American Health Care Act – R&R – Reachout and Rebuild

US Healthcare: no Bang for the Buck

David Posnett — Sat, 19 May 2018 22:36:07 +0000

Health care in the US is more expensive, by far, than anywhere else on this planet. It represents greater than 17.9% of the US GDP. Health spending is projected to grow 1.0 percentage point faster than Gross Domestic Product (GDP) per year over the 2017-26 period; as a result, the health share of GDP is expected to rise from 17.9 percent in 2016 to 19.7 percent by 2026. Other comparable developed countries pay much less:

The question is why are we so wasteful and what do we get for all this money. If you look at longevity as the overall measure of success for healthcare, we are not doing very well, as described in a recent article in the NY Times:

The above graph shows life expectancy over time compared to similar developed nations.

This shows life expectancy as a function of health spending per person.

So what are the proposed causes for this dramatic inefficiency? The authors propose many factors to explain the sudden up tick in health care spending around 1980. For example:

“suppliers marketed very costly technological innovations with gusto,”and they “found ready customers in hospitals, medical practices and other entities eager to keep up with rivals in the medical arms race.” The last third of the 20th century or so, was a fertile time for expensive health care innovation: Coronary artery bypass grafting, innovative drug treatments for H.I.V. for cancer and expensive NICU care for premature babies.

But innovation does not necessarily translate in to better outcomes. Almost no matter how it’s measured, longevity in the United States has not kept pace with that of other nations.

Another study, published in JAMA, found that even accounting for motor vehicle traffic crashes, firearm-related injuries and drug poisonings, the United States has higher mortality rates than comparably wealthy countries.

So here is the presumed bottom line.

“The lack of universal health coverage and less safety net support for low-income populations could have something to do with it. The most efficient way to improve population health is to focus on those at the bottom,” says Ms Glied from Columbia Univ. “But we don’t do as much for them as other countries.”

The effectiveness of focusing on low-income populations is evident from large expansions of public health insurance for pregnant women and children in the 1980s. There were large reductions in child mortality associated with these expansions. “Those reductions were much larger for poor children than for richer children,” Ms. Currie said.

In 1980 the United States spent 11 percent of its G.D.P. on social programs, excluding health care, while members of the European Union spent an average of about 15 percent. In 2011 the gap had widened to 16 percent versus 22 percent.

Slow income growth could play a role because poorer health is associated with lower incomes. “It’s notable that, apart from the richest Americans, income growth stagnated starting in the late 1970s,” Cutler said. “Social underfunding probably has more long-term implications than underinvestment in medical care.”

Read more here about how social programs can lead to increased longevity: Are better health outcomes related to social expenditure?

It has been known for some time that low income/wealth is associated with much decreased longevity:

as the income gap increases in the US, so does the disparity in life spans between rich and poor as reported in the NY Times
in the U.S., the richest 1 percent of men lives 14.6 years longer on average than the poorest 1 percent of men, while among women in those wealth percentiles, the difference is 10.1 years on average.
This eye-opening gap is also growing rapidly: Over roughly the last 15 years, life expectancy increased by 2.34 years for men and 2.91 years for women who are among the top 5 percent of income earners in America, but by just 0.32 and 0.04 years for men and women in the bottom 5 percent of the income tables.
U.S. tax and spending policy does relatively little, compared with its peers in the developed world, to reduce inequality and with the new tax policies enacted by our current government this will worsen.

In the NY Times (2014) Leonhardt and Quealy note that “The American Middle Class Is No Longer the World’s Richest”. The following interactive graph shows who many developped countries like Norway, Canada, Germany, Sweden, Netherlands are making gains for the lower 20th percentile of wage earners surpassing American incomes for this bracket. American incomes are losing their edge, except at the top:

It is this same bracket (the lower 20th percentile) that have such poor life expectancy dragging down the overall life expectancy for the entire country.

Finally, this study shows an interesting shift: since about 2004 the lowest quintile income group in the US is spending much less on healthcare on a per capita basis, than the highest income quintile. One of the authors remarks that “co-payments and deductibles have bent the cost curve. But it’s come at the expense of poor people and middle-income people.”

