Republicans learn the limits of reconciliation with failed ACA repeal

https://www.brookings.edu/blog/fixgov/2017/07/28/limits-of-reconciliation-and-failed-aca-repeal/?utm_campaign=Governance%20Studies&utm_source=hs_email&utm_medium=email&utm_content=54885356

Image result for Republicans learn the limits of reconciliation with failed ACA repeal

With late night drama not often seen on the Senate floor, Republicans’ latest attempts to pass a bill repealing the Affordable Care Act failed last night, thanks in part to a divide the party’s congressional leaders, especially in the Senate, could simply not bridge.

In Congress, we expect that the majority party’s choices about what to work on and how to work on it will be guided, in large part, by their desire to maintain and grow their majority in the future. As the process went on over the past several months, it became increasingly clear that, for the current GOP leadership, what they thought was best for the party’s collective fortunes was adopting something that they could credibly claim “repeals Obamacare.” After all, doing so has been one of their central campaign promises since the law was adopted in 2010—and what helped account for some of their electoral success since that time. The content of the narrow bill to which Senate Republicans retreated in an attempt to keep the process moving reflects this priority, in that it contained symbolic provisions that would be easy for voters to understand as “Obamacare repeal” should the bill have ultimately become law. Chief among these provisions was the repeal of the requirement that individuals purchase health insurance, known as the individual mandate. This provision is among the law’s best known and the change in the Senate bill would have been easy for voters to understand. Under Obamacare, they were required to do something; under the Republican bill, they would not have been.

At the end of the day, however, individual Senate Republicans concluded that even if leaders had judged that “repealing Obamacare” was in the best interests of the party collectively, they could not support the different proposals drafted to actually get there. This was perhaps most true of Senators Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), who opposed beginning debate and all three alternative proposals considered this week. There were also, however, 11 other senators who voted no on at least one of the alternatives offered this week. While some of those votes may have been strategic, as members knew that the proposal would not ultimately be enacted, they do help illustrate the persistent divides within the Republican Party about the best way to proceed on health policy. In an era of high party polarization and a well-sorted electorate, this kind of cross-pressuring, where what’s good for the party is not necessarily good for the individual member, is less common than it once was. But as the experience of the last few months suggests, those situations can still and do arise.

While the choice by Republicans to pursue their collective goal of “repealing Obamacare” through the fast-track budget reconciliation process meant that Senate Majority Leader Mitch McConnell (R-Ky.) only needed to find 50 votes, it also constrained his task in important ways. The rules of the budget process, including the Byrd Rule, place restrictions on the content of reconciliation bills and amendments to them. While it can be difficult to know exactly how these rules shape a particular piece of legislation, one consequence of them is that leadership does not necessarily have as much room to maneuver in terms of deal-making as they might have on other bills. What’s more, by turning to a process that did not require the support of any Democrats to move forward, Republicans could not rely on the opposition of the other party as a useful foil while they sought to build a winning coalition. Instead, all attention was focused on the party’s internal conflicts and inability to reach agreement—a task made harder by the presence of a same-party president without the policy expertise or interest to help broker the necessary deals. Special legislative procedures that prevent filibusters, in sum, can help majority parties get legislative wins, but only if the party agrees internally on the policy particulars of what that win should look like.

As an agenda item, health care generally and Obamacare specifically aren’t going anywhere any time soon. The Children’s Health Insurance Program, which covered about 9 million children in 2016, needs to be reauthorized by the end of September, and uncertainty about the continued payment of certain subsidies for some Obamacare enrollees on the individual marketplace remains. But with a range of other major issues needing action in the coming weeks—including spending bills and the debt ceiling—Republicans appear ready to move on from their legislative pursuit of their biggest collective goal of recent years.

Fitch: Failed ACA replacement efforts add to healthcare sector uncertainty

http://www.beckershospitalreview.com/finance/fitch-failed-aca-replacement-efforts-add-to-healthcare-sector-uncertainty.html

Image result for negative credit outlook fitch

As ACA repeal and replace efforts stall, significant uncertainty remains surrounding how federal policy will affect nonprofit healthcare organizations, leading to a negative sector outlook for healthcare, according to Fitch Ratings.

The uncertainty and negative outlook comes as the Trump administration looks for ways to weaken the ACA even if the health reform law is not repealed.

Nonprofit hospitals experienced declines in uncompensated care under the ACA because of an increase in healthcare coverage due to Medicaid expansion, rollout of healthcare exchanges and allowing children to stay on their parent’s health insurance plan until age 26.

While repeal efforts cause uncertainty for hospitals, current discussions regarding a bipartisan healthcare bill could be beneficial for nonprofit hospitals. A bipartisan effort could potentially reduce the insurance premium price hikes, according to Fitch.

Senate panel to hold bipartisan hearings on healthcare

Senate panel to hold bipartisan hearings on healthcare

Senate panel to hold bipartisan hearings on healthcare

The Senate Health Committee will begin holding bipartisan hearings the first week of September on how to stabilize and strengthen the individual insurance market, the panel’s top Democrat and Republican announced Tuesday.

