“Early last year as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health law using executive authority.
The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it.
Top administration officials had always said they would eradicate the law through both legislative and executive actions, but never provided the public with anything close to the detailed blueprint shared with the members of the House Freedom Caucus, whose confidence — and votes — President Donald Trump was trying to win at the time. The blueprint, built off the executive order to minimize Obamacare’s “economic burden,” that Trump signed just hours after taking the oath of office, shows just how advanced the administration’s plans were to unwind the law — plans that would become far more important after the legislative efforts to repeal Obamacare failed…
“The primary problem here is government officials, government agencies, were taking steps that would lead to fewer people having coverage and erecting barriers to people having coverage,” he said. “In addition to that, you have kind of a closed-door, back-room slimy deal here that should trouble anyone.”
The document lists 10 executive actions the Trump administration planned to take to “improve the individual and small group markets most harmed by Obamacare.”
Those include calling for stricter verification of people who try to sign up outside of the open enrollment period; cutting the sign-up period in half; and giving states authority to determine whether insurers had to cover the full range of benefits required by Obamacare and whether their networks of doctors were sufficient.
Those policies are among seven proposals in the plan that have since been implemented. Four of the ideas and a portion of a fifth had been publicly proposed but not yet finalized when the document was shared.” (A)
“Out on the campaign trail, Trump frequently called for the repeal and replace of Obamacare, and the executive order signaled that doing away with President Obama’s sweeping health care law would be a priority from day one. While Trump has been unsuccessful in repealing the Affordable Care Act during his first year in office, the Department of Health and Human Services has managed to make significant changes.
In 2017, Health and Human Services under the Trump administration rolled back the Obamacare birth control mandate, allowing employers to exempt themselves if they have a moral or religious objection, ended cost-sharing reduction payments to insurance companies to help provide lower cost insurance for middle and low income consumers, cut advertising and outreach spending for the Affordable Care Act 90 percent, cut the sign-up period on the federal health care exchanges in half, and threw out the individual mandate—a tax penalty for those who don’t sign up for health insurance.” (B)
“Unable to roll back Obamacare’s health-care expansion legislatively, they’re now doing so administratively, through a series of technical, boring-sounding regulatory changes.
This GOP effort ramped up last week, when the Trump administration began allowing states to erect new barriers to Medicaid eligibility.
In the half-century since Medicaid was first created, eligibility has always been based almost entirely on financial circumstances such as income and assets; the program’s goal, after all, was to help less-well-off Americans obtain medical care. Last week, though, the Trump administration announced that it would start allowing states to impose other requirements on Medicaid recipients, including proof that they are working, looking for work, volunteering or in school.” (C)
“The number of people in the U.S. without health insurance increased in 2017 for the first time since Obamacare took effect, a possible sign that Obamacare’s rising premiums are putting insurance out of reach for millions of people.
The number of uninsured rose by 3.2 million from 2016 to 2017, according to the latest Gallup-Sharecare Well-Being Index.
That increase means 12.2 percent of the U.S. population was uninsured last year. In contrast, 10.9 percent was uninsured in 2016, a record low since Gallup and Sharecare started tracking the rate in 2008.
The 2017 uninsured rate is still lower than the peak uninsured rate of 18 percent in 2013, before people became able to buy government-subsidized healthcare plans through exchanges or enroll in expanded Medicaid, both provisions of Obamacare.
But it still represents a significant increase, one that hit blacks hardest. The index said the uninsured rate rose 2.3 percent for blacks, 2.2 percent for Hispanics, and 2 percent for young adults aged 18 to 25.
One factor in the rising uninsured rate could be the rising price of Obamacare plans. Though most who are enrolled through the exchanges receive a subsidy that shields them from price increases, those without subsidies and others who buy plans with Obamacare’s mandates, often off-exchange, have to pay the full price of increases.” (D)
“SINCE THE big Obamacare repeal-and-replace bills failed in the Senate, Congress and President Trump have sought to undermine the law in subtler ways. First, Republican lawmakers repealed Obamacare’s individual mandate, a key element of the law’s design. Now the Trump administration is rolling out rules that threaten to damage the structure further.
The Labor Department this month proposed looser regulations on so-called association health plans, under which small businesses, professional associations and others in similar circumstances can band together and buy insurance coverage for their groups as though they were large employers. The department argues that up to 11 million people working at small businesses or as sole proprietors lack health insurance, and that the new rules would help provide them more options.
