Tag Archives: ACA

AHCA savings, $487 billion in Medicare cuts remain in House budget proposal

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

http://www.modernhealthcare.com/article/20170719/NEWS/170719888/ahca-savings-487-billion-in-medicare-cuts-remain-in-house-budget

Image result for medicare cuts

The House Budget Committee on Wednesday agreed to bake in hundreds of billions in Medicaid cuts from its ACA repeal bill to the budget resolution, plus an additional $114 billion in cuts over 10 years.

The committee’s Republicans’ unanimously approved the decision with no Democrats on board. The budget resolution, which is the foundation for passing tax reform in the Senate without Democratic votes, also assumes Medicare will reduce spending by $487 million from 2018 to 2027.

Some of the additional savings would come from imposing a work requirement on Medicaid adult beneficiaries who are younger than 65 and are not on Social Security disability as a condition of eligibility.

The Medicare savings are built on an idea long-favored by Republicans — using vouchers to buy insurance, though Republicans say future beneficiaries will have the option to buy traditional Medicare too. Democrats during Wednesday’s hearing complained that traditional Medicare would cost 25% more than it does now if vouchers come into play.

The Republicans also included savings that would stem from raising the Medicare eligibility age for future beneficiaries who are 51 or younger. Under the proposal, those individuals would not become eligible for full Social Security benefits or Medicare until the age of 67. The Congressional Budget Office has estimated that would reduce Medicare spending by 2% once everyone in the program is covered by the later eligibility age.

The proposal includes a requirement that affluent seniors pay higher premiums, and that people with incomes of $1 million or more pay the full cost of Medicare premiums without any federal subsidy.

Rep. Matt Gaetz, R-Fla., said during the hearing that the proposed changes are based on math rather than Tea Party politics, as some have alleged.

The Republican spending outline also assumes the government will do better at recouping or avoiding improper payments. The proposal said that there was $59.7 billion in improper Medicare payments in in the last fiscal year, and $36.3 billion in improper Medicaid payments. The outline assumes future improper payments will be 50% lower than today’s levels.

Rep. Debbie Wasserman-Schultz, D-Fla., introduced an amendment that would have changed the resolution so that it no longer assumed American Health Care Act changes would be future law, citing the Senate bill’s collapse this week.

But every Republican present on the committee voted against the amendment. “This is the official position of the House on repeal and reform efforts,” said Rep. Bill Johnson, R-Ohio.

The budget resolution also includes a reduction in health spending of $43.9 billion over 10 years, the CBO estimate of how much the malpractice reform bill that passed the House would save.

Ranking Member John Yarmuth, D-Ky., called the budget disgraceful and others called the cuts to Medicare, Medicaid and food stamps draconian, several Republicans worried what it envisions might not come to pass.

“We might fail to achieve savings in mandatory spending,” which includes Medicaid and Medicare, Johnson said, noting that the budget resolution might make it harder to pass tax reform in the Senate.

The first hurdle, however, is for the resolution to pass the entire House of Representatives.

Senate Republicans still at impasse after late-night health care meeting

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

http://www.politico.com/story/2017/07/19/trump-congress-no-recess-health-care-240718

Image result for Republican plan to ‘repeal and delay’ will leave millions more Americans uninsured

A key group of Senate Republicans met late into the night Wednesday to try to salvage their health care bill, but emerged without any breakthroughs and still appeared far from finding the votes to repeal Obamacare.

Still, as GOP senators left the nearly three-hour meeting, they professed optimism.

The Republicans initially planned to bring in chiefs of staff and health care wonks to advance the negotiations. White House Chief of Staff Reince Priebus was expected to join and help push the disagreeing GOP senators to yes.

But as the senators kept talking, they reevaluated their plan and decided not to allow staff in and keep the room to members only. Priebus strolled out of Sen. John Barrasso’s office, as did White House legislative director Marc Short. The senators would keep talking amongst themselves.

Talks “narrowed down to try to figure out what is causing members not to be able to vote in favor or problems they have with the bill,” said Sen. Jerry Moran (R-Kan.), who opposes the GOP’s latest repeal and replace draft. “It had merit and it’s something that should have been taking place.”

Added Sen. John Kennedy (R-La.): “We’re at our best when we’re among ourselves.”

As the night dragged on, however, Republicans cited good progress but nothing to suggest they had overcome the obstacles that have stymied their previous efforts.

At least 20 Republicans, including leadership allies, moderates and conservatives, worked through the party’s myriad disagreements over Medicaid, coverage numbers, lowering premiums and cutting regulations.

Health and Human Service Secretary Tom Price and top Medicaid official Seema Verma were in the room too. And earlier at the White House, senators and administration officials discussed adding billions more to help states worried about Medicaid cuts under the bill.

Yet the conversation among senators focused on the broad contours of the issues.

“We weren’t getting into the specifics,” said Sen. Dan Sullivan (R-Alaska). “We weren’t tossing around numbers.”

Indeed, senators left uncertain of how a planned vote will go next week, or whether it should even occur while Sen. John McCain (R-Ariz.) is being treated for cancer.

Senate Majority Leader Mitch McConnell (R-Ky.) has pledged to hold a vote next week, but with McCain gone and Sens. Rand Paul (R-Ky.) and Susan Collins (R-Maine) opposing the repeal and replace plan and not even attending the meeting, success appears far off. Republicans said privately they doubt McCain will be back next week.

“Hard to say [if we’re closer]. I’m fine voting next week,” said Sen. Pat Toomey (R-Pa.). McCain’s absence “does complicate things. And I just don’t know if he’s going to be back.”

Privately, senators doubted they could get the 50 votes together for a health care overhaul despite the productive meeting. There was a feeling that while a session that occasionally turned into venting was therapeutic, the challenges facing the fractious 52-member majority may be too great to bridge.

“You understand the math. It just makes things kind of more difficult,” said Sen. Bob Corker (R-Tenn.).

“We do have work to do to get to a vote of 50,” Barrasso said.

The meeting followed a gathering with President Donald Trump, who ordered senators to stay in Washington until they pass a bill to repeal and replace the 2010 health law. Barrasso said the meeting was planned before the White House lunch.

