August Recess 2018 - Where Do We Stand On Healthcare

Now that the ACA survived the August repeal and replace efforts, what comes next? Many in Congress are committed to bipartisan solutions to the instability in the ACA marketplaces and on the individual markets, and negotiations are underway.

Senator Lamar Alexander (R-TN), chair of the Senate Health, Education, Labor and Pension (HELP) committee, has expressed a need to quickly fix those problems. That committee has prominent Senators from all across the healthcare spectrum, including Bernie Sanders, Elizabeth Warren, Tim Kaine, Lisa Murkowski, Susan Collins, Bill Cassidy and Rand Paul. It is difficult to imagine that Cassidy and Paul are willing to do anything to help the ACA, even in the short term. In the House, the bipartisan Problem Solvers Caucus has been in contact with the Senate and a broad agreement seems to be coalescing around 4 fixes:

1. Making the Cost Sharing Reduction (CSR) payments;
2. Repealing the mandate for employers with fewer than 500 employees;
3. Repealing the medical device tax; and
4. Promoting flexibility for states through the use of waivers.

However, the President, Senator Cassidy and the Freedom Caucus remain committed to repealing the ACA. Trump continues to threaten to withhold CSR payments to insurers. Without a firm commitment to CSRs and uncertainty regarding the individual mandate, insurers continue to withdraw from markets and premiums for 2018 are skyrocketing. Most individuals will be shielded from the full force of the increased premiums as they receive subsidies. Not so for middle and upper middle class Americans, who will be paying substantially more in 2018 for the same level of coverage as in 2018. Click here for KFF article.

A large majority of Americans (78%) think the President and his administration should make the current health law work. A majority (60%) want bipartisan solutions to improve it. click here for KFF poll.

Congress reconvenes in early September.

Anthem Withdraws from California's Individual Health Markets

Anthem has announced that they are pulling out of the individual market in 16 of the 19 health insurance regions in California, including all of Southern California. Notices were sent to policyholders informing them that if they get their coverage through Covered CA or even individual policies directly from Anthem without subsidies, their policies will not be renewed on January 1, 2018. This action will impact approximately 250,000 Californians who must switch to new insurers. The instability in the Covered CA marketplace is due to the political attacks on the ACA according to Gerald Kominski of the UCLA Health Policy Center, and other policy experts.  Click here to read LA Times article.

On the same day, Anthem announced its quarterly earnings, beating expectations by nearly 10%. Their stock price is up over 30% since January on the strength of their government business and small business plans. Click here for SF Gate article.

Julia Brownley Supports Bipartisan Efforts to Fix the ACA

Julia Brownley, staunch supporter of the ACA, is a member of the New Democrats Coalition. a group of 61 "pro-economic growth, fiscally responsible" House Democrats. In addition to coming up with long term proposals to fix the ACA, the group has been working with the House's Problems Solvers Coalition and the Tuesday Group.  Click here for interview with Rep. Jim Himes. To read the New Democrats' long term proposed plan click here.

Some Bipartisan Support for Stabilizing Health Insurance Markets

Although Congress is on August recess, there is some bipartisan support to stabilize the ACA in both the Senate and the House. Lamar Alexander (R-TN), chair of the Senate Health, Education, Labor and Pensions, announced that his panel will work towards stabilization for 2018 when they return in September. The 23 members include several prominent Senators, including Bernie Sanders (I-VT), Elizabeth Warren (D-MA), Lisa Murkowski (R-AK), Susan Collins (R-ME) and Rand Paul (R-KY).

The Problem Solvers Caucus is leading the way in the House for bipartisan solutions for the individual markets as well. The 43 member group is made up of almost equal numbers of Republicans and Democrats. 

Most promising of all, the Senate and House groups have been coordinating efforts on similar quick-fix solutions that include (1) reinstating cost sharing reduction payments, (2) eliminating the medical device tax, (3) providing money and flexibility for states to further bolster their markets through reinsurance programs.

