Category Archives: Health Reform

H.R. 1628: The American Health Care Act (AHCA)

Source: Annie L. Mach, Congressional Research Service, CRS Report, R44785, May 4, 2017

….This report contains three tables that, together, provide an overview of all the AHCA provisions. Table 1 includes provisions that apply to the private health insurance market, Table 2 includes provisions that affect the Medicaid program, and Table 3 includes provisions related to public health and taxes. Each table contains a column identifying whether the AHCA provision is related to an ACA provision (e.g., whether it repeals an ACA-related provision). In addition to the three tables, the report includes more detailed summaries of each AHCA provision, and two graphics showing the effective dates of AHCA provisions. Figure 1 covers AHCA provisions related to the private health insurance market, public health, and taxes. Figure 2 covers AHCA provisions related to the Medicaid program…..

2017’s Cities Most Affected by Trumpcare

Source: Richie Bernardo, WalletHub, March 20, 2017

…According to estimates by the nonpartisan Congressional Budget Office, the recently proposed American Health Care Act — unofficially going by the names “Trumpcare” and “Ryancare” — would raise the average health-insurance premium for an individual policyholder by 15 to 20 percent just one or two years from now and lower federal subsidies. In contrast, the CBO projected, average Obamacare premiums would decrease 10 percent by 2026.

In order to gauge the AHCA’s impact on people who buy their own insurance, WalletHub’s analysts compared the differences in premium subsidies that the average households in 457 U.S. cities would receive under Obamacare and Trumpcare. Read on for our findings, commentary from a panel of experts and a full description of our methodology….

Source: WalletHub

Pre-ACA Market Practices Provide Lessons for ACA Replacement Approaches

Source: Gary Claxton, Larry Levitt, and Karen Pollitz, Kaiser Family Foundation, Issue Brief, February 2017

From the overview:
Significant changes to the Affordable Care Act (ACA) are being considered by lawmakers who have been critical of its general approach to providing coverage and to some of its key provisions. An important area where changes will be considered has to do with how people with health problems would be able to gain and keep access to coverage and how much they may have to pay for it. People’s health is dynamic. At any given time, an estimated 27% of non-elderly adults have health conditions that would make them ineligible for coverage under traditional non-group underwriting standards that existed prior to the ACA. Over their lifetimes, everyone is at risk of having these periods, some short and some that last for the rest of their lives.

One of the biggest changes that the ACA made to the non-group insurance market was to eliminate consideration by insurers of a person’s health or health history in enrollment and rating decisions. This assured that people who had or who developed health problems would have the same plan choices and pay the same premiums as others, essentially pooling their expected costs together to determine the premiums that all would pay.

Proposals for replacing the ACA such as Rep. Tom Price’s Empowering Patients First Act and Speaker Paul Ryan’s “A Better Way” policy paper would repeal these insurance market rules, moving back towards pre-ACA standards where insurers generally had more leeway to use individual health in enrollment and rating for non-group coverage.1 Under these proposals, people without pre-existing conditions would generally be able to purchase coverage anytime from private insurers. For people with health problems, several approaches have been proposed: (1) requiring insurers to accept people transitioning from previous coverage without a gap (“continuously covered”); (2) allowing insurers to charge higher premiums (within limits) to people with pre-existing conditions who have had a gap in coverage; and (3) establishing high-risk pools, which are public programs that provide coverage to people declined by private insurers…..
Related:
Compare Key Elements of ACA Repeal and Replace Proposals with New Interactive Tool

Affordable Care Act Executive Order: Legal Considerations

Source: Congressional Research Service, CRS Reports & Analysis Legal Sidebar, January 24, 2016

On January 20, 2017, President Donald J. Trump issued an executive order (EO) declaring his intention to “seek the prompt repeal of the Patient Protection and Affordable Care Act [ACA]” while minimizing “economic and regulatory burdens of the Act,” ensuring that the ACA is “efficiently implemented,” and preparing to allow states “more flexibility and control.” Broadly, the EO issues the following three directives to executive branch agencies:

– First, it directs agencies with authorities or responsibilities under the ACA to “waive, defer, grant exemptions from, or delay the implementation of” any ACA provision that would impose a fiscal or regulatory burden on states or a host of private entities (including individuals, health care providers, health insurers, and medical device manufacturers).
– Second, the EO directs those same agencies to provide greater flexibility and cooperation to states in implementing healthcare programs.
– Third, the EO directs all agencies with responsibilities relating to healthcare or health insurance to encourage the development of a free and open interstate market for health services and health insurance…

Repeal & Replace Watch

Source: Kaiser Health News, 2017

President-elect Donald Trump has promised to “repeal and replace” the Affordable Care Act, but has offered few details about what comes next. That’s why Kaiser Health News is launching Repeal & Replace Watch to track the new administration’s plans to revamp America’s health care system.

With a steady stream of analysis, explanation, investigation and data, Repeal & Replace Watch will follow how the new politics of health care are playing out here in D.C. We’ll also report on how the changes in Washington affect patients, hospitals, doctors and insurers across the country.

Repealing Federal Health Reform: Economic and Employment Consequences for States

Source: Leighton Ku, Erika Steinmetz, Erin Brantley, Brian K. Bruen, Commonwealth Fund, Issue Brief, January 2017

From the abstract:
Issue: The incoming Trump administration and Republicans in Congress are seeking to repeal the Affordable Care Act (ACA), likely beginning with the law’s insurance premium tax credits and expansion of Medicaid eligibility. Research shows that the loss of these two provisions would lead to a doubling of the number of uninsured, higher uncompensated care costs for providers, and higher taxes for low-income Americans.
Goal: To determine the state-by-state effect of repeal on employment and economic activity. Methods: A multistate economic forecasting model (PI+ from Regional Economic Models, Inc.) was used to quantify for each state the effects of the federal spending cuts.
Findings and Conclusions: Repeal results in a $140 billion loss in federal funding for health care in 2019, leading to the loss of 2.6 million jobs (mostly in the private sector) that year across all states. A third of lost jobs are in health care, with the majority in other industries. If replacement policies are not in place, there will be a cumulative $1.5 trillion loss in gross state products and a $2.6 trillion reduction in business output from 2019 to 2023. States and health care providers will be particularly hard hit by the funding cuts.
Related:
View job loss by state
State Fact Sheets
Appendix Tables
Press Release

As Republicans ready to dismantle ACA, insurers likely to bolt

Source: J.B. Silvers, The Conversation, December 29, 2016

….To entice insurers into the market, the ACA also offered well-established methods to reduce risk. For example, it built in protections for insurers who enrolled especially sick people. It also provided back-up payments for very high-cost cases and protected against big losses and limited big gains in the first three years.

These steps worked well in establishing a stable market for Medicare drug plans when this program started under President Bush in 2006. Competition there is vigorous, rates are lower than estimated and enrollees are satisfied. In other words, the market works well…..

…..But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12 percent of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the start-up years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.

It is no wonder that this year they have dramatically increased premiums, averaging 20 percent, to compensate for the extra risk they didn’t factor into the original lower rates. In contrast, underlying health costs are rising at about 5 percent…..