My conclusions:

efforts by the GOP to slash medicare will make things worse
the new tax law will make things worse by aggravating income disparity
advances in medicine benefit the health care industry and affluent Americans who have access to the newest treatments, but on average the population does not benefit as measured by life expectancy, for example.
How you vote may be a matter of life or death.

Out-of-pocket healthcare spending could rise thanks to Lee Zeldin

David Posnett — Wed, 24 Jan 2018 18:02:17 +0000

Implementation of the Affordable Care Act (ACA, Obamacare) was associated with reduced out-of-pocket spending for US medical care, particularly among those with lower incomes, but not with reduced premiums.

That is the conclusion of a new study published in the medical journal JAMA Internal Medicine.

As summed up by Les Masterson on the HealthCare Dive

the ACA led to reduced out-of-pocket spending, especially for low-income Americans. That said, many people still feel the burden of high out-of-pocket costs and premium spending.
medical expenses continue to “consume a large share of many families’ incomes and compound income inequities.”
repealing or reversing gains made by the ACA will “especially harm poor and low-income Americans.” Premiums will likely increase for people in the exchanges if healthier people leave the exchanges.

This affects residents in our Congressional district: NY-01. Rep. Lee Zeldin has consistently voted to undermine the ACA and has supported very unpopular Trumpcare. Republicans also putting Medicare and Medicaid in jeopardy via the recently passed tax bill. Thanks for stealing our money!

Read more about the LZ track record on healthcare:

https://resistancesuffolk.blog/2017/03/18/zeldins-deception-on-health-care/

https://resistancesuffolk.blog/2017/06/30/zeldins-approval-of-senate-healthcare-bill-reveals-his-lack-of-concern-for-veterans/

http://www.1clickdaily.com/1429473

https://resistancesuffolk.blog/2017/09/25/zeldin-must-stand-up-and-protect-long-islands-health-care/

https://resistancesuffolk.blog/2017/05/21/is-zeldin-untruthful-about-healthcare/

and Zeldin complicit in CHIP used as bargaining chip:

Taking the Heart out of Obamacare

David Posnett — Thu, 21 Dec 2017 02:47:53 +0000

Tax bill sets up 2018 attacks on our health care

This week, House and Senate Republicans passed their deficit-busting tax giveaway to corporations and the ultra-rich without a single Democratic vote, clearing it for Donald Trump’s signature. After failing to repeal the Affordable Care Act outright earlier this year, GOP leaders gloated that “doing away with the individual mandate [in the tax bill] makes the ACA unworkable” and “takes the heart out of Obamacare.”

It’s true that repealing the individual mandate will do real damage. According to the Congressional Budget Office, premiums will rise an average of 10% (wiping out any short-term tax cut that low- and middle-income families might see under the bill before their tax rates jump up again in a few years) and 13 million people will lose their health insurance as a result of the Republican tax bill. Combined with regulatory changes proposed by the Trump administration to make “junk” plans more attractive to healthy people and the GOP’s ongoing efforts to sabotage consumer protections, the coming year could be turbulent, expensive and scary for millions of people in need of affordable care.

But while it’s easy to feel despair, Republicans have not taken the “heart” out of the ACA. Not yet!

It will be up to us next year to fight against attacks on the true heart of the ACA: the Medicaid expansion, subsidies to help low- and moderate-income families pay their premiums and consumer protections for women and people with pre-existing conditions. That’s because GOP leadership has made clear that, having blown a giant hole in the deficit with tax cuts, they intend to use that hole as an excuse to dismantle core safety net programs including the ACA, Medicaid, food stamps and more.

Help Raising Women’s Voices protect the true heart of the ACA in 2018 by making a tax-deductible charitable donation before year’s end! You can donate through the Network for Good page

Our 2017 work isn’t over yet!
Meanwhile, our fight for affordable health care isn’t even over for the week. Having now given themselves and their donors an expensive Christmas bonanza with the national credit card, Republicans are hoping to leave town for the holidays without reauthorizing the Children’s Health Insurance Program (CHIP), which expired in September. CHIP funds health insurance for nine million kids, including two million kids with serious chronic conditions, but without federal support, states are spending down reserves and moving to cut off new enrollments as a first step to shutting down their CHIP programs altogether.

