Trump Team Prepares Rescue Package of at Least $800 Billion

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Source: Politico, by Nancy Cook and Ben White

The White House aims to deploy at least $800 billion in aid in the coming weeks to prop up the U.S. economy, as retailers, restaurants, sporting events and other businesses shut down and Americans slow their spending while staying home to guard against the coronavirus pandemic.

Among the administration’s targets this week: providing relief in the form of tax deferments, loans or even direct payments to airlines, the hospitality industry and small-to-medium businesses crippled by plunging demand. Officials know they need to release the contours of their plan quickly — potentially as soon as Tuesday — as turmoil accelerates in financial markets, said a person familiar with the White House’s plans.

Treasury Secretary Steven Mnuchin and Director of the National Economic Council Larry Kudlow have specifically cited aid for U.S. airlines, as travelers cancel trips or avoid new bookings and public health experts advise older Americans to avoid flying entirely.

“We don’t see the airlines failing, but if they get into a cash crunch, we’re going to try to help them,” Kudlow told reporters Monday at the White House. He said the airlines had been in touch seeking aid, “lots of them,” and that “we’re in touch about their balance sheets and their cash flow.”

Hotel CEOs are planning to visit the White House on Tuesday to meet with Vice President Mike Pence, as the hospitality industry also struggles from a serious downturn.

The Treasury Department and National Economic Council met several times over the weekend to develop a list of options for the administration’s next phase of fiscal stimulus and held several conversations with President Donald Trump, said one senior administration official.

So far, officials have discussed allowing industries such as airlines to defer tax payments or temporarily keep some of the taxes they collect from consumers. Airlines are seeking even greater assistance — nearly $60 billion worth — as they cancel flights and park plans due to collapsing demand for travel.

The hotel industry has suggested options to help with their cash crunch including loans from the Small Business Administration, deferring tax liabilities, a temporary payroll tax cut or a tax credit to retain employees. Other suggestions have included offering loan guarantees, loan forbearance or the cancellation of debts through executive action or regulatory changes, said a Republican in close contact with the administration.

Within the past week, as business plunged across the nation, the internal discussion among top economic officials has moved toward providing industries with cash and not just tax relief — even if no one in the White House wants to call it a bailout.

Kudlow said he preferred to call it more of a “short-term liquidity issue.”

The goal is to help industries deal with the cash-flow crises they’ll likely face in the coming weeks, even if the administration sees no evidence of systemic risk.

“They haven’t settled on any one thing at this point,” said Stephen Moore, a conservative economist and outside adviser to the president. “We proposed a four-step plan and the best idea is to suspend the payroll tax for the rest of the year. That’s something that would help everyone. It’s clean, and it doesn’t pick winners and losers.”

Industries across the board are starting to latch onto the idea of suspending the payroll tax for employers for the rest of the year. The largest business lobbying group, the U.S. Chamber of Commerce, included the idea in a letter it sent to Congress on Monday, and Trump has said he’d like the payroll tax either cut or suspended through the end of the year.

Leaders from sectors including airlines, hotels and casinos have been warning officials behind closed doors about concerns they’ll have to start laying off thousands of employees if the shutdown throughout America continues — including in politically sensitive states such as Ohio and Pennsylvania.

Half of the $800 billion in aid, under the latest White House estimates, would come from aid to workers and small businesses, tax deferrals and other moves already underway including deferring student-loan interest, buying oil and additional provisions of a relief bill already moving through Congress. The other half would come from a payroll-tax holiday through the end of the year — a move that would likely cost much more than $400 billion.

The administration is also exploring with the Federal Reserve how it can deploy the central bank’s emergency powers to lend to nonfinancial firms, though the central bank’s authorities were curtailed in the political backlash to the 2008 bailout of insurer American International Group.

The White House and economic officials are desperate to stave off a potential recession, since the economy has been one of the hallmark achievements of Trump’s first term and a key message for his reelection.

The former head of the White House Council of Economic Advisers, Kevin Hassett, said in an interview that the March jobs report out early next month might show losses of more than 1 million. “It really could be the worst jobs report we’ve ever seen in our history.” He said he did calculations over the weekend with conservative economist Larry Lindsey showing that the economy could contract by a severe 5 percent in the second quarter, though a swift containment of the virus could lead to a bounce-back in the third quarter.

“There is a dispute between the House and the Senate and the president about what to do,” Hassett said. “But imagine if it’s Friday when the jobs report comes out and it’s worse than we’ve ever seen. Then you’d see Congress act with urgency. The question is if they act with urgency ahead of the terrible numbers.”

Hassett, who remains in contact with the White House, says he is not in favor of direct industry bailouts but is arguing for the payroll tax suspension at least for a quarter of the year. “You can do it quickly on the employer side and we need employers not to fire people,” he said. “And on the employee side, it could have a macro-economic effect. You could even offset the 5 percent economic decline with the payroll tax cut. And we don’t have to have a recession if the virus fades and the third quarter booms.”

In addition to hearing from lobbyists and industry leaders directly, the White House is hearing from informal economic advisers such as Moore with their proposals.

Moore said he sent a plan to Kudlow for items to include in the next stimulus proposal that’s expected to emerge from the White House and Treasury Department in the coming days. Moore authored a proposal along with publishing magnate Steve Forbes and supply-side economics guru Art Laffer, a close Kudlow ally.

The group suggested financing the payroll tax cut by issuing 50- and 100-year Treasury bonds at 1 percent interest. They also suggested avoiding any direct cash bailouts to hard-hit industries like airlines or hotels.

“Every business is materially affected by this. Who is going to make these decisions about who gets aid and who doesn’t?” Moore said. The final piece of the plan would be for the Fed to open lending facilities for low-interest loans to any business that has collateral to avoid cash crunches that could force companies into fire sales of assets to raise cash to replace revenue lost to the crisis.

“We aren’t sure which of these Larry and [Treasury Secretary Steven] Mnuchin like, but Trump listens to us,” Moore said. “He seeks out our advice. We are urging him not to do things that are bad policy that he would not do otherwise.”

A former senior Treasury official still in contact with senior members of the department said Mnuchin is aware that many Republicans will have problems with direct bailout payments to individual industries, but that he may propose them anyway for airlines, cruise lines and the entertainment industry more broadly.

