Tagged The Health Law

Must-Reads Of The Week From Brianna Labuskes

We’re barreling toward November, folks. (How is it mid-October already?) As you might expect, election stories made up the bulk of the health care news this week. Other great gems and intriguing developments surfaced, though, so let’s get right to it.

Republicans on the campaign trail have been hammered by attack ads over their stance on the health law, with “preexisting conditions protections” — insurance safeguards for patients diagnosed with chronic illness — becoming a catch-all phrase for the most popular parts of the Affordable Care Act. Even the law’s most vocal opponents have been reading tea leaves and softening their stances. That’s why statements from GOP leadership this week that Congress could revisit their “repeal” fight post-midterms may have landed with a thunk.

The New York Times: Republican Candidates Soften Tone on Health Care As Their Leaders Dig In

The Washington Post: Trump Says ‘All Republicans’ Back Protections for Preexisting Conditions, Despite Repeated Attempts to Repeal Obamacare

Democrats are pulling out a tried-and-true talking point that seemed perfectly timed for them as news of the federal deficit reignited Republican talk about cutting entitlement programs. Dems (who have been playing defense over Medicare) seized the opportunity to accuse Republicans of putting the beloved program on the chopping block.

The Associated Press: Dems Shift Line of Attack, Warning of GOP Threat to Medicare

As the parties duke it out on the trail, voters seem to agree on one thing: Our health care system is broken and someone needs to fix it. “It’s crippling people. It’s crippling me,” one voter says in Politico’s deep read that takes us to a Pennsylvania county where the “margins of electoral victories traditionally are as slim as the spectrum of political opinion is vast.”

Politico Magazine: The Great American Health Care Panic

On the state level, a Missouri Democrat opposed to abortion struggles to find her place in the party. And Georgia becomes a preview of the growing political clout of home health aides.

The New York Times: Is It Possible to Be an Anti-Abortion Democrat? One Woman Tried to Find Out

Politico: Home Health Aides Test Political Clout in Georgia Governor’s Race


The Trump administration this week proposed a requirement that pharma add drug prices to TV ads — triggering skepticism. One problem is that ad prices wouldn’t reflect what most people end up paying for a drug at the pharmacy counter.

Politico: Trump Set to Force Drugmakers to Post Prices in Ads

What I found surprising, considering how common those ads are, is that just a few dozen drugmakers run any at all — nearly half are put out by five companies. Those manufacturers would bear the brunt of the new rules.

Stat: Five Drug Makers Will Be Hit Hardest By Trump’s New Proposal on Drug Ads

Trying to think outside the box to rein in high drug prices, several states are considering treating pharma as they would a public utility — with rate-setting bodies to review, approve or adjust medication prices.

Stat: A Growing Number of States Consider Legislation to Treat Pharma As a Utility

And keep an eye on this battle: Minnesota became the first state to sue drugmakers over the price of insulin, but I don’t think it will be the last. The “life-or-death” drug has gotten a lot of attention recently, synthesizing the human toll of high costs into a digestible talking point.

Stat: Minnesota Becomes First State to Sue Major Insulin Makers Over Price-Gouging


Another 4,100 Arkansas beneficiaries were dropped from the state’s Medicaid rolls, and 4,800 more are at risk next month (on top of the original 4,353 people dropped last month) — all because of the state’s new work requirements. For critics of the restrictions, their worst fears are realized, while state and national officials focus on what they call positive outcomes. It’s unclear why so many workers are failing to report their hours, but experts suggest limited internet access and lack of knowledge about the requirements as possibilities.

Modern Healthcare: 4,100 More Arkansans Lose Medicaid Over Work Requirements


Anthem was slammed this week with a $16 million settlement over its massive data breach. (Remember the biggest known health care hack in U.S. history?) That penalty is nearly three times the previous record paid over such a case.

The Associated Press: Insurer Anthem Will Pay Record $16M for Massive Data Breach


I’m not sure whether it’s because I saturate myself in health care stories, but I detect a serious reckoning in the field of medical research. The latest call for retractions involves a prominent cardiologist.

The New York Times: Harvard Calls for Retraction of Dozens of Studies by Noted Cardiologist


In the miscellaneous must-read file:

• A mysterious polio-like illness that causes sudden paralysis is hitting children in states across the country. The wave of cases is similar to one officials saw in 2014 and 2016, but experts are baffled.

Los Angeles Times: What Is AFM? Everything You Need to Know About the Polio-Like Virus Suddenly Affecting Children Across the U.S.

• I have to admit, this is the headline that most piqued my interest this week. Gene editing is such a hot field, but in the racially charged landscape of the country, scientists are worried their research into genes and genetic diversity will be twisted by hate groups to support their views.

The New York Times: Why White Supremacists Are Chugging Milk (And Why Geneticists Are Alarmed)

• Why hasn’t #WhyIStayed caught on fire like #MeToo? Stigma, for one. But also the #MeToo movement has shown how powerful multiple accusations can be, amplified to the point they can’t be ignored. In a domestic violence situation, it’s often only one survivor speaking out.

The New York Times: Domestic Violence Awareness Hasn’t Caught Up With #MeToo. Here’s Why.

• Viruses don’t always have to be a scary thing. This therapy uses bacteriophages — literally, eaters of bacteria — that inject themselves into germs and cause them to explode. (As this delightful image from the Stat article describes: The viruses can “pop bacteria the way middle schoolers pop zits.”)

Stat: How The Navy Brought a Once-Derided Scientist Out of Retirement — and Into the Virus-Selling Business

• “Pregnant? Don’t want to be? Call Jane.” That’s how a clandestine underground abortion network advertised during the years leading up to Roe v. Wade, according to this retro report from the NYT.

The New York Times: Code Name Jane: The Women Behind a Covert Abortion Network


It turns out, it is now scientifically supported that daylight helps kill germs indoors. So make sure to let the sun in this weekend! And have a good one.

Must-Reads Of The Week From Brianna Labuskes

We’re barreling toward November, folks. (How is it mid-October already?) As you might expect, election stories made up the bulk of the health care news this week. Other great gems and intriguing developments surfaced, though, so let’s get right to it.

Republicans on the campaign trail have been hammered by attack ads over their stance on the health law, with “preexisting conditions protections” — insurance safeguards for patients diagnosed with chronic illness — becoming a catch-all phrase for the most popular parts of the Affordable Care Act. Even the law’s most vocal opponents have been reading tea leaves and softening their stances. That’s why statements from GOP leadership this week that Congress could revisit their “repeal” fight post-midterms may have landed with a thunk.

The New York Times: Republican Candidates Soften Tone on Health Care As Their Leaders Dig In

The Washington Post: Trump Says ‘All Republicans’ Back Protections for Preexisting Conditions, Despite Repeated Attempts to Repeal Obamacare

Democrats are pulling out a tried-and-true talking point that seemed perfectly timed for them as news of the federal deficit reignited Republican talk about cutting entitlement programs. Dems (who have been playing defense over Medicare) seized the opportunity to accuse Republicans of putting the beloved program on the chopping block.

The Associated Press: Dems Shift Line of Attack, Warning of GOP Threat to Medicare

As the parties duke it out on the trail, voters seem to agree on one thing: Our health care system is broken and someone needs to fix it. “It’s crippling people. It’s crippling me,” one voter says in Politico’s deep read that takes us to a Pennsylvania county where the “margins of electoral victories traditionally are as slim as the spectrum of political opinion is vast.”

