Tag Archives: ACA Repeal

Hospitals Pan Senate ACA Repeal Plan

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he hospital sector offers unanimous thumbs down to the Senate’s proposal to repeal and replace the Affordable Care Act.

The nation’s largest hospital associations united in rejecting the Senate’s proposal to repeal and replace the Affordable Care Act, and urged lawmakers to “hit reset” and “go back to the drawing board.”

Senate Airs Obamacare Repeal ‘Draft’

The response to the Senate plan released Thursday was virtually identical to the unanimous disdain shown this spring for the House Republicans’ American Health Care Act.

That is not surprising because the two bills are fundamentally the same on key points. They both eliminate the individual mandate, slash Medicaid, and eliminate a 3.8% tax on investment income above $200,000 that is a key funding source for Obamacare.

Moody’s Investors Service said Thursday the Senate bill would hurt hospitals.

“Under the proposed Senate bill, both for-profit and not-for-profit hospitals would face weaker demand for services and higher rates of uncompensated care expense, with the most significant impact on the sector occurring after 2020 when the changes to federal Medicaid funding are phased in,” said Daniel Steingart, a vice president at Moody’s.

“Transitioning federal Medicaid payments to a per-capita, or block grant system, and freezing Medicaid expansion would reduce the number of people with insurance and increase hospitals’ exposure to bad debt and uncompensated care costs.”

The nonpartisan Congressional Budget Office has yet score the bill, but by some estimates as many as 11 million people who gained coverage under the Medicaid expansion would be booted from the rolls under the Senate plan.

Hospitals Say ‘Hit Reset’

Rick Pollack, president and CEO of the American Hospital Association, said the Senate Better Care Reconciliation Act “moves in the opposite direction” from “key principles” the AHA had set down to protect health insurance coverage, particularly for vulnerable patients.

How the American Health Care Act’s Changes to Medicaid Will Affect Hospital Finances in Every State

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http://www.commonwealthfund.org/publications/blog/2017/jun/how-changes-to-medicaid-will-affect-hospital-finances-in-every-state?omnicid=EALERT1231316&mid=henrykotula@yahoo.com

The American Health Care Act (AHCA), as passed by the U.S. House of Representatives, will reduce federal spending on Medicaid by more than $834 billion over the next 10 years. And the recently released Senate bill appears to cut Medicaid even more deeply. In addition to repealing the Medicaid expansion, the bills place caps on the federal dollars that states receive to provide health insurance to millions of low-income Americans, including the elderly, disabled, and people with opioid addiction.

We modeled the impact of this loss of Medicaid funding on U.S. hospitals and found that, over the next 10 years, hospitals in all states, but especially hospitals in Medicaid expansion states, will see an increase in uncompensated care—a treatment or service not paid for by an insurer or patient. We also saw declines in hospitals’ operating margins, particularly among hospitals in expansion states. Rural hospitals in nonexpansion states also would face marked operating margin decreases.

In the interactive state-by-state maps below, we present the estimated impact of the Medicaid provisions in the House-passed AHCA on the finances of all U.S. hospitals. The hospitals in the District of Columbia and the 31 states that expanded Medicaid are projected to see a 78 percent increase in uncompensated care costs between 2017 and 2026. Eleven of these states will see uncompensated care costs at least double between 2017 and 2026. For example, Nevada hospitals will see a 98 percent increase, West Virginia a 122 percent increase, and Kentucky a 165 percent increase.

In addition to growing uncompensated care, our projections indicate that under the AHCA, hospitals in most states will experience a decline in Medicaid revenues, even though the law restores Medicaid disproportionate share hospital (DSH) payments. Hospitals in Medicaid expansion states may experience a 14 percent drop in Medicaid revenues between 2017 and 2026, compared to a 3 percent anticipated reduction among hospitals in the 19 states that did not expand. Some states may see more dramatic drops. Arkansas hospitals, for example, are estimated to see a 31 percent decline in Medicaid revenue over the next 10 years.

