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ashoup
In News, Roundup

Roundup: Trump Justice Department Argues that Protections for Pre-existing Conditions are Unconstitutional

Tonight, the Trump Administration went to court to take away protections away from 52 million Americans with pre-existing conditions, and raise costs for millions more.

Headlines are emphasizing just how significant this decision is:

Washington Post: Trump Administration Won’t Defend ACA In Case Brought By GOP States. [6/7/18]

Vox: The Trump Administration Believes Obamacare’s Preexisting Conditions Protections Are Now Unconstitutional. [6/7/18]

CNN: Trump Administration Tells Court It Won’t Defend Key Provisions Of The Affordable Care Act. [6/7/18]

Axios: Trump’s Justice Department Says The ACA Is Unconstitutional. [6/7/18]

Politico: Trump Administration Backs Court Case To Overturn Obamacare Provisions. [6/7/18]

Talking Points Memo: Trump’s Justice Department Refuses To Defend Obamacare In Court. [6/7/18]

The Hill: Justice Dept. Argues Key Parts Of ObamaCare Are Unconstitutional. [6/7/18]

Washington Examiner: Trump Administration Tells Court It Won’t Defend Obamacare Against Lawsuit Seeking To Cripple It. [6/7/18]

Reuters: U.S. Justice Department Says Obamacare Individual Mandate Unconstitutional. [6/7/18]

And experts underscore just how dangerous it will be:

Larry Levitt, Vice President For Health Policy At Kaiser Family Foundation: “The Justice Department’s brief creates another cloud of uncertainty for insurers, just as they’re filing proposed ACA rates for 2019. When insurance companies face uncertainty, they increase premiums.” “The Trump administration is arguing in court that the ACA’s protections for people with pre-existing conditions should be thrown out. The Justice Department’s brief creates another cloud of uncertainty for insurers, just as they’re filing proposed ACA rates for 2019. When insurance companies face uncertainty, they increase premiums…27% of non-elderly adults have pre-existing conditions. Arguing in court that protections for them should be eliminated, as the Trump administration is now doing, could provoke a backlash in an election year.” [Larry Levitt, 6/7/18]

Andy Slavitt, Former Director Of Centers For Medicare And Medicaid Services: “The Biggest Health Care News of the Year.” “BREAKING: The biggest health care news of the year. The Trump DOJ tonight just told the courts to dismantle pre-existing conditions protections and other consumer protections. This may seem predictable, but these actions are unprecedented.” [Andy Slavitt, 6/7/18]

Nicholas Bagley, Health Law Professor at University of Michigan: “I’m at a loss for words to explain how big of a deal this is.” “This is an enormous blow to the integrity of DOJ…I am at a loss for words to explain how big of a deal this is. The Justice Department has a durable, longstanding, bipartisan commitment to defending the law when non-frivolous arguments can be made in its defense. This brief torches that commitment.” [Nicholas Bagley, 6/7/18]

Sam Berger, Senior Advisor At Center For American Progress: DOJ Wants To Take Health Care Away From Those With Pre-Existing Conditions. “For those who don’t have time to read the DOJ brief, a quick summary of the argument: ‘We want to take away health care from people with pre-existing conditions and are willing to make patently absurd legal arguments to do so.’ DOJ’s argument was so inconsistent with the law, that career lawyers actually asked the court to remove them from the case, so that they would not have to be associated with it. That almost never happens, and tells you how terrible DOJ’s legal argument is.” [Sam Berger, 6/7/18]

Topher Spiro, Vice President For Health Policy At Center For American Progress: “This Is A Political Attack On The ACA And People With Pre-Existing Conditions.” “Three respected career DOJ attorneys withdrew from the case in protest just before this brief was filed. That tells you how politicized this is. This is a political attack on the ACA and people with pre-existing conditions.” [Topher Spiro, 6/7/18]

Andy Slavitt, Former Director Of Centers For Medicare And Medicaid Services: “Collusion Between Conservative Plaintiffs And The ‘Defense’ Would Make Pre-Existing Protections And Age Rating Protections Unconstitutional.” “The DOJ, responsible for upholding the rule of law, is not defending the people in a frivolous lawsuit to say that without the mandate, the rest of the ACA can’t be enforced. This collusion between the conservative plaintiffs and the “defense” would make pre-ex protections and age rating protections unconstitutional. In an active of savage cynicism, the Trump Administration doesn’t want this to go into effect until after the election.” [Andy Slavitt, 6/7/18]

Sam Baker, Health Reporter At Axios: “Sick People Would Just Be Out.” “If DOJ gets its way here, insurers would be free to deny people coverage based on pre-existing conditions. Forget complicated market interactions — sick people would just be out.” [Sam Baker, 6/7/18]

Matthew Yglesias, Co-founder Of Vox: “Good Reminder Of The Real Stakes In The Midterms.” “Good reminder of the real stakes in the midterms; if Republicans do well, they will try as hard as they can to take people’s health care away.” [Matthew Yglesias, 6/7/18]

ashoup
In News, Stories, Roundup

Editorial Roundup: Across the Country, Standing Up to Health Care Sabotage

Across the country, editorial boards are speaking out against Republicans’ repeal-and-sabotage war on health care as rising costs and higher uninsurance rates take a toll on American communities:

San Antonio Express-News: Health Care Numbers Moving In The Wrong Direction. [5/27/18]

Los Angeles Times: CA Should Fight The Good Fight Against Bad Health Insurance Policies. [5/25/18]

Boston Globe: Repeal Failed, But The GOP’s ACA Attack Continues. [5/12/18]

Charlotte Observer: Get ready for Obamacare Sticker Shock. [5/9/18]

Valley News: Health-Care Sabotage Begins to Kick In. [5/7/18]

Washington Post: Americans Are Starting To Suffer From Trump’s Health Care Sabotage. [5/6/18]

Florida Times-Union: Obamacare has become Trumpcare. [4/12/18]

Des Moines Register: Elected officials undermine Iowans’ health insurance. [4/3/18]

Minneapolis Star Tribune: Sabotaging the Affordable Care Act will lead to pricier insurance. [3/27/18]

Portland Press Herald: Republicans responsible for looming chaos in health care marketplaces. [3/22/18]

Star-Ledger: State Lawmakers Must Rescue Obamacare. [3/11/18]

St. Louis Post-Dispatch: In Iron County, the rural health care catastrophe comes home. [3/8/18]

New York Times: Trump Tries to Kill Obamacare By A Thousand Cuts. [2/21/18]

Los Angeles Times: The Trump administration wants to cut premiums for the healthy at the expense of the sick. Again. [2/21/18]

ashoup
In News, Stories, Roundup

Research Roundup: Studies Show Better Health Care Outcomes, Stronger Household Finances Thanks to Affordable Care Act & Medicaid Expansion

Six new studies highlight the positive impact of the Affordable Care Act is having on health care in America. Three outcomes-focused studies show clear improvements in care for gynecological cancer, head and neck cancer, and serious psychological distress, while two Medicaid Expansion studies find that expanded coverage leads to lower out-of-pocket costs and stabler household finances. Meanwhile, health care reform has entirely closed the demographic coverage gap between Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) and white Americans.

This new research joins a growing body of work that leads to a simple conclusion: the Affordable Care Act provides measurable benefits for Americans’ health and financial well-being. Here’s a look at the six studies:

Effects of the Affordable Care Act on Young Women With Gynecologic Cancers [Obstetrics & Gynecology, 5/7/18]

This study finds that the ACA’s expansion of access of coverage allowed more young women to catch gynecologic cancer early, improving the likelihood of successful treatment.

  • The study examined nearly 4,000 cases of gynecologic cancer among 21-26-year-old-women and more than 20,000 cases among 27-35-year-old women, comparing those which came about before the ACA and those after its implementation, finding that those with access were more likely to be treated.
  • The study found that prior to the ACA just one in three women between the ages of 19 and 26 were insured, but after its implementation, more than nearly four in five women were covered, helping to account for the diagnoses.
  • The report concluded that, “Young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.”
  • “This study adds to the evidence of the positive effects of improved coverage through the ACA on young women’s healthcare costs and choices,” noted Dr. Laura Havrilesky, a gynecologist at the Duke University Medical Center, in an editorial published in accordance with the findings.

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act [Administration and Policy in Mental Health and Mental Health Services Research, 5/12/18]

This study examined mental health outcomes in accordance with the Affordable Care Act, concluding that the ACA has led to better coverage outcomes and increased affordability for non-elderly adults with serious psychological distress (SPD).

  • Examining non-elderly adults with SPD from 2014-2016, the study’s authors found that these adults saw increased coverage and a reduction in the delaying or foregoing of necessary care due to the ACA, and that the law “reduced the odds of an individual with SPD not being able to afford mental health care.”
  • As the study’s authors note, “Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014–2016,” something almost certainly attributable, at least in part, to the ACA

ACA Decreased Non-Insurance Rates Among Patients With Head and Neck Cancer [American Head & Neck Society, 4/19/18]

Another new study finds that in states that expanded Medicaid, patients with head and neck cancer had better health care access.

