Actuaries Identify Drivers of 2019 Health Insurance Premium Changes

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Source: PR Newswire

The American Academy of Actuaries has identified increasing health care costs and the effects of public policy changes as among the major drivers of 2019 premium rate changes for individual insurance coverage that is subject to Affordable Care Act (ACA) rules.

“The individual market, which had shown signs of stabilizing, now faces a potential deterioration of the risk pool due to policy changes that reduce incentives for healthy individuals to enroll in ACA marketplace plans. This deterioration and other factors could drive premiums higher for 2019,” said Academy Senior Health Fellow Cori Uccello.

Drivers of 2019 Health Insurance Premium Changes, an issue brief authored by the Academy’s Individual and Small Group Markets Committee, details the rate change drivers, including:

  • Underlying growth in health care costs. Projected increases in health care costs for 2019 are expected to be in the range of 5 to 8 percent, similar to the increases projected for 2018.
  • Recent and pending public policy changes. Insurers may be adjusting rates to account for the effects of the elimination of the individual mandate penalty, the pending availability of short-term limited duration plans and association health plans, and potential changes to how insurers load premiums to reflect the costs of providing cost-sharing reduction subsidies.
  • Changes in the risk pool composition and insurer assumptions. In addition to expected risk pool changes due to public policy changes, insurer assumptions for 2019 will reflect whether experience has differed from what was assumed for 2018 premiums.
  • State actions. Actions undertaken by individual states could have an impact on 2019 premiums, such as new state reinsurance programs, the imposition of individual mandate penalties, and rules that would either facilitate or prohibit the sale of plans that don’t comply with ACA requirements.

One of the factors broadly exerting downward pressure on premium rates for 2019 is the suspension of the health insurance provider fee, per the Extension of Continuing Appropriations Act of 2018. Excluding this fee will reduce expected 2019 premiums by about 1 to 3 percent.

Download the issue brief and other analysis of health policy issues from the Academy at actuary.org.

The American Academy of Actuaries is a 19,000-member professional association whose mission is to serve the public and the U.S. actuarial profession. For more than 50 years, the Academy has assisted public policymakers on all levels by providing leadership, objective expertise, and actuarial advice on risk and financial security issues. The Academy also sets qualification, practice, and professionalism standards for actuaries in the United States.

Bipartisan Group of Governors Denounces Trump Move On Pre-Existing Conditions

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Source: The Hill

A bipartisan group of governors on Monday called on the Trump administration to reverse its decision to argue in court that ObamaCare’s pre-existing condition protections should be overturned.

“The administration’s disappointing decision to no longer defend this provision of federal law threatens health care coverage for many in our states with pre-existing conditions and adds uncertainty and higher costs for Americans who purchase their own health insurance,” the governors said.

The statement was signed by Colorado Gov. John Hickenlooper (D), Ohio Gov. John Kasich (R), Alaska Gov. Bill Walker (I), Pennsylvania Gov. Tom Wolf (D), Nevada Gov. Brian Sandoval (R), Montana Gov. Steve Bullock (D), Maryland Gov. Larry Hogan (R), Washington Gov. Jay Inslee (D) and North Carolina Gov. Roy Cooper (D).

Several of the governors are seen as potential presidential candidates, including Kasich, a Republican who has been critical of Trump.

Kasich and Hickenlooper have teamed up on bipartisan health care proposals in recent months.

Congressional Democrats have been attacking Republicans for the Trump administration’s filing in court earlier this month calling for ObamaCare’s pre-existing condition protections to be overturned, seeking to leverage the issue for the midterm elections.

“We’re asking the Administration to reverse their decision and instead work with Congress and Governors on bipartisan solutions to protect coverage and lower health care costs for all Americans, all while protecting those with preexisting conditions,” the governors said.

Calif. Exchange Chief Sees No Rate Impact From Latest Trump Challenge To ACA

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Source: California Healthline

Covered California’s premiums are expected to rise significantly next year, but the head of the state’s insurance exchange said the Trump administration’s legal bid to dismantle protections for people with preexisting medical conditions will likely not contribute to the increases.

Health plans will only be “pricing for the changes that they can absolutely see,” Peter Lee, executive director of the agency, told California Healthline on Wednesday. And because the legal challenge will take time to work its way through the courts, California will have “an opportunity to implement state protections” should they be needed, Lee said.

In fact, Californians would already be temporarily cushioned by existing state rules that protect people with preexisting conditions for 12 months if that portion of the Affordable Care Act is struck down. The preexisting conditions clause prohibits insurers from refusing coverage to people with prior illnesses, or charging them more because of it. Lee is expected to address the matter at a Covered California board meeting later today.

