#csr gop

[philiponmycracker]

The kid.

Lawn Dogs (1997) - The Way Way Back (2013) - Jojo Rabbit (2019)

[thepoliticalpatient]

The state of things

Well, the tax bill passed both chambers of Congress. The Senate voted late last night. The vote was exactly along party lines this time.

The only Republican to not vote yes was John McCain, and that’s only because he’s at home recuperating from cancer treatments.

Bob Corker, who was the only Republican Senator to vote against the first version of the bill, voted yes this time, likely because they modified the bill to include some real estate changes that enrich Corker personally to the tune of $1 million.

Susan Collins earlier held back on her vote until she received assurances from McConnell that Congress would pass Alexander-Murray by year’s end. It’s now clear that that will not happen - particularly because it seems McConnell forgot to consult the House before making that promise. Even so, she voted again for the tax bill, which leaves many of us wondering whether she just naively believes Alexander-Murray will still happen, or whether she just doesn’t actually care that much.

The House voted on the tax bill again today, which they had to do because the version of the bill they voted on yesterday violated Byrd rules. So they voted today on a slightly modified version and passed it again. The only thing left to do now is for Trump to sign it into law, and I’ve heard he plans to do that in January (more on that in a minute).

Healthcare has taken so many hits this year. I fear for the collapse of our system.

First, Trump ended the CSR payments in October. This resulted in a 20% hike in premiums and a 200 billion dollar increase in the federal deficit.

Then, the signup process for individual market plans for 2018 was utterly sabotaged. The signup period was halved, the budget for advertising was reduced by 90%, and the website was randomly offline on Sundays. As a result, enrollment was down this year.

Now this tax bill deals another blow.

The individual mandate portion of the ACA is repealed by this bill. The CBO estimates that this results in 13 million fewer insured and premium hikes of 10%. Experts have predicted that it will not trigger a death spiral as I had originally feared, but it removes incentive for healthy people to sign up for healthcare, which is a big blow to the system. Prices rise for everyone when healthy people drop out. John Cornyn, the Senate Majority Whip, even came out and basically said that he hopes the removal of the mandate collapses the system, in order to force a more complete repeal of the ACA.

Secondly, the tax cuts may trigger an automatic $25 billion in cuts to Medicare. This is because of the pay-as-you-go act, better known as PAYGO: when revenue is decreased or spending increased - as this bill does - Congress has to make up the difference with cuts to eligible programs, of which Medicare is one. Paul Ryan even announced that the next item on the House GOP’s agenda is to tackle Medicare, Medicaid, and Social Security - and we know it won’t be to bolster them, as Republicans view these programs as handouts.

Trump will wait until January to sign the tax bill into law, because according to PAYGO, if he did it in 2017, the cuts to Medicare would be triggered in 2018. Waiting until 2018 means that they won’t happen until - you guessed it - after the midterms.

On the topic of Trump, let’s hear what he has to say about the repeal of the individual mandate today:

“...we have essentially repealed Obamacare and will come up with something that will be much better, whether it's block grants or whether it's taking what we have and doing something terrific.”

I’m sorry - what? What do you think your Congressmen spent the entirety of 2017 doing? They spent it trying to figure out something “much better” than the ACA, and they failed. They failed to come up with any alternative that was reasonable enough to convince even 50 Republican Senators that it was workable. Note too that he’s reverting to the exact same rhetoric - “something terrific” - that he used when asked about healthcare on the campaign trail. It’s Trump code for “I have no fucking idea.”

Let’s not forget that Congress has yet to renew CHIP, which is a program specifically for CHILDREN’S health insurance. 2 million children will lose insurance next month. This is not even an expensive program. They just don’t give a fuck.

I feel more hopeless with every passing day.

---

http://time.com/money/5068840/gop-tax-bill-corker-taxes-kickback/

http://www.slate.com/articles/news_and_politics/politics/2017/12/how_susan_collins_became_a_tax_bill_villain.html

https://www.huffingtonpost.com/entry/gop-sabotage-healthcare_us_5a3a8adbe4b06d1621b1187f?utm_content=buffer05cfa&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

https://www.aarp.org/politics-society/advocacy/info-2017/senate-tax-medicare-cuts-fd.html

https://www.theatlantic.com/politics/archive/2017/12/why-trump-wont-be-signing-his-tax-cuts-right-away/548906/

http://www.cnn.com/2017/12/20/politics/donald-trump-thinks-he-tricked-everyone-into-repealing-obamacare/index.html

https://www.nbcnews.com/health/health-news/2-million-kids-will-lose-chip-coverage-right-away-report-n831606

[justsomeantifas]

United States healthcare related updates coming soon.

(August 1st 2017)

Just because the Senate failed to pass their three healthcare bills does not mean the problems are over. Over the next couple months there will be some big choices that need to be made that could alter your coverage. Here’s what you need to know.

What Donald Trump Is Saying

"As I said from the beginning, let ObamaCare implode, then deal. Watch!" - Trump tweet

There are many decisions that will need to be made by the Trump administration starting now until the end of the year. So far the administration HAS been making cost-sharing reduction (CSR) payments every month despite threatening to stop every month. However, this month and September will be different because we're reaching the time when people will start to sign up for 2018 coverage. 

After failing to get a healthcare bill passed through the Senate, Trump started making threats that he will now stop the “bailouts,” for insurance companies. This isn’t an entirely accurate statement, what he’s doing isn’t a bailout - the CSR payments simply reimburse insurers for providing required financial assistance to low-income consumers which reduces their copays and deductibles. The money given by the government is to help make healthcare more affordable and accessible. 

What This Means For 2018 Premiums and Subsidies

We might see Trump cut off these CSR payments or we might see him end the enforcement of the individual mandate. Both which will make enrollment harder for people and drive up the costs. Insurers are already talking about the possibility of bigger premium costs if Trump pulls out of the CSR payments which currently helps millions of people afford coverage. Others might boost premiums if the individual mandate isn't enforced because it discourages healthy people from signing up meaning higher costs for them. Health and Human Services Secretary Tom Price has already said they might end the enforcement of the individual mandate. 

Trump will have to make the decision about August’s payments over the next couple weeks. Even if he does make the CSR payment for August there’s still September that is in jeopardy and these months could shape what the 2018 marketplace will look like. If these subsidies are cut we will likely see a 20% increase on premium rates. 