Politico Magazine: The Great American Health Care Panic

On the state level, a Missouri Democrat opposed to abortion struggles to find her place in the party. And Georgia becomes a preview of the growing political clout of home health aides.

The New York Times: Is It Possible to Be an Anti-Abortion Democrat? One Woman Tried to Find Out

Politico: Home Health Aides Test Political Clout in Georgia Governor’s Race


The Trump administration this week proposed a requirement that pharma add drug prices to TV ads — triggering skepticism. One problem is that ad prices wouldn’t reflect what most people end up paying for a drug at the pharmacy counter.

Politico: Trump Set to Force Drugmakers to Post Prices in Ads

What I found surprising, considering how common those ads are, is that just a few dozen drugmakers run any at all — nearly half are put out by five companies. Those manufacturers would bear the brunt of the new rules.

Stat: Five Drug Makers Will Be Hit Hardest By Trump’s New Proposal on Drug Ads

Trying to think outside the box to rein in high drug prices, several states are considering treating pharma as they would a public utility — with rate-setting bodies to review, approve or adjust medication prices.

Stat: A Growing Number of States Consider Legislation to Treat Pharma As a Utility

And keep an eye on this battle: Minnesota became the first state to sue drugmakers over the price of insulin, but I don’t think it will be the last. The “life-or-death” drug has gotten a lot of attention recently, synthesizing the human toll of high costs into a digestible talking point.

Stat: Minnesota Becomes First State to Sue Major Insulin Makers Over Price-Gouging


Another 4,100 Arkansas beneficiaries were dropped from the state’s Medicaid rolls, and 4,800 more are at risk next month (on top of the original 4,353 people dropped last month) — all because of the state’s new work requirements. For critics of the restrictions, their worst fears are realized, while state and national officials focus on what they call positive outcomes. It’s unclear why so many workers are failing to report their hours, but experts suggest limited internet access and lack of knowledge about the requirements as possibilities.

Modern Healthcare: 4,100 More Arkansans Lose Medicaid Over Work Requirements


Anthem was slammed this week with a $16 million settlement over its massive data breach. (Remember the biggest known health care hack in U.S. history?) That penalty is nearly three times the previous record paid over such a case.

The Associated Press: Insurer Anthem Will Pay Record $16M for Massive Data Breach


I’m not sure whether it’s because I saturate myself in health care stories, but I detect a serious reckoning in the field of medical research. The latest call for retractions involves a prominent cardiologist.

The New York Times: Harvard Calls for Retraction of Dozens of Studies by Noted Cardiologist


In the miscellaneous must-read file:

• A mysterious polio-like illness that causes sudden paralysis is hitting children in states across the country. The wave of cases is similar to one officials saw in 2014 and 2016, but experts are baffled.

Los Angeles Times: What Is AFM? Everything You Need to Know About the Polio-Like Virus Suddenly Affecting Children Across the U.S.

• I have to admit, this is the headline that most piqued my interest this week. Gene editing is such a hot field, but in the racially charged landscape of the country, scientists are worried their research into genes and genetic diversity will be twisted by hate groups to support their views.

The New York Times: Why White Supremacists Are Chugging Milk (And Why Geneticists Are Alarmed)

• Why hasn’t #WhyIStayed caught on fire like #MeToo? Stigma, for one. But also the #MeToo movement has shown how powerful multiple accusations can be, amplified to the point they can’t be ignored. In a domestic violence situation, it’s often only one survivor speaking out.

The New York Times: Domestic Violence Awareness Hasn’t Caught Up With #MeToo. Here’s Why.

• Viruses don’t always have to be a scary thing. This therapy uses bacteriophages — literally, eaters of bacteria — that inject themselves into germs and cause them to explode. (As this delightful image from the Stat article describes: The viruses can “pop bacteria the way middle schoolers pop zits.”)

Stat: How The Navy Brought a Once-Derided Scientist Out of Retirement — and Into the Virus-Selling Business

• “Pregnant? Don’t want to be? Call Jane.” That’s how a clandestine underground abortion network advertised during the years leading up to Roe v. Wade, according to this retro report from the NYT.

The New York Times: Code Name Jane: The Women Behind a Covert Abortion Network


It turns out, it is now scientifically supported that daylight helps kill germs indoors. So make sure to let the sun in this weekend! And have a good one.

As Billions In Tax Dollars Flow To Private Medicaid Plans, Who’s Minding The Store?

With no insurance through his job, Jose Nuñez relied on Medicaid, the nation’s public insurance program that assists 75 million low-income Americans.

Like most people on Medicaid, the Los Angeles trucker was assigned to a private insurance company that coordinated his medical visits and treatment in exchange for receiving a set fee per month — an arrangement known as managed care.

But in 2016, when Nuñez’s retina became damaged from diabetes, the country’s largest Medicaid insurer, Centene, let him down, he said. After months of denials, delays and erroneous referrals, he claimed in a lawsuit, the 62-year-old was left nearly blind in one eye. As a result, he lost his driver’s license and his livelihood.

“They betrayed my trust,” Nuñez said, sitting at his kitchen table with his thick forearms folded across his chest.

The current political debate over Medicaid centers on putting patients to work so they can earn their government benefits. Yet some experts say the country would be better served by asking this question instead: Are insurance companies — now receiving hundreds of billions in public money — earning their Medicaid checks?

More than two-thirds of Medicaid recipients are enrolled in such programs, a type of public-private arrangement that has grown rapidly since 2014, boosted by the influx of new beneficiaries under the Affordable Care Act.

States have eagerly tapped into the services of insurers as one way to cope with the expansion of Medicaid under the ACA, which has added 12 million people to the rolls. This fall, voters in three more states may pass ballot measures backing expansion. Outsourcing this public program to insurers has become the preferred method for running Medicaid in 38 states.

Yet the evidence is thin that these contractors improve patient care or save government money. When auditors, lawmakers and regulators bother to look, many conclude that Medicaid insurers fail to account for the dollars spent, deliver necessary care or provide access to a sufficient number of doctors. Oversight is sorely lacking and lawmakers in a number of states have raised alarms even as they continue to shell out money.

“We haven’t been holding plans to the level of scrutiny they need,” said Dr. Andrew Bindman, former director of the federal Agency for Healthcare Research and Quality and now a professor at the University of California-San Francisco. “This system is ripe for profit taking, and there is virtually no penalty for performing badly.”

In return for their fixed fees, the private insurers dole out treatment within a limited network, in theory allowing for more judicious, cheaper care. States contract with health plans as a way to lock in some predictability in their annual budgets.

More than 54 million Medicaid recipients are now covered by managed-care plans, up from fewer than 20 million people in 2000. (In traditional Medicaid, states pay doctors and hospitals directly for each visit or procedure — an approach that can encourage unnecessary or excessive treatment.)

Already, states funnel nearly $300 billion annually to Medicaid insurers. That’s up from $60 billion a decade ago. Today’s spending is approaching what Pentagon awards annually to contractors.

Jose Nuñez says he and daughter Diana Nuñez took turns calling his Medicaid plan and waiting on hold for answers after his eye surgery was canceled twice. He waited three months for his insurer to approve the operation, he says. By that time, his retina had deteriorated and Nuñez was nearly blind in one eye.(Heidi de Marco/KHN)

Medicaid is good for business: The stock price of Nuñez’s insurer, Centene, has soared 400 percent since the ACA expanded Medicaid eligibility. The company’s chief executive took in $25 million last year, the highest pay for any CEO in the health insurance industry. In California, the largest Medicaid managed-care market with nearly 11 million enrollees, Centene and other insurers made $5.4 billion in profits from 2014 to 2016, according to a Kaiser Health News analysis.