  • The study analyzed more than 89,000 patients, finding higher coverage rates among both Medicaid enrollees and private insurance, as well as an uninsured rate among diagnoses which decreased nearly 50% after January 2014, in states which expanded Medicaid.
  • The study found that those lacking coverage had an overall survival rate of just 49% compared to 63% among those insured, as well as a a 5-year disease-specific survival rate of just 57% compared to 72% among those insured.

The Effect of the Affordable Care Act Medicaid Expansions on Financial Wellbeing [Journal of Public Economics, 5/7/18]

Another study compiled by employees of the Federal Reserve Bank of Chicago and the University of Illinois, University of Michigan, and Northwestern University found that low-income residents saw better financial outcomes in states which expanded Medicaid.

  • Using credit reporting agency data, the researchers compared the financial outcomes among low-income adults in states which expanded Medicaid and those which did not, determining that Medicaid expansion “significantly reduced d the number of unpaid bills and the amount of debt sent to third-party collection agencies among those residing in zip codes with the highest share of low-income, uninsured individuals.”
  • The study found that Medicaid expansion lowered unpaid balances in collections “by between $65 and $88,” while Medicaid enrollees saw their amount of unpaid balances in collections decrease “by approximately $1,140.”
  • As the authors note: “Our findings suggest that the ACA Medicaid expansions had important financial impacts beyond increasing health care use.”

The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures [Medical Care Research and Review, 5/10/18]

A new analysis from the University of Michigan’s Institute for Social Research finds that Medicaid expansion lowered out-of-pocket medical expenses.

  • The study, conducted by Joelle Abramowitz of the Institute of Social Research, analyzed data from the Current Population Survey Annual Social and Economic Supplement between 2011-2016, finding that those in states which expanded Medicaid saw their medical spending decreases, due to fewer premiums and reduced out-of-pocket medical expenses.
  • The study’s findings “suggest that the expansions were associated with a relatively larger likelihood of having zero premium expenditures and of having zero nonpremium medical out-of-pocket expenditures for low-income individuals,” as well as suggest “that the expansions were effective in reducing medical out-of-pocket expenditures.”

Health Insurance for Asian Americans, Native Hawaiians, and Pacific Islanders Under the Affordable Care Act [JAMA Internal Medicine, 4/30/18]

Researchers from the Harvard T.H. Chan School of Public Health analyzed the impact of the Affordable Care Act on coverage among Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), finding that the ACA closed the uninsured rate gap between AANHPIs and white Americans.

  • Using data from the American Community Survey, the researchers examined the uninsured rate among AANHPIs prior to the ACA and after its implementation, the first study of its kind, finding that unlike other minority groups which saw a decrease in the coverage gap between themselves and white Americans, the coverage gap among AANHPIS was eliminated.
  • Overall, the uninsured rate among AANHPIs dropped 7.3% following the ACA. Among the subgroups of AANHPIs, all saw significant drops: 14.3% among Guamanian or Chamorro, 6.5% among Samoan, and 4.9% among Native Hawaiians, as well as 5.9% among other AANHPIs.
  • “The notable gains in health insurance coverage for AANHPI groups represent valued progress toward health equity,” said senior author Howard Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard Chan School and Harvard Kennedy School.
ashoup
In Roundup, News

COVERAGE ROUNDUP: A Year Later, Americans Remember House Republican Vote to Repeal Our Health Care

Associated Press: A Year After ‘Obamacare’ Vote, Democrats See Election Cudgel. “The Democratic charge on health care represents a turnaround from recent elections… [and] the failed GOP repeal effort helped turn the tables. A Wall Street Journal-NBC News poll last month showed people trust Democrats over Republicans for handling health care by 18 percentage points. A Kaiser Health Tracking Poll in February showed Obama’s law with a favorable rating from 54 percent of Americans, its highest score in more than 80 Kaiser surveys since the statute’s enactment. Marking the vote’s anniversary, progressive groups planned more than a dozen rallies Friday from California to Virginia. The liberal Save My Care was airing a 30-second television ad in Washington, D.C., showing top Republicans celebrating the House vote with Trump in the White House Rose Garden. ‘We won’t forget’ appears on a black screen after newscasters intone the bill’s impact, including letting insurers charge higher prices for people with pre-existing medical conditions.” [AP, 5/4]

Bakersfield Californian: A Year Later, Congress’ Attack On Healthcare Consumers Continues. “One year ago, May 4, 2017, is a day that should live in infamy for 14 California Representatives, including Bakersfield’s congressman Kevin McCarthy, who led the effort to shred healthcare protections for their constituents. While key parts of the Affordable Care Act, Medicaid, and other federal programs ultimately survived, it was only by a margin of a single vote in the U.S. Senate. We should never forget that these irresponsible Representatives voted for the so-called American Health Care Act and against their own constituents and that they continue attempts to undermine our health system… On this anniversary, Californians cannot forget the decisions made by their Congressmembers, or the continued attempts and administrative attacks on our health care. We must not just remember the past, but work to protect our health care into the future.” [Bakersfield Californian, 5/2]

Washington Examiner: Obamacare Allies Attack Gop To Mark Anniversary Of House Repeal Vote. “Obamacare advocacy groups and allies are trying to remind voters ahead of the November midterm elections about the one-year anniversary of the House’s passage of Obamacare repeal. Groups are planning ads, rallies, and other outreach efforts on Thursday and Friday centered around the May 4 anniversary of the House vote… Protect Our Care is holding a series of 18 to 20 events across 13 states Thursday and Friday…  The actions come as Democrats and Obamacare allies hope to hammer Republicans for their attempts to repeal Obamacare in the midterms. Protect Our Care Campaign Director Brad Woodhouse said that exit polls in several special elections that Democrats won showed healthcare as a top issue.” [Washington Examiner, 5/3]

Athens Messenger: Reflections On The American Health Care Act. “One year ago, on May 4, 2017, the House of Representatives passed the so-called ‘American Health Care Act,’ or AHCA. The health care repeal bill would have cut coverage, increased costs, and eliminated protections for tens of thousands of Ohioans. The bill also would have imposed an ‘age tax,’ letting insurers charge people over 50 times more for coverage, and put the health of one in five Americans on Medicaid — including seniors, children and people with disabilities — in jeopardy… As we remember the devastation that we narrowly escaped thanks to the Senate striking down the House’s AHCA, we must recommit ourselves to fighting for our health care, holding our representatives in Congress accountable, and, come November, voting out of office those who put partisan politics and big donors before us, their constituents.” [Athens Messenger, 5/4]

Huffington Post: For The First Time In An Election Cycle Since Obamacare’s Passage, A Majority Of The Public Now Approves Of The Health Care Law. “One year ago, President Donald Trump and House Republicans gathered in the Rose Garden for a victory ceremony. Speaker Paul Ryan (R-Wis.) had just shepherded through a bill repealing major parts of the Affordable Care Act, moving them a step closer to their promise of undoing President Barack Obama’s signature legislative achievement. ‘We don’t have to talk about this unbelievable victory — wasn’t it unbelievable? So we don’t have to say it again. But it’s going to be an unbelievable victory, actually, when we get it through the Senate,’ Trump boasted, standing in front of beaming House members… ‘We see health care as the defining issue of the 2018 midterms,’ said David Bergstein, spokesman for the Democratic Senatorial Campaign Committee. ‘The Republican health care agenda is incredibly toxic with voters of every political persuasion.’ For the first time in an election cycle since Obamacare’s passage, a majority of the public now approves of the health care law. Democrats now have a sizable advantage over the GOP on the issue, and candidates frequently bring up their support for Obamacare while meeting with voters.” [Huffington Post, 5/4]

Des Moines Register: A Year Later, Republicans’ American Health Care Act Is A Nightmare For Small Businesses. “One year ago this week, a majority of the House of Representatives, including representatives Rod Blum, David Young and Steve King, voted for and passed the so-called ‘American Health Care Act,’ or AHCA, an ACA repeal bill that would have cut coverage, increased costs and eliminated protections for more than 100,000 Iowans. They proved that they are willing to play political games with Iowa’s health care, including thousands of small businesses, farmers, entrepreneurs and the self-employed in their very own districts.” [Des Moines Register, 5/4]

The Hill: Say It With Me: Democrats Are The Party Of Health Care. “From looking at the polling, special election outcomes and national sentiment, the answer should be clear to all of us: Democrats are the party of health care… There has been a sea change for ObamaCare in America. Today, the law is favored by 49 percent of Americans and opposed by 41 percent in the Real Clear Politics average. According to Gallup, 56 percent now believe health care is the government’s responsibility, while only 42 percent think it’s not. A Washington Post-Kaiser Family Foundation poll even found that 51 percent support single-payer coverage, while 43 percent oppose it… This sentiment takes on special importance because Friday is the one-year anniversary of the Republicans voting to repeal ObamaCare. So when they say ‘MAGA!’ to you, simply reply ‘Health care!’ to them.” [The Hill, 5/3]

