Another frantic news week in health care policy, with the demise of both the Graham-Cassidy Obamacare repeal bill, and of Tom Price’s tenure as HHS secretary.
With passage of Graham-Cassidy looking doubtful, a revised draft of the bill was crafted over last the weekend. This version not-so-subtly moved additional funds to those states with “hold out” GOP senators; this move suggesting something of a vote-buying effort:
“The favoring of certain states over others in the new version of the bill, presumably to please Senators representing the favored states and obtain their votes, raises serious constitutional issues. Law Professor Brian Galle has argued that it would violate the Constitution’s Uniformity Clause, which prohibits laws specifically favoring particular states.”
The overall structure of the bill, including steep Medicaid cuts and a return of pre-existing condition exclusion, remained intact:
“Like the earlier version, the latest draft allows states that obtain block grants to waive certain consumer protections contained in the ACA…As with the earlier draft, however, the consumer protections that the bill does allow states to permit insurers to waive makes protection for people with preexisting conditions very tenuous.”
The CBO report on the Senate’s ACA repeal bill – BCRA – came out on Monday. There are a lot of details, but you can read the general summary here. Since a picture is worth 1,000 words, I think their predictions can best be captured in a single picture – which Alvin Chan and Sarah Kliff at Vox.com have produced from the CBO’s numbers.
If repealing Obamacare was the goal, it looks like BCRA would achieve that. This bill, if it becomes law, would erase all of the insurance coverage gains made over the last 5 years, and effectively take us back to the pre-Obamacare era.
The big health policy news this week was the revelation of the new GOP “repeal and replace”/Trumpcare plan, which has been named the American Health Care Act or AHCA.
Vox.com’s Sarah Kliff explains how some of the biggest proposed changes would work:
“In 2020, enrollment in the Medicaid expansion will “freeze” and states with no longer be able to sign new enrollees up for the program. Legislators expect that enrollment would slowly decline, as enrollees’ incomes change and they shift off the program…
On the surface, the tax credits for the oldest Americans seem the most generous. People in their 60s, for example, get twice as much help as those in their 20s….But under the Republican plan, insurers would be allowed to charge the oldest Americans five times as much as the youngest Americans. Their financial help would not scale nearly as much as their premiums would.”
I liked this “high yield” layout from the NYTimes of what the GOP plan will keep, change, or get rid of from Obamacare.
Conservative health policy expert Avik Roy weighed in on the plan in Forbes:
“Leading House Republicans have included a number of transformative and consequential reforms in their American Health Care Act, the full text of which was published Monday evening. But those reforms are overshadowed by the bill’s stubborn desire to make health insurance unaffordable for millions of Americans, and trap millions more in poverty.”
A large part of the ACA/Obamacare was to expand Medicaid; many (though not all) states elected to do so. New data out this week in JAMA Internal Medicine suggests that patients are benefiting. Compared to states that did not expand Medicaid, previously uninsured patients who have now gained access to Medicaid coverage do better on many metrics, including better access to outpatient care, increased diabetes screening, and reduced non-compliance due to cost.
The Oregon Medicaid experiment from a few years ago left Medicaid skeptics with some reason to be agnostic as to whether Medicaid actually improves people’s health. These data lessen the foundation for such skepticism, and should thus should help move the conversation forward. Continue reading Health Policy Updates: August 14 2016→
The Washington Post’s Wonkblog reports on a new study out of UNC-Chapel Hill, finding that significant out-of-pocket prescription drug costs still exist for seniors on Medicare. Even once the “donut hole” closes, prohibitive coverage gaps for seniors will still exist.
“What the researchers found is that closing the coverage gap will save money – about $2,500 at current cancer drug prices. But that still means around $4,000 to $10,000 out-of-pocket spending for patients, which may be unattainable for people on a fixed income. And that assumes that drug prices stay stable and do not increase, as they’ve been doing for many cancer drugs.”Continue reading Health Policy Updates: December 19 2015→