Plans get to keep what they don’t spend. That means profits can flow from greater efficiency — or from skimping on care and taking in excess government payments.

“States are just giving insurers the keys to the car and a gas card,” said Dave Mosley, a managing director at Navigant Consulting and former finance director at the North Carolina Medicaid program. “Most states haven’t pressed insurers for the information needed to determine if there’s any return on their investment.”

Two of California’s most profitable insurers, Centene and Anthem, ran some of California’s worst-performing Medicaid plans, state quality scores and complaints in government records show. California officials have been clawing back billions of dollars from health plans after the fact.

For nearly two decades, federal officials have tried building a national Medicaid database that would track medical care and spending across states and insurers. It’s still unfinished, hampered by differing state reporting methods and refusals by some health plans to turn over data they deem trade secrets.

In July, a federal inspector general’s report accused Medicaid insurers of purposefully ignoring fraud and overpayments to doctors because inflated costs can lead to higher rates in the future.

In a report last month, the U.S. Government Accountability Office disclosed that California’s Medicaid program is unable to electronically send records justifying billions of dollars in spending, forcing federal officials to sift through thousands of documents by hand. California said it can’t share key files electronically because it uses 92 separate computer systems to run the program.

“You simply cannot run a program this large when you can’t tell where the money is going and where it has been,” said Carolyn Yocom, a health care director at the GAO.

Today, Medicaid consumes the single-largest share of state budgets nationwide at nearly 30 percent — up from less than 21 percent a decade ago — crowding out funding for education, roads and other key priorities.

“If anything, our results suggest that the shift to Medicaid managed care increased Medicaid spending,” researchers at the Congressional Budget Office and the University of Pennsylvania concluded in 2013, based on a nationwide analysis.

Industry officials insist that managed care saves money and improves care. Medicaid Health Plans of America, an industry trade group, points to a study showing that health plans nationally saved the Medicaid program $7.1 billion in 2016.

Health plans also say they can help modernize the program, created more than a half century ago, by upgrading technology and adopting fresh approaches to managing complex patients.

Getting it right has big implications for patients and taxpayers alike, but the results in many states aren’t reassuring.

State lawmakers in Mississippi, both Republicans and Democrats, criticized their Medicaid program last year for ignoring the poor performance of two insurers, UnitedHealthcare and Centene, even as the state awarded the companies new billion-dollar contracts.

In Illinois, auditors said the state didn’t properly monitor $7 billion paid to Medicaid plans in 2016, leaving the program unable to determine what percentage of money went to medical care as opposed to administrative costs or profit.

In April, Iowa’s state ombudsman said Medicaid insurers there had denied or reduced services to disabled patients in a “stubborn and absurd” way. In one case, an insurer had cut a quadriplegic’s in-home care by 71 percent. Without the help of an aide to assist him with bathing, dressing and changing out his catheter he had to move to a nursing home, according to the ombudsman, Kristie Hirschman.

“We are not talking about widgets here,” Hirschman said. “In some cases, we are talking about life-or-death situations.”

Meanwhile, the Trump administration has sent mixed signals on Medicaid oversight. Seema Verma, administrator for the Centers for Medicare & Medicaid Services, has promoted a new, nationwide scorecard and vowed to ramp up audits targeting states and health plans.

“We need to do better,” Verma said in a Sept. 27 speech to the Medicaid managed-care industry. “Medicaid has never developed a cohesive system of accountability that allows the public to easily measure and check our results.”

But consumer advocates also are concerned that Verma’s efforts to roll back “burdensome regulations” will weaken accountability overall. Many also disagree with her support of Medicaid work requirements.

Nuñez, the truck driver who lost much of his sight, is suing a unit of Centene for negligence and breach of contract. The company has denied the allegations in court filings and declined to comment further, citing the pending litigation.

Talk of requiring Medicaid recipients to work is hard for him to take. “I need my health to work,” he said. “They took that away from me.”


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

Podcast: KHN’s ‘What The Health?’ Republicans’ Preexisting Political Problem

Ensuring that people with preexisting health conditions can get and keep health insurance has become one of the leading issues around the country ahead of this fall’s midterm elections. And it has put Republicans in something of a bind — many either voted to repeal these coverage protections as part of the 2017 effort in Congress or have signed onto a lawsuit that would invalidate them.

Meanwhile, the Trump administration, eager to show progress regarding high prescription drug costs — another issue important to voters — has issued a regulation that would require prices to be posted as part of television drug advertisements.

Also this week: an interview with California Attorney General Xavier Becerra, a former member of Congress who is using his current post to pursue a long list of health initiatives.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Stephanie Armour of The Wall Street Journal and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

  • Congress passed a package of bills addressing the nation’s opioid epidemic on a rare note of bipartisanship. Many of the measures are designed to help prevent opioid addiction but are short on treatment options.
  • Democrats have made health care — especially the protections for people with preexisting conditions — their central strategy in midterm campaigns. It’s an issue that the GOP did not want to be campaigning on.
  • Republicans say that despite their moves to destroy the federal health law, they would work to preserve coverage options for people with preexisting conditions. But they don’t lay out what those options would be and earlier efforts have major loopholes, Democrats point out.
  • The announcement by federal health officials this week that they want drug prices added to advertisements about the products is expected to have marginal effects because pricing is so complicated. If the federal government requires drugmakers to post their prices on ads, the manufacturers are widely expected to sue based on First Amendment issues.
  • Open enrollment for Medicare began this week and runs until Dec. 7. Medicare Advantage, the private-plan option for enrollees, is becoming increasingly popular and now covers more than a third of Medicare beneficiaries.
  • But while Medicare Advantage offers many benefits the traditional program does not — frequently including dental and foot care — a recent report from the inspector general at the Department of Health and Human Services finds that some of these plans may be wrongly denying care to Medicare patients. At the same time, Medicare beneficiaries who choose to use Medicare Advantage plans may be in for a shock if they later decide to switch back to the traditional form of Medicare. They may not be eligible at that point to buy a Medigap plan to help cover their cost sharing.

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

Julie Rovner: The New York Times’ “Is Medicare for All the Answer to Sky-High Administrative Costs?” by Austin Frakt

Stephanie Armour: The Associated Press’ “Study: Without Medicaid Expansion, Poor Forgo Medical Care,” by Ricardo Alonso-Zaldivar

Rebecca Adams: The New Yorker’s “Rural Georgians Want Medicaid, But They’re Divided on Stacey Abrams, the Candidate Who Wants to Expand It,” by Charles Bethea

Joanne Kenen: Seven Days Vermont’s “Obituary: Madelyn Linsenmeir, 1988-2018.”

To hear all our podcasts, click here.

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

Podcast: KHN’s ‘What The Health?’ Republicans’ Preexisting Political Problem

Ensuring that people with preexisting health conditions can get and keep health insurance has become one of the leading issues around the country ahead of this fall’s midterm elections. And it has put Republicans in something of a bind — many either voted to repeal these coverage protections as part of the 2017 effort in Congress or have signed onto a lawsuit that would invalidate them.

