CONSULTANTS are the one big winner of the Obamacare wars

July 8, 2018

“After failing to get a comprehensive Affordable Care Act repeal through Congress — you know, the place where laws are supposed to be made — and then winning a repeal of one of the law’s provisions in last year’s massive tax cut, the Trump administration now asks a judge to undo the rest of the law through the courts.
This is a brazen act of executive overreach. If it succeeds, it will endanger the coverage of thousands of sick Americans.
In federal court in Texas Thursday, where 20 states are suing to undo pieces of Obamacare, the Justice Department jumped in on the states’ side with a stunning argument…
It is one thing for states to claim in court that these interwoven pieces of the federal legislation should be invalidated. It is another and far more dangerous step for this administration to abandon, on the flimsiest rationale, a law duly passed by a previous Congress and signed by a previous President…
If the President gets his way, that’s just the early stage of a disease that’s about to get a whole lot deadlier.” (A)

“The Affordable Care Act, by contrast, has withstood numerous legal challenges in the eight years since it became law, including two at the Supreme Court. The current lawsuit against it hinges not on big questions of equality and justice, but on a technicality.
If that technicality were to carry the day, insurance companies could once again deny coverage, or charge much more for it, to people who have battled cancer, or are pregnant, or who have diabetes, or a heart condition, or arthritis. There’s no clear-cut definition of “pre-existing condition,” so this list goes on and on, affecting Americans of all political stripes. And even if the current law prevails in court, at least some damage will already have been done; uncertainty created by the Justice Department’s stance will almost certainly lead to higher premiums for Americans.
Add this latest move to a growing list of similar efforts — eliminating the mandate tax penalty to begin with, allowing more short-term plans on the market — and it becomes clear where the administration’s priorities lie: not in helping more Americans get good health care, not even in supporting the will of the people, but in dismantling what some political opponents built, just for the sake of doing so.” (B)

“In April, a group of conservatives put together guidance for another bid to overhaul the Affordable Care Act. The effort was and is being spearheaded by the Heritage Foundation and entails meetings with health-policy analysts to generate a consensus plan that would make it to the president’s desk. Those involved acknowledge the heavy lift, but the hope is that activists might pressure lawmakers to move before they potentially suffer losses in the midterm elections…
But for some directly involved with the plan, it’s vitally important to at least try to get something accomplished, precisely because, as it stands, Democrats are using Republican inaction on health care as an electoral cudgel.
“We need to have a plan that we can talk about as we go through the elections,” one source working on the initiative, requesting to speak on background, told The Daily Beast. “What it’s going to take is a political imperative to act. Republicans thought it was an existential crisis if they didn’t get tax reform done.”..
“‘Blame John McCain, then pivot to how great it is that the [individual mandate] is taken care of,’ is the president’s messaging strategy for this. Shift blame, show a win,” a senior Trump aide told The Daily Beast.” (C)

“For the first time since it became law in 2010, Obamacare is a political asset for Democrats heading into an election—a striking turn after several cycles in which the law’s unpopularity helped Republicans sweep into power in legislative races across the country. Still, Democrats face a challenge: President Trump’s attacks on Obamacare prompted a broad reassessment of its merits and hurt his party’s political standing. To successfully exploit the issue, Democrats have to find a way to cut through the din of Trump news and scandal coverage and convince voters they’ll defend the health-care law from ongoing GOP sabotage and repeal efforts…
Democratic strategists are convinced voters aren’t ignoring the assaults on Obamacare, even if press coverage has been dwarfed by Trump. “It’s the biggest disparity I’ve ever seen between what’s being covered on cable news and what candidates are actually running on in their home states: Medicare, Medicaid, the ACA, opioids,” Priorities USA’s Cecil says. That could change soon. Insurers have begun notifying states of their plans to increase premiums—some by double digits. Those rate hikes, set to take effect in October, could deliver voters a shock. “There’s a land mine waiting,” candidate Harder says. “That’s going to be an area where we’re going to have a pretty strong closing argument.”..
BOTTOM LINE – Democrats finally have something to sell with health care, which is the top issue for voters, according to a poll. The trick will be cutting through the noise to get voters’ attention.” (D)

