Tag Archives: Health Policy

Rival Senate healthcare group seeks to make waves

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Rival Senate healthcare group seeks to make waves

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A rival group of Republican senators is seeking leverage to influence the direction of the Senate’s ObamaCare replacement bill.

The group, led by Sens. Susan Collins (R-Maine) and Bill Cassidy (R-La.), has been meeting “a couple times a week,” according to Sen. Shelly Moore Capitol (R-W.Va.).

Cassidy is a physician and Collins is a former state insurance commissioner. Both have been outspoken opponents of the House-passed American Healthcare Act, and have co-sponsored their own version of an ObamaCare repeal bill called the Patient Freedom Act.

Cassidy told The Hill he and Collins have been meeting with Senate leaders to talk about their legislation. However, he noted the politics of the Senate mean that every member’s voice matters.

“When you only have 52 senators, everybody has significant leverage. That tight vote margin means everyone is essential,” Cassidy said.

The main GOP working group on healthcare includes 13 men backed by Senate leadership who are seeking to bridge the divide between conservatives and centrists.

What ever legislation emerges from that group is likely to be the bill that comes to the Senate floor.

But if all of the Senate’s Democrats oppose the measure, Senate Majority Leader Mitch McConnell (R-Ky.) will only be able to afford two defections.

That gives the other group leverage.

“Let’s look at it practically,” Capito  told The Hill. “You can only lose two votes on any one issue … so I think a bloc of four or five can be very effective.”

Health lobbyists have noted many members of the leadership-led group have been fairly measured in their criticisms of the House bill approved earlier this month.

Collins and Cassidy, in contrast, both seem keen on turning sharply from the House bill.

The Bipartisan ‘Single Payer’ Solution: Medicare Advantage Premium Support For All

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http://healthaffairs.org/blog/2017/05/11/the-bipartisan-single-payer-solution-medicare-advantage-premium-support-for-all/

US national flag flying over Capitol Hill Building in Washington DC

In my last Health Affairs Blog post, I outlined a potentially bipartisan four-step plan to move past the American Health Care Act’s (AHCA’s) disastrous framework toward a more stable, less expensive health care system. For those seeking incremental, near-term solutions, I hope those recommendations provide helpful guidance.

But the AHCA’s reckless drive through the US House of Representatives has taught us something about the current status of health care politics and may have opened the window to more significant, ultimately more successful, reforms. To put it mildly, the public is essentially fed up with debating how to realign the fragmented elements of our Rube Goldbergian system. Its machinations are too complex, its politics too fickle, and its rent is too damn high for the care we are getting.

Where do we turn, then? More complexity? Cutting millions from coverage and shifting more costs to working families? With those options likely to be rejected, as conservative heavyweight Charles Krauthammer recently asserted, we may be heading “inexorably” toward a single-payer system. Poll after poll has in fact shown that a majority of Americans support such an approach. Most recently, an Economist/YouGov survey found that 60 percent of Americans support expanding Medicare to cover everyone, with only 23 percent opposed. If the AHCA defies odds and is enacted, this will only become exponentially truer as its impacts are felt.

But, you are quick to add, there are a variety of deep-seated concerns with a single-payer approach that have kept it out of mainstream political discourse so far. That’s undoubtedly true. They include: It will necessitate massive tax increases; it will cut reimbursement for services to unsustainably low rates; it will be lower quality than the employer-sponsored coverage most Americans currently have; it will consolidate power into the hands of a small number of bureaucrats; etc., etc.

My goal with this post is to demonstrate that a “unified” (punchline: It wouldn’t truly be single payer…), market-driven, federally regulated, privately delivered system need not possess any of these objectionable attributes. In fact, the parameters of such a system are all but staring us right in the face. I call it: Medicare Advantage Premium Support for All (MAPSA).

While any flavor of single payer may be the last thing that comes to mind when contemplating bipartisan initiatives, just as the far left and far right share some libertarian (and other) commonalities, we may have indeed finally come full circle in this tiresome, so-far-futile debate. By combining two shots of conservative orthodoxy with one overflowing progressive one, and stirring slowly, it is not at all far-fetched to envision an endgame cocktail for our health care system that covers everyone, decreases costs, and can pass Congress. Cheers.

ObamaCare uncertainty driving premium hikes

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ObamaCare uncertainty driving premium hikes

ObamaCare uncertainty driving premium hikes

Uncertainty among insurers about how the Trump administration will handle the Affordable Care Act could translate into double-digit premium increases for 2018.

