Jan 7, 2018
Trump takes new tack to weaken ObamaCare
Nov 6, 2017
GOP unlikely to repeal ObamaCare mandate in tax measure
The House is unlikely to repeal the mandate to buy insurance under ObamaCare as part of its tax-reform bill, GOP sources say, though the issue could return down the road.
President Trump and conservative lawmakers are pushing for the individual mandate to be repealed in the bill, but House Ways and Means Committee Chairman Kevin Brady (R-Texas) has expressed worry that the controversial measure would jeopardize the broader tax-reform bill, given the Senate’s failure on health care earlier this year.
“It hasn’t ever been in the [House] bill,” said one Republican on the Ways and Means Committee who has been taking part in the negotiations. “I expect that it will be added somewhere down the sausage-making venture.”
“I agree there is a chance, but I think if it gets included, it would be on the Senate side,” added a second Ways and Means Republican. Read more
Oct 16, 2017
Why this investigation into Congress’s ties to the drug industry has Washington’s attention
This story has been updated with the latest developments of the fallout from this investigation.
Two popular villains in politics are the subject of a new Washington Post investigation: Congress and the pharmaceutical industry. And the investigation has grabbed Washington’s attention.
The deeply reported story by Scott Higham and Lenny Bernstein, in partnership with “60 Minutes,” latches Congress and drug companies so closely together on a piece of opioid legislation that it raises some big questions, including: How much industry involvement in crafting legislation is too much? And is Congress doing enough to address the nation’s prescription drug epidemic, or, have lawmakers, at the behest of drug companies making billions off addictive pain killers, potentially made it worse?
Higham and Bernstein report that in April 2016, at the height of the deadliest drug epidemic in U.S. history, Congress stripped the Drug Enforcement Administration of its most potent weapon to keep prescription narcotics from going straight from major drug companies to the nation’s streets.
On Monday, moderate Democratic Sen. Joe Manchin III (W. Va.) called on President Trump to withdraw the nomination of Rep. Tom Marino (R-Pa.) to be his drug czar. Manchin said he was “horrified” by the ties between the drug industry and Marino that were outlined in the investigation. And Sen. Claire McCaskill (D-Mo.) said Monday she’d be introducing legislation to repeal the law.
Also Monday, Trump characterized drug companies as “getting away with murder.” Though he was talking specifically about prescription drug prices, Trump’s eyebrow-raising comments suggests he’d be open to rolling back the industry’s power in Washington. Democrats like Manchin say the first step is to withdraw his nomination of the lawmaker at the center of the investigation. Read more
Oct 13, 2017
Trump Scrapped a key Obamacare payment. Here’s what’s next.
President Trump rocked the health-care world late Thursday by finally following through on a threat to end billions of dollars in subsidy payments that are made to insurers to lower deductibles and out-of-pocket costs for lower-income Americans.
Trump cast his decision as one that would stop a costly federal outlay that he has described as an insurer bailout. “Massive subsidy payments to their [Democrats’] pet insurance companies has stopped,” he tweeted.
The decision triggered sharp condemnations from major players across the American health-care system. But while the payments to insurance companies do benefit lower-income Americans, taking these payments away will have some counterintuitive effects — and likely won’t hurt the poorest the most.
Here’s how the effects could play out:
1) Taxpayers will pay more when premiums go up.
When the reimbursements — worth roughly $10 billion next year — to health insurers go away, the actual health plans with lowered out-of-pocket costs for lower-income people won’t. Insurers will still have to offer those plans with lower deductibles and co-pays to people who make up to 250 percent of the federal poverty level —$60,750 for a family of four in 2017.
To make up the difference, insurers will raise premiums. Many already factored this into their rate increases for next year. But as the premiums increase, so do the premium tax credits — the federal subsidies that help people afford their health insurance.
“The premiums are going to go up, the premium subsidies go up. They’re just paying out of their left pocket instead of their right pocket,” said David Windley, a managing director at Jefferies, an investment banking firm. “So it’s really kind of cutting off your nose to spite your face.”
Tax credits are pegged to income, so that people pay only a certain percentage of their income for their premiums, while the federal government pays the rest. That means people who benefit from cost-sharing reductions today will get bigger federal tax credits to pay for their monthly insurance costs, once those subsidies end.
