JustCare

Tag: ACA

  • President Trump blows up ACA adding $200 billion to deficit

    President Trump blows up ACA adding $200 billion to deficit

    President Trump has been saying for a long time that the ACA was going to implode. He was counting on Republicans in Congress to make sure that happened. Without their assistance, he just issued an Executive Order that blows up the ACA and  adds nearly $200 billion to the deficit.

    On October 12, 2017, Trump signed an Executive Order that ends subsidies to help people with modest incomes enrolled in state health insurance exchanges pay their deductibles and copays. These “cost-sharing reductions” cost the federal government about $7 billion a year and save the seven million people who benefit from this help about $1,000 each in out-of-pocket costs. Vox’s Sarah Kliff reports that this provision in Trump’s Executive Order means:

    • Insurers could increase premiums by 20 percent in 2018 in order to cover their increased costs. Premiums could increase by 25 percent by 2020.
    • The federal deficit will increase because the government will have to spend $194 billion more to subsidize the increased premiums of 10 million people in the health care exchanges, according to the Congressional Budget Office.
    • One million more people will be uninsured in 2018.
    • Some health insurers will lose a lot of money on 2018 premiums set before the Executive Order was signed.
    • More health insurers may decide to leave the health insurance exchanges.

    Congress could fix this problem by passing a law that specifically approves these cost-sharing reduction payments. Some believe that this is possible as part of a bi-partisan fix to avoid driving up the deficit.

    In addition, the Trump Executive Order allows insurers to sell skimpy policies that do not cover the essential benefits mandated in the ACA. Some healthy people might leave the state exchanges and buy these skimpy policies because they cost less. But, these people will put their own health at risk if they get sick, because they are likely not to have the coverage they need. And, they will drive up premiums for people in the state exchanges.

    Attorneys general from 18 states and the District of Columbia, including New York and California, filed a lawsuit on October 13 challenging Trump’s Executive Order, the Hill reports.

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  • If Trump undermines ACA, CBO says health insurance premiums will soar

    If Trump undermines ACA, CBO says health insurance premiums will soar

    President Trump has not succeeded on his promise to repeal the Affordable Care Act. Now, the Congressional Budget Office (CBO) says health insurance premiums will soar if Trump follows through on his vow to undermine the ACA. In fact, Trump’s plan to destroy the ACA would cost the U.S. almost $200 billion over the next ten years.

    According to the CBO, 2018 premiums would rise by 20 percent if Trump refuses to pay the ACA’s copay and deductible subsidies, called “cost-sharing reductions,” guaranteed to people with incomes under 250 percent of the federal poverty level. By 2025, premiums would rise by 25 percent. Insurers would need to raise premiums to make up for their lost copay and deductible revenue.

    Because the federal government helps pay the premiums of people with incomes under 400 percent of the federal poverty level who enroll in health plans through the state health insurance exchanges, a 20 percent premium increase would mean the government would have to pay an additional $194 billion in premium costs.

    The CBO further projects that some health plans would leave the ACA marketplace, reducing choice and competition. And, 5 percent of health care markets would not have a health plan in 2018. As of now, in 2018, one county in Wisconsin and one in Colorado will have no ACA plan options.

    Higher insurance premiums would mean that the federal deficit would increase $53 billion by 2026.

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  • Pre-hospice care allows people to stay in their homes

    Pre-hospice care allows people to stay in their homes

    An article in Kaiser Health News describes the value of pre-hospice care for people with a multitude of health conditions who would otherwise be spending the last years of their lives going in and out of hospital. Pre-hospice care allows people to stay home (age in place) and enjoy a better quality of life, as most would prefer to do, in the final years of their lives. At the same time, it saves our health care system billions of dollars.

    Pre-hospice services, sometimes described as home-based palliative care services, are relatively new. Sharp HealthCare, a non-profit Medicare managed care plan in San Diego, offers people with multiple conditions a Transitions program, pre-hospice services provided to them at home. Through this program, social workers and nurses spend time with people in their homes and help them better care for themselves and plan for a time when they are unable to speak for themselves.

    Pre-hospice services differ from hospice services in that they are not designed for people deemed to have six months or less to live. They are rather for people who still may want and need curative services and who also would benefit from care coordination and management. The Transitions program gives people access to a 24-hour nurse hotline so they can avoid calling 911 and receiving ambulance services when they are not warranted.

