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Obama blasts the ‘fundamental meanness’ of Senate health-care bill

Senate Majority Leader Mitch McConnell introduced the Senate health-care bill Thursday, and a vote is expected in the Senate next week. In the afternoon, former president Barack Obama offered a scathing critique of the bill for its “fundamental meanness.”

Here is Obama’s argument, which was laid out on Facebook, annotated with what we found eyebrow-raising. Click the highlighted words to see the annotations.

Our politics are divided. They have been for a long time. And while I know that division makes it difficult to listen…

Posted by Barack Obama on Thursday, June 22, 2017

Our politics are divided. They have been for a long time. And while I know that division makes it difficult to listen to Americans with whom we disagree, that’s what we need to do today.

I recognize that repealing and replacing the Affordable Care Act has become a core tenet of the Republican Party. Still, I hope that our Senators, many of whom I know well, step back and measure what’s really at stake, and consider that the rationale for action, on health care or any other issue, must be something more than simply undoing something that Democrats did.

We didn’t fight for the Affordable Care Act for more than a year in the public square for any personal or political gain — we fought for it because we knew it would save lives, prevent financial misery, and ultimately set this country we love on a better, healthier course.

Nor did we fight for it alone. Thousands upon thousands of Americans, including Republicans, threw themselves into that collective effort, not for political reasons, but for intensely personal ones — a sick child, a parent lost to cancer, the memory of medical bills that threatened to derail their dreams.

And you made a difference. For the first time, more than ninety percent of Americans know the security of health insurance. Health care costs, while still rising, have been rising at the slowest pace in fifty years. Women can’t be charged more for their insurance, young adults can stay on their parents’ plan until they turn 26, contraceptive care and preventive care are now free. Paying more, or being denied insurance altogether due to a preexisting condition — we made that a thing of the past.

We did these things together. So many of you made that change possible.

At the same time, I was careful to say again and again that while the Affordable Care Act represented a significant step forward for America, it was not perfect, nor could it be the end of our efforts — and that if Republicans could put together a plan that is demonstrably better than the improvements we made to our health care system, that covers as many people at less cost, I would gladly and publicly support it.

That remains true. So I still hope that there are enough Republicans in Congress who remember that public service is not about sport or notching a political win, that there’s a reason we all chose to serve in the first place, and that hopefully, it’s to make people’s lives better, not worse.

But right now, after eight years, the legislation rushed through the House and the Senate without public hearings or debate would do the opposite. It would raise costs, reduce coverage, roll back protections, and ruin Medicaid as we know it. That’s not my opinion, but rather the conclusion of all objective analyses, from the nonpartisan Congressional Budget Office, which found that 23 million Americans would lose insurance, to America’s doctors, nurses, and hospitals on the front lines of our health care system.

The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else. Those with private insurance will experience higher premiums and higher deductibles, with lower tax credits to help working families cover the costs, even as their plans might no longer cover pregnancy, mental health care, or expensive prescriptions. Discrimination based on pre-existing conditions could become the norm again. Millions of families will lose coverage entirely.

Simply put, if there’s a chance you might get sick, get old, or start a family — this bill will do you harm. And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.

I hope our Senators ask themselves — what will happen to the Americans grappling with opioid addiction who suddenly lose their coverage? What will happen to pregnant mothers, children with disabilities, poor adults and seniors who need long-term care once they can no longer count on Medicaid? What will happen if you have a medical emergency when insurance companies are once again allowed to exclude the benefits you need, send you unlimited bills, or set unaffordable deductibles? What impossible choices will working parents be forced to make if their child’s cancer treatment costs them more than their life savings?

To put the American people through that pain — while giving billionaires and corporations a massive tax cut in return — that’s tough to fathom. But it’s what’s at stake right now. So it remains my fervent hope that we step back and try to deliver on what the American people need.

That might take some time and compromise between Democrats and Republicans. But I believe that’s what people want to see. I believe it would demonstrate the kind of leadership that appeals to Americans across party lines. And I believe that it’s possible — if you are willing to make a difference again. If you’re willing to call your members of Congress. If you are willing to visit their offices. If you are willing to speak out, let them and the country know, in very real terms, what this means for you and your family.

After all, this debate has always been about something bigger than politics. It’s about the character of our country — who we are, and who we aspire to be. And that’s always worth fighting for.

