Updated October 12th, 2017
President Trump Signs Executive Order Aimed At Increasing Access To Alternatives To Obamacare
President Trump hasn’t been shy about letting everyone know that he thinks Obamacare is a failure. While it is true that Obamacare premiums have skyrocketed over the last few years, particularly this year, there’s also no question that President Trump and his administrations refusal to commit to funding the cost sharing reduction subsidies, CSR’s, have only made things worse. In fact, insurance carriers have been releasing two sets of figures that are reflective of how much premiums are increasing within each state. Florida is seeing an increase of either 13.7% or 44.7% as a state average. What’s driving the 31% difference between the two figures? Uncertainty. Insurance carriers filed two rates because they still do not know what the President is going to do.
A lot of the news surrounding the just signed executive order, is making it out to sound like this is simply an attempt to place the final nail in Obamacare’s coffin, as so many Republicans have campaigned on. There’s just one problem with that, none of what has been proposed so far can actually do anything long term.
It’s a bandaid for this season, it’s a way to show that the administration did “something” to help lower costs for this year. The way in which consumers who don’t have a full subsidy, who are impacted the most by premiums skyrocketing, many will be able to obtain cheaper healthcare by going around the ACA, and enrolling in a short term health insurance plan. Part of the executive order signed today, is a directive that will be applied to loosening restrictions on the sale of those plans. They were previously limited to 3 months policy terms, instead of being a 12 month or year round product.
It is too early to know if any of these measures will actually have any kind of impact regarding premium pricing and reducing costs. We’re certain to have more details and a more comprehensive update on the executive order signed by the President published sometime next week.
Here’s the official text, direct from the WhiteHouse.
– – – – – – –
PROMOTING HEALTHCARE CHOICE AND
COMPETITION ACROSS THE UNITED STATES
“By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:
Section 1. Policy. (a) It shall be the policy of the executive branch, to the extent consistent with law, to facilitate the purchase of insurance across State lines and the development and operation of a healthcare system that provides high-quality care at affordable prices for the American people. The Patient Protection and Affordable Care Act (PPACA), however, has severely limited the choice of healthcare options available to many Americans and has produced large premium increases in many State individual markets for health insurance. The average exchange premium in the 39 States that are using www.healthcare.gov in 2017 is more than double the average overall individual market premium recorded in 2013. The PPACA has also largely failed to provide meaningful choice or competition between insurers, resulting in one-third of America’s counties having only one insurer offering coverage on their applicable government-run exchange in 2017.
(b) Among the myriad areas where current regulations limit choice and competition, my Administration will prioritize three areas for improvement in the near term: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).
(i) Large employers often are able to obtain better terms on health insurance for their employees than small employers because of their larger pools of insurable individuals across which they can spread risk and administrative costs. Expanding access to AHPs can help small businesses overcome this competitive disadvantage by allowing them to group together to self-insure or purchase large group health insurance. Expanding access to AHPs will also allow more small businesses to avoid many of the PPACA’s costly requirements. Expanding access to AHPs would provide more affordable health insurance options to many Americans, including hourly wage earners, farmers, and the employees of small businesses and entrepreneurs that fuel economic growth.
(ii) STLDI is exempt from the onerous and expensive insurance mandates and regulations included in title I of the PPACA. This can make it an appealing and affordable alternative to government-run exchanges for many people without coverage available to them through their workplaces. The previous administration took steps to restrict access to this market by reducing the allowable coverage period from less than 12 months to less than 3 months and by preventing any extensions selected by the policyholder beyond 3 months of total coverage.
(iii) HRAs are tax-advantaged, account-based arrangements that employers can establish for employees to give employees more flexibility and choices regarding their healthcare. Expanding the flexibility and use of HRAs would provide many Americans, including employees who work at small businesses, with more options for financing their healthcare.
(c) My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system. To the extent consistent with law, government rules and guidelines affecting the United States healthcare system should:
(i) expand the availability of and access to alternatives to expensive, mandate-laden PPACA insurance, including AHPs, STLDI, and HRAs;
(ii) re-inject competition into healthcare markets by lowering barriers to entry, limiting excessive consolidation, and preventing abuses of market power; and
(iii) improve access to and the quality of information that Americans need to make informed healthcare decisions, including data about healthcare prices and outcomes, while minimizing reporting burdens on affected plans, providers, or payers.
Sec. 2. Expanded Access to Association Health Plans. Within 60 days of the date of this order, the Secretary of Labor shall consider proposing regulations or revising guidance, consistent with law, to expand access to health coverage by allowing more employers to form AHPs. To the extent permitted by law and supported by sound policy, the Secretary should consider expanding the conditions that satisfy the commonality‑of-interest requirements under current Department of Labor advisory opinions interpreting the definition of an “employer” under section 3(5) of the Employee Retirement Income Security Act of 1974. The Secretary of Labor should also consider ways to promote AHP formation on the basis of common geography or industry.
Sec. 3. Expanded Availability of Short-Term, Limited‑Duration Insurance. Within 60 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, consistent with law, to expand the availability of STLDI. To the extent permitted by law and supported by sound policy, the Secretaries should consider allowing such insurance to cover longer periods and be renewed by the consumer.
Sec. 4. Expanded Availability and Permitted Use of Health Reimbursement Arrangements. Within 120 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, to the extent permitted by law and supported by sound policy, to increase the usability of HRAs, to expand employers’ ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.
Sec. 5. Public Comment. The Secretaries shall consider and evaluate public comments on any regulations proposed under sections 2 through 4 of this order.
Sec. 6. Reports. Within 180 days of the date of this order, and every 2 years thereafter, the Secretary of Health and Human Services, in consultation with the Secretaries of the Treasury and Labor and the Federal Trade Commission, shall provide a report to the President that:
(a) details the extent to which existing State and Federal laws, regulations, guidance, requirements, and policies fail to conform to the policies set forth in section 1 of this order; and
(b) identifies actions that States or the Federal Government could take in furtherance of the policies set forth in section 1 of this order.
Sec. 7. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.”
DONALD J. TRUMP
THE WHITE HOUSE,
October 12, 2017.
Why The Graham-Cassidy Bill Is Impossible For Republicans To Pass
Updated September 26th, 2017
In their last-ditch effort to repeal and replace the Affordable Care Act (ACA) this year, the Republican lawmakers have put forth a new proposal that’s gained some traction in the Senate. Senators Lindsay Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin introduced a new plan on September 13th. Dubbed the “GCHJ” bill, this legislation was endorsed by President Trump on September 20th.
Elimination of Individual Mandate
One of the differences between the GCHJ and the ACA is that the individual mandate, the IRS penalty assessed on those who do not purchase health insurance, is not only eliminated but is repealed retroactively to 2016. Many experts believe that the elimination of the mandate with nothing to encourage health individuals to purchase health insurance could lead to higher insurance premiums because insurance companies would view the pools as limited to high-risk customers.
The Commonwealth Fund reported that between 15 and 18 million people could become uninsured as soon as 2019. This is not necessarily due to the inability to afford insurance, but because healthy people will no longer be required to pay for healthcare and may choose not to spend money on those premiums.
Elimination of Insurance Subsidies
The GCHJ also eliminates insurance subsidies under the ACA that allow insurance companies to offset out-of-pocket expenses and premium costs for low-income families. America’s Health Insurance Plans, a powerful insurance lobby, together with Blue Cross Blue Shield announced that they did not support the GCHJ. One of the reasons for their lack of support was that the elimination of subsidies increased uncertainty in the insurance marketplace. Although there is funding included in the bill to keep the market stable, some believe that the individual market could collapse before 2020 in some states.
Pre-Existing Condition Provisions
Like the ACA, the GCHJ requires insurance companies to offer coverage that is affordable to people with pre-existing conditions. However, the bill allows states to apply for a waiver so that insurance companies in those states can charge higher premiums for pre-existing conditions if they can prove that doing so significantly decreases premiums for everyone else. Experts say that this practice eliminates important protections for members of the insurance marketplace who suffer from chronic illnesses like diabetes, cancer or heart conditions.
Changes to Medicaid
The biggest change between the ACA and the GCHJ is that beginning in 2020, Medicaid expansion, which allowed millions of poor Americans to get coverage under the ACA, would be eliminated. In its place, the federal government would issue block grants to each state using a complicated formula loosely based on how many people in that state fell between 50 and 138 percent of the federal poverty level.
This new funding approach could result in significant financial losses for at least four states that make up 37 percent of all federal Medicaid funding: New York, Massachusetts, California and Maryland. Estimates for lost funding for these states have ranged from $5 billion in Massachusetts to $27 billion in California. Elimination of the Medicaid expansion is estimated to leave 26 million without insurance by 2026. The law also allows states to require able-bodied Medicaid recipients to work.
Challenges to Block Grant Program
Not only is the formula for the GCHJ Medicaid block grant program complicated, but states will also be required to draft legislation and may need to create agencies as well as administrative guidelines for using the federal funding. All of this will need to be done while states wait for the federal government to set their own rules. It will be challenging to put all of that in place by 2020.
States that expanded Medicaid under the ACA stand to lose a significant amount of funding while states that chose not to expand may see funding increase. Some states may see no change in their federal funding but will have more autonomy in how the funds are spent. Drafters of the bill believe that block grants allow states to take control of healthcare spending and that each state has a better idea of what its residents need than a “bureaucrat” at the federal level.
Under the ACA, only adults up to age 30 can purchase catastrophic plans in the marketplace. These are plans that cover serious health conditions like cancer, heart disease or significant injuries (and little else). The GCHJ plan allows all adults to purchase such plans, which often come with much lower premiums than those that cover a full bevy of benefits, including the 10 essential health benefits required under Obamacare major medical policies.
In addition, the GCHJ bill eliminates the requirement that all insurance policies cover those 10 essential health benefits, which includes maternity and mental health care, among other key services. Analyses suggest that eliminating the essential health benefits provision could lead many people with substance abuse problems to lose coverage for critical treatments.
Deadline For Passage
Republicans do not have much time to get the bill passed. Under Senate rules, the bill must be passed by September 30 with a simple majority in order to avoid a Democratic filibuster. The Congressional Budget Office has said that it will take several weeks to review the bill to determine what impact it may have on coverages and costs. Therefore, the bill could be passed without a review by the CBO.
Many also worry that the Republicans are desperate to pass the bill to make good on campaign promises, which may make them less likely to review the bill thoroughly before they take a vote and pass it. Currently, only Senator Rand Paul has stated he is opposed to the measure and would prefer a bipartisan effort to replace the ACA. Blue Cross Blue Shield, the American Medical Association, the American Hospital Association and AARP have all come out against the bill, stating that they, too, prefer a bipartisan effort to fix what’s wrong with the current healthcare system.
One significant problem that the bill faces is the third phase, which will occur in 2027. At that time, all appropriations and funding expires. Congress will be required to pass new legislation and create a new healthcare program plus a funding source. States that choose to expand under the GCHJ could face significant shortfalls when that occurs.
Many report that this bill is not significantly different than bills presented earlier in the year. Although one of those bills passed the House of Representatives, it failed to garner votes in the Senate. A Senate measure designed to replace it failed. It’s difficult to determine how much support this bill has among Republicans, but it has earned the support of President Trump, who chastised Senator Paul for his negative comments about the bill.
Congress Is Making Moves To Prevent Insurance Premiums From Spiking With Or Without The President
Updated August 17th, 2017
It seems that many members of Congress, Republicans and Democrats, are growing concerned about the health insurance ecosystem and the governments inability to get any significant legislation passed. So much so, that they’re actually making efforts to work together, with or without the Trump Administrations blessing. Go ahead and take a moment, pigs might have taken flight outside your window.
We’ve been asking for nearly a year now for Republicans and Democrats to work together on a true bipartisan solution for healthcare reform. We understand that it’s a bitter pill to swallow, but too bad it’s time to take your medicine and do what’s best for the American people. There are not just millions of lives impacted by the ACA, but quite literally hundreds of millions, essentially almost the entire nation is impacted by the ACA. It doesn’t matter if you receive Medicare, Medicaid, health insurance through the ACA, or coverage through an employer sponsored plan, the Affordable Care Act, or what is also know as Obamacare, it is all connected.
If there’s one issue where the politics shouldn’t matter, it’s healthcare. It’s the physical cornerstone to every Americans life, and according to national polling results, both before and after the election, health insurance costs are without question the main concern for Americans. Costs are perceived to be spiraling out of control, and consumers are demanding a solution to this problem. Earlier this week, the CBO released a report indicating that if the CSR payments (cost-sharing reduction) are not made in August, and moving forward, many of the few remaining insurance carriers will likely move out of the market entirely, literally leaving tens of millions without any option for coverage under Obamacare. Or alternatively, for the carriers who decide to remain and provide coverage, they will be forced to increase premiums immediately. That increase in monthly premiums is estimated to be between 20% and 25% nationally. Even more shocking is that within that CBO analysis, it is concluded that the deficit will actually increase as a result of CSR’s not being paid. Spending money up front now, actually costs the country a lot less money in the end.
However, there are some smaller regional insurance carriers who have already stated, that without the CSR payments they would be forced to submit out of necessity, in order to stay solvent and remain in business, premium increases of more than 50%. This would be a complete a total disaster for Americans who are already hurting because of healthcare costs. It goes without saying that the political damage Republicans would face, could be catastrophic for the 2018 midterm elections and beyond.
In light of how bad relations are currently with the Trump administration and Democrats, and now reflective of recent tragic events and how relations are starting to become fractured with President Trump and some Republicans, Congress is taking steps independently to secure the healthcare marketplace, and ensure that Americans are not going to be facing any greater burden with increased premium costs that otherwise could have been avoided.
While it was just announced that President Trump will in fact pay the CSR’s for the month of August to insurance carriers, the administration has yet to make official a decision on what its plans are indefinitely, so uncertainty remains. That is not something that insurance carriers will accept, uncertainty. If uncertainty remains, carriers who are already on the fence will either increase rates or leave the marketplace, both of which are outcomes that are harmful to Americans.
Congress is now taking measures so that when they return from break in September, they will circumvent the Trump Administration and their decision to pay, or not pay the CSR’s that are contractually due to insurance carriers. To be candid, what was already a mess, hasn’t gotten better exactly. That said, the silver lining here and why we’re going into such detail, is that the panic that’s coming from both sides of the political isle, is resulting in a far better outlook than just one week ago. CRS’s being paid, as they should, will keep the marketplace stabilized and prevent premiums from spiking.
Insurance premiums should not be expected to increase upwards of 20% or more nationally, should Congress follow through with what they’re proposing. Of course it certainly doesn’t hurt to call or mail your local or state representative with a friendly reminder.
As always check back for updates, or sign up for notifications when news breaks about healthcare reform. In closing we do feel you should feel more hopeful for a better future and better options with respect to your healthcare.
Trumpcare Is Derailed – Obamacare Lives! Don’t We All Agree Obamacare Is Actually Failing Though?
Updated July 29th, 2017
When you ask Americans their opinion of the Affordable Care Act (ACA), which is also called Obamacare, you may be met with immediate criticism, especially if the people you’re asking lean to the right politically.
Obamacare has been a constant target of conservatives criticism since it was signed into law seven years ago. Its detractors’ reactions to the ACA range from moderate distrust to outright expletive-peppered rage.
President Donald Trump rode a wave of hatred aimed at Obamacare right to the White House. He promised that his first act as president would be to repeal Obamacare and put something new in place. But as much as people say they hate Obamacare, Trump cannot get the support he needs in a GOP-dominated Congress to repeal the health care law. Is Obamacare really failing? Some don’t think it is. If it has failed, then why has it been so hard for Trump and a Republican Congress to pass a healthcare reform bill that they can agree on?
Why the Hate for Obamacare?
There are several legitimate reasons why so many people hate Obamacare. For one thing, Obama himself made a promise that his own law had to break when he said that people could keep their doctor and their plan if they wanted to. The law was passed after many closed-door sessions, and Republicans pounced on the cancellation letters that many people got from their insurance companies as a way to tarnish public opinion of the law.
Obamacare took away policies people had for years and replaced them with high-premium, high-deductible policies that made healthcare too expensive for people who did not qualify for government subsidies. As an example, a 61-year-old woman in Ohio was forced to purchase a plan from Anthem (the only health insurance carrier in her market on the federal exchange) for $340 per month, which included a $7,100 annual deductible. This means that no health insurance coverage would be offered until the deductible was met, and she was still responsible for the monthly premiums. For working Americans who don’t qualify for tax subsidies to help pay insurance premiums, these incredibly high healthcare costs are common.
Why would this woman from Ohio even buy a policy like that in the first place? Because Obamacare has something called the individual mandate, which applies a penalty to your income tax if you don’t have health insurance in place. The idea that the government forces citizens to buy health insurance and then penalizes people who don’t have the type of insurance the government mandates made Obamacare extremely unpopular, particularly among conservatives who value personal freedom.
Many Americans who had employer-sponsored health insurance and Americans with significant financial means have issues with the tax subsidies for the working poor. Some people find it offensive that their tax dollars are being used to help pay for health insurance for the poor, while they are stuck paying their full health insurance bill.
But is Obamacare Failing?
As we have seen, there are plenty of legitimate reasons for people to be upset with Obamacare. But the assertion by the Republican Party that Obamacare is currently failing, may be an overstatement. According to the Centers for Disease Control and Prevention (CDC), Obamacare is directly responsible for the national uninsured rate dropping from almost 16 percent in 2012 to 9 percent in 2015.
Obamacare included Medicaid expansion for the states that chose to participate, and in those states the rate of uncompensated care delivered by public hospitals fell sharply. There is also evidence that Obamacare allowed more people to see a doctor than in any previous year. More of the working poor had health coverage, and their doctors were welcoming that coverage with open arms.
Perhaps the most significant indication that Obamacare is effective comes with a look at the overall cost of healthcare in the United States. For 2014, the federal government projected that Obamacare would bring healthcare spending in the United States down to 18 percent of the gross domestic product. The reality is that health care spending was brought down to just above 17 percent of the GDP, and future projections had Obamacare bringing healthcare costs down even more heading into 2020.
Why Does the GOP Want to Repeal Obamacare?
