House GOP reveals AHCA: Update - Repeal of ACA IS BACK ON
- Thread starter Dr. Acula
- Start date
How Republicans can hobble Obamacare even without repeal
Hospitals and physician groups have been counting on support from Medicare - the federal insurance program for the elderly and disabled - to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost.
The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018. Although he has voiced general support for innovative payment programs, Price has been a loud critic of mandatory federal programs that dictate how doctors should deliver healthcare.
Providers such as Dr. Richard Gilfillan, chief executive of Trinity Healthcare, a $15.9 billion Catholic health system, say they will press on with these alternative payment plans with or without the government's blessing. But they have been actively lobbying Trump officials for support, according to interviews with more than a dozen hospital executives, physicians and policy experts.
Without the backing of Medicare, the biggest payer in the U.S. healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway U.S. healthcare spending.
How Republicans can hobble Obamacare even without repeal
Now What? Options for Consumers as Health Law Drama Fades
ARE THERE FIXES IN STORE?
Last month, the Health and Human Services Department, which runs exchanges in many states, proposed some adjustments to try to stabilize these marketplaces.
For example, insurers want greater scrutiny of people who sign up for coverage outside of the open enrollment period. Customers are supposed to be allowed to do so only if they have a life-changing event like the birth of a child, a marriage, or the loss of a job that provided coverage, but insurers have found that people are just waiting to sign up when they need care.
Another proposed adjustment would let insurers design cheaper plans tailored to younger people who may not need lots of health care but want to be protected in the event of a big injury or sickness. That could be very helpful, because insurers say they have struggled to attract younger and healthier customers to the marketplaces to balance out the claims they pay from those who use their coverage.
Those changes are expected to be finalized in the next month or so.
WHEN WILL INSURERS MAKE THEIR DECISIONS ON 2018?
Some have said they want to see the final version of the proposed federal adjustments before deciding where and what kinds of coverage they will offer.
But insurers generally have to decide by this spring whether they will participate in order to leave enough time for regulatory approvals and marketing before enrollment starts next fall.
Aetna, the nation's third largest insurer, has set an April 1 deadline for deciding on 2018. The company has already pared its marketplace participation down to 4 states this year from 15 because of heavy financial losses.
Customers won't know for certain who is selling on their exchanges until early next fall. While insurers have to apply to sell coverage on their exchanges generally by late spring or early summer, they can drop out later.
https://www.nytimes.com/aponline/20...BiLG653NzzAd65W-cZfFNvLHs5rfqw&_hsmi=49245612
Hospitals and physician groups have been counting on support from Medicare - the federal insurance program for the elderly and disabled - to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost.
The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018. Although he has voiced general support for innovative payment programs, Price has been a loud critic of mandatory federal programs that dictate how doctors should deliver healthcare.
Providers such as Dr. Richard Gilfillan, chief executive of Trinity Healthcare, a $15.9 billion Catholic health system, say they will press on with these alternative payment plans with or without the government's blessing. But they have been actively lobbying Trump officials for support, according to interviews with more than a dozen hospital executives, physicians and policy experts.
Without the backing of Medicare, the biggest payer in the U.S. healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway U.S. healthcare spending.
How Republicans can hobble Obamacare even without repeal
Now What? Options for Consumers as Health Law Drama Fades
ARE THERE FIXES IN STORE?
Last month, the Health and Human Services Department, which runs exchanges in many states, proposed some adjustments to try to stabilize these marketplaces.
For example, insurers want greater scrutiny of people who sign up for coverage outside of the open enrollment period. Customers are supposed to be allowed to do so only if they have a life-changing event like the birth of a child, a marriage, or the loss of a job that provided coverage, but insurers have found that people are just waiting to sign up when they need care.
Another proposed adjustment would let insurers design cheaper plans tailored to younger people who may not need lots of health care but want to be protected in the event of a big injury or sickness. That could be very helpful, because insurers say they have struggled to attract younger and healthier customers to the marketplaces to balance out the claims they pay from those who use their coverage.
Those changes are expected to be finalized in the next month or so.
WHEN WILL INSURERS MAKE THEIR DECISIONS ON 2018?
Some have said they want to see the final version of the proposed federal adjustments before deciding where and what kinds of coverage they will offer.
