Tag Archives: ACA

Why Republicans can’t – and won’t – repeal Obamacare

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https://www.brookings.edu/opinions/why-republicans-cant-and-wont-repeal-obamacare/?utm_campaign=Economic+Studies&utm_source=hs_email&utm_medium=email&utm_content=41494378

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Now that the Republicans control both the presidency and both houses of Congress, they must put up or shut up on their promise to repeal and replace Obamacare. Here is a flat-footed prediction: the effort will fail for three reasons. First, the Affordable Care Act (aka the ACA or Obamacare) has largely succeeded not failed, as president-elect Trump and other Republicans falsely allege. Second, it is impossible for the stated goals of repeal to be achieved. Finally, the political fallout from the consequences of partial or total repeal would be devastating. When it comes to casting votes, enough Republicans will conclude that repeal is a bad idea and will join Democrats to sustain the basic structure of the health reform law.

ACA Repeal Efforts Would Impact State Laws, Too

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http://www.commonwealthfund.org/publications/blog/2017/jan/aca-repeal-efforts-impact-state-laws

Although the debate over the future of the Affordable Care Act (ACA) focuses largely on federal legislation, repeal and replacement efforts would significantly affect state approaches to insurance regulation.

State-level legislation and regulations help ensure that state regulators have full authority to enforce the ACA market reforms. As of November 2013, 32 states and D.C. had taken legislative or regulatory action to implement at least one of them. States with full enforcement authority can, for example, issue regulations or guidance, undertake market conduct exams, or take disciplinary action related to the law’s consumer protections, such as its ban on denying coverage based on preexisting conditions or charging women more than men. (To learn more about states’ approaches, see this resource and previous reports on implementation of the early market reforms and the 2014 market reforms.)

Healthcare Triage: Republican Plans for The Affordable Care Act

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Healthcare Triage: Republican Plans for The Affordable Care Act

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After campaigning for years on a plan of “repeal and replace Obamacare,” Republicans finally have the means within their grasp to make much of that possible. They control the presidency, the House, and the Senate. The filibuster still poses some potential threats to their plans, but it’s also within their means to abolish its widespread use in such a way that they could both repeal the Affordable Care Act and replace it with something of their own design.

What would that be? In contrast to what many say, there are Republican plans out there to consider. They’re the topic of this week’s Healthcare Triage.

‘Not Turning Back’: California Governor Vows To Protect State’s Health Care

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http://khn.org/news/not-turning-back-california-governor-vows-to-protect-states-health-care/

Gov. Jerry Brown (Neon Tommy via flickr)

In an unusually impassioned speech, Gov. Jerry Brown vowed Tuesday to protect California’s health care gains under Obamacare against Republican attempts in Washington, D.C., to roll them back.

“More than any other state, California has embraced the Affordable Care Act,” Brown told state legislators and appointees in his annual State of the State address at California’s Capitol. “I intend to join with other Governors and Senators, and with you, to do everything we can to protect the health care of our people.”

Brown said California would not “turn back” on advances it’s made in health coverage under pressure from the new Republican administration in Washington. Under the new federal leadership, he said, the “future is uncertain and dangers abound.”

Health coverage for Californians under the Affordable Care Act “has come with tens of billions of dollars from the federal government,” said Brown. “Were any of that were to be taken away, our state budget would be directly affected, possibly even devastated.”

Leveraging an estimated nearly $20 billion federal money, health coverage has been extended to five million Californians under Obamacare, which includes federally subsidized private health plans and an expansion of eligibility for Medicaid, the program for low-income people — known in this state as Medi-Cal.

 

Health Law Coverage Has Helped Many Chronically Ill — But Has Still Left Gaps

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http://khn.org/news/health-law-coverage-helped-many-chronically-ill-but-still-left-gaps/

Insulin injection pen

As President Donald Trump and Republicans in Congress devise a plan to replace the 2010 health law, new research suggests a key component of the law helped people with chronic disease get access to health care — though, the paper notes, it still fell short in meeting their medical needs.

Research published Monday in the Annals of Internal Medicine found that the number of chronically ill Americans with insurance increased by about 5 percentage points — around 4 million people — in 2014, the first year the law required Americans to have coverage, set up marketplaces for people to buy coverage and allowed for states to expand eligibility for Medicaid, the federal-state insurance plan for low-income people. If states opted into the Medicaid expansion, people with chronic illnesses such as heart disease, diabetes, depression and asthma were more likely to see those gains.

Still, the study suggests, the law fell short in terms of guaranteeing those people could get medical treatment, see a doctor and afford medications.

2017’s States Most Affected by ACA Repeal

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https://wallethub.com/edu/states-most-affected-by-aca-repeal/31413/

Top-Image-Most & Least Affected States by ACA Repeal

As promised, President Donald Trump on Jan. 20 issued an executive order to undo the Affordable Care Act, or ACA, as his first order of business. Republican senators wasted no time advancing the president’s agenda, either, using a powerful process known as budget reconciliation on Jan. 12 to begin rolling back large sections of the health law. Passage of the resolution followed in the U.S. House of Representatives two days later.