East Central Minnesota Sun This Week: “I Will Be Forever Grateful That The Senate Failed To Pass A Bill.” “May 4 is the one-year anniversary of the day the Republican majority in the House of Representatives, including Rep. Jason Lewis, voted to repeal the Affordable Care Act. If this bill would have passed Congress, people we know would have lost their coverage through the repeal of the Medicaid expansion. Many people, especially seniors, would have been faced with the uncertainty of premium increases. I will be forever grateful that the Senate failed to pass a bill later in the summer.” [Sun This Week, 5/3]

New York Times: On Anniversary Of House Obamacare Repeal, Democrats Look To Extract A Price. “All told, the House bill would have increased the number of people without health insurance by 14 million this year and by 23 million in 2026, the Congressional Budget Office estimated… Beyond the House repeal bill, Democrats have also developed a broader argument that Republicans have inflicted damage on health insurance markets, partly because of actions taken by the Trump administration to undermine the Affordable Care Act. Just this week, they gained an assist from an unlikely figure: Tom Price, Mr. Trump’s former secretary of health and human services, who said that ending the requirement that most people have coverage, known as the individual mandate, would increase costs for people buying insurance. Helping the Democrats, polls have shown that the Affordable Care Act has gained in popularity since the 2016 elections. In an NBC News/Wall Street Journal poll conducted last month, Democrats had an 18-percentage-point edge when people were asked which party they thought would do a better job dealing with health care.” [NYT, 5/2]

Albany Times Union: Ad Campaign Targets Faso, Stefanik & Tenney. “On the anniversary of Congress’ passage of the American Health Care Act, which would have repealed key parts of the Affordable Care Act, the labor union 1199SEIU is launching a radio and print ad campaign to remind local voters of that three New York representatives who supported that version of the bill. The union, in a statement, said that the goal of the campaign is to remind voters of that efforts to sabotage healthcare and Medicaid are still ‘a very real threat.’” [Times Union, 5/4]

USA Today: Democratic Candidates Running On Health Care After GOP Attempts To Repeal Obamacare. “Friday marks the year anniversary of House Republicans’ vote to repeal and replace the Affordable Care Act.  It was the first vote of a months-long effort from congressional Republicans to get rid of the law. It ultimately failed in the Senate, but it left many Republicans on record voting to remove millions of Americans from the rolls of the insured — and Democrats are hammering them for it. After years of playing defense on health care, Democratic candidates have made it a top issue this election cycle. They are pledging to fix the flaws in Obamacare while targeting Republican attempts to “sabotage” it and take coverage away. And grassroots organizations that protested Republican efforts are keeping up the pressure with events planned around the anniversary. ‘This is going to be a continuing conversation throughout the election,’ said Sen. Chris Van Hollen, of Maryland, chairman of the Democratic Senatorial Campaign Committee. ‘I’m seeing this as an issue in every state.’” [USA Today, 5/2]

New Jersey Globe: New Kim Video Hits MacArthur On Health Care Vote. “Democratic congressional candidate Andy Kim is using the one-year anniversary of Rep. Tom MacArthur’s move to repeal Obamacare to launch a new web video ad that slams the GOP congressman for introducing legislation ‘that tried to take away health care for millions of Americans.’ In ‘Holding MacArthur Accountable,’ Kim points to the birth of his son as the moment he decided to run. ‘Last year, the doctor told me and my wife that our baby boy might not be able to make it. We had to prepare ourselves for the fact that he might have a problem that would affect him for the rest of his life,’ Kim says in the ad. ‘I remember turning to my wife and telling her that if our family gets through this, if our baby is born healthy, that I will do whatever I humanely can to hold Tom MacArthur accountable for what he did. That’s why I’m running for Congress.’” [New Jersey Globe, 5/4]

Roll Call: Liberal Groups Release Polls Showing Health Care Could Hurt GOP Incumbents. “A sizable percentage of voters surveyed said they were less likely to support Republican incumbents who voted for the GOP health care bill. More voters surveyed in the districts also approved of the health care law than disapproved. ‘It has been one year since House Republicans proudly voted for health care repeal, and it is clear that their constituents have neither forgotten nor forgiven them,’ Tim Hogan, a spokesman for Health Care Voter, said in a statement.” [Roll Call, 5/4]

ashoup
In News, Roundup

Research Roundup: Studies Confirm That ACA, Medicaid Improve Health Care Access and Outcomes, Boost Local Economies

Over the past month, five studies looking at the impact of the Affordable Care Act have been released: three analyzing Medicaid expansion, and two analyzing marketplace coverage. These studies covered a broad scope of health care-related outcomes, from treatment for chronic conditions to jobs created in a local economy, and each came to the same conclusion: the ACA is providing clear benefits for Americans.

Here’s a look at what these five studies found:

Louisiana Department of Health: Medicaid Expansion and the Louisiana Economy

A report released in April by the Louisiana Department of Health analyzed Louisiana’s Medicaid expansion, finding that expansion not only boosted the state’s economy but also save the state money, leaving Gov. John Bel Edwards to conclude, “It is costing us less to have more people insured.” Among its key takeaways:

  • The state saw a $1.85 billion economic impact due to Medicaid expansion, with Louisianans seeing $1.12 billion in personal earnings and local tax receipts totaling $746 million, with the economic impact “spread throughout the state.”
  • Louisiana saw 19,000 new jobs created under Medicaid expansion, making clear that “such healthcare can also positive affect the labor participation rate.”
  • Over 545,000 Louisianans have benefited under Medicaid expansion, including more than 180,000 Louisianans who visited a doctor and received new preventive services, more than 35,000 Louisianans who received breast cancer screenings, and more than 48,000 Louisianans who received mental health services.
  • Medicaid expansion saved the state $317 million, leading Gov. John Bel Edwards to note, “It was the easiest big decision I’ll ever make as governor.”
  • As the study’s authors concluded, the economic impact will continue “as long as the state maintains the program and as long as no major changes are instituted by the federal government, either through acts of the U.S. Congress or regulatory decisions made by the Center for Medicare & Medicaid Services.”

University of Montana Bureau of Business and Economic Research: Medicaid Expansion Has Boosted State’s Economy, Added Jobs, Improved Health Care

A March study from the University of Montana Bureau of Business and Economic Research examined the effects of Montana’s Medicaid expansion, and found that it has not only provided insurance to more than 94,000 Montanans, but had a major impact on the state’s economy. Among its key takeaways:

  • Montana’s Medicaid expansion was responsible for creating 5,000 new jobs,  in the health care, retail, construction and hospitality industries, and $280 million of personal income.
  • Labor-force participation has increased six points, from 58 to 64 percent, among those eligible for Medicaid expansion, Montanans aged 18-64 and earning up to 138 percent of the federal poverty level .
  • Medicaid expansion has saved $40 million in Medicaid benefits, in addition to providing $902 million worth of health care services. “The savings are enough to pay for the costs,” said Bryce Ward of the BBER.
  • Medicaid expansion accounts for an estimated $564 million per year on health care spending, with nearly 70% of this being “new money,” or an economic boost spurred only by expansion.
  • As Sheila Hogan, director of the state’s Department of Health and Human Services said, “Medicaid expansion is doing what it’s supposed to do, help Montanans live healthier lives and save the state money.”

America’s Health Insurance Plans: The Value of Medicaid: Providing Access to Care and Preventive Health Services

An April study from America’s Health Insurance Plans (AHIP) compared data from Americans covered by Medicaid, private insurance, and not covered, analyzing the access to care received under each, finding that Medicaid tremendously improves access to care. Among its key takeaways:

  • Adults (five-times as likely) and children (four-times) were significantly more likely to have access to “a usual source of care” than those without insurance.
  • Adults (four-times as likely) and children (two-to-three times) were significantly more likely to obtain preventative care than those without insurance.
  • Those enrolled in Medicaid had access to care at levels comparable to private coverage, and far better access to care than those without insurance.
  • As the authors concluded, “The findings from this study refute outdated, less rigorous studies that question the value of Medicaid, and add to the growing number of recent studies that demonstrate the value of having insurance coverage generally, and Medicaid more specifically.”

Health Affairs: Effects Of The ACA’s Health Insurance Marketplaces On The Previously Uninsured: A Quasi-Experimental Analysis

An April study published in Health Affairs, led by Harvard Medical School clinical fellow Anna Lise Goldman, MD, compared adults who had gone through periods without insurance to those with continuous coverage. It found that the ACA improved health care outcomes, especially among low-income adults. Among its key takeaways:

  • The introduction of the ACA saw the uninsured rate decrease by 11 percentage points and the number of of individuals unable to access necessary care fall by two points, as well as more outpatient visits, more prescriptions being filled, and a higher probability of a hospital stay.
  • Lower-income individuals, those with incomes of between 138 and 250 percent of the federal poverty level, saw even larger increases in the number of outpatient visits and prescriptions being filled.
  • As the study’s authors concluded, “The ACA led to a significant decline in the uninsurance rate, decreased barriers to medical care, increased the use of outpatient services and prescription drugs, and increased diagnosis of hypertension, compared to a control group with stable employer-sponsored insurance.”

