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2 GOP senators propose letting individual states keep versions of the ACA

January 24, 2017by Robert Whitcomb in Uncategorized tagged , , , , , , , ,

By CHAD TERHUNE

and PAULINE BARTOLONE

For Kaiser Health News

In a sign of how much easier it was to complain about the Affordable Care Act than to deal with angry patients who would lose their coverage if the Republicans repeal it,  two GOP senators have proposed letting states  keep their federally funded ACA insurance exchange with ACA consumer protections intact.

Senators Bill Cassidy, R-La., and Susan Collins, R-Maine, said their proposed legislation would allow states that embraced the Affordable Care Act to keep operating under many of the current federal rules.

Another option is for states to pursue a less regulated alternative to the ACA under the Patient Freedom Act. Or they could reject federal dollars completely in favor of a new state solution for health coverage.

“We give states the option,” Cassidy said at press conference Monday. “California and New York — you love Obamacare, you can keep it.”

Some health-law supporters say that the Cassidy-Collins proposal, one of several in the GOP-controlled Congress, could represent a lifeline for states such as California that have invested heavily in expanding coverage under the Affordable Care Act.

But many Democrats at the state and national level criticized the plan as potentially harmful to millions of Americans who rely on the health law because it does not promise sufficient funding and consumer protections.

“It provides a somewhat illusory option to stay in the ACA without the guarantee of federal assistance necessary to allow states to maintain the level of coverage they are currently providing,” California Insurance Commissioner Dave Jones, an elected Democrat, said in an interview.

The Golden State fully implemented the health law by expanding Medicaid coverage to millions of low-income people and creating its own insurance exchange, which ultimately covered 1.3 million enrollees. Supporters have held California up as proof that the health law can work as intended — and as a counterpoint to Republican contentions that Obamacare is collapsing nationally.

Cassidy said his legislation promotes the Republican doctrine of states’ rights while avoiding the one-size-fits-all approach from Washington.

Collins echoed that sentiment, saying she favors letting states that had success with the health law maintain the status quo. She described it as “reimplementation of the ACA” in those states.

“If a state chooses to remain covered by the ACA, exchange policies will continue to be eligible for cost-sharing subsidies and advance premium tax credits,” Collins said in a speech on the Senate floor Monday. “The insurance market will still be subject to ACA requirements, and the individual mandate and employer mandate will also remain in place in that state.”

Cassidy and Collins acknowledged that details of their bill haven’t been worked out, nor is it clear how it will mesh with other proposals. Competing plans in Congress don’t envision these state options, and it’s unclear what approach President Trump and his nascent administration will take in crafting a replacement plan.

Still, some industry experts and analysts say the Cassidy-Collins proposal is intriguing.

“The advantage to a state like California is we could protect what we have accomplished already,” said Howard Kahn, former chief executive of L.A. Care Health Plan, an insurer on the Covered California exchange. The large managed-care plan serves patients in Medi-Cal, the state’s Medicaid program.

“Cassidy’s proposal could work for California better than other alternatives in the short term. The question is whether they maintain federal funding for the longer term,” Kahn said. “My feeling is you do have to engage with the rational Republicans who are trying to find something that doesn’t tear it all apart.”

Some key state lawmakers are more skeptical. “I’ll be surprised if it really happens,” said state Sen. Ed Hernandez, D-West Covina, chairman of the Senate Health Committee. “This is just one of many proposals.”

State Sen. Richard Pan, D-Sacramento, a pediatrician and former Assembly Health Committee chairman, said he was relieved to hear of a Republican proposal that backs federal subsidies, but was concerned about potential loss of funding at current levels. “It looks good on the surface” Pan said, but it’s important “to look at the details.”

Pan also said, however, that the bill could further the fragmentation of the health-care system if some states keep Obamacare while others do not.

Covered California officials may weigh in on this Republican proposal and others at a board meeting Thursday. Executive Director Peter Lee didn’t respond to a request for comment Monday. After the November election, Lee emphasized that Covered California can show policymakers in Washington how to build a competitive insurance market.

California went beyond what other exchanges did. It chose to actively negotiate rates with insurers and didn’t allow every company to sell in its marketplace. It also simplified consumer shopping by requiring insurers to have standard copays and deductibles for each level of coverage.

Those moves pushed health insurers to compete more directly on price, and annual rate increases were a modest 4 percent in the first two years. Covered California’s rates are rising 13.2 percent, on average, this year. Still, that’s better than the 22 percent average rate hike in exchanges nationwide.