In fact, there is a potentially large downside. The rules would also excuse association health plans from covering 10 classes of essential health benefits. Plans would probably be cheaper, but they would likely cover less than the comprehensive ones Obamacare sought to make the national standard. It is likely that some people who buy these plans will develop significant health problems and find themselves disastrously under-covered. Some may be willing to take that risk. The bigger problem is that opening a new avenue to buying shoddier insurance may harm everyone else seeking affordable, comprehensive coverage when they cannot get it from a large employer.” (E)
“Having wiped out the requirement for people to have health insurance, Republicans in Congress are taking aim at a new target: the mandate in the Affordable Care Act that employers offer coverage to employees.
And many employers are cheering the effort.
While large companies have long offered health benefits, many have chafed at the detailed requirements under the health law, including its reporting rules, which they see as onerous and expensive. Now that relief has been extended to individuals, some companies believe they should be next in line.
The individual mandate and the employer mandate are “inextricably entwined,” said James A. Klein, the president of the American Benefits Council, an influential lobby for large companies like Dow Chemical, Microsoft and BP, the oil and gas producer.
“It is inequitable to leave the employer mandate in place when its purpose — to support the individual mandate — no longer exists,” Mr. Klein said. “We are urging Congress to repeal the employer mandate.”
Opposition to the employer mandate could increase as more employers are fined for not offering coverage or for not meeting federal standards for adequate, affordable coverage. Since October, the Internal Revenue Service has notified thousands of businesses that they owe money because they failed to offer coverage in 2015, when the mandate took effect.” (F)
“The Centers for Disease Control and Prevention (CDC) says it “has not banned, prohibited, or forbidden” the use of certain words in official documentation, the agency director says in response to concerns from Senate Democrats.
Democrats had been concerned, they said last month, “that the Trump Administration is yet again prioritizing ideology over science” after reports claimed agencies within the Department of Health and Human Services (HHS) had banned employees from using words including “fetus,” “vulnerable” and “science-based.”
CDC Director Brenda Fitzgerald told Sen. Brian Schatz (D-Hawaii) in a letter released Tuesday the HHS style guide does recommend avoiding the use of “vulnerable,” “diversity,” and “entitlement.” Fitzgerald added that CDC recommends substituting the colloquial “ObamaCare” for “Affordable Care Act” or “ACA.”” (G)
“Many states are eager to reverse the damage from Obamacare in 2018, but in some cases, they will need help from Congress, leading health care experts say.
The following are six ways the states and/or the federal government could push for change or reforms in the year ahead. 1.State innovation waivers; 2. Revive Graham-Cassidy; 3. Direct primary care; 4. Medicaid work requirements; 5. Telemedicine to cut costs; 6. Regulations for new hospitals. (H)
“The increasing number of people coming to the emergency room is partly due to Obamacare, because 880,000 more people in New Jersey became insured. The largest share of that number are low-income people who now qualify for Medicaid.
That’s where Gov. Chris Christie comes in. After the Affordable Care Act passed, most Republican governors said they wouldn’t opt into the voluntary expansion of Medicaid, even though the federal government would pay for 90 percent of the extra cost.
“Medicaid is pretty well expanded in our state already because of the legacy of previous democratic governors,” Christie told Fox and Friends in July 2012. “So I don’t think there’s a lot more for us to do in New Jersey in that regard.”
But six months later, squeezed between his ambition to run for president and re-election in a majority blue state, he bucked his own party and took the money. There are now more than half a million poor people who gained access to healthcare in New Jersey.
“It was a very big move,” said Joel Cantor, director of the Rutgers Center for Health Policy. “Expanding Medicaid has been huge for this state, enfranchising hundreds of thousands of people and helping to finance our healthcare system more robustly and more stable than it had been in the past.”..
But he turned his attention to the opioid epidemic, and worked almost exclusively on it. It was a good time to be working on the problem in New Jersey, because half a million low-income people were added to the Medicare rolls, and many of those people were now able to get treatment for drug addiction. A wide spectrum of people who work on recovery say that was the game changer in New Jersey.
Christie also gets credit for expanded access to Naloxone, which can save the life of someone overdosing, and for signing the Good Samaritan law, which encourages drug users to call for help without fear of arrest when a friend is overdosing.” (I)
“More American women started getting recommended mammography screening after an “Obamacare” rule made the tests free, a new study finds.
The rule meant that Medicare and most private insurers could no longer require women to foot part of the bill — whether through copays or requiring them to pay a deductible first.
