Threat Of Losing Obamacare Turns Some Apolitical Californians Into Protesters

http://khn.org/news/threat-of-losing-obamacare-turns-some-formerly-apolitical-californians-into-protesters/

Vicki Hall, 70, is professor of gender studies at Sacramento State. She was able to afford her total hip replacement surgery because of Medicare. “If the ACA goes away, people on Medicare will be worse off,\" she says. (Ana B. Ibarra/California Healthline)

Until recently, Paul Smith didn’t consider himself much of an activist. But he woke up hours before sunrise on Saturday to attend his first town hall meeting.

That meeting near Sacramento, organized by his district’s Congressman Tom McClintock (R-Roseville), sparked a peaceful — if large and raucous — protest over Obamacare, the travel ban and other issues. And it drew national headlines.

“I have noticed many of my friends who never speak [about] politics are getting political,” said Smith, a 46-year-old Rocklin, Calif., resident and registered Democrat who works in marketing. He said he did not vote for McClintock.

Once on the political sidelines, Smith now finds himself one of the leading members of a group called Indivisible California-04 — named for McClintock’s 4th Congressional district. It is one of hundreds of groups forming across the country to “resist” the Trump Administration’s agenda, which includes repealing and replacing the Affordable Care Act.

Alongside veteran protesters, recently galvanized Californians like Smith are demonstrating, calling lawmakers and taking other measures to make their voices heard. For many, the issues are not partisan. They are personal.

Placer County resident Veronica Blake said her mother had purchased health coverage through Covered California, the state’s Obamacare insurance exchange, just a few months before her death in 2013. She was never able to use the insurance, however, since exchange-based health plans did not become effective until Jan. 1, 2014.

Before that, her mother had not been covered for nearly 10 years. She had been diagnosed with breast cancer in her early 30s, and although she beat it after a mastectomy, the preexisting condition made her a high-risk patient whom insurers didn’t want to take on, Blake said.

Blake wonders how much longer her mother would have lived if she’d had health insurance all those years. Could her heart problems have been detected and treated earlier?

Blake joined hundreds of others at Saturday’s rally, she said, because she has other family members with illnesses that would be considered preexisting conditions and fears that their coverage could be taken away.

Laurel Ward, who is a nurse in Placer County, said she made her way to McClintock’s town hall event because of what she sees daily in her crowded emergency room.

She also has a younger sister who was able to obtain coverage as a result of the Medi-Cal expansion made possible by the Affordable Care Act. “It’s difficult for young people to afford health insurance,” Ward said. “I know, because I went without insurance when I was a student.”

“Without the ACA,” she said. “It’s only going to get worse.”

 

Indiana, Pence’s Home State, Seeks Federal OK To Keep Medicaid Expansion

http://khn.org/news/indiana-pences-home-state-seeks-federal-ok-to-keep-medicaid-expansion/

Statehouse of Indiana in Indianapolis (iStock/Getty Images Plus)

As Congress weighs repeal of the Affordable Care Act, the home state of Vice President Mike Pence Tuesday sought to keep its conservative-style Medicaid expansion under the federal health law.

Indiana applied to the Trump administration to extend a regulatory waiver and funding until Jan. 31, 2021, for its innovative package of incentives and penalties that are intended to encourage low-income Hoosiers on Medicaid to adopt healthy behaviors. Beneficiaries pay premiums, get health savings accounts and can lose their benefits if they miss payments.

Though Pence now supports the health law’s repeal, the Healthy Indiana Plan that he established in 2015 as the state’s governor has brought Medicaid coverage to more than 350,000 people. The architect of the plan was health care consultant Seema Verma, who has been nominated to head the Centers for Medicare & Medicaid Services.

Without Trump administration approval, federal money for Indiana’s expansion will run out Jan. 31, 2018. Indiana officials said the Medicaid expansion would continue even if Washington follows through on a Republican proposal to distribute federal Medicaid funds through a block grant program that would give states more flexibility in setting benefits and eligibility levels.

State officials refused to say whether the expansion would continue if Congress repealed Obamacare and eliminated funds for Medicaid expansions. If that happened, it’s unlikely states would have the money to make up for the lost federal aid.

