US Policy Changes Vol.25 (Healthcare Vol.3)

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

A plea to the president-elect Trump (12/4/2016) | PHILIP M. ROSOFF (@DukeMedSchool) @OUPPolitics
Under the Affordable Care Act (ACA, or “Obamacare”) millions of Americans were able to buy commercial health insurance and millions more who were fortunate to live in states that elected to expand Medicaid were enrolled – sometimes for the first time in their lives – and gained access to subsidized healthcare. … the Supreme Court’s decision to vacate the requirement to increase the Medicaid rolls, all led to not enough people being covered and the return of inexorably rising healthcare costs. But it certainly was an improvement over what we had before 2010, especially for those people without employer-provided (actually subsidized) insurance and those adults who couldn’t afford to buy their own coverage. …
…some of the more popular parts of the ACA, especially the provision to prevent insurers from discriminating against people with so-called pre-existing conditions and that which enables parents (mostly those with insurance via their employers) to keep their adult children on their policies up to the age of 26. …Jonathan Gruber @MITEcon…

Will Medicare Reform be a Republican Obamacare? (12/5/2016) | @shailinthomas @PetrieFlom
… Instead of providing for full insurance coverage through the government, as traditional Medicare currently does, Ryan’s proposal would have eligible patients purchase insurance from private companies with financial assistance from the government. The theory is that by having private insurers provide coverage, Medicare will capture efficiencies of the private market, while simultaneously offering consumers more choice in the coverage they receive.
… According to @KaiserFamFound’s analysis, the average out-of-pocket expense for beneficiaries increase from $5,630 under the current system to $12,500. The reason for this increase, according to the Congressional Budget Office, is that providing coverage is actually more expensive for a private insurer than it is for the government. …
… The Obama administration announced in October that premiums for 2017 will increase by an average of 25 percent — but for some they could increase by as much as 110 percent.
The GOP Medicare plan could have a similar effect, making affordable premiums short-lived. As with Obamacare, the plan would introduce a large number of older, sicker patients into insurers’ risk pools without adding any younger, healthier patients to offset them. As a result, it’s possible that the GOP plan would have the very same sustainability issues that Republicans are currently decrying in their criticism of the Affordable Care Act.
Proponents of the GOP proposal point to Medicare Advantage as an indication that all of Medicare can successfully and sustainably be privatized. But evidence from Medicare Advantage suggests that as people age and become sicker, they transition back to traditional Medicare, taking themselves out of the Medicare Advantage risk pools. …
…the 2016 Medicare trustees report estimates that Medicare as it currently exists will only be able to pay all its bills until 2028. …

University alum Tom Price chosen for Trump cabinet position (11/29/2016) | @c_chadwel ‏@michigandaily
… Under Price’s plan, individuals would receive age-adjusted tax credits when purchasing insurance and it would also allow insurers to sell policies across state lines in an effort to drive down costs by making insurance more competitive.
“True health reform in this country must put patients first while working to improve accessibility to, and affordability of, quality health care,” Price said in a press release on the legislation. “Rather than granting government more authority in the lives of patients and their doctors, we must seek reforms that empower patients while advancing the principles of accessibility, affordability, and quality of care.” …

Trump Picks Tom Price For HHS Secretary. Does This Really Mean He Wants to Repeal Obamacare? (11/29/2016) | @petersuderman @reason
… Price, in contrast, has actually drilled down, a sign of his seriousness about tackling the challenges of U.S. health care policy. Many of the Republican replacement plans take the form of statements of principle or white papers. Price’s plan, on the other hand, already exists in legislative form, as a 250-page bill known as the Empowering Patients First Act. The plan offers a level of detail that allows you to better imagine how it might work, and what sort of trade-offs it might entail.
… It would eliminate the health law’s essential health benefits rules—the list of mandates that require insurers to include a government-determined list of features, whether or not they’re wanted. This would free up insurers to offer a wider array of types of coverage, and could help make coverage cheaper for many people, especially those who are in relatively good health and don’t want or need comprehensive coverage. It would also allow for the purchase of health insurance across state lines to an even greater extent than already allowed under Obamacare.
Price’s plan offers two mechanisms for sicker individuals who might be sicker and more expensive to cover: a provision that does not allow insurers to charge more for health conditions so long as someone maintains continuous coverage, and $3 billion in funding, over a three year period, for high risk pools. …
…some real risks and worries… For one thing, it attempts to cut defensive medicine costs by offering legal protection to doctors who engage in best medical practices—which end up having to be determined by the federal government, or by some federally empowered board of medical providers. …
Price’s plan also relies on the creation of voluntary purchasing associations designed to give bulk purchasing power to small businesses and individuals—basically by allowing them to band together to act as large organizations that can get the discounted coverage and preferential treatment enjoyed by large corporations. But the voluntary association model has been tried in several big states already, including Texas, California, and North Carolina, and it didn’t work out. …
… As @brian_blase of @mercatus noted yesterday, new research indicates that about two thirds of Obamacare’s Medicaid enrollees were previously eligible—meaning they would have been able to get coverage without Obamacare, and would not be affected by repeal. …
… Sen. Lamar Alexander, who as Chair of the Senate Health, Education, Labor and Pensions Committee is likely to be a key player in any GOP replacement effort, recently said that it might take six years to draw up a replacement plan—not mentioning that Republicans have been promising to deliver a replacement plan for about that long already, but have failed to unify around a plan. …

