Since it's been a long time since we've had it, I thought you would appreciate seeing this:
Thursday, December 10, 2020
Tuesday, November 24, 2020
I've been doing health policy for thirty years. I arguably know something about health insurance.
For the life of me, I can't figure out what Kelly Loeffler is proposing under her health plan––particularly when it comes to current protections for preexisting conditions.
In 2017, Republicans proposed a plan that would have arguably given states the ability to reverse Obamacare's protections for preexisting conditions. Something I highly doubt states would have done if the Republican Obamacare repeal plan had passed. But states could have done it and that was enough for Democrats to jump on the possibility and make it a major issue in the 2018 elections––an election where Democrats made big gains.
The lesson Republicans should have learned from that episode is that it is foolish to tinker with preexisting conditions protections.
Now, this Georgia Senator is in a tight race to keep her Senate seat in a state Joe Biden just won.
Under these circumstances I would not be screwing around with the preexisting conditions issue.
You can access her four page plan summary here.
In the section titled, "Expand Affordable Health Insurance Options," she lists a number of steps she would take. While she condemns what Obamacare has done to the individual market in Georgia, she never says what she would do to the existing health care law aside from a few unconnected bullet point proposals.
Among her seven bullet points in this section, she says she would, "Establish guaranteed coverage plans to help patients with preexisting conditions." Why would she have to do this when current law now requires mainstream health insurance plans to cover preexisting conditions?
Is she proposing to repeal these current preexisting condition protections and replace them with separate high risk pool insurance policies just for people with preexisting conditions?
We had high risk pools in some states prior to the 2014 preexisting condition reforms that occurred under the Affordable Care Act/Obamacare. These pools often covered less and cost more.
It looks to me like Senator Loeffler is creating a huge opening for her Democratic opponent big enough to drive a big truck through.
Just like Republicans did in 2018 and paid a big election-year price for doing it.
Tuesday, November 10, 2020
After hearing the Supreme Court's oral arguments this morning over the constitutionality of the Affordable Care Act (Obamacare), I can double down on my prediction the Court will not wreck Obamacare.
If the conservative justices don't buy the plaintiff arguments, their attempts to destroy Obamacare will fail. Just two of the conservatives siding with the three remaining liberals would be enough to protect the health care law.
Listening to the arguments, at least three of the conservatives (Roberts, Kavanaugh, and Alito) were clear that whatever the Court does with what remains of the individual mandate the rest of the law should stand.
The best comment came from one of the most conservative justices, Samuel Alito, over the question of whether or not the mandate can be severed and the rest of the law could continue to stand:
“In the first case [NFIB vs Sebelius, 2012], there was a strong reason to believe the individual mandate was … essential to keep the plane flying. Now the part has been taken out and the plane has not crashed,” Alito said. “How would we explain why the individual mandate in its present form is essential to the operation of the act?”
Game, set, match. The Supreme Court will not wreck Obamacare!
Maybe the Court will strike down the hollow remains of the individual mandate. Aside from that, the only question left in my mind is whether or not the Court will be unanimous in upholding the rest of the health care law.
Monday, November 9, 2020
This is an update of an article originally posted in September.
With the Supreme Court due to hear arguments this week on a case brought by a number of Republican state attorneys general that could throw out the entire health care law, and with conservatives now having a 6-3 majority on the Supreme Court, there is great concern among ACA/Obamacare supporters that this could well mean the end of the health care law.
The Obamacare case currently before the court deals with the 2017 repeal of the law's tax penalty enforcing the individual mandate for people to buy health insurance coverage. In 2012, Chief Justice John Roberts cast the deciding vote in the 5-4 decision upholding Obamacare generally, and the individual mandate specifically, as valid under the Congress' taxing power. After the mandate's tax penalty was repealed in 2017, a number of Republican state attorneys general sued, arguing that since the mandate was no longer tied to a specific tax penalty, it had lost its legal underpinning. They also argued that because the individual mandate was key to a number of the law's provisions that made it a workable system of insurance, the entire law should fall, including preexisting conditions protections.
Saturday, November 7, 2020
Biden has won.
Presuming the North Carolina and Alaska Senate seats remain in Republican hands, the Senate will come out no better for Democrats than a 50-50 tie with Vice President-elect Harris being the tiebreaker. And, if Republicans win at least one of the two Georgia run-off Senate races, the Republicans will maintain control and the Democrats will not have the votes to move any partisan health care legislation.
