Private Sector Looks to Crush Medicare for All

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Source: Politico

The united front that helped Democrats save Obamacare just a year ago is falling apart over single-payer health care.

Deep-pocketed hospital, insurance and other lobbies are plotting to crush progressives’ hopes of expanding the government’s role in health care once they take control of the House. The private-sector interests, backed in some cases by key Obama administration and Hillary Clinton campaign alumni, are now focused on beating back another prospective health care overhaul, including plans that would allow people under 65 to buy into Medicare.

This sets up a potentially brutal battle between establishment Democrats who want to preserve Obamacare and a new wave of progressive House Democrats who ran on single-payer health care.

“We know the insurance companies and the pharma companies are all putting tens of millions of dollars into trying to defeat us,” said Rep. Pramila Jayapal (D-Wash.), who co-chairs the Medicare for All Congressional Caucus. “Which I take as a badge of honor — that they’re so concerned about a good policy that they’re going to put so much money into trying to defeat it.”

The rift could come into full view in the opening weeks of the new Congress, as the party long bound by a need to defend the Affordable Care Act tries to embrace a new health care vision it can carry into the 2020 presidential campaign.

House Democratic leaders already are emphasizing the need to align behind a more pragmatic agenda focused largely on shoring up Obamacare, without peering too far into the future.

“We want to continue promoting the idea of accessibility and improving the Affordable Care Act,” said incoming Ways and Means Committee Chairman Richard Neal (D-Mass.). “That should be the primary goal that we have.”

It’s a sentiment shared by the major lobbies that fought alongside Democrats against Obamacare repeal and now want to reap the benefits. These interest groups contend that, after a decade of upheaval in health care, the public would prefer simple fixes that strengthen the ACA over a headlong rush into another dramatic overhaul of the system.

But House progressives, buoyed by voter enthusiasm and a surge of single-payer support among the party’s base, have other ideas. Among their high-profile agenda items is “Medicare for All” legislation, an idea until recently on the fringes of policy debates that polling shows captivated voters during the 2018 election cycle, despite potentially staggering costs.

“It’s more of a mainstream position than it’s ever been before,” said Adam Green, co-founder of the Progressive Change Campaign Committee, which maintains close ties to House progressives. “There’s this hugely rapid advancement toward Medicare for All — single-payer — as not just an eventual North Star goal, but as something that’s increasingly possible.”

But major lobbies that fought shoulder-to-shoulder with Democrats last year are working now to derail such liberal ideas in order to preserve the status quo.

More than a dozen groups intend to press their point next year through The Partnership for America’s Health Care Future, a vehicle to combat an expanded government role in health care.

America’s Health Insurance Plans and the BlueCross BlueShield Association helped found the coalition alongside the Federation of American Hospitals, the big drug lobby PhRMA and the American Medical Association.

Since then, it’s added another 13 organizations — most representing companies with much to lose under a system that shrinks or in some cases eliminates private health care.

Medicare for All legislation would effectively eliminate private health coverage. And talk of greater government influence over health care has alarmed providers that contend Medicare and Medicaid currently pay only a fraction of what it costs to care for beneficiaries.

The Partnership, some of whose members began discussions within weeks of Senate Republicans’ failed Obamacare repeal vote in July 2017, is planning to launch a campaign featuring ads, polling and white papers playing up the private sector’s role and warning against further disruptions to the health system, people involved with the group said. Avalere, a consulting firm Democrats often leaned on to highlight the dangers of GOP repeal bills, is producing research for the coalition.

Avalere founder Dan Mendelson — a former Clinton White House official — declined to comment on the firm’s work, citing a policy of not talking about its clients.

The Partnership has also received support from Lauren Crawford Shaver, a veteran of the Obama administration’s Health and Human Services Department and Hillary Clinton’s 2016 campaign, who is running its operations out of the lobbying shop Forbes Tate Partners.

“We believe all Americans deserve access to affordable, high-quality health care. But a one-size-fits-all, government-controlled system like Medicare for All isn’t the answer,” Shaver said, predicting it would restrict choice and innovation and put “decisions regarding our health care in the hands of politicians in Washington.”

Former top Obama campaign aide Erik Smith has also been involved in running communications for the Partnership, though he told POLITICO his relationship with the coalition is ending in the next few weeks.

Other groups that fought Obamacare repeal are quietly working to limit Democrats’ ambitions by highlighting the practical complexities and political risks inherent in rewiring the entire national health care system — including an employer-sponsored insurance market that serves 151 million Americans.

Officials from several groups expressed confidence that public support for Medicare for All will plunge as people become more aware of the trade-offs it would require.

“We are convinced here that, whether it’s on the state basis or federal basis, incremental change is a real possibility and is doable,” said Kenneth Raske, president of the Greater New York Hospital Association, one of the loudest voices in 2017 against both ACA repeal and a state-level single-payer effort. “In New York, we have 5 percent uninsured. Why do we want to have a 100 percent solution to a 5 percent problem?”

That’s echoed in Democratic circles by strategists fearful of squandering the party’s advantage on health care and losing the support of industry groups that have proved helpful in recent health care fights.

Medicare for All skeptics point to the lengths the Obama administration went to secure industry support for the ACA prior to its passage in 2010, an effort that did little to insulate Democrats from eight years of political blowback. Yet another major government health care expansion could be even more painful, they say.

