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Below is a summary of recent events to help you stay current on healthcare reform news all in one place. To make your voice heard on these issues, visit OurCareBill.org, a non-partisan movement that lets you share your opinion on healthcare legislation with friends, family, and even Washington D.C.!
Healthcare Reform News Update for July 15, 2019
Appeals Court Blocks Trump Administration’s Exemptions to ACA Contraception Rules
The 3rd U.S. Circuit Court of Appeals upheld a decision to block the Trump administration from “allowing employers with moral and religious objections” to deny birth control coverage mandated by the Affordable Care Act.
The ACA requires that employer-sponsored health plans include birth control coverage with no copays. In 2017, President Trump signed an executive order encouraging federal agencies to expand “conscience-based objections” to the mandate.
The panel of three judges sided with Democratic state attorneys general from Pennsylvania and New Jersey who argued that the new exemption rules contained “serious substantive problems.”
Connecticut ACA Insurers Propose Rate Increases for 2020 Plans
Anthem and ConnectiCare, the two insurance companies on Connecticut’s state healthcare exchange, have proposed premium increases for individual Affordable Care Act plans in 2020.
Anthem has requested an average 15.2 percent rate increase for individual plans sold on and off the exchange and an average 14.8 percent rate increase for small group health plans.
ConnectiCare requested a 4.9 percent rate increase for individual plans sold on and off the exchange.
The companies attributed rising healthcare costs, the aging population, and the newly reinstated Health Insurance Tax (HIT) as factors in their proposals.
Healthcare Reform News Update for July 12, 2019
Cancer Patients Face Substantial Financial Burden
A recent study from the Centers for Disease Control and Prevention shows that the annual out-of-pocket expenses for cancer survivors is increasing with 25 percent experiencing problems paying their bills and 34 percent worried about their costs.
Average out-of-pocket spending for cancer survivors is $1,000 per year compared to $622 per year for people who’ve never had cancer. And those costs are growing. Even with health insurance in place, cancer patients incur an additional financial burden from things such as traveling to treatment and being away from work.
Other findings from the study:
- Out-of-pocket expenses were highest among cancer survivors ages 18-64 and those who were unemployed.
- Cancer survivors ages 40-49 reported the highest percentage of “material or psychological financial hardship.”
- A higher percentage of minority racial/ethnic cancer survivors reported “material or psychological financial hardship.”
- “Cancer survivors [are] more likely to be older, female, non-Hispanic white, married, privately insured,” full-time employees, more educated, and have more chronic conditions compared to people who’ve never had cancer.
Healthcare Reform News Update for July 10, 2019
Appeals Judges Question Validity of ACA’s Individual Mandate
A panel of three federal appeals court judges pressed the state attorneys general defending the Affordable Care Act on Tuesday over whether the law remains constitutional without its individual mandate penalty.
In the two hours of oral arguments, two Republican-appointed judges appeared skeptical about the constitutionality of the individual mandate. Judge Kurt Engelhardt suggested that severing the tax penalty from the ACA should be the job of Congress rather than the courts.
The two judges also questioned whether either side of the lawsuit had any legal standing to initially challenge the ACA or appeal the lower-court’s decision.
Carolyn Dineen King, the only Democratic-appointed judge, did not ask questions during the hearing.
The judges did not indicate when they would issue their ruling, but it is expected in the coming months.
California 2020 ACA Premiums Show Record Low Increases
Proposed premium increases for 2020 ACA plans in California are the lowest in the state exchange’s history, with an average hike of 0.8%, officials said. That’s down from an average increase of nearly 9% for 2019 plans and a five-year average increase of 8.4%.
Proposed bronze plan rates will increase an average of 5.7%, and silver plans will decrease an average of 4.3%.
Covered California Executive Director Peter Lee said the rate stabilizations were due to new state-funded tax credits to middle-class enrollees and a new state penalty imposed on uninsured residents.
All of the state’s 11 ACA insurers will return for 2020, and Anthem Blue Cross will expand into the Central Coast, parts of the Central Valley, Los Angeles County and the Inland Empire.
Minnesota 2020 ACA Premiums Show Modest Increase
Proposed 2020 ACA premiums in Minnesota show only slight increases compared to this year’s rates.
Proposed average individual rate changes for the state’s four ACA insurers are as follows:
- Medica: down 1.4%
- UCare: up 0.3%
- HealthPartners: up 2.1%
- Blue Cross HMO: up 4.8%
In the state’s small group market, the proposed rate increases were between 3 and 6%.
Final rates are scheduled to be released in early October.
Healthcare Reform News Update for July 8, 2019
Federal Appeals Court Hearing on ACA Constitutionality Begins Today
The 5th U.S. Circuit Court of Appeals will hear oral arguments today on whether a lower court ruling that declared the Affordable Care Act unconstitutional should be overturned.
The ACA is being challenged by 18 Republican-led states. The three-judge panel will also decide whether the coalition of Democratic states and the U.S. House of Representatives have standing to intervene in the case after the Trump administration declined to defend the health law.
It’s unclear when the panel will make its ruling. However, it’s expected that the case will ultimately be decided by the Supreme Court.
Connecticut Enacts Mental Health Parity Bill
Connecticut Governor Ned Lamont signed a bill into law that will require insurance providers to submit annual reports to state insurance commissioners, detailing their coverage of mental health and substance abuse services.
The new law intends to hold insurers accountable for complying with state and federal laws that mandate equal access to mental and physical health services.