The pressure to act quickly is mounting as insurers announce 2018 rate increases as high as 40% in some states.  Health policy experts and insurers have stated that rate increases would only be in the single digits in many markets were it not for the uncertainty in the government's commitment to uphold the Affordable Care Act.

The Affordable Care Act Survives Republican Repeal and Replace Attempts

For those of us who stayed up late to watch the final vote on the "skinny" Repeal and Replace, there was drama until the end. Senator McCain, having voted for the two earlier Repeal and Replace plans, voted against the minimalist "skinny" repeal bill, ending the Senate's attempts to sink the ACA before the August recess. He joined Senators Collins (R-ME) and Murkowski (R-AK) who steadfastly voted against all three plans despite huge pressure from their Republican colleagues and the Administration.

The President continues to call for further Repeal votes so the Republicans can fulfill their seven year pledge to dismantle the ACA. McConnell and other Senate Republicans seem to have little appetite to continue with healthcare as their primary legislative focus in coming weeks.

Republicans Focus on "Skinny" Repeal Now

Having failed to get 50 votes on either full repeal or on repeal and replace, Republicans are now focusing on "skinny repeal." Senators are not sure exactly what will be in the proposal, but it is expected to include a withdrawal of the individual mandate, tax penalty and medical devices tax. This initiative is gathering steam, with Heller and Rand both expressing support.

It would not cut Medicaid funding, but Blue Cross Blue Shield warned that premiums on the individual market would skyrocket without it. The self-employed would be among those hardest hit, especially those with chronic conditions who buy more comprehensive (and expensive) policies.

If it passes the Senate, it would then head to the House where it may be voted on as early as Saturday.

The bronze and silver policy offerings on the individual markets have been challenging for many consumers who balk at paying substantial premiums for high deductible policies. It is most frustrating for those who do not qualify for subsidies. They are paying thousands of dollars annually per family member without receiving much actual healthcare.

Click here for article from The Hill.

Republicans Just Voted to Proceed on Bill to Repeal ACA

VP Mike Pence cast the deciding vote to move forward out of regular order to repeal and/or replace the ACA. NYTimes article.

Senate Republicans Meet Late into the Night; No Breakthrough, but Some Optimism

President Trump is still insisting that the Senate Republican get an ACA repeal bill to him as soon as possible. McConnell is still planning to have a vote on such a bill next week. Senate Republicans are expressing optimism publicly, but are privately skeptical. The latest wrinkle is that Senator McCain has a brain tumor and there is no set date for his return to the Senate. Bipartisanship is not an option according to Republican party leadership. Meanwhile, millions of Americans are unsure what access they will have to health coverage and at what cost. The exchanges are set to go live with the 2018 policies and pricing in less than 3 months. Read the Politico article here.

Al Gore Calls for Single Payer Healthcare

Former Vice-President Al Gore has added his voice to the chorus calling for single payer. He told a packed audience at a screening of his new documentary that the private sector has been unable to provide "good, affordable healthcare for all." Citing the failure of the Republicans' repeal and replace efforts, he has "reluctantly" come to the conclusion that it is time for a national single payer plan. Read the article here.

McConnell's Repeal and Replace Bill Is Dead!

Republican Senators Moran and Lee have gone on the record opposing the BRCA, McConnell's repeal and replace bill in the Senate. By simultaneously releasing their statements, from an arch conservative and a more moderate, they are shielding any one faction of the Republican party from blame for the bill's failure. It is unclear whether the Republicans will take another go at full repeal in the coming weeks, or if the third "R" may come in to play - repair. The exchange markets go live with the 2018 policies on October 1st. Given the instability in the individual markets, hopefully there will be some bipartisan legislation coming fairly quickly.

I'm dancing around to the tune of "Hail, hail the wicked witch is dead;" dead like a zombie, but let me have my moment.