Tag Archives: ACA

Sanders’ single-payer push splits Democrats

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http://www.politico.com/story/2017/09/13/bernie-sanders-single-payer-democrats-medicare-242616

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Most liberals are on board with the bill being introduced Wednesday, but Democratic leaders and vulnerable incumbents largely steer clear.

Bernie Sanders’ single-payer health care plan has won over most other liberal senators, including many weighing 2020 bids.

The rest of the Democratic Party is another matter.

As Sanders prepares to unveil his Medicare for All legislation on Wednesday, most of the party’s congressional leaders and vulnerable Senate incumbents are steering clear. Even as the left celebrates Sanders’ ability to push the Democratic agenda leftward after his primary challenge to Hillary Clinton last year, that success appears to have its limits.

Senate Minority Leader Chuck Schumer told reporters that he would be “looking at all of” the party’s “many good” proposals to expand health care access, but declined to back Sanders. House Minority Leader Nancy Pelosi declared that her priority is shielding Obamacare from a GOP repeal push that’s not yet dead for good.

Connecticut Sen. Chris Murphy, one of the few Democrats subject to 2020 speculation who has not signed on to the Sanders bill, warned against letting the party’s attention slip to “longer-term health care policy” while the future of the Affordable Care Act remains up for debate.

“I think the risk is that we get distracted,” Murphy told reporters. “September’s not done. They can still ram through a repeal bill.”

Wisconsin Sen. Tammy Baldwin on Tuesday became the single-payer bill’s first supporter from the class of Senate Democrats up for reelection next year in states Trump carried. But other politically imperiled incumbent Democrats have said no to Sanders.

Sen. Claire McCaskill said in a brief interview that lawmakers have more work to do to keep health care costs in check “before we would think about expanding that [Medicare] system to everyone.”

Single-payer on a national level would have “a lot of problems,” McCaskill added, although she came out in support of allowing individuals as young as 55 to buy into Medicare. That idea is also backed by Baldwin and two other red-state Democrats up for reelection next year who are declining to endorse Sanders’ bill: Sens. Sherrod Brown of Ohio and Debbie Stabenow of Michigan.

Stabenow, also a member of Democratic leadership, said Tuesday that she would keep working on her Medicare-at-55 plan “because I think there is some bipartisan interest in that.” She said the party’s first order of business should be shoring up the Obamacare markets, followed by other goals.

“The first thing has to be to protect the health care people have now and stabilize markets, no question,” Stabenow said. “But we need to focus on lowering the cost of prescription drugs and providing more health care, more health care options.”

Improving the Affordable Care Act is the core of a bipartisan effort in the Senate health committee. The panel’s ranking member, Sen. Patty Murray of Washington, a member of the Democratic leadership, also declined to endorse Sanders’ bill on Tuesday.

“There’s a lot of Democratic ideas out there, and I haven’t had the chance to look at all of them,” Murray said, adding that she remains “very focused” on the committee’s work.

Republicans have already seized on the high costs of imposing a single-payer system — which Sanders’ presidential campaign proposed to pay for with new taxes on employers and wealthy individuals — to hammer Democrats for supporting the idea. The National Republican Senatorial Committee criticized Baldwin on Tuesday for backing “the left’s radical plans for government-run health care.”

Sen. John Barrasso (R-Wyo.), a member of GOP leadership, also reminded reporters Tuesday that Sanders’ home state of Vermont had to back away from its own single-payer health proposal after the economic burden proved too onerous.

Backers of the Sanders bill acknowledge that single-payer is a heavy political lift but describe it as an important benchmark for Democrats’ future. As the party hones its identity beyond opposition to Trump’s agenda, single-payer fans see enough room to set big long-term goals while waging the shorter-term battle to protect Obamacare.

“There’s nothing about the politics of the moment or the Affordable Care Act that in any way precludes supporting Medicare-for-all as the ultimate goal, and there’s a clear path to it,” said Sen. Richard Blumenthal. The Connecticut Democrat signed on to the bill Tuesday.

Sen. Al Franken (D-Minn.), who has been mentioned as a possible 2020 candidate, also expects to sign on to the single-payer bill, a spokesman said Tuesday. Franken noted that his cosponsorship reflects the bill’s status as a long-term goal while the party continues short-term work on Obamacare.

