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Why Do So Many People Hate Obamacare So Much?

ed31f_obamacare-protest-30603952e44f44b6e87754104ed8d075569fcbea-s1100-c15 Why Do So Many People Hate Obamacare So Much?

Opposition to Obamacare has been strong from the beginning. Demonstrators made their dissatisfaction clear in front of the Supreme Court in 2015.

Andrew Harrer/Bloomberg via Getty Images


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Andrew Harrer/Bloomberg via Getty Images

Opposition to Obamacare has been strong from the beginning. Demonstrators made their dissatisfaction clear in front of the Supreme Court in 2015.

Andrew Harrer/Bloomberg via Getty Images

The Affordable Care Act, aka Obamacare, has roiled America since the day it was signed into law in 2010. From the start, the public was almost evenly divided between those who supported it and those who opposed it.

They still are. The November monthly tracking poll from the Kaiser Family Foundation found that 50 percent of those polled had a favorable view of the health law, while 46 percent viewed it unfavorably.

Partisan politics drives the split. Eighty percent of Democrats were supportive in November, while 81 percent of Republicans were strongly negative. (Kaiser Health News is an editorially independent program of the foundation.)

That helps explain why Republicans are working to repeal a key element of the health law in the tax bill Congress is negotiating. The requirement that most Americans have health insurance or pay a tax penalty — the so-called individual mandate — is by far the most unpopular provision of the law, particularly among Republicans.

Still, while partisanship is a major reason why some people hate the health law, it’s far from the only one. Here are four more:

Ideology

Conservatives and libertarians strongly object to the federal government becoming ever more involved in the nation’s health care system. While the refrain that the ACA represented a “government takeover” of health care was a significant exaggeration, the law did insinuate the government significantly further in its funding and oversight of health care.

Adding to that was the unhappiness with the ACA’s individual mandate. Although the idea was originally suggested by Republicans in the late 1980s, the GOP had mostly backed away from it over the years (with the notable exception of Massachusetts Gov. Mitt Romney, who supported that state’s health overhaul in 2006).

But conservatives aren’t alone in opposing the ACA on ideological grounds. Many liberals don’t like the law, either. They think it does not go far enough toward a fully government-run system and gives too much power to private insurance companies.

Lack Of Knowledge

A big part of why people don’t like the health law is that they don’t understand what it does or how it works. Some of that is because health care is complicated.

Even some of the main arguments made by the law’s supporters are not well understood. For example, the health law is responsible for some 20 million Americans gaining health insurance. Yet in 2016, when the uninsured rate hit an all-time low, only one-quarter of respondents to the Kaiser tracking poll knew that. A little under half thought the rate had remained unchanged, and 21 percent thought the rate had risen to an all-time high.

But some misperceptions follow intentional fabrications or exaggerations of the law’s impact. Many people came to believe (incorrectly) that the law would create “death panels” to decide the fate of seniors on Medicare, which became PolitiFact’s “Lie of the Year” in 2009. Other outlandish and untrue claims about the law included the idea that it would require people to be microchipped, that it would create a “private army” for President Barack Obama and that it would require hospitals to fire obese employees.

Even the derisive nickname Obamacare fed the confusion. In a now-famous skit by comedian Jimmy Kimmel, people on the street expressed a strong preference for the Affordable Care Act over Obamacare — unaware that they were the same thing.

Confusing The Health Law With The Rest Of The Health System

Once the ACA became law, basically everything bad that happened in health care was attributed to it. This is the famous “you broke it, you bought it” problem. The law became the scapegoat for any number of shortcomings in the health care system, regardless of whether they predated its enactment.

For example, rising prices for prescription drugs has been a problem for years. But the ACA didn’t seek to address that, except for one provision that sought to facilitate generic copies of some of the most expensive biologic medications.

Also, before the ACA, some insurers stopped offering plans in the individual market, while others raised premiums dramatically and often wouldn’t cover care at high-cost providers like teaching hospitals.

Some People Are Worse Off

The ACA did create some losers. Healthy people who managed to buy individual health insurance before the law’s passage have seen their premiums and out-of-pocket costs soar as insurers have raised prices to accommodate sicker people who had been largely shut out of coverage. Among those hardest hit are people who earn just slightly too much to qualify for federal premium subsidies, particularly early retirees and people in their 50s and early 60s who are self-employed.

Many of those people would have been helped if Democrats had been able to pass some of their original ideas for the ACA, including a “public option” plan run by the government, or a so-called Medicare buy-in that would have given people age 55 and older the option of purchasing Medicare coverage before the normal eligibility age of 65. Both were rejected by more conservative Democrats in the Senate.

Some people found themselves in a coverage gap after the Supreme Court in 2012 ruled that the ACA requirement for states to expand Medicaid had to be optional. That meant people with incomes under the poverty line but still too high to qualify for Medicaid in their states have no affordable program available.

Others were forced to give up coverage that they liked, even if it did not offer many benefits, or were angry because their doctors and hospitals were no longer in their insurers’ networks. Obama’s promise that “if you like your health plan you can keep it” was PolitiFact’s “Lie of the Year” for 2013.

However, even some of those consumers have seen benefits from the law, although they might not realize it, like required rebates from insurers who charge too much for administrative costs.

But it is human nature for people who feel wronged to complain loudly, while people who are satisfied merely go on with their lives. In the end, that is why it seems so many more people hate Obamacare than actually do.

Kaiser Health News, a nonprofit health newsroom, is an editorially independent part of the Kaiser Family Foundation. You can follow Julie Rovner on Twitter: @jrovner.

The Health 202: Doug Jones victory nearly closes the GOP doorway to Obamacare repeal

THE PROGNOSIS

Republicans’ already narrow doorway to repealing Obamacare shrank even further last night as Alabamians — for the first time since 1992 — chose a Democrat as U.S. senator.

In what my colleagues describe as a “stunning setback for the Republican Party,” Doug Jones narrowly defeated Republican Roy Moore, a former state judge who was twice removed from the bench and faced allegations he’d made sexual advances toward teenagers while in his 30s.

Moore’s defeat is surely a relief to many Republicans – he already faced a likely ethics investigation in the Senate had he won – but it also means the GOP is now down to a one-vote margin in the Senate when it comes to repealing and replacing the Affordable Care Act, a task at which the party failed miserably over the summer but is contemplating returning to in 2018.

Up until now, the Senate GOP’s 52-seat majority allowed the party to lose two votes on a health-care bill, with tie-breaking help from Vice President Pence. That’s an important number, because the two most moderate Republicans – Sens. Lisa Murkowski of Alaska and Susan Collins of Maine – have been regarded as nearly impossible to bring on board.

When Jones joins the Senate likely in early January, Republicans will now have a 51-vote majority, meaning they can lose either Murkowski or Collins, but not both, and still achieve their long-touted political hopes of rolling back the ACA. Jones is likely to cross the aisle on some issues – he will represent Alabama, after all – the Democrat has already said the ACA should be improved, not repealed.

“Repeal and replace is a political slogan,” Jones said at a press conference in November. “It’s not something that’s workable.”

Politico’s Dan Diamond:

Time’s Nash Jenkins:

The whole situation is an increasingly big disappointment for President Trump, who has repeatedly promised to return to healthcare once Congress finishes its tax overhaul effort:

“The administration is confident Congress will come back to town in the new year and work to repeal and replace the Obamacare disaster,” White House Press Secretary Hogan Gidley said in a statement provided to The Health 202. “Healthcare costs continue to skyrocket and many doctors won’t take patients who have it – Obamacare has failed.”

It’s hard to imagine how Republicans could resume debating what were unpopular health-care bills in a midterm election year, when they couldn’t manage it in an off-election year, especially with what seems like Democratic political momentum. But behind the scenes, some GOP lawmakers are also convinced they should return to the effort once taxes are out of the way — after all, repealing Obamacare is something they relentlessly promised when a Democrat was in the White House.

The GOP idea is to pass a new budget resolution for next year, giving them another way to avoid attracting Democratic support for a controversial health-care measure by seeking just 50 votes for it.

“I don’t think we’re ever going to be able to get away from [health-care],” No. 2 Senate Republican John Cornyn (R-Texas) told me last week.

Republicans are particularly buoyed by the prospect of a health-care measure that might come in more favorably on coverage estimates as scored by the Congressional Budget Office. If the ACA’s individual mandate is repealed in the tax overhaul, which appears likely, future GOP health-care bills might compare more favorably to the status quo (we’ve explained this previously in The Health 202).

“I’ve been in meetings with members who say this is so awesome, we get to say we repealed the mandate and we take all our hits on the coverage losses,” one health-care lobbyist told me.

If Republicans return to health care – and that’s still a big, big if – GOP aides, members and lobbyists say the top contender remains the measure put forward by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.), which the Senate made a last-gasp effort to pass back in September after various versions of their other health-care bills failed.

“I think the general feeling is it will come up again — but not sure on the timing,” said Graham spokesman Kevin Bishop.

Sen. James Lankford (R-Okla.) said Cassidy-Graham is “still the leading candidate for whatever we’re doing.”

In the meantime, Jones is focusing his health-care energy on calling for Congress to reauthorize the Children’s Health Insurance Program, which technically expired in October. The House has passed a reauthorization bill, which Democrats tried to block because they disliked how it was paid for, but the Senate has yet to pass a measure. Some states have started notifying recipients that the program is in serious jeopardy as federal funds run low.

From BuzzFeed’s Brandon Wall: 

PBS NewHour’s Courtney Norris:

Sen. Chris Van Hollen (D-Md.):

Defeated Alabama Senate candidate Roy Moore. Mandatory Credit: Photo by DAN ANDERSON/EPA-EFE/REX/Shutterstock (9287508s)

AHH: Republican strategists believed that for Alabama’s antiabortion hard-liners, a vote for Jones would be a bridge too far. They were wrong, The Post’s Marc Fisher reports. Jones’s unlikely victory was driven in part by revulsion over the allegations of sexual misconduct against Moore, but also by resistance against a torrent of TV ads that urged voters to make abortion a defining litmus test, Marc writes.

In the run-up to yesterday’s election, Moore denied any improper sexual behavior but also went on the offensive against Jones for being a pro-abortion rights radical, a supporter of abortion at any time, for any reason, Marc writes. Moore’s campaign saw the issue as a time-tested way of painting Democrats as extremists — and indeed, it’s a tactic that has worked well in the past.

But most Alabama voters didn’t put abortion atop their list of defining issues, according to a Washington Post-Schar School poll last month which found that 41 percent of voters thought a candidate’s views on health care were most important, followed by moral conduct at 26 percent. Abortion trailed well behind at 14 percent. Moore did garner 70 percent of voters who said abortion should be illegal in all cases, according to exit polls. 

“Abortion remains one of the few issues that most voters call an absolute litmus test; that is, along with health care, same-sex marriage and immigration, abortion is a rare issue on which a majority of voters say they could not bring themselves to vote for a candidate who disagrees with them,” Marc writes. “But in Tuesday’s vote, many did exactly that — an indication, some scholars said, that as Americans, even in the Deep South, become more secular, abortion politics no longer wields the same sway it once did.”

(See my write up in yesterday’s Health 202 explaining why this was a difficult call for antiabortion activists.)

Demetra Ashley, acting assistant administrator for the Drug Enforcement Administration, testifies before the Senate Judiciary Committee on Tuesday. (Melina Mara/The Washington Post)

OOF: Recall that 2016 law curbing the DEA’s powers to use its most potent weapons against drug companies failing to report suspicious orders of prescription painkillers? The head of the DEA office that regulates pharmaceutical opioids said yesterday the law should be either repealed or amended, because it has made enforcement more difficult in urgent circumstances, The Post’s Lenny Bernstein and Scott Higham report.

Demetra Ashley told the Senate Judiciary Committee the DEA agrees with the Justice Department that the law should be altered to help curb the ongoing opioid epidemic. Under the law — which The Post and “60 Minutes” reported on in October — it’s been harder for DEA investigators to show a company’s conduct poses an immediate danger of death or harm in order to shut down shipments of painkillers from a distributor to a pharmacy. The law was originally pushed by a small group of lawmakers allied with drug companies.

“Since the law was passed, Ashley said, DEA investigators have faced a greater challenge showing that a company’s conduct poses an immediate danger of death or harm in order to shut down shipments of painkillers from a distributor to a pharmacy,” Lenny and Scott write. “That burden has moved the agency away from its traditional posture of preventing harm, she said.”

Senators in the hearing broke down largely — but not completely — along party lines about whether changes are needed. Sen. Dianne Feinstein (D-Calif.) said that in her view, the law has done harm. But Sen. Orrin Hatch (R-Utah), who led Senate negotiations over it, pushed back against Ashley’s criticisms.

“This wasn’t some effort to help drug companies kill people. Give me a break,” Hatch said. “This was an effort to ensure that DEA’s efforts . . . didn’t end up hurting legitimate patients.”

450d5_imrs The Health 202: Doug Jones victory nearly closes the GOP doorway to Obamacare repeal

Shawnee Wilson holds her son, Kingston, in her apartment in Indianapolis. Kingston was born in 2016, and it took a month for doctors to wean him off the heroin Wilson exposed him to. He is in foster care now in Indianapolis, and Wilson is fighting to get him back. (AP Photo/Darron Cummings)

OUCH: The Associated Press spent some time with Judge Marilyn Moores, who handles child welfare cases in Indianapolis, to illuminate how the nation’s spike in opioid abuse is straining an already overburdened foster care system. “Across the U.S., soaring use of opioids has forced tens of thousands of children from their homes, creating a generation of kids abandoned by addicted parents, orphaned because of fatal overdoses or torn from fractured families by authorities fearful of leaving them in drug-addled chaos,” Matt Sedensky and Meghan Hoyer write.

