Image by Gordon Johnson from Pixabay 

This is part two of my series of blogs about the ways that the GOP, under President Trump, attempted to destroy Obamacare. You may want to read part one before jumping into this blog post.

This blog post details the shenanigans that happened in 2018, during the 115th Congress. The GOP had the Presidency, the majority in the U.S. Senate and the majority in the U.S. House of Representatives.

One of the things I noticed when the GOP got started (last year) on attempting to destroy Obamacare was that they extended their efforts beyond it.

The GOP also tried to prevent poor people, disabled people, and those with pre-existing conditions from being able to afford the health care they needed. The GOP tried to cut off funding for women’s health care (including reproductive care and abortion). They even went after Medicaid, Medicare, and other established health care options for poor people.

January 5, 2018: Governor C.L. “Butch” Otter (Republican) posted a News Release on his official website. From the News Release:

Governor C.L. “Butch” Otter directed the Idaho Department of Insurance today to use flexibility provided by the Trump administration to develop guidelines under which Idaho health insurance carriers can offer coverage plans at significantly lower costs.

At the annual Associated Press Legislative Preview in the Capitol today, Governor Otter signed Executive Order 2018-02 instructing Insurance Director Dean Cameron to seek creative ways outside the restrictions of the Affordable Care Act to make health coverage more affordable for Idaho residents…

…Cameron said he hopes insurance plans from Idaho carriers can be available as early as March to reduce costs for essential health-care coverage by 30 to 50 percent. Such plans would not qualify for an Obamacare subsidy on premium payments but carriers involved must agree to continue offering plans through the Your Health Idaho insurance exchange, where federal subsidies will continue to be available.

Idaho sought greater flexibility from Health and Human Services “to continue innovating and creating new products under our State law,” in a March 10, 2017 letter from Governor Otter to then-Secretary Tom Price.

President Trump also issued an executive order on January 20, 2017 – the day of his inauguration – aimed at minimizing the economic burden of the Affordable Care Act “Pending Repeal.” It stated that the federal government should “take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.”

Cameron said those steps, and elimination of the individual mandate, should enable the State to take actions to keep Idahoans from having to pay too much for insurance, resort to unconventional alternative treatments or simply go without coverage. “We believe we have the authority already,” he said. “We want to act quickly.”

January 10, 2018: Financial Times posted a very long, detailed, heartbreaking article titled: “Why are so many Americans crowdfunding their healthcare?”  It was written by Barney Jopson.  From the article:

…Then there is the issue of money. In the US, where healthcare is not a human right, any serious illness comes with a financial shock. The average cost of hospital stays for cancer patients in 2015 was $31,290, according to government figures – about half that year’s median household income. The most common form of childhood cancer costs on average $292,000 to treat, says St. Jude Children’s Research Hospital in Memphis, Tennessee.

For the most fortunate Americans, these costs are covered by comprehensive insurance plans. For millions of others, they are a potentially crippling burden. After Isabella’s diagnosis, [Claudia] Koziner [Isabella’s mother] took unpaid family leave to care for her daughter, reducing the family to a single income. She and Isabella were able to stay on the health plan provided by her employer, ensuring they did not join the 28 million Americans who lack any health insurance. Instead, they are part of a larger group that is underinsured. The family pay $15,000 each year as part of cost-sharing arrangements with the insurer, then have to cover everything it will not, ranging from protein shots to hearing tests to two-way ambulance trips that can cost up to $3,000…

…For Isabella and her parents, crowdfunding has alleviated financial pressure at an agonizing time. “The fact that at least, at this point in time, we don’t have to stress about finances is huge,” says Koziner. I don’t even know how we’d get by.” But its spread is also a symptom of a particularly American affliction: a flawed, costly healthcare system that offers some of the best care in the world to those who can afford it, while forcing millions of others to either plunge into debt or leave their illnesses untreated.

The rise of online fundraising for medical expenses brings its own troubling consequences, replicating some of the inequalities already dividing the country by forcing people to compete for funds…

…It should be no surprise that healthcare proved fertile territory [for GoFundMe]. Crowdfunding is also growing in the UK, Australia, and Canada but is generally confined to treatments not covered by public healthcare systems. In the US, it is often about paying for the basics. American medicine is big business and the US spends more on it than any other nation, yet is the only developed country that lacks universal healthcare coverage. A fifth of US household spending went on healthcare in 2013, compared with just 4 per cent in the EU, according to Eurostat, a statistics agency.

Despite this, Americans are in worse health. Judged on measures including life expectancy and infant mortality, the US ranked last for healthcare outcomes among 11 high-income countries in a study last year by the Commonwealth Fund, a New York-based research foundation…

…Crowdfunding may also perpetuate existing inequalities. Well-off people can tap into networks of well-off friends who have money to donate in a crisis. Poorer people tend to have ties to poorer people with less to give. Kenworthy and co-researcher Lauren Berliner warn that results can also be distorted by prejudicial notions of “deservingness” based on race, class and immigration status…

… No business sector, not even Wall Street, has shelled out more on lobbying than pharmaceuticals and health products. From 1998 to 2017 it spent $3.7bn influencing policymakers, according to the Center for Responsive Politics. Physicians have also preserved their generous earnings. Jobs in medicine and dentistry accounted for none of the 10 highest-paying roles in American in 2016, according to Forbes, with anesthesiologists earning an average salary of $269,000, surgeons $252,910, and family doctors $200,810…

…By the time Obama became president, voter frustration with the system’s dysfunction was such that the industry decided it had to support his push for change in order to influence it. Obamacare’s signature achievement was to reduce the number of uninsured Americans – but in doing so it cemented the primacy of private insurers…

…Half of the population have private policies provided by employers, and 7 percent have plans purchased individually, including on Obamacare marketplaces. Government programs for the poor, elderly and veterans cover about 35 percent of the population.

Nine percent have no health insurance, because they can’t afford it or don’t see it as a priority. According to the Commonwealth Fund, three out of 10 working-age Americans were underinsured in 2016 (meaning they had high out-of-pocket healthcare costs relative to their incomes) – 41 million people…

January 11, 2018: The Center for Medicare and Medicaid Services (CMS) sent a letter to State Medicaid Directors. From the letter:

The Centers for Medicare & Medicaid Services (CMS) is announcing a new policy designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability. [1] Subject to the full federal review process, CMS will support state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for certain adult Medicaid beneficiaries in demonstration projects authorized under section 115 of the Social Security Act (the Act). Such programs should be designed to promote better mental, physical, and emotional health in furtherance of Medicaid program objectives. Such programs may also, separately, be designed to help individual families to rise out of poverty and attain independence, also in furtherance of Medicaid program objectives [2]…

…[1] States will have the flexibility to identify activities, other than employment, which promote health and wellness, and which will meet the state’s requirements for continued Medicaid eligibility. These activities include, but are not limited to, community service, caregiving, education, job training and substance use disorder treatment.

[2] Section 1901 of the Social Security Act authorizes appropriations to support State Medicaid programs: “For the purpose of enabling each State, as far as practicable under the current conditions in such State, to furnish (1) medical assistance on behalf of families with dependent children of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services, and (2) rehabilitation and other services to help such families and individuals to attain or retain capability for independence or self-care[.]”…

January 11, 2018: The New York Times posted an article titled: “Trump Administration Says States May Impose Work Requirements for Medicaid”. It was written by Robert Pear. From the article:

The Trump administration said on Thursday that it would allow states to impose work requirements in Medicaid, a major policy shift that moves toward fulfilling a conservative vision for one of the nation’s largest social insurance programs for low-income people.

Federal officials said they would support state efforts to require able-bodied adults to work or participate in other “community engagement activities” as a condition of eligibility for Medicaid…

…Ms. [Seema] Verma [Administrator of the federal Centers for Medicare and Medicaid Services] said the Trump administration was responding to requests from Medicaid officials in 10 states that wanted to run demonstration projects testing requirements for work or other types of community engagement like training, education, job search, volunteer activities and caregiving.

Under the new policy, Trump administration officials would allow work requirements in Medicaid somewhat similar to those already imposed in other programs like food stamps, now known as the Supplemental Nutrition Assistance Program, and the welfare program known as Temporary Assistance for Needy Families…

…The Medicaid proposals came from Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin. Several other states are considering work requirements…

…Advocates for Medicaid beneficiaries said the new policy was likely to be challenged in court if people were denied coverage for failure to meet a state’s work requirement.

Federal law gives the secretary of health and human services broad authority to grant waivers for state demonstration projects that “promote the objectives” of the Medicaid program. In the past, federal officials said that work was not among those objectives.

But Trump administration officials said on Thursday that work requirements were consistent with the goals of Medicaid, because work and work-related activities could improve the health of Medicaid beneficiaries….

…The Trump administration said that states imposing work requirement must have plans to help people meet those requirements and should help arrange job training, child care, and transportation as needed. But, it said, states cannot use federal Medicaid funds to pay for such “supportive services”…

January 11, 2018: The New York Times posted an opinion piece titled: “Trump’s Medicaid Work Requirement Will Backfire.”

It was written by Jared Bernstein (senior fellow at the Center on Budget and Policy Priorities) and Hanna Katch, (a health policy expert at the center and a former Senate health policy staff member and a California Medicaid administrator). From the opinion piece:

Just because President Trump and the Republican Congress were unable to pass health care legislation that would have unwound the coverage benefits of the Affordable Care Act doesn’t mean such attacks are behind us. To the contrary, Republicans are now making an end run around Congress to accomplish one of their harshest goals: kicking economically vulnerable people off Medicaid.

The administration’s new approach – one that no administration before it has taken – is to provide waivers to states that allow them to impose work requirements for Medicaid benefits. Thus far, the Centers for Medicare and Medicaid Services has received requests for waivers from 10 states. C.M.S. released guidance on Thursday describing how states can institute these work requirements.

Even before Thursday, C.M.S. had unilaterally changed the standards a waiver must meet to accord with Medicaid’s core mission – specifically, that whatever they do, states must increase and strengthen health coverage for people of limited means. Now the administration will be considering waivers that are likely to deprive thousands of low-income people of health care.

Some of these people will lose coverage because they can’t find jobs to fulfill the work requirements. Others will lose it because they fail to complete paperwork proving they’re working or that they qualify for exemptions. For example, people with mental illness, addiction, or chronic disease often struggle to meet bureaucratic demands; in programs that already demand that beneficiaries work, such individuals have often been punished for falling short on work requirements even though they’re supposed to qualify for exemptions…

…People losing coverage could suffer severe harm. A study of Medicaid expansion in Kentucky and Arkansas found that it led to significant gains in access to care, financial security and health, with increases in the share of low-income adults going for checkups, getting regular care for chronic conditions and reporting that they are in excellent health. It also found large decreases in the share of people struggling to pay medical bills and relying on hospital emergency rooms for care. Under the new waivers, these gains will be reversed.

It is also essential to recognize that Medicaid work requirements won’t work. There’s no evidence that Medicaid discourages work, which comports with common sense: You can’t pay rent or buy groceries with health coverage. About 80 percent of able-bodied adult Medicaid recipients are part of working families (that is, either they or their spouses work), and about 60 percent work themselves. Among adults on Medicaid who don’t work and could be subject to the work requirement, more than a third have a chronic health problem or disability, about half take care of family or go to school, and just under 10 percent can’t find work.

It’s far more likely that Medicaid work requirements will backfire, at least in terms of improving beneficiaries’ living standards. By providing coverage for workers in jobs that are unlikely to provide such benefits, and by helping to stabilize the finances of people with illnesses, Medicaid has been found to help people stay employed or find work.

Of course, not all the Republicans’ efforts to shrink Medicaid are occurring through executive, as opposed to congressional, action. The new tax law’s repeal of the Affordable Care Act’s individual mandate could, according to the nonpartisan Congressional Budget Office, cut five million from the Medicaid rolls by 2027. That’s because, absent the mandate, fewer low-income people will find out that they’re eligible for Medicaid, especially in expansion states…

January 12, 2018: Courier Journal (Part of the USA Today Network) posted an article titled: “Kentucky first to win federal approval to roll back Medicaid expansion under Obamacare”. It was written by Deborah Yetter. From the article:

Calling it an “exciting day,” Gov. Matt Bevin on Friday said federal authorities have given Kentucky broad power to reshape its Medicaid program, making it the first state in the nation to win such approval under rules that allow states to include work requirements for some recipients…

…The news was released Friday by U.S. Rep. John Yarmuth just minutes before Bevin’s announcement. Yarmuth called the move “dangerous and irresponsible,” saying it will cause tens of thousands of Kentuckians to lose health coverage.

But Bevin dismissed such comments and said the plan will transform Medicaid.

“It will be a model for the nation,” he said.

But advocacy groups disagreed, including Kentucky Voices for Health, a coalition of health organizations that had opposed the changes as unnecessary and harmful to low-income people who rely on Medicaid for health care…

…The approval comes 16 months after Bevin, a Republican elected in 2015, announced sweeping changes to the $10 billion federal-state program that provides health care for 1.4 million low-income and disabled Kentuckians, arguing it is “not sustainable”.

And it comes one day after the Centers for Medicaid and Medicare announced it has approved controversial new “community engagement” rules to allow stats to require some Medicaid beneficiaries to work or volunteer in order to get health coverage…

…The program will be phased in starting in July, officials said Friday.

Bevin’s plan would require some adults to work or volunteer at least 20 hours a week or be in school or job training to keep health benefits. He has said it will inject more personal responsibility into the government health plan and believes participants should have “some skin in the game.”…

…[Leonard] Cuello [a lawyer with the Washington-based National Health Law Program] said Medicaid law is designed purely as a health law and efforts by states to add a work requirement, as authorized by federal aid programs such as food stamps, are not allowed.

“Medicaid is a healthcare program,” he said. “It’s about health services. It’s not about employment encouragement.”…

…Advocates say the changes will cause up to 95,000 Kentuckians to lose Medicaid health coverage, according to the administration’s own calculations….

January 12, 2018: Rewire News posted an article titled: “Despite Republican Claims, Medicaid Work Requirements Would Hurt People With Disabilities”. It was written by Robyn Powell. From the article:

…Republicans have unwaveringly asserted that work requirement will only apply to people who are “able-bodied.” This claim is simply untrue. The disability exception promulgated in the new rules only covers people who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). In other words, anyone who has a disability and does not receive SSI or SSDI would likely need to adhere to the new work requirements, should their state implement them…

…To receive SSI or SSDI, a person must meet the Social Security Administration’s (SSA) stringent definition of disability: “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” Put differently, one’s disability must be deemed so significant that they are unable to work in any type of job.

According to Rebecca Cokley, senior fellow at the Center for American Progress, “Cancer survivors, some chronic conditions, people with mental health disabilities, and those who are substance abuse survivors will likely still be impacted, as often these are folks who get Medicaid but don’t meet the qualifications for [SSI or SSDI],”

Qualifying for SSI or SSDI is no small feat and most people who endure the lengthy application process do not ultimately receive benefits. In fact, fewer than four in ten applications for SSI and SSDI are ultimately approved. Moreover, applicants often are forced to wait years and go through many appeals processes before receiving SSI or SSDI; 10,000 people died last year while waiting for their appeal to process. Nevertheless, people with disabilities “will be forced to navigate a byzantine bureaucracy to qualify [for the work requirement] exceptions,” [Ari] Ne’eman [an Obama administration appointee to the National Council on Disability] said.

January 16, 2018: Los Angeles Times posted an article titled: “Number of Americans without health insurance grows in Trump’s first year, new figures show”. It was written by Noam N. Levey. From the article:

The number of Americans without health coverage, which declined for years after passage of the Affordable Care Act, shot up in President Trump’s first year in office, according to data from a new national survey.

At the end of 2017, 12.2% of U.S. adults lacked health insurance, up from 10.9% at the end of 2016, as President Obama was completing his final term.

The increase of 1.3 percentage points, although modest, marks the first time since at least 2008 that the share of adults without insurance increased from the previous year, according to the report from Gallup, which conducts a widely followed survey asking Americans about their health coverage.

The increase indicates that 3.3 million Americans lost health coverage in 2017, Gallup concluded.

The decline in coverage was most pronounced among slices of the population on which the Obama administration and its allies had focused enrollment efforts; young adults, blacks, Latinos and households making less than $36,000 a year, Gallup found.

The losses follow years of historic insurance gains driven by the healthcare law’s expansion of coverage, which started being fully implements in 2014…

…A recent study of data from two states that have dramatically expanded coverage, Arkansas and Kentucky, found, for example, that low-income patients with chronic illnesses are now much more likely to seek recommended care.

By contrast, there has been significantly less improvement among such patients in Texas, which has not expanded coverage fully through the healthcare law.

But many Republicans, including leading Trump administration officials, have dismissed coverage gains as meaningless. They have argued that the coverage provided under the healthcare law is unaffordable – because of out-of-pocket costs are too high – or that patients face too many restrictions in their choice of doctors.

Trump came into office last January pledging to roll back the law, common called Obamacare. His administration undertook a sustained campaign throughout 2017 to discredit the law while congressional Republicans tried to repeal it.

The repeal campaign failed. But it helped weaken health insurance markets around the country, in regions that already had few insurers and higher prices than the rest of the country.

At the same time, the Trump administration dramatically cut outreach and advertising efforts…

January 19, 2018: Rewire News posted an article titled: “For People With Disabilities, Trump’s First Year Has Threatened Nearly Every Facet of Life”. It was written by Robyn Powell.  From the article:

…One of the main attacks on autonomy for people with disabilities was Republican’s fight against the Affordable Care Act (ACA), egged on by the President. Over the summer, people with disabilities, particularly members of the grassroots ADAPT, gained national attention for successfully battling the repeated attempts to repeal the ACA. Beginning with a “die-in” staged outside the office of Sen. Mitch McConnell (R-Ky.) in late June, ADAPT held dozens of direct actions – at both the U.S. Capitol and congressional offices across the country. For people with disabilities, saving the ACA was a matter of life and death.

Notably, each attempt by the GOP to repeal the ACA included significant cuts to Medicaid. This threatened not only health care for people with disabilities, but also access to necessary supports that enable us to live in our communities. Medicaid is the primary health insurer of children and adults with disabilities. It covers services that other commercial health insurance does not, such as personal care assistants (PCAs) who provide in-home care to people with disabilities. Without PCAs, some people with disabilities cannot work, go to school, or be contributing members of their community.

Last week, the Trump administration delivered another blow to health care by allowing states to impose work requirements for people who receive Medicaid. Despite the GOP’s claims, Medicaid work requirements will likely harm people with disabilities, and will result in fewer disabled people receiving Medicaid…

…In December, the GOP passed – and Trump signed into law – the Tax Cuts and Jobs Act of 2017, harking this tax reform bill a win for everyone. While this bill will leave wealthy people far better off, people with disabilities will likely face greater tax burdens and decreased opportunities to live the life they choose. The bill includes massive cuts to Medicare and other safety-net programs and eliminates tax incentives for small businesses to modify their facilities to ensure accessibility for people with disabilities. Moreover, because the law includes a repeal of the ACA’s individual mandate, health insurance premiums will undoubtedly climb, leaving them unaffordable for many – including people with disabilities…

January 22, 2018: Covered California posted information titled “Covered California Announces Continued Strong Enrollment and Reminds Consumers That Penalty Remains in Place Through 2018”. From the information:

  • The Patient Protection and Affordable Care Act’s requirements that consumers have health insurance remains in place, and consumers may face stiff tax penalties if they are not covered in 2018.
  • A recent study estimates 70 percent of consumers, who are uninsured and eligible for financial help, could purchase health insurance coverage for less than the price of the tax penalty.
  • Most consumers are paying less in monthly premiums than they did a year ago.
  • More than 342, 000 consumers have newly enrolled during the current open-enrollment period, which remains ahead of last year’s pace, and continues in California through Jan. 31.

…Covered California also reminded consumers that the Affordable Care Act’s individual shared responsibility payment, often called the individual mandate, remains in place throughout calendar year 2018. Consumers who do not have health insurance could face stiff tax penalties if they are not covered. These penalties are a minimum of $695 per adult and $347.50 per child, up to $2,085 per family, or at least 2.5 percent of annual household income – whichever is greater (for an estimated maximum penalty of $3,816 per individual and $19,080 for a family of five). The recent tax bill removes the penalty but it does not go into effect until 2019…

…A recent Covered California analysis found that the net monthly premiums for enrollees who receive financial help are on average 10 percent lower than what new and renewing consumers paid last year. The lower prices are a result of more financial help being available for consumers who qualify for assistance. The Affordable Care Act is designed to protect consumers by providing more premium tax credits when premiums rise. And for the many Californians in the individual market who do not get financial help, the robust competition has meant that for many, premium increases have been kept in the single digits…

February 9, 2018: Covered California posted information titled: “Covered California Finishes Fifth Open Enrollment Strong – New Sign-ups of 423,484 up 3 Percent Over Last Year.” From the information:

  • More than 50,000 people selected health insurance plans through Covered California in the final three days of open enrollment.
  • Covered California has now served more than 3.4 million consumers since 2014.
  • The number of renewing enrollees dropped slightly, in part due to Covered California encouraging unsubsidized Silver plan enrollees to shop off-exchange.
  • Consumers made smart choices for 2018, picking Gold plans in many cases to get the best value for themselves and their families.
  • Subsidized consumers paid less for health coverage in 2018 than 2017 due to the protective effect of their subsidy rising to offset higher premiums, while unsubsidized consumers in the individual market – both in and out of Covered California – saw their costs rise.
  • Without action by Congress, unsubsidized consumers nationwide could see their costs rise steeply in 2019 and find coverage increasingly unaffordable.

February 14, 2018: Bloomberg posted an article titled: “Ignoring Obamacare Rules, Idaho ‘Freedom’ Plans Come With Limits”. It was written by Zachary Tracer. From the article:

After Idaho’s Republican governor promised to find creative ways to get around Obamacare, one health plan in the state plans to offer skimpy coverage that may violate many of the law’s protections for patients.

Blue Cross of Idaho said Wednesday that it will offer insurance plans that don’t comply with some Affordable Care Act requirements. The “Freedom Blue” coverage is a way to give some people lower premiums upfront in exchange for less comprehensive coverage.

Others will pay more — the plans have limits on annual medical spending and will charge sicker people higher premiums or deny them coverage in some cases. Those policies are specifically forbidden by the 2010 law.

The move sets up a potential conflict with the federal government. While President Donald Trump has said he opposes the law and has taken steps to undermine it, the administration will have to decide whether to enforce legal requirements that remain on the books…

…If the department [of Health and Human Services] doesn’t act, it could be up to the courts to resolve whether Idaho is violating the law…

…In early January, Idaho Governor Butch Otter directed the state’s insurance regulator to find “creative ways” for health insurers in the state to offer more affordable coverage. Otter said the state planned to use flexibility offered by the Trump administration in an executive order, and that it had authority to do so. The insurance regulator issued guidelines for the plans later that month…

…The Idaho plan believes it’s following the flexibility it has under the law…

…The proposed plans have a $1 million annual per-person limit to how much care the insurer will pay for. The plans have many of the same general benefits as ACA plans, though one won’t cover maternity care. They can also charge more to people who are sicker after asking them extensive questions about their health.

While such policies were banned by the Affordable Care Act, Idaho plans to use the law as a backstop. If individuals end up with medical expenses that exceed the $1 million limit in the non-Obamacare plans, Idaho will require insurers to help them move into ACA plans, which don’t have limits on medical spending.

February 15, 2018: The New York Times posted an article titled: “New Health Secretary Faces First Test as Idaho Skirts Federal Law”. It was written by Robert Pear. From the article:

Alex M. Azar II, the new secretary of health and human services, said Thursday that he would closely scrutinize a plan by Idaho to allow the sale of insurance that does not comply with the Affordable Care Act, an early test of how he will enforce a law he opposes.

But he said it was too early to know what action he might take…

…Democrats in Congress, as well as the American Cancer Society and other groups representing patients, say the Idaho plan would allow insurers to discriminate against people with pre-existing medical conditions, in defiance of the federal law…

…The plan presents Mr. Azar with a choice that he could face frequently in his new job: whether to try to shore up the health law or to “let Obamacare fail,” as President Trump has threatened to do. His decisions could have significant consequences both for consumers and for Republicans in the midterm elections…

…Mr. Azar described Idaho’s plan as “a cry for help” by a state seeking more affordable coverage options for its residents. He said the Idaho program would be subject to “searching review for compliance” with federal law…

…Idaho residents will still be able to obtain coverage that complies with the Affordable Care Act on the state’s health insurance exchange, Mr. Crapo said. But Idaho will allow other options, outside the exchange.

The Republican governor of Idaho, C.L. Otter, known as Butch, issues an executive order last month to combat what he called “the overreaching, intrusive nature of Obamacare.” And on Jan. 24, the state Insurance Department issued guidelines for the sale of insurance policies that do not meed coverage requirements of the Affordable Care Act.

Idaho’s new “state-based health benefit plans” will have to carry a disclaimer: “The policy is not fully compliant with federal health insurance requirements.”

Insurers in Idaho could, in some cases, charge different rates based on a person’s health status or claims experience. In addition, insurers would not have to comply with provisions of the federal law limiting out-of-pocket costs, and they could impose caps on the dollar amount of benefits available to consumers.

Dean L. Cameron, the director of the Idaho Department of Insurance, said in an interview on Thursday that insurers could start selling the new state-based health plans as early as April…

February 20, 2018: CNN Money posted an article titled “Trump administration unveils alternative to Obamacare”. It was written by Tami Luhby. From the article:

Officials Tuesday proposed regulations that will make it easier to obtain coverage through short-term health insurance plans — which don’t have to adhere to the Affordable Care Act’s consumer protections — by allowing insurers to sell policies that last just under a year. The new rules stem from an executive order President Trump signed in October aimed at boosting competition, giving consumers more choices and lowering premiums…

…The proposal would reverse an Obama administration decision to limit the duration of short-term health plans to no more than 90 days in order to make them less attractive.

Such plans could roil the Obamacare market, drawing healthier consumers away from the exchanges and pushing up the premiums for those who remain.

Short-term health plans, which have been available for years and were originally designed to fill a temporary gap in coverage, are likely to be cheaper than Obamacare policies. But that’s because they are allowed to exclude those with pre-existing conditions and base rates on an applicant’s medical history, unlike plans sold on the Obamacare exchanges.

Also, short-term plans don’t have to offer comprehensive coverage. Typically, they don’t provide free preventative care or maternity, prescription drugs and mental health benefits. They can also impose annual or lifetime limits, meaning they may only pay out a set amount — often $1 million or less — leaving the policyholder on the hook for the rest. And, unlike Obamacare policies, they don’t have to cap consumers’ cost-sharing burden at $7,350 for 2018…

…Also, insurers aren’t required to renew the policies so those who become sick could find themselves unable to sign up again for the same plan…

…The proposed regulations are the latest step in the Trump administration’s quest to weaken Obamacare. Last month, officials unveiled a proposed rule that would make it easier for small businesses — and some self employed folks — to band together and buy health insurance. That proposal also stemmed from Trump’s executive order and is designed to broaden access to what are known as association health plans.

February 26, 2018: CNN posted an article titled: “9 million fewer Americans expected to have health insurance in 2019”. It was written by Tami Luhby. From the article:

About 9 million fewer Americans will have health insurance next year, thanks to the Trump administration and Republicans in Congress, a new report estimates.

Congress’ elimination of the individual mandate, which takes effect in 2019, and a trio of moves by President Donald Trump are expected to fuel the decrease, the Urban Institute said.

Trump’s actions include the discontinuation of federal support of a key Obamacare subsidy, the reduction of advertising and assistance for Obamacare’s open enrollment season and the proposed expansion of short-term insurance policies. The Congressional Budget Office does not consider consumers with such policies to be insured…

…The individual mandate, one of Obamacare’s least popular provisions, requires nearly all Americans to get coverage or pay a penalty. The CBO estimated in November that 4 million fewer people would be insured in 2019 because healthier people would be less likely to buy policies without the mandate in place…

…The Urban Institute estimated that the mandate’s elimination, as well as the reduced federal support of open enrollment, would leave 6.4 million fewer people with coverage by 2019…

…About 2.5 million people who would have been otherwise insured will opt for short-term policies next year instead, the Urban Institute estimates.

Combined, the elimination of the individual mandate and the expansion of short-term plans will likely cause premiums for Obamacare policies to increase an average of 18.2% next year in the 43 states that do not prohibit or limit such policies, according to the Urban Institute.

February 28, 2018: Vox posted an article titled: “20 states file a new lawsuit arguing Obamacare is illegal”. It was written by Sarah Kliff. From the article:

Twenty state attorney generals have filed a new lawsuit that – like the many lawsuits before it – aims to take down the Affordable Care Act.

The suit, filed in a Texas district court on Tuesday, makes a new legal argument that relies on Congress’s recent repeal of the individual mandate penalty…

…Let’s start with the actual argument at play here. This lawsuit starts from Congress’s recent decision to ax Obamacare’s penalty for not carrying health insurance, reducing the fine from $695 to $0 – essentially getting rid of the provision.

In previous rulings, the brief argues, the Supreme Court has stated that this mandate is crucial to making the Affordable Care Act work. The mandate gets healthy people into the insurance market, thus allowing the Affordable Care Act to also require insurers to offer coverage to those with costly pre-existing conditions, too.

With the individual mandate penalty killed, the lawsuit argues that the entire law is no longer workable and ought to be struck down…

…Or, as the lawsuit itself puts it: “Once the heart of the ACA – the individual mandate – is declared unconstitutional, the remainder of the ACA must also fall.”…

…This lawsuit is brought by 20 different states, and they no doubt decided to bring their case in a district court that they thought might be more conservative, and more sympathetic to their arguments…

The lawsuit is called “State of Texas, et. al. v United States of America, et. al.” It was filed in the United States District Court Northern District of Texas. Full text of the lawsuit can be found on the Texas Attorney General website.

Plaintifs include:

Defendants include:

  • United States of America
  • United States Department of Health and Human Services, Alex Azar, in his Official Capacity as Secretary of Health and Human Services
  • United States Internal Revenue Service and David J. Kautter, in his Official Capacity as Acting Commissioner of Internal Revenue

March 1, 2018: Health Affairs posted a survey titled “Eliminating the Individual Mandate Penalty in California: Harmful but Non-Fatal Changes In Enrollment And Premiums”. It was written by John Hsu, Vicki Funs, Michael E. Chernew, Alan M. Zaslavsky, William Dow, and Joseph P. Newhouse.

The California Health Care Foundation provided funding for the 2017 survey and data analysis. The survey was done in partnership with Covered California.  From the survey:

The federal tax reform act of December 2017 eliminated the penalty for noncompliance with the Affordable Care Act’s (ACA) individual mandate (also known as the shared responsibility requirement) starting in 2019. This legislative change has highlighted uncertainty about the penalty’s importance in inducing lower-risk individuals to purchase insurance, to purchase insurance, and the potential for higher premiums in the individual insurance market should they not do so.

The Congressional Budget Office and the Joint Committee on Taxation (CBO/JCT) estimated that within one year, eliminating the penalty would leave four million fewer individuals insured nationwide, including three million fewer with individual market insurance. Moreover, the higher risk profile of the remaining insured would drive up individual insurance market premiums by 10 percent. CBO/JCT also predicted that over time more enrollees would drop out of the insurance market, partly due to the rising premiums, resulting in five million fewer insured in 2027 compared with baseline estimates without the repeal.

Proponents of the mandate repeal suggested that the CBO/JCT methodology is flawed because it overstates the importance of the mandate for coverage. Another recent analysis suggests that the size of the mandate penalty had little effect on coverage in 2014 and 2015, but ignores any generalized “woodwork” effect of the mandate. Importantly, the effect of eliminating the penalty on market stability depends both on 1) the number of people who no longer purchase insurance, and 2) whether these people are healthier than those retaining insurance and thus have below-average medical costs. If most enrollees continue to purchase insurance, or if those who do not purchase have similar average risk to those who do purchase, there will be less impact on premiums.

From here, the survey digs into data collected in a random sample of California enrollees in the individual market. A total of 3,010 people responded who either purchased individual insurance market plans through the Covered California marketplace or outside the marketplace.

Respondents were asked whether they knew that they would have to pay a tax penalty if they did not have insurance coverage, and if so, whether they would have purchased health insurance coverage this year (2017) if there were no penalty. The survey was conducted between May and September 2017, prior to the passage of the tax reform bill.

  • 18 percent of enrollees in California’s individual market in 2017 say they would not have purchased insurance in the absence of a penalty. The substantial majority of lower-risk enrollees would still have purchased.
  • Based on this changing mix, the surveyors estimate that eliminating the mandate penalty would have caused premiums to rise 5 percent to 9 percent in California’s individual market plans.
  • Overall, 91 percent of individual market enrollees in this California sample were aware that there was a mandate penalty, and 18 percent (or almost one in five enrollees) said they would not have purchased insurance in 2017 if the penalty had not existed.
  • This reduction (about 378,000 fewer enrollees in California) is comparable to the CBO/JCT estimate of enrollment reductions nationally in the first year following the elimination of the mandate penalty, but larger than the 7 percent reported in an October 2017 nationwide Kaiser Health Tracking Poll.
  • Enrollees with the lowest levels of predicted medical spending were more likely to say they would not have purchased insurance in 2017 in the absence of the penalty, compared with those at higher levels of predicted spending.
  • For example, 30 percent and 21 percent of those in the lowest two deciles of predicted spending said they would not have purchased insurance in the absence of the penalty, compared to 13 percent and 10 percent of those in the top two deciles of predicted spending.
  • At each level of predicted spending, the majority of respondents (70 percent to 90 percent) would likely have purchased insurance in the absence of the mandate penalty.
  • Eliminating the mandate penalty could matter less in California than in other states because California has one of the most stable individual markets in the nation with a more favorable risk mix than other states, as reflected in the average risk scores published by the Center for Consumer Information & Insurance Oversight.
  • California has implemented a number of policies to reduce adverse selection into and within the market. For example, California was one of 11 states that prohibited the sale of ACA non-compliant plans in 2014, which likely improved the favorability of the individual market risk pool. It was one of five states to mandate some kind of alignment of plans sold on and off the public marketplace by requiring that all plans sold on-markeptlace have a mirrored product sold off-marketplace.
  • Relative to other states, California has invested heavily in outreach and education efforts to increase insurance uptake, outreach, and education efforts to increase insurance uptake, emphasizing reasons other than the mandate for buying insurance such as financial and health protection.

March 8, 2018: Covered California released an analysis titled: “Individual Markets Nationally Face High Premium Increases in Coming Years Absent Federal or State Action, With Wide Variation Among States”. From the Highlights of the analysis:

  • All states’ individual markets risk higher than normal premium increases – ranging from 35 to 90 percent over three years – due to continued uncertainty at the federal level, but state variation informs understanding of local risks.
  • Premium increases in the individual markets will likely range from 12 to 32 percent in 2019, and cumulative increases from 2019-2021 will range from 35 percent to more than 90 percent.
  • Increases are on average more than double the rate of medical inflation as a result of healthier consumers leaving the individual market.
  • The report identifies 17 states that are more likely – because of their historic mix and enrollment – to have cumulative premium increases of 90 percent or more and 19 additional states are at a higher risk of experiencing hikes of 50 percent.
  • Policy actions could both lower premiums and promote more plan competition by reducing uncertainty – with independent actuarial analysis finding that reinsurance or similar programs could cut premium increases in half, bringing them to single digits in many states.

The analysis has details about premium costs in a “State-by-State Interactive Mapping of Premium Increase and Instability Risk” map. It is color coded to indicate which category each state falls into:

  • Significant Marketplace Risk: These states could face a possible 35% premium increase by 2021): Washington, Oregon, California, Nevada, Utah, Colorado, Nebraska, North Dakota, South Dakota, Minnesota, Kentucky, Massachusetts, Rhode Island, and Connecticut.
  • High Marketplace Risk: These states could face a possible 50% premium increase by 2021): Montana, Idaho, Wyoming, Arizona, New Mexico, Kansas, Iowa, Missouri, Illinois, Indiana, Georgia, Florida, Virginia, Maryland, Delaware, New York, Vermont, and Maine
  • Catastrophic Marketplace Risk: These states could face a possible 90% premium increase by 2021): Texas, Oklahoma, Arizona, Louisiana, Mississippi, Alabama, Tennessee, North Carolina, South Carolina, Wisconsin, Michigan, Ohio, West Virginia, Pennsylvania, New Jersey and New Hampshire.
  • It doesn’t say why Alaska and Hawaii are not on the map, or what level of marketplace risk they face.

March 8, 2018: New York Magazine posted an article titled: “White House Tells Idaho to Sabotage Obamacare More Subtly”. It was written by Eric Levitz. From the article:

In January, Republicans in Idaho decided that if Congress wasn’t going to repeal the Affordable Care Act, they would just have to repeal it themselves. Governor C.L. “Butch” Otter signed an executive order that nullified a whole host of ACA regulations: Insurers in the Gem State would now be able to sell health-care plans that didn’t cover maternity care, mental illness, or other “essential health benefits”; to charge higher premiums to people with preexisting conditions, and deny them coverage outright if they had failed to maintain “continuous coverage”; and set a dollar limit on the amount of benefits that consumers could draw on (which is to say, a sneak provision that renders the insurance plan useless if an enrollee happens to develop an exorbitantly expensive medical condition).

The one catch was that insurers who sold such skimpy plans would be required to also sell at least one Obamacare-compliant option over the exchanges. This arrangement would allow (temporarily) healthy people to get (junky) insurance at a very cheap price – while rendering the risk pool for Obamacare-compliant plans exceptionally sickly, there by causing premiums to skyrocket for people who required comprehensive coverage.

This all constituted a flagrant violation of federal law, But responsibility for enforcing said law lay with Trump’s Health and Human Services Department, which has been flagrantly violating the spirit of Obamacare for more than a year now…

…But on Thursday night, Trump’s Health Department (somewhat apologetically) announced that it would not allow Idaho to comport itself as a sovereign nation. In a letter to Governor Otter, Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), wrote, “CMS is committed to working with states to give them as much flexibility as permissible under the law to provide their citizens the best possible access to healthcare. However, the Affordable Care At remains the law.”…

…Verma encouraged Idaho to try a subtler approach to nullifying Obamacare, noting that its proposal could have passed legal muster “with certain modifications.”…

April 9, 2018: Reuters posted an article titled: “Trump administration issues rule further watering down Obamacare”. From the article:

The Trump administration took additional steps to weaken Obamacare on Monday, allowing U.S. states to relax the rules on what insurers must cover and giving states more power to regulate their individual insurance markets.

The Centers for Medicare and Medicaid Services issued a final rule that allows states to select essential health benefits that must be covered by individual insurance plans sold under former President Barack Obama’s healthcare law. The 2010 Affordable Care Act requires coverage of 10 benefits, including maternity and newborn care and prescription drugs. Under the new rule, states can select from a much larger list which benefits insurers must cover.

That could lead to less generous coverage in some states, according to Avalere Health, a research and consulting firm.

President Donald Trump’s administration has used its regulatory power to undermine Obamacare after the Republican-controlled Congress last year failed to repeal and replace the law. About 20 million people have received insurance coverage through the program…

April 10, 2018: Modern Healthcare posted an article titled: “5 takeaways from CMS’ final 2019 ACA marketplace rule”. It was written by Shelby Livingston. CMS stands for Centers for Medicare & Medicaid Services. From the article:

  • The CMS allows states to determine which essential health benefits individual and small-group plans must offer, starting in 2020. States can either adopt another state’s 2017 benchmark plan; replace one or more of its benefit categories with that of another state’s; or completely build a new essential benefits package from scratch so long as the new plan is not too generous and is in line with a “typical employer plan”.
  • Plans will still have to offer the 10 essential health benefits required by the Affordable Care Act, such as maternity care or mental health care.
  • The CMS is upping the rate increase threshold that triggers a review by state regulators to premium hikes of at least 15% for 2019. The agency is also exempting student health insurance coverage from rate review requirements, effective July 1.
  • HHS (Department of Health and Human Services) is allowing “a big chunk” of Obamacare customers to drop their insurance in 2018 without having to pay an individual mandate penalty. The CMS is allowing insurance exchanges to extend exemptions to the penalty based on a lack of affordable coverage available in an area.
  • CMS will allow anyone who lived an a region with just one insurer or none at all to claim a “hardship” exemption from the penalty for as far back as 2016.
  • Those who only have access to an insurance plan that covers abortion may also get out of the penalty if they object to abortion coverage.
  • The individual mandate penalty was zeroed out starting in 2019. The new exemptions would affect all those still subject to penalty for 2018 if they don’t buy coverage.
  • The CMS went ahead with its proposal to promote innovative plan designs by eliminating standardized options from the federal marketplace in 2019. This is a major win for the health insurance industry.
  • Starting in 2019, the CMS is relaxing the rules surrounding how much of an insurer’s premium income must bet spent on medical claims and quality improvement activities, a figure known as the medical-loss ratio. Insurers covering individuals and small businesses today must spend at least 80% of their premiums on healthcare and quality improvement.
  • In 2019, states will be able to request changes to the individual market medical-loss ratio that insurers must meet if states can demonstrate that a lower medical-loss ratio would help stabilize their markets.

April 23, 2018: Kaiser Family Foundation (KFF) posted information titled: “Understanding Short-Term Limited Duration Health Insurance”. Here are some key points from that information:

…Short-term health insurance policies offer lower monthly premiums compared to ACA-compliant plans because short-term policies offer less insurance protection. Medically underwritten policies can only be purchased by people when they are healthy. Individuals who buy short-term policies and then develop health conditions will lose coverage when the contract ends. Short-term policies typically do not cover essential benefits, such as prescription drugs, and often apply dollar caps and higher deductibles on coverage that are no longer allowed under ACA-compliant individual market and group health plans. As a result, people who buy short-term policies today in order to reduce their monthly premiums take a risk that, if they do need medical care, they could be left with uncovered bills and/or find themselves “uninsurable” under such plans in the future (though they would be able to buy ACA-compliant policies at the next open enrollment period).

With significant attention focused recently on issues like rising drug prices, the opioid epidemic, and mental health awareness, it is notable that short-term plans generally exclude or severely limit coverage for mental health, substance abuse, and prescription drugs. As is the case with four of the 10 products offered on eHealth and/or Agile Health Insurance the cover at least some substance abuse and mental health services, an enrollee suffering from a dual diagnosis may only recovered for care received up to a maximum of $3,000. And in 15 states, no short-term plans offered on these platforms cover prescription drugs.

To the extent that healthy individuals opt for cheaper short-term policies instead of ACA-compliant plans, such adverse selection contributes to instability in the reformed non-group market and raises the cost of coverage for people who have health conditions. Income-related premium subsidies in the non-group market offset the cost differential, and so help correct for adverse selection to a significant extent. Lower-income people would be protected by the premium subsidies, but middle-income people not eligible for subsidies who buy ACA-compliant plans would likely see premium increases. So far, the individual mandate penalty also has helped offset the cost differential between short-term plans and ACA-compliant plans, though this will disappear starting in 2019. The combined effect of repealing the individual mandate penalty has helped offset the cost differential between short-term plans and ACA-compliant plans, though this will disappear starting in 2019. The combined effect of repealing the individual mandate penalty and the administration’s efforts to promote the sale of short-term plans could result in fewer people signing up for ACA-compliant plans and higher premiums in the ACA-compliant individual market, potentially adversely affecting the stability of the ACA-compliant individual market….

April 30, 2018: Journal Sentinel (Part of the USA Today Network) posted an article titled: “Wisconsin unlawfully denies necessary treatment for transgender Medicaid recipients, lawsuit claims”. It was written by Bruce Vielmetti. From the article:

Wisconsin unlawfully denies Medicaid coverage for necessary transgender medical treatments, two transgender residents claim in a federal lawsuit filed Monday.

Their doctors say Cody Flack of Green Bay and Sara Ann Makenzie of Baraboo need additional surgery to help confirm their gender identities, but the state has turned them down for coverage, which they can’t afford on their own, citing a rule that groups the treatments with tattoo removal and earlobe repair.