Health Affairs: The Affordable Care Act’s Marketplaces Expanded Insurance Coverage For Adults With Chronic Health Conditions

An April study published in Health Affairs examined the role the ACA marketplace had on non-elderly adults with chronic conditions, finding that those far more Americans with chronic conditions obtained coverage through the marketplace. Among its key takeaways:

  • During the time period analyzed, 45% of marketplace enrollees aged 18-64 were treated for chronic conditions, compared to just 35% of those not enrolled in marketplace coverage and 38% of adults with employer insurance.
  • Those enrolled in marketplace coverage obtained more service use than those without it, underscoring the long-term benefits of the ACA.
ashoup
In News, Roundup

REACTION ROUNDUP: Health Care Proves Political Asset for Democrats in PA-18

DEMOCRATIC CANDIDATES REACT

Allison Stephens, D-Candidate for NV04: “In #PA18, 53% of dem voters & 63% of independent voters were opposed to #ACA repeal. One thing is clear: healthcare will be a deciding issue in 2018. The GOP must abandon repeal. We need access to quality, affordable healthcare in #NV04. #ProtectOurCare” [Allison Stephens, 3/14/18]

Christina Hartman, D-Candidate for PA10: “My opponent @RepScottPerry is a member of the House @freedomcaucus that pushed to gut protections for those with preexisting conditions. #PA10 voters will remember in November. #PA18 @ProtectOurCare #TrumpCare” [Christina Hartman, 3/14/18]

Pat Ryan, D-Candidate for NY19: “Must continue to remind voters in #NY19 that @RepJohnFaso (and fellow Rs) voted to rip healthcare away from our community. Protecting healthcare for working families key to @ConorLambPA victory in #PA18; cc @1199UpstateNY #ProtectOurCare” [Pat Ryan, 3/14/18]

Eddie Sundquist, D-Candidate for NY23: “ The voters of #PA18 proved that we will not stand idly by when Republicans like @RepTomReed vote to take away healthcare from 68,000 #NY23 constituents. A diagnosis should not be a death sentence or mean financial ruin.” [Eddie Sundquist, 3/14/18]

TOP INFLUENCERS: THIS IS BIG

Andy Slavitt, top Obama Administration health official: “BREAKING: Even with #PA18 officially too close to call, health care voters carried the day. 52% of voters ranked health care as a top issue. By 64-36, those voters favored @ConorLambPA.” [Andy Slavitt, 3/14/18]

Tom Perez: “That’s when we do well. That’s how Doug Jones won. He was talking about kitchen table issues, he was talking about healthcare. Conor Lamb was talking about health care… that’s how we’re winning elections by talking about those shared issues. That’s what Conor was fighting for. He was fighting for access to health care — the number one issue for voters in district 18, as it was across the country was health care. And they understand that Democrats believe health care should be a right for all and not a privilege for many.” [MSNBC, 3/14/18]

Mario Molina, former CEO of Molina Healthcare: “Reassuring to hear @ConorLambPA talk about the importance and support of critical health and safety net programs. “They are America’s way of saying, ‘We are all in this together.'” [Mario Molina, 3/14/18]

Steven Dennis, Bloomberg reporter: “ACA opposition *used* to be solid gold for GOP Conor Lamb took mend it, don’t end it position; PPP (D) poll found ACA at 44/42 approval in #PA18” [Steven Dennis, 3/14/18]

DNC: Voters Reject Trump-Republican Agenda. “Health care was a top issue in last night’s election and Conor Lamb won those voters by a wide margin, making it clear voters reject Republican policies that have already left millions more Americans without health insurance and sent premiums skyrocketing.” [DNC to press list, 3/14/18]

Topher Spiro, Vice President for health policy at Center for American Progress: “BOOM. This is it. Any vulnerable Republican who voted to repeal health care is toast.” [Topher Spiro, 3/14/18]

Jonathan Cohn, Senior National Correspondent at Huffington Post: “Maybe trying to take health insurance from millions of people is a political loser.” [Jonathan Cohn, 3/14/18]

HOW IT PLAYED IN THE HEADLINES

The Week: GOP efforts to kill ObamaCare might have tipped the scales for Conor Lamb in Pennsylvania’s special election [3/14/18]

ThinkProgress: Pennsylvania voters say the GOP’s health care antics cost Saccone their vote [3/14/18]

Daily Intelligencer: 5 Lessons From the Pennsylvania Special Election [3/14/18]

MarketWatch: Pennsylvania Democrat Lamb had upper hand with voters on health care, poll finds [3/14/18]

Vox: Conor Lamb decisively won the health care vote in the Pennsylvania special election [3/14/18]

ashoup
In Roundup, News

REACTION ROUNDUP: Despite “Wildly Illegal” Affordable Care Act End-Run, Trump Administration Urges Idaho to Continue Sabotage

Yesterday, the Trump Administration confirmed that Idaho’s Affordable Care Act end-run is wildly illegal. Even so, CMS encouraged Idaho to explore other ways to sabotage the law.

Here’s a roundup of reactions to the Trump Administration’s continuing bad faith on protecting Idahoans’ health care:

Idaho Statesman: “With Some Modifications, The Noncompliant Plans Could Be Turned Into Short-term Plans For Customers.”

“Verma said her agency was sympathetic to Idaho officials’ concerns, and said President Trump is ‘committed to doing everything in his power to increase competition, choice, and access to lower-priced, high-quality health care options for all Americans.’ ‘As you know, the Patient Protection and Affordable Care Act (PPACA) is failing to deliver quality health care options to the American people and has damaged health insurance markets across the nation, including Idaho’s,’ Verma wrote, noting that premium rates for coverage through the Idaho health insurance exchange have increased by more than 91 percent from 2014 to 2018, while insurance companies continue to incur losses. Verma also outlined some options that she believes Idaho could legally take under a recently proposed federal rule. That rule would expand the availability of short-term, limited duration health insurance by allowing consumers to buy short-term plans that would cover them for just under a year. She said that with some modifications, the noncompliant plans could be turned into short-term plans for customers.” [Idaho Statesman, 3/8/18]

Sen. Ron Wyden: “While They Claim To Be Upholding The Law, They Are Explicitly Inviting Idaho And Other States To Sell Short-term, Junk Insurance — The Exact Opposite Of The Protections Put In Place By The Affordable Care Act.”

“ObamaCare supporters were pleased but not overly impressed by the CMS move. ‘The Trump administration is talking out of both sides of their mouth,’ said Sen. Ron Wyden (D-Ore.). ‘While they claim to be upholding the law, they are explicitly inviting Idaho and other states to sell short-term, junk insurance — the exact opposite of the protections put in place by the Affordable Care Act.’” [The Week, 3/8/18]

New York Times: “Verma Said That Idaho Had Other Options And Could Perhaps Achieve Much Of What It Wanted To Do Under A Regulation Proposed Last Month By Mr. Trump.”

“While rejecting the Idaho plan in its current form, Ms. Verma encouraged the state to keep trying, and she suggested that ‘with certain modifications,’ its proposal might be acceptable… Ms. Verma said that Idaho had other options and could perhaps achieve much of what it wanted to do under a regulation proposed last month by Mr. Trump.” [New York Times, 3/8/18]

Washington Post: “‘We Sincerely Appreciate Your Dedication To The People Of Idaho And Your Efforts To Address The Damage Caused By The [ACA],” Said The Letter.”

“The four-page letter to Idaho Gov. C. L. “Butch” Otter (R) and Cameron, made public early Thursday evening, straddles the Trump administration’s antipathy for the ACA with its need to enforce the sprawling 2010 health-care law that is a path to insurance coverage for millions of Americans. ‘We sincerely appreciate your dedication to the people of Idaho and your efforts to address the damage caused by the [ACA],” said the letter, signed by CMS Administrator Seema Verma. The letter said the president is eager to give states ‘as much flexibility as possible under the law to address the unique needs of their health insurance markets.’” [Washington Post, 3/8/18]

Rep Frank Pallone: “The Administration Continues Its Many Efforts To Undermine The Law And Chip Away At Its Protections, Including By Encouraging Idaho To Sell Junk Plans In Another Way.”

“Democrats cheered the Trump administration’s decision, but they still criticized other actions HHS has taken in recent months to weaken the law. ‘Make no mistake, however, while this is the right decision, the Administration continues its many efforts to undermine the law and chip away at its protections, including by encouraging Idaho to sell junk plans in another way,’ said Rep. Frank Pallone of New Jersey, the top Democrat on the House Energy and Commerce Committee.” [Politico, 3/8/18]

Talking Points Memo: “Verma Notes In The Letter That Enforcing The ACA Is ‘Certainly Not Our Preference.”

