Number of uninsured children increases for first time in a decade

https://thehill.com/policy/healthcare/418884-number-of-uninsured-children-increased-for-first-time-in-a-decade-during

Number of uninsured children increases for first time in a decade

The number of uninsured children in the U.S. increased for the first time in a decade, according to a new report that puts much of the blame on policies spearheaded by Republicans.

An estimated 3.9 million children did not have health insurance in 2017, an increase of 276,000 compared to the previous year, according to the Georgetown University Center for Children and Families.

No state made statistically significant progress on children’s coverage last year, despite an improving economy and low unemployment rate, according to the report, which noted that the District of Columbia made substantive gains in 2017.

Researchers said the rising number for states was due to a variety of factors, though they said GOP-led states refusing to expand Medicaid played a major role, as well as Republican efforts in Congress to repeal ObamaCare and cap federal Medicaid funding.

Three-quarters of the children who lost coverage between 2016 and 2017 live in states that have not expanded Medicaid coverage to parents and other low-income adults, the report found. The uninsured rates for children in non-expansion states increased at almost triple the rate as states that have expanded Medicaid.

The report also noted that Congress eliminated the health law’s individual mandate and the Trump administration dramatically cut ObamaCare outreach and enrollment grants while shortening the open enrollment period.

“All of these changes in the national political and policy realm mark a sharp reversal after many years of successful efforts to reduce the uninsured rate for children and families,” the researchers wrote.

The report’s prognosis for the future was not encouraging.

“Barring new and serious efforts to get back on track, there is every reason to believe the decline in coverage is likely to continue and may get worse in 2018,” researchers concluded.

The number of uninsured children in the U.S. was particularly high in Florida and Texas, the two largest states that have not expanded Medicaid, according to the report.

Texas had an estimated 80,000 more children uninsured in 2017 than in 2016, and Florida had 37,000 more.

Researchers also pointed to President Trump‘s recent crackdown on immigration as a reason why the number of uninsured kids is rising.

One quarter of all children under 18 living in the United States have a parent who is an immigrant, according to the report. Several policies targeting immigrant communities, like the administration’s “public charge” proposal, are likely deterring parents from enrolling their eligible children in Medicaid or the Children’s Health Insurance Program, despite the fact that most of these children are U.S. citizens.

 

 

New insurance guidelines would undermine rules of the Affordable Care Act

https://www.washingtonpost.com/national/health-science/new-insurance-guidelines-would-undermine-rules-of-the-affordable-care-act/2018/11/29/ff467f46-f357-11e8-aeea-b85fd44449f5_story.html?utm_term=.c279fcb895a6&wpisrc=al_news__alert-hse–alert-national&wpmk=1

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The Trump administration is urging states to tear down pillars of the Affordable Care Act, demolishing a basic rule that federal insurance subsidies can be used only for people buying health plans in marketplaces created under the law.

According to advice issued Thursday by federal health officials, states would be free to redefine the use of those subsidies, which began in 2014. They represent the first help the government ever has offered middle-class consumers to afford monthly premiums for private insurance.

States could allow the subsidies to be used for health plans the administration has been promoting outside the ACA marketplaces that are less expensive because they provide skimpier benefits and fewer consumer protections. In an even more dramatic change, states could let residents with employer-based coverage set up accounts in which they mingle the federal subsidies with health-care funds from their job or personal tax-deferred savings funds to use for premiums or other medical expenses.

If some states take up the administration’s offer, it would undermine the ACA’s central changes to the nation’s insurance system, including the establishment of nationwide standards for many kinds of health coverage sold in the United States.

Another goal of the ACA, the sprawling 2010 law that was President Barack Obama’s preeminent domestic accomplishment, was to concentrate help on the individual insurance market serving people who do not have access to affordable health benefits through a job. Prices were often out of control and discrimination against unhealthy people was more prevalent before the ACA imposed required benefits, prohibited insurers from charging more to people with preexisting conditions and created a federal health exchange and similar state-run marketplace in which private insurance companies compete for customers.

The ACA health plans have been the only ones for which consumers can use the subsidies, designed to help customers with incomes up to the middle class — 400 percent of the federal poverty line — afford the premiums.

The new advice, called “waiver concepts” because they are ideas for how states could get federal permission to deviate from the law’s basic rules, stray from both of those goals. And it would allow states to set different income limits for the subsidies — higher or lower than the federal one.

