Despite Attacks on Obamacare, the Uninsured Rate Held Steady Last Year

Image result for images Despite Attacks on Obamacare, the Uninsured Rate Held Steady Last YearSource: New York Times

Last year, Trump administration officials declared Obamacare “dead,” pulled enrollment ads offline, distributed social media videos critical of the law and sent signals that the law’s requirement to buy health insurance was no longer in effect.

But the number of Americans with health insurance stayed largely unchanged. The results of a big, government survey on health insurance status were published Tuesday, and they show that the uninsured rate remained basically flat at 9.1 percent in the first year of the Trump presidency.

The new statistics come from the Centers for Disease Control and Prevention, which monitors the number of Americans with and without health insurance every quarter. A smaller survey from Gallup had shown the uninsured rate rising last year. And a survey from the Commonwealth Fund showed a small rise, though it was statistically insignificant. But the C.D.C. research includes a larger sample size, and is generally regarded as a more definitive study. Tuesday’s study contains data from the entire calendar year of 2017.

Among states that expanded their Medicaid programs under the Affordable Care Act, the uninsured rate actually fell last year. Among states that didn’t expand, it rose a little.

Overall, Obamacare has substantially reduced the number of Americans without insurance. According to the report, 19.3 million fewer people were living without health insurance in 2017 compared with 2010, when the Affordable Care Act passed Congress.

New health insurance options aren’t the only thing that has changed since the passage of the Affordable Care Act. A strengthening economy has nudged more Americans into the work force, increasing people’s access to health insurance at work.

Obamacare has shown other signs of hardiness. This year, the Trump administration slashed the program’s advertising budget by 90 percent, and withdrew key subsidies from insurance companies, leading to premium increases for some customers. But every market had at least one insurer that continued to offer plans on the Obamacare marketplaces, and sign-ups dipped only slightly.

That does not mean that the insurance trends will hold forever. There are several reasons the uninsured rate may rise in the future:

  • In the face of rising premiums, it is likely that some who do not qualify for federal subsidies have dropped coverage this year.

  • Several states are trying to set up work or other “community engagement” requirements for some Medicaid beneficiaries. A few will impose such rules this year. States requesting such changes estimate they will result in a declining number of residents covered by Medicaid.

  • The Trump administration is working on regulations to allow more loosely regulated insurance plans into the market. These plans could prove appealing to some people who are currently uninsured. But they could cause prices to rise for insurance plans with all of the Obamacare consumer protections, prompting other people to drop their coverage. According to an estimate from the Urban Institute, about 2.6 million fewer people may have comprehensive coverage next year.

  • The tax penalty for people who decline to obtain insurance will disappear entirely next year. That change alone is likely to cause several million fewer Americans to have insurance. Early filings by insurance carriers suggest the change will cause another round of big price increases. And economists at the Congressional Budget Office estimate that the policy’s disappearance will also cause fewer people eligible for government help from even investigating such options.

The combination of those changes is likely to mean some backsliding. But last year’s data suggest that Obamacare’s policies have helped create options that are appealing to many Americans who would have gone without insurance in the years before its passage.

FDA Names Drugmakers Accused of Blocking Cheaper Generics

Image result for images FDA Names Drugmakers Accused of Blocking Cheaper Generics

Source: ABC News

U.S. drug regulators are publicizing information on brand-name drugmakers that use what government officials call “gaming tactics” to block cheaper copycat versions.

The Food and Drug Administration’s new webpage names the makers of more than 50 brand-name drugs, many carrying five- or six-figure annual price tags, who are under scrutiny. The agency also lists inquiries it has received from generic drugmakers requesting FDA’s help in getting access to the brand-name drugs though not all the complaints have been verified.

Generic drug companies generally require 1,000 to 1,500 units, such as pills, of a brand-name drug to create much-cheaper drugs with identical active ingredients and effects. The FDA said Thursday that brand-name drugmakers sometimes refuse to sell generic companies drugs that may need extra safety monitoring or bar drug wholesalers from selling other medicines to generic drugmakers.

“We hope that this increased transparency will help reduce unnecessary hurdles to generic drug development and approval,” the FDA said in a statement.

