Tagged Trump Administration

Want An IUD? Take Note Of Trump’s New Birth Control Policy.

The Trump administration’s recently announced changes to health insurance rules have raised concerns among people wondering how they’ll be affected. This week, I address some of the questions likely on people’s minds.

Q: IUDS are expensive. Will they be unaffordable under the new contraceptive rules announced by the Trump administration? Should people make an appointment to get one now before employers change their minds about coverage?   

There’s probably no need to rush out to your doctor’s office to get an IUD, but you should keep an eye on this issue.

Under the Affordable Care Act, most health plans are required to cover all methods of birth control approved by the Food and Drug Administration without charging women anything for them. Religious employers and some private employers with strong religious objections are exempt from the requirement, but it’s a pretty limited group. Or it was until the Trump administration issued new rules during the first week of October that open the door for many companies or nonprofit organizations with religious or moral objections to contraception to stop offering it.

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“These new exemptions are sweeping,” said Adam Sonfield, a senior policy manager at the Guttmacher Institute, a reproductive health research organization. Essentially any employer will be able to claim an exemption from the birth control coverage requirement, he said, and there are no provisions to appeal it.

What’s not at all clear, however, is how many employers will take advantage of the new rules. The administration said it expected the number to be small, probably just the companies that had brought suit against the old rules.

Even before the ACA passed, women’s health experts note, many plans covered contraception. They didn’t necessarily cover all FDA-approved methods, however, and women typically had to pay a share of the cost.

Several states have laws that protect birth control coverage, said Mara Gandal-Powers, senior counsel at the National Women’s Law Center. Some require that if a plan offers prescription drug coverage, for example, it must cover contraceptives. Others have adopted the ACA rules that require coverage of all FDA-approved methods without cost sharing. But those laws would not apply to employers that pay their employees’ health care claims directly rather than buy state-regulated insurance.

The protection from cost sharing is key, experts say, especially for highly effective methods like the IUD, which might cost $1,000 upfront.

“Even if you’ve met your deductible, if you have 20 percent coinsurance, that’s $200, and for many people that’s not feasible,” Gandal-Powers said.

If your employer does decide to stop providing insurance coverage for contraception, in most cases plans have to give workers 60 days’ notice of the benefit change, giving you time to get that IUD if you decide to.

Q: Association health plans, which the Trump administration is encouraging, seem like kind of a good idea. If more small companies band together, won’t that make coverage cheaper? 

President Donald Trump signed an executive order last week that directs several federal agencies to consider proposing rules that, among other things, would allow more employers to buy health insurance through associations.

If you’re young and healthy, getting coverage through an association health plan might indeed be cheaper. But you’ll likely forgo consumer protections that are required for plans sold on the individual and small-group markets, said Kevin Lucia, a research professor at Georgetown University’s Center on Health Insurance Reforms.

Plans currently sold in those markets have to cover 10 so-called essential health benefits. Association health plans would likely sidestep that requirement. (However, implementing federal rules for these plans will take the administration some time, so it’s not clear if or when they might be expanded.)

“If you don’t cover maternity, mental health or hospitalization, the premiums are going to be lower,” Lucia said.

The administration’s press release about the executive order said that employers couldn’t exclude any employees from joining association health plans or “develop premiums based on health conditions.”

But association health plans have been known to use many strategies to cherry-pick employers with healthy workforces, Lucia said.

“The risk is that each individual small-employer’s rates would be separately determined based on its employees’ medical claims, potentially splitting the market into employers with sicker workers and those whose workers are healthier,” he said.

Q: Short-term plans are cheaper than Obamacare plans. If people don’t have preexisting conditions and are willing to pay the penalty under the law for not having minimum coverage, what’s the downside?

Trump’s executive order that encouraged the expansion of association health plans, discussed above, also aims to expand the availability of short-term plans. Under Obama administration rules, the coverage period of short-term plans was limited to less than three months. This executive order proposes to expand that, perhaps to just under a year.

In addition to not covering preexisting conditions, short-term plans often exclude certain types of coverage, such as prescription drugs and maternity care, and impose dollar limits on coverage. The maximum out-of-pocket spending limits are often higher than coverage in a marketplace plan too.

The potential downside is the possibility that you may develop a medical condition or have an accident that requires expensive medical care while you’re covered under this plan, experts say.

“If the reader has a car accident, the insurer wouldn’t renew the policy,” said Timothy Jost, an emeritus professor of law at Washington and Lee University in Virginia who is an expert on health law. “If coverage is terminated, you’re not eligible for a special enrollment period [on the exchange]. So you could just get marooned.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Insurance, Insuring Your Health, Public Health, The Health Law

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Trump actuando solo: lo que debe saber sobre los cambios a la ley de salud

Aparentemente frustrado por la incapacidad del Congreso de “derogar y reemplazar” la Ley de Cuidado de Salud Asequible (ACA), el presidente Donald Trump decidió tomar el asunto en sus manos.

