Florida leads 22 states with nearly 303,000 losing their Medicaid coverage
According to data from the Kaiser Family Foundation, more than one million people have lost their Medicaid coverage nationally and Florida had the most who are no longer eligible for benefits. According to data from KFF — a nonprofit that focuses on health policy and conducts its research and polling — at least 1.35 million people, spread across 22 states, lost their Medicaid coverage as of Tuesday based on the latest available data. Florida had the most recipients lose eligibility for the Medicaid program, with nearly 303,000 people losing their benefits. Second was Arizona, with 149,000 people disenrolled, according to the KFF Medicaid Enrollment and Unwinding Tracker. The reason was the redetermination process that resumed on March 31 after the COVID-19 pandemic emergency rules ended. These rules expanded the eligibility to receive Medicaid benefits. States are required to check the eligibility of recipients annually, a mandate sidelined by COVID-19 emergency rules. The tracker shows that Florida recipients began losing their coverage in May, while enrollment in Medicaid declined by 234,646 people between April and May. A total of 583,929 enrollees had renewed their coverage by May 2023, however, 302,556 people were disenrolled. Most of those who found themselves suddenly without Medicaid coverage in Florida — 197,367 people — lost their coverage for procedural reasons. This comprised 65% of the total number disenrolled, while the other 35% (105,189 beneficiaries) lost coverage due to ineligibility. Medicaid recipients who lost their coverage in the 22 reporting states vary greatly, with some states now finding enrollees ineligible for continued coverage that was maintained due to the COVID-19 pandemic, as is the case in Idaho, which had a disenrollment rate of 73%. According to a national survey conducted by KFF with Georgetown University Center for Children and Families, the lowest Medicaid disenrollment rates around the U.S. come from states that rely on renewals through ex parte (one-sided) processes. This reduces administrative burdens on the state and the enrollee while streamlining the renewal process. The KFF tracker noted that while Florida’s renewal process was mostly automated, and the state would complete all renewals within 12 to 14 months, less than 50% of renewals were done on an ex parte basis, and the state was not taking any steps towards improving it, partly explaining the state’s high disenrollment rate. Florida has also not adopted Medicaid expansion, nor has it adopted 12-month continuous eligibility for all children in Medicaid and CHIP, according to the tracker. However, 12-month postpartum coverage has been adopted. Republished with the permission of The Center Square.
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.
Donald Trump’s prescription to reduce drug prices takes small steps
President Donald Trump’s long-promised plan to bring down drug prices would mostly spare the pharmaceutical industry he previously accused of “getting away with murder.” Instead he focuses on private competition and more openness to reduce America’s prescription pain. In Rose Garden remarks at the White House Friday, Trump called his plan the “most sweeping action in history to lower the price of prescription drugs for the American people.” But it does not include his campaign pledge to use the massive buying power of the government’s Medicare program to directly negotiate lower prices for seniors. That idea has long been supported by Democrats but is a non-starter for drugmakers and most Republicans in Congress. Democratic Rep. Lloyd Doggett of Texas dismissed Trump’s plan as “a sugar-coated nothing pill.” The administration will pursue a raft of old and new measures intended to improve competition and transparency in the notoriously complex drug pricing system. But most of the measures could take months or years to implement, and none would stop drugmakers from setting sky-high initial prices. “There are some things in this set of proposals that can move us in the direction of lower prices for some people,” said David Mitchell, founder of Patients for Affordable Drugs. “At the same time, it is not clear at all how they are going to lower list prices.” Drugmakers generally can charge as much as the market will bear because the U.S. government doesn’t regulate medicine prices, unlike most other developed countries. Trump’s list of 50 proposals, dubbed American Patients First, includes: — A potential requirement for drugmakers to disclose the cost of their medicines in television advertisements. — Banning a pharmacist “gag rule,” which prevents druggists from telling customers when they can save money by paying cash instead of using their insurance. — Speeding up the approval process for over-the-counter medications so people can buy more drugs without prescriptions. — Reconsidering how Medicare pays for some high-priced drugs administered at doctors’ offices. Those ideas avoid a direct confrontation with the powerful pharmaceutical lobby, but they may also underwhelm Americans seeking relief from escalating prescription costs. Democrats pounced on Trump for not pursuing direct Medicare negotiations, an idea he championed before reaching the White House. “This weak plan abandons the millions of hard-working families struggling with the crisis of surging drug prices,” said Democratic Leader Nancy Pelosi, in a statement. Pharmaceutical investors and analysts expressed relief after the announcement, and shares of most top drugmakers rose Friday afternoon, including Pfizer, Johnson & Johnson and Eli Lilly. “Trump had a choice today: to seek disruptive fundamental reform or to embrace more incremental steps,” wrote Terry Haines, a financial analyst, in an investment note. “Trump chose the incremental over the disruptive.” Some parts of the plan were previously proposed in the president’s budget proposal sent to Congress, including providing free generic drugs to low-income seniors and sharing rebates from drugmakers with Medicare patients. Other parts could be implemented directly by the administration. A majority of Americans say passing laws to bring down prescription drug prices should be a top priority for Trump and Congress, according to recent polling by the Kaiser Family Foundation. As a candidate, Trump railed against the pharmaceutical industry. But as president he has shied away from major changes and has staffed his administration with appointees who have deep ties to the industry. They include Health Secretary Alex Azar, a former top executive at Eli Lilly and Co., who