Fox 17 News: The future of Obamacare under a Trump presidency (Video; 11/11/2016) | @FOXNashville @VUHealthPol
…@MelindaBBuntin…”…One potential model that would be followed is a bill that was passed last year in the house that would provide the Affordable Care Act to end in 2018 so there would be a couple of years for people to prepare.”…

How Trump Could Devastate Obamacare By Barely Lifting A Finger (11/19/2016) | @JeffYoung @HuffingtonPost
… “The law will enable a President Trump either to cut the cost-sharing payments off or to continue them if he’d like to. He’s got the discretion to keep them in place or to terminate them,” said @nicholas_bagley,‏@UMichLaw who has written extensively about the case, known as House vs. Burwell.
These subsidies are available to people earning between the federal poverty level and 250 percent of that amount, or a range of $11,880 to $29,700 a year for a single person.
During this year’s health insurance sign-up period, about 57 percent of enrollees, or approximately 7 million people, received this assistance. For the poorest beneficiaries ― those with incomes under $17,820 ― this means having no deductible instead of having to pay thousands upfront before benefits kick in. …
To avoid the near-term consequences of ending the cost-sharing payments, Trump could ask House Republicans to drop the lawsuit while they write new health care legislation or even to appropriate the dollars needed…
“It’s not clear why the Trump administration would make a political priority of enabling the House of Representatives to bring lawsuits against the executive branch,” Bagley said.

With Donald Trump’s election, Obamacare faces greatest threat yet (w Video; 11/9/2016) | @dchangmiami @MiamiHerald
… With millions of Americans expected to sign up for an ACA plan during open enrollment, which began Nov. 1 and runs through January, the logistics of repealing Obamacare are also complex.
“To sign up for an insurance policy and then have that taken away in January or February, logistically, would be quite curious,” Steven Ullmann @UMiamiBusiness said. “It’s unclear how that would occur and what it would mean to see the uninsured increase so quickly again with no access. That is something that would have to be addressed.”
The number of uninsured Floridians fell by 1.19 million from 2013, the year before the ACA exchange began, to 2015, according to a report from the U.S. Census Bureau. In South Florida, an estimated 487,000 people gained health insurance in that time.
In Miami-Dade, the uninsured rate in 2015 was 18.3 percent or about 488,000 — down from an estimated 600,000 who had no health insurance in prior years. …
Rouck, the Fitch Ratings analyst, said one possibility for an Obamacare replacement would be allowing insurers to sell health plans with fewer benefits than those required under the ACA, which mandates that all qualified plans must offer coverage for obstetrics, pediatric care and other services — even for single adults with no children. …

Will Obamacare health coverage continue under Trump’s presidency? (11/9/2016) | @lschencker @ChiTribBiz
…Laurel Harbridge Yong @WeinbergCollege…
…Timothy Jost @wlulaw…
…Scott Serota @BCBSAssociation…