“From a political perspective, it’s a really high priority to keep the focus on Republicans and what Republicans have done to harm health care,” said Brad Woodhouse, whose pro-Obamacare group Protect Our Care played a central role in the repeal fight. “The country just isn’t ready to rip it up and start over again.”

Liberals concede their effort faces institutional roadblocks but maintain they’re undaunted by the firepower aimed their way.

The House Democrats’ progressive wing is increasingly influential, the party has a clear advantage on health care for the first time in years and polls show the once-fringe concept of a single-payer system is captivating a growing portion of the nation.

“We want to make sure we shore up protections for pre-existing conditions [and] do everything we can to make sure the Affordable Care Act is effective as possible,” Jayapal said. “But, in the end, we still have a problem with the cost of health care for ordinary people. And so that’s what we’re trying to address.”

The progressive movement’s own lobbying campaign inside and outside Congress is just getting started, she added. That gives the party time to balance shoring up the ACA with figuring out a path to universal health care that could range from incremental steps like adding a public option all the way up to a full single-payer system.

And in the meantime, progressives say they’re more concerned about courting voters than winning over big business. For as much as the industry lobbies contributed to defending Obamacare, they argue, the repeal fight demonstrated even more convincingly that Democrats can win any health care battle if the public is on their side.

“People across this country have worked through for themselves the public debate on the government’s role in health care, and America has shifted,” said Sen. Elizabeth Warren (D-Mass.), a Medicare for All supporter and likely 2020 presidential candidate. “So the importance of persuading every one of the insiders that this is going to be a great deal for them has diminished.”

‘Public Charge’ Would Hit California’s Economy, Study Says

Image result for ‘Public Charge’ Would Hit California’s Economy, Study Says imagesSource: Los Angeles Times

Rules that could give immigrants reason to avoid enrolling in health safety net programs would deliver a blow to California’s economy, costing the state thousands of jobs and billions of dollars in economic output, a new study concluded.

Under the rules proposed by the Homeland Security Department, immigrants could jeopardize their chances of getting green cards if they enroll themselves or their children in Medicaid — the half-century-old government health insurance program for the poor — or nutrition assistance programs such as CalFresh or federal housing assistance.

The rules would likely cost the California economy more than 17,000 jobs and $2.8 billion in lost economic output if just 35% of the Californians in immigrant families currently making use of these programs decide to not enroll, said the study, which was done by the UCLA Center for Health Policy Research, UC Berkeley Labor Center and a nonprofit group, California Food Policy Advocates. The study said 6,200 of those lost jobs and $992 million of that lost output would be in the Los Angeles area.

California’s healthcare and food-related industries would be hit hardest by the resulting job losses, the study said. Of the jobs lost, 47% would be in healthcare and 10% would be food-related, said the study, which added that 4% would be in real estate.

“Every industry could be affected, though to a lesser degree than the top three industries we listed,” said Laurel Lucia, an author of the study and director of healthcare at the UC Berkeley Labor Center.

The proposal is an expansion of existing “public charge policies” that make it harder for immigrants who receive certain forms of public assistance — such as income assistance or long-term care at federally funded institutions — to apply to enter the U.S. or to become a permanent resident.

“Under the harsher ‘public charge’ test proposed, participation in public programs is one of a number of factors that would be considered to determine whether a person is likely to use public benefits in the future,” Lucia said. She also said prior enrollment in the expanded list of programs would not be considered unless the immigrant is still in one of the programs when the rule change takes effect.

For more than two centuries, the United States has placed restrictions on immigrants deemed to be a “public charge.” But government officials long viewed health programs as important tools for protecting the well-being of citizens and noncitizens alike.

If the proposed changes are implemented, about 765,000 immigrants in California may choose to disenroll from nutrition assistance and healthcare programs, according to the study. It said that level of disenrollment could in turn lead to California losing $1.46 billion in federal benefits.

“Immigrants make crucial contributions to California’s workforce, economy and tax base,” Ninez Ponce, director of the UCLA center and an author of the study, said in a statement. “The proposed changes to the ‘public charge’ test would significantly reduce the use of much-needed public programs among those who are eligible, and the economic ripple effect would hurt communities statewide.”

The public can still comment on the proposed rules through Monday. The rules are expected to be finalized and published in February.

In a joint statement in September, health officials, physician groups, hospitals and patient advocates across the country condemned the proposed changes and urged President Trump’s administration to withdraw the proposal.

“The order puts a governmental barrier between healthcare providers and patients and stands in stark contrast to the mission each of our organizations shares: ensuring meaningful access to healthcare for patients in need,” they said.

When announcing the proposed rule change in September, Homeland Security Secretary Kirstjen Nielsen said immigrants must show they can support themselves financially.

“This proposed rule will implement a law passed by Congress intended to promote immigrant self-sufficiency and protect finite resources by ensuring that they are not likely to become burdens on American taxpayers,” Nielsen said in a statement.

The California Health Care Foundation and the California Endowment funded the new study.

Poll: 6 in 10 Say Higher Health Care Premiums are ‘Major Concern’

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Source: The Hill

Six in 10 U.S. adults say they worry about having to pay higher health insurance premiums, according to a Gallup poll.

The poll finds that 61 percent say having their premiums raised is a “major concern,” higher than several other health-care-related problems.

