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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!
Healthcare Reform News Update for August 21, 2017
Iowa, Oklahoma Aim to Reform ACA Via Healthcare Waivers
Officials in Iowa are planning to submit a vast state healthcare waiver request to the Centers for Medicare and Medicaid Services (CMS) next week. The waiver would alter the “ACA premium tax credit model and use some of the federal subsidy money to set up a reinsurance program to protect insurers that sign up high-cost enrollees.”
Oklahoma officials filed a state waiver request to CMS last Wednesday. The waiver would “use federal subsidy money to fund a new reinsurance program, as the first step in a broader reform of the ACA coverage system.” The waiver also wants to change the ACA’s essential benefit requirements for individual coverage.
Both state waiver requests include replacing federal marketplaces with state-based platforms and changing the income eligibility for premium subsidies. They also share a main goal of lowering premiums and stabilizing the individual marketplace.
Healthcare Reform News Update for August 17, 2017
Iowa’s Single Remaining ACA Insurer Seeks Rate Hike
Medica, the only insurance company offering Obamacare marketplace plans in Iowa, has filed a revised premium rate increase of almost 57 percent. Medica cited uncertainty over cost-sharing reduction (CSR) payments as the reason for steep premium rate increases.
Geoff Bartsh, Medica’s vice president of individual and family business, said in a statement: “We remain hopeful the federal government will fund the cost-sharing reductions, but we are working with the Iowa Insurance Division to help consumers understand the implications of lack of this funding. We regret the disruption this creates for consumers.”
Trump Will Make August CSR Payments
August’s cost-sharing reduction (CSR) payments will be made to insurers, according to a White House spokesperson. However, no guarantee was made for future payments. An update on the CSR case (on whether or not the payments are constitutional) is expected Sunday, though it could get delayed again.
Healthcare Reform News Update for August 16, 2017
CBO Analysis Shows Impact of Ending CSR Payments
The Congressional Budget Office (CBO) released an analysis Tuesday titled “The Effects of Terminating Payments for Cost-Sharing Reductions.” Here are the overall effects noted in the analysis:
- Ending CSRs would increase the deficit by $194 billion over the next 10 years.
- The number of areas with no marketplace options (5 percent of Americans) would increase during the next two years and be about the same as it is now in 2020.
- The average premium for a marketplace silver plan will increase by 20 percent in 2018 and 25 percent in 2020.
- The premium increases will also expand the amount of premium tax credits, raising spending on subsidies by $365 billion over the next 10 years.
- The majority of people using premium tax credits (subsidies) will pay the same amount in premiums for the next 10 years.
- The uninsured rate would increase in 2018 but decrease slightly in 2020.
Centene Expands in Nevada to Cover ‘Bare’ Counties
Centene announced Tuesday that it will expand its individual marketplace coverage in Nevada. The company’s coverage means that no counties in Nevada, including rural areas, will be without a marketplace option. After Centene’s expansion, only 2 counties in the nation are currently left without a 2018 marketplace option: one county in Ohio and one in Wisconsin.
Healthcare Reform News Update for August 14, 2017
GOP Representatives Working on Marketplace Stabilization Bill
Representatives Mark Meadows (R-NC), chair of the Freedom Caucus, and Tom MacArthur (R-NJ), former chair of the Tuesday Group, are working together to create a marketplace stabilization bill. The bill is likely to fund cost-sharing reduction subsidies. Additionally, it may allow states to waive Obamacare regulations.
In relation to the bill, MacArthur said in a statement, “I’ve been working on a plan that will lower the cost of premiums, while stabilizing the individual marketplace, so that we can provide Americans with the high quality and affordable healthcare they deserve.”
CBO Analysis to Show Effects of Ending Insurer Payments
The Congressional Budget Office (CBO) announced Friday that it will release an analysis this week “detailing the effects of ending key Obamacare insurer payments,” also known as cost-sharing reduction (CSRs) payments. The president recently threatened to discontinue these payments, which help insurance companies lower out-of-pocket costs such as deductibles and copays.
CMS Extends Deadline for 2018 Rate Requests
The Centers for Medicare and Medicaid Services (CMS) announced Thursday that it would extend the Obamacare marketplace filing deadline. The deadline was extended by three weeks, making the new date September 5 and the final deadline September 20.
Anthem Exits Virginia’s Individual Marketplace
Health insurer Anthem Blue Cross Blue Shield announced Friday that it will stop offering individual marketplace plans for Virginia in 2018. The insurer cites the uncertainty in Washington as the reason for its departure. This is the third insurance company to exit Virginia’s ACA marketplace.
Healthcare Reform News Update for August 11, 2017
Freedom Caucus to Petition for ‘Clean Obamacare Repeal’ Bill
The conservative House Freedom Caucus is planning to file a petition Friday in order to influence House Speaker Paul Ryan (R-WI) to “bring up a so-called ‘clean Obamacare repeal’ bill.” The bill would repeal Obamacare after a transition of two years. However, the same bill failed in the Senate last month.
Kaiser Family Foundation Publishes 2018 Premium Preview
On Tuesday, the Kaiser Family Foundation published “An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges.” The study looks at initial premium rate charges and insurance companies’ participation in the marketplace for 2018 and makes comparisons to previous years. From the report: “In the past, requested premiums have been similar, if not equal to, the rates insurers ultimately charge. This year, because of the uncertainty insurers face over whether the individual mandate will be enforced or cost-sharing subsidy payments will be made, some companies have included an additional rate increase in their initial rate requests, while other companies have said they may revise their premiums late in the process.”
Healthcare Reform News Update for August 8, 2017
Anthem Exits More Marketplaces, BCBS Enters At-Risk Counties
Health insurer Anthem Inc announced Monday that it will no longer offer individual marketplace plans in Nevada and almost half of Georgia. However, the company’s Nevada exit does not create more counties without ACA options.
Meanwhile, Blue Cross and Blue Shield of Georgia will offer marketplace plans to 85 counties that would have had no ACA options in 2018 following Anthem’s exit. The insurance company will enter these counties after reaching an agreement with the state insurance commissioner.
A Look at Maine’s Medicaid Waiver
Maine has applied for a Medicaid waiver that includes:
- Work requirements
- Mandatory premiums ranging from $10-40
- Asset Testing: The asset test would be $5,000, though some argue the tests are unlawful.
Within the application, Maine states it is attempting to “preserve limited financial resources…[and] promote financial independence and transitions to employer-sponsored or other commercial health insurance.”
Healthcare Reform News Update for August 7, 2017
Senate Republicans Open Up to Bipartisan Healthcare Reform Ideas
Senate Majority Leader Mitch McConnell (R-KY) said Saturday that he is open to a bipartisan attempt to stabilize the individual marketplace. Other Republicans are also considering bipartisan ideas to reform Obamacare. Senator Thom Tillis (R-NC) said, “We have got a destabilized market where insurance rates are going to go up 20, 30, 40 percent next year. Anything that we can do to prevent that and the damage that that will have on people who need health care I think is something I have to look at.”
Molina Wins $52 Million in Obamacare Lawsuit
The U.S. Court of Federal Claims ruled Friday that the government owes Molina $52 million for payments the health insurer should have received under the risk corridor program. This temporary program established under Obamacare “was intended to promote accurate premiums in the early years of the exchanges (2014 through 2016) by discouraging insurers from setting premiums high in response to uncertainty about who will enroll and what they will cost.” According to the court’s opinion, “The government is liable for its breach of a statutory and contractual obligation to make full annual payments to insurers who participated in the risk corridor program.”
This Insurance Company’s Failure May Cause a Spike in Premiums
Recently, Penn Treaty American Corp., of Allentown, Pa., and two of its subsidiaries were forced to liquidate. It’s estimated that the parent company had $4 billion in claims liabilities but only $700 million in assets. The long-term care company’s implosion means that other companies have to “help pay off the company’s claims and protect policyholders through groups known as state guarantee associations.”
These industry assessments are usually based on market share, meaning larger insurers pay more. Health insurance companies that have to foot the bill may pass costs onto consumers, charging premium surcharges.
Healthcare Reform News Update for August 3, 2017
Six GOP Governors Move to Alter Medicaid
Republican governors in Arizona, Arkansas, Indiana, Kentucky, Maine, and Wisconsin have drafted plans that would modify the eligibility requirements for Medicaid enrollees in their states. Under some plans, employment requirements and drug testing for recipients would be introduced.
Molina Exits 2 Marketplaces, Eliminates Jobs
After significant second-quarter losses, Molina is exiting ACA marketplaces in Utah and Wisconsin. Molina’s exit in Wisconsin could leave one county without marketplace coverage options. Additionally, the company will increase premium rates in its remaining service areas in 2018 and eliminate around 1,500 jobs in an effort to save $300-$400 million by late next year.
BCBS of North Carolina Lowers Requested Rate Increase for ACA Plans
Blue Cross and Blue Shield of North Carolina announced Wednesday that it has lowered its requested rate increase for 2018 ACA plans from 22.9 percent to 14.1 percent. The company is the only healthcare insurer that offers ACA plans in the state. Brian Tajlili, director of actuarial and pricing services for BCBS of North Carolina, wrote this on the company’s website blog yesterday: “The individual market in North Carolina has become less volatile. […]We have gotten a better handle on the anticipated medical costs of people covered in this group which has made it easier for us to estimate the necessary price of our ACA health plans.”
Healthcare Reform News Update for August 2, 2017
Senate Will Hold Bipartisan Hearings to Stabilize Insurance Marketplace
The Senate’s Committee on Health, Education, Labor and Pensions will hold bipartisan hearings on ways to stabilize the Affordable Care Act marketplaces for 2018, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) announced Tuesday. Hearings are scheduled to start the first week of September. The committee will hear from ACA customers, governors, healthcare experts, insurance commissioners, and insurance companies.
The goal is to act by September 27, when health insurance companies must sign contracts to sell plans within the marketplace for 2018.
Democratic State Attorneys General Gain Right to Defend CSR Payments
A U.S. appeals court granted 16 attorneys general’s motion Tuesday to defend cost-sharing reduction (CSR) subsidy payments. Now, Democrats who want to uphold CSR payments have “the power to block a settlement or appeal a ruling blocking the payments.”
The court approved the motion because the attorneys general had displayed “a substantial risk that an injunction requiring termination of the payments at issue here…would lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the states will have to provide health care. In addition, state-funded hospitals will suffer financially when they are unable to recoup costs from uninsured, indigent patients for whom federal law requires them to provide medical care.”
Sanders Begins ‘Medicare for All’ Campaign
Senator Bernie Sanders (I-VT) has started his campaign for “Medicare for All”, a single-payer healthcare plan, with digital ads to gather voters’ support. The ads will direct supporters to Sanders’ website, where they can sign on to his bill. Sanders is currently finalizing the bill and creating a campaign strategy.
Sanders is also proposing a new rule for pricing on federally funded prescriptions. Sanders’ proposal would force “pharmaceutical companies to set reasonable prices for drugs developed using research funded by federal research dollars.”
States Expecting Premium Rate Increases, Decreases, and Coverage Changes
Increases: Insurance companies across the nation are raising premium rates as a result of the continued marketplace uncertainty. Covered California, for example, is expected to see an average rate increase of 12.5 percent. However, California’s increase is dwarfed by other states’ average increases. Premium rate increase requests of 20 percent, 30 percent, and even 50 percent for marketplace plans are being submitted to state insurance commissions.
Decreases: Going against the curve toward high rate increases, Alaska’s individual marketplace filed for a premium rate decrease of about 22 percent for 2018.
Coverage Changes: Anthem is exiting 16 regions in California’s Affordable Care Act marketplace for 2018. Anthem Blue Cross of California President Brian Ternan said in a statement, “The market for these plans has become unstable. And with federal rules and guidance changing, it’s no longer possible for us to offer some of those plans.”
Healthcare Reform News Update for August 1, 2017
If Trump Ends CSR Payments, Congress May Appropriate Funding
President Donald Trump is expected to decide early this week whether or not the administration will continue making cost-sharing reduction (CSR) payments. If he decides to end the payments, members of Congress have suggested that they might appropriate the funds.
- Senator John Thune (R-SD): “I hope the president will use his authority to extend those payments. He can do that. If he doesn’t, then Congress will have to look at what our options are.”
- Finance Committee Chairman Orrin Hatch (R-UT): “I think we’re going to have to [appropriate funds]…I’m for helping the poor, always have been. And I don’t think they should be bereft of healthcare.”
Republicans Rally Support for Graham-Cassidy Plan
A healthcare reform proposal suggested by senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) would give annual block grants to states, allowing each state to regulate healthcare as they see fit. States that expanded Medicaid are expected to be disadvantaged in the block grant proposal. The proposal would also:
- Force severe healthcare spending decreases
- Set new limits on Medicaid spending
- Endanger subsidies
Senators Cassidy, Graham, and Dean Heller (R-NV) met with Trump’s top aides Monday to discuss the proposal. The senators are trying to get the support of conservative colleagues Mike Lee (R-UT) and Mark Meadows (R-NC).
Senior GOP Senators Ready to Move Past Healthcare
Some Senate Republicans seem ready to move on to tax reform. During an interview with Reuters, Senator Orrin Hatch (R-UT) said, “There’s just too much animosity, and we’re too divided on healthcare. I think we ought to acknowledge that we can come back to healthcare afterward, but we need to move ahead on tax reform.”
Senator Roy Blunt (R-MO) echoed Hatch’s sentiment during an interview with CNN: “If the question is, ‘should we stay on healthcare until we get it done,’ I think it’s time to move on to something else. Come back to healthcare when we have more time to get beyond the moment we are in. See if we can put some wins on the board.”
Additionally, Senator John Thune (R-SD) told reporters, “Until someone shows us how to get that elusive 50th vote, I think it’s over.”
Five Insurers Will Cover 19 ACA Counties in Ohio
Buckeye Health Plan, CareSource, Medical Mutual of Ohio, Molina Healthcare Inc., and Paramount Health Care have all agreed to expand into the Ohio marketplace. The expansions will cover 19 of the 20 counties (about 11,000 people) that were at risk of having no Affordable Care Act marketplace options in 2018. Ohio is still working to cover the remaining county with no coverage options.
Healthcare Reform News Update for July 31, 2017
Bipartisan Leaders Unite to Fix Obamacare
The Problem Solvers caucus, a group of about 40 House Republicans and Democrats, have created a set of Obamacare fixes. The caucus plans to announce its potential solutions Monday and hope the suggestions will gain support after the recent failures to repeal and replace Obamacare.
The Obamacare fixes focus on:
- Stabilizing the marketplace as quickly as possible
- Funding cost-sharing reduction subsidies (CSRs)
- Altering the employer mandate to include only companies with more than 500 employees (rather than the current 50)
- Creating a federal stability fund to help states reduce healthcare costs for those with extremely high medical charges
- Eliminating the medical-device tax
- Creating greater flexibility for state innovation with stricter guidance on how states can use waivers
The Problem Solvers caucus is led by Tom Reed (R-NY) and Josh Gottheimer (D-NJ). Legislators from the New Democrat Coalition and the Republican moderate Tuesday Group are also involved with the caucus.
Trump Threatens to End CSR Payments if Reform Bill Fails
President Donald Trump threatened Saturday over Twitter to end cost-sharing reduction (CSR) payments if Congress doesn’t pass a healthcare reform bill. He also threatened to end funding for Congress’ healthcare. Trump’s tweet reads, “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”
What Could Happen if CSR Payments Are Eliminated?
If cost-sharing reduction (CSR) payments are no longer funded by the government, here are some likely effects.
Assuming states remain in ACA marketplaces:
- The cost of a silver plan’s premium will increase by 19 percent.
- 15 percent in states that expanded Medicaid
- 21 percent in states that did not expand Medicaid
- The increase in the benchmark silver plan would increase the amount of premium tax credits.
- The expense of increased tax credits would cost the federal government 23 percent more than it would save from eliminating CSRs.
- That is a cost of $2.3 billion for fiscal year 2018 and $31 billion over the next decade.
The change in price of silver plans may influence consumers to look for lower-cost plans, and enrollment could shift to other metal level plans. Some consumers might be encouraged to use subsidies they have not previously applied for.
Lawsuits Could Push Government to Pay ACA Insurers
Health insurance companies have filed almost two dozen lawsuits against the government over risk corridor funding. The companies claim that the government owes them $8 billion in payments from a program meant “to blunt their losses in the Obamacare marketplaces.”
Minuteman Health CEO Tom Policelli said, “[The Obama administration] repeatedly assured us it was there, and it would be a clear obligation of the government. Even the federal government is subject to the rules.”
HHS Secretary Promises to Uphold Obamacare
During an interview on “Meet the Press,” U.S. Health and Human Services Secretary Tom Price told NBC he would implement Obamacare as it was intended. “Our job is to follow the law of the land,” Price said, despite the fact he believes “the law … is failing the American people.”
Continued Marketplace Uncertainty Puts Hundreds at Risk
The four top health insurance companies that provide ACA coverage—Anthem Inc, Cigna Corp, Health Care Service Corp, and Molina Healthcare—continue to weigh whether or not to pull out of 2018 marketplaces.
There are currently 40 counties that could be left without a marketplace insurance option, but that could increase to hundreds of counties if insurance companies continue leaving the marketplace. Presently, more than 1,300 counties—primarily in 15 states—have only one insurer participating in 2018. Anthem and HCSC are the remaining insurers in one-third of those counties and states, leaving those areas at risk.
Healthcare Reform News Update for July 28, 2017
Senate Votes Down ‘Skinny’ Obamacare Repeal
A Republican Senate bill (nicknamed the “skinny repeal”) that would repeal the individual mandate, the employer mandate, and the medical excise tax was voted down Thursday night. Senators Susan Collins (R-ME), John McCain (R-AZ), and Lisa Murkowski (R-AK) joined their Democratic colleagues in voting against the measure.
Following to vote, Senate Majority Leader Mitch McConnell (R-KY) said it was time for the Senate to move on from healthcare reform. Other senators suggested attempting a bipartisan approach to stabilizing health insurance marketplaces, but the next steps in healthcare reform are unclear.
Healthcare Reform News Update for July 27, 2017
Senate Votes Down Two Healthcare Reform Proposals
Two healthcare reform proposals were put to a vote Wednesday on the Senate floor. First, the repeal and delay bill was voted down 45-55. The proposed legislation included an amendment from Senator Rand Paul (R-KY) that would ban the use of subsidies to buy plans that cover abortion. Seven Republicans and all Democrats voted against the measure. Next, a vote to return healthcare reform to a committee process was voted down 48-52. All Republicans voted against the measure, and all Democrats voted for it.
Senate Republicans Unite Behind ‘Skinny Repeal;’ House Is Wary
After a full repeal bill was rejected Wednesday, Senate Republicans are moving on to their back-up plan: a “skinny repeal.” The proposal would eliminate the individual mandate, the employer mandate, and one ACA tax. It would also allow Republicans to succeed in passing a healthcare reform bill.
However, House conservatives seem to disagree with a small repeal. On Wednesday, Representative Mark Meadows (R-NC) told reporters that a skinny repeal delivered to the House would be “dead on arrival.” Speaking on the idea of a scaled-back repeal, Representative Mark Walker (R-NC) said, “I don’t think it’s going to be very well received.”
What Could a ‘Skinny Repeal’ Mean for Individual Marketplaces?
Health insurance companies have warned that a “skinny repeal” of the ACA’s mandates could hurt the individual health insurance market. CareFirst BlueCross and BlueShield President and CEO Chet Burrell said that eliminating the individual mandate would dismantle the individual market. “It is hard to think of anything more devastating, especially if nothing else is done to stabilize the health insurance market,” Burrell said. “The significant coverage gains we have made for Americans in recent years would be wiped away with this damaging blow.”
The Congressional Budget Office (CBO) determined that a “skinny repeal” would cause 16 million more Americans to become uninsured by 2021. Additionally, premiums would increase by around 20 percent annually.
Anthem May Exit More Marketplaces
Anthem CEO Joe Swedish said Wednesday that the company needs “certainty quickly” on whether Congress will move to fund cost-sharing subsidies, which low-income Americans who buy ACA plans use to pay their out-of-pocket costs. Swedish said, “There are still many areas of marketplace uncertainty—principally, cost-sharing reduction subsidy funding—that make it challenging to be comfortable with the level of predictability of a sustainable marketplace. If we aren’t able to gain certainty on some of these items quickly, we do expect that we will need to revise our rate filings to further narrow our level of participation.”
The company has already announced its intentions to stop selling individual coverage on public exchanges in three states next year.
Healthcare Reform News Update for July 26, 2017
Senate Votes Against First ACA Repeal, Replacement Proposal
In a 43-57 vote, the Senate opposed an initial repeal-and-replacement proposal for Obamacare on Tuesday night. The vote rejected the Senate’s healthcare bill (the Better Care Reconciliation Act) and proposals from Senators Ted Cruz (R-TX) and Rob Portman (R-OH). This was the first amendment to get a vote after the Senate picked up the American Health Care Act, the House-passed bill that is being used as a vehicle for any Senate action.
Which Bills Will the Senate Vote on Next?
Wednesday afternoon: The Senate will vote on a repeal-and-delay bill with the Paul amendment, which would ban the use of subsidies to buy plans that cover abortion. If that bill does not pass, the Senate will vote on whether or not to return healthcare reform bills to a bipartisan process.
Later: If senators cannot agree on a comprehensive repeal or replacement for Obamacare, Republicans may move forward with a “skinny” repeal. The smaller repeal would eliminate the individual mandate, the employer mandate, and the medical device tax. The scaled-down bill would allow the Senate to succeed in passing a bill and start negotiations with the House.
The Senate may also vote on a Graham-Cassidy amendment, which keeps the ACA’s taxes and allows states to administer health insurance. As a note, Senate members still have time to propose new healthcare bills.
Senate Parliamentarian Advises Against Two Additional Senate Bill Provisions
Two more provisions from the Republican healthcare bill may not meet reconciliation standards, Senate Parliamentarian Elizabeth MacDonough said Tuesday. If the provisions are argued against and found to fall outside of reconciliation standards, they will need 60 votes (rather than 51) to be included in a healthcare bill. The two provisions advised against: 1) allowing insurance companies to increase the amount they charge older individuals in comparison to younger ones and 2) allowing small businesses to create association health plans.
Healthcare Reform News Update for July 25, 2017
Senate Healthcare Bill Advances With 51-50 Vote
Vice President Mike Pence cast the tiebreaking vote to move the legislation to repeal Obamacare to floor debate. Senator John McCain (R-AZ), who was recently diagnosed with brain cancer, returned to Washington on Tuesday to participate in the Republican-led healthcare vote. He voted in favor of the legislation—a critical move after fellow senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) expressed their opposition. Here’s a closer look at how each senator voted.
President Donald Trump praised the Senate and thanked McCain for advancing the legislation: “I’m extremely happy that we got this vote. This is the tough vote to get. Now we’re all going to sit together, and we’re going to try and come up with something that’s really spectacular. We have a lot of options and a lot of great options. And the Republican senators really went out there—it’s not easy.” Trump criticized Collins and Murkowski’s opposition, saying the result is “very, very sad for them.”
The legislation will move to floor debate; however, it’s not guaranteed what the final bill will look like or if there will be enough votes to pass it.
Democrats Lay Out a 3-Tier Approach to Lowering Prescription Costs
- The proposal would “create an independent, Senate-confirmed ‘price gouging’ enforcer to identify medicines with ‘unconscionable’ price increases and impose fines on manufacturers that are proportional to the size of the price hike. Money paid will be given to the National Institutes of Health (NIH) to further its work on new drug development.”
- Drug makers would also be required to publicly justify extreme pricing increases to the U.S. Department of Health and Human Services (HHS) at least 30 days before the cost change will begin
- The government would be allowed to negotiate prescription drug prices for medications covered by Medicare Part D.
Healthcare Reform News Update for July 24, 2017
Senate Parliamentarian: Parts of Updated Bill Don’t Meet Reconciliation Rules
Abortion provisions in the Senate bill would need a super-majority vote, Senate Parliamentarian Elizabeth MacDonough said Friday. Provisions eliminating Medicaid coverage requirements, altering medical loss ratios for insurance companies, and pertaining directly to New York would require a super-majority vote, MacDonough said. That means these provisions would need 60 favorable votes to pass and follow Senate rules (rather than the 50 Republicans anticipated) because they do not follow reconciliation rules.
Senate Republicans Determined to Hold Healthcare Vote This Week
Senate Majority Leader Mitch McConnell (R-KY) is pressing forward to hold a vote this week on healthcare reform. Two key factors remain unclear: which legislation will be voted on and whether or not Republicans have the necessary support to move the bill forward.
Senator Susan Collins (R-ME) told “Face the Nation” that Senators “don’t know whether we’re going to be voting on the House bill, the first version of the Senate bill, the second version of the Senate bill, a new version of the Senate bill, or a 2015 bill that would have repealed the Affordable Care Act now and then said that somehow we’ll figure out a replacement over the next two years.”
Senator Rand Paul (R-KY) echoed Collins’ confusion, telling CNN’s “State of the Union,” “The real question is, what are we moving to? What are we opening debate to?”
A Look at Premiums, Deductibles Under the ACA Versus the Senate Healthcare Bill
The Kaiser Family Foundation has published an interactive map comparing premiums and tax credits under the Affordable Care Act (current law) and the Better Care Reconciliation Act (Senate healthcare bill). The map includes estimates by county, age, and income.
The Hill has reported on the Congressional Budget Office’s (CBO) analysis of the Senate healthcare bill, specifically on drastically increasing deductibles. The CBO found that “a standard benchmark plan under the GOP bill could face a deductible of $13,000 in 2026.” Under Obamacare, someone making around $57,000 would have a deductible of $5,000, and someone making around $27,000 would have a deductible of $800.
Healthcare Reform News Update for July 21, 2017
GOP Plans a Healthcare Vote for Tuesday
Republican senators are pushing for a Tuesday vote on a healthcare reform bill. However, it’s not clear which legislation senators will be voting on or if Republicans have the necessary votes to move a bill forward.
This year, several different healthcare reform bills (and versions of those bills) have been introduced.
- The American Health Care Act was passed by the House.
- The Better Care Reconciliation Act, created by the Senate, was originally introduced June 22.
- The first revision, introduced July 13, included the Cruz Amendment, additional funding for opioid treatment, and other small changes.
- The second revision was introduced July 20. The Cruz Amendment was removed, some Obamacare taxes remained, and other small changes were made.
- The Obamacare Repeal Reconciliation Act, a repeal-only bill, has also been introduced by the Senate.
Even if Republicans can get enough votes to proceed, it isn’t clear which of the bills above will be presented. Also, Senator John McCain (R-AZ), who was diagnosed with brain cancer earlier this week, is still recovering from surgery, lowering the GOP’s already slim majority in the Senate. However, Rand Paul (R-KY) said Thursday he will vote yes to proceed with the House-passed bill, but he has stipulations. He told reporters, “If they want my vote, they have to at least agree that we’re going to at least have a vote on clean repeal.”
CBO Analysis: 22 Million Would Lose Coverage Under Latest Healthcare Bill
The Congressional Budget Office (CBO) released its examination of the Senate’s most recent healthcare bill. According to the report, the Senate healthcare bill will:
- Reduce the federal deficit by $420 billion over the next 10 years
- The initial Senate bill reduced the deficit by $321 billion.
- Increase the number of uninsured people by 22 million in 2026
- Decrease premiums by 30 percent after 2020
- Create a standard-level plan deductible of $13,000
Trump Administration Ends ACA Help in 18 Cities
Last week, community groups were told that “Affordable Care Act contracts that brought assistance into libraries, businesses, and urban neighborhoods in 18 cities” would be terminated. The end of these contracts means that potential enrollees shopping on the individual marketplace “will have fewer places to turn for help signing up for coverage.”
Centers for Medicare & Medicaid Services spokesperson Jane Norris said the contracts were never meant to last long term. “These contracts were intended to help CMS provide temporary, in-person enrollment support during the early years.”
Healthcare Reform News Update for July 20, 2017
Senate Republicans Resume Talks on Healthcare Bill
Rather than moving forward with a repeal-only bill, GOP senators are reopening negotiations on their healthcare reform legislation. This change in direction occurred after a Wednesday meeting at the White House with President Donald Trump.
During the meeting, Trump told senators they should cancel their August recess and stay until a healthcare reform bill is finalized. “We shouldn’t leave town until this is complete. We should hammer this out and get it done,” Trump said during the lunch meeting. Additionally, Trump suggested senators repeal and replace Obamacare at the same time: “We can repeal, but we should repeal and replace. Frankly, I don’t think we should leave town unless we have a health insurance plan, unless we can give people great health care.”
Senate Healthcare Bill Renegotiations May Include ‘Medicaid Wraparound’
Senate Republicans are rushing to settle their healthcare reform bill. In order to win over moderates, one change may include a “Medicaid wrap-around.” This would allow states to use additional Medicaid funding to cover healthcare costs for individuals who would lose coverage when Medicaid expansion ends. The additional funding, estimated around $200 billion, would primarily be given to states that expanded Medicaid.
CBO: 32 Million Would Lose Insurance By 2026 After a Straight ACA Repeal
The Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) released an analysis of the effects enacting the Obamacare Repeal Reconciliation Act of 2017 would have on Americans. This amendment would revoke many provisions of Obamacare. Here are the main findings:
- The bill will reduce the federal deficit by $473 billion over the next decade.
- The bill will increase the number of uninsured people by 17 million in 2018.
- 27 million in 2020
- 32 million in 2026
- The bill will increase the average individual premium by 25 percent in 2018.
- 50 percent in 2020
- 100 percent in 2026
- By 2020, 50 percent of Americans will live in areas with no individual health insurance options.
- 75% in 2026
Healthcare Reform News Update for July 19, 2017
Senate Will Hold Healthcare Repeal Vote Next Week
The Senate is expected to vote early next week on whether or not to pick up the House’s passed healthcare bill, Senate Majority Leader Mitch McConnell (R-KY) announced Tuesday night. If the vote passes, the Obamacare repeal proposal would be added as an amendment to the existing bill.
During his announcement, McConnell said, “For the information of all senators, at the request of the President [Trump] and Vice President [Pence] and after consulting with our members, we will have the vote on the motion to proceed to the Obamacare repeal bill early next week.”
Senators Susan Collins (R-ME), Lisa Murkowski (R-AK), and Shelley Moore Capito (R-WV) are expected to vote “no” on the legislation.
Trump to Talk Healthcare With GOP Senators Over Lunch
The meeting comes after Trump made several comments suggesting Republicans allow the marketplace to collapse. Trump said, “I think we’re probably in that position where we’ll let Obamacare fail. We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us.”
Are There Enough Insurance Companies on the Individual Marketplace for 2018?
Bloomberg has collected data on the nation’s individual insurance marketplace. Although select areas will struggle to find individual coverage, the vast majority of Americans will have options.
- 0.2 percent of enrollees will have no marketplace options.
- Nevada will be heavily affected by the lack of marketplace options.
- 20 percent of enrollees will have 1 marketplace option.
- 22 percent of enrollees will have 2 marketplace options.
- 23 percent of enrollees will have 3 marketplace options.
- 34 percent of enrollees will have 4 or more marketplace options.
Healthcare Reform News Update for July 18, 2017
GOP Senate Healthcare Bill Halted; Reform Talks Continue
Senate Majority Leader Mitch McConnell (R-KY) announced late Monday that the Senate will drop its latest healthcare reform bill. The decision came after Senators Jerry Moran (R-KS) and Mike Lee (R-UT) said they would not support the legislation. The senators joined colleagues Rand Paul (R-KY) and Susan Collins (R-ME) in their opposition, leaving the bill no chance of passing if put to a vote.
McConnell’s efforts are now focused on pushing senators to vote on a bill that will repeal Obamacare within two years.
In a statement, McConnell said: “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful. So, in the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.”
Healthcare Reform News Update for July 17, 2017
Senate Healthcare Vote, CBO Score Delayed
Senator John McCain (R-AZ) recently announced a planned absence to undergo surgery to remove a blood clot above his left eye. With the temporary loss of McCain’s vote, Senate Majority Leader Mitch McConnell (R-KY) decided Saturday to delay the highly anticipated vote on the Senate healthcare bill. The postponement is expected to last for a week, allowing McCain to recover from surgery and return to Capitol Hill. The Senate is split 52-48 between Republicans and Democrats. (Here is where GOP senators stand on the updated bill.) In order for the legislation to pass, McConnell can’t lose more than two votes.
Adding to the Senate’s delay, the Congressional Budget Office (CBO) announced Sunday that it was not prepared to release an analysis of the Senate’s updated bill. The CBO was expected to release an analysis on Monday.
Two Leading Health Insurance Organizations Oppose Cruz Amendment
America’s Health Insurance Plans and the Blue Cross Blue Shield Association, two influential health insurance groups, wrote the Senate a letter requesting the removal of the Cruz Amendment from the updated healthcare bill. The Cruz Amendment would allow insurance companies to sell plans that do not meet Affordable Care Act coverage requirements as long as at least one plan that does meet coverage requirements is offered.
In the letter, the organizations include these statements: “As healthy people move to the less-regulated plans, those with significant medical needs will have no choice but to stay in the comprehensive plans, and premiums will skyrocket for people with pre-existing conditions…Finally, this provision will lead to far fewer, if any, coverage options for consumers who purchase their plan in the individual market. As a result, millions of more individuals will become uninsured.”
Colorado’s Individual Market Will See Large Premium Hikes
Health insurance companies participating in Colorado’s individual market are requesting an average premium rate increase of 27 percent. Colorado Insurance Commissioner Marguerite Salazar expressed her lack of surprise in the high rate requests. In an interview, Salazar said, “I believe that the dubious situation at the federal level has contributed to the premium increase requests we’ve seen from the companies.”
Healthcare Reform News Update for July 14, 2017
Where GOP Senators Stand on the Updated Healthcare Bill
Here is how Senate Republicans are leaning. Two Republican senators have said they will oppose the new piece of legislation:
- Susan Collins (R-ME)
- Rand Paul (R-KY)
Eight Republican senators have either currently or previously expressed concerns over the bill’s language and are likely to vote against it without change:
- Shelley Moore Capito (R-WV)
- Bill Cassidy (R-LA)
- Bob Corker (R-TN)
- Dean Heller (R-NV)
- John McCain (R-AZ)
- Lisa Murkowski (R-AK)
- Rob Portman (R-OH)
- Ben Sasse (R-NE)
Twenty-three Republican senators are unsure, and the remaining 19 are likely to vote yes on the bill in its current state.
Senator Lindsey Graham Introduces State-Focused Healthcare Proposal
In the event that the Senate GOP’s healthcare bill does not progress, Senator Lindsey Graham has introduced a separate proposal. In Graham’s plan, federal funding for healthcare would be sent directly to states to allocate as they see fit.
When talking about the bill, Graham explained: “Instead of having a one-size-fits-all solution from Washington, we should return dollars back to the states to address each individual state’s health care needs. Just like no two patients are the same, no two states’ health care needs are the same. A solution that works in California may not work in Virginia. These funds are already being spent on Obamacare, but instead of having Washington decide, we’ll empower each individual state to choose the path that works best for them.”
Graham has been working with colleague Bill Cassidy on the proposition.
Healthcare Reform News Update for July 13, 2017
Senate Releases Updated Healthcare Reform Bill
- Obamacare taxes: For individuals making more than $200,000, a 3.8 percent investment tax would no longer be repealed. Additionally, taxes on health-insurance executives and a Medicare tax would no longer be repealed.
- Opioid crisis funding: Financing to tackle the nation’s opioid dilemma would increase from $2 billion to about $45 billion.
- The Cruz amendment: A modified version of Texas Senator Ted Cruz’s amendment, which allows health insurance companies to sell plans with less coverage if they also sell ACA-compliant plans, is included in the Senate’s healthcare bill.
- Tax credits on catastrophic coverage: Under the updated Senate healthcare bill, individuals would be allowed to use tax credits to purchase these high-deductible plans.
- State individual market stability fund: Funding to help states lower premiums and healthcare costs would increase by $70 billion. This is an addition to the $112 billion allotted in the Senate bill’s previous version.
- Health savings accounts and premiums: A new provision in the Senate bill would allow individuals to use health savings accounts to pay for their premiums.
The revised bill does not address cuts to the Medicaid program that concern many moderate Republican senators. However, it would lift federal budget restraints “for areas of a state during a declared emergency.”
Senate Parliamentarian Agrees House’s Healthcare Bill Follows Reconciliation Rules
Elizabeth MacDonough, the Senate Parliamentarian, has agreed with Republicans and decided that the House’s healthcare bill follows Senate reconciliation rules. This judgement will allow the Senate to make revisions without any procedural obstacles, although members are already modifying their own healthcare bill.
House Subcommittee Proposes $1.1 Billion Funding Increase for NIH
The House subcommittee proposed a $1.1 billion funding increase for the National Institutes of Health (NIH) on Wednesday. The White House previously suggested a $5.8 billion decrease in funding, though the proposal was met with opposition from members of both congressional parties.
President Trump Will Be ‘Very Angry’ If Obamacare Reform Bill Does Not Pass
During an interview with Christian Broadcasting Network’s Pat Robertson, President Donald Trump said this about the possibility that the Senate won’t pass a healthcare bill: “Well, I don’t even want to talk about it, because I think it would be very bad. I will be very angry about it, and a lot of people will be very upset. But I’m sitting waiting for that bill to come to my desk. I hope that they do it. They’ve been promising it for years…He’s got to pull it off. [Senate Majority Leader Mitch McConnell (R-KY)] has to pull it off. He’s working very hard. He’s got to pull it off.”
Healthcare Reform News Update for July 12, 2017
The Senate Is Looking Into a Possible Bipartisan Bill to Reform Healthcare
Since the GOP’s healthcare bill might not pass in the Senate, many lawmakers are considering a bipartisan effort to reform healthcare. Around a half-dozen Republicans are holding discussions with Democrats about coming together to prevent the possibility of a complete collapse of small-group and individual insurance markets throughout the country.
Many Democrats see this as an opportunity to prevent a complete repeal of a key accomplishment of the Obama years. Some Republican senators, under pressure from constituents who are worried about losing their healthcare, believe a bipartisan bill could alleviate many problems. The bill’s main ideas involve creating a reinsurance fund and authorizing cost-sharing payments for [insurance companies] so they don’t have to raise prices for covering a sicker pool of customers.
Senate Republicans Will Unveil a Revised Healthcare Bill on Thursday
Majority Leader Mitch McConnell (R-KY) plans to unveil the details of the Senate’s healthcare reform bill tomorrow. The Senate is expected to reject this bill, according to key Republican senators such as Charles Grassley (R-IA), John McCain (R-AZ), and Susan Collins (R-ME).
GOP Drops Tax Cuts For Higher-Income Earners in Revised Health Bill
In a move designed to win over some moderate Republicans, the Senate Republican leadership is dropping its plans to remove the Affordable Care Act’s 3.8 percent tax on investment income for people who earn more than $200,000 and couples who earn more than $250,000. This could produce nearly $231 billion in revenue over a decade, according to the Joint Committee on Taxation.
Some sources are suggesting that Senator Mitch McConnell, in closed-door talks, is negotiating with Republican holdouts about other components of healthcare spending as well. A GOP aide requesting anonymity suggested that increased Medicaid funding and increased funding to stabilize the cost of premiums for individuals might be under consideration.
Texas Senator’s Amendment Could Raise Premiums For 1.5 Million People With Pre-Existing Conditions
Senator Ted Cruz (R-TX) is sponsoring an amendment that would give insurance companies the power to sell plans in the individual insurance market that don’t meet two major Affordable Care Act requirements (essential health benefits and community rating). The stipulation is that insurance companies must also offer plans that do meet these ACA necessities. Many conservatives have expressed support for this amendment. They believe it would encourage insurance companies to offer cheaper insurance plans to some people.
The amendment’s critics, including Democrats and moderate Republicans, contend that the amendment would create two tiers of plans, which could allow insurance companies to entrap sick people into plans they’ll need but won’t be able to afford. Also, 1.5 million people with pre-existing conditions could face higher premiums with the amendment, according to a Kaiser Family Foundation analysis.
Healthcare Reform News Update for July 7, 2017
If Senate’s Bill Doesn’t Pass, McConnell to Seek Stabilizing Legislation
According to Senate Majority Leader Mitch McConnell, if a full repeal and replacement of Obamacare does not occur, the Senate will have to work on a limited bill to stabilize the individual marketplace. Because this type of limited bill would not fall under reconciliation, the GOP would have to work with Democrats to pass a stabilization bill.
In a response to questions about if the GOP will need bipartisanship for healthcare reform, Senator McConnell said, “If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur.”
Senate Not Expected to Vote on Bill Immediately After July 4 Recess
Several Republican senators have said that a healthcare vote won’t happen next week.
- Senator Pat Toomey: “We’re still several weeks away from a vote, I think.”
- Senator Ted Cruz said that a vote might occur “in the next several weeks.”
- Senator Mitch McConnell also predicted that a healthcare vote would happen in a “couple weeks.”
Aetna Better Health of Illinois Threatens to Leave Illinois Medicaid Program
In a court filing last week, Aetna Better Health of Illinois said Illinois had not paid an owed amount of $698 million dollars. Company President Laurie Brubaker said last week that Aetna will pull out of Illinois’ Medicaid program if the state did not pass a budget by July 1 and pay Aetna the owed amount.
Georgia Expected to See Large Premium Hikes for 2018 Marketplace Plans
Many Georgia health insurance companies are increasing premiums as healthcare reform uncertainty continues, including Blue Cross and Blue Shield of Georgia, which is the only insurance company in all Georgia counties. Companies are seeking these average premium increases:
- Blue Cross and Blue Shield of Georgia: 40%
- Kaiser Foundation Health Plan of Georgia: 25%
- Alliant: 18.6%
- Ambetter of Peach State: 12.4%
Healthcare Reform News Update for July 5, 2017
The House Has Drafted a Provision That Would Prevent the IRS from Enforcing the Individual Mandate
The House Committee on Appropriations has written a provision that would prevent the IRS from enforcing the tax penalties associated with the individual mandate. The drafted provision is not part of the House’s nor the Senate’s healthcare reform bills. The provision would also prevent the IRS “from enforcing a requirement that employers and insurance companies inform the government of the name and Social Security number of anyone to whom they provide health insurance coverage.” The government currently uses this information to enforce the individual mandate and other requirements.
