Democrats take a look at a practical health care approach
Democratic voters appear to be reassessing their approach to health care, a pragmatic shift on their party’s top 2020 issue. While “Medicare for All” remains hugely popular, majorities say they’d prefer building on “Obamacare” to expand coverage instead of a new government program that replaces America’s mix of private and public insurance. Highlighted by a recent national poll, shifting views are echoed in interviews with voters and the evolving positions of Democratic presidential candidates on a proposal that months ago seemed to have growing momentum within their party. Several have endorsed an incremental approach rather than a government-run plan backed by Sens. Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts. It could mean trouble for Sanders and his supporters, signaling a limit to how far Democratic voters are willing to move to the left and an underlying skepticism that Americans will back such a dramatic change to their health care. “We hear Medicare for All, but I’m not absolutely certain what that means and what that would then mean for me,” said Democrat Terrie Dietrich, who lives near Las Vegas. “Does it mean that private insurance is gone forever?” Dietrich, 74, has Medicare and supplements that with private insurance, an arrangement she said she’s pretty comfortable with. She thinks it’s important that everyone has health care, not just those who can afford it. She said she would support Medicare for All if it was the only way to achieve that. But “I don’t think we can ever get it passed,” Dietrich added. Erin Cross, her 54-year-old daughter and also a Democrat, said she’s not comfortable with switching to a system in which a government plan is the only choice. She said Democrats won’t be able to appeal to Republicans unless they strike a middle ground and allow people to keep their private insurance. “We’ve got to get some of these other people, these Republican voters, to come on over just to get rid of Trump,” she said. Democratic presidential candidates also have expressed skepticism. California Sen. Kamala Harris’ new plan would preserve a role for private insurance. New Jersey Sen. Cory Booker is open to step-by-step approaches. Meanwhile, health care moderates including former Vice President Joe Biden have been blunt in criticizing the government-run system envisioned by Sanders. In Nevada, the early voting swing state that tests presidential candidates’ appeal to labor and a diverse population, moderate Democrats have won statewide by focusing on health care affordability and preserving protections from President Barack Obama’s law. Nationwide, 55 percent of Democrats and independents who lean Democratic said in a poll last month they’d prefer building on Obama’s Affordable Care Act instead of replacing it with Medicare for All. The survey by the nonpartisan Kaiser Family Foundation found 39% would prefer Medicare for All. Majorities of liberals and moderates concurred. On a separate question, Democratic support for Medicare for All was a robust 72 percent in July, but that was down from 80 percent in April, a drop Kaiser says is statistically significant but not necessarily a definitive downward trend. That said, Kaiser pollster Liz Hamel said it wouldn’t be surprising if it turned into one. On big health care ideas, she said, “as the public starts seeing arguments for and against, we often see movement.” The Kaiser survey also found broad backing for the public-option alternative that moderates are touting, a government plan that would compete with but not replace private insurance. Eight-five percent of Democrats supported that idea, along with 68 percent of independents. Republicans were opposed, 62 percent to 36 percent. Large increases in federal spending and a significant expansion of government power are often cited as arguments against Medicare for All. However, the main criticism Democrats are hearing from some of their own candidates is that the Sanders plan would force people to give up their private health insurance. Under the Vermont senator’s legislation, it would be unlawful for insurers or employers to offer coverage for benefits provided by the new government plan. Ohio Rep. Tim Ryan argued during the last round of Democratic debates that that’s problematic for union members with hard-fought health care plans secured by sacrificing wage increases. However, Sanders has long asserted his plan will allow unions to obtain bigger wage increases by taking health care out of the equation. In interviews with The Associated Press, union workers in Nevada said they worried about how Medicare for All would affect their coverage. Chad Neanover, prep cook at the Margaritaville casino-restaurant on the Las Vegas Strip, said he would be reluctant to give up the comprehensive insurance that his union has fought to keep. He has asthma, and his wife is dealing with diabetes. The union’s plan has no monthly premium cost and no deductible. “I don’t want to give up my health insurance. I’ve personally been involved in the fight to keep it,” said Neanover, 44. “A lot of people have fought to have what we have today.”Savannah Palmira, a 34-year-old union construction worker in Las Vegas, said she’s open to supporting Medicare for All, but wants to know specifically what it would look like, how the country would transition and how it would affect her plan. “That’s one of the biggest things that I love about being in the union, is our quality health care,” Palmira said. Medicare for All backers say their plan has been unfairly portrayed. “The shift in polling on Medicare for All is a direct result of mischaracterizations by opponents,” said Rep. Ro Khanna, Democrat-California, a Sanders campaign co-chair. People are most interested in keeping their own doctors, Khanna added, and Medicare for All would not interfere with that. Longtime watchers of America’s health care debate see new energy among Democrats, along with a familiar pattern. “The long-standing history of health reform is that people want to hang on to what they have,” said Georgetown University public policy professor Judith Feder, who was a health policy adviser in the Clinton administration. Nonetheless, she noted a common interest