President Trump has referred to Obamacare as “a disaster” and something that he feels needs to be repealed. But the replacement plan the GOP offered was not appealing enough to Republican and Democratic lawmakers. Millions of Americans would have likely lost their health insurance or dropped it voluntarily if Obamacare were repealed and the GOP’s plan were put in place. For many Republican congressional representatives, losing healthcare for their constituents means losing votes. It is widely believed that healthcare reform, and the outrageous costs which go across the entire healthcare ecosystem, including prescription drug prices and a lack of pricing transparency with doctors networks and hospitals, was the very issue that pushed the election in favor of President Trump.
During the Presidential campaign, Americans who were polled on his various proposed policies were most in agreement on healthcare reform, than on the border wall, corporate tax reform or changes to environmental regulations.
The war of words between the realities of Obamacare and the perception of the GOP came to a head early Friday morning, July 28, when the Senate voted against a “skinny repeal” bill that would have stripped the ACA of its mandates and taxes on medical devices. Despite a staunch stance against Obamacare by leading Republicans, there were still not enough votes to repeal and replace the current law with something of the GOP’s own making.
Senator John McCain of Arizona led the charge in calling for his peers to come together in a bipartisan effort to reform healthcare. How Congress will proceed remains to be seen.
Updated July 28th, 2017
Skinny Repeal Is Rejected By The Senate Thanks To John McCain
After seven years of political maneuvering to get a GOP-backed bill to supplant the Affordable Care Act, the Senate narrowly voted against a Republican “skinny repeal bill” early on Friday, July 28th. The move comes as somewhat of a surprise to lawmakers and their constituents, as well as a shock to Republican Majority Leader Mitch McConnell, who had been pushing GOP reform efforts for weeks. With a failure to push the skinny bill through, Republicans will be forced to drop their reform plans, at least for the time being. Procedurally, lawmakers must now go back to the legislative drawing board.
The bill garnered zero Democratic support, and ultimately the “nay” votes from three Republican senators is what ultimately sank the Republican healthcare reform plan that became known as “skinny repeal”. Senators Lisa Murkowski of Alaska, Susan Collins of Maine and John McCain of Arizona all voted against the bill. McCain, who returned to Congress just days after brain surgery and a cancer diagnosis, felt strongly that the bill may have been passed as-is by the House, something that could have been disastrous to the American economy, not to mention the healthcare system.
It was anticipated that Republicans would pass the skinny bill as a “Trojan Horse” attempt to push through other legislation during a conference committee. On its own, the skinny repeal bill would have simply eliminated the individual and employer mandates, and eliminated the tax on medical devices under the ACA.
Once the bill had been passed, it was likely to move to conference, where an appointed team of House and Senate members, helmed by Republicans, would have created a collective report on healthcare measures that would eventually become the official bill. Early on Thursday, July 27, McCain and other Republican senators were concerned that this tactic could backfire. Without assurances from the House that it would agree to conference, some senators feared that the skinny repeal bill would have become law after the House adopted it without conference.
Debates and conversations lasted well into Thursday night. In dramatic, early-morning vote on Friday, the Senate voted against proceeding with the bill by a narrow margin. Senators McCain, Collins and Murkowski cast the key votes that demolished hope of moving forward with skinny repeal.
For the time being, healthcare reform efforts have been halted. McCain had warned his peers in the Senate earlier this week that they needed to return to the procedures that get laws passed on a bipartisan effort. The Arizona senator believes that the mantel of bipartisanship will need to be taken up by both sides of the congressional aisle if reform efforts are to be successful – a sentiment that many now seem to share. What lies ahead for the Republican-led Congress remains to be seen, but healthcare, at least for now, appears to be off the table.
Updated July 26th, 2017 @ 4:15 p.m.
Trumpcare “Repeal Only” Plan Does Not Pass Senate Vote
Senate members just voted against (45 to 55) a Trumpcare amendment that would have made “repeal only” without a replacement plan a reality in two years. This was considered to be the “Republican” favored update to the AHCA, which is also known as Trumpcare.
Seven Republicans Voted Against This Legislation
- Sen. Lamar Alexander (R) Tennessee
- Sen. Shelly Capito (R) West Virginia
- Sen. Susan Collins (R) Maine
- Sen. Dean Heller (R) Nevada
- Sen. John McCain (R) Arizona
- Sen. Lisa Murkowski (R) Alaska
- Sen. Rob Portman (R) Ohio
This would have allowed for the “repeal of Obamacare” to proceed without having a replacement actually ready to go, in place. In effect there would be a two year period in which the government and the health insurance industry would have the ability to create an alternative to Obamacare. Critics of this approach, of which there are many, have stated that moving forward with the repeal without a replacement, or more importantly a bi-partisian consensus on what that alternative to Obamacare should be, will only further destabilize the health insurance market, increase premiums and cause harm to the American people.
Interestingly, what was just rejected by members of the Republican led Senate was actually voted through in 2015, only to be vetoed by President Obama. In 2015 it was simply a symbolic vote, just for the purposes of political theatre. This time it was for real, and it seems that even though Senate Republicans who are facing tremendous pressure to pass this legislation through, couldn’t take the risk of passing legislation that is viewed by the overwhelming majority, as a step in the wrong direction.
We may be getting closer to a truly bi-partisian (if only by default) attempt to improve on the significant problems with Obamacare. More updates coming soon.
Updated July 26th, 2017 @ 10:40 a.m.
First Trumpcare Plan After Senate Votes to Debate Healthcare Fails 57 – 43
Yesterday afternoon, Republican Senators fulfilled their promise to their constituents and the President when they narrowly voted to begin healthcare debate and discussion in an effort to repeal and replace Obamacare.
A short time after VP Pence cast his tie-breaking vote, Senators from both sides of the aisle took to the floor to begin debating what an Obamacare repeal-only plan would look like and do to the country, what a repeal and replace with the AHCA would look like and do to the country and what a repeal and replace with the BCRA would look like and do to the country.
After several hours of debate, the Senate took up a vote on the BCRA, their attempt at healthcare reform, but with a few additional amendments. The first amendment was proposed by Senator Ted Cruz a couple of weeks ago and would allow insurance carriers to offer plans on the marketplace that did not cover pre-existing conditions, and would therefore be cheaper, so long as they offered at least one plan that did cover pre-existing conditions. The second amendment was proposed by Senate Majority Leader, Mitch McConnell and would strip away the individual and employer mandates. The last major amendment added $100 million to the pool of funds for states to support people who would lose Medicaid under the BCRA.
Unfortunately for the GOP, there were seven Republicans not on board with this proposal and the vote failed to reach the necessary 60 votes it needed to pass.
The Senate is currently debating the AHCA and will also discuss a repeal-only plan. There are votes scheduled for 11:30 a.m. EST and 3:30 p.m. EST on various amendments in an effort to find some kind of common ground.
Updated July 25th, 2017 @3:30 p.m.
Trumpcare Lives: Senate Republicans Narrowly Vote to Proceed with Healthcare Debate
After an intense few weeks of back-and-forth over healthcare reform, GOP lawmakers in the Senate have voted to proceed with debate on a bill. On Tuesday, July 25, voting came down to the wire as Senator John McCain, recently diagnosed with a brain tumor, traveled back to Washington, D.C., to support the motion to proceed. He wasn’t alone.
Previously outspoken senators like Rand Paul of Kentucky and Dean Heller of Nevada gave the go-ahead as well, while holdouts Lisa Murkowski of Alaska and Susan Collins of Maine stayed true to their fight against the bill that, as it is currently written, would leave millions without health insurance next year. No Democrat supported the motion to proceed. The vote passed after Vice President Mike Pence cast the tie-breaking vote, allowing the motion to proceed.
In the hours leading up the vote on the motion to proceed, it wasn’t clear whether Majority Leader Mitch McConnell had enough support to even make it to debate, let alone pass a healthcare reform bill. As many as nine senators had previously said they couldn’t support the Senate bill or the House bill as written. McConnell and the White House, spurred on by comments from President Trump himself, have spent weeks whipping votes out of thin air – and it appears to have worked, if only narrowly.
Now, the Senate will bring a version of healthcare reform to debate, but what’s happening next isn’t actually clear, not even to the senators who said “yea” to the motion to proceed. Rand Paul, a staunch opponent of Obamacare, wants to see the Affordable Care Act repealed completely – a “clean repeal” – rather than the repeal-and-replace attempt that’s been struggling to survive under various amendments over the past few weeks.
Senate rules dictate that debate should happen over the American Health Care Act, the bill that the House passed in May. Procedurally, the upper chamber has 20 hours to debate the bill, 10 for Republicans and 10 for Democrats. Within the 20-hour limit, there are sub-limits on how debate can happen. Debates over amendments can’t take more than two hours while senators have just one hour to debate an amendment to an amendment.
After debate, the bill and its amendments would go through the voting process, which is complex since each portion of a bill requires differing numbers of votes. Since Republicans are using a budgetary procedure to pass healthcare reform, they will need to vote on measures that fall under budgetary rules. Already, the Senate parliamentarian has ruled that two features of the Senate bill fall outside of budget reconciliation guidelines, making them ineligible for simple majority votes.
What the Senate will be voting on remains to be seen, the details of which will be released once debate gets underway. This story is developing.
Updated July 25th, 2017 @ 2:53 p.m.
Obamacare-Repeal Vote Count Update
Republicans have 48 “yes” votes and 2 “No votes. Senators Susan Collins of Maine and Lisa Murkowski of Alaska have voted “No”.
No Democrats have voted yet and Senators John McCain (R- AZ) and Ron Johnson (R-WI) have not voted yet either.
Updated July 25th, 2017
Obamacare-Repeal-Only Bill Will Go to Vote Today
Despite the very poor CBO score that an Obamacare-repeal-only plan would result in 17 million more people being uninsured in 2018 than if Obamacare remained in place, President Trump insisted that the Senate take up the issue right away or else delay their August break to spend more time on healthcare reform. Therefore – the vote is happening today, July 25th.
An affirmative vote to repeal Obamacare without having a replacement plan ready to go doesn’t mean that Obamacare is gone tomorrow. It actually only means that a majority of the Senate is agreeing to discuss and debate how to repeal Obamacare now.
It also doesn’t mean that healthcare will go back to a pre-Obamacare state – the plan was always to stretch out the roll-back of Obamacare over a long-term timeline of a year or two, which would give Senators time to find a better alternative that can actually have the support of a majority of Congress.
We’ll keep you posted on the vote and what has become the soap opera saga of healthcare in America.
Updated July 21st, 2017
Trumpcare (BCRA) Revised Again By Republican Lead Senate – CBO Says 15 Million Will Be Uninsured in 2018
On July 20th, 2017 the Senate snuck through yet another amendment to their healthcare reform proposal and the CBO announced later that same day, that it was still not as good as Obamacare.
Published quietly on their website, the second amended version of the BCRA proposed the changes to the overall healthcare bill listed below. Before you read the summary of the changes though, here’s the conclusion – the CBO still believes that these amendments would result in 15 million more people being uninsured by 2018 than if Obamacare remained in place and that number would rise to 19 million in 2020 and 22 million in 2026, which was on par with their original draft of the BCRA.
In addition to the changes listed below, the Senate also tossed aside everything that was contained within Ted Cruz’s version as well.
Highlights From The July 20th, 2017 Better Care Reconciliation Act (BCRA) Draft:
- If a person was given a tax credit because of the income that they estimated for the year and it it determined that they were given more tax credits than they should have received, they would have to pay the difference back in full starting in 2018.
- Tax credits would be given to people making up to 350% of the federal poverty level.
- The benchmark plan used to determine tax credits would have an actuarial value of 58% instead of 70%, which is what was established under Obamacare.
- People can use tax credits to pay for catastrophic plans, which was prohibited under Obamacare.
- If a health plan covered abortions, it would be excluded from being considered a qualified health plan, unless the abortion was necessary to save the life of the mother or the pregnancy was a result of rape or incest.
- Starting in 2020, people would go from a subsidy-based-on-income reimbursement to a tax credit based on age and income level. People who make less than 150% of the FPL, regardless of age, would pay the least for premiums, meaning they would get the highest tax credit. The money that a person earned above 150% of the FPL and they older they were, the less tax credit assistance they would receive. Therefore, Person A, who is 50 years old and earns 200% of the FPL would pay more than Person B, who is 25 years old and also earns 200% of the FPL. The more money Person A and Person B makes, the less financial help they get to pay for their premiums.
- The small business tax credit given to companies with less than 50 full-time employees, who offer group health coverage, would be gone in 2020.
- The individual mandate and employee mandate would be gone retroactively to the year 2016, meaning that anyone who did not get health insurance in 2016 or 2017 will not have to pay a penalty.
- CMS would be given $15 billion for the years 2018 and 2019 and $10 billion for years 2020 and 2021 to disburse to insurance carriers as grants to be used to address a lack of health insurance options in certain states.
- This same grant money would be available to states who wanted to create a Long-Term Stability and Innovation Program, which would be used to lower premium costs for high-risk individuals who need health insurance, to work with insurance carriers to create programs to stabilize the market and bring down premium costs or to provide financial assistance to people who need help paying their our-of-pocket costs.
- The Cadillac Tax on high-cost employer plans would be delayed until 2026.
- People could use their health savings accounts (HSA) to pay for over-the-counter medications and not just prescribed medications or insulin.
- A number of taxes imposed by Obamacare would be repealed.
- HSA funds can be used to pay for the medical bills of the account holder’s children, so long as they are under the age of 27, and to pay for premiums for a high deductible health plan starting in 2018. There are a number of other rule changes to HSA’s proposed as well.
- After 2019, the ACA Medicaid expansion rules would be optional for states (it already was optional after a court ruled that it was unconstitutional to require states to expand Medicaid) and will allow states the option to expand the eligibility requirements to be in the Medicaid program starting in 2020. It would repeal the provision in Obamacare that extends Medicaid to non-elderly individuals making between 133% to 138% of the FPL.
- Federal funding to Medicaid programs to states that chose to expand the eligibility requirements will begin to roll back in 2020.
- States would be able to re-determine the Medicaid eligibility of a person every 6 months and they would be allowed to impose a work requirement on non-disabled, non-elderly, or women who are not pregnant.
- Starting in 2020, Federal Medicaid funding would be issued on a per capita basis.
- Nearly $5 billion a year would be set aside to support states fighting opioid and substance abuse issues.
- The new age ratio premium rate would go from 3:1 under Obamacare to 5:1 under Trumpcare, meaning that an older person could not be charged more than 5x for a health plan than a younger person. States would have the option to change that ratio if they wanted.
- If a person is without continuous creditable coverage for more than 63 consecutive days, they will be prohibited from buying health insurance for another 6 months. If a person is able to enroll in a plan due to a Special Enrollment Period or an Open Enrollment Period, they can submit their application for coverage, but the coverage wouldn’t start until 6 months later.
Updated July 20th, 2017
CBO Says “Repeal And Replace Later” Will Leave 10% Of Americans Uninsured
After Senator Mitch McConnell admitted defeat once again and it was clear that the Senate’s amended version of an Obamacare replacement plan – the Better Care Reconciliation Act (BCRA) – was not going to move forward. The new game plan was to get an Obamacare repeal on the books now, but not have the actual affects of the repeal go into effect for a year, which would give the Republican lead Senate more time to work on a replacement plan that would actually be better than Obamacare.
Everyone now concedes, including the President, that healthcare is hard and it’s just not something you can rush. Many Senators as well as the President, had hoped that by fulfilling their campaign promises of repealing Obamacare, their supporters would be happy and by enforcing a longer timeline for the rollback of the requirements of Obamacare, law makers would have more time to confer, discuss, debate and collaborate on an adequate replacement because people would actually be without the protections of Obamacare.
This is of course without making an attempt at a truly bi-partisan effort from Republicans and Democrats to collaboratively draft a bill that will work for everyone.
Unfortunately, the CBO’s score of a repeal-now replace later plan may make that idea more unpopular than any other plan offered.
CBO Analysis of Repeal Now Replace Later Plan
On July 19th, the CBO released their score of what is called the Obamacare Repeal Reconciliation Act, or the repeal now and replace later plan. The CBO estimated that premiums would be 25% higher in 2018 if Obamacare was repealed than if it remained in place and that the increase would continue to climb until 2026 when premiums would be double what they would have been under Obamacare.
Worse yet, the CBO said that 17 million more people would find themselves uninsured in 2018 than if Obamacare remained in place and that number would grow to 32 million more in total. Much of the reason that the uninsured numbers are so high is because the CBO predicts that nearly half of the population would be living in an area that had zero carrier coverage options because many carriers would leave the market due to the skyrocketing premium prices.
There are approximately 325.5 million people living in the U.S. right now. If 32 million were uninsured under an Obamacare repeal only plan, that would mean that more than 10% of the country was left vulnerable to outrageous medical bills, unconscionable out-of-pocket prescription medication costs and the real fear that a person could be denied medical care or the type of medical care that they need because they don’t have insurance and can’t pay for the cost of care.
Republicans and Democrats have to work together otherwise they will remain stuck in this same position they are in now where nothing gets accomplished. That’s a path that leads to ultimately having to answer to tens of millions of angry voters.
Angry voters might not seem like anything new, but here’s what is actually different this time around. If the country reaches an all time high in general disgust with partisan politics, and the consensus is that either side of the aisle won’t behave like adults and find a way to compromise, it is an open invitation for every non-professional politician to jump into every election there is.
Updated July 18th, 2017
The Trumpcare Train Comes To A Grinding Stop – Will President Trump Work With Democrats On A Compromise?
So the latest is that there’s no longer enough support, with or without John McCain, to move the BCRA forward. A vote has indefinitely been put off, and some are saying Trumpcare is dead in the water. We think the BCRA is dead in the water, and any of the spin-offs brought forward by Ted Cruz or Lindsey Graham are as well. Repeal and delay won’t work, it won’t improve outcomes for Americans, it won’t lower costs, and the administration can’t simply blame Democrats for the bill not moving forward, because they haven’t been allowed to participate in this legislative process at all. You can’t actually use Democrats as the scape goat when you can’t get buy-in from every Republican in the Senate.
President Trump in his frustration has indicated that if Repeal and Delay isn’t an option, then just allowing Obamacare to fail is. That strategy might include not making the CSR payments to insurance carriers. If that happens, carriers will pull out of the marketplace and Obamacare will definitely fail, and quickly. Millions of people will lose their health insurance coverage, and the Democrats will seize on this opportunity to flip voters for the midterm election in 2018 and the general election in 2020.
