After Years of Quiet, Democratic Candidates Can’t Stop Talking About Health Care
A potent campaign theme emerges across the nation, with a particular emphasis on pre-existing conditions.
by Margot Sanger-Katz - NYT - August 1, 2018
In June, Senator Claire McCaskill of Missouri asked voters at a big political dinner to stand up if they had a pre-existing health condition.
She’d been hearing from voters at town hall meetings that they were worried about health care. “I just thought of it frankly at the podium,” she said. “I was just betting this is not that different from my town halls.”
The room was suddenly filled with standing voters. “Even I was stunned just how few people kept their seats,” she said.
Now, Ms. McCaskill asks the question at every event. A few weeks ago, she mentioned the experience to her colleague Joe Donnelly of Indiana, another Democratic senator in a close race for re-election this year. His version — asking coal workers at a Boonville, Ind., rally how many knew someone with a pre-existing condition — “really moved me,” Mr. Donnelly said. It has become a staple of his campaign events, too.
After nearly a decade of playing defense on the issue, Democratic congressional candidates around the country are putting a health care message at the center of their campaigns. After the Republicans’ failed effort to repeal the Affordable Care Act, Democrats have detected a newfound concern that the consumer protections established under the law might go away. And that fear has turned into a potent campaign theme.
More than a quarter of working-age adults have a pre-existing health condition, like asthma, diabetes or cancer, that might have locked them out of the insurance market in the years before Obamacare, according to research from the Kaiser Family Foundation. Surveys show that far more have a friend or family member with a serious medical problem. Because health problems tend to pile up as people age, the older voters who tend to turn out most reliably in midterm elections experience such worry disproportionately.
“I completely can see why they’re excited to be able to talk about this issue again,” said Mollyann Brodie, a senior vice president at Kaiser, who runs the group’s public opinion polling. The foundation’s most recent survey, released last week, found that pre-existing conditions had become the most important health care concern among voters, ranked the most important campaign issue for many of them over all. “I agree with the strategy, based on our polling and everyone else’s polling. It’s a time when it is going to work.”
It’s not just red-state Democratic senators who are focusing on pre-existing conditions. The issue is coming up in House races across the country. Tyler Law, a spokesman for the Democratic Congressional Campaign Committee, ticked off districts — in Arkansas, Washington, New Jersey — where it’s a major campaign theme. In markets with close races, the committee is running its own advertisements on health care.
“We’re seeing candidates in every single district talking about health care,” he said. “There is nowhere this does not play.”
TJ Cox, a candidate in California’s 21st District, in the state’s Central Valley, said the issue was personal to him. He remembers being pulled aside by a hospital employee while his wife was in labor and told that her C-section would not be covered by his insurance, because she was pregnant when he bought the policy. Fortunately for him, his wife, a physician, had her own coverage.
He also hears about the issue from voters, including one who recently told him about the high cost of medications for hepatitis C, which the man could afford only with the help of insurance. “He was saying literally, ‘I’m glad I got sick now, because before I don’t know what I would have done,’ ” Mr. Cox said. “He was uninsurable.”
Analysis of television ads through May from the Wesleyan Media Project found that health care was the most common subject of Democratic campaign ads.
The new emphasis on the issue stands in contrast with Democratic campaign themes of the last four election cycles. In those races, it was Republicans who were using health care as their rallying cry. “Repeal and replace” was the centerpiece of many Republican campaigns for four cycles, and one of the most unifying positions among Republican voters. It was not a coincidence that repealing Obamacare became President Trump’s first legislative priority after taking office.
Protection for people with pre-existing conditions was a major part of the Affordable Care Act, but Democrats struggled to find ways to champion the law, which was unpopular and polarizing. When asked, they would defend Obamacare. But they rarely emphasized their support. In 2014, ad research from Wesleyan shows, the vast majority of health care ads were those opposed to the health law.
“I’ll be the first to admit I’m as surprised as anyone to be in this position,” said Brad Woodhouse, the executive director of the health care advocacy group Protect Our Care. Mr. Woodhouse worked at the Democratic National Committee when the Affordable Care Act passed in 2010, and saw Democrats struggle to discuss it in the years afterward. “But every poll we take, it’s the issue that’s most important to people.”
The newfound Democratic health care enthusiasm may not translate into victories, of course. Republican campaigns are turning away from health care as a major issue this cycle, planning to pay more attention to other messages like immigration, job creation and attacks on Democrats. When they talk about health care, many candidates are focusing on Democratic efforts to expand public health insurance coverage, not on continued calls to repeal Obamacare.
