Rival Senate healthcare group seeks to make waves

Rival Senate healthcare group seeks to make waves

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A rival group of Republican senators is seeking leverage to influence the direction of the Senate’s ObamaCare replacement bill.

The group, led by Sens. Susan Collins (R-Maine) and Bill Cassidy (R-La.), has been meeting “a couple times a week,” according to Sen. Shelly Moore Capitol (R-W.Va.).

Cassidy is a physician and Collins is a former state insurance commissioner. Both have been outspoken opponents of the House-passed American Healthcare Act, and have co-sponsored their own version of an ObamaCare repeal bill called the Patient Freedom Act.

Cassidy told The Hill he and Collins have been meeting with Senate leaders to talk about their legislation. However, he noted the politics of the Senate mean that every member’s voice matters.

“When you only have 52 senators, everybody has significant leverage. That tight vote margin means everyone is essential,” Cassidy said.

The main GOP working group on healthcare includes 13 men backed by Senate leadership who are seeking to bridge the divide between conservatives and centrists.

What ever legislation emerges from that group is likely to be the bill that comes to the Senate floor.

But if all of the Senate’s Democrats oppose the measure, Senate Majority Leader Mitch McConnell (R-Ky.) will only be able to afford two defections.

That gives the other group leverage.

“Let’s look at it practically,” Capito  told The Hill. “You can only lose two votes on any one issue … so I think a bloc of four or five can be very effective.”

Health lobbyists have noted many members of the leadership-led group have been fairly measured in their criticisms of the House bill approved earlier this month.

Collins and Cassidy, in contrast, both seem keen on turning sharply from the House bill.

These 50 Health Issues Count as Pre-Existing Conditions

http://fortune.com/2017/05/04/ahca-pre-existing-conditions/

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The Republican plan to repeal and replace the the Affordable Care Act (ACA), which narrowly passed a vote in the House today, rolls back protections for people with pre-existing conditions, which could increase health care costs for an estimated 130 million Americans.

The American Health Care Act stipulates that states can allow insurers to charge people with pre-existing conditions more for health insurance (which is banned under the ACA) if the states meet certain conditions, such as setting up high-risk insurance pools. Insurers still cannot deny people coverage outright, as was a common practice before the ACA’s passage, but they can hike up premiums to an unaffordable amount, effectively pricing people out of the market.

In fact, premiums could reach as high as $25,700 per year for people in high-risk pools, according to a report from AARP. People who receive insurance through their employer would not be affected, unless they lost their job or moved to the individual insurance market for some other reason.

But what counts as a pre-existing condition? While it depends on the insurer—they have the right to choose what counts as “pre-existing”—these ailments and conditions were universally used to deny people coverage, according to the Kaiser Family Foundation, a nonprofit focusing on health care research.

  • AIDS/HIV
  • Alcohol or drug abuse with recent treatment
  • Alzheimer’s/dementia
  • Anorexia
  • Arthritis
  • Bulimia
  • Cancer
  • Cerebral palsy
  • Congestive heart failure
  • Coronary artery/heart disease, bypass surgery
  • Crohn’s disease
  • Diabetes
  • Epilepsy
  • Hemophilia
  • Hepatitis
  • Kidney disease, renal failure
  • Lupus
  • Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia)
  • Multiple sclerosis
  • Muscular dystrophy
  • Obesity
  • Organ transplant
  • Paraplegia
  • Paralysis
  • Parkinson’s disease
  • Pending surgery or hospitalization
  • Pneumocystic pneumonia
  • Pregnancy or expectant parent (includes men)
  • Sleep apnea
  • Stroke
  • Transsexualism

But Cynthia Cox, Kaiser’s associate director, notes that the above list is a conservative sampling of all of the issues and maladies that insurers could count as pre-existing conditions. ” There are plenty of other conditions, even acne or high blood pressure, that could have gotten people denied from some insurers but accepted and charged a higher premium by other insurers” says Cox.

Here are some examples of those other conditions that experts have noted could hike premiums:

  • Acid Reflux
  • Acne
  • Asthma
  • C-Section
  • Celiac Disease
  • Heart burn
  • High cholesterol
  • Hysterectomy
  • Kidney Stones
  • Knee surgery
  • Lyme Disease
  • Migraines
  • Narcolepsy
  • Pacemaker
  • Postpartum depression
  • Seasonal Affective Disorder
  • Seizures
  • “Sexual deviation or disorder”
  • Ulcers

The left-leaning Center for American Progress notes that high blood pressure, behavioral health disorders, high cholesterol, asthma and chronic lung disease, and osteoarthritis and other joint disorders are the most common types of pre-existing conditions.