Healthcare Reform And Actually Affordable Healthcare Is What Americans Care About The Most
Make no mistake about it, the definitive issue that tipped the election in President Trump’s favor is healthcare reform. Health insurance premiums are at levels that are simply not affordable for most Americans, especially when you take into consideration how “skimpy” plan selection is already. When you go further down the rabbit hole and take into account that most Americans are left without much of a choice but to accept a plan with very high deductibles, and that the Obamacare experience for anyone with an average health and wellness profile is somewhat similar to just being a “cash pay” customer, it simply reinforces the fact that the current trajectory for Obamacare is not on a sustainable path.
That said, what Republicans have learned within the last 24 hours, is that the American people are not willing to accept a new version of healthcare reform that makes things worse. Across the board, regardless if it is the AARP, The American Medical Association, AHIP (insurance carrier association) and many other organizations within healthcare ecosystem, they have all agreed the AHCA, which is the House version of Trumpcare, and the BCRA, the Republican lead Senate version of Trumpcare, is not an improvement on what we have already. According to polls being conducted from organizations on the left, right and center, what’s been proposed within “Trumpcare” so far, is not what the American people who elected President Trump want.
We don’t fault President Trump for trying to get healthcare reform moving without help or input from Democrats. Maybe it’s more accurate to say we are not surprised, because we’re not- it’s politics. Our position is that any real healthcare reform, that has any hope of remaining in place long term and quickly stabilizing the health insurance marketplace, will need to be a bipartisan effort. If politicians deliver healthcare reform that doesn’t drive down costs, and improve the overall experience for Americans, there’s going to be tens of millions of angry voters waiting for their chance to express their frustration at the ballot box.
Even if that weren’t a real political risk for the Trump administration, let’s not forget about the reality of how the health insurance industry works. It moves incredibly slowly, and it loathes “unknowns” and it is just too complicated a business for there to be a continual politicized battle over healthcare reform. Insurance carriers will not want to jump back into the health insurance marketplace unless there is certainty that there’s not going to be a political upheaval that will attempt to repeal whatever gets passed in two or four years. If the administration as well as Democrats think that the major insurance carriers have no choice but to participate, they’re wrong. United Healthcare has been out of the exchange for some time, they decided very early on that the business just isn’t worth it at this point. That decision hasn’t hurt them in the slightest. In fact, today they reported a record $50 billion in quarterly revenue. Their growth has been fueled not by Obamacare, or the individual market business, but by medicare, group health sales (employer plans) and Optum, their pharmacy benefits management company.
Insurance carriers and just about every stake holder who is impacted by healthcare reform, and that’s every American, even those who get insurance through an employer, are hoping that there will be a real effort made by Republicans and Democrats to compromise on Trumpcare. There’s very little time left for the administration to mobilize and get things moving. Open enrollment starts on November 1st, 2017 and technically speaking, insurance carriers were supposed to have submitted their plans and pricing already.
Political Backbone Required To Stand Up To The Freedom Caucus
One of the biggest issues facing any real opportunity to improve on things, is without question, the Freedom Caucus. They’ve thrown a wrench into this legislative process the entire time, even going so far as to threaten to financially support anyone who opposes any Republican in the Senate or Congress, who doesn’t align with their goals for healthcare reform. President Trump can no longer afford to listen to anything that the Freedom Caucus has to say on this issue, and he already knows this. They’ve requested that changes be made to the AHCA and the BCRA that are without question political suicide.
Elected officials who wish to defund Medicaid, give massive tax breaks on investment income to billionaires, and not keep any consumer protections in place, while simultaneously not making any real effort to actually reduce premiums on major medical coverage, are simply setting a trap for the administration to fall into. President Trump campaigned on being a deal maker who will be able to get Democrats and Republicans to lock themselves in a meeting room for however long it will take, until there’s meaningful healthcare reform drafted that will actually improve the quality of life, and improve on where Obamacare is failing. The Freedom Caucus and similarly funded political groups only have one group of Americans that they actually work on behalf of, that is the top 1/10th of 1% of the country, the wealthiest individuals and political donors in the United States.
We (HealthNetwork) have our finger on the pulse because we reach more than 15 million health insurance shopping households on an annual basis. We hear directly from Americans on a daily basis that healthcare reform is the #1 issue they’re concerned about. Considering that for a family of four, the average “Gold Plan” that has a reasonable deductible ($5,000 for the family) will run $1,200 a month or more, we get it. Right now Americans have little choice but to accept outrageously expensive high quality health insurance plans, or stripped down plans that even with a subsidy, are still unaffordable.
There’s just no real opportunity to actually bring something to market, and get participation from all major insurance carriers, unless both sides of the aisle, meaning Democrats and Republicans, come to an agreement. They’re going to have no choice but to do so either, because the more extreme left or right leaning members of both parties, are thrilled with the political fallout so far. The more fractured each party becomes, the larger the wedge between voters who typically identify with the Republican or Democratic party, the more political power those on the fringe have to say, “See, this is why you need us. This is why we need a revolution and a new party.”
We don’t need a revolution, we need calmer heads to prevail. If only every time a politician or political talking head “waxed poetic” about principle, liberty and the power of a truly free marketplace, $1 went into a risk pool for those with pre-existing conditions, we’d be able to fund it within a few months. If only… Well while the more extreme members of both parties grandstand and attempt to convince their constituents that they’re fighting the good fight, and reminding them to please donate to their next campaign fund, millions of American people are suffering.
Place A Higher Priority On The American People
Healthcare shouldn’t be politicized, and every elected official on both sides should have no issue placing more importance on the American people, than on party politics, and winning some battle of which no winner can actually ever emerge, nor that any American who is struggling to afford health insurance coverage, actually cares about.
Lives are at stake, the clock is ticking, and as we rapidly approach this next highly critical open-enrollment period, it is time to get “stuff” done, finally.
Updated July 17th, 2017
Trumpcare Vote On Hold Until John McCain Is Back
Trumpcare got some bad news over the weekend, and no, it has got nothing to do with the overwhelmingly negative reception it has received with Americans. Changes and tweaks to the bill are expected, and some of them should help address some of the complaints that individuals have expressed. That said, what is most likely not up for modification are the cuts to Medicaid. Regardless we’re getting ahead of ourselves, reason being, is because John McCain recently had surgery he’s currently recovering from and he could be unable to cast his essential vote for a week, or possibly longer.
Now that doesn’t mean that’s all the news there is to share with you. No, in another development, Senator Lindsey Graham of South Carolina and Senator Bill Cassidy have introduced their own version of healthcare reform, that we’re figuratively calling “GrassidyCare”. It’s another iteration of the AHCA and the BCRA, with some slight tweaks.
To add another layer to this already muddy discussion, Senator Lindsey Graham of South Carolina introduced his own version of a healthcare reform bill on Thursday, July 13th. The bill, created with the assistance of Senator Bill Cassidy of Louisiana and support from former Senator Rick Santorum, would reallocate federal funding for the Affordable Care Act to states in a block grant system similar to that created by the Welfare Reform Act of 1996.
Graham believes that his bill offers a fair compromise between opposing ideologies within the GOP, and he’s hoping to garner Democratic support in the process. The senator insists that his effort is not meant to undermine GOP leadership but rather support reform in general. It’s expected that Graham and Cassidy’s bill will be included as an amendment to the BCRA next week.
In an exclusive interview with CNN, Graham laid out why he believes his bill would be better than what’s being discussed in the Senate right now. For starters, his proposal would keep some features of Obamacare intact at the federal level, including taxes on the wealthy and guaranteed coverage for people with pre-existing conditions. Those taxes would pay for the block grants that Graham and Cassidy say will empower individual states to create healthcare systems that work for them.
Graham’s bill assumes approximately $500 billion in federal Obamacare money to be distributed to the states, but he’s awaiting confirmation from the Congressional Budget Office on his proposal. According to Graham, states would be rewarded for developing efficient and effective healthcare systems. The better a state is at offering quality, affordable coverage, the more money it would have to funnel back into its healthcare system.
Under this proposal, governors would wield the power in determining each state’s path forward for healthcare reform. Some states, most likely conservative ones, would opt to repeal and replace Obamacare. Others, notably left-leaning states like Vermont, might choose to adopt a single-payer system. Regardless of which path a state chooses, Graham made it clear that his proposal preserves ACA protections for people with pre-existing conditions.
The proposal laid out by Graham and Cassidy also eliminates the medical device tax, which could cut revenue by about $220 billion. The individual mandate requiring everyone to hold health insurance would also be eliminated, as would the requirement for large employers to offer insurance to full-time workers.
It’s unclear at this point how much support Graham and Cassidy have for their proposal, but it could serve as a starting point for discussion with Republican holdouts and Democrats if the Better Care Act fails to move forward on McConnell’s timeline.
Updated July 14th, 2017
Ted Cruz’s Big Idea: The Consumer Freedom Amendment
In late June, the Senate released its amended version of the American Health Care Act (AHCA), the House bill designed to replace the Affordable Care Act (ACA). The new bill, named the Better Care Reconciliation Act (BCRA) was immediately met with criticism not only from Democrats but from Republicans as well. In an effort to move the bill forward, Senator Ted Cruz of Texas proposed the “Consumer Freedom Amendment” a proposal developed with Senator Mike Lee of Utah. Conservatives hail the proposal as a fair compromise while moderates and those on the left dismiss the idea – or outright decry it – as a way to effectively eliminate protections for people with pre-existing conditions.
The Consumer Freedom Amendment is now being presented as an alternative to past legislative attempts by both the House and the Senate. This is also of course sharing the spotlight not only with the just revised Senate version of Trumpcare, but with Sen. Lindsey Graham (R-South Carolina) and Sen. Bill Cassidy’s (R-Louisiana) attempt at healthcare reform. Apparently drafting healthcare reform legislation is “the new hotness” in Washington, so don’t be surprised if other elected officials bring forward additional proposals.
The Consumer Freedom Amendment
Under the Consumer Freedom Amendment, insurers would be allowed to sell any kind of health plan that they wanted as long as they also sold at least one ACA-compliant policy. This means that insurers could create cheaper plans with less coverage for people who wanted bare-bones policies. Under current law, ACA-compliant plans have to cover 10 essential health benefits:
- Ambulatory patient services (outpatient care)
- Prescription drug coverage
- Pregnancy, maternity and newborn care
- Mental health services, including substance abuse treatment
- Emergency services
- Rehabilitative care and devices
- Laboratory services
- Preventive and wellness services
- Pediatric care, including vision and dental services
Basic plans wouldn’t have to cover any of these services, making them much more affordable but also less robust. Young, healthy people are more likely to buy these plans since they tend to visit doctors less often and use far fewer medical services than older people, those with pre-existing conditions, or families.
AHCA Elimination of Essential Benefits
The AHCA passed by the House in May eliminated the mandate that all insurance policies include the 10 essential health benefits, transferring the power to the states, which could determine what their policies must cover. Insurers could sell cheaper, bare-bones policies for lower premiums. The BCRA proposed by the Senate allows states to apply for a waiver in order to change what qualifies as an essential health benefit. The bill also allows states to define the terms of the exemption but would require a federal review.
Benefits of Cruz Amendment
In an effort to appease conservative Republicans who felt that the Senate bill was too similar to Obamacare, Cruz and Lee, who both said they could not support the BCRA as written, created the Consumer Freedom Amendment. By allowing insurance companies to sell policies that do not include the 10 essential health benefits, Senators Cruz and Lee believe that consumers will be provided more choice in the insurance marketplace. Insurance companies would be able to sell insurance policies at a lower cost because they do not include all the benefits covered under the ACA. Many older Americans feel they should not have to pay for policies that include maternity or newborn care. Younger Americans could choose policies that don’t cover medical devices or rehabilitative care as they are less likely to need such coverage. The amendment would require at least one ACA-compliant plan in the marketplace, so those who want to purchase coverage that includes the 10 essential benefits could continue to do so.
Risk of Extremely High Premiums for the Sick
Some experts say that the Consumer Freedom Amendment could create a significant problem for people with pre-existing conditions. They believe that if a lower-premium plan with fewer benefits is available, healthy people will choose that plan to keep costs lower. Because people with medical problems know that they may need extra medical services due to a pre-existing condition or age, they’ll need to choose the higher-cost plan that covers all 10 essential benefits.
With healthy people choosing only cheaper, bare-bones policies and sick people choosing costlier, robust plans, it would effectively create a high-risk pool. Insurers would have to raise rates for people with ACA-compliant plans to offset the higher cost of care for that pool of beneficiaries. Eventually, people with pre-existing conditions could be forced out of the individual market altogether due to unaffordable premiums.
Lack of Support From GOP And Democrats
Some members of the GOP say that the amendment comes too close to eliminating the pre-existing protection benefits of the ACA, something the majority of Republicans want to keep in the law. Because many of the essential health benefits are designed to protect those with pre-existing conditions, there are concerns that allowing insurance companies to offer plans with less coverage could lead those with pre-existing conditions to be priced out of the insurance market. There are estimates that the amendment could cost the bill 20 to 30 votes, essentially killing it in the Senate.
Why Consumers Will Want The Essential Health Benefits To Remain
Although it would seem easy to simply eliminate the essential health benefit requirement and allow people to choose the type of health insurance they want, research indicates that the requirements for coverage were beneficial under the ACA. Prior to the passage of the law, 62 percent of marketplace plans did not cover maternity while 34 percent did not cover substance abuse treatment.
In addition, the savings for removing some of the coverage may not amount to a significantly lower premium. Removing maternity coverage, for example, could result in a savings of between $8 and $14, but should a woman who elects not to have the coverage become pregnant, her out-of-pocket costs could be between $30,000 and $50,000. To make things worse, women without maternity coverage may avoid prenatal care, which could lead to complex medical issues and higher long-term medical costs over the child’s lifetime.
The Cadillac Plan Problem
Those who see benefits to the Cruz amendment say that there is no indication that only sick people will choose the “Cadillac plans.” In fact, they point to statistics for automobile and homeowner’s insurance that show many people purchase more insurance than they need in order to protect themselves and their families during a catastrophe. Supporters of the amendment say that this will more than likely occur with health insurance plans as well and that it already does happen with employer-provided health insurance. People who get insurance from their employer choose higher-level plans to get the most coverage possible and avoid out-of-pocket costs. Although there will be consumers who opt for plans with less coverage to save money, this could be the exception rather than the rule.
Senator Cruz initially announced that he would be unable to vote for the Senate bill as written. However, he and other senators also say that they are viewing the bill as a draft and are working together to amend the bill to make it more attractive to moderate Republicans. They would also like to create a bill that will attract some Democratic members of the Senate, although this is an unlikely scenario given the bill’s rocky standing at the moment.
Updated July 13th, 2017
Senate Releases Latest Version of Trumpcare (BCRA) – It’s An Improvement That Will Remain Unpopular With Many
Senate Republicans have released the latest version of Trumpcare and we’re pleased to say that it is in fact a major improvement. There will be plenty of detractors, and the current buzz on the Hill and in the industry is that there will be more revisions to come, but at its core, this is the basis for the Republican lead Senate’s Final Version of Trumpcare.
- No Big Tax Breaks For Billionaires
The bill is no longer a financial windfall for some of the most politically active billionaires seeking to save their investment income streams from having to pay the 3.8% Obamacare tax. It’s safe to assume that no American enjoys paying taxes. That said, the previous versions of the bill provided some of the most wealthy with incredible tax breaks at the expense of the entire health insurance marketplace and anyone receiving benefits from Medicaid.
While this certainly won’t be appreciated by some deep-pocketed billionaires, it’s time for the GOP to take a stand against the more extreme members of the Republican party, and more specifically their political campaign backers who have made completely unreasonable requests for Senate members drafting new healthcare reform laws. If anything is going to get passed, it has to directly benefit a much larger percentage of the population, not just the top 1/10th of 1% of the country. Tax reform is where these extremely wealthy individuals should be focusing their efforts to influence legislation that benefits them financially.
- Individual Mandate & The Employer Mandate Are Gone
Speaking of tax breaks, the new legislation removes the individual mandate (tax penalty) for anyone who doesn’t have health insurance coverage. It also gets rid of the mandate (tax penalty) on employers with a minimum number of employees who do not provide health insurance coverage.
This starts retroactively in 2016, which is a brilliant strategic move that will make gaining support from the public, or at least anyone who would be paying the tax penalty on their annual filing for not having health insurance during 2016 and part of 2017.
- CSR’s Will Continue To Be Paid
The cost sharing reduction payments will continue to be made through 2020 in an effort to help stabilize the health insurance marketplace.
There will be a pool of funds made available to insurance carriers to help offset the costs of premiums for 2018 through 2021. Starting in 2018 and running through 2019, $15,000,000,000 (fifteen billion dollars) will allocated on an annual basis and then for 2020 and 2021 that total lowers to $10,000,000,000 (ten billion dollars).
These funds will be used to cover individuals with complicated and costly health conditions. The reason for this is because under the latest version of the BRCA, insurance carriers would be allowed to offer plans with much less comprehensive coverage. This would also allow them to sell plans that don’t comply with the minimum standards that Obamacare has in place currently. It would also mean that with respect to some of the plans being offered, they would have the ability to deny coverage for anyone with a pre-existing condition.
If you do have a pre-existing condition, you would then be left with the option to purchase one of the higher risk pool plans that will cover individuals with higher medical costs. There have been a number of entities within the health insurance and medical community who have criticized this approach. Their concern is that creating a risk pool for the “sick” will create an even more unstable health insurance marketplace. We’ll have a more detailed analysis this afternoon regarding this part of the law.
- Medicaid Expansion Roll Back Remains In Place
Medicaid will begin a roll-back of the expansion it started under Obamacare starting in 2021. By 2024 Medicaid will be back at its Pre-Obamacare levels. Starting in 2020 states will be able to decide if they want Medicaid funding to be based on a block grant, or “per capita” basis. It also allows states to place a restriction on unemployed people from receiving Medicaid benefits unless they are pregnant, disabled or elderly.
- $45 Billion Set Aside For Opioid Crisis
A pool of funds will be made available for the funding of substance abuse and treatment programs. This has been a big sticking point for many states who are searching for money to combat this growing crisis.
