Second AHCA vote underway: Update - Vote Done; Exemption denied; ACHA passed in the House 217 - 213

[tru_m.a.c]

California shows why the Republican plan to rely on states to replace Obamacare may not work

Richard Figueroa still shudders at the memory of the calls he fielded as enrollment director of California’s special health plan for sick patients who’d been rejected by insurers.

Desperate callers pleaded to get off the waiting list as cancer or other illnesses worsened. Enrollees struggled to understand why the plan would not cover all the treatment they needed.

Most heart-wrenching were the quiet, polite calls from those who’d received a letter that a sick relative could finally get on the plan. “They would say, ‘Thank you, but you can give our slot to someone else, because my brother or my wife or my daughter has died,’” Figueroa recalled.

California’s high-risk pool — like similar overstretched state plans around the country —became obsolete when the Affordable Care Act established a new federal system to guarantee coverage to Americans even if they’re sick.

Now President Trump and congressional Republicans are trying to shift responsibility for overseeing health protections back to states. This approach, including re-creating state high-risk pools, is a cornerstone of the GOP healthcare bill.

Among other things, California tried to require large employers to provide health coverage to their workers, though that effort was defeated in a statewide referendum just months after it was enacted.

The state adopted insurance rules to give consumers more power to challenge decisions by health plans, though state leaders were never able to make insurers cover all sick patients.

In 1991, the state set up the Major Risk Medical Insurance Program, commonly called “Mr. Mip,” a high-risk insurance pool to offer a lifeline to patients who’d been turned down for coverage on the commercial insurance market.

By the late ’90s, the plan, which was funded in part by premiums and in part by a voter-approved tobacco tax, was serving 22,000 people.

But as premiums soared because insuring sick patients was so expensive, the program became increasingly difficult to sustain. Enrollment was capped, as were benefits. The plan would only cover $75,000 of enrollees’ medical costs per year.

By 2010, when Obamacare was signed, the cost for a 50-year-old consumer in the Sacramento area who wanted a PPO plan had soared to $878 a month.

“It was a nice little program for a few thousand people,” said Lucien Wulsin, former head of the Insure the Uninsured Project, a state advocacy group. “But we never got close to reaching the hundreds of thousands of Californians who needed help.”

Finally in 2007, then-Gov. Arnold Schwarzenegger, a Republican, launched a sweeping campaign to push through a major healthcare overhaul to extend coverage to millions of uninsured Californians.

The landmark effort, in which Schwarzenegger partnered with Democrats in the state Assembly, picked up critical support from hospitals, patient groups and even some insurers and leading businesses.

But the effort ultimately collapsed amid opposition from advocacy groups on the left and right, and questions about how the state could pay for extending health coverage.


California shows why the Republican plan to rely on states to replace Obamacare may not work

 

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But late Wednesday night, it became clear that three California GOP congressmen — Valadao, Jeff Denham, R-Turlock, and Steve Knight, R-Lancaster — who earlier Wednesday had indicated they were undecided are actually co-sponsors of a key amendment that might lead to the bill’s passage. The amendment adds $8 billion more to fund high-risk pools for Americans with pre-existing conditions. And that may be enough to change some “no’’ votes to “yes.’’

Voting for the bill will clearly put Denham in political danger: After winning his 2016 re-election bid by fewer than 5 percentage points, he is now facing a new challenger from the Bay Area.

Josh Harder, a venture capital investor at Bessemer Venture Partners in San Francisco who has worked in tech and cyber security investments, announced his candidacy for Denham’s Central Valley seat on Tuesday. Harder, 30, a Democrat, has strong connections in Silicon Valley’s VC industry, which could help him mount a well-funded challenge to Denham.

California's GOP delegation key to Obamacare repeal

 

[tru_m.a.c]

Republican senators say they don’t see a way to get healthcare reform over the finish line, even if the House passes a bill this week.

A senior GOP senator said the chances of getting 51 votes for legislation based on the House healthcare bill are less than 1 in 5.

The senator also put the chances that the House bill will meet Senate budgetary rules preventing a filibuster at less than 1 in 5, meaning portions of the legislation would have to be removed.

