Tagged The Health Law

Trump Administration Proposes Rule To Loosen Curbs On Short-Term Health Plans

[UPDATED at 12:30 p.m. ET]

Insurers will again be able to sell short-term health insurance good for up to 12 months under a proposed rule released Tuesday by the Trump administration that could further roil the marketplace.

“We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said Health and Human Services Secretary Alex Azar. “This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable to individual and family circumstances.”

The proposed rule said short-term plans could add more choices to the market at lower cost and may offer broader provider networks than Affordable Care Act plans in rural areas.

But most short-term coverage requires answering a string of medical questions, and insurers can reject applicants with preexisting medical problems, which ACA plans cannot do. As a result, the proposed rule also noted that some people who switch to them from ACA coverage may see “reduced access to some services,” and “increased out of pocket costs, possibly leading to financial hardship.”

The directive follows an executive order issued in October to roll back restrictions put in place during the Obama administration that limited these plans to three months. The rule comes on the heels of Congress’ approval of tax legislation that in 2019 will end the penalty for people who opt not to carry insurance coverage.

The administration also issued separate regulations Jan. 4 that would make it easier to form “association health plans,” which are offered to small businesses through membership organizations.

Together, the proposed regulations and the elimination of the so-called individual mandate by Congress could further undermine the Affordable Care Act marketplace, critics say.

Seema Verma, who now heads the Centers for Medicare & Medicaid Services, which oversees the marketplaces, told reporters Tuesday that federal officials believe that between 100,000 and 200,000 “healthy people” now buying insurance through those federal exchanges would switch to the short-term plans, as well as others who are now uninsured.

The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don’t include all the benefits required by the federal law — including plans that can reject people with preexisting medical conditions. Most short-term coverage excludes benefits for maternity care, preventive care, mental health services or substance abuse treatment.

“It’s deeply concerning to me, considering the tragedy in Florida and national opioid crisis, that the administration would be encouraging the sale of policies that don’t have to cover mental health and substance abuse,” said Kevin Lucia, a research professor and project director at Georgetown University’s Health Policy Institute.

Over time, those remaining in ACA plans will increasingly be those who qualify for premium tax credit subsidies and the sick, who can’t get an alternative like a short-term plan, predicts Lucia and other experts. That, in turn, would drive up ACA premiums further.

“If consumers think Obamacare premiums are high today, wait until people flood into these short-term and association health plans,” said industry consultant Robert Laszewski. “The Trump administration will bring rates down substantially for healthy people, but woe unto those who get a condition and have to go back into Obamacare.”

If 100,000 to 200,000 people shift from ACA-compliant plans in 2019, this would cause “average monthly individual market premiums … to  increase,” the proposed rule states. That, in turn, would cause subsidies for eligible policyholders in the ACA market to rise, costing the government $96 million to $168 million.

Supporters said the rules are needed because the ACA plans have already become too costly for people who don’t receive a government subsidy to help them purchase the coverage. “The current system is failing too many,” said Verma.

And, many supporters don’t think the change is as significant as skeptics fear.

“It simply reverts back to where the short-term plan rules were prior to Obama limiting those plans,” said Christopher Condeluci, a benefits attorney who also served as tax counsel to the U.S. Senate Finance Committee. “While these plans might not be the best answer, people do need a choice, and this new proposal provides needed choice to a certain subsection of the population.”

But, in their call with reporters, CMS officials said the proposed rule seeks comment on whether there are ways to guarantee renewability of the plans, which currently cannot be renewed. Instead, policyholders must reapply and answer medical questions again.  The proposal also seeks comments on whether the plans should be allowed for longer than 12-month periods.

The comment period for the proposed rule runs for 60 days. Verma said CMS hopes to get final rules out “as quickly as possible,” so insurers could start offering the longer duration plans.

Short-term plans had been designed as temporary coverage, lasting for a few months while, for instance, a worker is between jobs and employer-sponsored insurance. They provide some protection to those who enroll, generally paying a percentage of hospital and doctor bills after the policyholder meets a deductible.

They are generally less expensive than ACA plans, because they cover less. For example, they set annual and lifetime caps on benefits, and few cover prescription drugs.

Most require applicants to pass a medical questionnaire — and they can also exclude coverage for preexisting medical conditions.

The plans are appealing to consumers because they are cheaper than Obamacare plans. They are also attractive to brokers, because they often pay higher commissions than ACA plans. Insurers like them because their profit margins are relatively high — and are not held to the ACA requirement that they spend at least 80 percent of premium revenue on plan members’ medical care.

Extending short-term plans to a full year could be a benefit to consumers because they must pass the health questionnaire only once. Still, if a consumer develops a health condition during the contract’s term, that person would likely be rejected if he or she tried to renew.

Both supporters and critics of short-term plans say consumers who do develop health problems could then sign up for an ACA plan during the next open enrollment because the ACA bars insurers from rejecting people with preexisting conditions.

“We’re going to have two different markets, a Wild West frontier called short-term medical … and a high-risk pool called Obamacare,” said Laszewski.

KHN senior correspondent Phil Galewitz contributed to this article.