Walter Zelman, chairman of the public health department at California State University, Los Angeles, said it will be interesting to see whether state leaders try to negotiate with Republicans in Washington over funding levels.

“It’s not that Republicans don’t want people to have health insurance. They just don’t want to pay for it,” Zelman said. “It would be good for California to keep what it has and it would be much less disruption.”

Federal funding is a key issue for states. In a summary of the bill posted by Collins, it said states choosing to retain Obamacare or pick the Republican alternative could receive “funding equal to 95% of federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion.”

Dylan Roby, an assistant professor at the University of Maryland School of Public Health, said “California would still have to absorb a 5 percent cut, at least, in the premium tax credits and cost-sharing subsidies.”

Republicans will need 60 votes in the U.S. Senate to pass a full replacement for the Affordable Care Act. At his press briefing Monday, Cassidy said his compromise approach is designed to win over some Democrats and reach that 60-vote majority.

In her speech on the Senate floor, Collins said children could still stay on their parents’ health plans until they are 26. There would be no discrimination against preexisting conditions and no caps on annual or lifetime coverage, she said.

Other key features of the legislation include a provision allowing states to automatically enroll eligible people in health plans unless they opt out. The plan also promotes health savings accounts and price transparency requiring hospitals and other providers to disclose costs so consumers can shop around for the best price.

After the ACA repeal….

January 17, 2017by Robert Whitcomb in Uncategorized tagged ,

 

Timothy Jost, writing in Health Affairs, comments on the possible effects of the Republicans repealing the Affordable Care Act. Among his remarks:

“The CBO  {Congressional Budget Office} projects that the repeal legislation would not have an immediate dramatic effect in 2017 because premium increases would already be established and enrollment set for 2017. In 2018, however, 18 million people would become uninsured, including 10 million fewer enrollees in the nongroup (or individual) insurance market, 5 million fewer with Medicaid coverage, and 3 million fewer with employment coverage. ”

“In the year following the repeal of the Medicaid expansions and premium tax credits, the number of people without health insurance would grow to 27 million, further increasing to 32 million by 2026. If Congress repealed the insurance reforms as well, the number of uninsured people would only grow to 21 million in the year following repeal and to 23 million by 2026 (although coverage would be less comprehensive and individuals with pre-existing conditions may be unable to find coverage). The increase in the uninsured of 32 million would be the net result of 23 million fewer nongroup market enrollees, 19 million fewer covered by Medicaid, and 11 million more enrolled in employer coverage. In total, 59 million would be uninsured; 21 percent of the population.’’

“CBO projects that the repeal of the individual mandate, premium tax credits, and Medicaid expansions would destabilize the nongroup market and that the destabilizing effects would worsen over time. In the first year after the repeal of the marketplace subsidies took place, nongroup market premiums would increase by 50 percent relative to current law projections and about half of the population would live in states with no insurer participation in the nongroup market. By 2026, nongroup market premiums would double and three-quarters of the population would live in states with no insurers in the nongroup market. Fewer than 2 million people would have nongroup market coverage.’’

To read his entire article, please hit this link.

 

GOP should avoid Medicare third rail

January 11, 2017by Robert Whitcomb in Uncategorized tagged , , ,

rail

Rodney Whitlock writes in Health Affairs:

“Republicans have expressed interest in repealing and replacing the Affordable Care Act (ACA), restructuring Medicare to a premium support model, and reforming Medicaid through either block grants or per capita caps. Taking on all three programs is an extremely heavy lift — both politically and legislatively. If it is improbable to do all three, Republicans should openly acknowledge that they are taking Medicare restructuring off the table. This is not meant to belittle the importance of Medicare as a fiscal issue. The reality is that this election was in no way a mandate for major Medicare restructuring, and the President-elect came out rather strongly against the concept during the campaign.

“With premium support-style Medicare reform off the table, the political calculus changes dramatically for the Democrats. The Democrats have been revving up the Medicare privatization rhetoric that has been politically beneficial since 1995. Without Medicare as a rallying point, Democrats would be forced to defend the Affordable Care Act (ACA) which is relatively unpopular and in need of reconsideration. Refusing to engage might not be in their political interest. And while the Medicaid program is critical to the people it serves, it has not been shown to be the salient political issue that drives voters the way Medicare has.”

Of course Medicare has long since become a political third rail because elderly people vote at very high rates compared to younger and/or poorer folks.

To read Mr. Whitlock’s full piece, please hit this link.