Democrats focused heavily on health care on the midterm campaign trail and won back the House majority while saying they would preserve protections for people with pre-existing conditions.
The poll, though, finds that premiums are an even bigger concern for the public than pre-existing conditions.

Forty-two percent of adults said being denied coverage for a pre-existing condition is a major concern, compared to the 61 percent worried about higher premiums. In addition, 46 percent said they are concerned they will not have enough money to pay for health care.

“Many House members-elect have homed in on the issue of being denied coverage because of a pre-existing condition, which worries more than four in 10 Americans,” the Gallup analysis states.

“But concerns are greatest about the possibility of having to pay higher premiums — a scenario that raises major concerns across party lines,” it adds.

Not surprisingly, people making under $30,000 are even more concerned about higher premiums, at 70 percent. But even among those making more than $75,000, 57 percent are concerned with higher premiums.

Judge Adds New Hurdle to CVS-Aetna Merger

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Source: The Hill

A federal judge could throw a wrench into the mega-merger between health giants CVS and Aetna.

U.S. District Court Judge Richard Leon in Washington said this week he is considering delaying the $70 billion merger, and keeping the companies separate until he has a chance to weigh in.

The move is unprecedented, as the companies were already in the process of integrating after their deal formally closed last week.

The Justice Department approved the merger in October under the condition that the companies sell Aetna’s Medicare drug business to preserve competition, and every state has also signed off on the merger.

It’s not clear whether Leon, a George W. Bush appointee, can legally stop the merger. He ordered a hearing for Dec. 18 and told the companies to present arguments by Dec. 14 to convince him why they should be allowed to proceed.

“At this stage, I am less convinced of the sufficiency of the government’s negotiated remedy than the government is,” Leon wrote in the order.

A spokesman said CVS and Aetna are no longer two separate entities and is focused on their merger.

“CVS Health and Aetna are one company, and our focus is on transforming the consumer health experience,” the spokesman said.

Leon during the hearing said he was concerned that the Department of Justice (DOJ) hadn’t adequately addressed the potential competitive harms raised by the merger, according to reports.

He cited opposition from groups including the American Medical Association (AMA), which urged federal regulators to block the deal because of anticompetitive concerns.

According to the AMA, the merger “would likely substantially lessen competition in many health care markets, to the detriment of patients.”

The deal between one of the country’s largest insurers and one of the largest pharmacy benefit managers was a year in the making. The companies have touted the merger, saying it will usher in a new era of reduced costs to patients.

Leon is no stranger to major antitrust cases. In June, he issued an opinion blasting the government’s challenge to the AT&T merger with Time Warner and allowed the $85 billion deal to proceed. That ruling is currently being appealed by the government.

Antitrust experts said it’s unheard of for a federal judge to force companies to make substantial changes to a merger, even if the judge has some authority to question a federal settlement.

Federal courts have to oversee DOJ approvals under a law called the Tunney Act. The courts must decide whether the proposed settlement is in the public interest and not the result of a backroom deal. Up until now, the court reviews have been perfunctory, and mergers have been approved.

“We’re in a wonderful, uncharted land,” said David Balto, an attorney who works with consumer groups to fight large health-care mergers. “You haven’t ever had a judge say, ‘you can’t consummate this merger until you resolve the issues.’ ”

James Tierney, a former Justice Department antitrust lawyer now practicing with the law firm Orrick, said only the DOJ has the power to block the merger.

Since the agency approved the merger, Tierney said Leon can only decide if the proposed settlement addresses the harms the government identified.

“It is not the proper function of the court to make enforcement decisions. The court is free to review actions, but they can’t order the executive branch to take action it doesn’t want to take,” Tierney said.

Leon’s questioning though is being hailed by critics of the deal and could open the door for more scrutiny of major health-care mergers.

In Congress, Democrats have raised the alarm over the merger since it was announced.

Earlier this year, Rep. Jerrold Nadler (D-N.Y.), the likely incoming chairman of the House Judiciary Committee, called on antitrust officials to closely scrutinize the CVS-Aetna merger.

“The health-care sector is already highly concentrated, and there remains a concern that dominant firms — including a post-merger CVS-Aetna — would have the ability and the incentive to exclude competitors or to diminish competition,” Nadler said at a hearing on the merger earlier this year.

And with Democrats taking control of the House in January, they are likely to draw more attention to what they see as an increasing number of anticompetitive health-care mergers

For now, all eyes are on Leon.

The Justice Department in a status report Sunday said Leon’s role was limited to making sure the final settlement fixed the specific antitrust violations that spurred an initial government lawsuit.

The DOJ also said Leon already signed a preliminary order that effectively allowed the companies to move forward on their merger.

Tierney said Leon seems to have been caught off guard that the companies already closed the deal “and is apparently having second thoughts.”

Leon reportedly told lawyers for the companies last week he wouldn’t be a “rubber stamp” for the settlement.

Balto said Leon’s move could be the start of a new level of scrutiny over mergers.

“The time of DOJ asking for a rubber stamp is a bygone era disappearing,” Balto said. “We will see more courts doing this.”