Though the federal Medicaid Act and state statutes say coverage should not be arbitrarily withheld based on diagnosis or condition, a Wisconsin Department of Health and Human Services regulation from 1997 cites care related to gender transition – along with tattoo removal and earlobe repair – as “medically unnecessary”…

…Wisconsin is one of 10 states that deny Medicaid coverage of treatments for gender transition, according to the lawsuit. Nineteen states explicitly cover, and the rest have no explicit policy either way.

Ever since, bureaucrats cite the rule to deny breast removal or augmentation, genital surgeries and some hormone treatment coverage for transgender Medicaid recipients, even when admitting the procedures are effective in treating gender dysphoria, the range of conditions suffered by those who identify as a gender other than the one assigned at birth.

The lawsuit, filed in federal court in Madison, contends there is no rational or legitimate basis for excluding the coverage, which denies necessary care to members of a disfavored group…

…The suit says Wisconsin’s coverage exclusion violates the Affordable Care Act, the Medicaid Act and the due process guarantee of the Fourteenth Amendment. It asks that the court enjoin enforcement of the regulation and award damages and costs to the plaintiffs…

April 30, 2018: Politico posted an article titled: “Maine governor sued for defying Medicaid expansion ballot measure”. It was written by Rachana Pradhan. From the article:

Obamacare supporters are suing Maine Gov. Paul LePage’s administration to force him to expand Medicaid, accusing the Republican of ignoring a ballot initiative that ordered the state to join the coverage program.

LePage has refused to expand Medicaid nearly six months after 59 percent of the state’s voters approved it in a first-of-its-kind ballot measure. He has insisted he won’t adopt Medicaid expansion unless state lawmakers meet his conditions for funding the program.

“With the goal of getting health care to people as soon as possible, we decided we couldn’t wait any longer,” said Robyn Merrill of Maine Equal Justice Partners, one of the advocacy groups behind the lawsuit.

The lawsuit against LePage’s administration was expected after the Maine Legislature’s recent session ended without a funding agreement. A LePage spokesperson didn’t immediately respond to a request for comment.

LePage, now in his last year in office, previously vetoed Medicaid expansion bills five times, prompting the state’s Obamacare supporters to organize the ballot initiative last year. Advocates are spearheading similar campaigns to get measures on the ballot this year in Idaho, Nebraska, and Utah…

…Roughly 80,000 low-income Maine adults are supposed to qualify for Medicaid benefits starting July 2, according to the ballot measure. The LePage administration skipped an early April deadline to formally notify the federal government it would expand Medicaid.

The lawsuit against the Maine Department of Health and Human Services was filed in state Superior Court. Other groups bringing the lawsuit include the Maine Primary Care Association and Maine Consumers for Affordable Health Care.

The office of Maine Attorney General Janet Mills, a Democrat running for governor this year, declined to comment on whether she would defend the state in the litigation…

May 2018: Urban Institute posted The Healthy America Program.

It was written by Linda J. Blumbert (an Institute fellow in the Health Policy Center at the Urban Institute. She is an expert on private health insurance (employer and nongroup), health care financing, and health system reform.

It was also written by John Holahan (an Institute fellow in the Health Policy Center, where he previously served as center director for over 30 years. His recent work focuses on health reform, the uninsured, and health expenditure growth, and on developing proposals for health systems reform.)

It was also written by Stephen Zuckerman (a senior fellow and Vice President for health policy at Urban. He has studied health economics and health policy for 30 years and is a national expert on Medicare and Medicaid payment, including how payments affect enrollee access to care and the volume of services they receive.)

Here are some key points of The Healthy America Program:

Since efforts to “repeal and replace” the Affordable Care Act (ACA) have failed, and bipartisan attempts to improve the law have stalled, some policymakers are now looking beyond incremental fixes. Here, we present a set of policy ideas that would provide universal access to comprehensive coverage but would allow people to keep their employer-sponsored coverage, would offer a range of insurer options and ensure broad pooling of health care risk, would not have an employer mandate, would provide income-related federal assistance, and would create a more flexible individual incentive to remain insured under the ACA.

The proposal builds on components of the Medicare program and the ACA Marketplaces. However, it simplifies the current health insurance system by integrating Medicaid acute care for nonelderly people and the Children’s Health Insurance Program (CHIP) – while preserving access to their benefits – with coverage for people enrolled in private nongroup insurance and people currently uninsured.

This large new Medicare-style marketplace, featuring a public plan and private insurer options, would contain costs by fostering competition among many insurers, capping provider payment rates, and addressing prescription drug pricing. This proposal is less ambitious than a single-payer system (i.e. Medicare for All), but would get close to universal coverage with much lower increases in federal spending and less disruption for people currently enrolled in employer coverage or Medicare…

  • We propose a new program called Healthy America that would be open to all non elderly Americans. It would improve income-based assistance for premiums and cost-sharing and reduce costs in less competitive areas. Like Medicare, it would offer a public plan and private insurance plans; like Medicare Advantage, its private options would benefits from caps on provider payment rates.
  • The Healthy America program would collect enrollees’ monthly payments of income-related premiums, and these payments would be reconciled with actual income through tax filings at the end of the year. People who decide to remain uninsured would lose a tax benefit, but they could reverse some of that loss by becoming and remaining insured in the following year.
  • The tax-excluding for employer-sponsored insurance would stay in place, providing the financial incentive for most workers to continue obtaining coverage through their workplace. People who choose to enroll in employer-sponsored insurance would not pay income-related premiums for Healthy America.
  • The acute care portion of Medicaid for the non elderly and CHIP would be incorporated into the Healthy America program, along with supplemental benefits (e.g., transportation; early and periodic screening, diagnostic and treatment; access to essential community providers) for low-income children and enrollees with disabilities to ensure that people eligible for Medicaid under current law would have the same benefits under the new program.
  • States would be required to continue contributing what they currently do to Medicaid and CHIP for these populations, and future state spending amounts would be indexed to a five-year rolling average of gross domestic product (GDP) growth.  Adults and children would no longer have to change insurance plans when family income changes.
  • Nonelderly people with disabilities who are eligible for Medicare could choose between enrolling in coverage with income-related assistance through the Healthy America program or obtaining their coverage through Medicare as under current law. Nonelderly people with disabilities who are ineligible for Medicare would be edible for coverage through the Healthy America program.
  • The Medicare program would remain unchanged for all people ages 65 and older and for eligible people with disabilities. The current Medicare cost-sharing structure, including different deductibles for Parts A, B, and D and no out-of-pocket limits, could be changed to match the Healthy America program.
  • All Healthy American plans would cover the ACA’s essential health benefits, along with supplemental benefits for low-income children and for enrollees with disabilities. These supplements would ensure that people eligible for Medicaid under current law would have the same benefits under the new program.

Here are some details on how premiums would work:

  • Premiums for the Healthy America plans would be income related, with federal subsidies tied to the premium associated with the benchmark 80 percent AV public plan option.
  • People with incomes below the tax-filing threshold and others with incomes below 138 percent of FPL would not be charged premiums if they enroll in a plan with premiums no higher than the benchmark plan.
  • People with incomes between 138 and 150 percent of FPL would pay premiums ranging from 0 to 2 percent of income for the benchmark plan.
  • People with incomes between 150 and 200 percent of FPL would pay premiums ranging from 2 to 4 percent of income for the benchmark plan.
  • People with incomes between 200 and 250 precent of FPL would pay premiums ranging from 4 percent to 6 percent of income for the benchmark plan.
  • People with incomes between 250 and 300 percent of FPL would pay premiums ranging from 6 to 7 percent for the benchmark plan.
  • People win incomes between 300 and 400 percent of FPL would pay premiums ranging from 7 to 8.5% of income for the benchmark plan.
  • People with higher incomes would pay premiums of no more than 8.5 percent of income for the benchmark plan.
  • At all incomes, household premium contributions for the benchmark plan would never exceed the total benchmark premium for that person or family. Premiums would be subject to modified community rating rules as under ACA, with age rating limited to a ratio of 3 to 1, as in the ACA-compliant nongroup and small-group insurance markets today.

Here are some additional details:

  • The benchmark premium would be set much like it is in the Medicare program.
  • People who remain uninsured would be responsible for paying their own medical bills and dealing directly with providers. Uninsured people and people with employer-based insurance could enroll in insurance through the Healthy America program at standard rates during the annual open enrollment period, as under the ACA.
  • Limited special enrollment periods would also be available for circumstances such as birth, adoption, and loss of employer coverage.
  • To limit adverse selection, uninsured people would lose a percentage of their standard deduction (or the equivalent for the itemized deduction) when they pay income taxes. The percentage of the standard deduction they would lose would increase with income, making the penalty progressive.
  • By design, people with incomes below the tax-filing threshold would owe no penalty because they would not own premiums.
  • People with incomes of $1 million or more would lose the entire standard deduction.
  • Most people would need to take direct action to enroll in the Healthy America program. Higher federal investment (compared with that under ACA) in outreach and enrollment assistance during open enrollment periods and throughout the year would increase awareness and lead to higher coverage rates.
  • To boost enrollment in Healthy America and increase the diversity of its health insurance risk pools, people receiving SNAP and TANF payments would be automatically enrolled. This population would be eligible for coverage with no premium in a Healthy America plan.
  • Short-term and other private insurance plans that do not comply with Healthy America regulations (consistent with the ACA’s regulatory framework) would be prohibited. Prohibited types of plans include short-term, limited-duration policies, and association health care risks.

May 1, 2018: The Washington Post posted an article titled: “Trump’s former health secretary: Americans will pay more because GOP weakened Obamacare”. It was written by Jeff Stein. From the article:

President Trump’s former top health official on Tuesday said the Republican tax law would raise the cost of health insurance for some Americans because it repealed a core provision of the Affordable Care Act.

Tom Price, Trump’s first secretary of the Department of Health and Human Services, said people buying insurance on government-run marketplaces will face higher prices because the law repealed the ACA’s individual mandate. The mandate had forced most Americans to have health coverage or face a financial penalty.

“There are many, and I’m one of them, who believes that that actually will harm the pool in the exchange market, because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently that drives up the cost for other folks within that market,” Price said at the World Health Care Conference in Washington…

…”Those effects would occur mainly because healthier people would be less likely to obtain insurance and because, especially in the nongroup market, the resulting increases in premiums would case more people to not purchase insurance, the CBO [Congressional Budget Office] said at the time. [in November of 2017]…

May 4, 2018: MedPage Today posted an article titled: “ACP, ACOG Fear Return of ‘Domestic Gag Rule'”. It was written by Molly Walker. From the article:

Citing “something imminent” from the Trump administration in relation to Title X funding, the American College of Physicians (ACP) and the American College of Obstetricians and Gynecologists (ACOG) reiterated their concern about any changes to these programs.

While it is unclear if these changes will come in the form of an executive order or more formal rulemaking, the organizations are warning of a potential Reagan-era “domestic gag rule” that forbade providers receiving Title X funding from discussing or making referrals for abortion. The rule also mandated financial and physical separation of Title X-funded programs from activities related to abortion. It was reminded in 1993 by President Clinton.

In addition to reproductive healthcare, Title X clinics also provide preventative services, such as gynecology exams, for primarily low-income individuals.

Officials at ACOG and ACP, which represent more than 200,000 physicians nationwide, stressed that they haven’t seen the final action so they “don’t know yet what it’s going to do”. But they believe the current administration is planning to change eligibility requirements for providers and healthcare centers to receive Title X funding, inhibiting them from offering women the fullest range of preventative reproductive health services available. The officials characterized the anticipated regulations as “turning back the clock” on women’s healthcare.

“We are deeply concerned about anticipated changes to Title X, which move away from science-based principles and erode standard of care by interfering in the patient/provider relationship,” said Hal Lawrence, MD, ACOG executive vice president and CEO. “We don’t need the government interfering in the exam room, and the government should not be interfering in what women can know and what kind of options she should be given.”

He further characterized the idea of not being able to go in and discuss “something that is available” with a patient as “against the ethics of the practice of medicine.”

Shari Erickson, ACP’s Vice President for governmental affairs and medical practice, described any such changes to Title X as “out of date and out of touch” and that they have the potential to impact “millions of individuals,” especially women seeking access to contraception, reproductive healthcare and preventative services.

“We are strongly opposed to changes that restrict federal funding for physicians and healthcare professionals,” she added…

May 8, 2017: President Trump signed a Special Message to the Congress of the United States. It said:

In accordance with section 1012 of the Congressional Budget and Impoundment Control Act of 1974 (2 U.S.C. 683), I herewith report 38 rescissions of budget authority, totaling $15.4 billion.

The proposed rescissions affect programs of the Departments of Agriculture, Commerce, Energy, Health and Human Services, Housing and Urban Development, Justice, Labor, State, Transportation, and the Treasury, as well as the Corporation for National and Community Service, Environmental Protection Agency, Railroad Retirement Board, the Millennium Challenge Corporation, and the United States Agency for International Development.

The details of these rescissions are set forth in the enclosed letter from the Director of the Office of Management and Budget.

The letter from the Director of the Office of Management and Budget is long and very detailed.  Here are the parts that relate to health care:

  • Rural Community Facilities Program Account – $2,000,000 proposed for rescission. The community facilities grants provide assistance to low income rural communities for essential community facilities such as police stations and medical clinics. The FY 2018 appropriations fully funded the program, and these balances are not needed to carry out the program in FY 2018.
  • Children’s Health Insurance Fund – $5,149,512,000 proposed for rescission. The proposal would rescind $5.1 billion in amounts made available by the Medicare Access and CHIP Reauthorization Act of 2015 to supplement the 2017 national allotments to States, including the $3.1 billion in unobligated balances available on October 1, 2017, and $2 billion in recoveries as of May 7, 2018. The 2017 one-time appropriation was made available in addition to the annual Children’s Health Insurance Program (CHIP) appropriation to reimburse states for eligible CHIP expenses. Authority to obligate these funds to states expired on September 30, 2017, and the remaining funding is no longer needed. Enacting the rescission would have no programmatic impact. The proposed recession would have no effect on outlays.
  • Center for Medicare and Medicaid Innovation – $800,000,000 proposed for rescission. This proposal would rescind $800 million in amounts made available under Public Law 111-148 for FYs 2011 to 2019 for the Center for Medicare and Medicaid Innovation (the Innovation Center) of which there were $3.5 billion available on October 1, 2017. The Innovation Center was created to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and CHIP while preserving or enhancing quality of care. These funds are in excess of amounts needed to carry out the Innovation Center’s planned activities in FYs 2018 and 2019, and the Innovation Center will receive a new mandatory appropriation in FY 2020. Enacting the rescission would also the Innovation Center to continue its current activity, initiate new activity, and continue to pay for its administrative costs.
  • Child Enrollment Contingency Fund – $1,865,000,000 proposed for rescission. This proposal would rescind $1.9 billion in amounts available for the Children’s Health Insurance Program Contingency Fund, of which there were $2.4 billion available as of March 23, 2018. The Contingency Fund provides payments to States that experience funding shortfalls due to higher than expected enrollment. At this time, Centers for Medicare and Medicaid Services does not expect that any State would require a Contingency Fund payment in FY 2018; therefore, this funding is not needed. Enacting this rescission would have no programmatic impact. The proposed rescission would have no effect on outlays.
  • International Disaster Assistance – $252,000,000 proposed for rescission. This proposal would rescind $252 million in prior year balances of emergency funding appropriated in FY 2015 for the Ebola response, of which there were $470 million in emergency balances available for the Ebola respond on October 1, 2017. The Congress provided these for countries affected by, or at risk of being affected by, the Ebola virus disease outbreak in 2015. These funds remain from the initial outbreak in 2015, and are no longer needed because the Ebola response has largely concluded. Enacting the rescission would therefore not impact the Ebola response.

May 8, 2017: The Congressional Budget Office posted a Cost Estimate titled: “Proposed Rescissions for the Children’s Health Insurance Program”. From the Cost Estimate:

The proposals would rescind approximately $7 billion. Of this, $5.1 billion would be rescinded from the unobligated balances made available by section 301(b)(3) of Public Law 114-10, and $1.9 billion would be rescinded from amounts made available for fiscal year 2018 under the Child Enrollment Contingency Fund, section 2104(n)(2) of the Social Security Act.

CBO was asked for its assessment of the proposed rescissions’ effect on federal spending and insurance coverage. Authority to distribute the funds to states made available under 301(b)(3) expired in 2017. In addition, based on information from the Centers for Medicare and Medicaid Services, CBO projects the the rescission from the Child Enrollment Contingency Fund would not affect payments to states over the 2018-2028 period. For these reasons, CBO estimates that rescinding the unobligated balances would budget authority by $7 billion, but would not affect outlays, or the number of individuals with insurance coverage.

May 9, 2018: The Congressional Budget Office posted a Cost Estimate titled: “H.R. 3, Spending Cuts to Expired and Unnecessary Programs Act.” From the Cost Estimate:

H.R. 3 would rescind budget authority that was proposed to be rescinded in special messages transmitted to the Congress by the President on May 8, 2018, pursuant to Title X of the Impoundment Control Act of 1974.

Assuming enactment by the end of June 2018, CBO estimates that the provisions of H.R. 3 would reduce budget authority by approximately $15 billion and outlays by $1 billion over the 2018-2028 period. Further, CBO estimates that the combined budgetary effects of the President’s proposals would be the same as the contents of H.R. 3.

Outlay savings would be significantly lower that the amount of budget authority reminded for two reasons. First, many of the amounts proposed for recession have remained unspent by agencies for years; CBO reviewed the historical spending patterns of the affected accounts and concluded that most of the funding would not be spend under current law. Second, the administration has indicated that these proposals are aimed at reducing funding that is no longer necessary for agencies to fulfill the purposes for which it was originally appropriated by the Congress. In a letter from the Office of Management and Budget accompanying the President’s special messages, the Administration estimates that those proposals would reduce outlays by $3 billion…

May 11, 2018: The White House posted “President Donald J. Trump’s Blueprint To Lower Drug Prices”. From the Blueprint:

…President Donald J. Trump’s blueprint includes new actions and proposals to drive down drug prices for all Americans.

  • President Trump’s blueprint will seek to encourage innovation, while also promoting better price competition and addressing foreign freeloading.
  • The Department of Health and Human Services (HHS) will:
  • Take steps to end the gaming of regulatory and patent processes by drug makers to unfairly protect monopolies.
  • Advance biosimilars and generics to boost price competition.
  • Evaluate the inclusion of prices in drug makers’ ads to enhance price competition.
  • Streamline and accelerate the approval for over-the-counter drugs.
  • Speed access to and lower the cost of new drugs by clarifying policies for sharing information between insurers and drug makers.
  • Avoid excessive pricing by relying more on value-based pricing by expanding outcome-based payments in Medicare and Medicaid.
  • Work to give Part D plan sponsors more negotiation power with drug makers.
  • Examine which Medicare Part B drugs could be negotiated for a lower price by Part D plans, and improving the design of the Part B Competitive Acquisition Program.
  • Update Medicare’s drug-pricing dashboard to increase transparency.
  • Prohibit Part D contracts that include “gag rules” that prevent pharmacists from informing patients when they could pay less out-of-pocket by not using insurance.
  • Require that Part D plan members be provided with an annual statement of plan payments, out-of-pocket spending, and drug price increases.
  • Work across the Administration to address intellectual property theft and foreign freeloading…
  • ..The U.S. Trade Representative will prioritize addressing unfair intellectual property and market access policies in our trade agreements, so that partners contribute their fair share to innovation.
  • The Administration will publish a comparison of drug prices in the United States with those in other OECD countries, to examine freeloading…

The next part provides the following information on “Budge Proposals to Lower Drug Prices”:

  • President Trump has proposed reforms to the Medicare Part D program, including:
  • Allowing greater flexibility in benefit design to encourage better price negotiation.
  • Offering free generics to low-income seniors.
  • Requiring plans to share a minimum portion of drug rebates with patients.
  • Discouraging plans from accelerating beneficiaries into catastrophic phase of the benefit with costly brand name drugs.
  • Protecting seniors from catastrophic costs through a new out-of-pocket maximum, while ensuring plans are incentivized to limit excessive costs.
  • Medicaid Part B reforms proposed by the President would limit payment for price increases that are above the inflation rate and cut incentives for doctors to write high-price prescriptions.
  • Reforms would ensure hospitals paid under Medicare Part B that provide more than one precent of their patient costs in charity care could retain a discount under the 340B program.
  • The President has proposed actions to maximize competition and innovation, including curbing abuse of FDA safety rules an the 180-day “first-to-file” exclusivity clock…

May 12, 2018: President Trump released a statement titled: “Presidential Message on National Women’s Health Week”. From the statement:

This Sunday marks the beginning of National Women’s Health Week. This is an opportunity to honor the importance of women across America and renew our pledge to support their health and wellbeing.

Women are integral members of our families and communities who can face unique healthcare challenges. Whether breast cancer, heart disease, or Alzheimer’s, my Administration is committed to continue addressing women’s health through advancements in medical research, rapid reviews and approvals of new safe and effective therapies, and affordable treatments and care options.

The ongoing opioid crisis is of particular concern for women. On average, 115 Americans die each day from opioid-related overdoses – a faster that has contributed to the decrease in life expectancy over the past two years. The crisis has hit women particularly hard in part because they are more likely to suffer from chronic pain conditions for which opioids are often prescribed….

…The Department of Health and Human Services (HHS) has developed a comprehensive strategy to combat the opioid epidemic and enhance non-addictive pain treatments by working with medical experts, policymakers, community groups, and families who have experienced the tragedy of opioid addiction. Through these partnerships, the HHS Office of Women’s Health has awarded 20 grants to public and private organizations that are on the frontlines of the opioid crisis.

The Substance Abuse and Mental Health Services Administration has also published guidance for treating pregnant women and new mothers with opioid use disorder, a critical resource for the Nation’s hardworking medical professionals. It is vital for the wellbeing of our Nation that we support those who are suffering from drug addictions as well as all expecting and postpartum mothers. Similarly, the National Institutes of Health is engaging in research regarding interventions to help both the mothers and infants born to women with opioid use disorder.

…Through robust tax reform, we championed a doubled Child Tax Credit to ensure parents can adequately support their children. We are also focused on expanding access to paid family leave benefits for new mothers and fathers. The new reality is that in more than 60% of the homes of American married couples with children, both parents work…. Recent research suggests that women’s labor force participation has stalled due to the lack of family-friendly policies, including paid leave….Additionally, I signed an Executive Order to expand access to sports, fitness, and nutrition, with a specific focus on helping girls from economically challenged communities live act and healthy lifestyles…

May 14, 2018: 45 United States Senators sent a letter to Alex M. Azar II, Secretary of the U.S. Department of Health and Human Services. From the letter:

We are writing today in support of the Title X family planning program (Title X) and to express our strong opposition to any changes to Title X that would restrict access to affordable, high-quality and lifesaving reproductive healthcare in communities across the country.

Title X is the nation’s only federal program dedicated to providing family planning services to low-income and otherwise underserved individuals. Each year, roughly four million women, men, and adolescents rely on Title X-funded health centers for basic preventative health care, including cancer screenings, birth control, sexually transmitted infection (STI) screenings, pregnancy testing, and well-woman exams. Nearly two-thirds of Title X patients have incomes at or below the federal poverty level, and 43% of patients are uninsured. In 2016, nearly 4,000 Title X funded health centers performed 720,000 Pap tests, provided nearly one million women with breast exams, and administered 1.2 million HIV tests. Title X providers offer confidential, medically accurate, and evidence-based care, ensuring that patients relieve the highest standard of medical care.

In addition to providing care to low-income, uninsured, and underinsured individuals, Title X yeilds critical cost savings to the American healthcare system. Every dollar invested in Title X saves more than seven dollars in Medicaid-related costs. By helping individuals obtain the preventative services they need, Title X advances the health and well-being of individuals, families, and our nation as a whole while saving taxpayer dollars in the process.

In keeping with longstanding legal, ethical, and medical standards of healthcare, Title X providers offer patients medically accurate counseling on and referrals for all pregnancy options – including parenting, adoption, and abortion. The Title X program has never funded abortion services at its health centers. Health centers that receive Title X to provide family planning care may also separately provide abortions using non-federal funds.

In spite of the critical role that Title X-funded health centers play in promoting the health and wellbeing of millions of people, President Trump may seek to dramatically reduce the reach of Title X by reinstating the “domestic gag rule,” which was first issued under the Reagan administration but was never fully implemented. This “gag rule” would bar patients from receiving information to support their ability to make informed decisions about their own reproductive health. This means that the millions of patients who obtain care at Title X-funded health centers annually would be denied the ability to receive complete and accurate information about their medical options, including counseling on, and referrals, for abortion. On top of the ban on counseling and referrals, the “gag rule” would impose additional requirements intended to bar providers from participating in Title X that also separately provide abortion services.

Calls to reinstate these policies directly acknowledge this effort as an opportunity for President Trump to fulfill his pledge to “defund Planned Parenthood,” whose health centers remain an essential part of the family planning safety net, serving 40 percent of Title X patients. In reality, other providers of Title X-funded care would face immense challenges in attempting to absorb the patients that would lose access to care if Planned Parenthood were eliminated as a Title-X funded provider. According to recent analyses, other Title-X funded providers would have to expand their contraceptive caseloads by an average of 70 percent just to maintain access to contraceptive care at current levels.

A “domestic gag rule” would have a devastating impact on the overall Title X network and the millions of individuals who rely on it for care. This move would disproportionately impact communities of color, the uninsured, and low-income individuals, and it could reverse progress made in critical areas. For example, unintended pregnancy rates in the U.S. – including those among teenagers – have been declining. We cannot threaten to reverse this progress by crippling Title X: in 2015 alone, the contraceptive services supported by Title X helped women to avoid 822,000 unintended pregnancies, which would have resulted in 387,000 unplanned births to 278,000 abortions.

We strongly oppose efforts to undermine the integrity of the Title X program and harm the millions of people who rely on it for care. Federal health policy should be evidence-based and produced with the best interests of patients in mind.

May 15, 2018: 169 members of the United States House of Representatives sent a letter to Alex M. Azar II, Secretary of the U.S. Department of Health & Human Services. From the letter:

We would like to express our support of the Title X family planning program and our strong opposition to any plans to reinstate the “domestic gag rule,” which imposes restrictions on Title X providers and restricts access to affordable, quality, and lifesaving health care in communities across the country.

As you know, Title X is the only federal grant program dedicated to providing family planning services to low-income and otherwise underserved individuals. Each year, Title X offers roughly four million women and men confidential, medically accurate, and evidence-based care. With services ranging from cancer screenings to well-woman exams, Title X providers ensure their patients receive the highest standard of medical care. As every federal dollar invested in Title X saves Medicaid more than seven dollars, this is also a program that taxpayers can – and do – believe in.

In keeping with longstanding legal, ethical, and medical standards of health care, Title X providers offer patients medically accurate counseling on and referrals for all pregnancy options – including parenting, adoption and abortion. The Title X program has never funded abortion services at its health centers, and health centers that receive Title X funds to provide family planning care may also separately provide abortions using non-federal funds.

In spite of the critical role that Title X plays in promoting the health and well-being of millions of people, President Trump has indicated he plans to dramatically reduce its reach by reinstating the “domestic gag rule.” This rule would prevent health care providers from receiving Title X funding if they even mention aboriton or abortion-related services to their patients. The domestic gag rule would effectively restrict the ability of patients to receive medical counseling on abortion and make informed decisions about their own reproductive health. On top of the ban on counseling and referrals, the ‘gag rule’ would impose additional requirements intended to bar providers from participating in Title X that also separately provide abortion services. This would have a devastating effect on the millions of Americans who rely on Title X for basic health needs, and it would have a disproportionate impact on low-income individuals and communities of color.

Reinstating the domestic gag rule is nothing more than an opportunity for President Trump to fulfill his pledge to “defund Planned Parenthood,” whose health centers serve 40 percent of Title X patients and remain an essential part of the family planning safety net. Additionally, other providers of Title X-funded care would face immense challenges in attempting to absorb the patients that would lose access to care through Planned Parenthood.

Finally, a “domestic gag rule” could revers progress made in critical areas. Primarily, unintended pregnancy rates in the U.S. – including those among teenagers – have been declining. In 2015 alone, the contraceptive services supported by Title X helped women avoid 822,000 unintended pregnancies, which would have resulted in 387,000 unplanned births and 278,000 abortions. Cutting access to eligible providers would only pare back access to contraceptive services.

We strongly support efforts to undermine the integrity of the Title X program and harm the millions of people who rely on it for care. Federal health policy should be evidence-based and produced with the best interests of patients in mind. It should not be the result of the political whims of a partisan campaign pledge.

May 16, 2018: The Hill posted an article titled: “Graham working on new ObamaCare repeal bill”. It was written by Peter Sullivan. From the article:

Sen. Lindsey Graham (R-S.C.) said Wednesday he is working on a new version of his ObamaCare repeal-and-replace bill and has not given up on efforts to do away with the law despite Republicans’ failure last year…

…The effort appears to have little, if any, chance of passing this year. Republican leadership has made clear that it has moved on from the ObamaCare repeal effort, and the GOP has an even slimmer margin in the Senate than they did last year when they failed to win enough votes for a bill.

The new bill would keep the core element of last year’s bill from Graham and Sen. Bill Cassidy (R-La.), which is repealing ObamaCare’s subsides and Medicaid expansion and giving that money to the states in a block grant…

…Graham said Wednesday that he has been talking to other senators about his effort. “We’re talking to everybody,” he said.

Graham’s effort is working in parallel with an effort from conservative groups like the Heritage Foundation and the Galen Institute, which are working with former Sen. Rick Santorum (R-Pa.) and other groups on a new ObamaCare replacement plan.

The White House told The Hill earlier this month that it “fully supports” the effort, and White House staff have been attending meetings on the plan at the Heritage Foundation…

May 16, 2018: The Hill posted an article titled: “Trump expected to cut Planned Parenthood funding through regs”. It was written by Jessie Hellmann. From the article:

The Trump administration may take action to cut federal funding to Planned Parenthood as a result of pressure from congressional Republicans and anti-abortion lobbyists.

Opponents of abortion have launched an all-out campaign urging the administration to bring back Reagan-era abortion restrictions on federal family planning dollars that would target Planned Parenthood.

The regulations would ban organizations that receive family planning dollars under the Title X Family Planning Program, which funds organizations providing services like birth control to low-income women and men, from promoting abortion or referring patients for abortions. Former President Reagan first issues the regulations, which Democrats describe as a “domestic gag rule”, in 1988. They also require a physical separation of Title X funding recipients from abortion providers.

Republicans see the action as a way to movie the GOP base ahead of the midterm elections, where the party’s majorities in the House and Senate are in play…

…Due to a lengthy legal battle, the regulations were never fully implemented but were upheld by the Supreme Court after Reagan left office.

But with a Republican president who has promised to defund Planned Parenthood, now is the perfect time to restore the regulations, abortion opponents say…

…While federal law prohibits the use of federal funding for abortions in most cases, abortion opponents and Republicans have long argued money that goes to Planned Parenthood still indirectly supports the procedure.

Anti-abortion advocates have been frustrated over the GOP Congress’s failure to defund Planned Parenthood. The GOP’s slim majority in the Senate has been the obstacle.

Frustration swelled when Congress passed a spending bill earlier this year that excluded a measure defunding Planned Parenthood, a result negotiated between Democrats and Republicans to avoid a government shutdown…

May 16, 2018: Pacific Standard posted an article titled: “Transparency Advocates Log the Disappearance of Obamacare Information from Government Websites.” The article was written by Francie Diep. From the article:

Though the Affordable Care Act remains in effect, various mentions of it have disappeared from .gov webpages.

The only webpage on that was dedicated to describing how the Affordable Care Act affects Medicare was quietly taken down last year, a government transparency group has found.

Before December of 2017, visitors to could navigate to a page called “The Affordable Care Act & Medicare” from the website’s “About Us” section. The page told Medicare enrollees whether the passage of the Affordable Care Act – commonly known as Obamacare – meant the had to sign up for new plans. (It didn’t.) The page also emphasized that the law now meant Medicare covered more disease-prevention services and brand-name prescription drugs than before. Transparency advocates worry that the page’s unexplained disappearance, after months of hot debate over Obamacare’s fate, could be confusing for Medicare users, leaving them wondering if their status has changed.

“Doing things quietly can oftentimes be more confusing than having a notice or having some kind of communication about why things are changing,” says Toly Rinberg, who tracks changes to .gov websites for the non-profit Sunlight Foundation. Rinberg and a team of colleagues discovered the change to…

…Journalists and researchers have documented various mentions of the ACA disappearing from .gov websites. An ACA link was removed from the Department of Health and Human Services’ homepage within hours of President Donald Trump’s inauguration, The New York Times reports. Later, summaries of the law and positive user testimonies were taken down.

Rinberg says he and his colleagues, who are automatically tracking changes to about 25,000 .gov webpages having to do with health care and immigration, have seen removals of Obamacare information from numerous websites, including that of the Department of Health and Human Service, offices within the department, and other health agencies. The Sunlight Foundation plans to publish a detailed report about those changes in about a month…

May 17, 2018: Benefits Pro posted an article titled: “Obamacare startup Oscar plans expansion to new states”. It was written by Zachary Tracer. From the article:

Oscar Insurance Corp., the Obamacare-focused health insurance startup, plans to expand to Arizona and at least three other new markets next year, a bet on the health law’s survival despite the turbulent politics surrounding it.

In an interview, Chief Executive Officer Mario Schlosser said Oscar is meeting its goals to increase membership and revenue while gaining a better handle on medical costs…

…Oscar has stuck with Obamacare even after years of financial losses, as well as political uncertainty driven by the Trump administration’s push to repeal the law. After pulling back from several states for 2017, the company expanded to four markets for 2018 – Cleveland, New Jersey, Austin and Nashville – and enrolled about 240,000 members at the end of the first quarter, but from 90,000 last year…

…Schlosser said the company is expanding into four new markets, though he declined to name them because the company is still working on its filings with state regulators. Oscar will enter into close partnerships with hospitals systems, he said, as it did with the Cleveland Clinic in that hospital’s home city.

The hospital deals help Oscar make up for one of its main disadvantages to more-established health insurance rivals, which have already established networks of doctors, clinics and medical centers. By partnering, Oscar can offer customers access to care without having to rent a medical network – a costly proposition…

May 17, 2018: The New York Times posted an article titled: “Trump Administration to Tie Health Facilities’ Funding to Abortion Restrictions”. It was written by Julie Hirschfeld Davis and Maggie Haberman. From the article:

Clinics that provide abortions or refer patients to places that do would lose federal funding under a new Trump administration rule that takes direct aim at Planned Parenthood, according to three administration officials.

The rule, which is said to be announced Friday, is a top priority of social conservatives and is the latest move by President Trump to impose curbs on abortion rights, in this case by withholding money from any facility or program that promotes abortion or refers patients to a caregiver that will provide one…

…Federal family planning laws already ban direct funding of organizations that use abortion as a family planning method. But conservative activists and lawmakers have been pressing Alex M. Azar II, the secretary of health and human services, to tighten the rules further so that abortions could not occur – or be performed by the same staff – at locations that receive Title X federal family planning money.

Dawn Lagunes, the executive vice president of Planned Parenthood Federation of America, called the new proposal “outrageous” and “dangerous.”

The policy, she said in a statement Thursday, is “designed to make it impossible for millions of patients to get birth control or preventative care from reproductive health care providers like Planned Parenthood. This is designed to force doctors and nurses to lie to their patients. It would have devastating consequences across this country.”…

…Mr. Trump has shown ambivalence about Planned Parenthood, sometimes expressing support for its health-related services other than abortion. His daughter, Ivanka Trump, a senior adviser, has urged him not to strip funding for the organization, as many Republicans have proposed, warning of the possible political repercussions.

Mr. Trump is set next week to give the keynote speech at the “Champion for Life” gala held by the Susan B. Anthony List. Ms. [Marjorie] Dannenfelser [president of the Susan B. Anthony List, a group that opposes abortion rights] has called Mr. Trump “the most pro-life president of our nation’s history.”

The Trump administration has pressed repeatedly to impose abortion limits. Upon taking office, Mr. Trump signed a presidential memorandum reinstitution and expanding the so-called global gag rule, which bars federal funding for organizations around the world that provide abortion counseling or referrals.

Mr. Trump has also taken particular aim at Planned Parenthood, which serves 41 precent of women who receive federally funded family planning services. He signed legislation last year aimed at cutting off government money from the group and others that perform abortions…

…Doctors have also expressed alarm at the prospect of such changes to federal family planning rules. In a conference call this month, officials from the American College of Physicians and American College of Gynecologists said the policy would harm women’s health…

…Abortion rights advocates also argue that the new rules could result in women not receiving reproductive health care at all, leading to more unintended pregnancies and higher mortality rates. They note that Planned Parenthood and other groups that perform abortions are often the only federally funded health care providers in certain areas of the country, meaning that some women in those places may simply not receive medical care at all under the new policy…

May 18, 2018: HuffPost posted an article titled: “Trump’s New ‘Domestic Gag Rule’ Would Strip Funds from Planned Parenthood”. It was written by Laura Bassett. From the article:

The Trump administration will propose a new rule Friday that would block federal funds to any organization that provides or even shares space with an abortion provider – a domestic version of the so-called “Global Gag Rule” the president reinstated and expanded last year.

The move would notably strip Title X funding from Planned Parenthood, which provides birth control, STI testing and treatment, and cancer screenings to more than one-third of the federal family planning program’s 4 million low-income patients…

…”This is a far-reaching attack and attempt to take away women’s basic rights and reproductive rights, period,” Dawn Laguens, executive vice president of Planned Parenthood, said in a call with reporters Friday…

…Anti-abortion advocates have been pushing Trump since the beginning of his term to fulfill his campaign promise to defund Planned Parenthood, especially since Republicans in Congress have repeatedly tried and failed to do so. A coalition of conservative groups sent the administration a letter on May 1 urging them to take this step…

…Federal law already prohibits public funds from being used to pay for abortions. Women who seek abortions at Planned Parenthood or other providers must cover the cost of the procedure themselves unless their insurance plan covers it. Trump’s proposed rule would strip funds used for birth control and STD testing from organizations like Planned Parenthood and roll back a requirement that providers who receive federal subsidies for family planning services offer women information about the full range of reproductive health options, including abortion…

May 18, 2018: The White House posted a statement from the Press Secretary titled: “Statement from the Press Secretary Regarding the Proposed Title X Family Planning Program Rule from the Department of Health and Human Services.” From the statement:

The Administration’s announcement today of a proposed rule on Title X family planning program fulfills President Donald J. Trump’s promise to continue to improve women’s health and ensure that Federal funds are not used to fund the abortion industry in violation of the law.

The President is pleased to support the proposed rule from the Department of Health and Human Services (HHS), which would update the regulations governing the Title X family planning program. This important proposal would ensure compliance with the program’s existing statutory prohibition on funding programs in which abortion is a method of family planning. The new proposed rule would not cut funds from the Title X program. Instead, it would ensure that taxpayers do not indirectly fund abortions. Contrary to recent media reports, HHS’s proposal does not include the so-called “gag rule” on counseling about abortion that was part of the Regan Administration’s Title X rule.

May 18, 2018: Reuters posted an article titled: “Obamacare tied to earlier cancer detection in young women”. It was written by Shereen Lehman. From the article:

Under the Affordable Care Act (ACA) provision allowing adult children to stay on their parents’ health insurance policy until age 26, young women with gynecological cancers were diagnosed and treated sooner, researchers say.

Before the law, often called Obamacare, went into effect, one in three women ages 19 to 26 years had health insurance, and today more than four in five women in this age group are insured, the study team notes in Obstetrics & Gynecology.

In a comparison of young women who would have had access to insurance coverage under the law, and slightly older women who would not have had the same access, researchers found that 3.6 percent more of the younger group had their cancers diagnosed at an early stage…

…For their study, the researchers analyzed data from a national cancer database. They included in the analysis women aged 21 to 35 diagnosed with uterine, cervical, ovarian, vulvar or vaginal cancer during the yers 2004 to 2009, before the ACA went into effect, and 2001 to 2014, after the ACA went into effect.

Among women diagnosed at ages 21 to 26, the study team identified a total of 1,912 gynecologic cancer cases before the ACA and 2,059 during the ACA, and among women diagnosed between 27 and 35, there were 9,782 cases before ACA and 10,456 cases during the ACA.

In addition to the younger women being more likely to be insured and diagnosed when their cancer was at an earlier stage, women in both age groups were more likely to receive fertility-sparing cancer treatments during the ACA years, the study found…

…The immediate extension of insurance coverage to dependents under age 26 by the ACA in 2010 resulted in improved insurance coverage rates and earlier stage at diagnosis of uterine cancer in young women aged 21 to 25…

…Young women have traditionally faced discriminatory insurance practices such as higher insurance premiums than mean at the same age and denial of maternity coverage…

May 29, 2018: The Hill posted an article titled: “Fourth federal judge blocks Trump’s cuts to teen pregnancy prevention.” It was written by Jessie Hellman. From the article:

A fourth federal judge has ruled against the Trump administration’s decision to prematurely end grants aimed at cutting teen pregnancy rates.

Judge John Coughenour in Washington state ruled Tuesday afternoon that the administration unlawfully ended grants two years early for the King County Health Department in Seattle, which participated in the Teen Pregnancy Prevention (TPP) Program.

“This ruling is such a relief, as we are so close to the finish line for completing this study and building an evidence base for sex education nationwide,” said Patty Hayes, director of public health for Seattle and King County.

The ruling is significant as a class-action lawsuit filed by the remaining 72 grantees plays out in court.

Federal judges have now ruled in four different cases involving nine TPP grantees that the administrations actions were unlawful. The rulings mean the Department of Health and Human Services (HHS) will have to process applications for the final two years of funding…

…Trump appointees at HHS are pushing to give the TPP program a greater emphasis on abstinence education…

May 30, 2018: The White House posted a fact sheet titled: “President Donald J. Trump to Sign Right to Try Legislation Fulfilling the Promise He Made to Expand Healthcare Options for Terminal Americans”. From the fact sheet:

  • The bill amends Federal law to allow certain unapproved, experimental drugs to be administered to terminally ill patients who have exhausted all approved treatment options and are unable to participate in clinical drug trials.
  • Eligible drugs must have undergone the Food and Drug Administration’s (FDA) Phase I (safety) testing.
  • The bill requires any manufacturer or sponsor of an eligible investigational drug to report to the FDA on any use of the drug on a “Right to Try” basis.
  • The FDA wil post an annual summary report of “Right to Try” use on its website.
  • The bill limits the the liability of drug sponsors, manufacturers, prescribers, or dispensers that provide or decline to provide an eligible investigational drug to an eligible patient.
  • The FDA’s “compassionate use” application is complicated and time-consuming, resulting in only 1,200 approved applications per year.
  • With President Trump’s signature the Federal government joins with 40 states that have approved the right of terminally ill patients to try potentially life saving drugs.

May 30, 2018: Donald J. Trump @realDonaldTrump tweeted: “With the #RightToTry Law I signed today, patients with life threatening illnesses will finally have access to experimental treatments that could improve or even cure their conditions. These are experimental treatments and products that have shown great promise…”

May 30, 2018: The Hill posted an article titled: “Trump signs ‘right to try’ drug bill”. It was written by Jessie Hellmann. From the article:

President Trump signed a bill Wednesday allowing terminally ill patients access to experimental medical treatments not yet approved by the Food and Drug Administration (FDA).

Dubbed “right to try,” the law’s passage was a major priority of Trump and Vice President Pence, as well as congressional Republicans…

…Trump thanked lawmakers sitting in the audience who sponsored the bill, including Sen. Joe Donnelly, a vulnerable Democrat up for reelection in Indiana.

Despite calling Donnelly a “really incredible swamp person” earlier this month, Trump thanked the senator for his work on the bill.

Sen. Joe Manchin (W. Va.), another vulnerable Democrat up for reelection, was the only other Democratic co-sponsor on the bill, but did not attend the ceremony because he is in West Virginia this week, his office said…

…Most Democrats and public health groups oppose the bill, arguing that it could put patients in danger.