What This Means For The 2018 Marketplace

The end of September is when insurers will make their final decisions about whether or not they want to sell plans in the Obamacare marketplace. Depending on what we see from the Trump administration over these next couple months, this could mean big changes. 

Currently there are a few counties with no options in the marketplace and more with only one option - we might see this increase even more. Trump's constant threats mean that the payments are uncertain. He might now pay the CSR payments in August and September which would definitely influence the insurer’s decisions but they might not want to jump in with this amount of uncertainty that these payments will continue. 

By September 27th we will know what insurers will enroll in the marketplace and where, then in November open enrollment will begin for us. HOWEVER in that small timeframe between the 27th and November Trump could make decisions to pull out of the CSR payments. If he does this before open enrollment begins then insurers still have the opportunity to drop themselves from the marketplace.

Upcoming Bipartisan Senate Hearings

The health committee in the Senate is asking Trump to continue making the CSR payments and the GOP head of the committee is asking fellow Republicans to fund these subsidies. The health committee is also proposing that a one-year funding plan be enacted for 2018. This would keep premiums lower and ensure stability which, as I said above, is a big concern of insurers right now. According to the hearing announcement, these discussions should start the beginning of September.

As of right now, the administration is currently saying that some of these decisions will be coming any day now but some will be decided over the next couple months so keep an eye out. 

[libraford]

areyouahauntedpotato

even if it was true, like... oh no... they're trying to save the lives of millions of impoverished people.. illegally... *takes a sip of coffee*

Apparently money was taken out of the Treasury to fund CSR payments.  The article is mostly about how the GOP fought to sue for the funds taken out of the Treasury and are now dealing with the fallout of basically fighting against their own interest. 

And his argument is ‘I think they should follow the law.’

Following the law is really important to this dude who frequently uses people for their money and then expects them to still support him when he falls flat on his ass. Like this is a dude who frequently tries to weasel his way into my side hustles so he can make money off of my work. Totes legal, still a dickhole move. 

Oh no. They broke the law so they could prevent a large number of very preventable deaths. They broke the law to legislate a program that would benefit the working class. Like I’m trying to see it from a perspective that makes it damning without sounding like the Sheriff of Nottingham. It’s really fucking difficult. 

[vagabondretired]

Just gonna go up and grab them by the..........wallet.... He's desperate and he's pissed. And he could easily do this: Kellyanne Conway, an adviser to President Trump, said Sunday he will make a decision this week on ending key payments to insurance companies under ObamaCare. "He’s going to make that decision this week," she told "Fox News Sunday." The payments are known as Cost Sharing Reduction (CSR) payments. Referring to them as “bailouts,” Trump threatened to end the payments on Saturday. His tweet followed the collapse of the GOP effort to repeal and replace ObamaCare in the Senate this week. Trump is urging Republicans not to give up on the healthcare reform effort and threatening that if they do not pass a bill, he will end the federal subsidies to insurance companies. If the subsidies are taken away millions of middle class and working class people will see their premiums rise by hundreds, sometimes thousands, of dollars overnight. Remember, the eligibility is determined by the adjusted gross income. So people who make as much as 65-70k a year gross, particularly those who have small businesses or work as independent contractors are eligible for subsidies. But hey, fine. To hell with them. They deserve to suffer, amirite? Maybe those 60 year olds will get some initiative and go out and inherit millions from their rich daddies like all good Americans should do.

[pdougmc]

The CBO Finds the GOP Would Pay the Price If Trump Ended Obamacare's Cost-Sharing Reductions

Turns out that cost-sharing reductions actually reduce costs. That’s the conclusion of the Congressional Budget Office, which on Tuesday released a report estimating the effects of terminating federal payments to insurers, which the White House currently sends on a month-to-month basis. After failing to repeal Obamacare, President Trump has repeatedly threatened to end those payments in order to harpoon the law. But the CBO’s analysis finds that such a move would be as counterproductive as it would be spiteful.

https://www.theatlantic.com/politics/archive/2017/08/cbo-csr-trump-premiums/536991/?utm_source=atlgp

[eyeoninsurance]

Does the GOP actually want low-income families to pay more for health insurance?

The bill Republican leadership introduced in the Senate last week – repealing large chunks of the ACA and severely cutting federal Medicaid spending – reflects this. The so-called Better Care Reconciliation Act (BCRA) ends CSR subsidies, which reduce out-of-pocket costs for about 5 million current low-income ACA Marketplace enrollees to levels below those of most employer health plans. (Another million-odd enrollees get a much weaker level of CSR.) The Senate bill also phases out federal funding for the ACA Medicaid expansion, which has given 15 million poor and near-poor enrollees access to healthcare with no deductibles and little to no copays.

[gpipipahdpe-blog]

Meringankan Kekhawatiran Shutdown, Trump Berkaitan Dengan Rintangan Besar Lainnya

Dengan hanya tersisa dua hari untuk menghentikan penangguhan sebagian dari pemerintah federal, administrasi Trump pada hari Rabu menghapus satu lagi titik pelonggaran utama dalam negosiasi tagihan pengeluaran.

Gedung Putih mengatakan kepada anggota parlemen bahwa pihaknya tidak akan memotong subsidi federal yang membantu warga berpenghasilan rendah membayar asuransi kesehatan berdasarkan Undang-Undang Perawatan Terjangkau, setidaknya untuk saat ini, seorang pejabat administrasi dan sumber kongres mengkonfirmasi kepada NPR.

Demokrat berusaha mendapatkan pembayaran federal - yang dikenal sebagai pengurangan biaya berbagi, atau CSR - termasuk dalam paket pengeluaran.

Konsesi tagihan pengeluaran kedua oleh Gedung Putih membuat momok shutdown tidak mungkin terjadi. Awal pekan ini, Presiden Trump mendukung permintaannya bahwa setiap undang-undang pendanaan yang dikeluarkan Congress memberikan uang muka untuk dinding yang telah lama dijanjikan di sepanjang perbatasan A.S.-Meksiko.

Demokrat selama berminggu-minggu memberi isyarat kurangnya dukungan untuk setiap tagihan pengeluaran yang mencakup uang untuk proyek hewan peliharaan Trump.

