Tag Archives: Health Policy

Fitch: Failed ACA replacement efforts add to healthcare sector uncertainty

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

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

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outlook comes as the Trump administration looks for ways to weaken the ACA even if the health reform law is not repealed.

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

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

Senate panel to hold bipartisan hearings on healthcare

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Senate panel to hold bipartisan hearings on healthcare

Senate panel to hold bipartisan hearings on healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Trump’s Tweets Threaten To Destabilize Insurance Markets

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here’s the wonky reason why:

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

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

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

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

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

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

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

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

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

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

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

Trump on tricky legal ground with ‘Obamacare’ threat

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http://abcnews.go.com/Health/wireStory/trump-tricky-legal-ground-obamacare-threat-48962076

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President Donald Trump’s threat to stop billions of dollars in government payments to insurers and force the collapse of “Obamacare” could put the government in a legal bind.

Law experts say he’d be handing insurers a solid court case, while undermining his own leverage to compel Democrats to negotiate, especially if premiums jump by 20 percent as expected after such a move.

“Trump thinks he’s holding all the cards. But Democrats know what’s in his hand, and he’s got a pair of twos,” said University of Michigan law professor Nicholas Bagley. Democrats “aren’t about to agree to dismantle the Affordable Care Act just because Trump makes a reckless bet.”

For months, the president has been threatening to stop payments that reimburse insurers for providing required financial assistance to low-income consumers, reducing their copays and deductibles.

Administration officials say the decision could come any day.

Playing defense, some insurers are preemptively raising premiums for next year. For example, BlueCross BlueShield of Arizona this week announced a 7.2 percent average hike for 2018. But there would likely be no increase if the subsidies are guaranteed, the company said. And BlueCross BlueShield of North Carolina earlier requested a 22.9 percent average increase. With the subsidies, the company said that would have been 8.8 percent.

The “cost-sharing” subsidies are under a legal cloud because of a dispute over whether the Obama health care law properly approved the payments. Other parts of the health care law, however, clearly direct the government to reimburse insurers.

With the issue unresolved, the Trump administration has been paying insurers each month, as the Obama administration had done previously.

Trump returned to the subject last week after the GOP drive to repeal the health care law fell apart in the Senate, tweeting, “As I said from the beginning, let ObamaCare implode, then deal. Watch!”

He elaborated in another tweet, “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies…will end very soon!”

It’s not accurate to call the cost-sharing subsidies a bailout, said Tim Jost, a professor emeritus at Washington and Lee University School of Law in Virginia.

“They are no more a bailout than payments made by the government to a private company for building a bomber,” he said.

That’s at the root of the Trump administration’s potential legal problem if the president makes good on this threat.

The health law clearly requires insurers to help low-income consumers with their copays and deductibles. Nearly 3 in 5 HealthCare.gov customers qualify for the assistance, which can reduce a deductible of $3,500 to several hundred dollars. The annual cost to the government is about $7 billion.

The law also specifies that the government shall reimburse insurers for the cost-sharing assistance that they provide.

Nonetheless, the payments remain under a cloud because of a disagreement over whether they were properly approved in the health law, by providing an “appropriation.”

The Constitution says the government shall not spend money without a congressional appropriation.

Think of an appropriation as an electronic instruction to your bank to pay a recurring monthly bill. You fully intend to pay, and the money you’ve budgeted is in your account. But the payment will not go out unless you specifically direct your bank to send it.

House Republicans trying to thwart the ACA sued the Obama administration in federal court in Washington, arguing that the law lacked specific language appropriating the cost-sharing subsidies.

A district court judge agreed with House Republicans, and now the case is on hold before the U.S. appeals court in Washington. A group of state attorneys general is asking the appeals court to let them join the case, in defense of the subsidies.

Both Bagley and Jost have followed the matter closely, and disagree on whether the health law properly approved the payments to insurers. Bagley says it did not; while Jost says it did.

However, the two experts agree that insurers would have a solid lawsuit if Trump stops the payments. Insurers could sue in the U.S. Court of Federal Claims, which hears claims for money against the government.

“The ACA promised to make these payments — that could not be clearer — and Congress has done nothing to limit that promise,” said Bagley.

“I think there would very likely be litigation if the Trump administration tries to cut off the payments,” said Jost.

Another way to resolve it: Congress could appropriate the money, even if temporarily, for a couple of years. Some prominent GOP lawmakers have expressed support for that.

If the president makes good on his threat, experts estimate that premiums for a standard “silver” plan would increase by about 19 percent. Insurers could recover the cost-sharing money by raising premiums, since those are also subsidized by the ACA, and there’s no question about their appropriation.

But millions of people who buy individual health care policies without any financial assistance from the government would face prohibitive cost increases.

