Who are the GOP senators who worked on the American Health Care Act behind closed doors? You’ve likely heard they are all white men chosen by Majority Leader Mitch McConnell. Here are some of their vital stats that may have influenced the outcome.
Tag Archives: Health Policy
Access to Coverage and Care for People with Preexisting Conditions: How Has It Changed Under the ACA?
Abstract
Issue: Prior to the Affordable Care Act (ACA), people with preexisting health conditions could be denied insurance coverage or charged higher rates. If the law is repealed, these protections could be diluted or lost altogether.
Goals: Assess the ACA’s impact on coverage and access for people with preexisting conditions and compare their coverage gains with state high-risk-pool enrollment pre-ACA.
Methods: Analysis of Behavioral Risk Factor Surveillance System data for the period 2011–13 to 2015.
Key Findings and Conclusions: Between 2013 and 2015, 16.5 million nonelderly adults gained coverage following full ACA implementation. Of those, 2.6 million had preexisting conditions that could have otherwise precluded them from coverage because of discriminatory denials and pricing; 9.4 million had conditions that could have otherwise affected insurance cost. We found strong correlations between these coverage gains and access to care. Coverage and access gains for people with preexisting conditions were unrelated to the size or existence of the state high-risk pools that 35 states funded for such individuals pre-ACA. Our findings suggest that proposals to replace current protections for people with preexisting conditions with high-risk pools are unlikely to be sufficient to maintain the ACA’s gains.
Background
Americans with chronic health conditions are at the center of the debate over access to health care coverage. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) estimates the number of Americans with such “preexisting conditions” ranges from 19 percent to 50 percent of all nonelderly Americans.1,2 This range represents the difference between conditions that fit into a “narrow” definition of preexisting conditions (19%), and a “broad” definition (50%). The narrow definition includes very costly health conditions that would cause insurers to refuse coverage absent the Affordable Care Act’s (ACA) provisions; the broad definition includes slightly less expensive chronic health conditions that could nevertheless make the cost of insurance in the individual market without the ACA largely unaffordable for most patients.
In 2016, the Henry J. Kaiser Family Foundation, in its review of pre-ACA medical underwriting practices, estimated that 27 percent of nonelderly American adults had health conditions that “would likely leave them uninsurable if they applied for individual market coverage.”3 Similarly, a Commonwealth Fund study found that, in 2010, 36 percent of adults ages 19 to 64 who had tried to buy a plan in the individual market over the prior three years were turned down, charged a higher price, or had a condition excluded from their coverage because of a health problem.4
The presence of preexisting conditions is particularly important for the millions of Americans who have gained coverage under the ACA, which Congress and the Trump administration are seeking to repeal.5 The Commonwealth Fund study found significant improvements in the ability of people with health problems to purchase plans on their own in 2016 relative to 2010.6
In this issue brief, we observe whether the coverage gains for people with preexisting conditions also have resulted in better access to care. Better access is defined as a greater likelihood of having a regular health care provider (whether one or more than one clinician) and having less trouble seeing a provider because of the cost.
Prior to passage of the ACA, many states had high-risk pools that sought to provide coverage to individuals locked out of the individual insurance market because of expensive preexisting conditions. Between 2010 and 2013, the ACA funded the Pre-Existing Condition Insurance Program, a set of federally funded high-risk pools to provide interim coverage for those with such conditions. If these pools had been successful in addressing coverage for those with preexisting conditions, we would expect to see a smaller gain in access to care for this population in those states that had previously enrolled substantial shares of the nongroup market in the pools.
Under the ACA, Americans with Preexisting Conditions Gained Coverage and Better Access to Care
For this brief, we considered both the narrow and broad definitions of preexisting conditions. Among the general population surveyed between 2011 and 2015, data from the Behavioral Risk Factor Surveillance System (BRFSS) indicate that 20 percent of Americans have preexisting conditions under the narrow definition and 61 percent of Americans have these conditions under the broader definition. Using the BRFSS data, we estimate that 16.5 million more people were insured in 2015 than in the 2011–2013 period.7 Among this newly insured group, 2.6 million had one or more preexisting conditions under the narrow definition and 9.4 million had one or more under the broader definition (Exhibit 1).
Live coverage: Senate GOP unveils its ObamaCare repeal bill
Click to access SENATEHEALTHCARE.pdf
A discussion draft of the Senate bill has been posted. The full text of the 142-page bill can be read here.
Senators are still in their healthcare meeting, which began at 9:30 a.m.