“FDA overbite of access to experimental treatments exists for a reason – it protects patients from potential sale oil salesmen or from experimental treatments that might do more harm than good,” said Rep. Frank Pallone Jr. (D- N.J.), ranking member of the House Energy and Commerce Committee.

Opponents also argue it gives “false hope” to patients, since drugmakers aren’t required to give approved medicines to patients who ask for them.

Supporters say, however, it will provide new treatment opportunities for terminally ill patients who have exhausted existing options…

May 30, 2018: posted an article titled: “Phil Murphy signs law protecting Obamacare from Trump with N.J. mandate to have health insurance.” It was written by Susan K. Livio. From the article:

Gov. Phil Murphy on Wednesday signed a law preserving a critical yet controversial part of the Affordable Care Act that President Donald Trump’s administration repealed last year.

One of the laws creates a statewide individual mandate, which will require all New Jerseyans who don’t have health coverage through a government program like Medicare or their jobs to buy a policy, or pay a fee at tax time.

The landmark federal health care Lae, better known as Obamacare, imposed the mandate to ensure younger and healthier people who might otherwise forgo insurance will buy-in and share costs…

May 31, 2018: USA Today posted an article titled: “Virginia, after 5-year battle, passed Medicaid expansion for 400,000 poor people”. It was written by Doug Stanglin. From the article:

After a five-year battle, the Virginia legislature has voted to expand Medicaid coverage for some 400,000 poor people, despite opposition from the White House.

The Republican-controlled Senate voted Wednesday in favor of a state budget expanding Medicaid and the House of Delegates, which had previously backed the measure, gave its final approval shortly afterwards. Several Republicans in both chambers joined with Democrats to approve the measure.

Democratic Gov. Ralph Northam, a pediatrician who made Medicaid expansion a centerpiece of his campaign in 2017, is expected to sign the legislation soon…

…The votes makes Virginia the 33rd state to approve Medicaid expansion under the Affordable Care Act, or Obamacare, according to figures compiled by the Kaiser Family Foundation…

…The move also reflected the state’s sharp shift to the left in the 2017 elections in which Democrats picked up 15 seats in the House of Delegates and almost took control of the body.

In the final hours, Sen. Ben Chafin, a Republican lawmaker from Virginia’s economically depressed southwest coal country, announced his support for expansion on the Senate floor. He said his rural area needs expansion to bolster its hospitals and provide care for constituents.

“I came to the conclusion that no just wasn’t the answer anymore,” Chafin said.

Virginia GOP Speaker Kirk Cox, however, said the Trump administration’s openness to conservative reforms, including work requirements, “was probably the biggest key” in getting Republican support for the Medicaid expansion…

May 31, 2018: Bloomberg posted an article titled: “Senator Behind Right-to-Try Law Says Its Intent is to Weaken FDA”. It was written by Anna Edney. From the article:

Senator Ron Johnson, the chief sponsor of a new law giving terminally ill patients easier access to experimental drugs, said the aim of the measure is to weaken the U.S. Food and Drug Administration.

In a letter to FDA Commissioner Scott Gottleib on Thursday, the Wisconsin Republican said the goal is to “diminish the FDA’s power over people’s lives, not increase it.”

The blunt message came a day after President Trump signed the so-called right-to-try bill into law. It was in response to previous comments Gottleib had made detailing how the agency plans to implement the law.

Gottleib told the news outlet Stat this month that the FDA may need to propose new regulations to ensure that patients are protected. The agency has a program to approve patient requests for access to experimental drugs if they aren’t eligible for a clinical trial. The “right-to try” law allows patients to get the unproven medications without FDA permission…

…The law was backed by the Goldwater Institute, a libertarian think tank, and Americans for Prosperity, which is affiliated with the conservative Koch brothers….

May 31, 2018: The Democratic Governors Association (DGA) posted a letter that they sent to Secretary of Health and Human Service (HHS), Alex Azar. From the letter:

As governors representing 90 million Americans, we are deeply concerned with the Administration’s plan to undermine women’s health and place sweeping restrictions on reproductive healthcare providers across our country. For more than 40 years, Title X has been an important partnership between the federal government and states that has been supposed by Democrats and Republicans alike. This dangerous proposal would upend decades of bipartisan cooperation, taking away women’s healthcare through trusted medical providers like Planned Parenthood and eroding their access to comprehensive, medically accurate information. We strongly urge you to reconsider this plan, which is nothing more than a domestic “gag rule” that poses serious risks to women’s health.

We stand with women and men in our states by rejecting this Administration’s efforts to interfere with the doctor-patient relationship, gut women’s access to family planning services, and force medical professionals to knowingly withhold information from their patients. If the federal government breaks its commitment to states in the Title X program, we will react in kind and do what is necessary to protect the health of our constituents. We call on Americans to actively and aggressively oppose this proposed action. And if this reckless policy is finalized as written, we will have no choice but to explore all possible avenues, including legal options, to block it from harming the women in our states. Our voices will be heard on this damaging proposal, and we are prepared to match our words with actions.

We strongly urge you not to undermine the important work that Governors and administrations of both parties have done for decades to support women and families through Title X. We will continue to consult with our states’ Attorneys General, state legislatures, and state health agencies to stop this rule from harming the millions of women we are sworn to protect.

It was signed by the following Democratic Governors:

  • Governor Jay Inslee – Washington
  • Governor Gina Raimondo – Rhode Island
  • Governor Andrew Cuomo – New York
  • Governor Mark Dayton – Minnesota
  • Governor John Hickenlooper – Colorado
  • Governor Dan Malloy – Connecticut
  • Governor Steve Bullock – Montana
  • Governor David Ige – Hawaii
  • Governor Tom Wolf – Pennsylvania
  • Governor Kate Brown – Oregon
  • Governor John Carney – Delaware
  • Governor Roy Cooper – North Carolina
  • Governor Phil Murphy – New Jersey
  • Governor Ralph Northam – Virginia

June 1, 2018: Nevada Health Link posted a blog titled: “Short Term Limited Duration Plan Impact on The Individual Market”. From the blog post:

The U.S. Department of Health and Human Services (DHHS) released a final rule that will undermine high-quality, comprehensive insurance for adults, children, and especially people with pre-existing conditions. The final rule on short-term limited duration plans (STLD) loosens requirements on insurance plans that can discriminate against people with pre-existing conditions, don’t have to cover essential benefits, don’t cover prescription drugs outside of the hospital setting, and otherwise, leave people unprotected from health and financial harms. Nevada Revised Statutes limit STLD plans 185 days…

Nevada Health Link provided a list of benefits that are NOT covered by Short-Term Limited Duration health plans:

  • Maternity health care
  • Prescription drug coverage
  • Mental health care
  • Substance use disorder services
  • Preventative care – annual exams, check-ups, cancer screenings
  • Treatment for developmental delays

Nevada Health Link also provided information, in the form of a graphic, that shows other problems with Short-Term Limited Duration health plans:

  • Can decline coverage for pre-existing conditions
  • Can charge more for pre-existing conditions
  • Cannot apply financial subsidy assistance toward monthly cost
  • Not required by law to cover doctor visits
  • Not required by law to cover ER visits
  • Not required by law to cover prescription drugs
  • Not required by law to cover laboratory work
  • Not required by law to cover pediatric services
  • Not required by law to cover physical therapy
  • Not required by law to cover preventative and wellness services
  • Not required by law to cover maternity care
  • Not required by law to cover mental health and addiction services
  • Can place limitations on yearly or lifetime insurance coverage
  • Have no limits on out-of-pocket expenses
  • Do not have to clearly explain benefits to consumers

June 1, 2018: Fortune posted an article titled: “Virginia Will Expand Medicaid Under Obamacare. That’s a Huge Deal for 400,000 People.” It was written by Sy Mukherjee. From the article:

A raging political battle over Obamacare came to an abrupt end Wednesday when the Virginia legislature – controlled by Republicans – voted to expand Medicaid under the health law. Newly elected Democratic Governor Ralph Northam is expected to sign the legislation, which is projected to extend health coverage to some 400,000 low-income Virginia residents…

…While Congress did nix Obamacare’s individual mandate to carry health insurance as part of the tax law signed by President Trump late last year, most of its major provisions – including the popular Medicaid expansion aimed at households earning just 138% of the Federal Poverty Level (or about $35,000 for a family of four) – remain in effect…

June 1, 2018: Des Moines Register posted an article titled: “Sen. Chuck Grassley: ‘We’ve got to give up’ on repealing, replacing Obamacare”. It was written by Luke Nozicka. From the article:

Republican Sen. Chuck Grassley this week told people gathered at an Iowa town hall that politicians should “give up” on repealing and replacing the Affordable Care Act.

During the meeting Thursday in Orange City, Grassley started answering a question about bipartisan efforts to improve the legislation before saying, “Oh, by the way, we’ve got to give up on repeal and replace.” A video of his answer was posted online by American Bridge 21st Century, a Democratic organization.

In an email, Grassley’s press secretary, Nicole Teiman, said the senator was speaking to a “mathematical reality: the votes to repeal and replace Obamacare aren’t there in the current Congress, an assessment he and other senators have expressed before.”…

…A majority of Iowans, 58 percent. said they mostly oppose the direction congressional Republicans were heading in as they crafted health care legislation, the Des Moines Register/Mediacom Iowa Poll found in July 2017. Most of those opponents, 61 percent, said the GOP’s proposed changes go to far, while 31 percent said they do not go far enough.

June 2, 2018: The Hill posted an article titled: “States defy Trump on ObamaCare”. It was written by Nathaniel Weixel. From the article:

…Several states, including California and Maryland, are looking to put limits on short-term insurance plans, even as there Trump administration is poised to expand access to them nationwide.

The states are doing so because they fear the availability of the short-term plans will drive up premium costs for ObamaCare.

On another front, Vermont and New Jersey have passed laws that require people to buy health insurance. These individual mandate laws are meant to replace the now-repealed federal requirement.

Advocacy groups and state officials that back these measures say states are seeking to protect advances made under ObamaCare from attacks by the Trump administration, which sought to repeal and replace the law and, failing that, tried to chip away at it…

…Costs are a big driver in the efforts by states.

The cost of health insurance premiums on the ObamaCare exchanges is projected to jump in the coming weeks and months. Some states could see major double-digit spikes next year.

The high costs are blamed on actions the administration has taken that could cut into ObamaCare’s enrollment.

“There’s been a series of actions taken by the current administration that have undermined enrollment,” Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, said when he announced a potential 26 percent premium increase for next year in Maryland…

…Massachusetts first imposed a mandate in 2006 as part of then Gov. Mitt Romney’s (R) heart reform plan, which served as a model for ObamaCare.

Vermont’s Republican Gov. Phil Scott also signed an individual mandate bill late in May, but it won’t take effect until 2020, and many of the details, including the penalty and enforcement mechanisms, still need to be decided.

Maryland lawmakers discussed passing a mandate law for 2016, but ultimately only passed a commission to study it…

…California passed a bill that would completely prohibit the sale of short-term plans beginning in 2019, but it has yet to be signed into law.

Lawmakers in Hawaii passed a bill that would essentially eliminate the state’s short-term health plan market by prohibiting their sale to anyone eligible for a plan on the ObamaCare exchange. That bill is also awaiting the governor’s signature.

Maryland’s GOP Gov. Larry Hogan recently signed a bill that limits short-term plans to three month, and prohibits their renewal…

June 4, 2018: Reuters posted an article titled: “U.S. black lung fund will need taxpayer bailout of coal tax fails: GAO”. It was written by Valerie Volcovici. From the article:

A federal fund to help U.S. coal miners disabled by black lung disease will require a multibillion-dollar taxpayer bailout if Congress does not extend or increase the tax on coal production that funds it, according to a government report on Monday.

Coal companies are currently required to pay $1.10 per ton tax on underground coal production to finance the federal Black Lung Disability Trust Fund, which pays medical and living expenses for eligible miners, but that amount is scheduled to revert to the 1977 level of 50 cents.

“With the scheduled 2019 tax decrease, our moderate case simulation suggests that expected revenue will likely be insufficient to cover combined black lung benefit payments and administrative costs, as well as debt repayment expenditures,” according to a report from the non-partisan Government Accountability Office.

Cases of black lung, an incurable illness caused by inhaling coal dust, are rising to levels not seen in decades as miners plumb the depths of played-out coal seams using heavy blasting equipment, according to government health officials.

The fund that helps them is already roughly $6 billion in debt, as revenue since it was created in the 1970s has failed to keep up with outflows. The debt could balloon to $15 billion by 2050 without congressional action, the GAO report said.

The GAO offered three options to improve the solvency of the fund: extend the current excise tax rate to reduce the debt to $4.5 billion debt by 2050, increase the tax rate by approximately 25 percent to eliminate the debt entirely by 2050, or allow the tax rate to sunset as scheduled, cancel the current debt, and appropriate $7.8 billion to the fund.

The third option would amount to a multibillion-dollar transfer of liability for black lung victims from coal companies to taxpayers.

The coal industry has been lobbying hard against the tax, arguing its payments have already been too high at a difficult time for mining companies and that the fund has been abused by underserving applicants, such as smokers…

…The United Mineworkers Union of America, the coal miners’ trade union, called on Congress to ensure that the excise tax coal companies now pay remains at current levels, especially as the incidence of disease continues to rise and affect younger miners…

June 6, 2018: The New York Times posted an article titled: “Alex Azar, Health Secretary, Denies Sabotaging Insurance Markets”. It was written by Robert Pear. From the article:

Alex M. Azar II, the secretary of health and human services, denied on Wednesday that Trump administration policies were driving up health insurance costs, which many experts expect to surge again in 2019.

Mr. Azar, testifying before a House committee, vigorously disputed suggestions by Democrats that President Trump had sabotaged Affordable Care Act marketplaces, where millions of people obtain insurance subsidized by the federal government…

…The Congressional Budget Office said the full unsubsidized premium for a benchmark midlevel plan in the marketplaces rose 35 percent this year, on average, and was likely to increase about 15 percent next year. But some insurers have already requested rate increases of more than 30 percent for 2019…

…Insurers and consumer advocates say Mr. Trump’s efforts to undercut the Affordable Care Act have created uncertainty for insurers, causing some to withdraw from the public marketplaces…

…Nancy Pelosi, the House Democratic leader, cited news reports indicating that insurers around the country were using Trump administration policies to justify 2019 rate increases in Maine, Maryland, New York, Pennsylvania, Vermont, Virginia and Washington, among other states.

In seeking higher rates for 2019, insurers point to several developments. Mr. Trump cut off subsidies that insurers use to reduce out-of-pocket medical costs for low-income people. And Congress, with encouragement from Mr. Trump, eliminated tax penalties for people who go without insurance, starting next year, giving healthier people less incentive to obtain coverage…

…Mr. Azar did announce one policy that is likely to help consumers and insurers. He said the administration would, in effect, allow insurers to continue shifting certain costs to the federal government – because officials did not have time to issue rules banning the practice in 2019.

To offset the loss of federal “cost-sharing” payments, many insurers increased premiums this year. State officials in many states told them to load all the increases onto midlevel “silver plans,” because the federal government uses the cost of such plans as a benchmark in calculating premium subsidies. Those subsidies made insurance much more affordable, because they covered most or all of the premiums for many people this year.

Administration officials had expressed concern about the practice and considered banning it.

But Mr. Azar said, “We certainly are not able to regulate in time for the plan year” that starts in January.

He also defended the administration’s decision to allow states to impose work requirements on low-income people covered by Medicaid….

June 7, 2018: The Chicago Tribune posted an article titled: “Trump administration won’t defend Affordable Care Act in case brought by GOP states”. It was written by Amy Goldstein. From the article:

The Trump administration said Thursday night that it will not defend the Affordable Care Act against the latest legal challenge to its constitutionality – a dramatic break from the executive branch’s tradition of arguing to uphold existing statutes and a land mine for health insurance changes the ACA brought about.

In a brief filed in a Texas federal court and an accompanying letter to House Minority Leader Nancy Pelosi, D-Calif., the Justice Department agrees in large part wit the 20 Republican-led states who brought the suit. They contend that the ACA provision requiring most Americans to carry health insurance soon will no longer be constitutional and that, as a result, consumer insurance protections under the law are not valid either.

The three-page letter to Pelosi from Attorney General Jeff Sessions begins by saying that Justice adopted its position “with the approval of the President of the United States.” The letter acknowledges that the decision not to defend an existing law deviates from history but contends that it is not unprecedented.

The bold swipe at the ACA, a Republican whipping post since its 2010 passage, does not immediately affect any of its provisions. But it puts the law on far more wobbly legal footing in the case, which is being heard by a GOP-appointed judge who has in recent case ruled against more minor aspects.

The administration does not go so far as the Texas attorney general and his counterparts. In their suit, lodged in February in the U.S. District Court for the Northern District of Texas, they argue that the entire law is now invalid.

By contrast, the Justice brief and letter say that many other aspects of the law can survive because they can be considered legally distinct from the insurance mandate and such consumer protections as a ban on charging more or refusing coverage to people with preexisting medical conditions.

A group of 17 Democratic-led states that have won standing in the case also filed a brief on Thursday night arguing for the ACA’s preservation…

…It was an unusual filing just before 6 p.m. Thursday, when the brief was due, and three career Justice attorneys involved in the case – Joel McElvain, Eric Bekenhauer and Rebecca Kopplin – withdrew….

…The new challenge comes six years after the Supreme Court’s divided ruling that the ACA is constitutional. That ruling hinged on the reasoning that, while the government “does not have the power to order people to buy health insurance,” as Chief Justice John Roberts wrote for the majority, it “does have the power to impose a tax on those without health insurance.”…

…The suit is being heard by Judge Reed O’Connell, who was appointed by President George W. Bush and has ruled against the ACA in other cases the past few years…

June 7, 2018: The Hill posted an article titled: “Sessions explains to Congress rationale for not defending ObamaCare”. It was written by Julia Manchester. From the article:

Attorney General Jeff Sessions sent a letter to House Speaker Paul Ryan (R-Wis.) on Thursday defending the Department of Justice’s (DOJ) rationale for not defending the Affordable Care Act, also known as ObamaCare.

“As you know, the Executive Branch has a longstanding tradition of defending the constitutionality of duly enacted statutes if reasonable arguments can be made in their defense,” Sessions wrote.

“But not every professionally responsible argument is necessarily reasonable in this context,” he continued, adding this is “a rare case where the proper course is to forgo defense” of the law…

…Sessions’s move marks a break for the DOJ, which typically defends federal laws when they are challenged in court…

June 7, 2018: Reuters posted an article titled: “U.S. Justice Department says Obamacare individual mandate unconstitutional” From the article:

The U.S. Justice Department said on Thursday that the part of Obamacare requiring individuals to have health insurance is unconstitutional, an unusual move that could lead to stripping away some of the most significant and popular parts of the law.

In a brief filed in federal court in Texas, the department said a tax law signed last year by President Donald Trump that eliminate penalties for not having health insurance rendered the so-called individual mandate under Obamacare unconstitutional.

The Justice Department said that it also nullifies two other major provisions of Obamacare linked to the individual mandate, including one barring insurance companies from denying coverage to people with pre-existing conditions.

Attorney General Jeff Sessions, in a letter to House of Representatives Speaker Paul Ryan, said he had determined the individual mandate will be unconstitutional when the tax law becomes effective in 2019…

…Sessions said in his letter that the Justice Department was not arguing that the entire law does not pass constitutional muster. He said the department only refused to defend the pre-existing conditions provision as well as one forbidding insurers from charging people in the same community different rates based on gender, age, health status, or other factors…

June 7, 2018: The U.S. House of Representatives passed H.R. 3 “Spending Cuts to Expired and Unnecessary Programs Act”.  It is a recession bill designed allow Congress to take away appropriated funding from programs at the Departments of Agriculture, Commerce, Energy, Health and Human Services, Justice, Labor, State, Transportation, Treasury, and the Railroad Retirement Board.

H.R. 3 was sponsored by Representative Kevin McCarthy (California – Republican).

The health care related recessions included:

  • $5.1 billion from Children Health Insurance Fund – The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. The President’s proposal contains two provisions related to CHIP that would simply rescind funds that are either no longer necessary or can’t be spent because the authority to do so expired last year. Rescinding these funds will likely have no impact on the program.
  • $1.8 billion from the Child Enrollment Contingency Fund – Under CHIP, the Contingency Fund provides payments to States that experience funding shortfalls due to higher than expected enrollment. At this time, the Centers for Medicare and Medicaid Services does not expect that any State would require a Contingency Fund payment in FY 2018; therefore, this funding is not needed. It is important to note that the proposal would not rescind all available funding, meaning sufficient funding would be available should a state eventually qualify for a payment.
  • $800 million from the Center for Medicare and Medicaid Innovations – Created under the Affordable Care Act, the Center for Medicare & Medicaid Innovation (the Innovation Center) with CMS supports the development and testing of innovative health care payment and service delivery models.

Some details from the text of H.R. 3 about how much will be rescinded from certain programs:

  • $5,149,512,000 from the unobligated balances of the Social Security Act are rescinded
  • $800,000,000 from the amounts made available of the Social Security Act are rescinded
  • $1,865,000,000 of the amounts deposited in the Child Enrollment Contingency Fund for fiscal year 2018 are permanently rescinded

The vote on H.R. 3 in the House of Representatives happened on June 7, 2018. The vote was 201 YEAs to 205 NAYS. This means that the bill passed the House of Representatives. Next, it would be sent to the U.S. Senate.

All of the people who voted YEA were Republicans.

19 of the people who voted NAY were Republicans:

  • Vernon Buchanan (Florida – Republican)
  • Carlos Curbelo (Florida – Republican)
  • Mario Díaz-Balart (Florida – Republican)
  • Brian Fitzpatrick (Pennsylvania – Republican)
  • Will Hurd (Texas – Republican)
  • John Katko (New York – Republican)
  • Mike Kelly (Pennsylvania – Republican)
  • Leonard Lance (New Jersey – Republican)
  • Tom MacArthur (Connecticut – Republican)
  • Brian Mast (Florida – Republican)
  • David McKinley (West Virginia – Republican)
  • Ilena Ros-Lehtinen (Florida – Republican)
  • Peter Roskam (Illinois – Republican)
  • Keith Rothfus (Pennsylvania – Republican)
  • Elise Stefanik (New York – Republican)
  • Mike Turner (Ohio – Republican)
  • Fred Upton (Michigan – Republican)
  • Jackie Walorski (Indiana – Republican)
  • Kevin Yoder (Kansas – Republican)

187 of the people who voted NAY were Democrats.

11 people did not vote:

  • Joyce Beatty (Ohio – Democrat)
  • Salud Carbajal (California – Democrat)
  • Kristi Noem (South Dakota – Republican)
  • Steven Palazzo (Missouri – Republican)
  • Jared Polis (Colorado – Democrat)
  • Terri Sewell (Alabama – Democrat)
  • John Shimkus (Illinois – Republican)
  • Bill Shuster (Pennsylvania – Republican)
  • Juan Vargas (California – Democrat)
  • Mimi Waters (California – Republican)
  • Tim Walz (Minnesota – Democratic-Farmer-Labor Party)

June 7, 2018: The Hill posted an article titled: “House passes Trump’s plan to claw back $15 billion in spending”. It was written by JulieGrace Brufke and Niv Elis. From the article:

The House voted along party lines late Thursday to pass a White House proposal that would claw back nearly $15 billion in previously approved government funding.

The House approved the measure in a vote of 210 – 206, with conservatives calling ti a step in the right direction after they ripped into the price tag of the $13 trillion spending bill President Trump signed earlier this year…

…Trump had pushed lawmakers earlier this week to vote in favor of the clawback plan, known as the Spending Cuts to Expired and Unnecessary Programs Act, which GOP leaders have been working on for two months…

…While the move was welcomed by fiscal hawks, Democrats and a handful of moderates argued it could hinder future budget negotiations and drain unused funds that may prove necessary for programs down the road.

Opponents blasted the administration’s decisions to target unobligated funds within the Children’s Health Insurance Program (CHIP) – which make up nearly half of the $14.7 billion in rollbacks – alleging the cuts could lead to a loss of coverage that is higher than expected…

…The CBO analysis supported Republican arguments that the plan would not affect children’s health. Its analysis found that the recessions would not affect any spending on children’s health, and would not affect any coverage.

But it also showed that the move would have little impact on spending.

Because the funds in question were unobligated or associated with expired programs, canceling the budget authority to spend them would do little to affect the actual spending…

…Whether the Senate will move on the measure remains unclear…

June 7, 2018: CNN posted an article titled: “Trump moves pushing up Obamacare premiums for 2019”. It was written by Tami Luhby. From the article:

…Insurers in several states have requested large rate hikes for 2019, with many pointing to steps taken by President Donald Trump and Republicans in Congress as the main reason why.

New York insurers want to hike rates by 24%, on average, while carriers in Washington are looking for a 19% average premium increase. In Maryland, CareFirst is asking for an average 18.5% rate bump for its HMO plans and a 91% spike for its PPO policies (which have far fewer enrollees), while Kaiser Permanente wants to boost premiums by more than 37% on average.

Many insurers cite two key drivers of the increases: Congress’ elimination of the penalty for the individual mandate — which requires nearly all Americans to have coverage or pay up — and the Trump administration’s expected expansion of two types of health plans that don’t have to adhere to Obamacare’s regulations…

…Jettisoning the individual mandate penalty is expected to cause premiums to rise by about 10%, the industry group said, citing reports by the Congressional Budge Office and independent actuaries. That’s because younger and healthier people will be more likely to forgo insurance since they will no longer have to pay a penalty. Insurers fear they will be left with sicker and older policyholders, prompting them to request higher rates to cover the anticipated increase in claims.

Also, Trump last year issued an executive order directing federal agencies to make it easier to buy two alternates to Affordable Care Act plans. One would allow small business to band together to buy coverage through association health plans, while the other would let Americans buy short-term coverage that would last less than a year, rather than the current 90-day limit. Both of the types of policies are expected to have lower premiums, but would cover fewer benefits — making them more attractive to healthier Americans who don’t need comprehensive coverage.

Insurers in remaining states will file proposed rates in coming weeks. Regulators will review the requests and could change them significantly. Premiums will be finalized in September and open enrollment starts November 1…

…Also, most Obamacare enrollees won’t have to pay more for coverage next year, regardless of how much insurers hike premiums. That’s because they receive federal subsidies that limit their rates to less than 10% of their income.

However, the rate hikes will hit the millions of Americans who earn too much for subsidies or who buy individual coverage outside of the Obamacare exchanges.

June 8, 2018: The American Psychiatric Association posted a news release titled: “APA Calls on Administration to Defend Patient Progections in Affordable Care Act”. From the news release:

In response to the recent decision by the Department of Justice not to defend the constitutionality of the patient protections provided in the Affordable Care Act in the federal lawsuit Texas v. United States, the American Psychiatric Association (APA) issued the following statement:

“We strongly condemn the Administration’s decision not to defend the patient protections provided in the Affordable Care Act, an established law of the land,” said APA President Altha Stewart, M.D. “In particular, this decision could lead to insurers denying coverage to the 130 million Americans with pre-exsiting conditions. This is harmful to the health of these Americans and is very short-sighted considering the nation is in the midst of an opioid epidemic and 30% rise in suicide rates. We call upon the Administration to reverse this decision and defend the rights of our patients.”

June 8, 2018: NBC News posted an article title: “Sessions takes aim at heart of Obamacare – coverage for pre-existing conditions”. It was written by Andrew Harnik. From the article:

The Trump administration said in a court filing late Thursday that it will no longer defend key parts of the Affordable Care Act, including the requirements that people have health insurance and provisions that guarantee access to health insurance regardless of any medical conditions.

The decision, announced in a court filing in Texas, is a rare departure from the Justice Department’s practice of defending federal laws in court. Texas and other Republican-led states are suing to strike down the entire law because congress recently repealed a provision that people without health insurance must pay a fine. The repeal takes effect next year.

Texas says that without the fine in place the requirement to have health insurance is unconstitutional and that the entire law should be struck down as a result.

The administration said it agrees with Texas that the so-called individual mandate will be unconstitutional without the fine. It also said that provisions shielding people with medical conditions from being denied coverage or charged higher premiums and limiting how much insurer can charge older Americans should fall as well.

But it said the rest of the law, including Medicaid expansion, can remain in place.

In many ways, the lawsuit, filed in February, is a replay of the politically divided litigation that ended with the Supreme Court upholding the health care overhaul in 2012. In the new suit, California is leading a group of Democrat-led states in defending the law.

The major difference is that the Justice Department under President Donald Trump has largely switched sides.

Attorney General Jeff Sessions said in a letter to Congress on Thursday that Trump, who campaigned on repealing the law and nearly did so in his first year in office, approved the legal strategy…

…Shortly before the government’s court filing, three career lawyers at the Justice Department withdrew from the case and were replaced by two political appointees, according to court filings.

Timothy Jost, law professor emeritus at Washington and Lee University in Virginia said the Trump administration is trying to persuade the court to do what it was unable to achieve in Congress last year – essential, repeal key parts of the Obama health law.

Jost said its telling that three career Justice Department lawyers refused to support the administration’s position….

…Despite the Justice Department position, the Health and Human Services Department has continued to apply the health law. Indeed, sign-up season for 2018 under the Trump administration resulted in only a slight enrollment drop-off from Obama’s last year.

Insurers are now finalizing their premium requests for 2019, and Jost said the Justice Department filing may prompt jittery carriers to seek higher rates…

June 8, 2018: President Trump issued a statement titled: “Presidential Message on Men’s Health Week”. From the statement:

Men’s Health Week is an opportunity to raise awareness of the diseases and illness that are most prevalent among American men and to reiterate the importance of early detection and preventative health practices. During this week, I encourage all men to evaluate both their mental and physical health hand to focus on living a healthy lifestyle.

While there are many factors that contribute to a healthy life- including diet, exercise, stress management, and mental and emotional wellness – one of the most important practices is to regularly visit the doctor and the dentist. Men are less likely than women to visit their healthcare providers, often missing out on critical treatments that can protect their overall health and wellbeing. Individuals who have routine check-ups better understand the association between a healthy lifestyle and a greater quality of life.

Although Americans are living longer, healthier lives, we cannot ignore emotional and mental health, or the stigmas that prevent individuals from seeking treatment and recovery support services as part of their overall welfare. Serious mental illness, such as major depressive disorder, has robbed too many fathers, brothers, and sones, of their potential, and has contributed to rising suicide and drug overdoses. For these reasons, my fiscal year 2019 Budget request to Congress includes $10 billion in new funding to address the opioid abuse and overdose epidemic and mental health. This funding will improve access to evidence-based treatment services to support those suffering from mental disorders and substance use disorders…

…As we observe Men’s Health Week, we celebrate the advances we have made in improving men’s healthcare, while recognizing the importance of prioritizing both physical and mental health in men of all ages.

June 8, 2018: Senator Diane Feinstein (Democrat – California) posted a press release titled: “Senate Democrats Urge Trump DOJ to Reverse Decision Not To Defend Affordable Care Act In Court”. From the press release:

…The text of the Senate Democrat’s letter can be found below:

Dear President Trump:

We are deeply concerned that you have directed the Justice Department to no longer defend the constitutionality of the Affordable Care Act, including its vitally important protections for people with pre-existing conditions. Your decision yesterday to call protections for pre-existing conditions “unconstitutional” directly contradicts the 2012 U.S. Supreme Court decision, NFIB v. Sebelius. Disturbingly, this also represents another step in your administration’s continuous attacks on the rights of people with pre-existing health conditions and we urge you to reverse this decision.

There are currently as many as 133 million non elderly Americans with a pre-existing condition – which is more than half of the people not on Medicare. Taking this position could render millions of Americans uninsurable or facing higher premiums. Prior to 2014, people with pre-existing conditions often faced higher costs or were denied coverage altogether. Under your administration, Americans have repeatedly faced the prospect of a return to the dark days in which becoming sick could mean an inability to find health insurance, women could be charged more than men, or premiums and medical costs were so high that it sent families into bankruptcy in an effort to cover the payments.

During your presidential campaign, you repeatedly promised that you would retain protections for people with pre-existing conditions. Then you changed your position and supported numerous health care bills that would have gutted these protections and repealed the entire health care act. The bills would have allowed insurers to charge more or deny coverage outright based on a person’s health status, exclude critical benefits, and once again impose annual or lifetime limits on the amount of care a person could receive. Despite the repeated failure of this legislation, your administration remains undeterred in its efforts to eliminate protections for patients for pre-existing conditions and is currently in the process of finalizing a rule to expand “junk insurance.” These plans are allowed to exclude critical types of health care coverage, deny care when a person gets sick, and charge more based on gender or a pre-existing condition. You recently indicated you plan to finalize this rule, despite knowing that not a single group representing patients, physicians, nurses or hospitals is supportive.

Mr. President, it is time to stop the sabotage. We are a country of laws, and the law must be respected, defended, and enforced regardless of the person occupying the Oval Office. It is concerning that career Justice Department officials withdrew from the case and were replaced by political appointees as the administration abandoned its defense of the law.

The American public widely supports retaining protections for pre-existing conditions. We implore you to listen to the voices of career Justice Department lawyers, as well as concerned families, patients, doctors and hospitals that want to retain these protections, and start working with Democrats to strengthen our health care system instead of trying to tear it down.


  • Senator Diane Feinstein
  • Senator Charles E. Schumer
  • Senator Patty Murray
  • Senator Ron Wyden

June 8, 2018: Reuters posted an article titled: “Insurer lobby group weighs in on Obamacare individual mandate case.” It was written byTamara Mathias. From the article:

Removing certain provisions tied to the Affordable care Act, former U.S. President Barack Obama’s signature healthcare law, could strike out important consumer protections and potentially harm millions of Americans, a trade association that represents U.S. health insurers said on Friday.

The comments from America’s Health Insurance Plans (AHIP) come a day after the U.S. Justice Department called Obamacare’s individual mandate – which requires individuals to have health insurance or pay a penalty – unconstitutional…

…”Zeroing out the individual mandate penalty should not result in striking important consumer protections, such as guaranteed issue and community rating rules, that help with pre-existing conditions,” AHIP said in a statement.

Removing consumer friendly provisions like guaranteed issue, whereby health insurers cannot deny coverage to applicants or charge more based on health status, will result in renewed uncertainty in the market as well as push up rates for older and sicker patients, AHIP added…

June 8, 2018: Politico posted an article titled: “Trump’s latest health care move squeezes Republicans”. It was written by Jennifer Haberkorn and Adam Cancryn. From the article:

Republicans who have tried to repeal Obamacare for nearly a decade believe the Trump administration is reviving a politically risky battle with a court filing that could eliminate one of the most popular parts of the law: protections for people with pre-existing conditions.

The administration wants a federal court to strike the protections, providing fresh fodder to Democrats who argue that the GOP cannot be trusted to protect Americans’ health insurance months ahead of a midterm election in which health care was already a top issue. It also threatens to shift attention away from the GOP’s message on tax cuts, refocusing it on an Obamacare fight most Republicans wanted to put behind them.

The administration late Thursday asked a U.S. District Court in Texas to do something congressional Republicans weren’t willing take on themselves during last year’s repeal effort: Strike the most popular part of Obamacare.

Few congressional Republicans rushed to defend the administration’s move Friday, instead emphasizing their support for preserving pre-existing condition protections….

…Sen. Susan Collins of Maine – one of three GOP senators who blocked the Obamacare repeal effort last year – also pushed back, warning the administration’s new bid “exacerbates our current challenges” and could undermine key patient protections.

Other lawmakers points to past support for policies to prevent insurance companies from denying or dropping people with pre-existing conditions…

…Senate Democrats, who this week promised to force votes on health care during August, said the court filing proves their warnings that Republicans remain intent on repealing Obamacare through any means available…

…Within hours of the news, Democrats pounced on the Senate Republicans up for reelection this fall. The Democratic Senatorial Campaign Committee blasted releases questioning whether those Republicans – such as North Dakota hopeful Rep. Kevin Cramer – back the Trump administration’s decision…

…During last year’s repeal debate, Republicans decided to leave pre-existing conditions protections in place after they repeatedly became the subject of sometimes fiery town hall meetings with constituents…

…It is unclear how soon the U.S. District Court judge may respond to the administration’s request. If the courts strike the provision, the ruling would all but certainly be appealed – likely by a group of Democratic-led states that have weighed in on the case in courts…

…Insurance companies have already requested double-digit premium increases for 2019 in several states. The industry has blamed Trump administration decisions to undermine the health law, such as cutting off a key subsidy program to help low-income people pay their out-of-pocket health expenses…

June 8, 2018: HuffPost posted an article titled: “Democrats Say They Have Proof Health Care Can Turn Trump Voters Against Republicans”. It was written by Kevin Robillard. From the article:

…Clarity Campaigns, a Democratic polling firm, conducted the surveys in Maine’s 2nd Congressional District, a sprawling, heavily forested rural district that includes almost the entire state outside of Portland and its suburbs. The district, represented by Republican Congressman Bruce Poliquin, flipped back from backing Barack Obama by a 9-pont margin in 2012 to supporting Trump’s by 10 percentage points in 2016.

Two Democratic groups, Not One Penny and Protect Our Care, paid for the polls. They have spent the past 10 months on a sustained campaign against Poliquin in the Bangor media market, which includes half the district, and their polling shows real damage.

In a memo provided to HuffPost, Clarity Campaigns said the more voters fond out about Poliquin’s votes to repeal the Affordable Care Act and to support the GOP tax bill, the less they liked him. At the beginning of the campaign, 28 percent of voters in the media market approved of Poliquin and 38 percent disapproved. By the end, his numbers were significantly weaker: Just 25 percent approved, and 45 percent disapproved…

…The experiment reinforces the major Democratic strategy for winning back House districts where voters flipped from Obama to Trump: Focus relentlessly on unpopular GOP policies on taxes and health care, not directly on Trump’s behavior or the Russia investigation. Democrats need to win 24 seats to take back control of the House in November…

June 9, 2018: Brian Schatz (U.S. Senator from Hawaii – Democrat) posted a tweet on his verified Twitter account.  It said: “Whatever your political party of your views on the size of government or social issues or foreign policy or Rosanne or the NFL, if you are one of the 52 million Americans with a pre-existing health condition, I encourage you to vote for Democrats this year to save your healthcare.”

June 9, 2018: The American Academy of Family Physicians, American Academy of Pediatricians, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association, and American Psychiatric Association wrote a Joint Statement on Texas v United States. From the Joint Statement:

Our organizations, which represent a combined membership of more than 560,000 physician and medical student members are concerned about the Department of Justice’s decision to not defend the constitutionality of existing laws that extend patient protections to individuals in insurance markets as part of Texas v Unite States. The elimination of these protections could result in millions of people facing limited access to health care coverage and higher cost as a result of insurers being allowed to return to discriminatory coverage and pricing practices.

Our organizations disagree with the Department of Justice’s decision not to defend the protections established by the Affordable Care Act that prohibit insurance companies from denying or discontinuing coverage for individuals with pre-existing conditions or other factors such as gender or race.

As physicians who provide a majority of care to individuals for physical and mental conditions, we can speak clearly that these insurance reforms and protections are essential to ensuring that the more than 130 million Americans, especially the more than 31 million individuals between the ages of 55 an 64 who have at least one pre-existing condition are able to secure affordable health care coverage.

We strongly urge the Department of Justice to consider its decision in Texas v United States and that we all seek policy solutions that increase access to affordable health care that provides all individuals, regardless of their gender, race, and health status, reasonable protections against discrimination in coverage and pricing.

June 10, 2018: Bloomberg posted an article titled: “Health Warning: Obamacare Is in Legal Peril Once Again”. It was written by Noah Feldman. From the article:

…Just in case you haven’t thought about the individual mandate and the Constitution in the last six years, let me provide an update and a brief refresher. The update is that, in 2017, Congress passed the Tax Cuts and Jobs Act. In the law, Congress repealed the tax penalty associated with the individual mandate that everyone have health insurance.

In other words, the ACA still says you have to have insurance. But if you don’t, nothing happens to you…

…Now comes the new constitutional challenge to the ACA, filed by a group of states led by Texas. Their argument begins with the fact that, when the Supreme Court upheld the individual mandate, it did so in a very strange way. The five conservative justices all agreed that, under the commerce clause of the Constitution, Congress did not have the authority to make people buy insurance.

Their reasoning was borrowed from Prof. Barnett, who had proposed in his article that while the Congress has the power to regulate existing commercial activities, it can’t force people to undertake a commercial activity they are not already engaged in. This was the famous broccoli hypothetical: the conservatives argued that the commerce clause wouldn’t allow Congress to pass a law requiring everyone to buy and eat broccoli, even though Congress could lawfully regulate broccoli prices.

Despite this conclusion about the commerce clause, however, Chief Justice John Roberts joined the four liberals to uphold the individual mandate on the ground that it was a tax, and therefore fell within Congress’s separate taxing power. The other four conservatives were clearly frustrated with Roberts, but his vote carried the day.

The states are now arguing that once Congress repealed the tax penalty for the individual mandate in the 2017 law, no more constitutional authority exists for Congress to keep the individual mandate in place. The commerce clause is already excluded by the Supreme Court, and now the tax rationale is gone. Trump’s Department of Justice has agreed with this claim.

The states say that without the individual mandate, the whole ACA should be struck down as unconstitutional. Trump’s Justice Department didn’t go quite that far. But it did say the the ACA provisions on pre-existing conditions are so linked to the individual mandate that it should now be struck down….

…But it is entirely possible that five justices would follow the chain of formal logic laid out by the states and adopted by the Justice Department. The best argument in favor of that position is that the Obama Department of Justice told the Supreme Court years back that these provisions were interlinked – “irreversible” in legal jargon.

There is therefore a real and indeed significant chance that the most popular parts of the ACA could be struck down…

June 11, 2018: Bloomberg posted a very detailed article titled: “Air Ambulances Are Flying More Patients Than Ever, and Leaving Massive Bills Behind”. It was written by John Tozzi. From the article:

…Favorable treatment under federal law means air-ambulance companies, unlike their counterparts on the ground, have few restrictions on what they can charge for their services. Through a quirk of the 1978 Airline Deregulation Act, air-ambulance operators are considered air-carriers – similar to Delta Air Lines or American Airlines – and states have no power to put in place their own curbs.

Prices for emergency medical flights have increased dramatically, as air ambulance operators expanded their networks and responded to a wider set of emergencies, including traumas, strokes, and heart attacks.

The medical charge to Medicare for a medical helicopter flight more than doubled to almost $30,000 in 2014, from $14,000 in 2010, according to a report last year by the U.S. Government Accountability Office. Air Methods’ average charge ballooned from $13,000 in 2007 to $49,00 in 2016, the GAO said. Medicare, the federal health program for people 65 and older, pays only a fraction of billed charge; Medicaid, the state-federal program for the poor, pays even less…

…Seth Myers, president of Air Evac, said that his company loses money on patients covered by Medicaid and Medicare, as well as those with no insurance. That’s about 75 percent of the people it flies.

“I fly people based on need, when a physician calls or when an ambulance calls,” He said. “We don’t know for days whether a person has the ability to pay.”

According to a 2017 report commissioned by the Association of Air Medical Services, an industry trade group, the typical cost per flight was $10,199 in 2015, and Medicare paid only 59 percent that. Air-medical operators back U.S. legislation proposed by Senator Dean Heller of Nevada and Representative Jackie Walorski of Indiana, both Republicans, that would boost reimbursements by as much as 20 percent over three years. The bill would also have Medicare collect cost data from air-ambulance companies and use it to update rates to reflect “the actual costs of providing air ambulance services.” Both versions have co-sponsors from both parties.

For people with private insurance, short flights in an air ambulance are often followed by long battles over the bill…

…The industry says insurers put patients in the middle. “We need to hold the insurers’ feet to the fire to say we need a reasonable rate,” said Myers, the Air Evac executive. He said health plans often won’t agree to network contracts that could lower costs. He declined to say how large in-network discounts are, citing nondisclosure agreements.