Insurance Companies on the Marketplace May Ask for Enrollment Caps
Insurance companies that have not left the marketplaces have seen their enrollment increase, but those increases haven’t translated to higher profits, as many of the new enrollees are unhealthy individuals who require expensive medical care. Because their risk pools are unequal (with more sick individuals than healthy ones), many companies worry that they will lose money. In order to stem their losses, some companies may ask the government to cap enrollment for their plans.
Centene’s Entrance Into Missouri’s Marketplace Will Cover Potentially Barren Counties
On Friday, Centene announced that it would enter the Missouri health insurance marketplace for 2018. The company states that it plans to cover 39 counties, including 25 counties that would have had no individual insurance options. In a statement, Centene’s chairman, president, and chief executive Michael Neidorff said, “We strive to be a responsible partner with the state and are committed to working closely with regulators and policymakers to collaborate on actions that stabilize the market and offer affordable coverage options.”
Healthcare Reform News Update for July 3, 2017
Conservative Republicans Bring Up an Old Idea: Repeal Now and Replace Later
Senator Ben Sasse brought up the “repeal now and replace later” idea in both a letter to the President and on Fox News. Senator Rand Paul and an advocacy group called Americans for Prosperity seem to support the idea. In a Tweet, President Trump also voiced support for the two-step approach.
Premier Health Plan and Memorial Hermann Health System Announce Market Exits
Premier Health Plan has announced that it will leave Ohio’s individual health insurance market. The company cited uncertainty over the individual Marketplace and difficulty pricing as its reason to exit the market.
Memorial Hermann Health System will completely exit the individual market at the end of 2017. A spokeswoman explained the company’s exit in an email: “After careful consideration, Memorial Hermann Health Plans has made the difficult decision to withdraw from the individual segments due to challenging market conditions and continued uncertainty in this segment of the health insurance industry.” The company will still sell Medicare Advantage plans.
Healthcare Reform News Update for June 30, 2017
CBO Publishes Separate Analysis on Medicaid Spending and Its Effects
The Congressional Budget Office (CBO) has published a secondary Medicaid analysis titled the “Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending.” The analysis finds that under the Better Care Reconciliation Act of 2017, Medicaid spending would decrease by 26% in 2026. That percentage increases to 35% in 2036.
Senator Ted Cruz Proposes Allowing Insurance Companies to Sell Cheap Plans with Fewer Benefits
In order to win over conservatives and introduce plans with lower premiums, Senator Ted Cruz has given the GOP a proposal to let insurance companies sell plans that have fewer benefits. The plans would be less expensive, but may take young and healthy individuals out of the same market pool as sick and older Americans. This could increase costs for the ill and elderly, and it may also lead to adverse selection in the individual marketplace.
Healthcare Reform News Update for June 29, 2017
Changes to the Senate’s Healthcare Bill Underway
Two changes are already being added to the Better Care Reconciliation Act of 2017 (the Senate’s healthcare bill). The White House and Senate Republicans have agreed to add $45 billion in funding in order to address the opioid crisis. Additionally, Senators may soon agree to let Americans pay their premiums with their health savings accounts (HSAs).
Republican Senators Question Tax Eliminations in GOP’s Healthcare Bill
Some Republican senators have started questioning whether the GOP’s healthcare bill should repeal certain taxes on high-income earners while cutting back on subsidies and Medicaid. Susan Collins, Mike Rounds, and Bob Corker have publically criticized the tax repeal.
- Senator Collins: “I do not see a justification for doing away with the 3.8 percent tax on investment income, because that is not something that increases the cost of health care.”
Senator Corker: “I want to make sure that we’re not in a situation where we’re cutting taxes for the wealthy and at the same time … passing a larger burden on to [lower-income citizens].”
Senators Reiterate Requests After GOP’s Healthcare Vote Postponed
With the GOP’s healthcare vote delayed until after the July 4 recess, Senators on both sides of the aisle are repeating their previous healthcare reform requests. Republican Senator Rand Paul “highlighted a letter he sent to President Donald Trump and Senate GOP leaders with a list of conservative proposals that would help resolve his issues with Senate Republicans’ health care legislation.” While the proposal would please conservatives, the requests detailed in it are likely to alienate moderates.On Tuesday, Senate Minority Leader Chuck Schumer also repeated his previous requests for bipartisan healthcare reform.
President Trump Accuses Democrats of Misstating Facts About Medicaid Spending
In a Tweet posted on Wednesday, President Donald Trump said, “Democrats purposely misstated Medicaid under new Senate bill – actually goes up.” While the total spending for Medicaid would indeed slowly increase, “the accounting he uses to show Medicaid spending is wildly divergent from the way budget analysts, policymakers and many lawmakers account for spending levels.” When accounting for inflation, Medicaid spending would not increase. Instead, there would be a decrease of around $772 billion in federal Medicaid outlays.
Healthcare Reform News Update for June 28, 2017
Senate Healthcare Vote Won’t Happen Before July 4 Recess
On Tuesday, Senate Republicans announced they will delay a healthcare reform vote until after the July 4 recess. Although the GOP planned to have a vote by the end of this week, opposition within the Republican Party over the Senate bill’s current language remains unresolved.
After the announced delay, President Trump told senators at a White House meeting, “This will be great, if we get it done. And if we don’t get it done, it’s just going to be something that we’re not going to like, and that’s OK and I understand that very well. But I think we have a chance to do something very, very important for the public, very, very important for the people of our country that we love.”
Also after the announcement, 3 more Republican senators announced that they would not have supported a healthcare vote this week.
The GOP will revise its healthcare bill over the July 4 recess, which will need a new analysis from the Congressional Budget Office. Republicans hope to vote after the recess.
Healthcare Reform News Update for June 27, 2017
CBO Releases Analysis of Senate’s ‘Better Care Reconciliation Act of 2017’
The Congressional Budget Office (CBO) has released its analysis of the Senate’s healthcare reform bill, called the Better Care Reconciliation Act of 2017 (BCRA). Here are some of the main takeaways:
The Uninsured Rate
- 15 million more Americans would be uninsured by 2018. This is mostly due to the elimination of the individual mandate.
- 22 million more Americans would be uninsured (compared to the Affordable Care Act) in 2026.
- This means that a total of around 49 million Americans would be uninsured by 2026. (Around 28 million would be uninsured in 2026 under the ACA.)
- For comparison, the House’s bill increased the uninsured population to 23 million.
The Federal Deficit
The federal deficit would decrease by $321 billion by 2026. (The House’s bill decreased the deficit by $119 billion.)
- Over the next 10 years, the government would decrease Medicaid spending by $772 billion (26%). (The House’s bill reduced Medicaid spending by $834 billion.)
- By 2026, enrollment in Medicaid would decrease by 16% for those under the age of 65.
The Individual Market
- In most parts of the United States, the individual health insurance market will remain stable in 2020.
- Due to state waivers on essential health benefit requirements, some insurance plans that cover certain services will become more expensive in those areas.
- Individuals who require waived essential health benefits will see substantial increases in their out-of-pocket costs or skip those services.
- Individuals who live in states that have waived certain services could also see large increases in their out-of-pocket costs because annual and lifetime limits wouldn’t be capped.
- The average premium will rise faster than the ACA’s average premium until 2020. Then, the increase in premium costs will slow.
- By 2026, the average premium is expected to be 20% less.
- This is mostly because 1) plans will cover fewer costs and services and 2) there’s federal funding aimed at lowering premium prices.
- For example, let’s compare the costs for a 45-year-old male below 200% of the federal poverty level. For the ACA premium after tax credit, he would pay $67. For the Senate’s BCRA premium after tax credit, he would pay $215. See more premium comparisons here.
- Over the next 10 years, the government will lose $541 billion in revenue by repealing the ACA’s tax provisions.
- Because of the lower actuarial value for a benchmark plan (meaning a plan covers fewer costs) and higher deductibles, few low-income Americans will purchase Marketplace plans in 2020.
After CBO’s Analysis, Republican Senators to Oppose Procedural Vote
Shortly after the Congressional Budget Office (CBO) released its analysis of the Better Care Reconciliation Act of 2017, several Republican senators “threatened to oppose beginning debate.”
- Susan Collins said she would vote no to the Senate’s bill. In a tweet, she said she’d rather have a bipartisan fix to the ACA.
- Rand Paul, Dean Heller, Ted Cruz, and Mike Lee are expected to vote against the motion without further changes to the bill.
- Ron Johnson said he would have a “hard time believing” he had the information he needed to vote for a motion this week.
With the additional savings estimated by the CBO, Republicans have some leeway to try and negotiate with Senators (by editing the healthcare reform bill) in order to win their support.
Senate Adds a Waiting Period to Its Bill
The Senate has revised the Better Care Reconciliation Act of 2017 (BCRA) to include a waiting-period penalty for individuals who let their coverage lapse. “Starting in 2019, people who try to buy a healthcare insurance policy during open enrollment, or because of a life-qualifying event, will not be able to do so for six months if they had a break in coverage of 63 days or longer during the prior year.”
California Won’t See a Single-Payer Healthcare System This Year
The leader of the state Assembly in California announced that he will not proceed with a single-payer healthcare system this year. Although a single-payer bill passed the state Senate, Speaker Anthony Rendon said the bill doesn’t properly detail “delivery of care and cost.”
Senators May Add Penalties for Lapses in Coverage to Healthcare Bill
The “discussion draft” of the Senate’s healthcare bill did not penalize individuals who let their coverage lapse. According to health insurance industry sources, Senators are planning to add a provision that could prevent people from using the individual market for six months if their coverage lapses. The provision may be included to keep healthy people on the market, which balances out the cost for sicker individuals.
President Trump Talks to Reporters About the Senate’s Healthcare Bill
During an interview on Sunday with “Fox & Friends,” President Donald Trump said that he doesn’t think the GOP is “that far off” from finalizing its healthcare reform bill. The Senate is pushing to vote on the bill by the end of this week, despite Senators expressing opposition or concern over the current language.
When referring to the now 5 Republican Senators that have confirmed an opposition to the current bill’s language, the President said, “We have a very good plan. They want to get some points, I think they’ll get some points.”
Trump also complained about the lack of bipartisan efforts on healthcare reform. “It would be so great if the Democrats and Republicans could get together, wrap their arms around it and come up with something that everybody’s happy with. And I’m open arms; but, I don’t see that happening. They fight each other. The level of hostility.”
Healthcare Reform News Update for June 26, 2017
Updates on the Senate’s Position with the Healthcare Bill
The New York Times continues to update Senators’ standings on the GOP’s healthcare reform bill. Here are the numbers as they currently stand:
- 8—no without changes, or concerned
Kaiser Family Foundation Publishes a Topical Comparison of 3 Healthcare Reform Bills
The Kaiser Family Foundation has published an in-depth comparison of three healthcare reform bills: Better Care Reconciliation Act of 2017 (the Senate’s healthcare bill), the American Health Care Act (AHCA, the House’s healthcare bill), and the Affordable Care Act (ACA, also known as Obamacare). The comparison, starting with a summary and then making comparisons based on topic, can be viewed here.
Healthcare Reform News Update for June 23, 2017
Senators’ Current Positions on the GOP’s Healthcare ‘Discussion Draft’
All Democratic Senators (48) are expected to vote against the Republican Senate’s healthcare reform bill. That leaves 52 Republican Senators to vote in favor of the bill. The bill needs 50 votes in favor in order to pass (which will leave a tie breaker that Republicans expect to win). Here are the current standings on the remaining 52 votes according to The New York Times.
- 7 Senators are likely to vote against the bill if further changes are not made or if their concerns with the current bill’s language are not addressed.
- Ted Cruz, Mike Lee, Ron Johnson, and Rand Paul have required further repeal of the Affordable Care Act in order to vote in favor of the bill.
- Susan Collins, Dean Heller, and Rob Portman have expressed concerns over the cuts to Medicaid.
- 28 Senators are undecided.
- 17 Senators are in favor of the bill.
The Washing Post also counts Senators Shelley More Capito and Lisa Murkowski among those who are likely to vote against the bill over its current language. The site also only lists 16 Senators supporting the current bill.
President Trump Supports the Senate’s Healthcare Bill While Obama Denounces It
In a tweet posted on Thursday evening, President Donald Trump said, “I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, Obamacare is dead.” He was even supportive of the four conservative Republican Senators who have already voiced their opposition to the bill’s current language, saying, “They’re four good guys and they’re friends of mine. We have four very good people, and it’s not that they’re opposed. They’d like to get certain changes, and we’ll see if we can take care of that.”
Former President Barack Obama had stronger, more negative words for the Senate bill. Obama wrote, “The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else. Simply put, if there’s a chance you might get sick, get old, or start a family — this bill will do you harm. And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.”
Ways to Compare the Senate’s Healthcare Reform Bill to Previous Bills
There are several simple ways that you can compare the Senate’s healthcare bill to the House-approved American Health Care Act (AHCA) or the Affordable Care Act (ACA, also known as Obamacare). These news sources have done so, using easy-to-review charts and comparisons.
- Politico published a graphic that displays how the Senate’s bill affects Obamacare.
- NPR published a chart that compares all three healthcare reform bills based on the demographic they affect.
What Are the Senate Bill’s Next Steps?
The Senate has finally produced a draft of its healthcare reform bill. Now, that draft will go through the following processes to become law or be voted down:
- The Congressional Budget Office will analyze the bill, which is expected to be finished early next week.
- The Senate will debate the bill. Senators will also have the opportunity to offer amendments to the bill.
- Senate Majority Leader Mitch McConnell can offer the final amendment to the healthcare bill.
- The Senate will vote on the bill and amendments.
- If the bill passes, the House will either need to reconcile the bill with their own or approve the Senate version. If the bill is reconciled, both the Senate and the House will need to vote on the final bill again.
- If the bill does not pass, the bill does not move forward.
- If a final bill passes both the Senate and the House, the bill will be sent to the President for his signature.
Humana Won’t Return to Individual Market, Even With Healthcare Reform
During an interview, Humana CEO Bruce Broussard announced that Humana will not return to the individual health insurance market. Broussard said, “This is just not a business that we will be good at. No matter what they do in Washington, we are not going to go back in. And we’ve had a lot of people ask us from Washington D.C. if we would go back in and we’ve said no, it’s not there.”
Healthcare Reform News Update for June 22, 2017
Senate Republicans Release ‘Discussion Draft’ of GOP’s Healthcare Reform Bill
This Morning, Senate Republicans released their healthcare reform bill’s “discussion draft”. The 142-page bill:
- Makes deep cuts to Medicaid
- Puts the Medicaid program on a closed budget
- States would choose to receive funding as a block grant or per capita (a set amount per enrollee).
- Phases out Medicaid expansion
- The phase out would begin in 2020, gradually reducing the increased funding given for expansion over 4 years.
- Ends the individual and employer mandates
- Unlike the House-approved bill, individuals who let their coverage lapse will not be penalized with a surcharge
- Creates a new system of tax credits to replace health insurance subsidies
- Unlike the House-approved bill, tax credits will take into account income and geography in addition to age.
- Allows states to opt-out of many benefit requirements in the Affordable Care Act (like emergency services, mental health treatment, and maternity care)
- Repeals the tax increases created by the Affordable Care Act
- Provides $50 billion (over 4 years) to states to stabilize health insurance markets
- Provides funding (for 2 years) for cost-sharing reduction payments
- Keeps the popular Affordable Care Act feature of allowing children to stay on a parent’s plan until the age of 26
The Senate’s bill maintains the structure of the House-approved healthcare bill, but it is more moderate that the House’s AHCA (increasing financial assistance). Even with these adjustments the bill is still relatively conservative.
A vote on the Senate’s bill is expected to happen next week (after 20 hours of debate), with a Congressional Budget Office analysis expected in the next few days.
Republican Senators Voice Skepticism About Short Healthcare Vote Timeline
During an interview Wednesday, Republican Senator Ron Johnson voiced his uncertainty about holding a healthcare vote next week. The senator said, “I have a hard time believing anybody will have enough time to have a true evaluation and get (public) input on this by next week. … I am going to need the information to justify a yes vote. I’ll need the information to vote on a very imperfect bill that doesn’t even come close to doing the things that I want to see done.”
On Wednesday, Republican Bill Cassidy told MSNBC, “If I don’t get to read it, I don’t vote for it. If I don’t get to study it, I don’t vote for it.”
Will Hundreds of Amendments Stall the Senate’s Healthcare Reform Vote?
Senate Majority Leader Mitch McConnell has promised that senators will have the opportunity to bring any amendment to the floor during a healthcare reform vote. Democrats could use hundreds of proposed amendments to stall a healthcare vote. McConnell has the equal opportunity to cut off the multiple amendment votes if he calls them a delay tactic.
Anthem and Farm Bureau Health Plans Will Exit Certain ACA Marketplaces
Wednesday, Anthem announced plans to exit the Indiana and Wisconsin marketplaces for 2018. In a statement, spokesperson Leslie Porras explained the company’s exit: “Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies and the restoration of taxes on fully insured coverage.”
Farm Bureau Health Plans has also announced that it will not sell marketplace plans in 2018 due to projected losses of more than $15 million. The CEO, Anthony Kimbrough, put out this statement to explain the company’s exit from the marketplace: “Congress has yet to agree to new legislation and CMS Administrator Seema Verma acknowledges rule changes proposed by the department are only temporary corrections … not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system. So our decision is not solely about the year 2017; it is about the lack of a clearly drawn long-term solution from where things are today.” Farm Bureau Health Plans covered more than 25,000 Tennessee residents.
FDA to Hold Public Hearings on Drug Manufacturers Potentially Gaming the System
In order to investigate ways that drug makers could be manipulating federal regulations, the Food and Drug Administration will hold a public hearing next month. “The hearing, scheduled for July 18, is the latest step taken by newly installed FDA Commissioner Scott Gottlieb to have the agency take a more active role in policing drug prices.”
Healthcare Reform News Update for June 21, 2017
Senate’s Healthcare Bill to Be Released for Review Thursday
Senate Majority Leader Mitch McConnell told reporters a “discussion draft” of the GOP’s healthcare reform bill would be sent out Thursday. McConnell said that reporters would also have access to the draft, and a Senate vote on the bill is likely to occur next week.
Thursday will be the first time many senators see the GOP’s bill, including those meant to be working on it.
- Senator Mike Lee, who was part of the 13-member working group meant to create the Senate bill, said he hasn’t seen a draft. “It has become increasingly apparent in the past few days that even though we thought we were going to be in charge of writing this bill within this working group, it’s not being written by us. So, if you’re frustrated by the lack of transparency in this process, I share your frustration — I share it wholeheartedly,” Lee said.
- Senator Rob Portman, another member of the 13-member working group, also told reporters that he hasn’t seen a draft.
Senators have voiced their reluctance to support a bill they’ve yet to review thoroughly, making it hard to tell if a vote held next week would pass.
CSR Payments Made in June, But There’s No Guarantee They’ll Continue
The Trump Administration has made cost-sharing reduction (CSR) subsidy payments for June. However, the administration has not clarified whether these payments will continue through the rest of the year (or into 2018). Press secretary for the Department of Health and Human Services, Caitlin Oakley, put out this statement: “The June payment has been made. We are weighing our options and still evaluating the issues. Congress could resolve any uncertainty about the payments by passing the [American Health Care Act] AHCA and reforming Obamacare’s failed funding structure.”
Healthcare Reform News Update for June 20, 2017
Senate Expected to Vote on Healthcare Bill Next Week
Senator John Barrasso (R-WY) told Fox News that Senate Republicans are planning to vote on a healthcare bill next week. “I believe we’re going to vote before the Fourth of July recess on a healthcare plan, a repeal and replacement of Obamacare,” Barrasso said.
Lawmakers, and the public, have yet to see the Senate’s bill. If the week goes smoothly, “Senators are expected to see the text of the bill as soon as the end of this week.”
Will the Senate’s Healthcare Bill Have Enough Support From All Republicans?
With much of the Senate’s policy focus on winning over moderates, the GOP risks alienating conservatives in the Senate and the House.
- In the Senate: Senator Rand Paul (R-KY) has said that he will not support legislation that creates a new Republican entitlement program (specifically refundable tax credits). Senators Mike Lee (R-UT) and Ted Cruz (R-TX) have been pressing the Senate to allow states to opt out of guaranteed issue and community rating provisions to win their support. “Guaranteed issue mandates that insurance companies sell insurance plans to people regardless of how sick they are, and … community rating prohibits insurance companies from pricing those plans to reflect the greater financial risk of insuring people with pre-existing medical conditions.”
- In the House: The Republican Study Committee (RSC) is the largest conservative group in the House. The RSC warned GOP Senators that if the bill goes too far toward moderates, it will die in the House. The conservative group listed four provisions that it finds necessary in the Senate’s healthcare bill.
Democratic Senators Prepared to Slow Down Senate Over Closed-Door Healthcare Reform
Democrats are prepared to use procedural rules to slow down the Senate’s processes if Republicans continue creating healthcare reform behind closed doors. Senate Minority Leader Chuck Schumer (D-NY) said, “If Republicans won’t relent and debate their healthcare bill in the open for the American people to see, then they shouldn’t expect business as usual in the Senate.”
Senate’s Healthcare Bill Could Have Deeper Medicaid Cuts Than the AHCA
According to aides and lobbyists, the Senate has sent a Medicaid spending proposal — one that may “make even deeper cuts to Medicaid spending than the bill passed by the House” — to the Congressional Budget Office (CBO) for analysis. The Medicaid proposal “would start out the growth rate for a new cap on Medicaid spending at the same levels as the House bill, but then drop to a lower growth rate that would cut spending more, known as CPI-U, starting in 2025.”
Health Insurance Companies Work to Stay in State Marketplaces
While many health insurance companies have made the tough decision to exit the Marketplace, these companies are planning to stick around to provide coverage in these states.
- Washington: Premera Blue Cross will continue selling plans in a county that may have been left without any options. Only one county in Washington state remains without a marketplace option.
- Illinois: Blue Cross and Blue Shield of Illinois, the state’s largest health insurance company, has submitted rates for 2018. However, the company has not fully committed to selling plans in 2018.
- Iowa: The only carrier left in the state, Medica, plans to keep selling plans in 2018. However, premium rates could increase by 43.5%.
Healthcare Reform News Update for June 19, 2017
Senate’s Lack of Transparency With Healthcare Bill Raises Bipartisan Concerns
The lack of transparency and speedy process surrounding the Senate’s healthcare bill is raising concerns for both Republican and Democratic senators.
- Democratic Senator Richard Blumenthal is calling an “emergency healthcare hearing,” which is scheduled for Monday. The senator told the Hartford Courant that the committee writing the healthcare reform bill is “a small group of Republicans meeting in secret, [and] none of us on the Democratic side have a clue as to what they’re doing. … How do we vote in the next few weeks on a bill that has not been … reduced to writing, that has been done in secret without any kind of public hearing?”
- On Friday, Senate Minority Leader Charles Schumer reached out to Majority Leader Mitch McConnell. Schumer asked that an all-senator meeting be held on Friday to discuss the bill.
- Republican Senator Lisa Murkowski expressed unhappiness with the secrecy of the healthcare bill’s deliberations. She told the Alaska Dispatch News, “I think that we do better as a body when we respect the process. And the process allows for committee involvement, debate and discussion. … If I’m not going to see a bill before we have a vote on it, that’s just not a good way to handle something that is as significant and important as healthcare.”
- During an interview on CBS’ “Face the Nation,” Republican Senator Marco Rubio advised against rushing a secretive healthcare bill through the Senate. “The Senate is not a place where you can just cook up something behind closed doors and rush it for a vote on the floor,” Rubio said. “Every camera in the world’s going to have to see what’s in it.”
Senate Democrats Planning Late-Night Protest of GOP’s Healthcare Reform Plan
According to a Senate aide, Democratic Senators are planning to hold late-night speeches on the Senate floor Monday. The speeches are expected to last until at least midnight, with the main focus on protesting the GOP’s healthcare replacement plan.
Democratic Senators are also considering using other rules to halt Senate procedures, like preventing “any Senate committees from meeting after the Senate had been in session for two hours” and “objecting to routine requests on votes.”
7 Governors Write Bipartisan Healthcare Appeal Letter to Senate Leaders
On Friday, 7 governors sent letters to Senate Majority Leader Mitch McConnell and Senate Minority Leader Chuck Schumer. In the letter, the governors asked that Congress “focus on health care reform that cuts costs while promoting market stability and giving states more flexibility.” The letter also urges “Congress to scrap the GOP health care bill and work toward a bipartisan solution.”
Where Are 6 Major Healthcare Reform Policies Headed?
Speculation continues for what will end up in the Senate’s healthcare reform bill. According to the Hill, here is where these 6 controversial policies seem to be headed.
- Medicaid expansion will have a slower phase-out. Something between Senator Rob Portman’s proposed 7-year phase-out and Senate Majority Leader Mitch McConnell’s 3-year phase-out is expected to be in a final bill.
- Tax credits proposed in the House’s American Health Care Act (AHCA) will increase. Senator John Thune has been tasked with creating a tax credit structure that will provide more assistance to lower-income and older Americans. Thune’s tax credits are expected to be tied to age and income.
- Some Obamacare taxes will remain, at least for a while. These will help fund tax credits, among other healthcare allowances.
- More funding (than provided in the AHCA) will be provided to fight the opioid crisis. This is in part to assure senators worried that the phase-out of Medicaid expansion will hurt opioid addiction treatment.
- The bill will attempt to stabilize the individual health insurance Marketplace. This could be done by funding cost-sharing reductions.
- Funding to support those with pre-existing conditions will increase. After criticism that the AHCA underfunds high-risk pools for those with pre-existing conditions, the Senate’s bill is expected to increase this funding.
Nevada Gov. Brian Sandoval Signs Strict Insulin Pricing Legislation into Law
Thursday, Nevada Governor Brian Sandoval signed “the nation’s strictest requirements for pharmaceutical companies to reveal how they set certain prescription drug prices” into law. The law focuses on insulin, requiring “drugmakers to annually disclose the list prices they set, profits they make and discounts they give market middlemen on insulin.” Drugmakers must also “give state officials written explanations of any insulin price hikes that surpass the previous year’s inflation rate, or are higher than twice the inflation rate of the previous two years.”
Healthcare Reform News Update for June 16, 2017
Senator Lamar Alexander Calls for CSR Payments to Be Funded Through 2019
Senator Lamar Alexander is the chairman of the Senate Health, Education, Labor, and Pensions Committee. At a hearing on Thursday, Alexander recommended that funding for cost-sharing reduction (CSR) payments continue through 2019. Alexander said during the hearing, “The payments will help to avoid the real possibility that millions of Americans will literally have zero options for insurance in the individual market in 2018.”
Senator Rand Paul Criticizes “New Entitlements” in the Senate’s Healthcare Bill
Conservative Senator Rand Paul has denounced two important aspects of the Republican healthcare bill, each of which are seen in the House’s and the Senate’s healthcare bills. Refundable tax credits (which help people afford individual healthcare plans) and a “stabilization fund” (which helps lower premiums) are being called new entitlements by Paul.
Paul told reporters, “I think we shouldn’t have new entitlements that will go on forever in a Republican plan to fix healthcare. We can’t pay for what we already have: Medicare, Medicaid and Social Security.”
Trump Administration to Address Drug Pricing With New Executive Orders
On Friday, President Trump is scheduled to meet with key officials to discuss an executive order aimed at lowering prescription drug pricing. The order “could be to direct federal agencies to pursue value-based purchasing contracts for drugs.” Another policy being discussed “would instruct agencies to pursue trade policies that would strengthen the intellectual property rights of pharmaceutical companies.”
Neither of the executive orders under discussion would cause drastic changes to the pharmaceutical industry.
Healthcare Reform News Update for June 15, 2017
Four Democrats Introduce a Reinsurance Bill
Four Democratic Senators (including Tim Kaine and Tom Carper) introduced a bill on Wednesday that would make reinsurance a permanent component of the Obamacare individual marketplace. Specifically, the bill “would provide federal funding to cover 80% of claims from $50,000 to $500,000, starting next year, with the same level of support through 2020.” The bill would also help states improve enrollment by dedicating $500 million in federal funding each year (for the next three years).
Marketplace Rate Hikes Continue as Senate Works Through Healthcare Reform
Health insurance companies are filing proposed health insurance rates for individuals’ plans on and off the marketplace. In order to recoup losses, and prepare for funding provided through Obamacare to discontinue, many companies are filing double digit rate increases. These states are in recent news for their premium rate hikes:
- Michigan: If cost-sharing reduction subsidies are defunded, Blue Cross Blue Shield of Michigan could increase rates by up to 31%.
- Connecticut: Anthem, one of Connecticut’s largest insurance companies, has requested a 33.8% rate increase for plans sold on and off the exchange. ConnectiCare has requested a 17.5% increase for its plans on the marketplace and a 28.3% increase for its plans off the marketplace.
Healthcare Reform News Update for June 14, 2017
CMS Actuary Publishes AHCA Analysis That Differs Greatly From CBO’s
On Tuesday, the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary published an “Estimated Financial Effect of the ‘American Health Care Act of 2017’.” Here are the main takeaways from the CMS Office of the Actuary’s analysis:
- The AHCA will cause 12.6 million more Americans to become uninsured in the next 10 years.
- The Congressional Budget Office’s (CBO) analysis estimated that 23 million more Americans would become uninsured.*
- The AHCA will reduce federal spending by $328 billion in the next 10 years.
- The CBO’s analysis estimated that federal funding would be reduced by $119 billion.*
- Under the AHCA, the average premium will be 13% lower in 2026 for individuals without subsidies.
- Taking subsidies into account, premiums will increase by 5% and out-of-pocket costs will increase by 61%.
- The CMS analysis excludes the estimated effects of taxes repealed in the AHCA.
- The CMS analysis does not “reflect the possibility that some states could obtain waivers under the AHCA that severely limit what benefits must be covered or allow insurers to charge higher premiums for people with expensive medical conditions.”
- According to the CMS actuary, if states did receive such waivers “we would expect that the individual market in these areas would destabilize such that the premiums for comprehensive coverage for a significant proportion of the population would become unaffordable and the coverage would cease to be offered.”
*The estimates found in the CMS Office of the Actuary’s analysis and the Congressional Budget Office’s analysis vary due to “differing assumptions about whether cost-saving measures in the House bill will work.”
Centene to Enter 3 New States in 2018, Expand Its Presence in 6 More
On Tuesday, Centene announced plans to enter the Marketplace in Kansas, Missouri, and Nevada in 2018. The company will also expand its presence in 6 states that it currently participates in (Florida, Georgia, Indiana, Ohio, Texas, and Washington).
Michael F. Neidorff, chairman, president, and CEO of Centene, released this statement: “Centene recognizes there is uncertainty of new healthcare legislation, but we are well positioned to continue providing accessible, high-quality and culturally sensitive healthcare services to our members. Centene has demonstrated disciplined execution, agility and capacity to successfully navigate industry changes to the benefit of our members, customers and shareholders.”
Aetna May Offer Plans in Nevada After All
Despite sharing plans to exit the market, Aetna filed premium rates for the Nevada individual marketplace for 2018. Although it has filed rates, Aetna has not made a final decision on whether or not to participate in Nevada.
Trump Urges Senators to Draft a More “Generous” Healthcare Bill
President Trump met with Republican Senators on Tuesday during a White House lunch and discussed their in-progress healthcare bill. During the lunch, the President called the House’s AHCA “mean” and asked Senators to create a bill that was “more generous.”
Healthcare Reform News Update for June 9, 2017
Chairman of House Committee Calls for CSR Continuation
Kevin Brady, a Republican and the chairman of the House Ways and Means Committee, has called for the continuation of cost-sharing reduction subsidies (CSRs) in order to stabilize the individual market. “We should act within our constitutional authority now to temporarily and legally fund cost-sharing reduction payments as we move away from Obamacare. Insurers have made clear the lack of certainty is causing 2018 proposed premiums to rise significantly,” Brady stated.
Senate Parliamentarian Flags Language in AHCA That May Not Be Allowed
Elizabeth MacDonough, the Senate Parliamentarian, has found language that she warns may not meet reconciliation. The Hyde Amendment is a part of the American Health Care Act (AHCA) that disallows people from using refundable tax credits for private insurance plans that cover abortions. MacDonough has flagged this amendment, warning Republicans that it is “unlikely to be allowed.”
A precedent set in 1995 may support MacDonough’s warning. Robert Dove, the Senate Parliamentarian in 1995, “ruled that an abortion provision affecting a state block grant program failed to meet reconciliation requirements.”
Healthcare Reform News Update for June 8, 2017
What’s Going into the Senate’s Healthcare Bill?
As the Senate works to come to a consensus on dividing aspects of healthcare reform, there is an ongoing discussion over what will end up in the finalized bill. Here is a short breakdown of how the Senate is progressing through those aspects of healthcare reform.
- Pre-existing Conditions and CSRs: Provisions speculated to be in the Senate’s healthcare bill suggest that coverage for pre-existing conditions will not change as greatly as was written into the House’s bill. Additionally, during closed-door meetings, the Senate’s working group has discussed funding cost-sharing reduction (CSR) subsidy payments.
- ACA Taxes: The Senate is considering keeping certain Affordable Care Act taxes in order to fund its healthcare reform bill’s provision.
- Medicaid Expansion: Senate Majority Leader Mitch McConnell has proposed a 3-year phase-out of federal funding for the expansion of Medicaid. The phase-out would begin in 2020, ending in 2023. Moderate Senators have suggested they can support a phase-out, but they have proposed a longer, 7-year “glidepath.”
Healthcare Reform News Update for June 7, 2017
McConnell Tells Trump: Expect Healthcare Vote by July 4
During a meeting held Tuesday, Senate Majority Leader Mitch McConnell told President Donald Trump that the Senate may vote on healthcare reform by July 4. McConnell also said he expects the Congressional Budget Office (CBO) to score the Senate’s healthcare bill soon, at least on portions that it has submitted for review.
In a joint statement, McConnell and Paul Ryan said this about the meeting: “We had a good, productive meeting with President Trump, Vice President Pence, and congressional leadership. The discussion focused on the continued progress of our shared legislative agenda and how we can accomplish our goals.”
Budget Committee Approves Senate’s Healthcare Bill
On Tuesday, the Senate Budget Committee announced that the American Health Care Act (AHCA) fulfills reconciliation rules and can officially move on to the Senate.
Some State Waivers May Remain in the Senate’s Healthcare Bill
According to senior GOP aides, the following state waivers could be in the Senate healthcare bill:
- Essential Benefits
- Medical Loss Ratio Requirement (a “regulation on how much of [insurance companies’] premium revenue must be spent on claims”)
- Age Rating Band (The ACA allows “older people to be charged no more than three times as much as younger people.”)
The ACA’s requirements for insurance companies to insure people with pre-existing conditions, and the prohibition on charging those individuals more for coverage, are not likely to be included in state-allowed waivers.
Anthem Leaves Ohio Marketplace Over Unstable Market
On Tuesday, Anthem announced that it will not offer plans on the individual marketplace in Ohio for 2018. The company cited “volatility in the individual insurance market and uncertainty over funding for cost-sharing subsidies” as its reasons for exiting the exchange. Anthem’s exit will leave at least 18 counties with no marketplace options, affecting around 10,500 residents.
In a statement Anthem said, “Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to the shrinking individual market as well as continual changes in federal operations, rules and guidance.”
Healthcare Reform News Update for June 6, 2017
Senate Pushing for June Healthcare Vote
The Senate is under pressure to vote on healthcare reform and move onto tax reform before the August recess.
Although the Senate drafted portions of its bill during a recent recess, the draft leaves out many polarizing topics (like Medicaid expansion). In order to come to a consensus on the unresolved — and included — policy decisions, the GOP has scheduled a meeting Tuesday. Senate Republicans will be “presented with legislative options … with the goal of making decisions on what is in and what’s out of their bill.”
Whether or not the final bill is expected to pass, the Republican Senate is planning to vote on its healthcare bill as soon as this month.
New York’s Governor Takes Steps to Keep Obamacare Mandates, Repeal or Not
Governor Andrew M. Cuomo has announced plans to prevent the removal of Obamacare safeguards in the individual market in New York. The plans “include requiring any private company doing business on the state’s insurance marketplace to guarantee the 10 ‘essential health benefits’ … [and directs] the state’s health department to block any company that withdraws from the exchange from participating in Medicaid or its children’s health plan.”
Minuteman Health in New Hampshire Requests 30% Premium Rate Increases
During an interview Monday, Minuteman Health Chief Executive Officer Tom Policelli revealed a premium rate increase around 30% for 2018. The company blamed the high “increase on two provisions of the health care law — Medicaid expansion and federally imposed risk adjustments.”
Healthcare Reform News Update for June 5, 2017
State Insurance Commissioners Working to Keep Insurance Companies in the Market
For many state insurance regulators, keeping insurance companies in the individual market is their ultimate goal. In order to combat marketplace uncertainty, and keep health insurance companies in the market, state insurance commissioners are becoming increasingly flexible.
- The insurance superintendent of New Mexico, John Franchini, said: “As a regulator, instead of being rigid on timelines, the type of pricing I’m going to want, I’m being more open about this. I’m trying to be more flexible to give them confidence that if things change, we as regulators will be flexible with them.”
- The insurance commissioner for California, Dave Jones, said: “Based on what we were hearing from insurers, we anticipated Trump rates would be double-digit increases over the past year. I wanted to give insurers the opportunity to file rates based on Trump.”
In California, insurance companies may file two premium rate requests (one if Obamacare rules are upheld and one if they are eliminated).
Healthcare Reform News Update for June 2, 2017
Pennsylvania Insurance Companies File Low Rate Increases, But Only If Obamacare Rules Continue
Teresa Miller, Pennsylvania’s Insurance Commissioner, reported low aggregate rate increases (8.8%) for the state’s 5 insurance companies in 2018. But this low increase will only go into effect if the individual mandate is upheld and cost-sharing reduction subsidies (CSRs) are funded.
- If the mandate is repealed, rates could increase by 23.3% in the state.
- If CSRs are no longer funded, rates could increase by 20%.
- If they are both eliminated, rates could increase as much as 36%.
Senator Richard Burr Does Not Expect to Pass a Healthcare Reform Bill This Year
On Thursday, Republican Senator Richard Burr appeared on a North Carolina news station. During the interview, he painted a less-than-optimistic portrait of the Senate’s ability to pass healthcare reform laws in the next 6 months. “It’s unlikely that we will get a healthcare deal. I don’t see a comprehensive healthcare plan this year,” Burr said.
Healthcare Reform News Update for June 1, 2017
John Cornyn Promises Healthcare Reform Bill This Summer
Senate Majority Whip John Cornyn appeared on The Chad Hasty Show Wednesday. During his appearance, he asserted that the Senate would finish an Obamacare repeal bill by the end of the summer. “We’ll get it done by the end of July at the latest,” Cornyn said during the interview.
Healthcare Reform News Update for May 30, 2017
The Senate Parliamentarian’s Role in Healthcare Reform
Elizabeth MacDonough, the Senate parliamentarian, will soon decide if the American Health Care Act (AHCA) meets the reconciliation requirements that allow a bill to pass in the House and Senate with a simple majority vote. MacDonough will sit down with 8 lawyers (4 Democrats and 4 Republicans), listen to both sides’ arguments, and make an unbiased decision on each piece of the AHCA.
Healthcare Reform News Update for May 26, 2017
Senate to Begin Drafting Healthcare Bill During Weeklong Recess
Now that the CBO score for the American Health Care Act has been published, the Senate can begin drafting its own bill. Thursday, Senator Ron Johnson said, “Over the break, initial legislation will be drafted and then we’ll have more time, actually have a basis to discuss” policies. While there are no final agreements on critical reform points, the initial draft will be a step forward for the Senate.
FDA Steps Into Efforts to Lower Drug Prices
Scott Gottlieb, the new FDA Commissioner, informed a congressional panel that the FDA is creating a “drug competition action plan.” This plan would speed up the approval process for generic medications (specifically generic versions of brand-name drugs with no competition).
Blue Cross and Blue Shield of North Carolina Hikes Premiums over CSR Payment Uncertainty
Blue Cross and Blue Shield of North Carolina has asked state regulators to approve a 23% premium rate increase for 2018. The company did say it could afford a 9% increase with the assurance of CSR payments, but it is currently planning on the high rate increase “because it doesn’t expect [the] crucial payments from the federal government to continue.”
“Blue Cross and Blue Shield of North Carolina sells coverage in all 100 North Carolina counties, and it is the lone option in 95. It said Thursday that its participation for next year is not guaranteed.”
Wisconsin Proposes Drug Screenings for Medicaid Applicants
Wisconsin has proposed a drug-testing requirement for Medicaid applicants, as well as time limits for recipients who do not work or train for employment. Florida and Michigan, states that previously tried to implement drug-testing requirements, “faced lawsuits and court rulings that held that the requirement was unconstitutional.” The proposal “has won approval from the Legislature’s budget-writing committee.”
Healthcare Reform News Update for May 25, 2017
Key Findings From the CBO’s AHCA Report
Yesterday, the CBO published a report on the American Health Care Act, estimating its effect on healthcare costs and the insurance market. Here are the main findings:
- The uninsured rate will increase by 14 million after one year.
- The uninsured rate will increase by 23 million after 10 years.
- By 2026, the uninsured rate is estimated to reach 51 million (28 million under the Affordable Care Act).
- Medicaid funding would be cut by $834 billion and insure 14 million fewer people.
- Premiums would increase in 2018 and 2019. Then they will vary on the states’ decision to opt in or out of essential benefit rules.
- States that opt out of some essential benefit rules will see an estimated premium decline of 20% in the next 10 years.
- In 2020, 17% of Americans will experience an unstable insurance market in which sick people have difficulty getting coverage. Everyone else will experience fairly stable insurance markets.
- Low-income, older Americans will see higher premiums (about 9 times more).
- The federal deficit would reduce by $119 billion over the next 10 years, and $664 billion in taxes and fees would be repealed.
The report also gave the following predictions for coverage:
- “Less healthy people would face extremely high premiums, despite the additional funding that would be available.”
- In states that decided to opt out of coverage requirements, “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”
Blue Cross and Blue Shield of Kansas City to Exit Marketplace
On Wednesday, Blue Cross and Blue Shield of Kansas announced its decision to exit the ACA Marketplace for 2018. The marketplace exit will affect 67,000 residents in 30 counties in Missouri and Kansas. It was the only marketplace insurance plan for about 25 counties in Missouri. The company cited more than $100 million in losses for its decision.
