HHS Slashes Funding to Groups Helping ACA Consumers Enroll By Up to 92 Percent

Image result for hhs imagesSource: The Washington Post

Health and Human Services officials have informed grass-roots groups that assist with enrollment under the Affordable Care Act that their funding will be reduced by as much as 92 percent, a move that could upend outreach efforts across the country.

The groups, which fund organizations known as “navigators,” had been braced for the cuts since the Trump administration announced two weeks ago that it would shrink overall program funding by 41 percent and slash the department’s ACA advertising budget from $100 million to $10 million. At the time of the announcement, HHS officials said the outreach wasted taxpayers’ money.

But advocates of the navigator program, including congressional Democrats and some Republicans from rural states, said Thursday that the deep cuts would undermine work to help consumers get insurance coverage once open enrollment begins on Nov. 1. And the depth of some funding reductions, which were made official late Wednesday, raised questions about those state programs’ viability and the fairness of the administration’s method for deciding how much money each group gets.

“There is no way you can run what we had on $328,000,” said Sarah Sessoms of Insure Georgia, which was hit with a massive cut from the $2.2 million it received last year. The HHS email notice arrived at 11:53 p.m. Wednesday, and “I thought — it was disbelief — that something had to be wrong.”

Enroll Michigan executive director Dizzy Warren, whose group serves all of the state’s 83 counties though a network of more than two dozen groups, is contemplating shutting down within a matter of months now that its $1.2 million grant was slashed to $129,899.

“As you can imagine, this decimates our entire organization,” he wrote in an email. The collective effort there enrolled 16,290 Michiganders in health plans last year.

Navigator groups perform a range of services during the ACA’s annual enrollment season and throughout the year. They help individuals learn which health plans offered on state and federal insurance exchanges would best suit them, walk consumers through the sign-up process and conduct general outreach to communities about how to obtain coverage under the law. The program’s supporters argue that it is particularly critical during the upcoming six-week enrollment period, which is half as long as last year and comes after Republicans’ high-profile attempt to repeal the 2010 health-care law.

“I don’t know how the people who need this help are going to get it,” said Sessoms, adding that Insure Georgia is now exploring its options, including potentially legal ones.

HHS officials in the Trump administration have repeatedly questioned the value of paying navigators. They note that these groups received $62.5 million last year but signed up less than 1 percent of total enrollees. Seventeen of them enrolled less than 100 consumers each, according to the department, at an average cost of nearly $5,000 per enrollee.

“Navigators have been notified of their awards for the upcoming open enrollment period,” HHS spokesman Matt Lloyd, “and the next step is for the grantees to work … to align their activities to the awarded amount and accept the terms of the contract.”

Sen. Tammy Baldwin (D-Wis.), a member of the Health, Education, Labor and Pensions Committee said in a statement Thursday that the cuts reflected the president’s broader effort to undermine the ACA.

“This is nothing short of sabotage,” Baldwin said. “The Trump administration is actively creating chaos and making it harder for Wisconsinites in communities across the state to get covered. That’s just wrong, and it will further destabilize the market and can lead to higher costs for everyone.”

But some conservatives backed the administration’s action.

“The administration clearly has done a cost-benefit analysis in determining if the money that had been spent on the navigator program produced the needed results,” Grace-Marie Turner, president of the Galen Institute, said in an email. “Programs were significantly under performing in their cost per enrollee.”

Although Lloyd said the metric used to determine grant levels was the number of people a group had enrolled in ACA health plans, some organizations that reached past enrollment goals are facing major cuts while others were not touched.

The Kansas Association for the Medically Underserved, where officials said all targets had been met, received full funding, as did Planned Parenthood of St. Louis. Yet Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said New Jersey’s Center for Family Services had its grant go from $805,000 to $291,000 “despite the fact that they exceeded all of their numbers.”

“There doesn’t seem to be a pattern,” she said. “It looks like this could drastically cut back on the availability of in-person assistance in a lot of the heavily impacted states.”

At the Missouri Association of Area Agencies on Aging, which spread nearly $920,000 in navigator money among seven agencies across the state last year, executive director Catherine Edwards learned early Thursday morning that amount would be cut by 62 percent to just under $350,000.

Take Care Utah, a network of nonprofits with roughly 90 navigators, enrollment specialists and insurance brokers, suffered a 61 percent cut, from $740,000 to $289,584. Its director, Randal Serr, noted that Utah had the country’s third-highest increase in federal marketplace enrollment last year, behind Hawaii and South Dakota.

“We will have to make some tough decisions, there’s no way around it,” he said in an email.

At this point, navigators are scrambling to rework their approach for this fall’s enrollment period. As recently as May, federal officials had told Edwards that her association in Missouri could expect to receive a similar grant as last year. Having prepared a budget based on its 2016 award, she now is wondering how she can proceed with the digital and social media campaign planned, especially if many individual navigators are at risk of being laid off.

