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Tag Archives: 2018 Midterm Elections
A Sense of Alarm as Rural Hospitals Keep Closing
The potential health and economic consequences of a trend associated with states that have turned down Medicaid expansion.
Hospitals are often thought of as the hubs of our health care system. But hospital closings are rising, particularly in some communities.
“Options are dwindling for many rural families, and remote communities are hardest hit,” said Katy Kozhimannil, an associate professor and health researcher at the University of Minnesota.
Beyond the potential health consequences for the people living nearby, hospital closings can exact an economic toll, and are associated with some states’ decisions not to expand Medicaid as part of the Affordable Care Act.
Since 2010, nearly 90 rural hospitals have shut their doors. By one estimate, hundreds of other rural hospitals are at risk of doing so.
In its June report to Congress, the Medicare Payment Advisory Commission found that of the 67 rural hospitals that closed since 2013, about one-third were more than 20 miles from the next closest hospital.
A study published last year in Health Affairs by researchers from the University of Minnesota found that over half of rural counties now lack obstetric services. Another study, published in Health Services Research, showed that such closures increase the distance pregnant women must travel for delivery.
And another published earlier this year in JAMA found that higher-risk, preterm births are more likely in counties without obstetric units. (Some hospitals close obstetric units without closing the entire hospital.)
Ms. Kozhimannil, a co-author of all three studies, said, “What’s left are maternity care deserts in some of the most vulnerable communities, putting pregnant women and their babies at risk.”
In July, after The New York Times wrote about the struggles of rural hospitals, some doctors responded by noting that rising malpractice premiums had made it, as one put it, “economically infeasible nowadays to practice obstetrics in rural areas.”
Many other types of specialists tend to cluster around hospitals. When a hospital leaves a community, so can many of those specialists. Care for mental health and substance use are among those most likely to be in short supply after rural hospital closures.
The closure of trauma centers has also accelerated since 2001, and disproportionately in rural areas, according to a study in Health Affairs. The resulting increased travel time for trauma cases heightens the risk of adverse outcomes, including death.
Another study found that greater travel time to hospitals is associated with higher mortality rates for coronary artery bypass graft patients.
In many communities, hospitals are among the largest employers. They also draw other businesses to an area, including those within health care and others that support it (like laundry and food services, or construction).
A study in Health Services Research found that when a community loses its only hospital, per capita income falls by about 4 percent, and the unemployment increases by 1.6 percentage points.
Not all closures are problematic. Some are in areas with sufficient hospital capacity. Moreover, in many cases hospitals that close offer relatively poorer quality care than nearby ones that remain open. This forces patients into higher-quality facilities and may offset negative effects associated with the additional distance they must travel.
Perhaps for these reasons, one study published in Health Affairs found no effect of hospital closures on mortality for Medicare patients. Because it focused on older patients, the study may have missed adverse effects on those younger than 65. Nevertheless, the study found that hospital closings were associated with reduced readmission rates, which is regarded as a sign of increased quality. So it seems consolidating services at larger hospitals can sometimes help, not harm, patients.
“There are real trade-offs between consolidating expertise at larger centers versus maintaining access in local communities,” said Karen Joynt Maddox, a cardiologist and health researcher with the Washington University School of Medicine in St. Louis and an author of the study. “The problem is that we don’t have a systematic approach to determine which services are critical to provide locally, and which are best kept at referral centers.”
Many factors can underlie the financial decision to close a hospital. Rural populations are shrinking, and the trend of hospital mergers and acquisitions can contribute to closures as services are consolidated.
Another factor: Over the long term, we are using less hospital care as more services are shifted to outpatient settings and as inpatient care is performed more rapidly. In 1960, an average appendectomy required over six days in the hospital; today one to two days is the norm.
Part of the story is political: the decision by many red states not to take advantage of federal funding to expand Medicaid as part of the Affordable Care Act. Some states cited fiscal concerns for their decisions, but ideological opposition to Obamacare was another factor.
In rural areas, lower incomes and higher rates of uninsured people contribute to higher levels of uncompensated hospital care — meaning many people are unable to pay their hospital bills. Uncompensated care became less of a problem in hospitals in states that expanded Medicaid.