But with a new flicker of optimism, GOP leaders are still pushing for a way to advance a health bill next week even after two different repeal plans fell apart. Republican senators left a health care meeting at the White House Wednesday sounding more optimistic that they could revive their bill to replace the Affordable Care Act.

“We’re discussing that,” Senate Majority Whip John Cornyn (R-Texas) said when asked whether some version of the Better Care Reconciliation Act was coming back. “I’m more optimistic that that would be the case. But if there’s no agreement, then we’ll still vote on the motion to proceed but it’ll be to the 2015 just-repeal bill.”

“We have at least momentum. Before there was none,” said Sen. Bill Cassidy (R-La.).

Sens. Mike Lee (R-Utah) and Paul say the bill isn’t conservative enough, making it difficult for McConnell to get the 50 votes he needs. And it was unclear if billions more for Medicaid will be enough to move the moderate holds outs, with one senator saying there’s an “outside chance” of success next week. At the White House Trump, the senator said, was more effective than he’s been on healthcare in weeks.

The Senate GOP’s latest attempt to craft a replacement for Obamacare fell apart earlier this week, as four Republican senators announced that they would oppose the current version of the bill. But Cornyn told reporters following the White House meeting that about 40 members of the GOP conference are prepared to vote on any health care deal replacing Obamacare, and the “differences are narrowing.” Trump also sounded a note of optimism during the meeting.

But centrist GOP senators like Sens. Rob Portman (R-Ohio) and Sen. Shelley Moore Capito (R-W.Va.) are not happy about future reductions to Medicaid spending, worried it would kick hundreds of thousands of their constituents off healthcare. GOP leaders threw more than $100 billion to lower premiums and fight drug addiction into the bill, but thus far it hasn’t been enough.

Cornyn said a key procedural vote to take up legislation will be held regardless of whether it will succeed. McConnell, speaking to reporters after the White House meeting, said he expected to be able to at least proceed to the bill.

But three Senate Republicans — Sen. Lisa Murkowski of Alaska, Capito and Collins — said they would oppose proceeding to a repeal-only measure on Tuesday, effectively tanking the prospects that a floor debate over getting a straight repeal of Obamacare can even begin.

And some key holdouts said their position is unchanged. Portman, who is undecided on a procedural vote but has signaled opposition to a repeal-only bill, said the legislation needs “to do more to show low-income people that they have options” and said the vote next week will fail unless those improvements were made.

Capito said she’ll still vote no on proceeding to a bill unless there’s a replacement plan she supports.

“The president emphasized repeal and replace. We’re still working on it. It’s moved a lot farther in terms of where it was in terms of congealing,” Capito said.

Murkowski said she wasn’t even sure what they would be voting on.

“It’s not clear whether there will be a motion to proceed to this repeal and replace. I think that’s still under consideration. There will be a vote on something that much is certain,” she said, adding that it was hard to answer “unless you know what the question is.”

Collins said she was not invited to the meeting and wouldn’t be attending.

“I guess it’s open invitation but I didn’t know that until it was brought up at the White House. I’m unfortunately committed to something else,” she said.

Earlier at the lunch, Trump said he was surprised to see his “friends” — “They might not be very much longer,” he quipped — oppose Senate GOP leaders’ plan.

Trump singled out Dean Heller, who is widely considered the GOP’s most vulnerable incumbent in 2018, suggesting he was once worried but is now confident the Nevada senator will come around to supporting a replacement bill.

“Look,” Trump told the room of Republicans, “he wants to remain a senator, doesn’t he? OK? And I think the people of your state, which I know very well, I think they’re gonna appreciate what you hopefully will do.”

A chuckling Heller said as he returned to the Capitol that those comments were “President Trump being President Trump.” And after the late-night Senate meeting, Heller seemed a bit more optimistic.

“It was probably one of the most productive meetings I’ve been to in a long time,” Heller said. “We have some real honest brokers in there who are really trying to solve the problem.”

Republican plan to ‘repeal and delay’ will leave millions more Americans uninsured

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

http://www.politico.com/interactives/2017/republican-obamacare-repeal-uninsured-double/?lo=ap_a1

Image result for Republican plan to ‘repeal and delay’ will leave millions more Americans uninsured

 

Majority Leader Mitch McConnell wants to hold a vote on a bill that would repeal major parts of Obamacare and give Republicans two years to pass a replacement. A new CBO report finds that repealing Obamacare without a replacement would result in 32 million more Americans losing health insurance over a decade — far deeper coverage losses than any of the health plans Republicans have proposed. Further, 75 percent of Americans would live in areas without any insurers selling coverage in the individual market by 2026.

The latest GOP health plan would strike:

  •  Individual mandate
  •  Insurance subsidies
  •  Medicaid expansion
  •  Planned Parenthood funding

The bill would effectively kill Obamacare’s individual and employer coverage mandates, strike health insurance subsidies, roll back Medicaid expansion and defund Planned Parenthood.

Repealing Obamacare would more than double the number of Americans without health insurance.

Under Obamacare, 10 percentof Americans would lack health insurance.

But if Republicans repeal Obamacare, the number could grow to 21 percent by 2026.

NOTE: Data includes Americans under 65 who do not have health insurance and does not include persons who are Medicare-eligible.
SOURCE: Congressional Budget Office

The uninsured rate plunged under the ACA, but would now skyrocket

ACARepeal ACA0510152025%1997201020172026Before the ACAACA passed10%21%
NOTE: Data includes Americans under 65 who do not have health insurance
SOURCE: National Center for Health Statistics and the Congressional Budget Office

In the first year alone, nearly 17 million more people would no longer have insurance — or (16 percent) of Americans. That includes 10 million fewer buying plans on the individual market, 4 million fewer people covered through Medicaid, and 2 million fewer with job-based coverage.

But once Medicaid expansion and subsidies were repealed (roughly two years after enactment), the number of uninsured Americans would increase by 27 million in 2020. By 2026, about 59 million people or 21 percent of Americans would be uninsured.