“This isn’t a trickle. This isn’t a wave. It’s a tsunami,” Moores told the AP. Ever since Moores started as a judge in 2006, the number of filings for children in need of services has more than tripled to 4,649 in Marion County — and it’s largely because of a massive surge in cases involving opioids.

“Behind each of those cases is a child subjected to the realities of life amid addiction — of barren fridges, unwelcome visitors and parents who couldn’t be roused awake. Moores is still haunted by the story of a 2-year-old found alone at home with his father’s corpse, a needle still poking from his arm. A neighbor was drawn in by the boy’s relentless wails,” Matt and Meghan write. “By Friday, the largest pile of cases on Moores’ desk has reached a towering two feet, and she has plodded on in bureaucratic fights to get more judges, more court reporters and more mediators to deal with work in which the despair dwarfs the fleeting moments of hope.”

“It seems like there’s a whole generation of people disappearing,” Moores told them.

450d5_imrs The Health 202: Doug Jones victory nearly closes the GOP doorway to Obamacare repeal

The HealthCare.gov website. (AP Photo/Andrew Harnik, File)

Open enrollment on Healthcare.gov is scheduled to end on Friday. But more than half of people shopping for health insurance don’t know that enrollment is closing, according to a survey from eHealth out today. That’s true even among proactive health-care shoppers, the online broker finds. Here are some other key highlights from the survey.

  • There’s a sharp contrast between prices for consumers who received subsidies compared with consumers who did not receive subsidies. The survey found 36 percent of people eligible for subsidies say they are paying $100 or less per month for coverage. And 36 percent of unsubsidized consumers say they are paying at least $1,000 per month.
     
  • The survey found 71 percent of people overall would still buy insurance even if the individual mandate is repealed. And that’s especially true of people who pay full price for insurance. Unsubsidized consumers are more likely to continue buying insurance plans without the individual mandate than those who receive subsidies.
     
  • One in five subsidized consumers said they were eligible for a zero-premium plan, and 12 percent said they actually enrolled in a plan without a monthly premium. 

Sens. Ron Wyden (D-Ore.) and Sen. Patty Murray (D-Wash.) pause during a Senate Budget Committee hearing. (AP Photo/Carolyn Kaster)

–Two top Senate Democrats are urging the Trump administration to extend open enrollment, which spans only half the length of last year’s sign-up season. In a letter to acting Health and Human Services Secretary Eric Hagan, Sens. Ron Wyden (D-Ore.) and Patty Murray (D-Wash.) criticized the administration for cutting down the enrollment period (even though we should note the plan was originally conceived by the Obama administration; the Trump administration just hastened it by one year).

“The administration’s decision to depart from years of agency policy by ending open enrollment on December 15th is compounded by the many other efforts by this administration to destabilize the insurance market, making it likely that many consumers miss this deadline and forgo insurance next year—all despite clear indications that consumers are highly interested in seeking coverage for 2018,” they wrote.

Ohio Gov. John Kasich is among a dozen governors pleading for Congress to reauthorize the CHIP program. (AP Photo/Jay LaPrete, File)

–Twelve Democrat and Republican governors are urging Congress to reauthorize funding for the Children’s Health Insurance Program as soon as possible, after it technically expired in October, per the AP. 

In a letter sent yesterday, Ohio Gov. John Kasich (R) and Colorado Gov. John Hickenlooper (D) — along with the governors of Alaska, Louisiana, Massachusetts, Minnesota, Montana, Nevada, New Hampshire, Pennsylvania, Vermont and Virginia — urged members of Congress to quickly reauthorize CHIP so their states don’t experience any gaps in funding. Funding the program “without disruption” is something they can all agree on, the governors wrote.

Yet it’s looking less and less likely that Congress will find a solution to their gridlock over CHIP before the end of the year, according to multiple reports over the past several days. The House has actually passed a five-year CHIP reauthorization bill, but Democrats refused to support it because they didn’t like how it would be paid for. The Senate has agreed on a bipartisan reauthorization measure, but hasn’t dealt with the controversy over how to fund it.

–A few more good reads from The Post and beyond:

Today

  • The Kaiser Family Foundation holds an event on “Living in an Immigrant Family in America: How Fear and Toxic Stress Are Affecting Daily Life, Well-Being, and Health.”
  • The Senate Health, Education, Labor and Pensions Committee has a hearing on “Implementation of the 21st Century Cures Act: Responding to Mental Health Needs.”
  • The House Energy And Commerce Subcommittee on Health holds a hearing on “Examining the Drug Supply Chain.”

“It’s not over”: Republican Roy Moore raises possibility of recount:

Watch Jones supporters celebrate after the election is called:

CNN’s Jake Tapper explains to Roy Moore’s campaign spokesman that elected officials don’t have to be sworn in on the Bible:

White House press secretary Sarah Huckabee Sanders said there was no sexual connotation to President Trump’s tweet criticizing Sen. Kirsten Gillibrand (D-N.Y.):

Members of the Democratic Working Women’s Group are calling for the Government Oversight Committee to investigate President Trump’s sexual misconduct accusations:

Maryland health exchange extends deadline to enroll in Obamacare

Marylanders seeking health insurance under the federal Affordable Care Act will get an extra seven days to sign up, state officials plan to announce Wednesday.

The new enrollment deadline is December 22 rather than Friday.

The deadline was extended by a week to accommodate procrastinators and avoid a last-minute enrollment crush at the end of this week.

The state had adopted a shortened 45-day enrollment period set by the Trump administration for purchasing health insurance, known as Obamacare, on the federal exchange used by most states. But Maryland operates its own online marketplace for those who do not get insurance through their jobs and was free to extend the deadline.

Obamacare taxes, GOP tax cut bill frustrate health insurers

A pair of Obamacare taxes are poised to strike health companies at the end of this year, adding more pain to what’s already been a rough few months for insurers.

The 2010 law’s tax on health-insurance companies and a 2.3 percent excise tax on medical devices are both slated to take effect in the new year, after a two-year delay.

Combined with the GOP’s tax-cut push, which could sap millions of customers from insurers’ rolls over the next decade, insurance executives are pleading for relief, saying Congress should at least nix the tax on premiums, while device-makers point to bipartisan support for killing the levy on their sales.

“We’re sort of, writ large, frustrated as an industry,” said Greg Crist, spokesman for AdvaMed, a trade group for device manufacturers. “We felt like it should have been done sooner.”

Industry officials say they’re hopeful that GOP leaders can find some kind of reprieve by Jan. 1, though they didn’t get any relief in the tax-cut bills the House and Senate have passed. A final compromise is being worked out.

“All I can say right now is Republicans are staying at the table. We want those taxes out of the health care [system] and out of the economy as soon as possible. So stay tuned,” said House Ways and Means Committee Chairman Kevin Brady, Texas Republican and lead tax-writer for his chamber.

The tax-cut bill is one of a number of must-pass bills Congress is working on this month, giving industry advocates some hope they will win relief.

In a brief statement, the White House said Mr. Trump supports congressional efforts to delay Obamacare’s “harmful taxes” amid redoubled efforts to repeal and replace the whole law.

“The president remains committed to providing the American people with affordable health care, including relief from the onerous mandates and taxes of the catastrophic Obamacare law,” said Deputy Press Secretary Hogan Gidley.

The health insurance tax, or “HIT,” is a fee that rises by a set amount each year and is divvied among insurers based on the share of premiums they collected the prior year.

Freezing it in 2018 would cost the federal government about $14 billion.

Repealing the medical device tax would cost the government nearly $20 billion through 2026, the Joint Committee for Taxation said earlier this year.

Opponents of the device tax insist they have a strong case, saying it stifles innovation and was put into the 2010 law as a revenue raiser, rather than as a policy goal.

“I think there’s been bipartisan agreement about the tax for some time,” said Shaye Mandle, president and CEO of Medical Alley Association, which represents health care companies in Minnesota. “Whether it’s going to be a in a standalone bill or a larger package — [like] the extenders — or full repeal or suspension for a period of time is the work that needs to be resolved.”

Insurers, meanwhile, have railed against the HIT for years, saying they end up passing the costs on to consumers in the form of higher premiums.

“It is a fact that when a product or service is taxed, it is more expensive for consumers to purchase. Taxing health insurance is no different,” the top insurers’ lobby, America’s Health Insurance Plans, wrote earlier this year to Sen. Orrin G. Hatch when the Utah Republican and Senate Finance Committee chairman solicited ideas on reforming the tax code.

Analysts said customers are paying an extra 2.5-3 percent extra for coverage they’re buying right now, because insurers baked the cost into 2018 plans instead of assuming the tax would be delayed again.

“It’s not a huge amount of money, but it’s also not nothing,” said Chris Sloan, senior manager at Avalere, a health policy consultancy.

Congress is already trying to rein in runaway premiums, but has been looking instead at restoring cost-sharing payments for Obamacare insurers or federal funding for reinsurance programs that blunt the cost of sicker, pricier customers in the individual market, so healthier consumers don’t have to pay more.

While those fixes might have a bigger impact on premiums than repealing the health insurance tax, the HIT is more far-reaching, affecting coverage beyond the Obamacare exchanges and individual market, such as plans that private insurers offer through employers or government programs like Medicaid.

Copyright © 2017 The Washington Times, LLC. Click here for reprint permission.

Please enable JavaScript to view the comments powered by Disqus.blog comments powered by Disqus

 

Obamacare taxes, GOP tax cut bill frustrate health insurers

A pair of Obamacare taxes are poised to strike health companies at the end of this year, adding more pain to what’s already been a rough few months for insurers.

The 2010 law’s tax on health-insurance companies and a 2.3 percent excise tax on medical devices are both slated to take effect in the new year, after a two-year delay.

Combined with the GOP’s tax-cut push, which could sap millions of customers from insurers’ rolls over the next decade, insurance executives are pleading for relief, saying Congress should at least nix the tax on premiums, while device-makers point to bipartisan support for killing the levy on their sales.

“We’re sort of, writ large, frustrated as an industry,” said Greg Crist, spokesman for AdvaMed, a trade group for device manufacturers. “We felt like it should have been done sooner.”

Industry officials say they’re hopeful that GOP leaders can find some kind of reprieve by Jan. 1, though they didn’t get any relief in the tax-cut bills the House and Senate have passed. A final compromise is being worked out.

“All I can say right now is Republicans are staying at the table. We want those taxes out of the health care [system] and out of the economy as soon as possible. So stay tuned,” said House Ways and Means Committee Chairman Kevin Brady, Texas Republican and lead tax-writer for his chamber.

The tax-cut bill is one of a number of must-pass bills Congress is working on this month, giving industry advocates some hope they will win relief.

In a brief statement, the White House said Mr. Trump supports congressional efforts to delay Obamacare’s “harmful taxes” amid redoubled efforts to repeal and replace the whole law.

“The president remains committed to providing the American people with affordable health care, including relief from the onerous mandates and taxes of the catastrophic Obamacare law,” said Deputy Press Secretary Hogan Gidley.

The health insurance tax, or “HIT,” is a fee that rises by a set amount each year and is divvied among insurers based on the share of premiums they collected the prior year.

Freezing it in 2018 would cost the federal government about $14 billion.

Repealing the medical device tax would cost the government nearly $20 billion through 2026, the Joint Committee for Taxation said earlier this year.

Opponents of the device tax insist they have a strong case, saying it stifles innovation and was put into the 2010 law as a revenue raiser, rather than as a policy goal.

“I think there’s been bipartisan agreement about the tax for some time,” said Shaye Mandle, president and CEO of Medical Alley Association, which represents health care companies in Minnesota. “Whether it’s going to be a in a standalone bill or a larger package — [like] the extenders — or full repeal or suspension for a period of time is the work that needs to be resolved.”

Insurers, meanwhile, have railed against the HIT for years, saying they end up passing the costs on to consumers in the form of higher premiums.

“It is a fact that when a product or service is taxed, it is more expensive for consumers to purchase. Taxing health insurance is no different,” the top insurers’ lobby, America’s Health Insurance Plans, wrote earlier this year to Sen. Orrin G. Hatch when the Utah Republican and Senate Finance Committee chairman solicited ideas on reforming the tax code.

Analysts said customers are paying an extra 2.5-3 percent extra for coverage they’re buying right now, because insurers baked the cost into 2018 plans instead of assuming the tax would be delayed again.

“It’s not a huge amount of money, but it’s also not nothing,” said Chris Sloan, senior manager at Avalere, a health policy consultancy.

Congress is already trying to rein in runaway premiums, but has been looking instead at restoring cost-sharing payments for Obamacare insurers or federal funding for reinsurance programs that blunt the cost of sicker, pricier customers in the individual market, so healthier consumers don’t have to pay more.

While those fixes might have a bigger impact on premiums than repealing the health insurance tax, the HIT is more far-reaching, affecting coverage beyond the Obamacare exchanges and individual market, such as plans that private insurers offer through employers or government programs like Medicaid.

Copyright © 2017 The Washington Times, LLC. Click here for reprint permission.

Please enable JavaScript to view the comments powered by Disqus.blog comments powered by Disqus

 

Obamacare taxes, GOP tax cut bill frustrate health insurers

A pair of Obamacare taxes are poised to strike health companies at the end of this year, adding more pain to what’s already been a rough few months for insurers.

The 2010 law’s tax on health-insurance companies and a 2.3 percent excise tax on medical devices are both slated to take effect in the new year, after a two-year delay.

Combined with the GOP’s tax-cut push, which could sap millions of customers from insurers’ rolls over the next decade, insurance executives are pleading for relief, saying Congress should at least nix the tax on premiums, while device-makers point to bipartisan support for killing the levy on their sales.

“We’re sort of, writ large, frustrated as an industry,” said Greg Crist, spokesman for AdvaMed, a trade group for device manufacturers. “We felt like it should have been done sooner.”

