New Census data reveals how good policy choices can cut poverty, keep Alabamians healthier
People-friendly federal policies reduced poverty and made it easier for people to get health care in 2021, U.S. Census figures released this week show. Perhaps the most eye-opening improvement was a dramatic reduction in child poverty nationwide. The recent Child Tax Credit (CTC) expansion alone kept 5.3 million Americans above the poverty line. The one-year expansion under the American Rescue Plan Act (ARPA) made the full CTC available to children living in families with low or no earnings. It increased the maximum credit to $3,000 per child and $3,600 per child under age 6. And it extended the credit to 17-year-olds. The expansion expired in 2022 after Congress failed to renew it, but lawmakers could revisit that decision later this year.Child Tax Credit improvements fuel record drop in U.S. child poverty CTC expansion helped reduce disparities for Black and Hispanic children. It also drove the U.S. child poverty rate to a record low of 5.2% under the Supplemental Poverty Measure (SPM). Unlike the traditional poverty measure, the SPM reflects the poverty-reducing effects of tax credits and non-cash benefits like food assistance. Alabama’s official child poverty rate was 22% last year under the American Community Survey (ACS), a more traditional measure that accounts for fewer factors than the SPM. That was an apparent increase from the pre-pandemic level of 21.1% in 2019, though within the margin of error. (ACS data for 2020 is unavailable due to pandemic-related data collection disruptions.) SPM data paints a fuller picture of the poverty-reducing power of supports like the expanded CTC. Alabama’s three-year average overall poverty rate under the SPM was 10.3% in 2019-21. By contrast, the state’s overall ACS poverty rate moved from 15.5% in 2019 to 16.1% in 2021. That change was not statistically significant. “The success of the Child Tax Credit expansion was undeniable,” Alabama Arise executive director Robyn Hyden said. “This policy slashed child poverty and helped families make ends meet across our state and our country. Congress needs to renew the Child Tax Credit expansion and make it permanent. And our state lawmakers should do their part to help Alabama families keep food on the table by ending the state grocery tax and replacing the revenue in a responsible way.” Uninsured rates fall nationally despite tumult of COVID-19 pandemic Federal policy choices also fueled a slight reduction in the number of uninsured Americans last year. The U.S. uninsured rate dropped to 8.6% last year, down from 9.2% in 2019. Alabama’s uninsured rate stayed relatively flat, moving from 9.7% in 2019 to 9.9% in 2021. That change was within the margin of error. Alabama continued a years-long pattern of outperforming the national average in insuring children in 2021. The state’s rate of uninsured children (4%) remained the best in the Deep South last year. Much of that sustained success is attributable to ALL Kids, the state’s Children’s Health Insurance Program (CHIP) created in 1998. ALL Kids has played a crucial role in reducing Alabama’s rate of uninsured children from 20% in the late 1990s. A key factor in the overall health coverage improvements was the federal requirement for state Medicaid programs to keep participants covered throughout the ongoing COVID-19 public health emergency declaration. That declaration may end later this year, underscoring the importance of helping many enrollees transition to new coverage. Enhanced subsidies under ARPA also helped make health coverage more affordable for millions of Americans with private plans. This includes many of the 219,000 Alabamians with marketplace plans through the Affordable Care Act. Congress renewed subsidy enhancements through 2025 in the Inflation Reduction Act, which President Joe Biden signed into law last month. “Medicaid, ALL Kids, and ACA marketplace coverage have saved and improved the lives of millions of Alabamians,” Hyden said. “Alabama should build on these successes by expanding Medicaid to help more than 340,000 people who are uninsured or struggling to afford health insurance. “It’s time for Gov. Kay Ivey to say yes to the generous federal incentives for Medicaid expansion. It’s time for her to say yes to a healthier future for Alabama.” Alabama Arise is a statewide, member-led nonprofit organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit and civic groups, grassroots leaders and individuals from across Alabama. Republished with the permission of Alabama Arise.
Robyn Hyden: We can’t wait another decade: It’s time for Alabama to expand Medicaid
It’s been a decade of missed opportunity. On June 28, 2012, the U.S. Supreme Court ruled in NFIB v. Sebelius that Alabama and other states were not required to implement the Affordable Care Act fully. The decision declared that states could opt out of expanding Medicaid to provide health coverage to adults who have low incomes and could not otherwise afford insurance. Despite the ruling, a generous offer remained on the table: The federal government would fund Medicaid expansion in its entirety for the first three years and cover 90% of the cost thereafter. Still, Alabama sat by and did little even as 17 of our hospitals have closed since 2010. We watched with no response as more than 300,000 of our friends and neighbors – folks who make too little to afford private insurance but too much to qualify for our bare-bones Medicaid program – struggled to afford needed health treatments or simply went without care. We waited for help to come as major health indicators – including labor force participation rates, maternal mortality rates, substance use disorders, and mental health outcomes – continued to languish. During those ten years, we witnessed 38 of our neighboring states take the deal that we did not. The results speak for themselves. While many of Alabama’s rural hospitals closed, Arkansas expanded Medicaid back in 2014 and retained their rural hospitals and providers. While more than 600 Alabamians die every year due to lack of health coverage, Louisiana expanded Medicaid back in 2016 and saw a reduction in premature deaths. And while Alabama lost out on more than $1 billion in additional tax revenues that would have strengthened our economy and supported our long-term economic success, our federal tax dollars went to fund health care in other expansion states, including Kentucky, Missouri, Oklahoma, and Virginia. The good news is this: A new Medicaid expansion deal is now on the table, and it is even better financially than before. The American Rescue Plan Act offers additional incentives to states that have yet to expand Medicaid to ensure we don’t miss out. With these incentives, Alabama could more than afford to provide coverage for those 300,000 friends and neighbors who are struggling to make ends meet and pay for health care. Evidence is strong that states that build a strong social safety net, including more expansive Medicaid programs, enjoy faster economic recovery from recessions than those that don’t. And these federal funds will provide the most benefit to those most harmed during the COVID-19 recession. Medicaid expansion also will help K-12 schools and universities across Alabama by generating significant increases in income and sales tax revenues – the funding sources most at risk of decline in times of economic instability. When we look back on this moment ten years from now, I’d like for the story of Medicaid expansion to be one of an embraced opportunity. Let us say Alabama’s leaders brought billions of dollars back home to invest in our health care, our economy, and our people. Let us say we weathered the ups and downs of economic instability and came out stronger. And let us say we did it all because of leaders who had the courage, the vision, and the foresight to invest today in the Alabama of 2032. Robyn Hyden is executive director of Alabama Arise, a statewide, member-led nonprofit organization advancing public policies to improve the lives of Alabamians who are marginalized by poverty. Arise’s membership includes faith-based, community, nonprofit, and civic groups, grassroots leaders, and individuals from across Alabama. Email: robyn@alarise.org.