Pelosi: "Kami sekarang telah membuat kemajuan"

Para pemimpin Demokrat di DPR dan Senat menyambut perkembangan baru tersebut.

"Perhatian utama kami dalam negosiasi ini adalah tentang pendanaan untuk dinding dan ketidakpastian tentang pembayaran CSR yang penting bagi stabilitas pasar di bawah Undang-Undang Perawatan Terjangkau. Kami sekarang telah membuat kemajuan di kedua bidang ini," Pemimpin Minoritas Rumah Tangga Nancy Pelosi mengatakan dalam sebuah pernyataan.

Seorang ajudan Pelosi mengatakan bahwa dia berbicara dua kali pada hari Rabu dengan Kepala Staf Gedung Putih Reince Preibus saat negosiasi mengenai tagihan pengeluaran dilanjutkan.

Pemimpin Minat Senat Chuck Schumer, dalam sebuah pernyataan, mengatakan bahwa Presiden Trump menjatuhkan ancaman perawatan kesehatannya, "Seperti penarikan uang untuk tembok, keputusan ini membawa kita lebih dekat pada kesepakatan bipartisan untuk mendanai pemerintah dan merupakan kabar baik bagi orang Amerika. orang-orang."

Negosiator di DPR dan Senat bekerja menjelang tenggat waktu Jumat untuk mencapai kesepakatan pengeluaran untuk menghindari pemadaman pemerintah dan sepenuhnya membiayai departemen dan agen federal sampai akhir tahun fiskal berjalan pada bulan September. Mereka bisa mencari perpanjangan satu atau dua minggu, yang akan memungkinkan waktu pembuat undang-undang untuk mencapai kesepakatan yang lebih solid.

GOP memperbaharui perawatan kesehatan

Sementara itu, House Freedom Caucus menyuntikkan dorongan kesehatan GOP dengan sebuah momentum.

Blok dari sekitar 36 konservatif garis keras - yang mengesampingkan upaya Republikan sebelumnya untuk mencabut dan mengganti Affordable Care Act - pada hari Rabu melemparkan dukungannya di balik rencana revisi partai tersebut.

Ukuran yang diperbarui mencakup amandemen yang ditulis oleh Chairman Freedom Caucus Rep. Mark Meadows, R-N.C, dan pemimpin Grup Selasa Rep Tom MacArthur, R-N.J.

Grup Selasa adalah kaukus informal sekitar 50 anggota parlemen DPR moderat.

Rencana yang direvisi tersebut akan memungkinkan negara-negara mendapatkan keringanan untuk banyak mandat Affordable Care Act. Negara-negara dapat memilih untuk tidak menetapkan persyaratan untuk manfaat asuransi kesehatan harus mencakup kebijakan mereka dan larangan mengizinkan perusahaan asuransi untuk mengenakan biaya lebih berdasarkan usia dan status kesehatan seseorang.

"Karena perbaikan AHCA dan penambahan amandemen yang diajukan oleh Rep. Tom MacArthur, House Freedom Caucus telah mengambil posisi resmi untuk mendukung usulan saat ini," kata kelompok tersebut dalam sebuah pernyataan.

"Meskipun versi yang direvisi masih belum sepenuhnya mencabut Obamacare, kami siap mendukungnya untuk memenuhi janji kami kepada rakyat Amerika untuk menurunkan biaya perawatan kesehatan."

Dukungan resmi Freedom Caucus membutuhkan dukungan dari 80 persen anggotanya. Tapi setidaknya satu anggota - Rep. Mo Brooks, R-Ala. - mengatakan Rabu dini hari ia tidak akan mendukungnya.

Kaum Republikan moderat lamban untuk merangkul rencana baru

Namun, dukungan yang luar biasa dari kaum konservatif Freedom Caucus berarti masa depan upaya GOP untuk membongkar Undang-Undang Perawatan Terjangkau sekarang bertumpu dengan Republikan DPR moderat. Tapi banyak dari mereka tampak lamban untuk memeluknya.

"Kekhawatiran yang saya hadapi belum ditangani oleh proposal saat ini," kata Dan Dan Donovan, R-N.Y., Mengatakan pada hari Rabu. Donovan adalah anggota Grup Selasa. "Kami harus membantu orang-orang yang dilecehkan oleh Undang-Undang Perawatan Terjangkau, namun pada saat yang sama tidak membahayakan orang-orang yang dibantu olehnya."

Sementara itu, Ketua DPR Paul Ryan - yang bulan lalu menarik tagihan perawatan kesehatan GOP dari lantai setelah gagal mendapatkan cukup suara - bereaksi baik terhadap amandemen MacArthur, menyebutnya "sangat konstruktif."

"Saya pikir ini membantu kita mencapai konsensus," kata Ryan kepada wartawan saat jumpa pers Rabu di Capitol Hill.

Replika Republik Chris Collins, R-N.Y., Menyimpulkannya dengan lebih ringkas, berbicara dengan wartawan di lantai Rumah. "Jika ini yang diperlukan untuk mendapatkan undang-undang tersebut berlalu," Collins berkata, "Tuhan memberkati Donald Trump."

Distributor Pipa HDPE

[jscottscales]

Why it’s hard to keep voters scared about Obamacare repeal

Senate Democrats want to make the month of August about their ideas on health care, Politico reported today. They are envisioning a sort of hilarious call and response, the dorkiest summer concert series of all time:

Every time they say “nominations,” we’ll say “lower premiums.” When they say “appropriations process,” we’ll say “bring down drug prices.”

Though the messaging is novel, the strategy isn’t actually all that new.

Since early May, I’ve been getting regular updates on the “Trump-GOP Health Care Sabotage” from Senate Democratic leader Chuck Schumer’s office. Democrats have been saying for months that voters should hold Republicans and the Trump White House responsible for any future problems with the law. Trump, after all, cut off the law’s cost-sharing reduction subsidies (which led insurers to hike their rates for 2018), and Congress repealed the individual mandate (for which insurers will hike their rates in 2019).

And, of course, Republican tried to pass Obamacare repeal bills last year that would have led to millions fewer Americans having health insurance. That is still officially the GOP position.