“Verma notes in the letter that enforcing the ACA is “certainly not our preference,” and encourages Idaho to find ways within the letter of the law to accomplish the same goals. She specifically advises the state to look into creating short-term health insurance plans—which recently received the Trump administration’s blessing to be sold in violation of the ACA’s regulations. [TPM, 3/8/18]

Bloomberg: “The White House Has Suggested To Congress That People Should Be Able To Renew Short-term Plans Without Being Subject To Medical Underwriting, The Process By Which Insurers Can Exclude Or Charge More For Pre-Existing Conditions.”

“Idaho’s proposal has put the Trump administration in a position it has found itself in before: charged with upholding a law it wants to get rid of, and that it has taken active steps to dismantle. Verma left open the possibility that plans like the state was proposing could be sold in a different form. If they were offered as short-term policies instead of annual coverage, they might be allowable, she said. The administration has pushed short-term plans as a way to offer consumers less expensive, less comprehensive options. In her letter to Idaho authorities, Verma said that ‘with certain modifications, these state-based plans could be legally offered’ as short-term plans. The White House has suggested to Congress that people should be able to renew short-term plans without being subject to medical underwriting, the process by which insurers can exclude or charge more for pre-existing conditions.” [Bloomberg, 3/8/18]

CNN: “Verma [Said] That She Wanted To Work With Idaho And Other States To Repair The ‘Damage’ Caused By The Affordable Care Act.”

“However, Verma did say that she wanted to work with Idaho and other states to repair the ‘damage’ caused by the Affordable Care Act. She suggested that Idaho could legally implement many of its proposals through short-term health insurance plans, which don’t have to adhere to all of Obamacare’s rules. The Trump administration is on course to allow insurers to offer these plans for up to a year, rather than just three months.” [CNN, 3/8/18]

Modern Health Care: “Secretary Alex Azar Told Insurers Thursday That The Trump Administration Will Do What It Can ‘Within The Law’ To Let Insurers Offer More Affordable Plans That Don’t Meet ACA Requirements.”

“The Trump administration on Thursday unexpectedly shot down Idaho’s effort to let insurers sell health plans that don’t comply with the Affordable Care Act’s coverage mandates, thwarting conservative efforts to unravel the law’s consumer protections directly for now. But CMS Administrator Seema Verma indicated that Idaho and other states could achieve the same goal by refashioning such noncompliant health plans as short-term products, which the administration would allow under a controversial proposed rule. HHS Secretary Alex Azar told insurers Thursday that the Trump administration will do what it can ‘within the law’ to let insurers offer more affordable plans that don’t meet ACA requirements. In a letter to Idaho Republican Gov. Butch Otter and state Insurance” [Modern Health Care, 3/8/18]

Washington Times: Verma: “This Is Certainly Not Our Preference.”

“‘If a state fails to substantially enforce the law, the Centers for Medicare & Medicaid Services (CMS) has a responsibility to enforce these provisions on behalf of the State,’ Ms. Verma added. ‘This is certainly not our preference.’ She said Idaho, with some tweaks, might be able to offer similar plans under Mr. Trump’s bid to offer short-term plans for up to a year. There is a GOP effort to codify this change and let people renew these plans, setting up a parallel market for healthier people that could siphon valuable enrollees from Obamacare’s exchanges.” [Washington Times, 3/8/18]

Business Insider: Verma: Idaho’s Attempt “Was Admirable.”

“Verma said that while Idaho’s desire to bring down costs — the stated reason for the policy — was admirable, it was also illegal. ‘CMS is committed to working with states to give them as much flexibility as permissible under the law to provide their citizens the best possible access to healthcare,’ Verma said.” [Business Insider, 3/8/18]

The Hill: “Verma’s Letter Offered Alternatives To The State.”

“Verma’s letter offered alternatives to the state, including embracing a Trump administration move to allow different kinds of cheaper, skimpier insurance plans, known as short-term plans.” [The Hill, 3/8/18]

Vox: “The CMS Letter Did Include A Caveat That Provides Some Consolation To Republican Officials – In Washington And Boise – Who Want To Unwind Obamacare.”

“It is a victory for the rule of law, given how openly Idaho was defying the ACA. But the CMS letter did include a caveat that provides some consolation to Republicans officials — in Washington and in Boise — who want to unwind Obamacare. The state could conceivably tweak its proposal, Verma noted, to align with the Trump administration’s own proposed regulations to expand short-term insurance plans — which also do not have to comply with the ACA’s insurance regulations. It would be a back door to achieve the same end (providing an escape hatch from Obamacare for healthier customers, one that is likely to lead to higher premiums for those left behind in the law’s markets) and would be more clearly in line with the administration’s agenda.” [Vox, 3/8/18]

ashoup
In News, Roundup

Polling Roundup: The ACA Has Achieved Lasting Popularity & Republicans Have Been Hurt by Sabotage

Four polls over six weeks have reached the same conclusion: the Affordable Care Act has achieved lasting popularity, the electorate is aware of and angry about Republican health care sabotage, and these factors are making health care voters’ top priority. Here’s what the numbers say:

Last week, Public Policy Polling released its first national poll of the year, contrasting the rising popularity of the Affordable Care Act with the blame being leveled on President Trump’s sabotage:

  • Approval for the Affordable Care Act is 12 points above water (47% approval to 35% disapproval), a dramatic reversal from trends before Trump took office.
  • Over half of voters know Republicans are sabotaging health care, with 51% believing the Trump Administration is actively taking steps that will raise people’s health care costs.

Also last week, a Priorities USA memo found that President Trump’s handling of health care remains vastly unpopular, especially among independent voters:

  • On the policy of health care, Donald Trump has a 34/46 favorable/unfavorable message.
  • On his handling of drug pricing, 60% of voters have major concerns, including 71% among independents.

These two polls come on the heels of a January Washington Post/ABC News poll which asked Americans about the policies taking precedent during President Trump’s time in office and found that Americans are most united in opposition to the GOP’s health care agenda:

  • Asked if keeping “Obamacare” was a good thing for the country, 57 percent of respondents said yes – a significantly higher percentage than any other policy. Meanwhile, just one policy was underwater: the Republican tax scam, which kicked millions of people off of their insurance and was opposed 46% – 34%.

And all of these polls follow a Hart Research memo which found that health care is the number one issue among voters, far exceeding anything else in terms of driving voting preferences. A majority of those surveyed expressed strong disapproval for the health care policies pushed by the GOP:

  • “Healthcare far exceeds any other issue as an important driver of voting preferences, with over half of all voters identifying healthcare as one of their top priorities in the 2018 congressional elections, with 54% of those surveyed choose health care as one of the two issues that will be the most important to them in deciding how to vote for Congress.”
  • Healthcare is the most frequently cited priority among Democrats (68%), independents (54%), and Republicans (38%). It is particularly important to African-American voters (66%) and to white women voters, whether they are college graduates (62%) or non-college graduates (59%).

One poll can be an outlier, or two a coincidence, but four polls in six weeks independently highlighting the importance of health care and the contrast between the Affordable Care Act’s popularity and the GOP’s sabotage show just how important this issue is to the American people. From coast to coast, constituents are making their view abundantly clear: it’s time for the GOP to stop its war on health care, and there will be significant consequences should President Trump and Congressional Republicans fail to heed this advice.

ashoup
In News, Roundup

“Short-Term Insurance Plans Don’t Cover Pre-Existing Conditions, Don’t Cover The ACA’s Essential Benefits, And Can Impose Annual Limits On Coverage”: A Reaction Roundup to the Trump Administration’s Latest Sabotage Attempt

Today, the Trump Administration announced a plan to let insurance companies sell short-term junk insurance year-round, ramping up its sabotage of the Affordable Care Act. These scam insurance plans don’t have to cover people with pre-existing conditions, re-impose lifetime caps, and don’t have to cover the essential medical benefits required by the Affordable Care Act, including maternity care and prescription drug benefits. Today’s proposal would weaken American health coverage, something nearly every major media outlet, health care expert, and stakeholder pointed out.

