Tag Archives: Health Insurance Coverage Adequacy

Uncertain Fate Of Health Law Giving Health Industry Heartburn

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Uncertain Fate Of Health Law Giving Health Industry Heartburn

WASHINGTON, DC - NOVEMBER 10: President-elect Donald Trump (L) talks after a meeting with U.S. President Barack Obama (R) in the Oval Office November 10, 2016 in Washington, DC. Trump is scheduled to meet with members of the Republican leadership in Congress later today on Capitol Hill. (Photo by Win McNamee/Getty Images)

Six years into building its business around the Affordable Care Act, the nation’s $3 trillion health care industry may be losing that political playbook.

Industry leaders, like many voters, were stunned by the election of Donald Trump and unprepared for Republicans’ plans to “repeal and replace” Obamacare.

In addition, Trump’s vague and sometimes conflicting statements on health policy have left industry officials guessing as to the details of any substitute for the federal health law.

“It will be repealed and replaced,” Trump said Sunday in an interview on CBS’ “60 Minutes.” At the same time, he vowed to preserve popular provisions of the law like ensuring that people with preexisting conditions can get insurance and allowing young adults to stay on their parents’ health plans.

Charles (Chip) Kahn, chief executive of the Federation of American Hospitals, said that before the election, health groups had not been meeting with Republicans about a rewrite of the law “because the working assumption was we had a program that wasn’t going anywhere. That working assumption is now no longer operative.”

Upending the health law plays havoc with a health industry that had invested heavily in strategies geared to the ACA’s financial incentives. The flipped script initially left some industry groups speechless. Others issued bland statements pledging cooperation with the next administration as they awaited greater clarity from the next president.

Said Donald Crane, who heads CAPG, a national trade group for physician organizations: “Nobody was ready for this. We didn’t have a Plan B.”

The results appear to have rattled the fragile industry coalition that the Obama administration carefully crafted to support the law. Looking ahead, some health sectors might have even more reason to worry.

The hospital industry may be the most vulnerable to proposed changes, which could result in millions of Americans losing health coverage, both through the insurance exchanges and expansion in the Medicaid program for those with lower incomes.

Not Just Obamacare: Medicaid, Medicare Also On GOP’s Chopping Block

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http://www.huffingtonpost.com/entry/obamacare-medicaid-medicare-gop-chopping-block_us_582a19b8e4b060adb56fbae7?jn7jtocg8bzqia4i

rious about repealing Obamacare, and doing so quickly. But don’t assume their dismantling of government health insurance programs will stop there.

For about two decades now, Republicans have been talking about radically changing the government’s two largest health insurance programs, Medicaid and Medicare.

The goal with Medicaid is to turn the program almost entirely over to the states, but with less money to run it. The goal with Medicare is to convert it from a government-run insurance program into a voucher system ― while, once again, reducing the money that goes into the program.

House Speaker Paul Ryan (R-Wis.) has championed these ideas for years. Trump has not. In fact, in a 2015 interview his campaign website highlighted, he vowed that “I’m not going to cut Medicare or Medicaid.” But the health care agenda on Trump’s transition website, which went live Thursday, vows to “modernize Medicare” and allow more “flexibility” for Medicaid.

In Washington, those are euphemisms for precisely the kind of Medicare and Medicaid plans Ryan has long envisioned. And while it’s never clear what Trump really thinks or how he’ll act, it sure looks like both he and congressional Republicans are out to undo Lyndon Johnson’s health care legacy, not just Barack Obama’s.

f course, whenever Trump or Republicans talk about dismantling existing government programs, they insist they will replace them with something better ― implying that the people who depend on those programs now won’t be worse off.

But Republicans are not trying to replicate what Medicaid, Medicare and the Affordable Care Act do now. Nor are they trying to maintain the current, historically high level of health coverage nationwide that these programs have produced. Their goal is to slash government spending on health care and to peel back regulations on parts of the health care industry, particularly insurers.

This would mean lower taxes, and an insurance market that operates with less government interference. It would also reduce how many people get help paying for health coverage, and make it so that those who continue to receive government-sponsored health benefits will get less help than they do now.

It’s difficult to be precise about the real-world effects, because the Republican plans for replacing existing government insurance programs remain so undefined. Ryan’s“A Better Way” proposal is a broad, 37-page outline without dollar figures, and Senate Republican leaders have never produced an actual Obamacare “replacement” plan.

But the Republican plans in circulation, along with the vague ― and shifting ― health care principles Trump endorsed during the campaign, have common themes. And from those it’s possible to glean a big-picture idea of what a fully realized version of the Republican health care agenda would mean.

What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid?