Trump Administration Unveils Proposed Rule To Loosen Restrictions On Short-Term Health Plans

Insurers will again be able to sell short-term health insurance good for up to 12 months under a proposed rule released Tuesday by the Trump administration that could further roil the marketplace.

“We want to open up affordable alternatives to unaffordable Affordable Care Act policies,” said HHS Secretary Alex Azar. “This is one step in the direction of providing Americans health insurance options that are more affordable and more suitable to individual and family circumstances.”

The directive follows an executive order issued in October to roll back restrictions put in place during the Obama administration that limited these plans to three months. The rule comes on the heels of Congress’ approval of tax legislation that in 2019 will end the penalty for people who opt not to carry insurance coverage.

The administration also issued separate regulations Jan. 4 that would make it easier to form “association health plans,” which are offered to small businesses through membership organizations.

Together, the proposed regulations and the elimination of the so-called individual mandate by Congress could further undermine the Affordable Care Act marketplace, critics say.

Seema Verma, who now heads the Centers for Medicare & Medicaid Services, which oversees the marketplaces, told reporters Tuesday that federal officials believe that between 100,000 and 200,000 people now buying insurance through those federal exchanges would switch to the short-term plans, as well as other people who are now uninsured.

The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don’t include all the benefits required by the federal law — including plans that can reject people with preexisting medical conditions.

In addition, according to the proposed rule, the plans would not be required to sell to everyone, so people with medical problems may not be able to get this coverage.

“It will undermine the individual market risk pool,” said Kevin Lucia, research professor and project director at Georgetown University’s Health Policy Institute.

Over time, those remaining in ACA plans will increasingly be those who qualify for premium tax credit subsidies and the sick, who can’t get an alternative like a short-term plan, predicts Lucia and other experts. That, in turn, would drive up ACA premiums further.

“If consumers think Obamacare premiums are high today, wait until people flood into these short-term and association health plans,” said industry consultant Robert Laszewski. “The Trump administration will bring rates down substantially for healthy people, but woe unto those who get a condition and have to go back into Obamacare.”

Supporters said the rules are needed because the ACA plans have already become too costly for people who don’t receive a government subsidy to help them purchase the coverage. “The current system is failing too many,” said Verma.

And, many supporters don’t think the change is as significant as skeptics fear.

“It simply reverts back to where the short-term plan rules were prior to Obama limiting those plans,” said Christopher Condeluci, a benefits attorney who also served as tax counsel to the U.S. Senate Finance Committee.

But in their call with reporters, CMS officials noted that the proposed rule is seeking comment on guaranteeing the renewability of these short-term plans. That would be different than prior practice.

The comment period for the proposed rule runs for 60 days.

Short-term plans had been designed as temporary coverage, lasting for a few months while, for instance, a worker is between jobs and employer-sponsored insurance. They provide some protection to those who enroll, generally paying a percentage of hospital and doctor bills after the policyholder meets a deductible.

They are generally less expensive than ACA plans, because they cover less. For example, they set annual and lifetime caps on benefits, few cover prescription drugs, and most exclude coverage for maternity care, preventive care, mental health services or substance abuse treatment.

Most require applicants to pass a medical questionnaire — and they can also exclude coverage for preexisting medical conditions.

The plans are appealing to consumers because they are cheaper than Obamacare plans. They are also attractive to brokers, because they often pay higher commissions than ACA plans. Insurers like them because their profit margins are relatively high — and are not held to the ACA requirement that they spend at least 80 percent of premium revenue on plan members’ medical care.

Extending short-term plans to a full year could be a benefit to consumers because they must pass the health questionnaire only once. Still, if a consumer develops a health condition during the contract’s term, that person would likely be rejected if he or she tried to renew.

Both supporters and critics of short-term plans say consumers who do develop health problems could then sign up for an ACA plan during the next open enrollment because the ACA bars insurers from rejecting people with preexisting conditions.

“We’re going to have two different markets, a Wild West frontier called short-term medical … and a high-risk pool called Obamacare,” said Laszewski.

Gap Between People Who Can’t Afford Health Care And Those Who Can Barely Afford It Stokes Resentment

For those that don’t qualify for Medicaid under the Affordable Care Act, the requirement for insurance coverage can seem unfair. Meanwhile, the congressional spending deal raises doubts about what lawmakers are doing to control health costs that are only expected to get worse.

Gap Between People Who Can’t Afford Health Care And Those Who Can Barely Afford It Stokes Resentment

For those that don’t qualify for Medicaid under the Affordable Care Act, the requirement for insurance coverage can seem unfair. Meanwhile, the congressional spending deal raises doubts about what lawmakers are doing to control health costs that are only expected to get worse.

Podcast: KHN’s ‘What The Health?’ What Do The Budget, Idaho And FDA Chief Scott Gottlieb Have In Common?

President Donald Trump released his first full budget proposal this week, with many recommended cuts and some major changes to health programs. But Congress has already agreed on most spending levels for next year, so this budget is even more likely to be ignored than a typical presidential budget plan.

Meanwhile, states are trying to cope with last year’s changes to the Affordable Care Act in very different ways. Several states, mostly led by Democrats, are considering whether to set penalties for people who don’t have insurance — a provision of the ACA that Congress repealed in December. Idaho, meanwhile, is offering to let insurers sell plans that don’t cover the ACA’s required set of benefits and discriminate against people with preexisting health conditions.