    While pre-hospice services are now available in a number of places, the big obstacle to a large roll-out of pre-hospice services is that Medicare generally does not pay for them. Under the ACA, there are some opportunities for health plans and hospitals to innovate and receive payments for care that improves patient health and saves money, such as pre-hospice care. But, those opportunities are at risk if Congress replaces critical elements of the ACA.

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  • House votes to deny millions health insurance

    House votes to deny millions health insurance

    The House of Representatives voted last week to kill many provisions of the ACA and replace them with the Affordable Health Care Act (AHCA), a bill that would deny millions of Americans, including older adults and people with disabilities, good affordable health insurance. The bill passed by a vote of 217-213, without an estimate of its costs or an understanding from the Congressional Budget Office (CBO) of the full range of projected consequences for people with health insurance today, including people with Medicare and Medicaid.

    But, as Tim Jost reports in Health Affairs, the AHCA provisions entail substantial cuts in health care spending, deprive low-income Americans of Medicaid coverage and leave tens of millions of Americans–those with employer coverage and those with individual coverage–uninsured or underinsured. Based on earlier projections, because it eliminates the Medicare tax on wealthy Americans, if passed, AHCA would also shorten the life of the Medicare Trust Fund by two years.

    In brief, AHCA, the Republicans’ proposed health care law would:

    • Hand hundreds of billions of dollars in tax cuts to pharmaceutical companies, medical device companies, along with the wealthiest Americans. In the process, it would weaken Medicare, and it would jeopardize the financial base that supports health care subsidies for people with low incomes in the state health insurance exchanges. Some good news: It keeps the provision in the ACA that closes the Medicare prescription drug donut hole in 2o2o.
    • Allow insurers to charge older people five times more than younger people and even more than that if states permit it. Inevitably, this would mean that older people not yet eligible for Medicare and without employer coverage would be hard-pressed to afford health insurance.
    • Slashes Medicaid funding by $880 billion over the next 10 years. It also imposes either state block grants that may keep eligible individuals from getting coverage or per person payment caps that could limit Medicaid benefits. The 11 million people with Medicare and Medicaid might no longer be able to rely on Medicaid to help cover their Medicare premiums, coinsurance and deductibles, or their nursing home care.
    • Mean 24 million people will lose health insurance coverage. It would not be affordable for them.
    • Allow employers and states to offer policies that leave people without essential benefits and underinsured; moreover, if insurers are able to offer policies that do not cover key benefits, people will no longer be protected by the ACA’s cap on out-of-pocket costs for those benefits. They also will no longer be protected by the ACA’s protection against lifetime coverage limits for those benefits.
    • Keep tens of millions of people with pre-existing conditions from getting affordable coverage in states that permit insurers to raise rates on these people. And, even if people with pre-existing conditions could afford health coverage, it’s not clear that the coverage available would offer the health care benefits they would need.
    • Cut health insurance subsidies based on income for people in the health exchanges beginning in 2020 and replace them with a small tax credit based on age to people with low incomes.
    • No longer impose tax penalties on individuals who do not get coverage or employers who do not offer coverage. This would likely mean that younger healthier individuals would not buy coverage, driving up premiums by 15-20 percent for everyone else. And, many employers will stop offering health insurance coverage.
    • Lead to 1.8 million people losing their jobs.

    Of note, House Republicans, knowing full well the implications of these provisions, ensured that they and their staff continued to get good affordable coverage. The American Health Care Act protects members of Congress and their staff from some of its harshest provisions. Among other things, they are guaranteed coverage of all essential benefits even if their states opt to cut them for everyone else. Similarly, their insurers cannot charge them more if they have pre-existing conditions, even if their states waive this protection for everyone else.

    Not surprisingly, hospitals and doctors are expressing concern with this bill. It will likely leave hospitals and doctors holding the bag for the cost of care for millions of Americans, including people who opt not to get coverage and need costly health care and people who are forced to buy inadequate coverage. Given, Medicaid cuts, insurers are likely to lose a big block of Medicaid business. But, if the bill becomes law, they are also likely to be given the freedom to cut benefits and charge exorbitant premiums to people with pre-existing conditions in many states, which will be helpful to their bottom lines.

    AHCA is now in the hands of the Republican-controlled Senate.  In order to pass, every Senate Republican but two must support it.

    Here’s more from Just Care:

  • If Republicans destroy the ACA, will they give us Medicare for All?

    If Republicans destroy the ACA, will they give us Medicare for All?