The Health 202: Here’s what’s in the Senate health-care bill

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https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/06/22/the-health-202-here-s-what-s-in-the-senate-health-care-bill/594aa367e9b69b2fb981dde9/?utm_term=.fd77d3f3481a

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The Senate version of the repeal (and “replacement”) of the Affordable Care Act — which Mitch McConnell is now sharing with Senate Republicans — eliminates just about all of its extra taxes on the rich by deeply cutting Medicaid and reducing subsidies to the poor. But McConnell figures he can keep moderate Republicans in the fold (he needs almost all their votes) by delaying these provisions and allowing states to reduce insurance coverage.

The plan:

1. Basically retains Obamacare’s insurance subsidies. But starting in 2020 this assistance wouldn’t be available for most of the working-class who now receive them, nor for anyone ineligible for Medicaid. See #2.

2. Cuts Medicaid more deeply than the House version by giving states an amount per person that grows more slowly than the growth in healthcare costs. This provision won’t kick in for 7 years, well past senators’ next reelection battles.

3. Ends the Affordable Care Act’s Medicaid expansion in 5 years — gradually reducing the extra federal payments starting in 2021.

4. Continues to protect patients with preexisting conditions, but allows states to reduce insurance coverage to everyone, including people with preexisting conditions.

In other words, all cuts are made through the back door of delays and state waivers. It only looks like a kinder, gentler version of the House repeal of the Affordable Care Act — but 7 to 10 years from now its result would be even crueler.

The Senate health bill is out. Here’s your speed read

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https://www.axios.com/the-senate-bill-is-out-heres-your-speed-read-2446201141.html

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You can read it here, and a summary here. The highlights:

  • Ends the Affordable Care Act’s mandates and most of its taxes.
  • Phases out its Medicaid expansion over three years, ending in 2024.
  • Limits Medicaid spending with per capita caps, or block grants for states that choose them. The spending growth rate would become stricter in 2025.
  • States could apply for waivers from many of the insurance regulations.
  • The ACA’s tax credits would be kept in place, unlike the House bill — but their value would be reduced.
  • Funds the ACA’s cost-sharing subsidies through 2019, but then repeals them.

Want more? Keep reading.

  • There’s a stabilization fund to help states strengthen their individual health insurance markets.
    • $15 billion a year in 2018 and 2019, $10 billion a year in 2020 and 2021.
    • There’s also a long-term state innovation fund, $62 billion over eight years, to help high-cost and low-income people buy health insurance.
  • The ACA tax credits continue in 2018 and 2019.
  • After that, they’d only be available for people with incomes up to 350 percent of the poverty line.
  • The “actuarial value” — the amount of the medical costs that insurance would have to cover — would be lowered to 58 percent, down from 70 percent for the ACA’s benchmark plans. That’s likely to reduce the value of the tax credits.
  • All ACA taxes would be repealed except for the “Cadillac tax” for generous plans, which would be delayed.
  • Medicaid spending growth rate under per capita caps would be same as House bill until 2025. Then it switches to the general inflation rate, which is lower than House bill.
  • States would be able to impose work requirements for people on Medicaid, except for the elderly, pregnant women and people with disabilities.
  • Children with complex medical needs would be exempt from the per capita caps.

Meet The Republican Men Reshaping Your Health Care

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http://californiahealthline.org/news/meet-the-republican-men-secretly-reshaping-your-health-care/

Who are the GOP senators who worked on the American Health Care Act behind closed doors? You’ve likely heard they are all white men chosen by Majority Leader Mitch McConnell. Here are some of their vital stats that may have influenced the outcome.

Access to Coverage and Care for People with Preexisting Conditions: How Has It Changed Under the ACA?

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http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/coverage-care-preexisting-conditions-aca

Abstract

Issue: Prior to the Affordable Care Act (ACA), people with preexisting health conditions could be denied insurance coverage or charged higher rates. If the law is repealed, these protections could be diluted or lost altogether.
Goals: Assess the ACA’s impact on coverage and access for people with preexisting conditions and compare their coverage gains with state high-risk-pool enrollment pre-ACA.
Methods: Analysis of Behavioral Risk Factor Surveillance System data for the period 2011–13 to 2015.
Key Findings and Conclusions: Between 2013 and 2015, 16.5 million nonelderly adults gained coverage following full ACA implementation. Of those, 2.6 million had preexisting conditions that could have otherwise precluded them from coverage because of discriminatory denials and pricing; 9.4 million had conditions that could have otherwise affected insurance cost. We found strong correlations between these coverage gains and access to care. Coverage and access gains for people with preexisting conditions were unrelated to the size or existence of the state high-risk pools that 35 states funded for such individuals pre-ACA. Our findings suggest that proposals to replace current protections for people with preexisting conditions with high-risk pools are unlikely to be sufficient to maintain the ACA’s gains.

