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Health Affairs Blog- Andrew Goodman-Bacon and Emma Sandoe -August 23, 2017 Recent health reform debates have generated a new theory that claims that the Affordable Care Act’s (ACA) Medicaid expansion has either caused or exacerbated the opioid epidemic. The logic on its face seems clear: legal prescriptions fuel the opioid epidemic, Medicaid increases access to prescription opioids, hence the Medicaid expansion contributes to, or has even caused the epidemic. Proponents of this view point to a rise in opioid-related deaths in ACA Medicaid expansion states relative to non-expansion states. Political commentators, including some politicians, use this claim to justify their support for federal Medicaid cuts, despite the fact that Medicaid finances a significant amount of treatment for opioid use disorder. In this post, we argue that evidence for the claim that the ACA’s Medicaid expansion caused or exacerbated the opioid epidemic is not credible. First, trends in opioid deaths nationally and by Medicaid expansion status predate the ACA. Second, counties with the largest coverage gains actually experienced smaller increases in drug-related mortality than counties with smaller coverage gains. Third, the fact that Medicaid recipients fill more opioid prescriptions than non-recipients largely reflects greater levels of disability and chronic illness in the populations that Medicaid serves. While we do not reject the possibility that public policy has played a role in our current prescription abuse crisis, on balance we find little evidence to support the idea that Medicaid caused or worsened the epidemic. Existing Evidence On Medicaid And Opioids Comparing Medicaid Recipients To Non-Recipients Proponents of the view that Medicaid exacerbates drug abuse often cite the fact that Medicaid recipients are prescribed more opioids than non-recipients. In the early 2000s, for example, Medicaid enrollees in New York [...]

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REUTERS- Yasmeen Abutaleb #POLITICS AUGUST 16, 2017 / 12:53 PM /  WASHINGTON (Reuters) - The Trump administration will make cost-sharing payments to insurance companies under Obamacare for August, a White House spokesman said on Wednesday, but the announcement did little to quell long-term concerns about the insurance market. President Donald Trump, a Republican, has repeatedly threatened to stop the payments, which are made directly to insurance companies to help cover out-of-pocket medical expenses for low-income Americans enrolled in individual healthcare plans under the Affordable Care Act (ACA). The payments are estimated to amount to $7 billion in 2017. The Centers for Medicare and Medicaid Services also said on Wednesday that two counties were projected to have no insurer in 2018 selling plans on the individual market created under former Democratic President Barack Obama's healthcare policy, down from 40 earlier this year. Both announcements could bring some short-term stability to insurance markets, but the long-term outlook is uncertain, said Cynthia Cox, policy researcher and associate director at the nonprofit Kaiser Family Foundation. Over the past several months, Trump and Republicans lawmakers who control both chambers of Congress, regularly pointed to the number of expected so-called bare counties in 2018 to argue for a bill repealing and replacing Obamacare. Insurers are still unsure whether Republicans will again try to repeal or replace the law when they return in September from a recess and whether the Trump administration will permanently make the insurer payments. They also do not know whether the administration will enforce a requirement of the ACA that all Americans buy health insurance or else pay a fine. It is unclear whether the federal government played a role in providing incentives to insurers to offer plans in bare [...]

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Hartford Courant - Dan Haar- August 10,2017 It was a tense winter for Aetna, Cigna and the other giant national managed health care companies. Their mega-mergers collapsed in lawsuits by the Obama administration’s Department of Justice. The Trump administration’s promise to undo Obamacare injected uncertainty into the market. Profits at the end of 2016 were less than stellar except at UnitedHealth Group, the biggest of the five. A slowdown or even the end of a yearslong run-up in share prices that had seen the insurers far outpace the markets seemed possible. Months later, the party hasn’t slowed, it’s picked up even more energy. The companies — Aetna, Cigna, UnitedHealth, Humana and Anthem — have earned record or near-record profits in 2017 and their stock values continue to soar. Aetna and Cigna are each up five-fold from March 2010, the month the Affordable Care Act took effect. UnitedHealth is up more than six-fold. In the spring quarter, Aetna earned $1.2 billion in operating profit after taxes, more than double its quarterly average since Obamacare started. Cigna shares are up 31 percent in 2017. Could all this success bring a cost as the nation endures rising prices and political gridlock over reform? For the Big Five, it’s a sweet-spot built on a solid foundation: commercial health plans enjoying flat use of medical services by middle-class customers who now must pay thousands of dollars out of their own pockets; cost-cutting by the companies; growing Medicare and Medicaid management business; and broad exits from the perilous Obamacare exchanges. The profits and the market gains are drawing attention, not all of it welcome. Consumers don’t like paying rising premiums and big bucks for medical services that were once fully covered [...]