White House, Dems hurriedly reworking $2 trillion Joe Biden plan
The White House and Democrats are hurriedly reworking key aspects of President Joe Biden’s $2 trillion domestic policy plan, trimming the social services and climate change programs and rethinking new taxes on corporations and the wealthy to pay for a scaled-back package. The changes come as Biden more forcefully appeals to the American public, including in a televised town hall Thursday, for what he says are the middle-class values at the heart of his proposal. Biden mentioned during the evening event the challenge he faces in wrangling the sharply divergent factions in the Democratic party to agree to the final contours of the bill. With an evenly divided Senate, he can’t afford to lose a single vote, and he is navigating the competing demands of progressives, who want major investments in social services, and centrists, who want to see the price tag on the package come down. “When you’re president of the United States, you have 50 Democrats — every one is a president. Every single one. So you gotta work things out,” he said during a CNN town hall. Still, he expressed optimism about the process, saying “I think so” when asked if Democrats were close to a deal. “It’s all about compromise. Compromise has become a dirty word, but bipartisanship and compromise still has to be possible,” he said. Biden later said the discussions are “down to four or five issues.” On one issue — the taxes to pay for the package — the White House idea seemed to be making headway with a new strategy of abandoning plans for reversing Trump-era tax cuts in favor of an approach that would involve taxing the investment incomes of billionaires to help finance the deal. Biden has faced resistance from key holdouts, in particular Sen. Kyrsten Sinema, D-Ariz., who has not been on board with her party’s plan to undo President Donald Trump’s tax breaks for big corporations or individuals earning more than $400,000 a year. The president was unusually forthcoming Thursday night about the sticking points in the negotiations with Sinema and another key Democrat, conservative Sen. Joe Manchin of West Virginia. While the president said Sinema “will not raise a single penny in taxes” on the wealthy or corporations, a White House official later clarified that the president was referring to raising the top tax rates, not the range of tax proposals, “which Senator Sinema supports.” Biden said Manchin doesn’t want to “rush” the transition to clean energy so quickly it will result in major job losses in his coal-producing state. Even as he seemed encouraged by progress, Biden acknowledged major reductions to his original vision. He signaled the final plan would no longer provide free community college but said he hoped to increase Pell Grants to compensate for the loss of the policy. “It’s not going to get us the whole thing, but it is a start,” he said. He also said that what had been envisioned as a federally paid, months-long family leave program would be just four weeks. As long-sought programs are adjusted or eliminated, Democratic leaders are working to swiftly wrap up talks, possibly in the days ahead. Talks between the White House and Democratic lawmakers are focused on reducing what had been a $3.5 trillion package to about $2 trillion in what would be an unprecedented federal effort to expand social services for millions and address the rising threat of climate change. “We have a goal. We have a timetable. We have milestones, and we’ve met them all,” said House Speaker Nancy Pelosi, D-Calif., who predicted Thursday, “It will pass soon.” An abrupt change, of course, came late Wednesday when the White House floated new ways to pay for parts of the proposal. Biden himself signaled flexibility on the tax provisions of the bill, as long as it’s paid for and it doesn’t increase taxes on those earning $400,000 or less. “I’m willing to make sure that we pay for everything,” he said when pressed on what tax proposal he’d support. The newly proposed tax provisions, though, are likely to sour progressives and even some moderate Democrats who have long campaigned on scrapping the Republican-backed 2017 tax cuts that many believe unduly reward the wealthy and cost the government untold sums in lost revenue at a time of gaping income inequality. Many are furious that perhaps a lone senator could stymie that goal. The chairman of the tax-writing Ways & Means Committee, Rep. Richard Neal, D-Mass., said he spoke for more than 30 minutes with the centrist Arizona senator, whose closely held views are a mystery to her colleagues. “I said, Kyrsten, you and I both know this has got to pass. She said: ‘I couldn’t agree more,’” Neal told reporters at the Capitol. Sinema’s office did not respond to a request for comment. Under existing law passed in 2017, the corporate tax rate is 21%. Democrats had proposed raising it to 26.5% for companies earning more than $5 million a year. The top individual income tax rate would go from 37% to 39.6% for those earning more than $400,000, or $450,000 for married couples. Under the changes being floated, the corporate rate would not change. But the revisions would not be all positive for big companies and the wealthy. The White House is reviving the idea of a minimum corporate tax rate, similar to the 15% rate Biden had proposed this year. That’s even for companies that say they had no taxable income — a frequent target of Biden, who complains they pay “zero” in taxes. The new tax on the wealthiest individuals would be modeled on legislation from Sen. Ron Wyden, D-Ore., chairman of the Senate Finance Committee. He has proposed taxing stock gains of people with more than $1 billion in assets — fewer than 1,000 Americans. Other tax options are also being considered, and Democrats are almost certain to include a provision to beef up the Internal Revenue Service to go after tax dodgers. Biden and his party are trying to shore up middle-class households, tackle climate
Medicaid expansion incentives under review