Background

Americans with chronic health conditions are at the center of the debate over access to health care coverage. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) estimates the number of Americans with such “preexisting conditions” ranges from 19 percent to 50 percent of all nonelderly Americans.1,2 This range represents the difference between conditions that fit into a “narrow” definition of preexisting conditions (19%), and a “broad” definition (50%). The narrow definition includes very costly health conditions that would cause insurers to refuse coverage absent the Affordable Care Act’s (ACA) provisions; the broad definition includes slightly less expensive chronic health conditions that could nevertheless make the cost of insurance in the individual market without the ACA largely unaffordable for most patients.

In 2016, the Henry J. Kaiser Family Foundation, in its review of pre-ACA medical underwriting practices, estimated that 27 percent of nonelderly American adults had health conditions that “would likely leave them uninsurable if they applied for individual market coverage.”3 Similarly, a Commonwealth Fund study found that, in 2010, 36 percent of adults ages 19 to 64 who had tried to buy a plan in the individual market over the prior three years were turned down, charged a higher price, or had a condition excluded from their coverage because of a health problem.4

The presence of preexisting conditions is particularly important for the millions of Americans who have gained coverage under the ACA, which Congress and the Trump administration are seeking to repeal.5 The Commonwealth Fund study found significant improvements in the ability of people with health problems to purchase plans on their own in 2016 relative to 2010.6

In this issue brief, we observe whether the coverage gains for people with preexisting conditions also have resulted in better access to care. Better access is defined as a greater likelihood of having a regular health care provider (whether one or more than one clinician) and having less trouble seeing a provider because of the cost.

Prior to passage of the ACA, many states had high-risk pools that sought to provide coverage to individuals locked out of the individual insurance market because of expensive preexisting conditions. Between 2010 and 2013, the ACA funded the Pre-Existing Condition Insurance Program, a set of federally funded high-risk pools to provide interim coverage for those with such conditions. If these pools had been successful in addressing coverage for those with preexisting conditions, we would expect to see a smaller gain in access to care for this population in those states that had previously enrolled substantial shares of the nongroup market in the pools.

Under the ACA, Americans with Preexisting Conditions Gained Coverage and Better Access to Care

For this brief, we considered both the narrow and broad definitions of preexisting conditions. Among the general population surveyed between 2011 and 2015, data from the Behavioral Risk Factor Surveillance System (BRFSS) indicate that 20 percent of Americans have preexisting conditions under the narrow definition and 61 percent of Americans have these conditions under the broader definition. Using the BRFSS data, we estimate that 16.5 million more people were insured in 2015 than in the 2011–2013 period.7 Among this newly insured group, 2.6 million had one or more preexisting conditions under the narrow definition and 9.4 million had one or more under the broader definition (Exhibit 1).

 

 

 

Live coverage: Senate GOP unveils its ObamaCare repeal bill

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http://thehill.com/policy/healthcare/338922-live-coverage-the-senate-unveils-its-obamacare-repeal-bill

Click to access SENATEHEALTHCARE.pdf

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A discussion draft of the Senate bill has been posted. The full text of the 142-page bill can be read here.

Senators are still in their healthcare meeting, which began at 9:30 a.m.

The Senate draft includes deep cuts to Medicaid and would fundamentally reshape it from an open-ended government commitment to a system of capped federal payments that limit federal spending.

The bill repeals billions of dollars ObamaCare taxes used to raise money for the law’s coverage expansion and also abolishes the law’s mandates to buy coverage.

The health law’s tax credits to help people buy private coverage would be kept, but would be reshaped so that they are less generous and cost the government less money.

