GOP Senators Call on Trump Administration to Relax Ban on Short-Term Health Insurance Plans

Image result for short term health plan photos

Source: Fierce Healthcare

As the Senate continues to grapple with repealing the Affordable Care Act, 14 Republican senators are pushing the Trump administration to relax a ban on short-term health insurance plans in the interim.

The senators, led by Sen. Ron Johnson, R-Wisc., wrote in a letter (PDF) to Department of Health and Human Services Secretary Tom Price that HHS should reverse an Obama administration rule that limited these plans to three-month terms that cannot be renewed.

The Obama administration made adjustments to its regulations for short-term insurance plans as more people enrolled in them as an alternative to ACA exchange plans. Demand for such insurance plans would likely increase significantly if the ACA’s rules are relaxed.

Short-term plans offer “greater flexibility in the choice of health benefits than on-exchange plans,” the senators wrote. The Obama-era changes to short-term plans were potentially harmful to people who lost their jobs, for instance, and may have needed more than 90 days to find a new one, they said.

“Acknowledging Americans’ freedom to avail themselves of these insurance plans is a step the administration can take quickly to restore additional personal freedom and individual choice in healthcare markets,” they wrote.

Reversing the rule could be especially key as there will be regions across the country with no payers in the individual marketplaces for 2018, limiting the options available for consumers, the senators write.

Meanwhile, the tone of conversation in the Senate on health reform is creating more questions than answers.

Senate Majority Leader Mitch McConnell, R-Ky., has been almost downtrodden in talking about the report effort, reports The Wall Street Journal, and that could indicate the conversations are labored. But it could also be an effort to quiet opposition from the ACA’s most ardent supporters, who may lower their voices if it seems like the Senate is struggling on healthcare.

“There is always a wilier strategy where Mitch is concerned,” Rep. John Yarmuth, D-Ky., told the newspaper.

The repeal outlook in the divided Senate is improving, but still “problematic,” Sen. Lindsey Graham, R-S.C., told the WSJ.

The Senate is pushing to vote on its version of the American Health Care Act by the end of the month, and experts suggest that McConnell may push for a vote even if the bill would likely fail to pass.

Uncertainty Over Federal Money Could Spur Covered California Rate Hikes

Image result for covered california rate hike photosSource: California Healthline

If the federal government does not clarify by mid-August whether it will continue an important health insurance subsidy for consumers next year, California’s state-run exchange will instruct its insurers to sell plans with significantly higher premiums to cover the loss of the money.

“Bottom line, we have come to the conclusion that if there’s no federal commitment to fund [the subsidies] by mid-August, we will presume they will not be funded and use higher rates for 2018,” Amy Palmer, director of communications for Covered California, said in an email.

At issue are the so-called cost-sharing subsidies that reduce what some consumers pay out of their own pockets for medical expenses such as physician visits, prescription drugs and hospital stays. These reduced rates are only available to Covered California enrollees who choose silver-level plans, the second-least expensive among the exchange’s four tiers. The subsidies are to help people whose annual income is between 139 percent and 250 percent of the federal poverty level, or about $34,200 to $61,500 for a family of four.

As of last summer, about half of the exchange’s enrollees — currently about 1.4 million people — benefited from cost-sharing reductions, Palmer said.

The subsidies are under challenge in a pending lawsuit by House Republicans, and President Donald Trump has threatened to stop making the payments, which go directly to health insurers to cover the cost of lowering consumers’ out-of-pocket expenses. The subsidies are separate from the federal health law’s tax credits, which reduce monthly premiums for qualified consumers.

A recent analysis commissioned by Covered California estimated that premiums for silver plans would jump by 16.6 percent if federal funding for cost-sharing subsidies were lost. That is over and above any annual rate increases on the table.

Last week, Covered California instructed participating insurers to submit alternative premium hike proposals for 2018 in the event they lose the federal payments. The agency told them to apply the hikes only to silver-tier plans, since the cost-sharing subsidies are available only to people who buy those plans.

The insurers’ proposed rates are due to Covered California by June 30, and the agency will publicly announce the final rates in mid-July, after negotiations with the health plans.

After that, the exchange can’t wait too long before determining which rates consumers will face in 2018, Palmer said. State regulators will still have to review the rates, and Covered California as well as the health plans will need to time to prepare for open enrollment in the fall.

As a result, the exchange determined this week that it will move forward with the higher rates in August if the uncertainty remains about the federal payments.

“As we hear about health plans exiting some markets, and as we work hard to create necessary market stability, waiting for clear federal guidance on [the subsidy] funding is no longer an option,” Covered California Executive Director Peter Lee wrote in an email to colleagues and health policy leaders on Wednesday.

Lee noted that if Covered California adopts the higher premiums to cover the cost of the subsidies, many consumers would nonetheless be protected from them. That’s because as premiums rise to make up for the loss of the cost-sharing subsidies, federal tax credits would grow to offset those higher premiums.

“These increased costs will be borne by the federal government … and will be significantly more than the federal government would pay if it continued making direct payments” for the subsidies, Lee wrote in a separate letter to Seema Verma, head of the Centers for Medicare & Medicaid Services.