Plus, Scott Gottlieb, commissioner of the Food and Drug Administration, talks about getting generic drugs to market faster and how the agency is working with Congress on ways to help patients with terminal illnesses get easier access to experimental treatments.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Paige Winfield Cunningham of The Washington Post and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s podcast:

  • Even though few of the proposals in Trump’s budget are likely to be enacted, it does lay down some important markers for the administration. Those include backing sweeping changes to Medicaid and eliminating many of the ACA’s coverage requirements.
  •  Blue states considering stepping into the void left by Congress’ repeal of the individual insurance mandate penalties have limited time to act. Insurers start making decisions about whether to participate in the individual market in the spring.
  • The FDA’s Gottlieb tells Rovner and KHN’s Sarah Jane Tribble he expects there will be a compromise on Capitol Hill on “right-to-try” legislation that would make it easier for patients with terminal illnesses to gain access to experimental therapies.
  • Idaho is moving forward on its plan to allow insurers to offer policies that do not comply with the requirements of the Affordable Care Act. On Capitol Hill this week, Health and Human Services Secretary Alex Azar would not say whether the federal government will step up to stop them.

Plus, for “extra credit,” in honor of Valentine’s Day, the panelists offer their favorite “Health Policy Valentines” for 2018. You can see more by searching the hashtag #healthpolicyvalentines on Twitter.

Julie Rovner:

Stephanie Armour:

Paige Winfield Cunningham:

Margot Sanger-Katz:

To hear all our podcasts, click here.

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

Idaho Blue Cross Jumps Into Controversial Market For Plans That Bypass ACA Rules

That didn’t take long.

It’s barely been two weeks since Idaho regulators said they would allow the sale of health insurance that does not meet all of the Affordable Care Act’s requirements — a controversial step some experts said would likely draw legal scrutiny and, potentially, federal fines for any insurer that jumped in.

On Wednesday, Blue Cross of Idaho unveiled a menu of new health plans that break with federal health law rules in several ways, including setting premiums based on applicants’ health.

“We’re trying to offer a choice that allows the middle class to get back into insurance coverage,” said Dave Jeppesen, the insurer’s executive vice president for consumer health care.

The firm filed five plans to the state for approval and hopes to start selling them as soon as next month.

The Blue Cross decision ups the ante for Alex Azar, the Trump administration’s new Health and Human Services secretary. Will he use his authority under federal law to compel Idaho to follow the ACA and reject the Blues plans? Or will he allow state regulators to move forward, perhaps prompting other states to take more sweeping actions?

At a congressional hearing Wednesday, even as Blue Cross rolled out its plans, Azar faced such questions.

“There are rules. There is a rule of law that we need to enforce,” Azar said. Observers noted, however, he did not specifically indicate whether the federal government would step in.

Robert Laszewski, a consultant and former insurance industry executive, thinks it should.

“If Idaho is able to do this, it will mean other … states will do the same thing,” he said. “If a state can ignore federal law on this, it can ignore federal law on everything.”

Idaho’s move stirs up more issues about individual insurance market stability.

Policy experts say that allowing lower-cost plans that don’t meet the ACA’s standards to become more widespread will pull younger and healthier people out of Obamacare, raising prices for those who remain. Supporters say that is already happening, so this simply provides more choices for people who earn too much to qualify for subsidies to help them purchase ACA coverage.

The state’s move to allow such plans, announced in January, drew harsh and swift criticism.

“Crazypants illegal,” tweeted Nicholas Bagley, a law professor at the University of Michigan and former attorney with the civil division of the U.S. Department of Justice, who said that states can’t pick and choose which parts of federal law to follow. Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, pointed out that health insurers could be liable for sharp fines if they are found to be in violation of the ACA.

But both Idaho regulators and Blue Cross officials say they are not worried.

Jeppesen said the ACA gives states regulatory authority “to make sure the market works and is stable,” and the insurer is simply “following what the state has given us guidance” to do.

Other insurers in Idaho are taking a much more cautious approach, telling The Wall Street Journal they are not stepping up immediately to offer their own plans.

Laszewski said they are likely waiting to see what legal challenges develop.

“If I were running an insurance company, there’s no way I would stick my neck out until the high court has ruled in favor of this — and they’re not going to,” he said.

Jeppesen said his company has consulted with legal experts and is moving ahead with confidence. The aim is to bring people back into the market, particularly the young, the healthy and those who don’t get a tax credit subsidy and can’t afford an ACA plan.

For some people — especially younger or healthier applicants — the new plans, which the insurer has named Freedom Blue, cost less per month than policies that meet all ACA rules.

They accomplish that by limiting coverage. If they are allowed to be sold, consumers will need to weigh the lower premiums against some of the coverage restrictions and varying premiums and deductibles, policy experts say.

The plans, for example, will include a “waiting period” of up to 12 months for any preexisting conditions if the applicant has been without coverage for more than 63 days, Jeppesen said.