But insurers generally have to decide by this spring whether they will participate in order to leave enough time for regulatory approvals and marketing before enrollment starts next fall.
Aetna, the nation's third largest insurer, has set an April 1 deadline for deciding on 2018. The company has already pared its marketplace participation down to 4 states this year from 15 because of heavy financial losses.
Customers won't know for certain who is selling on their exchanges until early next fall. While insurers have to apply to sell coverage on their exchanges generally by late spring or early summer, they can drop out later.
https://www.nytimes.com/aponline/20...BiLG653NzzAd65W-cZfFNvLHs5rfqw&_hsmi=49245612
Inspector general reviewing HHS decision to halt ObamaCare ads
The Department of Health and Human Services' (HHS) inspector general is reviewing the Trump administration's decision earlier this year to halt its ObamaCare outreach efforts.
The review was initiated after Democratic Sens. Elizabeth Warren (Mass.) and Patty Murray (Wash.) requested the HHS watchdog investigate the administration's move in late January.
"We will conduct a fact-finding review of HHS's decision related to halting (and resuming, as applicable) paid advertisements, email, social media, and other outreach efforts related to Marketplace enrollment in 2017," HHS Inspector General Daniel Levinson wrote in a letter to the lawmakers dated Thursday.
"Our inquiry will include the timeline, decision-making process, and factors considered by HHS, including any HHS analyses of implications for enrollment and/or expected costs or savings," he added.
Inspector general reviewing HHS decision to halt ObamaCare ads
The Department of Health and Human Services' (HHS) inspector general is reviewing the Trump administration's decision earlier this year to halt its ObamaCare outreach efforts.
The review was initiated after Democratic Sens. Elizabeth Warren (Mass.) and Patty Murray (Wash.) requested the HHS watchdog investigate the administration's move in late January.
"We will conduct a fact-finding review of HHS's decision related to halting (and resuming, as applicable) paid advertisements, email, social media, and other outreach efforts related to Marketplace enrollment in 2017," HHS Inspector General Daniel Levinson wrote in a letter to the lawmakers dated Thursday.
"Our inquiry will include the timeline, decision-making process, and factors considered by HHS, including any HHS analyses of implications for enrollment and/or expected costs or savings," he added.
Inspector general reviewing HHS decision to halt ObamaCare ads
State agrees to help Medicaid companies shoulder huge losses
State leaders have agreed to help private Medicaid management companies shoulder huge losses they’ve suffered in covering more than 500,000 poor or disabled Iowans, documents released Friday show.
The three national companies have complained about “catastrophic” losses on the Iowa project, which started last April. They have pleaded for the government to help them make up for about $450 million in red ink.
Department of Human Services leaders signed contract amendments in February, under which the government agreed to shoulder losses beyond a certain point, the newly disclosed memos show.
The documents were released Friday afternoon in response to a Des Moines Register open-records request made Jan. 12. A previous Register open-records request led to the December disclosure that the companies were complaining of severe losses and demanding higher rates for a “severely underfunded” system, despite Gov. Terry Branstad’s public assurances the project was going well.
State Sen. Liz Mathis, a leading critic of the shift to private Medicaid management, was startled to learn from the Register Friday that the department had agreed to help shoulder the managed-care companies’ losses.
“This is a shock,” she said. “Where are we going to get the money?”
The state is already in a deep budget crunch. Department of Human Services spokeswoman Amy McCoy said Friday the agreements are expected to cost the state roughly $10 million, which would be paid more than a year from now. She said the federal government would also contribute.
The documents released Friday also show one of the companies, AmeriHealth Caritas, sought permission in February to stop taking new members. AmeriHealth, which wound up with the largest share of Medicaid recipients with serious disabilities, also asked state human services to reassign some of them to the other two companies, Amerigroup and UnitedHealthcare.
“This letter serves as notice that we are beyond the capacity of risk our rates allow us to absorb,” AmeriHealth’s Iowa president, Cheryl Harding, wrote to Iowa Medicaid Director Mikki Stier Feb. 15.
Stier turned down both of Harding’s requests, the memos show. She wrote that her department has no authority to reassign disabled members to different managed-care companies. She also wrote that AmeriHealth did not demonstrate a legal need to stop accepting new members.