In a Commonwealth Fund Issue Brief, researchers from Northwestern Kellogg School of Management found that hospitals in Medicaid expansion states saved $6.2 billion in uncompensated care, with the largest reductions in states with the highest proportion of low-income and uninsured patients. Consistent with these findings, the vast majority of recent hospital closings have been in states that have not expanded Medicaid.
In every year since 2011, more hospitals have closed than opened. In 2016, for example, 21 hospitals closed, 15 of them in rural communities. This month, another rural hospital in Kansas announced it was closing, and next week people in Kansas, and in some other states, will vote in elections that could decide whether Medicaid is expanded.
Richard Lindrooth, a professor at the University of Colorado School of Public Health, led a study in Health Affairs on the relationship between Medicaid expansion and hospitals’ financial health. Hospitals in nonexpansion states took a financial hit and were far more likely to close. In the continuing battle within some states about whether or not to expand Medicaid, “hospitals’ futures hang in the balance,” he said.
HOSPITALS SHOULD BE BRACING FOR SITE-NEUTRAL PAYMENTS
https://www.healthleadersmedia.com/finance/hospitals-should-be-bracing-site-neutral-payments
Even if the Trump administration were to delay its proposed site-neutral payments policy for outpatient facilities another year or longer, the political debate isn’t going away.
KEY TAKEAWAYS
Prominent hospital groups have said the rule, as proposed, would be illegal.
Lawmakers from both sides of the aisle in both chambers of Congress have voiced opposition.
Hospitals should do their long-term budgeting and strategizing with site-neutrality in mind.
A controversial proposal to cut reimbursement rates for hospital outpatient departments could be finalized this week if the Centers for Medicare & Medicaid Services hits its target date to publish the final rule.
The proposed change to the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System unveiled last July has drawn criticism from the American Hospital Association (AHA), America’s Essential Hospitals (AEH), lawmakers in both houses of Congress, and others who contend the so-called “site-neutral” payment policies fail to account for the added burden hospital-owned facilities shoulder.
Both AHA and AEH said in formal comments last month that the OPPS/ASC proposal for 2019 appears to be illegal. And lawmakers raised related concerns in two separate letters to CMS Administrator Seema Verma, suggesting the proposal flouts congressional intent.
A bipartisan group of 48 senators signed a letter last month urging CMS to rethink its approach, and a bipartisan group of 138 representatives followed suit this month with a letter of their own.
The political pressure could very well leave an imprint on the final version of the rule, which has been under review by the Office of Management and Budget since October 10. A spokesperson for CMS told HealthLeaders that the agency would not speculate on the potential outcome of the review process, reiterating the agency’s plan to publish the final version on or about Thursday, November 1.
But even if the Trump administration were to postpone the site-neutral payments policy another year or longer, hospitals should still be preparing for site-neutrality, since this political debate will play itself out over the next several years one way or another, says Greg Hagood, a senior managing director with the financial advisory firm SOLIC Capital.
That preparation for site-neutrality should include an ambulatory strategy with investments in outpatient settings, Hagood said, with a word of caution for hospitals and health systems.
“I think they need to do their budgeting, though, with an eye toward the fact that certain areas that have historically been anchors to the hospital—whether that’s the emergency room, cardiac care, or some of these hospital outpatient departments—are likely to see diminished margins,” he said.
Basing a budget around more-conservative revenue estimates for these service lines could prompt hospitals to rationalize their cost structures or even adjust their infrastructure, such as by reducing their number of clinics or inpatient beds, Hagood said.
Although the concept of site-neutrality “makes a ton of sense” on the surface, there’s also a complex history in how American reimbursement models have evolved over the past few decades, and hospitals provide expensive services that other outpatient facilities often don’t, such as indigent care, Hagood said. Switching to a site-neutral system would have “a very economically disruptive impact on a lot of large health systems,” he added.
The debate gains another layer of intrigue when you consider how any action taken by lawmakers will be perceived by their constituents.
“If you want to make a congressman vulnerable,” Hagood said, “you’ll say he was supportive of a policy that results in a closure of a hospital in your district.”
