High uninsured rates plague Alabama’s rural areas, new report shows
Alabama’s small towns and rural areas have among the highest rates of uninsured low-income adult citizens in the country, and residents there are more likely to be uninsured than those in metro areas, according to a new report by Georgetown University’s Center for Children and Families (CCF) and the University of North Carolina’s NC Rural Health Research Program. The uninsured rate for Alabama adults with low incomes is 36 percent in rural communities and small towns, and 29 percent in metro areas. Both rates are much higher than the national averages of 26 percent for rural areas and 18 percent for metro areas. In rural areas and small towns across Alabama, the report unveiled that the uninsured rate for low-income adults has grown stagnant — it has remained virtually unchanged between 2008-09 and 2015-16. Medicaid and the uninsured Alabama Arise — a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of low-income Alabamians — believe this number could look even worse in Alabama if the Medicaid “work requirement” plan that Alabama submitted for federal approval goes through. They say it would drive the uninsured rate even higher by stripping Medicaid coverage from thousands of parents in poverty. The proposal would require 35 hours of work, job training, education or volunteer service each week. Exceptions would be made for people with young or disabled children. State officials says the proposal only impacts a small number of Medicaid recipients, able-bodied parents and caretakers who qualify because their income is less than 18 percent of the federal poverty level. Most Medicaid beneficiaries in the state are children, disabled or elderly. But Alabama Arise disagrees — they believe, virtually all of those parents would be left with no realistic alternative for affordable coverage. “Not only has Alabama failed to move forward on health coverage, but now our state is seeking to move backward by leaving even more people uninsured,” said Alabama Arise policy director Jim Carnes. “Alabama should drop its cruel efforts to punish people living in poverty and focus instead on expanding Medicaid so all Alabamians can get the care they need to become and stay healthy. Medicaid expansion would save hundreds of lives, create thousands of jobs and keep rural hospitals and clinics open to serve residents across our state.” According to the report, nationally, the uninsured rate for low-income adults fell by more than half – from 35 percent to 16 percent – in rural areas and small towns in states that expanded Medicaid. For states that have not expanded, the decline was much smaller: from 38 percent to 32 percent. “Medicaid expansion would reduce the uninsured rate for residents across the entire state; however, the most dramatic improvement likely would be felt in small towns and rural areas of Alabama,” Georgetown CCF executive director Joan Alker explained. “Improved coverage rates typically translate to a more stable health care system and help rural areas and small towns maintain availability of health care providers in areas where shortages are all too common. Access to rural health providers is especially important to women of child-bearing age and those with chronic conditions like asthma.” In July 2018, 10 of the 11 Alabama counties with the highest unemployment rates were rural counties.
Alabama Hospital Association begins campaign for Medicaid expansion
With one in every 10 patients walking into state hospitals without insurance, the Alabama Hospital Association on Thursday launched a campaign to push for expansion of the state’s Medicaid program. Politicians in the Deep South have often opposed expansion, but the Alabama Hospital Association is urging citizens and policy makers to think of expansion as they would any other economic development investment, arguing it would benefit communities and the entire state health care system in addition to the estimated 300,000 people who would gain health care coverage “Health care is part of the state’s infrastructure,” Danne Howard, executive vice president and chief policy officer of the Alabama Hospital Association, said. Twelve Alabama hospitals have closed since 2011 and Howard said 75 percent of Alabama’s hospitals are operating in the red. She said expanding Medicaid would be a “significant investment in the state’s fragile health care infrastructure and would help maintain access to care for everyone.” “One in every 10 people who walk into a hospital