Tag Archives: ACA Repeal

THE RACES AND ISSUES HEALTHCARE LEADERS NEED TO WATCH ON ELECTION NIGHT

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , • Leave a comment

https://www.healthleadersmedia.com/strategy/races-and-issues-healthcare-leaders-need-watch-election-night

The 2018 midterm elections will decide the fate of numerous healthcare-related ballot measures as well as which leaders will shape health policy in the coming years.

KEY TAKEAWAYS

Issues to watch: Medicaid expansion in 4 states, a healthcare bond initiative in California, and the debate over preexisting condition protections.

Candidates to watch: Wisconsin Gov. Scott Walker, former Gov. Phil Bredesen, former HHS Secretary Donna Shalala, and others.

Healthcare has been an overarching issue for voters in the 2018 midterm election cycle, with many focusing on the future of the Affordable Care Act when it comes to national health policy but also taking stock of state and local ballot initiatives as well.

Several traditionally Republican states will decide whether to expand Medicaid under the ACA; staffing requirements for nurses are a hot-button topic in Massachusetts; and a major children’s hospital bond is on the table in California. 

Beyond the issues are the candidates, including many Republican leaders on Capitol Hill in tight races to defend their seats after voting to repeal and replace the ACA. At the state level, Republican governors and their attorneys general are having their healthcare records put to the test as Democrats make protecting preexisting conditions and rejecting Medicaid work requirements key parts of the campaign.

Here are the key issues and candidates healthcare leaders will be watching as results begin rolling in Tuesday evening, with voters determining the direction of healthcare policymaking for years to come.

MEDICAID EXPANSION IN 4 RED STATES

One year after voters approved Medicaid expansion in Maine, the first state to do so through a ballot initiative, four other states have the opportunity to join the Pine Tree State.

Montana: The push to extend Medicaid expansion in Montana before the legislative sunset at the end of the year is tied to another issue: a tobacco tax hike. The ballot measure, already the most expensive in Montana’s history, would levy an additional $2-per-pack tax on cigarettes to fund the Medicaid expansion which covers 100,000 persons.

Nebraska: Initiative 427 in traditionally conservative Nebraska, could extend Medicaid coverage to another 90,000 people. The legislation has been oft-discussed around the Cornhusker State, earning the endorsement of the Omaha World-Herald editorial board.

Idaho: Medicaid expansion has been one of the most talked about political items in Idaho throughout 2018. Nearly 62,000 Idahoans would be added to the program by Medicaid expansion, some rural hospitals have heralded the move as a financial lifeline, and outgoing Gov. Bruce Otter, a Republican, blessed the proposal last week.

Utah: Similar to Montana’s proposal, Utah’s opportunity to expand Medicaid in 2018 would be funded by a 0.15% increase to the state’s sales tax, excluding groceries. The measure could add about 150,000 people to Medicaid if approved by voters, who back the measure by nearly 60%, according to a recent Salt Lake Tribune/Hinckley Institute poll.

4 MORE BALLOT INITIATIVES

In addition to the four states considering whether to expand Medicaid, there are four others considering ballot initiatives that could significantly affect the business of healthcare.

Massachusetts mulls nurse staffing ratios. Question 1 would implement nurse-to-patient staffing ratios in hospitals and other healthcare settings, as Jennifer Thew, RN, wrote for HealthLeaders. The initiative has backing from the Massachusetts Nurses Association.

Nurses have been divided, however, on the question, and public polling prior to Election Day suggested a majority of voters would reject the measure, which hospital executives have actively opposed. The hospital industry reportedly had help from a major Democratic consulting firm.

California could float bonds for children’s hospitals. Proposition 4 would authorize $1.5 billion in bonds to fund capital improvement projects at California’s 13 children’s hospitals, as Ana B. Ibarra reported for Kaiser Health News. With interest, the measure would cost taxpayers $80 million per year for 35 years, a total of $2.9 billion, according to the state’s Legislative Analyst’s Office.

Proponents say children’s hospitals would be unable to afford needed upgrades without public assistance; opponents say the measure represents a fiscally unsound pattern. (California voters approved a $750 million bond in 2004 and a $980 million bond in 2008.)

