Tag Archives: Healthcare

Obamacare replacement bill to take center stage in Senate

U.S. Capitol is seen after the House approved a bill to repeal major parts of Obamacare and replace it with a Republican healthcare plan in Washington, U.S., May 4, 2017. REUTERS/Yuri Gripas

By Richard Cowan and Susan Cornwell

WASHINGTON (Reuters) – A seven-year push by U.S. Republicans to dismantle Obamacare and kill the taxes it imposed on the wealthy will reach a critical phase on Thursday when Senate Republican leaders unveil a draft bill they aim to put to a vote, possibly as early as next week.

Senate Majority Leader Mitch McConnell and his lieutenants have worked in secret for weeks on the bill, which is expected to curb Obamacare’s expanded Medicaid help for the poor and reshape subsidies to low-income people for private insurance.

Those subsidies are expected to be linked to recipients’ income in the Senate bill, a “major improvement” from a measure approved last month by the U.S. House of Representatives that tied them solely to age, Republican Senator Susan Collins of Maine said.

Some of the Senate bill’s provisions could be political land mines, with individual senators’ reactions to it crucial to determining whether or not the Affordable Care Act, popularly known as Obamacare, survives a Republican attack that has been under way since its passage in 2010.

The Washington Post reported on Wednesday that the bill would seek to repeal most of the taxes that pay for Obamacare, give states more latitude to opt out of its regulations and eliminate federal funding for Planned Parenthood, a healthcare provider that offers abortion services.

Former Democratic President Barack Obama’s signature domestic policy achievement has been a target of Republican wrath for years. But even with control of both chambers of Congress and the White House since January, the party has struggled to make good on its bold campaign promises to repeal and replace Obamacare.

The law is credited with expanding health insurance to millions of Americans. Republicans say it costs too much and involves the federal government too much in healthcare. President Donald Trump made Obamacare repeal a centerpiece of his 2016 campaign and celebrated the House-passed bill.

Democrats accuse Republicans of sabotaging Obamacare, and say the Republican bill will make healthcare unaffordable for poorer Americans while cutting taxes for the wealthy.

TOUGH SELL

But McConnell may have a tough job convincing enough Republican senators that the Senate bill improves on the House version. A Reuters/Ipsos poll found nearly 60 percent of adults believed the House bill would make insurance costlier for low-income Americans and people with pre-existing conditions. Only 13 percent said it would improve healthcare quality.

The non-partisan Congressional Budget Office estimated the House bill would kick 23 million people off their healthcare plans. Healthcare is a top priority for voters and many Republicans fear a legislative misstep could hurt them.

Collins said she would weigh the CBO’s upcoming assessment of the Senate bill’s impact on costs and coverage.

Conservative Republican Senator Rand Paul, who wants a full repeal of Obamacare, said he feared that with the legislation being developed, “we’re actually going to be replacing Obamacare with Obamacare,” referring to the continuing role of government.

If legislation is to prevail in the Senate, McConnell can lose the support of only two of his 52 Republicans, assuming all 48 Democrats and independents oppose the bill, as expected.

(Reporting by Richard Cowan and Susan Cornwell; Editing by Kevin Drawbaugh and Peter Cooney)

After weeks of secrecy, U.S. Senate to unveil healthcare bill

FILE PHOTO - U.S. President Donald Trump (C) acknowledges House Speaker Paul Ryan (3rdL) as he gathers with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, in Washington, U.S., May 4, 2017. REUTERS/Carlos Barria

By Susan Cornwell and Richard Cowan

WASHINGTON (Reuters) – U.S. Senate Republicans plan to unveil the text of their draft healthcare bill on Thursday as senators struggle over issues such as the future of the Medicaid program for the poor and bringing down insurance costs.

Republicans in the chamber have been working for weeks behind closed doors on legislation aimed at repealing and replacing major portions of the Affordable Care Act, former Democratic President Barack Obama’s signature healthcare law, popularly known as Obamacare.

The effort has been plagued from the start by tensions between moderates and conservatives, which surfaced again on Tuesday. Democrats have also criticized the behind-the-scenes meetings, staging a protest on the Senate floor on Monday.

“Republicans are writing their healthcare bill under the cover of darkness because they are ashamed of it,” Senate Democratic leader Chuck Schumer charged.

President Donald Trump campaigned on a promise to repeal Obamacare. The 2010 law extended insurance coverage to millions of Americans through both subsidized private insurance and an expansion of Medicaid.

The Republican-controlled House of Representatives narrowly approved its version of repeal last month.

Trump has urged the Republican-led Senate to pass a more “generous” bill than that approved by the House, whose version he privately called “mean,” according to congressional sources.

