News Update for January 31, 2017
Today Is the Last Day of Open Enrollment
Despite efforts to repeal the Affordable Care Act, enrollment on government exchanges continues. “Our volume has been the same as it has been in past years,” says Katie Nicol, a senior manager of 5 insurance navigators. Today is the last chance to sign up for Obamacare, unless you are eligible for a special enrollment period because of a qualifying life event.
New Executive Order Excites Some in Healthcare Industry
President Trump’s new executive order requiring executive departments and agencies to remove two regulations for every new regulation issued “could have major ramifications for healthcare, one of the most regulated industries in the U.S. economy.” However, some experts are unsure how workable the order is.
Short-Term Insurance Could See Growth If Parts of ACA Are Repealed
Short-term insurance plans, which are much less strictly regulated by the Affordable Care Act, could see a surge in popularity if certain provisions of the ACA are removed. These plans are much cheaper than ACA-compliant plans because they don’t need to cover many of the things that ACA-compliant plans are required to cover.
Efforts to Repeal ACA, Piece by Piece, Continue
Even though many conservatives feel that the GOP is losing momentum on the repeal of the Affordable Care Act, Republicans in Congress are moving forward with various strategies to repeal and replace the law.
- Some congressional Republicans are considering using the Congressional Review Act, an obscure law passed in 1996 that “enables Congress to overrule regulations issued by the executive branch through straight-majority votes,” to repeal regulations issued by the Obama administration. Read this for more information on this strategy.
- House Republicans have filed four separate bills to try to stabilize the individual insurance market while they work on repealing and replacing the ACA.
- One bill would give insurance companies more flexibility to charge older consumers 5 times more than younger consumers. The current limit is 3 times more. This could attract more consumers who are healthier and result in lower premiums, but it might make it harder for older people to afford coverage.
- Special enrollment periods allow people who have undergone certain hardships or life changes to obtain insurance outside of the normal enrollment period. The second bill would require the Department of Health and Human Services “to more rigorously verify that people meet the requirements for special enrollment, including job loss or divorce.”
- The third bill requires that insurers on the government exchange can only cancel a consumer’s coverage after 90 days of non-payment. This is designed to prevent consumers from signing up for insurance, getting medical services only in the first 3 months, and then immediately canceling their coverage.
- The last bill is a statement of policy that simply reiterates that Congress will not allow Americans to face denials of coverage due to pre-existing conditions.
- The Obama administration’s final Medicaid spending report might help the GOP justify Medicaid cuts, especially because the Medicaid expenses that are projected to steadily grow could “displace spending on other important programs.”
Democrats Boycott Confirmation Hearing for Secretary of HHS
In light of the news that President Trump’s nominee for Secretary of Health and Human Services, Representative Tom Price (R-GA), might have contradicted his testimony from last week about his trading of medical stocks, Senate Democrats are boycotting Price’s nomination in an attempt to delay it. The Democrats are pushing for ethics investigations before a vote can occur. Price is expected to eventually be confirmed.
News Update for January 30, 2017
Experts Say People Should Sign Up for Health Coverage Anyway, Despite Possibility of Repeal
Although Republicans still haven’t come to a consensus on the repeal and replacement of the Affordable Care Act, many experts are advising that consumers should continue to enroll in marketplace coverage. Policy experts and consumer advocates are saying there are many subsidies to help low-income consumers and, though the fate of the ACA is unclear, it is unlikely that Congress and/or the Trump Administration will be able to enact any sweeping changes that would deny coverage to a consumer who has already purchased a plan on the marketplace. “If people need coverage now, they should get it,” said Karen Pollitz, a senior fellow with the Kaiser Family Foundation.
ACA Repeal Threatens Loss of Services for Many
- The Affordable Care Act increased coverage for a variety of preventive services, such as cancer screenings, to seniors on Medicare. Nengliang Yao, an assistant professor of public health at the University of Virginia, said that “about 8,400 people had their colorectal cancer detected at an early stage” due to the ACA’s provisions to extend coverage for these services. According to Yao, these early detections are crucial for increasing a senior’s chances of survival. Many experts are worried that this part of the law will be removed.
