News Update for February 13, 2017
Unable to Kill ACA, Republicans Are Temporarily Strengthening It Instead
Even though they’ve been railing against the Affordable Care Act for years, the GOP is currently seeking to keep the health insurance marketplaces afloat. Many Republicans believe Obamacare is economically unsustainable, but its influence and scope are such that Republicans don’t want to take the chance of dismantling it recklessly, to the detriment of both their constituents and their political careers. In the meantime, both the Trump administration and House Republicans are proposing regulations, drafting legislation, and appropriating funds to keep insurance premiums lower so that the insurance marketplaces will have enough money to operate. Many Republicans, including some who are in support of this temporary policy, are opposed to propping up the exchanges at all, so this temporary solution is a bit of a contentious issue for the GOP right now and it could possibly become more contentious as time goes on. “How far do you go with short-term fixes, which could make the law work better in the long term? It’s a delicate political dance,” said Joel L. Michaels, a health lawyer at the firm McDermott Will & Emery.
Proposed Replacement for ACA’s Tax on Employer Health Plans Drawing Criticism
The Affordable Care Act’s “Cadillac tax,” which would tax employer health plans that have a value over a certain threshold, is one of the ACA’s most unpopular policies for employers and unions. However, Republicans are also hearing much criticism for their proposed replacement. Parts of the law have been tweaked since the ACA was first passed, so the Cadillac tax would not take effect until 2020. The tax was designed to disincentivize “overly generous health plans with high usage of costly care” by placing a 40% levy on health plans that cost over a certain amount.
In the meantime, Republicans have introduced a measure that would cap the amount that an employer-based health plan could be shielded from taxes. “In the end, [both proposals] would have similar effects,” said Steve Wojcik, an official with the National Business Group on Health, an organization that represents employers.
Organizers, Citizens Banding Together in Opposition to Obamacare Repeal
In town halls throughout the country, citizens are confronting their lawmakers with questions about the Affordable Care Act. Many of them are worried about losing coverage for themselves, their friends, and their families. Senators Charles Schumer (D-NY) and Bernie Sanders (I-VT) have also called for nationwide rallies in support of the law. These planned rallies will take place on Saturday, February 25.
Hearing Scheduled for Next ACA Boss Coming Up Soon
The Senate will be holding a hearing for Seema Verma, an Indiana health policy consultant, this Thursday morning. Verma is President Trump’s pick for the head of the Centers for Medicare & Medicaid Services (CMS). As the head of CMS, Verma will be directly overseeing Medicare, Medicaid, and the Affordable Care Act’s exchange system. Verma is known for her support for the expansion of health savings accounts (HSAs), including a variant of HSAs designed for lower-income people. You can read more here.
Failed Health Insurance Mergers Cost Major Insurers $1.5 Billion
Aetna’s attempt to merge with Humana and Anthem’s attempt to merge with Cigna were both shot down for antitrust reasons in the past few weeks. The four companies spent a total of $1.5 billion on legal and financial costs in their attempts at their respective mergers. These deals are estimated to have cost their investors and consumers money as well. Anthem, which has spent about $424.1 million, will continue to spend more because it is appealing the court’s decision.
News Update for February 10, 2017
12.2 Million Have Signed Up for Insurance Through ACA
Around 12.2 million people have signed up for insurance through the Affordable Care Act exchanges for 2017. Earlier this week, it was reported that 9.2 million signed up, but this was excluding the state exchanges. The 12.2 million figure is lower than the 13.8 million hoped for by the Obama Administration and it is expected that 20 percent of the current enrollees will drop out as the year goes on.
Senate Confirms Tom Price as New Secretary of HHS
With a 52 to 47 vote, the Senate confirmed Representative Tom Price as the new Secretary of Health and Human Services earlier today. No senators broke from their respective parties. Price is known for his longstanding efforts to repeal the Affordable Care Act and to defund Medicare. “This is the first vote in the dismantling of the Affordable Care Act,” said Senator Maria Cantwell (D-WA). Many people on all sides of the issue agree.