Today, the Georgetown University Center for Children and Families released new analysis which found that if Congress does not act soon to fund CHIP, an estimated 1.9 million children in separate CHIP programs could lose coverage in January. An additional 1 million children would also be at risk of losing coverage by the end of February.

According to congressional Republicans, “The reason CHIP’s having trouble is we don’t have any money anymore.” Having just voted to add $1.5 trillion to the deficit in order to slash taxes on the rich, Republicans are refusing to fund the $14 billion CHIP program unless they win deep health cuts elsewhere. They hope to push off dealing with CHIP until after the New Year, even though states like Alabama have already announced that they will be forced to freeze enrollment on January 1.

Also left without continuing funding are community health centers, which provide vital primary care to many low-income families, the Maternal Infant Childhood Home Visiting Program, and the Medicaid disproportionate share hospital payments program, which supports safety-net hospitals that serve large numbers of Medicaid and uninsured patients. Word today is that Congress will pass yet another short-term extender of government funding until early in 2018.

There’s still time to push Congress to take more decisive action this week! The number for the Capitol switchboard is 202-224-3121. You know what to do!

From Raising Women’s Voices, NY, NY

Zombie Health Care Repeal Part 5: What the GOP’s Sneaky Health Repeal Means for You

David Posnett — Wed, 15 Nov 2017 17:07:02 +0000

Yet another attempt to sabotage healthcare! They just don’t get it. David

View at Medium.com

The GOP is sneaking in a partisan health care repeal to pay for their tax cuts for the wealthy and big corporations. Here’s what you need to know:

GOP is sneaking in health repeal after failing four times. The American people rejected Republican repeal efforts four times over the course of the year. Now, they’re sneaking health repeal into their big tax cut bill for the wealthy and big corporations.
Sneaky repeal would rip coverage away from 13 million people and raise premiums by double digits. The nonpartisan Congressional Budget Office estimated that 13 million people would lose health coverage and premiums would increase double digits as a result of the health repeal provision Republicans are sneaking into their tax bill.
Key patient groups oppose sneaky repeal. Sixteen patient groups have announced their opposition: March of Dimes; the American Heart Association; the Cystic Fibrosis Foundation; the American Cancer Society Cancer Action Network; the Multiple Sclerosis Society; Lutheran Services in America; the American Lung Association; the American Diabetes Association; the National Health Council; the Epilepsy Foundation; the National Organization for Rare Disorders; the American Liver Foundation; Family Voices; Consumers Union; Little Mended Hearts; and Futures Without Violence.
Key industry stakeholders oppose sneaky repeal. Six health care industry groups have announced their opposition: America’s Health Insurance Plans; the American Academy of Family Physicians; the American Hospital Association; the American Medical Association; the Blue Cross Blue Shield Association; and the Federation of American Hospitals. In the words of CNBC: “Insurers, doctors and hospitals oppose repeal.”
The tax bill would trigger $25 billion in Medicare cuts. The nonpartisan Congressional Budget Office estimates that huge tax cuts for the wealthy and big corporations would trigger $25 billion in cuts to Medicare.
The tax bill raises health costs for middle class families and seniors with high medical expenses. The House Republican tax plan eliminates the medical expense deduction, which helps nearly 9 million people with high medical expenses, such seniors with long-term care, people with chronic health conditions and parents of children with disabilities. Nearly 70 percent of people who claimed this deduction earned $75,000 or less.
All of this is to pay for huge tax cuts for the wealthy and big corporations. Let’s be clear: Republicans are sneaking health repeal into their tax bill so they can pay for their huge tax cuts to the wealthy and big corporations. The Tax Policy Center found nearly half of the tax cuts would benefit the top 1 percent.
Republicans are not listening to the American people. Time and time again the American people have rejected health repeal. First, the GOP health care repeal is the most unpopular legislation in three decades. In last week’s elections, health care was the dominant issue. In the Virginia gubernatorial race, health care was the #1 issue to 39% of voters – more than double any other issue, and among those voters, Ralph Northam beat Ed Gillespie by 54 points (77-23). In New Jersey, 19% of voters ranked health care their top issue, and chose Phil Murphy over Kim Guadagno, who opposed the ACA, by 74 points (86–12). In Maine, voters “easily approved” an expansion of Medicaid by a nearly 60-40 margin. And in the Virginia House of Delegates races, Democrats ran on health care and achieved a historic victory, flipping fifteen seats.