Covered CA enrollment expected to drop as penalty ends
https://www.modbee.com/living/health-fitness/article220347880.html
Covered California’s fall enrollment period will show whether peace of mind is a motivation for people to keep their health insurance next year.
Last year, Congress passed legislation that in 2019 erases the federal tax penalty for people without coverage.
Without the threat of a penalty, Covered California, the state’s health exchange, estimates that 12 percent of its customers, or 162,000 residents, will leave the program and an additional 100,000 who purchase insurance from brokers in the state will discontinue coverage.
Affordable Care Act supporters believe there are sound reasons for the 1.4 million consumers in the program to stay insured — to protect themselves against crushing medical bills at rates subsidized by the federal government.
Almost 70,000 residents in a five-county pricing region, including Stanislaus, San Joaquin, Merced, Mariposa and Tulare counties, are covered on the exchange and 95 percent of them receive help with monthly premiums. About 18,000 are covered in Stanislaus County.
“Certainly it’s possible some will roll the dice and decide to go without coverage,” James Scullary, a Covered California spokesman, said Friday. “People generally want health insurance. They want to have that peace of mind of coverage in case of an injury or illness.”
The anticipated departure of some consumers from the pool accounts for part of an 8.7 percent average rate increase next year for Obamacare plans offered by 11 insurers in California. On average, those insurers tacked an extra 3.5 percent onto next year’s rates due to projected costs of serving a smaller, less healthy customer base when the tax penalty ends.
Individuals and families whose premiums are subsidized will see small increases because higher premiums are triggers for larger federal tax credits. It will serve to pass $250 million in additional costs to the federal government. Individuals earning between $16,754 and $48,560 a year are eligible for subsidized rates and the same applies to a family of four with income between $34,638 and $100,400 a year.
Those not eligible for subsidies will be stung by the rate increases, projected at almost 7 percent in the five-county region. A state bill to help middle-income households buy costly insurance on the individual market failed to pass this year.
The enrollment period for 2019 opened last week and runs through Jan. 15. The enrollment deadline is Dec. 15 for coverage to take effect Jan. 1.
A 40-year-old adult earning $35,000 a year can purchase a standard Silver plan for monthly costs ranging from $187 to $376, according to Covered California’s “shop and compare” online tool. Anthem Blue Cross, Kaiser Permanente, Blue Shield of California and HealthNet are the four insurance carriers offering the metal tier plans (Bronze to Platinum) in this region.
For a family of four with annual income of $62,500, monthly costs for Silver coverage will range from $254 to $625, depending on what plan is chosen. In that scenario, the two children may be eligible for free or low-cost care through the Medi-Cal program and the parents could receive extra help for co-payments.
Some residents not eligible for subsidies settle for the skimpy Bronze coverage through Covered California. A 55-year-old with $60,000 annual income will pay from $535 to $821 a month for Bronze plans next year. The cheapest Bronze HMO requires 40 percent co-pays for primary care visits and generic drugs; the annual out-of-pocket maximum is $6,000.
Citing data from Covered California’s consumer pool, Scullary said that 1.2 million customers have needed some health care and 153,000 have been protected from claims ranging from $5,000 to $50,000. Scullary said 15,000 consumers were shielded from health care costs over $50,000 and 42 people had claims in excess of $1 million.
The state exchange will promote enrollment this fall through an advertising campaign and a bus tour beginning after the November election, the spokesman said. The agency has local partners and certified brokers across the state to assist consumers with choosing suitable plans.
Covered California has a Monday-to-Saturday customer service line at 800-300-1506. Enrollment information is available at www.coveredca.com.
What’s at Stake for Health Care in Your District This Midterm Election?
What’s at Stake for Health Care in Your District This Midterm Election?
On November 6, 2018, Californians will head to the polls to vote for who will represent them in Congress. The outcome of races could have significant implications for health care in California and nationwide. Major policies at stake include the Affordable Care Act (ACA), the Medicaid program (called Medi-Cal in California), and protections for those with preexisting conditions.
What’s at stake for California?
- 1.4 million Californians purchase coverage through Covered California, the health insurance marketplace established under the ACA. Close to 90% receive federal subsidies to help them afford their premiums.