“We think the federal government might end up paying more,” said Chet Burrell, president of CareFirst BlueCross BlueShield. “We’re already getting word from other analyses that this could increase federal outflows.”
The nonpartisan Congressional Budget Office forecast that ending cost-sharing reductions would increase the federal deficit by $194 billion over a decade, because the tax credit amounts would increase and because more people would receive them. The Kaiser Family Foundation found that premium tax credits would cost an additional $12.3 billion if cost-sharing reductions end next year.
“It is important to note that, contrary to the desired impact of reducing insurance premium costs, defunding of cost-sharing reductions will cause the federal government to spend more money through higher funding expenditure” of premium tax credits, Michael Neidorff, chief executive of insurer Centene said in a statement.
2) Lower-income Americans aren’t really the ones at risk of paying more
Although the subsidies benefit lower-income Americans, they aren’t the ones on the hook if premiums skyrocket. Because of how premium tax credits increase, it should largely be a wash for people who receive credits, health-policy experts said.
People who make between 250 and 400 percent of the federal poverty level could find themselves getting more generous tax credits, because those are pegged to the size of the silver plans, the most popular plans.
“Federal subsidies are not going away and, as a result of this action, will go up, resulting in lower-cost options for many consumers,” Greg Bury, a spokesman for the Midwest insurer Medica said in an email.
People who make too much money to qualify for premium tax credits are the ones who feel the most pain when premiums increase. But since many states specifically allowed insurers to increase premiums due to cost-sharing reduction uncertainty on silver plans sold on their exchanges, this impact may be limited. The impacts will likely vary from state to state and insurer to insurer.
3) Ripple effects
The end of subsidies could affect large numbers of Americans if it pushes insurers that have been struggling with federal uncertainty to a tipping point, causing them to reevaluate whether they should offer plans in the individual market.
On Friday, many insurers said they were still committed to the market next year, but some signaled they could reevaluate. Molina Healthcare said it would “continue to evaluate our participation on a market-by-market basis” in a statement. Burrell indicated that CareFirst might reevaluate its plans this spring, as it sets rates for 2019.
“I think it will create a lot of uncertainty — and it’s a cumulative uncertainty created not only by this decision of this administration, but the executive order, the question of will Congress step in, what will the agencies do,” said Nicole Elliott, a partner at the law firm Holland and Knight.
Oct 10, 2017
Trump to cut off key ObamaCare Payments
President Trump will end key payments to insurers selling ObamaCare plans, the White House announced late Thursday, marking Trump’s most aggressive move yet to dismantle the law after multiple GOP efforts to repeal and replace it failed this year.
The Trump administration has continued making the the disbursements to insurers, known as cost sharing reduction (CSR) payments, on a monthly basis. But Trump had consistently threatened to end the payments, which are worth an estimated $7 billion this year.
“Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare. In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments,” the White House said in a statement Thursday night. Read more
Sept 26, 2017
Obamacare repeal on the ropes as pivotal Republican rebuffs Trump
WASHINGTON (Reuters) – U.S. Senator Susan Collins rebuffed intense lobbying from fellow Republicans and the promise of money for her state in deciding on Monday to oppose – and likely doom – her party’s last-ditch effort to repeal Obamacare.
The most moderate of Republican senators joined John McCain and Rand Paul in rejecting the bill to end Obamacare. It was a major blow for President Donald Trump who has made undoing Democratic former President Barack Obama’s signature healthcare law a top priority since the 2016 campaign and who pressured Collins in a call on Monday. Read more
Sept 21, 2017
What Graham-Cassidy means for pre-existing conditions
Jimmy Kimmel’s takedown of Sen. Bill Cassidy, and Cassidy’s response, ripped open the question of whether the GOP’s latest health reform bill protects people with pre-existing conditions. Cassidy and co-sponsor Sen. Lindsey Graham insist it does — as did President Trump in a tweet last night — but experts say that’s not really the case.
The bottom line: The bill’s funding cuts could pressure states — even blue states — to waive protections for sick people, as a way to keep premium increases in check. Older, sicker people in every state could end up paying more as states try to make up for a funding shortfall.
What the bill does: The bill wouldn’t repeal the Affordable Care Act’s rules about pre-existing conditions. But they might end up only existing on paper, the Kaiser Family Foundation’s Larry Levitt said.
