Tag Archives: ACA

Senate GOP punts ObamaCare repeal past recess

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http://thehill.com/policy/healthcare/339682-senate-gop-punts-obamacare-repeal-past-recess

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Senate Republicans are delaying their effort to vote on legislation repealing ObamaCare until after the July 4 recess after a number of members said they opposed the current bill.

Senate Majority Leader Mitch McConnell (R-Ky.) told members of the decision on Tuesday, according to a Senate GOP aide.

The news was first reported by CNN.

It appeared GOP leaders faced an almost certain defeat on a procedural vote for the measure that Sen. John Cornyn (R-Texas) earlier on Tuesday said was coming Wednesday.

Several GOP senators had said they would oppose their party on the vote, including Sens. Rand Paul (Ky.), Susan Collins (Maine), Mike Lee(Utah) and Ron Johnson (Wis.).

Many other GOP senators were at a minimum undecided on the vote.

A Congressional Budget Office score on the measure found it would leave 22 million more people without insurance compared to present law over the next decade. The analysis also found that the Senate bill would cause premiums to rise over the next two years, undercutting a GOP argument for the bill.

Does Health Insurance Save Lives?

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http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/66276?isalert=1&uun=g885344d5576R7095614u&xid=NL_breakingnews_2017-06-26

Data from multiple sources all point to one answer.

With multiple bills, strained markets, and CBO scores all competing for the public’s attention in the healthcare debate, some researchers are examining a presumably simple question: Does health insurance save lives? A couple of recent papers, including a review appearing Monday in Annals of Internal Medicine, prompted MedPage Today clinical reviewer F. Perry Wilson, MD, to take a look at the available data and the statistical tools used to parse them.

You may have noticed that there’s a bit of a debate going on about health insurance in this country. Reflecting the great diversity of American political life, we have those calling for a universal, single-payer healthcare system:

But in the end, there’s one question that seems to really cut through the political debate: does health insurance save lives? Multiple groups are synthesizing decades worth of data to answer that question. Last week, we saw a report co-authored by Atul Gawande and appearing in the New England Journal of Medicine that concluded:

 

Numbers of uninsured changes little from House version of healthcare bill, CBO score estimates

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http://www.healthcarefinancenews.com/news/numbers-uninsured-changes-little-house-version-healthcare-bill-cbo-score-estimates?mkt_tok=eyJpIjoiTldabVl6TmhaV1kyWm1RNSIsInQiOiJKTFFBemgxZnhNOXhNUHVWMnY1Wmt6U2JLaTlURnZ6SDM0ZVRcL2M0Mjd1NW1LTW16SmkxekpiSk1adnJodDI1T0hjdnRvUmRKTnJ2XC82ZWNXVGRHWkVlMEtZRnhEdFwvM1pBQ1wvSFVHQ0ZZZ3RQcWljeUthK0UrVU9FY3Arc05ST28ifQ%3D%3D

The number of uninsured by 2026 would increase by 22 million, 1 million less than what was estimated under the House bill.

Under the new Senate bill, the number of people who would be uninsured by 2026 would increase by 22 million as compared to the number under the current Affordable Care Act and 1 million less than what was estimated under the House bill’s American Health Care Act, according to a score of the bill released Monday afternoon by the Congressional Budget Office and the staff of the Joint Committee on Taxation.

By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under the current Affordable Care Act, the CBO said.

In 2018, 15 million more people would be uninsured under this legislation than under current law–primarily because the penalty for individuals and employers for not having insurance would be eliminated.

In later years, other changes in the legislation–lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market–would also lead to increases in the number of people without health insurance, the CBO said.

By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent.

Senate Majority Leader Mitch McConnell reportedly wants a vote prior to the July 4 recess but it’s unknown whether he’ll have the votes necessary among his own party members.

Democrats were quick to denounce the bill because of the CBO findings.