Individual Mandate Repeal in Latest Tax Bill Draft

David Posnett — Wed, 15 Nov 2017 16:30:36 +0000

Author Shannon Muchmore @stmuchmore

Published Nov. 15, 2017

Dive Brief:

Republican leaders said Tuesday the latest version of their bill to overhaul the tax system would repeal the individual mandate in the Affordable Care Act (ACA).
Sen. Orrin Hatch (R-Utah) said he estimates the repeal would save $338 billion that could be used to offset tax cuts elsewhere in the legislation, Politico reported.
The Congressional Budget Office and Joint Taxation Committee earlier issued an analysis that concluded eliminating the individual mandate would result in 14 million people losing coverage by 2025 and premium increases of about 20%.

Dive Insight:

As anyone who has watched Congress debate ACA legislation this year knows, a proposed bill can change frequently during negotiations. The individual mandate repeal could still be tossed before a vote, but several Republicans are still looking for any way to deal a blow to the ACA.

The mandate is an essential part of the law, although it’s an unpopular one. Requiring most people to have insurance helps more young and healthy people to enter the risk pool. This helps payers offset the costs of covering people with pre-existing conditions. A repeal of the mandate would likely lead to more insurance companies choosing to pull out of the ACA exchanges.

Repealing the mandate would add to a string of actions weakening the law. President Donald Trump’s administration has taken a number of steps to undermine the ACA, including putting an end to cost-sharing reduction payments to insurers and paving the way for more catastrophic health plans. HHS has also drastically scaled back efforts to promote the open enrollment period.

Call Lee Zeldin to voice your opinion! (202) 225-3826

There is a Phone-in “townhall” tonight on the topic of taxes!

https://zeldin.house.gov/contact/opt-request-telephone-town-halls

Zeldin Must Stand Up And Protect Long Island’s Health Care

David Posnett — Mon, 25 Sep 2017 17:27:26 +0000

Letter To Editor: Zeldin Must Stand Up And Protect Long Island’s Health Care

Published in “Smithtown Matters”, Friday, September 22, 2017 at 6:08PM

Dear Editor,

Next week, Senate Republicans will debate a cruel plan to take away health care from millions of Americans and tens of thousands of Long Islanders. Under the Graham-Cassidy bill, there would be a massive shift of federal support from “blue” states to “red” – especially from New York to Texas. In fact, New York could lose more than $45 billion dollars in federal funding. This would create enormous market uncertainty and devastate thousands of Long Islanders, particularly working families, the elderly, and the disabled.

Where is Rep. Lee Zeldin on the bill? Does he realize how much funding would be stripped from New York? Does he care? Even some New York Republicans, like Rep. Tom Reed and Rep. Peter King, have come out against Graham-Cassidy. I urge Rep. Zeldin – who voted to strip health care from millions of Americans earlier this summer – to stop playing politics with the lives of Long Islanders and oppose this bill for the good of his constituents.

Perry Gershon

Democratic candidate for New York’s 1^st congressional district

Also, check this out:

http://www.businessinsider.com/graham-cassidy-healthcare-bill-obamacare-insurance-2017-9

David Posnett MD

Why do we have Employer-Sponsored Health Insurance?

David Posnett — Thu, 14 Sep 2017 16:34:00 +0000

By Aaron E. Carroll. In the NY Times: THE NEW HEALTH CARE SEPT. 5, 2017

At a community enrollment drive in the 1950s for Blue Cross and Blue Shield in Oklahoma, Ralph Rhoades, left, a manager who later became president of the plan, greeted a new member. Credit Courtesy of Blue Cross Blue Shield of Oklahoma

The basic structure of the American health care system, in which most people have private insurance through their jobs, might seem historically inevitable, consistent with the capitalistic, individualist ethos of the nation.