doesn’t have insurance. At some point those providers, those hospitals, are not going to be able to maintain operation. They are not going to be there, either closing their doors or cutting back services. At that point, it really doesn’t matter what insurance card you have in your pocket. If the provider is not there, the care is not there,” Howard said. Alabama is one of 14 states that have taken no action toward expanding Medicaid eligibility under the Affordable Care Act, according to the Henry J. Kaiser Family Foundation. Thirty-three states and the District of Columbia have approved raising income limits for Medicaid coverage under the Affordable Care Act and another three will vote this fall in ballot measures. The Urban Institute estimated that Medicaid expansion would add 314,000 people to Alabama’s Medicaid rolls. Under the Affordable Care Act, states would put up 10 percent of the cost of covering the additional Medicaid patients and the federal government would pick up the rest. Estimates on what it would cost the state have varied. Gov. Robert Bentley in 2015 estimated that expansion would cost the state $710 million dollars over six years. Other estimates have pegged the cost higher. Alabama Gov. Kay Ivey said last week that she is not opposed to Medicaid expansion, but questioned how the state would pay for it. “Medicaid expansion is desirable perhaps, but how are you going to pay for it? That’s not an issue we can tackle at this point,” the Republican told reporters. Democratic gubernatorial nominee Walt Maddox has proposed striking a gambling compact with the Poarch Creek Indians and using the state’s share of revenue to pay for the state’s cost of Medicaid expansion. At Vaughan Regional Medical Center in Selma, 10-12 percent of patients are uninsured, and 40 percent of patients are on Medicaid, said CEO David McCormack. Looming over hospitals are possible cuts to the federal Disproportionate Share Hospital program for treating a disproportionate share of the indigent. Scheduled reductions were delayed several times, but McCormack said they will have a devastating impact if they go through in 2020 as planned. McCormack said expanding Medicaid would help keep hospitals open and providing services. “I don’t want to give you a dollar, if you give me ten dollars?” McCormack said questioning the argument that the state can’t afford expansion. “First of all, why would we not want billions of dollars coming into the state?” Republished with permission from the Associated Press.
83k Alabama children may lose health insurance due to missed deadline by Congress
On September 30, federal funding for the Children’s Health Insurance Program (CHIP) expired. Across the country, states are readying themselves for what happens when their current funds run out. In Alabama, funds for ALL Kids — the state’s CHIP that is administered by the Alabama Department of Public Health (ADPH) — is poised to be depleted in February should Congress not reauthorize funding for the program. Meaning the 83,000 families who rely on the service will lose access to health care. “Our best estimates indicate that we will exhaust CHIP funds in February,” Cathy Caldwell, Director of the Bureau of Children’s Health Insurance at the Alabama Department of Public Health (ADPH) told Alabama Today. More than 83,000 children in the state are covered by All Kids program. Meanwhile, another 75,000 are covered by an Alabama Medicaid component of CHIP. ALL Kids covers eligible children that live in Alabama whose households make up to 312 percent of the poverty line — up to $51,481 a year for a household of two, up to $64,732 for a household of three, and up to $77,982 for a household of four. Qualifying families pay premiums, which range from $52 to $104 per child per year, depending on income, along with co-pays Children must also: Be under age 19 Be a U.S. citizen or an eligible immigrant Not be covered by other insurance Not be a resident in an institution Not be covered by or eligible for Medicaid At the moment Alabama has no set plans when to warn families the program is ending. “We have not yet finalized a date,” added Caldwell. On Nov. 3, the U.S. House of Representatives voted to reauthorize CHIP by a 242 to 174 vote, largely along party lines with Republicans overwhelming supporting the legislation and Democrats against it. The bill advanced to the U.S. Senate, which has yet to take up its own version that passed out of committee last month. It remains unclear if, and when, CHIP will be reauthorized.