Healthcare Reform News Update for July 3, 2019
Federal Appeals Court Denies ACA Lawsuit Postponement
The 5th U.S. Circuit Court of Appeals rejected a request from Republican state attorneys general to delay oral arguments in the case to strike down the Affordable Care Act.
The lawyers had asked for a 20-day delay to file briefs relating to questions on whether the Democratic-led states defending the ACA have legal standing to intervene. The court allowed a two-day delay and will hear the case July 9 as scheduled.
Pennsylvania Will Switch to State-based ACA Exchange for 2021 Plans
Pennsylvania Governor Tom Wolf signed legislation Tuesday implementing a state-based Affordable Care Act exchange that’s expected to begin with next year’s Open Enrollment for 2021 plans.
The law also includes a new state reinsurance fund, which could help reduce premiums by as much as 10 percent, state officials say.
The Department of Health and Human Services must approve the law before it can be enacted.
Poll: Majority Support Medicare for All if Healthcare Providers Remain
A majority of voters would back a Medicare for All plan if they could keep their preferred doctors and hospitals, according to a new Morning Consult/Politico survey.
Of those surveyed, 55% of respondents backed a single-payer system that would reduce the role of private insurance companies but allow them to keep their healthcare providers.
But 46% were in favor when told the role of private insurers would be reduced, and 53% approved when not given any specifics about insurers or doctors.
The poll found that general support for a Medicare for All system comes from 77% of Democrats, 27% of Republicans and 50% of Independents.
Healthcare Reform News Update for June 27, 2019
Court Questions Democrats’ Right to Defend ACA
The U.S. Court of Appeals for the 5th Circuit has asked whether the Democrat-led House of Representatives or Democratic states have the legal right to appeal the ruling that struck down the Affordable Care Act.
It’s possible that the panel could toss out the appeal on procedural grounds if it decides that the opposing side does not have the authority to appeal U.S. District Judge Reed O’Connor’s decision to declare the ACA unconstitutional.
A three-judge panel requested that both sides of the lawsuit provide written arguments. Oral arguments will begin on July 9.
Senate Committee Approves Surprise Billing Package
The Senate health committee approved its healthcare package, called the Lower Health Care Costs Act, which includes a cap on how much providers can bill for out-of-network care.
Before approval, an amendment was added to the legislation. The change requires insurers to reveal all physicians and hospitals in their networks so patients can see all available options before choosing a plan.
Committee Chairman Lamar Alexander (R-TN) said that the bill will likely have more revisions before a vote in August.
Healthcare Reform News Update for June 26, 2019
New Study Shows 14% Increase in Out-of-Pocket Healthcare Costs
In 2018, out-of-pocket costs for inpatient services increased 14% over the previous year, according to a report from TransUnion Healthcare.
TransUnion tracked deductible and co-pay costs for patients with commercial insurance, Medicare Advantage, Traditional Medicare, and those who self-pay to find the annual averages.
2018 Average Out-of-Pocket Cost
2017 Average Out-of-Pocket Cost
In addition, the study found that 59% of patients had out-of-pocket expenses between $501 and $1,000, compared to 39% in 2017. Patients with expenses of $500 or less drop from 49% in 2017 to 36% in 2018.
Healthcare Reform News Update for June 25, 2019
Supreme Court to Rule on ACA Risk Corridor Suit
The Supreme Court agreed to hear a case that will decide if insurers are owed $12 billion in government payments from the Affordable Care Act’s risk corridor program.
The program was created to help offset potential financial losses during the initial years of the ACA. Insurers with lower-than-expected costs would pay into the program, and those with heavy-than-expected costs would be reimbursed from this fund.
In 2014, Congress required the program to be budget-neutral and limited payments, which insurers say lead to a shortfall.
President Signs Executive Order on Healthcare Pricing Transparency
President Trump signed an executive order on Monday that will require hospitals and insurance companies to publicly disclose their negotiated pricing.
The order is meant to increase price transparency through five policies:
- Providers must disclose the prices for insurers and patients in an easy-to-read format.
- Providers and insurance must provide patients with the estimated out-of-pocket costs before they receive care.
- Agencies must propose ways to simplify and improve quality measures across all healthcare programs.
- Researchers must gain increased access to healthcare claims information, stripped of individual details.
- The Treasury Department must look for ways to expand how health savings accounts can be used.
Before the changes can be implemented, government agencies, including Health and Human Services and the Treasury Department, must determine a rule-making process and work out the details of how the president’s plan will be executed.
California Lawmakers Approve State Individual Mandate
The California Legislature voted to impose a tax on residents who do refuse to purchase health insurance.
The penalty will go into effect on January 1, 2020, if the bill becomes law. The state will use the funds collected from the tax to provide insurance premium subsidies to middle-income Californians who earn up to six times the federal poverty limit.
The bill is expected to be signed by Governor Gavin Newsom.
Healthcare Reform News Update for June 20, 2019
Senate Committee to Propose Pay Cap for Surprise Medical Bills
The Senate health committee has come to decision on how its bipartisan healthcare package will help patients with surprise medical bills. Patients often face these unexpectedly-high bills after receiving care from a provider that isn’t in their insurance network.
To combat these charges, panel leaders Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) will include a “benchmark” system as part of their new healthcare bill. The benchmark system will cap charges for out-of-network care based on a plan’s median in-network rate for an area.