“People tend to vote with their pocketbooks, and the strong economic performance will be at the forefront of every discussion this fall,” said Jesse Hunt, a spokesman for the National Republican Congressional Committee, adding, “A contrast between single-payer health care and our ideas — a more patient-centered approach — is a debate we fully welcome.”
But some Republicans are sticking to the old anti-Obamacare script. In Missouri, Ms. McCaskill’s expected opponent, Josh Hawley, the state attorney general, talks about health care frequently. “I talk about Obamacare and just the broken health care system,” he said, noting that the rising cost of health insurance is one of several factors eroding middle-class security.
Two main changes appear to have turned the tide on health care as an issue. The Republican effort to repeal Obamacare last year made the embattled health law more popular than it has ever been. For the first time, the Affordable Care Act earned the support of a majority of Americans in public polls, a small shift but one that has been durable, even as Congress moved on to a tax overhaul and other issues. Pre-existing condition protections have always been much more popular than the law over all.
The threat of repeal appears to have been particularly galvanizing for Democratic activists, who came out to protest and contact their legislators during the debate.
The second change came more recently, when the Trump administration decided not to defend Obamacare from a lawsuit brought by the Republican attorneys general of 20 states. The lawsuit argues that the entire law should be invalidated as unconstitutional. The Trump administration’s position is that most of the law should remain on the books, but that its protections for people with pre-existing illnesses should be stripped away.
Mr. Hawley is one of the attorneys general who has signed on to the lawsuit, though he argues that pre-existing conditions protections could be preserved without the Affordable Care Act. Patrick Morrisey, the West Virginia attorney general, has also joined the lawsuit and is running for Senate.
Several Democratic candidates and campaign consultants described the lawsuit as a political gift, because it clarified the contrast between the two parties on an emotionally resonant issue.
“What has changed is all the warning lights are on right now,” Mr. Donnelly said.
Now, Ms. McCaskill asks the question at every event. A few weeks ago, she mentioned the experience to her colleague Joe Donnelly of Indiana, another Democratic senator in a close race for re-election this year. His version — asking coal workers at a Boonville, Ind., rally how many knew someone with a pre-existing condition — “really moved me,” Mr. Donnelly said. It has become a staple of his campaign events, too.
After nearly a decade of playing defense on the issue, Democratic congressional candidates around the country are putting a health care message at the center of their campaigns. After the Republicans’ failed effort to repeal the Affordable Care Act, Democrats have detected a newfound concern that the consumer protections established under the law might go away. And that fear has turned into a potent campaign theme.
More than a quarter of working-age adults have a pre-existing health condition, like asthma, diabetes or cancer, that might have locked them out of the insurance market in the years before Obamacare, according to research from the Kaiser Family Foundation. Surveys show that far more have a friend or family member with a serious medical problem. Because health problems tend to pile up as people age, the older voters who tend to turn out most reliably in midterm elections experience such worry disproportionately.
“I completely can see why they’re excited to be able to talk about this issue again,” said Mollyann Brodie, a senior vice president at Kaiser, who runs the group’s public opinion polling. The foundation’s most recent survey, released last week, found that pre-existing conditions had become the most important health care concern among voters, ranked the most important campaign issue for many of them over all. “I agree with the strategy, based on our polling and everyone else’s polling. It’s a time when it is going to work.”
It’s not just red-state Democratic senators who are focusing on pre-existing conditions. The issue is coming up in House races across the country. Tyler Law, a spokesman for the Democratic Congressional Campaign Committee, ticked off districts — in Arkansas, Washington, New Jersey — where it’s a major campaign theme. In markets with close races, the committee is running its own advertisements on health care.
“We’re seeing candidates in every single district talking about health care,” he said. “There is nowhere this does not play.”
TJ Cox, a candidate in California’s 21st District, in the state’s Central Valley, said the issue was personal to him. He remembers being pulled aside by a hospital employee while his wife was in labor and told that her C-section would not be covered by his insurance, because she was pregnant when he bought the policy. Fortunately for him, his wife, a physician, had her own coverage.
He also hears about the issue from voters, including one who recently told him about the high cost of medications for hepatitis C, which the man could afford only with the help of insurance. “He was saying literally, ‘I’m glad I got sick now, because before I don’t know what I would have done,’ ” Mr. Cox said. “He was uninsurable.”
Analysis of television ads through May from the Wesleyan Media Project found that health care was the most common subject of Democratic campaign ads.
The new emphasis on the issue stands in contrast with Democratic campaign themes of the last four election cycles. In those races, it was Republicans who were using health care as their rallying cry. “Repeal and replace” was the centerpiece of many Republican campaigns for four cycles, and one of the most unifying positions among Republican voters. It was not a coincidence that repealing Obamacare became President Trump’s first legislative priority after taking office.