The day before they were released by Seema Verma, administrator of the Department of Health and Human Services’ Centers for Medicare and Medicaid Services, an analysis by the Brookings Institution questioned the legality of the content and method of these concepts. The analysis by Christen Linke Young, a Brookings fellow and HHS employee during the Obama administration, contends that “there are serious questions” about whether the changes are allowable under the law and that “at the very least, it is likely invalid” for CMS to issue the advice to states without going through the formal steps to change federal regulations.

In a statement Thursday, HHS Secretary Alex Azar said: “The Trump administration is committed to empowering states to think creatively about how to secure quality, affordable healthcare choices for their citizens.” He said the four recommendations issued Thursday, including new accounts in which consumers could pool federal subsidies and other funds, are intended to “show how state governments can work with HHS to create more choices and greater flexibility in their health insurance markets, helping to bring down costs and expand access to care.”

In a midday speech before a gathering of the conservative American Legislative Exchange Council, Verma delivered a broadside against the health-care law in explaining the rationale for freeing states to rework health policies on their own. “It was such a mistake to federalize so much of health care in the ACA,” said Verma, who worked as a consultant to states before becoming one of Trump’s senior health-care advisers. While the law sought to make health coverage more available and affordable, she said, “the insurance problem has not been solved. For many Americans it’s even been made worse.”

In urging states to consider the changes, CMS is renaming a provision of the law, known as 1332, which until now has mainly been used to give states permission to create programs to ease the burden on insurers of high-cost customers. CMS is switching the name to “State Relief and Empowerment Waivers,” emphasizing the administration’s desire to hand off health-care policies to states.

The changes go beyond a variety of other steps Trump administration health officials have taken in the past year to weaken the ACA, which the president has opposed vociferously.

Until now, they have focused on bending the ACA’s rules for health plans themselves. The administration has rewritten regulations to make it easier for Americans to buy two types of insurance that is relatively inexpensive because it does not contain all the benefits and consumer protections that the ACA typically requires.

The new steps go further by undercutting the basic ACA structure of the individual insurance marketplaces created for those who cannot get affordable health benefits through a job.

During a conference call with journalists, Verma said that no state would be allowed to retreat from a popular aspect of the ACA that protects people with preexisting medical conditions from higher prices or an inability to buy coverage.

She said that, in evaluating states’ proposals, CMS would focus on several considerations, including whether changes would foster comprehensive coverage and affordability and would not increase the federal deficit. She said federal officials would favor proposals that help, in particular, low-income residents and people with complex medical problems.

Verma reiterated an administration talking point that insurance rates have escalated since the ACA was passed and that health plan choices within ACA marketplaces have dwindled. However, the current ACA enrollment period, lasting until mid-December, is different from the previous few because prices for the most popular tier of coverage have stabilized in many places and more insurers are taking part in the marketplaces.

 

JAMA Forum: Medicaid as a Safeguard for Financial Health

https://theincidentaleconomist.com/wordpress/jama-forum-medicaid-as-a-safeguard-for-financial-health/

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Home insurance doesn’t make a home less flammable. It protects homeowners against financial disaster should something happen to their home. The same holds true for auto insurance, for life insurance, and for disability insurance. And though we often talk about health insurance in terms of making people healthier, its true goal is the same as with other insurance: to safeguard the financial health of beneficiaries in the face of undesirable circumstances.

Even in that respect, the Medicaid expansion appears to be working.

Many articles have focused on the positive effects of Medicaid on health and well-being of recipients. A recent National Bureau of Economic Research working paper highlighted instead the effect of Michigan’s Medicaid expansion on Medicaid recipients’ financial health.

You’re still here? I said go read it at the JAMA Forum!

https://www.nber.org/papers/w25053

https://www.nber.org/papers/w25053.pdf

 

 

 

 

 

 

 

With Divided Congress, Health Care Action Hightails It to the States

https://www.rollcall.com/news/policy/divided-congress-health-care-action-states

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Medicaid expansion was the biggest winner in last week’s elections.

Newly-elected leaders in the states will be in a stronger position than those in Washington to steer significant shifts in health care policy over the next couple of years as a divided Congress struggles with gridlock.

State Medicaid work requirements, prescription drug prices, insurance exchanges and short-term health plans are among the areas with the potential for substantial change. Some states with new Democratic leaders may also withdraw from a multistate lawsuit aimed at killing the 2010 health care law or look for ways to curb Trump administration policies.