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Los Angeles Times- Soumya Karlamangla Contact Reporter -August 1, 2017 @ 4:15pm Amid uncertainty over the future of the Affordable Care Act, California officials announced Tuesday that monthly premiums for health plans sold on the state’s Obamacare exchange will rise by an average of 12.5% next year. Covered California, the state insurance marketplace, provides coverage to about 1.5 million people, the majority of whom receive subsidies that lower their premiums under the Affordable Care Act. Insurance plans for next year will be available for purchase in California from Nov. 1 to Jan 31. Next year, about 10% of people enrolled through the exchange will have to look for a new plan because Anthem Blue Cross will end its coverage in most of the state. State officials said Tuesday that Anthem will continue providing coverage only in Santa Clara County and parts of Northern California and the Central Valley. The announcement comes a week after a Republican plan to unwind key pieces of the Affordable Care Act — also known as Obamacare — failed in the U.S. Senate. President Trump has repeatedly urged lawmakers to keep working on a bill. Those repeal efforts, and Trump’s suggestions that he will not enforce the mandate that requires all Americans to have insurance, could lower enrollment this year, experts say. Next year’s premium estimates probably reflect insurers’ fears that not enough people will sign up for insurance, or that only sick people will enroll and their costs will be too high, experts say. “It’s not like we have a steady market. In fact, we have a market that’s in turmoil because of politics,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. Sabrina Corlette, a research professor [...]

Why Obamacare Is Still in Peril

NY Times - By THE EDITORIAL BOARD JULY 28, 2017 In a dramatic last-minute spectacle, the latest Republican plan to destroy the Affordable Care Act was defeated early Friday because of the courageous votes of three senators: Susan Collins, John McCain and Lisa Murkowski. This will come as an immense relief to millions of Americans who stood to lose their health insurance, but it would be naïve to think that this is the end of the road for the repeal-Obamacare movement. For the last seven years, Republican leaders have engaged in a fraudulent campaign against the A.C.A. based on the lie that the law is either unworkable or collapsing. The law, which is based on conservative market-based ideas, is certainly flawed and could be improved, but it has helped 20 million people gain insurance and, as a result, provided needed medical care to the poor and the sick. Not only was the Republican diagnosis wrong, but also leaders like the House speaker, Paul Ryan, and the Senate majority leader, Mitch McConnell, tried to push through legislation that was devoid of any ideas and would have weakened the health care system and left millions unable to afford health care. One telling sign: Insurance companies, hospitals, doctors and public interest groups like AARP opposed pretty much every proposal the Republicans put out over the last seven months. Ultimately, this deceitful campaign ran aground by the narrowest of margins in the Senate thanks to the three Republicans and all 48 Democrats and independents. Much attention has rightly focused on Mr. McCain. Returning to the Senate after surgery and a brain cancer diagnosis, he delivered a stirring speech on Tuesday calling on lawmakers from both parties to reach “agreements made [...]

Even Talking About Weakening Obamacare Provisions Weakens The Exchanges

NPR- July 21, 201710:56 AM ET DANIELLE KURTZLEBEN The Affordable Care Act is not "exploding" or "imploding," as President Trump likes to claim. But Trump does hold several keys to sabotaging the insurance marketplaces, should he so choose — one of which his administration is reportedly weighing using. Every month, the Trump administration faces a deadline to pay what are called "cost-sharing reduction" (or CSR) subsidies to insurers. Those are subsidies that reimburse insurers to help low-income marketplace customers afford health care, on top of the tax credits that help those people pay their premiums. A lawsuit filed by House Republicans during the Obama era has left the fate of those payments uncertain. Trump reportedly wants to end the payments, as Politico reported, but the White House chose this week to continue the payments once again. Still, the ongoing ambiguity about the future of the payments is apparently causing premiums to rise and insurers to pull out of markets. Obamacare isn't "imploding," but insurers are shaken Recent analyses from multiple organizations (including the Department of Health and Human Services itself) show that the exchanges aren't imploding; in fact, they're relatively stable. But the Affordable Care Act, also known as Obamacare, does have its problems: Premiums continue to increase, as they did throughout Obama's presidency (though subsidies have shielded a majority of people on the exchanges from those increases), and insurers have backed out of exchanges. Ending the CSR payments could be catastrophic for the exchanges. It could cause premiums to rise by 19 percent or even more, as the Kaiser Family Foundation found in a recent analysis — and that assumes that insurers even stay in the exchanges, Kaiser added. Uncertainty Over Obamacare Leaves Next Year's Rates [...]

Major insurance groups call part of health bill ‘unworkable’

By ALAN FRAM, ASSOCIATED PRESS WASHINGTON — Jul 15, 2017, 11:21 AM ET Two of the insurance industry's most powerful organizations say a crucial provision in the Senate Republican health care bill allowing the sale of bare-bones policies is "unworkable in any form," delivering a blow to party leaders' efforts to win support for their legislation. The language was crafted by conservative Sen. Ted Cruz, R-Texas, and leaders have included it in the overall bill in hopes of winning votes from other congressional conservatives. But moderates have worried it will cause people with serious illnesses to lose coverage, and some conservatives say it doesn't go far enough. Two of the 52 GOP senators have already said they will oppose the legislation. Senate Majority Leader Mitch McConnell cannot lose any others for the legislation to survive a showdown vote expected next week. The overall measure represents the Senate GOP's attempt to deliver on the party's promise to repeal President Barack Obama's health care law, which they've been pledging to do since its 2010 enactment. The criticism of Cruz's provision was lodged in a rare joint statement by America's Health Care Plans and the BlueCross BlueShield Association. The two groups released it late Friday in the form of a letter to McConnell, R-Ky. "It is simply unworkable in any form," the letter said. They said it would "undermine protections for those with pre-existing medical conditions," increase premiums and lead many to lose coverage. The provision would let insurers sell low-cost policies with skimpy coverage, as long as they also sell policies that meet a stringent list of services they're required to provide under Obama's law, like mental health counseling and prescription drugs. Cruz says the proposal would [...]