Republicans are using special rules known as budget reconciliation to avoid a Democratic filibuster on an ObamaCare replacement. This would allow them to pass the legislation with 51 votes.

The problem is that Senate Democrats are expected to argue that various parts of the House bill will not meet Senate rules governing what can be included in reconciliation.

Democrats will argue that those provisions, such as a rule allowing states to seek a waiver for a regulation that requires insurers to offer certain minimum benefits, do not have a straightforward connection to spending, taxes or the deficit — something required under reconciliation.

“All they care about is getting it out of the House so they can say that the Senate couldn’t pass healthcare reform,” said a second GOP senator who requested anonymity.

In Senate, pessimism over ObamaCare repeal

 

[tru_m.a.c]

The lack of a CBO score isn’t the only sign of a markedly rushed process.

House GOP leaders gave themselves flexibility earlier this week to speed up consideration of the bill if they decided to bring it up for a vote.

The House voted along party lines in a Tuesday procedural vote to waive a rule requiring lawmakers to wait a day before considering a measure out of the Rules Committee, which determines how legislation is considered on the floor.

The move, known as “martial law,” is typically reserved for tight deadlines like avoiding an imminent government shutdown.

It’s highly unusual for leaders to invoke the procedure while trying to move legislation that doesn’t face a pressing need for passage, especially for something as far-reaching as healthcare reform.

If the rushed process sounds familiar, that’s because GOP leaders used the same tactics when they tried to bring the bill up for a vote in March.

GOP rushing to vote on healthcare without analysis of changes

 

[tru_m.a.c]

Facility fees are ruining quality care

The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved corner of the Pacific Northwest is becoming a medical wasteland.

In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private clinic sold to a large medical corporation. Peninsula Children’s Clinic was a bustling pediatric office meeting the vital, complex healthcare needs of children in Port Angeles, WA for the commercially insured as well as Medicaid patients. Why were they forced to close? A phone call with their office manager six months ago foreshadowed the outcome, “We are losing a great deal of revenue seeing Medicaid patients making it difficult to survive.”

Hospital-based clinics tack on “facility fee” charges, which are separate from the bill for the doctors’ services, for the use of the room in which the patient was seen. One hospital administrator told me to think of it as “room rental.”

Facility fees bring in a considerable flow of cash and have the secondary benefit of incentivizing hospitals to buy independent practices because then the hospital can charge two to five times more. Buying independent practices, like Peninsula Children’s Clinic, expands the hospitals’ market share and allows greater leverage when negotiating reimbursements.

Payers must acquiesce and pay the facility fees. As the payers are forced to pay more to the hospitals and hospital-based clinics, guess where they make cuts? They cut their fees to the independent private practice physicians, already struggling to make ends meet. My practice was notified of the impending 50% cut in reimbursement from Kaiser Permanente for specific codes just last week for private providers. In the meantime, as the government incentivized hospitals, are costs getting lower? Are consumers spending less? Are outcomes improving at record speed? Nope, and they won’t be anytime soon.

Medicare pays double the amount for office visits at hospital-owned clinics as compared to private physician offices, according to 2012 and 2014 reports by the Medicare Payment Advisory Commission (MEDPAC), an agency that guides Congress on Medicare spending. For example, Medicare paid $453 for an echocardiogram at hospital-owned facilities, yet the same test performed at an independently owned physician office costs, on average, $189, according to the 2014 report. In its 2012 report, MEDPAC found Medicare paid 80 percent more for a 15-minute visit at a hospital-based clinic compared to one at a private practice.

Based on the prediction Medicare spending would increase $2 billion by 2020, MEDPAC lobbied Congress to equalize payments between hospital-based and private physician offices by eliminating the onerous facility fee. Eliminating the facility fee and setting hospital reimbursement equal to that of independent physicians for 66 procedure groups, results in $900 million per year in savings on Medicare costs. However, eliminating the charges has proved daunting, for $3 trillion “reasons.”

Although MEDPAC has long promoted the idea of “site-neutral payments,” the hospital lobby deafened Congress to this important recommendation. The American Hospital Association opposes MEDPAC’s recommendations on several grounds, including facility fees are warranted because they create the financial incentive hospitals “need” to shore up “loss leaders” like the ER, where they are obligated to treat everyone, regardless of ability to pay. Hospitals say the money helps make up for low government reimbursement rates and pay expenses outside of patient care ranging from electric bills to hospital administrator salaries.