In truth, it was hardly preordained. In fact, the system is largely a result of one event, World War II, and the wage freezes and tax policy that emerged because of it. Unfortunately, what made sense then may not make as much right now.

Well into the 20th century, there just wasn’t much need for health insurance. There wasn’t much health care to buy. But as doctors and hospitals learned how to do more, there was real money to be made. In 1929, a bunch of hospitals in Texas joined up and formed an insurance plan called Blue Cross to help people buy their services. Doctors didn’t like the idea of hospitals being in charge, so some in California created their own plan in 1939, which they called Blue Shield. As the plans spread, many would purchase Blue Cross for hospital services, and Blue Shield for physician services, until they merged to form Blue Cross and Blue Shield in 1982.

Most insurance in the first half of the 20th century was bought privately, but few people wanted it. Things changed during World War II.

In 1942, with so many eligible workers diverted to military service, the nation was facing a severe labor shortage. Economists feared that businesses would keep raising salaries to compete for workers, and that inflation would spiral out of control as the country came out of the Depression. To prevent this, President Roosevelt signed Executive Order 9250, establishing the Office of Economic Stabilization.

This froze wages. Businesses were not allowed to raise pay to attract workers.

Businesses were smart, though, and instead they began to use benefits to compete. Specifically, to offer more, and more generous, health care insurance.

Then, in 1943, the Internal Revenue Service decided that employer-based health insurance should be exempt from taxation. This made it cheaper to get health insurance through a job than by other means.

After World War II, Europe was devastated. As countries began to regroup and decide how they might provide health care to their citizens, often government was the only entity capable of doing so, with businesses and economies in ruin. The United States was in a completely different situation. Its economy was booming, and industry was more than happy to provide health care.

This didn’t stop President Truman from considering and promoting a national health care system in 1945. This idea had a fair amount of public support, but business, in the form of the Chamber of Commerce, opposed it. So did the American Hospital Association and American Medical Association. Even many unions did, having spent so much political capital fighting for insurance benefits for their members. Confronted by such opposition from all sides, national health insurance failed — for not the first or last time.

In 1940, about 9 percent of Americans had some form of health insurance. By 1950, more than 50 percent did. By 1960, more than two-thirds did.

One effect of this system is job lock. People become dependent on their employment for their health insurance, and they are loath to leave their jobs, even when doing so might make their lives better. They are afraid that market exchange coverage might not be as good as what they have (and they’re most likely right). They’re afraid if they retire, Medicare won’t be as good (they’re right, too). They’re afraid that if the Affordable Care Act is repealed, they might not be able to find affordable insurance at all.

This system is expensive. The single largest tax expenditure in the United States is for employer-based health insurance. It’s even more than the mortgage interest deduction. In 2017, this exclusion cost the federal government about $260 billion in lost income and payroll taxes. This is significantly more than the cost of the Affordable Care Act each year.

It’s Time For an Apology from the GOP

David Posnett — Mon, 04 Sep 2017 18:20:31 +0000

Published in The East Hampton Star

Dear David:

Republicans owe America an apology.

Sadly, we have arrived at a point at which the White House, the political crown jewel that the GOP so ardently sought, is in disarray, which has taken down the GOP-led Congress as well. After making President Obama’s failure its No. 1 priority (so much so that it became an obsession), the GOP worked hard to get a rich white guy – any rich white guy – to take the mantle of leadership after Obama. In pursuing its obsession, it abandoned its stated principles and abandoned those it promises to serve.

Republicans refused to negotiate honestly when Democrats spent months seeking Republican support for the Affordable Care Act. Then they tried repeatedly over seven-plus years to take away that health care – not, as it turns out because they had a better idea, but because it was Obama’s idea. Even worse, for seventy-plus years Congress has worked to create, and then perfect (or try to) a safety net that would protect working class America and the disadvantaged among us from financial and social ruin. The current Republican credo, adhered to from the top of the ticket to its most local echelons, holds dear the destruction of those protections.