Protection for people with pre-existing conditions was a major part of the Affordable Care Act, but Democrats struggled to find ways to champion the law, which was unpopular and polarizing. When asked, they would defend Obamacare. But they rarely emphasized their support. In 2014, ad research from Wesleyan shows, the vast majority of health care ads were those opposed to the health law.
“I’ll be the first to admit I’m as surprised as anyone to be in this position,” said Brad Woodhouse, the executive director of the health care advocacy group Protect Our Care. Mr. Woodhouse worked at the Democratic National Committee when the Affordable Care Act passed in 2010, and saw Democrats struggle to discuss it in the years afterward. “But every poll we take, it’s the issue that’s most important to people.”
The newfound Democratic health care enthusiasm may not translate into victories, of course. Republican campaigns are turning away from health care as a major issue this cycle, planning to pay more attention to other messages like immigration, job creation and attacks on Democrats. When they talk about health care, many candidates are focusing on Democratic efforts to expand public health insurance coverage, not on continued calls to repeal Obamacare.
“People tend to vote with their pocketbooks, and the strong economic performance will be at the forefront of every discussion this fall,” said Jesse Hunt, a spokesman for the National Republican Congressional Committee, adding, “A contrast between single-payer health care and our ideas — a more patient-centered approach — is a debate we fully welcome.”
But some Republicans are sticking to the old anti-Obamacare script. In Missouri, Ms. McCaskill’s expected opponent, Josh Hawley, the state attorney general, talks about health care frequently. “I talk about Obamacare and just the broken health care system,” he said, noting that the rising cost of health insurance is one of several factors eroding middle-class security.
Two main changes appear to have turned the tide on health care as an issue. The Republican effort to repeal Obamacare last year made the embattled health law more popular than it has ever been. For the first time, the Affordable Care Act earned the support of a majority of Americans in public polls, a small shift but one that has been durable, even as Congress moved on to a tax overhaul and other issues. Pre-existing condition protections have always been much more popular than the law over all.
The threat of repeal appears to have been particularly galvanizing for Democratic activists, who came out to protest and contact their legislators during the debate.
The second change came more recently, when the Trump administration decided not to defend Obamacare from a lawsuit brought by the Republican attorneys general of 20 states. The lawsuit argues that the entire law should be invalidated as unconstitutional. The Trump administration’s position is that most of the law should remain on the books, but that its protections for people with pre-existing illnesses should be stripped away.
Mr. Hawley is one of the attorneys general who has signed on to the lawsuit, though he argues that pre-existing conditions protections could be preserved without the Affordable Care Act. Patrick Morrisey, the West Virginia attorney general, has also joined the lawsuit and is running for Senate.
Several Democratic candidates and campaign consultants described the lawsuit as a political gift, because it clarified the contrast between the two parties on an emotionally resonant issue.
“What has changed is all the warning lights are on right now,” Mr. Donnelly said.
Single-Payer Health Plan in New York State Could Cover All Without Increasing Total Health Spending If Cost Growth Slows
by The Rand Corporation - August 1, 2018
A single-payer health care plan could expand coverage for all New York State residents, but would require significant new tax revenue, according to an analysisreleased today by the RAND Corporation and the New York State Health Foundation.
A plan outlined by the New York Health Act is likely to increase use of health services as more people receive coverage. But overall health care costs would decrease slightly over time if administrative costs are reduced and state officials slow the growth of payments to health care providers, according to the analysis.
The New York Health Act proposes progressively graduated taxes to fund the plan, but does not specify tax rates or structure. Researchers estimate that possible tax schedules imposed to support a single-payer plan would cut health care payments for most of the state's households, while the highest-income households would pay substantially more than they do today.
“Our analysis finds that a single-payer plan in New York does not have to increase the amount of money spent overall on health care in the state, but it would substantially change who pays for health care,” said Jodi Liu, the study's lead author and an associate policy researcher at RAND, a nonprofit research organization. “While we estimate the impacts of the New York Health Act across a number of reasonable assumptions, the actual effects would be subject to many future decisions that ultimately influence cost and who pays.”
“There was a great need for an independent, rigorous, and credible analysis of an issue that has arrived center stage for New York State and the nation,” said David Sandman, president and CEO of the New York State Health Foundation, a private, statewide foundation. “With a fair and factual assessment in hand, the public and policymakers can make up their own minds about the merits of a single-payer approach.”
by The Rand Corporation - August 1, 2018
A single-payer health care plan could expand coverage for all New York State residents, but would require significant new tax revenue, according to an analysisreleased today by the RAND Corporation and the New York State Health Foundation.