Article source: https://www.washingtonpost.com/news/the-fix/wp/2017/06/22/obama-blasts-the-fundamental-meanness-of-senate-health-care-legislation/

Obama on Senate bill: It’s ‘not a health care bill’

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Article source: http://www.cnn.com/2017/06/22/politics/barack-obama-health-care-bill-reaction/index.html

With Health Law in Flux, Insurers Scramble to Meet Filing Deadline

While the Wednesday deadline does not represent a final commitment by any insurer, “it will be a good indicator of the health of these markets,” said Sabrina Corlette, a research professor at Georgetown University.

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House Speaker Paul D. Ryan, whose home state of Wisconsin was among those Anthem plans to exit, pointed to the decision as reason the Republicans needed to pass their overhaul of the health care legislation.

“This law has failed our state,” he said. “Obamacare is clearly collapsing, and we have to step in before more families get hurt.”

Anthem’s exit underscores the rapidly changing dynamics of the market. Other insurers have indicated they will stay — and a few are even expanding into more states.

Oscar Health, the New York insurance start-up, said on Wednesday that it expected to offer policies in three additional states for 2018: Ohio, New Jersey and Tennessee. The company, which covers about 105,000 people, also plans to expand in California and Texas while remaining in New York. Oscar had previously sold policies in New Jersey but did not offer them there this year.


Counties With No Insurer in the 2018 Marketplace

Forty-four counties in three states currently have no insurer offering plans in the Affordable Care Act marketplaces next year.




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By The New York Times

Backed by venture capitalists, including Josh Kushner, one of the company’s founders and the brother of Jared Kushner, President Trump’s son-in-law, Oscar has focused almost exclusively on selling insurance in the market created by the Affordable Care Act.

“We’re confident that when the dust settles, the market for health insurance will stabilize in time for 2018,” Mario Schlosser, the company’s chief executive, wrote in a blog post. “For all of the political noise, there are simply too many lives at stake for representatives in Washington, D.C., not to do what’s right for the people.”

Other insurers also appear to be gambling on the current market, in spite of the political turbulence. Molina Healthcare, another major player in the market that has expressed concerns about its stability, said it had filed initial proposals in all nine states where it has business, according to a company spokeswoman.

Medica, a small nonprofit insurer, said on Monday that it would offer plans statewide in Iowa, although it is seeking rate increases that average 43 percent. Its decision would cover the yawning gap left by Aetna and the state Blue Cross plan, which left the market for next year, raising the possibility that no carrier would offer coverage to the bulk of the state’s residents.

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Centene, another large insurer, announced its plans last week to offer coverage for the first time in Nevada, Missouri and Kansas.

But other insurers have emphasized they remain ambivalent about staying. Health Care Service Corporation, which operates nonprofit Blue Cross plans, said it would file proposals in all five states where it offers coverage, but could still decide to leave. The insurer covers more than one million people in the individual market.

The overall market appears to be worsening as more insurers leave, said Dan Mendelson, the president of Avalere, a consultant, who said “there is a lot of variation by local market.”

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“There are some markets that are doing fine,” he said, while others, particularly rural ones, could still be left without an insurer willing to offer coverage.

Anthem’s departure from Wisconsin and Indiana, where the company is headquartered, does not seem to add to the dozens of so-called bare counties across the country where no insurer has yet said it will offer insurance in the state marketplace for that area.

Anthem covers about a million people through the state marketplaces or exchanges, and has filed proposals to sell policies in other states, like Connecticut.

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Joseph R. Swedish, Anthem’s chief executive, at a House hearing in 2015. He recently told CNBC, “We may have to exit certain markets because those markets are not sustainable.”

Credit
Jacquelyn Martin/Associated Press

In the three states that it is leaving, the insurer will offer at least one plan outside of the marketplace that reserves the option of returning to that state to offer coverage.

“Anthem’s view of the future of the marketplaces has clearly turned negative, driven by some underlying market instability and uncertainty drummed up by the Trump administration,” said Larry Levitt, an executive with the Kaiser Family Foundation.

If an insurer misses the Wednesday deadline, regulators could still choose to accept a last-minute application, as they did last year in Arizona, to make sure residents have access to a policy through the state marketplace. “State officials and governors are going to be very pragmatic to make sure people have coverage,” Ms. Corlette said.

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To stay, insurers are asking for much higher prices, according to Avalere, which analyzed filings in eight states. Insurers are seeking an 18 percent increase, on average, for the most popular so-called silver plans.

Many insurers are blaming the current political uncertainty when requesting much higher rates. The Trump administration and Congress have yet to commit to critical funding for subsidies worth billions of dollars to low-income individuals. Insurers are also concerned that the administration will stop enforcing the penalties people face when they choose to go without coverage, which they say would also drive up prices.