Capitol Hill health bill drama is leaving Obamacare exchanges in limbo

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

Capitol Hill health bill drama is leaving Obamacare exchanges in limbo

Question mark heap on table concept for confusion,

 

California’s Obamacare exchange scrubbed its annual rate announcement this week, the latest sign of how the ongoing political drama over the Affordable Care Act is roiling insurance markets nationwide.

The exchange, Covered California, might not wrap up negotiations with insurers and announce 2018 premiums for its 1.4 million customers until mid-August — about a month later than usual. Similar scenarios are playing out across the country as state officials and insurers demand clarity on health care rules and funding, with deadlines fast approaching for the start of open enrollment this fall.

“It’s insane,” said John Baackes, CEO of L.A. Care Health Plan, which has about 26,000 customers on the California exchange. “Here we are in the middle of July and we don’t even know what rules we will be operating under for open enrollment. It is not how you want to run a business.”

Consumers could face sharply higher premiums and fewer choices if more health insurers leave the insurance marketplaces due to lingering uncertainty. State and industry officials around the United States are concerned that the federal government could stop funding so-called cost-sharing subsidies that reduce out-of-pocket costs for low-income consumers. And they worry the Trump administration won’t enforce the individual mandate that requires people to purchase health coverage or pay a penalty.

Amid those concerns, there was a sense of relief Tuesday among many exchange officials and insurers after the U.S. Senate’s latest attempt to replace the Affordable Care Act failed.

Two large insurer trade groups bluntly warned last week that parts of the Senate plan were “unworkable” and could plunge the market into chaos. In a letter to the Senate, America’s Health Insurance Plans and the Blue Cross Blue Shield Association particularly objected to an amendment by Sen. Ted Cruz (R-Texas) that would have allowed insurers to sell bare-bones health plans to people who wanted cheaper premiums. That provision, the insurers said, would split the market between the healthy and the sick, driving up costs for people with pre-existing conditions.

However, the Republicans’ failure to pass that ACA replacement plan did not resolve questions swirling around the current health law.

Tuesday, President Donald Trump expressed disappointment at the outcome in the Senate, telling reporters, “We’ll let Obamacare fail and then the Democrats are going to come to us and they’re going to say, ‘How do we fix it?’”

Some Senate Republicans struck a more conciliatory tone, suggesting that lawmakers should work on a bipartisan measure that would help stabilize the individual insurance markets.

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Committee on Health, Education, Labor and Pensions, said he plans to hold hearings in the coming weeks on ways to shore up the individual insurance market. Lawmakers may look at creating a new stabilization fund that helps compensate insurers for higher-cost patients. Such a fund would be similar to one that existed during the first three years of the ACA exchanges.

Some insurance industry executives welcomed the talk of bipartisanship, but they said action must be taken quickly to resolve key issues affecting consumers.

“We are running out of time and we need a resolution on what we are charging for 2018,” said Gary Cohen, vice president of public affairs at Blue Shield of California in San Francisco, the largest Covered California insurer by enrollment.

Cohen, who helped launch the exchanges in 2014 as an official in the Obama administration, noted that the Republican bills in both the House and Senate included money for reinsurance that can help lower premiums industry wide. Those provisions are among the “immediate steps Congress and the Trump administration need to take in order for markets to provide coverage that is affordable.”

A federal reinsurance program helps compensate insurers for the high costs incurred by the sickest patients. That, in turn, allows health plans to keep their overall premiums lower and attract healthier customers into the insurance pool.

Lawmakers could also appropriate federal funds for the cost-sharing subsidies, which have a price tag of about $7 billion a year. Those payments, made directly to insurers, help reduce deductibles and other out-of-pocket costs for policyholders who earn up to 250 percent of the federal poverty level. This year, that’s up to about $29,000 for an individual or around $61,000 for a family of four. More than half of the people enrolled on exchanges nationwide qualify for this financial assistance.

Without it, many consumers would face annual deductibles of $2,000 or more when visiting the doctor or undergoing medical tests. That would make people far less likely to sign up with participating insurers.

Conservatives generally oppose the subsidies, calling them a bailout of the insurance industry and arguing that the Obama administration didn’t have the authority to pay them. Trump has repeatedly threatened to cut off those cost-sharing subsidies as well.

With their future up in the air, some states, including California and Pennsylvania, allowed insurers to submit two sets of proposed premiums. One filing reflects continued federal funding of those subsidies, and a separate one assumes they are eliminated and their cost is included in health plan premiums.

In Pennsylvania, premiums next year without the subsidies would increase by an average of 20 percent, compared with 9 percent if they remained intact.

Pennsylvania Insurance Commissioner Teresa Miller said the market in her state would be in good shape without the uncertainty over federal policy. “The only thing right now keeping everyone on edge is what’s going to happen in Washington, D.C.,” Miller said. “If things calm down in D.C. and if we don’t see further changes, then Pennsylvania’s market really is stabilizing.”

On Tuesday, Covered California said the two different rate filings its health plans submitted will be released Aug. 1. The exchange may announce that same day what the final premiums are, or it could postpone the decision for several more weeks if Congress has begun to pursue fixes to the ACA.

“This decision is based on the ongoing federal uncertainty around the repeal and replacement attempts of the Affordable Care Act and the dramatic potential impacts such uncertainty has on the rates and on California consumers,” the exchange said in a statement.

A recent analysis commissioned by Covered California estimated that premiums for silver-tier plans would jump by 16.6 percent if the federal government stopped paying for the cost-sharing subsidies. That would be in addition to normal increases meant to cover rising medical costs. An exchange spokeswoman declined to comment further Tuesday, citing the ongoing developments in Washington.

In the Florida exchange market, health insurers have sought an average rate increase of nearly 18 percent. But Florida Blue, the state’s largest health insurer, said those rates would go even higher if the cost-sharing reduction payments disappeared.

Robert Laszewski, an industry consultant in Virginia and a frequent ACA critic, said the exchange markets aren’t imploding, despite what the Trump administration has often said. But their premiums will continue to rise unless more young and healthy people are persuaded to buy coverage, he said.

“I think most insurance companies will at least break even, or even make a profit, in 2018,” Laszewski said. “Coverage will be ‘stable,’ but it will stabilize at a horrific premium rate level.”