Consumer groups and insurers counter that air-ambulance companies strategically stay out of health-plan networks to maximize revenue…

…Montana Senator John Tester, a Democrat, has introduced legislation that would rollback the special status of air-ambulance companies. A Federal Aviation Administration reauthorization bill passed by the House in April would make medical services provided by air ambulances subject to state regulation…

June 12, 2018: Axios posted at blog titled: “Private equity’s thirst for health care providers”. It was written by Bob Herman. From the article:

KKR’s $10 billion deal to take Envision Healthcare private, along with Bloomberg’s deep dive on the billing tactics of air ambulances, exemplifies private equity firms’ appetite for buying health care providers that weird a lot of market power.

The big picture: These companies are a leading source of surprise medical bills, which infuriate patients but are profitable for private equity owners. Emergency rooms and ambulances aren’t real marketplaces – consumers can’t stop and shop for the best price in the middle of an emergency.

The bottom line: Physician groups, emergency room staffing, and air and ground ambulances can (and in most cases do) make a lot of money because people will use their services regardless of the price…

…Physicians and ambulances can opt out of an insurance company’s network, unbeknown to a patient, if they feel they aren’t getting paid enough – and patients are saddled with the remaining costs…

…Physician and ambulance groups contend they need to bill commercial insurance more to make up for shortfalls in Medicare and Medicaid, but the cost-shifting theory often falls flat…

…The big question for the latest KKR deal: Will Envision stay transparent about its efforts to reduce surprise medical bills? Going private means health care groups don’t have to disclose a whole lot about their finances or strategy…

June 12, 2018: Politico posted an article titled: “McConnell: ‘Everybody’ in Senate likes pre-existing condition safeguards”. It was written by Jennifer Haberkorn.

Senate Majority Leader Mitch McConnell said “everybody” in the Senate wants to preserve consumer protections for people with pre-existing conditions, an Obamacare provision that the Trump administration last week said is unconstitutional and should be struck down.

“Everybody I know in the Senate – everybody – is in favor of maintaining coverage for pre-existing conditions,” McConnell told reporters in the Capitol. “There is no difference in opinion about that whatsoever.”

Obamacare’s prohibition on insurance companies canceling or denying coverage for people with pre-existing conditions is among the most popular provisions of the 2010 law. Congressional Republicans opted to preserve the idea of having a requirement last year even as they laid plans to repeal the law. Several GOP health plans last year would have barred insurance companies from denying coverage over pre-existing conditions but would have done so by requiring people to maintain continuous coverage or face higher costs or a waiting period. Critics said those requirements wouldn’t be as strong as the one in the Affordable Care Act.

The Trump administration surprised its congressional allies last week when it asked a U.S. district court in Texas to strike the provision, along with the law’s individual mandate and Obamacare’s requirement that people cannot be charged substantially more than other people in the same age range and geographic area. Democrats immediately pounced on the Justice Department move, warning they would make it a prominent issue in the midterm election…

…McConnell also touted forthcoming regulations the administration could issue as soon as this week expanding association health plans, which he said could bring down premium costs.

June 12, 2018: The Hill posted an article titled: “Warren presses health chief over Trump’s promise of drug price cuts.” It was written by Peter Sullivan. From the article:

Sen. Elizabeth Warren (D-Mass.) pressed Health and Human Services (HHS) Secretary Alex Azar on Tuesday about why no drug companies have announced price decreases despite President Trump saying they would.

Warren focused on Trump’s statement at the end of May that “in two weeks” drug companies would “announce voluntary massive drops in prices.” The two-week mark from that statement is this Wednesday.

“He said there would be massive decreases in drug prices within two weeks,” Warren said during a Senate Health Committee hearing. “It’s been two weeks and there have been no decreases and an indication of increase.” Azar counters at the hearing that there are drug companies working on price decreases…

…The health chief said the holdup is that negotiators known as pharmacy benefit managers (PBMs) are actually discouraging price decreases because that could reduce the amount of rebates that the PBMs get…

…Warren, a liberal champion who is a possible 2020 presidential contender, did not buy that argument, saying, “In the words, the president’s promise that we would see massive decreases in two weeks hasn’t happened and you don’t have anyone lined up who’s actually going to decrease drug prices.”…

June 13, 2018: The American Academy of Actuaries released an Issue Brief titled: “Drivers of 2019 Health Insurance Premium Changes”. From the Issue Brief Summary:

Key drivers of 2019 premium changes include:

  • Medical trend, which is the underlying growth in health care costs;
  • Recent legislative and regulatory changes, including the elimination of the individual mandate penalty, the pending expanded availability of short-term limited duration health plans and association health plans, and whether changes made regarding how insurers are instructed to load premiums to account for cost-sharing reduction subsidies;
  • Changes in the risk pool composition and insurer assumptions from 2018; and
  • Any state actions to implement reinsurance programs, impose individual mandate penalties, or enact rules that would facilitate or prohibit the availability of alternative coverage options.

Average premium rate changes may not represent the rate change experience by a particular consumer. A number of factors can result in a consumer’s premium differing from the average rate change, including changes in plan selection, age/family status, tobacco status, geography, or subsidy eligibility.

From the Issue Brief section titled: “Premium Changes From a Consumer Perspective”:

The following situations could result in a consumer’s premium change differing from the average premium change reflected in a premium rate filing.

  • Changes in Plan Selection: As insurers enter or exit marketplaces or otherwise change their plan offerings, consumers could have different choices of insurers or plans. If particular plans are discontinued, consumers may be re-enrolled in a different plan. Even if their current plan continues to be available, consumer may choose to enroll in a different plan. Either of these scenarios could lead to a consumer’s premium change that differs from the state’s or insurer’s average premium change.
  • Changes in Age/Family Status: Most individual consumer will experience a premium increase each year, due to aging one year.
  • The ACA allows premiums to vary by family size. Family premiums reflect the premiums for each covered adult plus the premiums for each of the three oldest covered children younger than 21. Therefore, consumers with family coverage who experience a change in family composition could face a premium change.
  • Tobacco Status: In most states, insurers are allowed to charge smokers more than nonsmokers, and this surcharge can vary by state and by age. For instance, older smokers can face higher surcharges than younger smokers. In plans that vary the surcharge by age, consumers who smoke will see a premium change due to the change in the tobacco use surcharge. In addition, consumers who have either started or stopped using tobacco products could see a premium change. Finally, carrier care allowed to change their tobacco rating factors with sufficient justification.
  • Geographic Area Factors: All states require all insurers within the state to use identical rating areas approved by the Centers for Medicare and Medicaid Services. Insurers are not allowed to change the rating areas, but they are allowed to change how premiums vary across areas due to differences in networks, relative provider charge levels, and levels of medical management.
  • While the overall impact of area factor modifications will be included in the average aggregate premium change, reported in the rate filing each insurer submits, the actual change a specific consumer experiences may vary significantly depending on where he or she lives.
  • In addition, a consumer moving from one rating area to another may experience a premium change due to the differences in area factors.
  • Subsidy Eligibility: The ACA provides premium subsidies in the individual market based on household income and the premium for the second-lowest silver plan. Changes in income alone can result in upward or downward changes in the net premiums that any specific consumer may have pay, even if there is no change in the underlying premiums. And even if there is no change in income, premium subsidies can increase if premiums increase. Changes in how states load premiums to cover cost-sharing reductions (CSRs) can also affect premium subsidies.
  • Insurers are required to notify subsidized enrollees of premium changes before open enrollment. However, the notification is based on the current year subsidy and will not reflect subsidy changes due to any premium changes, including how premiums are loaded to account for CSR’s.
  • Individuals may not be aware of the impact of the subsidy changes unless this process is changed or insurers develop additional communications. A change in available plans offered in the market also could affect the subsidy an individual receives.

June 14, 2018: The American Cancer Society posted News titled: “ACS CAN filed legal brief in support of protections for people with serious health needs”. From the News:

The American Cancer Society Cancer Action Network (ACS CAN) joined with four other national patient advocacy organizations today to file a legal brief or amicus curiae that describes the devastating impact patients would face if the district court rules the Affordable Care Act is not a valid law.

Twenty states, led by Attorney General of Texas, recently filed a lawsuit, Texas v United States of America. They argue that the Affordable Care Act must be struck down because it cannot stand now that Congress repealed the tax penalty that a person receives if they do not have health care coverage.

ACS CAN and the other patient groups urged the court in their legal brief to uphold the Affordable Care Act and to “recognize Congress’s clear intent to improve access to lifesaving health care for millions of Americans.”

The Department of Justice (DOJ) is typically responsible for defending the country’s laws, but, in this case, the Department has filed a brief declining to defend the Affordable Care Act.

The DOJ argues that certain protections the health care law guarantees for people with pre-existing conditions are invalid.

If the Affordable Care Act is struck down, this could have dire consequences, leaving millions of Americans with serious illnesses like cancer unable to get health care coverage. Studies show that uninsured patients are less likely to be screened for cancer, and are more likely to be diagnosed at more advanced stages of their cancer when it is harder and more expensive to treat.

“If people don’t have real health insurance – comprehensive health insurance – they die,” said Mary Rouvelas, senior counsel at ACS CAN.

Since the Affordable Care Act was signed into law, more people have signed up for health care coverage and the uninsured rate has decreased by more than six percent nationwide.

In a joint statement, ACS CAN and the patient groups said in reference to the health care law, “This has improved patients’ ability to prevent, detect, and treat their disease. For instance, there is already a small but statistically significant shift toward early-stage diagnosis for colorectal, lung, breast and pancreatic cancer in states that have increased access to health care through Medicaid because of the law.”

June 14, 2018: HuffPost posted an article titled: “They Fought Over the Last Obamacare Lawsuit, But They Agree This One Is Nonsense”. It was written by Johnathan Cohn. From the article:

Five scholars who argued with each other over past legal challenges to the Affordable Care Act have joined forces to file a friend of the court brief about a new lawsuit that could wreck the law.

They all think the courts should reject the lawsuit. And they don’t think it’s a particularly close call.

The lawsuit, Texas v. United States, comes from Republican officials in 20 states and alleges that the 2010 health care law is unconstitutional. Last week, the Justice Department declined to defend the law, breaking from the customary role the federal government plays when states challenge a federal statute…

…The case is now before a federal district judge in Texas. On Thursday, five well-known scholars were among those filing briefs urging the judge to reject the lawsuit.

The five are Johnathan Adler from Case Western Reserve University, Nicholas Bailey from the University of Michigan, Abbe Gluck from Yale University, Ilya Somin from George Mason University, and Kevin Walsh from the University of Richmond…

…Adler was actually an architect of the lawsuit in King v Burwell, which could have crippled the Affordable Care Act’s newly created private insurance markets in a majority of states. He filed a brief in the case and, and in a series of articles and public appearances, frequently squared off with Bailey and Gluck, who collaborated on their own brief in defense of the law.

The Supreme Court rejected that lawsuit in 2015. It was the second time the high court upheld the constitutionality of the law known as Obamacare. The first time was in 2012, in a case called NFIB v. Sebelius. Somin was an influential, high-profile supporter of the lawsuit and the author of a brief supporting it.

As for Walsh, he is an expert on “severability,” which is the legal doctrine about when a court must strike down an entire law, or large parts of it, because it has found one piece to be unconstitutional. Justice Clarance Thomas just cited one of Walsh’s briefs in a recent Supreme Court decision on the subject…

The Amici Curiae was posted by The Incidental Economist and is available to view as a PDF.

June 14, 2018: CBS News posted an article titled: “Pre-existing conditions coverage at risk for more than thought?” From the article:

…Two independent experts said Wednesday that the administration appears to be taking aim at provisions of the ACA that protect people in employer plans, not only the smaller pool of consumers who buy a policy directly from an insurer. The new Trump administration position was outlined last week in a legal brief filed by the Justice Department in a Texas case challenging the Obama health law.

Workers “could face the prospect of insurance that doesn’t cover their pre-existing conditions when they enroll in a plan with a new employer,” said Larry Levitt of the nonpartisan Kaiser Family Foundation.

University of Michigan law professor Nicholas Bailey said the administration does not appear to have thought through all the consequences of moving against one provision of a health law that has many complicated interlocking parts.

“The lack of care on the brief is jaw-dropping,” said Bagley, who supports the Obama health law but considers himself a “free agent” critic of both sides. “There is no question that the Trump administration has to clarify what the scope of its injunction would be and grapple with the consequences of mowing down parts of the ACA.

“For someone with a pre-existing condition thinking about switching jobs, the answer to that question could make a life-changing difference,” added Bagley…

…Nearly 160 million workers and family members have coverage through employers, although the number covered by small employers is much smaller.

June 15, 2018: Two Cents posted an article titled: “You Could Be Denied Pre-Existing Conditions Coverage by Employer Health Plans if the ACA Is Repealed”. It was written by Alicia Adamcyzk. From the article:

…If you don’t care much about the issue because you have insurance through your employer, it could affect you too. That’s because the provisions that the Trump administration is contesting apply to all private health coverage, including employer plans.

Before the ACA, your employer plan couldn’t deny you coverage or charge you more, but it could exclude coverage for your pre-existing conditions for a year if you don’t maintain continuous coverage. That’s what the plans would revert to if the ACA’s provisions are overturned. (Large and small group plans would face worse outcomes.)

As Timothy Jost, an Demetrius professor of law at Washington and Lee University writes, the biggest impact on those with employer insurance is that it would “lock you into” your jobs once again. The ACA gave some people more freedom to leave jobs and pursue entrepreneurial or freelance jobs, because they were guaranteed to find health insurance coverage… It also gives more freedom to leave an unfailing job you’re keeping simply for the benefits. That wasn’t a given before, and it could be on the line again…

June 19, 2018: AHIP posted a statement titled: “AHIP Comments on Final Rule Expanding the Use of Association Health Plans”. From the statement:

America’s Health Insurance Plans (AHIP) issued the following statement after the Department of Labor issued its final rule expanding the use of the Association Health Plans (AHP).

“Every American should be able to get comprehensive health care coverage they can afford, and we support the goal of increasing competition and choice in ways that improve affordability. The final rule provides some important protections by ensuring consumers, including those with pre-existing conditions, do not face discrimination as new association plans are created, and by preserving state authority to regulate AHPs offered in their markets.

“However, we remain concerned that broadly expanding the use of AHP’s may lead to higher premiums for consumers who depend on the individual or small group market for their coverage. Ultimately, the rule could result in fewer insured Americans and may put consumers at greater risk of fraudulent actors entering this market.

“We will continue to work with the Administration, Congress, and state leaders to ensure that all coverage markets remain steady and reliable for all Americans.”

June 19, 2018: The Washington Post posted an article titled: “House GOP plan would cut Medicare, Medicaid to balance budget”. It was written by Erica Werner. From the article:

…The House Republican budget, titled “A Brighter American Future,” would remake Medicare by giving seniors the option of enrolling in private plans that compete with traditional Medicare, a system of competition designed to keep costs down but dismissed by critics as an effort to privatize the program. Along with other changes, the budget proposes to squeeze $537 billion out of Medicare over the next decade.

The budget would transform Medicaid, the federal-state health-care program for the poor, by limiting per capita payments or allowing states to turn it into a block-grant program – the same approach House Republicans took in their legislation that passed last year to repeal the Affordable Care Act (the repeal effort died in the Senate, but the GOP budget assumes the repeal takes place). It also proposes adding work requirements for certain adults enrolled in Medicaid. Changes to Medicaid and other health programs would account for $1.5 trillions in savings.

Social Security comes in for more modest cuts of $4 billion over the decade, which the budget projects could be reached by eliminating concurrent receipt of unemployment benefits and Social Security disability insurance.

The budget also proposes a number of other cost-saving measures, some of which could prove unpopular if implements, such as adding more work requirements for food-stamp and welfare recipients and requiring federal employees  – including members of Congress – to contribute more to their retirement plans….

A legal brief filed by ACS CAN, American Heart Association, American Lung Association, American Diabetes Association, and the National Multiple Sclerosis Society is available to read online.

June 19, 2018: The Center on Budget and Policy and Priorities posted a CBPP statement titled “Greenstein: House Budget Committee 2019 Budget Continues Trend of Harsh, Deep Cuts” It was written by Robert Greenstein. From the statement:

House Budget Committee Chairman Steve Womack’s new 2019 budget shows that the House majority’s fiscal priorities haven’t changed. The budget plan maintains the costly 2017 tax cuts, while making deep cuts in health care and basic assistance for struggling families, repealing the Affordable Care Act (ACA), and severely cutting funding over time for investments that can boost the nation’s productivity and thereby foster economic growth.

The committee’s materials show that the budget would make nearly $6 trillion in cuts over ten years to entitlements and non-defense discretionary programs, including $2.1 trillion in health care alone, including to Medicaid, ACA premium tax credits, and Medicare. The budget incorporates the failed House ACA repeal bill, which, at the time the bill was considered, the Congressional Budget Office estimated would have taken away health coverage from 23 million Americans by 2026. (This estimate includes the effect of repealing the individual mandate, which Congress has since enacted.)…

June 20, 2018: The United States Senate voted on H.R. 3 “Spending Cuts to Expired and Unnecessary Programs Act”.  The vote was 48 YEAS to 50 NAYS.  This bill required at least 51 YEA votes to pass. It only got 48 YEA votes.

Senators who voted YEA:

  • Alexander (R-TN)
  • Barrasso (R-WY)
  • Blunt (R-MO)
  • Boozman (R-AR)
  • Capito (R-WV)
  • Cassidy (R-LA)
  • Corker (R-TN)
  • Cornyn (R-TX)
  • Crapo (R-ID)
  • Cruz (R-TX)
  • Daines (R-MT)
  • Enzi (R-WY)
  • Ernst (R-IA)
  • Fischer (R-NE)
  • Flake (R-AZ)
  • Gardner (R-CO)
  • Graham (R-SC)
  • Grassley (R-IA)
  • Hatch (R-UT)
  • Heller (R-NV)
  • Hoeven (R-ND)
  • Hyde-Smith (R-MS)
  • Inhofe (R-CA)
  • Isakson (R-GA)
  • Johnson (R-WI)
  • Kennedy (R-LA)
  • Lankford (R-OK)
  • Lee (R-UT)
  • McConnell (R-KY)
  • Moran (R-KS)
  • Murkowski (R-AK)
  • Paul (R-KY)
  • Perdue (R-GA)
  • Portman (R-OH)
  • Rich (R-ID)
  • Roberts (R-KS)
  • Rounds (R-SD)
  • Rubio (R-FL)
  • Sasse (R-NE)
  • Scott (R-SC)
  • Shelby (R-AL)
  • Sullivan (R-AK)
  • Thune (R-SD)
  • Tooney (R-PA)
  • Wicker (R-MS)
  • Young (R-IN)

Senators who voted NAY:

  • Baldwin (D-WI)
  • Bennet (D-CO)
  • Blumenthal (D-CT)
  • Booker (D-NJ)
  • Brown (D-OH)
  • Burr (R-NC)
  • Cantwell (D-WA)
  • Cardin (D-MD)
  • Carper (D-DE)
  • Casey (D-PA)
  • Collins (R-ME)
  • Coons (D-DE)
  • Cortez Masto (D-DE)
  • Donnelly (D-IN)
  • Duckworth (D-IL)
  • Durbin (D-IL)
  • Feinstein (D-CA)
  • Gillibrand (D-NY)
  • Harris (D-CA)
  • Hassan (D-NH)
  • Heinrich (D-NM)
  • Heitkamp (D-ND)
  • Hirono (D-HI)
  • Jones (D-AL)
  • Kaine (D-VA)
  • King (I-ME)
  • Klobuchar (D-MN)
  • Leahy (D-VT)
  • Manchin (D-WV)
  • Markey (D-MA)
  • McCaskill (D-MO)
  • Menendez (D-NJ)
  • Merkley (D-OR)
  • Murphy (D-CT)
  • Murray (D-WA)
  • Nelson (D-FL)
  • Peters (D-MI)
  • Reed (D-RI)
  • Sanders (D-VT)
  • Schatz (D-HI)
  • Schumer(D-NY)
  • Smith (D-MN)
  • Stabenow (D-MI)
  • Tester (D-MT)
  • Udall (D-NM)
  • Van Hollen (D-MD)
  • Warner (D-VA)
  • Warren (D-MA)
  • Whitehouse (D-RI)
  • Wyden (D-OR)

Senators who did not vote:

  • McCain (R-AZ)
  • Shaheen (D-NH)

June 20, 2018: The Press Herald posted an article titled: “Senate rejects billions in Trump spending cuts as 2 Republicans, including Collins, vote ‘no'”. It was written by Erica Werner. From the article:

The Senate on Wednesday rejected billions in spending cuts proposed by the Trump administration as two Republicans joined all Democrats in voting “no”.

The 48-50 vote rebuffed a White House plan to claw back some $15 billion in spending previously approved by Congress – a show of fiscal responsibility that was encouraged by conservative lawmakers outraged over a $1.3 trillion spending bill in March.

The House had approved the so-called “recessions” package earlier this month. But passage had never been assured in the Senate, where a number of Republicans had been cool to the idea from the start.

Nevertheless, Wednesday’s outcome was startling because one of the “no” votes came from Sen. Richard Burr (R-NC), who does not normally buck the White House or leadership. Burr’s office had no immediate comment.

Sen. Susan Collins (R-Maine), a moderate who is one of the Republicans who most frequently sides with the Democrats, cast the other ‘no’.

The cuts in the recessions package included $7 billion from the Children’s Health Insurance Program, mostly from an expired account that can no longer be used; $5 billion from Energy Department programs, including a little-used loan program for advanced technology vehicle manufacturing; and smaller amounts from a variety of other programs ranging from Forest Service land acquisition to the Millennium Challenge Corp…

June 20, 2018: Politicus USA posted an article titled: “As America Is Distracted By Trump Child Abuse, GOP Moves To Gut Medicare And Medicaid”. It was written by Jason Easley. From the article:

While the American people are rightly outraged by the Trump administration’s abuse abuse of migrant children, House Republicans proposed a budget that would gut Medicare and Medicaid.

The 2019 budget that Republicans are working on in the House Budget Committee would pay for tax cuts with a gutting of Medicare and Medicaid.

According to The Center for Budget and Policy Priorities, “House Budget Committee Chairman Steve Womack’s new 2019 budget shows that the House majority’s fiscal priorities haven’t changed. The budget plan maintains the costly 2017 tax cuts, while making deep health care and basic assistance for struggling families, repealing the Affordable Care Act (ACA), and severely cutting funding over time for investments that can boost the nation’s productivity and thereby foster economic growth. The committee’s materials show that the budget would make nearly $6 trillion in cuts over ten years to entitlement and non-defense discretionary programs, including $2.1 trillion in health care alone, including cuts to Medicaid, ACA premium tax credits, and Medicare. The budget incorporates the failed House ACA repeal bill which, at the time the bill was considered, the Congressional Budget Office estimated would have taken away health coverage from 23 million Americans by 2026.”…

June 20, 2018: Forbes posted an article titled: “Once More Into The Breach: Conservative Think Tankers Publish A New Obamacare Replacement”. It was written by Avik Roy.

Conservative health care think tank scholars have published a new proposal to repeal and replace Obamacare, hoping that they can persuade Congress to take up the issue one more time before November. Can it succeed where prior efforts have failed?

The proposal, entitled “The Health Care Choices Proposal: Policy Recommendations to Congress – Why Congress Much Act,” was published by the Health Policy Consensus Group, a kind of conservative health wonk Jedi Council led by Grace-Marie Turner of the Galen Institute, who is also a Forbes contributor. (I am also a participant in the Consensus Group.)

The plan emerged from the aftermath of the 2017 effort by Bill Cassidy (R., La.) and Lindsey Graham (R., S.C.) to put forth an Obamacare replacement after all the previous efforts by congressional GOP leadership had failed. The Graham-Cassidy bill…was designed to preserve the vast majority of Obamacare’s spending on the uninsured, but reformat that spending as block grants to state governments.

The critical flaw in Graham-Cassidy is that it bore the potential to make health insurance markets work, not better, because due to design flaws in the bill, most states would have been strongly incentivized to eliminate their private individual insurance markets and replace them with an enlarged expansion of Medicaid, a program whose enrollees have health outcomes no better than those who are uninsured.

…The Consensus Group proposal improves upon Graham-Cassidy by requiring that “at least 50% of the block grant goes toward supporting people’s purchase of private health coverage” in the individual insurance market. Under the new program, states would be required to offer Market enrollees the opportunity to purchase “commercially available coverage” with their Medicaid dollars, and plans sold under the block grants would be exempted from costly Obamacare rules, like 3:1 age bands that double the triple the costs of insurance for young people.

The proposal would also double contribution limits to health savings accounts, and it would reform the limits on what kinds of insurance can be associated with HSAs:

The Proposal would make more HSA-compatible. Today, in order to be HSA-compatible, a policy must have a deductible of a least $1,350 ($2,700 for families). The average Obamacare Silver plan had deductible of at $4,033 ($8,292 for families). In 2016, more than four of every five plans on the federal exchange had deductibles greater than the legal minimum for HSAs, but less than a fifth were HSA-eligible. This proposal would change the requirement to qualify, so that any plan with an actuarial value less than a specified (e.g., 70%, 80%) could be HSA-compatible…

…The likelihood that the Consensus Group proposal becomes law is low. And that’s despite the fact that its focus is narrow; it doesn’t attempt to reform the pre-Obamacare Medicaid program or any of our other health are entitlements, nor does it try to tackle the underlying reasons why health care is so expensive in the first place.

Graham-Cassidy died because there weren’t enough votes in the Senate to support it. Republicans control 51 seats in the Senate right now, and one of those belongs to John McCain (Ariz.), who is battling brain cancer and is rarely in Washington. Hence, every other GOP senator has to vote “aye” for any health care bill to pass.

And they can’t get to 50. Kentucky Sen. Rand Paul (R.) has repeatedly expressed his opposition to any plan that replaces Obamacare with subsidies for the uninsured. Mike Lee (R. Utah) has also been generally unfriendly to robust replacement bills. And that’s before you even get to the moderate Republican senators, who have their own suite of concerns. Democrats are almost certainly unwilling to entertain a proposal in which the word “uninsured” appears exactly zero times…

June 21, 2018: John Yarmuth (Ranking Member of the House Budget Committee), (Kentucky – Democrat) posted a statement on the House Committee on the Budget Democrats website. From the statement:

Kentucky Congressman John Yarmuth, Ranking Member of the House Budget Committee, issued the following statement after the Republican majority voted to pass the House Republican 2019 budget and rejected every amendment offered by Democrats:

“Today, during consideration of the Republican budget, Democrats offered amendment after amendment to advance the needs and priorities of the American people. We proposed protecting Medicare, Medicaid and Social Security, ending extreme cuts to infrastructure, education and nutrition assistance, and even ensuring that surviving military spouses receive full benefits with no penalties. At every turn, Republicans voted to protect their $2 trillion in tax cuts for millionaires and big corporations instead of American families.”

June 21, 2018: Topher Spiro (Senior Fellow, Economic Policy and VP, Health Policy at American Progress) posted a thread on his verified Twitter account that started with this tweet: “BREAKING: The House GOP just voted a budget bill out of committee that fast tracks ACA repeal and $2 TRILLION in cuts to Medicare and Medicaid. We need to flood them with calls to prevent a floor vote.”

June 21, 2018: USA Today posted an article titled: “Obamacare: Outreach groups nervous as Trump remains silent on funding.” It was written by Ken Alltucker. From the article:

A year after steep cuts to a key Affordable Care Act outreach program, the Trump administration has remained quiet on how much it will fund nonprofit and grass-roots groups that help people sign up for health insurance.

The federal navigator program funds groups that help people to sign up for health insurance on the Obamacare federal and state insurance exchanges or assist low-income adults and children sign up for Medicaid coverage.

Navigator groups located in federal exchange states are funded through September but have no idea how much money will be available then. The six-week open enrollment period that allow consumers to choose a plan for the upcoming year begins Nov. 1…

…The Trump administration, which has been critical of the efficiency of these groups, has reshaped the Obama-era program to operate with limited resources, according to an HHS draft rule.

Under new HHS regulations that took effect June 18, navigator groups would no longer need to be physically located in the states they serve. The new regulations also eliminate a requirement that at least one navigator group in a community be a consumer-focused nonprofit…

…Administration officials would not say when the funding details will be publicly released leaving navigator groups in limbo on budgets to prepare for this year’s six-week enrollment starting Nov. 1.

Last year, the Trump administration cut funding to the navigator program more than 40 percent weeks before the start of signups. While the administration has not publicly revealed budgets for the year. HHS officials noted that limited resources are a driving factor for the proposed regulatory overhaul this year…

June 22, 2018: Nancy Pelosi (Minority Leader of the U.S. House of Representatives) (California – Democrat) posted a tweet on her verified Twitter account: “It’s been 6 months since Republicans forced the $1.5 trillion #GOPTaxScam for the rich. It’s been ~24 hours since they voted to steal over $2 trillion from Medicaid, Medicare, Social Security and other key investments. They really don’t care about the harm they’re inflicting.”

June 22, 2018: Sun-Sentinel posted an article titled: “South Florida’s 3 Obamacare providers file proposals to return in 2019”. It was written by Ron Hurtibise.  From the article:

…Three companies that offered 2018 plans in South Florida are back – market leader Florida Blue, which has been offering a wide array of plans to fit all budgets and circumstances – plus narrow-network, lower-cost alternatives Molina Healthcare and Ambetter.

All three submitted 2019 rate proposals with the Florida Office of Insurance Regulation as required by June 20, along with four other companies that filed to sell plans in other areas of the state.

In all, rate increases proposed by eight companies offering ACA-compliant plans on and off the exchange, average 8.8 percent, according to a news release by the state office late Friday afternoon.

That compares with a 17.8 percent increase requested a year ago by the same companies….

…Of the 1.7 million Floridians who enrolled in 2018 marketplace plans, 92 percent qualified for subsidies and saw an average $595 monthly premium reduced to $70, according to data maintained by the Department of Health and Human Services. In the tricounty region, 762,000 are enrolled…

…A new company has even filed to offer ACA plans in the state. Oscar Health, which currently sells plans in California, Texas, and New York, on Thursday announced plans to expand into Florida, Michigan and Arizona in 2019…

…Market giant Florida Blue, which absorbed most of the policies abandoned by competitors Aetna, Cigna, UnitedHealthcare and Humana after Obamacare’s first three years, plans to remain in all 67 Florida counties…

June 24, 2018: Forbes posted an article titled “Poll: 66% Of Voters Oppose Trump DOJ’s Move To Gut Patient Protections”. It was written by Bruce Japsen. From the article:

By a 2-to-1 margin, U.S. voters disapprove of the U.S. Justice Department’s decision to support a lawsuit that would eliminate popular protections for patients with preexisting conditions under the Affordable Care Act, a new poll shows…

…The survey of more than 1,000 likely voters by Hart for the group Protect Our Care was conducted June 11 to 17 following the action by Republican state attorneys general to challenge the constitutionality of consumer insurance programs like the ban on refusing coverage or charging higher premiums to Americans with pre-exiting conditions.

The poll, which is the latest to show growing support for the ACA, and its consumer protections in particular, shows 66% of voters disapprove of the Trump Justice Department’s move and nearly half, or 47% of all voters “strongly disapprove” of the lawsuit gutting the ACA’s consumer protections. Only 11% strongly approve, the survey shows…

…Already, providers of medical care and health insurers have voiced strong opposition to the Justice Department’s brief in support of Texas and 19 other states attempt to declare as unconstitutional protections for patients with pre-existing conditions.

June 26, 2018: The Kansas City Star posted an article titled: “Insurer plans to expand Obamacare offerings into Missouri counties in KC area”. It was written by Andy Marso. From the article:

Another insurance company has filed to sell plans on the Affordable Care Act exchange in Kansas City next year, possibly bringing the total to three just one year after it appeared the city might have only one option.

Minnesota-based Medica announced this week it has filed documents with the Missouri Department of Insurance to sell its Select plan in Cass, Clay, Jackson and Platte counties.

The plan, which limits hospital coverage to St. Luke’s Health System locations, is now offered only to residents of Johnson and Wyandotte counties in Kansas…

…Medica’s announcement is the latest in a slew of market changes for the area’s Affordable Care Act, commonly called Obamacare, marketplace.

Major insurers like UnitedHealthcare and Blue Cross and Blue Shield of Kansas City have gotten out, but new players like Medica and Centene, with its “Ambetter” plans, have jumped in.

The one constant in the Missouri counties of the metro over the last few years has been Cigna. If the Connecticut-based insurer and Centene stay for 2019, then people in Jackson, Clay, Cass and Platte counties will have three companies to choose from when open enrollment starts in November.

Johnson County and Wyandotte County have also seen turnover the last few years. But according to the Kansas Insurance Department, Medica, Centene and Blue Cross Blue Shield of Kansas have again filed their intent to sell 2019 plans that are similar to what they’re offering those year. That would be Medica throughout the state, Centene in Johnson County and Wyandotte County, and BCBS Kansas in every county except Johnson and Wyandotte…

June 27, 2018: The New York Times posted an article titled: “The Stealth Campaign to Kill Off Obamacare”. It was written by Jay Hancock. From the article:

In 2010, before the Affordable Care Act was passed by Congress, the pharmaceutical industry’s top lobbying group was a very public supporter of the measure. It even helped fund a multimillion-dollar TV ad campaign backing passage of the law.

But last year, when Republicans mounted an aggressive effort to repeal the law, the group made a point of staying outside the fray. “We’ve not taken a position,” Stephen Ubl, head of the organization, the Pharmaceutical Research and Manufacturers of America, known as PhRMA, said in an interview March 2017.

That stance, however, was at odds with its financial support of another group, the American Action Network, which was heavily involved in the effort to repeal the act, often referred to as Obamacare. The network spent an estimated $10 million on an ad campaign designed to build voter support for its elimination.

“Urge him to repeal and replace the Affordable Care Act now,” one ad running in early 2017 advised viewers to tell their congressman. That and similar material (including robocalls) paid for by the American Action Network ran numerous times last year in 75 congressional districts.

PhRMA was one of AAN’s biggest diners the previous year, giving it $6.1 million, federal regulatory filings show. And PhRMA had a substantial interest in the outcome of the repeal efforts. Among other actions, the Republican-backed bill would have eliminated a fee the companies pay the federal government, one estimated at $28 billion over a decade.

But there was no way the public could have known at the time about PhRMA’s support of the network or the identity of the other deep-pocketed financiers behind the group…

…PhRMA’s $6.1 million, unrestricted donation to AAN was its single-biggest grant in 2016, dwarfing its $130,000 contribution to the same group the year before. Closely associated with House Republicans – AAN has a former Republican senator and two former Republican House members on its board – the group backed the G.O.P. health bill intended to replace the Affordable Care Act. It also supported the successful Tax Cuts and Jobs Act of 2017, which reduced corporate taxes by hundreds of billions of dollars over a decade…

June 27, 2018: SunSentinel posted an article titled: “South Florida’s 3 Obamacare providers file proposals to return in 2019”. It was written by Ron Hurtibise. From the articles:

…The three companies that offered 2018 plans in South Florida are back – market leader Florida Blue, which has been offering a wide array of plans to fit all budgets and circumstances – plus narrow-network, lower-cost alternatives Molina Healthcare and Ambetter.

All three submitted 2019 rate proposals with the Florida Office of Insurance Regulation as required by June 20, along with four other companies that filed to sell plans in other areas of the state.

In all, rate increases proposed by eight companies offering ACA-compliant plans on and off of the exchange, average 8.8 percent, according to a news release by the state office late Friday afternoon.

That compares with a 17.8 percent increase requested a year ago by the same companies…

…Of the 1.7 million Floridians who enrolled in 2018 marketplace plans, 92 percent qualified for subsidies and saw an average $595 monthly premium reduced to $70, according to data maintained by the Department of Health and Human Services. In the tricounty region, 762,000 are enrolled…

…A new company has even filed to offer ACA plans in the state. Oscar Health, which currently sells plans in California, Texas and New York, on Thursday announced plans to expand into Florida, Michigan and Arizona in 2019…

June 27, 2018: Kaiser Family Foundation posted an article titled: “Poll: Two-thirds of Voters Say a Candidate’s Position on Pre-existing Conditions is Important to their Vote, More than Say the Same about Drug Costs, ACA Repeal or Medicare-for-all”.  From the article:

About two-thirds (65%) of voters say a candidate’s support for continued protections for people with pre-existing health conditions is either the “single most important factor” or “very important” to their vote in the upcoming midterms elections, finds the Kaiser Family Foundation tracking poll.

That’s a larger share than says the same about other health care issues, including bringing down prescription drug costs (58%), repealing the Affordable Care Act (53%), stabilizing the ACA marketplaces (52%), or passing a national health plan or Medicare-for-all (48%), the poll finds.

There are differences by partisan identification. Eight in 10 Democratic (81%) and nearly two-thirds (63%) of independent voters say the issue is at least “very important” to their vote – making it top health care issue for both groups of voters. About half (51%) of Republican voters say the same, ranking the issue below repealing the ACA (58%) among Republicans….

…Almost six in 10 Americans (57%) say that they or someone in their household has a pre-existing condition of some sort, the poll finds. This includes majorities of men and women, and majorities in all age groups except those under 30.

Among the general public, large majorities say that the ACA’s provisions that bar insurers from discriminating against people with pre-existing conditions are “very important” to them, the poll finds…

June 29, 2018: NPR posted an article titled “Federal Judge Blocks Medicaid Work Requirements In Kentucky”. It was written by Alison Kodjak. From the article:

A federal judge has blocked work requirements for Medicaid patients in Kentucky, just days before new rules mandated by Gov. Matt Bevin’s administration were set to go into effect.

In Friday’s ruling, U.S. District Judge James Boasberg called the Trump administration’s approval of the program, Kentucky HEALTH, “arbitrary and capricious”.

He writes that in approving Kentucky’s work requirement proposal, Health and Human Services Secretary Alex Azar “never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

The judge pointed out that Azar did not mention that 95,000 people could lose coverage under the plan – an oversight that he called “glaring”…

…Bevin filed a counter lawsuit in February and has threatened to dismantle Kentucky’s Medicaid expansion if the courts do not allow him to add the work requirement.

HHS approved Bevin’s request to change Kentucky’s Medicaid program in January. It requires “able bodied” Medicaid recipients  to either find work, do job training or do volunteer work to be eligible for Medicaid benefits. It was the first state to get such approval, after Seema Varma, the administrator for the Centers for Medicare and Medicaid Services, said she would look favorably on such proposals.

Verma said in a statement that she is disappointed by the decision..

…She said the agency is talking with the Justice Department to decide whether to appeal…

…Verma and Azar have argued that Medicaid beneficiaries will benefit from what’s known as “community engagement” requirements because finding work will help lift them from poverty, and therefore improve their health.

But the judge didn’t buy that argument…

…HHS has approved work requirements for Medicaid in four states. An additional seven states have requests awaiting agency approval, according to the Kaiser Family Foundation.

The ruling is available to view online. The case is called “Ronnie Maurice Stewart, et. al., v. Alex M. Azar II, et. al.,”  From the ruling:

In 2010, Congress enacted the Patient Protection and Affordable Care Act – popularly known as Obamacare – which is “a comprehensive national plan to provide universal health insurance coverage” across the nation… …One central component of that statute was an expansion of Medicaid, allowing states to provide “health care to all citizens whose income falls below a certain threshold.”… …The “expansion,” the Supreme Court has held, represented “a shift in kind, not merely degree.”… …While the “original program was designed to cover medical services for four particular categories of the needy: the disabled, the blind, the elderly and needy families with dependent children,” the Affordable Care Act “transformed” Medicaid “into a program to meet the health care needs of the entire non elderly population with income below 133 percent of the poverty level…

…Defendants in this case sought to roll back those reforms. Upon assuming office in March 2017, Defendant Seema Verma, the Administrator for the Centers of Medicare & Medicaid Services – along with then-Secretary of the Department of Health and Human Services Tom Price – immediately circulated a letter to the Governors of all states to share her belief that the ACA’s Medicaid expansion”was a clear departure from the core, historical, mission of the program.”…

…The letter encouraged states to apply for “waiver[s]” of some of the program’s coverage requirements – especially for the expansion group – promising to “fast-track” approval of such petitions…

…Kentucky is one state to board that train. After the ACA went into effect, it elected to broaden Medicaid to include the expansion population, and by April 2016, more than 428,000 new residents had thereby received medical assistance. In July 2017, however, the state submitted an experimental plan to CMS called “KY HEALTH,” which is made up of several components, most significantly Kentucky HEALTH. That latter program promised to “comprehensively transform” its Medicaid program.

Under that plan, the state would impose “community engagement” requirements for the expansion population, along with some of the traditional population as well. This new mandate would require that those recipients work (or participate in other qualifying activities) for at least 80 hours each month as a condition of receiving health coverage. The project also called for, among other things, increased premiums and more stringent reporting requirements. Consistent with CMS’s earlier invitation, the Secretary approved Kentucky’s application on January 12, 2018, waiving several core Medicaid requirements in the process.

Plaintiffs in this case are fifteen Kentucky residents, each of whom is currently enrolled in the state’s Medicaid program. Together, they fear that that Kentucky HEALTH will relegate them to second-class status within Medicaid, putting them and others “in danger of losing” their health insurance altogether. They have thus brought this action to challenge the Secretary’s approval of Kentucky HEALTH.

Although the Secretary is afforded significant deference in his approval of pilot projects like Kentucky’s, his discretion does not insulate him entirely from judicial review. Such review reveals that the Secretary never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid. This signal omission renders his determination arbitrary and capricious. The Court, consequently, will vacate the approval of Kentucky’s project and remand the matter to HHS for further review.

The ruling included more specific details about the Kentucky HEALTH program:

  • Community -engagement requirement: which requires beneficiaries to spend at least 80 hours per month on qualifying activities (including employment, job-skills training, education, community service, and participation in SUD treatment) or lose their Medicaid coverage.
  • Limits on retroactive eligibility: which will excuse the state from “provide[ing] three months of retroactive eligibility for beneficiaries receiving coverage through the Kentucky HEALTH program; except for pregnant women and former foster care youth”
  • Monthly premiums: including premiums varied based on income and/or length of time enrolled in Medicaid;
  • Limits on non-emergency medical transportation: which “relieve Kentucky of the requirement to assure non-emergency medical transportation to and from providers for the new adult group” – i.e. adults without disabilities, except for those who are medically frail, former foster-care youth, or pregnant;
  • Reporting requirements: which mandate that individuals provide information for an annual redetermination and report changes in income or circumstances that affect Medicaid eligibility within 10 days; and
  • Lockouts: which allow the state to deny Medicaid coverage for up to six months for any beneficiary who (a) has income above 100% of the FPL and (b) failed to meet her premium or reporting requirements.

Other interesting parts of the ruling include:

…In this case, Plaintiffs accuse HHS of “take[ing] by regulatory fiat what it could not accomplish in Congress.”…The Secretary and Kentucky, they say, sought to do little more than “knock people off Medicaid and undermine the Medicaid expansion enacted by Congress.”… With that in mind, their nine-court Complaint – which relies almost exclusively on the APA – challenges nearly every component of Kentucky HEALTH…

…Considering all of its aspects, Plaintiff say Kentucky HEALTH might strip them of Medicaid coverage altogether. Generally, “an eligible recipient… ha[s] a concrete interest in Medicaid benefits.”…The D.C. Circuit had “no doubt,” for example, that agency actions “threaten[ed] an individual’s ability to obtain Medicaid coverage… satisf[ied] the injury element of constitutional standing…

…The Secretary does not dispute that any Plaintiffs subject to higher premiums would suffer a cognizable injury. Instead, he suggests that each named Plaintiff might be exempt from this requirement. Kentucky HEALTH, however, excepts only the following groups from premium payments: (1) former foster-care youth; (2) pregnant women; and (3) medically frail individuals. Although Kentucky has not yet defined medically frail, several Plaintiffs aver that they are “healthy and do not have any ongoing medical problems.”…

…CMS suggest that these Plaintiffs might nevertheless meet one of the other two exemptions… but the Court cannot agree. Quite obviously, Roode, a 39-year-old man, is not a pregnant woman. Medical advances notwithstanding, Kasey, a 56-year-old woman, is also unlikely to meet that criterion…. Plaintiffs also represent in their briefing that they will not “be exempted as former foster care youth.”