Nevada nixing sales tax for medical equipment? Question 4 would amend the Nevada Constitution to require the state legislature to exempt certain durable medical goods, including oxygen delivery equipment and prescription mobility-enhancing equipment, from sales tax. The proposal, which passed a first time in 2016, would become law if it passes again.

Bennett Medical Services President Doug Bennett has been a key proponent of the measure, arguing that it would bring Nevada in line with other states, but opponents contend the measure is vaguely worded, as the Reno Gazette Journal reported.

Oklahoma weighs Walmart-backed optometry pitch. Question 793 would add a section to the Oklahoma Constitution giving optometrists and opticians the right to practice in retail mercantile establishments.

Walmart gave nearly $1 million in the third quarter alone to back a committee pushing for the measure. Those opposing the measure consist primarily of individual optometrists, as NewsOK.com reported.

INCUMBENTS, PLAINTIFFS, PREEXISTING CONDITIONS

It’s been more than two months since Republican attorneys general for 20 states asked a federal judge to impose a preliminary injunction blocking further enforcement of the Affordable Care Act, including its coverage protections for people with preexisting conditions. Some see the judge as likely to rule in favor of these plaintiffs, though an appeal of that decision is certain.

Amid the waiting game for the judge’s ruling, healthcare policymaking—especially as it pertains to preexisting conditions—rose to the top of voter consciousness in the midterms. That explains why some plaintiffs in the ACA challenge have claimed to support preexisting condition protections, despite pushing to overturn them.

The lawsuit and its implications mean healthcare leaders should be watching races in the 20 plaintiff states in the Texas v. Azar lawsuit: Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Kansas, Louisiana, Maine Gov. Paul LePage, Mississippi Gov. Phil Bryant, Missouri, Nebraska, North Dakota, South Dakota, South Carolina, Tennessee, Texas, Utah, West Virginia, and Wisconsin. Thirteen of those plaintiff states have active elections involving their state attorneys general, and several have races for governor in which the ACA challenge has been an issue, including these noteworthy states:

  • Texas: Attorney General Ken Paxton, a Republican representing the lead plaintiff in the lawsuit, is facing a challenge from Justin Nelson, a Democrat, and the race seemed to be competitive, as The Texas Tribune reported. Gov. Greg Abbott was expected to win against Democratic challenger Lupe Valdez.
  • Florida: Attorney General Pam Bondi, a Republican, is term-limited, so she’s not running for reelection. Ashley Moody, a Republican, and Sean Shaw, a Democrat, are facing off for Bondi’s position. Moody expressed support for Florida’s participation in the ACA challenge, while Shaw said he would pull the state out, calling the case a “partisan stunt,” as the Tampa Bay Times reported. Bondi has campaigned, meanwhile, for Republican gubernatorial candidate Ron DeSantis, who’s facing off with Democrat Andrew Gillum. Gillum said he would back a state law to protect people with preexisting conditions, while DeSantis said he would step in if federal action removed the ACA’s preexisting condition protections, as the Miami Herald reported. Gillum and DeSantis are vying to succeed term-limited Gov. Rick Scott, a Republican who’s running for U.S. Senate.
  • Wisconson: Attorney General Brad Schimel, a Republican, is facing a challenge from Josh Kaul, a Democrat who has slammed Schimel’s participation in the ACA challenge, as The Capital Times reported. Gov. Scott Walker, a Republican, said he supports preexisting condition protections, despite authorizing his state’s participation in the lawsuit. Democratic challenger Tony Evers accused Walker of “talking out of both sides of his mouth,” as the Milwaukee Journal Sentinel reported.

PROPONENTS OF MEDICAID WORK REQUIREMENTS

Five states have received approvals from the Centers for Medicare and Medicaid Services to institute Medicaid work requirements: Kentucky, Indiana, Wisconsin, New Hampshire, and Arkansas. (Only four have active approvals, however, since a federal judge blocked Kentucky’s last summer.)

Three incumbent governors who pushed for work requirements are running for reelection:

New Hampshire: After receiving approval for New Hampshire’s Medicaid work requirements, Republican Gov. Chris Sununu said the government is committed to helping Granite Staters enter the workforce, adding that it is critical to the “economy as a whole.” Despite spearheading a controversial topic in a politically centrist state, Sununu has not trailed against his Democratic opponent Molly Kelly in any poll throughout the midterm elections.