El jueves 12 de octubre por la noche, la Casa Blanca anunció que cortaría pagos clave a las aseguradoras. Trump firmó una orden ejecutiva destinada a brindar a las personas que compran su propio seguro un acceso más fácil a diferentes planes de salud, que han sido fuertemente regulados o desalentados bajo las reglas de ACA establecidas por la administración Obama.

“Esto está promoviendo la elección de la atención médica y la competencia en todos los Estados Unidos”, dijo Trump en la ceremonia de firma. “Esto va a ser algo en lo que millones y millones de personas se inscribirán, y van a estar muy felices”.

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pagos de subsidios, conocidos como “reducciones de costos compartidos”, son pagos a las aseguradoras para reembolsarles por los descuentos que brindan a los asegurados con ingresos inferiores al 250% del nivel federal de pobreza, o alrededor de $30,000 en ingresos anuales para un individuo. Esos descuentos protegen a estos clientes de bajos y medianos ingresos de tener fuertes gastos de bolsillo, como deducibles o copagos. Estos subsidios han sido objeto de una demanda en curso.

Las reducciones de costos compartidos no son lo mismo que los subsidios a través de créditos impositivos, que ayudan a millones de personas a pagar sus primas. Estos no están afectados por la decisión de Trump.

Las acciones de Trump podrían tener un impacto inmediato en la inscripción para tener cobertura a través de ACA en 2018, cuyo período de inscripción comienza el 1 de noviembre. Aquí hay cinco cosas que debe saber.

  1. La orden ejecutiva no genera ningún cambio inmediato.

Técnicamente, Trump ordenó a los departamentos de Trabajo, de Salud y Servicios Humanos, y del Tesoro, dentro de 60 días, “considerar proponer reglamentos o revisar guías, en la medida permitida por la ley” sobre varias opciones diferentes para expandir los tipos de planes que individuos y pequeñas empresas pueden comprar. Entre sus sugerencias están ampliar las reglas para permitir que más pequeños empleadores y otros grupos formen lo que se conoce como “planes de salud de asociaciones” y para vender seguros de bajo costo y de corto plazo. Sin embargo, no hay ninguna garantía de que cualquiera de estos planes se presentará y, en cualquier caso, el proceso para ponerlos a disposición podría demorar meses.

  1. Los cambios en la reducción de costos compartidos SON inmediatos, pero podrían no afectar a tantas personas.

los pagos a las aseguradoras por los descuentos de bolsillo que brindan a los asegurados de ingresos moderados no significa que esas personas ya no recibirán ayuda. La ley y los contratos de las compañías de seguros con el gobierno federal exigen que se otorguen esos descuentos.

Eso significa que las compañías de seguros tendrán que averiguar cómo recuperar el dinero que se les prometió. Podrían (y muchos ya lo están haciendo) aumentar las primas. Para la mayoría de las personas que obtienen los subsidios por separado para ayudar a pagar sus primas, esos aumentos serán solventados por el gobierno federal. Los que se verán más afectados son las aproximadamente 7.5 millones de personas que compran su propio seguro individual, pero ganan demasiado para obtener ayuda federal para pagar por su cobertura.

Las aseguradoras también podrían abandonar ACA por completo. Eso impactaría a todos en el mercado individual y podría dejar algunos condados sin aseguradora para el próximo año. Las aseguradoras también podrían demandar al gobierno, y la mayoría de los expertos creen que eventualmente ganarían.

  1. Esto podría afectar las opciones de seguros para el próximo año. Pero es complicado.

El impacto en las primas para el próximo año variará según el estado y la aseguradora. Por un lado, las aseguradoras tienen una laguna jurídica que les permite salir de los contratos para 2018 dado el cambio en los pagos federales, por lo que algunos podrían decidir salir del mercado. Eso podría dejar áreas con menos aseguradoras, o sin ninguna. En agosto, la Oficina de Presupuesto (CBO) del Congreso estimó que detener los pagos dejaría a cerca del 5% de las personas que compran su propia cobertura a través de los mercados de ACA sin aseguradoras en 2018.

Para todos los demás, la medida daría como resultado primas más altas, dijo la CBO, agregando un promedio de alrededor del 20%. En algunos estados, los reguladores ya han permitido a las aseguradoras aumentar los precios en 2018 previendo esta acción de Trump de frenar los pagos.

Pero cómo se aplican esos aumentos varía. En California, Idaho, Louisiana, Pennsylvania y Carolina del Sur, por ejemplo, los reguladores hicieron que las aseguradoras cargaran los costos solo en un tipo de plan: el de nivel plata. Esto se debe a que la mayoría de las personas que compran planes plata también obtienen un subsidio del gobierno federal para ayudar a pagar su prima, y esos subsidios aumentan junto con el costo de un plan de plata.

