It's interesting that I hear them use the word agenda more than people or coverage.
House GOP reveals AHCA: Update - Repeal of ACA IS BACK ON
- Thread starter Dr. Acula
- Start date
It's interesting that I hear them use the word agenda more than people or coverage.
LogicFirst
Banned
The first step in ACA sabotage
LogicFirst
Banned
Before the ACA America was screaming at the top of it's lungs about how terrible health care was in this country.
Gotta keep the good folks informed!
6 Changes The Trump Administration Can Still Make To Obamacare
1. Cut off the subsidies
2. Remove the individual mandate's teeth
3. Let states be looser in defining "essential health benefits"
4. Redefine the EHBs
5. Let states experiment more
6. Let the architecture crumble
6 Changes The Trump Administration Can Still Make To Obamacare
1. Cut off the subsidies
One of the biggest threats to the Affordable Care Act has been a lawsuit filed by House Republicans that could have ended what are called cost-sharing subsidies, which help people limit their out-of-pocket expenses.
2. Remove the individual mandate's teeth
The Trump administration can't do away with the mandate requiring individuals to have health insurance on its own, but it can greatly weaken it. Doing so would be another way to seriously undermine the Affordable Care Act.
One way is through the IRS. That individual mandate is about tax incentives — fail to get insurance, and you have to pay a penalty. So to hobble Obamacare, the Trump administration can decide not to enforce that penalty.
In fact, the IRS already took a small step in that direction earlier this year. The agency said it will not reject "silent returns" — tax returns on which a person declines to say whether they have insurance.The IRS explained in a statement that this year, for the first time, the agency had been set to reject those silent returns. But Trump's January executive order on Obamacare changed that, telling the heads of executive branch offices to "waive, defer, grand exemptions from, or delay" parts of the act.
"Consistent with that, the IRS has decided to make changes that would continue to allow electronic and paper returns to be accepted for processing in instances where a taxpayer doesn't indicate their coverage status," the IRS said. "However, legislative provisions of the ACA law are still in force until changed by the Congress, and taxpayers remain required to follow the law and pay what they may owe."
One way is through the IRS. That individual mandate is about tax incentives — fail to get insurance, and you have to pay a penalty. So to hobble Obamacare, the Trump administration can decide not to enforce that penalty.
In fact, the IRS already took a small step in that direction earlier this year. The agency said it will not reject "silent returns" — tax returns on which a person declines to say whether they have insurance.The IRS explained in a statement that this year, for the first time, the agency had been set to reject those silent returns. But Trump's January executive order on Obamacare changed that, telling the heads of executive branch offices to "waive, defer, grand exemptions from, or delay" parts of the act.
"Consistent with that, the IRS has decided to make changes that would continue to allow electronic and paper returns to be accepted for processing in instances where a taxpayer doesn't indicate their coverage status," the IRS said. "However, legislative provisions of the ACA law are still in force until changed by the Congress, and taxpayers remain required to follow the law and pay what they may owe."
3. Let states be looser in defining "essential health benefits"
The ACA requires that health plans cover 10 "essential health benefits" — health services in basic, broad areas like emergency services, prescription drugs and maternity care. And the administration has a few paths for changing exactly what those are — changes that could weaken some people's health care but also maybe nudge more insurers into the marketplaces.
The federal government laid out and defined the benefits (known among health care wonks as EHBs), but the nitty-gritty of a state's essential health benefits can be found in its "benchmark plan."
"Right now each state has picked a small group plan or similar plan that would have existed before the ACA and used that as a benchmark for what all the plans in each state now have to cover," Cox says.
The Trump administration could loosen that, giving plans much more wiggle room for what services they include or exclude, Cox added.
The federal government laid out and defined the benefits (known among health care wonks as EHBs), but the nitty-gritty of a state's essential health benefits can be found in its "benchmark plan."
"Right now each state has picked a small group plan or similar plan that would have existed before the ACA and used that as a benchmark for what all the plans in each state now have to cover," Cox says.
The Trump administration could loosen that, giving plans much more wiggle room for what services they include or exclude, Cox added.
4. Redefine the EHBs
The administration could also simply tweak the EHBs by broadening or narrowing the definitions of some of the 10 broad benefit categories.
For example, one of the 10 benefits set by law includes preventive care. But the law itself didn't say exactly what that meant — rather, the Obama administration defined what exactly preventive services are through regulation.
That means the Trump White House could undo some of that through regulation, making particular benefits disappear.
For example, one of the 10 benefits set by law includes preventive care. But the law itself didn't say exactly what that meant — rather, the Obama administration defined what exactly preventive services are through regulation.
That means the Trump White House could undo some of that through regulation, making particular benefits disappear.
5. Let states experiment more
States can apply for waivers to deviate from the ACA as written in some way — the idea, Cox says, is to "allow for some experimentation or innovation at the state level" to improve the system. States could pass laws that change their health care system, then apply to the federal government for the waiver.
Price has promoted waivers as ways for states to alter their health care systems. Under a Trump administration that's no fan of the ACA, approved waivers might look substantially different than they would have under Obama.
For example, California had passed a law and filed a waiver that would have allowed people in the state illegally to get health insurance on the state exchange (though they would not have been allowed to get federal subsidies). When Trump won the presidency, California withdrew the waiver.
Price has promoted waivers as ways for states to alter their health care systems. Under a Trump administration that's no fan of the ACA, approved waivers might look substantially different than they would have under Obama.
