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- 05/12/17--14:46: _Watch a man stuff m...
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- 05/14/17--06:33: _'There's only one w...
- 05/14/17--11:12: _These are the Repub...
- 05/16/17--09:11: _Americans overwhelm...
- 05/17/17--14:07: _Early cancer diagno...
- 05/19/17--10:41: _States attempt to b...
- 05/19/17--13:28: _Trump reportedly wa...
- 05/22/17--08:38: _Trump just made a m...
- 05/23/17--14:09: _Trump's proposed tr...
- 05/23/17--14:58: _Key 'Trumpcare' arc...
- 05/24/17--07:23: _Trump's proposed tr...
- 05/24/17--08:10: _The GOP faces anoth...
- 05/24/17--09:12: _ANTHEM: Our 2018 Ob...
- 05/10/17--09:22: The new version of the GOP healthcare bill is incredibly unpopular
- 05/10/17--14:12: Aetna has officially ditched all of its Obamacare business
- 05/16/17--09:11: Americans overwhelmingly like Obamacare more than Trumpcare
- 05/17/17--14:07: Early cancer diagnoses increased after Obamacare went into place
- New York
- New Mexico
- The District of Columbia
- 05/22/17--08:38: Trump just made a move to save Obamacare — for now
- 05/23/17--14:58: Key 'Trumpcare' architect Tom MacArthur resigns from centrist caucus
- 05/24/17--08:10: The GOP faces another judgment day on healthcare
Jonathan Bush, CEO of athenahealth, sat down with Business Insider global editor in chief Henry Blodget to discuss our nation's current healthcare system. Following is a transcript of the video.
Blodget: Where does healthcare reform go from here?
A part of Tennessee's Obamacare market is getting a lifeline.
After insurer Humana decided to step away from the Knoxville, Tennessee-area individual insurance marketplace, the Affordable Care Act's exchange was left without an insurer for the 2018 plan year.
In a letter on Tuesday, however, Blue Cross Blue Shield of Tennessee (BCBST) said it would step into the area and provide coverage next year.
"With this in mind, I want to confirm that BlueCross is willing to serve the Knoxville region in the 2018 individual Marketplace," JD Hickey, CEO of BCBST, said in the letter.
Part of the reason that BCBST was willing to come back into the market, Hickey said in the letter, was improved financial stability in its existing Obamacare business.
"As we discussed, BlueCross’s journey to get and keep people covered under this program has proven challenging, with three consecutive years of volatility and losses totaling more than $400 million," Hickey wrote. "I’m pleased to report that, though still very early, our 2017 performance has improved due to a combination of better claims experience and a more sustainable rate structure based on the medical needs of the members we’re serving."
The average benchmark premium in Tennessee increased by 63% in 2017, according to the Department of Health and Human Services. Most health-policy analysts had projected it would be a one-time surge, since many plans had kept their costs artificially low during the early years of the exchanges. Critics pointed to the increases as a sign of collapse.
While Hickey stressed that the decision was "in no way a political decision," the BCBST CEO cited a number of uncertainties for the insurance market that are derived from political decisions. These uncertainties, said the letter, meant the company would have to raise premiums to protect against potential short falls.
From the letter:
"Given the potential negative effects of federal legislative and/or regulatory changes, we believe it will be necessary to price-in those downside risks, even at the prospect of a higher-than-average margin for the short term, or until stability can be achieved. These risks include but are not limited to the elimination of Cost Sharing Reduction subsidies (CSRs), the removal of the individual mandate and the collection of the health insurer tax."
According to Holly Fletcher at the Nashville-based Tennessean, the Tennessee insurance commissioner also spoke to other insurers, including Humana, about returning to the area to avoid having no insurers.
No areas of the country currently have zero insurers, but states like Iowa have faced that possibility. If all insurers backed out of an area, people in those parts of the country could have the penalty for not having insurance waived and be forced to go without coverage.
Sen. Orrin Hatch on Tuesday suggested public sentiment would make the GOP's healthcare fight more complicated because too many people are "on the dole" and won't want to give up benefits provided by the Affordable Care Act.
Hatch, the chair of the Senate Finance Committee, was asked by a reporter if public opposition to the GOP healthcare plan would impact the Senate's decision-making on its version of the bill.
"The public wants every dime they can be given. I mean face it, once you get them on the dole they're going to take every dime they can," Hatch told reporters leaving a healthcare planning meeting. "We've got to find some way of getting things under control or this country in the near future is going to be gone."
The American Health Care Act, which passed the House last week, has been shown to be generally unpopular among Americans. A HuffPost/YouGov poll released on Monday showed 31% of Americans support the AHCA, while 44% oppose it.
One of the sticking points that has emerged is funding for Obamacare's Medicaid expansion. The AHCA would shift the current funding structure to a per-capita block grant, which the Congressional Budget Office estimates would cut more than $800 billion in funding for the program that provides low-income Americans with health insurance.
Hatch, as head of the Senate Finance Committee, has purview over aspects of Medicaid.
Republicans have been critical of the Medicaid expansion, saying it adds to the funding burden of the federal government.
Other provisions of the Affordable Care Act, such as tax credits to help American pay for insurance, have been criticized by conservatives as new entitlement programs.
Senate Republicans have so far convened a working group to build their own version of a healthcare bill, but have not laid out a time table for its completion.
Hatch's office did not immediately return a request for comment.
A few hundred vocal protesters met House Speaker Paul Ryan when he arrived at Success Academy charter school in Harlem on Tuesday afternoon.
Ryan, who met with Success founder and CEO Eva Moskowitz and toured the school, is not the first Republican leader to visit New York's expansive and controversial charter network — Ivanka Trump and House Majority Leader Kevin McCarthy have both visited the schools.
“I was pleased to welcome Speaker Ryan to our flagship school in Harlem today," Moskowitz said in a statement. "The education crisis in our city and country is profoundly damaging to millions of children, and parent choice has proven to be an effective lever in education reform."
Moskowitz was under consideration to become President Donald Trump's education secretary before Trump chose Betsy DeVos, a wealthy and controversial proponent of school choice programs. DeVos praised Moskowitz's commitment to creating alternatives to public education after meeting with her in April.
Protesters, who gathered outside the school for several hours, voiced concerns about a range of Ryan's policies, prominent among them the Republican healthcare bill, which is currently being debated in the Senate. They argued that Ryan is attempting to privatize public services, including education, healthcare, and social security, which would disproportionately affect low-income people and people of color.
"It takes some nerve for him to come in here after trying to defeat healthcare that's necessary for the families of these children," Eve Goodman, a social worker from Brooklyn, told Business Insider.
For years, Success Academy, which is the city's largest charter network and serves predominantly low-income students of color, has attracted criticism for what some see as its harsh teaching tactics and pattern of weeding out students who fail to meet their academic standards.
Eliza Factor, whose 14-year-old son has autism and cerebral palsy and attends a non-profit school partially funded by Medicaid, fears the GOP healthcare bill would strip funding for education and healthcare that her son and other children with disabilities rely on.
"Any of the people that I know in my community, if we lost our health insurance now we'd never be able to get new health insurance if they change the laws," Factor, who also runs a non-profit for children with disabilities in Brooklyn and Queens, told Business Insider.
Factor does not think charter schools are necessarily harmful, but echoed a common criticism: that Success Academy weeds out students with learning issues or other disabilities, pushing them into struggling public schools whose funding is diverted to charters.
"The Success Academy has a record of kicking out kids with disabilities and kids who learn differently," Factor said. "They achieve their high scores by getting a homogenized body of learners."
Goodman called this practice "creaming," which she described as "taking students who are doing better as opposed to students who need more support and help in order to have their numbers and statistics look better."
Gloria Brandman, a special education teacher who has worked for New York City public schools for 34 years, told Business Insider that the expansion of charter schools is hastening "the privatization of our public school system," which she believes is Ryan's ultimate goal.
"And that is an affront to our democracy," she said.