The coverage of President’s Trump’s latest effort to sabotage American health care is brutal. Take a look:

NBC News: “Trump Pushes Insurance That Doesn’t Cover Pre-Existing Conditions.” “The Trump administration announced Tuesday that it is moving to expand the use of low-budget temporary insurance, which could offer customers a cut-rate alternative to plans on the Affordable Care Act’s exchange, but undermine more comprehensive insurance for others… Unlike the ACA’s plans, they are not required to cover pre-existing conditions, cover specific treatments, or provide unlimited benefits. The plans are normally supposed to cover a brief lapse in coverage, but the order makes it easier to rely on them as primary insurance. Health experts say they’re likely to be cheaper, but they could raise premiums for patients who need comprehensive plans through Obamacare by siphoning away young and healthy customers into a separate market.” [NBC News, 2/20/18]

Washington Post: Short-Term Plans Next Part Of Trump Administration’s Plan To “Dismantle” Affordable Care Act. “The order is part of the administration’s strategy to circumvent parts of the sprawling 2010 health-care law — President Barack Obama’s primary domestic legacy — through executive actions. The moves are an alternate route given the Republican-led Congress’s inability last year to dismantle much of the law — although Trump is still urging lawmakers to try again, despite GOP Senate leaders’ reluctance.” [Washington Post, 2/20/18]

NPR: “Trump Administration Wants To Let Insurers Offer Plans With Fewer Benefits.” “The Trump administration wants to allow insurance companies to offer more policies that have limited health benefits and that can reject customers if they have pre-existing medical conditions.” [NPR, 2/20/18]

Kaiser Health News: Trump Administration Proposes Rule “That Can Reject People With Preexisting Medical Conditions.” “The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don’t include all the benefits required by the federal law — including plans that can reject people with preexisting medical conditions.” [Kaiser Health News, 2/20/18]

Huffington Post: Plans Would Make “It More Difficult For People Who Need Or Want More Comprehensive Coverage To Get It.” “Taken together, the two steps ― getting rid of the mandate and then changing the rules on short-term plans ― could accelerate an evolution already underway for people buying insurance on their own, rather than through an employer… The new regulations would also render the law’s insurance reforms less effective, making it more difficult for people who need or want more comprehensive coverage to get it.” [Huffington Post, 2/20/18]

Reuters: “Another Trump Administration Move Aimed At Undercutting” The ACA. “The U.S. government on Tuesday proposed extending the availability of skimpy health insurance plans to millions of Americans in another Trump administration move aimed at undercutting the requirements of the Affordable Care Act, often called Obamacare…The plans will not include the benefits that define the insurance created under Democratic former President Barack Obama, including required health benefits such as maternity coverage and the guarantee of insurance regardless of health.” [Reuters, 2/20/18]

Wall Street Journal: Plans “Allow Insurers [To] Charge Higher Premiums Based On A Consumer’s Health Status.” “The plans are often sold only to people who qualify as healthy and they may have annual limits on the amount of care they will cover. The plans don’t have to cover people with pre-existing conditions, for example, and insurers can charge higher premiums based on a consumer’s health status. They also don’t have to include benefits mandated by ACA plans such as prescription-drug coverage… Health analysts say the more extensive short-term plans that would be allowed under the latest proposal could appeal to healthier customers seeking less-expensive alternatives to ACA plans. Higher-risk people would be likely to remain in traditional insurance coverage, however. That would cause their premiums to rise because healthier consumers are needed on the ACA’s exchanges to offset the costs of older and sicker people.” [Wall Street Journal, 2/20/18]

New York Times: Plans “Offer Significantly Less Protection To Consumers.” “Short-term policies are intended for people who are between jobs or need temporary coverage for other reasons. They are generally cheaper than insurance that meets the law’s requirements, but they offer significantly less protection to consumers. Insurers often deny short-term policies to people with pre-existing conditions and can charge higher premiums because of such conditions. Short-term policies do not have to provide the ‘essential health benefits’ that are required by the Affordable Care Act. They may, for example, omit coverage of maternity care, mental health care or addiction treatment. Short-term policies may impose limits on the amount the insurer will pay, but they do not have to cap the patient’s out-of-pocket costs.” [New York Times, 2/20/18]

USA Today: “Trump Proposes 12-month Insurance Plans That Don’t Cover People, Issues Obamacare Requires.” “The Trump administration proposed Tuesday that people be allowed to buy short-term insurance plans that don’t cover the benefits — or people — required to be covered by the Affordable Care Act (ACA)… The ACA was designed to prevent some of the situations the new plans would create, critics said. They could deny coverage based on pre-existing conditions, generally cover few benefits and can cap the benefits provided. The plans could also pull more healthy people out of the pool of people signing up for the ACA, and that could lead to higher premiums for those who remain and aren’t eligible for subsidies.” [USA Today, 2/20/18]

Bloomberg: “Trump Proposes Bigger Role for Skimpy Insurance, Undermining Obamacare.” “The Trump administration is proposing to expand the availability of short-term insurance plans, offering a cheaper health coverage option for consumers, while taking another step to undercut Obamacare… Combined with earlier moves by the Trump administration — such as ending the ACA requirement that all people buy health coverage or pay a fine — the latest proposals could result in higher costs or fewer options for individuals who still want to buy the more comprehensive Obamacare plans.” [Bloomberg, 2/20/18]

Politico: Trump Administration Pushing Plans “That Some Deride As ‘Junk Insurance.’” “The Trump administration is proposing to expand the availability of short-term health insurance plans that some deride as ‘junk insurance’ — an effort that could give consumers cheaper coverage options but undermine Obamacare’s marketplaces and popular protections for pre-existing medical conditions… Many health care experts fear expanding the availability of the health plans, which are exempt from Obamacare’s robust consumer protections, could further destabilize the law’s wobbly insurance markets. Critics say the plans offer just the illusion of coverage, and enrollees often don’t realize how limited their benefits are until it’s too late. Short-term plans maintain cheaper prices than traditional insurance by refusing coverage for pre-existing conditions, in some cases, and some medical services. Unlike Obamacare coverage, the short-term plans typically cap payouts, which could leave enrollees with catastrophic illnesses or injuries on the hook for huge medical bills.” [Politico, 2/20/18]

Talking Points Memo: Proposed Plans Represent “Further Gutting O’Care Market.” “Many health care experts and economists say the sale of these skimpy “junk insurance” plans will draw younger and healthier people out of Obamacare’s individual market, making the remaining risk pool older, sicker, less stable, and more expensive.” [Talking Points Memo, 2/20/18]

Vox: “Experts Anticipate [These] Changes Would Damage The Market.” By broadening the definition of short-term insurance, the Trump administration is opening more loopholes for more people to buy insurance outside the health care law’s marketplaces. In the eyes of the administration, this is fulfilling a campaign promise that President Trump made to give people relief from Obamacare… But experts anticipate those changes would damage the market for customers who are left behind. Because younger and healthier people are more likely to leave the markets and buy short-term insurance, leaving an older and sicker pool behind, the ACA markets are likely to face higher premiums. And some insurers might decide to leave the law’s markets altogether if the customers become too unhealthy and therefore too expensive.” [Vox, 2/20/18]

ThinkProgress: Trump Administration’s Latest Attack On Obamacare Would Cost Taxpayers Millions. “The administration is proposing to expand access to short-term health plans, which is intended to fill temporary gaps in coverage and provide some consumers with cheaper options because the plan’s coverage is limited. This is just the latest move to undermine the ACA, and it’ll cost the federal government anywhere between $96 to $168 million more every year.” [ThinkProgress, 2/20/18]

Stephanie Armour, Wall Street Journal: Short-Term Plans Will Mean Higher Premiums. “If the estimated 200,000 people leave exchanges for short term plans, average est. monthly premium goes from $649 to $718 on exchanges based on proposed rule.” [Twitter, 2/20/18]

Catherine Rampell, Washington Post: Short Term-Plans A “Recipe For Siphoning Off Health People And Unraveling The Individual Market.” [Twitter, 2/20/18]

Jonathan Cohn, Huffington Post:  “And Now, Another Effort To Undermine Aca Regulations.” [Twitter, 2/20/18]

Ana Marie Cox: “Another Awesome Thing To Be Doing In the Middle Of An Addiction Epidemic.” [Twitter, 2/20/18]

Norm Ornstein, American Enterprise Institute: “Disgraceful.” “Alex Azar at HHS now doing his part to sabotage Obamacare and cost taxpayers hundreds of millions, while taking healthy people out of risk pools and increasing premiums for others. Disgraceful.” [Twitter, 2/20/18]

Health care experts ripped the announcement, and previewed the extensive problems it would cause:

Mike Kreidler, Washington State Insurance Commissioner: “If You Get Sick You May Not Be Able To Renew Your Coverage — There Are No Protections For People With Pre-existing Conditions. Maternity Care And Mental-Health Benefits Often Are Excluded.” [New York Times, 2/20/18]

Larry Levitt, Kaiser Family Foundation Senior Vice President: “Short-Term Insurance Plans Don’t Cover Pre-Existing Conditions, Don’t Cover The ACA’s Essential Benefits, And Can Impose Annual Limits On Coverage.” “Short-term insurance plans don’t cover pre-existing conditions, don’t cover the ACA’s essential benefits, and can impose annual limits on coverage. The expansion of short-term health insurance plans is part of a strategy to create a parallel insurance market that does not comply with the ACA’s rules. Short-term insurance plans will cherry pick healthy people, leaving ACA-compliant plans to cover a sicker pool with higher premiums. With the expansion in short-term insurance plans, low-income people will be protected from higher premiums by subsidies. Middle-class people with pre-existing conditions will feel the full brunt of higher premiums.” [Twitter, 2/20/18]

Rachel Sachs, Health Law Professor: “The Government Will Spend Millions More To Provide Fewer People With Comprehensive Coverage.” “HHS projects this change will cost the government $96-$168 million more every year. So the government will spend millions more to provide fewer people with comprehensive insurance.” [Twitter, 2/20/18]