Additionally, they cap total medical care coverage at $1 million annually. And premiums are based, in part, on a person’s health: The healthiest consumers get rates 50 percent below standard levels, while those deemed unhealthy would be charged 50 percent more.

All those caveats violate ACA rules, which forbid insurers from rejecting coverage of preexisting conditions or setting dollar caps on benefits or higher premiums for people with health problems.

But the rates may prove attractive to some.

Premiums for a healthy 45-year-old, for example, could be as low as $195 a month, according to a comparison issued by the insurer, while a 45-year-old with health problems could be charged $526. In that case, the 45-year old would find a lower price tag — $343 a month — for an ACA-compliant bronze plan.

While Freedom Blues plans cover many of the “essential health benefits” required under the ACA, such as hospitalization, emergency care and mental health treatment, they do not include pediatric dental or vision coverage. One of the five plans does not include maternity coverage.

When compared with one of the Blues’ ACA-compliant plans — called the Bronze 5500 — the new standard Freedom Blue plan’s annual deductibles are a mixed bag.

That’s because they have two separate deductibles — one for medical care and one for drugs. If a consumer took only generic drugs, the new plan would be less expensive, according to details provided by the plan. But with a $4,000 deductible for brand-name drugs, the Freedom Blue plan requires more upfront money before full coverage kicks in than the ACA-compliant plan it was compared with.

Jeppesen said the insurer hopes to attract many of the “110,000 uninsured state residents who cannot afford [ACA] coverage.”

That’s the total number of uninsured people who earn more than 100 percent of the federal poverty level in the state, he said.

Sarah Lueck, senior policy analyst for the Center on Budget and Policy Priorities, cautioned that some of those residents might actually be eligible for subsidies under the ACA, which are available to people earning up to four times as much.

“Many … could be getting subsidies for more comprehensive coverage through the [ACA-compliant state exchange] and would be better off,” Lueck said.

Ahead Of Vote, Wisconsin Governor’s Reinsurance Plan Gets Support From Medical Community, Insurers

Gov. Scott Walker’s bill would authorize Wisconsin to seek a federal waiver to offer a reinsurance program to lower premium costs. Under the program, the government would provide money to health insurance providers to pay for between 50 percent and 80 percent of medical claims costing between $50,000 and $200,000.

Maryland Offers Many Insured Men Free Vasectomy Coverage

It was a well-intentioned effort to provide men with some of the same financial protection from birth control costs that women get. But a new Maryland law may jeopardize the ability of thousands of consumers — both men and women — to use health savings accounts.

The law, which took effect Jan. 1, mandates that insurers cover vasectomies without requiring patients to pay anything out-of-pocket — just as they must do for more than a dozen birth control methods for women.

But the measure may run afoul of Internal Revenue Service rules that do not include vasectomies among approved preventive services for high-deductible health plans. People with health savings accounts — which are exempt from tax liabilities — tied to those plans could no longer contribute to the savings accounts in that case.

Under the Maryland Contraceptive Equity Act, insurers generally can’t charge patients a copayment or require any other cost sharing for prescription contraceptive drugs or devices approved by the Food and Drug Administration. The 2016 law is similar to what’s required under the federal Affordable Care Act, with a twist: It adds male sterilization — vasectomies — to the list of services that are free for patients.

“While the ACA made important strides … it completely left men out of the equation,” said Karen Nelson, president and CEO of Planned Parenthood of Maryland, whose organization supported the bill.

Before the law took effect, a vasectomy at the organization’s Baltimore office would cost between $225 and $1,100, depending on someone’s ability to pay, said Nelson. Now the procedure will generally cost nothing for men in insured plans in Maryland.

The state law doesn’t apply to companies that are “self-funded,” meaning they pay their employees’ health care claims directly rather than buying state-regulated insurance policies.

Under IRS rules, consumers making tax-free contributions to health savings accounts (HSAs) that are linked to high-deductible health plans have to pay for all their medical care until they reach their deductible of at least $1,350 for individuals and $2,700 for families in 2018. The only exception is for preventive services. The hitch for the Maryland law is that vasectomies aren’t on the IRS list of approved preventive services.

The IRS hasn’t responded to a request for clarification by Maryland Insurance Commissioner Al Redmer Jr. A bill was reintroduced this year — after it failed to pass last year — that would exempt these high-deductible plans from the state mandate to cover vasectomies before the deductible is met. Such a move would preserve the tax advantages of the HSAs linked to them.

Maryland is joining a few other states, including Illinois, Vermont and, starting next year, Oregon, that have expanded contraceptive coverage without cost sharing to include male sterilization.

Vermont’s law includes language to exempt high-deductible plans with health savings accounts. While the issue has raised concerns in Maryland, in Illinois and Oregon it hasn’t appeared to generate much attention to date, legislative analysts say.

Some advocates for extending no-cost coverage to vasectomies noted that the IRS’ list of approved preventive services specifically says that it isn’t exhaustive.

But until the issue is clarified, “the safest thing to do is not make a contribution to your HSA,” said Roy Ramthun, a Maryland resident and president of HSA Consulting Services. Ramthun helped implement health savings accounts while working for the Treasury Department during the George W. Bush administration. He stressed that the uncertainty applies only to HSA contributions made after the law became effective in 2018, not to earlier contributions. The issue doesn’t affect people’s medical coverage.