Sen. Lamar Alexander (R-Tenn.) — the chairman of the Health, Education, Labor and Pensions Committee — said the goal is for the panel to craft a bipartisan, short-term proposal by mid-September, as insurers must finalize how much their premiums will cost by the end of that month.

“We need to put out the fire in these collapsing markets wherever these markets are,” Alexander said at the beginning of a HELP Committee hearing on nominations.

The committee plans to discuss the issue with insurance commissioners, patients, insurance companies, governors and healthcare experts. The committee’s staff will beginning preparing for the hearings this week, Alexander said.

The panel’s top Democrat, Sen. Patty Murray (D-Wash.) said she welcomed the bipartisan hearings and appreciated Alexander’s willingness to work with her on the issue. Alexander and Murray have previously crafted bipartisan deals, such as a rewrite of the No Child Left Behind Act last congressional session.

The move comes as some Senate GOP leaders are openly admitting they don’t see a path forward on their seven-years long campaign pledge to repeal ObamaCare, at least for now, after a scaled-down repeal bill failed to pass the upper chamber early Friday morning.

Still, in a press conference Tuesday, Senate Majority Leader Mitch McConnell noted the vehicle to repeal ObamaCare hasn’t yet expired.

“We’re continuing to score some of the options on healthcare [from] Senator Portman, Senator Cruz, Senator Graham, Senator Cassidy,” he said.

Even before last week’s vote, some Republicans have called for an open and bipartisan process. Others have said that letting Alexander and Murray work on healthcare in committee is at least one path worth pursuing.

“We’re not adverse to that,” Sen. John Thune (S.D.), the No. 3 Senate Republican said early Friday morning, after the skinny repeal bill failed.

“I just don’t have high hopes that we’re going to get anything that really solves the problems that we think exist with ObamaCare today,” Thune said.

Stabilizing the individual market could be one area of bipartisanship, though it’s already drawn ire from conservatives who argue that any action would be providing bailouts to insurance companies.

The bipartisan Problem Solvers Caucus, consisting of 43 Republicans and Democrats, unveiled proposals to fix problems with the Affordable Care Act on Monday. Included in the list was congressional funding for cost-sharing reduction payments.

Insurers have been pleading with Congress for long-term certainty that they’ll continue to receive crucial payments compensating them for subsidizing out-of-pocket costs for certain consumers. Without them, premiums on the ObamaCare exchanges would spike, insurers warn.

The Trump administration has been funding these cost-sharing reduction payments to insurers on a monthly basis. In tweets over the weekend, President Trump threatened to cancel the payments, which total $7 billion in fiscal 2017, if Republicans don’t pass a healthcare bill. White House adviser Kellyanne Conway said Sunday a decision would come this week.

“He’s going to make that decision this week, and that’s a decision that only he can make,” Conway said on “Fox News Sunday.”

Alexander said he has urged the president to continue CSR payments through September to give Congress time to work out a short-term solution.

Trump’s Tweets Threaten To Destabilize Insurance Markets

http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=54841830&_hsenc=p2ANqtz-_BS8nGbOG01O1u0VECBzsFH5X_-bRiY3X7lsxQ8ybqJDve3xJppemqizvSfn4B0RH50L84DFNZaG18htzfxHToUJIq2g&_hsmi=54841830

Image result for aca repeal

President Trump took to Twitter this week to threaten insurance companies that he may withhold crucial government payments in an effort to undermine the Affordable Care Act.

It’s not the first time the president has threatened to cut off these payments to insurers, which he refers to as “BAILOUTS.

But these payments aren’t designed to compensate insurers for business failures. Rather, they reimburse insurance companies for discounts the law requires them to give to low-income people who buy insurance through the Affordable Care Act exchanges. The federal money that goes to insurers in these payments, known as cost-sharing reductions, or CSRs, offsets the money insurers lose by lowering the deductibles and co-payments they require of these policyholders.

Trump, who is angry that the Congress failed to pass a law to repeal and replace the Affordable Care Act, or Obamacare, is wielding his threat to withhold these CSRs — which could cause chaos in the insurance markets – in hopes of forcing lawmakers back to the table to try again to get rid of the health care law.

The next cost-sharing payments are due to be paid in a few weeks and the president has said he’ll announce this week whether he’ll pay the money or keep it in the Treasury.

“In the absence of the CSR, the rate increases could be astonishing,” says Dr. Marc Harrison, CEO of Intermountain Healthcare, which operates nonprofit hospitals and clinics and insures more than 800,000 people across Utah.

“We’ll see [the number of] people who are uninsured, or functionally uninsured, go way, way up,” he adds.

Harrison says he and his company filed two sets of proposed rates for policies sold on the insurance exchange next year. If the president cuts off the cost-sharing payments, he says, the rates will be much higher.

The Congressional Budget Office estimates the payments, if they’re all made, will total $7 billion this year. Margaret Murray is CEO of the Association for Community Affiliated Plans, which represents these “safety net health plans” aimed at people with lower incomes. She says she has been in touch with the Department of Health and Human Services to urge them to fund the payments.

“Should the payments cease, insurers will be required to fund cost-sharing reductions on their own,” Murray says. If that happens, “they will either raise their rates – our plans indicate that it could be by up to 23 percent – to compensate for these losses, or they will withdraw from the markets altogether.”