After the rule went into effect, the study found, the number of women in Medicare Advantage plans who got mammography screening rose by 5.5 percentage points: from just under 60 percent in the two years before the rule, to 65.4 percent in the two years after.
That’s the good news. The worry is what could happen if the Affordable Care Act rule is repealed, said lead researcher Dr. Amal Trivedi, an associate professor of medicine at Brown University in Providence, R.I.
“Our study suggests that if the cost-sharing provisions are repealed and health plans reinstate copayments for screening mammograms, fewer older women will receive recommended breast cancer screening,” Trivedi said. “That could harm public health.” (J)
“A new study suggests that the Medicaid expansion helped hospitals in rural areas keep their doors open. But will this be enough going forward?
The Affordable Care Act’s Medicaid expansion drove down the uninsured rate in the United States.
Now a new study suggests that the expansion boosted the financial health of many hospitals that serve a high number of the uninsured, especially in rural areas.
Researchers found that hospitals in the 32 states and District of Columbia that expanded Medicaid were more than 6 times less likely to close than hospitals in the 18 states that said no to the expansion.
Some areas were helped more than others by the Medicaid expansion.” (K)
“Democrats are shifting to offense on health care, emboldened by successes in defending the Affordable Care Act. They say their ultimate goal is a government guarantee of affordable coverage for all…
Time will tell. Here’s a sample of ideas under debate by Democrats and others on the political left:
—Medicare for All: Vermont Sen. Bernie Sanders made single-payer, government-run health care the cornerstone of his campaign for the 2016 Democratic presidential nomination. It remains the most talked-about health care idea on the left. Financing would be funneled through the tax system. Individuals wouldn’t have to worry about deductibles, copays or narrow provider networks. Although state-level attempts to enact single-payer care have foundered because of the large tax increases needed, about one-third of Sanders’ Democratic colleagues in the Senate are co-sponsoring his latest bill.
—Medicare-X: The legislation from Sens. Kaine, and Michael Bennet, D-Col., would allow individuals in communities lacking insurer competition to buy into a new public plan built on Medicare’s provider network and reimbursement rates. Medicare would be empowered to negotiate prescription drug prices. Medicare-X would be available as an option through HealthCare.gov and state health insurance markets. Enrollees could receive financial assistance for premiums and copays through the Obama health law. Eventually, Medicare-X would be offered everywhere for individuals and small businesses.
—Medicare Part E: Yale University political scientist Jacob Hacker has proposed a new public health insurance plan based on Medicare, for people who don’t have access to job-based coverage meeting certain standards. It would be financed partly with taxes on companies that don’t provide insurance. Consumers would pay income-based premiums. Hospitals and doctors would be reimbursed based on Medicare rates, generally lower than what private insurance pays. “The crucial part of this is that you have guaranteed health insurance, just like you have guaranteed Medicare or Social Security,” said Hacker. He’s working with Democrats in Congress to turn the concept into legislation.
—Medicaid Buy-In: Sen. Brian Schatz, D-Hawaii, and Rep. Ben Ray Lujan, D-N.M., have introduced legislation that would allow states to open their Medicaid programs up to people willing to pay premiums. Although Medicaid started out as insurance for the poor, it has grown to cover about 75 million people, making it the largest government health program. Most beneficiaries are now enrolled in private insurance plans designed for the Medicaid market.” (L)
“Wisconsin Gov. Scott Walker (R) is looking to stabilize the state’s ObamaCare marketplace after Republicans failed to repeal and replace the law last year.
“Their failure to act on this issue is yet another call for us to step up and lead,” Walker told the Wisconsin State Journal.
“I wanted to get premiums for that individual market more compatible with where the group insurance premiums are.”
Walker said he will seek federal permission to set up a reinsurance program, which provides payments to plans that cover higher-cost enrollees in an effort to lower premiums for everyone else.
Walker also said he will ask state lawmakers to codify in state law protections for people with pre-existing conditions.
The proposed reinsurance program, to start in 2019 if approved by the Trump administration, would pay 80 percent of claims between $50,000 and $250,000.
The program would cost about $200 million a year, according to the newspaper, with $150 million coming from the federal government.
Lawmakers in Congress are also working to pass legislation to shore up ObamaCare.
A fix being pushed by Sens. Lamar Alexander (R-Tenn.) and Susan Collins (R-Maine) would fund key ObamaCare insurer payments and give states billions of dollars to set up reinsurance or high-risk pools for expensive patients.”