“At what point does it become ineffective to do any of that?” she asked.

Even before the emails began popping up in organizations’ inboxes, HHS’s abrupt announcement about an overall drop in funding had created havoc for enrollment helpers around the country. It came at the exact time of year when their work becomes intense, ramping up for the always feverish enrollment season, and left them with no money to spend during the first two weeks of September because their previous grants had expired as of Sept. 1.

According to notices sent to organizations late Wednesday, these groups now have just two weeks to send HHS a revised budget and work plan, which federal officials then must approve. They will be allowed to use 10 percent of their award to cover costs they have incurred since Sept. 2, and the reimbursement will be restricted to certain expenses.

HHS informed recipients that their award figures “are considered private and confidential and should not be shared.”

In addition to enrolling consumers, navigators typically advise consumers on how to provide proof of health coverage when filing their taxes; how to find a primary doctor and how to address issues related to premium payments and insurance billing. They also work with employers on fulfilling their obligations under the ACA.

“They don’t count all the other ways we help people,” Serr emailed from Utah. “This is completely a political decision, and not a decision made by people who do this for a living.”

While congressional Democrats have been most critical of the administration’s plan to cut navigator cuts, some GOP officials have warned it could hurt their constituents as well.

Lori Wing-Heier, director of the Alaska Department of Commerce, Community and Economic Development’s insurance division, testified on Capitol Hill last week that in some remote parts of the state “there’s not an insurance broker or a consultant to be found.”

“We are very concerned that it will have a major impact on our enrollment,” Wing-Heier told the Senate hearing. “This would be devastating, to our population.”

Funding for the state’s two navigator groups, Alaska Primary Care Association and United Way of Anchorage, were cut by 24 percent and 27 percent, respectively.

Dems Call for Action Against Cassidy-Graham ObamaCare Repeal

Image result for senate democrats imagesSource: The Hill

Democratic senators are reigniting their calls to fight against another Republican health-care push that aims to repeal and replace ObamaCare after reports surfaced that President Trump and GOP leaders are working to garner support for legislation introduced by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.).

Prominent upper-chamber lawmakers like Sens. Elizabeth Warren (D-Mass.), Dianne Feinstein (D-Calif.) and Chris Murphy (D-Conn.) are taking to Twitter to make impassioned calls for voters to speak up and demonstrate their opposition to the bill.

“Drop what you are doing to start calling, start showing up, start descending on DC,” Murphy tweeted Sunday.

“I’m alarmed,” Sen. Brian Schatz (D-Hawaii) tweeted, while linking to a Politico report that describes the GOP leadership’s back-door push to find support for the legislation.

The measure, put forward by Republican Sens. Bill Cassidy (La.), Dean Heller (Nev.), Ron Johnson (Wis.) and Lindsey Graham (S.C.), aims to give more power to states by converting ObamaCare funding for subsidies — which help people afford health-care coverage and pay for Medicaid expansion — into a block grant to states.

While Senate Majority Leader Mitch McConnell (R-Ky.) has withheld full-throttled support by telling Cassidy and Graham to find the necessary 51 votes on their own, Cassidy says leadership is asking the Congressional Budget Office (CBO) to prioritize its analysis of the measure in an effort to get it to the floor.

“We’re told that CBO was told by our leadership to make this a priority above all other priorities,” Cassidy said Friday, while predicting that he can get enough votes. “Mitch has always said, ‘Show me you can get 50 votes.’ ”

Employer Groups Targeting a Number of Healthcare Reforms in Congress

Image result for employer groups imagesSource: Employee Benefit News

Employer associations are regrouping after Congress failed to repeal and replace major elements of the Affordable Care Act this summer, and they have a number of priorities on their agenda.

Congress is now back in session following the August recess, and there are several deadlines that will bring attention back on the issue in the near term. The Senate has until the end of the month to pass an ACA replacement bill using a process known as budget reconciliation, which requires just 50 votes. Lawmakers also are working to shore up the individual market before Sept. 27, when insurers must finalize the plans they will sell on the exchanges for 2018. Funding for the Children’s Health Insurance Program also expires on Sept. 30.

Beyond that time frame, employer groups are likely to continue to press for a broad range of tweaks that could potentially be taken up as standalone bills or included in packages of must-pass legislation later this year.

Here are some of the biggest legislative priorities for employer associations this fall and what the efforts could mean for employer-sponsored care.

Roll back ACA taxes: Supporters of employer-sponsored healthcare are expected to continue their fight to repeal or delay several ACA taxes this coming fall.

The Cadillac tax, which imposes a 40% excise tax on high-cost plans, remains a particular area of focus for employers. Other taxes that will be targeted include the health insurance tax and the medical device tax.

Obamacare taxes are making healthcare more expensive for employers and employees alike, says James Gelfand, senior vice president for health policy at the ERISA Industry Committee, a national association that advocates for large employers on health, retirement and compensation public policies.