If Trump does decide to stop making the payments, it may end up costing the U.S. Treasury more, while insurance companies who remain in the markets could do just fine.

That’s because insurance companies will charge more in premiums to make up for the lost payments. And that will lead the Treasury to spend more on subsidies to policyholders who qualify, according to an analysis by the consulting firm Oliver Wyman.

If those subsidies go up enough, more people could be lured into the exchange markets.

Here’s the wonky reason why:

The Obamacare exchanges require insurance policies to conform to one of four “metal” levels — bronze, silver, gold or platinum — which coincide with how much an individual is expected to pay in premiums, deductibles and other out-of-pocket expenses. A bronze plan covers about 60 percent of a customer’s health care costs, with relatively low monthly premiums, while a platinum plan will cost more each month but pay 90 percent of total health costs.

The law provides income-based tax credits to people to buy insurance, and those credits are calculated based on the price of silver plans. Last year about 85 percent of people who bought Obamacare insurance got a credit, according to the Center for Medicare and Medicaid Services.

People with the lowest incomes also get those discounted deductibles and co-payments if they buy a silver plan; and then the government reimburses insurers through CSR payments.

If Trump decides not to make those payments, insurance companies are likely to raise rates about 19 percent, according to an analysis by the Kaiser Family Foundation.

That means subsidies will have to rise for many people to meet those higher premiums. Some people may take that bigger subsidy to buy a cheaper policy — and many could even get insurance for free, according to Oliver Wyman, because premiums on bronze plans probably would not rise as much as those on silver plans.

The higher subsidies could cost the government as much as $2.3 billion in 2018, according to the Kaiser Family Foundation’s Larry Levitt. Levitt notes that Congress could end the ambiguity over the payments by appropriating the money for them.

Sen. Orrin Hatch, R-Utah, said in an interview with Reuters that he thinks Congress will do just that.

“I’m for helping the poor; always have been,” Hatch said. “And I don’t think they should be bereft of health care.”

The reason CSRs are in limbo at all is because House Republican who did not want Obamacare to succeed sued the administration, claiming the payments to insurers were illegal because they had not appropriated money for them.

A federal judge agreed, but the Obama administration appealed. When Trump took the White House he continued the appeal, to allow lawmakers time to pass a bill to repeal Obamacare and make the payments disappear altogether.

Now that that effort has failed, the lawsuit and the cost-sharing money are once again in play.

Molina to cut 1,400 positions to improve financial performance

http://www.healthcarefinancenews.com/news/molina-cut-1400-positions-improve-financial-performance?mkt_tok=eyJpIjoiTXpVelkyRXhZMkpqTmpKaSIsInQiOiJFVjFscVRVVDdXZmZqek02STNMSVNjelwvREEwMmZmckZrWmNyZjNrQnVcL0szTGZuNXA4ZGdrOGRhT1V5bnREanBwWitPbTNkQllLZW5BTmd4VDk5TDg0ak1NNStnTllqdEllQlNpQmRZbDUwcm5JdVNaZ1lJcmpVVXJNYWxcL0JcL28ifQ%3D%3D

Image result for molina healthcare

The cuts follow removal of CEO and CFO due to financial losses blamed on Affordable Care Act market.

Molina Healthcare, which fired its CEO and CFO in May due to the poor financial performance of the company, will eliminate about 1,400 jobs over the next few months, according to an internal memo obtained by Reuters.

The cuts are due to financial losses blamed on Molina’s individual business in the Affordable Care Act market, in which it has been a major player.

Molina will reduce its workforce by the elimination of 10 percent of its 6,400 corporate positions and about 10 percent of 7,700 health plan jobs, according to Reuters. It will not affect Molina’s Pathways behavioral health business, which employs about 5,500 people.

Interim CEO and CFO Joe White sent the memo to employees saying the cuts aim to contribute to savings by 2018 in what he called “Project Nickel,” to do more with less.

In March, Molina was touted as an ACA success story.

Former CEO J. Mario Molina, MD, was an outspoken opponent of the Republican plan to repeal and replace the ACA. His brother, John C. Molina, who served as CFO. was also let go in a decision by the board to turn around the company’s financial position.

Last week Molina said it was concerned about Republicans repealing the ACA without having a replacement plan in place, the roll back of Medicaid expansion and the lack of a guarantee of federal cost-sharing reduction payments, which allows insurers to offer lower-income consumers lower deductibles and out-of-pocket expenses.

Molina also argued for the continuation of the individual mandate to get insurance.

“The bedrock of any coverage system is a requirement that people must obtain health insurance,” Molina said. “The lack of such a requirement will be detrimental to the individual market risk pool and will result in adverse selection, which would significantly increase costs.”

In June, Molina said it would file rates for 2018 to remain in the exchange market in Florida.

The California Department of Insurance is releasing on August 1 the insurers which have filed rates for the ACA market in 2018.

GOP lawmakers, Trump at odds over insurance payments

GOP lawmakers, Trump at odds over insurance payments

Image result for GOP lawmakers, Trump at odds over insurance payments

Lawmakers are facing off with President Trump over key ObamaCare payments that are in jeopardy after the collapse of efforts to repeal the healthcare law.