But much of the public as well as members of Congress, including several Republicans, have expressed concern about both the lack of a replacement for the current program and a clear timeline for its implementation — in addition to the cost of repealing the ACA.

Since former president Barack Obama’s signature health-care legislation — more popularly known as “Obamacare” — was passed in 2010, more than 20 million individuals have gained insurance coverage, resulting in the lowest uninsured rate in history by early 2016. Reversal of the law is expected to raise the uninsured rate by an estimated 18 million in the first plan year following repeal, then 32 million by 2026, according to official estimates.

What is clear from the prospect of the ACA’s dissolution is that certain states stand to suffer more than others. In order to assess repeal’s impact on Americans based on where they live, WalletHub’s analysts compared the 50 states and the District of Columbia across seven key indicators of both economic and coverage losses. Our data set ranges from “growth in uninsured population by 2019 post-ACA repeal” to “potential economic impact due to repeal of premium tax credits and Medicaid expansion (2019 to 2023).” Read on for our findings, expert insight and a full description of our methodology.

Keep or Replace Obamacare? It Might Be Up to the States

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Several Senate Republicans have proposed a plan that
offers three options for changing health care coverage
under the Affordable Care Act, also known as Obamacare.
One option allows states to continue using the existing
law. The other two options would change it in these ways:

Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans

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http://khn.org/news/block-grants-medicaid-faq/

block-grants

President Donald Trump’s administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year.

It’s called “block granting.” Right now, Medicaid, which was expanded under the 2010 health law to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —eventually translating into greater challenges in getting care for low-income people.

Block granting Medicaid is a centerpiece of health proposals supported by House Speaker Paul Ryan and Rep. Tom Price, Trump’s nominee to run the Department of Health and Human Services. This weekend, Trump adviser Kellyanne Conway emphasized the strategy as key to the administration’s health policy.

But what would this look like, and why is it so controversial? Let’s break down how this policy could play out, and its implications — both for government spending and for accessing care.

U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare

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http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20170123-story.html

Mergers in the healthcare sector: why you'll pay more

Aetna claimed this summer that it was pulling out of all but four of the 15 states where it was providing Obamacare individual insurance because of a business decision — it was simply losing too much money on the Obamacare exchanges.

Now a federal judge has ruled that that was a rank falsehood. In fact, says Judge John D. Bates, Aetna made its decision at least partially in response to a federal antitrust lawsuit blocking its proposed $37-billion merger with Humana. Aetna threatened federal officials with the pullout before the lawsuit was filed, and followed through on its threat once it was filed. Bates made the observations in the course of a ruling he issued Monday blocking the merger.

Aetna executives had moved heaven and earth to conceal their decision-making process from the court, in part by discussing the matter on the phone rather than in emails, and by shielding what did get put in writing with the cloak of attorney-client privilege, a practice Bates found came close to “malfeasance.”

The judge’s conclusions about Aetna’s real reasons for pulling out of Obamacare — as opposed to the rationalization the company made in public — are crucial for the debate over the fate of the Affordable Care Act. That’s because the company’s withdrawal has been exploited by Republicans to justify repealing the act. Just last week, House Speaker Paul Ryan (R-Wisc.) cited Aetna’s action on the “Charlie Rose” show, saying that it proved how shaky the exchanges were.
Bates found that this rationalization was largely untrue. In fact, he noted, Aetna pulled out of some states and counties that were actually profitable to make a point in its lawsuit defense — and then misled the public about its motivations. Bates’ analysis relies in part on a “smoking gun” letter to the Justice Department in which Chief Executive Mark Bertolini explicitly ties Aetna’s participation in Obamacare to the DOJ’s actions on the merger, which we reported in August. But it goes much further.

Before pulling the plug on Obamacare, listen to health care providers

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Before pulling the plug on Obamacare, listen to health care providers

As President Trump and the Republican majority in Congress prepare to repeal Obamacare, they would be wise to listen to those who actually provide health care.

No one is better positioned to see how the health care system is working — and how it can be improved — than the doctors, nurses, and support staff on the front lines. Clinical professionals understand the strengths and weaknesses of the law because they’ve had to live and work within the requirements of the Affordable Care Act.

So they should have a say in its fate, or at least its replacement.

I spent more than a decade studying the implementation of health care changes in the United States (the world’s most privatized health care system) and the United Kingdom (the world’s most socialized health care system). The findings were eye-opening.

When change was imposed from above, without the input and engagement of health care workers, implementation was rarely successful. Recall the fee-for-service reimbursement programs in Medicare and private insurance that incentivized more care rather than better care. Ask providers about the time wasted on the phone with insurance companies, or the mind-boggling number of clicks needed to execute a simple function in their electronic health record systems.