“The problem is the Wall Street [Troubled Asset Relief Program] vote still haunts those halls,” this former official said of the 2008 vote to bail out big banks. “It’s going to be like pulling teeth to get Republicans to vote for that. I think the White House is also open to refundable tax credits. And then you have the challenge of, ‘How do you help people exempt from the payroll tax?’’’

The person added that a plan could not wait until the end of the week. “It has to happen right away. Like, right now. Otherwise businesses are just going to start closing and laying people off right away.”

Trump Urges U.S. to Halt Most Social Activity in Virus Fight, Warns of Recession

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Source: Reuters

U.S. President Donald Trump urged Americans on Monday to halt most social activities for 15 days and not congregate in groups larger than 10 people in a newly aggressive effort to reduce the spread of the coronavirus in the United States.

Announcing new guidelines from his coronavirus task force, the president said people should avoid discretionary travel and not go to bars, restaurants, food courts or gyms.

As stocks tumbled, Trump warned that a recession was possible, a development that could affect his chances of re-election in November. The Republican president said he was focused on addressing the health crisis and that the economy would get better once that was in line.

“We’ve made the decision to further toughen the guidelines and blunt the infection now,” Trump told reporters at the White House. “We’d much rather be ahead of the curve than behind it.”

Trump has faced criticism for playing down the seriousness of the virus in the earlier days of its spread.

He has sought to portray a competent, coordinated government response in recent days while conceding on Monday that the virus was not under control.

That contrasted with his remarks only a day before, when he called the virus contagious but said the administration had “tremendous control” of it.

“I’m saying we are doing a very good job within the confines of what we’re dealing with,” Trump said when asked about his “control” comment from Sunday. He said his remark then referred to his administration’s response. “If you’re talking about the virus, no, that’s not under control for any place in the world.”

Asked to grade his response on a scale of 1 to 10, Trump gave himself a 10. Critics disagree.

Trump said the worst of the virus could be over by July or August, a more specific and lengthier timeframe than he has previously suggested. He called it an invisible enemy.

“With several weeks of focused action, we can turn the corner and turn it quickly,” he said.

MILLENNIALS KEY

The president’s advisers implored young people to follow the new guidelines to avoid spreading the virus even though they were at lesser risk of a severe case if they contract it. Older people, especially those with underlying health problems, are at the greatest risk if they develop the respiratory disease that has now killed more than 70 Americans.

White House coronavirus coordinator Debbie Birx said the behavior of the “millennial” generation was especially key.

“They’re the ones that are out and about, and they’re the most likely to be in social gatherings and they’re the most likely to be the least symptomatic,” she said. “There are more millennials now than any other cohort and they can help us at this moment.”

Birx said if Americans followed the new guidelines, the United States would see a dramatic difference in the outbreak’s trajectory.

Health officials are hoping the measures will help spread new cases over a longer period of time so as not to overwhelm the U.S. healthcare system as has happened in Italy.

Trump said a nationwide curfew was not under consideration at this point and that it was not necessary to postpone elections over the outbreak.

Normally a cheerleader for the U.S. economy, he acknowledged the possibility of a recession while brushing off another dramatic stock market decline as investors worried about the virus. The benchmark S&P 500 closed down 12% and the Dow 13% on Monday.

“The market will take care of itself,” Trump said, adding it would be very strong once the virus was handled. The president has long considered soaring stock markets to be a sign of his administration’s success.

Trump said the administration had talked regularly about domestic travel restrictions but hoped not to have to put such measures in place.

He said he thought it would still be possible for G7 leaders to meet at the Camp David retreat in Maryland in June. Trump upset European countries, which make up a large part of the G7, by instituting travel restrictions from much of Europe without consulting with those nations first.

Signs of seriousness permeated the White House.

Journalists and staff members had their temperatures taken before entering the complex. Reporters staggered their seating during the news conference, sitting in every other seat in the White House briefing room to implement social distancing measures. The White House has temporarily cut down the number of journalists permitted to come onto the complex on a daily basis.

Biden Falsely Blames Trump Administration For Rejecting WHO Coronavirus Test Kits (That Were Never Offered)

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Source: Kaiser Health News, by Victoria Knight and Jon Greenberg

During Sunday night’s debate, while leveling criticism at President Donald Trump’s handling of the national response to the coronavirus pandemic, former Vice President Joe Biden said the Trump administration refused to get coronavirus testing kits from the World Health Organization.

“Look, the World Health Organization offered the testing kits that they have available and to give it to us now. We refused them. We did not want to buy them. We did not want to get them from them. We wanted to make sure we had our own,” Biden said.

A similar claim about WHO test kits has also been circulating on Facebook.

The Biden campaign referred us to a Politico article that said the WHO shipped coronavirus tests to nearly 60 countries at the end of February, but the U.S. was not among them. That is technically correct, but it suggests that the United States would have been on the list under any circumstances.

The countries WHO helped are ones that lack the virology lab horsepower that exists across the United States. The outreach work by the Pan American Health Organization is a case in point.

The group is WHO’s arm in the Americas. It conducted trainings and sent materials to conduct tests to 29 nations. The list included Paraguay, Bolivia, Argentina, Chile, Belize, Costa Rica, El Salvador, Honduras, Nicaragua and many others.

The group said it focused most of its efforts on “countries with the weakest health systems.”

“No discussions occurred between WHO and CDC about WHO providing COVID-19 tests to the United States,” said WHO spokesperson Margaret Harris. “This is consistent with experience since the United States does not ordinarily rely on WHO for reagents or diagnostic tests because of sufficient domestic capacity.”

According to interviews with several infectious-disease experts, Biden’s statement leaves out context about how countries decided on which test they’d use to identify the presence of the coronavirus.

WHO lists seven different approaches — including that of China, the United States, Japan, Hong Kong, Thailand, France and Germany — each one targeting different parts of the COVID-19 genetic profile.

Christopher Mores, a global health professor at George Washington University, said that when faced with an outbreak, the WHO will usually adopt the best test that a research group brings forward.

The German one became the approach WHO circulated as its preferred model.

Aid groups, such as the Pan American Health Organization, took that model and built their training and supplies around it. If the model was like the recipe in a cookbook, the supplies were the ingredients in a home meal kit from Blue Apron.

Any country could use whatever recipe it preferred, and even if the United States had picked the WHO’s protocol, it wouldn’t need the WHO to sell it the materials to follow it. Germany released its protocol on Jan. 17, but the U.S. decided to have the Centers for Disease Control and Prevention develop its own. That protocol was published Jan. 28.

