet generally have worse outcomes? We overspend on medical care and underinvest in public health. (Horowitz, 7/22)

St. Louis Post-Dispatch: Collapse To Compromise: A Better Way To Health Care Reform
Republicans and Democrats disagree about the role of government; the trade-off between individual freedom and societal good; and about money and taxes. These long-standing disagreements play out repeatedly on the national stage, and today, health care is front and center. On our present course, these disagreements will turn our health care system upside down every time we vote to change party control of the White House and the Congress. (Steven H. Lipstein, 7/23)

The Washington Post: The GOP Cannot Fix Itself — Let Alone American Health Care
The inability of a Republican Congress and a Republican president to repeal Obamacare, or even just dial it back, is yet the latest demonstration that Republicans simply aren’t ready to govern. The facile explanation for this is the unresolved division, within the party, between its radical tea party populist wing and its more moderate, business-friendly establishment wing. But the bigger issue is that the party’s elected politicians are unwilling to make the trade-offs that are the essence of what governing is about. (Steven Pearlstein, 7/23)

The Washington Post: How Health Care Controls Us
If we learned anything from the bitter debate over the Affordable Care Act (Obamacare) — which seems doubtful — it is that we cannot discuss health care in a way that is at once compassionate and rational. This is a significant failure, because providing and financing health care have become, over the past half-century, the principal activity of the federal government. (Robert J. Samuelson, 7/23)

Huffington Post: Former CBO Directors Express ‘Strong Objection’ To GOP Attacks On Agency
Every economist who has previously served as director of the Congressional Budget Office has signed a letter registering “strong objection to recent attacks” on the agency. The letter, sent Friday morning and addressed to congressional leaders, does not specify who has been making those attacks. But only one political party is attacking the CBO right now ― and only one party has so brazenly questioned the agency’s methods to draw this kind of response from such a distinguished, bipartisan group of economists. It’s the Republicans, because they don’t like what the CBO has been saying about GOP proposals to repeal the Affordable Care Act. (Jonathan Cohn, 7/21)

Roll Call: How Bad Political Manners Fomented The Health Care Mess
[I]t’s not surprising that a secretive, churlish and entirely-outside-the-normal-channels approach has, from the start, distinguished [Senate Majority Leader Mitch McConnell’s] balky and now repudiated tackling of the defining legislative battle of Trump’s first year. Straightforward legislative etiquette would have required at least a few hearings and legislative markups on health care where Democrats could have gone on record in opposition and Republican skeptics, on the hard right and in the center, could have vented concerns and offered mollifying language — long before spreading anxieties at both ends of the GOP ideological spectrum crippled the bill. (David Hawkings, 7/24)

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

Perspectives: Despite Senate Difficulties, ACA Is Still At Risk; The Paths Forward For The GOP’s BCRA

Editorial pages analyze the current state of play in Republicans’ push to replace Obamacare.

The New York Times: Health Care Is Still in Danger
Will Senate Republicans try to destroy health care under cover of a constitutional crisis? That’s a serious question, based in part on what happened in the House earlier this year. As you may remember, back in March attempts to repeal and replace the Affordable Care Act seemed dead after the Congressional Budget Office released a devastating assessment, concluding that the House Republican bill would lead to 23 million more uninsured Americans. Faced with intense media scrutiny and an outpouring of public opposition, House leaders pulled their bill, and the debate seemed over. (Paul Krugman, 7/24)

RealClear Health: A Narrow Path Forward For The BCRA
Following a week of high-level negotiations among GOP senators, Republican leadership is planning a Tuesday vote on the motion to proceed to the House-passed American Health Care Act (AHCA) — the vehicle for their health care reform efforts. The process has been shrouded in confusion and uncertainty, as it still remains unclear what legislation Senate leaders ultimately hope to move forward. And while knowing what’s in the Senate bill may be, as Senate Whip John Cornyn said, a “luxury we don’t have,” it’s worth acknowledging that there’s still a narrow path towards passage. (Shea McCarthy, 7/24)

Boston Globe: Republicans Must Challenge Trump On Health Care
But though he [Donald Trump] has browbeaten Republican senators for failing to follow through on repealing the Affordable Care Act, abandoning his own campaign commitments doesn’t seem to bother him at all. Months into the GOP’s repeal-and-replace effort, not one piece of legislation Trump has backed, in either the House or the Senate, would keep all of those promises. (7/23)

The Wall Street Journal: Force Congress’s Hand On Health Care
If President Trump is serious about repealing ObamaCare—about delivering a better policy with more choice and lower costs—there’s a simple move he could make that wouldn’t require congressional approval. It would align the interests of lawmakers and their staffers with the interests of voters. (Heather R. Higgins, 7/23)

The Wall Street Journal: Congress Won’t End ObamaCare, So Here’s How To Mend It
Having so far failed to repeal and replace the Affordable Care Act, the best way forward for Republicans would be to work with Democrats to improve the marketplaces set up by the 2010 law. While legislation could help, all that really is needed for the marketplaces to succeed is for the Trump administration to do no harm. This means continuing to implement the law without actively undermining it. (Jason Furman, 7/23)

Los Angeles Times: Under Senate’s Obamacare Repeal, Some Americans Would Have To Pay More Than Their Total Income For Health Coverage
One of the ostensibly brilliant ideas in Senate Republicans’ plan to repeal the Affordable Care Act is to move low-income families from Medicaid to the private insurance marketplace, allowing them to use the premium subsidies provided by the ACA. But there’s a catch, according to a new analysis of the proposal. For many low-income families, the marketplace premiums and deductibles combined would amount to more than their total income, even after subsidies. Moreover, despite shifting more of these costs to enrollees, the change would cost the federal government more than Medicaid.  (Michael Hiltzik, 7/21)