joined Trump for Friday’s announcement. Azar and other Trump officials have hinted for weeks that the plan would, in part, “dismantle” the convoluted system of rebates between drugmakers and the health care middlemen known as pharmacy benefit managers, which negotiate price concessions for insurers, employers and other large customers. Trump called out those companies in his speech: “Our plan will end the dishonest double-dealing that allows the middleman to pocket rebates and discounts that should be passed onto consumers and patients,” Trump said. Azar later told reporters that the administration would “seek input” on doing away with drug rebates in the Medicare system to encourage more direct discounts. He gave no timeframe for more concrete steps. “It took decades to erect this very complex, interwoven system,” Azar said in a briefing following the speech. “I don’t want to overpromise that somehow by Monday there’s going to be a radical change, but there’s a deep commitment to structural change.” Public outrage over drug costs has been growing for years as Americans face pricing pressure from multiple sources: New medicines for life-threatening diseases often launch with prices exceeding $100,000 per year. And older drugs for common ailments like diabetes and asthma routinely see price hikes around 10 percent annually. Meanwhile Americans are paying more at the pharmacy counter due to health insurance plans that require them to shoulder more of their prescription costs. America has the highest drug prices in the world. The U.S. spent $1,162 per person on prescription drugs in 2015, according to the Organization for Economic Cooperation and Development. That’s more than twice the $497 per person spent in the United Kingdom, which has a nationalized health care system. Trump’s speech singled out foreign governments that “extort unreasonably low prices from U.S. drugmakers” using price controls and said U.S. trade representatives would prioritize the issue in trade deals. But experts are skeptical the U.S. can pressure foreign governments to pay more for drugs. “It’s hard to know why Germany or France or Australia would agree to something like that,” said Professor Jack Hoadley of Georgetown University’s Health Policy Institute. In the U.S., Medicare is the largest purchaser of prescription drugs, covering 60 million seniors and Americans with disabilities, but it is barred by law from directly negotiating lower prices with drugmakers. Allowing Medicare to negotiate prices is unacceptable to the powerful drug lobby, which has spent tens of millions of dollars since Trump’s inauguration to influence the Washington conversation around drug prices, including a high-profile TV advertising campaign portraying its scientists as medical trailblazers.
Poll: Only about 1 in 4 wants Donald Trump to repeal health law
Only about one in four Americans wants President-elect Donald Trump to entirely repeal his predecessor’s health care law that extended coverage to millions, a new poll has found. The postelection survey released Thursday by the nonpartisan Kaiser Family Foundation also found hints of a pragmatic shift among some Republican foes of “Obamacare.” While 52 percent of Republicans say they want the law completely repealed, that share is down from 69 percent just last month, before the election. And more Republicans now say they want the law “scaled back” under the new president and GOP Congress, with that share more than doubling from 11 percent before the election to 24 percent after. Kaiser CEO Drew Altman said the foundation’s polling experts aren’t quite sure what to make of that finding, and will continue to track the apparent shift in future polls. The organization is a clearinghouse for information and analysis about the health care system. It could be that some Republicans “got a protest vote off their chests, and they’re done with that,” Altman said. “They now have a more moderate position.” After branding the Affordable Care Act a “disaster” during an election campaign that saw big premium hikes unveiled in its closing days, Trump has been saying he’d like to keep parts of the law. On Capitol Hill, Republican leaders are trying to choreograph a legislative dance that would let them quickly repeal “Obamacare,” then allow an interlude to segue to a replacement. The complex undertaking is fraught with political risk, because success is not guaranteed. It could disrupt coverage for millions by destabilizing the law’s already fragile health insurance markets, such as HealthCare.gov. The poll found some skepticism about that approach. Forty-two percent of those who want the 2010 health care law repealed said lawmakers should wait until they figure out the details of a replacement plan before doing so. Americans were divided on next steps for President Barack Obama‘s signature law. Overall, 30 percent said the new president and Congress should expand what the law does, and another 19 percent said it should be implemented as is. On the other side, 26 percent said the law should be entirely repealed and 17 percent called for it to be scaled back. Among Trump voters, 8 in 10 viewed the health care law unfavorably, and half wanted it entirely repealed. As Republicans start to make changes in health care, potentially revamping Medicare and Medicaid as well, the politics of the issue could turn against them, Altman said. “They are going to go from casting stones to owning the problem,” he said. The poll found majorities across party lines support many of the health care law’s provisions, but not its requirement that individuals have coverage or risk fines, and its mandate that medium-to-large employers pay fines if they don’t offer health insurance. Among the provisions with support across party lines: — Allowing young adults to stay on a parent’s insurance until age 26. — No co-payments for many preventive services. — Closing the Medicare prescription drug coverage gap known as the “doughnut hole.” — Financial help for low- and moderate-income people to pay their insurance premiums. — A state option to expand Medicaid to cover more low-income adults. — Barring insurance companies from denying coverage because of a person’s medical history. — Increased Medicare payroll taxes for upper-income earners. The telephone poll was conducted from Nov. 15-21 among a nationally representative random digit dial sample of 1,202 adults, including people reached by landlines and cellphones. The margin of sampling error is plus or minus 3 percentage points for the full sample. For subgroups, the margin of sampling error may be higher. Republished with permission of The Associated Press.
