Tagged The Health Law

GOP Draft Repeal Plan Scraps Subsidies And Individual Mandate, Rolls Back Medicaid

Feb 24 2017

The replacement would be paid for by limiting tax breaks on generous health plans people get at work.

Politico: Exclusive: Leaked GOP Obamacare Replacement Shrinks Subsidies, Medicaid Expansion
A draft House Republican repeal bill would dismantle Obamacare subsidies and scrap its Medicaid expansion, according to a copy of the proposal obtained by POLITICO. The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high-risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020. (Demko, 2/24)

Bloomberg: GOP Obamacare Plan Would Cover Fewer People; Blowback Grows
Republican lawmakers expect that their Obamacare replacement will result in fewer Americans covered by health insurance, a fact that’s likely to increase blowback amid growing support for the program. New details of the plan are beginning to emerge, described by lawmakers and their aides. While still being worked out, it would do away with the Affordable Care Act’s requirement that all Americans have health coverage or pay a fine, and replace it with rules that let people choose not to buy insurance, instead paying higher premiums or penalties if they need it later. The result would be fewer people covered, said Republican lawmakers. (Tracer, House and Edney, 2/24)

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

Viewpoints: Executive Orders, Obamacare Replacements And Cold, Hard Facts; Medicare’s Challenges In Health Law Debate

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

The Wall Street Journal: The ObamaCare Holdouts
Republicans are getting battered at town halls on ObamaCare, with constituents — or least protestors — yelling about the benefits they’ll lose if the entitlement is repealed. But maybe the better measure of public sentiment is the choices that the people who are subject to ObamaCare have made in practice. (2/23)

The New England Journal Of Medicine: Trump’s Executive Order On Health Care — Can It Undermine The ACA If Congress Fails To Act?
Within hours after taking the oath of office, President Donald Trump executed his first official act: an executive order redeeming his campaign pledge to, on “day one,” begin repeal of the Affordable Care Act (ACA). The New York Times characterized his action as itself “scaling back Obamacare,” and the Washington Post said the order “could effectively gut [the ACA’s] individual mandate” to obtain health insurance coverage. But consumer advocate Ron Pollack dismissed Trump’s action as “much ado about very little.” To put these divergent assessments into perspective, it’s important to examine the actual executive order, recognize the departures from the Obama administration that it contemplates, and assess the scope and significance of changes the administration can lawfully make by executive order or other administrative actions. (Timothy Stoltzfus Jost and Simon Lazarus, 2/22)

Vox: John Boehner Told Republicans Some Inconvenient Truths On Obamacare
Didn’t Boehner hold repeal vote after repeal vote? Didn’t he win back the House in 2010, and hold it thereafter, promising to repeal Obamacare? Didn’t he participate in the government shutdown over Obamacare in 2013? He did. But to interpret Boehner generously, Obamacare is in a very different place now than it was in 2010, 2012, or even 2013. It’s delivering benefits to about 30 million people. Dozens of states have built budgets around Medicaid dollars flowing in from the federal government. Health systems nationwide have reorganized themselves around its provisions. (Ezra Klein, 2/23)

RealClear Health: Repeal & Replace: Missing The Medicare Forest For The Obamacare Trees
The Trump Administration has promised to deliver to the American people a healthcare plan that is, in President Trump’s own words, “much less expensive and far better” than Obamacare. But While Obamacare is expected to spend over $900 billion from 2018 to 2027, focusing solely on the Obama administration’s signature achievement ignores bigger fiscal challenges; Namely, the Medicare program. (Yevgeniy Feyman, 2/24)

Tribune News Service/Lincoln (Neb.) Journal-Star: A Simple Solution On Health Care
But the largest contributing factor to the voter anger directed at Republican senators and representatives didn’t require sly scheming — because it is very real, and even frightening to many voters. They are frightened about what they are NOT hearing from Trump and most Republicans in Congress about what will happen when they succeed in repealing President Obama’s Affordable Care Act. Republicans haven’t shown voters how they will replace it or sufficiently addressed what its elimination might mean to middle class folks who voted for Trump as an act of blind trust. (Martin Schram, 2/24)

Topeka Capital Journal: Medicaid Expansion Lives In Kansas
Considering how much disagreement there is on the economic and practical dimensions of Medicaid expansion – as well as the massive impact it has on the people of Kansas – didn’t it deserve a full debate in the Legislature? To Ward, Rep. Susan Concannon (a Beloit Republican who introduced the Medicaid amendment to HB 2044) and the legislators who voted in favor of expansion: Thank you for representing the interests of your fellow Kansans. While we’re not saying legislators should vote for a bill simply because it’s popular, they do have a responsibility to take their constituents’ concerns seriously and give critical issues their full attention. The lawmakers who tried to kill the Medicaid expansion bill in committee did the opposite. (2/23)

The New England Journal Of Medicine: Protecting The Tired, The Poor, The Huddled Masses
During Donald Trump’s presidential campaign and transition period, I worried that the climate of xenophobia and the widespread misunderstanding of the immigrants and refugees already in our country would dissuade others from seeking asylum here. … as a person who believes that health is a human right and that ensuring basic human rights promotes health, I remain terrified for the world’s well-being. The suspension of the U.S. Refugee Admissions Program for 120 days was poorly planned and discriminatory, and it has only intensified the fear and anxiety of people who are fleeing terror, bombings, domestic abuse, and other types of persecution because of their religion, sexual orientation, or ethnic background. … Moreover, many U.S. clinicians have noted that their patients who are already here are refraining from seeking the medical care they need or using other vital public services for fear of being incarcerated and deported. (Katherine Peeler, 2/22)

The Washington Post: Sean Spicer Seemed To Tie Marijuana Use To Opioids. The Evidence Isn’t On His Side.
The epidemic of opioid addiction in the United States has been well documented. A staggering 33,000 people died in 2015 from overdosing on prescription painkillers, heroin or similar drugs, on par with the number killed by firearms and in car accidents. The epidemic is growing, but its general causes are not in dispute. Nearly all research on the issue shows that excessive and improper prescriptions are what’s causing more people to become addicted. But White House press secretary Sean Spicer on Thursday appeared to link the surge in opioid abuse to another factor: recreational marijuana use. (Derek Hawkins, 2/24)

Milwaukee Journal Sentinel: Try Something New To Deal With Drug Crisis
In 2016, Milwaukee County saw a record high in deaths from drug overdoses, when at least 340 people died. Many of the drugs involved in this crisis such as oxytocin, vicodin and oxycodone are at first prescribed legally to treat physical pain. When users become addicted and lose avenues to these prescribed drugs, they often turn to illegal drugs. Bravo to Gov. Scott Walker, who has called for a special session of the Legislature to address this crisis. (Jerry Schultz, 2/23)

Stat: The Power — And The Fear — Of Knowing Your Cancer Genome
When it comes to cancer, all knowledge is power — even when that knowledge is scary. Knowing as much as you can about cancer lets you and your health care team act decisively in devising your treatment strategy. Even more important, it lets you act specifically in selecting treatments or clinical trials that might be best in treating your disease. … For me, learning everything about my disease has been essential to discovering how to attack and treat my cancer and, I believe, why I went into a surprising but welcome long-lasting remission. (Kathy Giusti, 2/23)

The New England Journal Of Medicine: The Perils Of Trumping Science In Global Health — The Mexico City Policy And Beyond
During his first week in office, President Donald Trump reinstated an executive order banning U.S. aid to any international organization that supports abortion-related activities, including counseling or referrals. The so-called Mexico City Policy — colloquially referred to as the “global gag rule” on women’s reproductive health — is allegedly intended to reduce the number of abortions around the world, in accordance with an antiabortion agenda. Scientific evidence suggests, however, that the policy achieves the opposite: it significantly increases abortion rates. The policy defunds — and in so doing, incapacitates — organizations that would otherwise provide education and contraceptive services to reduce the frequency of unintended pregnancies and the need for abortions. (Nathan C. Lo and Michele Barry, 2/22)

Seattle Times: Ethics And Trust Paramount In Physician, Patient Relationship
dramatic and complex changes in the health-care environment have placed a strain on medical professionalism and on physicians’ ability to exercise independent clinical judgment. We must ensure that doctors’ professionalism and independent judgment remain protected, even in our quest to have a healthy bottom line. (Jennifer Lawrence Hanscom, 2/22)

The New England Journal Of Medicine: Recreational Cannabis — Minimizing The Health Risks From Legalization
The cannabis-policy landscape is undergoing dramatic change. Although many jurisdictions have removed criminal penalties for possessing small amounts of cannabis and more than half of U.S. states allow physicians to recommend it to patients, legalizing the supply and possession of cannabis for nonmedical purposes is a very different public policy. Since the November 2016 election, 20% of the U.S. population lives in states that have passed ballot initiatives to allow companies to sell cannabis for any reason and adults 21 or older to purchase it. Although other states may move toward legalization, uncertainty abounds because of the federal prohibition on cannabis. The Obama administration tolerated these state laws; it’s unclear what the Trump administration will do. (Beau Kilmer, 2/22)

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

Research Roundup: Beverage Tax In Mexico; Health Care Access Survey; State Marketplaces

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

Health Affairs: In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax
Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages on January 1, 2014, and a previous study found a 6 percent reduction in purchases of taxed beverages in 2014. In this study we estimated changes in beverage purchases for 2014 and 2015. We used store purchase data for 6,645 households from January 2012 to December 2015. … Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. Households at the lowest socioeconomic level had the largest decreases in purchases of taxed beverages in both years. … Findings from Mexico may encourage other countries to use fiscal policies to reduce consumption of unhealthy beverages. (Cochero et al., 2/22)

Morbidity and Mortality Weekly Report/CDC: Surveillance for Health Care Access and Health Services Use, Adults Aged 18–64 Years — Behavioral Risk Factor Surveillance System, United States, 2014
This report summarizes 2014 BRFSS [Behavioral Risk Factor Surveillance System] data from all 50 states and the District of Columbia on health care access and use of selected [clinical preventive services]. … The findings … indicate substantial variations in health insurance coverage; other health care access measures; and use of CPS …. In 2014, health insurance coverage, having a usual source of care, having a routine checkup, and not experiencing unmet health care need because of cost were higher among adults living below the poverty level (i.e., household income <100% of FPL) in states that expanded Medicaid than in states that did not. Similarly, estimates of breast and cervical cancer screening and influenza vaccination were higher among adults living below the poverty level in states that expanded Medicaid than in states that did not. (Okoro et al., 2/23)

Pediatrics: Pediatric Resident Burnout And Attitudes Toward Patients
Burnout occurs in up to 75% of resident physicians. Our study objectives were to: (1) determine the prevalence of burnout, and (2) examine the association between burnout and self-reported patient care attitudes and behaviors among pediatric residents. … A total of 39% of respondents … endorsed burnout. Residents with burnout had significantly greater odds … of reporting suboptimal patient care attitudes and behaviors, including: discharging patients to make the service more manageable … not fully discussing treatment options or answering questions …, making treatment or medication errors …, ignoring the social or personal impact of an illness …, and feeling guilty about how a patient was treated. (Baer et al., 2/23)

The Kaiser Family Foundation: Pre-ACA Market Practices Provide Lessons For ACA Replacement Approaches
One of the biggest changes that the ACA made to the non-group insurance market was to eliminate consideration by insurers of a person’s health or health history in enrollment and rating decisions. … Proposals for replacing the ACA such as Rep. Tom Price’s Empowering Patients First Act and Speaker Paul Ryan’s “A Better Way” policy paper would repeal these insurance market rules, moving back towards pre-ACA standards where insurers generally had more leeway to use individual health in enrollment and rating for non-group coverage. … [This discussion] focuses on some of the issues faced by people with health issues in the pre-ACA non-group insurance market. These pre-ACA insurance practices highlight some of the challenges in providing access and stable coverage for people and some of the issues that any ACA replacement plan will need to address. (Claxton, Levitt and Pollitz, 2/16)

Brookings: How Has Obamacare Impacted State Health Care Marketplaces?
[O]ur five states had four years of experience in the open enrollment periods from 2014 through 2017. The states array themselves in a continuum of apparent success in enhancing and maintaining competition among insurers. California and Michigan appear to have had success in nurturing insurer competition, in at least the urban areas of their states. Florida, North Carolina, and Texas were less successful. This divergence is recent, however. As recently as the 2015 and 2016 open enrollment periods, all of the states had what appeared to be promising, if not always robust, insurance competition. Large changes occurred in the run-up to the 2017 open enrollment period. (Morrisey et al., 2/9)

Here is a selection of news coverage of other recent research:

CNN: Chronic Knee Pain Eased With The Help Of Skype
Exercise, an online pain-coping skills program and Skype sessions with a physiotherapist helped relieve patients’ chronic knee pain, according to a study published Monday in the journal Annals of Internal Medicine. … The new study was designed to investigate “the efficacy of a combined internet delivered treatment package including education, Skype-delivered exercise physiotherapy and an Internet-based interactive pain-coping skills training program,” said Kim Bennell, lead author of the study and a research physiotherapist and professor at the University of Melbourne. (Scutti, 2/20)

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

Extension On Non-ACA Compliant Plans Could Undermine Efforts To Stabilize Markets

The CMS issued the ruling Thursday to allow grandmothered plans to operate until Dec. 31, 2018. Meanwhile AHIP President Marilyn Tavenner and American Hospital Association President Rick Pollack talk about fixing the marketplace for individuals.