Delayed launches of generic versions of drugs whose patents have expired usually push higher costs onto patients, employers and taxpayers.

One drugmaker strategy — a limited distribution network in which the company only provides its medicine to one or two wholesalers or pharmacies instead of many distributors — enables the maker to better control and raise prices. That’s how former Turing Pharmaceuticals CEO Martin Shkreli was able to hike the price of a 60-year-old anti-infective drug, Daraprim, from $13.50 to $750 per pill.

Several of the world’s largest drugmakers were cited by FDA as having refused to sell more than one medicine to generic companies, often drugs long on the market that generate billions in annual sales. Those include Switzerland’s Novartis AG, cited for blocking access to four medicines, and Summit, New Jersey-based Celgene Corp., cited for blocking access to three drugs.

Many of the drugs are for various cancers, HIV and heart disease.

Novartis said in a statement that it “disagrees with the inclusion of our products on the list.” The company said its drugs on the list have a generic version under FDA review.

Celgene said generic versions of some of its drugs will reach the market “in coming years.” But the drugmaker said there needs to be a better process to ensure the safety of generic versions on the market since its three drugs on the list carries serious risks including birth defects.

Celgene is accused of using a second strategy for blocking generics that FDA also is targeting. It involves riskier-than-average drugs that fall under an FDA program intended to limit use to patients most likely to benefit, who are urged to take precautions such as preventing pregnancy.

The FDA said in some cases brand-name companies have improperly used that as a reason to refuse to sell samples to generic drugmakers.

That tactic costs patients, insurers and government programs more than $6 billion annually, according to a trade group for generic drugmakers.

Major Players Begin Meeting Today in Effort to Make Healthcare Safer for Patients

Image result for images Major Players Begin Meeting Today in Effort to Make Healthcare Safer for Patients

Source: Fierce Healthcare

Some of the top healthcare groups—including government agencies like the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services—will gather today for the first time to examine new ways to make healthcare safer for patients.

Led by the Institute for Healthcare Improvement (IHI), a newly launched steering committee will seek to refocus the industry’s attention on safety and quality goals, such as finding ways to cut down on medical errors. In all, a collection of 24 groups including private organizations like the American Hospital Association and the ECRI Institute will be part of the new committee.

Tejal K. Gandhi, M.D., chief clinical and safety officer at IHI and one of the committee’s co-chairs, told FierceHealthcare in an interview that the committee spawned from a call to action released last year by the National Patient Safety Foundation (NPSF). By joining forces, these agencies can “achieve more synergy” that drives change, she said.

“We can work together to accelerate our progress instead of all of us [working] independently,” Gandhi said.

Gandhi said the steering committee is looking to set between 10 and 15 patient safety goals that “haven’t had the attention they need.” Providers have focused on reducing readmissions or on improving infection rates, for example, but could put more focus on building a culture of safety, she said.

Innovations in patient safety are crucial as the healthcare system transitions its focus away from traditional sites of care to outpatient and ambulatory settings, according to an announcement from IHI.

The group notes that medical errors are a common problem. A study released late last year by IHI and NPSF found that one in five patients have experienced an error, and a 2016 study published in The BMJ found that medical harm is the third leading cause of death in the U.S.

The NPSF’s call to action, released in March 2017, centered on the idea that a coordinated effort across the healthcare system was necessary to achieve the ultimate goal of zero patient harm.

Jeffrey Brady, M.D., director of the Center for Quality Improvement and Patient Safety at AHRQ and the committee’s other co-chair, told FierceHealthcare that uniting groups with a broad patient safety perspective with ones with a more specialized focus is a crucial idea behind the committee.

“We’re really all at our best when we balance that broad perspective with the deep expertise in specific areas,” Brady said. “It’s a winning formula.”

Gandhi said the committee members are hoping their efforts bear fruit in the next three years, producing “real measures of success” within that window.

Premium Hikes Reignite the ObamaCare Wars

Image result for images Premium Hikes Reignite the ObamaCare Wars

Source: The Hill

The ObamaCare premium wars are back.

The cost of health insurance plans on the ObamaCare exchanges could jump in the coming weeks, some by double digits, inflaming the issue ahead of the midterm elections.