The Kansas City Star: Sens. Moran And Roberts: Don’t Endanger My Daughter’s Health
My beautiful daughter Hannah turns 26 this Saturday. Her birthdays are particularly special because she was diagnosed with stage 4 cancer at age 13. After successful treatment, her cancer returned when she was 14 and she had a less than 10 percent chance of survival. She wasn’t expected to be alive for her 15th birthday. Burkitt’s Lymphoma is a very aggressive cancer that doubles in size every two hours. We were fortunate to receive amazing care at Children’s Mercy Hosptital. Hannah endured dozens of surgeries, 69 days of intense chemotherapy and spent over 300 days in the hospital. She received hundreds of units of blood and platelets, had 38 spinal taps, 18 bone marrow biopsies, a stem cell transplant and countless other treatments and procedures. (Deedra Miller, 7/22)

Lincoln Journal-Star: Nebraska Needs Health Care Reform
Obamacare is failing in Nebraska. Proponents of the law argued that it would increase choice and lower costs, but the exact opposite has taken place. For instance, earlier this year, Blue Cross Blue Shield announced it would be leaving the state’s Obamacare exchange market. The last remaining Obamacare insurer — Medica Health — also announced it might pull out of the market by the end of the year, which would leave thousands of Nebraskans without health coverage. (Jarrett Stepman, 7/24)

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

Health Care Efforts Edge Toward Chaos As Senators ‘Don’t Even Know’ What Their Voting On

Jul 24 2017

“I don’t know whether we’re proceeding to the House bill, a new version of the Senate bill, the old version of the Senate bill, the 2015 repeal-and-hope-that-we-come-up-with something-in-two-years bill. I truly don’t,” Sen. Susan Collins (R-Maine) said. Senate Majority Leader Mitch McConnell (R-Ky.) is continuing his push for some vote this week.

The Washington Post: Senate Republicans Plan To Plow Ahead With Health-Care Vote This Week
The Senate returns to Washington on Monday with its GOP leaders determined to vote this week on their years-long quest to demolish the Affordable Care Act, even though the goal remains mired in political and substantive uncertainties. Central questions include whether enough Senate Republicans will converge on any version of their leaders’ health-care plan and whether significant aspects of the legislation being considered can fit within arcane parliamentary rules. (Goldstein, 7/23)

The Associated Press: GOP Health Bill Still A Mystery Before Planned Vote
The Senate will move forward with a key vote this week on a Republican health bill but it’s not yet known whether the legislation will seek to replace President Barack Obama’s health care law or simply repeal it. Sen. John Thune of South Dakota, the third-ranking Republican, said Senate Majority Leader Mitch McConnell will make a decision soon on which bill to bring up for a vote, depending on ongoing discussions with GOP senators. (7/24)

The Wall Street Journal: Senate Republicans Unsure Of What Health-Care Measure They Will Vote On
Some senators said Majority Leader Mitch McConnell (R., Ky.) has told them they would know before the vote whether they would be asked to allow debate on some version of a bill to repeal and replace the Affordable Care Act, or legislation that would repeal the ACA with a two-year expiration date. GOP leaders’ current strategy is to lean heavily on lawmakers to at least vote to allow debate on the bill, in the hopes that amendments and other tweaks could yield an agreement. (Andrews, Armour and Peterson, 7/23)

The Hill: Senate Heads To New Healthcare Vote With No Clear Plan 
The two leading options are a repeal-only bill or an updated version of the Senate’s repeal-and-replacement measure. But there has not been a breakthrough on either, despite senators holding a late-night meeting on Wednesday to try to revive the replacement bill. (Sullivan, 7/21)

Los Angeles Times: ‘I Don’t Even Know What We’re Proceeding To Next Week.’ Obamacare Vote Nears With Key Details Still Missing
The uncertainty so close to a major vote is feeding a growing sense of chaos on Capitol Hill, where GOP senators are openly fretting about the lack of information about legislation that could leave anywhere from 22 million to 32 million more Americans without health insurance. “I don’t even know what we’re proceeding to next week,” said Maine Sen. Susan Collins, a centrist Republican who has called on her party’s leaders to take a more measured approach to fixing the current healthcare law. (Levey, 7/21)

Politico: McConnell’s Last-Ditch Obamacare Strategy
Talking is no longer working. It’s time to vote. Senate Majority Leader Mitch McConnell is taking the rare step of forcing his members to take a tough vote on an Obamacare repeal bill, H.R. 1628 (115), that is on track to fail, making them own their votes. (Haberkorn and Kim, 7/21)

Meanwhile, in other health care legislation news —

CQ Roll Call: Repeal Debate Clouds Next Important Health Bill
The day-to-day uncertainty over the Republican health care effort is causing angst among the supporters of the next high-priority health policy item on the Senate’s agenda: a bill to renew crucial Food and Drug Administration funding authorizations before they expire in September. The bill would give the FDA the ability to collect about $1.4 billion in fees from the prescription drug and medical device industries, money which pays the salaries of employees who review product applications. If the fee collection authority is not renewed before Sept. 30, those employees could be furloughed. In the meantime, the FDA would start making plans for reducing staff and would begin notifying affected employees. (Siddons, 7/21)

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

5 Ways White House Can Use Its Muscle To Undercut Obamacare

President Donald Trump has vowed to “let Obamacare fail,” after legislative efforts to undo the Affordable Care Act have stalled.

He and congressional Republicans have repeatedly portrayed the Affordable Care Act insurance marketplaces, also known as exchanges, as being in a “death spiral.” But independent analyses have concluded that such spontaneous disintegration isn’t happening.

In a number of ways, the Trump administration’s policies are pushing Obamacare into the vortex.

Reports from Standard & Poor’s, the Congressional Budget Office and the Kaiser Family Foundation all suggest that the exchanges — where people can shop for coverage, often with the help of a government subsidy — are stabilizing. (Kaiser Health News is an editorially independent program of the foundation.)

Use Our Content

But, like every piece of legislation, Obamacare faces a difficult political reality: Its marketplaces require active maintenance and federal support.