Industry officials say they’re hopeful that GOP leaders can find some kind of reprieve by Jan. 1, though they didn’t get any relief in the tax-cut bills the House and Senate have passed. A final compromise is being worked out.

“All I can say right now is Republicans are staying at the table. We want those taxes out of the health care [system] and out of the economy as soon as possible. So stay tuned,” said House Ways and Means Committee Chairman Kevin Brady, Texas Republican and lead tax-writer for his chamber.

The tax-cut bill is one of a number of must-pass bills Congress is working on this month, giving industry advocates some hope they will win relief.

In a brief statement, the White House said Mr. Trump supports congressional efforts to delay Obamacare’s “harmful taxes” amid redoubled efforts to repeal and replace the whole law.

“The president remains committed to providing the American people with affordable health care, including relief from the onerous mandates and taxes of the catastrophic Obamacare law,” said Deputy Press Secretary Hogan Gidley.

The health insurance tax, or “HIT,” is a fee that rises by a set amount each year and is divvied among insurers based on the share of premiums they collected the prior year.

Freezing it in 2018 would cost the federal government about $14 billion.

Repealing the medical device tax would cost the government nearly $20 billion through 2026, the Joint Committee for Taxation said earlier this year.

Opponents of the device tax insist they have a strong case, saying it stifles innovation and was put into the 2010 law as a revenue raiser, rather than as a policy goal.

“I think there’s been bipartisan agreement about the tax for some time,” said Shaye Mandle, president and CEO of Medical Alley Association, which represents health care companies in Minnesota. “Whether it’s going to be a in a standalone bill or a larger package — [like] the extenders — or full repeal or suspension for a period of time is the work that needs to be resolved.”

Insurers, meanwhile, have railed against the HIT for years, saying they end up passing the costs on to consumers in the form of higher premiums.

“It is a fact that when a product or service is taxed, it is more expensive for consumers to purchase. Taxing health insurance is no different,” the top insurers’ lobby, America’s Health Insurance Plans, wrote earlier this year to Sen. Orrin G. Hatch when the Utah Republican and Senate Finance Committee chairman solicited ideas on reforming the tax code.

Analysts said customers are paying an extra 2.5-3 percent extra for coverage they’re buying right now, because insurers baked the cost into 2018 plans instead of assuming the tax would be delayed again.

“It’s not a huge amount of money, but it’s also not nothing,” said Chris Sloan, senior manager at Avalere, a health policy consultancy.

Congress is already trying to rein in runaway premiums, but has been looking instead at restoring cost-sharing payments for Obamacare insurers or federal funding for reinsurance programs that blunt the cost of sicker, pricier customers in the individual market, so healthier consumers don’t have to pay more.

While those fixes might have a bigger impact on premiums than repealing the health insurance tax, the HIT is more far-reaching, affecting coverage beyond the Obamacare exchanges and individual market, such as plans that private insurers offer through employers or government programs like Medicaid.

Copyright © 2017 The Washington Times, LLC. Click here for reprint permission.

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Some glitches seen in deadline week for ‘Obamacare’ sign-ups

Consumer advocates reported some glitches Monday in the final days for “Obamacare” sign-ups, although the Trump administration largely seemed to be keeping its promise of a smooth enrollment experience.

In Illinois, some consumers who successfully completed an application for financial assistance through HealthCare.gov got a message saying they would likely be eligible to buy a health plan, “but none are available to you in your area.”

That information was incorrect because every county in the nation currently has at least one health insurer offering plans under the Affordable Care Act for next year.

Friday is the last day to enroll for subsidized private coverage in 39 states served by the federal HealthCare.gov website. Consumer interest has remained brisk, even as the Trump administration cut the sign-up season in half, reducing it from roughly from 90 days to 45 days.

Former President Barack Obama offered encouragement Monday for the closing push, posting on social media and joining a conference call with enrollment counselors.

On the call, Obama accused “Republicans in Washington” of trying to “sabotage” progress made reducing the number of uninsured. The American people “don’t want a health care system that’s sent into chaos just for partisan reasons,” Obama said, according to a transcript provided by his office.

President Donald Trump came into office looking to dismantle his predecessor’s health law, but it survived. Although the administration slashed the ad budget for sign-up season and scaled back grants for enrollment counselors, officials promised the HealthCare.gov website would work seamlessly this year. That promise will be tested in this week’s crush.

Stephani Becker of the Sargent Shriver National Center on Poverty Law in Chicago said the glitch in which consumers were told there were no plans was reported by counselors starting late last week, and again Monday. It also surfaced in other states besides Illinois, she said.

Trained counselors know enough about the program to question the accuracy of the message, but “the average consumer might just walk away,” Becker said.

An administration official said the issue has been resolved, and HealthCare.gov is reaching out to the consumers affected to encourage them to complete their applications. However, Becker said advocates had gotten a similar response from the administration last week, and the problem continued.

For millions of consumers eligible to enroll time runs out on Dec. 15. Thursday and Friday are expected to be the heaviest days.

That could slow the HealthCare.gov website, and lead to long hold times at the federal call center. For most people, this is the last opportunity to secure coverage for 2018, or switch from an existing plan.

One exception: People living in hurricane-affected areas can get an extension to sign up by Dec. 31 by contacting the HealthCare.gov call center. That could make a difference in states such Florida, Texas, and Georgia.

Enrollment fluctuates in the course of the year, but it’s estimated that 9 million to 10 million people currently have coverage through the ACA’s marketplaces. The markets cater to people who don’t have access to a job-based plan, and participation is expected to dip somewhat next year.

In a twist, many people eligible for financial help may actually be able to pay lower premiums in 2018. Although list price premiums for the most popular plans went up sharply, so did taxpayer-provided subsidies that limit how much individuals actually have to pay. In many communities, bare-bones “bronze” plans are available for no monthly premium to those eligible for subsidies.

Deadline hour for enrollment will remain the same this year — midnight Pacific time. That means consumers on the East Coast will have until 3 a.m. on Saturday morning to enroll.

Although the Trump administration slashed the advertising budget, HealthCare.gov has been sending out targeted emails to people potentially eligible. Example:

— “FINAL DEADLINE: Enroll in a 2018 health plan before December 15 or risk going without Marketplace coverage.”

During the Obama years, officials allowed a grace period for consumers who started an application, but were unable to finish by the deadline. It’s unclear if the Trump administration will allow such extensions, or whether it will strictly enforce the deadline hour. Previous extensions allowed hundreds of thousands of consumers to enroll.

Failure to provide extensions this year would be a mistake, said Andy Slavitt, who oversaw HealthCare.gov under Obama.

“It really would not be fair to people, particularly if there are technology challenges with the last minute surge as there have been every year,” Slavitt said.

While Dec. 15 is the deadline for states served by HealthCare.gov, that’s not the case everywhere. Most states that run their own health insurance websites are providing an extended period for consumers to enroll. In California and New York, for instance, the deadline remains the same as last year — Jan. 31. Other states have deadlines spanning from late December to mid-January.

Mix-and-match health coverage can be a risky alternative to Obamacare

Health insurance à la carte?

As the Affordable Care Act open enrollment season moves into its final weeks, some consumers looking for lower-cost alternatives are considering a patchwork approach to health insurance. The products may secure some basic protection, but leave patients on the hook for high medical bills.

The idea involves mixing and matching several types of insurance products originally designed to cover the deductibles and other gaps in traditional coverage.

“We have several carriers” from which clients can choose “prescription coverage from one and accident coverage from another and critical illness care from someone else,” said Eric Jans, a Nashville, Tenn., broker.

An entire package, he added, usually costs $900 to $1,000 a month for a family.

Though not new, the tactic is gaining momentum and interest with consumers — particularly in regions of the country with high ACA plan premiums.

And it’s gone national with the online firm eHealth, which launched a set of packages Nov. 1 and promotes them on its website to people who “can’t afford Obamacare.”

The packages won’t exempt people from the IRS penalty under the ACA, experts warn.

And consumer advocates caution the concept falls far short of full coverage.

“We’re seeing increased marketing of these over the past year. It’s a very risky proposition for consumers,” said Betsy Imholz, special projects director for Consumers Union. “Proceed with extreme caution.”

The packages cobble together “fixed-benefit indemnity” plans, also known as “gap coverage” plans, with other types of policies.

Most such “gap coverage” plans are underwritten, meaning they ask about applicants’ health and can exclude people with medical problems, or exempt those conditions from coverage.

These plans pay an often small per-day or per-service amount toward hospital care, doctor visits and lab tests — for example, $65 for a primary care appointment or $175 for an advanced imaging test.

The packages usually include a prescription drug discount card.

Many also feature a “critical illness policy” that pays a lump sum of between $5,000 to as much as $50,000 if the policyholder is diagnosed with a qualifying illness, such as a heart attack, cancer or stroke. Some also incorporate short-term medical policies, which must be renewed every 90 days.

None provides comprehensive major medical coverage.

The effort to reinvigorate sales of such policies comes as premiums for some ACA plans are rising rapidly, fueled by that ban on rejecting people who are sick, the inability of Congress to agree on efforts to stabilize the market and Trump administration actions that undermine the federal health law.

In some markets, families now face ACA premiums that exceed $20,000 a year.

“There are entrepreneurs all over the insurance industry looking at the fact that people can’t access insurance they can afford,” said Robert Laszewski, an industry consultant based near Washington, D.C.

Detailing the coverage

The IHC Group, which offers the type of hospital indemnity coverage often included in such packages, provides a hypothetical example of how its plan works. A person in the hospital with pneumonia for five days, two of them in intensive care, would receive a flat payment of $12,250 in total toward that hospital bill.

While that may sound like a lot, the hospital bill, “if you’re on a ventilator and getting antibiotics, could be $12,000 a day,” said Missy Conley, director of consumer claims at Roanoke-based Medliminal, a firm that helps consumers sort out their medical bills.

“And that’s just the nursing staff and the room,” she said. “It doesn’t include the physician who pops in or the respiratory therapists.”

Most people have no clue how much big-ticket items like hospital care, chemotherapy or surgery can cost. And it’s hard to get medical providers to disclose their charges. Still, the average cost of a three-day stay in the hospital is $30,000, according to the federal government’s health website, healthcare.gov.

Even with those limitations, some consumers are now eying the packages for their sole coverage.

“With [these products], we try to put together carriers that provide something [as] close to major medical as we could get,” said Nate Purpura, eHealth’s vice president of marketing.

Prices vary by carrier, level of coverage and the age and gender of the applicant.

Even with lower premiums, a package might not end up being less expensive than an ACA plan if the consumer has a medical issue or two during the year.

The materials eHealth uses to explain its plans illustrate that point.

It starts by warning consumers that medical insurance packages “may not be the best option” if they have job-based insurance or can afford an ACA plan.

But then it highlights Jane, a hypothetical 28-year-old who says she can’t afford the $350 a month an ACA plan would cost her.

Instead, she gets an eHealth package plan for $230 a month, saving $1,440 in premiums for the year.

Unfortunately, Jane has a bike accident, breaks a bone and then a month later needs new glasses.

The example shows that her package of plans paid a total of $17,000 toward the ambulance ride, the hospital costs, her pain medicine and her new glasses. Jane saved $17,000 of total costs incurred of $21,550, the brochure says.

But, what it doesn’t spell out is that she still had to pay about $4,550 for her share of the rest of the tab.

Certainly, she’s better off financially than being uninsured. But, in reality, her package plan cost her $3,110 more than if she had gone with the seemingly more expensive ACA coverage.

“Every dollar you don’t spend on premiums looks like a savings,” said Michael Lujan, co-founder of employer benefit firm Limelight Health in San Francisco, and a board member of the Silicon Valley Association of Health Underwriters. “But let’s say you end up in the hospital with surgery or whatever, you need to weigh that and consider ‘What would my costs be?'”

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Health Insurers See Higher Prices And A Big Mess Ahead Without The Obamacare Mandate

“Let’s assume for a second that you eliminate the mandate and so those healthy people decide to sit out, whether they need a subsidy or not, the pool shrinks,” said Jim Havens, senior vice president of individual and senior markets for Mountlake Terrace, Washington-based Premera Blue Cross.

Health Insurers See Higher Prices And A Big Mess Ahead Without The Obamacare Mandate

“Let’s assume for a second that you eliminate the mandate and so those healthy people decide to sit out, whether they need a subsidy or not, the pool shrinks,” said Jim Havens, senior vice president of individual and senior markets for Mountlake Terrace, Washington-based Premera Blue Cross.

Health Insurance Challenges for Young People Off Obamacare | Time

Marguerite Moniot felt frustrated and flummoxed, despite the many hours she spent in front of the computer this year reading consumer reviews of health insurance plans offered on the individual market in Virginia. Moniot was preparing to buy a policy of her own, knowing she would age out of her parent’s plan when she turned 26 in October.

She asked her parents for help and advice. But they, too, ran into trouble trying to decipher which policy would work best for their daughter. The family had relied on her father’s employer-sponsored plan through his work as an architect for years, so no one had spent much time sifting through policies.

“Honestly, my parents were just as confused as I was,” said Moniot, a restaurant server in Roanoke.

In defeat, just before Thanksgiving, she went with her mother to meet a certified health insurance navigator, buying a policy that allowed her to keep her current doctors.

A new crop of young people like Moniot are falling off their parents’ insurance plans when they turn 26 — the age when the Affordable Care Act stipulates that children must leave family policies.

They were then expected to be able to shop relatively easily for their own insurance on Obamacare marketplaces. But with Trump administration revisions to the law and congressional bills injecting uncertainty into state insurance markets, that task of buying insurance for the first time this year is anything but simple.

The shortened sign-up period, which started Nov. 1, runs through Dec. 15. That window is half as long as last year’s, hampering those who wait until the last minute to obtain insurance.