“It’s super important that we eliminate taxes that are raising costs both for us and for them,” he says.

Limit the impact of 1332 Waivers: Employers also want to ensure that any changes to how so-called 1332 waivers are issued don’t have knock-on effects for employer-sponsored care. The waivers allow states to modify certain ACA health insurance requirements, such as essential health benefits and tiers of coverage, and several bills debated this summer included steps to streamline the process for states to obtain the waivers.

It’s an issue that could indirectly affect employer-sponsored care down the line, and it’s one that employer groups will be watching closely. The Employee Retirement Income Security Act currently bars states from passing any laws that would impact employee benefits, including employer-sponsored healthcare.

“Proposals such as providing states more flexibility, which we definitely support, could eventually lead to the erosion of ERISA, if states become accustomed to implementing their own health plans,” says Chatrane Birbal, senior advisor for government relations at the Society for Human Resource Management.

Employer groups say that they are broadly concerned the application of state-by-state variations in healthcare on the exchanges could potentially affect employer coverage in the longer term.

“Our feeling about this is that granting more flexibility to states is fine, as long as it’s focused on individual markets and potentially the small employer market,” says Jim Klein, president of the American Benefits Council. “For large, multi-state employers, the notion that there could be any erosion of the federal ERISA preemption is very troubling. I don’t think there’s necessarily any direct intention to adversely affect large, multi-state employers, so we’re just working with Congress to ensure that doesn’t happen inadvertently.”

Modify the definition of full-time work: Employers plan to continue to advocate for reforms that would raise the bar for when insurance must be offered to workers. The ACA defined full-time work at 30 or more hours, which employers have argued raised their costs, because they had to extend health benefits to additional people.

“It makes sense to set the bar at 40 hours, and if a particular retailer wants to offer coverage at a lower level, it can do so,” says Neil Trautwein, vice president of health care policy at the National Retail Federation.

Reduce reporting requirements: Efforts to fix the ACA’s reporting requirements for employers were largely blocked in the Senate this summer, because the issue could not be considered as part of budget reconciliation. Larger employers must report information about whether they offer coverage to full-time employees, whether that coverage meets certain minimum requirements and its cost.

Standalone bills that focus on streamlining employer requirements are likely to be introduced again this fall.

“We’d love to fix the dysfunctional ACA reporting system,” Trautwein says.

Improve health savings accounts: Gelfand says that employers are continuing to push for a broad array of changes to health savings accounts, including reforms that were not considered over the summer under budget reconciliation rules. Those might include efforts to allow use of HSA funds on concierge care or on a broader array of health activities, like the purchase of gym memberships or activity trackers, in addition to the changes that were introduced as part of earlier bills, such as raising the cap on contributions.

Stabilize individual markets: Many lawmakers are now focused on trying to advance a more limited package of reforms with bipartisan support that would also help shore up the state exchanges.

The Trump administration agreed to pay certain cost-sharing reduction subsidies to insurers for the month of August, but has yet to guarantee that the payments will be made through the rest of the year without congressional authorization. Cutting off those payments could significantly destabilize the exchanges in a number of states.

The issue is another that does not impact employer-sponsored plans directly, but numerous business and employer groups have spoken out in favor of shoring up the individual markets going forward, because of the indirect impacts.

“To the extent that there’s greater instability and more uninsured [in the absence of the CSR payments], the rest of us, whether that’s individuals or companies, end up getting cost-shifted,” Klein says. “We think this needs to be stable and funded.”

It’s also possible that any legislation addressing the subsidies could ultimately include other reforms beneficial to employers, including some of the items outlined above.

CBO: ObamaCare Uncertainty Will Lead to 15 Percent Hike in ACA Exchange Premiums

Image result for obamacare uncertainty imagesSource: The Hill

Premiums for ObamaCare’s benchmark silver plans will increase by an average of 15 percent in 2018, the Congressional Budget Office (CBO) estimated in a new report released Thursday.

CBO blamed the premium hikes on “short-term market uncertainty.”

Insurers have pleaded for more certainty on key ObamaCare payments called cost-sharing reduction subsidies, which reimburse them for giving discounts to low-income patients.

The Trump administration has made the payments on a month-to-month basis, but insurers want them funded on a long-term basis.

The Senate’s Health Committee is working on a bipartisan bill that would fund the payments at least through 2018, but it’s unclear if a deal can be reached between Democrats and Republicans.

They’re working on a short timeline, however.

Insurers must sign contracts by Sept. 27 to be able to participate in the ObamaCare markets next year.

Also contributing to higher premiums in 2018, CBO said, is a higher percentage of the population living in areas with only one ObamaCare insurer.

Several insurers have said they won’t participate in the markets next year, leaving many counties with only one insurer.

Uncertainty in the market will likely be resolved by 2019, CBO said, with premiums expected to be lower.