And more insurers might decide to leave already shaky markets.

“This is not a game,” said California Attorney General Xavier Becerra. “Millions of people would not be able to afford health insurance for their families.”

Trump’s threats to end CSR payments may mean hospitals will see a rise in uncompensated care costs

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http://www.fiercehealthcare.com/finance/trump-s-threats-to-end-csr-payments-may-mean-hospitals-will-see-a-rise-uncompensated-care?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiT0RKaVpETTRORE5sTURNeSIsInQiOiJ0QlwvRURDeTZRRnpcL2g1eVp4ek4yVTgwM3hcL1lqcjVJdzlqcER3S0JMbFpcL3FwVzI4VEhkYktjWDdiZ3VRcTdBVVZmMml0cHIrc3lrRmhTYWlcL1wvaVRTZTA5VlczZ3I3Z3JkN0FYYTI4VWlJb3grTXZ2UDA5XC9hVTVVN2M3U2UxT3gifQ%3D%3D

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Hospitals had better brace themselves for a possible rise in uncompensated care costs if President Donald Trump makes good on an implied threat to end cost-sharing reduction payments to health insurers.

Trump indicated on Twitter this weekend that he may end “bailouts” for both insurance companies and Congress. Those bailouts refer to CSR payments, which subsidize the out-of-pocket healthcare costs of low-income Affordable Care Act exchange customers.

And if he follows through and decides this week to end those payments, the individual marketplaces could see disastrous consequences. And that means doctors and hospitals may see a spike in uncompensated care costs and bad debt, reports Forbes.

Hospitals have seen a drop in uncompensated care costs and bad debt in the years under the ACA. A recent Politico report found that spending on charity care at the top seven hospitals in the U.S. dropped from $414 million in 2013 to $272 million in 2015.

Furthermore, a recent Kaiser Family Foundation report said that if the CSR payments are withheld, premiums for silver plans would rise by 19% and more payers will likely leave the marketplaces. Doctors and hospitals are concerned that means millions of patients who have purchased insurance through the ACA exchanges won’t be able to afford their out-of-pocket costs for care.

And they have reason to be concerned, Marc Harrison, M.D., president and CEO of Intermountain Healthcare, which operates nonprofit hospitals and clinics and insures more than 800,000 people in Utah, told NPR. Without the CSR payments, rate increases will likely skyrocket. “We’ll see [the number of] people who are uninsured, or functionally uninsured, go way, way up,” he said.

“The American people need this funding to lower what they pay for coverage and be able to see their doctor,” Kristine Grow, a spokeswoman for America’s Health Insurance Plans told Forbes.

Trump is threatening a move that could make Obamacare implode — here’s which states have the most to lose

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http://www.businessinsider.com/obamacare-cost-sharing-reductions-states-benefit-2017-8

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The Trump administration is threatening a move that could make Obamacare implode.

On Tuesday, the administration is expected to make a decision on whether it will stop payments  to insurers that that help offset healthcare costs. President Donald Trump referred to these payments as “bailouts” in a a tweet on Saturday.

“If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” Trump tweeted.

If the Trump administration does decide to end the payments, known as cost-sharing reductions, it could lead to higher premiums and fewer insurance plan choices in the exchanges. CSRs are paid to insurance companies to help offset the cost of discount health plans they provide to Americans making 200% of the federal poverty limit.

Deadline for 2018 coverage

Insurance companies have until late September to raise rates and finalize their coverage areas for 2018. Not receiving CSRs in 2018 could have a serious impact on what those look like.

Already, the market is in flux. On Wednesday, Anthem, the second-largest insurer in the US, said it might leave more markets in 2018. And on Monday, Ohio said it had managed to find insurers for 19 of the 20 counties that had no insurance plans on the exchanges. Ultimately, without the CSRs, many Americans could lose their health insurance.

Stop waiting for healthcare’s ‘twilight zone’ to end

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https://insight.athenahealth.com/stop-waiting-healthcares-twilight-zone-end?cmp=10177610&sf102811697=1&lipi=urn%3Ali%3Apage%3Ad_flagship3_feed%3BZewO0JRQR2W%2BPcv5Y2pfEw%3D%3D

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Healthcare might be complicated, but the Democrat-Republican divide on the subject is actually easy to explain. Because no one wants to deal with the difficult, complex moves we would need to create a system that is more consumer-oriented, fair, transparent, logical, and value-driven, those of us who pay the bills are consistently left with $1 to pay for $1.25 worth of services.

The Democrats say, “No problem … we’ll just give everyone an extra 25 cents to pay for that healthcare dollar until the cost goes down.”

Meanwhile, Republicans, who don’t like to give away money, say, “We just won’t completely cover 20 percent of people, so the net result will get us down to $1.”