Arkansas: Similarly, Arkansas Gov. Asa Hutchinson, is running in a race where he has held a sizable lead over his Democratic challenger Jared Henderson. Since enacting the work requirements over the summer, the state has conducted two waves where it dropped more than 8,000 enrollees.

Wisconsin: The most vulnerable Republican governor of a state with approved Medicaid work requirements is Wisconsin Gov. Scott Walker, who has been neck and neck with Democratic nominee Tony Evers. While the Badger state only received approval for its Medicaid work requirements last week, healthcare has been a central issue of the campaign as Walker, a longtime opponent of the ACA, works to address premium costs in the state and defend his record on preexisting conditions.

Indiana and Kentucky: Indiana Gov. Eric Holcomb and Kentucky Gov. Matt Bevin are not on the ballot this year.

When HealthLeaders issued its first list in April of the healthcare leaders running for public office during the primaries, there were more than 60 candidates with relevant healthcare backgrounds out on the campaign trail.

Now, for the general election, that list has nearly been halved, with 35 candidates still remaining. 

This collection of healthcare leaders includes registered nurses, former insurance company executives, physicians, and former government health policy leaders.

U.S. Senate: Running for the Senate are Florida Gov. Rick Scott, former Tennessee Gov. Phil Bredesen, former Celgene CEO Bob Hugin, and State Sen. Leah Vukmir.

U.S. House: Among those aiming to join the House are Lauren Underwood, RN, former HHS Secretary Donna Shalala, and Dr. Kim Schrier.

 

 

How Will the Midterm Elections Impact Healthcare?

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , , • Leave a comment

https://mailchi.mp/burroughshealthcare/pc9ctbv4ft-1586513?e=7d3f834d2f

Image result for 2018 Midterm Elections Impact Healthcare

With the midterms less than a week away,  a new poll published October 18th by the non-partisan Kaiser Family Foundation got a lot of attention. Over seventy percent of voters say health care is a very important issue in deciding who to vote for. 

But exactly what happens to key healthcare initiatives, especially the Affordable Care Act including expansion of Medicaid in many states—which tends to be more popular among Democratic lawmakers than Republicans–depends on whether it’s the Democrats or Republicans who get control of the House, says Eric Feigl-Ding, MPH, Ph.D., a health economist and visiting scientist at the Harvard Chan School of Public Health in Cambridge, Mass.

Based on multiple polls, the New York Times reported on October 23 that a likely outcome is that Democrats will gain the majority in the House of Representatives and the Republicans will keep the majority in the Senate. But the Times and many other news outlets continually point out that many factors including the news of each day make it difficult to predict the outcome.

Feigl-Ding says having opposing parties in the House, Senate and White House could make it harder to pass national legislation. Changes can still happen to the ACA, however, because the President can continue to make certain executive level decision such as ending the penalty for not having health insurance which he did last year. That change takes effect in 2019.

In terms of new legislation, Feigl-Ding says a split Congress and White House means that passing legislation will be difficult because what comes from the House side, if most members are Democrats in the next sessions, could be more liberal and the corresponding bills from the Senate, likely to remain Republican, could be more conservative. So, says Feigl-Ding, either a bill won’t pass at all, or there will have to be much more of a compromise. “And assuming they would get to compromise is a big assumption, that then requires the president to agree to sign that legislation,” adds Feigl-Ding.

A report this week by strategy and policy group Manatt Health, based in Washington, DC lists the health care issues the firm thinks will dominate in states and the federal government after the elections:

  • The role of Medicaid as either a welfare program or health insurance for low-income Americans: While Democrats generally support continued expansion of Medicaid with no cost or work requirements for low-income adults, Republican governors in a number of states—with the approval of the Trump administration– have introduced premiums, work requirements, increased paperwork and penalties for falling off on requirements those that can keep many adults from applying for or remaining on Medicaid.
  • Differences in states about expanding and stabilizing the Affordable Care Act (ACA) Marketplace or promoting non-ACA coverage: The ACA allows states to open their own health insurance marketplaces or simply offer access to the federal marketplace. According to 2017 data from the National Academy for State Health Policy, more consumers sign up for health care coverage in states that run their own marketplaces
  • Drug prices: According to the Organization for Economic Development, an international forum with 36-member countries, consumers in the U.S. spend just over $1,100 on prescription drugs each year, more than consumers in any other country. President Trump has promised to help lower drug prices and on October 25 he released a plan that would tie some drug prices for patients on Medicare to an index based on international prices. Those prices are often far lower than Americans pay. PhRMA, the largest drug trade association announced its opposition to the plan the same day it was announced.