“This bill is aspirational, and I’m hopeful that it can serve as a starting point for where we need to go as a country,” Franken said in a statement. “In the short term, however, I strongly believe we must pursue bipartisan policies that improve our current health care system for all Americans — and that’s exactly what we’re doing right now in the Senate Health Committee, on which both Senator Sanders and I sit.”

For other Democrats, however, the idea’s time may have not yet come.

Ben Cardin said in an interview that he supports universal health coverage but has “certain concerns” about using single-payer to achieve that goal.

“There’s the political issue, but there’s also the issue about how you make sure there will be adequate resources put into health care,” the Maryland Democrat said.

Sen. Joe Manchin of West Virginia, a member of leadership who’s among the GOP’s top targets in 2018, walked a fine line Tuesday as Republicans revived his past comments welcoming a discussion of a government-run health care system.

“I am skeptical that single-payer is the right solution, but I believe that the Senate should carefully consider all of the options through regular order so that we can fully understand the impacts of these ideas on both our people and our economy,” Manchin said in a statement on Tuesday.

Sen. Dianne Feinstein, facing consternation from liberals in her home state of California — where an effort to enact single-payer statewide ran aground this year — said that she would want to see the price tag before taking a position on Sanders’ bill.

“My understanding is, the cost of single-payer is enormous,” Feinstein said, noting that she supports a public option for health insurance outside the private market.

Murphy and Hawaii Sen. Brian Schatz have offered their own ideas to shift the party’s health care debate leftward without going as far as Sanders’ plan would. The Connecticut Democrat is working on legislation creating a Medicare buy-in for all individuals and businesses, while Schatz told POLITICO he expects to release a Medicaid buy-in proposal later this month.

Murphy said he would not sign on to Sanders’ bill before its release, urging “our party to take some time and look at all the options available to us before we decide on one unitary route.”

And even as some Sanders-aligned activists spook Democrats with talk of possible primary challenges to candidates who don’t support the single-payer plan, other liberals were content to cheer the Vermont independent for attracting more than one-quarter of the caucus to his legislation. Progressive Change Campaign Committee co-founder Adam Green, who worked with Murphy on the Medicare buy-in plan, said that “Democrats are increasingly wrapping themselves in the flag of” Medicare for all without closing off other options that advance the ball.

“This is how big ideas like expanding Social Security and debt-free college were moved into the mainstream — the North Star gets put up, solid organizing is done, critical mass is built in Congress and on the campaign trail, and party consensus falls into place,” Green said by email. “It’s happening now.”

Senate bargainers say deal reached on children’s health

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http://abcnews.go.com/Health/wireStory/senate-bargainers-deal-reached-childrens-health-49809048

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Senate Republican and Democratic bargainers reached agreement late Tuesday to extend financing for the children’s health insurance program for five years, a pact that if approved would avert an end-of-month cash crunch for the popular program.

In a concession to Republicans, the agreement would phase out extra federal funds that have gone to states for the program since the additional money was mandated as part of President Barack Obama’s 2010 health care law.

Money for the federal-state program is due to expire at the end of September. The program provides health coverage to around 8 million low-income children and pregnant women.

It was initially unclear how the agreement would fare in the Senate and the House.

But the two negotiators — Senate Finance Committee Chairman Orrin Hatch, R-Utah, and that panel’s top Democrat, Ron Wyden of Oregon — work closely with party leaders. In addition, having embarrassingly failed in this year’s attempt to repeal Obama’s health care statute, Republicans and President Donald Trump are eager for an accomplishment and would be unlikely to stymie the continuation of such a widely supported initiative.

It was also unclear if the pact would move quickly and by itself through Congress, or become a vehicle for other, less widely backed legislation.

In a written statement, Hatch said “Congress needs to act quickly” to extend the program.

Without providing detail, Hatch said the agreement would give states “increased flexibility” to run the program. He also said lawmakers will “continue to advance this agreement in a way that does not add to the deficit,” suggesting that a compromise on how to pay for the extra funds may have not yet been found.

Wyden called the agreement “a great deal for America’s kids.”

The federal government pays around $7 billion annually for the program. States by law pay a small share — until recently, an amount ranging from 15 percent to 35 percent of costs.