Consumer groups, such as Health Watch USA, say hospitals are charging patients, insurance companies and Medicare more without reason. Their board chairman, Kevin Kavanagh, has emphasized in many newspaper articles and publications that these fees are “essentially double billing,” without improving quality or patient outcomes. Many watchdog groups believe the fees have persisted to promote mergers between hospitals and clinics. Organizations, like the Association of Independent Doctors, have emphasized facility fees add “zero value” for the additional cost.

The facility fee adds billions of dollars to the nation’s health care costs. Patients with private insurance are responsible for as much as a 15 percent portion of the facility fee. One family in Port Angeles accustomed to paying $125 in out-of-pocket costs for doctor visits saw their costs skyrocket to more than $500 overnight. The increase reflects the new “facility fee” charge. Now, this family drives two hours each way to see me, because after accounting for gas and time, it costs less to visit my office than to visit Olympic Medical Center.

Facility fees are ruining quality care

 

[tru_m.a.c]

McCaskill: Missouri’s Rural Hospitals May Be At Risk Of Closure If Obamacare Is Repealed


You recently asked the Government Accountability Office to review the closures of rural hospitals and federal programs aimed at addressing the problem. Why is this of particular concern now?

Well, we have, first, more than 2 million Missourians live in rural areas of our state. And 41 percent of our state's hospitals are in rural areas. We know that they are under particular stress right now, particularly in states like Missouri that have refused the money that has been offered them for their Medicaid program under the Affordable Care Act. We know that there’ve been 78 rural hospitals closed, including three in Missouri. We know that 74 percent of those hospitals were actually in states that refused to accept the Medicaid money that was offered by the federal government back to the federal taxpayers in those states.

So I want to make sure that we understand all of the public policy reasons that are contributing to the closures of rural hospitals as the Republicans are trying to revamp the health care delivery in this country. I want to stay very focused on those folks, those 2 million Missourians who their medical care is more difficult to get, it is more expensive and frankly, just on the economic side, these hospitals, in most instances, are the No. 1 employers in these communities. And their health, the health of these hospitals, is very important to the health of rural Missourians.

So as you just pointed out, senator, Missouri is one of 19 states that have opted not to expand Medicaid under the Affordable Care Act. What effect has that had on rural hospitals in the state?

Well, there's no question that it has had a dramatic impact. Rural hospitals are more dependent on, first of all, Medicare because the populations tend to skew older. And they're more dependent on Medicaid because many of the people in rural Missouri, because there is no other hospital, they are taking in a lot of the Medicaid patients. And then frankly, they take in a lot of uninsured because of the gap in Missouri of people who make too much money. ... They're too poor to get on the exchanges and definitely not poor enough to get on Medicaid. So because the exchanges were designed assuming states would take the money, take their own tax dollars back, to help with health care.

That’s what’s so hard for me to understand, that the folks in Jefferson City, because they wanted to make a political point about Obamacare, they have steadfastly refused to accept Missourians’ own federal tax dollars – the same tax dollars they accept for highways, they accept for all kinds of economic development grants, they accept for all kinds of purposes – but they’ve refused to accept these dollars for people’s health care. And that is why the rural hospitals in Missouri are under more stress than hospitals in states that expanded Medicaid.

So I hope this GAO report will not only talk about that, but also talk about other reasons why rural hospitals are in such danger right now in terms of their ability to keep the doors open.

You mentioned earlier that three rural hospitals in Missouri have closed. How many rural hospitals in Missouri are at risk of closure?

I think that they would tell you many of them. Forty-six of the 50 counties in our state that have above average mortality rates are in fact in rural areas. And we know that almost half, over 40 percent of the state's hospitals, are in rural areas. We've now lost hospitals in Farmington, in Osceola, and down in Reynolds County. I talk to hospital leaders all the time and I've particularly spent time talking to leaders of rural hospitals in places like West Plains and Houston and other small communities across our state. And they are very worried. They're particularly worried if the Republican plan for health care involves even more Medicaid cuts that for a state like Missouri that never expanded, that then would be looking at additional cuts. That is really problematic.

