Wednesday, May 31, 2017

California’s Single-Payer Health Care Plan Would Cost More Than the State’s Whole Budget

From Reason:
Like in Colorado, New York, and Vermont, California is learning that a single-payer plan would be prohibitively expensive. 
Stop me if you've heard this one before. A state considers implementing a single-payer health care system, then learns it would have to use its entire annual budget, plus some, to fund the idea. 
The latest stop on this magical mystery tour of progressive health care plans is California, where U.S. Sen. Bernie Sanders (I-Vermont) has been campaigning on behalf of a proposed state-run single-payer system. On Monday, state lawmakers in Sacramento got their first look at the price tag for the proposal, which rings in at a whopping $400 billion annually. 
The Sacramento Bee notes that, even after accounting for an estimated $200 billion that could be saved by replacing current state-run health programs with the single-payer program, the state would still need to come up with $200 billion annually.

This year's state budget in California, by the way, is about $180 billion. That means that implementing a single-payer health care system would require doubling (at least) the state's current tax burden. The analysis of the health care proposal presented to lawmakers on Monday suggests a 15 percent increase to the state's payroll tax to provide the necessary revenue.
The cost analysis is seen as "the biggest hurdle to creating a universal system," the Bee reports. ...
Gee, ya think?  

Under PPACA, Insurance Premiums Have Doubled Since 2013

So, are you getting twice as much value for your money?

From Modern Healthcare:
An HHS report released late Tuesday paints a grim picture of the rising health insurance premiums under the Affordable Care Act. But health policy experts explained that while premiums may have gone up since the ACA was implemented, consumers are also getting more bang for their buck. 
The report, which is the first ACA report out of HHS' Office of the Assistant Secretary for Planning and Evaluation published under the direction of the Trump administration, concluded that individual health insurance premiums grew 105% on average between 2013—before the ACA exchange went into effect—and 2017. 
For the 39 states that use, average monthly premiums rose from an average of $232 in 2013 to $476 in 2017, the report said. ...

Stopping (or Delaying) Obamacare's Less Known, Unlawful Subsidies Accelerates Demise of PPACA

From the New York Times:
The Trump administration asked a federal appeals court on Monday to delay ruling on a lawsuit that could determine whether the government will continue paying subsidies under the Affordable Care Act to health insurance companies for the benefit of low-income people — effectively prolonging uncertainty that is already rattling the health law.
The request could further destabilize insurance markets as insurers are developing rates and deciding whether to participate in 2018.
Insurers are supposed to submit their proposals to the federal government by June 21 and have already filed rate requests with several states. Loss of the cost-sharing subsidies, they say, could lead them to increase premiums by 15 percent to 20 percent or more, on top of any increases they might seek for other reasons.
In recent statements, the administration has not made any commitment to pay the subsidies beyond this month. ...
The legal fight stems from a lawsuit that the House of Representatives filed in November 2014 against the Obama administration. Last May, Judge Rosemary M. Collyer of the Federal District Court here ruled for the House, finding that the Health and Human Services Department had illegally paid billions of dollars in subsidies to health insurance companies.
The subsidies reimburse insurers for reducing deductibles and other out-of-pocket costs for low-income consumers — seven million people this year.
Judge Collyer said the spending violated the Constitution because Congress had never provided explicit authority for it. In particular, she said, the payments violated Article I of the Constitution, which states, “No money shall be drawn from the Treasury, but in consequence of appropriations made by law.”
“An appropriation must be expressly stated; it cannot be inferred or implied,” Judge Collyer declared.
President Barack Obama requested money for the cost-sharing subsidies as part of a budget he sent Congress in April 2013. Congress never approved the request. But the Obama administration saw the subsidies as essential to the success of the Affordable Care Act and began making the payments in early 2014, using money from a separate account established for tax refunds and tax credits.
Judge Collyer ordered a halt to the payments last year but suspended her order to allow the government to appeal.
The case has created an awkward situation for the Trump administration and for Republicans in Congress who began the lawsuit.
If the government continues paying the subsidies, it will, in effect, prop up the Affordable Care Act, even though Mr. Trump and congressional Republicans want to tear it down. On the other hand, if the government stops paying the subsidies, many insurers say they will sharply increase premiums or pull out of Affordable Care Act marketplaces, and Democrats will surely accuse Republicans of taking coverage away from millions of Americans.
The Trump administration has sent mixed signals, confusing insurers and consumers alike. The Health and Human Services Department said last month that it would continue paying the subsidies while the lawsuit was being litigated. But Mr. Trump has threatened to withhold the subsidies as a way to force Democrats to negotiate with him on a replacement for the 2010 health care law.
Several senior House Republicans have said they are willing to appropriate money for the subsidies, but the administration does not want that.
Mick Mulvaney, the director of the White House Office of Management and Budget, refers to the subsidies as “Obamacare bailout payments” and said on May 2 that the administration had not made a commitment to pay them beyond this month. Mr. Trump said he could stop the payments “anytime I want.”
The Congressional Budget Office estimates that the cost-sharing subsidies will cost $7 billion this year and $135 billion from 2018 to 2027.
The subsidies are available to people with incomes from 100 percent to 250 percent of the poverty level ($11,880 to $29,700 a year for an individual). 