Alabama Republicans for years have opposed expanding Medicaid eligibility. Now, they may be cracking the door. Alabama Gov. Kay Ivey and legislative leaders said they are reviewing details of the nearly $2 trillion coronavirus relief package that includes new financial incentives for the states that have opted against expanding Medicaid to provide health coverage for more low-income Americans. A spokeswoman for Ivey said the governor is “open to the discussion” on expansion but that state leaders need additional information about the long-term cost projections. “Ensuring every Alabamian has access to quality health care is important to the governor and always has been a priority of hers. However, as she has made clear, the problem has always been how to pay for it. She is open to the discussion, but right now, we simply do not have all the facts,” spokeswoman Gina Maiola said. Alabama is one of 12 states that have taken no action toward expanding Medicaid eligibility under the Affordable Care Act. Previous studies have estimated that expansion would add around 300,000 people to state Medicaid rolls. Republican leaders have in the past expressed opposition to expanding Medicaid, at times citing both political opposition to the Affordable Care Act passed under former President Barack Obama and concerns about cost. Medicaid expansion under the Affordable Care Act allows people with family incomes less than 138% of the federal poverty limit— or around $17,000 for an individual and $29,000 for a family of three to qualify for Medicaid. Currently, Alabama’s Medicaid program covers very few able-bodied adults. “The bulk of the people who will gain coverage are people who are working,” said Jim Carnes, a policy analyst with Alabama Arise, an advocacy group for low-income Alabamians. Already, the federal government would pick up 90% of the cost of the expansion. A 2019 study by a University of Alabama at Birmingham projected the state’s cost would be about $250 million per year, but that the state would see a resulting boost in economic activity. The federal relief bill offers a new incentive by giving states a 5% boost to the federal match over the next two years for the people they currently cover. Democrats in the Alabama Senate have estimated that would generate an additional $900 million for the state. “I just want to say to Governor Ivey, if not now, when?” Senate Minority Leader Bobby Singleton said in the press conference. “I don’t care if we call it ObamaCare. We could call it Kay-Care. It could be Alabama Health Care. We need to expand Medicaid and the time to do it is right now,” Singleton said. Dr. Don Williamson, president of the Alabama Hospital Association, said the calculations are complex because of the intricacies of how Alabama funds Medicaid. The cost will also depend on how many people are added to the rolls. “To me, the most important thing that Medicaid expansion does is it absolutely improves health outcomes. You get earlier cancer diagnosis. You get lower infant mortality rates. You get earlier diagnosis if diabetes,” Williamson said. State Rep. Steve Clouse, the chairman of the Alabama House of Representatives general fund budget committee, said state officials are trying to gather information about the incentives and what would be the state’s share of costs in the long run. Sen. Greg Albritton, the chairman of the Senate budget committee, expressed some skepticism about the incentives. He said the incentives sound enticing but said the state has “got to have the answers” before making a commitment. “I’m not surprised this would be the same old song, the same old dance. … Buying a new car now. Nothing down, but the payment is due in two years,” Albritton said. Senate President Pro Tem Greg Reed said the analysis will continue over the coming weeks. The 12 states that have held out against the Medicaid expansion are: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. Republished with the permission of the Associated Press.
No sign of Donald Trump’s replacement for obamacare
As a candidate for the White House, Donald Trump repeatedly promised that he would “immediately” replace President Barack Obama’s health care law with a plan of his own that would provide “insurance for everybody.” Back then, Trump made it sound that his plan — “much less expensive and much better” than the Affordable Care Act — was imminent. And he put drug companies on notice that their pricing power no longer would be “politically protected.” Nearly three years after taking office, Americans still are waiting for Trump’s big health insurance reveal. Prescription drug prices have edged lower, but with major legislation stuck in Congress it’s unclear if that relief is the start of a trend or merely a blip. Meantime the uninsured rate has gone up on Trump’s watch, rising in 2018 for the first time in nearly a decade to 8.5 percent of the population, or 27.5 million people, according to the Census Bureau. “Every time Trump utters the words ACA or Obamacare, he ends up frightening more people,” said Andy Slavitt, who served as acting administrator of the Centers for Medicare and Medicaid Services during the Obama administration. He’s “deepening their fear of what they have to lose.” White House officials argue that the president is improving the health care system in other ways, without dismantling private health care. White House spokesman Judd Deere noted Trump’s signing of the “Right-to-Try” act that allows some patients facing life-threatening diseases to access unapproved treatment, revamping the U.S. kidney donation system and the FDA approving more generic drugs as key improvements. Trump has also launched a drive to end the HIV/AIDS epidemic. “The president’s policies are improving the American health care system for everyone, not just those in the individual market,” Deere said. But as Trump gears up for his reelection campaign, the lack of a health care plan is an issue that Democrats believe they can use against him. Particularly since he’s still seeking to overturn “Obamacare” in court. This month, a federal appeals court struck down the ACA’s individual mandate, the requirement that Americans carry health insurance, but sidestepped a ruling on the law’s overall constitutionality. The attorneys general of Texas and 18 other Republican-led states filed the underlying lawsuit, which was defended by Democrats and the U.S. House. Texas argued that due to the unlawfulness of the individual mandate, “Obamacare” must be entirely scrapped. Trump welcomed the ruling as a major victory. Texas v. United States appears destined to be taken up by the Supreme Court, potentially teeing up a constitutional showdown before the 2020 presidential election. In a letter Monday to Democratic lawmakers, House Speaker Nancy Pelosi singled out the court case. “The Trump administration continues to firmly support the recent ruling in the 5th Circuit, which they hope will move them one step closer to obliterating every protection and benefit of the Affordable Care Act,” Pelosi wrote, urging Democrats to keep health care front and center in 2020. Accused of trying to dismantle his predecessor’s health care law with no provision for millions who depend on it, Trump and senior administration officials have periodically teased that a plan was just around the corner. In August, the administrator of the Centers for Medicare and Medicaid Services, Seema Verma, said officials were “actively engaged in conversations and working on things,” while Trump adviser Kellyanne Conway suggested that same month an announcement was on the horizon. In June, Trump told ABC News that he’d roll out his “phenomenal health care plan” in a couple of months, and that it would be a central part of his reelection pitch. The country is still waiting. Meantime Trump officials say the