Modern Healthcare: Will CMS’ Decision To Extend Non-ACA Compliant Plans Help Or Hurt The Market? 
The Trump administration will allow insurers and consumers to extend for an additional year individual and small-group health plans that do not comply with the Affordable Care Act’s coverage rules. The insurance industry lobbied for the grandmothering extension. But some experts say it will hurt efforts to stabilize the individual market and moderate rate hikes by letting healthier people stay in plans outside the ACA-regulated insurance pool…It’s estimated that fewer than one million people currently remain in grandmothered individual-market plans in the three dozen or so states that still allow them. The rest of the states, including California and New York, already halted the sale of non-ACA compliant plans to strengthen their ACA-regulated markets. (Meyer, 2/23)

Modern Healthcare: Tavenner, Pollack Ask That ACA Replacement Plan Tackle Individual Markets First, Medicaid Later
If the Trump Administration and Congress repeal the Affordable Care Act, they ought to first fix the marketplace for individuals and put off the contentious debate of Medicaid reform for many months, two leading health association presidents said Thursday. Speaking at a Nashville Health Care Council luncheon, American Hospital Association President Rick Pollack and Marilyn Tavenner, president of the America’s Health Insurance Plans, agreed that the individual insurance market was unstable before the ACA and it remains so. Of the millions of newly insured on the exchanges, 70% are receiving subsidies to be able to afford coverage, Tavenner said. (Barkholz, 2/23)

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

Uncertainty Over Health Law Repeal Throws Taxpayers For A Loop This Season

As Americans are filing their taxes, many are confused about what they have to divulge about their health insurance status.

Politico: Obamacare’s Limbo Befuddles Taxpayers
Republicans’ stalled campaign to repeal the Affordable Care Act is sowing confusion among those now trying to do their taxes. Many taxpayers believe Republicans have already repealed the law, tax preparers say, and they’re surprised and upset to learn they are still subject to Obamacare’s penalty for failing to have health insurance — a charge that climbed this year to more than $2,000 per family. (Faler, 2/23)

California Healthline: To Pay Or Not To Pay – That Is The Question
K.A. Curtis gave up her career in the nonprofit world in 2008 to care for her ailing parents in Fresno, which also meant giving up her income. She wasn’t able to afford health insurance as a result, and for each tax year since 2014, Curtis has applied for — and received — an exemption from the Affordable Care Act’s coverage requirement and the related tax penalty, she says. This year, given President Donald Trump’s promise to repeal the ACA, along with his executive order urging federal officials to weaken parts of the law, Curtis began to wonder whether she’d even have to apply for an exemption for her 2016 taxes. (Bazar, 2/24)

Meanwhile, the threat of repeal hangs heavy over those who rely on the health law —

The Washington Post: Cancer Patients, Survivors Fear GOP Efforts To Dismantle The Affordable Care Act
Ashley Walton was 25 when a mole on her back turned out to be melanoma. She had it removed, but three years later she discovered a lump in her abdomen. She was then unemployed and uninsured, and so she put off going to a doctor. She tried to buy health insurance. Every company rejected her. By the time Walton finally sought medical help, the melanoma had spread to her brain, lungs and elsewhere. And she eventually became eligible for California’s Medicaid program, which had been expanded under the Affordable Care Act. Two major surgeries, radiation and immunotherapy did not cure the cancer — but did beat it back. (McGinley, 2/23)

Kaiser Health News: Threat Of Obamacare Repeal Leaves Community Health Centers In Limbo
Treating people for free or for very little money has been the role of community health centers across the U.S. for decades. In 2015, 1 in 12 Americans sought care at one of these clinics; nearly 6 in 10 were women, and hundreds of thousands were veterans. The community clinics — now roughly 1,300-strong — have also expanded in recent years to serve people who gained insurance under the Affordable Care Act. (2/24)

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

‘Obamacare Must Go’: Pence Draws Hard Line On Replacement At CPAC

The vice president promised those at the Conservative Political Action Conference that “America’s Obamacare nightmare is about to end.”

The Washington Post: VP Pence: ‘America’s Obamacare Nightmare Is About To End’
Vice President Pence forcefully defended on Thursday night the Trump administration’s plans to repeal and replace the Affordable Care Act, saying the law known as Obamacare is a “nightmare” and that the administration is committed to “an orderly transition” to a new health-care system. Addressing a gathering of conservative activists in the Washington area, Pence sought to minimize the voices of the hundreds of people who have demonstrated against changes to the law at congressional town hall meetings across the country. (Rucker, 2/23)

Politico: Pence: GOP Full Tilt On Obamacare Repeal
Pence said the administration would soon advance plans that preserve some of the current healthcare law’s most popular features — such as protections for patients with preexisting conditions — but that added more free market solutions, like the ability to purchase plans across state lines. And the vice president dismissed recent protests at Republican town halls as manufactured outcry, arguing that the GOP had the right principles behind their policies. (Jackson, 2/23)

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

Support For Health Law Grows, Leaving Republicans In A Bind

Republican members of Congress are at home this week, with many of them getting an earful from anxious constituents about their plans to “repeal and replace” the Affordable Care Act. A poll out Friday gives those lawmakers something to be anxious about, too.

The monthly tracking poll from the Kaiser Family Foundation finds overall support for the health law ticked up to 48 percent in February, the highest point since shortly after it passed in 2010. That was a 5-point increase since the last poll in December. (Kaiser Health News is an editorially independent project of the foundation.)

In addition, 6 in 10 people said they did not favor current GOP proposals for turning control of Medicaid, the federal-state program for low-income residents, over to the states or changing the federal funding method. More than half said Medicaid is important to them or family members.

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The increase in the law’s popularity is almost entirely due to a spike in support among independents, whose approval of the law has risen to 50 percent, compared with 39 percent unfavorable. Continuing a trend that dates to the passage of the law, the vast majority of Democrats approve of it (73 percent), while the vast majority of Republicans disapprove (74 percent).

Poll respondents are also concerned about the way Republicans say they will overhaul the measure. While they are almost evenly divided between wanting to see the law repealed (47 percent) or not repealed (48 percent), very few (18 percent) of those favoring repeal support the idea of working out replacement details later. More than half of the repeal supporters (28 percent of the sample) say the repeal and the ACA’s replacement should come simultaneously.

Interestingly, even among Republicans, fewer than a third (31 percent) favor an immediate repeal, while 48 percent support simultaneous repeal and replacement, and 16 percent don’t want the law repealed at all.

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Simultaneous repeal and replacement, which is what President Donald Trump has promised, could prove difficult since Republicans have not agreed to a plan. They are using a special budget procedure, called reconciliation, that allows them to move legislation with only a simple majority in the Senate, but that bill is limited in what it can remove from the law and what can be added to it. Other bills would likely have to overcome a filibuster by Democrats in the Senate, which requires 60 votes. Republicans currently have a 52-48 majority in that chamber.

When asked about the Republican plans to overhaul the Medicaid program, nearly two-thirds of those polled prefer the current Medicaid program to either a “block grant” that gives states more flexibility but would limit Medicaid’s currently unlimited budget, or a “per capita cap,” which would also limit spending to states but would allow federal funding to rise with enrollment increases.

Respondents also strongly favor letting states that expanded Medicaid under the Affordable Care Act continue to receive federal funding. The Supreme Court in 2012 made that expansion optional; 31 states (plus Washington, D.C.) adopted it. Eighty-four percent said letting the federal funds continue was very or somewhat important, including 69 percent of Republicans, and 80 percent of respondents in states that did not expand the program.

Republicans are counting on savings from capping Medicaid to pay for other health care options they are advocating.

The national telephone poll was conducted Feb. 13-19 with a sample of 1,160 adults. The margin of error is plus or minus 3 percentage points for the full sample.

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

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Threat Of Obamacare Repeal Leaves Community Health Centers In Limbo

Treating people for free or for very little money has been the role of community health centers across the U.S. for decades. In 2015, 1 in 12 Americans sought care at one of these clinics; nearly 6 in 10 were women, and hundreds of thousands were veterans.

The community clinics — now roughly 1,300-strong — have also expanded in recent years to serve people who gained insurance under the Affordable Care Act. In 2015, community health centers served 24.3 million people — up from 19.5 million in 2010. Most of the centers are nonprofits with deep roots in their communities and they meet the criteria to be a federally qualified health center. That means they can qualify for federal grants and a higher payment rate from Medicaid and Medicare.

The ACA was a game changer for these clinics — it has enabled them to get reimbursement for much more of the care they provided, because more of their patients now had private insurance or were on Medicaid. Revenue at many clinics went up overall, and many of the health centers used federal funding available under the law to expand their physical facilities and add more services, such as dentistry, urgent care or mental health care.

With repeal of the ACA looming, clinic directors said they stay up at night wondering what’s next. We spoke with four, who all say their clinics are in a holding pattern as Congress debates the health law’s future.

Saban Community Clinic, Los Angeles

Julie Hudman, the CEO of Saban Community Clinic in Los Angeles, Calif., said there’s a lot at stake for her patients.

“A lot of the folks that we see are single adults,” she explained. “They’re maybe more transitional. They’re homeless patients. They have behavioral health challenges. They’re really, to be honest, some of the most vulnerable and poorest patients of all.”

Before the ACA went into effect, eligibility for Medi-Cal, as Medicaid is known in California, depended on a variety of factors, including income, household size, family status, disability and others. Under Obamacare, according to the California Department of Health Care Services, people can now qualify for Medi-Cal on the basis of income alone if their household makes less than 138 percent of the federal poverty level — that’s $16,395 for an individual and $33,534 for a family of four.

Prior the ACA, about half of the Saban clinic’s 18,000 patients were uninsured, Hudman said. They paid little for treatment — maybe a copay of $5 or $10. Almost all of those patients qualified for Medi-Cal after the health law expanded eligibility, she said, and that’s made a big difference for the clinic’s bottom line: Medi-Cal pays the clinic around $200 per patient visit.

These days, more than half of Saban’s revenue comes from health insurance. The possibility of losing some of that money, Hudman said, is forcing some hard decisions. She had been looking to lease or buy a fourth facility, she said, but now that plan is on hold; as are her hopes of expanding free help for the homeless.

“I’m not willing to move forward and take some of those risks,” she said. “I need to make sure that we’re able to pay our bills and pay our staff.”

Before the last election, Hudman said, “we had a lot of momentum moving forward. And now we’ve just sort of stalled.” — Rebecca Plevin, KPCC, Los Angeles

Jordan Health, Rochester, N.Y.

In the last few years, funding has been on the rise at Jordan Health, in Rochester, N.Y., and so has the extent of the clinic’s services.

The boost in funding has partly come from higher reimbursement rates the ACA authorizes, and from the increased number of patients at the clinic who have insurance. But Jordan Health, which has 10 locations in the area, has also benefited from the federal government’s pumping of more money into what are known as section 330 grants that enable expansion of services and facilities.