Blue Shield’s Trims To Out-Of-State Coverage Give Some Californians The Blues

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Source: California Healthline

Denise Roberts is still coping with complications from a life-threatening bout of Valley Fever three years ago that claimed part of a lung. Roberts, who lives in Doyle, Calif., a tiny rural community near the Nevada border, typically drives to Reno for the care she needs. Specialists in her own state, she said, are too far away.

But starting Jan. 1, Roberts’ insurer, Blue Shield of California, likely won’t cover the out-of-state care Roberts has come to rely on.

In an effort to reduce costs, the insurer has quietly decided to scale back participation in the national Blue Card program that since 1994 has allowed Blue Shield’s members to receive a range of primary and specialty care services out of state. That could be a big problem for frequent travelers, college students, snowbirds and other people who divide their time between states – and for rural patients like Roberts who live close to state borders.

The change applies only to members with individual market preferred provider health plans,- not those with group coverage or Medicare. The restrictions appear to be confined to California.

Susan Edwards, a longtime insurance broker in the northeastern town of Susanville, Calif., described Blue Shield’s new restrictions as “a huge deal. We’re in a border county, we’re very rural, so when we need medical care we go to Reno. That’s where the specialists are. That’s where the bigger hospitals are.”

Blue Shield of California – the third largest insurer in the state – covers about 720,000 people in individual PPO plans, according to the state’s Department of Managed Health Care. Nearly a fifth are in the state’s insurance marketplace, Covered California. It’s impossible to know how many will be affected by the change.

“I now stand to lose either my coverage or my doctors when I have to renew this year,” said Roberts, 61, editor of a trade publication. “Tough choice to make when you’re held hostage by the insurance industry.”

Blue Shield of California downplayed the new restrictions. The insurer still will cover out-of-state emergency care, urgent care and some limited primary care, company officials said. It also will work with patients already undergoing a course of treatment in another state, and offer members the opportunity for telephone consultations with out-of-state doctors, spokeswoman Amanda Wardell said.

“We have a large network of providers in California,” Wardell said. “We’re trying to focus on affordability and part of that is focusing on our provider network in California. We’re able to manage our costs better.”

Kevin Knauss, a Sacramento-area health insurance agent who writes the InsureMeKevin blog, said he’s received calls from worried clients, including a man who divides his time between New York and California and a family that had hoped to seek highly specialized care outside California for their son’s brain disease.

The move isn’t particularly surprising to Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

In California’s competitive insurance market, she said, insurers are narrowing their networks of doctors and hospitals to lower their costs.

“Consumers are price-sensitive to premiums,” Corlette said. Under the ACA, “there is a more limited set of tools for insurers to lower premiums. They can’t discriminate against people based on their health status.”

Roberts, the Doyle resident, said that if she can’t get care in Reno – a roughly 45-minute drive from her home – she’ll have to travel through the Plumas Forest to Quincy, Calif., which takes nearly twice as long.

Roberts said she considered changing to Anthem Blue Cross, which still allows members access to out-of-state care through the Blue Card program. But she recalled having difficulties obtaining the care she needed when she was an Anthem client in the past.

“As a result, I’ve chosen to stay with Blue Shield and let the chips fall where they may,” she said.

Roberts’ health problems are significant: She nearly died from Valley Fever and had part of her left lung removed. She also suffers from heart disease, asthma, allergies and chronic obstructive pulmonary disease.

Dena Mendelsohn, a San Francisco-based senior attorney for Consumers Union, said all insurers need to ensure that their members – including rural residents – have timely access to both primary care and specialty doctors.

No law forces insurers to provide non-emergency care outside their regions, Mendelsohn said, but if Blue Shield is “lemon-dropping” – trying to get costlier members to drop their coverage – “it would be problematic.”

“It’s really important for consumers to really shop around and understand their options during open enrollment season,” which ends in California on Jan. 15, Mendelsohn said.

Lower Utilization Dampened Health Spending Growth in 2017

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Source: Modern Healthcare

The rate of U.S. healthcare spending growth slowed from 2016 to 2017, driven by reduced use and intensity of hospital care, physician services and prescription drugs, according to the new annual report by CMS’ Office of the Actuary published in Health Affairs.

Total spending hit $3.5 trillion, up from $3.4 trillion in 2016. But spending growth dropped to 3.9% last year, down from 4.8% the year before, despite a slight uptick in prices from 1.3% in 2016 to 1.6% in 2017. The share of gross domestic product spent on healthcare in 2017 was 17.9%, compared with 18% in 2016.

Growth has decelerated from higher rates in 2014 and 2015, when it averaged 5.5%, partly due to the Affordable Care Act coverage expansions. The 2017 growth rate was similar to average annual growth from 2008 to 2013, a period that included the Great Recession and its aftermath. It’s much lower than the average annual rate of 7.3% over the 1998-2007 period.

“This is unquestionably good news and adds to the evidence that we are in a new normal of lower cost growth,” said Andy Slavitt, CMS administrator during the Obama administration and now general partner at Town Hall Ventures. “The very slow per capita increases, particularly in Medicaid and Medicare, may provide evidence that the population health management that’s taken hold since the Affordable Care Act is working.”

In Medicare, per capita expenditures increased at a modest 1.7% pace in 2017, similar to the 1.6% rate the year before. For traditional Medicare, which accounted for two-thirds of the program’s $705.9 billion in spending in 2017, per capita expenditures grew 1.5%, up from 0.9% in 2016.