The White House can take a number of behind-the-scenes steps to sabotage the exchanges and hasten their undoing. Already, it’s deploying some of those tactics.

“The administration has a lot of power to undermine the markets and make them dysfunctional,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, who specializes in private insurance markets.

Here’s a look at five ways the White House is already working to weaken the health law, and what that means for consumers.

‘Cost-Sharing Reductions’

Under the ACA, when someone’s income falls between 100 and 250 percent of the federal poverty level — up to about $29,000 for an individual or around $61,000 for a family of four — marketplace carriers must offer a plan with “cost-sharing reductions” (CSRs) that reduce consumers’ out-of-pocket expenses.

Reducing cost-sharing — generally copayments and deductibles — makes plans more expensive for the insurers. The Obama administration used its rule-making power to set up direct payments to carriers to help offset this burden. The Trump White House has inherited that responsibility but also has the power to end the payment program.

The nonpartisan Congressional Budget Office estimated CSR subsidies in 2017 would total about $7 billion. Without that money, analysts say, more insurers might choose to exit, limiting options for consumers, and letting the insurers who remain charge higher prices.

Trump has been committedly noncommittal, publicly indicating he would like to halt the subsidies, but so far — on a month-to-month basis — letting them continue.

The uncertainty makes insurance companies skittish about participating, analysts noted. It’s also one reason some plans say they have had to increase their rates, noted Charles Gaba, a Michigan-based blogger who tracks ACA sign-ups. For instance: When filing plans for the 2018 marketplace, carriers on average raised premiums by about 34 percent — with about 20 points stemming from CSR uncertainty, Gaba said, based on an analysis of 21 states’ initial rate filings. Dropping the subsidies altogether would be even more damaging.

Weaken The Mandate

The White House has already signaled it does not want to enforce the individual mandate — the health law’s requirement that all people have coverage. And administration officials have repeated that position.

Meanwhile, in January, it issued an executive order that encouraged U.S. agencies to grant exemptions and waive or defer health law provisions that could put financial strain on companies or individuals — which could also be applied to the individual mandate.

For 2016 tax returns, though, the Internal Revenue Service continued to impose a financial penalty on people who didn’t have health insurance and who didn’t qualify for an exemption.

But enforcement may be waning. This year, the IRS was supposed to reject tax returns if people didn’t indicate whether they had coverage, flagging them for a potential penalty. Instead, it continued processing them, citing Trump’s executive order.

If the IRS has already processed any tax refunds for consumers, then they “don’t have much leverage” when attempting to collect the mandate fee, said Timothy Jost, emeritus law professor at Washington and Lee University in Virginia and an expert on health reform.

Enforcement of the mandate enforcement, economists note, is crucial to ensuring that enough healthy people buy coverage to balance the costs of sicker beneficiaries.

But even with the mandate in effect, the efforts to defang it bring confusion.

“A lot of people believe the Trump administration is not enforcing it,” Jost said.

As a result, healthy people may become less likely to buy insurance, even as sick ones continue seeking it. That means higher prices, and a shakier pool.

“If they don’t think they’re going to get healthy people in the risk pool, they’re going to increase their rates further to protect themselves,” Jost said. “And as they raise their rates further to protect themselves, people … start to drop out.”

Thus, the president’s position on the mandate is leaving insurance carriers and commissioners “apprehensive,” noted Mike Kreidler, Washington state’s insurance commissioner.

A Bare Market

Skittishness on the part of insurers could lead them to drop out of some marketplaces, leaving consumers in some areas with few or no choices. Those “bare markets” are possible under even stable circumstances — and preventing them requires active federal involvement.

Under the Obama administration, high-level officials were “on the phone daily with insurance company executives … trying to get them to participate,” Corlette said. “It was very much an all-hands-on-deck, ‘we’re going to make it work for you guys’ kind of communication.”

And so far Trump’s Department of Health and Human Services doesn’t appear to be emphasizing this kind of essential outreach, both Corlette and Jost suggested. A few months ago, Kreidler agreed, HHS staffers appeared interested in helping states fill their bare counties — but that support has since dwindled.

“This may be sort of under the radar, but it can have real, lasting effects” for consumer choice, Corlette said.

All Quiet On The Enrollment Front

The administration could further undermine the marketplace by dropping outreach to consumers. It’s already a shorter enrollment period this year — spanning six weeks instead of three months, from Nov. 1 to Dec. 15 — though that change was already slated to eventually take effect.

That shorter period means people may miss the memo on signing up — or at least need an extra push, Corlette said. And that’s another way the administration could undermine the marketplaces: simply choosing not to advertise them.

Last sign-up season, HHS stopped open enrollment advertising in January, pulling ads a few days before the period ended. Enrollment dropped compared with previous years, Jost and Gaba noted, with young, healthy people being more likely not to buy coverage.

The administration also just stopped funding federal contractors that supported efforts by community groups and other organizations in some of the nation’s largest cities to sign up people.

Dropping advertising, shortening open enrollment or simply scaling back on technical maintenance for the marketplace website could all have significant impact, Corlette said. People who are sick and need insurance will likely seek it out, but those who are healthier — for whom health insurance is a less pressing priority — could miss the boat.

Again, Jost said, that affects insurer participation.

“Insurance is a product that need to be sold,” he said. “If the insurers believe they’re not going to get any help at all in marketing their product,” he added, fewer will want to enter the marketplace.

Word of (Bad) Mouth

HHS has taken an active role in criticizing the health law — pushing press releases and videos that argue it has helped more than hurt. That strategy could do a lot of harm, experts said.

If consumers keep hearing the law is failing, Jost noted, some will ultimately believe it, buying coverage only if they need it and thereby skewing the insurance risk pool.

Perceived hostility also has an effect on insurers, steering them away from marketplace participation.

