Tag Archives: Health Policy

Under fire from hospitals, legislator drops measure requiring reports of superbug deaths

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http://www.latimes.com/business/la-fi-superbug-death-certificate-bill-20170427-story.html

Patients are tested for the presence of the deadly, antibiotic-resistant bacteria known as CRE by pl

After complaints from California hospitals and physicians, a state legislator has stripped his bill of a measure that would have required doctors to record deadly infections on death certificates.

The California Hospital Assn. and the California Medical Assn. wrote letters saying they opposed the plan by state Sen. Jerry Hill (D-San Mateo). The measure would have required physicians to include drug-resistant bacterial infections on the death certificate if in their opinion it helped cause a person’s death.

Underreporting of hospital-acquired infections is a problem across the country. California health officials do not track deaths from these infections, which experts say are preventable if hospitals use effective sanitary controls including ensuring that staff members wash their hands.

Hospitals have long fought efforts for more disclosure of the number of infections. The hospitals can face lawsuits and government financial penalties if they are found to have lax sanitary controls.

In a March 22 letter, the California Hospital Assn. wrote that it had “great concern” about the measure, in part because patients suffering from infections often have other diseases and problems that may contribute to their deaths.

“We fear that data obtained through death certificates alone do not represent a reliable way to determine causation and ultimately, we suspect that these data will not be interpretable, nor actionable,” the group wrote. The letter was also signed by the Infectious Disease Assn. of California.

In another letter, the California Medical Assn. said its physician members believed that the language in the bill “will increase confusion and is unlikely to result in reliable data.”

Hill said in an interview that he believed his amended bill would still improve reporting of drug-resistant infections so that health officials can look for dangerous trends and take measures to stop them.

The bill, SB 43, would require hospitals and labs to annually report the number of patients testing positive for superbugs that federal officials have identified as “urgent, serious, or concerning.” The name of the hospitals would not be revealed.

The state would also be required to develop a method for estimating the number of deaths from each superbug.

The Times reported in October about the death of Sharley McMullen at Torrance Memorial Medical Center. Doctors detailed in McMullen’s medical records how she died of a superbug that sickened her after a surgery and other procedures at the hospital. McMullen’s doctor did not list the bacteria on her death certificate.

A 2014 study by University of Michigan researchers showed how often death certificates are wrong. The group concluded that infections would replace heart disease and cancer as the leading causes of death in hospitals if the count was performed by looking at patients’ medical billing records rather than death certificates. Billing records show what patients were being treated for.

Pre-existing conditions drive moderates’ concern over repeal bill

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http://www.politico.com/story/2017/04/27/healthcare-repeal-pre-existing-conditions-moderates-237713?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=51306136&_hsenc=p2ANqtz-_Kd2qUCppTF1-MJzmxXc-yctQ3aukhBU3TjgUBmQorQj2jnFsKpRFmI9jaf7tldE1bHi7_7v6CLiebqofmJrqHhkUGzA&_hsmi=51306136

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Moderate Republicans are largely withholding their support for the Obamacare repeal bill, arguing it would hurt people with pre-existing conditions

House Republican leaders hoped that the House Freedom Caucus’s endorsement of the latest Obamacare repeal bill would light a fire under enough moderates to get their whip count to the 216 votes needed to pass the measure. Instead, the holdouts are digging in, saying that the latest changes only moved the bill to the right and could put more Americans at risk of losing their health insurance.

“My concern has always been and what a lot of us talked about: people with pre-existing conditions, the elderly,” said Rep. Mario Díaz-Balart (R-Fla.). “How this makes the original bill better? Where is the part that is better for the folks I’m concerned about it? I’m not seeing it at this stage.”

Protections for people with pre-existing conditions have only been in effect for seven years, but proven to be one of the most popular and well-known features of the Affordable Care Act. Moderate Republicans are worried about stripping the safeguards without a reliable replacement. If the resistance from moderates holds, it would be enough to block Obamacare repeal in the House — or send the effort back to square one.

GOP leaders have been buttonholing moderates for two days, arguing that the latest changes — drafted by Rep. Tom MacArthur (R-N.J.) with consultation from the House Freedom Caucus — would ensure people with pre-existing conditions wouldn’t be priced out of a reconfigured market, pointing to high-risk pool requirements in state that choose to opt out of Obamacare provisions.