Joe Biden campaigns as Obamacare’s top defender
Joe Biden is taking an aggressive approach to defending Obamacare, challenging not just President Donald Trump but also some of his rivals for the Democratic presidential nomination who want to replace the current insurance system with a fully government-run model. The former vice president will spend much of the coming week talking about his approach to health care, including remarks he’ll deliver on Monday in Iowa at a presidential forum sponsored by AARP. His almost singular focus on the 2010 health care law has been on display recently in the early voting states. In Iowa, he declared himself “against any Republican (and) any Democrat who wants to scrap” Obamacare. Later in New Hampshire, he said “we should not be scrapping Obamacare, we should be building on it,” a reference to his approach to add a government insurance plan known as the public option to existing exchanges that sell private insurance. Biden is hoping his positioning as Obamacare’s chief defender could be helpful on several fronts. It’s a reminder of his close work alongside President Barack Obama, who remains popular among Democratic voters. And it could reinforce his pitch as a sensible centrist promising to rise above the strident cacophony of Trump and Democrats including Sens. Bernie Sanders, Elizabeth Warren and Kamala Harris, all single-payer advocates. Perhaps as important, it’s an opportunity for Biden to go on offense ahead of the next presidential debate at the end of July. Biden has spent the past several weeks on defense, reversing his position on taxpayer funding for abortions and highlighting his past work with segregationist senators. Harris slammed him during the first debate, blasting the segregationist comment and criticizing his opposition to federal busing orders to desegregate public schools during the same era. Each of the episodes raised questions about whether Biden can maintain his front-runner status. In New Hampshire over the weekend, it was clear Biden wanted to turn the tables as he touted the idea of a “Medicare-like” plan that any American could buy as opposed to a “Medicare-for-all” that would be imposed on everyone. “I think one of the most significant things we’ve done in our administration is pass the Affordable Care Act,” Biden said. “I don’t know why we’d get rid of what in fact was working and move to something totally new. And so, there are differences.”He argued that some of his opponents, with the exception of Sanders, aren’t fairly representing the consequences of their proposals. “Bernie’s been very honest about it,” Biden said. “He said you’re going to have to raise taxes on the middle class. He said it’s going to end all private insurance. I mean, he’s been straightforward about it. And he’s making his case.” Asked specifically whether Harris has been honest about how her plan would affect private insurance, Biden said, “I’ll let you guys make that judgment.” During last month’s debates, Harris, Warren and Sanders raised their hands when candidates were asked as a group whether they supported eliminating private insurance. A day later, Harris, a Senate co-sponsor of Sanders’ single-payer bill, reversed her answer — the second time since her campaign launch that she’d walked back her seeming endorsement of eliminating private insurance. She explained that she interpreted the debate moderator’s question as asking whether she’d be willing to give up her existing coverage as part of a single-payer model. She said she wants private policies to remain “supplemental” options for consumers. Sanders, meanwhile, hit back at Biden, clarifying that his plan would be a net financial benefit for most households: Their federal taxes would go up, but their private insurance premiums, deductibles and co-pays would be eliminated. “At a time when Donald Trump and the health insurance industry are lying every day about ‘Medicare for All,’ I would hope that my fellow Democrats would not resort to misinformation about my legislation,” Sanders said in a statement responding to Biden’s New Hampshire comments. Biden hasn’t yet introduced his full health care plan, but has said it will be anchored by a “Medicare-like” plan that would be available to anyone — including the 150 million-plus Americans now covered by job-based insurance, a group now ineligible for exchange-based policies. Biden has indicated that income-based subsidies would ensure that any household could get coverage. The idea is to expand coverage immediately and shake up insurance markets long-term by forcing private insurers to compete alongside the government, theoretically pressuring to lower their premiums and out-of-pocket costs for private policy holders. Biden isn’t the only public-option advocate running for president. Former Colorado Gov. John Hickenlooper warns that Republicans will brand single-payer as “socialism,” hurting Democrats in the general election. Colorado Sen. Michael Bennet echoes Biden’s argument with a call to “finish the work we started with Obamacare.”Minnesota Sen. Amy Klobuchar touts a public option as the next logical move even for single-payer advocates. “I think it is a beginning and the way you start and the way you move to universal health care,” she said in the first debate. If anything, the dynamics illustrate Democrats’ overall leftward shift on health care.A decade ago, as Obama pushed for ACA, the public option was effectively the left-flank for Democrats, a reality made obvious when Obama angered House liberals by jettisoning the provision to mollify some moderate Senate Democrats needed to pass the legislation. Now, after Sanders’ insurgent 2016 presidential bid and his promise of “health care as a human right,” the left has embraced single-payer, with moderates moving to the public option.Yet with the exception of Biden, the moderates are languishing far back in polls, leaving the former vice president to capitalize on the dividing lines and promising that he would do what Obama couldn’t. “And,” he declared, “it can be done quickly.” By Bill Barrow Associated Press Associated Press writers Hunter Woodall and Julie Pace contributed from Portsmouth, New Hampshire. Follow Barrow on Twitter at https://twitter.com/BillBarrowAP. Republished with the permission of the Associated Press.
