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Analysis | The Health 202: It’s employer-sponsored health plans that are getting stingier

THE PROGNOSIS

House Democratic leaders. (J. Scott Applewhite/AP)

Democrats and Obamacare advocates have been pounding a relentless drum over the Trump administration’s moves to undermine the 2010 health-care law. But it’s the health coverage people secure through their workplaces that is looking less generous by the year, a new survey finds.

A study released today by the nonpartisan research foundation Commonwealth Fund finds the number of Americans lacking coverage didn’t worsen during the first two years of President Trump’s term, despite a series of efforts by Republicans in the administration and Congress to ease the Affordable Care Act’s coverage requirements and remove its penalty for being uninsured.

What’s more, a growing pool of Americans with skimpy health insurance plans is fed by those with employer-sponsored coverage — not people buying plans on their own via the ACA’s individual marketplaces, Commonwealth found. That underscores a long-standing trend wherein employers have grappled with rising health-care costs by requiring workers to pay a larger share of their premiums or offering plans with higher deductibles.

“I think our employer-based insurance system is facing a crisis that is related to escalating health care costs and the limited systems available to them to manage those costs,” Commonwealth President David Blumenthal told reporters.

Citing a goal of making health insurance less expensive, the administration has expanded access to potentially leaner health plans via association plans and short-term coverage –  and has invited states to request changes to their insurance marketplaces that would allow insurers to duck some coverage requirements. Democrats, deeply frustrated by the efforts, routinely accuse the administration of severely undermining the ACA and its consumer protections.

“In all these ways, the administration has tried to undermine the ACA,” Rep. Rosa DeLauro (D-Conn.), chairwoman of the House Appropriations subcommittee that deals with health-care services, said at a hearing yesterday. “I would ask to what end? Due to the administration’s actions, costs for families and working people are skyrocketing.”

Rep. Jaime Herrera Beutler (R- Wash.). (Alisha Jucevic/Columbian/AP)

Republicans pushed back, airing their well-worn accusation that the health-care law was rotten to the core. “The problem is with the ship, not the deck chairs on the ship,” said Rep. Jaime Herrera Beutler (R-Wash.)

The hearing was the fourth panel House Democrats have recently convened for the purpose of slamming Republicans for trying to undercut the health-care law even after they failed in their promises to repeal and replace it.

The House’s Energy and Commerce health subcommittee and its Education and Labor Committee met Wednesday in separate hearings to highlight a lawsuit against the ACA from GOP-led states that could ultimately wipe out its protections for people with preexisting medical conditions. The Ways and Means Committee held a similar hearing last week.

Some tweets from the Energy and Commerce hearing. Via the Hill’s Peter Sullivan: 

Author and journalist James Surowiecki:

Charles Gaba, health-care analyst at ACASignups.net:

But all of this politically fueled debate has less bearing on employer-sponsored coverage, under which roughly half of all Americans get their insurance. The challenges in this space have often taken a back seat to arguments over Obamacare, even though workers are increasingly covered by plans that require them to dig ever deeper into their wallets.

According to the Commonwealth survey, 28 percent of people with coverage through their workplaces were “underinsured” last year, meaning they faced out-of-pocket costs totaling at least 10 percent of their income (5 percent, if they were low-income). Twenty-four percent of these workers were underinsured in 2016.

In contrast, the survey found incremental improvements in this area among people who bought insurance on their own — even though Democrats have charged the opposite would be true. Forty-two percent of people purchasing individual market coverage were underinsured last year, compared with 44 percent in 2016, before Trump took office.

Now, Trump and his allies haven’t made additional progress in expanding coverage to more Americans — a marked success of the health-care law that has nonetheless stalled in recent years. And the effects of the administration’s new policies haven’t yet been fully borne out. But so far, the administration may not have moved the needle significantly backward.

Amber Gorrow, her daughter Eleanor, 3, and her son Leon, 8 weeks, at their home in Vancouver, Wash. Leon is too young for a measles vaccination right now, so his mother keeps him at home as much as possible to limit his exposure to the disease. (Alisha Jucevic for The Washington Post) 

AHH: The state of Washington is grappling with its worst measles outbreak in more than two decades. At least 55 people in Washington and neighboring Oregon have gotten sick with the virus, and our Post colleagues Lena H. Sun and Maureen O’Hagan report new cases are being discovered nearly every day. 