A plan outlined by the New York Health Act is likely to increase use of health services as more people receive coverage. But overall health care costs would decrease slightly over time if administrative costs are reduced and state officials slow the growth of payments to health care providers, according to the analysis.
The New York Health Act proposes progressively graduated taxes to fund the plan, but does not specify tax rates or structure. Researchers estimate that possible tax schedules imposed to support a single-payer plan would cut health care payments for most of the state's households, while the highest-income households would pay substantially more than they do today.
“Our analysis finds that a single-payer plan in New York does not have to increase the amount of money spent overall on health care in the state, but it would substantially change who pays for health care,” said Jodi Liu, the study's lead author and an associate policy researcher at RAND, a nonprofit research organization. “While we estimate the impacts of the New York Health Act across a number of reasonable assumptions, the actual effects would be subject to many future decisions that ultimately influence cost and who pays.”
“There was a great need for an independent, rigorous, and credible analysis of an issue that has arrived center stage for New York State and the nation,” said David Sandman, president and CEO of the New York State Health Foundation, a private, statewide foundation. “With a fair and factual assessment in hand, the public and policymakers can make up their own minds about the merits of a single-payer approach.”
About the New York Health Act
The New York State Legislature is considering a bill that would create a single-payer plan providing coverage to all state residents. In addition, calls for some type of single-payer health plan have increased at the national level.
As outlined in the legislation, the plan—to be called New York Health—would offer comprehensive benefits, except for long-term care benefits that may be included later. Patients would have no deductibles, copayments or other out-of-pocket costs at the point of service for covered services.
The plan would be funded by a new trust fund, which would receive funding from the federal government (in lieu of federal financing for current health programs in the state, if federal waivers are approved), current state and local funding for health care, and revenue from two new state taxes. One would be a payroll tax paid jointly by employers (80 percent) and employees (20 percent). A second tax would be on income not subject to payroll taxes, such as interest, dividends and capital gains.
RAND researchers used a microsimulation model to estimate the plan's effects on health care use, spending, and payments in New York compared to what is expected under the status quo for the years 2022, 2026 and 2031.
The New York State Legislature is considering a bill that would create a single-payer plan providing coverage to all state residents. In addition, calls for some type of single-payer health plan have increased at the national level.
As outlined in the legislation, the plan—to be called New York Health—would offer comprehensive benefits, except for long-term care benefits that may be included later. Patients would have no deductibles, copayments or other out-of-pocket costs at the point of service for covered services.
The plan would be funded by a new trust fund, which would receive funding from the federal government (in lieu of federal financing for current health programs in the state, if federal waivers are approved), current state and local funding for health care, and revenue from two new state taxes. One would be a payroll tax paid jointly by employers (80 percent) and employees (20 percent). A second tax would be on income not subject to payroll taxes, such as interest, dividends and capital gains.
RAND researchers used a microsimulation model to estimate the plan's effects on health care use, spending, and payments in New York compared to what is expected under the status quo for the years 2022, 2026 and 2031.
Key Findings
The analysis estimates that under the New York Health Act, total health spending would be similar in 2022 as with the status quo and become 3 percent lower by 2031. The decrease reflects the assumption that provider payment rates would grow more slowly over time under New York Health than the current health system, as has been the case with other publicly financed health programs.
Researchers estimate that new taxes for health care would need to be about $139 billion in 2022 and $210 billion in 2031 to fully finance New York Health. Under the status quo, the state is expected to collect about $89 billion in taxes from all sources in 2022; thus, the new taxes would be a 156 percent increase in total state tax revenue.
As payments for health care shift from premiums and out-of-pocket payments to progressive taxes, most households in New York could pay less and the highest-income households could pay substantially more, suggests the RAND study. The shift in who pays more or less would ultimately depend on the design of the tax schedule.
The analysis estimates that under the New York Health Act, total health spending would be similar in 2022 as with the status quo and become 3 percent lower by 2031. The decrease reflects the assumption that provider payment rates would grow more slowly over time under New York Health than the current health system, as has been the case with other publicly financed health programs.
Researchers estimate that new taxes for health care would need to be about $139 billion in 2022 and $210 billion in 2031 to fully finance New York Health. Under the status quo, the state is expected to collect about $89 billion in taxes from all sources in 2022; thus, the new taxes would be a 156 percent increase in total state tax revenue.
As payments for health care shift from premiums and out-of-pocket payments to progressive taxes, most households in New York could pay less and the highest-income households could pay substantially more, suggests the RAND study. The shift in who pays more or less would ultimately depend on the design of the tax schedule.