Both sides are missing the tyranny of math. If you increase access to healthcare, you will by definition either increase cost or decrease quality (or both). If you want to increase quality, you will inevitably increase cost or decrease access.

That means the true solution to our national healthcare dilemma is disruption, which to this point none of us has had the incentive or gumption to deliver.

Here’s what needs to be disrupted:

1. The runaway pricing of drugs, especially given the fact that the largest payer in the universe (Centers for Medicare and Medicaid Services, which is the U.S. government, which really means the taxpayer) cannot negotiate pricing

2. The problem of OPM, or “other people’s money:” Healthcare is the only service we use that is largely disconnected from our wallets.

3. The lack of data coordination and/or aligned incentives between payers and providers

4. The way we handle end of life issues. No, we don’t need death panels, but we do need a logical, ethical, just, realistic allocation of finite resources.

5. The ridiculous contingency and malpractice rules that really don’t benefit anyone other than plaintiff lawyers (and maybe the Gulfstream Aerospace Corp., which sells those lawyers their private jets).

6. A payment structure for providers in which we ask primary care doctors to act like NFL quarterbacks, but we pay them like NFL kickers.

7. The lack of an “open-source coding” opportunity for EHRs that would significantly decrease costs for legacy systems and allow companies to compete on differentiation.

Managing the change

I know what you’re thinking: Aren’t we in the age of alternative payment models, like MACRA? Why aren’t all of us scared to death that we won’t be ready for all these alternative payment models? Simply put, many doctors and hospitals believe they can just wait out the current “twilight zone” of healthcare.

We all talk about transitioning from volume to value, but the pace is painfully slow and depending on your age, you can probably outlast the change. Why? Again, both government and providers are satisfied with incremental change — no pressure, no pain — when an “extreme makeover” is what we need.

As the CEO of Thomas Jefferson University and Jefferson Health, a large academic health system, I do not absolve myself from this grand overspending. Because of OPM, hospitals send ridiculously unreadable bills, because we know someone else is paying them. (Your brain would explode if you actually had to interpret them.) We have too many beds in many communities, yet we oversee organizations that are adding beds, and we have no way of ferreting out underperforming hospitals.

But we understand the need for change, so we have decided to make the leap from a hospital company to a consumer health entity. This means that while we have tripled in size since 2014, we have not increased beds. Instead, we’ve invested in telehealth, digital solutions, and strategic partnerships.

It means that in the last year we have merged our health science university with a university known for design, the built environment, and Nexus Learning. It means that we are working with technology partners to learn how to provide efficient, integrated, value-driven services — something academic medical centers are not necessarily known for.

And it means, most importantly, that we are taking a cue from the retail industry. That the future is getting care out to where people are. Malls are not dead, but I would rather do my holiday shopping in my pajamas watching “Game of Thrones” than deal with the cars and people at a mall an hour away.

Similarly, hospitals will still be needed, but our goal is to get care out to people wherever they are — in what we call a “hub and hub” model (as opposed to the traditional academic “hub and spoke” system).

At Jefferson, we are moving in this direction with our community hospital mergers and our investment in telehealth. But we know the change can’t come all at once if we want to keep our doors open. So we are leveraging our strength as a top-tier academic medical center to attract patients in need of our fee-for-service procedures like surgeries. We are deliberately phasing in telehealth as a replacement for ER visits.

And, importantly, we’re establishing appropriate incentives for physicians and other providers. To paraphrase Upton Sinclair, it’s hard to get people someone to do something when their salary depends on them not doing it. So we tied our chairs’ salary incentives to telehealth adoption. And we connected our payer partnerships to the savings elicited by getting care closer to home. It takes a lot of work and communication and some time, but you can start to align your physicians’ incentives with where the organization is going.

So, politicians, providers, pharma, insurers, lawyers, software folks, doctors, nurses, and everyone else in the healthcare ecosystem: Let’s get away from Congress’s current game, as Democrats and Republicans yell at each other about who has the best solution for an impossible task.

Instead, let’s think about ‘D & R’ not as Democrat and Republican, but Disruption and Re-imagination. Then we can stop blaming each other and enjoy the fruits of a logical, forward thinking, and equitable healthcare system.

GOP lawmakers, Trump at odds over insurance payments

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GOP lawmakers, Trump at odds over insurance payments

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

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

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

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

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

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

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

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

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

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

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

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

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

Many congressional Republicans have called for continuing the CSR payments.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Senate Republicans brush off Trump’s healthcare demands

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Senate Republicans brush off Trump’s healthcare demands

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

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

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

But Trump’s demands might fall on deaf ears.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Healthcare executives call for bipartisan health reform

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Affordable Care Act highlighted

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

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

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

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

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

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

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

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

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

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