The announcement came right before a new Kaiser Family Foundation study found that 1 in 6 insured Americans have been affected by surprise bills after a hospital stay.
The committee expects to vote on the legislation next week.
Healthcare Reform News Update for June 14, 2019
New Rule Allows Workers to Use HRAs to Purchase Health Insurance Plans
The Trump administration has issued a new rule that will enable employees of small businesses to use tax-free health reimbursement accounts (HRAs) to purchase individual health insurance plans.
Previously, employers could set up tax-deductible HRAs to help reimburse workers for out-of-pocket medical expenses.
Beginning January 1, 2020, small employers who do not offer group health insurance can set up HRAs that workers can use to purchase ACA-compliant plans on the individual market.
Employers who offer group insurance can set up an “excepted benefit” HRA that can be used to purchase short-term health insurance plans that don’t comply with the ACA. These HRAs will be limited to $1,800 per year.
White House officials said provisions have been created to block employers from using the new rule to send only their oldest and/or sickest employers to the individual marketplace.
The rule change will provide coverage to an estimated 800,000 people who currently do not have health insurance, according to the Trump administration.
Healthcare Reform News Update for June 13, 2019
House Committee Debates Medicare for All Proposals
For the first time, the House Ways and Means Committee held a hearing on the various Democratic proposals for universal healthcare.
The discussion, held Wednesday with a panel of healthcare experts and advocates, primarily served as a platform for partisan debate. Republicans were united in the belief that Medicare for All measures would cost too much, raise taxes and dilute the quality of healthcare. Democrats remain split on what type of public plans to support and whether the Affordable Care Act could be used to move those proposals forward.
Lawmakers from both parties agreed that the current healthcare system needs to be revised so that more people can have access to quality care and affordable coverage.
Healthcare Reform News Update for June 5, 2019
Medicare for All Hearing Set for Next Week
The House Ways and Means Committee has scheduled a Medicare for All hearing for June 12. It will be the first time the measure is examined by a panel that oversees healthcare issues.
The House version of the proposal is sponsored by Rep. Pramila Jayapal (D-WA) and currently has 110 Democratic cosponsors.
This hearing could encourage the House Energy and Commerce Committee, which also has control over healthcare issues, to consider the Medicare for All proposal.
Healthcare Reform News Update for June 4, 2019
Premiums for 2020 ACA Plans Trend Toward Modest Increases
States have just begun to release rate filings for 2020 Affordable Care Act plans, and so far the modest premium rate increases indicate that the market remains stable.
Some of the proposed average rate changes by state include:
- Maryland: 2.9 percent decrease
- Washington: less than 1 percent increase
- New York: 8.4 percent increase
- Vermont: 13 percent increase
Increases in premiums for 2020 are attributed to 4 to 8 percent increase in medical costs and the return of the ACA’s health insurance tax.
New Poll Shows Nearly Half of Country Struggles With Paying Medical Expenses
A national survey released by Monmouth University shows that 45% of Americans have difficulty paying out-of-pocket medical expenses, and 40% have trouble paying their health insurance premiums.
In addition, the report found that 49 percent of adults believe that access to health insurance plays a significant role in their decision to pursue a new job opportunity, with 20% saying that the need to keep their employer-sponsored plan prevented them from pursuing a new job opportunity in the past 10 years.
Other poll findings:
- 46 percent say that their health care costs have increased over the past two years.
- 27 percent say that a family member did not seek medical care in the past two years because of the costs.
- 52 percent of people who earn less than $50,000 a year say it is difficult for them to pay out-of-pocket medical expenses.
Minnesota Will Continue ACA Reinsurance Program
Legislators in Minnesota voted to extend the Minnesota Premium Security Plan, the state’s reinsurance program, which has helped stabilize ACA premium rates.
The program’s initial $542 million appropriation has not been exhausted, so its continuation will not require additional funds.
Healthcare Reform News Update for June 3, 2019
Studies Link ACA to Reduced Racial Gap in Cancer Care & Earlier Ovarian Cancer Diagnosis
New research suggests that the Affordable Care Act improved the racial disparities in cancer treatment and helped women with ovarian cancer get diagnosed earlier.
Before the implementation of the ACA, African Americans were 4.8 percent less likely than white patients to begin treatment for advanced cancers within a month of diagnosis. A new study shows that today, 49.6 percent of black patients receive treatment within 30 days, compared to 50.3 percent of white patients, in the states were Medicaid has been expanded under the ACA.
A second study found that since the ACA became law, more women with ovarian cancer have begun receiving treatment within one month of diagnosis.
The studies were presented at a meeting of the American Society of Clinical Oncology on Sunday.
California Governor Proposes Health Insurance Subsidies for Middle-Class
Governor Gavin Newsom has asked California state legislators to provide tax subsidies for middle class residents that would help pay the premiums on Affordable Care Act health plans. The proposal would affect an estimated 850,000 residents.
If approved, individuals who earn between $50,000 and $75,000, and families who earn between $103,000 and $154,500, would receive tax credits of $144 per month on average.
The proposal also provides some additional tax credits for individuals and families who earn between 200% and 400% of the federal poverty level.
The subsidies would be funded by a tax penalty on state residents who do not have insurance coverage, much like the original federal mandate that was recently removed from the ACA.
Healthcare Reform News Update for May 28, 2019
Senate Committee Proposes Bipartisan Fix for Healthcare Costs, Billing
The Health, Education, Labor and Pensions Committee released a draft bill last week aimed at lowering out-of-pocket costs and reforming other healthcare issues such as surprise billing and prescription drug pricing.