Just how expensive are pre-existing conditions? A recent report from the Center for American Progress found that insurers could charge people with metastatic cancer as much as $142,650 more for their coverage, a 3,500% increase.

A Squeaker In The House Becomes Headache For The Senate: 5 Things To Watch

A Squeaker In The House Becomes Headache For The Senate: 5 Things To Watch

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After weeks of will-they-or-won’t-they tensions, the House managed to pass its GOP replacement for the Affordable Care Act on Thursday by a razor-thin margin. The vote was 217-213.

Democrats who lost the battle are still convinced they may win the political war. As the Republicans reached a majority for the bill, Democrats on the House floor began chanting, “Na, na, na, na … Hey, hey, hey … Goodbye.” They claim Republicans could lose their seats for supporting a bill that could cause so much disruption in voters’ health care.

Now the bill — and the multitude of questions surrounding it — moves across the Capitol to the Senate. And the job doesn’t get any easier. With only a two-vote Republican majority and no likely Democratic support, it would take only three GOP “no” votes to sink the bill.

Democrats have made clear they will unanimously oppose the bill. “Trumpcare” is just a breathtakingly irresponsible piece of legislation that would endanger the health of tens of millions of Americans and break the bank for millions more,” said Senate Minority Leader Chuck Schumer (D-N.Y.).

And Republicans in the Senate have their own internal disagreements, too.

Here are five of the biggest flashpoints that could make trouble for the bill in the upper chamber.

I have a pre-existing condition. I do things “the right way”.

I have a pre-existing condition. I do things “the right way”.

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When I was a medical student, I started to notice blood in the toilet. I was a medical student, so I panicked. I called my father, who at the time was still a practicing surgeon, and he told me it was likely hemorrhoids. Given the alternatives, I breathed a sigh of relief.

The blood didn’t go away, though. Soon, I started to have diarrhea, cramps, and the urge to go to the bathroom all the time. That summer, I worked at Children’s Hospital of Philadelphia on a research project, and I had to go to the bathroom so many times, I thought they were going to fire me. It got so bad, my Dad (who is a minimalist), finally sent me to the gastroenterologist. The short version of the story is they determined I had ulcerative colitis.

I’ve written about this before, so I’m not going to get into the details of the disease. The only reason I bring any of this up is so you understand that I was diagnosed when I was 22 years old and a full-time student.

None of it was my fault.

Today, I eat a well-balanced diet. My weight is good. I exercise 5 times or so a week. I don’t smoke or do drugs. I don’t drink more than socially. I do everything I’m supposed to do. I still have ulcerative colitis, and I will until I die, likely. I’m doing the things I need to do to keep my body healthy. I lead a good life.

__________________________________________

I try very hard to see the good in others. When I write, when I debate others, I do my best to assume that the intentions of those with whom I disagree are righteous. Even when we see the world differently, I make every effort not to think that others are “bad” or want to see people suffer. I’m not one who writes that people who want to reform the insurance system want “to kill people”. I don’t think that people who want to reform welfare “hate the poor”. I’m not perfect, so sometimes I screw up. When I do, I apologize.

Yesterday, a Congressman went on TV and said (emphasis mine):

“My understanding is that it will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool. That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now those are the people—who’ve done things the right way—that are seeing their costs skyrocketing.”

I cannot adequately describe how much this enraged me. This is one of those things that you hear people say “the other side believes”, but discount. I don’t want to believe that people think this. I don’t want to believe that people think that some others deserve to be sick. I don’t want to believe that people equate being ill with a moral failing.

I didn’t do anything to get ulcerative colitis. I did nothing wrong. I lead a good life. I didn’t fail.

___________________________________________

My brother, amazingly enough, has Crohn’s disease; the Carroll GI protoplasm ain’t the best. When I was a resident, and he was a law student, we would talk often about how we would both have to work for very large companies or organizations in order to get health care. It was a fact of life. We both knew that on the individual market, no insurance company would touch us. Ever. Because of our pre-existing conditions, we’d be screwed for the rest of our lives.

He didn’t do anything wrong either, by the way. He was diagnosed in high school, and he was a really good boy, too.