Daniel Sutter: Mandates and the cost of kindness
Last spring Alabama’s legislature mandated coverage of autism therapy by health insurance plans. Such mandates provide benefits to people without spending our tax dollars, but threaten the viability of health insurance. The main issue for autism coverage was Applied Behavioral Analysis (ABA), an intensive therapy program with demonstrated benefits for patients. Helping persons with disabilities lead fulfilling lives is a worthwhile goal. We should celebrate a therapy helping persons with autism. But the therapy is expensive. Few families can afford the $15,000 (or more) a year cost out-of-pocket. Mandating insurance coverage spreads the cost across all patients. We decided to help autistic children receive ABA regardless of their parents’ incomes. Although some business and insurance groups opposed the mandate, the legislature still decided to help. But similar issues are sure to arise in the years to come. I think that state lawmakers should have provided this benefit out of tax dollars. Mandates contribute to the slow death of health insurance, which may lead to more extensive government involvement with health care in the future. Insurance mandates allow lawmakers to provide benefits to people without spending tax dollars. Spending state funds, by contrast, would require either increasing taxes or cutting other spending. An insurance mandate spreads out the cost; coverage might only cost a few more dollars per policy per year. Furthermore, the link between the mandate and cost increases for policyholders will be indirect. This process gets repeated over and over. States have enacted around 2,000 mandates for 70 different services over the past thirty years, about 40 per state. In each case, the coverage likely represents a “good” cause and benefits some families, like with autism therapy. The accumulation of mandates forces employers to reduce salaries or increase deductibles and co-pays. Many employees never use most of the mandated coverage. Eventually employers stop providing health insurance as a benefit, increasing the ranks of the uninsured and the constituency for further government intervention. When we decide to help autistic children receive ABA, we are spending somebody’s money. Ultimately government money is our money. Taxes are how we should pay for things that we direct government to do. Insurance mandates act like a tax, but the hidden element leads to poor decisions. Suppose that autism therapy will cost $30 million a year. If lawmakers raised taxes, citizens would see the full cost. The weak link between mandates and higher costs for policyholders makes mandates less visible; perhaps they have a perceived impact equal to $10 million in taxes. Suppose we decide that helping autistic children is worth $20 million per year. If we think that the cost is $10 million because of the mandates, this looks like a good deal. But in reality the benefits are less than the cost. Another option which might be even better is philanthropy to assist families unable to pay the full price. Charities, I think, do a much better job than government verifying need and controlling cost. Insurance creates a third party payment problem: neither the patient nor provider pays the bills, and so neither worries about cost. We can always spend more on any service. For example, Board Certified Behavioral Analysts (most expensive), Board Certified Assistant Behavioral Analysts, or registered behavioral technicians (least expensive) can provide ABA. If we ignore the cost, making greater use of Board Certified Behavioral Analysts is always attractive. We could also extend the therapy and provide it to more children. Mandates make insurance companies even less likely to contain costs since employers cannot drop mandated coverage due to expense. Government also seems unlikely to wisely control costs. Americans believe strongly in the equality of opportunity. We are willing to help children to make this a reality, by paying for things like autism therapy. When we choose to help, we should be willing to bear the cost. Insurance mandates only appear to lower the cost, and contribute to the slow implosion of the health insurance market. ••• Daniel Sutter is the Charles G. Koch Professor of Economics with the Manuel H. Johnson Center for Political Economy at Troy University and host of Econversations on TrojanVision. The opinions expressed in this column are the author’s and do not necessarily reflect the views of Troy University.
Terri Sewell promotes ACA health care open enrollment period
Alabamians who wish buy insurance on the individual market could start signing-up for plans Wednesday and Alabama’s 7th District U.S. Rep. Terri Sewell wants to be sure her constituents, and fellow Alabamians, know. The open enrollment period for EnrollALA, the state’s Affordable Care Act marketplace, runs now through December 15. “The open enrollment period is a great opportunity for my constituents to shop for new coverage with the help of premium assistance,” said Sewell. “Enroll Alabama and the free support provided by Alabama’s local health care navigators makes it easy for families to find insurance that fits their needs. Whether you already have coverage through the individual marketplace or you are looking to get covered next year, I encourage everyone to check out their health care options during the open enrollment period.” Sewell continued, “As hospitals in my district face financial challenges and families struggle to afford doctor’s visits, I am deeply disappointed by the Trump Administration’s decision to cut advertising for the open enrollment period. Too many Americans do not know how to navigate the insurance enrollment process and I believe we have a responsibility to raise public awareness about how to sign up for affordable health insurance.” “We must do everything in our power to increase coverage, reduce costs, and stabilize the insurance marketplace for all Americans.” Individuals who need assistance in signing-up may contact (844) 248-7698. A list of Alabama’s local navigators, who can provide free guidance on signing up for health care through the individual marketplace, is also available here. See Sewell’s video remarks on the beginning of open enrollment below:
Ex-Obama officials begin health insurance sign-up campaign
