Congresswoman gives inspirational talk at NAIFA's annual Advocacy Meeting.
via https://www.naifa.org/news-publications/naifa-blog/november-2018/rep-lisa-blunt-rochester-thanks-advisors-for-the?feed=blogs
0 Comments
NAIFA CEO Kevin Mayeux wishes members a happy Thanksgiving.
via https://www.naifa.org/news-publications/naifa-blog/november-2018/naifa-members-protect-the-things-americans-are-tha?feed=blogs via https://www.naifa.org/news-publications/naifa-blog/november-2018/naifa-new-jersey-testifies-on-state-fiduciary-prop?feed=blogs via https://www.naifa.org/news-publications/naifa-blog/november-2018/naifa-members-to-convene-for-national-advocacy-mee?feed=blogs Health services researcher Lisa Lines has taken the helm in the latest edition of Health Wonk Review. over at The Medical Care Blog. Welcome, Lisa, and thanks for including our own submission, from Louise Norris. (Louise tackles a frequently question about changing income and how it affects ACA subsidy eligibility.) The edition includes eight more great blog posts. Among our favorites? Joe Paduda’s look at the mid-term elections and his conclusion that the big winner was … wait for it … Medicaid expansion. It’s a short and sweet edition, but as usual, it’s packed with great writing. Check it out! Next up: Peggy Salvatore hosts Health Wonk Review at Health System Ed on December 13. via https://www.healthinsurance.org/blog/2018/11/17/health-wonk-review-for-november-15-2018/
NAIFA supports federal approach to STLDI regulation.
via https://www.naifa.org/news-publications/naifa-blog/november-2018/states-move-to-regulate-short-term-limited-duratio?feed=blogs via https://www.naifa.org/news-publications/naifa-blog/november-2018/naifa-staff-meet-with-newly-appointed-senior-offic?feed=blogs via https://www.naifa.org/news-publications/naifa-blog/november-2018/naifa-ceo-kevin-mayeux-comments-on-the-midterm-ele?feed=blogs As a practicing physician for going on nearly 50 years now, I often feel like that auto insurance company that says “We know a thing or two because we have seen a thing or two.” After years of dealing with people who are insured, people who are uninsured and health insurance companies, I know that having real, comprehensive coverage can mean the difference between life and death. A few years back, one Republican Congressman – speaking about the impact of GOP legislation that would have drastically cut Medicaid – defended the plan he supported by stating, “Nobody dies because they don’t have access to health care.” That false assurance has been widely debunked by people who actually report on health reform or work in healthcare. But that hasn’t stopped critics of the Affordable Care Act from continuing to promise “Relax. We’ve got this” … all the while promising to dismantle a law that greatly expanded access to affordable health coverage for millions. Pre-existing conditions are a matter of life and death …The current ongoing line of false reassurances has to do with health coverage for people with pre-existing conditions. Many Republicans are on the campaign trail right now claiming that they’ve been protecting folks with pre-existing conditions all along. And these would be the same people who voted for the American Health Care Act in 2017. (The AHCA, passed by the GOP House last year, would have stripped health insurance away from people with pre-existing conditions, had its passage in the Senate not been derailed by late Sen. John McCain. The folks who wrote the ACA bent over backward to ensure that protections for millions would be a central plank of the law: Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. … for millions of Americans.In 2017, about half of non-elderly Americans – or about 130 million non-elderly people – had pre-existing conditions in the U.S., according to a brief from the U.S. Department of Health and Human Services. Nationally, the most common pre-existing conditions were high blood pressure (44 million people), behavioral health disorders (45 million people), high cholesterol (44 million people), asthma and chronic lung disease (34 million people), and osteoarthritis and other joint disorders (34 million people). – U.S. Department of Health and Human Services More and more people are beginning to understand that. Of American voters, 66 percent of registered voters said that continued protections for people with pre-existing conditions was either the “single most important factor” (14 percent) or a “very important factor” (52 percent) in their vote for a candidate. (Which explains why the GOP is suddenly claiming they love these protections.) Who are these people with pre-existing conditions?If you don’t have a pre-existing condition – or you can’t think of someone right off the top of your head who might have one – let me offer a glance at some