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Are Republicans ready to give up on repeal? Here’s what might happen next.

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https://www.washingtonpost.com/blogs/plum-line/wp/2017/06/06/are-republicans-ready-to-give-up-on-repeal-heres-what-might-happen-next/?utm_term=.064d61593064

Senate Republicans are moving into high gear on their effort to repeal the Affordable Care Act, making it likely that within the next few weeks they’ll either pass something and keep the process hurtling forward, or abandon it altogether.

Judging from what they’re saying, it looks like the latter is the most likely scenario: They fail to pass their version of repeal, then say, “Well, we tried,” shake that albatross off their shoulders, and move on to the rest of their agenda. It would leave many in the party infuriated, but it might be the best of the bad options available to them.

The latest developments suggest Senate Majority Leader Mitch McConnell (R-Ky.) may be hoping to rip the Band-Aid off as quickly as possible and get this whole thing behind them.

After spending a month deliberating over a response to the House’s passage of a bill to repeal the law, Senate Majority Leader Mitch McConnell (R-Ky.) is accelerating the party’s stagnant work as a jam-packed fall agenda confronts congressional leaders and President Donald Trump. Republican leaders want resolution to the tumultuous Obamacare repeal debate by the Fourth of July recess, Republican sources said, to ensure that the whole year isn’t consumed by health care and that the GOP leaves room to consider tax reform.

It’s a gut-check situation for Republicans, who are about to be confronted with tough choices that may result in millions fewer people with insurance coverage as a condition for cutting taxes and lowering some people’s premiums.

While it’s possible that McConnell is pushing this accelerated schedule because he thinks it’ll produce a bill that passes before anyone has a chance to realize what’s happening, that seems like a long shot, particularly given how many Republicans are expressing doubts about whether they can get the 50 votes they need to pass it (the current GOP margin in the Senate is 52 to 48):

  • McConnell himself said “I don’t know how we get to 50 at the moment” in an interviewtwo weeks ago.
  • “I don’t think there will be” a successful vote this year, said Sen. Lindsey O. Graham (R-S.C.). “I just don’t think we can put it together among ourselves.”
  • Sen. Richard Burr (R-N.C.) said the same thing last week: “I don’t see a comprehensive health-care plan this year.”
  • And Sen. Jeff Flake (R-Ariz.) said: “There are some still saying that we’ll vote before the August break. I have a hard time believing that.”

That’s a whole lot of skepticism. One big problem they’re facing is that there are multiple factions and working groups among Senate Republicans, all potentially coming up with their own very different versions of the bill. That’s a result of McConnell’s decision not to run the bill through the ordinary committee process, since he didn’t want there to be public hearings at which Democrats would have a chance to speak and question witnesses. In that vacuum, everyone wants to exercise their own influence. So apart from the 13-member group that McConnell appointed, there’s also a group led by Sen. Susan Collins (R-Maine) and Sen. Bill Cassidy (R-La.), and a group led by Sen. Rob Portman (R-Ohio).

But the intractable problems are likely to be substantive. Can senators from states that have benefited hugely from the ACA’s Medicaid expansion — such as West Virginia, where 28 percent of the state population is now enrolled in Medicaid, including 170,000 citizens who got it because of the expansion — come to an agreement with senators such as Ted Cruz (Tex.) and Mike Lee (Utah) who would like to see Medicaid undermined if not utterly destroyed? And can they all agree on something that can also get a majority in the House, where ultra-conservative Freedom Caucus members wield so much power?

So here are the potential outcomes:

With Spotlight on Obamacare, Public’s Opinion of Drugmakers Softens

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https://morningconsult.com/2017/06/05/spotlight-obamacare-publics-opinion-drugmakers-softens/

Consumer perceptions of several major pharmaceutical companies have softened in recent months amid an industry push to counter public uproar over high drug prices, Morning Consult Brand Intelligence data show.

Large drugmakers this spring have seen a decline in the the percentage of Americans who view them unfavorably, according to weekly national surveys of thousands of U.S. adults.