The two senators are hoping the bills get added to an upcoming long-term spending deal.” (M)
“Sen. Susan Collins (R-Maine) said Monday that she is “optimistic” that the ObamaCare fixes she is pushing for can still pass, despite the deadline for voting on them having “slipped.”
“Our negotiations with the House are going very, very well,” Collins told reporters. “The deadline slipped but the policy is what is important.”
Senate Majority Leader Mitch McConnell (R-Ky.) in December gave a commitment to Collins to support the passage of two bills aimed at stabilizing ObamaCare markets and lowering premiums before the end of the year, in exchange for her vote for the tax reform bill.
The end of the year came and went without votes on the two bills, but Collins said Monday she is still “optimistic.”” (N)
“Rep. Pat Meehan (R-Pa.) denied allegations that he sexually harassed a young female staffer and blamed Obamacare for some of his behavior that she perceived as hostile..
Meehan denied that he retaliated against her and instead blamed any negative behavior on stress over the Republican effort to dismantle Affordable Care Act. On the day Meehan penned the letter to his aide, the House voted to partially repeal and replace the health care law.” (O)
(A) Trump’s secret plan to scrap Obamacare, by JENNIFER HABERKORN, https://www.politico.com/story/2018/01/10/trump-obamacare-secret-plan-278145
(B) HHS goal under Trump: rolling back Obamacare, by MERIDITH MCGRAW, http://abcnews.go.com/Politics/hhs-goal-trump-rolling-back-obamacare/story?id=52222200
(C) Trump is hoping you won’t notice his backdoor repeal of Obamacare,by Catherine Rampell, https://www.washingtonpost.com/opinions/trump-is-hoping-you-wont-notice-his-backdoor-repeal-of-obamacare/2018/01/15/aa33f968-fa3b-11e7-8f66-2df0b94bb98a_story.html?utm_term=.d1bdb2297f9d
(D) Number of people without health insurance rises for first time since Obamacare, by Kimberly Leonard , http://www.washingtonexaminer.com/number-of-people-without-health-insurance-rises-for-first-time-since-obamacare/article/2646021
(E) These Trump administration changes could make health-care coverage worse , https://www.washingtonpost.com/opinions/these-trump-administration-changes-could-make-health-care-coverage-worse/2018/01/15/70319d64-f267-11e7-b3bf-ab90a706e175_story.html?utm_term=.bd8f10c8d781
(F) Individual Mandate Now Gone, G.O.P. Targets the One for Employers, By ROBERT PEARJAN, https://www.nytimes.com/2018/01/14/us/politics/employer-mandate.html
(G) CDC rejects censorship reports: ‘There are absolutely no “banned” words’, by NATHANIEL WEIXEL, http://thehill.com/policy/healthcare/368105-cdc-rejects-censorship-reports-there-are-absolutely-no-banned-words
(H) 6 Actions States, Federal Government Could Take on Obamacare, Health Care in 2018, by Fred Lucas, http://dailysignal.com/2018/01/12/6-actions-states-federal-government-could-take-on-obamacare-health-care-in-2018/
(I) What Christie May Not Want to Admit: He Had Success with Obamacare, by Nancy Solomon, https://www.wnyc.org/story/what-christie-may-not-want-admit-he-had-success-obamacare/
(J) Obamacare Led to Rise in Breast Cancer Screening, by BY TOBY MURPHY, http://www.infosurhoy.com/cocoon/saii/xhtml/en_GB/health/obamacare-led-to-rise-in-breast-cancer-screening/
(K) Rural hospitals rely on Medicaid expansion to stay open, study shows, https://www.pbs.org/newshour/health/rural-hospitals-rely-on-medicaid-expansion-to-stay-open-study-shows
(L) On health care, Democrats are shifting to offense, by Ricardo Alonso-Zaldivar, http://www.norwichbulletin.com/news/20180108/on-health-care-democrats-are-shifting-to-offense
(M) Wisconsin’s Republican governor looks to shore up ObamaCare market, by JESSIE HELLMANN, http://thehill.com/policy/healthcare/370128-wisconsins-republican-governor-looks-to-shore-up-obamacare
(N) Collins ‘optimistic’ ObamaCare fixes will pass, by PETER SULLIVAN, http://thehill.com/policy/healthcare/370152-collins-optimistic-obamacare-fixes-will-pass
(O) GOP Rep. Blames Obamacare For Sexual Harassment Allegations, by Willa Frej, https://www.huffingtonpost.com/entry/pat-meehan-obamacare-sexual-harassment_us_5a6841a1e4b002283007d9bc