…The Court therefore finds it likely that at least two Plaintiffs would be required to pay increased premiums and thus would suffer a concrete injury from Kentucky HEALTH. This is all that is needed to challenge the program…

…Kentucky tries to muddy the waters, arguing that Plaintiffs cannot satisfy the repressibility prong because “if [they] prevail in this action, the Commonwealth will not continue participating in expanded Medicaid.”… While the Governor has indeed issues an Executive Order directing the Commonwealth to “unexpand” Medicaid if any aspect of Kentucky HEALTH is invalidated… that Order has no bearing on the standing analysis here. The Executive Order calls for the Commonwealth’s Medicaid agency “to take the necessary actions to terminate Kentucky’s Medicaid expansion program” only after a final court judgement… The EO cannot take effect before this Court’s decision. Even if Kentucky were able to “unexpand” Medicaid (far from a foregone conclusion), Plaintiffs would have, at a minimum, momentary relief….

…At bottom, the record shows that 95,000 people would lose Medicaid coverage, and yet, the Secretary paid no attention to that deprivation. Nor did he address how Kentucky HEALTH would otherwise help “furnish… medical assistance.” In other words, he glossed over “the impact of the state’s project” on the individuals whom Medicaid “was enacted to protect.”…By doing so, he “failed to consider adequately” a salient purpose of Medicaid, and, thus, an important aspect of the program. The Court, consequently, cannot validate his approval of Kentucky HEALTH…


For the foregoing reasons, the Court will deny Defendants’ Motions for Summary Judgement. It will also grant Plaintiff’s Motion for Summary Judgement via Count VII, vacate the Secretary’s approval of Kentucky HEALTH, and remand to the agency. A contemporaneous Order to that effect will issue this day.

July 1, 2018: Forbes posted an article titled: “Trump’s Medicaid Work Rules Were Adding To Costs Even Before A Judge Blocked Them”. It was written by Bruce Japsen. From the article:

The Trump administration’s efforts to require Medicaid patients to work has already been adding to costs from a new layer of administrative bureaucracy that began even before a federal judge ruled against them in one state, insurers say.

U.S. District Judge James Boasberg said Trump’s health Secretary “never adequately considered whether Kentucky HEALTH would in fact furnish medical assistance to its citizens, a central objective of Medicaid.” Thus, that “omission renders his determination arbitrary and capricious.”

The ruling Friday not only puts in doubt the effort to implement Medicaid work requirements proposed earlier this year by the Trump administration and the Centers for Medicare & Medicaid Services (CMS) under Seema Verma. But the work requirement implementation continues to be a headache for health insurers that administer Medicaid benefits for low income Americans as the health plans predicted it would be…

…Prior to Trump and Verma, past administrations found work requirements “could undermine access to care and were thus inconsistent with the purposes of Medicaid,” background in the case says. In Kentucky, the work requirement added an annual reporting requirement and “redetermination” of eligibility as well as other rules patients, health plans and medical providers had to take into consideration when caring for patients.

If the new requirements are still pursued in Kentucky and elsewhere, providers and insurers predict patients could face gaps in care and cause Medicaid patients to avoid seeing a doctor, and get sicker down the road and end up costing taxpayers and the health system more money in the long run…

…With Medicaid work requirements, there’s a worry of an extra layer of burden to vet people who largely already have jobs. Studies show that most Medicaid beneficiaries are working and adding more paperwork could lead to unnecessary gaps in coverage…

July 2, 2018: The Hill posted an article titled: “Ky. governor cancels Medicaid dental, vision benefits after losing work requirement ruling”. It was written by Peter Sullivan. From the article:

Kentucky Gov. Matt Bevin’s (R) administration is canceling dental and vision benefits for thousands of people on Medicaid in the state following a judge blocking the state’s Medicaid work requirements.

The cancellation of dental and vision coverage for almost 500,000 enrollees in the state’s Medicaid expansion is “an unfortunate consequence of the judge’s ruling,” Doug Hogan, a spokesman for the Kentucky Cabinet for Health and Family Services, told the Louisville Courier-Journal.

Democrats denounced the move and said they did not think Bevin had the legal authority to cancel the benefits…

…Under Bevin’s Medicaid proposal, along with work requirements, enrollees would have had to earn dental and vision benefits through completing activities like taking classes or searching for a job.

With the proposal blocked in court, Bevin’s administration is now canceling dental and vision benefits altogether…

…Bevin has threatened to cancel the state’s Medicaid expansion altogether if the work requirements are struck down. Friday’s ruling can be appealed, though, so the issue is not fully resolved.

July 2, 2018: MHPA (Medicaid Health Plans of America) posted a statement titled: “Statement from Jeff M. Myers, president and CEO of Medicaid Health Plans of America, on the US District Court’s rejection of the Kentucky HEALTH waiver”. From the statement:

Today, U.S. District Judge James Boasberg rejected HHS Secretary Azar’s approval of the Kentucky HEALTH waiver that included not only Medicaid work requirements provisions, but other changes to the program as well.

MHPA shares the concerns raised by Judge Boasburg about how the proposal would affect Medicaid enrollees. Our member health plans in Kentucky and other states that have proposed work requirements have invested significant resources in an attempt to address these issues. However, the ruling now puts in limbo all of the state infrastructure to implement these measures that our plans have been building.

Furthermore, the states where work requirements, community engagement, co-pays, etc., were used to find legislative compromise now must perform a delicate balancing act to bring needed health care to hundreds of thousands of the working poor via state expansion. We encourage the prompt legal review of these issues to provide clarity and direction to all stakeholders.

We expect that the ruling will be appealed. In the meantime, we are committed to working with our state partners over the next several months to determine the best path forward.

July 6, 2018: Los Angeles Times posted an article titled: “South Carolina governor cuts healthcare to take antiabortion stand”. From the article:

South Carolina Gov. Henry McMaster removed $16 million for healthcare from the state budget, saying Friday he wanted to make sure no taxpayer money goes to abortion providers.

The Republican governor said he was keeping a promise he made repeatedly as he campaigns for a full term, disagreeing with Democrats and some Republicans who said Planned Parenthood gets less than $100,000 of the money and all of it goes for family planning and not abortion…

…Planned Parenthood said the veto is a “political stunt” and the practical effect will be to remove birth control, testing for sexually transmitted disease and even cancer screenings for hundreds of thousands of poor women on Medicaid…

…Republicans have been fighting over the “Family Planning” line in the budget for months. McMaster did not veto the entire $34 million in the item, with his office saying eliminating all that money would keep 700,000 women and children from getting prescriptions through Medicaid.

Democrats and Republicans – even those adamantly against abortions – called removing the money from the budget shortsighted because so little goes to Planned Parenthood in the first place and removing ti from the spending plan could mean less money for things like law enforcement or help for families with children with autism…

…McMaster said he would prefer if the federal government approves his request for a waiver that would allow South Carolina to withhold any public funds from Planned Parenthood, but his office does not know when that might be considered.

July 7, 2018: CMS (Centers for Medicare & Medicaid Services) posted a press release titled: “United States Court Ruling Puts Risk Adjustment On Hold”. From the press release:

On February 28, 2018, the United States District Court for the District of New Mexico issued a decision invalidating use of the statewide average premium by the Center for Medicare & Medicaid Services (CMS) in the risk adjustment transfer formula established under section 1343 of the Patient Protection and Affordable Care Act for the 2014 – 2018 benefit years. The ruling prevents CMS from making further collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, until the litigation is resolved.

In light of a contrary decision by the United States District Court for the District of Massachusetts, the government moved the New Mexico district court to reconsider its decision, and CMS is currently awaiting the court’s ruling. CMS is seeking a quick resolution to the legal issue raised and will inform stakeholders of any update to the status of collections or payments at an appropriate future date. The calculated risk adjustment transfer amounts for the 2017 benefit year are $10.4 billion, which includes transfers across catastrophic, small group, and individual non-catostrophic risk pools…

…The New Mexico district court’s ruling bars CMS from collecting or making payments under the current methodology, which uses the statewide average premium. This aspect of the risk adjustment methodology was promulgated as part of a regulation first issued by the Obama Administration in 2013. CMS will provide additional guidance shortly on how it will handle other issues relating to risk adjustment payments, including EDGE server data collection operations, appeals of 2017 risk adjustment amounts, and how issuers should treat risk adjustment amounts in the calculation of medical loss ratios…

July 7, 2018: Protect Our Care posted a statement titled: “Protect Our Care Statement On Historic DOJ Health Care Sabotage”.  From the statement:

After a partisan team of Department of Justice lawyers decided to abandon the rule of law in order to help a lawsuit that could eliminate the Affordable Care Act overnight, Protect Our Care Campaign Director Brad Woodhouse made the following statement:

“The Trump Administration just made history by undermining the rules of law in order to continue its no-holds barred war on American health care. By abandoning its legal and constitutional responsibilities to defend the law of the land, Jeff Sessions’ Department of Justice is prioritizing a political vendetta over centuries of legal precedent. If Trump and Sessions have their way, the Affordable Care Act and Medicaid expansion will disappear overnight, stealing coverage from millions of Americans, winding back the clock on people with pre-existing conditions, and undermining the stability of the U.S. economy. Tonight, as the President and his Administration launch their most dangerous sabotage effort yet, we are seeing just how far Republicans are willing to go in their quest to undermine the American health care system. And by sowing even more uncertainty into the health care markets, tonight’s action could encourage insurance companies to propose even higher rate increases than the double-digit hikes already threatening to hit American families next year.”

July 7, 2018: BlueCross BlueShield posted a statement titled: “Blue Cross Blue Shield Association Statement on Risk Adjustment Payment Freeze.” From the statement:

The Blue Cross Blue Shield Association issued the following statement today from President and CEO Scott Serota:

“We are extremely disappointed that the administration has frozen payment transfers under the Affordable Care Act’s (ACA) risk adjustment program, which is designed to keep costs down for consumers while meeting the medical needs of those requiring significant care. Risk adjustment is a Congressionally-mandated program that supports both the individual and small group health insurance markets.

“Without a quick resolution to this matter, this action will significantly increase 2019  premiums for millions of individuals and small business owners and could result in far fewer health plan choices. It will undermine Americans’ access to affordable coverage, particularly for those who need medical care the most.

“CMS should use all legal avenues available to make the payments on schedule and should do so to protect consumers.

“Risk adjustment is a concept that has been long supported and embraced by both Republicans and Democrats through programs like Medicare Advantage. The Program does not cost taxpayers any money and has worked effectively to help balance the cost of caring for those with significant health need by ensuring that health plans are able to enroll all consumers, regardless of their health status.

“The actions taken today will create turmoil not only for the individual market – particularly as insurers finalize their offerings for the next open enrollment that begins in November – but also for the millions of businesses that rely on the small group market to provide affordable insurance options for their employees.

“Risk adjustment is a mandatory program under federal law. CMS should take immediate action to reinstate these payment transfers to ensure the market works as intended under the law and that coverage for millions of Americans is not disrupted.”

July 7, 2018: AHIP posted a statement titled: “AHIP Statement on the Freeze of Risk Adjustment Payments for the Individual and Small Group Markets.” From the statement:

America’s Health Insurance Plans (AHIP) issued the following statement following the Administration’s decision to freeze risk adjustment payments for the individual and small group markets, in light of the decision earlier this year by the United States District Court for the District of New Mexico:

“We all agree that Americans deserve affordable, comprehensive coverage and care – regardless of whether they are sick, healthy, or have a pre-existing condition. Because different plans cover different people, the health of the people they server differs as well. The risk adjustment program helps ensure coverage is available for high-need patients by sharing the cost of covering them. If a plan covers more patients who require more health care services, that plan receives funds from other plans that cover fewer high-ned patients – all without using any taxpayer dollars.”

“We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments. This decision comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates. This decision will have serious consequences for millions of consumers who get their coverage though small businesses or buy coverage on their own. It will create more market uncertainty and increase premiums for many health plans – putting a heavier burden on small businesses and consumers, and reducing coverage options. And costs for taxpayers will rise as the federal government spends more on premium subsidies.

“We agree that a quick resolution is needed to avoid greater harm to individual and small group markets. More than ever, American business and families want affordable coverage and care they need and deserve. We encourage the Administration to reevaluate its decision and work with all stakeholder to make health care more affordable for all Americans.”

July 8, 2018: NPR posted an article titled: “Trump Administration Freezes Payments Required By the Affordable Care Act”. It was written by Maggie Penman. From the article:

The Trump administration said Saturday that it is temporarily halting billions of dollars in payments designed to help insurers meet the Affordable Care Act requirement that they provide coverage regardless of whether a person is healthy or sick.

The administration said it was withholding $10.4 billion in the so-called “risk adjustment” payments, citing a district court ruling from earlier this year in New Mexico. While the administration says it is required to stop payments because of the court decision, insurers say the move could result in higher premiums for millions of individuals and small businesses…

…The New Mexico ruling fond fault with the formula the government used to calculate the payments, saying it was “arbitrary and capricious”. But another district court in Massachusetts upheld the formula.

The announcement came as insurers were awaiting an annual report that usually comes at the end of June, informing them of whether they owe money into the risk adjustment program or will be paid out for the previous year. Insurers say the sudden halting of those payments creates uncertainty at a critical time, as they are currently developing their premiums for 2019…

…”Insurers hate uncertainty, and when faced with it tend to raise premiums to hedge their bets,” says Larry Levitt, Senior Vice President at the Kaiser Family Foundation. He says halting the risk adjustment program will disrupt the individual markets, and might even cause insurers not to participate next year.

“When the rules of the game chance after the fact – insurers don’t necessarily see the federal government as a particularly reliable partner right now,” Levitt says. “This is one of several steps the Trump administration has taken to undermine the ACA.”…

July 10, 2018: Slate posted an article titled: “Trump’s Office of Refugee Resettlement Is Budgeting for a Surge in Child Separations”. It was written by Mark Joseph Stern. From the article:

…There are currently about 11,800 children in ORR’s (Office of Refugee Resettlement) care. Alex Azar, the secretary of the Department of Health and Human Services, has started that somewhere between 2,000 and 3,000 of those children were separated from their parents at the border. The remaining children in ORR custody are unaccompanied minors – children who crossed the border without a parent or guardian.

In the documents obtained by Slate, ORR officials describe the budget implications of a potential surge in immigrant minors over the next three months. The ORR’s budgeting exercise is premised on the possibility that the agency could need as many as 25,400 beds for immigrant minors by the end of the calendar year. The documents do not indicate that ORR officials have specific knowledge that family separations will increase but do show that the agency is preparing for the possibility.

The internal documents estimate that if 25,400 beds are needed, ORR would face a budget shortfall of $585 million for ORR for fiscal year 2018, which ends on Sept. 30. Under this scenario, that shortfall would increase to $1.3 billion in the first quarter of fiscal year 2019, adding up to a total shortfall of $1.9 billion for the period between Oct. 1, 2017, and Dec. 31, 2018. The documents stress that these budget estimates represent maximum possible expenditures and that actual expenses may be lower. The Department of Health and Human Services did not respond to multiple requests for comment about these figures or anything else relating to the documents,

To help cover potential costs, the documents say, HHS will seek supplemental appropriations from Congress. The documents also indicate that HHS plans to pay for child separation by reallocating money from the Ryan White HIV/AIDS Program, which, according to its website “provides a comprehensive system of care that includes primary medical care and essential support services for people living with HIV who are uninsured or underinsured.” Per the documents, the process of transferring those HIV/AIDS funds has already begun…

July 12, 2018: The New York Times posted an article titled “Fact Check of the Day: Democrats Overstate Kavanaugh’s Writings on the Affordable Care Act”. It was written by Linda Qiu.  The article starts with quotes from three Democratic Senators, and states that their comments are exaggerated. This is followed by a fact check.

The reason this is noteworthy is because Justice Anthony Kennedy retired from the Supreme Court of the United States – giving President Trump a second opportunity to nominate someone to fill that seat. Trump selected Judge Brett M. Kavanaugh, who would have to go through at least one hearing, and a favorable vote by the full Senate, before he can join the Supreme Court.

…Judge Kavanaugh has written two dissenting opinions in the legal challenges to the Affordable Care Act while serving on the United States Court of Appeals for the District of Columbia Circuit.

In both cases, he refrained from making broad pronouncements about the constitutionality of the Affordable Care Act, said Wendy Parmet, a professor of health law at Northeastern University.

She characterized one dissent as “very boring, technical, very arcane” and the other as “very technical, lawyerly, and boring.”

Nicholas Bagley, a professor of health law and administrative law at the University of Michigan disagreed with the Democrats’ framing of Judge Kavanaugh’s writings. He said Judge Kavanaugh “doesn’t think of these cases as Affordable Care Act cases” but instead focuses on specific legal issues…

The article then looks at three Affordable Care Act related cases in which Judge Kavanaugh was involved.

…Seven-Sky v. Holder: In 2011, Judge Kavanaugh’s appeals court upheld the Affordable Care Act’s individual mandate that compelled most Americans who do not have health insurance to pay a penalty. (The tax law signed by President Trump in December repealed the mandate, effective 2019.)

In his dissent, Judge Kavanaugh argued that the court should not have heard the case in the fist place, since the Anti-Injunction Act of 1867 forbids judges to rule on tax cases until the tax has already been collected. The individual health care mandate did not take effect until 2014 so, he wrote, plaintiffs sued prematurely and “the Anti-Injunction Act precludes us from deciding this case at this time.”…

…”I do not take a position here on whether the statute as currently written is justifiable under the Taxing Clause or the Commerce Clause,” Judge Kavanaugh wrote. “What I am saying is that the only potential Taxing Clause shortcoming in the current individual mandate provision appears to be relatively slight.”…

…Sissel v. Department of Health and Human Services: In 2015, taxpayers challenged the Affordable Care Act on grounds that it violated the Constitution because revenue-raising bills must originate from the House of Representatives under the Origination Clause.

This appeals court rejected the challenge, ruling that the clause did not apply because the law’s primary purpose was to expand health care, not to raise revenue. Judge Kavanaugh again wrote the dissenting opinion which argued that although the health law is a revenue-raising bill, it “did in fact originate in the House, as required by the clause.”…

July 12, 2018: The Hill posted an article titled: “Trump health chief defense suspending ObamaCare payments.” It was written by Nathaniel Weixel. From the article:

The Trump administration is bound by a federal court decision to suspend billions of dollars in ObamaCare payments, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said Thursday…

…In a surprise announcement last week, the administration said it had suspended $10.4 billion in “risk adjustment” funding that is supposed to be paid to insurers to help them provide coverage to particularly sick and costly enrollees…

…A federal court ruling in New Mexico found the administration did not properly justify its formula for dispensing the funds. Varma said the administration is defending the risk adjustment regulation, even though it was written under the Obama administration.

Verma said CMS is asking the court to reconsider, but until that happens, the agency’s hands are tied…

…Legal experts have expressed skepticism that the administration is doing everything it can to fix the problem.

Some have said CMS is being deliberately disruptive because of its hostility to ObamaCare, and that government programs should not be at the mercy of a lone federal judge.

But at the same time, Verma would not say if the administration plans to stop approving state Medicaid work requirement waivers…

July 12, 2018: The Hill posted an article titled: “House panel advances bill that would temporarily halt ObamaCare’s employer mandate”. It was written by Jessie Hellmann. From the article:

The House Ways and Means Committee on Thursday approved legislation that would chip away at ObamaCare, including a measure that would temporarily repeal the law’s employer mandate.

The bill sponsored by GOP Reps. Devin Nunes (Calif.) and Mike Kelly (R- Pa.) would suspend penalties for the employer mandate for 2015 through 2019 and delay implementation of the tax on high-cost employer-sponsored health plans for another year, pushing it back to 2022.

Congress repealed the penalty associated with the individual mandate last year, but it doesn’t take effect until 2019…

…Powerful lobbying groups like the U.S. Chamber of Commerce have pushed for a repeal of the employer mandate.

The other measure, sponsored by Reps. Peter Roskam (R.-Ill.) and Michael Burgess (R-Texas), would allow the use of ObamaCare’s tax credits for plans outside of the exchanges in the individual market. It would also allow anyone to purchase a catastrophic plan – plans that are cheaper but cover fewer services and are currently only available for those under the age of 30….

…Both measures advanced on party-line votes.

Democrats opposed the bills, saying they would cost too much and destabilize ObamaCare.

July 13, 2018: Vox posted an article titled: “How the slow sabotage of Obamacare may hurt America’s breast-feeding rate”. It was written by Julia Belluz.

…the Affordable Care Act (ACA), also known as Obamacare, included provisions aimed at supporting mothers who want to breastfeed, as part of its expansion of preventative-health services coverage. The regulations – and how they are applies by companies – haven’t been perfect, and some women have fallen through the cracks.

But in recent years, several studies have shown that the provisions – giving moms access to lactation consultants, breast pumps, and time and space at work to pump their milk until as late as a year after birth – have contributed to rising breastfeeding rates in the US.

The ACA’s regulations went into effect in 2010 and 2012. From 2011 to 2014, the rate of women who were breastfeeding 12 months after giving birth rose from 27 percent to 34 percent, according to the Centers for Disease Control and Prevention. That amounted to the largest increase in any recent three-year period.

Now, women’s health and breastfeeding advocates worry that we  might be poised for a reversal of this trend.

The news that the administration of President Donald Trump undermined breastfeeding at a United Nations global health meeting and aligned itself with the $70 billion baby formula industry has sent a powerful signal that expanding breastfeeding access won’t be a priority for his administration…

…In addition, the administration’s focus on sabotaging the ACA doesn’t bode well for breastfeeding rates. It means that fewer people will access health care and insurance companies can now sell skimpier, short-term plans with few benefits and protections (such as coverage for preventative services like breastfeeding support.)…

…Section 2713 of the law [the ACA] requires health insurance plans to provide coverage for breastfeeding support (like lactation counseling) and supplies (such as breast pumps) without any co-payments, deductibles, or co-insurance, as long as a woman opts for breastfeeding. This coverage is required for employer-sponsored plans, individual plans purchased through the Obamacare marketplaces, and for Medicaid enrollees who access public coverage through the ACA’s Medicaid expansion.

Section 4207 of the ACA also requires that companies with annual sales of more than $500,000 provide break times and a private place (not including a bathroom) where moms can use breast pumps to express their milk at work…

…Mara Gandal-Powers, of the Women’s Health Law Center, explained that these stories [of women whose health insurance companies refused to cover lactation consulting] are not uncommon. Because lactation consulting is a service that women need immediately after birth, they’re not typically in a position to haggle with insurance companies over coverage. “If you don’t get the services to help you increase your [breast milk] supply quickly, nursing can become difficult or impossible and not really happen. So we see women who pay out of pocket.”

Instead of working to fix these gaps in coverage, the Trump administration has been attempting to dismantle the ACA. And while Republicans have failed to fully repeal the law, they’ve put forward a series of policies that have caused the uninsured rate to rise and have weakened the law in the process…

…Breastfeeding is a “preventative service,” said Kaiser’s Salganicoff. “So if its a short-term plan, it doesn’t have to have maternity care, preventative services and women who enroll in the plans would not have the entitlement to the breastfeeding coverage.”

July 13, 2018: Press of Atlantic City posted an article titled “N.J. extends 2019 Obamacare rates deadline amid federal shakeups”. It was written by Nicole Leonard.  From the article:

…State insurers are expected this month to determine how much residents who get health care coverage through the ACA should pay for their plans in 2019, but a recent disruption by President Donald Trump’s administration on payments that have helped stabilize the market is causing delays.

The White House announced earlier this month that billions of dollars in federal payments under the ACA’s risk-adjustment program will be put on hold…

…The freeze on the payments comes at a crucial time when insurers try to calculate what they should charge customers next year. Nearly 275,000 New Jersey residents selected Obamacare plans on the federal exchange during last year’s enrollment period, according to the U.S. Centers for Medicare and Medicaid…

…In response to the federal announcement, New Jersey Department of Banking and Insurance officials said they extended the deadline for insurers to file ACA plan rates by another week to July 18 because the decision to halt adjustment payments came just days before the state’s original deadline of July 11…

…The state’s insurance department told New Jersey Obamacare insurers, which this year included Horizon BlueCross BlueShield of New Jersey, AmeriHealth and Oscar, in a July 9 memo that they should calculate their plan rates, or premium prices, assuming the risk-adjustment payments will resume…

…State officials said final ACA plan rates are expected to be finalized and released by the end of the summer ahead of open enrollment, which begins Nov. 1.

July 13, 2018: Nashville Patch posted an article titled: “Tennessee Obamacare Insurers Cutting Premiums”. It was written by J. R. Lind. From the article:

For the first time, Tennesseans with coverage through the health-insurance exchanges set up by the Affordable Care Act will see their premiums go down.

According to state regulatory filings, Cigna plans to reduce premiums for its individual plans by an average of 4.8 percent and BlueCross BlueShield of Tennessee will slash its average rate by 10.9 percent.

Both Cigna and BCBST increased premiums by double digits the last four years.

Oscar, the only other company offering individual plans in Tennessee, requested a 10.8 percent premium increase…

July 16, 2018: Pacific Standard posted an article titled: “After a Report Criticizing Obamacare Removals From Medicaid.Gov Starts to Circulate, The Law Gets A Boost on Medicaid’s History Page.”  It was written by France Diep. From the article:

After a government transparency group tried to alert the Centers for Medicare and Medicaid Services (CMS) of an upcoming report, – which showed that a bank of webpages about Obamacare had been pulled from – a fresh batch of Obamacare information appeared in a prominent place on the site. At the bottom of’s “Program History” page, there’s now a table breaking down the numerous ways that the Affordable Care Act has affected Medicaid, expanding the number of Americans who are eligible and improving its benefits.

…But a spokesman for CMS said that the update is a coincidence…

…Pacific Standard noticed the update after reporting on work from the Sunlight Foundation’s Web Integrity Project, which uses software to track tens of thousands of .gov webpages. Web Integrity Project Director Toly Rinberg says a staffer sent out inquiries to CMS in the afternoon on July 9th, and on July 11th.

The project’s software shows the “Program History” page did not contain the Affordable Care Act table on the morning of July 9th; Google’s caching shows that, by the early morning hours of July 10th, it did. The table contains all the sections that had previously appeared on an Affordable Care Act landing page that was removed from in June.

July 19, 2018: WLKY posted an article titled: “Reversal: Kentucky restoring Medicaid benefits for thousands.” From the article:

Kentucky Gov. Bevin’s administration says it’s reinstating dental and vision care for hundreds of thousands of Medicaid recipients who had their benefits cut recently amid an outcry.

The benefits were abruptly cut after a federal judge rejected the Republican governor’s plan to overhaul Kentucky’s Medicaid program. The cuts triggered stinging criticism from Democrats and public health advocates.

The reversal was announced late Thursday by the state’s Cabinet for Health and Family Services. It says dental and vision coverage are being restored to “mitigate the consequences” of the ruling.

The ruling marked a setback for President Donald Trump’s administration, which has been encouraging states to impose work requirements and other changes on the state and federal health insurance program for poor and disabled people.

The ruling blocks those requirements for now in Kentucky.

July 19, 2018: The New York Times posted an 0pinion piece titled: “Want Reliable Medical Information? The Trump Administration Doesn’t”. It was written by The Editorial Board of The New York Times.  From the Opinion piece:

…On Monday, the Department of Health and Human Services took it [The National Guideline Clearinghouse] offline, the latest casualty in an administration determined to eliminate science from the government’s agenda.

The official explanation is maddening enough: a budget shortfall that roughly equals the amount Tom Price spent on travel during his brief tenure as department secretary. The site costs just $1.2 million a year to operate, and is maintained by an agency with a budget of more than $300 million.

But the more complete explanation – involving political discord over the site’s parent agency and sustained indifference on the part of the doctors and patents – should concern anyone worried about the state of American health care.

The clearinghouse was created in the 1990s as part of a wider movement to better link the practice of medicine to sound scientific research. It has been in danger of disappearing almost since the start.

Republicans argue that the database is redundant with other programs. But in some cases, other motivations for eliminating it have been all too clear. In the late 1990s, when it endorsed nonsurgical interventions for back pain, the back surgeon lobby waged an attack that resulted in huge funding cuts and placed a permanent target on the Agency for Healthcare Research and Quality (A.H.R.Q.), the agency that houses the database.

Since then, A.H.R.Q. has survived numerous attempts on its life, most recently in 2017, when the Trump administration proposed folding it into the National Institutes of Health. To its credit, Congress rejected that proposal, and instead gave the agency a $10 million bump. But the increase was not enough to undo the damage done by all the previous years’ cuts. Adjusted for inflation, A.H.R.Q. has lost about $120 million in funding since 2010…

…Budget cuts are not the only problem, though. The clearinghouse gets about 200,000 visitors a month, and professional medical societies have protested the database’s closing. But many individual doctors have greeted the news with a shrug, saying they only rarely visit the site anyway. And most consumers have no idea what the database is, or why it matters.

That’s too bad. America spends around $3.5 trillion a year on health care, and more than $30 billion on biomedical research. But we have made very little effort to link the two. In fact, studies indicate that the care we receive is not based on any sound scientific evidence; we receive only about half of the care we do need, and a lot of care that doesn’t benefit us at all. The clearinghouse, were it better utilized, could help solve this problem, and in doing so, could improve patient outcomes and reduce health care costs…

…A better solution would almost certainly be for Congress to appropriate the money needed to keep the database up and running. It could do that simply by renewing the Affordable Care Act fund that was covering the database’s operating costs, and that is scheduled to expire in 2019…

July 19, 2018: Bloomberg posted an article titled: “Trump Administration Preparing Fix for Obamacare Risk Payments”. It was written by Zachary Tracer. From the article:

The Trump administration is preparing a regulation that would allow the resumption of billions of dollars in payments to health insurers in Obamacare.

The Office of Management and Budget was sent a rule on Wednesday from the Centers for Medicare and Medicaid Services tied to the risk-adjustment program, which transfers money to insurers who take on sicker customers.

An administration official said the rule is an option being considered to resolve the legal dispute that has held up the payments.

The rule is labeled as an interim final rule, a status that would allow it to go into effect immediately. It’s titled “Ratification and Resistance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act.”…

…Health-insurance industry groups had pushed the Trump administration to issue a interim final rule for the risk-adjustment program to resolve a legal dispute that had threatened to halt payments under the program. The risk-adjustment payments, worth $10.4 billion for 2017, are part of a program in the Affordable Care Act meant to help balance the insurance markets when some insurers inevitably got stuck with costlier patients…

July 19, 2018: Sunlight Foundation posted a blog post titled: “HHS removes sex discrimination prohibition language from civil rights office website.” It was written by Rachel Bergman and Jon Campbell. From the article:

The Department of Health and Human Services’ Office for Civil Rights has altered messaging on its website related to Section 1557, the provision of the Affordable Care Act prohibiting discrimination, including sex discrimination. Advocates and experts say the changes to informational webpages about Section 1557, detailed in the latest Web Integrity report, could foreshadow a shift in policy regarding the prohibition of sex discrimination as the Department of Health and Human Services (HHS) prepares to release new regulations as soon as this month…

…Section 1557 has been the focus of a long-running legal battle of whether OCR [the Office for Civil Rights], the office responsible for enforcing regulations stemming from 1557, can respond to complaints of discrimination against transgender and gender nonconforming individuals. HHS had determined that the text of Section 1557 allowed it to prohibit all forms of sex discrimination, including discrimination based on an individual’s sex, pregnancy, gender identity, and sex stereotyping, and it put in place these Section 1557 regulations to do so.

HHS’s ability to implement Section 1557 regulations, however, was limited after a lawsuit by religiously affiliated healthcare providers argued that they would “require them to perform and provide insurance coverage for gender transitions and abortions,” according to court records. In December of 2016, the federal court in Texas hearing the case issues a nationwide preliminary injunction that prevents OCR from enforcing Section 1557 protections against discrimination baed on gender identity and termination of pregnancy, without affecting protections from other forms of sex discrimination.

The lawsuit is ongoing, but experts told WIP that the documented changes to OCR website seem to go well beyond what the injunction requires. First, language on the OCR webpages about Section 1557 has been removed such tat, while the pages do still refer to sex discrimination on the basis of an individual’s sex and pregnancy, they no longer explicitly state that sex stereotyping and discrimination on the basis of gender identity are prohibited. Second, after language was added to the webpages to explain the outcome of an injunction, some of the language was later removed that explicitly stated that, even with the injunction in place, OCR can still enforce prohibitions on sex stereotyping and discrimination on the basis of one’s sex…

…Additionally, the website, after being changed, now simply states that OCR “will continue to enforce… sex discrimination provisions that are not impacted by the court’s order.” The court has not enjoined OCR from enforcing the Section 1557 regulations’ prohibition on sex stereotyping, as [Kelli] Garcia [director of the Reproductive Justice Initiative at National Women’s Law Center] pointed out, but, without a stated definition of sex discrimination and an explicit statement about which provisions are not impacted by the injunction, OCR is not making clear to the public that it still has that power…

…On June 25, HHS filed a status update to the Texas court, stating that it is “reevaluating the reasonableness, necessity, and efficacy of the Rule that is challenged in this case” and asking the court to maintain the injunction. The rule being suggested by the HHS in the update, which might roll back all or part of the current 1557 regulations, won’t be made public until after its publication in the Federal Register, at which point HHS will begin accepting public comment…

July 19, 2018: The Press Democrat posted an article titled: “California ‘Obamacare’ premiums to rise 8.7 percent in 2019”. It was written by Jonathan J. Cooper.

Monthly health insurance premiums sold under former President Barack Obama’s health care law will rise by an average of 8.7 percent in 2019, less than the double-digit increases seen in the past two years and in other states.

The boost would be closer to 5 percent if not for the decision by Congress and President Donald Trump to eliminate the penalty for people who don’t carry insurance coverage, said Peter Lee, Covered California’s executive director. The penalty was credited with keeping rates down by driving healthier people into the market, but critics say nobody should be forced to buy a health plan…

…Covered California customers who get federal tax credits to lower their monthly premiums will be shielded from all or part of the higher costs because their subsidies will rise in tandem. But the higher prices will be felt by more than 1 million Californians who have unsubsidized coverage in the individual market, whether they get their plans through Covered California or not…

…Unsubsidized premiums in the individual market will be an average of $547 next year, up from $373 in 2014 when Obama’s health care law took effect. Actual premiums vary significantly across the state, with people in Southern California generally paying less than those in the North.

Covered California projects about 250,000 people in the individual market will drop their health coverage next year because they’ll no-longer pay a penalty…

July 19, 2018: Two Democratic Senators on the U.S. House of Representatives Committee on Energy and Commerce sent a letter to U.S. Department of Health and Human Services Secretary Alex. M. Azar and the Administrator for Medicare & Medicaid Services, Seema Verma.

The two Democratic Representatives were Ranking Member Frank Pallone, Jr. (Democrat – New Jersey) and Vice Ranking Member Kathy Castor (Democrat – Florida). From the letter:

We write to you with serious concerns regarding the Trump Administration’s intentional effort to end assistance for consumers shopping for affordable health care options, specifically authorized in the Affordable Care Act (ACA). Given the Administration’s repeated attempts to sabotage the ACA at the expense of consumers across the nation, the practical elimination of Navigators constitutes another costly blow to consumer simply for partisan gain. This lates effort to undermine the ACA ahead of the upcoming 2019 open enrollment period will further contribute to rising premiums and make it more difficult for millions of consumers across the country to access high-quality, affordable health insurance.

Navigators empower community nonprofits and health care organizations to provide in-person assistance to consumers with Marketplace enrollment. Under federal law, Navigators are tasked with a number of Marketplace enrollment responsibilities that are critical in reducing the uninsured rate. Navigators conduct public education activities to raise awareness of qualified health plan availability and are responsible for the distribution of “fair and impartial information” on enrollment and financial assistance.

The statue requires that Navigators “provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange or Exchanges,” which means that Navigators, by law, are required to perform targeted outreach to individuals in communities that may experience difficultly with enrollment, such as those with language barriers or those without access to the Internet. In addition, Navigators serve as valuable resources for enrollees seeking to better understand their coverage, and many enrollees rely on Navigators for assistance even after they have signed up for coverage. For instance, Navigators also assist enrollees with appealing claims denials.

This year, CMS slashed funding for Navigators to $10 million – an 84 percent cut in funding from the $63 million awarded to Navigators during the final years of the Obama Administration. Last year, abruptly cuts to funding prompted some Navigators to shut down completely. This year, Trump Administration cuts to the Navigator program once again threaten the ability of Navigators to perform their crucial work. Per the Funding Opportunity Announcement (FOA), numerous states, such as North Dakota and West Virginia, are eligible for only $100,000 in Navigator funding. In response to these funding cuts, numerous Navigators are sounding the alarm…

…In addition to making deep cuts to the Navigator program, the Centers for Medicare & Medicaid Services (CMS) stipulates that funding awards will be based on Navigator performance from previous year. According to CMS, “accomplishments” constitute ten percent of the criteria that will be used to evaluate a Navigator’s funding application to “ensure accountability with the program.” However, it remains unclear what methodology CMS will employ to evaluate these “accomplishments”.

Furthermore, the Administration is promoting the use of junk plans, as opposed to solely encouraging enrollment in qualified health plans (QHPs). According to CMS, Navigators will be “encouraged to demonstrate how they provide information” on associated health plans (AHPs) and short-term, limited-duration insurance (STLDI). The Administration appears to tie Navigator funding to the promotion of junk plans by evaluating funding applications on a Navigator’s ability to establish relationships with “left behind” individuals who “may be unaware of the range of available options in addition to qualified health plans (QHPs), such as association health plans [and] short-term, limited-duration insurance.” These junk plans, which are not required to cover the Essential Health Benefits or include protections for people with preexisting health conditions, will not only leave consumers saddled with more medical debt, but will also raise premiums for individuals in the ACA-compliant market. That the Trump Administration continues in its attempts to promote junk plans over high-quality insurance and raise premiums for people with preexisting conditions further draws into question the President’s commitment to enforcing the law of the land and preserving the well-being of the American people.

We remain committed to ensuring that consumers across the country are able to access high-quality, affordable health insurance, despite repeated efforts by the Trump Administration and congressional Republicans to sabotage the ACA. In addition, we are deeply concerned that the Trump Administration is not making adequate preparations for the upcoming 2019 enrollment period. Therefore, we request responses to the following by August 2, 2018:

Here is a list of the questions that the two Democratic Representatives want responses to:

Please provide an explanation of how the Department arrived at the $10 million funding level, as well as an explanation of how the Department expects Navigators to fulfill the wide breadth of responsibilities legally required… at the $10 million funding level.

  • At this funding level, how will Navigators be able to fulfill their legally mandated responsibility to “conduct public education activities to raise awareness of the availability of qualified health plans?”
  • At this funding level, how will Navigators be able to fulfill their legally mandated responsibility to “distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits…and cost sharing reductions?
  • At this funding level, how will Navigators be able to fulfill their legally mandated responsibility to “provide information that is culturally and linguistically appropriate to the needs of the population being served by the Exchange or Exchanges?

CMS Claims in the FOA that the decision to slash funding for the Navigator program was based on the percent of people Navigators enrolled in QHPs, as well as a comparison of the average cost for a Navigator to assist an enrollee against that for agents and brokers. Please provide teh underlying data used to arrive at these conclusions.

Please explain why Navigator funding period was reduced from three years – as was the case in the previous grant period – to one year. Please provide all communications pertaining to this decision. Such communications should include, but not be limited to, emails, letters, faxes, and any other written materials, as well as a list of any meetings, calls, or other oral communications, please include the date, time, and location at which such communication took place, as well as a list of individuals who participated.

Given that 42 U.S.C. 18031 stipulates that Navigator responsibilities pertain to QHPs, please explain why the criteria used to evaluate a Navigator’s grant applications for this funding period includes its ability to promote plans that do not satisfy consumer protections required under the ACA.

Please provide a detailed explanation of how Navigators’ performance in previous years will be evaluated as part of the “Accomplishments” criteria for scoring applications. As part of this explanation, please specify which metrics will be used to quantify and evaluate past performance, and what process will be used to review applications.

How does the Department intend to use the funds slashed from the Navigator program this year? Please provide an itemized list of how these funds will be used, including whether any of these funds will be directed to activities that promote enrollment in AHPs and STLDI, as well as enrollment through agents and brokers.

How did the Department use the funds diverted from the Navigator program last August? Please provide an itemized list of how these funds were used.

Please provide all analyses conducted by the Department to determine the impact that reductions to Navigator funding will have on the upcoming enrollment period, as well as any analysis conducted by the Department to determine the impact that last year’s funding cuts had on enrollment during the 2018 open enrollment period.

Please provide a justification for the Navigator funding distribution methodology implemented last year.

Please provide all self-reported performance data by current Navigators for the 2016-2017 year and for the 2017-2018 year.

July 19, 2018: The Hill posted an article titled: “House Dems want answers on cuts to ObamaCare outreach groups”. It was written by Nathaniel Weixel. From the article:

A pair of House Democrats want answers from the Trump administration about the decision to significantly slash funding for outreach groups that help people enroll in ObamaCare coverage.

The funding will be cut from $36 million this year to $10 million in 2019, the Centers for Medicare and Medicaid Services (CMS) said last week.

The administration’s funding for such outreach had already been slashed last year to well below the $63 million budgeted annually under former President Obama.

In a letter to CMS Administrator Seema Verma and Health and Human Services (HHS) Secretary Alex Azar, Democrat Reps. Frank Pallone Jr. (N.J.) and Kathy Castor (Fla.) asked the agencies to explain how they arrived at the $10 million funding level…

…They also asked Verma and Azar how the agencies expect the groups, known as navigators, to fulfill all the responsibilities legally required of them with only $10 million in funding…

…They also asked how the HHS plans to use the money that was saved from reducing Navigator funding….

July 23, 2018: The Morning Call posted an article titled: “More options for Lehigh Valley Obamacare buyers”. It was written by Carol Thompson and Binghui Huang. From the article:

Lehigh Valley residents seeking insurance through the Affordable Care Act’s individual marketplace will have more options in 2019, according to filings released Monday by the Pennsylvania Insurance Department.

Buyers across the state will have more options as well with premiums rising less than 1 percent despite the Trump administration’s moves to chip away at the federal health insurance program.

UPMC, a Pittsburgh-based insurance company, will offer plans in Lehigh County for the first time next year. Its offerings add to the growing number of plans available in the county.

Next year, residents will be able to choose from 30 individual plans of varying coverage and price. This year, they were offered 15.

Northampton County residents also will have more choices – 26 plans are available for individual buyers next year compared to 15 this year.

The trend is statewide. Four out of five companies that offered individual health insurance plans will expand through more of Pennsylvania in 2019, Insurance Department Commissioner Jessica Altman said. One new company, Pennsylvania Health & Wellness Inc., entered the state market.

The expansion speaks to a healthy individual insurance market in Pennsylvania, Altman said…

July 24, 2018: The U.S. House of Representatives voted on H.R. 184 “Protect Medical Innovation Act”. The vote was 283 YEAS to 132 NAYS. This means that H.R. 184 passed the House of Representatives. Next, it will be sent to the U.S. Senate.

  • 226 Republicans voted YEA
  • 1 Republican voted NAY
  • 57 Democrats voted YEA
  • 131 Democrats voted NAY
  • 13 Representatives did not vote at all. Out of that number, 8 were Republicans and 5 were Democrats

The summary of H.R. 184 says:

This bill amends the Internal Revenue Code to repeal the excise tax on the sale of a medical device by the manufacturer, producer, or importer.

July 24, 2018: The Hill posted an article titled: “House votes to repeal ObamaCare medical device tax”. It was written by Peter Sullivan. From the article:

The House on Tuesday voted to repeal ObamaCare’s medical device tax, a provision that members of both parties have criticized as harming innovation.

The House voted 283 to 132 to repeal the 2.3 percent tax on sales of medical devices, with some Democrats joining Republicans to approve the measure. 57 Democrats voted for the measure.