A Democrat’s Well-Reasoned SB 562 Slam: “Illegal, Unworkable and Ill-Informed”

Image result for california assembly democratsSource: Modesto Bee

I am a lifelong Democrat who has worked for more than a decade to improve the policies and build the coalitions necessary for the success of the Affordable Care Act. Even so, I believe the ACA didn’t go far enough to guarantee universal and affordable health coverage.

So why I am so hopping mad about the “single-payer” bill – SB 562 – making its way through California’s legislature?

My frustration is with how the bill exploits widespread confusion about good healthcare policy and how other countries achieve them. The bill’s proponents lead people to believe that only the United States has a profit-based system and everywhere else has a fully government-run system producing better care at lower cost. In truth, every industrialized country has a hybrid system and all are wrestling with the same challenges – especially healthcare costs.

But advocates press on, saying SB 562 will bring healthcare access to people who can’t afford it, that it is backed by all right-thinking Democrats. Poppycock.

If you care about people, you have to care about policy. And this proposal is very poorly designed and impossible to implement.

Those legislators who voted it out of the Senate ignored the spectacular work of the Senate Appropriations committee staff, who pointed out all the bill’s fatal flaws. In any sane world, that would have sent proponents back to the drawing board. Instead, it sent them to the barricades, denouncing anyone who might oppose it.

What are these flaws? Start with the bill’s illegality. It would take all of the healthcare money being spent through Medicare, Medicaid, the Veterans Administration and other programs and put it into one big pot then California would ask for waivers from federal laws so we could spend the money as we please. In fact, we could not.

States are temporarily allowed to waive certain requirements of Medicare and Medicaid to experiment with improving those programs. But these waivers do not allow states to do away with these programs entirely. It would take a change in federal law to make the basic financing scheme possible, and there are many other provisions that would violate other federal laws – such as prohibitions on state regulation of the health benefits of large employers.

This bill takes an enormous problem – rising healthcare costs – and makes it a runaway train. The Senate Appropriations Committee put the price tag at $400 billion, twice the size of the state budget. But as big as the initial spending would be, the long-term cost would be much greater.

The bill encourages people to consume more health care, adding to costs. The bill makes co-payments for doctor’s visits illegal. The initial draft proposed that only providers of medical care would determine what is medically necessary. The legislation is based on a fee-for-service system – doctors would get paid for every procedure. That would encouraging them to perform a higher number of procedures.

There is literally nothing we have learned about healthcare in the past century that this bill’s authors appear to understand.

Health care systems, especially government-run systems, require management. The system being proposed here is essentially unmanaged. No country or state could afford such a system, in which patients are encouraged to consume as much healthcare as they want and doctors are paid more for every additional service they perform.

One final frustration: the efforts of those who are truly committed to universal affordable healthcare are needed elsewhere. The American Health Care Act, now in the Senate, would take a buzzsaw to our efforts to create universal healthcare, wiping away the gains of the ACA but also handicapping (if not destroying) the Medicaid program for lower-income individuals.

The California legislature should devote all its attention to opposing the federal legislation, and saving Medicaid.

Instead, the legislature is wasting time on this nonsense. Californians should be united around real progress on healthcare reform, not scattered by divisive fantasies.

Senate Republicans Draft Obamacare Repeal Bill Behind Closed Doors

Image result for senate republicans photosSource: USA Today

Top Senate Republicans and their staff are plowing ahead with a plan to repeal and replace Obamacare in the hopes of getting legislation on the floor by mid-summer — even if their own GOP colleagues have no idea what the bill will contain.

“It’s coming together and there’s a lot of feedback of (Congressional Budget Office) trying to get scores on different policy options … but it’s coming,” South Dakota Sen. John Thune, the third-ranking Republican in the Senate, told reporters Monday evening. The CBO does nonpartisan scoring of legislation, analyzing things like how many people will gain or lose health care or how much the bill will cost if enacted.

“I think we’re getting there,” Thune said when USA TODAY asked whether the bill was getting close to completion.

“We’re getting close to having a proposal to whip and to take to the floor,” Senate Majority Leader Mitch McConnell, R-Ky., told reporters last week when he was asked whether Republicans could pass a bill by the July Fourth recess.

But that confidence was lost on rank-and-file Republicans, many of whom told reporters at the Capitol on Monday that they had no idea what was being drafted.

“I want to know exactly what’s going to be in the Senate bill, I don’t know it yet,” Wisconsin Republican Sen. Ron Johnson told reporters. “It’s not a good process.”

Sen. Lindsey Graham, R-S.C., told reporters he didn’t know any details about the bill, except that “they’re writing it.”

“We’re trying to do it from a one-party prospective because no Democrat is willing to help us … but no, this is not the best way to do health care, but it’s the way we’re having to do it,” Graham said.

“Until I see the language I don’t know what’s there and so I would like to see language. If you don’t see language, sure you’ve got a sense but your sense could be wrong,” said Sen. Bill Cassidy, R-La.