Juan Peralta, a 24-year-old public school aide, kitchen hand, and community organizer from Harlem, also argued that charter schools are sapping resources from public education.
"Charter schools are trying to close down a lot of public education," Peralta said. "The money that is going to charter schools can be going to better our public education."
The New York City public advocate, Letitia James, attended the protest in solidarity with the demonstrators, and told Business Insider that Ryan's visit is "nothing more than a political stunt."
"This is nothing more than an attempt by Paul Ryan to appease individuals who support these charter schools," James said. "If he really cared about the quality of education, he would visit the public school as well as Success Academy."
Some demonstrators directed their anger specifically towards Moskowitz and DeVos.
"We have to call Eva Moskowitz out on her ridiculousness, her hatefulness and her immoral self," protesters called out.
But James said she understands why Moskowitz is working with Ryan and other Republicans.
"It's politics ... it's really about your donors," she said, adding, "but there's larger issues involved here in the city of New York, and it's really critically important that Paul Ryan address us."
In her statement on Tuesday, Moskowitz implicitly addressed the politics surrounding her decision to work with Republican leaders. She argued that she, like her sometime foe New York City Mayor Bill de Blasio, aims to rise above politics to do what she believes is best for the city's students.
"I share Mayor de Blasio’s view (in at least this one case), that open dialogue is essential in finding solutions to our most difficult problems,” Moskowitz said.
Ryan arrived at the school shortly after 2 p.m. and stayed for just over an hour, touring the school, meeting students, and stopping by a special education classroom in public school 149, which shares a building with the charter school.
"Today was special — touring Success Academy, listening to these great kids and their committed teachers, hearing their stories. The quality of teacher training and preparedness was extraordinary," Ryan said in a statement. "They have a lot to be proud of, and these remarkable kids are getting a great education. That's what matters — giving every kid a fair shot at the American Dream."
The American public is not a fan of the GOP plan to repeal and replace Obamacare.
A new Morning Consult/Politico poll released Wednesday showed just 38% of people surveyed said they were in favor of the American Health Care Act and 44% are against the bill. The poll, conducted after the bill was passed by the House, showed a drop off from one conducted last week in which the bill had 42% approval to 37% disapproval.
A poll released by The Economist/YouGov on Wednesday also showed 33% approval for the AHCA and 50% disapproval.
Another poll released Monday by HuffPost/YouGov also showed the AHCA was unpopular with 31% approval and 44% disapproval.
Particularly disliked, based on polling, was a recent addition to the bill that won over conservatives. The amendment would allow states to gain a waiver for two of Obamacare's biggest protections: essential health benefits and community ratings.
Health policy experts said that allowing states to get around these provisions could lead to weaker protections for people with pre-existing conditions and allow insurers to offer plans that covered fewer healthcare needs.
The previous Morning Consult/Politico poll, released May 3, showed that many Americans were against these later additions to the AHCA. 46% of those surveyed were in favor of federal standards for health coverage in insurance plans, while 38% were in favor of giving that power to the states.
50% of Americans were against a state opt out on pre-existing protections, while only 38% were for it in the Morning Consult/Politico poll. Additionally, an ABC News/Washington Post poll showed just 26% support for the state waivers when it came to pre-existing conditions.
Those aspects of the bill were highly publicized in the week leading up to the vote, with late night host Jimmy Kimmel even weighing in during a monologue that went viral with more than 10 million views on Youtube in just over a week.
Aetna, one of the major five public health insurers in the US, announced it will remove its products from the Obamacare exchanges in Nebraska and Delaware.
The moves mean Aetna has completely removed itself from every Obamacare exchange for now.
The move comes after Aetna announced it was pulling out of Iowa and Virginia over the past few weeks, citing losses sustained in the Affordable Care Act's individual insurance exchanges.
A statement from Aetna spokesperson TJ Crawford said:
"Our individual Commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership. Those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration. We will not offer on- or off-exchange individual plans in Delaware or Nebraska for 2018, and at this time have completely exited the exchanges."
Reports indicated that Nevada officials convinced Aetna to enter the state's exchange for 2018, but Aetna has not made that official and Crawford did not immediately respond to Business Insider's request for comment on the insurer's offerings in Nevada.
Aetna announced in August 2016 that it was removing its offerings from roughly 70% of the exchanges in which the company participated. That came after Aetna CEO Mark Bertolini told the Department of Justice that unrealized savings from a proposed merger with rival Humana would force the insurer to pull out of the market. The merger was blocked.
The move also comes at a fraught political moment for President Barack Obama's signature healthcare law.
Political uncertainty surrounding funding for a key provision of the ACA and the looming possible repeal of the law after the passage of the American Health Care Act in the House have caused insurers to reconsider their offerings for the 2018 plan year.
North Dakota Representative Kevin Cramer hosted a "Coffee with Cramer" town hall where a man repeatedly confronted the congressman and eventually stuffed money in his collar.
A Cramer supporter tried to intervene but was kicked out.
Cramer voted in favor of the American Health Care Act (AHCA) earlier this month. The legislation would repeal and replace the Affordable Care Act, commonly known as "Obamacare."
Cramer said he's never had a confrontation like this at previous town halls.
WILLINGBORO, NJ — The anger seemed to mount as attendees piled into the room here where Republican Rep. Tom MacArthur was about to hold a town hall.
Seats were filled within minutes — 200 to 250 people packed into a small room, anxious to air their grievances against the Republican plan to overhaul the Affordable Care Act, MacArthur himself, and President Donald Trump.
"Is rape considered a preexisting condition under your amendment?" asked 17-year-old Daisy Confoy, who attended the event with two friends. "Yes or no? Yes or no? One word, please."
"Folks, you get to ask the questions, and I get to give the answers," MacArthur said, as the audience booed him.
MacArthur, the leader of the moderate Tuesday Group in the House of Representatives, was the recipient of a frosty welcome back in his home state on Wednesday evening.
In recent weeks, he has gained prominence by wading into the healthcare debate in a big way: He's the author of an amendment to the American Health Care Act that was key to its passage in the House.
MacArthur returned here, to the New Jersey 3rd Congressional District he has represented since 2015, to host a town hall. The event itself started at 6:30, but protesters and demonstrators clustered outside the venue at least two hours beforehand, with many calling for constituents to vote MacArthur out of his congressional seat based on his leadership on what's become known as the MacArthur amendment.
The American Health Care Act, which recently passed the House and is currently being debated in the Senate, has a 38% approval rating, according to a Morning Consult/Politico poll released Wednesday. The Congressional Budget Office has projected its implementation would result in millions of Americans losing their health insurance, as well as potentially skyrocketing costs for older and sicker Americans.
Prior to the town hall, demonstrators gathered outside and shouted slogans.
"Pro-life, that's a lie, you don't care if people die," they chanted. "Hey hey, ho ho, Tom MacArthur's got to go!"
'You answer to us ... We will vote you out'
As Confoy, who is a senior in high school, continued to press him, MacArthur said he would not "reduce" the experience of sexual violence by calling it a preexisting condition, but he never answered her question outright.
Though the question of whether sexual assault and rape could be considered preexisting conditions has led to an uproar since the AHCA's passage in the House, that notion has been debunked by fact-checkers.
Nevertheless, Confoy and her friends were furious over MacArthur's amendment, which allows states to apply for waivers to the preexisting conditions mandate. They said they would vote in the 2018 midterms.
"You answer to us. You are our representative. We will vote you out," Confoy said, as other attendees stood up and cheered.
Ashwin Suseendran, who attended the town hall with Confoy and their friend Joseph Zetkulic, told Business Insider that they'd decided to come to the event as soon as they found out about his amendment to the AHCA. Suseendran said none of them had participated in the protests before the town hall.
"We wanted to wait in line and make sure we got in so MacArthur would hear directly from us," he said. "We're all voting next year."
The Trump-Russia cloud hangs over
MacArthur was also grilled on Congress' handling of investigations into the Trump campaign's possible collusion with Russia during the 2016 election.