An estimated 23 million people could lose their healthcare under the House plan, according to the non-partisan Congressional Budget Office. Senate Majority Leader Mitch McConnell said on Tuesday the Senate healthcare bill would be different from the House version, but he did not elaborate.

In the Senate, moderates including Senator Shelley Moore Capito have argued for a long, seven-year phase-out to the Medicaid expansion that happened under Obamacare. But Senator John Thune, a member of the Republican leadership, said on Tuesday the phase-out in the bill might just be three years.

Capito said on Tuesday she was also concerned the Senate healthcare plan might cap Medicaid spending and shift it to a lower growth rate in 2025. “That’s an issue,” she said.

CONSERVATIVES WARY

Senate conservatives also seemed wary of the emerging bill. Ted Cruz, a member of a core group of 13 Republicans who have been working on the legislation, told reporters the bill did not yet do enough to lower health insurance premiums. “If it is going to pass, the bill is going to have to make meaningful steps to reduce premiums,” he said.

Given the opposition of all Senate Democrats to repealing Obamacare, Republican leaders will need the support of at least 50 of the chamber’s 52 Republicans to ensure passage.

McConnell announced a discussion draft would be laid out on Thursday. The bill will be brought to the Senate floor once the CBO has assessed its cost and impact, “likely next week,” McConnell said.

Thune said the bill was not yet finalized, saying: “We’re trying to get definitive determinations” on a range of issues.

Vice President Mike Pence predicted that new healthcare legislation would be enacted this summer.

“I want to assure you, before this summer is over … President Donald Trump and this Congress will keep their promise to the American people, and we will repeal and replace Obamacare,” Pence told a meeting of the National Association of Manufacturers.

(Editing by Caren Bohan and Peter Cooney)

Democrats protest Senate Republican healthcare secrecy

FILE PHOTO - U.S. President Donald Trump (C) turns to House Speaker Paul Ryan (3rdL) as he gathers with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, in Washington, U.S., May 4, 2017. REUTERS/Carlos Barria

By Susan Cornwell

WASHINGTON (Reuters) – U.S. Democrats took to the Senate floor on Monday to throw a spotlight on behind-the-scenes efforts by the Republican majority to repeal former President Barack Obama’s healthcare law, known as Obamacare.

In a series of floor motions, inquiries and lengthy speeches, Democrats criticized the closed-door meetings that Republicans have been holding to craft a replacement for Obamacare, formally known as the Affordable Care Act. They called for open committee hearings and more time to consider the bill before a Senate vote, which Republicans say could come in the next two weeks, although a draft bill has yet to emerge publicly.

Lacking the votes to derail or change the Republican process, the maneuvers by the Democratic minority seemed more aimed at highlighting Republican efforts on a controversial issue. Polls have said that a majority of Americans disapprove of the Obamacare replacement that has passed the House of Representatives and that Senate Republicans are now considering.

Senate Democratic Leader Chuck Schumer said that the closed-door Republican meetings on healthcare amounted to “the most glaring departure from normal legislative procedure that I have ever seen.”

“Republicans are writing their healthcare bill under the cover of darkness because they are ashamed of it,” Schumer charged. The resulting legislation would likely throw millions out of health insurance, he said, while granting “a big fat tax break for the wealthiest among us.”

Senators are not obligated to hold meetings in the open, but Democrats pointed out that there were lengthy committee meetings and many days of floor debate on Obamacare before it passed in 2010.

Several Democrats moved for the healthcare legislation to be referred to Senate committees for hearings, but Senate Majority Leader Mitch McConnell refused.

McConnell said all Republican senators have been involved to some degree in healthcare meetings and that Democrats would have a chance to amend the legislation they produce, once it is brought to the Senate floor.

“We’re going to have a meeting on the Senate floor, all hundred of us, with an unlimited amendment process,” McConnell said. “So there will be no failure of opportunity.”

Senate Republican leaders would like a vote on healthcare legislation in July, before the July 4 recess if possible. But Republicans have struggled to coalesce around a bill, with moderates and conservatives pushing in different directions.

Senate Republicans also face pressure from the right. In the House, conservatives have written to McConnell to express concern about reports that say the Senate may water down the House bill.

(Reporting by Susan Cornwell; Editing by Jonathan Oatis and Leslie Adler)

California to give health clinics $20 million to counter possible Trump cuts

FILE PHOTO: Demonstrators protest over the repeal and replacement of Obamacare outside the offices of Republican congressman Darryl Issa in Vista, California, U.S., March 7, 2017. REUTERS/Mike Blake

By Lisa Lambert

WASHINGTON (Reuters) – California on Monday will announce plans to award $20 million in emergency grants to local health and Planned Parenthood clinics in anticipation of possible U.S. healthcare funding cuts, according to State Treasurer John Chiang’s office.