Meanwhile, the Trump administration, eager to show progress regarding high prescription drug costs — another issue important to voters — has issued a regulation that would require prices to be posted as part of television drug advertisements.

Also this week: an interview with California Attorney General Xavier Becerra, a former member of Congress who is using his current post to pursue a long list of health initiatives.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Stephanie Armour of The Wall Street Journal and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

  • Democrats have made health care — especially the protections for people with preexisting conditions — their central strategy in midterm campaigns. It’s an issue that the GOP did not want to be campaigning on.
  • Republicans say that despite their moves to destroy the federal health law, they would work to preserve coverage options for people with preexisting conditions. But they don’t lay out what those options would be and earlier efforts have major loopholes, Democrats point out.
  • The announcement by federal health officials this week that they want drug prices added to advertisements about the products is expected to have marginal effects because pricing is so complicated. If the federal government requires drugmakers to post their prices on ads, the manufacturers are widely expected to sue based on First Amendment issues.
  • Open enrollment for Medicare began this week and runs until Dec. 7. Medicare Advantage, the private-plan option for enrollees, is becoming increasingly popular and now covers more than a third of Medicare beneficiaries.
  • But while Medicare Advantage offers many benefits the traditional program does not — frequently including dental and foot care — a recent report from the inspector general at the Department of Health and Human Services finds that some of these plans may be wrongly denying care to Medicare patients. At the same time, Medicare beneficiaries who choose to use Medicare Advantage plans may be in for a shock if they later decide to switch back to the traditional form of Medicare. They may not be eligible at that point to buy a Medigap plan to help cover their cost sharing.

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

Julie Rovner: The New York Times’ “Is Medicare for All the Answer to Sky-High Administrative Costs?” by Austin Frakt

Stephanie Armour: The Associated Press’ “Study: Without Medicaid Expansion, Poor Forgo Medical Care,” by Ricardo Alonso-Zaldivar

Rebecca Adams: The New Yorker’s “Rural Georgians Want Medicaid, But They’re Divided on Stacey Abrams, the Candidate Who Wants to Expand It,” by Charles Bethea

Joanne Kenen: Seven Days Vermont’s “Obituary: Madelyn Linsenmeir, 1988-2018.”

To hear all our podcasts, click here.

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

Georgia’s Gubernatorial Race Shines Light On Growing Political Force: Home Health Aides

Georgia state Rep. Stacey Abrams (D) is locked in a tight race with Republican Secretary of State Brian Kemp, and members of The National Domestic Workers Alliance have been knocking on doors and pouring money into ad campaigns in support of the Democrat. News on the upcoming elections comes out of Alabama, Kansas, California and New Hampshire.

In Sign Of The Times, One Of Health Law’s Most Vocal Opponents Vows To Protect Preexisting Conditions Coverage

Sen. Ted Cruz (R-Texas) is in a high-profile race with Democrat Beto O’Rourke. For years he has called for a repeal of “every word” of the health law but now his tone has shifted, but in a reflection of the current political landscape and of many races across the country. Meanwhile, in a recent poll, health care comes in as the top issue for voters this year.

GOP’s Talk About Medicare Cuts Provides Democrats With Tried-And-True Talking Point Weeks Before Midterms

The widening budget deficit announced in recent days has sparked conversation among Republicans of cutting budgets and look for trims to entitlement programs. The Democrats are seizing on the tone shift, and using the potential changes to Medicare, Medicaid and other safety net programs as talking points on the campaign trail.

Health Care Tops Guns, Economy As Voters’ Top Issue

Health care has emerged as the top issue for voters headed into the midterm elections, but fewer than half of them say they are hearing a lot from candidates on the issue, according to a new poll released Thursday.

Seven in 10 people list health care as “very important” as they make their voting choices, eclipsing the economy and jobs (64 percent), gun policy (60 percent), immigration (55 percent), tax cuts (53 percent) and foreign policy (51 percent).

When asked to choose just one issue, nearly a third picked health care, according to the survey by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Still, midterm elections are traditionally a referendum on the president and his party, and that holds true this year as two-thirds of voters say a candidate’s support or opposition to President Donald Trump will be a major factor in their voting decision, the poll found.

Health care was also the top issue chosen overall by voters living in areas identified in the survey as political battlegrounds, although the results varied when pollsters drilled down to political parties. Nearly 4 in 10 Democratic battleground voters and 3 in 10 independents chose health care as their most important issue in voting for Congress.

Among Republican voters, immigration was their top issue, garnering 25 percent compared with 17 percent for health care.

The poll results in two battleground states — Florida and Nevada — also underscored voters’ interest for keeping the Affordable Care Act’s protections for people with preexisting conditions, one of the most popular provisions in the law.

Democrats have made that a key part of their campaign, pointing to Republicans’ votes to repeal the entire law and trying to drive home the message that the GOP’s efforts would strip that guarantee.

Nonetheless, Republicans have recently sought to fight back on that issue, promising on the stump and in campaign ads that they understand the need to keep the protections and would work to do that.

Nearly 7 in 10 Florida voters said they are more likely to vote for a candidate who wants to maintain the protections for people with preexisting conditions, while 9 percent said they are more likely to vote for a candidate who wants to eliminate these protections.

In Nevada, nearly 70 percent of voters also said they wanted the ACA preexisting protections guaranteed.

In Florida, where the deadliest mass school shooting in American history took place last February, health care also was the top issue among voters. Twenty-six percent of Florida voters listed health as their top issue. The economy and gun policy tied for the second-biggest issue at 19 percent.

The shooting at Marjory Stoneman Douglas High School in Parkland, Fla., left 17 students and staff members dead, spurred massive marches around the country and stirred national debate on gun policy.

Florida is traditionally a key battleground state but more so this year with close races for the U.S. Senate and governor’s race hanging in the balance.

Nearly half of Florida voters said they are more likely to vote for a candidate who wants to expand Medicaid.

Florida is one of 17 states that has chosen not to expand Medicaid under the health law, leaving tens of thousands of its adult residents without health insurance. The Republican-controlled legislature has refused to accept millions of dollars in federal funding to extend the coverage.

Two in 10 Democratic voters in Florida said support for a candidate supporting a national health plan, or “Medicare-for-all,” is the most important health care position for a candidate to take. Andrew Gillum, the Florida Democratic gubernatorial nominee, has said he would support a national health plan.

In Nevada, which also has a key Senate battle, the poll found nearly a quarter of voters said health care was the top issue in their decisions this year, but immigration and the economy were very close behind.

Nearly a third of Democrats in Nevada said they are looking for a candidate who supports a single-payer health plan.

Just under a third of Republicans in Florida and Nevada said that a candidate’s support of repealing the ACA is the most important health issue when they vote.

The poll of 1,201 adults was conducted Sept. 19-Oct. 2. The national survey has a margin of error of +/-3 percentage points.

GOP Gubernatorial Candidate John Cox: Limit Government In Health Care

John Cox stood on a presidential debate stage and told the audience that he was glad abortion wasn’t legal in 1955.

If it had been, he said, he wouldn’t have been born.

“I wouldn’t be standing here before you today. This is personal to me,” Cox said in the 2007 GOP presidential primary debate, explaining that his biological father walked out on his mother.

“My mother took responsibility for me,” he said. “She’s glad she did, and I’m glad she did.”