"We seem to have a pattern that most people who are investigating Russia seem to be getting fired," said Willingboro resident Kimberly Stuart, referring to Trump's dismissal of high-profile figures like FBI Director James Comey, whom he unexpectedly fired Tuesday. "Do you support an independent group investigating Russia's ties into the 2016 election?"
"So, Director Comey got fired less than a day ago ... and my view right now is the FBI has still got some work to do in their investigation, and both the Senate and the House Intelligence Committee are still investigating," MacArthur said. "This isn't the first FBI director that was fired; Bill Clinton fired his, too," MacArthur said as attendees shouted him down.
Multiple constituents asked, "Yes or no?"
MacArthur replied: "The answer is no, not yet," and the audience again booed.
One constituent pointed to the apparent disarray on the House Intelligence Committee's investigation into Russian meddling in the election, such as Rep. Devin Nunes, the committee's chairman, deciding to step aside from leading the probe.
"This week, we listened to a subcommittee hearing in which most of the Republicans could not bring themselves to ask even one question about Russia, and now we have Comey fired," the constituent said. "If that isn't enough to convince you that the legislature cannot do this on its own, what specifically do you need to see before you're convinced?"
"You're right, the chairman of the House Intelligence Committee did recuse himself, but that investigation is now continuing in a bipartisan manner," MacArthur said.
The audience groaned.
He continued, addressing the constituent: "The Senate chair and the ranking member have both publicly declared that they're working closely together on their investigation — publicly. So, you asked what I want to see. I want to see the result of their investigation."
"That'll take four years," some in the audience shouted out.
"I don't think it'll take four years. I don't think so," MacArthur said.
"How is [the investigation] ever going to get finished if you keep firing the people that are doing the investigation?" Stuart asked, before she was drowned out by raucous applause.
"Well, you asked and I answered," MacArthur said.
'The greatest threat to democracy in our lifetime'
Constituents were also furious at MacArthur and his congressional colleagues for what they characterized as Congress' refusal to stand up to Trump.
Lavonne Bebler Johnson, who was the mayor of Willingboro and sat on the town council for seven years, implored MacArthur to hold Trump accountable for his actions.
Trump "seems to be learning day by day that he can do whatever he pleases, and no one will hold him to account," she said. "He did whatever he wanted during the election and got elected. He does whatever he wants in office, and nobody holds him to account, and he keeps doing it. It's a sign of tyranny."
Paul Ziegler, a constituent from Edgewater Park, New Jersey, shared her fear.
"I am concerned that I have a president that praises Vladimir Putin and other dictators around the world," he said. "I am concerned that I have a president that attacks the free press and calls them the enemy of the people. I am concerned because I have a president who attacks the independence of the judiciary when they have a ruling that doesn't go his way."
"Donald Trump is the greatest threat to democracy in our lifetime," Ziegler continued, becoming increasingly agitated as the audience gave him a standing ovation. "My question to you: How long are you and your fellow Republicans going to defend this American nightmare? You? Mitch McConnell? How long? Open your eyes."
"Let me — let me respond," MacArthur said. "Folks, I didn't come here to defend our president tonight, I came to answer your questions ... and to tell you what I think and what I'm doing. That's what I came here for."
"I hear your anger, and I hear all of the angst in this room," MacArthur added. "But — but when I drive across the pine barrens, there'll be people that totally disagree with you," he said, referring to Ocean County, New Jersey, which he also represents and which strongly supported Trump in the 2016 election. As MacArthur continued speaking, he was drowned out by jeers and shouts of disapproval from the audience.
"What is it going to take, congressman? What is it going to take for you and your fellow Republicans to open your eyes and realize what's going on?" Ziegler asked. "We need an independent prosecutor. We need a bipartisan select committee to investigate this. When are you going to open your eyes? We all see it ... You don't see it? When are you going to decide to be an American and not a politician?"
When are you going to decide to be an American and not a politician?
"I hear you, but there are loads of other people who don't see it that way. That's the reality," MacArthur said. "I swore an oath to the Constitution. When and if I see —"
"And we're in a constitutional crisis now!" Ziegler interjected.
"No, I don't think we are. I don't think we are," MacArthur said. "When I see what I believe is a violation of that, I will act. But right now, right now, we have three independent groups investigating this, and I think we owe them a chance to give us an answer before we jump to —"
Some people in the audience said the investigation would go on for over a year.
"Well, I don't think it'll take that long. Honestly, I don't," MacArthur said, before moving on.
The 'Trump effect'
But more than anything, MacArthur faced hostility from attendees about the GOP's healthcare bill.
"It's ridiculous because half these people in Congress haven't even read their own bill," a man, who identified himself as Cliff, told Business Insider as he waited in line before the town hall began. "They don't even know what's in it. How do you vote for something that affects people's lives — these are our lives — when you haven't even read the whole thing?"
One man said he has a heart condition and told MacArthur he was worried about what would happen if he lost his job, had a gap in coverage, and couldn't afford insurance in the individual market. "This is very real. This is my life," he said. "Without healthcare coverage, I'm dead. I'm dead. I can't afford it."
"This is your health care bill," the man continued, addressing MacArthur. "It was dead in the water and could have stayed dead in the water. It was done. ... Because of that MacArthur amendment, you brought it back from the dead, with that amendment. It's yours. You own it."
Another man said his wife was a breast cancer survivor. "She will always have a preexisting condition. I don't want to choose what state I live in, in order to get healthcare for her," the man said, as the audience signaled its approval.
The forceful response from attendees surprised Johnson, the former Willingboro mayor.
"This was the most well-informed crowd on the issues I've ever seen," Johnson told Business Insider. "And I think it's because Trump has forced people to pay attention. People have woken up and taken a crash course in what's going on in this country."
She added that she'd never felt or witnessed the level of fear she does now.
When asked about her reaction to MacArthur's appearance, she told Business Insider, "Everything he says sounds hollow and empty."
"He's giving us a good line on some of this stuff, and the high-risk pool he's talking about sounds a little different than a standard insurance company high-risk pool," Johnson added. "But when the American Medical Association, the National Nurses Association, the AARP — when they call this a horrible law, and when you see that it's going to take $880 billion out of the system and redistribute it to the rich, how can you take anything MacArthur says seriously?"
And people are recognizing that, Johnson said.
"The folks in here tonight knew what they were talking about," she said. "That's the Trump effect."
Republican Sen. Bill Cassidy of Louisiana has been around healthcare for a long time, but he hadn't made it to a late-night show to talk about it until now.
Cassidy's suggestion that any new GOP healthcare bill pass the "Jimmy Kimmel test"— named after the late-night host, who gave an impassioned speech about his newborn son's open-heart surgery and US healthcare policy — led to an appearance on "Jimmy Kimmel Live!" on May 8.
While Cassidy is not a member of the Senate working committee devising a new healthcare bill, the appearance on Kimmel's show has helped shine a light on a proposal from Cassidy and Sen. Susan Collins.
Cassidy is a medical doctor specializing in treating liver diseases, and he has helped to open a free clinic for the working poor in Louisiana.
Cassidy spoke with Business Insider about the appearance, healthcare policy, and President Donald Trump's recent firing of FBI Director James Comey.
This interview has been edited for length and clarity.
Bob Bryan: You've been involved in healthcare reform for a long time, but you've never been on a late-night show for it. I was wondering how it came to be that you went from proposing the "Jimmy Kimmel test" to being on air with Jimmy?
Bill Cassidy: I think it started on a Sunday morning show when I was asked by [CNN's] John Berman — I think it was a Sunday morning show, or maybe Saturday, I forgot which — but asked, "How would you know the adequacy of coverage?" which is clearly one of Trump's contract points with the American voter, that he wanted to lower premiums.
You can lower premiums in a variety of ways, but one way to lower premiums is to just give people lousy coverage. So the thought occurred to me in that moment, just kind of spontaneously, "Well, there's Jimmy Kimmel — his son had all the coverage he needed."