And by the way, the plan the Republicans are talking about is going to make insurance much more expensive for, particularly, people between the ages of 55 and 65 that live in rural communities. So it’s going to be a double whammy if the House bill that’s being contemplated actually ever makes it to the president’s desk.

And how likely do you think that is?

I can’t tell you at this point. You know, when I went around the state recently on town halls and I was in rural communities, and I would explain in places like Hannibal that an average 60-year-old man who is making around $30,000 as a small farmer, his premiums on the exchange would go from, currently, about $2,400, $2,500 a year, to as high as $13,000 a year. That was shocking to the people that were at my town halls in these communities outside of Kansas City and St. Louis. And what people have to realize is that their plan allows older people to be charged five times as much as younger people, and it’s based on how much insurance premiums are where you live. And insurance premiums are higher in rural Missouri. So it’s going to be particularly devastating to rural Missouri if the Republicans and President Trump have their way with what they’re trying to do.

And what we should be doing, frankly, is just fixing the problems in the Affordable Care Act, shoring up the individual markets, expanding Medicaid in Missouri. We could improve the number of people that actually have insurance in our state and make it more affordable for everybody else, because everyone who shows up without insurance at the emergency room, we all pay the bills through our insurance premiums. It’s not like that money comes from the fairy. The money for people who show up and who we take care of in America that don’t have insurance, we just pay it indirectly rather than directly.

McCaskill: Missouri’s Rural Hospitals May Be At Risk Of Closure If Obamacare Is Repealed

 

[tru_m.a.c]

Molina, Key Provider Under Obamacare, Ousts C.E.O., a Trump Critic

Dr. J. Mario Molina, the outspoken chief executive of the California health insurance company founded by his father, was abruptly removed from his position at Molina Healthcare, according to an announcement by the company on Tuesday. His brother, John, the company’s chief financial officer, was also immediately replaced.

Dr. Molina, the subject of a profile in The New York Times earlier this year, was one of the foremost critics of the steps taken by the Trump administration and Republicans in Congress to overhaul the federal health care law. Under his leadership, Molina, which specializes in providing care to low-income individuals under the Medicaid program, had become a mainstay of the individual insurance markets created by the law. The company signed up about one million customers in the state marketplaces, and it offers Medicaid plans in 12 states and Puerto Rico.

But Molina had been struggling financially in the individual marketplaces and stunned investors when it reported that it had lost hundreds of millions of dollars last year, for which executives blamed a flawed government formula. Dr. Molina repeatedly warned that the company could withdraw from the markets if federal officials failed to make changes to the program. Molina’s stock fell significantly on the news of its 2016 results.

Like other insurers, Molina also stressed the uncertainty over the individual market’s future, pointing to the lack of clarity over whether the federal government will provide critical funding for low-income customers. Just last week, Dr. Molina had written a letter to Congress urging them to fund the subsidies.

https://www.nytimes.com/2017/05/02/...-i090Txjkwok-N8TmvIikJ7C4vJL6A&_hsmi=51473967

 

[tru_m.a.c]

A Squeaker In The House Becomes Headache For The Senate: 5 Things To Watch

Some analysts have suggested that the House amendment sought by conservatives to allow states to waive some of the health law’s regulations might run afoul of Senate’s “Byrd Rule,” which limits what can be included in a budget reconciliation measure.

“It could be argued that any budgetary effects of the waiver are ‘merely incidental,’” said the Committee for a Responsible Federal Budget in a blog post.

Even Rep. Mark Meadows, R-N.C., who negotiated that amendment that won the backing of conservatives, conceded that it could prove problematic in the upper chamber. “There’s still a lot of work that needs to be done before we can celebrate and all go home,” he said in an interview outside the House chamber.

Democrats say it is one of several provisions in the House bill that might not pass parliamentary muster in the Senate.

For example, analysts have suggested that the GOP replacement for the much-disliked “individual mandate” requiring most people to have insurance or pay a fine might not pass Byrd Rule scrutiny either. That’s because the 30 percent premium penalty that people with a lapse in insurance would have to pay under the bill would go to the insurance company, not the federal government, so it would have no budget impact.

