Obamacare Finds Stability Under Siege

Republicans who have been thwarted in their attempts to repeal former President Barack Obama’s health care law appear instead to have settled on a strategy of dismantling the law piece by piece. But despite a series of seemingly crippling blows since Donald Trump took office, Obamacare has proved hard to kill.

As recently as this month, the Trump administration announced it would temporarily halt what are called “risk-adjustment payments” in the wake of a March federal court order that questioned the formula by which the payments were calculated. The payments required providers with fewer sick patients to transfer some funds to providers that have higher numbers of patients needing more expensive care, spreading out the cost of covering sicker patients as they obtained insurance. One of a series of moves designed to protect insurers participating in Obamacare, it was widely seen as a way to prevent providers from seeking out only the healthiest patients as customers.

Some fear that the move, involving billions of dollars in payments, could lead providers to raise premiums to offset the added risks if it were made permanent – the latest in what seem to be frequent disruptions of the market that show no sign of abating… Read More at US News & World Report

Next Year’s Obamacare: More Insurers but Steeper Prices

Health insurers are planning to expand in Obamacare amid rising profits, but the trend is coming at the expense of higher premiums for certain customers.

Premiums are expected to rise by an average of 15 percent for customers whose incomes aren’t low enough to qualify them for subsidies, according to early estimates from Avalere Health.

Still, the entrance by insurers into Obamacare is a reversal from years of exits. Health insurers were fleeing Obamacare in droves around this time last year, and it looked as though people in as many as 47 counties would have no options for coverage.

The Trump administration and Republicans have made several changes to Obamacare since then that Democrats call “sabotage.” President Trump ended payments to insurers, the GOP tax law will end the requirement in 2019 that people must buy health insurance or pay a fine, and people soon will be able to buy less-expensive coverage that doesn’t follow Obamacare’s rules.

Yet, the Obamacare exchanges are showing an unexpected trend: No empty counties have been reported. Not only are insurers not leaving, but they’re also expanding or returning. Read More at the Washington Examiner

Pro-ObamaCare Group Launches Ad in Supreme Court Fight

A pro-ObamaCare group has launched the first television ad focused on health care in the fight over the next Supreme Court justice.

The Protect Our Care ad tells viewers that President Trump could nominate a Supreme Court justice who opposes ObamaCare — specifically its protections for those with pre-existing conditions, like diabetes and asthma.

“This is an emergency,” the narrator says. “Trump and Mitch McConnell have a plan to install a Supreme Court justice who will overturn those protections,” the ad continues, referring to Senate Majority Leader Mitch McConnell (R-Ky.)

The ad refers to a lawsuit brought by Republican attorneys general against the Trump administration targeting ObamaCare, arguing Congress’s recent repeal of the individual mandate to have health insurance makes the whole law unconstitutional. Read More at The Hill

Obamacare Is Proving Hard to Kill

As health insurers across the country begin filing their proposed rates for 2019, one thing is clear: The market created by the Affordable Care Act shows no signs of imminent collapse in spite of the continuing threats by Republicans to destroy it.

In fact, while President Trump may insist that the law has been “essentially gutted,” the A.C.A. market appears to be more robust than ever, according to insurance executives and analysts. A few states are likely to see a steep spike in prices next year, but many are reporting much more modest increases. Insurers don’t appear to be abandoning markets altogether. In contrast to last year, regulators are not grappling with the prospect of so-called “bare” counties, where no carrier is willing to sell A.C.A. policies in a given area.

“The market is in a better position now than it has ever been since the exchanges have opened,” said Deep Banerjee, who follows insurers for S & P Global Ratings. The companies first began selling policies in the state exchanges, or marketplaces, five years ago. After years of losses, the insurers are now generally making money.

With roughly a third of states releasing information, the insurers’ rate requests vary widely, according to an analysis by the Kaiser Family Foundation. In Maryland, companies are seeking increases averaging 30 percent. A midlevel policy in Baltimore could cost $622 a month, roughly a third higher than the average of the other states reporting to date. Read More at The New York Times

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