The CBO also estimated that enrollment will increase from 10 million this year to 11 million next year.

That growth is limited, however, because of premium increases, the Trump administration’s cuts in ObamaCare advertising and outreach funding, and a shorter enrollment period, CBO said.

Medicare for All or State Control: Health Care Plans Go to Extremes

Image result for medicare for all imagesSource: The New York Times

In one Senate office building, some of the leading lights of the Democratic Party gathered Wednesday to embrace what was once a proposal only of the far left: a huge expansion of Medicare, large enough to open the popular, government-run health program to all Americans.

In another Senate office building, a smaller but equally adamant group of Republican senators stood together to take one last stab at dismantling the Affordable Care Act. They proposed instead to send each state a lump sum of federal money, along with sweeping new discretion over how to use it.

Important elements in both parties are trying to move beyond President Barack Obama’s health care law, which has always been a complicated, politically difficult mix of government and private health insurance. But they are moving in radically different directions.

The proposals appeared to have only one thing in common: Neither is likely to be enacted any time soon.

Senator Bernie Sanders of Vermont, the onetime candidate for the Democratic presidential nomination, proposed what he called “a Medicare-for-all, single-payer health care system,” and he said 16 Democratic senators supported it. Those included Elizabeth Warren of Massachusetts, Cory Booker of New Jersey, Kirsten E. Gillibrand of New York and Kamala Harris of California — all names on the list of possible candidates for president in 2020.

“Instead of wasting hundreds of billions of dollars trying to administer an enormously complicated system of hundreds of separate insurance plans, there would be one insurance plan for the American people with one single payer,” said Mr. Sanders, the ringmaster of an event that felt like a political rally, with banners and placards, consumers and patients, labor union members, nurses in red T-shirts and an audience full of fans who applauded, whooped and hollered.

Heading in the other direction were several Republican senators, led by Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, who would take money spent under the Affordable Care Act and give it to states in the form of block grants.

Their proposal was the last gasp of Republican efforts to undo the Affordable Care Act. Those efforts, which seemed sure of success in January, appeared to meet a dead end on the Senate floor in late July, when Republicans could not muster even a simple majority for a repeal bill. Mr. Graham’s gathering had the feel of a health policy discussion at a conservative think tank.

While Mr. Sanders was joined by possible presidential contenders, Mr. Graham and Mr. Cassidy were accompanied by two lower-profile senators, Dean Heller of Nevada and Ron Johnson of Wisconsin.

“The only thing stopping us from having this idea debated on the floor of the United States Senate is lack of leadership,” Mr. Graham said, pleading for help from President Trump and the Senate majority leader, Mitch McConnell of Kentucky.

An hour later Mr. Trump issued a statement saying, “I sincerely hope that Senators Graham and Cassidy have found a way to address the Obamacare crisis.’’

Under the Graham-Cassidy proposal, money would be distributed to states based on a complex formula. The regional cost of living would be one factor, but the sponsors acknowledged that higher-spending states like Massachusetts would receive less than under current law.

The block grant would replace federal money now being spent under the Affordable Care Act for the expansion of Medicaid, for premium tax credits and for subsidies that reimburse insurers for reducing out-of-pocket costs for low-income people.

The Graham-Cassidy bill would repeal the Affordable Care Act’s requirements for most Americans to have coverage and for larger employers to offer it. And it would make deep cuts in Medicaid.

But time is running out on the bill. After Sept. 30, the Graham-Cassidy legislation would lose procedural protections that allow passage in the Senate with a simple majority, rather than the 60 votes often required for major legislation.

Even with those protections, Senator John Cornyn of Texas, the No. 2 Senate Republican, said he had seen no evidence that the bill had the votes needed to win approval in the Senate in the next two weeks. And he noted that it had not been analyzed by the Congressional Budget Office, which could take a week or two to estimate how much the bill would cost and how many people would lose or gain coverage.

Mr. Sanders said he was prepared for a long battle to establish health care as a right. (That was supposedly a goal of the Affordable Care Act.) His bill could serve as a political manifesto and a possible campaign platform for progressive candidates.

That so many Democrats are embracing it is a milestone. About 60 percent of House Democrats have endorsed a “Medicare for all” bill introduced by Representative John Conyers Jr., Democrat of Michigan.

But Democratic leaders in the House and the Senate are steering clear, saying their immediate concern is to protect coverage under the Affordable Care Act, which still faces attacks from Republicans.

Mr. Sanders’s bill would expand Medicare, one of the nation’s largest, most popular entitlement programs. The federal government would establish an annual budget for covered health care services. Medicare’s benefit package would be expanded to include coverage of dental care, vision services and hearing aids. The bill would also cover “comprehensive reproductive, maternity and newborn care, including abortion,” according to a summary prepared by Mr. Sanders’s office.

The federal government would establish a standard list of covered drugs, and the secretary of health and human services would negotiate prices with drug companies.