Last week, the administration announced it would not defend the key pillars of the ACA in court. It argued that those provisions, including the health law’s protection for people with preexisting conditions, should be declared unconstitutional.

One federal health care move that will factor into Covered California’s 2019 premiums, Lee said, is the decision by Congress to eliminate the tax penalty on people who choose not to buy insurance starting next year.

Many experts believe that without any consequences for not having insurance, more young and healthy people will decide to forgo it, leaving health plans with a higher concentration of elderly and ill — and more expensive — people.

The repeal of the tax penalty could add 1.7 million Californians to the ranks of the uninsured by 2027, according to the University of California-Berkeley Labor Center.

Covered California, which currently provides coverage for about 1.5 million people, last month unveiled preliminary projections showing that its health plan rates could spike about 11 percent on average next year, in tandem with an enrollment drop of about 12 percent. The elimination of the tax penalty accounts for more than half the projected premium spike, according to Covered California’s analysis.

But actual premiums have not been set yet. Covered California is still negotiating with insurance companies and is expected to announce 2019 rate increases, and the lineup of participating insurers, next month.

The premium increases in question apply only to health plans covering the approximately 2.3 million people — about 5.8 percent of the state’s population — who buy health insurance either through Covered California or the private individual market outside the exchange. Most Californians, like most Americans, get their health coverage through an employer or a government program such as Medicare or Medicaid.

Despite Lee’s prediction, some observers believe that Trump’s legal assault on the preexisting conditions rule will intensify tumult in the industry, making it more difficult for insurers to make well-informed business decisions for next year.

“Insurers are going to have an extremely difficult time projecting rates for 2019 given this degree of uncertainty,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. He said the impact on “California’s marketplace would be complicated.”

Nationally, premiums in the individual market, including health plans sold both on and off government-run insurance exchanges, are expected to rise about 10 percent annually in most years through 2027, propelled by the elimination of the penalty, according to an analysis by the Congressional Budget Office.

The average premium hikes in some states could be even higher: Washington state’s exchange recently projected an average rate hike of 19 percent, and New York estimates an average increase of 24 percent, with about half of that rise attributed to the repeal of the tax penalty. But officials in both states caution that these are preliminary proposals and final rates may be different.

The good news is that most people who buy their insurance through state-run exchanges, or the federal one, will not feel the bite of the higher premiums. That’s because nearly 90 percent of exchange customers get federal tax credits to offset the cost of their premiums, and the amount of those credits rises as premiums do. However, higher-income enrollees, who don’t qualify for financial assistance, will bear the brunt of the premium hikes, said James Scullary, a Covered California spokesman.

Whatever the final rate increase, it will only be a statewide average, meaning rates will vary — as they always do — by geography, age, insurer and the level of coverage you purchase. California’s Central Coast communities, for example, have seen higher-than-average premium increases in recent years than other regions of the state.

The extent to which the expected decline in Covered California enrollment will affect the stability of the exchange remains to be seen.

As younger, healthier people drop coverage, leaving a costlier insurance pool, insurers could decide at some point that it’s no longer worthwhile to stay.

There’s plenty of precedent for that: UnitedHealth Group terminated individual coverage in California last year — both on and off the exchange — blaming “smaller overall market size” and a “higher-risk profile.” Anthem pulled out of most of California’s individual market this year, citing changing federal rules and an “increasing lack of predictability.”

Anthem blamed its decision in part on uncertainty over whether the Trump administration would maintain subsidies that help reduce medical costs for some low-income individuals. The administration ultimately stopped funding those subsidies, a decision that contributed to this year’s rate increases.

Covered California sees marketing and outreach as countermeasures to federal policies that weaken the ACA, and it budgeted a whopping $111 million for them this year. While waiting for the outcome of factors beyond its control, “we will do everything we can to remind Californians that to go without insurance is a bad gamble,” Lee said.

New Trump AHP Rule Rolls Back Protections of the Affordable Care Act

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Source: New York Times

The Trump administration issued a sweeping new rule on Tuesday to make it easier for small businesses to band together and set up health insurance plans that skirt many requirements of the Affordable Care Act, offering lower costs but also fewer benefits.

President Trump, speaking at a 75th anniversary celebration of the National Federation of Independent Business, said the new rule would allow small businesses to “escape some of Obamacare’s most burdensome mandates” by creating new entities known as association health plans.

“You’re going to save massive amounts of money and have much better health care,” Mr. Trump said to cheers from the audience of small-business owners. “It’s going to cost you much less.”