administration has made strides by championing transparency on hospital prices, pursuing a range of actions to curb prescription drug costs, and expanding lower-cost health insurance alternatives for small businesses and individuals. One of Trump’s small business options — association health plans — is tied up in court. And taken together, the administration’s health insurance options are modest when compared with Trump’s original goal of rolling back the ACA. Since Trump has not come through on his promise of a big plan, internecine skirmishes among 2020 Democratic presidential hopefuls have largely driven the health care debate in recent months. Bernie Sanders and Elizabeth Warren are leading the push among liberals for a “Medicare for All” plan that would effectively end private health insurance while more moderate candidates, like Joe Biden, Pete Buttigieg and Amy Klobuchar, advocate for what they contend is a more attainable expansion of Medicare. Brad Woodhouse, a former Democratic National Committee official and executive director of the Obamacare advocacy group Protect Our Care, said it is important for Democrats to “put down the knives they’ve been wielding against one another on health care.” “Instead turn their attention to this president and Republicans who are trying to take it away,” Woodhouse counseled. Some Democratic hopefuls appear to be doing just that. During a campaign stop in Memphis, Tennessee. this month, former New York Mayor Michael Bloomberg called out Trump on health care, saying the president is “determined to throw Americans off the boat, without giving them a lifeline.” Polling suggests Trump’s failure to follow through on his promise to deliver a revamped health care system could be a drag on his reelection effort. Voters have consistently named health care as one of their highest concerns in polling. And more narrowly, a recent Gallup-West Health poll found that 66 percent of adults believe the Trump administration has made little or no progress curtailing prescription drug costs. Prescription drug prices did drop 1 percent in 2018, according to nonpartisan experts at U.S. Health and Human Services. That was the first such price drop in 45 years, driven by declines for generic drugs, which account for nearly 9 out of 10 prescriptions dispensed. Prices continued to rise for brand-name drugs, although at a more moderate pace. Trump’s broadsides against the pharmaceutical industry might well have helped check prices, though drug companies have
Takeaways from the democratic presidential debate
Democrats spent more time making the case for their ability to beat President Donald Trump than trying to defeat each other in their fifth debate Wednesday night. Civil in tone, mostly cautious in approach, the forum did little to reorder the field and may have given encouragement to two new entrants into the race, Mike Bloomberg and Deval Patrick. Here are some key takeaways. IMPEACHMENT CLOUD HOVERS The impeachment inquiry of President Donald Trump took up much of the oxygen early in the debate. The questions about impeachment did little to create much separation in a field that universally condemns the president. The candidates tried mightily to pivot to their agenda. Massachusetts Sen. Elizabeth Warren talked about how a major Trump donor became the ambassador at the heart of the Ukraine scandal, and reiterated her vow to not reward ambassadorships to donors. Former Vice President Joe Biden tried to tout the investigation as a measure of how much Trump fears his candidacy. Impeachment is potentially perilous to the Democratic candidates for two reasons. A Senate trial may trap a good chunk of the field in Washington just as early states vote in February. It also highlights a challenge for Democrats since Trump entered the presidential race in 2015 — shifting the conversation from Trump’s serial controversies to their own agenda. Vermont Sen. Bernie Sanders warned, “We cannot simply be consumed by Donald Trump, because if you are you’re going to lose the election.” OBAMA COALITION Perhaps more than in any debate so far, Democrats explicitly acknowledged the importance of black and other minority voters. California Sen. Kamala Harris said repeatedly that Democrats must reassemble “the Obama coalition” to defeat Trump. Harris, one of three black candidates running for the nomination, highlighted black women especially, arguing that her experiences make her an ideal nominee. Another black candidate, New Jersey Sen. Cory Booker, added: “I’ve had a lot of experience with black voters. … I’ve been one since I was 18.” Neither Booker nor Harris, though, has been able to parlay life experiences into strong support in the primary, in no small part because of Biden’s strong standing in the black community. Biden’s standing is also a barrier to other white candidates, including South Bend, Indiana, Mayor Pete Buttigieg, who is surging in overwhelmingly white Iowa but struggling badly with black voters in Southern states like South Carolina that have proven critical to previous Democratic nominees. Buttigieg acknowledged as much, saying he welcomes “the challenge of connecting with black voters in America who don’t yet know me.” The exchanges show that candidates seemingly accept the proposition that the eventual nominee will have to put together a racially diverse coalition to win, and that those whose bases remain overwhelmingly white (or just too small altogether) aren’t likely to be the nominee. CLIMATE CRISIS GETS AIR The climate crisis, which Democratic voters cite as a top concern, finally gained at least some attention. There were flashes of the debate Wednesday night, as billionaire environmental activist Tom Steyer swiped at Biden by suggesting the former vice president wants an inadequate, piecemeal approach to the crisis. Biden hit right back, reminding Steyer that he sponsored climate legislation as a senator in the 1980s while Steyer built his fortune in part on investments in coal. Buttigieg turned a question about the effects of Trump’s policies on farmers into a call for the U.S. agriculture sector to become a key piece of an emissions-free economy. But those details seem less important than the overall exchange — or lack thereof. Perhaps it’s the complexities of the policies involved. Or perhaps it’s just the politics. Whatever the case, the remaining field simply doesn’t seem comfortable or willing to push climate policy to the forefront, and debate moderators don’t either. HEALTH CARE GROUNDHOG DAY Before every debate, Democratic presidential campaigns aides lay out nuanced, focused arguments their candidates surely will make on the stage. And every debate seems to evolve quickly into an argument over health care. So it was again. Within minutes of the start, Warren found herself on the defensive as she explained she still supports a single-payer government run insurance system — “Medicare for All” — despite her recent