Indiana’s effort to continue its Medicaid expansion demonstrates how states that expanded Medicaid under the Affordable Care Act — even Republican-controlled ones — are counting on additional federal dollars to pay for those expansions. It also reflects deadline pressure: They can’t wait for Congress to finish its debate over the future of the health law because they need to set budgets and programs now for next year.

According to Indiana’s request, continuing the Medicaid expansion will cost Indiana $1.5 billion but bring $8.6 billion in federal funding from 2018 to 2020.

“Indiana has built a program that is delivering real results in a responsible, efficient, and effective way,” Gov. Eric Holcomb, a Republican, said in a statement. “I look forward to maintaining the flexibility to grow this remarkably successful tool and to preserve our ability to respond to the unique needs of Hoosiers.”

Several other states including Kentucky and Ohio are considering adopting features of Indiana’s Medicaid plan.

 

Five Quick Ways HHS Secretary Tom Price Could Change The Course Of Health Policy

http://khn.org/news/five-quick-ways-a-new-hhs-secretary-could-change-the-course-of-health-policy/?utm_campaign=KFF-2017-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=42404172&_hsenc=p2ANqtz–5EWkVt5sjIUe_63Pbf6RTjOO_GqSTuaRBRwH_raPCxqrbMpsVfuUSNHyZm7pv8SbHa4es7RH84q1NOLCwj0m44NZyWQ&_hsmi=42404172

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After a bruising confirmation process, the Senate confirmed Rep. Tom Price, R-Ga., to head up the Department of Health and Human Services, by a 52-to-47 vote.

As secretary, Price will have significant authority to rewrite the rules for the Affordable Care Act, some of which are reportedly nearly ready to be issued.

But there is much more now within Price’s purview, as head of an agency with a budget of more than $1 trillion for the current fiscal year. He can interpret laws in different ways than his predecessors and rewrite regulations and guidance, which is how many important policies are actually carried out.

“Virtually everything people do every day is impacted by the way the Department of Health and Human Services is run,” said Matt Myers, president of the Campaign for Tobacco-Free Kids. HHS responsibilities include food and drug safety, biomedical research, disease prevention and control, as well as oversight over everything from medical laboratories to nursing homes.

Price, a Georgia physician who opposes the Affordable Care Act, abortion and funding for Planned Parenthood, among other things, could have a rapid impact without even a presidential order or an act of Congress.

Some advocates are excited by that possibility. “With Dr. Price taking the helm of American health policy, doctors and patients alike have sound reasons to hope for a welcome and long-overdue change,” Robert Moffit, a senior fellow at the conservative Heritage Foundation, said in a statement when Price’s nomination was announced.

Others are less enthusiastic. Asked about what policies Price might enact, Topher Spiro of the liberal Center for American Progress said at that time: “I don’t know if I want to brainstorm bad ideas for him to do.”

Here are five actions the new HHS secretary might take, according to advocates on both sides, that would disrupt health policies currently in force:

The Republican health-care plan the country isn’t debating

https://www.washingtonpost.com/opinions/the-republican-health-care-plan-the-country-isnt-debating/2017/02/09/919464e2-eee8-11e6-9662-6eedf1627882_story.html?_hsenc=p2ANqtz-_zh-MmG6tEeoYRPpXGnfQ4Br6yG61Zm_BUto5iuDDy7KmrCnce1x4mfC1IJZgA7lEGZpWUtS2wTehJJCZgUSr8nli9FQ&_hsenc=p2ANqtz-_g3ACJaUm5w_DwBb7DyuzIOw5pujA6z1qZbrcFLgKCShQytC1zSXx63-Yuh-gFk2Ivyjf6z-tWrzEpQHRkhxEck_TU4w&_hsmi=42381353&_hsmi=42404172&utm_campaign=KFF-2017-Drew-WashPost-feb10-GOPplans&utm_campaign=KFF-2017-The-Latest&utm_content=42381353&utm_content=42404172&utm_medium=email&utm_medium=email&utm_source=hs_email&utm_source=hs_email&utm_term=.ce2754889c96

With the debate about the Affordable Care Act drawing so much scrutiny, a broader Republican agenda to fundamentally change the federal role in health care is flying under the radar. It’s the most important issue in health care we are not debating.