Loren Adler, Director of USC-Brookings Schaeffer Initiative for Health Policy:  “For Middle Class & Above, This Moves Individual Market Away From Providing Insurance, ↓ Costs For The Healthy, ↑ Them For The Sick. This Is A VERY Expensive Rule For Taxpayers.”  [Twitter, 2/20/18]

Robert Laszewski, Health Industry Consultant: Plans Will “Woe Unto Those Who Get A Condition And Have To Go Back Into Obamacare.” “If consumers think Obamacare premiums are high today, wait until people flood into these short-term and association health plans…The Trump administration will bring rates down substantially for healthy people, but woe unto those who get a condition and have to go back into Obamacare.” [Kaiser Health News, 2/20/18]

Robert Laszewski, Health Industry Consultant: “We’re Going To Have Two Different Markets, A Wild West Frontier Called Short-Term Medical…And A High-Risk Pool Called Obamacare.” [Kaiser Health News, 2/20/18]

Kevin Lucia, Georgetown University Health Policy Institute Project Director: “It Will Undermine The Individual Market Risk Pool.” [Kaiser Health News, 2/20/18]

Sarah Lueck, Center On Budget And Policy Priorities Health Policy Expert: Plans Mean “Making People With Pre-Existing Conditions Pay Premiums That Reflect Their Health Status.” “Something I learned from the proposed rule on short-term plans: ‘Actuarially fair’ apparently means, in this Administration, making people with pre-existing conditions pay premiums that reflect their health status.” [Twitter, 2/20/18]

Dania Palanker, Former National Women’s Law Center Senior Counsel For Health And Reproductive Rights: “Mental Health Crisis? Short-Term Plans Exclude Mental Health. Opioid Crisis? Short-Term Plans Exclude Substance Use Treatment. Maternal Mortality Crisis? Short-Term Plans Exclude Maternity Coverage.” [Twitter, 2/20/18]

Center On Budget And Policy Priorities: Short-Term Health Plans Would Raise Premiums In Individual Market, Undermine Market Reforms, And Expose More Consumers To Gaps And High Costs. “This would let a parallel market for skimpy plans operate alongside the market for comprehensive individual health insurance, exposing consumers to new risks and raising premiums for people seeking comprehensive coverage, especially middle-income consumers with pre-existing conditions.” [Center on Budget and Policy Priorities, 2/20/18]

The announcement was also criticized by stakeholders, who know first-hand what such a proposal will mean for Americans’ health:

American Cancer Society Cancer Action Network, American Heart Association, American Liver Foundation, American Lung Association, Arthritis Foundation, Consumers Union, Crohn’s & Colitis Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation, Leukemia And Lymphoma Society, Lutheran Services In America, March Of Dimes, National Health Council, National Ms Society, National Organization For Rare Disorders, United Way, World Wide Volunteers Of America: “The Proposed Rule Released Today Would Permit Insurance Companies To Offer Substandard Insurance Policies To Millions Of Americans… As Organizations Committed To Ensuring That Coverage Remains Affordable, Accessible, And Adequate For All Americans, We Cannot Support This Proposal. “The proposed rule released today would permit insurance companies to offer substandard insurance policies to millions of Americans. As drafted, the rule could result in the proliferation of lower-premium plans, known as ‘short-term limited duration’ plans that could exclude coverage for critically important health care services, charge individuals with pre-existing health conditions higher rates, increase deductibles, and place strict limits on benefits. These lower-premium plans are designed to draw younger and healthier individuals away from the individual marketplace – leaving them with inadequate coverage if they become ill or injured. Older and less healthy individuals that remain in more comprehensive plans will likely see their insurance premiums increase dramatically, making it even more challenging to secure the care they need and deserve. It will also create confusion for the American public about which types  of plans will cover the services they need – creating an opportunity for consumers to purchase plans that would leave them unknowingly underinsured. As organizations committed to ensuring that coverage remains affordable, accessible, and adequate for all Americans, we cannot support this proposal.” [Consumers Union, 2/20/18]

America’s Health Insurance Plans: “We Remain Concerned The Expanded Use Of Short-Term Plans Could Further Fragment The Individual Market, Which Would Lead To Higher Premiums For Many Consumers, Particularly Those With Pre-Existing Conditions.”While we are reviewing the proposed rule to understand its impact on the people we serve, we remain concerned that expanded use of short-term policies could further fragment the individual market, which would lead to higher premiums for many consumers, particularly those with pre-existing conditions.” [Twitter, 2/20/18]

American Cancer Society-Cancer Action Network: Plans Represent A Roll Back of Critical Patient Protections. “Short-term plans can deny coverage based on pre-existing conditions, often cover very few benefits and can set caps on what limited benefits are provided. While these exemptions make these policies inexpensive, they also create plans with potentially inadequate coverage. Short-term plans are meant to be a bridge, not a substitute, for long-term meaningful coverage. Permitting plans to be renewed indefinitely would likely result in more people struggling with unexpected health care bills and insufficient insurance.” [ACS-CAN, 2/20/18]

Community Catalyst: Short-Term Plans Proposed by Trump Administration Would Roll Back Consumer Protections Enshrined in Affordable Care Act. “By giving insurance companies more leeway to sell plans that can skirt protections the ACA put in place specifically to ensure people with preexisting conditions such as cancer, asthma or diabetes wouldn’t be denied or priced out of coverage, President Trump is once again prioritizing politics over peoples’ health.” [Community Catalyst, 2/20/18]

Wisconsin Cancer Council: “Bottom Line: These Plans Do Not Have Protections Guaranteed.” “Bottom line: these plans do not have protections like guaranteed issue and bans on coverage limits, and may contribute to rising premiums for full coverage #ACA plans in the individual market, especially after the tax penalty goes away in 2019.” [Twitter, 2/20/18]

Today’s announcement represents the Administration’s latest salvo in their war on health care, and yet again it is the American people who will be the victims. These junk insurance plans would be another way for the Trump Administration and insurance companies to dismantle the Affordable Care Act and the benefits that millions of Americans have come to rely on. Enough is enough – it’s time for the Trump Administration to end its war on our health care.

ashoup
In News, Roundup

REACTION ROUNDUP: States Face Wave of Resistance to Trump-Inspired Medicaid Cuts

As states start to take advantage of the Trump Administration’s invitation to strip Medicaid coverage away from millions by imposing restrictions such as ‘work’ requirements designed to reduce access to coverage, these proposals face a wave of backlash from local editorial boards, lawmakers, health care providers, hospitals, and advocates:

Iowa (legislation to impose work requirements introduced in Feb. 2018)

Des Moines Register editorial: Medicaid bill demonizes low-income Iowans with delays, drug tests, work requirements. Iowa state Sen. Tom Greene, R-Burlington, is sponsoring Senate File 2158, a measure which “directs the Iowa Department of Human Services to seek federal approval to impose work requirements on Medicaid recipients.” The paper adds, “One would think Greene, who worked as a pharmacist for four decades, would understand the importance of ensuring Iowans get care needed to be productive members of society. Then again, the part-time lawmaker was not required to pee in a cup or wait six months to enjoy his taxpayer-subsidized family coverage.” [Des Moines Register, 2/14/18]

Louisiana (expected to propose work requirements in mid-Feb. 2018)

Republican state lawmaker skeptical: “Medicaid work requirements probably would not save much money as the state tries to close a looming $1 billion budget shortfall, he added. Louisiana legislators have expressed similar concerns. ‘I’m skeptical that it’s going to be any real savings,’ said Rep. Kirk Talbot, R-River Ridge.” [Louisiana Daily Comet, 2/6/18]

West Virginia (considering Medicaid work requirements as of Feb. 2018)

Charleston Gazette-Mail editorial: Work requirements don’t help people work. “Helping people achieve gainful employment and self-sufficiency is exactly the right goal. Disrupting people’s health coverage will not accomplish it. Medicaid recipients already struggle to maintain employment and support themselves. Otherwise, they wouldn’t qualify for Medicaid…A smarter, not to mention more humane, approach would be to remove as many barriers to health care access as possible for the state’s most challenged residents. The smarter approach would be to err on the side of inclusion. Cover more West Virginians, and don’t hassle them off of Medicaid month after month as their work status fluctuates.” [Charleston Gazette-Mail, 1/25/18]

Missouri (state has called for legislation to pursue work requirement)

St. Louis Post-Dispatch editorial: Job requirements for Medicaid recipients won’t work and might actually backfire. “Tracking down these people will require state governments to expand their staffing to police the work requirement and administer the paperwork. If the work requirement is similar to that required for coverage under the Temporary Assistance for Needy Families program, child care and transportation will have to be subsidized if it’s available. The cost savings for taxpayers is starting to look a little hazy…Ironically, researchers say that taking health insurance away from people makes it less likely they will be able to get and keep a job. This will be particularly true if, as expected, the burden of the work requirement falls most heavily on those with physical or mental impairments not yet certified as permanent disabilities.” [St. Louis Post-Dispatch, 1/15/18]