Graham-Cassidy doesn’t let states waive the part of the Affordable Care Act that says insurers have to cover sick people. But it does allow states to opt out of several other ACA rules that can cause people with pre-existing conditions to pay more for their health care. Those provisions include:
The ban on charging sick people higher premiums than healthy people.
The requirement that insurers cover “essential health benefits,” including prescription drugs. People who need expensive drugs might not have access to a plan that covers those drugs, requiring them to pay out of pocket.
Services that aren’t “essential” benefits aren’t subject to the ACA’s ban on annual and lifetime limits.
The bill also would also loosen rules about how much insurers can raise their premiums because of a customer’s age. (Older people are more likely to have pre-existing conditions.) Read more
Sept 19, 2017
A bipartisan group of governors just blasted the new Republican healthcare bill — and it has a key addition
A bipartisan group of 10 governors on Tuesday attacked the latest Republican attempt to repeal and replace the Affordable Care Act in a strongly worded letter to Senate leaders.
The letter to Senate Majority Leader Mitch McConnell and Senate Minority Leader Chuck Schumer said the Graham-Cassidy-Heller-Johnson healthcare legislation should not be considered. Instead, the group said, the Senate should prioritize the bipartisan bill being drafted in the Senate Health, Education, Labor and Pensions Committee to stabilize the law known as Obamacare.
“As you continue to consider changes to the American health care system, we ask you not to consider the Graham-Cassidy-Heller-Johnson amendment and renew support for bipartisan efforts to make health care more available and affordable for all Americans,” the letter said. “Only open, bipartisan approaches can achieve true, lasting reforms.” Read more
Sept 19, 2017
What’s in the latest Obamacare repeal bill?
Republican senators’ latest attempt to repeal Obamacare could be the most far-reaching of GOP efforts this year.
Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana last week released a bill that would eliminate or overhaul major sections of the health reform law. The duo had been trying to garner interest in earlier versions of their bill for months, but hadn’t gotten much traction.
Now, however, Republicans likely have only two weeks left to use their 2017 budget reconciliation bill as a way to dismantle Obamacare with a simple majority in the Senate. The Graham-Cassidy bill is the only repeal effort left on the table, coming even as a bipartisan Senate committee is working on legislation to stabilize the Affordable Care Act.
The Congressional Budget Office said Monday it may take several weeks for it to release an analysis of the Graham-Cassidy bill so it remains to be seen how many fewer people could be insured under it or what the impact on premiums may be.
Repeal Obamacare individual and employer mandates: Obamacare levies penalties on most Americans who don’t have health insurance and larger employers who don’t provide affordable coverage for their workers. The bill would eliminate the penalty, retroactive to 2016.
Repeals Obamacare subsidies and ends Medicaid expansion funding: The legislation would eliminate Obamacare subsidies that lower premiums, deductibles and co-pays in 2020. It would also jettison federal funding for Medicaid expansion, which 31 states use to provide coverage for residents with incomes up to about $16,000.
The legislation would turn the federal funding for Medicaid expansion and the subsidies into a block grant program. States would be given a lump sum of money and would have a lot of leeway over how to spend it.
For instance, they could help enrollees pay their premiums and out-of-pocket costs or set up high-risk or reinsurance pools to help protect insurers from costly enrollees and entice them to stay in the individual market. States could use a portion of money to help those enrolled in Medicaid afford care.
Graham and Cassidy say that this provision would return power to the states and allow them to create programs that fit their residents’ needs. Also, it would equalize Medicaid funding across the states. The bill’s authors note that four states — New York, California, Massachusetts and Maryland — get 37% of Obamacare funding.
But Democrats and consumer advocates say that many states, particularly those that expanded Medicaid, would lose a lot of federal funding, making it harder for them to provide coverage or assistance to their residents. Also, they note, the block grant is only authorized through 2026, jeopardizing the continuation of funding after that.
Loosens Obamacare’s regulations regarding pre-existing conditions: The bill would also waive several key Obamacare protections for those with pre-existing conditions. While it would still require insurers to provide coverage to everyone, it would allow carriers to charge enrollees more based on their medical history. So younger, healthier folks could see their premiums go down, but sicker Americans could find themselves priced out of policies.
The legislation also would eliminate Obamacare’s essential health benefits provision, which mandates insurers cover an array of services, including hospitalization, maternity care, prescription drugs, mental health and substance abuse services. This could lower premiums somewhat and give consumers a wider choice of plans. But it would also make it harder for people to buy comprehensive policies so those with pre-existing conditions may not be able to find coverage that meets their health care needs.
