John Hanno, March 23, 2017
‘The Great, Bait and Switch, Flim Flam, American Not So Healthy Care Act’
Trump and the Republi-cons have finally been forced to put their health care cards on the legislative table. The Donald trumpeted countless times, that his health care plan would be a “beautiful thing,” that “everyone would be covered,” even the poorest 25% who can no way afford health insurance; and that his plan would be “much better” and “much cheaper” than Obamacare.
We’ve all been subjected to the typical bait n switch tactics salesmen use to hawk their products. Ryan and the Republi-cons were forced to divulge some of the fine print in the deal; America donned it’s reading glasses but don’t like what they see. “Everyone would be covered” has morphed into, minus 24 million and eventually 52 million desperate souls, who for the first time, have life saving health care through Obama’s ACA. A “much better plan” changed into, except for the 10 basic T1 Article requirements now covered under Obamacare, including outpatient care, emergency room trips, in hospital care, pregnancy, maternity and newborn care, mental health and substance abuse care, prescription drugs, emergency services, rehabilitation and habilitative services, lab tests, preventative care and pediatric services. In other words, this plan basically provides no health care at all. And thrown in for good measure is the speedup of the tax cuts for healthcare executives making over $500,000 and on tanning beds and also shifting to block grants for Medicaid.
But the fish are balking at this boondoggle, so Paul Ryan has turned the buyer over to his sales manager, Art of the Donald, to try to close the deal.
Everyone will lose on this deal except for the dealership owners (er insurance companies, millionaires and billionaires).
Hospitals, nursing homes, cities, communities, states and most importantly, the American health care consumer will all be stuck with a clunker that will break down before the first oil change. Even the Republi-cons in congress with Trump blinders on realize they must walk away from this bad deal.
And the bottom line reveals that much cheaper, actually means, America will be paying for decades on a piece of crap they can’t use, can’t trade in and will steer them towards default, repossession and bankruptcy.
And anyone in congress who votes for this bill will suffer at the polls in the next election. American’s have seen this Insurance Industry Health Care Act sham before; been there – done that. President Obama and the Democrats, threw the un-insured and the under-insured a credible lifeline in 2010; 63% of America favors sinking some cash into the old model to bring it up to snuff; 60% of the buyers don’t want to trade Obamacare in on a shinier new pig in a poke. Only 17% of America (and only 7% strongly) believe TrumpCare is a viable plan; I’m guessing most of them work in the health insurance industry.
Some Republicans have stated they will stand firm because it’s a bad deal for those who elected them. They’re under a lot of pressure; we’ll have to see how much integrity they really have. I think the Donald and Paul Ryan will come to the conclusion that, President Obama and Speaker Pelosi were the real closers. John Hanno
Update! America 1 – Trump/Ryan 0.
It’s not surprising that the Trump/Ryan American Health Care plan went down in flames. The Republi-cons were never in favor of crafting a health care plan that would improve on Obamacare, only in fostering another tax cut for millionaires and billionaires. They don’t believe in giving poor folks health insurance; never did, never will. But after 7 years, and thanks to President Obama and the Dems, America has come to the conclusion that health care for everyone is a right, not a privilege. Obamacare gets more popular every day because real people are being favorably impacted by life saving care. And they refuse to go back to what we had before the ACA.
Thanks to everyone who stood up to Trump and the Republicans in Congress, and especially to all the folks who showed up at the Republican town hall meetings and demanded to be heard. It made all the difference. Real folks telling their real stories. America is closer to universal, single payer healthcare than anytime in our history.
So we can take a little time to celebrate; but this is not over. The Repubs in charge will do everything they can to cripple and defund the ACA, attempting to prove their wild claims that Obamacare is failing.
The Patient Protection and Affordable Care Act attempted to nudge the American Health Care System into the 21st Century. These Republi-cons are pulling back on the reins with all their misguided might. Stay informed and engaged. Our job now (as Bernie keeps preaching) is to improve the PPACA by making it Medicare for all single payer, just like the rest of the developed world. John Hanno
How Republicans can hobble Obamacare even without repeal
By Julie Steenhuysen, March 26, 2017
CHICAGO (Reuters) – Republicans may have failed to overthrow Obamacare this week, but there are plenty of ways they can chip away at it.