“Conservative health care think tank scholars have published a new proposal to repeal and replace Obamacare, hoping that they can persuade Congress to take up the issue one more time before November. Can it succeed where prior efforts have failed?…
The Consensus Group proposal improves upon Graham-Cassidy by requiring that “at least 50% of the block grant goes toward supporting people’s purchase of private health coverage” in the individual insurance market. Under the new program, states would be required to offer Medicaid enrollees the opportunity to purchase “commercially available coverage” with their Medicaid dollars, and plans sold under the block grants would be exempted from costly Obamacare rules, like 3:1 age bands that double or triple the cost of insurance for young people…
It comes down to a tension among conservatives between those who most highly value individual rights, and those who most highly value states’ rights.
The states’ rights wing believes that the best policy outcomes can be achieved by consolidating control of taxpayer funds in the hands of state governments…
On the other hand, the individual-rights wing believes that central planning by state governments often leads to the same results as central planning by federal governments, and that true free-market reform involves helping individuals directly purchase the health insurance and health care services that best suit their needs…” (E)

“The first Sunday after his inauguration, New Jersey Gov. Phil Murphy signed an executive order directing state agencies to report everything they could do to ramp up the visibility of the Affordable Care Act and persuade more people to buy health coverage under the law.
Four months later, the Democratic governor signed into law a requirement that makes New Jersey the first state in a dozen years to compel most residents to carry insurance….
Several states are erecting barriers against rules the Trump administration is writing to promote short-term health plans that are comparatively inexpensive because they lack benefits and consumer protections guaranteed by the ACA. And some states, led by Democrats and Republicans alike, are trying to slow insurance rate increases through methods that Congress considered but did not pass.
“There are all these federal changes that are happening, and some states are pushing back on them and some states are taking advantage of them,” said Jason Levitis, a consultant who led the development of the ACA’s tax components at the Treasury Department during the Obama administration. “The most important and interesting health policy action is in states.” (F)

“Associate Justice Anthony Kennedy’s retirement from the Supreme Court may lead to big changes in constitutional law, some court-watchers say, but others are not so sure…
“This suit has a greater likelihood of attracting a majority,” he wrote in an email. “With a more reliable conservative, and Roberts having dug his own hole after basing the constitutionality of the ACA on the mandate being a tax — and the tax now having been repealed, that leaves the door open to a different decision in the Supreme Court.”
Indeed, “several of the recent decisions have been 5-4,” said Gail Wilensky, PhD, senior fellow at Project HOPE, in Bethesda, Maryland, in an email. “With a second Trump appointee, the conservative wing of the court will be clearly strengthened. However, as became clear in the [NFIB v. Sebelius] decision regarding the constitutionally of the ACA, predicting Supreme Court decisions is not always straightforward.” (G)

“The Trump administration’s decision to join a conservative lawsuit challenging some of the most popular parts of the Affordable Care Act continues to be the gift that keeps on giving, at least politically, for Democrats ― first in the midterms and now in the upcoming Supreme Court fight…
Democrats immediately went to town on the suit, blasting out ads and fundraising emails warning that the Trump administration wants to take away coverage for people with pre-existing conditions.
And now, Democrats say they plan to use the suit to their advantage when Trump picks his Supreme Court nominee, expected to be announced July 9.
The lawsuit, brought by 20 states led by Republicans, argues that the law’s protections were supposed to work in tandem with the mandate that individuals have health insurance. Because Congress is no longer enforcing the mandate, they say, insurers no longer have to sell policies to everyone regardless of medical status.
Democratic senators are assuredly going to question the nominee as to whether he or she supports Trump’s position on the lawsuit. Normally, nominees punt on these sorts of questions, arguing that the issue could come before them if they are confirmed to the court.” (H)

“Forget the Affordable Care Act: The future of our health care system will be shaped by a much bigger and broader fight — one that will likely culminate with a 2020 choice between private markets and an authentic government-run program in the form of a Bernie Sanders-style Medicare for All…
This is one of America’s great unsolved problems: We have the world’s best care, talent and innovation. But before it gets to patients, the magic goes through a hodgepodge of inexplicable, expensive and unnecessary hurdles.” (I)

“Trump administration highlights customers being ‘priced out’ of Obamacare. The health law is “increasingly failing” to cover people who don’t get the government to pay for premiums, according to the Trump administration. Twenty percent of people who don’t receive subsidies dropped their Obamacare coverage in 2017 due to increasing costs, show data from the Centers for Medicare and Medicaid Services, highlighting a trend that has been occurring since 2015. Between 2015 and 2016, unsubsidized enrollment fell in 23 states, with 10 states seeing double-digit declines. “As the Trump administration took office, there were warning signs that we were dealing with a crisis in the individual health insurance market and Obamacare was failing its consumers,” Seema Verma, CMS administrator, said in a statement. “These reports show that the high price plans on the individual market are unaffordable and forcing unsubsidized middle class consumers to drop coverage.”” (J)