The Budget Committee is drafting legislation with the input of members following a meeting last week where Republicans were presented with a broad outline of a plan, said a Republican Senate aide who was not authorized to discuss the legislation before it is unveiled.

The ideas presented last week were non-binding, but they were the clearest breakdown yet of provisions the bill may end up being included. The aide said staff took feedback from Republicans and will present an updated — and more detailed — version of a plan at Tuesday’s Republican policy lunch. The aide said July 4 was the goal but “all this stuff is a moving target.” If there is overall consensus during Tuesday’s meeting, legislation will likely soon follow.

Last week’s PowerPoint presented a skeleton of ideas including more generous Medicaid funding than the bill that passed the House last month. Senators discussed phasing out Obamacare’s expanded Medicaid enrollment over seven years rather than the two-year timeline in the House bill, according to another GOP aide familiar with the plan. Senators were told that the goal would be to keep insurance companies from charging more for people with pre-existing conditions, a provision which was eliminated from the House bill — although the House bill did set aside money in the hope of offsetting higher costs.

Thune said the final bill would be submitted to CBO before it is shown to the public. The House approved their version of an Obamacare repeal-and-replace bill in May, weeks before getting an updated CBO score. CBO ultimately concluded the bill would lead to 23 million fewer American having health insurance by 2026.

Even if Republicans come up with a bill, the chances of it passing are still hazy. No Democrats are expected to vote to repeal former president Barack Obama’s signature health care legislation, and Republicans can’t lose more than two votes if they want to pass the bill. Already Sen. Susan Collins, R-Maine, and Sen. Lisa Murkowski, R-Alaska, have expressed concerns over the House bill’s blocking of federal funding for Planned Parenthood. Meanwhile, Sen. Mike Lee, R-Utah, one of the Senate’s more conservative members, said Sunday he had some “grave concerns” about the direction the bill was going.

“It’s not yet clear what it is going to look like at the end of the day,” Lee told ABC’s This Week. “If we bring forward something that doesn’t repeal Obamacare and doesn’t bring down the health of health care that’s probably something I won’t be able to vote for.”

Democrats pounded Republicans for not being more transparent about the bill.

“What Senate Republicans are doing on health care is one of the most outrageous examples of legislative malpractice in decades,”  Minority Leader Chuck Schumer, D-N.Y. announced on the Senate floor Monday afternoon. “It will not go down as a fine moment in history for (McConnell), for his party or for the Senate.”

Sen. Bernie Sanders, I-Vt., tweeted a blank piece of paper that he said was the schedule of markups, hearings and public testimony the bill would go through.

Top Court Exempts Church-Affiliated Hospitals from Pension Law

FILE PHOTO: The Supreme Court is seen ahead of the Senate voting to confirm Judge Neil Gorsuch as an Associate Justice in Washington, DC, U.S. on April 7, 2017.  REUTERS/Aaron P. Bernstein/File PhotoSource: Reuters

The U.S. Supreme Court on Monday ruled that church-affiliated hospital systems do not have to comply with a federal law governing employee pensions, overturning lower court decisions that could have cost the hospitals billions of dollars.

The court ruled 8-0 that church-affiliated organizations are exempt from the Employee Retirement Income Security Act, a 1974 law that forces private employers to follow rules aimed at protecting pension plan participants.

The ruling was a victory for New Jersey-based Saint Peter’s Healthcare System, Illinois-based Advocate Health Care Network and California-based Dignity Health, which had faced separate employee lawsuits accusing them of wrongly claiming a religious exemption under ERISA.

Federal agencies had long interpreted the law as exempting not just church plans but also those of church-affiliated organizations.

The employees challenged that view, in effect accusing the hospital systems of being big businesses posing as church organizations in order to avoid minimum funding and reporting requirements under ERISA.

The three hospital systems maintained that their religious affiliation made them exempt from ERISA. St. Peters is affiliated with the Roman Catholic Church. Dignity operates both Catholic and non-Catholic hospitals. Advocate is affiliated with the United Church of Christ and the Evangelical Lutheran Church in America.

Writing for the court, Justice Elena Kagan said the law’s religious exemption applies to plans whether they were established by churches themselves or organizations affiliated with the churches.

Justice Sonia Sotomayor agreed with the ruling based on the text of the law. But, in a separate opinion, she wrote that she was “troubled” with the outcome, noting that some church-affiliated organizations operate for-profit subsidiaries, earn billions of dollars in revenues and compete with companies that must comply with ERISA.

Sotomayor suggested that the U.S. Congress take action, adding that “scores of employees – who work for organizations that look and operate much like secular businesses – potentially might be denied ERISA’s protections.”

The ruling is the latest in which the justices endorsed the idea that certain businesses deserve wider latitude because of religious considerations. In 2014, the justices sided with Hobby Lobby, a retailer owned by conservative Christians, that objected to a federal requirement that it pay for insurance coverage for women’s birth control, saying that violated a U.S. law protecting religious freedom.

Three separate regional federal appeals courts had ruled against Saint Peter’s, Advocate and Dignity in separate cases, refusing to dismiss employees’ lawsuits against them.