But under Obama’s law, states each received an additional 23 percent share from Washington. Many Republicans, particularly conservatives, have chafed at that added amount.

Under the agreement, the full 23 percent share would continue for two more years. It would phase down to 11.5 percent in 2020 and the extra money would disappear completely the following year. The details were provided by a Senate aide who spoke on condition of anonymity because full details weren’t released.

Uninsured Rate In U.S. Falls To A Record Low Of 8.8%

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Uninsured Rate In U.S. Falls To A Record Low Of 8.8%

Three years after the Affordable Care Act’s coverage expansion took effect, the number of Americans without health insurance fell to 28.1 million in 2016, down from 29 million in 2015, according to a federal report released Tuesday.

The latest numbers from the U.S. Census Bureau showed the nation’s uninsured rate dropped to 8.8 percent. It had been 9.1 percent in 2015.

Both the overall number of uninsured and the percentage are record lows.

The uninsured rate has fallen in all 50 states and the District of Columbia since 2013, although the rate has been lower among the 31 states that expanded Medicaid under the health law. California’s rate was 7.3 percent in 2016, less than half of its 17.2 percent rate in 2013.

“California has shown that the Affordable Care Act is working to expand health coverage and provide new patient protections,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group. “While many thought our nation’s rising uninsured rate was unsolvable, the advancement in California shows that if policymakers and the public are united in trying to make reform work, we can do big things.”

The latest figures from the Census Bureau effectively close the book on President Barack Obama’s record on lowering the number of uninsured. He made that a linchpin of his 2008 campaign, and his administration’s effort to overhaul the nation’s health system through the ACA focused on expanding coverage.

When Obama took office in 2009, during the worst economic recession since the Great Depression, more than 50 million Americans were uninsured, or nearly 17 percent of the population.

The number of uninsured has fallen from 42 million in 2013 — before the ACA in 2014 allowed states to expand Medicaid, the federal-state program that provides coverage to low-income people, and provided federal subsidies to help lower- and middle-income Americans buy coverage on the insurance marketplaces. The decline also reflected the improving economy, which has put more Americans in jobs that offer health coverage.

The dramatic drop in the uninsured over the past few years played a major role in the congressional debate over the summer about whether to replace the 2010 health law. Advocates pleaded with the Republican-controlled Congress not to take steps to reverse the gains in coverage.

The Census numbers are considered the gold standard for tracking who has insurance because the survey samples are so large.

Among the states, the lowest uninsured rate last year was 2.5 percent in Massachusetts and the highest was 16.6 percent in Texas, the Census Bureau said. States that expanded Medicaid had an average uninsured rate of 6.5 percent compared with an 11.7 percent average among states that did not expand, the Census Bureau reported.

More than half of Americans — 55.7 percent — get health insurance through their jobs. But government coverage is becoming more common. Medicaid now covers more than 19 percent of the population and Medicare nearly 17 percent.

Hospital Impact—The only thing clear about healthcare policy is the continued lack of clarity

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http://www.fiercehealthcare.com/hospitals/hospital-impact-only-thing-clear-about-healthcare-policy-continuing-lack-clarity?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWldFeE1XUXlPRFE0TlRneCIsInQiOiJ5dzRsZ1IwekxcL2FMZnN3NkJIOHZGbnpNV1RPcmtMNmdPd1MwV0RLUXNBSXl6QzJnK0s0NktPVzBLOUtRRjF1K0puZzZMZG95dERnN2VUcVRpeForakRVZVJsXC9GWllyU1g1Rk9ZY2pERVRQcjVyT1wvQkMycXdobjd5UnNKa2p3NiJ9

Executive looking out window

For healthcare leaders, it’s discouraging that federal policy decisions seem to be made at the last minute without much planning or consideration of unintended consequences.