modified proposal to get there in phases. Not to be outdone, Sanders reminded people that he’s the original Senate sponsor of the “Medicare for All” bill that animates progressives. “I wrote the damn bill,” he quipped. Again. Biden jumped in to remind his more liberal rivals that their ideas would not pass in Congress. The former vice president touted his commitment to adding a government insurance plan to existing Affordable Care Act exchanges that now sell private insurance policies. The debate highlights a fundamental tension for candidates: Democratic voters identify health care as their top domestic policy concern, but they also tell pollsters their top political priority in the primary campaign is finding a nominee who can defeat Trump. The top contenders did nothing to settle the argument Wednesday, instead offering evidence that the ideological tug-of-war will remain until someone wins enough delegates to claim the nomination. DID YOU HEAR THE ONE … The debate was so genial that some of the most memorable moments were the candidates’ well-rehearsed jokes. Asked what he’d say to Russian President Vladimir Putin if he’s elected to the White House, technology entrepreneur Andrew Yang said his first words would be, “Sorry I beat your guy.” Minnesota Sen. Amy Klobuchar drew laughs for an often-repeated anecdote about how she set a record by raising $17,000 from ex-boyfriends during her first campaign. She also pushed back at fears of a female candidacy by saying, “If you think a woman can’t beat Donald Trump, Nancy Pelosi does it every day.” Booker, criticizing Biden for not agreeing to legalize marijuana, said, “I thought you might have been high when you said it.” And Harris may have issued the zinger of the night at the president when discussing his nuclear negotiations with North Korea: “Donald Trump got
Donald Trump touts support for medicare, slams “medicare for all”
President Donald Trump intends to tout his support for Medicare and slam left-leaning Democrats on their “Medicare for All” proposal when he visits Florida on Thursday. Administration officials say Trump plans to sign an executive order that calls for a series of changes, including a broader role for Medicare’s private insurance option, as he visits The Villages, a bustling community for adults in Central Florida. That part of the state overwhelmingly supported Trump in 2016. The trip is political messaging combined with a dose of health care policy, and it comes as the Republican president angrily defends himself against House Democrats’ impeachment inquiry. Trump is calling the Medicare for All plan from Vermont Sen. Bernie Sanders a “socialist” idea that would destroy Medicare. Sanders’ “single-payer” approach would cover people of any age under a new government plan for all. Medicare administrator Seema Verma said on Thursday that Trump is a “great protector of the Medicare program” and that Sanders’ plan would “eviscerate” it. She called Sanders’ idea not just impractical but “morally wrong,” saying it would “demote American seniors to little more than second-class status.” The Sanders plan would incorporate the Medicare program, but private health insurance _ including the Medicare Advantage option used by about one-third of seniors _ would no longer have a role. Sanders, who unexpectedly underwent a heart procedure this week, says Medicare for All would offer seniors broader benefits and lower costs. Sanders’ style of single-payer health care has long been popular among liberals, but polling lately has shown that a majority of Democrats and independents who lean Democratic prefer expanding coverage by building on the Affordable Care Act, or “Obamacare.” Trump is asking federal courts to overturn that law as unconstitutional, after a Republican-controlled Congress failed to repeal it his first year in office. Trump’s executive order does not involve a major overhaul of Medicare, which would require congressional approval. Instead, it pulls together a series of technical changes and administration priorities. The subject of prescription drug costs also is sure to come up. Trump enthusiastically endorsed a plan by Florida’s Republican Gov. Ron DeSantis to allow patients to import lower-cost medicines from abroad and is pursuing a federal version. But the impeachment inquiry has cast a cloud on prospects for major legislation to reduce drug prices. Trump’s executive order is basically a to-do list for the Department of Health and Human Services. It will require months of follow-up. Among the priorities are an expansion of telemedicine and changes to avoid overpaying for procedures just because they get done in a hospital instead of a doctor’s office. Much of the order focuses on Medicare Advantage, the private insurance option under Medicare. Medicare Advantage plans offer savings on premiums and an annual limit on out-of-pocket costs. They provide one-stop shopping, eliminating the need for separate supplemental insurance. Offered by major insurers, the plans also cover prescription drugs in most cases. But there are trade-offs. Seniors joining a Medicare Advantage plan generally must accept limits on their choice of hospitals and doctors as well as prior insurer approval for certain procedures. If they change their minds and decide to return to traditional Medicare, they’re not always guaranteed supplemental “Medigap” coverage, which is also private. Health and Human Services Secretary Alex Azar said Trump’s order directs his department to examine whether its current policies and practices put traditional Medicare ahead of the private Medicare Advantage option. Some advocates for older people say that it’s the other way around and that the administration is trying to put private plans ahead. The order also would seek to expand the range of additional services that can be offered by the private plans and would direct regulators to find more ways for seniors to financially benefit from plans that provide cost-efficient service. Many Medicare Advantage insurers offer some dental and vision coverage, along with basics like transportation to medical appointments. But the industry lately has started to experiment with in-home assistance, including nutritious meals, and financial help with safety-related home improvements. As a presidential candidate, Trump promised not to cut Medicare. As president, he has avoided calling for privatization of the program or raising the eligibility age beyond 65 or rolling back benefits. However, Trump’s latest budget proposed steep cuts in Medicare payments to hospitals and other service providers, prompting protests from the industry and accusations by Democrats that he was going back on his promises to seniors. The Medicare cuts have gone nowhere in Congress, as Republicans backed away from the president’s budget. By Kevin Freking and Ricardo Alonso-Zaldivar Associated Press. Republished with the permission of the Associated Press.