But the Democrats will control the Department of Health and Human Services and the federal government's health care regulatory apparatus.
I will suggest that the health care plan Biden campaigned on can be summarized into three primary parts:
- Fixing the Obamacare/Affordable Care Act (ACA) individual health insurance subsidies for the middle class.
- Giving Medicare the power to negotiate prescription drug prices.
- Creating a government-run individual health insurance plan option called the Public Option.
Thursday, September 24, 2020
So, after twenty years of national public policy debate and hard-fought Congressional and Presidential approval, how does Trump conclude he can restore these protections should the Republican Supreme Court suit overturn them, with a simple executive order?
Wednesday, September 23, 2020
Now that it appears certain that the Republicans will approve a new Supreme Court justice in the coming weeks, there is great concern among Obamacare supporters that this could well mean the end of Obamacare.
That concern is being amplified in the hyper partisan environment in the ramp-up to the election––it makes for good scare tactics.
The Obamacare case currently before the court deals with the 2017 repeal of the law's individual mandate for people to buy health insurance coverage. In 2012, Chief Justice John Roberts cast the deciding vote in the 5-4 decision upholding Obamacare generally, and the individual mandate specifically, as valid under the Congress' taxing power. After the mandate repeal in 2017, a number of Republican state attorneys general sued, arguing that since the mandate was no longer tied to a specific tax penalty, it had lost its legal underpinning. They also argued that because the individual mandate was key to a number of the law's provisions that made it a workable system of insurance, the entire law should fall, including preexisting conditions protections.
Tuesday, September 8, 2020
IF the Democrats capture the White House, keep the House and take over the Senate the Biden health care outline stands a good chance of being enacted.
The Biden health care proposal directly takes on the big things that haven't worked in Obamacare.
Monday, August 24, 2020
President Trump recently signed two executive orders directly related to prescription drug prices in the U.S.
One order would allow the "reimportation" of prescription drugs from Canada. This longstanding idea would allow U.S. pharmacies and drug wholesalers the ability to pay generally much lower prices for their prescription drugs by getting them from Canadian suppliers who benefit from government management of the system. Many consumers have been buying direct from Canadian pharmacies for years since current prohibitions have not been enforced against individuals.
Saturday, August 15, 2020
Kamala Harris has had some notable difficulty with the health care issue.
At a Democratic debate in June 2019, the candidates were asked, "Who here would abolish [employer-provided] health insurance in favor of a government-run plan?'
Harris enthusiastically raised her hand––joined over the two evenings of the debate by Sanders, Warren, and de Blasio. Not a surprise since she had already signed on to Bernie Sanders' single-payer health bill.
But the next day she walked that hand raising back. This from NBCNews.com:
Kamala Harris was one of two candidates who raised their hands when asked at Thursday night's debate if they would get rid of private health insurance, but the California senator said Friday she'd misunderstood the question.
"No," Harris told MSNBC's "Morning Joe" when asked if she'd work to abolish private health insurance in favor of "Medicare for All" if elected president.
But in her subsequent answers, she struggled to clarify her position about the role of private insurance under her plan, something that has become a pattern in recent months as Democratic candidates look to navigate politically charged questions about Medicare for All's policy implications.
Sunday, August 9, 2020
President Trump said over the weekend, "If I'm victorious on November 3rd, I plan to forgive these [payroll
taxes for Social Security] and make permanent cuts to the
Currently, employers and employees split the 12.4% payroll tax on the first $137,700 of 2020 earnings and also split the 2.9% Medicare tax on all earnings. The self-employed pay the entire tax.
Trump not only wants to suspend the Social Security tax during the pandemic crisis, he says he wants to make permanent cuts to the tax.
First, the only people who pay these taxes are people who still have their jobs and their earnings. With millions unemployed it can be argued that it would make more sense to increase deficit spending by providing help directly to those who don't have any earnings––the unemployed.
But the bigger question revolves around the suspension of funding to Social Security––particularly permanent cuts.
Both the Medicare and Social Security trust funds are running out of money––both face an inability to pay full benefits if their problems aren't solved by either increasing funding or cutting benefits. That is projected by the Congressional Budget Office to happen for Medicare in 2025 and Social Security in 2031.