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http://www.commonwealthfund.org/publications/issue-briefs/2016/nov/medicaid-block-grants

ABSTRACT

Issue: President-elect Trump and some in Congress have called for establishing absolute limits on the federal government’s spending on Medicaid, not only for the population covered through the Affordable Care Act’s eligibility expansion but for the program overall. Such a change would effectively reverse a 50-year trend of expanding Medicaid in order to protect the most vulnerable Americans.

Goal: To explore the two most common proposals for reengineering federal funding of Medicaid: block grants that set limits on total annual spending regardless of enrollment, and caps that limit average spending per enrollee.

Methods: Review of existing policy proposals and other documents.

Key findings and conclusions: Current proposals for dramatically reducing federal spending on Medicaid would achieve this goal by creating fixed-funding formulas divorced from the actual costs of providing care. As such, they would create funding gaps for states to either absorb or, more likely, offset through new limits placed on their programs. As a result, block-granting Medicaid or instituting “per capita caps” would most likely reduce the number of Americans eligible for Medicaid and narrow coverage for remaining enrollees. The latter approach would, however, allow for population growth, though its desirability to the new president and Congress is unclear. The full extent of funding and benefit reductions is as yet unknown.

New 11-Country Health Care Survey: U.S. Adults Skip Care Due To Costs, Struggle Financially, And Have The Worst Health

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http://www.commonwealthfund.org/publications/press-releases/2016/nov/international-survey-release

A new 11-country survey from The Commonwealth Fund finds that adults in the United States are far more likely than those in 10 other high-income nations to go without needed health care because of costs and to struggle to afford basic necessities such as housing and healthy food. The survey findings, published today as a Health Affairs Web First article, also indicate that Americans are sicker than people in other countries and experience high levels of emotional distress.

Despite a significant decline from 2013, about one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. By comparison, as few as 7 percent in the U.K. and Germany and 8 percent in the Netherlands and Sweden experienced these cost problems. The U.S. also stands out for its exceptionally high rate of material hardship. Fifteen percent of U.S. adults reported worrying about having enough money for nutritious food and 16 percent reported struggling to afford their rent or mortgage.

Adults in the U.S. were also the most likely to be in poor health. More than a quarter (28%) of U.S. respondents reported having multiple chronic illnesses—by far the highest rate of any country surveyed—and a similar proportion (26%) said they experienced emotional distress in the past year that was difficult to cope with on their own. Respondents in Canada (27%) and Sweden (24%) reported similar levels of emotional distress.

The Commonwealth Fund’s 2016 international survey interviewed 26,863 adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Questions focused on people’s experiences with their country’s health care system—comparing their assessments of health care access, quality, and affordability—as well as on self-reported health and well-being. The study’s authors note that by examining the variation in performance of national health systems, the U.S. can gain useful insights as it implements new reforms and seeks to meet the needs of vulnerable patients.

“Previous surveys have shown that, especially compared to other industrialized nations, the U.S. has far too many people who can’t afford the care they need, even when they have health insurance,” said Robin Osborn, Vice President and Director of The Commonwealth Fund’s International Program in Health Policy and Practice Innovations and the study’s lead author. “This survey underscores that we can do better for our sickest and poorest patients, and that should be a high priority in efforts to improve our current system.”

AMA Says New Health Policy Must Maintain Coverage for All Currently Covered

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https://morningconsult.com/2016/11/15/ama-says-new-health-policy-must-maintain-coverage-for-all-currently-covered/?utm_source=RealClearHealth+Morning+Scan&utm_campaign=5952aea6b6-EMAIL_CAMPAIGN_2016_11_16&utm_medium=email&utm_term=0_b4baf6b587-5952aea6b6-84752421

Image result for american medical association

The American Medical Association’s House of Delegates vowed Tuesday to work with the incoming Trump administration and Congress on health care reform, but said any new reforms shouldn’t result in people losing coverage.

“A core principle is that any new reform proposal should not cause individuals currently covered to become uninsured,” the group said in a statement. “We will also advance recommendations to support the delivery of high quality patient care. Policymakers have a notable opportunity to also reduce excessive regulatory burdens that diminish physicians’ time devoted to patient care and increase costs.”

The group added that it was committed to improving health insurance so patients can access high quality and affordable care. The group released a policy framework, noting they would advocate for expanding insurance coverage and choice.

Additionally, the group says it will also advocate to make sure policies offered through insurance exchanges, Medicare Advantage and Medicaid managed care offer wide provider networks. They’re also focused on encouraging prescription drug price and cost transparency.

“The new AMA policy acknowledges the carte blanche approach to drug pricing needs to change to align with the health system’s drive for high-quality care based on value,” AMA President Andrew Gurman said in a separate statement. “This transformation should support drug prices based on overall benefit to patients compared to alternatives for treating the same condition. We need to have the full picture to assess a drug’s true value to patients and the health care system.”