Despite calls to start over, U.S. health system covers 90 percent
America’s much-maligned health care system is covering 9 out of 10 people, a fact that hasn’t stopped the 2020 presidential candidates from refighting battles about how to provide coverage, from Bernie Sanders’ call for replacing private insurance with a government plan to President Donald Trump’s pledge to erase the Affordable Care Act and start over. The politicians are depicting a system in meltdown. The numbers point to a different story, not as dire and more nuanced. Government surveys show that about 90 percent of the population has coverage , largely preserving gains from President Barack Obama’s years. Independent experts estimate that more than one-half of the roughly 30 million uninsured people in the country are eligible for health insurance through existing programs. Lack of coverage was a growing problem in 2010 when Democrats under Obama passed his health law. Now the bigger issue seems to be that many people with insurance are struggling to pay their deductibles and copays. “We need to have a debate about coverage and cost, and we have seen less focus on cost than we have on coverage,” said Colorado Sen. Michael Bennet. He is among the Democratic presidential candidates who favor building on the current system, not replacing it entirely, as does Sanders. “The cost issue is a huge issue for the country and for families,” Bennet said. A report this year by the Commonwealth Fund think tank in New York found fewer uninsured Americans than in 2010 but more who are “underinsured,” a term that describes policyholders exposed to high out-of-pocket costs, when compared with their individual incomes. The report estimated 44 million Americans were underinsured in 2018, compared with 29 million in 2010 when the law was passed. That’s about a 50 percent increase, with the greatest jump among people with employer coverage. “When you have 90 percent of the American people covered and they are drowning in their health care bills, what they want to hear from politicians are plans that will address their health care costs, more than plans that will cover the remaining 10 percent,” said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan research organization that tracks the health care system. “When Democrats talk about universal coverage more than health care costs, they are playing to the dreams of activists and progressives … much less to the actual concerns of the 90 percent who have coverage today.” Sanders’ office responds that the Vermont senator’s “Medicare for All” plan would solve both the coverage and cost problems for individual Americans. Medical care would be provided with no deductibles or copays. No one would be uninsured or underinsured.“The simple answer is that our health care system becomes more unmanageable for more and more Americans every year,” Sanders spokesman Keane Bhatt said in a statement. “This is not a system that needs a few tweaks. This is a system that needs a complete overhaul.” But other countries that provide coverage for all and are held up by Sanders as models for the U.S. don’t offer benefits as generous as he’s proposing. If he is elected president, there’s no way of telling how his plan would emerge from Congress, or even whether something like it could pass. Four other 2020 Democrats are co-sponsors of Sanders’ bill: Sens. Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California, and Elizabeth Warren of Massachusetts. On the other side of the political spectrum, Trump is talking about big changes. His administration is seeking to have federal courts declare the entire Obama-era health care law unconstitutional, jeopardizing coverage for 20 million people, jettisoning protections for patients with preexisting conditions, and upending the rest of the 970-page statute, now nearly 10 years old. The president says there’s nothing to worry about. Earlier this summer Trump told ABC News that he was working on a plan that would provide “phenomenal health care,” protect people with preexisting conditions, and would be “less expensive than ‘Obamacare’ by a lot.” White House spokesman Judd Deere said in a statement that the Obama law was “sold and passed on a litany of broken promises” and now “Democrats are proposing even more radical government takeovers of our health care system.” As president-elect, Trump promised a health plan but never offered one upon taking office. Instead he backed bills from congressional Republicans, including one he called “mean” during a private meeting. Trump says he might come out with his new plan within months, but that passing it would hinge on his getting reelected and Republicans winning back the House in 2020 while keeping control of the Senate. That’s a bit of political deja vu. Republicans controlled Washington back in 2017 when Trump, then-Speaker Paul Ryan, Republican-Wisconsin, and Senate Majority Leader Mitch McConnell, Republican-Kentucky, tried for months to repeal and replace the Obama law, only to fail. The repeal effort was widely seen as contributing to Republicans losing the House in 2018. Since then, many GOP lawmakers have tried to avoid the issue altogether. Economist Sara Collins of the Commonwealth Fund, who led the study about underinsured Americans, says cost and coverage problems are intertwined. Citing the Democrats’ debate over Medicare for All, she says what’s missing from that discussion is that “one doesn’t have to go that far in order to improve the financial situation for millions of people — you can do that with much more targeted, incremental policies.” By Ricardo Alonso-Zaldivar Associated Press. Republished with permission of the Associated Press.
Modest premium hikes as ‘Obamacare’ stabilizes
Millions of people covered under the Affordable Care Act will see only modest premium increases next year, and some will get price cuts. That’s the conclusion from an exclusive analysis of the besieged but resilient program, which still sparks deep divisions heading into this year’s midterm elections. The Associated Press and the consulting firm Avalere Health crunched available state data and found that “Obamacare’s” health insurance marketplaces seem to be stabilizing after two years of sharp premium hikes. And the exodus of insurers from the program has halted, even reversed somewhat, with more consumer choices for 2019. The analysis found a 3.6 percent average increase in proposed or approved premiums across 47 states and Washington, D.C., for next year. This year the average increase nationally was about 30 percent. The average total premium for an individual covered under the health law is now close to $600 a month before subsidies. For next year, premiums are expected either to drop or increase by less than 10 percent in 41 states with about 9 million customers. Eleven of those states are expected to see a drop in average premiums. In six other states, plus Washington, D.C., premiums are projected to rise between 10 percent and 18 percent. Insurers also are starting to come back. Nineteen states will either see new insurers enter or current ones expand into more areas. There are no bare counties lacking a willing insurer. Even so, Chris