Sin embargo, los consumidores que obtienen un subsidio no verán mucho aumento en sus gastos de bolsillo para la cobertura. Los consumidores sin subsidios tendrán los costos adicionales si se quedan en un plan de plata. En esos estados, los consumidores pueden encontrar un mejor negocio en en una franja de planes, incluidos planes de oro de alto nivel. Sin embargo, muchos estados permitieron a las aseguradoras repartir el aumento esperado en todos los niveles de los planes.

  1. El Congreso podría actuar.

Se han renovado las negociaciones bipartidistas entre los senadores Lamar Alexander (republicano de Tennessee) y Patty Murray (demócrata de Washington) para crear una legislación que continúe con los subsidios para compartir costos y otorgue a los estados más flexibilidad para desarrollar y vender planes menos generosos de atención médica que las que actualmente se ofrecen en los mercados. La decisión de Trump de poner fin a los subsidios de participación en los costos puede reforzar esas discusiones.

En un comunicado, Murray llamó a la acción de Trump para retirar los subsidios de participación en los costos “imprudente”, pero dijo que continúa “siendo optimista sobre nuestras negociaciones y creemos que podemos llegar a un acuerdo rápidamente. Insto a los líderes republicanos en el Congreso esta vez hacer lo correcto para las familias apoyando nuestro trabajo”.

El presidente Trump instó el viernes a los demócratas a que trabajen con él para “llegar a un acuerdo” sobre la atención de salud. “Ahora bien, si los demócratas fueran inteligentes, lo que harían sería venir a negociar algo para que las personas realmente pudieran obtener el tipo de atención médica que merecen, siendo ciudadanos de nuestro gran país”, dijo el viernes por la tarde.

El viernes 6, el líder de la mayoría del Senado Chuck Schumer (demócrata de Nueva York) no parecía estar de humor para cerrar un trato.

“Los republicanos han estado haciendo todo lo posible durante los últimos diez meses para inyectar inestabilidad en nuestro sistema de atención médica y forzar el colapso a través del sabotaje”, dijo en un comunicado.

Una encuesta publicada el viernes 13 de octubre por la Kaiser Family Foundation muestra que el 71% del público prefiere que la administración Trump trate de hacer que la ley funcione en lugar de acelerar el reemplazo alentando su fracaso. La encuesta se llevó a cabo antes de que Trump hiciera su anuncio sobre los subsidios. (KHN es un programa editorial independiente de la fundación).

          5. Algunos estados están demandando, pero el resultado es difícil de adivinar.

A pesar que todos los estados regulan sus propios mercados de seguros, los estados tienen opciones limitadas para lidiar con el último movimiento de Trump. Dieciséis estados y el Distrito de Columbia, encabezados por Nueva York y California, están demandando a la administración Trump para defender los subsidios para los costos compartidos. Pero no está claro si un tribunal federal podría decir que la administración Trump está obligada a continuar haciendo los pagos mientras el caso está pendiente.

Diane Webber contribuyó con este informe.

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

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Trump Acting Solo: What You Need To Know About Changes To The Health Law

Apparently frustrated by Congress’ inability to “repeal and replace” the Affordable Care Act, President Donald Trump this week decided to take matters into his own hands.

Late Thursday evening, the White House announced it would cease key payments to insurers. Earlier on Thursday, Trump signed an executive order aimed at giving people who buy their own insurance easier access to different types of health plans that were limited under the ACA rules set by the Obama administration.

“This is promoting health care choice and competition all across the United States,” Trump said at the signing ceremony. “This is going to be something that millions and millions of people will be signing up for, and they’re going to be very happy.”

The subsidy payments, known as “cost-sharing reductions,” are payments to insurers to reimburse them for discounts they give policyholders with incomes under 250 percent of the federal poverty line, or about $30,000 in income a year for an individual. Those discounts shield these lower-income customers from out-of-pocket expenses, such as deductibles or copayments. These subsidies have been the subject of a lawsuit that is ongoing.

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The cost-sharing reductions are separate from the tax credit subsidies that help millions of people pay their premiums. Those are not affected by Trump’s decision.

Some of Trump’s actions could have an immediate effect on the enrollment for 2018 ACA coverage that starts Nov. 1. Here are five things you should know.

1. The executive order does not make any immediate changes.

Technically, Trump ordered the departments of Labor, Health and Human Services and Treasury within 60 days to “consider proposing regulations or revising guidance, to the extent permitted by law,” on several different options for expanding the types of plans individuals and small businesses could purchase. Among his suggestions to the department are broadening rules to allow more small employers and other groups to form what are known as “association health plans” and to sell low-cost, short-term insurance. There is no guarantee, however, that any of these plans will be forthcoming. In any case, the process to make them available could take months.

2. The cost-sharing reduction changes ARE immediate but might not affect the people you expect.

Cutting off payments to insurers for the out-of-pocket discounts they provide to moderate-income policyholders does not mean those people will no longer get help. The law, and insurance company contracts with the federal government, require those discounts be granted.