Barack Obama administration confirms double-digit premium hikes
Premiums will go up sharply next year under President Barack Obama‘s health care law, and many consumers will be down to just one insurer, the administration confirmed Monday. That’s sure to stoke another “Obamacare” controversy days before a presidential election. Before taxpayer-provided subsidies, premiums for a midlevel benchmark plan will increase an average of 25 percent across the 39 states served by the federally run online market, according to a report from the Department of Health and Human Services. Some states will see much bigger jumps, others less. Moreover, about 1 in 5 consumers will have plans only from a single insurer to pick from, after major national carriers such as UnitedHealth Group, Humana and Aetna scaled back their roles. “Consumers will be faced this year with not only big premium increases but also with a declining number of insurers participating, and that will lead to a tumultuous open enrollment period,” said Larry Levitt, who tracks the health care law for the nonpartisan Kaiser Family Foundation. Republicans pounced on the numbers as a warning that insurance markets created by the 2010 health overhaul are teetering toward a “death spiral.” Sign-up season starts Nov. 1, about a week before national elections in which the GOP remains committed to a full repeal. “It’s over for Obamacare,” Republican presidential candidate Donald Trump said at a campaign rally Monday evening in Tampa, Florida. Trump said his Democratic rival, Hillary Clinton, “wants to double down and make it more expensive and it’s not gonna work. … Our country can’t afford it, you can’t afford it.” He promised his own plan would deliver “great health care at a fraction of the cost.” The new numbers aren’t too surprising, said Sen. Orrin Hatch, R-Utah, who chairs a committee that oversees the law. It “does little to dispel the notion we are seeing the law implode at the expense of middle-class families.” HHS essentially confirmed state-by-state reports that have been coming in for months. Window shopping for plans and premiums is already available through HealthCare.gov. Administration officials are stressing that subsidies provided under the law, which are designed to rise alongside premiums, will insulate most customers from sticker shock. They add that consumers who are willing to switch to cheaper plans will still be able to find bargains. “Headline rates are generally rising faster than in previous years,” acknowledged HHS spokesman Kevin Griffis. But he added that for most consumers, “headline rates are not what they pay.” The vast majority of the more than 10 million customers who purchase through HealthCare.gov and its state-run counterparts do receive generous financial assistance. “Enrollment is concentrated among very low-income individuals who receive significant government subsidies to reduce premiums and cost-sharing,” said Caroline Pearson of the consulting firm Avalere Health But an estimated 5 million to 7 million people are either not eligible for the income-based assistance, or they buy individual policies outside of the health law’s markets, where the subsidies are not available. The administration is urging the latter group to check out HealthCare.gov. The spike in premiums generally does not affect the employer-provided plans that cover most workers and their families. In some states, the premium increases are striking. In Arizona, unsubsidized premiums for a hypothetical 27-year-old buying a benchmark “second-lowest cost silver plan” will jump by 116 percent, from $196 to $422, according to the administration report. But HHS said if that hypothetical consumer has a fairly modest income, making $25,000 a year, the subsidies would cover $280 of the new premium, and the consumer would pay $142. Caveat: if the consumer is making $30,000 or $40,000, his or her subsidy would be significantly lower. Dwindling choice is another issue. The total number of HealthCare.gov insurers will drop from 232 this year to 167 in 2017, a loss of 28 percent. (Insurers are counted multiple times if they offer coverage in more than one state. So Aetna, for example, would count once in each state that it participated in.) Switching insurers may not be simple for patients with chronic conditions. While many carriers are offering a choice of plan designs, most use a single prescription formulary and physician network across all their products, explained Pearson. “So, enrollees may need to change doctors or drugs when they switch insurers,” she said. Overall, it’s shaping up to be the most difficult sign-up season since HealthCare.gov launched in 2013 and the computer system froze up. Enrollment has been lower than initially projected, and insurers say patients turned out to be sicker than expected. Moreover, a complex internal system to help stabilize premiums has not worked as hoped for. Nonetheless, Obama says the underlying structure of the law is sound, and current problems are