John McCain diagnosed with brain cancer

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

John McCain diagnosed with brain cancer

Image result for senator mccain

Sen. John McCain (R-Ariz.) has been diagnosed with brain cancer, the Mayo Clinic Hospital in Phoenix said Wednesday.

The tumor was discovered after the senior Arizona senator underwent a minor procedure last week to remove a blood clot from above his left eye.

“Subsequent tissue pathology revealed that a primary brain tumor known as a glioblastoma was associated with the blood clot,” the hospital said in a statement.

“The Senator and his family are reviewing further treatment options with his Mayo Clinic care team. Treatment options may include a combination of chemotherapy and radiation.”

McCain’s latest diagnosis is not his first battle with cancer. He underwent a procedure in 2000 to remove a type of skin cancer called melanoma from the left side of his face.

McCain, 80, also had a melanoma removed from his left arm in 2000 and another removed from his nose in 2002. Both were determined to be the least dangerous types of melanoma.

McCain’s office said in a statement that the Arizona Republican remained in good spirits Wednesday and is confident that any treatments will be effective.

“He is in good spirits as he continues to recover at home with his family in Arizona,” his office said.

“He is grateful to the doctors and staff at Mayo Clinic for their outstanding care, and is confident that any future treatment will be effective.”

His office said further consultations with his doctors will determine when he will return to the Senate.

Sen. Lindsey Graham (R-S.C.), a close friend of McCain and one of his most ardent allies on Capitol Hill, spoke with the Arizona senator on Wednesday. He said they talked only briefly about McCain’s diagnosis before shifting to a conversation about the Senate’s healthcare reform efforts and the National Defense Authorization, the federal defense spending bill.

“Literally, it went five minutes until we turned away from what I think most people have a hard time absorbing and focused on what he loves the best,” Graham told reporters after speaking with McCain.

The news of McCain’s diagnosis prompted an immediate outpouring of support from fellow lawmakers.

“God knows how this ends, not me,” Graham said. “But what I do know is this disease has never had a more worthy opponent.”

Senate Majority Leader Mitch McConnell (R-Ky.) characterized McCain as a fighter, saying in a statement that “he will face this challenge with the same extraordinary courage that has characterized his life.”

“John McCain is a hero to our Conference and a hero to our country. He has never shied away from a fight and I know he will face this challenge with the same extraordinary courage that has characterized his life,” McConnell said in a statement. “The entire Senate family’s prayers are with John, Cindy and his family, his staff, and the people of Arizona he represents so well.”

Sen. John Cornyn (Texas), the No. 2 Senate Republican, echoed McConnell’s characterization of McCain, and said the diagnosis was “just the latest challenge” for Arizona Republican.

McCain’s eldest daughter Meghan, a Fox News host, said in a statement that her father appeared to be the calmest family member upon receiving the diagnosis.

“It won’t surprise you to learn that in all of this, the one of us who is the most confident and calm is my father,” she said. “He is the toughest person I know.”

President Trump issued a statement shortly after news of McCain’s diagnosis broke, calling him a fighter and sending his family well wishes from the White House.

“Senator John McCain has always been a fighter,” Trump said. “[First lady] Melania and I send our thoughts and prayers to Senator McCain, Cindy, and their entire family. Get well soon.”

Former President Barack Obama, whom McCain ran against in the 2008 presidential election, called his former opponent “one of the bravest fighters” he has ever known, saying that “cancer doesn’t know what it’s up against.”

McCain was first elected to the House in 1982, and won a bid for the Senate just four years later.

Before entering Congress, McCain served in the U.S. Navy as a pilot. While fighting in the Vietnam War, he spent five-and-a-half years as a prisoner of war in North Vietnam.

GOP reverses course on healthcare

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

http://thehill.com/policy/healthcare/342850-trump-tries-to-save-health-repeal?utm_source=&utm_medium=email&utm_campaign=9827

Image result for aca repeal failure

Senate Republican leaders are desperately searching for the 50 votes they need to open a debate on ObamaCare repeal-and-replace legislation after a Wednesday scolding at the White House from President Trump.

Leaders have reopened negotiations on their previous bill, reversing course from their plans to move to a vote on a straight repeal of ObamaCare.

But it’s not clear if they will have any more luck this time in corralling enough centrist and conservative Republicans to move the bill forward.

Senate Majority Leader Mitch McConnell (R-Ky.) needs to win 50 votes to proceed and has faced opposition from conservatives, who believe the previous bill kept too much of ObamaCare, and centrists, who think it would leave too many people without affordable insurance.

GOP leaders haven’t closed the door on bringing a straight repeal of ObamaCare, with a two-year delay, to the floor.

But Trump, who has given mixed messages on whether he wants to just repeal or simultaneously repeal and replace ObamaCare, on Wednesday told Republican senators at a White House lunch that repealing ObamaCare without a replacement was not an option.

“We can repeal it, but we should repeal it and replace, and we shouldn’t leave town until this is complete, until this bill is on my desk,” Trump said.

McConnell appears to believe that if he can get the Senate to agree to open debate on an ObamaCare measure, he’ll have an opportunity to clear legislation by grinding away at his members. As the pressure intensifies, he clearly hopes that opposition will fall away.

But he first must get past the motion to proceed.

“Next week, we’ll be voting on the motion to proceed, and I have every expectation that we’ll be able to get on the bill,” McConnell told reporters Wednesday at the White House.

McConnell has failed three times so far to win the support that he needs.

A mix of conservative and centrist senators said they would oppose a procedural motion to begin work on an initial repeal-and-replace bill.

That led to a new round of negotiations and a second repeal-and-replace measure largely similar to the first bill.

On Monday, it became clear that the new bill also lacked the support to advance in the Senate.

McConnell then signaled he’d abandon repeal-and-replace, saying the Senate would seek to advance legislation repealing ObamaCare — with no guarantee on any replacement.

Centrists then came out against that plan, too.

After the Trump meeting, GOP leaders changed course and signaled a third effort to win support for a repeal-and-replace bill.

Senate Majority Whip John Cornyn (R-Texas) told reporters after the lunch that while the repeal-only bill might come to the floor, he preferred to negotiate a version of the repeal-and-replace bill, known as the Better Care Reconciliation Act (BCRA).

