Insurers, hospitals, physicians united in stance on ACA lawsuit

https://www.healthcarefinancenews.com/news/insurers-hospitals-physicians-united-stance-aca-lawsuit?mkt_tok=eyJpIjoiWldGbU16WmxOak00TmprMiIsInQiOiIzeGkycUpwcmtPUk42Z2R0b1k4RHd0NUVoY0k3UmE5TktUSkhMUzVtNVVWOWtWY3BhWkdUbjcrZndNS0tZRnA1cWFSajhWdmlZcUc4VE5DbFB4VEZNNkJyYTkyXC9XK3hxZVMwVzhSaVF2ZjZIdUFjbzZwcnF6aGE0UmowZ2w1eHcifQ%3D%3D

Hospitals, physicians and insurer groups are united in wanting to preserve the Affordable Care Act and have defended it in briefs filed with the Fifth Circuit Court of Appeals.

The American Hospital Association, the American Medical Association and America’s Health Insurance Plans are among groups that are fighting a lower court ruling in Texas that struck down the law.

On the other side is the Department of Justice, which last month reversed an earlier opinion and sided with the Texas judge who ruled that without the individual mandate, the entire ACA has no constitutional standing.

WHY THIS MATTERS

The ACA has insured millions who otherwise may not have been insured, allowing them to get care when needed instead of going to the more expensive emergency room when they have a medical crisis.

Hospitals and physicians see less uncompensated care under the ACA.

Without the ACA, patients would no longer have protections for pre-existing conditions, children would no longer have coverage under their parents’ health insurance plan until age 26, insurers would no longer be held to the 85 percent medical loss ratio, 100 percent coverage for certain preventive services would cease and individual marketplace and subsidies based on income would be eliminated.

Also, federal funding for Medicaid expansion would end.

TREND

Republicans under President Trump have tried unsuccessfully to repeal and replace the law.

The lawsuit, brought by 19 Republican governors, puts the GOP in a political bind over supporting the repeal of a law that is popular with consumers and their constituents. President Donald Trump recently said Republicans would unveil an ACA replacement after the 2020 election.

Democrats are also facing a crisis within their party over healthcare as it becomes a priority issue in the presidential election. Some of the leading candidates, such as Senator Kamala Harris, support Medicare for all. The Medicare for All Act of 2019  has been introduced in the Democratic-led House of Representatives.

Veteran politician and attorney Earl Pomeroy said he believes the Texas versus United States appeal changes the political course for 2020. The entire MFA argument will move to the back burner because of the Texas lawsuit, he said.

“The fight is going to be trying to underscore the Congressional importance of the provisions of the ACA and enhancing them,” Pomeroy said. “I do not believe that supporting Medicare for all is an advantageous position for a Democratic candidate running in a district that is not a secure Democratic seat. I believe Kamala Harris will spend much of the campaign walking back her comments on health insurance.”

Pomeroy is a former member of the U.S. House of Representatives for North Dakota’s at-large district, a North Dakota Insurance Commissioner and senior counsel in the health policy group with Alston & Bird.

“The safe political ground is defending a law people have warmed up to,” he said. “All politics is local but all healthcare is personal. There is little risk tolerance in the middle class for bold experiments in healthcare.”

BACKGROUND

The lawsuit was brought by Texas and the 19 other Republican-led states, based on the end of the individual mandate. In February, U.S. District Court Judge Reed O’Connor agreed that the federal law cannot stand without the individual mandate because if there is no penalty for not signing up for coverage, then the rest of the law is unconstitutional.

Twenty-one Democratic attorneys general appealed and the House of Representatives has intervened to defend the ACA in the case.

Either outcome in the appeals court may see the case headed to the U.S. Supreme Court.

WHAT THE PROVIDERS AND INSURERS ARE TELLING THE COURT

In a court brief filed by the AHA, the Federation of American Hospitals, The Catholic Health Association of the United States, America’s Essential Hospitals, and the Association of American Medical Colleges urged the Fifth Circuit Court of Appeals to reject a district court decision they said would have a harmful impact on the American healthcare system.

“Those without insurance coverage forgo basic medical care, making their condition more difficult to treat when they do seek care. This not only hurts patients; it has severe consequences for the hospitals that provide them care. Hospitals will bear a greater uncompensated-care burden, which will force them to reallocate limited resources and compromise their ability to provide needed services,” they said.

