Category Archives: Congress

Executive (Dis)order

The signing this morning of an executive order by the Orangutan will have, in the opinion of some of the bloggers and politicians, spell disaster for the nation’s health care system.

It will, if carried into action, likely siphon healthy people from the Affordable Care Act-compliant market, continuing a pattern of regulatory actions under the Trump administration that have undermined the ACA.

The rationale for such a move that has been given is that since Congress has not been able to repeal and replace the ACA, an executive order will, piece by piece.

Coupled with the recent budget move to eliminate the CHIP program for children’s health (New York State faces dire consequences if Congress does not act on CHIP), and cut backs to Medicare and Medicaid, the intent here is to privatize health care for some, and eliminate it for others, and to get government out of health care providing altogether.

There are provisions in this order for greater competition, short-term coverage, and lower premiums with less coverage. Why this is better is beyond me, unless the Orangutan is seeking to destroy health care so that single-payer will be the only option.

Cutting healthy people out of the ACA means leaving sick people to struggle with a health care law that many say needs to be fixed, not repealed and replaced. But because the Tea Party ranted and raved before it was enacted, and the Orangutan and the GOP campaigned on getting rid of it, they had no choice but to sabotage it if they could not do so through legislation.

I predict that we will soon see the total collapse of our health care system thanks to this stupid, overreaching, and ill-advised Executive Order. I even read today that the Vice President had to remind the Orangutan to sign the darn thing, something that almost slipped what is left of his so-called mind.

Welcome to Crackerbox Palace.

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The End of the World Is Near (The Health Care World, That Is)

Fellow blogger, Joe Paduda, brilliantly summed up the current GOP attempt to blow up the nation’s health care system in today’s post.

Rather, than repeat and comment on what he wrote, I am letting you read the post here.

Then there is a great graphic on what the Cassidy-Graham bill will mean for states, and from a brief look at it, I can say that they are playing favorites with some, but not all of the states of the former Confederacy, and sticking it to those states in the North (and West like California) who they have disdain for.

Because of it’s dire impact on the health care system, it should actually be called the Butch Cassidy and the Sundance Kid bill, because like those two 19th century bandits, they are going to rob us blind. How do you say “We are taking back your health care” in Spanish?

But, in actuality, it is just another way of giving a tax break to the wealthy at the expense of everyone else.

If this bill passes, and the Orangutan signs it, the end of the world in health care would soon follow. The only option then would be single-payer, and it would be ironic and even cruel if that was the GOP’s game plan all along. Wreck the health care system so that single-payer is the only option left, and if that fails, they drop the whole thing and move on.

We shall see next week, as there are two Senators who may hold the future of health care in their hands, Collins of Maine and Murkowski of Alaska.

The “Curse” of For-Profit Health Care

Recently, Vermont Senator Bernie Sanders introduced a Medicare for All bill into the U.S. Senate, and many Democratic Senators signed on as co-sponsors of the bill.

Earlier yesterday morning, on his way to a photo-op in Naples, Florida to see the damage from Hurricane Irma (why didn’t he go to the Keys), the Orangeman tweeted that Senator Sanders’ bill would visit a curse on the U.S.

This from a man who said that he preferred the Canadian system, and told the Australian Prime Minister to his face, and the cameras, that they had a better health care system than the US.

What are we to make of someone who likes other countries health care systems as long as it is not our system? What do we do when the elected leaders of this country are dead set against providing the best health care system to their constituents, and in fact, are determined to take away what little health care they already have?

I find it rather odd, and callous that the Orangutan calls Sen. Sanders’ plan a curse, when millions of Americans are cursed everyday with not having any health care, or minimal care at best.

No, what is a curse are families going broke paying for medical care, individuals forgoing needed care because it costs too much, doctors and nurses burned out because they are overworked, underpaid (in some cases), and trying to work in a broken, bureaucratic, sclerotic, and byzantine system.

The American “health care” system is the curse. The cure, or rather the silver bullet for this vampiric monster, is single-payer. Maybe Sen. Sanders’ bill won’t pass this time, with this Congress and this President, but it or something like it should in the future.

Our curse as a nation is in our slavish devotion to making everything conform to the will and whim of the free market. We have seen that the free market is great for the production and selling of goods and services, but health care is not a consumer good. It is a right of every man, woman, and child.

The Canadians, the Australians, the British, and many other nations are not so slavishly devoted to the free market as we are when it comes to providing health care to all their citizens, and they cannot be called “Socialist” or “Communist” in any way, shape, or form.

Only because of the greed of a few insurance companies, Wall Street players and their investor clients, as well as very wealthy Libertarian brothers from the energy sector do we continue to be cursed with the worse system for providing health care.

Finally, the ultimate curse this nation has is the individual who said single-payer would be a curse. And like Dracula, only the light of day will stop him.

Follow-up to Insurers Jacking Up Premiums Ahead of End of CSR’s

Health Affairs blog posted the following stating that if the Administration terminates cost-sharing reduction payments (CSR’s), the states can use 1332 waivers to fund their own.