The vote comes during a week of health-care measures put forward by the GOP as they try to blunt Democratic attacks over rising premiums, a key midterm message…

…There is no clear path forward for the measure in the Senate this year, however.

The tax has already been delayed twice, but this bill would permanently repeal it, which backers say is needed to give certainty to industry.

Some Democrats opposed repeal of the tax, though, pointing out it would deprive the government of about $20 billion over 10 years and that repeal of the tax is not paid for…

July 24, 2018: The Centers for Medicare and Medicaid Services (CMS) Department of Health and Human Services (HHS)  issued a document that had not yet been published on the Federal Register. This means there could be some changes made to the document when it is published on the Federal Register. The wording of the document that is placed on the Federal Register (whenever that may be) will be the official HHS-approved document.

This document is about the “Adoption of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act for the 2017 Benefit Year.” From the document:

This action of this document is described as: “Final Rule”.  From the Summary of the Final Rule:

This final rule adopts the risk adjustment methodology that HHS previously established for the 2017 benefit year. Section 1343 of the Patient Protection and Affordable Care Act (PPACA) established a permanent annual risk adjustment program under which payments are collected from health insurance issuers that enroll relatively low-risk populations, and payments are made to health insurers that enroll relatively higher risk populations. HHS sets the risk adjustment methodology in advance of each benefit year through a notice-and-comment rulemaking process. HHS sets the parameters ahead of the applicable benefit year so that insurers are able to rely on the methodology in pricing their plans.

In February of 2018, a district court vacated the use of statewide average premium as a basis for HHS-operated risk adjustment methodology for the 2014, 2015, 2016, 2017, and 2018 benefit years on the grounds that HHS did not adequately explain its decision to adopt a methodology that ensures that amounts collected from issuers equal payments made to issuers for the applicable benefit year (New Mexico Health Connections v. United States Department of Health and Human Services et all….).

The government’s motion for reconsideration of the ruling remains pending with the district court. Absent this administrative action, HHS would be unable in the coming months to collect charges or make payments to issuers for the 2017 benefit year. These amounts total billions of dollars, and failure to make the payments in a timely manner threatens to undermine the stability of the insurance markets, as issuers are now in the process of determining the extent of their market participation and the rates and terms of plans they will offer for the 2019 benefit year.

We hereby adopt the rules set out in the Federal Register on March 23, 2012 and the rules set out in the publication in the Federal Register on March 23, 2012 and the publications in the Federal Register on March 8, 2016…

July 24, 2018: Nicolas Bagley (University of Michigan Law Professor) posted a tweet on his verified Twitter account: “The new rule doesn’t make any substantive changes. It just offers the additional explanation that the court said it was looking for.” This tweet included an image of some of the text from the “Final Rule”:

…This final rule adopts HHS-operated risk adjustment methodology previously published at 81 FR 12204 for the 2017 benefit year with an additional explanation regarding the use of statewide premium and the budget neutral nature of the program. This rule does not make any changes to the previously published HHS-operated risk adjustment methodology for the benefit year…

This was followed by another tweet:”The tl;dr explanation is pretty straightforward. If you want risk adjustment to discourage insurers from competing over how well they discourage unhealthy people from signing up, you’ve got to make it budget neutral.”  This tweet includes another image of some of the text from the “Final Rule”:

…In light of the budget-neutral framework discussed above, HHS also chose not to use a different parameter for the payment transfer formula under the HHS-operated methodology, such as each plan’s own premium, that would not have automatically achieved equality between risk adjustment payments and charges in each benefit year. As set forth in prior discussions, use of the plan’s own premium or some similar parameter would have required the application of a balancing adjustment in light of the program’s budget neutrality – either reducing payments to issuers owed a payment, increasing charges on issuers due a charge, or splitting the difference in some fashion between issuers owed payments and issues assessed charges. Such adjustments would have impaired the risk adjustment program’s goals, discussed above, of encouraging insurers to rate for the average risk pool and avoiding the creation of incentives for issuers to operate less efficiently, set higher prices, develop benefit designs or create marketing strategies to avoid higher-risk enrollees…

This was followed by another tweet: “Plus, making the program dependent on annual appropriations from Congress isn’t exactly good for market stability.” This tweet include another image of some of the text of the “Final Rule”:

…Furthermore, if HHS had elected to adopt a HHS-operated risk adjustment methodology that was contingent on appropriations from Congress in the annual appropriations process that would have created uncertainty for insurers in the amount of risk adjustment payments they could expect. That uncertainty would undermine one of the central objectives of the risk adjustment program, which is to assure insurers that they will receive risk adjustment payments if, for the applicable benefit year, they enroll a high risk population compared to other issuers in the state market risk pool…

July 24, 2018: The New York Times posted an article titled: “Trump Administration, in Reversal, Will Resume Risk Payments to Health Insurers.” It was written by Robert Pear. From the article:

The Trump administration, in an abrupt reversal, said Tuesday that it would restart a program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act.

The administration suspended the program less than three weeks ago, saying it was compelled to do so by a federal court decision in New Mexico.

But the administration said Tuesday it would reverse the program because otherwise health plans could become insolvent or withdraw from the market, causing chaos for consumers.

In adopting a new rule, the administration essentially accepted the arguments of critics, including consumer groups, health insurance companies, and Democrats in Congress, who said that suspending the payments would cause turmoil in insurance marketplaces…

…Payments will resume around Oct. 22, the Department of Health and Humans Services said of the rule…

…President Trump has taken many steps to undermine the Affordable Care Act. The record of the Department of Health and Human Services is mixed. Officials like Ms. [Seema] Verma [administrator of the Centers for Medicare and Medicaid Services] have denounced the law, but said they are obliged to carry it out while it remains on the books…

July 25, 2018: Politico posted an article titled: “Risk adjustment is back”. It was written by Sarah Kaelin-Smith, Renuka Rayasam and Dan Diamond. From the article:

The Trump administration is resuming Obamacare’s risk adjustment program, just weeks after it abruptly froze billions of dollars in insurer payments citing a court ruling invalidating parts of the program. CMS late Tuesday night issued a final rule that it said clarifies the program methodology and addresses issues raised earlier this year by a federal judge, clearing the way for the government to begin making payments again.

“Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today,” CMS Administrator Seema Verma said. The risk adjustment program, created to protect Obamacare insurers that attract sicker and more expensive customers, has been targeted in court by some companies that allege it penalizes smaller startup health plans. The freeze affected 2017 payments totaling $10.4 billion…

…Ways and Means Chairman Kevin Brady praised the move. Not making the payments “would have had a devastating impact and increased health care costs on millions of hardworking Americans,” he said…

July 25, 2018: The U.S. House of Representatives voted on H.R. 6311 “Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018”.  The vote was 242 AYES to 176 NAYS. This means that H.R. 6311 has passed the House of Representatives. It will go to the Senate next.

  • 239 Republicans voted AYE
  • 12 Democrats voted AYE
  • 1 Republican voted NAY
  • 175 Democrats voted NAY
  • 10 Representatives did not vote

Some of the text of H.R. 6311 says:

To amend the Internal Revenue Code of 1986 and the Patient Protection and Affordable Care Act to modify the definition of qualified health plan for the purposes of the health insurance premium tax credit and to allow individuals purchasing health insurance in the individual market to purchase a lower premium copper plan.

Other key parts of H.R. 6311 include:

  • Carryforward of health flexible spending arrangement account balances: A plan shall not fail to be treated as a health flexible spending arrangement under this section or section 105 merely because the lesser of – (1) such arrangement’s account balance (or any portion thereof) determined at the end of any plan year, or (2) the product of the dollar limitation in effect under section 125(i) for such a plan year… multiplied by 3, may be carried forward to the succeeding plan year.
  • Coordination with limitation on salary reduction contributions: Coordination with carry forward of account balances – The dollar amount otherwise in effect under paragraph (1) for any plan year shall be reduced (but not below zero) by the excess (if any) of – (A) the amount of any account balance which is carried forward to such plan year from the preceding year, over (B) twice the dollar limitation in effect under paragraph (1) (determined without regard to this paragraph).
  • Maximum contribution limit to health savings account increased to amount of deductible and out-of-pocket limitation: In short, this part raises the limitation on Self-Only coverage, and on Family coverage.
  • Allows both spouses to make catch-up contributions to the same health savings account
  • Special rule for certain medical expenses incurred before the establishment of health savings account: If a health savings account is established during the 60-day period beginning on the date that coverage of the account beneficiary under a high deductible health plan begins, then, solely for purposes of determining whether an amount paid is used for a qualified medical expense, such account shall be treated as having been established on the date that such coverage begins.
  • Allowance of bronze and catastrophic plans in connection with health savings accounts
  • Allowing all individuals purchasing health insurance in the individual market the option to purchase a lower premium copper plan.
  • Delay of reimposition of annual fee on health insurance providers: This part strikes the date “December 31, 2019” and replaces it with “December 31, 2021”.

July 25, 2018: The U.S. House of Representatives voted on H.R. 6199 “Restoring Access to Medication Act of 2018”. The vote was 277 YEAS to 142 NAYS. This means that H.R. 6199 has passed the House of Representatives. It will go to the U.S. Senate.

  • 231 Republicans voted YEA
  • 46 Democrats voted YEA
  • 1 Republican voted NAY
  • 141 Democrats voted NAY
  • 9 Representatives did not vote

The Summary of H.R. 6199 (as written by the nonpartisan Congressional Research Service) is:

This bill repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, health flexible spending arrangements, and health reimbursement arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). The bill also allows the accounts to be used for menstrual care products.

July 25, 2018: USA Today posted an article titled: “House votes to delay Obamacare insurance tax, loosen health savings accounts restrictions”. It was written by Ken Alltucker. From the article:

The House of Representatives voted Wednesday on bills to delay an Affordable Care Act tax and allow consumers broader use of health savings accounts.

In a 242-176 vote, House Republicans joined one dozen Democrats to support a bill that would postpone the health insurance tax through 2021. The tax, which already had been delayed through 2019, is intended to help fund the health law’s insurance expansion.

But House Republicans said the tax helped drive the cost of health insurance premiums higher. Democrats blamed the Trump administration’s actions for higher insurance premiums this year and said eliminating the tax would reduce federal revenue by $50 billion over the next decade, worsening the federal deficit.

Another health-related tax bill allowing consumers to use health savings accounts to purchase over-the-counter medications and other health-related products received bipartisan support in a 277-142 vote.

Other provisions would allow consumers to use health savings accounts for exercise and fitness programs and for “direct primary care” doctors who give patients expanded access in exchange for an annual fee. The measure also would allow consumers to carry a balance from year to year in flexible-spending accounts; these accounts now require users to spend the entire account within a calendar year.

The two measures were approved one day after the House voted to repeal a 2.3 percent tax on medical devices, a bill that also received bipartisan support.

Some Democrats said the bills would add to the federal deficit and undermine the Affordable Care Act. They also questioned whether the legislation was intended to help vulnerable lawmakers in an election year…

July 26, 2018: The U.S. Government Accountability Office (GAO) responded to Representative Frank Pallone, Jr, (New Jersey 6th District – Democrat) Ranking Member of the House Committee on Energy and Commerce with a report. From the report:

On July 25, 2017, the U.S. Department of Energy (Energy) issued a tweet concerning a guest column by the Secretary of Energy on health care. The next day, you asked us whether Energy violated any appropriations laws by “us[ing] agency resources on matters well beyond [its] jurisdiction.” We analyzed whether Energy violated the purpose statute, 31 U.S.C.§ 1301, and applicable appropriations law prohibitions on using appropriations for grassroots lobbying or for publicity or propaganda. We find that Energy violated the purpose statute when it tweeted about the Secretary’s Columbia because Energy did not show that its appropriation is available for the purpose of informing the public about health care legislation. As explained below, we also find that Energy did not violate the prohibitions on using appropriations for grassroots lobbying or for publicity or propaganda…

…On July 25, 2017, published the Secretary’s column on health care. In the column, the Secretary criticized “Obamacare,” a common reference to the Patient Protection and Affordable Care Act (PPACA), and advocated for the enactment of “patient-centered reform” that “empower[s] the states.” The Secretary wrote that “[m]illions of Americans are depending on their representatives to repeal this crushing law and can benefit from common-sense solutions being considered in the Senate.” He added that the Better Care Reconciliation Act, then pending in the Senate, included “many positive reforms to Medicaid” and “would give states more control to deliver better care at lower costs for those in need.”…

…Energy’s Office of Public Affairs issued a tweet concerning the column that same day. @EnergyPressSec tweeted: “Time to discard the burdens and costs of Obamacare: @SecretaryPerry” and linked to the Secretary’s column in E&E News reported that Energy deleted the tweet later in the day. Energy acknowledged that the tweet occurred.

Energy obligates amounts for the expenses of its Office of Public Affairs from its Departmental Administration appropriation….

…The purpose statute, 31 U.S.C. § 1301, provides that appropriations are only available for the purpose for which Congress has provided. In order to interpret the purpose of an appropriation, we turn to its statutory language.

The Departmental Administration appropriation is a lump-sum appropriation that is broadly available for “salaries and expenses of the Department of Energy necessary for departmental administration in carrying out the purposes of the Department of Energy Organization Act… The Department of Energy Organization Act, in turn, authorizes Energy to carry out various energy programs. Because neither the appropriation nor the authorization plainly makes amounts available for the purpose of informing the public about health care, we apply the “necessary expense” rule and first consider whether Energy’s expenditure bears a reasonable and logical relationship to the purpose of this appropriation…. We generally look to the agency to determine whether an expenditure is reasonably related to accomplishing its statutory mission, but the relationship must not be “so attenuated as to take it beyond that range” or permissible discretion…

…Energy told us that it obligates its Departmental Administration appropriation for the Office of Public Affairs, which “facilitate[s] the dissemination of information relevant to the agency and administration.” Energy Letter, at 1 (emphasis added). With regard to whether Energy’s appropriation is available to disseminate information “relevant to the agency,” we agree that an agency’s appropriations are generally available to communicate with the public about agency activities…. In its congressional budget justification for fiscal year (FY) 2017, Energy explains that the mission of its Office of Public Affairs is to “communicate information about DOE’s work in a timely, accurate, and accessible way to the news media and the general public.” Here, however, Energy did not provide any explanation or make any particularized showing that communicating about health care is part of its work or is related to accomplishing its statutory mission…

…Here, however, Energy merely asserted – with no further explanation or support – that its Departmental Administration appropriation was available for disseminating information important to the administration. Energy Letter, at 1. As explained above, in order to use this appropriation, Energy would have to show a reasonable and logical relationship between tweeting about health care and the purposes of its Departmental Administration appropriation. Energy did not make this connection. In other words, Energy did not meet the requirements of the necessary expense rule because it did not show that the tweet was reasonably and logically related to the purpose of its appropriation. Therefore, we find that Energy violated the purpose statute, 31 U.S.C. § 1301…

July 26, 2018: The Hill posted an article titled: “Congressional watchdog finds Energy Dept. violated law with anti-ObamaCare tweet”. The article was written by Peter Sullivan.  From the article:

A congressional watchdog agency found Thursday that the Department of Energy violated the law last year with a negative tweet about ObamaCare.

The report from the Government Accountability Office, an investigative arm of Congress, finds that the Department of Energy violated the law because its funding is not directed to be used for health-care messaging.

The tweet in question, from last July, linked to an anti-ObamaCare opinion piece by Energy Secretary Rick Perry, stating, “Time to discard the burdens and costs of Obamacare: @SecretaryPerry.”

The agency deleted the tweet later in the day.

“We find that Energy violated the purpose statute when it tweeted about the Secretary’s column because Energy did not show that its appropriation is available for the purpose of informing the public about health care legislation,” the GAO report states.

Rep. Frank Pallone Jr. (N.J.), the top Democrat on the House Energy and Commerce Committee, denounced the Trump administration over the findings…

July 26, 2018: The Hill posted an article titled: “Trump says new health plans, not available until September, already doing ‘record business'”. It was written by Brett Samuels. From the article:

President Trump on Thursday touted his administration’s new health insurance plans, which aren’t available to the public until Sept. 1, saying they’re already generating “record business.”

Speaking at a roundtable in Iowa, where he was joined by state and local officials, as well as a few members of his Cabinet, the president highlighted forthcoming health plans that serve as alternatives to the ones offered under ObamaCare.

Trump said Alex Acosta, who was at the event, “has come up with incredible healthcare plans.”

“Alex, I hear it’s like record business that they are doing,” Trump said of the plans, which aren’t available for another five weeks. “We just opened about two months ago and I’m hearing that the numbers are incredible — the numbers of people getting really, really, good healthcare instead of Obamacare, which is a disaster.”…

…Trump did not site any numbers regarding the health plans at Thursday’s event, while Acosta said he’d heard Iowa businesses are “putting those associations together.”

The Labor Department has said associations cannot establish association health plans until Sept. 1…

July 26, 2018: The Fiscal Times posted an article titled: “Top Trump Health Official Slam Obamacare, Medicare for All”. It was written by Yuval Rosenberg. From the article:

In a speech Thursday morning at the conservative Heritage Foundation, Health and Human Services Secretary Alex Azar criticized the Affordable Care Act and said that the Trump administration was committed to “building markets and competition, restoring price signals and incentives, and empowering consumers through choice, rather than having government decide what is best for the individual.”

The Fiscal Times article then lists some of what Azar said.  Here is a one quote:

  • Obamacare’s Medicaid expansion made the program “a free source of coverage for 15 million new able-bodied adults, including many without children. In fact, the ACA offers more generous support for states to insure these populations, currently covering more than 90 percent of their costs, than it does for traditional Medicaid populations. Supporting legislation to undo those perverse incentives is a priority for this administration. But in the meantime, we want to rethink how Medicaid serves able-bodies, working-age adults, which is why we have encouraged states to consider work and community requirements for these populations.”

…Azar’s comments come a day after another top Trump administration health care official, Centers for Medicare and Medicaid Services Administrator Seema Verma, also critiqued the Affordable Care Act. “It wasn’t working when we came into office and it continues not to work,” she said. “The program is not designed to be successful.”

Verma also took a swipe at the idea of “Medicare for all,” which has become increasingly popular with Democrats. Verma said the idea would endanger Medicare’s focus on seniors. “We don’t want to divert the purpose and focus away from our seniors,” she said. “In essence, Medicare for all would become Medicare for none.”

Verma also said she didn’t think a single-payer system would work. “By choosing a socialized system, you are giving the government complete control over the decisions pertaining to your care or whether you receive care at all. It would be the furthest thing from patient-centric care,” she said in her speech…

July 27, 2018: Bloomberg posted an article titled: “States Could Change Obamacare”. It was written by Sara Hansard. From the article:

States may soon get more leeway to make changes to Obamacare that could affect the comprehensiveness of coverage…

…Section 1332 of the Affordable Care Act enables states to ask for permission from the Department of Health and Human Services to make changes to the ACA, including changes to requirements on health plans and the ACA marketplaces, as well as changes to the ACA-mandated essential health benefits coverage and to the financial assistance system.

But there are “guardrails” on those major changes written into the law, requiring that coverage be at least as comprehensive and affordable as it would be without waivers, a comparable number of residents are covered, and the waiver doesn’t increase the federal deficit…

…About 87 percent of people enrolled in marketplace plans receive subsidies, but from 2016 to 2017, the number of people who didn’t receive subsidies dropped 20 percent in the ACA-compliant individual market, according to a recent HHS report.

For example, many people in the individual market in Wisconsin are farmers who used to purchase health insurance policies that included work-related injuries before the ACA rules took effect, Wisconsin Deputy Commissioner of Insurance J.P. Weiske said. Wisconsin would like to add benefits to its individual plans to make them more useful to farmers, he said.

Wisconsin is also looking for more flexibility to promote the use of association health plans, Weiske said. The Trump administration recently issued final rules that make it easier to offer association health plans, which may not comply with all ACA requirements.

July 28, 2018: The Washington Post posted an article titled: “‘A different level of intensity’: Collins and Murkowski find pressure over Supreme Court lacks emotional pleas on health care”. It was written by Paul Kane. From the article:

…In July 2017, Sens. Susan Collans (R-Maine) and Lisa Murkowski (R-Alaska) joined Sen. John McCain (R-Ariz.) to defy GOP leaders and defeat legislation to scrap the Affordable Care Act. Now, with McCain home battling brain cancer, the two moderate Republicans are in the crosshairs of well-organized campaigns that are expected to pour millions of dollars into advertising into the small-market towns throughout Maine and Alaska.

Liberal activists are trying to re-create last year’s playbook and pressure Collins and Murkowski into opposing [Judge Brent M.] Kavanaugh, highlighting the judge’s rulings on the ACA and abortion as potential red flags. Almost every other Republican has praised the conservative jurist, so liberals are targeting the two moderates in the hope that if they opposed Kavanaugh, that would be enough to defeat his nomination, assuming all 49 members of the Democratic caucus held together.

But that’s where the similarities end. In separate interviews, Collins and Murkowski said constituents view the health-care debate and the Supreme Court very differently.

“The protests are similar, the media campaign is more aggressive this time, but constituent involvement is less. And I think that’s because health care is so personal and affects everybody,” Collins said.

“A different level of intensity, a different level of intensity. What I was hearing at home were very personal stories,” Murkowski recalled of last summer’s interactions with constituents. “Literally people in tears. The level of emotional outpouring that made it just – intense is the best word – is different than it is now.”

Both Republicans remain adamant that they have not made a decision on how they will vote on Kavanaugh, but the reduced constituent engagement makes the Supreme Court fight more difficult for liberals than last year’s defense of the ACA…

July 29, 2018: Forbes posted an article titled: “As Trump Attacks, Insurers Boost Obamacare Marketing”. It was written by Bruce Japsen. From the article:

Large health insurers have joined the parade of startups investing more in marketing and operations to expand their geographic footprints and sell more individual coverage under the Affordable Care Act.

Anthem, the nation’s second-largest health insurer, said last week its performance has improved from last year when losses triggered a major retreat from Obamacare. So much so, Anthem last week said the number of individual customers dropped by more than 1 million to 712,000 in the second quarter compared to last year.

But Anthem executives say the insurer’s ACA individual business has stabilized enough that the operator of Blue Cross and Blue Plans in 14 states will expand in 2019 near areas where it still offers Obamacare coverage. It didn’t specify which states would see expansions, executives said in an update during Anthem’s second quarter earnings call…

…Centene is the largest player in the Obamacare business, ending the second quarter with 1.5 million marketplace health plan members, which is up from 10.8 million last year, the insurer reported least week…

…This year, Centene entered Kansas, Missouri, and Nevada and expanded in six other states where it already sells individual ACA policies, including markets Aetna, Humana, and UnitedHealth Group scaled back or left altogether. In 2019, Centene is filing with states to expand into new states and expand offerings in areas where it already sells ACA-compliant individual coverage…

…Bright Health will enter Arizona and Tennessee with individual plans in 2019 on the ACA’s public exchanges after already selling ACA-compliant policies in Colorado and Alabama this year. And Oscar Health has said it would sell health insurance in six new markets, the insurer said last month…

July 29, 2018: Milwaukee Journal Sentinel posted an article titled: “Scott Walker’s $200 million plan to lower Obamacare costs gets OK from Trump administration”. It was written by Patrick Marley and Samantha Hernandez. From the article:

President Donald Trump’s administration signed off Sunday on Gov. Scott Walker’s $200 million plan to lower Affordable Care Act premiums.

It was the latest effort by the GOP governor to work within the confines of Obamacare as he simultaneously tries to end the federal health care law…

…Under Walker’s plan, consumer costs are expected to go down by 3.5 percent on average next year for individuals getting insurance through the marketplaces established by the act.

Democrats dismissed Walker’s plan as an election-year effort by the governor to score points on health care while refusing to accept additional federal money under Obamacare for the state’s BadgerCare Plus health program…

…Wisconsin taxpayers will spend $34 million on Walker’s plan. The remaining $166 million will come from federal taxpayers…

Walker and lawmakers approved their plan in February but needed permission from the Centers for Medicare and Medicaid Services because the federal government would fund the bulk of it.

They received the federal approval Sunday, and within hours Walker put his signature on it during his stop here. The plan will take effect Jan. 1.

Under the plan, the number of people getting insurance on the Obamacare marketplace would dip in 2019 to an estimated 184,000.

The program – dubbed the Health Care Stability Plan – is targeted at consumers who buy individual health insurance through the Affordable Care Act but who make too much money to qualify for federal subsidies to lower their premiums. Those consumers saw their premiums go up by 44 percent in 2018 in Wisconsin….

Walker’s plan will help insurers cover the cost of patients with claims of $50,000 to $250,000. With the Walker plan covering half those costs, insurers will be able to charge lower premiums.

Under the plan, premiums on average will drop 3.5 percent from current levels and will be 11 percent lower than they would have been in 2019 without the plan, according to his administration. Walker noted that not everyone will see a reduction in their premiums.

Now, individuals using the Obamacare marketplaces in Wisconsin pay a monthly premium of $762.

Walker’s plan won the backing of the Wisconsin Hospital Association, though the group contended the government needs to pay hospitals more to care for people who get health care through BadgerCare and other Medicaid programs…

July 29, 2018: posted an article titled: “New Republican plan to address Obamacare gives biggest breaks to the rich.” It was written by Jonathan D. Salant. From the article:

Health care legislation passed by the U.S. House before departing for its annual August recess will do little to lower premiums or provide more Americans with insurance, but will give a bigger break to wealthier taxpayers, according to studies and experts.

Two bills focus on expanding Health Savings Accounts, which are funded with pre-tax dollars and are combined with bare-bones plans that cover only major expenses. That puts most of the burden for paying medical expenses on individuals, but they can use tax-free savings to cover them.

They would expand the list of allowable expenses from the accounts and increase the maximum contribution to $6,900 from $3,450 for individuals and $13,300 from $6,900 for families.

“These bills provide more opportunities for higher-income people to tax shelter but won’t really make much of a difference in the health care system,” said Larry Levitt, senior Vice President at the Kaiser Family Foundation, which studies health care…

…But few middle class families use HSAs. More than 16 percent of those earning at least $200,000 a year have health savings accounts and contribute an average of $4,716, according to the Tax Policy Center, a research group.

That’s more than double the 7.8 percent with HSAs among those earning between $50,000 and $100,000, who have contributed half as much on average, $2,240.

“Most low and moderate Americans do not have excess income to invest after they pay for their premium and other up front out-of-pocket costs,” said Ray Castro, director of health policy for New Jersey Policy Perspective, a progressive research group.

What the bills will do is encourage wealthier, healthier Americans to buy the catastrophic health plans and put tax-free money into HSAs. They can pay lower premiums for little coverage and put away thousands of dollars without ever having to pay taxes on the money…

July 31, 2018: Bloomberg posted an article titled: “Short-Term Health Plans Backed by Trump Are Cheap for a Reason”. It was written by Zachary Tracer and Emma Ockerman. From the article:

Short-term health plans with a history of consumer complaints will get a larger role in the U.S. insurance market under a Trump administration plan to expand alternatives to Obamacare.

The temporary plans, which were originally intended for people between jobs, are allowed to offer coverage that’s far skimpier than what the Affordable Care Act requires. The administration has promoted them as a cheaper alternative to Obamacare for individuals who have seen their premiums climb or lost access to doctors. The plans were limited to three months, and President Trump is making them available for longer…

…The rule released Wednesday makes the short-term plans available for a duration of up to a year, and insurers can make the plans renewable for as long as three years. Under the rule, insurers are required to warn their customers that the policies may not cover pre-existing conditions and may offer limited benefits.

Losening limits on short-term health plans is just one of several ways the Trump administration is pushing to weaken Obamacare. The health law’s requirement that Americans buy comprehensive insurance coverage was repealed as part of the December tax cuts, which helped open the door for a bigger role for the short-term health plans…

…Short-term coverage for an individual cost approximately $124 a month in late 2016, compared with about $400 a month for Obamacare, according to the Centers for Medicare and Medicaid Services.

For some people, though, the cheaper premiums can come at a cost, such as when insurers claim that a cancer treatment shouldn’t be covered because a patient had the disease before buying coverage, as Bloomberg reported in October. These plans are effectively banned in New York, New Jersey and Massachusetts, and several other states impose restrictions on them.

State regulators told the administration that they’ve received complaints from consumers about the plans failing to cover their treatments. Pennsylvania’s insurance regulator said some consumers complained about services that weren’t covered, based on fine print in plan policies…

August 1, 2018: CBS News posted an article titled: “Feds approve Maine insurance program that Obamacare halted”. From the article:

Republican President Donald Trump’s administration has given the go-ahead to Maine’s efforts to re-launch a $93 million program to reduce health insurance premiums and reduce the uninsured population. The U.S. Centers for Medicare and Medicaid Services approved by GOP Gov. Paul LePage administration’s request Monday.

Maine’s program first launched in 2011 but a similar federal Affordable Care Act replaced it. States have used “reinsurance” programs to help insurers afford to cover their most seriously ill, expensive consumers.

The program redistributes insurance money in part by charging a $4 per-person fee on individual and group plans expected to yield $22.6 million. The program would also direct $37 million premiums from seriously ill patients and put it into an “invisible high-risk pool”…

August 1, 2018: The Advocate posted an article titled: “Obamacare premiums to drop in Louisiana in 2019 after years of rate hikes.” It was written by Sam Karlin. From the article:

After seeing years of rate hikes, Louisiana residents getting health insurance through the Affordable Care Act’s individual exchange will see premiums drop in 2019 by an average of 6.4 percent.

The direction is an abrupt turnaround for the individual exchange, created under the ACA – commonly known as Obamacare – to offer insurance to people who don’t receive it through their jobs or other means. Until now, Louisiana’s individual market has weathered years of rising premiums, including a jump of 18.5 percent on average for 2018…

…More than 100,000 Louisianians get insurance through the individual exchange, and the majority receive federal subsidies to offset the cost. A smaller group not covered by subsidies feel the full weight of premium changes.

Blue Cross and Blue Shield of Louisiana, the state’s largest insurer, and Vantage Health Plan, a small, north Louisiana-based insurer, are the only insurers in the state left offering plans on the individual exchange…

…Rates unveiled Wednesday by the Louisiana Department of Insurance show declines in a range from about 4 percent to more than 15 percent, depending on the policy chosen. Premiums in the small group market will rise by 0.1 on average…

August 1, 2018: USC-Brookings Schaeffer Initiative for Health Policy posted an analysis titled “How Would Individual Market Premiums Change in 2019 in a Stable Policy Environment?” It was written by Matthew Fiedler.  Here is some key points from the Introduction:

In recent weeks, insurers in many areas of the country have unveiled the premiums they propose to charge for individual market health insurance policies in 2019. In setting premiums for 2019, insurers are taking account of several policy changes that will be newly in effect for the 2019 plan year, including repeal of the individual mandate penalty and Trump Administration actions to expand the availability of plans that are exempt from various Affordable Care Act (ACA) requirements. These policy changes are generally expected to cause many healthier people to leave the individual market and thereby raise individual market premiums…

…This analysis examines how premiums might have changed in 2019 in a stable policy environment. To do so, I first estimate insurers’ revenues and costs in the ACA-compliant individual market through 2018, drawing primarily on insurers’ reports to state and federal regulators. With these estimates as a starting point, I then estimate how premiums would have changed in 2019 under various assumptions about how insurers’ costs and margins would have evolved in 2019 without the major pending policy changes. This analysis reaches two main conclusions:

  • Insurers will earn large profits in the ACA-compliant market in 2018: I project that insurers’ revenues in the ACA-compliant market will far exceed their costs in 2018, generating a positive underwriting margin of 10.5 percent of premium revenue. This is up from a modest positive margin of 1.2 percent of premium revenue in 2017 and contrasts sharply with the substantial losses insurers incurred in the ACA-compliant market in 2014, 2015, and 2016. The estimated 2018 margin also far exceeds insurers’ margins in the pre-ACA individual market. These estimates for 2018 as a whole are broadly consistent with estimates for the first quarter of 2018 derived from insurers’ first quarter financial filings by researchers at the Kaiser Family Foundation…

The estimated improvement in insurers’ margins for 2018 is driven by the substantial premium increases implemented for 2018, which will almost certainly be more than sufficient to offset the loss of cost-sharing reduction (CSR) payments and what appears likely to be another year of moderate growth in underlying claims spending. Prior analysis of insurers’ 2018 rate filings suggest that many insurers expected policy changes that are now scheduled to take effect in 2019, notably repeal of the individual mandate penalty, to take effect in some form during 2018…This may have led insurers to incorporate those policy changes into their premiums a year early.

  • In a stable policy environment, average premiums for ACA-compliant plans would likely fall in 2019: In this analysis, I define a stable policy environment as one in which the federal policies toward the individual market in effect for 2018 remain in effect for 2019. Notably, this scenario assumes that the individual mandate remains in effect for 2019, but also assumes that policies implemented prior to 2018, like the end of CSR payments, remain in effect as well. Under those circumstances, insurers’ costs would rise only moderately in 2019, primarily reflecting normal growth in medical costs. Meanwhile, for reasons I discuss in detail in the main text, it is unlikely that insurers would set 2019 premiums with the goal of keeping margins at their unusually high 2018 level. Downward pressure on premiums from falling margins would likely offset upward pressure on premiums from underlying cost pressures, so premiums would fall on net.

Indeed, under my base assumptions, I estimate that the nationwide average per member per month premium in the individual market would fall by 4.3 percent in 2019 in a stable policy environment. This estimate is subject to some uncertainty, primarily because of uncertainty about underlying individual market claims trends and about the margins insurers are likely to target for 2019. However, I estimate that average premiums would have declined in a stable policy environment under a range of plausible alternative assumptions…

August 1, 2018: NCCS (National Coalition for Cancer Survivorship) posted a statement titled: “NCCS Statement on HHS Final Rule for Short-Term, Limited Duration Health Plans”. From the statement:

The National Coalition for Cancer Survivorship (NCCS) issued the following statement regarding the Trump administration’s announcement of the final rule on short-term, limited-duration health insurance plans:

“NCCS is deeply concerned that the administration’s new rule on short-term limited-duration plans, called ‘junk insurance’ by health insurance experts, will harm cancer patients and survivors by providing inadequate coverage for cancer care and by driving up premiums for comprehensive plans that cover the health care needs of those with cancer. While the administration touts the affordability of these plans, affordability comes at the expense of coverage. Encouraging the use of short-term plans breaks the promise of the administration and Members of Congress to protect people with pre-existing conditions.

“Millions of cancer survivors were relieved when Congress rejected efforts to repeal the Affordable Care Act (ACA) last year, but now the administration is again eroding the ACA protections. Short-term plans do not have to cover people with pre-existing conditions and are not required to offer benefits such as maternity care, prescription drugs, or preventative care. These plans will not help people with a history of cancer or people who will be newly diagnosed with cancer. Additionally, these barebones plans will attract young and healthy individuals, leaving older and sicker individuals in the individual market. Premiums in the individual market will go up and choices may go down. People with cancer and cancer survivors who rely on the individual market for insurance will find that adequate and affordable insurance is beyond their reach.

“NCCS is concerned that individuals will buy short-term plans thinking they are getting a good deal until the moment they need health care services, or worse, face a diagnosis of cancer, when they will be stuck with enormous out-of-pocket costs. These plans are NOT a substitute for short-term limited duration plans, the administration is taking patients back to the days when insurance companies denied individuals who are sick and excluded coverage for the care that cancer survivors need.”

August 1, 2016: The Cancer Action Network posted a press release titled “Insufficient Coverage and Higher Costs Likely Under Short-Term Plan Rule”. From the press release:

Today the Department of Health and Human Services (HHS), Department of Labor and Department of Treasury issued a final rule governing the extension of short-term limited duration plans.

Under the rule, insurers can issue new short-term plans that can be extended for up to 36 months. Previously, these policies were limited to three months as a way to protect consumers from out-of-pocket financial hardship should they get sick and need coverage these bare bones plans don’t include.

These new expanded short-term plans can deny or charge people more for coverage based on their health status, and are exempt from covering essential health services, like prescription drugs or hospitalization. The new plans can also charge older people more than three times what they charge a younger person for the same coverage.

A statement from Chris Hansen, President of the American Cancer Society Cancer Action Network (ACS CAN) follows:

“This rule released today poses a serious threat to cancer patients’ ability to access quality, affordable health coverage. Allowing insurers to issue these short-term health plans that dodge important patient and consumer protections alongside more comprehensive plans will likely leave older and sicker Americans in the individual insurance marketplace with few, if any, affordable health coverage choices. Young and healthy people could be more apt to pick one of these new, inadequate plans with lower premiums, poor coverage and few benefits – leaving them vulnerable if they are diagnosed with a serious illness like cancer. Patents living with serious conditions will be left paying more for the coverage they need if they can afford coverage at all.

“Although this rule is new, its likely impact on the health insurance market is familiar. Prior to 2014, similar plans aimed solely at lowering monthly health care costs were widely available and cancer patients, survivors, and others with a history of serious illness often found it impossible to get coverage on the individual insurance market. Prior to the enactment of the Affordable Care Act (ACA) healthy people discovered these plans were highly problematic and often entirely inadequate when they faced an unexpected cancer diagnosis. Today, these plans will compete with ACA-compliant plans, drawing young and healthy people away from the individual marketplace and driving up costs for those who need the most adequate, affordable health care coverage.

“ASC CAN encourages states to take into account patient needs and move to protect and strengthen their insurance markets with state laws regulating these potentially damaging products. Cancer patients and survivors must have access to high-quality, affordable insurance that provides comprehensive coverage, and ASC CAN stands ready to work with state lawmakers in this effort.”

August 1, 2018: The Charlotte Observer posted an article titled: “Blue Cross proposes to lower NC Obamacare rates for the first time”. It was written by Cassie Cope. From the article:

Many Affordable Health Care Act health plan participants in North Carolina could see their insurance get cheaper.

Blue Cross and Blue Shield of North Carolina said Tuesday it requested an average 4.1 precent decrease among ACA plans, known as Obamacare, that are offered to individuals. The N.C. Department of Insurance will need to approve rate changes in late August or early September. Some customers, however, may see a rate increase.

Open enrollment for the plans begins Nov. 1 and ends Dec. 15…

…Blue Cross is the only insurance provider to offer ACA plans in all N.C. counties and serves more than 475,000 ACA customers in the state, according to the insurer.

This is the first time the company has requested a rate decrease on the plans it offers on the federal market since Obamacare went into effect in 2014. It’s also the first time the insurer has requested a rate reduction for individual plans in more than 25 years…

…This year, some areas of North Carolina may see a rate increase, according to Blue Cross. But all of the requested county increases are less than 10 percent, the company said…

August 2, 2018: Daily Intelligencer posted an article titled: “Trumpcare Means Leaving the Poor and Sick to Fend for Themselves”. It was written by Jonathan Chait. From the article:

Yesterday, the Trump administration unveiled plans to allow insurers to skim healthy customers out of the insurance pool by offering skimpy plans that last for up to three years. The legally dubious maneuver is the crowning touch on the administration’s persistent efforts to undermine the Affordable Care Act…

…Many people are either too poor or too sick to afford access to medical care. In every democracy in the world save the United States, a broad social consensus accepts the need to subsidize care for those people. This includes the conservative parties in those countries. Among right-of-center parties in the developed world, only the Republicans are so committed to anti-government dogma as to oppose measures to subsidize medical care for those who can’t afford it themselves….

…Trump’s most recent step is to allow insurers to sell those skimpy plans with little coverage – excluding customers with expensive medical needs, who would be left in exchanges without healthy customers to help share the costs. This would provide some immediate cost-benefit to healthy customers, who would be free from cross-subsidizing the less fortunate. Of course, if they happen to suffer unexpected medical misfortune themselves, they will be out of luck.

The new Trumpcare plans will be cheap for people who are healthy enough to qualify. But they don’t cover much. If you find you’re having a baby, or need a weekend stay at a hospital, or even something as exotic as prescription drugs, you’re out of luck…

…What is striking about the Trump-era Republican health agenda is the lack of policy ambition. Having spent years insisting they had an army of wonks would could design a better alternative to the Obamacare “train wreck,” the Republican plan of attack has dissolved into a rearguard sabotage campaign with no pretense of doing anything to help the poor and sick afford medical care. Health care remains a policy ground with which conservative-movement dogma cannot grapple.

August 2, 2018: Axios posted an article titled: “Trump’s effect on ACA premiums”. It was written by Sam Baker. From the article:

ACA premiums would probably be going down next year if the Trump administration and congressional Republicans had simply left it alone, Brookings’ Matt Fiedler says in a new analysis this morning.

The big picture: Insurers are raking in money this year, largely thanks to the very large premium hikes they enacted. They’ll likely see a profit margin north of 10% on their ACA business this year, up from 1.2% last year and losses in the years before.

Fielder estimated what would happen if the regulatory status quo at the beginning of 2018 had carried over into 2019. In that world, cost-sharing payments would still be gone, but the individual mandate would remain in place and the expansion of short-term plans wouldn’t have happened…

August 2, 2018: The Hill posted an article titled: “Four cities sue Trump saying ObamaCare ‘sabotage’ violates Constitution”. It was written by Peter Sullivan. From the article:

Four cities on Thursday sued President Trump, arguing that he is violating his constitutional duty to enforce the law by ‘sabotaging’ ObamaCare.

The cities of Baltimore, Chicago, Columbus and Cincinnati filed the lawsuit in federal court in Maryland, arguing that Trump’s actions against the Affordable Care Act violate the Constitution’s provision that the president “shall take care that the laws be faithfully executed.”

The lawsuit states that Trump’s actions are “an affront to the rule of law: to our constitutional system, under which Congress enacts laws and the President faithfully implements them.”

The lawsuit points to a range of administration actions in arguing the case, including that it expanded insurance options that do not comply with the health-care laws rules, that it cut funding for outreach to help people sign up for coverage, and that it shortened the sign-up period for ObamaCare…

…It cites Trump’s statements like “we are getting rid of ObamaCare,” and “essentially, we have gotten rid of it” to argue that Trump has sabotaged the law…

A copy of the lawsuit is viewable on  Here are some key points:

The Plaintiffs in the lawsuit are:

  • City of Columbus
  • Mayor and City Council of Baltimore
  • City of Cincinatti
  • City of Chicago
  • Stephen Vondra – Democracy Forward Foundation
  • Bonnie Morgan – Democracy Forward Foundation

The Defendants in the lawsuit are:

  • Alex M. Azar II, in his official capacity as Secretary of the United States Department of Health and Human Services
  • United States Department of Health and Human Services
  • Seema Verma, in her official capacity as Administrator of the Centers for Medicare and Medicaid Services
  • Centers for Medicare and Medicaid Services

Here are some key parts of the first section of the Complaint:

…1. Having failed to persuade Congress to repeal the Affordable Care Act, President Trump and his Administration are waging a relentless campaign to sabotage and, ultimately, to nullify the law. President Trump has repeatedly admitted as much: because Congress rejected his demand to have “Obamacare repealed,” he has said, he decided “to go a different route” and “end [ ] Obamacare” through his actions. To that end, President Trump and his Administration are deliberately trying to make the Act fail. They are discouraging Americans from enrolling in comprehensive plans that protect them against debilitating medical expenses. They are working to raise prices and reduce choices for Americans seeking insurance in the Act’s exchanges. And they are misappropriating funds Congress allocated to support the Act, instead using those funds to attack it. The Trump Administration’s strategy: to deceptively shift the blame from their own actions to the Act itself. Their objective: to pressure Congress to repeal the Act or, if that fails, to achieve de facto repeal through executive action alone. The Administration’s actions are unlawful.

2. The scope of this Complaint is testament to the breadth and persistence of the Trump Administration’s efforts to undermine the Affordable Care Act (“ACA”). As Plaintiffs – individuals and cities representing almost 4.5 million Americans – allege in detail below, the Administration has tried to prevent families from obtaining health insurance through the ACA’s exchanges by, for example:

  • promoting insurance that does not comply with the ACA’s requirements, including insurance that does not cover preexisting conditions;
  • slashing funding for outreach strategies that have been proven to encourage individuals, and healthy individuals in particular, to sign up for coverage;
  • misusing federal funds for advertising campaigns aimed at smearing the ACA and its exchanges, and spinning false narratives about the efficacy and success of the Act;
  • providing individuals and families with less time to choose a plan that is appropriate for them;
  • imposing unnecessary and onerous documentation requirements, making enrollment even harder

In addition, the Administration has worked to increase premiums for ACA-compliant insurance by, for example, shirking oversight of insurance rate increases and reducing rebates owed to consumers when insurers underperform. Finally, the Administration has attempted to make affordable, high-quality health insurance unavailable by sowing uncertainty in insurance markets, causing insurers to raise rates or exit markets altogether.