As a result, he said, “you’re going to save a fortune.”

Labor Secretary Alexander Acosta said the rule would give small businesses access to insurance options like those available to large companies, starting as soon as Sept. 1. Millions of people could benefit, he said.

“As the cost of insurance for small businesses has been increasing,” Mr. Acosta said, “the percentage of small businesses offering health care coverage has been dropping substantially. Today the Trump administration helps level the playing field between large companies and small businesses.”

The new entities would be exempt from many of the consumer-protection mandates in the Affordable Care Act. They may not have to provide certain “essential health benefits” like mental health care, emergency services, maternity and newborn care, and prescription drugs.

Labor Department officials said that association health plans would not be able to deny coverage or charge higher rates to individual employees with pre-existing medical conditions.

Still, consumer groups and many state officials have opposed the push for association health plans. They say the new plans will draw healthy people out of the Affordable Care Act marketplace, driving up costs for those who need comprehensive insurance.

Senator Chuck Schumer of New York, the Democratic leader, said on Tuesday that the new rule would open the door to “junk health insurance.” It is, he said, “the latest act of sabotage of our health care system by the Trump administration.”

Trump administration officials said premiums were already soaring because of flaws inherent in the Affordable Care Act, President Barack Obama’s signature domestic achievement.

The new final rule carries out an executive order signed by Mr. Trump on Oct. 12.

The rule will allow small-business owners, their employees, sole proprietors and other self-employed people to join together to buy or provide insurance in the large-group market through association health plans.

Because they will be exempt from many requirements of the 2010 health law, Mr. Trump has said, the association health plans can “provide more affordable health insurance options to many Americans, including hourly wage earners, farmers, and the employees of small businesses and entrepreneurs that fuel economic growth.”

The new health plans might, for example, appeal to restaurant workers, real estate agents, dry cleaners, florists, plumbers and painters, officials said.

Under the rule, Mr. Acosta said, “business associations from city chambers of commerce to nationwide industry groups can offer health care insurance to the employees of their employer members through the large-group market.”

Trump administration officials said that small businesses and self-employed people in the same industry, state or region could band together and obtain health coverage as if they were a single large employer — even if they had no other connections to one another.

Until now, the Labor Department has required a much greater “commonality of interest” among small businesses that wanted to be treated as a large group when buying insurance. To qualify under prior rules, small businesses generally had to have some purpose “unrelated to the provision of benefits.” And the government often looked at the size of each company, rather than the group as a whole, to determine if it was a large or small employer.

The new rule takes a step toward fulfilling Mr. Trump’s campaign promise to make it easier for companies to sell insurance across state lines.

“For the first time ever,” Mr. Trump said on Tuesday, “sole proprietors will be able to come together and buy lower-cost group insurance instead of getting ripped off by this disaster that we all know as Obamacare. These actions will result in very low prices, much more choice, much more freedom, including in many cases new opportunities to purchase health insurance. You’ll be able to do this across state lines.”

Critics said the new plans would cost less because they would provide fewer benefits.

Republicans in Congress have been trying for two decades to promote association health plans through legislation. Now the Trump administration is using its regulatory authority to accomplish what Congress could not.

Trade groups like the National Restaurant Association, the National Retail Federation and the National Federation of Independent Business have supported association health plans and could potentially sponsor them.

But consumer groups, state officials and Blue Cross Blue Shield plans have expressed concern. They say association health plans will tend to attract employers with younger, healthier workers, leaving behind sicker people in more comprehensive, more expensive plans that fully comply with the Affordable Care Act.

People with serious illnesses like cancer could face “ever-increasing premiums for comprehensive coverage,” said Chris Hansen, the president of the lobbying arm of the American Cancer Society.

Similar small-business health plans have a history of fraud and abuse that have left employers and employees with hundreds of millions in unpaid medical bills. The problems are described in dozens of court cases and enforcement actions taken over more than a decade by federal and state officials.

In past years, the Labor Department said, it has identified many “unscrupulous promoters who sell the promise of inexpensive health benefit insurance, but default on their obligations.”

The Coalition Against Insurance Fraud, representing insurers, consumer groups and law enforcement officials, met with Trump administration officials last month and emphasized the need for states to have a strong role in combating possible fraud by association health plans.

“Tens of thousands of innocent consumers and small businesses were victimized by a surge of fake health insurance plans that swept across the country in the early 2000s,” James Quiggle, a spokesman for the coalition, said on Tuesday. “We have to avoid a repeat of that sorry history.”

In another move this summer, Mr. Trump is expected to issue a final rule expanding access to “short-term, limited-duration” insurance, allowing such policies to run for 364 days, instead of the current limit of three months.