Democrats argue the price increases are the result of what they refer to as “Republican sabotage.” They contend that, since the GOP controls Congress and the White House, the price hikes are their responsibility — and that’s the message they plan to take into the fall campaign.

“If these early states are any indication, health insurance companies are going to ask for huge hikes in the wake of President Trumpand congressional Republicans’ repeated efforts to sabotage our health-care system,” Senate Minority Leader Charles Schumer (D-N.Y.) said at a press conference last week. “And we Democrats are going to be relentless in making sure the American people exactly understand who is to blame for the rates.”

Republicans counter that it was Democrats who passed the law, enacted in 2010, in the first place and without any GOP votes. And they blame Democrats for the failure to pass a bill that was aimed at shoring up ObamaCare’s exchanges.

Democrats wrote the Affordable Care Act, so “they should look in the mirror,” Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health Committee, said last week on the Senate floor.

“And this is the very worst. When Republicans were prepared one month ago to stabilize these markets — and according to the Oliver Wyman health-care experts, to lower rates by up to 40 percent over three years — the Democrats said no,” he said.

For years, Republicans had the upper hand on health care, with the backlash to the Affordable Care Act helping them win the House in 2010, the Senate in 2014 and the White House in 2016.

During the Obama administration, Republicans railed against ObamaCare premium hikes while pledging to repeal and replace the law.

But that repeal push ended in failure last year, and Democrats say the political winds have shifted in their favor.

Democrats argue that any higher premiums this year will be a direct result of the Republican Congress and the Trump administration. They refer to certain actions by the GOP — such as the repeal of the individual mandate to have health insurance — as acts of “sabotage” that will siphon healthy people out of the ObamaCare insurance markets, leading to sicker people on the plans and higher costs.

“Thus far, Democrats have been on the defensive about premium increases,” said Cynthia Cox, a health insurance expert with the Kaiser Family Foundation. “Now they’re starting to play offense, and from our polling we’ve seen that a lot of the public now feels that the Trump administration and Congress are responsible for any problems with the [Affordable Care Act] going forward, so it may be that the politics of premium increases has changed.”

Protect Our Care, a pro-ObamaCare group, launched “Rate Watch” on Tuesday, a media campaign and website aimed at getting out the Democrat’s message that Republicans are to blame for rate hikes.

Only a handful of states have released proposed premiums for next year, as insurers are largely still hammering out what their preliminary rates are going to be.

In Maryland, the average proposed increase among insurers and plans was 30 percent. CareFirst BlueCross BlueShield, for example, requested an 18.5 percent hike for its HMO plans and 91.4 percent for its PPO plans.

In Virginia, proposed rate hikes varied widely, from 15 percent to 64 percent. Vermont’s proposed premium increases were more modest.

It’s too early to know the full picture for what premiums will look like around the country for 2019. Insurers tend to file proposed rates in the late spring and early summer, and they’re generally not finalized until early fall — a little more than a month before the ObamaCare exchanges open for business on Nov. 1.

“It’s hard to come up with a general impression … but I think what we can expect is probably another year of double-digit rate increases driven in large part by the individual mandate repeal and the expansion of short-term health plans and association health plans,” Cox said.

The Trump administration proposed a rule to increase the length of time a consumer can keep a plan that doesn’t comply with ObamaCare’s insurance regulations from three months to nearly a year. Democrats deride those plans as “junk insurance.”

Association health plans would let small businesses and self-employed individuals band together to buy coverage that doesn’t comply with ObamaCare’s rules.

Republicans say the rules will expand choice and allow people to buy cheaper alternatives to ObamaCare plans.

Some insurers have cited the repeal of the individual mandate as a factor in their decision to propose rate hikes, and at least one also included the proposed regulations from the administration as a factor.

Some insurance commissioners across the country are approaching the open enrollment period with a level of “concern and a bit of trepidation,” said Julie Mix McPeak, Tennessee’s insurance commissioner who serves as the president of the National Association of Insurance Commissioners.

In McPeak’s home state, she’s hopeful that signs are pointing to rates beginning to plateau and that Tennessee won’t see the large hikes of years past.

“My experience in Tennessee … is not typical for all of the states in the United States,” said McPeak, who was appointed to run the state’s insurance department by Gov. Bill Haslam (R.).