Trump is threatening to cancel the payments, known as cost-sharing reductions (CSRs), as part of his effort to make ObamaCare “implode.”

But he is running into opposition from key Republicans, including Senate Finance Committee Chairman Orrin Hatch (Utah) and House Ways and Means Committee Chairman Kevin Brady (Texas), who say they want to find a way to guarantee the payments, which reimburse insurers for giving discounted deductibles to low-income ObamaCare enrollees.

If the payments were cancelled, insurers have warned they would either have to spike premiums to make up for the lost money, or drop out of the market altogether, limiting people’s options for coverage.

Trump could announce that he is cancelling the payments as early as Tuesday.

Rep. Chris Collins (R-N.Y.), one of Trump’s top supporters on Capitol Hill, told CNN on Monday that he had encouraged Trump to announce the cancellation on Tuesday.

Trump has long warned that he could cancel the payments, though it is unclear if he will follow through.

In addition to a premium spike that experts estimate could reach 20 percent, Democrats warn that there would be a political fallout as well if people blame Trump for the chaos.

A Kaiser Family Foundation poll in May found that 63 percent of the public thinks Trump and congressional Republicans are responsible for problems with the Affordable Care Act going forward.

Senate Democratic Leader Chuck Schumer (N.Y.) on Monday said there would be a “Trump tax” on people’s premiums if he cancelled the payments.

Trump seemed to refer to cancelling CSRs on Saturday when he tweeted: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

Trump has alternated between saying he will simply cause ObamaCare to implode and calling for Congress to repeal the law.

In another tweet on Saturday, Trump called for Congress not to give up on repeal and to vote on it before acting on any other bill.

Many congressional Republicans have called for continuing the CSR payments.

In a statement Friday, Brady warned that “simply letting Obamacare collapse” would cause “even more pain” for people in his district facing high premiums and fewer choices.

“For those trapped in Obamacare, we must continue to look for immediate solutions to deliver relief, stop premiums from soaring even higher, and help people get the health care that’s right for them,” Brady said.

Hatch told Reuters in an interview Monday that he did not want to provide funding for the CSRs, but “I think we’re going to have to do that.”

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate health committee, has also called for Congress to act on the payments. His committee will be holding hearings on improving the stability of the ObamaCare markets in the near future, which could lead to bipartisan action.

“I guess I’m hopeful that the administration, the president will keep making them and if he doesn’t then I guess we’ll have to figure out from a congressional standpoint what we do,” Sen. John Thune (R-S.D.), the No. 3 Senate Republican, said on Monday.

Sen. John Cornyn (R-Texas), the No. 2 Republican, noted that Trump would have to sign legislation guaranteeing the payments, making it a “challenge.” He also said that the prospect of action by Congress is a “real live issue.”

A House GOP aide said Monday that Republicans are still looking at different legislative vehicles for temporarily guaranteeing the CSR payments.

Democrats are pushing for Congress to guarantee the payments soon, to reduce uncertainty for insurers ahead of an Aug. 16 deadline for filing their premium rates for next year.

In more momentum for congressional action, a bipartisan group of more than 40 House lawmakers on Monday unveiled a proposal to fix problems with ObamaCare, including guaranteeing funding for the CSRs, which would take the issue out of Trump’s hands.

“Cutting off those payments further destabilizes the individual market and these are real people,” Rep. Tom Reed (R-N.Y.), one of the leaders of the bipartisan effort in the House, told The Hill on Monday.

Reed said that while he still supports repeal of the health law, Republicans should try a different, bipartisan, direction rather than “engage in insanity by doing the same thing over and over again.”

Still, there are other Republicans who are still pressing to repeal and replace ObamaCare.

Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) have both attended meetings at the White House in recent days focused on trying to revive such legislation.

The two senators have written a measure that would convert current ObamaCare spending into a block grant given to states, which is aimed at giving states flexibility. Democrats warn the block grants would be significantly less than current spending levels, leading to cuts.

The proposal faces a steep path to passage, especially given that McConnell indicated he is moving on from repeal efforts for now.

Reed said that he had kept House GOP leaders apprised of the bipartisan group’s work.

“I hope so,” Reed said when asked if leadership is open to bipartisan action on healthcare. “The other path is not working.”

Senate Republicans brush off Trump’s healthcare demands

Senate Republicans brush off Trump’s healthcare demands

Image result for Senate Republicans brush off Trump's healthcare demands

Senate Republicans appear poised to ignore President Trump’s demands that they immediately resurrect ObamaCare repeal and abolish the legislative filibuster.

Trump has waged a public pressure campaign against GOP senators since they failed to pass even a “skinny” bill repealing ObamaCare last week.

Unless Republicans are “total quitters,” Trump tweeted, they will revive their years-long effort to repeal and replace ObamaCare. While they’re at it, Trump wrote, Republicans should get rid of the 60-vote procedural hurdle for legislation, saying they “look like fools and are just wasting time.”

But Trump’s demands might fall on deaf ears.

Sen. John Cornyn (R-Texas) warned reporters Monday not to “leap to conclusions” that Republicans won’t be able to pass a healthcare bill, but appeared to hint that a second vote isn’t imminent.