“Today’s CBO score has pulled back the curtain of Senate Republicans’ healthcare bill: it’s about giving huge tax cuts to millionaires and billionaires and dismantling important middle class programs like Medicaid and Medicare, all in the name of ‘health care reform,’ said Ways and Means Committee Ranking Member Richard Neal, a Democrat from Massachusetts.

Providers also find little to like in a bill that takes away coverage in both the individual market and through Medicaid.

“The Senate’s Better Care Reconciliation Act would be as damaging to the country as its deeply unpopular House counterpart, the American Health Care Act,” said Bruce Siegel, MD, president and CEO America’s Essential Hospitals.

The score reflects a last-minute amendment by McConnell to stabilize the insurance market through a continuous coverage provision giving a penalty for a lapse in insurance.

The Senate’s Better Care Reconciliation Act of 2017 is the Senate’s answer to H.R. 1628 put forward by House Majority Leader Paul Ryan in May.

The CBO forecasts stability for the nongroup market in most areas of the country under the new bill, including in states that obtain waivers for coverage of essential benefits.

This is because there would be substantial federal funding to directly reduce premiums available through 2021. Premium tax credits would continue to provide insulation from changes in premiums through 2021 and in later years, the CBO said.

Lower premiums will help attract enough relatively healthy people for the market in most areas of the country.

That stability would continue even when cost-sharing reduction payments to insurers are eliminated starting in 2020, a move payers have said would drive up the price of premiums.

A small fraction of the population resides in areas in which — because of this legislation — no insurers would participate in the nongroup market or insurance would be offered only with very high premiums.

Insurance covering certain services would become more expensive–in some cases, extremely expensive–in some areas because the scope of coverage for essential health benefits would be narrowed through waivers affecting close to half the population, CBO and JCT said.

The CBO and JCT estimate that enacting this legislation would reduce the federal deficit over the 2017-2026 period by $321 billion. This is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House.

The largest savings would come from reductions in Medicaid. Spending on the program would decline by 26 percent in 2026 compared with what CBO projects under current law.

Spending would be reduced because of the elimination of federal spending for Medicaid expansion under the ACA’s subsidies for nongroup health insurance.

Those savings would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage including additional spending designed to reduce premiums and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance.

The largest increases in deficits would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage, including repealing a surtax on net investment income and repealing annual fees imposed on health insurers, the CBO said.

Why Geisinger’s health plan stays on the ACA exchange

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http://www.beckershospitalreview.com/payer-issues/why-geisinger-s-health-plan-stays-on-the-aca-exchange.html

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Danville, Pa.-based Geisinger Health Plan has maintained a steady presence in Pennsylvania’s individual ACA exchange, despite other insurers leaving the state’s marketplace.

Over the last two years, a number of U.S. insurers decided to exit states’ ACA exchanges, citing financial losses as well as concerns regarding future stability of the individual market. Pennsylvania’s individual ACA exchange is no exception. Hartford, Conn.-based Aetna, for instance, pulled out of ACA exchanges for 2017 in 11 states, including Pennsylvania. Additionally, Minnetonka, Minn.-based UnitedHealthcare left ACA exchanges in Pennsylvania and nearly 30 other states for 2017.

Ultimately five insurers remained on Pennsylvania’s individual ACA exchange for 2017 and will remain in the market for 2018 — Geisinger Health Plan, Pittsburgh-based UPMC Health Plan, Harrisburg, Pa.-based Capital BlueCross, Philadelphia-based Independence Blue Cross and Pittsburgh-based Highmark.

Because some insurers left the state’s individual ACA exchange, Geisinger Health Plan experienced an increase in membership, says Kurt Wrobel, the plan’s CFO and chief actuary. The plan currently has 47,000 members, up from more than 30,000 in 2016. About 60 percent of the plan’s enrollment is individuals with Medicaid, Medicare or plans on the state’s individual ACA exchange.