In a separate friend-of-the-court brief, 24 state hospital associations also urged the Fifth Circuit to reverse, highlighting specific innovative programs and initiatives for more coordinated care.

The American Medical Association, the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics and the American Psychiatric Association filed a brief. AMA President Dr. Barbara L. McAneny said, “The district court ruling that the individual mandate is unconstitutional and inseverable from the remainder of the ACA would wreak havoc on the entire healthcare system, destabilize health insurance coverage, and roll back federal health policy to 2009. The ACA has dramatically boosted insurance coverage, and key provisions of the law enjoy widespread public support.”

AHIP said the law impacts not only the individual and group markets, but also other programs such as Medicaid, Medicare and Part D coverage.

“Since its passage in 2010, the ACA has transformed the nation’s healthcare system,” AHIP said. “It has restructured the individual and group markets for purchasing private health care coverage, expanded Medicaid, and reformed Medicare. Health insurance providers (like AHIP’s members) have invested immense resources into adjusting their business models, developing new lines of business, and building products to implement and comply with those reforms.”

 

 

 

 

Trump is reading the GOP base wrong on the Affordable Care Act

https://www.axios.com/trump-reading-base-wrong-aca-b6e2521c-d386-4c94-81e8-b018a6aaf3b1.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for Trump is reading the GOP base wrong on the Affordable Care Act

 

The only plausible explanation for President Trump’s renewed effort through the courts to do away with the Affordable Care Act, other than muscle memory, is a desire to play to his base despite widely reported misgivings in his own administration and among Republicans in Congress.

Reality check: But the Republican base has more complicated views about the ACA than the activists who show up at rallies and cheer when the president talks about repealing the law. The polling is clear: Republicans don’t like the ACA, but just like everyone else, they like its benefits and will not want to lose them.

The big picture: About three quarters of Republicans still have an unfavorable view of the ACA, and seven in 10 say repealing the law is a top health priority for Congress — higher than other priorities such as dealing with prescription drug costs. And yes, 7 in 10 Republicans still want to see the Supreme Court overturn the law.

But as the chart shows, majorities of Republicans like many elements of the ACA —especially closing the “donut hole” in Medicare prescription drug coverage (80%), eliminating copayments for preventive services (68%), keeping young adults under 26 on their parents’ plans (66%) and subsidies for low and middle-income households (63%).

  • Nearly half of Republicans want the Supreme Court to keep the protections for pre-existing conditions (49%), and even more show general support for the pre-existing conditions protections (58%).
  • During the repeal and replace debate in 2017, even Republicans were nervous to hear that these sorts of things would go away. The 2020 campaign would drive home to the public, and to Republicans, what they have to lose — and it would become especially real to them if the 5th Circuit Court of Appeals upholds the ruling striking down the ACA.

Maybe Republicans would forget about these lost benefits if they could agree on a replacement plan they liked? But there isn’t one, and many of the ideas thought to be elements of one — such as cutting and block granting both Medicaid and ACA subsidies — are non-starters with Democrats and moderate Republicans on Capitol Hill. They’re unpopular with the public, too. 

The bottom line: It is widely accepted that a renewed debate about repeal hands Democrats a powerful new political opportunity. Deeper in the polling, it’s also clear that’s it’s more of a mixed bag for Republicans than President Trump may realize.  

 

 

 

So, about being the “party of health care”

https://www.axios.com/newsletters/axios-vitals-4b66c0e1-2525-4bb1-a974-f97c9e3e5392.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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GOP leaders are trying their best to put a lid on President Trump’s talk of a new and wonderful health care plan that would define the Republican Party for 2020.

“Not any longer,” Senate Majority Leader Mitch McConnell said yesterday when asked whether he and Trump differ on health care.

  • McConnell said he spoke to Trump Monday and “made it clear to him that we were not going to be doing that in the Senate.”
  • RNC Chair Ronna McDaniel and Trump campaign manager Brad Parscale also “tried to tell the president they could not understand what he was doing,” The New York Times reports.

Rhetorically, Trump has kicked the can past 2020, just after pushing his administration to dive back into — and escalate — the legal fight that hurt Republicans so badly in 2018.