Yet, in the last election cycle, all one heard from GOP candidates was the mantra that working class America had been “forgotten” and only they were the ones capable of repairing this so-called injustice. Decrying the political opposition by fomenting race-based paranoia allowed these candidates to camouflage their real agenda. It is not the furtherance of the “forgotten,” it is the furtherance of unscrupulous greed.

Help the “forgotten”? Not Trump. The policies that have actually been implemented by the Trump administration, with the help of a Republican Congress, reflect a disdain for ordinary working-class Americans. Shortly after Trump took office, he and the GOP-led Congress rejected numerous Obama-era regulations that were actually designed to support workers, including rules barring worker discrimination, rules designed to enhance workers’ wages and rules enhancing workplace protection, such as barring companies with a history wage, labor or workplace safety violations laws from receiving federal contracts. And this is just the tip of the iceberg.

So, the GOP agenda has no intention of protecting the “forgotten.” Its true colors are shown in its efforts to rip away healthcare, savage the social safety net and, in so doing, leaving the “forgotten” to fend for themselves. Under the GOP agenda, the “forgotten” will soon be the “trampled.”

The sad truth behind the GOP camouflage is that millions of hard-working Americans drank the GOP Kool-Aid, believing that the party truly cared for them and would make good on promises to deliver wealth, improve healthcare and preserve the all-important safety net protecting these folks. For some, it was hard not to be seduced by Trump and his GOP cohorts.

However, like everyone else who has succumbed to Trump’s wiles, these voters too have been had.

And for this, the GOP owes America an apology. And the lesson for voters from all this is that old adage: Fool me once, shame on you; fool me twice, shame on me. Let’s not be fooled again, either in our local elections this year or next year when the GOP Congress has to face the music. Trust not the GOP Kool-Aid another time.

Sincerely,

Bruce Colbath

Why ACA market upheaval still looms large

David Posnett — Wed, 16 Aug 2017 11:36:26 +0000

Don’t take your eye off the ball! With all the distractions from the WH its easy to forget: healthcare is still in serious jeopardy. Here is why. …and where exactly does Lee Zeldin stand? Still with 45? DP

Whether lawmakers are done with efforts to repeal the ACA or not, some important changes for healthcare could be on the horizon.

By: Shannon Muchmore @stmuchmore Published: Aug. 14, 2017

At least one part of the healthcare industry is still looking to Washington D.C. after the flurry of activity last month, if only for one action. In addition to the highly public failure to pass major healthcare legislation before leaving town for a month, Congress and President Donald Trump also left the Affordable Care Act (ACA) exchange markets in a dangerous flux by not taking action on the cost-sharing reduction (CSR) payments for insurers.

It’s not clear whether Congress will continue to take up Republican healthcare legislation to repeal the ACA when it returns. Even within the party, senators are singing different tunes, while President Donald Trump continues to pressure lawmakers to get an ACA repeal bill on his desk. A bipartisan group with members from both chambers has a few ideas, but the majority of lawmakers appear ready to move on. Regardless, they will still have to take up reauthorization of the Children’s Health Insurance Program (CHIP) in September, potential reigniting some debates around the ACA.

If GOP leaders do declare ACA repeal off the table for this year, its opponents will look to the executive branch for efforts to weaken the law and its effects. Here’s what to look out for.

Cost-sharing reduction payments

Payers have been begging for assurance that CSRs will continue to be paid, but the White House and Congress have so far refused. The result has been many payers pulling out of the exchange markets or reducing their footprints, as well as premium hikes of 30% or more. Just last week, Anthem announced it is pulling out of the Nevada and Virginia exchange markets and reducing its participation in Georgia.

Not paying the CSRs would increase federal spending, because the higher premiums will require higher premium subsidies for the 84% in the exchanges who qualify for help. That’s not to mention the 30,000 or more who would have no insurance options.

Trump hasn’t been shy about his plan to halt any efforts that stabilize the exchange markets (like CSRs) in an effort to sabotage the ACA and force unwilling Democrats to cooperate on a repeal bill. Others in the GOP, however, have been reluctant to hurt constituents with such an overtly political play.

America’s Health Insurance Plans has said it is imperative the CSRs are funded. “These benefits are essential to making coverage and care affordable for American families who receive them,” the organization said. “Clarity and commitment to this funding is needed to eliminate confusion and anxiety for consumers.”