Healthcare Reform News Update for May 24, 2017
The CBO Has Released Its Score on the Newest Draft of the AHCA
The Congressional Budget Office (CBO) released its estimate of the American Health Care Act of 2017 (AHCA) this afternoon. According to the estimate, the House-approved AHCA would reduce the federal deficit by $119 billion over the next 10 years. It would also increase the number of uninsured people by 23 million in 2026. The bill is confirmed in following reconciliation rules and can now move on to the Senate.
Senate Working Group Meets With BCBS to Discuss Healthcare Reform
On Tuesday, the 13-member Senate group working on healthcare reform met with Blue Cross Blue Shield. Senator John Hoeven spoke on the meeting, intended to get health insurance companies’ perspectives. “We really focused on the insurance aspect — how do we build a plan that works for the insurers in terms of making sure they participate and helping keep premium costs down?”
Senate Interested in Phasing Out Medicaid Expansion
According to Senator John Thune, Republican Senators on the 13-member working group are planning to end Medicaid expansion in their healthcare reform proposal. However, a gentle phase-out is being discussed over a quick termination of the expansion. “There’s an interest among many of our members having a longer phaseout, a smoother glide path. At some point you’re gonna get back to the original [reimbursement rate], it’s just a question of how quickly that happens.”
Administration’s Proposed Budget Draws Concern and Criticism
After the White House proposed steep spending cuts, legislators and analysts have voiced their concerns and criticisms over the effect of certain funding decreases.
- “Lower-income children would have their federal health benefits cut sharply, … which analysts say could reverse gains that have pushed uninsured rates for this vulnerable population below 5 percent.”
- The EVP of the Planned Parenthood Foundation of America, Dawn Laguens, called the budget “the worst budget for women and women’s health in a generation.”
- Senator Bill Cassidy, on Medicaid cuts: “I don’t think the president’s budget is going anywhere … You don’t cut $800 billion over 10 years and keep your same level of coverage. I think that President Trump’s campaign contract with the voters should be fulfilled.”
- Senator Susan Collins: “Obviously I’m concerned about the additional cuts proposed in Medicaid.”
- Tom Cole, on NIH cuts: “I certainly understand wanting to plus up defense, but you have to remember part of defending the American people is protecting them from pandemics,” said Cole, the chairman of the House health appropriations subcommittee. “Part of getting hold of the long-term expenses of the federal government is dealing with things like Alzheimer’s.”
California’s Single-payer Healthcare Plan Expected to cost $400 billion
Legislative analysts estimate that California’s proposed single-payer healthcare bill will cost the state $400 billion and result in payroll tax increases. The cost would be offset by existing spending and payroll tax increases, though individuals may see savings from no longer paying premiums and out-of-pocket costs.
States Passing Bills Aimed to Lower Prescription Drug Pricing
Several states have recently passed, or proposed, bills to curb prescription drug prices.
- New York passed a bill that increases pricing scrutiny to influence drug makers.
- Nevada’s Senate has passed a bill that would require diabetes drug manufacturers to disclose insulin pricing, profit, expense information, aimed to increase transparency.
- California’s Senate has passed a bill that restricts most payments made by drug manufacturers to doctors, citing a study showing such practices increased the use of more expensive medications.
- Ohio is working to pass a bill that “would require state agencies to pay no more for prescription drugs than the lowest price paid by the U.S. Department of Veterans Affairs.” The bill faces heavy opposition from the group called Ohioans Against the Deceptive Rx Ballot Issue.
Healthcare Reform News Update for May 23, 2017
Administration Asks for Third Postponement in CSR Case
On Monday, the Trump administration and House Republicans requested a 90-day extension over the ongoing cost-sharing reductions (CSR) payment case. This is the third requested delay in the case as the House and the administration try to work out CSR payments out of court.
White House’s Proposed Budget Cuts for Medicaid, Biomedical Research, and More
The administration mistakenly posted (and quickly removed) their planned budget for 2018. Significant budget reductions include:
- $610 billion cut from Medicaid, in addition to the $839 billion cut included in the AHCA
- 18% cut from the National Institutes of Health (NIH)
- 19% cut from the National Cancer Institute
- Elimination of the Fogarty International Center (an NIH program “that promotes medical research overseas”)
- 17% cut from the Centers for Disease Control and Prevention
- 17% cut in spending for HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis prevention
- 18% cut from the CDC’s global health program
- 28% cut in spending for environmental health
- Elimination of the Agency for Healthcare Research and Quality (NIH would absorb many functions)
- 31% cut from the FDA
- $403 million cut from physician training programs
Healthcare Reform News Update for May 22, 2017
Will the CSR Subsidy Payment Case Continue, Drop, or Stall?
The administration has to make a decision today about the ongoing court case regarding cost-sharing reductions (CSRs), mainly whether or not it will continue to fight in favor of the payments. President Trump has said he wants to end the payments, but a number of his advisers are opposed to that idea.
Rather than supporting or dropping the payments, the administration and House also have the option of asking for a 3-month hold on the case.
Planned Budget Reduction Includes $800 Billion Cut from Medicaid
President Trump’s upcoming budget cuts are expected to include an $800 billion cut from the Medicaid program. “The $800 billion reduction … assumes that the GOP health care bill that the House passed earlier this month would become law.”
Other programs, like the Children’s Health Insurance Program (CHIP), are also expected to see cuts as a result of the planned budget reduction.
Healthcare Reform News Update for May 19, 2017
The House Hasn’t Officially Handed Off the AHCA to the Senate
Despite not publically announcing plans to hold onto its healthcare reform bill, the House has not officially delivered the American Health Care Act to the Senate. The House decided to hold onto the bill out of caution, waiting to see if last-minute revisions still meet reconciliation rules.
The Congressional Budget Office’s (CBO) estimates must prove that the AHCA will reduce spending by at least $2 billion. If it does not, the AHCA will not meet the reconciliation rules the House used to pass the bill by a simple majority. Republicans would have to revise their bill and vote on it again.
Democratic Attorneys General Seek to Intervene in Ongoing CSR Case
A group of Democratic attorneys general want to intervene in the ongoing lawsuit against cost-sharing reduction subsidies (CSRs). Arguing that the administration is not defending CSRs strongly enough, at least 15 attorneys general are looking to take up the defense.
In their motion, the attorneys general wrote, “The States [that the attorneys general represent] have a vital interest in this litigation. If the district court’s injunction goes into effect, it would critically undermine the proper implementation of the ACA—just as the House, and now the President, intend. Immediate loss of CSR funding, with any future funding subject to the myriad uncertainties of the appropriations process, would harm millions of state residents and the States themselves. Those harms amply justify intervention.”
Senate Finance Committee Passes Legislation to Improve Medicare for Chronically Ill Patients
On Thursday, the Senate Finance Committee unanimously approved Medicare legislation in order to improve care for patients with chronic illnesses. The bipartisan bill “is aimed at reducing costs associated with chronic illness by giving people greater access to telehealth services, promoting care coordination between providers, and expanding value-based payment models.”
Bipartisan Amendment Aims to ‘Curb Abusive Drug Pricing’
A bipartisan amendment “aiming to curb abusive drug pricing on pharmaceuticals without generic competition” was added to the FDA user fee reauthorization bill as it was approved on Thursday. The amendment “offers a six-month exclusive rights period [to] generic manufacturers who choose to compete against an off-patent drug that currently has no competition.”
Healthcare Reform News Update for May 18, 2017
Individuals Will Be Able to Buy ACA-approved Health Plans Without HealthCare.gov
Wednesday, Centers for Medicare & Medicaid Services announced plans for an enrollment change for individuals purchasing health insurance approved by the Affordable Care Act (ACA). Rather than having to use HealthCare.gov, an individual can purchase an approved plan directly through an agent, broker, or health insurance company’s website.
The motivation of this announcement, according to Seema Verma, is to make shopping for coverage as simple and easy as possible. Eliminating the step of using HealthCare.gov could increase the use of agents and brokers, who tend to allow consumers to “get the most appropriate coverage.”
Senate May Consider a Short-Term Healthcare Package
Insurance companies have to decide whether or not to participate in Obamacare (ACA) exchanges by June 21. With no expectation that a full healthcare reform bill will be finished in the next month, the Senate may consider passing short-term market stabilization bills. A bill has already been introduced that would allow individuals with no marketplace options to use subsidies to buy plans outside of the exchange.
Republican Governors Create Healthcare Reform Proposal
Around a dozen governors crafted a healthcare reform proposal (9 pages) in February. The group is using that proposal to influence the Senate to adopt what they think an Obamacare (ACA) replacement bill should entail. Their proposal recommends maintaining Medicaid expansion “while also limiting federal spending for certain populations.”
The group of governors is also trying to form a bipartisan partnership with multiple states to propose individual insurance market reforms.
State Insurance Departments Release Early Insurance Rate Increase Requests
Five states and the District of Columbia have now released rate increase requests for 2018 Obamacare plans. Within those states, the lowest rate increase is 6.7% and the highest jumps to 54.3%
|Connecticut||Lowest: 15.2%||Highest: 33.8%|
|D.C.||Lowest: 13%||Highest: 39.6%|
|Maryland||Lowest: 9.1%||Highest: 53.4%|
|Oregon||Lowest: 6.9%||Highest: 21.8%|
|Vermont||Lowest: 6.7%||Highest: 12.7%|
|Virginia||Lowest: 9.8%||Highest: 54.3%|
New York State Assembly Passes Single-Payer Healthcare Bill
A single-payer healthcare bill was passed Tuesday by New York’s state Assembly. The bill provides universal coverage to all state residents, paid for with a “progressive payroll tax and levies on non-earned income, such as capital gains.” While one economist suggests the bill could save New York $45 billion in the first year, another suggests the bill would need $226 billion in increased tax revenue. The bill is now in the hands of the Republican-controlled New York Senate.
Healthcare Reform News Update for May 17, 2017
Senator John Thune Working to Improve AHCA’s Subsidies
Senate Republicans largely agree that subsidies laid out in the American Health Care Act (AHCA) need to be altered. Tennessee Senator Bob Corker has said, “The way the subsidies were in the House bill, it really wasn’t enough to help people who were on the lower end of the economic spectrum to be able to actually purchase it.”
South Dakota Senator John Thune, who said, “We clearly want to drive more of the benefit of the tax credit to people on the lower-income part of the scale and the elderly,” is crafting a proposal with others that would:
- Tie subsidies to income
- Lower the income-based eligibility limit currently listed in the AHCA
- Increase tax credits for those still eligible
- Provide more support for older Americans
Healthcare Reform News Update for May 16, 2017
Bipartisan Group of Senators Meets for Healthcare Reform Talk
Monday night, a group of Democratic and Republican Senators met to “discuss whether there is a bipartisan way forward on healthcare reform.” The preliminary meeting, organized by Republican Senators Susan Collins and Bill Cassidy, was attended by around 10 Senators.
Bipartisan Lawmakers Re-Introducing Fair Drug Pricing Act
Lawmakers plan to re-introduce a drug-pricing transparency bill Tuesday. The bill requires drug manufacturers to justify price increases and detail their expenses before raising the cost of certain medications. “Under the Fair Drug Pricing Act, companies will have to notify the U.S. Department of Health and Human Services and submit a report 30 days before they increase the price of certain drugs that cost at least $100 by more than 10 percent in one year, or 25 percent over three years.”
CMS Plans to Close Online SHOP Enrollment, Offer Small Business Health Care Tax Credits
In a press release published on Monday, the Centers for Medicare and Medicaid Services (CMS) announced a plan to alter the Federally-Facilitated Small Business Health Options Program (SHOP). Currently through SHOP, small businesses could apply for a determination of SHOP eligibility. After receiving the designation, small businesses could purchase health insurance coverage for their employees through the SHOP online marketplace and received a Small Business Health Care Tax Credit.
In CMS’s planned change, SHOP would discontinue online enrollment through HealthCare.gov. Small businesses could still receive a SHOP eligibility determination and receive the Small Business Health Care Tax Credit. However, small businesses would “access coverage through an agent or broker, or an issuer of their choice, for plan years beginning on or after January 1, 2018.”
Healthcare Reform News Update for May 15, 2017
An Update on Senate’s Healthcare Bill Progress
The Senate is currently debating healthcare reform, mostly on a partisan basis. While no proposal has been released (the Senate will wait for a CBO score on the AHCA), here is an update on their progress:
- It has been difficult for conservative and centralist Republicans to come to a consensus. After the 13-member Senate working group negotiated on Medicaid and Obamacare regulations last week, a Republican aid felt “much less optimistic that something will get done.”
- Centralist Senators Bill Cassidy and Susan Collins have been reaching out to Democrats, hoping for bipartisan healthcare reform. Collins said in a recent interview, “I really want us to have a bipartisan bill. I just think [it] will be so much better. And we have better ideas. So that’s my goal. You end up with a better bill, you end up with better acceptance by the public.” The two Senators are also working on their own healthcare bill.
Legislative Conversations on Drug Pricing Continue
A prior proposal to allow drug-importation from Canada was dismissed by the Senate last week. However, legislators are still working to find ways to lower drug prices. All ideologies seem interested in speeding up the generic drug approval process and increasing transparency in drug pricing.
Department of Health and Human Services Secretary Tom Price is holding listening sessions with patient groups, insurance companies, pharmacy groups, and hospital groups. Proposals from these organizations “include boosting competition through generic drug development, price transparency, and more communication between regulators and government payers.”
Mick Mulvaney, the White House budget director, also suggested changing Medicare drug pricing negotiations during a conference at Stanford University. During the conference, Mulvaney drew a direct comparison between drug price negotiations in Medicaid (which includes mandatory rebates) and Medicare (in which drug companies and insurance companies negotiate to win rebates).
Trump Releases Supportive Statement in Celebration of Women’s Health Week
“Ensuring affordable, accessible, and quality health care is critical to improving women’s health and ensuring that it fits their priorities at any stage of life,” Trump said in a statement released on Mother’s Day, during Women’s Health Week.
The statement continues: “The number of women dying from heart disease and cancer—the top two killers of women in America—has been decreasing for decades. Thanks to new breast cancer treatments, our health care professionals have saved lives and improved the quality of life for millions of women. We must continue to foster an environment that rewards these needed advances in research.”
Trump added that “he is committed to working with Congress on behalf of paid family leave for mothers and fathers, and to ‘invest in the comprehensive care that women receive at community health centers.’”
Healthcare Reform News Update for May 12, 2017
Conservative Senators Begin Outlining Healthcare Reform Ideals
Conservative Republicans have several ideals for the healthcare bill they are currently drafting and negotiating with other members of the Senate:
- Change the AHCA’s refundable tax credits to non-refundable tax credits
- Remove Medicaid expansion eligibility for “able-bodied” adults
- Repeal insurance regulations put in place by the ACA — “such as the requirement that plans don’t charge higher premiums to people with pre-existing conditions — or make states opt in.”
Senate Assures Women’s Involvement in Healthcare Reform
The Republican Senate has recently faced criticism pointing at the lack of women in the 13-member healthcare reform working group, despite the number of women’s health issues at play. Senate Majority Leader Mitch McConnell has assured his colleagues, and the public, that women will not be (and haven’t been) excluded. According to a member of the GOP, “The leader has assured us that at least one of the women will attend all of the meetings going forward.”
McConnell extended invitations to three female colleagues for a Tuesday meeting of the working group, which Senator Shelley Moore Capito attended. A Thursday meeting was attended by Senator Joni Ernst. Additionally, McConnell has reportedly given an open invitation to any Republican Senator interested in attending the working group’s meetings.
Senate May Revert to Income-Based Subsidies in Revised Healthcare Bill
According to Senator John Hoeven, the House bill’s financial assistance “is just not robust enough to make sure that low-income individuals can actually afford a [health] plan.” Because of this, the Senate may consider using income-based health insurance subsidies in their healthcare bill.
Healthcare Reform News Update for May 11, 2017
Aetna Pulls Final 2 States From Individual Marketplace
Aetna has announced that the company will not offer any ACA Marketplace plans in Delaware or Nebraska in 2018. This marks the withdrawal of Aetna’s last two Marketplace plans, leaving the company with no ACA Marketplace participation for 2018. Aetna cited financial losses.
Healthcare Reform News Update for May 10, 2017
Republican Senators Take Different Sides on Medicaid Expansion
Ohio Senator Rob Portman and West Virginia Senator Shelley Moore Capito want two very different things for Medicaid. Portman “supports rolling back the Medicaid expansion by ending the extra federal money for it, as long as there is a ‘soft landing.’” On the other hand, Capito “wants the expansion of coverage to remain, though she said it did not have to be in the same form.”
Healthcare Reform News Update for May 9, 2017
Health Insurance Companies Raise Premiums as Marketplace Uncertainty Continues
Three states—Connecticut, Maryland, and Virginia—are the first to make their health insurance premium rates public. In each state, premiums will increase by more than the anticipated 20%.
- Connecticut, with 2 marketplace insurance companies, will have an average rate increase of 24%.
- Maryland, with 4 marketplace insurance companies, will have an average rate increase of 45%.
- Virginia, with 6 marketplace insurance companies, will have an average rate increase of 31%.
Moderate Senators’ Concerns May Reshape Healthcare Bill
With a slim margin needed to pass the bill (Republicans can lose only two votes), the Senate’s Republicans will have to negotiate and appease both sides (conservative and moderate) of their party. Because of this, moderate Republicans have the leverage to alter several more controversial aspects of the AHCA. Moderate Republicans’ concerns with the current healthcare reform bill are predominantly about:
- Changes to Medicaid
- Early CBO estimates that the AHCA would result in 24 million people losing coverage
- Coverage for pre-existing conditions
- Planned Parenthood Funding and abortion language
Healthcare Reform News Update for May 8, 2017
Senate Healthcare Vote Will Likely Be a Simple Majority
Republican Senate Majority Leader Mitch McConnell told the Associated Press that he didn’t expect Democratic support on healthcare legislation. “We don’t anticipate any Democratic help at all, so it will be a simple majority vote situation.”
More Senators Suggest Rewriting, Not Refining, GOP Healthcare Bill
Rather than revising the American Health Care Act of 2017 (AHCA), more members of the Senate have said that a completely new bill will be written. Moderate Republican Senator Susan Collins stated, “The Senate is starting from scratch. We’re going to draft our own bill, and I’m convinced that we’re going to take the time to do it right.”
Senator Collins and Senator Bill Cassidy have already introduced a bill called the Patient Freedom Act. Their bill “keeps some of the consumer protections within Obamacare for people with pre-existing conditions while seeking to solve some of the flaws within the healthcare law.”
Democrats Criticize Lack of Women in Republican Group Working on Healthcare Reform
Republicans have created a group of 13 Senators to “craft a plan to pass legislation to repeal and replace Obamacare.” Democratic Senators questioned why the group included no women, despite the number of women’s health issues involved in healthcare reform.
- Democratic Senator Dianne Feinstein: “Women’s health is a big part of this and women are a majority of the population, and their health interests deserve to be contemplated in any reform.”
- Democratic Senator Patty Murray: “It matters to have women at the table—and it matters when they aren’t.”
- Democratic Senator Kamala Harris: “The GOP is crafting policy on an issue that directly impacts women without including a single woman in the process. It’s wrong.”
Trump Relying on Senate to Improve Healthcare Bill
White House chief of staff Reince Priebus told reporters that President Trump expects Senate Republicans to improve the healthcare reform bill. “Everyone is committed to getting this thing done and getting it done as soon as possible,” Priebus told Fox News. Trump also tweeted, adding pressure to the Senate, “Republican senators will not let the American people down!”
Former President Obama Pressures Senate to Preserve ACA
On Sunday night, Former President Barack Obama urged Congress to maintain the ACA (or Obamacare) and its patient protections. “I hope they understand that courage means not simply doing what’s politically expedient, but doing what, deep in our hearts, we know is right,” Obama said. Obama also expressed his hope that Congress members “recognize it takes little courage to aid those who are already powerful, already comfortable, already influential—but it takes some courage to champion the vulnerable and the sick and the infirm, those who often have no access to the corridors of power.”
Healthcare Reform News Update for May 5, 2017
Senators Likely to Alter House-Approved AHCA
Senator Roy Blunt (R-MO) has already indicated that the AHCA will be altered in the Senate. “We’re going to look at what the House has done and see how much of that we can incorporate in a product that works for us with reconciliation.”
Senator Lamar Alexander (R-TN) supported his colleague’s statement, saying, “We’re writing a Senate bill and not passing the House bill. We’ll take whatever good ideas we find there that meet our goals.” Alexander also gave no hints about when a Senate bill would be ready. “There will be no artificial deadlines in the Senate. We’ll move with a sense of urgency but we won’t stop until we think we have it right.”
Senator Lindsey Graham (R-SC) gave a harsher statement against the House’s passage of the AHCA, noting the lack of a score from the Congressional Budget Office. “Like y’all, I’m still waiting to see if it’s a boy or a girl. Any bill that has been posted less than 24 hours, going to be debated three or four hours, not scored? Needs to be viewed with suspicion.”
House Passes Bill Removing AHCA Coverage Exemptions
Shortly after passing the AHCA, the House voted on a separate piece of legislation. This separate bill nullifies exemption language in the AHCA (which allows lawmakers and their staff to maintain coverage regardless of their states’ coverage changes). The bill is now with the Senate.
What’s Next for the American Health Care Act Bill?
Now that the AHCA has been approved by the House, it will go straight to the Senate. In order for the Senate to pass the bill by a simple majority (51 votes), the bill must follow the “Byrd Rule.” The rule dictates that, as a reconciliation bill, the AHCA can only alter budget-related provisions of the Affordable Care Act. Additionally, the bill cannot increase the federal deficit in the long term. Any provisions in the bill that are not budget-related can be rejected, and the Senate has the authority to completely alter the bill.
After the Senate has reviewed and potentially changed the bill, they will vote on it. If the bill passes, the House must review the Senate’s altered bill. The House can approve the Senate’s bill, or they can try to reconcile the differences between the two. In the latter case, the two chambers of Congress will create a bill that meets the needs of both chambers, and each will vote again on the final bill.
When a final bill has been approved by the House and the Senate, the bill goes to the President. Trump can accept the bill and sign it into law, or he can veto the bill.
Healthcare Reform News Update for May 4, 2017
House Passes the American Health Care Act (H.R 1628)
This afternoon at 2:19 p.m. EST, the House passed the amended American Health Care Act of 2017 (AHCA). The bill passed by a slim margin (217 to 213). As with any bill, the AHCA will be sent to the Senate. The Senate might amend different parts of the bill or write its own bill. If the Senate passes a different version of the bill, then the House and Senate will hold a conference committee to resolve the differences between the two bills. Once a new bill has been created, it must then pass unchanged through both the House and Senate, and be signed by the President, in order to become a law.
Under the AHCA, the following will be repealed:
- The individual mandate
- The employer mandate
- Cost-sharing reduction subsidies
- Certain ACA taxes
The following will be changed:
- Medicaid expansion
- Pre-existing condition policies
- Essential health benefit policies
- Restrictions on increased costs for older Americans (age band rating)
- Premium subsidies
- Health savings accounts
The following will not change:
- Dependent coverage until the age of 26
- Prohibitions on annual and lifetime limits
GOP Healthcare Plan Still Includes Congressional Exemption
Language in the GOP healthcare plan still exempts Congress and their aids from being subject to state waiver provisions. This protects Congress and their staff from “losing the [ACA’s] popular provisions.” According to Rep. Tom MacArthur’s office, separate legislation will eliminate this controversial exemption.
Aetna to Exit Virginia ACA Marketplace
Aetna will no longer offer individual health insurance plans, on- and off-exchange, in Virginia. The company cited $200 million in anticipated losses and market uncertainty as its reason to exit Virginia’s individual market. Including Iowa, this marks the second state where Aetna has withdrawn individual plans.
News Update for May 3, 2017
Can Moderate Republicans Draft a Winning Proposal?
After moderate Republican Reps. Fred Upton (MI) and Billy Long (MO) announced their opposition to the current healthcare reform bill, they drafted a proposal addressing their concerns. Upton’s and Long’s proposal “would provide $8 billion over five years to help some people with pre-existing medical conditions afford coverage.” Upton and Long “said Wednesday they were now backing the high-profile [healthcare reform bill] after winning President Donald Trump’s support for their proposal.”
News Update for May 2, 2017
Will Republicans Have Enough Support for a Healthcare Reform Vote?
Concern over pre-existing conditions isn’t helping the GOP pass healthcare reform legislation. In addition to moderates withholding their support, a Republican legislator—and Trump supporter—has decided to vote against the amended American Health Care Act (AHCA). Rep. Billy Long (MO-R), in explaining his decision to vote no, said this: “I have always stated that one of the few good things about Obamacare is that people with pre-existing conditions would be covered. The MacArthur amendment strips away any guarantee that pre-existing conditions would be covered and affordable.”
The New York Times has created a report of the number of “no” votes, collecting and updating numbers from 4 additional news organizations. To see how many “no” votes there currently are, and who is voting “no,” read their article here.
Trump Talks Pre-existing Conditions With Bloomberg News
During an interview with Bloomberg News, President Trump said, “I want it to be good for sick people. It’s not in its final form right now. It will be every bit as good on pre-existing conditions as Obamacare.”
By “final form,” it is not clear if the President is saying that the current, amended healthcare bill is still being negotiated or if he is commenting on future Senate revisions after the bill is passed in the House.
10 Patient Advocacy Groups Speak Out Against Revised AHCA
Patient advocacy groups, including the American Cancer Society Cancer Action Network and the American Heart Association, have spoken out in opposition to the most recent Republican healthcare reform proposal. In the group’s statement, they wrote: “As introduced, the bill would profoundly reduce coverage for millions of Americans—including many low-income and disabled individuals who rely on Medicaid—and increase out-of-pocket costs for the sickest and oldest among us. We are alarmed by recent harmful changes to the AHCA, including provisions that will weaken key consumer protections.”
News Update for May 1, 2017
Will GOP Try for Another Healthcare Vote Before One-Week Recess?
The House will leave for a one-week recess on Thursday. This gives Republicans four days to shore up enough votes before going back home to their constituents. Some lawmakers have hinted at a vote this week, but publically GOP leaders have said they have until the end of May to pass healthcare legislation.
President Trump Comments on New Healthcare Bill, Pre-existing Conditions
Trump told CBS, during an interview Sunday on “Face the Nation,” that the Republican healthcare bill has “evolved” and will protect those with pre-existing conditions. While he mentioned that the proposed bill would set up high-risk pools, he “also repeatedly seemed to suggest continuing the current mandate.” Trump said, at different points in the interview:
- “Pre-existing conditions are in the bill—and I mandate it. I said, ‘Has to be,’ Trump said, later adding that the proposal has ‘a clause that guarantees’ protection for those with preexisting conditions.”
- “Pre-existing is going to be in there, and we’re also going to create pools, and pools are going to take care of the pre-existing.”
Trump Vows Not to Alter the ‘Concept of Medicare’
President Trump, during an interview Sunday with “Face the Nation” on CBS, said he had no intentions of altering Medicare. Trump said, “I’m not going to touch it, because I said it. Now, waste, fraud and abuse, I’m going to touch. If there’s something in Medicare that’s been abused, I will touch that. There are certain provisions in Medicare that are horrible and abusive and there’s been terrible things happening. So that kind of stuff, I will absolutely touch … But the concept of Medicare, I’m not touching.”
NIH Gets Funding Increase
Rather than the proposed cut of $1.2 billion, the National Institutes of Health (NIH) will receive $2 billion in increased funding through the next five months.
New Kaiser Family Foundation Poll on Prescription Drug Prices
In a new poll, the Kaiser Family Foundation found that 60% of Americans think that lowering prescription drug costs is a “top priority.” Most of those polled supported the following actions to lower drug prices:
- Allowing the government to negotiate Medicare drug prices (92% in favor)
- Making it easier for generic medications to enter the market (87% in favor)
- Requiring drug companies to release how they set their prices (86% in favor)
- Limiting how much companies can charge for high-cost medications (78% in favor)
- Allowing Americans to purchase imported Canadian prescriptions (72% in favor)
- Creating an independent group to oversee the pricing of drugs (72% in favor)
- Allowing Americans to purchase prescriptions from online Canadian pharmacies (64% in favor)
- Eliminating prescription advertisements (56% in favor)
- Encouraging consumers to purchase lower-cost drugs by increasing responsibility for higher-cost drugs (52% in favor)
News Update for April 28, 2017
No Vote on Revised Healthcare Bill This Week
The Republican healthcare reform bill doesn’t have the 216 votes needed to pass the House this week. Despite revisions that were made to appeal to conservative lawmakers, recent changes have not persuaded moderate Republicans to support the bill. Rep. Ryan Costello (R-PA) stated his concerns by saying, “Protections for those with pre-existing conditions without contingency and affordable access to coverage for every American remain my priorities for advancing health care reform, and this bill does not satisfy those benchmarks for me. I remain a no vote on this bill in its current form.”
Healthcare Industry Shut Out of Republican Healthcare Reform
In addition to excluding Democrats, healthcare officials are also being shut out of healthcare reform talks. “Health insurers, who initially found House Republicans and Trump administration officials open to suggestions for improving insurance markets, say it is increasingly difficult to have realistic discussions, according to numerous industry officials.”
At almost every level (insurance companies, patient advocates, healthcare providers, and hospitals), those working in the healthcare system have had little luck in talking with the administration. “‘To think you are going to revamp the entire American healthcare system without involving any of the people who actually deliver healthcare is insanity,’ said Sister Carol Keehan, president of the Catholic Health Assn., whose members include many of the nation’s largest medical systems.”
News Update for April 27, 2017
House Freedom Caucus Officially Endorses Revised Healthcare Bill
The House Freedom Caucus has made an official endorsement in favor of the amended Republican healthcare reform bill, meaning at least 80 percent of its members will vote yes on the bill. House Freedom Caucus spokesperson Alyssa Farah stated, “Over the past couple of months, House conservatives have worked tirelessly to improve the American Health Care Act to make it better for the American people. [Because of those changes,] the House Freedom Caucus has taken an official position in support of the current proposal.”
Despite Revisions, Moderate Republicans Remain Opposed to Republican Healthcare Bill
While revisions have won the support of conservative Republicans, moderates seem to be backing away from the most recent healthcare proposal. “Rep. Charlie Dent (R-Pa.), co-chair of the moderate, 50-member Tuesday Group, said he hasn’t detected any reversals among the opponents of the health care bill — in fact, he said, their ranks may grow.”
Democrats also opposed language that “appeared to exempt members of Congress and their aides from weakened regulations that states would be allowed to adopt.” Spokesman for Nancy Pelosi, Drew Hammill, stated, “It should be no surprise that TrumpCare has gotten so terrible that Republicans have resorted to exempting themselves and their families from the pain it inflicts. Speaker Ryan and congressional Republicans promised that Americans with pre-existing conditions would be protected, but it turns out they were only talking about themselves.”
Republicans are quickly trying to revise this controversial portion of their current healthcare reform proposal.
CSR Payments Not in Upcoming Spending Bill
Paul Ryan told reporters on Wednesday that funding for cost-sharing reductions (CSRs) will not be in the upcoming spending bill (which will fund the government through September). “We’re not doing that,” Ryan said. “That is not in an appropriation bill. That’s something separate the administration does.”
But this doesn’t mean the payments will be stopped. The White House has agreed to continue funding CSRs for the time being. Nancy Pelosi, House Minority Leader, confirmed the news. “Our major concerns in these negotiations have been about funding for the wall and uncertainty about the CSR payments crucial to the stability of the marketplaces under the Affordable Care Act. We’ve now made progress on both of these fronts.”
The future of CSR subsidies will be decided “outside of the congressional spending process.”
News Update for April 26, 2017
Healthcare Reform Discussions Ongoing After April Recess
The deadline for passing a government spending bill, and avoiding a shutdown, is Friday. While nothing has been fully agreed upon or scheduled, here is a short update of what’s happening with healthcare reform:
- A new Obamacare repeal and replace plan has been finalized by the Republican Party. The Freedom Caucus has not given an official statement about the revision, though it conceded to many Freedom Caucus demands. You can read the document, an amendment to the previous American Health Care Act bill, here.
- Democrats will agree to increase the military budget by $15 billion if funding for cost-sharing reduction subsidies is guaranteed (around $10 billion). Otherwise, “Democrats will demand that the $15 billion … be matched with an equal increase in supplemental funding for non-military programs.”
News Update for April 19, 2017
Most Health Insurance Companies Plan to Stay on the Marketplace
A survey conducted by Oliver Wyman indicates that 96 percent of health insurance companies intend to keep offering Marketplace plans. A majority of those intending to continue on the Marketplace (71 percent) have no plans to change the coverage they offer. Of the companies surveyed, 75 percent plan to increase their rates, with increases ranging from less than 10 percent to more than 20 percent. Read the full survey here.
News Update for April 14, 2017
CSR Subsidy Funding Now a Top Priority for Democrats
After President Trump’s suggestions that he would use cost-sharing reduction (CSR) subsidies as a negotiating tactic, Democrats are insisting that any new healthcare spending bill should guarantee funding for subsidies. A Senate Democratic aide said, “Given [Trump’s] threat, we’ll be pushing for a robust cost-sharing reduction appropriation.”
Aside from prompting a funding requirement to be included in the next healthcare bill, Trump’s tactic of potentially withholding CSR funding has received negative criticism from Democrats.
- Senator Ron Wyden: “There is no outcome in which the administration sabotaging insurance markets persuades Democrats to pass Trumpcare, a disastrous proposal which would only make our health care system worse. When the president drops his threats on Americans’ health care — including the latest threat to withhold insurance payments, which he clearly understands puts people’s care in danger — Democrats will be prepared to work on bipartisan improvements to the Affordable Care Act.”
- Senate Democratic Leader Chuck Schumer: “Our position remains unchanged: drop repeal, stop undermining our health care system, and we will certainly sit down and talk about ways to improve the Affordable Care Act.”
- House Democratic Caucus Head Joseph Crowley: “Rather than improving our country’s healthcare system, President Trump is bent on destroying it. His most recent threat — to raise premiums for millions of Americans by withholding the law’s cost-sharing reduction payments — amounts to nothing more than political blackmail.”
Administration Finalizes Proposed Market Stabilization Rule
Late Thursday, a proposed rule aimed at stabilizing the ACA marketplace was finalized. As reported yesterday, the final rule affects outstanding premium payments and plan renewals, the open enrollment period, special enrollment verifications, and actuarial value requirements. Read the final rule document produced by the Department of Health and Human Services here.
Trump’s Statement on CSRs Concerns Health Insurance Industry
The threat of discontinuing CSRs in order to pull Democrats into negotiations is also weighing heavily on the health insurance industry. Chief Executive of Avalere Health commented on Trump’s recent statements: “This is a very potent threat, because the administration has the authority unilaterally to do this, and this is really a kill switch. This makes the program unprofitable for the majority of health plans operating in it today. The timing of this threat is really curious, in the sense that now is the time that the plans have to be deciding whether to bid on 2018. If you’re on the bubble and the president is making a threat like this … this just puts more uncertainty on the program.”
News Update for April 13, 2017
Trump Plans to Use CSR Subsidies as a Negotiation Tactic
Three administration officials told Politico that “President Donald Trump wants to use a key Obamacare subsidy program as leverage to draw Democrats to the negotiating table on health care.” During an interview with The Wall Street Journal, President Trump acknowledged his plans to use the cost-sharing reduction (CSR) subsidies to start negotiations. “I don’t want people to get hurt. What I think should happen—and will happen—is the Democrats will start calling me and negotiating,” said Trump.
Democratic Senator Chuck Schumer criticized Trump’s statements, saying, “President Trump is threatening to hold hostage health care for millions of Americans, many of whom voted for him, to achieve a political goal of repeal that would take health care away from millions more. This cynical strategy will fail.”
Healthcare Groups Write Letter to Trump, Calling on Administration to Continue CSR Payments
Healthcare industry groups wrote a direct appeal letter to the President and administration on April 12. In an excerpt from the letter, the groups state that “the most critical action to help stabilize the individual market for 2017 and 2018 is to remove uncertainty about continued funding for cost sharing reductions (CSRs).” Along with the clarity needed by insurance companies, the letter explains what will happen if CSR funding is lost.
A Proposed Rule Could Make Big Changes to the ACA Marketplace
The Trump administration has proposed a rule to try and stabilize the Marketplace. The current draft’s changes to the Affordable Care Act (ACA) Marketplace include:
- Allowing insurance companies to require customers to pay outstanding premiums before issuing a new plan. (For example: If you owe 2 months of premiums at the end of 2017, you will have to pay them before your 2018 plan begins.)
- Shortening the open enrollment period to run from November 1 through December 15. (The previous open enrollment period ran from November 1 through January 31.)
- Increasing verification before individuals may enroll in special enrollment period plans (sold outside of the normal open enrollment period).
- Increasing the allowable variation of actuarial values used in metal tier plan determination. “Bronze plans, for example, currently must cover an average of 60 percent of costs, while a silver one is 70 percent — and insurers are allowed wiggle room of plus or minus 2 percent around those averages. The Trump proposal would tweak the formula. … So, for example, a bronze plan might cover only 56 percent of costs and silver 66 percent.”
Poll Shows Support for a Single-Payer Healthcare System
In a Morning Consult/Politico poll of 1,988 registered voters, 44 percent of those polled were in favor of a single-payer healthcare system. Thirty-six percent oppose it, and 19 percent don’t know. Read here to see more on the poll and how political affiliation affected individuals’ outlooks.
News Update for April 12, 2017
Freedom Caucus Working With Paul Ryan on 2 Healthcare Reform Options
Rep. Mark Meadows, the House Freedom Caucus leader, stated Tuesday that Republicans are close to striking a deal on healthcare reform. Meadows stated that his group is waiting for Paul Ryan to contact them today about two potential options, adding during a local radio show, “We’re very close. The biggest thing for all of us is we want to make sure we don’t just have repeal, but we have a replacement that drives down insurance premiums. It’s our encouragement to have a vote as soon as we possibly can, even perhaps before we return back to DC in 13 days.”
Meadows also spoke to USA TODAY about the deal. “What I’m getting to [Ryan] is based on conversations that I’ve had with (Tuesday Group co-chairman) Tom MacArthur and leadership, but I wouldn’t say that it’s approved at this point. What we’re trying to do is work through issues that are important to all of us but make sure that pre-existing conditions are taken care of.”
CSR Subsidies Still Not in the Clear
Despite previous statements, the Department of Health and Human Services (HHS) seems to be walking back assurances for cost-sharing reduction (CSR) subsidies. HHS spokesperson Alleigh Marré gave this statement recently after a New York Times article stated that CSRs were safe during the lawsuit:
“The New York Times report is inaccurate. The administration is currently deciding its position on this matter. We have not been contacted by Democrats to help save Obamacare, perhaps because they consider Obamacare to be a losing cause. Democrats need to help solve this failed Obamacare plan. The report was in reference to the current status of the lawsuit and is not an indication of what will happen in the future. No decisions have been made about how the administration will proceed.”
Trump Interview Confirms President Isn’t Moving Past Healthcare if He Can Help It
During an interview between President Trump and Fox Business Network, Trump stated his desire to pass healthcare reform legislation before moving on to tax reform. “We’re going to have a phenomenal tax reform, but I have to do health care first. I want to do it first to really do it right.” However, he isn’t willing to hold back on tax reform if healthcare takes too long. “Now, if it doesn’t happen fast enough, I’ll start the taxes. But the tax reform and the tax cuts are better if I can do health care first.”
Moderate Republicans Calling for Bipartisanship on Healthcare Reform
Co-chair of the moderate Tuesday Group, Rep. Charlie Dent, spoke to Axios about the need for bipartisanship when trying to reform healthcare. “If we attempt to muscle this thing through on a partisan basis, I feel we’ll have a similar result … the reform won’t be durable.”
Republican Senator David Perdue also talked about the need to make a bipartisan effort to reform healthcare. “How’d the other direction work out? It didn’t work out very well when we pretty much ignored them. There’s a great chasm up there and I would argue that polarization is one of our great threats to solving a problem. I believe there’s no danger to finding a compromise solution.”
Democrats Fight Back in Battle of Ad Campaigns
A $1 million ad campaign supported by “a liberal group backed by labor and progressive interests” is targeting seven Republicans. The campaign attacks these Republicans’ support of the American Health Care Act (AHCA), utilizing growing support for Obamacare.
News Update for April 11, 2017
Ad Campaigns Target Moderates and Democrats Over Healthcare Reform During April Recess
Club for Growth, a conservative group, wants moderate Republicans to accept the most recent healthcare bill proposal. The group announced Monday that it will use a $1 million dollar ad campaign to target at least 10 moderate House Republicans. Club for Growth President David McIntosh commented on the campaign, “Our message in this ad is: Come on board, keep the promise that you and our party made to finally repeal Obamacare and lower health-care insurance costs for Americans across the board.”
The National Republican Congressional Committee (NRCC) is also using ad campaigns to target those who opposed the most recent healthcare reform draft: Democrats. NRCC is aiming at 5 Democrats with digital billboards. The billboards highlight “each Democrats’ support for Obamacare and [urge] constituents to contact their representatives.”
Lawyers Create Watchdog Group to Monitor Conversations Surrounding Obamacare
A group of lawyers have created the watchdog group called “American Oversight.” By using the Freedom of Information Act, they hope to review emails and other conversational documents between Department of Health and Human Services (HHS) officials and other agencies concerning Obamacare. Their ultimate goal is to promote transparency, discover how Obamacare decisions are being made, and “[look] for evidence of ‘sabotage.’”
“The topics they’re focusing on:
- The decision to cut back Obamacare advertising in the last week of enrollment
- Whether HHS will advertise in the next enrollment season
- What it will do about the law’s ‘essential health benefits’
- What it will do about the cost-sharing subsidies
- Any changes it might make to the Obamacare marketplaces
- What insurers have told the Trump administration about whether they’ll participate next year”
News Update for April 10, 2017
Health Insurance Companies May Start Seeing Obamacare Profits, According to S&P
Standard & Poor’s (S&P) analyzed the performance of many Blue Cross plans operating in different states. According to the analysis, these insurance companies stemmed their losses in 2016, could break even in 2017, and could make a marginal profit in 2018. S&P analysts commented on their findings: “We are seeing the first signs in 2016 that this market could be manageable for most health insurers. The market is not in a ‘death spiral.’ ”
House Republicans Defending Popular Obamacare Policies in Face of Freedom Caucus’ Demands
Many House Republicans are speaking up for popular Obamacare policies. This support is in opposition to the Freedom Caucus’ strict goal of repealing them. Coverage for pre-existing conditions, Medicaid expansion, and coverage mandates for mental health services and prescription drugs are all getting support from the middle-right.