I spent my Labor Day vacation in Monterrey, California, watching the waves crash into the sand and wondering what the future of healthcare will look like in the coming months and years. Some clarity is emerging that we have not seen in the past, and I feel comfortable making some observations and predictions:

  • Congress will not revisit the repeal and replacement of the Affordable Care Act before the end of the year. It is simply dealing with far too many other issues—passing a budget, raising the debt ceiling, approving disaster aid for Harvey and Irma, not to mention its desire for tax reform—that lawmakers must address.
  • While the Senate HELP committee is attempting a bipartisan effort to shore up the ACA, the issues listed above will make it almost impossible for such a law to be passed during this session.
  • The leadership of the Department of Health and Human Services ideologically opposes the very concept of the ACA and is also responsible for implementing the law. The tension between those two facts will lead to confusion and uncertainty for those of us in healthcare.
  • The passage of the ACA changed the terms of debate around healthcare reform. Granting health insurance to more than 20 million Americans has now shifted public opinion so that a solid majority believes the federal government should ensure that its citizens have insurance.
  • The ACA is not failing, but going forward it can be undermined without congressional action.

As a former anatomic pathologist, I am always interested in postmortem examination of failures, and the failure of Republicans to repeal the ACA ranks high in any list of stunning political disasters. Pundits have identified several possible causes:

  • Republicans never had a clear replacement plan or goal.
  • Taking away benefits from 22 million Americans is politically unpopular.
  • The ACA was not in a “death spiral.”
  • The president did not exert necessary leadership to get GOP senators to support his unpopular position.
  • Republican governors who had expanded Medicaid did not support the effort.
  • Organized opposition to repeal led to most Americans not supporting repeal.

Autopsy results always arrive too late for those of us who are still alive, and it is more important for those of us in healthcare to interpret the mixed messages coming out of HHS and Congress so that our organizations can continue to care for patients under the current system.

HHS seems willing and eager to let states experiment with healthcare reform. Alaska has received approval for $323 million over five years to subsidize insurance carriers and stabilize its individual ACA marketplace. Iowa is likely to receive approval for a radical 1332 waiver approach to healthcare reform in the Hawkeye state, and other states are preparing waiver submissions.

Meanwhile, HHS actions that seem to undermine the ACA include refusing to guarantee cost-sharing reduction subsidies to insurance companies and slashing the budget to support ACA enrollment for 2018. HHS recently announced advertising budget cuts of 90% for 2018 and the navigator program cuts of 40%.

A recent study—detailed in a post on The Incidental Economist blog—compared Kentucky ACA enrollment under a Democratic governor who supported advertising and a Republican governor who cut advertising. It found that lack of TV advertising led to 450,000 fewer page views on the ACA website and 20,000 fewer unique visits to the enrollment website.

ACA supporters, meanwhile, have recently put together a private enrollment campaign for 2018 to fill in the gap created by HHS decisions, Axios reported.

Last week, the Senate HELP Committee heard from state insurance commissioners and governorsabout ideas to stabilize the ACA marketplaces. They include:

  • Funding the cost-sharing reduction subsidies to insurance companies.
  • Facilitating reinsurance programs.
  • Expanding the ACA 1332 waiver programs to let states innovate.
  • Funding enrollment activities such as advertising and navigator programs.

Although health policy experts largely support these recommendations, it is hard to see how such a divided Congress could pass such proposals. Even if such legislation were approved, it would likely come too late to impact health insurance company decisions for 2018.

So, as of early September, we are left with the ACA continuing to be the law of the land, but with those in charge of the federal government not entirely supporting its success. Healthcare organizations have difficulty caring for patients when the rules keep changing and when clarity is hard to come by. It is also discouraging that decisions seem to be made at the last minute without much planning or consideration for unintended consequences.

That said, we still need to keep taking care of patients. My advice is to:

  • Continue to prepare for the transition from fee-for-service to value-based payments, but be aware that the Trump administration might slow down this process.
  • Continue to cut unnecessary costs.
  • Continue to improve the measurable quality of the care you give.
  • Participate in efforts in your individual states to innovate through waiver programs.
  • Collaborate with your physicians who are confused by all the uncertainty.
  • Keep up to date with the frequent changes that nobody can predict.

 

 

Healthcare Triage News: Congress is Back, and Healthcare Should Be on the To-do List

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Healthcare Triage News: Congress is Back, and Healthcare Should Be on the To-do List

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Congress is back in session, and it has a full month ahead. They have to deal with hurricanes, raise the debt limit, fund the government, keep us out of war, AND they want to talk about cutting taxes, too. With all this going on, it’s going to be hard to get anything done around healthcare, but there’s lots that needs to be done.