- Health Savings Accounts
President Trump has always been a big proponent of Health Savings Accounts. Under this amendment of the BCRA, HSA can be used to pay for your health insurance premiums. Previously, the rules were that HSA funds, which are pre-taxed dollars, could only be used to pay for out-of-pocket expenses.
- Tax Credits
Under the BCRA, subsidies will be gone and replaced with tax credits that are provided to people based on their age and income level. Under Obamacare, you could only use financial assistance to pay for a Platinum, Gold, Silver or Bronze level plan, but under the BCRA, you can now use the tax credits to also pay for Catastrophic plans or Lower-Premium Health Insurance Plans, which are ones that have a high deductible but allow the person to visit their primary care physician three times a year and have restrictions on how much you have to pay out-of-pocket a year.
Senate Republicans Take Another Shot At Trumpcare – New Draft Expected Later Today
Here Are 9 Senators Who The New Senate Healthcare Bill Needs To Win Over
Republican lawmakers may be forced back to the healthcare reform drawing board whether they like it or not thanks to increasingly vocal dissent among GOP senators. Majority Leader Mitch McConnell reluctantly delayed a Senate vote on the Better Care Reconciliation Act of 2017 (BCRA) until after the July Fourth recess because he didn’t have enough votes to secure its passage. Unfortunately for reform proponents, nothing seems to have changed over the break. In fact, some senators appear to have been bolstered by the recess, making it unlikely that the BCRA will ever pass, especially in its current form.
You might think that after seven full years of talking trash about Obamacare – and to be clear, the current law has not achieved all it set out to do and has failed in many ways – Republicans would have a solid, well-thought-out plan of attack to repeal and replace the Affordable Care Act with a law of their own design. Here we are, nearly six months since President Trump took office, and healthcare reform remains as much of a hotly contested mystery as it was in January.
Now, as many as nine Republican senators, including a handful of moderates and far-right conservatives, are vocally opposed to the BCRA. McConnell can afford to lose just two votes since Republicans hold a slight majority in the Senate (with Vice President Mike Pence as a tiebreaker). Who are these GOP holdouts, and what do they want?
- Shelley Moore Capito (West Virginia): Representing a state that’s been devastated by the nationwide opioid crisis, Capito has been a strong opponent of the Senate bill. She also has no qualms about being the vote that kills it according to an interview with Politico. Capito will not support a reform proposal that significantly rolls back Medicaid funding or ends expansion since about 30 percent of West Virginia families depend on the program for insurance. She also wants to see more federal effort where opioid treatment is concerned.
- Susan Collins (Maine): Collins has been a strong opponent of the Senate healthcare bill, but her objections appear to be broad. In a recent interview, she said that she could only support the GOP effort after a “complete overhaul” of the existing proposal. Collins also wants to work with Democrats on healthcare reform, noting that legislation is stronger with bipartisan support.
- Ted Cruz (Texas): Former presidential candidate Cruz introduced an amendment to the Senate bill last week after July 4th. Called the “Consumer Freedom Act,” the amendment would allow insurers to sell any health plan they wanted as long as they also offered at least one plan that complied with Obamacare guidelines. The CBO is slated to crunch the numbers on this amendment this week, but the response has been mixed at best. Conservatives are hailing the proposal as a fair compromise between people who want to keep the ACA essential benefits provision – and the protections that come with it – intact and those who want more freedom in choosing a less comprehensive health plan. Democrats and moderate Republicans, however, believe that Cruz’s proposal could price people with pre-existing conditions out of the individual market altogether.
- Dean Heller (Nevada): Heller was the first GOP senator to speak out against the BCRA from a moderate perspective. He represents a state that embraced Medicaid expansion, and he’s not willing to end this particular ACA provision. Heller also stated that the Senate bill does nothing to lower premiums, something he can’t support in the bill’s current form.
- Ron Johnson (Wisconsin): Johnson has taken heat from both Democrats and Republicans for his stance on healthcare reform, but the senator isn’t backing down anytime soon. This may be because he was just reelected last fall and won’t be running again, making him immune to pressure from constituents and GOP leadership to fall in line with Republican reform efforts. As a rightwing conservative, Johnson wants the Senate bill to go further in repealing Obamacare provisions. He does not support moderate compromises.
- Mike Lee (Utah): Lee is one of the senators pushing for a harder conservative stance with reform. He supports Sen. Cruz’s consumer freedom amendment, which he helped draft, and would like to see the Senate bill adopt more rightwing ideas, including strengthening health savings accounts.
- Lisa Murkowski (Alaska): It’s not clear whether Murkowski will support the Senate bill when or if it ever reaches the floor for a vote. Murkowski has been noncommittal, but it’s assumed that her objections to the bill as a moderate Republican will keep her from voting “yes.” At the end of June, she and Sen. Collins planned to introduce an amendment to the bill that would scrap the provision that defunds Planned Parenthood for one year.
- Rand Paul (Kentucky): Paul is no fan of big government, a position that he’s not afraid to elaborate on when asked. So it should come as no surprise that the Kentucky senator objects to the BCRA, which he refers to as “Obamacare Lite.” Paul wants to scrap the individual mandate, for starters. He has proposed repealing the law entirely in a “clean repeal,” which would allow conservatives to vote for it while Congress works on a separate bill to replace the ACA. He objects to several other features of the BCRA, including bailouts for insurance companies, which he calls “very un-Republican.”
- Rob Portman (Ohio): Like Sen. Capito, Portman objects to the Senate bill’s approach to Medicaid, specifically its provision to end expansion and drastically reduce funding over the next two decades. Reining in Medicaid is a typically conservative stance, but in states like Ohio, where the opioid crisis has struck hard, GOP leaders are hesitant to kick people off of their only feasible option for coverage.
Of course, these are just the nine GOP senators who publicly oppose the Senate bill, but that’s not to say that others aren’t holding on to an unpublicized “no” vote. Still, nine is more than enough to kill the BCRA – three would be enough to kill it given that no Democrats support the bill either.
As Republican senators continue to squabble over healthcare reform, American consumers continue to wait for information about what the individual insurance market will look like in 2018. Major insurers have already fled the Obamacare exchanges due to uncertainty, and Republican infighting isn’t helping. Some GOP lawmakers seem to be shifting toward the idea of working with Democrats on a reform bill that appeals to more people in a wider pool of political ideologies. Unless lawmakers from both sides of the aisle can work together on repeal, healthcare reform could evolve into an ugly cycle depending on which party holds power.
After the updated bill is released later today we will provide our own analysis regarding it. Specifically what the changes would mean for consumers, and its likelihood of being able to get passed by the Senate.
Updated July 12th, 2017
Alaska Is Not Counting On Trumpcare – Announces Launch Of Their Own Insurance Carrier
You might not live in Alaska, but some very specific actions the state is taking could have some significant ramifications for anyone who is hoping that the Senate’s version of Trumpcare, the BCRA, will solve the problems that exist within the current health insurance marketplace.
Alaska was just granted a waiver by CMS that will in effect create their own insurance carrier. This very quickly allows them to address the issues that the state is currently facing under the proposed Trumpcare bill brought forward by the Senate, the BCRA.
Alaskan Insurance Exchange
The State of Alaska has faced a 203 percent increase in premium prices since the start of Obamacare and is left with only one insurance carrier – Premera Blue Cross – as they head into the 2018 open enrollment period. In order to create a more stabile market and in an effort to bring down premium prices and drive carriers back into the marketplace, the State of Alaska applied for and was granted a 1332 State Innovation Waiver by CMS and the Department of Treasury. According to the Obamacare law, states weren’t allowed to apply for this waiver until after January 1, 2017.
The 1332 State Innovation Waiver allows the State of Alaska to essentially create an insurance plan and become a carrier that will cover and pay for medical claims for Alaskans that have one of 33 specifically identified medical conditions. Alaska and CMS hopes that by covering these costly medical claims internally, insurance carriers will be able to come back into the state and offer coverage to a healthier pool of people, which will drive down the costs of premiums. In total, the State of Alaska predicts that insurance premiums will come down by 20% in 2018.
Another benefit of this program is that by bringing down the costs of premiums, the cost of the benchmark silver plan, which is used to determine the amount of subsidies and tax credits that people are offered by the government, will also decrease and the government would have to pay out less in financial help to Alaskans. Because the Obamacare law does not allow the 1332 State Innovation Waiver to have an affect on the federal deficit, the tax credit savings will go to the State of Alaska to help fund this state-operated coverage.
The 33 medical conditions that the State of Alaska will cover are:
- HIV and AIDS
- Sepsis shock
- Metastatic cancer
- Lung, brain, pediatric acute lymphoid, leukemia and other severe cancers
- Non-Hodgkin’s lymphomas and other cancers and tumors
- Mucopolysaccharidosis (a metabolic disorder)
- Lipidoses and glycogenosis
- Amyloidosis, porphyria and other metabolic disorders
- End-stage liver disease
- Chronic hepatits
- Acute liver failure or disease and neonatal hepatitis
- Intestinal obstruction
- Chronic pancreatitis
- Inflammatory bowel disease
- Rheumatoid arthritis and other autoimmune disorders
- Hemolytic anemia including in newborns
- Sickle cell anemia
- Thalassemia major
- Coagulation defects and other hematological disorders
- Anorexia and bulimia nervosa
- Amyotrophic lateral sclerosis and other anterior horn cell diseases
- Quadriplegic cerebral palsy
- Cerebral palsy (not quadriplegic palsy)
- Myasthenia gravis/ myoneural disorders including Guillain-Barre syndrome and inflammatory and topic neuropathy
- Multiple sclerosis
- Parkinson’s disease, Huntington’s disease, sponocerebellar disease and other neurodegenerative disorders
- Cystic fibrosis
- End stage renal disease
- Premature newborns
- Stem cell and bone marrow transplants including complications from the procedures
- Amputation of limb including complications from the surgery
Could this be a model of the future for certain states?
We are going to have to wait and see exactly how things play out, but now that a state has put this option into play, it could be a game changing moment for healthcare reform. Why didn’t they just do this years ago?
States were prevented from doing so until January 1st, 2017 according to the laws and regulations under Obamacare.
If you are wondering if the timing of this, approximately 24 hours before the latest version of the BCRA is revealed on Thursday is connected, you’re correct. If Obamacare is repealed, this option, for a state to in effect become its own insurance carrier, goes away.
We will have another update within a few hours.
Updated July 5th, 2017
Latest With Trumpcare – Could We Be Headed For Repeal And Delay in 2017?
Republicans are shifting their strategy once more when it comes to healthcare reform – at least if the president and a select group of senators have their way. On Friday, June 30th, President Trump declared that senators needed to pass their healthcare bill or ditch it altogether in favor of the “repeal and delay” approach they abandoned months ago. The president isn’t alone in his sentiments. A group of frustrated conservatives in the upper chamber, led by Senator Ben Sasse of Nebraska, sent a letter to President Trump urging him to adopt a repeal-and-delay approach.
This isn’t the first time that a delayed replacement plan has been suggested. Early into the president’s term, Republican lawmakers had considered repealing the Affordable Care Act and giving themselves time to create a plan to replace it. That idea was scrapped almost immediately, however, in face of little support and a lot of criticism from both ends of the political spectrum.
Repealing the Obamacare legislation without implementing immediate safeguards could create chaos in the private insurance market, and it is strongly believed that this would lead to premiums going up, not down. This was true when the plan was first suggested, but it’s even more of an issue today than it was six months ago as we get closer and closer to Obamacare open-enrollment season.
Both the House and Senate have now released plans to dismantle the ACA, with the House passing its bill (AHCA) at the beginning of May and the Senate still struggling to get GOP lawmakers on board with its plan (BCRA). No one has consulted with Democratic senators as it’s unlikely that they’ll support a conservative effort to replace Obamacare, based on what has been proposed currently. One area where Democrats are mostly inflexible, is with respect to medicaid. With approximately 20% of Americans who have health coverage receiving benefits through the medicaid program, anything that is viewed as a means to restrict or reduce coverage, could be viewed as a non-starter by Democrats.
Absent any Democrat support, Republicans can only afford to lose two votes to pass their bill. To date, as many as nine Republican lawmakers have publicly objected to the bill, making it highly unlikely that Republican leadership will get the necessary support in time to pass a healthcare reform bill until further changes have been made.
If Congress adopts the repeal and delay strategy, the health insurance market could destabilize over the next year as lawmakers work on an alternative to the legislation. Already, insurers have either bowed out or raised their rates for 2018. Despite the fact that technically speaking, carriers were required to file plan pricing already, if the market becomes less stable, they could file an update right before open-enrollment begins.
Without Obamacare legislation in place – and the cost-sharing subsidies that come with it – more insurers could pull out or increase premiums even higher in an effort to limit the amount of money they will lose on Obamacare plans. Very few insurance carriers have been able to squeeze out a profit on ACA compliant plans, the overwhelming majority of carriers are losing money.
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released a report outlining insurer participation for 2018. They found that up to 40 percent of the country could have only one option on the Obamacare exchanges for next year, and in 47 counties spread across three states – Washington, Ohio, and Missouri – plan availability dropped to zero. These numbers are based on insurer withdrawal from big names in the industry, which have fled the marketplaces out of uncertainty over cost-sharing reduction payments.
The Congressional Budget Office, a nonpartisan number-crunching committee for congressional legislation, estimated that about 22 million more people would be uninsured under the Better Care Reconciliation Act, the Senate’s legislation, than would be under current law over the next decade. Medicaid funding would be cut by 35 percent by 2036.
Republican moderates are deeply concerned that the changes proposed in the BCRA would negatively impact too many people nationwide. On the other end of the conservative spectrum, far-right lawmakers are concerned that the Senate bill doesn’t go far enough in repealing Obamacare. Factions inside the Republican Party could continue to derail healthcare reform efforts even without adding Democrat’s opposition into the mix.
According to a survey conducted by CNN/ORC in March, just 17 percent of Americans supported repealing portions of Obamacare without a replacement at hand. Even among Republicans, the support rate was just 26 percent.
Updated June 28th, 2017
McConnell Delays A Vote On Trumpcare (BCRA) In Light Of Limited Support – Will This Lead To Compromise With Democrats?
We’ve said it before, and we will say it again, if there’s anything that Republicans and Democrats agree on, it’s that Obamacare hasn’t lived up to all of its promises. Naturally there are members of the GOP who would word it more harshly than that.
One other point of agreement, is that the Affordable Care Act just isn’t living up to its name-sake either. ACA plans are not affordable for most Americans, and unless you and or your household just happens to fall right within that financial sweet-spot, where the majority of the premium costs are covered by subsidies, it is hard not to be disappointed with what the coverage offers. Even when you’re hardly coming out of pocket for the monthly premiums, it is still expensive health insurance, with deductibles often exceeding $5,000 for a single individual.
This of course excludes anyone on Medicaid, or on an ACA plan who currently has a life threatening illness they are receiving care for. For either of those respective groups, the ACA is often quite literally saving their life, or vastly improving the quality of it. Both of these outcomes, healthcare saving one’s life, or vastly improving it, should be viewed as the most ideal of outcomes. That is also also precisely what healthcare should be entirely about, people, not politics.
That said, we’re pragmatic, and not idealists, so let us take a moment and explain why Mitch MoConnell and President Trump might not have too much choice but to strike a deal with Democrats, unless they want to become very unpopular with the majority of the country.
Right now there’s two factions within the Republican party who are trying to bend the Senate Majority Leader Mitch McConnell’s ear and his will in order to make it more acceptable to their respective base. Ironically they’re both striving for the same goal – drastically revise, or simply undermine the BCRA in order to avoid having to vote on it.
Only real difference here, is that ultra-conservatives want to presumably derail Medicaid on a faster timeline and further defund it, and moderate Republicans want to keep Medicaid expansion in place, or at the very least retain it in the states that expanded Medicaid coverage and not roll it back on the same level and timeline as the BCRA does.
Coming Soon To A Political Theatre Near You: Democrats & Republicans Part 3 – The Trumpcare Files
So this is the point at which the Senate Majority Leader could come to the realization that it might be easier and more efficient to actually compromise with realistic and motivated Democrats, than it will be to make peace between two feuding sides of the Republican party.
Another reason why a Bi-Partisian healthcare reform effort should be a goal, is that if we’re going to have a truly stable health insurance marketplace, that’s competitive and innovative, it is going to require there be a significant level of insurance carrier confidence in the legislative roadmap ahead.
If carriers think there is any real chance that they will be going through this process again after the mid-term election or after the next Presidential Election, many of the carriers who have already pulled out of the ACA market may continue to wait things out on the sidelines even after a Senate healthcare reform bill is passed.
Even though there may be health insurance carrier executives who are politically aligned more often than not with the Republican party, it really doesn’t impact in a significant way their decision making when it comes to running a very complicated and serious business.
Politics thrive on chaos and confusion, the health insurance industry wants to avoid chaos and confusion like the plague.
– Politicians think in terms of two and four year timelines, following along with election cycles.
– Insurance executives think in terms of ten and twenty year timelines, following along with accurate risk modeling.
It’s difficult to imagine a business that is currently more challenging to operate at scale than the health insurance industry. This constant battling betweens Democrats and Republicans over healthcare reform does wonders for each parties’ respective fund raising efforts, while simultaneously causing incredible harm to the health insurance marketplace.
Then There’s The President And His Popularity With Voters
President Trump doesn’t want to bring forward legislation that is going to be harmful and that makes life harder for Americans. However you feel about him and the job he’s doing so far, it’s important to remember that he cares what people think about him and his job performance as President. The fact that he actually called the AHCA “mean”, despite knowing that doing so would not be taken well by his own party, indicates that he’s not going to sign off on just anything that is brought forward. If he thinks legislation is mean, or parts of it are under-funded, he’s going to say it.
We’re not policy wonks, we’re extremely pragmatic nerds who work within healthcare, so let’s just get something out of the way. Even if you’re going to speculate that President Trump won’t want the “hardest job in the world” any longer after four years, because lets be honest, very few people would after a couple weeks in the White House, it doesn’t make a bit of sense that he’s going to want to leave office responsible for inflicting damage to the country which is already suffering. Doing so would most likely tank his entire personal brand, and subsequently all of his companies.
So even if you didn’t vote for President Trump, and do not support or endorse the job he’s done so far, let’s be real. Simply from the perspective of not harming the Trump business he’s worked so hard to build, simply out of self preservation, he’s going to want to make the overwhelming majority of Americans happy with his job performance. Healthcare is the cornerstone of every American’s life and it’s the overwhelming reason why, not only President Trump, but also former President Obama was elected.