“I’m hearing from some of my colleagues from the national perspective that they are looking at significant rate increases,” she said.

Dave Jones, California’s Democratic insurance commissioner, said he’s worried that some insurers may leave parts of the state.

“We’re working closely with our exchange and other California agencies to do everything we can to encourage insurers to stay and to create as much stability as we can, not withstanding all of the rocks that the Trump administration is throwing at health-care reform,” he said.

If the short-term and association health plan rules are implemented, Jones said he’s prepared to file litigation aimed at stopping the regulations.

In North Dakota, the state’s Republican insurance commissioner is more optimistic.

Jon Godfread said he expects North Dakota’s marketplace will consist of three carriers selling plans across the state — an increase from last year, when areas had only one or two insurers to choose from.

As for rate hikes, he’s hoping in the low double-digits or, worst case, in the 18 percent to 22 percent range. He believes the repeal of the individual mandate won’t have much impact on consumer behavior in North Dakota because people who couldn’t afford insurance have likely already left the marketplace in the state.

“Health insurance and health care by its very nature is demographic,” Godfread said. “We may be leading into a somewhat calm year — in North Dakota, at least that’s what we’re hoping for. But that doesn’t mean my colleagues in Iowa and Nebraska and other places aren’t facing some pretty significant challenges, and we very well, that could be us next year, or it could be us this year still, too. There’s a lot of time between now and open enrollment.”

GOP Chairman In Talks With ‘Big Pharma’ On Moving Drug Pricing Bill

Image result for images GOP Chairman In Talks With ‘Big Pharma’ On Moving Drug Pricing Bill

Source: The Hill

Sen. Chuck Grassley (R-Iowa) said Monday he is in talks with drug companies about a possible deal to pass a drug-pricing bill in exchange for separate action that the companies want.

Grassley, the chairman of the Senate Judiciary Committee, said he is hoping the Senate will soon pass a bill known as the Creates Act, which cracks down on the tactics drug companies use to delay the introduction of cheaper generics.

Grassley told reporters that he is in talks with “Big Pharma” about using the savings from passing that bill to fund other priorities that drug companies want, likely a reference to a separate fix that drug companies have been pushing for to reduce their costs in Medicare.

“I think we’re getting some talk between us and Big Pharma,” Grassley told reporters Monday evening. “Big Pharma’s interested in the money that it brings in to offset some things they want done, and so we’re in talks on that and I hope it can get done.”

The talks could be a way to finally get the Creates Act moving and get a bipartisan bill aimed at lowering drug prices over the finish line. The measure has been stalled for months, despite support from members of both parties, amid strong lobbying in opposition from the pharmaceutical industry.

Grassley indicated that opposition from drug companies could change if they can get the separate fix in exchange.

Namely, drug companies have been pushing to undo a provision from the budget deal in February that shifted significant new costs onto the pharmaceutical industry as part of closing a gap in Medicare coverage known as the “donut hole.”

The roughly $4 billion in savings from the Creates Act could be used to help pay for undoing that change.

Asked if they were open to a possible deal on those issues, a spokesman for the Pharmaceutical Research and Manufacturers of America declined to comment.

Grassley said he had thought that a similar deal could be worked out for inclusion in the government funding bill in March, but that it fell through at the time.

President Trump’s announcement of a plan to lower drug prices earlier this month has increased talk about action, although Trump’s plan is largely focused on executive actions, not on Congress.

Speaker Paul Ryan (R-Wis.) said last week there are discussions on the Creates Act in the House as well. He said lawmakers are working on a “compromise” on the bill.

Grassley said he is also hoping for action on “pay for delay” legislation, which cracks down on branded drug companies paying generic companies to delay introduction of competitors.

Ab 3087 Would Dismantle California’s Health Care System

Image result for images AB 3087

Source: Bakersfield Californian

Preserving and improving access to health care should be a priority for lawmakers. But a proposal now under consideration in the state Assembly would do the opposite dismantling our state’s health care system as we know it, resulting in massive cuts to patient care services and the potential loss of 175,000 jobs across the state.

Assembly Bill 3087, introduced by Assemblyman Ash Kalra,  D-San Jose, would create a government-run rate-setting process that would unilaterally cap payments to doctors, dentists, hospitals and other clinicians for the health care services they provide to people with commercial health insurance.