“What we do know is next is nominations and hopefully Sen. [Charles] Schumer will agree to break the logjam … and that would be a good use of our next two weeks,” the No. 2 Senate Republican said.

Sen. Roy Blunt (R-Mo.), another member of Senate GOP leadership, said Republicans could circle back to healthcare when they reach a consensus. Until then, “it’s time to move on” and put “wins on the board,” he said.

“Obviously we didn’t give up and we didn’t quit and we gave it our best shot, and we can come back to this at a later time,” Blunt said, asked about Trump’s tweets.

Trump targeted GOP leadership by name in his tweetstorm, saying “Mitch M, go to 51 Votes NOW and WIN. IT’S TIME!”

Senate Majority Leader Mitch McConnell (R-Ky.) regularly declines to weigh in on Trump’s tweets, except to say he wishes the president would tweet less.

But he’s shot down previous calls from Trump to end the legislative filibuster.

“That will not happen,” he told reporters after a similar request in May.

Asked if that was still McConnell’s position, a spokesman for the Kentucky Republican said that if Senate Republicans change their mind on the rules, they’d make an announcement.

Changing the rules might not make it easier to pass healthcare — which only needed a simple majority — but it would allow Republicans to leapfrog Democrats on other legislative issues like immigration, funding the government and raising the debt ceiling.

But many Republicans have shown little interest in getting rid of the 60-vote threshold. Many Republican senators fear ending the filibuster would have disastrous repercussions.

Sen. Jeff Flake (R-Ariz.), who is up for reelection in 2018 and has been a target of Trump’s ire, predicted Senate Republicans are unlikely to change the rules.

“I don’t want to lurch back and forth every couple of years from one extreme to the other,” he told CBS News on Monday. “Those rules are there for a reason. They’re good. … They invite us to work across the aisle.”

Senators in both parties have warned that nixing the filibuster would essentially turn their chamber into the House and backfire on Republicans in the minority, when they would no longer have the power to block Democratic legislation.

After Republicans went “nuclear” to ensure Supreme Court nominations could be approved with a simple majority, 61 senators sent a letter to McConnell and Schumer in support of preserving the 60-vote legislative filibuster.

Meanwhile, GOP leadership has also given no indication that it wants to spend the spend first two weeks of August relitigating the healthcare vote despite efforts by the White House to inject fresh urgency.

During an emotional speech after the failed healthcare vote, McConnell told his caucus, most of whom were still in their seats on the Senate floor, “that it is time to move on.”

When he opened up the Senate late Monday afternoon, the message-disciplined GOP leader made no mention of the healthcare fight.

Instead, McConnell talked of working on a Trump judicial nominee and teed up consideration for a National Labor Relations Board member. Those nominations, if senators drag out debate time, could easily eat up the Senate’s week.

Sen. Orrin Hatch (R-Utah), the second highest-ranking Senate official, also broke with Trump on Monday, telling Reuters “there’s just too much animosity and we’re too divided on healthcare.”

Senate Republicans pointed to a backlog of nominations when they decided to delay their summer recess by two weeks. They also want to approve Christopher Wray’s nomination to be the FBI director before leaving town.

But even as senators shift their attention to nominees, the White House is playing hardball, unwilling to let ObamaCare repeal drop.

Trump is warning GOP senators that the “world is watching.” Mick Mulvaney, the president’s budget chief, said over the weekend that the Senate shouldn’t move on to other issues until they pass a healthcare bill.

Asked about Mulvaney’s remarks, Cornyn advised the former House member to focus on his own job.

“I don’t think he’s got much experience in the Senate, as I recall,” he said.

GOP leadership doesn’t appear to have the votes to take up a healthcare bill for the time being.

With Sen. John McCain (R-Ariz.) in Arizona for cancer treatments until September, McConnell can only afford to lose one GOP senator and still be able to take up the House-passed healthcare bill.

“Everything’s harder when you have people missing, and certainly that would have an effect,” Cornyn said when asked about McCain’s absence.

To move forward on a bill, leadership would have to flip GOP Sen. Lisa Murkowski (Alaska) or Susan Collins (Maine), which seems unlikely.

Both voted against taking up the healthcare bill and have signaled they won’t be strong-armed by the administration or leadership. They also were celebrated back in their home states over the weekend for opposing the “skinny repeal.”

Collins added on Sunday that Trump’s threat to cut off ObamaCare’s cost-sharing reduction payments wouldn’t impact her vote.

Even as Trump publicly pressures GOP senators, the White House is also playing host to a rotating door of lawmakers. Top conservatives, including GOP Sen. Ted Cruz (Texas), are predicting colleagues will come back to the negotiating table.

“No party can remain in power by lying to the American people, and I hope and pray that our party doesn’t try to do that,” Cruz told reporters after the failed healthcare vote.

Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.) and Dean Heller (R-Nev.) are now pushing a proposal that would shift most of the decision-making power on healthcare back to state governments.

Trump met with Graham on Friday, while Cassidy went to the White House on Monday to meet with Tom Price, Trump’s healthcare chief, and several governors.

It’s unclear whether their proposal could win over conservatives, and it doesn’t yet have a Congressional Budget Office (CBO) score, which means it would need 60 votes to pass.