In Washington State, Molina is seeking rate increases that average 38.5 percent, citing the lack of enforcement and the return of a special tax on insurers. In developing its rates, the company said it assumed that major provisions of the law, including the existing subsidies and tax credits, would continue.

In Connecticut, Anthem wants an average rate increase of 33.8 percent, much of which it attributed to higher medical costs and increased demand for services.

“We are forecasting that the individual market will continue to shrink and that those individuals with greater health care needs will be the most likely to purchase and retain their coverage,” the insurer told state regulators.

Companies are likely to seek very high rates, said Ms. Corlette. They “are going to build all of this uncertainty into their rates to the maximum extent to protect themselves,” she said, and insurance regulators will have to decide whether to push back.

Even those insurers that plan to stay say the market has been challenging. While its losses have narrowed, Oscar lost about than $200 million last year and said that other changes were needed to stabilize the market. “We are not immune to the pressures in the individual market,” Mr. Schlosser said.

But he said the insurer’s partnerships with health systems like the Cleveland Clinic to offer new plans in northeastern Ohio should allow it to be successful. “If you have the right products and the right partner, you can make it work,” Mr. Schlosser said.


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Article source: https://www.nytimes.com/2017/06/21/health/health-insurance-marketplace-acha.html

CEOs Say They’ll Sell Health Insurance Next Year, But Are Flying Blind

Mario Schlosser, CEO of the startup Oscar Health, says he’s optimistic that Congress will come up with a humane health care bill.

Noam Galai/Getty Images


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Noam Galai/Getty Images

Mario Schlosser, CEO of the startup Oscar Health, says he’s optimistic that Congress will come up with a humane health care bill.

Noam Galai/Getty Images

The Senate vote on a bill to repeal and replace the Affordable Care Act is, according to conventional wisdom, one week away.

And we still don’t know what’s in the bill.

Not having concrete information is deeply uncomfortable for a journalist like me.

But for lots of people, like those who work in the insurance industry, not knowing what’s in that bill is a bigger deal. Wednesday is a deadline of sorts for these companies. If they want to sell policies next year in states that use the federal health exchange on Healthcare.gov, they have to let Health and Human Services know their intentions.

How are they dealing?

I reached out to a couple of insurance executives and asked.

Mario Schlosser is CEO of Oscar, the insurance startup that’s betting hard on the Affordable Care Act, also known as Obamacare.

Here's What We Know About The Senate GOP Health Care Bill

Wednesday morning, Oscar announced it’s going to keep selling individual insurance in New York in 2018, and expanding its offerings in five states – New Jersey, Ohio, California, Florida and Tennessee.

It’s a bold move, considering Congress is right now considering dismantling the Affordable Care Act markets and changing the rules governing health insurance.

“When the dust settles, the individual market will be stable, and we want to be part of getting it there,” Schlosser told me.

He agreed with President Trump that the American Health Care Act, passed by the House in May, is “mean.”

“I think that bill was mean and I think that bill would lead to loss of coverage that would be bad for pretty much everybody in the system,” he said.

Schlosser said it’s crucial for the Trump administration to stabilize the current system in preparation for any changes. That includes enforcing the individual mandate, which penalizes people who don’t buy insurance, and promising to make cost-sharing payments required under the ACA that reimburse insurers for giving extra discounts to the lowest-income customers.

If they don’t, “it would kill the market overnight.” Schlosser said.

“That would be terrible for society, it would be terrible for the whole health care system, and everybody would be worse off,” he said.

I pointed out to Schlosser that his company has a direct line to the White House. His partner and co-founder is Joshua Kushner, the brother of Jared Kushner, Trump’s son-in-law and senior adviser.

Schlosser avoided talking about that relationship and suggested he didn’t know what Trump will do.

Later, I sat down for a cup of coffee at the National Press Club with Dan Hilferty, who runs Independence Blue Cross in Philadelphia and is chairman of the board of the Blue Cross Blue Shield Association. His company sells ACA health plans in the Philadelphia area and southern New Jersey.

“I’m here in DC because of what’s happening in health care,” he said. But acknowledged he doesn’t know what’s in the Senate bill, even though the Blue plans he represents as chairman of the association insure one-third of all Americans.

Hilferty said the ACA has problems, but it did manage to bring insurance coverage to about 20 million people who didn’t have it before. That’s what he’s focused on in meetings with members of Congress.