Now, in that circumstance, perhaps anybody's son would, because there is Children's Hospital Los Angeles nearby. But we know there are other conditions where that's not the case. So the question in the Jimmy Kimmel test — the coverage does not have to have bells and whistles — but does the coverage cover a tragedy that could occur in someone's health or to a loved one? So I coined the Jimmy Kimmel test. For whatever reason, it went viral, and that led to a conversation with the "Jimmy Kimmel" show folks.
Bryan: The Jimmy Kimmel test in part focuses on preexisting conditions, and right now House Republicans that passed the American Health Care Act have talked about "layers of protection" for those people. They say the MacArthur Amendment says no one can be denied. They say there are layers of coverage. Do you believe there are enough protections for preexisting conditions in the AHCA? And if there are gaps in those layers, how would you fill those in?
Cassidy: Ultimately, to address the issue of preexisting conditions and conditions that suddenly occur — for example, you develop a preexisting condition when something terrible happens, imagine you get hepatitis, your liver fails, and you get a liver transplant. You went from being healthy to having a liver transplant to now having a preexisting condition.
The way to most effectively do that, the only way you can control expense, is to have a larger risk pool, that person who is sick is in the midst of a lot of other people that tend to be healthy.
Now within that group, you can do reinsurance of some sort that would mitigate the cost of an individual patient. But ultimately, you need a big risk pool.
I use the example of ExxonMobil. They have 50,000 employees, give or take, and if one person gets sick — say, the liver transplant I just mentioned — it hardly affects premiums at all, if at all, because you're spreading that expense over so many people. Spreading over so many people is the way insurance always works.
Now you can have a different layer here or a different layer there, but ultimately, if you don't have a big enough risk pool, it is going to be very expensive care highly concentrated among those that are really expensive, and that's not the way to go.
Bryan: You talk about widening the risk pool. How would you open up the risk pool? One way the Affordable Care Act tried to do it was to use the individual mandate to penalize people. You are not a supporter of the individual mandate, so how would you incentivize people to come into that risk pool?
Cassidy: One thing I've talked about, and it's in the Cassidy-Collins plan ... we suggest using what we use in Medicare. When I turn 55, I'm going to be on Medicare. I can call up and tell them I don't want to be on Medicare, but otherwise, I'll be on Medicare. So they use this kind of automatic enrollment. We give states the option of automatically enrolling those who are eligible.
We do it for other things like 401(k)s. Research shows that if a business automatically enrolls somebody with an opt out, they get 95% enrollment. If it's an opt in, they start out with 54% enrollment. And this is when a business is doing a match. So we just think that sort of opt-out provision from the business community works well.
Bryan: More conservative voices have criticized auto-enrollment because auto-enrollment is forcing people onto insurance and government shouldn't force people to have something they don't want. What would your response be to that?
Cassidy: They must not have heard me say that you can call up if you don't want to be. How is it forcing if all I have to do is call up and say I don't want to be? How is it forcing if all I have to do is make a phone call and tell them to take me off? I think it'd be incredibly stupid on something that is most obviously not an issue.
Bryan: Another concern with the AHCA, especially the MacArthur Amendment, was the possible repeal of essential health benefits. Some advocates for it say plans with lower actuarial values will bring down costs. What are your thoughts about removing some of those essential health benefits?
Cassidy: I think the better alternative is what we do in the Cassidy-Collins plan, in which those who are eligible for a credit would get a credit sufficient for an annual premium. They would get a pre-funded health savings account, so money would be deposited into the HSA and they would get a high-deductible health plan on top of it.
Now, if you look at current law, current law says a high-deductible health plan has to cover significant benefits, which is taken to mean, for example, hospitalization.
One thing that has not been established is whether HSAs or high-deductible health plans are to cover mental illness and addiction, so that was the only essential health benefits that we included. But aside from that, we think you could end up with the same sort of coverage.
I will point out that once you pre-fund health savings accounts, someone can pay for their colonoscopy, or for their Pap smear, or for their cholesterol check with the HSA. That's what it's there for. So we think we cover that, but we do it in a cost-effective way.
Bryan: In terms of costs-sharing-reduction payments — something that the insurers have said they need to see going forward to offer plans in 2018 — are you in favor of the Trump administration continuing to offer these CSR payments? In addition, would you be in favor of a congressional appropriation to remove the uncertainty surrounding the lawsuit regarding those payments?
Cassidy: Legally, I agree with the lawsuit, so I think whatever the president does he should do with Congress to make sure it passes constitutional law, that it passes constitutional muster.
No. 2, remember President Trump's contract with voters, the four points he said over and over: He said we're going to care for those with preexisting conditions, we're going to eliminate mandates, and we're going to lower costs. Which I think most voters took to mean we're going to lower premiums, not a better Congressional Budget Office score.
At least in the interim, Obamacare is such a mess — the only way you're going to keep premiums from totally exploding next year is to continue the CSR payments. If we decide we don't care about premiums next year because we can blame it on Obamacare, that's fine, but we're going to recognize that premiums are going to increase by 40% or more.
So maybe that's what it takes to get Democrats to the table. This process has become much more difficult because they don't seem to care about people paying $20,000, $30,000, $40,000 in premiums. As a negotiating ploy, I can't say anything about it.
Legally speaking, we've got to work to get a replacement, and that's what we have to keep families from being damaged.
Bryan: In terms of those two elements, though, President Trump has said the most easy political path is to let Obamacare collapse, but then you also talk about his contract with the American voter. Does using skyrocketing premiums by removing CSR payments as a negotiating tactic jibe with President Trump's contract with the voters to lower their costs?
Cassidy: At some point, you've got to react to the circumstances you're in. I think the president is not the czar. The Constitution says certain things, and frankly, I think constitutionally, Congress has to appropriate. So far, Democrats have not done anything to help on this issue, so if they refuse to help, then the president has to deal with a very difficult process in the House. So there is a political reality. So I cut the president slack in that regard.
Bryan: The Senate is working on its own version of a healthcare bill. Is there a sense of a deadline that the Senate wants to meet? Especially considering insurers are facing deadlines to submit their plans for 2018.
Cassidy: All due haste, we want to not live forever on this issue, but we want to fully consider it. I know that's not a definite, like saying by September 8, for example. But with all due haste — I mean, how long does it take to understand this issue and make a decision going forward and then have it scored by the CBO and passed? That's obviously going to take some time, but I can't tell you how long.
Bryan: You mentioned the CBO. The House moved toward with the AHCA despite not having a CBO score for the Upton and MacArthur amendments. Do you feel that every step of the process in the Senate needs a CBO score, or do you feel there are times you could go without it?
Cassidy: By law, I'm told we have to have a CBO score before we vote.
Bryan: Looking at the process in the Senate right now, there is the working group of 13 Republican senators. There has been some criticism of the group. Yourself and Senator Collins, who produced your own bill, were not in that working group. Do you feel like the working group as it is constructed now is a fair way to go about the process? Is it an open enough process?
Cassidy: I think anytime you bypass regular order in the Senate, the committees of jurisdiction, it's a little bit problematic. On the other hand, I say that if we're going to fulfill President Trump's contract with the American voter, those four points I listed earlier, then the only way you're going to get there is something like the Cassidy-Collins plan. Now, if you decide you're not going to fulfill those and you're not going to fulfill that contract, you could get something far different.
And then the caveat on the lowering premium aspect is what I said as, well, the Jimmy Kimmel test: If we take the primary goal to lower premiums, is the coverage adequate if something terrible happens to someone's loved one? There's only one way to get there, to fulfill his goals and pass the Jimmy Kimmel test, and that's going to look like the Cassidy-Collins plan. That is if we're serious about that goal.
Bryan: If the Senate working group comes out with a bill that fails to live up to that goal or the Jimmy Kimmel test, or does not provide enough protections for people with preexisting conditions, would you vote against it? Even if there's pressure from leadership?