The state's pledge to help cover the companies' losses is contained in “risk-corridor agreements," which were included in February amendments to the companies' contracts with Iowa's Medicaid program. Those agreements are complicated arrangements under which the government agency agrees to shoulder the management companies’ financial losses if they grow beyond a certain point. McCoy said federal officials, who pay more than half of Iowa’s Medicaid costs, have signed off on the contract amendments.
The risk-corridor agreements are to run through this June. They would affect payments the management companies receive for covering care for about 150,000 poor Iowa adults on the Iowa Health and Wellness Plan, which is Iowa’s version of an expanded Medicaid program. The managed care companies have complained that many of those people, who previously were uninsured, are using more health care than predicted. The risk-corridor agreements also would affect payments the management companies receive for care of 57,000 seriously disabled Medicaid members, who tend to need extensive services.
Under the risk-corridor agreements, the Department of Human Services would cover 100 percent of financial losses for the Medicaid expansion population if the management companies spend at least 94 percent of their income on services for the recipients. For the Medicaid recipients with serious disabilities, the state agreed to cover 100 percent of losses if costs are between 8 percent and 12.5 percent more than expected.
The risk-corridor arrangements also say the companies would have to refund money to the state if they make more than a certain amount of profit, although that is unlikely to come into play during this budget year.
Mathis, a Robins Democrat who is her party’s top-ranked member on the Senate committee overseeing the Department of Human Services, said she had not been told of the contract amendments, which were signed last month.
Mathis said Branstad, who is a Republican, should speak frankly about how he intends to address the privatized Medicaid program’s problems, including widespread complaints that the management companies are failing to pay service providers properly. She said that every time there’s a new piece of troubling news about the program, “he puts out a media release saying everything’s hunky-dory, and it’s not. … It’s almost like he’s in denial.”
Branstad has contended the shift to private management of Medicaid will save the state more than $118 million this year, by providing more efficient and effective care. Branstad's spokesman did not respond to a request for comment Friday afternoon.
Rep. David Heaton, a Mount Pleasant Republican who helps oversee Medicaid spending, said Friday that he had not been informed about the Branstad administration’s agreement to help the managed-care companies shoulder their financial losses. Heaton is the longtime co-chairman of the joint House and Senate subcommittee that works out budgets for health-care programs.
Heaton said “it would have been comforting to me,” to be told about the arrangements before now, but he understands why the agreements could be a good idea. He hopes they could bring in substantially more federal money to help the managed-care companies do a better job of paying bills from the many community agencies providing crucial services to Iowa's Medicaid members. “Some of them can hardly make payroll at the rate things are going,” he said of the agencies.
Heaton said he expects more details to come next week, when Branstad’s office releases proposals to deal with the state’s worsening budget problems. The situation is so dire that legislators plan to dip into the state’s reserves to cover a $131 million gap in the current fiscal year’s budget before tackling the next fiscal year’s budget.
McCoy, the human-services department spokeswoman, said the state’s share of the risk-corridor payments would come out of the fiscal year 2019 budget, which takes effect on July 1, 2018. McCoy noted that the risk-corridor agreements do not include increases in rates paid to the management companies for the current budget year.
"We remain confident in our rates and a risk corridor provides an extra level of protection for taxpayers," she wrote in an email to the Register.
Negotiations are to begin in April for rates to be paid to the Medicaid management companies for the budget year that begins July 1. The companies are expected to seek sharp increases in their payments from Iowa's Medicaid program. If they succeed, their new contracts could further pinch the state budget.
Spokespeople for the three management companies either declined comment or did not respond to requests for it Friday afternoon.
http://www.desmoinesregister.com/st...caid-companies-shoulder-huge-losses/99593570/
State leaders have agreed to help private Medicaid management companies shoulder huge losses they’ve suffered in covering more than 500,000 poor or disabled Iowans, documents released Friday show.
The three national companies have complained about “catastrophic” losses on the Iowa project, which started last April. They have pleaded for the government to help them make up for about $450 million in red ink.
Department of Human Services leaders signed contract amendments in February, under which the government agreed to shoulder losses beyond a certain point, the newly disclosed memos show.