of your fellow Americans whose stories as patients have crossed my desk over my years as a Physician Executive. Patient #1: Atrial fibrillationThis middle-aged female was sent to the Emergency Department by her cardiologist because of symptoms that included a five-day history of palpitations (feeling heart beat in chest), dizziness (imbalance) and headache. The EKG showed Atrial Fibrillation with a rapid ventricular response. She also had an elevated blood pressure that was persistent. The admitting diagnosis was new onset atrial fibrillation with rapid ventricular response. Result: This patient now has developed the dreaded “pre-existing condition.” Patient #2: Herniated discThis 30-something male patient had a 12-year history of a herniated disc. He presented to the Emergency Department with back pain and sciatica going into his left leg, associated with difficulty walking. A CT scan indicated a disc protrusion in the lower back. This patient had a medical history of a weightlifting injury and known herniated disc. On top of that he presented with a two-week history of gradually increasing low back pain with sciatica. The pain was impacting his ability to walk. An MRI revealed the thecal sac at the nerve root was indented. In layman’s terms, that means the arthritis of the spine was putting pressure on the nerve. Result: Patient #2 had a pre-existing condition and could be denied health coverage. Patient #3: High blood pressure, heart disease, chronic lung diseaseA middle-aged female patient came to the Emergency Department complaining of a pounding headache located mostly in her forehead, associated with lightheadedness. The patient had a medical history of high blood pressure and heart disease but had not taken her blood pressure medication due to financial reasons for at least two months. The patient also had a history of mild atrial fibrillation and chronic lung disease, but the patient reported that she had not had treatment for those. The patient also reported swelling in her lower extremities for which she took an over-the-counter medication. Result: This is not an unusual scenario in today’s healthcare landscape. And this patient could be denied coverage for these pre-existing conditions. Short-term plansWhile Republicans did their level best in 2017 to pass a law that would erode protections for folks like the three examples above (and many more), President Donald Trump has been providing his own false assurances about about health coverage. His promise: that Americans can relax, because he’s coming to the rescue with more (and CHEAPER) short-term health insurance alternatives. Short-term coverage is not an ideal solution for people with pre-existing conditions. The plans:
In October, new federal rules expanded the duration of short-term health plans in many states. But other states have taken a “buyer beware” approach and a handful of states – including New York and New Jersey – completely ban the sale of short-term health plans. Lack of insurance can kill you.So let’s go back to the original point of this column: that pre-existing conditions are a matter of life and death. They most definitely are – because having a pre-existing condition in the ‘good old days‘ before Obamacare meant that getting comprehensive health coverage on the individual market was difficult or near impossible. But can being uninsured really kill you? From my literature review, it’s clear that you are from 3 to 29 percent more likely to die if you don’t have health insurance than those who do! Here’s some of research:
It’s time to pay attention.The Congressman at the start of this column also famously stated that “Nobody wants anybody to die.” It sounds great – and it’s a notion that most of us can probably agree with. But at this critical juncture in our nation’s healthcare history – when Americans are more concerned than ever about losing the protections they gained from the ACA – we must pay even closer attention. We must closely examine our candidates’ voting records on healthcare. We must not simply nod our heads at last-minute promises about preserving ACA’s protections. We can’t simply decide that cheap coverage is good coverage. We should know better. After all, we’ve all “seen a thing or two.” Brian Casull has been a physician for almost 50 years in service, including 21 years in the United States Army as a Medical Corp Pediatrician and Hospital Commander. In the private sector, he has served as Medical Director for the Rocky Mountain Rehabilitation Center, Chief of Staff at the Cigna Staff Model, Medical Director for The Traveler’s Insurance Company, Los Angeles Medical Director for UnitedHealthcare, and Assistant Vice President for a Pharmacy Benefit Manager PCS in Arizona. He currently operates his own firm – Casull Healthcare Consulting – and has obtained an MPA in Health Care Organizations. He has also authored This Can Kill You: American Healthcare in Transition and is currently working on a second healthcare book. via https://www.healthinsurance.org/blog/2018/11/03/yes-not-having-health-insurance-can-kill-you/ Public health officials, advocates and scholars are mostly good souls. When healthcare access for poor or sick people is curtailed they think it’s a tragedy. And they’re right. At the same time, professional and personal commitment to improving access may have partially blinded some of these fiercely committed souls to the miracle that progressive citizen action has wrought on the healthcare front in the Trump era. Since January 2017, Republicans have hurt access to healthcare – by multi-front sabotage that’s driven up the cost of ACA-compliant, comprehensive insurance in the individual market by (conservatively) 16 percent – and via Medicaid work requirements, sought or implemented by 14 states, which could reduce ACA expansion gains by perhaps 20 to 25 percent in those states. More broadly, the U.S. healthcare system remains a hot mess, distorted by a profit-maximizing ethos, relentless consolidation, private equity ownership and balance billing that renders most people’s insurance at least partially illusory. What we haven’t lostNonetheless, the revenue streams and basic program structure implemented by the ACA to provide comprehensive health insurance to low-to-moderate-income Americans who might otherwise be uninsured remain intact. About 20 million people currently hold insurance directly subsidized through the ACA – 60 percent of that through the Medicaid expansion.* $110 billion in federal spending will flow to those programs in 2018, and $1.6 trillion from 2019 through 2028, according to the Congressional Budget Office (page 18). The percentage of uninsured Americans under age 65 has dropped from 17 percent in 2013 to 10 percent in 2018. That’s the miracle – its durability contingent on Democrats taking control of the House of Representatives on Tuesday. The damage doneIn coming years, Republican actions to undercut the ACA marketplace by creating a parallel market of medically underwritten, lightly regulated insurance may further drive up premiums and limit options for people with pre-existing conditions who need coverage in the individual market and don’t qualify for ACA subsidies. The latest blow is new guidance to states encouraging them to radically redesign their ACA marketplaces, including by allowing premium subsidies to be applied to short-term plans for which insurers can vary price according to an applicant’s medical condition and exclude coverage for pre-existing conditions. States always had the option of proposing alternative designs for their marketplaces, but previously those proposals had to stay within strict “guardrails” stipulating that the alternative scheme had to cover just as many people just as comprehensively as the default ACA design – and not hurt vulnerable groups such as low-income, sick or older enrollees. The new guidance allows “slight” disadvantaging of such groups if more people are covered as a whole. Under these loose rules, Republican-governed states might favor lightly regulated markets catering to healthy people, driving up the cost for those who don’t qualify for ACA subsidies of comprehensive insurance offered on equal terms to people with pre-existing conditions. They might also weaken or eliminate vital Cost Sharing Reduction (CSR) subsidies available to lower income enrollees – and currently accessed by more than half of marketplace enrollees. Those changes could indeed disadvantage vulnerable groups. Battered but still standingBut these blows to the ACA goal of making affordable insurance available to all – which the ACA at its best only half attained – should be viewed in light of what seemed an overwhelming likelihood in the wake of the November 2016 election and through the first half of 2017: repeal of the ACA’s core programs and funding, coupled with additional deep long-term cuts to Medicaid – which covers 75 million Americans. The repeal bill that passed the House in May 2017 would have un-insured 23 million Americans and cut $834 billion in Medicaid funding, according to the estimate of the Congressional Budget Office. If you’d have told progressives in January 2017 that the ACA would still be standing for Open Enrollment 2019 – albeit with a parallel “short-term” market and an open invitation to states to take their federal funding and redesign their markets – most would have sung hosannas. The alternative barely-regulated market and new freedom for states should also be viewed in light of the ACA’s longer history. The law has been under existential threat since it was enacted – endangered not only by