“If I had a vote on my bill right now I would get in the high 40s,” Graham told reporters late last week, adding wanted more time to get a CBO score that could help him make his case.

Sen. Ron Johnson (R-Wis.) on Monday said that they were continuing to have talks with the White House and governors on healthcare.

“We’re moving forward. Maybe set this aside while we do tax reform,” he said, “but we have to continue working on his healthcare system because ObamaCare is a mess.”

Healthcare executives call for bipartisan health reform

http://www.fiercehealthcare.com/healthcare/healthcare-execs-call-for-bipartisan-health-reform?mkt_tok=eyJpIjoiTkdWbE16bGlOMlJrWWpKaSIsInQiOiJWYVwvZWxBWjZGWEREN3BuSHBkNGZHN3ZqUVJNcWVzTVEwRDk5TWV6OVBkQ1RoZGhuVmlRbXFWMmpVMFgyb1NhbDNDeEhtYUVaaEdJVXBZXC9MWEpqUlZcLzR6WU9kQkowUk5OS1hcL1BcL21oSnphRXMrOFwvOHRhekVyQ2dlbktSc2pLdiJ9&mrkid=959610&utm_medium=nl&utm_source=internal

Affordable Care Act highlighted

Despite the Senate’s failure to pass any of several measures to repeal and replace the Affordable Care Act last week, healthcare executives are watching Washington closely to see what’s next—and what role they can play in future debates.

Michael Dowling, the CEO of Northwell Health, which includes providers and a health plan, said in an interview with National Public Radio that the Trump administration still has many tools at its disposal to hinder key parts of the healthcare law.

“One thing that has to be done is make sure that they don’t sabotage what currently exists, even though legislation wasn’t passed,” Dowling said. “That would be an unbelievable thing for the administration to do. It would be, I think, pretty ridiculous.”

Instead, he believes that lawmakers should come together and look to fix certain elements of the ACA, such as adjusting the individual mandate to better encourage younger, healthier people to enroll in individual market plans and taking a look at what Dowling called “unnecessary micro-regulations” in the healthcare law.

Sister Carol Keehan, CEO of Catholic Health Association, echoed Dowling’s sentiment, saying in an interview with America Magazine that her organization is relieved that the ACA remains intact. The GOP’s efforts to repeal the law were “poorly thought-out,” she said, and were done with limited input from the healthcare industry and the public. Now that several variations of a repeal have failed, there’s room for a bipartisan solution.

“The American genius,” she told the publication, “can make [the ACA] so much better. We need to marshall that genius, to use everybody’s input and gifts to make this bill so much more of service to the American people and the American economy.”

A number of healthcare CEOs opposed the Senate’s original bill, the Better Care Reconciliation Act, prior to last week’s series of votes, expressing concern about significant cuts to Medicaid funding. Many providers benefited from the ACA’s expansion of Medicaid, as it cut down on uncompensated care costs.

Mason VanHouweling, CEO of the University Medical Center of Southern Nevada, told the Las Vegas Sun that those cuts could significantly undo financial gains made by the hospital. In 2015, University Medical Center required a $70 million subsidy from its county and $45 million in emergency loans just to continue operating. It also had to lay off hundreds of staff as well.

But by 2016 it was in the black, with much thanks to expanded Medicaid coverage. Prior to the expansion, 29% of UMC’s patient population was on Medicaid, and 24% was self-pay, but now 47% of its patients are on Medicaid and just 10% are self-pay, according to the article.

“The ACA was a true blessing,” Lawrence Weekly, chairman of the UMC board, told the newspaper. “There wasn’t a whole lot of love when it came to the hospital. We were there through some tough times. I’m grateful for management stepping up.”

GOP confronts an inconvenient truth: Americans want a healthcare safety net

http://www.latimes.com/politics/la-na-pol-obamacare-repeal-analysis-20170728-story.html?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=54783651&_hsenc=p2ANqtz-8QmJGr2PDeEKnnZdJs6m30vcZz9vHx060Bw8uOKvZtYf4f6oENTqr97q-xzfjpCjyNwrlUVZAQ0cufacwlbeutnNBlnQ&_hsmi=54783651

Image result for GOP confronts an inconvenient truth: Americans want a healthcare safety net

The dramatic collapse of Senate legislation to repeal the Affordable Care Act may not end the Republican dream of rolling back the 2010 healthcare law.

But it lay bare a reality that will impede any GOP effort to sustain the repeal campaign: Americans, though ambivalent about Obamacare in general, don’t want to give up the law’s landmark health protections.

“There may be a whole lot of Americans who are complaining about government, but that doesn’t mean they agree with eliminating the safety net,” said former Sen. Dave Durenberger, a Minnesota Republican and healthcare policy leader in the 1980s and ’90s. “We saw that with Social Security and Medicare in Reagan’s day. Now it is a much broader group of people who rely on those health protections.”

And as the Senate debate this week illustrated, Obamacare’s safety net — both guaranteed insurance for the sick and expanded Medicaid coverage for the poor — proved too valued to tear apart.

