Hospitals With History Get A Second Life

https://khn.org/news/hospitals-with-history-get-a-second-life/

When Laura Kiker rented a new apartment in September a few blocks from the U.S. Capitol in Washington, she knew she was moving into a historical neighborhood.

She had no idea, though, that her new home at 700 Constitution Ave. Northeast was a former hospital dating back nearly a century.

Today, she loves living in what used to be a patient room, in a four-story building with wide hallways, high ceilings and restored post-World War II-style architecture. A spacious rooftop deck, yoga studio and indoor dog wash are added bonuses for Kiker, and her dog, Stella. “There is so much history in this town, it’s nice to live in a place that has its own,” said Kiker, 30, a management consultant.

Across the country, hospitals that have shut their doors are coming back to life in various ways: as affordable senior housing, as historical hotels and as condos, including some costing tens of millions in the heart of New York’s Greenwich Village.

When Laura Kiker rented a new apartment in September, a few blocks from the Capitol, she had no idea that her new home, at 700 Constitution Ave. in Northeast Washington, was a former hospital dating back nearly a century. (Katherine Frey/The Washington Post)

The trend of converting hospitals to new uses has accelerated as real estate values have soared in many U.S. cities. At the same time, the demand for inpatient beds has declined, with the rise of outpatient surgery centers and a move toward shorter hospital stays.

As health systems consolidate for financial reasons, they might prefer that patients visit their flagship hospital while buildings related to smaller hospitals in their orbit get sold off — especially if the latter have a disproportionate share of indigent patients.

David Friend, chief transformation officer at the consulting firm BDO in Boston, noted that real estate is one of urban hospitals’ most valuable assets. “A hospital could be worth more dead than alive,” he said.

The number of hospitals in the U.S. has declined by 21 percent over the past four decades, from 7,156 in 1975 to 5,627 in 2014, according to the latest federal data.

Even when the conversions make medical sense, they pull at the heartstrings of communities whose residents have an emotional attachment to hospitals where family members were born, cured or died. But they sometimes create health deserts in their wake.

St. Vincent’s Hospital in New York treated survivors of the Titanic’s sinking in 1912, the first AIDS patients in the 1980s and victims of the 9/11 terrorist attacks in 2001, went bankrupt and closed seven years ago. Developer Rudin Management bought it for $260 million and transformed it into a high-end condo complex, which opened in 2014. Earlier this year, former Starbucks CEO Howard Schultz reportedly bought one of the condos for $40 million.

Jen van de Meer, an assistant professor at the Parsons School for Design in New York, who lives in the neighborhood, said residents’ protests about the conversion were not just about the optics of a hospital that had long served the poor being repurposed. “Now, if you are in cardiac arrest, the nearest hospital could be an hour drive in a taxi or 20 minutes in an ambulance across the city,” van de Meer said.

St. Vincent’s is one of at least 10 former hospitals in New York City that have been turned into residential housing over the past 20 years.

But many older hospitals are too outmoded to be renovated for today’s medical needs and patient expectations. For example, early 20th-century layouts cannot accommodate large operating room suites and private rooms, said Friend.Closing a hospital and converting it to another use is not exactly like renovating an old Howard Johnson’s, said Jeff Goldsmith, a health industry consultant in Charlottesville, Va. “A hospital in a lot of places defines a community — that’s why it’s so hard to close them,” said Goldsmith, who noted that after Martha Jefferson Hospital closed its downtown facility in 2009 to move closer to the interstate highway, an apartment building took its place.

Real estate investors say the location of many older hospitals — often in city centers near rail and bus lines — makes them attractive for redevelopment. The buildings, with their wide hallways and high ceilings, are often easy to remake as luxury apartments.

Spurring Development

In some circumstances, a conversion provides a much-needed lift for the community. New York Cancer Hospital, which opened on Central Park West in 1887 and closed in 1976, was an abandoned and partially burned-out hulk by the time it was restored as a condo complex in 2005. Developer MCL Companies paid $24 million for the property, branded 455 Central Park West.

“The building itself is fantastic and a landmark in every sense of the word,” said Alex Herrera, director of technical services at the New York Landmarks Conservancy. He noted that it retained some of its original 19th-century architecture.