    David Leonhart makes the case in The New York Times that if Republicans destroy the ACA, they may unwittingly give us Medicare for all. Leonhart suggests that Democrats in Congress may realize that Medicare for all is the only viable alternative to a conservative health care system like the ACA. What would it take?

    Leonhart bases his thesis on the belief that once Congress bestows benefits that improve people’s lives, it’s very difficult to take them away. Taking away these benefits would mean losing public support. And, some would argue that that’s why the Republicans have failed to repeal the ACA as of now.

    Yet, to be clear, Republicans really did want to kill the ACA and take away significant benefits. Powerful conservative forces, including the Koch brothers’ Americans for Prosperity, the Heritage Foundation and the House Freedom Caucus, kept the Republican leadership and Trump from repealing the ACA because of the replacement plan, which was not conservative enough; these conservatives wanted the ACA repealed but did not want a new plan with coverage for people with pre-existing conditions or for dependents of working people to the age of 26 or coverage of essential benefits.

    And, the Freedom Caucus may yet get what it wants, even though there likely would not be the votes in the House and the Senate for their agenda. Republicans may succeed at killing the ACA through lack of adequate funding or administrative oversight of its provisions. It seems pretty clear that the Republican leadership is very much intent on gutting or cutting the ACA, so long as there’s a way to pin the ACA’s demise on the Democrats by arguing the ACA model was unsustainable.

    Will public pressure lead to a replacement plan? As Leonhart acknowledges, “passing major social legislation is fantastically difficult,” because it tends to mean that powerful corporate forces see their profits shrink in the process, through taxes and reduced revenues. It’s also difficult because even when the legislation will improve people’s lives, many people like the devil they know and fear change.

    But, Leonhart posits that people will insist on a replacement to the ACA if the ACA goes down. He believes that Congress will feel pressure to replace it since the public now counts on government health care coverage,  And, if Republicans in Congress don’t feel that pressure, when Democrats are next in power, they should enact Medicare for all.

    Democrats should recognize that Medicare for all is the only health care system that will withstand the test of time because it provides automatic coverage, offers people the choice of doctors and hospitals they want and need, and controls costs. Medicare (and Medicaid) work well, have overwhelming support across the political spectrum, and staying power. In sharp contrast, Republicans will always have the power to undermine a conservative health care system like the ACA.

    We all should now see that the healthcare marketplace does not work like the marketplace for consumer products and services. Health care competition does not drive down prices. And, the federal government can innovate and drive system improvements in ways that the private health care marketplace has not and cannot. The question is not whether Medicare for all is the way to go but whether Democrats will have the spine to take on opposition from the medical industrial complex.

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  • Medicare for all controls spiraling health costs

    Medicare for all controls spiraling health costs

    It may be some time before Democrats in Congress can drive health care policy–or any policy for that matter–but it is due time that they unite around Medicare for All as the way to ensure good affordable coverage for everyone in America. Even if Republicans were unsuccessful at repealing the Affordable Care Act, we can be sure they are doing what they can to undermine it. And, they will do nothing either to control spiraling health care costs or to ensure that all Americans have coverage.

    Democrats need to be playing offense with a smart health care plan. A decade ago, Jacob Hacker proposed one version of Medicare for All that Congress should consider.

    Common Dreams reports that RoseAnn DeMoro, executive director of National Nurses United (NNU), makes the case that Democrats “are fighting for an unacceptable status quo.” We cannot rely on private insurers to deliver good affordable care. In a press release, she further observes that even with the ACA, health care is unaffordable to millions with coverage, and 28 million Americans still don’t have coverage. We need to put people’s health care needs first, not insurer profits.

    Representative Luis Guttierez of Illinois echoes DeMoro, saying that it is time that the government took responsibility for the health of its citizenry.

    According to Steffie Woolhandler and David Himmelstein, we can replace our current health care system with Medicare for All–similar to HR 676–and immediately insure 26 million uninsured Americans. Medicare for All would save nearly 21,000 lives in its first year. As Senator Bernie Sanders has said for years, health care should be guaranteed to everyone as a right.

    Please sign this petition if you want Congress to keep its hands off Medicare.

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  • Republicans could hurt Medicare, Medicaid and ACA without ACA repeal

    Republicans could hurt Medicare, Medicaid and ACA without ACA repeal

    A splintering in the Republican party forced Speaker Paul Ryan to pull the American Health Care Act, aka Trumpcare, from a House of Representatives vote, and, at least for now, it has been put to bed. Ryan did not have the votes to repeal the Affordable Care Act and replace it with Trumpcare. But, beware, as Margot Sanger-Katz reports for the New York Times, the Trump administration and the Republican leadership could hurt Medicare, Medicaid and the ACA without ACA repeal.