For example, California had passed a law and filed a waiver that would have allowed people in the state illegally to get health insurance on the state exchange (though they would not have been allowed to get federal subsidies). When Trump won the presidency, California withdrew the waiver.
6. Let the architecture crumble
It takes a lot of upkeep to keep Obamacare running — the exchange websites need to hum along, and people need to be ready to answer the helpline. But the administration could hypothetically make a lot of that a lower priority, Georgetown's Corlette says, essentially letting the Obamacare system atrophy.
"The Price administration [at HHS] can redirect resources so they would have a fair amount of flexibility for how they direct resources for the fall enrollment," Corlette says.
In his first week on the job, Trump killed the advertising surrounding the Affordable Care Act, as well as outreach, as Politico explained:
"The Price administration [at HHS] can redirect resources so they would have a fair amount of flexibility for how they direct resources for the fall enrollment," Corlette says.
In his first week on the job, Trump killed the advertising surrounding the Affordable Care Act, as well as outreach, as Politico explained:
6 Changes The Trump Administration Can Still Make To Obamacare
Did Republicans sabotage Obamacare? Ohio insurers owed $100M they'll likely never see
WASHINGTON -- Ohio health insurers are owed more than $100 million by the federal government, which was supposed to protect them from losses during Obamacare's startup, according to a cleveland.com review of records. They may never get it, thanks to a Republican provision.
The provision slipped into a spending bill in late 2014, after the Affordable Care Act was under way, restricted the government in making payments.
As a result, some insurers have been forced to pare down their medical networks, cut their markets or leave Obamacare altogether -- contributing to the higher premiums for customers and insurer withdrawals that Republicans point to as proof of the program's failure.
Republicans say they were just preventing an ill-advised insurer bailout because, they say, Obamacare was bound to fail. But Democrats and some health policy analysts say Republicans purposely sabotaged the Affordable Care Act by denying promised payments to insurers at a crucial time.
It was when insurers were trying to find the right equilibrium between premiums and the cost of patient health care. The insurers were supposed to be protected against large losses if their early projections proved wrong -- and had they been protected, they would not be waiting for the millions the government owes them.
The federal government owes $96.5 million to Ohio insurers for losses in just 2014 and 2015. The figures and size of the problem in Ohio have gone unreported until now.
Cleveland.com examined them after House Republicans failed to repeal and replace the Affordable Care Act last week and then maintained they wanted to help the program succeed. Democrats said if that were true, the payments to insurers -- a way to assure Obamacare's success -- would never have been blocked.
Among the cleveland.com findings:
It is unlikely to ever be paid. Companies with deep pockets and other insurance products have managed to survive anyway, but the losses informed even their subsequent decisions.
In other words, said U.S. Rep. Tim Ryan, a Niles Democrat, the Republicans helped create problems for insurers and then were able to say, "Look at all these insurers pulling out."
Did Republicans sabotage Obamacare? Ohio insurers owed $100M they'll likely never see
WASHINGTON -- Ohio health insurers are owed more than $100 million by the federal government, which was supposed to protect them from losses during Obamacare's startup, according to a cleveland.com review of records. They may never get it, thanks to a Republican provision.
The provision slipped into a spending bill in late 2014, after the Affordable Care Act was under way, restricted the government in making payments.
As a result, some insurers have been forced to pare down their medical networks, cut their markets or leave Obamacare altogether -- contributing to the higher premiums for customers and insurer withdrawals that Republicans point to as proof of the program's failure.
Republicans say they were just preventing an ill-advised insurer bailout because, they say, Obamacare was bound to fail. But Democrats and some health policy analysts say Republicans purposely sabotaged the Affordable Care Act by denying promised payments to insurers at a crucial time.
It was when insurers were trying to find the right equilibrium between premiums and the cost of patient health care. The insurers were supposed to be protected against large losses if their early projections proved wrong -- and had they been protected, they would not be waiting for the millions the government owes them.
The federal government owes $96.5 million to Ohio insurers for losses in just 2014 and 2015. The figures and size of the problem in Ohio have gone unreported until now.
Cleveland.com examined them after House Republicans failed to repeal and replace the Affordable Care Act last week and then maintained they wanted to help the program succeed. Democrats said if that were true, the payments to insurers -- a way to assure Obamacare's success -- would never have been blocked.
Among the cleveland.com findings:
- The inability to get the money played a role in the demise of Coordinated Health Mutual, also known as InHealth, a nonprofit Consumer Operated and Oriented Plan (CO-OP) in Ohio that went out of business last year. A financial statement in September showed the federal government owed the Ohio cooperative $62.7 million. That money would have gone a long way toward wiping out the nonprofit's $74 million in liabilities.
- Medical Mutual of Ohio says the government owes it $31.5 million for the combined years of 2014, 2015 and 2016. Medical Mutual remains in business but has narrowed its market and its network of providers as it adapted to the challenges.
- HealthSpan, which last year ceased operations after financial losses and moved its members to other insurers and providers, was owed $12.9 million for 2014 and 2015.
- Humana Health Plan of Ohio, which as part of the national Humana network is pulling out of the Affordable Care Act market next year, is owed $8 million for 2014 and 2015.
- Summa Insurance Company, part of the Akron-based Summa Health System, is owed $2.1 million for 2014 and 2015 combined
It is unlikely to ever be paid. Companies with deep pockets and other insurance products have managed to survive anyway, but the losses informed even their subsequent decisions.