- Birth control coverage: The ACA required insurance plans to provide women with contraception, but this has been controversial to many organizations and individuals who object on religious grounds. Price could direct the Department of Health and Human Services to exempt employers and houses of worship from having to offer insurance that covers birth control. Price could also just “eliminate no-copay birth control coverage” because the inclusion of birth control was a regulation and not a law.
- Medicare payment changes: The ACA restructured the way doctors and hospitals were paid by using payment models that were dependent on quality of care. These models are often seen as a bureaucratic intrusion by many doctors and hospitals, but others see it as a way of innovating healthcare. Price could put a stop to these newer payment models.
- Planned Parenthood funding: Price has been trying to defund Planned Parenthood for years. As HHS Secretary, Price’s political clout and administrative power mean that he “has many tools at his disposal to make life miserable for the organization.”
- Tobacco regulation: Price “has very broad discretionary authority not to vigorously enforce or implement [tobacco regulation] in an aggressive manner,” says Matt Myers of the Campaign for Tobacco-Free Kids. Price has been ambiguous about his position on tobacco regulation in the past.
Republicans Considering Different Plans to Reform Medicaid
Medicaid reform is one of the most contentious issues among Republicans. Many Republican governors, like Ohio’s John Kasich, expanded Medicaid within their states and are vocal proponents of Medicaid expansion within their states. Many conservatives would like to repeal all aspects of Medicaid expansion that have occurred since the passing of the Affordable Care Act. Other Republican politicians are floating various ideas to rein in federal spending on Medicaid in varying degrees. You can read more here.
Federal Government Owes $214 Million to Oregon Insurer Moda Health Says Courts
Moda Health, an Oregon health insurer, won a case Thursday with the U.S. Court of Claims. The Court has decided that the government must pay the company $214 million.
The federal government, under the provisions of the Affordable Care Act, had set up a risk corridor program that gave financial assistance to companies if they lost money from their participation on the insurance exchanges. Moda has lost money for three consecutive years on these exchanges and was seeking hundreds of millions in funds from the government. The Centers for Medicare and Medicaid paid Moda about $11 million in 2014, but gave the company nothing for the next two years afterward. Moda had to sell many of its assets and borrow in order to stay afloat. “The Court finds that the Government made a promise in the risk corridors program that it has yet to fulfill. Today the Court directs the Government to fulfill that promise,” wrote Judge Thomas Wheeler. Other insurance companies have filed similar claims. Collectively, they are seeking billions of dollars.
News Update for February 9, 2017
Republicans Weighing Alternatives for Removing the ACA’s Individual Mandate
Congressional Republicans are weighing different proposals for getting rid of the individual mandate, one of the Affordable Care Act’s most controversial policies. However, the mandate is directly tied to one of the ACA’s most popular policies: making sure that insurers continue to cover people with pre-existing conditions. The mandate works as an incentive to get younger, healthier people to sign up for health insurance to offset the increased cost of covering pre-existing conditions, and the mandate helps to prop up the insurance system, financially. The Republican proposals have the potential to turn contentious within the party itself. These are the most commonly discussed proposals by the GOP:
- Continuous coverage – Supported by House Speaker Paul Ryan, this idea would require that Americans stay enrolled in insurance without any interruptions in their enrollment if they want their pre-existing conditions to be covered. Some conservatives feel that this option would restrict consumer choice.
- Premium surcharges – This option would incentivize people to get insurance early, during an initial open enrollment period. The later they sign up for insurance in their life, the more they would have to pay. Healthy people who sign up earlier but who don’t use as many services could theoretically make up for the cost of covering people with pre-existing conditions.
- Automatic enrollment – This option would automatically enroll people who are eligible for subsidized coverage but aren’t signed up for insurance. They would be enrolled in a “bare-bones policy that would be paid for entirely through the available federal subsidy.” Selecting which plan these individuals would receive could be a contentious political issue. Some conservatives see this as an even greater overreach by the government than the current individual mandate.
Confirmation for Secretary of HHS Probable for Friday Morning
The Senate will undergo a procedural vote Thursday night, which will set up a final confirmation vote for Representative Tom Price’s nomination to the Secretary of Health and Human Services position. Despite an expected party-line vote, Price is widely expected to be confirmed Friday morning.
