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Posts Tagged 'obamacare repeal'

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Trump's Executive Order on Healthcare is Bad Medicine

With all the skill of a surgeon wielding a machete, President Trump signed an executive order today that could undermine the affordability and quality of health insurance in America.  Republicans in Congress couldn’t enact their ill-considered legislation to repeal Obamacare, so the President hastily reached for his pen, despite admitting earlier this year that he had no idea “healthcare could be so complicated.”

The executive order instructs Trump’s cabinet agencies to look at ways to allow insurers to sell health policies across state lines.  The aim is to open-up association health plans (currently covering employees of various businesses and organizations) to people in the individual market.  These insurance policies would not be subject to Obamacare rules mandating coverage for pre-existing conditions or essential benefits, in theory making them cheaper – but also skimpier.  

These lower-cost, bare bones plans could siphon off younger and healthier enrollees, leaving older and sicker patients in the Obamacare exchanges and driving up their premiums. Ultimately, this could result in a death spiral for Obamacare, as we discussed on today’s Behind the Headlines Facebook Live broadcast. The administration’s own Centers for Medicare and Medicaid Services (CMS) says on its website:

Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. 

To some, the idea of selling insurance across state lines sounds appealing. (Republicans have been proposing this scheme in one form or another since 2005.)  Senator Rand Paul (R-KY) has been pushing it hard this year. But evidence – and history – indicate that the idea doesn’t work.  This Kaiser Health News video briefly and crisply explains why.

Not only does the selling-across-state-lines concept undermine important patient protections and drive up premiums for the most vulnerable, it has never proven viable for insurers or the insured.  According to today’s Hill newspaper:

A few states have opened their borders to out-of-state health insurers, and the response has been a uniform, “Thanks, but no thanks.”

One of Obamacare’s architects, Dr. Zeke Emanuel, told CNN today that, in addition to other concerns, association health plans have a “checkered history” and are especially vulnerable to fraud and scam artists. “Hundreds of thousands of people could be affected by fraud, unreimbursed medical bills,” he warned.  Emanuel also cautioned that patients with employer-provided insurance could see their rates rise “significantly.”

The biggest problem of all, though, is that Trump’s executive order may well be illegal.  The New York Times reports:

Several experts in healthcare and employment law said Trump’s plan could violate the U.S. Employee Retirement Income Security Act (ERISA), a federal law that governs large group plans that must be provided or maintained by employers or employee organizations.

In fact, a coterie of Democratic states attorneys general are poised to sue the administration if it enacts these harmful changes.

For all the Republicans’ talk of federalism, the executive order would actually weaken states’ power to regulate insurance markets, which is one of their primary responsibilities in the health care arena.

But as with the President’s trickle-down tax plan and other haphazard policies, history, precedent and data don’t seem to matter to this White House.  That’s especially troubling when – once again – the most vulnerable members of society will pay the price.


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Throwing More Money at Wavering Senators’ States Doesn’t Improve Graham-Cassidy

To paraphrase W.C. Fields, it seems as if news of the death of the Graham-Cassidy bill is greatly exaggerated.  As veteran Kaiser Health News correspondent Julie Rovner tweeted this morning:

FWIW I will not believe health bill is really dead until I see it with an actual stake through it.

Her caution is well warranted.  Anti-repeal advocates breathed a sigh of relief last Friday when Senator John McCain (R-AZ) announced his opposition to the bill.  But opponents of Graham-Cassidy still need one more GOP vote to kill it before the September 30th deadline, and so far only McCain and Senator Rand Paul (R-KY) have announced as ‘No’s.  Some Hill-watchers are wary of Rand Paul’s position and predict he will flip to ‘Yes’ at the last minute, as he has done previously.  On the other hand, this weekend Sen. Ted Cruz (R-TX) threw cold water on Graham-Cassidy because he says it doesn’t go far enough in undoing Obamacare regulations:

"Right now they don't have my vote, and I don't think they have Mike Lee's either," Cruz said. "I want to be a yes."              –  Senator Ted Cruz