In other words, said U.S. Rep. Tim Ryan, a Niles Democrat, the Republicans helped create problems for insurers and then were able to say, "Look at all these insurers pulling out."
Did Republicans sabotage Obamacare? Ohio insurers owed $100M they'll likely never see
Fact check: Medicaid’s doctor participation rates
In seeking to repeal and replace the Affordable Care Act, Health and Human Services Secretary Tom Price has said “one out of every three physicians in this nation aren’t seeing Medicaid patients.” House Speaker Paul Ryan said “more and more doctors just won’t take Medicaid.”
It’s a common criticism of the Medicaid program — that the doctor participation rate is lower than the rate for Medicare beneficiaries or the privately insured. The implication is that Medicaid patients cannot access care and that it has gotten worse since the Affordable Care Act expanded the health care program for the low-income and disabled.
But experts say that implication is misleading:
State Variation
The lower doctor participation rate for Medicaid, as compared with Medicare or private insurance, is largely tied to lower reimbursement rates. “Research suggests strongly that there’s a positive correlation between provider payment rates in Medicaid and participation rates in Medicaid,” KFF’s Paradise said in a phone interview. “And there’s a lot of variation in state payment rates.”
While the most recent report from the National Center for Health Statistics found that 68.9% of physicians said they accepted new Medicaid patients, that figure is nationwide. The participation rate was “significantly higher than the national average in 25 states,” and “significantly lower” than the average in five states, the report said.
The variation went from a low of 38.7% in New Jersey (where primary care reimbursement rates are 48% of Medicare rates) to a high of 96.5% in Nebraska (where the primary care reimbursement is 75% of Medicare). Montana, with a 90% physician participation rate, pays the same rate as Medicare for primary care, while California, with a 54.2 participation rate, pays 42% of the Medicare reimbursement rate.
“The states that restricted their coverage to the mandatory coverage and only minor deviations, meaning they had a smaller population covered, tended to have reimbursement rates that were close to Medicare,” she said. “And the states like New York and New Jersey, which had very expansive eligibility coverage in Medicaid tended to have among the lowest reimbursement rates.”
A lower reimbursement rate isn’t the only aspect of Medicaid that can deter some doctors from accepting patients. “What I’ve seen both in speaking to physicians and some research that’s been done, it’s not just the lower pay, it’s the lower pay on top of the paperwork burden and sometimes delays in payment,” Wilensky said.
Access to Care
The question is how much of a problem this 70% participation rate is. The experts we interviewed cautioned us that the participation rate for Medicaid was a limited measure.
The supply of doctors and their geographic distribution are important factors, Paradise said. Access to care could be better in an area with a high supply of doctors but low participation, compared with an area with few physicians but high participation rates.
And there are other caveats. “It depends not just on whether they participate, but how much they participate,” Wilensky said. “You have people who have a couple patients and you have people whose practice is primarily Medicaid.”
A 2016 paper in the Journal of Health Politics, Policy and Law also said that “measures focusing exclusively on physicians ignore the growing role played by nonphysician providers, particularly in underserved settings” and that it wasn’t clear “whether having a large number of providers each treating a small proportion of low-income adults is preferable to greater concentration among providers with particular expertise caring for low-income populations.”
One of the authors of that paper, Harvard’s Benjamin Sommers, told us via email: “When a politician says, ‘Doctors don’t take Medicaid,’ they are implying that patients with Medicaid can’t access care. But there have been numerous studies of the ACA’s Medicaid expansion that consistently show large improvements in access to medical care from Medicaid expansion.”
http://www.usatoday.com/story/news/...RuEg8uPvScPhke5qg5jEBCotub0yQw&_hsmi=49566186
In seeking to repeal and replace the Affordable Care Act, Health and Human Services Secretary Tom Price has said “one out of every three physicians in this nation aren’t seeing Medicaid patients.” House Speaker Paul Ryan said “more and more doctors just won’t take Medicaid.”
It’s a common criticism of the Medicaid program — that the doctor participation rate is lower than the rate for Medicare beneficiaries or the privately insured. The implication is that Medicaid patients cannot access care and that it has gotten worse since the Affordable Care Act expanded the health care program for the low-income and disabled.
But experts say that implication is misleading:
- There are no continuous measures on Medicaid participation, but federal statistics gathered over recent years show that the percentage of physicians accepting new Medicaid patients has remained around 70%. We found no support for the idea that the participation rate has declined under the ACA.
- The participation rate varies by state, and it’s largely tied to reimbursement rates. For example, Montana pays primary care doctors the same rate for Medicaid and Medicare, and has a Medicaid doctor participation rate of 90%.
- Participation rates are limited measures of patient care. The supply of doctors and their geographic distribution are important factors — low rates in high population areas versus rural areas would have different impacts on patients.
- Studies show Medicaid beneficiaries fare as well as the privately insured on key measures of access to care. One analysis of federal survey data found that 74% of adults with Medicaid coverage had seen a doctor in the previous 12 months, while 69% with private insurance had done so.
State Variation
The lower doctor participation rate for Medicaid, as compared with Medicare or private insurance, is largely tied to lower reimbursement rates. “Research suggests strongly that there’s a positive correlation between provider payment rates in Medicaid and participation rates in Medicaid,” KFF’s Paradise said in a phone interview. “And there’s a lot of variation in state payment rates.”
While the most recent report from the National Center for Health Statistics found that 68.9% of physicians said they accepted new Medicaid patients, that figure is nationwide. The participation rate was “significantly higher than the national average in 25 states,” and “significantly lower” than the average in five states, the report said.