New Federal Regulations for Home Health Agencies
“Home health services under Medicare are available for seniors and younger adults with disabilities,” and they “will be required to become more responsive to patients and their caregivers under the first major overhaul of rules governing these organizations in almost 30 years.” The new regulations strengthen patients’ rights, specify operating conditions for home health agencies that take part in Medicare and Medicaid, and ensure that home health agencies will better coordinate services with their patients. You can read more here.
$54 Billion Anthem-Cigna Merger Blocked by Courts
A federal judge has blocked the proposed $54 billion merger between major health insurers Anthem and Cigna. U.S. District Judge Amy Berman Jackson wrote that “the merger is likely to result in higher prices, and that it will have other anticompetitive effects: it will eliminate the two firms’ vigorous competition against each other for national accounts, reduce the number of national carriers available to respond to solicitations in the future, and diminish the prospects for innovation in the market.” This decision follows a similar ruling made last month in which a judge blocked a merger between major insurance carriers Aetna and Humana.
Humana Reports $401 Million Loss
Major insurer Humana is reporting a net loss of $401 million for the fourth quarter of 2016, compared to $101 million in net income for the fourth quarter of 2015. Humana ended 2016 with about 244,000 fewer individual major medical insurance enrollees than it had at the end of 2015, and the company “has discontinued the sale of most [of its] off-exchange individual major medical coverage.” Humana is also “facing challenges in the private Medicare plan market.”
News Update for February 8, 2017
Significant Minority of Americans Don’t Know ACA and Obamacare Are the Same Thing
A recent poll found that about 35% of Americans don’t know that Obamacare and the Affordable Care Act are the same policy. Registered Republicans were more likely to know that Obamacare was a colloquialism for the ACA, but confusion over the ACA’s specific policies remains rampant.
Major ACA Exchange Player Centene Willing to Adapt
Centene chairman Michael Neidorff has faith in the Trump administration’s efforts to stabilize the ACA exchange program and believes that the company will adapt favorably to any of the Trump administration’s proposed policy decisions. While many other major insurance carriers are considering exits from the Affordable Care Act exchanges, Centene has announced that they are opting to stay in the exchange program. “I’m not backing off at all,” said Neidorff. The company has about a million ACA exchange plan enrollees this year, which is up from about 540,000 in 2016.
Republicans Looking to Steer Obamacare Repeal and Replace Efforts Back on Track
The GOP is looking to right their efforts to repeal and replace the Affordable Care Act. Republicans have been sidetracked by confirmation hearings and internal disagreements over whether the repeal and replacement of Obamacare should happen simultaneously or not. Their current strategy is to combine replacement policies into a measure that repeals Obamacare. This measure would be taken up and passed under a sped up process that only needs 51 Senate votes to pass. Some are unsure if Senate rules would permit this process. The GOP’s current repeal and replace strategy involves 4 points:
- Expanding health savings accounts
- Enacting high-risk health insurance pools
- Medicaid reform
- Authorizing tax credits to help Americans afford insurance policies
Pharmaceutical Stocks Sink as Trump Expresses Support for Medicare Drug Price Negotiation
According to remarks by White House spokesman Sean Spicer, President Trump supports Medicare drug price negotiations. Tuesday’s expression of support sent pharmaceutical stocks swinging. “The easier way to look at this is to look at what other countries have done: Negotiating costs to keep [drug prices] down,” said Spicer. Investors are unsure how Trump’s policies would impact the industry’s profits. Spicer’s comments also caught investors off guard as Trump seemed to have given indications that he was backing off drug price negotiations in a meeting with top pharmaceutical industry leaders last week.
Trump Administration Backing “Right to Try” Legislation
President Trump is lending his support to a “Right to Try” proposal that would let terminally ill patients gain access to medicines not yet approved by the Food and Drug Administration. Supporters of a federal “Right to Try” law met with Vice President Mike Pence on Tuesday.
News Update for February 7, 2017
Documents Obtained by Politico Show Trump Administration’s Proposals for ACA Reform
According to 2 draft documents from the Trump administration, there may be major changes to the Affordable Care Act that could entice health insurers to stay in the ACA marketplaces until Congress passes a replacement health law. However, these proposed changes could lead to a decline in enrollment and an increase in the cost for coverage older enrollees. Politico writes, “The administration is looking to alter rules around insurers charging older customers more, how much cost they can shift onto customers, and who’s allowed to sign up outside the standard enrollment window. They represent changes that the industry had previously asked the Obama administration to make.” Health insurers must begin submitting health plans for 2018 to state insurance regulators by April, so the Trump administration has a short amount of time to persuade them to stay in the marketplaces.
