Tag Archives: High Premiums 5 to 1

White House pitch to bolster Obamacare includes tough trade-offs for Democrats

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https://www.politico.com/story/2018/03/06/obamacare-democrats-white-house-insurance-stable-388816

The White House is pictured. | Getty

The White House is seeking a package of conservative policy concessions — some of which are certain to antagonize Democrats — in return for backing a legislative package bolstering Obamacare markets, according to a document obtained by POLITICO.

The document indicates the administration will support congressional efforts to prop up the wobbly marketplaces, in exchange for significantly expanding short-term health plans and loosening other insurance regulations.

The document also makes severalreferences to abortion language that will be problematic for Democrats. A potential stumbling block in passing any stabilization package is whether conservatives will insist on including language prohibiting the use of government dollars to pay for abortions.

“Although congressional efforts to provide taxpayer money to prop up the exchanges is understandable, any such efforts must also provide relief to middle-class families harmed by the law and protect life,” the document states.

The source of the document provided to POLITICO isn’t identified and it isn’t dated. The White House declined to comment on the document but didn’t question its authenticity. A spokesperson for HHS said the department does not comment on leaked documents.

Two health policy experts who have been in contact with White House officials indicated that the document is consistent with ideas the administration has discussed for creating more stability and flexibility in the insurance markets.

“It’s legit,” said one former White House policy official.

Republican and Democratic lawmakers have been in delicate negotiations over a stabilization package that could clear the House and Senate. Democrats want to bolster the federal health care law after Republicans failed in their efforts to repeal it last year.

The list of White House policy requests includes allowing insurers to charge older enrollees up to five times as much as their younger counterparts, as opposed to the current three-to-one cap. That policy would require amending the Affordable Care Act.

The White House is also seeking to allow short-term plans — which offer skimpier benefits with lower premiums — to be renewed. Short-term plans, exempt from Obamacare rules, can deny people coverage or charge them more based on a health condition, in a process known as underwriting. The Trump administration recently proposed expanding the maximum length of these plans from three months to one year. However, the White House document envisions allowing people to renew this coverage “without those individuals going through health underwriting.”

The document doesn’t include support for reinsurance, which insurers have been pushing to shield them from the costs of particularly expensive customers.

The document also reiterates that the administration supports funding for cost-sharing reduction payments, which Trump cut off in October. The president’s budget proposal including funding for the payments, which help insurers reduce out-of-pocket costs for low-income Obamacare customers.

There is at least one item on the White House list that could garner bipartisan support: Expanding the use of health savings accounts. Last week, a bipartisan group of House members introduced a package of potential changes, and business groups have been pushing for HSA proposals to be part of the appropriations package Congress must pass by March 23.

Republicans fear another year of eye-popping premium increases will hit voters just before Election Day — and that they’ll get the blame this time since they’re now in charge.

But the White House asks could further unsettle those talks. In particular, the emphasis on abortion language tripped up earlier negotiations.

Democrats have been seeking a very different list of policies to boost the markets. They want to increase the subsidies provided to Obamacare customers, reinstate funding for outreach and marketing, and prevent the executive branch from expanding the availability of what they deride as “junk” insurance plans.

“People nationwide are looking at higher premiums and out-of-pocket costs as a direct result of the damage President Trump has done on health care,” said Sen. Patty Murray (D-Wash.), who has been in the middle of negotiations over a stabilization package, in a statement to POLITICO. “I certainly hope the president and Republican leaders won’t once again sabotage an opportunity to undo some of the damage they’ve done by choosing to play politics with women’s health and making last-minute, harmful demands that would raise families’ costs even more and place an age tax on seniors.”

 

Insurers shred Senate health care bill: “Premiums will skyrocket for preexisting conditions”

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https://www.vox.com/policy-and-politics/2017/7/15/15976244/senate-health-care-bill-health-insurance-companies-letter

Health insurance companies have largely bit their tongues about the Senate health care plan, but they are turning against it now, warning that a recent revision would send premiums skyrocketing for people with high medical costs.

The insurance industry has been one of the few health care sectors to even tentatively embrace the Senate’s plan, as Vox has documented, but that has changed in the last few days. Their most influential representatives in Washington — America’s Health Insurance Plans and the Blue Cross Blue Shield Association — sent a letter to Senate leaders Friday urging them to remove Sen. Ted Cruz’s amendment from the legislation.

The Cruz amendment, added in the revised Senate plan, would allow health plans to sell insurance on the individual marketplaces that does not comply with Obamacare’s insurance regulations as long as they also sold plans that did comply. Outside experts have warned this would segment the market, with healthy people buying skimpier non-Obamacare coverage and sicker people buying more robust Obamacare plans.

That would then send costs, and in turn premiums, spiraling upward in the Obamacare market, the insurance trade associations warned in their letter. They noted particularly that middle-class families who do not qualify for financial assistance would not be shielded at all from those increasing premiums.