The proposal from Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) includes three
suggestions to stop the practice of surprise billing:
- Require that all hospital providers, as well as corresponding labs and diagnostic tests, be “in network.”
- Use outside arbitration to resolve disputed charges higher than $750.
- Establish a standard benchmark for physician pay.
Consumer protections in the draft legislation include a requirement that patients receive “good-faith” estimates of out-of-pocket costs within two days of a request and receive their full bills within 30 days of a procedure.
To lower drug costs, the patent process would be revised to make it faster and easier for generic drugs to be available.
The draft legislation also addresses hospital and insurer contracts, vaccine education, grants to improve maternal mortality rates, and measures to improve cybersecurity.
Alexander said that he expects a Senate vote on the bill in July.
Proposed HHS Rule Reverses ACA Transgender Protections
The Trump administration has proposed a rule that would roll back Affordable Care Act protections for transgender individuals.
The Department of Health and Human Services (HHS) says the ACA’s definition of sex discrimination is too broad, and the change makes regulations more consistent with other agencies.
Critics of the proposal say the rule would impact the treatment of both LGBTQ and female patients. Legal challenges are expected when the final rule is released.
ACA Lawsuit Hearing Date Set
The 5th Circuit Court of Appeals has slated July 9 as the hearing date for Judge Reed O’Connor’s ruling that the Affordable Care Act is unconstitutional.
O’Connor ruled that the Affordable Care Act became unconstitutional in 2017 when Congress eliminated the tax penalty for not having health insurance.
Healthcare Reform News Update for May 17, 2019
House Passes Bill That Strengthens ACA Measures
The Democrat-led House passed a package of healthcare bills designed to lower drug prices and strengthen the Affordable Care Act on Thursday.
The bills’ ACA changes include:
- Restoring $100 million in funding for the open enrollment period navigator program
- Reversing the Trump administration’s expansion of short-term health insurance plans
- Funding for states to create their own online healthcare exchanges
Other provisions in the legislation address lowering prescription drug prices by increasing the availability of generic alternatives.
Though Republicans are in favor the drug-pricing measures, the changes to the ACA are expected to prevent the bill’s passage in the GOP-led Senate.
Bipartisan Senators Create Legislation on Surprise Medical Bills
A bipartisan senate coalition introduced legislation to protect patients from unexpected out-of-pocket medical costs. The surprise bills can occur when a patient receives care from a medical provider who is not in their insurance network.
The bill would take the patient out of price disputes between out-of-network healthcare providers and insurance companies.
Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), and Maggie Hassan (D-NH) propose that insurers automatically pay out-of-network providers approximately the same rate as in-network providers. Instead of billing patients the difference in cost, hospitals, specialty physicians and insurers would use arbitration to settle any disputes with the pay rate proposed.
Healthcare Reform News Update for May 13, 2019
Washington to Become First State With a Public Healthcare Option
Washington will establish the country’s first universally available public insurance option when Governor Jay Inslee signs the legislation today.
The public option, called Cascade Care, is a hybrid insurance model: the state will create the terms of the plans and private insurance companies will administer the day-to-day operations, such as enrollment and claims payments.
Premiums are expected to be up to 10 percent lower than comparable private insurance coverage. The reduced costs are made possible by capping payments to healthcare providers at 160 percent of federal Medicare rates.
The set of tiered plans will available by 2021 and will be offered to all Washington residents, regardless of income.
Uninsured in Maryland Will Get Help via State Income Tax Returns
Maryland residents will soon be able to see if they qualify for free or low-cost insurance after filing their taxes, as Governor Larry Hogan is scheduled to sign a bill today that will alter the state’s income tax form.
If the new checkbox on the form is selected, Maryland’s healthcare exchange will determine if the tax filer is eligible for help with insurance.
Residents who qualify for Medicaid will be automatically enrolled. Those who qualify for Affordable Care Act plans will be contacted by the exchange.
Healthcare Reform News Update for May 10, 2019
House Passes Bill Strengthening Pre-Existing Condition Protections
The House voted to overturn a new Trump administration waiver program that weakens the Affordable Care Act’s pre-existing condition protections.
The waiver allows states to offer low-cost, low-coverage policies that can deny coverage to people with pre-existing conditions or charge them more for the same policy.
House Republicans said the waivers promote state flexibility and expand consumer healthcare choices.
The bill its not expected to clear the Republican-led Senate.
Healthcare Reform News Update for May 8, 2019
Study: 2018 Brought Record Financial Performance for ACA Insurers
Last year was the most profitable year for Affordable Care Act plans since they were made available, according to the Kaiser Family Foundation’s recently published analysis of 2018 individual market performance.
The data also show that “financial results suggest the market is still stable and sustainable.”
Some of the report’s findings also include:
- Insurers are expected to owe rebates totaling almost $800 million to consumers as a result of not meeting the medical loss ratio threshold.
- Insurers are regaining profitability, but the Trump administration’s proposed changes to the ACA make predictions for the future uncertain.
- Premium increases combined with modest growth in medical expense claims helped fuel improvements in financial performance.
- The premium increases for 2017 plans were a necessary one-time market correction adjustment due to a “sicker-than-expected risk pool.”
- Premium increases in 2018 were mostly “compensating for policy uncertainty and the termination of cost-sharing subsidy payments.”