We are hopeful that when everyone returns from their holiday break on July 10th that there’s an amazing revelation. That we learn that cooler heads have prevailed, and that the impossible was actually made possible. That Republicans and Democrats secretly got together during their break and had a collaborative discussion about what is a realistic, long term goal, for a better version of healthcare reform in the United States of America.
Because if there is no real effort to find a middle-ground, one that involves a timeline and roadmap that extends beyond two or four years, it is very likely that all of the major insurance carriers that would need to participate if we’re going to have a competitive marketplace with actual, affordable healthcare, just won’t.
Updated June 27th, 2017
Medicaid Expansion Rollback Concerns Might Result In Trumpcare Not Reaching A Vote
There’s growing concern within the GOP that is currently in support of BCRA, which is the Senate’s version of Trumpcare, that there might not be enough support to get to 50 votes. As a result, a vote on the BCRA could very well get pushed back until after the July 4th holiday break.
There are members within the Republican party who are opposed to the BCRA because of its rollback of Medicaid, and more specifically how that will negatively impact voters and their families within their state. Medicaid is responsible for providing healthcare benefits for 20% of the insured population within the USA. According to the recent CBO analysis, by 2026, more than 15 million Americans who were previously covered under Medicaid coverage will no longer have any health insurance coverage at all. In states that expanded Medicaid coverage in particular, taking coverage away from families on any timeline, could very well be political suicide. Here’s a link to our updated analysis on Medicaid and Trumpcare.
In the all but “life is stranger than fiction” healthcare reform quagmire we now find ourselves within, another faction within the GOP, lead by ultra-conservative members, are balking at voting in favor of the BCRA for the exact opposite reason. These individuals have expressed concern that the Medicaid roll back doesn’t go far enough, and fast enough.
So this has resulted in Vice President Pence having to focus his own efforts on helping assure more conservative members of the Republican party, and their respective campaign backers, that additional changes will be made to the bill that will satisfy their requirements.
It’s a difficult position for the administration to find itself in.
We will be posting more updates later today.
CBO Analysis – If Americans Are Not Forced To Have Insurance, Many Will Choose To Remain Uninsured
The CBO released its rating of the Better Care Reconciliation Act (BCRA), also known as the Senate’s version of Trumpcare, and the news isn’t much better than when the CBO scored the House’s version of Trumpcare, the AHCA.
In their analysis released today, the CBO predicts that by 2026, 22 million more Americans will be uninsured under the BCRA (Better Care Act) than would be uninsured under Obamacare. This would mean that in total more than 49 million Americans would be uninsured. If you recall, the CBO thought 23 million Americans would be uninsured by 2026 under the AHCA. In contrast according to the CBO, if Obamacare were to remain in place, only 28 million would be uninsured in 2026.
A large portion of this uninsured group would be from those who would have been eligible for Medicaid under Obamacare but are no longer eligible under the Medicaid rollback provisions of the BCRA. The CBO predicts that Medicaid enrollment would go down by 15 million more under the BCRA by 2026 than under Obamacare.
If There’s No Tax Penalty Americans Won’t Be Motivated To Enroll In Coverage
The CBO doesn’t believe that the continuous coverage requirement would be as effective as the individual mandate. According to their analysis, 15 million more Americans will be uninsured at the end of the 2018 because there is no tax penalty for being uninsured. This as well as increased costs in most markets, initially.
Under the BCRA version of Trumpcare, it proposes to remove the individual mandate and instead adopt a continuous coverage requirement model. Under this model, it would impose a premium hike of 30% per month, for a full calendar year.
In addition, for any consumer who went more than 63 days without health insurance coverage and as soon as the consumer reached that gap in coverage, they would be barred from re-enrolling, or enrolling in another plan for six-months.
Just to recap that; if you let your coverage lapse for 63 days, you not only lose your coverage, but you will also not be allowed to re-enroll in a plan again for six months.
When you are able to re-enroll, it will cost you 30% more, for one year.
We Should Point Out:
To some extent a similar measure is already in place with the ACA, (Obamacare). Each year there is what is called an open-enrollment season. It is only during this period of the year that consumers can enroll in a health insurance plan that is compliant with the rules set in place under the Affordable Care Act (ACA/Obamacare). This is typically a window of time 45 to 60 days.
Some Senate GOP members are said to believe that imposing these rules will prevent sick people from “gaming the system” and only getting insurance only when they needed it, and not paying for it when they are healthy. This is said to be another measure that would help stabilize the health insurance marketplace. The CBO believes that this continuous coverage requirement would not increase overall enrollment initially until premium costs came down. Once premium costs continued to move down to a significant point, the continuous coverage requirement would increase enrollment slightly according to the CBO’s calculations.
Similar to the AHCA, the CBO projects that the BCRA will reduce the country’s deficit by $321 billion, which is mostly attributed to the eventual roll back of Medicaid funding and due to the savings from the removal of subsidies. This number would be much greater if the BCRA would keep in place many of the Obamacare taxes or the individual mandate.
The CBO admits that there is room for error in their estimates in large part due to the fact that there are so many provisions in the BCRA that give opportunities to the states and different agencies to affect enrollment numbers and costs.
We will have more detailed analysis soon.
Updated June 26th, 2017
Trumpcare (BCRA) CBO Score Is Out – 22 Million More Will Be Uninsured By 2026
The Senate’s version of Trumpcare, also known as the Better Care Reconciliation Act, is out, and it’s not looking good. According to the CBO’s analysis, this version of Trumpcare would lead to 22 million more Americans being without health insurance by 2026. This is 22 million more without coverage than if Obamacare and the expansion of Medicaid were to remain in place. This is a slight improvement on the House version of Trumpcare released in March. We will be releasing an additional update with more substantial details within a few hours.
Susan Collins of Maine has already expressed that she can not support this version of the BCRA.
Updated June 22nd, 2017
The Senate Releases Their Version of Trumpcare – The “Better Care Act” (BCRA)
After weeks of speculation about how the American Health Care Act (AHCA or Trumpcare) would change once it reached the Senate, Republican lawmakers on Thursday, June 22, released a draft proposal of their bill. Titled the Better Care Reconciliation Act of 2017, the new bill cuts back on several provisions of the current law – the Affordable Care Act, or Obamacare as it’s more commonly called – and changes several features of the House bill that came before it. Here’s a summary of what we might expect under Trumpcare if the Senate bill gets signed into law as-is, albeit an unlikely scenario.
Among the biggest points of contention between Republicans and Democrats alike is the treatment of Medicaid. The House bill (AHCA) made substantial changes to the joint federal and state program for low-income Americans, and the Senate bill appears to go even further. Under the Better Care Reconciliation Act:
- Medicaid expansion will end much sooner than it might have under the AHCA. Over the next four years, the expansion guidelines (allowing those earning up to 138 percent of the federal poverty level) would be phased out. By 2020, no new enrollees in the expanded guidelines would be permitted. Federal funding for expansion shrinks to 90 percent by 2020 and decreases by 5 percent until 2023, at which point expansion funding ends entirely.
- Funding for the Medicaid program shifts to a per-capita system based on the consumer price index for medical care until 2025. At that point, per-capita funding will be based on the consumer price index for all goods, which is a lower mark of growth. Effectively, this would force even larger spending cuts to the program on a nationwide basis.
- States will be given the option to require Medicaid recipients to work, with notable exceptions for students, disabled people and pregnant women. States can also decide what constitutes employment for Medicaid purposes, including how long someone has to work in order to qualify for state assistance.
Cost Assistance Under The BCRA
Under Obamacare, cost assistance exists in the form of tax credits or subsidies designed to reduce the burden of monthly premiums for low- and middle-income Americans. Credits are based on income. The House bill created tax credits based on age, but the Senate reverts to the ACA’s approach of income-based assistance – with limitations:
- Under the Senate bill, people who earn up to 350 percent of the federal poverty level would qualify for tax credits to reduce the cost of premiums. By contrast, current law caps assistance at 400 percent of the FPL.
- Tax credits decrease with age. Older people will spend a greater portion of their income on health insurance premiums than younger people.
- The Senate bill also caps tax credits at a lower overall percentage of the cost of medical care, effectively making them less robust than the subsidies that exist under current law.
- For insurers, the Senate bill continues funding for cost-sharing subsidies through 2019. This is a significant concession as several major insurers have bowed out of the individual marketplace due to uncertainty over cost-sharing subsidies. These subsidies reimburse insurance companies for offering lower cost-sharing amounts to lower-income enrollees. CSR payments have been on hold this year while a case is pending in court.
Other Changes In The BCRA
There are several other important changes that the Senate bill makes to the original AHCA, including state waivers for essential health benefits, a repeal on certain Obamacare taxes, funding for grants to fight the opioid crisis in America, and a lack of funding for any abortion services. In summary:
- States could apply for a waiver of the essential health benefits requirement currently mandated by law, which would allow them to define essential health benefits for their individual marketplaces instead of requiring all health plans to cover a robust set of benefits. This could open up the possibility of cheaper plans with higher out-of-pocket costs.
- Insurers may be able to reduce the overall percentage of medical care that they cover under the Senate bill, going from an average of 75 percent to 58 percent. The Senate plan also might increase average out-of-pocket expenses by 68 percent.
- The Senate bill keeps the House bill’s elimination of Obamacare taxes – such as the 3.8 percent tax on investment income for people earning about $200,000 a year – primarily for the very wealthy, who could see significant tax cuts as a result.
- There’s a one-time total grant of $2 billion available to states that need assistance in developing programs to combat the growing opioid addiction epidemic. This provision may prove popular in states that have been particularly affected by the drug crisis.
- Under the Senate bill, people can’t use any funding from the Better Care Reconciliation Act to pay for abortion or to buy plans that cover abortion. Funds from the BCRA also can’t be given to providers who deal with abortion in any way, which means that this provision of the Senate bill effectively defunds Planned Parenthood.
These changes in no way represent the final bill that will be submitted to President Trump, but Senate Majority Leader Mitch McConnell is hopeful of a vote in the upper chamber as early as next week. Senate moderates have been vocal in their stance against deep Medicaid cuts. The Senate bill does not appear to reflect this vocal opposition, nor does it do anything to strike a balance between the middle and far-right members of the Republican Party, not to mention opponents on the left. The Better Care Reconciliation Act of 2017 will undoubtedly go through a host of changes as it works its way to the president’s desk.
Updated June 21st, 2017
Will Americans Have Enough Time To Understand What’s In The Senate Version Of Trumpcare Before A Vote?
One of the most often used and cliched expressions in history is the one that describes the definition of insanity.
Insanity: “Doing something over and over again and expecting a different outcome.” We’ll come back to insanity in a bit.
There’s growing concern coming from Americans, be it Republicans, Democrats or Independents, that the Senate version of AHCA, which is also know as Trumpcare, will be rushed to the floor for a vote without providing enough time for it to be thoroughly reviewed. According to reports, the Senate version of Trumpcare is expected to be released on Thursday, (June 22nd) with a vote coming sometime the following week. This is supposed to be enough time for the CBO to review the latest version of Trumpcare before a vote.
President Trump Expressed Concerns About The House Version Of Trumpcare
Regarding the President, it has been reported that President Trump personally expressed concerns to Senate Republicans about the forthcoming Senate version of Trumpcare. According to numerous sources, who were in attendance at a Senate luncheon where healthcare reform was being discussed, President Trump referred to the House version of the AHCA as “mean” and encouraged Senators drafting this next version of Trumpcare to “add more money” to the bill. That request is most likely in reference to the risk pool funds that are going to be required if states opt out of preventing insurance carriers from excluding individuals with pre-existing conditions or charging them significantly more for coverage. Any state that does not prevent individuals with pre-existing conditions from being rejected for coverage or being priced out of coverage, will have to opt into doing so. They will then have to place those Americans with pre-existing conditions into a high-risk pool where their higher medical expenses would be covered by a pool of funds provided by the government.
By many accounts, the total amount of money that was projected to be required to cover those individuals under the House version of Trumpcare, was not nearly enough. We should note that insurance carriers won’t have to directly reject anyone from obtaining coverage if they have a serious health condition. Technically speaking, according to the House version of Trumpcare, Americans will still have access to health insurance coverage, it will simply be priced at a cost that is far out of reach for 98% of Americans. In effect, if you are healthy, your health insurance could be far less expensive than, for example, someone who has cancer, diabetes, hepatitis or plans on having a child. It is unknown what the total list of pre-existing conditions that would impact access because of higher costs would be.
CBO analysis of the House version of the AHCA projected that by 2026 the new legislation would result in 23 million more Americans being left without health insurance coverage. This is approximately 80% higher than the current uninsured rate under Obamacare. Additionally, the CBO analysis projected that the House version of Trumpcare would actually increase the total number of Americans without health coverage to 18.2% by 2026.
That is approximately a 10% increase from the uninsured rate in 2013, before the launch of Obamacare. Individuals who are thought to be most at risk immediately under the House version of Trumpcare are those who are getting coverage from Medicaid.
All of this is lining up to be very politically dangerous, particularly for any state that actually expanded Medicaid coverage under Obamacare. This explains why three Republican governors have sent a letter to Congressional leaders expressly rejecting the current version of Trumpcare that rolls back Medicaid expansion. Their states have all expanded medicaid under Obamacare, and many Americans in those states rely on it for health coverage. If that coverage is stripped away from voters in those states, there is a very good chance that come next election, Republican governors in those states that allowed it to happen will be out of a job. Individuals who have healthcare under Medicaid and CHIP (Children’s Health Insurance Program) are the second largest group of insured individuals within the United States of America.
Freedom Caucus Continues To Tout Their Version Of The Bill Without A Real Explanation Why It Is Better
So, if the House version of Trumpcare is so bad, who exactly is in favor of it, or will be in favor of the Senate version of Trumpcare, if it is similar? Well, it is actually quite difficult to find a Republican touting the House version as a great solution, this is of course excluding the Freedom Caucus members who are responsible for it. That said, even Freedom Caucus members are light on substantive details as to why it’s better for Americans.
Rep. Scott DesJarlais of TN, a Freedom Caucus member, as well as a physician, couldn’t make much of an argument for it in an Op-Ed published on June 1st. First he falsely implies that insurance carriers are seeing record profits from Obamacare.
Some insurance carriers are seeing record profits, but it isn’t from Obamacare or Medicaid, it is from Medicare.
He then cites the recent decrease in life expectancy as proof that Obamacare is a failure. Of course he provides no sources for this data, and doesn’t get into the details that explain how the national average went from 78.9 years old to, wait for it, 78.8 years old!
So what is the real reason why there was the first fractional decline in average life expectancy in decades? There are many contributing factors, but the most significant ones can be attributed to diabetes, alcoholism, opioid addiction, depression and poverty. All of the actual reasons for the slight increase, excluding poverty, are conditions that will not be required to be covered by the House version of Trumpcare. So naturally, stripping away access to care to address those actual reasons for the increase is not going to improve people’s outcomes and increase life expectancy. One other point regarding poverty — if someone is sick and unhealthy and living in poverty, how are they expected to lift themselves out of that scenario unless they can get access to healthcare and get healthy?
The Atlantic, an actual fiscally conservative organization, gets into the details and explains the real reasons for the fractional decline, and spoiler alert, it’s not because of Obamacare.
DesJarlais then states that the house version of Trumpcare, which rolls back Medicaid expansion, “modernizes it to ensure that only those who truly need the program can take advantage of it”.
There’s no real explantation what “modernizes it” means. Unless the modern version of medicaid according to the Freedom Caucus, is one that is simply available to a much smaller number of Americans.
Then, in what has to be the best part of his Op-Ed, he writes the following:
“If you can believe it, ObamaCare’s Medicaid expansion favors able-bodied adults over the poor and disabled who rely on the program. That’s unfair.”
“If you can believe it”…
So it’s very clear, we do not believe it.
That statement does sound dreadfully familiar though… Where have we read that baloney before? Oh right, The Heritage Foundation, the lobby that is funded by billionaires, you know who immediately benefit the most from the repeal of Obamacare.
No sir, “what is unfair” is that you are allowed to publish a misleading Op-Ed that cites ZERO sources to an audience of millions, as fact, because you’re a doctor and an elected official. What is unfair is that there are no consequences for misleading the American people by withholding important facts and details.
Why A Rushed Vote Can Only Be A Bad Sign For Things To Come
Behind closed doors and away from the press, it is said that there are a number of Republicans who are extremely concerned about what lies beneath with Trumpcare. They say “what lies beneath” because it is often weeks or months later that unseen details and important fine print, that can easily be missed in hastily passed legislation, finally reaches the surface. Sadly only then are facts finally separated from falsehoods, but at that point it’s too late.
That is precisely what happened with the House version of Trumpcare. It was only really highlighted by The Wall Street Journal that according to the House version of Trumpcare, employer plans could see drastic changes that could harm employees of corporations by allowing lifetime caps on coverage to be put in place. Most employers wouldn’t offer these kind of plans, because it would just lead to employees leaving for jobs that offer better healthcare.That said, the fact that they could do it, that the option is there, that is what is troubling to many people.
If you think that maybe that is just one isolated example of hastily passed legislation coming back around to be a real problem, think again. Because in 2013 Marco Rubio was successful in sneaking into the federal funding bill a rider that stripped away cost sharing payments that are required to be paid out to insurance carriers for their loses on Obamacare. Rubio and his team kept this somewhat under wraps until they felt it was politically timely to take credit for it, and boy did he.
He wasn’t just responsible for it, but campaigned on it during the Presidential election.
— Marco Rubio (@marcorubio) December 2, 2015
Two weeks ago, Anthem announced it was exiting 18 different counties in Ohio, leaving many Americans within the state with no coverage options at all. Anthem, in a move that is indicative of just how frustrated they are with the lack of communication and transparency from the current administration regarding healthcare reform, and the CSR payments, announced the move with a clear indication that the politics and uncertainty are to blame.
Since the election is history and Obamacare is now more popular with Americans than it ever has been, Senator Rubio is keeping quiet about his role in helping tank Obamacare. He’s certainly not tweeting it out like he was on the campaign trail!
Without question Senator Rubio’s actions encouraged other carriers to pull out of the market, decreased competition, increased costs and was ultimately successful in weakening Obamacare and the individual market.