News Update for April 7, 2017
House Goes on April Recess But Continues Healthcare Reform Talks
After last-minute amendments to the latest healthcare reform draft, the House commenced its two-week recess. The changes intended to swing the Freedom Caucus seem to be working, with Freedom Caucus chairman Rep. Mark Meadows stating positively that “the majority of the Freedom Caucus would be favorably inclined to vote for” a bill that eliminated essential health benefits, community ratings, and guaranteed issue plans. While these changes suit conservative Republicans, moderates seem less enthusiastic. Moderate GOP Rep. Leonard Lance said of the latest draft, “I favor making sure no one is denied coverage due to a pre-existing condition. So I doubt [the latest revision] would be enough.”
Despite the recess, healthcare reform talks are still in progress. House Majority Leader Kevin McCarthy warned representatives that the planned recess could be cut short. If a healthcare reform deal can be made between moderates and conservatives, representatives could be called back to vote on a new bill.
Aetna Leaves Iowa’s Marketplace
Aetna announced on Thursday that it would stop selling individual health insurance plans in Iowa, both on and off of the Affordable Care Act (ACA) Marketplace. Aetna made the decision based on “financial risk and an uncertain outlook for the marketplace.” After the Wellmark Blue Cross and Blue Shield withdraw — and now Aetna’s withdraw — from Iowa, this leaves 5 counties with two insurance options and the remaining 99 counties with only one health insurance option.
Cost-Sharing Reduction Subsidies and Medicaid: What Effects Would Funding Cuts Have?
Based on a recent Kaiser Family Foundation analysis, the loss of cost-sharing reduction (CSR) funding would lead to a 19% increase in silver tier plan premiums. “The analysis … finds that the estimated premium increase for silver plans would be higher (21%) in states that did not expand Medicaid under the ACA than in states that expanded Medicaid (15%).” And according to the Commonwealth Fund, cuts to Medicaid funding would mostly affect older and sicker individuals. “Any changes to the Medicaid program could disproportionately affect many of our neediest, sickest Americans.”
News Update for April 6, 2017
Insurance Companies Withhold Commissions, Brokers Forced to Leave Marketplace
In order to mitigate losses in the individual market, insurance companies are refusing to pay brokers on platinum tier and special enrollment plans that brokers have already sold. Additionally, companies are lowering commission rates for those being delivered.
Despite their moral conflict over leaving consumers without an advocate, 36,000 brokers (35% of those representing the Marketplace) have had to exit the Marketplace in order to protect their livelihood. This mass exodus may negatively impact the Marketplace’s enrollment because 50% of enrollments are attributed to brokers.
House GOP Schedule Emergency Meeting to Amend Latest Healthcare Reform Draft
House Republicans are scheduled to meet today (Thursday) to add a “risk-sharing fund” to their current healthcare reform draft. This addition would allocate $15 billion to health insurance companies to help subsidize care for those with pre-existing conditions or high medical costs. Sources do not believe that this meeting will affect the upcoming 2-week recess.
Fate of Cost-Sharing Subsidies Still Unknown
“Trump’s advisers, who had expected Congress to have passed a repeal bill by now, have not agreed what to do about the subsidies, which help low-income people covered by Obamacare pay for their out-of-pocket health costs. One senior official said that the Department of Health and Human Services and the White House Office of Management and Budget were studying the impact of abruptly stopping billions of payments to the health plans that participate in the Obamacare markets. Insurers would have to pick up these costs, regardless of whether the federal funds are released.”
The fate of cost-sharing subsidies hinges on the lawsuit. “The House Republicans won the first round of the lawsuit over the cost-sharing subsidies, although the Obama administration appealed the decision. The Trump administration asked for some extra time, and the next deadline for the Trump Justice Department is May 22.”
Another complicating factor is how the government will decide to budget for the subsidies, at least until the outcome of the lawsuit is decided. “Congress must approve a spending bill for the rest of the year by late April to avoid a government shutdown.”
News Update for April 4, 2017
Revisions to Republican Healthcare Bill Stir Hope for Winning Vote
Accompanied by White House officials, Vice President Mike Pence presented an offer for healthcare reform to the Freedom Caucus during a closed-door meeting Monday night. While it was not an official revision, the offer included:
- Allowing states to apply for coverage requirement waivers (specifically the essential health benefits) and pre-existing condition coverage exemptions
- Removing the “community rating” rule, which “requires insurance companies to charge the same price to everyone who is the same age.”
States would apply for waivers if they could “improve coverage and reduce costs” without the essential health benefits. There was also discussion of creating high-risk pools for those with pre-existing conditions, redirecting money from state stability funds to cover the cost.
The Freedom Caucus will not make a final decision until the members can review the new bill in writing.
Proposed NIH Funding Cuts Meet Strong Opposition
Months after increasing biomedical research funding, Republicans and Democrats are visibly unhappy with proposed cuts to the National Institutes of Health (NIH). Representatives are “extremely concerned about the potential impact of the 18 percent cut” and believe that patients and researchers could see “catastrophic results” if the funding cuts are approved.
Joe Biden, former Vice President, had this to say about the proposed cuts. “[President Trump is] proposing draconian cuts—not only to biomedical research, but also to the entire scientific expertise across the board. This would set the NIH budget, and biomedical research, back 15 years—and that’s not hyperbole.”
A Proposed Rule Could Lower the Value of Your Health Plan
A rule proposed by the Trump administration in February could lower the actuarial value of all metal tier health plans by 2%. This means insurance companies could offer “bronze plans with actuarial values as low as 56 percent instead of the 60 percent standard” coverage of medical costs. While it may lower expenses for insurance companies, consumer advocates and insurance experts think the rule falls short of consumer needs and concerns. The lower actuarial value both reduces potential subsidies and increases out-of-pocket costs.
Wellmark Blue Cross and Blue Shield Withdraws from Iowa’s ACA Marketplace and Regulations
Without clarity into the future of healthcare reform, Iowa’s Wellmark Blue Cross and Blue Shield has had to make a difficult decision. Wellmark will stop offering health plans on the Marketplace, and it will no longer offer ACA-compliant plans in 2018. The company cites a $90 million dollar loss, 43% premium rate increases, and unclear healthcare reform as its primary reasons for making such enormous changes. Without Wellmark on the Marketplace, 21,400 individual enrollees will have to weigh the changes to their plans or seek new coverage in 2018.
News Update for April 3, 2017
Trump Meets with Zeke Emanuel and Rand Paul on Healthcare
The Trump administration met with both Obamacare architect Zeke Emanuel and Republican Senator Rand Paul last week. White House press secretary Sean Spicer said, “I think that despite our political and policy differences, [Trump] wants to hear ideas not just of [Emanuel] but a lot of people.” Trump and Rand Paul golfed together on Sunday, Paul commenting that he “had a great day with the president. Played some golf, and we talked and we talked about a little bit of healthcare. I continue to be very optimistic that we are getting closer and closer to an agreement on repealing Obamacare.”
“Trump, who took a political hit last month when House Republicans failed to agree on an alternative health care plan, also tweeted: ‘Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck.’”
Wisconsin Works on Medicaid, Florida House Passes Legislation
Scott Walker, the Republican Governor of Wisconsin, wants to implement drug tests and work requirements for Medicaid recipients. Both ideas have drawn criticism because they could further stigmatize the poor and waste money. Two state examples and a Kaiser Family Foundation (KFF) analysis support critics of Walker’s proposal:
- North Carolina and Michigan, who screen their welfare applicants, have seen little use in drug testing—less than 0.3% of North Carolina’s applicants and 0% of Michigan’s applicants tested positive.
- An analysis done by the KFF broke down the work status of Medicare beneficiaries. Of those not working, 35% were disabled or unwell, 28% were taking care of family members, 18% were enrolled in school, 8% were retired, and 8% were not able to find work. This leaves only 3% of those not working to fail proposed work requirements.
The Florida House passed a “direct primary care” bill on Thursday. This bill allows patients to directly negotiate regular payments and costs with doctors.
News Update for March 31, 2017
The Importance of CSRs to the Marketplace and Current Litigation Threatening Them
Under the Obama administration, subsidies used to lower the cost of out-of-pocket expenses were created. These subsidies, called cost-sharing reductions (CSRs), guaranteed payments to health insurance companies if they offered reduced out-of-pocket pricing to certain customers. However, “the GOP argued the payments were being made unconstitutionally, without a congressional appropriation.”
Republican House members sued the Obama administration over the funding of CSRs, and Trump’s administration inherited this ongoing lawsuit. If the lawsuit is won, or if the current administration dismisses the case, insurance companies stand to lose millions (which have already been used to fund CSRs) promised by the government. The potential loss is influencing many insurance companies to drop out of the Marketplace or increase premiums.
Speaker Paul Ryan stated on Thursday that payments will continue to be made to insurance companies that offer CSRs. However, his guarantee was limited to the ongoing case. “While the lawsuit is being litigated, then the administration funds these benefits. That’s how they’ve been doing it and I don’t see any change in that. We don’t want to drop the lawsuit because we believe in the separation of powers. We believe in Congress retaining its lawmaking power, but this lawsuit hasn’t run its full course,” Ryan said.
Ryan’s statement has done little to comfort insurance companies. Kristine Grow, spokesperson for America’s Health Insurance Plans, doesn’t think payments continuing only during the lawsuit are enough. “Insurers need certainty that the payments will be there throughout 2018, or else they might need to raise premiums for next year to factor in the uncertainty.” Grow said, “As soon as this lawsuit stops the CSRs no longer have a guarantee.”
Chairman of the House Energy and Commerce Committee, Greg Walden, gave a stronger guarantee with the hope of keeping insurance companies in the marketplace. “I will do everything I can to make sure the cost-sharing reduction payments get made, especially this year where they were promised by the federal government under the contracts. That’s an obligation not only to insurers but also to the people who took on those plans. We cannot leave them high and dry.”
Healthcare Reform Vote Doesn’t Have a Set Date, or Enough Support, According to Speaker Ryan
House Speaker Paul Ryan addressed questions surrounding Republican healthcare reform during his weekly news conference. When asked about the timeline and bill details, Ryan stated, “I’m not going to commit to when and what the vote is going to look like, because it’s my job to make sure that House Republicans can coalesce and come together and draw a consensus.”
Ryan also commented on President Trump’s frustrations with Republicans’ inability to pass the first reform bill, shared during conferences and on Twitter. “I understand the president’s frustration. I share that frustration. About 90 percent of our conference is for this bill and about 10 percent are not. And that’s not enough to pass the bill.”
States Continue to Move Forward With Their Own Healthcare Reforms
In California, Democratic Senator Ricardo Lara released proposed details for a state-wide single-payer healthcare system. “With Republicans’ failure to repeal the Affordable Care Act, Californians really get what is at stake with their healthcare. We have the chance to make universal healthcare a reality now. It’s time to talk about how we get to healthcare for all that covers more and costs less,” Lara said in a statement.
In Florida, the State House passed two bills that support “a free-market, consumer-driven healthcare system.” HB 161 allows individuals and employers to negotiate and contract with doctors directly for healthcare services (this is normally done by health insurance companies). HB 145 lets surgical centers hold patients for 24-hours and makes new recovery centers to care for post-operative patients for 72 hours.
In Kansas, Governor Sam Brownback has vetoed a Medicaid expansion bill previously approved by the state’s House and Senate. In his veto message, Brownback stated, “I am vetoing this expansion of Obamacare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs.” The House and Senate have 30 days to override the veto.
News Update for March 30, 2017
Ryan Doesn’t Want Bipartisan Healthcare Reform
During an interview on “CBS This Morning,” Ryan voiced his concerns on Trump’s sway toward Democratic healthcare reform. Republicans’ inability to come together on healthcare reform, as well as campaign promises, may be leading the President to consider Democrats’ reform requests. “This is a can-do president, who’s a business guy, who wants to get things done, and I know that he wants to get things done with a Republican Congress, but if this Republican Congress allows the perfect to be the enemy of the good, I worry we’ll push the president into, um, working with the Democrats; he’s suggested as much,” Ryan said during the interview.
Two GOP Senators Introduce Legislation to Help Those With No Marketplace Options
If insurance providers withdraw from already limited markets, many Americans would have no options on the Marketplace and couldn’t utilize subsidies. Republican Tennessee Senators Lamar Alexander and Bob Corker introduced legislation on Wednesday hoping to limit this fallout. Their proposed bill would allow Americans to use their subsidies to purchase coverage off the exchange.
States Take Action to Lower Healthcare Spending
Colorado’s State Senate has approved a $26.8 billion state budget bill. The bill includes controversial funding cuts to state hospitals ($500 million).
Texas’ House submitted a spending proposal that cuts $2.4 billion in funding from Medicaid ($1 billion from Texas state and $1.4 billion from the federal government).
Minnesota’s House and Senate announced they’d made a deal on a bill aimed to control health insurance costs in their state. This deal would support health insurance companies (helping them cover the cost of high medical claims) and cost $542 million dollars in the next two years.
News Update for March 29, 2017
Republican House Members Not Ready to Leave Healthcare Reform Behind
House Speaker Paul Ryan brokered a meeting between the Tuesday Group of moderates and the House Freedom Caucus. During the meeting, the two groups “reopened the conversation on how to repeal and replace Obamacare.” While there hasn’t been a consensus, it was clear to meeting attendees that “everyone in that room is dying to get to yes.”
Despite House Republicans voicing their desire to revive reform efforts, Senate Republicans and White House officials seem ready to move past healthcare.
The American public seems divided on healthcare reform. Review the public’s views on healthcare reform.
Insurance Companies Uncertain About Staying in Marketplaces
Without clarity into the administration’s plans for subsidies and the individual mandate, insurance companies are hesitant to create and adapt their 2018 products. Dr. Mario Molina, CEO of Molina, said, “We need some clarity on what’s going to happen with cost-sharing reductions and understand how they’re going to apply the mandate. [If subsidy payments stopped,] it would certainly play into our decision [to leave Marketplaces]. We’ll look at this on a market-by-market basis. We could leave some. We could leave all.”
States Move Forward With Medicaid Legislation
The Kansas Senate voted to approve Medicaid expansion on Tuesday. Kansas Governor Sam Brownback now has the opportunity to approve or veto the expansion. A veto can be overridden by 84 House and 27 Senate votes.
The Arkansas Senate voted to keep its hybrid Medicaid expansion and budget. Arkansas’ House is now voting on the Medicaid bill.
News Update for March 28, 2017
Is Obamacare Really Exploding, Like Trump Says?
No, the Affordable Care Act (ACA) isn’t about to fail or explode. Health insurance marketplaces—also known as exchanges—are stable, allowing people to shop for the best price possible. The uninsured rate has fallen greatly, and premiums rates are relatively steady.
But the healthcare bill still has room for improvement. Many Americans have few choices in their regions for health insurance providers, some states have seen varying levels of success and failure (like enormous premium rate hikes in Arizona), and the rise in deductibles is making out-of-pocket spending increase. Additionally, the U.S. is still spending more per capita than other industrialized nations on healthcare.
Tom Price to Administer Obamacare, May Be Working to Stabilize Marketplace
Tom Price, secretary of the Department of Health and Human Services, came into his position with the goal of repealing the ACA. But after the failure of the American Health Care Act, he doesn’t seem to be letting Obamacare (the healthcare reform he fought against) fail. In fact, he may be working to stabilize health insurance markets. Small regulatory changes made in February and a letter from Price to governors support these stabilizing claims.
4 Potential Healthcare Solutions Gaining New Attention
Right now, health insurance companies are developing plans they will file for 2018. So, planned healthcare reform efforts have to happen as soon as possible to keep these companies in the health insurance marketplace. With time ticking on the reform clock, here are 4 potential healthcare reform solutions that are currently gaining traction:
- Gain insight from Seema Verma on potential improvements to the ACA. Verma is “famous for being the woman who figured out how to build health reimbursement arrangements into Medicaid coverage for moderately low income adults.”
- Repeal the ACA completely, rather than through a budget reconciliation process. Two full repeal bills (H.R. 175 and H.R. 370) have already been introduced by members of congress.
- Use a single-payer healthcare system, also called universal healthcare, to cover everyone. Senator Bernie Sanders (D-VT) made headlines and has said a draft of his bill will be ready within weeks.
- Cross party lines by having Republicans and Democrats work together to craft healthcare reform. At the moment, small bursts of bipartisan effort have been made. “Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) are hoping they can convince Democrats to back their health insurance overhaul, which would let states choose whether to keep or replace Obamacare.”
News Update for March 27, 2017
Are Single-Payer Plans the Next Big Talking Point in Healthcare Reform?
On Sunday, Senator Bernie Sanders (D-VT) told CNN’s “State of the Union” that he is “going to introduce a Medicare-for-all single-payer program.” The plan, which can be called universal healthcare, was also mentioned during a town hall the previous day. According to Vermont Public Radio, Sanders said the plan could be ready within weeks. “It is a commonsense proposal, and I think once the American people understand it, we can go forward with it,” Sanders said after the Saturday town hall. Sanders invited Republicans to negotiate his upcoming plan; he even invited the President to work with him. “President Trump, come on board. Let’s work together. Let’s end the absurdity of Americans paying by far the highest prices in the world for prescription drugs.”
The plan seems to have the support of Rep. Peter Welch (D-VT), who said he planned to introduce Sanders’ single-payer plan to the House. Welch commented on the single-payer plan by saying, “We need in this country, like any industrialized country, a healthcare system that’s affordable, accessible and universal.”
Democrats See Opportunity for Universal Healthcare After AHCA Loss
In addition to Bernie Sanders (D-VT), other Democrats are rallying behind the idea of a single-payer program, also known as universal healthcare. Here are what some lawmakers are saying in favor of universal healthcare:
- Jim Langevin (D-RI): “We have to look harder at a single-payer system.”
- Jack Reed (D-RI): “I’m old enough to have voted for a single-payer system in the House.”
- House Minority Leader Nancy Pelosi (D-CA): “I supported single payer since before you were born.”
- Sheldon Whitehouse (D-RI): “The very best market-based solution is to have a public option. The best way to show that a stick is crooked is to put a straight stick next to it. If you do that, the private sector can’t manipulate the market by withdrawing.”
Trump May Have Lost the AHCA Battle, But He Can Still Undermine Obamacare
Even though the American Health Care Act did not have enough Republican support to hold a vote on the House floor, the White House can still help or hurt the current “law of the land.” Here is what the administration can still do to help or harm Obamacare—with the aid of Health and Human Services (HHS) secretary Tom Price.
- The lawsuit over cost-sharing reduction payments: Although the House of Representatives is currently winning, Trump has the power to stop defending the lawsuit that addresses the legality of these subsidies. If he did stop defending the lawsuit, 7 million people could lose their subsidies.
- The individual mandate: There is already an executive order in place telling government agencies to lessen the individual mandate’s burden on individuals. The IRS has agreed to “use a light touch” when enforcing the law, which “requires people to sign up for health insurance or pay a fine.”
- Advertising the public healthcare Marketplace: Trump’s administration pulled some ads and outreach toward the end of this year’s open enrollment period. “One big question is how much the Trump administration will encourage people to sign up for next year.” Without advertisements and outreach, enrollment could be undermined.
- Market regulations: The HHS has proposed rules in order to make the Marketplace more appealing to insurance companies. Some of the rules “could reduce the number of people taking advantage of loopholes in the [Affordable Care Act], potentially lowering premiums for the rest.”
- Political influence: Obamacare kept insurance companies in the Marketplace with the help of the Obama administration’s persuasion. Without such persuasion, insurance companies could decide to drop out of the Marketplace in greater numbers and leave some people with fewer choices.
News Update for March 24, 2017
News Update as of 4:25 p.m. CST
Obamacare Is Here To Stay
News Update as of 3:12 p.m. CST
White House Pulls AHCA Ahead of House Vote
Republicans have decided to pull the American Health Care Act from the House floor. Despite last-minute concessions to conservative Republicans, the party still lacked the votes to approve the healthcare reform bill. House Speaker Paul Ryan was seen rushing to the White House during the House’s debate to inform President Trump. In a phone interview with The Washington Post, President Trump said, “We just pulled it.” The President did not cast blame on Ryan, telling The Washington Post, “I don’t blame Paul.”
Trump Demands Friday Vote on AHCA
Mick Mulvaney, Office of Management and Budget Director, issued strong words from Trump to lawmakers Thursday. Trump wants the vote on American Health Care Act to happen today (March 24), and if it fails, he will leave Obamacare in place and move on to other priorities.
The House Is Debating the American Health Care Act
Currently, the U.S. House is debating for and against the AHCA. The scheduled 4-hour debate began at 10:20 a.m. central and can be viewed live here. It still is not clear if the bill has gained enough Republican votes to pass.
Kansas Moves Forward With Medicaid Expansion Amid Federal Medicaid Debate
On Thursday, state lawmakers in Kansas moved a Medicaid expansion proposal forward. It is currently headed to the Senate floor, despite healthcare reform debates over Medicaid funding. Supporters of the expansion don’t want national debate to derail Kansas-state needs, but opponents want Kansas lawmakers to wait until federal debates over Medicaid-expansion funding have settled.
News Update for March 23, 2017
Healthcare Reform Vote Postponed
While the House planned to pass the American Healthcare Act tonight (Thursday, March 23), the vote has been postponed. The White House remains confident in its ability to vote quickly on the bill despite the delay. Sarah Huckabee Sanders, White House deputy press secretary, said, “Debate will commence tonight as planned and the vote will be in the morning to avoid voting at 3 a.m. We feel this should be done in the light of day, not in the wee hours of the night and we are confident the bill will pass in the morning.”
Last-Minute Changes to AHCA Aim to Appease Conservatives but Irk Moderates
Recent changes to the American health Care Act (AHCA) have been focused on persuading conservative Republicans, particularly the Freedom Caucus. Unfortunately, these changes might be repelling moderate Republicans.
Late Wednesday, conservatives of the Freedom Caucus added the removal of some essential health benefits (like prescription drugs, maternity care, and substance abuse treatment) and protections for people with pre-existing conditions to their list of things the bill must do before they will vote in favor of it. While even these changes may not guarantee all conservative voters, Randy Weber (R-Texas) of the Freedom Caucus told reporters, “Negotiations are taking place. The president’s moving our way.”
Moderate Republicans seem dissuaded by these potential additions to the AHCA. GOP Rep. Ryan Costello of Pennsylvania stated, “The Freedom Caucus has presented what it will take for them to get some yeses, and I think there are now members who will have to now evaluate things a little bit further.” A more strongly worded disapproval was given by Rep. Charlie Dent of Pennsylvania. Dent said, “After careful deliberation, I cannot support the bill and will oppose it. I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals.”
According to ABC News, at least 30 Republicans still oppose the AHCA.
Biden Speaks Out Against AHCA Before House Vote
On Wednesday, Former Vice President Joe Biden shared his strong opposition to the AHCA. Joined by fellow Democrats, Biden said, “The costs [of an Affordable Care Act repeal] are enormous” and the proposed healthcare bill uses tax benefits for the “transfer of about a trillion dollars” to wealthy households.
Two Non-ACA Healthcare Bills Have Been Passed by the House
On Wednesday, two healthcare bills were passed by the U.S. House:
- R. 372, the Competitive Health Insurance Reform Act of 2017, means to repeal the McCarran-Ferguson Act. The McCarran-Ferguson Act is an antitrust exemption directed toward health insurance companies.
- R. 1101, the Small Business Health Fairness Act, “would let a multi-state association health plan sell coverage outside its state of domicile, even if the other states objected. The regulators in the state of domicile would regulate the plan.”
Read more about the passing of these bills here.
News Update for March 22, 2017
The Senate Is Just as Divided Over the AHCA
If as few as 3 Republicans vote against the American Health Care Act (AHCA) in the Senate, it will fail. Factions of the Republican Senate want more from the AHCA, and they may be willing to kill the bill if they don’t see even greater changes. And those refining the bill will have a hard time pleasing these differing factions.
- More Affordable Care Act (ACA) Repeal: Conservatives (particularly Rand Paul, Ted Cruz, and Mike Lee) have stated strong opposition toward the current draft of the AHCA and want stronger repeals of the ACA.
- Planned Parenthood: Those defending Planned Parenthood (particularly Susan Collins and Lisa Murkowski) oppose the AHCA’s defunding of the program, but removing the bill’s current provision could upset conservative voters.
- Medicaid: Those protecting Medicaid expansion (particularly Murkowski, Rob Portman, Shelley Moore Capito, Cory Gardner, Dean Heller, and Brian Sandoval) have expressed shared concerns about the bill’s plans to withdraw Medicaid expansion funding from their represented states. Removing this phase-out would upset conservatives, who want it to happen even sooner than planned in the bill.
- Loss of Coverage & House Majority: Those concerned over the loss of coverage for people, as well as the loss of the House majority, make up the last two factions (Bill Cassidy and Tom Cotton). Bill Cassidy has grave concerns about the 24 million who will lose coverage based on the Congressional Budget Office (CBO) estimate. Tom Cotton “thinks the bill could endanger the House majority and won’t pass the Senate.”
Can Mitch McConnell Save the AHCA?
Senior United States Senator and Majority Leader Mitch McConnell will be in charge of altering the AHCA before it can be rejected by the Senate. On Tuesday, McConnell said, “We’re not slowing down. We will reach a conclusion on health care next week.”
How Do American Voters Feel About Current Healthcare Reform?
The Morning Consult and Politico recently published a new poll asking nearly 2,000 registered voters how they felt about the AHCA and other healthcare reform. Here are the results:
- 43% think the GOP needs to take more time
- 17% think Republicans are taking the right amount of time
AHCA Effects on Healthcare Costs
- 39% think healthcare costs will increase
- 20% think healthcare costs will decrease
AHCA Effects on Quality of Healthcare
- 32% think quality will decrease
- 28% think quality will increase
AHCA Effects on the Healthcare System
- 36% think the healthcare system will be negatively affected
- 30% think the healthcare system will improve
Around half of the respondents stated that they were more likely to back the bill after the CBO predicted a $337 billion decrease in the federal deficit in 10 years, as well as an eventual 10% decrease in the average premium. However, over half of respondents stated that they were less likely to back the bill after CBO estimates that 24 million people would lose coverage and premiums would increase by 15%-20% for the first two years of the AHCA.
To see if your representative shares your feelings on upcoming healthcare reform, visit this NPR article.
News Update for March 21, 2017
House Freedom Caucus Won’t Vote as a Bloc, But That Doesn’t Mean a Yes Vote
The conservative House Freedom Caucus has around 3 dozen members, enough to kill the healthcare reform bill in the House if they voted against it as a bloc. However, chairman of the Freedom Caucus Rep. Mark Meadows (R-NC) has announced that the group will not be voting in bloc. “We’re not taking any official positions. I’m going to encourage them to vote for their constituents,” Meadows told reporters.
But this doesn’t mean the Freedom Caucus will be voting for the AHCA. Because of ongoing concerns with the bill, many members have expressed that they will vote against it in the House. A co-founder of the Freedom Caucus, Rep. Jim Jordan (R-OH) said after negotiations with the White House, “Nothing’s changed. We’ve still got lots of problems with this bill. … The president’s a good man, and the White House has been great to work with, but opposition is still strong with our group.”
Republicans Changing AHCA to Strengthen Chances of Passing It
While Democrats are set to oppose the AHCA bill, the White House is making changes to try and win more Republican votes.
- A provision may be added to lower prescription costs with a “competitive bidding process”
- An amendment may:
- Remove a provision allowing consumers to move excess tax credit funds into health savings accounts (HSAs). Anti-abortion groups fear the provision allows taxpayers to fund abortions.
- Accelerate the repeal of around a dozen Affordable Care Act (ACA) taxes.
- Delay implementing the Cadillac tax again (from 2025 to 2026).
- In addition to allowing states to choose block grants and requiring enrollees to provide proof of employment, Medicaid enrollees may:
- Be required to renew their coverage every six months.
- Lose the ability to request retroactive coverage.
While some have changed their votes based on recent changes to Medicaid, subsidies for older Americans, and ACA taxes, these changes aren’t enough to sway all lawmakers. Justin Amash, Michigan Rep. and strong critic of the bill, tweeted, “They haven’t changed the bill’s general framework. They don’t have the votes to pass it. They have seriously miscalculated.”
Republicans Reintroduce Small Business Healthcare Legislation
A bill passed by the House in 2003, which did not advance, has been reintroduced in help improve small businesses’ health insurance purchasing power. At the time, the bill was criticized because it “would do little to enhance the coverage options or control costs of many small businesses, especially those that employ older, sicker workers, while at the same time weakening consumer protections against plan insolvency and fraud.” “Health policy experts say there’s no reason to change that assessment now.” The bill would:
- Establish nationwide “association health plans,” allowing small business owners to join associations and purchase health insurance in larger groups. In turn, this would ideally lower costs.
- These plans have existed, but were not regulated well and neither states nor the federal government had clear authority over them. Fraud and insolvency cases in the ’70s and ’80s lessened the appeal of these plans.
- Federal law was amended to let states regulate them, and in 2010 the ACA required them to meet qualified health plan standards.
- Remove state regulations and give the federal Department of Labor oversight of association health plans.
- Remove ACA group health insurance requirements but maintain individual health insurance ACA requirements for association health plans.
- Allow association health plans to charge companies with more unhealthy workers higher premiums.
News Update for March 20, 2017
Likely Changes for the American Health Care Act (AHCA)
Under strong opposition, House Speaker Paul Ryan and other Republican leaders have opened the door to making changes to the AHCA. Particularly, the bill will likely see changes to states’ flexibility with Medicaid and individual coverage for older Americans. The House is expected vote on the bill this Thursday. Here is more on the proposed changes.
States’ Flexibility With Medicaid
- States may gain the option to require “able-bodied Medicaid recipients to work” in order to receive coverage. Health & Human Services Secretary Tom Price and Administrator of Centers for Medicare and Medicaid Services Seema Verma have stated in letters to governors that they are open to this option.
- States may have the option of receiving federal funding in the form of block grants, meaning they would receive a set amount of funding regardless of the state’s number of enrollees. The current legislation calls for per capita funding, meaning a set amount per enrollee.
Individual Coverage for Older Americans
- Older Americans, those in their 50s and 60s, shopping on the individual market may see enhanced tax credits compared to the AHCA’s original proposal. Sunday, Ryan said, “We believe that we do need to add some additional assistance with people in those older cohorts.”
- Americans in their 50s would receive $3,500 in refundable tax credits.
- Americans in their early 60s would receive $4,000 in refundable tax credits.
- There is no mention of how allowing insurance companies to charge older individuals more may change, but the CBO projection does not bode well, even with the increased subsidy amount. A 64-year-old with an income of $26,500 might end up paying up to $14,600 in 2026 under the AHCA. Compare this to the projected Affordable Care Act (ACA) cost of $1,700 in 2026.
Republican Governors Argue the Current AHCA “Hurts States”
Ohio, Michigan, Nevada, and Arkansas governors sent a joint letter to the House and Senate leaders arguing against the current version of the AHCA. Republican governors John Kasich (OH), Rick Snyder (MI), Brian Sandoval (NV), and Asa Hutchinson (AR) all signed the letter, which states that the AHCA “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to the state.” Each of these states expanded Medicaid under the ACA, and the governors outlined alternative approaches to Medicaid reform.
States Will Take Greater Share of Medicaid Costs Under AHCA
Moody’s Investors Service theorizes that states’ credit ratings could suffer under the AHCA. States would take on a larger share of Medicaid funding, increasing their borrowing costs and lowering the current value of bonds. Any funding decrease from the federal government would force states to reduce spending on their individual Medicaid programs, raise taxes, or do both.
Rand Paul Does Not Believe the AHCA Will Pass
Senator Rand Paul sat down with ABC’s “This Week” on Sunday to voice his feelings about the AHCA and its chances of passing through Congress: It won’t happen. “I think there’s enough conservatives that do not want ‘Obamacare Lite.’ … None of us ran on this plan,” Paul said.
News Update for March 17, 2017
Are You Confused by Terms in the Obamacare Repeal and Replacement Process?
Kaiser Health News has released a new article that helps clear up some of the more confusing terms pertaining to the Obamacare repeal and replacement process going on right now. Here are some of those terms. Check out the article for more details.
- Budget Reconciliation: An obscure legislative process that permits bills to pass through Congress with just a simple majority. Budget reconciliation bills only deal with budgetary issues and can’t be filibustered.
- Health Savings Accounts: HSAs allow consumers to save money on a tax-free basis for healthcare expenses.
- High-Risk Pools: Insurance groups that cover individuals with pre-existing conditions. These individuals tend to have high health insurance costs.
- Individual Market: The individual market is where people who don’t have health insurance through their employer or the government can get a plan from an insurance company.
- Medicaid Block Grants: A block grant is when the federal government gives states a “set amount of money to pay for coverage for Medicaid recipients.” Right now, the federal government matches a percentage of a state’s Medicaid spending to help alleviate states’ costs.
- Per-Capita Caps: With per-capita caps, states would get a fixed amount of money each year, but that fixed amount would be determined by how many people are enrolled in each Medicaid program.
American Health Care Act Narrowly Passes House Budget Committee
The Republican plan to repeal Obamacare passed a key hurdle on Thursday. The House Budget Committee “narrowly voted to move [the bill] to the House floor and recommended a series of changes to the plan reflecting concerns from conservatives and centrists.” The committee voted for two motions supporting more cuts to Medicaid beyond what is currently in the bill, as well as a third motion “endorsing a requirement that ‘able-bodied’ participants in [Medicaid] work in exchange for their benefits.” This is in line with what many conservatives have wanted from this bill. The committee voted 19 to 17 to advance the bill. All the Democrats and three Republicans voted against moving the bill to the House floor. All the dissenting Republicans are members of the conservative House Freedom Caucus. More revisions are expected soon.
Republican Leaders Planning Vote on AHCA Bill Next Thursday
GOP leaders have told reporters at CNN that they are planning on holding a vote on the American Health Care Act in the House of Representatives on Thursday. Thursday also happens to be the 7th anniversary of former President Barack Obama’s signing of the Affordable Care Act. The bill is currently being reworked to include Medicaid work requirements. Other changes “may also include making tax credits for older Americans more generous” in order to appease moderate Republicans.
Many in Disabled Community Worried About Medicaid Cuts
Medicaid covers some in-home and transportation services for disabled people in every state. However, the federal government doesn’t require those things to be covered. It does require that states cover “doctor’s visits, nursing home care and laboratory tests.” In-home and transportation services are important for providing disabled people with a degree of independence throughout their everyday lives. These services aren’t required by the federal government. Many people are worried that if federal Medicaid funding decreases, these services would be the first to go and disabled people will see their quality-of-life and independence greatly decreased.
News Update for March 16, 2017
Speaker Paul Ryan Changes Tune, Says AHCA Must Change In Order to Pass House
In a private meeting on Wednesday, Speaker of the House Paul Ryan told House Republicans the American Health Care Act would have to be modified if Republicans wanted to pass it through the House. The bill had initially been crafted by Republican leadership in the House with little input from rank-and-file Republicans. However, resistance from within Ryan’s own party, coupled with an unfavorable Congressional Budget Office report, made Ryan walk back “from his earlier position that the carefully crafted legislation would fail if substantially altered.” Ryan hasn’t given any details on what changes are currently under consideration. “Now that we have our [CBO] score we can make some necessary improvements and refinements to the bill,” said Ryan.
Republicans Debate Adding and Subtracting Different Provisions from Obamacare Repeal
Some Republican leaders are thinking about getting rid of a provision in the American Health Care Act. As a way of replacing the individual mandate, which requires that eligible Americans sign up for health insurance, the AHCA would institute a provision that would require insurance companies “to charge a 30 percent penalty to customers who go without coverage for at least 63 days.” Like the individual mandate, this 30 percent penalty is also an incentive to encourage young, healthy consumers to buy insurance so that insurance pools will have the finances to cover people with pre-existing conditions. Many conservatives are not onboard with the 30 percent penalty, believing that it is another form of the individual mandate. Senator Ted Cruz (R-TX) called for something that would “scrap the requirement to cover pre-existing conditions along with other [insurance company] regulations.” Cruz believes these regulations to be the “principal driver of skyrocketing premiums.”
Conservative House Republicans are also proposing an amendment to the AHCA that “would institute work or education requirements for Medicaid.” The hope is that this Medicaid work requirement would be enough to persuade conservatives to vote yes on the bill. Some critics believe that work requirements could block Medicaid beneficiaries who aren’t currently working from getting needed medical care. Going without this medical care, say these critics, would in turn prevent the beneficiaries from rejoining the workforce.
American Health Care Act Supporters Stress ‘Three Phases’ Approach, But Critics Are Skeptical
On Wednesday, President Donald Trump told a rally in Tennessee that he was in the midst of negotiations on the American Health Care Act. “We’re going to arbitrate, we’re going to all get together. We’re going to get something done,” said Trump. He reiterated that “the end result … is going to be great” once people consider the fact that the AHCA is only the first phase of the Republican plan to repeal Obamacare. The other two phases include regulatory actions taken by Secretary of Health and Human Services Tom Price and more bills passed by Congress that would undo the core tenets of Obamacare.
However, many GOP leaders and other detractors remain critical. “There is no three-phase process,” said Senator Tom Cotton (R-AK). “There is no three-step plan. That is just political talk, it’s just politicians engaging in spin.” Cotton believes that the third phase of repeal is unrealistic because it would require 60 votes to pass the Senate, meaning 8 Democrats would need to defect. Senator Lindsey Graham (R-SC) also said that passing a second bill was a “fantasy.” Senator Ted Cruz (R-TX) believes that “anything in so-called bucket three will never pass.” Democrats, for their part, are even more critical. Senate Minority Leader Charles Schumer said, “We think this bill is so bad there’s no way to make it better.”
First Decline in Total Obamacare Enrollment Numbers Reported
According to a new report by the Trump administration released on Wednesday, a total of 12.2 million Americans enrolled in the Obamacare marketplaces during the 2017 open enrollment period. This is the first annual period in which enrollment dropped. In 2016, 12.7 million Americans enrolled. The exchanges saw “slow but steady increases in 2015 and 2016.”
News Update for March 15, 2017
New KFF Poll: People Expect Obamacare Repeal to Result in Higher Costs and Less Coverage
A new poll published Wednesday by the Kaiser Family Foundation shows that the public expects that the Obamacare replacement plan to increase costs and decrease coverage. 48 percent of respondents believe that the proposal would decrease the number of people who have health insurance. About 30 percent say that the number would stay the same, and 18 percent believe the number would increase. A plurality of people believe that costs would increase for deductibles and for people who buy their own insurance. Results were mixed based on party-affiliation: “Majorities of Democrats believe the plan will decrease the number of people with insurance and increase costs, [while] Republicans’ views are more mixed.” You can read more about the poll here.
Is Obamacare Repeal Putting Republicans at Risk in 2018?
The contentiousness of the GOP’s Obamacare repeal process has been well-documented, and “Republicans concede they’re growing increasingly concerned about falling into familiar traps.” Some are theorizing that the GOP’s inability to satisfy the American public’s desire for healthcare reform might prove to be the party’s undoing in the 2018 midterm elections. Former Republican House Speaker Newt Gingrich said, “By next spring, they have to have a health solution clear enough — and implemented enough — that people feel comfortable” or else the midterms could go very poorly for them.
Three Strange Effects of the America Health Care Act on the Individual Marketplace
LifeHealthPro just published an article yesterday detailing some strange things that might happen if the American Health Care Act passes.
- The rules that force “individual or small-group major medical” insurance plans to maintain coverage for around 60 percent of the predicted value of essential health benefits would be taken away. However, the AHCA would still keep Obamacare’s cap on how much a plan can expect an enrollee to pay out of pocket each year. The CBO predicts “that the typical consumer in the individual market would get a mid-level silver plan in 2026 if current ACA rules continue.”
- With the AHCA, the removal of the 60 percent rule, combined with the enforcement of the out-of-pocket cap, would result in “the same consumer [ending] up with a plan that was more like a bronze plan than a silver plan,” meaning that average consumers would have less valuable plans.
- Because the AHCA is actually a budget resolution bill, it will only require 50 votes to pass. However, the bill can’t actually repeal core elements of the Obamacare law. Another bill would have to handle that, and that bill would require 60 votes, which means that 8 Democrats would have to defect. This is highly unlikely. As a result, we could live in a world in which an “Obamacare repeal bill” is passed, yet major Obamacare provisions would still be in place.
- The percentage of a plan’s predicted value, or actuarial value, of its essential health benefits coverage dictates its placement on Obamacare’s metal tier system. The system goes from bronze to gold to silver to platinum and represents plans that cover between 60 percent and 90 percent of the cost of essential health benefits coverage. Confusing? That’s partially why the metal tier system was implemented.
- The AHCA would eliminate this system, which is used as a sort of standard to help consumers compare plans. This could make it a bit harder for people to compare health plans.
Drug Prices Are Too High, Say Novo Nordisk CEO & Many Others
A Kaiser Health News study shows that “with new cancer drugs commonly priced at $100,000 a year or more … hundreds of thousands of cancer patients are delaying care, cutting their pills in half or skipping drug treatment entirely.” Dr. Hagop Kantarjian, a leukemia specialist, believes that high drug costs are “causing more death than necessary.” New medications and their “jaw-dropping costs” have led to much criticism of the pharmaceutical industry.
One such critic comes from within the industry itself. In an interview on Tuesday, Novo Nordisk A/S CEO Lars Fruergaard Jorgensen said, “It was never the intention that individual patients should end up paying the list price. I have a big problem with that.”