 

 

 

Ryan now has the muscle to phase out Medicare — within months

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http://www.sfgate.com/politics/article/Ryan-now-has-the-muscle-to-phase-out-Medicare-10613139.php?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=37625118&_hsenc=p2ANqtz-8__03zRw-gu7XJrwOBmO6XYdGObArnMQTK9_dRrTgDh69s7q3OUq53AcYCfr9bwrtHj5mbLYOPIBBdQVoE_yCtdZWBTg&_hsmi=37625118

Image result for Ryan now has the muscle to phase out Medicare — within months

House Speaker Paul Ryan’s plan to phase out Medicare is nothing new. But now, under a Trump presidency and with both houses of Congress in Republican hands, it looks like he could finally make it happen, possibly within months.

Back in 2011, as a U.S. representative for Wisconsin’s 1st Congressional District, Ryan floated a plan to turn Medicare into a “premium support” program. The “premium support” would be a payment that would let you buy insurance from private insurers. But you won’t get full coverage.

As Josh Marshall acidly noted Sunday in a blog for TPM, “In any case, rather than Medicare you’ll have insurance from an insurance company, which everybody should love because haven’t you heard from your parents and grandparents how bummed they were when they had to give up their private insurance for Medicare?

“You’ll hear lots of people calling this ‘reform’ and other catchwords. But Medicare is a single payer, universal health care system. Replacing it with private insurance means getting rid of it. Even calling it ‘privatization’ masks what is really afoot.”

On Fox News Special Report on Thursday, Ryan was asked about entitlement reform. His answer:

“You have to remember, when Obamacare became Obamacare, Obamacare rewrote Medicare, rewrote Medicaid. If you are going to repeal and replace Obamacare, you have to address those issues as well. What a lot of folks don’t realize is this 21-person board called the IPAP is about to kick in with price controls on Medicare. What people don’t realize is because of Obamacare, Medicare is going broke, Medicare is going to have price controls because of Obamacare, Medicaid is in fiscal straits. You have to deal with those issues if you are going to repeal and replace Obamacare. Medicare has serious problems [because of] Obamacare. Those are part of our plan.”

Marshall says that’s false, and Ryan knows it. Instead of putting Medicare under deeper financial stress, the Affordable Care Act has had the opposite effect and actually extended Medicare’s solvency by over 10 years, he says.

According to Medicare’s trustees, the “Part A” trust fund — the costliest component of Medicare, covering hospitalization — is set to become insolvent in 2028. In 2009, before the passage of the Affordable Care Act, it was projected that fund would go broke in 2017.

Paul Ryan is determined to gut Medicare. This time he might succeed

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http://www.latimes.com/business/hiltzik/la-fi-hiltzik-medicare-ryan-20161114-story.html?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=37625118&_hsenc=p2ANqtz-8op3UbE6wkf1QHSbmlOITUvS45OW4rFAoMDUSaFiNXpSZN2Afucl6wLeww-aou9CIZqsrb3AUTqQwZmAAU0vubnznweA&_hsmi=37625118

Image result for Paul Ryan is determined to gut Medicare. This time he might succeed

Bursting with the policymaking power that control of both houses of Congress and the White House gives Republicans, House Speaker Paul D. Ryan (R-Wis.) has lost no time in teeing up a favorite goal: gutting Medicare.

In an interview with Fox News Channel last Thursday, Ryan said: “Obamacare rewrote Medicare … so if you’re going to repeal and replace Obamacare, you have to address those issues as well. … What people don’t realize is that Medicare is going broke, that Medicare is going to have price controls. … So you have to deal with those issues if you’re going to repeal and replace Obamacare. Medicare has got some serious problems because of Obamacare. Those things are part of our plan to replace Obamacare.”

There’s no secret about what specifically Ryan has in mind. He intends to replace traditional Medicare, an efficient program offering guaranteed treatment and featuring rock-bottom administrative costs, with a privatized program. Seniors would get a federal voucher to help them pay premiums charged by commercial insurance plans. Ryan calls this system “premium support.”

Drug prices tug on the economy of healthcare

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http://www.fiercehealthcare.com/finance/drug-prices-tug-economy-healthcare?mkt_tok=eyJpIjoiTmpjd1pURm1NR0ZqTlRWbSIsInQiOiI5MkdaMWJlaGV4dlppeWNkY1NqNTNtTFJ1MFlrcWtQQWxcL2hvYWVUK3lmNEJRT1lCVTJLQTFwdGFcL0dLWWlGMnBzbGNQbXhDdnFDVUdsdkthR3Y4UzJIVm5sT25iNHJmYWd2aGlFXC9ycVNDST0ifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

Money Pills

Drug prices continue to bedevil the economics of the U.S. healthcare system in a variety of ways.