Here is the article in full by Steven Chen:

One of the main causes of instability in the Affordable Care Act (ACA) health exchanges, aside from the constant stream of repeal-and-replace efforts, is the uncertainty over the future of the cost-sharing reduction (CSR) payments. CSR and the advanced premium tax credits (APTC) are subsidies created by the ACA to enhance the affordability of the qualified health plans sold on the health exchanges. Whereas the APTC reduces the cost of premiums to beneficiaries with incomes between 100 and 400 percent of the federal poverty level, CSR lowers the out-of-pocket expenses of beneficiaries with incomes between 100 and 250 percent of the federal poverty level.

Unlike the APTC, whose legal status is not in question, the U.S. House of Representatives had challenged the appropriation status of the CSR payments by filing a lawsuit against the Obama administration, thereby creating doubts about CSR’s future. In addition to the said litigation, the current administration has compounded the uncertainty by often withholding the CSR payments until the 11th hour and threatening to terminate the payments completely.

This uncertainty comes at a cost. Some insurers have cited the uncertainty as one of the reasons for their exodus from the health exchanges while others have referenced the uncertainty as a source for their 2018 premium hikes. While the extent of the premium increase is yet to be determined, a study by the Kaiser Family Foundation estimated that without CSR payments, the insurers would need to raise silver plan premiums by about 19 percent.

Can States Step In?

What can States do if the administration follows through on its threat to terminate the CSR payments? A simple solution is for the States to provide the CSR payments themselves. In addition to making health insurance affordable, CSR payments are cost effective: The provision of CSR payments by the Federal government lowers the silver plan premiums offered on the health exchanges because the insurers are compensated for the reduced cost-sharing they are required to provide. Without the CSR payments, insurers will raise silver plan premiums—including the premiums for the benchmark silver plans—to offset their losses, which leads to higher APTC for all eligible beneficiaries, ultimately resulting in greater overall Federal expenditure. The aforementioned Kaiser Family Foundation study quantified this effect by demonstrating that if CSR payments were terminated in 2018, although the Federal government would save $10 billion from not making the CSR payments, it would have to pay an additional $12.3 billion in APTC, thus increasing overall Federal expenditure by $2.3 billion.

Creating a State-administered CSR mechanism will undoubtedly require expenditure from the State. While some will argue that the limited resources available in State budgets would render the idea all but theoretical, it would be beneficial to examine how States can use Section 1332 of the ACA to fund—and potentially profit from—providing CSR.

The California Example

The intricacies of a Section 1332 State Innovation Waiver (1332 Waiver) have been explained in depth elsewhere, but on a fundamental level, Section 1332 of the ACA permits a State to apply for a waiver to modify or waive certain provisions of the ACA, such as the individual mandate and the establishment of health exchanges, among others. The waiver application must satisfy four statutory constraints—comprehensiveness, affordability, scope of coverage, and will not increase the Federal deficit—but should an application meet all the criteria, the State is eligible to receive any APTC or CSR that the State would have otherwise received without the 1332 Waiver. In layman terms, if a State can create a system that meets the Federal standard at a cost that is the same or less than the existing Federal model, the State gets to keep the money the Federal government would have otherwise spent.

Using California as an example, Covered California showed that the termination of CSR payments by the Federal government would cause insurance premiums for silver plans in the individual market to increase by 16.6 percent in 2018. The study also showed an inverse relationship between CSR and APTC: The Federal government paid $750 million in CSR payments in 2016, but if it were to defund CSR payments, not only would it not receive any savings, it would incur an additional $976 million in APTC spending. Using these figures as illustration, if the Federal government had terminated CSR payments in 2016 and if California had provided CSR payments through a 1332 Waiver, under this scenario California would have to pay $750 million in CSR payments, but it would receive $976 million from the Federal government in lost APTC payments—payments California would have otherwise received without waiver—ending up with a total net profit of $226 million! California could use the profit to create a reinsurance program to bolster its health exchange, to increase payments to providers, or it could spend the excess on non-health related projects like fixing potholes and infrastructure because there is no restriction on the usage of the excess pass-through funding.

Even without a lengthy legal analysis, it is obvious this waiver satisfies all the statutory constraints: (1) since the waiver does not modify the Essential Health Benefits or any coverage requirements, it meets the comprehensiveness test; (2) since the waiver would lower premiums and out-of-pocket costs, it would actually improve affordability; (3) since the waiver would improve affordability, it is expected to increase scope of coverage; and finally (4) the numbers show that the waiver will not increase the Federal deficit. In fact, it should be intuitive why this proposal would meet the requirements of the ACA — it was built to be part of the ACA to begin with.

While the Administration isn’t obligated to approve any waiver applications, a 1332 Waiver application that creates a State-operated CSR payment mechanism—and uses the excess pass-through funding to finance a State reinsurance program—is conceptually consistent with the Administration’s emphasis on enhanced State flexibility and empowerment. The first executive order by the Administration, for example, promised to provide greater flexibility to the States under the ACA. Moreover, the Secretary of Health and Human Services recently sent a letter to State governors encouraging the application of 1332 Waivers and even provided a checklist to help expedite the process.