The variation went from a low of 38.7% in New Jersey (where primary care reimbursement rates are 48% of Medicare rates) to a high of 96.5% in Nebraska (where the primary care reimbursement is 75% of Medicare). Montana, with a 90% physician participation rate, pays the same rate as Medicare for primary care, while California, with a 54.2 participation rate, pays 42% of the Medicare reimbursement rate.
“The states that restricted their coverage to the mandatory coverage and only minor deviations, meaning they had a smaller population covered, tended to have reimbursement rates that were close to Medicare,” she said. “And the states like New York and New Jersey, which had very expansive eligibility coverage in Medicaid tended to have among the lowest reimbursement rates.”
A lower reimbursement rate isn’t the only aspect of Medicaid that can deter some doctors from accepting patients. “What I’ve seen both in speaking to physicians and some research that’s been done, it’s not just the lower pay, it’s the lower pay on top of the paperwork burden and sometimes delays in payment,” Wilensky said.
Access to Care
The question is how much of a problem this 70% participation rate is. The experts we interviewed cautioned us that the participation rate for Medicaid was a limited measure.
The supply of doctors and their geographic distribution are important factors, Paradise said. Access to care could be better in an area with a high supply of doctors but low participation, compared with an area with few physicians but high participation rates.
And there are other caveats. “It depends not just on whether they participate, but how much they participate,” Wilensky said. “You have people who have a couple patients and you have people whose practice is primarily Medicaid.”
A 2016 paper in the Journal of Health Politics, Policy and Law also said that “measures focusing exclusively on physicians ignore the growing role played by nonphysician providers, particularly in underserved settings” and that it wasn’t clear “whether having a large number of providers each treating a small proportion of low-income adults is preferable to greater concentration among providers with particular expertise caring for low-income populations.”
One of the authors of that paper, Harvard’s Benjamin Sommers, told us via email: “When a politician says, ‘Doctors don’t take Medicaid,’ they are implying that patients with Medicaid can’t access care. But there have been numerous studies of the ACA’s Medicaid expansion that consistently show large improvements in access to medical care from Medicaid expansion.”
http://www.usatoday.com/story/news/...RuEg8uPvScPhke5qg5jEBCotub0yQw&_hsmi=49566186
They can sue the government for their money thought right?
Unfortunately, that does noothing to fix the problem this creates and just makes it more of a cluster. I hate these pricks
Minnesota lawmakers strike reinsurance deal
Saying they cannot afford to wait for a congressional rewrite of the nation's health laws, House and Senate negotiators announced a deal on a bill that aims to rein in soaring health insurance costs in Minnesota.
The proposal would prop up the individual insurance market by creating a reinsurance program to help insurers cover expensive medical claims.
Lawmakers are expected to finalized the legislation later Wednesday.
Insurers have experience hundreds of millions of dollars in losses in the individual market, prompting the largest, Blue Cross Blue Shield of Minnesota, to drop out this year.
Republican Sen. Gary Dahms of Redwood Falls warned more insurers might do the same — if the state doesn't provide the reinsurance safety net.
"So now we have a marketplace that's collapsed and we need to do something to bring that marketplace back," said Dahms. "And this one of the ways we can do that."
The bill has a price tag of $271 million in each of the next two years. Some funding would come from the state's general treasury and some from a special health account fed by medical-related taxes. More could come from a pending legal case with insurers, if that is resolved in the state's favor.
Plus, there's a chance federal grants might take some of the load off state taxpayers. But Gov. Mark Dayton expects the state to shoulder most of the tab.
"It would be great if the federal government would face up this need for reinsurance and use its much deeper pockets to provide for all of the states," said Dayton. "But I don't see that happening at this point."
Dayton says the state has no choice but to do what it can to prevent further erosion of the individual insurance market.
The reinsurance bill applies only to a small slice of the overall insurance market, specifically policies sold to people who don't get coverage from an employer or a government program.
The individual insurance market serves about 5 percent of Minnesota's insured population, and they're the ones who have experienced especially sharp increases in costs the past couple of years.
Already this year, state lawmakers approved more than $300 million in one-year discounts for individual policy-holders who don't qualify for other subsidies available through the federal Affordable Care Act.
Here's how the reinsurance idea would work starting next year: The backup insurance wouldn't be available until an individual's claims exceed $50,000. Beyond that threshold, the state program would pay 50 percent or more of the costs. Once claims exceed $250,000 the primary insurer would be back on its own.
The thinking is that if the state provides a financial buffer for insurers they won't have to jack up premiums as high.
Customers themselves won't have to do anything. It's a largely back-office program.
Commerce Commissioner Mike Rothman says he expects the program will help ease premiums for consumers.
"In terms of the annual premium relief target, again it's an approximation based on the estimates, of about 20 percent," he said.
There's actually a requirement in the bill to make insurance companies report how much they would have charged in premiums absent the reinsurance plan. The information will be included in annual rate filings with state regulators.
Minnesota lawmakers strike reinsurance deal
Saying they cannot afford to wait for a congressional rewrite of the nation's health laws, House and Senate negotiators announced a deal on a bill that aims to rein in soaring health insurance costs in Minnesota.
The proposal would prop up the individual insurance market by creating a reinsurance program to help insurers cover expensive medical claims.
Lawmakers are expected to finalized the legislation later Wednesday.
Insurers have experience hundreds of millions of dollars in losses in the individual market, prompting the largest, Blue Cross Blue Shield of Minnesota, to drop out this year.