Trump’s HHS pick dislikes Medicare bundles program

January 3, 2017by Robert Whitcomb in Uncategorized tagged , , , , , , , , ,

hip

By RACHEL BLUTH

Kaiser Health News

A recent change in how Medicare pays for joint replacements is saving millions of dollars annually — and could save billions — without impacting patient care, a new study has found. But the man whom Donald Trump has picked to be the secretary of  the Department of Health and Human Services has vocally opposed the new mandatory payment program and is likely to revoke it.

Under the new program, Medicare effectively agrees to pay hospitals a set fee — a bundled payment — for all care related to hip- or knee-replacement surgery, from the time of the surgery until 90 days after. Traditionally hospitals collect payments for many components of care and rehabilitation individually.

Tom Price, M.D., the president elect’s HHS nominee, a congressman from Georgia and a very affluent orthopedic surgeon, has actively opposed the idea of mandating bundled payments for these orthopedic operations, calling it “experimenting with Americans’ health,” in a letter to the Medicare agency just last September. In addition, the agency which designed and implemented the experiment, the Center for Medicare and Medicaid Innovation, was created by the Affordable Care Act to devise new methods for encouraging cost-effective care. It will disappear if the act is repealed, as President-elect Trump has promised to do.

The study appeared Jan. 3 in the Journal of the American Medical Association. Though one of its authors is Ezekiel Emanuel, M.D., a professor at the University of Pennsylvania who helped design the ACA, the research relies on Medicare claims data from 2008 through mid-2015, long before the presidential election.

Starting in April 2016, CMS required around 800 hospitals in 67 cities to use the bundled payment model for joint replacements and 90 days of care after the surgery as part of the Comprehensive Care for Joint Replacement program. The program had previously been road-tested on a smaller number of hospitals on a voluntary basis, which formed the focus of the research.

The study found that hospitals saved an average of 8 percent under the program, and some saved much more. Price has been skeptical that bundled payments did save money, but the researchers estimate that if every hospital used this model, it would save Medicare $2 billion annually.

The bundled payment program works like this: For some specific kinds of medical procedures, including joint replacements or some heart surgeries, the Centers for Medicare & Medicaid Services will add up the costs for the entire episode, from the hospital stay and medical supplies to the rehabilitation afterwards. If the total costs are below a target set by CMS, the hospital gets to keep the savings. If not, the hospital has to pay Medicare the difference. It’s supposed to incentivize more efficient spending and better care coordination between providers, so they can lower costs.

In practice, it seems to be working. Baptist Health System, a network of five hospitals in San Antonio, saved an average of $5,577 on each joint replacement without sacrificing the quality of care, according to the study. Baptist was an early adopter of bundled payments; it began experimenting with them in 2008. Over seven years, the hospital system has cut Medicare’s costs on knee replacements by almost 21 percent.

The savings came without impacting quality. Patients at Baptist Health System were just as likely to be readmitted to the hospital or end up in the emergency room as patients nationally. There was some indication that quality of care may be better, fewer patients under bundled payments had long, extended hospital stays.

In Price’s letter from September, he said that Medicare had exceeded its powers in imposing such bundled payments, which he said took decisions out of the hands of doctors and patients.

That doesn’t seem to be the case, according to Amol Navathe, M.D., an assistant professor of medicine and health policy at the University of Pennsylvania, and one of the authors of the JAMA study. Instead, Navathe and his colleagues suggest that the bundled payments actually fostered greater collaboration between surgeons, administrators and patients because programs could only succeed in saving money if physicians were engaged in creating standardized pathways for care.

For example, the Baptist Health System saved about 30 percent on implant costs, around $2,000 on each artificial joint, by using the least expensive medically equivalent implants as determined by the hospitals’ surgeons.

Usually, physicians are prevented from benefitting when hospitals save money because of anti-kickback laws. Waivers under bundled-payment models mean that surgeons can put in the time to find the best, most cost-effective implants, and share in some of that savings.

“It takes that extra level of effort and coordination, and proactively communicate with [patients],” Navathe said. “Preplanning, setting of expectations and communicating up-front is resource intensive, when they have the incentive to do that they were willing to expend the extra resources to make that happen.”

When bundles included care after a patient’s hospital stay, spending on rehabilitation went down 54 percent. That’s because hospitals took the time to match patients to the right level of care, Navathe said.

Patients who didn’t need to stay in a nursing home or rehab center were set up with home health care or physical therapy.