Revamps funding for Medicaid overall: The legislation would send the states a fixed amount of money per Medicaid enrollee, known as a per-capita cap, starting in 2020.
States could also opt to receive federal Medicaid funding as a block grant for the non-disabled adults and children in their program. Under a block grant, states would get a fixed amount of federal funding each year, regardless of how many participants are in the program.
States, however, cannot opt to receive block grant funding for elderly and disabled participants.
Graham-Cassidy would also shrink the program even more over time by pegging the annual growth rate of funding for children and non-disabled adults to standard inflation after 2024, rather than the more generous medical inflation.
Either per-capita caps or block grants would limit federal responsibility, shifting that burden to the states. However, since states don’t have the money to make up the difference, they would likely either reduce eligibility, curtail benefits or cut provider payments. The block grant would be more restrictive since the funding level would not adjust for increases in enrollment, which often happens in bad economic times.
Allows states to institute work requirements for Medicaid: States would now be able to require adult Medicaid recipients to work. The disabled, elderly and pregnant women would be exempt, however.
Permits everyone in the individual market to buy catastrophic plans: Obamacare only allows those under age 30 to buy catastrophic policies, which usually have higher deductibles and fewer benefits. This legislation would allow anyone to buy these plans starting in 2019.
Repeals a handful of taxes: The bill would repeal the tax on over-the-counter medicine, health savings accounts and medical devices, a levy unpopular on both sides of the aisle. But it keeps in place Obamacare’s taxes on the wealthy, health insurers and others.
Defunds Planned Parenthood: In keeping with longstanding Republican beliefs, the legislation prohibits federal funding for Planned Parenthood. But the restriction is only for a year, beginning when the bill is enacted.
Increases maximum contributions to health savings accounts: Today, individuals can save up to $3,400 and families can save up to $6,750 a year tax-free in a health savings account. The bill would raise that limit to the annual out-of-pocket maximum for high-deductible plans. For 2018, that would be $6,650 for individuals and $13,300 for families. Source
Policy/ Healthcare here
Patrick Meehan’s website
Meehan Bill Improves Medicare Advantage for Chronically Ill Seniors
WASHINGTON – Congressman Patrick Meehan (R-Pa.) has introduced H.R. 3044, bipartisan legislation that allows Medicare Advantage insurance plans to offer a wider array of benefits to chronically ill enrollees. The legislation waives uniformity requirements among Medicare Advantage plans and allows insurers to offer plans better tailored to meet the individual needs of patients with chronic illness.
“Increasing rates of chronic illness among older Americans and an aging population are real challenges for our health care system,” said Congressman Meehan. “Chronic illnesses account for 70 percent of deaths in Pennsylvania each year, and seniors with chronic conditions are more likely to visit an emergency room or require hospitalization. More than a million seniors in Pennsylvania utilize Medicare Advantage plans. This bill will help seniors obtain a Medicare Advantage plan with benefits that best meet their needs. The result will be improved care and services for seniors coping with diabetes, arthritis and other chronic conditions.”
The legislation’s co-sponsors include Reps. Leonard Lance (R-N.J.), Terri Sewell (D-Ala.) Diana DeGette (D-Colo.) and Joseph Kennedy (D-Mass.). Read more
June 27, 2017
Toomey ‘conflates two things’ in latest health care claim
U.S. Sen. Pat Toomey of Pennsylvania has made clear he supports the Senate’s new health care bill, which is expected to be voted on this week. The Republican said on CBS’s “Face the Nation” Sunday the plan would “make permanent” Medicaid expansion and that the federal government would “pay the lion’s share of the cost.”
“Remember, Obamacare created a new category of eligibility,” Toomey continued. “Working-age, able-bodied adults with no dependents for the first time became eligible for Medicaid if their income is below 138 percent of the poverty level. We’re going to continue that eligibility. No one loses coverage.”
What did Toomey mean by “no one loses coverage?” And how will the Senate plan affect coverage for people who became eligible for Medicaid under Obamacare?
Steve Kelly, Toomey’s press secretary, said that when the Senator said “no one loses coverage” he was referring to federal eligibility for expanded Medicaid and was not saying no single person would lose coverage.