That means that, while attacks on Obamacare will probably continue, it’s increasingly unlikely that President Trump or GOP congressional leaders will be able to rip out the law “root and branch,” as Senate Majority Leader Mitch McConnell (R-Ky.) once promised.

The GOP’s failure to dismantle the expanded healthcare safety net also may provide an opening for Republicans and Democrats to cooperate on measures to help Americans who have struggled in recent years with rising premiums brought about, in part, by Obamacare.

“Now the real work lies before us,” March of Dimes President Stacey D. Stewart said Friday, following the defection overnight of three GOP senators who voted against a last-ditch Republican bill to begin unraveling the law.

“Our healthcare system and the laws that govern it are far from perfect, and many opportunities exist to find areas of common ground to make improvements,” Stewart said.

The March of Dimes is among scores of patient advocacy organizations, hospitals, physicians’ groups and others who bitterly fought the GOP repeal push, warning of disastrous consequences for tens of millions of sick and vulnerable Americans.

This was not how Republicans had sketched out repeal.

For years, GOP politicians cast themselves as saviors, promising to deliver Americans from a law that former Republican presidential candidate Ben Carson, now Trump’s Housing secretary, once called the “worst thing that has happened in this nation since slavery.”

Demonizing Obamacare, initially a derisive label the GOP coined for the ACA, proved good politics. Republicans scored major victories in the 2010, 2014 and 2016 elections on pledges to roll back the law.

But the successful political message — which built off deep partisan divisions — obscured much broader support for the law’s core elements.

For example, 80% of Americans in a national survey last fall reported favorable views of allowing states to expand Medicaid to cover more poor adults, and of providing aid to low- and moderate-income Americans to help them buy health coverage, two pillars of the law.

The same proportion, according to the poll by the nonprofit Kaiser Family Foundation, liked the law’s insurance marketplaces, which allow consumers to shop among health plans that must offer a basic set of benefits.

Nearly 70% backed the law’s coverage guarantee, which prohibits insurers from turning away people due to their medical history of preexisting conditions.

“As a law, Obamacare got caught up in the politics of the time. It became the symbol of the Obama administration,” said Mollyann Brodie, who oversees polling for the Kaiser Family Foundation. “But the policies themselves have always been quite popular, even among Republicans.”

GOP politicians didn’t have to reckon with that contradiction as they took dozens of essentially meaningless repeal votes while Obama was still in the White House to veto their bills.

That changed after the 2016 elections. No longer was repeal an abstract political slogan.

It was a concrete set of plans that cut insurance subsidies for millions of Americans, slashed hundreds of billions of dollars in federal Medicaid assistance to states and weakened coverage guarantees by allowing insurers to once again charge sick people more for coverage.

That is not what Americans wanted, said Dr. Jack Ende, president of the American College of Physicians.

“No version of legislation brought up this year would have achieved the types of reforms that Americans truly need: lower premiums and deductibles, with increased access to care,” said Ende, a University of Pennsylvaniaprimary care doctor.

Independent analyses of the GOP repeal bills by the Congressional Budget Office and others estimated they would leave tens of millions more Americans without health coverage and drive up costs for many older and sicker consumers.

In the crosshairs were not just unemployed adults whom conservative critics derided as freeloaders, but also poor children, disabled Americans and seniors who worked all their lives but depended on Medicaid for nursing home care.

Altogether, nearly 1 in 4 Americans rely on Medicaid and the related Children’s Health Insurance Program for coverage.

And as the repeal debate dragged on in Washington and in congressional districts across the country, stories of these Americans and others who rely on Obamacare’s healthcare protections brought the safety net to life.

National polls ultimately showed that fewer than 1 in 5 Americans surveyed supported the Republican repeal legislation.

By contrast, 60% of Americans in a recent Pew Research Center poll said that it is the federal government’s responsibility to ensure all Americans have health coverage — the highest level in nearly a decade.

Even many Republican state leaders — including the governors of Ohio, Nevada and Arizona — balked at the congressional rush to roll back the Medicaid safety net. In a bipartisan letter to Senate leaders this week, several of these governors urged lawmakers to turn away from the repeal push.

“We ask senators to work with governors on solutions to problems we can all agree on: fixing our unstable insurance markets,” wrote the governors — five Republicans and five Democrats.

Some congressional Republicans seemed reluctant to give up the repeal campaign. “As long as there is breath in my body, I will be fighting for the working men and women of this country that are being hurt by Obamacare,” Texas Sen. Ted Cruz said after the vote early Friday morning.

And conservative activists continue to demand action. “In Washington, there are no permanent victories or permanent defeats,” said Heritage Foundation President Edwin J. Feulner.

The president, meanwhile, reiterated his threats to “let Obamacare implode,” as he said in a Twitter post after the early Friday vote.

The administration could potentially sabotage insurance markets across the country by refusing to enforce the current law’s requirement to buy insurance or withholding payments to health insurers that subsidize costs for very low-income consumers.

But at the Capitol, Democrats and some Republicans appear willing to begin considering legislation to protect those markets and help millions of American consumers who have seen insurance premiums rise dramatically in recent years.

“Simply letting Obamacare collapse will only cause even more pain,” warned Rep. Kevin Brady (R-Texas), chairman of the powerful House Ways and Means Committee.