Estimates of New Taxes
While the bill mandates only that the new taxes be graduated and does not specify the levels, RAND researchers estimate the impacts of one possible set of graduated marginal tax rates applied to three income brackets. The analyzed scenario has a payroll tax that begins at 6 percent for the lowest bracket (those earning under $27,500 in 2022), rises to 12 percent for the middle bracket, and to 18 percent for those in the highest bracket (above $141,200 in 2022). The nonpayroll tax follows the same schedule and the rates are about 6 percent, 12 percent, and 19 percent for the three brackets.
Under these analyzed tax schedules in 2022, New Yorkers with household compensation (income plus employer contributions to health care) below the 90th percentile would pay an average of $2,800 less per person for health care. While payments decline for most people in this group, payments would likely increase for those people who work for employers that did not previously offer health care coverage.
For New York residents in the 90th to 95th percentile of the household compensation, average health care payments would increase by $1,700 per person in 2022. The top 5 percent of New Yorkers by household compensation—a heterogeneous group with average household compensation of about $1,255,700 in 2022—would pay an average of $50,200 more per person.
The effects on employer health care payments would vary by whether the business currently provides health care to workers, according to the study. Employers that currently offer health coverage would contribute $200 to $800 less per worker on average for employee health benefits under the single-payer plan in 2022. Meanwhile, employers who do not offer coverage under the status quo would pay an estimated $1,200 to $1,800 more per worker on average in 2022 because of new payroll taxes.
Researchers say that the introduction of new taxes could result in some residents and businesses leaving the state, potentially altering the financing of the plan. If even a small percentage of the highest-income residents move or find a way to shield income from the new taxes, tax schedules would need to be revised and could require increasing the financial burden on middle and lower-income residents.
“The estimated effects of the New York Health Act are highly dependent on assumptions about provider payments, administrative costs, and drug prices,” said Christine Eibner, co-author of the study and the Paul O'Neill Alcoa Chair in Policy Analysis at RAND. “The actual cost of a single-payer health plan in New York would be sensitive to the extent to which state officials would negotiate or set price levels and generate efficiencies that would curb health care spending.”
The study, “An Assessment of the New York Health Act: A Single-Payer Option for New York State,” is available at www.rand.org. Other authors of the study are Chapin White, Sarah A. Nowak, Asa Wilks, and Jamie Ryan.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
The New York State Health Foundation is a private, statewide foundation dedicated to improving the health of all New Yorkers, especially the most vulnerable. Find NYSHealth online at http://www.nyshealth.org and on Twitter at @nys_health.
While the bill mandates only that the new taxes be graduated and does not specify the levels, RAND researchers estimate the impacts of one possible set of graduated marginal tax rates applied to three income brackets. The analyzed scenario has a payroll tax that begins at 6 percent for the lowest bracket (those earning under $27,500 in 2022), rises to 12 percent for the middle bracket, and to 18 percent for those in the highest bracket (above $141,200 in 2022). The nonpayroll tax follows the same schedule and the rates are about 6 percent, 12 percent, and 19 percent for the three brackets.
Under these analyzed tax schedules in 2022, New Yorkers with household compensation (income plus employer contributions to health care) below the 90th percentile would pay an average of $2,800 less per person for health care. While payments decline for most people in this group, payments would likely increase for those people who work for employers that did not previously offer health care coverage.
For New York residents in the 90th to 95th percentile of the household compensation, average health care payments would increase by $1,700 per person in 2022. The top 5 percent of New Yorkers by household compensation—a heterogeneous group with average household compensation of about $1,255,700 in 2022—would pay an average of $50,200 more per person.
The effects on employer health care payments would vary by whether the business currently provides health care to workers, according to the study. Employers that currently offer health coverage would contribute $200 to $800 less per worker on average for employee health benefits under the single-payer plan in 2022. Meanwhile, employers who do not offer coverage under the status quo would pay an estimated $1,200 to $1,800 more per worker on average in 2022 because of new payroll taxes.
Researchers say that the introduction of new taxes could result in some residents and businesses leaving the state, potentially altering the financing of the plan. If even a small percentage of the highest-income residents move or find a way to shield income from the new taxes, tax schedules would need to be revised and could require increasing the financial burden on middle and lower-income residents.
“The estimated effects of the New York Health Act are highly dependent on assumptions about provider payments, administrative costs, and drug prices,” said Christine Eibner, co-author of the study and the Paul O'Neill Alcoa Chair in Policy Analysis at RAND. “The actual cost of a single-payer health plan in New York would be sensitive to the extent to which state officials would negotiate or set price levels and generate efficiencies that would curb health care spending.”