“As health insurers across the country begin filing their proposed rates for 2019, one thing is clear: The market created by the Affordable Care Act shows no signs of imminent collapse in spite of the continuing threats by Republicans to destroy it.
In fact, while President Trump may insist that the law has been “essentially gutted,” the A.C.A. market appears to be more robust than ever, according to insurance executives and analysts. A few states are likely to see a steep spike in prices next year, but many are reporting much more modest increases. Insurers don’t appear to be abandoning markets altogether. In contrast to last year, regulators are not grappling with the prospect of so-called “bare” counties, where no carrier is willing to sell A.C.A. policies in a given area.
“The market is in a better position now than it has ever been since the exchanges have opened,” said Deep Banerjee, who follows insurers for S & P Global Ratings. The companies first began selling policies in the state exchanges, or marketplaces, five years ago. After years of losses, the insurers are now generally making money.” (K)

“Republicans could still repeal and replace ObamaCare if they are able to keep the House majority and gain seats in the Senate, Republican National Committee (RNC) spokeswoman Kayleigh McEnany told Hill TV’s “Rising” on Thursday.
McEnany specifically noted legislation proposed by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.), which was defeated last fall.
“We were a big proponent of Graham-Cassidy. That, of course, was the Senate bill that gave the states the power and allowed each state to select what the best way forward was for them on health care,” McEnany told Hill TV’s Krystal Ball and Buck Sexton on “Rising.”
“That was one vote short, and if we maintain the House as we expect we will, pick up a few Senate seats, Graham-Cassidy can become a reality,” she said.” (L)

“The Trump administration on Saturday halted billions of dollars in payments to health insurers under the Obamacare healthcare law, saying that a recent federal court ruling prevents the money from being disbursed.
The Centers for Medicare and Medicaid Services, which administers programs under the Affordable Care Act, said the action affects $10.4 billion in risk adjustment payments.
President Donald Trump’s administration has used its regulatory powers to undermine Obamacare after the Republican-controlled Congress last year failed to repeal and replace the law. About 20 million Americans have received health insurance coverage through the program.
The payments are intended to help stabilize health insurance markets by compensating insurers that had sicker, more expensive enrollees in 2017. The government collects the money from health insurers with relatively healthy enrollees, who cost less to insure.
CMS, which is overseen by the U.S. Department of Health and Human Services, said the move was necessary because of a February ruling by a federal court in New Mexico, which found that the federal government was using an inaccurate formula for allocating the payments.” (M)

“The Trump-era attack on the Affordable Care Act has left the nation’s health system plagued with uncertainties: Will “Obamacare” insurance survive? Can independent hospitals make it? What’s next for doctors? And will patients ever really get “affordable” care?
But one certainty is prevailing: No matter what the outcome, it will be a bonanza for health-care consultants.
These fixers—the visionaries, the mercenaries and everyone in between—have been dramatically increasing their role in the economy since the Affordable Care Act was passed in 2010. A Modern Health Care Magazine survey of just 25 prominent national consultant firms found that revenue rose from $2.3 billion in 2008—the year before Obama took office—to $6.6 billion in 2014, the start of the ACA coverage expansion. Deloitte, for instance, which topped the list in 2014, saw its health-related revenue rise from $725 million to $2.2 billion in that time…
The reasons for the health care fixing frenzy are varied: Digitization forced doctors to abandon their bulging file folders in favor of computerized records. Obamacare expanded insurance coverage at a pace not seen since the creation of Medicare in 1965—and Trumpcare has begun to contract it. And doctors, hospitals, government and the private sector are all grappling with how to pay for medical care in ways that reward the quality, not quantity, in a system that may not really be the “best in the world,” but is certainly the most expensive…
THE ONLY THING that can compare to the rapid change of the Obama years is whatever’s next under Donald Trump’s administration—and that changes tweet by tweet. Repeal fervor has dissipated, and a more concrete anti-ACA framework is taking shape: repeal of the Obamacare mandate as part of the tax law, the emergence of skimpy health plans that will cost less than Obamacare but lack its comprehensive protections, and vast but still ill-defined “state flexibility” that has already generated a rash of lawsuits.” (O)