Republican Sen. Gary Dahms of Redwood Falls warned more insurers might do the same — if the state doesn't provide the reinsurance safety net.
"So now we have a marketplace that's collapsed and we need to do something to bring that marketplace back," said Dahms. "And this one of the ways we can do that."
The bill has a price tag of $271 million in each of the next two years. Some funding would come from the state's general treasury and some from a special health account fed by medical-related taxes. More could come from a pending legal case with insurers, if that is resolved in the state's favor.
Plus, there's a chance federal grants might take some of the load off state taxpayers. But Gov. Mark Dayton expects the state to shoulder most of the tab.
"It would be great if the federal government would face up this need for reinsurance and use its much deeper pockets to provide for all of the states," said Dayton. "But I don't see that happening at this point."
Dayton says the state has no choice but to do what it can to prevent further erosion of the individual insurance market.
The reinsurance bill applies only to a small slice of the overall insurance market, specifically policies sold to people who don't get coverage from an employer or a government program.
The individual insurance market serves about 5 percent of Minnesota's insured population, and they're the ones who have experienced especially sharp increases in costs the past couple of years.
Already this year, state lawmakers approved more than $300 million in one-year discounts for individual policy-holders who don't qualify for other subsidies available through the federal Affordable Care Act.
Here's how the reinsurance idea would work starting next year: The backup insurance wouldn't be available until an individual's claims exceed $50,000. Beyond that threshold, the state program would pay 50 percent or more of the costs. Once claims exceed $250,000 the primary insurer would be back on its own.
The thinking is that if the state provides a financial buffer for insurers they won't have to jack up premiums as high.
Customers themselves won't have to do anything. It's a largely back-office program.
Commerce Commissioner Mike Rothman says he expects the program will help ease premiums for consumers.
"In terms of the annual premium relief target, again it's an approximation based on the estimates, of about 20 percent," he said.
There's actually a requirement in the bill to make insurance companies report how much they would have charged in premiums absent the reinsurance plan. The information will be included in annual rate filings with state regulators.
Minnesota lawmakers strike reinsurance deal
Texas House budget writers send budget to full House with massive health care cut
“I am absolutely confident that services won’t be compromised," state Rep. John Zerwas, R-Richmond, said of the cuts.
Just one day after the Texas Senate passed its two-year budget, a key House committee sent their own spending proposal to the full House – but not before cutting $2.4 billion from the state’s largest health care program for the poor and disabled.
Emboldened by the election of President Donald Trump, Texas House budget writers voted to cut $1 billion in state funding for Medicaid, the federal-state insurance program that mostly serves children, pregnant women and people with disabilities. In doing so, they agreed to forfeit another $1.4 billion in federal funding, though they promised the move would not harm patients’ ability to receive health care.
The latest version of the budget directs the Texas Health and Human Services Commission, which administers Medicaid with financial help and guidance from the federal government, to work with the Trump administration to find “flexibility” to reduce costs. It would amount to almost a 4 percent cut to the total two-year funding for the Texas Medicaid program.
The proposal could mean reducing the amount doctors and other health care providers get paid by the public insurance program, or restricting patients’ eligibility for health care services. Texas health officials could also ask the federal government to pony up more matching funds for certain specialty programs, including for women’s health, Zerwas said in a telephone interview.
State lawmakers have less money at their discretion this year in crafting a two-year budget. By cutting taxes in 2015, the Legislature reduced state revenue available to them for this session by about $4 billion. Lawmakers also dedicated nearly $5 billion that year to highways — a move that voters later approved in a statewide election — which left fewer dollars for priorities like health care and education.
Texas House budget writers send budget to full House with massive health care cut
“I am absolutely confident that services won’t be compromised," state Rep. John Zerwas, R-Richmond, said of the cuts.
Just one day after the Texas Senate passed its two-year budget, a key House committee sent their own spending proposal to the full House – but not before cutting $2.4 billion from the state’s largest health care program for the poor and disabled.
Emboldened by the election of President Donald Trump, Texas House budget writers voted to cut $1 billion in state funding for Medicaid, the federal-state insurance program that mostly serves children, pregnant women and people with disabilities. In doing so, they agreed to forfeit another $1.4 billion in federal funding, though they promised the move would not harm patients’ ability to receive health care.
The latest version of the budget directs the Texas Health and Human Services Commission, which administers Medicaid with financial help and guidance from the federal government, to work with the Trump administration to find “flexibility” to reduce costs. It would amount to almost a 4 percent cut to the total two-year funding for the Texas Medicaid program.
The proposal could mean reducing the amount doctors and other health care providers get paid by the public insurance program, or restricting patients’ eligibility for health care services. Texas health officials could also ask the federal government to pony up more matching funds for certain specialty programs, including for women’s health, Zerwas said in a telephone interview.
State lawmakers have less money at their discretion this year in crafting a two-year budget. By cutting taxes in 2015, the Legislature reduced state revenue available to them for this session by about $4 billion. Lawmakers also dedicated nearly $5 billion that year to highways — a move that voters later approved in a statewide election — which left fewer dollars for priorities like health care and education.
Texas House budget writers send budget to full House with massive health care cut
Waivers represent a quieter way for Republicans to change health care
Section 1332 waivers
In short, Section 1332 waivers let states operate their health care systems as if major parts of the ACA do not exist. In a recent letter to governors, Tom Price, the new secretary of Health and Human Services, signaled the department’s eagerness to pursue Section 1332 waivers with states. In the letter, Price noted a promising proposal out of Alaska, which uses re-insurance (payments to insurers facing higher than expected costs) to lower premiums.