There’s one Obamacare repeal bill left standing. Here’s what’s in it.

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https://www.washingtonpost.com/graphics/2017/politics/cassidy-graham-explainer/?utm_term=.c90e0ce41aa2

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After a dramatic series of failed Senate votes in July, there’s one repeal-and-replace plan for the Affordable Care Act left standing. Trump is pushing for a vote, per Politico, and John McCain has announced his support, but the bill has yet to gain significant traction.

The proposal, crafted by Sens. Bill Cassidy (R-La.), Lindsey O. Graham (R-S.C.) and Dean Heller (R-Nev.), essentially turns control of the health-care markets over to the states. Rather than funding Medicaid and subsidies directly, that money would be put into a block grant that a state could use to develop any health-care system it wants. It also allows states to opt out of many ACA regulations. “If you like Obamacare, you can keep it,” Graham has said, using a common nickname for the health-care law. “If you want to replace it, you can.”

In reality, that may not be true. The Medicaid expansion and subsidy funding would be cut sharply compared to current spending, going to zero in a decade.

 “You can’t actually keep the same program if your federal funding is being cut by a third in 2026,” said Aviva Aron-Dine, a senior fellow at the left-leaning Center on Budget and Policy Priorities. And even putting aside the cuts, she said, the block grant structure would fundamentally change the health-care landscape. “[Funding] is capped, so it wouldn’t  go up and down with the economy,” when fewer or more people become eligible for subsidies.

Republicans contest this. The drop in funding “gives strong incentives for the states to be more efficient with their program,” said Ed Haislmaier, a senior fellow at the conservative Heritage Foundation. That is, states may be able to maintain the ACA structure and regulations as long as they streamline operations.

If the streamlining turns out to be insufficient, the cuts would hit liberal states the hardest, according to a report by the Center for Budget and Policy Priorities. This is largely because they tend to be the biggest spenders on health care: They’ve expanded Medicaid and aggressively signed people up for marketplace coverage. They have the most to lose.

 On the whole, Aron-Dine says, “This is a lot more similar to the [Senate repeal bill] than different. All of them end with devastating cuts to marketplace subsidies, Medicaid, and weakening of consumer protections.”

Haislmaier agreed, pointing out the Cassidy-Graham plan was originally intended as an amendment to the Senate bill.

Here’s the nitty gritty of what would change, compared to the ACA and the Senate plan that failed in July:

Who would need to be covered

Under the Cassidy-Graham plan, the mandates would be eliminated at the federal level. States could choose to keep the measure, replace it or get rid of it completely.

How they would pay for coverage

The federal health insurance subsidies that help most people with ACA marketplace plans afford their coverage would change. This bill would shift those subsidies to the state-level, so people in some states may see their subsidy scaled back or eliminated.

Proposed changes to Medicaid

The bill would restructure Medicaid and decrease its funding. That would make it very difficult for states to maintain the Medicaid expansion.

 

Trump wants one last Senate push on Obamacare repeal

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http://www.politico.com/story/2017/09/05/trump-obamacare-repeal-senate-242346

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The odds are slim, but the White House still hopes for action on a bill drafted by Lindsey Graham and Bill Cassidy.

President Donald Trump and some Senate Republicans are refusing to give up on Obamacare repeal, even after this summer’s spectacular failure and with less than a month before a key deadline.

The president and White House staff have continued to work with Republican Sens. Lindsey Graham of South Carolijna and Bill Cassidy of Louisiana over the summer on their proposal to block grant federal health care funding to the states. And though the bill is being rewritten and Congress faces a brutal September agenda, Trump and his allies on health care are making a last-gasp effort.

“He wants to do it, the president does. He loves the block grants. But we’ve got to have political support outside Washington,” Graham said in an interview. He said the bill needs to have a “majority of the Republican governors behind the idea” to gain momentum in the Senate.

But there’s far more work to do even than that. Senate Majority Leader Mitch McConnell would need to find room on the packed calendar this month to hold another uncertain push to repeal Obamacare on party lines. The Senate has only until the end of the month to pass the measure using powerful budget reconciliation procedures, but is also planning to fund the government, raise the debt ceiling, write a new defense policy bill and extend a host of expiring programs.