  • “I wanted to delay it myself,” Trump said in the Oval Office yesterday, denying that McConnell forced his hand. “I want to put it after the election, because we don’t have the House.”

Reality check: It’s still the Justice Department’s position that the courts should strike down the Affordable Care Act. As long as this lawsuit is still active — and that will be a while — it’ll be accurate for Democrats to say on the campaign trail that Trump is trying to end protections for pre-existing conditions.

  • In the short term, Trump’s rhetorical punt to 2021 may dampen the intensity of questions about how Republicans would rebuild a new system for individual coverage — questions the party has struggled to answer for the past 9 years.
  • But in the end, the only good way out is for the Trump administration to lose this case.

 

 

 

The winning health care message will be about out of pocket costs

https://www.axios.com/winning-2020-health-care-out-of-pocket-costs-d5708e35-b308-4c91-a636-121e45f82032.html

Illustration of a wallet full of band-aids

As the 2020 campaign ramps up, Democrats may be able to rally their base by talking about universal coverage and making health care a right through Medicare-for-all. Republicans may be able to motivate their core voters by branding progressive Democratic ideas as socialism.

The catch: But it’s the candidates who can connect their plans and messages to voters’ worries about out of pocket costs who will reach beyond the activists in their base. And the candidates aren’t speaking to that much, at least so far.

By the numbers:

  • The anxiety over out of pocket costs is real. In a January 2017 Kaiser poll, 48 percent of voters worried about paying their health care bills.
  • People who are sick are especially concerned, with 66 percent worried and 49 percent very worried.
  • It isn’t just in their heads: a whopping half of people who are sick have a problem paying their medical bills over the course of a year. The health insurance system is not working for people who are sick.

Thanks in part to the Affordable Care Act, only 10 percent of the population remains uncovered. But that means many Americans are less focused on getting to universal coverage, even though candidate after candidate talks about it. They have insurance and are focused on their own, often crippling health care costs.

  • Most Americans are healthy and don’t use much care, but almost everyone, not just people with a major illness, worries about what might happen if they or a family member get cancer or heart disease or suffer a permanent injury.
  • That’s what fuels health care as an issue: the fear of facing costs people know they cannot afford. And that’s why protections for people with pre-existing conditions broke through as a prominent issue in the midterm election.
  • The debate and the Democratic message could shift back to the ACA again, after President Trump and the Justice Department’s surprise decision to push for throwing out the entire law in the courts. That move handed Democrats a political opportunity they will not ignore: a pre-existing conditions debate on steroids.

Recent trends have made problems with out of pocket costs worse:

Some of the administration’s policies are exacerbating the problem, such as their efforts to push cheaper short term insurance plans for the healthy, which drive up costs for the sick because they leave fewer healthy people in the regular insurance plans to help pay for sick people’s costs.

  • Several of the candidates’ plans address out of pocket costs, including the Bernie Sanders plan, which eliminates them. Their advocates just don’t talk about it much.

The bottom line: It’s hard to see the new debate about the health system breaking out of familiar boxes unless the messaging changes. And when the general election comes, both parties will have to convince voters that they will do something about out of pocket costs if they want to reach beyond core base voters. 

 

 

 

DOJ supports striking entire ACA: 5 things to know

https://www.beckershospitalreview.com/legal-regulatory-issues/doj-supports-striking-entire-aca-5-things-to-know.html

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In a March 25 court filing, the Department of Justice said it supports a judge’s ruling that the entire Affordable Care Act should be invalidated, according to CNN.

Five things to know:

1. In December, a federal judge in Texas held that the ACA is unconstitutional. He sided with the Republican-led states that brought the lawsuit, Texas v. United States, calling for the entire ACA to be struck down because Congress eliminated the healthcare law’s individual insurance mandate penalty.

2. The case is now pending in the 5th Circuit Court of Appeals. In a filing with the appellate court on March 25, the Justice Department said it supports the federal judge’s ruling that invalidated the ACA.

3. “The Department of Justice has determined that the district court’s judgment should be affirmed,” lawyers for the Justice Department wrote to the 5th Circuit Court of Appeals, according to Politico. “[T]he United States is not urging that any portion of the district court’s judgment be reversed.”

4. The filing signals a major shift in the Justice Department’s position. When Jeff Sessions was attorney general, the administration argued only certain parts of the ACA, like protections for people with pre-existing conditions, should be struck down, but the rest of the law could stand, according to CNN.