The Pharmaceutical Research and Manufacturers of America, the industry’s largest trade group, took action in January to revamp its public image by rolling out a multiyear ad campaign that promotes breakthrough medicines. The drug lobby, which consistently outspends other industries in an effort to exert influence on Capitol Hill, spent $245 million last year, an increase of more than $18 million since 2013, according to the Center for Responsive Politics.

The shift in public opinion has occurred amid GOP efforts to overhaul the nation’s health insurance system and the high-profile battle over the Affordable Care Act. The White House has prioritized replacing the 2010 ACA over lowering drug prices, though newly installed Food and Drug Administration Commissioner Scott Gottlieb announced last month that his agency is looking for ways to reduce some costs to consumers.

Since the House GOP health care legislative effort began in earnest in March, some of the most unpopular drugmakers have seen declines in the percentage of Americans who view them unfavorably. Still, favorability rankings for drugmakers have not improved significantly.

Some of the most-liked drugmakers include Johnson & Johnson and Bayer — the most well-known drug manufacturers among U.S. consumers.

Results are based on online surveys, with a nationally representative sample of adults, that ask participants if they have a favorable or unfavorable impression of certain companies.

Pfizer, which last year killed a proposed $160 billion merger with Allergan after the Obama administration announced new rules on tax inversions, had the highest unfavorability percentage among drugmakers tracked in March, at 29 percent. As of June 5, that figure had fallen to 12 percent.

Another drugmaker – Bristol-Myers Squibb – saw its unfavorability decline 13 percentage points during the same time period, from 23 percent in March to 10 percent in June. Merck had its unfavorable views peak at 25 percent in March before falling to 12 percent in June.

AHCA Defeat Is Not the End of Repeal Efforts, Analysts Say

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http://www.healthleadersmedia.com/health-plans/ahca-defeat-not-end-repeal-efforts-analysts-say

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The Trump administration will likely chip away at healthcare reform through administrative actions to reduce subsidies and weaken health insurance exchanges.

he American Health Care Act (AHCA) may have been scrapped, but that doesn’t mark the end of efforts to repeal the Affordable Care Act (ACA).

Instead, opponents will likely take a piecemeal approach to dismantling the ACA through administrative action, analysts said.

The Trump administration is unlikely to renew its push to repeal and replace the ACA through a single bill like the AHCA, but may attempt to water down elements of healthcare reform through administrative actions designed to reduce federal subsidies and weaken health insurance exchanges.

The War Isn’t Over
“This is an enormous, significant defeat, but I don’t think the war on the ACA is over yet,” said Gerald Kominski, PhD, director of the UCLA Center for Health Policy Research.

“Of course, the White House can disrupt the Affordable Care Act by issuing regulations that destabilize the market and make it more difficult to renew [coverage] or enroll for the first time.”

In January, the Trump administration took actions along those lines when it cut federal funds designed to help state health exchanges advertise and reach consumers with notices about the annual deadline for open enrollment.

The Trump administration could attempt to reduce or eliminate federal subsidies and take other actions to weaken state and federal health insurance exchanges, said Micah Weinberg, president of the Bay Area Council Economic Institute.

“First, the Trump administration needs to decide whether they want to burn down the house we’re all living in through regulatory actions that will end the viability of the exchanges,” said Weinberg. “If they want to destroy the thing, they can. So the ACA is very much not out of the woods.”

 

The Doctor Is In. Co-Pay? $40,000

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For five-figure annual fees, boutique medical services offer the wealthiest Americans the chance to cut the line and receive the best treatment.

When John Battelle’s teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.

“They’re taking him to a local hospital,” Mr. Battelle’s wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. “No, they’re not,” Dr. Shlain instructed them. “You don’t want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city.”

Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco’s top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.

For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.

“I feel badly that I have the means to jump the line,” he said. “But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?”

Increasingly, it is a question being asked in hospitals and doctor’s offices, especially in wealthier enclaves in places like Los Angeles, Seattle, San Francisco and New York. And just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered.