- Premiums in 2019 decreased partly because 2018 premiums “were higher than necessary to cover claims costs.”
Poverty Threshold Changes Would Affect ACA Premium Tax Subsidies
The Trump administration has proposed changes to how the poverty level is determined, which would influence the number of consumers eligible for premium tax credits on Affordable Care Act health plans.
Currently, the poverty level is determined by the consumer price index. The Office of Management and Budget is considering a different measure called “chained CPI” that raises the poverty level at a slower rate. This means fewer Americans would qualify for services that are based on their incomes.
To qualify for the ACA premium tax credit, an enrollee’s estimated income must fall between 100% and 400% of the federal poverty level.
Critics of the plan say the change would cause harm to low-income workers who would be stripped of benefits they are currently eligible for.
The administration notes that the poverty threshold has not changed in 40 years and “is worth re-evaluating.”
Bipartisan Senators Ask Trump Administration to Defend the ACA
Senators Susan Collins (R-ME) and Joe Manchin (D-WV) wrote a letter to Attorney General William Barr asking that the Trump administration stop its attempt to dismantle the Affordable Care Act in federal court.
The senators said Congress’ repeal of the individual mandate was not a move to invalidate the entire health law and that the administration’s position would cause 133 million Americans to lose their health coverage.
Healthcare Reform News Update for May 2, 2019
Trump Administration Formally Files To Strike Down Entire ACA
The Trump administration filed its support of overturning the entire Affordable Care Act with the Fifth Circuit Court of Appeals this Wednesday. The administration, along with a coalition of Republican-led states, are asking the court to uphold U.S. District Court Judge Reed O’Connor’s ruling that the ACA became invalid when the individual mandate was repealed.
Previously, the Justice Department’s held the position that some provisions of the law should continue to stand, including Medicaid expansion, premium tax subsidies and health insurance markets. The administration has since reconsidered.
In the legal filing, Justice Department stated that “the remaining provisions of the ACA should not be allowed to remain in effect — again, even if the government might support some individual positions as a policy matter.”
California Attorney General Xavier Becerra, who leads the group of 21 Democratic states defending the ACA, said, “Our legal coalition will vigorously defend the law and the Americans President Trump has abandoned.”
Oral arguments in the case are expected to begin in July.
CBO Report Highlights Complexities of a Medicare for All System
The Congressional Budget Office released a report on Wednesday that analyzes the “opportunities and risks” of creating a Medicare for All type of healthcare system like those proposed by some Democratic lawmakers and presidential candidates.
Instead of cost estimates, “Key Design Components and Considerations for Establishing a Single-Payer Health Care System” lays out the positive and negative outcomes that lawmakers and consumers could face if current system were revised.
The report outlines ways in which Congress could address issues that may arise with a single-payer system, such as:
- Funding the system
- Plan oversight
- The role of private insurance providers
- Management of provider rates and prescription drugs
The analysis suggests drawbacks of single-payer healthcare could include longer wait times and decreased access to care. New taxes would also have to be established for income, payroll, or consumption to help pay for the system.
Benefits of a single-payer system, according to the report, include costs savings from administrative streamlining, and a greater focus on preventive care and increasing the nation’s health as a whole.
Other considerations for legislators include whether or not to pay for undocumented immigrants and long-term care services, and what strategies should be used to maintain costs.
Democrats Reintroduce Compromise Medicare Expansion Proposal
Democratic Representatives Rosa DeLaura of Connecticut and Jan Schakowsky of Illinois presented their plan for expanding healthcare coverage on Wednesday. The Medicare for America Act is considered a more moderate approach than a single-payer models like Medicare for All.
The plan debuted last year, but now has 16 cosponsors.
The proposal would maintain employer-based health plans, but employees would have the option to enroll in Medicare coverage. Consumers who have coverage though Affordable Care Act plans, Medicaid, Medicare and CHIP would all transition to the newly expanded Medicare plans.
Premiums for the plans would be based on income, but cost would be capped at 8 percent of monthly pay. Tax subsidies would be provided to those with low-incomes. There would be no deductibles to be met before coverage begins.
CMS Seeks New Ideas for State ACA Waivers
The Centers for Medicare & Medicaid Services and the Treasury Department has issued a call for ways to improve the system states use to ask for exceptions to Affordable Care Act regulations.
“Ultimately, the goal here is to see states develop new waiver concepts and submit waiver applications that improve their health insurance markets,” said CMS Administrator Seema Verma via a blog post.
Healthcare Reform News Update for May 1, 2019
President Trump Asks Senator to Restart Bipartisan ACA Stabilization Deal
President Trump asked Senator Patty Murray (D-WA) on Tuesday to renew her efforts to create a bipartisan bill that would help stabilize the Affordable Care Act.
Murray’s previous proposal with Senator Lama Alexander (R-TN) stalled last year after legislators could not agree on modifications to the Hyde Amendment, which concerns abortion funding restrictions. At the time, the president waivered in his support of the bill.
Murray said through an aide that she is willing to try again, and that she is ready to work with either Democrats or Republicans to roll back any sabotage to the ACA and make healthcare more affordable.
Alexander remains firm on the issue that derailed the initial bill. “I was extremely disappointed our legislation didn’t become law. If Democrats are willing to modify their position on the Hyde Amendment and renew their interest in Alexander-Murray, I would welcome the opportunity to discuss it,” he said.