Reminders and help are scarcer than before: The federal government cut marketing and outreach funds by $90 million, and federal funding to groups providing in-person assistance was whacked by 40 percent.

“I think it’s definitely going to be difficult. There’s just additional barriers with [less] in-person help, just fewer resources going around,” said Erin Hemlin, director of training and consumer education for Young Invincibles, an advocacy group for young adults.

Emily Curran, a research fellow at Georgetown University’s Health Policy Institute, said those actions combined with the Trump administration’s vigorous criticism of the health law could further handicap the uphill battle to entice young people to enroll. As of Nov. 25, nearly 2.8 million people had enrolled through the federal marketplace, according to the Centers for Medicare Medicaid Services. The data were not sorted by age.

“There’s already a barrier where young adults are having difficulty understanding what the value of insurance is,” she said. “Coming out … and saying prices are going up, choice is going down and this law is a mess doesn’t really get at the young adult population.”

Trouble attracting young ddults

Before the Affordable Care Act, young adults had the highest uninsured rate of any age group.

The ACA made coverage more affordable and accessible. It allowed states to expand Medicaid to cover single, childless adults. Tax credits to help pay for premiums made plans on the individual market more affordable for people whose incomes fell between 100 and 400 percent of the federal poverty level (between $12,060 and $48,240 for an individual). And young adults were allowed to stay on their parents’ plan until their 26th birthday.

In all, the uninsured rate dropped to roughly 15 percent among 19- to 34-year-olds in 2016. Still, young adults have not joined the individual market in the numbers as expected. About a quarter of marketplace customers in 2016 were ages 18-34, according to the Department of Health and Human Services. But that age group makes up about 40 percent of the exchanges’ potential market, according to researchers and federal officials.

If the Trump administration’s moves dampen enrollment, insurers could face additional challenges in attracting healthy adults to balance those with illnesses, who drive up costs.

“When you’re relatively healthy, it’s not something that you’re thinking about,” said Sandy Ahn, associate research professor at Georgetown University’s Health Policy Institute.

But illness does not recognize age. Dominique Ridley, who turns 26 on Dec. 6, knows this all too well.

Ridley has asthma. She always carries an inhaler and sees a doctor when she feels her chest tighten. The student at Radford University in Virginia relies on her mother’s employer-sponsored plan for coverage.

Ridley started peppering her parents with questions about health insurance as soon as she started seeing ads for this year’s open enrollment.

“I don’t want to just go out there and apply for health insurance, and it be all kinds of wrong and I can’t afford it,” she said.

Her parents didn’t have the answers, but her mother linked up Ridley with a friend that runs a marketing company tailored to promoting the Affordable Care Act. Ridley then connected with a broker who signed her up for a silver plan that will cost her less than $4 per month, after receiving a premium subsidy of more than $500 a month.

“If you don’t have health insurance, you don’t have anything,” Ridley said.

A digital campaign

The Obama administration relied in part on partnerships to attract young enrollees to sign up. Last year, it collaborated with national organizations like Planned Parenthood Federation of America and Young Invincibles on a social media campaign called #HealthyAdulting. Emails, according to Joshua Peck, former chief marketing officer for healthcare.gov, were particularly effective for recruitment.

The Centers for Medicare Medicaid Services, which oversees the marketplaces, said it will focus this year’s resources on “digital media, email and text messages.”

Hemlin said the government has not asked Young Invincibles to assist in marketing. Her group will use its own resources to pay for targeted ads on social media to reach the target demographic, she said.

“But obviously we can’t make up for $90 million in advertising” that’s been cut, said Hemlin.

One factor that might compensate is that 20-somethings are facile at shopping online, said Jill Hanken, director of Enroll! Virginia, a statewide navigator program.

“Our job is to make sure they understand to look at provider networks and drug formularies if they have health concerns. But they’re able to do the mechanics of enrollment on their own very often.”

James Rowley, a 26-year-old entrepreneur from Fairfax, Va., is among those who signed up without help. He started his own company two years ago while covered under his father’s health plan. When he turned 26, he signed up for health insurance on his own through a special enrollment period this year. When general enrollment opened, he once again picked a plan.

“I might not 100 percent need it now, but there will come a time where health insurance is important,” said Rowley.

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Carmen Heredia Rodriguez is a Kaiser Health News reporter.

The Health 202: Senate GOP intensifies push to send more cash to Obamacare marketplaces

THE PROGNOSIS

Sen. Susan Collins (R-Maine) says she’s confident Congress will pass two measures to stabilize the Obamacare marketplaces, even after lawmakers repealed the individual mandate to buy insurance. (AP Photo/J. Scott Applewhite)

Senate Republicans are increasingly resolved to infuse more funding into the Obamacare marketplaces, even as they work on a parallel measure to undermine the health-care law by erasing its mandate to buy coverage.

In an email sent to senators Tuesday night, Senate Majority Leader Mitch McConnell (R-Ky.) promised imminent action on a pair of measures designed to stabilize the marketplaces and help mitigate the premium hikes that some consumers are experiencing. “We will address legislation that Lamar, Susan and others are drafting to protect our constituents from skyrocketing premium increases,” McConnell wrote, referring to Sens. Lamar Alexander (R-Tenn.) and Susan Collins (R-Maine).

Yesterday, Collins told reporters she has a fresh promise from Alexander that the Senate will take up the marketplace funding bills, probably as part of a big, year-end spending deal. And although members of the House Freedom Caucus have often characterized the measures as an Obamacare “insurer bailout,” their leader, Mark Meadows (R-N.C.) indicated he might be willing to back them, after all.

Characteristic of their rather helter-skelter approach to the Affordable Care Act, McConnell and his leadership team seem intent on passing the marketplace stabilization measures right on the heel of voting to dismantle the health-care law’s centerpiece — its requirement to buy health insurance. The two-prong approach is designed to keep both the GOP’s right flank as well as those closer to the center on board as Republicans heave themselves toward the heavy year-end lifts of a major tax overhaul, plus a bill to keep the government funded.

It appears virtually certain that repeal of the law’s individual mandate to buy coverage will be included in a final tax bill. Two of the moderate senators most likely to defect over that issue — Collins and Lisa Murkowski of Alaska — are okay with getting rid of the mandate, arguing it has been less effective than expected and its associated penalty is paid chiefly by lower-income Americans.

The question is whether Republicans will also manage to pass the two bipartisan measures essentially infusing cash into marketplace plans — a move that analysts say will help insurers lower premiums, which have been spiking across the country.

A measure from Alexander and Sen. Patty Murray (D-Wash.) would fund $7 billion in extra cost-sharing discounts; another one from Collins and Sen. Bill Nelson (D-Fla.) would provide $4.5 billion in reinsurance funding. If either one passes, it probably would be as part of a big spending measure.

Senate Majority Whip John Cornyn (R-Tex.). (Photo by Melina Mara/The Washington Post)

No. 2 Senate Republican John Cornyn (R-Tex.) said yesterday that at least Alexander-Murray will get a vote. “I do think we’re going to take up the Alexander-Murray proposal to try to stabilize the insurance markets in the interim and bring premiums down,” he told reporters.

Underlying the whole issue is a complex web of political considerations and policy disputes, as Republicans remain divided over whether they have a responsibility to improve the ACA and Democrats stew over their colleagues’ recent move to undermine the law by repealing its individual mandate.

“Alexander-Murray should have been passed months ago to reduce damage Republicans have already done to families’ health care, and is not designed to fix the higher premiums, coverage losses, and health-care chaos that the Republican tax bill will cause if it becomes law,” a Murray aide said.

(Here’s a helpful idea: Perhaps Sens. Alexander and Murray could hash all this out on a joint visit to fortuitously-named Scottish whiskey bottler Alexander Murray Company. The Health 202 would be glad to accompany them to cover the deal-making.)

Collins has emerged as a central player in this debate, hinging her support for repealing the mandate in the Senate’s tax bill on promises from GOP leaders they’d also bring up the stabilization bills. Yesterday, she told reporters that after meeting Tuesday with Alexander, she has been reassured that is leadership’s intention.

Of course, things aren’t playing out in exactly the order Collins would wish. Congress probably will pass a temporary two-week spending patch on Friday, then finish taxes and end the year with some kind of spending agreement. Collins would rather the stabilization measure happen first, but she’s not going to die on that hill.

“I want to make sure if the timing is not as I would prefer … that we will have the commitment that it will be done before the end of the year,” Collins told me.

Of course, it may not be so crucial at the end of the day that Collins supports a final tax overhaul. The Senate bill passed last week with 51 votes, and Republicans need just 50 votes with tiebreaking help from Vice President Pence. Still, it’s a tight margin, and there’s no guarantee other Republicans might not defect at the last minute over other issues, such as action on the federal DACA program for young immigrants.

House Speaker Paul Ryan (R-Wis.) is another big question mark. His office indicated this week he hasn’t committed to passing any Obamacare stabilization bills, which the most conservative Republicans have characterized as insurer “bailouts.” A spokeswoman didn’t respond Wednesday to a request to clarify his stance.

But Collins dismissed Ryan’s seeming indifference, saying she’s confident because she also has a promise from President Trump to prop up the ACA marketplaces, which cover about 11 million Americans.

“[Ryan] has not said he’s not on board — and the president is on board — so I think we’ll have significant influence with House members,” she said.

d6539_imrs The Health 202: Senate GOP intensifies push to send more cash to Obamacare marketplaces

House Freedom Caucus Chairman Rep. Mark Meadows (R-N.C.). (Drew Angerer/Getty Images)

In another positive sign for the funding bills, Meadows indicated Wednesday that he’s open to passing Alexander-Murray if it would bring Senate Democrats on board a government spending bill, even though he previously said it’s not a move he’d back. Other Republicans have also suggested they wouldn’t withhold votes on a spending bill over the stabilization measures.

“I will support whatever we have to do to keep the government open,” Rep. Chris Collins (R-N.Y.) told my colleague Erica Werner on Tuesday. “I do not support the CSRs, but I will not let that stand in the way of me voting for” a spending measure. 

Democrats are furious that Republicans moved to repeal the mandate, even after Murray worked extensively with Alexander on their marketplace stabilization bill. But there’s little they can do; they can’t block the GOP from passing its tax overhaul, and it seems unlikely at the end of the day that they’d oppose a bill to improve the ACA.

So for now, they’re taking a step back as Collins takes the lead on the issue.

“This is a check McConnell needs to cash to Collins,” a Democratic aide told me.

The policy question underpinning all of this: Does infusing more cash into the Obamacare marketplaces compensate for the damage done by repealing the mandate?

Eliminating the mandate would cause marketplace premiums to increase 10 percent annually, as more healthy people, freed of the penalty, choose not to buy coverage, according to the Congressional Budget Office. The CBO has said that providing the cost-sharing subsidies to insurers, although it would help them lower premiums, wouldn’t be enough to offset the premium hikes from the mandate repeal.

“It’s like putting a Band-Aid on a leg that’s been cut off,” a GOP lobbyist characterized it to me last week.

But yesterday, Collins pointed to a new analysis from the firm Avalere, which found that the CSR payments in combination with the reinsurance she has proposed, would lower individual market premiums by 18 percent next year and the following year — although the report also said that repealing the mandate could “overshadow” the effects.

HuffPost’s Jonathan Cohn:

“The combination of the two bills more than offsets the premium increase that is caused by the repeal of the individual mandate,” Collins said. “This is something I’ve said from the beginning.”

d6539_imrs The Health 202: Senate GOP intensifies push to send more cash to Obamacare marketplaces

This file photo shows one of an assortment of marijuana strains during the High Times Harvest Cup in San Bernardino, Calif. (AP Photo/Richard Vogel, file)

AHH: Los Angeles is set to become the largest city in the country legalizing recreational marijuana. Members of the L.A. City Council unanimously passed new regulations allowing pot cultivation and sales next year, according to the Associated Press. But under the regulations,  pot businesses would be prohibited in residential neighborhoods and in zones around schools, libraries and parks.

It’s not yet clear how many businesses, if any, would be ready to begin selling by the start of 2018. And businesses that want to sell marijuana will need local permits before they can apply for state licenses required to open their doors. The rules are now headed to L.A. Mayor Eric Garcetti, who is expected to approve them.

While some cities around the country have banned commercial pot sales, many California municipalities have embraced them, partly because of the tax revenue such sales could bring in. Also yesterday, the mayor of San Francisco signed legislation allowing the sale of recreational marijuana possibly beginning in January if local businesses get licensed in time. And San Jose will allow its 16 medical marijuana dispensaries to start selling recreational pot starting next year.

d6539_imrs The Health 202: Senate GOP intensifies push to send more cash to Obamacare marketplaces

A woman holds a birth control pill. (Eric Gaillard/Reuters)

OOF: Women who use birth control pills or IUDs that release hormones are at a slightly elevated risk for breast cancer, a new study finds. Researchers found that for every 100,000 women who use hormonal contraceptives, there are 68 cases of breast cancer every year, compared with 55 cases annually among women who use birth control without hormones, the New York Times reports. The possible culprit might be the commonly used hormone progestin.

A connection between birth-control pills and breast cancer has previously been acknowledged, but the new study is the first to assess the risks linked to the currently used pill formulas and other devices, the NYT writes. Researchers found there’s only a minor difference in the risks from either pills or devices, which means women cannot necessarily protect themselves from the elevated breast cancer risk by switching to a birth control implant or intrauterine device.

So what have we leaned? Dr. Marisa Weiss, an oncologist who founded breastcancer.org and wasn’t involved in the study, told the Times the research is important because doctors didn’t know how modern-day pills compared to the “old-fashioned pills” — and had no idea at all whether IUDs (which are increasing in popularity) caused an increased breast cancer risk.