Cassidy: If you don't mind, I'll avoid answering hypotheticals. Not to dodge your question, but I've learned in life it's best not to do so.
Bryan: You know, I had to ask the question.
Cassidy: Oh, I know, but I'm a physician, and my training for however many decades has been patients would ask me questions that were almost existential, then I would have to say, "Why don't we wait and see what happens?"
Bryan: You've talked about working with Democrats. Is there serious consideration about bringing Democrats into the process? Are you currently having discussions with Democrats in the Senate about a bipartisan solution?
Cassidy: Yes, I'm serious. Yes, I've spoken to Democrats. So far, there has been no one seriously interested. They're under incredible political pressure not to cooperate, but some of the parts of Cassidy-Collins require 60 votes [to avoid a filibuster]. For example, allowing price transparency so that someone would know the price of a blood test before they get it as opposed to getting a bill for $200 six months later — we need Democrats to pass because of the 60-vote threshold on such a bill.
As long as they decide to be passive, stay on the sidelines, there's nothing that can be done. I'm just amazed. You become a senator not by being passive, but by being active, and all of a sudden, we've got a whole group just deciding to sit on their palms.
Bryan: You talk about political pressure — is there any sense from Democrats that there are concessions that would bring them on to actually support the bill?
Cassidy: I don't know. If you look at the Cassidy-Collins bill, we return power to the states. We give power to a blue state to do a blue thing. Then we give power to a red state to do a red thing. It's federalism, a conservative principle I grant, but a conservative principle that totally works to the advantage of a blue state and, oh, by the way, to a red state that happens to be represented by a Democratic senator.
So I think it's frustrating because not only do I think it's a good thing for our country and our people, but in the interest of politics. That's my take on it. I think we should put patients before party.
Bryan: You're in favor of protections for preexisting conditions, the elimination of caps on lifetime limits — these were all things that were part of the Affordable Care Act. Obviously, there are issues with the ACA, but overall, do you think the ACA represented a step in the right direction for the US healthcare system? Obviously, you are not a fan, but were there any positives in that bill?
Cassidy: You could've accomplished the positive things in the Affordable Care Act for a fraction of the cost, in terms of tax dollars, and in terms of disruption of institutions, and in terms of economic growth. There are businesses after businesses and municipalities after municipalities that have taken full-time workers and made them part-time workers to avoid paying mandatory benefits or penalties. There's been, by some estimates, 1% per year loss to our GDP growth.
The opportunity cost of Washington, DC, taking all the power from patients and states and bringing it to Washington, DC, far outweighs the benefit. You could've have done it for far less with far less disruption. So sure, you throw 3,000 pages against the wall, some of it is good. But that said, there is a tremendous cost for our economy and out people.
Bryan: What are your thoughts on the firing of FBI Director James Comey by President Trump?
Cassidy: Obviously, the timing looks bad, but I'm not sure there ever is good timing. Mr. Comey had become an issue, criticized both from the right and the left. At some point when you're director — I think he's a great American, by the way, who cares deeply about our country, who's passionate about our country, who tried to do a good job in an exceptionally tough situation — but when the director himself becomes the issue, that is probably a distraction from the mission of the institution.
Bryan: A number of your colleagues on either side of the aisle have said that an outside investigator should take over the FBI's investigation into possible ties between the Trump campaign and the Russian government. What are your thoughts on that?
Cassidy: That's absurd. One, the bipartisan Senate Intelligence Committee is doing a great job — no one has criticized the work they've done.
Secondly, Comey had just testified saying there had been no evidence of everything that people are alleging.
Thirdly, the idea that Comey goes away and, if there is an investigation, the investigation goes away? Comey's first meeting of the day is about his budget. The second meeting is with his HR department. The third meeting is, you know, fill in the blank. Then he's got a chief lieutenant who's doing everything, who is the point. And then on Friday afternoon, that's when Comey gets his briefing from that chief lieutenant. That chief lieutenant is still there. That chief lieutenant will still be driving that investigation.
Following the House of Representatives vote to pass the Republican health care bill, a left-leaning advocacy group, Save My Care, launched a $500,000 campaign targeting 24 Republican congresspeople who voted to repeal and replace President Barack Obama's signature healthcare legislation.
The ads, which are a mix of television and digital, accuse congressional Republicans of voting to raise healthcare costs on average Americans and seniors, strip insurance from 24 million individuals, and raise costs for those with pre-existing conditions. It describes the GOP's American Health Care Act as a "disastrous health care repeal bill" that is opposed by the American Medical Association, the AARP, and the American Cancer Society.
"How could you do this to us?" the ad asks lawmakers.
Most of the two dozen Republicans targeted in the campaign either barely won in the 2016 election or represent districts that were carried by Hillary Clinton or narrowly won by President Donald Trump in the presidential election.
Democrats are hoping the congressmembers' votes for the Obamacare replacement legislation will help drive them out of office in the 2018 midterm elections.
The effort is reminiscent of a similar campaign (with opposite aims) launched by conservative groups in 2009 and 2010 to whip up anti-Obamacare sentiment, which helped Republicans take control of the House and gain a significant number of seats in the Senate in the 2010 midterm elections.
Here are all of the Republicans being targeted by the Save My Care campaign:
Rep. Don Young of Alaska refused to support the House's first version of the AHCA and repeatedly said he was undecided leading up to last week's vote. Alaska has the nation's highest healthcare premiums, which are at risk of increasing under the AHCA.
Rep. Martha McSally of Arizona hails from a key battleground district, where 50% of her constituents voted for Hillary Clinton.
Rep. Jeff Denham won just 52% of his central California district, which has traditionally leaned Republican but is becoming increasingly Democratic.
See the rest of the story at Business Insider
A new poll shows Americans aren't big fans of the new GOP healthcare bill and even like the old system better.
According to a poll from Public Policy Polling released Tuesday, 53% of those surveyed said they preferred the Affordable Care Act over the Republicans' American Health Care Act. Just 27% said they preferred the AHCA over the ACA.
In terms of simple approval, only 25% of those in the poll supported the AHCA, while 52% opposed it.
This comes as numerous other polls have shown the new GOP bill, also called Trumpcare, to be incredibly unpopular. Polls taken in the past two weeks showed approval ranging from a high of 38% to a low of just 21%. Disapproval has been anywhere from 44% to a solid majority of 56%.
At the same time, recent polls have shown that the ACA, better known as Obamacare, has hit its highest popularity ever. In the PPP poll, 44% of those surveyed said they supported the ACA, while 37% opposed it.
Sixty-four percent of people told PPP that lawmakers should "keep what works in the Affordable Care Act and fix what doesn’t," while 29% said Congress should "repeal the Affordable Care Act and start over with a new healthcare law."
In terms of political implications, some lawmakers who voted for the AHCA in the House faced angry town halls during a weeklong recess last week, and the PPP poll suggested their support for the bill may be a drag on their electoral chances.
Forty-seven percent of those surveyed told PPP that they would be less likely to vote for a representative who supported the AHCA, while only 27% of Americans said they would be more likely to vote for an AHCA supporter.
There was a slight increase in early-stage cancer diagnoses after the Affordable Care Act, often called "Obamacare," went into effect in January 2014.
More than 20 million Americans were able to get insurance because of various ACA provisions in the years that followed its introductions, which might have led to more people getting screened for cancer.
Comparing data from 2013 and 2014, the study, which will be presented at the upcoming American Society of Clinical Oncology meeting in June, the researchers from the American Cancer Society looked at the data from 273,000 patients, and focused on cancers that can be detected through screening.
The researchers saw a 1% increase happened in breast and cervical cancer in women and lung and colorectal cancer in both men and women. Over the same time period, though, early stage prostate cancer diagnoses decreased by 1%.