Cox, California’s Republican candidate for governor, frequently invoked his anti-abortion views during his unsuccessful political bids for Congress and president. He unapologetically framed himself as the anti-abortion candidate – a Christian who believes in the right to life, and whose “absolute opposition to abortion on demand” was born from his mother’s circumstances.

Cox has been less vocal about his abortion views in blue-state California, where Republicans, Democrats and independents overwhelmingly favor a woman’s right to choose. But his argument that it is an issue of personal responsibility provides a window into Cox’s thinking when it comes to health care overall: He contends that free markets, combined with people taking responsibility for their actions, ought to guide health care policy — and that government should mostly stay out of it.

His views on health care contrast starkly with those of the Democratic gubernatorial nominee, Lt. Gov. Gavin Newsom, who calls for health care coverage for all Californians, and supports the creation of a single-payer, government-run health care system financed by taxpayers. In the latest Public Policy Institute of California poll released in late September, Cox trailed Newsom by 12 percentage points among California’s likely voters, with 7 percent undecided.

As a candidate for governor, Cox has not released detailed health care positions. Nor would he agree to an interview with California Healthline to explain his views or allow those closest to him to comment.

On Monday, with less than a month before the election, Cox issued a statement following a live gubernatorial debate saying that he supports affordable health care for everyone, including those with preexisting conditions. He again failed to provide any specifics.

A review of his statements, old and current campaign websites, and interviews with previous campaign aides portrays a successful businessman who believes in limiting government in health care and in general — a political philosophy inspired by Jack Kemp’s focus on free enterprise, fiscal conservatism and family values during the 1988 presidential campaign.

Cox, who grew up in a Chicago suburb he describes as lower-middle class, became a successful tax attorney, investor and developer before getting involved in Illinois Republican politics. He didn’t do as well in that arena: He ran unsuccessfully for Congress — the House in 2000 and the Senate in 2002 — and for Cook County Recorder of Deeds in 2004 and president in 2008.

“John is a principled guy. He didn’t come from much and he did very well,” said Nicholas Tyszka, who was Cox’s campaign manager in his U.S. Senate bid. “He’s certainly more of a limited-government guy who believes if you give people an opportunity to do good things, they will.”

Cox, 63, settled in California permanently in 2011, and now lives in the affluent San Diego suburb of Rancho Santa Fe.

He has spent much of his campaign lamenting California’s high cost of living, along with the recent gas tax increase that he is encouraging voters to repeal in November.

Cox’s mindset of limited government, combined with his conviction of personal responsibility, feeds his argument that competition is the answer to rising health care costs, high prescription drug prices and nurse shortages.

“I’ve heard him say many times health care should be run more by the free markets and the federal government should have less involvement,” said Phil Collins, a Republican county treasurer candidate in Nevada who worked on two of Cox’s campaigns in Illinois.

In Monday’s statement, Cox complained that “our current system was designed by political insiders and health care corporate lobbyists to protect their monopoly profits, not to provide decent health care at a reasonable price.”

Cox said previously that, if elected governor, he isn’t interested in defending the Affordable Care Act, and that if Congress and the Trump administration were to repeal the law, the millions of Californians who now have coverage could go into high-risk insurance pools. That could increase the ranks of the uninsured.

In the hour-long debate Monday hosted by KQED, a San Francisco National Public Radio affiliate, Newsom challenged Cox’s desire to repeal the ACA and criticized his abortion views when asked how the confirmation of Brett Kavanaugh to the U.S. Supreme Court could affect California.

“It could have a profound impact on Californians, on their reproductive rights, which you believe a woman does not have a right to choose, regardless whether or not they are raped or a tragic incident of incest,” Newsom said.

Cox, who has dodged questions about his views on abortion during the gubernatorial campaign, did so again during the debate, saying only that he would appoint justices in California who will respect the U.S. and state constitutions.

“The things I’ve seen him say are very much aligned with what we hear coming out of the Trump administration and the Republican leadership of Congress,” said Dr. Andy Bindman, a primary care doctor at Zuckerberg San Francisco General Hospital and professor at the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco who helped draft the Affordable Care Act.

When the state legislature this year considered bills that would have opened Medi-Cal, California’s Medicaid program, to unauthorized immigrants between ages 19 and 25, as well as those 65 and older, Cox went on national television to call the Democratic plans a “freebie” and told Fox News that “our government has been grabbed by a bunch of people who believe that government is the most important thing.” The bills died in the legislature.

Cox has also criticized Newsom for advocating both a single-payer system, which he says would destroy California’s economy, and health coverage for unauthorized immigrants.

“Gavin Newsom wants to make problems even worse, by increasing the costs of health care of Californians and then rewarding those who cut in line,” Cox said in an August news release. “If we want to see how Newsom’s government health care would work, just look at the DMV.”

If elected governor, Cox said in his post-debate statement, he “will break up the health care corporate monopolies, make insurance companies compete and turn patients into consumers with power over their health care dollars.”

He declined to provide any details in response to questions submitted to his campaign.

Bindman said Cox is taking a page out of the national Republican playbook — bash the Affordable Care Act without offering solutions.

“John Cox is not talking a lot about health care other than saying what he’s against because he doesn’t have any viable alternatives that ensure people retain coverage,” Bindman said.

But over the years, Cox has made suggestions that display his confidence in free markets to solve problems. What exists now, he argued in his 2006 book, “Politic$, Inc.,” is an “illogical system” where insurance companies and government have taken over individual patient care.

The solution, Cox argued both in his book and on his website as a presidential candidate, would be to end the federal tax deduction for employee health insurance, opening the door to more competition and lower prices. Like auto insurance, consumers ought to be able to choose their own health insurance plans in a free market, he said.

The poor could benefit from a limited government voucher program, he proposed, one with incentives to save money and get preventive care, as well as health savings accounts that encourage consumers to find care at the most reasonable cost.

“Wealthier people may well have better choices, but that should be one of the awards for upward mobility,” he wrote.


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

Medicare For All? CMS Chief Warns Program Has Enough Problems Already

The Trump administration’s top Medicare official Tuesday slammed the federal health program as riddled with problems that hinder care to beneficiaries, increase costs for taxpayers and escalate fraud and abuse.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS), said those troubles underscore why she opposes calls by many Democrats for dramatically widening eligibility for Medicare, now serving 60 million seniors and people with disabilities, to tens of millions other people.

“We only have to look at some of Medicare’s major problems to know it’s a bad idea,” Verma told health insurance executives at a meeting in Washington.

CMS lacks the authority from Congress to operate the program effectively, Verma said, which means it often pays higher-than-necessary rates to doctors and hospitals and can’t take steps used by private insurers to control costs.

“We face tremendous barriers to supporting and bringing innovation to Medicare, and it literally takes an act of Congress to add new types of benefits for the Medicare population,” she added.

Since Medicare was approved in 1965, Congress has held power over eligibility and benefits — largely to control spending. That has meant efforts to expand services can get weighed down by partisan politics and swayed by lobbying groups, which significantly delay changes. One example: Congress didn’t add a pharmaceutical benefit to Medicare until 2003 — decades after drugs became a mainstay in most treatments.

Advocates for seniors have called for adding vision and dental benefits for many years, but the proposals have gotten little traction because of cost concerns.

Another problem, according to Verma, is that her agency reviews less than 0.2 percent of the more than 1 billion claims that Medicare receives from providers. “That is ridiculously low,” she said.