Geisinger Health Plan also requested a rate increase for 2018 that it says is consistent with other insurers in the state. According to the Pennsylvania Department of Insurance, the five insurers that will continue selling on Pennsylvania’s individual ACA exchange for 2018 requested average statewide rate increases of 8.8 percent for individual plans.

Regarding Geisinger Health Plan’s choice to stay on the ACA exchange in Pennsylvania, Mr. Wrobel says it comes down to Geisinger’s commitment to the people of central Pennsylvania. “As a nonprofit, our primary stakeholders are the people, so with that we’re going to have a different calculation as far as our interest in staying in a program. While policy improvements are still needed, we’ve stayed in the program and we believe it’s workable as it stands now.”

One significant advantage Geisinger Health Plan has is its connection with Geisinger Health System. Geisinger Health Plan representatives said that connection allows it to develop programs such as care management programs for members, and many of the plan’s case managers work directly with physicians’ offices to provide more support and connectivity to members’ physicians.

“We think that’s a really clear differentiator. Within that, we have more robust care management systems and programs that allow us to control costs and improve outcomes, especially relative to traditional insurance companies,” Mr. Wrobel says.

As far as the future, the health plan will remain on Pennsylvania’s individual ACA exchange as long as it has a workable program.

Mr. Wrobel says Geisinger Health Plan wouldn’t rule out expanding to ACA marketplaces in other states at some point, but it’s not a high priority right now.

Overall, without the elimination of cost-sharing reductions, which help insurers subsidize the cost of coverage for low-income Americans, Mr. Wrobel believes Geisinger Health Plan could see greater stability moving forward.

“It’s our hope we can move beyond discussions, beyond all the financial issues with the program and really get to the meat of what we try to do as a health plan, which is provide cost-effective quality care,” he says. “I think we all look forward to the day when there’s sufficient stability — and that’s what we have in the Medicare and Medicaid program as well as the employer group program — where the focus is on that operational excellence of providing cost-effective quality care and we can move beyond these discussions about financial issues.”

 

What the Senate healthcare bill could mean for Californians

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http://www.latimes.com/local/lanow/la-me-ln-senate-healthcare-bill-calif-20170623-htmlstory.html?utm_campaign=CHL%3A%20Daily%20Edition&utm_source=hs_email&utm_medium=email&utm_content=53556425&_hsenc=p2ANqtz-_hPx1HfAdYE1P-TUg2uSAZhzRObBW1gNiZE5LA54kKyb8YsTq2NfZcYDzf9ZbJqqw2CN0F7uk5g9kdOQXlj_KSKRTUow&_hsmi=53556425

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Senate leaders have released their Obamacare repeal bill, which would slash federal funding for healthcare and could leave millions of Americans uninsured.

Though the plan has not yet been analyzed by the Congressional Budget Office, it isn’t too different from the one passed by the House last month. The CBO projected the House bill would save the federal government $119 billion over the next decade, raise insurance deductibles and leave 23 million fewer Americans with health coverage.

Both bills would also undo several taxes on high-income Americans that are used to fund Obamacare.

The Affordable Care Act has had a huge impact on California, where roughly 4 million people have gained insurance and the percentage of uninsured residents has dropped more than half.

Below is a breakdown of some of the ways the Senate bill could affect healthcare coverage in California if it becomes law.

Conservative Koch Network Criticizes U.S. Senate Healthcare Bill

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https://www.nytimes.com/reuters/2017/06/25/us/politics/25reuters-usa-healthcare-koch.html?utm_campaign=CHL%3A%20Daily%20Edition&utm_source=hs_email&utm_medium=email&utm_content=53556425&_hsenc=p2ANqtz–djYFrda8WaYTSvjAGXvhQeoYibGMMBXE0-JZ8fkciqAicltqEnzobfmLi5nqpEe85UhjPan-YY-HNpx57iUBW7xUyKA&_hsmi=53556425

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Officials with the conservative U.S. political network overseen by the Koch brothers say they are unhappy with the healthcare bill that may be voted on by the Senate this week and will lobby for changes to it.

