Tag Archives: Affordable Care Act

Health insurers quietly shape Obamacare replacement with fewer risks

fed forms for applying for health insurance through affordable care act aka obamacare

By Caroline Humer and Susan Cornwell

NEW YORK/WASHINGTON (Reuters) – U.S. health insurers are making their case to Republican lawmakers over how Americans sign up for individual insurance and pushing for other changes to shape the replacement of former President Barack Obama’s national healthcare law.

The health insurers, including Independence Blue Cross and Molina Healthcare Inc, are also recommending ways to put more control over insurance in the hands of states as the federal oversight of Obamacare is dismantled. They emphasize that it is crucial to keep government subsidies for low income people.

These changes, described by executives, high level officials in the health insurance sector and lawmakers in nearly a dozen interviews with Reuters, include pushing for more strict enforcement of eligibility for these plans.

Because Republicans are just starting to work with the new Trump administration and the debate is fluid, it is not clear ultimately what changes will take hold. But some of these ideas have started to surface in early Republican legislation, such as a co-sponsored bill from Maine Senator Susan Collins that would keep subsidies.

The moves underscore that private insurers are quietly working on how to benefit under the Trump administration, which is focusing on deregulation in healthcare, energy and manufacturing. And they show that insurers want to save aspects of Obamacare individual plans, but cut down on the risk to their own bottom lines and any hikes in premiums that threaten the viability of this insurance market.

This market for individual insurance covers about 10 million people and is small compared to the employer-based system that covers more than 160 million Americans and the government-paid programs for over 120 million people.

But it is one that insurers have described as having growth potential. While Obamacare cut the uninsured rate to 11 percent, there are still millions of uninsured Americans. The largest U.S. insurer UnitedHealth Group Inc told investors recently that it sees opportunities in new state-based markets and is talking to policymakers.

Many investors believe that the Republican deregulation push with Trump will benefit insurers.

“Clearly they support the private insurers and the role that they are going to play in any sort of new market,” said Jeff Jonas, a portfolio manager at Gamco Investors in Rye, New York, which he said owns the publicly traded insurers.

INFLUENCING WHAT “REPLACE” LOOKS LIKE

President Donald Trump campaigned on a promise to repeal Obama’s national healthcare law on his first day in office. He and Republicans have not presented an agreed upon replacement plan, but key issues they are expected to address include the law’s requirements for individuals to have insurance.

Insurers’ main “ask” takes into account replacement plans under discussion in Congress, and largely assumes that government funds will continue to subsidize health benefits, at least for the next two to three years.

Daniel Hilferty, CEO of Independence Blue Cross in Pennsylvania, told Reuters that he advocated tightening the rules around signing up for insurance outside of the open enrollment period, and tight control of which third parties are allowed to pay premiums for patients.

Independence is part of a nationwide network of Blue Cross Blue Shield licensees such as Anthem Inc and has enrolled more than 300,000 consumers in individual plans.

Hilferty’s requests, echoed by other people in the industry who did not want to be named, are similar to demands the industry made of Obama. Enrollment outside of the regular period – and third-party groups that keep poorer, sicker patients in the private market by paying their premiums – has helped lead to hundreds of millions of dollars in losses for insurers and pushed three of the nation’s largest players out of the Obamacare market.

In addition, Independence is also asking for a bigger role in signing up new customers who want to buy individual plans. Insurers sell plans both on the exchanges and off the exchanges, but subsidized plans are currently mostly sold on the government run HealthCare.gov and on state-run websites in a dozen states.

“It would be really helpful if we in the industry played a more significant role in the actual enrollment process,” Hilferty said.

Trump signed an executive order on Friday directing the federal government to scale back regulations, taxes and penalties related to the law. But the directive did not change the priorities outlined to Reuters by the insurers and industry sources, they said.

FOCUS ON THE MANDATE, COST SHARING

Insurers have built their list of top priorities assuming in part that Republicans will try to overturn the existing individual mandate, which requires Americans to pay a fee if they do not have insurance. A replacement plan would need to include some type of bonus to entice healthy people to get insurance.