Republicans lack votes — and appetite — to end ‘Obamacare’
Arizona’s new senator says he’d vote to repeal the nation’s health care law. That’s one additional Republican ready to obliterate the statute because his predecessor, the late Sen. John McCain, helped derail the party’s drive with his fabled thumbs-down vote last year. It could well be too little, too late. After years of trying to demolish former President Barack Obama‘s prized law, GOP leaders still lack the votes to succeed. Along with the law’s growing popularity and easing premium increases, that’s left top Republicans showing no appetite to quickly refight the repeal battle. “I’m not going to be asking for another vote on that this year,” No. 2 Senate GOP leader John Cornyn of Texas said last week when asked if he favored reopening the issue in a postelection lame duck session. No. 3 House leader Steve Scalise, R-La., said, “We need to win this election and then get more seats next year.” Each is their party’s chief vote counter. That means any serious push to annul the statute would almost certainly hinge on Republicans retaining House control and adding Senate seats in November’s elections, neither of which is assured. If either goal eludes them on Election Day, President Donald Trump’s ability to deliver on one of his top campaign promises would have to wait for a second term, if he gets one. Republicans seemed to gain ground last week when Sen. Jon Kyl replaced McCain, who died in August from brain cancer. Kyl said in a brief interview that he would have backed the measure that McCain opposed, a pivotal vote that would have sustained the repeal drive. “It seems to me that would have been a useful thing to do,” Kyl said. That bill failed 51-49. A “yes” from McCain would have meant a 50-50 tie that Vice President Mike Pence could have broken by casting his own vote. Yet the two other GOP senators who also voted no, Maine’s Susan Collins and Lisa Murkowski of Alaska, haven’t relented. With Republicans controlling the Senate 51-49, the GOP remains short of the 50 votes they’d need. “I would still oppose outright repeal,” Collins said in a short interview last week. In a written statement, aides said Murkowski “is not interested in another rushed, partisan process in the absence of a quality, comprehensive replacement” for the law. Republicans have one fewer seat this year because Alabama Democrat Doug Jones defeated Republican Roy Moore in a December special election. Moore had defeated incumbent GOP Sen. Luther Strange in a party primary. Senate Majority Leader Mitch McConnell, R-Ky., has ruled out revisiting the health care fight before November’s midterm elections, citing the crush of spending and other bills facing Congress. He’s displayed little desire to revisit the issue, which many Democrats are using in their election campaigns because Obama’s law is widely accepted, especially provisions like requiring insurers to cover people with pre-existing medical conditions. Returning to the health care fight is a decision “I don’t have to reach anytime soon and don’t have time to facilitate, even if I was so inclined,” McConnell told reporters last week. He has said he doesn’t want to resume the fight unless he can win, and his House counterpart is also showing his focus is elsewhere. “I haven’t even thought about it,” said House Speaker Paul Ryan, R-Wis. A lame-duck session would last barely over a month and likely be absorbed with lingering budget disputes and picking the new Congress’ leaders. That would leave scant time for health care work, such as resolving intractable disputes about what a replacement bill would look like. Then they would need an official cost estimate of any bill from the nonpartisan Congressional Budget Office, which could take weeks. They’d also have to take procedural steps to protect their bill from a Senate Democratic filibuster, which would otherwise essentially kill the measure by requiring Republicans to garner 60 votes to succeed. “There’s still a process that we have to go through, and people have to be aware of it,” said Sen. Bill Cassidy, R-La., who opposes the health care program. “You don’t just drop it from heaven like manna.” Explaining the diminished urgency, Cornyn cited Congress’ repeal last December of the tax penalty on people who don’t buy individual insurance. That requirement, aimed at prodding healthier people to buy coverage and stabilize health markets, was one of the law’s least popular provisions. Cornyn also mentioned Trump administration rules making it easier for people to buy short-term health care policies or association plans offered by groups of small businesses or self-employed people. Such packages could offer lower premiums but cover fewer benefits, and Democrats criticize them as undermining the consumer protections Obama’s law was designed to enshrine. Also easing pressure on Republicans to act are indications that insurance premiums, a major vexation for voters, are growing more slowly. An analysis by the consulting firm Avalere Health and The Associated Press last week found a 3.3 percent average increase in proposed or approved premiums across 47 states and Washington, D.C., for 2019. The average increase nationally this year was about 30 percent. Meanwhile, the House plans to vote this week on a bill easing requirements the law imposed on employers. The measure would make it easier for companies to provide health insurance for fewer workers, refund tax penalties firms paid for not covering employees and postpone a levy on expensive policies companies provide workers. Further underscoring the effort’s lack of traction, that measure seems certain never to emerge from Congress. Republished with permission from 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
Gary Palmer receives FGA award for health care reform efforts