“When you undermine confidence in the marketplace, you don’t need a Ph.D. in economics to know it’s not good long term,” Corlette said.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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

Tags: , ,

5 Ways White House Can Use Its Muscle To Undercut Obamacare

President Donald Trump has vowed to “let Obamacare fail,” after legislative efforts to undo the Affordable Care Act have stalled.

He and congressional Republicans have repeatedly portrayed the Affordable Care Act insurance marketplaces, also known as exchanges, as being in a “death spiral.” But independent analyses have concluded that such spontaneous disintegration isn’t happening.

In a number of ways, the Trump administration’s policies are pushing Obamacare into the vortex.

Reports from Standard & Poor’s, the Congressional Budget Office and the Kaiser Family Foundation all suggest that the exchanges — where people can shop for coverage, often with the help of a government subsidy — are stabilizing. (Kaiser Health News is an editorially independent program of the foundation.)

Use Our Content

But, like every piece of legislation, Obamacare faces a difficult political reality: Its marketplaces require active maintenance and federal support.

The White House can take a number of behind-the-scenes steps to sabotage the exchanges and hasten their undoing. Already, it’s deploying some of those tactics.

“The administration has a lot of power to undermine the markets and make them dysfunctional,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, who specializes in private insurance markets.

Here’s a look at five ways the White House is already working to weaken the health law, and what that means for consumers.

‘Cost-Sharing Reductions’

Under the ACA, when someone’s income falls between 100 and 250 percent of the federal poverty level — up to about $29,000 for an individual or around $61,000 for a family of four — marketplace carriers must offer a plan with “cost-sharing reductions” (CSRs) that reduce consumers’ out-of-pocket expenses.

Reducing cost-sharing — generally copayments and deductibles — makes plans more expensive for the insurers. The Obama administration used its rule-making power to set up direct payments to carriers to help offset this burden. The Trump White House has inherited that responsibility but also has the power to end the payment program.

The nonpartisan Congressional Budget Office estimated CSR subsidies in 2017 would total about $7 billion. Without that money, analysts say, more insurers might choose to exit, limiting options for consumers, and letting the insurers who remain charge higher prices.

Trump has been committedly noncommittal, publicly indicating he would like to halt the subsidies, but so far — on a month-to-month basis — letting them continue.

The uncertainty makes insurance companies skittish about participating, analysts noted. It’s also one reason some plans say they have had to increase their rates, noted Charles Gaba, a Michigan-based blogger who tracks ACA sign-ups. For instance: When filing plans for the 2018 marketplace, carriers on average raised premiums by about 34 percent — with about 20 points stemming from CSR uncertainty, Gaba said, based on an analysis of 21 states’ initial rate filings. Dropping the subsidies altogether would be even more damaging.

Weaken The Mandate

The White House has already signaled it does not want to enforce the individual mandate — the health law’s requirement that all people have coverage. And administration officials have repeated that position.

Meanwhile, in January, it issued an executive order that encouraged U.S. agencies to grant exemptions and waive or defer health law provisions that could put financial strain on companies or individuals — which could also be applied to the individual mandate.

For 2016 tax returns, though, the Internal Revenue Service continued to impose a financial penalty on people who didn’t have health insurance and who didn’t qualify for an exemption.

But enforcement may be waning. This year, the IRS was supposed to reject tax returns if people didn’t indicate whether they had coverage, flagging them for a potential penalty. Instead, it continued processing them, citing Trump’s executive order.

If the IRS has already processed any tax refunds for consumers, then they “don’t have much leverage” when attempting to collect the mandate fee, said Timothy Jost, emeritus law professor at Washington and Lee University in Virginia and an expert on health reform.

Enforcement of the mandate enforcement, economists note, is crucial to ensuring that enough healthy people buy coverage to balance the costs of sicker beneficiaries.

But even with the mandate in effect, the efforts to defang it bring confusion.

“A lot of people believe the Trump administration is not enforcing it,” Jost said.

As a result, healthy people may become less likely to buy insurance, even as sick ones continue seeking it. That means higher prices, and a shakier pool.

“If they don’t think they’re going to get healthy people in the risk pool, they’re going to increase their rates further to protect themselves,” Jost said. “And as they raise their rates further to protect themselves, people … start to drop out.”

Thus, the president’s position on the mandate is leaving insurance carriers and commissioners “apprehensive,” noted Mike Kreidler, Washington state’s insurance commissioner.

A Bare Market

Skittishness on the part of insurers could lead them to drop out of some marketplaces, leaving consumers in some areas with few or no choices. Those “bare markets” are possible under even stable circumstances — and preventing them requires active federal involvement.

Under the Obama administration, high-level officials were “on the phone daily with insurance company executives … trying to get them to participate,” Corlette said. “It was very much an all-hands-on-deck, ‘we’re going to make it work for you guys’ kind of communication.”

And so far Trump’s Department of Health and Human Services doesn’t appear to be emphasizing this kind of essential outreach, both Corlette and Jost suggested. A few months ago, Kreidler agreed, HHS staffers appeared interested in helping states fill their bare counties — but that support has since dwindled.

“This may be sort of under the radar, but it can have real, lasting effects” for consumer choice, Corlette said.

All Quiet On The Enrollment Front

The administration could further undermine the marketplace by dropping outreach to consumers. It’s already a shorter enrollment period this year — spanning six weeks instead of three months, from Nov. 1 to Dec. 15 — though that change was already slated to eventually take effect.

That shorter period means people may miss the memo on signing up — or at least need an extra push, Corlette said. And that’s another way the administration could undermine the marketplaces: simply choosing not to advertise them.

Last sign-up season, HHS stopped open enrollment advertising in January, pulling ads a few days before the period ended. Enrollment dropped compared with previous years, Jost and Gaba noted, with young, healthy people being more likely not to buy coverage.

The administration also just stopped funding federal contractors that supported efforts by community groups and other organizations in some of the nation’s largest cities to sign up people.