“If we can get an agreement here, my preference would be to start with the BCRA, agree to language — and I think we’re getting closer,” he said.

Senators were expected to meet Wednesday evening in Sen. John Barrasso’s (R-Wyo.) office with Vice President Pence, Health and Human Services Secretary Tom Price and Seema Verma, administrator for the Centers for Medicare and Medicaid Services, to discuss the bill. At press time it was not clear which senators would attend the meeting.

“There are going to be some meetings tonight up here with people who still have outstanding issues, and I think the question will be, yeah, can we find a way to get to yes?” said Sen. John Thune (S.D.), the Senate’s No. 3 Republican.

Leaders face the same problem that has bedeviled them since the beginning. If the bill is moved to the right, moderate senators are lost. If the bill moves to the center, conservative senators defect.

The bill’s treatment of Medicaid is a major sticking point for moderates.

The latest attempt to win over members is being called a “Medicaid wraparound.”

This would allow states to take money allocated to them through Medicaid and use the money to cover healthcare expenses for people who no longer qualify for Medicaid because the program’s expansion ended.

The idea is to make up for the reduction of federal funding for ObamaCare’s Medicaid expansion, which would be curtailed by the Senate bill. Under the previous bill, states are given federal tax credits to help people who would no longer quality for Medicaid, but senators have expressed fears that this will not be a big enough pool — particularly considering the nation’s opioid epidemic.

But the plan would actually involve taking more money away from Medicaid, which would already see its federal funding reduced under the Senate bill.

Verma discussed the proposal at the White House lunch.

“She explained very briefly, very, very briefly some of the parameters of what they’re calling this wraparound for Medicaid,” said Sen. Lisa Murkowksi (R-Alaska), one of the moderates who has threatened to vote against a motion to proceed to the bill.

Despite all the problems they’ve had with their ObamaCare effort, a number of Senate Republicans said they believe they are close to getting enough votes on a repeal-and-replace bill.

McConnell’s move to bring a repeal-only bill to the floor “brought it to a head, and he offered one way forward,” Sen. Mike Rounds (R-S.D.) told The Hill after the lunch at the White House. “A lot of us went back in and talked with leadership and said, ‘Look, we’re close enough on this, we put a lot of work into this, we don’t want to go that route.’ ”

They are also facing increasing pressure from groups warning of political repercussions if they fail.

The conservative group FreedomWorks said they will hand out “traitor” awards to Republicans who oppose a healthcare procedural vote next week.

And the conservative Club for Growth said it will track the motion to proceed leading to a vote on a repeal-only bill as a “key vote,” warning that voting against it would be “tantamount to supporting ObamaCare.”

CBO: ObamaCare repeal without replace would cost 32 million insurance

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

CBO: ObamaCare repeal without replace would cost 32 million insurance

Image result for uninsured

Repealing ObamaCare without a replacement would result in 32 million people losing their insurance in the next 10 years, according to the Congressional Budget Office.
The bill, much of which would take effect in 2020, would also massively increase insurance premiums. According to the CBO, average premiums would increase by about 25 percent in 2018 alone. The increase would reach about 50 percent in 2020, and premiums would increase nearly 100 percent by 2026, CBO said.
Senate Republicans said this week they would consider voting on repeal only, after it appeared their replacement legislation had failed. However, negotiations attempting to revive repeal and replace continue and senators are scheduled to huddle Wednesday night to discuss if there’s a path forward.
The unfavorable score of the repeal-only bill could help jumpstart discussions about returning to the repeal-and-replace legislation.

A previous CBO score of the Senate’s repeal-and-replace bill estimated that 22 million people would lose insurance over the next decade.

The CBO hasn’t released a score on the most recent revision, which includes a controversial amendment from Sen. Ted Cruz (R-Texas).

The Senate will vote next week on a motion to proceed, though it’s not clear which bill Majority Leader Mitch McConnell (R-Ky.) wants to move to — a straight repeal or the repeal-and-replace legislation that seemed dead just days ago.

Both the House and Senate passed the “repeal-only” bill in 2015 that was vetoed by President Obama. Among other provisions, the “repeal only” bill would eliminate: ObamaCare’s individual and employer mandates, the Medicaid expansion, and subsidies for low-income individuals.

It would retain the requirements that protect people with pre-existing conditions from discrimination and would continue to require insurers to offer specific benefits.

According to the CBO “eliminating the penalty associated with the individual mandate and the subsidies for insurance while retaining the market regulations would destabilize the nongroup market, and the effect would worsen over time.”

Republicans have argued that they need to repeal and replace ObamaCare to “rescue” the growing number of people who live in counties with no insurers on the healthcare exchanges. But according to the CBO, repeal-only would make the problem worse.

The repeal-only bill would cause insurers to begin dropping out of the marketplace as soon as next year, the CBO said. It would also leave about half of the nation’s population without any ObamaCare insurers by 2020, a figure that would increase to about three-quarters of the population by 2026.

The BCRA is dead, but don’t take your eye off Capitol Hill

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

http://www.healthcaredive.com/news/the-bcra-is-dead-but-dont-take-your-eye-off-capitol-hill/447356/

Image result for keeping an eye on

The healthcare industry may have dodged a bullet, but this week’s legislative stumbles for the GOP don’t mean healthcare is off the table for Congress. Here’s what to watch.

The bulk of the Affordable Care Act (ACA) has survived the latest Republican efforts to repeal it, as Senate leaders were forced to admit Tuesday their best chance to fulfill years of campaign promises to gut the law has floundered.

The Senate plan to replace the ACA sank Tuesday night when the total number of Republicans opposing the bill rose to four. Republican Senate Leader Mitch McConnell immediately pivoted to an effort to repeal the ACAwithout a replacement plan. Only hours later, however, that plan also became unrealistic, as moderate Republicans said such a move would be too risky and they would not vote for it.

Industry groups were happy with the news. Scores of policy experts and healthcare professionals had railed against both the Senate and House bills to replace the ACA. Congressional Budget Office estimates found they would take away health insurance coverage for more than 20 million people. Both proposals also drastically cut Medicaid and eliminated protections for people with pre-existing conditions.

