News Update for February 21, 2017
State Government Officials Speak Out Against Full Obamacare Repeal
As Congress works to dismantle the Affordable Care Act, officials from different state governments are speaking out about their healthcare reform concerns.
- In Ohio, Republican governor John Kasich continues to express his strong support for the Medicaid expansions provided by the ACA. Repealing Medicaid expansions would be “a very, very bad idea, because we cannot turn our back on the most vulnerable,” said Kasich.
- Washington governor Jay Inslee held a press conference in which he warned that repealing the ACA recklessly could lead to many people dying early, preventable deaths.
- California has largely managed to avoid some of the more glaring problems of the ACA. In particular, because of its insurance industry enjoys robust competition and its premium hikes have been lower than most other states. Support for the law is high in the state. State government officials are working hard to reassure Californians that they will fight back against President Trump’s attempts to repeal the law.
As GOP Lawmakers Are Flooded by ACA Supporters, Critics of the Law Grow Quiet
For years, animated conservative constituents rallied together to oppose the Affordable Care Act, otherwise known as Obamacare. Today, liberals are overwhelming town hall meetings and flooding their congressional representatives with letters and phone calls beseeching them not to take the law away. On the other hand, many Republicans representing conservative and more moderate districts note that “there is significantly less intensity among opponents of the law than when Mr. Obama was in office.” Polls seem to indicate that support for the law is increasing, even amongst Republicans, who are inclined to support reforming it rather than abolishing it outright.
Secretary of HHS Tom Price Working to Save Obamacare After Years Trying to Kill It
After spending a significant portion of his six terms in Congress attempting to dismantle the Affordable Care Act, Secretary of Health and Human Services Tom Price now finds himself in the ironic position of keeping it alive. Many Republicans are hoping for a smooth transition from Obamacare to whatever the Republicans end up replacing Obamacare with. They believe that stabilizing the individual insurance market is a vital component of this smooth transition. As the HHS head, Price could propose rule changes that would directly affect requirements for coverage, such as preventive services for women. By easing these requirements, Price could alleviate financial burdens for insurance companies, but critics such as Kathleen Sebelius, a former Secretary of HHS, contend that this would have “a huge ramification and impact on women.”
Insurance Companies Loosening Rules for Covering Drug Addiction Treatment
In an attempt to assist doctors in alleviating the problem of opioid addiction, Aetna will stop requiring that doctors must obtain approval before prescribing medications to treat withdrawal symptoms. More than 33,000 people died from opioid overdoses in 2015. This measure is designed to limit delays in getting prescriptions filled. Other insurance companies, such as Anthem and Cigna, had already dropped this required authorization in previous months. Addiction specialists say that the delays and red tape can be dangerous for people. “If someone shows up in your office and says, ‘I’m ready,’ and you can make it happen right then and there ― that’s great. If you say, ‘Come back tomorrow, or Thursday, or next week,’ there’s a good chance they’re not coming back,” says Josiah Rich, a professor of epidemiology at Brown University and a doctor who treats patients with opioid addictions.
News Update for February 20, 2017
Senate Majority Leader: Republicans Aren’t Expecting Any Help from Democrats on Obamacare
Last Friday, Senate Majority Leader Mitch McConnell (R-KY) went on record to say, “It’s clear that in the early months [Obamacare repeal is] going to be a Republicans-only exercise.” McConnell also added that he could see the Democrats entering talks with the GOP later on. The Democrats have not shown much desire to sit down at the table with the Republicans to craft a new agenda. Instead, they’ve pursued a strategy of rallying grassroots supporters of the Affordable Care Act to voice their displeasure and various concerns to the GOP.
Conservatives Stand Firm Against Tax Credits in Obamacare Replacement
Many conservative Republicans are continuing to stand up against the idea of implementing refundable tax credits to help Americans buy insurance coverage as a major part of replacing Obamacare. In a closed-door meeting last week between leading House Republicans and rank-and-file Republicans, House Ways and Means Chairman Kevin Brady presented suggestions that the government could provide refundable tax credits to Americans to help them afford insurance coverage. “I don’t like the refundable tax credit. … This is Obamacare light,” said Rep. Ted Yoho (R-FL). Many conservative Republicans believe that a refundable tax credit system would be a “new entitlement program” and might be easy to defraud. Speaker of the House Paul Ryan has gone on record to approve the idea of refundable health credits.