The sponsors of AB 3087 falsely believe this approach will somehow lower the actual cost of health care. That simply is not true.

Because AB 3087 does nothing to address the underlying causes for rising health care costs, this legislation would mean that hospitals and doctors will be paid less, regardless of what it actually costs to provide care. That is like telling your local coffee shop that you are only going to pay them $2 for a $3 cup of coffee. Just because you have decided to pay less doesn’t mean that the actual cost of that cup of coffee has dropped. The coffee shop would lose money since the price it charges includes not only the cost of the coffee itself but also the costs for labor, materials and rent.

The same would be true for hospitals if AB 3087 is enacted. The bill would not regulate the prices Adventist Health Bakersfield must pay for a new imaging equipment, medical devices or life-saving drugs. Nor would it solve the chronic payment shortfalls that plague the Medicare and Medi-Cal programs. For more than two decades, these government-sponsored programs have paid hospitals, doctors and other providers far less than the actual cost of care. For example, Medi-Cal only pays hospitals about 68 cents for every dollar of care provided to a Medi-Cal patient.

According to an analysis by the California Hospital Association, AB 3087 would cut $18 billion every year from hospitals throughout the state. Cuts this deep will result in devastating impacts on your ability to get the health care services you need, when you need them. Many hospitals could be forced to cut vital programs or even close altogether. Even getting a doctor’s appointment could be in jeopardy as many established doctors cut back or retire early, and newer physicians decide to flee the state.

Concerns about health care affordability are important, and hospitals are committed to making health care services more cost-efficient. It should be noted that California ranks in the bottom 25 percentile nationally for health care costs. Certainly there is more than can – and must – be done. But AB 3087 is not the answer.

AB 3087 should be relegated to the ash-heap of legislative history. It is a bad bill for the health of Californians, including residents in our communities of Kern County.

Sharlet Briggs is president of Adventist Health Bakersfield. The opinions expressed are her own.

Covered California Premiums Projected to Rise 11 Percent in 2019

Tiffany Lin opens a acceptance letter from Covered California at her parents home on Thursday, May 17, 2018, in Cupertino, California. Tiffany Lin is a part-time art teacher and artist recently enrolled with Kaiser health insurance through Covered California. She pays just $1 a month in premiums, but her co-pays are high -- $75 for many types of doctors' visits, and $100 for some prescriptions. Photo: Tony Avelar / Special To The Chronicle

Source: SF Gate

The cost of health insurance continues to climb in California.

Estimates released Thursday by Covered California, the state insurance marketplace, project that premiums in the individual market will rise 11 percent next year, while enrollment in the exchange — which is larger than any other state’s — will drop 12 percent.

A big reason is the elimination of a federal requirement to buy health insurance, which had been included in the Affordable Care Act of 2010 but was removed last year by the Republican-led Congress. The requirement, enforced by threat of a tax penalty, was designed to ensure that even healthy people bought insurance, thus bringing down the cost of care for everyone. Republicans saw it as onerous, and their repeal of the provision takes effect next year.

In California, more than 2.4 million people buy health plans in the individual market. That includes nearly 1.3 million people who receive Affordable Care Act federal subsidies to buy insurance through Covered California, and roughly 1.2 million who buy plans without subsidies — typically not through the exchange. People whose incomes are too high to qualify for subsidies will likely be hit harder, because they will have to absorb the higher costs on their own without financial assistance.

The projected 11 percent premium increase includes the expected rise in health care costs overall, which is about 6 percent each year. But these are just estimates: Final rates for 2019 will not be released until July, after Covered California finishes negotiations with insurance carriers. The estimated 11 percent increase is less drastic than those in some other states, such as Maryland, where insurers are requesting average premium hikes of 30 percent.

This year, Covered California rates were up 12.5 percent compared with 2017.

Nationally, in 2019, the uninsured rate is expected to reach 14 to 16 percent — up from the current 12 percent, according to an analysis also released Thursday by Covered California. This would increase the cost of providing care to uninsured people by between $1.5 billion and $7 billion in 2019 because more uninsured patients are expected to seek care at hospitals and other health providers. If those costs are shifted to private insurers, it would lead to a 2 to 4 percent increase in the cost of employer-sponsored health coverage, according to the analysis. That increase would probably be shared between the employer and the employee.