Dropping advertising, shortening open enrollment or simply scaling back on technical maintenance for the marketplace website could all have significant impact, Corlette said. People who are sick and need insurance will likely seek it out, but those who are healthier — for whom health insurance is a less pressing priority — could miss the boat.

Again, Jost said, that affects insurer participation.

“Insurance is a product that need to be sold,” he said. “If the insurers believe they’re not going to get any help at all in marketing their product,” he added, fewer will want to enter the marketplace.

Word of (Bad) Mouth

HHS has taken an active role in criticizing the health law — pushing press releases and videos that argue it has helped more than hurt. That strategy could do a lot of harm, experts said.

If consumers keep hearing the law is failing, Jost noted, some will ultimately believe it, buying coverage only if they need it and thereby skewing the insurance risk pool.

Perceived hostility also has an effect on insurers, steering them away from marketplace participation.

“When you undermine confidence in the marketplace, you don’t need a Ph.D. in economics to know it’s not good long term,” Corlette said.

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

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Ruling By Senate Parliamentarian Upends GOP Hopes For Health Care Bill

The official rules keeper in the Senate Friday tossed a bucket of cold water on the Senate health bill by ruling that major parts of the  legislation cannot be passed with a simple majority, but rather would require 60 votes. Republicans hold only 52 seats in the Senate.

Senate parliamentarian Elizabeth MacDonough advised that a super-majority is required for the temporary defunding of Planned Parenthood, abortion coverage restrictions to health plans purchased with tax credits and the requirement that people with breaks in coverage wait six months before they can purchase new plans.

The list released by Democrats on the Senate Budget Committee is the results of what is called the “Byrd Bath,” a process in which the Senate parliamentarian ensures that provisions of budget bills comply with the Byrd Rule, which requires that only matters directly pertaining to the budget are included. The rule is named for the late Sen. Robert Byrd (D-W.Va.).

(Story will be updated soon.)

Categories: Repeal And Replace Watch, The Health Law

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Perspectives: End The ‘War On Medicaid’; Keep Eyes On Medicaid In Congressional Health Debate

Opinion writers examine Medicaid’s role in the current effort to replace the health law as well as ideas about controlling the program’s costs, ethical issues related to spending down assets to qualify for it and other provocative topics.

Morning Consult: Time To End The War On Medicaid
Any cuts to Medicaid would be devastating. Changing Medicaid from an entitlement into a state-based per capita grant program will cause permanent and growing damage to people’s health and the ability of our nation to respond to natural or economic disaster. Medicaid is the backbone of health coverage in America. One in two Americans will need Medicaid at some point during their lifetimes. Medicaid provides for healthy births and assistance for older people to be able to remain in their homes. Today, Medicaid is also there to help many thousands of people who lose their jobs in the aftermath of unforeseen disasters like recessions or hurricanes. Similarly, when an outbreak of illness occurs, Medicaid is there to provide coverage for needed care. (Doug Wirth, 7/20)

The Washington Post: Don’t Get Distracted: The GOP’s Cruel Health-Care Plan Isn’t Dead Yet
Focus, America, focus. The most urgent task right now is to make sure a stake is driven through the heart of the Republican effort to gut Medicaid and balloon the ranks of the uninsured. I know that the Russia investigations are charging ahead, with Capitol Hill appearances by members of President Trump’s inner circle scheduled for next week. I know that Trump gave an unhinged interview to the New York Times on Wednesday, bizarrely undermining his own attorney general. I know that one of the few remaining giants in Washington, Sen. John McCain (R-Ariz.), has received a tough medical diagnosis. (Eugene Robinson, 7/20)

The New England Journal Of Medicine: Controlling The Cost Of Medicaid
The federal–state Medicaid program is facing the possibility of the largest and most consequential changes to its funding since its inception in 1965. The American Health Care Act (AHCA), H.R. 1628, as adopted by the House of Representatives on May 4, would replace the current federal matching program for Medicaid with a per capita cap on federal funds. This cap would limit the growth of these funds to the growth rate of the medical care component of the Consumer Price Index, with an additional 1% growth allowed for older adult and disabled Medicaid enrollees. The Congressional Budget Office has projected that this policy would result in federal funding reductions of more than $800 billion over the next 10 years, equivalent to a 26% reduction in federal support by 2026. These large reductions represent an unprecedented shift of financial risk to the states. Missing from the debate has been consideration of policies that could improve the value of the Medicaid program, controlling Medicaid spending without diminishing coverage or quality. (K. John McConnell and Michael E. Chernew, 7/20)

The New York Times: The Ethics Of Adjusting Your Assets To Qualify For Medicaid
Whatever twists and turns the health insurance debates in Washington take, Medicaid will be at the center, and the program will probably affect you and your family more than you know. After all, if you run out of money in retirement, it is Medicaid that pays for most of your nursing home or home-based care. (Ron Lieber, 7/21)

Morning Consult: The Value Of A Human Life
As you can see, not only does McConnell’s BCRA dramatically roll back funding for hospitals and insurance companies to cover more people, and slash funding for Medicaid — a program which disproportionately helps poor and low-income Americans — but it also devalues human life as a whole. And with the value of a life now redefined, will Senate Republicans next move to make massive cuts to the Transportation Department highway safety programs, or the Food and Drug Administration’s food safety programs? (Dr. J. Mario Molina, 7/21)

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

Different Takes: How The Trump Administration Is Sabotaging Obamacare; Fear And Loathing In The Health Policy Debate

Editorial pages offer tough takes on the Trump administration’s executive maneuvers to render the Affordable Care Act powerless, the Republican’s plans to replace it and how this particular legislative fight shows Washington ‘at its worst.’