The Trump administration has already begun using its regulatory authority to water down less prominent aspects of the 2010 healthcare law.
Earlier this week, newly confirmed Health and Human Services Secretary Tom Price stalled the rollout of mandatory Medicare payment reform programs for heart attack treatment, bypass surgery and joint replacements finalized by the Obama administration in December.
The delays offer a glimpse at how President Donald Trump can use his administrative power to undercut aspects of the Affordable Care Act (ACA), including the insurance exchanges and Medicaid expansion that Republicans had sought to overturn.
The Republicans’ failure to repeal Obamacare, at least for now, means it remains federal law. Price’s power resides in how to interpret that law, and which programs to emphasize and fund.
Hospitals and physician groups have been counting on support from Medicare – the federal insurance program for the elderly and disabled – to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost.
The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018. Although he has voiced general support for innovative payment programs, Price has been a loud critic of mandatory federal programs that dictate how doctors should deliver healthcare.
Providers such as Dr. Richard Gilfillan, chief executive of Trinity Healthcare, a $15.9 billion Catholic health system, say they will press on with these alternative payment plans with or without the government’s blessing. But they have been actively lobbying Trump officials for support, according to interviews with more than a dozen hospital executives, physicians and policy experts.
Without the backing of Medicare, the biggest payer in the U.S. healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway U.S. healthcare spending.
Price “can’t change the legislation, but of course he’s supposed to implement it. He could impact it,” said John Rother, chief executive of the National Coalition on Health Care, a broad alliance of healthcare stakeholders that has been lobbying the new administration for support of value-based care.
The move Friday to pull the Republican bill only reinforces the risk to the existing law, which Trump said on Friday “will soon explode.”
“It seems that the Trump Administration now faces a choice whether to actively undermine the ACA or reshape it administratively,” Larry Levitt, senior vice president at Kaiser Family Foundation, wrote on Twitter.
“The ACA marketplaces weren’t collapsing, but they could be made to collapse through administrative actions,” he added.
NEW PAYMENT PLANS AT RISK
The United States spends $3 trillion a year on healthcare – more by far than 10 other wealthy countries – yet has the lowest life expectancy and the highest infant mortality rate, according to a 2013 Commonwealth Fund report. Link to Graphic: http://tmsnrt.rs/2nkTWoC
Health costs have soared thanks in part to the traditional way doctors and hospitals get paid, namely by receiving a fee for each service they provide. So the more advanced imaging tests a doctor orders or pricey procedures they perform, the more money he or she makes, regardless of whether the patient’s health improves.
“We have a completely broken economy in healthcare,” said Blair Childs, senior vice president at hospital purchasing group Premier Inc. “Literally, all of the incentives in fee-for-service are for higher cost.”
Alternative payment models are designed to remove incentives that reward overtreatment of patients. Private insurers are on board, with Aetna Inc, Anthem Inc, UnitedHealth Group and most Blue Cross insurers announcing plans to shift half of their reimbursement to alternative payment models to control costs.
To promote the shift to alternative payments, the ACA created an incubator program at the Centers for Medicare & Medicaid Services (CMS). The CMS innovation center is funded by $10 billion over 10 years to test payment schemes aimed at improving quality and cutting the cost of care.
The Obama administration’s decision to make some of these payment programs mandatory has drawn the ire of Price, a former U.S. senator and orthopedic surgeon. In response to a mandatory payment program for joint replacements last September, for example, Price charged that the CMS innovation center was “experimenting with Americans’ health.”
In his January 17 confirmation, Price said he was a “strong supporter of innovation,” but said he believed the CMS innovation center “has gotten a bit off track.”