According to the report what states do will depend on the election outcomes for governors in more than a dozen states and many of those races are as impossible to predict as the Congressional races.

Other important health care issues for 2019-20120 include:

Pre-Existing Conditions 

Listening to ads for some Republicans candidates for Congress makes it appears protecting pre-existing conditions will be a top priority for some Republicans, even among some who voted against them previously. But Feigl-Ding says keeping coverage for preexisting conditions in health insurance plans also requires figuring out how to pay for it. Under the original ACA legislation, the hope was that a financial penalty for not having health coverage would keep more healthy people in the plans—along with the prohibition against letting insurers “cherry pick” only healthy consumers. But that penalty is now gone. “Take that away and you probably can’t sustain the preexisting conditions, says Feigl-Ding.

Medicaid Work Requirements and Other Conditions of Eligibility.

Legal challenges in several states could impact the implementation of work requirements. Some governors have said they’ll cut the number of state Medicaid beneficiaries to save money if work requirements are overturned.

ACA Repeal. Twenty states are challenging the constitutionality of the ACA in Texas v. The U.S., a case that could make it to the Supreme Court.

Association Health Plans and Short-Term Plans. Several Democratic state attorneys general have filed a lawsuit against the administration’s rule promoting association health plans that allow individuals and small businesses to join to purchase health care coverage and short-term plans. The suit argues that the new rules for both avoid protection for people with pre-existing conditions, according to Manatt.

No one has a crystal ball for what will happen, but everyone has hindsight. According to the Manatt report, in 2010 Republicans replaced Democratic governors in eleven states, and all but one of those states ended plans to establish a state-based health insurance marketplace (SBM). In five states where Democrats replaced Republicans, all those states set up those marketplaces.

And whatever the outcome of the 2018 elections, their impact on healthcare may only be short lived. At a foundation briefing on the midterm elections earlier this week Mollyann Brody, Executive Director, Public Opinion and Survey Research at the Kaiser Family Foundation reminded the crowd that “the day the 2018 elections are over the 2020 campaign starts.”

Still the end of the week also brought a glimmer of hope. In response to President Trumps remarks on October 25thabout his administration’s plan to test new drug pricing models in Medicare Part B help to lower drug prices Frederick Isasi, executive director of FamiliesUSA, a liberal leaning health insurance advocacy group, released a statement that said, in part, “I hope this is a serious policy that will be formally proposed and finalized by the Trump administration. If so, it is an important step forward for our nation’s seniors and taxpayers.”

 

 

The ACA Protects People with Preexisting Conditions; Proposed Replacements Would Not

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , • Leave a comment

https://www.commonwealthfund.org/blog/2018/aca-protects-people-preexisting-conditions-proposed-replacements-would-not?omnicid=EALERT%%jobid%%&mid=%%emailaddr%%

Patient with preexisting condition

The Affordable Care Act’s health insurance marketplaces open for enrollment today for the sixth time. But this year the marketplace health plans in many states will face some new competition from insurance products that don’t meet the law’s standards, including the ban on denying coverage or charging more based on a person’s preexisting health conditions.

New Trump administration regulations released earlier this year have undermined the coverage protections in the ACA by making it possible for insurers to renew often skimpy short-term health insurance for up to three years, and for small businesses to form associations that sell substandard health plans. One of the reasons insurers can charge low premiums for these plans is that they generally cover less that ACA-compliant plans and insurers can deny them to people with diabetes or a history of cancer, for example. Only healthy people get these plans. And the more healthy people who buy them, the more expensive coverage becomes for people with a history of illness who buy their own insurance and have incomes too high to qualify for marketplace subsidies. In guidance released last week, the administration will allow states to further encourage the sale of these plans by letting people use federal subsidies to buy them.