Millions more uninsured would have caused a hefty increase in uncompensated care costs for hospitals. The Commonwealth Fund estimated both replacement bills would have meant nearly a million healthcare jobs lost by 2026.

The industry may have dodged a bullet, but this week’s legislative stumbles for the GOP don’t mean healthcare will be off the table in Congress. Here’s what to watch.

Stabilizing the individual market

The most immediate concern for payers with ACA repeal out of the picture is cost-sharing reduction (CSR) payments and the stabilization of the individual market. McConnell has said legislation to help shore up the market would be needed if the Senate’s Better Care and Reconciliation Act (BCRA) failed. But at least one lawmaker — Senate Majority Whip John Cornyn — said Tuesday he would “not be part of any bailout of insurance companies.”

President Donald Trump said Tuesday that Republicans should “let Obamacare fail” and pin the blame on Democrats. This would likely mean withholding CSRs, a position Trump has repeatedly advocated.

CSRs are meant to help insurers pay for beneficiaries with more care needs and therefore higher costs. They help payers keep a balanced risk pool. Congress and the White House have so far refused to commit to the payments for next year, and insurance companies pulling out of the ACA exchange markets have cited that inaction as a major reason for withdrawal.

The Trump administration still has to decide whether to continue defending a lawsuit against the White House from House Republicans claiming the Obama administration was paying the CSRs without proper appropriation. Payers are hoping Republicans agree to commit to future CSRs with a clearly above-board fund.

Republicans who balk at the CSRs may try to push their own ideas for how to stabilize the market. They have previously proposed changing the age band to allow insurers to charge older people more and tightening requirements for special enrollment periods. The BCRA included $112 billion to help payers stabilize the market, but that funding lasted only two years and assumed the other numerous changes the BCRA called for would go into effect.

Payers would much prefer a commitment to funding CSRs with a clearly above-board fund. That would certainly help steady the ACA marketplaces, but Republican rhetoric about the markets’ “death spiral” is overblown. The CBO has said the individual market would remain stable in most areas under current law, and a Kaiser Family Foundation report showed that payers are regaining profitability in the market while stability is increasing.

Executive actions

The White House will likely be making its own plans in case efforts in Congress fall through.

Trump has said very little about healthcare policy during his time in office. Other than a few tweets, Trump didn’t participate in vote-wrangling for the ACA replacement bills and didn’t make much use of his bully pulpit.

He held a celebratory press conference in the Rose Garden when the House passed its ACA replacement bill and also supported the BCRA. When the Senate bill failed, he immediately called for a repeal without replacement, but the administration didn’t elaborate on when a replacement might come or what it would look like.

Trump has already issued one major executive order on healthcare. Immediately after taking office, he told federal agencies to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay any provision or requirement that of the Act that would impose a fiscal burden on any state or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, purchasers of health insurance, or makers of medical devices, products, or medication.”

The IRS under Trump is still technically enforcing the individual mandate, although it also accepted tax returns that don’t indicate whether the filer has health insurance. With the failure to replace the ACA in Congress, Trump could push for complete abandonment of the requirement. Without the mandate, healthy people who don’t need much care would be less likely to get coverage and risk pools would become more unstable.

HHS has already indicated it will allow more state waivers under the ACA, letting states dictate what benefits are required and how people qualify for Medicaid. Conservative states have started planning waiver applications with aspects like a requirement that Medicaid beneficiaries have a job.

The administration could also weaken the ACA by refusing to publicize it. Immediately after Trump took office, the government scaled back advertising for the ACA open enrollment period. This led to fewer signups in the typically busy final days of enrollment. Without a push for young and healthy people to enroll, risk pools could again get off balance.

It hasn’t meant much yet, but with repeal off the table for now, the administration could push for more use of the order. Executive action could be tricky, however, as HHS remains understaffed.

Bipartisan options

Although Republicans and Democrats are far apart on nearly every aspect of healthcare reform, they could find that working together is their only chance of getting anything passed.

One jumping off point could be the bill put forward earlier this year by two of the more moderate Senate Republicans. It would repeal the individual and federal mandates as well as essential health benefits, but keep some aspects of the ACA, like a ban on coverage caps. It would also allow states to implement their own alternative plans, possibly with federal assistance.

Giving more control to state governments — a tactic embraced by HHS Secretary Tom Price — appeals to the left in some ways, but Democrats and patient advocates will oppose any weakening of protections for people with pre-existing and chronic conditions. Republican plans that throw out coverage mandates cannot guarantee such protections because they can easily create unbalanced risk pools.

One initiative that has nearly universal support is MACRA, as well as the movement toward value-based care in general. As providers deal with implementing MACRA payment model changes, Congress may be asked to make some tweaks or delays.

It’s unlikely any major healthcare changes in the near future will be bipartisan, but lawmakers willing to reach across the aisle could try to tackle some smaller issues.

CHIP reauthorization

Another chance to pass healthcare legislation will come at the end of September when the Children’s Health Insurance Program (CHIP) is set to expire. Lawmakers want to ensure the program continues, but may also see it as a possible vehicle for other bills. Republicans have already delayed hearings on renewing CHIP as they’ve debated how to move forward on healthcare changes.

This could be the route for a bill to stabilize the individual market. Republicans and Democrats may try to use this opportunity to push through other changes, but any delay that threatens the continuation of CHIP will be heavily criticized.

Healthcare weighs in on BCRA failure: 6 reactions

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

http://www.beckershospitalreview.com/hospital-management-administration/healthcare-weighs-in-on-bcra-failure-6-reactions.html

Image result for aca repeal failure

The Senate GOP’s revised Better Care Reconciliation Act stalled indefinitely Monday evening after two more Republican senators defected from the bill. With the bill dead, Senate Majority Leader Mitch McConnell, R-Ky., has proposed a full ACA repeal strategy that involves repealing the ACA and initiating a two-year delay.

Here are six reactions from healthcare industry leaders, provided via emailed statements.

American Medical Association President David Barbe, MD, stressed that the debate over healthcare reform is ongoing, and said a collaborative process must commence among lawmakers “that produces a bipartisan approach to improve healthcare in our country.”