Mr. Sanders did not say how he would pay for his bill. He issued a list of a dozen financing options, which included higher tax rates for high-income people and “an annual 1 percent federal wealth tax on the net worth of the wealthiest one-tenth of 1 percent of U.S. households.’’

The Sanders bill would eliminate deductibles and most other out-of-pocket costs for consumers, but the government “may impose limited co-payments for prescription drugs in order to encourage the use of lower-cost generic drugs.”

Under the bill, Medicare — now available to people 65 and older and to some younger people with disabilities — would be expanded over four years. In the first year, Medicare would be opened to children through age 18 and to adults from 55 to 64. The eligibility age would be reduced to 45 in the second year and to 35 in the third year, with “every resident of the United States” entitled to benefits in the fourth year.

That would bring huge changes to the health care system, affecting many people who are content with the coverage they have. More than 150 million people under the age of 65 have employment-based coverage. The Sanders bill would separate health insurance from employment, shrinking the role of employers and insurance companies.

Employer-sponsored plans could not duplicate benefits provided by Medicare, but could offer extra benefits.

Mr. Sanders predicted that “insurance companies, drug companies and Wall Street won’t like this legislation,” and he was right.

David Merritt, an executive vice president of America’s Health Insurance Plans, a lobby for insurers, said: “Whether it’s called single-payer or Medicare for all, government-controlled health care cannot work. It will eliminate choice, undermine quality, put a chill on medical innovation and place an even heavier burden on hard-working taxpayers.”

Senate Committee Closer to Bipartisan ACA Fix, Kaiser CEO Bernard Tyson Makes a Promise

Image result for bipartisan aca fix imagesSource: Fierce Healthcare

Members of a Senate committee are moving closer to creating bipartisan legislation to stabilize the individual insurance markets, but they’re mostly split along party lines over the finer points—including how long the stabilization measures should be in place.

A prime example: There’s consensus that payers need the government to continue funding cost sharing reduction (CSR) payments, which the Trump administration has threatened to cut off.

Several witnesses who came before the Senate Health, Education, Labor and Pensions committee in the first three of four hearings stressed that insurers, already making plans for 2019, need at least a two-year guarantee.

Committee Chairman Sen. Lamar Alexander, R-Tenn., said he’ll support a single year fix, while Sen. Patty Murray, D-Wa., the committee’s ranking member, called for a “multi-year” fix.

CSR payments—or the lack thereof—will have the biggest impact on the rates payers set for 2018. Those rates are due to state insurance commissioners by the end of this month.

There also seems to be a consensus that states should have more flexibility to design their own fixes and choose what programs are best for their own patient populations.

But, again, it’s a matter of degrees. Republicans are more bullish on loosening ACA regulations than Democrats, who want to protect so-called “guardrails,” minimum requirements for any state requests for ACA waivers.

Although there have been reports that Democrats are worried that their peers on the other side of the aisle are pulling the negotiations in a more conservative direction, Alexander continued to stress that the “partisan political stalemate” is a big problem.

Lamar expressed support for some of those guardrails and other parts of the ACA. “I’m not proposing we change” protection for patients with pre-existing conditions, allowing young adults to stay on their parents’ health plans, guaranteeing consumers the right to buy health insurance or regulations against annual limits, he said.

As the CEO of Kaiser Permamente, which has both a payer and a provider arm, Bernard Tyson was the first—and only—industry witness at the three hearings the committee has held so far.

Not surprisingly, he urged the committee to guarantee “multi-year” CSR payments, to enforce the ACA’s individual mandate, to continue funding marketing and outreach programs and to repeal the unpopular insurance tax.

But Tyson also spoke at yesterday’s hearing about what payers would give in exchange for those stabilization efforts.

“In return I will recommend that you demand … my colleagues [and I] step up to the plate. I can tell you with certainty that many will get back into the market. You don’t have to take my word alone, call them directly,” he said, adding that he has already made calls and that high-profile payer CEOs including Anthem’s Joe Swedish and Cigna’s Mark Bertonlini agree.

The fourth and final hearing is Thursday at 10 a.m. and the committee will hear from payer and provider leaders, including Susan L. Turney, M.D., CEO of Marshfield Clinic Health System and Robert Ruiz-Moss, vice president of Anthem’s individual market segment.

Obamacare Is Suddenly In Grave Dangers. Here’s Why

Image result for obamacare danger imagesSource: MSN

A last-ditch Republican effort to repeal Obamacare picked up steam on Monday as a key senator opened the door to supporting the bill, which is popularly known as Graham-Cassidy.

The GOP got a boost when Sen. John McCain, R-Ariz., who was one of three Republican “no” votes in July that derailed the last GOP health care effort, said he might “reluctantly” vote for the bill if his governor supported it.