Conservative Republicans Insisting on ACA Repeal for Spring
- House Ways and Means Committee Chairman Kevin Brady (R-TX) and No. 2 Senate leader John Cornyn (R-TX), announced on Monday that they plan to start the ACA repeal process this spring. Brady told the press that he’s going by House Speaker Paul Ryan’s timeline to have repeal legislation ready by the end of March. Cornyn told reporters that the Republicans’ repeal bill under the reconciliation method is expected to come to the Senate in the next 30 days. This spring timeline to repeal the health law may be a stretch because Republicans still face challenges with their repeal-and-replace plan. Concerning replacement, “Trump told Fox News on Sunday that ‘maybe it’ll take till sometime into next year’ to put forward a replacement plan, calling the process ‘very complicated.’”
- Some Republicans are wondering what happened to President Trump’s campaign promise of repealing Obamacare quickly. Representative Jim Jordan (R-OH), a member of the conservative House Freedom Caucus, said in a CNN interview, “For goodness sake, we should be able to put something on President Trump’s desk that’s at least as good as what we put on President Obama’s desk. Not something watered down. Let’s repeal it. Let’s do what the voters sent us here to do.” House Freedom Caucus Chairman Mark Meadows (R-NC) told CNN that he wants Republicans to move faster with the repeal. “I don’t know that there’s any new revelations that are going to come up by waiting 60 to 90 more days. We’re making the whole idea of repeal and replacement far more complex and laborious than it needs to be and I think it’s time that we just make some decisions and move forward with (the repeal bill),” Meadows said.
Senators Bernie Sanders and Ted Cruz to Debate the ACA Tonight on CNN
“On Tuesday night at 9 p.m. ET, CNN is hosting a Town Hall with Senators Bernie Sanders [D-VT] and Ted Cruz [R-TX] to debate the merits of Obamacare and of repealing it.” Sanders is likely to argue the Democratic point of view that Obamacare has brought affordable coverage to millions of Americans while Cruz is likely to argue the Republican point of view that Obamacare has damaged the healthcare system and led to high premiums and deductibles.
Repeal of the ACA Could Mean Job Losses
Research studies indicate that repealing major parts of the ACA could lead to job losses across all states, which would affect the whole economy and not just the healthcare industry. “Josh Bivens, Director of Research at the Economic Policy Institute, estimates the proposed repeal would eliminate nearly 1.2 million jobs in 2019.” Repealing the ACA would cut federal funding for premium tax credits and Medicaid services, which the studies indicate are the 2 main factors that would contribute to job loss. Bivens commented, “These are not job losses that would send us back into a recession, but they could potentially cut the rate of job creation by 50 percent.”
Will the Uninsured Still Face Penalties if the ACA Is Repealed?
Kaiser Health News released answers to questions its readers brought up such as, “Should people bother paying the penalty for not having health insurance when they file their taxes this year?” and “Will they be able to sign up on the exchange for 2018 after their COBRA benefits end?” The answer concerning the penalty said, “As long as the ‘individual mandate’—which requires most people to have health coverage or face a tax penalty—is the law of the land, you should pay the fine for not having coverage in 2016 unless you qualify for an exemption.” Kaiser Health News writes regarding the COBRA question, “Under the health law, people who have certain life changes, including losing other types of health insurance such as COBRA, are entitled to a special enrollment period to enroll in coverage on the exchange.” You can read the details of these answers here.
News Update for February 6, 2017
President Trump Dials Back Expectations on Immediate ACA Repeal
In an interview on Sunday, President Trump began dialing back on his earlier campaign promises to immediately repeal and replace the Affordable Care Act upon taking office. Trump gave indications that his administration was in the process of drafting up plans for repealing and replacing the ACA: “It’s in the process and maybe it will take till sometime into next year. … It’s very complicated.”