But by the time the condominium opened early this year after a five-year, $40 million renovation, the response was positive.Nicky Cymrot, president of the Capitol Hill Community Foundation in Washington, D.C., a neighborhood group, said that when Specialty Hospital Capitol Hill sold off a little-used 100,000-square-foot wing of its facility that became 700 Constitution, neighbors weighed in with concerns about aesthetics and traffic. The building was first known as Eastern Dispensary Casualty Hospital, which opened in 1905.

Sophie White, 28, who moved into 700 Constitution this summer, watched the building’s transformation and renovation from a rental property a few blocks away. “It used to be a blight on the neighborhood with unsavory people milling around it,” she said. “Now, it’s a bright spot and with its dog park out front, it’s really a cool place to live.”

Nearly half of the 139-unit building, where one-bedroom apartments rent for nearly $2,600 per month, is already leased. Asked why former hospitals are being bought and redeveloped as housing: “It’s all about location, location, location,” said Terry Busby, CEO of Arlington-based Urban Structures.

Likewise Columbia Hospital for Women, which had delivered more than 250,000 babies since it opened shortly after the Civil War, closed in 2002 and reopened in 2006 as condos with a rooftop swimming pool in the city’s fashionable West End.

Some former hospitals are used for purposes other than housing.

In Santa Fe, N.M., St. Vincent Hospital moved into a new facility in 1977 and the old structure downtown was reborn as a state office building. Later, it was abandoned and locals listed it as one of the spookiest places in town. In 2014, the building reopened yet again as the 141-room Drury Plaza Hotel.

‘A Building With Tremendous History’

After Linda Vista Community Hospital, in L.A.’s Boyle Heights neighborhood, closed in the 1990s, the abandoned six-story building fell into disrepair — its empty patient rooms, discarded medical equipment and aging corridors serving as sets for movies such as “Pearl Harbor” and “Outbreak.” Amcal Multi-Housing Inc. bought the property in 2011 and redeveloped it into a low-income senior apartment house called Hollenbeck Terrace.

“They really rescued a building with tremendous history … while providing really needed low-income senior housing,” said Linda Dishman, CEO of the Los Angeles Conservancy, a group dedicated to preserving and revitalizing historical structures. “It is such an iconic building in the neighborhood.”

Fitch: Rating downgrades will likely outweigh upgrades for US healthcare companies in 2018

https://www.beckershospitalreview.com/finance/fitch-rating-downgrades-will-likely-outweigh-upgrades-for-us-healthcare-companies-in-2018.html

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US healthcare companies will likely see more credit rating downgrades than upgrades in 2018, according to Fitch Ratings.

Fitch attributes the increased pressure on industry credit ratings to the uncertain future of the ACA, a changing tax plan, the adoption of alternative payment models and the potential for outsider disruption, which includes Amazon’s entrance into healthcare and advancements in technology.

Further, Fitch explains that technology is increasingly moving patients away from hospitals and enabling decentralization — thus reshaping the healthcare landscape. Due to this changing landscape, the healthcare industry is, “facing secular challenges to pricing power and profitability and these forces are expected to influence certain segments more than others in 2018,” Fitch notes.

However, despite the higher potential for credit downgrades, the US healthcare sector outlook is stable for 2018 due to sheer demand for services, an overall favorable liquidity profile, and generally consistent leverage and debt coverage.

 

Freedom Caucus chair opposes ObamaCare funding pushed by GOP senator

Freedom Caucus chair opposes ObamaCare funding pushed by GOP senator

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House Freedom Caucus Chairman Mark Meadows (R-N.C.) said Wednesday that he opposes ObamaCare funding known as “reinsurance” that was part of a commitment given to Sen. Susan Collins(R-Maine) to help gain her vote for tax reform.

“That’s a totally different thing because that actually puts more money into a failing system where the money will not actually lower premiums and reduce costs in a substantial way,” Meadows told The Hill. “I think that’s a bigger problem.”

Meadows’s objections, and those among House Republicans more broadly, could be an obstacle to the deal that Collins worked out on Tuesday.

Collins said that President Trump had agreed to support the reinsurance funding, as well as another bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), to help assuage her concerns about repealing ObamaCare’s individual mandate in the tax bill.

Senators said those two ObamaCare bills could be added to a must-pass government funding bill after the tax bill passes the Senate. But Meadows’s objections are an obstacle in that situation.

Reinsurance is government funding that helps pay for the cost of sick enrollees, with the intention of bringing down premiums. But conservatives oppose it as simply throwing more money at the health-care law.