To get a Section 1332 waiver, a governor must gain authorization from his or her state legislature and approval from the Trump administration through executive branch agencies (HHS and, for some requests, the Treasury Department). Under the ACA, these agencies may approve a 1332 waiver request that shows that the state will cover just as many people as the ACA and with just as comprehensive coverage that is just as affordable — all without increasing the federal deficit. In other words, states must develop their own viable replacement plans.
Unlike federal legislation, which requires approval from Congress, evaluation of whether a state proposal passes muster lies solely in the executive branch. A state must show specific types of evidence to demonstrate the quality of its replacement plan, but most of the specifics are in regulation or guidance, which can be undone without action by the US Congress. Say, for example, that a state proposes to reduce premium tax credits and cost-sharing subsidies in order to use those funds for other purposes. Health policy experts might conclude that the number of people covered by health insurance in the state would decrease, violating one of the requirements for the waiver’s approval. But would the Trump administration agree?
There are a few checks on this process. States can’t waive the market protections of the ACA, such as the ban on excluding people for preexisting conditions. A governor can only request a Section 1332 waiver that has been authorized by his or her state legislature. States must engage in a transparent public process when requesting a waiver, including publicizing requests on state websites, holding hearings, and collecting comments.
Section 1115 waivers
These give states the opportunity to waive a key part of federal health care law — in this case, federal Medicaid law. The changes made possible by Section 1115 waivers aren’t as dramatic as those contained in the AHCA — for example, states can’t use these waivers to fully restructure Medicaid under block grants or per capita caps, nor can the federal government use them to take away federal reimbursements for Medicaid expansion — but they are still significant.
Last year, Seema Verma, who later became administrator of the Centers for Medicare and Medicaid Services, advised several states to try to gain authorization using 1115 waivers to increase Medicaid premiums, lock people out of Medicaid for non-payment of premiums, and add Medicaid work requirements. The Obama administration rebuffed many of these requests, stating that they did not further Medicaid’s goals of promoting health care and access. The Trump administration, on the other hand, has signaled a willingness to new ideas with its recent letter to move forward on work requirements, increased premiums, and fewer transportation benefits.
To get a Section 1115 waiver approved, a state must show the secretary of HHS that its proposal meets the goals of the Medicaid program and federal budget requirements. Suppose a state requests that its Medicaid program include a work requirement. As long as HHS agrees that the proposal fits the scope of the waiver, meets Medicaid goals, and meets budget requirements, it can be approved.
As with Section 1332 waivers, there must be a transparent process for submitting them. Though state legislation isn’t required to submit an 1115 request, state legislatures can impose requirements on such submissions.
National implications of waivers
Section 1115 waivers have a long history, with at least one approved in almost every state in the country. They offer an example of how state-based reform using waivers can have far-reaching effects. The ACA, for example, was based in part on Massachusetts’s reforms implemented under an 1115 waiver. And limits on the number of months families can be on welfare (Temporary Assistance for Needy Families) didn’t start out as national policy, but instead grew out of an 1115 waiver in Iowa.
https://www.statnews.com/2017/03/29...Aq6TNWKwQMqqrxSKBM5zNPSsmVWOFw&_hsmi=49566186
Section 1332 waivers
In short, Section 1332 waivers let states operate their health care systems as if major parts of the ACA do not exist. In a recent letter to governors, Tom Price, the new secretary of Health and Human Services, signaled the department’s eagerness to pursue Section 1332 waivers with states. In the letter, Price noted a promising proposal out of Alaska, which uses re-insurance (payments to insurers facing higher than expected costs) to lower premiums.
To get a Section 1332 waiver, a governor must gain authorization from his or her state legislature and approval from the Trump administration through executive branch agencies (HHS and, for some requests, the Treasury Department). Under the ACA, these agencies may approve a 1332 waiver request that shows that the state will cover just as many people as the ACA and with just as comprehensive coverage that is just as affordable — all without increasing the federal deficit. In other words, states must develop their own viable replacement plans.
Unlike federal legislation, which requires approval from Congress, evaluation of whether a state proposal passes muster lies solely in the executive branch. A state must show specific types of evidence to demonstrate the quality of its replacement plan, but most of the specifics are in regulation or guidance, which can be undone without action by the US Congress. Say, for example, that a state proposes to reduce premium tax credits and cost-sharing subsidies in order to use those funds for other purposes. Health policy experts might conclude that the number of people covered by health insurance in the state would decrease, violating one of the requirements for the waiver’s approval. But would the Trump administration agree?
There are a few checks on this process. States can’t waive the market protections of the ACA, such as the ban on excluding people for preexisting conditions. A governor can only request a Section 1332 waiver that has been authorized by his or her state legislature. States must engage in a transparent public process when requesting a waiver, including publicizing requests on state websites, holding hearings, and collecting comments.
Section 1115 waivers
These give states the opportunity to waive a key part of federal health care law — in this case, federal Medicaid law. The changes made possible by Section 1115 waivers aren’t as dramatic as those contained in the AHCA — for example, states can’t use these waivers to fully restructure Medicaid under block grants or per capita caps, nor can the federal government use them to take away federal reimbursements for Medicaid expansion — but they are still significant.