San Francisco’s universal health care plan eyed as model for California

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San Francisco’s universal health care plan eyed as model for California

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Maria Consuelo believes she’s alive today because of a groundbreaking program this left-leaning city created a decade ago – one that guarantees health coverage to every one of its 864,000 residents.

It’s made San Francisco the only place in the country where truly universal health coverage exists, similar to what’s available in every other developed nation. Called Healthy San Francisco, it offers health care to those who can’t afford private insurance and are ineligible for other government health programs.

In Consuelo’s case, she visited a government-funded clinic in the fall of 2015 and told a doctor she had pain in her pelvis. Tests later showed cancer in her ovaries, leading to successful surgery to remove them in January 2016.

“This law really helped me,” Consuelo, a 55-year-old mother of five grown children, said while waiting to pick up some medication last week at San Francisco General Hospital. “If it could help others, that would be great.”

A similar thought is percolating in the mind of Lt. Gov. Gavin Newsom, a Democrat who helped implement the plan when he was San Francisco’s mayor.

Now, two years after he launched his campaign to succeed Gov. Jerry Brown, Newsom has been wondering: Would such a program work in every county in the Golden State?

His suggestion comes at a time when proposals for universal health care are receiving a surprising amount of attention. Last week, Sens. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego, unveiled details of their bill to create a single-payer system that would cover all California residents – just a few days after Vermont Sen. Bernie Sanders vowed to introduce a bill to launch a similar system nationwide.

Ironically, all of the universal health care buzz is coming after the GOP’s plan to replace the Affordable Care Act with a bare-bones substitute plan collapsed. The Congressional Budget Office had estimated that the Republican plan would have decreased the federal deficit by more than $300 billion, but increased the ranks of uninsured Americans by 24 million by 2026.

But Republicans in Congress are still vowing to chip away — if not replace — the law, commonly called “Obamacare,” which has insured five million Californians since 2014, bringing down the state’s uninsured rate from 17 percent to 7.1 percent in just three years.

Trump Budget, Revised AHCA, Credit Negatives for NFP Hospitals

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The one-two punch of massive cuts to Medicaid that are proposed in both the new budget and the House Republicans’ revised American Healthcare Act would result in cuts of close to $1 trillion over 10 years, analysis shows.

Cutting Medicaid by more than $860 million over the next decade would be a credit negative for states and not-for-profit hospitals, both of which would be left scrambling for alternative funding to cover the loss, according to a new report from Moody’s Investors Service.

Last week the Trump administration unveiled a budget proposal that includes $610 billion in cuts to core Medicaid services, and an additional $250 million in reductions to Medicaid expansion programs created under the Affordable Care Act.

The following day, the Congressional Budget Office released its scoring of the revised American Health Care Act – the Republican plan to repeal and replace the Patient Protection and Affordable Care Act and estimated that it would reduce Medicaid spending by $834 million through 2026.

“The proposals significantly change the longstanding Medicaid financing system and are credit negative for states and not-for-profit hospitals,” Moody’s said in an issues brief.

For states that don’t have the luxury of ignoring budget imbalances, the changes would increase pressure to either kick people off Medicaid, increase the state share of Medicaid funding, or cut payments to hospitals and other providers, Moody’s says.

Hospitals, particularly those serving a high mix of Medicaid patients, could expect to see reimbursement cuts and more cases of uncompensated care as Medicaid patients lose the coverage they’d gained under the ACA’s expansion.

Medicaid is already a significant budget burden for states, consuming between 7% to 34% of state revenue and averaging 16%.

Under the ACA, bad debt expense at not-for-profit hospitals in states that expanded Medicaid eligibility declined on average by 15% to 20% since 2014, enhancing these hospitals’ cash flow. Similarly, the gains in insurance coverage lowered the nationwide uninsured rate to approximately 11%, with uninsured rates even lower in states that expanded their Medicaid rolls, Moody’s says.

“Although the budget would give states limited new flexibility to adjust their Medicaid programs, the measure overall reflects a significant cost shift away from federal funding to states,” Moody’s says. “This cost shift is significant and would force states to make difficult decisions about safety-net spending for hospitals that serve large numbers of indigent patients.”