Tag Archives: Preexisting Conditions

AHIP: Cruz proposal would destabilize the ACA exchanges

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http://www.fiercehealthcare.com/aca/ahip-cruz-proposal-would-destabilize-individual-marketplaces?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiT1RFeFl6QTBOalV4WlRsayIsInQiOiJ2ZkV5eXJiTVp5ZGZQYk5NRlozSzYwdEdoVTduQW1SMDkyVVdqR0lPbXVGMDNJUjJEN0U3b2dDcmp1NlNncSthUStTeFordHNGcVwvMFRtNnFGXC9mczBpa3NDU0NkZHBSa003NkQ4bjVcL3krTkZ1R2ZNb3R4MGtWYWo3UVwvcjkwZVIifQ%3D%3D

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The health insurance industry’s largest trade group is warning that a proposed amendment to the Senate’s healthcare bill could not only destabilize the individual marketplaces, but also harm patients with pre-existing conditions.

The amendment, introduced by Sen. Ted Cruz, R-Texas, would allow insurers to sell health plans that aren’t compliant with the Affordable Care Act’s rules in any given state as long as they sell at least one ACA-compliant plan on that state’s exchange.

Cruz and the amendment’s other supporters in the Senate said the concept would allow insurers to offer a wider variety of coverage options and help lower premiums. Senate Majority Leader even reportedly went so far as to ask the Congressional Budget Office to score the proposal.

But the idea also has plenty of critics, including America’s Health Insurance Plans (AHIP).

In a document (PDF) posted on its website, the trade group said that allowing health insurance products to be governed by different rules would effectively “fracture and segment insurance markets into separate risk pools and create an un-level playing field that would lead to widespread adverse selection and unstable health insurance markets.”

The trade group pointed out that part of the exchanges’ current woes stemmed from the Obama administration’s transitional policy, which allowed individuals to renew their non-ACA-compliant plans. In states that opted to adopt this policy, actuaries estimated that exchange market premiums were an average of 10% higher.

Cruz’s amendment, which would essentially make that transitional policy permanent, “would create even greater instability,” AHIP said.

The fact that the proposal would require insurers to also offer an ACA-compliant plan, the group said, is not enough to protect consumers with pre-existing conditions or higher-than-average healthcare costs. The ACA’s consumer protection provisions, such as guaranteed issue and community rating, AHIP notes, “only work if there is broad participation to assure stable markets and affordable premiums,” which wouldn’t be the case under Cruz’s proposal.

In fact, a newly released analysis from the Kaiser Family Foundation estimated that the amendment could result in 1.5 million people with pre-existing conditions facing higher premiums.

Finally, it’s simply not practical to maintain a single risk pool if all health plans don’t have to provide coverage for the same benefits, AHIP stated, adding that the Cruz amendment also would make programs like risk adjustment “unworkable.”

Healthcare Triage News: The Senate’s BCRA Bill – High Premiums, Huge Deductibles, AND Massive Medicaid Cuts

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Healthcare Triage News: The Senate’s BCRA Bill – High Premiums, Huge Deductibles, AND Massive Medicaid Cuts

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Podcast: What The Health? Why Is This Stuff So Complicated?

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Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post discuss the latest on the Senate’s effort to “repeal and replace” the Affordable Care Act, and why it is so difficult to make popular changes, such as requiring insurers to cover people with preexisting health conditions.

What we know about Senate health care bill 2.0

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https://www.axios.com/what-we-know-about-the-senate-health-care-bill-2-0-2450356848.html

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Majority Leader Mitch McConnell is trying to wrangle members from opposite ends of the Republican caucus together to support some revised version of the Senate health care bill, offering both moderates and conservatives new policies to shore up support for the bill.

On the table: More funding to fight the opioid epidemic, revised health savings account policies, potentially getting rid of the repeal of the net investment tax on the wealthy.