Insurers are beginning to file rate requests with state insurance regulators, and some states could see premium increases of 50 percent or more.

Insurers are worried about how President Trump’s plans for -ObamaCare — particularly whether the requirement for individuals to buy insurance will remain and whether insurer subsidies for covering low-income enrollees will continue.

“It’s a significant factor in pricing this year,” said Cynthia Cox, a health insurance expert with the Kaiser Family Foundation.

“I think it’s fair to say these rates are higher than we would have expected to see in the absence of uncertainty.”

Insurers also blamed rate increases on an unbalanced risk pool — which means there are too many sick, expensive patients and not enough healthy ones — higher claims for medical care and drugs, and the reinstatement of an -ObamaCare tax on health insurers.

Maryland’s largest health insurer, CareFirst BlueCross BlueShield, is proposing an average rate increase of more than 50 percent.

In a statement, CareFirst said the “lack of clarity” about whether the individual mandate would be enforced played a “significant role” in its proposed rate increases.

“Failure to enforce the Individual Mandate makes it far more likely that healthier, younger individuals will drop coverage and drive up the cost for everyone else,” CareFirst said in a statement.

The company is also requesting premium increases of 35 percent in Virginia and 29 percent in Washington, D.C.

Another Maryland insurer, Evergreen Health, is requesting rate increases of 27 percent, blaming uncertainty about -the ObamaCare insurer payments and the enforcement of the individual mandate as the “primary driver.”

In Connecticut, Anthem is requesting an average premium increase of 34 percent for plans on the -ObamaCare exchanges. The state’s other exchange insurer, CTCare, is requesting a 15 percent increase.

Rate requests must be reviewed and approved by state regulators and can often change.

Connecticut and Maryland both have earlier filing deadlines than most other states, which align more closely with the federal deadline of June.

Still, these states have been a good indicator of how insurers in other states will set their premiums, Cox said.

Because -ObamaCare subsidies are designed to increase as premiums go up, the people most affected by rate hikes would be those with higher incomes getting insurance through the exchanges and people getting insurance in the individual market.

It is difficult for insurers to price plans when they don’t know what will happen to -ObamaCare next year.

What moderate GOP senators want in ObamaCare repeal

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What moderate GOP senators want in ObamaCare repeal

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The House managed to narrowly pass its ObamaCare repeal bill by finding a delicate balance between hard-line conservatives and moderates. Now the Senate is looking to achieve the same feat, only with a smaller margin for error.

Senate moderates have already put their markers down on the healthcare issues that concern them the most. Individual senators hold much more power in advancing the health bill than individual House members, and if Senate Republicans can’t find a balance among their caucus, the ObamaCare repeal effort could be doomed.

The Senate will only need 51 votes to pass the bill, but because of their slim majority, Republicans can only afford to lose two votes.

The centrist senators have several major concerns with the House bill, known as the American Health Care Act (AHCA), most notably its changes to Medicaid.

The Affordable Care Act allows states to expand Medicaid coverage to more people, funded mostly by the federal government. So far, 31 states and D.C. have done so.

Even as the healthcare bill was working its way through the House, moderate GOP senators hailing from states that took the Medicaid expansion objected to the proposed cuts to the program.

In early March, Republican Sens. Rob Portman (Ohio), Shelly Moore Capito (W.Va.) Cory Gardner (Colo.) and Lisa Murkowski (R-Alaska) sent a letter to Majority Leader Mitch McConnell (R-Ky.) objecting to the Medicaid cuts in the House bill. “We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states,” the lawmakers wrote.

The legislation has changed since then, but the Medicaid provisions have been largely left alone. The House bill would undo ObamaCare’s Medicaid expansion by 2020, and would cut over $800 billion from the program.

After the House passed the legislation last week, Portman, Capito and Sen. Dean Heller (R-Nev.) were quick to say they still opposed the bill because of the Medicaid provisions.

Capito on Monday said she would like to see some form of Medicaid expansion remain permanent.

“I have seen a lot benefits to the Medicaid expansion in our state, particularly in the mental health and opioid and drug abuse areas,” Capito told reporters. As for the people who have gained coverage through expansion, Capito said “you can’t just drop them off and wish them good luck. “

Moderates have also objected to the fact that the most recent estimates of an earlier version of the House bill would have resulted in 24 million fewer people having insurance coverage over a decade.