Cassidy said he hopes to have the bill text finalized by this week and has declined to reveal details about what changed in the bill during August.

“We are still refining the legislative language — just things you got to clear up,” he said. “We think we have good legislation, good policy.”

The Congressional Budget Office would also still need time to analyze the cost of the bill, a process that could take several weeks.

Trump berated McConnell and the Senate GOP over the summer for falling one vote short of sending repeal into conference with the House in July, when Sen. John McCain of Arizona voted down the GOP’s “skinny” repeal bill. So the White House has continued to work on the Graham-Cassidy bill behind the scenes, seeing it as the best option to make progress, according to several administration officials.

The bill would keep most of Obamacare’s taxes and devolve many spending decisions to the states. It was submitted as an amendment to the repeal bill in July but did not receive a vote; aides say it could not pass the Senate in its current form.

Trump has intermittently told aides he wants progress on health care and is still frustrated that the bill failed. The White House’s legislative team has talked with Republican governors in recent weeks and is planning to bring more to the White House, according to one of the officials. Internally, White House officials say they have listened to concerns from governors and tried to tweak the state block grant formulas.

Hill leadership hasn’t played a central role in the effort.

McConnell said in Kentucky last month that the path forward is “somewhat murky” and pointed to efforts by Sen. Lamar Alexander (R-Tenn.) to stabilize insurance markets as one avenue forward, though he doubted Democrats’ resolve on the bipartisan effort.

“We’re going to see what Sen. Alexander and his team can do on a bipartisan basis. The Democrats have been pretty uninterested in any reforms. They’re really interested in sending money to insurance companies but not very interested in reforms,” McConnell said then.

Inside the White House, there is little hope that a health care bill can happen quickly, with a stacked legislative agenda. And some close to the president prefer he would focus on tax reform and other immediate fiscal issues.

The Senate parliamentarian has ruled that the chamber’s reconciliation instructions, which allow the GOP to evade a Democratic filibuster and the chamber’s 60-vote requirement, expire at the end of the month. Republicans are planning to use their next budget measure to pass tax reform via a simple majority. But Graham insisted there’s a short window to fulfill the party’s seven-year promise if the GOP goes into overdrive, starting this week.

“It’s possible, yes. But you’ve got to do it quickly … introduce it this week, have a hearing soon about the bill, then the process is set to actually take it to floor and vote,” Graham said. “Everything has to fall in place.”

State officials plead for bipartisan ObamaCare fix

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State officials plead for bipartisan ObamaCare fix

State officials plead for bipartisan ObamaCare fix

State insurance officials pleaded with senators on Wednesday to quickly act to stabilize the ObamaCare markets, calling for a multiyear extension of key payments to help fund premiums for low-income customers.

Congress must pass a fix by the end of September to shore up the wobbly individual markets, several officials said, in particular funding for key ObamaCare insurer payments known as cost-sharing reductions (CSR).

“The CSR funding issue is the single most critical issue that you can address to help stabilize insurance markets for 2018 and potentially bring down costs,” Tennessee’s insurance commissioner Julie Mix McPeak told the Senate Health Committee.

The panel kicked off a series of hearings Wednesday on stabilizing the markets. If Congress can pass a bill, it would represent the biggest bipartisan update since President Obama signed the law in 2010.

Health committee Chairman Lamar Alexander (R-Tenn.) wants to find consensus by the end of next week. To sell the fix, he and ranking member Patty Murray (D-Wash.) held a private meeting with senators not on the committee and the witnesses who testified as Wednesday’s hearing.

“If we can do two things, that would be two more things that we have agreed on in a bipartisan way in the last seven years in health insurance,” Alexander told reporters.

“And then let the leaders see if we can pass it, and hope the House does and that the president signs it.”

Despite some pushback that could still come from conservatives calling the payments an “insurer bailout,” Alexander and Murray hope to cobble together a bipartisan group that agree some continuation of the payments is necessary.

The cost sharing subsidies, which reimburse insurers for giving discounted deductibles and co-pays to low-income customers, have been made by the Trump administration on a month-to-month basis.

Republicans had sued the Obama administration over the payments, calling them unconstitutional, but many have since acknowledged they need to continue at least in the near term to prevent steep premium hikes.