5. A coalition of Democratic-led states is challenging the Texas ruling. Regardless of the outcome, the 5th Circuit’s ruling is likely to be appealed to the Supreme Court, according to Politico.

Access the full CNN article here.

Access the full Politico article here.

 

 

Trump admin now backs elimination of ACA in court

https://www.healthcaredive.com/news/trump-admin-now-backs-elimination-of-aca-in-court/551319/

UPDATED: AHA blasted the decision, calling it “unprecedented and unsupported” by law or facts and warned it would lead to repeal of Medicaid expansion and gut protections for those with pre-existing conditions.

Dive Brief:

  • The Trump administration has reversed its stance on the Affordable Care Act, arguing in a court filing Monday that the entire law should be eliminated instead of just removing provisions protecting people with preexisting conditions.
  • The move came hours after Democratic attorneys general defending the ACA filed their brief arguing that the landmark law is still constitutional even without an effective individual mandate penalty. Both filings are in the Fifth Circuit following an appeal of a Texas judge’s decision from December declaring the law unconstitutional after Congress set the mandate penalty to zero in tax overhaul legislation. That decision was stayed pending appeal.
  • Industry groups lambasted the administration’s about-face. America’s Health Insurance Plans CEO Matt Eyles said in a statement the decision was, like the Texas ruling, “misguided and wrong.” He added the payer lobby “will continue to engage on this issue as it continues through the appeals process so we can support and strengthen affordable coverage for every American.” Federation of American Hospitals CEO Chip Kahn said in a statement the decision is “unfortunate but not unexpected considering [the administration’s] long-held views on the health law.”

Dive Insight:

Elimination of the ACA would be a particular blow for some payers that have found increasing profitability in the individual market. Centene and Molina have found success with the exchanges and have expanded their footprints.

It would also put major hospital chains in a bad spot. Companies like HCA, Tenet and Community Health Systems have exposure that could subject them to reduced patient volumes and more bad debt, Leerink analyst Ana Gupte said when the Texas ruling first came down.

Public support for the ACA has gradually increased over the years, and the latest polling from the Kaiser Family Foundation shows about 53% of respondents giving a favorable view and 40% unfavorable. Individual components of the law are even more popular.

The ACA, which just days ago marked its ninth anniversary, brought forth massive change in American healthcare. A repeal of the law would do the same, stripping insurance coverage for as many as 17 million people.

The Trump administration’s new stance presents an intensely stark contrast with the growing field of Democratic presidential contenders, who have shifted the healthcare conversation to the left as the 2020 field shapes up. Candidates have proposed various forms of Medicare for all as well as scaled back versions that still greatly expand government coverage.

It moves the DOJ away from even some Republicans. During last year’s midterms a few GOP candidates said they approved of the ACA’s most popular element — protection for people with preexisting conditions (although voting records didn’t necessarily back them up).

Most Democrats in Congress aren’t fully backing any single-payer model at the moment, but their support for the ACA is strong. Democrats in the House of Representatives are expected to announce a legislative package Tuesday that would strengthen the ACA by eliminating short-term health plans that don’t comply with the law and increasing subsidies for exchange plans.

Since the GOP’s quite public failure to repeal the law two years ago, efforts to do so through Congress have sputtered to nearly a halt. Instead, the Trump administration started chipping away at the law’s provisions. It cut the open enrollment period for ACA plans, as well as the advertising budget for promoting sign-ups, and stopped cost-sharing reduction payments to insurers.

More recently, HHS has bolstered short-term and association health plans that offer cheap but skimpy coverage not in line with ACA requirements. Analysts fear proliferation of these plans could draw young and healthy people away from the exchanges, jeopardizing the stability of the risk pool.

A Democratic-led House panel launched an investigation into short-term plans and is requesting documents from Anthem and UnitedHealth Group, among other companies.

The legal issue at hand is known as severability — the question of whether a single provision of the law, in this case the individual mandate, becoming unenforceable invalidates the entire statute. The mandate was also the key question in the original U.S. Supreme Court ruling allowing the ACA to move forward.

The high court has since lurched to the right, which is notable if the appeal on the Texas ruling reaches that stage, although that would likely be far down the road.