- According to a new study by the Urban Institute, the repeal of the ACA, along with a likely elimination of funding for Medicaid expansion, could end up being particularly costly to hospitals that treat gunshot victims. According to Modern Healthcare, the study found that “early Medicaid expansion adopters such as Kentucky saw uncompensated care for gun victims fall from 54% in 2010 to 13% in 2014, with Medicaid accounting for 68% of coverage.” States that did not expand coverage had relatively unchanged percentages for uncompensated care costs for gunshot victims. The study indicates that Medicaid reduction would likely shift the cost onto the victims, hospitals, and private payers who would have to pay higher rates to cover the uncompensated care costs.
Small Businesses Are Looking to Help Reshape the ACA
A new survey released by the Women’s Business Development Center and the nonprofit Health & Disability Advocatesfinds that many small businesses, particularly ones that are mostly owned, managed, or controlled by women, support changes to the Affordable Care Act. Most of the small businesses responded that costs are the main reason why coverage isn’t offered to their employees. However, these businesses support many of the provisions under the ACA, particularly the ones requiring insurers to cover pre-existing conditions. Emilia DiMenco, the president and CEO of the Women’s Business Development Center, said that the lack of affordable health insurance “could discourage the formation of businesses, which would have a significant impact on our economy.”
Approval Ratings for the ACA Are on the Rise
A poll released today by Morning Consult/Politico shows that more registered voters now approve of the Affordable Care Act. The approval rating for the law went up from 41 percent to 47 percent in the time span from the beginning of January to just after President Donald Trump’s inauguration. The disapproval rating dropped from 52 percent to 45 percent. Experts such as Paul Ginsburg, director of the Center for Health Policy at the Brookings think tank, believe that “[t]he enormous attention to repeal and replace likely has substantially increased knowledge about the ACA and many of the impressions [are] positive.” Others, such as Thomas Miller, a health policy expert at the American Enterprise Institute, believe that people’s opinions have changed because “coverage about the health care law had transformed since early January, focusing more on instability and the issues facing Republican repeal plans rather than on earlier problems with the ACA itself.”
News Update for January 27, 2017
Trump Administration Issues Order to Stop Advertisements for Healthcare.gov Open Enrollment
- The Trump administration issued a directive on Thursday toscale back advertising for the final days of Healthcare.gov’s open enrollment period, which ends on Jan 31. The Department of Health and Human Services, which has already spent $60 million this year on open enrollment advertising under the Obama administration, responded to the directive by withdrawing around $5 million in ad funding to help cut costs. Kevin Counihan, former CEO of Healthcare.gov, called the move from the Trump administration “outrageous” because it could prevent young, healthy individuals from being a part of the insurance pool; if they aren’t part of the pool, it could increase the cost of coverage. “We know that more young people enroll during the final days of open enrollment, but they need to be reminded of the Jan. 31 deadline,” Counihan said.
- Previous years’ open enrollment has shown that alarge number of people sign up for coverage right before the deadline. To take advantage of this, Healthcare.gov has continued to send emails to promote sign-ups.
5 State Exchange Leaders Share Their Concerns on the ACA
Eleven states and Washington D.C. use their own state exchanges to sell individual health insurance plans instead of going through Healthcare.gov. Executives of 5 state exchange companies share their concerns on the future of the Affordable Care Act (ACA), which are published in this Kaiser Health News article.
- Executive Director Peter Lee of Covered Californiasays, “I do think we have a number of the ingredients of [how to] make the individual market work. And we want to take those lessons to members of Congress and to policy leaders.”
- Executive Director Donna Frescatore of NY State of Healthdoesn’t want the cost of coverage for New Yorkers to go back to pre-ACA days of $1,000 a month. Kaiser Health News writes, “Without financial support from the federal government, premiums may increase. Options may become reminiscent of health insurance plans as they were in pre-health-law New York.”
