Tagged U.S. Congress

Americans Eager For Leaders To Cooperate To Make Health Law Work

Move on.

That’s what most people say Congress and the Trump administration should do after the Senate failed to approve legislation in July to  revamp the Affordable Care Act, according to a survey this month.

Nearly 8 in 10 Americans say President Donald Trump should be trying to make the health law work, according to poll conducted by the Kaiser Family Foundation. This includes large majorities of Democrats (95 percent) as well as half of Republicans (52 percent) and President Trump’s supporters (51 percent). (Kaiser Health News is an editorially independent program of the foundation.)

Almost 6 in 10 people think the Republicans should work with Democrats to improve the health law.

Only 17 percent of the public — and 40 percent of Republicans — think the Trump administration should take steps to make the health law fail, the survey said.

Trump has threatened to end funding to insurers to cover cost-sharing subsidies that cover the out-of-pocket health expenses for millions of low-income people buying coverage on the Obamacare exchanges. Insurers say such a move would force them to leave the health law marketplaces or raise premiums. Nearly two-thirds of the public oppose the president’s negotiating tactics, the survey said.

Just 21 percent of respondents — but 49 percent of Republicans — want the GOP to continue working on a plan to repeal and replace Obamacare, the survey said.

The GOP-controlled Senate failed to pass a health bill before it left for a summer break last week. The House in May passed a bill to partially repeal the law and drastically cut Medicaid.

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About 60 percent of people says that Trump and congressional Republicans are responsible for any problems with the health law. Trump has said the public will blame Democrats for any problems.

The health law is more popular than ever with 52 percent of respondents saying they hold a favorable view of it.  There has been a 9-percentage-point increase in people who hold a favorable view since November.

Still, confusion about the law remains.

Even though only about 10 million people receive coverage through the marketplaces, about 60 percent of Americans believe that their family will be negatively affected by rising premiums in the marketplaces.

The same number of people say that insurers’ decisions not to sell insurance plans in certain marketplaces will affect everyone with insurance. Marketplace coverage affects only those buying individual insurance — not  those who get job-based plans or Medicare or Medicaid.

The poll of 1,211 adults was conducted Aug. 1- 6.The margin of sampling error is plus or minus 3 percentage points.

Categories: Repeal And Replace Watch, The Health Law

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Podcast: ‘What The Health?’ No Vacation For Insurers

Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of Vox.com and Margot Sanger-Katz of The New York Times discuss the state of the individual health insurance markets in the wake of the failure (for now) of Congress’ efforts to repeal and replace the Affordable Care Act.

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

Julie Rovner: The Nation’s “Medicare-for-All Isn’t the Solution for Universal Health Care,” by Joshua Holland.

Joanne Kenen: NPR’s “Your ZIP Code Might Be As Important To Your Health As Your Genetic Code,” by Kristian Foden-Vencil.

Sarah Kliff: The Washington Post’s  “Trump administration won’t answer questions about Obamacare enrollment,” by Paige Winfield Cunningham.

Margot Sanger-Katz: Health Affairs’ “Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information,” by Ateev Mehrotra and others; and “Offering A Price Transparency Tool Did Not Reduce Overall Spending Among California Public Employees and Retirees,” by Sunita Desai and others.

To hear all our podcasts, click here.

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

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

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Senate Democrats Delay HHS Nominee Over Women’s Health Funding

Last week, 65 administration nominees — including four to Health and Human Services — sailed through the Senate confirmation process by unanimous vote without any debate. One candidate left out was Dr. Brett Giroir, a Texas physician, who is the president’s choice for assistant secretary of health.

Now, shedding light on their reservations, Senate Democrats are saying that Giroir’s testimony before the Health, Education, Labor and Pensions Committee left them skeptical that he would support women’s health programs, which they say are under threat. The Democrats are insisting on a roll call vote on the Senate floor — after the Senate reconvenes Sept. 5.

The position for which Giroir is nominated includes oversight of the Office of Population Affairs, which administers Title X grants, and the Office of Adolescent Health, which oversees the Teen Pregnancy Prevention Program. Title X funding goes to clinics for family planning and reproductive health services.

“After carefully reviewing his qualifications, I am unconvinced Dr. Giroir would be willing to stand up to this administration’s ideological attacks on women in a key leadership role at HHS,” Sen. Patty Murray (D-Wash.) said in a statement in response to questions from KHN.