The CDC’s test was different and more complicated than the German test. It worked in the CDC lab, but when the materials went out to state labs, results were inconsistent. The CDC had to resend packages with new chemical reagents.

State laboratories started developing their own tests and were ready to use them, but had to wait for emergency approval from the Food and Drug Administration. All of this added up to a delay in testing capabilities, which resulted in fewer Americans being tested and an overall slower U.S. response compared with other countries.

When asked to respond to Biden’s claim, the Trump campaign pointed to multiple news stories that said it’s not uncommon for the U.S. and other countries to develop their own tests during outbreaks, and that the CDC did so during the Ebola and Zika outbreaks. The campaign also said the CDC’s test had a quick turnaround compared with other diagnostic tests like those for MERS and Zika, which took months to develop. And the issue with the CDC’s protocol was not the test itself, but rather a manufacturing defect, the campaign added.

That’s Not How It Works

While it might seem odd that the Trump administration shunned the WHO’s coronavirus test protocol, it’s normal for countries with advanced research capabilities to want to develop a measure they trust.

“I don’t know if WHO agreed to sell the kits to us, but it should never have been something we needed to do given our technological expertise and the fact we would have ‘taken kits from low- and middle-income countries’ that otherwise could not make or afford them,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, in an email.

It’s also unlikely, Mores said, that the WHO offered to sell kits to the U.S., because that’s not normally what the organization does.

“In my experience, this is never something that I would have to purchase,” he said.

Typically, Mores said, American labs have all of the basic ingredients and equipment to run the test — all that would be needed is the viral sequences and an exact testing protocol. The only catch at the moment is that supplies of those basic ingredients are stretched thin due to high demand.

Our Ruling

Biden said, “The World Health Organization offered the testing kits that they have available and to give it to us now. We refused them. We did not want to buy them.”

Biden has a point that the U.S. did not attempt to use the WHO test. But the U.S. would never have needed complete kits from WHO. Even if it had adopted the WHO testing approach, it already had access to all the necessary materials.

WHO said there was never any talk of WHO sending testing kits to the United States.

Biden’s words leave out other important context and information.

The U.S. chose to use its own test, rather than the one circulated by WHO. Other nations, such as China, Japan and France, also developed their own tests. Multiple public health experts said that is not unusual.

Biden’s emphasis on WHO offering kits is simply wrong. We rate this claim Mostly False.

White House Says Has Sent ‘Principles’ for Drug Pricing Reform to Congress

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Source: Reuters

U.S. President Donald Trump has sent “principles” for drug pricing reform to lawmakers, White House spokeswoman Stephanie Grisham said in a statement on Tuesday.

The White House has called for legislation that would:

– “Cap Medicare Part D beneficiary annual out-of-pocket pharmacy expenses

– “Provide an option to cap Medicare Part D beneficiary monthly out-of-pocket pharmacy expenses

– “Offer protection for seniors against the out-of-pocket cost cliff created by ObamaCare

– “Give insurance companies an incentive to negotiate better prices for costly drugs

– “Limit drugmakers’ price increases.”

Potential Costs of Coronavirus Treatment for People with Employer Coverage

Coronavirus

Source: Health System Tracker, by Matthew Rae

As the new coronavirus spreads within the United States, questions have arisen over the potential costs people may face if they become severely ill and need treatment. To address concerns over costs associated with COVID-19, Vice President Pence met with a group of large private insurers, who agreed to waive copayments and deductibles for COVID-19 tests. However, America’s Health Insurance Plans (AHIP) clarified that the out-of-pocket costs for treatment – such as hospitalizations for more serious cases – would not be waived, meaning people with private insurance who face deductibles could be on the hook for large costs.

In this brief, we examine the potential cost to employer health plans and their enrollees of COVID-19 treatment by looking at typical spending for hospital admissions for pneumonia. We use a sample of the IBM MarketScan Commercial Claims and Encounters claims database, which includes claims from 18 million people enrolled in large employer plans in 2018. Specifically, we look at the costs of admissions for people with pneumonia, including three diagnosis-related groups (DRGs) for pneumonia without complications or comorbidity, with complications or comorbidity, and with major complications or comorbidity. These DRGs include pneumonia caused by similar (SARS-associated) coronavirus, as well as other viruses and bacteria. DRGs are groups of similar diagnoses for which the same level of hospital resources are generally required. (It is important to note that at this time, there are no curative treatments for the new coronavirus infection itself; rather, treatment addresses the complications from COVID-19-related illnesses). Our sample is limited to people under age 65.

Total costs of admissions for pneumonia

Beginning with the total cost of treatment, paid for by a combination of the employer plan and the employee’s out-of-pocket costs, we find that the average cost of an admission for pneumonia with major complications and comorbidities is $20,292 in 2018. However, costs vary greatly across the country, with admissions for pneumonia with major complications or comorbidities ranging from $11,533 (25th percentile) to $24,178 (75th percentile).

Those without major complications could see lower total costs for a pneumonia admission, averaging $13,767 for people with less serious complications or comorbidities and $9,763 for those without any complications or comorbidities.

Out-of-pocket costs for pneumonia admissions

The chart above shows the total costs for admissions, including both the amount paid by insurance and the amount paid out-of-pocket. People with employer and other private coverage often face a deductible for hospital stays, which is the amount patients must pay before their insurance begins covering the cost of certain services. Across people with employer-sponsored coverage, 82% of covered workers had a deductible, with 55% having a deductible of over $1,000. On average, across people with and without deductibles, the typical deductible in employer sponsored plans is $1,396. Aside from deductibles, plans may charge other forms of cost-sharing for hospitalizations, such as copays (fixed dollar amounts) and coinsurance (a percent of the allowed charges) as well. The chart below examines total out-of-pocket costs, including deductibles, copayments, and coinsurance.

We find that for pneumonia admissions without complications, out-of-pocket costs average $1,464. Out-of-pocket costs are similar, though a bit lower for people with major complications.  Average out-of-pocket costs for pneumonia admissions are similar regardless of severity because many people with hospitalizations reach their deductible and/or out-of-pocket max, thus limiting their exposure to the underlying cost. (People with comorbidities may have slightly lower out-of-pocket exposure because they may have incurred earlier health care costs that contributed toward them meeting their deductible).