California Seeks to Expand Government Healthcare for Undocumented Persons

From California Healthline:
California could become the first state to extend full Medicaid benefits to undocumented immigrants up to age 26 after two key legislative committees last week approved money for such an expansion. 
The Assembly and Senate budget committees both approved using some of the money from California’s recently passed tobacco tax to cover up to 80,000 unlawfully present young adults under the state’s version of Medicaid, known as Medi-Cal. 
The committees approved different amounts of money for the next budget year — about $54 million in the Assembly and about $86 million in the Senate — and they must agree on a single amount before starting state budget negotiations with Democratic Gov. Jerry Brown, who would have the final say. ... 
Beginning last May, California allowed eligible children who were in the U.S. without permission and under 19 to receive full Medi-Cal benefits. An estimated 190,000 such children have signed up for it since then. Previously, they were eligible for emergency services only under Medi-Cal. 
The federal government generally pays at least half of Medicaid costs, but California uses its own money to pay for these expanded Medi-Cal benefits. U.S. law largely bars the use of federal money for providing non-emergency Medicaid coverage to immigrants here without permission. 
Health Access, a Sacramento-based advocacy group, estimates that anywhere from 50,000 to 80,000 young adults without papers might enroll in Medi-Cal were the expansion to be approved. ...

Tuesday, May 30, 2017

On the Michael Berry Show Today to Discuss The Obamacare Replacement Proposal and Its CBO Score

I was on for a full hour with Michael this afternoon - only about 30 minutes once all of the commercials are edited out below.  My visit is the first half of this podcast:


Thursday, May 25, 2017

Benefits Opt-Out Payments Must Be Included in Overtime Calculation

Just in case employers needed any more reason to end their opt-out payment practices, this is from Kate McGovern Tornone over at the HR Daily Advisor:
The U.S. Supreme Court has left intact a 2016 appeals court ruling addressing how benefits opt-out payments interact with the Fair Labor Standards Act (FLSA). 
In a case of first impression, the 9th U.S. Circuit Court of Appeals (which covers Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, Oregon, and Washington) ruled that when an employer pays an employee cash for opting out of its health insurance, that payment must be considered part of the employee’s “regular rate of pay” under the FLSA. This means it must be used in calculating compensation for overtime hours. ...
The 9th Circuit agreed with the city that its ruling may cause employers to discontinue cash-in-lieu of benefits payments, but said its hands were tied....
Full story here.

Friday, May 5, 2017

Obamacare Replacement Passes U.S. House, a Visit with Armstrong & Getty on Pre-Existing Conditions

On May 4, 2017 the U.S. House of Representatives narrowly passed the American Health Care Act (AHCA) by a vote of 217 to 213. The bill must still go to the Senate where it is expected to undergo substantial changes.

We’ll continue to update you on pertinent developments.

I went on the air with Jack and Joe this morning to discuss this, the media's coverage of it and what the AHCA will actually do with respect to pre-existing conditions.

You can listen to all Armstrong and Getty shows here.

Here is a smattering of some of the better media coverage on this proposed law:

How the GOP health care plan differs from Obamacare
May 4, 2017 - ABC News
Excerpt: "In brief: What the AHCA does:
  • Ends individual mandate, imposes surcharge for coverage lapse
  • Ends Obamacare premium subsidies, offers tax credits instead
  • Rolls back Medicaid expansion across 30 states
  • Allows states to impose Medicaid work requirement
  • Expands health savings accounts
  • Allows states to waive federal "essential health benefits" requirement and set own standard
  • Allows insurers to charge older people up to 5 times as much as younger
  • Repeals consumer taxes
  • Imposes abortion restriction on tax credits
  • Imposes Planned Parenthood restriction for Medicaid
  • Requires insurers to allow young adults to stay on parents' plans until 26
  • Allows states to permit insurers to charge more for pre-existing conditions
  • Allocates $8 billion to help subsidize people with pre-existing conditions in state high-risk pools
  • Prohibits insurers from imposing lifetime or annual limits on coverage
  • Establishes "patient and state stability fund" to help states service low-income Americans" 

House passes ObamaCare repeal
May 4, 2017 – The Hill
Excerpt: “The narrow 217-213 vote is a victory for GOP leaders, who faced a tumultuous path to getting the bill to the floor. The measure had to be pulled in March because of a lack of votes, but a series of deals since then brought on board the conservative Freedom Caucus and then wavering moderates.”

U.S. House Narrowly Passes AHCA; Bill Heads to Senate, Fate is Unclear

May 4, 2017 – The Council of Insurance Agents & Brokers
Excerpt: “The bill eliminates the employer and employee mandates; replaces the ACA’s income-based subsidies with tiered tax credits, gradually increasing for older Americans; allows states to apply for waivers to define their own essential health benefit requirements; expands the limits for Health Savings Accounts; discontinues Medicaid expansion in 2020; and repeals most of the ACA’s taxes. The legislation would delay implementation of the Cadillac Tax by five years, from 2020 to 2025, and it importantly preserves the tax exclusion for employer sponsored insurance.”

The health care bill's path forward in the Senate
May 4, 2017 – Axios
Excerpt: “It’s been widely assumed the current GOP health care bill working its way through the House would be vastly changed in the Senate-in fact, that’s part of leadership’s pitch to moderate holdouts. But Senate Republicans are already thinking about what it will take to get the bill through the upper chamber, and the changes are not as vast as some might think.”