The Senate draft includes deep cuts to Medicaid and would fundamentally reshape it from an open-ended government commitment to a system of capped federal payments that limit federal spending.
The bill repeals billions of dollars ObamaCare taxes used to raise money for the law’s coverage expansion and also abolishes the law’s mandates to buy coverage.
The health law’s tax credits to help people buy private coverage would be kept, but would be reshaped so that they are less generous and cost the government less money.
It also phases out the federal funding for ObamaCare’s expansion of Medicaid over four years — from 2020 to 2024 –less than the seven-year phase out favored by more moderate Republicans.
Five things to watch in Senate GOP’s ACA repeal bill
A draft of the long-awaited Senate healthcare bill, crafted behind closed doors, will be publicly unveiled on Thursday.
Just a day before the bill’s scheduled release, some senators said they still didn’t know the details of some key provisions, creating uncertainty as Senate Majority Leader Mitch McConnell (R-Ky.) pushes toward a vote next week.
Here’s what to watch for.
Obamacare’s exchanges face their moment of truth
Insurers hit a major deadline Wednesday: They must inform regulators in 39 states whether they will sell insurance on many Affordable Care Act marketplaces and, if so, how much they would like to charge.
It’s something of a moment of truth for the Affordable Care Act’s marketplaces, whose health depends in large part on the participation of private insurers. And so far, states are seeing mixed results: One major insurer has made a big pullout, while a different one announced it would expand into new states.
Insurance giant Anthem announced it would leave the marketplaces — also called exchanges — where individuals can use federal subsidies to buy health plans in two states in 2018, Indiana and Wisconsin. Oscar Health, a start-up company that was co-founded by Ivanka Trump’s brother-in-law, announced it would expand in Ohio, New Jersey, Texas, Tennessee, California and New York.
The deadline applies to all 39 states whose marketplaces are run by the federal government. An evolving map by the Kaiser Family Foundation showing which counties are at risk of having no insurance options next year highlights 44 counties in four states, where about 30,000 people buy insurance through the marketplaces.
People who buy individual insurance plans in the marketplaces can take advantage of federal tax credits that are pegged to income and reduce monthly premium payments. To date, there has not been a county with zero insurers selling policies on its marketplaces, and it’s not totally clear what will happen if a county is left without any plans. It’s possible, however, that without a functional exchange, would-be participants would have to shoulder the full costs of their health insurance — or go without.
The future of the marketplaces has become a major political talking point, with the White House declaring the marketplaces a failure. Democrats blame the struggles of the market on Republicans’ failure to offer insurers reasonable clarity about the future. In particular, insurers have complained that decision-making has been difficult without certainty that cost-sharing reduction subsidies, federal payments that help bring down the out-of-pocket costs for lower-income Americans, will be paid next year.
The business of selling health coverage on the Affordable Care Act marketplaces has become “difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage,” Anthem said in a statement announcing the decision.
Mario Schlosser, chief executive of the start-up Oscar, made the opposite decision to expand its small footprint because of his faith in the long-term business of selling insurance to individuals.
“When the dust settles, there is more work to be done on the regulatory side to make sure it will be stable, but I’m confident we will see a stable market there,” Schlosser said.
MDwise Marketplace, an insurer in Indiana also announced it would leave that state’s exchange. That could put four counties at possible risk of having no insurer next year, according to Kaiser, although that is uncertain because a different insurer, Centene, has announced it is expanding in the state. A spokeswoman for Centene said the company was still working through the filing process and would not share information until it was complete.
Kaiser found counties in Ohio, Missouri and Washington are at risk of having no insurers.
Wall Street Investor Call Unveils the Secret of High Drug Prices
http://www.businessinsider.com/mallinckrodt-acthar-express-scripts-call-by-wells-fargo-2017-6
- Mallinckrodt Pharmaceuticals is facing scrutiny over the price of its blockbuster drug Acthar, some say it wouldn’t be viable without an opaque distribution system.
- The company depends on pharmacy-benefit manager (PBM) Express Scripts to distribute the drug, manage co-pays, and provide patients with assistance paying for it.
- The role of PBMs is under scrutiny from Congress, they fear PBMs pushes prices up, and that could threaten Mallinckrodt’s Achtar franchise.
Earlier this month, Wells Fargo pharma analyst David Maris called a Wall Street huddle.
He held a call for embattled pharmaceutical firm Mallinckrodt, giving its CEO Mark Trudeau an opportunity to explain the uproar surrounding his company’s $36,382 blockbuster drug, Acthar.