Arizona Gov. Doug Ducey, a Republican, backed the legislation later that day. McCain has yet to take a solid position on the measure and has said he prefers a longer bipartisan approach. The Senate Finance Committee announced it would hold a hearing next week on the bill, which could help address his complaints about the rushed process.

Democrats and health care advocacy groups opposed to the legislation, which include AARP and the American Heart Association, are taking the latest Republican push very seriously.

Republicans lawmakers face a tight deadline to get it done: They can only pass the bill using budget reconciliation, which lets them bypass a Democratic filibuster, if they vote before September 30.

Here’s what you need to know about what the new GOP health care bill does, where senators stand, and what would have to happen for it to pass.

What’s in the bill?

In many ways, the bill is the most sweeping proposal yet. It would do away with Obamacare’s Medicaid expansion, subsidies for private insurance, eliminate the requirement that Americans have insurance under the Affordable Care Act, and payments to insurers to reduce out-of-pocket costs.

In their place, it would offer states a new block grant they could use to spend on health care mostly as they saw fit. But the block grant would include less total federal spending, meaning states would struggle to cover the same number of people.

How much states would get would depend on a new formula that would cut funding for some states and potentially raise it for others. It would slash the most from large blue states that spend more on health care, like New York and California, and redistribute it to poorer red states that spend less, like Texas and Alabama. Smaller states that rely on Obamacare’s Medicaid funding, like Kentucky and Alaska, could be hit hard as well.

In effect, the bill would open up all 50 states to major health care changes depending on their approach. Some might loosen protections on pre-existing conditions by allowing insurers to charge sick patients more or drop requirements that insurers cover certain essential health benefits. States also would not be required to focus their spending on low-income residents, who were the largest beneficiaries of Obamacare.

Other features are common to Republican repeal-and-replace bills: Traditional Medicaid would face new per-person caps on spending and would likely grow at a slower rate than under current law. The bill would also repeal Obamacare’s requirements that individuals buy insurance and employers offer it. It would also cut off funding to Planned Parenthood.

How many will be covered? Cost?

There isn’t a detailed estimate yet and the senators, if the vote on it, won’t see one either. That’s because the Congressional Budget Office, a nonpartisan agency that reviews legislation, announced on Monday that it would not be able to complete a full study by September 30.

When the CBO looked at previous GOP bills that scaled back Medicaid funding and imposed caps on future spending, however, it estimated major losses from those policies alone. The CBO also predicted that loosening protections on pre-existing conditions would cause some insurance markets to become unstable and significantly raise costs for certain medical treatments while lowering premiums.

Who could stop it?

That’s hard to answer. The Senate Republicans can only lose two members.

McCain’s position is unclear and Sens. Susan Collins, R-Maine and Lisa Murkowski, R-Alaska, the other two Republican who voted with McCain against GOP “skinny repeal” health care bill, have been highly critical of Medicaid cuts. Collins and Murkowski also opposed defunding Planned Parenthood, which Graham-Cassidy would do as well.

Neither Murkowski nor Collins have taken a decisive position on Graham-Cassidy, but they are likely to be tough gets based on their many concerns with prior repeal bills. Collins said she had a “number of concerns” with the bill, including its Medicaid changes, in a statement on Monday.

“Medicaid was probably the policy area that was the most sensitive in the Senate,” said Joe Antos, a scholar at the American Enterprise Institute.

Graham-Cassidy also has at least one strong “no” vote from the right from a lawmaker who had supported “skinny repeal.” Sen. Rand Paul, R-Ky., has gone on a public rampage against Graham-Cassidy in recent days, which he says doesn’t go far enough in repealing Obamacare.

Meanwhile, Sen. Lamar Alexander, R-Tenn., who chairs the Senate HELP committee, is currently making progress on a bipartisan health care bill with modest Obamacare tweaks. If Graham-Cassidy fails, it could be a fallback option.

Many Republicans are still undecided on Graham-Cassidy and prior repeal attempts have attracted some surprising holdouts in crunch time. Already, some conservatives have said they’re worried the bill would open the door to liberal states enacting single-payer health care programs, which could provide another reason for them to oppose it.

On the other hand, Republicans have been hammered — including sharply by President Donald Trump — for failing to produce a health care bill after years of promises to repeal and replace Obamacare. That pressure could prompt holdouts to take a chance on the bill.

If the measure does pass the Senate, it would have to then clear the GOP-controlled House without any changes — and there’s a deadline. After September 30, any new bill would be subject to a 60-vote threshold in the Senate to get past a Democratic filibuster.

Health-Care Industry Asks Senate for Two Years of Obamacare Subsidies

Image result for health care carriers images

Source: Forbes

The health-care industry is asking for a two-year commitment of funds from the U.S. Senate’s health committee as a bipartisan group of legislators begins work Wednesday and Thursday to fix the individual insurance market under the Affordable Care Act.

Lobbies for health insurance companies, doctors and big business are asking the Senate Committee on Health, Education, Labor and Pensions to provide more stability than the Donald Trump White House, which has paid for cost-sharing reductions (CSRs) on a month-to-month basis.