These plans — originally intended for people between jobs — are cheaper than comprehensive insurance, provide fewer benefits and would also be exempt from many requirements of the Affordable Care Act.

HHS To Allow Insurers’ Workaround On 2019 Prices

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Source: Kaiser Health News

Federal officials will not block insurance companies from again using a workaround to cushion a steep rise in health premiums caused by President Donald Trump’s cancellation of a program established under the Affordable Care Act, Health and Human Services Secretary Alex Azar announced Wednesday.

The technique — called “silver loading” because it pushed price increases onto the silver-level plans in the ACA marketplaces — was used by many states for 2018 policies. But federal officials had hinted they might bar the practice next year.

At a hearing Wednesday before the House Education and Workforce Committee, Azar said stopping this practice “would require regulations, which simply couldn’t be done in time for the 2019 plan period.”

States moved to silver loading after Trump in October cut off federal reimbursement for so-called cost-sharing reduction subsidies that the ACA guaranteed to insurance companies. Those payments offset the cost of discounts that insurers are required by the law to provide to some low-income people to help cover their deductibles and other out-of-pocket costs.

States scrambled to let insurers raise rates so they would stay in the market. And many let them use this technique to recoup the lost funding by adding to the premium costs of midlevel silver plans in the health exchanges.

Because the formula for federal premium subsidies offered to people who purchase through the marketplaces is based on the prices of those silver plans, as those premiums rose so did the subsidies to help people afford them. That meant the federal government ended up paying much of the increase in prices.

At the committee hearing Wednesday, under questioning from Rep. Joe Courtney (D-Conn.), Azar declined to say if the department was considering a future ban.

“It’s not an easy question,” Azar said.

The fact that the federal government ended up effectively making the payments aggravated many Republicans, and there have been rumors over the past several months that HHS might require the premium increases to be applied across all plans, boosting costs for all buyers in the individual market.

Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, told reporters in April that the department was examining the possibility.

Apparently that will not happen, at least not for plan year 2019.

GOP Embraces Single-Payer Healthcare Attack in California

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Source: The Hill

Republicans are seizing on Democratic demands for a single-payer health-care system as an attack line in California, arguing that candidates backing the issue spearheaded by Sen. Bernie Sanders (I-Vt.) are out of step with their districts.

“My opponent wants socialized medicine and government-run health care,” Rep. Mimi Walters (Calif.), a GOP incumbent and top Democratic target, told The Hill. “The district does not support it.”

Walters represents one of seven GOP-held seats in California that Democratic presidential nominee Hillary Clinton won in 2016 that Democrats are seeking to flip. If Republicans lose those seats, it would greatly increase the chances that the GOP loses the House majority.

Republicans say that Democratic candidates might have done well running on “Medicare for all” in crowded primaries, when they needed to move to the left. But they say that position will be a major drag in a general election decided by more centrist voters.

“The anger of the Democratic base against the president is pushing the party aggressively leftward,” said Michael Steel, a Republican strategist and former aide to Speaker John Boehner (R-Ohio). “That’s going to leave them with a lot of candidates who aren’t a good fit for their districts.”

In the seven Clinton-won districts in California, at least five will have Democrats on the November ballot who support single-payer.

They include Josh Harder, who’s expected to challenge Rep. Jeff Denham(R) in the Central Valley; Katie Hill, who is running for Rep. Steve Knight’s (R) seat in northern Los Angeles County; Katie Porter, who’s challenging Walters in her Orange County district; and Mike Levin, who’s running to succeed retiring Rep. Darrell Issa (R) in San Diego County.

Most of those races are considered to be toss-ups by nonpartisan election handicapper Cook Political Report, while Walters’s seat is rated lean Republican. Cook moved Issa’s open-seat race from toss-up to lean Democrat days after the California primaries.

Democrats also hope to defeat Rep. Dana Rohrabacher (R-Calif.), who has held his Orange County district for 15 terms. As of Friday afternoon, stem cell researcher Hans Keirstead was up 129 votes over businessman Harley Rouda for the second spot on the November ballot. Both Democrats back Medicare for all.

Porter, who defeated a more moderate Democrat in the primary, pushed back on the idea that her support for a single-payer health-care system will hurt her in November.

“The status quo in our health-care system is broken and people know,” said Porter, who was endorsed by Sens. Elizabeth Warren (D-Mass.) and Kamala Harris (D-Calif.). “Washington does not need more can’t-do Democrats.”

Democrats generally think the issue of health care will help them in November.