3. President Trump and his Administration have been remarkably transparent about their intent and their approach. “If we don’t get it done” in Congress, President Trump has said, “we are going to watch Obamacare go down the tubes, and we’ll blame the Democrats…[a]nd at some point, they are going to come and say, ‘You’ve got to help us.””. “[W]e are getting rid of Obamacare, President Trump boasted, “essentially, we have gotten rid of it,” “[I]t’s dead[,] [i]t’s essentially dead,” “there is no Obamacare, it’s dead.” Of course, as a matter of constitutional law, the Affordable Care Act has not been repealed; as a matter of fact, it is not dead, and indeed has proven more resilient than the Administration might have hoped. But the Administration’s death-by-a-thousand-cuts campaign to undermine the Act via executive action alone has also taken a toll.

4. All Americans are, quite literally, paying the price. The Trump Administration’s actions are driving insurers out of ACA exchanges, raising premiums, and increasing the population of underinsured and uninsured individuals. Defendants’ actins are therefore imposing significant costs on families and governments nationwide, including Plaintiffs in this case. Specifically, the Trump Administration’s actions force the cities of Columbus, Ohio, Baltimore, Maryland, Cincinnati, Ohio, and Chicago, Illinois, to spend more on uncompensated care for their residents. The Trump Administration’s actions force Steve Vondra and Bonnie Morgan to pay more for the quality health insurance coverage they need – insurance that, for example, covers Steve’s preexisting condition. That is the precise opposite of what Congress intended the ACA to achieve. Congress passed the ACA to make comprehensive health insurance more affordable and to reduce the costs of uncompensated care. The ACA was achieving both those aims before the Trump Administration came to power.

5. The Trump Administration’s actions are also an affront to the rule of law; to our constitutional system, under which Congress enacts laws and the President faithfully implements them. The Administration’s actions raise questions that go to the heart of our structure of government: whether the executive branch must “take care that the laws be faithfully executed,”… and whether the Constitution therefore prohibits the President and his appointees from welding executive power to destroy a duly-enacted law. The Administration’s actions violate the Take Care Clause and the Administrative Procedure Act. They should be declared unlawful and set aside….

August 6, 2018: The State posted an article titled: “Nevada health exchange rates expect to see lowest rise yet.” It was written by Michelle L. Price. From the article:

After years of double-digit increases, Nevadans who get health coverage through the online insurance marketplace are only expected to see slight increases in rates next year.

Nevada insurance officials said an average increase for premiums in Nevada is expected to be 1.9 percent in 2019 – the lowest proposed rate increase since the Affordable Care Act took effect in 2014.

Insurance officials say the change comes as the markets have started to stabilize around the country…

…Nevada Insurance Commissioner Barbara Richardson said her division is helping to stabilizing the market by becoming more involved with insurers as they start setting rates, working to ensure prices are where they need to be when weighing the risks of the market…

August 8, 2018: The Texas Tribune posted an article titled: “Texas is suing – again – to end Obamacare. This time it has some advantages”. It was written by Emma Platoff. From the article:

The immediate fate of President Barack Obama’s landmark health care law is in the hands of a federal judge in North Texas – right where the state of Texas put it.

At the helm of a 20-state coalition, Texas sued the federal government in February to end the Affordable Care Act, known as “Obamacare,” arguing that the law is no longer constitutional after Congress gutted one of its key provisions, the individual mandate. In April, the state asked a U.S. district judge to block the law nationwide as the case works it’s way through the system.

After a deadline last week for parties to submit all their arguments, the judge could decide any day whether to let the law stand, block it in part or entirely, or to ask for more arguments from both sides. Experts predict a decision in the next few months.

It’s not the first time Texas has sued over Obamacare, but this attempt has several weighty advantages. One comes from Congress, which in December shrunk the penalty for not having health insurance to $0, putting the individual mandate on shaky legal grounds. Another may come from the judge, who has made news in recent years for ruling against policies pushed by the Obama administration. And, perhaps most importantly, this time Texas won’t face the U.S. Department of Justice: The Trump administration said in June that it agrees with certain features of the Texas’ case and won’t defend the individual mandate, a relatively rare move that took many by surprise.

Texas’ real adversary, then, will be a counter-coalition of 16 states and the District of Columbia, headed by California. Those states argue the law is both constitutionally valid and critical for the health of their citizens…

…Critics dismiss the lawsuit as politically motivated, a strike at the Obama policy dressed up as a constitutional challenge. Still, it’s hard to overstate the lawsuit’s potential impacts. Still, it’s hard to overstate the lawsuit’s potential impacts. A decision in Texas’ favor could do what scores of congressional attempts have failed to do: upend a health care law that touches all corners of the United States…

The article states that the U.S. District Judge who will hear this case is Judge Reed O’Connor. He was appointed by President George W. Bush.

August 9, 2018: NPR posted an article titled: “Trump Administration To Overhaul A Program Designed To Save Medicare Money”. It was written by Phil Galewitz. From the article:

A key initiative of the Affordable Care Act was a program designed to help control soaring Medicare costs by encouraging doctors and hospitals to work together to coordinate patients’ care. This led to the formation of what are known as accountable care organizations or ACOs.

The program was expected to save the government nearly $5 billion by 2019, according to the Congressional Budget Office.

It hasn’t come anywhere close.

On Thursday, the Trump administration proposed an overhaul to the program. The move could dramatically scare back the number of participating health providers.

Trump administration officials say ACOs have led to higher Medicare spending.

The announcement was just the latest in a steady drumbeat of moves by Trump administration officials to unwind health policies set in place by the Obama administration.

Medicare ACOs began in 2012 and today enroll more than 10 million beneficiaries. ACOs are part of push across government and private sector health programs to pay doctors and hospitals for the value of care they provide rather than just provide a fee for each patient they treat.

If ACOs provide care for less than certain cost targets – while meeting quality of care standards – then they get to share in any of the savings. Commercial insurers and Medicaid have also adopted ACOs in the past decade.

About 82 percent of the 561 Medicare ACOs are set up so that they are not at risk of losing money from Medicare. They can share in any savings they achieve. The remaining 18 percent can gain a higher share of savings, but also risk paying back money to Medicare if they do not meet their savings targets. Those ACS have been more successful in saving money, Medicare officials said.

The Trump Administration said it would phase out its no-risk model beginning in 2020

A recent industry sponsored survey showed 70 percent of ACOs would rather quit than assume such financial risk.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said it’s wrong to have ACOs that can only make profits but not risk any losses.

“We want to put the accountability back into accountable care organizations,” she said during a briefing with reporters.

Existing ACOs will one year to switch to a model accepting financial risk. New ACOs will have two years.

Under existing rules, ACOs would have had up to six years to shift to a model where they share in financial risk…

…CMS estimated that its new policy would lead to a net drop of about 100 ACOs by 2027.

Industry observers say that prediction seems modest at best…

August 13, 2018: Nashville Public Radio posted an article titled: “Tennessee Obamacare Rates Drop Even Lower After Trump Backs Off Funding Cuts”. It was written by Blake Farmer. From the article:

Rates for individual health insurance plans in Tennessee will drop even more than expected next year, after the Trump Administration reversed plans for cutting payments to insurance companies.

BlueCross BlueShield of Tennessee, for example, will have average rates that are nearly 15 percent less than this year.

The largest insurer on the federal marketplace in the state was already planning to drop rates by nearly 11 percent, even with announced cuts to so-called “risk adjustment payments”, meant to offset unexpected costs related to a sicker-than-average population. That announcement came just days before the July 12 deadline to file premium requests in Tennessee.

But after the Trump Administration backed off those cuts in late July, Tennessee’s insurance commissioner asked companies to resubmit. All five lowered their premiums…

August 14, 2018: New York Magazine posted an article titled: “White House Will Ask Judge to Scrap Obamacare’s Protections This September”. It was written by Eric Levitz. From the article:

The Democratic Party believes that its strongest argument against Donald Trump’s latest Supreme Court nominee and the GOP’s congressional majority is that both pose a clear and present danger to American’s health care.

Specifically, Democrats maintain that Brett Kavanaugh’s jurisprudence on the power of regulatory agencies suggests that he would be open to striking down the Affordable Care Act’s regulatory protections for people with preexisting conditions. And the party further argues (more indisputably) that the GOP’s congressional leadership would love to undermine those protections – and gut funding for Medicaid and federal health-care subsidies – if they ever get a large enough Senate majority to pull off such feats.

It isn’t hard to see why Democrats have chosen to put health care at the center of both their midterm campaign and opposition to Kavanaugh’s confirmation. The GOP’s proposed Obamacare replacement, the American Health Care Act, ended up being the most unpopular piece of legislation in our nation’s modern history…

Thus, it is difficult to understand why the Trump administration decided to revive its crusade against Obamacare or, more precisely, against the law’s single most popular provision – its protections for people with preexisting conditions – this summer…

…On Tuesday, a federal judge scheduled oral arguments in the case for September 10 – just days after Kavanaugh’s confirmation hearings conclude, and weeks before the midterms. Which is to say: Right before the Senate casts its vote on Kavanaugh – and voters cast theirs on the congressional GOP – the White House and allies will be making the Democratic Party’s case against both for it.

August 14, 2018: Politico posted an article titled: “Oral arguments in Texas Obamacare suit set for Sept.” It was written by Paul Demko. From The article:

Oral arguments have been scheduled for Sept. 10 in a Texas lawsuit seeking to strike down Obamacare as unconstitutional…

…The lawsuit is certain to factor into the mid-term elections. Democrats have already pilloried Republicans for trying to eliminate one of the most popular provisions of Obamacare. Polling shows widespread support for pre-existing conditions protections across party lines.

The arguments are scheduled to take place at 9:30 a.m. before Judge Reed O’Connor.

August 17, 2018: Governing posted an article titled: “Trump’s New Immigration Rule Could Hurt Obamacare Markets”. It was written by Mattie Quinn. From the article:

The Trump administration is reportedly preparing to propose a rule that would deter legal immigrants from using government services. The rule, according to leaked drafts of it, would make it harder for legal immigrants to become citizens or get green cards if they have ever used a wide range of public welfare, including Medicaid, food stamps, the Children’s Health Insurance Program (CHIP) and subsidies to buy health insurance.

There are already scattered reports of immigrants, afraid of jeopardizing their shot at permanent residency, choosing not to use health benefits for which they – or their children – qualify. If a significant number of legal immigrants forgo health insurance, that could have negative ripple effects on so-called Obamacare premiums and on health-care system as a whole…

…The marketplace has struggled to attract younger, healthier populations, which has contributed to rising premiums. If more legal immigrants go uninsured, they could exacerbate that issue…

…People are asked about their immigration status when they enroll in health plans, but those numbers are not made public. According to a report released this month by the New England Journal of Medicine, 19 percent of non-citizen adults use Medicaid, and 38 percent of their children are either on Medicaid or CHIP. If those populations are discouraged from enrolling, the study estimates that up to 1 million people would suddenly become uninsured…

…Health care is already one of the government’s biggest spending areas, reaching more than $4 trillion in 2016, averaging out to $10,348 per person, according to the Centers for Medicare and Medicaid Services.

While it’s unlikely that the rule would be finalized in time for this fall’s open enrollment period, experts say that the Trump administration’s harsh immigration policies are already having an impact on health care in communities across the country…

…The Trump administration is expected to release the rule this month or next, opening it up to a public comment period that would likely be met with resistance from immigration, health care and social service advocates. Even if the rule isn’t enacted, experts say it has instilled fear in many communities – and that could be enough to rattle the health-care system…

August 21, 2018: The Baltimore Sun posted an article titled: “U.S. approves waiver allowing Maryland to lower Obamacare premium costs”. It was written by Michael Dresser. From the article:

State officials plan to announce Wednesday that the Trump administration has approved a federal waiver that is expected to stave off increases in health insurance costs for more than 200,000 Marylanders.

The two main sponsors of the legislation designed to control costs under Obamacare confirmed that the federal government had given Maryland the green light for its reinsurance program…

…The plan imposes a one-year state tax on insurance companies and uses that revenue to subsidize the most expensive health insurance claims from policies sold through Maryland’s health exchange. By lowering the risk to insurers selling on the individual market, state leaders hope to lower premiums enough to make them affordable next year.

If lawmakers had done nothing, officials said, the individual market had the potential to collapse weeks before the Nov. 6 election. [Governor Larry] Hogan, a Republican, is running for reelection against Democrat Ben Jealous, the former president of the NAACP.

The Republican governor worked with Democratic leaders to cushion the blow to ratepayers in the individual health insurance market after Congress eliminated the federal mandate that had required taxpayers to insure themselves or pay a penalty…

…[Del. Joseline] Pena-Melnyk said the waiver will allow the state to create a reinsurance program to shore up a market largely made up of self-employed people and proprietors of “mom-and-pop” businesses too small to buy health insurance on the group market.

“You’re talking about over $800 million to create a reinsurance program to help people in Maryland,” she said. She warned a longer-term solution will be needed in four to five years….

…The plan would bring an estimated 60,000 to 100,000 uninsured Maryland residents under coverage.

August 21, 2018: Courthouse News posted a ruling made by the United States District Court for the Northern District of Texas Wichita Falls Division. The ruling is on the case State of Texas, et. al., vs United States of America, et. al.,From the ruling:

Plaintiffs: States of Texas, Indiana, Kansas, Louisiana, Nebraska, and Wisconsin.

Defendants: The United States Government; the United States Department of Health and Human Services (HHS); Alex Azar, in his official capacity as Secretary of HHS; the United States Internal Revenue Service (IRS); David Kautter, in his official capacity as Acting Commissioner of the IRS.

…Plaintiff filed their amended complaint, alleging that Defendants, in violation of the Patient Protection and Affordable Care Act (the “ACA”), the Administrative Procedure Act (the “APA”), and the United States Constitution, required them to pay the ACA’s Health Insurance Provider Fee (the “HIPF”)…

…The ACA imposed the HIPF on medical providers, but exempted the states from paying it… Notwithstanding Congress’s exemption of the states in the ACA, HHS enacted a regulation (the “Certification Rule”) that empowered a private actuarial board to require Plaintiffs to account for the HIPF in payments to their managed care organizations (“MCOs”) – the medical providers who contract with Plaintiffs to service their Medicaid recipients….Plaintiff’s amended complaint challenged the legality and constitutionality of both the HOPF and the Certification Rule…

Plaintiffs asserted 10 counts in their amended complaint:

  • The HIPF violates Article I’s Spending Clause and the Tenth Amendment, thereby entitling Plaintiffs to declaratory and injunctive relief. (Counts I, IV, VI, VIII, IX and X)
  • The Certification Rule violates Article I’s Vesting Cause, the APA, and the ACA, thereby entitling Plaintiffs to declaratory relief. (Counts II, III, and V)
  • Plaintiffs are entitled to a tax refund of their HIPF payments under the “Tax Refund claim”.
  • Plaintiffs also made 13 requests for relief in their concluding prayer, including declaratory relief, injunctive relief, a tax refund, and “such other and further relief to which Plaintiffs are justly entitled at law and equity”.

The Plaintiffs made four requests in their motion for reconsideration and entry of judgement, asking the Court to consider the following:

  • Finding that the HIPF is a tax for the purposes of the AIA, and to instead find that the HIPF is a “fee” under the AIA, DJA, and APA.

The Court ruled that it had found correctly in its March 5, 2018 Order on summary judgement that the HIPF is a “tax” for the purposes of the AIA. The Cout DENIED Plaintiff’s motion to reconsider this finding.

  • Finding that the Plaintiffs are not entitled to equitable disgorgement

In “plain English”, the States are asking the court to force the Government to repay them for their HIPF payments. The Court found that the APA and the ACA entitle Plaintiffs to disgorgement because the ACA waives immunity for “a suit seeking to enforce [a] statutory mandate,” and disgorgement enforces the Government’s compliance with the ACA’s mandate specifically exempting the states from paying the HIPF.

The Court found that Plaintiffs are entitled to disgorgement of their HIPF payments. “Defendants unlawfully required Plaintiffs to account for and pay the HIPF in their MCO capitation rates and have no right to retain those funds that properly belong to Plaintiffs.” The court GRANTED the Plaintiff’s motion to reconsider the Court’s grant of declaratory relief without disgorgement.

  • Finding that reconsidering a dismissed count (Count VII) is unnecessary

…Because the Court finds that Plaintiffs are entitled to equitable disgorgement of the HIPF payments – a remedy that gives Plaintiffs complete relief – the Court finds that it is unnecessary under these circumstances to reconsider its dismissal of Plaintiffs’ request for a tax refund under the IRC.

The Court Denied Plaintiff’s motion to reconsider the Court’s dismissal of Count VII.

  • Finding that the Plaintiffs are not entitled to a permanent injunction

…Because Plaintiffs have not shown a substantial threat of irreparable injury, Plaintiffs have not carried their burden of establishing a need for permanent injunctive relief. The Court therefore DENIES Plaintiff’s request for a permanent injunction.

August 22, 2018: Courthouse News posted an article titled: “Six States Win Refund of Obamacare Fees”. It was written by David Lee. From the article:

A federal judge in Texas ordered the government Tuesday evening to pay bak six states nearly $840 million in questionable Obamacare fees on state Medicaid programs.

U.S. District Judge Reed O’Connor concluded plaintiffs Texas, Indiana, Kansas, Louisiana, Wisconsin, and Nebraska are entitled to disgorgement “as a means of enforcing” the Affordable Care Act’s statutory mandate exempting states from paying the health insurance provider fee, abbreviated as HIPF in court documents….

…”The court finds that the [Administrative Procedure Act] and the ACA entitle plaintiffs to disgorgement because the ACA waives the immunity for ‘a suit seeking to enforce [a] statutory mandate’, and disgorgement in this case enforces defendant’s compliance with the ACA’s mandate specifically exempting states from paying the HIPF”, Judge O’Connor wrote in a 17-page ruling…

…Texas Attorney General Ken Paxton lauded the ruling late Tuesday. He said Texas will receive over $304.7 million, Indiana $94.8 million, Kansas $142.1 million, Louisiana $172.4 million, Wisconsin $88.9 million, and Nebraska $36.2 million, for a total of $839.3 million…

August 22, 2018: Tennessean posted an article titled: “After years of price hikes, Obamacare likely to be cheaper next year across Tennessee”. It was written by Brett Kelman. From the article:

Tennesseans on who depend on federally assisted health insurance are likely to have more options and face cheaper prices next year, a reversal of a trend that has plagued the state since the enactment of the Affordable Care Act, known widely as Obamacare, for years ago.

The most dramatic gains will be felt in the city of Memphis, which may have three new options for Obamacare health insurance.

Knoxville has the potential to gain two new insurance options. Nashville may get one.

However, Tennessee’s largest insurance company, BlueCross BlueShield of Tennessee, will remain the only option for Obamacare insurance many in rural areas of the state. And BlueCross will continue to not compete in the Obamacare marketplace in Nashville and Memphis, the state’s two largest cities.

The improving Obamacare outlook was announced Wednesday by the Tennessee Department of Commerce and Insurance, which recently approved 2019 marketplace rates requested by five insurance carriers – including two new companies, Bright Health and Celtic Insurance…

August 24, 2018: Los Angeles Times posted an article titled: “Red-state voters look to expand Medicaid this fall, despite Trump’s enduring hostility to Obamacare”. It was written by Noam Levey. From the article:

Even as President Trump launches new attacks on the Affordable Care Act, voters in four deep red states are poised this fall to expand access to government Medicaid coverage through the 2010 law, often called Obamacare.

Nebraska on Friday became the fourth state to qualify a Medicaid expansion initiative for the November ballot, giving voters there the chance to do an end-run around the state’s Republican political leaders who have fought the healthcare law for years.

Similar measures have already qualified in Idaho and Utah, where GOP officials for years have resisted Medicaid expansion, and in Montana, where a Medicaid expansion begun in 2015 is slated to sunset next year unless the state moves to extend it. Polling in the states shows widespread public support…

…The unprecedented number of Medicaid ballot measures underscores the enduring popularity of the half-century-old government health insurance program for the poor, which – along with the related Children’s Health Insurance Program – now covers more than 70 million Americans.

The state initiatives also represent another challenge to the president and his GOP allies in Congress, who continue to champion moves to roll back the law and the sweeping coverage gains it has made possible…

…This spring, Virginia moved to expand eligibility for its Medicaid program, after group of Republican lawmakers joined Democrats in the GOP-controlled legislature to back expansion.

And last year, more than 59% of voters in Maine backed a Medicaid expansion initiative, repudiating Republican Gov. Paul LePage’s longstanding opposition. LePage, a strong Trump ally, continues to resist, despite a court order to abide by the initiative…

August 24, 2018: The Philadelphia Tribune posted an article titled: “Report: Trump administration needs to step up on ‘Obamacare'”. It was written by Ricardo Alonso-Zaldivar. From the article:

A congressional watchdog said Thursday the Trump administration needs to step up its management of sign-up season under former President Barack Obama’s health care law after mixed results last year in the throes of a failed GOP effort to repeal it.

The report from the Government Accountability Office is likely to add to Democrats’ election-year narrative that the administration actively undermined “Obamacare” without regard for the consequences to consumers…

…The report found that:

  • The Health and Human Services Department under Trump broke its own previous practice by failing to set enrollment targets for last year. The watchdog recommended that HHS resume setting goals, a standard management tool for government agencies. Without setting numeric goals, HHS won’t be able to measure whether it is meeting “its current objective of improving Americans’ access to health care,” the report said. The administration responded that it does not believe such targets are relevant.
  • HHS uses “problematic” and “unreliable” data to justify a 40 percent cut in funding for enrollment counseling programs known as Navigators. HHS responded that its making changes to how those counseling programs are evaluated. But it has cut funding again, by 70 percent.
  • When HHS slashed money for open-enrollment advertising by 90 percent overall, officials said they were doing away with wasteful spending. But an internal study by the department had already found paid television ads were one of the most effective ways to enroll consumers. The budget for TV ads went from $26.6 million in the Obama administration’s final year to zero under President Donald Trump…

The report validated a longtime Republican criticism that high premiums discourage consumers from signing up for coverage. But it also found that Trump contributed to premium increases for 2018 by canceling payments that reimburse insurers for lower deductibles and copays provided to low-income people. That forced the carriers to jack up rates…

August 28, 2018: The Los Angeles Times posted an article titled: “The GOP claims its proposal would protect people with preexisting conditions. That’s a lie”. It was written by Michael Hiltzik. From the article:

Republican foes of the Affordable Care Act always have taken pains to assure the public that whatever they do, they’ll protect people with preexisting medical conditions…

…Before the ACA’s enactment, it was common in the individual health insurance market for applicants to be turned down for coverage over conditions from anemia to varicose veins; the exclusion rules for Blue Shield of California ran to 25 pages. Nor was it uncommon for insurers facing a big claim to pore through the patient’s medical background in search of an undisclosed prior condition, no matter how trivial…

…Accordingly, congressional Republicans have cooked up what they call a rescue plan. It’s billed as the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” and introduced by Sen. Them Tillis (R.-N.C.), with the support of nine other red state senators.

The measure says that no insurer may reject an insurance applicant based on his or her medical condition or history. But it’s got a loophole that even the dimmest insurance company could drive a hearse through: It doesn’t require that the insurance provide treatment of the applicant’s preexisting condition…

…Put another way, under the Tillis measure, an insurer couldn’t reject a cancer patient’s application for insurance – but could provide that patient with coverage for everything except cancer. As [Larry] Levitt [senior Vice President of the Kaiser Family Foundation] puts it, the minimum standards for “protecting” people with preexisting conditions include no denial of coverage based on health, no surcharging of those patients over the standard premium, coverage of all the ACA’s “essential benefits,” including hospitalization, maternity care, and prescription drugs, and no exclusions or waiting periods for specific conditions or treatments…

You can read the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” online.

August 30, 2018: WFPL posted an article titled: “Ky. Officials Warn of Shortfall, Consider Ending Medicaid Expansion”. It was written by Lisa Gillespie. From the article:

The Medicaid program that pays for almost one in four Kentuckian’s health insurance has an estimated $296 million budget shortfall over the next to years, state officials said Thursday.

Adam Meier, the Secretary of the Cabinet for Health and Family Services, said during a legislative hearing that the estimated deficit in Medicaid funding for fiscal years 2019 and 2020 was caused by an increase in payment rates to services for people with developmental or intellectual disabilities, an increases in what the state pays to pharmacies, and problems with technology.

Meier said the Cabinet will have to look at cutting certain optional benefits in the Medicaid program like dental, vision, or pharmacy. He also said the administration could eliminate Kentucky’s expanded Medicaid program, potentially taking away benefits from more than 482,000 people…

…The state would have to go through the federal government to cut dental and vision benefits, as well as pulling eligibility from the Medicaid population…

September 4, 2018: The Sacramento Bee posted an article titled: “Ban health insurance that doesn’t cover pre-existing conditions? JerryBrown to Decide”. It was written by Angela Hart. From the article:

California is poised to become the first state in the nation to ban cheap, short-term health insurance plans pushed by the Trump administration as a low-cost alternative to Obamacare.

New federal rules, finalized Aug. I, allow insurers to deny coverage to people with pre-existing conditions and institute annual and lifetime caps on how much money they are required to spend on covered benefits over the course of a year or the life of a plan. Insurers can also sell health insurance plans that do not cover prescription drugs, and can exclude a broad scope of services, including maternity, pediatric, and mental health care…

…A California bill, authored by State Sen. Ed Hernandez, D-Azusa, would outlaw them altogether. Gov. Jerry Brown has until Sept. 30 to veto it or sign it into law….

…Other states, including New York, New Jersey, and Massachusetts, have policies banning plans that do not comply with Obamacare, but California would be the first to pass a law explicitly prohibiting the sale of the short-term policies. If signed into law, all current short-term plan policies that don’t include the consumer protections outlined in the Affordable Care Act would terminate by the end of the year and no others could be sold.

The move to ban such plans is part of a broad effort under way, at the state level, to blunt actions by the Trump administration to unravel the federal health care law after President Donald Trump and the Republican-controlled Congress failed last year to repeal and replace Obamacare.

Brown is also considering bills that would prohibit low-income people on Medi-Cal form being required to work to receive benefits, require health plans to spend at least 80 percent of their revenue from insurance premiums on health care rather than profits and administrative costs, and ban individuals from creating their own so-called “association health plans,” which allow employers to join forces to form plans that can also exclude coverage for maternity and mental health care, prescription drugs, and pediatric care…

…The number of Californians enrolled with short-term plans has fallen in recent years, state insurance regulators said. At present, there are roughly 10,000 policies in effect, according to an analysis by Georgetown University’s Center on Health Insurance Reforms.

Researchers said without state action, enrollment would likely grow, with an estimate at more than 600,000 people potentially signing up for short-term plans. That could lead young, healthy people to leave the Covered California market, threatening greater premium spikes…

The article includes links to the bills it mentioned:

  • Senate Bill 910: Would prohibit insurers from selling, renewing or offering short-term health plans in California.
  • Senate Bill 1108: Would allow California to seek waivers from the federal government to increase enrollment in MediCal,  the low-income health care program. It would also ban the state from requiring anyone on MediCal to work in order to receive benefits.
  • Senate Bill 1375: Would prohibit individuals from forming “association health plans,” which are not required to comply with Obamacare coverage mandates.
  • Senate Bill 2499: Would require health plans to spend at least 80 percent of premium dollars on health care.

September 5, 2018: The Texas Tribune posted an article titled: “Texas asks a federal judge to block Obamacare nationwide”. It was written by Emma Platoff. From the article:

…Both groups [lawyers and protesters] had assembled Wednesday morning to mark a critical hearing in a Texas-led challenge to the Affordable Care Act, a sweeping lawsuit that aims to do what dozens of Congressional attempts could not: entirely repeal perhaps the greatest legislative success of former President Barack Obama. Texas Attorney General Ken Paxton, leading a coalition of 20 states, sued in February to end the law, arguing that after Congress gutted one of its key provisions, the entire statute must fall. California, leading a counter-coalition of 16 states and Washington D.C., argues that the entire law remains constitutional and should remain in place.

At the hearing Wednesday, Texas aimed to convince U.S. District Judge Reed O’Connor to block the law across the country as it continues to fight a months- or years-long legal case that could land before the U.S. Supreme Court.

Citing rising health care premiums, Texas says such an injunction is necessary to preserve sate sovereignty and to relieve the burden on residents forced to purchase expensive insurance coverage. California counters that temporarily blocking or ending the law would case more harm to the millions of people insured under it, particularly the 133 million people the state says enjoy the law’s protections for pre-existing conditions. The U.S. Department of Justice, which has taken up may of Texas’ positions in the case, nonetheless sided with California, arguing that an immediate injunction would throw the health care system into chaos…

…The case will likely turn on that question of “severability” – whether one slice of a law, if ruled unconstitutional, must necessarily doom the rest. O’Connor, who nodded along carefully throughout the hearing, lobbed most of his questions at the California attorneys, and many of them focused on whether the various pieces of Obamacare can be disentangled…

…O’Connor – a George W. Bush-appointee who has ruled against Obamacare several times, albeit on narrower grounds – also honed in on the legislative intent. Texas argued that the individual mandate was a critical piece of the law’s original version. But California argued that in 2017, in gutting the individual mandate without touching the rest of the law, lawmakers made it clear they wanted the law to persist without that provision…

…A decision is expected in the coming weeks. As he left the courtroom, O’Connor said he’d “get something out just as quickly as I can.”

September 6, 2018: Dana Singiser, Vice President of Public Policy and Government Relations for Planned Parenthood Federation of American released a Memorandum to “Interested Parties”.  The Memorandum is in regards to the Senate Judiciary Committee hearing about Judge Brett Kavanaugh.  From the memo:

…1. Brett Kavanaugh was given at least 12 opportunities to give a straight answer on Roe v. Wade and he dodged every time. Brett Kavanaugh dodged, ducked, and danced — all to avoid answering whether he believes Roe v. Wade was rightly decided, or if there is a constitutional right to have an abortion.

a. Kavanaugh refused to respond on whether he thought Roe was rightly decided — minutes after he made clear he thought the U.S. v. Nixon case was rightly decided.

b. Kavanaugh refused to answer whether he agreed that a woman’s right to control her reproductive health impacts her ability to participate in the economic and social life of the nation.

c. Kavanaugh danced around questions on the Garza case — where he ruled to allow the government to continue to block a young, undocumented woman from accessing abortion — but made clear he did not consider the indefinite delay of the young woman’s abortion to be imposing an unconstitutional burden on her.

d. When asked if he believed immigrants have a constitutional right to access abortion, he stoped short, and sat in awkward silence.

e. He was asked directly by Senator Harris if he believed the constitutional right to privacy includes the right to access abortion – and he refused to answer.

2. When talking about precedent, he cherry-picked which cases he claimed were the “precedent” he was following. It’s notable that not once all day did Judge Kavanaugh mention Whole Woman’s Health, the Court’s most recent precedent affirming a woman’s right to choose. Furthermore, Brett Kavanaugh claimed that in the Garza v Hargan case (where her ruled on a young, undocumented woman seeking an abortion) he wrongly asserted that he was following the Supreme Court’s cases allowing states to enact laws requiring minors to get the consent of a parent prior to an abortion. Those cases actually hold that the state cannot allow the parent to exercise a “veto” over the minor’s decisions. In fact, the Supreme Court has made clear that a state must give a minor an alternative mechanism to bypass a parental consent require meant if the minor is mature enough to make the decision on her own or if the abortion is in her best interest. And in that case, Jane Doe had met that requirement and obtained a bypass, but Judge Kavanaugh dismissed that as “irrelevant.”…

…3. This is not business as usual. During her confirmation, Justice Ruth Bader Ginsburg gave real answers and affirmatively declared the constitutional right to safe, legal abortion. That is the real Ginsberg Standard

Justice Ginsburg: “The argument was it’s her right to decide either way, her right to decide whether or not to bear a child… But you asked me about my thinking about equal protection versus individual autonomy, and my answer to you is it’s both. This is something central to a woman’s life, to her dignity. It’s a decision that she must make for herself. And when Government controls that decision for her, she’s being treated as less than a fully adult human responsible for her own choices.”…

…Throughout the day, he [Kavanaugh] claimed to be following the “nominee precedent” of the eight sitting justices, invoking the Ginsburg standard. However, when faced with Justice Ginsburg’s actual testimony by Senators Harris in the 12th hour of the hearing, he suddenly revised his statement and referred only to seven justices.

4. This isn’t theoretical – it’s likely the Supreme Court will rule on the right to access abortion, access birth control, and get care at Planned Parenthood, in the next two years. There are currently 13 cases related to abortion that are one step away from the Supreme Court. Every single one of these 13 cases provides an opportunity for the Court to overrule or severely weaken a woman’s constitutional right to access abortion, including:

  • A law in Kentucky that would effectively ban abortion by shutting down the one health center in the state that provides safe, legal abortion. This would force women to travel out of state to access an abortion, if they can at all.
  • A law in Arkansas that would ban medication abortion entirely and leave only one health center in the state that provides safe, legal abortion. This means women in areas like Fayetteville would be forced to make a 380-mile round trip to access an abortion in Little Rock or travel out of state.
  • Missouri continues to enforce similar laws that make abortion nearly inaccessible for countless women.
  • A policy of the Department of Health and Human Services under the Trump-Pence administration prevents young, undocumented women in the custody of Scott Lloyd and the Office of Refugee Resettlement from accessing safe, legal abortion.

The court is also poised to determine a person’s basic right to access affordable birth control, cancer screenings, and other care at Planned Parenthood. These cases include:

  • Cases from Louisiana and Kansas that will determine if politicians can block access to birth control, cancer screenings, and other care at Planned Parenthood through Medicaid. Cases on Ohio and Texas are close behind.
  • Three cases that will determine whether the Trump-Pence administration can roll back the birth control benefit, which would allow employers to refuse to provide workers with insurance coverage for affordable birth control.
  • Three cases that will decide if the Trump-Pence administration can dismantle the Teen Pregnancy Prevention program and turn it into an abstinence-only program.
  • A case to stop the Trump-Pence administration from dramatically remaking Title X – the nation’s program for affordable birth control and reproductive health care – to focus on abstinence and less effective forms of contraception..

September 7, 2018: Press of Atlantic City posted an article titled: “N.J. residents to see Obamacare rates fall for 2019 coverage”. It was written by Nicole Leonard. From the article:

Gov. Phil Murphy announced Friday that some residents who get health coverage through the individual health insurance market next year will see average premium rates drop by 9.3 percent – a departure from an estimate earlier this year that predicted an increase of 5.8 percent.

Murphy, speaking at a press conference at Hackensack Meridian Health Riverview Medical Center, said despite federal actions to dismantle parts of the Affordable Care Act, New Jersey has taken steps to protect the health care law, which will save many residents from paying higher insurance premiums in 2019…

…About 275,000 New Jersey residents selected individual market plans during last year’s enrollment period, according to the U.S. Centers for Medicare & Medicaid Services.

Health care insurance experts have said that New Jersey has emerged as a nationwide leader in preserving parts of the Affordable Care Act repealed by the Trump administration by establishing its own individual mandate and developing a reinsurance program…

…New Jersey got approval last month from the U.S. Centers for Medicare and Medicaid Services to start a reinsurance program in 2019, which resulted in a total average rate decrease of 9.3 percent…

…The reinsurance program will help Obamacare insurers for some of the highest-cost claims by people covered in the individual market. The program will reimburse 60 percent of claims between $40,000 and $215,000 by an individual in a single year.

The program will primarily be paid for with federal grant money and revenue that comes from the state’s individual mandate policy…

September 7, 2018: U.S. News and World Report posted an article titled: “‘Obamacare’ Insurance Rates Will Stay Level in Mississippi”. It was written by the AP. From the article:

Rates for Mississipians who get health insurance through the Affordable Care Act are projected to stay basically level next year.

The consulting firm Avalere Health and The Associated Press analyzed state data and found premiums in “Obamacare’s” health insurance market will rise only 0.2 percent in Mississippi next year.

That’s lower than the average 3.6 percent increase in proposed or approved premiums across 47 states and Washington D.C….

September 7, 2018: Senator Tim Kaine posted an article titled: “Trump’s “junk insurance” plans don’t have to provide health care coverage for people with pre-existing conditions” on his official website. From the article:

Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) cosponsored legislation to overturn President Trump’s expansion of “junk insurance” plans. The Trump Administration recently released its final regulation on allowing Short-term Limited Duration Insurance (STLD) plans to expand eligibility for bare-bones health insurance plans, which do not have to provide the same level of minimum coverage as individual policies sold under the Affordable Care Act. According to experts, this move will undermine protections for individuals with pre-exsisting conditions by allowing insurance companies to market and sell more plans without vital consumer protections. In addition, this change will destabilize our country’s health care system and drive up health care costs for patients by shrinking the number of individuals in plans on the individual insurance marketplace.

The resolution of disapproval introduced in the Senate and cosponsored by 44 Senators, including Sens. Warner and Kaine, would rescind the final “junk insurance” plan rule. Congressional Review Act (CRA) disapproval resolutions that obtain the support of 30 Senators on a discharge petition force a vote on the Senate floor. Senators now have the support needed to file a discharge petition and force a vote under the CRA. A simply majority vote in the Senate would pass the resolution and send it to the House of Representatives…

In addition to Senators Warner and Kaine, the resolution is cosponsored by the following Senators:

  • Tammy Baldwin (Democrat – Wisconsin)
  • Richard Blumenthal (Democrat – Connecticut)
  • Cory Booker (Democrat – New Jersey)
  • Sherrod Brown (Democrat – Ohio)
  • Maria Cantwell (Democrat – Washington)
  • Ben Cardin (Democrat – Maryland)
  • Tom Carper (Democrat – Delaware)
  • Bob Casey (Democrat – Pennsylvania)
  • Christopher Coons (Democrat – Deleware)
  • Catherine Cortez Masto (Democrat – Nevada)
  • Joe Donnelly (Democrat – Indiana)
  • Tammy Duckworth (Democrat – Illinois)
  • Dick Durbin (Democrat – Illinois)
  • Dianne Feinstein (Democrat- California)
  • Kristen Gillibrand (Democrat – New York)
  • Kamala D. Harris (Democrat – California)
  • Maggie Hassan (Democrat – New Hampshire)
  • Martin Heinrich (Democrat – New Mexico)
  • Mazie K. Hirono (Democrat – Hawaii)
  • Doug Jones (Democrat – Alabama)
  • Angus King (Independent – Maine)
  • Amy Klobuchar (Democrat – Minnesota)
  • Patrick Leahy (Democrat – Vermont)
  • Ed Markey (Democrat – Maryland)
  • Clair McCaskill (Democrat – Missouri)
  • Bob Menendez (Democrat – New Jersey)
  • Jeff Merkley (Democrat – Oregon)
  • Chris Murphy (Democrat – Connecticut)
  • Patty Murray (Democrat – Washington)
  • Bill Nelson (Democrat – Florida)
  • Gary Peters (Democrat – Michigan)
  • Jack Reed (Democrat – Rhode Island)
  • Bernie Sanders (Independent – Vermont)
  • Brian Schatz (Democrat – Hawaii)
  • Jeanne Shaheen (Democrat – New Hampshire)
  • Tina Smith (Democrat – Minnesota)
  • Debbie Stabenow (Democrat – Michigan)
  • Jon Tester (Democrat – Montana)
  • Tom Udall (Democrat – New Mexico)
  • Chris Van Hollen (Democrat – Maryland)
  • Elizabeth Warren (Democrat – Massachusetts)
  • Sheldon Whitehouse (Democrat – Rhode Island)
  • Ron Wyden (Democrat – Oregon)

The text of the joint resolution is on Scribd. It does not yet have a number. It says:

JOINT RESOLUTION providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to “Short-Term, Limited Duration Insurance”.

Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That Congress disapproves the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Heart and Human Services relating to “Short-Term, Limited Duration Insurance” (83 Fed Reg. 38212 (August 3, 2018), and such rule will have no force or effect.

September 12, 2018: The Hill posted an article titled: “Nearly 600 Russian troll accounts tweeted about Obamacare: report”. It was written by Nathaniel Weixel. From the article:

Nearly 600 Russian-linked troll accounts posted conservative, anti-ObamaCare messages to Twitter from 2014 through this past May, the Wall Street Journal reports.

According to research from Clemson University, the Internet Research Agency (IRA) tweeted nearly 10,000 messages about health policy and Obamacare.

Eighty percent of those tweets had conservative-leaning political messages, often disparaging the health-care law, a Journal analysis found…

…Twitter shut down the accounts once congressional investigators unearthed their origin, but intelligence experts told the Journal the assault is continuing through similar accounts and channels.

Pro-ObamaCare tweets peaked around the spring of 2016, as Hillary Clinton and Sen. Bernie Sanders (I-Vt.) were in the middle of a bruising Democratic presidential campaign. The tweets were likely aimed at dividing their supporters.

According to the report, anti-ObamaCare tweets intensified in spring of 2017 and again that summer, as congressional Republicans were ramping up an ultimately failed effort to repeal ObamaCare.

September 13, 2018: The Chicago Tribune posted an article titled: “Feds slash Illinois funding for Obamacare assistance”. It was written by Lisa Schencker. From the article:

Illinois is getting 78 percent less federal money this year to hire Obamacare workers to help people enroll in health insurance plans, causing some advocates to worry that more Illinois residents will go without coverage

The federal Centers for Medicare & Medicaid Services is handing two Illinois organizations $389,216 this year, down from nearly $1.8 million distributed to five Illinois groups last year, the agency announced Wednesday. One of the largest groups that got grant money for navigators in the past, the United Way of Metro Chicago, won’t get any money this time around…

…This year, Planned Parenthood of Illinois is receiving $208,527 to serve Cook and Kane counties and SIHF Healthcare is receiving $108,689 to serve a number of central and southern Illinois counties. Some counties, such as DuPage and Lake, might no longer have navigator coverage.

Planned Parenthood plans to hire three navigators, to be based in Flossmoor, the Loop, and Aurora, said spokeswoman Julie Lynn, and those navigators will be available to anyone, not just Planned Parenthood patients.

Funding for navigators has been cut nationwide. Across the country, the federal government is distributing $10 million for navigators, down from $37 million last year and $63 million the year before…

September 14, 2018: The Baltimore Sun posted an article titled: “Marylanders in Obamacare individual market poised to see rate drop thanks to reinsurance”. It was written by Michael Dresser. From the article:

Thousands of Marylanders covered by Obamacare plans purchased on the individual market are likely to see hefty decreases in their 2019 premiums, thanks to legislation the General Assembly adopted this year with bipartisan support.

The first two providers active on the insurance exchange for individual plans in the state, CareFirst BlueCross BlueShield and Kaiser Permanente, have told the Maryland Insurance Administration they want to reverse their earlier requests for rate increases averaging about 30 percent.

CareFirst is now proposing a decrease of 22.3 percent and Kaiser a 7.8 percent drop in their health maintenance organization plans. The decreases would affect about 250,000 people in the individual market, in particular the roughly have of them who receive no federal assistance with their premiums.

The declines would follow several years of steady increases in rates on the individual market, which serves people who don’t have insurance through their employers…

September 15, 2018: WiscNews posted an article titled: “Scott Walker pledges to protect pre-existing conditions coverage as candidates clash over health care.” It was written by Scott Bauer. From the article:

Gov. Scott Walker pledged Friday to ensure those with pre-existing conditions would be covered in Wisconsin if the Affordable Care Act were repealed – a key provision of the law known as Obamacare that he has long opposed….