That means insurance companies will have to figure out how to recover the money they were promised. They could raise premiums (and many are raising them already). For the majority of people who get the separate subsidies to help pay their premiums, those increases will be borne by the federal government. Those who will be hit hardest are the roughly 7.5 million people who buy their own individual insurance but earn too much to get federal premium help.

Insurers could also simply drop out of the ACA entirely. That would affect everyone in the individual market and could leave some counties with no insurer for next year. Insurers could also sue the government, and most experts think they would eventually win.

Facebook Live: Trump Ends Payments For Cost-Sharing Reductions. What’s Next?

3. This could affect your insurance choices for next year. But it’s complicated.

The impact on your plan choices and premiums for next year will vary by state and insurer. For one thing, insurers have a loophole that allows them to get out of the contracts for 2018, given the change in federal payments. So, some might decide to bail. That could leave areas with fewer — or no — insurers. The Congressional Budget Office in August estimated that stopping the payments would leave about 5 percent of people who purchase their own coverage through the ACA marketplaces with no insurers in 2018.

For everyone else, the move would result in higher premiums, the CBO said, adding an average of about 20 percent. In some states, regulators have already allowed insurers to price those increases into their 2018 rates in anticipation that the payments would be halted by the Trump administration.

But how those increases are applied varies. In California, Idaho, Louisiana, Pennsylvania and South Carolina, for example, regulators had insurers load the costs only onto one type of plan: silver-level coverage. That’s because most people who buy silver plans also get a subsidy from the federal government to help pay their premium, and those subsidies rise along with the cost of a silver plan.

Consumers getting a premium subsidy, however, won’t see much increase in their out-of-pocket payments for the coverage. Consumers without premium subsidies will bear the additional costs if they stay in a silver plan. In those states, consumers may find a better deal in a different metal-band of insurance, including higher-level gold plans. Many states, however, allowed insurers to spread the expected increase across all levels of plans.

4. Congress could act.

Bipartisan negotiations have been renewed between Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to create legislation that would continue the cost-sharing subsidies and give states more flexibility to develop and sell less generous health care plans than those currently offered on the exchanges. Trump’s move to end the cost-sharing subsidies may bolster those discussions.

In a statement, Murray called Trump’s action to withdraw cost-sharing subsidies “reckless” but said she continues “to be optimistic about our negotiations and believe we can reach a deal quickly — and I urge Republican leaders in Congress to do the right thing for families this time by supporting our work.”

Trump on Friday urged Democrats to work with him to “make a deal” on health care. “Now, if the Democrats were smart, what they’d do is come and negotiate something where people could really get the kind of healthcare that they deserve, being citizens of our great country,” he said Friday afternoon.

Earlier Friday, Senate Minority Leader Chuck Schumer (D-N.Y.) did not sound as if he was in the mood to cut a deal.

“Republicans have been doing everything they can for the last ten months to inject instability into our health care system and to force collapse through sabotage,” he said in a statement. “Republicans in the House and Senate now own the health care system in this country from top to bottom, and their destructive actions, and the actions of the president, are going to fall on their backs. The American people see it, and they know full well which party is doing it.”

A poll released Friday by the Kaiser Family Foundation shows that 71 percent of the public said they preferred that the Trump administration try to make the law work rather than to hasten replacement by encouraging its failure. The poll was conducted before Trump made his announcement about the subsidies. (Kaiser Health News is an editorially independent program of the foundation.)

5. Some states are suing, but the outcome is hard to guess.

Even though all states regulate their own insurance markets, states have limited options for dealing with Trump’s latest move. Eighteen states and the District of Columbia, led by New York and California, are suing the Trump administration to defend the cost-sharing subsidies. But it is unclear whether a federal court could say that the Trump administration is obligated to continue making the payments while that case is pending. 

Diane Webber contributed to this report.

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

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Facebook Live: Trump Ends Payments For Cost-Sharing Reductions. What’s Next?

President Donald Trump has followed through on a long-standing threat. His administration announced late Thursday it will halt federal payments for the Affordable Care Act’s cost-sharing reductions. This is the latest blow to the stability of the ACA’s insurance marketplaces, and it is triggering significant confusion among consumers and insurers. This live chat features KHN senior correspondent Jay Hancock answering questions about what it might mean for the upcoming open enrollment period and beyond.

For more in-depth conversations with KHN reporters, check out our Facebook video archive.

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While Trump Moves to Dismantle Health Law, Public Favors Repair

President Donald Trump has collided with a wave of public disagreement by moving to strip the Affordable Care Act of provisions intended to keep insurance prices stable.

In a poll conducted before Trump’s Thursday announcement of unilateral changes to the law, 71 percent of the public said they preferred the administration try to make the law work rather than to hasten replacement by encouraging its failure. Even Republicans, by a small margin, favored a more conciliatory approach to the law, according to the poll from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Trump took the opposite tact Thursday, in the wake of Congress’ failure to replace the 2010 law. He announced two actions that are likely to disrupt the insurance markets for people who buy their policies on their own rather than through their employers.