News Update for March 14, 2017
CBO Says AHCA Would Result in Millions More Uninsured, Reduction of Budget Deficit
The Congressional Budget Office, a non-partisan Congressional agency, released its analysis of the American Health Care Act on Monday. The analysis projects that, compared to the Affordable Care Act, 24 million more Americans would be uninsured in a decade under the AHCA. However, the bill would also lower the deficit by $337 billion thanks to decreased government spending. Representing the Trump administration, Secretary of Health and Human Services Tom Price said, “We disagree strenuously with the report that was put out. It’s just not believable is what we would suggest.” Price said that the CBO’s job was “virtually impossible,” and that the figures should be taken with skepticism. The White House’s own Office of Management and Budget, however, forecasted an even grimmer prediction: 26 million more Americans would lose coverage in the next decade. However, White House Communications Director Michael Dubke stressed that this figure was designed as a prediction of what the CBO’s prediction would be. Dubke stated that the 26 million figure was not to be taken as “an analysis of the bill in any way whatsoever. This is OMB trying to project what CBO’s score will be using CBO’s methodology.”
Senate Republicans Uneasy Over New CBO Figures on AHCA, Obamacare Supporters Emboldened
The 24 million more uninsured figure released by the CBO is not sitting well with many Republicans in the Senate. “Can’t sugarcoat it. Doesn’t look good,” said Republican Senator Bill Cassidy of Louisiana. “The CBO score was, shall we say, an eye-popper.” The CBO numbers don’t bode well for garnering centrist and conservative Republican votes behind the bill. However, some Republicans are taking the White House’s line of discounting the CBO score. Representative Greg Walden (R-OR) said that the CBO hasn’t evaluated the GOP’s “entire proposal to repeal and replace Obamacare, and today’s score reflects only a portion of the actions we will take to roll back red tape, free markets and empower consumers.”
Some of the Senate’s more conservative members will visit the White House on Tuesday. Senator James Lankford (R-OK) said that he and his fellow Republican Steering Committee members “will offer ways to ‘strengthen’ the bill and make it ‘actually viable.’”
Because of the CBO score, which reduces the amount of insured Americans while lowering the deficit, the AHCA is being accused of “throwing 24 million people off their health care to give billionaires a tax break,” according to prominent Democratic Senator Elizabeth Warren of Massachusetts.
Major Insurance Company Comes Out in Support of AHCA
Anthem, the country’s second biggest health insurance company, has endorsed major parts of the American Health Care Act. This is notable not only for Anthem’s stature, but because major insurance company groups had expressed concerns about the American Health Care Act earlier this week. In a letter from Anthem CEO Joseph Swedish to two House committees, Swedish wrote that the bill “addresses the challenges immediately facing the individual market and will ensure more affordable health plan choices for consumers in the short term.” Anthem expressed further support for provisions in the proposal that “would repeal Obamacare’s health insurance tax, temporarily continue the law’s cost-sharing subsidies, and allow customers to receive tax credits off the Obamacare exchanges.” Swedish wrote, “These provisions are essential and must be finalized quickly to have the intended impact on products and prices to benefit customers.” Anthem is still looking for the federal government’s approval to acquire Cigna, another major insurance company. Anthem is currently the largest insurance company participating in the Obamacare exchanges.
Companies That Manage HSAs Could See Big Earnings Under GOP Proposals
Health savings accounts have been a popular Republican talking point for some time now. They were introduced in 2003 and have seen consistent championing by the GOP since that time. The American Health Care Act “reflects the [GOP’s] broad consensus for giving more Americans access to HSAs, which allow people to put aside money tax-free for medical expenses.” If the GOP is successful, it could mean “millions more customers” and earnings from account management fees for companies that manage HSAs. Read more about HSAs and how quickly they’ve grown in the last decade.
News Update for March 13, 2017
What Is the “Obamacare Nightmare Scenario?”
Axios and researchers at the Robert Wood Johnson Foundation have developed some findings that show what would happen to coverage availability if various insurance companies decided to exit the individual insurance exchanges for 2018. The findings estimate how many people would be left either without coverage or with only one insurance company as an option for coverage if certain insurance companies were to opt out. The departure of Anthem, for instance, would result in around 250,000 people having no option for coverage through the Obamacare exchanges. Over 550,000 consumers would have only one option for insurance. Compounding this “nightmare scenario” is the fact that each time an insurance company leaves the exchanges “it raises the stakes for the next carrier to leave,” says Katherine Hempstead of the Robert Wood Johnson Foundation.
Speaker Paul Ryan Interviewed on Obamacare Repeal
Speaker of the House Paul Ryan was interviewed on CBS’s “Face the Nation” on Sunday. Here are some highlights:
- Ryan said that he didn’t know how many Americans would lose coverage under the American Health Care Act. “It’s up to people. Here’s the premise of your question: Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country.” Ryan went on saying that “[i]t is our job to have a system where people can get universal access to affordable coverage if they choose to do so or not.”
- Ryan also said that if this bill is not passed, “premiums will go far, far, far higher.” When asked if premiums would still rise under the AHCA, Ryan said, “I think they’ll go down once this system comes into place,” a process that he indicated would take place during a transition process taking about two years. This transition period would include setting up high risk pools for people with pre-existing conditions and offering tax credits.
- When asked if Republicans might face a “bloodbath” in the 2018 midterm elections if the GOP doesn’t pass an Obamacare reform and/or replace bill, Ryan said “I do believe that if we don’t keep our word to the people who sent us here, yeah.”
New Bill Proposed by House Republicans Would Help Employers Find Out How Healthy Their Employees Are
The Preserving Employee Wellness Programs Act has been introduced by Representative Virginia Foxx (R-NC). This bill seeks to strengthen company wellness programs by making it easier for an employer to obtain personal medical and genetic data from employees and their dependents. The bill “would also significantly increase the financial costs faced by someone who does not join a company wellness program.”
The bill is currently under review by House committees, but many consumer and privacy advocacy groups are already voicing passionate opposition to the bill. The bill’s opponents object to the bill on privacy grounds and also believe it could lead to the imposition of “draconian penalties on employees who choose to keep [their] information private. The bill’s supporters believe it would help companies make better decisions to help lower healthcare costs.
How Will the AHCA Cover People with Pre-Existing Conditions?
A new article by the Kaiser Health Foundation examines how the American Health Care Act might attempt to keep coverage available for people with pre-existing conditions. The provision to protect that coverage is one of Obamacare’s more popular provisions. Many insurance companies were worried that if they were required to allow sick people to buy their products, medical costs would get out of hand, and healthy people would leave the insurance pool because of rising premium costs. Obamacare’s individual mandate to require people to pay insurance or be subject to a fine was a way of offsetting this worry. The new bill takes out this mandate and, instead, would put in place a fine for “[p]eople who experience a gap in coverage.” The fine of a 30 percent higher premium for a year would be paid to the insurance company. According to Kaiser, this would make it so that people with pre-existing conditions would be guaranteed that their insurance plans would cover their illnesses, but there wouldn’t be a way to guarantee that they could buy the plan.
News Update for March 10, 2017
Voting on Second Healthcare Bill Early Next Week?
Speaker Paul Ryan, speaking with Sean Hannity on Thursday, said that House Republicans will be voting on a second, currently unrevealed, healthcare bill the same “week they vote to repeal Obamacare.” Republican leaders are tackling Obamacare repeal and replacement in 3 phases: passing the American Health Care Act, cutting down healthcare industry regulations through the Department of Health and Human Services, and passing more healthcare reform bills.
In a private meeting with grassroots conservative leaders recently, President Donald Trump said that the companion healthcare bill to the American Health Care Act would be revealed to the public soon, possibly as early as next week. Republicans are intending for the AHCA to handle budgetary measures related to the Affordable Care Act. By doing so, the bill will only require 50 Senate votes to pass. The second bill will need 60 votes. This second bill will be part of the third phase discussed earlier.
White House Takes on Congressional Budget Office in Fight over AHCA
White House Press Secretary Sean Spicer is asking people not to pay too much attention to the Congressional Budget Office’s upcoming budgetary evaluations next week for the American Health Care Act. The CBO is a bipartisan Congressional agency that helps Congress with economic and budgetary findings.
Many lawmakers, including prominent Republicans, are interested in what effect the AHCA will have on the federal deficit. Some experts predict that “the CBO score of [the AHCA] is almost certain to be less favorable than that of Obamacare.” This could greatly influence whether or not the AHCA will pass. CBO Director Keith Hall, a Republican appointee who favors “free-market economic views” and rejects “the political limelight,” is widely considered by his peers as a staunch non-partisan in terms of assessing the budget. His office is coming under fire for some miscalculations with Obamacare’s budget. Others believe that the White House is preemptively discrediting the CBO in anticipation of a bad review in order to drum up support for the AHCA.
House Majority Whip Is Confident the House Will Pass the AHCA
In the past few weeks, there has been a lot of focus on whether or not conservative and moderate Republicans would fall in line to vote to pass the AHCA through the House. On Thursday, Representative Steve Scalise, the House Majority Whip, told the media that the House was going to get the AHCA passed. The Majority Whip is responsible for rallying and keeping track of votes. “Despite being awake for 33 straight hours, fueled by adrenaline and several cups of chicory coffee from New Orleans,” Scalise appeared to be in a very good mood and, smiling, elatedly told reporters, “We’re gonna get this done.” Scalise also said that the GOP divisions were blown out of proportion by the media.
White House Weighs Supporting Rollback of Medicaid Expansion
According to “two senior [Trump] administration officials and a senior House conservative aide,” the White House is privately considering rolling back Medicaid expansion sooner than the American Health Care Act currently calls for. This is a possible concession to House conservatives who want to rein in spending as soon as possible.
While talking to reporters on Thursday, Representative Mark Walker (R-NC) said if this provision was added he would “lean yes.” Walker said that if the bill instituted work requirements for healthy, childless adults on Medicaid, he would definitely vote yes.
This move has a great capacity to alienate moderates in the Senate, however. Many Republicans are strong supporters of the Medicaid expansion.
News Update for March 9, 2017
AHCA Clears Two House Panels, Even as Democrats Attempt to Stall
Despite some obstructionist tactics from the Democrats, the GOP was able to advance the American Health Care Act through two key committees. The House Ways and Means Committee advanced the bill early in the morning (around 4:30 a.m., Eastern Standard Time) on Thursday. The House Energy and Commerce Committee advanced it Thursday afternoon. “Despite what you hear in the press, healthcare is coming along great,” tweeted President Donald Trump. However, many Democrats and Republicans think that the House bill is advancing too quickly. Senator Tom Cotton (R-AK) tweeted, “Get it right, don’t get it fast.”
Doctors, Hospitals, and Many Insurance Companies Line Up Against AHCA
On Wednesday, the American Medical Association released a letter to Congress saying that it “cannot support the [American Health Care Act] as it is currently written.” The AMA “calls itself the largest physician advocacy group in the country.” It backed the nomination of Tom Price, one of the principal authors of the bill, for the office of Secretary of Health and Human Services. Other major physician groups have also come out to either voice their opposition or major concerns with the bill.
Most hospital associations have come out against the bill as well. The nation’s largest hospital association, the American Hospital Association, joined with 6 other associations to send a letter to Congress voicing their disapproval. The letter stated that the associations feared the proposal would “lead to tremendous instability for those seeking affordable coverage.” According to USA Today, “virtually every type of hospital” is represented among the opposition. The hospital associations are also “deeply concerned” that the law will result in massive cuts in federal funding for their healthcare services.
The health insurance industry’s largest trade association, America’s Health Insurance Plans, also sent a letter on Wednesday. This letter was much more appreciative of some of the proposed changes, but it was concerned that the bill would not give enough money to Medicaid and that the new system of tax credits wouldn’t be enough to keep younger, healthier consumers in the insurance marketplace.
White House Avoiding “Trumpcare” Nickname for New Bill
The Trump Administration will not be using “Trumpcare” as a nickname for the American Health Care Act, the Republicans’ new proposed bill to replace Obamacare. Ryan Williams, a former longtime spokesman for Mitt Romney, told Politico, “Anything with the word ‘care’ in it pretty much sounds bad to people these days.” Many other Republican figures were asked about the name “Trumpcare,” and many of them avoided the question or shot down the suggestion.
On the other hand, Democrats are eager to utilize the nickname, possibly as a way of assigning any perceived faults in the law to the president himself. “What we have after the repeal is Trumpcare. Whatever is left after the dust settles is Trumpcare,” said Senator Claire McCaskill (D-MO).
Only 3% of Americans Affected by Premium Increases
More than 90 percent of Americans have health insurance and get it through an employer or government programs that don’t include the Obamacare exchanges. Eighty-five percent of people who buy insurance through these exchanges receive federal subsidies that protect them from premium increases. According to a new, interactive infographic released by The New York Times, only 3 percent Americans are affected by Obamacare’s premium increases. According to the U.S. Census Bureau though, the population of the U.S. is around 320 million, so this number would still affect about 10 million Americans.
News Update for March 8, 2017
Conservatives Continue to Oppose “Obamacare Lite” while Trump Pushes for Speedy Replacement
Conservatives continue to oppose Paul Ryan’s new healthcare reform draft, giving it several disparaging nicknames: Obamacare Lite, RyanCare, and RINOcare (Republican in Name Only). Michael Cannon from the Cato Institute said, “It is remarkable that they’ve produced a bill that is so out of touch with ACA opponents.”
However, President Trump doesn’t seem to want any more delays in repealing and replacing Obamacare. Trump has been very direct when addressing lawmakers about the proposed bill: He wants it to be approved promptly and delivered “largely intact.” Trump has also committed himself to becoming “personally involved in persuading skeptical lawmakers and warned that failing to pass the legislation would result in trouble at the ballot box for Republicans who pledged to repeal and replace Obamacare.”
GOP Factions Pose a Threat to New Healthcare Bill
Three GOP factions pose a threat to Paul Ryan’s American Health Care Act’s ability to become law over certain healthcare reforms.
- Western and Midwestern senators: This faction is opposed to any plan that doesn’t provide stability for Medicaid.
- Conservative and Libertarian senators: This faction is opposed to subsidizing individuals’ healthcare expenses.
- Moderate Supporters of Planned Parenthood: This faction may oppose the bill because of severely decreased funding for Planned Parenthood, a nonprofit healthcare clinic catering to women.
To see the Senators in each faction and a full explanation of their arguments, read the Washington Post’s article.
Elijah Cummings Continues Attempts to Lower Prescription Drug Costs
After being delayed for a month, House Democrat and Senior Black Caucus Member Elijah Cummings is meeting with President Trump today to discuss potential ways to lower prescription drug prices. Cummings stated that Trump “promised—both during the campaign and after—that he would support efforts to stem the skyrocketing prices of prescription drugs, so I am looking forward to discussing ideas he said he supports.”
News Update for March 7, 2017
House Republicans Unveil Long-Awaited Obamacare Reform Bill: The American Health Care Act
On Monday, House Republicans released a long-awaited proposal to replace Obamacare. Billed as a “more conservative vision” for American healthcare, the bill would be a “remarkable moment” in healthcare legislation because Congress has never before reversed a major program of social benefits that has affected this many people. The House has proposed the legislation, which is designed to ensure the long-term financial stability of the healthcare industry, under two bills.
Here are some of the changes:
- The individual mandate, which penalizes Americans for not having health insurance, would be removed. Insurance companies would be permitted to “impose a surcharge of 30 percent” to people who discontinue coverage and then resume it later on.
- The employer mandate, which penalizes large employers when they don’t provide health insurance to their employees, would also be eliminated.
- “Age-based tax credits ranging from $2,000 to $4,000 [would replace] the Affordable Care Act’s income-based subsidies.”
- A major overhaul of Medicaid that phases out the open-ended federal funding system it is currently using with a program with spending caps.
- Insurance companies would be permitted to charge older enrollees 5 times as much in premiums as compared to the cap of 3 times as much under Obamacare.
American Health Care Act Has Long, Uphill Climb Before Passage
In the House, many conservative Republicans are still voicing their displeasure with the bill. Representative Dave Brat (R-VA), a member of the conservative Freedom Caucus, told Politico that he has “seen no evidence that this bill will bring the cost curve down.” Representative Justin Amash (R-MI) insulted the bill by calling it “Obamacare 2.0.” It’s not known if House conservatives will attempt to vote against the bill though. GOP leaders in the House expect that some conservatives and moderates in their party will vote against it. The bill can only lose 21 Republican votes, assuming that the Democrats stand against it unanimously.
If Democrats vote against it along party lines, the bill would lose if just 3 of the Senate’s 52 Republican senators defected. Four Republican senators have already told Senate Majority Leader Mitch McConnell (R-KY) that they plan to oppose any plan that would cut Medicaid for people in their states. Two conservative Republican senators, Rand Paul (R-KY) and Mike Lee (R-UT), have already come out publicly against the plan as well.
American Health Care Act Reforms Obamacare, But Also Leaves Parts of It Unchanged
The American Health Care Act seeks to get rid of almost all of Obamacare’s taxes, except the “Cadillac” tax, which taxes high-cost health plans. There is a lot of bipartisan opposition to this tax, which was originally going to take effect in 2020 under Obamacare. The new bill proposes keeping this provision in order to not add to the deficit.
- Insurance companies “have to offer health plans to people, regardless of” pre-existing conditions.
- “Plans cannot cap the amount they pay in claims in a year or” in their customers’ lifetime.
- Adult children can stay on their parents’ plans until age 26.
- Some of the required benefits of Obamacare’s Essential Health Benefits will stay in place, including “preventive medicine and maternity care.”
Tax Credits Between Affordable Care Act vs. American Health Care Act
The Kaiser Family Foundation has released a new tool that compares estimates of premium tax credits Obamacare Marketplace enrollees would receive under Obamacare in 2020 with what they would receive under the newly proposed American Health Care Act. The map shows county-by-county results for how much more or less enrollees would receive in tax credits depending on age, income, and home county. Both policies include tax credits, but Obamacare “takes family income, local cost of insurance, and age into account,” whereas the new policy focuses “only on age, with a phase out for individuals with incomes above $75,000.”
News Update for March 6, 2017
Newest Version of House Obamacare Replacement Bill Leaked Again
Last Friday, Politico was able to obtain leaked documents outlining the latest version of the House’s Obamacare replacement bill. This is the second Obamacare replacement bill proposal to be leaked in the span of a month.
- Tax credits based on age, but it wouldn’t allow wealthier Americans to qualify for the tax credits. No specific cut-offs have been proposed yet though.
- Eliminating many of Obamacare’s taxes.
- Extending the lifetime of health plans that pre-existed Obamacare that don’t meet many of the law’s requirements.
- Creating a “reinsurance” fund for states to help shore up the individual health insurance market. The bill would grant states the ability to reimburse insurance companies from the fund if medical claims of covered individuals are between $50,000 and $350,000.
Healthcare Executives Worried About Trump Administration’s Changes to Obamacare and Healthcare Industry
Healthcare industry CEOs are, according to a survey by Modern Healthcare, nervous about many things they believe will result in major changes to the healthcare industry. The survey, which contacted 110 CEOs and received 81 responses, shows that more than 75% of the respondents do not support a repeal of the Affordable Care Act “with a phaseout period and a promise of a replacement.” Many CEOs “fervently hope Republicans move deliberately and thoughtfully, and preserve affordable coverage for the 20 million people who obtained insurance under the ACA.” According to Catherine Jacobson, the CEO of Froedtert Health, “Any drop-off in coverage falls 100% on health systems, because we’re the ones who pay in terms of bad debt and charity care.”
The survey shows CEO opinions on a wide variety of healthcare concerns. You can read more here.
Conservative Activist Groups to Launch Campaigns to Pressure Republicans on Obamacare Repeal
Conservative activist groups, many of which can be traced back to the billionaire Koch brothers, are about to launch a campaign called “You Promised.” The campaign seeks to strongly pressure GOP lawmakers into repealing Obamacare, as the GOP has been running on the idea of Obamacare repeal for years. Many Republican lawmakers are worried that they’ll lose their seats in Congress since backing the law’s repeal might prove unpopular to their constituents, particularly, but not exclusively, in swing districts and swing states.
Older Americans Are Continuing to Voice Their Concerns About Obamacare Repeal
AARP and other representatives of America’s elder community “are bombarding congressional offices with objections as two House committees” are planning to vote on Republicans’ Obamacare repeal bill. They are worried over insurance premium increases of 20 to 25 percent or higher. The Affordable Care Act prevents older Americans from being charged more than 3 times what younger insurance enrollees are charged. The House bill could possibly allow premiums to be 5 times higher. Some states could choose to charge even more than that.
The proposal could have “a severe impact on Americans age 50 to 64 who have not yet become eligible for Medicare,” said David M. Certner, the legislative policy director of AARP. In the meantime, Secretary of Health and Human Services Tom Price stated on Sunday that he and the White House would stand firm behind not cutting Medicare.
News Update for March 3, 2017
House Speaker Paul Ryan Plans Vote on Obamacare Replacement Bill for Later This Month
House Speaker Paul Ryan is feeling more and more confident about getting an Obamacare replacement bill passed through the House of Representatives. In a closed-door meeting on Thursday, Ryan said he expects a vote on an Obamacare replacement bill to occur sometime in the next 3 weeks, according to various sources who attended the meeting.
At a press conference on Thursday, Ryan stressed Republican unity on the progress for repeal and replace so far. Despite concerns from conservative Republicans over the GOP leadership’s insistence on refundable tax credits, Ryan said the GOP is “in sync – the House, the Senate and the Trump administration, because this law is collapsing.” Privately, many Republicans are stressing that “they have no problem steamrolling conservatives by daring them to vote against” the bill.
Majority Leader Mitch McConnell (R-KY) is much more apprehensive about the Senate. McConnell told reporters, “The goal is for the administration, the House and the Senate to be in the same place. We’re not there yet.”
Senate Republicans Opting Not to Write Their Own Bill, Taking Up House’s Obamacare Bill Instead
Senator John Cornyn (R-TX) told the media on Thursday that Senate Republicans would wait on the House’s upcoming Obamacare repeal bill rather than creating one on their own. “The goal is for the House to pass a bill that we can then take up and pass here in the Senate,” Cornyn said. If the Senate were to decide to change the House bill, it would have to be sent back to the House for the House to pass again before returning the bill back to the Senate. Although much of the media’s coverage on Obamacare is focused on House Republicans and their difficulties unifying around an Obamacare replacement plan, Senate Republicans themselves might face some difficulty in regard to unity when it comes time for them to vote.
Some Republicans Worried About Tying Obamacare Repeal with Planned Parenthood Defunding
Many Republicans, particularly more conservative ones, have pushed to defund Planned Parenthood for many years. Moderate Republicans are worried that conservatives will include measures to defund Planned Parenthood in an Obamacare replacement bill. “I, for one, do not believe that Planned Parenthood has any place in our deliberations on the Affordable Care Act,” said Senator Lisa Murkowski (R-AK). Murkowski also added that she wouldn’t vote on any measure that would deny her constituents access to healthcare provided by Planned Parenthood. Representative Charlie Dent (R-PA) believes that “healthcare reform is controversial and complex enough without Planned Parenthood. Why put it in? It makes this whole exercise more difficult.”
Trump’s CMS Pick Approved by Senate
On Thursday, the Senate confirmed President Trump’s nominee to run the Centers for Medicare and Medicaid Services (CMS). Seema Verma, who was confirmed on a 13-12 vote, “is the owner of SVC, a healthcare consulting firm” that “has helped redesign Medicaid programs in several states, including Indiana.” In this capacity, she worked closely with Vice President Mike Pence, who was then the governor of Indiana. Some Democrats have expressed concern about possible conflicts of interest that might have come up during her time working with the Indiana state government.
News Update for March 2, 2017
Republicans Are Working on a New, Top Secret Obamacare Replacement Draft
House Republicans are currently working on a new draft of an Obamacare repeal and replacement bill. The Republicans are being extremely secretive with the document, which is currently locked up in a “dedicated reading room” and can only be read by certain members and staff on the House Energy and Commerce panel. No copies are allowed outside of the room.
The heightened security is a response to last week, when a previous draft was leaked and widely panned by conservative House members. Today, Representative Chris Collins (R-NY) told the media, “The [new] draft is going to be available tomorrow for those of us on the health subcommittee to start poring through.”
GOP Infighting Is “How You Come Up With a Good Public Policy”
There has been some recent concern over the GOP’s seeming inability to find a compromise on an Obamacare replacement bill. In light of this, Senator Marco Rubio (R-FL) appeared on Fox & Friends to alleviate this concern. Rubio stated, “This notion that because there’s five different ideas about it, that’s a sign of weakness – is ridiculous.” The senator argued that it was “a good thing that there are a lot of different ideas” because it was a sign of a healthy debate that would result in better public policy.
New Study Indicates More and More Americans Are Having Trouble Paying for Their Insurance
- Around 43 percent of adults with health insurance are having difficulty affording their deductible. This is an increase from 34 percent from a comparable survey taken in 2015.
- Around 37 percent of adults say that they are having trouble affording their premiums. This is an increase of 27 percent.
- Around 31 percent of adults say they are having trouble paying for prescriptions and copays for doctor visits. This is an increase of 24 percent.
Many Community Clinics Fear Being Shut Down in Face of Obamacare Repeal
Coinciding with the implementation of Obamacare, 950 community health center sites have opened in the last 7 years. Much of the costs to open and maintain these community clinics are paid for through provisions in the Affordable Care Act. Many operators of these clinics are now worried about the futures of their clinics, which often provide healthcare services in parts of the country with large shortages of availability in service. “Between 2011 and 2015, local clinics across the country received $11 billion” through the Community Health Center Fund, one of Obamacare’s provisions, in order to maintain operations.
Congress, with bipartisan support, has extended funding before, most recently in 2015 in order to provide $7.2 billion. However, the funding is set to expire in September of this year, and, with so much of the Affordable Care Act up in the air, many people are worried.
News Update for March 1, 2017
President Outlines Five Major Components for Replacing Obamacare
In President Trump’s address to Congress last night, he laid out some key points in his plan to replace Obamacare. The outline for his plan includes:
- Making sure that “people with pre-existing health conditions are guaranteed ‘access’ to health insurance.”
- Giving tax credits to “people who buy their own health coverage” and expanding health savings accounts so that people can more easily design their own health insurance plans.
- Making sure states have “the resources and flexibility” to use Medicaid programs to help poor people with their healthcare concerns.
- Bringing “down the price of high-cost drugs” and lowering insurance costs with various legal reforms.
- “Creating a national insurance marketplace” that lets insurance companies sell plans across state lines.
New Study Shows Current ACA Replacement Plans, Compared to ACA, Will Lower Health Insurance Tax Credits for Consumers
The Kaiser Family Foundation has released a new analysis estimating that health insurance tax credits in 2020 would, on average, be at least 36 percent lower under replacement plans proposed by Republicans than under Obamacare. The analysis states that the current tax credit for Obamacare exchange customers would rise from an average of $4,615 in 2020 to $6,648 in 2027. However, at least one ACA replacement plan would see a much slower rise in tax credits: from $2,957 in 2020 to $3,729 in 2027.
GOP Set to Hold Meeting to Discuss Obamacare Repeal Bill
Congressional Republicans are currently far from a consensus about how to repeal and replace Obamacare. The party’s reaction to the President’s speech last night has also highlighted differences between conservative and moderate Republicans, who are in disagreement over tax credits for people who pay for their own health coverage. Trump did not specify if the tax credits he supports will be refundable or nonrefundable, which is at the root of the disagreement among the factions of the GOP.
Other disagreements revolve around the nature of Medicaid expansion. “My concern is that we want to make sure none of these folks gets dropped. And I’m not fully convinced that what the House is working on can give me that assurance,” said Senator Shelley Capito (R-WV). Other Republicans, like Representative Jim Jordan of Ohio, believe that voters “didn’t tell us to repeal [Obamacare] but keep the Medicaid expansion.” Senate Majority Leader Mitch McConnell will hold a special meeting with Republican members of both houses of Congress on Wednesday in order to try to hash out an understanding.
Is Obamacare Tied to Early Retirement?
An article from The New York Times suggests that it might be harder for people to retire early if the Affordable Care Act is repealed. Many of Obamacare’s provisions helped prevent a phenomenon “called job lock — the need to maintain a job to get health insurance.” Many studies have shown that there was “evidence of job lock in the pre-Obamacare” years. Some suggest that if it wasn’t for job lock, there would be more job mobility and growth in business because people would be more likely to take risks and innovate.
News Update for February 28, 2017
Conservative Republicans Are Opposing a Leaked Obamacare Replacement Draft
Many conservative Republicans are now voicing their opposition to the draft of a recently leaked Obamacare replacement bill. Representative Mark Meadows, the conservative House Freedom Caucus chairman, and Representative Mark Walker, the chairman of the Republican Study Committee, went on record Monday to say that they would vote against the bill. They believe the bill would increase government spending and that the bill’s tax credits will needlessly benefit wealthier Americans. Senators Ted Cruz (R-TX), Rand Paul (R-KY), and Mike Lee (R-UT) made a joint statement of opposition to the bill for the same reasons.
House Speaker Paul Ryan Insists He and the President Are United
President Trump’s recent proposal to slash domestic spending while preserving Social Security and Medicare sits at odds with House Speaker Paul Ryan’s life’s work. Ryan has been attempting to reform and cut entitlement spending, such as Social Security and Medicare, for the duration of his career. Many are wondering how the GOP can be reconciled over this fundamental difference in ideology. Ryan himself went on record on Tuesday to say that he and the president are united as they are working on reforming something else he sees as an entitlement: Obamacare.
Governors Believe Trump Administration Is Working on Its Own Obamacare Replacement Proposal
Last week, many congressional Republicans went on record to state that they believed the Trump administration would stand back and let Congress draft Obamacare replacement proposals. After meeting with the president at the White House on Monday, many governors, including Virginia Governor Terry McAuliffe (D) and Nevada Governor Brian Sandoval (R), are now working under the assumption that the Trump administration might be drafting its own plan. Governor McAuliffe said that Secretary of Health and Human Services told the governors that the Trump plan would be ready to be unveiled “within a few weeks.”
Health Insurance Companies More Optimistic About Health Insurance Industry After Meeting with Trump
CEOs from many health insurance companies attended a meeting with the President on Monday morning. The meetings allowed the CEOs to discuss their various concerns about the future of the Affordable Care Act and any of its possible replacements. Previously, insurance companies were hoping that the government could provide some assurance that subsidies to help pay for individual premiums would remain. Few details have emerged, but, after the meeting, many of the CEOs said “they were optimistic about the future of the healthcare landscape.”
News Update for February 27, 2017
President Trump to Talk Healthcare in Public Address to Congress
President Trump will be making a nationally televised address to a joint session of Congress this Tuesday night. He will be discussing healthcare and the repeal and reformation of the Affordable Care Act, as well as many other topics.
Tensions Flare over Obamacare and Medicaid Reform at National Governors’ Association Meeting
At the National Governors’ Association Meeting this weekend, a heated debate arose between Democratic and Republican governors. After hearing a report that a Medicaid overhaul “would result in tens of thousands of people losing their insurance coverage in an average-size state,” Democrats, such as Washington Governor Jay Inslee, called the report “disturbing” and accused Republicans of wanting “to spend less money on people’s healthcare so they can do tax cuts for the rich.”
Some Republicans, including Governor Matt Bevin of Kentucky, believe these results are necessary to fix what they see as a broken Medicaid system. Governor Bevin stated, “The piper has to get paid at some point.” Other Republicans, such as Governor Doug Ducey of Arizona said that none of the governors “want to see any citizen have the rug pulled out from underneath them” and that the governors would work hard to improve healthcare and reform the Medicaid system.
House Republicans Might Present Obamacare Plan Later This Week
A leaked draft of a House Republican bill to repeal the Affordable Care Act was obtained by Politico last week. The draft is most likely undergoing some changes at the moment, possibly because many experts said that the proposal would result in a large increase in the country’s rate of uninsured people. House Speaker Paul Ryan has said that he wants to present a repeal bill later this week.
Execs from Major Insurance Companies to Meet with President Today
Cigna Corp, Humana Inc, and the Blue Cross Blue Shield Association announced that some of their executives would be meeting with President Donald Trump on Monday. Representatives of other insurance companies are also expected to attend. Last week, the Trump administration proposed rules to attempt to alleviate concerns that many of these companies had about the individual insurance marketplace. However, many insurance companies felt that the proposals were inadequate and they are looking for assurances “that the government will continue to provide cost-sharing subsidies” for the individual marketplace.
Vermont, a Blue State, Redesigns Its Healthcare Plan to One Similar to Republican-Approved Plan
Vermont is attempting a statewide experiment to change how its healthcare is delivered and paid for. The new experiment “aims to test new payment systems, prevent unnecessary treatments, constrain overall growth in the cost of services and drugs, and address public health problems such as opioid abuse.”
The Affordable Care Act has a provision that permits state governments to launch experimental healthcare reforms so long as certain coverage expansions and consumer protections remain. Vermont’s experiment, which was approved by the Obama administration in October, is notable because it is being enacted in a blue state, despite the experimental plan’s many similarities to Republican proposals.
News Update for February 24, 2017
Draft of Obamacare Replacement Bill Leaked
Politico has obtained a draft of a House Republican repeal bill. The bill would take apart the Obamacare individual mandate, end subsidies based on income for the individual insurance marketplace, roll back Medicaid expansion funding, and give state governments money to help them create high-risk pools for people with pre-existing conditions.
The replacement would fund itself “by limiting tax breaks on generous health plans people get at work.” Read more.
House Republicans Are Trying to Work With Republican Governors on Obamacare Repeal Compromise Bill
The National Governors Association is meeting in Washington for the next couple of days. President Donald Trump will meet with many Republican leaders over the issue of Medicaid funding. Ohio governor John Kasich, a Republican and key supporter of the Medicaid expansion under Obamacare, is a major critic of defunding Medicaid. He will meet with Trump privately over the next few days. House Republicans have reached out to Kasich and Nevada governor Brian Sandoval, another Republican supportive of Medicaid expansion. Many Republican officials throughout the country are in the same boat as Kasich and Sandoval: having to choose between the party line, or whether or not to defund a program that hundreds of thousands rely on in their own states.
Republicans in the House are hoping that Sandoval and Kasich can work out a compromise with other Republican governors who rejected Medicaid expansion. The GOP is hoping that if the governors can resolve concerns amongst themselves, then the party can use the public support of the president and the governors to help get an Obamacare repeal bill passed.
A current plan from House Republicans would temporarily continue using federal funds to cover people who are already insured through Obamacare’s Medicaid expansion. This would, for a time, alleviate concerns for Republican governors who support Medicaid expansion. This plan would also give funding to the 19 Republican-led states that rejected Medicaid expansion.
Former Speaker of the House Says Obamacare Probably Won’t Be Repealed
Former House Speaker John Boehner, at a healthcare conference in Orlando on Thursday, stated that a complete repeal and replace of the Affordable Care Act is “not what’s going to happen.” Boehner, who left politics in 2015 after being pressured out by conservatives in his own party, said that he “started laughing” when Republicans said that they were going to quickly repeal and replace the law. Boehner believes that the Republicans will probably “fix the flaws and put a more conservative box around it,” but the essential framework of the law would probably stay intact. He added, “In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a healthcare proposal should look like. Not once.”
Can the GOP Ensure Coverage for Pre-Existing Conditions?
Many experts and veteran healthcare industry officials have gone on record to say they believe House Speaker Paul Ryan’s plan to set up high-risk pools for people with pre-existing conditions won’t work. High-risk pools are devoid of healthier (and less expensive) consumers who would otherwise offset the costs of covering people with pre-existing conditions.
The pools under Speaker Ryan’s plan would be run by state governments and be partially financed by the federal government. Ryan’s “A Better Way” plan would give out $2.5 billion a year for the next decade in order to help fund high-risk pools. High-risk pools operated in 35 states before the Affordable Care Act, but their effectiveness was inconsistent. Before the ACA’s reforms took effect, $5 billion was set aside by the federal government to set up a “temporary national high-risk pool program.” According to Kathleen Sebelius, a former Secretary of Health and Human Services under President Obama, the pools “ran out of money because the costs were far more expensive than anyone could have, would have predicted just given the fact that there’s some really sick folks out there.” Many conservative health policy experts also agree that the plan and its financing are unworkable. “The needed amount is more like $16 billion [a year],” says Dean Clancy, a health policy consultant who worked in the George W. Bush administration.
News Update for February 23, 2017
Polls Indicate Approval for Obamacare Continues to Rise
New polls conducted by Morning Consult/Politico show that the Affordable Care Act has again increased in popularity compared to polls conducted earlier this year, since President Trump first took office. “Fifty-one percent of registered voters said Obamacare should be completely or partially repealed,” which is “down 8 percentage points from the beginning of the year. … Seventy-eight percent of GOP voters want the ACA to be at least partially repealed,” which is down 5 percentage points. Support for whether the law should be completely or partially repealed declined by 9 percent for independent voters and 6 percent for Democrats.
Congressional Republicans Not Expecting Trump to Offer His Own Plans for Obamacare Repeal
In January, President Donald Trump said that he and his allies in Congress would be “filing a plan” for Obamacare’s repeal and replacement as soon as Tom Price was confirmed as Secretary of Health and Human Services. Now, indications from the executive branch and the House suggest that Trump will go for a hands-off approach. Congressional Republicans are expecting Trump to not involve himself in the crafting of the legislation. They are, however, expecting him to provide his public endorsement of later proposed bills in order to get them passed.
GOP Looking to Cut Out Parts of Obamacare’s 10 Essential Benefits
Hoping to cut costs, some Republicans are suggesting a roundabout solution to cutting or weakening Obamacare’s 10 essential health benefits. Because the benefits are explicitly laid out in the Affordable Care Act, the law would have to be changed outright in order to get rid of them. This is unlikely to happen immediately as it would be highly improbable for Republicans to obtain the 60 Senate votes needed to enact this scenario. Instead, Republicans could change regulations that federal officials wrote to enact the law. This would, in effect, weaken or eliminate the enforcement of the 10 essential health benefits. Read this NPR article to learn more.
Small Businesses Are Worried Congress Will Continue Ignoring Their Insurance Complaints in Obamacare Repeal
Many small business owners believe Democrats focused too much on reforming the individual insurance marketplace when they created and passed Obamacare. Small businesses (defined as businesses with fewer than 50 workers) feel that this focus was done at the expense of their own concerns.
Employer-based health insurance is the largest source of coverage in America, and “more than 56 million Americans work for small businesses,” which make up to 90 percent of the country’s employers. The percentage of employers who offer employer-based health benefits has been falling over the last 20 years, led mostly by small businesses who struggle to afford the coverage.
Barbara Otto, the director of Health and Disability Advocates in Chicago, an organization that advocates for increased access to healthcare, said “Small business must have a seat at the table. They were not central to the first round of healthcare reform.” She believes that if the new administration can center small employers as a cornerstone for any new healthcare reform laws, the administration will be able to provide an environment for financial growth and more efficient health insurance coverage.
News Update for February 22, 2017
Protests and Contentious Town Halls Continue for Republican Lawmakers Seeking to Repeal Obamacare
Multiple sources have been reporting over the past week or so a marked increase in rallies, protests, and town hall meetings swarmed by Obamacare supporters. These passionate displays of support stem from constituents’ fear over losing their healthcare coverage. Many of them feel that a rushed repeal process could threaten their lives or livelihoods. This Business Insider article collects footage and recollections of constituents’ grievances from around the country.
Group Tied to Senate Majority Leader to Release Pro-Repeal AND Replace Campaign in Response to Obamacare Hardliners
A group affiliated with Senate Majority Leader Mitch McConnell, One Nation, is announcing a series of TV ads in 9 states to both highlight the failings of the Affordable Care Act as well as to promise that the GOP will repeal AND replace the law. The campaign is expected to cost over $3 million. The campaign will also use polling data to show the Freedom Caucus that its hardline stance is out of touch with public opinion.
The poll’s findings include:
- Only 17 percent of Americans polled (1,201 likely voters in 12 Senate battleground states) believe the ACA should be repealed immediately. 34 percent believe it should be repealed only when a replacement is available.
- Only 33 percent of Republicans believe the law should be repealed immediately. 56 percent believe in repeal and replace.
- If repeal passes, 69 percent of respondents believe that the replacement should be enacted immediately. 10 percent believe repeal should be enacted within 6 months. Another 10 percent believe it should take place within a year.
- 66 percent of all voters say they would oppose Democrats who would oppose all replacement plans.
Republican Senators Offer Two Proposals for ACA Risk Corridors Program
The Affordable Care Act’s risk corridors program was designed to attract more comprehensive insurance plans onto the ACA exchanges. As these new plans would be covering more benefits, the ACA established the risk corridors program to help keep these plans affordable to consumers while at the same time economically sustainable for the insurance companies. The risk corridors program used cash from exchange plan companies that did well between 2014 to 2016 to help those that did not do as well in the same years. Many Republicans oppose the risk corridors program. They believe that it is a bailout for health insurance companies. The program, according to the Department of Health and Human Services, owes insurance companies about $8 billion for 2014 and 2015. “Risk corridors program managers have collected enough cash to pay only 15 percent of the 2014 program obligations. Managers have not made any payments for 2015.”
- Senator Marco Rubio (R-FL) has proposed a bill that would prevent the HHS from making any payments to these plans.
- Senator Bill Cassidy (R-LA) has proposed a bill that “would create an optional grant program for states, using the cash that otherwise would be spent on each state’s Affordable Care Act coverage expansion programs.” This bill would allow state governments more autonomy over their approaches to risk corridors programs.
California Senate Introduces Single-Payer Healthcare Bill
State Senator Ricardo Lara (D-Bell Gardens) has introduced a single-payer healthcare bill in the California State Senate. The bill is a preliminary step and, if passed, would officially designate that it would be the “intent of the [State] Legislature” to create a “comprehensive, single-payer health care program.” Experts agree that, while the plan might appeal to many Californians worried about the status of the Affordable Care Act, the disruption that a single-payer system might cause could prove to be its downfall. No specifics were included in the legislation as Lara has, self-admittedly, “not yet figured out the financing” because it is “still early in the legislative process.” Lara was an instrumental figure in last May’s passage of state legislation, which resulted in coverage for 170,000 undocumented immigrant children.
News Update for February 21, 2017
State Government Officials Speak Out Against Full Obamacare Repeal
As Congress works to dismantle the Affordable Care Act, officials from different state governments are speaking out about their healthcare reform concerns.
- In Ohio, Republican governor John Kasich continues to express his strong support for the Medicaid expansions provided by the ACA. Repealing Medicaid expansions would be “a very, very bad idea, because we cannot turn our back on the most vulnerable,” said Kasich.
- Washington governor Jay Inslee held a press conference in which he warned that repealing the ACA recklessly could lead to many people dying early, preventable deaths.
