Here is my question for the week, with all this talk of Medicare for All what happened to Obamacare the pride of the Democratic Party and the Golden Trophy of President Obama?
This was and still is a great idea to provide health care for many/all and was designed by very smart people. The only big problem was how to pay for it and therefore how to make it sustainable, especially after removing the Individual Mandate. Why then Medicare for All with all of its own problems? Susannah Luthi wrote that the Centrist House Democrats on Wednesday launched a push to revive Obamacare stabilization talks, two hours after their progressive wing unveiled new Medicare for All legislation.
But Now Some of the Moderate Democrats revive talks to fund CSRs, reinsurance
The 101-strong New Democrat Coalition wants to fund reinsurance and cost-sharing reduction payments in a package that closely resembles the deal struck last Congress by Senate health committee leaders Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.).
That bill, known colloquially as Alexander-Murray, fell apart at the last minute following a GOP-Democratic dispute over including anti-abortion language.
“Well, we would call it Schrader-Bera-Kuster,” joked Rep. Kurt Schrader (D-Ore.), one of the co-chairs of the coalition’s healthcare task force as he referred to fellow co-chairs Reps. Ami Bera (D-Calif.) and Annie Kuster (D-N.H.).
He said the group wants to take another run at it, as this is a “different Congress, with different makeup,” and voters gave Congress a mandate to make the individual market more affordable.
To prod leadership into action, the group sent a letter urging prompt committee action to key committee leaders—Frank Pallone (D-N.J.) of Energy and Commerce, Chair Richard Neal (D-Mass.) of Ways and Means, and Bobby Scott (D-Va.) of Education and Labor.
“Building upon your work and the work of the New Democrat Coalition last Congress, we urge your committees to deliver on the promises made to our constituents by prioritizing strengthening the ACA and continuing the path toward universal affordable coverage,” the group wrote.
The group hopes numbers are on their side. It’s now the largest ideological caucus in Congress and owes its swelling ranks to the 40 Democratic freshmen who swept into office largely with the ACA on their platform.
The coalition announced its healthcare policy wish list two hours after progressive Democrats’ 70-minute press conference unveiling the new Medicare for All or single payer legislation.
Coalition members downplayed their role as opposing single payer—highlighting instead the pragmatism of lowering ACA individual market premiums as action Congress can take immediately for people who remain unsubsidized.
They also said they want to discuss public options, such as a policy to allow people to buy into Medicare or Medicaid.
Democratic leaders have pushed support for the ACA as a key part of their agenda, but proposals so far this Congress haven’t included funding for CSRs—whose cut-off led to the silver-loading that boosts premiums for people who can’t get subsidies—or reinsurance.
The Pallone-Neal-Scott proposal from last year includes reinsurance and CSRs, but enthusiasm for funding CSRs has waned since last year. Liberal advocates like the fact that the CSR cut-off led to bigger subsidies for low-income people.
And while insurers hope stabilization talks resurface, their profitability on the exchanges is soaring.
On Wednesday, Pallone told an audience at an Atlantic Live event that he’s most interested in growing the subsidies—increasing the pool of people who qualify for them and raising what’s available for people who currently receive them.
“It’s clear now that people at the higher income level, who were not eligible for those subsidies before, that we need to raise that, for people with a higher income, because there are people now making over $85, $90k a year who don’t get any subsidy,” Pallone said Wednesday morning. “In a place like New Jersey, that’s not a lot of income for a family of four.”
He also confirmed that the House will push back against the Trump administration’s expansion of short-term, limited duration plans.
Pallone was pressed on the cost problem: that an increase in subsidies puts the government on the hook for most of the high premiums, he pointed to his proposal to set up a reinsurance pool.
On whether Congress could overcome last year’s dispute over abortion language, Schrader was optimistic.
However, a Republican aide for the Senate health committee responded by referring to a comment made to Modern Healthcare last week.
“The only way Congress could pass an appropriation for CSRs is if Democrats reverse course and agree to apply the Hyde Amendment which applies to all other healthcare appropriations,” the staffer said.
Dems hit GOP on health care with additional ObamaCare lawsuit vote
At the beginning of January, Jessie Hellmann reported that in the first week of this year the House passed a resolution backing the chamber’s recent move to defend ObamaCare against a lawsuit filed by GOP states, giving Democrats another opportunity to hit Republicans on health care.
GOP Reps. Brian Fitzpatrick (Pa.), John Katko (N.Y.) and Tom Reed (N.Y.) joined with 232 Democrats to support the measure, part of Democrats’ strategy of keeping the focus on the health care law heading into 2020. The final vote tally was 235-192.
While the House voted on Friday to formally intervene in the lawsuit as part of a larger rules package, Democrats teed up Wednesday’s resolution as a standalone measure designed to put Republicans on record with their opposition to the 2010 law.
A federal judge in Texas last month ruled in favor of the GOP-led lawsuit, saying ObamaCare as a whole is invalid. The ruling, however, will not take effect while it is appealed.
Democrats framed Wednesday’s vote as proof that Republicans don’t want to safeguard protections for people with pre-existing conditions — one of the law’s most popular provisions.