Winners And Losers Under The House GOP Health Bill

The Congressional Budget Office says the bill passed by the House would result in 23 million fewer people having insurance coverage in 10 years, compared to current law.

“So I would say let’s build a system that doesn’t that doesn’t push those 20 million people back to uninsured, “Hilferty said.

He says his company is focused on ensuring that whatever lawmakers do, they don’t make it harder for low-income people to get insurance.

“Frankly, we don’t care if it’s the ACA or the AHCA as long as it gives us the ability to cover more people, get them access to care and not lose money,” Hilferty said.

Like Schlosser, Hilferty is worried about what’s going to happen next year. His company has filed to sell ACA plans in the Philadelphia area. But if the Trump administration doesn’t commit to making cost-sharing payments or to enforcing the individual mandate that requires people to have insurance, his rates could go up a lot.

Either way, both companies are operating as if the ACA markets will be alive and functioning in 2018.

“I do think that in the end, reason and compassion will prevail in DC,” Schlosser said.

Article source: http://www.npr.org/sections/health-shots/2017/06/21/533808635/ceos-say-theyll-sell-health-insurance-next-year-but-are-flying-blind

Abortion Adds Obstacle as Republicans Plan to Unveil Health Bill

The changes being considered in Congress could “amount to a 25 percent shortfall in covering the actual cost of providing care to our nation’s neediest citizens,” the top executives of 10 insurance companies wrote this week. “These amounts spell deep cuts, not state flexibilities, in Medicaid.”

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As senators struggle to develop a health care bill, their handiwork appears to be too moderate for some Senate conservatives and too conservative for some Senate moderates. The latest version, without the abortion-coverage prohibition and with steep Medicaid cuts, may prove unacceptable to some in both camps. To pass it, Senate leaders can afford to lose only two Republican votes of the 52 in the chamber.

Republican senators got a glimpse Wednesday of the highlights of the bill, which was drafted in secret by the majority leader, Senator Mitch McConnell of Kentucky, and top aides. White House officials were granted a formal briefing, which risked irking many senators who had yet to see the actual bill.

The House abortion provision has sweeping implications because many health plans subsidized under the Affordable Care Act include coverage for abortion services. The provision has encountered outspoken opposition from officials in states like Oregon, where most health plans on the public insurance exchange cover abortion.

But senators said the provision might have to be dropped for a more prosaic reason: It may not comply with the Senate rules that Republicans are using to speed the health care bill through the Senate.

The bill is scheduled to go to the Senate floor next week under these procedures, which limit debate and preclude a Democratic filibuster.

“It’s one of the problems we have to work with,” Senator Orrin G. Hatch, Republican of Utah and the chairman of the Finance Committee, said of the abortion issue. “We’re not quite sure how that’s going to be resolved.”

Mr. McConnell is determined to get a vote on the bill by the end of next week, before a break for the Fourth of July holiday, but he still does not have enough committed votes to ensure passage.

Senator Rand Paul, Republican of Kentucky, made clear on Wednesday that he was not on board with the Republican bill.

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“I’m still hoping we reach impasse, and we actually go back to the idea we originally started with, which is repealing Obamacare,” Mr. Paul said, adding, “I’m not for replacing Obamacare with Obamacare lite.”

Document: Health Insurers Speak Out


The House bill and the Senate version, like the Affordable Care Act, would provide tens of billions of dollars in tax credits to help people pay insurance premiums.

The federal government is expected to spend more than $30 billion this year on tax credits to help lower- and middle-income people pay premiums. The Senate bill would provide more assistance to lower-income people than the House bill, which bases tax credits on a person’s age.

The Senate bill would also repeal most of the taxes imposed by the Affordable Care Act. It would delay the effective date of a tax on high-cost employer-sponsored health coverage, but Republicans plan to offer an amendment next week to eliminate this “Cadillac tax,” which is opposed by labor unions and employers.

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Senators Thom Tillis of North Carolina and Susan Collins of Maine, both Republicans, said they understood that the House restrictions on the use of tax credits for insurance covering abortion had encountered parliamentary problems.

“What I heard earlier from the parliamentarian is they didn’t think it would pass” muster under Senate rules, Mr. Tillis said.

Mr. Tillis and Ms. Collins said they understood that Senate Republican leaders were hoping to devise some kind of workaround to address concerns of anti-abortion lawmakers. But it was not clear whether those anti-abortion lawmakers would be satisfied with such a plan, which could involve separate legislation.