There are several reasons to believe out-of-pocket costs could be even higher during this outbreak than this analysis indicates:

First, many patients will have higher deductibles, so their out-of-pocket exposure is largely a function of their plan design. The 75th percentile for out-of-pocket costs for pneumonia (regardless of severity) was just over $2,000 in 2018. This analysis is based on claims from large employer plans, which tend to be the most generous private plans. People with private coverage through small businesses and the individual market tend to face higher deductibles.

Second, the pandemic is emerging early in the calendar year, meaning that many people have not yet accrued much health spending to satisfy their deductibles. Deductible and out-of-pocket spending is concentrated early in the year, particularly January through March. On average, employee out-of-pocket spending does not reach the typical employer plan deductible until mid-to-late May. In a normal year, many enrollees never meet their deductible, though it is possible more people will if the coronavirus pandemic leads to greater numbers of hospitalizations.

Third, these figures do not include balance billing, which is when an out-of-network provider sends an additional bill directly to the patient for an amount not covered by the health plan. Patients often receive these surprise medical bills for care, even when they go to in-network hospitals. Some large health insurance companies have assured the public they will not charge higher cost-sharing for people who inadvertently go out-of-network, but only health care providers (such as hospital and physician groups) would be in a position to halt balance bills. Prior to the COVID-19 pandemic, Congress had considered bipartisan legislation to address surprise billing, but had been met by resistance from both health care providers and insurers (more background is here).

Potential surprise billing

Given concerns of surprise billing for COVID-19 treatment, we examined the incidence of out-of-network charges for in-network admissions related to pneumonia.

We estimated that nearly 1 in 5 (18%) of patients who have in-network admissions for pneumonia with major complications or comorbidities face out-of-network charges. Fifteen percent of patients admitted into an in-network facility for all other medical conditions received an out-of-network charge. (This analysis builds on earlier analysis demonstrating that the incidence of surprise bills vary by diagnosis and type of admission.)

Discussion

Medical costs are already a common concern in the U.S., particularly for people without insurance, those with high deductibles, and those in worse health. In the context of the COVID-19 pandemic, it is of even greater concern, as many people could be incurring high out-of-pocket costs, at a time when there is also risk of a recession. The pandemic could add more costs to the healthcare system, employers, and insurers as well, though that will depend on how many people are infected and how many become seriously ill. For individuals with private insurance who do become seriously ill, it is likely their out-of-pocket costs could top $1,300.

The challenge of addressing these concerns over costs in the United States is exacerbated by a fragmented health insurance system and decentralized regulation process. Several states have moved to require fully-insured health plans regulated by the state to waive cost-sharing for testing. These states, however, are unable to regulate the self-insured employer plans, which are regulated by the federal government and cover 59% of covered workers at private sector employers. To date the federal response has been to ask insurers to voluntarily waive costs of testing. Consequently, some insurers administering self-insured employer plans have responded by extending this policy to their self-funded business, while allowing employers to opt-out.

Even if testing is made widely available without cost-sharing, people with private coverage who contract COVID-19 risk high out-of-pocket costs if they need hospitalization. Former Vice President Joe Biden’s proposed response to COVID-19 would cover treatment costs through an emergency medical plan. At this time, the U.S. Congress is currently considering legislation to respond to COVID-19, but there is no indication that it will address treatment costs.

Methods

We analyzed a sample of medical claims obtained from the 2018 IBM Health Analytics MarketScan Commercial Claims and Encounters Database, which contains claims information provided by large employer plans. We only included claims for people under the age of 65, as people over the age of 65 are typically on Medicare. This analysis used claims for almost 18 million people representing about 22% of the 82 million people in the large group market in 2018. Weights were applied to match counts in the Current Population Survey for enrollees at firms of a thousand or more workers by sex, age and state. Weights were trimmed at eight times the interquartile range.

Admissions were classified as pneumonia when the associated diagnosis-related group (DRG) was 193, “Simple Pneumonia and Pleurisy with major complications,” 194 with “complication or comorbidity” or 195 “without complication.” Total cost was trimmed for admissions below the 1st percentile and above the 99.5th percentile within DRG

Inpatient claims were aggregated by admission. Each claim has a variable (‘ntwkprov’) that indicates whether or not the provider or facility providing the service was in the health plan’s network. In-network admissions were defined as admissions that included an in-network room and board charges. Some in-network admissions may include out-of-network facility charges.

To Help Fight Coronavirus, California Seniors Should Isolate and Bars Should Close, Gov. Gavin Newsom Says

An elerly woman pushes another elderly woman, wearing a mask, in a wheelchair | Getty Images

Source: Los Angeles Times, by Phil Willon, John Myers, Taryn Luna, and Anita Chabria

Gov. Gavin Newsom asked Californians over the age of 65 on Sunday to isolate themselves from others and said that neighborhood bars and pubs should close their doors as the number of confirmed coronavirus cases in the state continued to rise.

But Newsom again stopped short of using the full force of his authority to mandate response measures to protect Californians from the virus that causes COVID-19, a global pandemic that has resulted in six deaths and 335 confirmed cases in the state.

Instead, the governor said his request of bars and pubs is akin to an announcement he made last week asking for the cancellation of gatherings of 250 people or more. The governor is allowing restaurants to remain open and advised customers to practice “deep social distancing” when dining out — in effect, a recommendation to reduce occupancy by half.

The governor’s office said his request for the elderly to remain at home also extended to residents with underlying health issues, such as blood disorders, chronic kidney disease, asthma, chronic liver disease, compromised immune systems, pregnancies in the last two weeks, metabolic disorders, heart disease and other conditions that make them more susceptible to serious illness from the coronavirus.

In all, Newsom’s list of new efforts and recommendations reflected the fast-moving nature of the public health crisis and the complexity of how to respond in protecting some 40 million Californians.

In addition to the requests for older residents to remain isolated and bars to close, the governor announced additional testing options for two Bay Area counties hit hard by the virus. He also called for a tighter limit on visitors to hospitals and assisted living facilities to only those patients in end-of-life situations. He promised more action to help public school students out of school as well as homeless people. And he pledged additional tax dollars to be spent through the state budget process as needed.

“We need to anticipate spread, but we also need to prioritize our focus,” Newsom said.

Newsom defended his lack of action to close restaurants, saying he’s removing the most vulnerable people from those environments and allowing eateries to continue to provide meals.