Janice Harbin, CEO of Jordan Health in Rochester, N.Y. says section 330 grants have allowed Jordan Health to hire more health practitioners. (Karen Shakerdge/WXXI)

Janice Harbin, CEO of Jordan Health in Rochester, N.Y. says section 330 grants have allowed Jordan Health to hire more health practitioners. (Karen Shakerdge/WXXI)

The 330 grant money gives qualified clinics the option of offering services that aren’t billable to insurance plans. At Jordan Health, the funds enabled the hiring of some different types of health practitioners who were not previously part of the team — dietitians, behavioral health specialists and care coordinators. And that, in turn, said Janice Harbin, president and CEO of Jordan Health, means patients can increasingly get the different kinds of care they need in one place.

Almost 90 percent of Jordan’s patients are considered a racial or ethnic minority, and over 97 percent live at or below 200 percent of the federal poverty line, according to data gathered by the federal Health Resources & Services Administration.

“When you’re dealing with a situation of concentrated poverty,” Harbin said, “your patient needs more than just ‘OK, let me give you a checkup, and pat you on the back and say now go out and do all these things I told you to do.’”

Jordan Health received an increase of about $1 million since 2013, according to its grant coordinator, Deborah Tschappat.

Tschappat said she expects Jordan will get about the same annual award in 2017, assuming federal funding for the 330 program stays about the same. If federal funding is cut significantly, they would potentially lose some services.

For now, Jordan Health plans to “expand services judiciously, while increasing efficiency and productivity,” Tschappat said.

In the coming months Harbin and her colleagues will be lobbying lawmakers in Albany and Washington, D.C., to renew Jordan’s funding — including the 330 grant, which is set to end in September.

“We’re used to doing a lot with a little, but we increasingly know that we do need to have financial support,” Harban said. “And that’s keeping us up at night.” — Karen Shakerdge, WXXI, Rochester

Adelante Healthcare, Phoenix

Adelante Healthcare has been part of the health safety net in Phoenix for nearly four decades — when its doctors began helping farm workers in the city’s surrounding fields. But the Affordable Care Act enabled Adelante to expand like a brand new business.

“Adelante has grown by 35 percent in the last 12 months,” said Dr. Robert Babyar, Adelante’s assistant chief medical officer. “We’ve increased our provider staffing — almost doubled our providers. And the number of services we provide has doubled.”

Adelante operates nine clinics throughout the Phoenix metro area. The one where Babyar met with me includes play areas for children and a dental office.

Most of their 70,000 patients are low-income and about half are covered by either Medicaid or KidsCare — Arizona’s version of the Children Health Insurance Program. In 2014, Arizona became one of the Republican-led states that expanded Medicaid under the ACA. That brought more than 400,000 people onto the state’s Medicaid rolls and created big demand for Adelante. Low-income patients who did not have insurance before the expansion had relied on Adelante’s sliding fee schedule. Much of that population now has health coverage, either through the ACA marketplace or the state.

“That opened up more options for our patients, more specialists they could see, procedures they could have done,” Babyar said.

As Congress moves to repeal and replace the health care law, Adelante is in a holding pattern. It has delayed the groundbreaking of a new site until later this year because of the uncertainty. A full repeal of the ACA — without a replacement that keeps its patients covered — would limit any future growth, and strain the new staff and resources it has added. It wouldn’t be the first time Adelante had to scale back its services because of changes to Medicaid. In 2010 and 2011, Arizona lawmakers froze enrollment for its CHIP program and for childless adults in Medicaid. Then, in 2012, Adelante lost more than a million dollars.

Babyar said it has taken several years to get their new patients into the system and working with doctors consistently to manage their conditions.

“All the progress we made with those patients to stay and be healthy — that can fall apart really quick,” said Babyar. — Will Stone, KJZZ, Phoenix

Denver Health, Denver

Denver’s Federico F. Peña Southwest Family Health Center is part of Denver Health — the safety-net system that takes care of low-income people.

“Definitely this clinic has benefited from Obamacare,” said Dr. Michael Russum, who practices family medicine for Denver Health and helps lead the clinic. “And this population has benefited from Obamacare by the expansion of Medicaid.”

That’s what helped make the economics work as Denver Health put a new $26 million clinic in a high poverty neighborhood in 2016, said Dr. Simon Hambidge, Denver Health’s CEO of Community Health Services. With the ACA in place, he said, the health system was able to count on the new clinic having a population of paying patients with insurance that could help support it.

Hambidge predicted the hospital will weather the storm if Obamacare is repealed and there are serious cuts to safety-net programs, like Medicaid and Medicare, as some Republicans have suggested. But it will probably be harder to open new clinics in other high-need neighborhoods, he conceded.

“We’ll survive,” Hambidge said. “We may not be able to be as expansive, because we would be back to less secure times.” — John Daley, Colorado Public Radio

This story is part of NPR’s reporting partnership with local member stations and Kaiser Health News.

Categories: Medicaid, Public Radio Partnership, Repeal And Replace Watch, States, Syndicate, The Health Law

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Viewpoints: Taking Stock Of The GOP Repeal-Replace-Repair Effort; Anti-Vaxxers See A Friend In President Trump

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

The Washington Post: Republicans Suddenly Realize Burning Down The Health-Care System Might Not Be A Great Idea
The Republican effort to repeal the Affordable Care Act is not going well, in large part because it turns out that making sweeping changes to a system that encompasses one-sixth of the American economy turns out to be rather more complicated than they imagined. Their backtracking has an interesting character to it, in particular how they’ve been gobsmacked by the transition from shaking their fists at the system to being responsible for it. (Paul Waldman, 2/22)

JAMA Forum: Replacing ACA Would Harm Economically Vulnerable Persons And The Health Care Safety Net
The US Congress recently took its first steps toward repealing the Affordable Care Act (ACA). The Congressional Budget Office projected that repeal would increase the number of uninsured by 18 million people initially, and by 27 million after funding for Medicaid expansion and subsidies are eliminated. Repealing the ACA also threatens the safety net critical to health care access for economically vulnerable individuals and families. (Roy Grant, 2/20)

The Washington Post: Under Trump, Obamacare’s Medicaid Enrollments May Actually Go Up
Much of the media coverage and public political battle has focused on regulations and subsidies that impact middle America and those with coverage. The program targeted at the poor — Medicaid —has received less attention but demands more. For now, it looks as if the Republican Congress will end up leaving the structure of Obamacare’s expanded Medicaid program intact and that Tom Price — President Trump’s secretary of health and human services — will use his administrative powers to grant states greater discretion in running their Medicaid programs. (Timothy Callaghan and Lawrence R. Jacobs, 2/22)

Modern Healthcare: Fierce Medicaid Critic Joins Trump’s ACA Repeal Team
A fierce critic of Medicaid expansion has joined the White House team working on repealing and replacing the Affordable Care Act. White House staffers are expected to play a key role in helping craft the upcoming budget reconciliation bill to repeal and replace the ACA. One of those key aides is Brian Blase, who recently left the conservative Mercatus Center at George Mason University to serve as health policy adviser to Gary Cohn, director of President Donald Trump’s National Economic Council and former president of Goldman Sachs. (Harris Meyer, 2/22)

The New York Times: The Anti-Vaccine Movement Gains A Friend In The White House
Vaccine opponents, often the subject of ridicule, have found fresh energy in the election of a president who has repeated discredited claims linking childhood immunizations to autism and who has apparently decided to pursue them. With President Trump’s support, this fringe movement could win official recognition, threatening lives and making it urgent that health officials, educators and others respond with a science-based defense of vaccines. Vaccines have saved lives by protecting children and adults from diseases like measles, polio, smallpox, cervical cancer and whooping cough. And there is no evidence whatsoever that vaccines or a preservative used in flu shots cause autism. (2/23)

JAMA Forum: Vaccines And The Trump Administration
Writing recently in the New York Times, infectious disease physician Peter Hotez warned: “It’s looking as if 2017 could become the year when the anti-vaccination movement gains ascendancy in the United States and we begin to see a reversal of several decades in steady public health gains. The first blow will be measles outbreaks in America.” (Joshua M. Sharfstein, 2/22)

Stat: Scientists Can’t Cower In The Face Of Trump Policies That Threaten Research
Fear of speaking and debating openly on controversial issues and inquiry is antithetical to science. So it has been chilling for me to listen to the fear expressed by medical students, resident physicians, faculty members, and administrators engendered by Trump’s actions. I’ve heard medical students say they are worried about speaking out because they might be branded as “activists” by residency programs. Faculty members worry about how their opposition to the Trump agenda may be perceived by philanthropists who fund their work. Administrators fear overstepping the line in response to Trump and struggle to balance supporting their staff’s concerns about how new policies affect their colleagues and families while avoiding perceived political conflict. (Duncan Maru, 2/22)

JAMA: Revamping the U.S. Federal Common Rule: Modernizing Human Participant Research Regulations
On January 19, 2017, the Office for Human Research Protections (OHRP), Department of Health and Human Services, and 15 federal agencies published a final rule to modernize the Federal Policy for the Protection of Human Subjects (known as the “Common Rule”).1 Initially introduced more than a quarter century ago, the Common Rule predated modern scientific methods and findings, notably human genome research. (James G. Hodge and Lawrence O. Gostin, 2/22)

The Washington Post: A Health-Care Change That Could Prove Catastrophic
While a handful of high-profile policy questions have preoccupied Americans since the election, one potentially catastrophic health-care change has quietly been taking shape without much media attention. The Accreditation Council for Graduate Medical Education — the professional body charged with overseeing the nation’s physician training programs is poised to eliminate the 16-hour limit on work shifts for first-year resident physicians (referred to as interns) that it implemented in 2011. It proposes allowing interns to return to working extreme shifts of 28 hours — twice each week. (Christopher P. Landrigan and Charles A. Czeisler, 2/22)

Bloomberg: That Free Health Tracker Could Cost You
Using big data to improve health might seem like a great idea. The way private insurance works, though, it could end up making sick people — or even those perceived as likely to become sick — a lot poorer. Suppose a company offers you an insurance discount and a free FitBit if you agree to share your data and submit to a yearly physical. You’re assured that the data will be used only in aggregate, never tied back to specific identities. If that makes you feel safe, it shouldn’t. (Cathy O’Neil, 2/23)

The Washington Post: If Abortion Rights Fall, LGBT Rights Are Next
We represent the organizations that won leading Supreme Court cases in recent years on sexual and reproductive rights: Obergefell v. Hodges in 2015, which secured legal protections for the marriage of same-sex couples, and Whole Woman’s Health v. Hellerstedt in 2016, which struck down Texas’s attempt to use sham health regulations to shut down 75 percent of the state’s abortion clinics. President Trump has taken sharp aim at the rights affirmed in those cases. During the campaign, he attacked the Obergefell opinion and repeatedly and unambiguously promised to put justices on the Supreme Court who would overturn Roe v. Wade. According to the president, it’s the government, not each individual, that should hold the power to decide who can get married and whether women can terminate a pregnancy. (Nancy Northup and Rachel B. Tiven, 2/22)

The Des Moines Register: Lawmakers, You Still Owe Us For Illegal Health Plans
Iowa Code allows state lawmakers to enroll in health insurance plans offered to executive branch employees “excluded from collective bargaining.” Those workers pay 20 percent of the total cost of their monthly premium. A few weeks ago, The Des Moines Register reported that legislators are instead enrolled in health plans negotiated by unions on behalf of union-covered state employees. Many lawmakers are paying as little as $20 in monthly premiums when they should be paying hundreds of dollars. (2/22)

Louisville Courier-Journal: Dangers Lurking In E-Cigs
During my nursing career, I have come across numerous heroes, but my first was Surgeon General Everett Koop. More than 50 years ago, he published the first report on Smoking and Health. … Today, my new hero is another Surgeon Gen. Vivek Murthy, who released the first report on E-cigarette Use Among Youth and Young Adults in December 2016. We now have data and ammunition to halt the debate that e-cigarettes are harmless. The report lays out in clear, indisputable terms that e-cigarette use increases the risk of nicotine addiction, harm to brain development and future use of other tobacco products for young users. (Janie Heath, 2/22)

The Washington Post: Helmets Save Lives So Why Don’t All States Require Them?
A new report from the World Health Organization suggests we’ve made some progress in reducing traffic fatalities through seat belt laws, improved highway and vehicle design, and campaigns to reduce drunk or drug-impaired driving. But motorcycles are bucking the trend, even in the world’s wealthiest and most developed countries, including the United States. (Fredrick Kunkle, 2/22)

Stat: Global Health Is An Investment We Can’t Afford To Pass Up
More than at any time in history, good health for all is a real possibility. The technology, scientific advancement, and remarkable understanding of disease now available to the medical and nursing community show the progress we have made. As a career physician, I have seen modern medicine rescue people from the brink of death with the power of machines, medicines, and smart minds. The successes aren’t just in developed countries — they’re global. For example, the number of people newly infected with HIV around the world has stopped growing. There are now 18.2 million people undergoing treatment for HIV, up from 15.8 million in the last year alone. Equally encouraging, new infections in children are down 50 percent since 2010. (Vanessa Kerry, 2/22)

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

KHN On Call: What’s Next For The ACA?