First, he ordered the government to allow associations of small employers or other membership groups to band together and offer their own insurance that would not have to provide all the types of coverage required under the health law. That same executive order also directs officials to loosen rules for low-cost, short-term health insurance.

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Trump argues these changes would give consumers cheaper coverage options, while many health care experts fear it could shift insurance markets back toward their pre-ACA configuration, when healthy people paid less but people with medical conditions often found coverage unaffordable.

Second, Trump ordered the government to stop paying insurers subsidies that allowed low-income people to avoid out-of-pocket medical costs that otherwise this year can be as high as $7,150 for individuals and $14,300 for families. Those insurance subsidies, technically known as cost-sharing reductions, or CSRs, had been embroiled in a legal and political battle between former President Barack Obama and Republicans over whether Congress had authorized the president to pay them.

The foundation’s poll, conducted Oct. 5-10, found that 60 percent of the public thought Congress should guarantee that these payments continue. A majority of Republicans, however, considered them bailouts of insurance companies and should cease.

The poll found that 69 percent of the public favored broader bipartisan congressional compromise to continue the payments — as most Democrats desire — in exchange for allowing states to have greater (but unspecified) flexibility in what kind of plans could be sold on their marketplaces, as Republicans generally favor. Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have been trying to forge a deal to stabilize insurance markets that could draw support from both parties. The poll found that support for a compromise was equally strong among independents and members of both political parties.

The poll found no such comity in the views of most other issues relating to the health law. Democrats overwhelmingly want Trump and Congress to work together to stabilize the marketplaces, while Republicans by a narrow margin prefer lawmakers resuscitate efforts to replace the law. A majority of Republicans (56 percent) are confident Trump and Congress can work together on improving health care, while only 1 in 7 Democrats (14 percent) think so. Independents leaned toward the Democrats’ skepticism.

Even before Trump’s actions Thursday, 66 percent of Democrats thought his approach was undermining the insurance markets, but only 12 percent of Republicans thought so. Among independents, 41 percent thought Trump was hurting the markets.

The poll found similar partisan divides on many of the other current debates over the law, including whether the government should fine people who do not obtain insurance and whether the federal government should spend less on advertisements encouraging people to sign up for coverage.

The federal enrollment period for 2018 coverage begins Nov. 1 and runs through Dec. 15.

The telephone poll included 1,215 adults. Its margin of error is plus or minus 3 percentage points for the full sample.

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

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Podcast: ‘What The Health?’ Let’s Blow It All Up

With Congress having given up on repealing and replacing the Affordable Care Act, at least for now, President Trump stepped in to try to make some changes himself.

On Thursday he signed an executive order aimed at making insurance cheaper for some people, but in ways that could make it more expensive for others.

And late Thursday night the White House announced it would no longer pay insurance companies money they are owed for providing discounts to policyholders who earn less than 250 percent of poverty. Those “cost-sharing reductions” have been the subject of a long-running lawsuit filed by the U.S. House of Representatives against the Obama Administration.

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Margot Sanger-Katz of The New York Times, and Julie Appleby of Kaiser Health News discuss these issues, as well as the recent rules making it easier for employers with religious or moral objections to stop offering birth control as part of their employee health plans.

Among their observations:

  • More than half of people buying insurance through the federal health law’s marketplaces get the cost-sharing subsidies. But they will still get the subsidies–it’s their insurance companies that will feel the pain.
  • Consumers should carefully consider any insurance options that come out of the president’s earlier announcement Thursday to expand the types of policies available. Some of them may not offer the kinds of protection that consumers have come to expect after the passage of the federal health law.
  • And the administration’s effort to offer more exemptions to employers who do not want to offer birth control at no cost to women is unlikely to lead to a lot of companies reinstating copayments, but some may cut back on the number of contraceptive options they cover.

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

Julie Rovner: Statnews.com’s “An old-school pharmacy hand-delivers drugs to Congress, a little-known perk for the powerful,” by Erin Mershon; and Statnews.com’s, “The pharmacists to Congress has something to say about that Alzheimer’s remark,” by Erin Mershon.

Sarah Kliff: Vox.com’s podcast, “The Impact,” hosted by Sarah Kliff.

Margot Sanger-Katz: “The Constitution Finally Takes Precedence over Obamacare,” by Chris Jacobs.

Julie Appleby: Vox.com’s “Everything that’s been reported about deaths in Puerto Rico is at odds with the official count,” by Eliza Barclay and Alexia Fernandez Campbell; and Vice.com’s “Not Even Hospitals in Puerto Rico Know How Many People Have Died,” by Alexa Liautaud.

To hear all our podcasts, click here.

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

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Podcast: ‘What The Health?’ Let’s Blow It All Up

With Congress having given up on repealing and replacing the Affordable Care Act, at least for now, President Trump stepped in to try to make some changes himself.

On Thursday he signed an executive order aimed at making insurance cheaper for some people, but in ways that could make it more expensive for others.