Backers of the repeal measure say the bill protects people with pre-existing conditions, arguing that people with coverage, for instance, can’t be priced out if they maintain it.

But buying into the plan would pose big political risks for centrists in swing districts. Voicing concerns about pre-existing conditions could prevent a tough vote on an issue that Democrats would surely spotlight in the 2018 election.

 

Several Republican sources say at least some moderates have climbed aboard, but they’re not inclined to say so publicly. House Appropriations Chairman Rodney Frelinghuysen (R-N.J.), who was widely panned by fellow Republicans for not supporting an earlier version of the repeal bill given his high-profile post, is expected to now support it, according to several sources.

Other than Frelinghuysen, there are no moderates who have publicly flipped to support the bill.

Republicans can absorb no more than 22 defections (depending on how many members are seated when the vote is held) from the 238-member Republican conference. The leaders still need fewer than 10 votes, according to several sources.

Rep. Ryan Costello (R-Pa.) said the latest changes to the bill didn’t bring him to a yes.

“Protections for those with pre-existing conditions without contingency and affordable access to coverage for every American remain my priorities for advancing healthcare reform, and this bill does not satisfy those benchmarks for me,” he said in a statement.

Rep. Barbara Comstock (R-Va.), one of the most vulnerable Republicans in 2018, said she is still a no. Rep. Carlos Curbelo of Florida is undecided— he’s still talking with leadership but claims no one is twisting his arm.

“They know better than to pressure me,” he said.

It’s not just traditional moderates who have qualms. Rep. Chris Smith (R-N.J.), who is very conservative on most social issues, is still a no.

Rep. Pete King (R-N.Y.) doesn’t want Obamacare’s Medicaid expansion repealed under the latest GOP plan, but told POLITICO he would vote to move the bill forward and assumes the Senate would restore Medicaid expansion. If the bill were to come back with Medicaid repealed, “it would be a problem,” he said.

The latest changes may have even eroded the support of moderates who backed the earlier repeal bill that was pulled in March. Rep. Adam Kinzinger of Illinois said he’s undecided. Rep. Steve King of Iowa, one of the House’s most conservative members, told reporters he’s undecided now, too.

Rep. Jim Renacci (R-Ohio), who supported the original repeal bill, is undecided but inclined to move the process forward.

“My biggest concern is that we’re changing things based on amendments written in backrooms and not everyone knows what is said and what’s part of the deal,” he said.

Some Republicans just don’t want to talk about it.

Rep. Darrell Issa of California paused to hear a reporter’s question on his vote, then kept walking.

4 key questions surrounding Obamacare repeal

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http://www.politico.com/story/2017/04/27/will-obamacare-be-repealed-237696?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=51306136&_hsenc=p2ANqtz-91DD9raN2n1umqmo9b8-k4OlgLXPyEkzYPXWWRbdIcAe7dVIMt6R7ki08jRw6FoDweDXiNFAYwLxupQZu-Acb4cLNFKQ&_hsmi=51306136

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House Republicans are mounting yet another effort to tear down Obamacare and remake the health care system — but the path to delivering on one of the GOP’s longest-standing priorities remains complicated and fraught with uncertainty.

House GOP leadership is working furiously to rally support for its Obamacare repeal bill amid threats of a government shutdown, rebellion within its ranks and dire warnings about the consequences for the nation’s most vulnerable Americans. The Trump administration and Republican leaders contend they’re drawing closer to a deal. Still, the situation is more fluid than ever. Here’s where things stand on the biggest outstanding questions:

Give it to us straight: Is the House going to vote on Obamacare repeal this week?

The official answer is no — at least not yet. The Republican leaders are working behind the scenes to win over enough lawmakers to get the 216 votes they need. They’re not there, and there’s little expectation that enough holdouts will flip in time for a Friday vote.

“We’re going to go when we have the votes,” Speaker Paul Ryan said this morning. “It takes time to do that.”

Republicans can only absorb 22 defections — and preliminary counts suggest there are more than that number either opposed to the bill or still undecided. Most are moderate Republicans still wary of provisions in the bill that would roll back Obamacare’s expansion of Medicaid and give states new opportunities to opt out of some of the health law’s core provisions.