“KHN On Call” is a new regular feature, a product of our ongoing partnership with NPR. Each week, Julie Rovner, KHN’s chief Washington correspondent, will answer a few audience questions about the new administration’s effort to revamp U.S. health care — to “repeal and replace” the Affordable Care Act. Which changes are real and imminent? What can the president do without congressional agreement? How will policy changes affect patient lives? Tell us what you’d like to know. The segment will air on Morning Edition and we’ll repost the audio and a story here. You can submit questions via Twitter @MorningEdition #ACAchat or @KHNews #KHNOnCall.

Health care under the Affordable Care Act is poised to change — again. The Republican-led Congress has vowed to “repeal and replace” the health law known as Obamacare.

That has left many people anxious and confused about what will happen and when. So NPR’s Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead.

Many of the questions or comments that have come in so far have to do with timing. For example, Steva Stowell-Hardcastle of Lewisburg, Pa., said, “I’m confused about what parts of the ACA have been repealed and when those changes take place.”

First, while some parts of the huge health law have been altered since it passed in 2010, nothing substantive has been repealed in 2017.

In January, Republicans in Congress passed a budget resolution that called for major changes to the law to be made in a subsequent bill, called budget reconciliation. That will allow the bill to pass the Senate with only a majority of votes, rather than the 60 votes needed to overcome a filibuster by Democrats. Congressional leaders have yet to unveil what they plan to put in that second bill.

Whatever they include, however, they cannot repeal the entire law in reconciliation. That’s because the budget process limits changes to those that directly affect the federal budget. Put simply, they can modify money but not rules. While there is some debate over how that will look, most people believe the rule that requires insurers to cover people with preexisting conditions could not be repealed through a budget bill.

The Trump administration has taken a few actions, but none making concrete changes — yet. In January, Trump signed an executive order calling for federal agencies to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act” that would “impose a fiscal burden” on states, individuals, healthcare providers, and others in the health industry.

But so far the only federal action in response to that order has come from the IRS, which decided not to more strictly enforce the “individual mandate” that requires most Americans to have health insurance. The IRS, however, noted that the requirement is still law.

A related question comes from Kathryn Henry of Iowa City, Iowa. She asks, “If it is repealed, what happens to people like me who currently have insurance through it and when?”

Both President Trump and GOP congressional leaders have insisted that they want a smooth transition from the current system to a new one, particularly for the 11 million or so people who purchased coverage on the federal or state health insurance exchanges.

“We don’t want to pull the rug out from under people while we’re replacing this law,” said House Speaker Paul Ryan (R-Wis.) in January. Trump has insisted that repealing the law and replacing it be done “essentially simultaneously,” so as not to leave people without insurance.

Unless something unexpected happens, people who purchased insurance for 2017 should be covered through the remainder of the year.

The bigger question is what happens in 2018. The uncertainty alone is prompting some insurers to get out of the individual insurance market, which is the most affected by the health law.

Insurance company Humana has already said it won’t participate in the health insurance exchanges next year, and the CEO of Aetna told reporters that his company might drop out, too. If Congress deadlocks over how to overhaul the health law, that exodus could accelerate.

Insurers were supposed to tell the federal government whether they planned to participate in the insurance exchanges by May 3, but the Trump administration has now given them until the end of June.

Categories: Repeal And Replace Watch, The Health Law

Viewpoints: Health Policy Moves Back To Town Halls; GOP Wrestles With Medicaid Debate

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

Chicago Tribune: To The GOP On Obamacare: This Spud’s For You
Health care policy as a political hot potato has become a popular metaphor. Writers at Vox, CNBC, the American Constitution Society and elsewhere have compared Obamacare to a fresh-from-the-oven tuber that’s too painful to hold and must be tossed back across the aisle as quickly as possible. Noting growing concerns about inherent flaws in the complex structure of Obamacare — formally known as the Patient Protection and Affordable Care Act — libertarian Bloomberg View columnist Megan McArdle argued in a Feb. 15 essay that Congress is no longer “arguing about whether (and how) the exchanges can be saved, but playing hot potato as both parties vie to avoid being stuck with the blame for the ensuing disaster.” Nice try. (Eric Zorn, 2/21)

Roll Call: Town Hall Winners And Losers So Far
We’re halfway through the Presidents Day recess, the first during President Donald Trump’s first term in office. … it’s no surprise that town halls would become a focal point for the anger swirling on the left. Some members have plainly refused to meet with groups they think will be hostile to them. Others have flung open the sashes and let the emotions fly. Others have worked assiduously to restrain something that is inherently not theirs to control — the reaction of voters to their government’s actions in Washington. With half of the recess still left to play out, here are the winners and losers so far. (Patricia Murphy, 2/22)

The Wall Street Journal: Repeal And Replace Panic
In the 2009 ObamaCare debate, White House aide David Plouffe told nervous Democrats “no bed-wetting,” meaning keep calm and all will be well. House Democrats went on lose 63 seats in 2010, but the double irony is that Mr. Plouffe’s advice now applies to those reporters and liberals who seem to be invested in the failure of the GOP’s version of health-care reform. Every day brings a new story about Republicans in disarray, the “mirage” of the GOP’s reform and the impossibility of change. … The reality is that Congress is on schedule, progress is underway, and the many potential problems are avoidable. (2/21)

Forbes: Cassidy-Collins Patient Freedom Act Looks Better As Other Reform Efforts Falter
In a different political climate, the “Patient Freedom Act” introduced last month by Republican Senators Bill Cassidy and Susan Collins would be getting close scrutiny and perhaps some significant support. It is — and I apologize for language that appears to have become profane in these polarized times — a compromise. The bill recognizes that an outright repeal and replacement of Obamacare is going to be politically challenging for at least the next two years. It likewise recognizes that the persistence of Obamacare nationwide is likely to be challenging and expensive. (Seth Chandler, 2/21)

Bloomberg: A GOP Tax Idea Would Upend Health Insurance 
Last week brought thwarted mergers, threats by insurers to leave the Affordable Care Act’s individual exchanges, and the release of a (very) rough sketch of a possible GOP repeal-and-replace plan for the ACA. What’s missing in that skeletal outline is how to pay for new initiatives, such as an expanded tax credit to help people buy insurance, while also repealing the new taxes established by the ACA. Some in the GOP are floating one possible solution: capping the federal tax breaks workers and companies get for employer-provided health insurance. (Max Nisen, 2/21)

WBUR: Caring For Immigrant Patients When The Rules Can Shift Any Time
Knowing patients’ immigration status and the reasons they came to this country can affect the services they are eligible for, the relative costs of medications, the fears that may keep them from returning for needed services, and even the diagnosis of unexplained symptoms. Immigration policy, Marlin told us, “is no longer a spectator sport” for us or for our patients. But it is not simple to practice medicine under these new and uncertain circumstances. (Elisabeth Poorman, 2/21)

Bloomberg: ‘Right To Try’ Laws Don’t Help The Dying 
A national “right to try” law, supported by Vice President Mike Pence and scores of Republicans in the the House and Senate, is meant to circumvent the FDA’s regulatory authority by giving patients who are terminally ill the right to use drugs that the agency hasn’t yet approved. The idea sounds reasonable; in the past few years, bipartisan majorities in two-thirds of state legislatures have passed essentially the same law. In reality, however, these laws give patients no new rights at all. They do nothing to compel drug makers to provide experimental medicines to the dying, or insurers to pay for them. They merely eliminate a patient’s right to sue for any injuries that might arise — that is, if any patient ever gets an untested drug in this way. (2/21)

Boston Globe: Did Dana-Farber Pay Too High A Price For Its Mar-A-Lago Fund-Raiser?
When asked why he robbed banks, the legendary bank robber Willie Sutton said, “Because that’s where the money is.” That’s also why the Dana-Farber Cancer Institute holds fund-raisers at Mar-a-Lago, the posh Palm Beach resort that serves as President Trump’s Florida home. It’s where the money is. The most recent gala, held over the past weekend, raised $2.2 million. All for a good cause. But at what cost? (Joan Vennochi, 2/21)

St. Louis Post-Dispatch: Turn Off The Drug Spigot In The St. Louis Region
Heroin and opioid overdoses have increased to the point where they claim more lives regionally than homicides. State and local lawmakers need to focus greater efforts on combating a growing epidemic. Gov. Eric Greitens’ pledge to help create a statewide prescription drug database is a good start, but a more comprehensive law enforcement effort would go even further to push down the number of drug-related deaths. (2/21)

Pittsburgh Post-Gazette: Overprescribed: Curbing The Easy Fix Of Psychiatric Meds For Seniors
With many communities still struggling to manage the opioid epidemic, the last thing the nation needs is a new drug-related problem — the overprescribing of psychiatric and other medications to senior citizens. A new report in the journal JAMA Internal Medicine raises a red flag about the trend, saying it appears to be particularly common in rural areas where patients with symptoms of mental illnesses might have less access to talk therapy and other nondrug treatments. But even in these communities, there are alternatives to medications that can and should be explored. (2/20)

Stat: Patient Reviews Published Online Can Help Improve Health Care
It’s no secret that the US health care system needs to improve. Consumers — in this case patients and employers — have more collective power to influence change than they realize by choosing how, where, and from whom they get health care. Uber, Nordstrom, and many other companies seek their customers’ opinions and respond to them. Health care needs to follow suit to become the patient-centered service industry that it should be. The University of Utah, where I work, began collecting patient feedback early on and was the first health system in the US to publicly post patients’ reviews of their providers. It has paid off in many ways. (Vivian S. Lee, 2/21)

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

The Health Law’s Two Americas: Those Who Qualified For Help And Those Who Didn’t

For those who were able to get federal subsidies, the health law was a blessing. The ones who didn’t were left feeling angry and short-changed.

The Associated Press: Health Law Created Winners And Losers When Buying Insurance
Michael Schwarz is a self-employed business owner who buys his own health insurance. Subsidized coverage through “Obamacare” offers protection from life’s unpredictable changes and freedom to pursue his vocation, he says. Brett Dorsch is also self-employed and buys his own health insurance. But he gets no financial break from the Affordable Care Act. “To me, it’s just been a big lie,” Dorsch says, forcing him to pay more for less coverage. (Alonso-Zaldivar, 2/22)

Kaiser Health News: GOP Fix To Insurance Markets Could Spike Premiums For Older Customers
Dale Marsh has not been enamored with his health insurance since the Affordable Care Act took effect. Premiums for Marsh, 53, and his wife, Tammy, rose, their deductibles grew, and they gave up access to their regular doctors to keep costs down. This year, facing monthly premiums of $1,131 — a 47 percent increase from four years before — they decided to go without coverage. “It’s useless insurance,” said Marsh, who owns a software company with Tammy, 52, in Graford, Texas. “We’re praying for the best, that neither one of us need insurance, that we don’t have to go the hospital.” Yet, a new premium spike may be in store for those in their 50s and 60s. (Rau and Appleby, 2/22)

In other news, worries about repeal persist —

The Associated Press: ‘It Saved My Life’: Talk Of Obamacare Repeal Worries Addicts
While the Affordable Care Act has brought health coverage to millions of Americans, the effects have been profound, even lifesaving, for some of those caught up in the nation’s opioid-addiction crisis. In Kentucky, which has been ravaged worse than almost any other state by fentanyl, heroin and other drugs, Tyler Witten went into rehab at Medicaid’s expense after the state expanded the program under a provision of the act. Until then, he had been addicted to painkillers for more than a decade. “It saved my life,” he said. (Beam and Johnson, 2/22)

The Philadelphia Inquirer: Advocates: Repealing Obamacare Would Cost N.J. Jobs And Lives
The generally left-leaning groups detailed county-by-county effects in an effort to get residents to put pressure on representatives at town hall meetings during this week’s congressional recess. Some lawmakers who have not scheduled meetings are discovering that gatherings have been planned in their absence. With more than $4 billion a year in direct federal funding at stake, the ripple effect of rescinding the law would kill 86,000 jobs, according to an analysis by New Jersey Policy Perspective. About 800,000 residents would lose health insurance without the ACA’s Medicaid expansion and subsidies for coverage purchased on the federal exchange. Plus, 212,000 seniors who fall into Medicare’s “doughnut hole” would each lose an average $1,241 in prescription assistance. (Sapatkin, 2/21)

Asbury Park Press: Group: Obamacare Repeal Costs Jersey Shore Over $500M
The Jersey Shore would lose more than $500 million a year in federal funding and 11,000 jobs if Obamacare is repealed without a replacement, according to a study released by consumer advocates on Tuesday. While replacement proposals on the table would soften the blow, they would leave New Jersey and consumers with less financial help for health care and possibly insurance policies that don’t cover as much, they said. (Diamond, 2/21)

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

Administration, House GOP Agree To Freeze ‘Insurer Bailout’ Lawsuit

House Republicans had filed the suit in response to a series of President Barack Obama’s unilateral executive actions on paying insurers that they said were unconstitutional.