The New York Times: Health Care In A Time Of Sabotage
Is Trumpcare finally dead? Even now, it’s hard to be sure, especially given Republican moderates’ long track record of caving in to extremists at crucial moments. But it does look as if the frontal assault on the Affordable Care Act has failed. And let’s be clear: The reason this assault failed wasn’t that Donald Trump did a poor selling job, or that Mitch McConnell mishandled the legislative strategy. Obamacare survived because it has worked — because it brought about a dramatic reduction in the number of Americans without health insurance, and voters didn’t and don’t want to lose those gains. (Paul Krugman, 7/21)

Los Angeles Times: The Trump Administration Is Using Obamacare Marketing Dollars To Attack Obamacare
President Trump keeps saying Obamacare will fail on its own. So why is his administration trying so hard to kill it? The latest effort was uncovered by the Daily Beast website, which reported Thursday that Trump’s Department of Health and Human Services was dipping into its “consumer information and outreach” budget — money Congress provided to encourage people to obtain insurance through Obamacare — to produce nearly two dozen YouTube videos blasting the law as burdensome and harmful. (7/21)

The Washington Post: The GOP’s Repeal-And-Replace Plan Should Stay Dead
Republican senators have been huddling in hopes of reviving their Obamacare repeal-and-replace bill. The Congressional Budget Office (CBO) reminded them Thursday of why the bill should, on the contrary, stay dead. Congress’s scorekeepers found that the latest version of the Senate bill would result in 22 million more people without health coverage by 2026. That is true even after the CBO accounted for $70 billion in new funds meant to stabilize health-insurance markets by driving down premiums and other costs. (7/20)

The New York Times: A Republican Health Care Fix
Imagine a young father stepping into the street. He is alert and conscientious. Then, a government truck speeds around the corner. The man lunges out of the way, but it’s too late: The truck runs him over, causing serious injury. Absent government misconduct, the man would have been just fine. While the primary effect of the government’s conduct is an injured man, there are significant secondary consequences. His children will lose his emotional comfort and financial support. His neighborhood loses a valued contributor to its social fabric. His employer must find at least a temporary replacement for the man’s labor. (J.D. Vance, 7/21)

Fortune: Where The Republican Health Care Bill Stands After A Chaotic 72 Hours
It’s been a topsy turvy three days for health care reform (please consider hugging a health care reporter). The Senate’s original Better Care Reconciliation Act (BCRA), which was largely considered to be dead just two days ago, has been revived and somewhat tweaked as of this morning. And the Congressional Budget Office (CBO) is already out with an analysis of that new legislation: 15 million more uninsured Americans next year relative to Obamacare and 22 million more uninsured by 2026. It would also reduce federal deficits by $420 billion over the next decade, according to CBO. (Sy Mukherjee, 7/20)

The Wall Street Journal: Trump, ObamaCare And The Art Of The Fail
It was a political drubbing of the first order. A new Republican president and a Republican Senate and House put everything they had into a bill to repeal and replace ObamaCare, and couldn’t do it. The leadership is rocked. The president looks confused and hapless, while publicly enacting determination and a scolding tone toward those who’d let him down. He rarely showed signs of fully understanding the details or even the essentials of the plan he backed. His public remarks were all over the place: He’ll let ObamaCare collapse of its own weight; he’ll replace it with something big and beautiful; just repeal it; no, let it collapse. He criticized Hill Republicans: They “never discuss how good their healthcare bill is.” But neither did he, not in a persuasive way. (Peggy Noonan, 7/20)

San Francisco Chronicle: Health Care Fight Shows Washington At Its Worst
I like partisan fights when those fights are about something real. The Medicaid fight was at least about something real. But most of this nonsense is a battle of liars trying to protect past lies in the hope of being able to make new lies seem just plausible enough for the liars to keep repeating them. (Jonah Goldberg, 7/21)

Cleveland Plain Dealer: Republicans Trip Over Health Care: Editorial Board Roundtable
It was supposed to be a sprint to the finish line — Republican leadership of the GOP-dominated U.S. Senate planned to repeal speedily the long-hated Obamacare, replace it with the Better Care Reconciliation Act and ride off into the sunset. Instead, it’s been an Army crawl under withering fire for Senate Majority Leader Mitch McConnell, whose initial health care bill was too harsh for moderate Republicans who found it would leave 22 million more people without health insurance, and too generous for conservative Republicans who wanted to strip it bare. (7/20)

Lexington Herald Leader: Ky. Lawmakers Offer Us Hypocrisy, Selfishness In Health-Care Bills
The implosion of the Republican effort to repeal and replace the Affordable Care Act brought to mind the iconic scene in Tennessee Williams “A Cat on a Hot Tin Roof.” There, egged on by his son (Paul Newman) Big Daddy (played by Burl Ives) goes on a verbal rampage about the state of his world, which he characterizes as one of mendacity, lies and hypocrisy. (Ernie Yanarella, 7/20)

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

Podcast: What The Health? Mostly Dead

Julie Rovner of Kaiser Health News, Stephanie Armour of the Wall Street Journal, Sarah Kliff of Vox.com, and Margot Sanger-Katz of The New York Times discuss the ever-changing status of the Senate’s effort to “repeal and replace” the Affordable Care Act, and the Trump Administration’s efforts to undermine the working of the law.

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

Julie Rovner: Politico’s “How hospitals got richer off Obamacare,” by Dan Diamond

Stephanie Armour: This tweet from Sam Stein of The Daily Beast:

Margot Sanger-Katz: The Daily Beast’s “Team Trump used Obamacare money to run PR effort against it,” by Sam Stein.

Sarah Kliff: Axios.com’s “The ripple effect of declining births,” by Bob Herman.

Subscribe to What the Health? on iTunesStitcher or Google Play.

Categories: Health Industry, Multimedia, Repeal And Replace Watch, The Health Law

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Perspectives From Across The Country: Placing Blame For Senate GOP Health Bill’s Implosion; The Local Damage Repeal Could Do

Opinion writers examine how repealing Obamacare would play out in their states and towns.