Beyond the uncertainty around health savings account contributions, Maryland’s law requiring coverage of vasectomies without cost sharing addresses a gap in men’s preventive coverage.

“There are arguments to be made that male condoms and vasectomies have preventive benefits for both women and men, in terms of [sexually transmitted infection] prevention and preventing pregnancy,” said Mara Gandal-Powers, senior counsel at the National Women’s Law Center.

Seven percent of men ages 18 to 45 have had a vasectomy, according to a 2013 study by researchers at Northwestern University. The prevalence increased to 16 percent among men ages 36 to 45. Men with higher incomes, higher education and a regular source of health care were more likely to have had the procedure, the study found.

The Maryland law doesn’t apply to the method of birth control that many men use: condoms. A bill introduced this month by state Sen. John Astle, a Democrat, would expand the law to include condom coverage.

Podcast: KHN’s ‘What The Health?’ There’s A Really Big Health Bill In That Budget Deal

The bipartisan budget deal that passed Congress this week includes enough health policy changes to keep reporters and analysts busy for months.

In addition to renewing funding for Community Health Centers for two more years, the bill extends funding for the Children’s Health Insurance Program for four years beyond the six approved last month; repeals the controversial (but never implemented) Independent Payment Advisory Board for Medicare and permanently repeals Medicare’s caps on certain types of outpatient therapy.

Also, the final enrollment numbers for individual insurance purchased under the Affordable Care Act came out this week. Spoiler: They are higher than most analysts expected.

Plus, Andy Slavitt, former acting head of the Centers for Medicare & Medicaid Services under President Barack Obama, talks about his new group, “The United States of Care.”

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

Among the takeaways from this week’s podcast:

  • The budget bill signed by President Donald Trump on Friday provides a lot of funding for health programs, but it also takes money away from others. It takes a big chunk of funding out of the Affordable Care Act’s Prevention and Public Health Fund and raises premiums for some wealthier Medicare beneficiaries.
  • That bill could make a number of changes to how Medicare works, including some new rules for accountable care organizations and more flexibility in telemedicine rules.
  • Trump’s proposed budget for next year, which comes out Monday, will offer a number of options to bring down drug prices. Some of them might be possible through the regulation process rather than requiring congressional action.
  • A data analysis this week of the ACA marketplace enrollment numbers points out big variations among states.
  • The panel takes on a listener’s question about the possibility that states could let insurers charge higher premiums to marketplace customers who didn’t have insurance before.
  • In the recent debate about the administration’s approval of work requirements for some Medicaid enrollees, officials often talk about “able-bodied” adults. That term has little definition and goes back to Elizabethan England.

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

Julie Rovner: Vox.com, “Why a Simple, Lifesaving Rabies Shot Can Cost $10,000 in America,” by Sarah Kliff.

Alice Ollstein: The New York Times, “In Sweeping War On Obesity, Chile Slays Tony The Tiger,” by Andrew Jacobs.

Joanne Kenen: Politico, “Trump’s Controversial New Health Care Idea,” by Sarah Karlin-Smith.

Margot Sanger-Katz: Harvard Business Review, “What Could Amazon’s Approach to Health Care Look Like,” by Robert S. Huckman.

To hear all our podcasts, click here.

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

 

Podcast: KHN’s ‘What The Health?’ There’s A Really Big Health Bill In That Budget Deal

The bipartisan budget deal that passed Congress this week includes enough health policy changes to keep reporters and analysts busy for months.

In addition to renewing funding for Community Health Centers for two more years, the bill extends funding for the Children’s Health Insurance Program for four years beyond the six approved last month; repeals the controversial (but never implemented) Independent Payment Advisory Board for Medicare and permanently repeals Medicare’s caps on certain types of outpatient therapy.

Also, the final enrollment numbers for individual insurance purchased under the Affordable Care Act came out this week. Spoiler: They are higher than most analysts expected.

Plus, Andy Slavitt, former acting head of the Centers for Medicare & Medicaid Services under President Barack Obama, talks about his new group, “The United States of Care.”

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

Among the takeaways from this week’s podcast:

  • The budget bill signed by President Donald Trump on Friday provides a lot of funding for health programs, but it also takes money away from others. It takes a big chunk of funding out of the Affordable Care Act’s Prevention and Public Health Fund and raises premiums for some wealthier Medicare beneficiaries.
  • That bill could make a number of changes to how Medicare works, including some new rules for accountable care organizations and more flexibility in telemedicine rules.
  • Trump’s proposed budget for next year, which comes out Monday, will offer a number of options to bring down drug prices. Some of them might be possible through the regulation process rather than requiring congressional action.
  • A data analysis this week of the ACA marketplace enrollment numbers points out big variations among states.
  • The panel takes on a listener’s question about the possibility that states could let insurers charge higher premiums to marketplace customers who didn’t have insurance before.
  • In the recent debate about the administration’s approval of work requirements for some Medicaid enrollees, officials often talk about “able-bodied” adults. That term has little definition and goes back to Elizabethan England.