Former Obama administration officials are undertaking a private campaign to encourage people to sign up for coverage next year under the Affordable Care Act. With the start of open enrollment on Nov. 1, the Trump administration has slashed the Obama health law’s ad budget, as well as grants to outside organizations that are supposed to help people sign up. Although Republican attempts to repeal the law have proven futile so far, President Donald Trump hasn’t changed his view that the program is a “disaster.” The former Obama officials said their campaign, set to begin Wednesday, will focus on young adults and try to encourage people to sign up for government-backed private health insurance because of subsidies available to cushion the impact of rising premiums. The effort is headed by Lori Lodes and Joshua Peck, who directed outreach and sign-up efforts during much of former President Barack Obama‘s second term. Joining them are Andy Slavitt, who ran federal health insurance programs for Obama, activist-actors Alyssa Milano and Bradley Whitford, social commentator Van Jones and insurance industry veteran Mario Molina. Lodes said the campaign has a modest budget for now, meaning that targeted internet advertising is probably all it can manage, at least initially. About 10 million people are signed up for subsidized private insurance plans through HealthCare.gov and state-run insurance markets. That figure is well below projections when the law was passed in 2010. An additional 11 million or so have signed up for Medicaid in states that took advantage of the law’s expansion of the program to serve more low-income adults. Under Trump, the open enrollment period for 2018 has been shortened by about half. It now runs through Dec. 15. That’s the last day when people can sign up to get coverage that will be effective on Jan. 1. Some Democrats say that’s another indication that Trump is trying to “sabotage” insurance markets. But health insurers, with a vested interest in enrolling people, say a shorter, focused sign-up season period may actually be more manageable. Returning customers will be automatically re-enrolled unless they shop around and pick another plan. Health care consultant Dan Mendelson, president of data-tracker Avalere Health, said in an interview that he expects enrollment will remain relatively stable. “If you think about it, most of the people who are enrolled need the insurance,” he said. “They are heavily subsidized and they are going to show up because they need insurance for themselves and their families. I think there will be a base stability to enrollment, but I wouldn’t be looking for any major expansion.” Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., are trying to negotiate a limited bipartisan deal to stabilize state-level markets for individual health insurance policies. People covered under the health law represent about half of those who purchase individual policies. Republished with permission from the Associated Press.
Senate bargainers say deal reached on children’s health
Senate Republican and Democratic bargainers reached agreement late Tuesday to extend financing for the children’s health insurance program for five years, a pact that if approved would avert an end-of-month cash crunch for the popular program. In a concession to Republicans, the agreement would phase out extra federal funds that have gone to states for the program since the additional money was mandated as part of President Barack Obama‘s 2010 health care law. Money for the federal-state program is due to expire at the end of September. The program provides health coverage to around 8 million low-income children and pregnant women. It was initially unclear how the agreement would fare in the Senate and the House. But the two negotiators – Senate Finance Committee Chairman Orrin Hatch, R-Utah, and that panel’s top Democrat, Ron Wyden of Oregon – work closely with party leaders. In addition, having embarrassingly failed in this year’s attempt to repeal Obama’s health care statute, Republicans and President Donald Trump are eager for an accomplishment and would be unlikely to stymie the continuation of such a widely supported initiative. It was also unclear if the pact would move quickly and by itself through Congress, or become a vehicle for other, less widely backed legislation. In a written statement, Hatch said “Congress needs to act quickly” to extend the program. Without providing detail, Hatch said the agreement would give states “increased flexibility” to run the program. He also said lawmakers will “continue to advance this agreement in a way that does not add to the deficit,” suggesting that a compromise on how to pay for the extra funds may have not yet been found. Wyden called the agreement “a great deal for America’s kids.” The federal government pays around $7 billion annually for the program. States by law pay a small share – until recently, an amount ranging from 15 percent to 35 percent of costs. But under Obama’s law, states each received an additional 23 percent share from Washington. Many Republicans, particularly conservatives, have chafed at that added amount. Under the agreement, the full 23 percent share would continue for two more years. It would phase down to 11.5 percent in 2020 and the extra money would disappear completely the following year. The details were provided by a Senate aide who spoke on condition of anonymity because full details weren’t released. Republished with permission from the Associated Press.
State regulators slap BCBS of Alabama with $8M penalty
State regulators have hit Blue Cross Blue Shield of Alabama (BCBSAL) with an $8 million penalty for charging rates other than those approved by the Alabama Department of Insurance (ALDOI). According to AL.com, BCBSAL charged different rates in roughly 1,400 small-group employer plans — those with two to 50 employees — and some COBRA plans for former employees from 2005 to 2013. The result? Nearly $107 million undercharges and almost $33 million overcharges. “The goal was to smooth rate adjustments over time and provide small employers more predictability in their business planning,” said a statement issued by Blue Cross Blue Shield of Alabama to AL.com. “We believed these practices were beneficial overall to our small business customers.” BCBSAL has 60 days to pay the penalty, as well as an additional $100,000 to the department for costs related to the investigation. “Within 60 days of the date of this order, Blue Cross shall pay the amount of $8,000,000 to the commissioner of insurance as an assessment for Blue Cross’ oversight in not filing its renewal rating methodology with the department pursuant to [Alabama law],” the order from ALDOI read. “This assessment is a result of Blue Cross’ inability to reasonably conduct variance analysis outside of the study period due to incomplete data.”