They are emphasizing the GOP’s opposition to ObamaCare, arguing efforts by President Trump and his party to repeal and replace the law has led to rising premiums and higher health-care costs for Americans.

Every California Republican in the House voted to repeal ObamaCare.

“If Republicans wage this election on health care, that’s an argument that Democrats win,” said Mac Zilber, a Democratic strategist in California.

“[Medicare for all favorability] might not be as clean and as pretty as it looks right now, but ultimately if you’re about expanding access versus taking away access, I think that’s exactly the battlefield that Democrats want to be on,” he added.

But not everyone is so certain the issue will be such a winner.

Rob Pyers, research director at California Target Book, which does nonpartisan political analysis in the state, noted that the California House districts that Democrats are seeking to take back from the GOP are all “somewhat conservative” and that Sanders won none of them during the 2016 Democratic presidential primary.

“I wouldn’t be surprised to see the [National Republican Congressional Committee] and Mimi Walters pummeling Porter on the airwaves over [single-payer] and a host of her other positions,” he said, referring to the House Republicans’ campaign arm. “In a few months, I’m guessing voters there will be confused as to whether Mimi Walters is running against Porter or Elizabeth Warren.”

Walters brushes off attacks on her vote to repeal ObamaCare.

“I’m not worried about her,” she said of Porter.

Rohrabacher, who was first elected at the end of Ronald Reagan’s presidency and has served through a changing political culture in his state, sounded a similar note.

“That district isn’t going to support any Democratic candidates that just mouth the liberal left line,” he told The Hill.

He said he had no regrets on his ObamaCare repeal vote.

“My votes reflect what I think is good for America and consistent with my philosophy and it has nothing to do with electability,” he said.

House Republicans have signaled that they plan to take Democrats to task over Medicare for all.

The Congressional Leadership Fund, a super PAC aligned with House GOP leadership, sent press releases following the California primaries targeting Porter’s and Hill’s stances on single-payer.

And Republicans quickly seized on House Minority Leader Nancy Pelosi’s (D-Calif.) statement from a Thursday press conference that if Democrats retake the House, proposals like Medicare for all should be “evaluated.”

A Democratic strategist familiar with the California races said polling conducted in the swing districts shows that Medicare for all is popular, but acknowledged a GOP messaging campaign could change things.

“It does really well right now, but will that change with millions of dollars of spending in a concerted effort by Republicans to make people feel like Medicare for all means trillions of dollars in tax increases?” the strategist said.

“I don’t think we’ve yet seen the Republican media apparatus really make a concerted effort to demonize Medicare for all the way they did with ObamaCare and when that happens, I think the public opinion is going to change.”

Administration Challenges ACA’s Preexisting Conditions Protection In Court

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Source: Kaiser Health News

The Trump administration is refusing to defend key parts of the Affordable Care Act, essentially arguing that federal courts should find the health law’s protection for people with preexisting conditions unconstitutional.

The federal lawsuit hinges on the ACA’s individual mandate, or the requirement to get health coverage or pay a penalty. The mandate has long been a sticking point for conservatives, who argue that the government should not be telling individuals what coverage they must have.

But that mandate was crucial to persuading insurers to offer plans under the ACA. It helped expand their risk pools while the law forced them to guarantee coverage to any customer. Insurers were not allowed to raise costs for people with preexisting conditions. The administration’s brief, filed Thursday in federal district court in Fort Worth, Texas, takes aim at those links.

Twenty Republican state attorneys general filed suit on Feb. 26, charging that Congress’ changes to the law in last year’s tax bill rendered the entire ACA unconstitutional. In the tax law, Congress repealed the penalty for people who fail to have health insurance starting in 2019.

The attorneys general argue that a Supreme Court decision in 2012 saved the ACA from being declared an unconstitutional overreach of congressional power by declaring the penalty a tax and pointing out that Congress has the power to levy taxes. Without the tax penalty, they argue, “the Court should hold that the ACA is unlawful and enjoin its operation.”

The Trump administration Thursday did not go that far. Rather, it argued that without the tax to encourage healthy people to sign up, the parts of the law guaranteeing coverage to people with health conditions and charging them the same rates should be struck down as well.

The administration called on the court to declare the provisions that guarantee coverage to be “invalid beginning on January 1, 2019,” when the mandate penalty goes away.

Here are five things to know about this latest in a long line of challenges to the health law:

If This Lawsuit Succeeds, Who Would Be Affected?

People who buy their own insurance because they are self-employed or don’t get coverage through their jobs or the government. There are about 21 million people who do so, buying either through brokers or from a state or federal Affordable Care Act marketplace.