It may soon be too late for CSR payments to matter for next year. Payers must sign their contracts with HealthCare.gov by Sept. 21. The CMS and some states have tried to give insurers more flexibility because of the uncertainty by pushing back rate filing deadlines. Connecticut said it will allow payers to refile their rates if the CSR payments are eliminated, and California allowed them to file two sets of rates, one of which assumes no CSRs.

Weakening the ACA

Trump’s threat to “let Obamacare implode” may go beyond refusing to shore up the exchange markets. His administration has already pulled advertising and promotion of the exchanges, and is being investigated by the Government Accountability Office for pushing the GOP healthcare bills in official HHS communication channels. Immediately after his inauguration, Trump signed a wide-ranging executive order instructing federal agencies to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay any provision or requirement” of the ACA that imposes a fiscal or regulatory burden.

No major changes have resulted from the order so far, but it could be used to roll back benefit requirements for preventive care, contraception and mental health services.

HHS Secretary Tom Price could also make changes that weaken the ACA’s individual mandate. Repealing the mandate would mean 15 million fewer Americans would have coverage by 2026 and result in premium increases of about 20%, according to the Congressional Budget Office. Watering down the requirement instead of ditching it completely would have less drastic results, but there would still be an impact.

Price could create more exemptions for the mandate or attempt to force the Internal Revenue Service to stop enforcing it. Either of these actions would add turmoil to the exchanges markets and undermine the efforts of the ACA.

Reauthorizing CHIP

Those watching health legislation in Congress are eyeing CHIP reauthorization as a possible vehicle for changes to the ACA. Lawmakers will be hesitant, though, as CHIP is a successful program with bipartisan support.

The program, which turned 20 years old this past weekend, covered nearly 9 million children in fiscal 2016. CHIP coverage is more affordable than employer-sponsored or marketplace coverage, while children covered under CHIP are more likely to have a usual source of care and regularly attend well-child visits, according to the Medicaid and CHIP Payment and Access Commission, which recommends Congress extend CHIP funding through 2022.

The commission estimates more than a million children would lose coverage if CHIP loses funding.

Bipartisan legislation and state waivers

A bipartisan group of about 40 members of the House is proposing some relatively small changes to the ACA that have received support from both sides of the aisle in the past. The plan is to put them in a bill that would also immediately fund the CSRs.

Their suggestions include exempting smaller businesses from the employer mandate, a fund states can go to for help covering people with high care costs and more flexibility and guidance for states looking to apply for ACA waivers. Another possible measure is repeal of the medical device tax.

Their proposal is to change the employer mandate by having it apply only to businesses with 500 or more employees, instead of the current requirement for businesses with 50 or more workers. Analysis from the Urban Institute and Rand Corporation has shown the employer mandate has little effect on the number of people who have coverage, partly because nearly all businesses with at least 50 employees offered coverage even before the mandate went into effect.

The ACA has always given states the option of applying for a waiver that allows them to eschew essential health benefits and other requirements — as long as they can prove their plans will cover the same number of people with coverage that is just as comprehensive and affordable. HHS under President Barack Obama was careful in ensuring that state proposals met those guidelines, but current HHS Secretary Tom Price has said he wants to encourage more waivers and will be less strict with approvals of those waivers and Medicaid demonstration waivers.

With this in mind, some recent proposals have included aspects that would have previously been rejected. Last week, Maine applied for a Medicaid demonstration waiver that includes work requirements and asset testing. Those measures are likely to restrict access to coverage for people with low incomes.

Many of the options available for Congress and the executive branch could roil the industry, but some bipartisan options could provide much needed clarity. Summer is usually pretty quiet in Washington D.C., but this year has not been business as usual. Healthcare leaders would be wise to be ready for new developments with the ACA and beyond.