Seeing their Obamacare repeal bill appear to collapse before their eyes, Senators Lindsay Graham (R-SC) and Bill Cassidy (R-LA) have now sweetened the deal to try to buy off two wavering moderate Senators, Lisa Murkowski (R-AK) and Susan Collins (R-ME).   The Graham-Cassidy bill was changed over the weekend to give away tens of millions of dollars to two of America’s least populous states.  Alaska would net $3 million more in federal health spending than under current law from 2020-2026, and Maine $43 million.  Of course, when Graham-Cassidy’s block grants to states expire in 2026, both states will lose funding along with the other 48.   Steven Dennis of Bloomberg handicaps it this way:


These buy-offs may or may not bring Senators Murkowski and Collins over to the ‘Yes’ side.  Nor should they.  Both Senators have expressed deep concerns about other parts of the bill:  Sen. Murkowski for its elimination of protections for pre-existing conditions; Sen. Collins for its deep cuts to Medicaid.  And of course, these bribes for Alaska and Maine do not make the Graham-Cassidy bill any less egregious.  Every major group of stakeholders – insurers, doctors, hospitals, patients, and all 50 state Medicaid directors – have condemned this bill as a reckless assault on America’s health care system.  National Committee president Max Richtman lays out the case in testimony given to the Senate Finance Committee. 

The Republicans supporting Graham-Cassidy don’t seem to care as much about improving healthcare as they do about fulfilling a reckless campaign promise and scoring a legislative “win,” even though the vast majority of the American people would actually lose.  Premium subsidies would be eliminated, pre-existing conditions no longer protected, essential benefits gutted, and Medicaid decimated to the point where crucial services would be cut for seniors, children and the disabled.  One look at this chart from Kaiser Health News showing where most Medicaid spending goes makes it crystal clear who gets hurt if Graham-Cassidy becomes law.

Senators Graham and Cassidy, along with their enablers in the Trump administration, will continue to falsely claim that their bill protects people with pre-existing conditions, when by leaving it to the states to decide, there is no such protection at all.  If states seek waivers to pre-existing conditions, insurers can jack up rates for patients with diabetes, cancer, heart disease and other chronic illnesses to the point of unaffordability.

Instead of believing more pablum, or trusting that the Republican-led Senate will do the right thing, we must keep up the pressure on wavering Senators (especially Collins and Murkwoski) to vote ‘No’ when the bill comes to the floor later this week.  If we are to see a stake through Obamacare repeal, we must make sure to put it there ourselves. 

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Summertime No Time to Stop Protecting Seniors' Healthcare

Washington, D.C. is noticeably mellower with Congress beginning its August recess.  Our “worst-in-the-U.S.” traffic is noticeably lighter.  The sidewalks are emptier.  The news from Capitol Hill has slowed to a trickle.  But the summer doldrums are no time for advocates here in D.C. or the 50 states to let our guard down.  (We just discussed this on "Behind the Headlines" from Capitol Hill on Facebook Live.) 

Last week, we narrowly escaped the passage of healthcare legislation that would have been devastating for poorer, older, and sicker Americans. The heroism of three GOP Senators and a united Democratic party pulled us back from the brink by voting against the latest Obamacare repeal bill.  

Make no mistake, intense grassroots activism in Congressional districts across the country played no small part in the defeat of repeal legislation in both houses of Congress.  From New Hampshire to Nevada, everyday Americans challenged their elected representatives to protect their healthcare – and won in a heart-pounding showdown.  

In the end, only Senators Collins, Murkowski, and McCain had the courage to defy party leadership and do the right thing.  That’s a thin reed on which to hang future hopes.  If a single one of those votes had gone the other way, at least 22 million Americans would have been well on their way to losing healthcare coverage – and the Medicaid program would have been decimated.  In fact, it’s disappointing that some of the Republican moderates who seemed to oppose the various repeal bills voted yes in the end.  Perhaps it’s because Senator McCain’s no vote gave them cover.  But where is the courage in that?