Verma also lamented the traditional Medicare program’s limited ability to require doctors and hospitals to get prior authorization from the federal government before performing certain procedures. That process — which has been routine for decades in the private sector — can lead to higher improper payments to doctors and more fraud and abuse, she said.

Jonathan Oberlander, a professor in the department of health policy and management at the University of North Carolina-Chapel Hill, agreed with Verma that “Medicare is not always nimble, particularly in adjusting benefits,” and officials have long complained that Congress micromanages the program. Still, he added, “with a program as large and important to Americans as Medicare, it is perfectly appropriate for Congress to weigh in on the addition of new benefits, especially since taxpayers will bear the costs of those changes.”

Verma for months has spoken out against the “Medicare-for-all” proposals pushed by Sen. Bernie Sanders (I-Vt.) and a growing chorus of Democrats. But her 35-minute address to the meeting of the trade group America’s Health Insurance Plans marked the first time she listed the litany of problems with Medicare, which she has run since March 2017.

Proponents of “Medicare-for-all” are reacting to problems caused by the Affordable Care Act, she said, and should know expanding Medicare will worsen the program’s existing challenges of controlling costs and improving care.

“But their solution is literally to do more of what’s not working,” she added. “It’s like the man who has a pounding headache, who then takes a hammer to his head to make it go away.”

Verma’s comments, however, overlooked the key leadership role that Medicare plays in the health sector, which is often emulated by private insurers, Oberlander said.

“In payment reform, Medicare has a record of being a leader and innovator,” he said. “For all of their supposed advantages, private insurers pay much higher prices than Medicare does for medical services. Verma ignores the fact that Medicare’s price regulation has produced substantial savings.”

Although Verma heavily criticized the traditional Medicare program, which covers two-thirds of enrollees, she boasted about how she and the Trump administration were running Medicare Advantage, the fast-growing alternative program that is operated by private insurers such as UnitedHealthcare and Humana.

More than 20 million Medicare beneficiaries are enrolled in these plans, which often cost members less than traditional Medicare and have additional benefits. But they generally require members to use only the plan’s network of providers.

“Medicare Advantage represents value for our beneficiaries and taxpayers,” Verma said.

She touted a 2019 CMS initiative that will for the first time allow the Advantage plans to offer supplemental health benefits that go beyond traditional dental and health services. These include adult day care, in home support services and meals.

It is “one of the most significant changes made to the Medicare program” and “will have a major impact” on improving health for plan members, she said.

But the private plans have taken a cautious approach to adding those benefits.

About 270 Medicare Advantage plans — or fewer than 10 percent of the total — agreed to offer these services next year.

At the AHIP conference on Monday, health insurance executives said they were still trying to figure out which of their members would most likely benefit from the new offerings.

“We are operating in a vacuum of good evidence,” said William Shrank, chief medical officer of UPMC Health Plan in Pittsburgh. Nonetheless, Shrank said the opportunity to offer new benefits going beyond just health care could help beneficiaries stay out of the hospital and lead healthier lives.

Verma did not mention a report last month by the Department of Health and Human Services’ inspector general that found many Advantage plans were improperly denying claims from patients and doctors.

Administration critics were quick to note that omission.

“Her intemperate attack on traditional Medicare — on which two-thirds of all beneficiaries rely and which millions value so highly” — is “striking,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. As is “her utter failure to acknowledge the serious challenges in making Medicare Advantage operate fairly, which her own inspector general underscored.”

Medicare For All? CMS Chief Warns Program Has Enough Problems Already

The Trump administration’s top Medicare official Tuesday slammed the federal health program as riddled with problems that hinder care to beneficiaries, increase costs for taxpayers and escalate fraud and abuse.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS), said those troubles underscore why she opposes calls by many Democrats for dramatically widening eligibility for Medicare, now serving 60 million seniors and people with disabilities, to tens of millions other people.

“We only have to look at some of Medicare’s major problems to know it’s a bad idea,” Verma told health insurance executives at a meeting in Washington.

CMS lacks the authority from Congress to operate the program effectively, Verma said, which means it often pays higher-than-necessary rates to doctors and hospitals and can’t take steps used by private insurers to control costs.

“We face tremendous barriers to supporting and bringing innovation to Medicare, and it literally takes an act of Congress to add new types of benefits for the Medicare population,” she added.

Since Medicare was approved in 1965, Congress has held power over eligibility and benefits — largely to control spending. That has meant efforts to expand services can get weighed down by partisan politics and swayed by lobbying groups, which significantly delay changes. One example: Congress didn’t add a pharmaceutical benefit to Medicare until 2003 — decades after drugs became a mainstay in most treatments.

Advocates for seniors have called for adding vision and dental benefits for many years, but the proposals have gotten little traction because of cost concerns.

Another problem, according to Verma, is that her agency reviews less than 0.2 percent of the more than 1 billion claims that Medicare receives from providers. “That is ridiculously low,” she said.

Verma also lamented the traditional Medicare program’s limited ability to require doctors and hospitals to get prior authorization from the federal government before performing certain procedures. That process — which has been routine for decades in the private sector — can lead to higher improper payments to doctors and more fraud and abuse, she said.

Jonathan Oberlander, a professor in the department of health policy and management at the University of North Carolina-Chapel Hill, agreed with Verma that “Medicare is not always nimble, particularly in adjusting benefits,” and officials have long complained that Congress micromanages the program. Still, he added, “with a program as large and important to Americans as Medicare, it is perfectly appropriate for Congress to weigh in on the addition of new benefits, especially since taxpayers will bear the costs of those changes.”

Verma for months has spoken out against the “Medicare-for-all” proposals pushed by Sen. Bernie Sanders (I-Vt.) and a growing chorus of Democrats. But her 35-minute address to the meeting of the trade group America’s Health Insurance Plans marked the first time she listed the litany of problems with Medicare, which she has run since March 2017.

Proponents of “Medicare-for-all” are reacting to problems caused by the Affordable Care Act, she said, and should know expanding Medicare will worsen the program’s existing challenges of controlling costs and improving care.

“But their solution is literally to do more of what’s not working,” she added. “It’s like the man who has a pounding headache, who then takes a hammer to his head to make it go away.”

Verma’s comments, however, overlooked the key leadership role that Medicare plays in the health sector, which is often emulated by private insurers, Oberlander said.

“In payment reform, Medicare has a record of being a leader and innovator,” he said. “For all of their supposed advantages, private insurers pay much higher prices than Medicare does for medical services. Verma ignores the fact that Medicare’s price regulation has produced substantial savings.”

Although Verma heavily criticized the traditional Medicare program, which covers two-thirds of enrollees, she boasted about how she and the Trump administration were running Medicare Advantage, the fast-growing alternative program that is operated by private insurers such as UnitedHealthcare and Humana.

More than 20 million Medicare beneficiaries are enrolled in these plans, which often cost members less than traditional Medicare and have additional benefits. But they generally require members to use only the plan’s network of providers.

“Medicare Advantage represents value for our beneficiaries and taxpayers,” Verma said.

She touted a 2019 CMS initiative that will for the first time allow the Advantage plans to offer supplemental health benefits that go beyond traditional dental and health services. These include adult day care, in home support services and meals.

It is “one of the most significant changes made to the Medicare program” and “will have a major impact” on improving health for plan members, she said.

But the private plans have taken a cautious approach to adding those benefits.

About 270 Medicare Advantage plans — or fewer than 10 percent of the total — agreed to offer these services next year.