Sloan, an Avalere director, says, “This is still a market that’s unaffordable for many people who aren’t eligible for subsidies.” Nearly 9 in 10 ACA customers get government subsidies based on income, shielding most from premium increases. But people with higher incomes, who don’t qualify for financial aid, have dropped out in droves. It’s too early to say if the ACA’s turnabout will be fleeting or a more permanent shift. Either way, next year’s numbers are at odds with the political rhetoric around the ACA, still heated even after President Donald Trump and congressional Republicans failed to repeal the law last year. Trump regularly calls “Obamacare” a “disaster” and time again has declared it “dead.” The GOP tax-cut bill repealed the ACA requirement that Americans have health insurance or risk fines, effective next year. But other key elements remain, including subsidies and protection for people with pre-existing conditions. Democrats, meanwhile, accuse Trump of “sabotage,” driving up premiums and threatening coverage. The moderating market trend “takes the issue away from Republican candidates” in the midterm elections, said Mark Hall, a health law and policy expert at Wake Forest University in North Carolina. “Part of the mess is now their fault, and the facts really don’t support the narrative that things are getting worse.” Market stability also appears to undercut Democrats’ charge that Trump is undermining the program. But Democrats disagree, saying the ACA is in danger while Republicans control Washington, and that premiums would have been even lower but for the administration’s hostility. “Voters won’t think that the Trump threat to the ACA has passed at all, unless Democrats get at least the House in 2018,” said Bill Carrick, a strategist for Sen. Dianne Feinstein, D-Calif., whose re-election ads emphasize her support for the health law. As if seconding Democrats’ argument, the Trump administration has said it won’t defend the ACA’s protections for pre-existing conditions in a federal case in Texas that could go to the Supreme Court. A new Kaiser Family Foundation poll found that Americans regardless of partisan identification said those protections should remain the law of the land. In solidly Republican Arkansas, Democratic state legislator and cancer survivor Clarke Tucker is using the ACA in his campaign to try to flip a U.S. House seat from red to blue. Tucker, 37, says part of what made him want to run is the House vote to repeal the ACA last year and images of Trump and GOP lawmakers celebrating at the White House. Business analysts say the relatively good news for 2019 is partly the result of previous premium increases, which allowed insurers to return to profitability after losing hundreds of millions of dollars. “They can price better, and they can manage this population better, which is why they can actually make some money,” said Deep Banerjee of Standard & Poor’s. Repeal of the ACA’s requirement to carry insurance doesn’t seem to have had a major impact yet, but Banerjee said there’s “a cloud of uncertainty” around the Trump administration’s potential policy shifts. Yet some administration actions have also helped settle the markets, such as continuing a premium stabilization program. April Box of Spokane Valley, Washington, lives in a state where premiums could rise substantially since insurers have proposed an 18 percent increase. In states expecting double-digit increases, the reasons reflect local market conditions. Proposed increases may ultimately get revised downward. Box is self-employed as a personal advocate helping patients navigate the health care system. She has an ACA plan, but even with a subsidy her premiums are expensive and a high deductible means she’s essentially covered only for catastrophic illness. “I’m choosing not to go to the doctor, and I’m saying to myself I’m not sick enough to go to the doctors,” Box said. “We need to figure out how to make it better and lower the price.” Now in her 50s, Box was born with dislocated hips. She worries she could be uninsurable if insurers are allowed to go back to denying coverage for pre-existing conditions. She might need another hip surgery. “It needs to be a level playing field for everybody,” said Box. “We need to have universal coverage — that is really the only answer.” Tennessee is a prime example of the ACA’s flipped fortunes. Last year, the state struggled to secure at least one insurer in every county. But approved rates for 2019 reflect an 11 percent average decrease. Two new insurers — Bright Health and Celtic— have entered its marketplace, and two others —Cigna and Oscar— will expand into new counties. Tennessee Republican
Doug Jones warns Alabama may be most affected if pre-existing conditions are eliminated from ACA
U.S. Senator Doug Jones is stepping up to defend pre-existing conditions in the Affordable Care Act (ACA), which the Trump Administration argues are unconstitutional. In February, 20 attorneys general, including Alabama Attorney General Steve Marshall filed a lawsuit against the U.S. Department of Health And Human Services (HHS) arguing changes made during the 2017 tax bill made the ACA unconstitutional. “The attorneys general argue that a Supreme Court decision in 2012 saved the ACA from being declared an unconstitutional overreach of congressional power by declaring the penalty a tax and pointing out that Congress has the power to levy taxes,” the Washington Post reported. “Without the tax penalty, they argue, ‘the Court should hold that the ACA is unlawful and enjoin its operation.’” In a court filing in June, the Trump administration specifically “urged the Texas federal court to strike down two provisions from the ACA: one that requires insurers to cover people with pre-existing conditions, and the other that prevents insurers from charging individuals a higher premium because of their pre-existing condition,” according ABC News. Jones pushes back Now, Jones is warning that Alabama may be one of the most affected states if those protections are eliminated. “I have just spent the last couple of weeks in a couple of roundtables listening to people affected: 900,000 people in Alabama affected by pre-existing conditions; and that’s just the people affected not their families,” Jones said. People are scared to death that they’ll lose protections for pre-existing conditions. I’m stunned at the way the Administration is saying they want to protect them, but at the same time taking actions that would roll back these protections. pic.twitter.com/v3tmpJfVAe — Doug Jones (@SenDougJones) August 21, 2018 “One in three Alabamians under age 65 lives with a pre-existing condition that would’ve left them with no health insurance or higher-cost insurance before the ACA was passed. That ranks Alabama among the states with the highest rates of residents with pre-existing conditions in the country and makes our state one of those hurt most if protection for pre-existing conditions is rolled back or eliminated,” Jones wrote in an Op-Ed to AL.com. “And that’s not just a possibility – these protections are under serious threat because the Trump Administration is refusing to defend key provisions of the ACA in court.”