While Senate Majority Leader Mitch McConnell says it’s time to “move on,” Speaker Paul Ryan signaled that the House isn’t done trying to repeal the Affordable Care Act.   Meanwhile, President Trump continues to threaten to cut off crucial cost-sharing payments, spooking insurers and threatening to drive up premiums.  As Phil Moeller pointed out in his column for PBS NewsHour, there’s a real danger that the majority party will re-attack Obamacare after August recess ends.  

With Capitol Hill’s largely silent and long-postponed summer vacations underway, there is little appetite for re-engaging in nasty policy fights. But when the leaders and their troops are rested, there is little doubt that [they] will be back at it again. – Phil Moeller, PBS NewsHour

This means that we in the advocacy community cannot simply relax this month – tempting as that may be.  Advocates and everyday activists must continue to deliver the message to our elected representatives that it’s time to stop trying to destroy the Affordable Care Act and work across the aisle to improve it, as National Committee President Max Richtman argued in The Hill newspaper this week.  We must maintain the drumbeat whenever and wherever we encounter members of Congress this summer:  at their district offices, by phone, by email, or around town.

Make no mistake:  the activism we saw last winter and spring made a difference.  Members of Congress heard their constituents loud and clear at contentious town halls.  Phone lines, fax lines, and email accounts were jammed. Congress heard us when we said “Hands Off Our Healthcare!”

But even after all that full-throated activism, several GOP moderates in the House and Senate still caved when it was time to cast crucial votes. We came dangerously close to losing the Affordable Care Act. If anything, we must step up our activism.  We must make the case for protecting the healthcare of seniors – and all Americans – even more vociferously, letting our leaders know in personal terms the true impact of changes to our healthcare coverage. But we must also demand that our elected representatives talk to us. Hold town halls, don’t cancel them.  Keep phone lines open instead of shutting them down.  Hear us instead of hiding. And if there are future votes to undermine our healthcare, we must insist that more GOP moderates stick to their stated principles instead of running with the herd.


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Mr. President, Stop Saying Obamacare Is Imploding (Because It's Not)

updated 7/10/17

During a CNN focus group of Trump voters last week, one educated, white collar professional said that the Republican congress had to repeal and replace Obamacare because it is “imploding.”  That Trump supporter directly mimicked Trump’s own comments about Obamacare – comments which are patently misleading.  This proves once again the effectiveness of demagogic language (“Obamacare is a disaster!”) shamelessly applied to important policy questions that impact almost every American.

Obamacare is most definitely not imploding, but Trump and the GOP in Congress have convinced an awful lot of people that it is – simply by repeating the same falsehoods on a regular basis. Why does this matter?  It matters because the Senate may vote on its Obamacare repeal and replacement plan within the next couple of weeks.

The GOP’s Better Care Reconciliation Act would deprive 22 million Americans of health coverage over the next ten years and gut Medicaid, hitting the old and the sick unusually hard. As long as Republicans continue to justify repeal with false claims that Obamacare is in a “death spiral,” advocates for the most vulnerable members of our society must continue to call them out.

Both the New York Times and the Washington Post this week found it necessary to debunk misleading Republican claims about Obamacare and the Senate bill to replace it.  The Times entitled its piece, “Five Misleading Republican Claims About Health Care,” while the Post went with “Decoding the White House spin on Obamacare ‘failures.’”  The papers’ fact-checkers had plenty of material to work with. 

These and other analyses are crucial to understanding what’s really happening with Obamacare and the GOP repeal and replace legislation:

1) Obamacare is not “imploding” or in a “death spiral.”  Despite recent instability mostly induced by the Trump administration and Congress itself, Obamacare is hardly imploding.  A new study by the Kaiser Family Foundation suggests that Obamacare markets are, in fact, "stabilizing" and "regaining profitability."  The CBO forecasts that the Obamacare system will remain stable for the foreseeable future - if it is not further undermined. 