“If you support coverage for pre-existing conditions, you will support this measure to try to protect it. It’s that simple,” said Rules Committee Chairman Jim McGovern (D-Mass.) before the vote.
Most Republicans opposed the resolution, arguing it was unnecessary since the House voted last week to file the motion to intervene.
“At best, this proposal is a political exercise intended to allow the majority to reiterate their position on the Affordable Care Act,” said Rep.Tom Cole (R-Okla.). “At worst, it’s an attempt to pressure the courts, but either way, there’s no real justification for doing what the majority wishes to do today.”
The Democratic-led states defending the law are going through the process of appealing a federal judge’s decision that ObamaCare is unconstitutional because it can’t stand without the individual mandate, which Congress repealed.
Democrats were laser-focused on health care and protections for people with pre-existing conditions during the midterm elections — issues they credit with helping them win back the House.
The Trump administration has declined to defend ObamaCare in the lawsuit filed by Republican-led states, which argue that the law’s protections for people with pre-existing conditions should be overturned. It’s unusual for the DOJ to not defend standing federal law.
The House Judiciary Committee, under the new leadership of Chairman Jerrold Nadler (D-N.Y.), plans to investigate why the Department of Justice decided not to defend ObamaCare in the lawsuit.
“The judiciary committee will be investigating how the administration made this blatantly political decision and hold those responsible accountable for their actions,” Nadler said.
Democrats are also putting together proposals to undo what they describe as the Trump administration’s efforts to “sabotage” the law and depress enrollment.
“We’re determined to get that case overruled, and also determined to make sure the Affordable Care Act is stabilized so that the sabotage the Trump administration is trying to inflict ends,” said Rep. Frank Pallone Jr. (D-N.J.), chairman of the Energy and Commerce Committee, which has jurisdiction over ObamaCare.
One of the committee’s first hearings this year will focus on the impacts of the lawsuit. The hearing is expected to take place this month.
The Ways and Means Committee, under the leadership of Chairman Richard Neal (D-Mass), will also hold hearings on the lawsuit and on protections for people with pre-existing conditions.
Those two committees, along with the Education and Labor Committee, are working on legislation that would shore up ObamaCare by increasing eligibility for subsidies, blocking non-ObamaCare plans expanded by the administration and increasing outreach for open enrollment.
And Now the House Democrats Decry ‘Junk Plans’ and are introducing bills to reverse Trump-inflicted ACA “sabotage”
Shannon Firth noted that the Democrats blasted attempts by the Trump administration to “sabotage” the Affordable Care Act during a House Energy & Commerce Health Subcommittee hearing on Wednesday.
“We’re inviting people back into a world with mirrors and trap doors, which was exactly the place we wanted to get away from when we passed the ACA,” said Rep. John Sarbanes (D-Md.), who called on his colleagues to “push back against these junk plans.”
House Democrats introduced four bills to roll back administration efforts to loosen or circumvent the ACA’s insurance requirements. In the very unlikely event that they pass the Republican-controlled Senate and gain the president’s signature, they would:
- Require all short-term health plans to include a warning explicitly stating which benefits are included and which aren’t
- Restore marketing and outreach funding for ACA exchanges
- Rescind a regulation that extended the allowable duration of short-term plans (including renewals) to just under 3 years
- Cancel the administration’s new guidance around 1332 waivers, which relaxed certain “guard rails”
Republicans complained that ACA plans are unaffordable for middle-income Americans who don’t receive subsidies, and argued that the Trump administration’s actions allow those same Americans more options for cheaper health plans.
“They’re really trying to give consumers new options, particularly those who were shut out of the market because of costs,” said Grace-Marie Turner, a witness at the hearing and president of the Galen Institute, a conservative think tank, in defense of the administration.
Republicans also pushed back on criticism of the administration’s 1332 waiver guidance, saying Democrats were denying states the right to innovate their programs and instead of trying to impose the will of Washington.
Turner stressed that states are better positioned to regulate their own local health insurance markets.
Rep. Michael Burgess, MD (R-Texas), the subcommittee’s ranking member, said that none of the bills being discussed would increase the availability of “reasonably priced plans.”
Are Short-Term Plans Junk?
Much of Wednesday’s discussion focused on short-term plans, which are cheaper than ACA exchange plans but offer a shrunken set of benefits.
In August, the Trump administration issued a final rule extending the duration of these plans for just under 12 months and made plans eligible for renewals for nearly 3 years. Previously, the plans were available for just under 3 months at a maximum.
Rep. Kathy Castor (D-Fla.), who introduced a bill to rescind the short-term plan rule, said she’s worried “the public is being snookered here.”
Hearing witness Katie Keith, JD, MPH, of Georgetown University, highlighted “post-claims underwriting” as a major risk to buyers of short-term plans.
“Maybe you were healthy when you signed up. Then, something happens — you have a big medical claim. It triggers an alarm and [the insurers] go back and look at your application, and pull all your medical records again and go, ‘Oh, you should have told us about this,'” she told MedPage Today after the hearing.