Alabama 7th District U.S. Rep. Gary Palmer was honored with the Foundation for Government Accountability’s (FGA) 2017 Congressman of the Year Award for his commitment to reversing the devastating impact of Obamacare. “ObamaCare has devastated Americans who are no longer able to afford skyrocketing premiums and has left state budgets crippled under its weight. Congressman Palmer’s dedication to relieving the pressure of Obamacare on people across the nation with the inclusion of an invisible risk-sharing program should be applauded,” said Tarren Bragdon, CEO and President of FGA. The award recognized Palmer’s diligent work in repealing and replacing Obamacare, particularly his role in drafting the Palmer-Schweikert Amendment to the GOP’s American Health Care Act (AHCA). The Palmer-Schweikert Amendment, which would have created a federal invisible-risk sharing program, was crafted in order to provide relief for Americans struggling with the unsustainable cost of Obamacare. A federal invisible risk-sharing program would result in lower premiums, coverage for those with pre-existing coverage, and fewer uninsured Americans. Bragdon continued, “Congressman Palmer worked tirelessly to develop a solution that would help stabilize state budgets, lower costs for individuals across the country, and protect the truly needy. I am honored to award Congressman Palmer with FGA’s 2017 Congressman of the Year Award for his diligence and hard-work.” Palmer said he’s honored to receive the award. “It is an honor to receive this award from the Foundation for Government Accountability,” said Palmer. “FGA was indispensable in developing the amendment that I introduced on invisible risk sharing. This innovative approach would have driven down the cost of health insurance premiums and helped ensure that those with pre-existing conditions had access to affordable coverage. FGA is a tremendous asset and I look forward to more opportunities to work together to find solutions for major issues”
Survey: US uninsured up 3.5M this year; expected to rise
The number of U.S. adults without health insurance is up nearly 3.5 million this year, as rising premiums and political turmoil over “Obamacare” undermine coverage gains that drove the nation’s uninsured rate to a historic low. That finding is based on the latest installment of a major survey, released Friday. The Gallup-Sharecare Well-Being Index asks a random sample of 500 people each day whether they have health insurance. The survey found that the uninsured rate among adults was 12.3 percent during the period from July 1-Sept. 30, an increase of 1.4 percentage points since the end of last year. The increase in the number of uninsured is more striking because it comes at a time of economic growth and low unemployment. The annual sign-up season for subsidized private insurance plans under the Affordable Care Act starts Nov. 1, but it may not make much of a difference. President Donald Trump has stopped federal payments that reimburse insurers for lower copays and deductibles that the Obama-era law requires them to provide to people with modest incomes. His administration slashed the advertising budget for 2018 sign-ups, cut the length of open enrollment in half, and sharply reduced federal grants to groups that help consumers navigate the process. “The number of uninsured Americans likely will continue to rise,” the Gallup-Sharecare analysis noted, unless Trump and Congress take steps to stabilize insurance markets. A bipartisan bill to restart the canceled insurer payments faces opposition from conservatives and Trump has sent mixed signals. While “Obamacare” remains politically divisive, its coverage expansion helped about 20 million people get health insurance, bringing the uninsured rate to a historic low. Continued progress seems unlikely now. Next year’s premiums for plans sold on the health law’s marketplaces are expected to increase significantly in many communities, and insurer participation is down sharply, with about half of U.S. counties having only one carrier. Although consumers who are eligible for ACA subsidies are shielded from price hikes, many who buy individual plans get no financial assistance from the government. All told, more than 17 million people purchase their own policies. Independent experts who reviewed the Gallup-Sharecare findings said they appear to confirm other available evidence. “The results make sense and they track with the results of other rapid surveys,” said Matthew Buettgens, a senior research analyst with the Urban Institute health policy center. “No one is expecting this open-enrollment period to increase enrollment.” GOP health economist Gail Wilensky said the overall direction of the Gallup-Sharecare results seems reasonable, but she’ll await confirmation from government surveys that take longer to produce results, but dig deeper. “The only thing most Republicans in Congress seem to agree on is that they don’t like the ACA,” she said. “Hard to build an alternative legislative package without a sounder basis for policy and with the very narrow majority in the Senate.” Except for seniors covered by Medicare, the Gallup-Sharecare survey found that the uninsured rate increased among all major demographic groups. The loss of coverage was concentrated among middle-aged adults, with the uninsured rate rising by 1.8 percentage points among those 35-64 since the end of 2016. Households making less than $36,000 a year saw their uninsured rate go up by 1.7 percentage points. Among Hispanics, the rate increased by 1.6 percentage points, and among blacks the increase was 1.5 percentage points. The Gallup-Sharecare results are based on telephone interviews conducted July 1-Sept. 30, with a random sample of 45,743 adults, aged 18 and older, living in all 50 states and Washington, D.C. The margin of error is plus or minus 1 percentage point. Republished with permission from the Associated Press.