Resistance for ACA Repeal Continues
Now that the Affordable Care Act’s popularity might be at its peak, the GOP is finding itself face-to-face with increased resistance. During town hall meetings in their respective districts this weekend, representatives Tom McClintock (R-CA) and Gus Bilirakis (R-FL) faced down tough lines of questioning by conservative constituents frustrated over potential losses of coverage. Hundreds of protestors also showed up to McClintock’s town hall meeting.
ACA Enrollee Numbers Released for January
According to managers of the Affordable Care Act exchanges, the open enrollment period for 2017 ended with 9.2 million people selecting insurance plans. Last year, the number was 9.6 million. Approximately 3 million users are new to the exchange system and 6.2 million are holdovers from last year. Some experts believe that this drop by itself isn’t significant. However, fewer than 400,000 sign-ups occurred in the last two weeks before the deadline. This, in comparison with last year’s 700,000 sign-ups in the same time span, has led some experts to believe “that Trump administration actions may have confused consumers, discouraged them from enrolling or simply made it easier to forget about the deadline.”
Healthcare Industry Created 18,300 New Jobs in January
In the midst of great uncertainty over the future status of the Affordable Care Act, the healthcare industry still created 18,300 new jobs in the month of January. The overall employment numbers in the sector have risen to 15,617,200, according to the Bureau of Labor Statistics.
Immigration Ban Might Have Long-Term Detrimental Effects on Healthcare Industry
According to an article by Modern Healthcare, President Donald Trump’s travel ban issued on Jan. 27 might have major effects on the healthcare industry. The ban applies to people from Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen. The U.S. relies “heavily on immigrant and foreign-born students, researchers and faculty” throughout the healthcare industry.
- “We are going to keep folks out of the U.S. who we know are filling key roles in our healthcare and research systems. It’s sending a message about who is welcome here, and when we have an important field so dependent on foreign-educated professionals, that’s going to have an impact,” said Nikki Cicerani, CEO of Upwardly Global, a non-profit that helps immigrants with their careers.
- Foreign-born individuals accounted for 16% of the healthcare industry’s more than 14 million-person workforce in 2015. Of those, “more than 60,000 were from the seven countries” listed in Trump’s executive order.
- “Foreign-born workers make up 28% of the country’s physicians and surgeons, more than half of medical scientists in the biotechnology sector, 22% of nursing, psychiatric and home health aides, and 15% of all registered nurses,” according to a George Mason University Institute for Immigration Research 2016 report.
- The U.S. also needs immigrants to take up healthcare jobs in places with worker shortages. According to Jim Stone, president of Medicus Firm, a physician-staffing agency, “The shortage of physicians is acute, especially in primary care, and eliminating 25% of the available pool of candidates obviously makes a difficult situation even more difficult.”
- Of the researchers at the country’s top seven cancer research centers, 42% were foreign born, according to a 2013 study by the National Foundation for American Policy.
The ban’s effects may go further than just the ones listed in Trump’s executive order. Some people are worried that potential researchers and healthcare workers, alienated by the immigration ban, could decide to go to other countries. This could exacerbate healthcare workforce shortages and stall medical research and innovation in the U.S. “It has nothing to do with just these seven countries,” said Manu Prakash, an Indian-born bioengineer at Stanford University. “It is much more what it speaks to, what it means to be invited into a home.”
News Update for February 3, 2017
AARP Voicing Discontent Toward Republican Efforts to Repeal ACA
As a warning sign for Republicans, AARP has issued letters and statements voicing its dissatisfaction with current Republican policy proposals to repeal and/or reform the Affordable Care Act. As one of the most notable organizations representing seniors in this country, AARP has significant clout with the GOP as older voters are considerably more likely to vote Republican than younger voters. AARP is worried that the GOP will remove ACA protections that keep seniors from being charged more than 3 times the rate charged to younger, healthier insurance enrollees. Many Republicans have been talking about relaxing this “age band” in order to make premiums cheaper for younger Americans. AARP is also worried the conversion of Medicaid to a block grant system will lead to state governments cutting health benefits for seniors.
