Can Congress Get Past Obamacare?

The Republican head of the Senate’s health panel is trying to look beyond Obamacare to the issue of rising health costs, but faces an uphill battle as the cost of health insurance continues to grow and make headlines.

A Senate panel will hold a series of hearings aimed at looking at the cost of health care in America, from the federal hospital drug discount program to the administrative burden on doctors to drug prices and other issues. Sen. Lamar Alexander (R-Tenn.), chairman of the committee, told me he wants to avoid getting bogged down in the debate over the individual health insurance market, where Obamacare’s policies have the most impact, and focus on the big picture of why health costs are so high in the U.S.

“We’ve spent the last eight years and expended a lot of energy on health insurance, especially on the individual market, which is just 6 percent of the total market,” Alexander, head of the Senate Health, Education, Labor and Pensions Committee, said. “We’re never going to get the cost of insurance down unless we get the overall cost of health care down.”

The hearings on health costs will be a good litmus test for whether lawmakers can reach agreement on legislation to address health-care costs. Read More at Bloomberg

Defying Predictions, Obamacare Insurers See Boom Times Ahead

Health insurers are finding success in ObamaCare this year and are planning to expand their offerings in many states, defying expert’s predictions.

Insurance startup Oscar Health filed to sell ObamaCare plans in Florida, Arizona and Michigan for the first time, and will enter new markets in Ohio, Tennessee and Texas.

Smaller insurers are also making moves, such as Bright Health in Tennessee and Presbyterian Healthcare in New Mexico. It will be the first time Bright Health is selling plans in Tennessee, while Presbyterian is returning to the state exchange after leaving in 2016.

Experts have been hailing these developments, saying that insurers have finally figured out how to become profitable in the ObamaCare marketplace.

But the success is also coming in the face of persistent GOP hostility toward the health-care law and brings the risk of double-digit premium hikes for customers. Read More at The Hill

ObamaCare Can Be Worse Than Medicaid

This year will be the last in which uninsured Americans are forced to pay ObamaCare’s penalty for lack of coverage. The change—part of the GOP’s tax reform—comes as relief on the demand side of health insurance. Yet nothing has changed on the market’s supply side. Without additional reforms to ObamaCare’s restrictions on insurers, millions of Americans will continue to choose from a limited range of lackluster plans.

Many of the country’s top hospitals are off limits to patients covered by ObamaCare’s current plans. Take Houston’s MD Anderson Cancer Center, which was named America’s best cancer-care hospital by U.S. News & World Report in 13 of the past 16 years. The hospital’s website suggests that it takes even Medicaid, but it doesn’t accept a single private health-insurance plan sold on the individual market in Texas.

Since Blue Cross of Minnesota withdrew from the individual market in 2016, the state’s Mayo Clinic—once cited by President Obama as a model for the nation—has been off limits to Minnesotans covered by ObamaCare exchange plans. Memorial Sloan Kettering appears out of bounds for every exchange plan in New York. Both of these hospitals are open to some Medicaid patients, though Mayo’s chief executive has predicted publicly that Medicaid patients may eventually have to queue behind their privately insured peers.

Think about these developments. When Mr. Obama promised to insure the uninsured, what kind of insurance was he talking about? Most people, and maybe even the president himself, imagined it would look like a typical employer plan or a standard Blue Cross individual policy. Who imagined that the only products available would be more limited than Medicaid? Read More at The Wall Street Journal

As Midterms Approach, Conservatives and GOP Again Attempt to Destroy Obamacare

Not satisfied with a raft of legislative and administrative steps likely to drive up health premiums just as voters turn their attention to the November elections, a coalition of conservatives on Tuesday unveiled another attempt to kill the Affordable Care Act.

This one also has Republican fingerprints on it. The “Health Care Choices Proposal” advanced by the Health Policy Consensus Group closely tracks the so-called Graham-Cassidy healthcare bill proposed by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) that enjoyed a brief moment in the sun last fall before fading away. The sponsoring group comprises the Heritage Foundation, the free-market Galen Institute, the right-wing Goldwater Institute and former Sen. Rick Santorum (R-Pa.), among others.

Like Graham-Cassidy, the latest proposal would effectively do away with protections for people with preexisting medical conditions and would remove the ACA’s requirements that all health plans offer minimum essential benefits, such as hospitalization, maternity care and mental health services.

Graham-Cassidy would have eliminated the Medicaid expansion and funneled money away from states that covered their poorest residents via Medicaid, such as California, and toward those that didn’t bother, such as Texas, via a block-grant system providing each state with a capped amount of federal funding.

The new proposal is vague on how its block-grant system would work, but on the surface it has some of the same features as Graham-Cassidy. As Duke University health insurance expert David Anderson puts it, the message for Americans saddled with a healthcare law like this is: “Don’t get sick.” Read More at LA Times

Once More Into the Breach: Conservative Think Tankers Publish a New Obamacare Replacement

Conservative health care think tank scholars have published a new proposal to repeal and replace Obamacare, hoping that they can persuade Congress to take up the issue one more time before November. Can it succeed where prior efforts have failed?

Graham-Cassidy 2.0

The proposal, entitled “The Health Care Choices Proposal: Policy Recommendations to Congress—Why Congress Must Act,” was published by the Health Policy Consensus Group, a kind of conservative health wonk Jedi Council led by Grace-Marie Turner of the Galen Institute, who is also a Forbes contributor. (I am also a participant in the Consensus Group.)

The plan emerged from the aftermath of the 2017 effort by Senators Bill Cassidy (R., La.) and Lindsey Graham (R., S.C.) to put forth an Obamacare replacement after the previous efforts by congressional GOP leadership had failed. The Graham-Cassidy bill, which I reviewed in detail, was designed to preserve the vast majority of Obamacare’s spending on the uninsured, but reformat that spending as block grants to state governments.