A third potentially problematic element of the original House bill would allow insurers to charge older adults five times more in premiums than younger adults — up from a ratio of 3-to-1 under the Affordable Care Act. That provision could be viewed as not directly affecting federal spending, some analysts predict.

A Squeaker In The House Becomes Headache For The Senate: 5 Things To Watch

 

[Pressure]

This is extremely wrong. Stop it.

First of all it's medicaid, not medicare.

Secondly, medicaid expansion is part of the ACA. It's the largest part of the bill. I've explained how terrible Texas' public health system is in another thread.

What part there is extremely wrong? Due to Texas's medicaid expansion refusal they don't provide coverage for low income people, whereas a state such as Ohio does.

The point he's making, very well might I add, is that the healthcare discussion is always talked about from a 10,000 foot view. So when it comes time for someone in Texas to complain about healthcare, instead of them pointing the finger to their state reps, they look past them and blame the failures on Obama. The ACA reduced premiums through tax credits and assisted low income consumers reach their deductibles with cost sharing subsidies. In Texas, the people who need it the most don't receive the benefits.

That's why his story starts by explaining why the poor don't vote democrat.

The point as presented earlier is that this is a Texas issue, but the anecdote presented earlier is placing almost all of the blame on the ACA and not the state of Texas refusing medicaid expansion and also not taking part of the Effective Rate review program.

The only complaint he makes about Texas are the poor people causing him to make sometimes 100k less and that medicaid is hard to get in Texas (see above for one reason why).

 

[ineedsleep212]

 

[tru_m.a.c]

What part there is extremely wrong? Due to Texas's medicaid expansion refusal they don't provide coverage for low income people, whereas a state such as Ohio does.


The point as presented earlier is that this is a Texas issue, but the anecdote presented earlier is placing almost all of the blame on the ACA and not the state of Texas refusing medicaid expansion and also not taking part of the Effective Rate review program.

The only complaint he makes about Texas are the poor people causing him to make sometimes 100k less and that medicaid is hard to get in Texas (see above for one reason why).

This is the quote I responding to:

This is why people are so confused about the ACA. Everything in this dudes thread has nothing to do with Obamacare and everything to do with TX blocking Medicare expansion. So much misinformation going around.

If you don't understand that medicaid expansion is one aspect of the ACA, I don't know what to tell y'all. And like 7 people dapped this post.

Secondly the tweets were about why poor people don't vote Democrat, considering Dems thought the ACA would provide automatic wins for the decades.

As I already stated, everything that man is saying rings true and that's why it took til 2017 for Democrats to be able to explain what and why the ACA is so important. How many of y'all actually knew about community ratings, high risk pools, the wide range of pre-existing condition classification, or the 10 essential health benefits until February?

How do you expect the poor to understand your bill if your leaders don't understand or communicate the benefits themselves? Why would that man ever fight for the ACA or Obama when he can't differentiate between the actions of the state and the federal government? Texas, Kansas, or Florida not expanding their medicaid program is the problem if the people it's most likely to serve don't understand how/why they're getting fukked over.

But I fully expect Democrats to fail at messaging because of this "we go high when they go low" BS.

 

[Hood Critic]

This is the quote I responding to:


If you don't understand that medicaid expansion is one aspect of the ACA, I don't know what to tell y'all. And like 7 people dapped this post.

Secondly the tweets were about why poor people don't vote Democrat, considering Dems thought the ACA would provide automatic wins for the decades.

As I already stated, everything that man is saying rings true and that's why it took til 2017 for Democrats to be able to explain what and why the ACA is so important. How many of y'all actually knew about community ratings, high risk pools, the wide range of pre-existing condition classification, or the 10 essential health benefits until February?

How do you expect the poor to understand your bill if your leaders don't understand or communicate the benefits themselves? Why would that man ever fight for the ACA or Obama when he can't differentiate between the actions of the state and the federal government? Texas, Kansas, or Florida not expanding their medicaid program is the problem if the people it's most likely to serve don't understand how/why they're getting fukked over.