- 13.5 million Californians are covered by Medi-Cal.
- 6.7 million Californians would have lost coverage by 2027 if the last attempt by Congress to repeal the ACA and cut Medicaid (through a proposal called Graham-Cassidy) had passed. It is widely anticipated that a future attempt to repeal the ACA would be modeled after Graham-Cassidy.
- 550,000 fewer jobs would have been created in California by 2027 if Graham-Cassidy had passed.
- 16.7 million nonelderly Californians are estimated to live with a preexisting condition.
What’s at stake in your district?
Despite Coverage Gains, One-Third Of People In Small-Firm Low-Income Families Were Uninsured In 2014–15
Dinged, Dented, Defiant: The ACA Is Still Standing
https://www.healthleadersmedia.com/dinged-dented-defiant-aca-still-standing
Texas v. Azar is the latest in a long line of lawsuits and legislation that Republicans have used to undermine the Affordable Care Act, which has shown itself to be remarkably resilient.
KEY TAKEAWAYS
A federal judge in Texas could slap a preliminary injunction on the ACA.
The case is the latest in a long string of efforts to dismantle the ACA since its inception in 2010.
A federal judge in Texas is poised to drop a ruling that could determine the future of the Affordable Care Act.
Or, maybe not.
The Republican plaintiffs from 20 states in Texas v. Azar argued before U.S. District Judge Reed O’Connor in early September that the entire ACA became unconstitutional when Congress zeroed out the individual mandate penalty, effective 2019.
Led by Texas Attorney General Ken Paxton, the Republican plaintiffs are asking for a preliminary injunction. The Department of Justice, which declined to defend portions of the ACA, also urged O’Conner to delay any injunction until after the enrollment period, saying any attempts to impose the injunction during the enrollment period would invite “chaos.”
If the injunction goes through, it could end premium subsidies for ACA beneficiaries and cripple enrollment. The Urban Institute has estimated that 17 million people would lose their health insurance coverage if the ACA was overturned.
As potentially catastrophic as this sounds, the healthcare sector doesn’t seem to be overly concerned. In fact, business couldn’t be better.
A report in Axios shows that many players in the healthcare sector are prospering under the ACA. The website notes that S&P 500 healthcare index of 63 major companies has grown by 186% since the ACA became law in 2010, outstripping the S&P 500 and the Dow Jones.
In addition, health insurance companies are flush. Shares of UnitedHealth Group have gone up more than 700% since 2010, and the stock price of ACA marketplace insurer Centene has gone up 1,100% over the same period, Axios reports.
While hospitals have had a tougher time of it, especially in states that refused to expand Medicaid, they’re still seeing reductions in charity care and bad debt owing.
Regardless of how O’Connor rules in Texas v. Azar, ACA payers, providers, and other stakeholders will continue to presume that the law isn’t going anywhere, says healthcare economist Gail Wilensky.
“They’re assuming it’ll be around, or something very similar will be,” says Wilensky, a former director of Medicare and Medicaid, and a former chair of the Medicare Payment Advisory Commission.
“I don’t think people are regarding any serious likelihood of it going away again,” she says.
Even if O’Connor, appointed to the court in 2007 by President George W. Bush, agrees with the severability arguments raised by the Republican governors and attorneys general in 20 states who brought the suit, the matter likely would get shot down on appeal, Wilensky says.
” I would be surprised if it doesn’t get reversed someplace else,” says Wilensky, now a senior fellow at Project HOPE.
“If it had go all the way to the Supreme Court, the Supreme Court isn’t going to tolerate it, but I don’t know that it would even get that far,” she says.
The case is just one in a long string of legal and legislative actions Republicans are taking at the state and federal level to either undermine or bolster the ACA.
Earlier this year, O’Connor sided with Texas and five other states and threw out an Obama administration tax on states receiving Medicaid funds.
The Republican-controlled Congress has tried more than 50 times to repeal Obamacare, and Senate Majority Leader Mitch McConnell said this week that Republicans may try again in 2019.
While the signature legislation of the Obama era has been dinged and dented, it’s also proven to be remarkably resilient.