Obamacare and Trumpcare Both Ignore This Massive Underlying Healthcare Issue

Lawmakers are so focused on ensuring people have access to health insurance that they've completely overlooked the root causes of medical care inflation. Sean Williams (TMFUltraLong)  Jul 8, 2017 at 6:49AM Who knew healthcare could be so complicated? Apparently not the president or Congress, as both are struggling to reach a consensus as to what to do with the future of healthcare in America. Obamacare: Should it stay or should it go? Obamacare, which is officially known as the Affordable Care Act (ACA) and was signed into law by Barack Obama in March 2010, has been controversial and mostly disliked since the start. However, it's been successful in reducing the number of people without insurance. The expansion of Medicaid in 31 states, the provision of subsidies for low- and middle-income Americans, and insurance mandates that require member acceptance, regardless of pre-existing conditions, have been crucial in pushing the uninsured rate down to around 9% from 16%, according to data from the Centers for Disease Control and Prevention. At the same time, Obamacare has had its shortcomings. The Shared Responsibility Payment (SRP), which is the penalty consumers pay for not purchasing health insurance, has been far too low relative to the cost of buying an annual health plan, thus fewer young, healthy people have enrolled than expected. The risk corridor, which was a fund designed to provide money to insurers with excessive losses that had set their premiums too low, also sputtered due to insufficient funding. With little in the way of financial protections for insurers, many big names have significantly reduced their ACA plan coverage in 2017 and beyond. There are ways Obamacare can be fixed. These include adjusting the penalty on the SRP upward [...]

Five myths about health insurance…

Washington Post- By Alexis Pozen June 30, 2017 Alexis Pozen is a professor of Health Economics at CUNY School of Public Health and a co-author of the textbook "Navigating Health Insurance. It is no wonder so many myths about health insurance persist. The U.S. health insurance system is opaque and labyrinthine, and at times purposely so. The current debate over whether to repeal major provisions of the Affordable Care Act (ACA), otherwise known as Obamacare, comes down to whether consumers should subsidize services they never expect to use. But who pays for what, and how, is not straightforward. MYTH NO. 1 The ACA has forced millions to buy insurance they don’t want. House Speaker Paul Ryan deployed this myth when defending repeal — which the Congressional Budget Office estimated this past week would increase the number of uninsured people by 22 million by 2026. “It’s not that people are getting pushed off a plan,” Ryan said. “It’s that people will choose not to buy something they don’t like or want.” That reasoning echoes the late Supreme Court justice Antonin Scalia, who during a 2012 challenge to the ACA suggested that the law’s individual mandate started the federal government down a slippery slope. “Everybody has to buy food sooner or later,” he said. “Therefore, you can make people buy broccoli.” And no one wants broccoli, right? But both before and after the ACA, most of the uninsured consistently have reported that they want insurance. In a 2009 Department of Health and Human Services report, 48 percent of uninsured people under age 65 said they didn’t have health insurance because of the cost, 38 percent cited life changes (they had lost their jobs, left school or changed their [...]

CMS lifts sanctions on Cigna’s Medicare plans

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services FierceHealthcare- by Leslie Small | Jun 16, 2017 4:48pm Nearly a year and a half after it was hit with government sanctions, Cigna has gotten the green light to resume selling Medicare products. Cigna can start marketing Medicare Advantage and Part D plans immediately and can begin enrolling individuals in those plans with effective dates beginning July 1, the insurer said in a Securities and Exchange Commission filing Friday. Cigna has been banned from both marketing and enrolling people in MA and Part D plans since January 2016. The Centers for Medicare & Medicaid Services said the insurer violated regulations regarding coverage determinations, appeals and grievances; Part D formulary and benefit administration; access to facilities and records; and compliance program effectiveness. These violations led to increased out-of-pocket expenses for enrollees, as well as delays or denials in receiving medical services and prescription drugs, CMS said at the time, noting such issues posed a serious threat to enrollees' health and safety. "We are a better and stronger company as a result of collaborating with CMS and investing further in our processes and technology over the past year and half,” Shawn Morris, interim president for Cigna-HealthSpring, said in a statement emailed to FierceHealthcare. “As a company that puts customers first, we look forward to continuing that partnership while delivering high-quality healthcare plans to both existing and new customers.” The process of fixing the issues cited by regulators has been a lengthy one for Cigna, and it wasn’t able to finish in time to participate in the 2017 open enrollment period for Medicare. Because of that, the insurer said in February that it expects [...]