“Liberals and conservatives in Congress were planning on Wednesday to set forth two radically different proposals for health care: a huge expansion of Medicare, which would open the program to all Americans, and a rollback of the Affordable Care Act, which would give each state a lump sum of federal money with sweeping new discretion over how to use it….
Senator Bernie Sanders of Vermont, the onetime candidate for the Democratic presidential nomination, proposed what he called “a Medicare-for-all, single-payer health care system,” and he said 15 Democratic senators supported it….
At the same time, several Republican senators, led by Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, unveiled their bill, which would take money spent under the Affordable Care Act and give it to states in the form of block grants.” (A)
“Sen. Bernie Sanders, I-Vt., unveiled his Medicare-for-All bill Wednesday, with over a dozen Democratic senators coming out in support of the proposal, according to CNN….. All Americans would receive a “Universal Medicare card” that would qualify them for all patient services, including hospital stays, dental and vision care, hearing aids, substance abuse treatment and abortion.
The proposal would be phased in over a four-year period. In the first year, the Medicare eligibility age would be lowered to 55 and all children under 18 would also be eligible. Coverage would grow to include dental, vision, reproductive health and behavioral health coverage. The next year the eligible age would drop to 45, 35 the year after that and then finally cover every citizen by the fourth year. (B)
“..Graham and Cassidy have been shopping versions of their bill for months now, and submitted a detailed version as an amendment in July. As it stands, the legislation would make it virtually impossible for dozens of states to continue operating Obamacare as we know it without kicking in unrealistic amounts of their own money. That’s because, in the short term, the law is designed to penalize states that embraced the ACA while rewarding those that resisted it. Further down the line, the legislation simply zeroes out all of Obamacare’s spending, a de facto repeal of the entire program that doesn’t include a replacement. As policy, it’s a bit like walking into somebody’s house, lighting the whole ground floor on fire, then telling them, “Hey, you can keep living here—if you like it.” “ (C)
“President Trump promised Thursday to veto legislation for a single-payer, government-run health care system. “Bernie Sanders is pushing hard for a single payer healthcare plan — a curse on the U.S. & its people,” the president tweeted. “I told Republicans to approve healthcare fast or this would happen. But don’t worry, I will veto because I love our country & its people.”
There’s just one major thing to remember about this promise: He’ll never get the chance to veto the bill, because it’s never going to reach his desk during this current session of Congress. “ (D)
“Lawmakers hope to pass bipartisan legislation to steady the individual insurance market, but health plan officials aren’t optimistic that a solution will come in time for them to make strategic business decisions.
Those subsidies help lower the out-of-pocket costs for consumers with incomes below 250% of the federal poverty level. Without them, insurers will likely hike rates by as much as 20%, or stop offering coverage on the exchanges altogether. Some states are publicly releasing approved 2018 rates, while others are waiting for a signal from the Trump administration that it will pay the subsidies through next year.
The notion of funding the cost-sharing reduction subsidies is gaining momentum. Sen. Lisa Murkowski (R-Alaska), a swing vote who helped kill a partial repeal of the ACA, said what matters when it comes to appropriating money for the subsidies is that both parties agree it should be done. “Whether it’s one year, two years or perhaps longer, we can figure that out,” she said.” (E)
In his opening statement, Senator Orrin Hatch (R-UT), the (Senate Finance) committee chair, blasted the ACA, saying that it hadn’t reined in costs and was driving up premiums for many people who buy insurance on the state exchanges. He was dubious about the idea of trying to fix the law.
Alluding to the cost-sharing subsidies that some experts believe must be paid to insurers to stabilize the exchanges, he said, “In my view, an Obamacare bailout that is not accompanied by real reforms would be inadvisable. We can’t simply invest more resources into a broken system and hope that it fixes itself over time.” (F)
“A senior Democratic aide told The Hill that some Democrats in the Senate’s Health, Education, Labor and Pensions (HELP) committee are concerned that the GOP members may be trying to pull the bipartisan negotiations in a more conservative direction. The committee is hoping to hammer out a deal by the end of the week.
“Republicans appear to be pulling the negotiations in a more partisan direction from their side by pushing changes that Democrats have made clear from the start they wouldn’t agree to—like rolling back protections for patients with pre-existing conditions,” ..” (G)
“I asked six of these Obamacare opponents, policy experts at conservative and libertarian think tanks, what they learned from the spectacular failure of Obamacare repeal and what they think happens now, in this strange new reality we all occupy…
Roy described his ideal end state as one similar to the Swiss system: Universal coverage, through private insurance and subsidization, but without that country’s individual mandate or overly prescriptive federal mandates for benefits.
Still, there were some shared visions. Any wonk on the right will talk about equalizing the tax code by capping the unlimited tax break for employer-based insurance and dramatically expanding health savings accounts. Everybody wants more power returned to the states. Everybody is concerned about reining in the costs of the Medicare and Medicaid programs over the long term.” (H)
Bipartisan teams in the Senate and House are separately taking important first steps toward fixing the nation’s individual health insurance market.
Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), as well as some representatives in the House, are looking at ways to improve and strengthen state innovation waivers, which already exist in the Affordable Care Act (ACA), or ObamaCare. Also known as Section 1332 waivers, they give states flexibility to bypass some of the law’s requirements and to help develop localized ways to lower health-care costs, broaden coverage and improve treatment in their states.