Medicare for All Bill Receives First Congressional Hearing
The first public congressional discussion on Medicare for All was held on Wednesday in front of the House Rules Committee. The hearing centered on a bill from Representative Pramila Jayapal (D-WA), which has over 100 Democratic co-sponsors.
Speakers included healthcare providers, a conservative economist, liberal activists with disparate opinions on how a single-payer system would operate, and Ady Barkan, a supporter with Lou Gehrig’s disease who described his struggles with exorbitant out-of-pocket costs.
Jayapal’s bill currently lacks support from centrist Democrats and would not be able to pass in the Republican-controlled Senate. However, she and other advocates were positive about gaining a hearing. “This was the first step, it’s a big step, but we’re on our way. Medicare for All is possible. It is reasonable. It can move forward, and I think it should,” said the Chairman of the Rules Committee Jim McGovern (D-MA.).
Republicans remained skeptical about Medicare for All efforts. Representative Tom Cole (R-OK), the ranking Republican on the committee, said that supporters have “not told us how much this massive new program would cost, who would pay for it and how much taxes would have to go up.”
Additional hearings on Medicare for All were confirmed during Wednesday’s discussion: one for The House Budget Committee and another for the House Ways and Means Committee.
Healthcare Reform News Update for April 30, 2019
Florida Senate Approves New Standards for State Health Plans
On Thursday, the Florida senate passed a health benefits package that could define new standards for health insurance in the state if the Affordable Care Act is removed. The bills address pre-existing condition protections, association plans, short-term health plans, and essential health benefits.
The package will allow insurance companies to offer plans that limit or deny coverage for people with pre-existing conditions, as long as policies without these restrictions are actively marketed. No limits would be set on the differences in premiums for the two types of plans, which means that the state would allow insurance companies to charge those with pre-existing conditions higher rates.
The package will also allow association health plans and three-year short-term plans to be sold in the state. Part of the package allows for the defining of a new list of essential health benefits.
Senators who sponsored the package said that they believed the new standards will help in lowering premiums.
Healthcare Reform News Update for April 25, 2019
New Poll Shows Americans Concerned About Drug Costs and Pre-Existing Condition Protections
Americans believe the top healthcare priorities for Congress should be lowering prescription drug costs, pre-existing condition protections, and protecting people from surprise medical bills, according to a new Kaiser Family Foundation poll released Wednesday. The poll gathered opinion data on the Affordable Care Act, healthcare concerns and future healthcare legislation.
While 54% of Americans do not want the Affordable Care Act overturned, opinions are split between political parties. Of Republicans, 73% support striking down the entire ACA. Conversely, 83% of Democrats are against eliminating the ACA. However, a majority of Democrats, Republicans, and Independents (67%) believe the government should require health insurance plans to cover a designated set of benefits and pre-existing conditions.
In addition, a majority of respondents are worried that they or a family member could lose, or not be able to afford, coverage if the Supreme Court overturns the ACA or pre-existing condition protections.
Other findings from the poll include:
- Nearly six in 10 Americans (56%) support a Medicare-for-all plan.
- More than half (52%) of Democrats prefer a focus on improving and protecting the ACA over passing a Medicare-for-all plan.
- Only 26% of Americans believe low-cost, short-term plans without required coverage or pre-existing condition protections should be allowed.
- Four in 10 insured families (41%) received an unexpected medical bill over the last two years.
Healthcare Reform News Update for April 23, 2019
Two Republican Bills Address Pre-Existing Condition Protections
Two similar bills introduced by Republican legislators seek to protect patients with pre-existing conditions in the event that the Affordable Care Act is struck down. Senator Thom Tillis of North Carolina and Representative Greg Walden of Oregon have authored similar proposals.
The bills would prohibit insurance companies from denying coverage on the basis of health status, but they are missing some of the protections available under the current law. Insurance companies would be allowed to charge women higher premiums and put lifetime limits on benefits.
Democrats say that the bills fall short in their promise to protect insurance beneficiaries. “You could theoretically buy insurance if you have a pre-existing condition, but it is very deceptive because the bill will still allow insurers to set premiums based on health status.” said Representative Frank Pallone Jr. (D-NY) chairman of the Energy and Commerce Committee.
Healthcare Reform News Update for April 22, 2019
Congressional Budget Office Revises its Insurance Estimate Model
The Congressional Budget Office announced that it will change how it estimates the financial impact of new health insurance legislation, beginning with its budget projections later this spring. The new model will consider consumer and employer preferences.
The revisions were made to address Republican criticism of how the nonpartisan agency makes estimates, specifically regarding the repeal of the Affordable Care Act and its individual mandate.
“The new model better captures underlying relationships among individuals, families, employment, income, and insurance coverage because it incorporates new data and includes refinements in modeling insurance choices,” said CBO Director Keith Hall.
Kansas Governor Allows Farm Bill to Pass
The Kansas Farm Bureau will be allowed to offer health coverage that does not meet Affordable Care Act standards, as Governor Laura Kelly declined to block the law.
The new association health plan is not considered insurance, so it will be exempt from state and federal insurance regulations. It does not include protections for people with pre-existing conditions, nor does it include the ACA’s ten essential benefits, such as coverage for prescription drugs, maternity care, or mental health services.
In a statement, Kelly mentioned reservations about the law, but chose not to block it as a demonstration or compromise. “I believe the potential risks of this legislation can be mitigated if they are coupled with a stable, secure, proven health care option: Medicaid expansion,” said Kelly.