“Gynecologists just assumed that a lower dose of hormone meant a lower risk of cancer. But the same elevated risk is there,” Weiss said.

The increase of just 13 cases per 100,000 women is significant when you consider the millions of  women who use birth control, Weiss said. Nearly 10 million American women use oral contraceptives, per the Times, including 1.5 million women who use them for reasons other than to prevent pregnancy. Still, the American College of Obstetricians and Gynecologists emphasizes that hormonal birth control options are “among the most safe, effective and accessible options available” for preventing pregnancy.

d6539_imrs The Health 202: Senate GOP intensifies push to send more cash to Obamacare marketplaces

Sen. Rand Paul (R-Ky.) and his wife Kelley Paul arrive for the Kennedy Center Honors on Dec. 3. (REUTERS/Joshua Roberts)

OUCH: What in the world provoked one wealthy, accomplished doctor to attack another wealthy, accomplished doctor? Justin Jouvenal explores this question for The Post from Bowling Green, Ky., where Sen. Rand Paul (R-Ky.) experienced the worst attack on a sitting senator in decades, right in his own yard.

“Rand Paul was on the verge of becoming a powerful senator and the nation’s leading libertarian. His neighbor was a successful doctor and Kennedy-style Democrat who favored nationalized medicine,” Justin writes. “They might have sparred over health care or taxes, but an acquaintance of both said they stood in their yards roughly a decade ago shouting at each other over the grass clippings Paul’s mower had shot on Rene Boucher’s property.”

Boucher’s attorney said in an interview his client attacked Paul over long-simmering disagreements between the two about the care of grass, trees and other landscaping on their adjacent properties in an exclusive gated community. Yet Paul has been more cryptic about the cause, telling Fox News last week that he hasn’t spoken with Boucher in a decade. The assault left Paul with six cracked ribs, a case of pneumonia and briefly sidelined during a crucial debate over a tax overhaul in Washington.

“After my ribs were broken then he said things to me to try to indicate why he was unhappy but I think the, I guess to me the bottom line is it isn’t so important — if someone mugs you is it really justified for any reason?” Paul said.

“Intrigue has deepened in the weeks since the Nov. 3 assault as Paul and Boucher have remained largely quiet about what prompted it,” Justin writes. “Into the vacuum, competing theories for the assault have been floated, like so many Washington trial balloons. They range from the mundane, such as bad blood over spoiled views of a lake, to the outlandish — an Antifa plot.”

d6539_imrs The Health 202: Senate GOP intensifies push to send more cash to Obamacare marketplaces

House Speaker Paul Ryan (R-Wis.) (AP Photo/J. Scott Applewhite)

–House Speaker Paul Ryan (R-Wis.) says his agenda items for 2018 include shrinking federal health-care and welfare programs, which are the biggest drivers of government spending.

“We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” Ryan said on Ross Kaminsky’s talk radio show. “Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.”

That would mean making cuts to Medicare spending, as our colleague Jeff Stein writes. That task is politically tricky not only because Medicare is popular, and because it’s an election year, but also because President Trump vowed during his campaign that he wouldn’t cut spending on Social Security, Medicare or Medicaid. But Ryan said he has discussed the possibility of Medicare cuts with the president.

“I think the president is understanding that choice and competition works everywhere in health care, especially in Medicare,” Ryan said. “This has been my big thing for many, many years. I think it’s the biggest entitlement we’ve got to reform.”

Ryan’s remarks add to a chorus of Republicans who have targeted government spending as a critical item on next year’s to-do list, even as they strive to pass a tax plan that nonpartisan analysts say would increase the deficit by at least $1 trillion over a decade.

d6539_imrs The Health 202: Senate GOP intensifies push to send more cash to Obamacare marketplaces

Seema Verma, administrator of the Centers for Medicare and Medicaid Services. (AP Photo/Julio Cortez)

— U. S. health-care spending in most categories — including for Medicare, Medicaid and retail prescription drugs — grew at a slower rate in 2016 compared to the year prior, according to the annual health expenditures report released yesterday by the Centers for Medicare and Medicaid Services. Overall spending grew 4.3 percent last year, down from 5.8 percent growth the year prior. Spending growth had increased in 2014 and 2015, as more Americans obtained coverage via the ACA, but that growth has slowed as the insured rate has stabilized.

“The overall rate of increase in health care spending experienced a slight slowdown over the previous year, driven in part by the expected moderation in growth after the expansion of insurance coverage through the Affordable Care Act,” my colleague Carolyn Y. Johnson reports. “There was also a sharp decrease in the growth of prescription drug expenditures, as hepatitis C treatment costs have declined and fewer patients are receiving them.”

But spending did accelerate for one important category that directly affects consumers: The extra costs such as copayments and deductibles they must pay out of pocket for care or medications. Out-of-pocket spending grew 3.9 percent last year, significantly faster than a 2.8 percent growth rate in 2015. The faster growth reflects a continued shift among consumers toward high-deductible health plans, which carry a cheaper monthly premium but require more on-the-spot payments to visit the doctor or obtain medication from a pharmacy.

The Healthcare.gov website. (AP Photo/Alex Brandon)

–Nine days remain in the 2018 ACA enrollment season. Enrollment on Healthcare.gov accelerated last week, bringing the total to 3.6 million sign-ups, The Post’s Amy Goldstein reports.

“The latest federal snapshot, coming amid fresh political turbulence over the future of insurance marketplaces created under the law, is slightly ahead of the first five weeks’ pace last fall,” Amy writes. “But compared with data from two-thirds of the way through the longer enrollment seasons of past years, the number of consumers who have chosen health plans is lagging far behind.”

The 3.6 million figure is half of the total at the comparable point in last year’s sign-up period, but to reach last year’s 9.2 million enrollee total, a huge surge of people would need to take action by the time the season concludes on Dec. 15 or be automatically re-enrolled just afterward, Amy notes.

–A few more good reads from The Post and beyond:

Today

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the “Implementation of the 21st Century Cures Act: Progress and Path Forward for Medical Innovation.”
  • The House Veterans Affairs Committee holds a hearing on the VA Medical Surgical Prime Vendor Program.

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on prescription drug costs on Dec. 12.
  • The Kaiser Family Foundation holds an event on “Living in an Immigrant Family in America: How Fear and Toxic Stress Are Affecting Daily Life, Well-Being, and Health” on Dec. 13.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on “Implementation of the 21st Century Cures Act: Responding to Mental Health Needs” on Dec. 13.

Watch House Speaker Paul Ryan (R-Wis.) light up the Capitol Christmas tree at an outdoor ceremony:

A majority of Senate Democrats have called on Sen. Al Franken (D-Minn.) to resign as he faces multiple allegations of sexual harassment:

Samantha Bee takes on the Republican tax bill and lawmakers’ response to sexual misconduct:

The Daily Show with Trevor Noah compiles “Trump’s Best Words of 2017:”

Overnight Health Care: Ryan’s office warns he wasn’t part of ObamaCare deal | House conservatives push for mandate …

Speaker Paul RyanPaul Davis RyanPaul Ryan: ‘I don’t know’ if there’s a difference between Trump and Moore accusers DACA advocates see efforts gaining steam in the House Senate Democrats reject initial DACA offer MORE‘s (R-Wis.) office told a meeting of congressional leadership offices on Monday that the Speaker is not part of a deal to get ObamaCare fixes passed before the end of the year, according to a source familiar with the meeting.

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellTop GOP senators say they have the votes to pass tax bill Angus King on GOP tax push: ‘To call this a circus would be an insult to circuses’ McConnell works to salvage tax bill MORE (R-Ky.) made a commitment to Sen. Susan Collins (R-Maine) that he would support passage of two bipartisan ObamaCare bills before the end of the year, a promise that helped win her vote for tax reform.

However, Ryan’s office told a meeting of staff from the four top congressional leadership offices on Monday that he has not made that same commitment, raising further questions about whether the ObamaCare bills, already opposed by House conservatives, can pass the House.

Ryan’s office did not go so far as to say it opposed the bipartisan bills, the source said, and it is still possible the measures could pass before the end of the year. The Senate is expected to add the measures to a government funding bill later this month, which would put pressure on the House to accept it or else risk a government shutdown.

Collins also got a commitment from President Trump to support the bills, which could help get them to passage.

One of the measures in question, from Senate Health Committee Chairman Lamar AlexanderAndrew (Lamar) Lamar AlexanderOvernight Health Care: House conservatives won’t back spending bill with ObamaCare payments | State officials worry about mandate repeal | Trump donates paycheck to fight opioids House conservatives won’t back spending bill with ObamaCare payments Collins: Health-care fix will pass before tax bill MORE (R-Tenn.) and ranking member Patty MurrayPatricia (Patty) Lynn MurrayOvernight Health Care: House conservatives won’t back spending bill with ObamaCare payments | State officials worry about mandate repeal | Trump donates paycheck to fight opioids House conservatives won’t back spending bill with ObamaCare payments Collins: Health-care fix will pass before tax bill MORE (D-Wash.), would fund key ObamaCare payments to insurers for two years in exchange for additional flexibility for states to change ObamaCare rules. The other bill, from Collins and Sen. Bill NelsonClarence (Bill) William NelsonOvernight Health Care: House conservatives won’t back spending bill with ObamaCare payments | State officials worry about mandate repeal | Trump donates paycheck to fight opioids House conservatives won’t back spending bill with ObamaCare payments Collins: Health-care fix will pass before tax bill MORE (D-Fla.), would provide funding known as “reinsurance” that helps pay for the costs of sick ObamaCare enrollees with the intent of bringing down premiums.

Collins hopes that these two bills would make up for the premium increases caused by repealing ObamaCare’s individual mandate in the tax bill.

Read more here.

 

Top House Dem calls for probe into CVS-Aetna merger

A top House Democrat is calling for a hearing to examine the merger between CVS and Aetna.

In a letter to House Energy and Commerce Committee chairman Greg WaldenGregory (Greg) Paul WaldenOvernight Regulation: Senators push DOJ to review online gambling opinion | EPA holds steady on biofuel mandate targets | Trump moves to fill financial regulatory posts Dem pushes for oversight on Trump officials using private jets House passes bill to fund children’s insurance program MORE (R-Ore.), the committee’s ranking member Frank Pallone Jr. (D-N.J.) asked for a hearing on the merger as soon as possible.

“As the business of healthcare continues to morph, it is critical that Congress closely examine the changing relationships among healthcare entities and the impact these changing relationships have on the way healthcare is delivered in this country,” Pallone wrote.

If approved, the $69 billion merger of the nation’s largest pharmacy and third-largest health insurer could have major implications for the health care industry.

The companies are arguing that when merged, they will be able to improve health outcomes and reduce costs by integrating the pharmacy and insurer. They are promising significant changes to the business of health care delivery.

Read more here.

 

Chairman expects ‘strong support’ in House GOP for mandate repeal in tax bill 

House Ways and Means Committee Chairman Kevin BradyKevin Patrick BradyAmerica First brigade rode to the rescue on carried interest loophole GOP gains momentum on tax cuts Groups make year-end push to delay ObamaCare taxes MORE (R-Texas) told reporters Tuesday that he expects most House Republicans will support repealing ObamaCare’s individual mandate in tax legislation, as GOP senators did.

“We’ll be asking our members where do they want us to be on that position. I suspect there will be strong support,” he said.

The House-passed tax bill did not include repeal of the individual mandate, while the Senate bill did. The two chambers now must reconcile their versions of tax-reform legislation in a bicameral conference.

Twenty Republicans voted against the House’s health-care bill in May, which included mandate repeal, though some of those members voted for the House’s tax bill.

Read more here.

 

House conservatives push for repeal of ObamaCare mandate in final tax bill

The Republican Study Committee (RSC), a group of conservative Republicans in the House, is pushing for tax reform to include a repeal of the individual mandate.

“Including language to repeal this harmful policy will return personal decisions about health care choices to patients, fulfilling a key promise we have made to the American people,” the RSC wrote in a letter being circulated among members.

In a letter to Ways Means Chairman Kevin Brady (R-Texas) and Senate Finance Chairman Orrin HatchOrrin Grant HatchSusan Collins is swing vote on tax bill GOP sets 23 percent deduction for small businesses to save tax bill Top GOP senators say they have the votes to pass tax bill MORE (R-Utah), the RSC asks that the final package that emerges from a conference committee between the two houses contain a repeal of the mandate.

“Obamacare’s coercive individual mandate represents perhaps the worst example of the federal government violating individual freedom and liberty — which is why we have repeatedly promised to repeal it,” the letter, which has about 50 signatures, says.

Read more here.

 

From The Hill’s opinion pages

American taxpayers will be Alex Azar’s shareholders — let’s hope he can serve them

Congress should massively ramp up funding for the NIH

Medicaid funds shouldn’t be used to subsidize state taxes on health care

 

What we’re reading

Orrin Hatch just made the Republican agenda startlingly clear (Vox)

Trump science job nominees missing advanced science degrees (AP)

The CHIP program is beloved. Why is its funding in danger? (The New York Times)

 

State by state

Abortion limits advance in Pennsylvania House (Associated Press)

New maternal mortality strategy relies on ‘medical homes’ (Stateline)

State Medicaid director Michael Heifetz resigning (Wisconsin State Journal)

Premera to reimburse Alaska state insurance program $25M (AP)

Overnight Health Care: Ryan’s office warns he wasn’t part of ObamaCare deal | House conservatives push for mandate …

Speaker Paul RyanPaul Davis RyanPaul Ryan: ‘I don’t know’ if there’s a difference between Trump and Moore accusers DACA advocates see efforts gaining steam in the House Senate Democrats reject initial DACA offer MORE‘s (R-Wis.) office told a meeting of congressional leadership offices on Monday that the Speaker is not part of a deal to get ObamaCare fixes passed before the end of the year, according to a source familiar with the meeting.