“We need the capacity to meet the needs of our population. And let me say this, frankly, we need a productive society,” Newsom said in response to questions about why he wasn’t taking more dramatic measures. “I’m not willing to submit that in this moment we can’t have cohorts of society being productive, just in a radically different way.”

Newsom’s new directive came shortly after Govs. Mike DeWine of Ohio, J.B. Pritzker of Illinois and Charlie Baker of Massachusetts on Sunday issued orders requiring all bars and restaurants across their states to close. Restaurants may continue to offer carryout and delivery service in Ohio, which has approximately 36 confirmed cases of COVID-19.

Newsom insisted that the difference in what he has recommended and what’s happening in other states and localities is a “nuance” that will not affect the effectiveness of protecting public health. He expressed confidence that Californians would follow his directives voluntarily.

When asked whether he had been tested himself, the governor said he had not, noting that he believed available test kits should be prioritized for those who need them most.The governor said the request of older Californians was made in hopes of limiting their exposure to the virus, given that health officials have pointed out higher dangers for those who are older. He said plans are being made to help carry out the sweeping directive.

“We are prioritizing their safety,” Newsom said.

The new guidelines come following other broad efforts announced in recent days to combat the virus in California. Most of those have been taken on the local level, including the decision by dozens of school districts to shut down operations for the next two weeks or longer. On Friday, Newsom issued an executive order assuring those schools of continued funding during closures.

The governor said he would issue additional directives Tuesday to schools that remain open and said he was especially focused on providing support to low-income families. He suggested some local school officials had not fully thought through the consequences when closing their campuses, including how to continue providing meals to students eligible for free or reduced-price lunches and how to ensure that students with special needs receive adequate care and supervision.

“It’s one thing to say you have a plan and it’s another to actually deliver that plan,” Newsom said.

Pelosi, Seeking to Insulate House Majority, Presses Plan to Lower Health Costs

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Source: The New York Times, by Sheryl Gay Stolberg

Speaker Nancy Pelosi is preparing to unveil a sweeping plan to lower the cost of health care, moving to address the top concern of voters while giving moderate Democrats who face tough re-election races a way to distance themselves from the Medicare for All plan embraced by the progressive left and derided by Republicans as socialism.

The legislation, timed to coincide with the 10th anniversary of the Affordable Care Act, is part of a major push by Democrats to position themselves as the party of health care before the 2020 elections. Former President Barack Obama will support the effort, appearing with Ms. Pelosi at American University in Washington on March 23, 10 years to the day he signed the Affordable Care Act into law.

While the measure has little chance of survival in the Republican-controlled Senate, it is the latest evidence that Democratic leaders, determined to protect their House majority and the moderate lawmakers who helped them to power, are looking for ways to distinguish their rank and file from the party’s presidential nominees.

The plan bears no resemblance to Medicare for All, the national health insurance system championed by Senator Bernie Sanders of Vermont, the self-described democratic socialist. And it omits a “public option” to create a government-run health insurer, an idea embraced by former Vice President Joseph R. Biden Jr., the Democratic front-runner.

In steering clear of the ideas promoted by both leading presidential candidates, Ms. Pelosi is hoping to protect the so-called front-liners who flipped Republican seats in 2018 and delivered Democrats the majority.

The speaker’s new proposal is aimed at reducing costs under the current health bill, according to people familiar with it, who insisted on anonymity to describe a plan that was not yet public. Details are still being finalized, and Ms. Pelosi — who was to meet Monday evening with Democratic committee chairs to discuss a response to the coronavirus epidemic — has not yet shared them with her rank and file. The speaker’s office declined to comment.

The plan could be unveiled as early as this week, though coronavirus could upend that timeline. In eschewing Medicare for All, Ms. Pelosi is turning away from a proposal that does not have the votes to pass the House and has divided Democrats on Capitol Hill.

Instead, the speaker is expected to propose a series of steps to make health care more cost-effective under the Affordable Care Act, including expanding tax credits and subsidies to help people buy insurance and creating a national program to help cover expenses for those with medical conditions. The plan is expected to spotlight ideas put forth by vulnerable freshmen like Representatives Lauren Underwood of Illinois and Angie Craig of Minnesota.

But Ms. Pelosi’s reluctance to embrace Mr. Sanders’s bold vision may draw the ire of her caucus’ left wing, which is pushing for a vote on Medicare for All. Her decision to shy away from the public option is especially notable, given that the House included such a system when it passed its version of the Affordable Care Act in 2009. The provision was later stripped out by the Senate.

“I think it’s way too cautious an approach,” said Representative Ro Khanna, Democrat of California and a national co-chairman of Mr. Sanders’s campaign, though he added that Democrats would most likely embrace any plan that lowered costs, even incrementally.

“No one is opposed to a pragmatic step that’s feasible,” he said. “What we’re opposed to is a lack of imagination and boldness in not giving a vote on policies that economics and health experts are saying is what the country needs.”

But Leslie Dach, a Democratic strategist and the chairman of Protect Our Care, an advocacy group, said it was important for Democrats to spotlight what they could agree on, especially after a string of presidential primary debates where Democrats beat up one another over their health care plans instead of going after President Trump.

“If you do the polling, 80 percent of the people want to lower costs, and they want to protect critical things like pre-existing conditions. That unifies the country and unifies the party,” Mr. Dach said. “What we have had is a debate with tremendous missed opportunities. Democrats should have been up there reminding people what Donald Trump has been doing to their health care, not arguing as much about where they want to go.”

Polls show the public is deeply concerned about the high cost of health care but divided over what to do about it. A recent poll by the Kaiser Family Foundation found that a slight majority of respondents — 53 percent — favored a Medicare for All approach that would cover everyone on a single government plan. A much larger majority, 65 percent, favored a public option.

Republicans have latched onto Mr. Sanders and Medicare for All as a way to paint Democrats as socialists, a strategy that is unlikely to change no matter what proposal Ms. Pelosi puts forth or who becomes the Democratic nominee.

“Voters have watched as the Democratic Party has moved further and further left, to the point where now a majority of their members support canceling private health care entirely for BernieCare,” said Dan Conston, the president of the Congressional Leadership Fund, a political action committee affiliated with House Republicans. Such positions, he said, “make the argument that Democrats have become socialists a particularly effective one, no matter how much they now try to run away from it.”