The study, “An Assessment of the New York Health Act: A Single-Payer Option for New York State,” is available at www.rand.org. Other authors of the study are Chapin White, Sarah A. Nowak, Asa Wilks, and Jamie Ryan.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
The New York State Health Foundation is a private, statewide foundation dedicated to improving the health of all New Yorkers, especially the most vulnerable. Find NYSHealth online at http://www.nyshealth.org and on Twitter at @nys_health.
About the RAND Corporation
‘Short Term’ Health Insurance? Up to 3 Years Under New Trump Policy
by Robert Pear - NYT - August 1, 2018
WASHINGTON — The Trump administration issued a final rule on Wednesday that clears the way for the sale of many more health insurance policies that do not comply with the Affordable Care Act and do not have to cover prescription drugs, maternity care or people with pre-existing conditions.
President Trump has said that he believes that the new “short-term, limited duration insurance” could help millions of people who do not want or need comprehensive health insurance providing the full range of benefits required by the health law.
The new plans will provide “much less expensive health care at a much lower price,” Mr. Trump said. The prices may be lower because the benefits will be fewer, and insurers do not have to cover pre-existing conditions or the people who have them.
Under the current rule, issued in late 2016 by the Obama administration, short-term insurance cannot last for more than three months, as it was meant to be a stopgap. Under the new rule, the limit would be 364 days, and insurers would be allowed, but not required, to extend policies. The maximum duration, including any extensions, would be 36 months.
The new options will help people struggling to afford coverage under the 2010 law, said James Parker, a senior adviser to Alex M. Azar II, the secretary of health and human services. But Mr. Parker added: “We make no representation that it’s equivalent coverage. These policies will not necessarily cover the same benefits or extend coverage to the same degree.”
The new rule is presented as a redefinition of “short-term, limited-duration insurance.” But it stretches the common understanding of those terms, and some of the new policies could be an attractive option for healthier consumers who now pay high prices for major medical coverage and are willing to take more risk in return for lower prices.
“Short-term is getting longer!” one insurance marketing company advised clients this week.
Democrats deride the new health plans as “junk insurance” and say consumers will discover the limits of such plans when they become sick.
Randy Pate, a senior official at the Centers for Medicare and Medicaid Services, said the Trump administration expects 600,000 people to buy the new insurance policies next year, with enrollment increasing to 1.6 million by 2022.
The agency’s chief actuary, Paul Spitalnic, has estimated that premiums for short-term policies would be about half of the average premium for coverage sold in insurance exchanges under the Affordable Care Act, roughly $340 against $620 next year.
Consumer advocates, doctors, hospitals and some insurance companies expressed deep concern about the new plans, saying they would not adequately protect people who develop serious illnesses and could further destabilize insurance markets by drawing away healthy people.
People who buy the new policies and develop cancer could “face astronomical costs” and “may be forced to forgo treatment entirely because of costs,” said Chris Hansen, the president of the American Cancer Society Cancer Action Network.
Stung by such criticism, Trump administration officials said they would require insurers to tell consumers exactly what is and what is not covered under the new policies.
“There are individuals today who have been priced out of coverage” because of the Affordable Care Act, Mr. Parker said. “Until we have a more comprehensive replacement for the Affordable Care Act and Obamacare, we are looking to do everything we can to take incremental steps that will make insurance coverage of any type more affordable to those who today cannot afford insurance coverage.”
The new rule takes effect in about two months. The new policies, which will be subject to state regulation, could be on sale before the end of the year. States can restrict their sale or require specific benefits, and some states have indicated that they intend to do so.
In another rule, issued only six weeks ago, the Trump administration made it easier for small businesses to band together to set up health plans that skirt many requirements of the Affordable Care Act.
Erika Sward, an assistant vice president of the American Lung Association, described the rule on short-term insurance as “one more blow of an ax to stable state marketplaces.”
In the past year, the Trump administration has also cut funds for groups that help people sign up for coverage; ended cost-sharing subsidies paid to insurers on behalf of low-income people; and asked a federal court to throw out parts of the Affordable Care Act, including the popular protections for people with pre-existing conditions.
Some insurers that lost money in the Affordable Care Act marketplace see the new short-term plans as a potentially lucrative opportunity.
The UnitedHealth Group has largely withdrawn from the Affordable Care Act marketplace, but is actively selling short-term medical plans through its Golden Rule Insurance Company.
On its website, UnitedHealth says that short-term plans are available for as little as $23.70 a month — for some unmarried women aged 19 to 24 who do not smoke. The plans have a $10,000 deductible, which is $2,650 more than the out-of-pocket costs allowed under a plan that complies with the Affordable Care Act.