Meadows was more open to the Alexander-Murray bill, but said that he wanted certain concessions for Republicans on that before adding it to a short-term government funding bill, known as a continuing resolution (CR).

“The Alexander-Murray bill, the problem with it is that it was more give on Sen. Alexander’s part than Sen. Murray’s part, so suggesting that Sen. Murray would perhaps be a little bit more engaging in the negotiation, I would certainly be willing to [work with them],” Meadows said.

The Alexander-Murray bill funds key payments to insurers for two years in exchange for more flexibility for states. But conservatives say the flexibility in the bill currently is not substantial.

Meadows said Wednesday he is willing to work on the issue.

“I think with the CR really at this point, I’ve been one that’s been willing to work with our Senate colleagues on a CR,” he said.

Stat: In A Shift, Debate Over Drug Prices Overshadows Obamacare

Obamacare? That’s so last month. On Capitol Hill, drug prices are now the hot topic

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Obamacare? That’s so last month. On Capitol Hill, drug prices are now the hot topic.

Drug prices finally have lawmakers’ attention.

After years in which the debate over Obamacare has dominated all health policymaking discussion on Capitol Hill, U.S. lawmakers are increasingly turning their attention to the prices that everyday Americans pay for their prescription drugs.

Less than one year ago, when the Senate health committee spent four hours grilling Tom Price, President Trump’s nominee as secretary of health and human services, Democrats focused their most aggressive attention on his support for repealing Obamacare and for making major changes to the Medicare and Medicaid programs, as well as his investments in an Australian biotech company.

After years in which the debate over Obamacare has dominated all health policymaking discussion on Capitol Hill, U.S. lawmakers are increasingly turning their attention to the prices that everyday Americans pay for their prescription drugs.

Less than one year ago, when the Senate health committee spent four hours grilling Tom Price, President Trump’s nominee as secretary of health and human services, Democrats focused their most aggressive attention on his support for repealing Obamacare and for making major changes to the Medicare and Medicaid programs, as well as his investments in an Australian biotech company.

On Wednesday, the same panel heard from Alex Azar, who has been nominated as the next official to take over the helm of HHS. This time the grilling was bipartisan: All but four of the 18 lawmakers, on both sides of the aisle, used their opening remarks and questions to press Azar about different drug pricing and pharmaceutical issues.

Chairman Lamar Alexander of Tennessee and the panel’s top Democrat, Sen. Patty Murray of Washington, made drug prices the subject of their very first questions. Sen. Johnny Isakson (R-Ga.) pressed Azar to draft a list of proposals to “end the gaming of the system” by drug makers and other companies before next July. And Sen. Rand Paul (R-Ky.) suggested he could even oppose Azar’s confirmation unless he receives clearer answers on the safety risks of drug importation.

Most of the Obamacare questions, if they came at all, came as the hearing wound down. Other issues, like Medicare payment initiatives, got almost no attention. It was a stark contrast to the same panel’s focus even just in June, when Democrats derailed a hearing on drug pricing to focus on Republican efforts to repeal Obamacare.

Even Alexander noticed something different was taking place on Wednesday.

“For the last, oh, seems like forever, we have focused on health insurance,” he said in his closing remarks. “There’s so much other important [work] we should we working on when we talk about health, health care and the agencies that you work on. Drug pricing is one this committee has a great interest in.”

The debate over Obamacare is hardly over; a tax reform bill approved by the House and a similar version up for consideration in the Senate this week, for instance, would repeal the law’s individual mandate, a provision that has prompted outcry among Democrats.

It’s also true that congressional interest in drug prices isn’t entirely new. Lawmakers turned their attention to drug pricing in the wake of state-budget-busting drugs like the hepatitis C treatment Sovaldi, headline-grabbing increases like Martin Shkreli’s 5,500 percent price spike for the HIV medication Daraprim, and widespread public outcry. Trump made the issue a central tenet of his campaign for president, and lawmakers on both sides of the aisle have introduced legislation aimed at tackling aspects of the issue.

For the most part, however, lawmakers’ interest has yielded few concrete results. They have largely avoided any policymaking on the issue, even as they delivered major priorities for the industry, like a package of so-called user fees and the 21st Century Cures Act to spur medical innovation.