It also phases out the federal funding for ObamaCare’s expansion of Medicaid over four years — from 2020 to 2024 –less than the seven-year phase out favored by more moderate Republicans.

Five things to watch in Senate GOP’s ACA repeal bill

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Five things to watch in Senate GOP’s ObamaCare repeal bill

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A draft of the long-awaited Senate healthcare bill, crafted behind closed doors, will be publicly unveiled on Thursday.

Just a day before the bill’s scheduled release, some senators said they still didn’t know the details of some key provisions, creating uncertainty as Senate Majority Leader Mitch McConnell (R-Ky.) pushes toward a vote next week.

Here’s what to watch for.

Obamacare’s exchanges face their moment of truth

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https://www.washingtonpost.com/news/wonk/wp/2017/06/21/obamacares-exchanges-face-their-moment-of-truth/?_hsenc=p2ANqtz-8F5Et7EX-urS45blQiAgeOiovYIB4wXwv7AdGl1uVqRN78tI5gRCLl9EBfi-9z5qrbDTnToj2wGgiL5MWgwa6otTMFYA&_hsmi=53440118&utm_campaign=KHN%3A%20First%20Edition&utm_content=53440118&utm_medium=email&utm_source=hs_email&utm_term=.3252edd9c52b

Insurers hit a major deadline Wednesday: They must inform regulators in 39 states whether they will sell insurance on many Affordable Care Act marketplaces and, if so, how much they would like to charge.

It’s something of a moment of truth for the Affordable Care Act’s marketplaces, whose health depends in large part on the participation of private insurers. And so far, states are seeing mixed results: One major insurer has made a big pullout, while a different one announced it would expand into new states.

Insurance giant Anthem announced it would leave the marketplaces — also called exchanges — where individuals can use federal subsidies to buy health plans in two states in 2018, Indiana and Wisconsin. Oscar Health, a start-up company that was co-founded by Ivanka Trump’s brother-in-law, announced it would expand in Ohio, New Jersey, Texas, Tennessee, California and New York.

The deadline applies to all 39 states whose marketplaces are run by the federal government. An evolving map by the Kaiser Family Foundation showing which counties are at risk of having no insurance options next year highlights 44 counties in four states, where about 30,000 people buy insurance through the marketplaces.

People who buy individual insurance plans in the marketplaces can take advantage of federal tax credits that are pegged to income and reduce monthly premium payments. To date, there has not been a county with zero insurers selling policies on its marketplaces, and it’s not totally clear what will happen if a county is left without any plans. It’s possible, however, that without a functional exchange, would-be participants would have to shoulder the full costs of their health insurance — or go without.

The future of the marketplaces has become a major political talking point, with the White House declaring the marketplaces a failure. Democrats blame the struggles of the market on Republicans’ failure to offer insurers reasonable clarity about the future. In particular, insurers have complained that decision-making has been difficult without certainty that cost-sharing reduction subsidies, federal payments that help bring down the out-of-pocket costs for lower-income Americans, will be paid next year.

The business of selling health coverage on the Affordable Care Act marketplaces has become “difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage,” Anthem said in a statement announcing the decision.

Mario Schlosser, chief executive of the start-up Oscar, made the opposite decision to expand its small footprint because of his faith in the long-term business of selling insurance to individuals.

“When the dust settles, there is more work to be done on the regulatory side to make sure it will be stable, but I’m confident we will see a stable market there,” Schlosser said.

MDwise Marketplace, an insurer in Indiana also announced it would leave that state’s exchange. That could put four counties at possible risk of having no insurer next year, according to Kaiser, although that is uncertain because a different insurer, Centene, has announced it is expanding in the state. A spokeswoman for Centene said the company was still working through the filing process and would not share information until it was complete.

Kaiser found counties in Ohio, Missouri and Washington are at risk of having no insurers.

Democrats to slow-walk Senate business over health care bill

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https://www.usatoday.com/story/news/politics/2017/06/19/democrats-halt-senate-business-over-health-care-bill/103012262/?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=53324518&_hsenc=p2ANqtz-8NpDGDFUkQIuhKz8d8GWAlDDWC2mqcN0hJfp_LlAcTnc81nyyDtb3Ah782Ee3PptGo5xWZ8yPbj1T7bkeh-DIp55enpQ&_hsmi=53324518

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Democrats will begin slow-walking Senate business on Monday as part of their opposition to Republican attempts to overturn the Affordable Care Act.