But last week’s biggest health care winner is undeniably Medicaid expansion, with upwards of half a million low-income Americans poised to gain insurance coverage following successful expansion ballot initiatives and Democratic victories in key governors’ races.

“In state health policy, it was a big election,” said Trish Riley, executive director of the nonpartisan National Academy for State Health Policy. “It was a year when many candidates had pretty thoughtful and comprehensive proposals.”

Boost for Medicaid expansion

Voters in three deep-red states — Nebraska, Idaho and Utah — bucked their Republican lawmakers by approving ballot initiatives to extend Medicaid coverage to more than 300,000 people.

Meanwhile, Democratic gubernatorial wins in Kansas and Wisconsin boosted the chances of expansion in those states. And Maine’s new governor-elect is expected to act quickly to grow the government insurance program when she takes office in January.

The election outcomes could bring the biggest increase in enrollment since an initial burst of more than two dozen states expanded Medicaid under the 2010 health care law in the early years of the landmark law’s rollout.

“This election proves that politicians who fought to repeal the Affordable Care Act got it wrong,” said Jonathan Schleifer, head of The Fairness Project, an advocacy group that supported the initiatives, referring to the 2010 health care law. “Americans want to live in a country where everyone can go to the doctor without going bankrupt.”

The successful ballot initiatives require state leaders to move quickly toward expansion. In Idaho, the state must submit an expansion plan to federal officials within 90 days of the new law’s approval, while Nebraska must submit its plan by April 1, according to the nonpartisan Kaiser Family Foundation. Utah’s new law also calls for the state to expand beginning April 1.

In Kansas, where Medicaid supporter Laura Kelly prevailed, state lawmakers passed expansion legislation last year only to have it vetoed by the governor. Meanwhile, Wisconsin’s new Democratic governor Tony Evers, who eked out a win over Republican incumbent Scott Walker, has said he will “take immediate action” to expand, though he faces opposition from a Republican-controlled legislature.

Expansions in the five states would bring the number of states that adopted expansion under the health law to 38, plus the District of Columbia.

Still, Democrats fell short of taking one of the biggest Medicaid expansion prizes — Florida — after Andrew Gillum’s defeat. The outcome of Georgia’s tight governor’s race was still unclear as of Monday, with Republican Brian Kemp holding a narrow lead over Democrat Stacey Abrams. Both Abrams and Gillum made health care, and Medicaid expansion in particular, central to their campaigns.

Florida might be a 2020 target for an expansion ballot initiative, along with other states such as Missouri and Oklahoma, according to The Fairness Project.

Expansion supporters also suffered defeat last week in Montana, where voters did not approve a ballot initiative that would have extended the state’s existing Medicaid expansion, which covers nearly 100,000 people but is slated to expire next year. However, state lawmakers have until June 30 to reauthorize the program, according to Kaiser.

In Maine, Democratic gubernatorial winner Janet Mills is expected to expedite expansion implementation. GOP Gov. Paul LePage stymied implementation over the past year, despite nearly 60 percent of voters approving an expansion ballot initiative in 2017.

Medicaid’s future

The midterm results carry other ramifications for Medicaid, including whether states embrace or move away from controversial work requirements backed by the Trump administration.

Gretchen Whitmer, a Democrat who won Michigan’s governor race, opposed the idea and could shift away from an existing plan to institute them that’s awaiting federal approval.

“This so-called work requirement is not for one second about getting people back to work. If it was, it would have been focused on leveling barriers to employment like opening up training for skills or giving people child care options or transportation options,” Whitmer said in a September interview with Michigan Radio. “It was about taking health care away from people.”

Kansas, Wisconsin and Maine also have work requirement proposals that new Democratic governors could reverse.

But experts also say it’s possible some states, including those with Democratic governors, could end up pursuing Medicaid work requirements if that’s what it takes to get conservative legislators to accept expansion like Virginia did earlier this year.

Nebraska Republican state senator John McCollister, who supports expansion, predicted recently that the legislature would fund the voter-approved expansion initiative. But he indicated lawmakers might pursue Medicaid work requirements too.

Marie Fishpaw, director of domestic policy studies at the conservative Heritage Foundation, warned that states expanding Medicaid would face challenges. She called expansion “a poor instrument for achieving the goal that they’re trying to achieve.”

A number of new governors, including Whitmer, could pursue the so-called “Medicaid buy-in” concept.