Sara Rosenbaum, the Harold and Jane Hirsh Professor of Health Law at George Washington, said Toomey “conflates two things.” She said the Medicaid eligibility category for adults below 138 percent of the federal poverty level was continued.
“But of course what he glosses over is what states will continue to cover these adults once the money starts disappearing,” Rosenbaum said. Read more
June 27, 2017
Facing revolt on healthcare bill, Senate Republicans delay vote
U.S. Senate Republican leaders postponed a vote on a healthcare overhaul on Tuesday after resistance from members of their own party, and President Donald Trump summoned Republican senators to the White House to urge them to break the impasse.
The delay put the future of a longtime top Republican priority in doubt amid concerns about the Senate bill from both moderate and conservative Republicans. With Democrats united in their opposition, Republicans need almost every vote among their own ranks in the Senate.
Senate Majority Leader Mitch McConnell had been pushing for a vote ahead of the July 4 recess that starts at the end of the week on the legislation, which would repeal major elements of Obamacare and shrink the Medicaid government healthcare program for the poor. Read more
June 24, 2017
Casey, Toomey square off from afar over Senate health care plan
HARRISBURG — At a rally Friday morning in the state Capitol, U.S. Sen. Bob Casey urged voters to help him and other Democrats defeat the Senate Republicans’ plan to replace the Affordable Care Act.
“In the next couple of days, into the very last hour, please keep advocating,” Mr. Casey, D-Pa., told several dozen people gathered in the rotunda. “Please keep writing and marching and calling, and going on social media, and calling senators in other states as well as Pennsylvania. Keep going, keep pushing, because we can defeat this bill if we keep working together.”
He spoke a day after Senate Republicans unveiled their long-awaited proposal to replace Obamacare, a bill their leaders hope to bring to a vote next week. With Republicans clinging to a two-seat majority in the chamber and Democrats unified against the plan, every vote will count.
Mr. Casey said debate about the bill had paid too little attention to how the proposal would affect people who get their health insurance through their employers — more than 150 million Americans.
“If you’ve got employer coverage, they’re coming for you, too,” he said. “Because if you live in a state in the future where there’s a waiver, you will not get protection from pre-existing conditions.
“They can still make sure that if you’re pregnant, you’re not going to get the kind of maternity benefits that you might need. All that will be legal if the state you live in goes with a waiver,” he said. “So don’t think you’re in the clear because we’re talking a lot about Medicaid. That’s why I said this bill is bad for the whole country.” Read more
June 21, 2017
Meet the 13 Senators Deciding on Your Health Care Behind Closed Doors
The most closely guarded piece of writing this summer isn’t the new season of Game of Thrones —it’s the GOP Senate’s health care bill.For the last several weeks, media outlets have reported that 13 Senate Republicans have been meeting behind closed doors to discuss legislation that could lead to millions fewer Americans having health coverage—and make it hard for many people with pre-existing conditions to buy an affordable plan. While Vox and The New York Times have reported the names of the 13 members, a spokesman for Senate Majority Leader Mitch McConnell didn’t even confirm the existence of the group in an email to MONEY, pointing instead to working lunches that include all 52 Republican senators. Read more
June 20, 2017
GOP Health Bill Kept Secret From Senators Assigned to Write It
One of the Senate Republicans charged with negotiating an Obamacare replacement expressed frustration Tuesday with the secret process, saying that even he hasn’t seen the proposal set to be released in two days for a possible floor vote next week.
“I haven’t seen it yet, either,” said Senator Mike Lee of Utah amid complaints by other Republicans that they don’t know what’s in the health-care measure being drafted by their own party’s leaders. Read more
New York Times
The Senate Is Close to a Health Care
Bill, but Do Republicans Have the Votes?
he 52 Republican senators have been meeting several times a week behind closed doors to develop a bill to repeal and replace the Affordable Care Act. At least 50 of them must be on board for the bill to pass, and they could try as soon as next week.
Republican senators are arranged based on their ideology scores 13 of them, highlighted below, are leading the effort. Read more
June 18, 2017
ObamaCare: Six key parts of the Senate bill
While Senate Republicans are drafting their healthcare plan behind closed doors, they’ve given reporters a general idea of what might be in it.
The bill is shaping up to have a similar structure as the House’s bill, while more reflecting the principles of centrist Republicans in both chambers.
Senators are still hashing out the specifics, but here’s a look at where they appear to be headed. Read more
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