But I fully expect Democrats to fail at messaging because of this "we go high when they go low" BS.

I'm still not understanding what you're getting at..yes, medicaid expansion is one aspect of ACA but it's an optional aspect. And the tweet thread you posted worked on the premise that the ACA was soley responsible for high deductibles and costs of healthcare for the poor. That's not true, especially in the example that he used. The patient he discussed wouldn't have had a $5K deductible if Texas hadn't opted out of medicaid expansion. These costs aren't the result of the ACA, they are the result that the state has to foot the bill on uninsured treatment.

 

[tru_m.a.c]

I'm still not understanding what you're getting at..yes, medicaid expansion is one aspect of ACA but it's an optional aspect. And the tweet thread you posted worked on the premise that the ACA was soley responsible for high deductibles and costs of healthcare for the poor. That's not true, especially in the example that he used. The patient he discussed wouldn't have had a $5K deductible if Texas hadn't opted out of medicaid expansion. These costs aren't the result of the ACA, they are the result that the state has to foot the bill on uninsured treatment.

No. His tweets pointed out that the implementation of the ACA did not help/confused a lot of poor people, so it's unwise to think they are going to come out in droves to help you in the election - especially if they don't know why the law isn't working and who is responsible for its failure.

His point with the deductibles was that giving people access to healthcare ended up backfiring on dems because high deductibles are still a barrier to care, low reimbursement rates for medicaid is a barrier to care, med authorization through your insurer is till a barrier to care. So knowing that these issues exists, it's important that your messaging is top of the line to help the neediest people, most of whom are gaining health insurance for the first time in their lives.

Secondly, many people in Texas' individual market probably still had a 5k deductible because the cost sharing subsidies, which can only be used to lower deductibles, only kick in on silver plans. (I'm not looking at the tweets right now but I don't think dude qualified for Texas' Medicaid, and it looks like he made too much to qualify for a cost sharing reduction or premium tax credits through the Federal marketplace. Again, messaging that I'm sure most congressmen/women would not be able to communicate.

It's all messaging. And the dems suck at it. Because they don't know the law themselves.

The #1 headline going into the summer should be "Trump and Republican Congress withholding funds/sabotaging ACA". I keep posting about insurers pulling out of counties because the administration won't assure them of the cost sharing subsidies. That should be national priority right now.

 

[tru_m.a.c]

NY Dem trolls GOP rep by showing up at Trumpcare town hall he was too scared to attend

Rep. Patrick Maloney (D-NY) trolled Rep. John Faso (R-NY) in his colleague’s own district on Monday, holding a town hall in Faso’s place after the GOP congressman refused to face his constituents to explain why he voted for the American Healthcare Act.

Faso was one of 217 House Republicans to vote for the GOP’s Obamacare replacement plan last Thursday, despite lacking a score from the Congressional Budget Office.

Faso was invited to Monday’s “Save our Healthcare Town Hall” in Kingston, but a spokesman last week said he would not attend the event. In a tweet Saturday, Maloney said if his Republican colleague refused to answer constituents’ questions, he would.

“I’m not doing you a favor by answering your questions if I represent you. It’s my job,” Maloney said at the town hall Monday.

Maloney ridiculed Faso for refusing to make himself available to voters in his district.

“This guy should not be on some milk carton, he’s your congressman, right?” Maloney said. “He should be here. Don’t take this the wrong way: I have my own district, I shouldn’t be here.”

“I love you all, I will wave to you as I drive by to my district,” he joked.

Maloney also took the opportunity in front of Faso’s constituents to slam the GOP’s “bum’s rush to pass a bill.”

“They overlooked so many things,” Maloney said. “And the irony of this [is] they’re doing it to the very people who put [President] Donald Trump in office.”

In a statement Faso dismissed Maloney, insisting his Democratic colleague’s attendance at a town hall he declined to attend is “sad, but I can’t tell you it’s unexpected.”

“That’s his reputation,” Faso said.

NY Dem trolls GOP rep by showing up at Trumpcare town hall he was too scared to attend

 

[Regular_P]

It should be federal law that these reps hold and attend town halls in their districts. If they don't, they should be put in prison for the remainder of their term.