Per capita spending for Medicare Advantage plans, excluding the effects of the congressional moratorium on the health insurance tax, rose from 1.7% in 2016 to 3.2% in 2017.

In Medicaid, per capita growth decelerated to 0.9% last year, down from 1.2% in 2016. While total federal spending on Medicaid slowed sharply last year, from 4.6% to 0.8%, total state and local spending jumped from 3.6% to 6.4%. That was due to states picking up a larger percentage of Medicaid expansion costs, with states assuming 5% of the cost under the ACA.

“This shows that Medicaid costs are very well-controlled, and should put an end to politically driven talk about how much we need to have block grants and to put up other barriers for people to enroll in Medicaid,” Slavitt said.

The rate of retail prescription drug spending—which made up 10% of total expenditures—slowed to just 0.4% in 2017, down from 2.3% in 2016 and 8.9% in 2015, according to the actuaries’ report. That was the slowest rate of growth since 2012.

The key factors included slower growth in the number of prescriptions dispensed; a continued shift to lower-cost generic products; and slower growth in use of some high-cost drugs such as those used to treat hepatitis C. In particular, 2017 saw a dampened growth rate for pain prescriptions, which could be driven by broad concern about overprescribing contributing to the nation’s epidemic of opioid addiction.

Contrary to widespread belief, the actuaries found that generic drug prices declined, and there were lower price hikes for existing brand-name drugs.

Payers and consumers, however, remain extremely concerned about the cost of drugs. Steve Wojcik, vice president of public policy for the National Business Group on Health, said his organization’s members report that specialty pharmacy costs are the top drivers of rising cost trends.

Hospital spending—which made up 33% of total spending—grew faster than the overall healthcare spending rate, up 4.6% in 2017. That still was less than the 5.6% growth rate in 2016. The actuaries said the deceleration reflected a slowdown in the use and intensity of goods and services. Hospital prices increased 1.7%, up slightly from 1.2% in 2016.

Spending for physician and clinical services, making up 20% of total spending, rose 4.2% in 2017, slowing from 5.6% in 2016 and 6% in 2015. Spending for outpatient care centers outpaced that for physician services.

Private health insurance spending growth slowed to 4.2% in 2017, following a 6.2% rate the year before. This was partly influenced by a slowdown in enrollment growth, from 0.4% in 2016 to 0.2% in 2017.

Household spending, including premiums and out-of-pocket costs, also grew at a slower rate—3.8% in 2017 versus 4.8% in 2016. This was driven mainly by slower growth in out-of-pocket spending, which in turn resulted by slower growth in spending for long-term care, and physician and dental services.

While the overall reduction in intensity and use of goods and services suggests greater use of more cost-effective outpatient care, the new data raised concerns among some observers about people forgoing needed care because of high-deductible plans and other affordability issues.

“To the extent that cost reductions are coming from lower utilization because people aren’t getting needed care, that would be a bad thing,” Slavitt said. “But I suspect a lot of what we’re seeing in this report is better care management and more appropriate sites of care.”

Wojcik found the lower spending growth rate in 2017 encouraging, but said there’s still a long way to go.

“3.9% is better than 4.8% and definitely better than the double-digit inflation of the 1990s,” he said. “But that’s still a faster growth rate than the overall economy and wage growth. So there are still financial sustainability issues.”

State Explores How to Counteract End of Obamacare Mandate

Source: Cal Matters

In a scramble to keep people enrolled in health care plans, what did New Jersey, Vermont and the District of Columbia do earlier this year that California has not done?

They began requiring that their residents carry health coverage or face a state penalty for going without it. Such “individual mandates” aim to replace the federal mandate—perhaps the most controversial but essential part of the Affordable Care Act, often called Obamacare —that sought to force people to sign-up for health insurance or pay a tax penalty. The Republican Congress and the Trump administration have repealed that federal penalty, effective next year.

The clock is ticking. Obamacare has led to a record number of Californians having medical coverage. But a new studywarns that if the state does nothing to counteract the Trump administration’s moves to undermine Obamacare, up to 1 million more Californians could be without health insurance within the next five years.

What’s kept California from enacting its own mandate?

Some state Democratic leaders are wary of enacting a state mandate without also making  health insurance cheaper for Californians.

“Providing subsidies is a better reality for members of our community than providing penalties,” said Assemblyman Joaquin Arambula, a Fresno Democrat who co-chaired the select committee on universal healthcare that conducted town halls across the state last summer. “It’s the carrot versus the stick.”

Sacramento State Sen. Richard Pan, a Democrat who chairs the Senate Health Committee, said the Legislature is focused on keeping the state’s insurance market exchange, known as Covered California, strong. Some 2 million Californians buy health coverage through the exchange, which provides federal subsidies to low-income purchasers.

“We are going to do what we can in California to stabilize the insurance market, to do what we can to make health insurance, particularly on Covered California, affordable,” said Pan, who has not yet endorsed any particular remedy. “We are up against a federal administration that is doing the opposite and forcing people to pay higher premiums.

“As we look at options, like do we want to do an individual mandate, we also need to recognize part of what is driving that is not only the removal of the federal mandate, but also actions taken to increase insurance premiums,” said Pan.