More than a dozen state legislatures, such as in Minnesota and Iowa, explored the idea in recent years, according to State Health and Value Strategies, part of the nonprofit Robert Wood Johnson Foundation. Nevada lawmakers passed a “Medicaid buy-in” plan last year that was vetoed by the governor.

There are a variety of ways to implement such a program, but the goal is to expand health care access by leveraging the government insurance program, such as by creating a state-sponsored public health plan option on the insurance exchanges that consumers could buy that relies on Medicaid provider networks. Illinois, New Mexico, Maine and Connecticut are among the states that could pursue buy-in programs, Riley said. States are considering the concept as a way to increase affordability and lower cost growth by getting more mileage out of the lower provider rates Medicaid pays, said Katherine Hempstead, a senior policy adviser with Robert Wood Johnson Foundation.

“So many [people] struggle with the affordability of health care,” Hempstead said. “That is an environment in which Medicaid buy-in opportunities could flourish.”

Health care law

This month’s election also carries implications for the future of states’ administration of the 2010 health care law.

States that flipped to Democratic governors could switch to creating their own insurance exchanges rather than relying on the federal marketplace, said Joel Ario, a health care consultant with Manatt Phelps & Phillips and the former head of the federal health insurance exchange office under the Obama administration. The costs of running an exchange have come down in recent years, so it’s potentially cheaper for a state to run its own, Ario said.

Trump administration actions, such as cuts in federal funding for insurance navigators that help consumers enroll and the expansion of health plans that don’t comply with the law, may make states such as Michigan or Wisconsin rethink use of the federal exchange, he said.

“If [the administration] continues to promote policies that really leave a bad taste in the mouth for Democratic governors, I think they’ll be asking questions,” Ario said.

States where governors and attorneys general offices went from red to blue are likely to pull out of a lawsuit by 20 state officials that aims to take down the health care law, he added.

Wisconsin’s Evers vowed that his first act in office will be to withdraw from the lawsuit.

“I know that the approximately 2.4 million Wisconsinites with a pre-existing condition share my deep concern that this litigation jeopardizes their access to quality and affordable health care,” Evers wrote in a letter he said he plans to send to the state attorney general.

Hempstead said that states with both Republican and Democratic leaders will likely continue to pursue reinsurance programs, which cover high-cost patients, to bolster their marketplaces.

Republican governors could also pursue waivers under a recent Trump administration guidance that allows states to circumvent some requirements of the health law under exemptions known as 1332 waivers. But experts say it’s too soon to know exactly what approaches states might take.

“It will be interesting to see what the 1332 guidance means and whether it opens doors for some things and not for others,” Hempstead said. States that shifted to Democratic governors could also look to ban some Trump-supported policies, such as expansions of short-term and association health plans that avoid the health care law’s rules.

States are also likely to take steps to address high prescription drug costs in the coming years, with a number of new governors wanting to improve transparency, explore drug importation from other countries and target price gouging, Riley said.

“There’s a long history of the states testing, fixing, tweaking and informing the national debate,” said Riley.

 

Dems Won on Health Care. Now What?

 

Democrats rode a health care message to their Election Day takeover of the House. Now that the election is (mostly) over, how will they follow through on that campaign focus?

The party is still figuring out its next steps on health care, and Nancy Pelosi and her colleagues will have a lot of decisions to make and details to sort out. “The new House Democratic majority knows what it opposes. They want to stop any further efforts by Republicans or the Trump administration to roll back and undermine the Affordable Care Act or overhaul Medicaid and Medicare,” writes Dylan Scott at Vox. “But Democrats are less certain about an affirmative health care agenda.”

Some big-picture agenda items are clear, though. “The top priorities for Ms. Pelosi, the House Democratic leader, and her party’s new House majority include stabilizing the Affordable Care Act marketplace, controlling prescription drug prices and investigating Trump administration actions that undermine the health care law,” reports Robert Pear in The New York Times.

House Democrats also plan to vote early next year on plans to ensure patients with preexisting medical conditions are protected when shopping for insurance, Pear reports. And they’ll likely vote to join in the defense of the Affordable Care Act and its protections for those with pre-existing conditions against a legal challenge now before a Texas federal court.

Here are a few areas where House Democrats will likely look to exercise their newly won power.