HOW TO SURVIVE A TRUMP PRESIDENCY (11/9/2016) | @dorfonlaw @Newsweek
…@VolokhC…

Repeal and replace Obamacare: what could it mean? (11/30/2016) | @stuartmbutler @BrookingsInst
…on his first day in office. For instance, he could decide not to appeal the lower court ruling in House v Burwell. A federal district court has ruled that that money cannot be spent on cost-sharing subsidies because Congress has not appropriated the money. So dropping the appeal would mean the end of these payments. In similar vein, he might demand repayment from insurers of billions of dollars of transitional reinsurance payments, citing a recent General Accountability Office letter declaring that the Administration lacks the legal authority to reassign to health plans some funds…
During the campaign, Trump supported the familiar Republican themes of tax-free HSAs and allowing families to deduct health insurance premiums in their tax-returns. …
… Let’s recall that many leading Republicans have in the past proposed tax credits for the purchase of health insurance, including “refundable” credits that are within the same species as ACA subsidies. …Orrin Hatch…Tom Price…Paul Ryan…
… Under a Trump administration, many red states could reverse themselves and agree to the Medicaid expansion and, with the Trump White House’s blessing, combine the new Medicaid money with tax credits to finance subsidies to buy private insurance.
… Also on day one, Trump could give states a bright green light to use Section 1332 of the ACA. This provision permits states to apply for waivers to jettison core elements of the ACA, including the individual and employer mandates, exchanges, and components of the required benefit package, as long as financial protections for families stay in place. …
… In a proposal written 12 years ago, when the ACA was not yet a gleam in elected officials’ eyes, and the prospects for any health legislation were particularly bleak, my now-colleague Henry Aaron and I offered a somewhat similar proposal for radical state-led coverage expansion within a national framework…

Obamacare repeal could be biggest 2017 tax cut for wealthy (12/8/2016) | @Brian_Faler @POLITICOPro
Rescinding the Affordable Care Act… means scrapping two big tax increases Democrats imposed on the wealthy to help pay for it all.
Republicans are likely to ax those taxes on the earnings and investments of those making more than $250,000…
…@GroverNorquist @taxreformer…
For those in the top 0.1 percent of incomes, repealing the investment tax alone would mean $154,000 in annual savings…@TaxPolicyCenter
… Some Democrats argue the Republican plan amounts to a tax increase on low-income people, because Obamacare insurance subsidies take the form of refundable tax credits, though budget scorekeepers generally consider those to be spending provisions.
…@ChuckCBPP @CenterOnBudget…
Repealing Obamacare’s tax increases, which budget analysts put the neighborhood of $1 trillion, will also make Republicans’ tax-reform plans easier to finance.
… Killing the ACA’s investment tax, for example, will reduce the total capital gains tax to 20 percent, from the current 23.8 percent. …
… the so-called “baseline.” … If they project the government will take in less revenue in the future, thanks to ACA repeal, it means less money Republicans have to make up as part of tax reform.
Democrats financed the law with more than a dozen tax increases…
But two of the largest were aimed at the wealthy: A surcharge on capital gains as well as dividends and interest income, and a surtax on their earnings, both of which took effect in 2013. Rescinding those two provisions would cost $346 billion…

Controversial Obamacare lab in GOP’s crosshairs (11/17/2016) | @rking_19 @dcexaminer
… Chief among the complaints is a mandatory experiment to cut payments to doctors under Medicare Part B for drugs administered in doctors’ offices such as chemotherapy. The idea behind the project was to get doctors to prescribe drugs that have better value, rather than just prescribing more expensive drugs in order to get a higher reimbursement. …
…Bob Berenson ‏@urbaninstitute…
…voluntary experiment where doctors can get a 5 percent boost to Medicare payments if they participate in comprehensive primary care plus.
The model would phase in a quality-of-care payment model for doctors, tying Medicare payments to certain quality measures including adopting electronic health records and 24/7 patient access.

Why Obamacare enrollees voted for Trump: In Whitley County, Kentucky, the uninsured rate declined 60 percent under Obamacare. So why did 82 percent of voters there support Donald Trump? (12/13/2016) | @sarahkliff @voxdotcom
…one of the more divisive pieces of the law — Medicaid expansion — might become even more robust, offering more of the working poor a chance at the same coverage the very poor receive.
… Narrow networks have become a problem in the area too. When Oller hosted an enrollment event at a hospital, she had to warn the enrollees that they couldn’t use their insurance at that particular facility.
… Medicaid is reserved for people who earn less than 138 percent of the poverty line — about $22,000 for a couple like the Atkinses. …
Obamacare currently limits how much insurers can charge older patients… insurance companies can only charge its oldest patients three times as much as the youngest ones. But the Price plan would get rid of that requirement and let insurers charge older patients… whatever they want.