And late Thursday night the White House announced it would no longer pay insurance companies money they are owed for providing discounts to policyholders who earn less than 250 percent of poverty. Those “cost-sharing reductions” have been the subject of a long-running lawsuit filed by the U.S. House of Representatives against the Obama Administration.

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Margot Sanger-Katz of The New York Times, and Julie Appleby of Kaiser Health News discuss these issues, as well as the recent rules making it easier for employers with religious or moral objections to stop offering birth control as part of their employee health plans.

Among their observations:

  • More than half of people buying insurance through the federal health law’s marketplaces get the cost-sharing subsidies. But they will still get the subsidies–it’s their insurance companies that will feel the pain.
  • Consumers should carefully consider any insurance options that come out of the president’s earlier announcement Thursday to expand the types of policies available. Some of them may not offer the kinds of protection that consumers have come to expect after the passage of the federal health law.
  • And the administration’s effort to offer more exemptions to employers who do not want to offer birth control at no cost to women is unlikely to lead to a lot of companies reinstating copayments, but some may cut back on the number of contraceptive options they cover.

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

Julie Rovner: Statnews.com’s “An old-school pharmacy hand-delivers drugs to Congress, a little-known perk for the powerful,” by Erin Mershon; and Statnews.com’s, “The pharmacists to Congress has something to say about that Alzheimer’s remark,” by Erin Mershon.

Sarah Kliff: Vox.com’s podcast, “The Impact,” hosted by Sarah Kliff.

Margot Sanger-Katz: “The Constitution Finally Takes Precedence over Obamacare,” by Chris Jacobs.

Julie Appleby: Vox.com’s “Everything that’s been reported about deaths in Puerto Rico is at odds with the official count,” by Eliza Barclay and Alexia Fernandez Campbell; and Vice.com’s “Not Even Hospitals in Puerto Rico Know How Many People Have Died,” by Alexa Liautaud.

To hear all our podcasts, click here.

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

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Facebook Live: Things To Know About Trump’s Directive On Health Insurance

The executive order that President Donald Trump signed Thursday touches on a range of GOP policy approaches — such as association health plans and short-term health insurance policies, among other things. This live chat features KHN senior correspondent Julie Appleby answering questions about how implementing these ideas could alter the current health insurance marketplace.

For more in-depth conversations with KHN reporters, check out our Facebook video archive.

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

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Facebook Live: Things To Know About Trump’s Directive On Health Insurance

The executive order that President Donald Trump signed Thursday touches on a range of GOP policy approaches — such as association health plans and short-term health insurance policies, among other things. This live chat features KHN senior correspondent Julie Appleby answering questions about how implementing these ideas could alter the current health insurance marketplace.

For more in-depth conversations with KHN reporters, check out our Facebook video archive.

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

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Trump’s Order Advances GOP Go-To Ideas To Broaden Insurance Choices, Curb Costs

Note: This story was last updated at 12:28 p.m. ET to reflect additional information from administration officials and other comments.

The Trump administration Thursday advanced a wide-ranging executive order aimed at expanding lower-cost insurance options, allowing employers to give workers money to buy their own coverage and slowing consolidation in the insurance and hospital industries.

Critics said that, if implemented, the changes could result in more bare-bones coverage and pull healthier people out of the already struggling insurance markets, leading to higher premiums for those who remain in more-regulated coverage.

President Donald Trump’s action, which will not take effect in time to affect the upcoming open enrollment for coverage in 2018, signals a shift in the administration’s strategy, which relied on Congress to repeal the Affordable Care Act. Trump is now using the force of his executive rule-making authority to implement long-favored GOP policy alternatives.

“With Congress the way it is, I decided to take it upon myself,” Trump said in remarks at the White House earlier in the week. Senate Republicans failed within recent months to pass legislation to overhaul the ACA.

The executive order directs many agencies, including the Department of Labor, to consider proposing rules or new guidance to loosen current restrictions on what are called “association health plans” and on selling low-cost, short-term insurance.

Such rules could potentially exempt such plans for a number of the requirements of the Affordable Care Act.

This order will “help millions of Americans who have been harmed by Obamacare,” said Andrew Bremberg,  director of the Domestic Policy Council, who briefed the press.

The directive also instructs agencies to consider new regulations or guidance to:

  • Permit the practice of providing a tax-free employer contributions through health reimbursement accounts that workers could use to buy individual market plans. The Obama administration had barred that practice. This adjustment might result in more employers dropping job-based coverage and simply giving workers money to buy their own plans.
  • Report on steps federal and state governments could take to “increase choice and reduce consolidation” in the health care market. A senior administration official said Trump is concerned about the growing number of regions served by only one or two insurers or hospital systems.

Facebook Live Explainer: Things To Know About Trump’s Directive On Health Insurance

The Pros And The Cons

Associations are generally membership groups based on a profession or business. Proponents say allowing consumers to buy insurance through these organizations gives them more clout with insurers than they’d have buying their own plan on the individual market — and results in lower premiums.