The bill has changed a lot since it was first introduced. What would the latest version actually do?

The core elements of the GOP’s original American Health Care Act remain intact — the measure would eliminate big parts of Obamacare, such as its requirement that everybody purchase health insurance, and it would replace the law’s subsidies with a new set of tax credits to help pay for coverage. Those credits would be less generous than what’s offered under Obamacare, and the amount people would receive is based on their age.

The legislation also would overhaul Medicaid, rolling back its expanded coverage and capping its federal funding.

Originally, Republicans planned to keep several other major Obamacare provisions intact. But the changes proposed by the new Tom MacArthur amendment would let states apply for waivers to opt out of federal requirements that insurance plans cover a minimum set of benefits, and reopen the door to charging more based on a person’s health status under certain circumstances. States that take advantage of that flexibility would have to set up a high-risk pool or some other program to ensure that people would not be priced out of the market.

Those changes were essential to winning support from conservatives who complained that the original bill didn’t go far enough to repeal Obamacare. But that shift also threatens to alienate moderates, who were already nervous about leaving more people uninsured.

Who are these moderates? And what will it take to get them on board?

Many of the Republican holdouts belong to the Tuesday Group, the caucus of some 50 centrist House members. Their opposition was key to the GOP’s last-minute decision to abandon a planned vote on Obamacare repeal last month, and they’re still standing in the way. The moderates’ objections vary, but they essentially have one concern: That the repeal bill would leave far more people uninsured than there are with Obamacare.

So far, it looks like that concern hasn’t yet been addressed. The latest version of the bill would retain the phase-out of Obamacare’s Medicaid expansion and wouldn’t make the tax credits more generous. On top of that, the new state waivers could result in more people seeing higher premiums and fewer benefits. The AHCA’s proponents disagree, maintaining that the legislation would incentivize states to customize the health care system to residents’ needs. But it’s not clear that the argument has won over many centrists.

Exactly how many more uninsured are we talking about under the AHCA?

That’s not clear, and won’t be without an updated estimate from the nonpartisan Congressional Budget Office. The agency’s evaluation of the original bill predicted that 24 million more people would end up without coverage over a decade, than there are with Obamacare — losses that would come largely as a result of the restructuring of Medicaid.

But the legislation has changed several times since then, and the CBO hasn’t had an opportunity to take a second look. In fact, it may not do so until after the House votes, assuming that Republicans bring the bill to the floor in the next couple of weeks. The CBO told lawmakers’ offices that it won’t have time to fully reevaluate the revised bill, according to Democrats, and Republicans already under pressure to show progress on the bill don’t seem worried about plowing ahead without a new score.

California Senate Health Committee approves universal healthcare bill: 5 things to know

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http://www.beckershospitalreview.com/payer-issues/california-senate-health-committee-approves-universal-healthcare-bill-6-things-to-know.html

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A California single-payer healthcare bill is one step closer to passage after approval from the Senate Health Committee, according to a Los Angeles Times report.

Here are five things to know.

1. The bill in question, SB 562, would create a government-run healthcare plan, covering people living in America illegally and all other California residents, according to the report.

2. California would foot the bill for all medical expenses, according to the report. The measure, the report notes, states the program would be paid for by “broad-based revenue,” although exact details on how the program would be funded were not included.

3. Lawmakers had a few ideas on how to implement the single-payer system, including the use of EHRs and securing federal waivers to administer Medicaid and Medicare monies, according to the report.

4. Among the bill’s supporters are labor groups, such as the California Nurses Association, as well as consumer groups and the grassroots group Our Revolution, reports the Los Angeles Times. Opposing groups cited in the report include insurers, manufacturers and the California Chamber of Commerce.

5. One of the bill’s co-authors, Sen. Ricardo Lara, D-Bell Gardens, said a detailed financial study would be completed next month, according to the report.

Essential Facts About Health Reform Alternatives: Eliminating Cost-Sharing Reductions

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http://www.commonwealthfund.org/publications/explainers/2017/apr/cost-sharing-reductions?omnicid=EALERT1202020&mid=henrykotula@yahoo.com

How do cost-sharing reductions work?