Many Republicans in Congress want to convert Medicaid to a block-grant program and transform Medicare from a plan that guarantees care into one in which seniors would receive a set amount of money to purchase coverage. Meanwhile, Republicans would replace existing subsidies for premiums under the ACA with less generous tax credits — all while eliminating the expansion of Medicaid that enables states to cover low-income childless adults.

Taken together, these changes would amount to a fundamental rewriting of the health-care role of the federal government. They would end the entitlement nature of Medicaid and Medicare, cap future increases in federal health spending for these programs and shift much more of the risk for health costs in the future to states and consumers.

If Republicans shy away from Medicare for the time being, for fear of angering senior voters, the fulcrum for this policy shift will be the debate about converting the Medicaid program to some form of a block grant, most likely one that would cap spending on a per- enrollee basis. This would be an enormous shift. Medicaid spending exceeds half a trillion dollars , and the program represents more than half of all federal funds spent by states. Medicaid has changed dramatically from its beginnings as a program largely for women and children on welfare. It now has more than 70 million beneficiaries, and its reach is so broad that almost two-thirds of Americans say that they, a family member or a friend have been covered by Medicaid at some point.

Physician: Consequences of ACA Repeal ‘Gigantic for Us’

http://www.healthleadersmedia.com/physician-leaders/physician-consequences-aca-repeal-gigantic-us?spMailingID=10400909&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1100770334&spReportId=MTEwMDc3MDMzNAS2#

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Physician organization leaders are trying to plot business strategies for a post-ACA landscape of increased healthcare consumerism, lower reimbursement, and new partnerships.

Rolling Back the ACA’s Medicaid Expansion: What Are the Costs for States?

http://www.commonwealthfund.org/publications/blog/2017/feb/states-roll-back-aca-medicaid-expansion

Millions of people have gained health insurance coverage though the Affordable Care Act’s (ACA) Medicaid eligibility expansion, adopted by 31 states and Washington, D.C., over the past three years. Should Congress decide to eliminate or reduce federal funding for this coverage as part of ACA repeal, states that expanded will be faced with the prospect of either maintaining coverage out of their own funds or dropping the new beneficiaries from the program. Along with the loss of coverage or the creation of large budget holes, rolling back Medicaid benefits would present states with expensive and complex administrative challenges.

Were Congress to repeal federal funding for the expansion group, coverage for these newly eligible enrollees—estimated at 11 million as of 2015—inevitably would disappear. No state is in a position to support this population without considerable federal funding. For example, were ACA Medicaid expansion funding to disappear, California would lose more than 27 percent of the total federal Medicaid funding the state is projected to receive over the 2019 to 2028 time period; federal funding would drop from $364 billion to $265 billion, a $99 billion loss.

If a repeal bill retains the Medicaid expansion but reduces federal funding for the expansion group to traditional Medicaid funding levels,1  some states might seek flexibility to roll back coverage to a lower level such as 75 percent of poverty, rather than the eligibility standard used under the expansion (138 percent of poverty). Rather than terminate insurance eligibility altogether for populations without an alternative source of coverage, states also might try to trim benefits or reduce or freeze provider payments.

But even if funding is eliminated completely, federal laws place important brakes on the process. For example, federal Medicaid rules dating back decades require states to determine if there is another basis of eligibility prior to terminating coverage. At least some of the people covered as part of the expansion population may qualify for Medicaid on other grounds such as pregnancy, being the parent of a minor child, or disability.

How Would Republican Plans for Medicaid Block Grants Actually Work?

How Would Republican Plans for Medicaid Block Grants Actually Work?

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There are only so many ways to cut Medicaid spending.

You can reduce the number of people covered. You can reduce the benefit coverage. You can also pay less for those benefits and get doctors and hospitals to accept less in reimbursement. Or you can ask beneficiaries to pay more.