Republicans have been promising to repeal the health law ever since it was signed by President Barack Obama in 2010. On Wednesday, in the final hours before the Senate repeal bill was to be unveiled, members of Congress, consumer groups and health care executives engaged in frenetic advocacy in hopes of shaping the bill.

Women’s groups and at least two moderate Republicans, Ms. Collins and Senator Lisa Murkowski of Alaska, continued to object to a provision of Mr. McConnell’s bill that would cut off funds for Planned Parenthood.

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In a letter to Mr. McConnell on Wednesday, more than two dozen House members in the conservative Republican Study Committee listed several parts of the House bill they view as crucial, including cutting funds to Planned Parenthood and restricting the use of the tax credits. The bill, they wrote, fulfills “an important conservative commitment to promote life and protect the unborn.”

Leaders of the 10 insurance companies told Mr. McConnell that proposed caps on federal Medicaid spending would cause “an enormous cost shift to the states,” which could force them to raise taxes, reduce benefits, cut payments to health care providers or eliminate coverage for some beneficiaries. Among those signing the letter were top executives of AmeriHealth Caritas, Molina Healthcare, Blue Shield of California and Healthfirst, in New York.

But Senator John Kennedy, Republican of Louisiana, said the Medicaid provisions were one of the bill’s chief attractions for him.

“In my state,” Mr. Kennedy said, “we are now spending 47 percent of our budget on Medicaid. That’s up from 23 percent in 2008. It’s crowding out money for universities and roads and public safety and coastal restoration, and it just keeps climbing.”

Even senators who might support the legislation said they did not want to be rushed.

Asked how he felt about the prospect of having a vote on the bill a week after its release, Senator John McCain, Republican of Arizona, said, “I feel terrible about it.”

Senator Ron Johnson, Republican of Wisconsin, said, “I need the information, I need to hear from constituents, and that’s going to take some time.”

Debate on the Senate bill will be shaped by an analysis from the Congressional Budget Office, which will estimate the impact on federal spending and the number of people without health insurance. Under the House bill, the office said, the number of uninsured would be 23 million higher than under the Affordable Care Act in 2026. And for some older Americans and sick people, it said, premiums and out-of-pocket costs could be significantly higher.


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Article source: https://www.nytimes.com/2017/06/21/us/politics/abortion-republicans-health-bill.html

Middle Class, Not Poor, Could Suffer if Trump Ends Health Payments

But combined with her monthly premiums — which have nearly tripled since 2014, the first year people could buy Affordable Care Act plans — the financial burden is enough that Ms. Goren started taking her Social Security retirement benefits early, which lowers the amount.

“We will use every available resource we have financially until we’ve ground it down to nothing,” Ms. Goren said during an interview in her home in a rural subdivision outside Asheville. “But I’m scared of what’s coming.”

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With the distinct possibility that the Affordable Care Act could soon be repealed altogether, she is afraid to touch the $15,000 that her two sons raised this spring through a 5K race to help with her medical expenses.

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“We’re sitting on it like Horton with the egg,” Ms. Goren said, referring to the Dr. Seuss book.

When President Barack Obama was still in office, the Republican-controlled House sued to stop the cost-sharing subsidies on grounds that Congress had not appropriated the money. A judge sided with the House last year, but the Obama administration appealed. Mr. Trump, who has talked about using the payments as a bargaining chip to help pass a Republican health bill, has twice asked the court to delay a ruling.

Although the 5.9 million low-income Americans who do benefit from cost-sharing payments will continue to have deductibles and co-payments waived as long as the Affordable Care Act survives, they, too, are facing uncertainty about the future of their health care. If Republicans in Congress succeed at repealing and replacing the law — still a big “if,” but the House has already passed a bill that would do so and the Senate is hurrying to finish its own version — insurance costs for low-income Americans could leap. The House bill provides flat premium subsidies based on age, not income — a formula that penalizes older and poorer people.

Lonnie Carpenter, 55, a self-employed roofer in Winston-Salem, N.C., is in that category. His back was badly injured in a car accident in 2013, and he has not been able to work full time since. Last year, his spinal surgery was paid for by his Affordable Care Act plan from UnitedHealthcare. He owed only about $2,000 thanks to cost-sharing reductions, compared with $11,000 for an operation in 2014, before he got subsidized insurance under the law.

“I’m in a position where I’m maxed out with bills because I’ve missed so much work in the last four years,” Mr. Carpenter said. “But it would have been a whole lot tougher to survive without that insurance. If I hadn’t had that, I’m being honest, I don’t know where I’d be right now.”

