JustCare

Tag: ACA

  • Trump’s health care executive orders

    Trump’s health care executive orders

    As with many sectors of our economy, when it comes to health care you should expect a lot of changes from the Trump administration. And, based on Trump’s recent executive orders, millions of Americans could face higher health care and prescription drug costs. Tarena Lofton lays out the latest developments for KFF Health News.

    But, Trump’s most consequential health care act is to push Republicans in Congress to drastically cut Medicaid spending in order to pay for massive tax cuts for the wealthiest Americans. Republicans intend to push through these cuts in a reconciliation package to be finalized shortly. Cuts to Medicaid will affect more than 70 million Americans directly and their families and communities indirectly. If you oppose Medicaid cuts, please reach out to your Congressperson and Senators and let them know.

    Now, to some of the executive orders:

    1. Revoked: Trump revoked a Biden administration executive order requiring the Centers for Medicare and Medicaid Services to focus on new ways to lower prescription drug costs, including a Medicare project that would have established a list of drugs with a $2 copay. The bigger question is whether Republicans will try to undo provisions in the Inflation Reduction Act that allow Medicare to negotiate drug prices and set an annual out-of-pocket cap in Medicare Part D at $2,000.
    2. Revoked: Trump undid a Biden administration executive order that extended the enrollment period for Affordable Care Act health plans, as well as money dedicated to assisting people with enrollment. The bigger question is whether Republicans will end subsidies for people with lower incomes who are insured through the ACA health insurance exchanges. Those subsidies are set to expire at the end of this year.
    3. Withdrawn: Trump withdrew the US from the World Health Organization. The US had been a large supporter, giving the organization $1.3 billion in 2022 and 2023. WHO focuses on global health. It funds health projects around the world and responds to public health emergencies. Trump says he did not like the way the WHO handled the COVID pandemic. The bigger question is how the US will respond to public health emergencies.
    4. Unrecognized: Trump ordered the federal government to not recognize transgender and nonbinary identities. He ended federal support of health care delivered to people on the basis of gender identity. This order will likely be challenged in court. The bigger question is whether this order will be reversed in court.
    5. Expanded: Trump ended a policy that kept immigration officials from arresting people not legally in the US near schools, hospitals and churches.
    6. Withdrawn: Trump withdrew the US from the Paris Climate Agreement for the second time. The agreement specifically states that this process takes a year, but Trump ordered the immediate withdrawal.

    Here’s more from Just Care:

  • What will happen to ACA subsidies in 2025?

    What will happen to ACA subsidies in 2025?

    The Trump administration, in partnership with the next Congress, will determine whether or not subsidies will continue for people getting health insurance through the state health insurance exchanges under the Affordable Care Act. Axios reports on the state of play.

    Republicans in Congress, who will be the majority in both the House and the Senate, will spark a lot of rage among millions of people in the state health insurance exchanges, if they do not extend the subsidies. They will force millions of people to lose their insurance because, without the subsidies, they won’t be able to afford it. Without subsidies, the Republicans will force others to pay far higher health insurance premiums. Of note, the premium subsidies are most helpful to residents of Republican states that have not expanded Medicaid. So, Republicans in Congress could pay a big price if they eliminate the subsidies.

    But, as of now, the Republicans are not biting. They would not agree to a Democratic proposal to extend the ACA subsidies for one year.

    The Senate Finance Committee’s new Chairman, Mike Crapo (R-Idaho), is considering whether to include the subsidies in the budget reconciliation process that will happen in early 2025. He has not taken the subsidies off the table.

    However, Republicans in the House are saying that they do not support the subsidies. Jodey Arrington, who chairs the House Budget Committee, does not see an extension of the subsidies in the future. His response, when asked about extending the subsidies, was “hell no.” But, who knows?

    What would be the consequences of not extending the subsidies? Without the ACA subsidies in 2026, 2.2 million Americans are projected to lose their health insurance. In 2027, 3.8 million would lose their health insurance. People in the state health insurance exchanges would see their premiums rise 4.3 percent in 2026 and 7.7 percent in 2027.

    As of yet it is unclear what the Republicans in Congress would do for the millions of uninsured Americans, particularly if they end the ACA subsidies.

    Here’s more from Just Care:

  • Trump’s health care plan could be a winning ticket for Biden

    Trump’s health care plan could be a winning ticket for Biden

    Jonathan Cohn reports for the Huffington Post on what Donald Trump claims is his health insurance proposal for Americans. Trump’s proposal would effectively end the Affordable Care Act and offer no viable alternative; it could turn Medicare into a voucher program that drives up costs for older adults and people with disabilities.