Democrats see this as a winning 2018 campaign strategy, particularly with 2019 premiums set to be finalized in October, mere weeks before voters go to the polls. As Vox’s Ella Nilsen reported last month:

Insurers in Virginia and Maryland recently announced they are seeking steep rate hikes on some of their Obamacare exchange plans. One company called CareFirst, which covers 15,000 people in Maryland, is proposing to raise rates by 91 percent, with premiums as high as $1,334 a month for a 40-year-old.

Senate Democrats have seized on this, and on Tuesday, they made it clear they are going to hammer the point home from now until the fall.

“When those rates go up, coverage goes down,” Senate Minority Leader Chuck Schumer told reporters Tuesday. “It’s important to remember, President Trump and congressional Republicans are fully responsible for the significantly higher premiums and millions fewer people insured.”

They have good reason to think it’s a winner. On the issues, health care ranks toward the top for American voters, and the public has said pretty consistently that Trump and Republicans are responsible for the success or failure of Obamacare going forward.

Kaiser Family Foundation

The Kaiser Family Foundation released findings in March that 63 percent of Americans thought Congress should focus on improving Obamacare; just 32 percent thought they should focus on repealing it. In an earlier poll, 71 percent said lawmakers should try to make it work and just 21 percent said they should let it fail.

Democrats have the public on their side. But I think there’s nonetheless a big challenge for them on health care.

This is a hunch, but one shared by pollsters and informed by years of watching health care politics: I think Democrats do have to fight against health care fatigue. Obamacare repeal was hugely unpopular, and it was also the biggest politics story of the 2017 summer. But that was a year ago.

Graham-Cassidy had a brief moment in September, but since then, the ACA has felt safer. Nobody is taking the latest repeal rumors too seriously, probably because the votes aren’t there for Republicans right now.

That means that for more than a year, Democrats have had to keep reminding voters that Republicans tried to take health care away from 20 million people.

Repeal was a clean, simple, and big story. “Sabotage” — in the form of cutting CSRs, expanding non-Obamacare insurance, and slashing outreach — is more nebulous. People still care about health care, but they aren’t hearing about it in the news every day anymore. The threat on health care can feel less real, even if sabotage is having very concrete effects.

You can see it, at least indirectly, in the law’s approval rating. The ACA’s popularity started trending upward last spring, as House Republicans tried to pass their repeal bill. It hit new heights after surviving the Senate and the revival of Graham-Cassidy in September. But it seems to dip a bit when it’s been in the news less, like in April, when it fell below 50 percent for the first time in six months.

Kaiser Family Foundation

To be sure, some of this is probably statistical noise, but I think the surge in popularity during last year’s repeal crusade points to a real phenomenon here: When the ACA faces an existential threat, the public will come to its defense; when it fades out of the news, it can slip to a more divisive status quo.

This is why Democrats are preparing to respond to every Republican initiative with, “But health care!” The biggest risk for Democrats in the 2018 elections, as far as health care is concerned, is complacency.

But hey, how else are they going to use the time Mitch McConnell got them from canceling August recess?

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to along with more health care stats and news.

Join the conversation

Are you interested in more discussions around health care policy? Join our for conversation and updates.

Source

https://www.vox.com/policy-and-politics/2018/6/6/17435662/voxcare-health-care-fatigue

[morganbelarus]

Secret Pro-Life Meeting With Mike Pence Killed Obamacare FixFor Now

A bipartisan effort to stabilize the U.S. health-insurance markets collapsed last month after anti-abortion groups appealed directly to Vice President Mike Pence at the 11th hour, The Daily Beast has learned.

Amid opposition from conservatives in the House of Representatives, a group of pro-life activists met with Pence to lobby the Trump administration against supporting a health-insurance market-stabilization bill on the grounds that it does not contain sufficient language on abortion restrictions, according to sources with direct knowledge of the meeting. Senate Majority Leader Mitch McConnell (R-KY) was also in attendance at the Dec. 19 meeting, three of the sources said.

The next day, key lawmakers involved in crafting the legislation announced they were punting on the issue until 2018.

A spokeswoman for the vice president confirmed the meeting to The Daily Beast. A spokesman for McConnell did not respond to requests for comment.

Efforts to pressure Pence, a hardline social conservative and a former lawmaker, are thrusting abortion back onto the national stage in a debate over the future of health care in America, as Republicans deliberate behind closed doors on whether to try to scrap Obamacare again in 2018.

That effortthough it failed in the Senate several times last yearwas bolstered when the House and Senate passed a sweeping tax-overhaul bill last month. The legislation included a provision that scrapped the Obamacare individual mandate, a measure that required Americans to buy health insurance or pay a penalty.

The tax bill passed the Senate due in large part to Sen. Susan Collins (R-ME) vote, which was contingent upon the Senate voting at a later date on the bipartisan health-insurance market-stabilization bill that was crafted by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA). Collins has argued that the legislation would mitigate the effects of the individual-mandate repeal, which the Congressional Budget Office said would result in 13 million more Americans without insurance over the next 10 years. Collins also pushed for her bill with Sen. Bill Nelson (D-FL) that would allocate $10.5 billion for a federal reinsurance pool.

The Alexander-Murray legislation would restore Obamacare subsidies that the Trump administration cut off in October, and it would give individual states more flexibility to set insurance regulations. The Republican proponents of the bill argue that it would serve as a short-term stabilization measure to transition away from the Affordable Care Act, assuming congressional Republicans can come toor even seekan agreement on a replacement.

The bill, though, has an unclear path forward. It was thought to have enough support to pass the Senate, but Democrats appear to be backing off the bill, blaming the GOPs elimination of the individual mandate.

The Republicans want the bill. My question is, with the change in the marketplace that they created with the tax bill, is it still going to work? We dont have the answer, Murray, the co-creator of the compromise bill, told The Daily Beast. The marketplace has changed dramatically. So were looking at it.

Even before the individual mandate was repealed as part of the tax bill, Alexander-Murray did not pass muster with House Republicans, who last month floated the idea of adding a provision on the Hyde Amendment, which prevents federal dollars from being used for abortions. The pro-life activists who met with Pence last month said the absence of such a measure in the Alexander-Murray bill is a major red flag because it means that the subsidies, known as cost-sharing reduction (CSR) payments, could be used on health plans that fund abortions.