Letter from Former CBO Directors on the Importance of CBO’s Role in the Legislative Process

David Posnett — Sat, 22 Jul 2017 21:02:07 +0000

July 21, 2017

Honorable Paul Ryan
Speaker
United States House of Representatives
Washington, DC 20515

Honorable Nancy Pelosi
Minority Leader
United States House of Representatives
Washington, DC 20515

Honorable Mitch McConnell
Majority Leader
United States Senate
Washington, DC 20510

Honorable Charles Schumer
Minority Leader
United States Senate
Washington, DC 20510

Dear Mr. Speaker, Madam Leader, Mr. Majority Leader, and Mr. Minority Leader:

The undersigned represent every former Director of the Congressional Budget Office (CBO). We write to express our strong objection to recent attacks on the integrity and professionalism of the agency and on the agency’s role in the legislative process.

CBO began serving the Congress in 1975. Over the past 42 years CBO has been firmly committed to providing nonpartisan and high-quality analysis — and that commitment remains as strong and effective today as it has been in the past. Because CBO works for the Congress, and only the Congress, the agency’s analysis addresses the unique needs of legislators.

To meet the standard of nonpartisan objectivity, CBO makes no recommendations about policy, regularly consults with researchers and practitioners with a wide range of views (as can be seen in the agency’s panels of advisers and reviewers for major studies), and enhances its transparency by releasing extensive descriptions of its analytic techniques and forecast record. To produce estimates of high quality, CBO uses its detailed understanding of federal programs and economic conditions, ongoing interactions with government officials and private-sector experts, the best academic research, and the latest available data consistent with the timing of the Congressional budget process.

CBO’s approach produces consistent comparisons of competing legislative proposals and unbiased projections of the impact of policy changes. Unfortunately, even nonpartisan and high-quality analysis cannot always generate accurate estimates. Policy changes are often complex, the economy is dynamic and defies precise prediction, and many policies are modified over time. However, such analysis does generate estimates that are more accurate, on average, than estimates or guesses by people who are not objective and not as well informed as CBO’s analysts.

In sum, relying on CBO’s estimates in the legislative process has served the Congress — and the American people — very well during the past four decades. As the House and Senate consider potential policy changes this year and in the years ahead, we urge you to maintain and respect the Congress’s decades-long reliance on CBO’s estimates in developing and scoring bills.

Sincerely,

Dan L. Crippen
Former Executive Director, National Governors Association (CBO Director, 1999–2003)

Douglas W. Elmendorf
Dean and Don K. Price Professor of Public Policy, Harvard Kennedy School (CBO Director, 2009–2015)

Douglas Holtz-Eakin
President, American Action Forum (CBO Director, 2003–2005)

June E. O’Neill
Wollman Distinguished Professor Of Economics, The City University of New York (CBO Director, 1995–1999)

Peter R. Orszag
Vice Chairman of Investment Banking and Managing Director, Lazard (CBO Director, 2007–2008)

Rudolph G. Penner
Institute Fellow, Urban Institute (CBO Director, 1983–1987)

Robert D. Reischauer
Distinguished Institute Fellow and President Emeritus, Urban Institute (CBO Director, 1989–1995)

Alice M. Rivlin
Senior Fellow, The Brookings Institution (CBO Director, 1975–1983)

American Health Care Act – R&R – Reachout and Rebuild

US Healthcare: no Bang for the Buck

Out-of-pocket healthcare spending could rise thanks to Lee Zeldin

Taking the Heart out of Obamacare

Zombie Health Care Repeal Part 5: What the GOP’s Sneaky Health Repeal Means for You

Individual Mandate Repeal in Latest Tax Bill Draft

Author Shannon Muchmore @stmuchmore

Published Nov. 15, 2017

Dive Brief:

Dive Insight:

Recommended Reading:

Call Lee Zeldin to voice your opinion! (202) 225-3826

Zeldin Must Stand Up And Protect Long Island’s Health Care

Why do we have Employer-Sponsored Health Insurance?

It’s Time For an Apology from the GOP

Why ACA market upheaval still looms large

By: Shannon Muchmore @stmuchmore Published: Aug. 14, 2017

Cost-sharing reduction payments

Weakening the ACA

Reauthorizing CHIP

Bipartisan legislation and state waivers

Recommended Reading:

Letter from Former CBO Directors on the Importance of CBO’s Role in the Legislative Process