only “growing pains.” The president has called for a government-sponsored “public option” insurance plan to compete with private companies. Republicans, including Trump, are united in calling for complete repeal, but they have not spelled out how they would address the problems of the uninsured. Clinton has proposed an array of fixes, including sweetening the law’s subsidies and allowing more people to qualify for financial assistance. The law makes carrying health insurance a legal obligation for most people, and prohibits insurers from turning away the sick. It offers subsidized private plans to people who don’t have coverage through their jobs, along with a state option to expand Medicaid for low-income people. Largely as a result, the nation’s uninsured rate has dropped below 9 percent, a historically low level. More than 21 million people have gained coverage since the Affordable Care Act passed in 2010. Republished with permission of the Associated Press.
Poll: More voters trust Hillary Clinton on health care
From Medicare to medical costs, more voters trust Democratic presidential candidate Hillary Clinton to do a better job on health care issues facing the United States, according to a poll out Thursday. But they’re not holding out hope for big improvements. The survey from the nonpartisan Kaiser Family Foundation also found that the future of Medicare and overall access and affordability are the top health care issues for voters. Neither of those is getting much attention in a campaign that has been dominated by questions of character and temperament. On the basic pocketbook question, the poll found that 36 percent of voters feared their own access to affordable care would get worse if Republican Donald Trump is elected, versus 24 percent who worried their own situations would worsen under Clinton. Just over half said a Clinton presidency would not make much difference to their own personal access, while 37 percent felt the same way about Trump. “Even though Hillary Clinton is trusted by more of the public on these issues, they have pretty low expectations that things will get better, no matter who wins,” said Kaiser polling chief Mollyann Brodie. (The foundation is not associated with health insurer Kaiser Permanente.) Clinton has played a prominent role on health care issues for more than 20 years, since she led the failed effort to pass a bill providing health care for all in her husband’s first presidential term. She’s a candidate of continuity, expressing strong support for Medicare, Medicaid, and President Barack Obama’s health care law. She’s proposed incremental improvements but no sweeping changes. Trump’s views on health care seem fluid. He has said he wouldn’t cut Medicare and he won’t stand for people “dying on the street,” but his health care plan is basically a collection of Republican talking points. He’d repeal “Obamacare,” and he has expressed support for a House Republican plan to limit Medicaid spending and turn the program for low-income people over to the states. Both candidates have said they’d authorize Medicare to negotiate drug prices. That puts Trump at odds with most Republicans, who see Medicare negotiations as nothing more than the government dictating prices. Republican policy experts say they expect House Speaker Paul Ryan of Wisconsin to take the Republican lead on health care if Trump is elected. Ryan favors a major overhaul of Medicare for future retirees, gradually replacing open-ended government coverage with a limited payment that beneficiaries could use for a range of insurance options. Women’s access to reproductive health accounted for the biggest trust gap between Clinton and Trump. Sixty-four percent of voters – and 71 percent of female voters – said they trusted Clinton to do a better job. The numbers for Trump were 28 percent and 20 percent, respectively. On the future of Medicare, 53 percent of voters said they trusted Clinton, compared to 38 percent trusting Trump. Interestingly, voters age 65 and older were much more closely divided, with 47 percent saying they trusted Clinton and 44 percent trusting Trump. The split on Medicaid was 54 percent trusting Clinton and 37 percent trusting Trump. On the overall access and affordability of health care, 52 percent trusted Clinton, compared with 39 percent saying Trump would do better. Clinton led by double-digit margins on most issues, but the closest split – 9 percentage points – was on the fate of the Obama health care law. Fifty percent said they trusted Clinton, compared with 41 percent for Trump. The public remains divided over the 2010 health overhaul, with 42 percent holding an unfavorable view, and 40 percent favoring it. The Kaiser foundation poll was conducted from Aug. 18-24 among a nationally representative random digit dial telephone sample of adults that included 1,020 registered voters. The margin of sampling error is plus or minus 4 percentage points for registered voters. Republished with permission of The Associated Press.