Almost all of the Washington cases are in Clark County, an anti-vaccine hot spot where nearly a quarter of kids go to school without immunizations for measles, mumps and rubella.

“Measles outbreaks have sprung up in nine other states this winter, but officials are particularly alarmed about the one in Clark County because of its potential to go very big, very quickly,” Lena writes in this extensive look at the dangers of this outbreak.

“The Pacific Northwest is home to some of the nation’s most vocal and organized anti-vaccination activists,” she adds. “That movement has helped drive down child immunizations in Washington, as well as in neighboring Oregon and Idaho, to some of the lowest rates in the country, with as many as 10.5 percent of kindergartners statewide in Idaho unvaccinated for measles,” she adds. “That is almost double the median rate nationally.”

“You know what keeps me up at night?” said Clark County Public Health Director Alan Melnick. “Measles is exquisitely contagious. If you have an under-vaccinated population and you introduce a measles case into that population, it will take off like a wildfire.”

Seema Verma, head of the Centers for Medicare and Medicaid Services. (Kelly P. Kissel/AP)

OOF: In the push to implement Medicaid work requirements in several states, the Trump administration has so far failed to enforce federal rules meant to protect patients, the Los Angeles Times’s Noam N. Levey reports.

Out of the eight states approved to implement work requirements for Medicaid beneficiaries, not one is set up with plans to track the effect of the change, including whether beneficiaries find jobs or see health improvements. “And nine of the 17 states that have sought federal permission to implement Medicaid work mandates have been allowed by the Trump administration to proceed with their applications despite failing to calculate the number of people who could lose coverage, according to a review of state and federal Medicaid records,” Noam writes.

“Federal regulations issued under the Obama administration direct states seeking permission to experiment with new Medicaid policies to, in most cases, estimate effects on coverage before the initiative starts, and then independently evaluate the impact of the programs after they begin to assure they are achieving their goals,” Noam writes. Federal regulations from 2012 state applications to implement Medicaid experiments “will not be considered complete” unless states make “an estimate of the expected increase or decrease in annual enrollment.”

But Noam reports “the Trump administration deemed all the state Medicaid applications ‘complete,’ CMS documents show.”

William M. McSwain, U.S. attorney for the Eastern District of Pennsylvania, speaks during a news conference in Philadelphia. (Heather Khalifa/Philadelphia Inquirer/AP)

OUCH: A U.S. attorney has filed a lawsuit to block Philadelphia from opening the first supervised drug injection facility in the country.

U.S. Attorney William M. McSwain’s filing calls for a judge to rule that such a facility is illegal under federal law, the Philadelphia Inquirer’s Jeremy Roebuck and Aubrey Whelan report. But individuals behind the site, called Safehouse, are pledging to move forward.

“It is the [Justice] Department’s job to promote and enforce the rule of law, not to look the other way,” McSwain said at a news conference. “Normalizing the use of deadly drugs like heroin and fentanyl is not the answer to solving the opioid epidemic.”

There are currently no sanctioned supervised injection sites in the United States, though numerous cities have sought to open one, as The Health 202 has reported.

“From our perspective at DLA, we are in it for the long haul to defend Safehouse and to advocate for its legal rights to be able to go forward in its lifesaving mission,” said Ilana Eisenstein, a partner at law firm DLA Piper, which is representing Safehouse for free.

In a statement, the Drug Policy Alliance’s Lindsay LaSalle compared the issue to states legalizing cannabis “in favor of the promotion of public health,” despite federal drug laws. ”The federal government initially attempted to interfere with state and local syringe exchange and medical cannabis programs, but hindsight has proved they were on the wrong side of science and history,” she said.

President Trump delivers his State of the Union address, with Vice President Pence and House Speaker Nancy Pelosi (D-Calif.) behind him. (Carolyn Kaster/AP)

— House Speaker Nancy Pelosi (D-Calif.) reportedly bluntly criticized Trump’s plan to dole out $500 million in funding for childhood cancer research, saying it’s not nearly enough. 

“$500 million over 10 years — are you kidding me?” she said during a closed-door meeting, Politico’s Adam Cancryn reports. “Who gave him that figure? It’s like the cost of his protection of his Mar-a-Lago or something.”