As a nation, it is important for us to focus our energy on ways to improve people’s health. We are experiencing an unprecedented decline in life expectancy which will ultimately affect our economic health and the ability of Americans to compete in a global workforce. One of the most basic things we can do is preserve the coverage protections for people with health problems that have been law for more than four years, rather than poke holes in them. Americans say they support this idea. Recent polls have found that majorities of Americans believe that people with health conditions should not be denied affordable health insurance and health care. As a result, House and Senate candidates of both parties are running on their support for protecting coverage for people with preexisting conditions. But some of those very candidates voted to repeal the ACA last year.

The ACA has dramatically improved the ability of people with preexisting conditions to buy coverage. In 2010, before the law passed, we conducted a survey that found 70 percent of people with health problems said it was very difficult or impossible to buy affordable coverage, and just 36 percent said they ended up purchasing a health plan. By 2016, the percentage of people who had trouble buying an affordable plan had dropped down to 42 percent — still high but much improved — and 60 percent ultimately bought a plan.

While the congressional ACA repeal bills failed last year, a Republican Congress could try again next year. And in the meantime, the law’s preexisting conditions protections and other provisions face another threat from a lawsuit brought by Republican governors and attorneys general in 20 states. The U.S Department of Justice has agreed with the plaintiff states in part, and refused to defend the law’s preexisting condition protections. The court decision is pending. Should the states win, an estimated 17 million people could become uninsured.

Some congressional candidates from these states and others are pointing to their support for Republican proposals, such as the “Ensuring Coverage for Patients with Pre-Existing Conditions Act,” as proof they support coverage for preexisting conditions. This bill would prevent insurers from refusing or varying premiums based on preexisting conditions. But, unlike the ACA, this bill would allow insurers to sell plans that entirely exclude coverage for care pertaining to the preexisting conditions themselves. The reality is that this bill would not protect sick Americans, or those who may become ill in the future, from high out-of-pocket health care costs.

Several million people will be going to the marketplaces in the next few weeks to sign up for coverage since they do not have it through an employer. At this time, not one of them who buys a plan in the marketplace has to fear that an insurance company will deny them coverage or charge them a higher premium because of their health. The efforts to undermine the individual market and invalidate the ACA’s consumer protections are real-life threats for people who depend on this insurance for their health care. The nation cannot move forward with tackling our most pressing health care problems if we continue to debate a core protection of the ACA that most Americans support.

 

 

Covered CA enrollment expected to drop as penalty ends

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

https://www.modbee.com/living/health-fitness/article220347880.html

Image result for Covered CA enrollment expected to drop as penalty ends

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?

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

What’s at Stake for Health Care in Your District This Midterm Election?

Image result for What’s at Stake for Health Care in Mid Term Elections

 

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?

 

Repeal of ACA on Republican agenda after midterms

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , • Leave a comment

https://www.healthcarefinancenews.com/news/repeal-aca-republican-agenda-after-midterms?mkt_tok=eyJpIjoiTldNeU1qQmpOMk14WXpRMyIsInQiOiJDSlRcL25VMHRkNTlLQzZqU1dERHJzWnFlUmR2MCtJcWNaT0VZVUprSWY4ejJ2a1ZlemRaZStIaVA4bWRIM3h6VlphdWJreDRwK1cwbjhNWnZ0WmFCeVQ3b2lTSTQ5Y1krdHFKQTdCQ1dPRDd2a1NOVDFBTG5ESWpNUnhQYzVvdWwifQ%3D%3D

Related image

Repeal would end the ACA’s most popular provision, to cover those with preexisting conditions.

Republicans could try again to repeal the Affordable Care Act if they win enough seats in the midterm election this November, Senate Republican Leader Mitch McConnell said on Wednesday, according to Reuters.

WHY THIS MATTERS

Providers want to keep the ACA to minimize the cost of uncompensated care from treating individuals who have no insurance.

Insurers this year have turned around earlier losses and exits, expanding their footprint in the market and, in many cases, offering lowering premium rates for 2019.

Studies show most consumers like the ACA but remain confused about the healthcare law, with close to 80 percent unaware that open enrollment starts on November 1.