Marjorie Dannenfelser, the president of the pro-life Susan B. Anthony List, wrote in a letter to lawmakers last month that supporting Alexander-Murray is a vote to directly appropriate taxpayer dollars for insurance that includes abortion. Dannenfelser attended the meeting with Pence, which was viewed as critical because President Donald Trump had expressed support for Alexander-Murray in closed-door meetings on Capitol Hill, according to senators who attended those meetings.

Supporters of the legislation note that Hyde protections already exist under Obamacarethough pro-life activists claim that those are watered downand Republican senators pointed to a recent memo from the Centers for Medicare and Medicaid Services stating that the Trump administration would enforce those existing abortion provisions more strictly than the Obama administration did.

Moreover, the law itself only lasts through 2019 as a way to give Republicans enough time to come up with an Obamacare replacement. Still, social conservatives are seeking to further codify those protections so that they could outlast the Trump administration.

Adding Hyde Amendment language would shore up conservative support in the House, where Alexander-Murray has faced stiff opposition from hardliners who argue that the legislation simply props up Obamacare. At the same time, though, such a change to the legislationwhich was already brokered in a way that gave concessions to both sideswould nearly eliminate Democratic support for the bill, tanking it altogether.

McConnells attendance at the meeting was notable because he, at the urging of Alexander and Collins, delayed a vote on Alexander-Murray until after the holiday recess after initially promising Collins a vote on the bill in December. Republicans were considering adding Alexander-Murray to the government-funding bill before lawmakers left for the holidays, but such a move would have given House Republicans a reason to vote against the short-term funding measure, thereby threatening a government shutdown just three days before Christmas.

The day after the Pence meeting, Collins and Alexander announced they were urging McConnell to punt on the issue until January.

But as congressional leaders continue to negotiate a two-year government funding bill and an immigration deal, health care is expected to take a back seat even as talks continue. Lawmakers must come to an agreement on a funding mechanism before Jan. 19 in order to keep the governments lights on.

Betsy Woodruff contributed reporting.

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[philiponmycracker]

[livingwellpage]

Health Wonk Review: Quote-of-the-day Edition

It’s Health Wonk Review time!  We have some great posts lined up for today’s quotation-themed version of the Health Wonk Review.  We even have a few videos for your viewing pleasure.  Enjoy!

“It’s the economy, stupid” – Bill Clinton

How do factors like job loss, wage stagnation and low productivity affect the economy at large and, in turn, the effect on injured workers?  Tom Lynch of Workers’ Comp Insider has the answer.

  “It is health that is real wealth and not pieces of gold and silver” – Mahatma Gandhi

What health insurance plan in the exchange should you pick: gold, silver or bronze?  Andrew Sprung of xpostfactoid looks at how the Trump’s cutoff of federal reimbursement to insurers for Cost Sharing Reduction (CSR) subsidies affects this choice.

  “Obamacare is dead” – Donald Trump

What are the Dumb, Incoherent, Confused, Perhaps Psychotic Things President Trump Says and Does About Health Care Policy?  Head over to visit Roy Poses at Health Care Renewal to find out.

  “America’s health care system is neither healthy, caring, nor a system.” ― Walter Cronkite

Unable to gut healthcare by repeal-and-replace, the GOP is trying to slash 30% from Medicaid and hundreds of billions from Medicare.  Learn more by reading Joe Paduda’s take at Managed Care Matters.

In “Shaking the Faith“, Bob Vineyard of InsureBlog looks at the problems being faced by those interacting with Christian Health Care Sharing Ministries.

How is the Trump administration responding to the opioid epidemic?  According to David Harlow of HealthBlawg, with lots of bluster (declaration of state of emergency), but little follow-through.

  “The bigger they are, the harder they fall. And the better the world liked seeing them fall.” –  Loretta Chase

David Williams of Health Business Blog also has an article examining his thoughts on how formidable Amazon would be if it entered the market for pharmaceutical distribution.

We have a multimedia entry from the Homefront with David Williams (Health Business Group) and John Driscoll (CareCentrix) arguing whether bigger is better or smaller is more beautiful in healthcare.

    “The man with a new idea is a crank – until the idea succeeds.” – Mark Twain

On Healthcare Economist, I highlight how the Innovation and Value Initiative–as part of its Open-Source Value Project– has released the IVI-RA Value Tool to measure the value of treatments for patients with rheumatoid arthritis.

  Health Wonk Review: Quote-of-the-day Edition published first on your-t1-blog-url

[anchorarcade]

When Trump Doesn't Want to Decide, He Punts to Congress

http://ryanguillory.com/when-trump-doesnt-want-to-decide-he-punts-to-congress/

When Trump Doesn't Want to Decide, He Punts to Congress

WASHINGTON — President Donald Trump campaigned on his strength as an executive decision-maker — the CEO of the Trump Organization, the reality-TV star who barked “You’re fired!” at humiliated contestants and the candidate who said of the political system, “I alone can fix it.”

But lately, he’s been kicking tricky issues to Congress.

In just the past couple of months, Trump’s put congressional Republicans on the hook for deciding whether to slash Obamacare subsidies, tear up the Iran nuclear deal and expose hundreds of thousands of DACA recipients to deportation.

He has cast himself as an agent of action against these Obama-era policies while at times appearing to push Congress to leave them in place. By sending these thorny issues to Capitol Hill, he can stand at the other end of Pennsylvania Avenue ready to take credit for anything that works and distance himself from anything that doesn’t — particularly if there’s a backlash from Republican activists.

“He’s clearly torn between the pragmatic, solutions-driven guy he pitched himself as and the right-wing base he is wedded to,” said Scott Mulhauser, a former Democratic Senate aide and Obama administration official. “He can’t get himself out of that box, so he throws the entire host of problems to Congress and says ‘you fix it.'”

As a result, congressional Republicans find themselves loaded down with issues that have bedeviled Washington for years — exposed to political peril whether they act or not — at a time when their party is in the throes of a civil war and they have done little to demonstrate that they can legislate on even the most basic items.

But that’s what they signed up for, said Sen. Cory Gardner of Colorado.

Colorado Republican Sen. Cory Gardner, chairman of the National Republican Senatorial Committee, who says lawmakers get paid to make tough decisions. Brennan Linsley / AP

“We’re here to make politically difficult decisions,” said Gardner, who is chairman of the National Republican Senatorial Committee. “If we don’t, then we’ll continue to see problems not being solved.”