Insurers have asked for long-term certainty on the payments, threatening to hike premiums and leave the ObamaCare markets altogether if they don’t get it.

Democrats, and some Republicans like Alexander, agree Congress should fund the payments, but there’s disagreement on the time frame.

Alexander wants to fund the payments through 2018 while Murray has pushed for multiple years.

“It is critical that we work toward a multiyear solution in order to provide the kind of certainty that will have the most impact on families’ premiums and choices in the marketplaces,” Murray said.

America’s Health Insurance Plans, the nation’s largest insurer trade association, and other stakeholder groups urged Congress to fund the payments through at least 2019.

“Without two years of CSR funding, uncertainty will persist and the Congress will need to address these same issues early next year,” the groups wrote in a letter to the committee Tuesday.

Meanwhile, Republicans say a bipartisan health bill must include changes to ObamaCare’s state waivers so states have more control over what their insurance plans look like.

Alexander said ObamaCare’s waivers should be amended so “states can have more flexibility to devise ways to provide more coverage with more choices and lower costs.”

“It just hasn’t been very appealing to states because it is a difficult tool to use,” he said.

This point was echoed by Pennsylvania’s insurance commissioner Theresa Miller, who called the process to get approved cumbersome.

“Baseline coverage requirements should be kept intact as much as possible … but make it easier for states to respond to market issues,” she said.

For example, it takes at least six months to get a waiver approved with the federal government, which the commissioners said made it difficult to quickly respond to market issues.

But Democrats have been wary of anything they say could result in coverage losses and the availability of less comprehensive insurance plans.

The Senate GOP’s ObamaCare repeal plan, which failed in a dramatic vote with Sen. John McCain (R-Ariz.) joining two other Republicans in opposition, contained language intended to make it easier for states to approve less comprehensive plans.

However, Democrats say that is going in the wrong direction.

We should be “moving forward not backward on affordability, coverage and quality of care,” Murray said.

“We’re all well aware threading this needle won’t be easy,” she said, “but I do believe an agreement that protects patients and families from higher costs and uncertainty, and maintains the guardrails in our current health care system, is possible.”

Several commissioners also recommended setting up a temporary reinsurance program to help insurers with high cost patients with the intent of lowering premiums for healthier ones.

“Congress should enact a federal reinsurance program with a minimum duration of three years,” said Washington state insurance commissioner Mike Kreidler, adding that it would “significantly help stabilize the individual health insurance market.”

But Alexander indicated it’s unlikely for the bill to include reinsurance funding, noting that the U.S. is already trillions in debt.

“If a reinsurance program is such a good idea … why don’t states do it?” he asked, suggesting states impose small fees on every insurance plan sold to help fund it.

Democrats are also pushing for a bill to restore ObamaCare outreach funding after the Trump administration announced drastic cuts to the program.

Alaska’s insurance director Lori Wing-Heier said the cuts concern her because “these programs reduce the number of uninsured citizens and maximize public participation.”

Insurance official to Congress: ObamaCare not collapsing

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Insurance official to Congress: ObamaCare not collapsing

Insurance official to Congress: ObamaCare not collapsing

A Pennsylvania insurance official told Congress Wednesday that ObamaCare is not collapsing, as some Republicans have argued.

Speaking at a Senate Health Committee hearing on efforts to stabilize Affordable Care Act (ACA) markets, Teresa Miller, Pennsylvania’s acting Human Services secretary and former insurance commissioner, said that the notion is “just false.”

“I’m not going to sit here this morning and tell you that the ACA is perfect,” she said. “I think we all know that it’s not, but the narrative that the ACA is failing and imploding is just false.”

Miller, who works in the administration of Democratic Gov. Tom Wolf, noted that insurers in the state filed average premium increases of just 8.8 percent for next year, and that most enrollees receive government subsidies to help them afford premium costs.

While there have been “difficulties” in the market, she said, “our individual market is not collapsing.”

Other states have encountered more problems with their markets, but every state is on track to have at least one insurer offering ObamaCare coverage in every county next year, after some worries that there would be empty counties.