TRUMP SETS WHEELS IN MOTION ON DAY 1
President Trump has already signed an executive order directing the HHS to begin unraveling Obamacare. In the early hours of his presidency, Trump directed government agencies to freeze regulations and take steps to weaken the healthcare law.
The order directed departments to “waive, defer, grant exemptions from, or delay the implementation” of provisions that imposed fiscal burdens on states, companies or individuals. These moves were meant to minimize the costs and regulatory burdens imposed on states, private entities and individuals.
David Cutler, the Harvard health economist who helped the Obama Administration shape the ACA, said Price could do all sorts of things to undermine the law.
“If he wants to blow it up, he can,” Cutler said in an email. But if they do, he added, “they alone will own the failure.”
Will Obamacare Really Explode?
Health-care expert Larry Levitt says it’s the Republicans who own Obamacare now—and here’s what they can do with it.
By Katelyn Fossett March 24, 2017
“Obamacare, unfortunately, will explode,” President Donald Trump said on Friday afternoon after House Republicans pulled their bill to repeal and replace the Affordable Care Act, a stunning defeat seven long years—and 18 sudden days—in the making. A glum House Speaker Paul Ryan, the architect of the doomed bill, was forced to acknowledge “Obamacare is the law of the land,” but likewise warned that the current system is unsustainable.
But is it? It’s true that the big problems of skyrocketing premiums in certain states and insurance companies backing out of the exchanges set up under the 2010 law have yet to be solved. Even Democrats admit that. But will Obamacare really explode in one big death spiral? Trump has repeatedly said Republicans would be better off letting it fail in the hopes that votes will blame Democrats when they next go to the polls in 2018.
We tried to pare back some of the spin and grandstanding in the wake of Friday’s no-vote and talk to someone who knows health care inside and out: Larry Levitt, senior adviser at the Kaiser Family Foundation and former senior health policy adviser to the White House. He told us what might really become of Obama’s signature health law in the months and years to come.
Politico Magazine: What do you think is next? Do you think they will just let Obamacare go, and what will that look like?
Larry Levitt: The Trump administration faces some tough decisions over what to do with the Affordable Care Act. The president has talked in the past about how the law is collapsing, and he has said maybe he’ll just let it collapse. The general consensus is that the law is actually not collapsing, and the Congressional Budget Office recently said that regionally, the insurance market would be stable under the ACA or the alternative the House GOP was considering. But the Trump administration could actively undermine the Affordable Care Act marketplaces or own them and work to improve them, from their perspective, and work to reshape it in a more conservative mold. I think the insurers are going to be watching very closely how the Trump administration approaches this in the next weeks and months.
Politico: You said they could reshape it. What would that look like?
Levitt: The administration has a lot of authority to reshape the law, both on the Medicaid side and the insurance marketplaces. There’s been this big fight over the essential benefits that insurers are required to provide, and the administration has some flexibility in altering those benefits administratively. There’s a lot the administration could do with state waivers, both to Medicaid and under the ACA.
Politico: So with the essential benefits, for instance, they could exempt some things from those?
Levitt: Well, so the statute lays out the 10 benefits that insurers have to provide, but within those broad categories, it’s up to the secretary of HHS to define the details. So HHS could allow insurers to set more limits on those benefits, could give states more leeway in defining them. There’s some limits to the authority: The benefits have to be comparable to a typical employer insurance policy, but you know, there’s still a lot they could do to alter the benefits. So the Pottery Barn rule does apply here: If they break it, they own it. From this point forward, anything that happens to the ACA belongs to the Trump administration.
Politico: So you’re saying, for instance, that they can’t take maternity care out of the essential benefits, but they can say what falls under that umbrella?
Levitt: Well, maternity care is a tough one. Prescription drugs, there’s probably a little bit more flexibility—allowing insurers more leeway in defining which drugs they cover. Or in some benefits being able to set limits on the number of physical therapy limits an insurer has to cover.
Politico: The case that Obamacare is collapsing is driven by this uncertainty, which is making insurers pull out. What does this fight do that uncertainty?