Expanding this flexibility, which we have written about before, could be the key to unlocking some of the partisan gridlock surrounding health-care reform. If strengthened, these waivers could help governors and state legislatures across the nation innovate and find health insurance solutions that work best for their states. More conservative states could pursue market-oriented reforms, while more liberal states could pursue their own models. (I)
“Democrats desperately needed the Affordable Care Act to thrive while they still controlled the White House. But with President Barack Obama gone, and GOP majorities in the House and Senate, they’re pretty much off the hook — at least, according to polls showing 60 percent of Americans find Republicans responsible for the ACA.
As for Republicans, they’re still deeply bitter they weren’t able to repeal one iota of Obamacare despite their high-drama effort over the spring and summer. Many members have spent too many years characterizing the extra Obamacare subsidies now at stake as improper insurer “bailouts” to get excited about funding them, even though providing them could somewhat improve otherwise skyrocketing rates next year.” (J)
CBO directly contradicts the claim that Obamacare is in a death spiral: “The nongroup health insurance market to be stable in most areas of the country. Preliminary data for 2018 show that insurers will offer coverage in all or almost all areas. Although premiums have been increasing, most subsidized enrollees buying health insurance through the marketplaces are insulated from those increases because their out-of-pocket payments for premiums are based on a percentage of their income; the federal government pays the difference between that percentage and the premium for a benchmark plan.” Remarkably, only “one-half of one percent of people in the country” will live in areas with no individual group insurers. Interestingly, now that Obamacare is here to stay, CBO expects that “over time” more states will expand Medicaid.
CBO does find some problems — caused by the uncertainty this administration created….” (K)
“Senators on the health committee are working over the weekend to try to reach an agreement on a stabilization bill for Obamacare that they hope will temper insurer exits and premium increases expected for customers who will buy coverage on the exchanges….
“It’s going to be a tough needle to thread for both sides,” a senior GOP aide told the Washington Examiner. “We got a clear indicator on actually how interested many Democrats are in a bipartisan solution for healthcare when 17 of them introduced single payer this week.”
Like many Republicans, Democrats have not indicated whether they would sign on to a stabilization package, and many of them have laid the stability of the exchanges at the feet of Trump, who has not said whether he would fund cost-sharing reduction subsidies, a part of Obamacare they have said he must pay.” (L)
“Having failed to repeal Obamacare, President Donald Trump has said his strategy would be to let the health law “implode.” The Congressional Budget Office released a report Thursday that predicts Trump administration policies on Obamacare could help it on its way by leading to rising premiums and decreased enrollment in individual insurance markets over the next year.” (M)
(A) Medicare for All or State Control: Health Care Plans Go to Extremes, by ROBERT PEAR, https://www.nytimes.com/2017/09/13/us/politics/health-care-obamacare-single-payer-graham-cassidy.html?_r=0
(B) Bernie Sanders’ Medicare-for-All bill: 4 things to know, by Leo Vartorella, http://www.beckershospitalreview.com/hospital-management-administration/bernie-sanders-medicare-for-all-bill-4-things-to-know.html
(C) Republicans Claim That Their New Plan to Repeal Obamacare Is a Moderate Compromise. LOL., by Jordan Weissmann, https://slate.com/business/2017/09/the-new-republican-plan-to-repeal-obamacare-is-even-more-vicious-than-the-old-plan.html
(D) Trump promises to veto Bernie Sanders health care bill that will never reach his desk, by Jessica Estepa, https://www.usatoday.com/story/news/politics/onpolitics/2017/09/14/trump-promises-veto-bernie-sanders-backed-health-care-bill-never-reach-his-desk/667456001/
(E) Left in the lurch: Ongoing uncertainty is taking a toll on health insurers, by Mara Lee and Shelby Livingston, http://www.modernhealthcare.com/article/20170909/NEWS/170909887
(F) Senate Hearing on Healthcare Shows Continuing Conflicts, by Ken Terry, http://www.medscape.com/viewarticle/885593
(G) Signs of trouble in Senate’s ACA stabilization talks, by Paige Minemyer, http://www.fiercehealthcare.com/aca/democrats-fear-gop-wants-to-take-senate-healthcare-hearings-a-partisan-direction
(H) Once Obamacare repeal is dead, the GOP has no plan B, by Dylan Scott, https://www.vox.com/policy-and-politics/2017/9/11/16271168/obamacare-repeal-dead-what-now
(I) Gingrich and Daschle: Senate and House making key steps to fix health care, http://thehill.com/opinion/healthcare/350696-senate-and-house-making-key-first-steps-to-fix-health-care
(J) The Health 202: Why Congress might fail to fund extra Obamacare subsidies, by By Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/09/15/the-health-202-why-congress-might-fail-to-fund-extra-obamacare-subsidies/59bada3730fb045176650c73/?utm_term=.58a56a9d5f1a
(K) Three ways to do health-care reform, Jennifer Rubin, https://www.washingtonpost.com/blogs/right-turn/wp/2017/09/15/three-ways-to-do-health-care-reform/?utm_term=.be329bc3a55b
(L) Bipartisan Senate group prepares to present Obamacare fix, by Kimberly Leonard, http://www.washingtonexaminer.com/bipartisan-senate-group-prepares-to-present-obamacare-fix/article/2634607
(M) Trump wanted to hurt the Obamacare markets. The CBO says he’s a success, by Sam Petulla, http://www.cnn.com/2017/09/15/politics/20170915-cbo-insured-rate-uncertainty-premiums/index.html