Hundreds of hospitals and hospital systems have claimed the exemption since 1980, when Congress amended ERISA to extend what is known as the “church plan” exemption, originally only for churches, more broadly to certain religiously affiliated entities.

The plaintiffs were seeking retroactive penalties for past violations of ERISA, which the hospitals said could add up to hundreds of millions or billions of dollars.

Justice Neil Gorsuch, who joined the court after the arguments were presented in the case, did not participate in Monday’s decision.

Feds To Waive Penalties For Some Who Signed Up Late For Medicare

Source: Kaiser Health News

Each year, thousands of Americans miss their deadline to enroll in Medicare, and federal officials and consumer advocates worry that many of them mistakenly think they don’t need to sign up because they have purchased insurance on the health law’s marketplaces. That decision can leave them facing a lifetime of enrollment penalties.

Now Medicare has temporarily changed its rules to offer a reprieve from penalties for people who kept Affordable Care Act policies after becoming eligible for Medicare.

“Many of these individuals did not receive the information necessary [when they became eligible for Medicare or when they initially enrolled] in coverage through the marketplace to make an informed decision regarding” Medicare enrollment, said a Medicare spokesman, explaining the policy change.

Those who qualify include people 65 and older who have a marketplace plan or had one they lost or canceled, as well as people who have qualified for Medicare due to a disability but chose to use marketplace plans.

They have until Sept. 30 to request a waiver of the usual penalty Medicare assesses when people delay signing up for Medicare’s Part B, which covers visits to the doctor and other outpatient care. Medicare beneficiaries who already pay the penalty because they had a marketplace plan can request that it be eliminated or reduced.

Medicare also imposes a waiting period for coverage on people who do not sign up when first eligible. If they meet the waiver requirements, they now can request that be lifted.

“This has been a problem from the beginning of the Affordable Care Act, because the government didn’t understand that people would not know when they needed to sign up for Medicare,” said Bonnie Burns, a consultant for California Health Advocates, a consumer group. “Once they had insurance, that relieved all the stress of not having coverage and then when they became eligible for Medicare, nobody told them to make that change.”

One of them is Lisa Grimes’ 49-year-old sister, who receives Social Security disability benefits because of mental illness. She became eligible for Medicare because she receives those disability benefits but had marketplace coverage at that time.

For the past year, Grimes, a St. Louis real estate lawyer, has been trying to unravel the problems that ensued after her sister opted to keep her marketplace plan and drop her Part B coverage, probably because her marketplace premium at the time cost half as much. Only after that $50 monthly premium ballooned to $360 did they learn that marketplace customers lose their premium subsidies when they join Medicare. (Grimes agreed to be interviewed as long as her sister was not identified.)

Other Medicare beneficiaries have made similar mistakes by assuming they didn’t need Part B if they had a marketplace plan, retiree coverage from a former employer or coverage through a current employer with fewer than 20 workers or with the Department of Veterans Affairs. None of these is a substitute for Medicare Part B.

Grimes said her sister couldn’t afford the new marketplace premium and had to drop her plan last year. The Social Security Administration denied her appeal to reinstate her Part B coverage with no penalty or wait period. Then she learned about the new Medicare waiver from a Missouri counselor at the State Health Insurance Assistance Program.

It took several hours for Grimes to find the right letters and other documents needed to apply since her sister’s “filing system was a large shopping bag,” Grimes said. With assistance from the Medicare Rights Center, her sister received Part B coverage without a late fee or waiting period. It was retroactive, so she might be reimbursed for the medical bills she paid last fall and winter when she had no insurance coverage for doctor visits.

People need to sign up for Part B usually within three months before or after turning 65 if they aren’t getting job-based insurance, or when their job-based health insurance ends if they are older than 65, according to Medicare rules. Most people under 65 who receive Social Security disability benefits qualify for Part B after 24 months of benefits.

Under the health law, people who qualify for Medicare will lose subsidies in the online exchange plans. And enrolling in one of those plans does not protect them from a permanent late enrollment penalty.

Marketplace insurers, who are often the first to spot when a member is turning 65, are barred under the health law from canceling coverage because that member may qualify for Medicare, Burns said. They are required, however, to cancel a Medicare-eligible member’s subsidies.

Last summer, Medicare officials began sending emails each month to about 15,000 people with subsidized coverage through the federally run marketplace. The notices target people approaching their 65th birthday and tell them how “to avoid an unwanted overlap in Marketplace and Medicare coverage.” Officials also began contacting individuals who already have both Medicare and subsidized marketplace coverage, urging them to discontinue the latter.

Yet the warnings have missed some people with marketplace coverage, who could find themselves on the hook to cover their own medical bills if their private insurer indicates they should have been on Medicare and refuses to pay.

“These are very complex rules,” said Stacy Sanders, federal policy director at the Medicare Rights Center, a consumer advocacy group that spearheaded an effort in 2015 by nearly 50 unions, insurance companies and seniors’ advocacy organizations urging Medicare officials to address the problem. “The lack of good notification was leading people down a dangerous path in terms of declining or delaying Part B.”