But the real savings in premiums is likely to come because the policies could offer fewer benefits than more regulated ACA plans, and the associations would have more leeway to set premiums based on the health of the group.

Trump’s order is likely to please some groups, including the National Federation of Independent Business. This organization has long supported association health plans, which it says allow small businesses to buy coverage across state lines.

Not all small businesses back association health plans, though, or the idea that they need help banding together to buy coverage.

“The truth is, that’s how they get insurance today and it’s called the small group market. Every state has one,” said David Chase, spokesman for Small Business Majority, a group that supports the ACA.

“What association plans would do is actually pull people out of those small group pools and start a bunch of new pools. That doesn’t band people together,” he added.

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Critics also warn that such plans, with pared-down coverage and lower premiums, could siphon off the healthiest consumers. Older, sicker people would be left to seek health insurance through more regulated plans available through state and federal insurance marketplaces. That could cause premiums to rise more rapidly for those groups.

The combination of allowing less-regulated association plans, making it easier for employers to send workers to buy their own coverage and making short term plans more broadly available “is a concerted effort to undermine the individual market” by drawing out the healthiest consumers, said Kevin Lucia, a research professor at Georgetown’s Health Policy Institute.

Still, some employers now sitting on the sidelines might end up adding workers to that pool, countered Chris Condeluci, a Washington, D.C., attorney who previously worked for Sen. Chuck Grassley (R-Iowa) and served as counsel to the U.S. Senate Finance Committee during the drafting of the ACA.

“Some will want to give workers a chunk of change to make sure they get coverage, but not be in the game of sponsoring a [group] plan themselves,” said Condeluci.

Administration officials said Thursday that they had not studied the effect of the changes on the marketplace but might do so in the future.

Some consumer advocates also warn that association plans and short-term policies are generally less generous with benefits — and could leave some unwary consumers stuck with large medical bills. Such plans might not cover maternity care, for example, or prescription drugs.

Additionally, short-term plans can exclude paying for any preexisting medical conditions, either upfront or upon renewal, something the ACA bars for all other types of insurance.

Legal challenges to the executive order could result from these issues.

For one thing, policy experts question whether the Trump administration can allow associations broad leeway to sign up individuals, rather than following the Obama administration’s strict definition of “rare instances” in which an association would qualify as an employer offering group coverage.

Trump administration officials said that issue would be studied as part of the consideration around setting new rules, but that the law may allow self-employed individuals to join associations.

Associations want to be designated as a large group because a complex mix of laws cover employment-based insurance coverage, and rules can differ from those governing small-group or individual coverage.

Large-group plans need not cover all 10 of the ACA’s “essential health benefits,” which include things like hospitalization, drug coverage, maternity care and substance abuse treatment.

They would have to follow other rules, however, such as the ban on setting annual or lifetime limits and the rule allowing parents to keep their children on the policy until age 26.

But insurers could vary premiums for large groups based on medical claims history of the overall group, so younger, healthier groups would likely get lower premiums.

In the individual market, insurers cannot base a premium on a policyholder’s health.

A Speckled Past

Association health plans are not new. They’ve been around for decades, and Republicans have traditionally eyed them as a means to make it easier for small businesses and individuals to band together to buy insurance.

In the past, though, some had solvency problems and went bankrupt, leaving consumers on the hook with unpaid medical bills.

In several states, regulators investigated whether the plans were advertising that they had comprehensive coverage when, in fact, they provided little or no coverage for such things as chemotherapy or doctor office visits.

The ACA answered some of those concerns by setting minimum standards for coverage on most insurance policies, including association plans, which prevent them from skimping on such things as doctor visits or prescription drugs.

Their numbers fell after the sweeping law went into effect.

Meanwhile, the Trump proposal also would allow people to buy short-term plans that last up to 364 days, overturning an Obama administration rule limiting short-term policies to 90 days.

Advocates of the change have always argued that this limit simply meant people had to renew more often — and then face their deductibles all over again.

But How Will Associations Plans Fare?

Joe Antos, at the conservative American Enterprise Institute, questions how popular such plans would be with both consumers and insurers.

“The people on the left who say this will doom the exchange marketplace are, as usual, exaggerating the likely effects of this,” said Antos.

That’s because many of the approximately 9 million people who currently buy coverage through federal or state insurance marketplaces get a premium subsidy to help them purchase. They are unlikely to switch from that, he said.

The main group that it would appeal to are the additional 10 million or so who buy coverage because they don’t get it through their jobs, and don’t get a subsidy.

Key will be just what the plans cover — and what they exclude.

“They’ll only be attracted if these association plans actually provide them coverage they want at a price that is better than the exchange plans,” said Antos.

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Trump’s Order Advances GOP Go-To Ideas To Broaden Insurance Choice, Hold Down Costs

President Donald Trump planned Thursday to move forward in changing U.S. health care by signing an executive order aimed at expanding low-cost insurance options, which critics say will leave some with skimpy coverage and hurt already-struggling insurance markets.