Azar, a former pharmaceutical executive at Eli Lilly, was sensitive to the shift in tone over drug prices on Wednesday, and gave far longer and more detailed answers to related questions than to queries about issues like access to contraception. He took an early stand on the topic himself, saying the issue would be his top priority for his time at the agency and declaring emphatically, in his opening remarks, that prices are “too high.”

For the most part, the policy solutions he offered are more in line with other conservative thinkers than with Trump, who broke with some Republicans to support more liberal policies like drug importation and Medicare price negotiations on the campaign trail. Azar pushed back on importation in his testimony and dodged questions about negotiation, highlighting instead efforts to increase generic competition and deter abuses of the patent system.

He, like other Republicans and pharmaceutical executives, also shifted some blame from drugmakers and highlighted the role other industry players play in the pricing debate.

“Everybody in the system owns a piece of this,” he said, as Sen. Tammy Baldwin (D-Wis.) pushed him to admit that drug makers, too, had a role. “The system has to get fixed. That’s the problem. … What we need to do is work to fix the system so that [consumers] have insurance that covers that insulin, so they have low out-of-pockets. We’ve got to get the list prices down, also.”

If not for Azar’s tenure at Lilly, drug pricing might be considered an unusual focus for a hearing ostensibly aimed at vetting Azar as health secretary. Few of Azar’s day-to-day responsibilities — or even his authority — would center on drug pricing if he is confirmed. Most of the concerns senators raised would need to be addressed with congressional action, not regulatory changes at the Health and Human Services Department.

Sen. Maggie Hassan of New Hampshire, for example, pressed Azar to opine on the drug company Allergan’s efforts to avoid patent challenges by selling its intellectual property to a Native American tribe. Azar said he shared her concerns — but even he noted he wouldn’t have jurisdiction on the issue. Indeed, any of the major patent system changes he suggested Wednesday would fall to the Patent and Trademark Office Director or, more likely, to Congress.

Major changes to spur generic competitors to existing prescription drugs — the subject of questions from Sen. Susan Collins (R-Maine) — would likely require congressional action. Lawmakers, too, would have to make changes about who is held liable in cases like a Lilly lawsuit, focused on its marketing for the drug Zyprexa, that Sen. Elizabeth Warren (D-Mass.) made the centerpiece of her questions. The same goes for efforts to speed changes to over-the-counter drug marketing, as Sen. Lisa Murkowski (R-Alaska) raised.

In the handful of areas in which Azar could, if confirmed, actually affect pricing policy, his attitude was mixed.

Though he would legally have the authority to encourage the importation of drugs from other countries, he expressed great skepticism of that idea when pressed by Paul and other senators. That skepticism is in line with his earlier comments on the issue, though notably differs from Trump’s.

Interestingly, Azar suggested he would like to explore changes to the way Medicare pays for drugs administered by doctors — an area over which he would have jurisdiction alongside the administrator of the Centers for Medicare and Medicaid Services, Seema Verma. His remarks were notably vague, but offered insight into policies he may try to pursue if confirmed.

“How could we think about the ways to take the learnings from Part D and actually bring lower costs to the system, but also lower costs to the patient because they pay a share of whatever Medicare reimburses in part B?” he asked. “That’s a double win. Lower for the system and lower for the patient on their out-of-pocket costs. That’s the kind of thing I would have energy to see, where we could really save money and actually improve things for our patients.”

Many senators used their second round of questioning to press harder on Obamacare — and lawmakers on the Senate Finance Committee, which has jurisdiction over Medicare policy, will have another chance to question him on those and other issues when that panel takes up Azar’s nomination officially.

That hearing has not yet been scheduled. But Alexander used his remarks Wednesday to announce a few future hearings for his panel, including a Dec. 12 meeting — on drug prices.

Patients With Rare Diseases And Congress Square Off Over Orphan Drug Tax Credits

Patients With Rare Diseases And Congress Square Off Over Orphan Drug Tax Credits

As President Donald Trump talked tax reform on Capitol Hill Tuesday, Arkansas patient advocate Andrea Taylor was also meeting with lawmakers and asking them to save a corporate tax credit for rare-disease drug companies.

Taking the credit away, Taylor said, “eliminates the possibility for my child to have a bright and happy future.”

Taylor, whose 9-year-old son, Aiden, has a rare connective tissue disorder, spoke as part of a small rally thrown together this week by the National Organization for Rare Disorders (NORD) — the nation’s largest advocacy group for patients with rare diseases.