An estimated 1.7 million people will be diagnosed with cancer in the US, at any stage, per year which means the 1% increase in early-stage diagnoses could represent a sizeable chunk of patients diagnosed earlier than they might have been otherwise. Diagnosing cancer at its earliest stages can increase a person's chances of responding to treatment.
Of course, this study only compares data between 2013 and 2014. It remains to be seen if there's a consistent increase in early cancer diagnoses in the years to come. And the fate of the ACA is up in the air after the House passed The American Health Care Act, the GOP plan to overhaul the US healthcare system, on May 4.
A group of 15 states and Washington, DC, is stepping into the fight to save the Affordable Care Act's insurance exchanges.
The states have filed a motion to intervene in a court case that could decide whether critical payments, called cost-sharing-reduction payments, are made to insurers in the ACA's individual insurance exchanges.
In 2015, the House of Representative filed a lawsuit against the Obama administration to prevent the White House from funding the CSR payments in their current fashion. The GOP-led House argued that since the payments were not appropriated by Congress as part of the ACA, they were unconstitutional.
In 2016, a federal judge ruled in favor of the House, putting CSR payments in jeopardy. The Obama administration filed an appeal. Now the Trump administration must decide whether to continue or drop the appeal.
President Donald Trump has repeatedly threatened to drop the case and end the payments, which experts say would cause premiums to skyrocket and likely lead to even more insurers ditching the exchanges. The states say his threats are why they decided to file the motion, which would allow them to continue the appeal even if Trump dropped it.
"If successful, the suit could — to use the president's expression — 'explode' the entire act," the filing says. "Until recently, states and their residents could rely on the executive branch to respond to this attack. Now, events and statements, including from the president himself, have made clear that any such reliance is misplaced."
The states argued that pulling the payments would endanger the health insurance of millions of people on the exchanges.
From the filing (emphasis added):
"The loss of funds and financial uncertainty threatened by this case would lead at least to higher health insurance costs for consumers, and more likely to many insurers abandoning the individual health insurance market. The number of uninsured Americans would go back up, hurting vulnerable individuals and directly burdening the states. The wrong decision could trigger the very system-wide 'death spirals' that central ACA features, such as stable financing, were designed to avoid."
The states also argued that the rise in the uninsured population would put a financial burden on state budgets, since they would have to cover more hospital costs for people without insurance. Thus, they argued, they should be able to carry on the case even if the Trump administration dropped the appeal.
The filing says the need to step in is urgent since insurance companies are leaving the exchanges because of uncertainty. Virginia, Iowa, and Nebraska have seen insurers ditch their exchanges in the past month.
"Meanwhile, the president has increasingly made clear that he views decisions about providing access to health insurance for millions of Americans — including the decision whether to continue defending this appeal — as little more than political bargaining chips," the filing said. "The states and their residents cannot continue to rely on the executive branch to represent them in this appeal."
The intervention must be approved by the court for the states to become part of the case.
Here's a rundown of the states (and DC) on the filing:
President Donald Trump reportedly wants to light the fuse that many experts say could cause the Affordable Care Act's individual insurance exchanges to crumble.
According to Politico's Josh Dawsey, Paul Demko, and Jennifer Haberkorn, Trump told White House aides in a Tuesday meeting that he wanted to end the cost-sharing-reduction payments that are part of the ACA.
The payments help to offset costs for insurers in exchange for offering more affordable coverage to low-income Americans. Experts say that without the payments premiums would likely skyrocket and insurers would drop out of the market.
Currently, the CSR payments are funded by the executive branch, but a House of Representatives lawsuit has alleged the payments are illegal since they should be appropriated by Congress, not the White House.
In 2016, a federal judge ruled in favor of the House, putting CSR payments in jeopardy. The Obama administration filed an appeal. Now the Trump administration must decide whether to continue or drop the appeal.
The Trump administration has committed to funding the payments through May as part of a deal to keep the federal government funded.
According to Politico, while Trump favors dropping the payments, some administration officials like Tom Price, the health and human services secretary, worry that if the CSR payments stopped, the Trump administration could be blamed for the resulting chaos in the insurance markets.
Concerns about the payments have already led some insurers to drop out of the ACA's exchanges in states such as Iowa and Virginia. Additionally, a group of 15 states and Washington, DC, filed a motion on Thursday to continue the Obama administration's appeal even if the Trump administration dropped the case.
"If successful, the suit could — to use the president's expression — 'explode' the entire act," the filing says. "Until recently, states and their residents could rely on the executive branch to respond to this attack. Now, events and statements, including from the president himself, have made clear that any such reliance is misplaced."
The Trump administration must provide an update to the US District Court of Appeals on Monday about whether it wishes to continue the case.
The White House and Congress filed a motion Monday to delay a court hearing on a vital funding element of the Affordable Care Act, the healthcare law also known as Obamacare.
The two sides asked for a 90-day delay on an appeal in the lawsuit known as House v. Price, a move first reported by The Washington Examiner and Politico. The lawsuit centers on the executive branch's funding of so-called cost-sharing-reduction payments.
The payments help to offset costs incurred by insurers to provide low-income Americans with affordable healthcare coverage. Without them, health-policy experts say, premiums for the 2018 plan year would skyrocket above current projections, and insurers would most likely ditch many of Obamacare's individual insurance exchanges.
In 2015, the Republican-controlled House of Representatives sued the Obama administration, arguing that the payments had not been appropriated by Congress and were therefore illegal. A lower court ruled in the House's favor in 2016, but the Obama administration appealed the ruling.
According to the motion, legislators and the administration are still working on ways to avoid a legal ruling on the case.
"The parties continue to discuss measures that would obviate the need for judicial determination of this appeal, including potential legislative action," the motion said.
Put another way, the idea of Congress setting aside money for the CSRs — making the ruling moot — is still on the table and thus a delay in a formal ruling was needed.
The move is another in a series of delays by the Trump administration as it decides whether to continue the payments. According to reports last Friday, President Donald Trump told advisers he was in favor of ending the payments and dropping the case. Many other White House officials are wary of that idea, and a poll from the Kaiser Family Foundation found that a majority of Americans would place most blame for healthcare problems — such as rising premiums — on Trump.
Additionally, on Thursday, 15 states and Washington, DC, filed a motion to intervene in the case to continue the appeal even if the Trump administration decided to drop the fight.
For the moment, the delay provides some relief for insurers concerned about the CSR payments, but the lawsuit continues to sow uncertainty in the market that some experts say could cause costs to rise even more rapidly.
"A delay in the court case over ACA cost-sharing payments avoids an immediate crisis, but continues uncertainty for insurers," tweeted Larry Levitt, a senior vice president at the Kaiser Family Foundation, following the announcement.
Senate Majority Leader Chuck Schumer said the decision to continue the funding showed the administration knew that continuing the payments was the right thing to do. He criticized the uncertainty from Trump on their future.
"Unfortunately, by kicking the can down the road once again, the administration is continuing to sow uncertainty in the markets that will hurt millions of Americans," Schumer said in a statement. "Instead of hemming and hawing, they ought to step up to the plate and say once and for all that they will make these payments permanently, which help millions of Americans pay less for their healthcare."
While the delay will move the next update for the case to mid-August, the deadline for insurers to submit their 2018 plans for Obamacare exchanges in most states is June 21.
The Trump administration's 2018 budget proposal released Tuesday included massive cuts to Medicaid, the government-run health program that provides insurance primarily to pregnant women, single parents, people with disabilities, and seniors with low incomes.
The plan calls for cuts amounting to $627 billion over the next 10 years.
That number does not include the roughly $880 billion in proposed cuts to the program through the American Health Care Act, the GOP leadership's plan to repeal and replace the Affordable Care Act, which the administration supports.
The plan has already received near-universal pushback in Congress, as even members of President Donald Trump's own party expressed skepticism over its provisions. The drastic cuts to Medicaid, among other programs, have drawn blowback from lawmakers in districts whose constituents would stand to be affected by the slashes.
Rep. Hal Rogers, the Republican chair of the House Appropriations Committee, told The Washington Post that the proposed Medicaid cuts are a particular problem for his district.