(A) Unhealthy and unwise: Trump undermines Obamacare, and the American people will suffer, http://www.nydailynews.com/opinion/ny-edit-unhealthy-and-unwise-20180608-story.html
(B) The Health Care Stalkers, https://www.nytimes.com/2018/06/11/opinion/the-health-care-stalkers.html
(C) A ‘Suicide’ Mission: White House and GOP Leadership Fear New Obamacare Repeal Push, https://www.thedailybeast.com/a-suicide-mission-white-house-and-gop-leadership-fear-new-obamacare-repeal-push
(D) The Dems Take Obamacare on the Road, by Joshua Green and SahilKapur, https://www.bloomberg.com/news/articles/2018-06-25/democrats-see-health-care-as-boon-not-burden-as-midterms-near
(E) Once More Into The Breach: Conservative Think Tankers Publish A New Obamacare Replacement,by Avok Roy, https://www.forbes.com/sites/theapothecary/2018/06/20/once-more-into-the-breach-conservative-think-tankers-publish-a-new-obamacare-replacement/#4492f4422c32
(F) States act on their own to fill holes Washington is knocking in Affordable Care Act, by Amy Goldstein, https://www.washingtonpost.com/national/health-science/states-act-on-their-own-to-fill-holes-washington-is-knocking-in-affordable-care-act/2018/07/01/15374aae-73f8-11e8-9780-b1dd6a09b549_story.html?noredirect=on&utm_term=.cdc891785d12
(G) How Will SCOTUS Roll on Healthcare Without Kennedy?, by Joyce Frieden, https://www.washingtonpost.com/national/health-science/states-act-on-their-own-to-fill-holes-washington-is-knocking-in-affordable-care-act/2018/07/01/15374aae-73f8-11e8-9780-b1dd6a09b549_story.html?noredirect=on&utm_term=.cdc891785d12
(H) Obamacare To Be Central To Democrats’ Fight Against Trump’s Supreme Court Pick, by Amanda Terkel, https://www.huffingtonpost.com/entry/obamacare-trump-supreme-court_us_5b3a7ab4e4b09e4a8b262965
(I) What’s next: The health care debate is no longer a linear fight over a straight repeal of President Obama’s health care law. Instead, it has metastasized into a multi-front war, Special report: The next health care wars, by David Nather, https://www.axios.com/health-care-wars-medicare-for-all-insurance-bernie-d91da849-6c0e-4cd0-8662-091cc51676a9.html
(J) Daily on Healthcare: Trump administration highlights customers being ‘priced out’ of Obamacare, by Philip Klein, by Kimberly Leonard, & Robert King, https://www.washingtonexaminer.com/daily-on-healthcare-trump-administration-highlights-customers-being-priced-out-of-obamacare
(K) Obamacare Is Proving Hard to Kill, by Reed Abelson, https://www.nytimes.com/2018/07/03/health/obamacare-insurance-rates.html
(L) RNC spokeswoman: ObamaCare repeal possible if GOP keeps House, by Julia Manchester, http://thehill.com/hilltv/rising/395574-rnc-obamacare-repeal-possible-if-gop-keeps-house
(M) Trump administration halts billions in insurance payments under Obamacare, https://www.cnbc.com/2018/07/07/reuters-america-trump-administration-halts-billions-in-insurance-payments-under-obamacare.html
(N) RNC spokeswoman: ObamaCare repeal possible if GOP keeps House, by Julia Manchester, http://thehill.com/hilltv/rising/395574-rnc-obamacare-repeal-possible-if-gop-keeps-house
(O) The one big winner of the Obamacare wars, by JOANNE KENEN, https://www.politico.com/agenda/story/2018/07/07/affordable-care-act-health-consulting-000680

Prequels
From REPEAL & REPLACE to WRECK & REJOICE (from Obamacare to Trumpcare) (April 25th)

From REPEAL & REPLACE to WRECK & REJOICE (from Obamacare to Trumpcare)

“This would appear to be Republicans’ last-ditch attempt (well, their latest last-ditch attempt) to repeal Obamacare.” (June 7th)

“This would appear to be Republicans’ last-ditch attempt (well, their latest last-ditch attempt) to repeal Obamacare.”