Friday, August 7, 2020
Well, That's a Fine Fiscal Mess They've Gotten Us Into––Fiscal Irresponsibility and Hard Hearted Republicans
The Covid pandemic has led to extraordinary government spending.
I have no doubt that it is necessary in order to avoid not only further economic collapse but massive suffering. Sure, there are some people making more in unemployment benefits than they made working and have spent the summer partying at the beach and ignoring social distancing rules.
Remember, the $600 a week additional unemployment benefit was originally the Trump administration's idea.
But I have no doubt there have been more families that have been able to put food on the table had it not been for this assistance. Emergency action gets really messy.
Republicans seem only to be able to see the partying and have a blind eye to the suffering.
Wednesday, April 22, 2020
Is the Federal Government Prepared to Give 300 Million Coronavirus Vaccine Injections in Early 2021?
Are any of the world's governments and drug companies ready to give a billion or more injections in 2021?
Anyone who believes that our economy will be able to fully open up before a vaccine is not only developed but deployed is dreaming. Will you take a vacation without being vaccinated? Sit at a bar? Attend a business meeting or convention? Go to a movie?
After watching our federal government constantly playing from behind these past few months, I don't see any evidence the White House is thinking about the logistics necessary to vaccinate everyone in America––or the diplomatic issues that are going to occur when the rest of the world wants to get their hands on that vaccine.
Friday, April 3, 2020
It is the most comprehensive and practical primer on the epidemic that I have seen and I highly recommend it to you.
You can access it here.
Sunday, March 29, 2020
My last post directed you to David Katz's op-ed which generally outlined such an approach.
The American Enterprise Institute (AEI) now has a more lengthy paper authored by a number of experts, led by former FDA Commissioner Scott Gottlieb.
Their plan has three key phases:
- Slow the Spread - This is essentially where we are in the nation's various lock downs. "These measures will need to be in place in each state until transmission has measurably slowed down and health infrastructure can be scaled up to safely manage the outbreak and care for the sick."
- State-by-State Reopening - "Individual states can move to Phase II when they are able to safely diagnose, treat, and isolate COVID-19 cases and their contacts."
- Eliminating Physical Distancing Restrictions and Other Phase II Measures - "Can be lifted when safe and effective tools for mitigating the risk of COVID-19 are available, including broad surveillance, therapeutics that can rescue patients with significant disease or prevent serious illness in those most at risk, or a safe and effective vaccine."
But, I will also suggest we will not be able to get back to anything resembling normal until we have a vaccine, mass produce it, and have made it available to the general population. Hearing experts tell us that all of this won't likely occur for one to two years makes it necessary to come to an agreement on what Phase Two will look like and when we can move to it.
You can see the full AEI report here.
Monday, March 23, 2020
I am not an epidemiologist so I offer no professional opinion on just what that plan should be.
But, if you haven't yet read the op-ed in the NY Times by David Katz of Yale University, you should.
The data from South Korea, where tracking the coronavirus has been by far the best to date, indicate that as much as 99 percent of active cases in the general population are “mild” and do not require specific medical treatment. The small percentage of cases that do require such services are highly concentrated among those age 60 and older, and further so the older people are. Other things being equal, those over age 70 appear at three times the mortality risk as those age 60 to 69, and those over age 80 at nearly twice the mortality risk of those age 70 to 79...
The experience of the Diamond Princess cruise ship, which houses a contained, older population, proves the point. The death rate among that insular and uniformly exposed population is roughly 1 percent...
The clustering of complications and death from Covid-19 among the elderly and chronically ill, but not children (there have been only very rare deaths in children), suggests that we could achieve the crucial goals of social distancing — saving lives and not overwhelming our medical system — by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure...
If we were to focus on the especially vulnerable, there would be resources to keep them at home, provide them with needed services and coronavirus testing, and direct our medical system to their early care. I would favor proactive rather than reactive testing in this group, and early use of the most promising anti-viral drugs. This cannot be done under current policies, as we spread our relatively few test kits across the expanse of a whole population, made all the more anxious because society has shut down.This focus on a much smaller portion of the population would allow most of society to return to life as usual and perhaps prevent vast segments of the economy from collapsing. Healthy children could return to school and healthy adults go back to their jobs. Theaters and restaurants could reopen, though we might be wise to avoid very large social gatherings like stadium sporting events and concerts...A pivot right now from trying to protect all people to focusing on the most vulnerable remains entirely plausible. With each passing day, however, it becomes more difficult. The path we are on may well lead to uncontained viral contagion and monumental collateral damage to our society and economy. A more surgical approach is what we need.