Levitt: The uncertainty insurers had been facing was what would come next after the Affordable Care Act, after this repeal-and-replace debate. It now looks like, for the foreseeable future, the Affordable Care Act is what’s coming next. So in some sense, there is greater certainty for insurers now in knowing that the ACA is here to stay. The big uncertainty has come in what the Trump administration may do administratively.
The most immediate risk is what happens with cost-sharing subsidy payments to insurers. These are the payments that are at issue in the lawsuit that the House filed against the HHS, challenging their authority to make these payments. If the administration decides to stop those cost-sharing subsidy payments, you could see insurers running for the exits.
Politico: So there is a case that in some ways this uncertainty is at a new low after this. So that’s a case the marketplaces might do better, right?
Levitt: Right, so those insurers know that the ACA is here to stay. But what they don’t know is what the administration might do to undermine the law or allow it to collapse. This is a program that has to be operated for it to succeed. So, for example, for insurers to be profitable in this market, there has to be active outreach to bring in new customers. The Obama administration was active in doing that outreach, including the president himself. It’s hard to imagine President Trump going on “Between Two Ferns” to encourage young people to sign up for health insurance through the ACA.
Politico: So you mentioned the cost-sharing subsidies to undermine Obamacare. What other tools can the Trump administration use to undermine it?
Levitt: The individual mandate, as we heard recently from the Congressional Budget Office, is key to keeping insurance markets stable. And the Trump administration has a lot of administrative authority to undermine the individual mandate. They could grant waivers to large groups of people because they could lead to hardship under the individual mandate. They could announce they’re not going to enforce the penalties under the individual mandate, so there could be an open invitation for people to flaunt it. You know, it is the individual mandate that is the stick to try to get young, healthy people to sign up to balance out the sick people who know they need insurance.
Politico: So when you were looking at the disagreements that sank the bill, did you think there were any kind of creative workarounds or middle-ground options that you thought people had left unturned?
Levitt: There was this idea of a stability pool—the hundred million dollars in grants to states that would go a long way toward keeping some markets that are now fragile. That hundred-million-dollar pool could go a long way toward stabilizing fragile markets around the country. This was the kind of thing that Republicans in the past called a bailout to insurers, but was a part of their own bills. It’s hard to imagine any congressional action at this point to shore up the ACA, but a grant pool like that could shore things up.
Politico: So what problem would that get around?
Levitt: So, by and large, insurance markets are stable under the ACA, but insurance risk is pooled at the state level, and there are some states where the markets are fragile, where premiums have increased substantially and in some cases, enrollment has started to drop. These markets are still well short of a death spiral, but there could be bigger premium increases to come in these places. And a pool of money that states could use to help cover the cost of a very expensive and sick people could help stabilize those markets. This is what I think people will be watching for in how the Trump administration responds. For example, in Tennessee, which is one of those markets that’s fragile, [the insurance company] Humana recently announced it is pulling out, and it will leave a number of counties in the state with literally no insurers participating. Now, under the Obama administration, there would be a lot of jawboning going on to try to get an insurer to offer coverage there—it’s not clear that will happen under this administration. That happened in Arizona this past year when there was a risk there might be no insurers participating.
Politico: So let’s say the Trump administration pulls out all of its tricks and goes after Obamacare. Do you think it could collapse?
Levitt: The worst case is there are parts of the country where there are no insurers offering coverage, and that could certainly happen, but it’s not going to be the case in the vast majority of the country. I don’t think that in the vast majority of states there’s a risk of collapse. But things could absolutely get worse, with fewer people enrolled and premiums rising fasters.
That’s insurance markets, but with Medicaid—the Medicaid expansion continues as long as states continue to get federal money.
Politico: Would there be a Trump way of undermining the Medicaid expansion?
Levitt: Not so much undermine, but the Trump administration has already signaled it would grant waivers to states that want to experiment more broadly with how they run the Medicaid programs. So things like work requirements, things like requiring more low-income people to pay premiums to enroll in Medicaid. I think those are likely to change.
Katelyn Fossett is a web producer for POLITICO Magazine.