Sen. Bill Cassidy (R-La.) has crafted, along with Collins, a different ObamaCare replacement bill that would allow states to decide whether they want to keep ObamaCare or enact something different.

Cassidy has repeatedly objected to the House version of the legislation because he says it doesn’t fulfill President Trump’s promises to “lower premiums, maintain coverage and protect those with pre-existing conditions.” During a May 8 speech at the American Hospital Association, Cassidy said that while the AHCA may lower premiums, it does so by giving people “terrible coverage.”

Aside from coverage issues, abortion is also likely to cause some headaches in the Senate.

The primary group in the Senate working on the bill includes prominent conservatives like Ted Cruz (R-Texas) and Mike Lee (R-Utah), who are likely to insist that the Senate keep a provision from the House that largely strips Planned Parenthood of funding. But Collins has said any Planned Parenthood language is a non-starter.

Moderates are also likely to insist on making sure language is removed from the House bill that would prohibit the bill’s tax credits from being used to purchase coverage on insurance plans that cover abortion. That could be a major problem for conservatives, especially if the revised bill is to have any chance at passing the House again.

Senate Majority Whip John Cornyn (R-Texas) on Monday acknowledged the balancing act leaders will need to pull off. “Now it’s a question of building consensus within the Republican conference. All 52 Republican senators are going to be part of the process … because we’re going to need everybody.”

Cornyn also said he wasn’t concerned about losing votes if the Planned Parenthood language remained in the bill.

PREPARING FOR HEALTH CARE COSTS IN RETIREMENT: AN AMERICA’S HEALTH RANKINGS® ISSUE BRIEF

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http://www.americashealthrankings.org/learn/reports/issue-brief-financial-preparedness

Click to access ahr_issuebrief17.pdf

This issue brief, released in collaboration with United Health Foundation and the Alliance for Aging Research, examines current and future seniors’ readiness for health care costs in retirement. Based on analysis of a recently conducted survey of retired seniors (age 65+) and non-retired adults (age 50-64), as well as data from studies on recommended health care savings targets in retirement, key findings include:

  • Many current and future retirees are at risk of not being able to afford the high costs of health care in retirement;
  • A high percentage of current and future retirees are unsure about how much to save to cover both anticipated as well as unexpected health care costs; and
  • Current and future retirees with retirement savings of $20,000 or less are more likely to be in poor health, have chronic disease, and have lower incomes than those with higher rates of retirement savings.

A Medicare Drug Incentive That Leads to Greater Hospitalizations

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Many studies have demonstrated what economics theory tells us must be true: When consumers have to pay more for their prescriptions, they take fewer drugs. That can be a big problem.

For some conditions — diabetes and asthma, to name a few — certain drugs are necessary to avoid more costly care, like hospitalizations. This simple principle gives rise to a little-recognized problem with Medicare’s prescription drug benefit.

For sicker Medicare beneficiaries, the Harvard economist Amitabh Chandra and colleagues found, increased Medicare hospital spending exceeded any savings from reduced drug prescriptions and doctor’s visits. Consider patients who need a drug but skip it because they feel the co-payment is too high. This could increase hospitalizations and their costs, which would make them worse off than if they’d selected a higher-premium plan with a lower co-payment.

Though just a simplified example, this is analogous to what Medicare stand-alone prescription drug plans do. They achieve lower premiums by raising co-payments. This acts to discourage the use of drugs that would help protect against other, more disruptive and serious health care use, like hospitalization.

Studies show that insurers, many of which are for-profit companies after all, are using such incentives to dissuade high-cost patients from enrolling or using the benefit. There’s evidence this occurs for Medicare’s drug benefit, as well as in the Affordable Care Act’s marketplaces.

 The most popular type of Medicare drug coverage is through a stand-alone prescription drug plan. A stand-alone plan never has to pay for hospital or physician visits — those are covered by traditional Medicare. Another way to get drug benefits from Medicare is through a Medicare Advantage plan that also covers those other forms of health care and is subsidized by the government to do so.

Because of this difference, stand-alone drug plans are less invested than Medicare Advantage plans in keeping people healthy enough to avoid some hospital visits.

A study by the economists Kurt Lavetti, of Ohio State University, and Kosali Simon, of Indiana University, quantifies the cost. Compared with Medicare Advantage plans, stand-alone drug plans charge enrollees about 13 percent more in cost sharing for drugs that are highly likely to help patients avoid an adverse health event within two months. They charge up to 6 percent more for drugs that help avoid adverse health events within a year.