2) Premiums for Obamacare policies are not generally rising 200-300%.  Though a few states have unfortunately seen triple digit premium hikes, the National Conference of State Legislatures found that average premium increases nationwide were 25% this year.  Because some 84% of enrollees’ premiums are covered by Obamacare subsidies, few feel the effects of the increases.  Their net costs may even decrease.  

As the Post’s fact-checkers point out, “Average insurance premiums in the Obamacare marketplace now are about at the level predicted by the Congressional Budget Office for 2017 when it first evaluated the law in 2009.”  In other words, some premium hikes were predictable as the new marketplaces found their footing – and not likely to be repeated every year.

3) Insurers are not abandoning state insurance exchanges in droves.  The Post reports that an average of five insurers participated in each state’s marketplace in 2014, ranging from one to 16 companies per state. According to the Kaiser Family Foundation, the average number of insurers in 2017 is 4.3, ranging from one to 15 companies per state.  Not a huge decline.  Still, “slightly more than 2 million people, mostly in rural areas, don’t have competitive plans to choose from and are seeing premium increases,” writes the Post’s Dana Milbank.  But again, many of those premium hikes are offset by Obamacare subsidies.

4) The Trump administration and Congress could have done a lot more to stabilize Obamacare; instead they undermined it.  Here’s how:  

*The administration balked at paying cost-sharing subsidies that would have relieved financial pressure on reluctant insurers.

*President Trump signed an executive order soon after taking office instructing federal agencies not to enforce the Obamacare mandate that all Americans have health insurance, discouraging participation in the exchanges.

*The administration ended public outreach efforts to encourage Americans to sign up for health care.

*In fact, President Obama and the Democrats in Congress asked Republicans to work with them to strengthen Obamacare during the    first six years after the law was passed, only to have the GOP Congress vote to repeal it some 60 times.   

5) The President and his allies in Congress have spooked the insurance markets.  They have sown tremendous uncertainty about Obamacare’s future with their attempts to repeal the law and harsh rhetoric, spooking insurance companies and potential customers.  The former chief marketing officer for HealthCare.gov estimated that Trump’s rhetoric alone has deterred nearly 500,000 people from signing up this year.

Furthermore, the Post reports that figures the White House uses to smear Obamacare are often based on comparisons of the insurance markets from before the law took effect and today.  Such apples-to-oranges comparisons are misleading and not useful.

Meanwhile, the Republicans have employed similar demagoguery to promote their own repeal and replace legislation.  The Times found several GOP claims about the Senate healthcare bill to be factually dubious, including assertions that the legislation does not “pull the rug from anyone currently covered by Obamacare” – and that the bill “reduces taxes on the middle class” when, in fact, the top 1% of earners reap most of the benefits.  The cruel truth is that some 22 million Americans would lose health coverage under the GOP bill over the next ten years, including 15 million Medicaid beneficiaries – many of whom are needy seniors who rely on the program to pay for long-term care.  We must not allow the clever manipulation of language by those who would destroy Obamacare to hurt so many millions. 

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Mitch McConnell's "Secret" Healthcare Plan... and the SeniorHeroes who could stop him

When the House passed its American Health Care Act (AHCA) last month, conventional wisdom said it was doomed in the Senate.  Moderate Republican Senators would never go along with the more harmful provisions of the House bill – or so the narrative went.  It appears those predictions were off base.  If the latest reporting from Capitol Hill is accurate, Majority Leader Mitch McConnell has put the Republican healthcare plan on a fast-track for passage in late June or early July.  A 13-member working group has been meeting in secret to craft the Senate version of the AHCA – without committee hearings.  Zero open debate.  Zero public input.  Or as the Washington Post described the process:  “sabotage, speed and secrecy.”  In order to keep pushback to a minimum, McConnell may not release the details of the bill until about 48 hours before the Senate votes on it.  That is insufficient time for Senators – and the public at large – to evaluate legislation that could dramatically affect the lives of tens of millions of Americans.

