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March 5, 2018

Headlines in Health Policy d1195439-f458-4f5f-93d4-147ddda3802b

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Quotable

“The Trump administration has now followed up with a new plan to allow insurance companies to sell junk health insurance. Make no mistake, this is part of the continuing...drive to overturn the Affordable Care Act. It has gone from the headlines to the back pages, but to Americans with preexisting conditions, or those living on the margins, the threat is just as real.  — Andy Slavitt, United States of Care

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The Administration

  • Survey: Most Americans Support the Right to Affordable Care, but Remain Pessimistic about ACA's Future Fierce Healthcare by Matt Kuhrt —Findings from a new survey conducted in the last two months of 2017 mark the Commonwealth Fund’s sixth snapshot of public opinion regarding the health care landscape. Federal efforts to dismantle the Affordable Care Act (ACA) over the past year have stoked uncertainty among those who receive their coverage through the exchanges or under the Medicaid program. Roughly 1 in 3 reported pessimism about keeping their current coverage, and half of those voiced concern that either Congress or the Trump administration would undercut the ACA through a full repeal or discontinued implementation of the law.

  • ACA's Popularity Grows, Even as GOP Lauds Change to Requirement to Have Coverage Kaiser Health News by Phil Galewitz — Despite President Donald Trump's boasting that "we have essentially repealed Obamacare," a new poll shows the ACA is more popular than ever. In fact, many people don't know Congress repealed the ACA's penalty for not having insurance. The poll from the Kaiser Family Foundation found 54 percent of Americans had a favorable view of the 2010 health law that expanded health coverage to millions. That was up four points from January, and it's highest point since the monthly survey began in 2010. (KHN is an editorially independent program of the foundation.) The survey found 40 percent of respondents were unaware that Congress in January repealed the individual mandate penalty as part of the federal tax overhaul. It takes effect in 2019. About one in five people were aware of the repeal but believed incorrectly that it had taken effect this year.

  • A Big Divergence Is Coming in Health Care Among States New York Times by Margot Sanger-Katz — Little by little, the Trump administration is dismantling elements of the ACA and creating a health care system that looks more like the one that preceded it. But some states don't want to go back and are working to build it back up....Several states are considering whether to adopt their own versions of the individual mandate, Obamacare's rule that people who can afford insurance should pay a fine if they don't obtain it. A few are looking to tighten rules for short-term health plans. Some states are investing heavily on Obamacare outreach and marketing, even as the federal government cuts back. The result is likely to be big differences in health insurance options and coverage, depending on where you live. States that lean into the changes might have more health insurance offerings with small price tags, but ones that are inaccessible to people with health problems and don't cover major health services, like prescription drugs. States pushing back may see more robust Obamacare markets of highly regulated plans, but the price of those plans is likely to remain higher.

  • 20 States Sue Over Obamacare Mandate — Again Politico by Jennifer Haberkorn —Twenty states have filed a lawsuit against the Trump administration over Obamacare's individual mandate — again. Wisconsin, Texas, and several other red states claim in the lawsuit filed today that since Congress repealed the individual mandate's tax penalty for not having coverage, that means the mandate itself — and the whole health care law — is invalid. The GOP tax law "eliminated the tax penalty of the ACA, without eliminating the mandate itself," the states argue in a complaint filed in U.S. District Court in the Northern District of Texas. "What remains, then, is the individual mandate, without any accompanying exercise of Congress's taxing power, which the Supreme Court already held that Congress has no authority to enact."

  • Iowa Lawmakers Move to Allow Health Plans That Skirt Obamacare Rules The Hill by Nathaniel Weixel — State lawmakers in Iowa are moving to allow the Iowa Farm Bureau Federation to offer health insurance plans that don't comply with Obamacare protections. Two bills moving through the state legislature aim to provide Farm Bureau members with plans that cost much less than plans that are currently available on Iowa's individual market. But since the plans will be exempt from Obamacare protections, people with preexisting conditions could be charged more.  According to the Des Moines Register, the proposal calls for the Iowa Farm Bureau to partner with Wellmark Blue Cross and Blue Shield to offer "benefit plans." The plans would not be subject to state or federal insurance regulations, which critics say drive up the cost of health care for younger, healthier people....Democrats say the order is illegal and have called on the Department of Health and Human Services to intervene.

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Medicaid

  • Medicaid Changes Require Tens of Millions in Upfront Costs Roll Call by Misty Williams — The addition of work requirements and other sweeping changes to Kentucky's Medicaid program could cost nearly $187 million in the first six months alone to get up and running. Republican Gov. Matt Bevin projects that the program will eventually yield savings, but the changes require an upfront investment in administrative expenses. Much of that money is aimed at creating complex electronic systems and other changes needed to track work hours, monthly premium payments and other elements of Kentucky's recently approved plan to revamp the government insurance program for low-income Americans. The vast majority of those dollars — more than $167 million — would be covered by the federal government, according to Bevin's revised budget for fiscal 2018. The budget increase offers a glimpse into the initial costs to launch the Medicaid changes numerous states are seeking.


  • As Trump Pushes Medicaid Testing, the Grading Falls Short New York Times by Robert Pear — The Trump administration is hoping to transform Medicaid by allowing states to test work requirements, premiums, and other conservative policies, but a new government report says federal and state officials do not properly evaluate whether such experiments improve patient care or reduce costs. Evaluations “generally lacked rigor,” and the findings were often kept secret for years, so they were of little use to policymakers, the Government Accountability Office, a nonpartisan investigative arm of Congress, said in the report issued last month. In granting Medicaid waivers, federal officials typically require states to measure the effects of a policy change on costs and the health of beneficiaries. But, the report said, it is often difficult to isolate those consequences because the overall health care system is changing so fast.

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Gun Control

  • Limits on Federal Gun Research Spur States to Step In Stateline by Michael Ollove — As deaths from mass shootings have mounted across the United States, some states are moving to collect hard data to guide their decisions about guns — even as the federal government has retreated from such research in the face of pressure from pro-gun groups. The New Jersey Legislature, for example, is weighing a measure that would create a gun-violence research center at Rutgers University. The center would be modeled on the new Firearm Violence Prevention Research Center at the University of California at Davis, which launched last summer with $5 million in state money over five years. The impetus for both initiatives is the vacuum created by the federal government's virtual abandonment of research into gun violence — its causes, its patterns, its perpetrators, its victims, and the best ways, based on scientific evidence, to curtail it. … "What isn't known?" Hemenway said. "Everything. Everything." For instance, there are no national studies of who owns guns, how gun owners acquired their weapons, the theft of guns, the number of households with guns, the attributes of a high-quality gun training, or the risk factors associated with gun violence. Without that knowledge, Hemenway said, "How are you supposed to come up with effective policy?"

  • School Killings Spur Effort to Renew Government Gun-Violence Research Wall Street Journal by Kristina Peterson, Betsy McKay and Stephanie Armour — For more than 20 years, federal law has effectively halted the government's ability to research gun violence. Now, the shooting that killed 17 at a Florida high school in February has prompted a bipartisan group of lawmakers to take another look at the restrictions. As lawmakers tangle over other gun-violence prevention measures, Democrats and some centrist Republicans are pushing to eliminate a provision tucked into spending bills that has restricted the Centers for Disease Control and Prevention's ability to conduct research on the topic.

 

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Editor

Editor: Peter Van Vranken

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http://www.commonwealthfund.org/publications/newsletters/headlines-in-health-policy/2018/mar/mar-5-2018