Off the table: Undermining pre-existing conditions protections, which could happen indirectly under a plan Sen. Ted Cruz is pushing,

What we’re hearing:

  • There’s a push to include as much as $45 billion in funding for the opioid crisis, up from $2 billion under last week’s bill. This would be a win for moderates like Sens. Rob Portman and Shelley Moore Capito.
  • There’s also an effort to add more funding to the state stabilization fund, and to make the funding available sooner to states.
  • There will likely be a provision allowing health savings accounts to be used for premiums. This is a win for conservatives, and could help middle-class people afford their premiums. One aide said the price tag could be around $60 billion, as it would result in lost tax revenue. (HSA contributions aren’t taxed.)
  • There’s chatter about removing a repeal of the Affordable Care Act’s 3.8 percent investment tax, which benefits wealthy people. This would free up some extra funding to help coverage levels, and would also help combat the narrative that the bill cuts coverage for the poor to give money to the wealthy.

What’s becoming a big problem: Cruz is pushing to allow insurers offering ACA-compliant plans to also offer non-compliant plans, which wouldn’t be required to meet the ACA’s pre-existing conditions protections or other insurance regulations. Cruz wants to include that in the revised bill to cut the cost of individual insurance, and says sick people could still get subsidies that would protect them from premium hikes.

But that’s off the table, senior GOP aides say, because most Republican senators have already decided they don’t want to undermine the ACA’s pre-existing condition protections in any way.

Promises Made To Protect Preexisting Conditions Prove Hollow

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Built into the Senate ACA replacement bill are loopholes for states to bypass those protections and erode coverage for preexisting conditions. That could lead to perverse situations in which insurers are required to cover chronically ill people but not the diseases they suffer from.

Senate Republicans praised the Affordable Care Act replacement bill they presented Thursday as preserving coverage for people with cancer, mental illness and other chronic illness. But the legislation may do no such thing, according to health law experts who have read it closely.

Built into the bill are loopholes for states to bypass those protections and erode coverage for preexisting conditions. That could lead to perverse situations in which insurers are required to cover chronically ill people but not the diseases they suffer from.

Depending on what states do, plans sold to individuals might exclude coverage for prescription drugs, mental health, addiction and other expensive benefits, lawyers said. Maternity coverage might also be dropped.

Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.

“The protection your insurance provides could depend a lot on where you live,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. In some states, “over time, [patients with chronic illness] might find it increasingly difficult to find insurance companies that will offer plans that cover their needs.”

The Senate provisions aren’t expected to affect job-based health plans or Medicare for seniors. It would mainly affect the kind of insurance sold to individuals through the Affordable Care Act’s online exchanges, which cover about 10 million people.

The Health 202: Here’s what’s in the Senate health-care bill

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https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/06/22/the-health-202-here-s-what-s-in-the-senate-health-care-bill/594aa367e9b69b2fb981dde9/?utm_term=.fd77d3f3481a

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The Senate version of the repeal (and “replacement”) of the Affordable Care Act — which Mitch McConnell is now sharing with Senate Republicans — eliminates just about all of its extra taxes on the rich by deeply cutting Medicaid and reducing subsidies to the poor. But McConnell figures he can keep moderate Republicans in the fold (he needs almost all their votes) by delaying these provisions and allowing states to reduce insurance coverage.

The plan:

1. Basically retains Obamacare’s insurance subsidies. But starting in 2020 this assistance wouldn’t be available for most of the working-class who now receive them, nor for anyone ineligible for Medicaid. See #2.

2. Cuts Medicaid more deeply than the House version by giving states an amount per person that grows more slowly than the growth in healthcare costs. This provision won’t kick in for 7 years, well past senators’ next reelection battles.

3. Ends the Affordable Care Act’s Medicaid expansion in 5 years — gradually reducing the extra federal payments starting in 2021.

4. Continues to protect patients with preexisting conditions, but allows states to reduce insurance coverage to everyone, including people with preexisting conditions.

In other words, all cuts are made through the back door of delays and state waivers. It only looks like a kinder, gentler version of the House repeal of the Affordable Care Act — but 7 to 10 years from now its result would be even crueler.

Access to Coverage and Care for People with Preexisting Conditions: How Has It Changed Under the ACA?