“The status quo is unacceptable. Near-term action is needed to stabilize the individual/nongroup health insurance marketplace. In the long term, stakeholders and policymakers need to address the unsustainable trends in health care costs while achieving meaningful, affordable coverage for all Americans. The American Medical Association is ready to work on short- and long-term solutions.”

American Hospital Association President and CEO Rick Pollack called for “protect[ing] care for patients.”

“This [consistent call from the organization] is grounded in the belief that coverage must be preserved for all who currently have it. Repeal without any effort to replace would leave millions of patients at risk during their most vulnerable times. We have urged Congress to consider advancing solutions aimed at making our healthcare system stronger, protecting access and coverage, and exploring new delivery system reforms that have the potential to make care both more affordable and safer. Our hope is that the Senate will use this opportunity to regroup and work in a bipartisan manner to make the much-needed repairs and refinements, creating a healthcare system that can stand the test of time. We ask Congress to extend the Children’s Health Insurance Program and vital rural health programs and stabilize the health insurance marketplaces by funding the cost-sharing reduction payments.”

American Association of Medical Colleges President and CEO Darrell Kirch, MD, said his organization has maintained that an ACA repeal “must be accompanied by a simultaneous replacement that provides at least comparable healthcare coverage.”

“Patients — particularly those with complex conditions — require stability and continuity in their care. Without access to affordable meaningful coverage, many would forego or delay necessary medical care. This puts millions of Americans, including the most vulnerable patients, at risk. Any healthcare reform legislation must put patients first by maintaining or improving current levels of coverage.”

America‘s Essential Hospitals President and CEO Bruce Siegel, MD, said his organization welcomes the BCRA failure.

“We hope lawmakers seize on this opportunity to bring all stakeholders to the table and develop a plan to protect coverage for everyone — especially those in greatest need. The newly surfaced plan to repeal the ACA’s core provisions with a two-year delay is not the way to protect coverage and almost certainly would jeopardize care for people who face financial hardships.”

He added, “The repeal-and-delay strategy would leave millions of lives in limbo and create uncertainty that would destabilize insurance markets and paralyze hospitals and other providers. Needed improvements and expansion of services would stall without a clear path forward, threatening access in communities across the country. Insurers might abandon the ACA marketplace, further degrading access.”

Physicians for Reproductive Health Board Chair Willie Parker, MD, hopes congressional leaders realize ” it is time to cease efforts to destroy what is a literal lifeline for millions of Americans.”

“It’s time to stop inventing ways to deny people the right to affordable, comprehensive health care. It’s time to stop targeting women’s healthcare via making it more expensive and finding new ways to restrict care. It’s time to start treating abortion care as what is it is: a part of comprehensive healthcare that should be covered by all forms of insurance, including public insurance. It’s time to listen to evidence: birth control without extra copays has helped patients be healthier and thrive, access to preventive care saves lives, and comprehensive sex education and resources work. It’s time for healthcare equity for all. It’s time to stop attacking Medicaid, one of the most successful health care programs in our country’s history. It’s time to close the gap between Americans who have healthcare and those who don’t. In short, repeal of the ACA is an idea whose time will never come.”

Catholic Health Association of the United States President and CEO Sister Carol Keehan penned a letter to senators.

“On behalf of the Catholic Health Association of the United States, the national leadership organization of more than 2,000 Catholic healthcare systems, hospitals, long-term care facilities, sponsors, and related organizations, I strongly urge you to start anew in an open dialogue and bipartisan effort to improve healthcare coverage in our country. We believe that this moment calls for statesmanship on the part of both political parties to work together to make the improvements in our healthcare system that will stabilize the individual insurance market, improve affordability, and strengthen and expand the coverage gains already achieved.”

Republicans Now Have 3 Options for Dealing With Health Care

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

https://www.thefiscaltimes.com/2017/07/18/GOP-Health-Care-Failures-Leave-3-Paths-Open-None-Them-Very-Appealing

Image result for three paths

Badly wounded and humiliated by the latest turn of events, President Trump and Senate Majority Leader Mitch McConnell (R-KY) are blaming Democrats and a few disloyal Republicans who helped block action on the Senate GOP’s star-crossed plan to repeal and replace the Affordable Care Act.

In the aftermath of the devastating announcement late Monday by two conservative Republicans, Sens. Mike Lee of Utah and Jerry Moran of Kansas, that they were joining with Sens. Rand Paul of Kentucky and Susan Collins of Maine in opposing the bill, Trump and McConnell apparently are choosing retribution over statesmanship.

Related: The GOP Senate Health Bill Just Died as Two More Senators Say No

Unable to muster at least 50 of the 52 Senate Republicans to support the legislation – the bare majority they would need under budget reconciliation to pass the bill without a single Democratic vote and Vice President Pence casting the tie-breaking vote –the president and majority leader are vowing to press for action in the coming days to outright repeal the ACA while giving Congress two years in which to concoct a replacement plan.

But already there are indications that this Hail Mary pass approach will fail as well, with moderate Republicans pushing back.

Congressional Republicans and the Trump administration have argued for months that Obamacare, with its soaring premiums and diminished insurance choices, is in a death spiral and that Congress must save Americans from the ill effects of the 2010 legislation. But for all the problems of a program that has provided coverage to more than 20 million people, including expansion of Medicaid, the Congressional Budget Office (CBO) and other individual analysts say that the Obamacare markets have remained relatively stable, while polls show that voters much prefer to hang onto Obamacare than take their chances with the Republican approach.

McConnell, whose reputation as a shrewd deal maker has taken a beating in recent days, insisted Monday night and again today in a floor speech that the Republican-controlled Senate and House already approved a “repeal and delay” bill in early 2015 that President Obama vetoed, and that the two chambers could replicate that vote in the coming days.

Related: Why Trump Can’t Sell Health Care Reform – and the Price He’ll Pay for It

“Our Democratic friends have spoken a lot recently about wanting bipartisan solutions,” McConnell said. “This legislation will provide the opportunity for senators of all parties to engage with a fresh start and a new beginning for the American people.”