    Trump is proposing “less expensive” health coverage than the Affordable Care Act, which effectively would enable insurers to sell junk coverage that won’t meet people’s needs. Trump also would once again allow insurers to stop covering people with pre-existing conditions. And, he would eliminate Medicare’s authority to negotiate prescription drug prices.

    Last November, Trump wrote: “The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives.” Don’t hold your breath.

    While Trump no longer talks of “repealing” the Affordable Care Act, his message is otherwise the same. He knows that Americans don’t want him to repeal the Affordable Care Act, and that Republicans lost control of the House of Representatives and the presidency in part because of their threat to repeal the ACA. Forty-five million Americans now rely on the Affordable Care Act for their health care coverage.

    Not surprisingly, Ronald Brownstein writes for the Atlantic that health care could be a winning issue for the Democrats. It is one major issue that voters trust Biden to address better than Trump. The Republican Study Committee, which represents 80 percent of the House Republicans, has recently said that it would repeal the ACA and restructure Medicare.

    Today less than eight percent of the US population is uninsured as a result of the Affordable Care Act. While that still leaves nearly 30 million Americans without health care coverage, that number is lower than in years past.

    Here’s more from Just Care:

  • Free preventive care: New avenue for health care price gouging

    Free preventive care: New avenue for health care price gouging

    Watch out. Don’t assume that the free preventive care services to which you are entitled under the Affordable Care Act (ACA) will not cost you a bundle. Samantha Liss reports for KFFHealthNews on how a free colonoscopy service turned into a huge bill.

    One couple with coverage through the Illinois state health insurance exchange were charged $600 for their “free” preventive care colonoscopies. Of course, the health care facility did not bill them for their colonoscopies, since that would be illegal.

    Rather the health care facility, seemingly in cahoots with the couple’s insurer, billed the couple for “supply trays.” The story exposes how providers and insurers game the system at the expense of patients in our current out-of-control health care system.

    Here’s what happened: At 45, the couple went to a facility for what they believed to be free colonoscopies. The bill for the two procedures was $4,068. The insurer discount brought the bill down to just under $800—the insurers’ cost.

    Afterwards, the couple were each billed $600 by the facility for “supply trays.”  Their insurer brought their charges down to $250 each. But, their bill still totaled $500 for the two “free” colonoscopies and the couple appealed.

    What happened? The story suggests that the gastroenterology practice, owned by a private equity company, did an end-run around the ACA. It does not make clear whether charging for supply trays is legal, although it’s hard to believe it is. It also appears that the couple’s insurer was in on the game since the gastroenterology practice had arranged this charge with the couple’s insurer. The more revenue the gastroenterology practice can get from patients, the less it needs to get from their insurers.

    The couple filed complaints. Federal law does not protect people in these cases, even though the ACA is federal law. States are in charge. The couple were at the mercy of their insurer.

    Here’s more from Just Care:

  • President Biden drafts a package of health care reforms for his second term

    President Biden drafts a package of health care reforms for his second term

    President Joe Biden is assembling a package of health care reform proposals for his second term, including a proposal to bring down the price of prescription drugs, reports CNN. It’s a smart move given that health care affordability is the second most important issue for Americans, after inflation.

    At the same time as President Biden looks to enhance people’s health care benefits, former President Donald Trump is calling to repeal the Affordable Care Act (ACA). President Biden wants to keep federal subsidies for people receiving care through the ACA and do more to reduce drug prices for people with Medicare and all other Americans. Biden’s goals are modest given the state of health care in the US and we need to push him to call for affordable health care for all, but his goals are far better than Trump’s.

    The ACA not only gives 10 million more Americans health insurance through the state health insurance exchanges, it expanded Medicaid to cover more Americans. People with incomes up to 135 percent of the federal poverty level are Medicaid-eligible. President Biden is looking into ways to ensure that the three and a half million people in the 10 states that opted against expanding Medicaid have Medicaid coverage.

    President Biden is again calling for a public health insurance option. In theory, such an option could remove the private insurer middlemen and all the waste and increased costs they bring. But, it’s not at all clear, based on Medicare Advantage and traditional Medicare (the public option) that a public health insurance option would bring down costs. The devil is in the design.