    The ACA requires Trump administration support and Congressional appropriations in order for its effective implementation. There is strong reason to believe that President Trump and Secretary of Health and Human Services, Tom Price, have every intention of doing what they can to destroy the ACA and reform Medicare and Medicaid through executive action. Indeed, they’ve already begun, with Trump declaring that “[The ACA] is exploding now,” when it is not.

    Under the ACA, for example, the Department of Health and Human Services has the authority to change Medicare significantly through demonstration programs intended to bring down costs and improve patient outcomes. Secretary Price could use this power to reform Medicare in dramatic ways. Moreover, Secretary price can give more authority to the states with regard to Medicaid through the CMS Innovation Center. For example, he could give states waivers to impose premiums and cost-sharing requirements on Medicaid.

    With regard to the state health insurance exchanges, President Trump has already directed the IRS not to enforce the ACA requirement that everyone either have insurance or pay a penalty for not having insurance. And, the IRS believes it has a way to do so without violating the ACA. If people don’t fill out the line on their tax return indicating whether they had insurance in 2016, the IRS plans not to reject the return. As a result, fewer young people will likely sign up for coverage, gambling that they will not need health care. With more older and less healthy people in the exchange, premiums and out-of-pocket costs for enrollees will rise, possibly putting the health plans in the exchange in a death spiral.

    And, though insurance premiums are relatively steady in the state health insurance exchanges, insurers understandably are wary about their future. If Trump and Price show little or no support for the exchanges, it is to be expected that more insurers will pull out of the exchanges. They will need to decide by June 21 whether they will continue to offer insurance in the exchanges in 2018.

    The Trump Administration is also not likely to oppose a House challenge to the deductible and copay subsidies the ACA provides to people with low incomes in the exchanges, as the Obama Administration did. More than half of enrollees in the exchanges rely on those subsidies. Without them, both enrollees and insurers will be hurt.

    And Secretary Price may not be willing to use his muscle to ensure that the exchanges deliver robust coverage, which Obama administration officials did. Rather, he may support insurers who want to raise deductibles and restrict coverage, to the extent he has leeway to do so.

    If you want Congress to keep its hands off Medicare, please sign this petition.

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  • The latest on ACA, Medicaid and Medicare

    The latest on ACA, Medicaid and Medicare

    This year, Trump’s budget does not include cuts to either Social Security or Medicare. But, sadly, that’s likely irrelevant given that the Republican leadership plans to repeal the Affordable Care Act, drive up costs for people with Medicare, and jeopardize care for millions of people with Medicaid. While we still don’t know exactly when Republicans will focus on Medicare, we know Speaker Paul Ryan plans to gut Medicare, if not this year then next year or soon thereafter.

    Here’s what we know about the Republican leadership’s agenda: A leaked copy of the Republican plan to replace the ACA reported in Stat, phases out Medicaid expansion by 2020 and turns Medicaid into a “block grant” program. Put differently, instead of Medicaid remaining a defined benefit program that covers everyone who qualifies and provides set benefits, each state would have a limited amount of money to spend on Medicaid. If the money is not enough to cover all benefits or all people who are Medicaid eligible, states would be able to decide what benefits to cut or could limit enrollment.

    Who benefits from the Republican plan? Insurers, drug companies and device companies. The leaked Republican plan wipes out ACA taxes on drug and device companies as well as insurance companies. Moreover, as predicted, the Republican plan benefits insurers and puts people at risk by allowing the sale of insurance that does not cover all essential benefits. For example, states could decide that insurers do not have to cover mental health or substance abuse benefits.

    Who loses from the Republican plan? McKinsey and Avalere Health estimate that about half of all people covered by the ACA would no longer have health insurance coverage if the leaked Republican plan were to become law. Moreover, the Republican plan allows insurers to charge older members five times more than younger members, meaning that people in their mid-50’s to early 60’s would see large premium increases. The ACA limited the difference in premiums for older adults to no more than three times those paid by younger adults. And, while some people may see premiums drop. they are likely to see their out-of-pocket costs rise when they need essential care that their health plan no longer covers.

    It’s still hard to know what will happen on the health care front or when. Trump’s first priority is “tax reform,” which will mean cutting corporate taxes and taxes for the wealthy as well. And, according to his Treasury Secretary, Steven Mnuchin, “We are not touching [Medicare and Social Security] now. But, one thing we do know, big health care changes are in the offing.