Health Savings Accounts Generating Buzz During Talks on Repeal and Replace
Kaiser Health News has published a new article that delves into some of the details behind health savings accounts (HSAs). The article explains how they work and how the GOP is proposing to reform them. One proposal, by House Speaker Paul Ryan (R-WI), would increase HSA contribution limits so that eligible individuals and families could put more money into their HSAs. Sen. Rand Paul (R-KY) has proposed getting rid of upper contribution limits altogether. His proposal would also allow people on all insurance plans to be eligible for an HSA. Read more about HSAs and their potential changes here.
GOP Efforts to Repeal ACA Stalled
Although the GOP came into Congress about a month ago setting out to “immediately repeal and replace the Affordable Care Act,” they have been finding the process of doing so to be quite difficult.
- The extremely conservative House Freedom Caucus is pushing for a vote on a 2015 bill that would immediately repeal the ACA.
- The Energy and Commerce Health Subcommittee is discussing drafts of four bills that are looking to repeal, replace, or reform different aspects of the ACA.
- One bill addresses the popularity behind the ACA’s requirement to guarantee coverage for people with pre-existing conditions. This bill would incentivize younger people into getting insurance early on in their lives, before they get sick, in order to fund the insurance pool for people who aren’t as healthy.
- Another bill seeks to change the “age band” that prevents insurers from charging seniors 3 times as much as younger people. The proposed change would allow insurers to charge seniors up to 5 times as much as younger people.
- The third bill would restrict special enrollment periods.
- The last bill would restrict grace periods for people who haven’t paid their premiums.
- The Subcommittee’s approach above reflects the GOP’s strategy to “pursue a piecemeal approach because [the GOP has] no desire to supplant [Obamacare] with a single comprehensive Republican plan,” which would not only require a much higher level of cohesion by the GOP, but also bipartisan cooperation.
Trump Administration Submits New Rule to Help Individual Insurance Market
Insurance companies must decide by May if they would like to participate in the Affordable Care Act’s individual insurance exchange in 2018. Due to regulatory uncertainty, many major carriers, such as Aetna, Cigna, and Anthem, seem to be opting to bow out. During a Senate committee yesterday, many insurers testified that they will need assurances that government subsidies will be available for them if they choose to participate in the ACA marketplace. Many Republican lawmakers are against these subsidies. The Trump administration, in order to keep the individual market going in the meantime, has passed a new rule. The details and language of the new Trump policy haven’t been made available to the public yet, but what is known is that it will be “economically significant” to the point of annually affecting the economy by at least $100 million.
News Update for February 2, 2017
Republicans Moving From “Repeal” to Repair?
During last week’s closed-door policy discussion retreat, Republicans began discussing a possible rebranding of their healthcare reform strategy. The party line for the GOP’s approach to the Affordable Care Act had originally been, more or less, “repeal and replace.” This strategy might be giving way to a “repair” approach, as evidenced by statements made by Sen. Susan Collins (R-ME), House Speaker Paul Ryan (R-WI), and Rep. Pete Sessions (R-TX). This new branding “is a less partisan but no less action-oriented phrase that Americans overwhelmingly embrace,” said Frank Luntz, a prominent Republican consultant. Many see this rebranding to be a compromise inspired by the GOP’s desire to dismantle the ACA and their worries about the political fallout they might face if millions of Americans were to lose insurance coverage during a possible repeal process. Some of the GOP’s more conservative members are frustrated at this rebranding. “I’m out there saying repeal and no replace—that’s as pretty strong as it gets,” said Rep. Roger Williams (R-TX), who “believes things should ‘just go back the way they were’” prior to the ACA.
Republicans Weighing Plans to Keep Individual Market Afloat
Last year, a federal judge sided with House Republicans and said that the Obama administration had overstepped its authority by subsidizing premiums without specific appropriations from Congress. Some Republican lawmakers are considering funding the ACA’s cost-sharing reduction or reinsurance programs “that they haven’t given money to in recent years in order to both stabilize the individual insurance market” and to prevent a massive increase in the uninsured rate.
Large Insurers Continue to Be Unsure About Individual Market
More uncertainty about changes to the Affordable Care Act has made large insurers wary of participating in the individual insurance market for 2018. Tuesday’s announcement that Aetna would be opting out of the individual insurance market in 2018 was already a large blow to the marketplace.