The Wall Street Journal: Trump Administration Seeks Delay In Lawsuit Over Health-Law Subsidies
The Trump administration and House Republicans on Tuesday asked a court for a further delay in a lawsuit over certain Affordable Care Act subsidies, a move that may help assuage insurers debating whether to participate in the health law’s 2018 exchanges. In May, a federal district court judge ruled that the government was improperly reimbursing insurers to help them cover discounts they were required to give some low-income consumers, potentially a major blow to the insurers. (Hackman, 2/21)

CQ Roll Call: Trump, House GOP Seek Delay In Key Obamacare Lawsuit
An end to the lawsuit could mean an end to the subsidy payments, so lawmakers would be prompted to act if they want to keep the insurance market stable while they come up with legislation. Insurers have called the payments “critical,” and made the issue their chief lobbying priority. Top Republicans, including appropriators, now say they’re willing to make the payments as they implement a health policy overhaul, despite a previous unwillingness to do so under the Obama administration that sparked the lawsuit in the first place. (Ruger, 2/21)

Morning Consult: House, DOJ Seek To Continue Hold In Case Over Obamacare Payments
Now lawyers for the House of Representatives and the Department of Justice want the case to remain on hold, meaning insurers would still receive payments in the meantime. Both sides proposed keeping the case on hold and giving status reports every three months, beginning May 22, 2017, according to a joint motion. “The House and Department of Justice filed a motion seeking more time to continue efforts to resolve the lawsuit without the court’s assistance,” Doug Andres, a spokesman for House Speaker Paul Ryan, said in an email. (McIntire, 2/21)

In other news —

Modern Healthcare: Filing Extension May Not Be Enough To Keep Insurers In Individual Market 
Health insurers are pleased the Trump administration wants to give them seven extra weeks to file rates for individual-market plans in 2018. But that move does little to settle their uncertainty about whether to offer plans at all. Their anxiety has been heightened by the Republican drive to repeal and replace the Affordable Care Act and by a pending House Republican lawsuit to block certain payments to insurers. Carriers say they need to know the rules of any new system before they can design plans and set rates. (Dickson, 2/21)

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

Tax Proposals In GOP Repeal Plan Could Be Hard To Swallow For Conservatives

In addition to a credit to help people buy insurance, Republicans have suggested opening up some employer-sponsored health insurance plans to taxation. Both ideas are drawing opposition from the right wing of the party. Meanwhile, the fight over Medicaid looms large in the Senate.

The Hill: Two Tax Issues Dividing Republicans On ObamaCare
Republican lawmakers are objecting to two key elements of their party’s plan to replace ObamaCare, creating obstacles in the road to repeal. Conservatives worry a tax credit to assist people with the cost of insurance, which would help people maintain or get coverage, will be too costly and that recipients might abuse the government help…Objections also are being raised against a proposal to open up some employer-sponsored health insurance plans to taxation. Some Republicans worry that proposal is essentially a new version of ObamaCare’s much-reviled “Cadillac tax.” (Sullivan, 2/21)

The Hill: ­ObamaCare Fix Hinges On Medicaid Clash In Senate 
The most divisive issue for Senate Republicans when it comes to repealing and replacing ­ObamaCare is what to do with Medicaid. The Affordable Care Act gave states the option of accepting federal funds to expand Medicaid, the healthcare program for the poor and disabled. Millions of people gained health insurance after 31 states — including many with Republican governors — decided to accept the deal. Repealing ­­ObamaCare would end the Medicaid expansion, cutting federal funds to all of those states. (Bolton, 2/22)

Iowa Public Radio: Loebsack: GOP Plan To Replace ACA “Wholly Inadequate” 
Iowa’s only Democrat in the U.S. House of Representatives says he still doesn’t know the details of what Republicans will propose as a replacement for the Affordable Care Act. Dave Loebsack is on the House Energy and Commerce Committee, which will vote on a replacement before sending it to the full House. (Kieffer, Perkins and Leland, 2/21)

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

A Not-So-Fun Recess: Hostile Crowds Confront GOP Lawmakers Over Repeal Plans

“With all due respect, sir, you’re the man that talked about the death panels. We’re going to create one great big death panel in this country,” the vice chairman of the Iowa Democratic Party’s Rural Caucus said at Sen. Chuck Grassley’s town hall meeting. Across the country, lawmakers are facing agitated and concerned voters during their weeklong recess.

The New York Times: At Town Halls, Doses Of Fury And A Bottle Of Tums
Representative Marsha Blackburn may have expected to draw a friendly crowd by scheduling a town hall-style meeting in a Tennessee community that had voted overwhelmingly for President Trump, but she instead faced a hurricane-strength blast of disapproval on Tuesday. Ms. Blackburn, an eight-term Republican, was sharply questioned about a wide range of issues that have unsettled Mr. Trump’s first month in office, including health care, the environment, education and the president’s links to Russia. (Gabriel, Kaplan, Alvarez and Huetteman, 2/21)

The Associated Press: GOP Members Of Congress Meet With Protests At Town Halls
A month into Trump’s presidency, protests continue over his immigration policies, Cabinet selections and the GOP’s push to repeal the Affordable Care Act, without all the specifics on how to replace it. At the town halls, protesters are probing their lawmakers to see if they will veer from some of Trump’s more controversial decisions, and if they will promise coverage for those currently served by the Affordable Care Act. Trump took to Twitter on Tuesday to address the town halls. “The so-called angry crowds in home districts of some Republicans are actually, in numerous cases, planned out by liberal activists. Sad!” he tweeted. (Matisse, 2/21)

The Associated Press: US Senate Leader: Winners Make Policy, Losers Go Home
Nearly 1,000 people jeered Senate Majority Leader Mitch McConnell as he drove to a speech Tuesday where he told local business leaders that “winners make policy and the losers go home.” … Several people stood and booed as McConnell finished his remarks, including answering a few questions about the Affordable Care Act and regulations on the financial industry imposed by the legislation known as Dodd-Frank. McConnell was largely unfazed by those he called “the people outside,” saying he was “proud” of them for expressing their views. (Beam, 2/21)

Politico: This Time, Grassley Hears Pro-Obamacare Voices
What a difference eight years makes. More than 100 Iowans on Tuesday packed into a small farm town community center by 7:45 a.m. to urge Sen. Chuck Grassley not to repeal Obamacare, and to air their opposition to President Donald Trump’s agenda, his Cabinet nominees and his Supreme Court pick. (Haberkorn, 2/21)

Politico: GOP Lessons From The Latest Round Of Brutal Town Halls
An overflow crowd here was eager to take on Rep. Dave Brat, the conservative Republican who just weeks earlier needled liberal protesters in his district and groused about all the women “in my grill” over GOP plans to repeal and replace Obamacare. But with a plain-spoken approach — and a format that didn’t revolve around live-fire questions from the combative crowd — Brat offered his colleagues a potential blueprint for defusing tense constituent town halls that have bedeviled his Republican colleagues as they’ve been swarmed by protesters. (Cheney, 2/21)

CNN: Brat Faces Raucous Crowd At Town Hall
Rep. Dave Brat faced a raucous crowd Tuesday night at a town hall here in the outer edge of his district, where a majority of the room interrupted him with angry shouts and jeers. The Virginia Republican took at least 34 questions for over an hour and at times appeared to enjoy the back-and-forth. “I don’t mind boisterousness. I’m having fun,” Brat said toward the end, swinging his arm in the air as people continued to shout at him. “I like having debate, spirited conversation — if you can have a conversation.” (Killough, 2/21)

WAVY (Hampton Roads, Va.): Boisterous Crowd Voices Concerns At Rep. Taylor’s First Town Hall In Va. Beach
Representative Scott Taylor (R-VA) held a packed town hall meeting at Kempsville High School in Virginia Beach Monday night. 10 On Your Side’s Joe Fisher reports the crowd was at capacity with about 750 people inside. Hundreds more were turned away at the door because they couldn’t fit in the school’s auditorium. … Taylor also said he supports the repeal of the Affordable Care Act and the implementation of a new policy that doesn’t discriminate against people with pre-existing conditions. “The vast majority of people are getting crushed by Obamacare,” he said. “What’s responsible I believe, is dissecting, having a discussion, and finding the best thing.” (Satchell, 2/21)

KTVH (Helena, Mont.): Hundreds Gather In Helena To Ask Daines To Hold Town Hall
U.S. Sen. Steve Daines was scheduled to speak before the Montana House Tuesday, but several hours before the address, his office announced it had been rescheduled to Wednesday. Despite that change, hundreds of protesters still gathered on the State Capitol steps in Helena in hopes of getting the senator’s attention. … Celeste Thompson, a home care worker, said she has health care because of the federal Affordable Care Act. She asked for more information on how Republicans in Congress plan to replace the ACA if it is repealed. “Our lives and so many others depend on access to health care,” Thompson said. “If the Affordable Care Act is repealed, that access will be stripped away from us.” (Ambarian, 2/21)

Montana Public Radio: Protesters Give Sen Daines An Earful At The State Capitol
Just before U.S. Senator Steve Daines was scheduled to give a speech in front of Montana lawmakers Tuesday afternoon, a crowd of protesters gathered on the Capitol steps. The event was organized by a Facebook group called “Bring The Town Hall to Steve Daines”. … About an hour and a half before Senator Daines was scheduled to arrive at the Capitol Tuesday to address Montana’s House of Representatives, he postponed his speech, pushing it to Wednesday. Staff with Senator Daines’ office say he pushed his speech back a day to work with his schedule, saying Daines had several other reasons to be in Helena on Wednesday. (Cates-Carney, 2/21)

Arkansas Online: Cotton Hears Medicare Concerns
A group of Arkansas senior citizens told U.S. Sen. Tom Cotton on Tuesday that they like their Medicare Advantage plans, but a few expressed concerns about higher spending caps and rising medication costs. Cotton, a Republican from Dardanelle, told the group that he supports the federally-funded program and will defend it on Capitol Hill. Nonetheless, the overall health care system needs changes, he said, promising to work to improve it. (Lockwood, 2/22)

CQ Roll Call: Health Coverage Questions Persist For Republicans
As Republican lawmakers face questions from constituents and colleagues about their plans to repeal and replace the 2010 health care law, they’re finding few answers, including what kind of legislation could pass the Senate. Republicans do not need Democratic support to undo parts of the law, since they will move the legislation through the budget reconciliation process that requires a simple majority in the Senate. But with only 52 Republican senators, the GOP plan will need support from the party’s conservatives and moderates, and it’s not clear what could get everyone on board. (Bowman, 2/22)

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Different Takes On Inside-The-Beltway Health Policy Developments

Opinion writers offer a variety of views on how the plans being advanced by the Trump administration and GOP Congress will shape a range of health concerns — from the effort to repeal, replace or repair the health law effort to federal health programs and Planned Parenthood’s future.