California’s uninsured rate is about 7 percent. In 2019, as a result of the mandate’s repeal, between 475,000 and 1 million fewer Californians will be insured, according to the analysis, which was done by PricewaterhouseCoopers for Covered California.

In California, the cost for uninsured patients is expected to grow by $420 million to $1 billion, according to the analysis.

Health policy experts anticipate that some people may not buy coverage next year if they are not required by law to get it. That would leave the remaining pool of customers on the exchange, who are likely to be older and sicker, with higher costs.

Aristeo Alvarez of San Jose said he is considering dropping his Covered California Blue Shield plan next year and instead signing up for a cheaper plan covering only emergencies, because he rarely needs to go to the doctor. Alvarez, 42, receives federal subsidies and pays about $270 a month in premiums.

“I don’t know what the cost is yet, but if it’s too high, then most likely I’ll look elsewhere for something else,” said Alvarez, who works at a jewelry store and drives part time for Uber.

Today, the emergency coverage — often called a “catastrophic plan” — does not meet the requirements under the Affordable Care Act, so people who buy such plans must pay a tax penalty. But starting in 2019, patients can buy these types of plans and not pay a penalty. Some people prefer lower-cost catastrophic plans if they rarely need routine medical care, but are covered in the event of emergencies. However, they typically have to pay for all medical care up to a certain amount, often several thousand dollars, before insurance kicks in.

Tiffany Lin, a 29-year-old freelance artist who has a Kaiser plan through Covered California, said she would continue buying the insurance just in case — even though she is relatively healthy. Lin pays just $1 each month in premiums because her income qualifies her for significant subsidies. But her co-pays are substantial: $100 for lab tests and $75 for doctors’ visits. Lin sometimes puts off lab workups and some medical visits, such as physical therapy appointments for her mild scoliosis, to save money.

“I would keep it, because I like the idea of still having a health provider, even though it’s been expensive,” said Lin, who lives in Cupertino. “I would hate that if anything did happen, I didn’t have anywhere to go and I’d have to pay even more out of pocket.”

Consumers Brace For Premium Hikes While Lawmakers Grasp At Remedies

Image result for Consumers Brace For Premium Hikes While Lawmakers Grasp At Remedies images

Source: Kaiser Health News

As some insurers angle for hefty premium hikes and concerns grow that more Americans will wind up uninsured, the federal health law is likely — once again — to play big in both parties’ strategies for the contentious 2018 election.

Candidates are already honing talking points: Is the current dysfunction the result of the law or of GOP attempts to dismantle it?

The impact of changes to the law made by Republicans over the past year — modifications short of the “repeal and replace” they promised — is becoming clear. Initial announcements show health insurers in several states are seeking big increases in premiums for next year for people who buy their own insurance. That is renewing concerns about the potential for “bare” counties that will have no insurer selling coverage and hints that the number of uninsured Americans could again be on the rise.

“It’s sort of Insurance 101,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. Insurers “are facing a smaller and sicker risk pool as a result of both Trump administration and congressional action, and that means higher premiums,” she said.

“A number of policy changes definitely impacted rates,” said Jeanette Thornton, a senior vice president for the trade group America’s Health Insurance Plans.

Among those changes are the elimination of the tax penalty for those who forgo insurance, included in December’s tax overhaul, and President Donald Trump’s cancellation of federal payments to insurers who provide discounts to some low-income customers.

Democrats say they will make sure voters know that Republicans deserve the blame.

“Senate Democrats will be on the floor of the U.S. Senate every week talking to the American public about these rate increases and make sure they know about this campaign of sabotage,” said Sen. Chris Murphy (D-Conn.).

Republicans, however, say Democrats are at fault for blocking bipartisan legislation, which might not even have had enough GOP votes to pass. The effort sought to stabilize the Affordable Care Act’s marketplace through measures such as setting up reinsurance funding to help keep an individual insurer from facing devastating losses and guarantees for insurers to help pay their share of the out-of-pocket expenses for low-income customers.