Wilensky says the ACA is resilient because it solves a problem “for a small but non-trivial group of people,” and that Republicans don’t have a credible alternative.
“Once a benefit is in place for any measurable amount of time, certainly two or three years would qualify, there’s no precedent for removing it,” she says.
“And most of the proposals that had come up did not seriously get the job done,” Wilensky says.
“They really weren’t effective as an alternative and you simply aren’t going to take away a benefit, like the extension of insurance to people who are above the poverty line and not offered traditionally employer sponsored insurance without having a credible alternative.”
“It’s just not going to happen because there are too many issues that have already been adjudicated at a more serious level,” Wilensky says. “I don’t know why they did this other than that this is 20 attorneys general and they’re running for something.”
Both Parties Seek to Energize Base Voters on Health Issues
As Republicans talk Obamacare repeal, Democrats re-emphasize top issue.
Democrats are seeking to energize their core supporters by repeating Senate Majority Leader Mitch McConnell’s remark this week that Republicans hope to revive a push to overhaul the 2010 health care law.
“McConnell gave us a gift,” Senate Minority Leader Charles E. Schumer told MSNBC on Friday. “That’s a game-changer when he shows who he is and wants to really hurt people on health care.”
McConnell said Wednesday that the GOP may pursue repeal next year if it wins enough seats in the elections. The Kentucky Republican also said entitlement programs such as Medicare and Medicaid are driving deficits.
Democratic candidates are issuing press releases and tweets warning that a GOP-controlled Congress might roll back the law and its protections for pre-existing conditions, which has enjoyed growing support nationwide since Republicans targeted it last year. They also say Republicans want to reduce the growth of popular entitlement programs.
But McConnell appears to expect the idea of repeal to also rile up GOP base voters. For months, polls have shown that health care is the top issue for Democratic voters, but Republicans still want to repeal the health care law, also known as the Affordable Care Act.
“Republicans overwhelmingly disapprove of the law,” said Ashley Kirzinger, a senior survey analyst at the Kaiser Family Foundation. “I think that Sen. McConnell is trying this out because despite the fact that some of the provisions that are part of the ACA are really popular, the ACA overall is still not.”
A Kaiser Family Foundation poll released Thursday found that of Republican voters who said health care was their top campaign issue this year, 18 percent said they specifically meant repealing the health care law. That comes behind 23 percent of survey respondents who said they meant addressing high health care costs.
In Nevada, where health care has been a marquee issue in the Senate race between Republican incumbent Dean Heller and Democratic Rep. Jacky Rosen, 29 percent of GOP voters said a candidate’s commitment to overhauling the law is most important to determining their votes.
In Florida, where the health care law is less of an issue in the Senate race between Democratic incumbent Bill Nelson and Republican Gov. Rick Nelson, 31 percent of Republican voters said wanting to scale it back is the most important issue in determining who they would vote for.
But while Republican voters may say they’re clamoring for Congress to overhaul the law, GOP candidates are not talking loudly about their plans to do so on the campaign trail. When it comes to health care, many are campaigning to protect pre-existing conditions, which the 2010 law does. Polls show a majority of voters across the political spectrum support keeping that provision.
GOP on defense
President Donald Trump said Thursday on Twitter that if any Republican did not support pre-existing conditions coverage, “they will after I speak to them.”
Texas GOP Sen. Ted Cruz built his national political ambitions around his opposition to the health care law, going so far as to shut down the government in 2013. Now, as he faces off against Democratic Rep. Beto O’Rourke, Cruz has taken a quieter tone on the law, vowing to maintain protections for pre-existing conditions although he has said he wants to roll back other parts of the law.
While Republicans say they could revisit legislation to overhaul the law, they’re also doubling down on a commitment to guarantee coverage for people with pre-existing conditions. Those protections have become a focal point across the country after the Trump administration declined to defend those provisions against a lawsuit. A group of conservative state officials sued to overturn the law after Republicans used a tax overhaul last year to effectively end the requirement that most Americans have health insurance.