The documents were released Friday afternoon in response to a Des Moines Register open-records request made Jan. 12. A previous Register open-records request led to the December disclosure that the companies were complaining of severe losses and demanding higher rates for a “severely underfunded” system, despite Gov. Terry Branstad’s public assurances the project was going well.
State Sen. Liz Mathis, a leading critic of the shift to private Medicaid management, was startled to learn from the Register Friday that the department had agreed to help shoulder the managed-care companies’ losses.
“This is a shock,” she said. “Where are we going to get the money?”
The state is already in a deep budget crunch. Department of Human Services spokeswoman Amy McCoy said Friday the agreements are expected to cost the state roughly $10 million, which would be paid more than a year from now. She said the federal government would also contribute.
The documents released Friday also show one of the companies, AmeriHealth Caritas, sought permission in February to stop taking new members. AmeriHealth, which wound up with the largest share of Medicaid recipients with serious disabilities, also asked state human services to reassign some of them to the other two companies, Amerigroup and UnitedHealthcare.
“This letter serves as notice that we are beyond the capacity of risk our rates allow us to absorb,” AmeriHealth’s Iowa president, Cheryl Harding, wrote to Iowa Medicaid Director Mikki Stier Feb. 15.
Stier turned down both of Harding’s requests, the memos show. She wrote that her department has no authority to reassign disabled members to different managed-care companies. She also wrote that AmeriHealth did not demonstrate a legal need to stop accepting new members.
The state's pledge to help cover the companies' losses is contained in “risk-corridor agreements," which were included in February amendments to the companies' contracts with Iowa's Medicaid program. Those agreements are complicated arrangements under which the government agency agrees to shoulder the management companies’ financial losses if they grow beyond a certain point. McCoy said federal officials, who pay more than half of Iowa’s Medicaid costs, have signed off on the contract amendments.
The risk-corridor agreements are to run through this June. They would affect payments the management companies receive for covering care for about 150,000 poor Iowa adults on the Iowa Health and Wellness Plan, which is Iowa’s version of an expanded Medicaid program. The managed care companies have complained that many of those people, who previously were uninsured, are using more health care than predicted. The risk-corridor agreements also would affect payments the management companies receive for care of 57,000 seriously disabled Medicaid members, who tend to need extensive services.
Under the risk-corridor agreements, the Department of Human Services would cover 100 percent of financial losses for the Medicaid expansion population if the management companies spend at least 94 percent of their income on services for the recipients. For the Medicaid recipients with serious disabilities, the state agreed to cover 100 percent of losses if costs are between 8 percent and 12.5 percent more than expected.
The risk-corridor arrangements also say the companies would have to refund money to the state if they make more than a certain amount of profit, although that is unlikely to come into play during this budget year.
Mathis, a Robins Democrat who is her party’s top-ranked member on the Senate committee overseeing the Department of Human Services, said she had not been told of the contract amendments, which were signed last month.
Mathis said Branstad, who is a Republican, should speak frankly about how he intends to address the privatized Medicaid program’s problems, including widespread complaints that the management companies are failing to pay service providers properly. She said that every time there’s a new piece of troubling news about the program, “he puts out a media release saying everything’s hunky-dory, and it’s not. … It’s almost like he’s in denial.”
Branstad has contended the shift to private management of Medicaid will save the state more than $118 million this year, by providing more efficient and effective care. Branstad's spokesman did not respond to a request for comment Friday afternoon.
Rep. David Heaton, a Mount Pleasant Republican who helps oversee Medicaid spending, said Friday that he had not been informed about the Branstad administration’s agreement to help the managed-care companies shoulder their financial losses. Heaton is the longtime co-chairman of the joint House and Senate subcommittee that works out budgets for health-care programs.
Heaton said “it would have been comforting to me,” to be told about the arrangements before now, but he understands why the agreements could be a good idea. He hopes they could bring in substantially more federal money to help the managed-care companies do a better job of paying bills from the many community agencies providing crucial services to Iowa's Medicaid members. “Some of them can hardly make payroll at the rate things are going,” he said of the agencies.
Heaton said he expects more details to come next week, when Branstad’s office releases proposals to deal with the state’s worsening budget problems. The situation is so dire that legislators plan to dip into the state’s reserves to cover a $131 million gap in the current fiscal year’s budget before tackling the next fiscal year’s budget.