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellTop GOP senators say they have the votes to pass tax bill Angus King on GOP tax push: ‘To call this a circus would be an insult to circuses’ McConnell works to salvage tax bill MORE (R-Ky.) made a commitment to Sen. Susan Collins (R-Maine) that he would support passage of two bipartisan ObamaCare bills before the end of the year, a promise that helped win her vote for tax reform.

However, Ryan’s office told a meeting of staff from the four top congressional leadership offices on Monday that he has not made that same commitment, raising further questions about whether the ObamaCare bills, already opposed by House conservatives, can pass the House.

Ryan’s office did not go so far as to say it opposed the bipartisan bills, the source said, and it is still possible the measures could pass before the end of the year. The Senate is expected to add the measures to a government funding bill later this month, which would put pressure on the House to accept it or else risk a government shutdown.

Collins also got a commitment from President Trump to support the bills, which could help get them to passage.

One of the measures in question, from Senate Health Committee Chairman Lamar AlexanderAndrew (Lamar) Lamar AlexanderOvernight Health Care: House conservatives won’t back spending bill with ObamaCare payments | State officials worry about mandate repeal | Trump donates paycheck to fight opioids House conservatives won’t back spending bill with ObamaCare payments Collins: Health-care fix will pass before tax bill MORE (R-Tenn.) and ranking member Patty MurrayPatricia (Patty) Lynn MurrayOvernight Health Care: House conservatives won’t back spending bill with ObamaCare payments | State officials worry about mandate repeal | Trump donates paycheck to fight opioids House conservatives won’t back spending bill with ObamaCare payments Collins: Health-care fix will pass before tax bill MORE (D-Wash.), would fund key ObamaCare payments to insurers for two years in exchange for additional flexibility for states to change ObamaCare rules. The other bill, from Collins and Sen. Bill NelsonClarence (Bill) William NelsonOvernight Health Care: House conservatives won’t back spending bill with ObamaCare payments | State officials worry about mandate repeal | Trump donates paycheck to fight opioids House conservatives won’t back spending bill with ObamaCare payments Collins: Health-care fix will pass before tax bill MORE (D-Fla.), would provide funding known as “reinsurance” that helps pay for the costs of sick ObamaCare enrollees with the intent of bringing down premiums.

Collins hopes that these two bills would make up for the premium increases caused by repealing ObamaCare’s individual mandate in the tax bill.

Read more here.

 

Top House Dem calls for probe into CVS-Aetna merger

A top House Democrat is calling for a hearing to examine the merger between CVS and Aetna.

In a letter to House Energy and Commerce Committee chairman Greg WaldenGregory (Greg) Paul WaldenOvernight Regulation: Senators push DOJ to review online gambling opinion | EPA holds steady on biofuel mandate targets | Trump moves to fill financial regulatory posts Dem pushes for oversight on Trump officials using private jets House passes bill to fund children’s insurance program MORE (R-Ore.), the committee’s ranking member Frank Pallone Jr. (D-N.J.) asked for a hearing on the merger as soon as possible.

“As the business of healthcare continues to morph, it is critical that Congress closely examine the changing relationships among healthcare entities and the impact these changing relationships have on the way healthcare is delivered in this country,” Pallone wrote.

If approved, the $69 billion merger of the nation’s largest pharmacy and third-largest health insurer could have major implications for the health care industry.

The companies are arguing that when merged, they will be able to improve health outcomes and reduce costs by integrating the pharmacy and insurer. They are promising significant changes to the business of health care delivery.

Read more here.

 

Chairman expects ‘strong support’ in House GOP for mandate repeal in tax bill 

House Ways and Means Committee Chairman Kevin BradyKevin Patrick BradyAmerica First brigade rode to the rescue on carried interest loophole GOP gains momentum on tax cuts Groups make year-end push to delay ObamaCare taxes MORE (R-Texas) told reporters Tuesday that he expects most House Republicans will support repealing ObamaCare’s individual mandate in tax legislation, as GOP senators did.

“We’ll be asking our members where do they want us to be on that position. I suspect there will be strong support,” he said.

The House-passed tax bill did not include repeal of the individual mandate, while the Senate bill did. The two chambers now must reconcile their versions of tax-reform legislation in a bicameral conference.

Twenty Republicans voted against the House’s health-care bill in May, which included mandate repeal, though some of those members voted for the House’s tax bill.

Read more here.

 

House conservatives push for repeal of ObamaCare mandate in final tax bill

The Republican Study Committee (RSC), a group of conservative Republicans in the House, is pushing for tax reform to include a repeal of the individual mandate.

“Including language to repeal this harmful policy will return personal decisions about health care choices to patients, fulfilling a key promise we have made to the American people,” the RSC wrote in a letter being circulated among members.

In a letter to Ways Means Chairman Kevin Brady (R-Texas) and Senate Finance Chairman Orrin HatchOrrin Grant HatchSusan Collins is swing vote on tax bill GOP sets 23 percent deduction for small businesses to save tax bill Top GOP senators say they have the votes to pass tax bill MORE (R-Utah), the RSC asks that the final package that emerges from a conference committee between the two houses contain a repeal of the mandate.

“Obamacare’s coercive individual mandate represents perhaps the worst example of the federal government violating individual freedom and liberty — which is why we have repeatedly promised to repeal it,” the letter, which has about 50 signatures, says.

Read more here.

 

From The Hill’s opinion pages

American taxpayers will be Alex Azar’s shareholders — let’s hope he can serve them

Congress should massively ramp up funding for the NIH

Medicaid funds shouldn’t be used to subsidize state taxes on health care

 

What we’re reading

Orrin Hatch just made the Republican agenda startlingly clear (Vox)

Trump science job nominees missing advanced science degrees (AP)

The CHIP program is beloved. Why is its funding in danger? (The New York Times)

 

State by state

Abortion limits advance in Pennsylvania House (Associated Press)

New maternal mortality strategy relies on ‘medical homes’ (Stateline)

State Medicaid director Michael Heifetz resigning (Wisconsin State Journal)

Premera to reimburse Alaska state insurance program $25M (AP)

The Senate just passed a tax bill that would strike a blow to a fundamental part of Obamacare

Over a 40-year career, this ‘stubborn scientist’ helped change the way we think about cancer and genetics

The Health 202: Obamacare’s centerpiece is hanging by a thread

THE PROGNOSIS

24634_imrs The Health 202: Obamacare's centerpiece is hanging by a thread

Senate Majority Leader Mitch McConnell is surrounded by reporters as Republicans work to pass their sweeping tax bill, a blend of generous tax cuts for businesses and more modest tax cuts for families and individuals. (AP Photo/J. Scott Applewhite)

The centerpiece of the Affordable Care Act — its infamous requirement to buy health coverage — is really, truly in hospice care, eight years after its birth.

As Senate Republicans aim to pass their tax overhaul despite a big bump last night, some significant health-care pieces are also in play. Not only is the GOP still desperate to repeal some part of Obamacare, but health care is also a major expense for the government via its big insurance programs and various tax breaks.

The most controversial health-related piece at stake in the Senate tax plan — and also the most likely to stay in a final tax agreement with the House  — is repeal of the ACA’s individual mandate to buy coverage or pay a fine.

But the final tax bill could also open the door to annual Medicare cuts if Democrats refuse to join Republicans in waiving what’s known as “paygo” rules. And it may also erase or whittle down two tax breaks that help people with steep medical expenses and incentivize drugmakers to develop treatments for rare diseases that might be less profitable to treat.

Some of these elements are contained only in the tax bill the House passed two weeks ago, while other components are only in the Senate version that the chamber is struggling to pass right now. Last night, the fast-moving bill unexpectedly stalled as several conservatives demanded that it not drive up the nation’s debt, forcing leadership to consider ways to alleviate those concerns in order to get the 50 votes they need to pass it.

“Now, Republican leaders may have to brace for an intraparty battle over how far to go to accommodate deficit concerns,” my colleagues Damian Paletta, Erica Werner and Mike DeBonis report. “Other Republicans are arguing strongly against reducing the size of the bill’s tax cut, as may now be necessary to satisfy the deficit hawks.”

Assuming senators ultimately pull their package across the finish line — and as things stand now, it’s a big “if” — lawmakers from both chambers would then have to merge the two versions in a conference committee. Let’s look at the major health-related elements in the tax debate, and their likelihood of actually becoming law:

1. Individual mandate repeal.

If the Senate manages to pass its tax bill with repeal of the mandate, even over the concerns of some moderates, it’s hard to see how mandate repeal won’t make it into a final bill, too. It’s safe to say that a majority of House members are pretty gung-ho about getting rid of the least-popular part of Obamacare.

In Republicans’ minds, this is a win-win strategy.

One, it gives them hundreds of billions more dollars ($338 billion over a decade, according to the Congressional Budget Office to fund tax cuts. Two, repealing the mandate makes passing a future health-care bill potentially easier: It disposes of a major reason previous GOP measures were projected to result in fewer Americans with coverage. If the mandate is repealed, future GOP health-care bills would compare more favorably to current law.

2. The potential for Medicare cuts.

Let’s assume for a moment that Congress passes — and President Trump signs — a final tax overhaul that raises deficit spending (a Joint Committee on Taxation report released late yesterday showed the measure would add at least $1 trillion to the deficit over 10 years, even after economic growth is accounted for). If lawmakers don’t waive a 2010 rule known as “paygo,” aimed at keeping government spending in check, that deficit spending would trigger automatic cuts to mandatory spending.

That’s where Medicare cuts come in. Although the mandatory cuts are limited to 4 percent of the program, that still translates to a hefty sum of $25 billion in cuts to future Medicare spending starting next year, because the health insurance program for seniors is so big. 

24634_imrs The Health 202: Obamacare's centerpiece is hanging by a thread

Sen. Susan Collins (R-Maine) says she has misgivings about the health-care elements of the Senate tax bill. (AP Photo/Robert F. Bukaty, File)

Sen. Susan Collins (R-Maine), who generally opposes cuts to entitlement programs, has said that Senate Majority Leader Mitch McConnell (R-Ky.) has promised her the cuts won’t happen, because Congress will waive “paygo” rules. But such a decision is beyond McConnell’s ability to control. Waiving “paygo“ requires 60 votes in the Senate, and it’s not at all clear that Democrats would be willing to help Republicans save themselves from mandatory cuts.

3. Repeal of the medical expenses deduction.

The House bill fully repeals this tax break, which allows people to deduct from their taxes qualified medical expenses that exceed 10 percent of their income (for seniors, the threshold is 7.5 percent of their income). The credit was created during World War II, intended to give Americans a form of tax relief during wartime.

But the Senate version leaves the popular tax break intact, and lobbyists say a final bill probably will, too, given the pushback from seniors and disability rights groups.

4. Repeal of the orphan drug tax credit.

Repeal of this tax break seems more likely to stay in a final tax agreement, according to those tuned into deliberations on Capitol Hill. Right now, the breakdown in the chambers is the same as for the medical expenses deduction; the House version repeals it and the Senate version leaves it alone.

The credit benefits makers of treatments for “orphan diseases,” which affect fewer than 200,000 people. Congress passed it in 1983 as part of a bucket of incentives for pharmaceutical companies to develop drugs needed by much smaller patient populations. Pharma doesn’t want to see it go, but the industry might be willing to swallow a repeal, lobbyists say. So, a repeal could end up in the final package.

Sen. John McCain (R-Ariz.) arrives for votes on Capitol Hill on Monday. (AP Photo/J. Scott Applewhite)

–The three GOP senators who sank the Senate’s health-care bill back in July now appear to be on board with the GOP tax overhaul, even though it would repeal the ACA’s individual mandate. Sens. John McCain of Arizona and Lisa Murkowski of Alaska say they’re backing the measure, and Sen. Susan Collins of Maine has indicated she’s close to signing on. Both Collins and Murkowski have partially justified their support for the tax bill by noting that the health-care bill would have repealed much more of the ACA and defunded Planned Parenthood.

“The skinny repeal bill had many other provisions in it,” Collins told the Washington Examiner. “It repealed the employer mandate, eliminated funding for Planned Parenthood and had many other provisions and so it is not comparable at all [to mandate repeal].”

But here’s a wild card with the potential to swing Collins’s vote: that bipartisan measure from Sens. Lamar Alexander (Tenn.) and Patty Murray (Wash.) to fund extra Obamacare subsidy payments. Collins  said she’s been promised a vote on that measure by Senate Majority Leader Mitch McConnell (R-Ky.). But the measure’s prospects seems awfully shaky; the Senate is focused right now on the tax overhaul; yesterday House conservatives told The Hill they wouldn’t support it (they’ve labeled it an “insurer bailout”); and, as conservative policy wonk Chris Jacobs writes over at The Federalist, even if the payments are included in a year-end spending bill, they might not ever get made due to mandatory sequester cuts.

(Do you need some Christmas cookies after that last graf? I do.)

Here’s the interesting question at play over the next few weeks: Will Congress make two changes to the ACA marketplaces that are contrary to each other? Repealing the mandate undermines the marketplaces by ultimately weakening their risk pools (some healthy people drop coverage without the mandate). Making the subsidy payments (known as cost-sharing reductions) helps lower marketplace premiums, but it’s kind of moot if you’ve already removed the key requirement underpinning the whole ACA. Just another day in Congress, in other words.

The new Apple Watch Series 3. (AP Photo/Marcio Jose Sanchez)

AHH: Want to participate in Apple’s first-ever medical study? There’s an app for that. The new app, rolled out yesterday, works with the Apple Watch’s heart-rate monitor to check for irregular heart rates as part of a study the company is running with Stanford University. “While others have used Apple’s software and devices in medical studies, this is the first time that it’s actually sponsored one itself,” The Post’s Hayley Tsukayama reports. “The move is another sign that Apple is moving deeper into the health space.”