 Another false prediction from a few weeks ago said that the Senate would scrap the House bill and start from scratch. But this week Senator John Cornyn (R-TX) revealed that the Senate bill retains about 80% of what the House passed.  Since the House bill was so unequivocally bad for older Americans, hearing that the Senate version is at least 80% as bad is cold comfort. The Senate leadership will try to appease GOP moderates with the same kind of token gestures that saved the AHCA from defeat in the House.  It is vitally important that those moderates not cave like their House colleagues did.  Too much is at stake for our nation’s seniors and Americans as a whole.

 The National Committee has identified 11 moderate GOP Senators who may be persuaded to vote against the Republican health care plan – if they are willing to put their constituents’ well-being above party and political expediency.  They are:

 Sens. Lisa Murkowski and Dan Sullivan (R-AK)

Sens. John McCain and Jeff Flake (R-AZ)

Sen. Cory Gardner (R-CO)

Sen. Charles Grassley (R-IA)

Sen. Susan Collins (R-ME) 

Sen. Dean Heller (R-NV)

Sen. Rob Portman (R-OH)

Sen. Lamar Alexander (R-TN)

Sen. Shelley Moore Capito (R-WV)

 In fact, we call on these Senators to become what we call “SeniorHeroes” – real-life superheroes standing up for older Americans while the rest of their party pursues a dubious scheme.  From what we know of the Senate bill, there isn’t much in the evolving Senate bill for moderates to applaud.  Sen. Lisa Murkowski expressed those doubts publicly on Thursday.  Here are some of the key areas where the Senate version will likely fail older Americans:

 MEDICAID EXPANSION.  Senate Republicans are considering “compromises” that would phase out funding more slowly – but do not appear to be considering any approach that would maintain Medicaid expansion over the long run.  (Many of the more moderate Senators represent states which chose to expand Medicaid – and have a lot to lose.)

 PER CAPITA CAPS.  The Senate reportedly will retain the House-passed bill’s Medicaid per capita caps, which would strain state budgets and possibly force rollbacks in benefits or outright termination of coverage for millions of seniors who depend on Medicaid to pay for long-term care.  Although it’s unclear whether the Senate will keep the House bill’s $834 billion in Medicaid cuts, Medicaid still likely will be slashed by hundreds of billions of dollars. 

PRE-EXISTING CONDITIONS AND ESSENTIAL HEALTH BENEFITS.  The Senate may reject provisions in the House bill that would have allowed insurers to charge higher premiums for individuals with pre-existing conditions, but will likely allow states to waive essential benefits coverage.  This would dearly cost older Americans seeking essential benefits, such as hospitalization, ambulance services, and rehabilitation services. 

TAX CREDITS.  The House bill would drive up seniors’ out-of-pocket costs by replacing Obamacare’s income-based subsidies with tax credits based solely on age.  Older Americans could pay up to 800 percent more in net premiums under this plan.  The Senate has toyed with making these tax credits more “robust,” but the more it increases these credits, the deeper it must cut Medicaid to match the savings in the House bill. 

We do not know whether the Senate will allow insurers to charge older enrollees five times more than younger ones, as the House legislation does.  Also uncertain is whether the Senate will repeal the Medicare payroll tax on high income wage earners (as the House did), which would reduce the solvency of Medicare by three years.

It’s a safe bet that, like the House version, the Senate GOP healthcare plan will cost older Americans more, make essential health benefits harder to obtain, and cause millions who desperately need healthcare to lose coverage.  GOP moderates will be under intense political pressure to toe the line and support the party’s plan, even though the Republican bill has scant public support in even the reddest of states.  In asking GOP moderates to don their capes and become SeniorHeroes, we hope they remember who they were elected to serve.  It certainly wasn’t Mitch McConnell. 

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For more about the GOP's secret Senate healthcare plan, watch this week's "Behind the Headlines" on Facebook Live from Capitol Hill. 

 

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