At the AHIP conference on Monday, health insurance executives said they were still trying to figure out which of their members would most likely benefit from the new offerings.

“We are operating in a vacuum of good evidence,” said William Shrank, chief medical officer of UPMC Health Plan in Pittsburgh. Nonetheless, Shrank said the opportunity to offer new benefits going beyond just health care could help beneficiaries stay out of the hospital and lead healthier lives.

Verma did not mention a report last month by the Department of Health and Human Services’ inspector general that found many Advantage plans were improperly denying claims from patients and doctors.

Administration critics were quick to note that omission.

“Her intemperate attack on traditional Medicare — on which two-thirds of all beneficiaries rely and which millions value so highly” — is “striking,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. As is “her utter failure to acknowledge the serious challenges in making Medicare Advantage operate fairly, which her own inspector general underscored.”

Architect Of Maine’s Conservative Reforms To Social Safety Net Tapped For Position Overseeing Medicaid

Mary Mayhew, who was announced as the deputy administrator and director of Medicaid and the Children’s Health Insurance Program, worked previously as Maine’s health commissioner under Gov. Paul LePage, a Republican known as a fierce opponent to Medicaid expansion.

Listen: Health Care Issues Reverberate In The States

Julie Rovner, chief Washington correspondent for Kaiser Health News, joined “1A” host Joshua Johnson, Scott Greenberger, the executive editor of Stateline, and Reid Wilson, national correspondent for The Hill, to discuss health policy initiatives in the states.

Among the topics they examined are Medicaid expansion efforts, work requirements that some states are implementing for Medicaid, efforts to bring down the price of prescription drugs and programs to battle the opioid epidemic. You can listen to the discussion on the “1A” broadcast page.

Listen: Health Care Issues Reverberate In The States

Julie Rovner, chief Washington correspondent for Kaiser Health News, joined “1A” host Joshua Johnson, Scott Greenberger, the executive editor of Stateline, and Reid Wilson, national correspondent for The Hill, to discuss health policy initiatives in the states.

Among the topics they examined are Medicaid expansion efforts, work requirements that some states are implementing for Medicaid, efforts to bring down the price of prescription drugs and programs to battle the opioid epidemic. You can listen to the discussion on the “1A” broadcast page.

Medicare Advantage Riding High As New Insurers Flock To Sell To Seniors

EMBARGOED UNTIL 5 AM., MONDAY, OCT. 15

Health care experts widely expected the Affordable Care Act to hobble Medicare Advantage, the government-funded private health plans that millions of seniors have chosen as an alternative to original Medicare.

To pay for expanding coverage to the uninsured, the 2010 law cut billions of dollars in federal payments to the plans. Government budget analysts predicted that would lead to a sharp drop in enrollment as insurers reduced benefits, exited states or left the business altogether.

But the dire projections proved wrong.

Since 2010, enrollment in Medicare Advantage has doubled to more than 20 million enrollees, growing from a quarter of Medicare beneficiaries to more than a third.

“The Affordable Care Act did not kill Medicare Advantage, and the program looks poised to continue to grow quite rapidly,” said Bill Frack, managing director with L.E.K. Consulting, which advises health companies.

And as beneficiaries get set to shop for plans during open enrollment — which runs from Monday through Dec. 7 — they will find a greater choice of insurers.

Fourteen new companies have begun selling Medicare Advantage plans for 2019, several more than a typical year, according to a report out Monday from the Kaiser Family Foundation. (KHN is an editorially independent part of the foundation.)

Overall, Medicare beneficiaries can choose from about 3,700 plans for 2019, or 600 more than this year, according to the federal government’s Centers for Medicare & Medicaid Services.

CMS expects Medicare Advantage enrollment to jump to nearly 23 million people in 2019, a 12 percent increase. Enrollees shopping for new plans this fall will likely find lower or no premiums and improved benefits, CMS officials say.

With about 10,000 baby boomers aging into Medicare range each day, the general view of the insurance industry, said Robert Berenson, a Medicare expert with the nonpartisan Urban Institute, “is that their future is Medicare and it’s crazy not to pursue Medicare enrollees more actively.”

Bright Health, Clover Health and Devoted Health, all for-profit companies, began offering Medicare Advantage plans for 2018 or will do so for 2019.

Mutual of Omaha, a company owned by its policyholders, is also moving into Medicare Advantage for the first time in two decades, providing plans in San Antonio and Cincinnati.

Some nonprofit hospitals are offering Medicare plans for the first time too, such as the BayCare Health system in the Tampa, Fla., area.

While Medicare beneficiaries in most counties have a choice of several plans, enrollment for years had been consolidated into several for-profit companies, primarily UnitedHealthcare, Humana and Aetna, which have accumulated just under half the national enrollment.

These insurance giants are also expanding into new markets for next year. Humana in 2019 will offer its Medicare HMO in 97 new counties in 14 states. UnitedHealthcare is moving into 130 new counties in 13 states, including for the first time Minnesota, its headquarters for the past four decades.

Extra Benefits

Seniors have long been attracted to Advantage plans because they often include benefits not available with government-run Medicare, such as vision and dental coverage. Many private plans save seniors money because their premiums, deductibles and other patient cost sharing are lower than what beneficiaries pay with original Medicare. But there is a trade-off: The private plans usually require seniors to use a restricted network of doctors and hospitals.

The federal government pays the plans to provide coverage for beneficiaries. When drafting the ACA, Democratic lawmakers targeted the Medicare Advantage plans because studies had shown that enrollees in the private plans cost the government 14 percent more than people in the original program.

Medicare plans weathered the billions in funding cuts in part by qualifying for new federal bonus payments available to those that score a “4” or better on a five-notch scale of quality and customer satisfaction.

Health plans also gained extra revenue by identifying illnesses and health risks of members that would entitle the companies to federal “risk-adjustment” payments. That has provided hundreds of billions in extra dollars to Medicare plans, though congressional analysts and federal investigators have raised concerns about insurers exaggerating how sick their members are.

A study last year found that those risk adjustments could add more than $200 billion to the cost of Medicare Advantage plans in the next decade, despite no change in enrollees’ health.

For-profit Medicare Advantage insurers made a 5 percent profit margin in 2016 — twice the average of Medicare plans overall, according to the Medicare Payment Advisory Commission, which reports to Congress. That’s slightly better than the health insurance industry’s overall 4 percent margin reported by Standard & Poor’s.

Those profit margins could expand. The Trump administration boosted payments to Medicare Advantage plans by 3.4 percent for 2019, 0.45 percentage points higher than the 2018 increase.

Betsy Seals, chief consulting officer for Gorman Health Group, a Washington company that advises Medicare Advantage plans, said many health plans hesitated to enter that market or expand after President Donald Trump was elected because they weren’t sure the new administration would support the program. But such concerns were erased with the announcement on 2019 reimbursement rates.

“The administration’s support of the Medicare Advantage program is clear,” Seals said. “We have seen the downstream impact of this support with new entrants to the market — a trend we expect to see continue.”

Getting Consumers To Switch

Since the 1960s, Mutual of Omaha has sold Medicare Supplement policies — coverage to help beneficiaries in government-run Medicare pay the portion of costs that program doesn’t pick up. But the company only briefly entered the Medicare Advantage business once — in its home state of Nebraska in the 1990s.

“In the past 10 or 20 years it never seemed quite the right time,” said Amber Rinehart, a senior vice president for the insurer. “The main hindrance was around the political environment and funding for Medicare Advantage.”