Those who enroll in Part B 12 months or later after becoming eligible can face a permanent penalty of 10 percent added to the Part B premium for each full 12-month period that a beneficiary could have had Part B, but didn’t enroll. This year, the Part B standard average monthly premium is $109.

Medicare began emailing letters in March about the temporary waiver to some people 65 and older who are enrolled in plans sold on the marketplaces run by the federal government. But the federal government is not reaching out to others who may be eligible.

California, with the largest state-run marketplace — serving 1.4 million consumers — is planning a similar information campaign. So are some other states that run their own marketplaces, including Connecticut, Massachusetts and New York.

For information on how to apply for the waiver, officially called “time-limited equitable relief,” go to the Medicare Rights Center’s Medicare Interactive webpage or call the center’s helpline at 800-333-4114.

Insurance Companies Duck Obamacare Repeal Fight

Source: Politico

The once-powerful health insurance lobby — the same one that killed Hillarycare a generation ago and helped usher in Obamacare — can’t pick a side in the latest battle over America’s health care system.

Some major members of the sprawling trillion-dollar industry, like Humana and Cigna, have little at stake in the fight. Other insurers heavily invested in the Obamacare markets, like the regional Blue Cross Blue Shield plans, are urging Congress to fix the 2010 health law instead of shredding it. And then there’s Anthem, a rare industry voice supporting repeal.

The result is the lobby has lost influence and is now struggling to mount a unified front against Republican efforts to push through an Obamacare replacement. At the same time, the Trump administration has ignored their pleas to stabilize Obamacare’s exchanges in the short term, which could send the wobbly insurance marketplaces crashing before the GOP agrees on a health care plan.

“I’m still hoping they’ll step forward more aggressively and articulate how horrendous this plan is,” said Sen. Richard Blumenthal (D-Conn.), whose home state is the headquarters for several health insurance giants. “They know full well what the impact will be.”

Rep. Michael Burgess (R-Texas), who chairs the Energy and Commerce Committee’s health subcommittee, said officials from the main industry lobby, America’s Health Insurance Plans, never reached out to him while the House drafted an Obamacare replacement bill.

“I may have had one meeting in January [with] an insurer in my state,” Burgess said. “Otherwise I have not been contacted.”

AHIP officials and allies push back strongly against suggestions that the organization has been weakened. They argue that AHIP has picked its battles carefully, enabling the lobbying group to maintain communication with the Trump administration and lawmakers.

“There’s a time to be in the fray, and there’s a time to be above the fray and to provide nuanced counsel to the policy makers,” said Mark Ganz, CEO of Cambia Health Solutions and the immediate past board chair of AHIP. “I’ve been a voice that we need to be thoughtful and nuanced and not add to the noise.”

Insurers were at the center of the last two major health care brawls. They torpedoed the Clinton health plan of the early 1990s with a devastating $20 million ad campaign, including the now-legendary “Harry and Louise” commercials. Eight years ago, insurers begrudgingly went along with Obamacare when reform seemed inevitable.

But the health insurance lobby has fewer resources after losing some large companies as members. AHIP has also seen a wholesale turnover of senior leadership following the departure of its longtime CEO Karen Ignagni two years ago. That upheaval has been made tougher by the diverging interests among its remaining members.

“What insurers ought to recognize is that the bill is a disaster for them because it’s a disaster for their customers,” said Tom Epstein, who until recently headed public affairs at Blue Shield of California. “It’s a difficult predicament, but I think they need to take a stronger stand.”

AHIP’s decision in 2015 to hire former Obama health official Marilyn Tavenner as CEO was seen as a coup at the time, given her central role in implementing Obamacare and her solid relationships with Republican lawmakers.

“She’s got a very long and storied history of looking at the health care system from a lot of different angles,” AHIP spokeswoman Kristine Grow said.

However, the GOP’s full takeover of the federal government last November has made the decision to hire someone so closely identified with Obamacare look like less of a triumph.

Grow pointed to recent AHIP meetings with HHS Secretary Tom Price and CMS Administrator Seema Verma as evidence of the lobby’s efforts to shape the GOP health plan.

“AHIP always has a seat at the table,” Grow said. “While people continue to be frustrated with the nuance of our messaging, we’re representing the interests of our members.”

Insurers generally have two major problems with the repeal bill that passed the House in May. They think its tax credits to help low-income Americans purchase coverage are too stingy, and they’re worried about its $834 billion cut to Medicaid — a program that’s been increasingly lucrative for them.

But insurers also aren’t happy with the status quo. They’ve lost billions of dollars on their Obamacare customers — $7.9 billion in 2015 alone, according to McKinsey — and some of the biggest plans have abandoned the marketplaces.

Despite widespread misgivings about the repeal effort, the industry has largely held its fire. House Republicans showed little interest in engaging with the health care industry as they pushed through their repeal bill, but the Senate may be more receptive. Last week, AHIP sent a detailed letter to Senate Finance Chairman Orrin Hatch (R-Utah) laying out its concerns with the House bill, which the Senate is expected to rewrite.