“As healthy people move to the less-regulated plans, those with significant medical needs will have no choice but to stay in the comprehensive plans, and premiums will skyrocket for people with preexisting conditions,” the groups said.

The Senate does include $70 billion to offset increased costs under the Cruz amendment. But that money does not appear to be enough to assuage the insurance industry’s concerns.

“Finally, this provision will lead to far fewer, if any, coverage options for consumers who purchase their plan in the individual market,” the groups said. “As a result, millions of more individuals will become uninsured.”

It is unclear whether the Cruz amendment will be evaluated as part of the Congressional Budget Office score of the Senate bill to be released this coming week. A source familiar with the situation told me that the US Department of Health and Human Services office of planning and evaluation has been asked to review the proposal and its cost and coverage implications.

The insurance groups urged Senate Republicans leaders to remove the Cruz provision from the legislation.

Dave Dillion, an expert with the Society of Actuaries, told me Friday that part of the insurance industry’s objections is likely the uncertainty that the Cruz plan would introduce to the insurance market.

“I think while obviously a lot of carriers have not been enthralled with [Obamacare], you get comfortably number, you know the rules, and you go on about your business,” he said, adding of the Cruz proposal: “There’s so much uncertainty about what it really means. It’s not black and white.”

House Bill Targets Pre-Existing Conditions in Multiple Ways

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http://www.realclearhealth.com/articles/2017/05/18/house_bill_targets_pre-existing_conditions_in_multiple_ways_110599.html?utm_source=RC+Health+Morning+Scan&utm_campaign=38995c8cb7-EMAIL_CAMPAIGN_2017_05_19&utm_medium=email&utm_term=0_b4baf6b587-38995c8cb7-84752421

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For those with pre-existing medical conditions, the House-passed health bill became notorious for a last-minute addition that would let insurers once again charge them higher premiums in the individual market based on their health status. But the focus on this single provision distracts from a troubling fact: even without it, the bill would threaten health care for those with pre-existing conditions in four broader ways.

#1: The bill would cap and cut federal funding for virtually all of Medicaid by imposing a per capita cap or letting states convert Medicaid into a block grant.

A per capita cap would set annual limits on federal funding per beneficiary that would grow more slowly than actual health care costs. A block grant would cap the amount of overall federal Medicaid funding the state could receive. Either way, states would receive significantly less federal funding compared to current law, under which the federal government pays a fixed share of state Medicaid costs, and the funding cuts would grow deeper each year.

Faced with large cuts in federal funding, states would have no choice but to sharply cut their programs. Consequently, tens of millions of people with pre-existing conditions – including millions of children with disabilities and special health care needs – would face the threat of Medicaid cuts.  They could lose coverage entirely or go without needed care as states scaled back covered benefits and payments to medical providers.

Home- and community-based services, an optional Medicaid benefit that most states already limit based on available funds, would be at particular risk. These services, which include nursing and home health care and help with chores, meals, transportation, and other services, let seniors and other low-income people with serious health problems remain in their homes instead of having to go to a nursing home.

#2: The federal government wouldn’t provide any more enhanced funding after 2019 for Medicaid enrollees who were enrolled because their states took the option, under the Affordable Care Act (ACA), to expand their Medicaid programs.

That would force states to pay three to five times more for the ACA’s Medicaid expansion.  Most or all of the 31 states and Washington, D.C. that have adopted it would have no choice but to drop it because they could no longer afford it.

The Medicaid expansion now covers 11 million people, including many who have pre-existing conditions. For example, almost 30 percent of those benefitting from the Medicaid expansion have a mental illness or substance use disorder. By effectively ending the Medicaid expansion starting in 2020, the House bill would leave millions of low-income people with pre-existing conditions without coverage.

#3: The bill would let insurers charge older people — many of whom have pre-existing conditions —at least five times more to buy coverage compared to younger consumers, while also slashing the subsidies that help them afford insurance. 

For example, a 60-year-old woman with $22,000 of annual income who faced the national average benchmark premium would pay $8,200 more in premiums after accounting for federal tax credits than she does now. The Congressional Budget Office projects that uninsured rates for people age 50-64 would double due to the House bill.  Some 84 percent of people age 55-64 have pre-existing health conditions.

#4: The bill would eliminate a broad range of consumer protections that the ACA established in the individual market, threatening access to health care and coverage for those with pre-existing conditions.

Plans would no longer need to offer a comprehensive set of benefits and could exclude even core benefits such as maternity services and mental health care. Nor would they have to limit the amount that people with expensive health care must pay out-of-pocket for deductibles and other cost-sharing each year.  Insurers could again place annual and lifetime limits not only on individual and small-group plans but also on coverage that people get from large employers, leaving millions with costly pre-existing conditions to once again worry about exhausting their benefits.

All told, then, the House bill would bring back the highly-flawed, pre-ACA individual insurance market that made it impossible for millions with pre-existing conditions to get adequate, affordable health coverage.  Additionally, it would threaten the coverage of millions of Medicaid recipients with pre-existing conditions.

That’s not a health care system that should make us proud.