- CEO Jim Wadleigh of Access Health in Connecticutwants his board to approve stronger enforcement of special enrollment periods. “What the carriers are telling us is, these customers are coming in… finding a reason that they have a life event because they’re sick, get services and then drop out.” Wadleigh added, “If we can do a better job enforcing the special enrollment, we think we can reduce the premiums by potentially 6 to 10 percent.”
- Executive Director Louis Gutierrez of Massachusetts Health Connectorreported that he’s unable to guarantee whether the 240,000 enrollees in his state exchange would have coverage through the remainder of 2017. “‘I don’t want to be in the business of speculating or making commitments about things I can’t personally control,’ Gutierrez said, adding, ‘I don’t think any of us really know’ what’s going to happen with the repeal of the ACA.”
- CEO Kevin Patterson of Connect for Health Coloradoreported that, “Enrollment numbers for 2017 are running 15 percent ahead of last year. ‘I think we’re feeling like things are going really well,’ he said. But two things are clouding its future – first, the new Trump administration and Congressional Republicans vowing to undo Obamacare.”
Republicans Leaders at the Party’s Retreat Still Searching for Agreement on Health Law
Republican leaders wrapped up day 2 of their 3-day policy retreat in Philadelphia on Thursday, but have still not reached an agreement on the specifics of reforming the health law. They did, however, seem to agree on a plan to reform the health law by this summer. House Speaker Paul Ryan (R-WI) said at the retreat, “We don’t want to set arbitrary deadlines on things. We want to move quickly, but we want to get things right.”
The Cadillac Tax May Shape ACA Repeal
“Edward Fensholt, a lawyer who tracks the ACA for Kansas City, Missouri-based Lockton Companies, said today in an email interview that the group health tax exclusion is in trouble because cutting it would be a way to free up the federal budget power to pay for repealing ACA revenue-raising provisions,” writes LifeHealthPRO. “What we hear most often is that the exclusion needs to be at least partially rolled back to pay for the lost revenue when the ACA’s Cadillac [plan] tax is repealed,” Fensholt said.
Rand Paul Introduced Obamacare Replacement Bill
On Wednesday, Senator Rand Paul (R-KY) introduced a bill to replace Obamacare as a way to get Republicans to act more quickly in creating an alternative. “There is no excuse for waiting to craft an alternative until after we repeal Obamacare, and the Obamacare Replacement Act charts a new path forward that will insure the most people possible at the lowest price,” Paul said in a statement.
News Update for January 26, 2017
Republican Leaders Meet for Annual Policy Retreat
- Congressional Republicans met in Philadelphia on Wednesday for their annual policy retreat, which was led by House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY). Topics discussed include repealing major parts of the healthcare law and replacing it with alternatives, and passing new legislation to amend the tax code by August.
- President Trump, who attended the retreat on Thursday, commented that he wanted to wait a while before getting rid of Obamacare but changed his mind. He told lawmakers at the retreat, “It’s a disaster. I actually talked with Paul and the group about just doing nothing for two years and the Dems would come begging to do something. … We have to take care of the American people so we can’t wait.” You can read more of Trump’s comments here.
- Chairwoman Diane Black of the House Budget Committee told reporters at the retreat that the House will start drafting a bill to repeal Obamacare over the next 2 weeks, and that the bill will then go the floor between late February and early March.
- President Trump’s recent statement that he plans to send his own Obamacare replacement plan to Congress was also a hot issue at the retreat. Some Republicans worry that if the executive branch writes legislation instead of Congress, it may cause conflict with the separation of powers. Others say they would support Trump’s healthcare plan even if it clashes with their own ideas because it would at least make priorities more clear given that there are several Republican healthcare proposals.
- Concerning Trump’s executive order that seeks to minimize the economic and regulatory impact of Obamacare, lawmakers at the retreat said they didn’t review the executive order before it was signed, so they don’t know if any of its directives would be in contradiction with current laws. “Critics are questioning whether the documents are being rushed through without the necessary review from agency experts and lawmakers who will bear the burden of actually carrying them out,” says the Politico article.