The Kansas City Star: Blame Donald Trump For The Collapse Of Health Care Reform
Let’s be clear and up front: President Donald Trump is primarily responsible for this week’s collapse of Obamacare reform. There are other suspects: Sen. Rand Paul, who demanded full repeal and would not compromise. And Senate Majority Leader Mitch McConnell, who cloaked reform efforts in single-party secrecy. Moderates such as Sen. Susan Collins played a role, as did Sens. Mike Lee of Utah and Jerry Moran of Kansas, who drove stakes into the heart of the preferred reform bill Monday night. And, of course, the liberal mainstream media. Might as well throw us in. But the failure is Trump’s. (Dave Helling, 7/19)

Lexington Herald Leader: My Mistake: I Thought GOP Really Wanted To Pass Obamacare Repeal
I owe my liberal Democratic friends an apology. For years they have been saying the congressional GOP was just passing Obamacare repeals for show, and that they didn’t have a valid replacement bill. I defended them, thinking, naively perhaps, that they really did want to repeal the Affordable Care Act, popularly known as Obamacare, and that one of the many bills they had proposed would unify the party and it would pass with a Republican majority in Congress and become law with a Republican president’s signature. (J. Brandon Thompson, 7/19)

WBUR: Who Killed The GOP Health Care Bill? The American People
After eight years of promising voters fix for the ACA’s high deductibles and paltry provider networks, the Republican House and Senate delivered a bill that would have worsened nearly everything that most people hate about health insurance. Their failure is our calling to envision something better and unite behind it. (Miles Howard, 7/20)

Kansas City Star: Repealing Obamacare Outright Would Hurt Kansans
Without enough votes to pass the U.S. Senate’s proposed health reform bill, we’re still hearing calls to simply repeal the Affordable Care Act — including from President Donald Trump. If successful, an outright repeal would greatly harm Kansans and create instability in our insurance markets. (Michael Munger, 7/19)

Lexington Herald Leader: Kentuckians Must Advocate For Their Health Care
Physicians, like our nation, have strong, diverse opinions about the Affordable Care Act and efforts underway to repeal it. As a physician, dean and president of the American Osteopathic Association, which represents more than 129,000 osteopathic physicians (DOs) and medical students, my mandate is to support policies that will ensure patients are better off in the future than they are today. (Boyd R. Buser, 7/19)

Lincoln Journal-Star: Time Ripe For Bipartisan Health Care Revisions
The American Health Care Act is dead. So are the Better Care Reconciliation Act and a repeal of Obamacare without a replacement, as both have sufficient opposition to be dead on arrival. With the Republicans’ efforts for health care reform reduced to smoldering ruins, now what? (7/20)

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

Different Takes: A Win For Obamacare?; Women Senators Flex Muscles In Health Care Debate

Editorial writers offer a range of views on how the push to replace the Affordable Care Act reached its current state of collapse and what it means going forward.

The Washington Post: Why Obamacare Won And Trump Lost
The collapse of the Republican effort to repeal the Affordable Care Act is a monumental political defeat wrought by a party and a president that never took health-care policy or the need to bring coverage to millions of Americans seriously. But their bungling also demonstrates that the intense attention to Obamacare over the past six months has fundamentally altered our nation’s health-care debate. (E.J. Dionne, 7/19)

The Wall Street Journal: Obama’s Last Laugh
Like pop-up dolls, across the length of Barack Obama’s presidency, Republicans voted to “repeal” the law that bears his name—ObamaCare. He laughed at them then, and he’s laughing now. No repeal and no replace. They can’t even do repeal and punt. For Democrats, this doesn’t quite make up for losing the election to Donald Trump, but it has to help. Schadenfreude can’t get much better than watching the Republican Party self-humiliate with an abject inability to win while controlling the House, Senate and White House. (Daniel Henninger, 7/19)

Bloomberg: Health-Care Debacle Exposes The Monster In Trump
Let’s put aside for now the extent to which the Affordable Care Act would “fail” without active measures by the White House and the Republican Congress to undermine the state marketplaces; for that matter, ignore the extent to which active Republican resistance, such as the various lawsuits against the law and the decision by many Republican governors to not expand Medicaid, is responsible for a fair number of problems in the first place. Let’s just stipulate for the sake of argument that Trump is correct and the law is doomed if his administration and Republicans in Congress adopt a passive stance of watching and waiting. (Jonathan Bernstein, 7/19)

Bloomberg: Letting Obamacare Fail Would Break Trump’s Oath
Having failed to repeal the Affordable Care Act, President Donald Trump is now stating openly that his plan is to let Obamacare fail instead. 1 Although the end result may be the same, there’s a vast difference between these two options, constitutionally speaking. Repeal is a normal legislative initiative, completely within the power of Congress and the president. But intentionally killing a validly enacted law violates the Constitution’s order that the president “shall take care that the laws be faithfully executed.” (Noah Feldman, 7/19)

Boston Globe: Protecting The Affordable Care Act Was In Trump’s Oath Of Office
At a minimum, if Trump lives up to his threat not to enforce the Affordable Care Act, it will lead to yet more lawsuits against him and his administration like those that have led federal courts to find his Muslim ban unconstitutional. Shirking his constitutional obligation to faithfully execute the laws, and thereby imperiling the health care market and the well-being of millions of Americans, will only bring the nation closer to a constitutional crisis. (Edward Markey, 7/19)

Los Angeles Times: As The Healthcare Bill Goes Down, It’s Another Bad Week For Male Separatists
It’s been a bad week for male separatists. In Washington, D.C., the all-male Republican Senate leadership, which chose not to invite any female senators to their working-group meetings on repealing the Affordable Care Act, watched in frustration as their bill fizzled after those women declined to support it. Sen. Majority Leader Mitch McConnell, demonstrating that overconfidence and sexism often go hand-in-hand, had insisted the bill could succeed without women senators’ input. “Nobody’s being excluded based upon gender,” he said. “Everybody’s at the table.” Sure, if your definition of everybody is “13 middle-aged guys in ill-fitting suits.” (Ann Friedman, 7/20)