The Washington Post: Obamacare’s Enduring Victory
What’s the holdup, House Republicans? During the Obama administration, you passed literally dozens of bills to repeal all or part of the Affordable Care Act — knowing that none had any chance of being signed into law. Now that Donald Trump is in the White House, why can’t you seem to pull the trigger? (Eugene Robinson, 2/20)

The New York Times: Ryancare: You Can Pay More For Less!
President Trump promised to replace the Affordable Care Act with something that is better, is cheaper and covers more people. Scratch that. Republican leaders in the House and Mr. Trump’s secretary of health and human services released a plan last week that would provide insurance that is far inferior, shift more medical costs onto families and cover far fewer people. (2/19)

Los Angeles Times: ‘Death Spirals,’ Deceit And Pampering The Rich: The Republicans Face High Noon On Repealing Obamacare
Congressional Republicans who have visited their home districts over the last few weeks have gotten a faceful of constituent rage about their plans to eviscerate the Affordable Care Act, which brings health coverage to more than 20 million Americans. If past is prologue, those heading home now for the Presidents Day recess are likely to feel a lot more heat. That may be why House Republicans this week rushed out a “policy brief” on “Obamacare Repeal and Replace.” Unfortunately for the poor souls who will be meeting with constituents, the brief answers none of the key questions about the GOP’s plans for the ACA. (Michael Hiltzik, 2/17)

The Washington Post: Republicans Are Selling Health-Care Reform That People Don’t Want 
House Speaker Paul Ryan (R-Wis.) says Obamacare is failing. Club for Growth president David McIntosh warns that voters “gave Republicans the charge to repeal and replace Obamacare,” so the “delays and discussions about repairing Obamacare need to stop.” The problem is that voters fear disruption, don’t want to lose what they have and won’t find what Republicans are selling very attractive. (Jennifer Rubin, 2/20)

The Washington Post: Ryan’s Health-Care Plan Will Be Hard To Defend
House Speaker Paul Ryan (R-Wis.) outlined a health-care plan to his members yesterday. Surprisingly, it did not include much detail, either because the speaker has not gotten that far or because he’s afraid of the reaction when the numbers are revealed. (Jennifer Rubin, 2/17)

Modern Healthcare: Give Seema Verma A Chance
Seema Verma, the Indiana consultant who injected personal responsibility requirements and health savings accounts into that state’s Medicaid program, deserves a shot at working with other states that want to redesign their programs. She repeatedly testified last week that her main goal for the program, if confirmed as CMS administrator, will be to achieve better outcomes for the vulnerable populations served by the program. “This shouldn’t be about kicking people off,” she said. (Merrill Goozner, 2/18)

Fox News: Seema Verma For Medicaid/Medicare Czar Is The Final Piece In The Health Care Puzzle
Seema Verma is a bold pick by President Trump to head the Centers for Medicare and Medicaid Services. She should be approved without further delay. During a hearing by the Senate Finance Committee this week she appeared confident and informed, refusing to take positions on raising Medicare’s eligibility age, price negotiation with drug companies, or caps on Medicaid allotments to the states. She stated that these decisions are up to Congress, showing an understanding of her role’s limits. (Marc Siegel, 2/20)

The Washington Post: Staffing, Budget Shortages Put Indian Health Service At ‘High Risk’
There’s a sliver of good news for a stricken federal agency during the first alarming month of President Trump’s administration: relief from Trump’s hiring freeze for the Indian Health Service (IHS). “This exemption is a step in the right direction,” seven Democratic senators said in a statement Friday. “Indian Health Services facilities face staff vacancy rates of 20 percent or higher, and a hiring freeze would make these challenges even more severe, further impacting access to health care and even patient health.” (Joe Davidson, 2/20)

Stat: Vaccine Programs Threatened By Exemptions, ACA Repeal
Our highly successful vaccination programs will be in danger if they are not factored into the current discussion of the repeal of the Affordable Care Act (ACA). There’s a clear connection between having health insurance and getting vaccinated, so reducing the number of people with health insurance, which could likely happen if the ACA is repealed, will translate into fewer children and adults who get their recommended vaccines. (John Auerbach, 2/17)

Los Angeles Times: An Attack On Abortion Rights And A Handout To The Rich: The Republicans’ New Plan For Repealing Obamacare
Congressional Republicans who have visited their home districts over the last few weeks have gotten a faceful of constituent rage about their plans to eviscerate the Affordable Care Act, which brings health coverage to more than 20 million Americans. If past is prologue, those heading home now for the Presidents Day recess are likely to feel a lot more heat. (Michael Hiltzik, 2/17)

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Kansas Committee Narrowly Tables Bill To Expand Medicaid, Likely Dooming The Effort

After three days of testimony, the House committee was prepared to vote when one member called for putting the bill aside until the legislature finds out how the state Supreme Court rules in a school case that could be expensive for the state.

Kansas City Star: Medicaid Expansion Falls In Kansas House Panel, Likely Done For Year
Republicans and Democrats on the panel listened to three days of testimony on the proposal to expand coverage of KanCare, the state’s privatized Medicaid program. After debating the bill Monday afternoon, lawmakers were primed to vote on the legislation and consider moving it to the House floor for further discussion. That failed to happen after Rep. John Barker, an Abilene Republican, asked the panel to set the bill aside until April 3. Barker cited anxiety about the possible cost of an upcoming decision by the Kansas Supreme Court in a school finance case. (Woodall, 2/20)

Wichita (Kan.) Eagle: ‘It’s Dead’: Medicaid Expansion Tabled In Kansas Committee
Rep. John Barker, R-Abilene, asked to table the bill until April 3 or later to allow the Kansas Supreme Court more time to make its school finance ruling that could obligate the state to spend millions of dollars more on K-12 education. He called the impending ruling the “big elephant in the room.” “We could get a decision next week,” Barker said. “And then what are we going to do?” (Salazar, 2/20)

Topeka Capital Journal: Kansas House Committee Kills Medicaid Expansion Proposal In 9-8 Vote
A new contingent of moderate Republican and Democratic lawmakers backing expansion had raised the hopes of supporters. Some believe expansion could pass the House if put up to a vote. But President Donald Trump’s White House victory and the ascendance of congressional Republicans determined to repeal the Affordable Care Act has scrambled the Medicaid expansion discussion in Kansas and other states. Expansion opponents argue it will soon be a thing of the past, while supporters say expansion would put Kansas in a better position if the federal government converts Medicaid into a block grant program. (Shorman, 2/20)

Lawrence (Kan.) Journal-World: Kansas House Panel Tables Medicaid Expansion Bill Over Objections Of Hospital Supporters
State Medicaid officials estimated the expansion would have cost the state about $52 million a year once fully implemented, and that it would bring in nearly $1 billion in federal health care money. Supporters of the expansion said that money could help save many small hospitals in the state that are struggling financially because the state hasn’t expanded Medicaid. (Hancock, 2/20)

KCUR: House Committee Votes To Sideline KanCare Expansion Bill 
Rep. Susan Concannon, a Beloit Republican, said the move to table deceived new legislators, who may not have understood they were killing the bill. “I’m just speechless because it was such an underhanded move,” she said. Kansas limits eligibility for Medicaid to children, pregnant women, people with severe disabilities and parents earning less than a third of the federal poverty line, or about $9,200 annually for a four-person family. (Wingerter, 2/20)

And in other Kansas news —

KCUR: KU Economists: Medicaid Expansion May Have Reduced ‘Medical Divorces’ 
The Affordable Care Act has been credited – and blamed – for lots of things, but lowering the divorce rate generally hasn’t been one of them. Not until now, anyway. A paper co-authored by two KU economists suggests that states that expanded Medicaid saw fewer so-called medical divorces than states, like Kansas and Missouri, that didn’t expand Medicaid. How so? Used to be Medicaid had an asset limit. The program’s income eligibility requirements limited the maximum amount of assets and income individuals could possess. The Affordable Care Act, also known as Obamacare, did away with the asset requirement. (Margolies, 2/20)

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The Uncertainty Of Future Medicaid Policies Rattles Many Who Want Coverage

Two articles about very different circumstances — a young child adopted out of foster care and a woman who was disabled after a work accident — point to the interest in the debate in Washington about the federal-state program that provides coverage for low-income residents.

Stat: A Boy Who Can’t Speak Depends On Medicaid. What Happens To Him If It’s Cut?
As the Rankins recast their lives as parents of a medically demanding infant, one reassurance was that Nathaniel’s health care would be covered; as an adopted foster child, he could stay on the state’s Medicaid program. The Rankins would have to monitor Nathaniel’s many health problems, but they wouldn’t have to worry about whether they could afford to do so. Now, though, the Rankins don’t feel so reassured. (Joseph, 2/21)

Salt Lake Tribune: Caught In Utah’s Medicaid Expansion Limbo: Homeless Woman Wants To ‘Try To Be Happy Again’
Kimberly Fox rolled her wheelchair through the hallways of the Road Home shelter in Salt Lake City last month, reflecting on the events of the past decade that left her homeless and alone. She used to be a photographer at a glossy magazine in Baltimore. She used to manage a record store. She used to be a productive member of society, she said. But when Fox, now 53, tripped on a pile of paint supplies in 2002 while working in a Baltimore shipyard, the fall wrecked her foot and her ability to work along with it. … Just a few months ago, there was hope that Fox would get health insurance coverage from Medicaid this year. (Stuckey, 2/20)

Meanwhile, Ohio’s governor and the Tennessee legislature respond to the debate in Washington, too —

The Hill: Kasich: House GOP Medicaid Plan ‘Very Bad Idea’
Republican Ohio Gov. John Kasich on Sunday criticized the House Republicans’ plan to phase out ObamaCare’s expansion of Medicaid. “I’m in Munich, but I understand that there was an initial effort by House Republicans to, for example, phase out Medicaid expansion, which means phasing out coverage,” Kasich said on CNN’s “State of the Union.” “That is a very, very bad idea, because we cannot turn our back on the most vulnerable. We can give them the coverage, reform the program, save some money and make sure that we live in a country where people are going to say, ‘At least somebody is looking out for me.’” (Sullivan, 2/19)

Nashville Tennessean: Bill Would Smooth Tennessee Pursuit For Medicaid Block Grant If D.C. Signals OK
A new bill in the state legislature would help pave the way for Tennessee to pursue a Medicaid block grant if the incoming federal administration moves in that direction. The bill, SB0118 filed by Sen. Richard Briggs, would allow the Division of Health Care Finance and Administration to expand TennCare to include people up to 138 percent of the federal poverty line if President-elect Donald Trump and the Republican-led Congress move toward fewer federal regulations and block grants for Medicaid. Under a block grant, the state would get some fixed level of funding to provide care for eligible Medicaid enrollees. (Fletcher, 2/17)

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As Health Law Debate Shifts From Theoretical To Tangible, Opponents No Longer Have Loudest Voices

Now that the spotlight is off of the president who created the law, the focus is on the care it provides. The shouts for repeal have quieted as those clamoring for answers about their coverage flood the space. Meanwhile, despite his vocal criticism of the Affordable Care Act, Mike Pence, while governor of Indiana, turned to it when his state was in a crisis.

