A day after the Trump administration announced that it would allow states to compel poor people on Medicaid to work or get ready for jobs, federal health officials on Friday granted Kentucky permission to impose those requirements.
Becoming the first-in-the-nation state to move forward with the profound change to the safety-net health insurance program is a victory for Kentucky’s Republican governor, Matt Bevin, who during his 2015 campaign for office vowed to reverse the strong embrace of the Affordable Care Act by his Democratic predecessor.
. . .
President Trump has selected Alex Azar, a former pharmaceutical executive and a top health official during the George W. Bush administration, to lead the Health and Human Services Department.
In announcing that he is nominating Azar to be secretary of the government’s largest civilian department, the president turned to a health-policy insider and conservative thinker. Azar spent a decade at Eli Lily and Co., including five years as president of Lilly USA, its biggest affiliate, before stepping down in January to work as a health-care consultant. He previously was HHS general counsel, then served for two years as the department’s second-in-command.
. . .
The Oct. 26 editorial “Health-care reform that pays off” unfairly maligned a bill introduced by two committee chairmen as “dismantling major pieces of Obamacare.” It does nothing of the sort.
Like the bill proposed by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) that the editorial praised, a bill from Sen. Orrin Hatch (R-Utah) and Rep. Kevin Brady (R-Tex.) would appropriate money for cost-sharing-reduction subsidies. That’s not nearly enough to provide relief to consumers, who are leaving health-insurance markets in droves. Gallup reported that the uninsurance rate in the third quarter of 2017 reached its highest level since 2014, as the Affordable Care Act makes insurance unaffordable.
. . .
Federal health officials are proposing changes to rules for coverage sold through the ACA’s insurance marketplaces that, starting in 2019, would let states alter the benefits that health plans must provide and limit enrollment help for consumers. In envisioning a larger role for states in setting benefits, the draft rule would still require ACA plans to cover 10 categories of medical services. But for the first time, any state could adopt benefits standards already in use by another state—or rewrite its own standards.
. . .
Finally, a Republican has gotten a boost from the CBO. A bipartisan Senate plan to try to stabilize Affordable Care Act marketplaces would lower the federal deficit by nearly $3.8 billion during the next decade and would not affect the number of people with health insurance, Congress’s official budget scorekeepers said Wednesday. This bill does what the CBO predicted Congress would eventually need to do so the costs were built in to existing budget estimates.
. . .
Iowa is abandoning its quest to shed major elements of the Affordable Care Act, after federal health officials failed to approve the plan in time for the insurance-buying season that begins in just over a week. The state’s withdrawal comes two months after President Trump telephoned a top federal health official with instructions to reject Iowa’s proposal.
. . .
President Trump has defended his decision to end cost-sharing reduction (CSR) subsidies — an element of the Affordable Care Act that helped lower the cost of deductibles and co-pays for people making less than 250 percent of the federal poverty level — by pointing to the gain in stock prices for health-insurance companies.
Insurance companies do not make money through the cost-sharing provision, estimated to be worth about $7 billion in fiscal 2017. They’re being paid back for money they’ve already spent. If they do not get repaid for doing what is required under law, companies say they will raise premiums to make up the difference.
That in turn will raise the cost to taxpayers, because whatever savings result from eliminating the CSRs will be exceeded by additional costs for higher tax credits to defray the new premiums.
. . .
Cassidy-Graham has an important, albeit fixable, flaw—what we might call “asymmetric federalism.” The core idea in the bill is to take the money Obamacare spends on expanding coverage to the uninsured and give it to state governments in the form of block grants. States, in turn, could use these block grants to address the health-care needs of their populations. It’s an attractive idea, in theory. But the bill would put a heavy Washington hand on the federalism steering wheel. It would make it relatively easy for blue states to expand the role of single-payer health care, while making it rather difficult for red states to achieve market-oriented reforms.
. . .
“While most reasonable people would welcome a bipartisan outcome to the Obamacare mess, the solutions proffered thus far would do little more than shore up the bad policies already in place with another slate of bad policies. We need legitimate, long-term reforms,” argues Sen. Hatch. “Case in point: Some are working on an approach that amounts to little more than a congressional bailout of Obamacare, including pumping tens of billions of dollars into the already failing system in the form of cost-sharing reduction payments and reenacting a temporary reinsurance program included in Obamacare that has expired.”
. . .
A bipartisan group of governors is trying to jump-start efforts to strengthen private insurance under the Affordable Care Act, urging Congress to take prompt steps to stabilize marketplaces created by law while giving states more freedom from its rules.
In a blueprint issued Thursday, the eight governors ask House and Senate leaders of both parties to take several steps to reverse the rising rates and dwindling choices facing many of the 10 million Americans who buy health plans on their own through ACA marketplaces.
Specifically, the state leaders say Congress should devote money for at least two years toward “cost-sharing subsidies” that the 2010 health-care law promises to pay ACA insurers to offset deductibles and other out-of-pocket expenses for lower-income customers.
. . .