News Update for January 23, 2017
Trump Signs Executive Order to Scale Back the Healthcare Law
- Hours after taking office on Friday, President Donald Trump signed an executive order that authorizes certain federal agencies to lessen the fiscal and regulatory burdens brought on by the Patient Protection and Affordable Care Act (PPACA). The order also mentions that the Trump administration is doing work to repeal the PPACA. This executive order will affect “….individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products or medications.”
- Trump’s executive order didn’t target any specific parts of the healthcare law. “But its broad language gave federal agencies wide latitude to change, delay or waive provisions of the law that they deemed overly costly for insurers, drug makers, doctors, patients or states.”
- Kaiser Health News reported that because there are no appointees in place for the agencies that the order would affect, it’s unlikely that any changes will take place very quickly.
Trump’s Executive Order May Weaken Key ACA Mandates
- Healthcare industry experts think that the executive order could allow the Trump administration to put forth less enforcement of the individual mandate to buy health insurance, as well as the mandate that companies of certain sizes must offer coverage. “The administration could also alter, or fail to enforce, requirements that insurers cover a basic set of health benefits in all of their plans, from maternity and newborn care to mental health services.”
- One healthcare expert and critic of Obamacare called Trump’s executive order a “bomb” in the “already shaky” health insurance market. Robert Laszewski also said, “Instead of sending a signal that there’s going to be an orderly transition, they’ve sent a signal that it’s going to be a disorderly transition.”
- President Trump’s senior adviser Kellyanne Conway said about the individual mandate in a Sunday interview with ABC News’s “This Week,” “What President Trump is doing is, he wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans, to have to pay a penalty for not buying government-run health insurance.” You can read more about the interview here.
Republican Senators Introduced Obamacare Replacement Bill
On Monday, Senators Susan Collins (R-ME) and Bill Cassidy (R-LA) introduced a bill that is centered on giving states the choice to decide if they want to keep Obamacare. The senators are calling the bill an “Obamacare replacement plan.” But it’s not for certain whether or not the bill will gain support from Republican leaders. “We recognize that our bill is not perfect. It is still a work in progress. I expect that we will get many ideas from my colleagues for further refinements and we are completely open to that,” Collins said. “But if we do not start putting specific legislation on the table that can be debated, refined, amended and enacted, then we will fail the American people.”
How Obamacare Has Helped Women and What a Repeal Could Change
The uninsured rate for American women before the Affordable Care Act was fully implemented in 2013 was at 18 percent compared to 11 percent today. Pre-ACA laws also allowed insurance companies to charge women more for coverage. “This ‘gender rating’—which the ACA made illegal—is estimated to have cost women approximately $1 billion a year. This inequity is particularly troubling when considering women on average are paid and save less, and therefore have less disposable income to spend on health coverage and care.”
News Update for January 19, 2017
Republicans in Congress are considering the idea of automatically enrolling everyone in coverage unless they choose to opt out. This auto-enrollment idea has been presented before in some of the top Obamacare replacement proposals. But there is no agreement among Republicans as of yet about implementing this idea. A senior GOP aide said, “There’s a lot of work being done to look into it.”
Representative Greg Walden (R-OR), who has been a longtime opponent of Obamacare, is now the Chairman of the Energy and Commerce Committee, which oversees healthcare policy. In an interview with Politico, Walden said his plan is to “repair” and “rebuild” the healthcare law—a softer approach than that of some of his fellow Republicans who emphasize “replacement” of the law. “Walden insists that any replacement plan for Obamacare won’t be ‘preordained’ by GOP leaders. Rather, he said he intends to solicit ideas from colleagues on both sides of the aisle and is already in touch with governors and those in the health care market.”
Governor Scott Walker of Wisconsin wants each state to be in control of the Obamacare replacement process. Walker told CNBC’s “Squawk Box”: “We’re one of the best states in the nation in terms of coverage. We have one foundation called No Insurance Gap, and we didn’t take the Obamacare Medicaid expansion, we didn’t set up a state exchange, yet we have one of the lowest rates of uninsured in the country.” He also added, “We can do it elsewhere as well. Just give us the flexibility to do it state by state.”
In an interview with CNBC’s “Squawk Box” on Thursday, Senator Ron Johnson (R-WI) said that Republicans will need help from Democrats to fix the healthcare law. “My thought process is let’s start working with Democrats, let’s transition to a system that’ll actually work that Democrats are talking about. They want to fix it, let’s fix it for the benefit of the American public,” Johnson said.
In a courtesy hearing before the Senate Health, Education, Labor and Pensions Committee on Wednesday, Trump’s nominee for secretary of the Department of Health & Human Services, Tom Price (R-GA), said he wants every American to have access to health insurance. However, Price didn’t say the same thing as Trump concerning “insurance for everyone.” “During Wednesday’s hearing, Price also insisted his ideas for replacement would put patients at the center of their care by providing them with more choices and fewer mandates.”
