US Policy Changes Vol.22 (Healthcare Vol.2)

Here are articles on healthcare. Excerpts are on our own.

Republicans can repeal Obamacare. They can’t repeal the logic of health insurance. (11/23/2016) | Uwe Reinhardt @voxdotcom
Chart: Health Spending by Decile of the U.S. population, 2013
… For the most part, however, they represent chronically ill people, often with multiple conditions that can be medically treated, albeit at great expense that exceeds these individuals’ capacity to finance their care with their own financial resources.
The fundamental questions in the US, as in other countries, are a) what kind of treatments these very sick members of society should receive, especially end-of-life treatments, and b) how those treatments should be financed, given that these treatments can quickly exhaust the budgets of the afflicted.
…three alternative outside sources of financing…:
1. public subsidies financed from general taxation,
2. cross-subsidies baked into health insurance premiums, forcing healthier individuals to subsidize through the premiums they pay the health care of chronically sicker member in the same insurance risk pool, or
3. cross-subsidies baked into the prices charged paying patients by doctors, hospitals and other providers of health care, which forces paying patients to cover these providers’ so-called “uncompensated care.”…
Canada…the first…
Germany…the second…
…Public programs…
The far flung employment-based private health insurance system… …younger or healthier employees cross-subsidize the care of their sicker colleagues.
Finally… an informal catastrophic health insurance system operated mainly by hospitals. …the cost of health care rendered to uninsured patients unable to pay for it is added to the prices charged insured or self-paying patients.
The Affordable Care Act of 2010 (ACA) incorporates a judicious mixture of the first two approaches. Within age belts… The law limits the differences among age groups, so that people over 64 pay no more than three times what 21-year-olds pay…
Chart: “Actuarially fair” versus “Community-Rated Premiums”
…the remaining risk pool of insured individuals will contain relatively more sick people… …one major reason why premiums between 2016 and 2017 have risen by an average of 25 percent across the nation…
…the increase will seriously impact individuals with higher incomes and those who for one reason or another procure coverage apart from the ACA exchanges and are therefore not entitled to federal subsidies…
…Germany, the Netherlands, and Switzerland — impose strictly enforced mandates on all individuals to purchase health insurance with a specified benefit package.
…the penalty of disobeying it (an amount equal to 2.5 percent of income) is generally much lower…
First…very difficult to repeal the ACA in its entirety. …the Senate…is not filibuster proof, which would require 60 Republican votes… The Senate could use a maneuver called “budget reconciliation” to get rid of any provision…
Second…the actuarial problem… they would face the problem of how to finance health care for the very sick…
…many components of the ACA would actually reappear under…Trumpcare or Freedomcare…

OPINION: MOVING ON TO TRUMPCARE (11/28/2016) | Joel Cantor ‏@njspotlight
… Over 670,000 New Jersey residents gained Medicaid or nongroup private health insurance since the implementation of the main coverage provisions of the Affordable Care Act (ACA) in 2014.
…over the first two years of ACA implementation, the share of nonelderly adults in New Jersey without coverage dropped nearly 40 percent (from 17.5 percent to 10.8 percent). Over the same period (2013 to 2015), the share of New Jersey’s nonelderly adults with private health insurance, mostly through employers, grew modestly from 72.3 percent to 78.2 percent.
… Repeal of the ACA in the first 100 days of the new administration is exceedingly unlikely. A super-majority of the U.S. Senate would be required to repeal the law, enabling Democrats to block repeal. Defunding the ACA is possible without a super-majority, but…
The White House could unilaterally and immediately trigger a similar defunding scenario by simply withdrawing its appeal of House v. Burwell, a court ruling that would block federal funding of some ACA subsidies. …people living in solidly Republican counties have disproportionately benefited from ACA coverage subsidies.
… Healthy people would drop coverage until they need it, and insurance carriers would withdraw from the market as they faced unsustainable costs. …
Another, more likely, path would enable the congressional majority and new administration to keep their repeal-and-replace promise without triggering immediate market failure. Congress could enact a budget resolution that ends marketplace subsidies and the tax penalty for being uninsured, but delay…
Starting the clock to defund Obamacare down the road if Congress does not act to replace the rest of the ACA would be very risky, not just for insurance markets. …a true bipartisan compromise, but…
…health insurance can already be sold across state lines and health savings accounts are already available… …changing Medicaid from an entitlement to a capped block grant has historically been opposed even by Republican governors.
…majorities, including about half of self-identified Republicans, favor expanding Medicaid and subsidizing private health insurance for those who cannot afford it…
…“repeal and replace” would have to proceed more like precision surgery than the swing of an ax. …they can undermine many ACA provisions by simply changing implementation plans, working through the courts, and issuing executive orders, none of which require congressional action…
… Obama, for example, sought to entice ideologically resistant states to adopt the ACA Medicaid expansion by allowing them to impose “personal responsibility” requirements on enrollees such as cost sharing and behavior changes or to move some enrollees into the private health insurance markets. …
… ACA Section 1332 waivers will permit states to reshape not just Medicaid, but many other ACA provisions including the mandate, penalties, and some insurance rules. Section 1332 waivers can only be approved if they are budget-neutral and do not reduce the number of people with comprehensive coverage. …