I could start quoting statistics here, but what’s the point? A huge number of Americans have pre-existing conditions. They couldn’t get insurance on the individual market before the ACA because it was in insurance companies’ best interest not to issue them policies. It made good business sense. That didn’t mean it was right.

There is certainly a case to be made that people have some responsibility for their health. But the lines aren’t clear at all. It’s easy to point at smokers and say they’re doing something harmful and are raising costs for all of us. That’s why we can charge smokers more under the ACA. After that… it gets dicey.

Do you start regulating what people eat? What they drink? If you eat dessert, and I don’t, why should I have to pay for your healthcare? Should we charge people more if they drive cars (number one killer of children!)? I like to ski. That has risks. So does rock climbing. Or playing contact sports. Should we make them stop, or charge them more? What about people who scuba dive?

Should we start penalizing people who have different organs in their body than we do?

____________________________________________

I expect that this Congressman will soon be issuing a statement saying he was “taken out of context”. Something along the lines of “he misspoke”. But maybe not. Maybe he does believe what he said, that people who did things the right way are the ones who are healthy. If that’s the case, then I have just one question for him.

What did the baby born prematurely, the one with congenital heart disease, or the toddler with sickle cell disease, or the child with autism, or the little girl with leukemia, or the boy with asthma, or the adolescent with juvenile arthritis, or the young woman with lupus, or the young man with testicular cancer, or the new mother with breast cancer, or the new father with inflammatory bowel disease, or the woman with familial heart disease, or the man with early onset Parkinson’s disease, or the retiring woman with Alzheimer’s disease, or the elderly man with lymphoma – what did they do wrong?

Did they lead bad lives?

I guess I had two questions. Take your time answering. I’ll wait.

 

What Are Pre-Existing Conditions and What Would the GOP Bill Do?

http://www.nbcnews.com/health/health-care/what-are-pre-existing-conditions-what-would-gop-bill-do-n754836

Image: Planned Parenthood Funding Threatened By GOP Legislation

Important background for understanding what happened today in the House:

America has the only healthcare system in the world designed to avoid sick people. Private for-profit health insurers do whatever they can to insure groups of healthy people, because that’s where the profits are. They also make every effort to avoid sick people, because that’s where the costs are.

The Affordable Care Act puts healthy and sick people into the same insurance pool. But under the Republican bill that just passed the House, healthy people will no longer be subsidizing sick people.

Healthy people will be in their own insurance pool. Sick people will be grouped with other sick people in their own high-risk pool – which will result in such high premiums, co-payments, and deductibles that many if not most won’t be able to afford the cost.

Republicans say their bill creates a pool of money that will pay insurance companies to cover the higher costs of insuring sick people. Rubbish. Insurers will take the money and still charge sick people much higher premiums. Or avoid sick people altogether.

The only real alternative here is a single-payer system, such as Medicare for all, which would put all Americans into the same giant insurance pool. Not only would this be fairer, but it would also be far more efficient, because money wouldn’t be spent marketing and advertising to attract healthy people and avoid sick people.

Republicans’ plan to protect sick people has a long history of not protecting sick people

https://www.washingtonpost.com/news/wonk/wp/2017/05/05/republicans-plan-to-protect-sick-people-has-a-long-history-of-not-protecting-sick-people/?utm_term=.ae6a7d83164d&wpisrc=nl_wonk&wpmm=1

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Republicans technically have a plan for covering sick people: setting up a system that could do so, but, if history is any guide, wouldn’t.

Welcome to “high-risk pools,” the government-subsidized groups for people who — in the world where insurance companies can go back to their pre-Obamacare practice of discriminating against those with preexisting conditions — can’t get covered on their own. In theory, the pools can be a good way to make sure money is going to the people who need it the most. But in practice, they don’t tend to give out enough money in the first place. Which is why the GOP’s plan to repeal Obamacare’s protections for the sick and replace them with high-risk pools might literally be a life-or-death gamble for a lot of people.

Now, the first thing to know about high-risk pools is that they aren’t magic. They don’t make it any cheaper to cover sick people. That costs what it costs regardless of whether we pay for it with a combination of higher premiums and higher taxes (like Obamacare does), or with higher taxes alone (like high-risk pools would). And yes, it’s something that “we” have to pay for, since the most serious illnesses cost far more than anyone could pay on their own. Indeed, the sickest 5 percent of people make up 50 percent of health-care spending. Although there’s a big caveat here. The idea that high-risk pools won’t save any money is based on the assumption that, as President Trump put it, we won’t have people “dying in the streets.” In other words, that we’ll adequately fund the high-risk pools.

