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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Former Speaker of the House Says Obamacare Probably Won’t Be Repealed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.

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:

  1. The individual health insurance market is collapsing.
  2. Out-of-pocket spending is too high.
  3. Medicaid patients can’t find doctors to treat them.
  4. 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.

Kaiser Health News has published an article on ways Price could reform health policy in the U.S.

  1. 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.
  2. 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.
  3. 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.”
  4. 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:

  1. 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.
  2. 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.
  3. 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:

  1. Expanding health savings accounts
  2. Enacting high-risk health insurance pools
  3. Medicaid reform
  4. 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.

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.

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.
    1. 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.
    2. 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.”
    3. 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.
    4. 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.

  1. 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.”
  2. 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.”
  3. 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.”
  4. 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.”
  5. 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.

  1. “Spend more government money on subsidies”
  2. “Shorten the open enrollment period”
  3. “Add barer-bones ‘copper’ level plans”
  4. “Let insurers widen the gap between what the youngest and oldest enrollees pay”
  5. “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