Daniel Sutter: Good Samaritans and health insurance
The Affordable Care Act (ACA) taxes Americans without health insurance. The unpopular individual mandate violates personal freedom and was targeted by Congressional Republicans in their recent “Obamacare” repeal efforts. The health insurance mandate addresses a conundrum known as the Samaritan’s Dilemma, which arises frequently in public policy. A strong case exists for the individual mandate even though it infringes on personal freedom. In the Biblical parable, the Good Samaritan stopped to assist a traveler who had been beaten by robbers after several other travelers passed by. The tale teaches us to treat people, even strangers, with compassion. Economist James Buchanan first explained the Samaritan’s Dilemma, which concerns an implication of compassion. Knowledge that a Good Samaritan will be there to assist if needed leads people to take risky actions, like say traveling the road from Jerusalem to Jericho through bandit territory. Such interactions occur frequently. For instance, availability of a search and rescue team can induce hikers to try longer, more difficult trails, increasing the number of hikers needing rescue. The presence of a lifeguard can lead weak swimmers to venture farther out into the water. Today we often have government to assist our fellow citizens instead of waiting on a Good Samaritan. The Samaritan’s Dilemma plagues government as well. Politicians face enormous pressure to assist persons in distress due to natural disasters or illness. This assistance undermines the incentive for personal responsibility. The challenge for Good Samaritans is strategic: How to keep the increased demand for help from overwhelming our resources? A wealthy Samaritan cannot care for everyone if they all need help. As individuals, we frequently help friends and relatives whom we know well; we can consequently evaluate if their distress is truly due to circumstances beyond their control. Government programs typically are designed to help anyone, especially strangers. We can sometimes manage the dilemma by charging for help, like with ambulance rides or wilderness rescues. Charges limit the incentive of people to take advantage of compassionate taxpayers, but the inability of some persons needing assistance to pay a charge limits this mechanism’s usefulness. Governments also manage the Samaritan’s Dilemma by limiting our freedom, as with the ACA’s individual insurance purchase mandate. Let’s see how this works. Debates over health care sometimes imply that the uninsured do not receive life-saving emergency care. This is not true in America; the uninsured get treated in emergency rooms, with costs shifted to patients able to pay their bills. People can take advantage of our willingness to provide life-saving medical care regardless of whether people can pay. I think that we can say that everyone who can afford it has a responsibility to purchase health insurance to avoid burdening others. But we are not going to withhold care when needed. So this responsibility must be enforced by a law. Social Security addresses a form of the dilemma arising from people outliving their savings. If we will have the government support any retiree who runs out of savings, fewer people will save for retirement. Forcing savings through Social Security or employer-provided pension plans reduces the need for assistance to retirees. Disaster assistance also faces the Samaritan’s Dilemma since it makes living in flood zones attractive. We can limit the dilemma by forcing flood zone residents to buy flood insurance. Or government can restrict freedom even further and prohibit living in flood zones altogether. Does the Samaritan’s Dilemma justify restricting freedom? Personally I do not think so. We should simply accept that helping anyone, regardless of how they wound up in distress, will be really costly. Restricting freedom, however, is a natural reaction for taxpayers frustrated about paying for others’ possibly irresponsible acts. Freedom and compassion are virtues, but often conflict in the design of government policy, and quite often this leads to restrictions on freedom, like the ACA’s individual mandate. A third virtue, namely responsibility, could avoid this conflict, but is also undermined by government compassion. ••• Daniel Sutter is the Charles G. Koch Professor of Economics with the Manuel H. Johnson Center for Political Economy at Troy University and host of Econversations on TrojanVision. The opinions expressed in this column are the author’s and do not necessarily reflect the views of Troy University.