Lower costs, fewer benefits in new Trump administration health insurance option
The Trump administration Tuesday rolled out a health insurance option for small businesses and self-employed people that could lead to lower premiums but may also cover fewer benefits than current plans. Labor Secretary Alex Acosta said the new “association health plans” will allow small business to pool their purchasing power, gaining access to some of the advantages that large employers have in the health insurance market. “Today the Trump administration helps level the playing field between large companies and small businesses,” Acosta said. “This expansion will offer millions of Americans more affordable health care options. The new plans would retain the same protections for people with pre-existing conditions, older workers, and women, that large company plans now have, Acosta added. Details were expected later Tuesday. The plans could be marketed across state lines within a geographic region to businesses in a given industry — auto repair shops, for example. Or a local chamber of commerce could sponsor one in a given community. The plans could be sold to self-employed people, like musicians. Allowing interstate marketing within a geographic region represents a shift from the original concept that the plans would be offered nationwide. President Donald Trump has long asserted that promoting the sale of health insurance across state lines can bring down premiums without sacrificing quality. But many experts weren’t convinced, because medical costs vary greatly according to geography. Ultimately, the idea’s success depends on buy-in from plan sponsors, consumers, insurers and state regulators. No major consequences are expected for people covered by large employers. Acosta cited enrollment estimates that predict a modest impact: about 4 million people covered by the plans within a few years, including 400,000 who would have been uninsured. Compare that to the total number of about 160 million covered by job-based insurance. After Republicans hit a dead end trying to repeal the Affordable Care Act, the Trump administration has pushed regulatory actions to loosen ACA requirements and try to lower premiums for individuals and small businesses, which now reflect the cost of comprehensive coverage. Another major initiative is expected later this summer when the administration eases rules for short-term health plans lasting less than a full year that could be purchased by individuals. Those plans wouldn’t have to cover people with pre-existing conditions, but would offer healthy people much lower premiums. Critics say the administration’s approach will draw healthy people away from the Obama health law’s insurance markets, raising the cost of coverage, which is subsidized by taxpayers. About 11 million people are covered by HealthCare.gov and state markets, but the administration’s priority is to try to lower premiums for another 7 million or so who buy their coverage directly and don’t get any help from the government. “To the extent that these plans develop and serve as a parallel market, that could have a destabilizing effect,” said Karen Pollitz of the nonpartisan Kaiser Family Foundation, an expert on individual health insurance. Pollitz also served as a consumer protection regulator in the Obama administration. “People who think they can get by without those (comprehensive) benefits will look for cheaper premiums,” she added. State insurance regulators have been concerned about association health plans because similar plans in the past had problems with financial solvency and fraud. Administration officials said Tuesday that states and the federal government would share regulatory oversight of the plans, with states retaining their current authority. The new plans will be phased in, starting in September. A small business group called Job Creators Network welcomed the Trump administration move. Group president Alfredo Ortiz said it “will create more options, more competition, and lower costs for Main Street small businesses.” Republished with the permission of the Associated Press.
Justice Department move on health law has risks for GOP
The Trump administration’s decision to stop defending in court the Obama health law’s popular protections for consumers with pre-existing conditions could prove risky for Republicans in the midterm elections — and nudge premiums even higher. The Justice Department said in a court filing late Thursday that it will no longer defend key parts of the Affordable Care Act, beginning with the unpopular requirement that people carry health insurance, but also including widely-supported provisions that guarantee access for people with medical problems and limit what insurers can charge older, sicker adults. Friday, the insurance industry warned in stark terms of “harm that would come to millions of Americans” if such protections are struck down, causing premiums “to go even higher for older Americans and sicker patients.” Weighing in on a Texas challenge to the health law, the Justice Department argued that legally and practically the popular consumer protections cannot be separated from the unpopular insurance mandate, which Congress has repealed, effective next year. That argument is likely to be lost on consumers, said Robert Blendon, a polling expert at the Harvard T.H. Chan School of Public Health — particularly in the heat of an election that will determine control of Congress. “The pre-existing condition thing is what the ads will be run on,” said Blendon. “Pre-existing conditions have gotten to be an issue that people walking on the streets understand … it’s very emotional.” Some Democratic politicians didn’t waste much time. “Democrats will not allow Republicans to get away with quietly trying to strip away pre-existing conditions protections for millions of Americans through a legal backdoor,” said Rep. Frank Pallone, D-N.J., a spokesman for his party on health care. Senate Democratic Leader Chuck Schumer of New York urged President Donald Trump to reverse the decision. Administration officials at the departments of Health and Human Services and Treasury would not comment, instead pointing to the Justice Department filing, which said other parts of the health law would continue to stand, including its Medicaid expansion covering about 12 million low-income people. HHS and Treasury administer the health law’s coverage and subsidies. Loosening the health law’s rules on pre-existing conditions and on charging more to older adults is a key goal for the Trump administration. Partly that’s because those consumer protections also raise premiums across the board, as the cost of covering the sick is spread among all customers, including healthier people who previously benefited from lower rates. Indeed, people who pay the full cost of their individual health plans and aren’t eligible for subsidies under the health law have been clamoring for relief from several years of double-digit premium increases. Economist Gail Wilensky, who’s advised Republicans, said she’s not sure about the timing of the administration’s action. “You can definitely assume Democrats will use it to whip up their side,” said Wilensky, administrator of Medicare under former President George H.W. Bush. “For the people not affected by the ACA, or not particularly supportive, I don’t know that it will matter much.” The issues in the court case are unlikely to be resolved quickly, but some experts said the added uncertainty could prompt insurers to seek higher premiums in 2019 for health plans sold to individuals. “Insurance companies hate uncertainty, and when they face uncertainty they tend to increase premiums and hedge their bets,” said Larry Levitt of the nonpartisan Kaiser Family Foundation. America’s Health Insurance Plans, the main industry trade group, bemoaned the Justice Department’s stance, saying it could upset a market that is becoming “more steady” for most consumers. “Zeroing out the individual mandate penalty should not result in striking important consumer protections,” the group said. It will lead to “renewed uncertainty in the individual market” and a “patchwork of requirements in the states” and make it more challenging to offer coverage next year. The lawsuit, filed in February by Texas and other GOP-led states, is in many ways a replay of the politically divided litigation that ended with the Supreme Court upholding the health care overhaul in 2012. In this case, California is leading a group of Democrat-led states in defending the law. The Trump administration’s stance is a rare departure from the Justice Department’s practice of defending federal laws in court. Attorney General Jeff Sessions said in a letter to Congress that Trump, who campaigned on repealing the law and nearly did so his first year in office, approved the legal strategy. Donald Verrilli Jr., President Barack Obama’s top Supreme Court lawyer who defended the law, called the decision “a sad moment.” “I find it impossible to believe that the many talented lawyers at the department could not come up with any arguments to defend the ACA’s insurance market reforms, which have made such a difference to millions of Americans,” Verrilli said. Shortly before the government’s court filing Thursday, three career lawyers at the Justice Department withdrew from the case and were replaced by two political appointees, according to court filings. Republished with the permission of the Associated Press.