Healthcare Reform News Update for April 19, 2019
Changes to 2020 ACA Plans Announced by CMS
The Centers for Medicare and Medicaid Services (CMS) released its finalized rule for 2020 Affordable Care Act health plans on Thursday.
The agency will reduce user fees to plans on the federal exchange from 3.5 percent of premiums to 3 percent. User fees for plans sold on state exchanges will drop from 3 percent to 2.5 percent.
CMS Administrator Seema Verma said in the announcement that “The rule issued today will give consumers immediate premium relief for 2020 by reducing the federal exchange user fees thanks to successful efforts to improve the efficiency of the exchange. At CMS, we have improved the operations of the exchange to deliver a better consumer experience at a lower cost.”
- raising the maximum out-of-pocket limit to $8,150 for individuals and $16,300 for families and increase of by 3.16 percent,
- slightly decreasing the amount subsidized enrollees are required to contribute toward benchmark silver plans to 8.24 percent, and
- allowing insurers to block drug manufacturer coupons from applying to annual out-of-pocket limits if a generic version of the drug is available.
Healthcare Reform News Update for April 18, 2019
Colorado Pushes Forward on Government-Run Insurance Option
The Colorado Senate moved closer to the creation of a state public-option health insurance plan by endorsing a study that will examine the impact of such a plan.
The proposed bill asks state agencies to present recommendations for a healthcare plan in November that could compete with plans available on Colorado’s Affordable Care Act exchange in 2021.
Supporters of the measure say the public-option plan would reduce premiums in areas that have some of the highest costs in the nation.
Republican Senator Jim Smallwood, an opponent of the bill, suggests that instead of creating competition, a public healthcare option would cause private insurers to abandon the Colorado market.
Connecticut House Passes Pre-Existing Condition Protections for Short-Term Plans
A bill to protect consumers with pre-existing conditions from being denied coverage or charged more for short-term health insurance plans was passed by the Connecticut House of Representatives.
According to the Kaiser Family Foundation, approximately 522,000 Connecticut citizens under 65 have a pre-existing condition.
The bill is opposed by the Connecticut Conference of Municipalities, which stated that the measure would raise insurance premiums for municipal employers. However, analysts with the Office of Fiscal Analysis say the bill has no financial impact on the state.
Healthcare Reform News Update for April 11, 2019
Bernie Sanders Debuts Revamped Medicare for All Bill
Senator Bernie Sanders (I-VT) debuted an updated version of his Medicare for All bill on Wednesday with the support of 14 Democratic cosponsors.
In his proposal, Sanders calls for replacing private insurance with a single-payer, government-run system with no premiums or deductibles. Certain services would come with small copays, and copays for brand-name prescription would be capped at $200. This new version of the proposal adds coverage for long-term care.
“The American people are increasingly clear: They want a health care system which guarantees healthcare to all Americans as a right,” said Sanders.
Sanders did not outline how the program would be funded, but did offer general suggestions.
In response, White House press secretary Sarah Huckabee Sanders called the plan a “total government takeover of health care that would actually hurt seniors, eliminate private health insurance for 180 million Americans, and cripple our economy and future generations with unprecedented debt.”
Healthcare Reform News Update for April 10, 2019
House Democrats Seek Justification for ACA Lawsuit Strategy
Democratic House committee chairmen are insisting that the Trump administration reveal documents and information that explain why the Department of Justice came to the decision to not defend the Affordable Care Act in the lawsuit against it.
The five committees involved have sent letters to the White House, the Justice Department, and Health and Human Services, requesting the legal justification for the administration’s decision to seek the elimination of the healthcare law. They also request that the DOJ allow four of its attorneys to testify.
Judiciary chairman Jerry Nadler (D-NY) told reporters on Tuesday that “The Judiciary committee will hold those responsible for this complete abdication of the department’s legal duty. They are in contempt of the law in the way they are carrying out their intentions.”
During testimony in front of a House appropriations subcommittee on Tuesday, Attorney General William Barr defended the administration’s strategy. “When we face a legal question, we try to base our answer on the law. If you think it’s such an outrageous position, you have nothing to worry about. Let the courts do their job,” he said.
Wisconsin Allowed to Withdraw From Remaining ACA Lawsuit
The 5th District Court of Appeals has agreed to dismiss Wisconsin from the appeal of the Affordable Care Act ruling that declared the healthcare law unconstitutional.
Last week, the court allowed the state to withdraw from two related cases. This latest court decision removes Wisconsin from all the federal lawsuits filed against the ACA.
ACA Medicaid Expansion Approved in Idaho
Idaho Governor Brad Little signed voter-approved legislation to expand Medicaid to approximately 90,000 residents by covering those earning up to 138 percent of the federal poverty level.
The bill also includes requests for two federal waivers. One requires Medicaid recipients to be employed in order to receive benefits. The other will allow Medicaid-eligible residents to stay on the state’s health insurance exchange instead of moving to the government plan.
Expanded Medicaid coverage is created via provisions of the ACA. Idaho is the 37th state to adopt the expansion.
Healthcare Reform News Update for April 9, 2019
ACA Lawsuit Timeline May Be Accelerated
The Department of Justice filed a motion to begin oral arguments in the appeal of a lower-court ruling against the Affordable Care Act the week of July 8. The Democrat-led opposition defending the law did not oppose the DOJ’s request.