Americans with low or moderate incomes can get their out-of-pocket health care expenses reduced if they have purchased a silver plan in the Affordable Care Act’s (ACA) health insurance marketplaces. The ACA’s cost-sharing reductions (CSRs) mean lower copayments and deductibles for people in households earning between 100 percent and 250 percent of the federal poverty level (about $12,000 to $30,000 for an individual, and about $24,000 to $60,750 for a family of four).1 The federal government reimburses insurers for providing the subsidies, which in 2016 totaled $7 billion.2

Those who use health care the most see the largest savings. A 2016 Commonwealth Fund analysis of marketplace plans in 38 big-city markets found that without CSRs, a 40-year-old man with a silver plan who is a high health care user and earns $35,000 a year—too much to qualify—might face up to $6,500 in out-of-pocket expenses.3 But for someone earning $17,000 who is also a high user of care, projected out-of-pocket spending would be no higher than $650—a savings of nearly $6,000 compared to the average silver plan. In other words, instead of potentially spending more than a third of his income on health care expenses, he spends no more than 3.8 percent of his income with CSRs.

What’s the backstory?

In 2017, 7 million people qualified for CSRs—58 percent of all marketplace enrollees.4 But the subsidies face challenges on several fronts. In 2014, Republicans in the U.S. House of Representatives sued the Obama administration, alleging that the U.S. Department of Health and Human Services’ payments to insurers were unlawful because Congress had not appropriated funds to pay for them.5 A May 2016 ruling by a federal judge in favor of the GOP would have stopped payment of the subsidies, but the Obama administration appealed. The case, now known as House v. Price, has been paused since the November election.

The Trump administration has indicated that, at least for now, it will continue making payments to insurers.6 And some congressional Republicans, wishing to preserve the subsidies, are willing to appropriate the necessary funds.7 However, the GOP’s recent health care reform proposal—the American Health Care Act—would eliminate cost-sharing reductions entirely.

How would eliminating cost-sharing reductions affect consumers?

If the Trump administration decides at some point to stop defending the lawsuit to end cost-sharing reductions and Congress fails to appropriate funds for them, payments to insurers would end. While insurers have signed contracts with federal and state regulators to offer health coverage, some might seek to terminate them early because of the loss of payments. Doing so would throw consumers off their coverage midyear.8

Insurance costs would rise as well, as companies opting to remain in the market would be forced to increase premiums to make up for the lost government payments. Analysts say that marketplace insurers across the country would likely raise premiums for silver plans by anywhere from 9 percent to 27 percent.9 This also would increase federal spending above what the CSRs cost, since higher premiums mean larger premium tax credits.10

How would eliminating cost-sharing reductions affect insurance markets?

Eliminating cost-sharing reductions could destabilize insurance markets. The insurers relying most heavily on cost-sharing reduction payments could see their current 7 percent profit margins turn into 25 percent losses, on average.11 Since marketplace insurers would need to substantially raise premiums, there is a risk of further market instability as healthy individuals earning too much to be eligible for the ACA’s tax credits decide to drop out of the market entirely.12

Given the magnitude of their prospective losses, many insurance companies may opt to exit the ACA marketplaces altogether. Ending the cost-sharing reductions also would discourage insurers from participating in future years. Carriers must decide before June 21, 2017, whether they will sell plans on the marketplaces in 2018. Uncertainty surrounding the payment of cost-sharing reductions is already dissuading some insurers from participating.13

Ultimately, insurers might sue the federal government to recover cost-sharing reduction payments promised under the ACA. Such litigation would be expensive and time-consuming, with the legal costs likely passed on to consumers in the form of higher premiums and out-of-pocket costs.14

What’s in the GOP’s latest deal to repeal Obamacare

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http://www.politico.com/tipsheets/politico-pulse/2017/04/whats-in-the-gops-latest-deal-to-repeal-obamacare-219988

POLITICO PulsePOLITICO PulsePOLITICO PulsePOLITICO Pulse

It’s here: Republicans’ latest Obamacare repeal-and-replace proposal dropped last night, as top House conservatives and a prominent moderate try to jump-start the stalled American Health Care Act.