Without CSRs, Obamacare customers face cost increases of 20%-25% or more, insurers say . And hospitals have said they expect unpaid bills to begin piling up faster than they already are.

“We urge the committee to include continuous funding for CSR benefits for at least the next two years (2018-2019) as part of bipartisan legislation to stabilize the individual market,” the health-care lobbies, led by America’s Health Insurance Plans, wrote to Sens. Lamar Alexander (R-Tennessee) and Patty Murray (D-Washington) in a letter issued Tuesday. “Without two years of CSR funding, uncertainty will persist, and the Congress will need to address these same issues early next year.”

The lack of a commitment on CSRs has led some insurers like Anthem and Molina Healthcare to scale back their individual offerings in certain states under the ACA. Aetna, UnitedHealth Group and Humana have also complained of an unstable individual insurance market in deciding to pull individual products off the exchange after being unable to successfully manage health costs of sick patients who had bought Obamacare policies.

Trump committed to funding CSRs for August but not beyond that, despite intensifying pressure from the health-care industry. But neither Trump or Health and Human Services Secretary Tom Price have offered a long-term commitment to CSRs.

Without CSRs, there will be an average increase in premiums for “benchmark silver plans by 20 percent in 2018 and by 25 percent in 2020,” the lobbies said. The others that signed the letter to Senators Alexander and Murray were the American Academy of Family Physicians, the American Benefits Council, the American Hospital Association, the American Medical Association, the Blue Cross Blue Shield Association, the Federation of American Hospitals and the U.S. Chamber of Commerce.

“CSR benefits help those who need it most: low- and moderate-income Americans with incomes under 250 percent of the federal poverty level,” the industry’s letter says. “Nearly 60 percent of exchange-plan enrollees rely on CSR benefits, which translates into comprehensive coverage and access for nearly six million individuals and families. The CSR program makes it more affordable for patients to receive needed medical care and services by reducing deductibles, co-payments and out-of-pocket maximums.”

Doak to Senate Panel: Audit the ACA Navigators

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Source: Think Advisor

John Doak, the Oklahoma insurance commissioner, today gave members of a Senate panel advice that would please many health insurance agents and brokers: He called for the Senate Committee on Health, Education, Labor and Pensions to investigate the Affordable Care Act Navigator program.

“I would ask for the full Senate committee to do an audit of the Navigator program,” Doak told Sen. Tammy Baldwin, R-Wis., a Senate HELP Committee member. “Are they doing the job they’re supposed to be doing? Where’s the checks and balance there?”

Doak was one of five state insurance commissioners who appeared as witnesses at a Senate HELP hearing in Washington on stabilizing the individual major medical insurance market. The hearing is one of four the committee has scheduled on the topic for this week and the next. The other witnesses at today’s hearing were Mike Kreidler of Washington state; Julie Mix McPeak of Tennessee; Lori Wing-Heier of Alaska; and Teresa Miller, who recently left her post as Pennsylvania’s insurance commissioner to take over as head of the state’s Health and Human Services Department.

The ACA drafters hoped the Navigator program would create independent, nonprofit ombudsmen who would help consumers use the new ACA public health insurance exchange system. The idea was that the ombudsmen would show consumers the difference between a premium and a deductible, and how to use exchange websites, without trying to sell the consumers insurance.

Agents and brokers have complained for years that the Navigator ombudsmen have competed with them for business, and given consumers advice about complicated, sensitive matters without having the proper training or liability insurance.

As of Tuesday, none of the 20 witnesses scheduled to appear at the Senate HELP individual health hearings was appearing as an agent or broker.

Doak, however, has worked in the past as an insurance broker for Aon. One of the other commissioner witnesses, Wing-Heier, has worked as an independent broker and as a corporate risk manager.

Doak brought up the topic of agents and brokers at the hearing. Oklahoma has agents and brokers in each of its 77 counties, he said.

“They’re trained insurance professionals that should be the ones helping folk,” Doak said.

The Senate HELP Committee streamed the hearing live on the web. A recording of the video, and written versions of the witnesses’ testimony, are available here.

Here’s a look at seven other idea that came up at the hearing.

1. Make using an existing ACA rule waiver program earlier.

The ACA itself includes a provision, Section 1332, that lets states apply for waivers from some ACA rules in an effort to increase access to coverage, improve the quality or reduce the cost.

The Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services arm in charge of the Section 1332 waiver program, has been helpful, Wing-Heier said.

But one problem is that, even though CMS is helpful, it has not created a form that a state can use to apply for a waiver and know whether its waiver proposal meets CMS guidelines, Wing-Heier said.

Officials at CMS then take six months to make a decision on the waiver program application, she said.

She said one thing officials could do to stabilize the individual major medical market is to create a clear process a state can use to apply for an individual market stabilization-related waiver.