You see, a very Wall Street thing has just happened to Acthar. Short sellers are circling, and people are now asking questions about what was once considered business as usual. For months, some in the market, like Citron Research’s Andrew Left, have been daring Mallinckrodt to test Acthar’s efficacy as a treatment for multiple sclerosis. They say it doesn’t work.
Worse yet, other short sellers say they think they know how Acthar gets away with not working. At a Las Vegas hedge fund conference in May, Jim Chanos accused the company of having a “murky alliance” with pharmacy benefits manager Express Scripts.
“This alliance may lead to performance-enhancing drug prices,” Chanos said, “but it could give investors the blues.”
Why? Because lawmakers are starting to realize that drug pricing and distribution is a black box. What happens to the price of a drug from the time it is made to the time it gets to a patient — who gets paid and how much — is something of a mystery. It’s something, it seems, the pharmaceutical industry would rather not share.
Maris’ Wall Street huddle call opened that black box just a crack, and what it revealed is just the tip of everything Washington is worried about.
Turning to the States to Solve the National Problem of Drug Pricing
Drug pricing is a national problem. So a nonprofit wants to help hand off some of that burden to the states.
The National Academy for State Health Policy just launched a new center, called the Center for State Rx Drug Pricing, to help state governments navigate the treacherous waters of drug pricing. It just received about a million dollars in funding from the Laura and John Arnold Foundation to help states get drug pricing initiatives underway.
“We believe that pricing is such a difficult, complicated issue at the federal level that states can serve as laboratories of innovation,” said Trish Riley, executive director of NASHP. “It’s an opportunity for states to try all kinds of different approaches to lower drug prices.”
It’s an opportunity, too, to allow states to learn from one another — seeing what works and what does not in lowering pricing, and using the new NASHP center as a conduit of information.
“States are desperate for meaningful efforts to address the ever-increasing burden of drug prices on our budget,” said Dr. Rebekah Gee, secretary of the Louisiana Department of Health. There was initial optimism that President Trump might enforce a new drug price negotiating process — “but that interest seems to have dwindled, so it’s up to states to drive the conversation,” she said.
NASHP, a nonprofit, has long served as a coalition of state health policy wonks. Last year it assembled 11 points of possible policy options for states to lower prices — suggesting reforms in rate regulation, importation, bulk drug ordering, and more.
Some states already have drug cost-containment initiatives underway. Maryland, for instance, now has a law in place that punishes price gouging on generic drugs. And Nevada just passed a strict pricing transparency law that focuses primarily on diabetes drugs.
“Over the last year, 79 bills on transparency, PBMs, and the like have been introduced,” Riley said. “It’s now a very active field.”
But some think that such state-driven measures to lower prices just aren’t enough. The federal government has to be involved.
“Generally it’s difficult for programs such as these to effect real industry-level change without policy-setting power at the national level,” said Scott Hinds, an analyst at Sector & Sovereign Research. Public pressures on pricing have prompted drug makers to voluntarily decrease their inflation rates, he pointed out. And payers are now limiting formularies — lists of medicines with favored insurance coverage — which forces price competition, and could therefore lower rates, he said.
“Absent policy changes that would allow Medicare to negotiate Part D prices, I’m skeptical that there’s much that would have as much of an impact at the aggregate level as these self- or market imposed- changes,” Hinds said.
Rachel Sachs, an associate professor of law at Washington University of St. Louis, agrees that it’s likely not feasible for states to go it alone. While states could embark on a number of initiatives to promote transparency in drug pricing decisions, or tinker with spending, “most of the ambitious proposals states have advanced so far would require the federal government’s cooperation.”
She said that states could, indeed, use their existing Medicaid formularies more aggressively to also force that competition, as evidenced by the work states did around Hepatitis C drugs. However, Sachs said that price cap provisions simply won’t work on their own.
The new drug pricing center will also dole out small grants — taken from the larger Arnold Foundation gift — to a handful of states in order to help fuel their proposals for lowering drug pricing.
“We’re on a fast track to get that money out,” Riley said.
The Arnold Foundation has had a sustained interest in lowering drug pricing. Last year, for instance, it gave Memorial Sloan Kettering Cancer Center a $4.7 million grant to support the Evidence Driven Drug Pricing Project — a three-year study that examines the payment structures of specialty drugs. It also granted $5.2 million to a Boston nonprofit, the Institute for Clinical and Economic Review, to analyze whether new drugs are worth what they cost.