At a weekend event with conservative donors, top aides to Charles Koch, the billionaire energy magnate, said the Senate bill does not go far enough to dismantle former President Barack Obama’s signature healthcare law, also known as Obamacare.

“We have been disappointed that movement has not been more dramatic toward a full repeal,” said Tim Phillips, president of Americans for Prosperity, a grassroots advocacy group backed by Charles Koch and his brother, David.

The Senate’s 142-page proposal, worked out in secret by a group led by Senate Majority Leader McConnell, aims to deliver on a central campaign promise of President Donald Trump to repeal Obamacare, which has provided coverage to 20 million Americans since its passage in 2010.

Republicans view the law, formally called the Affordable Care Act, as a costly government intrusion and say individual insurance markets created by it are collapsing.

Phillips and other aides to the Koch network told Reuters they want to see the Senate bill do more to roll back Obamacare’s expansion of the Medicaid program for poor and disabled Americans. They also contend the bill does not do enough to reform the U.S. healthcare system and cut costs.

The aides said lobbying efforts to reshape the bill are continuing ahead of a planned vote.

Similar concerns helped steer the House’s version of the bill in a more conservative direction. A primary mover of that effort, Mark Meadows, a Republican congressman from North Carolina, attended the Koch donor event.

Meadows, chairman of the conservative Freedom Caucus in the House, said he is prepared to support the Senate bill if it clears that chamber, a sign that quick action to land the legislation on Trump’s desk is possible.

However, Meadows said the Senate version of the bill would need to be amended to allow insurers who sell plans on Obamacare’s insurance exchanges to offer less-expensive plans that do not comply with that law’s coverage requirements.

Republican Senator Ted Cruz of Texas, who currently opposes the Senate bill, has offered an amendment along those lines. Cruz attended the Koch event here, as did Senators Jeff Flake of Arizona and Ben Sasse of Nebraska, who remain undecided.

Meadows also seeks an amendment that would allow some consumers who have private health savings accounts to deduct the cost of insurance premiums from their taxes.

Senate leaders have set a goal of passing the healthcare measure by the end of this week, ahead of the July 4 congressional recess, which would then send it back to the House.

If the Senate passes legislation this week that is palatable to the House, Meadows said it is conceivable the House could pass that version and choose to forgo a formal conference committee that would reconcile the Senate and House bills. That, he said, could result in sending the bill to Trump’s desk for his signature before the recess.

Getting a vote by the end of the week could be difficult.

Five Senate Republicans, including Cruz, have publicly voiced their opposition to the current Senate draft. No Senate Democrats are expected to back it, which means McConnell cannot afford to lose more than two Senate Republicans.

As a sign of the Koch network’s influence, Phillips said his organization is prepared to spend as much as $400 million before next year’s congressional elections to advocate for the network’s conservative causes.

How Medicaid Works, and Who It Covers

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One of the biggest flash points in the debate over Republican legislation to repeal and replace the Affordable Care Act is the future of Medicaid. Here are some basic facts about the 52-year-old program.

What is Medicaid?

It’s a public health insurance program largely for low-income people, though some middle-class disabled and elderly people also qualify. States and the federal government share the cost.

Whom does Medicaid cover?

■ Nearly one in five Americans, 74 million people, are on Medicaid.

■ Federal law guarantees Medicaid coverage to pregnant women, children, elderly and disabled people under certain income levels.

■ It covers more than a third of the nation’s children and pays for half of all births.

■ It also covers almost two-thirds of nursing home residents, including many who are middle class and spent of all their savings on care before becoming eligible.

States also have the option of covering other groups, like children and pregnant women whose household incomes are higher than the federal thresholds, or young adults up to age 26 who were once in foster care.