Some insurers have come out aggressively against key pieces of the House’s repeal plan in recent days. UnitedHealth wrote a letter to Hatch this week arguing that Obamacare’s Medicaid expansion should be preserved. And the CEO of Blue Cross Blue Shield of Massachusetts penned an op-ed warning against weakening protections for individuals with costly medical conditions.

But insurers have mostly focused on trying to get the Trump administration to continue a key Obamacare subsidy program that’s being challenged in court. President Donald Trump has repeatedly threatened to cut off that funding, which most insurance experts believe would trigger an implosion of the struggling Obamacare markets. The fate of the subsidies, worth about $7 billion per year, remains in limbo after the Trump administration recently asked a federal court for another 90 days to consider how to proceed.

Insurers are “caught in this debate right now,” said Chris Jennings, a veteran Democratic health policy expert. “They find themselves in a little bit of no-man’s land.”

The industry stood by Obamacare for years through court challenges and the rocky rollout. But the fragmented industry started to come apart two years ago, shortly after Ignagni left AHIP. Since then, two of the five largest national insurers — UnitedHealth Group and Aetna — left the group, as did WellCare, one of the country’s largest Medicaid plans.

Those defections were a blow to the association’s muscle. As other health care industries ramped up lobbying in the first quarter of this year, AHIP scaled back. The organization spent $1.7 million in the quarter, well behind the $2.2 million it spent the same time last year.

“I don’t know what these companies think they gain by going solo,” Epstein said. “The stakes are very high and the only way the industry can be effective is to speak with one voice.”

Departures within AHIP have also turned heads on Capitol Hill. Its former senior vice president for federal affairs, Jeremy Allen, a former GOP House staffer, left in March. Then another top federal affairs staffer, Courtney Lawrence, left to join HHS. In addition, four executive vice presidents and the group’s top attorney have left since Ignagni’s 2015 departure — perhaps not surprising given her long tenure.

“Virtually the entire team involved in advocacy has turned over,” said one industry source, speaking on condition of anonymity. “It’s hard to play a game at this level when the team is just getting to know each other.”

Tavenner, the AHIP CEO, faces a daunting task in placating the various interests within the organization, said Mario Molina, a former insurance CEO who’s been critical of the GOP’s repeal effort.

“She’s very, very knowledgeable. She knows what to say and what to do,” said Molina, who this month was fired from the insurance company he ran for over 20 years. “But she’s operating with one hand tied behind her back because she doesn’t have the full support of her board.”

AHIP has beefed up its Republican ties since the election. It hired David Merritt, who worked for former House Speaker Newt Gingrich, a Trump confidante; Adrienne Morrell, a former top lobbyist for Health Net; and Matt Eyles, who’s worked for health insurers and pharma. It also hired a public affairs shop, Firehouse Strategies, staffed by veterans of Sen. Marco Rubio’s 2016 presidential campaign.

But there’s still a perception on Capitol Hill that the lobbying powerhouse has lost some of its muscle at a crucial time for the health insurance industry.

“They’re afraid of alienating Republicans that they think control their fate over the next four years,” Epstein said.

Conservatives Tell Senators to Pass Health Care Bill or Lose Control of Congress

Source: MSN

Senate Republicans this week will try to prove they’re not slow-walking the remake of America’s health care system, a dicey approach under President Donald Trump and one that’s been causing considerable conservative angst.

To that end, Senate Republicans will get a status update during their weekly caucus luncheon Tuesday, during which they’ll learn about some options being considered for repealing the Affordable Care Act. They’ll hear about potential tax credits, a possible timeline for ending Medicaid expansion and considerations about state waivers.

And with dozens of reporters outside the meeting room, details will get out quickly, allowing Republicans to reassure constituents and interest groups through the press that they’re moving ahead on one of the Republican Party’s most high-profile campaign promises over the past seven years.

“Every day you get closer to an election is a day that it gets harder to do the tough stuff,” said Scott Jennings, a Republican political consultant in Kentucky who has worked for Senate Majority Leader Mitch McConnell. “And the risk in ultimately not getting something done is that you’re accused of breaking your campaign promises. Failure to act is a message to the voters that the status quo reigns in Washington, and that was absolutely what they didn’t want coming out of the November election.”

Failure to deliver would be lethal, said Andy Roth, vice president of government affairs at the Club for Growth.

“Republicans campaigned on full repeal of Obamacare not just this past November, but for multiple election cycles, and now they’ve been given the mandate and the White House to do it,” Roth said. “If they don’t they’re going to lose their majorities in 2018.

“The reason why voters voted for Trump is because they wanted to get something done. Republicans keep saying one thing and then not following through when they get elected,” Roth said.

The Senate prides itself on taking a cautious, deliberative approach to legislation. But that style poses risks, including that the demands of the legislative calendar means a health overhaul will bump up against must-do legislation, including raising the debt limit and writing the 2018 federal budget.

Pushing health care beyond Congress’ August recess could imperil the legislation and give Democrats an opportunity to spend the summer bashing the plan — just as conservative activists spent the summer of 2009 lambasting Democrats and the Obama administration for the Affordable Care Act.