Possible Republican ACA Replacement Suggests Giving States a “Pot of Cash”
Some House Republicans are suggesting that the federal government should give each state an infusion of funds to spend on whatever they want in order to improve their commercial health insurance systems. This idea is partially based on House Speaker Paul Ryan’s Obamacare replacement proposal, “A Better Way.” Ryan’s proposal would give more autonomy to the states, along with approximately $50 billion (how the $50 billion would be divided amongst the states is currently unclear) to help them subsidize individual coverage users with pre-existing conditions.
Health-Savings Accounts Show Slowed Growth
Many Republicans are rallying around the idea of expanding the system of health savings accounts as a possible partial replacement for the Affordable Care Act health system. A recent report by LifeHealthPro, indicates that the rate of enrollment for HSAs is slowing.
News Update for February 17, 2017
Obamacare Repeal Is “Moving Fast” According to Recent Trump Tweet
In a recent tweet, President Donald Trump has asserted that “despite the long delays by the Democrats in finally approving Dr. Tom Price, the repeal and replacement of Obamacare is moving fast!” Trump had originally campaigned on repealing and replacing the Affordable Care Act. However, he went on record last week to say that the process might take until 2018.
House Republican Leaders Hold Closed-Door Session to Outline Obamacare Repeal with Rank-and-File GOP
In the midst of growing dissension amongst Republicans, House Republican leaders held a closed-door meeting on Thursday to lay out components of a possible Affordable Care Act replacement bill. A policy brief obtained by Morning Consult shows some of the proposals discussed:
- Repealing Medicaid expansion
- Offering tax credits to help people afford insurance that would be age and not income-based.
- Capping tax exclusions offered to employer-sponsored health plans.
Molina Healthcare Inc. Might Pull Out of ACA Exchanges
Molina Healthcare Inc., previously “One of the health insurers that has been happiest with the Affordable Care Act public exchange system,” is weighing an exit from the exchanges for 2018. Molina executives are expressing discontent over what they perceive as the ACA’s inefficient risk-adjustment program. The law’s drafters created the program “to help insurers sell individual and small-group health coverage without knowing anything about the health of the new enrollees” when they first sign up. The program requires insurance companies to give new enrollees a “risk score” after they are enrolled. Insurance companies with healthier-than-average enrollees (as determined by the risk scores) are supposed to send money to insurance companies that have more high-risk enrollees. This would, theoretically, help keep the individual and small-group markets afloat while simultaneously offering coverage to everyone, regardless of pre-existing conditions.
Molina executives contend that the risk-adjustment program “punishes issuers with low premiums, even when those issuers enroll a reasonable number of high-risk enrollees.” Molina insists that it has lost money and is looking to recover some of it from the federal government.
Department of Justice Joins Medicare Fraud Case Against UnitedHealth
UnitedHealth Group is being accused of allowing its subsidiaries and other insurance companies to defraud “Medicare by hundreds of millions – and likely billions – of dollars,” according to a whistleblower lawsuit made public on Thursdaywhen the Department of Justice decided to intervene in the case.
UnitedHealth and the federal government have been opposing one another for years. Last year, UnitedHealth companies sued the Health and Human Services Department over disagreements on how companies should handle overpayments by Medicare. In the same time frame, whistleblowers were continuing to file lawsuits against UnitedHealth subsidiaries, stating that they were overcharging programs. Ongoing whistleblower accusations against UnitedHealth began in 2011.
News Update for February 16, 2017
Insurers Wary as Trump Administration Tries to Keep Them on ACA Exchanges
The Trump administration is going to give insurance companies and states extra time to help them adjust to changes in the Affordable Care Act exchanges. The administration is hoping that this extra time will entice more insurers to stay with the individual market exchanges.