California and more than a dozen other Democratic-leaning states are fighting against regulatory changes and policies coming from Republican President Donald Trump and the Republican-controlled Congress.

The grants are intended to buy time for state lawmakers to address potential shortfalls caused by federal attempts to undo the Affordable Health Care Act, commonly called Obamacare, and to eliminate funding for women’s health and for contraception, the state said.

A California financing program will provide money for the grants, said Treasurer spokesman Marc Lifsher.

“The Community Clinic Lifeline Grant Program will help small or rural nonprofit clinics, including Planned Parenthood clinics, keep their doors open and provide critical services,” according to an announcement the Treasurer’s office posted on Friday.

Planned Parenthood, a national non-profit that provides contraception, health screenings and abortions, and the country’s long-standing divide over abortion are at the heart of the state’s move. Planned Parenthood representatives will join Chiang in unveiling the grant program, the announcement said.

Republicans generally oppose abortion. Recently, they approved a measure in Congress to allow states to block Planned Parenthood from receiving federal reproductive health funds. By law the funds cannot be used for abortions, but former Democratic President Barack Obama had ensured some money would go to Planned Parenthood clinics.

Actual federal funding reductions are still a while off.

In his recent proposed budget President Donald Trump called for slashing health and human services spending, and the Obamacare repeal the House of Representatives passed in April would eliminate federal funds for Planned Parenthood. But those moves do not have the force of law yet.

No other state appears to be developing a similar grant program.

(Reporting by Lisa Lambert; Editing by Cynthia Osterman)

Trump seeks to slash government spending in budget plan

FILE PHOTO - President Donald Trump's FY2018 budget is seen printed at the Government Publishing Office in Washington, U.S. on May 19, 2017. REUTERS/Yuri Gripas/File Photo

By Roberta Rampton

WASHINGTON (Reuters) – The White House on Tuesday will ask Republicans who control the U.S. Congress – and federal purse strings – to slash spending on healthcare and food assistance programs for the poor as they push ahead on plans to cut taxes and trim the deficit.

President Donald Trump is set to propose a raft of politically sensitive cuts in his first full budget, for the fiscal year that starts in October, a proposal that some analysts expected would be put aside by lawmakers as they craft their own budget and spending plans.

Trump, who is traveling overseas and will miss the unveiling of his plan, wants lawmakers to cut $3.6 trillion in government spending over 10 years, balancing the budget by the end of the decade, according to a preview given to reporters on Monday.

More than $800 billion would be cut from the Medicaid program for the poor and more than $192 billion from food stamps.

Republicans are under pressure to deliver on promised tax cuts, the cornerstone of the Trump administration’s pro-business economic agenda, which would cut the business tax rate to 15 percent from 35 percent, and reduce the number of personal tax brackets to three from seven.

But their policy agenda has stalled as the White House grapples with the political fallout from Trump’s firing of former FBI Director James Comey.

Comey had been leading a probe of alleged Russian meddling in the 2016 U.S. election.

Trump’s biggest savings would come from cuts to the Medicaid program made as part of a Republican healthcare bill passed by the House of Representatives.

The bill aims to gut the Obama administration’s signature 2010 Affordable Care Act, known as Obamacare, that expanded insurance coverage and the government-run Medicaid program for the poor. But it faces an uncertain future in the Senate, which is writing its own law.

The White House proposed changes that would require more childless people receiving help from the Supplemental Nutrition Assistance Program, better known as food stamps, to work.

STEEP CUTS

The plan would slash supports for farmers, impose user fees for meat inspection and sell off half the nation’s emergency oil stockpile. Another politically fraught item is a proposal for cuts to the U.S. Postal Service, a goal that has long eluded lawmakers and administrations from both political parties.

The first look at the plan came in a “skinny budget” released in March – a document that received a tepid response from Congress.

Most departments would see steep cuts, particularly the State Department and the Environmental Protection Agency.

There is some new spending. The Pentagon would get a boost, and there would be a down payment to begin building a wall on the southern border with Mexico, which was a central promise of Trump’s presidential campaign.

The budget includes $25 billion for a plan to give parents six weeks of paid leave after the birth or adoption of a child, and $200 billion to encourage state and local governments to boost spending on roads, bridges, airports and other infrastructure programs.

The plan drew immediate fire from lobby groups, including from the Committee for a Responsible Federal Budget, which said it relied on “rosy assumptions,” gimmicks and unrealistic cuts.

“While we appreciate the administration’s focus on reducing the debt, when using more realistic assumptions, the president’s budget does not add up,” Maya MacGuineas, the group’s president, said in a statement.