Healthcare Reform News Update for April 8, 2019
Kansas Lawmakers Approve Bill That Permits Farm Bureau Health Plan
Both the Kansas House and Senate passed a Republican-backed bill that allows the Farm Bureau to offer health coverage that doesn’t meet Affordable Care Act provisions.
Because the plans would not be considered insurance, people with pre-existing conditions could be refused coverage or have to pay more than other enrollees.
The Farm Bureau estimates that 42,000 Kansas residents who currently have no healthcare or who have problems affording an ACA plan would enroll in the new lower-cost option.
Democratic Governor Laura Kelly has not announced if she will sign the legislation.
Trump Administration Plans Future Healthcare Policy at Camp David Meeting
Acting White House Chief of Staff Mick Mulvaney met with White House aides and administration officials at Camp David on Saturday to discuss President Trump’s plan to replace the Affordable Care Act with a Republican option.
Attendees included Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma.
Mulvaney stressed that he’d like to see a proposal in place to put in front of voters prior to the 2020 elections. “I do think you’ll see a plan here fairly shortly,” he said.
Healthcare Reform News Update for April 3, 2019
Plan to Postpone ACA Replacement Came From Senate Majority Leader
Senate Majority Leader Mitch McConnell (R-KY) said that it was his consultation that prompted President Trump to announce that a Republican replacement to the Affordable Care Act would not occur until after the 2020 elections.
“We had a good conversation yesterday afternoon and I pointed out to him the Senate Republicans’ view on dealing with comprehensive healthcare reform with a Democratic House of Representatives,” said McConnell on Monday.
Instead of attempting to repeal and replace the ACA, McConnell said that Republican senators would focus on trying to lower prescription drug prices and other less comprehensive measures.
Wisconsin Withdraws From Two ACA Lawsuits
A federal judge granted permission for Wisconsin to drop out of two lawsuits against the Affordable Care Act at the request of Wisconsin Attorney General Josh Kaul.
The first lawsuit argues that the entirety of the ACA is unconstitutional. A federal Judge’s ruling that declared the ACA unconstitutional is currently being heard in a U.S. Appeals court, where Wisconsin is still party to the case. The state has also requested to be removed from the appeal and is awaiting a decision.
The second lawsuit challenges the ACA’s protections for transgender individuals and women seeking abortion. Arizona, Kentucky, Nebraska, and Mississippi continue to be listed as plaintiffs in that case.
Healthcare Reform News Update for April 2, 2019
President Moves Republican ACA Replacement Plan to After 2020
In a series of three tweets, President Trump said that a Republican replacement for the Affordable Care Act would be put up for a vote after the 2020 elections.
“The Republicans…are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare,” said Trump on Monday night. “Vote will be taken right after the Election when Republicans hold the Senate & win…back the House.”
GOP Attorneys General in Two States Ask Court to Uphold ACA
Republican attorneys general in Ohio and Montana filed a brief in the 5th U.S. Circuit Court of Appeals arguing that the federal judge that ruled that the Affordable Care Act unconstitutional was incorrect.
Dave Yost of Ohio and Timothy Fox of Montana say they support the elimination of the mandate, but believe that “…the District Court’s ruling is wrong, and its errors threaten harm to millions of people.”
As part of the appeal process, the court will review the ruling that declared that the elimination of the ACA’s individual mandate means the entire law should be struck down.
Healthcare Reform News Update for April 1, 2019
Senators to Debut Revised “Medicare X” Plan
Democratic Senators Tim Kaine (VA) and Michael Bennet (CO) will introduce a new “Medicare X” healthcare plan next week, which would create a public health insurance option.
The proposal retains employer health plans, but also allows consumers to purchase Medicare plans through the individual or small-business ACA exchanges.
“180 million people in America get their insurance through an employer-based plan and Medicare X gives people the opportunity to decide whether they want to stay on that plan,” said Bennet.
Features of the Medicare X plan include:
- access to the Medicare network of doctors,
- the ACA’s essential benefits, such as maternity and newborn care,
- the establishment of a federal reinsurance program to keep premiums down, and
- tax credits for higher-income Americans.
The plan would be gradually phased in over a five-year period, beginning in rural areas, then nationwide, and lastly to small businesses.
The proposal has no Republican cosponsors, although Bennet and Kaine are optimistic about the idea catching on.
House Resolution Criticizes President’s Position on ACA Lawsuit
The House will vote this week on a resolution that denounces President Trump’s decision to support a lawsuit that would eliminate the Affordable Care Act in its entirety.
The effort is led by Rep. Colin Allred (D-TX). According to the resolution, Trump has publicly claimed to support protections for those with pre-existing conditions while ordering the Department of Justice to “actively pursue the destruction” of the ACA and its protections in federal court.
Mick Mulvaney, the president’s acting chief of staff, said on Sunday that no Americans would lose healthcare coverage, even if the ACA is struck down. Currently, no replacement healthcare law has been proposed.
Republican Senator Asks Attorney General to Reverse ACA Decision
Sen. Susan Collins (R-ME) has sent a letter to Attorney General William Barr asking that he reverse the Department of Justice’s decision to support the removal of the Affordable Care Act.
“Rather than seeking to have the courts invalidate the ACA, the proper route for the administration to pursue would be to propose changes to the ACA or to once again seek its repeal,” Collins writes in the letter. “The administration should not attempt to use the courts to bypass Congress.”
In addition, Collins criticizes the DOJ’s refusal to defend the healthcare law in court. “The administration should reconsider its decision and defend the remainder of the ACA,” wrote Collins.