We haven’t in the past. Before Obamacare, you see, a lot of states had their own high-risk pools that were supposed to do what Republicans say they will today: cover sick people separately so that healthy people aren’t burdened with higher premiums. The only problem was they forgot to do that first part. State governments didn’t put anywhere near enough money into their high-risk pools, with the predictable result that these only slightly subsidized costs were still too expensive for a lot of people with preexisting conditions. And even then, they often faced lifetime limits on their coverage. Not to mention the fact that there were long waiting periods before you could join — not something, say, a cancer patient could afford.

Here’s why that matters now. Republicans don’t actually want to set up their own high-risk pool. They want the states to do that themselves — with $138 billion coming from Washington over the next 10 years. But there are three problems with this. First, this almost certainly isn’t enough money. Even conservatives like James Capretta and Tom Miller think that high-risk pools would need around $150 billion to $200 billion to work over the next decade. Emily Geeof the left-leaning Center for American Progress, meanwhile, thinks it’s more like $330 billion. Second, this money isn’t even required to go to high-risk pools. States could also use it to offset costs for healthy people in the individual market — which is what the nonpartisan Congressional Budget Office expects they’ll do. And third, this funding isn’t flexible. It’s a one-time grant that states won’t have an easy time supplementing since they have to balance their budgets every year. The result would be a much more precarious than the system we have now where sick people can’t be charged more and any subsidy they get automatically goes up with their premiums to try to keep them from being priced out of the market.

 

 

House to vote Thursday on Obamacare repeal bill

http://www.cnn.com/2017/05/02/politics/republican-health-care-bill/

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BREAKING: The House will vote Thursday on the GOP bill to repeal and replace Obamacare.

Majority Leader Kevin McCarthy said the bill will pass.
“We will be voting on the health care votes tomorrow. Because we have enough votes. It’ll pass. It’s a good bill,” McCarthy, R-California, told reporters.
“We’re gonna pass it. We’re gonna pass it,” he added. “Let’s be optimistic about life.”
An eleventh-hour deal renewed momentum for House Republicans working to repeal and replace Obamacare, as leaders Wednesday furiously lobby undecided or skeptical lawmakers on the plan that has been teetering on the brink of collapse.
House leaders have made clear that if everything goes their way, their preference is to have a vote Thursday. But they won’t call a vote unless they believe it will pass.
Vice President Mike Pence is on Capitol Hill. Members have been walking in and out of the speaker’s office all day.
The change in mood comes after GOP Reps. Fred Upton and Billy Long met with President Donald Trump at the White House and flipped their votes from “no” to “yes.” Trump committed to backing an amendment spending $8 billion over five years to fund high-risk pools and go toward patients with pre-existing conditions.
The new “yes” votes mark an incremental but symbolically important victory for the White House and Republican leaders, who have been trying without success for weeks to revive a health care bill that was pulled from the House floor in March.
Other than Long and Upton, there have not been major switches from the “no” to “yes” category, but several undecided members are seemingly open to the new changes.
The focus is on moderate lawmakers concerned the GOP bill will erode too many protections in Obamacare. As originally introduced, the bill would leave 24 million fewer people insured by 2026 than under Obamacare, the non-partisan Congressional Budget Office said.
But the House Freedom Caucus, a group of conservatives who helped scuttle the previous bill in March, now supports the legislation.
Importantly, the Freedom Caucus continues to back the bill Wednesday, even with the new spending being added.
Freedom Caucus Chairman Mark Meadows said only one member of the group opposes the bill. “We’re not going to lose any votes because of it,” he said.
The situation remains extremely fluid.
The future of the bill “as uncertain as we’ve seen it,” a Republican involved in the health care talks said.
Around the same time that Upton and Long unveiled their moves to “yes,” their colleague, Rep. Carlos Curbelo of Florida, declared on Twitter that he opposed the bill.
“I just reiterated to @HouseGOP leaders that #AHCA in its current form fails to sufficiently protect Americans with pre-existing conditions,” Curbelo said.
New Jersey Rep. Leonard Lance, a moderate Republican opposed to the bill, also told CNN Wednesday morning that Upton’s proposed change would not sway him to support the health care legislation. Lance also noted that he has not heard from Trump or Vice President Mike Pence in several weeks
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Moderate Reps. Charlie Dent, Frank LoBiondo and Jaime Herrera Beutler say they still oppose the bill even with the Upton amendment.