Price has objected to CMS making bundled payments mandatory, calling it an instance of federal overreach. But bundled payments only work if everyone has to participate, according to Darshak Sanghavi, M.D., the former director of prevention and population health at the Center for Medicare and Medicaid Innovation.

If hospitals can choose whether or not to participate, only the ones that are already delivering care efficiently –and coming in under CMS’s cost target — will use bundles and Medicare will constantly be paying out bonuses. The system needs to be mandatory, Sanghavi said, to pull in less efficient hospitals and give them incentive to change.

“Stopping the programs for ideological reasons I think impedes innovation in a way that is going to consign us to having really, really high costs of care that’s going to continue in the future,” Sanghavi said.

Bundled payments aren’t just for hip and knee replacements. On Dec. 20, CMS announced it would expand mandatory bundled payments to treatments for heart attacks, bypass surgery and cardiac rehab beginning in July 2017. In its waning days, the Obama administration is effectively throwing down the gauntlet to the incoming administration on bundled payments, one of its signature reforms.

AHA warns of clinical, fiscal disaster if ACA repealed

December 7, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

The American Hospital Association (AHA) and Federation of American Hospitals (FAH) warn of  possible clinical and financial catastrophe if the Affordable Care Act is repealed, as the Republicans have vowed to do.  They  released this statement:

“The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) {have} sent letters to President-elect Trump and Congressional leaders highlighting a new report that details the impact a potential repeal of the Affordable Care Act (ACA) would have on hospitals and health systems as they strive to care for their communities.”

To read the report, please hit this link.

The AHA and FHA press release went on:

Rick Pollack, AHA president and CEO, and Chip Kahn, FAH president and CEO, stressed that health coverage is key to ensuring patients have access to the care they need.  They noted that any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage to those who would lose it.  They also highlighted the important role hospitals play in providing essential medical services and critical public health infrastructure.

It appears Congress is moving to reconsider the ACA in the early days of the new year without enacting accompanying legislation specifically guaranteeing similar coverage for those who will lose it.  If that approach is taken, they asked that any repeal legislation prospectively restore key hospital reductions included in the ACA to offset the cost of providing coverage. In that instance, the groups stated:

“… [W]e respectfully urge you to also include in such legislation the prospective repeal of funding reductions for Medicare and Medicaid hospital services for patient care that were included in the ACA for purposes of helping fund coverage for the insured. Specifically, we seek your support for the restoration of the Medicare hospital inflation update, as well as Medicare and Medicaid Disproportionate Share Hospital (DSH) payments that support those facilities that take care of high volumes of uninsured, poor and disabled Americans. Restoring these cuts for the future is absolutely essential to enable hospitals and health systems to provide the care that the patients and communities we serve both expect and deserve.”

The report, which was commissioned by the AHA and FAH, was prepared by the health care economics firm Dobson/ DaVanzo. The report finds that, under the most recent repeal without replacement bill, H.R. 3762, hospitals would face a net negative impact of $165.8 billion from 2018-2026 after accounting for the restoration of the Medicaid DSH cuts that H.R. 3762 contemplates. It also found that hospitals would suffer a loss of $289.5 billion in Medicare inflation updates if the payment reductions in the ACA are not restored. Finally, the study authors calculate that the impact of retaining the Medicare and Medicaid DSH reductions would amount to $102.9 billion.

“Losses of this magnitude cannot be sustained and will adversely impact patients’ access to care, decimate hospitals’ and health systems’ ability to provide services, weaken local economies that hospitals help sustain and grow, and result in massive job losses. As you know, hospitals are often the largest employer in many communities, and more than half of a hospital’s budget is devoted to supporting the salaries and benefits of caregivers who provide 24/7 coverage, which cannot be replaced,” wrote Pollack and Kahn.

The letter also calls attention to a second Dobson | DaVanzo analysis that estimates the cumulative federal payment reductions to hospital services that have been imposed through other Congressional and Executive Branch actions subsequent to and independent of the ACA. These reductions alone total another $148 billion from 2010 – 2026, and come on top of the ACA reductions.

Pollack and Kahn concluded the letter by committing to work with the President-elect Trump and Congress during this challenging process and reiterating the importance of properly funding hospital services.

They wrote, “As you begin reconsideration of the ACA, we want to be a constructive partner in this discussion. We strongly believe that any repeal legislation must be accompanied by provisions that protect the coverage for those currently receiving such protection. However, if that is not the legislative path to be pursued, then it is vital that such legislation provide a true clean slate and also include repeal of the reductions in payments for hospitals services embedded in the ACA – specifically the substantial reductions to hospitals’ annual inflation updates and the cuts to Medicare and Medicaid DSH payments. If the coverage associated with the ACA disappears, the importance of these payments would be heightened – they are vital in helping defray the costs of treating our most vulnerable patients.”