The president told reporters at the White House today that he wants to “let Obamacare fail” and then have the Democrats and GOP leader to “fix it.” He blamed the Democrats for putting the Republicans in an impossible position to pass comprehensive legislation and insisted that voters would ultimately hold the Democrats responsible. “I’m not going to own it,” he declared.

But in passing the repeal and delay legislation two years ago, the Republicans weren’t shooting with live ammunition: The bill was largely campaign messaging by the GOP, and everyone knew that Obama would prevent it from taking effect. Republicans blithely ignored the warning of the Congressional Budget Office (CBO) that the bill, if enacted, would result in havoc in the individual insurance market, skyrocketing premiums and out of pocket costs, and the loss of coverage for 32 million Americans by 2026.

Related: There’s a Nasty Surprise Hidden in the Fine Print of the GOP Health Care Bill

Trump’s and McConnell’s assertion that Democrats would have little choice but to join forces with the Republicans and negotiate a bipartisan compromise on replacement legislation if Obamacare were given a death sentence effective two years from now is fanciful at best. Senate Minority Leader Chuck Schumer (D-NY) says the Democrats are open for talks now on a wide range of measures to strengthen the existing law and bring down costs, but only if the Republicans abandon their insistence on repealing Obamacare.

“Make no mistake about it, passing repeal without a replacement would be a disaster,” Schumer said in a floor speech today. “Our health care system would implode, millions would lose coverage, coverage for millions more would be diminished, our health care system would be in such a deep hole that repair would be nearly impossible.”

While Republican prospects of making good on a seven-year promise to dismantle the Affordable Care Act appear next to zero at this point, the political situation remains fluid, with the outcome still very much in doubt. Here are three possible scenarios in the coming days and weeks: 

Repeal and delay: Like just about everything else connected with the Senate health care deliberations, the decision to go for repeal without replacing Obamacare was made in haste by McConnell and Trump after Lee and Moran jointly announced their opposition to the Better Healthcare Reconciliation Act.

Related: GOP Health Plan Hits Another Wall and McConnell Once Again Postpones a Vote

McConnell, 75, has few peers as a legislative strategist, and he is inclined to make split second decisions, as he did in declaring that the Senate wouldn’t consider a replacement for the late Supreme Court justice Antonin Scalia until after the 2016 presidential election, in hopes that a Republican president would make the choice.

Rather than allowing for a day or two of contemplation and consultation on how to proceed, McConnell announced that he intended to hold a vote in the coming days to take up the House-passed version of the Republican health care plan. He would seek passage of an amendment that would strip out many of the new GOP policies but eliminate major portions of Obamacare, including Medicaid expansion, insurance subsidies and fines for individuals and employers who failed to adhere to the law’s mandates.

But McConnell is likely to have as much trouble pushing through this backup approach as winning majority support for the health care reform legislation he almost single-handedly drafted.

Collins, a leading moderate in the party, denounced the approach and promised to vote against it this week or next when it is brought up. “I think [passage] would create great anxiety for individuals who rely on the ACA, I believe it would cause insurance markets to go into turmoil, and I don’t think it is the right way to proceed,” Collins told reporters today.

Related: Last Chance for the Senate GOP Health Plan: Let the Arm Twisting Begin

What’s more, moderate Sens. Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska told reporters that they too would oppose a repeal and delay approach, bringing to three the number of Republicans opposed to McConnell’s tactics and enough to stop them in their tracks. 

A bipartisan deal: Feelings about health care reform are running high on both sides of the aisle, and Republican disdain of Democrats for refusing to assist in rewriting the law is matched by Democrats’ contempt for McConnell in totally shutting them out of the backroom deliberations. For those who still believe that Obama and the Democrats passed the ACA without trying to make the bill a bipartisan effort, read this piece in The Atlantic, which shows how McConnell urged Senate to stonewall any cooperation with the Obama administration.

McConnell said recently that if the Republicans couldn’t agree among themselves on legislation to supplant the ACA, they would have no choice but to seek a limited bipartisan deal with the Democrats to buttress the nation’s insurance marketplaces. Schumer has repeatedly said that he was open to talks with the Republicans over the future of Obamacare, provided they abandoned their demand for outright repeal of the law and massive cuts in Medicaid for 70 million poor and disabled people,

“We’re ready to sit down right now” and negotiate “if Republicans abandon cuts to Medicaid, abandon huge tax breaks for the wealthy and agree to go through the regular order, through the committees, with hearings, onto the floor, with time for amendments,” Schumer said in a floor speech. “That’s how we perfect legislation here. That’s how it’s been done for nearly 200 years…. Almost inevitably when you try to draft something behind closed doors and not vet it with the public, it becomes a failure – in this case, a disaster.”

Related: The Lesson of the GOP Health Care Collapse: Make America Simpler Again

Should the two sides eventually get to the bargaining table, the Democrats are likely to press for a handful of other requirements, including the guarantee of a continuous flow of federal cost-sharing subsidies to enable insurers to lower premium costs for low-income consumers, a resumption of reinsurance or “rate corridor” measures that protect the insurance industry from unexpected massive losses, and some steps to rein in the cost of prescription drugs.

Robert Laszewski, a health care consultant, wrote to his clients today, “The fact is that there is no common ground that could garner more than a handful of Republicans willing to save Obamacare. Such an effort would almost certainly now take 60 votes and would require the cooperation of the Republican leadership in both houses willing to let some of their caucus give the Democrats an enormous victory.”

Status Quo and stumbling along: A third possibility is that dysfunction in Congress and a lack of leadership from President Trump could result in a prolonged state of the current status quo. That would present its own problems because the ACA needs serious repair in order to bring premiums and deductibles down to more manageable levels.

Related: Everything You Need to Know About Your Health Savings Account (HAS)

The cutoff of some subsidy payments to insurers and the Trump administration’s purposefully vague statements about whether it intends to keep paying others has created the sort of uncertainty that either pushes insurers out of markets they would otherwise serve or forces them to raise premiums to compensate for additional risk.

A continuation of the status quo could help Republicans sell their narrative of a failed Obamacare if it drives more insurers away, but it’s unclear that it would bring lawmakers closer to a viable alternative to the ACA.