- Another big insurer has gone on record to say that it is reevaluating its position in the individual insurance market. Anthem Inc. chairman Joseph Swedish “wants to see how insurance regulators, members of Congress and other policymakers respond to [Anthem’s] requests for efforts to stabilize the individual market” before coming to a more concrete decision.
- Fellow insurance giant Cigna has announced that its profits in the individual market have fallen compared to last year. They are also reconsidering their position in the individual insurance market.
ACA Repeal Puts Women’s Health Benefits at Risk
Before the Affordable Care Act, insurance companies were allowed to charge women more than men for policies purchased directly from the companies. The ACA ended this practice and made newborn and maternity care required benefits in the individual insurance market plans. Preventive care — “including birth control and breast pumps used by nursing mothers” — was also offered at no extra cost to insured women. These services add to the cost of the ACA-approved plans, and some critics think these requirements should be stripped so that premiums for all consumers will be lower. Many others are worried that these benefits are too crucial to be removed.
News Update for February 1, 2017
Discussions of ACA Repeal Causing Much Uncertainty for Potential Enrollees
Various executive orders by President Trump and bill proposals from Congress have managed to throw much uncertainty into the final weeks of what could possibly be the Affordable Care Act’s last Open Enrollment Period. According to Emily Black Bremer, an insurance agent in Clayton, Missouri, “Some people [are asking], ‘What’s the point if the law is going to be repealed?’” Some enrollment service centers are seeing greatly increased traffic compared to this time last year; others have experienced a steep drop. According to the last figures released by the Obama administration on January 14, 8.8 million people had signed up for coverage through the federal marketplace. This number is about 100,000 higher than at the same time last year. A higher number of enrollees could translate to a higher level of stability for the individual insurance marketplace over the coming months.
Aetna Opts Out of Individual Health Market for 2018
Citing its higher-than-expected losses in 2016 and the murkiness of where government regulation is headed, Aetna chairman Mark Bertolini has announced that the major insurance provider will be opting out of the individual insurance market in 2018. The company, which was once a big supporter of the Affordable Care Act, has been drastically reducing its participation in the individual insurance marketplace in the last couple quarters. “The company now has about 240,000 individual major medical enrollees, down from 965,000 at the end of 2016,” said various executives.
Key Questions on Medicaid Reform
The Kaiser Family Foundation has released a brief that outlines key questions about Medicaid reform. The proposed changes in Medicaid funding — either block grants or a per capita cap — could lower the amount the federal government puts toward Medicaid in each state.
- Block grants would give states a pre-set amount of funding for Medicaid. The dollar amount of the block grants would be capped below the amount of expected spending. The state governments would have to make up the difference with state revenue or cut spending. Block grant caps wouldn’t account for economic downturns or changes in the cost of healthcare, but the caps would increase every year based on inflation.
- A per capita cap would cap federal funding for Medicaid per each enrollee. There would be separate caps for different types of coverage groups (children, adults, seniors, and people with disabilities). This cap would also be set below the amount of expected spending. Unlike a block grant, a per capita cap would adjust for the number of enrollees.
Block grants or a per capita cap could end up saving the federal government some money, but some experts are worried that limiting federal financing could hamstring state governments and leave a lot of people without healthcare or with poor quality healthcare.
Trump’s Pick for Supreme Court and the ACA
Last night, President Donald Trump announced Judge Neil Gorsuch as his pick to replace Justice Antonin Scalia’s former spot on the Supreme Court. Gorsuch’s nomination has been praised by many conservatives. Gorsuch has ruled twice against the contraception coverage requirement of the Affordable Care Act. In 2013, Gorsuch supported Hobby Lobby Stores, Inc. when the retailer protested, on religious grounds, the ACA requirement to provide no-cost contraception access as part of its employees’ health insurance plans.
Vote to Confirm Secretary of HHS to Proceed to Senate Floor Despite Boycott by Democrats
Despite yesterday’s boycott by Democrats, Republicans were able to push the vote to confirm Representative Tom Price (R-GA) to the Senate floor. It is unclear when the final vote to confirm Rep. Price will occur, but it is widely expected that he will eventually be confirmed as Secretary of Health and Human Services.