And Republicans in Congress can hardly complain. For years, they accused President Barack Obama of overstepping his authority and making end runs around Capitol Hill. In the view of several Republicans who spoke to NBC News, Trump is righting those wrongs.

They say Obama didn’t have the authority to create the Deferred Action for Childhood Arrivals (DACA) program, which stopped the deportation of children brought to the U.S. illegally by their families.

Backed up by a federal court ruling that has been stayed for the time being, they say he went too far in creating a cost-sharing reduction, or CSR, subsidy that pays health insurers without an appropriation from Congress.

And the GOP contends that the Iran nuclear deal usurped the authority of Congress to enter into treaties.

Senate Majority Whip John Cornyn of Texas, who says President Donald Trump is right to let Congress act on key issues. Jacquelyn Martin / AP

“I think the president’s done the right thing,” Texas Sen. John Cornyn, the Republican whip, said of Trump’s decision to make lawmakers the deciders.

“On Iran, we know the previous president was loathe to go through the legislative process and didn’t want to do things with the Congress, when clearly this is part of our shared responsibility,” he added.

While Trump attacked Obama for overreach on the same issues — a popular theme among Republicans during the Democratic president’s two terms — he also promised to be a powerful executive. And he hasn’t shied away from making policy on his own when it suits him.

For example, he has tried three times to institute a ban on travel from certain countries, his Environmental Protection Agency is rolling back an Obama-era rule that would have reduced emissions from power plants, and he just used an Executive Order to make it easier for small businesses to band together to buy into health insurance plans.

Early in the Trump administration, congressional Republicans sometimes complained that the president wasn’t consulting them — or anyone else — before rolling out expansive new policies. They point to his travel ban as an example.

Trump understands the political thicket on the issues he’s dumped on Congress. But it’s easier for Trump if lawmakers shoulder the decision-making responsibility. And, while that might put some Republicans in a state of crisis, others see it as a chance to demonstrate that they can take power back from the executive branch and govern effectively.

“In a certain sense, congressional Republicans are like the dog that caught the car,” said Michael Steel, a managing director at Hamilton Place Strategies and former aide to John Boehner, R-Ohio, when he was House speaker. “They spent the latter years of the Obama era complaining — rightly — about executive overreach. Now they are again being asked to perform their appropriate constitutional role. It’s a great opportunity to rise to the occasion.”

The White House did not respond to requests for comment.

Source link

[awesomefelicitylewis-blog]

When Trump Doesn't Want to Decide, He Punts to Congress

http://ryanguillory.com/when-trump-doesnt-want-to-decide-he-punts-to-congress/

When Trump Doesn't Want to Decide, He Punts to Congress

WASHINGTON — President Donald Trump campaigned on his strength as an executive decision-maker — the CEO of the Trump Organization, the reality-TV star who barked “You’re fired!” at humiliated contestants and the candidate who said of the political system, “I alone can fix it.”

But lately, he’s been kicking tricky issues to Congress.

In just the past couple of months, Trump’s put congressional Republicans on the hook for deciding whether to slash Obamacare subsidies, tear up the Iran nuclear deal and expose hundreds of thousands of DACA recipients to deportation.

He has cast himself as an agent of action against these Obama-era policies while at times appearing to push Congress to leave them in place. By sending these thorny issues to Capitol Hill, he can stand at the other end of Pennsylvania Avenue ready to take credit for anything that works and distance himself from anything that doesn’t — particularly if there’s a backlash from Republican activists.

“He’s clearly torn between the pragmatic, solutions-driven guy he pitched himself as and the right-wing base he is wedded to,” said Scott Mulhauser, a former Democratic Senate aide and Obama administration official. “He can’t get himself out of that box, so he throws the entire host of problems to Congress and says ‘you fix it.'”

As a result, congressional Republicans find themselves loaded down with issues that have bedeviled Washington for years — exposed to political peril whether they act or not — at a time when their party is in the throes of a civil war and they have done little to demonstrate that they can legislate on even the most basic items.

But that’s what they signed up for, said Sen. Cory Gardner of Colorado.

Colorado Republican Sen. Cory Gardner, chairman of the National Republican Senatorial Committee, who says lawmakers get paid to make tough decisions. Brennan Linsley / AP

“We’re here to make politically difficult decisions,” said Gardner, who is chairman of the National Republican Senatorial Committee. “If we don’t, then we’ll continue to see problems not being solved.”

And Republicans in Congress can hardly complain. For years, they accused President Barack Obama of overstepping his authority and making end runs around Capitol Hill. In the view of several Republicans who spoke to NBC News, Trump is righting those wrongs.

They say Obama didn’t have the authority to create the Deferred Action for Childhood Arrivals (DACA) program, which stopped the deportation of children brought to the U.S. illegally by their families.

Backed up by a federal court ruling that has been stayed for the time being, they say he went too far in creating a cost-sharing reduction, or CSR, subsidy that pays health insurers without an appropriation from Congress.

And the GOP contends that the Iran nuclear deal usurped the authority of Congress to enter into treaties.

Senate Majority Whip John Cornyn of Texas, who says President Donald Trump is right to let Congress act on key issues. Jacquelyn Martin / AP

“I think the president’s done the right thing,” Texas Sen. John Cornyn, the Republican whip, said of Trump’s decision to make lawmakers the deciders.

“On Iran, we know the previous president was loathe to go through the legislative process and didn’t want to do things with the Congress, when clearly this is part of our shared responsibility,” he added.

While Trump attacked Obama for overreach on the same issues — a popular theme among Republicans during the Democratic president’s two terms — he also promised to be a powerful executive. And he hasn’t shied away from making policy on his own when it suits him.

For example, he has tried three times to institute a ban on travel from certain countries, his Environmental Protection Agency is rolling back an Obama-era rule that would have reduced emissions from power plants, and he just used an Executive Order to make it easier for small businesses to band together to buy into health insurance plans.

Early in the Trump administration, congressional Republicans sometimes complained that the president wasn’t consulting them — or anyone else — before rolling out expansive new policies. They point to his travel ban as an example.

Trump understands the political thicket on the issues he’s dumped on Congress. But it’s easier for Trump if lawmakers shoulder the decision-making responsibility. And, while that might put some Republicans in a state of crisis, others see it as a chance to demonstrate that they can take power back from the executive branch and govern effectively.