Trump’s plan relies on forecasts for economic growth of 3 percent a year by the end of his first term – well beyond Congressional Budget Office assumptions of 1.9 percent growth.

“That assumes a pessimism about America, about the economy, about its people, about its culture, that we’re simply refusing to accept,” White House budget director Mick Mulvaney told reporters on Monday.

(Additional reporting by Yasmeen Abutaleb, David Shepardson, Timothy Gardner, Ginger Gibson, Jason Lange and Julia Edwards Ainsley in Washington, and PJ Huffstutter in Chicago; Editing by Peter Cooney)

Global cyber attack slows but experts see risk of fresh strikes

An ambulance waits outside the emergency department at St Thomas' Hospital in central London, Britain May 12, 2017. REUTERS/Stefan Wermuth

By Jeremy Wagstaff and Eric Auchard

SINGAPORE/FRANKFURT (Reuters) – A global cyber attack described as unprecedented in scale forced a major European automaker to halt some production lines while hitting schools in China and hospitals in Indonesia on Saturday, though it appeared to die down a day after its launch.

Capitalizing on spying tools believed to have been developed by the U.S. National Security Agency, the cyber assault has infected tens of thousands of computers in nearly 100 countries, with Britain’s health system suffering the worst disruptions.

Cyber extortionists tricked victims into opening malicious malware attachments to spam emails that seemed to contain invoices, job offers, security warnings and other legitimate files.

Once inside the targeted network, so-called ransomware made use of recently revealed spy tools to silently infect other out-of-date machines without any human intervention. This, security experts said, marked an unprecedented escalation in the risk of fresh attacks spreading in the coming days and weeks.

The ransomware encrypted data on the computers, demanding payments of $300 to $600 to restore access. Researchers observed some victims paying via the digital currency bitcoin, though no one knows how much may have been transferred to extortionists because of the largely anonymous nature of such transactions.

Researchers with security software maker Avast said they had observed 126,534 ransomware infections in 99 countries, with Russia, Ukraine and Taiwan the top targets.

The hackers, who have not come forward to claim responsibility or otherwise been identified, took advantage of a worm, or self-spreading malware, by exploiting a piece of NSA spy code known as “Eternal Blue” that was released last month by a hackers group known as the Shadow Brokers, according to researchers with several private cyber security firms.

Renault said it had halted auto production at several sites including Sandouville in northwestern France and Renault-owned Dacia plants in Romania on Saturday to prevent the spread of ransomware in its systems.

Nissan’s manufacturing plant in Sunderland, northeast England, was also affected by the cyber assault though “there has been no major impact on our business”, a spokesman for the Japanese carmaker said.German rail operator Deutsche Bahn [DBN.UL] said some electronic signs at stations announcing arrivals and departures were infected, with travelers posting pictures showing some bearing a message demanding a cash payment to restore access.

“UNPRECEDENTED” ATTACK EASES

Europol’s European Cybercrime Center said it was working closely with country investigators and private security firms to combat the threat and help victims. “The recent attack is at an unprecedented level and will require a complex international investigation to identify the culprits,” it said in a statement.

Some experts said the threat had receded for now, in part because a British-based researcher, who declined to give his name, registered a domain that he noticed the malware was trying to connect to, and so limited the worm’s spread.

“We are on a downward slope, the infections are extremely few, because the malware is not able to connect to the registered domain,” said Vikram Thakur, principal research manager at Symantec.

“The numbers are extremely low and coming down fast.”

But the attackers may yet tweak the code and restart the cycle. The researcher in Britain widely credited with foiling the ransomware’s proliferation told Reuters he had not seen any such tweaks yet, “but they will (happen).”

Researchers said the worm deployed in the latest attack, or similar tools released by Shadow Brokers, are likely to be used for fresh assaults not just with ransomware but other malware to break into firms, seize control of networks and steal data.

Finance chiefs from the Group of Seven rich countries were to commit on Saturday to joining forces to fight the growing threat of international cyber attacks, according to a draft statement of a meeting they are holding in Italy.

“Appropriate economy-wide policy responses are needed,” the ministers said in their draft statement, seen by Reuters.

HOSPITALS IN FIRING LINE

In Asia, some hospitals, schools, universities and other institutions were affected, though the full extent of the damage is not yet known because it is the weekend.

“I believe many companies have not yet noticed,” said William Saito, a cyber security adviser to Japan’s government. “Things could likely emerge on Monday” as staff return to work.

China’s information security watchdog said “a portion” of Windows systems users in the country were infected, according to a notice posted on the official Weibo page of the Beijing branch of the Public Security Bureau on Saturday. Xinhua state news agency said some secondary schools and universities were hit.