None of those are attractive options, which is why Medicaid reform is so hard. Medicaid already reimburses providers at lower rates than other insurance programs. How do you reduce the number of beneficiaries when the vast majority of people covered are poor children, poor pregnant women, the disabled, and poor older people? Which of those would you cut?

Reducing benefit coverage has always been difficult because most of the spending has been on the disabled and poor older people, who need a lot of care. Beneficiaries don’t have much disposable income, so asking them to pick up more of the bill is almost impossible.

That doesn’t mean that states haven’t tried. As I’ve discussed in past columns, a number are attempting to increase cost sharing. But this isn’t really a solution because it doesn’t change overall spending much at all.

Part of the challenge lies in the way Medicaid was set up in the first place. The federal government picks up between 50 percent and 100 percent (depending on the population and the per-person income) of whatever it costs to provide health care to a state’s population. Many, if not most, Republican plans would like to change that.

They are pushing for what many refer to as a block grant program. The federal government would give a set amount of money to each state for Medicaid; it would be up to the states to spend it however they like. These block grants could be set based on overall past state needs or based on the number of beneficiaries in the state, referred to as a “per capita” block grant. Some per-capita block grants function more like “ceilings” than outright grants, allowing the state to be paid at normal Medicaid rates, but with a maximum each state could get based on the per-capita calculation.

The feds have been ordered to cough up risk corridor money.

The feds have been ordered to cough up risk corridor money.

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A judge on the Court of Federal Claims has entered a $214 million judgment against the United States in favor of Moda Health, an Oregon insurer. Moda sued to recover money owed to it under the risk corridor program, a three-year program that was supposed to protect insurers from excessive losses on the exchanges. In emphatic language, the court ordered the government to pay up.

The Court finds that the ACA requires annual payments to insurers, and that Congress did not design the risk corridors program to be budget-neutral. The Government is therefore liable for Moda’s full risk corridors payments under the ACA. In the alternative, the Court finds that the ACA constituted an offer for a unilateral contract, and Moda accepted this offer by offering qualified health plans on the [exchanges]. …

Today, the Court directs the Government to fulfill [its] promise. After all, “to say to [Moda], ‘The joke is on you. You shouldn’t have trusted us,’ is hardly worthy of our great government.” Brandt v. Hickel, 427 F.2d 53, 57 (9th Cir. 1970).

http://www.nejm.org/doi/full/10.1056/NEJMp1612486#t=article

 

Judge, Citing Harm to Customers, Blocks $48 Billion Anthem-Cigna Merger

Today a federal judge blocked the proposed $48 billion merger of giant health insurers Anthem and Cigna, just two weeks after another federal judge blocked the proposed $37 billion merger between Aetna and Humana. (That judge found Aetna had lied when it said its decision to pull out of Obamacare was triggered by mounting losses; it was triggered by its desire to merge with Humana.)

Both judges agreed with Justice Department that the mergers would violate antitrust laws — giving the combinations too much economic power to raise prices.

Both decisions will almost certainly be appealed by the companies. But Trump’s and Jeff Session’s Justice Department might back down and allow the mergers to proceed.

Which will reveal the underlying choice America faces: Either a private-for profit health insurance system run by a few giant corporations charging as much as possible, or a single-payer system run to keep Americans health at the lowest cost.

What do you think?

Everything You Need to Know About Block Grants: The Heart of GOP’s Medicaid Plans

http://www.realclearhealth.com/articles/2017/01/24/everything_you_need_to_know_about_block_grants_the_heart_of_gops_medicaid_plans_110404.html

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President Donald Trump’s administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year.

It’s called “block granting.” Right now, Medicaid, which was expanded under the 2010 health reform to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —eventually translating into greater challenges in getting care for low-income people.

Block granting Medicaid is a centerpiece of health proposals supported by House Speaker Paul Ryan and Rep. Tom Price, Trump’s nominee to run the Department of Health and Human Services. This weekend, Trump adviser Kellyanne Conway emphasized the strategy as key to the administration’s health policy.

But what would this look like, and why is it so controversial? Let’s break down how this policy could play out, and its implications — both for government spending and for accessing care.

Q: How would a block grant work?