Democrats to slow-walk Senate business over health care bill
Democrats will begin slow-walking Senate business on Monday as part of their opposition to Republican attempts to overturn the Affordable Care Act.
Senate Minority Leader Chuck Schumer of New York said Democrats will object to requests for “unanimous consent” to set aside rules and expedite proceedings. The procedural move is a tactic the minority party can use to draw out the legislative process for days, forcing Republicans to jump through procedural hurdles to get anything done.
The goal, he said, is to refer the GOP health care bill to a committee where it can be debated and amended publicly. Republicans are writing their bill “under the cover of darkness because they’re ashamed of it,” he said.
“This is a bill that would likely reorder one-sixth of the American economy and have life-and-death consequences for millions of Americans, and it’s being discussed in secret with no committee hearings, no debate, no amendments, no input from the minority,” he said. “This is the most glaring departure from normal legislative procedure that I have ever seen.”
The move coincides with a new #AmericaSpeaksOut campaign Senate Democrats launched Monday urging Americans to “speak out against Trumpcare and share their stories.” They also plan to hold the Senate floor tonight with speeches about health care.
The House passed its Obamacare repeal bill in May, but Senate Republicans have been drafting their own bill behind closed doors.
In a letter, Democrats provided some Senate Republican leaders with a list of all 31 potential Senate rooms “to assist” Republicans in scheduling a hearing.
They wrote that Democrats, by comparison, held about 100 hearings and meetings, accepted more than 150 amendments sponsored or cosponsored by GOP senators and spent 25 days in floor debate during the drafting of the Affordable Care Act.
The move by Democrats to slow Senate business will not impact consideration of President Trump’s nominee to lead the Federal Emergency Management Agency, Brock Long, who is expected to be confirmed Tuesday, according to a Senate Democratic aide. Schumer said Democrats would not object to requests for unanimous consent on honorary resolutions, either.
The greater impact likely will be the interruption of the legislative process and routine Senate business.
Speaking on the Senate floor, Schumer asked Senate Majority Leader Mitch McConnell of Kentucky to hold an all-senators meeting to discuss a bipartisan way forward on lowering the cost of health care, raising the quality of care and stabilizing the insurance marketplaces.
McConnell responded that senators would meet on the Senate floor with an unlimited amendment process. He said there would be “ample opportunity” to read and amend the bill when Schumer asked whether Democrats would have more than 10 hours to review it.
“I rest my case,” Schumer said.
Republicans blame Democrats for refusing to negotiate on a health care bill.
“Democrats for MONTHS have stated they have no interest in working with Republicans on fixing Obamacare,” Michael Reed, the Republican National Committee’s research director and deputy communications director, wrote in a statement. “Now, Democrat efforts to feign outrage over health care negotiations should be seen for what it is — a pure partisan game aimed at placating the far-left.”
McConnell, in a Senate floor speech, said Obamacare has increased costs and reduced choice, causing Americans to drop coverage. He said the entire Senate Republican conference has been “active and engaged” for months on legislation that would stabilize insurance markets, remove mandates to buy insurance, and preserve access to care for those with pre-existing conditions.
“We believe we can and must do better than Obamacare’s status quo,” he said.
The House-passed health care bill, called the American Health Care Act, would lead to 23 million fewer people having health insurance by 2026, according to the Congressional Budget Office. If the Senate is able to pass health care legislation, the two chambers will have to come to a compromise to get a final bill to Trump’s desk.
As Democrats prepared for battle over the Senate bill, conservative House Republicans planned to send a letter to McConnell warning against letting the legislation get too moderate if he wants to keep support from the House after it passed the Senate.
The letter from the Republican Study Committee, which has more than 150 members, states that its members have “serious concerns regarding recent reports suggesting that the Senate’s efforts to produce a reconciliation bill repealing the Affordable Care Act are headed in a direction that may jeopardize final passage in the House of Representatives,” according to a copy of the draft obtained by USA TODAY.
The Senate Is Close to a Health Care Bill, but Do Republicans Have the Votes?
The 52 Republican senators have been meeting several times a week behind closed doors to develop a bill to repeal and replace the Affordable Care Act. At least 50 of them must be on board for the bill to pass, and they could try as soon as next week.
Healthcare Triage: Employer-Based Insurance Can Trap You at Work
Healthcare Triage: Employer-Based Insurance Can Trap You at Work
Here’s another possible consequence of repealing the Affordable Care Act: It would be harder for many people to retire early. That’s the topic of this week’s Healthcare Triage.
HENRY KOTULA 