Since the Affordable Care Act was implemented in 2013, the state’s uninsured rate has dropped from 20 percent to 7 percent. Currently 3.4 million Californians are uninsured, undocumented immigrant adults making up the majority of that group.

But without more aggressive state intervention to counter Washington’s retreat from the program, an estimated 500,000 to 800,000 more Californians under 65 will be uninsured by 2023, according to the new study from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.

A mandate and state subsidies are among options the Legislature will be exploring to combat the expected exodus from insurance. But both are controversial. An Economist/YouGov poll found that 66 percent of Americans oppose a mandate. And although a few other states such as Vermont and Massachusetts do offer state subsidies, in California state subsidies could cost up to an estimated $500 million, at a time when an incoming Democratic governor and Democratic supermajorities in the Legislature have promised pricey programs such as universal healthcare and universal preschool.

So far Covered California enrollment, now underway through Jan. 15,  is meeting projections—with a big caveat. As of the end of November, more than 90,000 newly insured people signed up, said Peter Lee, its executive director. But those projections already were lowered by 10 to 12 percent compared to last year because it was unknown what effect the removal of the penalty would have on sign-ups.

“There’s no question that a penalty imposed on individuals for whom health insurance is affordable is a good policy,” said Lee, who said he would follow whatever rules the Legislature adopts. “The penalty encourages people to participate in a system that, if they don’t, we all bear the cost. And it encourages people to do the right thing for themselves.”

Covered California is working on a report commissioned by the Legislature on how to best bolster the system. It’s due in February, and Lee said a variety of options are on the table including a mandate, expanding subsidies and using state money to lower premiums, a process called reinsurance.

Some of those ideas echo the recommendations UC researchers offered in their study: incorporate a state mandate with penalty funds going to toward making insurance more affordable, state-funded subsidies in addition to the existing federal subsidies, and a Medi-Cal expansion to include low-income undocumented immigrants.

These are not new ideas but they are politically and financially costly, said Gerald Kominski, a fellow at the UCLA Center for Health Policy Research.

“We know that the mandate drives people into the market,” said Kominski. “If you’re going to pay a tax penalty and not have health insurance, why not look for insurance when almost 90 percent of those who buy in through Covered California received some sort of subsidy.”

“The state could consider bringing the whole threshold down for everybody,” he continued. “The point is to lower the thresholds and make people pay less out of pocket. That would increase affordability for lots of families.”

Some advocates agree that a potential state mandate must also include a mechanism for making insurance more attainable.

“We don’t want to require people to buy coverage that they can’t afford. And what they can afford may be different in a high-cost-of-living state like California,” said Anthony Wright, executive director of Health Access, which advocates for consumers. “That’s why it’s hard to have a conversation about a mandate without affordability assistance.”

Under the federal mandate, Americans were compelled to carry health insurance or pay a penalty of $695 per adult or 2.5 percent of household income, whichever is higher, unless insurance costs more than 8 percent of a household’s income.

With the repeal of that ultimatum, California is bracing for the biggest dropouts among its residents who have been buying insurance through the subsidized Covered California program. The program projects it could lose 10 to 30 percent of its participants.

But the state also expects wider losses, including among the 46 percent of Californians who get insurance through employers, because they also will no longer be required to have it. Even Medi-Cal, the state-paid program for low-income Californians, will lose about 350,000 people, the study estimates, because the lack of a federal mandate may deter people from seeking health coverage at all—meaning they’ll never discover they qualify for Medi-Cal.

Last year the California Legislature considered creating a state mandate as part of budget discussions that included making insurance more affordable, but neither idea made it into the final budget proposal submitted to the governor.

Experts and advocates are hopeful that these ideas may gain traction under Gov.-Elect Gavin Newsom, who has talked a big game on health care and access pledging during his campaign to support single payer and universal coverage.

If more Californians drop their health insurance, everyone pays. People most likely to drop out are the young and the healthy, expert say. But they are critical to keeping the whole operation afloat because the system cannot be made up of only sick people.

California already has taken steps to shore up the Affordable Care Act: banning short-term health plans, adopting legislation barring work requirements for Medi-Cal, and offering a longer open enrollment period.

“Legislators tell us to expect a fresh look at state initiatives to stabilize the insurance market,” said Richard Cauchim who oversees health initiatives for the National Conference of State Legislators. “So ‘stay tuned’ to see how many states will create their own solutions.”

Dem Single-Payer Fight Set to Shift to Battle Over Medicare ‘Buy-In’

Image result for Dem Single-Payer Fight Set to Shift to Battle Over Medicare ‘Buy-In’ images

Source: The Hill

Momentum is building among House Democrats for a more moderate alternative to single-payer health-care legislation.

The legislation, which would allow people aged 50 to 65 to buy Medicare, is being championed by Rep. Brian Higgins (D-N.Y.), who supported House Minority Nancy Pelosi (D-Calif.) for Speaker in exchange for a commitment to work on his bill when Democrats take control of the House early next year.

“We agreed in principle to get this done,” Higgins told The Hill.

Higgins told The Hill that Pelosi’s support of his buy-in legislation was the key to switching his position on her Speakership.

Higgins said he wasn’t promised a vote on the legislation, just a commitment that he will be the point person of the effort to shepherd it through the legislative process.

“It’s got to be scored, go through committee. It’s got to do a lot of things,” Higgins said. “We fell short of a vote in committee [with Republicans in control]. So now that changes.”