The Affordable Care Act anniversary comes as the law itself is in fresh peril. It has survived numerous Republican attempts and a vow by Mr. Trump to repeal it, as well as a string of court challenges.

But the Supreme Court, which has twice ruled to leave most of the provisions intact, recently agreed to hear a third case, which could wipe out the Affordable Care Act entirely. When Democrats took over the House in January 2019, they voted to intervene in the case, Texas v. U.S., which was brought by conservative state attorneys general seeking to overturn the law.

Democrats campaigned aggressively in 2018 on lowering costs and protecting health coverage, and they have already taken some steps to make good on those promises.

In May, they passed legislation to reverse Trump administration rules that allowed the expansion of health care plans that did not have to comply with the Affordable Care Act’s mandated coverage of pre-existing medical conditions. And in December, the House voted to lower the rising cost of prescription drugs by empowering the federal government to negotiate prices with pharmaceutical manufacturers.

But like most legislation passed by House Democrats, the two health bills are languishing in the Senate, where Senator Mitch McConnell, Republican of Kentucky and the majority leader, refuses to take them up.

The legislation Ms. Pelosi is drafting is based in part on the Protecting Pre-Existing Conditions & Making Health Care More Affordable Act, a measure introduced about a year ago by the three chairmen whose committees have jurisdiction over health care: Representative Frank Pallone Jr. of New Jersey, the Energy and Commerce chairman; Representative Richard E. Neal of Massachusetts, the Ways and Means chairman; and Representative Robert C. Scott of Virginia, the Education and Labor chairman.

That bill aims to lower health insurance premiums by expanding eligibility for premium tax credits beyond 400 percent of the federal poverty line. It also increases the size of tax credits for people in all income brackets. It would create a so-called reinsurance program, which would provide government funds to help insurers offset the cost of patients with expensive medical conditions. And it would make subsidies more generous for people with incomes below 250 percent of the federal poverty line.

Other Democrats, including Ms. Underwood and Ms. Craig, have put forth similar ideas. Ms. Underwood is the chief sponsor of a stand-alone plan to expand tax credits. Ms. Craig is promoting federal funding for states to run their own programs to reduce insurance premiums.

It is measures like Ms. Pelosi’s — not the kind of systemwide overhaul advocated by Mr. Sanders — that House Democrats want to focus on as they seek to maintain their majority.

“Our front-liners have been very focused on their message, which has been strengthening the A.C.A., making sure we’re continuing to cover pre-existing conditions, and making sure that we resist the constant cuts to Medicaid and Medicare and even Social Security that have been proposed,” said Representative Katherine M. Clark, Democrat of Massachusetts and a member of the leadership. “Whatever’s happening on the national level, I don’t think their strategy is going to change.”

Even if Sanders Wins, Medicare for All Almost Certainly Won’t Happen

Image result for Even if Sanders Wins, Medicare for All Almost Certainly Won’t Happen imagesSource: The New York Times, by Abby Goodnough and Reed Abelson

With the Democratic presidential contest down to a two-person race, Senator Bernie Sanders has declared that he will wield his signature issue, Medicare for all, as a crucial distinction between his campaign and the surging candidacy of former Vice President Joseph R. Biden.

“Joe essentially wants to maintain what I consider to be a dysfunctional and cruel health care system,” Mr. Sanders said this week, adding that he hoped they could devote an entire debate to the issue.

But an even bigger hurdle than winning the presidency stands between Mr. Sanders and his goal of generous government health insurance for all Americans: Congress.

No legislation to advance or achieve universal health care has succeeded over the past 70 years without Democrats not only controlling all three branches of government, but also having a supermajority in the Senate. At this point, Mr. Sanders’s plan has nowhere near that support.

Just 14 members of the Senate have signed on to his Medicare for All Act, which would require a huge expansion of federal spending, and Democrats would need to pick up four seats in November to gain majority control of the chamber. Even if they succeeded, most of the Democrats seeking to unseat vulnerable Senate Republicans — John Hickenlooper in Colorado, for example, and Mark Kelly in Arizona — have come out against Medicare for all, raising the curious prospect of Democratic Senate candidates opposing the Democratic presidential nominee’s most prized policy plan.

In the House, a similar Medicare for all bill has 119 sponsors, all Democrats, out of a total 435 members — at least 218 votes are needed to pass legislation — and Speaker Nancy Pelosi is not among the supporters. Nor are most of the roughly 40 freshman Democrats known as “front liners,” who helped their party win control of the House in 2018 by flipping Republican seats.

“I’m not sure that the government is prepared or qualified to take over the health care for every single American,” Representative Elissa Slotkin, a Democrat who flipped a Republican district in southern Michigan in 2018, told a local newspaper there.

Whether because of the cost — $34 trillion in new federal spending over 10 years, according to the Urban Institute — or opposition to eliminating private insurance in favor of government control, most congressional Democrats instead support improving the Affordable Care Act or pursuing a new government-run plan, or “public option,” that would compete with private insurance.

A public option is at the core of Mr. Biden’s health plan, but it too could prove extremely challenging to enact, depending on how threatening it seemed to insurers and hospitals. Industry groups that are already mobilizing against Medicare for all could also doom public option legislation, as they did in 2010, when supporters of the Affordable Care Act had to drop a relatively modest public option provision to get the law passed.

It is always possible that sentiments could shift — perhaps sooner rather than later if the coronavirus outbreak were to disproportionately harm people who could not afford care, a possibility Mr. Sanders has already raised. He lost no time in making the case for Medicare for all after Health Secretary Alex M. Azar II suggested while testifying before Congress recently that federal officials would not be able to guarantee that all Americans would be able to afford a coronavirus vaccine if it were to become available.

But for now, many Democratic lawmakers have expressed trepidation that a legislative showdown over Medicare for all would make it impossible to advance other important initiatives, including on climate change and immigration.

And with the Supreme Court’s announcement Monday that it would hear a major new challenge to the Affordable Care Act as soon as this fall, even some who support Medicare for all said that for now, Democrats should unify behind the law, which President Trump’s administration is seeking to invalidate.

Asked in an interview how the House would treat Medicare for all legislation if Mr. Sanders were elected president, Representative Hakeem Jeffries, a co-sponsor on the House Medicare for all bill, promptly changed the subject to the court case.