The critical flaw in Graham-Cassidy is that it bore the potential to make health insurance markets worse, not better, because due to design flaws in the bill, most states would have been strongly incentivized to eliminate their private individual insurance markets and replace them with an enlarged expansion of Medicaid, a program whose enrollees have health outcomes no better than those who are uninsured.

The Consensus Group proposal improves upon Graham-Cassidy by requiring that “at least 50% of the block grant goes toward supporting people’s purchase of private health coverage” in the individual insurance market. Under the new program, states would be required to offer Medicaid enrollees the opportunity to purchase “commercially available coverage” with their Medicaid dollars, and plans sold under the block grants would be exempted from costly Obamacare rules, like 3:1 age bands that double or triple the cost of insurance for young people. Read More at Forbes

Obamacare Enrollment in State Drops

Nearly 329,000 New Jersey residents were getting their health care plans through Obamacare in a recent check, representing a drop of 39,858 fewer people than a year earlier.

That’s according to data from the New Jersey Department of Banking and Insurance, which compared the number of Obamacare enrollees in the first quarter of 2018 and a year earlier.

“Federal actions to undermine the Affordable Care Act, including the failure to fund Cost Sharing Reduction payments and the elimination of the individual mandate, created enormous uncertainty in the market and had a significant negative effect on health insurance enrollment in New Jersey,” said DOBI Commissioner Marlene Caride.

The DOBI report shows that 239,738 individuals were getting health care through marketplace plans, 25,386 fewer than in 2017. And 89,023 were getting their health care through off-the-marketplace plans in the first quarter of 2018, 14,472 fewer than the first quarter of 2017. Read More at NJBIZ

Obamacare: Outreach Groups Nervous as Trump Remains Silent on Funding

A year after steep cuts to a key Affordable Care Act outreach program, the Trump administration has remained quiet on how much it will fund nonprofit and grassroots groups that help people sign up for health insurance.

The federal navigator program funds groups that help people sign up for health insurance on the Obamacare federal and state insurance exchanges or assist low-income adult and children sign up for Medicaid coverage.

Navigator groups located in federal exchange states are funded through September but have no idea how much money will be available beyond then. The six-week open enrollment period that allow consumers to choose a plan for the upcoming year begins Nov. 1. Read More at USA Today

Oscar Health to Enter Six New Insurance Markets Despite Obamacare Attacks

Oscar Health said it will sell health insurance in six new markets, an aggressive expansion for 2019 despite continued regulatory and political assault on individual markets by the Donald Trump administration and Republicans in Congress.

The New York startup, which has made a big bet on offering individual coverage under the Affordable Care Act, has expanded Obamacare offerings this year to more states. That expansion into new markets paid off, with the insurer enrolling more than 250,000 in individual products under the ACA for this year.

Now Oscar has filed to offer insurance in nine states and 14 markets in 2019, “nearly doubling” its current footprint . The expansion is possible thanks to growth, improving financial operations and new funding announced earlier this year.

“Our six new markets will be spread across three new states — Florida, Arizona, and Michigan — and three additional large metro areas in Ohio, Tennessee, and Texas,” Oscar CEO and co-founder Mario Schlosser said in announcing the expansion. Oscar’s other co-founder is Josh Kushner, the brother of President Trump’s son-in-law, Jared.

The expansions come despite repeated and ongoing attempts by the Republican-led Congress and Donald Trump White House to end subsidies for individual customers, destabilize the market with unpredictable and 11th-hour regulatory changes and verbally trash the ACA’s individual coverage.

Read More at Forbes

Sen. Alexander to HHS: Help States Riff on Obamacare to Slash Costs

Senate Health Committee Chairman Lamar Alexander urged the Trump administration to explore ways to make waivers baked into Obamacare a “more powerful tool” for states looking to slash premiums.

Mr. Alexander, Tennessee Republican, said Thursday his bipartisan push to stabilize the Obamacare markets might have fallen apart this year, but the Health and Human Services Department should find ways to forge ahead with parts of the deal that would empower states.

The package would have let states to seek changes to the 2010 law more quickly or submit “copycat” waiver to copy ideas that won approval in other states. He said HHS should solicit ideas from governors and state insurance commissioners and encourage states to apply for wiggle room under the 2010 health law.

“I am turning to you to help Americans harmed by Obamacare by putting states back in charge of health insurance through the State Innovation Waivers,” Mr. Alexander wrote to HHS Secretary Alex Azar and Seema Verma, administrator at the Centers for Medicare and Medicaid Services.

States like Alaska have used the waiver system to set up a “reinsurance” program that subsidizes pricey customers, so others can pay less, while Hawaii used the program to eliminate a small-business aspect of Obamacare that overlapped with state law.

Read More at The Washington Times

Trump’s Plan to Lower Drug Prices Tests Limits of the Law

In his effort to bring down prescription drug prices, President Trump is testing the limits of a law that prohibits the government from interfering in negotiations between drug manufacturers and insurance companies that provide drug coverage to more than 42 million people on Medicare.

The prohibition was adopted 15 years ago when a Republican Congress added drug benefits to Medicare, and since then Republicans have repeatedly invoked it to quash Democratic demands for the government to rein in drug costs.

But now, with prices of new drugs often topping $10,000 a year, Mr. Trump has unveiled a blueprint to lower drug prices, and some of his ideas envision a larger role for the government.

He wants to require insurers to reduce retail drug prices to reflect the discounts they receive from drug manufacturers. These discounts often take the form of rebates paid to insurers and middlemen known as pharmacy benefit managers.

Read More at The New York Times