- California has largely managed to avoid some of the more glaring problems of the ACA. In particular, because of its insurance industry enjoys robust competition and its premium hikes have been lower than most other states. Support for the law is high in the state. State government officials are working hard to reassure Californians that they will fight back against President Trump’s attempts to repeal the law.
As GOP Lawmakers Are Flooded by ACA Supporters, Critics of the Law Grow Quiet
For years, animated conservative constituents rallied together to oppose the Affordable Care Act, otherwise known as Obamacare. Today, liberals are overwhelming town hall meetings and flooding their congressional representatives with letters and phone calls beseeching them not to take the law away. On the other hand, many Republicans representing conservative and more moderate districts note that “there is significantly less intensity among opponents of the law than when Mr. Obama was in office.” Polls seem to indicate that support for the law is increasing, even amongst Republicans, who are inclined to support reforming it rather than abolishing it outright.
Secretary of HHS Tom Price Working to Save Obamacare After Years Trying to Kill It
After spending a significant portion of his six terms in Congress attempting to dismantle the Affordable Care Act, Secretary of Health and Human Services Tom Price now finds himself in the ironic position of keeping it alive. Many Republicans are hoping for a smooth transition from Obamacare to whatever the Republicans end up replacing Obamacare with. They believe that stabilizing the individual insurance market is a vital component of this smooth transition. As the HHS head, Price could propose rule changes that would directly affect requirements for coverage, such as preventive services for women. By easing these requirements, Price could alleviate financial burdens for insurance companies, but critics such as Kathleen Sebelius, a former Secretary of HHS, contend that this would have “a huge ramification and impact on women.”
Insurance Companies Loosening Rules for Covering Drug Addiction Treatment
In an attempt to assist doctors in alleviating the problem of opioid addiction, Aetna will stop requiring that doctors must obtain approval before prescribing medications to treat withdrawal symptoms. More than 33,000 people died from opioid overdoses in 2015. This measure is designed to limit delays in getting prescriptions filled. Other insurance companies, such as Anthem and Cigna, had already dropped this required authorization in previous months. Addiction specialists say that the delays and red tape can be dangerous for people. “If someone shows up in your office and says, ‘I’m ready,’ and you can make it happen right then and there ― that’s great. If you say, ‘Come back tomorrow, or Thursday, or next week,’ there’s a good chance they’re not coming back,” says Josiah Rich, a professor of epidemiology at Brown University and a doctor who treats patients with opioid addictions.
News Update for February 20, 2017
Senate Majority Leader: Republicans Aren’t Expecting Any Help from Democrats on Obamacare
Last Friday, Senate Majority Leader Mitch McConnell (R-KY) went on record to say, “It’s clear that in the early months [Obamacare repeal is] going to be a Republicans-only exercise.” McConnell also added that he could see the Democrats entering talks with the GOP later on. The Democrats have not shown much desire to sit down at the table with the Republicans to craft a new agenda. Instead, they’ve pursued a strategy of rallying grassroots supporters of the Affordable Care Act to voice their displeasure and various concerns to the GOP.
Conservatives Stand Firm Against Tax Credits in Obamacare Replacement
Many conservative Republicans are continuing to stand up against the idea of implementing refundable tax credits to help Americans buy insurance coverage as a major part of replacing Obamacare. In a closed-door meeting last week between leading House Republicans and rank-and-file Republicans, House Ways and Means Chairman Kevin Brady presented suggestions that the government could provide refundable tax credits to Americans to help them afford insurance coverage. “I don’t like the refundable tax credit. … This is Obamacare light,” said Rep. Ted Yoho (R-FL). Many conservative Republicans believe that a refundable tax credit system would be a “new entitlement program” and might be easy to defraud. Speaker of the House Paul Ryan has gone on record to approve the idea of refundable health credits.
Possible Republican ACA Replacement Suggests Giving States a “Pot of Cash”
Some House Republicans are suggesting that the federal government should give each state an infusion of funds to spend on whatever they want in order to improve their commercial health insurance systems. This idea is partially based on House Speaker Paul Ryan’s Obamacare replacement proposal, “A Better Way.” Ryan’s proposal would give more autonomy to the states, along with approximately $50 billion (how the $50 billion would be divided amongst the states is currently unclear) to help them subsidize individual coverage users with pre-existing conditions.
Health-Savings Accounts Show Slowed Growth
Many Republicans are rallying around the idea of expanding the system of health savings accounts as a possible partial replacement for the Affordable Care Act health system. A recent report by LifeHealthPro, indicates that the rate of enrollment for HSAs is slowing.
News Update for February 17, 2017
Obamacare Repeal Is “Moving Fast” According to Recent Trump Tweet
In a recent tweet, President Donald Trump has asserted that “despite the long delays by the Democrats in finally approving Dr. Tom Price, the repeal and replacement of Obamacare is moving fast!” Trump had originally campaigned on repealing and replacing the Affordable Care Act. However, he went on record last week to say that the process might take until 2018.
House Republican Leaders Hold Closed-Door Session to Outline Obamacare Repeal with Rank-and-File GOP
In the midst of growing dissension amongst Republicans, House Republican leaders held a closed-door meeting on Thursday to lay out components of a possible Affordable Care Act replacement bill. A policy brief obtained by Morning Consult shows some of the proposals discussed:
- Repealing Medicaid expansion
- Offering tax credits to help people afford insurance that would be age and not income-based.
- Capping tax exclusions offered to employer-sponsored health plans.
Molina Healthcare Inc. Might Pull Out of ACA Exchanges
Molina Healthcare Inc., previously “One of the health insurers that has been happiest with the Affordable Care Act public exchange system,” is weighing an exit from the exchanges for 2018. Molina executives are expressing discontent over what they perceive as the ACA’s inefficient risk-adjustment program. The law’s drafters created the program “to help insurers sell individual and small-group health coverage without knowing anything about the health of the new enrollees” when they first sign up. The program requires insurance companies to give new enrollees a “risk score” after they are enrolled. Insurance companies with healthier-than-average enrollees (as determined by the risk scores) are supposed to send money to insurance companies that have more high-risk enrollees. This would, theoretically, help keep the individual and small-group markets afloat while simultaneously offering coverage to everyone, regardless of pre-existing conditions.
Molina executives contend that the risk-adjustment program “punishes issuers with low premiums, even when those issuers enroll a reasonable number of high-risk enrollees.” Molina insists that it has lost money and is looking to recover some of it from the federal government.
Department of Justice Joins Medicare Fraud Case Against UnitedHealth
UnitedHealth Group is being accused of allowing its subsidiaries and other insurance companies to defraud “Medicare by hundreds of millions – and likely billions – of dollars,” according to a whistleblower lawsuit made public on Thursday when the Department of Justice decided to intervene in the case.
UnitedHealth and the federal government have been opposing one another for years. Last year, UnitedHealth companies sued the Health and Human Services Department over disagreements on how companies should handle overpayments by Medicare. In the same time frame, whistleblowers were continuing to file lawsuits against UnitedHealth subsidiaries, stating that they were overcharging programs. Ongoing whistleblower accusations against UnitedHealth began in 2011.
News Update for February 16, 2017
Insurers Wary as Trump Administration Tries to Keep Them on ACA Exchanges
The Trump administration is going to give insurance companies and states extra time to help them adjust to changes in the Affordable Care Act exchanges. The administration is hoping that this extra time will entice more insurers to stay with the individual market exchanges.
Despite these overtures, insurance companies remain wary. They don’t think that the extra time, nor any of the administration’s other proposed measures, will be enough to stabilize the market. They want the administration to enforce the individual mandate in order to shore up the financial stability of insurance pools with young, healthy enrollees. They also want cost-sharing subsidies to continue. Ceci Connolly, the CEO of the Alliance of Community Health Plans, told Modern Healthcare, “Right now, plans are missing key pieces of information to make smart business decisions for 2018.”
Republicans in Congress Still Talking About Obamacare Repeal Plans
In the midst of divisions appearing between hard-right and moderate Republicans in Congress, House Majority Leader Kevin McCarthy (R-CA) and House committee leaders will be meeting with GOP lawmakers on Thursday morning to discuss specific policy proposals related to Obamacare repeal. According to the Washington Post, a senior aide said that “lawmakers would be presented with a menu of replacement items such as tax credits for purchasing insurance, health savings accounts, ‘high-risk pools’ for the chronically sick, and major Medicaid reforms, as well as potential ways those elements could be passed into law.” Many Republicans are opposed to some aspects of those replacement items.
In opposition to House members looking for immediate repeal, Senator Lamar Alexander (R-TN) has taken up the cause for drafting a gradual reform of the country’s healthcare system.
Health Spending Growth Expected to Slow Over Next Decade Under ACA
The Centers for Medicare and Medicaid Services (CMS) have released data that suggests that the average rate of national health spending will grow by 5.6 percent in the next 8 years. This growth level is slower than the one expected in CMS’s report from July 2016, which had the number at 5.8 percent. This growth in spending projects that healthcare will make up about 19.9 percent of gross domestic product (GDP) in 2025. In 2015, healthcare was 17.8 percent of GDP.
Candidate for Top Medicare Position Under Scrutiny
A debate is currently brewing in regard to Seema Verma, President Donald Trump’s pick to head the Centers for Medicare and Medicaid Services. Her detractors believe that profits from her previous work for SVC Inc., her Indianapolis-based consulting firm, involved multiple conflicts of interest. Verma maintained a “web of business arrangements” while simultaneously acting as an advisor on healthcare issues to Mike Pence, who was Indiana’s governor at the time. Many Democrats have “concerns about her philosophy about government entitlement programs, lack of background in Medicare and inexperience leading a large organization.” Marcus Barlow, Verma’s spokesman, said that Verma and her firm were “completely transparent” and “there was never a conflict of interest.”
News Update for February 15, 2017
Trump Administration Announces New Rules for ACA’s Individual Insurance Exchanges
The Centers for Medicare and Medicaid Services (CMS) has announced new proposed rules for Obamacare’s individual exchanges. These rules, some of which were proposed by the Obama administration, would be the Trump Administration’s first tweaks to Obamacare. According to Patrick Conway, the acting CMS administrator, “This proposal will take steps to stabilize the marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”
Here are some of the proposed rule changes:
- Give insurance providers more time to figure out what to do with their 2018 plans.
- Increase scrutiny of potential enrollees who sign up during special enrollment periods.
- Make beneficiaries pay the premiums they owe before they can get on the next year’s coverage.
Many Republicans Looking to Trump for Guidance on ACA Repeal
As the GOP continues to fight with itself on the particulars of repealing the Affordable Care Act, many of the party’s prominent figures are asking the president for assistance and direction. Senator Lamar Alexander (R-TN), a leading Republican figure supporting simultaneous repeal and replace, said, “It’s hard to see how this gets done unless the president says, ‘OK, let’s do it this way.’” Republican leaders in Congress might be able to formulate a new healthcare bill without the President, but it might require the president to get the rest of Congress in line to vote yes on it. Health and Human Services Secretary Tom Price, who is widely seen of as a proxy for the president, will attend lunch with Senate Republicans today to discuss President Trump’s position on repealing Obamacare.
Humana to Pull Out of Exchanges
Major insurance carrier Humana announced on Tuesday that it is withdrawing from the Affordable Care Act’s individual exchanges for 2018. Many insurance providers are wary of the political and financial uncertainty surrounding the exchanges. Humana’s decision comes after it was announced that the company would no longer attempt a merger with fellow large insurer Aetna. Humana’s exit “‘could be a harbinger of things to come,’ said Sabrina Corlette, a research professor at Georgetown University who studies the health insurance market.”
Cigna and Anthem Clashing in Aftermath of Failed Merger
Long-simmering tensions between insurance carriers Cigna and Anthem have boiled over. After a federal judge struck down the two providers’ attempt at a merger, the two companies have been feuding. Anthem is in the process of appealing the judge’s decision. Cigna is suing Anthem, insisting on a $1.85 billion termination fee and $13 billion in damages “for what it says were Anthem’s breaches of the merger agreement.”
Uninsured Rate Hits Historic Low, But High Deductibles Are Up
The latest numbers from the Centers for Disease Control and Prevention show that only 8.8 percent of Americans were uninsured as of September 2016. This is a new historic low stemming from Obamacare’s attempts to expand insurance coverage.
On the other hand, more insured people are having to pay for their own expenses for healthcare costs as the number of Americans on high deductible plans has also risen. More than 39 percent of Americans under 65 are enrolled in a high deductible plan. Read this article for more information.
News Update for February 14, 2017
Conservative House Members Pledge to Only Support an Aggressive Obamacare Repeal
Throwing a wrench in the GOP’s plans to repeal and replace Obamacare simultaneously, a group of 35-40 House conservatives has come together around a pledge not to approve of any Obamacare replacements that aren’t at least as aggressive as a hardline repeal bill that was passed by Congress in 2015. The 2015 bill repealed Obamacare’s mandates, subsidies, and Medicaid expansion, a popular provision that is supported by many Republican governors. The bill was vetoed by President Obama, but this new group is hoping to bring the bill back for another vote.
Many of these conservatives are not opposed to replacement provisions necessarily, but they “worry that adding them to the reconciliation bill will drag the process out for weeks and months.” More moderate Republicans feel that repealing the bill now and replacing it later would greatly antagonize their relationship with some of their constituents. “If we just passed what we did in 2015? Nobody is seriously proposing that, because it doesn’t have any replacement,” said Senator Lamar Alexander.
Agency Completes Review of Trump’s Unreleased Executive Order for ACA
President Trump’s currently unknown rule to stabilize the individual insurance market, which was proposed a little less than 2 weeks ago, just took one step closer to enactment. The draft for this rule is still not available to the public, but regulatory reviewers from the Office of Management believe that “the order could affect the federal government’s relationship with the states, that it would be a major regulatory action, and that it would be economically significant.”
GOP Talking Points on Healthcare Reform and ACA
Kaiser Health News has released an article today that dives into various Republican talking points about the Affordable Care Act. The article addresses common fears and perceptions about the ACA using testimonials from experts from both sides of the aisle. The talking points consist of the following:
- The individual health insurance market is collapsing.
- Out-of-pocket spending is too high.
- Medicaid patients can’t find doctors to treat them.
- The ACA has reduced jobs.
Insurers Want White House to Keep Individual Mandate and Subsidies
Documents from the White House’s Office of Management and Budget reveal that health insurance industry lobbyists have been talking with the Trump Administration in order to try to convince the administration to keep both the individual mandate and the subsidization of their plans on the Affordable Care Act exchanges. Republicans have expressed hostility toward both. The insurance companies see the mandate and the subsidies as crucial for sustaining their plans financially, at least until a clearer replacement for the ACA emerges. Cori Uccello, a senior health fellow at the American Academy of Actuaries, contends that “cost-sharing reduction subsidies are a big deal” and that if they aren’t paid, the effect of that non-payment could result in insurers weakening some of the popular perks of the ACA in order to retain profitability. These perks include:
- Keeping the age band rating low so that older people don’t have to pay so much more than younger people in order to receive coverage.
- Special enrollment periods.
- Three-month grace periods for nonpayment of premiums.
News Update for February 13, 2017
Unable to Kill ACA, Republicans Are Temporarily Strengthening It Instead
Even though they’ve been railing against the Affordable Care Act for years, the GOP is currently seeking to keep the health insurance marketplaces afloat. Many Republicans believe Obamacare is economically unsustainable, but its influence and scope are such that Republicans don’t want to take the chance of dismantling it recklessly, to the detriment of both their constituents and their political careers. In the meantime, both the Trump administration and House Republicans are proposing regulations, drafting legislation, and appropriating funds to keep insurance premiums lower so that the insurance marketplaces will have enough money to operate. Many Republicans, including some who are in support of this temporary policy, are opposed to propping up the exchanges at all, so this temporary solution is a bit of a contentious issue for the GOP right now and it could possibly become more contentious as time goes on. “How far do you go with short-term fixes, which could make the law work better in the long term? It’s a delicate political dance,” said Joel L. Michaels, a health lawyer at the firm McDermott Will & Emery.
Proposed Replacement for ACA’s Tax on Employer Health Plans Drawing Criticism
The Affordable Care Act’s “Cadillac tax,” which would tax employer health plans that have a value over a certain threshold, is one of the ACA’s most unpopular policies for employers and unions. However, Republicans are also hearing much criticism for their proposed replacement. Parts of the law have been tweaked since the ACA was first passed, so the Cadillac tax would not take effect until 2020. The tax was designed to disincentivize “overly generous health plans with high usage of costly care” by placing a 40% levy on health plans that cost over a certain amount.
In the meantime, Republicans have introduced a measure that would cap the amount that an employer-based health plan could be shielded from taxes. “In the end, [both proposals] would have similar effects,” said Steve Wojcik, an official with the National Business Group on Health, an organization that represents employers.
Organizers, Citizens Banding Together in Opposition to Obamacare Repeal
In town halls throughout the country, citizens are confronting their lawmakers with questions about the Affordable Care Act. Many of them are worried about losing coverage for themselves, their friends, and their families. Senators Charles Schumer (D-NY) and Bernie Sanders (I-VT) have also called for nationwide rallies in support of the law. These planned rallies will take place on Saturday, February 25.
Hearing Scheduled for Next ACA Boss Coming Up Soon
The Senate will be holding a hearing for Seema Verma, an Indiana health policy consultant, this Thursday morning. Verma is President Trump’s pick for the head of the Centers for Medicare & Medicaid Services (CMS). As the head of CMS, Verma will be directly overseeing Medicare, Medicaid, and the Affordable Care Act’s exchange system. Verma is known for her support for the expansion of health savings accounts (HSAs), including a variant of HSAs designed for lower-income people. You can read more here.
Failed Health Insurance Mergers Cost Major Insurers $1.5 Billion
Aetna’s attempt to merge with Humana and Anthem’s attempt to merge with Cigna were both shot down for antitrust reasons in the past few weeks. The four companies spent a total of $1.5 billion on legal and financial costs in their attempts at their respective mergers. These deals are estimated to have cost their investors and consumers money as well. Anthem, which has spent about $424.1 million, will continue to spend more because it is appealing the court’s decision.
News Update for February 10, 2017
12.2 Million Have Signed Up for Insurance Through ACA
Around 12.2 million people have signed up for insurance through the Affordable Care Act exchanges for 2017. Earlier this week, it was reported that 9.2 million signed up, but this was excluding the state exchanges. The 12.2 million figure is lower than the 13.8 million hoped for by the Obama Administration and it is expected that 20 percent of the current enrollees will drop out as the year goes on.
Senate Confirms Tom Price as New Secretary of HHS
With a 52 to 47 vote, the Senate confirmed Representative Tom Price as the new Secretary of Health and Human Services earlier today. No senators broke from their respective parties. Price is known for his longstanding efforts to repeal the Affordable Care Act and to defund Medicare. “This is the first vote in the dismantling of the Affordable Care Act,” said Senator Maria Cantwell (D-WA). Many people on all sides of the issue agree.
- Birth control coverage: The ACA required insurance plans to provide women with contraception, but this has been controversial to many organizations and individuals who object on religious grounds. Price could direct the Department of Health and Human Services to exempt employers and houses of worship from having to offer insurance that covers birth control. Price could also just “eliminate no-copay birth control coverage” because the inclusion of birth control was a regulation and not a law.
- Medicare payment changes: The ACA restructured the way doctors and hospitals were paid by using payment models that were dependent on quality of care. These models are often seen as a bureaucratic intrusion by many doctors and hospitals, but others see it as a way of innovating healthcare. Price could put a stop to these newer payment models.
- Planned Parenthood funding: Price has been trying to defund Planned Parenthood for years. As HHS Secretary, Price’s political clout and administrative power mean that he “has many tools at his disposal to make life miserable for the organization.”
- Tobacco regulation: Price “has very broad discretionary authority not to vigorously enforce or implement [tobacco regulation] in an aggressive manner,” says Matt Myers of the Campaign for Tobacco-Free Kids. Price has been ambiguous about his position on tobacco regulation in the past.
Republicans Considering Different Plans to Reform Medicaid
Medicaid reform is one of the most contentious issues among Republicans. Many Republican governors, like Ohio’s John Kasich, expanded Medicaid within their states and are vocal proponents of Medicaid expansion within their states. Many conservatives would like to repeal all aspects of Medicaid expansion that have occurred since the passing of the Affordable Care Act. Other Republican politicians are floating various ideas to rein in federal spending on Medicaid in varying degrees. You can read more here.
Federal Government Owes $214 Million to Oregon Insurer Moda Health Says Courts
Moda Health, an Oregon health insurer, won a case Thursday with the U.S. Court of Claims. The Court has decided that the government must pay the company $214 million.
The federal government, under the provisions of the Affordable Care Act, had set up a risk corridor program that gave financial assistance to companies if they lost money from their participation on the insurance exchanges. Moda has lost money for three consecutive years on these exchanges and was seeking hundreds of millions in funds from the government. The Centers for Medicare and Medicaid paid Moda about $11 million in 2014, but gave the company nothing for the next two years afterward. Moda had to sell many of its assets and borrow in order to stay afloat. “The Court finds that the Government made a promise in the risk corridors program that it has yet to fulfill. Today the Court directs the Government to fulfill that promise,” wrote Judge Thomas Wheeler. Other insurance companies have filed similar claims. Collectively, they are seeking billions of dollars.
News Update for February 9, 2017
Republicans Weighing Alternatives for Removing the ACA’s Individual Mandate
Congressional Republicans are weighing different proposals for getting rid of the individual mandate, one of the Affordable Care Act’s most controversial policies. However, the mandate is directly tied to one of the ACA’s most popular policies: making sure that insurers continue to cover people with pre-existing conditions. The mandate works as an incentive to get younger, healthier people to sign up for health insurance to offset the increased cost of covering pre-existing conditions, and the mandate helps to prop up the insurance system, financially. The Republican proposals have the potential to turn contentious within the party itself. These are the most commonly discussed proposals by the GOP:
- Continuous coverage – Supported by House Speaker Paul Ryan, this idea would require that Americans stay enrolled in insurance without any interruptions in their enrollment if they want their pre-existing conditions to be covered. Some conservatives feel that this option would restrict consumer choice.
- Premium surcharges – This option would incentivize people to get insurance early, during an initial open enrollment period. The later they sign up for insurance in their life, the more they would have to pay. Healthy people who sign up earlier but who don’t use as many services could theoretically make up for the cost of covering people with pre-existing conditions.
- Automatic enrollment – This option would automatically enroll people who are eligible for subsidized coverage but aren’t signed up for insurance. They would be enrolled in a “bare-bones policy that would be paid for entirely through the available federal subsidy.” Selecting which plan these individuals would receive could be a contentious political issue. Some conservatives see this as an even greater overreach by the government than the current individual mandate.
Confirmation for Secretary of HHS Probable for Friday Morning
The Senate will undergo a procedural vote Thursday night, which will set up a final confirmation vote for Representative Tom Price’s nomination to the Secretary of Health and Human Services position. Despite an expected party-line vote, Price is widely expected to be confirmed Friday morning.
New Federal Regulations for Home Health Agencies
“Home health services under Medicare are available for seniors and younger adults with disabilities,” and they “will be required to become more responsive to patients and their caregivers under the first major overhaul of rules governing these organizations in almost 30 years.” The new regulations strengthen patients’ rights, specify operating conditions for home health agencies that take part in Medicare and Medicaid, and ensure that home health agencies will better coordinate services with their patients. You can read more here.
$54 Billion Anthem-Cigna Merger Blocked by Courts
A federal judge has blocked the proposed $54 billion merger between major health insurers Anthem and Cigna. U.S. District Judge Amy Berman Jackson wrote that “the merger is likely to result in higher prices, and that it will have other anticompetitive effects: it will eliminate the two firms’ vigorous competition against each other for national accounts, reduce the number of national carriers available to respond to solicitations in the future, and diminish the prospects for innovation in the market.” This decision follows a similar ruling made last month in which a judge blocked a merger between major insurance carriers Aetna and Humana.
Humana Reports $401 Million Loss
Major insurer Humana is reporting a net loss of $401 million for the fourth quarter of 2016, compared to $101 million in net income for the fourth quarter of 2015. Humana ended 2016 with about 244,000 fewer individual major medical insurance enrollees than it had at the end of 2015, and the company “has discontinued the sale of most [of its] off-exchange individual major medical coverage.” Humana is also “facing challenges in the private Medicare plan market.”
News Update for February 8, 2017
Significant Minority of Americans Don’t Know ACA and Obamacare Are the Same Thing
A recent poll found that about 35% of Americans don’t know that Obamacare and the Affordable Care Act are the same policy. Registered Republicans were more likely to know that Obamacare was a colloquialism for the ACA, but confusion over the ACA’s specific policies remains rampant.
Major ACA Exchange Player Centene Willing to Adapt
Centene chairman Michael Neidorff has faith in the Trump administration’s efforts to stabilize the ACA exchange program and believes that the company will adapt favorably to any of the Trump administration’s proposed policy decisions. While many other major insurance carriers are considering exits from the Affordable Care Act exchanges, Centene has announced that they are opting to stay in the exchange program. “I’m not backing off at all,” said Neidorff. The company has about a million ACA exchange plan enrollees this year, which is up from about 540,000 in 2016.
Republicans Looking to Steer Obamacare Repeal and Replace Efforts Back on Track
The GOP is looking to right their efforts to repeal and replace the Affordable Care Act. Republicans have been sidetracked by confirmation hearings and internal disagreements over whether the repeal and replacement of Obamacare should happen simultaneously or not. Their current strategy is to combine replacement policies into a measure that repeals Obamacare. This measure would be taken up and passed under a sped up process that only needs 51 Senate votes to pass. Some are unsure if Senate rules would permit this process. The GOP’s current repeal and replace strategy involves 4 points:
- Expanding health savings accounts
- Enacting high-risk health insurance pools
- Medicaid reform
- Authorizing tax credits to help Americans afford insurance policies
Pharmaceutical Stocks Sink as Trump Expresses Support for Medicare Drug Price Negotiation
According to remarks by White House spokesman Sean Spicer, President Trump supports Medicare drug price negotiations. Tuesday’s expression of support sent pharmaceutical stocks swinging. “The easier way to look at this is to look at what other countries have done: Negotiating costs to keep [drug prices] down,” said Spicer. Investors are unsure how Trump’s policies would impact the industry’s profits. Spicer’s comments also caught investors off guard as Trump seemed to have given indications that he was backing off drug price negotiations in a meeting with top pharmaceutical industry leaders last week.
Trump Administration Backing “Right to Try” Legislation
President Trump is lending his support to a “Right to Try” proposal that would let terminally ill patients gain access to medicines not yet approved by the Food and Drug Administration. Supporters of a federal “Right to Try” law met with Vice President Mike Pence on Tuesday.
News Update for February 7, 2017
Documents Obtained by Politico Show Trump Administration’s Proposals for ACA Reform
According to 2 draft documents from the Trump administration, there may be major changes to the Affordable Care Act that could entice health insurers to stay in the ACA marketplaces until Congress passes a replacement health law. However, these proposed changes could lead to a decline in enrollment and an increase in the cost for coverage older enrollees. Politico writes, “The administration is looking to alter rules around insurers charging older customers more, how much cost they can shift onto customers, and who’s allowed to sign up outside the standard enrollment window. They represent changes that the industry had previously asked the Obama administration to make.” Health insurers must begin submitting health plans for 2018 to state insurance regulators by April, so the Trump administration has a short amount of time to persuade them to stay in the marketplaces.
Conservative Republicans Insisting on ACA Repeal for Spring
- House Ways and Means Committee Chairman Kevin Brady (R-TX) and No. 2 Senate leader John Cornyn (R-TX), announced on Monday that they plan to start the ACA repeal process this spring. Brady told the press that he’s going by House Speaker Paul Ryan’s timeline to have repeal legislation ready by the end of March. Cornyn told reporters that the Republicans’ repeal bill under the reconciliation method is expected to come to the Senate in the next 30 days. This spring timeline to repeal the health law may be a stretch because Republicans still face challenges with their repeal-and-replace plan. Concerning replacement, “Trump told Fox News on Sunday that ‘maybe it’ll take till sometime into next year’ to put forward a replacement plan, calling the process ‘very complicated.’”
- Some Republicans are wondering what happened to President Trump’s campaign promise of repealing Obamacare quickly. Representative Jim Jordan (R-OH), a member of the conservative House Freedom Caucus, said in a CNN interview, “For goodness sake, we should be able to put something on President Trump’s desk that’s at least as good as what we put on President Obama’s desk. Not something watered down. Let’s repeal it. Let’s do what the voters sent us here to do.” House Freedom Caucus Chairman Mark Meadows (R-NC) told CNN that he wants Republicans to move faster with the repeal. “I don’t know that there’s any new revelations that are going to come up by waiting 60 to 90 more days. We’re making the whole idea of repeal and replacement far more complex and laborious than it needs to be and I think it’s time that we just make some decisions and move forward with (the repeal bill),” Meadows said.
Senators Bernie Sanders and Ted Cruz to Debate the ACA Tonight on CNN
“On Tuesday night at 9 p.m. ET, CNN is hosting a Town Hall with Senators Bernie Sanders [D-VT] and Ted Cruz [R-TX] to debate the merits of Obamacare and of repealing it.” Sanders is likely to argue the Democratic point of view that Obamacare has brought affordable coverage to millions of Americans while Cruz is likely to argue the Republican point of view that Obamacare has damaged the healthcare system and led to high premiums and deductibles.
Repeal of the ACA Could Mean Job Losses
Research studies indicate that repealing major parts of the ACA could lead to job losses across all states, which would affect the whole economy and not just the healthcare industry. “Josh Bivens, Director of Research at the Economic Policy Institute, estimates the proposed repeal would eliminate nearly 1.2 million jobs in 2019.” Repealing the ACA would cut federal funding for premium tax credits and Medicaid services, which the studies indicate are the 2 main factors that would contribute to job loss. Bivens commented, “These are not job losses that would send us back into a recession, but they could potentially cut the rate of job creation by 50 percent.”
Will the Uninsured Still Face Penalties if the ACA Is Repealed?
Kaiser Health News released answers to questions its readers brought up such as, “Should people bother paying the penalty for not having health insurance when they file their taxes this year?” and “Will they be able to sign up on the exchange for 2018 after their COBRA benefits end?” The answer concerning the penalty said, “As long as the ‘individual mandate’—which requires most people to have health coverage or face a tax penalty—is the law of the land, you should pay the fine for not having coverage in 2016 unless you qualify for an exemption.” Kaiser Health News writes regarding the COBRA question, “Under the health law, people who have certain life changes, including losing other types of health insurance such as COBRA, are entitled to a special enrollment period to enroll in coverage on the exchange.” You can read the details of these answers here.
News Update for February 6, 2017
President Trump Dials Back Expectations on Immediate ACA Repeal
In an interview on Sunday, President Trump began dialing back on his earlier campaign promises to immediately repeal and replace the Affordable Care Act upon taking office. Trump gave indications that his administration was in the process of drafting up plans for repealing and replacing the ACA: “It’s in the process and maybe it will take till sometime into next year. … It’s very complicated.”
Resistance for ACA Repeal Continues
Now that the Affordable Care Act’s popularity might be at its peak, the GOP is finding itself face-to-face with increased resistance. During town hall meetings in their respective districts this weekend, representatives Tom McClintock (R-CA) and Gus Bilirakis (R-FL) faced down tough lines of questioning by conservative constituents frustrated over potential losses of coverage. Hundreds of protestors also showed up to McClintock’s town hall meeting.
ACA Enrollee Numbers Released for January
According to managers of the Affordable Care Act exchanges, the open enrollment period for 2017 ended with 9.2 million people selecting insurance plans. Last year, the number was 9.6 million. Approximately 3 million users are new to the exchange system and 6.2 million are holdovers from last year. Some experts believe that this drop by itself isn’t significant. However, fewer than 400,000 sign-ups occurred in the last two weeks before the deadline. This, in comparison with last year’s 700,000 sign-ups in the same time span, has led some experts to believe “that Trump administration actions may have confused consumers, discouraged them from enrolling or simply made it easier to forget about the deadline.”
Healthcare Industry Created 18,300 New Jobs in January
In the midst of great uncertainty over the future status of the Affordable Care Act, the healthcare industry still created 18,300 new jobs in the month of January. The overall employment numbers in the sector have risen to 15,617,200, according to the Bureau of Labor Statistics.
Immigration Ban Might Have Long-Term Detrimental Effects on Healthcare Industry
According to an article by Modern Healthcare, President Donald Trump’s travel ban issued on Jan. 27 might have major effects on the healthcare industry. The ban applies to people from Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen. The U.S. relies “heavily on immigrant and foreign-born students, researchers and faculty” throughout the healthcare industry.
- “We are going to keep folks out of the U.S. who we know are filling key roles in our healthcare and research systems. It’s sending a message about who is welcome here, and when we have an important field so dependent on foreign-educated professionals, that’s going to have an impact,” said Nikki Cicerani, CEO of Upwardly Global, a non-profit that helps immigrants with their careers.
- Foreign-born individuals accounted for 16% of the healthcare industry’s more than 14 million-person workforce in 2015. Of those, “more than 60,000 were from the seven countries” listed in Trump’s executive order.
- “Foreign-born workers make up 28% of the country’s physicians and surgeons, more than half of medical scientists in the biotechnology sector, 22% of nursing, psychiatric and home health aides, and 15% of all registered nurses,” according to a George Mason University Institute for Immigration Research 2016 report.
- The U.S. also needs immigrants to take up healthcare jobs in places with worker shortages. According to Jim Stone, president of Medicus Firm, a physician-staffing agency, “The shortage of physicians is acute, especially in primary care, and eliminating 25% of the available pool of candidates obviously makes a difficult situation even more difficult.”
- Of the researchers at the country’s top seven cancer research centers, 42% were foreign born, according to a 2013 study by the National Foundation for American Policy.
The ban’s effects may go further than just the ones listed in Trump’s executive order. Some people are worried that potential researchers and healthcare workers, alienated by the immigration ban, could decide to go to other countries. This could exacerbate healthcare workforce shortages and stall medical research and innovation in the U.S. “It has nothing to do with just these seven countries,” said Manu Prakash, an Indian-born bioengineer at Stanford University. “It is much more what it speaks to, what it means to be invited into a home.”
News Update for February 3, 2017
AARP Voicing Discontent Toward Republican Efforts to Repeal ACA
As a warning sign for Republicans, AARP has issued letters and statements voicing its dissatisfaction with current Republican policy proposals to repeal and/or reform the Affordable Care Act. As one of the most notable organizations representing seniors in this country, AARP has significant clout with the GOP as older voters are considerably more likely to vote Republican than younger voters. AARP is worried that the GOP will remove ACA protections that keep seniors from being charged more than 3 times the rate charged to younger, healthier insurance enrollees. Many Republicans have been talking about relaxing this “age band” in order to make premiums cheaper for younger Americans. AARP is also worried the conversion of Medicaid to a block grant system will lead to state governments cutting health benefits for seniors.
Health Savings Accounts Generating Buzz During Talks on Repeal and Replace
Kaiser Health News has published a new article that delves into some of the details behind health savings accounts (HSAs). The article explains how they work and how the GOP is proposing to reform them. One proposal, by House Speaker Paul Ryan (R-WI), would increase HSA contribution limits so that eligible individuals and families could put more money into their HSAs. Sen. Rand Paul (R-KY) has proposed getting rid of upper contribution limits altogether. His proposal would also allow people on all insurance plans to be eligible for an HSA. Read more about HSAs and their potential changes here.
GOP Efforts to Repeal ACA Stalled
Although the GOP came into Congress about a month ago setting out to “immediately repeal and replace the Affordable Care Act,” they have been finding the process of doing so to be quite difficult.
- The extremely conservative House Freedom Caucus is pushing for a vote on a 2015 bill that would immediately repeal the ACA.
- The Energy and Commerce Health Subcommittee is discussing drafts of four bills that are looking to repeal, replace, or reform different aspects of the ACA.
- One bill addresses the popularity behind the ACA’s requirement to guarantee coverage for people with pre-existing conditions. This bill would incentivize younger people into getting insurance early on in their lives, before they get sick, in order to fund the insurance pool for people who aren’t as healthy.
- Another bill seeks to change the “age band” that prevents insurers from charging seniors 3 times as much as younger people. The proposed change would allow insurers to charge seniors up to 5 times as much as younger people.
- The third bill would restrict special enrollment periods.
- The last bill would restrict grace periods for people who haven’t paid their premiums.
- The Subcommittee’s approach above reflects the GOP’s strategy to “pursue a piecemeal approach because [the GOP has] no desire to supplant [Obamacare] with a single comprehensive Republican plan,” which would not only require a much higher level of cohesion by the GOP, but also bipartisan cooperation.
Trump Administration Submits New Rule to Help Individual Insurance Market
Insurance companies must decide by May if they would like to participate in the Affordable Care Act’s individual insurance exchange in 2018. Due to regulatory uncertainty, many major carriers, such as Aetna, Cigna, and Anthem, seem to be opting to bow out. During a Senate committee yesterday, many insurers testified that they will need assurances that government subsidies will be available for them if they choose to participate in the ACA marketplace. Many Republican lawmakers are against these subsidies. The Trump administration, in order to keep the individual market going in the meantime, has passed a new rule. The details and language of the new Trump policy haven’t been made available to the public yet, but what is known is that it will be “economically significant” to the point of annually affecting the economy by at least $100 million.
News Update for February 2, 2017
Republicans Moving From “Repeal” to Repair?
During last week’s closed-door policy discussion retreat, Republicans began discussing a possible rebranding of their healthcare reform strategy. The party line for the GOP’s approach to the Affordable Care Act had originally been, more or less, “repeal and replace.” This strategy might be giving way to a “repair” approach, as evidenced by statements made by Sen. Susan Collins (R-ME), House Speaker Paul Ryan (R-WI), and Rep. Pete Sessions (R-TX). This new branding “is a less partisan but no less action-oriented phrase that Americans overwhelmingly embrace,” said Frank Luntz, a prominent Republican consultant. Many see this rebranding to be a compromise inspired by the GOP’s desire to dismantle the ACA and their worries about the political fallout they might face if millions of Americans were to lose insurance coverage during a possible repeal process. Some of the GOP’s more conservative members are frustrated at this rebranding. “I’m out there saying repeal and no replace—that’s as pretty strong as it gets,” said Rep. Roger Williams (R-TX), who “believes things should ‘just go back the way they were’” prior to the ACA.
Republicans Weighing Plans to Keep Individual Market Afloat
Last year, a federal judge sided with House Republicans and said that the Obama administration had overstepped its authority by subsidizing premiums without specific appropriations from Congress. Some Republican lawmakers are considering funding the ACA’s cost-sharing reduction or reinsurance programs “that they haven’t given money to in recent years in order to both stabilize the individual insurance market” and to prevent a massive increase in the uninsured rate.
Large Insurers Continue to Be Unsure About Individual Market
More uncertainty about changes to the Affordable Care Act has made large insurers wary of participating in the individual insurance market for 2018. Tuesday’s announcement that Aetna would be opting out of the individual insurance market in 2018 was already a large blow to the marketplace.
- Another big insurer has gone on record to say that it is reevaluating its position in the individual insurance market. Anthem Inc. chairman Joseph Swedish “wants to see how insurance regulators, members of Congress and other policymakers respond to [Anthem’s] requests for efforts to stabilize the individual market” before coming to a more concrete decision.
- Fellow insurance giant Cigna has announced that its profits in the individual market have fallen compared to last year. They are also reconsidering their position in the individual insurance market.
ACA Repeal Puts Women’s Health Benefits at Risk
Before the Affordable Care Act, insurance companies were allowed to charge women more than men for policies purchased directly from the companies. The ACA ended this practice and made newborn and maternity care required benefits in the individual insurance market plans. Preventive care — “including birth control and breast pumps used by nursing mothers” — was also offered at no extra cost to insured women. These services add to the cost of the ACA-approved plans, and some critics think these requirements should be stripped so that premiums for all consumers will be lower. Many others are worried that these benefits are too crucial to be removed.
News Update for February 1, 2017
Discussions of ACA Repeal Causing Much Uncertainty for Potential Enrollees
Various executive orders by President Trump and bill proposals from Congress have managed to throw much uncertainty into the final weeks of what could possibly be the Affordable Care Act’s last Open Enrollment Period. According to Emily Black Bremer, an insurance agent in Clayton, Missouri, “Some people [are asking], ‘What’s the point if the law is going to be repealed?’” Some enrollment service centers are seeing greatly increased traffic compared to this time last year; others have experienced a steep drop. According to the last figures released by the Obama administration on January 14, 8.8 million people had signed up for coverage through the federal marketplace. This number is about 100,000 higher than at the same time last year. A higher number of enrollees could translate to a higher level of stability for the individual insurance marketplace over the coming months.
Aetna Opts Out of Individual Health Market for 2018
Citing its higher-than-expected losses in 2016 and the murkiness of where government regulation is headed, Aetna chairman Mark Bertolini has announced that the major insurance provider will be opting out of the individual insurance market in 2018. The company, which was once a big supporter of the Affordable Care Act, has been drastically reducing its participation in the individual insurance marketplace in the last couple quarters. “The company now has about 240,000 individual major medical enrollees, down from 965,000 at the end of 2016,” said various executives.
Key Questions on Medicaid Reform
The Kaiser Family Foundation has released a brief that outlines key questions about Medicaid reform. The proposed changes in Medicaid funding — either block grants or a per capita cap — could lower the amount the federal government puts toward Medicaid in each state.
- Block grants would give states a pre-set amount of funding for Medicaid. The dollar amount of the block grants would be capped below the amount of expected spending. The state governments would have to make up the difference with state revenue or cut spending. Block grant caps wouldn’t account for economic downturns or changes in the cost of healthcare, but the caps would increase every year based on inflation.
- A per capita cap would cap federal funding for Medicaid per each enrollee. There would be separate caps for different types of coverage groups (children, adults, seniors, and people with disabilities). This cap would also be set below the amount of expected spending. Unlike a block grant, a per capita cap would adjust for the number of enrollees.
Block grants or a per capita cap could end up saving the federal government some money, but some experts are worried that limiting federal financing could hamstring state governments and leave a lot of people without healthcare or with poor quality healthcare.
Trump’s Pick for Supreme Court and the ACA
Last night, President Donald Trump announced Judge Neil Gorsuch as his pick to replace Justice Antonin Scalia’s former spot on the Supreme Court. Gorsuch’s nomination has been praised by many conservatives. Gorsuch has ruled twice against the contraception coverage requirement of the Affordable Care Act. In 2013, Gorsuch supported Hobby Lobby Stores, Inc. when the retailer protested, on religious grounds, the ACA requirement to provide no-cost contraception access as part of its employees’ health insurance plans.