Politico: How Mike Pence Used Obamacare To Halt Indiana’s HIV Outbreak
When then-Gov. Mike Pence faced the worst public health crisis to hit Indiana in decades, he turned to Obamacare — a program he vilified and voted against. In 2015, as a rash of HIV infections spread through rural southern Indiana, state health officials parachuted into Scott County and enrolled scores of people into Obamacare’s expanded Medicaid program so they could get medical care and substance abuse treatment. Many were addicted to opioids and had contracted HIV by sharing dirty needles. (Ehley, 2/20)

The Washington Post: Obamacare Launched A New Wave Of Start-Ups. Now They’re Bracing For What’s Next.
Four years ago, Noah Lang saw an opportunity in Obamacare. With an eye toward the millions of people set to purchase health insurance on their own for the first time, the 29-year-old Silicon Valley entrepreneur founded a start-up, Stride Health, that helps them compare and choose between plans — and do it all from a smartphone. Steadily and without fanfare, the Affordable Care Act has created a boom in Silicon Valley. (Dwoskin, 2/20)

The Wall Street Journal: The Affordable Care Act: The View From A Hospital CEO
Health care in the U.S. appears to be heading toward dramatic changes for the second time in less than a decade. As president and chief executive of New York-Presbyterian, Steven Corwin will have to maneuver a system with 10 hospitals and $7 billion in annual revenue through what may be years of regulatory uncertainty and upheaval for U.S. hospitals. (Evans, 2/20)

And in news from the states —

Nashville Tennessean: Amid Health Care ‘Chaos,’ Tennesseans Push Lawmakers For Assurances
With Tennessee’s healthcare.gov market for 2018 at a breaking point, some are ramping up calls on federal lawmakers to take action to make sure people aren’t without health insurance options next year. Since Humana’s decision last week to leave the federally run exchange, the Tri-Cities area is the only region of the state that will have two insurers from which residents can choose in 2018. The Greater Knoxville area will have none. Yet, without progress on repeal-and-replace or repair of the Affordable Care Act in Washington, D.C., the exchange’s existence in the state beyond 2017 will depend on business decisions by insurers BlueCross BlueShield of Tennessee and Cigna. (Fletcher, 2/20)

Texas Tribune: UT/TT Poll: Texans Want A Health Care Program That’s Not Called Obamacare 
Texans want to dump the previous president’s signature health care program, but only a small minority want to move on without replacing it, according to the latest University of Texas/Texas Tribune Poll. If the Affordable Care Act, better known as Obamacare, were to be repealed and replaced, 68 percent of Texans said lawmakers should wait until they have a replacement plan worked out before they repeal the current law. A smaller group — 23 percent — would repeal Obamacare immediately and figure out the details of a replacement plan later. (Ramsey, 2/21)

The Philadelphia Inquirer: I Have Obamacare Insurance. What Do I Do Now?
If you are already enrolled in a plan through the ACA, there are ways to maximize your coverage before any changes happen.  Remember those labs, specialist referrals or imaging that your physician recommended, but maybe you’ve postponed?  Now is the time to follow through with them.  Also, talk to your physician about switching from brand-name medications to generics when possible to cut down on future co-pays.  There are many generics that work as well as brand names, and which certain pharmacies offer through discounted prescription plans. (Chan, 2/19)

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Trump Promises Health Plan Will Be Coming ‘In A Couple Of Weeks’

“Just so you understand, our plan will be much better healthcare at a much lower cost,” the president said. “OK? Nothing to complain about.” Meanwhile, Tuesday is the deadline for the Trump administration to decide the actions it will take on controversial insurer bailouts.

The Hill: Trump: ObamaCare Replacement Coming In ‘A Couple Of Weeks’ 
President Trump said on Saturday that a plan to replace the Affordable Care Act will come “in a couple of weeks.” “We are going to be submitting in a couple of weeks a great healthcare plan that’s going to take the place of the disaster known as ObamaCare,” he said at a campaign rally in Melbourne, Fla. “It will be repealed and replaced.” “Just so you understand, our plan will be much better healthcare at a much lower cost,” he added. “OK? Nothing to complain about.” (Greenwood, 2/18)

CQ Roll Call: Appropriators Watch Trump’s Next Move On Obamacare Lawsuit
The Trump administration faces a key legal deadline Tuesday in the push to repeal and replace the 2010 health care law — and it could prompt Republican lawmakers to appropriate funds for a part of the statute they once sued to stop. The Justice Department will tell a federal appeals court what it sees as the future of a lawsuit over appropriations for subsidy payments to health insurance providers under the law  (PL 111-148, PL 111-152), estimated at $175 billion over 10 years. House Republicans filed the lawsuit in 2014 to stop the payments, as a response to a series of President Barack Obama’s unilateral executive actions that they said were unconstitutional. (Ruger and Mejdrich, 2/21)

The Hill: Trump Officials Weigh Fate Of Birth-Control Mandate 
The era of free birth control for women could be coming to an end. The requirement that insurance companies cover contraception at no cost is believed to be on the chopping block now that Tom Price has taken over the Department of Health and Human Services (HHS). Price opposed the mandate as a member of Congress and could take aim at the regulation — and other rules related to ObamaCare — as Republicans in Congress move to repeal and replace the Affordable Care Act. (Hellmann, 2/21)

And in other news on President Donald Trump —

Stat: Trump Attends Controversial Dana-Farber Fundraiser At Mar-A-Lago
President Trump attended Saturday night’s fundraising ball for the Dana-Farber Cancer Institute, which was held at Mar-a-Lago — his Florida home and so-called winter White House. While the Harvard-affiliated Boston hospital has held the posh annual event at the private club since 2011, and in 2008, this year’s gala drew criticism from Dana-Farber’s staff and Harvard medical students, who saw Trump’s actions, especially his executive order on immigration, as in direct conflict with the hospital’s mission. Dana-Farber declined to cancel, saying it was too late to change plans, but said it would avoid “controversial venues” in the future. (Swetlitz, 2/19)

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Lawmakers, Headed Home For Recess, Braced To Face ‘Dam-Bursting Levels’ Of Activism

Constituents are gearing up to flood town halls with questions about Republicans’ plans on health care.

The New York Times: Congress Goes Home, And Constituents Fired Up Over Health Care Are Waiting
As Republican lawmakers prepare to leave Washington for a weeklong congressional recess, liberal groups and Democratic Party organizers are hoping to make their homecoming as noisy and uncomfortable as possible. But national organizers concede they are playing catch-up to a “dam-bursting level” of grass-roots activism that has bubbled up from street protests and the small groups that have swelled into crowds outside local congressional offices.  (Zernike and Burns, 2/17)

The Wall Street Journal: Lawmaker Answers To Hometown Critics At Town Halls
Rep. Tom Reed (R., N.Y.) easily won re-election last year after being one of the first congressional Republicans to endorse President Donald Trump. On Saturday, he drew huge, often angry crowds in this small-town area as he tried to sell a Republican agenda that the president’s victory made possible. At a veterans hall and senior citizens center along New York’s Southern Tier region, Mr. Reed made his pitch for repealing the Affordable Care Act and explained why he had cast a committee vote against allowing members of the panel to review Mr. Trump’s tax returns. (Hughes, 2/18)

NPR: New York Republican Rep. Tom Reed Faces Angry Crowds, Deep In Trump Country
New York GOP Rep. Tom Reed probably knew what kind of day he was in for when he arrived at the Ashville senior center for his first town hall on Saturday. The crowd was so large the gathering had been moved outside to a slushy parking lot. “First and foremost, we are going to repeal and replace the Affordable Care Act — Obamacare,” Reed said at the outset, using a loudspeaker propped up on a ladder to try to reach the sprawling crowd. The response was loud and sustained boos. (Taylor, 2/19)

Georgia Health News: Protesters In Atlanta Urge Preservation Of ACA 
[Vicki Hopper] was among scores of people who gathered Monday across the street from the state Capitol in Atlanta to rally against Republican plans to repeal the ACA. The noon rally was part of the Save My Care Bus Tour, a two-month, cross-country effort to oppose repeal efforts. The tour is being led by the Alliance for Healthcare Security, a coalition of groups including Doctors for America and the Service Employees International Union, according to the Washington Post. (Miller, 2/20)

Atlanta Journal-Constitution: Rally To Maintain Affordable Care Act Draws Hundreds
Republican lawmakers in Washington, who for years derided the measure as coercive and expensive for healthy individuals, are now balancing campaign promises to repeal the plan with potential blame for disruptions or loss in coverage if no replacement plan is enacted. While Georgia Republicans took a wait-and-see approach after Donald Trump was elected president, Democrats have focused on Medicaid. (Baruchman, 2/20)

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Don’t Expect Any ‘Bipartisan Kumbaya Moments’ When It Comes To Repeal, McConnell Says

Senate Majority Leader Mitch McConnell says he does not expect any cooperation from Democrats as Congress works toward dismantling and replacing the health law. Meanwhile, The Associated Press breaks down what’s in the Republicans’ plans, and the intra-party divide on the right continues to grow.

The Associated Press: McConnell Intends To Replace ‘Obamacare’ Without Democrats
Republicans will repeal and replace the health care law and overhaul the tax code without Democratic help or votes, Senate Majority Leader Mitch McConnell said Friday. “It’s clear that in the early months it’s going to be a Republicans-only exercise,” the Kentucky senator said at a news conference before lawmakers left for a weeklong President’s Day recess. “We don’t expect any Democratic cooperation on the replacement of Obamacare, we don’t expect any Democratic cooperation on tax reform.” (Werner, 2/17)

The Associated Press: GOP Health Plan: Lower Costs, Better Care, Or Road To Ruin?
Top House Republicans say their outline for replacing President Barack Obama’s health care law is a pathway to greater flexibility and lower costs for consumers. Democrats see a road to ruin for millions who’d face lost coverage and higher medical expenses, particularly the poor. The plan “ensures more choices, lower costs and greater control over your health care,” according to talking points GOP leaders handed lawmakers heading home to face constituents during this week’s recess. (Fram, 2/20)

Modern Healthcare: GOP Anxiety Rises As Conservatives And Moderates Split On ACA Repeal 
Divisions sharpened last week between hard-right and more pragmatic Republicans over both policy and strategy for repealing and replacing the Affordable Care Act. Those differences—along with the apparently slow progress in drafting actual legislation that could be scored by the Congressional Budget Office on cost and coverage impact—underscore the tough struggle Republicans face in dismantling Obamacare and establishing an alternative system. (Meyer, 2/18)

Bloomberg: Conservatives Object To Obamacare Replacement’s Tax Credits
Some conservative House Republicans are objecting to a major part of the Obamacare replacement outline presented to them by party leaders, underscoring the party’s continuing inability to agree on an alternative health plan. The proposal would allow Americans who lack insurance to buy coverage with refundable tax credits they can receive before the end of a tax year. House Ways and Means Chairman Kevin Brady said he and other leaders presented the idea during Thursday’s private conference of the House GOP. (Kapur and House, 2/17)

CQ Roll Call: Key Senator Sees Promise In House GOP Health Care Proposal
A key Republican senator on Friday said the House GOP’s health care proposal was written with input from the Senate, and the House would ultimately pass a bill the upper chamber can accept.  Meanwhile, Democrats are spurring their allies to rally in support of President Barack Obama’s 2010 health care law, which Republicans want to replace. House Republicans on Thursday began their recess with a committee document to help them respond to constituents’ questions about plans to repeal and replace the 2010 law. It outlines proposals for age-based tax credits, an expansion of health savings accounts and transitioning out the Medicaid expansion. (Siddons, 2/17)

CQ HealthBeat: GOP Leaps On Congressional Review Act To Kill Obama Rules
A law that’s been successfully used only once until now is the conduit for a whole lot of action on Capitol Hill. Republicans in Congress are expected to send a stream of bills — most of which require a single sentence — to President Donald Trump’s desk, using a process to repeal agency rules known as the Congressional Review Act (PL 104-121). The act was tucked into 1996 legislation tied to former House Speaker Newt Gingrich’s famous “Contract With America.” So far, Trump has signed two of the rule repeals into law. (Mejdrich, 2/21)

Meanwhile, insurers weigh in on Republicans’ replace plans and more —

The Wall Street Journal: Insurers Voice Concern Over House GOP’s Outline For Health Law Repeal
The new House Republican plan, whose backers include House Speaker Paul Ryan (R., Wis.), is far from a complete bill, and the limited summary highlighted many GOP divisions over the health overhaul’s future. President Donald Trump has promised to deliver an initial ACA replacement plan next month. Still, insures saw the House document as a key signal and parsed it closely. Many were concerned that they found no answers to some of their most important questions—and some of what they did find was alarming. For instance, insurers said, the outline promised to immediately end enforcement of the ACA’s coverage mandate but appeared to offer no replacement mechanism that would prod healthy consumers to purchase plans. (Wilde Mathews, 2/17)

Kaiser Health News: Health Law’s 10 Essential Benefits: A Look At What’s At Risk In GOP Overhaul
As Republicans look at ways to replace or repair the health law, many suggest shrinking the list of services insurers are required to offer in individual and small group plans would reduce costs and increase flexibility. That option came to the forefront last week when Seema Verma, who is slated to run the Centers for Medicare & Medicaid Services in the Trump administration, noted at her confirmation hearing that coverage for maternity services should be optional in those health plans. Maternity coverage is a popular target and one often mentioned by health law critics, but other items also could be watered down or eliminated. (Andrews, 2/21)

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Viewpoints: GOP Health Plan Runs Contrary To Robin Hood’s Rules By Redirecting Funding From Poor To Rich; The Town Hall Duck And Run