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

Julie Rovner: Vox.com, “Why a Simple, Lifesaving Rabies Shot Can Cost $10,000 in America,” by Sarah Kliff.

Alice Ollstein: The New York Times, “In Sweeping War On Obesity, Chile Slays Tony The Tiger,” by Andrew Jacobs.

Joanne Kenen: Politico, “Trump’s Controversial New Health Care Idea,” by Sarah Karlin-Smith.

Margot Sanger-Katz: Harvard Business Review, “What Could Amazon’s Approach to Health Care Look Like,” by Robert S. Huckman.

To hear all our podcasts, click here.

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

 

Centros comunitarios de salud obtienen fondos a largo plazo

Luego de tres meses de espera, los centros comunitarios de salud obtuvieron un financiamiento clave a largo plazo, como parte de la legislación que firmó el presidente Donald Trump el viernes 9 de febrero para mantener al Gobierno en funcionamiento.

El Community Health Center Program sirve a 27 millones de personas en casi 10,000 clínicas sin fines de lucro en todo el país, la mayoría de las cuales se encuentran en áreas rurales y urbanas de bajos ingresos.

La legislación les otorga a los centros $3.8 mil millones para este año, y $4 mil millones en 2019.

En los últimos años, el Congreso ha asignado $3.6 mil millones anuales para los centros de salud. Eso representa alrededor del 20% de los presupuestos de las clínicas; gran parte del resto proviene de reembolsos por servicios. Defensores y directores de los centros aseguran que este dinero es fundamental para proporcionar servicios que no siempre están cubiertos por Medicare, Medicaid, o por seguros privados, incluidos los de salud mental y abuso de sustancias, transporte y visitas domiciliarias.

Se esperaba que el Congreso renovara el financiamiento a largo plazo para los centros el 22 de enero cuando los legisladores votaron el financiamiento por seis años del Programa de Seguro de Salud Infantil (CHIP). Uno de cada 10 niños cubiertos por CHIP recibe la mayor parte de su atención en un centro comunitario de salud.

Pero ese proyecto no se ocupó de los centros. Aunque el dinero federal se agotó el 1 de octubre, un parche presupuestario anterior les proporcionó fondos temporales hasta el 31 de marzo.

“Estamos atrapados en la disfunción política de Washington”, dijo una semana atrás Carmela Castellano-García, directora ejecutiva de la Asociación de Atención Primaria de California. “Estos centros son un salvavidas para millones de personas, especialmente en las zonas rurales, donde pueden ser el único proveedor de atención médica en millas a la redonda”.

Castellano-García dijo que el impasse presupuestario había obligado a muchos centros en el estado a congelar las contrataciones, posponer expansiones de servicios y utilizar las reservas financieras.

A nivel nacional, el 20% de los centros de salud ya habían congelado contratos, y el 4% despedido personal. Agregó que otro 53% podría haber despedido a empleados si no hubieran recibido los fondos federales, según una encuesta sobre centros de salud comunitarios realizada por la Universidad George Washington e investigadores de la Kaiser Family Foundation, publicada hace pocos días. (Kaiser Health News es un programa editorialmente independiente de la fundación).

Dan Hawkins, vicepresidente senior de la Asociación Nacional de Centros Comunitarios de Salud, con sede en Bethesda, Maryland, y expertos en políticas de salud, especularon que la razón del impasse en la asignación de fondos para los centros pudo ser por desacuerdos en el nivel de financiación y la cantidad de años. Según informes, los demócratas presionaron para que fuera de cinco o seis años, pero los republicanos pueden haber preferido un período más breve. Los senadores Debbie Stabenow (demócrata de Michigan) y Roy Blunt (republicano de Missouri), lideraron este debate.

Para los líderes de los centros comunitarios, y para los pacientes, la nueva asignación de fondos es un alivio.

California tiene la red de centros de salud más grande del país. Uno de cada 6 californianos -6,5 millones de personas- reciben atención médica en los cerca de 1,300 centros alrededor del estado. La mitad está inscrita en Medi-Cal, el programa estatal de Medicaid.

Dave Jones, director ejecutivo de Mountain Valleys Health Centers, que opera seis clínicas comunitarias cerca de la ciudad de Redding en el norte de California, dijo que podrían haber enfrentado el cierre de uno de sus seis locales de no haber recibido el dinero federal.

Anderson Valley Health Center, en Boonville, California, enfrentó la misma situación. El pequeño centro atiende a 2,800 pacientes por año, el 45% de los cuales son trabajadores agrícolas de bajos ingresos.

Chloë Guazzone-Rugebregt, directora ejecutiva del centro, dijo que la renovación de su edificio estaba esperando la señal de los fondos federales.

MMaría Soto, de 72 años, y su esposo Efrén, de 77, sus seis hijos adultos y 13 nietos, se atienden en el Anderson Valley Health Center, en Boonville, California. (Esther Soto/Cortesía de María Soto)

María Soto, de 72 años y su esposo, Efrén, de 77, junto con sus seis hijos adultos y sus 13 nietos, reciben atención en Anderson. Los abuelos Soto, ambos jubilados, tienen Medicare. El resto de la familia tiene seguro privado o está inscrito en Medi-Cal.