But it’s not clear how many Americans have preexisting conditions and could be affected. Estimates vary widely because there is not a standard definition of what counts as a preexisting condition. Before the ACA passed, insurers commonly rejected people with cancer, heart failure, diabetes, arthritis and even less serious conditions.

Based on those pre-ACA examples, the Kaiser Family Foundation estimates that 27 percent of people under age 65 have a preexisting condition. Of course, not all of them buy coverage on their own. (Kaiser Health News is an editorially independent program of the foundation.)

America’s Health Insurance Plans, an industry trade group, Friday criticized the federal government’s filing.

“Zeroing out the individual mandate penalty should not result in striking important consumer protections” that help guarantee coverage to people with preexisting conditions, the statement said. “Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019.”

Is Anything Going To Change Right Away? What About Next Year?

Don’t look for big changes yet.

The lawsuit could easily go all the way to the Supreme Court before there is a resolution, which could take years. So, the preexisting conditions protection is likely to stay in place during that period.

More immediately, there might be some effect on premiums for next year. Health insurers are currently deciding whether to sell coverage in the individual market in 2019 — and what they’re going to charge.

“The more uncertainty there is, the more the actuaries are going to be plugging into their projections for premium rates,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute.

But others say the legal brief may have minimal impact next year on premiums. That’s because insurers already expected the Trump administration would not defend the ACA — and they know that a resolution of the case will be years away, said industry consultant Robert Laszewski.

A bigger effect on premiums, according to both Corlette and Laszewski, are factors already in play that are expected to draw younger and healthier people out of the ACA marketplace. Those include Congress’ decision to repeal the individual mandate penalty and rules expected soon from the administration that will expand the market for lower cost and short-term policies that won’t have to follow all the ACA rules.

How Is This Lawsuit Different From Previous Challenges To The ACA?

The Supreme Court has twice upheld the constitutionality of the health law. Most famously, in 2012, a narrow majority led by Chief Justice John Roberts turned back a challenge that was also filed by Republican attorneys general, along with the National Federation of Independent Business. Roberts wrote in a 5-4 ruling that the requirement for most Americans to either have insurance or pay a fine constitutes a tax — even though Democrats had gone to great lengths to not call it a tax — and was therefore constitutional.

In 2015, the court ruled that Congress did not intend to provide financial aid exclusively for premiums to individuals in states that operated their own insurance exchanges.

This current lawsuit, led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, argues that since Congress has changed the law to remove the penalty forcing individuals to get insurance, it has inadvertently rendered the rest of it impermissible under the 2012 Supreme Court ruling.

“Texans have known all along that Obamacare is unlawful and a divided Supreme Court’s approval rested solely on the flimsy support of Congress’s authority to tax,” said Paxton when the suit was filed. “Congress has now kicked that flimsy support from beneath the law.”

Other legal observers point out that’s not how it works.

“Congress is always free to amend its statutes, even to omit what it previously thought was essential,” wrote Nick Bagley, a law professor at the University of Michigan, in a blog. “That’s what Congress did when it zeroed out the mandate. So we don’t have to speculate what Congress would’ve done if it had a choice between invalidating the ACA’s insurance reforms or just invalidating the mandate. Congress made that choice.”

If The Trump Administration Isn’t Going To Defend The Health Law In This Lawsuit, Who Will?

In May, the court allowed more than a dozen Democratic attorneys general to “intervene” in the case and defend the law.

“The goal of Texas’ lawsuit is to leave Americans without health insurance, forcing them to choose between their health and other needs,” said California Attorney General Xavier Becerra. Allowing the Democratic officials to join the suit “allows us to protect the health and well-being of these Americans by defending affordable access to healthcare.”

If Nothing Is Going To Happen Right Away, Why Is This Such A Big Deal?

The guarantees for coverage for people with preexisting conditions are among those most valued by the public. Even if the lawsuit stands little chance of success, putting those provisions back in play can create uncertainty for insurers and patients. It could also possibly provide Democrats another talking point for the coming midterm elections in November.

Legal experts also point out that the Trump administration’s failure to defend the law could have long-lasting implications for the rule of law in the nation.

“If the Justice Department can just throw in the towel whenever a law is challenged in court, it can effectively pick and choose which laws should remain on the books,” wrote Bagley. “That’s as flagrant a violation of the President’s constitutional duty to take care that the laws are faithfully executed as you can imagine.”

Could California Shape The Fate Of The Affordable Care Act In November?

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Source: California Healthline

In the state that’s leading the opposition to many of President Donald Trump’s health policies, California voters will face a stark choice on the November ballot: keep up the resistance or fall in line.