THE TREND

Republicans last year tried and failed to repeal the ACA. In another attempt to get rid of the individual and employer mandates for coverage, the GOP this summer introduced the “skinny” repeal in the Health Care Freedom Act.

On July 28, Senator John McCain cast the deciding vote when he joined two other Republican senators in voting down the skinny repeal of the ACA that the Congressional Budget Office said could result in 16 million more people becoming uninsured. Provider groups such as America’s Essential Hospitals and the American Medical Association, voiced their approval that the skinny repeal failed.

Republicans got rid of the individual and employer mandates in this year’s budget bill.

The Trump Administration also introduced a less expensive alternative to ACA plans in allowing consumers to buy short-term limited duration plans that offer coverage for up to a year and can be extended for three years. The short-term plans are not mandated by law, as are ACA plans, to cover pre-existing conditions and offer essential benefits.

THEIR TAKE

Republicans have long promised to end the ACA because they say it’s not working.

OUR TAKE

Republicans have been chipping away at Obamacare and the government has drastically cut funds to promote it, but at the same time, the Department of Health and Human Services has helped to stabilize the market. Most significantly, it has allowed insurers to silver load plans to apply full premium increases to silver plans in the ACA to make up for the loss of cost-sharing reduction payments that were eliminated by President Trump. Since nine out of 10 consumers get tax subsidies for buying plans, this move was essentially subsidized by the federal government.

Even if the GOP retains its majority this November, repeal of the ACA will be an uphill battle. It would end the ACA’s most popular provision to cover those with preexisting conditions.

President Trump tweeted on Friday his support of protecting those who have preexisting conditioins saying. “All Republicans support people with pre-existing conditions, and if they don’t, they will after I speak to them. I am in total support. Also, Democrats will destroy your Medicare, and I will keep it healthy and well!”

 

 

 

Dinged, Dented, Defiant: The ACA Is Still Standing

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , • Leave a comment

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

Posted on by • Posted in Uncategorized • Tagged , , , , • Leave a comment

http://www.rollcall.com/news/politics/both-parties-seek-to-energize-base-voters-on-health-issues?utm_source=just-in&utm_medium=email&utm_campaign=energize-health-parties&utm_content=101918&bt_ee=05ccTe0Lp820lMqsIKZ9rsEC84uBk8tCGVMHpj2I80iDh%2BrNDK%2BwJpRqg0%2BFWTO2&bt_ts=1539981664412

Image result for pre existing conditions

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.

 

Is Obamacare Constitutional? The Battle Begins Again

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , • Leave a comment

http://www.thefiscaltimes.com/2018/09/05/Obamacare-Constitutional-Battle-Begins-Again

 

The debate over the Affordable Care Act entered a new phase Wednesday as a federal court in Texas began hearing oral arguments in a lawsuit brought by 20 Republican-led states challenging the constitutionality of the 2010 law.

Eighteen Republican state attorneys general and two GOP governors bringing the suit argue that the law’s individual mandate was rendered unconstitutional when Congress lowered the penalty for individuals who don’t buy coverage to zero.

The Supreme Court, in upholding the law in 2012, deemed that penalty a tax and thus a valid and legal exercise of Congress’ power of the purse. The lawsuit claims that the law is no longer constitutional because the zeroed-out penalty can no longer raise revenue. “It’s nothing but a hollow shell because its core has been invalidated,” said Misha Tseytlin, Wisconsin’s solicitor general.

The plaintiffs also claim that this means the entire ACA — and, in particular, its protections for patients with pre-existing conditions looking to buy insurance — must be struck down because the mandate can’t be severed from the rest of the law. The Trump Justice Department decided not to defend the ACA in the case.

What a Kavanaugh Confirmation Might Mean

The case, which legal experts see as a long shot, may still wind up before the Supreme Court — which is why Democrats have brought up Obamacare and its protections for patients with pre-existing conditions in this week’s confirmation hearing for Brett Kavanaugh, President Trump’s nominee to replace Justice Anthony Kennedy.