"I've got one of the poorest districts in the country, with lots of Medicaid recipients as well as other programs. ... The cuts are draconian," Rogers said.
The proposal also amounts to a reversal from Trump's repeated assertions throughout his presidential campaign that he would not make cuts to social safety-net programs.
Robert Greenstein, president of the Center on Budget and Policy Priorities, slammed the proposal as "the most radical, Robin-Hood-in-reverse budget that any modern President has ever proposed."
In a statement, Greenstein said Trump's "steep cuts" lay to "rest any belief that he's looking out for the millions of people the economy has left behind."
What is striking is that the budget enacts drastic cuts on top of those proposed by AHCA, which were denounced by politicians of both parties when announced in March. The AHCA proposed a significant rollback of Medicaid and the ending of the Medicaid expansion program established under the ACA, the healthcare law better known as Obamacare.
Under the ACA, eligibility for Medicaid was expanded to include any adult living under 138% of the federal poverty level — an income of $27,821 for a family of three in 2016. It's up to states to decide whether they want to participate. States that expanded Medicaid under the new ACA requirements received federal funds to do so.
Thirty-two states and the District of Columbia have chosen to participate so far, leading to more than 11 million new people nationwide gaining coverage, a number that continues to grow.
The Congressional Budget Office estimated in March that changes to eligibility under the AHCA would most likely result in a loss of 14 million people from the Medicaid rolls by 2026. While the AHCA has since been amended, and a new CBO report should arrive soon, it is unlikely that it will find drastically different results in regards to Medicaid.
When rumblings of Trump's proposed cuts to Medicaid began to surface in February, the Kaiser Family Foundation did a tracking poll to gauge public sentiment on the plans. The February poll found that 65% of Americans said Medicaid should continue largely as it exists today, despite Republican proposals to change the program,
Governors in charge of expansion states, 16 of them Republican, have also been in favor of retaining the expansion. Many have acknowledged the program's importance to their states in recommendation letters solicited by Republican congressional leaders.
It is unlikely they will be in favor of the further cuts proposed by Trump's budget.
Bad news for states suffering from the opioid crisis
The Health and Human Services Department 2018 budget proposal released by the Trump administration states that the cuts are being made in the interest of "financial stability" and to "focus Medicaid on the most vulnerable Americans—the elderly, people with disabilities, children, and pregnant women—those Medicaid was intended to serve."
But the expansion to Medicaid that the Trump administration has proposed to gut have gone to extremely vulnerable populations, namely those states suffering from the opioid crisis. States have leaned heavily on Medicaid to treat those affected by the opioid crisis in recent years.
Of the 10 states with the highest drug-overdose death rates, only Tennessee and Utah opted out of the ACA's Medicaid expansion.
About 1.29 million people in the US are receiving treatment for substance-use disorders or mental illnesses thanks to the Medicaid expansion, according to research conducted by Harvard Medical School health economics professor Richard Frank and New York University dean Sherry Glied.
If the AHCA does become law and the Medicaid expansion is phased out, then Ohio, Pennsylvania, and West Virginia, among other states suffering the brunt of the opioid crisis, would be ill-suited to handle the loss in funds, government officials and treatment experts told Business Insider in February.
Pennsylvania was suffering a $600 million budget shortfall as of December that could reach $1.7 billion by July, according to the Pittsburgh Post-Gazette. Republican State Rep. Gene DiGirolamo of Pennsylvania told Business Insider that there were "no extra dollars" to insure residents or provide addiction treatment to those who lose coverage because of an ACA repeal. The situation is equally dire in West Virginia.
"I'm really, really worried about what's happening in Washington," DiGirolamo said in February. "And I say that as a Republican."
Co-chairman of the moderate Republican caucus Tom MacArthur resigned from his leadership role on Tuesday, Politico reports.
MacArthur, who represents New Jersey in the House of Representatives, engineered the amendment that allowed the Republican-backed Obamacare replacement — the American Health Care Act — to pass.
According to Politico, MacArthur's moves to pass the bill by negotiating with far-right Republicans caused him to fall out with some of his centrist colleagues.
"I’m not looking to be divisive within the group and I’m not looking to change who I am," MacArthur told Politico. "I’m going to continue to govern the way I believe the American people need us to govern. That means we engage with the Freedom Caucus. We engage with everybody."
After the new health bill passed, MacArthur also faced outrage from his mostly-Democratic district. People crowded in for a town hall and criticized MacArthur for pushing a bill that could cause thousands of people to see their insurance rates soar due to preexisting conditions. In what has since become known as the MacArthur Amendment, Obamacare's restrictions on increasing insurance costs based on previous illnesses might no longer apply.
While many moderate Republicans spoke out against the American Health Care Act, MacArthur insisted that only a small percentage of Americans lose coverage under the new bill.
"This unwillingness to engage with members of our own party is unacceptable to me," he said. A full report on the number of people who could lose health care coverage will be released just one day after MacArthur's resignation.
Still, the former insurance broker told Politico that he intends to remain active in the caucus. After stepping down from the leadership role, he hopes to dedicate more time to negotiating with other Republicans.
You can read MacArthur's full resignation statement here»
The Trump administration's 2018 budget proposal released Tuesday included massive cuts to Medicaid, the government-run health program that provides insurance primarily topregnant women, single parents, people with disabilities, and seniors with low incomes.
While the plan calls for cuts amounting to $627 billion over the next 10 years, it also proposes an even bigger change to how the program has operated since its inception.
The budget plan calls for providing states "flexibility" by forcing them to make a choice between receiving Medicaid funds as a per-capita cap grant or a block grant beginning in fiscal year 2020.
That change, first proposed by the American Health Care Act, the GOP leadership's plan to repeal and replace the Affordable Care Act, is a "fundamental" change in how Medicaid operates, Richard Frank, a professor at Harvard Medical School professor, told Business Insider recently.
The CBO estimated that changes to eligibility under the AHCA would most likely result in a loss of 14 million people from the Medicaid rolls by 2026.
"It's no longer an open-ended matching program," Frank said. He added that changing funding to block grants or per-capita cap grants "fundamentally changes the kind of contract that exists between the states and the federal government."
Since its establishment in 1965, Medicaid has been an open-ended entitlement program. Anyone who meets the eligibility requirements has a right to enroll, and if costs go up because of new, expensive treatments or increasing healthcare needs, states receive more federal money. While states fund a big portion of their individual Medicaid programs, the federal government matches up to a certain percentage, with bigger matches for poorer states.
If passed, Trump's budget proposal would change the federal Medicaid funding by telling states to either accept a per-capita spending cap — meaning the federal government would send states a fixed amount of money per Medicaid enrollee, regardless of whether that would cover needs or care — or a block grant — a fixed grant based on a state's Medicaid spending that the state is then free to spend as it sees fit and grows according to some rate to compensate for inflation.
The possibility that Medicaid might change from an open-ended entitlement to block grants or per-capita cap grants has sent conservative states scrambling to expand their Medicaid program under expansion afforded by the Affordable Care Act, the law better known as Obamacare. Under the ACA, eligibility for Medicaid was expanded to include any adult living under 138% of the federal poverty level — an income of $27,821 for a family of three in 2016. It's up to states to decide whether they want to participate. States that expanded Medicaid under the new ACA requirements received federal funds to do so.
Kansas, Virginia, and North Carolina all made pushes to expand Medicaid in March, though none were successful. Kansas came the closest, with its legislature falling a few votes shy of overriding a veto for Kansas governor Sam Brownback.
The problem with block grants and per-capita cap grants
Whether a state chooses per-capita cap grants or block grants, it is likely that the grants would increase yearly according to the medical-care component of the consumer price index — between 2% and 5%, depending on the year.
Frank said that using medical-care CPI (or any other inflation rate) as a benchmark for Medicaid would become a problem for states because it doesn't take into account changes to population or unexpected crises.