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http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/coverage-care-preexisting-conditions-aca

Abstract

Issue: Prior to the Affordable Care Act (ACA), people with preexisting health conditions could be denied insurance coverage or charged higher rates. If the law is repealed, these protections could be diluted or lost altogether.
Goals: Assess the ACA’s impact on coverage and access for people with preexisting conditions and compare their coverage gains with state high-risk-pool enrollment pre-ACA.
Methods: Analysis of Behavioral Risk Factor Surveillance System data for the period 2011–13 to 2015.
Key Findings and Conclusions: Between 2013 and 2015, 16.5 million nonelderly adults gained coverage following full ACA implementation. Of those, 2.6 million had preexisting conditions that could have otherwise precluded them from coverage because of discriminatory denials and pricing; 9.4 million had conditions that could have otherwise affected insurance cost. We found strong correlations between these coverage gains and access to care. Coverage and access gains for people with preexisting conditions were unrelated to the size or existence of the state high-risk pools that 35 states funded for such individuals pre-ACA. Our findings suggest that proposals to replace current protections for people with preexisting conditions with high-risk pools are unlikely to be sufficient to maintain the ACA’s gains.

Background

Americans with chronic health conditions are at the center of the debate over access to health care coverage. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) estimates the number of Americans with such “preexisting conditions” ranges from 19 percent to 50 percent of all nonelderly Americans.1,2 This range represents the difference between conditions that fit into a “narrow” definition of preexisting conditions (19%), and a “broad” definition (50%). The narrow definition includes very costly health conditions that would cause insurers to refuse coverage absent the Affordable Care Act’s (ACA) provisions; the broad definition includes slightly less expensive chronic health conditions that could nevertheless make the cost of insurance in the individual market without the ACA largely unaffordable for most patients.

In 2016, the Henry J. Kaiser Family Foundation, in its review of pre-ACA medical underwriting practices, estimated that 27 percent of nonelderly American adults had health conditions that “would likely leave them uninsurable if they applied for individual market coverage.”3 Similarly, a Commonwealth Fund study found that, in 2010, 36 percent of adults ages 19 to 64 who had tried to buy a plan in the individual market over the prior three years were turned down, charged a higher price, or had a condition excluded from their coverage because of a health problem.4

The presence of preexisting conditions is particularly important for the millions of Americans who have gained coverage under the ACA, which Congress and the Trump administration are seeking to repeal.5 The Commonwealth Fund study found significant improvements in the ability of people with health problems to purchase plans on their own in 2016 relative to 2010.6

In this issue brief, we observe whether the coverage gains for people with preexisting conditions also have resulted in better access to care. Better access is defined as a greater likelihood of having a regular health care provider (whether one or more than one clinician) and having less trouble seeing a provider because of the cost.

Prior to passage of the ACA, many states had high-risk pools that sought to provide coverage to individuals locked out of the individual insurance market because of expensive preexisting conditions. Between 2010 and 2013, the ACA funded the Pre-Existing Condition Insurance Program, a set of federally funded high-risk pools to provide interim coverage for those with such conditions. If these pools had been successful in addressing coverage for those with preexisting conditions, we would expect to see a smaller gain in access to care for this population in those states that had previously enrolled substantial shares of the nongroup market in the pools.

Under the ACA, Americans with Preexisting Conditions Gained Coverage and Better Access to Care

For this brief, we considered both the narrow and broad definitions of preexisting conditions. Among the general population surveyed between 2011 and 2015, data from the Behavioral Risk Factor Surveillance System (BRFSS) indicate that 20 percent of Americans have preexisting conditions under the narrow definition and 61 percent of Americans have these conditions under the broader definition. Using the BRFSS data, we estimate that 16.5 million more people were insured in 2015 than in the 2011–2013 period.7 Among this newly insured group, 2.6 million had one or more preexisting conditions under the narrow definition and 9.4 million had one or more under the broader definition (Exhibit 1).

 

 

 

Five things to watch in Senate GOP’s ACA repeal bill

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Five things to watch in Senate GOP’s ObamaCare repeal bill

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A draft of the long-awaited Senate healthcare bill, crafted behind closed doors, will be publicly unveiled on Thursday.

Just a day before the bill’s scheduled release, some senators said they still didn’t know the details of some key provisions, creating uncertainty as Senate Majority Leader Mitch McConnell (R-Ky.) pushes toward a vote next week.

Here’s what to watch for.