Vote to Confirm Secretary of HHS to Proceed to Senate Floor Despite Boycott by Democrats
Despite yesterday’s boycott by Democrats, Republicans were able to push the vote to confirm Representative Tom Price (R-GA) to the Senate floor. It is unclear when the final vote to confirm Rep. Price will occur, but it is widely expected that he will eventually be confirmed as Secretary of Health and Human Services.
News Update for January 31, 2017
Today Is the Last Day of Open Enrollment
Despite efforts to repeal the Affordable Care Act, enrollment on government exchanges continues. “Our volume has been the same as it has been in past years,” says Katie Nicol, a senior manager of 5 insurance navigators. Today is the last chance to sign up for Obamacare, unless you are eligible for a special enrollment period because of a qualifying life event.
New Executive Order Excites Some in Healthcare Industry
President Trump’s new executive order requiring executive departments and agencies to remove two regulations for every new regulation issued “could have major ramifications for healthcare, one of the most regulated industries in the U.S. economy.” However, some experts are unsure how workable the order is.
Short-Term Insurance Could See Growth If Parts of ACA Are Repealed
Short-term insurance plans, which are much less strictly regulated by the Affordable Care Act, could see a surge in popularity if certain provisions of the ACA are removed. These plans are much cheaper than ACA-compliant plans because they don’t need to cover many of the things that ACA-compliant plans are required to cover.
Efforts to Repeal ACA, Piece by Piece, Continue
Even though many conservatives feel that the GOP is losing momentum on the repeal of the Affordable Care Act, Republicans in Congress are moving forward with various strategies to repeal and replace the law.
- Some congressional Republicans are considering using the Congressional Review Act, an obscure law passed in 1996 that “enables Congress to overrule regulations issued by the executive branch through straight-majority votes,” to repeal regulations issued by the Obama administration. Read this for more information on this strategy.
- House Republicans have filed four separate bills to try to stabilize the individual insurance market while they work on repealing and replacing the ACA.
- One bill would give insurance companies more flexibility to charge older consumers 5 times more than younger consumers. The current limit is 3 times more. This could attract more consumers who are healthier and result in lower premiums, but it might make it harder for older people to afford coverage.
- Special enrollment periods allow people who have undergone certain hardships or life changes to obtain insurance outside of the normal enrollment period. The second bill would require the Department of Health and Human Services “to more rigorously verify that people meet the requirements for special enrollment, including job loss or divorce.”
- The third bill requires that insurers on the government exchange can only cancel a consumer’s coverage after 90 days of non-payment. This is designed to prevent consumers from signing up for insurance, getting medical services only in the first 3 months, and then immediately canceling their coverage.
- The last bill is a statement of policy that simply reiterates that Congress will not allow Americans to face denials of coverage due to pre-existing conditions.
- The Obama administration’s final Medicaid spending report might help the GOP justify Medicaid cuts, especially because the Medicaid expenses that are projected to steadily grow could “displace spending on other important programs.”
Democrats Boycott Confirmation Hearing for Secretary of HHS
In light of the news that President Trump’s nominee for Secretary of Health and Human Services, Representative Tom Price (R-GA), might have contradicted his testimony from last week about his trading of medical stocks, Senate Democrats are boycotting Price’s nomination in an attempt to delay it. The Democrats are pushing for ethics investigations before a vote can occur. Price is expected to eventually be confirmed.
News Update for January 30, 2017
Experts Say People Should Sign Up for Health Coverage Anyway, Despite Possibility of Repeal
Although Republicans still haven’t come to a consensus on the repeal and replacement of the Affordable Care Act, many experts are advising that consumers should continue to enroll in marketplace coverage. Policy experts and consumer advocates are saying there are many subsidies to help low-income consumers and, though the fate of the ACA is unclear, it is unlikely that Congress and/or the Trump Administration will be able to enact any sweeping changes that would deny coverage to a consumer who has already purchased a plan on the marketplace. “If people need coverage now, they should get it,” said Karen Pollitz, a senior fellow with the Kaiser Family Foundation.
ACA Repeal Threatens Loss of Services for Many
- The Affordable Care Act increased coverage for a variety of preventive services, such as cancer screenings, to seniors on Medicare. Nengliang Yao, an assistant professor of public health at the University of Virginia, said that “about 8,400 people had their colorectal cancer detected at an early stage” due to the ACA’s provisions to extend coverage for these services. According to Yao, these early detections are crucial for increasing a senior’s chances of survival. Many experts are worried that this part of the law will be removed.
- According to a new study by the Urban Institute, the repeal of the ACA, along with a likely elimination of funding for Medicaid expansion, could end up being particularly costly to hospitals that treat gunshot victims. According to Modern Healthcare, the study found that “early Medicaid expansion adopters such as Kentucky saw uncompensated care for gun victims fall from 54% in 2010 to 13% in 2014, with Medicaid accounting for 68% of coverage.” States that did not expand coverage had relatively unchanged percentages for uncompensated care costs for gunshot victims. The study indicates that Medicaid reduction would likely shift the cost onto the victims, hospitals, and private payers who would have to pay higher rates to cover the uncompensated care costs.
Small Businesses Are Looking to Help Reshape the ACA
A new survey released by the Women’s Business Development Center and the nonprofit Health & Disability Advocates finds that many small businesses, particularly ones that are mostly owned, managed, or controlled by women, support changes to the Affordable Care Act. Most of the small businesses responded that costs are the main reason why coverage isn’t offered to their employees. However, these businesses support many of the provisions under the ACA, particularly the ones requiring insurers to cover pre-existing conditions. Emilia DiMenco, the president and CEO of the Women’s Business Development Center, said that the lack of affordable health insurance “could discourage the formation of businesses, which would have a significant impact on our economy.”
Approval Ratings for the ACA Are on the Rise
A poll released today by Morning Consult/Politico shows that more registered voters now approve of the Affordable Care Act. The approval rating for the law went up from 41 percent to 47 percent in the time span from the beginning of January to just after President Donald Trump’s inauguration. The disapproval rating dropped from 52 percent to 45 percent. Experts such as Paul Ginsburg, director of the Center for Health Policy at the Brookings think tank, believe that “[t]he enormous attention to repeal and replace likely has substantially increased knowledge about the ACA and many of the impressions [are] positive.” Others, such as Thomas Miller, a health policy expert at the American Enterprise Institute, believe that people’s opinions have changed because “coverage about the health care law had transformed since early January, focusing more on instability and the issues facing Republican repeal plans rather than on earlier problems with the ACA itself.”
News Update for January 27, 2017
Trump Administration Issues Order to Stop Advertisements for Healthcare.gov Open Enrollment
- The Trump administration issued a directive on Thursday toscale back advertising for the final days of Healthcare.gov’s open enrollment period, which ends on Jan 31. The Department of Health and Human Services, which has already spent $60 million this year on open enrollment advertising under the Obama administration, responded to the directive by withdrawing around $5 million in ad funding to help cut costs. Kevin Counihan, former CEO of Healthcare.gov, called the move from the Trump administration “outrageous” because it could prevent young, healthy individuals from being a part of the insurance pool; if they aren’t part of the pool, it could increase the cost of coverage. “We know that more young people enroll during the final days of open enrollment, but they need to be reminded of the Jan. 31 deadline,” Counihan said.
- Previous years’ open enrollment has shown that alarge number of people sign up for coverage right before the deadline. To take advantage of this, Healthcare.gov has continued to send emails to promote sign-ups.
5 State Exchange Leaders Share Their Concerns on the ACA
Eleven states and Washington D.C. use their own state exchanges to sell individual health insurance plans instead of going through Healthcare.gov. Executives of 5 state exchange companies share their concerns on the future of the Affordable Care Act (ACA), which are published in this Kaiser Health News article.
- Executive Director Peter Lee of Covered Californiasays, “I do think we have a number of the ingredients of [how to] make the individual market work. And we want to take those lessons to members of Congress and to policy leaders.”
- Executive Director Donna Frescatore of NY State of Healthdoesn’t want the cost of coverage for New Yorkers to go back to pre-ACA days of $1,000 a month. Kaiser Health News writes, “Without financial support from the federal government, premiums may increase. Options may become reminiscent of health insurance plans as they were in pre-health-law New York.”
- CEO Jim Wadleigh of Access Health in Connecticutwants his board to approve stronger enforcement of special enrollment periods. “What the carriers are telling us is, these customers are coming in… finding a reason that they have a life event because they’re sick, get services and then drop out.” Wadleigh added, “If we can do a better job enforcing the special enrollment, we think we can reduce the premiums by potentially 6 to 10 percent.”
- Executive Director Louis Gutierrez of Massachusetts Health Connectorreported that he’s unable to guarantee whether the 240,000 enrollees in his state exchange would have coverage through the remainder of 2017. “‘I don’t want to be in the business of speculating or making commitments about things I can’t personally control,’ Gutierrez said, adding, ‘I don’t think any of us really know’ what’s going to happen with the repeal of the ACA.”
- CEO Kevin Patterson of Connect for Health Coloradoreported that, “Enrollment numbers for 2017 are running 15 percent ahead of last year. ‘I think we’re feeling like things are going really well,’ he said. But two things are clouding its future – first, the new Trump administration and Congressional Republicans vowing to undo Obamacare.”
Republicans Leaders at the Party’s Retreat Still Searching for Agreement on Health Law
Republican leaders wrapped up day 2 of their 3-day policy retreat in Philadelphia on Thursday, but have still not reached an agreement on the specifics of reforming the health law. They did, however, seem to agree on a plan to reform the health law by this summer. House Speaker Paul Ryan (R-WI) said at the retreat, “We don’t want to set arbitrary deadlines on things. We want to move quickly, but we want to get things right.”
The Cadillac Tax May Shape ACA Repeal
“Edward Fensholt, a lawyer who tracks the ACA for Kansas City, Missouri-based Lockton Companies, said today in an email interview that the group health tax exclusion is in trouble because cutting it would be a way to free up the federal budget power to pay for repealing ACA revenue-raising provisions,” writes LifeHealthPRO. “What we hear most often is that the exclusion needs to be at least partially rolled back to pay for the lost revenue when the ACA’s Cadillac [plan] tax is repealed,” Fensholt said.
Rand Paul Introduced Obamacare Replacement Bill
On Wednesday, Senator Rand Paul (R-KY) introduced a bill to replace Obamacare as a way to get Republicans to act more quickly in creating an alternative. “There is no excuse for waiting to craft an alternative until after we repeal Obamacare, and the Obamacare Replacement Act charts a new path forward that will insure the most people possible at the lowest price,” Paul said in a statement.
News Update for January 26, 2017
Republican Leaders Meet for Annual Policy Retreat
- Congressional Republicans met in Philadelphia on Wednesday for their annual policy retreat, which was led by House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY). Topics discussed include repealing major parts of the healthcare law and replacing it with alternatives, and passing new legislation to amend the tax code by August.
- President Trump, who attended the retreat on Thursday, commented that he wanted to wait a while before getting rid of Obamacare but changed his mind. He told lawmakers at the retreat, “It’s a disaster. I actually talked with Paul and the group about just doing nothing for two years and the Dems would come begging to do something. … We have to take care of the American people so we can’t wait.” You can read more of Trump’s comments here.
- Chairwoman Diane Black of the House Budget Committee told reporters at the retreat that the House will start drafting a bill to repeal Obamacare over the next 2 weeks, and that the bill will then go the floor between late February and early March.
- President Trump’s recent statement that he plans to send his own Obamacare replacement plan to Congress was also a hot issue at the retreat. Some Republicans worry that if the executive branch writes legislation instead of Congress, it may cause conflict with the separation of powers. Others say they would support Trump’s healthcare plan even if it clashes with their own ideas because it would at least make priorities more clear given that there are several Republican healthcare proposals.
- Concerning Trump’s executive order that seeks to minimize the economic and regulatory impact of Obamacare, lawmakers at the retreat said they didn’t review the executive order before it was signed, so they don’t know if any of its directives would be in contradiction with current laws. “Critics are questioning whether the documents are being rushed through without the necessary review from agency experts and lawmakers who will bear the burden of actually carrying them out,” says the Politico article.
California’s Democratic Governor Says He Will Protect State’s Healthcare
On Tuesday, Governor Jerry Brown (D-CA) delivered a speech at his annual State of the State address in which he promised to protect the benefits that Californians have gained under Obamacare from Republicans in Congress who want to scale back benefits. Brown told state legislators and appointees at the event, “More than any other state, California has embraced the Affordable Care Act. I intend to join with other Governors and Senators, and with you, to do everything we can to protect the health care of our people.” Brown’s speech also called for cooperation between the two political parties, which was well-received by some state Republicans.
How Primary Care Doctors Feel About Obamacare
Among primary care physicians (PCPs) who participated in a postelection survey that was conducted from December 2016 to January 2017, 73.8 percent support making changes to the health law while 15.1 percent want the law repealed completely. Responses also differed by political affiliation—no Democratic PCPs were in favor of a repeal while 32.4 percent of Republican PCPs support repeal. Among those who voted for President Trump, 37.9 percent want full repeal. This Los Angeles Times article provides an overview of the survey.
Actuaries Present 5 ACA Solutions
Actuaries from the Individual and Small Group Markets Committee, which is a branch of Washington D.C.’s American Academy of Actuaries, came up with 5 ways to reform the Affordable Care Act.
- “Spend more government money on subsidies”
- “Shorten the open enrollment period”
- “Add barer-bones ‘copper’ level plans”
- “Let insurers widen the gap between what the youngest and oldest enrollees pay”
- “Set up high-risk pools for people with health problems”
News Update for January 25, 2017
Health Insurance Companies Are Quietly Working to Have Their Say in Obamacare Replacement
In the wake of Republicans repealing Obamacare and coming up with a replacement solution, some of the leading health insurance companies are pushing for Republican lawmakers to make changes like implementing stricter enforcement on eligibility for individual plans and giving states more control over insurance. Although, the insurance companies stressed that government subsidies for low-income people should remain intact. You can read more in this Reuters article.
Trump’s Nominees for Head of HHS and Budget Departments Have Confirmation Hearings
- The Senate Finance Committee held a confirmation hearing on Tuesday for Rep. Tom Price (R-GA), Trump’s nominee for Department for Health and Human Services (HHS) secretary. Democrats questioned Price about how he would lead the healthcare system, but he gave them few details. For example, Price didn’t provide any clear answers about the possible effects of Trump’s executive order to give federal agencies the power to weaken certain aspects of the healthcare law. He also avoided answering whether or not the Trump administration would stop enforcing the individual mandate before coming up with a replacement plan.
- Despite Democrats’ frustration with Price’s lack of detail, “Senate Finance Committee Chairman Orrin Hatch, R-Utah, praised Price and said he’ll schedule a committee vote on sending Price’s nomination to the full Senate as quickly as possible.”
- Mick Mulvaney (R-SC), whom Trump picked to lead the White House budget office, said at his confirmation hearing on Tuesday that changes need to be made to Medicaid, Medicare, and Social Security. Mulvaney said during the hearing that he doesn’t want to cut benefits for people already in these programs. “But, he added, younger workers should expect to work longer than their parents. He also said Medicare should be means-tested, which means benefits would be limited for wealthy retirees. They already pay higher premiums.”
Healthcare Expert Proposes 6 Alternatives to Replace the ACA’s Individual Mandate
Thomas Miller, senior fellow at the American Enterprise Institute based in Washington D.C., met with the House Ways & Means oversight subcommittee to discuss why the individual mandate isn’t working and why it needs to be replaced. Miller referenced research from economist Jonathan Gruber, who found that the mandate’s penalty contributed very little to the number of people with health insurance in 2014. Miller proposed 6 alternatives to the Affordable Care Act’s individual mandate, which you can find in this LifeHealthPRO article.
Trump’s Executive Order Probably Won’t Be Implemented Soon
According to Joe Antos of American Enterprise Institute (a Conservative organization), implementing Trump’s executive order will likely be met with little effort in the short term because key members of the Trump administration are not yet installed. “‘They need their appointees,’ said Antos. Until more Trump personnel actually start work, he added, ‘I don’t think they’re going to be able to do much.’” Among the key appointees who are going through difficult Senate confirmation hearings include the secretaries for the HHS, Labor, and Treasury departments.
News Update for January 24, 2017
Trump’s Executive Order May Throw Curveball in Obamacare Open Enrollment
- With President Trump issuing an executive order that could dismantle certain parts of healthcare law, thousands of Americans are contacting Obamacare call centers to find out if they can still sign up for coverage before the January 31 open enrollment deadline. “In a normal year, you would see really strong demand Monday and Tuesday,” said Michael Z. Stahl, senior vice president at HealthMarkets, a health insurance agency that is licensed in all 50 states. “But we’ve got a new administration that has thrown a curveball in all this.” Read more about what Stahl and other health insurance executives have to say in this Politico article.
- Outreach workers in Washington D.C. are rushing to sign up millennials for coverage before January 31 in the wake of the Republicans’ repeal efforts and Trump’s executive order. “‘When we talk to folks, some say they want to make sure they have a policy in place,’ before it’s too late, said Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority.” Kofman also reported that 41 percent of new Obamacare enrollees in D.C. are “ages 26 to 34.”
Ryan Says Obamacare Is in a ‘Death Spiral’
House Speaker Paul Ryan (R-WI) and other Republicans are saying that Obamacare is in a “death spiral” and is about to collapse. This month at a press conference Ryan said, “You have to remember the law is in what the actuaries tell us [is] a death spiral. So we’ve got to intervene to prevent this from getting worse.” Despite Ryan’s comments, non-partisan groups like the American Academy of Actuaries say that there hasn’t been any evidence of a “death spiral” or collapse of the healthcare law.
Some Calling for Repeal of Certain ACA Laws While Others Are Bracing for Repeal Consequences
- Healthcare industry groups are lobbying for a quick repeal of taxes and spending cuts under the Affordable Care Act (ACA). ACA taxes were used to finance things like premium subsidies, Medicaid expansion, and Medicare benefit enhancements. “But now insurers, hospitals and other stakeholder groups are loudly demanding elimination of those financing measures as part of the law’s repeal.” The ACA implemented a tax on health plans, which is set to go into effect in 2018. But lobby groups want to get rid of this tax as a way to reduce premiums.
- Pennsylvania officials are bracing for what they call “disastrous” consequences if the ACA’s funding for Medicaid expansion is repealed, which includes loss of coverage for over 670,000 residents who mostly reside in “poor and rural areas.” “There would be no way for the state to continue to provide health care for those folks,” Ted Dallas, secretary of the state’s Department of Human Services, said just before a Capitol rally on keeping the law’s funding intact. The Pittsburgh Post-Gazette also reported that “the state’s deficit could grow by another $1.4 billion, in part because the state would once again have to pick up the tab for several health care programs that the ACA now pays for.”
Impact of Obamacare on Certain Patient Groups
- Coal miners benefit from a special provision included in the ACA that makes it easier for them to get benefits to treat black lung disease. The ACA also shifted the burden of proof onto coal mining companies—meaning the companies must show that mining didn’t cause miners’ black lung disease, rather than miners having to prove that it did.
- On Monday, the Annals of Internal Medicine published research, which found that insurance coverage “increased by about 5 percentage points — around 4 million people — in 2014” among Americans with chronic illnesses. But the study also suggests that the ACA fell short in being able to guarantee that people with chronic conditions have access to see doctors, get medical treatment, and buy affordable medications. “The study is the first to examine how the health law affected people with these long-term diseases, which require careful and continuous management, and whose treatment drives a vast majority of the nation’s health care costs.” This article from Kaiser Health News has more details on the research study.
News Update for January 23, 2017
Trump Signs Executive Order to Scale Back the Healthcare Law
- Hours after taking office on Friday, President Donald Trump signed an executive order that authorizes certain federal agencies to lessen the fiscal and regulatory burdens brought on by the Patient Protection and Affordable Care Act (PPACA). The order also mentions that the Trump administration is doing work to repeal the PPACA. This executive order will affect “….individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products or medications.”
- Trump’s executive order didn’t target any specific parts of the healthcare law. “But its broad language gave federal agencies wide latitude to change, delay or waive provisions of the law that they deemed overly costly for insurers, drug makers, doctors, patients or states.”
- Kaiser Health News reported that because there are no appointees in place for the agencies that the order would affect, it’s unlikely that any changes will take place very quickly.
Trump’s Executive Order May Weaken Key ACA Mandates
- Healthcare industry experts think that the executive order could allow the Trump administration to put forth less enforcement of the individual mandate to buy health insurance, as well as the mandate that companies of certain sizes must offer coverage. “The administration could also alter, or fail to enforce, requirements that insurers cover a basic set of health benefits in all of their plans, from maternity and newborn care to mental health services.”
- One healthcare expert and critic of Obamacare called Trump’s executive order a “bomb” in the “already shaky” health insurance market. Robert Laszewski also said, “Instead of sending a signal that there’s going to be an orderly transition, they’ve sent a signal that it’s going to be a disorderly transition.”
- President Trump’s senior adviser Kellyanne Conway said about the individual mandate in a Sunday interview with ABC News’s “This Week,” “What President Trump is doing is, he wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans, to have to pay a penalty for not buying government-run health insurance.” You can read more about the interview here.
Republican Senators Introduced Obamacare Replacement Bill
On Monday, Senators Susan Collins (R-ME) and Bill Cassidy (R-LA) introduced a bill that is centered on giving states the choice to decide if they want to keep Obamacare. The senators are calling the bill an “Obamacare replacement plan.” But it’s not for certain whether or not the bill will gain support from Republican leaders. “We recognize that our bill is not perfect. It is still a work in progress. I expect that we will get many ideas from my colleagues for further refinements and we are completely open to that,” Collins said. “But if we do not start putting specific legislation on the table that can be debated, refined, amended and enacted, then we will fail the American people.”
How Obamacare Has Helped Women and What a Repeal Could Change
The uninsured rate for American women before the Affordable Care Act was fully implemented in 2013 was at 18 percent compared to 11 percent today. Pre-ACA laws also allowed insurance companies to charge women more for coverage. “This ‘gender rating’—which the ACA made illegal—is estimated to have cost women approximately $1 billion a year. This inequity is particularly troubling when considering women on average are paid and save less, and therefore have less disposable income to spend on health coverage and care.”
News Update for January 19, 2017
Republicans in Congress are considering the idea of automatically enrolling everyone in coverage unless they choose to opt out. This auto-enrollment idea has been presented before in some of the top Obamacare replacement proposals. But there is no agreement among Republicans as of yet about implementing this idea. A senior GOP aide said, “There’s a lot of work being done to look into it.”
Representative Greg Walden (R-OR), who has been a longtime opponent of Obamacare, is now the Chairman of the Energy and Commerce Committee, which oversees healthcare policy. In an interview with Politico, Walden said his plan is to “repair” and “rebuild” the healthcare law—a softer approach than that of some of his fellow Republicans who emphasize “replacement” of the law. “Walden insists that any replacement plan for Obamacare won’t be ‘preordained’ by GOP leaders. Rather, he said he intends to solicit ideas from colleagues on both sides of the aisle and is already in touch with governors and those in the health care market.”
Governor Scott Walker of Wisconsin wants each state to be in control of the Obamacare replacement process. Walker told CNBC’s “Squawk Box”: “We’re one of the best states in the nation in terms of coverage. We have one foundation called No Insurance Gap, and we didn’t take the Obamacare Medicaid expansion, we didn’t set up a state exchange, yet we have one of the lowest rates of uninsured in the country.” He also added, “We can do it elsewhere as well. Just give us the flexibility to do it state by state.”
In an interview with CNBC’s “Squawk Box” on Thursday, Senator Ron Johnson (R-WI) said that Republicans will need help from Democrats to fix the healthcare law. “My thought process is let’s start working with Democrats, let’s transition to a system that’ll actually work that Democrats are talking about. They want to fix it, let’s fix it for the benefit of the American public,” Johnson said.
In a courtesy hearing before the Senate Health, Education, Labor and Pensions Committee on Wednesday, Trump’s nominee for secretary of the Department of Health & Human Services, Tom Price (R-GA), said he wants every American to have access to health insurance. However, Price didn’t say the same thing as Trump concerning “insurance for everyone.” “During Wednesday’s hearing, Price also insisted his ideas for replacement would put patients at the center of their care by providing them with more choices and fewer mandates.”
On Wednesday, Mike Pence said that the replacement for Obamacare will “make health insurance affordable for everyone.” “Pence promised an ‘orderly transition out of Obamacare’… and said that the incoming administration is ‘very close’ to completing a plan with Congressional leadership.”
News Update for January 18, 2017
Senator Bill Cassidy (R-LA) proposed to Democrats that states can keep the health law if they like it, get rid of it, or transition to a replacement system using health savings accounts (HSAs) and automatic health insurance enrollment. Cassidy commented, “You can go to the reddest state and say we have the option to root and branch it, and you can go to the bluest state and say we have the option to keep what we like.” With Cassidy’s plan, “Republicans say, ‘You have the option to keep your plan,’ and we mean it.”
Senator Susan Collins (R-ME) and Senator Bill Cassidy (R-LA) will be introducing legislation for replacing Obamacare to lawmakers on Monday. “The Cassidy-Collins plan comes after congressional Republicans voted last week to lay the groundwork for ObamaCare repeal by passing a budget resolution that includes rules for repeal.”
On Tuesday, the nonpartisan Congressional Budget Office along with Congress’ Joint Committee on Taxation issued a report, which claims that health insurance premiums would increase for millions of people and 18 million more would become uninsured in one year if most of the healthcare law is repealed without a replacement. The budget committees reviewed a Republican bill – which was vetoed by President Obama last January – that proposed getting rid of federal subsidies, Medicaid expansion, and tax penalties for people who don’t buy insurance and for large employers that don’t offer coverage. If Republicans pass a new health law that gets rid of these provisions, individual insurance premiums (excluding employer-sponsored coverage) would go up by 25 percent after the first year of passage and double by 2026. In addition, the uninsured rate would jump to 32 million over the next 10 years.
News Update for January 17, 2017
Certain provisions in the Affordable Care Act (ACA) that apply to individual health and small employer plans also apply to large employer group plans. For example, the ACA mandated that all health plans must meet a minimum value of coverage. Because of this provision, “large employers generally no longer offer so-called ‘mini-med’ policies with very skimpy benefits.” Another provision that may affect large employer group plans is the ACA’s “no waiting period” mandate, which ensured that employers can no longer let new employees wait to enroll in health benefits for more 90 days.
House Speaker Paul Ryan and President-elect Donald Trump may go head-to-head over their views on Medicare reform. Ryan wants reform for entitlement benefits like Medicare and wants to turn Medicare into a voucher program. However, Trump said during his campaign that he doesn’t want entitlement reform. “But if Ryan sides with Trump and doesn’t include his proposal to turn Medicare into a voucher program in the budget, it may never pass.”
Sean Spicer, incoming White House press secretary, said in an interview with NBC’s “Today Show” that Trump’s plan is “to get insurance for everybody through marketplace solutions, through bringing costs down, through negotiating with pharmaceutical companies, [and] allowing competition over state lines.” Concerning an expansion of government healthcare, Spicer commented that there would be improvements on access to healthcare and costs would go down through marketplace competition.
Trump said over the weekend that he wants “insurance for everybody.” But Trump’s vision for healthcare not only differs from that of his own party, but it also seems to be different from that of his pick for Health and Human Services Secretary, Tom Price. Price’s conservative proposal for healthcare favors a complete overhaul of the current system and doesn’t include universal coverage for everyone. With opposing ideas from Trump and Price, Republican lawmakers aren’t sure how to proceed with drafting a replacement plan.
Despite the pending repeal of the healthcare law by Republicans, survey results show that Obamacare is growing in popularity. “And half of Americans—50 percent—say they have little to no confidence that Republican proposals to replace the law will make things better.” The survey also found that 45 percent of people think the healthcare law is a good idea while 41 percent thinks it’s a bad idea.
News Update for January 16, 2017
Senator Rand Paul (R-KY) said he’s writing legislation to replace Obamacare, which includes making the sale of limited-coverage insurance policies legal. In a CNN “State of Union” interview on Sunday, Paul said, “That means getting rid of the Obamacare mandates on what you can buy.” Paul also talked about small businesses being able to join together to better negotiate health insurance prices.
Regarding an interview that President-elect Donald Trump did over the weekend, the Washington Post writes, “We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.” Health insurance for everyone is known as universal healthcare, which has not been a part of the Republicans’ healthcare reform plans.
The House approved the Republicans’ budget resolution measure on Friday with a vote of 227 to 198. This approval prevents Democrats from using a Senate filibuster to stop the repeal-and-replace process. With the budget resolution now approved by both the House and Senate, the next step for Republicans is to decide which parts of the healthcare law to reform.
Senate Leader Chuck Schumer (D-NY) warned Republicans that Democrats will not help them if they repeal Obamacare without first implementing a replacement plan. Schumer reported that he would work with Republicans to improve Obamacare or create reform bills, but only under certain conditions. “So long as it covers as many people as the ACA, so long as it helps bring healthcare costs down, so long as it doesn’t move our healthcare system backward,” he said.
Senate Finance Committee Chair, Orrin Hatch (R-UT), and House Energy & Commerce Committee Chair, Greg Walden (R-OR), sent a letter to the Medicaid and CHIP Payment and Access Commission (MACPAC) asking for a report that would help them find ways to cut spending for optional benefits and eligibility groups under Medicaid. “They gave MACPAC until Jan. 25 to outline what it would take to create such a report. A spokeswoman for MACPAC confirmed receipt of the letter and said it will respond by the deadline.”
News Update for January 13, 2017
Lawmakers in the House of Representatives are expected to give a final vote on approving the Republicans’ budget resolution measure today. But Rep. Andy Harris of Maryland, a member of the conservative House Freedom Caucus said, “We’d like to see a little more flesh on the bone before we sign on the dotted line.”
Members of the House Liberty Caucus want House lawmakers to reject the budget resolution that passed in the Senate on Thursday. “‘This may be the worst budget ever seriously considered by Congress,’ said caucus Executive Director Matt Weibel, in a statement announcing the recommendation. ‘It never balances, and it grows the national debt by more than $9 trillion over the next decade—to nearly $30 trillion—dwarfing debt increases proposed by even the most far-left budgets.’”
Republican governors whose states have benefited from Obamacare are at odds with their fellow Republicans in Congress over the health law. These governors could have some influence over how the House will vote on the budget resolution. Tommy Thompson, a former governor of Wisconsin and a former secretary of the Department of Health and Human Services said, “They will have a much more or a substantial influence on things like Medicaid.”
Some policy experts think that Republicans are at risk of causing a meltdown of the insurance market and 30 million people to lose coverage if they repeal the healthcare law without an immediate replacement system. But some healthcare industry leaders think a market crash may not happen because they feel like Republican lawmakers are listening to their proposals on how to smoothly transition through the repeal-and-replace process to avoid a crash.
Senate Republicans voted against legislation that would keep certain parts of Obamacare intact, including the provision allowing young adults to stay on their parents’ health plan up to age 26. But some insiders feel that this topic will come up again when it comes time to draft a replacement healthcare law. Health policy expert Joe Antos thinks this provision will remain under the new administration because Trump has said he wants to keep this part of the law, and proposals from several Republicans support keeping the up-to-26 provision.
Kaiser Health News reported on what they call “health law sleepers.” These are parts of the health law that you may not be aware of that could go away under a repeal. These include:
- Calorie counts at restaurants and fast food chains
- Workplace requirements for breast-feeding rooms
- Limits on surprise medical costs from hospital emergency visits
- Non-profit hospitals’ community health assessments
- A women’s right to choose her own OB/GYN
- Therapy coverage assurances for families who have kids with autism
News Update for January 12, 2017
Republicans Are One Step Ahead in Repealing Obamacare
- The Republicans’ budget resolution measure to start the process of repealing Obamacare was approved in the Senate on Thursday with a simple majority vote of 51 to 48. This puts Republicans one step ahead for the next voting session, which is expected to take place among House members this Friday. “We must act quickly to bring relief to the American people,” said Senate Majority Leader Mitch McConnell (R-KY).
- The approval of the budget resolution involved voting on 19 of its amendments. Senators began voting about 6:30 p.m. on Wednesday and ended around 1:30 a.m. on Thursday.
- The passing of the bill came with much protest from Democrats on the Senate floor. “One by one, Democrats rose to voice their objections. Senator Maria Cantwell of Washington said that Republicans were ‘stealing health care from Americans.’ Senator Ron Wyden of Oregon said he was voting no ‘because health care should not just be for the healthy and wealthy.’” Senator Cory Gardner (R-CO), who presided over the voting, had to bang his gavel several times to tell Democrats they were out of order. “Debate is not allowed during a vote,” he said. The passing of the budget resolution is more of a procedural step that the Republicans need to introduce a special type of legislation known as a reconciliation bill, which will allow them to repeal major parts of Obamacare. You can read more here.
Republican Senator Says the Party Doesn’t Have Total Agreement on Obamacare
“Sen. Ron Johnson said Thursday he ‘will freely admit that Republicans in the House and Senate don’t have total agreement’ on an Obamacare replacement plan despite a late-night budget move to begin repealing the law.” The Republican senator from Wisconsin also said, “I don’t think you’re going to see one massive plan like Obamacare. You’re going to see a step-by-step approach targeting the individual damage of the individual reforms, and we’ll put in replacements for each individual one of those problems. Anyway, that would be my approach. Other people have different ideas.”
Largest U.S. Lobby Group Weighs in on Obamacare Repeal
The U.S. Chamber of Commerce, which is the country’s largest business lobby group, said on Wednesday that quickly repealing Obamacare without having a replacement plan could be a mistake. The group also appealed to the incoming Trump administration to not put up trade barriers. “As a new healthcare plan takes shape, it’s important to remember things were far from perfect before we started, before Obamacare,” Chamber President Tom Donohue said in his annual address outlining the group’s priorities. “Repeal alone is not going to fix our health care, there should be a smooth transition.” You can get more details on the lobby group’s views here.
News Update for January 11, 2017
Trump Pushes for Swift Repeal and Replacement of the Healthcare Law
- President-elect Donald Trump demanded on Tuesday that Congress repeal the health care law now and pass a replacement law quickly. Trump said in an interview with the New York Times, “We have to get to business. Obamacare has been a catastrophic event.” Congress has scheduled for voting to take place this week on the Republicans’ budget resolution bill to repeal certain parts of Obamacare. But Trump appears to be unaware of the voting schedule because he commented that repeal votes should “probably [happen] sometime next week.” Regarding replacement, Trump said it should take place, “very quickly or simultaneously, very shortly thereafter” the repeal. Trump also “threatened Democrats who might stand in his way, saying he would campaign against them, especially in states that he won in November. ‘It may not get approved the first time, and it may not get approved the second time, but the Democrats who will try not to approve it’ will be at risk, he said, warning that ‘they have 10 people coming up’ for re-election in 2018. That alluded to Democratic senators in states he won.”
- Trump also said in his New York Times interview, “I feel that repeal and replace have to be together, for very simply, I think that Democrats should want to fix Obamacare. They cannot live with it, and they have to go together.” But these comments contradict the desires of some of his fellow Republicans who want to have a solid replacement plan before tackling a repeal. “Senate Majority Leader Mitch McConnell (R-KY) and House Speaker Paul Ryan (R-WI) insisted Tuesday that they have no intention of moving ahead with repeal without a consensus replacement plan.” And with the amendment to delay repeal legislation that GOP leaders submitted on Tuesday, Republicans are further divided on the structure and timing of a replacement healthcare law. Read more here in this Washington Post article.
- Lawmakers were surprised at Trump’s demands and some scoffed at the idea of a repeal and replace happening so quickly. Senate Finance Chairman Orrin Hatch said, “That would be pretty fast. It’s possible. I don’t know that it will happen, but it could.” Many GOP leaders were also expecting that Trump would provide more specific details as to what he wants. “‘It would be very helpful for him to weigh in and say exactly basically what he wants done,’ said Sen. Ron Johnson (R-Wis.), before Trump’s interview broke. ‘He’s going to carry a fair amount of weight.’”
GOP Rep Says Obamacare Replacement Bill Will Be Shorter
The Chairman of the House Ways and Means Committee said on Wednesday that the bill to replace Obamacare will be shorter and have more direct language. Rep. Kevin Brady (R-TX) said in an interview, “One big thing, I think people are assuming Republicans will act like Democrats with a 2,000-page bill that no one knows what’s in it. We’re doing just the opposite. Our replacement is going to be step-by-step, thoughtful and understandable.” Brady also commented that the White House will receive legislation to repeal Obamacare in February.
Some Obamacare Enrollees Want the Health Law Repealed
Research from the Kaiser Family Foundation found that the number of Obamacare plan members who are dissatisfied with their coverage increased from 14 percent in 2014 to 29 percent in 2016—some wanting to see Obamacare repealed. Although, some hope that the Republicans’ repeal-and-replace plan will be more financially beneficial. “‘What people really care about is lowering what they and other people have to pay,’ said Liz Hamel, director of public opinion and survey research at the Kaiser Family Foundation. ‘They care less about how you get there and the details. They only want to hear their costs are going down, and that’s where people feel disappointed in the ACA.’” Kaiser found that the cost of premiums and deductibles are two of the biggest concerns. And that unfairness is a major complaint for some enrollees. “In their view, they are being hit with higher costs, while low-income Americans receive free or low-cost treatment.”
News Update for January 10, 2017
Republicans’ Repeal-and-Delay Plan Faces Challenges
- Republicans in the Senate introduced a budget reconciliation bill last Tuesday as a way to repeal major portions of Obamacare. “On Monday night, however, five GOP Senators … submitted an amendment to the bill in the Senate that would extend the deadline for the committees to craft a repeal bill from its current January 27 deadline to March 3.” Senator Bob Corker (R-TN), who was among GOP leaders who submitted the amendment, said on Monday night, “By extending the deadline for budget reconciliation instructions until March, Congress and the incoming administration will each have additional time to get the policy right.” Corker also commented on the fact that Trump had said the repeal-and-replace process should happen at the same time. Senator Tom Cotton (R-AK) is among several GOP leaders who are adamant about a replacement plan before a repeal. Cotton told reporters, “It would not be the right path for us to repeal Obamacare without laying out a path forward.” This Business Insider article talks more about the story.
- Senator Rand Paul (R-KY) is also strongly opposed to repeal-and-delay, “as he argues that the two votes must happen simultaneously.” Paul said to CNN’s Wolf Blitzer on Monday, “I will do everything in my power to have a vote on it the day we repeal Obamacare.”
- In a phone conversation between Senator Rand Paul and President-elect Donald Trump, Paul reported, “He showed willingness and openness and was interested in getting a replacement that could be passed as part of repeal. Now, we’re trying to get a bill out there this week.” Paul also commented that Trump didn’t provide any details about what would be included in a replacement plan. You can read more about his story here.
- For a repeal to happen, “Republicans need a House majority, 50 Senate votes, and soon-to-be President Trump to pass repeal and delay.” If the party loses 3 Senate votes, this will bring the number of Senate Republican votes down to 49, and the repeal-and-delay bill won’t pass. Along with Democrats who are against the repeal-and-delay bill, at least 3 Senate Republicans are now in opposition.
- With the addition of 3 Republican senators who expressed opposition to repeal-and-delay at the Senate meeting Monday night, the number of Republicans who oppose this strategy now total 9. Besides the Senate, “members of the House Freedom Caucus on Monday evening issued their own call for slowing down the repeal process.” In light of these events, the Republicans’ expectation for a smooth and quick repeal-and-replace is unlikely.
News Update for January 9, 2017
GOP Planning Quick Repeal of Obamacare
- “The Senate is expected to take a long string of votes on Wednesday, known as a ‘vote-a-rama,’ on a budget resolution that is the first step to repealing ObamaCare.” This voting process allows Democrats to offer provisions that could make things difficult for Republicans. However, Democrats don’t have enough votes to stop the budget resolution.
- Republicans told the press that they will act quickly to pass a new healthcare law, but they didn’t provide a timeline for doing so. Senate Majority Leader Mitch McConnell (R-KY) commented, “We will be replacing it rapidly after repealing it.”
- Trump advisers, Kellyanne Conway and Reince Priebus, told interviewers that Trump is still deciding on how fast replacing Obamacare will take. In an interview on CNN’s “State of the Union,” Conway said, “Well, it really depends what — what the piece of legislation is.” Conway didn’t provide any details about Trump’s timing for a replacement, but said that a replacement solution should allow people to buy coverage across state lines and use health savings accounts. Priebus gave a little more detail about Trump’s possible plan in his interview on CBS’ “Face the Nation.” He said, “I will tell you that it would be ideal if we could do it all in one big action. But look, it may take time to get all the elements of the replace in place.”
Senate Democrats Plan to Hold Late-Night Meeting to Oppose Repeal
“On Monday night, Senate Democrats plan to stay up late, delivering floor speeches and Facebook Live broadcasts attacking the Republicans’ drive to dismantle President Barack Obama’s signature health care law.” This late-night fight against Obamacare repeal was organized by Senate Minority Leader Chuck Schumer (D-NY). Schumer said, “We are taking to the floor and social media to denounce this plan and warn the American people that the Democrats will be fighting tooth and nail against this potentially catastrophic move.”
Obama Open to Calling New Healthcare Law ‘Trumpcare’
President Obama told the press on Sunday that he’s fine with Republicans creating changes to the healthcare law and naming it “Trumpcare” instead of “Obamacare.” “The president … also suggested that he has wanted to make the kind of changes to ObamaCare that Trump and fellow Republicans in control of Congress are seeking.” Obama said, “But they wouldn’t cooperate because they didn’t want to make the system work.”
News Update for January 6, 2017
Few Americans Support Republicans’ Repeal-and-Delay Plan
- According to a Kaiser Family Foundation poll released today, just 20 percent (1 in 5) of Americans are in favor of lawmakers voting to repeal the health law immediately and figuring out a replacement plan later. The survey also found that:
- 47 percent don’t think there should be a vote to repeal
- 48 percent are in favor of a vote to repeal
- 28 percent support a vote to delay a repeal until there’s a replacement plan
- 20 percent support a vote to repeal immediately and figure out a replacement plan later
- 5 percent either don’t know or refused to answer concerning a vote to repeal and replace
- The survey revealed that “Obamacare isn’t even people’s top health care concern. The vast majority—67 percent—say their top priority is finding a way to lower their health care costs.” The second priority for Americans is lowering prescription drug costs, which came in at 61 percent.