One of the most obvious pitfalls would come with the aging of the baby boomer generation, Frank said.
By 2050, the population of people 65 and is expected to have increased to 83.7 million — nearly double the 43.1 million in 2012 — according to a 2014 US Census Bureau report, with big increases in the number of people over the age of 85 as well.
Under Trump's budget proposal, the cost to cover Medicaid recipients in those categories would be determined by their 2016 spending patterns and then increased according to medical-care CPI. The problem, according to Frank, is that healthcare costs for elderly people would increase at a far higher rate than medical-care CPI.
In addition, the per-capita system would divide Medicaid recipients into different categories, such as elderly people or people with disabilities, to determine the size of payments.
However, those categories are broad. For instance, 65-year-olds are in the same category as 85-year-olds, even though healthcare costs go up substantially as people age.
Frank estimated that the AHCA plan (which is more or less the same as the budget proposal) would lead to a 9% shortfall in the coming decades, or about $10 billion a year that states would have to make up for.
"Even under the best-case scenario for the per-capita cap, you are going to fall behind. That assumes there are no new drugs or treatments. Together, that's problematic," Frank said. "The states are going to take a big hit here."
Current CBO projections say Medicaid spending under the per-capita system would be about 25% less than it would be under the ACA by 2026. Block granting presents similar problems.
The choice for states
To stay above water, states would either have to spend more money on their Medicaid programs — a daunting proposition for poorer states like West Virginia, where one-third of its population is on Medicaid— or cut costs.
Because Medicaid is already one of the lowest-cost providers of healthcare, a state could either cut benefits, which would affect the quality of coverage, or reduce who is eligible for the program, which could hurt people with disabilities, older people, or people suffering from substance abuse.
One of the first things to go could be treatments for substance use and mental illnesses, Frank said.
Even if state Medicaid programs don't cut coverage for substance-use treatments, the per-capita and block granting proposals would likely be devastating in terms of the opioid epidemic.
Opioid-overdose deaths increased by about 15% in 2014 and 2015, and Medicaid has paid for more than 50% of substance-use treatment services in some states, according to official statistics. Medicaid recipients' access to treatment has increased by between 20% and 25% over the past several years, according to Frank.
Those numbers far outpace a growth in spending fixed to medical-care CPI.
If the budget proposal were to become law, Ohio, Pennsylvania, and West Virginia — among other states suffering the brunt of the opioid crisis — would be ill-suited to handle the loss in funds, government officials and treatment experts say. And that's to say nothing of states like Florida, where a disproportionately aging population could suffer.
The plan wouldn't likely be popular with the public. When presented with a choice of accepting the Republicans' proposals to limit Medicaid spending or keeping the program the same, 65% of respondents said they would want the program to stay the same, according to a tracking poll released in February by the Kaiser Family Foundation
The Congressional Budget Office on Wednesday is set to release its latest score for the American Health Care Act, the GOP's healthcare bill, in a move that has been highly anticipated for weeks.
The score will measure the AHCA's potential effects on the total number of people with insurance coverage, how the federal deficit would increase or decrease because of the bill, and other measures over the next decade.
The bill has been scored twice before. But two amendments that were added to the bill just before it passed through the House of Representatives have changed the game significantly for the CBO score.
While Republicans have sought to downplay the score ahead of its release, it could have serious implications for the future of the AHCA.
The technical test
The most important aspect of the bill for Republicans will come in how the CBO scores the AHCA's potential effect on the federal deficit.
The GOP introduced the AHCA using a process known as budget reconciliation. The procedure allows Republicans to need only a simple majority in the Senate to pass the bill and avoid a Democratic filibuster.
To use this procedure, however, Senate rules mandate the bill must save at least $2 billion.
One of the two amendments House Republicans added to the bill would allow states to opt out of two Affordable Care Act regulations with a waiver from the federal government, and the other calls for an additional $8 billion in funding to protect people with preexisting conditions.
Those two factors could shave off some of the $151 billion in deficit savings estimated in the previous scoring of the bill, and it could affect the bill's future.
Given the uncertainty, House Republicans have not yet sent the bill to the Senate. A GOP aide, however, told Business Insider that the delay was simply "an abundance of caution" on the part of leadership.
The public-relations test
All versions of the American Health Care Act have been unpopular with the American public. The new CBO score could make it even worse.
The previous score estimated that 24 million fewer Americans would have health coverage by 2026 than under the current baseline. Democrats have seized on that number to attack the bill.
Any change to that statistic could be the headline-grabbing feature of the new score.
Margot Sanger-Katz at The New York Times polled six healthcare experts ahead of the new CBO score, and their estimates ranged from 20 million more uninsured to 25 million.
Cynthia Cox, the associate director at the nonpartisan Kaiser Family Foundation, said the new amendments could bring down the number of people without coverage.
"I think we could still see substantial coverage losses but maybe not to the same degree as the previous CBO score," Cox told Business Insider. "The reason for that would be that the waivers that states would take up could mean more healthy people are able to purchase insurance. Sick people would be more likely to be priced out of the market in states that take up the waiver, meaning those exchanges would be more affordable for healthy people to get in."
Put another way, if states take up waivers and insurers are able to price some sicker people out of the market, premiums could fall, incentivizing more healthy people to enter the individual exchanges established by the ACA. But this would assume that a fairly large number of people with preexisting conditions would go uncovered.
This also plays into the budget dynamic, according to Cox, because as more people are covered, more people will use the tax credit, which will cost the federal government more.
Matthew Fiedler, a fellow at the Brookings Institution's Center for Health Policy, said that while there may be a lower number of people without coverage, the changes would most likely be at the margins and still leave millions without coverage.
"It's important not to get too focused on the change between the last score and this score, because what we know for sure is the CBO is going to show a very large coverage loss under this bill, and all we'll learn from the score is just how large," Fiedler told Business Insider.
(Reuters) - Anthem Inc on Wednesday said its plans for selling 2018 Obamacare individual plans are still up in the air because of political and regulatory uncertainty, making it the latest health insurer to say questions about continued funding of government subsidies will affect consumers next year.
Anthem, the biggest provider of individual health plans, is looking at all 14 states where it sells Obamacare coverage to determine to what extent it will participate next year, given the continued uncertainty around subsidies and regulations, its chief executive said on Wednesday.
CEO Joseph Swedish, speaking at the UBS Global Healthcare Conference, said the No. 2 health insurer is talking to regulators in each of the 14 states where it sells BlueCross BlueShield plans about total or partial participation or "surgically extracting" itself from the market.
Republican lawmakers are trying to repeal and replace the Affordable Care Act, often called Obamacare, but have not agreed on how or on a transition plan for the income-based subsidized individual plans created under the law.
Rival insurers Aetna Inc and Humana Inc have said they will not sell Obamacare plans next year. Anthem is assessing the ramifications of selling individual plans in later years if it withdraws, Swedish said. It has 1.1 million members in exchange-based plans and another 500,000 in similar plans sold through brokers and other third parties.
"We would prefer not to extract ourselves if we can get the math to work," Swedish said.
Some states require insurers to sell subsidized plans on the exchanges created under Obamacare in order to sell non-subsidized plans elsewhere. Others bar insurers that leave the exchanges from re-entering for a number of years.
The window has nearly closed for the government to remove uncertainty about paying the cost-sharing subsidies created under Obamacare.
Republican lawmakers fought the Obama administration in court to nullify the subsidies and won. The case has been at a standstill while an appeal is heard, and earlier this week Republicans put the case on hold for another three months.
Swedish said a report coming later on Wednesday from the Congressional Budget Office that will lay out how proposed U.S. House of Representatives legislation would affect the budget and insurance coverage will guide how the U.S. Senate proceeds on its own healthcare bill.
"I think we are going to end up with a repair more than a repeal and replace once the Senate gets their arms around it," Swedish said. (Reporting by Caroline Humer; Editing by Jeffrey Benkoe and Steve Orlofsky)