Yet after watching Medicare Advantage enrollment soar and government funding increase, the insurer has decided now is the time to act. “We have seen a lot more stability of funding and the political tailwinds are there,” she said.

One challenge for the new insurers will be attracting members from existing companies since beneficiaries tend to stick with the same insurer for many years.

Vivek Garipalli, CEO of Clover Health, said his San Francisco-based company hopes to gain members by offering low-cost plans with a large choice of hospitals and doctors and allowing members to see specialists in its network without prior approval from their primary care doctor. The company is also focused on appealing to blacks and Hispanics who have been less likely to join Medicare Advantage.

“We see a lot of opportunity in markets where there are underserved populations,” Garipalli said.

Clover has received funding from Alphabet Inc., the parent company of Google. Clover sold Medicare plans in New Jersey last year and is expanding for 2019 into El Paso, Texas; Nashville, Tenn.; and Savannah, Ga.

Newton, Mass.-based Devoted Health is moving into Medicare Advantage with plans in South Florida and Central Florida. Minneapolis-based BrightHealth is expanding into several new markets including Phoenix, Nashville, Cincinnati and New York City.

BayCare, based in Clearwater, Fla., is offering a Medicare plan for the first time in 2019.

“We think there is enough market share to be had and we are not afraid to compete,” said Jim Beermann, vice president of insurance strategy for BayCare.

Hospitals are attracted to the Medicare business because it gives them access to more of premium dollars directed to health costs, said Frack of L.E.K. Consulting. “You control more of your destiny,” he added.

Must Reads Of The Week From Brianna Labuskes

Just in case our ever-decreasing anonymity in this tech-driven world hasn’t scared you enough, new studies find that within a few years 90 percent — 90 percent! — of Americans of European descent will be identifiable from their DNA. If you fall into that group, it doesn’t even matter whether you’ve given a DNA sample to one of the popular gene-testing sites (like 23andMe). Enough of your distant relatives have, so there’s a good chance you’re in the system.

Take your mind off that by checking out what you may have missed in health care this week.

The biggie, of course, was President Donald Trump’s opinion piece in USA Today about “Medicare-for-all.” (And the rebuttal from Vermont Sen. Bernie Sanders.)

Fact checkers came out in droves to comb through Trump’s arguments and found that nearly every paragraph contained a misleading statement or falsehood.

The Washington Post: Fact-Checking President Trump’s USA Today Op-Ed on ‘Medicare-for-All’

More than shedding any kind of light on the complicated topic, the back-and-forth highlights how much of a role health care is playing in the upcoming midterm elections. Each side has doubled down on its respective talking points (read: preexisting conditions and Medicare-for-all — I warned you you’d get tired of me saying that). In fact, health care is featured so heavily in ads that it trumps the topics of jobs or taxes.

The Wall Street Journal: Health Care Crowds Out Jobs, Taxes in Midterm Ads

(Side note: If you do want some light shed on Medicare-for-all and single-payer systems, check out these great pieces from KHN’s own Shefali Luthra.)

Speaking of midterms, the Democrats’ attempt to block the administration’s expansion of short-term plans (very predictably) failed, with only Maine Republican Sen. Susan Collins joining the Democrats. It was never about winning, though. What it did was force Republicans to go on record with a vote that is potentially politically dangerous in the current landscape.

Politico: Senate Democrats Fail to Block Trump’s Short-Term Health Plans

In stark contrast to the sharply partisan discourse, Trump signed two bipartisan health care measures into law this week. The bills banned “gag clauses” on pharmacists, which had prohibited them from offering consumers cheaper options. The legislation won’t directly affect drug prices, but it might mean people will pay less at the register.

The New York Times: Trump Signs New Laws Aimed at Drug Costs and Battles Democrats on Medicare


For the first time, premiums for the most popular level of insurance sold in the health law marketplaces have gone down. The numbers are the latest sign that the marketplace is stabilizing. (Centene’s expansion into new states is another from this week.) CMS Administrator Seema Verma touted the success, saying the news counters any accusations of sabotage. Health experts, however, said those price tags would have been even lower if not for the administration’s actions over the past year.

The Washington Post: Premiums for Popular ACA Health Insurance Dip for the First Time


The Justice Department approved CVS’ $69 billion merger with Aetna, and although the deal still needs approval from state regulators, the green light is a major hurdle cleared. The merger would reshape the health landscape and mark the end of an era for free-standing pharmacy benefit managers. The potential consolidation is just one of many in recent years in a fast-evolving industry — a trend critics worry will lessen competition and drive up prices for consumers.

The New York Times: CVS Health and Aetna $69 Billion Merger Is Approved With Conditions


Hospitals scrambled to ensure patient safety as Hurricane Michael battered Florida and Georgia this week. “It was like hell,” said one doctor who rode out the storm at Bay Medical Center in Panama City, Fla. The hurricane brought with it memories of last year’s power outages that came with Hurricane Irma and were linked to the deaths of several nursing home residents.

The New York Times: Hospitals Pummeled by Hurricane Michael Scramble to Evacuate Patients


Now that the Brett Kavanaugh battle is over and he’s taken a seat on the Supreme Court, Planned Parenthood has gone into planning mode in case anything happens to Roe v. Wade. A key component of the organization’s plan is to shore up networks in states where abortion would likely remain legal (with longer hours for clinics, for example). On the other side, abortion-rights opponents are getting primed for a new high court that’s likely friendlier to them by strategizing what cases would be best to move forward with.

NPR: With Kavanaugh Confirmed, Both Sides of Abortion Debate Gear Up for Battle

How do you fight measures to expand abortion rights in progressive states? Make it about money. A battle in Oregon illustrates a strategy that — although unlikely to be successful — gives opponents of the bills at least a hope of winning.

Politico: Oregon’s Unlikely Abortion Fight Hinges on Taxes


Holes in the court system have allowed state judges to grant full custody of migrant children to American families — without notifying their parents. Federal officials say it should never happen, but oversight of the problem is scattershot and challenging because states handle adoption proceedings differently.

The Associated Press: Deported Parents May Lose Kids to Adoption

Democrats have been vocal about what they don’t like when it comes to immigration policy. But they have a problem: a lack of cohesion within the party about the correct way forward.

The New York Times: The Democrats Have an Immigration Problem


In the miscellaneous, must-read file:

• A gripping piece takes you into the bowels of a Philadelphia neighborhood dubbed the “Walmart of heroin.” “Drug tourists” come from all over to buy the cheap, pure heroin flowing through the veins of the streets, and some never make it out. (Warning: Make sure you have some time before you start, it will suck you in completely.)

The New York Times: Trapped by the ‘Walmart of Heroin’

• Why were nursing home residents getting extremely pricey therapy in the last weeks of their lives? Bloomberg takes a closer look at these cash-strapped facilities and the questionable decisions made about patients’ rehab.

Bloomberg: Nursing Homes Are Pushing the Dying Into Pricey Rehab

• In good news from the segment of people who were too old to take advantage of the HPV vaccine, the Food and Drug Administration just approved its use for those up to age 45.

The Associated Press: FDA Expands Use of Cervical Cancer Vaccine up to Age 45


As an office of ardent dog lovers, we were distressed to hear the news that therapy dogs in hospitals are little germ machines, leaving behind happiness but also superbugs.

Have a great (hopefully superbug-free) weekend!