- Kaiser Family Foundation’s president, Drew Altman, said, “For me, the really pertinent question, the big question, is: Is there a mandate for repealing the ACA without a replacement plan? What we see in our poll and what we see in our focus groups is: If there is, it is a very weak one. It’s not obvious there’s a mandate for repealing the ACA without putting a replacement plan on the table.”
Paul Ryan Says Lawmakers Will Act on Bills to Replace Obamacare, Not Just Repeal It
House Speaker Paul Ryan (R-WI) told the press on Thursday that, “Our legislating on Obamacare, our repealing and replacing and transitioning, the legislating will occur this year.” “Ryan spokeswoman AshLee Strong said by ‘legislating,’ Ryan meant lawmakers will write legislation and vote on it.” John Cornyn (R-TX), who is the No. 2 GOP leader of the Senate, said he would make creating new legislation for healthcare a top priority in his chamber. However, he didn’t comment on whether or not senators would finish writing legislation this year. Cornyn also told reporters that, “The Senate operating at warp speed is still nothing compared to what the House can do.”
Democrats Appeal to Republicans for Compromise on Health Law
“With Republican leaders pressing to dismantle the Affordable Care Act, possibly within weeks, moderate Senate Democrats reached out on Thursday to Republicans, appealing for them to slow down the repeal efforts and let lawmakers try to find acceptable, bipartisan changes to make the existing law work better.” Senator Tim Kaine (D-VA), who was selected to be the Democratic Vice President, said, “There’s so much we can improve, but by pushing an immediate repeal through a partisan budget process, we won’t have the opportunity to work together to build on that common ground.”
Republican Governors Want to Save Medicaid Expansion From Repeal
Some Republican governors are appealing to congressional members of their party to keep ACA Medicaid expansions, but GOP experts don’t think their appeals will persuade congressional Republicans to do so. Several Republican governors also report on how Medicaid expansion is helping their states. Republican Ohio Governor John Kasich said on Wednesday that expansion was a major factor in helping those in his state who struggle with opioid addiction—about 700,000 people in Ohio were able to get Medicaid because of the expansion. Kasich commented, “Thank God we expanded Medicaid because that Medicaid money is helping to rehab people.” Republican Michigan Governor Rick Snyder in an interview with The Detroit News said, “I hope they carefully look at the success we’ve had in Michigan. We’re seeing a huge increase in coverage.”
News Update for January 5, 2017
Republicans Divided Over Obamacare Repeal-and-Replace
- The meeting between Vice President-elect Mike Pence and Senate GOP members was meant to bring unity on the proposal to get rid of Obamacare. However, many senators expressed disagreement on repealing and replacing Obamacare because doing so could crush the budget. Some of the rising members of the party argued that dismantling the healthcare law that has provided coverage to millions of Americans is a more difficult undertaking than simply campaigning against it. Senator John Thune (R-SD) in commenting on the chaos within the caucus said, “Most of the issues are with respect to replace. I don’t think repeal is that complicated. We’ve done that once. But yes there are budgetary considerations when it comes time to replace. It’s complicated, we’ve got a lot of moving parts.” Because of different opinions among members of the House and Senate, the party has not reached a consensus on how long the healthcare law will remain in effect and how to replace it.
- The disagreement within the party is also due to the lack of details from Trump and Pence. According to Pence, Trump will use executive orders to “ensure that there is an orderly transition during the period after we repeal Obamacare to a market-based healthcare economy in America.” But Senator Shelley Moore Capito (R-WV) said, “We’re not sure exactly what direction we’re going to go to have a full and careful transition period.” Another member of the party, Senator Rand Paul (R-KY), has made public criticisms about repealing Obamacare. On Wednesday, Paul sided with Democrats to vote against a motion to debate resolutions for a repeal.
Battle Over Obamacare Leads to a War of Words
- Trump issued a warning to Republicans in Congress that rushing to repeal the health law could spark backlash, and that they would fare better by allowing Democrats to own what he described as “the failed Obamacare disaster.” This morning, Trump said of Senate Minority Leader Chuck Schumer (D-NY) that he is the “head clown” of the Democrats, and that he and his party “know how bad Obamacare is and what a mess they are in.” Trump posted on Twitter in several tweets, “Instead of working to fix it, they do the typical political thing and BLAME. The fact is ObamaCare was a lie from the beginning. ‘Keep you [sic] doctor, keep your plan!’ It is time for Republicans & Democrats to get together and come up with a healthcare plan that really works—much less expensive & FAR BETTER!”
- Schumer counteracted by proposing an investigation of Tom Price, whom Trump selected for Secretary of the Department of Health and Human Services, because of stocks he has with health insurance companies. This Reuters article writes that Price, an orthopedic surgeon, “bought and sold more than $300,000 in stock in about 40 healthcare, pharmaceutical and biomedical companies over the past four years while sponsoring and advocating legislation that could influence those companies’ shares.”
- “President Barack Obama delivered a mandate to Democrats on Wednesday: ‘Don’t rescue’ Republicans on Obamacare.” This mandate was issued at a meeting Obama had with Democrats at Capitol Hill, the same day Vice President-elect Pence visited the hill. Price said to reporters, “The reality is that I was here in March of 2010 in another capacity when Obamacare was signed into law. I remember all those promises. We were told that if you like your doctor, you can keep it. Not true.” You can read more about this story here.
Democrats Warn the GOP About the ‘Pottery Barn Rule’
According to this Washington Post article, the “Pottery Barn rule” is: “You break it, you own it.” And Democrats are saying that’s exactly what Republicans will be faced with. Schumer said at a news conference, “They’re going to own it and all the problems in the health-care system.” Schumer argued that Republican alternatives to health care will be practically impossible to implement because their plans require a major source of funding that would likely require approval votes from Democrats. Senator John Cornyn (R-TX), who is the 2nd ranking leader of the GOP, in response to Schumer’s comments, said, “I understand his political argument. He’s praying and hoping for failure, which means he’s praying and hoping for more pain on the part of the American people. I would hope they would get past that and would agree to work with us, because a long-term, sustainable replacement for Obamacare is going to need to be done on a bipartisan, consensus-building basis.”
News Update for January 4, 2017
Republicans Introduced a Budget Resolution to Repeal Obamacare
- Congress convened yesterday and their first order of business to dismantle Obamacare was to introduce a budget resolution, which was done by Senate Budget Committee Chair Michael Enzi (R-WY). “Republicans aren’t actually going to repeal all of Obamacare…but they’re going to repeal enough of it to reverse almost all of the coverage gains made under it,” states this Vox article. The article also mentions that the budget resolution repeal bill can’t be filibustered, so Democrats won’t be able to stop the Republicans’ plan “unless three or more Republican senators defect (or 24 House members do). [If this doesn’t happen], it’ll be smooth sailing for the repeal effort from there on out.”
- The budget resolution can only repeal parts of Obamacare, which include tax credits that help make buying health insurance more affordable, the individual mandate to buy health insurance, and the employer mandate to offer health coverage or pay penalties. But the resolution “isn’t expected to include measures that would replace the health law with a new insurance program.”
- After introducing the budget resolution, Enzi posted a press release on his website that says, “Today, we take the first steps to repair the nation’s broken health care system, removing Washington from the equation and putting control back where it belongs: with patients, their families, and their doctors.” If the resolution is approved, the committees involved in deciding which parts of Obamacare to repeal and when repeal changes would go into effect have until January 27 to do so.
- Approval of the resolution requires 60 votes in the Senate of which 52 are Republicans. “That means they [Republicans] won’t be able to pass a full repeal of the law on their own, and it is unlikely eight Democrats would join to overturn President Barack Obama’s signature legislation.”
Repealing Obamacare Could Prove Difficult
Republicans’ repeal efforts may be halted if they don’t get the majority votes they need from the 40-member Freedom Caucus. Leader of the caucus, Rep. Mark Meadows of North Carolina, commented on Tuesday, “It would have to be an unbelievable, compelling case to suggest we need more than two years to repeal and replace the Affordable Care Act.” He also said, “If we’re going to repeal it, we need to repeal the taxes.” One health policy expert said, “Repealing all of the taxes will be politically difficult and structurally problematic.”
Obama and Pence Hold Dueling Meetings at Capitol Hill
- President Obama met with Democrats today, and he commented, “Keep up the fight. Tell the stories about the people who have benefited from it. The more you can get that message through, the better off we’re going to be.” After Vice President-elect Mike Pence’s meeting with House Republicans, he told reporters the goal is to get repeal legislation for Trump to sign by February 20. Pence also commented, “Trump’s team is already working with GOP congressional leaders on plans to undo Obama’s law with both legislation and executive action the president and federal agencies would be able to take.” This ABC News article provides more details.
- Following Pence’s meeting, House Speaker Paul Ryan (R-WI) told reporters, “We have plenty of ideas to replace it [Obamacare].” However, Ryan didn’t provide any details about the ideas; he just said that ideas can be expected in the “weeks and months ahead.”
Democrats Prepared to Fight for Obamacare
- Democrats are ready to fight to keep Obama’s signature health law intact. Two of the most outspoken advocates of Obamacare are Senate Minority Leader Chuck Schumer (D-NY) and House Minority Leader Nancy Pelosi (D-CA). Schumer told the press that, “They have no idea what to put in place of the Affordable Care Act. Republicans will soon learn that you can’t keep the good parts of the ACA and remove the rest of the law and still have it work.” Pelosi commented, “They don’t have the votes for a replacement plan. Repeal and then delay is an act of cowardice.”
- Under the slogan, “Make America Sick Again,” Democrats are launching a counter-attack against the Republicans’ repeal bill by having rallies and using the stories of Americans in red states who’ve benefited from Obamacare. Democrats are “urging followers to bombard lawmakers’ district offices and phone lines with calls against repeal. And they’re targeting moderate Republicans in Alaska, Arizona, Maine, Nevada and Tennessee who are up for reelection in 2018—or who could be influential in the repeal vote—with a seven-figure television and print ad campaign.” The main point of their message is to convey that repeal of the health law without a replacement is reckless.
Trump Advisor Says No One Will Lose Coverage After Obamacare Repeal
Senior advisor to Trump, Kellyanne Conway, stated in an interview with MSNBC’s “Morning Joe” that people who currently have health insurance won’t lose their coverage when Obamacare is repealed and replaced. Conway said, “We don’t want anyone who currently has insurance to not have insurance.” She also commented, “There’s no question that there will be different health insurance coverage in this country under President Trump. Some people, some experts, say it could take years to complete the process.”
News Update for January 3, 2017
Trump Says ‘Obamacare Just Doesn’t Work’
President-elect Donald Trump wrote on Twitter this morning that, “People must remember that Obamacare just doesn’t work, and it is not affordable—116% increases (Arizona). Bill Clinton called it ‘CRAZY.’” He also made a follow-up tweet saying, “The Democrat Governor of Minnesota said, ‘The Affordable Care Act (Obamacare) is no longer affordable!’—And, it is lousy healthcare.” In an NBC Today interview this morning, incoming counselor to Trump, Kellyanne Conway, reported that he “is committed to retaining those pieces [of the Affordable Care Act] his advisers say are working.”
Pence Plans to Rally With House Republicans on Obamacare Repeal
Vice President-elect Mike Pence plans to meet with House Republicans this Wednesday to discuss repealing Obamacare. This Politico article calls the meeting “a counter-punch to President Barack Obama’s visit to the Hill the same day.”
Republican-Led Congress Convenes Today and They Plan to Quickly Tackle ACA Repeal
- The Republican Party now has control of Congress, which convened at noon today. The first thing on the Republicans’ agenda is to proceed with their repeal-and-delay strategy for Obamacare, which involves getting rid of major overhauls and putting off some of their proposed changes for up to 4 years.
- “They plan to pass a truncated budget resolution for the remainder of the fiscal year—already a quarter over—that includes special instructions ensuring that the final repeal legislation could circumvent any Democratic filibuster.” But Republicans may face some challenges because some are divided on how to tackle the ACA and rewrite the tax code while others are hesitant about issues like making major changes to Medicare. You can get more details on this story here.
Republicans’ Lawsuit Against Obamacare Subsides May Be in Jeopardy Under Trump
The House Republicans’ lawsuit against the Obama administration concerning health insurance subsidies faces uncertain outcomes under the Trump administration. But because the case is suspended, House lawmakers report that this will “provide the president-elect and his future administration time to consider whether to continue prosecuting or to otherwise resolve this appeal.” This New York Times article talks more about this issue.
President Obama Will Meet With Democrats to Save Obamacare
- “Obama will visit Wednesday with House and Senate Democrats, the day after the 115th Congress convenes and Republicans, who have the majority in both chambers, are expected to start repealing and replacing Obamacare.”
- Obama’s meeting with Democratic leaders is to discuss how they can protect the ACA from being dismantled by the Republicans. While some Democrats are not in agreement with how to keep the ACA and others are willing to help Republicans with a replacement plan, “almost all are united against attempts to repeal it.”
Democrats Sent Letter to Trump to Veto Cuts to Medicare and Medicaid Funding
In regard to Trump’s campaign promise not to cut funding for Medicare, Medicaid, and Social Security, “Senate and House Democrats, led by Bernie Sanders, are calling on the president-elect to veto any legislation that would slash funds for Medicare and Medicaid.” This call-to-action was sent in a letter to Trump that states, “Sunday, Jan. 15, will be a ‘day of action.’ Rallies will be held around the country to vigorously oppose the Republican plan to end Medicare as we know it and throw our health care system into chaos.” Democrats in support of the letter are against the Republicans’ proposal to turn Medicare into a voucher program.
Self-Employed Worried About ‘Job Lock’ if ACA Is Repealed
Some self-employed business owners fear that if the ACA is repealed, they may have to close their businesses and go back to finding a job to get access to affordable health insurance. (Taking a job you don’t want just to get health insurance is called “job lock.”) The prospect of losing protections for preexisting conditions is also a concern for some self-employed individuals with major health problems who were able to get coverage because of the ACA. For one entrepreneur (Namir Yedid) who left his job to start a tech company and was later diagnosed with cancer, this Modern Healthcare article stated, “He’s angry that the Republicans are rushing to repeal the law without telling the public exactly what they’re going to put in its place, making it impossible for people to plan their business lives.” If an ACA repeal removes the provision that allows young people to stay on their parents’ health plan until age 26, some are worried that this could discourage young people from pursuing entrepreneurship.
News Update for Dec. 22, 2016
Nancy Pelosi Urges Democrats to Fight for Obamacare
House Minority Leader Nancy Pelosi (D-CA) wrote a letter to Democrats saying, “In January, we will face a new Congress and a new Administration. House Democrats stand ready to fight vigorously for America’s hard-working families.” Pelosi called on Democrats to “plan press events to ‘highlight the risks’ of repealing the ACA and ending the Medicare guarantee.” This article from The Hill talks more about how Pelosi is planning to fight to protect Obamacare.
Democratic Governors Warn Republicans About Obamacare Repeal
Members of the Democratic Governors Association wrote a letter to top Republican leaders in which they “estimated that states could face nearly $69 billion in costs for uncompensated care over the next 10 years if the health law is repealed.” Democrats who signed the letter called the Republicans’ repeal and delayed replacement plan “nothing more than a Washington, D.C. bait-and-switch.”
GOP Congressman Says Americans Need to Manage Their Own Healthcare Costs After Repeal
- Congressman Bill Huizenga (R-MI) told reporters that changes in the way healthcare is delivered will be a sure thing after Obamacare is repealed, so Americans will need to become more responsible for their treatment costs. In his interview, Huizenga gave an example of when his son injured his arm, and he took his son to the doctor the next day because an immediate emergency room visit would have been more costly. As reported in this Huffington Post article, “The Michigan congressman’s comments are in line with a long-held, free-market view of the health care system.”
- Huizenga reported that delaying treatment for his son’s broken arm is “an example of the kind of choices Americans would face if Republicans’ repeal of the health care law shifts more out-of-pocket costs to consumers.” (Although, he later said in another interview “that using the experience of his son’s broken arm was a bad example to cite.”) When asked about health savings accounts, he said, “We as consumers and users of this need to get better acquainted with what are the true costs. HSAs can do that.”
News Update for Dec. 21, 2016
Obamacare Recipients File Motion to Protect Cost-Sharing Payments
In regard to the lawsuit Republicans filed against the Obama administration for using federal dollars to pay for cost-sharing subsidies, a group of Obamacare recipients filed a motion to enter the case with the hope of protecting cost-sharing payments from being defunded. “The consumers argue that they should be allowed to become parties to the case because once President-elect Donald Trump enters office, the interests of Obamacare defenders will no longer be represented.” They also warned that their health coverage would be in jeopardy because insurance companies would pull out of the market if these payments are cancelled.
White House Encourages Researchers to Protect Obamacare Data from Trump
Independent researchers who began taking measures to “download key health care data and documents before Jan. 20” say they were further motivated to so by top White House health reform official Jeanne Lambrew “who also sounded alarms [that] the new administration might expunge reams of information from public websites and end access to data.” Researchers aim to quickly collect data released by new offices that were created under the Affordable Care Act (ACA) “to regulate health insurance and test reforms.” They argue that collecting ACA data is essential because it may be needed to support the Democratic Party’s case for keeping major parts of the ACA intact.
Democrats Urge Trump to Work With Them on Drug Price Reform
- A group of 19 Democratic senators wrote a letter on December 20 in which they urged Trump to cooperate with them on the issue of rising prescription drug costs. The letter noted 5 areas that Trump should help with: “allowing the Medicare program to negotiate prescription prices, increasing transparency, stopping abusive pricing, passing reform on incentives for innovation and supporting generic competition for branded drugs.”
- Democrats want Trump to work with them on legislation that would “lift the ban on the HHS secretary negotiating drug prices for Medicare Part D beneficiaries” and “combat overnight price hikes or regular, unjustified price increases.”
News Update for Dec. 20, 2016
Trump’s Pick for Budget Director Could Shape ACA Repeal
President-elect Donald Trump has named conservative Republican, Mick Mulvaney (R-S.C.), as his pick for Director of the Office of Management and Budget. Mulvaney is a strong opponent of the Affordable Care Act (ACA) and Planned Parenthood, and he was among leaders who held a “standoff over the ACA that led to a government shutdown” back in 2013. The Trump administration’s repeal of the ACA could be shaped by Mulvaney’s views, which include having less involvement from the federal government in healthcare, a premium-support system for Medicare, and Medicaid block grants for states. You can get more info on Mulvaney’s views here.
Connecticut Hospitals and Clinics Fear Medicaid Cuts Under Trump
The Republicans’ proposed scaling back of Medicaid expansion is a major concern for Connecticut’s hospitals and clinics. The Chief Medical Officer of the Hartford Healthcare system, Dr. Rocco Orlando, stated that cuts to Medicaid would result in revenue loss of “tens of millions of dollars” and would lead to “staff reductions and scaling back of services.” Orlando also stated that “Connecticut hospitals’ fiscal stability and sustainability, as well as patient access to care, will be compromised” if the ACA is repealed and Medicaid cuts remain in effect. For clinics, the Republicans’ block grant proposal would reduce or freeze “federal Medicaid spending” for the Connecticut’s clinics that serve low-income residents.
Counties That Support Trump May Be Impacted the Most by a Repeal
A study conducted by Gallup revealed that of the 8 county types that experienced an increase in health insurance coverage above the national average, “six of those types— representing about 77 million people or 33 million votes, a quarter of the total cast—sided with Mr. Trump, some by very large margins.” Some of the county types where Trump voters reside are in “large parts of Florida, Michigan, Pennsylvania, and Wisconsin,” and those counties are considered “rural Graying America, Rural Middle America and Working Class Country counties.” These areas were among regions that the ACA targeted to expand coverage, and thus would be greatly impacted by a repeal. This Wall Street Journal article talks more about this subject.
News Update for Dec. 19, 2016
How a Repeal Could Affect Job-Based Coverage
The ACA removed the coverage limit on how much an insurance plan will pay for medical services over a person’s lifetime, which has been instrumental for people diagnosed with serious medical conditions. But a repeal could bring this back, which would affect both individual and employer-sponsored health insurance. Some experts don’t think a ban on coverage limits will remain if the ACA is repealed and that this issue may be left up to the states to decide. Experts also predict that the mandate, which requires companies with 50 or more full-time equivalent employees to offer health coverage, may be repealed because it has led to such problems as “companies limiting their full-time hiring.” However, it’s expected that “many firms will ‘continue offering coverage to their employees because employees insist on it,’” said University of Michigan law professor Nicholas Bagley.
New Rules for Obamacare Marketplaces
On December 16, the Obama administration issued a new regulation for the 2018 insurance marketplace. The regulation “seeks to address some insurer complaints with how the marketplaces operate.” Some of these complaints have led to insurers leaving the marketplaces. The regulation has also implemented a new formula that changes the way payments to insurers are calculated. This was done to help protect insurers from the financial loss of insuring high-cost enrollees. But “insurers have complained that it does not work effectively.” Given that the GOP plans to delay an Obamacare replacement, it’s expected that the marketplaces will “remain in operation in some form for a couple of years.”
Obamacare Enrollment Hits Record High
In the wake of the Trump-GOP plan to repeal the healthcare law, more than 670,000 Americans signed up for Obamacare on December 15—the “busiest single enrollment day since the healthcare law’s coverage expansion began three years ago.” This enrollment came from the 38 states that participate in the marketplaces and includes new and returning Obamacare sign-ups—many of which are low-income Americans who receive premium subsidies.
A Repeal Could Push Residents Back to Free Clinics in Iowa
In Iowa, an increasing number of low-income and homeless patients are receiving care from the Eastern Iowa Health Center (EIHC) instead of the area’s free clinic. Joe Lock, CEO of the EIHC, argues that “those patients could be pushed back to the free clinic or to hospital emergency rooms” if they become uninsured due to Obamacare repeal. Darlene Schmidt, who is the chief executive of the free clinic, said, “We’ll have to come up with resources. Right now we don’t have the dollars or the volunteers to provide [that level] of care.” If a repeal happens, about 230,000 Iowa residents who have coverage through Obamacare and Medicaid would be affected.
News Update for Dec. 16, 2016
Repealing and Replacing Obamacare
- Congressional Republicans who previously said replacing Obamacare could take 3 years are now saying they want to keep Obamacare for up to 4 years. However, they’re still planning to begin the repeal process early next year by starting with a vote for a proposed budget on January 3. The Republicans’ plan is to repeal Obamacare “with small bills that tackle one part of the health care system at a time.” They’re also planning to put together health care laws based on House Speaker Paul Ryan’s “A Better Way” proposal. But this plan is not yet official.
- On replacing Obamacare, House Republicans reported that their goal is to “guarantee ‘universal access’ to health care and coverage.” But that this goal is “not necessarily to ensure that everyone actually has insurance.” A House leadership aide told reporters, “Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” and “repealing major provisions” in Obamacare will be a top “priority for the first 100 days of the Trump administration.”
- If Obamacare is repealed and revenue provisions for premium subsidies go away, some Republicans and health policy experts warn that federal revenue would be reduced by nearly $1.2 trillion over a 10-year period. An option GOP strategists are considering is doing a repeal while keeping some of the ACA’s financial provisions intact. Another option is to give states federal funding to run their own health coverage systems and allow states to set up their own ACA reform models. Find out more about the GOP’s repeal plans.
News Update for Dec. 15, 2016
Democrats Open to Replacing Obamacare
Although Democrats in the Senate oppose repealing Obamacare, they’re willing to help Republicans with replacing it. Democratic Senator Claire McCaskill of Missouri said, “If it makes sense, I think there’ll be a lot of Democrats who would be for it.” Another Democratic leader, Senator Chris Coons of Delaware, believes that if the GOP can keep the best parts of Obamacare that give millions of Americans access to affordable coverage while addressing some of its flaws, “we [Democrats] should work hard with Republicans on that. But we don’t know yet if they’re serious.” The GOP may have some leverage in getting certain Democrats on their side because 25 Democrats are up for re-election in 2018 with 10 from states that President-elect Donald Trump won.
HHS Secretary Reiterates Warning on Dangers of Repeal
The current secretary of the Department of Health and Human Services (HHS), Sylvia Mathews Burwell, met with Congress last week to warn that a repeal will cause chaos. On December 14, Burwell spoke with CNN to talk more about this issue. Burwell warned that even if Trump does a partial repeal, it would lead to a downward spiral of the entire healthcare system and that drafting a replacement plan would be a “massive endeavor.” She told CNN, “It is a difficult task and our system is one where when you move one piece, it’s related to another piece. It’s like a Jenga puzzle. And if you pull a piece out, you can make the thing tumble.” You can get more details on Burwell’s warnings in this CNN article.
News Update for Dec. 14, 2016
A Repeal Bill Before Trump’s Inauguration May be Unlikely
Congressional Republicans hope to pass a repeal bill between January 3 when lawmakers reconvene and January 20 on inauguration day. But Republican G. William Hoagland, who is a senior staff member of the Senate Budget Committee and senior vice president at the Bipartisan Policy Center said, “No way. I just don’t think it’s possible.” Ed Lorenzen, who serves as a senior adviser to the nonpartisan Committee for a Responsible Federal Budget, thinks January 20 isn’t possible. But he said, “I think they could do it by the end of January.” He also stated, “Mechanically they can get it done. The bigger question is, can they decide what should be in the package?”
Nancy Pelosi Doesn’t Think Repeal Will Happen
In a statement to reporters, House Minority Leader Nancy Pelosi (D-CA) said, “They’re not going to repeal it. I don’t think they’re going to repeal the Affordable Care Act.” Pelosi argues that Republicans and the Trump administration will find repealing and replacing Obamacare to be an enormous task. She also predicts that they won’t repeal the law because people would lose benefits they value and “they won’t be able to replace it because that would cost the government money they don’t want to spend.”
News Update for Dec. 13, 2016
ACA Repeal Set to Begin Early Next Year
- On Monday, December 12, Senate Majority Leader Mitch McConnell said that the Senate will begin voting to repeal the Affordable Care Act (ACA) shortly after Jan 1. “And then we will work expeditiously to come up with a better program than current law, because current law is simply unacceptable and not sustainable.” However, McConnell did not give an answer on a timeline for a replacement.
- Although Republicans plan to repeal much of the ACA, they say they don’t want to do any harm to the millions of people who get health coverage under the law. Health insurance consultants argue that repealing the healthcare law and “expecting that [the] insurance market [will] remain healthy may be [a] fantasy.”
Millions With Preexisting Conditions Could be Denied Coverage
A study from the Kaiser Family Foundation found that “52 million non-elderly adult Americans (27% of those under the age of 65)” with a preexisting condition would be at risk of being denied coverage if they were buying a health insurance policy in the individual market prior to the ACA. So without ACA protections for preexisting conditions, this group would likely be turned downed by insurance companies if a repeal happens. More details on people at the highest risk can be found in this Kaiser Health News article.
News Update for Dec. 12, 2016
Republicans Divided Over Obamacare Repeal
- Republicans continue to be divided on delaying an Obamacare replacement for 3 years. Some House Republicans feel that this 3-year strategy “is too long to leave voters, insurers and health care providers in suspense.” Like other GOP leaders, Texas Republican Senator John Cornyn supports President-elect Donald Trump’s healthcare plan, and he said, “We’re not going to let anybody fall through the cracks.”
- Some Republicans are pushing to keep many portions of Obamacare through 2019, while others say they see no reason to move so slowly. Republicans are battling over what exactly a replacement plan will look like and when to schedule a replacement.
Opposition to Obamacare Repeal Continues
- Possible market disruptions from Trump and the GOP’s repeal and replacement plan continue to be a major concern for groups like the American Academy of Actuaries, which wrote a letter to Republican lawmakers last week warning that insurers will pull out of state marketplaces if Obamacare is repealed.
- Insurance companies and healthcare industry groups continue to lobby against Congress and Trump over a repeal. Some insurers are saying they would have a hard time remaining in the state marketplaces if Obamacare subsidies and the individual mandate are eliminated. If Obamacare is repealed, one health insurance executive said of the individual market, “We could see a situation where no carrier would want to offer insurance.”
- Hospital lobby groups that oppose the delayed repeal-and-replace strategy project that their members would lose more than $200 billion. The country’s largest health insurance lobby group reported that its members need time to transition to new rules under a different health insurance system and assurance that there will be money from the government to fund the system. Check out this New York Times article for more backstory.
Some Physicians Oppose Tom Price as Pick for HHS Secretary
More than 4,800 physicians have signed a petition in protest of Tom Price’s nomination by Trump for secretary of the Department of Health and Human Services. Some also feel that Price is interested in protecting physicians, and not patients. This is due in part to a 2011 bill that Price co-sponsored to limit what doctors must report about malpractice judgments, hospital discipline, and other confidential information, all of which is used by health licensing boards and hospitals when hiring medical professionals. One physician from a consumer advocacy group said, “Dr. Price is a physician who is just obviously responding to pressure from colleagues in the medical field who’d like to be exempt from being held accountable.”
News Update for Dec. 9, 2016
Obamacare Supporter Group Wants to Block Repeal
- A coalition that supports Obamacare plans to stop Congress from doing a repeal without a simultaneous replacement. The coalition stated that “repeal and delay is no better than repeal. American families deserve to know what will happen to them before Congress acts.”
- Organizers of the coalition say their protest could include rallies in Washington, D.C., as well as the states and districts that Republicans in Congress represent. The group also plans on “mobilizing constituents, including Trump voters who would be negatively affected by repeal.”
Doctors Form Organization to Fight Trumpcare
Clinician Action Network (CAN), a group composed of healthcare providers, plans to take an active role in opposing legislation that supports Trump’s healthcare reform, as well as reform proposals from Tom Price whom Trump nominated for secretary of the Department of Health and Human Services (HHS). A spokesperson for CAN said, “We’re going to be very responsive to legislation that is being introduced and voted on in Congress, both at the state level and the national level.” You can get more backstory on CAN in this Huffington Post article.
Current HHS Secretary Warns About Dangers of Repeal
Current HHS secretary Sylvia Mathews Burwell met with Democrats in Congress to issue a warning about the dangers of the Republicans’ repeal-and-delay strategy. Burwell stated that there would be market chaos if Obamacare is repealed but a replacement for it is delayed, which is in agreement with healthcare industry experts’ concern that insurance companies will drop out of the market.
News Update for Dec. 8, 2016
The Uninsured Rate Could Be Higher if Obamacare Is Repealed
According to a study from the Urban Institute, if Obamacare is repealed the uninsured rate could be higher than what it was pre-Obamacare. Below are some highlights from the study.
- 8 million Americans would become uninsured, which would push the uninsured rate to 58.7 million in 2019.
- Of the 29.8 million who would become uninsured, 5 million of those people would lose coverage because of eliminating premium tax credits, Medicaid expansion, and the individual mandate. The remaining 7.3 million would lose insurance due to the collapse of the non-group insurance market.
- 82 percent of the newly uninsured would be working families.
- 9 million fewer people would have Medicaid or CHIP coverage in 2019.
- Nearly 9.3 million people who would have received tax credits for individual health insurance in 2019 would stop receiving assistance.
News Update for Dec. 7, 2016
Many Trump Supporters at Risk of Becoming Uninsured
Non-Hispanic whites and those without college degrees are among President-elect Donald Trump’s biggest supporters who benefited the most from Obamacare. So these 2 groups are included in those most at risk of becoming uninsured if Obamacare is repealed. If a repeal happens:
- The uninsured rate would jump to 58.7 million in 2019
- 80 percent of those without college degrees would become uninsured
- 56 percent of non-Hispanic whites would lose health insurance
- 24 percent of those with some college-level education would lose coverage
- 3 in 10 high school graduates would become uninsured
Far-Right Republicans Want Obamacare Replaced Much Sooner
Trump and Republican leaders may face strong resistance from ultra-conservative House Republicans because of the delayed 3-year plan to replace Obamacare. Congressman Mark Meadows (R-NC), who is elected to be the next chairman of the House Freedom Caucus, reported that the GOP’s new outlook on Obamacare is “the first big fight I see coming for the Freedom Caucus.” He also stated that any delays in replacing Obamacare until after the 2018 elections — when some Republicans hope to win seats in the Senate — “will meet with major resistance from Freedom Caucus members.” Read more on why the caucus is challenging Trump for a quicker Obamacare replacement.
Health Insurers Issue Demands Over Obamacare Repeal
- Health insurance trade groups have publicly demanded what they need from the Trump administration to remain in the state marketplaces if a repeal happens. Their demands for Trump and Congress include:
- A clear commitment that the government will continue subsidizing health insurance for low-income people
- Keep rules that encourage young and healthy Americans to enroll in health insurance
- CNN Money also reported more demands from insurance companies, which include:
- Making it harder for people to enroll in coverage outside of open enrollment periods to prevent people from only signing up for insurance when they get sick.
- Expanding risk payments to help offset the cost of care for sick enrollees.
- Preventing healthcare providers from steering patients to the individual insurance market when they could qualify for Medicaid.
- Structuring high-risk pools differently from what was in place before Obamacare—high-risk pools for those with preexisting conditions who let their coverage lapse prior to Obamacare lacked proper funding and had waiting lists.
Hospitals Warn Trump and Congress About Repealing Obamacare
The hospital industry issued a letter warning Trump and leaders in Congress that repealing Obamacare “could cost hospitals to lose $165 billion by the middle of the next decade and trigger ‘an unprecedented public health crisis.’” If the Trump administration and Congress repeal Obamacare without a simultaneous replacement, the hospital industry says that government payments to hospital groups that treat Medicare and Medicaid patients should be restored to what they were before the 2010 Affordable Care Act law.
News Update for Dec. 6, 2016
The House Republicans’ lawsuit against Obamacare’s subsidy program has been delayed by the U.S. Court of Appeals for the Washington, D.C. Circuit. A judge previously ruled that Obamacare premium tax credits were unlawful because funding did not come from Congress. And further proceedings have been delayed to give Trump’s Justice Department time to decide on settling or withdrawing the case.
- If House Republicans win the suit to get rid of premium tax credits, also called cost-sharing subsidies, it could cause insurance companies “to sharply raise premiums or exit the ACA exchange markets, since the law requires them to reduce cost-sharing burdens for eligible members in silver plans,” as this Modern Healthcare article
- Without a replacement option for cost-sharing funds, this would also prevent insurance companies from receiving payments, and companies would lose out on money they expected to receive.
ACA Repeal on the Insurance Market
GOP lawmakers are slowly coming to terms with the need to take action to protect the individual insurance market from collapse and prevent plans from exiting the market in 2018. Health plan carriers are watching to see if Republicans will delay the elimination of premium tax credits and Medicaid expansion, both of which insurance companies say are the “key to making the individual insurance business financially viable.”
Obamacare Subsidies and Republican States
Based on a premium tax credit study from the Kaiser Family Foundation (KFF), people in Republican “red” states that Trump won may be impacted the most if subsides are eliminated because of an ACA repeal. Of the $32.8 billion in subsidies the KFF study revealed Americans received, a CNBC article points out that half of the amount went to people in 5 states: Florida, California, Texas, North Carolina, and Georgia. Except for California, Trump won these states.
News Update for Dec. 5, 2016
Selling across state lines
Republicans want insurance companies to sell policies across state lines while only meeting the regulations of their home state. Supporters of President-elect Donald Trump’s healthcare reform say this will boost competition and allow consumers to buy plans that better suit their needs. Insurance executives say it may be costly for insurance companies to enter a new market and arrange contracts with local doctors and hospitals. Some consumer groups argue that:
- Companies may flock to states that have limited regulations for the industry, which could lead to cheaper plans with limited coverage.
- States that sell comprehensive coverage may see healthy people leaving their state marketplace to buy bare-bones plans in other states.
- If more healthy people are leaving states with comprehensive coverage, this will drive up premiums for people with health problems in those states.
ACA tax credits
The Kaiser Family Foundation released a study showing that Marketplace enrollees received about $32.8 billion in tax credits because of the ACA, and that this tax credit will disappear if the ACA is repealed.
Despite some Republicans like House Speaker Paul Ryan and Tom Price (R-Ga.) proposing to privatize Medicare, Vice President-elect Mike Pence during an interview said that a Medicare overhaul is not on Trump’s healthcare agenda. Pence also stated that the first thing the Trump team has to do is get the weight of Obamacare off the back of the national economy. “We think that will create tremendous economic growth in businesses large and small, and then setting an orderly transition process in place to capture the power of the free market.”
- In a 60 Minutes interview, Ryan said that repealing Obamacare will be the congressional Republicans’ first priority once Trump takes office. When asked about the3-year transition plan, Ryan said, “I don’t know the answer to that right now. What we know is we have to make good on this promise. We have to bring relief as fast as possible to people who are struggling under Obamacare.” This article provides more info and a clip of the interview.
- Healthcare associations are launching effortsto save the 20 million people who have gained coverage through Obamacare. CEO of the American Hospital Association Richard Pollack wrote a letter urging Trump that any repeal of the ACA should simultaneously include a replacement plan that continues to provide affordable coverage. The American Medical Association also made similar requests that a Trump healthcare “reform proposal should not cause individuals currently covered to become uninsured.”
News Update for Dec. 2, 2016
- Employers could slow down on hiring and investments because of unclear plans about Trump’s healthcare reform. Potential reforms could mean the loss of about 200,000 jobs in the healthcare industry. A plan to repeal and replace Obamacare could take years to achieve, which may prolong confusion for business owners.
- Americans are divided over repealing Obamacare, according to a Kaiser Family Foundation survey:
- 30 percent want Obamacare to be expanded
- 26 percent want Obamacare to be repealed
- 19 percent want Obamacare to remain as is
- 17 percent want Obamacare to be scaled back
- 3 percent don’t know or want something else
- The GOP’s plan to privatize Medicare is facing resistance from the Senate because some GOP lawmakers say they’re not planning to make big changes—“at least not in the first year of the Trump administration.”
News Update for Dec. 1, 2016
Possible Impact of Repealing Obamacare
- Repealing the Affordable Care Act (ACA) could lead to about 7 million fewer people with health insurance and cause out-of-pocket costs to be as high as $4,700 a year for each individual.
- Without a replacement, repealing the ACA could cause insurance companies to “abandon the individual insurance markets in 2018,” which could affect the exchange, as well as off-exchange markets. Companies may panic because people who are still in the market in 2018 could be sicker, and healthier people could leave the market because of higher premiums.
- A repeal could create a huge domino effect for hospitals, insurance companies, employers, and employees, according to this Fox Business article.
Trump’s Picks for Healthcare Leaders
- Trump picked Congressman Tom Price (R-GA), an Obamacare critic, as secretary of the Department of Health and Human Services (HHS).
- Trump also announced Seema Verma as his pick for administrator of the Centers for Medicare & Medicaid Services. You can get a backstory on Verma here.
- Some healthcare companies, insurers, doctor groups, and hospitals feel encouraged by the appointments. Some insurance companies that sell in both the state and federal markets feel that changes from the GOP will allow them to sell more flexible and cheaper plans.
- Price is an advocate of Republican Speaker of the House Paul Ryan’s proposed Medicare changes, such as raising the Medicare-eligible age to 67 and giving vouchers (referred to as premium support) to Medicare beneficiaries so they can buy plans directly from insurance companies.
- Some lawmakers from both political parties feel that Price as head of the HHS could lead to major overhauls and cuts in funding, even though Trump promised to protect Medicare during his campaign.
- The GOP is pushing for major changes and cuts to Medicare to start within the first 6 to 8 months after Trump takes office. This could mean Trump’s healthcare plan would involve raising premiums and the Medicare-eligible age by 2020. The GOP is also in favor of Medicare vouchers.
- Medicare Advantage is expected to be expanded because Republicans are in favor of privatizing Medicare.
- Verma’s proposals for the Medicaid program in some Republican states appeal to conservatives who support things like requiring beneficiaries to pay more and be working or actively looking for work. Some critics feel that with the nominations of Verma and Price, a restructuring of the Medicaid program could be damaging and chaotic.
- Experts predict that Donald Trump’s healthcare plan will involve privatizing Medicaid, and one expert said that doing so shouldn’t be a big threat to insurance companies.
- Price has proposed a full repeal of Medicaid expansion, which would affect millions of low-income Americans. But some Republicans are looking at ways to keep certain parts of Obamacare’s Medicaid expansion. Ryan proposes to continue running the expansion program for states that have already expanded.
- Medicaid reform could reflect Ryan’s proposals to have either a block grant or per-capita allotment option.
- Block grants could cause 25.1 million people to lose coverage, but the grants could also help “balance the increase in the deficit if the states take measures like reducing eligibility or cutting down enrollment outreach,” as an article on 6 ways Trump could impact healthcare reform pointed out.
Trumpcare involves keeping certain parts of the Obamacare law on preexisting conditions, but Trump hasn’t provided a plan. Vice President-elect Mike Pence and Congressman Ryan have made some proposals on preexisting conditions in this CNN Money article.
- House Republicans have asked a federal appellate court to temporarily delay the case that could end ACA cost-sharing subsidies to give Trump time to put together an ACA replacement.
- Stopping subsidies could mean massive losses for insurance companies because those companies would have to pay out-of-pocket costs for each patient and not get any reimbursement from the government. Insurance companies filed a brief with the appeals court warning about “$1,000 premium increases and a market exodus by consumers and [insurance companies].”
Health Savings Accounts (HSAs)
Donald Trump’s healthcare plan includes expanding the use of HSAs. “But experts say HSAs alone can’t make individual insurance coverage affordable. … The accounts work best for those who already have high incomes,” as reported in a MarketWatch article. Without cost assistance, health insurance would be out of reach, especially for those with low incomes. Experts suggest that HSAs could be a way to replace the ACA subsidies if they’re going to be funded by the government.
- A survey from the Kaiser Family Foundation found that many Americans want the Trump administration to tackle high-cost drugs for chronic conditions as a top priority. Trump’s healthcare goals don’t currently align with this priority.
- Trump’s healthcare reform does include a proposal to “remove barriers to entry in free markets for drug providers that offer safe, reliable, and cheaper products,” but this goal is near the bottom of Trump’s top 8 healthcare agenda.
Under Trump’s proposed healthcare plan, women could see the return of paying more for health insurance than men. Women may also lose benefits, including free contraceptives, free preventive services, and guaranteed coverage for maternity services in the individual market.