“Kavanaugh has signaled in private meetings with Senate Democrats that he is skeptical of some of the legal claims being asserted in the latest GOP-led effort to overturn the Affordable Care Act,” the Los Angeles Times’ Jennifer Haberkorn reported last week. Three Democrats in the meetings told the Times that Kavanaugh suggested that if one piece of the law is struck down, the rest of the law doesn’t necessarily have to fall with it.

But that may not be enough to assuage Democratic fears that Kavanaugh could be the deciding Supreme Court vote against Obamacare. “Democrats are more concerned about Kavanaugh’s past writings on expansive presidential powers, which they say could lead to his supporting efforts by the Trump administration to dismantle the health-care law without Congress,” The Washington Post’s Colby Itkowitz notes.

Where Public Opinion Stands

The political debate over Obamacare has shifted as public perception of the law has improved. The latest Kaiser Family Foundation tracking poll, released Wednesday, finds that 50 percent now view the law favorably while 40 percent see it unfavorably, with the divide still falling along partisan lines. Just under 80 percent of Democrats support the law, while a similar percentage of Republicans oppose it.

That may be why Republicans still view repealing the law as a potent issue with their base. Vice President Mike Pence, in Wisconsin last week to campaign for Senate candidate Leah Vukmir, said the GOP push to repeal and replace the health care law was still alive: “We made an effort to fully repeal and replace Obamacare and we’ll continue, with Leah Vukmir in the Senate, we’ll continue to go back to that,” he told reporters. With Sen. Jon Kyl (R-AZ) replacing John McCain, a critical vote against the GOP’s 2017 Obamacare repeal bill, there has been chatter about another potential repeal effort — though Senate Majority Leader Mitch McConnell effectively shot that down on Wednesday.

In the meantime, open enrollment on the ACA exchanges is set to begin on November 1, with the Trump administration once again providing reduced funding for outreach groups that help people enroll. A recent report by the nonpartisan Government Accountability Office criticized the administration’s management of Obamacare signup periods.

ACA court case causing jitters in D.C. and beyond

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

http://www.modernhealthcare.com/article/20180831/NEWS/180839976

Image result for 2018 midterm elections

 

For months, congressional Republicans have ignored the Texas-led lawsuit seeking to overturn the Affordable Care Act. With the midterm elections looming, talk of the case threatened to reopen wounds from failed attempts to repeal the law. Not to mention that legal experts have been panning the basis of the suit.

But that’s all changing as the ACA faces its day in court … again. The queasy feeling of uncertainty that surrounded the law just one year ago is back. The level of panic setting in for the industry and lawmakers is pinned to oral arguments set for Sept. 5 in Texas vs. Azar. Twenty Republican state attorneys general, led by Ken Paxton of Texas, are seeking a preliminary injunction to halt enforcement of the law effective Jan. 1. Their argument is built around the Supreme Court’s 2012 ruling in which Chief Justice John Roberts said the law is constitutional because it falls under Congress’ taxing authority. The AGs have seized on the congressional GOP’s effective elimination of the individual mandate penalty in the 2017 tax overhaul as grounds to invalidate the law. 

They have the Trump administration on their side, in part. The Justice Department in June filed a brief arguing that the individual mandate as well as such consumer protection provisions as barring insurance companies from denying coverage to people with pre-existing conditions are unconstitutional. But the department stopped short of suggesting that the entire law be vacated.

Conservative U.S. District Judge Reed O’Connor will hear the case in Austin, Texas. O’Connor has already ruled against an ACA provision that prohibited physicians from refusing to perform abortions or gender-assignment surgery based on religious beliefs, and he is considered a wild card.

Even ACA supporters who downplay the legal standing of the case are bracing for the possibility that O’Connor will side with the plaintiffs, who ultimately see a path to the Supreme Court.

Republicans, meanwhile, are trying to head off a potential political storm. A coalition of Senate Republicans led by Sen. Thom Tillis of North Carolina introduced a bill to codify guaranteed issue for people with pre-existing conditions into HIPAA laws. But they left out the key mandate that insurers can’t exclude coverage of treatment for pre-existing conditions. That omission left health insurers scratching their heads and Democrats came out swinging, with Democratic Sen. Claire McCaskill of Missouri dubbing the measure “a cruel hoax.”