A footnote on the website says, “Short-term health insurance is medically underwritten and does not cover pre-existing conditions.”
UnitedHealth supported the Trump administration’s move to extend the duration of short-term policies, saying this would “ensure that more consumers have consecutive months of coverage and fewer consumers experience coverage gaps during a year.”
Short-term plans were originally intended for people who were between jobs or needed temporary coverage for other reasons.
Maine receives federal waiver that will help lower ACA insurance premiums
by Joe Lawlor - Portland Press Herald - August 1, 2018
The federal government has approved a request by the Maine Bureau of Insurance to relaunch its $93 million reinsurance program, which will help reduce premiums for individual insurance on the Affordable Care Act marketplace.
On Monday, the U.S. Centers for Medicare and Medicaid Services granted a waiver that permits the state to diverge from the normal rules set up by the ACA for insurance. The CMS waiver will be effective from 2019 through 2023. Maine previously had operated a reinsurance program, but it was shelved in 2013 after the ACA went into effect.
Reinsurance is a complex program that involves many shifting costs, but the bottom line is it’s a way for the state to pump money into the system, reducing risk for insurance companies in exchange for lower premiums for enrollees. Maine insurers submitted two sets of rates in June for 2019 ACA premiums – one including a revived reinsurance program and one without.
The average rate increase for Harvard Pilgrim is 4.6 percent with reinsurance, but would have been 9.5 percent had reinsurance not been approved. Community Health Options, a Lewiston-based cooperative, requested a 6.9 percent increase with reinsurance compared with a 9.2 percent hike without the program, called the Maine Guaranteed Access Reinsurance Association.
Also, Anthem Blue Cross Blue Shield said in its June filings that it would resume offering coverage on the Maine marketplace in 2019 if the reinsurance program was approved. Anthem had exited the Maine ACA marketplace, and did not offer individual plans for 2018 coverage.
The Maine reinsurance program redistributes insurance money by charging a fee of $4 per person per month on individual and small- and large-group plans, including employer-based insurance not on the ACA marketplace, and then funneling the revenue to individual plans. For 2019, the $4 fee is expected to raise $22.6 million. Reinsurance also will capture $33.4 million in federal money, and the state will collect $37 million in premiums from patients with high-risk health conditions. The $37 million will go into an “invisible high-risk pool,” which will help reduce costs for insurers.
A July 30 letter from CMS administrator Seema Verma concluded that implementation of this reinsurance program would lower individual market premiums in the state.
In a tweet Monday, Verma wrote that the “waiver will provide relief, but underlying causes of the problems (with) Obamacare need to be addressed to create affordability and choice.” Wisconsin’s reinsurance waiver also was approved this week, which Verma lauded.
The Trump administration has largely sought to sabotage the ACA and has advocated for repealing the law.
A Republican effort to repeal the ACA, former President Obama’s signature domestic policy achievement, failed by one vote in July 2017. Maine Sen. Susan Collins was one of three Republicans to buck the party and vote to preserve the ACA.
About 75,000 Mainers have ACA individual insurance, but about 85 percent are shielded from premium increases because they receive subsidies to help lower the cost of premiums. The remaining 15 percent earn too much to qualify for subsidies – the limit is 400 percent of the federal poverty limit, or $83,000 for a family of three.
Those who don’t qualify for subsidies pay the full amount of premium increases, but the reinsurance program helps limit those price spikes.
Eric Cioppa, superintendent of the Maine Bureau of Insurance, declined to comment Tuesday.
Mitchell Stein, a Maine-based independent health policy consultant, said reinsurance is an effective program that does help lower premiums, and it usually avoids partisan fights.
“Reinsurance is the unicorn of health insurance in that both sides (Democrats and Republicans) agree that it’s useful,” Stein said. “It’s an easy way for the administration to do something useful that is less controversial than just about anything else.”
The Maine reinsurance program was originally approved in 2011 but suspended in 2013 because the ACA had a reinsurance program that made the state-based measure moot. However, the federal reinsurance program expired in 2016, paving the way for Maine to restart a state-based effort.
A bill promoted by Collins would have launched a new $30 billion federal reinsurance program, along with other ACA stabilization measures, but those efforts collapsed in Congress this spring.
https://www.pressherald.com/2018/07/31/feds-approve-maine-reinsurance-program-will-help-with-aca-premium-costs/
Maine Will Reinstate Program That Can Lower Individual Insurance Premiums
by Patty Wight - Maine Public - July 31, 2018
The federal government has approved Maine's request to reinstate a program that has previously lowered individual insurance premiums.