That, they say, would be a step towards a good mix of sick and healthy people that will keep the plans profitable. Ideas include creating high-risk pools to keep the very sick in a separate market and offering low prices to the young and healthy.

Without a punishment for not buying insurance that is like the individual mandate, the market can’t survive, according to Dr. J. Mario Molina, Chief Executive Officer of Molina Healthcare Inc, a company that provides Medicaid for the poor and individual insurance plans on the exchanges.

“It probably needs to be a combination of both an incentive and a penalty,” Molina said.

Insurers also want to keep the cost-sharing subsidies that have made healthcare costs affordable for millions of people as well as the premium subsidies that help to reduce the monthly cost for people with low incomes. Those subsidies are part of a court case filed last year that is on hold.

“If it’s free or close to free, you are more likely to sign up in the absence of the mandate,” said Dan Mendelson, CEO of Avalere Health, a research group and consultant that advises health insurers and is part of Inovalon Holdings.

Insurers also want continued premium subsidies, skewed to keep up enrollment of younger people.

“I think if you don’t have the subsidies, then the whole thing falls apart,” said Molina.

(Reporting by Caroline Humer; additional reporting by Susan Cornwell in Washington D.C.; editing by Edward Tobin)

Trump vows ‘insurance for everybody’ in replacing Obamacare

Donald Trump at conference disucssing Obamacare

WASHINGTON (Reuters) – U.S. President-elect Donald Trump aims to replace Obamacare with a plan that would envisage “insurance for everybody,” he said in an interview with the Washington Post published on Sunday night.

Trump did not give the newspaper specifics about his proposals to replace Democratic President Barack Obama’s signature health insurance law, but said the plan was nearly finished and he was ready to unveil it alongside the leaders of the Republican-controlled Congress. The Republican president-elect takes office on Friday.

“It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump told the Post, adding he was waiting for his nominee for health and human services secretary, Tom Price, to be confirmed.

The plan, he said, would include “lower numbers, much lower deductibles,” without elaborating.

“We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

Trump was also quoted as saying in the interview that he would target pharmaceutical companies over drug pricing and insist they negotiate directly with the Medicare and Medicaid government health plans for the elderly and poor.

U.S. House Republicans won passage on Friday of a measure starting the process of dismantling the Affordable Care Act, popularly known as Obamacare, despite concerns about not having a ready replacement and the potential financial cost of repealing the law.

With the vote, Republicans began delivering on their promise to end Obamacare, also a campaign pledge of Trump, who has called the program a “disaster.”

The law, which expanded health coverage to some 20 million people, has been plagued by increases in insurance premiums and deductibles and by some large insurers leaving the system.

Republicans have called Obamacare federal government overreach and have sought to undermine it in Congress and the courts since it was passed by Democratic majorities in the House and Senate in 2010.

Democrats say Obamacare has allowed growing numbers of Americans to get medical insurance and helped slow the rise in healthcare spending.

(Writing by Mary Milliken; Editing by Will Dunham and Peter Cooney)

U.S. Senate approves measure launching Obamacare repeal process

The federal government forms for applying for health coverage are seen at a rally held by supporters of the Affordable Care Act, widely referred to as "Obamacare", outside the Jackson-Hinds Comprehensive Health Center in Jackson, Mississippi, U.S

By Susan Cornwell

WASHINGTON (Reuters) – The U.S. Senate on Thursday took a first concrete step toward dismantling Obamacare, voting to instruct key committees to draft legislation repealing President Barack Obama’s signature health insurance program.

The resolution, passed in the early hours of Thursday in a 51-48 vote, now goes to the House of Representatives, which is expected to vote on it this week. Scrapping Obamacare is a top priority for Republican President-elect Donald Trump and the Republican majorities in both chambers.

Republicans have said the process of repealing Obamacare could take months, and developing a replacement plan could take longer. But they are under pressure from Trump to act fast after he said on Wednesday that the repeal and replacement should happen “essentially simultaneously.”