On Wednesday, Mike Pence said that the replacement for Obamacare will “make health insurance affordable for everyone.” “Pence promised an ‘orderly transition out of Obamacare’… and said that the incoming administration is ‘very close’ to completing a plan with Congressional leadership.”
News Update for January 18, 2017
Senator Bill Cassidy (R-LA) proposed to Democrats that states can keep the health law if they like it, get rid of it, or transition to a replacement system using health savings accounts (HSAs) and automatic health insurance enrollment. Cassidy commented, “You can go to the reddest state and say we have the option to root and branch it, and you can go to the bluest state and say we have the option to keep what we like.” With Cassidy’s plan, “Republicans say, ‘You have the option to keep your plan,’ and we mean it.”
Senator Susan Collins (R-ME) and Senator Bill Cassidy (R-LA) will be introducing legislation for replacing Obamacare to lawmakers on Monday. “The Cassidy-Collins plan comes after congressional Republicans voted last week to lay the groundwork for ObamaCare repeal by passing a budget resolution that includes rules for repeal.”
On Tuesday, the nonpartisan Congressional Budget Office along with Congress’ Joint Committee on Taxation issued a report, which claims that health insurance premiums would increase for millions of people and 18 million more would become uninsured in one year if most of the healthcare law is repealed without a replacement. The budget committees reviewed a Republican bill – which was vetoed by President Obama last January – that proposed getting rid of federal subsidies, Medicaid expansion, and tax penalties for people who don’t buy insurance and for large employers that don’t offer coverage. If Republicans pass a new health law that gets rid of these provisions, individual insurance premiums (excluding employer-sponsored coverage) would go up by 25 percent after the first year of passage and double by 2026. In addition, the uninsured rate would jump to 32 million over the next 10 years.
News Update for January 17, 2017
Certain provisions in the Affordable Care Act (ACA) that apply to individual health and small employer plans also apply to large employer group plans. For example, the ACA mandated that all health plans must meet a minimum value of coverage. Because of this provision, “large employers generally no longer offer so-called ‘mini-med’ policies with very skimpy benefits.” Another provision that may affect large employer group plans is the ACA’s “no waiting period” mandate, which ensured that employers can no longer let new employees wait to enroll in health benefits for more 90 days.
House Speaker Paul Ryan and President-elect Donald Trump may go head-to-head over their views on Medicare reform. Ryan wants reform for entitlement benefits like Medicare and wants to turn Medicare into a voucher program. However, Trump said during his campaign that he doesn’t want entitlement reform. “But if Ryan sides with Trump and doesn’t include his proposal to turn Medicare into a voucher program in the budget, it may never pass.”
Sean Spicer, incoming White House press secretary, said in an interview with NBC’s “Today Show” that Trump’s plan is “to get insurance for everybody through marketplace solutions, through bringing costs down, through negotiating with pharmaceutical companies, [and] allowing competition over state lines.” Concerning an expansion of government healthcare, Spicer commented that there would be improvements on access to healthcare and costs would go down through marketplace competition.
Trump said over the weekend that he wants “insurance for everybody.” But Trump’s vision for healthcare not only differs from that of his own party, but it also seems to be different from that of his pick for Health and Human Services Secretary, Tom Price. Price’s conservative proposal for healthcare favors a complete overhaul of the current system and doesn’t include universal coverage for everyone. With opposing ideas from Trump and Price, Republican lawmakers aren’t sure how to proceed with drafting a replacement plan.
Despite the pending repeal of the healthcare law by Republicans, survey results show that Obamacare is growing in popularity. “And half of Americans—50 percent—say they have little to no confidence that Republican proposals to replace the law will make things better.” The survey also found that 45 percent of people think the healthcare law is a good idea while 41 percent thinks it’s a bad idea.
News Update for January 16, 2017
Senator Rand Paul (R-KY) said he’s writing legislation to replace Obamacare, which includes making the sale of limited-coverage insurance policies legal. In a CNN “State of Union” interview on Sunday, Paul said, “That means getting rid of the Obamacare mandates on what you can buy.” Paul also talked about small businesses being able to join together to better negotiate health insurance prices.
Regarding an interview that President-elect Donald Trump did over the weekend, the Washington Post writes, “We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.” Health insurance for everyone is known as universal healthcare, which has not been a part of the Republicans’ healthcare reform plans.
The House approved the Republicans’ budget resolution measure on Friday with a vote of 227 to 198. This approval prevents Democrats from using a Senate filibuster to stop the repeal-and-replace process. With the budget resolution now approved by both the House and Senate, the next step for Republicans is to decide which parts of the healthcare law to reform.
Senate Leader Chuck Schumer (D-NY) warned Republicans that Democrats will not help them if they repeal Obamacare without first implementing a replacement plan. Schumer reported that he would work with Republicans to improve Obamacare or create reform bills, but only under certain conditions. “So long as it covers as many people as the ACA, so long as it helps bring healthcare costs down, so long as it doesn’t move our healthcare system backward,” he said.