Critics say Donald Trump birth control rule ignores science
The Trump administration’s new birth control rule is raising questions among some doctors and researchers, who say it overlooks known benefits of contraception while selectively citing data that raise doubts about effectiveness and safety. “This rule is listing things that are not scientifically validated, and in some cases things that are wrong, to try to justify a decision that is not in the best interests of women and society,” said Dr. Hal Lawrence, CEO of the American Congress of Obstetricians and Gynecologists, a professional society representing women’s health specialists. Two recently issued rules – one addressing religious objections and the other, moral objections – allow more employers to opt out of covering birth control as a preventive benefit for women under the Obama health care law. Although the regulations ultimately address matters of individual conscience and religious teaching, they also dive into medical research and scholarly studies on birth control. It’s on the science that researchers are questioning the Trump administration. They say officials ignored some recent research and stretched other studies. “The interpretation is very selective in terms of the science that they use,” said Alina Salganicoff, director of women’s health policy at the nonpartisan Kaiser Family Foundation. “It’s always possible to find one study that validates your claim, but you have to look at the quality of the study and the totality of the research. You can make an argument that you don’t agree because of your religious or moral objections, but that is a different discussion.” In a statement, Health and Human Services Department spokeswoman Caitlin Oakley responded to critics, saying: “The rules are focused on guaranteeing religious freedom and conscience protections for those Americans who have a religious or moral objection to providing certain services based on their sincerely held beliefs.” The administration also says some parts of the rules are meant to illustrate the sorts of concerns that religious objectors may have, and don’t necessarily reflect government policy. Here’s a look at examples from the Trump administration’s birth control rules that are raising questions: THE MORNING-AFTER PILL Emergency contraception is birth control for use after unprotected sex, often called the “morning-after pill.” Referring to the morning-after pill as well as intrauterine devices or IUDs, the regulations state that the Food and Drug Administration “includes in the category of ‘contraceptives’ certain drugs and devices that may not only prevent conception (fertilization), but also may prevent implantation of an embryo.” Because of that, “many persons and organizations” believe emergency contraception methods cause “early abortion,” the regulations add. But Princeton researcher James Trussell said that while studies years ago suggested the morning-after pill might affect the lining of a woman’s uterus and interfere with the implantation of a fertilized egg, more recent studies have not found such an effect. “The preponderance of the evidence, and certainly the most recent evidence, is that there is no post-fertilization effect,” said Trussell. That’s not included in the administration’s rule. “The actual medical evidence is that it blocks ovulation,” or the release of an egg from the ovaries, explained Lawrence, the ob-gyn. “If you don’t ovulate, there is no egg to get fertilized. It’s not blocking implantation.” EFFECTIVENESS OF BIRTH CONTROL The Trump administration’s rule takes issue with the science behind the Obama-era decision to require most employers to cover birth control as preventive care. It suggests that some studies cited in a key 2011 report did not show a direct cause-and-effect link between increased birth control use by women and a decline in unintended pregnancy. But Adam Sonfield of the Guttmacher Institute said solid research does in fact exist. The organization does studies on reproductive health that are cited by opposing sides in the political debate. For example, Sonfield cited a Guttmacher report which found that women who used birth control consistently year-round accounted for only 5 percent of unintended pregnancies in 2008. “The vast majority of women use birth control at some point in their lives,” said Sonfield. “As a medical service, it’s far more universal than almost anything covered by insurance.” George Washington University public health professor Susan Wood, a former women’s health chief for the FDA, said there’s very clear clinical data that contraception prevents pregnancy. Why else would the FDA approve birth control pills? “They are just using this as a smoke screen,” Wood said of the administration. “They are picking out things that they like, and leaving out (studies) that support access to contraception.” THE SEXUAL REVOLUTION The Trump administration’s rule suggests there may be a link between birth control and promiscuity. It cites a study finding that between 1960 and 1990, “as contraceptive use increased, teen sexual activity outside of marriage likewise increased.” (The administration added a caveat that the study did not prove a cause-and-effect link.) Lawrence, the ob-gyn, said he thinks that’s a stretch. “There were a whole lot of other things going on in the ’60s,” he said, such as changing social mores about sex before marriage. Also, many people relied on condoms, diaphragms and spermicides. “The world of birth control in 2018 is about as similar to the world of birth control in 1960 as a Ralph Nader Chevy Corvair is to a space shuttle,” he said. Republished with permission from the Associated Press.