“Democrats could have worked with us to lower premiums by as much as 40 percent but instead choose to cling to an unworkable law,” Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, said on the Senate floor Tuesday. “So if you have an insurance premium that is going up 40 percent next year, on top of an over 105 percent increase since 2013, you can thank a Democrat.”

The heightened political rhetoric comes after the first two states unveiled insurance company premium requests for policies on the individual market for 2019.

These are not final rates, but they give an idea of what premiums for next year might be for people who don’t get insurance through their job or the government and buy their own coverage on the individual market.

That market included about 15.6 million people, both inside and outside the ACA insurance marketplaces, in the final quarter of 2017, according to the consulting firm Mark Farrah Associates.

State deadlines for filing next year’s rates run from May through July. Once insurers have made their initial premium requests, state regulators negotiate final rates before open enrollment begins in the fall.

In Virginia and Maryland, insurers are seeking a wide range of significant increases, from about 15 percent for some plans up to more than 91 percent for one Maryland PPO.

Analysts are not surprised by the requested rate hikes and predict more to come. The first requests in past years have often moderated before being finalized, but this year’s political uncertainties could play a bigger role.

The Congressional Budget Office estimated that the elimination of the tax penalty for people without health insurance, which was included in last December’s tax law, by itself would result in premium increases of around 10 percent per year. That’s because without the prospect of a fine, healthier people would be more likely to forgo coverage, making the pool of people who continue to buy insurance sicker and more expensive for insurers.

Separately, Trump roiled the individual insurance market by canceling federal “cost-sharing reduction” payments for moderate-income insurance buyers.

The administration is also trying to extend the availability of short-term insurance plans, which frequently offer only bare-bones coverage, and “association health plans,” which can provide cheaper alternatives for those who are considered healthy. But such plans don’t include all the benefits of ACA plans. Analysts say both types of options would draw even more healthy people out of ACA plans..

The insurance industry acknowledges the actions have boosted next year’s rates.

Chet Burrell, the CEO of CareFirst Blue Cross Blue Shield, which serves both Maryland and Virginia markets, told The Washington Post that “continuing actions on the part of the administration to systematically undermine the market … make it almost impossible to carry out the mission.”

AHIP’s Thornton cautioned that it is still early in the process and many things could change. Maryland, for example, has passed legislation to create a “reinsurance” pool that could substantially lower premiums for next year. It still requires formal permission from the Trump administration, however.

And while Congress could still help ameliorate next year’s increases, that appears increasingly unlikely.

In a sign that the bipartisanship that characterized the effort last fall has broken down, Alexander said in his Senate speech that he plans to move on to other health issues, including ways to address the opioid crisis.

“Given Democrats’ attitude, I know of nothing the Republicans and Democrats can agree on to stabilize the individual health insurance market,” he said.

Sen. Susan Collins (R-Maine), who was promised a vote on her bipartisan bill by Senate Majority Leader Mitch McConnell (R-Ky.) that never materialized, now blames Democrats.

In a column she wrote for her home-state Portland Press-Herald late last month, Collins said Democrats refused to accept additional restrictions on abortion funding.

“Although federal funding has not been used to pay for elective abortions for decades, some Democrats reopened the long-settled debate on the Hyde Amendment in order to block these much-needed insurance reforms,” she wrote.

Democrats, however, say it was Republicans who reopened the abortion debateby demanding language to create new, permanent restrictions that could eliminate abortion even in private insurance plans.

Even so, some say they still hope consensus may be reached.

“Patients and families deserve better than the higher costs and dysfunction they are getting under Trumpcare by sabotage,” Sen. Patty Murray (D-Wash.) told reporters Tuesday. “And as soon as Republicans are ready to work again in a bipartisan way and act actually to lower families’ costs, Democrats will be at the table.”

Trump Health Chief Defends Short-Term Insurance Plans

Image result for Trump Health Chief Defends Short-Term Insurance Plans images

Source: The Hill

President Trump’s goal of expanding short-term health plans will not harm the insurance marketplace, Health and Human Services (HHS) Secretary Alex Azar said Thursday.

Under questioning from Senate Democrats during a hearing on the HHS budget, Azar repeatedly defended a proposed rule from the administration that would allow the sale of short-term health plans for up to an entire year.