Some 20 million previously uninsured Americans gained health coverage through the Affordable Care Act, as Obamacare is officially called. Coverage was extended by expanding Medicaid and through online exchanges where consumers can receive income-based subsidies.

Republicans have launched repeated legal and legislative efforts to unravel the law, criticizing it as government overreach. They say they want to replace it by giving states, not the federal government, more control.

But in recent days some Republicans have expressed concern about the party’s current strategy of voting for a repeal without having a consensus replacement plan ready.

House Speaker Paul Ryan said this week he wants to pack as many replacement provisions as possible into the legislation repealing Obamacare. But Senate Finance Committee Chairman Orrin Hatch, also a Republican, said that could be difficult under Senate rules.

The resolution approved Thursday instructs committees of the House and Senate to draft repeal legislation by Jan. 27. Both chambers will then need to approve the resulting legislation before any repeal goes into effect.

Senate Republicans are using special budget procedures that allow them to repeal Obamacare by a simple majority so that they will not need Democratic votes. Republicans have 52 votes in the 100-seat Senate. One Republican, Senator Rand Paul, voted no on Thursday.

Democrats mocked the Republican effort, saying Republicans have never united around an alternative to Obamacare. “They want to kill ACA but they have no idea how they are going to bring forth a substitute proposal,” said Senator Bernie Sanders of Vermont, an independent who caucuses with the Democrats.

On Wednesday, Trump said he would submit a replacement plan as soon as his nominee to lead the Health and Human Services Department, Representative Tom Price, is approved by the Senate. Trump gave no details.

Trump senior adviser Kellyanne Conway praised lawmakers for clearing the way for repeal and said the replacement effort will likely tackle medication costs.

“To repeal and replace Obamacare and not have a conversation about drug pricing seems not like a very reasonable prospect and not (a) responsible prospect,” Conway told Bloomberg Television on Thursday, one day after Trump targeted the pharmaceutical industry, a traditional Republican ally.

Democrats passed the Affordable Care Act in 2010 over united Republican opposition. Democrats say the act is insuring more Americans and helping to slow the growth in healthcare spending.

But Republicans say the system is not working. The average Obamacare premium is set to rise 25 percent in 2017.

(Reporting by Susan Cornwell; Additional reporting by Susan Heavey; Editing by Nick Macfie and Bill Trott)

U.S. court puts Obamacare case on hold until Trump takes office

President-elect Donald Trump

By Lawrence Hurley

WASHINGTON (Reuters) – A federal appeals court on Monday brought to an end President Barack Obama’s bid to overturn a ruling that threatens to gut his signature healthcare law by putting the case on hold until after President-elect Donald Trump, who aims to repeal Obamacare, takes office.

The Obama administration had appealed a judge’s May ruling favoring the challenge filed by Republicans in the U.S. House of Representatives against a key part of the 2010 law. But the U.S. Court of Appeals for the District of Columbia Circuit agreed to a request by the Republicans to delay its consideration of the government’s appeal until after Trump takes office on Jan. 20.

The Obama administration opposed the move.

If the law is repealed by Congress, the case would be moot. The court’s decision to put the case on hold will not have an immediate effect on the law, as the lower court ruling was put on hold pending the appeal. The court said both sides should provide an update on the status of the case by Feb. 21.

The challenge targeted government reimbursements to insurance companies to compensate them for reductions that the law required them to make to customers’ out-of-pocket medical payments.

Trump has said he favors repealing and replacing Obamacare but would consider retaining certain elements.

The law has enabled millions of previously uninsured Americans to obtain health insurance, but Republicans condemn Obamacare as a government overreach and have mounted a series of legal challenges.

The Obama administration appealed U.S. District Judge Rosemary Collyer’s ruling that the government cannot spend billions of dollars in federal funds without congressional approval to provide subsidies under the healthcare law to private insurers to help people afford medical coverage.