The repeal measure that House Republicans passed last year would have weakened protections for pre-existing conditions by allowing states to seek waivers that would allow insurers to charge sick patients more for coverage. In the Senate, Cruz proposed to let insurers sell plans that do not meet all of the health care law’s requirements if they also offer policies that do comply with it, which health experts said would lead to higher costs for sick patients.
In both chambers, allowing insurers to sell plans that would not comply with all of the law’s requirements were critical to earning votes from more conservative members.
Two Republican lawmakers fighting for re-election, Reps. David Young of Iowa and Pete Sessions of Texas, each recently proposed nonbinding resolutions that commit to protecting pre-existing conditions if a federal judge rolls back the protections.
U.S. District Judge Reed O’Connor has yet to rule on the lawsuit by the conservative state officials, but said during oral arguments last month that he would try to do so as soon as possible. The administration asked that O’Connor postpone judgment until after the sign-up period for insurance sold on the federal and state exchanges ends in December in order to avoid chaos in the markets.
GOP defeats bid to cancel expansion of Obamacare-evading plans
https://www.washingtontimes.com/news/2018/oct/10/gop-defeats-bid-cancel-expansion-obamacare-evading/
Senate Republicans turned back a Democratic bid Wednesday to kill President Trump’s plan to expand the sale of health plans that fall short of Obamacare’s rules, saying Americans who buy insurance on their own need more options, not fewer.
Sen. Susan Collins, Maine Republican, sided with Democrats in the 50-50 vote, though the resolution needed a majority to advance.
Its defeat was never in doubt, really, though the vote allowed Democrats to paint Republicans as “junk plan” peddlers who don’t care about people with preexisting conditions who might pay more for robust coverage, as healthier people who cross-subsidize their costs ditch Obamacare for skimpier options.
“This administration wants to let these junk insurance plans run rampant and let people be duped into thinking they’re having insurance when it covers almost nothing,” Senate Minority Leader Charles E. Schumer said. “They are a massive risk to any family who purchases them, and worse, they cause rates to go up for everyone else.”
Democrats are elevating their defense of health coverage for sicker Americans this mid-term season, citing polling that shows GOP threats to undo Obamacare’s protections for preexisting conditions are unpopular.
Sen. Tammy Baldwin, Wisconsin Democrat facing re-election, pushed Wednesday’s resolution under the Congressional Review Act, which gives Capitol Hill a chance to veto new rules and regulations.
She targeted a Trump rule, finalized in August, that would allow companies to sell “short-term” health plans that fall short of Obamacare’s full coverage menu, and to allow Americans to hold the plans for up to a year.
President Barack Obama himself allowed consumers to hold short-term insurance for a full year until 2016, when he capped short-term plans at three months.
Republicans were quick to point that out, although Mr. Trump’s regulation would let consumers renew for an additional two years.
The administration and its GOP allies say Americans have been priced out of Obamacare’s market, so invalidating Mr. Trump’s attempt to extend a lifeline would be cruel.
“Surely, they must have a better answer than snatching away one of the remaining options that some Americans still prefer,” Senate Majority Leader Mitch McConnell said.
“Our constituents deserve more options, not fewer,” he said. “The last thing we should do is destroy one of the options that still is actually working for American families.”
The Health 202: Preexisting Conditions
THE PROGNOSIS
With less than a month before the midterm elections, endangered Republican lawmakers are mounting a defense against attacks they’re trying to dismantle a core element of the health-care law they fought to eliminate.
Democratic candidates on the campaign trail now regularly accuse Republicans of wanting to take away health-care protections for people with preexisting conditions. They’ve pointed to a lawsuit brought by 20 attorneys general in Republican-led states aiming to overturn the Affordable Care Act as proof the GOP wants to let such protections go down with the health-care law. That’s after Republicans whiffed in their effort to repeal and replace the ACA last summer.
Vulnerable Republican contenders are responding to the slams by airing campaign ads saying they embrace this portion of the ACA. They’re also introducing a wave of bills in Congress they say would protect those with prior illnesses from losing access to affordable health care. But experts question the efficacy of those measures, saying they seem more designed as protection against Democratic attacks than significant policy solutions, as I helped report in a story with Colby Itkowitz this week.