    Right now, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, is focused on bringing down the price of ten drugs that cost the Medicare program the most, as required by the Inflation Reduction Act. That’s both the camel’s nose under the tent for lower drug prices and small potatoes. The swiftest and easiest way to bring down drug prices is to allow people to import drugs from abroad and require insurers to cover those far less costly drugs.

    The Inflation Reduction Act also penalizes drug companies for raising drug prices more than the rate of inflation. This measure should keep drug prices from going up at obscene rates. But, it is also small potatoes, given how high drug prices are in the US–often four times higher than in France.

    Here’s more from Just Care:

  • Health insurers increasingly deny coverage for critical care

    Health insurers increasingly deny coverage for critical care

    Elisabeth Rosenthal writes for The Washington Post on the rising rate of health insurance denials.  High denial rates are not surprising given that health insurers generate greater revenues on each claim they deny. Consequently, they often use proprietary computer algorithms to deny claims in a systematic fashion, with no regard for people’s medical needs.

    Since the Affordable Care Act, health insurers can no longer refuse to cover people with pre-existing conditions in many instances. Instead, to maximize profits, they find ways to deny care. Rosenthal highlights how one insurance company literally has as a job title “denial nurse.”

    Although the US Department of Health and Human Services is charged with overseeing insurance company denials, it has not undertaken its oversight responsibilities in a meaningful way. Rather, too often, patients are faced with care denials and the obligation to pay for their care themselves or skip getting care altogether.

    The Kaiser Family Foundation (KFF) recently reported that, in 2021, one in six claims for in-network care in the state health insurance exchanges were denied, 17 percent. In one case, the insurer denied half of all claims, 49 percent! Worse still, another insurer denied four in five claims, 80 percent. And, while insurers reverse the majority of denials when people appeal, patient appeal rates are extremely low–one in 500.

    At times, denials are not only medically incomprehensible but nonsensical. For example, one patient with arrhythmia had his insurer’s approval for a heart procedure, but he was denied coverage “for injections into nerves in your spine,” which he had not received. The insurer had not paid the claim many months later, notwithstanding endless attempts to fix the error.

    In another instance, the insurer wrote a newborn to let the baby know that his neonatal care was denied because the baby could drink from a bottle and breathe on his own. Of course, the baby could not read the denial! And, an insurer denied coverage for epinephrine and steroids received in the emergency room to treat a young man with a deadly anaphylactic allergic reaction, which the insurers claimed was medically unnecessary. Though the patient’s mother has appealed, she still has not gotten the insurance to cover the services.

    Increases in insurer denial rates are likely a product of a computer system, PXDX, which I wrote about here, that allows insurers’ medical claims-review staff to deny 50 claims in ten seconds. This system saves insurers billions of dollars a year, at the expense of the health and well-being of their enrollees.

    To add insult to injury, claims can be denied because an insurer does not have a contract with a particular drug or device manufacturer. It doesn’t matter that the patient needs the treatment.

    Of course, these denials are also happening in Medicare Advantage plans. And, the Centers for Medicare and Medicaid Services (CMS) is not reporting plan denial rates to enable people to avoid plans with high denial rates. In fact, most likely, those plans are getting four and five-star ratings, because the rating system is such a farce! (You can read about why the Medicare Advantage star-ratings are a farce here.)

    The Affordable Care Act gives health insurer oversight responsibilities to HHS and requires HHS to collect and publicly report denial rates among corporate health insurers in the state health exchanges. But, HHS has not undertaken this data collection and reporting, as required. So, after more than a decade of failed government oversight, the insurers continue to deny claims with impunity.

    Here’s more from Just Care:

  • Will Biden expand Medicare benefits or strengthen the ACA?

    Will Biden expand Medicare benefits or strengthen the ACA?

    Jeff Stein reports for the Washington Post on health care reform proposals the Biden administration could include in the American Families Plan. House Speaker Nancy Pelosi is urging President Biden to invest in strengthening the Affordable Care Act. Senator Bernie Sanders wants him to add additional benefits to Medicare and make Medicare available to people 60 and older.

    Speaker Pelosi wants the next Congressional legislation to make greater subsidies to people under the Affordable Care Act permanent. In March, Congress expanded subsidies but they are  temporary. Her proposal would further entrench for-profit insurers in our health care system.

    Senator Sanders wants to shore up .the Medicare benefit package. He wants it to include dental, vision and hearing services. He also wants to lower the age of Medicare eligibility to 60 or 55. These benefits could bring down health care costs substantially for the 23 million people over 6o who are not eligible for Medicare today as well as for the 65 million people with Medicare.