Of course, people have choices about plans. Those who have selected a stand-alone drug plan, as opposed to a Medicare Advantage plan, have done so voluntarily. Why do some make this choice?

One answer is that some people are not comfortable with the more narrow networks Medicare Advantage plans offer, with their fewer choices of doctors and hospitals. By choosing a stand-alone drug plan, they can remain in traditional Medicare, which has an open network.

In addition, consumers are generally more attracted to lower-premium plans than higher ones, even if the difference is exactly made up in co-payments. This may be because premiums are easier to understand than cost sharing. Moreover, premiums reflect a sure loss — you must pay the premium to remain in the plan. A higher co-payment, on the other hand, won’t necessarily lead to a loss because you may not use a service.

The appeal of lower premiums is an incentive for stand-alone drug plans to reduce them and increase co-payments. But that can dissuade those who need medications from filling prescriptions and taking them.

Part of the purpose of Medicare’s drug benefit is to encourage enrollees to take prescription drugs that can keep them out of the hospital. In July 2003, promoting the legislation that created Medicare’s drug benefit, President George W. Bush articulated this point. “Drug coverage under Medicare will allow seniors to replace more expensive surgeries and hospitalizations with less expensive prescription medicine,” he said.

But the design of Medicare’s drug benefit includes stand-alone plans that aren’t liable for hospital costs, so they don’t work as hard to avoid them. Encouraging more beneficiaries into comprehensive plans — through Medicare Advantage — or offering a drug plan as part of traditional Medicare itself would address this limitation.

 

 

The ‘Oracle of Omaha’ Condemns Republican Health Care Bill At Berkshire Meeting

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http://www.npr.org/sections/thetwo-way/2017/05/06/527193477/the-oracle-of-omaha-condemns-republican-health-care-bill-at-berkshire-meeting?utm_content=buffer46568&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

Billionaire investor Warren Buffett fielded questions at the annual shareholders meeting for his company Berkshire Hathaway. He offered thoughts and insights on everything from Republicans voting to repeal Obamacare, to the Wells Fargo scandal, to how artificial intelligence and technology might reshape America. Here are some highlights:

Repealing Obamacare is “a huge tax cut for guys like me”

When asked about the bill Republicans in Congress just voted to pass to repeal and replace Obamacare, Buffett signaled his distaste for a tax cut provision. Obamacare pays for health care for Americans in part by taxing wealthier people. The Republican bill scraps that tax on the wealthy.

And Buffett has apparently done the math here. If the Republican bill had been law last year, he said, “my federal taxes would have gone down 17 percent last year, so it’s a huge tax cut for guys like me.”

“That is in the law that was passed a couple days ago,” he added. “Anybody with $250,000 a year of adjusted gross income and a lot of investment income is going to have a huge tax cut.”

In the past, Buffett has bristled at tax policy that he sees as favoring the wealthy — famously saying it’s not fair that he pays taxes at a lower rate than his secretary.

The medical cost “tapeworm”

Buffett said at the meeting that health care costs have become a bigger issue for American businesses than taxes.

He said if you go back to about 1960, corporate taxes were about 4 percent of GDP and now they’re about 2 percent of GDP. At that time, healthcare was 5 percent of GDP and now it’s 17 percent of GDP. “So when American business talks about taxes strangling our competitiveness,” he said, “they’re talking about something that as a percentage of GDP has gone down from 4 to 2.” Meanwhile, medical costs have exploded. “So medical costs are the tapeworm of American economic competitiveness,” he said.

He argued against the tax system crippling competitiveness “or anything of the sort.” He also noted that other developed countries appear to have found better ways to contain medical costs.

These 50 Health Issues Count as Pre-Existing Conditions

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http://fortune.com/2017/05/04/ahca-pre-existing-conditions/

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The Republican plan to repeal and replace the the Affordable Care Act (ACA), which narrowly passed a vote in the House today, rolls back protections for people with pre-existing conditions, which could increase health care costs for an estimated 130 million Americans.

The American Health Care Act stipulates that states can allow insurers to charge people with pre-existing conditions more for health insurance (which is banned under the ACA) if the states meet certain conditions, such as setting up high-risk insurance pools. Insurers still cannot deny people coverage outright, as was a common practice before the ACA’s passage, but they can hike up premiums to an unaffordable amount, effectively pricing people out of the market.