House GOP eyes budget passage that is key to tax debate
Republicans are focused on cutting taxes instead of deficits as they look to power a $4.1 billion budget plan through the House on Thursday. The 2018 House GOP budget promises deep cuts to social programs and Cabinet agency budgets but its chief purpose is to set the stage for action later this year on a comprehensive Republican overhaul of the U.S. tax code. The tax overhaul is the party’s top political priority as well as a longtime policy dream of key leaders like Speaker Paul Ryan. The plan calls for more than $5 trillion in spending cuts over the coming decade, including a plan to turn Medicare into a voucher-like program for future retirees, slash Medicaid by about $1 trillion over the coming decade, and repeal the “Obamacare” health law. But Republicans are not actually planning to impose any of those cuts with follow-up legislation that would be required under Washington’s byzantine budget rules. Instead, those GOP proposals for spending cuts are limited to nonbinding promises, and even a token 10-year, $200 billion spending cut package demanded by tea party House Republicans appears likely to be scrapped in upcoming talks with the Senate. Instead, the motivating force behind the budget measures is the Republicans’ party-defining drive to cut corporate and individual tax rates and rid the tax code of loopholes. They promise this tax “reform” measure will put the economy in overdrive, driving economic growth to the 3 percent range, and adding a surge of new tax revenues that would help bring the budget toward balance. Passing the measure through the House and Senate would provide key procedural help for the tax measure because it sets the stage for follow-on legislation that can’t be filibustered by Senate Democrats. Republicans used this so-called reconciliation procedure in their failed attempt to kill “Obamacare,” including its tax surcharges on wealthy people. “Through reconciliation, our budget specifically paves the way for pro-growth tax reform that will reduce taxes for middle class Americans and free up American businesses to grow and hire,” said House Budget Committee Chairman Diane Black, R-Tenn. The House vote comes as the Senate Budget Committee is considering a companion plan that differs in key details and is set for a vote Thursday afternoon. Both the House and Senate plans rely on rosy estimates of economic growth and illusory spending cuts to promise to wrestle the federal budget back into surplus within a decade. The House measure also assumes that the upcoming tax bill won’t add to the deficit; the Senate version, however, would permit the measure to add $1.5 trillion to the $20 trillion-plus national debt over the coming 10 years. The final version is likely to stick closely to the Senate measure. The real-world trajectory of Washington, however, is for higher deficits as Republicans focus on tax cuts, a huge hike in the defense budget, and a growing disaster aid tally that is about to hit $45 billion. “The train’s left the station, and if you’re a budget hawk you were left at the station,” said Rep. Mark Sanford, R-S.C. Democrats blasted the sweeping spending cuts proposed by Republicans – $5.4 trillion over 10 years in the House plan and somewhat less in the Senate GOP measure – as an assault on middle-class families and the poor. “This is, like Yogi Berra said, ‘deja vu all over again.’ Republicans used their Trumpcare bill to sneak in tax cuts for the rich,” said Senate Minority Leader Chuck Schumer, D-N.Y. “Now they’re using their tax cut plan … and they’re sneaking in cuts to Medicaid and Medicare. But it’s the same playbook.” Republished with permission from the Associated Press.
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.