Democrats to slow-walk Senate business over health care bill

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https://www.usatoday.com/story/news/politics/2017/06/19/democrats-halt-senate-business-over-health-care-bill/103012262/?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=53324518&_hsenc=p2ANqtz-8NpDGDFUkQIuhKz8d8GWAlDDWC2mqcN0hJfp_LlAcTnc81nyyDtb3Ah782Ee3PptGo5xWZ8yPbj1T7bkeh-DIp55enpQ&_hsmi=53324518

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Democrats will begin slow-walking Senate business on Monday as part of their opposition to Republican attempts to overturn the Affordable Care Act.

Senate Minority Leader Chuck Schumer of New York said Democrats will object to requests for “unanimous consent” to set aside rules and expedite proceedings. The procedural move is a tactic the minority party can use to draw out the legislative process for days, forcing Republicans to jump through procedural hurdles to get anything done.

The goal, he said, is to refer the GOP health care bill to a committee where it can be debated and amended publicly. Republicans are writing their bill “under the cover of darkness because they’re ashamed of it,” he said.

“This is a bill that would likely reorder one-sixth of the American economy and have life-and-death consequences for millions of Americans, and it’s being discussed in secret with no committee hearings, no debate, no amendments, no input from the minority,” he said. “This is the most glaring departure from normal legislative procedure that I have ever seen.”

The move coincides with a new #AmericaSpeaksOut campaign Senate Democrats launched Monday urging Americans to “speak out against Trumpcare and share their stories.” They also plan to hold the Senate floor tonight with speeches about health care.

The House passed its Obamacare repeal bill in May, but Senate Republicans have been drafting their own bill behind closed doors.

In a letter, Democrats provided some Senate Republican leaders with a list of all 31 potential Senate rooms “to assist” Republicans in scheduling a hearing.

They wrote that Democrats, by comparison, held about 100 hearings and meetings, accepted more than 150 amendments sponsored or cosponsored by GOP senators and spent 25 days in floor debate during the drafting of the Affordable Care Act.

The move by Democrats to slow Senate business will not impact consideration of President Trump’s nominee to lead the Federal Emergency Management Agency, Brock Long, who is expected to be confirmed Tuesday, according to a Senate Democratic aide. Schumer said Democrats would not object to requests for unanimous consent on honorary resolutions, either.

The greater impact likely will be the interruption of the legislative process and routine Senate business.

Speaking on the Senate floor, Schumer asked Senate Majority Leader Mitch McConnell of Kentucky to hold an all-senators meeting to discuss a bipartisan way forward on lowering the cost of health care, raising the quality of care and stabilizing the insurance marketplaces.

McConnell responded that senators would meet on the Senate floor with an unlimited amendment process. He said there would be “ample opportunity” to read and amend the bill when Schumer asked whether Democrats would have more than 10 hours to review it.

“I rest my case,” Schumer said.

CBO: House Obamacare repeal will increase uninsured by 23 million

Senate Republicans draft Obamacare repeal bill behind closed doors

Republicans blame Democrats for refusing to negotiate on a health care bill.

“Democrats for MONTHS have stated they have no interest in working with Republicans on fixing Obamacare,” Michael Reed, the Republican National Committee’s research director and deputy communications director, wrote in a statement. “Now, Democrat efforts to feign outrage over health care negotiations should be seen for what it is — a pure partisan game aimed at placating the far-left.”

McConnell, in a Senate floor speech, said Obamacare has increased costs and reduced choice, causing Americans to drop coverage. He said the entire Senate Republican conference has been “active and engaged” for months on legislation that would stabilize insurance markets, remove mandates to buy insurance, and preserve access to care for those with pre-existing conditions.

“We believe we can and must do better than Obamacare’s status quo,” he said.

The House-passed health care bill, called the American Health Care Act, would lead to 23 million fewer people having health insurance by 2026, according to the Congressional Budget Office. If the Senate is able to pass health care legislation, the two chambers will have to come to a compromise to get a final bill to Trump’s desk.

As Democrats prepared for battle over the Senate bill, conservative House Republicans planned to send a letter to McConnell warning against letting the legislation get too moderate if he wants to keep support from the House after it passed the Senate.

The letter from the Republican Study Committee, which has more than 150 members, states that its members have “serious concerns regarding recent reports suggesting that the Senate’s efforts to produce a reconciliation bill repealing the Affordable Care Act are headed in a direction that may jeopardize final passage in the House of Representatives,” according to a copy of the draft obtained by USA TODAY.