The House Republicans argued that the administration violated the U.S. Constitution because it is the legislative branch, not the executive branch, that authorizes government spending.

The Obama administration has interpreted the provision as a type of federal spending that does not need to be explicitly authorized by Congress.

The U.S. Supreme Court in 2012 and 2015 issued major rulings authored by conservative Chief Justice John Roberts that preserved Obamacare and rejected conservative challenges.

(Reporting by Lawrence Hurley; Editing by Will Dunham)

Some Republicans see attacking Obamacare through regulation

Obama signs Affordable Care Act AKA Obamacare

By Susan Cornwell

WASHINGTON (Reuters) – Congressional Republicans are looking for the quickest ways to tear down Obamacare following Donald Trump’s election as U.S. president, including rapidly confirming a new health secretary who could recast regulations while waiting for lawmakers to pass sweeping repeal legislation.

Trump’s victory on Tuesday means Republicans will control the White House, Senate and House of Representatives. But congressional Democrats are expected to put up a huge fight against Republican efforts to repeal the 2010 law considered President Barack Obama’s signature domestic policy achievement.

The Affordable Care Act, dubbed Obamacare, has provided 25 million previously uninsured Americans with health coverage. Republicans have launched repeated legal and legislative efforts to dismantle the law, which they call a government overreach.

Wyoming Senator John Barrasso, a member of Senate Republican leadership, said one way for the incoming president and Congress to attack Obamacare immediately after Trump takes office on Jan. 20 would be to quickly confirm a new secretary of Health and Human Services, the official who writes the rules and regulations that enforce the law.

“We could confirm someone on Jan. 20 who could come in immediately and could be working right now on rewriting rules and regulations to give more freedom and choice to the states, to insurance companies and to businesses that are trying to provide affordable care to their workers,” Barrasso said in a telephone interview.

Barrasso noted that the Senate needs only a simple majority vote in the 100-seat chamber to confirm Cabinet members, as opposed to 60 votes to overcome procedural hurdles the Democrats could present to repeal legislation.

Passing repeal legislation “is not a ‘Day One’ activity. But a new secretary of HHS going after the regulations can be a ‘Day One’ activity,” Barrasso added.

Trump during the campaign called Obamacare “a disaster” and joined fellow Republicans in vowing to repeal and replace it with proposals like tax-free health savings accounts. His transition website says Trump wants a solution that “returns the historic role in regulating health insurance to the states.”

In repealing Obamacare, congressional Republican may have to resort to a special procedure known as reconciliation to get around Democrats in the Senate, where rules protect the rights of the minority party.

Republicans in Congress used reconciliation to try to undo large chunks of Obamacare in January, but Obama vetoed the legislation. The bill would have wiped out tax subsidies provided to help people afford insurance coverage, as well as tax penalties on people who do not obtain insurance as required by the law, and would have eliminated expansion of the Medicaid insurance health insurance program.

Republican Representative Chris Collins of New York, one of Trump’s earliest supporters on Capitol Hill, said he hopes Congress can pass a similar bill gutting Obamacare within Trump’s first 100 days in office, a promise Trump made during the presidential campaign. But some changes will doubtless be phased in over time, Collins said.

“There’s nothing that we will be able to do or would want to do that would impact anyone’s health insurance plan for 2017,” Collins said in an interview.

“From a replacement standpoint, our position has always been as Republicans to move forward in a step-by-step fashion,” Barrasso said.

In an interview with the Wall Street Journal published on Friday, Trump said he was considering retaining parts of Obamacare including provisions letting parents keep adult children up to age 26 on their insurance policies and barring insurers from denying coverage to people with pre-existing medical conditions.

MORE FLEXIBILITY

While waiting for Congress to act on legislation, the new HHS secretary could be reworking Obamacare regulations, Barrasso said. For example, regulations could give U.S. states more flexibility under a provision that lets states seek waivers from key provisions of the law, such as exemptions from the so-called individual mandate requiring Americans to obtain insurance and the employer mandate to provide it.