    If you want Congress to keep its hands off of Medicare, please sign this petition.

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  • ACA reduces medical divorces

    ACA reduces medical divorces

    Among the Affordable Care Act’s many benefits, it’s common knowledge that it has reduced significantly the number of uninsured in America, in part by expanding Medicaid. What you may not know is that in states that opted to expand Medicaid, the ACA has also kept more married couples together. New research suggests that states that opted not to expand Medicaid not only have a higher rate of uninsured residents but also have a higher rate of medical divorces.

    What’s a medical divorce? It’s a practical decision to divorce one’s spouse in order to secure affordable health care without going completely broke. With a medical divorce, one partner with costly health care needs is forced to divorce his or her spouse in order to qualify for Medicaid without spending down all of their collective assets.

    A new NBER paper reveals that the Affordable Care Act appears to have reduced medical divorces in states that took advantage of the ACA’s Medicaid expansion. In those states, there is no longer a Medicaid asset test for people under 65 . In other words, married people with costly health care needs do not have to separate assets from their spouses’ assets in order to qualify for Medicaid.

    In comparing divorce rates in states that expanded Medicaid and states that did not expand Medicaid, the researchers found that almost six percent (5.6%) fewer people between the ages of 50 and 64 divorced in states with Medicaid expansion.

     

    CDC
    CDC

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  • Without ACA, how many sick people will die?

    Without ACA, how many sick people will die?

    Before people began getting health insurance under the Affordable Care Act (ACA), the Commonwealth Fund projected that as many as 84,000 people were dying each year because they lacked access to care. In fact, the Commonwealth Fund ranked the U.S. at the bottom of its list of wealthy nations on preventable deaths–96 for every 100,000 people in 2006-07. With health care costs continuing to rise way faster than inflation, we need to consider how many sick people will die after the Republican leadership repeals the ACA?

    Stat news reports that organizations representing patients with costly conditions fear that ACA repeal will undo health care protections that people in poor health need. Their particular focus is on how to keep insurers from refusing to cover people with pre-existing conditions. That’s just the tip of the iceberg.

    What’s likely to happen once the ACA is repealed? It wouldn’t be surprising if the Republicans allowed insurers to revert to their old ways: If so, insurers will sell expensive policies that leave people with inadequate coverage when they need costly health care and will likely deny coverage to people with costly health care needs or charge exorbitant premiums, very high deductibles and/or very high copays.

    Here’s what people without employer coverage and not yet eligible for Medicare should likely expect from commercial insurers:

    • Coverage will be unavailable to many people with costly conditions. The Republican leadership has no plan to mandate that everyone have health insurance coverage. As a result, to save money, many young and relatively healthy people will likely take a gamble and go without health insurance, driving up health care costs for everyone else and inevitably leading insurers to impose huge cost-sharing responsibilities on people with pre-existing conditions. The Republican leadership is considering a plan that would require insurers to cover people who are switching out of one health plan to another, but that’s of little help if the coverage is unaffordable or inadequate.
    • Coverage will be unaffordable for many people. The Republican leadership does not want to provide subsidies to help offset premium costs for people with incomes under 400 percent of the Federal Poverty Level as the ACA does. Nor do Republicans want to regulate prices or provide automatic coverage to everyone in the country through a tax system that covers most of the cost of health care, as Medicare does for people over 65 and people with disabilities. Moreover, Republicans don’t want to limit the amount insurers can charge people through a cap on their administrative costs and profits, as the ACA does. Since commercial insurers are unable to rein in costs and aim to deliver their shareholders as high profits as possible, we can expect them to impose far higher cost-sharing on their enrollees than they do today.
    • Coverage will be inadequate for many people with costly conditions. Even if people can get coverage, people who need a significant amount of health care are likely to find their health plans don’t meet their needs. The Republican leadership is unlikely to mandate that health plans cover essential benefits, or that health plans cover as much care as people need, or that health plans impose a cap on out-of-pocket costs, as the ACA does. Without these mandates, health plans are likely to do what they did prior to the ACA–sell policies that offer only limited coverage, leaving people with costly conditions to forego needed care or pushing them into medical debt and often bankruptcy.

    Neither the Republican leadership nor the Democratic leadership in Congress say they approve of “death panels.” It might be time to ask our representatives the difference between a health care system that denies needed health care to its citizens and a death panel.

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