Last year, Seema Verma, who later became administrator of the Centers for Medicare and Medicaid Services, advised several states to try to gain authorization using 1115 waivers to increase Medicaid premiums, lock people out of Medicaid for non-payment of premiums, and add Medicaid work requirements. The Obama administration rebuffed many of these requests, stating that they did not further Medicaid’s goals of promoting health care and access. The Trump administration, on the other hand, has signaled a willingness to new ideas with its recent letter to move forward on work requirements, increased premiums, and fewer transportation benefits.
To get a Section 1115 waiver approved, a state must show the secretary of HHS that its proposal meets the goals of the Medicaid program and federal budget requirements. Suppose a state requests that its Medicaid program include a work requirement. As long as HHS agrees that the proposal fits the scope of the waiver, meets Medicaid goals, and meets budget requirements, it can be approved.
As with Section 1332 waivers, there must be a transparent process for submitting them. Though state legislation isn’t required to submit an 1115 request, state legislatures can impose requirements on such submissions.
National implications of waivers
Section 1115 waivers have a long history, with at least one approved in almost every state in the country. They offer an example of how state-based reform using waivers can have far-reaching effects. The ACA, for example, was based in part on Massachusetts’s reforms implemented under an 1115 waiver. And limits on the number of months families can be on welfare (Temporary Assistance for Needy Families) didn’t start out as national policy, but instead grew out of an 1115 waiver in Iowa.
https://www.statnews.com/2017/03/29...Aq6TNWKwQMqqrxSKBM5zNPSsmVWOFw&_hsmi=49566186
Could A New Obamacare Replacement Allow Health Insurance Sales Across State Lines?
Sometimes, interstate insurance sales are brought up as an idea that can singlehandedly eliminate the health cost problem in America. That’s not true, but what is true is that interstate insurance—especially in metropolitan areas that cross state lines, like New York City or St. Louis, a regional multi-state plan could do a better job of playing cross-state hospitals against each other.
Prominent health economists at the University of Minnesota, including Stephen Parente and Roger Feldman, estimated in 2011 that interstate insurance sales could lower costs, in part because of this metropolitan cross-state feature, and in part because local insurers would be freed from state-based insurance mandates.
As Republicans debate the role of federally-mandated essential health benefits in their Obamacare replacement, it’s relevant to revisit the interstate insurance debate. There are many states whose insurance mandates are even more numerous and stringent than Obamacare’s; for those states, repealing Obamacare’s EHBs alone will not make a big difference. But states with a lighter regulatory touch could benefit significantly if interstate insurance sales brought more business to their localities.
How to enact interstate insurance via reconciliation
One challenge for Paul Ryan’s replacement plan—the American Health Care Act—is that its flat tax credit structure makes it hard to include regulatory changes in a reconciliation bill.
Reconciliation bills—which can pass with 50 senators rather than the usual 60—require each and every provision to be germane to taxing and spending. Regulatory changes, like buying insurance across state lines, are considered “incidental” to taxing and spending.
Ryan’s flat tax credits stay constant regardless of the regulatory environment, making it that much harder to enact regulatory reforms via reconciliation. But under a means-tested approach in which tax credits kicked in above a certain percentage of someone’s income, as is contemplated in Section 202 of the AHCA, any regulation that reduces premiums also reduces federal spending, and is therefore germane to the budget process.
Another issue is that under a normal legislative process, allowing interstate health insurance sales would be the province of the Senate Judiciary Committee. Because the 2017 reconciliation vehicle contains no instructions for the Judiciary Committee—but solely the Finance Committee and the Health, Education, Labor, and Pension Committee—a reconciliation bill that includes work for the Judiciary Committee can lose its parliamentary privilege and fail altogether.
A way around this problem may be to link a portion of the AHCA’s State Innovation Grants to whether or not a state allows interstate health insurance sales. That way, the across-state-lines legislative provision does not fun afoul of the Senate Parliamentarian, because it remains connected to parts of the bill that are legitimately associated with reconciliation.
Not a magic bullet—but a lead one
Interstate insurance is not the be-all and end-all of health reform by any stretch. But it could reduce costs, especially in major cities that cross a state border.
State-based insurance companies won’t like such a change, because it exposes them to competition and regulatory change. State insurance commissioners won’t like it, because it decreases their power when insurers can relocate. Some conservatives fear that a national insurance market could lead to more federal insurance regulation. But consumers would gain the same choices in health care that they gain in auto care, life insurance, and homeowner’s insurance. And President Trump would finally get his elusive first policy victory.
Could A New Obamacare Replacement Allow Health Insurance Sales Across State Lines?
Sometimes, interstate insurance sales are brought up as an idea that can singlehandedly eliminate the health cost problem in America. That’s not true, but what is true is that interstate insurance—especially in metropolitan areas that cross state lines, like New York City or St. Louis, a regional multi-state plan could do a better job of playing cross-state hospitals against each other.
Prominent health economists at the University of Minnesota, including Stephen Parente and Roger Feldman, estimated in 2011 that interstate insurance sales could lower costs, in part because of this metropolitan cross-state feature, and in part because local insurers would be freed from state-based insurance mandates.
As Republicans debate the role of federally-mandated essential health benefits in their Obamacare replacement, it’s relevant to revisit the interstate insurance debate. There are many states whose insurance mandates are even more numerous and stringent than Obamacare’s; for those states, repealing Obamacare’s EHBs alone will not make a big difference. But states with a lighter regulatory touch could benefit significantly if interstate insurance sales brought more business to their localities.