Senate Finance Committee Chair, Orrin Hatch (R-UT), and House Energy & Commerce Committee Chair, Greg Walden (R-OR), sent a letter to the Medicaid and CHIP Payment and Access Commission (MACPAC) asking for a report that would help them find ways to cut spending for optional benefits and eligibility groups under Medicaid. “They gave MACPAC until Jan. 25 to outline what it would take to create such a report. A spokeswoman for MACPAC confirmed receipt of the letter and said it will respond by the deadline.”
News Update for January 13, 2017
Lawmakers in the House of Representatives are expected to give a final vote on approving the Republicans’ budget resolution measure today. But Rep. Andy Harris of Maryland, a member of the conservative House Freedom Caucus said, “We’d like to see a little more flesh on the bone before we sign on the dotted line.”
Members of the House Liberty Caucus want House lawmakers to reject the budget resolution that passed in the Senate on Thursday. “‘This may be the worst budget ever seriously considered by Congress,’ said caucus Executive Director Matt Weibel, in a statement announcing the recommendation. ‘It never balances, and it grows the national debt by more than $9 trillion over the next decade—to nearly $30 trillion—dwarfing debt increases proposed by even the most far-left budgets.’”
Republican governors whose states have benefited from Obamacare are at odds with their fellow Republicans in Congress over the health law. These governors could have some influence over how the House will vote on the budget resolution. Tommy Thompson, a former governor of Wisconsin and a former secretary of the Department of Health and Human Services said, “They will have a much more or a substantial influence on things like Medicaid.”
Some policy experts think that Republicans are at risk of causing a meltdown of the insurance market and 30 million people to lose coverage if they repeal the healthcare law without an immediate replacement system. But some healthcare industry leaders think a market crash may not happen because they feel like Republican lawmakers are listening to their proposals on how to smoothly transition through the repeal-and-replace process to avoid a crash.
Senate Republicans voted against legislation that would keep certain parts of Obamacare intact, including the provision allowing young adults to stay on their parents’ health plan up to age 26. But some insiders feel that this topic will come up again when it comes time to draft a replacement healthcare law. Health policy expert Joe Antos thinks this provision will remain under the new administration because Trump has said he wants to keep this part of the law, and proposals from several Republicans support keeping the up-to-26 provision.
Kaiser Health News reported on what they call “health law sleepers.” These are parts of the health law that you may not be aware of that could go away under a repeal. These include:
- Calorie counts at restaurants and fast food chains
- Workplace requirements for breast-feeding rooms
- Limits on surprise medical costs from hospital emergency visits
- Non-profit hospitals’ community health assessments
- A women’s right to choose her own OB/GYN
- Therapy coverage assurances for families who have kids with autism
News Update for January 12, 2017
Republicans Are One Step Ahead in Repealing Obamacare
- The Republicans’ budget resolution measure to start the process of repealing Obamacare was approved in the Senate on Thursday with a simple majority vote of 51 to 48. This puts Republicans one step ahead for the next voting session, which is expected to take place among House members this Friday. “We must act quickly to bring relief to the American people,” said Senate Majority Leader Mitch McConnell (R-KY).
- The approval of the budget resolution involved voting on 19 of its amendments. Senators began voting about 6:30 p.m. on Wednesday and ended around 1:30 a.m. on Thursday.
- The passing of the bill came with much protest from Democrats on the Senate floor. “One by one, Democrats rose to voice their objections. Senator Maria Cantwell of Washington said that Republicans were ‘stealing health care from Americans.’ Senator Ron Wyden of Oregon said he was voting no ‘because health care should not just be for the healthy and wealthy.’” Senator Cory Gardner (R-CO), who presided over the voting, had to bang his gavel several times to tell Democrats they were out of order. “Debate is not allowed during a vote,” he said. The passing of the budget resolution is more of a procedural step that the Republicans need to introduce a special type of legislation known as a reconciliation bill, which will allow them to repeal major parts of Obamacare. You can read more here.
Republican Senator Says the Party Doesn’t Have Total Agreement on Obamacare
“Sen. Ron Johnson said Thursday he ‘will freely admit that Republicans in the House and Senate don’t have total agreement’ on an Obamacare replacement plan despite a late-night budget move to begin repealing the law.” The Republican senator from Wisconsin also said, “I don’t think you’re going to see one massive plan like Obamacare. You’re going to see a step-by-step approach targeting the individual damage of the individual reforms, and we’ll put in replacements for each individual one of those problems. Anyway, that would be my approach. Other people have different ideas.”
Largest U.S. Lobby Group Weighs in on Obamacare Repeal
The U.S. Chamber of Commerce, which is the country’s largest business lobby group, said on Wednesday that quickly repealing Obamacare without having a replacement plan could be a mistake. The group also appealed to the incoming Trump administration to not put up trade barriers. “As a new healthcare plan takes shape, it’s important to remember things were far from perfect before we started, before Obamacare,” Chamber President Tom Donohue said in his annual address outlining the group’s priorities. “Repeal alone is not going to fix our health care, there should be a smooth transition.” You can get more details on the lobby group’s views here.