The plans skirt ObamaCare rules about coverage requirements, so while they will be cheaper, they will not be required to cover pre-existing conditions. They also don’t have to cover the law’s essential health benefits, such as maternity care, mental health or prescription drugs.

Democrats argue the proposal will result in steep premium increases, as healthy people will buy into the short-term plans and leave the ObamaCare individual market.

Azar told lawmakers the administration’s plan is simply returning to a status quo that was only recently changed. Current law says the short-term plans can only be sold for three months, but that rule only took effect in 2017.

“These short term plans are the same ones the Obama administration had for eight years,” Azar said. He emphasized that the short-term plans “may not be the right option for everybody” but noted that for some individuals, “it may be better than nothing.”

Short-term plans historically have higher out of pocket costs than plans on ObamaCare exchanges, but lower monthly costs.

Azar said the administration won’t require any coverage guarantees from the short-term plans.

“If we start making them the equivalent of the Affordable Care Act, we’ll end up with the same pricing regime” and the problem of unaffordable insurance won’t be solved, Azar said.

Now that the GOP tax law has repealed the individual mandate penalty, insurance experts and Democrats say there’s no incentive for young, healthy people to stay in the individual market. That will leave only the sickest and oldest people left in the market, and insurers will be forced to either massively raise their rates or leave the market completely.

Azar said he doesn’t think that will happen, because ObamaCare subsidies designed to make plans more affordable will keep people from leaving.

“People are not going to be leaving subsidized insurance” for short-term plans, Azar said.

Insurers in Maryland and Virginia have already requested double-digit premium hikes for their ObamaCare plans in 2019, and some plans have said Trump administration policies are making the risk pool sicker.

No Major Bump For Medi-Cal, Covered California in Governor’s Revise Despite Push From Lawmakers

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Source: Capital Public Radio

Gov. Jerry Brown opted not to include major long-term investments in public health insurance programs in his budget revision on Friday, citing a preference for one-time spending measures.

“I’m going to be reluctant to embark upon programs that will continue and will grow into the future,” he said. “They all have some merit to them, but we’re already over-extended.”

The governor said he will “certainly look at any measure” that expands health care access.

The announcement comes after an ambitious request from an Assembly health committee last week: $1 billion from the general fund surplus to make a number of investments.

Their proposal is part of a package of new bills and includes expanding Medi-Cal to adults up to age 25, increasing subsidies and tax credits for Covered California consumers, streamlining the Medi-Cal enrollment process for low-income women and children, and increasing the number of doctors in rural areas.

“We continue to be disappointed by the lack of investment our Governor has made in improving health care in this state,” said Democratic Assemblymember Jim Wood in a statement. “The Assembly, on the other hand, has made health care a priority and we will continue to fight for our $1 billion funding package as budget discussions continue in the coming weeks.”

Wood led a special group of Assembly members that met regularly over the last few months to discuss ways to reach universal coverage, or health care for all Californians. It was the continuation of earlier discussions about single-payer health care, which Assembly Speaker Anthony Rendon shelved due to a lack of a concrete funding source.

A small group of Assembly members met several times this year to discuss ways to reach universal coverage, or health care for all Californians. It was the continuation of earlier discussions about single-payer health care, which Assembly Speaker Anthony Rendon shelved due to a lack of a concrete funding source.

The number of Californians on Medi-Cal grew rapidly during the Obamacare expansion and the Covered California marketplace gained 1.4 million enrollees. But there are still about 2.8 million Californians without health insurance, and advocates say it’s time to close the gap.

“Especially when our federal government continues to undermine our health system … California can and should make a meaningful down payment to the goal of universal coverage,” said Anthony Wright, director of consumer group Health Access, in a statement.

Health care costs rose for some marketplace customers when the federal government cut cost-sharing reductions for premiums in October.

Brown’s budget does include $55.3 million to “support new growth in Medi-Cal” in 2018-2019. It maintains a previously announced $163 million investment in physician payments and $70 million allocation for dental payments.

But much larger swathes of funding announced in the May revise are going toward mental health care for homeless individuals, assistance for housing-insecure people in the CalWORKS program and medical services in the state justice system.

Last Updated 05/23/2018

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