Stabilizing Affordable Care Act markets: “I’m staying as speaker to protect the Affordable Care Act,” Pelosi said in an interview with CBS’s “Face the Nation,” calling that her “main issue.” And Vox’s Scott says that “a bill to stabilize the Obamacare insurance markets would be the obvious first item for the new Democratic majority’s agenda,” adding that a bill put forth by Reps. Richard Neal (MA), Frank Pallone (NJ) and Bobby Scott (VA) is the likely starting point. Democrats may look to provide funding for the Obamacare “cost-sharing reduction” subsidy payments to insurers that President Donald Trump ended in October 2017. And they may look to restore money for Affordable Care Act outreach and enrollment programs after the Trump administration slashed that funding by 84 percent, to $10 million, Pear says. “Another idea is for the federal government to provide money to states to help pay the largest medical claims,” he adds. “Such assistance, which provides insurance for insurance carriers, has proved effective in reducing premiums in Alaska and Minnesota, and several other states will try it next year.”

Investigating the Trump administration ‘sabotage’: “Administration officials who have tried to undo the Affordable Care Act — first by legislation, then by regulation — will find themselves on the defensive, spending far more time answering questions and demands from Congress,” Pear writes.

Reining in prescription drug prices: Trump, Pelosi and Senate Majority Leader Mitch McConnell have all pointed to this as an area of potential cooperation, But Vox’s Scott calls this “another area where Democrats know they want to act but don’t know yet exactly what they can or should do.” Some options include pushing to let Medicare negotiate drug prices directly with manufacturers and requiring makers of brand-name medications to provide samples to manufacturers of generics, potentially speeding the development of less expensive competitors.

“There are a lot of levers to pull to try to reduce drug prices: the patent protections that pharma companies receive for new drugs, the mandated discounts when the government buys drugs for Medicare and Medicaid, existing hurdles to getting generic drugs approved, the tax treatment of drug research and development,” Scott writes. But it’s not clear just what policy mix would really work to bring down drug prices, and the pharmaceutical industry lobby is likely to push back hard on such efforts. Democrats may also be hesitant to give President Trump a high-profile win on the issue ahead of the 2020 election.

Medicare for all: Much of the Democratic Party may be gung-ho for some sort of Medicare-for-all legislation, but don’t expect significant progress over the next two years. “House Democratic leaders probably don’t want to take up such a potentially explosive issue too soon after finally clawing back a modicum of power in Trump’s Washington,” Scott writes. And Democrats have to forge some sort of internal consensus on just what kind of plan they want to push in order to further expand health insurance coverage.

HEALTHCARE WINNERS AND LOSERS FROM ELECTION NIGHT 2018

https://www.healthleadersmedia.com/strategy/healthcare-winners-and-losers-election-night-2018

The most significant developments of the night focused around Medicaid expansion, how healthcare leaders who ran for public office fared in the elections, and several down-ballot healthcare initiatives.


KEY TAKEAWAYS

Healthcare leaders who were elected: Gov. Rick Scott, Lauren Underwood, RN, and former HHS Secretary Donna Shalala.

Races where healthcare was a major factor: mixed bag for vulnerable House Republicans who voted to repeal-and-replace the ACA, as well as Medicare for All proponents.

Healthcare ballot initiatives: Three states approve Medicaid expansion, one does not; Massachusetts votes down Question 1.

The 2018 midterm elections are over but made a significant impact on healthcare policies at the federal and state level across the country, while also determining who will be in office to enact them.

The future of healthcare policymaking will be influenced by the decisions made by millions of voters on Tuesday night, as Democrats took back the House while Republicans held onto control in the Senate.

Healthcare was a top priority for voters as they made their way to the polls to vote on issues such as Medicaid expansion and the healthcare leaders seeking to represent them on Capitol Hill.

Below are some of the most significant healthcare-related developments from the 2018 midterms:

MEDICAID EXPANSION APPROVED IN 3 RED STATES, DEFEATED IN MONTANA

Three traditionally conservative states joined Maine in approving Medicaid expansion via ballot initiative, while voters in Montana sank the measure which was attached to a proposed tobacco tax hike proposal.

More than 300,000 residents across Nebraska, Idaho, and Utah are likely to receive extended Medicaid coverage as a result of expansion. The number of places with Medicaid expansion now totals 37 states as well as the District of Columbia.

Support for the measure exceeded 60% in Idaho, while Utah and Nebraska approved Medicaid expansion with 54% and 53% of the vote, respectively.

Montana, voting on the most expensive ballot measure in state history, voted down the expansion proposal, which will sunset at the end of the year.

NURSE STAFFING RATIO PROPOSAL SHOT DOWN IN MASS.