The insurance commissioners testifying largely called for efforts to further stabilize ObamaCare markets, for example by funding key payments known as cost-sharing reductions, which President Trump has threatened to cancel.

Multiple commissioners also called for a program called reinsurance that provides government funding to bring down premiums by paying for part of especially sick enrollees’ claims.

The Senate Health Committee is trying to reach a deal on a bipartisan stabilization bill by the end of next week, a tough task on such a polarizing issue.

A Glimmer of Bipartisanship on the ACA

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http://www.commonwealthfund.org/publications/blog/2017/sep/bipartisanship-on-the-aca?omnicid=EALERT1267321&mid=henrykotula@yahoo.com

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With the eclipse of Republican efforts to repeal and replace the Affordable Care Act (ACA), bipartisan approaches to improving the law are having a moment in the sun. This week, Senators Lamar Alexander (R-Tenn.) and Patti Murray (D-Wash.) are cosponsoring hearings before the Senate Health, Education, Labor and Pensions (HELP) committee on bipartisan solutions to stabilizing private health insurance markets. The Problem-Solvers — a new caucus of House Democrats and Republicans — are similarly at work on a cross-party package of reforms. Eight governors have released a bipartisan plan, as has a group of health policy experts with mixed party affiliations.

The value of bipartisanship is indisputable. The alternative — on excruciating display over the last seven months — is ongoing partisan warfare that destabilizes our health care system. Health care providers and insurers cannot function effectively when changes in party control at the federal level threaten to upend the health care system every two to four years. And the fear of health coverage loss is unquestionably stressful for the millions of Americans who depend upon the ACA.

But the growing apparent consensus on key elements for a short-term, cross-party package is encouraging. These proposals focus on strengthening individual insurance marketplaces by legislating cost-sharing reduction payments; helping private insurers manage the risk of very high-cost patients using reinsurance and other means; creating a source of backup coverage for “bare markets” that lack private insurers; and offering states greater flexibility in implementing federal regulations governing private insurance markets.

Different groups propose additional bells and whistles, and there is much room for disagreement on how to design and implement specific provisions. But at least both parties are at the table. Where there’s a will, there may be a way.

Still, important practical questions remain. One is whether the will really exists. Republican supporters of repeal and replace continue to divide the Senate Republican caucus. Conservatives in the House — including the Freedom Caucus — will likely oppose anything that threatens their hope that the ACA will collapse of its own weight. And it is possible that President Trump, still grumbling about the failure of repeal and replace, will veto any narrow package that he believes pours salt in his health care wound.

Ironically, the failure of ACA markets to self-destruct may also sap the will for bipartisan reforms. Deadlines and crisis drive congressional action and, until recently, the threat that some individual markets — admittedly, small in number and population — would lack any insurer was an important spur for Congress to act. Now, that threat has receded as the last of the bare markets has found a carrier.  Bipartisanship is the legislative equivalent of nuclear fusion; it needs major external pressure to push those mutually repelling atoms together.

Even if there were a will, there might not be a way to get an ACA package into the queue. The fall congressional calendar is packed with other high-profile, high-stakes, deadline- and crisis- driven legislation. By September 30, Congress must reauthorize the Children’s Health Insurance Program (CHIP), which has traditionally enjoyed bipartisan support and is vital to the health care of more than 9 million American children. To respond to Hurricane Harvey, Congress also needs to rapidly enact emergency aid for Texas and Louisiana, which will require the extension of previously controversial flood relief legislation.

And these measures are just the beginning. Congress has to fund the federal government by September 30 — with or without support for the border wall — or face a government shutdown. There is the need to pass a controversial increase in the federal debt ceiling by the same date. And to have any hope of enacting major tax reform before the 2018 election, work must accelerate right after Labor Day. Putting the tax project off until after January is dangerous for proponents, because passing controversial tax legislation is infinitely more difficult in an election year.

Bipartisanship on health care action could lay vital groundwork in the short term for bolstering the individual health insurance market. Longer term, bipartisanship is essential for the kind of fundamental change that is necessary to increase coverage and contain costs in our health care system. We should not, however, underestimate the huge political and procedural obstacles that lie in the way of current admirable efforts to bring the two parties together on health care. It will take all the skill of committed Senate and House leaders from both parties to make progress on health care this year — or thereafter.