Senators on a weeklong recess last week sounded pessimistic about the chances for progress, even as Senate staffers began putting some proposals to paper. Echoing several of his colleagues, Sen. Richard Burr, R-N.C. told a North Carolina TV station it was “unlikely” the Senate would reach a deal this year. Senate Majority Whip John Cornyn, R-Texas, insisted otherwise, telling a Texas radio station he was confident the Senate would act before leaving town for August.

“Oh, absolutely, we’ll get it done by the end of July at the latest,” Cornyn said.

Monday evening, Sen. John Thune, R-S.D., said the Senate leadership is narrowing its options, but that the Senate needed to hold a vote, trailing off as he said, “if we don’t pass something and we go into ’18 ….”

But he suggested that Republican supporters don’t yet have the votes. “In the end we’ll get to where we have something to vote on and I would hope that we get to where we have 50 votes plus the vice president because I think it’s really important for us to act on this and try to put a fix in place.”

Sen. Roy Blunt, R-Mo., said leadership is “optimistic and we’ll see how it goes in the next few days.” But he said the Senate at a certain point will need to move on: “I don’t think this gets better over time,” he said. “My personal view is we’ve got now until the Fourth of July to decide whether the votes are there or not.”

What’s the risk of not holding a vote?

“Oh, I won’t answer that,” Sen Bill Cassidy, R-La., said.

Health care has been the chief talking point at the weekly lunches for the Republican caucus for weeks. House and Senate Republican leaders also are expected to meet Tuesday with Trump at the White House and discuss health care.

The slow pace so far could prompt additional prodding from Trump, who didn’t hesitate to lash out at House conservatives when he blamed them for imperiling the legislation in the House.

“Oh, Mark, I’m gonna come after you big time,” Trump said at one point, singling out Rep. Mark Meadows, R-N.C., who at the time opposed the bill that Trump and House leaders wanted to pass.

For now, Trump has stuck to cajoling Republican senators, saying on Twitter that they are “good people” who could “hopefully” get a bill passed.

Vice President Mike Pence offered some pressure, telling a crowd in Iowa over the weekend that “this summer, this Congress must come together and heed the president’s leadership, and we must repeal and replace Obamacare.”

More moderate Senate Republicans and those from states that have expanded Medicaid under the 2010 law have voiced worries that the House plan would not provide stability for families in Medicaid expansion programs, which would be phased out under the bill. Conservatives, meanwhile, say the alternatives don’t go far enough to repeal what they consider overreaching provisions in the 2010 law.

Some conservative groups are pressing the Trump administration to move ahead dismantling the Affordable Care Act in the face of Senate inaction. Freedom Partners and Americans for Prosperity last week sent a letter to Health and Human Services Secretary Tom Price urging him not to wait for the Senate.

“We’re disappointed that the Senate is taking so long and that some senators are saying ‘Can this really be done this year?’” said Tim Phillips, president of Americans for Prosperity. “We certainly hope it can be done this year, but either way we’re encouraging Price to move now.”

Still, Freedom Partners noted that rushing legislation would be as much a risk as moving cautiously.

“Repealing is a top priority, but we want the best legislation possible,” said Nathan Nascimento, Freedom Partners’ vice president of policy. “From our point of view, we’ve always called on Congress to take a thoughtful, orderly and transparent approach.”

Senate Republicans have a tenuous path. They hold a narrow majority of 52 to 48 and can lose only a few votes, if Pence casts a tiebreaking vote. And divisions in the GOP there are just as stark as the differences between its factions in the House, which stymied the bill’s progress in that chamber.

Democrats are looking to 2018, believing they have a case to make, regardless of the outcome. Failing to pass the legislation opens Republicans to charges that they broke their promises, but Democrats point out that recent polls suggest Americans are recoiling at reports that millions of people could lose insurance under the Republican plan.

“This bill is as popular as a toxic waste dump so the longer it lingers, the more damage it will do to people who are carrying it,” said Jesse Ferguson, a Democratic strategist working with Protect Our Care, a coalition of liberal groups that have joined to fight repeal of the Affordable Care Act. “Yet even as we’ve seen a lot of Republicans who don’t want to own the damage of health care repeal, we’ve not seen a lot willing to stand up and stop it.”

GOP Senators Weigh Taxing Employer-Health Plans

Source: Fox Business

Senate Republicans set on reworking the Affordable Care Act are considering taxing employer-sponsored health insurance plans, a move that would meet stiff resistance from companies and potentially raise taxes on millions of people who get coverage on the job.

The move could raise billions in revenue that could be used to help stabilize the fragile individual insurance market. But it could be politically risky, since it could expand the impact of GOP health proposals from Medicaid recipients and those who buy insurance on their own to the roughly 177 million people who get coverage through their employers.

A number of lawmakers are open to the idea, including Sen. Mike Lee (R., Utah), GOP aides said, but there is no consensus yet on whether it should be included in the draft bill being written during this week’s congressional recess.