This step would signal a shift in the administration’s strategy, which relied on Congress to repeal the Affordable Care Act. Trump is now using the force of his executive rule-making authority to implement long-favored GOP policy alternatives.

“With Congress the way it is, I decided to take it upon myself,” Trump said in remarks at the White House earlier in the week. Senate Republicans failed within recent months to bring up legislation to overhaul the ACA.

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In Thursday’s directive, Trump is expected to loosen rules around policies sold through “associations,” which can be for instance, professional-affiliation groups.

While details are sparse, it could effectively exempt more insurance plans from a number of ACA requirements.

The order also will likely instruct regulators to allow insurers greater leeway in selling low-cost, short-term insurance that can exclude coverage of policyholders’ preexisting medical conditions.

“A big percentage of people will be able to get health care,” Trump said, “and it will not cost our country anything, but they’ll have great, great health insurance again.”

The Pros And The Cons

Proponents say allowing small businesses and possibly self-employed people to buy insurance through associations gives them more clout with insurers than buying their own plan on the individual market — and results in lower premiums.

But the real savings in premiums is likely to come because the policies could offer fewer benefits than more regulated ACA plans, and the associations would have more leeway to set premiums based on the health of the group.

Trump’s order is likely to please some groups, including the National Federation of Independent Business. This organization has long supported association health plans, which they say allows small businesses to buy coverage across state lines.

Critics warn that such plans, with pared-down coverage and lower premiums, could siphon off the healthiest consumers. Older, sicker people would be left to seek health insurance through more regulated plans available through state and federal insurance marketplaces. That could cause premiums to rise more rapidly for those groups.

Some consumer advocates also warn that association plans and short-term policies are generally less generous with benefits – and could leave some unwary consumers stuck with large medical bills. Such plans might not cover maternity care, for example, or prescription drugs.

Additionally, short-term plans can exclude paying for any preexisting medical conditions, either upfront or upon renewal, something the ACA bars for all other types of insurance.

Legal challenges to the executive order could result from these issues.

For one thing, policy experts question whether the Trump administration can allow associations broad leeway to sign up individuals, rather than following the Obama administration’s strict definition of “rare instances” in which an association would qualify as an employer offering group coverage.

That distinction is important because a complex mix of laws cover employment-based insurance coverage, and rules can differ from those governing small-group or individual coverage.

It could be challenging “for them to extend [this coverage] to individuals who are not associated with an employer group,” said Kevin Lucia, a research professor at Georgetown’s Health Policy Institute.

Associations prefer to be viewed as employers offering large-group coverage because then their polices need not cover all 10 of the ACA’s “essential health benefits,” which include things like hospitalization, drug coverage, maternity care and substance abuse treatment.

Insurers can also vary premiums for large groups based on medical claims history of the overall group, so younger, healthier groups would likely get lower premiums.

In the individual market, insurers cannot base a premium on a policyholder’s health.

A Speckled Past

Association health plans are not new. They’ve been around for decades, and Republicans have traditionally eyed them as a means to make it easier for small businesses and individuals to band together to buy insurance.

In the past, though, some had solvency problems and went bankrupt, leaving consumers on the hook with unpaid medical bills.

In several states, regulators investigated whether the plans were advertising that they had comprehensive coverage when, in fact, they provided little or no coverage for such things as chemotherapy or doctor office visits.

The ACA answered some of those concerns by setting minimum standards for coverage on most insurance policies, including association plans, which prevents them from skimping on such things as doctor visits or prescription drugs.

Their numbers fell after the sweeping law went into effect.

Meanwhile, the Trump proposal also would allow people to buy short-term plans that last up to 364 days, overturning an Obama administration rule limiting short-term policies to 90 days.

Advocates of the change have always argued that this limit just meant people had to renew more often — and then face their deductibles all over again.

But How Will Associations Plans Fare?

Joe Antos, at the conservative American Enterprise Institute, questions how popular such plans would be with both consumers and insurers.

“The people on the left who say this will doom the exchange marketplace are, as usual, exaggerating the likely effects of this,” said Antos.

That’s because many of the approximately 9 million people who currently buy coverage through federal or state insurance marketplaces get a premium subsidy to help them purchase. They are unlikely to switch from that, he said.

The main group that it would appeal to are the additional 10 million or so who buy coverage because they don’t get it through their jobs, and don’t get a subsidy.

Key will be just what the plans cover — and what they exclude.

“They’ll only be attracted if these association plans actually provide them coverage they want at a price that is better than the exchange plans,” said Antos.

Critics of ACA rules requiring policies to cover maternity care or mental health conditions have always cited these dictates as a reason for high premiums. Antos noted, though, that those costs pale when compared with the expense of what most people want, such as coverage for hospitalization.

“That’s really expensive,” said Antos. “But no one wants coverage that excludes hospitalization.”

So, insurers — if they even want to back association coverage — may end up offering coverage “that will look a lot like the exchange plans,” Antos said.

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