WHAT’S IN REPUBLICANS’ LATEST DEAL — The eight-page amendment to the AHCA, which was hammered out by House Freedom Caucus Chairman Mark Meadows and Tuesday Group Co-Chair Tom MacArthur and scooped by POLITICO on Tuesday night, would allow states to opt out of Obamacare’s regulations on essential health benefits, community rating requirements and how much older Americans are charged for coverage.

It also would permit states to reject the continuous coverage provision that Republicans have proposed in their replacement bill. See the legislative text.

House Republicans exempted themselves from the proposal, Vox’s Sarah Kliff flagged first.

WHAT STATES WOULD NEED TO DO TO OPT OUT — Frankly, not that much. The amendment says that states would need to propose at least one of the following five to receive a waiver from HHS:

1) Reduce average premiums for coverage
2) Increase enrollment
3) Stabilize the market
4) Stabilize premiums for individuals with pre-existing conditions
5) Increase the choice of health plans

Based on the waiver, states also would have to set up a high-risk pool, presumably to push back on expected criticisms that the GOP plan would harm the sickest patients.

THE PRACTICAL IMPLICATIONS — The amendment dismantles major elements of the ACA that Republicans’ previous proposal would’ve kept, which had been a sticking point for wary conservatives. But cutting those protections means that even more Americans stand to lose coverage, which was already a no-go for many moderates.

Notably, the Congressional Budget Office projected last month that Republicans’ bill would result in 24 million fewer Americans having coverage in a decade. That number would likely increase under this amendment, a former CBO analyst told PULSE.

Expect quick reaction on the proposal: Both the Tuesday Group and the Freedom Caucus have meetings with their members today. But ahead of that …

 

Why the ‘free market’ for drugs doesn’t work and what we can do about it

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https://theconversation.com/why-the-free-market-for-drugs-doesnt-work-and-what-we-can-do-about-it-70007

The United States faces a major problem with prescription drug prices. Even as the prices of most goods and services have barely budged in recent years, the cost of drugs has surged.

During the presidential campaign, both Hillary Clinton and Donald Trump cited the high cost of prescription drugs as an issue that needed to be addressed. Most recently, the president-elect took direct aim at the pharmaceutical industry, saying it’s “getting away with murder” and arguing “new bidding procedures” are necessary to lower drug prices.

Trump didn’t get into specifics about what that would mean, but the most often suggested way to lower drug prices has been to expand the ability of major government buyers, such as Medicare, to negotiate prices.

While such negotiations could result in lower prices, we believe, based on our experience as economists and public policy experts, an alternative using public utility pricing would work better and ensure the discovery and distribution of important new medications.

‘Medically necessary’

The recent drug price data are indeed frightening.

In 2015 spending on prescription drugs rose by 8.5 percent to US$309.5 billion, compared with a rise of just 1.1 percent for consumer goods and services. Spending for specialty drugs increased by an even heftier 15 percent, on average. Individual examples that made big headlines, such as Turing Pharmaceuticals raising the price of Daraprim (a lifesaving drug for people with weakened immune systems) from $13.50 to $750 a tablet, are even more extreme.

In a competitive market, prices of a product are forced down to their costs plus a fair profit. Drug companies, on the other hand, can get away with raising prices without losing customers because the demand for certain medications is insensitive to their cost. If a drug will save your life, you’ll probably pay whatever the cost, if you can.

The problem may soon get worse. Last May, Washington state’s Medicaid program was ordered to provide the hepatitis C drugs Sovaldi and Harvoni after a court ruled they were “medically necessary.” The Washington State Health Care Authority had previously provided Harvoni – which costs $94,500 for an eight-week course of treatment – and Sovaldi – $84,000 for 12 weeks – to only the sickest patients.

Since then, other participants in Medicaid and private insurance plans have filed similar suits. Some states, including Florida, Massachusetts and New York, have already altered their Medicaid programs to pay for such life-preserving expensive drugs.

If “medically necessary” rulings become more common, producers of these drugs will have no need to worry that higher prices will reduce sales. They will be able to charge whatever they want and increase revenue and profit without hurting unit sales because insurance providers will need to make such drugs available to their policy holders.

A proposed solution

So what can be done to fix the problem?