NORD advocate Andrea Taylor holds a picture of her sons, Aiden, 9, and Aaron, 11. Aiden has the rare connective-tissue disorder arterial tortuosity syndrome, which causes symptoms such as aneurysms and congestive heart failure. The syndrome has no treatment. Taylor says Congress is sending a message “that my child’s life does not matter” if the orphan drug tax credit is eliminated or reduced. (Sarah Jane Tribble/KHN)

Earlier this month, House Republicans proposed eliminating the orphan drug tax credits, which Congress passed as part of a basket of financial incentives for drugmakers in the 1983 Orphan Drug Act. The law, intended to spur development of medicines for rare diseases, also gives seven years of market exclusivity for drugs that treat a specific condition that affects fewer than 200,000 people.

The Senate Finance Committee, led by Sen. Orrin Hatch (R-Utah), put the tax credit back into the tax legislation. After some negotiations, the committee settled on reducing the credit to 27.5 percent of the costs of preapproved clinical research, compared with the current 50 percent. The committee also restored a provision that would have eliminated any credits for drugmakers who repurpose a mass-market drug as an orphan.

“As with any major reform, tough choices have to be made,” a Hatch spokesperson wrote in an emailed statement, adding that the senator will continue to work “to make the appropriate policy decisions” to deliver a comprehensive tax overhaul.

Hatch, a member of a rare-disease congressional caucus, received $102,600 in campaign contributions from pharmaceutical and related trade group political action committees in the first half of 2017, making him the top recipient of pharmaceutical cash in the Senate.

If the Senate provision remains untouched, reducing the tax credit would save the federal government nearly $30 billion over a decade, according to a markup of the bill released late last week.

Orphan drug development has become big business in recent years and advocates as well as critics of the industry say tax credits have been an important motivation for companies. Orphan drugs accounted for 7.9 percent of total U.S. drug sales last year, according to a report released by QuintilesIMS and NORD.

Because patient populations for rare-disease drugs are relatively small, companies often charge premium prices for the medicines. EvaluatePharma, a company that analyzes the drug industry, estimates that among the top 100 drugs in the U.S. the average annual cost per patient for an orphan drug last year was $140,443. Giant pharmaceutical companies such as Celgene, Roche, Novartis, AbbVie and Johnson & Johnson have led worldwide sales in the orphan market, according to EvaluatePharma’s 2017 Orphan Drug Report.

Jonathan Gardner, the U.S. news editor for EvaluatePharma, said the orphan drug tax credit is “probably the most important incentive for developing an orphan drug.” Cutting the credit will force even the large companies to question development of drugs for rare diseases, Gardner said.

Dr. Aaron Kesselheim, an associate professor of medicine at Harvard Medical School, has been critical of the Orphan Drug Act’s incentives and of companies taking advantage of the law’s financial incentives for profit. But he warned against rushing to eliminate the tax credit.

“We need to think about ways we can improve the Orphan Drug Act and stop people from gaming the system and exploiting it,” Kesselheim said. But there “are a lot of rare diseases that don’t have treatments. So, we need to be careful in making changes.”

The battle over the tax credit is the latest controversy for the Food and Drug Administration’s orphan drug program. FDA Commissioner Scott Gottlieb announced a “modernization” plan for the agency this summer, closing a pediatric testing loophole and eliminating a backlog of corporate applications for orphan drug status. And, this week, the agency confirmed that Dr. Gayatri Rao, director for the Office of Orphan Products Development, is leaving.

Meanwhile, the Government Accountability Office confirmed this month that it recently launched an investigation of the orphan drug program. The GAO’s review was sparked by a letter from top Republican Sens. Hatch, Chuck Grassley (R-Iowa) and Tom Cotton (R-Ark.), asking the agency to investigate whether drugmakers “might be taking advantage” of the drug approval process.

When the 1983 Orphan Drug Act was passed, the law described an orphan drug as one that affects so few people that drugmakers might lose money after covering the cost of developing a drug. Congress added the 200,000-patient limit in 1984.

Today, many orphan medicines treat more than one condition and often come with astronomical prices. Many of the medicines aren’t entirely new, either. A Kaiser Health News investigation, which was also aired and published by NPR, found that more than 70 of the roughly 450 individual drugs given orphan status were first approved for mass-market use, including cholesterol blockbuster Crestor, Abilify for psychiatric conditions, cancer drug Herceptin and rheumatoid arthritis drug Humira, which for years was the best-selling medicine in the world.