In Vietnam, Vu Ngoc Son, a director of Bkav Anti Malware, said dozens of cases of infection had been reported there, but he declined to identify any of the victims.

South Korea’s Yonhap news agency reported a university hospital had been affected, while a communications official in Indonesia said two hospitals there had been hit.

The most disruptive attacks were reported in Britain, where hospitals and clinics were forced to turn away patients after losing access to computers on Friday.

International shipper FedEx Corp said some of its Windows computers were also breached. “We are implementing remediation steps as quickly as possible,” a FedEx statement said.

Telecommunications company Telefonica was among many targets in Spain. Portugal Telecom and Telefonica Argentina both said they were also targeted.

Only a small number of U.S.-headquartered organizations were hit because the hackers appear to have begun the campaign by focusing on targets in Europe, said Thakur.

By the time they turned their attention to the United States, spam filters had identified the new threat and flagged the ransomware-laden emails as malicious, he added.

MICROSOFT BOLSTERS WINDOWS DEFENCES

Private security firms identified the ransomware as a new variant of “WannaCry” that had the ability to automatically spread across large networks by exploiting a known bug in Microsoft’s Windows operating system.

“This is one of the largest global ransomware attacks the cyber community has ever seen,” said Rich Barger, director of threat research with Splunk, one of the firms that linked WannaCry to the NSA.

The Shadow Brokers released Eternal Blue as part of a trove of hacking tools that they said belonged to the U.S. spy agency.

The attack targeted Windows computers that had not installed patches released by Microsoft in March, or older machines running software that Microsoft no longer supports and for which patches did not exist, including the 16-year-old Windows XP system, researchers said.

Microsoft said it pushed out automatic Windows updates to defend existing clients from WannaCry. It had issued a patch on March 14 to protect them from Eternal Blue. Late on Friday, Microsoft also released patches for a range of long discontinued software, including Windows XP and Windows Server 2003.

“Today our engineers added detection and protection against new malicious software known as Ransom:Win32.WannaCrypt,” Microsoft said in a statement on Friday, adding it was working with customers to provide additional assistance.

POLITICALLY SENSITIVE TIMING

The spread of the ransomware capped a week of cyber turmoil in Europe that began when hackers posted a trove of campaign documents tied to French candidate Emmanuel Macron just before a run-off vote in which he was elected president of France.

On Wednesday, hackers disrupted the websites of several French media companies and aerospace giant Airbus. The hack happened four weeks before a British general election in which national security and the management of the state-run National Health Service are important issues.

Authorities in Britain have been braced for cyber attacks in the run-up to the election, as happened during last year’s U.S. election and on the eve of the French run-off vote on May 7.

But those attacks – blamed on Russia, which has repeatedly denied them – followed a different modus operandi involving penetrating the accounts of individuals and political organizations and then releasing hacked material online.

On Friday, Russia’s interior and emergencies ministries, as well as its biggest bank, Sberbank, said they were targeted by ransomware. The interior ministry said about 1,000 computers had been infected but it had localized the virus.

Although cyber extortion cases have been rising for several years, they have to date affected small- to mid-sized organizations. “Seeing a large telco like Telefonica get hit is going to get everybody worried,” said Chris Wysopal, chief technology officer with cyber security firm Veracode.

(Additional reporting by Kiyoshi Takenaka, Jim Finkle, Eric Auchard, Jose Rodriguez, Alistair Smout, Andrea Shalal, Jack Stubbs, Antonella Cinelli, Dustin Volz, Kate Holton, Andy Bruce, Michael Holden, David Milliken, Rosalba O’Brien, Julien Toyer, Tim Hepher, Luiza Ilie, Patricia Rua, Axel Bugge, Sabine Siebold and Eric Walsh, Engen Tham, Fransiska Nangoy, Soyoung Kim, Mai Nguyen; editing by Mark Heinrich)

UK government in dark over who behind cyber attack

FILE PHOTO: A National Health Service (NHS) sign is seen in the grounds of St Thomas' Hospital, in front of the Houses of Parliament in London June 7, 2011. REUTERS/Toby Melville/File Photo

LONDON (Reuters) – The British government does not yet know who was behind Friday’s global cyber attack that disrupted the country’s health system, interior minister Amber Rudd said on Saturday.

“We’re not able to tell you who’s behind the attack. That work is still ongoing,” she told BBC radio.

She said Britain’s National Cyber Security Center was working with the country’s health service to ensure the attack was contained, while the National Crime Agency was working with them to find out where it came from.

Rudd said the government did not know if the attack was directed by a foreign government.

On Friday, cyber extortionists tricked victims into opening malicious malware attachments to spam emails that appeared to contain invoices, job offers, security warnings and other legitimate files. Nearly 100 countries were impacted.