During his State of the Union address, the president said he would call for the increase in funding as part of his budget. “But allotting an extra $500 million over the next decade pales in comparison to the National Cancer Institute’s nearly $6 billion annual budget — or even the Obama administration’s cancer moonshot, which resulted in Congress approving $1.8 billion over seven years to finding a cure,” Adam writes.

“We’re talking about a moonshot,” Pelosi said at the meeting. “He’s talking about a trolley ride.”

Sen. Chuck Grassley (R-Iowa) and Sen. Ron Wyden (D-Ore.). (J. Scott Applewhite/AP)

— There are now five drug companies that have accepted an invitation from Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and ranking Democrat Ron Wyden (Ore.) to testify before Congress.

Grassley’s office confirmed Pfizer, Sanofi, Johnson Johnson, Bristol-Myers Squibb and Merck have agreed to send representatives to appear before the panel at a hearing scheduled for Feb. 26. The two companies that have yet to respond to the summons are AbbVie and AstraZeneca.

House Minority Whip Steve Scalise (R-La.). (Jose Luis Magana/AP)

— House Minority Whip Steve Scalise (R-La.) and Rep. Ann Wagner (R-Mo.) are hoping to force a vote on the House floor on a bill that would require medical care protections for infants born alive during an abortion procedure.

The pair said they have started the process for a discharge petition, which would require at least 218 signatures in the House to pull a bill out of committee and force a floor vote. The “Born Alive Abortion Survivors Protection Act” would require health-care providers to provide the same level of care to infants born during an abortion procedure as they would to any other infant and would require doctors and hospitals to report violations to law enforcement.

“Congress must act to protect those who cannot protect themselves,” Wagner said in a statement. “To my colleagues, this is the simplest vote you will ever take: either you support babies being killed after they are born or you don’t. It is time to go on the record and make clear if you think babies born alive deserve medical care, or if you think they should be left to die.”

Anti-abortion activists protest outside of the U.S. Supreme Court, during the March for Life in Washington. (AP Photo/Jose Luis Magana)

— Gallup has found a majority of Americans believe abortions should be legal in the first trimester, but just 13 percent feel abortion should be legal in the third trimester. Legislation in Virginia and New York making it easier to obtain a late-term abortion has drawn recent attention to questions around fetal viability and how late in pregnancy the procedure should be allowed.

“Medical advances have made this conflict more acute,” our Post colleague Ariana Eunjung Cha reports. “When the Roe v. Wade decision was handed down by the U.S. Supreme Court in 1973, it emphasized the concept of fetal viability — the point at which a fetus might be able to survive outside the womb — and that a woman’s right to an abortion was not absolute. It gave states the right to restrict abortion after that time as long as there are exceptions for the endangerment of a woman’s life or health.”

But fetal viability timing has progressed from around 24 to 28 weeks more than four decades ago to closer to 22 to 26 weeks now, Ariana notes. It’s a change that Justice Sandra Day O’Connor predicted, warning Roe v. Wade was “on a collision course with itself.”

“The earliest-term baby known to survive was born at 21 weeks and 4 days of gestation,” Ariana writes. “The girl, born in San Antonio to Courtney Stensrud, weighed a mere 0.9 pounds. Her skin was see-through, her lungs underdeveloped, and her eyes unable to focus. Obstetric guidelines do not recommend doctors resuscitate in this situation, but Stensrud asked them to try. Writing in the journal Pediatrics in December 2017, her doctors reported she had grown in to a healthy 2-year-old toddler but cautioned that this doesn’t mean all babies born at this stage of development could be saved.”

In this explainer, Ariana answers more common questions about late-term abortions and the women who get them.  

— And here are a few more good reads: 

Today

  • The House Energy and Commerce Health Subcommittee holds a hearing on the Trump administration’s family separation policy.

During a House hearing on gun violence, Rep. Matt Gaetz (R-Fla.) called for the removal of two fathers whose children were killed in last year’s mass shooting in Parkland, Fla.:

Was Trump’s State of the Union address bipartisan?

Article source: https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2019/02/07/the-health-202-it-s-employer-sponsored-health-plans-that-are-getting-stingier/5c5b38cc1b326b66eb098643/