The Washington Post: No Women, No Health Care Bill
After Senate Republicans’ second version of a health-care bill collapsed Monday under the weight of more than a dozen senators (male and female) who had concerns, Senate Majority Leader Mitch McConnell decided to just vote on repealing Obamacare without a replacement… And it was Senate Republican women who killed it. (Amber Phillips, 7/19)

The New York Times: If Dr. Trump Were Your Surgeon …
It’s a dark and stormy night, and the hospital corridor is eerily illuminated by lightning flashes as Dr. Trump and Dr. McConnell enter a patient’s room and approach the bed of a young woman, Janet. “We have the best health care plan ever for you!” Dr. Trump says exultantly, to a thunderclap outside. “Tremendous! I’m the best! I take care of everybody.” He uses his stethoscope to listen to Janet’s heart, and frowns slightly. “Er, doctor?” Janet says. “I think my heart is on my left side, not the right.” (Nicholas Kristof, 7/20)

The Hill: How Medicaid Brought Down TrumpCare
Republican efforts to repeal and replace the Affordable Care Act have failed, largely because their legislation did so much more. In their hubris they sought to also dismantle the traditional Medicaid that predated the law by 45 years, something Speaker Paul Ryan had admitted was a dream since his fraternity kegger days. And it was the Medicaid cuts that forced Republicans into their worst public contortions. (Brendan Williams, 7/19)

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

Cruz Plan Gets Thumbs Up From HHS But Thumbs Down From Most Everyone Else

Contradicting the opinion of most policy experts, a draft report from the Trump administration forecasts better enrollment and lower premiums for everyone who buys their own health insurance if a controversial amendment proposed by Sen. Ted Cruz of Texas were to become law.

The draft surfaced just as Republican senators were lunching with President Donald Trump on Wednesday to talk about the next steps in the health care debate.

“The Republicans never discuss how good their healthcare bill is, & it will get even better at lunchtime,” tweeted Trump, before the group convened.

But findings from the draft report drew immediate criticism from health policy experts as opaque and misleading.

“The details get a bit dicey,” said Craig Garthwaite, director of the health care program at Northwestern University’s Kellogg School of Management. “No one I’ve talked to thinks [the analysis] is well done.”

The forecasts in a 22draft analysis by the Department of Health and Human Services are exactly opposite from what many experts forecast.

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Still, the HHS analysis did provide some insight into how HHS envisioned that the Cruz plan, part of the Senate bill that appeared to die this week, could have worked. Particularly notable: The analysis assumes annual deductibles of $12,000, which means consumers would have to pay that amount — which is far higher than allowed under the ACA — before most benefits are covered.

On Wednesday, health care developments continued to unfold at a breakneck pace, and with a zigzagging trajectory, when the Senate Budget Committee posted on its website yet another bill. This one is an updated version of the 2015 “repeal and delay” bill, which is likely the measure the Senate will consider next week if a vote to start debate succeeds.

It would repeal all of the taxes that paid for the Affordable Care Act’s benefits, roll back the expansion of Medicaid (but not cap the underlying program), nullify the requirement for most people to have insurance and rescind the financial aid for low- and moderate-income Americans.

Late in the afternoon, the Congressional Budget Office released an updated estimate of an earlier analysis concluding that the new “repeal and delay” measure could result in 32 million fewer Americans having coverage and premiums doubling by 2026. By 2020, according to CBO, “about half the nation’s population would live in areas having no insurer participating in the non-group market.” The new bill does not include the Cruz amendment, the subject of the HHS report.

Opposition to the Cruz amendment from powerful health care sectors, like the insurance industry, is cited as one reason why the Senate was unable to muster enough votes to move the whole Senate bill forward for debate this week.

Last Friday, the insurance industry trade lobby sent a harsh warning to Congress, saying the Cruz amendment “is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage.”

Today, the HHS report took a very different view.

First reported in the right-leaning Washington Examiner, it forecasts far more people covered by insurance in 2024 if the Cruz plan were adopted, as compared with how many would be insured under the Affordable Care Act.

It also projects premiums would fall, both in plans that meet all the rules of the ACA, and in plans Cruz proposes, which would not have to follow the rules. The Cruz plans would have lower premiums, however, because they could come with far fewer benefits — and could reject people with medical problems or charge them more.

Insurers and actuaries said the Cruz proposal would result in a segmented market, with younger and healthier people drawn to the skimpier, less expensive plans. That, in turn, would leave older or sicker enrollees in the ACA-compliant plans, causing their premiums to spiral upward.

But the analysis by HHS shows premium costs for ACA-compliant plans would go down by more than $250 a month in 2024 when compared with what they would be under current law. The Cruz plans would be super cheap, at under $200 a month under the rosiest scenario outlined.

Experts today immediately pounced on the department’s methods — in as much as they could be determined, since the full report was not released.

(HHS did not respond to requests for comment or for the release of the full report.)

For starters, the draft report, they say, compares premiums for a 40-year-old with the “weighted average” of all people of all ages purchasing ACA plans now.

“It’s not apples to apples,” said Matt Fiedler, a fellow at the USC-Brookings Schaeffer Initiative for Innovation in Health Policy.

It cited its own “proprietary model” used to determine how many people would switch from ACA plans to the new Cruz plans, without spelling out its assumptions. Not including such details is highly unusual and makes the results difficult to analyze, said Garthwaite, adding: “There’s nothing in this that gives me any hope that the entire report will be any more accurate, complete or unbiased.”

Meanwhile, over lunch at the White House, President Trump asked senators to skip all or part of their August recess in order to work on another proposal to repeal and replace the ACA. He promised premiums that would be significantly lower, without citing details on how that would occur.

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

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