In August, 10 Senate Republicans, including Sen. Dean Heller of Nevada, one of the most vulnerable GOP senators facing reelection in November, sponsored a bill to guarantee protections for patients with preexisting conditions regardless of whether the ACA is struck down in court.
The bill, spearheaded by Sen. Thom Tillis (R-N.C.), would guarantee that insurers sold plans to individuals regardless of whether they have preexisting conditions. But critics and health-policy experts contend the bill leaves a loophole that would exclude coverage for certain services associated with those conditions. For example, a person with cancer wouldn’t be denied coverage, but the insurer wouldn’t be required to cover that patient’s cancer treatments.
Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, explained the Justice Department’s argument in the Texas lawsuit that certain provisions of the ACA should be thrown out, including a “preexisting condition exclusion prohibition.”
Levitt said that such exclusions were common before Obamacare. While Tillis’s bill would restore some parts of the ACA if the Texas lawsuit is successful, it wouldn’t change rules that prohibit insurers from excluding coverage for those with prior illnesses.
“The thing about insurance regulation is it’s kind of like plumbing: A small leak becomes a big leak,” Levitt said. “Insurers would take advantage of that loophole.”
Tillis spokesman Daniel Keylin pushed back on those criticisms and said they are based on an assumed outcome of the Texas lawsuit.
Keylin said there have been “misleading and inaccurate claims made about this bill, claims that assume the courts will strike down the entirety of the Affordable Care Act in Texas versus United States.”
Keylin said the Tillis bill wasn’t meant to be “comprehensive health-care legislation,” or the “totality of Congress’s answer to the Affordable Care Act falling.”
“There is obviously no ironclad way to precisely predict how the court will rule. However, this legislation is an important preemptive step toward getting feedback, hashing out ideas, and underscoring the importance of protecting Americans with preexisting conditions,” Keylin said
He said Tillis would consider “modifications or amendments” to the measure if the court ruling goes beyond what the bill addresses.
On the House side, Rep. Steve Knight (R-Calif.), locked in a tight race in California’s 25th district, introduced a bill last month similar to Tillis’s proposal. Two other vulnerable Republican congressmen also introduced nonbinding resolutions affirming their support for protecting those with preexisting conditions, though neither contains substantive policy solutions.
Iowa Republican Rep. David Young’s resolution says regardless of what happens to the ACA, Congress should retain protections for preexisting condition. Texas Republican Rep. Pete Sessions’s resolution says states should be allowed the authority to restructure their individual health-care marketplaces, but should ensure people with preexisting conditions can access affordable coverage.
“It seems not to be politically acceptable anymore to be against protecting people with preexisting conditions,” Levitt said, pointing to all the Republican proposals. “If you look at an example, like Sen. Tillis’s bill, it shows how wide a gap there can be between a state of desire to protect people and the reality of what an actual piece of legislation does.”
For their parts, spokespeople for Young and Sessions said the congressmen’s views on protecting patients with certain conditions are not new. In a statement, Knight said he has “always advocated” for such coverage.
“He’s always been supportive of protecting preexisting conditions going back to the [American Health Care Act]. This is just another step,” Young spokesman Cole Staudt said. “This is not a new position for him.”
Sessions, Young and Knight voted to repeal the ACA, though Young co-sponsored an amendment to the Republican bill that would have buffered the impact of the repeal on people with preexisting conditions. Staudt added that Young would consider introducing legislation in the future depending on the outcome of the Texas lawsuit.
Yet Joel Ario, managing director of Manatt Health and former director of the Health and Human Service’s Office of Health Insurance Exchanges, said any proposal that “deviates from what was originally in the ACA as a single risk pool concept is going to disadvantage people with preexisting conditions.”
He pointed to Republicans’ record opposing individual pieces of Obamacare, pointing to the elimination of the individual mandate in the GOP tax overhaul: “Anybody who voted for the mandate repeal voted against people with preexisting conditions,” he said.
Ario called GOP messaging ahead of the midterms a response to public polling that shows how important preexisting condition coverage is to voters.
“Republicans are trying to play into public support for protecting preexisting conditions,” he said, adding they’re “ignoring the fact that their previous action disadvantaged people with preexisting conditions.”
HENRY KOTULA 