Tuesday, March 10, 2020
Will the Trump Administration's Testing Snafus for Coronavirus Be Their Political Version of the Democrats' Catastrophic Launch of Obamacare?
As I have watched the Trump administration fumble the ball on getting mass coronavirus testing available to communities, I am reminded of the way the Obama administration fumbled their own ball during the Obamacare launch in 2013:
- Repeated statements on how well things were going in the face of facts that did not match their rhetoric.
- Not having a handle on what could go wrong and what did go wrong from beginning to end.
- Delays that led to a public lack of confidence in the administration.
The difference this time is that the Obamacare fiasco was ultimately brought under control and, while people not being able to sign up for their health insurance for a few weeks was not a small deal, it wasn't the life and death scenario we are facing today.
Monday, February 24, 2020
Tuesday, February 11, 2020
And, readers already know that no one has been more supportive of the Medicaid expansion from the very beginning.
Now, the Trump administration wants to give states the option to abolish the open-ended federal funding of Medicaid via fixed block grants for only a small portion of those eligible, or potentially eligible.
Critics argue that by fixing these funds, particularly at a growth rate lower than paid in the past, will result in less money and if there is less money there will be fewer benefits and fewer people covered given the flexibility states would have to redefine the program.
That is a logical conclusion.
But it's a lot more complicated than that.
Monday, February 10, 2020
Despite All of Its Efforts to Insure Everyone and Control Health Costs Things Are Getting Worse in Massachusetts
Few states have done as much as Massachusetts (MA) over the last 30 years to lower healthcare costs, improve quality and outcomes and, in general, to innovate.
Wednesday, February 5, 2020
His latest covers the state of Florida and provides what I am sure is a representative sample of what is happening across the country.
A few excerpts:
About 6 in 10 Democrats at the Iowa caucuses on Monday reported that they support eliminating private health insurance as part of establishing a single-payer health-care system, according to preliminary poll results, suggesting that most of the party’s voters agree with Sen. Bernie Sanders (I-Vt.) on the divisive issue.Only these voters can reelect Donald Trump.
Monday, January 27, 2020
Comprehensive Enrollment and Cost Estimates for the Biden Health Plan, the Buttigieg Health Plan, the Warren Health Plan, and the Sanders Health Plan
Their mission is to keep the federal budget process honest and responsible.
Its current board members include a veritable who's who of Washington, DC adults; Mitch Daniels, Leon Panetta, Tim Penny, Erskine Bowles, Kent Conrad, Vic Fazio, and Bill Gradison.
The Committee has just released a comprehensive evaluation of the leading Democratic candidates' health care plans.
It is required reading for any serious health policy wonk. Disbelieve their work at your own peril.
Monday, January 13, 2020
Their opposition is irrational.
It is also unpopular with voters. In dark red states like Nebraska, Idaho and Utah voters recently went over the heads of their Republican legislators and governors by approving referendums to expand the program. And, Kansas is about to become the 37th state to expand Medicaid under Obamacare after a bipartisan agreement between the Democratic governor and Republican leaders in the legislature.
While Obamacare's individual health insurance reforms and subsidies have been a disaster for the middle class (See: Obamacare is "Stable" at an Incredibly Unstable Place), the Medicaid expansion in the states that have approved it has covered millions of people that would never have been covered otherwise––at a cost that could never have been less.
Republican opposition has centered around a number of arguments. Let's take a look at each of them.
Wednesday, January 8, 2020
Then Elizabeth Warren showed us just how politically unrealistic single-payer health care is when she released her funding plan and then quickly backtracked to the public option approach in the face of rapidly declining polls. See my post: Elizabeth Warren Backs Into the Public Option and Effectively Takes Medicare for All Off the Table for Democrats in 2021
In a separate post, I pointed out that single-payer advocates, like Sanders and Warren, have yet to answer the biggest financial questions surrounding putting the entire country on a single government reimbursement system: How will their paying providers Medicare rates for everything not bankrupt hospitals and doctors? And, if they don't pay providers these lower Medicare rates, how will their proposals save us any money?
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