The politics around coverage protections will really start to matter for Republicans should O’Connor signal support for the plaintiff states, according to Rodney Whitlock, a Washington healthcare strategist and former GOP Senate staffer. “It ups the pressure considerably,” he said. “There’s no question it complicates things for Republicans if a decision comes down in October.”

Insurers are on the lookout for signs of what could happen next. If O’Connor’s decision comes down before open enrollment starts on Nov. 1, the GOP will feel increasing pressure to do something substantive, according to an industry official who asked not to be identified.

Although a ruling striking down the law wouldn’t necessarily impact the individual market in 2019, it would spark the kind of massive uncertainty that insurers hate and complained of last year during the GOP repeal-and-replace efforts.

America’s Health Insurance Plans filed an amicus brief urging the court to deny the request for a preliminary injunction, citing the massive impact such a move would have on insurers in the individual market, Medicaid managed care and Medicare Advantage plans.

“It creates a lot of impetus for federal or state action,” the insurance official said, noting that insurers would have to rely on HHS to interpret how the law’s regulations would apply going forward. If mounting court decisions start to drastically affect the law’s mandates, it would fall to HHS how to manage complicated questions around how to follow ACA rules.

HHS and Justice Department officials declined to comment. CMS Administrator Seema Verma in August told McCaskill when pressed at a Senate committee hearing that she would support legislation to protect pre-existing conditions, but she declined to specify how the CMS would respond administratively if the suit succeeds.

For now, lawmakers aren’t showing any willingness to take a bipartisan approach. The House GOP plans to introduce a companion bill to the Senate measure, Tillis told Modern Healthcare last week. Meanwhile Democrats have made hay over the fact that the protections in his legislation are incomplete. Tillis said leaving out the prohibition of coverage exclusions was not intentional and GOP senators would look again at the bill if the lawsuit advances.

He added that he envisions the legislation as just one piece that could build into a bigger overhaul effort, and wants to see protections of other popular provisions such as allowing people up to age 26 to stay on their parents’ health insurance.

“It’s similar to what we talked about last year,” Tillis said, referencing the 2017 repeal-and-replace efforts. “Any sort of court challenge that would cause a precipitous voiding of Obamacare would leave a lot of people in the lurch, and one of those areas is pre-existing conditions.”

Sen. Bill Cassidy (R-La.), who spearheaded the last major GOP effort to repeal and replace the ACA last year, also said he would want to look at more comprehensive legislation if the lawsuit advances. “I certainly would,” Cassidy said. “I can’t speak for all, but I do think there would be a drive to.”

How Republicans will move past messaging and into action remains to be seen, Whitlock said.

“If you think of the seminal moments of 2017, you think of pre-existing conditions and the Jimmy Kimmel test,” Whitlock said, referencing the talk show host’s attack on the repeal-and-replace effort following emergency heart surgery for his newborn son. “This was a big deal because people were concerned. It is a very important issue, and it’s also one that Republicans have tried to say in every bill that they’re trying to protect. They have been successful to varying degrees in making that case. But with the Texas lawsuit, there’s no protecting it. It says, throw out the entire ACA root and branch.”

And as nomination hearings for Supreme Court nominee Brett Kavanaugh get underway Sept. 4, Democrats will keep using the GOP’s dilemma as a cudgel. McCaskill, for instance, is leveraging the issue in her neck-and-neck race against Missouri Attorney General Josh Hawley, who is part of the lawsuit.

“How do you have a pre-existing conditions bill that says we’re not going to protect someone with a pre-existing condition?” she told reporters last week. “It’s embarrassing, it’s the Potomac two-step. Do they think nobody’s paying attention? They’re just trying to cover themselves politically, isn’t it obvious?”

And then there’s the other political dilemma for Republicans who want to show they can secure Obamacare’s protections: convincing their base that they still fundamentally oppose Obamacare even if they don’t want to talk about repeal-and-replace anymore.

“You can be sure there are folks out there who really desperately don’t want to see the Texas side laughed out of court,” Whitlock said. “It destroys the whole narrative about the lawsuit. It’s this bizarre dynamic where an obscure lawsuit that has no legal basis whatsoever leaves the opportunity to talk about” repeal.

He added: “There are people who are flat-earthers on ACA, still preaching complete and total repeal.”