Last night, Massachusetts voters had their say on ballot Question 1, which sought to implement nurse- to-patient ratios in hospitals and other healthcare settings.

It was met with a resounding ‘no’ from the electorate, with about 70% voting against the measure and almost 30% voting for it.

For months, the law has been hotly debated. Those in favor said it would improve patient safety and care. Those opposed said it didn’t account for patient acuity and would create a financial burden on hospitals and healthcare systems.

Had the law passed, Massachusetts would have joined California as the only other state to require that level of mandatory ratios.

PROPONENTS OF MEDICAID WORK REQUIREMENTS

As expected, two of the three governors who received federal approval for Medicaid work requirements and were on the ballot for the midterms, Gov. Chris Sununu, R-N.H. and Gov. Asa Hutchinson, R-Ark., cruised to election night victories.

Sununu defeated Democratic challenger Molly Kelly by a 52% to 46% margin while Hutchinson dispatched Democratic opponent Jared Henderson with 65% of the vote.

The most vulnerable of the three Republican incumbents, Wisconsin Gov. Scott Walker, was unseated by Democratic opponent Tony Evers by just over a single percentage point.

Wisconsin had just received CMS approval for its Medicaid work requirements last week, which was the latest development in a race dominated by healthcare issues that ultimately pushed Walker out of office. 

ADDITIONAL HEALTHCARE BALLOT INITIATIVES YIELD MIXED RESULTS

Oklahoma voters rejected the Walmart-backed Question 793, which would have amended the Oklahoma Constitution to give optometrists and opticians the right to practice in retail stores. Walmart gave nearly $1 million in the third quarter alone to proponents of the initiative, which was narrowly defeated by less than 6,000 votes.

Nevada voters approve exemption of durable medical goods from state sales tax. Local media in Nevada are reporting that more than 67% of voters in state voted for Question 4, which amends the Nevada Constitution to require the state legislature to exempt some durable medical goods, including oxygen delivery equipment and prescription mobility-enhancing equipment, from sales tax.

California voters roundly rejected an initiative to cap the profits of kidney dialysis providers at 15% above direct patient cost. However, Golden State voters approved a ballot initiative that authorizes $1.5 billion in bonds to fund capital improvements at the state’s 13 children’s hospitals.

BITTERSWEET NIGHT FOR VULNERABLE HOUSE REPUBLICANS AND MEDICARE FOR ALL PROPONENTS

The race in Kentucky’s 6th Congressional District set the tone for the night among House races, as Rep. Andy Barr, who was targeted by Democrats for his support of House GOP plans to repeal-and-replace the ACA, faced Democratic challenger Amy McGrath, who voiced support in Medicare-for-All legislation.

A neck-and-neck race throughout the early part of the evening, Barr ultimately defeated McGrath, but other vulnerable House Republicans did not fare as well.

In New York, Rep. John Faso lost to Democratic challenger Antonio Delgado in the 19th Congressional District, a race highlighted by disagreements over healthcare policy, and Rep. Claudia Tenney, a vocal critic of the ACA, was unseated by Democratic opponent Anthony Brindisi in the 22nd Congressional District.

Sen. Bernie Sanders, I-VT, and Rep. Pramila Jayapal, D-Wash., two of the most notable proponents of Medicare for All were reelected, while newcomer Alexandria Ocasio-Cortz, a self-described Democratic Socialist, became the youngest woman ever elected to Congress in New York’s 14th Congressional District.

However, other Medicare for All proponents did not perform as expected across the country, with Tallahassee Mayor Andrew Gillum losing a tight gubernatorial race in Florida to Republican Rep. Ron DeSantis, and Rep. Beto O’Rourke falling to Republican incumbent Sen. Ted Cruz in the Texas Senate race.

HEALTHCARE LEADERS ON THE BALLOT

After a lengthy primary season and contentious general election cycle, numerous healthcare leaders won their respective elections Tuesday night.

Healthcare was one of the most prominent issues concerning voters in the midterm election cycle, punctuated by more than 60 declared candidates with healthcare backgrounds running for public office in 2018.

Around 35 candidates made it to the general election ballot and more than two dozen received a stamp of approval from the voters.

Most notably were Gov. Rick Scott, former head of Columbia/HCA, who won a neck-and-neck race against Sen. Bill Nelson, D-Fla.,Lauren Underwood, RN, a former HHS adviser under former President Barack Obama, who defeated Rep. Randy Hultgren, R-Illi., and former HHS Secretary Donna Shalala, who won a hotly contested campaign in Miami.