…The protection is extended under former President Barack Obama’s Affordable Care Act, which Walker has been working for years to repeal. He signed off on Wisconsin Attorney General Brad Schimel joining a multistage lawsuit this year that seeks to undo the law and the pre-existing conditions protection.

But Walker this year also called for the Legislature to pass a state law guaranteeing coverage for people with pre-existing conditions. The bill did not pass.

As of 2015, the state had about 852,000 adults with pre-existing conditions that could have prevented them from getting insurance before the health law, according to the Kaiser Family Foundation.

Walker has no credibility on the issue because of his long opposition to the federal law, [state Superintendent Tony] Evers, his Democratic challenger in the upcoming election, said in a statement…

September 25, 2018: USA Today posted an article titled: “Obamacare a central issue in state attorney general races”. From the article:

For years, congressional Republicans vowed to repeal the Affordable Care Act.

In a case sending shockwaves through midterm election campaigns, Republican attorneys general across the country might be poised to make good on that promise.

The case, Texas v. United States, reveals how high the stakes are for health care in this year’s attorney general races – elections that rarely receive much attention but have the power to reverberate through though the lives of Americans…

…This will be the first major election since Republicans voted to abandon a deal they brokered with Democrats roughly two decades ago not to challenge each other’s incumbents in attorney general races. That gentlemen’s agreement acknowledged the need for attorneys general from both parties to collaborate on investigations and lawsuits.

But some of the partisan forces that embittered Capitol Hill spread to these contests. While Republicans control the executive and legislative branches – and are close to staking their claim on the Supreme Court – Democratic attorneys general see themselves as a check on the Trump administration. (Similarly, their Republican counterparts frequently took the Obama administration to court.)…

…Of this year’s 30 contested attorney general races, 18 posts are held by Republicans and 12 are held by Democrats. (An additional five are in play this year, but those posts are appointed by the governor or state lawmakers.)

Unlike in Congress, there is no inherent advantage to one party claiming the majority of attorney general posts. It just takes one attorney general to file a lawsuit.

But Democratic attorneys generals see themselves as a firewall against an administration and their Republican counterparts focused on overturning many of the Obama-era policies they favor. In that arena, for both sides, every lawyer counts…

October 9, 2018: The Hill posted an article titled: “Trump officials plan maintenance downtime for during ObamaCare sign-ups.” It was written by Peter Sullivan. From the article:

The Trump Administration is planning hours-long downtimes for maintenance on during the coming ObamaCare sign-up period.

The administration Drew criticism for a similar move last year from advocates who said the downtime would hinder efforts to sign people up for coverage, but the administration counters that maintenance downtime happens every year and is designed to occur during the slowest periods on the site.

The maintenance schedule is the same as last year, the federal Centers for Medicare and Medicaid Services said Tuesday, meaning is scheduled to be offline for maintenance from 12 a.m. to 12 p.m. each Sunday during the sign-up period, except for the final Sunday, for a total of 60 hours of downtime.

Officials said that is the maximum possible downtime, and said last year the actual downtime was significantly less than what was scheduled, at 21.5 hours out of a scheduled 60…

…The coming sign-up period, for 2019 coverage, runs from Nov. 1 to Dec. 15…

October 15, 2018: The Advocate posted an article titled: “Louisiana ‘Obamacare’ policies set for rate drop with enrollment, barring ‘ugly surprises'”. It was written by Sam Karlin. From the article:

…Federal data released by the Centers for Medicare and Medicaid Services last week provide the first official glimpse of what premiums look like in all the states using, the federally run portal for Affordable Care Act was rolled out, premiums are dropping, CMS said of what is commonly known as “Obamacare.”

Premiums analyzed by CMS will be lower in Louisiana than in most other states, and Louisiana will see a larger drop from last year compared with the 38 other states using

After years of double-digit rate hikes, experts say Louisiana’s market may finally be showing signs of stabilizing, a trend seen in dozens of other states across the country this year. The drop in rates comes after the state’s insurers, mainly Blue Cross posted a profit in the individual exchange last year.

“Barring any ugly surprises…then yes, I’d say we’re looking at a much more stable, predictable performance from that block of business,” said Mike Betaut, health care economist and exchange coordinator for Blue Cross and Blue Shield of Louisiana.

But for the second year in a row, the enrollment period, starting Nov. 1, comes amid significant changes to the health care law. The individual mandate requiring people to buy health insurance or pay a penalty goes away Jan.1. …

…An ongoing lawsuit by 20 Republican attorneys general, including Louisiana’s Jeff Landry, argues components of the law, including coverage for pre-existing conditions, should be struck down.

Despite all that, the Louisiana Department of Insurance announced this summer that Louisiana’s individual market will experience its first drop in premiums – by 6.4 percent – since the Affordable Care Act debuted.

Last week’s CMS report suggests Louisiana’s market is doing better than those in other states…

October 17, 2018: Reuters posted an article titled: “McConnell says Senate Republicans might revisit Obamacare repeal”. It was written by David Morgan. From the article:

Republicans could try again to repeal Obamacare if they win enough seats in U.S. elections next month, Senate Republican Leader Mitch McConnell said on Wednesday, calling a failed 2017 push to repeal the healthcare law a “disappointment.”

In a forecast of 2019 policy goals tempered by uncertainty about who would win the congressional elections, McConnell blamed social programs, such as Social Security and Medicare, for the fast-rising national debt.

On Nov. 6, Americans vote for candidates for the Senate and House of Representatives.

McConnell’s Republicans now hold majority control of both chambers. Democrats will try to wrest control in races for all 435 House seats and one-third of the 100 Senate seats.

Despite their dominance of Congress and the White House, Republicans failed last year to overturn former President Obama’s signature healthcare law, known as Obamacare. McConnell called it “the one disappointment of this Congress from a Republican point of view.”

He said, “If we had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks… We’re not satisfied with the way Obamacare is working.”…

…President Donald Trump favors ending Obamacare, which Republicans critiqued as a costly unneeded intrusion on Americans’ healthcare. About 20 million Americans have received health insurance coverage through the program, a landmark legislative achievement for Obama and Democrats…

October 17, 2018: Politico posted an article titled: “House GOP leader McMorris Rodgers faces Obamacare backlash”. It was written by Paul Demko. From the article:

…In past election cycles, the seven-term lawmaker might have had an easy talking point: Repeal and replace Obamacare. But like other Republicans who suddenly find themselves on the defensive on health care, she avoids mentioning her party’s long-standing pledge to eliminate the 2010 law.

McMorris Rodgers is not just another endangered Republican facing a tough race. She’s the No. 4 in the House Republican leadership – and the only woman. The fact that she’s now steering clear of one of the GOP’s core tenants about repealing Obamacare shows just how treacherous the health care issue has become on the campaign trail. A mother of three, including a child with Down syndrome, McMorris Rodgers is often portrayed as a softer, more compassionate face of a party that’s tacked harder right in the age of Trump. But she’s also the sole Washington state lawmaker to have voted to repeal Obamacare last year.

Now, she faces attack ads spotlighting that vote, not to mention lawn signs imploring voters to “repeal McMorris Rodgers, not our health care.” And while McMorris Rodgers talks about the importance of insurance protections for people like her son who have pre-existing conditions, she voted for a bill that health experts largely agree would have eroded those protections…

…When pressed on health care on the campaign trail, she promises to ensure that vulnerable people, including those with pre-existing conditions, get the care they need, even though the Trump administration is asking the courts to throw out Obamacare’s insurance safeguards…

October 17, 2018: posted an article titled: “Forget Trump. The 2018 Midterm Election Is a Fight About Obamacare’s Pre-Existing Conditions Rules”. It was written by Peter Suderman. From the article:

On the surface, the run-up to the 2018 midterms looks a lot like a circus, with Donald Trump as the ringmaster…

…But outside of Twitter and cable news chyrons, the midterm itself looks a lot more conventional, a contest about classic kitchen table issues, especially health care, and protections for pre-existing conditions in particular. And in this fight, you can see the shape of the health policy debates for years to come…

…”I voted to protect people with pre-existing conditions,” [Republican Senate candidate Martha] McSally said during a debate this week. “We cannot go back to where we were before Obamacare, where people were one diagnosis away from going bankrupt, because they could not get access to health care.” Republicans in a number of races have begun to run ads insisting that they favor pre-existing conditions rules; in Texas, GOP Sen. Ted Cruz closed out a debate with Beto O’Rourke by saying that he wants to preserve those rules…

Liberal pundits have argued that Republicans health care promises are misleading, if not outright lies. I wouldn’t go quite that far, but its fair to say that much of what Republicans have said about pre-existing conditions this year is designed to obscure rather than illuminate.

McSally did, for example, vote to preserve some of Obamacare’s pre-existing conditions rules, but only as part of a bill that would have repealed and rewritten the health law (hence the argument that the replacement plan was Obamcare-lite), provided less funding for coverage and allowed insurers to charge sick people more than under existing law. Other Republicans have pointed to their support for the legislation that would have required insurers to cover people with pre-existing conditions – but would allow insurers to decline to cover care related to the conditions themselves…

…[Republicans]…are pretending to support Obamacare’s regulations as they exist under Obamacare. They are saying that Obamacare got it right.

You can understand why Republicans might choose to obfuscate. Voters trust Democrats more on health care, Obamacare has become more popular since Republicans tried and failed to repeal it last year, and the pre-existing conditions regulations almost always poll well. The presence of Obamacare has altered the policies around pre-existing conditions rules…

…What the polling suggests, then, is that the public prefers the version of Obamacare we have now, with stable rates and insurer participation, along with access to a wider variety of plans. The popular version of Obamacare is the one remodeled, but not repealed, by Republicans…

October 19, 2018: the Washington Post posted an article titled: “Trump administration set to expand religious exemptions to birth control coverage”. It was written by Samantha Schmidt. From the article:

The Trump Administration is expected to soon issue regulations that would expand religious and moral exemptions for covering birth control in employer health insurance plans, a move that critics say would limit women’s access to contraception.

The rules would probably roll back a controversial Obama-era mandate in the Affordable Care Act that required employers to cover birth control. The regulations were filled last week for review with the Office of Management and Budget, indicating that the administration is in the final stages of issuing the expanded exemptions.

The exact details of the exemptions, and when they would take effect, remain unclear. But women’s health advocates are bracing for a legal fight. They expect the rules to mimic earlier regulations enacted by the Trump administration last year before being blocked by federal judges.

The rules allowed nearly every employer – nonprofit or for-profit – with a religious or moral objection to opt out of the Affordable Care Act provision requiring the coverage of contraception at no cost for the employee. The rules vastly expanded which companies could be exempt from the mandate and why, including a broad exemption for a “sincerely held moral conviction” not based in any particular religious belief. Perhaps most significantly, it required employers to provide no other accommodations for employees seeking birth control coverage…

October 19, 2018: Mother Jones posted an article titled: “A Pro-Obamacare Ballot Measure Has a Big Lead in Utah”. It was written by Patrick Caldwell.

It’s looking like voters are fans of Obamacare when they have a chance to directly vote on it – even in deeply red states like Utah.

Utah is one of four states with ballot initiatives next month that ask voters about Medicaid expansion, the part of the Affordable Care Act that broadens eligibility for Medicaid to anyone making up to 138 percent of the poverty line. But as in a number of other Republican-controlled states, lawmakers in Utah hav refused to fully participate in the expansion. A new poll from the Salt Lake Tribune released on Thursday suggests they soon might not have a choice. According to the poll, 59 percent of respondents favor adopting Medicaid expansion, with just 33 percent opposed. That’s up from 54 percent in June.

An estimated 150,000 Utahans stand to gain Medicaid coverage if the initiative passes…

October 19, 2018: Governor Tom Wolf (Democrat – Pennsylvania)posted on his official website news titled: “Governor Wolf Takes Action on Legislation”. From the news:

…Governor Wolf also vetoed House Bill 2138.

“Medicaid has served as a critical resource for Pennsylvanians who are suffering from a substance use disorder as our commonwealth battles an unprecedented prescription drug and heroin public health crisis. Through Medicaid expansion, almost 124,000 newly eligible Medicaid enrollees were able to access drug and alcohol treatment that is critical to helping patients recover from the disease of addiction,” said Governor Wolf. “This legislation does not promote health coverage, access and treatment. Instead, this legislation increases costs, creates unnecessary delays and confusion, penalizes individuals who need healthcare, and terminates health coverage for those who need it the most.”

House Bill 2138 was titled: “Promote Work and Community Engagement Among Medical Assistance Beneficiaries”. Its Prime Sponsor was Matthew D. Dowling (Republican – serving Fayette County (part) and Somerset County (part).

Here is a summary of what some of HB 2138 said:

  • The work requirement shall require a medical assistance enrollee to become employed, actively seek employment as verified by the department, or attend a job training program in accordance with the following:
  • A medical assistance enrollee who is employed or attending job training programs, in order to maintain enrollment in the medical assistance program shall work twenty hours a week or complete twelve job training program-related activities a month.
  • A medical assistance enrollee who has failed to comply with the work requirement… shall relinquish medical assistance program eligibility for the following time periods: (A) Three months beginning in year two of enrollment in medical assistance; (B) Six months beginning after the time period under A expires; (C) Nine months beginning after the time period under clause B expires
  • The next section requires “able-bodied medical assistance enrollee who is nineteen years of age or older to verify on a biannual basis or by request of the department of medical assistance enrollee’s family income or the medical assistance enrollee’s compliance with the provisions under [the above sections] for the purpose of determining the medical assistance enrollee’s eligibility.
  • Here are things that would enable a medical assistance enrollee to be exempt from that: attending high school as a full-time student; currently receiving temporary or permanent long-term disability benefits; is an individual eighteen years of age or older or younger than sixty-five years of age or older; is a pregnant woman, receives Supplemental Security Income (SSI) benefits; resides in a mental health institution or correctional institution
  • Here’s a key part: “The medical assistance enrollee is experiencing a crisis, serious medical condition, or temporary condition that prevents the Medicaid enrollee from actively seeking employment INCLUDING BUT NOT LIMITED TO, domestic violence or a substance abuse disorder
  • “The secretary’s application for the demonstration program under subsection (a) shall also align with other assistance programs that have work requirements in order to reduce the cost of monitoring the work requirements.”
  • “The demonstration program under subsection (a) may also include a medical assistance buy-in component to allow workers with disabilities to have higher wage earnings and maintain their medical assistance coverage.

October 22, 2018: HuffPost posted an article titled: “Trump Administration Launches New Attack on ACA’s Pre-existing Protections”. It was written by Jonathan Cohn. From the article:

…Health care has become a defining issue of next month’s midterm elections, and Republicans across the country, including President Donald Trump, are promising voters that they care deeply about protecting people with pre-existing conditions.

But Monday’s rule change almost certainly means that, overall, people with serious medical problems are likely to have a harder time finding coverage – and ultimately, paying their medical bills.

Under guidance from the Department of Health and Human Services that takes effect immediately but likely won’t affect insurance markets for another year, state governments will have new leeway to request waivers from some of the federal health care law’s core requirements…

..The less generous plans that [Seema] Verma and the Trump administration are touting, and that Monday’s rule change will favor, frequently leave beneficiaries exposed to catastrophic costs if they get seriously sick or injured, precisely because they leave out benefits that people need when they have serious medical problems. Often, the buyers of these plans aren’t even aware of the limits until it’s too late, because deciphering the fine print of these plans is so difficult…

October 24, 2018: The National Archives posted a rule by the Treasury Department and Health and Human Services Department on the Federal Register. The rule is titled: “State Relief and Empowerment Waivers”. Here is a key points from the rule:

…This guidance intends to expand state flexibility, empowering states to address problems with their individual insurance markets and increase coverage options for their residents, while at the same time encouraging states to adopt innovative strategies to reduce overall health care spending. Section 1332 of the PPACA permits a state to apply for a State Innovation Waiver (referred to as a section 1332 waiver or a State Relief and Empowerment Waiver) to pursue innovative strategies for providing their residents with access to higher value, more affordable health coverage.

The overarching goal of section 1332 waivers is to give all Americans the opportunity to gain high value and affordable health coverage regardless of income, geography, age, gender, or health status while empowering states to develop health coverage strategies that best meet the needs of their residents.

Section 1332 waivers provide states an opportunity to provide a stable health insurance market that offers more choice and affordability to state residents, in part through expanded competition. These waivers could potentially be used to allow states to build on additional opportunities for more flexible and affordable coverage that the Administration opened through expanded options for Association Health Plans (AHP) and short-term, limited-duration insurance (STLDI)…

The key thing to be aware of is that Association Health Plans, and short-term, limited-duration insurance plans, are not required to cover everything that “Obamacare” plans do.

In short, a state government that chooses to push these “junk insurance” plans, could put the people of that state in a situation where the medication, care, treatment, and recovery from their pre-existing conditions WOULD NOT BE COVERED by the (somewhat less expensive) health insurance they have purchased.

This rule went into effect on October 24, 2018 – leaving no room for public comment before the rule was put into effect.  That’s not how this process is supposed to go.

November 1, 2018: Wisconsin State Journal posted an article titled: “Gov. Scott Walker’s Medicaid work requirement approved; drug testing rejected”. It was written by David Wahlberg. From the article:

President Trump’s administration has approved Gov. Scott Walker’s controversial plan to require childless adults on Medicaid to work or lose coverage, but the federal government rejected Walker’s proposal to require drug screening and testing.

The state on Wednesday received permission to enact several changes to BadgerCare coverage for poor adults who don’t have dependent children, such as limiting eligibility to four years unless people work, train for a job or participate in certain other activities.

Wisconsin can now also charge monthly premiums of up to $8 along with $8 co-payments for emergency room visits for problems that aren’t considered emergencies. Members can reduce their premiums through “healthy behaviors,” such as not smoking or maintaining a healthy weight.

But Walker’s plan to require enrollees to be screened for drug abuse – and tested if screening called for it – was not approved. Instead, people will have to complete a health risk assessment, which will include questions about drug use. If the HRA indicates a concern about substance abuse, people will be referred for treatment but won’t have to comply to be eligible for Medicaid…

…The work requirement applies to able-bodied childless adults ages 19-49. If they don’t work or engage in related activities for 48 months, they’ll lose coverage for six months, after which they can re-apply…

…Health care advocates have opposed the changes, saying they’ll make it more difficult for the poorest residents to maintain health coverage that could help them stay healthy and employable…

November 6, 2018: Ballotpedia posted information about the “United States Congress elections, 2018”. Here are some key points:

  • On November 6, 2018, 470 seats in the U.S. Congress (35 Senate seats and all 435 House seats) were up for election.
  • The Democratic Party won control of the House, and the Republican Party retained control of the Senate.
  • Democrats had gained a total of 39 U.S. House seats, 16 more than the 23 seats they needed win control of the House.
  • Before the election, Republicans controlled the House with a 235-193 majority (plus seven vacancies).

November 8, 2018: Politico posted an article titled: “House Democrats weigh joining Obamacare suit”. It was written by Alice Miranda Ollstein and Adam Cancryn. From the article:

House Democrats are considering using their new majority to intervene in a lawsuit brought by 20 conservative state attorneys general that could abolish Obamacare.

That move would come soon after the next Congress is sworn in and marks an early attempt to make good on campaign pledges to protect the Affordable Care Act, House Sources told POLITICO. Bringing up a resolution to intervene in the case would also force an early vote that puts chamber’s Republicans on record about protecting the law and its popular preexisting condition protections.

Congressional Republicans, facing a backlash over their attempts to repeal Obamacare, introduced legislation earlier this year that addressed preexisting conditions, though the measures either weren’t binding or would have allowed insurers to opt out of paying for treatments…

November 19, 2018: Reuters posted an article titled: “House Democrats target DOJ decision not to defend Obamacare”. From the article:

Democrats will scrutinize the Trump administration’s decision not to defend Obamacare in federal court, when Democrats take control of the U.S. House of Representatives next year, a leading Democrat said on Monday.

In June, the Department of Justice declared the healthcare law’s individual mandate unconstitutional in federal court, which threatened to undermine insurance protections for people with preexisting conditions, and helped make healthcare a winning issue for Democrats in House elections on Nov. 6.

The decision was also a break with a long-standing executive branch practice of defending existing statutes in court and prompted three Justice Department career attorneys to withdraw from the case. The Affordable Care Act (ACA) known as Obamacare is a favorite target for Republicans, who have repeatedly tried and failed to repeal it.

Representative Jerrold Nadler, who is expected to become chairman of the House Judiciary Committee in January, said he is concerned about the Justice Department’s actions, which took place in a Texas court in response to a lawsuit brought by 20 state attorneys general…

…The New York Democrat asked [acting Attorney General Matthew] Whitaker to respond by Dec. 31 to two June 2018 letters sent to former Attorney General Jeff Sessions, seeking details about the decision as well as coverage for pre-existing conditions and cost-sharing subsidy payments provided by the ACA…

November 20, 2018: Salon posted an article titled: “That robocall about Obamacare health insurance is probably a scam… and illegal”. It was written by Christopher Curley. From the article:

The open enrollment period for obtaining health insurance for 2019 through the Affordable Care Act started Nov. 1.

But for health insurance scammers, the season’s been in full swing for a while.

Nearly half a billion – that’s billion with a “b” – health insurance scam robocalls were made in September, according to YouMail’s Robocall Index.

In addition, there was a new monthly record for robocalls in October, with 5.1 billion received. Scams made up 42 precent of all robocalls…

…”If you get a recorded sales call, but you didn’t give the caller written permission to call you, the call is illegal,” Bridget Small, a consumer education specialist at the Federal Trade Commission (FTC), wrote in a blog post about health insurance scams…

…Among these robocalls, health insurance scams are the most popular, which YouMail’s data show have been increasing in volume.

People are used to giving away a lot of information to obtain health insurance. This makes people looking for insurance a ripe target for scammers, Alex Quilici, CEO of YouMail, told Healthline.

From that perspective, it makes sense that health insurance scam calls would increase right around the time people using Obamacare plans are trying to renew or obtain insurance…

…It’s not just Obamacare plans that scammers target, either.

After the FTC announced that Medicare recipients would be receiving new cards with new numbers in the mail, scammers took the opportunity to cold-call Medicare beneficiaries to try and trick them into giving away valuable personal data, the commission reported…

November 28, 2018: Crooks And Liars posted a blog titled: “Obamacare Lives! But Signups End December 15”. It was written by Frances Langum. From the article:

…Like last year, there is a very short window to sign up for coverage and the Trump administration continues to make it harder for people to get the information they need to get and stay covered. In-person assistance funding has been cut by an additional 70%. Advertising will be limited. The administration also has taken actions to undermine the marketplace – repealing the mandate and creating short-term junk plans. On top of all that, the 2018 elections interfered with media attention on Open Enrollment….

…You must take action to sign up for coverage by December 15 for 2019 coverage…

…Because if financial help, most people can find a plan for $50 to $100 per month In fact, last year, more people than ever before will be able to find plans with $0 monthly premiums…

November 28, 2018: Politico posted an article titled: “Trump may finally be undermining Obamacare”. It was written by Paul Demko. From the article:

There has been a steep drop in Obamacare insurance numbers, halfway through the sign-up season for 2019, raising concerns that the Trump administration’s controversial policy changes are undermining the marketplaces.

The 9.2 percent drop to roughly 100,000 sign-ups per day has surprised close observers of the Obamacare markets, who expected the the number of customers to remain fairly stable even after Republicans eliminated the unpopular individual mandate penalties for being uninsured. Premiums hikes were fairly low in most states in 2019, and many parts of the county saw an increase in consumer choice as more health plans participated in what they now see as a more profitable, stabilizing, market…

…One of the biggest challenges is probably ignorance: Hardly anyone knows that it’s open enrollment season. Just 1 in 4 Americans who buy their own health insurance or are uninsured are aware that the deadline for enrolling in coverage is Dec. 15, according to the latest polling data from the Kaiser Family Foundation.

In addition, barely 1 in 4 respondents reported seeing advertising explaining how to enroll in Obamacare coverage. By comparison, more than half of respondents reported seeing such ads during the inaugural Affordable Care Act sign-up period, which ran from October 2013 through the following April.

One possible reason for this: President Donald Trump’s agencies are putting far less time and money into promoting the enrollment period than the Obama administration did…

…Some people, particularly those who don’t get their premiums subsidized in the ACA markets, may be opting for the skimpier but cheaper plans the Trump administration is pushing as an Obamacare alternative. Some may be getting insured outside the exchanges, either in states that are finally expanding Medicaid or through employer-provided coverage in a booming job market.

The drop off applies to the 39 states that rely on the once troubled website for enrollments. Some states that run their own exchanges are seeing a more stable or improving environment. Covered California, the largest state-based marketplace, won’t release any enrollment figures until later this week. California committed to spending about $100 million on advertising and outreach this year – 10 times what the federal government is spending to drum up sign-ups for…

…Outreach groups that saw their funding slashed are focusing their limited budgets on re-enrolling existing clients rather than trying to reach new customers. The Dallas-based Community Council, for instance, eliminated advertising this year after the group lost its $1.8 million federal grant. Even though the group has managed to enroll roughly the same number of people as last year, CEO Ken Goodgames worries about the people they aren’t reaching…

November 29, 2018: The New York Times posted an article titled: “Federal Subsidies Could Expand to Health Programs That Violate Obamacare”. It was written by Robert Pear and Abby Goodnough. From the article:

The Trump administration said Thursday that states could bypass major requirements of the Affordable Care Act by using federal funds for a wide range of health insurance programs that do not comply with the law.

Federal officials encouraged states to seek waivers from provisions of the law that specify who is eligible for premium subsidies, how much they get and what medical benefits they receive…

…The new policy outlined by the administration on Thursday upends a premise of the Affordable Care Act: that federal subsidies can be used only for insurance that meets federal standards and is purchased through public marketplaces, also known as insurance exchanges.

Under the new policy, states could use federal subsidies to help people pay for employer-sponsored insurance. Consumers could combine federal funds with employer contributions to buy other types of insurance.

Under the Affordable Care Act, premium tax credits are available to people with incomes up to four times the poverty level, roughly $83,000 a year for a family of three. With a waiver, states could provide assistance to higher-income families.

The  Trump administration laid out templates for state programs – waiver concepts – that could significantly depart from the model enacted by Congress in 2010…

…Democrats assailed the initiative as an audacious effort to undermine the Affordable Care Act. And they said the administration was ignoring the midterm election successes of Democrats who had promised to defend health care that they said was threatened by President Trump and Republicans in Congress…

November 29, 2018: The Detroit News posted an article titled: “GOP moves to dilute power of governor, AG, secretary of state”. It was written by Beth LaBlanc and Johnathan Oostling. From the article:

With Democrats set to take over top statewide offices next year, Michigan Republicans are considering proposals that would allow the Legislature to intervene in legal battles and shift the oversight of the state’s campaign finance law to a new commission.

The lame-duck power plays would limit the power of Gov.-elect Gretchen Whitmer, Attorney General Dana Nessel and Secretary of State Jocelyn Benson. Democrats have not held all three posts since 1990…

…First reported by Gongwer News Service, the bill would let the Legislature intervene in any court case to protect the rights and interests of the state or Legislature. It would give the state House and state Senate the right to take any action that other parties to the litigation have, including prosecuting an appeal and applying for a re-hearing…

…A longstanding Michigan law gives the attorney general the authority to intervene in any civil or criminal case “when in his own judgement the interest of the state require it” but does not give special privileges to legislators, who can ask judges to intervene in cases but are not guaranteed the right.

But the Legislature can compel the attorney general to defend the state in certain cases…

On February 21, 2014, posted an article titled: “Attorney General Bill Schutte signs onto anti-Obamacare appellate brief over tax credits”. It was written by Brian Smith. From that article:

…Attorney General Bill Schuette is arguing an IRS rule offering tax credits to individuals buying health insurance on the federal exchange from states without their own exchanges violates the U.S. Constitution.

The argument was made in a “friend of the court” brief filed in a case before the U.S. Court of Appeals for the D.C. Circuit, where individuals and businesses from states without insurance exchanges are challenging the ability of the IRS to offer tax credits for buying insurance through the federally established exchange…

…A lower court judge ruled the IRS had the authority to offer the credits, saying the provisions of the health care law do not limit the availability of the credits even in states without their own exchanges…

…Michigan is among the states which is not operating its own exchange, although the state did enact an expansion of Medicaid eligibility to offer coverage to more low-income residents…

In short, the Republican candidate for Attorney General lost the election. So, the GOP are desperately trying to prevent the Democratic Attorney General-elect from having to power to remove Michigan from that lawsuit.

November 30, 2018: The State posted an article titled: “GOP lame-duck bills would move primary, limit early voting”. It was written by Todd Richmond.

The article is filled with details about what the Republican-majority Wisconsin legislature is doing in an effort to suppress the power of  Democratic Governor-elect  Tony Evers and  Democratic Attorney General-elect Josh Paul. For the purpose of this blog, I will only include the parts relating to health insurance. From the article:

Wisconsin Republicans released sweeping lame-duck legislation Friday that would move the 2020 presidential primary, restrict early voting and weaken both Democratic Attorney General-elect Josh Kaul and Gov.-elect Tony Evers….

…The move comes after nearly 60 percent of eligible Wisconsin voters went to the polls in the Nov. 6 election, a record for a midterm contest. The turnout helped Democrats seize all four statewide offices, ousting Walker and GOP Attorney General Brad Schimel along the way…

…The legislation also would largely sideline Kaul, the new attorney general, unless he adopts Republican stances in court.

Typically the attorney general represents the state in court, but the proposals would allow GOP legislative leaders to intervene in cases and hire their own attorneys. If lawmakers feel they represent the state’s best interests, they could push the attorney general aside.

Currently, the governor approves whether the attorney general can withdraw from a lawsuit. Under the bills, the Legislature’s finance committee would approve withdrawal rather than the governor. The Democratic Kaul has pledged to end Wisconsin’s involvement in a multi-state lawsuit challenging the federal Affordable Care Act…

December 14, 2018: Donald Trump tweeted: “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”

December 14, 2018: HuffPost posted an article titled: “Emails Show Trump Administration Was Told Obamacare Ad Cuts Could Hurt Enrollment”. It was written by Jonathan Cohn and Jeffery Young. From the article:

The Trump administration last year eliminated television advertising for despite projections suggesting that Obamacare enrollment would fall by more than 100,000 as a result, newly disclosed government emails show.

The decision to cut television advertising, announced in August 2017, was part of a larger and dramatic cut to outreach efforts for the federal government’s insurance website, which is part of the Affordable Care Act. At the time, administration officials said they had no reason to believe those reductions, including the end of TV advertising, would cause fewer people to sign up.

But in a series of email conversations last year, analysts at a private contractor and senior staff at the agency of discussed an economic model designed to predict the likely effect of changes to the advertising budget.

Weeks before the announcement of the cut, one of the analysts cited a prediction that enrollment would fall by 102,029 without television spots promoting and the availability of coverage on the site. The estimate, which the analyst described as “very conservative,” covered just a portion of the advertising cuts…

…The emails, which the left-leaning watchdog group Democracy Forward obtained through the Freedom of Information Act and then provided to HuffPost, starts in January 2017, when Trump became president. One of his administration’s very first moves was to cut off advertising for the remainder of the 2017 open-enrollment period, which still had a few days to go.

That turned out to be the harbinger. At the end of August, the administration announced it was wiping out nearly the entire promotional budget. Instead of allocating $100 million, as the Obama administration had done for the final year of enrollment it was overseeing, the Trump administration would spend just $10 million. It would also be focusing exclusively on digital advertising and outreach, with no funding at all for television…

December 14, 2018:The Hill posted an article titled: “Federal judge in Texas strikes down Obamacare”. It was written by Peter Sullivan. From the article:

A federal judge in Texas on Friday struck down the Affordable Care Act, throwing a new round of uncertainty into the fate of the law just one day before the deadline to sign up for coverage next year.

U.S. District Court Judge Reed O’Connor ruled that the law’s individual mandate is unconstitutional, and that because the mandate cannot be separated from the rest of the law, the rest of the law is also invalid.

The ruling is certain to be appealed, and legal experts in both parties have said they ultimately expect the challenge to the health law will not succeed. ObamaCare will remain in effect while the case is appealed….

…O’Connor, an appointee of former President George W. Bush, acknowledged in his ruling that health care is a “politically charged affair – inflaming emotions and testing civility.”…

…The reasoning of the ruling states that in 2012, the Supreme Court upheld the mandate to have coverage because of Congress’s power to tax. But, last year, Congress removed the fine for failing to comply with the mandate, which, he argues, means the mandate is no longer a tax and therefore is unconstitutional…

…The Trump administration, in a rare move, declined to defend the law in court and instead argued the pre-existing condition protections should be overturned…

December 14, 2018: Donald Trump tweeted from his verified Twitter account: “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”

This was followed by a second tweet: “Wow, but not surprisingly, ObamaCare was just ruled UNCONSTITUTIONAL by a highly respected judge in Texas. Great news for America!”

December 15, 2018: KCRA 3 posted an article titled: “Covered California extends deadline amid questions over Obamacare future”. It was written by Max Resnik. From the article:

After a U.S. District Court judge in Texas dealt a significant blow to the Affordable Care Act by calling it unconstitutional, Covered California announced that it’s extended the deadline to apply for Jan. 1 coverage to December 21.

The original deadline was Saturday, but Covered California said in a news release it extended the deadline “in response to a surge of interest in enrollment and to ensure consumers have ample time to enroll amid news reports of a legal ruling on the Affordable Care Act.”

“People should still sign up, and also, if you have coverage today through Covered California or MediCal, you can be totally at ease — your coverage is locked down,” Covered California Executive Director Peter Lee said Friday following the judge’s ruling. “The ACA is the law of the land. It’s been upheld by the Supreme Court before. This ruling is a total aberration, and I don’t want Californians to be confused by it.”…

December 16, 2018: The Hill posted an article titled: “Schumer vows to put a vote on the floor urging intervention in ObamaCare was ‘first thing’. It was written by Michael Burke. From the article:

Senate Minority Leader Charles Schumer (D-N.Y.) on Sunday pledged that Democrats in the Senate will fight “tooth and nail” against a Texas judge’s ruling that the Affordable Care Act is unconstitutional…

…U.S. District Court Judge Reed O’Connor ruled on Friday that the health-care law is unconstitutional because of the law’s individual mandate, but lawmakers and legal experts from both parties have said they expect the ruling will be overturned…

December 16, 2018: The New York Times posted an article titled “What the Obamacare Court Ruling Means for Open Enrollment”. From the article:

When a federal judge in Texas struck down the Affordable Care Act on Friday, ruling that its mandate requiring most people to buy health insurance was unconstitutional, it thrust Obamacare into the spotlight right at the deadline to sign up for next year’s coverage.

Open enrollment was scheduled to end on Saturday in most states, and every year, a surge of people sign up at the last minute.

The Centers for Medicare and Medicaid Services sent out an email to millions of Americans on Saturday trying to allay concerns, and displayed a red banner alerting people that the court’s decision would not affect open enrollment…

…But, because things were not complicated enough already, you might still have time to enroll depending on where you live. Some states have deadlines in January…

…In his ruling, Judge Reed O’Connor of the Federal District Court for the Northern District of Texas said the individual mandate “can no longer be sustained as an exercise of Congress’s tax power.” Judge O’Connor, a George W. Bush appointee, said that he would not “parse the A.C.A.’s provisions one by one,” but that he had to invalidate the whole law.

That does not mean the Affordable Care Act is immediately null. The judge did not issue an injunction to stop federal officials from enforcing the law, and a group of states led by Democrats have promised to appeal the decision…

…The case is “still moving through the courts,” the Centers for Medicare and Medicaid Services said in an email on Saturday. “The marketplaces are still open for business, and we will continue with open enrollment. There will be no impact to enrollees’ current coverage or their coverage in a 2019 plan.”…

December 16, 2018: Senator Susan Collins (Republican – Maine) posted a transcript of her interview by George Stephanopoulos of ABC’s “This Week”. From the transcript:

…Stephanopoulos: Let’s talk about health care. You heard Senator Durbin say that this judge’s ruling is a real problem for Republicans now. What’s your reaction to the judge’s ruling?

Collins: The judge’s ruling was far too sweeping. He could have taken a much more surgical approach and just struck down the individual mandate and kept the rest of the law intact. I believe that it will be overturned…

December 16, 2018: ABC Eyewitness News 5 posted an article titled: “Minnesota governor says Obamacare still ‘law of the land’, despite federal judge ruling”. From the article:

Minnesota Gov. Mark Dayton and other top lawmakers in the state said the Affordable Care Act and the state’s health insurance marketplace, MNsure, is still intact and is open for business despite a federal judge’s ruling that the law is unconstitutional…

…Gov. Dayton and officials from MNsure stressed that the ruling has no immediate impact on people who have signed up for coverage that begins Jan. 1.

“Nothing that we’re seeing in the ruling prohibits us or gives us pause for how things are going to proceed the rest of this enrollment period,” said MNsure CEO Nate Clark in a phone interview Saturday.

Jacobs predicts a lengthy court battle that could make it all the way up to the Supreme Court…

December 16, 2018: The Providence Journal posted an article titled: “Raimondo: Obamacare ruling could hurt thousands”. From the article:

Gov. Gina Raimondo says a federal judge’s ruling “threatens the health care of thousands” of Rhode Island residents.

The Democrat on Saturday pledged to “take all steps necessary” to protect the Affordable Care Act, which a federal judge in Texas last week ruled unconstitutional.

In a written statement, Raimondo says the court decision “is dangerous, destructive and threatens the health care coverage of thousands of Rhode Islanders.” She says those with preexisting conditions and those that rely on the law’s consumer protections are particularly at risk…

…Raimondo says Rhode Island’s health exchange, HealthSource RI, remains open for business. Open enrollment ends Dec. 31.

December 16, 2018: Boston Herald posted an article titled: “Obamacare architect: Dire consequences for Massachusettes”. It was written by Jordan Graham. From the article:

The architect of Obamacare warned the Affordable Care Act could die if the U.S. Supreme Court backs a ruling by a Texas judge calling the law unconstitutional – a decision that would force Massachusetts to strip coverage or pay astronomical bills.

“It’s got very important financial implications for Massachusetts,” said Jonathan Gruber, an economist who has been described as the engineer of the law. “If the Affordable Care Act goes away, it means Massachusetts will have to bear all the costs of covering these people.”…

…O’Connor, a conservative judge appointed by President George W. Bush, had been widely expected to rule against the law, at least in part. His ruling, however, swept more broadly than many had expected, striking down the entirety of the health care law, including its provisions that allowed California and 31 other states to expand Medicaid to 15 million Americans and the subsidies that keep insurance affordable for millions of others who do not get health care coverage through their employers…

…A group of left-leaning states, led by California, have stepped in to defend the health care law, quickly saying they would appeal O’Connor’s ruling…

…The states will appeal to the 5th U.S. Circuit Court of Appeals. Eventually, the case could wind up back at the Supreme Court, which has twice ruled in favor of the law.

December 17, 2018: The New York Times posted an article titled: “States Ask Judge to Declare Health Law Still in Effect While Ruling Is Appealed”. From the article:

California and 15 other states asked a federal judge on Monday to protect the current health care coverage for millions of Americans while courts sort out the implications of his ruling that the Affordable Care Act was invalid in its entirety.

The states, which support the health care law, said the ruling on Friday, by Judge Reed O’Connor of the Federal District Court in Fort Worth, had caused immense confusion about whether the law was still in effect, and whether consumers were still entitled to its benefits and protections.

The states asked Judge O’Connor to clarify whether he meant his decision to have “any immediate legal effect.”

“in light of this ambiguity,” California and the other states asked Judge O’Connor on Monday to affirm that the Affordable Care Act was still the law and should be enforced while supporters and opponents of the measure continue their battle in court…

…Caitlin Oakley, a spokeswoman for the Department of Health and Human Services, said Monday that because Judge O’Connor had not issued a final judgement or an injunction, the department “will continue administering and enforcing all aspects of the A.C.A. as it had before the court issued its decision.”…

December 21, 2018: NPR posted an article titled: “Short-Term Health Plans Boost Profits For Brokers and Insurers”. It was written by Julie Appleby. From the article:

…Short-term plans can be far less expensive than ACA plans because they set annual or lifetime payment limits. Most of these plans exclude people with pre-existing medical conditions, don’t cover prescription drugs and exclude in fine print some conditions or treatments. Injuries sustained in school sports, for example, are not covered…

…The rising demand for short-term plans is a boon for insurance brokers, who often see commissions on such policies hit 20 percent or more.

On a policy costing $200 a month, for example, that would translate to a $40 payment each month. By contrast, ACA plan commissions are often flat dollar amounts rather than a percentage of premium and can range from zero to $20 per enrollee per month…

…Insurers, too, see strong profits from [short-term] plans because they generally pay out very little toward medical care when compared with the more comprehensive ACA plans…

…A 2016 report from the National Association of Insurance Commissioners showed that, on average, short-term plans paid out about 67 percent of their earnings on medical care.

That compares with ACA plans, which are required under the law to spend at least 80 percent of premium revenue on medical claims…

…And recent guidelines to states say they could seek permission to allow federal subsidies to be used for short-term plans. Currently, those subsidies apply only to ACA-compliant plans.

Granting subsidies for short-term plans “would mean tax dollars are not only subsidizing commissions, but also executive salaries and marketing budgets,” said Sabrina Corlette of Georgetown University Center on Health Insurance Reforms.

No state has yet applied to do that…

December 30, 2018: The New York Times posted an article titled: “Obamacare, Ruled Invalid by Federal Judge, Will Remain in Effect During Appeal”. From the article:

The federal judge in Texas who ruled this month that the entire Affordable Care Act was invalid issued a stay in the case on Sunday, meaning that the law will remain in effect while the ruling is appealed.

The judge, Reed O’Connor of the Federal District Court in Fort Worth, said that the ruling should not go into immediate effect “because many everyday Americans would otherwise face great uncertainty” during an appeal.

The ruling opened the door for an appeal by California and 15 other states that support the health care law.

Judge O’Connor’s original ruling had caused some confusion because it came as many states were finishing up open enrollment for 2019. Though he ruled that the law’s individual mandate was unconstitutional and that the rest of the law was therefore invalid, he did not issue an injunction stopping the law from being enforced…

January 1, 2019: Politico posted an article titled: “Trump wants to bypass Congress on Medicaid plan”. It was written by Rachana Pradhan and Dan Diamond. From the article:

The Trump administration is quietly devising a plan bypassing Congress to give block grants to states for Medicaid, achieving a longstanding conservative dream of reining in spending on the health care safety net for the poor.

Three administration sources say the Trump administration is drawing up guidelines on what could be a major overhaul of Medicaid in some states. Instead of the traditional open-ended entitlement, states would get spending limits, along with more flexibility to run the low-income health program that serves nearly 75 million Americans, from poor children, to disabled people, to impoverished seniors in nursing homes.

Caping spending could mean fewer low-income people getting covered, or state-designated cutbacks in health benefits – although proponents of block grants argue that states would be able to spend the money smarter with fewer federal strings attached…

…Republicans have sought to rein in Medicaid spending, especially as enrollment swelled Obamacare’s expansion of the program to millions of low-income adults in recent years. CMS Administrator Seema Verma has warned increased spending on the Medicaid population could force cutbacks on sicker, lower-income patients who rely on the program.

…The administration wants to let states use waivers to reshape their Medicaid programs, but the effort could face legal challenges in the courts. Waivers approved by the Trump administration to allow the first-ever Medicaid work requirements for some enrollees, for example, are already being challenged in two states.

Also complicating the administration’s push: the newfound popularity of Medicaid, which has grown to cover about one in five Americans. Voters in three GOP-led states in November approved ballot measures to expand Medicaid, which has been adopted by about two-thirds of states. Newly elected Democratic governors in Kansas and Wisconsin are pushing their Republican-led legislatures to expand Medicaid this year.

Verma has been trying to block grant language into federal guidance for months but has encountered heavy scrutiny from agency lawyers, two CMS staffers said. She mentioned interest in using her agency’s authority to pursue block grants during a meeting with state Medicaid directors in the fall but did not provide details, said two individuals who attended….

What happened next? The answers are in my blog post titled: “A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three“.

A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Two is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites.

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