Rudd said the attack was not specifically targeted at Britain’s health service.

“(The virus) feels random in terms of where it’s gone to and where it’s been opened,” she said.

Though 45 health service organizations in England and Scotland were affected by malicious software, no patient data has been accessed or transferred, said Rudd.

The minister said lessons had to be learned from the attack.

“There will be lessons to learn … Why is it certain regions are affected more than others? Is it to do with the software? Is it to do with better IT?”

Separately on Saturday, finance chiefs from the Group of Seven rich countries will commit to join forces to fight the growing threat of international cyber attacks, according to a draft statement of a meeting they are holding in Bari, Italy.

(Reporting by James Davey; Editing by Mark Potter)

How one U.S. state is leading the charge to dismantle Obamacare

FILE PHOTO: U.S. Vice President Mike Pence, sitting with Kentucky Governor Matt Bevin (L), discusses the American Health Care Act during a meeting with local business leaders at the Harshaw-Trane Parts and Distribution Center in Louisville, Kentucky, U.S. on March 11, 2017. REUTERS/Bryan Woolston/File Photo

By Yasmeen Abutaleb and Robin Respaut

FRANKFORT, Ky./SAN FRANCISCO (Reuters) – For nearly three years, Democrats and former President Barack Obama pointed to Kentucky as one of the Affordable Care Act’s biggest success stories.

A poor, rural state that straddles the North and South, Kentucky was an early adopter of the healthcare law commonly known as Obamacare and saw one of the country’s largest drops in the uninsured rate.

Now Kentucky is poised for a new distinction: to be the first state to save money by reducing the number of people on Medicaid, the government health insurance program for the poor and disabled and a central tenet of Obamacare.

If successful, Kentucky would provide a roadmap for other states who are worried about paying an increasing share for people on Medicaid.

A new Republican health law that passed the U.S. House of Representatives on Thursday, along with state initiatives like Kentucky’s, would dramatically change the national healthcare system and cut more than $800 billion from Medicaid over the next 10 years.

The Republican bill still faces a long road ahead in the U.S. Senate and its final passage is far from assured, making initiatives like Kentucky’s all the more important.

Kentucky has proposed to lessen its financial burden before it grows by reducing the number of residents on Medicaid by nearly 86,000 within five years, saving more than $330 million in the process. (For a graphic click http://tmsnrt.rs/2on0HVK)

Kentucky’s plan also calls for new work requirements for able-bodied adults to get insurance. Plus, it would establish new fees for all members based on income and lock out some people who miss a payment or fail to re-enroll.

By following these proposed rules, Kentucky believes Medicaid enrollees will over time graduate from Medicaid to private and employer insurance plans.

“One of the most remarkable lies that has perpetrated in recent years in the healthcare community in America is that expanded Medicaid was working well in Kentucky,” Republican Governor Matt Bevin, who is leading the state effort, told Reuters from the governor’s mansion in Frankfort, Kentucky.

That view is in line with President Donald Trump’s administration, which has criticized Obamacare’s Medicaid expansion and urged states to pursue similar Medicaid reforms to what Kentucky is now attempting.

“If Kentucky is successful, you’ll see this spread through the more conservative-leaning states. It’s possible even a Democratic blue state could do it,” said George Huang, director and senior municipal healthcare research analyst at Wells Fargo Securities. “It’s the flexibility that some states are seeking.”

INSURING THE POOR AT A PRICE

Kentucky, a state Trump won handily last November, has been devastated by the loss of coal mining jobs and an opioid epidemic. The state sits near the bottom of health rankings for smoking rates, cancer deaths and diabetes.

“To me, morally, it was the right thing to expand Medicaid, but I had a responsibility to not to do something that would bankrupt the state,” said former Governor Steve Beshear, a Democrat, referring to the increased costs of caring for a larger population with Medicaid insurance.

More than 30 states, about a dozen of which are led by Republican governors, expanded Medicaid under Obamacare. In Kentucky, more than 400,000 people gained health insurance through the program, the highest growth rate of Medicaid coverage of any state.

Beshear commissioned independent studies by PricewaterhouseCoopers and Deloitte on the financial and health impacts of expanding Medicaid. Both studies found health and economic gains. Deloitte reported that 90,000 newly covered residents received cholesterol screening and 80,000 got preventative dental care within a year. It estimated Kentucky would see an economic boost of $30 billion and 40,000 new jobs by 2021.

Beshear’s successor, Republican Governor Bevin, was elected in 2015 on a promise to repeal and replace the healthcare law on the view that thousands of Kentuckians had unaffordable premiums and only one health insurer to choose from.

