Health Policy Updates: April 22 2017

Like a phoenix rising from its own ashes, Republican health care reform is alive again.’s Sarah Kliff runs through some of the features of the new version of their bill:

“What we do know is that this latest proposal doesn’t do much at all to assuage concerns about the older proposals. While it meets many of the demands of the party’s far-right wing — namely, the deregulation of the individual insurance market — it does nothing to address concerns about massive coverage loss. Instead, it likely makes those problems worse…

…This GOP amendment to let states waive community rating would once again allow insurers to charge people based on their expected health care costs. Insurers would not be able to deny coverage to people with preexisting conditions, but they would have free rein to charge them especially high premiums.”

President Trump demonstrated his expertise in the complex details of health policy, with his analysis of the changes to this new version of the health care reform bill:

“‘The plan gets better and better and better, and it’s gotten really, really good, and a lot of people are liking it a lot,’ Mr. Trump said.”

Outside of Congressional circles, a group of conservative health care experts proposed using “auto enrollment” as a policy tool in future reform efforts. Rather than require everyone to have health insurance – as the ACA does – would it be possible to reach most of the same ends simply by “nudging” people towards health insurance coverage as a default?

“Capretta and Chen also frame the idea of auto enrollment quite differently from the mandate. ‘Opponents will argue that automatic enrollment infringes on personal liberty,’ they write. ‘But people placed into such coverage would be free to opt out or to select an option that better suits their needs’…It seems impossible to imagine Democrats proposing a plan to automatically enroll Americans in the marketplaces without causing outrage over a government-run health care system. But if the proposal comes from the right? It might just have a shot.”

Be wary! Interested parties with the goal of protecting their marketshare and preventing fair competition often come in the guise of patient safety. Opposition to imported generic drugs is a good example.

“The nonprofit, called the Partnership for Safe Medicines, has recently emerged as a leading voice against Senate bills that would allow drugs to be imported from Canada. Both the lobbying group [PhRMA] and the nonprofit partnership have gone to great lengths to show that drugmakers are not driving what they describe as a grass-roots effort to fight imports…the nonprofit describes PhRMA as a dues-paying member with no larger role in shaping the group’s activities…PhRMA spokeswoman Allyson Funk declined to say whether PhRMA funds the partnership.”

Insurers and state governments are struggling with having to guess how the Trump Administration will move forward with ACA policy. Will the exchanges still exist? Will they be defunded? The mixed messages coming from DC are foreshadowing a chaotic year.

“After the failure of Republicans’ first attempt to repeal and replace the Affordable Care Act and President Donald Trump’s subsequent threats to let the program “explode,” more health insurers are threatening to pull out next year, while others may sharply raise the premiums they charge. They’ll start to declare in the next few weeks whether they’re in or out…

…The political uncertainty is overshadowing what is, for some carriers, an improving financial picture. Without the overhang of the cost-sharing subsidies or major changes to the law, health insurers would be on their way to a profitable 2018, after increasing rates more than 20 percent on average for this year”

Is Obamacare “exploding”? Imploding? You hear these assertions tossed around quite a bit. What do people who make these claims even mean? Presumably, they are talking about the insurance exchange markets that the ACA/Obamacare set up, and that these markets are in the process of losing patients and/or insurers in such a manner that threatens their long-term existence. But is this actually happening? Larry Levitt of the Kaiser Family Foundation comments.

“…the enrollment mix has skewed more toward individuals who are older and sicker than insurers expected, and many had to raise premiums significantly in 2017…There were some fragile insurance markets going into 2017—particularly in rural areas, with low population density and little competition among hospitals and physicians—but by and large, the marketplaces have been stabilizing and improving.”


One thought on “Health Policy Updates: April 22 2017

  1. On the return to pre-existing-condition screening and high-risk pools that may be coming up as soon as next week let me add these 3:

    1)Nice Margot Sanger-Katz New York Times article on the process of pre-existing-condition screening: the long application, etc:

    2)An older Margot-Sanger Katz article complementing (1) with discussion of malfunctioning of high-risk pools pre-Obamacare (closed, waiting-list, coverage limits, etc.) and also discussing that going to the doc when you are sick may lead to a new pre-existing condition: often it was a bad idea to go if what what you had wouldn’t actually have killed you:

    3Both Sanger-Katz articles leave out that a pre-existing-condition you accidentally left off your application could cause an insurer to not pay your bills and rescind your policy only after you got sick and they re-examined your medical records, so I have links here (labelled (1),(2),(3)) on a page from my own pre-Obamacare site:

    (Especially nice is a video from the old Bill Moyers show.)

    4)Finally, broader than pre-existing-conditions, let me toss in a nice Paul Krugman article from last week with a nice “stuffing a balloon into a box that’s too small to hold all the balloon’s air” analogy for the promises Trump and the Republicans have been making (to do the impossible).:

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