■ The Affordable Care Act allowed a new optional group: any adults with income up to 138 percent of the poverty level, which would be $16,643 for an individual this year. Thirty-one states now offer Medicaid to this group.

When was it created?

■ In 1965, as part of President Lyndon B. Johnson’s “Great Society.”

■ There was little political debate; the bigger fight was over creating Medicare, the program to cover the elderly, which Medicaid is often confused with.

Is Medicaid an entitlement
program?

Yes. Anyone who meets the eligibility rules has a right to Medicaid coverage, and for now, states are guaranteed open-ended financial support from the federal government.

How much does it cost?

■ Medicaid cost $553 billion in fiscal year 2016. Of that amount, $348.9 billion came from the federal government; the states paid $204.5 billion.

■ Medicaid accounts for 9 percent of federal domestic spending. For states, it is the biggest source of federal funding and the second-largest budget item, behind education.

The biggest costs in Medicaid are for the elderly and the disabled, often because of long-term care in nursing homes.

■ Washington pays 50 to 75 percent of Medicaid costs for most eligible groups, with poor states receiving more money.

■ Under the Affordable Care Act, the federal government initially covered all of the costs for the roughly 11 million people insured under the law’s expansion of Medicaid, who are largely adults without disabilities.

■ Under the law, Washington picks up 95 percent of state costs for the expansion of Medicaid this year, whittling down to 90 percent in 2020.

What changes are in store?

■ Both the House and Senate health bills would fundamentally change the way the federal government pays its share of Medicaid costs, setting a per-person limit on spending that would adjust annually for inflation.

■ The bills would also effectively end the Medicaid expansion, by sharply reducing how much the federal government pays for that population starting in 2020.

■ The result of these changes, according to independent analyses, would be major reductions in federal Medicaid spending over time.

■ Enrollment would drop, too, according to the nonpartisan Congressional Budget Office, with states making it harder to qualify for the program and getting rid of certain benefits to make up for tightened federal spending.

What happens when the federal government eliminates health coverage? Lessons from the past

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http://theconversation.com/what-happens-when-the-federal-government-eliminates-health-coverage-lessons-from-the-past-79989?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20June%2023%202017%20-%2076926066&utm_content=Latest%20from%20The%20Conversation%20for%20June%2023%202017%20-%2076926066+CID_9d5a64ed9bc2c466c25f5335c06389e5&utm_source=campaign_monitor_us&utm_term=What%20happens%20when%20the%20federal%20government%20eliminates%20health%20coverage%20Lessons%20from%20the%20past

After much secrecy and no public deliberation, Senate Republicans finalized release their “draft” repeal and replace bill for the Affordable Care Act on June 22. Unquestionably, the released “draft” will not be the final version.

Amendments and a potential, albeit not necessary, conference committee are likely to make some adjustments. However, both the House version – American Health Care Act (AHCA) – and the Senate’s Better Care Reconciliation Act (BCRA) will significantly reduce coverage for millions of Americans and reshape insurance for virtually everyone. The Congressional Budget Office (CBO) is expected to provide final numbers early the week of June 26.

If successful, the repeal and replacement of the Affordable Care Act would be in rare company. Even though the U.S. has been slower than any other Western country to develop a safety net, the U.S. has rarely taken back benefits once they have been bestowed on its citizenry. Indeed, only a small number of significant cases come to mind.

My academic work has analyzed the evolution of the American health care system including those rare instances. I believe historical precedents can provide insights for the current debate.

Like the AHCA, the Senate’s health care bill could weaken ACA protections against catastrophic costs

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https://www.brookings.edu/blog/up-front/2017/06/23/like-the-ahca-the-senates-health-care-bill-could-weaken-aca-protections-against-catastrophic-costs/?utm_campaign=Brookings%20Brief&utm_source=hs_email&utm_medium=email&utm_content=53522663

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Editor’s Note:This analysis is part of USC-Brookings Schaeffer Initiative on Health Policy, which is a partnership between the Center for Health Policy at Brookings and the USC Schaeffer Center for Health Policy & Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.