More than 80 other orphans won FDA approval for more than one rare disease and, in some cases, multiple rare diseases, the KHN investigation showed.

The pharmaceutical industry has had a muted response to the tax bill, which includes a corporate tax cut. The powerful industry lobbying group PhRMA said it is pleased Congress is looking at overhauling the tax code but “encourages policymakers to maintain incentives” for rare diseases. BIO, the Biotechnology Innovation Organization that represents biomedical companies, said it was “gratified” the Senate committee chose to partially retain the credit but would prefer to keep the existing incentive.

The group that rallied Tuesday — wearing bright-orange shirts that read “Save the Orphan Drug Tax Credit” — planned to meet with a couple of dozen lawmakers, including Grassley, who is a member of the Senate Finance Committee.

NORD, like many patient advocacy groups, receives funding from pharmaceutical companies, but the organization’s leaders say the industry does not have members on the board and does not dictate how general donations are spent.

On Tuesday, NORD leaders said they are open to discussions about the tax credit and whether the overall law is working as intended.

“We’re here to have that conversation, we’re ready to have that conversation,” said Paul Melmeyer, director of federal policy for NORD. “Sadly, that’s not the conversation we are having today.”

Abbey Meyers, a founder of NORD and the leading advocate behind passing the initial 1983 law, said she fears the high cost of the drugs will make it impossible to sustain the orphan drug program. Now retired, Meyers said she has followed the law’s success over the years and believes the tax credit should not be changed.

“There are other things that have happened since the law was passed where there wasn’t any logic to what they did,” Meyers said, adding “because somebody went to a senator and they put into the law.”

 

Stabilization Bill Couldn’t Fix the Damage of Repealing Obamacare’s Mandate

https://www.bloomberg.com/news/articles/2017-11-29/obamacare-stabilization-bill-can-t-fix-harms-of-mandate-repeal

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  • CBO has estimated 4 million would lose coverage in 2019
  • Stabilization bill would have no impact on predictions: CBO

Passing a bipartisan Obamacare stabilization bill wouldn’t do much to cushion the blow from repealing the health law’s requirement that all individuals buy health insurance, the Congressional Budget Office said.

 The CBO has estimated that scrapping the mandate would result in 4 million people losing health coverage in 2019 and premiums in the individual market to increase by 10 percent. On Wednesday, the nonpartisan Congressional agency said a stabilization proposal backed by some Republican Senators would have no impact on its calculations.
The CBO’s conclusion could have an impact on the fate of the Senate tax overhaul bill that is expected to get a vote this week. Senate Republicans included the repeal of the Affordable Care Act’s individual mandate in their tax proposal. And several Senators concerned about their states’ health insurance markets, including Susan Collins of Maine and Lisa Murkowski of Alaska, had pushed forward the stabilization bill as a way to mitigate the blow.
President Donald Trump endorsed the proposal, known as the Bipartisan Health Care Stabilization Act, on Tuesday.

“The effects on premiums and the number of people with health insurance coverage would be similar to those referenced above,” the CBO said Wednesday.

The CBO projection comes with caveats. It compares the effect of the stabilization bill to a baseline in which Obamacare’s cost-sharing reduction subsidies are paid. The Trump administration has halted the payments, which lower deductibles and out-of-pocket costs for low-income people, and the funds are the subject of a legal dispute.

“I find it baffling,” Collins said Wednesday. She and Murkowski voted against earlier Republican efforts to repeal the ACA, blocking them.

The CBO report also doesn’t evaluate the effect of giving insurers additional funding, an approach that’s also under discussion. Collins introduced a bill with Senator Bill Nelson of Florida to give states seed money for high-risk pools “which would ensure that people with pre-existing conditions are protected and also to lower premiums,” she said on Tuesday. Alexander specified that Collins’s bill would provide $3 billion to $5 billion to states to set up the high-risk pools. Collins said on Tuesday that Trump also supporters her proposal.

Are You Your Organization’s Editor-in-Chief?

https://www.masterclass.com/classes/ron-howard-teaches-directing?utm_source=Paid&utm_medium=Facebook&utm_term=Aq-Prospecting&utm_content=Video&utm_campaign=RH

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