California’s Democratic Governor Says He Will Protect State’s Healthcare
On Tuesday, Governor Jerry Brown (D-CA) delivered a speech at his annual State of the State address in which he promised to protect the benefits that Californians have gained under Obamacare from Republicans in Congress who want to scale back benefits. Brown told state legislators and appointees at the event, “More than any other state, California has embraced the Affordable Care Act. I intend to join with other Governors and Senators, and with you, to do everything we can to protect the health care of our people.” Brown’s speech also called for cooperation between the two political parties, which was well-received by some state Republicans.
How Primary Care Doctors Feel About Obamacare
Among primary care physicians (PCPs) who participated in a post-election survey that was conducted from December 2016 to January 2017, 73.8 percent support making changes to the health law while 15.1 percent want the law repealed completely. Responses also differed by political affiliation—no Democratic PCPs were in favor of a repeal while 32.4 percent of Republican PCPs support repeal. Among those who voted for President Trump, 37.9 percent want full repeal. This Los Angeles Times article provides an overview of the survey.
Actuaries Present 5 ACA Solutions
Actuaries from the Individual and Small Group Markets Committee, which is a branch of Washington D.C.’s American Academy of Actuaries, came up with 5 ways to reform the Affordable Care Act.
- “Spend more government money on subsidies”
- “Shorten the open enrollment period”
- “Add barer-bones ‘copper’ level plans”
- “Let insurers widen the gap between what the youngest and oldest enrollees pay”
- “Set up high-risk pools for people with health problems”
News Update for January 25, 2017
Health Insurance Companies Are Quietly Working to Have Their Say in Obamacare Replacement
In the wake of Republicans repealing Obamacare and coming up with a replacement solution, some of the leading health insurance companies are pushing for Republican lawmakers to make changes like implementing stricter enforcement on eligibility for individual plans and giving states more control over insurance. Although, the insurance companies stressed that government subsidies for low-income people should remain intact. You can read more in this Reuters article.
Trump’s Nominees for Head of HHS and Budget Departments Have Confirmation Hearings
- The Senate Finance Committee held a confirmation hearing on Tuesday for Rep. Tom Price (R-GA), Trump’s nominee for Department for Health and Human Services (HHS) secretary. Democrats questioned Price about how he would lead the healthcare system, but he gave them few details. For example, Price didn’t provide any clear answers about the possible effects of Trump’s executive order to give federal agencies the power to weaken certain aspects of the healthcare law. He also avoided answering whether or not the Trump administration would stop enforcing the individual mandate before coming up with a replacement plan.
- Despite Democrats’ frustration with Price’s lack of detail, “Senate Finance Committee Chairman Orrin Hatch, R-Utah, praised Price and said he’ll schedule a committee vote on sending Price’s nomination to the full Senate as quickly as possible.”
- Mick Mulvaney (R-SC), whom Trump picked to lead the White House budget office, said at his confirmation hearing on Tuesday that changes need to be made to Medicaid, Medicare, and Social Security. Mulvaney said during the hearing that he doesn’t want to cut benefits for people already in these programs. “But, he added, younger workers should expect to work longer than their parents. He also said Medicare should be means-tested, which means benefits would be limited for wealthy retirees. They already pay higher premiums.”
Healthcare Expert Proposes 6 Alternatives to Replace the ACA’s Individual Mandate
Thomas Miller, senior fellow at the American Enterprise Institute based in Washington D.C., met with the House Ways & Means oversight subcommittee to discuss why the individual mandate isn’t working and why it needs to be replaced. Miller referenced research from economist Jonathan Gruber, who found that the mandate’s penalty contributed very little to the number of people with health insurance in 2014. Miller proposed 6 alternatives to the Affordable Care Act’s individual mandate, which you can find in this LifeHealthPRO article.