Cost-sharing reductions apply to people with annual incomes up to 250 percent of the poverty level; that comes to $29,700 for a single person and $60,750 for a family of four. Deductibles for those with incomes below 150 percent of the poverty level were reduced to $243 on average this year, from $3,703, according to Avalere Health, a consulting firm.

Even as Mr. Trump has remained coy about whether to continue the cost-sharing reductions next year — or even, for that matter, after this month — some powerful Republicans in Congress have begun lobbying for him to do so. They include Representative Kevin Brady of Texas, the chairman of the House Ways and Means Committee, and Senator Lamar Alexander of Tennessee, chairman of the Senate Health Committee, who urged in a hearing last week that the payments be extended through 2019.

“The payments will help to avoid the real possibility that millions of Americans will literally have zero options for insurance in the individual market in 2018,” Mr. Alexander said, adding that Republicans should “do some things temporarily that we don’t want to do in the long term.”

In North Carolina, Blue Cross and Blue Shield increased rates even more this year and last than it is proposing for 2018, blaming unexpectedly high claims costs among its marketplace customers. But the insurer said last month that it now had “a better handle on expected medical costs,” and thus would seek a far more modest rate increase if the cost-sharing payments were guaranteed.

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“You don’t mean to wish your life away, but my prayers are that I wake up and my wife is 65,” said Mr. Goren, a former radio advertising salesman, referring to the age at which people become eligible for Medicare. “We saved, but that money, it goes fast.”


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Article source: https://www.nytimes.com/2017/06/20/health/health-subsidy-cuts-could-hurt-the-middle-class-the-most.html

GOP Rift Over Medicaid and Opioids Imperils Senate Health Bill

The emerging Senate bill, like the one approved narrowly by the House in early May, would end Medicaid as an open-ended entitlement program and replace it with capped payments to states, Republicans said. But starting in 2025, payments to the states would grow more slowly than those envisioned in the House bill.

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Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act.

But that, too, is running into opposition from conservatives. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine.

Without some opioid funding, Mr. Portman cannot vote for the bill, he said, adding, “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”



Graphic

The Senate Is Close to a Health Care Bill, but Do Republicans Have the Votes?

How senators have different priorities on health care.


Republicans hold 52 seats in the Senate and can afford to lose only two of their members if they hope to pass the bill, which is opposed by all Democrats and the two independents.

Two Democratic senators from states plagued by opioid addiction, Bob Casey of Pennsylvania and Joe Manchin III of West Virginia, said the Republican proposal for federal grants would not come close to mitigating the harm caused by the bill’s Medicaid cuts, pushed just as overdose deaths are soaring. From 2005 to 2014, according to the latest data available, opioid-related hospital visits increased nearly 65 percent, to 1.27 million emergency room visits or inpatient stays a year.

While the proposed money for drug abuse treatment is relatively modest compared with spending for other items like Medicaid and premium tax credits, without it, hundreds of thousands of addicts would go without treatment, advocates say. The issue holds outsize political importance for senators like Mr. Portman, who has made advocacy for treatment legislation a calling card with voters at home.

“The opioid issue has been a particular concern of mine and has been for years,” said Mr. Portman, who has been leading the efforts with Senator Capito. “The reality is we have the worst drug crisis that our country’s ever faced, and it’s being driven by opioids.”

Senator John Barrasso, Republican of Wyoming, who serves on a group shaping the final bill, said: “We need to address the opioid crisis in America. I want us to find a bipartisan solution with adequate funding.”

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But Republican leaders would not commit to Mr. Portman’s proposal.

The Medicaid and opioid issues are far from the only ones dividing Republican senators, who have been kept largely in the dark about a bill they are supposed to finally see on Thursday. Republican leaders are determined to keep their seven-year promise to unravel President Barack Obama’s signature health care law, but the near unanimity they need on a replacement is proving elusive.

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The House bill would allow per-capita Medicaid payments to states to grow along with the prices of medical goods and services, starting in 2020, with an extra allowance for older Americans and people with disabilities. Senator Toomey and several other conservatives have been pushing for a slower growth rate, to reflect increases in the overall Consumer Price Index, starting in 2025. Medical prices have historically grown faster than the overall index.

“I think that’s a problem,” Senator Capito of West Virginia told the website Axios, reflecting the misgivings of a state that relies heavily on the program. “I think that sort of defeats the purpose of keeping people on, and at a level at which the program can be sustained.”

Several Republican senators, including Orrin G. Hatch of Utah, the chairman of the Finance Committee, have indicated they would like to exempt disabled children from the caps.