Health care bill teeters, GOP adds money to woo dissidents
Top Republicans are adding money to their staggering effort to repeal the Obama health care law and say they’re pushing toward a climactic Senate faceoff this week. Yet their path to succeeding in their last-gasp effort has grown narrower, perhaps impossible. GOP senators’ opposition to their party’s drive to scrap President Barack Obama’s Affordable Care Act swelled to lethal numbers Sunday. Moderate Sen. Susan Collins all but closed the door on supporting the teetering bill and conservative Sen. Ted Cruz said that “right now” he doesn’t back it. President Donald Trump has pressed for a fresh vote, and White House legislative liaison Marc Short and Sen. Lindsey Graham, R-S.C., one of the measure’s sponsors, said Republicans would move toward a vote this week. Senate Majority Leader Mitch McConnell, R-Ky., has said he intends to consider the measure but hasn’t firmly committed to a vote. The Congressional Budget Office was expected to release its analysis of the legislation early this week. But the CBO, which is lawmakers’ nonpartisan fiscal analyst, has said that it doesn’t have time to determine the bill’s impact on coverage and premiums, major factors for some lawmakers deciding their votes. Instead, the office is expected to only detail its estimates of the measure’s effect on federal deficits. A vote must occur this week for Republicans to have any chance of prevailing with their narrow Senate majority. Next Sunday, protections expire against a Democratic filibuster, bill-killing delays that Republicans lack the votes to overcome. Already two GOP senators, Rand Paul of Kentucky and John McCain of Arizona, have said they oppose the legislation. All Democrats will vote against it. “No” votes from three of the 52 GOP senators would kill the party’s effort to deliver on its perennial vow to repeal “Obamacare” and would reprise the party’s politically jarring failure to accomplish that this summer. In a late stab at attracting votes, Republicans were adding $14.5 billion to the measure including extra funds for states of dissenting GOP senators, according to documents obtained late Sunday by The Associated Press. A chart Republicans circulated said the legislation’s grants would provide 14 percent more money for Arizona than under Obama’s law; 4 percent more for Kentucky; 49 percent more for Texas; 3 percent more for Alaska, home to undecided GOP Sen. Lisa Murkowski; and 43 percent more for Maine, home to Collins. Some extra money is specifically directed at sparsely populated states. The numbers are misleading, partly because they omit GOP Medicaid cuts from clamping per-person spending caps on the program, said Matt House, spokesman for Senate Minority Leader Chuck Schumer, D-N.Y. In a statement, Schumer said the measure would “throw our health insurance system into chaos.” Collins’ criticisms included the bill’s cuts in the Medicaid program for low-income people and the likelihood that it would result in many losing health coverage and paying higher premiums. “It’s very difficult for me to envision a scenario where I would end up voting for this bill,” said Collins. The conservative Cruz also voiced opposition, underscoring the bill’s problems with both ends of the GOP spectrum. “Right now, they don’t have my vote,” Cruz said at a festival in Austin, Texas. He suggested the measure doesn’t do enough to reduce premiums by allowing insurers to sell less comprehensive coverage than Obama’s law allows. Paul said even though the bill transforms federal health care dollars into block grants that states would control, the GOP bill left too much of that spending intact. McCain has complained that Republicans should have worked with Democrats in reshaping the country’s $3 trillion-a-year health care system and cited uncertainty over the bill’s impact on consumers. Murkowski has remained uncommitted, saying she’s studying the bill’s impact on Alaska. Her state’s officials released a report Friday citing “unique challenges” and deep cuts the measure would impose on the state. She and Collins were the only Republicans who voted “no” on four pivotal votes on earlier versions of the GOP legislation in July. The bill now in play would repeal much of the 2010 law, including its tax penalties on people who don’t buy insurance and on larger employers not offering coverage to workers. States could loosen coverage requirements under the law’s mandates, including prohibiting insurers from charging seriously ill people higher premiums and letting them sell policies covering fewer services. It would eliminate Obama’s expansion of Medicaid and the subsidies the law provides millions of people to reduce their premiums and out of pocket costs, substituting block grants to states. Collins was on CBS’ “Face the Nation” and CNN’s “State of the Union,” Graham appeared on ABC’s “This Week” and Paul was on NBC’s “Meet the Press,” and Short was on CBS, NBC and “Fox News Sunday.” Republished with permission from the Associated Press.
Former health chiefs to Donald Trump: Avoid new ‘Obamacare’ crisis
Don’t make things worse. That’s the advice of former U.S. health secretaries of both parties to President Donald Trump and the GOP-led Congress, now that “Obamacare” seems here for the foreseeable future. The 2018 sign-up season for subsidized private health plans starts Nov. 1, with about 10 million people currently served through HealthCare.gov and its state counterparts. Stability should be the immediate goal, said former Health and Human Services secretaries Kathleen Sebelius, Mike Leavitt and Tommy Thompson. At minimum: Dispel the political and legal uncertainty – fueled by presidential tweets – around billions in subsidies for consumers’ insurance copays and deductibles. The three former officials shared their views with The Associated Press. Beyond the urgent need to calm markets by providing clarity on subsidies, Democrat Sebelius and Republicans Leavitt and Thompson differ on the direction Trump and Congress should take. They agree that Republicans still have an opportunity to put their stamp on the Affordable Care Act, even if the drive to “repeal and replace” former President Barack Obama‘s legacy program appears to have hit a dead end. “They can make changes that signal a new ideological direction without generating a logistical and political mess,” said Leavitt, who led HHS during former President George W. Bush‘s second term. “They won the right to make changes. However, they should do it in a skillful way.” Leavitt shepherded the Medicare prescription drug benefit through its rocky rollout in 2006. “Stabilizing the current situation can only – I think – be to