Given the cost-saving advantages of CSR payments, it is puzzling that the Federal government would consider terminating this effective subsidy. In addition to the money the Federal government would save, forcing States to spend the time and expense to develop and administer separate CSR operations also argue against ending Federal CSR payments. Indeed, even Republican members of Congress have begun to warm to the idea of continuing CSR payments. However, should the Federal government decide against it, States have a viable, and potentially profitable, means of administering CSR payments to stabilize their insurance markets.

 

Single Payer Supported by Majority of Physicians

A shout-out to Dr. Don McCanne for posting the following article from Merritt Hawkins.

Merritt Hawkins
August 14, 2017
Survey: 42% of Physicians Strongly Support a Single Payer Healthcare System, 35% are Strongly Opposed
By Phillip Miller
A plurality of physicians strongly support a single payer healthcare system, according to a new survey by Merritt Hawkins.
The survey of 1,033 physicians indicates that 42 percent strongly support a single payer health care system while 14 percent are somewhat supportive. Over one-third (35 percent) strongly oppose a single payer system while six percent are somewhat against it. The remaining three percent neither support nor oppose single payer.
The results contrast with a national survey of physicians Merritt Hawkins conducted in 2008, which indicated that 58 percent of physicians opposed single payer at that time while 42 percent supported it.
In Merritt Hawkins’ experience, there are four reasons why a growing number of physicians are in favor of single payer. First, they are seeking clarity and stability. The fits and starts of health reform and the growing complexity of our current hybrid system are a daily strain on most doctors. Many of them believe that a single payer healthcare system will reduce the distractions and allow them to focus on what they have paid a high price to do: care for patients.
Second, it’s a generational issue. The various surveys that Merritt Hawkins has conducted for The Physicians Foundation in the past show that younger doctors are more accepting of Obamacare, ACOs, EHR, and change in general than are older physicians As the new generation of physicians comes up, there is less resistance among doctors to single payer.
Third, there is a feeling of resignation rather than enthusiasm among some physicians about single payer. These physicians believe we are drifting toward single payer and would just as soon get it over with. The 14% of physicians surveyed who said they “somewhat” support single payer are probably in this group.
Fourth, there is a philosophical change among physicians that I think the public and political leaders on both sides of the aisle now share, which is that we should make an effort to cover as many people as possible.
However, while single payer has gained acceptance among some physicians, it remains strongly opposed by over one third and strongly or somewhat opposed by over 40 percent. It is still a polarizing issue among physicians and is likely to remain so for the foreseeable future.
So, if a majority of physicians support single payer, and they are the ones we should listen to when it comes to taking care of our health, and if a growing majority of Americans are coming around to this idea, then the only ones standing in the way are our politicians.
POTUS, the Secretary of Health and Human Services, Mitch McConnell, Paul Ryan, Rand Paul, and the medical-industrial complex of insurance companies, drug companies, and medical device manufacturers are all opposed and are preventing this nation from joining the rest of the developed world in providing health care to ALL its citizens.
And there is one more obstacle in our way: Wall Street investors and their clients who are funding insurance and medical companies, engaging in adverse selection and determining who lives and who dies. Who gets covered and who goes into bankruptcy.
They need to removed from the equation.

The Economist Explains it All: What the U.S, Needs to Do With Health Care

Thursday’s The Economist had the following article.

It explains what the U.S. needs to do to fix health care.

Our leaders in Congress, both Democrats, and especially Republicans should listen to what it has to say.

Medicare for All is not socialism, socialized medicine, or communism. But the status quo is health care capitalism, and has been a disaster.

Insurers Jacking Up Premiums Ahead of End of CSRs

An article in Healthcare Finance News.com on Friday, said that insurers are factoring in the end of the cost-sharing reduction payments into their rate increases from 2 to 23 percent, according to a report from the Kaiser Family Foundation.

The article states the following:

“Insurers in 20 states and the District of Columbia have filed premium rate requests for the federal exchange ahead of an August 16 deadline, many on the assumption that cost-sharing reduction payments will not be paid and that the individual mandate will either not be enforced or weakly enforced, according to a Kaiser Family Foundation report released Thursday.”

According to Kaiser, silver premiums would have to increase by 19 percent on average to compensate for the loss of CSR payments.

Susan Moore, the Associate Editor for Healthcare Finance News.com, also said that insurers are building uncertainty into their rates, filing under multiple scenarios involving CSRs and the individual mandate.

The threat from the POTUS to Mitch McConnell to push him to repeal and replace the ACA means that if POTUS does get his way, CSR’s would end and so would the individual and employer mandates. Also, the health insurance tax return in 2018 will add 3 percent to premiums.

You can read the rest of the article yourselves, but consider this. Isn’t time to end this nonsense of charging people insurance premiums that are constantly rising just so that a bunch of greedy health insurance companies and their Wall Street investors profit from people’s health?

When are we going to wise up and put and end to this game of playing with people’s health and forcing many into bankruptcy because they have severe medical issues?

When are we going to realize that health care is a human right, and not a commodity that can be marketed like consumer goods?

Medicare for All will end this constant round of rate increases and shenanigans the health insurers perpetrate on the American people.