McCoy, the human-services department spokeswoman, said the state’s share of the risk-corridor payments would come out of the fiscal year 2019 budget, which takes effect on July 1, 2018. McCoy noted that the risk-corridor agreements do not include increases in rates paid to the management companies for the current budget year.
"We remain confident in our rates and a risk corridor provides an extra level of protection for taxpayers," she wrote in an email to the Register.
Negotiations are to begin in April for rates to be paid to the Medicaid management companies for the budget year that begins July 1. The companies are expected to seek sharp increases in their payments from Iowa's Medicaid program. If they succeed, their new contracts could further pinch the state budget.
Spokespeople for the three management companies either declined comment or did not respond to requests for it Friday afternoon.
http://www.desmoinesregister.com/st...caid-companies-shoulder-huge-losses/99593570/
The claims of a market collapse are not evident in markets across America where over 80 percent of consumers paid no rate increases because their tax subsidies increased with the rate increases.
Overall medical inflation has increased at the slowest rate in 50 years, and we now have fewer medical bankruptcies.
Read more here: Kathleen Sebelius: Americans want a health care solution that works for everyone
Overall medical inflation has increased at the slowest rate in 50 years, and we now have fewer medical bankruptcies.
Read more here: Kathleen Sebelius: Americans want a health care solution that works for everyone
How to Build on Obamacare
One important answer would be to spend a bit more money. Obamacare has turned out to be remarkably cheap; the Congressional Budget Office now projects its cost to be about a third lower than it originally expected, around 0.7 percent of G.D.P. In fact, it’s probably too cheap. A report from the nonpartisan Urban Institute argues that the A.C.A. is “essentially underfunded,” and would work much better — in particular, it could offer policies with much lower deductibles — if it provided somewhat more generous subsidies. The report’s recommendations would cost around 0.2 percent of G.D.P.; or to put it another way, would be around half as expensive as the tax cuts for the wealthy Republicans just tried and failed to ram through as part of Trumpcare.
What about the problem of inadequate insurance industry competition? Better subsidies would help enrollments, which in turn would probably bring in more insurers. But just in case, why not revive the idea of a public option — insurance sold directly by the government, for those who choose it? At the very least, there ought to be public plans available in areas no private insurer wants to serve.
There are other more technical things we should do too, like extending reinsurance: compensation for insurers whose risk pool turned out worse than expected. Some analysts also argue that there would be big gains from moving “off-exchange” plans onto the government-administered marketplaces.
So if Mr. Trump really wanted to honor his campaign promises about improving health coverage, if he were willing to face up to the reality that Obamacare is here to stay, there’s a lot he could do, through incremental changes, to make it work better. And he would get plenty of cooperation from Democrats along the way.
Needless to say, I don’t expect to see that happen. Improving Obamacare requires doing more, not less, moving left, not right. That’s not what Republicans want to hear.
https://www.nytimes.com/2017/03/27/...LAiotF0T4CYiUboiZLvHCNtobnbx5g&_hsmi=49245612
One important answer would be to spend a bit more money. Obamacare has turned out to be remarkably cheap; the Congressional Budget Office now projects its cost to be about a third lower than it originally expected, around 0.7 percent of G.D.P. In fact, it’s probably too cheap. A report from the nonpartisan Urban Institute argues that the A.C.A. is “essentially underfunded,” and would work much better — in particular, it could offer policies with much lower deductibles — if it provided somewhat more generous subsidies. The report’s recommendations would cost around 0.2 percent of G.D.P.; or to put it another way, would be around half as expensive as the tax cuts for the wealthy Republicans just tried and failed to ram through as part of Trumpcare.
What about the problem of inadequate insurance industry competition? Better subsidies would help enrollments, which in turn would probably bring in more insurers. But just in case, why not revive the idea of a public option — insurance sold directly by the government, for those who choose it? At the very least, there ought to be public plans available in areas no private insurer wants to serve.
There are other more technical things we should do too, like extending reinsurance: compensation for insurers whose risk pool turned out worse than expected. Some analysts also argue that there would be big gains from moving “off-exchange” plans onto the government-administered marketplaces.