On Thursday, Senate Republicans unveiled the Better Care Reconciliation Act (BCRA), its Affordable Care Act (ACA) repeal bill. One provision of that legislation would greatly expand states’ ability to waive a range of provisions of federal law that affect health insurance. As both my Brookings colleague Jason Levitis and Nicholas Bagley have explained in pieces published earlier today, states would need to meet only very weak standards in order to obtain a waiver under the Senate bill, and waivers could have wide-ranging implications for the extent and affordability of insurance coverage.

One potential effect of these state waivers is weakening a pair of protections against catastrophic costs included in the ACA. In particular, states can directly use this expanded waiver authority to eliminate the requirement that individual and small group plans cap annual out-of-pocket spending. States can also indirectly weaken or effectively eliminate both the ACA’s requirement that plans limit out-of-pocket spending and its ban on individual and lifetime limits by setting a definition of “essential health benefits” that is weaker than the definition under current law. Both of these protections against catastrophic costs apply only with respect to care that is considered essential health benefits, so as the definition of essential health benefits narrows, the scope of these protections narrows as well.

Allowing states to change the definition of essential health benefits unavoidably weakens these protections against catastrophic costs in waiver states’ individual and small group markets. But waivers’ effects could also cross state lines and weaken these protections for people covered by large employer plans in every state.[1]  Under current regulations, large employer plans are allowed to choose the definition of essential health benefits in effect in any state in the country for the purposes of determining the scope of these protections against catastrophic costs. If the Trump Administration maintains that approach as it implements the BCRA and even one state uses the waiver process under the BCRA to set a lax definition of essential health benefits, then these protections against catastrophic costs could be weakened or effectively eliminated for people working for large employers nationwide.

The potential effects of the the BCRA waiver provisions on the ACA’s protections against catastrophic costs are essentially identical to those of a waiver provision included in the House-passed American Health Care Act (AHCA), which I have written about previously. The only substantive difference is that the Senate version would allow states to directly waive the out-of-pocket maximum requirement for some plans; under the House-passed bill, states could only affect this requirement indirectly by changing the definition of essential health benefits.

The remainder of this blog post examines these issues in greater detail.

Changes to state innovation waivers in the Senate health bill undermine coverage and open the door to misuse of federal funds

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https://www.brookings.edu/blog/up-front/2017/06/23/changes-to-state-innovation-waivers-in-the-senate-health-bill-undermine-coverage-and-open-the-door-to-misuse-of-federal-funds/?utm_campaign=Brookings%20Brief&utm_source=hs_email&utm_medium=email&utm_content=53522663

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Editor’s Note:This analysis is part of USC-Brookings Schaeffer Initiative on Health Policy, which is a partnership between the Center for Health Policy at Brookings and the University of Southern California Schaeffer Center for Health Policy & Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.

On June 22, Senate Republicans released their much-awaited health reform bill, the Better Care Reconciliation Act of 2017 (BCRA). Much attention has rightfully focused on the bill’s myriad changes to the Medicaid program and to subsidies for the purchase of private insurance. But the legislation also makes potentially highly impactful changes to state innovation waivers, which are included in section 1332 of the Affordable Care Act (ACA).

Under current law, section 1332 provides broad flexibility for states to waive key ACA provisions so long as health coverage is not jeopardized and federal deficits not increased. Waivers can affect a wide range of provisions, including the premium tax credit, the definition of essential health benefits, the requirement that insurance plans cap annual out-of-pocket spending, and the requirement for states to operate a Marketplace, among others.

The changes in the Senate bill would upset this structure, removing the coverage-related guardrails and thereby opening the door for states to pursue waivers that would result in substantial losses in health coverage and affordability. The weakened guardrails would also allow states significant latitude to misuse federal health care dollars.