Kim Monk, an analyst at Capital Alpha Partners, which provides policy research to financial institutions, said Trump’s HHS might be able to tighten up the rules governing special enrollment periods for Obamacare. Insurers complain that these periods have allowed some people who initially skipped buying insurance to sign up after becoming ill.

HHS might also be able to alter the language on “essential benefits” that the law requires insurance plans to cover, which include trips to the emergency room, maternity and newborn care, and mental health services, Monk said.

“The law requires they have to cover 10 essential health benefit categories, but how that gets defined, a lot of that is interpretative,” Monk said. “And of course, everything the Obama administration interpreted was more, more, more, more expensive coverage, and all these things lead to premium increases.”

Collins, a member of the Trump transition team’s executive committee, said the job of HHS secretary or surgeon general “would be great for Ben Carson,” referring to the neurosurgeon who ran unsuccessfully for the Republican presidential nomination and later endorsed Trump.

(Reporting by Susan Cornwell; Editing by Will Dunham)

Obama vetoes efforts to repeal Affordable Care Act, defund Planned Parenthood

Republican-backed legislation that would have repealed portions of the Affordable Care Act and prevented federal funds from going to Planned Parenthood was vetoed by President Barack Obama on Friday, effectively ending the legislature’s latest efforts to eliminate Obamacare.

Obama returned the bill to Congress without his signature, according to a message to lawmakers that appears on the White House’s website. A Republican majority controls both the House and Senate and had enough votes to send the bill to Obama’s desk for the first time, but the party lacks the two-thirds majority required to override his veto and force the bill to become law.

“This legislation would not only repeal parts of the Affordable Care Act, but would reverse the significant progress we have made in improving health care in America,” Obama wrote in the veto message to lawmakers. He added there have been more than 50 attempts to “ to repeal or undermine” the legislation, and criticized Republicans for continuing to pursue the goal.

“Rather than refighting old political battles by once again voting to repeal basic protections that provide security for the middle class, Members of Congress should be working together to grow the economy, strengthen middle-class families, and create new jobs,” Obama wrote Congress.

Citing data from the Congressional Budget Office, Obama wrote that the bill would have caused the number of uninsured Americans to rise by 22 million after next year, and 1.2 million people would have experienced difficulties paying other bills because of a higher cost of health care.

In sending the bill back to Congress, Obama also wrote that about 150 million Americans who obtain health insurance through their employers would have been at risk of higher premiums.

“This legislation would cost millions of hard-working middle-class families the security of affordable health coverage they deserve,” Obama wrote Congress. “Reliable health care coverage would no longer be a right for everyone: it would return to being a privilege for a few.”

Critics of the Affordable Care Act say it has actually led to increased health care costs and limited the options of many Americans since the president initially signed it into law six years ago.

In a statement, House Speaker Paul Ryan (R-Wisconsin) said Congress would hold an override vote (which will be mostly symbolic) and vowed to continue efforts to eliminate Obamacare, adding Friday’s vetoed bill “will get signed into law” if a Republican wins the presidential election this fall.

“The idea that Obamacare is the law of the land for good is a myth. This law will collapse under its own weight, or it will be repealed,” Ryan said in a statement.

Obama also wrote the bill would “effectively defund” Planned Parenthood because it would have prevented the group from obtaining federal Medicaid funding. The group is often criticized because it provides abortions, though it also provides many other health services to women.

Obama noted there are existing laws in place that prevent using federal money for abortions, unless the pregnancy was the result of rape or incest or could endanger the mother’s life.

Sixteen States Back Christian Universities in Appeal Against ACA

Three Christian Universities found themselves with unexpected supporters for their appeal to the Supreme Court over the contraception mandates in the Affordable Care Act (ACA):  16 state governments.  Alabama, Arizona, Florida, Georgia, Kansas, Louisiana, Michigan, Montana, Nevada, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, and West Virginia announced their support for the school’s appeal.