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Shelley Moore Capito, Republican of West Virginia, wants funding to combat the opioid crisis and has misgivings about proposed caps on Medicaid spending.

Credit
Doug Mills/The New York Times

Senator Collins’s concerns cover almost the entire landscape of Republican problems: the loss of care for Medicaid recipients, the worries of states with especially high health care costs, and money for opioid treatment (8 percent of all births in her state, Maine, were to addicted mothers last year, she said). Then there are her complaints about the process.

“First, we haven’t seen the bill,” Ms. Collins said. “Second, it has yet to receive a score from the Congressional Budget Office. And third is the process we are using.”

That process — an arcane budget procedure that Republicans denounced when Democrats used it to pass just a small part of the Affordable Care Act — could make some provisions vulnerable to Democratic challenges to the bill. Not knowing which provisions will stay and which could be removed on the Senate floor makes evaluating the substance of the bill that much harder.

Republican aides speculated that the restrictions on the growth of Medicaid, among other issues, could be altered later by Senate Republican leaders, in a bid to pick up support from the moderates.

A bill this large with so much in flux days before it is to receive a vote on the floor is largely without precedent in the Senate.

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Senior Republican senators said six weeks ago that they would start afresh in writing a bill to undo Mr. Obama’s health care law, but the legislation they are developing is similar in many respects to the bill passed by the House.

The Senate bill would eliminate penalties for people who do not have insurance and larger employers who do not offer it to employees — eviscerating the individual and employer mandates that were hallmarks of the Affordable Care Act. The Senate bill, like the House measure, would provide billions of dollars to states to help stabilize insurance markets, which Republicans say are tottering in many states.

The Senate bill would also allow states to opt out of many federal insurance standards. Republican leaders said they wanted to protect people with pre-existing conditions, but it was not immediately clear how they would do so.

Democrats stepped up their protests over the secrecy of the bill-writing process on Tuesday, and some Republicans chimed in. Senator Mike Lee, Republican of Utah, was a member of a health care working group formed by Senator Mitch McConnell of Kentucky, the majority leader, but even he was vexed by the process.

“It has become increasingly apparent in the last few days that even though we thought we were going to be in charge of writing a bill within this working group, it’s not being written by us,” Mr. Lee said in a video on Facebook. “It’s apparently being written by a small handful of staffers for members of the Republican leadership in the Senate. So if you’re frustrated by the lack of transparency in this process, I share your frustration.”


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Article source: https://www.nytimes.com/2017/06/20/us/politics/health-care-medicaid-opioid.html

Conservatives on Capitol Hill anxiously await health care bill

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Article source: http://www.cnn.com/2017/06/20/politics/health-care-conservatives/index.html

Apple is working with this small start-up to change how we track our health

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Apple is working on a secret plan to turn the iPhone into a personal hub for all your medical information, CNBC reported last week.

But it isn’t doing it alone. The company’s health team has been working with a tiny start-up called Health Gorilla, according to two people familiar with the initiative.

Sources said that Health Gorilla is specifically working with Apple to add diagnostic data to the iPhone, including blood work, by integrating with hospitals, lab-testing companies such as Quest and LabCorp and imaging centers.

The start-up, which has raised just shy of $5 million in funding, specializes in giving doctors a “complete picture of patient health history,” according to its website. CEO Steve Yaskin founded the company after a doctor friend of his was frustrated with the process of transferring patients’ diagnostic test results in their practice, according to a blog post from Health Gorilla investor True Ventures.

It is primarily geared to physicians and serves as a marketplace for them to place orders and share medical records. But it also has a free offering for patients, which promises to gather up medical information in 10 minutes.

Both Apple and Health Gorilla’s Yaskin declined to comment on the partnership.

Apple is looking to solve a big problem that has plagued the medical sector for decades.

Hospitals often struggle to access vital data about their patients at the point of care, which is spread among third-party labs, primary care groups and specialists. And those knowledge gaps can often lead to missed diagnoses or unnecessary medical errors, numerous studies have found.

Sources told CNBC that Apple is attempting to solve this “interoperability” problem by making the patient the center of their own care. The goal is to give iPhone users the tools to review, store and share their own medical information, including lab results, allergy lists and so on. That’s a deviation in strategy from Apple’s current health efforts, which have focused on aggregating fitness information like the number of steps taken during the day or hours of sleep.

Apple isn’t the first technology giant to jump into the personal health record space: Microsoft has a portal called Health Vault, while Google had a project called Google Health which shut down in 2011.