 

Trying to make sense of Ryan’s Medicare reform

December 7, 2016by Robert Whitcomb in Uncategorized tagged , , , , , ,

circus

Herewith some points to help understand House Speaker Paul Ryan’s proposal to overhaul Medicare:

His plan calls changing the program so that individuals eligible for Medicare would get a fixed contribution from the Feds to put toward buying private insurance.

The idea is to boost payer competition and encourage more cost- consciousness in beneficiaries as they select plans.  The hope is that giving beneficiaries  a choice of various health plans will lead payers to offer more competitive prices, leading to lower premiums.

Many Republican senators have said that they want to focus on “repealing” the Affordable Care Act and not touch Medicare for a year.  But the tricky thing is that the ACA is interwoven with Medicare.

Meanwhile, Democrats senators strongly oppose privatizing  Medicare.

And President-elect Trump  himself may also present an obstacle for Medicare changes, which could be very, very unpopular with many voters. In the past, he has said that he would not cut Medicare, Social Security or Medicaid. Of course, he says wildly conflicting things all the time, so who knows?

His transition Web site includes a promise to “modernize Medicare, so that it will be ready for the challenges with the coming {it is actually already underway} retirement of the Baby Boom generation — and beyond.” His nomination of Tom Price, M.D., as secretary of health and human services, might signal Medicare reform; Dr. Price has said that Republicans could push Medicare reform through a “fast-track budget procedure” to  would void a Democratic filibuster.

But are they willing to take the heat from millions of elderly people if they do?

 

Court stays cost-sharing cut payment case

December 6, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

Timothy Jost writes in Health Affairs:

”{T}he Circuit Court of Appeals for the District of Columbia acceded to the request of the House of Representatives and stayed further proceedings in House v. Burwell pending further motions by the parties, due by February 21, 2017. In this case, the House of Representatives claims that government payments to insurers to reimburse them for reducing cost sharing for silver plan marketplace enrollees with incomes not exceeding 250 percent of the poverty level are illegal because Congress has not appropriated the funds for those payments.

“The ACA requires insurers to reduce cost-sharing for these enrollees and the government to reimburse them. However, the House and the Obama administration have taken different positions as to whether money has in fact been appropriated for the reimbursement payments. The lower court sided with the House.”

Mr. Jost opines:

“The reasonable course for Congress at this time is to appropriate funds to cover the cost-sharing reduction payments for 2017 (and 2018 to avoid a collapse of the marketplaces at the end of 2017), and then to negotiate with the Trump administration the withdrawal of the appeal and the vacating of the district court’s order with the administration. Until Congress appropriates these funds, the Trump administration should delay the resolution of the appeal and leave the district court’s stay of its order in place. These actions will undoubtedly be difficult for some Republicans to accept, but the alternative should be far more distasteful.”

To read the whole article, please hit this link

5 reactions to HHS and CMS nominees

November 30, 2016by Robert Whitcomb in Uncategorized tagged , , , , , , , , , , , , ,

comic

Becker’s Hospital Review asked five figures in the healthcare industry for their reactions to President-elect Trump’s selection of Georgia Congressman Tom Price, M.D., to be secretary of the Department of Health & Human Services and Seema Verma, founder and CEO of health-policy consultancy SVC, to be administrator of the Centers for Medicare & Medicaid Services (CMS).

Ted Shaw, president and CEO of the Texas Hospital Association:


“Trump’s nominees to lead the national conversation on healthcare both have long careers in health policy. Their depth of understanding of complex health policy issues will be essential as Congress debates the future of healthcare reform and states continue their work to more effectively manage their Medicaid programs.”

Chip Kahn, president and CEO of the Federation of American Hospitals:


“The Federation of American Hospitals congratulates Chairman Tom Price on his nomination to be HHS Secretary.

“His decades of experience in the medical field make him uniquely qualified to confront the challenges facing patients, families, and caregivers. As chairman of the Budget Committee, he has proven to be a thoughtful, detail-oriented legislator who cares deeply about public policy. In light of expected legislative action on the ACA, it is noteworthy that his repeal and replace proposal recognizes the need to protect access to hospital care for millions of Americans by restoring deep Medicare and Medicaid cuts. ”

“President-elect Trump’s selection to lead CMS, Seema Verma, has a solid reputation as an effective innovator in assisting states in reforming and modernizing Medicaid programs for low-income Americans.”