If Blue Cross Blue Shield of Florida, one of the carriers serving the largest number of Americans under Obamacare, ends up doing the same thing as Anthem in Ohio, it is very likely Rubio is not re-elected for office in Florida ever again. Even if he intends on running for President in 2020, he likely won’t win over the majority of Floridians.
If the Senate version of Trumpcare closely follows the House version, the version viewed as mean and underfunded by the President, and as a far more dangerous alternative to Obamacare by the American Medical Association that’s bad enough. If Americans are mislead about what it actually contains, what it potentially could lead to, and if it is not crystal clear just exactly how the legislation will change healthcare within the United States immediately, it will just lead to more chaos.
Chaos is great for politicians who are campaigning, or who are seeking donations for future campaigning. Chaos doesn’t work when it comes to healthcare or health insurance, that has become painfully obvious.
We’re not insane, and we know you’re not either.
It’s time for Republicans and Democrats to be fully transparent with the American people, and with insurance carriers, about what this next iteration of healthcare reform will bring.
Updated June 12th, 2017
How Things Go From Bad To Worse If Trumpcare Passes
One major problem neither side of the aisle is talking about is the lack of insurance carriers willing to stay in the exchanges. Aetna, United Healthcare, Humana and Anthem, have all announced exits from the ACA, either entirely, or almost entirely. Anthem, the latest to announce, is exiting 18 major counties in Ohio. This was an ominous announcement, in part because Anthem was very direct and transparent about their reason for doing so. Their decision centers around how it seems that politics are taking priority over people, and the governments contractual agreements with insurance carriers.
Despite the majority of Americans supporting Obamacare, the ACA, or Trumpcare for that matter, it will in fact fail Americans if insurance carriers aren’t willing to offer coverage under the law. Time is literally running out for insurance carriers to “stay on or get off” this healthcare reform highway, as they have to submit plans for 2018 by late June.
This is compounded by the fact that in March of this year, a regulation brought forward by the previous administration, limits the amount of time a consumer can have a “short term health insurance plan”. Short term health insurance has become an increasingly popular alternative to Obamacare plans, especially within the last 18 months as premium prices have risen dramatically in certain states.
Short term plans are not a fit for all consumers, especially those with serious health issues, or anyone planning to have a child. Short term plans can deny an applicant coverage for pre-existing conditions and the level of coverage benefits is approximately the same as catastrophic coverage. That said, if you’re relatively healthy, short term health insurance can be a great option as plans typically cost about 30% of what an ACA plan does.
Most American’s health plans require them to pay out-of-pocket for doctors visits and urgent care services and other general expenses, just like with short term plans. Short term health plans are in fact widely available, but like with anything else, the devil is in the details, and with short term health plans, you really do need to pay attention to the fine print. Short term coverage, or “term plans” as they are sometimes called, are less regulated than ACA plans. This results in there being a number of plans offered by some less than ethical companies, who often have no issue ignoring laws, regulations and moral guidelines.
According to this new regulation, short term plan coverage is capped at 3 months, which means that at the end of 3 months, that consumers short term plan ends. Brokers and carriers are required to determine if in fact a consumer previously had a short term plan at any point during the previous 12 months. This places larger, well established companies offering “short term health insurance” in a very difficult position. While they abide by the rules and regulations required of them according to HHS, others on the fringes of the industry will not.
What does this mean for Americans? It means that if there are a number of states where there are no plans, or limited plan choices or only cost prohibitive plans, consumers will very likely be forced to purchase a short term health insurance plan. This could result in Americans having to work with brokers who don’t operate in a 100% above-board manner.
Unfortunately, like in almost every other industry, the health insurance space has no shortage of scammers and con artists. Continuing to restrict short term health insurance plans to a 3-month coverage max will only increase the probability that consumers end up having to purchase coverage through one of these “shady” companies. Boiler room call centers, overstated claims on coverage benefits, pushy sales people and a generally horrendous claims process, are just some of the things Americans, who have to rely on short term health coverage, can look forward to if they don’t enroll with an ethical and transparent company.
Updated June 7th, 2017
18 Counties in Ohio without Coverage as Anthem Announces Withdrawl From ACA
Over 10,000 people in Ohio could lose access to an Obamacare health plan in 2018. On Tuesday, June 7, Anthem announced that it would be scaling back its participation in the federal health exchange in the Buckeye State, leaving about 18 counties without any options on the exchange for next year. The major insurer joins other big names in the industry in breaking ties with the Obamacare exchanges, but Anthem’s withdrawal from the Ohio market is somewhat surprising. Earlier in 2017, the company was cited as the most significant marketplace participant. Now, only residents of Pike County in Ohio will have access to a single Anthem plan, available outside of the exchange.
Anthem’s decision to back out of the marketplace in Ohio has come at a critical time for healthcare reform. As Republicans work diligently to push the American Health Care Act (AHCA) through Congress and onto President Trump’s desk, opponents of the current law – the Affordable Care Act (ACA) – point to Anthem’s withdrawal as yet another sign that Obamacare is floundering. Skyrocketing premium rates in 2017 combined with the exit of major insurers from the marketplace lend fuel to the fire for Republican reform.
Worse still, Anthem indicated that it could pull out from more than just Ohio in 2018. If the company did withdraw from the 14 states in which it currently offers plans, that would leave approximately 250,000 marketplace enrollees without any options for coverage on the exchange. Residents of Georgia, Mississippi and Kentucky would take the brunt of the impact. These three states, all of which are considered Republican leaning states, the latter being the home state of Senator Mitch McConnell, would potentially be in in play in the mid-term election in 2018 if healthcare accessibility were to get worse than it is currently.
Anthem cites several reasons for its exit next year, chief among them is the instability created by uncertainty when it comes to healthcare reform. Republican lawmakers have been consistent in their dogma to “repeal and replace,” but until last month, no single plan existed to accomplish their goals. With the AHCA making its way through the Senate this summer, conservatives and President Trump are hoping to put healthcare reform behind them so they can focus on tax reform.
Despite the official stance from Anthem that business considerations and uncertainty are driving their withdrawal from the Ohio exchanges, Democrats point the finger to politics. They claim that the Republican proposal does more harm than good, and debate over healthcare reform is the real reason why insurers are getting skittish for 2018.
In the meantime, Anthem isn’t alone in fearing for the future. Aetna and Humana, giants in the insurance industry, also announced cuts for 2018. More industry leaders could follow as state deadlines for rate filings – already pushed back for the year – come to a close.
Updated May 24th, 2017
CBO’s Analysis Of Trumpcare Doesn’t Help Its Prospects With The Senate
The CBO finally released their report on the House of Representative’s healthcare reform bill that was passed by Republicans on May 4th.
The CBO announced today that the AHCA or Trumpcare as it is also called, would cause 14 million more people to become uninsured in 2018 than if Obamacare remained in place. In 2026, the CBO estimates that a total of 51 million people would be uninsured under the AHCA compared to 23 million under Obamacare. Anyone who took their tax credits (in lieu of Obamacare’s subsidies) and bought a non-major medical plan such as a mini-med plan or some sort of supplemental plan were counted as uninsured by the CBO because their plan would not cover regular medical claims.
This version of Trumpcare would also decrease the federal deficit by $119 billion, which is $32 billion less than the first iteration would have done for the country. While the changes to Medicaid and the removal of Obamacare’s subsidies would save the program money, funding the high-risk pool for people with pre-existing conditions and eliminating a number of taxes imposed on employers and individuals, which previously helped fund the program, would result in less savings overall under the new law. It is also largely viewed as incredibly beneficial for the top 1% of earners within the United States, as they will see a significant tax cut.
One of the big questions for insurers is whether the AHCA would stabilize the market. The CBO concluded that the market would be stable while subsidies were still in place, which is until 2020 and then it would continue to be stabile after the tax credits went into place. But the CBO believes that one-sixth of the population would live in an area of the country where the market would not be stable because their state took waivers to not require insurance carriers to cover the ten essential health benefits and to charge higher premiums for pre-existing conditions. People with pre-existing conditions would likely find their coverage options unaffordable, even with financial help, and would choose to be uninsured.
Another big outstanding question with the AHCA is whether it would bring premium costs down. The CBO believes that premium prices would increase until 2020. However, after that point, premiums would be lower than under Obamacare because insurance carriers could offer plans that didn’t cover the essential health benefits or charge more for people with pre-existing conditions in states that took those waivers. Even though premiums would be lower, out-of-pocket expenses for families that had plans that didn’t cover the essential health benefits would be much greater because they would have to pay out of pocket for services that would have been covered, at least in part, by Obamacare such as maternity and prenatal care, emergency services and preventative care.
The Senate now has the bill and they were very clear that they were going to carefully weigh the CBO’s report when reviewing and modifying the AHCA passed by the House. It remains to be seen whether this report will cause the Senate to change more or less.
Updated May 17th, 2017
Online Enrollment Streamlined by CMS Today
CMS announced today, May 17th, that they are changing the process to enroll online for consumers and agents for the upcoming 2018 open enrollment period. This new process will make enrolling much easier and faster than what was in place last year.
Last open enrollment period, consumers and agents were required to go through the income verification process on Healthcare.gov. That meant that if a consumer called an agent on the phone or if the consumer tried to enroll on their own through an online broker, only part of the application process could be completed before the consumer or the agent on the consumer’s behalf had to deal with a series of questions to verify identity and income on Healthcare.gov. If someone was trying to do this on a particularly busy day or on a day where Healthcare.gov was having technical issues, this part of the process was very slow
The industry called this Healthcare.gov interruption the “Double Redirect” and it was a nuisance to everyone and caused a lot of people to choose to enroll over the phone, which is less efficient because there’s only so many agents who can answer the phone, or to not enroll at all. Thankfully, CMS recognized that this was a hindrance to enrollment and fixed the problem before the next open enrollment period.
The new process allows consumers enrolling through an online broker or on the phone through an agent to go through the whole application process, start – to – finish, on one website, without having to deal with verifying their income on Healthcare.gov. This new enrollment process is only available to consumers with straightforward enrollments that don’t require supporting documentation and to those enrolling during the open enrollment period, which starts on November 1st and ends on December 15th. Anyone looking to enroll in a plan during a Special Enrollment Period will have to use the Double Redirect process.
CMS also announced that they have a more detailed plan for upcoming seasons to improve the enrollment process but that this temporary solution should help streamline things in the meantime.
Updated May 16th, 2017
Answers To Your Questions About What Conditions May Not Be Covered Under Trumpcare
We receive a lot of emails and calls on a daily basis from individuals who have concern about what Pre-existing conditions will or will not be covered when Trumpcare is passed. Without question it is the most significant concern for Americans that engage with our organization on a daily basis. First it is important to note that the facts are, we just do not know that much yet, because the law is still being drafted. We won’t have concrete and definitive answers until the Senate version is completed and then presented for analysis. Even at that point, technically insurance carriers will have some level of discretion to what they provide coverage for. Even if an insurance carrier could legally exclude someone for having, for example, “anxiety”, it doesn’t mean that they will in fact reject everyone who has been diagnosed with that condition. We hear from a lot of people on a daily basis who seem pretty anxious about what Trumpcare has in store for them. We know these uncertain times are unsettling, it is for everyone, even us, so please forgive us if we try to inject some humor into this serious subject matter when possible.
So all that said, you should not necessarily expect the worst outcome to be the likely one. There could be some restrictions imposed by Trumpcare that will not allow insurance carriers to exclude for as many pre-existing conditions as they did before. It remains to be seen if everything will revert back to how things used to work five years ago, before Obamacare. Five years ago, someone with a condition as common as migraines, technically they could be rejected from receiving coverage. We don’t know if Trumpcare will impose limitations on the list of pre-existing conditions to include only the more costly chronic conditions, like cancer or diabetes.
So just to be clear, we are having to speculate at this point about what we think might be likely to happen. We base all of this on real factual information and data that is available today, and we also take into account how the health insurance industry operated prior to the launch of the Affordable Care Act / “Obamacare”. It is our preference to not speculate, but we still receive a massive amount of feedback from concerned Americans on a daily basis. We would prefer to err on the side of “accurately speculating” instead of just sticking our heads in the sand and not answering your questions as best we can. As always we will continue to update this website with the latest on Trumpcare. Feel free to sign up for updates and share our infographics with whomever you like via email or social media. We are a free resource for consumers, and we have no issue with anyone sharing any of our content.
Below is a link to our Trumpcare pre-existing conditions page where we get into the details of how we compiled the data that is highlighted in the infographic below. Again, it is early in this process, so per our constant repetitive reminder, do not panic, just keep staying informed as Trumpcare moves forward.
Updated May 10th, 2017
A Factual Analysis of the Ten Essential Health Benefits and Why They Should Matter To You
We have been receiving a consistent flood of emails and calls from Americans with questions about what the ten essential health benefits are, and what it could mean for their healthcare if insurance carriers are no longer required to cover them as the AHCA is proposing. We need to be clear that according to the”Trumpcare” bill, the power to not require insurance carriers to provide for the ten essential health benefits is left up to each individual state to determine. We will explain this in more detail below. So ultimately it becomes a “states rights” issue should the AHCA or Trumpcare be passed into law as it is written as of today.
It is being reported that the bill that was passed by the house, is universally unpopular and thought to be dead-on-arrival and viewed as a non-starter for nearly everyone within the Senate. There is an entirely new version of the AHCA that is being drafted from scratch, and it will no doubt address the issues that most people, elected officials and their constituents, have expressed opposition to or great concerns about.
That said, it doesn’t mean that you should expect that the Senate version will not be heavily influenced by what was included in the previous version of the AHCA. As the expression goes, the devil is in the details, and we want to give you a very detailed rundown of the ten essential health benefits, and what they provide, so that you can make an informed decision about what you think should included in Trumpcare.
The 10 Not So “Essential” Health Benefits Under The House Version Of Trumpcare
After the House of Representatives passed the American Health Care Act (Trumpcare) on May 4th, people were concerned that states would allow insurance companies to “opt out” of providing coverage for essential benefits that were required under the Affordable Care Act (Obamacare). Under current law, there are 10 essential health benefits that all major medical policies must offer, whether you buy a private plan or get your insurance through work.
In the House version of the ACHA, it allows states to request a waiver from this provision that allows insurance companies to offer plans that don’t cover these benefits if they can demonstrate that offering plans without the 10 EHB’s, would reduce premiums.
Ten Essential Health Benefits Currently Required
These are the 10 essential benefits that your major medical plan has to cover:
- Ambulatory (outpatient) care
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services
- Laboratory services
- Preventive and wellness services, and chronic disease management
- Pediatric services, including oral and vision care
- Prescription drugs
- Rehabilitative and habilitative services and devices
Essential benefits offered under the ACA were designed to help people prevent and treat illnesses but were not designed to cover elective or non-essential treatment. Employer-sponsored plans offer essential health benefits already so the change would primarily affect plans offered through the individual market. However, there is some concern that if states were allowed to define essential benefits, large employers (who base their plans on any state’s definition of essential benefits) could scale back on coverage or at least the financial caps that are currently in place. Right now, most Americans with coverage get health insurance from an employer.
How Things Worked Before Obamacare
Prior to the passage of Obamacare, insurance companies could offer low-rate policies that didn’t offer coverage for some conditions or services. They could also charge higher deductibles or co-pays for some services, like emergency room care or laboratory services. Some fear that too many people in the individual marketplace will opt for less expensive plans that don’t cover maternity care, mental health services or rehabilitative devices. Unfortunately, these are costly services to cover out of pocket. If you buy a less expensive plan with fewer benefits, you may end up paying much more out of your own pocket if you need costlier care.
One of the reasons Republicans wanted to remove the essential benefits requirement is that this provision has been instrumental in making plans more expensive for a lot of people. It has also limited consumer ability to choose a lower-priced insurance plan. Older Americans, for example, felt that they shouldn’t be required to pay for maternity care they won’t ever use while people without children felt that it was unfair to be forced to carry pediatric coverage. Other consumers prefer to pay very low premiums for what used to be known as catastrophic plans. Catastrophic coverage only covers, as you might expect, catastrophic situations, such as a broken back or a sudden and debilitating illness. For example, if you end up in a car accident for example, and have a traumatic head injury, you could end up with total costs of $500,000 or more in claims. A catastrophic plan would prevent you from being on the hook for the entire $500,000. Instead you would be looking at total costs of $12,000. That’s certainly not an insignificant amount of money, but it isn’t the kind of medical debt that ruins the average persons life, much like a $500,000 debt would.
The bill faces an uphill battle in the Senate, especially with the added provision that states could allow insurance companies to opt out of the essential benefits requirement. Senate leaders have been clear that they will not approve any bill that eliminates the provision covering 10 essential benefits.
Republicans in the House were reluctant to include the provision as they feel it could lead to a Democratic filibuster over the budget reconciliation used to repeal Obamacare. Should a filibuster occur, Republicans would be unable to break it and the law could die on the Senate floor.
However, even if the bill does not pass the Senate, the essential benefits provision could be weakened by Health and Human Services Secretary Tom Price, who has said that he plans to change the regulations that govern it. Secretary Price cannot eliminate the law, but he does have the power to determine how it’s implemented. In addition, Seema Veema, who runs the Centers for Medicare and Medicaid Services, has said that she doesn’t support coverage for maternity care in every policy. The legislative branch may not pass Trumpcare, but changes at the Cabinet level could still take place.
Potential Race to the Bottom
Experts in the healthcare industry say that eliminating requirements for essential healthcare coverage entirely could lead to a “race to the bottom.” Insurers would have a strong incentive to drop expensive coverage – like cancer treatment, high-cost prescriptions or mental health treatment – in order to offer plans at extremely low rates. There’s concern that this practice could make it more difficult, if not impossible, for people with pre-existing conditions to find a company that would cover their treatment at an affordable rate.
State Waivers And High Risk Pools
One of the important things to note about the AHCA, more specifically the MacArthur Amendment that allows for waivers to eliminate essential health benefits, is that states must apply to the federal government to obtain a waiver. States that apply for a waiver must create high-risk insurance pools to accommodate people with pre-existing conditions who may be affected by the elimination of essential health benefits. States would also need to prove that eliminating or reducing essential benefits would lower the cost of healthcare or increase the number of people covered by insurance. Waivers would be automatically approved if the federal government failed to respond to a state’s request within 60 days.