    Biden, for his part, should recognize that pumping more money into our nation’s corporate health insurance system is going to drive up costs and keep us from having a sustainable universal health care system. Expanding public health insurance administered directly by the federal government is the only way to get a handle on health care costs and drive health care system improvements.

    The Biden administration is working on the American Families Plan. Right now, it appears it will cover child care, anti-poverty programs and health care. It could reduce prescription drug spending by $450 billion over ten years. Senator Sanders wants these savings, which are largely from Medicare, to benefit people with Medicare. Using the money on the ACA or any other health care initiative would take money out of Medicare.

    The savings on prescription drug costs should go to helping people with Medicare. The most up-to-date data show that older and disabled Americans suffer deeply as a result of not having comprehensive dental, vision and hearing benefits. Benefits available through Medicare Advantage plans appear to be theoretical and not meaningful. To the extent Medicare Advantage plans offer these benefits, they pay for only a fraction of the cost of treatment. Most people do not have the means to pay the substantial out-of-pocket costs.

    Consequently, nearly one in five people with Medicare over 70 have no teeth. An additional one in five of them suffer from tooth decay. Millions of people with Medicare also suffer from untreated severe or profound hearing loss. And millions suffer from lack of vision care. All of these services are prohibitively expensive. Lack of vision, dental and hearing care can lead to depression, increased risk of falls, social isolation, diabetes, cardiovascular disease and other co-morbidities.

    Whichever direction Biden goes, it will take enormous public pressure for Congress to pass the legislation. It will come after Congress passes an infrastructure package, which also will require a large public push.

    Here’s more from Just Care:

  • To save money, invest in Medicare not Obamacare

    To save money, invest in Medicare not Obamacare

    Most experts agree that health care costs in the US are out of control. And, Congress needs to rein them in because corporate health insurers have shown year after year that they cannot. Gerald Friedman and Travis Campbell explain in The Hill that the best and only way to bring costs under control without reinventing our health care system from scratch is to improve and expand on Medicare.

    The two biggest cost drivers in our health care system are: 1. the prices we pay for care and medicines; and 2. the hundreds of billions we spend in administration. Unfortunately, making it easier to enroll in the Affordable Care Act’s health insurance exchange plans through bigger subsidies, one of President Biden’s health care reform proposals, will do nothing to address either of these cost drivers. (It should improve access.) Another of Mr. Biden’s proposals, expanding Medicare, could be a big step forward in reducing costs, depending upon how it is done. (It should also improve access.)

    Medicare does a far better job of controlling costs than private health insurance. In the last 12 years alone, the per person cost for Medicare has gone up 26 percent. The per person cost for private health insurance has gone up 51 percent, almost double Medicare. Private health insurers now pay more than twice as much as Medicare for inpatient and outpatient hospital services. They pay 43 percent more than Medicare for physician services.

    On top of provider costs, private health insurers have astronomically high administrative costs relative to Medicare. Medicare’s administrative costs are one-tenth of private insurance. Consequently, expanding Medicare to everyone would generate costs per person that are 30 percent lower than they are today for people with private insurance.

    The ACA exchange plan premiums cost an average of more than $13,000 a year for a 64-year old. That’s double what Medicare spends for a 65-year old. It’s easy to see why moving people into Medicare reduces overall health care spending. Thankfully, President Biden supports that move.

    In short, helping more people receive insurance through the ACA state health insurance exchange plans only drives up costs. Subsidies that lower premiums do not address high provider or administrative costs. Rather, they increase national health spending. Moreover, out-of-pocket costs in these plans are so high that, even with insurance, many people will not be able to get care.

    If the goal is insuring more people, opening up Medicare to more people is far more cost-effective than providing people with subsidies that make it less costly for them to enroll in private health insurance.