Houston Baptist University (HBU), East Texas Baptist University (ETBU) and Westminster Theological Seminary have appealed to the Supreme Court over a lower court’s ruling they expand the contraception options in their health insurance plans.  The schools currently offer 10 different forms of contraception, but do not want to carry four forms of contraception that fall into the category of abortifacient drugs, or drugs that cause an abortion.

The Becket Fund for Religious Liberty, who is defending the school’s rights, says the support of 16 states through friend-of-the-court briefs is a major bonus to the school’s case.

“This strong show of support for HBU and ETBU (and Westminster Theological Seminary) demonstrates just how important it is that the Supreme Court address the impact of the HHS mandate, particularly on religious groups,” said Diana Verm, Legal Counsel at the Becket Fund, in a statement. “It is especially significant that the 16 state governments are supporting HBU and ETBU at the Supreme Court.

The 16 states claim in their briefs that the schools maintain “a sincere religious conviction that complying with the disputed mandate is forbidden.”  The Attorneys General for the states also endorsed providing the schools with the same exemptions that are given to churches.

A federal appeals court ruled against the Little Sisters of the Poor in a similar case last month.  If the exemptions are not given to the schools and organizations challenging the mandate, they could face millions of dollars in IRS fines for not making the abortifacient drugs available as part of their health care plans.

Supreme Court Upholds ACA Subsidies

The Supreme Court has upheld by a 6-3 decision a key provision of President Obama’s signature healthcare law by saying that tax subsidies are Constitutional even though the law does not specifically say that federal subsidies can be issued in states with no state healthcare exchanges.

“After more than 50 votes in Congress to repeal or weaken this law, after a presidential election based in part on preserving or repealing this law, after multiple challenges to this law before the Supreme Court, the Affordable Care Act is here to stay,” Obama said in the White House Rose Garden.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote in the court’s decision, adding that nationwide availability of the credits is required to “avoid the type of calamitous result that Congress plainly meant to avoid.”

“In this instance,” he wrote, “the context and structure of the act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”

The decision was the second time in three years that the Supreme Court has ruled against major challenges to the Affordable Care Act.

Justice Antonin Scalia said: “We really should start calling the law SCOTUScare,” Scalia said. SCOTUS is the acronym for the Supreme Court of the United States. “This court has no free-floating power to rescue Congress from its drafting mistakes.”

Supreme Court Justice Grants Abortion Pill Relief

A Supreme Court justice has given temporary relief to two religious groups that objected to the compromise to the abortion pill mandate in the Affordable Care Act.

Geneva College of Beaver Falls, Pennsylvania and the Roman Catholic dioceses in Erie and Pittsburgh along with their affiliated organizations.  The groups sued the Obama administration because the so-called “compromise” still required them to provide abortion-inducing drugs.

The University of Notre Dame had previously filed a lawsuit over the same issue.

“Signing such a form or letter facilitates moral evil,” the groups wrote in legal briefs. “This is true whether or not applicants pay for the objectionable coverage.”

Supreme Court Justice Samuel Alito granted temporary relief and ordered the Obama administration to respond to the appeal by Monday.

The Supreme Court has already remanded the Notre Dame ruling to the 7th Circuit Court of Appeals to be reconsidered in light of the 2014 Hobby Lobby stations.

Supreme Court Remands Notre Dame Contraception Suit

Lower court justices who voted to deny Notre Dame’s religious rights will have to take a second look at their ruling after the U.S. Supreme Court threw out their decision.

The justices of the 7th Circuit Court of Appeals is being ordered to reconsider their decision in favor of the Obama Administration blocking Notre Dame’s request to have an exemption to the President’s signature health care law’s mandate of abortion causing drugs.

The Supreme Court said the 7th Circuit needed to take into account the court’s 2014 ruling in the Hobby Lobby case.

The Notre Dame case is the only appeals court decision that was issued prior to the Hobby Lobby ruling.  In other cases, the judges have upheld the rights of the Christian organizations to not pay for abortion causing drugs.

The school said their rights were protected under the Religious Freedom Restoration Act.