OPINION: RISING PREMIUMS FOR OBAMACARE PLANS, SOME HIDDEN GOOD NEWS (10/31/2016) | Joel Cantor ‏@njspotlight
… First… the costs for plans on the Affordable Care Act’s online marketplaces for 2017 coverage… In New Jersey, however, the increase of the benchmark silver plan rose by less than a third as much, by 7 percent.
… But happily, the New Jersey increase was lower than all but 11 states…
The pain will be even less for the eight-in-ten buyers on the marketplace who are eligible for federal subsidies. …
…healthy people would be slow to enroll. …part of the 2017 premium hike reflects the one-time impact of this subsidy going away.
This year three of five insurers stopped selling marketplace plans… But… the carriers that left had small market shares and the remaining two, AmeriHealth and Horizon Blue Cross Blue Shield, appear to be competing in a fairly stable market. …we may see more carriers return to the subsidized marketplace in 2018…
A second important marker that augurs well for New Jersey is that our premiums are looking comparatively better than other states. …

Rep. Price, Obamacare Critic, Is Trump’s Choice to Lead Health Agency (11/29/2016) | @annaedney,@HouseInSession,@JenniferJJacobs @ijournal

Trump Names Obamacare Detractor As HHS Secretary (11/29/2016) | @nic_fisher @Forbes

The future of public health under President Trump | John McDonough, Karen Feldscher @HarvardChanSPH

How might the election affect Obamacare? (11/18/2016) | @NicoleEFeldman
@MichelleM_Mello and David Studdert: … In an interview on Nov. 11, he said he is interested in keeping some of the key provisions of the law, such as a ban on insurers discriminating on the basis of pre-existing conditions and provisions allowing young people to stay on their parents’ plans until age 26. But his opposition to other provisions, including the cornerstone provision requiring individuals to purchase insurance coverage, likely will remain. …
Laurence Baker: The reality of the health care system is that there are not easily available alternatives to the ACA that would protect coverage and be palatable to broad groups of Republicans. Single-payer, or national health insurance, is a non-starter, so they’d be left with market-oriented reforms, and there are not obvious ways to pursue those without at least some core features of the ACA. Most of the proposals recently put forward for a replacement, including those highlighted by the Trump campaign, like cross-state competition, tax credits for insurance purchase and block granting Medicaid, would not really offer coverage to a large number of the people who would lose it under repeal. …

Post-election Q&A: What Now? (11/21/2016) | @HealthforceUCSF
It appears highly likely that people with pre-existing health conditions will be protected and young adults on their parents’ plans will still be covered until age 26. These are popular components that President Obama and Senate Republicans support.
What are good sources of information to remain up-to-date on health care policy and news? ー @HealthforceUCSF, @politico, @KHNews, @MorningConsult, @CalHealthline, @statnews, @NASHPhealth

Trump’s First 100 Days: Health Care (11/28/2016) | @Saragoud @sciam
…“I can’t imagine a full house and a third of the Senate wants to run in 2018 having withdrawn funding for expanded coverage without having anything in its place,” says @gailwilenskycom,@projecthopeorg…
“You’ve got to convince people that it’s a good idea to take health care away from middle- and low-income Americans and give tax cuts to high-income Americans,” @Cutler_econ,@HarvardEcon says.
… “Generally speaking, as a matter of constitutional law, it is up to Congress how federal money is spent,” says David Law, a professor of constitutional law and political science @WUSTL. “If Congress wants to ensure Planned Parenthood gets money, it can do so regardless of what the president wants—because the president carries out the laws and can’t contradict the laws. Conversely, if Congress wants to strip Planned Parenthood of money, it can do so regardless of what the president wants.” …
Other initiatives, such as Trump’s call for reduction in drug prices through increased drug importation would require legislation to pass, a process unlikely to occur in the first three months of his presidency. “While drug importation could provide relief in narrow situations, like a drug shortage, it will not provide immediate relief to consumers that struggle to afford high drug costs,” Caitlin Morris @FamiliesUSA says. “To protect consumers from rising prescription drug costs, we need a comprehensive set of reforms, including increased transparency surrounding drug companies’ pricing and practices, and alignment of prices with the value they provide to patients. …

Trump’s Obamacare Repeal Could Spell Chaos for Consumers (11/21/2016) | @nadiaprupis @commondreams
@adamcancryn,@pauldemko write: Even if Congress delays immediate action to kill the health care law, Obamacare insurers would have just a few months to decide whether to stay in the law’s marketplaces for 2018. Deep uncertainty about the Republicans’ Obamacare replacement could drive out those companies, cutting off insurance for, potentially, millions of customers.
@WA_OIC…
@MarcSantoraNYT write: … “The fact that more than 20 million children in the U.S. experience insurance and noninsurance barriers to getting comprehensive and timely health care is a challenge that needs to get the highest-priority attention from the new administration,” said @IrwinRedlenerMD,@ColumbiaMSPH.
@CeciConnolly,@_ACHP…