Even in cases where a patient was not diagnosed with an illness prior to enrollment, insurers find ways to justify cancellation, she said.
Rep. Nanette Barragán (D-Calif.) offered one example, a Chicago businessman who was encouraged to buy a short-term plan by a broker even after disclosing symptoms of serious back pain. After he enrolled, the businessman was diagnosed with non-Hodgkin lymphoma. Insurers then reviewed his medical records and determined that the businessman’s cancer was a pre-existing condition because he had visited a chiropractor in the past, leaving him with over $800,000 in medical bills after 6 months, Barragán said.
“You would never expect your cancer treatment to be denied because you’ve had bad back pain,” Keith said. “That’s something that, I think, disclosures can’t fix.”
Jessica Altman, Pennsylvania Insurance Department commissioner, pointed out that short-term plans may not cover ACA-defined “essential health benefits.” She cited a study showing that less than 60% cover mental health, only about one-third cover treatment for substance use disorder or prescription drugs, and none included maternity benefits.
Altman also noted that short-term plans aren’t required to abide by the ACA’s medical loss ratio requirements. The two largest short-term plan vendors, which control 80% of the market, spend less than half of each premium dollar on “actual medical care,” she said.
But Turner said short-term plans are meant to serve as “bridge plans” for individuals such as early retirees, people in the gig economy, and young entrepreneurs starting a business, who would convert before long to more comprehensive coverage. Turner also emphasized the plans’ affordability — with premiums less than half of what an ACA plan would cost — and stressed that consumers understand the plans aren’t permanent.
Rep. Richard Hudson (R-N.C.) pointed out that states are allowed to impose limits on short-term plans or ban them altogether.
“I think it’s important to note that we’re not forcing anyone into this. We’re giving flexibility to the states,” he said.
He suggested bringing in witnesses from states where plans are available to learn their true impact.
New Waiver Guidance
Another bill, explored at the hearing, would revoke the administration’s changes to 1332 waivers, which loosened standards for what qualifies as healthcare coverage. The administration’s waiver also allows ACA subsidies to be spent on short-term plans.
Rep. Frank Pallone (D-N.J.), who chairs the full Energy & Commerce Committee, said the changes “turn the statute on its head,” exceeding the administration’s authority and “contrary to congressional intent.”
Keith agreed. She said the guidance was inconsistent with the statute itself. Instead of improving access to healthcare, the guidance “undermines” it. In particular, subsidizing short-term health plans “flies in the face of 1332,” she said.
Several Republicans, including Rep. Greg Walden (R-Ore.), ranking member for the full committee, highlighted the successful implementation of reinsurance programs in states such as Alaska, Minnesota, Oregon, and others, claiming that Democrats oppose state innovation.
Keith clarified that the reinsurance programs were approved under the 1332 rules as written by the previous administration, without the Trump administration’s changes.
Any waivers approved under the Trump administration’s new guidance would likely trigger a lawsuit, she said. As for short-term health plans, several patient advocacy groups have already filed a lawsuit targeting the administration’s new guidance for those plans.
So, I am not going to pursue this issue anymore because I want all of us to consider my first question-Why are Bernie Saunders and most of the multiple Democrat candidates running for President in 2020 touting Medicare for All instead of coming up with fixes for the Affordable Care Act/ Obamacare?
Let us discuss possible fixes to Obamacare next week.
And to a lighter side:
You can now buy an actual hospital room on Amazon
- Amazon is increasingly moving into the business of selling supplies to hospitals.
- Now, that includes “smart” hospital rooms that can be purchased on its marketplace as of Thursday.
- The units are targeted to hospitals and are made by a company called EIR Healthcare.
You can buy almost everything on Amazon. And that includes, as of Thursday, a “smart” hospital room in a box.
A New York-based company called EIR Healthcare is now selling units of its hospital room, dubbed MedModular, for $814 a square foot on Amazon.com, which the company claims are more affordable than traditional construction. The design is customizable but all the rooms come with a bathroom and a bed.
These rooms don’t come cheap at $285,000 per unit, but they are targeted to business buyers that are increasingly flocking to Amazon.
So who would buy the units?
“We’re targeting hospitals and health systems,” said Grant Geiger, CEO of EIR Healthcare, the company selling the units. “There’s a trend towards bringing more transparency in the health care space,” he added.
Geiger said he’s currently seeing an uptick in interest from hospitals in using the units for things like simulation labs, or urgent care facilities.
Geiger has also considered looking into potential customers in the military.
But hospital administrators are an obvious place to start, he said, as Amazon is already selling them medical supplies ranging from bedpans to syringes. Previously, large hospital systems would buy everything through group purchasing organizations, or GPOs, which provided discounts but also a lack of transparency around costs.
Now, Amazon is looking to carve out its own slice of that lucrative business with its own growing portfolio of medical supplies.
Geiger said he talked to that group for months before he got permission to sell his units on Amazon’s marketplace. He also needed the company’s approval to ship and deliver the product, which involves transporting the units in giant shipping containers down the freeway.
Incidentally, you can also buy tiny houses on Amazon.