Fixing the safety net represents a far better approach than a new push to tear it down, said Durenberger, the former GOP senator.

“Bipartisanship is the only option,” he said.

Obamacare 101: Trump threatens to let the Affordable Care Act fail. Can he?

http://www.latimes.com/politics/la-na-pol-trump-obamacare-fail-20170728-htmlstory.html?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=54783651&_hsenc=p2ANqtz-8vEN78oNitfKoUkIPeSF6DEOsiRTGJOyRk5ws0ecawm63hF_8jNr7wIbxAZ2KnFSYIv-rmcU0EeeC0g0yVvx3eq8bHVA&_hsmi=54783651

Image result for undermining

President Trump has said he wants to “let Obamacare implode” as a way to force Democrats to negotiate a deal over replacing the Affordable Care Act. How real is that threat, and how imminent?

Here are some key questions and answers.

Obamacare 101 is a periodic primer on the debate over repealing and replacing the Affordable Care Act »


Can the Trump administration cause the healthcare law to collapse?

Not entirely, and not all at once, but the administration does have the ability to cause some amount of chaos in certain parts of the healthcare system.

Causing chaos in health coverage sounds bad. Why would Trump want to do that?

At least some administration officials believe that if more people have trouble getting coverage, pressure will increase on Congress to either repeal the Affordable Care Act entirely or make big changes in it. So far, Republicans have not been able to agree on a plan to do that.

Which parts of the system are most vulnerable?

Two different government programs help provide coverage for low- and middle-income working-age people and children. One is the marketplace for individual healthcare plans, which the Affordable Care Act created. The other is Medicaid, which the law expanded.

There’s not much the administration can do to undermine Medicaid without getting a law through Congress, at least in the short term. It’s a program jointly run by the states and the federal government, and the states have a lot of authority over what is covered and who benefits.

The individual marketplace is more at risk.

Which of those involves more people?

Medicaid is far larger. Roughly 75 million Americans are covered by Medicaid and the related Children’s Health Insurance Program. That’s more than 1 in 5 Americans.

About 10 million people have purchased coverage on the Obamacare marketplaces in 2017. Remember that most working-age Americans get health insurance through their jobs.

Under the law, low- and middle-income people buying health plans on the marketplaces can get government subsidies to make premiums more affordable.

What could the administration do to cause the individual market to implode, as Trump says?

Think of this in two buckets. Some actions the administration could take would passively allow the marketplaces to become less stable. That would cause a slow erosion.

There are also steps they could take to actively sabotage the markets, which could cause trouble much faster.

What would cause slow erosion?

Officials could stop marketing and outreach efforts that encourage people to sign up during open enrollment periods. They could refuse to enforce the requirement that people buy insurance or pay a tax — a step that officials already have said they will take. And they could stop trying to keep insurance companies in the markets.

None of those actions would cause the markets to collapse overnight, but they would destabilize them over time by driving out healthy people, which causes costs to rise, which in turn drives out more healthy people. That’s what’s known as a death spiral, and it could happen at least in some parts of the country eventually.

What would cause harm quickly?

The biggest issue involves money that has the bureaucratic-sounding name of cost-sharing reductions.

Basically, the government tells insurers that they need to hold down the insurance deductibles and co-payments that they charge low-income people.

That costs the insurers money. To make the insurers whole, the government is supposed to reimburse them. For more detail, here’s an explainer.

Every month, Washington sends insurers checks that total close to $600 million. And every month since he took office, Trump has raised the possibility that he might cut the money off, although he hasn’t actually done so.

If Trump cut off the payments, what would insurers do?

Some insurers would raise premiums to cover the higher costs, as several have already said they plan to do. Others would probably pull out entirely and stop selling insurance in the individual market.

When’s the next deadline?

In late August.

Could Congress stop Trump from doing that?

Yes, and it’s quite possible that they will since many Republican members of Congress fear that chaos in the markets would be bad for their constituents, not to mention their political futures.

I’ve been hearing that in many parts of the country there already are no insurers selling individual policies. Is that true?

Only in some fairly limited areas. As of July, 38 counties in the U.S. with about 25,000 people covered by individual policies were at risk of having no insurer in the coming year, according to a study of insurance company data by the Kaiser Family Foundation. Those counties were located in three states: Nevada, Indiana and Ohio.

But about one-fifth of consumers live in a county with just one insurer, Kaiser’s data showed. That number has grown a lot since last year.

The places with only one insurer are mostly rural and concentrated in a few states, mostly in the South and Southwest, although Alaska is also heavily affected.

That’s largely because rural areas, where the population is spread out and doctors and hospitals are more scarce, cost more to insure.

Those states are mostly Republican, right?

Yes, that’s one reason why Republican members of Congress have been as concerned as Democrats about the issue.

It also reflects the fact that many Republican states have actively impeded the Affordable Care Act from working. Not surprisingly, those states are among the ones with the biggest problems.

Who would get the blame if the insurance market soured?

Trump has said in his tweets and speeches that he believes the public would blame Democrats because they’re the ones who put the Affordable Care Act into place.

Few Republican lawmakers are confident that’s true, and recent polling indicates that the public holds the Republicans responsible since they control both houses of Congress and the White House.