Under longstanding tax law, compensation in the form of health insurance isn’t treated as income for workers. That means employers can deduct the cost and the value isn’t subject to payroll taxes or individual income taxes. It is a system that economists say distorts the market in favor of generous insurance packages, but like other tax breaks, it has proven popular and difficult to dislodge.

Previous efforts to end the tax break have faltered. House Republicans, in crafting their version of the health bill earlier this year, considered limiting the amount companies could exclude from employees’ income for health coverage, but dropped the idea when it faced an immediate pushback.

Business groups opposed the House proposal vigorously, and many House Republicans expressed alarm over the practical and political impact.

“Most of America gets their insurance through the workplace,” said Rep. Warren Davidson (R., Ohio) in an interview Thursday. The House proposal “was an overhaul of the only part [of the health system] that isn’t broken inherently,” he said.

House Speaker Paul Ryan (R., Wis.), who floated the idea in his own health proposal, has said the tax code unfairly favors people who get their health insurance through work over those who buy it on their own. Republicans, Mr. Ryan said in March, want to “stop the discrimination in the tax code against people who want to go out in a free marketplace and buy the health care of their choosing.”

A spokesman for Sen. Lee said he was open to a tax on employer plans but wasn’t ready to commit to supporting anything until he saw the details, particularly how the revenue would be used.

Republicans are hoping to get the health-care law passed in the Senate by the end of June, an ambitious goal given that they have yet to reach consensus on key policy issues.

Nearly all premiums for employer-provided insurance are excluded from federal income and payroll taxes, an arrangement that cost the federal government more than $250 billion in fiscal 2016, according to the nonpartisan Congressional Budget Office. The portion of premiums paid by employees is often also excluded from taxable income.

The exclusion gives employers an incentive to offer more generous coverage, and economists say that raises total premiums and encourages unnecessary spending. Companies and unions who have fought to retain the exclusion say taxing the plans would prompt employers to scale back benefits, pass the cost of the tax to workers, or stop offering coverage altogether.

Despite the political risk, the idea appeals to some senators because it could bring in a lot of money. That is critical because the health bill must achieve at least $119 billion in budgetary savings over the next decade, under Senate procedures allowing the legislation to pass with a simple majority.

Republicans in both chambers have long favored limiting the exclusion but recognized the political risk. “If you start taxing workers for health benefits, you’re really expanding the number of people affected by these proposals,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation.

Discomfort with the tax-free status of employer-sponsored health coverage isn’t limited to Republicans. Former President Barack Obama supported a 40% levy on generous employer plans, though that move, known as the Cadillac tax, has been delayed by Congress until 2020.

Senate GOP Aiming for Vote This Month on Health Legislation

Source: ABC News

Senate GOP leaders plan to vote as soon as this month on major health care legislation even though they remain uncertain, for now, whether their still-unwritten bill will pass, lawmakers said Monday.

The House narrowly passed its own version of legislation to repeal and replace former President Barack Obama’s health care law last month. Senate Republicans have rejected the House bill but have struggled to come to agreement on a version of their own.

But now, with pressing budget deadlines looming and President Donald Trump eager to focus on tax legislation, Senate GOP leaders have decided it’s time to vote and move on.

“We’ve been talking about this for seven years, so now is the time to start coming up with some tangible alternatives and building consensus,” GOP Sen. John Cornyn of Texas said Monday.

Cornyn and others said Senate Republicans would be presented with legislative options at a meeting Tuesday with the goal of making decisions on what is in and what’s out of their bill. A sticking point remains how to unwind the Medicaid expansion in Obama’s law, since some states expanded Medicaid and some did not, and there are Republican senators representing states that did both.

Sen. John Thune of South Dakota, the No. 3 Republican, said that ideally the Senate would vote this month, but certainly before scattering for Congress’ annual August recess.

“The sooner we can do that the better and obviously it gives us time to work through whatever differences there are between our bill and the House bill,” Thune said.

Republicans control the Senate 52-48 and will need 50 votes, plus Vice President Mike Pence, to pass their bill. That means they can only lose two lawmakers, a tall order given significant disagreements that persist over Medicaid and other issues, including money for Planned Parenthood.

But increasingly the expectation is that Majority Leader Mitch McConnell will hold a vote, even if the outcome is that it fails, in order to be able to move on to other issues.

The major goal of the health legislation in the Senate and House has been to lower premiums and expand choices while getting rid of the mandates in “Obamacare” that require people to buy insurance. The House bill would cause 23 million people to lose insurance over a decade, according to the nonpartisan Congressional Budget Office, an outcome that spooked senators. But the other option is spending more money which is also difficult for many to accept.

That’s created a series of tough choices, and resulted in difficulty in drafting legislation that’s acceptable to Republican senators from states with diverse needs.

In a briefing for reporters Monday, White House legislative director Marc Short said of the health care legislation: “What we’re looking to do is get the job done.”

“I think we recognize that this is a crisis that needs to be addressed,” Short said, pointing to rising prices and shrinking choices for some consumers under the existing system.

Last Updated 6/4/2017

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