If the removal of essential health benefits remains in the bill after it passes the Senate, it could mean that consumers will be able to choose less expensive policies for their healthcare in the marketplace. However, those lower-cost policies could come with a hefty price in the event of unexpected medical bills.
You should give serious thought to which ion the ten essential health benefits under Obamacare, would be essential for you in a plan under Trumpcare.
We encourage you to sign up for updates and notifications from us regarding Trumpcare if you have not done so already.
Updated May 6th, 2017
Trumpcare and the Legislative Process
If you’re afraid that the passage of the American Health Care Act in the House of Representatives means that it is the law of the land and that your health coverage is now different or gone, you’re not alone. We’ve received a lot of emails with questions about how the House of Representative’s passing of the AHCA affects their health insurance coverage. If there are parts of the AHCA, or Trumpcare as it is also called, that you want changed, you may still get your wish because the AHCA has a long road of review, amendments and votes ahead of it.
The Legislative process is confusing, so we’ve laid it out as simply as possible. For reference, the AHCA is only on Step 5 and according to the interviews with different Senators this week, Step 5 is going to take a few months.
- The Representative gets support from others to sponsor the bill and it is sent to committee
- Committee discusses the bill and makes changes before it is sent back to the floor of the House
- Representatives debate the bill and make changes before they vote.
- The House votes on the bill. If a majority of the House votes “Yes”, the bill is passed and moves on to the Senate
- Bill first goes to a Senate committee that discusses the bill and makes changes and amendments.
- The bill is then debated on the Senate floor before it is voted on with a “Yea” or “Nay” vote
- If a majority of the Senators vote “Yea” on the bill, it is passed back to the House for review.
- House and Senate members in a joint committee discuss the differences between the two bills and make any final changes.
- The jointly approved bill goes back to the House and the Senate for final vote. If approved by Congress, it goes to the President
- The President can sign the bill, veto it, or do nothing (will become a law after 10 days if Congress is in session.)
- If vetoed, it goes back to the House and Senate to reconsider. If 2/3 of Congress vote to pass the bill, the veto is overridden
- The bill becomes a law!
Updated May 5th, 2017 at 2:05 PM EST
Individuals Enrolled In Obamacare With Concerns About Losing Your Coverage – Do Not Panic
In the last twenty-four hours this website along with the other healthcare information properties operated by HealthNetwork have received more than one million visits. Many of you have contacted us with concerns about losing your current coverage under Obamacare and or coverage through an employer sponsored plan. Here is the most important thing you need to know right now. As of today, and throughout the rest of 2017, nothing has changed for you and your existing coverage. Insurance carriers are required to honor any 2017 plan regardless of what legislation is ultimately passed. Continue to pay your monthly premiums and you will continue to have full coverage. We encourage you to remain informed of the facts and not make any decision that could result in you losing coverage, as an example, such as for non-payment.
We understand and appreciate your concerns, and that is why we will continue to be working seven days a week to provide you with factual information and answers to your questions each and every day. We encourage you to sign up for updates and notifications from us regarding Trumpcare. You can do so at this link.
The AHCA that was passed in the house on May 4th, 2017 still has many important hurdles it must pass before it becomes law. There is growing sentiment that what was passed in the house will not be what ultimately reaches the Senate for a vote. Republicans and Democrats are going to have little choice but to find a way to work together in a truly collaborative effort in order to draft a bill that meets the needs of the American people and has a real opportunity to become law.
For more information on the differences between Obamacare and Trumpcare updated for the latest version of the AHCA, please use the following link below.
For a more detailed explanation of Pre-existing conditions and what that means under Trumpcare, please use the link below.
More updates regarding Trumpcare to follow soon.
Updated May 4th, 2017 at 8:40 p.m. EST
Republican Senators Comment on AHCA
Several Republican Senators quickly chimed in on the passage of the American Health Care Act, and or Trumpcare, and the forecast isn’t looking good for anyone in the House who was hoping that the Senate would pass the bill as written.
A number of Republican Senators including Lindsay Graham (R-SC), Dean Heller (R-NV), and Lamar Alexander (R-TN) made it clear in interviews with the media that the Senate will be pouring through the AHCA, determining the probable results of the AHCA’s provisions on issues such as essential health benefits, pre-existing conditions, and the Medicaid expansion roll-back on the real costs of healthcare. They will be carefully examining and actually considering reports and commentary from the CBO and determining what kind of compromises are necessary to not only take care of Americans, improve the system, and bring down costs, but to also get it passed when it is taken to vote. Republicans have a slim majority in the Senate and it’s going to be a difficult to get the majority vote – 51 Yea’s – it needs to send the bill back to the House for a final vote, before it can then go to President Trump’s desk.
Another point made pretty clear by Republican Senators after the House passed the AHCA was that it will not rush this issue like it believes the House did. Several Republican Senators commented that the House moved too quickly and did not properly consider all of the ramifications of the bill. They vowed to take however long it takes to get the bill right. This is great news for all Americans who are in favor of affordable healthcare that will provide essential coverage options.
Another point to keep in mind is that whatever is passed by the Senate and then ultimately the House and President Trump will not fully replace Obamacare, but will rather just make changes to certain parts. While it may be frustrating with how this is all playing out, we are encouraging people to not panic and instead just stay informed of the facts. If you would like to sign up for updates and notifications from us regarding Trumpcare, you can do so at this link.
Updated May 4, 2017
AHCA Passes the House
The House GOP voted on and passed the American Health Care Act today by a 217 – 213 vote, and not a single Democrat “Yea”.
Right after the final votes were tallied, you could hear Democrats sing”Na Na Hey Hey Goodbye” in the background. Although you would initially think that it was Republicans singing this tune, saying goodbye to Obamacare, it was actually a bunch of optimistic Democrats who believe that this vote will upset constituents around the country so much that they will vote for Democrats in the midterm elections.
Now it’s on to the Senate where the ACHA may be sliced and diced and amended.
To be continued…
Updated May 4th, 2017
It’s The Final Countdown For The Trumpcare Vote – Part Duex
The House is set to vote later today on President Trump’s AHCA, or what it is also known as, “Trumpcare”. According to reports, the Freedom Caucus has no intention of blocking the proposed bill from passing this time (the AHCA has technically never gone up for a vote, but it has gotten close two other times), despite the fact that it is not exactly what the Freedom Caucus originally pushed for in an Obamacare replacement plan. What they wanted could have been a complete and total disaster for Americans who receive subsidized health insurance or even those with an employer based plan.
After the last failed attempt at getting the AHCA to a vote, Republicans worked on an amendment proposed by Tom MacArthur of NJ that allowed states to seek waivers from some popular pieces of Obamacare, including essential health benefits and no discrimination on pre-existing conditions, which will be discussed in more detail below. It’s unknown how they planned on making that popular with anyone who lives in a state that decided to ask for these waivers, but really why spend time trying to figure that out.
Here’s where things stand right now as of 11:35AM EST.
President Trump’s Administration, as well as the Republicans who have been trying to move Trumpcare forward, have been able to get the latest version of the AHCA to a point where it could be passed by making some major concessions to its detractors.
To quickly summarize and allow you to not have to read about the many different tweaks and modifications that have occurred, the version of the AHCA that’s going up for a vote today, will now give states the ability to opt out of requiring that the ten essential benefits be included in any plan offered to consumers by insurance carriers.
States will also have the option to allow insurance carriers to charge people with pre-existing conditions more money for their plan. Insurance companies are not permitted to deny coverage due to a pre-existing condition, which is similar to Obamacare, but under the AHCA, they may charge more for it since these people are technically more expensive to cover. It should be noted that pre-existing conditions doesn’t just mean people with cancer or a very costly illness. Diabetes is a pre-existing condition that carriers may charge higher premiums for and that is a wildly growing problem in the United States. This is concerning in states where there has been limited Medicaid expansion, specifically “red states” where there is less support for government mandated health coverage. That said, also included in this latest version of the AHCA is a stipulation that says that states that choose to allow insurance carriers to charge more to people with pre-existing conditions will also have access a pool of money to help lower the costs passed on to the consumer. This past week, Republicans who were still undecided or were a hard “No” on the AHCA bill as amended and changed worked with President Trump to increase the amount of money in the risk pool. The total amount of additional funds set aside for this “high risk pool”, for a five-year period from 2018 to 2023, is $8,000,000,000 (Eight Billion Dollars). Time will only tell whether the amount of money now in the high risk pool will be enough to cover everyone living in a state that took the waiver on pre-existing conditions.
Proponents of the bill say that this should be a state’s issue and that by allowing states to better control what kind of plans are offered and what is or is not required to be covered and included, will allow costs to come down significantly and will benefit Americans in that state. Is this possible? Yes, maybe it is, in theory. That said, there is a very high probability that the actual roll-out of a state-focused healthcare initiative will be a very bumpy road that leaves many people even more dissatisfied with their coverage options. Insurance products are just not created and rolled out in a time efficient manner. If Americans are disappointed with how slowly the legislative process works in the United States, they should take a closer look at how long it typically takes an insurance carrier to bring a product to market. Let’s be clear that it is not insurance companies wanting to be difficult or not wanting to provide coverage to as many people as possible, as quickly as possible. It is simply because health insurance and all of its thousands of moving parts are incredibly complicated, and it is impossible to just slap together a health insurance product in a couple weeks.
One of the most important questions that we have that remains unanswered is exactly how the risk pool functions when it comes to consumers with pre-existing conditions. If someone with a pre-existing condition, who was previously covered under Obamacare now has to transition into a new plan that they’re being charged more for because they have a pre-existing condition, how is that difference in price covered? Is it out-of-pocket from the consumer and they are reimbursed, because that’s a non-starter for 98% of consumers. Or will carriers simply offer the same plans to everyone with or without pre-existing conditions, but the risk pool funds will simply be paid out from the government, direct to carriers, for costs they incur from those individuals with costly pre-existing conditions.
How vague the AHCA is and lacking in specific details is not a selling point. Leaving things up to the interpretation of state legislators is often how the federal government finds itself being sued by its own states. We would be more concerned if it were not for the simple fact this is all kind of irrelevant because the AHCA still has the most difficult obstacles ahead of it- passing the Senate and ultimately the President’s desk.
There are many other revisions to come over the coming months and spending too much of your energy focusing on this version on a daily basis just might not be the best use of your time. While many have been reporting that President Trump may not be totally up to date on the day to day of the AHCA and all of its complicated details, or lack-thereof, there is one thing that has been made very clear since he was sworn into office – he will veto anything that he feels will be unpopular with Americans. It is very unlikely that he would not break out his own veto pen if it meant that legislation with his (figuratively speaking) name on it, Trumpcare, was going to cause harm to Americans. Regardless if it meant upsetting Republicans or individuals in his cabinet, right or wrong the man does what he wants to do. He has zero reason to care what the Freedom Caucus or organizations like Americans For Prosperity think of him. They have undermined him at every opportunity. It seems that there’s been, to some extent, a game of political chicken going on. It is almost as if the Freedom Caucus members have been trying to get him to have to resort to working with Democrats, because apparently that will be viewed negatively by American voters in the upcoming midterm elections. We’re not sure that’s a strategy that’s going to work, because at HealthNetwork we engage with and communicate with more than 18 million health insurance shoppers each year and what we have learned is that when it comes to individuals and their family’s healthcare, partisan politics and typical voter’s issues – excuse the pun – is all Trumped by healthcare.
Since President Trump has been sworn into office, Americans have gotten a very good look at how messy and complicated all of this is. Contentious or downright hostile town hall meetings with a much more informed and skeptical Republican electorate has become the new normal. There’s an outcry from voters on both sides for elected officials to stop fighting with one another and work together to get something that is actually better put in place quickly. If voting against the GOP means that Americans get to keep minimum essential health insurance coverage options in place, especially in a midterm election where it is psychologically easier for someone to flip their vote, we are 100% certain that is precisely what the majority of Americans will do. People want to live, so an informed and motivated electorate will vote in favor of living over the alternative.
Updated April 24th , 2017
CMS Releases Updates That Have A Major Impact On Obamacare And Trumpcare
On April 13th, CMS released a final rule that changes the Obamacare law and is designed to stabilize the market, which is something that carriers have been requesting for more than a year. Republican’s efforts to repeal and replace Obamacare are ongoing, but until there’s something else in place, Americans and the healthcare industry are left with Obamacare. CMS is hopeful that these new rules will not only bring down the costs of healthcare for both Americans and the healthcare industry, but will also stabilize the market, which will allow carriers to continue to offer coverage. They are also hopeful that this will encourage insurance carriers who have either exited the exchanges or are planning to, instead to remain on board and ultimately get behind this next iteration of healthcare reform by expanding their coverage. This will create a more competitive and robust marketplace which in turn should result in consumers paying less for their healthcare.
OEP – The open enrollment period is now shortened to just 45-days. The new period will start on November 1st and end on December 15th of every year moving forward. We are not entirely sure why this is beneficial to either insurance carriers or consumers, but it’s going to become the new normal moving forward. We strongly believe that this past OEP was not successful when compared to previous seasons, in large part because CMS limited the ability of other HC.gov partners with unnecessary red tape. Regardless if it was a broker or carrier, for the first time ever they were all forced to hand the consumer off to HC.gov for data verification before they could complete enrollment. This was through something called “the double redirect”. Forcing the consumer to have to engage with HC.gov simply increases the probability that the consumer hits some kind of bottleneck in the enrollment process and doesn’t end up enrolling. It is the equivalent of shopping at the grocery store and then at checkout being forced to go to the DMV to obtain some new kind of identification, simply so that you can now go back to the grocery store and pay for your stuff.
It has been proven that alternative channels for enrollment are more efficient than HC.gov, and when the double-redirect went into effect it brought enrollment rates down for certain partners of HC.gov, by upwards of 80%. Industry wide it is estimated that enrollments rates were cut in half.
We mention this simply because of our concern that shortening the enrollment window to 45 days, and keeping the “double redirect” in place, it could very well ensure that even fewer consumers are able to enroll in a plan which will ultimately cost Americans their healthcare, and potentially their lives.
Application of the binder payment – If you didn’t pay any of your premiums from the last year, your carrier can take the payment you are required to make to enroll in a new plan (the binder payment), and apply it to the missed payment(s). This only applies if you enroll in a plan with the same carrier.
Having an outstanding balance may bite you later – If your coverage was canceled a couple of years ago because you didn’t make all of your payments and you now need to enroll in a plan with that same carrier today, that carrier can make you pay the outstanding balance before giving you coverage.
The new pre-enrollment verification process – In past years, Healthcare.gov’s procedure for approving coverage during the Special Enrollment Period was to have the carrier issue coverage immediately and then request proof of the qualified life event afterwards, if at all. Under the new rule, you are required to provide the proof first and after Healthcare.gov validates your life event, the carrier will get your application for coverage.
Limitations to certain QLE’s – If you get married or give birth, foster, or adopt a child and you need coverage for that additional person, you may only add that person to your current plan. This life event does not permit you to change your carrier or plan. Also, losing coverage due to non-payment of your bills does not create a qualified life event. You will simply not have insurance.
Permitting carriers to get creative with plan coverage options –This rule is a bit complicated, so we’ll keep it simple. Under Obamacare, a bronze plan had to cover an average of 60% of the costs, silver covered 70%, gold covered 80% and platinum covered 90%. Under this new rule, the range of coverage is expanded so that carriers have the ability to offer a gold plan that covers more and may cost a little more or a gold plan that covers a little less and may cost a little less. This should mean more plan options at different prices.
Defer to the States to validate a plan’s network – Most states review the details of a health plan before approving it. Previously, Healthcare.gov would do a similar review, which is ultimately unnecessary. This rule now permits Healthcare.gov to just accept the state’s review of the plan and its network and save the money on the independent review for something else.
Change contract requirements regarding ECPs – Carriers are now required to contract with 20% of the total number of essential community providers available in a service area, which is down from 30%. An essential community provider is a medical provider that serves low-income or medically underserved communities.
For more detailed specifics about these changes, you can visit our page on the Latest CMS Rules Changes Full Details .
Updated March 24th, 2017
Trump Administration And Paul Ryan Are Forced To Pull The Trumpcare Bill
Today, in a somewhat surprising turn of events, the Trump administration was forced to pull their bill for healthcare reform from the House before it was able to be voted on. We say this is surprising simply because President Trump and his Administration, along with Republicans, are now faced with what are really two far worse alternatives. They can now watch as Obamacare continues on its current path, which almost no one really believes is a positive one, or they can begin the process to compromise with Democrats in the House, instead of within the Senate.
If we were callous enough to be placing bets on the most likely outcome, we’re going with the latter. No one is happy with limited choices, high deductibles, limited access to doctors and the host of other complaints that Americans have with their current coverage under the ACA. Let’s not forget that across both sides of the aisle, Democrats and Republicans seem to agree on at least one thing, that Obamacare needs major improvement.
In a news conference President Trump blamed Democrats for the failure of this bill to be passed in the House. It seems ridiculous to think that after making absurd concessions to the House Freedom Caucus, purely for the purpose of appeasing their ridiculous demands, that any Democrat would even consider for a second voting in favor of the bill. Democrats are just as concerned about preserving their image with their base voters as Republicans are. Even if Democrats know that once the Trumpcare bill reaches the Senate it will then be revised, because it has to be revised, no Democrat is actually going to sign off on it now in the House because of the political backlash they would receive. Furthermore, to do that would really reveal in a very public way, just how gross the process is by which legislation works and how absurd politics are. As the saying goes, no one wants to see how the sausage gets made, you just want to eat it.
Where Should The Blame Really Go?
Without question, every American who is tired of paying higher premiums, deductibles of $10,000 or more, tired of having limited choices, and is just generally dissatisfied with their healthcare options, should place the entire blame for Trumpcare not passing the House, on the House Freedom Caucus. Even President Trump eluded to shifting some of the blame towards the House Freedom Caucus in an interview, although his tone was fairly muted.
Now you might be wondering why exactly we’re calling the Freedom Caucus out for derailing healthcare reform. It’s really simple, and we have covered this before, but until this past Wednesday, when the Freedom Caucus was emboldened by a political action group backed with tens of millions of dollars, the majority of the House Freedom Caucus was set to vote the bill through, as were the rest of the Republicans. That’s when Americans For Prosperity announced that they would financially support any Republican who voted against the bill.