Under Higgins’s plan, anyone aged 50 to 64 who buys insurance through the health-care exchanges would be eligible to buy in to Medicare.

It would also apply to people with employer-sponsored insurance and allow employers to pay Medicare premiums on their behalf — a feature that could expand the number of older working individuals who select the buy-in option.

Hillary Clinton offered a similar proposal when she ran for president in 2016. Former President Bill Clinton also proposed expanding Medicare in 1998 by allowing certain workers between the ages of 55 and 65 to buy Medicare. Those workers had to either lack insurance or be retired or laid-off.

Rep. Frank Pallone Jr. (D-N.J.), the likely chairman of the Energy and Commerce Committee next year, said he thinks a Medicare buy-in should be on the agenda next year.

“We certainly would consider a Medicare buy-in,” Pallone told The Hill. “I think we’ve got to wait and see what the caucus wants to do and what the committee wants to do, but I’ll just say it’s certainly something we should consider.”

“Medicare for all” supporters are energized after sweeping Democratic victories in the midterm elections, however, and see the Medicare buy-in bill as too small a step.

“We are dead set against any buy-in or public option,” said Kenneth Zinn, political director of National Nurses United. “Our goal as RNs is to ensure a universal system of guaranteed health care for everyone and this does not accomplish that. I would urge Congress to reject it.”

Zinn said private insurance shouldn’t have any role in health coverage moving forward. A single-payer plan covers everyone, regardless of income, and eliminates copays, deductibles and premiums. It also eliminates private insurance.

Rep. Pramila Jayapal (D-Wash.), who is co-chair of the Medicare for All Caucus in the House, told The Hill said she has spoken with Higgins and expressed her concerns about his bill.

“We have to be careful not to perpetuate the system we have,” Jayapal said.  “I would prefer to have a reduction of the age of Medicare so that more people could qualify but not a buy-in, because that continues the problems that we have right now.”

Jayapal added that lowering the eligibility age “would be an appropriate way to go where we’re taking a step forward towards a system that will ultimately cover everybody.”

Still, she said with Democrats in control of the House, there will be more of an “exchange of ideas” than there has been previously.  

Higgins said a Medicare buy-in is quicker and cheaper to implement than single-payer. It can also be a bridge to Medicare for all, he said.

“I support the exploration of Medicare for all, but you have to be well balanced and practical about this. Establishing a brand-new health insurance program is going to take time,” Higgins said.

Adam Green, co-founder of the Progressive Change Campaign Committee, said he supports giving everyone the option to buy in to Medicare, and thinks the legislation from Higgins will start a conversation. He wants a “buy-in for all” to be the “new floor” in the debate.

“It’s ironic that it took a conservative Democrat to jumpstart the momentum for Medicare buy-in but now that it’s there, there will be a huge push for Medicare option for all,” Green said. 

“It’s jumpstarting the concept of a buy-in in 2019 and will lead to momentum of a buy-in for every family and small business.”

Democrats Winning Key House Leadership Jobs Have Taken Millions From Pharma

Image result for Democrats Winning Key House Leadership Jobs Have Taken Millions From Pharma images

Source: Kaiser Health News

Three of the lawmakers who will lead the House next year as Congress focuses on skyrocketing drug costs are among the biggest recipients of campaign contributions from the pharmaceutical industry, a new KHN analysis shows.

On Wednesday, House Democrats selected Rep. Steny Hoyer of Maryland to serve as the next majority leader and Rep. James Clyburn of South Carolina as majority whip, making them the No. 2 and No. 3 most powerful Democrats as their party regains control of the House in January.

Both lawmakers have received more than $1 million from pharmaceutical company political action committees in the past decade. Just four members of Congress hold that distinction, including Rep. Kevin McCarthy of California, whom Republicans chose as the next House minority leader earlier this month.

Adding Rep. Nancy Pelosi, the California Democrat expected to be the next speaker, the three-person House Democratic leadership team has collected more than $2.3 million total in campaign contributions from drugmakers since the 2007-08 election cycle, according to KHN’s database.

High drug prices surfaced as a major campaign issue in 2018. With almost half of Americans saying they were worried about prescription drug costs last summer, many Democrats told voters they’d tackle the issue in the next Congress. But the large amount of money going to key Democrats, and Republicans, raises questions about whether Congress will take on the pharmaceutical industry.

In the past decade, members of Congress from both parties have received about $81 million from 68 pharma PACs run by employees of companies that make drugs and industry trade groups.

Brendan Fischer, who directs federal reform programs at the nonpartisan Campaign Legal Center, said drugmakers, like other wealthy industries, “shower money” on congressional leaders who are mulling legislation that could affect the pharmaceutical industry.

“Both Democrats and Republicans have discussed taking action on prescription drug prices, and drug companies likely expect that big contributions will help them maintain access to, and influence over, powerful lawmakers,” he said.

McCarthy, who has close ties to President Donald Trump, has received more than $1.08 million from drugmaker PACs since 2007. According to the latest data, which runs through September, he received about $250,000 this election cycle.

The fourth lawmaker to top $1 million is Sen. Richard Burr, a North Carolina Republican who serves on both the Senate Committee on Health, Education, Labor and Pensions and the Senate Committee on Finance. North Carolina is also home to a number of research universities and drugmakers’ headquarters.