“Working alongside the medical community, not only can we inform people of certain health conditions, we also hope to advance discoveries in heart science,” said Apple chief operating officer Jeff Williams, in a statement.

“Health and fitness have been a key focus for Apple, especially since launching the Apple Watch two years ago,” Hayley writes. “That has allowed the company to tap the $3 billion health care market and, analysts say, find new audiences for its products and services. Apple already employs a small staff of medical professionals to develop its health products…The new study takes all of that a step further: Now Apple itself will be running a study and submitting data to the Food and Drug Administration. The heart-rate researcher will look specifically at atrial fibrillation — or afib — which refers to an irregular heart rate and is a leading cause of stroke and other heart conditions.”

A CVS store and pharmacy in Philadelphia. (AP Photo/Matt Rourke, File)

OOF: CVS Health Corp. could announce a deal as soon as Monday to buy major health insurer Aetna for more than $66 billion in cash and stock, creating a health-care giant selling everything from drugs to insurance, the Wall Street Journal reports. The company is in the advanced stages of negotiating the deal, likely valued at between $200 and $205 per Aetna share, WSJ writes. By merging with Aetna, CVS could gain more leverage in its drug price negotiations with pharmaceutical makers. It’s just the latest in a trend toward consolidation in the industry, as insurers and pharmacies face increasing pressure to tamp down soaring medical spending.

Healthcare.gov website. REUTERS/Mike Segar/File Photo

OUCH: The small networks in Obamacare plans are getting even narrower, according to an analysis released yesterday by Avalere. The percentage of marketplace plans with severely limited networks of doctors and hospitals have been on an upward trajectory; they comprised 54 percent of plans in 2015, 68 percent in 2017 and, next year, 73 percent of plans will feature narrow networks, the firm found.

“We continue to see insurers focusing on narrow network exchange products that enable them to offer competitive premiums and manage medical costs,” said Caroline Pearson, Avalere senior vice president. “These narrow network plans may come at a lower price tag for consumers, but they may also limit consumer choice and access to specialist care.” 

Deductibles are also going up for the most popular “silver” level plans, averaging $3,937 in 2018, up from an average of $3,703 in 2015. Gold-plan deductibles are rising, too, but average bronze and platinum deductibles are dropping from 2017 rates. Avalere also notes that consumers earning less than 250 percent of the federal poverty level can get cost-sharing discounts that typically result in cheaper deductibles.

–A few more good reads from The Post and beyond:

Today

  • The House Appropriations Subcommittee on Transportation, Housing and Urban Development and Related Agencies holds a hearing on HUD and community block grants for disaster recovery.

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on “Implementation of the 21st Century Cures Act: Responding to Mental Health Needs” on Dec. 13.  

The Senate voted Thursday not to send the Republican tax reform bill back to committee:

President Trump worries that Americans don’t say ‘Merry Christmas:’

Will President Trump be a drag on Republicans running in 2018?:

Watch Jimmy Kimmel talk about his Twitter war with Roy Moore: 

The Health 202: Obamacare’s centerpiece is hanging by a thread

THE PROGNOSIS

a7e81_imrs The Health 202: Obamacare's centerpiece is hanging by a thread

Senate Majority Leader Mitch McConnell is surrounded by reporters as Republicans work to pass their sweeping tax bill, a blend of generous tax cuts for businesses and more modest tax cuts for families and individuals. (AP Photo/J. Scott Applewhite)

The centerpiece of the Affordable Care Act — its infamous requirement to buy health coverage — is really, truly in hospice care, eight years after its birth.

As Senate Republicans aim to pass their tax overhaul despite a big bump last night, some significant health-care pieces are also in play. Not only is the GOP still desperate to repeal some part of Obamacare, but health care is also a major expense for the government via its big insurance programs and various tax breaks.

The most controversial health-related piece at stake in the Senate tax plan — and also the most likely to stay in a final tax agreement with the House  — is repeal of the ACA’s individual mandate to buy coverage or pay a fine.

But the final tax bill could also open the door to annual Medicare cuts if Democrats refuse to join Republicans in waiving what’s known as “paygo” rules. And it may also erase or whittle down two tax breaks that help people with steep medical expenses and incentivize drugmakers to develop treatments for rare diseases that might be less profitable to treat.

Some of these elements are contained only in the tax bill the House passed two weeks ago, while other components are only in the Senate version that the chamber is struggling to pass right now. Last night, the fast-moving bill unexpectedly stalled as several conservatives demanded that it not drive up the nation’s debt, forcing leadership to consider ways to alleviate those concerns in order to get the 50 votes they need to pass it.

“Now, Republican leaders may have to brace for an intraparty battle over how far to go to accommodate deficit concerns,” my colleagues Damian Paletta, Erica Werner and Mike DeBonis report. “Other Republicans are arguing strongly against reducing the size of the bill’s tax cut, as may now be necessary to satisfy the deficit hawks.”

Assuming senators ultimately pull their package across the finish line — and as things stand now, it’s a big “if” — lawmakers from both chambers would then have to merge the two versions in a conference committee. Let’s look at the major health-related elements in the tax debate, and their likelihood of actually becoming law:

1. Individual mandate repeal.

If the Senate manages to pass its tax bill with repeal of the mandate, even over the concerns of some moderates, it’s hard to see how mandate repeal won’t make it into a final bill, too. It’s safe to say that a majority of House members are pretty gung-ho about getting rid of the least-popular part of Obamacare.

In Republicans’ minds, this is a win-win strategy.

One, it gives them hundreds of billions more dollars ($338 billion over a decade, according to the Congressional Budget Office to fund tax cuts. Two, repealing the mandate makes passing a future health-care bill potentially easier: It disposes of a major reason previous GOP measures were projected to result in fewer Americans with coverage. If the mandate is repealed, future GOP health-care bills would compare more favorably to current law.

2. The potential for Medicare cuts.

Let’s assume for a moment that Congress passes — and President Trump signs — a final tax overhaul that raises deficit spending (a Joint Committee on Taxation report released late yesterday showed the measure would add at least $1 trillion to the deficit over 10 years, even after economic growth is accounted for). If lawmakers don’t waive a 2010 rule known as “paygo,” aimed at keeping government spending in check, that deficit spending would trigger automatic cuts to mandatory spending.

That’s where Medicare cuts come in. Although the mandatory cuts are limited to 4 percent of the program, that still translates to a hefty sum of $25 billion in cuts to future Medicare spending starting next year, because the health insurance program for seniors is so big. 

a7e81_imrs The Health 202: Obamacare's centerpiece is hanging by a thread

Sen. Susan Collins (R-Maine) says she has misgivings about the health-care elements of the Senate tax bill. (AP Photo/Robert F. Bukaty, File)

Sen. Susan Collins (R-Maine), who generally opposes cuts to entitlement programs, has said that Senate Majority Leader Mitch McConnell (R-Ky.) has promised her the cuts won’t happen, because Congress will waive “paygo” rules. But such a decision is beyond McConnell’s ability to control. Waiving “paygo“ requires 60 votes in the Senate, and it’s not at all clear that Democrats would be willing to help Republicans save themselves from mandatory cuts.

3. Repeal of the medical expenses deduction.

The House bill fully repeals this tax break, which allows people to deduct from their taxes qualified medical expenses that exceed 10 percent of their income (for seniors, the threshold is 7.5 percent of their income). The credit was created during World War II, intended to give Americans a form of tax relief during wartime.

But the Senate version leaves the popular tax break intact, and lobbyists say a final bill probably will, too, given the pushback from seniors and disability rights groups.

4. Repeal of the orphan drug tax credit.

Repeal of this tax break seems more likely to stay in a final tax agreement, according to those tuned into deliberations on Capitol Hill. Right now, the breakdown in the chambers is the same as for the medical expenses deduction; the House version repeals it and the Senate version leaves it alone.

The credit benefits makers of treatments for “orphan diseases,” which affect fewer than 200,000 people. Congress passed it in 1983 as part of a bucket of incentives for pharmaceutical companies to develop drugs needed by much smaller patient populations. Pharma doesn’t want to see it go, but the industry might be willing to swallow a repeal, lobbyists say. So, a repeal could end up in the final package.

Sen. John McCain (R-Ariz.) arrives for votes on Capitol Hill on Monday. (AP Photo/J. Scott Applewhite)

–The three GOP senators who sank the Senate’s health-care bill back in July now appear to be on board with the GOP tax overhaul, even though it would repeal the ACA’s individual mandate. Sens. John McCain of Arizona and Lisa Murkowski of Alaska say they’re backing the measure, and Sen. Susan Collins of Maine has indicated she’s close to signing on. Both Collins and Murkowski have partially justified their support for the tax bill by noting that the health-care bill would have repealed much more of the ACA and defunded Planned Parenthood.

“The skinny repeal bill had many other provisions in it,” Collins told the Washington Examiner. “It repealed the employer mandate, eliminated funding for Planned Parenthood and had many other provisions and so it is not comparable at all [to mandate repeal].”

But here’s a wild card with the potential to swing Collins’s vote: that bipartisan measure from Sens. Lamar Alexander (Tenn.) and Patty Murray (Wash.) to fund extra Obamacare subsidy payments. Collins  said she’s been promised a vote on that measure by Senate Majority Leader Mitch McConnell (R-Ky.). But the measure’s prospects seems awfully shaky; the Senate is focused right now on the tax overhaul; yesterday House conservatives told The Hill they wouldn’t support it (they’ve labeled it an “insurer bailout”); and, as conservative policy wonk Chris Jacobs writes over at The Federalist, even if the payments are included in a year-end spending bill, they might not ever get made due to mandatory sequester cuts.

(Do you need some Christmas cookies after that last graf? I do.)

Here’s the interesting question at play over the next few weeks: Will Congress make two changes to the ACA marketplaces that are contrary to each other? Repealing the mandate undermines the marketplaces by ultimately weakening their risk pools (some healthy people drop coverage without the mandate). Making the subsidy payments (known as cost-sharing reductions) helps lower marketplace premiums, but it’s kind of moot if you’ve already removed the key requirement underpinning the whole ACA. Just another day in Congress, in other words.

The new Apple Watch Series 3. (AP Photo/Marcio Jose Sanchez)

AHH: Want to participate in Apple’s first-ever medical study? There’s an app for that. The new app, rolled out yesterday, works with the Apple Watch’s heart-rate monitor to check for irregular heart rates as part of a study the company is running with Stanford University. “While others have used Apple’s software and devices in medical studies, this is the first time that it’s actually sponsored one itself,” The Post’s Hayley Tsukayama reports. “The move is another sign that Apple is moving deeper into the health space.”

“Working alongside the medical community, not only can we inform people of certain health conditions, we also hope to advance discoveries in heart science,” said Apple chief operating officer Jeff Williams, in a statement.

“Health and fitness have been a key focus for Apple, especially since launching the Apple Watch two years ago,” Hayley writes. “That has allowed the company to tap the $3 billion health care market and, analysts say, find new audiences for its products and services. Apple already employs a small staff of medical professionals to develop its health products…The new study takes all of that a step further: Now Apple itself will be running a study and submitting data to the Food and Drug Administration. The heart-rate researcher will look specifically at atrial fibrillation — or afib — which refers to an irregular heart rate and is a leading cause of stroke and other heart conditions.”

A CVS store and pharmacy in Philadelphia. (AP Photo/Matt Rourke, File)

OOF: CVS Health Corp. could announce a deal as soon as Monday to buy major health insurer Aetna for more than $66 billion in cash and stock, creating a health-care giant selling everything from drugs to insurance, the Wall Street Journal reports. The company is in the advanced stages of negotiating the deal, likely valued at between $200 and $205 per Aetna share, WSJ writes. By merging with Aetna, CVS could gain more leverage in its drug price negotiations with pharmaceutical makers. It’s just the latest in a trend toward consolidation in the industry, as insurers and pharmacies face increasing pressure to tamp down soaring medical spending.

Healthcare.gov website. REUTERS/Mike Segar/File Photo

OUCH: The small networks in Obamacare plans are getting even narrower, according to an analysis released yesterday by Avalere. The percentage of marketplace plans with severely limited networks of doctors and hospitals have been on an upward trajectory; they comprised 54 percent of plans in 2015, 68 percent in 2017 and, next year, 73 percent of plans will feature narrow networks, the firm found.

“We continue to see insurers focusing on narrow network exchange products that enable them to offer competitive premiums and manage medical costs,” said Caroline Pearson, Avalere senior vice president. “These narrow network plans may come at a lower price tag for consumers, but they may also limit consumer choice and access to specialist care.” 

Deductibles are also going up for the most popular “silver” level plans, averaging $3,937 in 2018, up from an average of $3,703 in 2015. Gold-plan deductibles are rising, too, but average bronze and platinum deductibles are dropping from 2017 rates. Avalere also notes that consumers earning less than 250 percent of the federal poverty level can get cost-sharing discounts that typically result in cheaper deductibles.

–A few more good reads from The Post and beyond:

Today

  • The House Appropriations Subcommittee on Transportation, Housing and Urban Development and Related Agencies holds a hearing on HUD and community block grants for disaster recovery.

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on “Implementation of the 21st Century Cures Act: Responding to Mental Health Needs” on Dec. 13.  

The Senate voted Thursday not to send the Republican tax reform bill back to committee:

President Trump worries that Americans don’t say ‘Merry Christmas:’

Will President Trump be a drag on Republicans running in 2018?:

Watch Jimmy Kimmel talk about his Twitter war with Roy Moore: 

Without Obamacare Mandate, ‘You Open the Floodgates’ for Skimpy …

While repeal supporters argue that people would benefit by having the choice to buy less expensive plans, state regulators have been cracking down on rogue agents who have misled customers about what such inexpensive plans cover or more important don’t.