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

The Washington Post: Trump’s Toxicity Has Republicans Running Away From Their Constituents
As recent town-hall meetings of GOP Reps. Tom McClintock of Elk Grove, Jason Chaffetz of Utah, Gus Bilirakis of Florida, Diane Black of Tennessee and others turn into well-publicized tongue-lashings, their colleagues are ducking and running. … The scene is reminiscent of the tea party summer of 2009, but the energy is on the other side this time. Now, as then, the victims say the perpetrators are outsiders – Chaffetz said those who protested him included “paid” people from out of state, an echo of Nancy Pelosi’s claim of “astroturfing” – but now, as then, the anger is real. (Dana Milbank, 2/15)

Los Angeles Times: Trump Tries To Save Obamacare Exchanges While Undermining Them
With the drive to “repeal and replace” Obamacare losing steam, the Trump administration quietly moved to shore up a key feature of the healthcare law this week: the state exchanges where people shop for non-group coverage. And to its credit, Trump’s Department of Health and Human Services zeroed in on some of the factors that have led a handful of major insurers to leave the exchanges. (Jon Healey, 2/16)

Bloomberg: A Sign That Obamacare Exchanges Are Failing
Yet more bad news for Obamacare this week: Molina Healthcare lost $110 million on the exchanges last year, and the CEO told investors, “There are simply too many unknowns with the marketplace program to commit to our participation beyond 2017.” At first glance, it’s hard to see why this piece of news is worth worrying about. UnitedHealth recently projected several times those losses, and it’s a bigger player on the exchanges. Why spend so much time looking at one modest-size insurer? Because Molina is one of the companies that has been repeatedly pointed to, by virtually every health-care-policy wonk in the business, as one of the “bright spots” on the exchanges. (Megan McArdle, 2/16)

The New England Journal Of Medicine: Adjusting Risk Adjustment — Accounting For Variation In Diagnostic Intensity
In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving sicker or harder-to-treat patients and insurers aren’t penalized for covering them. For example, the private insurance companies that participate in Medicare Advantage and the Affordable Care Act (ACA) exchanges receive risk-adjusted payments from the U.S. government, with the rationale that insurers should be reimbursed more for enrollees with higher expected costs. (Amy Finkelstein, Matthew Gentzkow, Peter Hull and Heidi Williams, 2/16)

RealClear Health: A Small HSA Fix Could Produce Big Results
As Congress and the Trump administration begin laying the foundation for their replacement plan for the Affordable Care Act (ACA), their starting point should be ensuring all Americans have a ready path for enrollment in health insurance that, at a minimum, provides protection against major medical expenses. They should also promote broadened enrollment in Health Savings Accounts (HSAs) as an important means for paying for care before insurance coverage kicks in. (James C. Capretta, 2/17)

Louisville Courier-Journal: Demand For Medicaid Waivers Exceeds Funds
The “most vulnerable of our society” is a phrase that gets thrown around a lot. Politicians employ it in speeches and press releases to describe constituents who cannot take care of themselves. People with intellectual and developmental disabilities fall under this banner of protection. (Amanda Beam, 2/16)

Sacramento Bee: California Provides Model To Replace The Affordable Care Act
The new administration and Congress are under intense pressure to craft a market-based alternative to the Affordable Care Act. It won’t be easy. To achieve the financial stability required to make the market work, reformers should heed some important lessons from California. Health plans and risk-taking medical groups essentially made a “deal” with Congress to participate in the ACA. They agreed to cover applicants with pre-existing conditions without charging higher premiums in return for: an expanded individual market driven by a federal mandate that everyone buy insurance; premium and cost-sharing subsidies financed by insurers and the government; and three federal risk-mitigation programs to help stabilize the new marketplaces. (Leonard D. Schaeffer and Dana Goldman, 2/14)

Orange County Register: California Job Losses From Obamacare Repeal? Fear Not!
Obamacare was a cash cow for providers, which now argue it was a program for jobs and economic growth. They now say that repealing Obamacare will kill California jobs. That grabs any politician’s attention, but it is not true. According to a study by the UC Berkeley Labor Center, which is promoted by the California Hospital Association, “The majority (135,000) of these lost jobs would be in the health care industry, including at hospitals, doctor offices, labs, outpatient and ambulatory care centers, nursing homes, dentist offices, other health care settings and insurers. (John R. Graham, 2/16)

Cleveland Plain Dealer: Boost Funding To An Ohio Foster Care System Increasingly Burdened By The Opioid Crisis
Ohio Gov. John Kasich has been in the thick of the battle against deadly opioids, signing a bill this year to tighten restrictions on prescription opioids, speaking at conferences about heroin and even sending an Ohio Highway Patrol superintendent in April to Trumbull County after beleaguered officials there begged for help in quelling a rising tide of opioid overdoses and deaths. (2/17)

The Des Moines Register: A Second Chance To Pass Aid-In-Dying Bills
In a Gallup Poll conducted May 4-8, 2016, respondents were asked: “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it?” Sixty-nine percent of respondents answered yes. (John S. Westefeld, 2/16)

Lexington Herald Leader: Whooping Cough Making A Comeback
In the past few weeks, there have been several confirmed cases of whooping cough, also known as pertussis, in Fayette County schools and other surrounding counties. Many parents are concerned about exposure and have questions about preventing pertussis infection or recognizing symptoms. (Jessica Murray, 2/16)

The New England Journal Of Medicine: Addressing The Fentanyl Threat To Public Health
Fentanyl, a powerful synthetic opioid, poses an increasing public health threat. Low production costs encourage suppliers to “cut” heroin with the drug, particularly white powder heroin sold in the eastern United States. Fentanyl also appears as a prevalent active ingredient in counterfeit OxyContin (oxycodone) tablets. The result is that fentanyl plays a major role in rising mortality due to heroin or opioid overdose. It poses a serious overdose risk because it can rapidly suppress respiration and cause death more quickly than do other opioids. (Richard G. Frank and Harold A. Pollack, 2/16)

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

Research Roundup: Medicaid Block Grants; Job Loss And The ACA; Growing HIV Coverage

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

Urban Institute: What TANF Can Teach Us About Block Granting Social Services
White House officials and congressional leaders have talked about seizing the opportunity to pass sweeping changes to federal antipoverty programs. One potential change is to give block grants of federal funds to states and allow states greater flexibility …. House Speaker Paul Ryan has long contended that expanding the block grant model to other facets of the safety net — such as Medicaid and food stamps — would afford states the flexibility to drive innovation in combating poverty. But examining the results of welfare reform after two decades presents a more cautionary tale …. Simply put, all states ended up with far fewer funds and a diminished ability to meet their residents’ needs. (Hahn and Coffey, 2/7)

The Kaiser Family Foundation: Current Flexibility In Medicaid: An Overview Of Federal Standards And State Options
This brief provides an overview of current federal standards and state options in Medicaid to help inform upcoming debates about increasing state flexibility in the program as part of efforts to restructure Medicaid financing. Today, states operate their Medicaid programs within federal standards and a wide range of state options in exchange for federal matching funds that are provided with no limit. Each state Medicaid program is unique, reflecting states’ use of existing flexibility and waiver authority to design their programs to meet their specific needs and priorities. As proposals to restructure Medicaid financing develop, it will be important to examine what additional flexibilities they would provide to states and what standards, accountability and enrollee protections would remain for states to access federal funds. (Artiga et al., 1/31)

Urban Institute/Robert Wood Johnson Foundation: Recent Evidence On The ACA And Employment: Has The ACA Been A Job Killer? 2016 Update
We find no evidence to support claims that the ACA has been a job killer. Through 2016, the ACA had little to no adverse effect on employment and usual hours worked per week. For both measures, levels in 2014, 2015, and 2016 are statistically identical to our projections based on patterns existing before 2014, the year the major provisions of the ACA went into effect. Our conclusion applies to the full sample of nonelderly persons and to subgroups of nonelderly persons based on gender and educational attainment. Levels of part-time work (29 or fewer hours per week) have fallen since 2014, but remain at somewhat higher levels than would be expected given recent declines in the unemployment rate and overall economic improvement. (Garrett, Kaestner and Gangopadhyaya, 2/16)

The Kaiser Family Foundation: Insurance Coverage Changes For People With HIV Under The ACA
This brief provides the first national estimates of changes in insurance coverage among people with HIV since the implementation of the ACA. It is based on analysis of data from the Centers for Disease Control and Prevention (CDC). We find that coverage increased significantly for people with HIV due to the ACA’s Medicaid expansion; indeed, increased Medicaid coverage in expansion states drove a nationwide increase in coverage for people with HIV. In addition, the share relying on the Ryan White HIV/AIDS Program also increased. (Kates and Dawson, 2/14)

Brookings/USC Schaeffer Center for Health Policy & Economics: Re-Balancing Medical And Social Spending To Promote Health: Increasing State Flexibility To Improve Health Through Housing
The health impacts of interventions that improve economic conditions such as household income are still the subject of considerable debate. Some economists find little support to show that public transfer payments improve health outcomes, while others argue that federal assistance frees family income to spend on better access to health care, and thereby improves population health. Some researchers have identified evidence that stressful work environments and educational disparities are social mechanisms with a deleterious impact on health, but the evidence that increased public spending targeting these mechanisms will improve health outcomes is nascent. In contrast, the research showing that expenditures that improve access to safe, affordable housing improve population health is relatively strong. (Butler, Matthew and Cabello, 2/15)

Here is a selection of news coverage of other recent research:

MedPage Today: Study: Beware The Snippy, Snarky Surgeon?
The more complaints lodged at surgeons, the more likely it was for their patients to suffer complications after going under the knife, a study found, helping explain why operators with the least favorable reviews get sued the most. Surgeons who had a history of unsolicited patient reviews — often regarding rudeness and intimidation directed at patients and other healthcare professionals alike — were tied to greater risks of: Complications for patients …. Surgical complications …. Patient readmissions. (Lou, 2/15)

Reuters: Salt Reduction Policies Cost-Effective Even Without Healthcare Savings
Government policies designed to reduce how much salt people eat may be cost-effective even without considering the potential healthcare savings, a recent study suggests. That’s because efforts to curb salt use through policies like public education and industry agreements would not cost that much relative to their potential to reduce mortality and disability, researchers estimate. (Rapaport, 2/10)

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

Kansas Committee Expected To Take First Vote On Medicaid Expansion Today

The issue has been swatted down repeatedly since the health law went into effect, but after moderates ousted several conservatives in last fall’s elections, a legislative panel is scheduled to vote on a measure today. The committee’s chairman, Rep. Dan Hawkins, a Wichita Republican, says it will be close. News outlets also report on Medicaid developments in Ohio, Alabama and California.

KCUR (Kansas City, Mo., Public Radio): Close Vote Expected On KanCare Expansion Bill 
Kansas lawmakers are getting ready to do something they have never done before: vote on a Medicaid expansion bill. For the past three years, conservative Republicans who controlled the Legislature refused to allow a vote on the issue. Things are different this session due to the ouster of several conservative incumbents by moderate Republican and Democratic challengers. (McLean, 2/16)

Toledo Blade: After Expansion, Medicaid Attracts More Older Men
Those enrolled in Ohio’s expanded Medicaid program in partnership with the federal Affordable Care Act turned out to be older than expected. Barbara Sears, Gov. John Kasich’s Medicaid director and former state representative from Monclova Township, said Thursday she was a little surprised to see how the population skewed older. “But when we knew we weren’t getting the younger folks into the [federal Obamacare private insurance] marketplace, we knew they probably weren’t getting into [the Medicaid expansion],” she said after speaking to the legislative Joint Medicaid Oversight Committee. (Provance, 2/16)

Modern Healthcare: Alabama Could Lose Medicaid Funding For Allegedly Rejecting Eligible Enrollees
The CMS may cut Alabama’s Medicaid funding after learning state officials reject people eligible for Medicaid coverage if they are found to have engaged in fraud or abuse but were never convicted of any criminal act. The CMS said Alabama officials also had a practice of recouping funds from these individuals. Alabama has said it is simply trying to take action against those who lie on their applications about having been previously accused of criminal activity. (Dickson, 2/16)

California Healthline: Some Immigrants, Fearful Of Political Climate, Shy Away From Medi-Cal
Some foreign-born Californians are canceling their Medi-Cal coverage or declining to enroll in the first place, citing fears of a Trump administration crackdown on immigrants. Among those dropping coverage are people in the country legally but concerned about jeopardizing family members who lack permanent legal status, according to government officials, immigration attorneys and health care advocates. (Bazar, 2/16)

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