Allowing more government agencies to negotiate prices is one option. While this has lowered the prices paid by the Veterans Administration, it may not be the best way to go in a market like the one for many innovative new specialty drugs in which consumers have no good substitutes to choose from.

Economists have shown that negotiated outcomes are not always the most efficient ones. As an example, if the government were to push drug producers too hard in negotiations, the public could get a great deal on prices in the short term but that could end up discouraging the development and testing of new drugs, which would hurt everyone in the long run.

A better approach is to start with a public utilities method, which is frequently used when there is a natural monopoly in production, such as for water or power. In these cases, state and local governments typically allow a company to have a monopoly over the market but also establish regulatory commissions to determine “fair” prices. Such prices take into account current costs, the need for investment in production facilities and the need to earn a rate of return on capital invested.

A wrinkle with drug developers is that they can incur substantial costs in their quest for new medications, including dead-end ideas and extensive testing. A 2014 report put the cost to develop a new drug at $2.6 billion, while others put it at around half that.

Under our proposal, an independent federal panel consisting of scientists, medical professionals, public health experts and economists – perhaps working as part of the FDA approval process and called on when the price of a drug is above a specific threshold – would determine the maximum price a government buyer such as Medicare or Medicaid could pay for a new drug. It could also do the same for existing treatments – for example, it could have turned down Turing’s huge Daraprim price hike.

A key element of this idea is that the panel would develop methods to identify and set maximum prices for existing and prospective drugs that cure a serious illness, improve the quality of life, limit contagion or otherwise provide large benefits to society. These procedures would need to make sure that producers of these important new drugs are sufficiently rewarded for those costly efforts.

A defensible drug-pricing system

Tough negotiations can help lower how much the government has to pay for its purchases, yet they’re not always the optimal way to achieve intended long-term results. With drugs, we definitely need to lower prices but we also need to ensure drug companies can “win” as well to avoid compromising their ability to develop lifesaving medicines.

While economists generally oppose government intervention in a “free market,” the current situation cries out for change. It is time to establish a defensible system for pricing drugs, one that both protects the public from price-gouging and encourages the development of new drugs.

The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments

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The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments

Controversy has emerged recently over federal payments to insurers under the Affordable Care Act (ACA) related to cost-sharing reductions for low-income enrollees in the ACA’s marketplaces.

The ACA requires insurers to offer plans with reduced patient cost-sharing (e.g., deductibles and copays) to marketplace enrollees with incomes 100-250% of the poverty level. The reduced cost-sharing is only available in silver-level plans, and the premiums are the same as standard silver plans.

To compensate for the added cost to insurers of the reduced cost-sharing, the federal governments makes payments directly to insurance companies. The Congressional Budget Office (CBO) estimates the cost of these payments at $7 billion in fiscal year 2017, rising to $10 billion in 2018 and $16 billion by 2027.

The U.S. House of Representatives sued the Secretary of the U.S. Department of Health and Human Services under the Obama Administration, challenging the legality of making the cost-sharing reduction (CSR) payments without an explicit appropriation. A district court judge has ruled in favor of the House, but the ruling was appealed by the Secretary and the payments were permitted to continue pending the appeal. The case is currently in abeyance, with status reports required every three months, starting May 22, 2017.

If the CSR payments end – either through a court order or through a unilateral decision by the Trump Administration, assuming the payments are not explicitly authorized in an appropriation by Congress – insurers would face significant revenue shortfalls this year and next.

Many insurers might react to the end of subsidy payments by exiting the ACA marketplaces. If insurers choose to remain in the marketplaces, they would need to raise premiums to offset the loss of the payments.

We have previously estimated that insurers would need to raise silver premiums by about 19% on average to compensate for the loss of CSR payments. Our assumption is that insurers would only increase silver premiums (if allowed to do so by regulators), since those are the only plans where cost-sharing reductions are available. The premium increases would be higher in states that have not expanded Medicaid (and lower in states that have), since there are a large number of marketplace enrollees in those states with incomes 100-138% of poverty who qualify for the largest cost-sharing reductions.

There would be a significant amount of uncertainty for insurers in setting premiums to offset the cost of cost-sharing reductions. For example, they would need to anticipate what share of enrollees in silver plans would be receiving reduced cost-sharing and at what level. Under a worst case scenario – where only people eligible for sharing reductions enrolled in silver plans – the required premium increase would be higher than 19%, and many insurers might request bigger rate hikes.