 

 

Shifting the Healthcare Debate

http://click1.email.thehill.com/ViewMessage.do?m=ndkqkwkw&r=jnjbrjrv&s=ugcmvzybchhjzjhgnccmmcykhyhddfcbzpk&q=1541641771&a=view

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Welcome to Wednesday’s Overnight Health Care, where Democrats have won back the House, opening the door to a shift in the health care debate.

Here’s what we’ll be watching for on health care when the new Democratic House majority takes over:

  1. Oversight. Democrats are sure to launch investigations and hearings into all sorts of actions Republicans have taken that they think undermined the Affordable Care Act, from expanding skimpier short-term health insurance plans to cutting outreach efforts. They could also bring up different industry executives to testify, for example those from drug companies. We’ve seen some of this happen already with Martin Shkreli and Heather Bresch, but Democrats may want to go even further to shame the industry for high prices.
  2. Drug pricing. Speaking of which, legislation to fight high drug prices is an early priority for House Democrats. They think it could be an area for bipartisan support, as President Trump has also focused on the issue. Democratic Leader Nancy Pelosi said Tuesday she thinks there could be “common ground” with Trump on the idea, and Trump listed the issue as a possible area of cooperation Wednesday as well. But any drug pricing action always faces an uphill climb.
  3. Pre-existing condition protections. If a federal judge rules in favor of Texas and the other Republican state attorneys general challenging the law, Congress is going to need to have a backstop in place. Republicans in the Senate already passed their versions of such legislation, but left the door open to insurers charging higher premiums for people with pre-existing conditions. If the law’s protections are truly at risk, Senate Republicans will need to back up their campaign rhetoric with action.
  4. Medicare for All. The most sweeping change Democrats have discussed does not have any real chance of being enacted into law with a Republican Senate and president. But it’s worth watching whether liberal Democrats start planning and agitating for some action on Medicare for all, with hearings, revised legislation, etc.

 

Medicaid wins big at the polls

It was a big night for Medicaid. Three red states voted to expand Medicaid, giving health coverage to potentially hundreds of thousands of newly eligible people.

Idaho voters approved expansion with more than 61 percent of the vote, Utah passed expansion with 54 percent and Nebraska passed it with 53 percent. In Nebraska and Utah, the approval came despite opposition from the states’ Republican governors.

Democrats also won close gubernatorial races in Kansas and Wisconsin, putting expansion on the table. In Kansas, expansion legislation passed in 2017 but former Gov. Sam Brownback (R) vetoed it. In Wisconsin, Gov. Scott Walker (R) lost to Democrat Tony Evers, who campaigned on a platform that included expansion.

 

The Trump administration finalized two rules today making it easier for some employers to avoid complying with the Affordable Care Act’s contraception mandate. Here’s what they do:

  • The first rule provides an exemption to the mandate for entities that object to contraception based on their “sincerely held religious beliefs.”
  • The second rule gives ax exemption to nonprofits, small businesses and individuals that have non-religious, moral objections to the mandate.

These rules are largely similar to two interim final rules released by the administration last year. But the second rule was amended to state that the moral exemptions don’t apply to publicly traded businesses and government entities.

The rules take effect 60 days after their publication in the Federal Register.

Context: These rules are already the subject of multiple lawsuits against the administration. From National Women’s Law Center President Fatima Goss Graves:

“The Trump Administration decided to finalize these outrageous rules, despite several pending lawsuits and two federal courts blocking them. It’s clear that this Administration will stop at nothing to attack women’s health care… if the Administration thinks it can move these rules forward without a fight, they’re wrong.”

 

On the topic of abortion, two states last night laid the groundwork to ban abortion if the Supreme Court makes changes to Roe v. Wade.

Voters in Alabama and West Virginia approved sweeping amendments to state constitutions that could put major limitations on access to abortions if Roe v. Wade is overturned by the Supreme Court.

Alabama’s amendment makes it state policy to protect “the rights of unborn children” and “support the sanctity of unborn life.” It also says there are no constitutional protections for a woman’s right to an abortion.

Fifty-nine percent of voters approved the measure.

West Virginia narrowly passed a similar amendment that states nothing in the state Constitution “secures or protects a right to abortion or requires the funding of abortion.” That vote was 52 percent to 48 percent.

Read more here.