their benefit,” Sebelius said of the Trump administration. “In an environment in which (insurance) companies are enrolling customers, they’ve got a lot of time to actually go back to the drawing board and figure this out. The worst of all worlds for them would be to have the current situation unravel because of decisions by this administration.” Sebelius helped steer Obama’s law through Congress and later oversaw the troubled launch of HealthCare.gov, when the computer system locked up on the first day of sign-up season, frustrating millions of consumers and embarrassing the White House. She took the heat, but Sebelius stayed on task and ultimately helped deliver a successful open enrollment. “It would be a mistake to further destabilize the (insurance) market,” said Thompson, who served during Bush’s first term and led HHS preparations to meet the bioterrorism threat after the deadly anthrax mailings that followed closely the Sept. 11 attacks. Thompson urged a health care summit between Trump and congressional leaders of both parties, followed by a period of intensive legislative work under a deadline to reach a truce in the political battle over health care. Trump and top lieutenants like HHS Secretary Tom Price have sent mixed signals. Leading congressional Republicans want to try to move limited legislation after lawmakers return next month, worried they’ll suffer consequences in next year’s midterm elections. At the very least such legislation would provide clear legal authority for the ACA’s cost-sharing subsidies, which reduce copays and deductibles for people with modest incomes. Stopping the payments would lead to a spike in premiums, more insurers leaving the markets and increased federal deficits, the Congressional Budget Office warned last week. The markets already saw steep premium increases this year, and more insurers have since bailed out, citing financial losses. The administration has continued to make monthly subsidy payments to insurers, as recently as last week. But Trump on Twitter and in interviews has repeatedly threatened to pull the plug. Sebelius has been sharply critical of the Trump administration’s stewardship of the ACA. Two of the former health secretaries – Leavitt and Sebelius – said states are now likely to assume a bigger role in shaping the future of Obama’s law. A waiver pathway for states was built into the law, and Republicans want to make it less restrictive. That’s a key focus for Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., as he plans bipartisan hearings this fall with Democratic counterpart Patty Murray of Washington. Leavitt sees waivers as a way to provide states more flexibility to tailor their insurance market rules to local needs and preferences. Sebelius says that should not be done in a way that undermines federal consumer protections like standard benefits. She’d like to see states use waivers to help offset the cost of care for the sickest patients. Thompson says he believes a bigger deal, at the federal level, is still possible if Trump plays his cards right with Congress. Former HHS Secretary Sylvia Burwell, who served during most of Obama’s second term, declined interview requests. Republished with permission of The Associated Press.
White House: Government to make health law payments this month
The government will make this month’s payments to insurers under the Obama-era health care law that President Donald Trump still wants to repeal and replace, a White House official said Wednesday. Trump has repeatedly threatened to end the payments, which help reduce health insurance copays and deductibles for people with modest incomes, but remain under a legal cloud. A White House spokesman said “the August payment will be made,” insisting on anonymity to discuss the decision ahead of the official announcement. The so-called “cost-sharing” subsidies total about $7 billion this year and are considered vital to guarantee stability for consumers who buy their own individual health insurance policies. Insurers say they want to the administration to do more, and guarantee the payments at least through next year. But on Capitol Hill, a senior Republican applauded Trump’s move. “State insurance commissioners have warned that abrupt cancellation of cost-sharing subsidies would cause premiums, copays and deductibles to increase and more insurance companies to leave the markets,” said Sen. Lamar Alexander, R-Tenn., chairman of the Health, Education, Labor and Pensions Committee. “Congress now should pass balanced, bipartisan, limited legislation in September that will fund cost-sharing payments for 2018.” The Congressional Budget Office reported this week that premiums for a popular type of individual health care plan under the Affordable Care Act would rise sharply, and that more people would be left without options for coverage, if Trump kept his threat to stop the payments. Moreover, ending the payments would only increase federal deficits since it would trigger a rise in separate health law subsidies for premiums, wiping out any potential savings. The subsidies are snared in a legal dispute over whether the Obama health care law properly approved the payments to insurers. Adding to the confusion, other parts of the law clearly direct the government to reimburse the carriers. The disagreement is over whether the law properly provided a congressional “appropriation,” similar to an instruction for the Treasury to pay the money. The Constitution says the government shall not spend money unless Congress appropriates it. House Republicans trying to thwart the health law sued the Obama administration in federal court in Washington, arguing that it lacked specific language appropriating the cost-sharing subsidies. A district court judge agreed with House Republicans, and the case has been on hold before the U.S. appeals court in Washington. For months, Trump has been raising the prospect of terminating payments as a way to trigger a crisis and get Democrats to negotiate on a health care bill. After the GOP drive to repeal “Obamacare” collapsed, the president tweeted: “As I said from the beginning, let ObamaCare implode, then deal. Watch!” Trump elaborated in another tweet, “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies…will end very soon!” But with polls showing the public would blame Trump for “Obamacare” problems on his watch, congressional Republicans are not keen on going that route. It’s estimated that nearly 18 million people purchase individual health insurance policies. About half of them pay the full cost themselves and would risk the biggest disruptions from a spike in premiums. Republished with permission of The Associated Press.