“There is an unrelenting attack on the health care of everyday Americans, and it seems to me the focus at the moment should be on protecting and strengthening the Affordable Care Act,” said Mr. Jeffries, a New York Democrat who is chairman of the House Democratic Caucus.

History, too, suggests the chances of a President Sanders pushing Medicare for all through Congress would be slim to none. President Harry S. Truman failed to win comprehensive universal coverage in 1950 even with Democrats controlling the House and Senate. That defeat, as John McDonough, a health policy expert at Harvard, noted recently in the journal Health Affairs, led President Lyndon B. Johnson to seek a less ambitious fallback 15 years later: universal coverage limited to older people in his 1965 legislation that created Medicare, a historic accomplishment in its own right.

“If Democrats can further advance toward near-universal coverage without the life-or-death struggles of Medicare for All,” Mr. McDonough wrote, “they might just achieve meaningful and historic progress even as they preserve the political capital to make progress on other compelling and urgent policy needs.”

Mr. McDonough also pointed out that the landmark coverage expansions in 1965 (which also created Medicaid, but for a very limited group at the time) and in 2010 with the Affordable Care Act were passed not merely by a Democratic-controlled Congress, but also with Democratic supermajorities in the Senate.

“There’s no prospect of having majorities like that,” said Paul Starr, a professor of sociology and public affairs at Princeton University. “It’s not going to happen.”

Even if the rules were changed to get rid of the filibuster, making it possible to pass major legislation with only 50 Senate votes, “there is not any guarantee that the 51st Democrat would be willing to support Medicare for all or anything close to it,” said Mark Peterson, a professor of public policy, political science and law at the University of California, Los Angeles.

Rep. Pramila Jayapal, Democrat of Washington, who wrote the House Medicare for all bill, said in an interview that she was not discouraged by the math, noting that since she introduced her bill a year ago, a dozen more members had signed on as co-sponsors, House committees had held four hearings on it, and coalitions representing people of color, labor unions and businesses had begun lobbying for the bill.

“A lot of the members I speak to that aren’t on the bill, I actually believe they would like to be on the bill but think, ‘I don’t know if it’s politically good for me,’” Ms. Jayapal said. “That would fundamentally change if Bernie were to be elected president.”

Proponents of Medicare for all like to cite some polls that suggest there is strong support for the idea. But Mollyann Brodie, who oversees public opinion research at the Kaiser Family Foundation, says only a minority of Democrats are solely in favor of a sweeping Medicare for all plan, compared to a majority who support offering the option of buying a Medicare-like plan or Medicare for all as a way to address high costs and the challenges of getting care.

People are wary of the high taxes that could come with Medicare for all, Ms. Brodie said, partly because they do not necessarily trust the federal government to determine how the dollars are spent.

What also makes Medicare for all unlikely is massive opposition from the health care industry, particularly insurance companies whose very survival is at risk. Hospitals are also opposed, because the federal government typically pays them much less than private health insurers. Being paid at Medicare rates, industry groups say, would cause many hospitals to close and others to lay off their workers.

The industry groups that were largely on board for the Affordable Care Act have already mobilized, through groups like the Partnership for America’s Health Care Future, to squelch any thoughts of Medicare for all. They are aggressively lobbying Congress and spending on television ads, one of which aired during the most recent Democratic debate.

Short of a public option, which all the Democratic presidential candidates besides Mr. Sanders embraced in one form or other, there are more incremental proposals that have broad public and congressional support.

Increasing the generosity of premium subsidies for people who buy coverage through the Obamacare marketplaces, as California has already done, is one such idea. Another is to offer premium subsidies to adults with incomes below the poverty level in states that have not expanded Medicaid, a population that is still largely uninsured.

Ms. Jayapal acknowledged that short of a rapid sea change in public attitudes, full Democratic control of Congress would be necessary to even begin moving forward on Medicare for all. She noted, however, that congressional Republicans have fallen in line behind Mr. Trump’s agenda to an extent that no one predicted, and said the same could happen with Democrats and Mr. Sanders.

“A president can lead his or her party to a different place in a very short period of time,” she said. “Sometimes we think the tipping point is much further away than it actually is.”

Health Care Lobby Urges Congress to Foot the Bill for Coronavirus Quarantines

Image result for Health Care Lobby Urges Congress to Foot the Bill for Coronavirus Quarantines images

Source: Politico, by Susannah Luthi and Jennifer Scholtes

The health care industry wants the federal government to pay for mandatory quarantines of patients who may be carrying coronavirus but don’t need hospital care — a potentially high-dollar request for the emergency funding bill now under negotiation in Congress.

A growing number of Americans entered self-isolation over the weekend, including health care workers and other responders who’ve been exposed to the virus. This has only intensified the need for answers to a question hospitals flagged late last week, even as insurers grappled with the potential need to elaborate on their coverage policies.

The core issue is how to handle patients who are undergoing tests, or who’ve been diagnosed with coronavirus but are showing only mild symptoms, if any — yet who risk further spreading the virus to other members of their household if they isolate at home. Hospitals want the government to supply temporary facilities, such as hotel rooms.

One health care lobbyist framed the problem as one of potential bed shortages for the critically ill if the epidemic worsens, and patients who might otherwise go home have to stay in hospitals. In Washington state, where there are 14 confirmed cases of coronavirus in Seattle and King County, the county executive signed an emergency declaration that will allow the purchase of a motel as well as the setting up of modular housing units on publicly owned parking lots and other available land.

This pressure could further intensify if coronavirus snowballs in the U.S. as it has elsewhere in the world, where mass quarantines have become status quo.

There’s no word yet whether Congress will agree to include that language in the initial supplemental appropriations bill now under negotiation. Appropriators are still hammering out details of what’s now a $7 billion to $8 billion funding package to fight the coronavirus, but an individual familiar with talks said the text of legislation could come as soon as Tuesday. A vote on the package is expected in the House later this week, and the Senate will likely follow next week.

In a letter last week, the American Hospital Association formally asked Congress to, among other things, “provide housing, care and monitoring of patients” who don’t require hospitalization but need to be isolated. The ask was part of a $1 billion request for initial emergency funds. The American Nurses Association joined the petition.

“This includes persons with suspected or confirmed COVID-19 infections who experience mild to moderate symptoms,” the letter said.

Meanwhile, insurers are scrambling to come up with their own requests of the government.