 

 

GOP senators not so keen on House’s Obamacare repeal

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http://www.politico.com/story/2017/04/27/senate-republicans-obamacare-repeal-237656

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The House may finally be on its way to scrapping Obamacare, but don’t expect the Senate to go along: Any plan sent over will undergo major surgery — and survival is far from assured.

The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.

Not to mention that some Senate conservatives still seem opposed to the emerging House deal.

“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”

Phil Novack, a spokesman for Sen. Ted Cruz , also indicated that the conservative Texas firebrand isn’t sold, saying “significant work remains” in the Senate, “specifically to address Obamacare’s insurance mandates and enact major patient-centered reforms that will further reduce the cost of health care.”

Sources say it may take more than a month for any House health care bill to run through the traps in the Senate, including internal party discussions and an analysis of how the measure would affect the deficit and insurance rolls. No committee hearings are planned because Republicans don’t want to give Democrats a public forum to bash an effort they are not involved in. And similar to the Senate’s dim view of the House’s proposal, the lower chamber may not ultimately be able to pass whatever the Senate is able to produce on Obamacare.

Plus, a procedural rift is beginning to emerge within the GOP, with several Republicans questioning whether reconciliation — the fast-track legislative process that circumvents a filibuster, and thus the need for Democratic support — is even the best avenue for health care overhaul efforts.

Few Senate Republicans are currently engaged in the health care efforts. Several GOP senators declined Wednesday to wade in to the specifics of the revised plan drafted by Rep. Tom MacArthur (R-N.J.) and Freedom Caucus Chairman Mark Meadows (R-N.C.), taking pains to note that senators will probably have to rewrite it anyway.

“It isn’t discussed a lot over here,” said Sen. Chuck Grassley (R-Iowa). “Except for the hard work of [Susan] Collins and [Bill] Cassidy, there’s hardly anything being done.”

Senate Majority Whip John Cornyn (R-Texas), the party’s chief vote counter, also downplayed any notion that the new House version of an Obamacare replacement will sail through the Senate intact.

“Once they pass a bill, my assumption is, the Senate’s going to take a look at it but not necessarily be rubber-stamping what they’re proposing,” Cornyn said. “So I would anticipate that we’ll do what we used to do all the time which is, the House will pass a bill, we’ll pass a bill and then we’ll reconcile those in a conference committee.”

Weeks after the spectacular collapse of Obamacare repeal efforts last month, MacArthur and Meadows struck a deal with new language that would allow states to opt out of several key Obamacare provisions, such as its ban on charging sick people higher premiums and the so-called essential health benefits mandate that requires insurers to provide a set of minimum benefits.

The new language was enough to earn the formal endorsement of the Freedom Caucus, but House moderates who were opposed to the previous plan remain wary of backing a proposal that could cause constituents with pre-existing conditions to lose affordable health care coverage. In fact, the new plan may be having the reverse effect on some centrists: Rep. Mike Coffman (R-Colo.) had supported the initial Obamacare replacement but now says he’s a “maybe.”

Influential Senate Republicans also raised doubts about whether the new House proposal is workable.

How Medicaid Enrollees Fare Compared with Privately Insured and Uninsured Adults

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http://www.commonwealthfund.org/publications/issue-briefs/2017/apr/how-medicaid-enrollees-fare?omnicid=EALERT1201088&mid=henrykotula@yahoo.com

Abstract

Issue: The number of Americans insured by Medicaid has climbed to more than 70 million, with an estimated 12 million gaining coverage under the Affordable Care Act’s Medicaid expansion.1,2 Still, some policymakers have questioned whether Medicaid coverage actually improves access to care, quality of care, or financial protection.

Goals: To compare the experiences of working-age adults who were either: covered all year by private employer or individual insurance; covered by Medicaid for the full year; or uninsured for some time during the year.

Method: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016.

Findings and Conclusions: The level of access to health care that Medicaid coverage provides is comparable to that afforded by private insurance. Adults with Medicaid coverage reported better care experiences than those who had been uninsured during the year. Medicaid enrollees have fewer problems paying medical bills than either the privately insured or the uninsured.