Prescription drug prices rose 7 percent between September 2015 and September of this year, according to a new report (.pdf) from the Altarum Institute’s Center for Sustainable Healthcare Spending. No other category rose more than 2.9 percent. Hospital prices rose just 1.2 percent, although that’s up significantly from the 0.7 percent annual increase between September 2014 and September of last year.

Meanwhile, Altarum’s healthcare spending report (PDF) tells a slightly different story. Prescription drug spending rose only at a 4.5 percent annual rate between September 2015 and August of this year. That’s down from the 7.2 percent growth rate from September 2014 to 2015, and the 12.4 percent rate between August 2013 and 2014.

However, hospital spending grew at a 6.6 percent annual rate in September, up from 3.4 percent between September 2014 and 2015. That’s higher than the overall 5.5 percent growth rate.

That dovetails with forecasts that U.S. healthcare spending will reach 20 percent of the gross domestic product (GDP) by the middle of next decade. According to Altarum, it currently amounts to 18.2 percent of GDP. But another report suggested that the Affordable Care Act will actually cut healthcare spending over the long term by $2.6 trillion.

The report, which is closely read by many healthcare policy experts but gains little attention in most media circles, raised some concerns from advocacy groups.

California Dreamin’ in a post-Trump healthcare world

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http://www.fiercehealthcare.com/finance/suddenly-it-s-much-darker-california-dreaming-may-be-one-silver-lining?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTmpjd1pURm1NR0ZqTlRWbSIsInQiOiI5MkdaMWJlaGV4dlppeWNkY1NqNTNtTFJ1MFlrcWtQQWxcL2hvYWVUK3lmNEJRT1lCVTJLQTFwdGFcL0dLWWlGMnBzbGNQbXhDdnFDVUdsdkthR3Y4UzJIVm5sT25iNHJmYWd2aGlFXC9ycVNDST0ifQ%3D%3D

California flag and American flag

The consensus among policymakers and observers: Not good.

“At risk is insurance coverage for literally millions of Americans,” said Anthony Wright, executive director of the advocacy group Health Access California.

Jim Lott, who teaches healthcare policy at USC and Cal State Long Beach and was the longtime executive vice president of the Hospital Association of Southern California, noted that even if parts of the law are preserved the way Trump suggests, it would still be imperiled.

“If you don’t have an employer mandate and an individual mandate, the market would self-destruct,” Lott said. “It will create havoc.”

Barcellona, an attorney by training, concurred with Lott. “The law matters and these federal programs are conditioned on the act being implemented in a certain way,” he said.

Barcellona also brought up a consequence that would be utterly disastrous for millions of middle-class Americans: If the ACA is eliminated in the middle of a calendar year, it could put them on the hook for repaying billions of dollars in premium tax credits.

Donald Trump is about to face a rude awakening over Obamacare

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https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donald-trump-is-beginning-to-face-a-rude-awakening-over-obamacare/?utm_source=RealClearHealth+Morning+Scan&utm_campaign=c672ab1b84-EMAIL_CAMPAIGN_2016_11_12&utm_medium=email&utm_term=0_b4baf6b587-c672ab1b84-84752421

After reiterating his promise to repeal and replace the Affordable Care Act, President-elect Donald Trump has indicated that he may keep two of the law’s most popular provisions. One is straightforward enough — children up to age 26 being allowed to stay on their parents’ plan. The other — preventing insurance companies from denying coverage because of preexisting conditions — offers a perfect illustration of why Trump and most of the other Republicans critics of Obamacare don’t understand the health insurance market.

Let’s say that in the beautiful new world of “repeal and replace,” insurers are required to sell you insurance despite the fact that your kid has a brain tumor. Insurance companies know what to do with that. Their actuaries can calculate that kids with brain tumors typically require (I’m making this number up) about $200,000 a year in medical care. So they’ll offer to sell you a policy at an annual premium of $240,000.

At this point your response will probably be that such an outcome is not fair. When the law says insurance companies can’t discriminate on the basis for preexisting conditions, surely what it means is that they have to charge roughly the same price for health insurance, irrespective of your preexisting condition. In the language of insurance, that’s called “guaranteed issue at community rates.”

Unfortunately, in the states that have tried guaranteed issues at community rates, the insurance markets have collapsed. That’s because if you guarantee everyone the right to buy health insurance at community rates, then some consumers will game the system. The young and healthy ones won’t buy any health insurance at all — they’ll go without until they are diagnosed with diabetes or a brain tumor or get hit by a truck crossing the street. And when that happens, they will immediately call up Aetna or Anthem and exercise their right to buy health insurance at the low community rate, irrespective of their medical condition. It won’t be long before insurance companies begin losing a ton of money and are forced either to raise premiums through the roof or stop writing policies altogether.