The results of Tuesday’s primary have set up general-election contests between candidates — for governor, attorney general, insurance commissioner and some congressional seats — with sharply differing views on government’s role in health care.

The outcome in the Golden State could help shape the fate of the Affordable Care Act and influence whether Republicans in Washington take another shot at dismantling the landmark law.

“For the Affordable Care Act, California is a bellwether state,” said David Blumenthal, president of the Commonwealth Fund, a New York-based health policy research organization. If California voters don’t elect more Democrats to Congress, it will be harder for the party to gain legislative control and “the Affordable Care Act will continue, as it has been, to be under attack from an empowered Republican majority,” he said.

Despite being targeted for voting last year to repeal the ACA and cut Medicaid funding, several Republican incumbents performed well at the polls in California.

In the California governor’s race, Democratic front-runner Gavin Newsom quickly sought to cast the November contest as a referendum on Trump and his effort to undo much of President Barack Obama’s legacy, particularly on health care.

A series of Trump tweets endorsing Republican candidate John Cox, a multimillionaire real estate investor, helped propel the political outsider to the general election.

“It looks like voters will have a real choice — between a governor who will stand up to Donald Trump and a foot soldier in his war on California,” Newsom said Tuesday night to supporters in San Francisco.

California has embraced the federal health law enthusiastically and stands to lose more than any other state if the ACA is gutted. About 1.5 million Californians buy coverage through the state’s Obamacare exchange, Covered California, and nearly 4 million have joined Medicaid as a result of the program’s expansion under the law.

Newsom, a former San Francisco mayor and the current lieutenant governor, has pledged to defend the coverage gains made under the ACA. He has vowed to go even further by pursuing a state-run, single-payer system for all Californians.

Newsom won the primary with 33 percent of the vote and Cox placed second with 26 percent. Some mail-in votes and provisional ballots continue to be counted.

Cox has slammed Newsom and fellow Democrats for imposing government controls on health care that he says make coverage too expensive for families. He said he isn’t interested in defending the Affordable Care Act and that, if the law is scrapped, millions of Californians can go into high-risk insurance pools — an idea that predates the health law.

Andrew Busch, a government professor at Claremont McKenna College, said the political divide over health care has grown even wider this year as single-payer has gained support from mainstream Democrats in California.

“I’d say the Republican candidates are pretty much where the Republicans have been, but the Democratic candidates have shifted to the left, so the choice is starker than it has been,” Busch said.

Heading into Tuesday’s primary, it wasn’t clear that California voters would face such drastically different choices on the November ballot. Under the state’s primary system, the top two vote-getters, regardless of party affiliation, advance to the general election. That left many experts predicting single-party matchups across the state.

But that scenario also didn’t pan out in the race for attorney general, a position that has played a key role in California’s resistance politics since Trump was elected. Democratic incumbent Xavier Becerra, who has become a national leader against Trump’s agenda, will face off against Republican Steven Bailey in the fall.

Becerra has filed more than 30 lawsuits on health care and other issues since taking office in January 2017.

Bailey, a criminal attorney and former judge, has blamed the Affordable Care Act for driving up health care costs, and he favors less industry regulation. He also has criticized Becerra for fixating too much on Trump.

“Just because a tweet comes out of Washington, it doesn’t require a lawsuit to be filed the next day,” Bailey said.

Health care could also play a role in several of California’s congressional races. Democrats are trying to win back control of the House, in part to better block Republican efforts to roll back the ACA.

“The actions of the Trump administration, the elimination of the individual mandate and its impact on markets will become more of an issue,” said Chris Jennings, a former health care adviser in the Obama administration. “The conservative caucus has been forcefully advocating for another aggressive return to the repeal effort.”

One of the most-watched races nationally is in a district of California’s San Joaquin Valley where Republican incumbent Jeff Denham drew several Democratic opponents after voting to repeal the health law last year — as did all of California’s Republican House members.

Denham led a crowded primary field with 38 percent of the vote Tuesday. Democrat Josh Harder is holding on to second place with nearly 16 percent, just ahead of a Republican challenger. The results are pending until late-arriving ballots are counted.

Harder said the Republicans’ repeal-and-replace effort on health care was a major reason he decided to run. He made it a centerpiece of his campaign and ran ads criticizing Denham for voting to take away coverage from thousands of his constituents. About 40 percent of residents in this Modesto-area district are enrolled in Medicaid, the government insurance program for the poor and disabled.

Denham has defended his repeal vote, saying that patients’ access to doctors has only gotten worse since coverage was expanded under the ACA. In a statement last year, Denham said, “coverage does not necessarily equal care and families must resort to overflowing emergency rooms to be seen.”