Giroir and HHS declined to comment when contacted Wednesday.

President Donald Trump signed legislation in April that allows states to block Title X money from going to Planned Parenthood and other clinics that also perform abortions. The administration’s budget proposal called for a cut of $213.6 million for teen pregnancy prevention programs and research grants that go to more than 80 institutions. Congress has not yet set funding levels for 2018.

Challenged by Murray during a confirmation hearing last week about his views on the administration’s proposals, Giroir’s replies were polite, cooperative — and unrevealing.

For example, when Murray asked Giroir if he believed family planning funds should be made available to all providers (suggesting she was including Planned Parenthood), Giroir affirmed his belief that family planning services are important but said, “If there are restrictions that are handed down to me, I am obliged to follow the law.”

Giroir, 56, a pediatrician and researcher affiliated with Baylor College of Medicine in Houston, has served Republican politicians in various capacities. Former Texas Gov. Rick Perry, now the U.S. secretary of Energy, appointed Giroir to lead a state task force on infectious disease preparedness to combat the Ebola emergency in 2014. He headed the science office in the secretive Defense Advanced Research Projects Agency (DARPA) in President George W. Bush’s administration.

Giroir holds advisory positions in several companies in their development phase. He’s the consultant CEO of ViraCyte, which is working on drugs for organ transplants. He is on the scientific advisory board of NonInvasix, a company developing equipment for neonatal intensive care units; Esperance Pharmaceuticals, whose focus is anti-cancer drugs; and BrainCheck, an app that tests cognitive skills.

Last year, Giroir earned $424,124 from his independent consulting company, Health Science and Biosecurity Partners, according to the financial disclosure statement he submitted after his nomination to the HHS position. He has pledged to cease his consulting work and resign his university and business-related board positions if confirmed.

The four people confirmed last week to other HHS posts were Dr. Jerome Adams, surgeon general; Dr. Robert Kadlec, assistant secretary for preparedness and response; Dr. Elinore McCance-Katz, assistant secretary for mental health and substance abuse; and Lance Robertson, assistant secretary for aging.

Adams, Robertson and McCance-Katz all held positions in state health departments. Kadlec was previously the deputy staff director for the Senate Select Committee on Intelligence.

Murray’s reservations about Giroir cap earlier controversies about the backgrounds of other Trump administration appointees to HHS posts.

Charmaine Yoest, the assistant secretary of public affairs, was the former president of Americans United for Life, a group that lobbies for anti-abortion legislation at the state level.

Valerie Huber, who would serve as Giroir’s chief of staff, previously led Ascend, formerly known as the National Abstinence Education Association. It advocates for abstinence-only sex education in schools.

Teresa Manning, who will help oversee Title X grants as the deputy assistant secretary for population affairs, was a lobbyist with the National Right to Life Committee.

None of those three appointments required Senate confirmation.

Categories: Health Industry

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Congress Revamps Housing Program To Benefit Areas Where HIV Is Spreading

In a bipartisan push, Congress has restructured a federal program that provides housing assistance for people living with HIV to funnel more money into areas struggling to control the outbreak.

While legislators and housing advocates say the adjustments will better target regions with high rates of the virus, these changes are likely to mean less money for some of the large cities that confronted the early effects of the epidemic.

To help with the transition, Congress increased funding for the Housing Opportunities for Persons With AIDS (HOPWA) program about 6 percent this year. In the past, this money was distributed across the country based on a jurisdiction’s cumulative number of cases (including people who had died).

Now under the 2017 funding, finalized by Congress in May, HOPWA has awarded $320.4 million to qualifying states and local jurisdictions to be apportioned primarily based on their share of the total number of people living with the virus. The number of cases required to qualify for funding also changed from 1,500 cumulative AIDS cases to 2,000 living cases of HIV/AIDS.

No jurisdiction will receive less HOPWA money than in 2016, but about 25 cities and counties are getting a smaller piece of the pie than before. The top five seeing their percentage of funding drop are, in order, New York City, Atlanta, Miami, Washington, D.C., and Houston.