Examples abound of people who are dumped from such policies or denied coverage, mired in debt and medical bills totaling thousands, if not hundreds of thousands of dollars.

One case pending in federal court involves Kevin Conroy, who had a heart attack in 2014 and underwent triple bypass surgery, just two months after his wife, Linda, obtained a short-term policy over the telephone.

Their insurer, HHC Life, refused to pay the bills.

“We freaked out,” Ms. Conroy said. “What were we going to do? It was $900,000.”

Photo

ba290_merlin_130083077_0d61a3cf-6177-4607-9908-51108befb29b-blog427 Without Obamacare Mandate, 'You Open the Floodgates' for Skimpy ...

Grace Wood, a university instructor, at home in Berkeley, Calif. Her insurer left her with $150,000 in medical bills after she had a heart procedure, but ultimately paid them.

Credit
Christie Hemm Klok for The New York Times

The insurer informed the Conroys the policy was “rescinded,” to use the industry jargon. After poring through his medical records, HCC claimed Mr. Conroy failed to disclose he suffered from alcoholism and degenerative disc disease, conditions he said were never diagnosed. “When one thing didn’t work, they went to another,” Mr. Conroy said.

HCC Life, a unit of Tokio Marine HCC, says it will defend its case. The company is also the subject of a multistate review by insurance regulators to see if it engaged in unfair or deceptive acts. It says it has fully cooperated. HCC Life stopped selling short-term policies last May.

A major player in this area is UnitedHealth Group, which abandoned the Affordable Care Act market after incurring sizable losses. United offers short-term plans through its Golden Rule unit. Before the federal law, Golden Rule was among those insurers criticized for rescinding policies. The company recently told investors it was excited by the president’s executive order because that would mean an increase in business for these plans.

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Last year, a short-term policy averaged $109 a month for an individual, according to a recent analysis by eHealth, an online broker, compared with $378 a month during last year’s open enrollment period for an A.C.A. plan.

The policies are particularly attractive to the millions of people who don’t qualify for federal subsidies; only about half of the 17 million people buying coverage are subsidized, according to the Congressional Budget Office. Another target audience would be the 28 million who are uninsured. And some brokers are deliberately promoting the policies without pointing out they do not meet the same levels of coverage of A.C.A. plans, said Scott Flanders, the chief executive of eHealth. “They’re selling the hell out of it,” he said.

Jeff Smedsrud, a founder of Healthcare.com, another online broker, said, “There are companies that aggressively, and some very aggressively, market it as a panacea.”

In recent years, state regulators have investigated the marketing practices of particular brokers, and consumers have sued to expose the actions of some bad actors.

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In Pennsylvania during the past two years, the state took action against seven agents for misrepresenting the plans they sold. One woman who had a stroke was left with $250,000 in unpaid medical bills because the policy did not cover prescription drugs and other basic treatment.

While a handful of states, including New Jersey, now effectively ban short-term plans, others review rates and make sure the policies follow state law, said Dania Palanker, an assistant research professor at Georgetown University.

But other states will likely do little to prevent more sales of these policies, said Katherine Hempstead, a policy expert at the Robert Wood Johnson Foundation. “You’re going to make it easier in places where it is already easy,” she said.

Photo

ba290_merlin_130083077_0d61a3cf-6177-4607-9908-51108befb29b-blog427 Without Obamacare Mandate, 'You Open the Floodgates' for Skimpy ...

Obamacare map. More stuff

Credit
Person

Industry experts estimate as many as a million people may now have these policies, though the official tally is much lower. And others may fall under this umbrella, because it’s hard to distinguish from alternatives, like so-called limited benefit plans, which cap how much the insurer will pay, and association plans, available to small businesses, that will also be expanded under Mr. Trump’s executive order.

Several companies are poised to capitalize on a less restrictive environment. Health Insurance Innovations, which markets short-term policies, including those once offered by HCC Life, is under scrutiny by state insurance regulators. It recently told investors that there were “tens of millions” of people who could benefit from these plans. The company declined to comment.

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Continue reading the main story

These plans typically offer much higher commissions to brokers selling them, and they can be much more profitable for insurers. UnitedHealth’s Golden Rule spent about half of every dollar it took in premiums for medical expenses, according to regulatory filings. Under the federal law, insurers must spend at least 80 cents of each dollar on care for their customers. UnitedHealth declined to comment.

Some experts speculate that insurers are likely to exploit the existing A.C.A. market as a way of selling short-term policies to people until they have serious medical conditions. Coverage sold under the federal law would become increasingly expensive, with people priced out of the market if they didn’t get subsidies, Mr. Laszewski, the industry consultant, said.

While the market for subsidized coverage is largely protected, the market for those who pay the full cost is already shrinking, he said.

Like the insurance that was sold before the federal health care law, people with chronic conditions or a history of illness are mostly turned away. Companies will sometimes rescind policies if an individual has high medical bills.

UnitedHealth’s Golden Rule recently won a lawsuit involving one of its short-term policies, claiming it did not have to cover $400,000 in medical bills because it said a woman with breast cancer had an abnormal mammogram before she enrolled. The case is being appealed.

“Insurance companies today are interpreting their short-term health insurance policies so as to label any condition that arises during the policy term as a pre-existing condition for which the company can exclude coverage,” said a lawyer representing Ms. Jones in a statement. UnitedHealth declined to comment.

Customers often have had to argue about whether something was a pre-existing condition. When Karen Campbell and her husband looked for insurance before Obamacare, “we had this extensive, unbelievable interview, each of us about our medical history,” she said. After rupturing her Achilles’ tendon, which required $30,000 in surgery and physical therapy, the insurer asked for medical records to make sure it wasn’t something she previously had. “They just made it really difficult,” Ms. Campbell said.

Grace Wood, an instructor at a university in San Francisco, bought a short-term plan in 2013. When she had to have a heart procedure, her insurer, HCC Life, balked, leaving her with roughly $150,000 in unpaid medical bills.

“Why should I go bankrupt?” Ms. Wood recalled asking herself. It took her a year and a half, but she appealed and turned to regulators when the insurer ignored her. HCC eventually paid the claims.


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Trump Health Nominee Embraces Obamacare Programs the Last Guy Ended

President Donald Trump’s nominee to oversee Medicare says he’s a fan of paying doctors and hospitals in new, potentially more efficient ways through experimental payment programs set up under Obamacare.

The federal agency he’s been picked and that administers the programs to run just killed off three of them.

75d2e_60x-1 Trump Health Nominee Embraces Obamacare Programs the Last Guy Ended

Alex Azar

“One of the great legacies of Secretary Burwell’s tenure was launching so many of the alternative payment models that we have out there,” Alex Azar, Trump’s nominee to lead the Department of Health and Human Services, said Wednesday in Washington. “I’d like to keep driving that forward.”

Sylvia Mathews Burwell ran the department under President Barack Obama, and was responsible for implementing and running some of the Affordable Care Act programs that changed how Medicare pays for services. Medicare covers more than 50 million elderly and disabled Americans, and its payment policies have wide influence.

Obamacare mandated what are known as bundled payments for some episodes of care, such as heart attacks or hip fractures. Medicare typically pays for individual procedures, which critics say drives up costs by giving doctors or hospitals incentives to provide more services. Bundling creates a single payment for an entire course of treatment, giving doctors an incentive to be more efficient.

Read more: Trump Slows Efforts to Cut Health-Care Costs

On Thursday, the Centers for Medicare and Medicaid Services — a sub-agency of the health department — said it will shift to voluntary participation for the hip and cardiac programs, and shrink a third program for other joint replacements while also making it voluntary in many parts of the country.

Without Obamacare Mandate, ‘You Open the Floodgates’ for Skimpy Health Plans

While repeal supporters argue that people would benefit by having the choice to buy less expensive plans, state regulators have been cracking down on rogue agents who have misled customers about what such inexpensive plans cover or more important don’t.

Examples abound of people who are dumped from such policies or denied coverage, mired in debt and medical bills totaling thousands, if not hundreds of thousands of dollars.

One case pending in federal court involves Kevin Conroy, who had a heart attack in 2014 and underwent triple bypass surgery, just two months after his wife, Linda, obtained a short-term policy over the telephone.

Their insurer, HHC Life, refused to pay the bills.

“We freaked out,” Ms. Conroy said. “What were we going to do? It was $900,000.”

The insurer informed the Conroys the policy was “rescinded,” to use the industry jargon. After poring through his medical records, HCC claimed Mr. Conroy failed to disclose he suffered from alcoholism and degenerative disc disease, conditions he said were never diagnosed. “When one thing didn’t work, they went to another,” Mr. Conroy said.

HCC Life, a unit of Tokio Marine HCC, says it will defend its case. The company is also the subject of a multistate review by insurance regulators to see if it engaged in unfair or deceptive acts. It says it has fully cooperated. HCC Life stopped selling short-term policies last May.

A major player in this area is UnitedHealth Group, which abandoned the Affordable Care Act market after incurring sizable losses. United offers short-term plans through its Golden Rule unit. Before the federal law, Golden Rule was among those insurers criticized for rescinding policies. The company recently told investors it was excited by the president’s executive order because that would mean an increase in business for these plans.

Advertisement

Continue reading the main story

Last year, a short-term policy averaged $109 a month for an individual, according to a recent analysis by eHealth, an online broker, compared with $378 a month during last year’s open enrollment period for an A.C.A. plan.

The policies are particularly attractive to the millions of people who don’t qualify for federal subsidies; only about half of the 17 million people buying coverage are subsidized, according to the Congressional Budget Office. Another target audience would be the 28 million who are uninsured. And some brokers are deliberately promoting the policies without pointing out they do not meet the same levels of coverage of A.C.A. plans, said Scott Flanders, the chief executive of eHealth. “They’re selling the hell out of it,” he said.

Photo

66ba4_merlin_130083077_0d61a3cf-6177-4607-9908-51108befb29b-blog427 Without Obamacare Mandate, 'You Open the Floodgates' for Skimpy Health Plans

Grace Wood, a university instructor, at home in Berkeley, Calif. Her insurer left her with $150,000 in medical bills after she had a heart procedure, but ultimately paid them.

Credit
Christie Hemm Klok for The New York Times

Jeff Smedsrud, a founder of Healthcare.com, another online broker, said, “There are companies that aggressively, and some very aggressively, market it as a panacea.”

In recent years, state regulators have investigated the marketing practices of particular brokers, and consumers have sued to expose the actions of some bad actors.

In Pennsylvania during the past two years, the state took action against seven agents for misrepresenting the plans they sold. One woman who had a stroke was left with $250,000 in unpaid medical bills because the policy did not cover prescription drugs and other basic treatment.

Newsletter Sign Up

Continue reading the main story

While a handful of states, including New Jersey, now effectively ban short-term plans, others review rates and make sure the policies follow state law, said Dania Palanker, an assistant research professor at Georgetown University.

But other states will likely do little to prevent more sales of these policies, said Katherine Hempstead, a policy expert at the Robert Wood Johnson Foundation. “You’re going to make it easier in places where it is already easy,” she said.

Industry experts estimate as many as a million people may now have these policies, though the official tally is much lower. And others may fall under this umbrella, because it’s hard to distinguish from alternatives, like so-called limited benefit plans, which cap how much the insurer will pay, and association plans, available to small businesses, that will also be expanded under Mr. Trump’s executive order.

Several companies are poised to capitalize on a less restrictive environment. Health Insurance Innovations, which markets short-term policies, including those once offered by HCC Life, is under scrutiny by state insurance regulators. It recently told investors that there were “tens of millions” of people who could benefit from these plans. The company declined to comment.

Advertisement

Continue reading the main story

These plans typically offer much higher commissions to brokers selling them, and they can be much more profitable for insurers. UnitedHealth’s Golden Rule spent about half of every dollar it took in premiums for medical expenses, according to regulatory filings. Under the federal law, insurers must spend at least 80 cents of each dollar on care for their customers. UnitedHealth declined to comment.

Some experts speculate that insurers are likely to exploit the existing A.C.A. market as a way of selling short-term policies to people until they have serious medical conditions. Coverage sold under the federal law would become increasingly expensive, with people priced out of the market if they didn’t get subsidies, Mr. Laszewski, the industry consultant, said.

While the market for subsidized coverage is largely protected, the market for those who pay the full cost is already shrinking, he said.

Like the insurance that was sold before the federal health care law, people with chronic conditions or a history of illness are mostly turned away. Companies will sometimes rescind policies if an individual has high medical bills.

UnitedHealth’s Golden Rule recently won a lawsuit involving one of its short-term policies, claiming it did not have to cover $400,000 in medical bills because it said a woman with breast cancer had an abnormal mammogram before she enrolled. The case is being appealed.

“Insurance companies today are interpreting their short-term health insurance policies so as to label any condition that arises during the policy term as a pre-existing condition for which the company can exclude coverage,” said a lawyer representing Ms. Jones in a statement. UnitedHealth declined to comment.

Customers often have had to argue about whether something was a pre-existing condition. When Karen Campbell and her husband looked for insurance before Obamacare, “we had this extensive, unbelievable interview, each of us about our medical history,” she said. After rupturing her Achilles’ tendon, which required $30,000 in surgery and physical therapy, the insurer asked for medical records to make sure it wasn’t something she previously had. “They just made it really difficult,” Ms. Campbell said.

Grace Wood, an instructor at a university in San Francisco, bought a short-term plan in 2013. When she had to have a heart procedure, her insurer, HCC Life, balked, leaving her with roughly $150,000 in unpaid medical bills.

“Why should I go bankrupt?” Ms. Wood recalled asking herself. It took her a year and a half, but she appealed and turned to regulators when the insurer ignored her. HCC eventually paid the claims.

Continue reading the main story




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