Senate Minority Leader Chuck Schumer of New York said Democrats will object to requests for “unanimous consent” to set aside rules and expedite proceedings. The procedural move is a tactic the minority party can use to draw out the legislative process for days, forcing Republicans to jump through procedural hurdles to get anything done.

The goal, he said, is to refer the GOP health care bill to a committee where it can be debated and amended publicly. Republicans are writing their bill “under the cover of darkness because they’re ashamed of it,” he said.

“This is a bill that would likely reorder one-sixth of the American economy and have life-and-death consequences for millions of Americans, and it’s being discussed in secret with no committee hearings, no debate, no amendments, no input from the minority,” he said. “This is the most glaring departure from normal legislative procedure that I have ever seen.”

The move coincides with a new #AmericaSpeaksOut campaign Senate Democrats launched Monday urging Americans to “speak out against Trumpcare and share their stories.” They also plan to hold the Senate floor tonight with speeches about health care.

The House passed its Obamacare repeal bill in May, but Senate Republicans have been drafting their own bill behind closed doors.

In a letter, Democrats provided some Senate Republican leaders with a list of all 31 potential Senate rooms “to assist” Republicans in scheduling a hearing.

They wrote that Democrats, by comparison, held about 100 hearings and meetings, accepted more than 150 amendments sponsored or cosponsored by GOP senators and spent 25 days in floor debate during the drafting of the Affordable Care Act.

The move by Democrats to slow Senate business will not impact consideration of President Trump’s nominee to lead the Federal Emergency Management Agency, Brock Long, who is expected to be confirmed Tuesday, according to a Senate Democratic aide. Schumer said Democrats would not object to requests for unanimous consent on honorary resolutions, either.

The greater impact likely will be the interruption of the legislative process and routine Senate business.

Speaking on the Senate floor, Schumer asked Senate Majority Leader Mitch McConnell of Kentucky to hold an all-senators meeting to discuss a bipartisan way forward on lowering the cost of health care, raising the quality of care and stabilizing the insurance marketplaces.

McConnell responded that senators would meet on the Senate floor with an unlimited amendment process. He said there would be “ample opportunity” to read and amend the bill when Schumer asked whether Democrats would have more than 10 hours to review it.

“I rest my case,” Schumer said.

CBO: House Obamacare repeal will increase uninsured by 23 million

Senate Republicans draft Obamacare repeal bill behind closed doors

Republicans blame Democrats for refusing to negotiate on a health care bill.

“Democrats for MONTHS have stated they have no interest in working with Republicans on fixing Obamacare,” Michael Reed, the Republican National Committee’s research director and deputy communications director, wrote in a statement. “Now, Democrat efforts to feign outrage over health care negotiations should be seen for what it is — a pure partisan game aimed at placating the far-left.”

McConnell, in a Senate floor speech, said Obamacare has increased costs and reduced choice, causing Americans to drop coverage. He said the entire Senate Republican conference has been “active and engaged” for months on legislation that would stabilize insurance markets, remove mandates to buy insurance, and preserve access to care for those with pre-existing conditions.

“We believe we can and must do better than Obamacare’s status quo,” he said.

The House-passed health care bill, called the American Health Care Act, would lead to 23 million fewer people having health insurance by 2026, according to the Congressional Budget Office. If the Senate is able to pass health care legislation, the two chambers will have to come to a compromise to get a final bill to Trump’s desk.

As Democrats prepared for battle over the Senate bill, conservative House Republicans planned to send a letter to McConnell warning against letting the legislation get too moderate if he wants to keep support from the House after it passed the Senate.

The letter from the Republican Study Committee, which has more than 150 members, states that its members have “serious concerns regarding recent reports suggesting that the Senate’s efforts to produce a reconciliation bill repealing the Affordable Care Act are headed in a direction that may jeopardize final passage in the House of Representatives,” according to a copy of the draft obtained by USA TODAY.