But Dan Schnur, a Republican political strategist who teaches at the University of Southern California and the University of California-Berkeley, said health care has gone from a negative to a positive for Democratic candidates, who have spent the past several elections defending Obamacare.

“As a result, they’re doing everything they can to emphasize the health care debate rather than run away from it,” he said.

Trump Signs ‘Right to Try’ Drug Bill

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Source: The Hill

President Trump signed a bill Wednesday allowing terminally ill patients access to experimental medical treatments not yet approved by the Food and Drug Administration (FDA).

Dubbed “right to try,” the law’s passage was a major priority of Trump and Vice President Pence, as well as congressional Republicans.

“Thousands of terminally ill Americans will finally have hope, and the fighting chance, and I think it’s going to better than a chance, that they will be cured, they will be helped, and be able to be with their families for a long time, or maybe just for a longer time,” Trump said at a bill signing ceremony at the White House, surrounded by terminally ill patients and their families.

Trump thanked lawmakers sitting in the audience who sponsored the bill, including Sen. Joe Donnelly, a vulnerable Democrat up for reelection in Indiana.

Despite calling Donnelly a “really incredible swamp person” earlier this month, Trump thanked the senator for his work on the bill.

Sen. Joe Manchin (W.Va.), another vulnerable Democrat up for reelection, was the only other Democratic co-sponsor on the bill, but did not attend the ceremony because he is in West Virginia this week, his office said.

Congress is on recess this week for Memorial Day.

Most Democrats and public health groups oppose the bill, arguing that it could put patients in danger.

“FDA oversight of access to experimental treatments exists for a reason — it protects patients from potential snake oil salesmen or from experimental treatments that might do more harm than good,” said Rep. Frank Pallone Jr. (D-N.J.), ranking member of the House Energy and Commerce Committee.

Opponents also argue it gives “false hope” to patients, since drugmakers aren’t required to give unapproved medicines to patients who ask for them.

Supporters say, however, it will provide new treatment opportunities for terminally ill patients who have exhausted existing options.

“While a long time coming, today is a monumental win for patients desperately seeking the ‘right to try’ investigational treatments and therapies,” said Energy and Commerce Committee Chariman Greg Walden (R-Ore.) and health subcommittee chairman Michael Burgess(R-Texas).

“With ‘right to try’ being the law of the land, we are confident that the Trump Administration, and FDA Commissioner [Scott] Gottlieb, will take both congressional intent and the safety of patients into consideration when implementing this important law.”

Trustees: Medicare Exhausted in 2026

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Source: Politico

Medicare’s trust fund will start running out of money in 2026, two years later than the program’s trustees estimated last year as the trend toward slower spending continues.

And here’s a fact that puts an exclamation point on that trend: This year, for the first time ever, the government expects to spend less money per Medicare beneficiary than it did the year before, in part because of the sequester.

The trustees in the annual report noted that the long-term challenges to the program remain as the massive baby boomer population heads into retirement. They called on Congress to address Medicare’s troubled finances “as soon as possible.”

But the looming crisis is less imminent.

Medicare and other entitlement spending will remain hot buttons in the coming fight over the budget and the debt ceiling, but the spending slowdown will help keep the lid on one political flash point at least: the hugely controversial Independent Payment Advisory Board.

Based on the new report, the chief Medicare actuary concluded that Medicare spending won’t trigger action from the controversial panel, which is tasked with curbing the program’s costs if they run too high, through at least 2015.

Administration officials said the improved outlook reflects changes in health care spending as well as policies put in place under President Barack Obama’s health law.

“The Medicare report demonstrates, once again, the importance of the Affordable Care Act, which has strengthened Medicare’s finances by reining in health care costs,” Treasury Secretary Jack Lew said. Indeed, the trust fund has been extended by nine years since the health reform law passed.

But Medicare trustee Robert Reischauer warned against seeing this year’s report as a significant development for Medicare, saying, “I think that such an interpretation would be a mistake.”

He said the “discipline” in the federal health care law is partly responsible for the slowdown in spending in addition to the country’s broader economic problems, but sustaining the trend will require concerted effort in the public and private sectors that is anything but guaranteed.

Congress must make “unavoidable adjustments” for cost savings beyond what’s in the Affordable Care Act, and the sooner it acts, the less disruptive those changes will be, he said.

Health care providers must become more efficient, and employers, labor unions, insurers and others must pitch in to reinforce the transformation of the health care payment system begun in the federal health care law, Reischauer said.

Last Updated 06/20/2018

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