Under the program, consumers with expensive medical conditions will be placed into an invisible high risk pool. Their medical costs will be paid through their premiums, as well as a $4 per month surcharge on all policyholders in the state.
Bureau of Insurance Superintendent Eric Cioppa says that in a state like Maine with a small population, a few high claims can raise premiums for everyone.
“By subsidizing those high cost claimants, it drives down the premium that everyone pays, and you get a bigger bang for your buck by doing that,” Cioppa says.
Cioppa says the lower premiums will help middle income earners who purchase insurance on the individual market, but who don't qualify for subsidies.
http://www.mainepublic.org/post/maine-will-reinstate-program-can-lower-individual-insurance-premiums
State senator’s lawsuit says LePage is flouting law calling for more public health nurses
by Joe Lawlor - Portland Press Herald - July 30, 2018
A Democratic state senator is suing the LePage administration for its failure to hire public health nurses, as required by a recently approved law he championed
Sen. Brownie Carson of Brunswick sued in Kennebec County Superior Court on Monday, charging the LePage administration with failing to hire and maintain a public health nursing staff of 48, as spelled out in a 2017 law. Carson said LePage is flouting the law because the governor does not believe in the value of public health nursing.
The law, passed with substantial bipartisan support, forced the LePage administration to increase public health nurse staffing after the workforce dwindled from 59 in 2011 to about 25 in early 2017. Gov. Paul LePage vetoed the bill, but the Legislature overrode the veto in the summer of 2017. Joining Carson in the lawsuit are two nurses who applied for public health nursing positions but were told that the state was not hiring.
Public health nurses earn between $40,000 and $50,000 a year, and do front-line work in the communities, such as responding to infectious disease outbreaks, helping at-risk mothers and their newborn babies, and performing a number of health prevention duties.
At first, it appeared that the Maine Department of Health and Human Services was following the law, the lawsuit said. DHHS was required to have hired the nurses by March 1, according to the law.
In January, Ricker Hamilton, health and human services commissioner, told the Press Herald that the state was having a “great response” in the recruitment effort, that seven new nurses had been hired, and that state officials were moving forward with hiring additional nurses.
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“We’re re-committed and re-energized with this process. We want it to succeed and it will,” Hamilton said in January. Hamilton’s comments were an about-face from the spring of 2017, when Maine DHHS opposed hiring public health nurses, arguing they were not needed,
But hiring efforts stalled out this spring, according to the lawsuit, and the workforce remains stuck in the low 20s. The state stopped advertising for the positions, according to the lawsuit. One of the public health nursing job applicants, Sarah DeCato, submitted a resume in April but received a response from the DHHS human resources department that they were “not currently hiring Public Health Nurses,” the suit said.
Carson slammed the LePage administration for putting the public’s health at risk.
“Maine’s public health nursing service used to be our first line of defense against an outbreak of infectious disease, such as life-threatening strain of the flu, which we saw with the H1N1 in 2009. Yet today, fewer than half of the funded public health nurse positions are filled, leaving Maine children, families and seniors at risk,” Carson said in a statement.
“It’s unacceptable that the department continues to ignore the laws crafted in the Legislature to the detriment of Maine people. It’s unfortunate that it has come to this, but Maine people deserve answers, and more importantly, a vibrant and functioning public health nursing service.”
The lawsuit claims LePage may have intervened, stopping the compliance with the new law.
“The department initially acted as if it intended to comply with the law, posting notices and attempting to hire nurses. In early 2018, however, something changed. While the exact internal communications remain a mystery – the department has refused to disclose them – the governor appears to have intervened,” the lawsuit said.
The governor’s office did not immediately respond to requests for comment Monday. Maine DHHS spokeswoman Emily Spencer declined to comment, saying she couldn’t speak about a pending lawsuit.
Carson recounted a June 2018 meeting with Julian Baer, director of government relations and policy for Maine DHHS, in which Baer refused to answer questions before telling the senator, “You will not see LD 1108 (the public health nursing law) fully implemented within the next seven months.”
By then, LePage will be out of office. Democrat Janet Mills, Republican Shawn Moody and independents Terry Hayes and Alan Caron are vying to replace LePage in the November election.
Baer declined to comment when reached by the Press Herald, citing the pending lawsuit.
Carson, in a brief phone interview on Monday, said even though there will be a new governor, it’s unclear what will happen to public health nursing under the new administration. Meanwhile, he said, “every day counts” for those who are lacking services. Carson said LePage and DHHS officials have been mostly “hostile” to public health nursing.
“They don’t believe in public health nursing or understand the value of public health nursing,” Carson said.
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