“In a certain sense, congressional Republicans are like the dog that caught the car,” said Michael Steel, a managing director at Hamilton Place Strategies and former aide to John Boehner, R-Ohio, when he was House speaker. “They spent the latter years of the Obama era complaining — rightly — about executive overreach. Now they are again being asked to perform their appropriate constitutional role. It’s a great opportunity to rise to the occasion.”

The White House did not respond to requests for comment.

Source link

[janekira2]

The Scoop: December 11, 2019 Edition

In this edition

In most states, open enrollment ends Sunday

4.7 million uninsured Americans could get FREE coverage

Virginia pauses implementation process for Medicaid work requirement

Michigan still on track to have Medicaid work requirement in January

Health reform bills pre-filed for 2020 legislative sessions

California brokerage markets sharing ministry plans as short-term plans

Lawmaker wants Indiana’s short-term law to be template for other states

Welcome to this week’s round-up of state-level health reform news, including:

In mosts states, open enrollment ends Sunday

If you buy your own health insurance, the deadline to enroll in a plan for 2020 is quickly approaching. In most states, Sunday is the last day to enroll, although there are a few exceptions where the deadline is later:

Idaho: Dec. 16 (The 15th falls on a Sunday.)

Minnesota: Dec. 23 (All plans take effect Jan. 1.)

Rhode Island: Dec. 31 (Enroll by Dec. 23 for a Jan. 1 effective date.)

Colorado: Jan. 15 (Deadline for a Jan. 1 effective date extended to Dec. 16.)

Massachusetts: Jan. 23 (Enroll by Dec. 23 for a Jan. 1 effective date.)

California: Jan. 31 (Enroll by Dec. 15 for a Jan. 1 effective date.)

District of Columbia: Jan. 31 (Enroll by Dec. 15 for a Jan. 1 effective date.)

New York: Jan. 31 (Enroll by Dec. 15 for a Jan. 1 effective date.)

4.7 million uninsured Americans could get FREE coverage

According to a new Kaiser Family Foundation analysis, 4.7 million Americans who are currently uninsured could get free Bronze plans for 2020 (thanks to premium subsidies that are large enough to cover the entire cost of the premiums). You can use our subsidy calculator to quickly determine your own subsidy eligibility. You may be surprised at how affordable the coverage is.

Andrew Sprung rightly notes that a significant portion of those 4.7 million people are likely eligible for cost-sharing reductions (CSR) as well. CSR is only useful if you select a Silver plan (which wouldn’t be free). But it would be fairly low-cost thanks to premium subsidies, and the plans would have much lower out-of-pocket costs than the free Bronze options. Sprung also points out that another several million uninsured people are eligible for Medicaid, which is either free or very low-cost.

Virginia pauses implementation process for Medicaid work requirement

Virginia has joined a growing list of states putting the brakes on their planned Medicaid work requirements. Medicaid expansion took effect in Virginia in January 2019, and 342,000 people have gained coverage as a result. But the state has also been awaiting federal approval for a Medicaid work requirement proposal that was submitted in the fall of 2018. The proposed work requirement was a key provision in winning enough GOP support for Medicaid expansion to pass in 2018. But Democrats gained a majority in both chambers of the legislature after the state’s recent election, and it was no surprise when Gov. Northam’s administration announced last week that it was officially pausing the work requirement negotiations with the federal government.

Medicaid work requirements have been overturned by court rulings in Arkansas, Kentucky, and New Hampshire. Indiana’s work requirement has been challenged in court and the state has opted to pause the program for the time being. Arizona had planned to implement a Medicaid work requirement in the fall of 2020, but has indefinitely suspended implementation amid the legal uncertainty surrounding these programs. Montana had planned to implement a Medicaid work requirement in January 2020, but tis waiver proposal was just submitted to the federal government in August, and the state has announced that implementation could be delayed by up to a year.

Michigan still on track to have Medicaid work requirement in January

Michigan’s Medicaid work requirement is scheduled to take effect in January, despite the fact that it’s being challenged in court. GOP lawmakers have rejected Gov. Whitmer’s request to pause the work requirement. If it takes effect as scheduled, it will be the only Medicaid work requirement in the country in effect as of January.

Health reform bills pre-filed for 2020 legislative sessions

The 2020 legislative session starts next month in most states, and several health reform bills have already been pre-filed for consideration during the 2020 session. That includes Medicaid expansion legislation in Kansas, a Virginia bill that would require short-term health plans to cover essential health benefits, and another Virginia bill that would prohibit out-of-network balance billing in emergency situations.

Last spring, New Jersey’s Assembly passed – nearly unanimously – a bill that would cap out-of-pocket prescription drug costs on state-regulated health plans. The bill was just taken up by the New Jersey Senate last week. (New Jersey’s legislature is still in session; the companion Senate bill is here.)

California brokerage markets sharing ministry plans as short-term plans

Last week, Charles Gaba wrote a fascinating (and frustrating) account of how an exchange-certified brokerage in California is selling healthcare sharing ministry plans from Aliera Healthcare, and calling them “short-term health plans,” despite the fact that California no longer allows short-term health insurance to be sold in the state. (The agency is calling them “plans” instead of “insurance.”) Over the last several months, regulators in several states have taken action against Aliera Healthcare and Trinity Healthshare. (As Colorado regulators note here, the two entities work in tandem to enroll people in health care sharing ministry plans).

Lawmaker wants Indiana’s short-term law to be template for other states

Earlier this year, Indiana enacted a new law that allows short-term health plans to follow federal duration limits. (The state had previously capped these plans at six months and prohibited renewals.) But the state’s law also requires short-term plans to have benefit caps of at least $2 million. And now the Indiana lawmaker who sponsored the state’s legislation is sponsoring a similar model act that could be used as a template in other states.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

from RSSMix.com Mix ID 8246807 https://www.healthinsurance.org/blog/2019/12/11/the-scoop-december-11-2019-edition/

[johndonohueus]

The GOP is still coming after your ACA coverage (whether you have a pre-existing condition or not).

Missouri Attorney General Josh Hawley, running for Claire McCaskill’s Senate seat, is out with an ad in which he pledges to maintain guaranteed access to health insurance for people with pre-existing conditions – a policy goal supported by 90 percent of the public, according to a recent Kaiser Family Foundation poll.