He dismissed the projections in the Beshear-commissioned studies as “preposterous,” and says the state’s share of expanded Medicaid – $74 million in 2017 and totaling $1.2 billion over five years – was too expensive and unsustainable.

“We want this to be a helping hand for people at a time when they need it, but then be able to return to the commercial marketplace,” Bevin said.

Last year, Bevin submitted the waiver to restrict Medicaid eligibility by requiring enrollees to work or volunteer at least 20 hours per week and to pay monthly premiums based on income. He’s still awaiting approval.

Bevin said he has spoken with several governors about the waiver and has had extensive conversations with Health and Human Services Secretary Tom Price about fast-tracking the approval process in order for other states to quickly adopt similar programs. Such conversations are occurring across the country in response to encouragement from the new administration to reform state Medicaid programs, said Alleigh Marre, a Health and Human Services spokeswoman.

Louisiana and Wisconsin are considering work requirements for Medicaid enrollees. The Obama administration rejected previous attempts by other states, including Ohio and Arizona, to require work programs and monthly premiums for Medicaid, historically a free program for those eligible.

“Every state is watching this to see what happens,” said Bevin of Kentucky’s waiver. “It’s the first one in the queue.”

SIGNS POINT TO “YES” FOR KENTUCKY WAIVER

The odds look good for Kentucky to get the waiver in the coming months, based on the track records of health officials that Trump named after his inauguration.

Seema Verma, the new head of the Centers for Medicare and Medicaid Services, which approves Medicaid waivers, said during congressional testimony that the agency will usher in “a new era of state flexibility and leadership.”

Verma helped craft Kentucky’s waiver, but said she will recuse herself from the approval process to avoid conflicts of interest.

She and Tom Price wrote a letter to governors in March encouraging Medicaid reforms that more closely resemble commercial insurance plans. In the letter, they suggested features such as premium fees, health savings accounts, and emergency room co-payments that encourage the use of primary care.

CMS declined to comment on Kentucky’s waiver and said it does not speculate on the process while ongoing.

Under federal law, waivers must promote Medicaid’s objective of delivering healthcare services to vulnerable populations who cannot otherwise afford them.

“Waivers have never been used to cut people from the rolls,” said Emily Parento, associate professor at the University of the Pacific’s law school and the former executive director of Kentucky’s Office of Health Policy.

But Verma’s office is encouraging changes to Medicaid that make the government program look more like private insurance policies – goals that are similar to Bevin’s in Kentucky.

“I think what will happen is that other states will look at it and go, ‘We want everything they got,’” Bevin said.

(This story has been refiled to fix spelling in paragraph 3.)

(Reporting by Yasmeen Abutaleb in Kentucky and Robin Respaut in San Francisco; Editing by Caroline Humer and Edward Tobin)

With Obamacare vote, House Republicans free to turn to tax reform

U.S. President Donald Trump (C) celebrates with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, in Washington, U.S., May 4, 2017. REUTERS/Carlos Barria

By David Morgan

WASHINGTON (Reuters) – The Republican-controlled U.S. House of Representatives plans to turn to tax reform in earnest, after concluding a lengthy healthcare debate this week with a vote to repeal and replace Obamacare.

But even as Republicans predicted that tax reform would succeed before year-end, lawmakers encountered new uncertainties about what a final tax package might contain, as well as doubts about whether Republicans will be able to enact reforms without Democratic help.

President Donald Trump and Republicans in Congress have pledged to complete the biggest tax reform since 1986, when President Ronald Reagan was in office, before the end of 2017. But they face an uphill battle, mainly over policy differences within their own ranks.

Thursday’s 217-213 House vote on healthcare legislation raised confidence in the Republican-controlled chamber’s ability to move major legislation after two earlier pushes ended in failure.

But to move forward on tax reform, the House, Senate and Trump administration must agree on where to set tax rates, how to pay for cuts and whether the final package should add to the deficit or pay for itself, all areas where common ground may be hard to find.

A plan to enact reforms without Democratic support will also require Republicans to pass a 2018 budget authorizing the parliamentary process known as reconciliation. But a new budget agreement poses a daunting task given Republican opposition to Trump demands for deep domestic spending cuts.

“That may prove to be one, if not the most difficult votes of the tax reform process,” Jonathan Traub, a managing principal at the consulting firm Deloitte Tax LLP.

Meanwhile, the need to reach agreement between the House, Senate and White House will likely delay introduction of a tax reform bill, which had been expected in early June.

But Republicans say it will ultimately make it easier to enact reforms before the end of the year.

The House Ways and Means Committee, which will unveil the initial tax bill, is still aiming for a revenue-neutral package that raises $2.4 trillion for tax cuts through a new border adjustment tax and elimination of business deductions for net interest payments, both controversial measures.