This was a devastating blow that did two things. First, it signaled to members of the House Freedom Caucus that they better get in line with the demands being made by Americans for Prosperity or that organization would be looking for new blood to shift their financial support to come the next election cycle in 2018.
The second thing it did was to force the House Freedom Caucus members to come up with a list of ridiculous demands to amend the bill. Demands so hurtful to all Americans, even those who get insurance through their employer, that once given enough time to be fully explained in the news cycle, Americans were so against the proposed bill that it made it impossible for any Democrat to go along with, or any moderate Republican for that matter.
Removing the Ten Essential Health Benefits from Trumpcare meant that pregnant women wouldn’t be guaranteed access to prenatal care or care after childbirth, or that there wouldn’t be support for opioid addiction – you know, that massive problem impacting millions of families in the country. In less than a week the House Freedom Caucus forced the Administration to distort the Trumpcare bill into something unrecognizable and politically cancerous. House Freedom Caucus members apparently care more about ensuring their seats than doing what is right for the American people.
Who Are The Men And Women In The House Freedom Caucus?
It’s a question that’s been trending heavily within the last 48 hours and for good reason. So first off, “gotcha”, there are no women in the House Freedom Caucus. Secondly, not dissimilar to organized crime rings that don’t officially put members’ names on a list for publication, there is no official list of House Freedom Caucus members. Some of them openly identify themselves as members and some don’t. They don’t have a website or some official fan club, and they don’t always openly identify themselves as members to the news media. Oh, but they do have a Facebook, and a Twitter!
All of the members are basically known to Washington insiders and according to reports, the news media can “un-officially” identify them by literally watching them walk into meeting rooms.
Here’s a link to the un-official list of current members. This list is believed to be accurate.
It is pretty ridiculous that a group of elected officials, who feel so empowered to have so much influence over legislation in this country, yet have only been elected by and actually represent such a small percentage of Americans, don’t all have the courage to face the American people and answer for their actions that affect all of us.
Instead, they chose to throw a wrench into the process by which our great country has been founded on.
In closing, don’t give up hope on healthcare reform that improves outcomes for all Americans. If there’s one thing that might quickly unite both Republicans and Democrats, it very well could be taking down the Freedom Caucus members and not allowing them to derail democracy any longer.
Updated March 23rd, 2017
It’s The Final Countdown To The House Vote On Trumpcare
President Trump is reported to have made his stance clear to the House Freedom Caucus on their continually increasing demands on what they believe should be in the “Trumpcare bill”. In effect, according to President Trump, there’s no more room for negotiation. Either vote the bill through or take responsibility for not moving forward an alternative to Obamacare, and subsequently prepare yourself to answer to the Americans who voted you into office for not doing so.
Let’s face facts, there are many people who are not happy with the healthcare options that they have available to them. Premiums in some states are absurdly high, choices are limited, and the actual process to use ones healthcare can be quite difficult. There are however tens of millions of people who, despite the inherent flaws that the current solution has, don’t want to lose the coverage they have. There’s plenty of blame to go around that reaches across the aisle, Democrats and Republicans have all played their part in bringing the health insurance industry to this point.
Lets also address the reality that creating a much better healthcare system, one that works for everyone, is not an easy task. If Republicans and Democrats had worked collaboratively from the start, almost ten years ago, instead of simply toeing the line of their respective political parties, we might not be in this situation.
What was once originally the framework for Obamacare, is far different than what ended up being passed. That’s politics in the Unites States and that is the beast that Americans have to remind themselves they have to fight against. As every day Americans who are simply trying to scratch out a better life for themselves and their families, we have to remind politicians that simply focusing on party politics is no longer acceptable. People should always be above party, especially when you’re talking about policy that literally leaves peoples lives in the balance.
The Freedom Caucus has not only forgotten that they serve the American people, but they’ve quite literally asked for revisions to “Trumpcare” that are going to put millions of families at risk immediately. Why did they do this — pure partisan politics. The Freedom Caucus is a small faction within the GOP who are regarded and thought of as the more extreme members of the republican party. They frustrate to no end the majority of the GOP because they often make demands and push for policy that might sound “principled” in theory, but in practice, will often do more harm than good for the majority of Americans, especially those who are not wealthy.
Their latest efforts with respect to healthcare reform under President Trump is the best indicator of that. President Trump, Paul Ryan and Trump’s cabinet allowed the Freedom Caucus to make additional requests, or demands really, of provisions to be included in the AHCA, “trump care”. Their first set of changes were once thought to be sufficient to placate them. As we headed towards a date for a vote, word began to spread that their original demands were not enough. Shortly thereafter, it was announced that if the ten essential requirements for coverage under Trumpcare, as it is in the ACA, were not removed they would vote against the bill. President Trump, true to his word, again negotiated with the Freedom Caucus. Agreeing to remove the ten essential benefits in order to move the bill forward and pass the house.
Then, with less than twenty-four hours before a vote was to take place, Americans For Prosperity, a political action group backed by the Koch brothers, who have a combined net worth estimated to be $100 billion, announced that they would invest millions into supporting any member of the House who would dare to vote against Trumpcare. That is of course unless President Trump made one final concession. Remove the protections that prevent health insurance carriers from denying coverage to individuals with pre-existing conditions.
That’s when things came to a grinding halt and why the vote is now being pushed off until Friday. Here’s the real reason why you should be upset about all of this. All of the grandstanding that the Freedom Caucus members, and or the more extreme members of the GOP have been doing, is just a big ruse. They know that what they’re proposing, removing the ten essential benefits and asking for pre-existing conditions to be removed, which were the most popular parts of Obamacare and now Trumpcare, will never have a chance of passing in the senate. ZERO chance of passing. For the Freedom Caucus and or anyone to deny this, would be a massive whopper of a lie.
Tomorrow, the President is going to find out just how willing some members of the Republican Party are to burning it all to the ground. Democrats and Republicans, who actually want to make progress, need to prepare themselves for the grand bargain that will come in the later stages of this legislative process. If anyone thinks that there won’t be healthcare reform of some sort moving forward during Donald Trump’s presidency, they’re delusional.
It’s time that we all put our best foot forward and stop thinking of ourselves and starting thinking about the country, about the American people, and how collectively all of us — Republicans, Democrats and *miscellaneous — can all work together to improve healthcare for all Americans.
Regarding *miscellaneous, no disrespect to the other political parties not mentioned, it’s a joke. We had to throw some humor in at the end. We’d prefer you stop reading this with a smile on your face.
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Updated March 21st, 2017
Trumpcare (AHCA) Is Revised In An Attempt To Compromise With Conservative Members of GOP
President Trump, Paul Ryan and GOP leadership took a step forward in their effort to appease the more conservative members of the house, which are mostly made up of members of the House Freedom Caucus. There have been a number of complaints from Freedom Caucus members that the current bill does not go far enough in its repeal of Obamacare. In fact, they’ve mockingly referred to the “Trumpcare Plan” that was put forth as Obamacare 2.0.
Their outright rejection of the AHCA as it stands prior to yesterday’s modifications, has lead to some adjustments being made to the bill that will be up for a full vote by the House on Thursday. Those adjustments ironically aren’t going to make much of a positive impact for voters, especially the ones they should be most concerned about.
According to recent CBO estimates, the 50 to 64 demographic will be the group most hurt by the repeal and quick replacement of Obamacare. Some will see their premiums increase from an average cost of $200 month to more than $1,200, in large part because the AHCA doesn’t prevent insurance carriers from pricing plans to reflect the increased risk that older individuals represent, as compared to a younger and more active demographic.
The changes to the AHCA that came out yesterday are going to bring cheers from the wealthy, as one of the modifications moves up the date of the full repeal of the Obamacare taxes from 2018 to 2017.
Another update is that there will now be a work requirement for Medicaid eligibility. There are exceptions to this rule for people under the age of 19, heads of household who are under the age of 20 and are in school or a work training program, any woman who is pregnant, single parents and caregivers of children under the age of 6. States will have the flexibility to add their own exemptions and any state that implements a work requirement for Medicaid eligibility will receive federal funding assistance of 5%.
Another modification to Medicaid regulations are a proposed shift from Medicaid expansion based on a per capita system, to that of a block grant system. This measure is aimed at limiting the amount of coverage that states would be responsible for in all demographics and in theory would free them up to shift funds towards helping those within the 50 to 64 demographic, who are going to see such a significant increase in their premiums. That demographic is viewed as the most at risk to shift their votes should people care that their monthly costs are going to skyrocket under the current AHCA plan.
Again we feel like a broken record over here, but all of this is still very early, and there are still many changes to come. Hurdle number one for the President is to simply get the AHCA through the House. If the Freedom Caucus is allowed to be such a thorn in the side of the moderate GOP members who want to do a full repeal and replacement of Obamacare, and actually succeed in preventing the bill from passing the house, it is going to make the next steps even more unlikely to come to fruition within a reasonable timeline.
It is just not likely that the current legislation is actually what ends up moving forward and ultimately is endorsed by both republicans and democrats. As it stands now the AHCA is very light on details and specifics and is more window dressing being used to appease the irrational members of the GOP who simply want to “repeal Obamacare” regardless of who it would harm.
Early Tuesday morning President Trump met with house republicans and made clear that if the house doesn’t vote in favor of the leadership’s proposed healthcare bill, there will be consequences. According to John Bresnahan of Politico and Phil Mattingly of CNN, he expressly warned that a lot of them will lose their seats in 2018 if they don’t get this done.
While the majority of the polling population has indicated that they are not in favor of Trumpcare as it stands now, that very well might not matter. President Trump has demonstrated that he’s a master of selling things in such a way that the details don’t matter. He’s great at getting the press to cover the polarizing statements that place blame on others, and the facts that ultimately matter, those are often covered in a less sensational way that people find boring. This results in many people buying into his message and not getting into the actual details. That is a very dangerous scenario for Republicans who aren’t on Team Trump and was clearly made known with his warning to the house Freedom Caucus this morning.
What Republican voters will remember in 2018, because President Trump will remind them, and he’s got the tweets to prove it, is that President Trump was bringing forth a better solution to repeal and replace Obamacare. Unfortunately the House Freedom Caucus got in the way of that simply because of self-serving politics. Instead of allowing the mainstream GOP to roll out Trumpcare in a manner that didn’t harm Americans and prevent people from being left behind, and doing so in step with their self-described, three-step process, House Freedom Caucus Chairman, Rep. Mark Meadows and the other members felt it was more important to give tax breaks to the wealthy immediately and kick single mothers off of Medicaid.
We anticipate that the latest version of the AHCA will pass the House, because it is a lose-lose scenario for the holdouts of the more conservative members of the GOP if it does not. If President Trump’s own party doesn’t uniformly fall in line, it sends a very bad message to its base, it will slow down other legislation, and it simply further opens the door for Democrats in 2018 and beyond.
When there’s more to read about we’ll let you know. If you would like to sign up for alerts, you can do so at this link.
Updated March 13th, 2017
CBO Estimates That The “Trumpcare Bill” As It Stands Now Will Result In 24 Million Losing Coverage
Estimates from the CBO, just released today, March 13th, 2017, indicate that by 2026 more than 24 million Americans will lose their health insurance coverage under the new AHCA (American Healthcare Act), also known as “Trumpcare”. This estimate is thought to be considerably higher than what was anticipated and a significant portion of those individuals losing coverage would be Americans currently enrolled in Medicaid. Most of those individuals would see their benefits cut in 2020, a much shorter timeline than the remainder of the individuals and families within that estimate put forth by the CBO.
As always, our focus is to provide you with facts and as little commentary as possible. That said, we do feel that we should again disclose that we do not believe that the bill that has been put forth is actually meant to move forward in the first place. Instead, we feel that it is, just as President Trump hinted at, simply a starting point for negotiations.
Why do we believe this? Well excluding the more extreme members of the Republican party who view medicaid as some kind of entitlement for individuals who are not deserving of health coverage, most republicans, and all democrats, believe that taking Medicaid away from tens of millions of Americans, especially in rural areas, could eventually end up pushing votes in the next midterm election to democrats.
A Serious Cause For Concern – A Lack Of “Inside Baseball” Being Discussed
Inside baseball, for those unaware, is a term used to describe “insider knowledge” or information those within a specific industry have because they work within it on a daily basis.
What concerns us at HealthNetwork, owner of Trumpcare.com, is that we have yet to find one elected official to have discussed the real mechanics of how the health insurance industry works, more specifically how slowly it moves. Health insurance carriers are notoriously slow moving, and this isn’t intentional in the sense that moving slowly allows them to make more money. No, it’s a by-product of how complicated the entire industry is and how many moving parts there are to fix in order to make changes.
We can’t help but to be alarmed at what we often hear and read from everyday people who seem to be under the impression that when President Trump’s healthcare legislation is passed, the positive effects of what is being promised will be available immediately. There generally seems to be some kind of expectation by politicians and more importantly Americans that if any legislation, let alone the one being currently proposed is passed, that it would result in immediate cost savings and improve outcomes and quality of care.
For example if the “Trumpcare plan” being proposed now guaranteed a 40% cut in monthly premium costs, it wouldn’t be possible for health insurance carriers to bring plans to market for approximately 18 months if not longer. Health insurance carriers think about future changes and or introducing new products, expanding their footprint into new states and so on, on timelines that are typically two to three years out.
Any new healthcare reform, once passed, will take a significant amount of time for the health insurance industry to adapt to and then bring products to market reflective of that legislation. That could mean that individuals who are losing coverage could be waiting for a very long time before they see plans offering the same (approximate) level of coverage and or any other beneficial aspects to come to market. Many major health insurance carriers have jumped out of the market because they were not making money from ACA plans. It will be some time before even those who want to get back into the market can do so.
We believe a more realistic timeline for most of the United States to see a major rollout of “Trumpcare plans”, for lack of a better term, is three years.
All that said, we don’t believe that the AHCA in its current form was ever intended to move forward. It’s a really great way for both republicans and democrats to have something to work off of that most agree is very flawed. Both sides will need to save face with their respective electorate, making the AHCA the perfect vehicle to force their hands in collaboration with one another, something they historically do not often do. In their all but inevitable grand compromise with one another, something that needs as much work as the AHCA does is well suited to play that role.
Below are some bullet-point highlights from the CBO analysis.
Here are the highlights from the CBO report and how they rated Trumpcare:
- Within the next decade, 24 million Americans will be uninsured under Trumpcare.
- By 2018, 14 million more Americans would be without insurance than would be uninsured if Obamacare remained in place. CBO believes this is mostly due to the fact that the individual mandate is not part of the Trumpcare plan.
- Trumpcare would reduce the federal deficit by 337 billion dollars over the next decade.
- Most of the budgetary savings and most of the pool of newly uninsured people would come from Trumpcare’s proposal to roll back Medicaid expansions put in place by Obamacare.
- The CBO predicts that the tax credit method of public financial assistance under Trumpcare would be attractive to lower expenditure, health people and those people would enter the market and purchase insurance.
- The CBO estimates that insurance premiums would rise until 2020 and then begin to lower as was also the case under Obamacare and that by 2026, the average premium would be 10% less than it would be if Obamacare were to stay in place.
- Insurance for older people would be more expensive under Trumpcare than Obamacare. Under Trumpcare, insurance carriers are permitted to charge older Americans five-times more per month than a younger person. Under Obamacare they are permitted to charge no more than three-times more.
Updated March 7th, 2017
The Trumpcare Bill Is Out And It Is Clearly Not What Will Ultimately Be Passed And Become Law
Servers across all of our healthcare information sites, including this one, have been absolutely swamped with traffic. In fact, for HealthNetwork as a company, this is one of the largest days with respect to consumers seeking answers about the future of Obamacare, and more importantly, the healthcare reform becoming know as “Trumpcare”.
With respect to why so many people are researching Trumpcare today, it’s simple, GOP leaders within the house released a draft of a bill that outlines the first proposed steps to repeal and replace Obamacare with the GOP and President Trump’s alternative. We could have jumped on the bandwagon and started covering this in full detail immediately, but from the outset, to anyone working within the health insurance industry, it was clear that this wasn’t the final bill. This document is not what is expected to actually get passed by both republicans and democrats.
First of all, with respect to sweeping legislative change and the documents that outline any new laws, regulations and rules, this document is very succinct. It also spends a fair amount of time covering things that are not top of mind for most Americans. For example, rules that prevent individuals who have won large lottery prizes from receiving government sponsored health benefits. Put another way, there’s some “filler” material in this document.
Here are the main points that you should pay attention to in the proposed bill:
- Repeals The Individual Mandate (The Tax Penalty For Not Having Health Insurance Coverage)
- Provides Coverage For Those With Pre-Existing Conditions
- Allows Children To Stay On Parents Plan Until They Are 26
- Medicaid Expansion Is not Impacted Until 2020
- Replaces Subsidies With Refundable Tax Credits
- Removes The 3.8% Tax On Individuals Earning More Than $250,000 A Year
- Places More Focus On Encouraging People To Open Health Savings Accounts
So all that said, it doesn’t really matter at this point. Those bullet-points are nice, but truthfully what’s in the bill doesn’t matter simply because everyone on the inside knows it is simply a starting part. Right now the more conservative part of the GOP is flipping out and calling the plan “Obamacare-Lite” or “Obamacare 2.0”. Democrats are saying it is going to result in 20 million people losing their health insurance coverage. As they say, the devil is in the details, and we don’t actually have all of the details yet because they have yet to be determined.
Over the next couple of weeks or months, President Trump and his cabinet along with republicans, democrats and insurance industry executives will all be forced to begin the painful process of understanding “compromise”. Because that is what is going to be required in order to draft a replacement to Obamacare that will actually get passed.
It has to serve the interests of the American people first and foremost. We’re not going to cover and provide guidance on every little bit of information that gets released in dramatic fashion by politicians. It’s great if you’re in the news business, because drama equals dollars, but for us, we’re in this to help people make good decisions. Decisions that are based around facts and unbiased information, and right now there’s just not too much to share with you at this point.
What was released is nothing more than a working document to build from, even President Trump said so himself today.
Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster – is imploding fast!
— Donald J. Trump (@realDonaldTrump) March 7, 2017
So we suggest you sign up to receive notifications from us, and when there’s something to actually inform you about, we will. Right now everything else is basically just focused on politics, and there’s no shortage of websites that handle that “stuff”.
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