“As the formula is fully implemented, without additional funds those jurisdictions will lose out,” said Opal Jones, vice president of the National AIDS Housing Coalition, a housing advocacy group in favor of the formula change. “It’s a great start. It’s just not enough.”

The program, which began in 1992, provides financial assistance to help participants pay for rent, mortgage and utility costs. HOPWA also offers competitive grants to jurisdictions and organizations, but that allotment accounts for only about 10 percent of its budget and is not included in the $320.4 million.

Shelter represents one of the most important factors in determining an individual’s success in HIV treatment. According to the Department of Housing and Urban Development, which administers the HOPWA program, housing instability is linked to delayed testing and gaps in care. The department estimates roughly half of the individuals living with HIV in the U.S. will experience a housing crisis in their lifetime.

“I think we can’t underestimate the power that home has in improving the health in somebody with a chronic condition,” said Russell Bennett, executive director of the National AIDS Housing Coalition.

Shyronn Jones, 39, has struggled financially since she was diagnosed with HIV. She was once a homeowner in New York, but when she moved to Atlanta several years ago, the only housing she could afford was an apartment in a crime-ridden pocket of the city. She was having trouble getting medical care, her white blood cell count dipped to dangerously low levels, and her mental health deteriorated.

But then, a housing assistance organization connected Jones to HOPWA, which helped her to move into a better neighborhood with a nearby grocery store, post office and park, where her daughter can play.

“I had a lot riding on HOPWA,” she said. “HOPWA just saved me.”

Reslicing The Pie

Seeking to soften the impact of the formula change, the law increased appropriations this year so that each jurisdiction would see at least a small rise in funding. Over time, areas with higher rates of HIV transmission, such as the South, will continue seeing increases. The Centers for Disease Control and Prevention estimated 44 percent of all individuals living with HIV in the country reside in the South, even though only 37 percent of the U.S. population live in the region.

The extra $20 million allocation nationwide this year translated to double-digit percentage increases for more than 100 out of the 140 participating jurisdictions. Smaller cities such as Greenville, S.C., and Syracuse, N.Y., saw their funding jump by nearly 14 percent. Notably, some larger metropolitan hubs such as Portland, Ore., and Chicago also saw similar growth in their grants.

But efforts to funnel money into current HIV epicenters without additional funding could mean cuts for large metropolitan areas such as Atlanta and New York. To mitigate potential losses, the program’s statute stipulates that over the next five years, a grantee cannot lose more than 5 percent or gain more than 10 percent of its share of the previous year’s total HOPWA formula funds.

“We’ll see some losses in funding [for some areas] over the years,” said Rita Flegel, director of the Office of HIV/AIDS Housing. “And then money will be distributed more evenly among people living with HIV.”

Rep. David Price (D-N.C.), who was one of the co-sponsors of the bill that reformulated the funding, said the phase-in coupled with the boost in funding helped assuage fears of cutbacks among lawmakers from areas with a legacy of large numbers of HIV cases.

“People of all sorts of political persuasions supported this because this was a question of fairness,” he said. Yet, “it was very clear that we needed to increase the size of the pie to make this proposition less difficult.”

One of the cities that could lose out is the nation’s capital. Nearly 13,000 residents, or nearly 2 percent of the population, live with HIV in Washington, D.C., according to the city’s health department.

HOPWA has not been able to keep up with demand of the area’s residents and the city discontinued its waiting list last year with more than 1,200 individuals, according to Michael Kharfen, the senior deputy director of the city’s HIV/AIDS, Hepatitis, STD, and TB Administration. The area is expected to receive $11.2 million, a 1 percent increase from last year’s funding.

But the nation’s capital is not unique in its struggle to keep up with the demand. According to the latest data from HUD, 138,427 HIV-affected households across the country were in need of housing assistance.

Jones, of Atlanta, now resides in a three-bedroom, two-bathroom apartment in a neighborhood she dreamed of while growing up in New York City.

Her white blood cell count has doubled since her move, she said, and her mental state has improved. Jones, who is a policy fellow for the HIV advocacy organization Positive Women’s Network USA and runs a business that advises HIV patients on resources, is grateful to HOPWA for the assistance. But she said she hopes to become self-sufficient and help others dealing with situations similar to those she once faced.

“That’s what I’m striving for,” she said.

Categories: Cost and Quality, Public Health

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