Trump’s Executive Order Probably Won’t Be Implemented Soon
According to Joe Antos of American Enterprise Institute (a Conservative organization), implementing Trump’s executive order will likely be met with little effort in the short term because key members of the Trump administration are not yet installed. “‘They need their appointees,’ said Antos. Until more Trump personnel actually start work, he added, ‘I don’t think they’re going to be able to do much.’” Among the key appointees who are going through difficult Senate confirmation hearings include the secretaries for the HHS, Labor, and Treasury departments.
News Update for January 24, 2017
Trump’s Executive Order May Throw Curveball in Obamacare Open Enrollment
- With President Trump issuing an executive order that could dismantle certain parts of healthcare law, thousands of Americans are contacting Obamacare call centers to find out if they can still sign up for coverage before the January 31 open enrollment deadline. “In a normal year, you would see really strong demand Monday and Tuesday,” said Michael Z. Stahl, senior vice president at HealthMarkets, a health insurance agency that is licensed in all 50 states. “But we’ve got a new administration that has thrown a curveball in all this.” Read more about what Stahl and other health insurance executives have to say in this Politico article.
- Outreach workers in Washington D.C. are rushing to sign up millennials for coverage before January 31 in the wake of the Republicans’ repeal efforts and Trump’s executive order. “‘When we talk to folks, some say they want to make sure they have a policy in place,’ before it’s too late, said Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority.” Kofman also reported that 41 percent of new Obamacare enrollees in D.C. are “ages 26 to 34.”
Ryan Says Obamacare Is in a ‘Death Spiral’
House Speaker Paul Ryan (R-WI) and other Republicans are saying that Obamacare is in a “death spiral” and is about to collapse. This month at a press conference Ryan said, “You have to remember the law is in what the actuaries tell us [is] a death spiral. So we’ve got to intervene to prevent this from getting worse.” Despite Ryan’s comments, non-partisan groups like the American Academy of Actuaries say that there hasn’t been any evidence of a “death spiral” or collapse of the healthcare law.
Some Calling for Repeal of Certain ACA Laws While Others Are Bracing for Repeal Consequences
- Healthcare industry groups are lobbying for a quick repeal of taxes and spending cuts under the Affordable Care Act (ACA). ACA taxes were used to finance things like premium subsidies, Medicaid expansion, and Medicare benefit enhancements. “But now insurers, hospitals and other stakeholder groups are loudly demanding elimination of those financing measures as part of the law’s repeal.” The ACA implemented a tax on health plans, which is set to go into effect in 2018. But lobby groups want to get rid of this tax as a way to reduce premiums.
- Pennsylvania officials are bracing for what they call “disastrous” consequences if the ACA’s funding for Medicaid expansion is repealed, which includes loss of coverage for over 670,000 residents who mostly reside in “poor and rural areas.” “There would be no way for the state to continue to provide health care for those folks,” Ted Dallas, secretary of the state’s Department of Human Services, said just before a Capitol rally on keeping the law’s funding intact. The Pittsburgh Post-Gazette also reported that “the state’s deficit could grow by another $1.4 billion, in part because the state would once again have to pick up the tab for several health care programs that the ACA now pays for.”
Impact of Obamacare on Certain Patient Groups
- Coal miners benefit from a special provision included in the ACA that makes it easier for them to get benefits to treat black lung disease. The ACA also shifted the burden of proof onto coal mining companies—meaning the companies must show that mining didn’t cause miners’ black lung disease, rather than miners having to prove that it did.
- On Monday, the Annals of Internal Medicine published research, which found that insurance coverage “increased by about 5 percentage points — around 4 million people — in 2014” among Americans with chronic illnesses. But the study also suggests that the ACA fell short in being able to guarantee that people with chronic conditions have access to see doctors, get medical treatment, and buy affordable medications. “The study is the first to examine how the health law affected people with these long-term diseases, which require careful and continuous management, and whose treatment drives a vast majority of the nation’s health care costs.” This article from Kaiser Health News has more details on the research study.