“La clínica juega un papel muy importante en nuestras vidas”, dijo María Soto. “Confiamos en este centro de salud para todos nuestros cuidados regulares. No tengo idea de a dónde iríamos si tuviera que cerrar”.

Charles Allbaugh y Paula Tomko, quienes dirigen Central Virginia Health Services, dijeron que también se han demorado en contratar personal y expandir los servicios en su red de 16 clínicas que atienden a 43,000 residentes de Virginia, a la espera del resultado del debate sobre los fondos.

“El Congreso juega al fútbol político con nosotros”, dijo Tomko. “No es la forma en que deberían funcionar las cosas”.

Jean Grutzius estuvo de acuerdo. Su madre de 97 años se atiende en una de las clínicas de Tomko, cerca de la pequeña ciudad de Bumpass.

“Sin la clínica, estaríamos en grandes problemas”, dijo Grutzius. Su madre, Eleanor Ciombor, está ciega y sorda, en silla de ruedas y toma múltiples medicamentos, incluso para una afección psiquiátrica. Ciombor, quien vive con su hija, está inscrita tanto en Medicare como en Medicaid. Su único ingreso es $900 por mes del Seguro Social.

“Recibe una gran atención [en la clínica] y nos cuesta poco”, dijo Grutzius, quien tiene 75 años y también vive con un ingreso fijo. “No podría pagar de otra manera. Estoy rezando para que el centro obtenga la financiación que necesita”.

Los fondos para los centros fueron apoyados sólidamente por la Ley de Cuidado de Salud Asequible (ACA). Entre 2010 y 2016, ese financiamiento impulsó un aumento del 50% en el número de locales de centros de salud en todo el país y un incremento del 33% en el número de pacientes atendidos.

Los centros de salud también participaron activamente en el registro de personas para los mercados de seguros de ACA y para Medicaid en los estados que ampliaron ese programa bajo el Obamacare.

Sin embargo, a pesar de la creciente división partidista sobre ACA, los legisladores votaron abrumadoramente -y en un acuerdo bipartidista- en 2015 para extender los fondos del centro de salud al nivel de $3.6 mil millones anuales durante dos años adicionales.

“Estos son dólares federales muy bien gastados, y $3.6 mil millones no es un gran gasto federal”, dijo Peter Shin, profesor asociado de políticas y gestión de salud en la Universidad George Washington, en Washington, DC. “De hecho, hay un fuerte argumento de por qué deberían obtener más dinero”.

Shin dijo que la investigación muestra que los centros ahorran dinero al gobierno federal a largo plazo. Lo hacen proporcionando atención primaria, preventiva y prenatal de rutina que mantiene a las personas fuera del hospital y previene las costosas visitas a las salas de emergencias.

El experto dijo que, según un estimado, los centros de salud ahorran al gobierno federal casi $25 mil millones anuales en costos para los afiliados de Medicare y Medicaid.

Centros comunitarios de salud obtienen fondos a largo plazo

Luego de tres meses de espera, los centros comunitarios de salud obtuvieron un financiamiento clave a largo plazo, como parte de la legislación que firmó el presidente Donald Trump el viernes 9 de febrero para mantener al Gobierno en funcionamiento.

El Community Health Center Program sirve a 27 millones de personas en casi 10,000 clínicas sin fines de lucro en todo el país, la mayoría de las cuales se encuentran en áreas rurales y urbanas de bajos ingresos.

La legislación les otorga a los centros $3.8 mil millones para este año, y $4 mil millones en 2019.

En los últimos años, el Congreso ha asignado $3.6 mil millones anuales para los centros de salud. Eso representa alrededor del 20% de los presupuestos de las clínicas; gran parte del resto proviene de reembolsos por servicios. Defensores y directores de los centros aseguran que este dinero es fundamental para proporcionar servicios que no siempre están cubiertos por Medicare, Medicaid, o por seguros privados, incluidos los de salud mental y abuso de sustancias, transporte y visitas domiciliarias.

Se esperaba que el Congreso renovara el financiamiento a largo plazo para los centros el 22 de enero cuando los legisladores votaron el financiamiento por seis años del Programa de Seguro de Salud Infantil (CHIP). Uno de cada 10 niños cubiertos por CHIP recibe la mayor parte de su atención en un centro comunitario de salud.

Pero ese proyecto no se ocupó de los centros. Aunque el dinero federal se agotó el 1 de octubre, un parche presupuestario anterior les proporcionó fondos temporales hasta el 31 de marzo.

“Estamos atrapados en la disfunción política de Washington”, dijo una semana atrás Carmela Castellano-García, directora ejecutiva de la Asociación de Atención Primaria de California. “Estos centros son un salvavidas para millones de personas, especialmente en las zonas rurales, donde pueden ser el único proveedor de atención médica en millas a la redonda”.

Castellano-García dijo que el impasse presupuestario había obligado a muchos centros en el estado a congelar las contrataciones, posponer expansiones de servicios y utilizar las reservas financieras.