    Here’s more from Just Care:

  • Health care reform in 2021: What you need to know

    Health care reform in 2021: What you need to know

    Mark Dudcik, National Coordinator of the Labor Campaign for Single Payer, offers ten important facts that will affect health care reform in 2021 and over the long-term. They help to highlight the challenges and opportunities for health care justice with President-elect Joseph Biden at the helm. Here’s what you need to know:

    1. 72% of voters support Medicare for All. Fox News exit polls reveal that 72% of the voters were in favor of a “government run healthcare plan”  
    2. All House candidates who cosponsored the Medicare for All Act were reelected. These advocates for Medicare for All even won in swing states. 
    3. The COVID-19 pandemic has caused 14 million people to lose employer-sponsored health coverage. The 14 million Americans include workers who lost their jobs and their families. Since 2017, when President Trump took office, and pre-novel coronavirus pandemic, an additional 2.3 million people lost their health insurance.
    4. Unions are beginning to see the risk of tying health care to jobs. They are struggling to guarantee health care to their members who have lost their jobs since the pandemic or who are likely to lose them if the economy sinks. With state and local governments in economic distress, union members are likely to face health care benefit cuts. 
    5. President-elect Joe Biden is seeing an outpouring of support from the for-profit health care sector, including the health insurance industry and the pharmaceutical industry.  
    6. President-elect Biden has said that he does not support Medicare for All.  Indeed, he said that he would veto it, if passed. 
    7. President-elect Biden proposes a “public option.” It doesn’t look like people will be able to opt for public health insurance, a “public option” in the next year or two. But, even if Congress were to enact legislation allowing people to buy a version of traditional Medicare with an out-of-pocket cap–the only public option that would give people access to the doctors they want to see at a lower cost than they currently pay–it would not address out-of-control health care costs or eliminate the $600 billion in administrative waste in our health care system.
    8. President-elect Biden proposes lowering the age of Medicare eligibility age to 60. Helping 20 million older people get good coverage is beneficial. But, if Congress were to enact this legislation, which is unlikely in the next two years, it would also need to offer a subsidy to people 60-64, or most people would not be able to afford to enroll inMedicare. Congress would also need to improve traditional Medicare, adding an out-of-pocket cap and drug benefits or it would not be a viable option. People under 65 do not have the right to buy Medicare supplemental insurance, which they would otherwise need to fill gaps in traditional Medicare.  
    9. The Supreme Court could undo some or all of the ACA. Most people do not believe that the Supreme Court will completely undo the ACA, but it still might undo some of it. Democrats in Congress might not have the power to strengthen the ACA.  
    10. Without Congressional action, our people and our economy are likely to suffer tremendously. Congress should pass the Health Care Emergency Guarantee Act, which would help Americans get needed care and stimulate the economy. So, long as Mitch McConnell is Senate Majority Leader, it is unlikely to happen.

    Given the state of our Congress and President-elect Biden’s policy agenda, it’s hard to see a clear path forward to a better health care system in the near future. But, those of us who believe health care is a human right need to continue to make our voices heard and to pressure our political leaders to do right by Americans and guarantee everyone access to affordable care.  

    Here’s more from Just Care:

  • Pharma doesn’t have your back

    Pharma doesn’t have your back

    You might think that Pharma is doing more good than harm, but, watch out, it does not put your interests first; it doesn’t have your back. Stat News reports that the pharmaceutical industry has given $1.5 million in the last election cycle to Republican State Attorneys General working to repeal the Affordable Care Act. As always, Pharma’s focus is only on its bottom line, driving profits for shareholders.

    Pharmaceutical companies must see more benefits for themselves from overturning the Affordable Care Act than in keeping it. What’s interesting is that the ACA generates a lot of revenue for the pharmaceutical industry. The ACA insures millions of people. And with that coverage comes prescription drug benefits. So, it makes sense that Pharma’s support of the State Attorneys General working to repeal the ACA stems from its belief that it will  generate greater revenue from its repeal.

    The state health insurance exchange health plans tend not to offer particularly good access to care, and they are very expensive. But, they are still a way better option than going without insurance for the millions of Americans who need it. And, the majority of Americans (58 percent) do not want to see the ACA repealed.

    With their support of Republican State Attorneys General, drug corporations are undermining the needs of more than 20 million Americans who depend on coverage from their state health insurance exchanges. Pharmaceutical companies are endangering their health and, in the process, tarnishing the industry’s image. In addition, in the short term, the pharmaceutical companies will lose revenue, if the ACA is repealed.

    But, states can confer lots of additional benefits on the pharmaceutical industry, including tax waivers. States can also fail to enact regulations that would lower drug prices. Pharma does not want states regulating drug prices or otherwise forcing them down. So, it appears that Pharma has chosen to play this long game.

    Of course, Pharma claims it never intended to support the ACA’s repeal. That’s hard to believe. There’s a lot that pharmaceutical companies could be doing now to demonstrate support for the ACA if the pharmaceutical companies so chose. Their inactions speak louder than words.

    Here’s more from Just Care: