Health insurance – Capitol Hill Blue

Dems go to to war with each other in first primary debate

June 26, 2019 by <a href="https://www.capitolhillblue.com/node/byline/juana-summers-and-steve-peoples" rel="tag">JUANA SUMMERS and STEVE PEOPLES</a>

Democratic presidential candidate Sen. Elizabeth Warren, D-Mass., gestures towards New Jersey Sen. Cory Booker, during a Democratic primary debate in Miami. (AP Photo/Wilfredo Lee)

Massachusetts Sen. Elizabeth Warren raised her hand as one of the only Democratic presidential contenders willing to abolish her own private health insurance in favor of a government-run plan, demanding “structural change” in the economy and the government as Democrats met on the debate stage for the first time in the 2020 presidential season.

Warren’s position highlighted a rift within her party’s most ambitious contenders over how to approach inequality in America in a prime-time meeting that marked the unofficial starting line for the Democratic Party’s quest to wrest the White House from Donald Trump and deny him a second term.

The debate marked a new phase in the 2020 presidential season as Democrats seek to break out from the crowded field. While the candidates have been courting voters in key states for several months already, the vast majority of the nation has yet to pay close attention to the diverse field.

On immigration, the Democratic presidential hopefuls were united in blaming Trump for the deaths of a migrant father and his toddler daughter whose bodies were seen in searing photographs after they drowned in the Rio Grande on the U.S.-Mexico border.

Former Obama administration housing chief Julian Castro said, “Watching that image of Oscar and his daughter Valeria was heartbreaking. It should also piss us all off.”

But the candidates didn’t agree on everything. Castro assailed fellow Texan and former Rep. Beto O’Rourke for not calling for fully decriminalizing crossing the U.S.-Mexico border illegally.

O’Rourke said he doesn’t support fully decriminalizing such border crossings because of fears about smugglers of drugs and people.. New Jersey Sen. Cory Booker also sided with Castro, arguing for full decriminalization

Most of Warren’s rivals Wednesday night, including former O’Rourke and Minnesota Sen. Amy Klobuchar, called for universal health care, but also favored preserving the private insurance market. Vermont Sen. Bernie Sanders, who will be in a second debate group Thursday night, has proposed a “Medicare for All” system without private insurance, and Warren said she agreed with him.

On economic fairness in general, Warren declared, “Who is this economy really working for? It’s doing great for a thinner and thinner slice at the top. … That is corruption pure and simple … and we need to make structural change.”

One of the few voices for the moderate wing of the Democratic Party on stage, former Maryland Rep. John Delaney, pushed back: “We should be the party that keeps what’s working and fixes what’s broken,” he said. “Why do we have to stand for taking away something from people.”

New York Mayor Bill de Blasio, who joined Warren in raising his hand on health insurance, cast the debate as part of “the battle for the heart and soul of our party.”

Wednesday night featured a collection of 10 candidates, led by Warren, on national television for two hours. The overall field is so large that a second group of 10 Democrats, led by early front-runner Joe Biden, are to debate 24 hours later.

The groupings were chosen at random by debate host NBC.

Democrats are unified in their deep desire to beat Trump but divided on what kind of candidate is best positioned to do so.

On one side: candidates like Warren who are demanding dramatic change that includes embracing liberal policy priorities like free universal health care, debt-free college, a forgiving immigration policy and higher taxes on the rich. On the other: pragmatic-minded Democrats like Biden — and little-known former Maryland Rep. John Delaney — who are calling for modest policy solutions that could ultimately attract bipartisan support.

Wednesday’s slate also featured Reps. Tulsi Gabbard of Hawaii and Tim Ryan of Ohio, along with Washington Gov. Jay Inslee.

Trump, the elephant not in the room, was in the air traveling to Japan for a round of trade talks as Democrats faced the nation for the first time in the 2020 campaign.

Earlier in the day, he confirmed that he would watch the debate from Air Force One.

His first tweet of the night: “BORING!”

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Peoples reported from Washington. Associated Press writers Laurie Kellman and Elana Schor in Washington, Sara Burnett in Chicago, David Bauder in New York, Alexandra Jaffe in Miami and Elana Schor in Washington contributed to this report.

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Copyright © 2019 Capitol Hill Blue

Health care coverage gains remain steady

May 22, 2018 by <a href="https://www.capitolhillblue.com/node/byline/ricardo-alonso-zaldivar" rel="tag">RICARDO ALONSO-ZALDIVAR</a>

The main page of the healthcare.gov website in Washington, on Monday, May 21, 2018. (HealthCare.gov via AP)

The U.S. clung to its health insurance gains last year, an unexpected outcome after President Donald Trump’s repeated tries to take apart the Obama-era coverage expansion, according to a major government survey released Tuesday.

Overall, the survey from the Centers for Disease Control and Prevention found that 9.1 percent of Americans were uninsured in 2017, or a little more than 29 million people

After nearly a year of Trump, that was almost the same as toward the end of the Obama administration. For perspective, the uninsured rate dropped from 16 percent since the Affordable Care Act was signed in 2010, which translates roughly to 19 million people gaining coverage.

“Despite all the noise and despite the chain-rattling Republicans have done with their failed attempts at repeal, at the end of the day the number of uninsured has stayed flat,” said health economist Gail Wilensky, a longtime GOP adviser. “That’s good news for the country, and it might turn out to be good news for Republicans when it comes time for the midterm elections.”

But the CDC’s National Health Interview Survey also showed uninsured numbers edged higher for some groups, raising questions about potential problems this year and beyond. It doesn’t reflect congressional repeal of the health law’s unpopular requirement that individuals carry health insurance, since that doesn’t take effect until next year.

Considered authoritative by experts, the CDC report contradicts popular story lines from both ends of the political spectrum. On the right, Trump and others warn that Obamacare is “imploding.” (Instead, enrollment is fairly resilient.) On the left, Democrats blame Trump administration “sabotage” for coverage losses. (No hemorrhaging was found.)

“It’s a testament to the high value people place on health insurance,” said Katherine Hempstead, a senior health policy adviser at the nonpartisan Robert Wood Johnson Foundation. “People will tenaciously hang on to their health insurance.”

Still, the survey found some worrisome indicators of issues potentially ahead:

—The uninsured rate rose among “not poor” adults. (Translation: middle class.) That increase was statistically significant, rising to 8.2 percent in 2017. Hempstead said it may reflect the impact of sharp premium increases for individual plans for people in the solid middle class, who aren’t eligible for subsidized coverage under the ACA. “They are uniquely required to pay the full retail cost of health care,” she said.

—The uninsured rate also rose significantly in states that have not taken advantage of the ACA’s Medicaid expansion for low-income people. It averaged 19 percent for adults in states that had not expanded Medicaid, a big difference from about 9 percent uninsured in states expanding low-income coverage. The Medicaid expansion survived repeal efforts and several states are moving to join the 32 others, plus Washington, D.C., that have expanded.

Last year was tumultuous for health care, with Trump and Congress finally poised to deliver on the GOP vow to repeal President Barack Obama’s signature law. After repeated tries, the effort collapsed in the Senate. But Republicans did manage to undo the law’s unpopular requirement that most Americans maintain coverage or risk fines. Many experts believe the number of uninsured will increase when repeal of the so-called individual mandate goes into effect in 2019.

Trump also used his executive authority to undermine Obama’s law. He pulled the plug on legally contested subsidies for deductibles and copayments, triggering a spike in premiums. His administration cut the HealthCare.gov sign-up season in half, and slashed the ad budget. Changes pending this year will allow insurers to offer lower-cost plans that have fewer benefits, and can also turn away people in poor health.

Separately, the CDC survey showed no slowing down of the longstanding shift to high-deductible health insurance, with nearly 44 percent of Americans now in plans that require individuals to pay at least $1,300 of medical bills each year, or $2,600 for family coverage.

Two independent private surveys have recently shown an increase the U.S. uninsured rate, but the CDC’s approach is different. The government survey relies on face-to-face interviews, not telephone polling. And it’s based on data from about 78,000 people — a very large pool.

“This report is as credible a data source on the uninsured as we have,” said Wilensky.

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Health insurance no longer affordable

December 11, 2017December 11, 2017 by <a href="https://www.capitolhillblue.com/node/byline/tom-murphy" rel="tag">TOM MURPHY</a>

Stephanie and Lance Schmidt pose fwith their children, from left, Stella, Solomon and Theo, at their home in Oklahoma City. (AP Photo/Sue Ogrocki)

Margaret Leatherwood has eight choices for health insurance next year but no good options.

The cheapest individual coverage available in her market would eat up nearly a quarter of the income her husband brings home from the oilfields.

The Bryson, Texas, couple makes too much to qualify for Affordable Care Act tax credits that help people buy coverage. But they don’t make enough to comfortably afford insurance on their own, even though Paul Leatherwood works seven days a week.

“I hate to put it like this, but it sucks,” said Margaret Leatherwood, who stays at home and takes care of her grandchildren.

This largely middle-class crowd of shoppers is struggling to stay insured. They’ve weathered years of price hikes and shrinking insurance choices with no help. Faced with more price increases for next year, they’re mulling options outside insurance or skipping coverage entirely — a decision that could lead to a fine for remaining uninsured and huge bills if an emergency hits.

The sign-up period for 2018 coverage closes on Friday in most states, meaning shoppers have only a few more days to find something that squeezes into their budgets.

“I kind of cringe when I am meeting with those clients because I don’t have a solution for them,” said Kelly Rector, a Missouri-based insurance agent.

The ACA helped chop the U.S. uninsured population 41 percent to 28.8 million people earlier this year from 48.6 million in 2010, when it became law, according to the latest government figures.

The law expanded Medicaid coverage for the poor and created health insurance marketplaces where people can use income-based tax credits to buy a single or family individual insurance plan if they don’t get coverage through work. Those subsidies cover part or all of the bill, capping insurance costs at a percentage of income for those who are eligible. That shields recipients from price hikes of 20 percent or more that have hit many markets.

But that help stops abruptly for people making four times the federal poverty level or more — around $48,000 for an individual and more than $98,000 for a family of four.

Of the roughly 15 million people who bought ACA-compliant individual insurance for this year, nearly 7 million had no tax credit help, according to the Kaiser Family Foundation.

Meanwhile, the uninsured rate among adults who make too much to qualify for help buying coverage jumped to 5 percent this year from 2 percent in 2016, according to The Commonwealth Fund.

Brokers and health care researchers expect that to climb again, especially for people with income levels close to the cutoff for federal help.

“It’s not going to be like an on-off switch where prices get too high and nobody buys coverage,” said Sherry Glied of New York University. “It’s more like a drip, drip, drip.”

The vulnerable population includes the self-employed, small business owners and those close to qualifying for the Medicare program that covers people age 65 and over.

These customers can face monthly bills that climb past $2,000 for a family plan and then a big deductible before most coverage starts. Plus fewer markets this year have insurance that comes with a health savings account, which lets people save for medical expenses before taxes. Those accounts are popular with individual insurance shoppers who don’t get tax credit help, said St. Louis broker Emily Bremer.

Leslie Glogau said some of her customers in the Orlando, Florida area are considering short-term, limited-benefits plans that are cheaper than ACA-compliant coverage but can leave them vulnerable to big medical bills. Such plans also won’t stave off the uninsured penalty, which can amount to a few thousand dollars depending on income.

“People just don’t know which way to turn,” Glogau said.

Insurance shoppers won’t be fined if they can’t find an affordable option in their market. But going uninsured would still leave them exposed to huge medical bills.

Margaret and Paul Leatherwood wound up with a limited-benefits plan this year, but they want better protection in case of a big bill. She’s 58 and he just turned 60. They’re weighing joining a medical cost-sharing ministry for next year.

These ministries are not insurance, but they allow people to band together to share expenses, often by making monthly payments. They can be cheaper than regular coverage, and belonging to one allows customers to escape the ACA penalty for remaining uninsured.

Such arrangements usually come with restrictions or qualifications. For instance, participants may not be allowed to use tobacco, and there might be limits on help for medical conditions that existed before the customer signed up.

“That’s really the only option we have that’s going to cover anything,” Margaret Leatherwood said.

Lance and Stephanie Schmidt bought family coverage in the individual insurance market for years because they don’t get employer-sponsored coverage through Lance’s dental practice. But the Oklahoma City couple opted for a cost-sharing ministry this year after they realized the monthly insurance bill for their family of five would have more than doubled to over $1,200 and stuck them with a deductible that topped $7,000.

They now pay $450 a month for a plan through Liberty HealthShare, and they are leaning toward returning next year.

“There’s still some risk there, but so far it has proven to be just fine,” said Stephanie Schmidt.

Cost-sharing ministries and short-term plans aren’t the only alternatives to individual insurance. Tom Morrill, a broker from Kansas City, Missouri, has helped many of his customers set up group coverage through their businesses.

He said that gives them better options than what they would find on the individual market, where coverage prices from the dominant insurer, Cigna, are climbing an average of 42 percent. Four insurers have left that market. The 10 remaining plans all have narrow networks of providers and don’t pay for care outside those networks.

“It’s nuts,” Morrill said. “Rates have jumped dramatically. It’s not good coverage.”

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Trump pulls plug on health insurance subsidies

October 14, 2017October 13, 2017 by <a href="https://www.capitolhillblue.com/node/byline/ricardo-alonso-zaldivar" rel="tag">RICARDO ALONSO-ZALDIVAR</a>

President Donald Trump waves after signing an executive order on health care in the Roosevelt Room of the White House, Thursday, Oct. 12, 2017, in Washington. (AP Photo/Evan Vucci)

In a brash move likely to roil insurance markets, President Donald Trump will “immediately” halt payments to insurers under the Obama-era health care law he has been trying to unravel for months.

The Department of Health and Human Services made the announcement in a statement late Thursday. “We will discontinue these payments immediately,” said acting HHS Secretary Eric Hargan and Medicare administrator Seema Verma. Sign-up season for subsidized private insurance starts Nov. 1, in less than three weeks, with about 9 million people currently covered.

In a separate statement, the White House said the government cannot legally continue to pay the so-called cost-sharing subsidies because they lack a formal authorization by Congress.

However, the administration had been making the payments from month to month, even as Trump threated to cut them off to force Democrats to negotiate over health care. The subsidies help lower copays and deductibles for people with modest incomes.

Halting the payments would trigger a spike in premiums for next year, unless Trump reverses course or Congress authorizes the money. The next payments are due around Oct. 20.

The top two Democrats in Congress sharply denounced the Trump plan in a joint statement.

“It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” said House and Senate Democratic leaders Nancy Pelosi of California and Chuck Schumer of New York. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.”

The president’s action is likely to trigger a lawsuit from state attorneys general, who contend the subsidies to insurers are fully authorized by federal law, and say the president’s position is reckless.

“We are prepared to sue,” said California Attorney General Xavier Becerra. “We’ve taken the Trump Administration to court before and won.”

Word of Trump’s plan came on a day when the president had also signed an executive order directing government agencies to design insurance plans that would offer lower premiums outside the requirements of President Barack Obama’s Affordable Care Act.

Frustrated over setbacks in Congress, Trump is wielding his executive powers to bring the “repeal and replace” debate to a head. He appears to be following through on his vow to punish Democrats and insurers after the failure of GOP health care legislation.

On Twitter, Trump has termed the payments to insurers a “bailout,” but it’s unclear if the president will get Democrats to negotiate by stopping payment.

Experts have warned that cutting off the money would lead to a double-digit spike in premiums, on top of increases insurers already planned for next year. That would deliver another blow to markets around the country already fragile from insurers exiting and costs rising. Insurers, hospitals, doctors’ groups, state officials and the U.S. Chamber of Commerce have urged the administration to keep paying.

Leading GOP lawmakers have also called for continuing the payments to insurers, at least temporarily, so constituents maintain access to health insurance. Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., is working on such legislation with Democratic Sen. Patty Murray of Washington.

The so-called “cost-sharing” subsidies defray copays and deductibles for people with low-to-modest incomes, and can reduce a deductible of $3,500 to a few hundred dollars. Assistance is available to consumers buying individual policies; people with employer coverage are unaffected by the dispute.

Nearly 3 in 5 HealthCare.gov customers qualify for help, an estimated 6 million people or more. The annual cost to the government is currently about $7 billion.

But the subsidies have been under a legal cloud because of a dispute over whether the Obama health care law properly approved them. Adding to the confusion, other parts of the Affordable Care Act clearly direct the government to reimburse the carriers.

For example, the ACA requires insurers to help low-income consumers with their copays and deductibles.

And the law also specifies that the government shall reimburse insurers for the cost-sharing assistance that they provide.

But there’s disagreement over whether the law properly provided a congressional “appropriation,” similar to an instruction to pay. The Constitution says the government shall not spend money unless Congress appropriates it.

House Republicans trying to thwart the ACA sued the Obama administration in federal court in Washington, arguing that the law 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. Up to this point the Trump administration continued making the monthly payments, as the Obama administration had done.

While the legal issue seems arcane, the impact on consumers would be real.

The Congressional Budget Office estimated that premiums for a standard “silver” plan will increase by about 20 percent without the subsidies. Insurers can recover the cost-sharing money by raising premiums, since those are also subsidized by the ACA, and there’s no legal question about their appropriation.

Consumers who receive tax credits under the ACA to pay their premiums would be shielded from those premium increases.

But millions of others buy individual health care policies without any financial assistance from the government and could face prohibitive increases. Taxpayers would end up spending more to subsidize premiums.

Earlier Thursday, Trump had directed government agencies to design a legal framework for groups of employers to band together and offer health insurance plans across state lines, a longstanding goal of the president.

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Associated Press Writers Ken Thomas and Catherine Lucey contributed to this report.
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Trump triggers insurance rate hikes

August 12, 2017August 10, 2017 by <a href="https://www.capitolhillblue.com/node/byline/ricardo-alonso-zaldivar" rel="tag">RICARDO ALONSO-ZALDIVAR</a>

President Donald Trump, accompanied by Vice President Mike Pence, Health and Human Services Secretary Tom Price, and others, speaks about healthcare. (AP Photo/Alex Brandon)

The Trump administration’s own actions are triggering double-digit premium increases on individual health insurance policies purchased by many consumers, a nonpartisan study has found.

The analysis released Thursday by the Kaiser Family Foundation found that mixed signals from President Donald Trump have created uncertainty “far outside the norm,” leading insurers to seek higher premium increases for 2018 than would otherwise have been the case.

The report comes with Republicans in Congress unable to deliver on their promise to repeal and replace the Obama-era Affordable Care Act. Trump, meanwhile, insists lawmakers try again. The president says “Obamacare” is collapsing, but he’s also threatened to give it a shove by stopping billions of dollars in payments to insurers. Some leading Republicans are considering fallback measures to stabilize markets.

Researchers from the Kaiser foundation looked at proposed premiums for a benchmark silver plan across major metropolitan areas in 20 states and Washington, D.C. Overall, they found that 15 of those cities will see increases of 10 percent or more next year.

The highest: a 49 percent jump in Wilmington, Delaware. The only decline: a 5 percent reduction in Providence, Rhode Island.

About 10 million people who buy policies through HealthCare.gov and state-run markets are potentially affected, as well as another 5 million to 7 million who purchase individual policies on their own.

Consumers in the government-sponsored markets can dodge the hit with the help of tax credits that most of them qualify for to help pay premiums. But off-marketplace customers pay full freight, and they face a second consecutive year of steep increases. Many are self-employed business owners.

The report also found that insurer participation in the ACA markets will be lower than at any time since “Obamacare” opened for business in 2014. The average: 4.6 insurers in the states studied, down from 5.7 insurers this year. In many cases insurers do not sell plans in every community in a state.

The researchers analyzed publicly available filings through which insurers justify their proposed premiums to state regulators. To be sure, insurers continue to struggle with sicker-than-expected customers and disappointing enrollment. And an ACA tax on the industry is expected to add 2 to 3 percentage points to premiums next year.

But on top of that, the researchers found the mixed signals from the administration account for some of the higher charges. Those could increase before enrollment starts Nov. 1.

“The vast majority of companies in states with detailed rate filings have included some language around the uncertainty, so it is likely that more companies will revise their premiums to reflect uncertainty in the absence of clear answers from Congress or the administration,” the report said. Once premiums are set, they’re generally in place for a whole year.

Insurers who assumed that Trump will make good on his threat to stop billions in payments to subsidize copays and deductibles requested additional premium increases ranging from 2 percent to 23 percent, the report found.

Insurers who assumed the IRS under Trump will not enforce unpopular fines on people who remain uninsured requested additional premium increases ranging from 1.2 percent to 20 percent.

“In many cases that means insurers are adding double-digit premium increases on top of what they otherwise would have requested,” said Cynthia Cox, a co-author of the Kaiser report. “In many cases, what we are seeing is an additional increase due to the political uncertainty.”

That doesn’t sound like what Trump promised when he assumed the presidency.

In a Washington Post interview ahead of his inauguration, Trump said, “We’re going to have insurance for everybody.”

“There was a philosophy in some circles that if you can’t pay for it, you don’t get it,” he added. “That’s not going to happen with us.”

People covered under Obama’s law “can expect to have great health care,” Trump said at the time. “It will be in a much simplified form. Much less expensive and much better.”

But the White House never produced the health care proposal Trump promised. And the GOP bills in Congress would have left millions more uninsured, a sobering side-effect that contributed to their political undoing.

The Trump administration sidestepped questions about its own role raised by the Kaiser study.

Spokeswoman Alleigh Marre said rising premiums and dwindling choices predate Trump.

“The Trump administration is committed to repealing and replacing Obamacare and will always be focused on putting patients, families, and doctors, not Washington, in charge of health care,” Marre said in a statement.

The ongoing political turmoil for people who buy individual health insurance stands in sharp contrast to relative calm and stability for the majority of Americans insured through workplace plans. The cost of employer-sponsored coverage is expected to rise around 5 or 6 percent next year, benefits consultants say.

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Associated Press Health Writer Tom Murphy in Indianapolis contributed to this report.

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Online:

Kaiser report – https://tinyurl.com/ya2yneqj
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Selling healthcare to the young

July 19, 2017July 17, 2017 by <a href="https://www.capitolhillblue.com/node/byline/carla-k-johnson" rel="tag">CARLA K. JOHNSON</a>

Julian Senn-Raemont in Woodstock, Ill. (AP Photo/Nam Y. Huh)

Julian Senn-Raemont isn’t convinced he needs to buy health insurance when he loses coverage under his dad’s plan in a couple of years — no matter what happens in the policy debate in Washington, or how cheap the plans are.

The 24-year-old musician hasn’t known a world without a health care safety net. But he hates being forced by law to get coverage, and doesn’t think he needs it.

“I’m playing the odds,” said Senn-Raemont, who lives in Woodstock, Illinois. He will go without insurance, he said, until he starts a family or gets a job with benefits. “I feel comfortable I could get care if I needed it.”

Senn-Raemont’s outlook could pose a major problem for Republicans building a replacement for the Affordable Care Act. Insurers need young and healthy enrollees like him to buy insurance because they keep premiums down for everyone. The current law attempts to do that by mandating that everyone get coverage. The Republican plan replaces that mandate with penalties for those who let coverage lapse, and aims to entice young adults by allowing insurance companies to sell bare-bones coverage that could be cheaper.

But cheap isn’t free, which turns off people like Senn-Raemont. And other young adults worry that opening the door to these bare-bones plans will make the more comprehensive coverage they know now too expensive or even unavailable.

In Houston, 29-year-old Jimmieka Mills pays $15 a month for a government-subsidized “Obamacare” health plan. She fears Congress will weaken the health law’s guarantees of free preventive care, so she made an appointment to get a birth control implant that will last for years.

“I’m scared,” Mills said. “I’m like a bear getting ready for hibernation. That’s how I feel.”

Language is still being nailed down in the retooled bill, but it includes a proposal from conservative Sen. Ted Cruz, R-Texas, which would let insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by the Obama-era health care law. Insurers could deny the slimmer coverage to people with pre-existing conditions or charge them more.

Georgetown University health policy researcher Sabrina Corlette said young adults may find the “Cruz plans” more affordable, but they should “read the fine print.”

“You may end up with unexpected costs,” Corlette said. “And if, God forbid, you do end up needing better coverage, you will be blocked from that coverage for six months.” To encourage continuous coverage, the GOP plan installs a six-month waiting period for anyone with a two-month gap in coverage. The skimpy policies wouldn’t qualify as continuous coverage.

The insurance industry also sharply questioned this approach. In a statement last week, the industry group America’s Health Insurance Plans said the proposal would create an “un-level playing field” that would lead to “unstable health insurance markets.”

Other features of the proposal aimed at young adults include allowing them to stay on their parents’ insurance until they turn 26, as they can now, and shifting costs to older enrollees.

Current law restricts how much insurers can charge for insurance based on age. “Obamacare” limits the ratio to 3-to-1, meaning a 50-year-old can be charged only three times as much as a 20-year-old. The Republican plan shifts that ratio to 5-to-1.

More flexible pricing could attract young adults, the Congressional Budget Office said in a review of a previous draft of the Senate plan. But other provisions, including cuts to Medicaid, would result in 22 million people losing insurance over the next decade. All ages and income levels would have higher uninsured rates. For low-income young adults, CBO said, the uninsured rate would double.

A CBO analysis of the new proposal is expected this week.

“On the whole, the bill is bad for young people,” said Jen Mishory, executive director of the youth advocacy group Young Invincibles. “It is particularly concerning for the most vulnerable young people, those who are low-income and folks with pre-existing conditions.”

Young Americans, ages 18-34, remain more likely to be uninsured than older age groups, but the rate of uninsured young Americans dropped under “Obamacare” to 16 percent from 29 percent.

Obama’s health law also gives them job flexibility because good health insurance was no longer tied to employment, said Republican labor economist Craig Garthwaite of Northwestern University’s Kellogg School of Management.

“That gives young adults the opportunity to find a first job that’s right for their talents,” Garthwaite said.

Alexandra Flores, 29, works as a library assistant at University of South Florida in St. Petersburg while pursuing a master’s degree in library science. She credits the Obama health law for her decision to go back to school rather than be locked into her previous office job. She pays $77 a month for her “Obamacare” health plan. The government kicks in about $100.

“Without health care, I wouldn’t feel comfortable growing my career the way I have,” Flores said.

Republican proposals to ban federal funding of Planned Parenthood for a year would affect 34-year-old Renee Wsol of Chicago. A Medicaid beneficiary, she received a free IUD for long-acting birth control from the organization this year. Planned Parenthood is now her regular source of women’s health care, including cancer screenings.

“I feel comfortable and safe at Planned Parenthood,” she said. “It makes no sense to pluck that care away from people who already have limited choices.”

Jackie Todd, 28, of Chicago, feels hemmed in by the health care debate because she would like to pursue a master’s in filmmaking, but doesn’t want to risk losing the insurance she has through her job. She has an implanted device for a heart rhythm problem, which will need to be replaced in two years, “and I cannot be uninsured when that happens.”

“The GOP doesn’t think I deserve a shot at an even playing field because being sick is somehow my fault,” she said.

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Follow AP Medical Writer Carla K. Johnson on Twitter: @CarlaKJohnson
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New anxieties over health insurance

March 27, 2017March 26, 2017 by <a href="https://www.capitolhillblue.com/node/byline/michael-warren-and-sudhin-thanawala" rel="tag">MICHAEL WARREN and SUDHIN THANAWALA</a>

In this photo provided by Clare Schexnyder, small business owner Clare Schexnyder, 49, poses with her daughter, Sofi, in their kitchen in Decatur, Ga. (Clare Schexnydervia AP)

Americans who have benefited from the Affordable Care Act are feeling some relief at the failure of Republican efforts to repeal it, but they face new anxieties with President Donald Trump tweeting that “ObamaCare will explode.”

Premiums have risen and major insurers have backed out of the state markets where people can buy insurance online under Obama’s signature health care law. But people who say it saved their lives or helped them start a business want lawmakers to fix these problems, not encourage them.

“It does need its fixes, I totally see that,” said Inge Hafkemeyer, 57, who credits the law’s subsidies for containing her costs as her home-based event-planning business took off in Mission, Kansas, a Kansas City suburb. “But if your roof leaks, you don’t burn down the house to fix it.”

Clare Schexnyder, 49, is convinced she’s alive today because of it. As a small business owner in Decatur, Georgia, she couldn’t afford health insurance until the rollout in 2013. She began getting mammograms, and her breast cancer was spotted in time. Her double mastectomy and reconstruction surgery was priced at $250,000, but she paid no more than her $6,200 annual deductible.

Then, her daughter spent a week in the hospital after her appendix burst, costing them another $6,200. They took out a second mortgage to pay the bills.

“An appendectomy shouldn’t have to make me refinance my house,” she said. “It’s still not a perfect system by any means, but I’m glad we have it.”

Schexnyder’s insurer pulled out of the Affordable Care Act last year, leaving fewer alternatives in Georgia, one of the states that refused to set up insurance exchanges or participate in Medicaid expansion.

But she objects to tweets like this one Trump sent on Saturday: “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry.”

“They’re setting it up to fail, which is irresponsible and unforgiveable,” Schexnyder said.

Shannon Henson, a 49-year-old unemployed conference planner in the Kansas City suburb of Independence, Missouri, said the Affordable Care Act has been a good starting point.

“It wasn’t going to be perfect from the get-go,” she said.

Republican promises to repeal and replace the law foundered on Friday when House Speaker Paul Ryan abruptly pulled the party’s health care bill to avoid almost certain defeat.

“We’re going to be living with Obamacare for the foreseeable future,” Ryan, R-Wis., told reporters.

The law has covered more than 20 million people who were previously uninsured through private insurance sold on the law’s marketplaces and by expanding Medicaid, the health program designed to help poor Americans. It required insurers to cover “essential” services, including mammograms, and barred them from refusing policies to the very sick or others with pre-existing health conditions.

But premiums jumped by double digits this year as the cost of medical care and prescription drugs continues to soar, and the marketplaces created by the law are short on the healthy consumers who make insurance companies profitable. In about one-third of U.S. counties, consumers in the individual markets don’t have a choice of plans.

Mina Viladas, 53, of Fairfield, Connecticut, said she was covered under the Affordable Care Act when she needed emergency surgery. But the self-employed fitness trainer said the insurance plans are getting more expensive.

“The Democrats need to work on improving it, with the Republicans, if possible,” she said. “But I’m happy it’s still where it is because it’s saved me.”

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Thanawala reported from San Mateo, Calif. Associated Press writers Pat Eaton-Robb in Bridgeport, Conn. and Jim Suhr in Kansas City contributed to this report.

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Obama closes health insurance loopholes

May 21, 2015May 13, 2015 by <a href="https://www.capitolhillblue.com/node/byline/ricardo-alonso-zaldivar" rel="tag">RICARDO ALONSO-ZALDIVAR</a>

The HealthCare.gov website, (AP Photo/Don Ryan)

From contraception to colonoscopies, the Obama administration Monday closed a series of insurance loopholes on coverage of preventive care.

The department of Health and Human Services said insurers must cover at least one birth control option under each of 18 methods approved by the FDA — without copays.

Also, insurers can’t charge patients for anesthesia services in connection with colonoscopies to screen for cancer risk.

President Barack Obama’s health care law requires most insurance plans to cover preventive care at no additional charge to patients. That includes employer plans serving about 3 in 4 workers.

The types of services covered generally dovetail with the recommendations of a government advisory panel. Also on the list are birth control pills and other contraceptives.

But independent experts and women’s groups had recently found coverage gaps for some birth control methods. Insurers said they were trying to comply with the law, but that federal rules did not provide enough detail.

“This has been a problem for women,” said Cindy Pearson, executive director of the National Women’s Health Network. “It seems like some insurers were trying to control costs under cover of medical management.” Her organization advocates on reproductive health and other issues.

Other services covered without copays or cost-sharing include:

— Preventive screening, genetic counseling and BRCA genetic testing for women at increased risk for having a potentially harmful mutation in genes that suppress cancerous tumors.

— Prenatal care and other services to promote healthy pregnancies. The requirement applies to insurance plans that cover children as dependents.

— Certain preventive services for transgender people. For example, a mammogram for a transgender man who has residual breast tissue.

On birth control, insurers will be required to offer at least one no-cost option in each FDA-approved category. These include daily birth control pills as well as longer-acting hormonal patches and IUDs, and the morning-after pill. The option provided can be a generic, but if a woman’s doctor says a more expensive alternative is medically necessary, the plan must cover it without a copay.

Insurance billing is notorious for breaking down procedures into different subcategories. The new rules made it clear that patients cannot be billed a copay for anesthesia during a colonoscopy.

“The plan or issuer may not impose cost sharing with respect to anesthesia services performed in connection with the preventive colonoscopy if the attending provider determines that anesthesia would be medically appropriate for the individual,” HHS said in its guidance document.

For insurers, the new government requirements take effect in 60 days. In practice, most consumers will not notice major changes until their coverage renews for 2016.

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Nine out of 10 American adults now have health insurance

April 13, 2015April 13, 2015 by <a href="https://www.capitolhillblue.com/node/byline/ricardo-alonso-zaldivar" rel="tag">RICARDO ALONSO-ZALDIVAR</a>

Underlining a change across the nation, nearly 9 out of 10 adults now say they have health insurance, according to an extensive survey released Monday.

As recently as 2013, slightly more than 8 out of 10 had coverage.

Whether the new number from the Gallup-Healthways Well-Being Index turns out to be a high-water mark for President Barack Obama’s health care law, or a milestone on the path toward his goal of getting virtually all U.S. residents covered, remains to be seen.

The law’s future is still up in the air, and will turn on factors ranging from an upcoming Supreme Court decision on consumer subsidies to actions by Republican leaders in states opposed to Medicaid expansion.

The Gallup-Healthways survey found that the share of adults who lack insurance dropped to 11.9 percent for the first three months of this year, the lowest level since that survey began its tracking in 2008. The latest update overlaps with the period when the health law’s second sign-up season was winding down.

Coverage gains from 2014-2015 translate to about 3.6 million fewer adults uninsured since the fall, before open enrollment got under way, according to Gallup.

“The Affordable Care Act had three major objectives: increase coverage, slow the rate of increase in costs, and improve health,” said Dan Witters, research director for the poll. “The first one is clearly a win. Coverage is increasing; there is no question about it.”

On balance, an estimated 14.75 million adults have gained coverage since the fall of 2013, when the law’s first open enrollment season was about to begin, according to Gallup.

“A big outstanding question is what will happen over the next couple of years,” said Larry Levitt, a health insurance expert with the nonpartisan Kaiser Family Foundation. “To meet expectations, enrollment has to continue to grow and push the number of uninsured down.”

The Gallup-Healthways survey is closely followed because it combines the depth of government-sponsored research with the timeliness of media polls. Pollsters interview 500 people a day, nearly every day of the year. One of the questions they ask is whether people have health insurance.

The health care law offers subsidized private insurance for people who don’t have access to job-based coverage, combined with an expansion of Medicaid aimed at low-income adults in states that accept it. Big states like Florida and Texas are among those refusing to expand Medicaid.

The law requires nearly all Americans to have coverage, either through an employer, a government program, or by purchasing their own plan. Those remaining uninsured risk fines. It also provides subsidies to help low- to moderate-income people buy their own insurance.

Comparing the most recent sign-up period with the first open enrollment season, the survey found that the uninsured rate declined at a slightly slower pace this time around. In the first three months of this year, the uninsured rate fell by 1 percentage point. Over the same period last year there was a 1.5 percentage-point decline.

From government officials to local volunteers, many people involved with the health care law expected some kind of second-year slowdown. Open enrollment season was shorter, and those who had remained uninsured were seen as more skeptical about the value of coverage.

The survey also found:

—Hispanics saw the biggest coverage gains of any ethnic or racial group. The uninsured rate dropped 8.3 points among Latinos since the end of 2013. Even so, Hispanics are still more likely to be uninsured. “At a time when Republicans are very keenly trying to court the Hispanic vote, a large chunk of Hispanics are gaining insurance via the Affordable Care Act,” Witters said.

—Recent gains in coverage have benefited people up and down the income ladder. But the most notable improvement has been among those making less than $36,000 a year, a group that traditionally struggled to get and keep health insurance. Their uninsured rate dropped 8.7 points since the end of 2013.

—Although the economic recovery is likely to be contributing to coverage gains, the uninsured rate is now significantly lower than it was in early 2008, before the recession. That suggests that the gains in coverage are due to more than an improving economy.

Five years after its passage, the biggest question now for Obama’s health care law is a Supreme Court challenge.

Opponents of the law argue that its literal language only allows the government to subsidize premiums in states that set up their own online insurance markets. Most have not done so, defaulting to the federal HealthCare.gov.

Supporters say that while some provisions may be confusing when read in isolation, the intent of Congress was to help consumers in every state pay their premiums. A decision in that case is expected by late June.

The survey results were based on landline and cellphone interviews conducted from Jan. 2 to March 31 with a random sample of 43,575 adults ages 18 and older. For results based on the total sample, the margin of sampling error is plus or minus 1 percentage point.

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Online:

Survey: http://www.gallup.com/poll/182348/uninsured-rate-dips-first-quarter.aspx
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Obamacare success? More Americans now insured

February 26, 2015February 24, 2015 by <a href="https://www.capitolhillblue.com/node/byline/ricardo-alonso-zaldivar" rel="tag">RICARDO ALONSO-ZALDIVAR</a>

Chief Justice John Roberts (AP Photo/Nati Harnik) — Chief Justice John Roberts
(AP Photo/Nati Harnik)

The share of Americans without health insurance dropped to its lowest level in seven years in 2014 as President Barack Obama’s overhaul took full effect, according to an extensive survey released Tuesday.

The Gallup-Healthways Well-Being Index found that the trend appears likely to continue this year, since 55 percent of those who remained uninsured told the pollster they plan to get coverage rather than face escalating tax penalties.

No state saw a statistically significant increase in the share of its residents uninsured. However, states that have embraced the health care law continued to outperform those where political opposition remains strong.

Ten of the 11 states with the biggest declines in their uninsured rates accepted the health care law’s Medicaid expansion, which provides safety-net coverage for low-income residents, mainly adults with no children living at home. Topping the list were Arkansas and Kentucky, with double-digit decreases.

Montana, in the midst of an oil boom, was the exception among the top-performing states. Its uninsured rate dropped by 4.9 percentage points from 2013 to 2014, although that state has not expanded Medicaid and is letting the federal government run its online insurance market.

In addition to expanded Medicaid, Obama’s law offers subsidized private coverage for people who don’t have access to it on the job. The federal government is running the online insurance markets, or exchanges, in most states.

The Gallup report comes at a time of continuing uncertainty over the health care law. Next week, the Supreme Court will hear arguments in a case that challenges insurance subsidies for residents of states that have not set up insurance exchanges, defaulting instead to federal management. The federal HealthCare.gov currently serves 37 states.

The survey is considered authoritative because it combines the speed of media polls with the thoroughness of large government studies. Pollsters interview 500 people a day, 350 days a year. In 2014, that added up to nearly 177,000 adults aged 18 and older.

Comparing full-year results, Gallup found a drop of 3.5 percentage points in the share of Americans without health insurance from 2013 to 2014.

The five most populous states all saw declines. For California, it was a drop of 6.3 percentage points; Texas, 2.6 points; Florida, 3.8 points; New York, 2.5 points and Illinois, 4.5 points.

Texas remained the state with the highest uninsured rate, at 24.4 percent, while Massachusetts had the lowest, at 4.6 percent. Massachusetts had expanded coverage earliest, under former GOP Gov. Mitt Romney, whose approach foreshadowed some of the central elements of Obama’s law.

Dan Witters, research director for the poll, said about 12.3 million fewer adults were uninsured in the last three months of 2014, when compared with the third quarter of 2013, when HealthCare.gov was launched.

The survey has a margin of sampling error of plus or minus 1 to 2 percentage points for most states. The ongoing survey plans to report in April on the law’s impact in the first three months of this year.

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Online:

Gallup-Healthways Well-Being Index — http://tinyurl.com/lbenbx6

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