2. Keep existing ACA subsidy programs in place until and unless new market rules replace the current ACA rules.

Doak, a Republican, is strongly opposed to the ACA, but he said the individual major medical market, as it is now structured, needs the ACA reinsurance program, which helps shield insurers against some of the cost of covering individual policyholders with catastrophic claims, and the ACA cost-sharing reduction subsidy program, which helps low-income exchange plan users pay their co-payments, coinsurance amounts and deductibles.

The other commissioners at the hearing, including both ACA opponents and ACA supporters, said they also agree on the need to keep the current stabilization programs in place at least until 2019.

3. Recognize that changing an insurance plan takes time.

The commissioners emphasized that insurers and regulators need a chance to comment on any proposed changes, and adequate time to implement any proposed changes.

“Insurers, right now, are already planning for 2019,” Kreidler said.

Any indication that policymakers will impose sudden changes or continue the current state of uncertainty about the market rules will chase more carriers out of the individual market, Kreidler said.

4. Consider letting individuals team up to buy health coverage.

Sen. Rand Paul, R-Ky., argued that the individual market works as poorly as it does partly because consumers have no ability to team up to buy coverage, and to enjoy the same kind of regulatory framework large, self-insured employers enjoy.

Another challenge is that health insurers have increased their overall profits to $15 billion per year, from $6 billion per year before the ACA started, largely because of strong profits in the group market, but then cherry pick and refuse to stay in the individual market, Paul said.

In the past, many insurance regulators and insurers have argued that various types of health plan purchasing coalition proposals would lead to antiselection programs, but Doak told Paul he thinks the purchasing coalition idea has some merit.

5. Remember that each state has its own problems.

Wing-Heier pointed out that Alaska has built-in cost problems because it has a small number of people in its individual market, many of those people have chronic conditions, and care is expensive.

Wing-Heier said Alaska has tried to find ways to merge its individual market with individual markets in other states, to benefit from putting its residents in a larger individual market risk pool.

“Our experience has been so bad that nobody’s wanted us,” she said. “We have not been an attractive risk.”

6. Invest in advertising for the individual major medical open enrollment period for 2018.

The Trump administration has proposed cutting overall advertising spending 90%, focusing on digital advertising, and cutting the Navigator organizations’ funding 40%.

Miller, Kreidler and Wing-Heier that stronger advertising and marketing support will help increase individual health enrollment, and that increasing enrollment will improve the stability of the individual market, by improving the average health level of the insured population.

7. Be open-minded about Navigators.

Oklahoma may have agents and brokers in every county, but Alaska has few agents and brokers outside the big cities, and it has few agents and brokers who can speak the many languages that the uninsured residents of Alaska speak, Wing-Heier said.

States like Alaska need Navigators to fill in outreach gaps, she said.

Booker Signs On To Sanders’s “Medicare-for-all” Bill

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Source: The Hill

Sen. Cory Booker is throwing his support behind a “Medicare for all” bill being introduced by Sen. Bernie Sanders (I-Vt.), becoming the latest Democrat floated as a 2020 contender to back the legislation.

The New Jersey senator told NJTV News that he would sign on as a co-sponsor of the bill, which is scheduled to be rolled out on Wednesday.

“This is something that’s got to happen. ObamaCare was a first step in advancing this country, but I won’t rest until every American has a basic security that comes with having access to affordable health care,” Booker told the New Jersey outlet.

He added that “you should not be punished because you are working-class or poor and be denied health care. I think health care should be a right to all.”

Booker’s office didn’t immediately respond to a request for comment about his decision.

Sanders put his push for a single-payer healthcare system at the center of his 2016 presidential bid, and he has pledged for months that he would introduce legislation.

The idea is also gaining traction within the Democratic Party and is emerging as a litmus test for potential 2020 presidential candidates.

In addition to Booker, Democratic Sens. Elizabeth Warren (Mass.) and Kamala Harris (Calif.) are supporting Sanders’s legislation.

Sen. Jeff Merkley (D-Ore.) also announced his support on Monday.

Booker had previously voiced some support for single-payer.

Asked on Twitter if he would support the government-run healthcare system, he said “there is great value if not justice In opening up Medicare to all” but Democrats should be focused on stopping the GOP effort to repeal and replace ObamaCare.

Despite growing support from the party’s 2020 presidential crowd, Sanders’s push for a single-payer system doesn’t have unanimous support from the Senate Democratic caucus.

Senate Minority Leader Charles Schumer (D-N.Y.) said earlier this year that it should be one of the options on the table.

And four Democrats up for reelection in states won by President Trump, as well as Independent Sen. Angus King (Maine), voted against a recent single-payer amendment offered by GOP Sen. Steve Daines (Mont.).

Daines’s amendment, which was expected to fail, was largely viewed as an attempt by Republicans to get Democrats to go on the record on the issue.

Last Updated 9/8/2017

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