Study: Donald Trump actions trigger health premium hikes for 2018
The Trump administration’s own actions are triggering double-digit premium increases on individual health insurance policies purchased by many consumers, a nonpartisan study has found. The analysis released Thursday by the Kaiser Family Foundation found that mixed signals from President Donald Trump have created uncertainty “far outside the norm,” leading insurers to seek higher premium increases for 2018 than would otherwise have been the case. The report comes with Republicans in Congress unable to deliver on their promise to repeal and replace the Obama-era Affordable Care Act. Trump, meanwhile, insists lawmakers try again. The president says “Obamacare” is collapsing, but he’s also threatened to give it a shove by stopping billions of dollars in payments to insurers. Some leading Republicans are considering fallback measures to stabilize markets. Researchers from the Kaiser Foundation looked at proposed premiums for a benchmark silver plan across major metropolitan areas in 20 states and Washington, D.C. Overall, they found that 15 of those cities will see increases of 10 percent or more next year. The highest: a 49 percent jump in Wilmington, Delaware. The only decline: a 5 percent reduction in Providence, Rhode Island. About 10 million people who buy policies through HealthCare.gov and state-run markets are potentially affected, as well as another 5 million to 7 million who purchase individual policies on their own. Consumers in the government-sponsored markets can dodge the hit with the help of tax credits that most of them qualify for to help pay premiums. But off-marketplace customers pay full freight, and they face a second consecutive year of steep increases. Many are self-employed business owners. The report also found that insurer participation in the ACA markets will be lower than at any time since “Obamacare” opened for business in 2014. The average: 4.6 insurers in the states studied, down from 5.7 insurers this year. In many cases, insurers do not sell plans in every community in a state. The researchers analyzed publicly available filings through which insurers justify their proposed premiums to state regulators. To be sure, insurers continue to struggle with sicker-than-expected customers and disappointing enrollment. And an ACA tax on the industry is expected to add 2 to 3 percentage points to premiums next year. But on top of that, the researchers found the mixed signals from the administration account for some of the higher charges. Those could increase before enrollment starts Nov. 1. “The vast majority of companies in states with detailed rate filings have included some language around the uncertainty, so it is likely that more companies will revise their premiums to reflect uncertainty in the absence of clear answers from Congress or the administration,” the report said. Once premiums are set, they’re generally in place for a whole year. Insurers who assumed that Trump will make good on his threat to stop billions in payments to subsidize co-pays and deductibles requested additional premium increases ranging from 2 percent to 23 percent, the report found. Insurers who assumed the IRS under Trump will not enforce unpopular fines on people who remain uninsured requested additional premium increases ranging from 1.2 percent to 20 percent. “In many cases that means insurers are adding double-digit premium increases on top of what they otherwise would have requested,” said Cynthia Cox, a co-author of the Kaiser report. “In many cases, what we are seeing is an additional increase due to the political uncertainty.” That doesn’t sound like what Trump promised when he assumed the presidency. In a Washington Post interview ahead of his inauguration, Trump said, “We’re going to have insurance for everybody.” “There was a philosophy in some circles that if you can’t pay for it, you don’t get it,” he added. “That’s not going to happen with us.” People covered under Obama’s law “can expect to have great health care,” Trump said at the time. “It will be in a much-simplified form. Much less expensive and much better.” But the White House never produced the health care proposal Trump promised. And the GOP bills in Congress would have left millions more uninsured, a sobering side-effect that contributed to their political undoing. The Trump administration sidestepped questions about its own role raised by the Kaiser study. Spokeswoman Alleigh Marre said rising premiums and dwindling choices predate Trump. “The Trump administration is committed to repealing and replacing Obamacare and will always be focused on putting patients, families and doctors, not Washington, in charge of health care,” Marre said in a statement. The ongoing political turmoil for people who buy individual health insurance stands in sharp contrast to relative calm and stability for the majority of Americans insured through workplace plans. The cost of employer-sponsored coverage is expected to rise around 5 or 6 percent next year, benefits consultants say. Republished with permission of The Associated Press.