the prospect of Republican takeover (avoided in 2012) but by two court challenges that made it to the Supreme Court. The second suit, King v. Burwell, which challenged the authority of the federal ACA exchange then serving 36 states, HealthCare.gov, to issue ACA premium and CSR subsidies, prompted talk of legislative compromises that would guarantee funding in exchange for creating “superwaivers” empowering states to take marketplace funding and do what they would with it. A conservative scholar, Stuart Butler of the Brookings Institute, proposed such a “superwaiver” compromise while King was awaiting a Supreme Court ruling, in April 2015. His progressive Brookings colleague, Henry Aaron, presciently forecast in January 2017 that Republicans would fail to repeal the ACA and the Trump administration would fall back on opening up the waiver process. The waiver requests aheadProgressives won’t like red states’ waiver requests. In 2017, Iowa proposed cutting out CSR and making just one plan design, with a deductible in excess of $7,000, available to all, albeit at very low premiums. Oklahoma floated a proposal, never formally submitted**, to begin subsidy eligibility at zero income (in lieu of Medicaid expansion), cut it off at 300 percent of the Federal Poverty Level (instead of the ACA’s 400 percent FPL), and, again, end CSR, shifting some of the funding to Health Savings Accounts (HSAs) to be used for out-of-pocket expenses. CSR radically cuts out-of-pocket costs for enrollees with incomes up to 200 percent FPL (with a much weaker benefit at 200 to 250 percent FPL) and thus makes actual healthcare, as opposed to mere “insurance,” affordable for many. But there’s something to be said for letting red states be … red states. Many Republican-controlled states have resisted effective ACA implementation, actively or passively – refusing to expand Medicaid eligibility, declining to actively regulate their insurance markets, putting roadblocks in the way of nonprofit enrollment assistance programs established by the ACA. A state government that redesigns its program would presumably feel a sense of ownership and try to make the scheme work, whether it struck most health care experts as good policy or not. There’s something to be said for such state ownership. More broadly, the battle over ACA repeal, embroiled as it’s been in ideological combat over marketplace design, has always fundamentally been about federal funding to provide healthcare access to those who might otherwise lack it. Republicans tried – and failed – to repeal roughly $1 trillion in healthcare funding over 10 years. They tried – and failed – to repeal expanded access to Medicaid, which provides the poor and near-poor access to healthcare free of out-of-pocket costs they can’t manage. They tried – and failed – to restructure the marketplace so that low-income enrollees got less assistance and affluent people – earning over 400 percent FPL – got more. They failed because massive, spontaneous and highly effective citizen protest induced just enough Republicans – three in the Senate, to be exact – to take their fingers off the trigger – one of them (the late John McCain) after midnight on a vote where repeal seemed certain. That was a miracle of not-dead-yet democracy. Election day – and health reform’s fateThat miracle will either be extended or negated on election day. If Republicans hold House and Senate, they have vowed to get repeal done – and this time, with McCain dead and their Senate majority likely extend, they won’t fail. If Democrats win control of the House of Representatives, Republicans will lose power to redesign or defund the ACA. That’s one of the many existential choices facing Americans on November 6. * Probably another 8 to 10 million are insured through indirect effects of the ACA – increased enrollment in Medicaid by people who would have been eligible even without the ACA’s expansion of eligibility, unsubsidized enrollment in the individual market by those who would have been shut out because of pre-existing conditions or who were induced by the individual mandate, and other effects of the mandate. ** Oklahoma did submit a more limited waiver proposal to establish a reinsurance program, as several states have done successfully. The state withdrew the proposal when CMS failed to approve it in time to affect premiums for 2018. Andrew Sprung is a freelance writer who blogs about politics and policy, particularly health care policy, at xpostfactoid. His articles about the rollout of the Affordable Care Act have appeared in The Atlantic and The New Republic. He is the winner of the National Institute of Health Care Management’s 2016 Digital Media Award. via https://www.healthinsurance.org/blog/2018/11/02/the-healthcare-miracle-that-this-election-could-ratify/ |
|