To read the whole piece, please hit this link.

Donald W. Fisher, president and CEO of AMGA:
“AMGA offers its congratulations to Rep. Tom Price (R-Ga.) on his nomination to become the next secretary of the United States Department of Health and Human Services. From his experience as a practicing physician for nearly 20 years and his leadership on the House Ways and Means Committee, House Budget Committee, and the House GOP Doctors Caucus, he brings a wealth of clinical and policy expertise.”

Bruce Siegel, M.D., President and CEO of America’s Essential Hospitals:


Ms. Verma “offers a deep understanding of healthcare delivery and policymaking and can contribute an important state-level perspective on Medicaid, insurance and public health.”

Jodi Magee, president of Physicians for Reproductive Health:


“President-elect Trump’s plan to nominate Rep. Tom Price (R-Ga.) to be the Secretary of Health & Human Services (HHS) signals an alarming direction for reproductive health. Price has been a staunch opponent of women’s health and the Affordable Care Act during his time in Congress.

“Although Price has insisted that ‘patients, families and doctors should be making health decisions, not Washington, D.C.,’ he has directly contradicted that by supporting legislative efforts that interfere in the patient-doctor relationship. For example, Price has voted for anti-choice legislation that would harm our doctor’s patients, including bans on abortion, defunding Planned Parenthood and repealing the Affordable Care Act. We are deeply troubled that Price, though he is a physician, seems to disregard the strong medical evidence that access to safe and legal abortion and contraception protects not just a woman’s health, but that of her family and community.”

To read the whole piece, please hit this link.

GOP ideologues will have to face healthcare math

November 28, 2016by Robert Whitcomb in Uncategorized tagged , , ,

oldhand

Princeton healthcare economist Uwe Reinhardt writes in Vox that the Republicans can repeal the Affordable Care Act but they can’t repeal the mathematics of healthcare and especially the huge expense of caring for the chronically ill. He notes that:

In 2013, 10 percent of patients accounted for nearly two-thirds of healthcare spending and 1 percent accounted for more than a fifth of spending.

He says that a central question is: “Which treatments should high-cost patients receive and how should they be financed?’’

The ACA subsidizes care for high-cost patients through  such provisions as the individual mandate and community rating premiums, which  force younger, healthier individuals to pay more than their “fair” share in premiums. Republican ideology against the ACA targets rising premiums, but, he notes,  “the health insurance debate will be driven mostly by actuarial logic, not ideology.”

The GOP will face the problem of how to finance healthcare for the very sick  — and generally older — part of the population. Giving everybody a refundable tax credit, as proposed by House Speaker Paul Ryan’s “A Better Way,” wouldn’t do much for a very sick person charged very high actuarially “fair” premiums.

The complaints by younger, healthier people about what they see as their too-high premiums and co-pays ignore the reality of all health insurance, if it is to work  — that the healthier must help subsidize the unhealthy, and that younger, healthier people should bear in mind that they, too, will eventually get sick as they age.

As Vox’s Sarah Kliff points out, Mr. Ryan’s proposal “makes insurance better for people who are young and healthy. It makes insurance worse for people who are old and sick.”

Mr. Reinhardt asks if GOP-run government will be “content to leave millions of Americans without the benefits of health insurance, and the access to essential healthcare it provides.”

There would be quite a political reaction t0 throwing the 22 million people who have gained health insurance through the ACA off the insurance rolls.

To read Professor Reinhardt’s piece, please hit this link.

GOP threats may cause insurers to quit exchanges

November 22, 2016by Robert Whitcomb in Uncategorized tagged ,

flee

”Greeks fleeing the Destruction of Psara in 1824,” by Nikolaos Gyzis.

Many observers think that Republican threats to dissolve the Affordable Care Act could lead many insurers to bail out of the insurance marketplaces for individuals at the end of next year.

No one seems to know whether the right-wing Republicans about to control the federal government will carry out their threat to immediately kill the ACA in January or more gradually dissolve it. But even the latter is bound to cause enough confusion, disruption and anxiety to push out insurers.

FierceHealthcare reported: “{E}ven  {just} the prospect of a repeal—or a reconciliation bill with a delayed effective date—would disrupt existing markets. The federal government announced earlier this month that insurers must file proposed premium rates by May 3. If there is still uncertainty surrounding the individual marketplace, payers are likely to pull out altogether….”

T0 read more, please hit this link.

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