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Democrats Tie Up The Senate To Protest GOP Health Care Push

Senate Minority Leader Chuck Schumer of N.Y. speaks to reporters on Capitol Hill.

J. Scott Applewhite/AP


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Senate Minority Leader Chuck Schumer of N.Y. speaks to reporters on Capitol Hill.

J. Scott Applewhite/AP

The Republican effort to overhaul the Affordable Care Act, or Obamacare, has led to a standoff in the Senate.

Senate Democrats on Monday night began using parliamentary maneuvers to slow Senate business as part of a coordinated protest against the GOP push to pass an Obamacare replacement bill. A small group of Republican senators has been working in private for weeks, shielding from public view the bill and the negotiations surrounding it.

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In a show of frustration with what they deem the GOP’s “shameful” and “secret” legislative process, Democrats on Monday also held the Senate floor with a series of back-to-back speeches.

“If Republicans are not going to allow debate on their bill on the floor or in committee, Democrats will make opportunities to debate,” said Senate Minority Leader Chuck Schumer, speaking Monday on the Senate floor. “And these are merely the first steps we’re prepared to take in order to shine a light on the shameful Trumpcare bill and reveal to the public the GOP’s backroom deal-making.”

Liberal activists cheered on social media as Schumer forced McConnell to object to a motion to hold public hearings on the health care bill, and then pressed the Republican leader to commit to 10 hours of open debate.

Senate Democrats, in taking action Monday, are inserting themselves into a process that has excluded them by design. Democratic lawmakers are also responding to growing pressure from progressive activists who have been calling for more aggressive opposition. Members of the Democratic base have expressed concern that Republicans are moving forward with their health care bill while attention has been focused elsewhere — namely on the Russia investigations.

Some Republicans are also out of the loop

It’s not just Democrats who have been left out of the health care deliberations. Many Republican senators have seen little more than an outline and a Power Point summary of the Senate health care legislation that is being drafted.

“It’s not unusual, especially for a big bill like this. It’s okay that the drafting is happening behind closed doors,” Tommy Binion, a congressional liaison at the conservative Heritage Foundation, told NPR’s Morning Edition.

While GOP senators aren’t objecting to the process as vehemently as Democrats, a number of Republicans, including Sen. Marco Rubio, R-Fla., say the health care legislation should eventually be subject to open debate.

“If it’s an effort to rush it from a small group of people straight to the floor on an up or down vote, it’ll be a problem,” Rubio said Sunday on CNN’s State of the Union.

McConnell: “Nobody is hiding the ball here”

The Republican health care bill could be voted on as early as next week – ahead of the July 4th recess — without any committee hearings or public input. For his part, Senate Majority Leader Mitch McConnell is defending the closed health care talks.

“Nobody is hiding the ball here,” McConnell, R-Ky., told reporters last week. “There have been gazillions of hearings on this subject when [Democrats] were in the majority, when we were in the majority. We understand the issue very well and we are now coming up with a solution.”

Republicans contend the secret Senate negotiations give them time and space free from scrutiny to hash out the significant and serious differences among themselves over contentious issues, such as phasing out Medicaid expansion and determining the plan’s coverage requirements.

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Democrats say the closed talks are a tacit acknowledgment by Republicans that their efforts are unpopular.

“There’s only one reason why Republicans are doing this: They’re ashamed of their bill,” said Schumer on Monday. “The Republicans are writing their health care bill under the cover of darkness because they’re ashamed of it, plain and simple.”

While the Senate is crafting its own legislation, the House-passed American Health Care Act is viewed unfavorably by a majority of Americans – 55 percent – compared with 31 percent who viewed it favorably, according to a Kaiser Family Foundation poll released in May.

What’s more, the Congressional Budget Office estimated that the House health care bill would result in 23 million fewer people with insurance in a decade, and it would leave many sicker and older Americans with much higher costs.

Republicans eager to move on from health care

Still, Senate Republicans badly want to take up other priorities such as overhauling the country’s tax code.

“We’ve been debating Obamacare’s failures and what to do about them for so many years now,” McConnell said Monday on the Senate floor. “Members are very, very familiar with this issue. Thankfully, at the end of this process, the Senate will finally have a chance to turn the page on this failed law.”

Any legislation the Senate passes would head back to the House for consideration before President Trump can sign it into law.

Article source: http://www.npr.org/2017/06/19/533580464/democrats-tie-up-the-senate-to-protest-gop-health-care-push