Tag Archives: repeal and replace

Health Policy Updates: August 6 2017

The Vox.com policy podcast The Weeds gives a great recap on last week’s demise of GOP efforts to repeal the ACA. Link on Player.FM.

With GOP efforts to repeal the ACA currently stalled, a bipartisan group has begun meeting in order to improve on the ACA framework and stabilize its insurance markets.

“The roll out of their stabilization agenda follows months of private meetings between various members involved in the House’s centrist caucuses about ways to stabilize Obamacare if the GOP’s repeal effort sputtered.”

These efforts put lawmakers at odds with the President, who continued to suggest allowing (and causing) the ACA markets’ collapse.

“These problems have been exacerbated by a president who has publicly predicted that the Affordable Care Act will ‘implode’ and appears determined to help fulfill that prophecy. Mr. Trump has repeatedly threatened to cut off the subsidies, known as cost-sharing reduction payments, which reimburse insurers for cutting deductibles and other out-of-pocket costs for millions of low-income people. Without them, insurers would almost certainly raise premiums…”

 
Continue reading Health Policy Updates: August 6 2017

Health Policy Updates: July 29 2017

As of Tuesday, the Senate voted to open debate on a bill which, 24 hours prior, its members did not know the contents of.

“…there are at least four different draft health care bills floating around right now…The lack of clarity is part of a larger lack of direction for Senate Republicans’ six-month health care effort…Throughout this process, Republicans have struggled to articulate what exactly they want to achieve — aside from delivering on a seven-year campaign promise to repeal and replace Obamacare.”

Votes on the BCRA and then “full” Obamacare repeal followed shortly thereafter, and were both defeated by slim margins. Attention then turned to the so-called “skinny repeal,” which would leave the ACA/Obamacare’s Medicaid expansion intact and get rid of only the individual and employer mandates to have health insurance. Finally, even skinny repeal went down in a vote early Friday morning, with John McCain breaking party ranks (and joining Sens. Collins and Murkowski) to become the decisive “no” vote, in a dramatic fashion on the Senate floor – video here.

It remains to be seen whether the ACA repeal effort is truly dead this time, or will continue to rise from its own ashes.
Continue reading Health Policy Updates: July 29 2017

Health Policy Updates: July 23 2017

Wow, another incredibly hectic week. Health policy has never been so frenzied…even though we ought to be getting used to it by now.

To sum up the horse-trading, by Monday night enough Senate Republicans had come out against the Better Care Reconciliation Act that it became clear the bill would never pass. Senate Leader Mitch McConnell, followed by Donald Trump, quickly reverted to the old “repeal and delay” strategy of voting to repeal the ACA in two years time, giving a prolonged interval to work on replacement. This strategy already failed back in February. Again, enough Senate Republicans came out against “repeal and delay” by Tuesday that this, too, seemed unlikely.

“But it became quickly apparent that GOP leaders, who were caught off guard by defections of their members Monday night, lacked the votes to abolish parts of the 2010 law outright. Three centrist Republican senators — Susan Collins (Maine), Shelley Moore Capito (W.Va.) and Lisa Murkowski (Alaska) — all said they would oppose any vote to proceed with an immediate repeal of the law.”

(the repeal and delay strategy, by the way, would result in 32 million Americans losing insurance, according to the CBO report that came out Wednesday).

Despite what looks like a lack of sufficient vote and the continually-damning CBO scores, GOP leadership continues to plan for a vote next week.

Continue reading Health Policy Updates: July 23 2017

Health Policy Updates: July 16 2017

On Thursday, the Senate released its latest version of its Obamacare-repeal bill, known as the BCRA. Vox.com ran a brief explainer on the key provisions that have changed since prior versions, including a shift towards low-premium (and low-coverage) plans:

“The bill will include a provision based on a proposal by Sen. Ted Cruz (R-TX), which allows health plans to offer skimpy coverage options so long as they have at least one plan that covers a robust set of benefits. The insurance industry opposes the policy, calling it ‘infeasible’ and fearing it would create ‘greater instability.'”

Politico ran a similar outline of the bill’s contents.

The GOP efforts at health care reform, overall, continue to be a “solution in search of a problem.”

“The GOP health care bill doesn’t even have pretextual justifications. Republican leaders like to claim that Trumpcare is necessary because Obamacare is “collapsing” into a “death spiral,” but not only is Trumpcare non-responsive to a death spiral, the death spiral they posit as the basis for Trumpcare is wholly fabricated.”


The supposed urgency behind Obamacare repeal is that it is “collapsing.” This doomsday claim is a bit premature, however, as the exchanges have continued creep along slowly but surely. In fact, a new report out from Kaiser appears to show that the Obamacare insurance exchanges are looking healthier than ever.

“Early results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. Insurer financial results show no sign of a market collapse…Although individual market enrollees appear on average to be sicker than the market pre-ACA, data on hospitalizations in this market suggest that the risk pool is stable on average and not getting progressively sicker as of early 2017. Some insurers have exited the market in recent years, but others have been successful and expanded their footprints, as would be expected in a competitive marketplace.”


The ongoing challenge for the GOP in passing health care legislation is that different GOP senators have different goals. Some want sustained Medicaid spending, others want even deeper cuts. The NY Times gives a summary of which senators are breaking with the party line to request more changes to the bill – and which senators are pulling in opposite directions.


More great writing on Medicaid by Aaron Carroll and Austin Frakt this week. This time, the topic at hand is the idea that private insurance is inherently “better” insurance than Medicaid. This is one of the chief arguments among Medicaid critics (typically, the GOP) that Americans would be better off by defunding Medicaid and transitioning people to some for of private plans. While it is true that some doctors do not accept Medicaid, causing access problems, in general Medicaid is actually better than private insurance. Medicaid simply pays more of your medical costs; that is, it has lower “cost sharing” requirements – low/no deductibles, copayments, and coinsurance.

And based on well-established research, having low cost sharing is important for the quality of health care that people receive…

“The Senate’s health care plan, for example, would offer much less generous plans. A 64-year-old woman with an income of $11,400 would face a deductible of at least $6,000. For her, such a plan is not better than Medicaid; it is most likely much worse if she is also sick. Because of the deductible, the care she’d need would be financially out of reach.”


Kaiser Health News has recently started a new health policy news podcast called “What the Health.” I just listened to episode #3, a conversation including Margot Sanger-Katz at the NYTimes and Sarah Kliff at Vox.com about the politics behind the BCRA.

I’ll be a new subscriber! Highly recommended.


 

Health Policy Updates: July 1 2017

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.

CBO projections for uninsurance rates after BCRA passage

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.

Continue reading Health Policy Updates: July 1 2017