A nivel nacional, el 20% de los centros de salud ya habían congelado contratos, y el 4% despedido personal. Agregó que otro 53% podría haber despedido a empleados si no hubieran recibido los fondos federales, según una encuesta sobre centros de salud comunitarios realizada por la Universidad George Washington e investigadores de la Kaiser Family Foundation, publicada hace pocos días. (Kaiser Health News es un programa editorialmente independiente de la fundación).

Dan Hawkins, vicepresidente senior de la Asociación Nacional de Centros Comunitarios de Salud, con sede en Bethesda, Maryland, y expertos en políticas de salud, especularon que la razón del impasse en la asignación de fondos para los centros pudo ser por desacuerdos en el nivel de financiación y la cantidad de años. Según informes, los demócratas presionaron para que fuera de cinco o seis años, pero los republicanos pueden haber preferido un período más breve. Los senadores Debbie Stabenow (demócrata de Michigan) y Roy Blunt (republicano de Missouri), lideraron este debate.

Para los líderes de los centros comunitarios, y para los pacientes, la nueva asignación de fondos es un alivio.

California tiene la red de centros de salud más grande del país. Uno de cada 6 californianos -6,5 millones de personas- reciben atención médica en los cerca de 1,300 centros alrededor del estado. La mitad está inscrita en Medi-Cal, el programa estatal de Medicaid.

Dave Jones, director ejecutivo de Mountain Valleys Health Centers, que opera seis clínicas comunitarias cerca de la ciudad de Redding en el norte de California, dijo que podrían haber enfrentado el cierre de uno de sus seis locales de no haber recibido el dinero federal.

Anderson Valley Health Center, en Boonville, California, enfrentó la misma situación. El pequeño centro atiende a 2,800 pacientes por año, el 45% de los cuales son trabajadores agrícolas de bajos ingresos.

Chloë Guazzone-Rugebregt, directora ejecutiva del centro, dijo que la renovación de su edificio estaba esperando la señal de los fondos federales.

MMaría Soto, de 72 años, y su esposo Efrén, de 77, sus seis hijos adultos y 13 nietos, se atienden en el Anderson Valley Health Center, en Boonville, California. (Esther Soto/Cortesía de María Soto)

María Soto, de 72 años y su esposo, Efrén, de 77, junto con sus seis hijos adultos y sus 13 nietos, reciben atención en Anderson. Los abuelos Soto, ambos jubilados, tienen Medicare. El resto de la familia tiene seguro privado o está inscrito en Medi-Cal.

“La clínica juega un papel muy importante en nuestras vidas”, dijo María Soto. “Confiamos en este centro de salud para todos nuestros cuidados regulares. No tengo idea de a dónde iríamos si tuviera que cerrar”.

Charles Allbaugh y Paula Tomko, quienes dirigen Central Virginia Health Services, dijeron que también se han demorado en contratar personal y expandir los servicios en su red de 16 clínicas que atienden a 43,000 residentes de Virginia, a la espera del resultado del debate sobre los fondos.

“El Congreso juega al fútbol político con nosotros”, dijo Tomko. “No es la forma en que deberían funcionar las cosas”.

Jean Grutzius estuvo de acuerdo. Su madre de 97 años se atiende en una de las clínicas de Tomko, cerca de la pequeña ciudad de Bumpass.

“Sin la clínica, estaríamos en grandes problemas”, dijo Grutzius. Su madre, Eleanor Ciombor, está ciega y sorda, en silla de ruedas y toma múltiples medicamentos, incluso para una afección psiquiátrica. Ciombor, quien vive con su hija, está inscrita tanto en Medicare como en Medicaid. Su único ingreso es $900 por mes del Seguro Social.

“Recibe una gran atención [en la clínica] y nos cuesta poco”, dijo Grutzius, quien tiene 75 años y también vive con un ingreso fijo. “No podría pagar de otra manera. Estoy rezando para que el centro obtenga la financiación que necesita”.

Los fondos para los centros fueron apoyados sólidamente por la Ley de Cuidado de Salud Asequible (ACA). Entre 2010 y 2016, ese financiamiento impulsó un aumento del 50% en el número de locales de centros de salud en todo el país y un incremento del 33% en el número de pacientes atendidos.

Los centros de salud también participaron activamente en el registro de personas para los mercados de seguros de ACA y para Medicaid en los estados que ampliaron ese programa bajo el Obamacare.

Sin embargo, a pesar de la creciente división partidista sobre ACA, los legisladores votaron abrumadoramente -y en un acuerdo bipartidista- en 2015 para extender los fondos del centro de salud al nivel de $3.6 mil millones anuales durante dos años adicionales.

“Estos son dólares federales muy bien gastados, y $3.6 mil millones no es un gran gasto federal”, dijo Peter Shin, profesor asociado de políticas y gestión de salud en la Universidad George Washington, en Washington, DC. “De hecho, hay un fuerte argumento de por qué deberían obtener más dinero”.

Shin dijo que la investigación muestra que los centros ahorran dinero al gobierno federal a largo plazo. Lo hacen proporcionando atención primaria, preventiva y prenatal de rutina que mantiene a las personas fuera del hospital y previene las costosas visitas a las salas de emergencias.

El experto dijo que, según un estimado, los centros de salud ahorran al gobierno federal casi $25 mil millones anuales en costos para los afiliados de Medicare y Medicaid.