Health Policy Updates: May 20 2017

There was some buzz this week that the AHCA, as passed by the House, might actually run afoul of Senate budgetary rules that would invalidate the bill. Potentially, this could mean having to revise and re-pass the bill in the House, separately from any process going on in the senate. The potential issues appear to stem from requirements that laws not add to the deficit. I have seen some skepticism that this potential scenario would actually play out; offered an explainer.

“Depending on what the CBO says, the House might have to change the American Health Care Act and pass it again or even start over, according to Bloomberg…Experts have wondered if the House bill would work under the Senate’s rules, which are supposed to restrict a bill considered under “budget reconciliation” to make sure it affects only federal spending and revenue. If those strict conditions are met, then the Senate can advance a bill with just 50 votes. Republicans are using that process because otherwise Democrats could block the legislation.”

The ACA exchange plans may be in for another year of steep premium hikes, if the insurers’ requests end up panning out:

“This is how much insurance plans want to raise rates, and insurance commissioners will be charged with evaluating whether these rate increases are reasonable. So there is decent reason to believe some of the especially big numbers might decline a bit in the process of those negotiations. Still, let’s not beat around the bush: These are big, big rate increases that insurance plans are asking for. A 50 percent requested rate hike that falls to 40 percent or even 20 percent in the course of negotiations is still a big increase.”

The data continue to come in: the ACA has improved access and outcomes for low-income adults.

“By the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state. For uninsured people gaining coverage, this change was associated with a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23-percentage-point increase in “excellent” self-reported health.”

The Trump Administration continued its incoherent approach towards Obamacare, both continuing to threaten removal of market-stabilizing subsidies and also proposing technical fixes to the website that will facilitate more people signing up for ACA exchange plans.

“That change, which the brokers have sought for more than four years, is likely to make it easier for those third-party brokers to enroll customers in Obamacare plans by removing a requirement that they have customers ping-pong between the brokers’ websites and”

The idea of “Medicare for All” has been trending in left-leaning/universal coverage circles. But would “Medicaid for All” be a better model?
“Many conservatives mistakenly believe Medicaid is an out-of-control entitlement and want to cap federal Medicaid spending. But Medicaid provides low-cost care to millions of the nation’s oldest, sickest and most vulnerable populations. In 2013, a report by the Urban Institute demonstrated that if an average adult on Medicaid had traditional private insurance instead, the cost of care would be over 25 percent higher.”

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