So if Mr. Trump really wanted to honor his campaign promises about improving health coverage, if he were willing to face up to the reality that Obamacare is here to stay, there’s a lot he could do, through incremental changes, to make it work better. And he would get plenty of cooperation from Democrats along the way.
Needless to say, I don’t expect to see that happen. Improving Obamacare requires doing more, not less, moving left, not right. That’s not what Republicans want to hear.
https://www.nytimes.com/2017/03/27/...LAiotF0T4CYiUboiZLvHCNtobnbx5g&_hsmi=49245612
Here's the bipartisan path forward on health care: Andy Slavitt
First, the administration, with support from Congress, should commit to permanently funding payments that reduce the size of deductibles for lower-income Americans (called cost-sharing reductions). Republicans need to drop a lawsuit they filed to stop these payments, or Trump needs to say they are going to continue. Second, the administration should enforce the individual insurance mandate until a different approach can be agreed upon. Those two actions will reduce costs for millions and need to be done now before insurers submit initial premiums for next year, or inaction will drive up premiums. Americans should watch this intently.
A third step would be to grant states the flexibility to increase competition and reduce costs. Non-partisan analysts such as Standard & Poor's confirm that the online exchanges that sell ACA insurance policies are stable, but in some states the cost of insurance is out of reach for those who earn too much to receive tax credits.
The administration has tools to do this, including a section of the ACA designed to allow states to pursue different approaches, including those more suited to their political philosophy, so long as they continue to meet the basic aims of covering more people with high-quality coverage. Alaska was the first to use this process last year by creating a statewide reinsurance pool. Such pools protect insurers against losses in high-cost cases, and the savings are passed along to consumers. In Alaska, the result was a dramatic reduction in premiums.
Many red or purple states, such as Kansas and North Carolina, have expressed recent interest in expanding Medicaid to low-income adults. This will not only cover more people, it also would reduce premiums for private policies on the exchanges. Premiums are 7% lower in states that have expanded Medicaid, the result of lower-income people (who tend to have more health problems) moving off the exchanges and into the Medicaid program.
The president has pledged to bring down drug costs and should push forward with initiatives to bundle payments (charge patients for a set of services related to a health episode rather than separately for every test, pill, bandage and procedure) and to pay for what works, so American taxpayers and families get the most for our money. Common ground can be found here and was the focus of what Emanuel reviewed with the president last week.
Here's the bipartisan path forward on health care: Andy Slavitt
First, the administration, with support from Congress, should commit to permanently funding payments that reduce the size of deductibles for lower-income Americans (called cost-sharing reductions). Republicans need to drop a lawsuit they filed to stop these payments, or Trump needs to say they are going to continue. Second, the administration should enforce the individual insurance mandate until a different approach can be agreed upon. Those two actions will reduce costs for millions and need to be done now before insurers submit initial premiums for next year, or inaction will drive up premiums. Americans should watch this intently.
A third step would be to grant states the flexibility to increase competition and reduce costs. Non-partisan analysts such as Standard & Poor's confirm that the online exchanges that sell ACA insurance policies are stable, but in some states the cost of insurance is out of reach for those who earn too much to receive tax credits.
The administration has tools to do this, including a section of the ACA designed to allow states to pursue different approaches, including those more suited to their political philosophy, so long as they continue to meet the basic aims of covering more people with high-quality coverage. Alaska was the first to use this process last year by creating a statewide reinsurance pool. Such pools protect insurers against losses in high-cost cases, and the savings are passed along to consumers. In Alaska, the result was a dramatic reduction in premiums.
Many red or purple states, such as Kansas and North Carolina, have expressed recent interest in expanding Medicaid to low-income adults. This will not only cover more people, it also would reduce premiums for private policies on the exchanges. Premiums are 7% lower in states that have expanded Medicaid, the result of lower-income people (who tend to have more health problems) moving off the exchanges and into the Medicaid program.
The president has pledged to bring down drug costs and should push forward with initiatives to bundle payments (charge patients for a set of services related to a health episode rather than separately for every test, pill, bandage and procedure) and to pay for what works, so American taxpayers and families get the most for our money. Common ground can be found here and was the focus of what Emanuel reviewed with the president last week.
Here's the bipartisan path forward on health care: Andy Slavitt
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Reminds me of Hank Paulson kneeling and begging for a bank bailout in 2008
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