Alabama sees America’s highest premium spike under Obamacare
A new report from the Department of Health and Human Services (HHS) details the premium changes Americans across the country have experienced under former President Barack Obama‘s signature legislation, Affordable Care Act, better known as Obamacare. According to the report, which uses the data the Obama administration relied on, “average exchange premiums were 105 percent higher in the 39 states using Healthcare.gov in 2017 than average individual market premiums in 2013.” “Premiums for individual market coverage have increased significantly since the Affordable Care Act’s key provisions have taken effect,” the new report reads. The report also found the State of Alabama saw the nation’s highest premium increase since the implementation of Obamacare with an average 223 percent increase between 2013 and 2017 due to the new regulations. That’s more than double the national average. Alabama 2nd District U.S. Rep. Martha Roby said the statistics show why Republicans are working to offer Americans relief from the burdensome law. “The numbers are staggering. Insurance premiums and deductibles have skyrocketed due to the regulations and mandates imposed by Obamacare,” Roby said. “Providers have been forced out of the market, and Alabama consumers now only have one option for health insurance. Problems like these are why I worked to help build support for our three-step plan to repeal and replace Obamacare.” Earlier this month the U.S. House of Representatives passed the American Health Care Act (AHCA), which is the first of a three-phase plan by Republicans in Congress and the Trump Administration to repeal and replace Obamacare and rebuild America’s health care system, based on a plan that is intended to lower premiums and other out-of-pocket costs that have come to weigh on patients.
Donald Trump’s health care budget means deep cuts for safety net
Candidate Donald Trump promised to improve health care, but as president his first full budget calls for deep cuts to popular insurance programs. And it omits any proposal for negotiating prescription drug prices, a Trump talking point. While not addressing Medicare’s long term financial problems, the budget targets the much smaller Children’s Health Insurance Program, or CHIP. And Trump’s Medicaid cuts appear even bigger than those in the health care bill recently passed by House Republicans, above what would be needed to fulfill the GOP vow to repeal “Obamacare.” Both safety net programs are federal-state collaborations, and such cuts would leave states with hard choices: spend more of their own money; restrict enrollment; cut benefits, or reduce payments to hospitals and doctors. “If states get fewer dollars from the federal government, there are only so many options, because states have to balance the budget every year,” said Elizabeth Carpenter, a health policy expert with the consulting firm Avalare Health. Trump’s budget was silent on bargaining with the pharmaceutical industry to reduce the cost of prescription drugs, a topic the president has often touched on. But the budget repeated Trump’s previous proposals for double-digit percentage cuts to the National Institutes of Health and the Centers for Disease Control and Prevention, considered nonstarters even by Republican lawmakers. The trillion-dollar-plus Department of Health and Human Services, whose programs cover more than 130 million people, did not hold its customary budget briefing on Tuesday. From Europe where he is attending a world health conference, HHS Secretary Tom Price released a statement that said the budget “outlines a clear path toward fiscal responsibility by creating efficiencies that both improve services and save money.” As a candidate and as president Trump has frequently talked about making health care more affordable for regular folks, including by lowering premiums and deductibles. He promised not to cut Medicare, and initially, Medicaid as well. But to some experts, Trump’s budget looks more like a cost shift from the federal government to the states and to people now benefiting from coverage expansions in the Obama years. “I think it will be challenging for states to try to figure out what to do,” said Trish Riley, executive director of the nonpartisan National Academy for State Health Policy, which advises states. Children’s health insurance previously had not figured as a major issue for the administration. The CHIP program covers about 7 million children, and traditionally enjoyed bipartisan support. Trump’s budget would extend CHIP for another two years, but it would also cut $5.8 billion. “It’s a big impact,” said Riley. States would receive significantly lower overall payments from the federal government, and Washington would no longer match state spending on coverage for kids whose families make more than two-and-a-half times the federal poverty level, about $51,000 for a family of three. More than half the states now cover children above the administration’s proposed cutoff, Riley said. Administration officials say that the limitation proposed in the budget would focus taxpayer money on families who need it the most. Medicaid is facing even bigger cuts. Already, the House GOP bill would roll back former President Barack Obama‘s Medicaid expansion while also capping future federal financing for the program. The Congressional Budget Office estimates that would reduce federal Medicaid spending by $839 billion over 10 years. Trump’s budget would squeeze additional savings beyond that, but congressional aides say how much is not exactly clear. White House Budget Director Mick Mulvaney has indicated that the budget uses a lower growth rate for the federal government’s share of future Medicaid spending. “The Trump budget assumes hundreds of billions more in Medicaid cuts than the House bill,” said Edwin Park, a health policy expert with the Center on Budget and Policy Priorities, which advocates for low-income people. Republished with permission of The Associated Press.