While campaign contributions may seem tantalizing as a metric for influence, industries are not necessarily buying votes with their cash. More likely, they are buying access — a sizable donation from a drugmaker’s PAC may increase the chances its lobbyists get a meeting with an influential lawmaker, for example.

Clyburn, who like Hoyer has served as a top Democratic leader since 2007, has received more from drugmaker PACs over the past decade than any other member of Congress — more than $1.09 million. During the 2018 election cycle, he received at least $170,000, despite trouncing his Republican opponent in his safely Democratic district.

A party leader and the highest-ranking African-American in Congress, Clyburn has had ties to the pharmaceutical industry over the years. In 2013, he was a featured speaker at a conference hosted by PhRMA, the industry’s leading trade group. The conference was held at the James E. Clyburn Research Centerat the Medical University of South Carolina, a hub for biopharmaceutical research.

This fall, Hoyer topped the million-dollar mark in drugmaker PAC contributions over the past decade, collecting more than $1.02 million since 2007 and more than $128,000 this election cycle.

“Mr. Hoyer’s positions on legislation are based on what is in the best interest of his constituents and the American people, and he has made it clear the new Congress will tackle rising health care and prescription drug costs,” said Mariel Saez, a Hoyer spokeswoman.

Clyburn, McCarthy and Pelosi’s offices did not respond to requests for comment.

Pelosi, in contrast to her deputies, has received nearly $193,000 total from drugmaker PACs the past decade. In the month before the midterm elections, she intensified her calls for action to control drug prices, saying on Election Day that she believed Democrats could find “common ground” with Trump on addressing the problem.

Senior committee members also tend to draw huge sums from the industries they oversee. Rep. Frank Pallone of New Jersey, the Democrat who is expected to chair the House Committee on Energy and Commerce, received nearly $169,000 this election cycle from drugmaker PACs, according to KHN’s database. Since 2007, he has collected more than $840,000.

Similarly, Rep. Greg Walden, the Oregon Republican who is finishing his term as chair of the committee, received $302,300, the most of any member this election cycle in contributions from drugmaker PACs.

By contrast, Rep. Elijah Cummings — the Maryland Democrat who is expected to head the House Committee on Oversight and Government Reform — has attracted minimal drugmaker cash, receiving just $18,500 since the 2007-08 election cycle. He has made it clear that he intends to target pharmaceutical companies next year as he investigates climbing drug costs.

Editorial: How Newsom, California Should Approach Single-Payer

Image result for Editorial: How Newsom, California Should Approach Single-Payer imagesSource: Mercury News

A single-payer health care system may yet prove to be the best alternative for California and the nation. But Gov.-elect Gavin Newsom should make clear that the Legislature shouldn’t waste time on any legislation in 2019 unless it includes a prudent financial plan that makes sense for California consumers, health care providers and business interests.

Newsom called for installing a single-payer system during his campaign but has been tamping down expectations since July — with good reason. California can’t possibly make it work unless Congress and the president cooperate.

The federal government would need to turn over to the state all the Medicare and Medicaid money it spends in California. That’s about $200 billion annually. How far do proponents think they will get as long as Republican Mitch McConnell is Senate Majority Leader and Donald Trump sits in the White House?

Until there’s a viable financial plan, the governor should instead prioritize other pressing California issues that demand immediate attention, including tax reform, wildfires and paying down pension debt.

Meanwhile, single-payer proponents should use 2019 to bring together the broadest range of interested parties possible to explore the issue in detail. It’s the best way to bring forward a credible plan that can win widespread support throughout the state and in Washington, D.C. It also would serve to put health care front-and-center, where it belongs, in the 2020 presidential campaign.

Warren Buffett has it right when he says “the ballooning costs of health care act as a hungry tapeworm on the American economy.”

In 2000, the United States spent only $4,881 per person on health care. That equals $7,312 in today’s dollars. Today, the United States spends $11,193 per person, or more than $3.3 trillion a year.

]Health care accounts for roughly 18 percent of the U.S. economy. The United States cannot expect to compete on the global level when its major Western competitors spend on average only $5,169 per person on health care, or less than 10 percent of their economies. Especially when those same competitors enjoy better outcomes than their American counterparts.

Ultimately, this is a problem that requires a national solution. Jeopardizing state finances is not the way to solve it. California shouldn’t waste time as it did earlier this year debating SB 562, Sen. Ricardo Lara’s single-payer plan. Assembly Speaker Anthony Rendon killed the effort, accurately calling it “woefully incomplete.”

appalling that the state Senate passed the legislation despite, as Rendon noted, failing to address such critical issues as financing, delivery of care, cost controls and the need for federal cooperation. Keep in mind that if California were to adopt a single-payer plan, it would mean, for example, that nearly 6 million senior citizens would no longer be covered by Medicare.  They would instead be placed under the new state plan along with every California resident. That level of change demands a broad, transparent public debate before passage and implementation.

California has made great strides under the Affordable Care Act in bringing down the number of uninsured residents, but the state and the nation clearly need major changes to get health care costs under control. Further exploration of the merits of a single-payer system has merit, but California’s new governor should only move forward when a prudent financial plan with broad support in Washington and Sacramento that has been developed and fully vetted.

Last Updated 12/12/2018

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