Missouri family medicine physician: Rolling back Medicaid will worsen Missouri’s opioid crisis. “For Missourians struggling with opioid addiction, Medicaid is the difference between life and death. The medications I prescribe can help 50 percent of patients begin recovery and stay healthy in the long term. With access to these medications, I see many of my patients rebuilding their lives, advancing in their careers and enjoying life with their families. But without Medicaid, many will lose access to the treatment and medications that we know are effective. Even for those with full-time jobs, many Missourians simply don’t make enough to afford private health insurance, and Medicaid is their only option to afford health care.” [Columbia Missourian, 1/31/18]

Maine (work requirement submitted for approval on 8/2/2017)

Portland Press-Herald editorial: Medicaid limits are not what Maine voters want. “MaineCare is health care, not welfare. People on the program don’t get a check every month that discourages them from working. But they do get a chance to go to see a doctor when they are sick, or fill prescriptions that keep chronic diseases at bay. Adding more hurdles to applying for benefits will inevitably result in eligible people failing to be enrolled. The bureaucratic nightmare of trying to figure out who has received how much coverage during their lifetimes would slow the process for everyone … Cutting off someone’s health care is not going to make them more likely to work — just the opposite is true. Illness is one of the main barriers that prevents people from working.” [Portland Press Herald, 2/8/18]

Bangor Daily News editorial: The contorted logic of allowing states to require work as a condition for Medicaid. “If work requirements in a food assistance program are likely to lead to a diminished state of health for thousands of low-income adults, it’s not hard to imagine the damaging health effects of imposing work requirements in a benefit program designed explicitly to ensure that the poorest among us can access health care.” [Bangor Daily News, 1/19/18]

South Dakota (Gov. Dennis Daugaard has called for Medicaid work requirements)

Yankton Daily Press & Dakotan editorial: Be wary of what’s lurking in the details of Medicaid work requirements. “The statement also feeds the long-held generalization embraced by some people that many of those receiving some form of low-income assistance are basically living off the government dole instead of working. However, a lot of low-income people who receive Medicaid are already working but aren’t able to make ends meet or afford basic health care, which Medicaid helps provide…If handled properly, the work requirement for Medicaid proposed by Daugaard — and pushed by the White House — may impact only a small segment of recipients. If this move becomes something more than that — which, unfortunately, could be vaguely implied by Verma’s blunt remarks — then the idea may be little more than subterfuge for something else.” [Yankton Daily Press & Dakotan, 1/20/18]

Kansas (work requirement submitted for approval on 12/20/2017)

Health execs: Don’t equate work requirements with job stability. “‘If the state is going to make further changes to the KanCare program, it will put a greater burden on the state’s general fund, hospitals and providers, said Brenda Sharpe, CEO of the REACH Healthcare Foundation. ‘The misconception of who is on Medicaid is rampant.’ Sharpe also said the proposed changes fail to account for the type of jobs most low-income workers hold. For example, a construction job may be seasonal, and a retail worker’s schedule may very week by week — then throw in the need for child care. ‘If they lose their job for three months because they work in an outdoor setting, are you going to kick them off benefits for three months?… The best thing you can do to get someone to keep a job is to give them health insurance.’” [Kansas City Business Journal, 1/24/18]

Arizona (work requirement submitted for approval on 1/4/2018)

Arizona Alliance for Healthcare Security: “They have no evidence of anyone taking advantage of the system, so this just becomes another obstacle for people to overcome in order to get Medicaid benefits.” [Inside Tucson Business, 1/19/18]

Arkansas (work requirement submitted for approval on 6/30/2017)

Arkansas Advocates for Children and Families: “Arkansas Works, the state’s Medicaid expansion program, has successfully provided hundreds of thousands of Arkansans with affordable health care coverage and has saved the state money in charity payments to providers for uncompensated care. But the proposed changes are designed to remove people from coverage without giving them a comparable alternative. This is not just bad policy – it runs counter to Medicaid’s core mission of providing health care coverage to low-income people.” [AACF report, 1/4/18]

Kentucky (work requirement approved on 1/12/2018)

Lexington Herald-Leader editorial: Cutting unemployment benefits won’t strengthen Ky. workforce. “The best hope for addiction treatment is Medicaid, but the state is getting ready to impose new work requirements and other hurdles to treatment and the chance at a responsible life.” [Lexington Herald-Leader, 2/14/18]

Policy analyst: “You’re spending more money to cover fewer people.” “Cost savings come from the assumption that nearly 100,000 people will drop out of Medicaid by the end of the five-year project recently approved by the federal government. For those who remain, the monthly cost of care increases faster than it would have had the state made no changes, according to the administration’s projections. ‘You’re spending more money to cover fewer people,’ said Dustin Pugel, a policy analyst for the Kentucky Center for Economic Policy in Berea and a critic of the Bevin plan. I’m not crazy about the idea of us spending more money to cover fewer people.'” [Louisville Courier Journal, 2/14/18]

Indiana Daily Student editorial: Kentucky’s Medicaid requirements hurt more than help. “There are patients on Medicaid who are disabled, need cancer treatment and have other situations that would make working impossible or incredibly difficult.” [Indiana Daily Student, 2/5/18]

Utah (work requirement submitted for approval on 8/16/2017)

Op-ed: Medicaid ‘work mandate’ is misguided policy. “The 1115 waiver’s “work requirement” is a fancy term for ‘work mandate’; it is in fact designed to provide less coverage overall.  Utah children and parents will be caught in a poverty cycle. Utahns will be far less healthy than they would be with full Medicaid expansion through the Utah Decides ballot initiative.” [Utah Policy, 1/11/18]

 

Wisconsin (work requirement submitted for approval on 6/15/2017)

Policy analyst: “Requiring you to work to get healthy — there’s something backwards there.” “‘If you’re not healthy, it’s difficult to work,’ said Mike Bare, research director for Community Advocates’ Public Policy Institute in Milwaukee. ‘Requiring you to work to get healthy — there’s something backwards there.’” [Wisconsin State Journal, 1/11/18]

Madison nonprofit: Work requirements only make lives harder. “‘This is targeted at the lowest-income folks that we have out there, people who have difficult lives already,’ said Bobby Peterson, executive director of ABC for Health, a nonprofit public interest law firm in Madison. ‘We’re just making it harder for them.’” [Wisconsin State Journal, 1/11/18]

Illinois (Rauner administration developing Medicaid work requirement)

Shriver National Center on Poverty Law: A Medicaid work requirement would be cruel — and costly. “Medicaid work requirements will largely be used to punish people in dire need for forces beyond their control…Ironically, by taking crucial medical assistance away from people who are already struggling, work requirements will make finding or maintaining employment much more difficult. The fact of the matter is that Medicaid, like most other major anti-poverty programs, serves as a work support.” [Chicago Tribune, 1/23/18]

Ohio (Kasich administration preparing to submit application)

Ohio Center for Community Solutions: “To suddenly remove these resources not only dis-benefits this huge area of employment and this huge area of economic impact for providers and others, it would have drastic impacts on things like the opioid epidemic, on chronic-disease management.” [Cleveland Scene, 2/12/18]

South Carolina (McMaster administration has directed Medicaid agency to submit application)

South Carolina Hospital Association VP: “If anything, we should help them get the care they need so they can return to work and lead more fulfilling lives.” “After all, most Medicaid beneficiaries in South Carolina are already working. Among those who are not, 52 percent are disabled or too sick, while another 32 percent act as caregivers. Community-engagement requirements shouldn’t punish the sick or discriminate against those with disabilities; if anything, we should help them get the care they need so they can return to work and lead more fulfilling lives.” [The State, 2/7/18]

Tennessee (House speaker has filed Medicaid work requirements bill)

TennCare Work Plan Would Affect 86K, Cost $18.7M. “A state analysis says legislation seeking to require certain able-bodied TennCare recipients to work, volunteer or attend school would affect 86,400 people and cost the state $18.7 million annually…The $18.7 million net cost notably includes $22.3 million more in anticipated case management state costs and $3.7 million in estimated state savings from disenrollments, assuming a 2020 program start.” [U.S. News & World Report, 2/14/18]

Chattanooga Times Free Press: Nearly 87,000 adult TennCare enrollees could be affected under work requirement plan. “As many as 86,400 able-bodied adult enrollees on Tennessee’s Medicaid program could be affected by a bill that seeks to require they work, attend school, volunteer or face losing their health benefits, according to a legislative analysis … Rep. John Ray Clemmons, D-Nashville, said ‘the data is clear’ with proponents’ ‘ultimate’ goal being ‘to kick people off’ of TennCare, the state’s Medicaid program.” [Chattanooga Times Free Press, 2/14/18]

… and 160 National, State, and Local Organizations Oppose Work Requirements in Letter to Secretary Azar: “CMS’s Medicaid work requirements policy is directly at odds with bipartisan efforts to curb the opioid crisis .. and will have a significant and disproportionately harmful effect on individuals with chronic health conditions, especially those struggling with substance use disorders (SUDs) and mental health disorders.”  [2/15/18]

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