Despite these overtures, insurance companies remain wary. They don’t think that the extra time, nor any of the administration’s other proposed measures, will be enough to stabilize the market. They want the administration to enforce the individual mandate in order to shore up the financial stability of insurance pools with young, healthy enrollees. They also want cost-sharing subsidies to continue. Ceci Connolly, the CEO of the Alliance of Community Health Plans, told Modern Healthcare, “Right now, plans are missing key pieces of information to make smart business decisions for 2018.”
Republicans in Congress Still Talking About Obamacare Repeal Plans
In the midst of divisions appearing between hard-right and moderate Republicans in Congress, House Majority Leader Kevin McCarthy (R-CA) and House committee leaders will be meeting with GOP lawmakers on Thursday morning to discuss specific policy proposals related to Obamacare repeal. According to the Washington Post, a senior aide said that “lawmakers would be presented with a menu of replacement items such as tax credits for purchasing insurance, health savings accounts, ‘high-risk pools’ for the chronically sick, and major Medicaid reforms, as well as potential ways those elements could be passed into law.” Many Republicans are opposed to some aspects of those replacement items.
In opposition to House members looking for immediate repeal, Senator Lamar Alexander (R-TN) has taken up the cause for drafting a gradual reform of the country’s healthcare system.
Health Spending Growth Expected to Slow Over Next Decade Under ACA
The Centers for Medicare and Medicaid Services (CMS) have released data that suggests that the average rate of national health spending will grow by 5.6 percent in the next 8 years. This growth level is slower than the one expected in CMS’s report from July 2016, which had the number at 5.8 percent. This growth in spending projects that healthcare will make up about 19.9 percent of gross domestic product (GDP) in 2025. In 2015, healthcare was 17.8 percent of GDP.
Candidate for Top Medicare Position Under Scrutiny
A debate is currently brewing in regard to Seema Verma, President Donald Trump’s pick to head the Centers for Medicare and Medicaid Services. Her detractors believe that profits from her previous work for SVC Inc., her Indianapolis-based consulting firm, involved multiple conflicts of interest. Verma maintained a “web of business arrangements” while simultaneously acting as an advisor on healthcare issues to Mike Pence, who was Indiana’s governor at the time. Many Democrats have “concerns about her philosophy about government entitlement programs, lack of background in Medicare and inexperience leading a large organization.” Marcus Barlow, Verma’s spokesman, said that Verma and her firm were “completely transparent” and “there was never a conflict of interest.”
News Update for February 15, 2017
Trump Administration Announces New Rules for ACA’s Individual Insurance Exchanges
The Centers for Medicare and Medicaid Services (CMS) has announced new proposed rules for Obamacare’s individual exchanges. These rules, some of which were proposed by the Obama administration, would be the Trump Administration’s first tweaks to Obamacare. According to Patrick Conway, the acting CMS administrator, “This proposal will take steps to stabilize the marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”
Here are some of the proposed rule changes:
- Give insurance providers more time to figure out what to do with their 2018 plans.
- Increase scrutiny of potential enrollees who sign up during special enrollment periods.
- Make beneficiaries pay the premiums they owe before they can get on the next year’s coverage.
Many Republicans Looking to Trump for Guidance on ACA Repeal
As the GOP continues to fight with itself on the particulars of repealing the Affordable Care Act, many of the party’s prominent figures are asking the president for assistance and direction. Senator Lamar Alexander (R-TN), a leading Republican figure supporting simultaneous repeal and replace, said, “It’s hard to see how this gets done unless the president says, ‘OK, let’s do it this way.’” Republican leaders in Congress might be able to formulate a new healthcare bill without the President, but it might require the president to get the rest of Congress in line to vote yes on it. Health and Human Services Secretary Tom Price, who is widely seen of as a proxy for the president, will attend lunch with Senate Republicans today to discuss President Trump’s position on repealing Obamacare.