How to enact interstate insurance via reconciliation
One challenge for Paul Ryan’s replacement plan—the American Health Care Act—is that its flat tax credit structure makes it hard to include regulatory changes in a reconciliation bill.
Reconciliation bills—which can pass with 50 senators rather than the usual 60—require each and every provision to be germane to taxing and spending. Regulatory changes, like buying insurance across state lines, are considered “incidental” to taxing and spending.
Ryan’s flat tax credits stay constant regardless of the regulatory environment, making it that much harder to enact regulatory reforms via reconciliation. But under a means-tested approach in which tax credits kicked in above a certain percentage of someone’s income, as is contemplated in Section 202 of the AHCA, any regulation that reduces premiums also reduces federal spending, and is therefore germane to the budget process.
Another issue is that under a normal legislative process, allowing interstate health insurance sales would be the province of the Senate Judiciary Committee. Because the 2017 reconciliation vehicle contains no instructions for the Judiciary Committee—but solely the Finance Committee and the Health, Education, Labor, and Pension Committee—a reconciliation bill that includes work for the Judiciary Committee can lose its parliamentary privilege and fail altogether.
A way around this problem may be to link a portion of the AHCA’s State Innovation Grants to whether or not a state allows interstate health insurance sales. That way, the across-state-lines legislative provision does not fun afoul of the Senate Parliamentarian, because it remains connected to parts of the bill that are legitimately associated with reconciliation.
Not a magic bullet—but a lead one
Interstate insurance is not the be-all and end-all of health reform by any stretch. But it could reduce costs, especially in major cities that cross a state border.
State-based insurance companies won’t like such a change, because it exposes them to competition and regulatory change. State insurance commissioners won’t like it, because it decreases their power when insurers can relocate. Some conservatives fear that a national insurance market could lead to more federal insurance regulation. But consumers would gain the same choices in health care that they gain in auto care, life insurance, and homeowner’s insurance. And President Trump would finally get his elusive first policy victory.
Could A New Obamacare Replacement Allow Health Insurance Sales Across State Lines?
Bill to keep Arkansas Medicaid plan falls short in House
LITTLE ROCK, Ark. (AP) -- An effort to keep Arkansas' hybrid Medicaid expansion for another year fell short in the state House days after an attempt by congressional Republicans to repeal the federal health law that created the program failed.
The House voted 73-17 Wednesday for the budget for the state Medicaid program, including the expansion, falling two votes short of the 75 needed to send the measure to the governor. House leaders did not indicate when they would try another vote on the bill.
More than 300,000 people are on the program that uses Medicaid funds to buy private insurance for low-income residents. The program has divided Republicans, who control the Legislature, since it was created in 2013.
Republican Gov. Asa Hutchinson has said he'll seek federal approval to add new limits to the program.
Bill to keep Arkansas Medicaid plan falls short in House
Missouri House votes down Medicaid expansion
JEFFERSON CITY (AP) — Missouri's Republican-led House has squashed an attempt by Democrats to expand Medicaid eligibility.
Members voted 102-41 against a proposal by Columbia Democratic Rep. Kip Kendrick to broaden eligibility under former President Barack Obama's federal health care law.
Kendrick tried to add the proposal to a Republican-sponsored bill that's advancing to create a taskforce on how the state can revamp health care in order to get a waiver from the law.
While neighboring Kansas and other Republican-led states have taken steps toward expanding Medicaid eligibility, the House vote is another act of opposition in Missouri.
Missouri Republican Gov. Eric Greitens also this week told reporters he still opposes the law and wants an overhaul by Congress.
http://www.news-leader.com/story/ne...house-votes-down-medicaid-expansion/99812562/
LITTLE ROCK, Ark. (AP) -- An effort to keep Arkansas' hybrid Medicaid expansion for another year fell short in the state House days after an attempt by congressional Republicans to repeal the federal health law that created the program failed.
The House voted 73-17 Wednesday for the budget for the state Medicaid program, including the expansion, falling two votes short of the 75 needed to send the measure to the governor. House leaders did not indicate when they would try another vote on the bill.
More than 300,000 people are on the program that uses Medicaid funds to buy private insurance for low-income residents. The program has divided Republicans, who control the Legislature, since it was created in 2013.
Republican Gov. Asa Hutchinson has said he'll seek federal approval to add new limits to the program.
Bill to keep Arkansas Medicaid plan falls short in House
Missouri House votes down Medicaid expansion
JEFFERSON CITY (AP) — Missouri's Republican-led House has squashed an attempt by Democrats to expand Medicaid eligibility.
Members voted 102-41 against a proposal by Columbia Democratic Rep. Kip Kendrick to broaden eligibility under former President Barack Obama's federal health care law.
Kendrick tried to add the proposal to a Republican-sponsored bill that's advancing to create a taskforce on how the state can revamp health care in order to get a waiver from the law.
While neighboring Kansas and other Republican-led states have taken steps toward expanding Medicaid eligibility, the House vote is another act of opposition in Missouri.
Missouri Republican Gov. Eric Greitens also this week told reporters he still opposes the law and wants an overhaul by Congress.
http://www.news-leader.com/story/ne...house-votes-down-medicaid-expansion/99812562/
Anyway we can get this thread stickied back since this seems to be an ongoing issues still?
Maybe under a "general healthcare fukkery" thread. Because this look like it will be an ongoing fight for the foreseeable future.
Maybe under a "general healthcare fukkery" thread. Because this look like it will be an ongoing fight for the foreseeable future.