Panel chairman Kevin Brady told reporters that revenue neutrality is necessary to ensure bold, permanent changes to tax policy that can drive economic growth.

“That’s the argument and the case we’re going to make to the Senate and the Trump administration,” he said.

But Representative Mark Meadows, who chairs the conservative Freedom Caucus that helped block Trump’s first healthcare bill,

voiced opposition to a revenue neutral approach.

“If it’s revenue neutral, you’re not really lowering taxes. You’re shifting the burden,” Meadows told reporters.

The Trump tax plan unveiled last week calls for steep tax cuts financed by government revenues that officials say will result from higher growth. Some fear the plan could add trillions of dollars to the deficit if growth does not materialize.

Meadows said tax cuts should be offset by cuts to entitlement programs including Social Security and Medicare, which Trump has promised not to touch.

(Editing by Alistair Bell)

Trump faces major test as vote looms on U.S. healthcare bill

A cyclist passes the the U.S. Capitol, on the day the House is expected to vote here to repeal Obamacare in Washington, D.C., U.S., May 4, 2017. REUTERS/Kevin Lamarque

By Richard Cowan and Yasmeen Abutaleb

WASHINGTON (Reuters) – The U.S. House of Representatives was set on Thursday for a cliffhanger vote to repeal Obamacare, as Republican leaders worked to deliver President Donald Trump a win for one of his top legislative priorities.

House Republican leaders have expressed confidence the bill would pass and several party moderates who previously objected to the measure got behind it on Wednesday, giving it new momentum.

“We’re optimistic that we’ll pass it out of the House today,” Representative Mark Meadows of North Carolina, chairman of the conservative Freedom Caucus, told MSNBC’s “Morning Joe” program on Thursday.

The vote, which a House Republican aide said was due this afternoon, was expected to be close. Even if the measure passes the House, it faces daunting odds in the Senate where Republicans hold a narrower majority.

“Today is the next step in what is likely to be a very long process,” Republican Representative Michael Burgess of Texas also said on MSNBC.

Keen to score his first major legislative victory since taking office in January, Trump threw his own political capital behind the bill, meeting Burgess and other lawmakers and calling them in an effort to win their support.

Trump, whose Republican party controls both the House and Senate, is seeking to make good on his campaign promise to repeal and replace Obamacare.

Aides said he worked the phones furiously.

Wavering moderate Republicans had worried that the legislation to overhaul President Barack Obama’s 2010 signature healthcare law would leave too many people with pre-existing medical conditions unable to afford health coverage.

But the skeptical Republican lawmakers got behind the bill after meeting with Trump to float a compromise proposal expected to face unanimous Democratic opposition.

The legislation’s prospects brightened after members of the Freedom Caucus, a faction of conservative House lawmakers who played a key role in derailing the original version last month, said they could go along with the compromise.

Millions more Americans got healthcare coverage under Obamacare, but Republicans have long attacked it, seeing it as government overreach and complaining that it drives up costs.

Called the American Health Care Act, the Republican bill would repeal most Obamacare taxes, including a penalty for not buying health insurance. It would slash funding for Medicaid, the program that provides insurance for the poor, and roll back much of Medicaid’s expansion.

The latest effort comes after earlier pushes by Trump collapsed twice, underscoring the difficulty in uniting the various factions of the Republican party.

Earlier this week, prospects for the legislation appeared grim as several influential moderate Republicans said they could not support the bill, citing concerns about people with pre-existing conditions.

House Energy and Commerce Committee Chairman Representative Greg Walden of Oregon on Thursday defended the leaders’ plan to vote on the bill without a new Congressional Budget Office analysis of the costs or impact on coverage, factoring in the recent changes.

“Obviously, it’s a work in progress,” Walden, who also met with Trump on Wednesday, said in a separate MSNBC interview.

House Democrats have rejected the latest change to the Republican legislation, saying it did not go far enough toward protecting people with pre-existing conditions.

“Republicans have made Trumpcare even more dangerous and destructive than the last time they brought it to the floor,” Democratic Leader Nancy Pelosi said to her caucus in a letter late Wednesday night.

Democrats have long thought their best chance of stopping the repeal would be in the Senate, where only a few Republicans would need to defect to stop the law from moving forward.

Republican Meadows told MSNBC he expected the Senate to make changes to the bill that would improve it. The bill would then face a final vote in the House.

With the difficulties in the House, Democrats are optimistic Republicans will face a backlash from voters and could lose seats in the 2018 mid-term elections.

(Additional reporting by David Morgan, Steve Holland, Roberta Rampton, Eric Beech and Susan Heavey; Writing by Ginger Gibson; Editing by Caren Bohan and Jeffrey Benkoe)