Humana to Pull Out of Exchanges
Major insurance carrier Humana announced on Tuesday that it is withdrawing from the Affordable Care Act’s individual exchanges for 2018. Many insurance providers are wary of the political and financial uncertainty surrounding the exchanges. Humana’s decision comes after it was announced that the company would no longer attempt a merger with fellow large insurer Aetna. Humana’s exit “‘could be a harbinger of things to come,’ said Sabrina Corlette, a research professor at Georgetown University who studies the health insurance market.”
Cigna and Anthem Clashing in Aftermath of Failed Merger
Long-simmering tensions between insurance carriers Cigna and Anthem have boiled over. After a federal judge struck down the two providers’ attempt at a merger, the two companies have been feuding. Anthem is in the process of appealing the judge’s decision. Cigna is suing Anthem, insisting on a $1.85 billion termination fee and $13 billion in damages “for what it says were Anthem’s breaches of the merger agreement.”
Uninsured Rate Hits Historic Low, But High Deductibles Are Up
The latest numbers from the Centers for Disease Control and Prevention show that only 8.8 percent of Americans were uninsured as of September 2016. This is a new historic low stemming from Obamacare’s attempts to expand insurance coverage.
On the other hand, more insured people are having to pay for their own expenses for healthcare costs as the number of Americans on high deductible plans has also risen. More than 39 percent of Americans under 65 are enrolled in a high deductible plan. Read this article for more information.
News Update for February 14, 2017
Conservative House Members Pledge to Only Support an Aggressive Obamacare Repeal
Throwing a wrench in the GOP’s plans to repeal and replace Obamacare simultaneously, a group of 35-40 House conservatives has come together around a pledge not to approve of any Obamacare replacements that aren’t at least as aggressive as a hardline repeal bill that was passed by Congress in 2015. The 2015 bill repealed Obamacare’s mandates, subsidies, and Medicaid expansion, a popular provision that is supported by many Republican governors. The bill was vetoed by President Obama, but this new group is hoping to bring the bill back for another vote.
Many of these conservatives are not opposed to replacement provisions necessarily, but they “worry that adding them to the reconciliation bill will drag the process out for weeks and months.” More moderate Republicans feel that repealing the bill now and replacing it later would greatly antagonize their relationship with some of their constituents. “If we just passed what we did in 2015? Nobody is seriously proposing that, because it doesn’t have any replacement,” said Senator Lamar Alexander.
Agency Completes Review of Trump’s Unreleased Executive Order for ACA
President Trump’s currently unknown rule to stabilize the individual insurance market, which was proposed a little less than 2 weeks ago, just took one step closer to enactment. The draft for this rule is still not available to the public, but regulatory reviewers from the Office of Management believe that “the order could affect the federal government’s relationship with the states, that it would be a major regulatory action, and that it would be economically significant.”
GOP Talking Points on Healthcare Reform and ACA
Kaiser Health News has released an article today that dives into various Republican talking points about the Affordable Care Act. The article addresses common fears and perceptions about the ACA using testimonials from experts from both sides of the aisle. The talking points consist of the following:
- The individual health insurance market is collapsing.
- Out-of-pocket spending is too high.
- Medicaid patients can’t find doctors to treat them.
- The ACA has reduced jobs.
Insurers Want White House to Keep Individual Mandate and Subsidies
Documents from the White House’s Office of Management and Budget reveal that health insurance industry lobbyists have been talking with the Trump Administration in order to try to convince the administration to keep both the individual mandate and the subsidization of their plans on the Affordable Care Act exchanges. Republicans have expressed hostility toward both. The insurance companies see the mandate and the subsidies as crucial for sustaining their plans financially, at least until a clearer replacement for the ACA emerges. Cori Uccello, a senior health fellow at the American Academy of Actuaries, contends that “cost-sharing reduction subsidies are a big deal” and that if they aren’t paid, the effect of that non-payment could result in insurers weakening some of the popular perks of the ACA in order to retain profitability. These perks include:
- Keeping the age band rating low so that older people don’t have to pay so much more than younger people in order to receive coverage.
- Special enrollment periods.
- Three-month grace periods for nonpayment of premiums.