So far the only public guidance on coronavirus from America’s Health Insurance Plans, the insurance industry’s main trade group, reiterates that testing for the disease should be free and conducted by the Centers for Disease Control and Prevention, and that plans cover “reasonable, medically necessary health care costs related to infectious diseases and medical conditions.”

Plans haven’t fully defined which aspects of treatment they deem medically necessary and therefore eligible for payment, saying it’s too early. A representative for AHIP said insurers are evaluating if they have to loosen policy restrictions for coverage related to the coronavirus.

Amid the funding talks, public concern over unexpected bills related to coronavirus treatment continues to mushroom.

And the question of who’s going to pay for any quarantines outside the home comes amid warnings that the U.S. health care affordability crisis could exacerbate the disease if people avoid testing or treatment over cost concerns. Democratic presidential hopeful Sen. Elizabeth Warren raised the alarm in a speech on Saturday.

“No one should face thousands of dollars in medical bills and lost wages if they’re put in mandatory quarantine by the government,” the Massachusetts senator said. “It’s not only the moral thing to do, it keeps us all safer.”

The Department of Health and Human Services and the CDC didn’t respond to requests for details on the administration’s plan for handling the quarantine matter.

The person familiar with talks in Congress confirmed lawmakers are working on one provision addressing cost concerns — a measure to guarantee affordability of any forthcoming vaccine for the virus.

The White House has fielded strong criticism from Democrats and Republicans alike over its reluctance to request more than its initial $2.5 billion plan focused mostly on early containment over long-term strategies.

HHS Secretary Alex Azar has defended the early request, saying $2.5 billion is meant to carry the country through Sept. 30, which marks the end of the current fiscal year, and that the administration will then work with Congress to expand funding for fiscal 2021. President Donald Trump has said he’s open to more funding.

New Federal Rules Will Let Patients Put Medical Records On Smartphones

Image result for New Federal Rules Will Let Patients Put Medical Records On Smartphones images

Source: Kaiser Health News, by Fred Schulte and Erika Fry

Federal officials on Monday released groundbreaking rules that will let patients download their electronic health records and other health care data onto their smartphones.

“Patients should have control of their records, period. Now that’s becoming a reality,” said Health and Human Services Secretary Alex Azar. “These rules are the start of a new chapter in how patients experience American health care.”

Officials said the rules likely will give patients a greater say in health care decisions and put an end to a long-standing practice in which some doctors and hospitals resist handing complete medical files over to patients upon demand. Many of the provisions are set to take effect in 2022.

“The days of patients being kept in the dark are over,” said Centers for Medicare & Medicaid Services Administrator Seema Verma. “In today’s digital age, our health system’s data-sharing capacity shouldn’t be mired in the Stone Age.”

Yet the new rules also have raised concerns about privacy as technology companies, such as Google, Microsoft, Apple and Amazon, open up new markets for providing medical records through mobile apps. Major EHR vendor Epic, for instance, has warned that freer flow of medical records could spur the unwanted sale of data or other unauthorized uses.

“Family members may be shocked to find that their most personal health data has been mined and sold by data brokers and is now known by others, Epic CEO Judy Faulkner wrote last June in opposing the rules.

Administration officials said they have taken privacy considerations into account and would require developers to attest to plans to protect the security and use of medical data.

Verma took a swipe at Epic in an interview with KHN and Fortune.

“We’re not afraid to take on special interests to do what’s right for patients. Some people disagree because they want to keep the data,” she said. “The reality is that patient data belongs to patients. It doesn’t belong to EHR companies.”

Verma said the nation’s health care system remains “hugely expensive and inefficient as repeat tests drive up costs and, perhaps most importantly, doctors are forced to provide care with an incomplete clinical picture, especially at a time when the health care systems could be under stress.”

“With the handling of the COVID virus, the urgent need for coordinated integrated care could not be clearer,” she said.

Donald Rucker, who coordinates health information technology policy for HHS, said the new rule “will allow patients the ability to manage their health care the same way they manage their finances or the travel or other parts of their life on their smartphone.”

While Epic, the maker of the most-used electronic health records software, led a campaign to derail the rules, its chief competitor, Cerner Corp., argued the rules were long overdue.

“Consumers should have the right to access the health care information their providers have about them and dictate where they want it to go. Although existing laws allow patients to access their data, it doesn’t work,” Cerner CEO Brent Shafer said in a statement.

The rules also attempt to prevent EHR vendors from silencing critics of their software products. The government wants to encourage doctors and other users of EHR technology to share their experiences about software problems by prohibiting so-called gag clauses in sales contracts. That could free users to criticize EHR systems, including more open discussion of flaws, software glitches and other breakdowns.

Botched Operation,” an investigation published by Kaiser Health News and Fortune last year, found that the federal government has spent more than $36 billion on the EHR initiative. Thousands of reports of deaths, injuries and near misses linked to digital systems have piled up in databases over the past decade — while many patients have reported difficulties getting copies of their complete electronic files, the investigation found.

Consumers have long sought to be more in the loop on health care decisions in a user-friendly form. Many specifics about how that will happen, including how patients would make sense of complex pricing policies for purchasing health care and insurance and assessing quality, remain unclear, however.

To cut down on exorbitant “surprise” medical bills, Verma said, the CMS’ new rule would require insurers to let patients know which medical providers are in their networks. One study found that such bills — often not covered by insurance — have struck more than half of American adults.

For well over a decade, federal officials have struggled to set up a digital records network capable of sharing medical data and patient records. In 2004, President George W. Bush said he hoped to have a digital record for most Americans within five years. In early 2009, the Obama administration funneled some $36 billion in economic stimulus money to help doctors and hospitals buy the software needed to replace paper medical files.

Despite the slow progress, federal officials remain optimistic that digital records will save the nation billions of dollars while reducing medical errors, unnecessary medical testing and other waste — and encouraging more Americans to take a bigger role in managing their health care by comparing prices.

Trump administration officials on Monday sought to blame the Obama administration for creating what they called a “tower of Babylon,” in which doctors and health systems couldn’t seamlessly share patient information or “talk to one another.”

“It’s led to a tremendous amount of frustration on the part of medical professionals and patients as physicians, interacting with patients, oftentimes spend more time looking at computer screens than they do into the eyes of the people they’re trying to heal,” said White House official Joe Grogan.

Last Updated 07/01/2020

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