In fact, premiums could reach as high as $25,700 per year for people in high-risk pools, according to a report from AARP. People who receive insurance through their employer would not be affected, unless they lost their job or moved to the individual insurance market for some other reason.

But what counts as a pre-existing condition? While it depends on the insurer—they have the right to choose what counts as “pre-existing”—these ailments and conditions were universally used to deny people coverage, according to the Kaiser Family Foundation, a nonprofit focusing on health care research.

  • AIDS/HIV
  • Alcohol or drug abuse with recent treatment
  • Alzheimer’s/dementia
  • Anorexia
  • Arthritis
  • Bulimia
  • Cancer
  • Cerebral palsy
  • Congestive heart failure
  • Coronary artery/heart disease, bypass surgery
  • Crohn’s disease
  • Diabetes
  • Epilepsy
  • Hemophilia
  • Hepatitis
  • Kidney disease, renal failure
  • Lupus
  • Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia)
  • Multiple sclerosis
  • Muscular dystrophy
  • Obesity
  • Organ transplant
  • Paraplegia
  • Paralysis
  • Parkinson’s disease
  • Pending surgery or hospitalization
  • Pneumocystic pneumonia
  • Pregnancy or expectant parent (includes men)
  • Sleep apnea
  • Stroke
  • Transsexualism

But Cynthia Cox, Kaiser’s associate director, notes that the above list is a conservative sampling of all of the issues and maladies that insurers could count as pre-existing conditions. ” There are plenty of other conditions, even acne or high blood pressure, that could have gotten people denied from some insurers but accepted and charged a higher premium by other insurers” says Cox.

Here are some examples of those other conditions that experts have noted could hike premiums:

  • Acid Reflux
  • Acne
  • Asthma
  • C-Section
  • Celiac Disease
  • Heart burn
  • High cholesterol
  • Hysterectomy
  • Kidney Stones
  • Knee surgery
  • Lyme Disease
  • Migraines
  • Narcolepsy
  • Pacemaker
  • Postpartum depression
  • Seasonal Affective Disorder
  • Seizures
  • “Sexual deviation or disorder”
  • Ulcers

The left-leaning Center for American Progress notes that high blood pressure, behavioral health disorders, high cholesterol, asthma and chronic lung disease, and osteoarthritis and other joint disorders are the most common types of pre-existing conditions.

Just how expensive are pre-existing conditions? A recent report from the Center for American Progress found that insurers could charge people with metastatic cancer as much as $142,650 more for their coverage, a 3,500% increase.

A Squeaker In The House Becomes Headache For The Senate: 5 Things To Watch

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A Squeaker In The House Becomes Headache For The Senate: 5 Things To Watch

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After weeks of will-they-or-won’t-they tensions, the House managed to pass its GOP replacement for the Affordable Care Act on Thursday by a razor-thin margin. The vote was 217-213.

Democrats who lost the battle are still convinced they may win the political war. As the Republicans reached a majority for the bill, Democrats on the House floor began chanting, “Na, na, na, na … Hey, hey, hey … Goodbye.” They claim Republicans could lose their seats for supporting a bill that could cause so much disruption in voters’ health care.

Now the bill — and the multitude of questions surrounding it — moves across the Capitol to the Senate. And the job doesn’t get any easier. With only a two-vote Republican majority and no likely Democratic support, it would take only three GOP “no” votes to sink the bill.

Democrats have made clear they will unanimously oppose the bill. “Trumpcare” is just a breathtakingly irresponsible piece of legislation that would endanger the health of tens of millions of Americans and break the bank for millions more,” said Senate Minority Leader Chuck Schumer (D-N.Y.).

And Republicans in the Senate have their own internal disagreements, too.

Here are five of the biggest flashpoints that could make trouble for the bill in the upper chamber.

On the AHCA in the Senate

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https://www.brookings.edu/podcast-episode/on-the-ahca-in-the-senate/?utm_campaign=Brookings%20Brief&utm_source=hs_email&utm_medium=email&utm_content=51599934

Image result for Molly Reynolds, fellow in Governance Studies, considers what’s next for the AHCA in the Senate following the House narrowly passing the bill.

Molly Reynolds, fellow in Governance Studies, considers what’s next for the AHCA in the Senate following the House narrowly passing the bill.