In the ad, Hawley intones with quiet fervor that one of his “perfect” sons has “a rare chronic disease – a pre-existing condition.” He declares, “I support forcing insurance companies to cover all pre-existing conditions, and Claire McCaskill knows it.”

This is rich, since Hawley is party to a suit by 20 Republican attorneys general and governors seeking to have the entire ACA struck down on grounds that the individual mandate is unconstitutional, and therefore the entire law is unconstitutional.*

Hawley’s promise is not a literal lie, however. In the ad, he states that he supports “forcing insurance companies to cover all pre-existing conditions” (note the verb – bashing insurers is now a bipartisan sport). He does not say that those with pre-existing conditions can’t be charged more. And that’s precisely what the Pre-existing Conditions Protection Act, a House bill introduced last year by Greg Walden (R-Oregon) that embattled Republicans are currently scrambling to support, would do, as McClatchy’s Lindsay Wyse and Brian Lowry report:

“They have to cover you, they can’t exclude coverage of your pre-existing condition or deny you coverage, but they can charge you a million a month, they can charge you a deterrent premium,” said Karen Pollitz, senior fellow at Kaiser Health Family Foundation.

A similar bill introduced in the Senate a few weeks ago by Dean Heller, R-Colorado, has a companion flaw: it fails to forbid insurers from excluding coverage for an applicant’s own pre-existing condition from a policy offered to that individual.

Let’s assume, though, for the sake of argument, that a Republican House and Senate, with Hawley a member of the latter, do repeal the ACA and offer a replacement. Let’s assume, too, that the replacement fully maintains the ACA protections for people with pre-existing conditions in the individual market. That is, the new law maintains the ACA’s essential health benefits that every plan must cover; forbids denying coverage or charging people more based on their medical history; and allows pricing to vary only by age and geographical area. What would such a Republican replacement look like?

Here’s a wild inference. The replacement bill would advance various other Republican priorities by

Rolling back the ACA Medicaid expansion – the primary engine of the ACA’s reduction in the uninsured population. The ACA aimed to make Medicaid available to all adults with incomes up to 138 percent of the Federal Poverty Level. The Supreme Court made it optional for states to participate, as 32-33 states will do as of 2019.

Imposing per capita caps on federal Medicaid spending, weakening a wide range of Medicaid programs (with the effects varying by state) that collectively insure 75 million Americans, including about 40 percent of the nation’s children and over 60 percent of those in nursing homes. . In a speech today, CMS administrator Seema Verma called for such caps.

Reducing premium subsidies for most ACA marketplace recipients and eliminating their adjustment by income, so that someone earning $65,000 is subsidized at the same level as someone earning $15,000.

Wiping out the ACA’s Cost Sharing Reduction (CSR) subsidies, which make actual care affordable for about 5 million enrollees with incomes up to 200% FPL. CSR reduces to deductibles roughly to a $0-500 range for enrollees up to 150% FPL and to $500-1000 for those in the 150-200% FPL range.

Allowing insurers to charge the oldest enrollees five times more than the youngest adult enrollees instead of the ACA’s 3-to-1 ratio – without adjusting subsidies to render older enrollees’ premiums affordable.

Repealing the reviled individual mandate and replace it with a weaker incentive to obtain insurance.

Un-insuring over 20 million Americans.

Sound familiar? That’s the American Health Care Act, introduced in the House by Paul Ryan in March 2017. The Congressional Budget Office estimated that the bill would increase the ranks of the uninsured by 24 million over ten years. Medicaid enrollment would be 14 million lower than under current law. A shrunken individual market offering high deductible coverage would be more attractive to younger and more affluent enrollees and unaffordable to older and lower income people.

That original bill did maintain the ACA’s protections for people with pre-existing conditions. It never came to a vote because House leadership knew it was a few votes short of passage, rejected by a handful of relative Republican moderates on one side and by hard-right Freedom Caucus members on the other, who thought its subsidies were too generous and it coverage rules too like the ACA’s. Only when Tom MacArthur, R-NJ offered an amendment that enabled states to adulterate the ACA’s pre-ex protections did the Freedom Caucus come aboard and enable the bill to pass the House.

For a few months in 2017, it seemed that undoing pre-ex protections was the sine qua non of ACA repeal. Most Republicans now recognize that goal as political poison. If they maintain power – in part by obfuscating their record on this front – they could learn from experience and jettison this passion for medical underwriting – though it does have a way of repeatedly creeping back into their legislation.

But AHCA 1.0 serves as a reminder that Republicans could undergo conversion on the pre-ex front and still take access to health care away from tens of millions of Americans. They could permanently cripple Medicaid by capping the federal government’s contributions to states. They could also convert Medicare to a “premium support” or “voucher” system in which private Medicare Advantage plans’ pricing is no longer tethered to traditional Medicare’s. They could radically reduce government support to people who need to look to the individual market for insurance, rendering coverage unaffordable to millions.

They will attempt all of this, and achieve most of it, if they maintain control of the House and Senate.

* The individual mandate, which requires all for whom insurance is deemed affordable by ACA standards to obtain it or pay a tax penalty, has always been the ACA’s most unpopular feature. It exists because the ACA’s creators considered it a necessary condition for making insurance available on equal terms to people with pre-existing conditions. Republican zeroed out the tax penalty last December as part of their tax cut bill. Since the Supreme Court had upheld the mandate only as an exercise of Congress’s taxing power, the AG suit argues, the mandate and the entire law are unconstitutional now that there’s no penalty. The suit ignores the fact that the current Republican Congress deliberately zeroed out the penalty while not repealing the ACA, reflecting learned experience that ACA subsidies are enough to keep the ACA private plan marketplace functioning, albeit in impaired fashion, no matter what measures (other than repeal) Republicans take to sabotage it.

Andrew Sprung is a freelance writer who blogs about politics and policy, particularly health care policy, at xpostfactoid. His articles about the rollout of the Affordable Care Act have appeared in The Atlantic and The New Republic. He is the winner of the National Institute of Health Care Management’s 2016 Digital Media Award. 

from RSSMix.com Mix ID 8246807 https://www.healthinsurance.org/blog/2018/09/27/the-gop-is-still-coming-after-your-aca-coverage-whether-you-have-a-pre-existing-condition-or-not/