Could their be a bipartisan Obamacare fix?

bipartisan Obamacare fixRepublican efforts to repeal and replace the Affordable Care Act appear to be dead – at least for now. But two U.S. senators may soon unveil a bipartisan proposal to make modest healthcare fixes.

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor, and Pensions Committee, and Sen. Patty Murray (D-Wash.), the committee’s ranking member, are back at work negotiating a bipartisan plan, according to reports in The Hill, Politico and elsewhere.

Alexander told Politico on Sept. 29 that there might be a piece of legislation ready for Senate leaders by the end of this week.

The deal reportedly would safeguard Obamacare exchange subsidies, which President Donald Trump’s administration has threatened to pull, while giving states more leeway when it comes to the ACA’s requirements. States could potentially have more freedom to offer cheaper, less generous plans on the insurance exchanges.

Whether the proposal will gain traction is anyone’s guess, though Trump has started to show a willingness to sometimes cut deals with Democrats.

Repealing and replacing the Affordable Care Act was a top priority for Trump and the Republican Congress. But as Trump famously (or infamously) said last February as the debate heated up, “Nobody knew health care could be so complicated.” With an end-of-September deadline looming, Republicans made a last push in September with the Graham-Cassidy bill, but the bill was pulled Sept. 26.

Efforts to repeal and replace received another blow on Sept. 29 when Tom Price resigned from his post as U.S. health and human services secretary. Price – a longtime ACA critic when he was a U.S. representative from Georgia – had been a point person for rolling back executive branch efforts to promote Obamacare.

The post Could their be a bipartisan Obamacare fix? appeared first on MassDevice.

Republicans are stuck on healthcare but they have no choice but to persevere

Republican health analysts said party officials had little choice but to keep trying to reach consensus — or at least enough consensus to pass a bill out of the House.

Will Anthem exit the ACA exchanges?

Anthem could be the next insurer on the block to depart from the Affordable Care Act exchanges.

A recent report from Jefferies analysts, who claimed they met with Anthem, found the insurer might be planning to drop from the exchanges next year. Analysts David Windley and David Styblo said Anthem “is leaning toward exiting a high percentage of the 144 rating regions in which it currently participates.”

Bloomberg initially reported news of the Jefferies analysis.

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According to the report, Anthem told Jefferies analysts that “regulatory advocacy needs to progress significantly in the next ‘month or so.’” In Anthem’s opinion, “[i]mprovements such as eligibility verification, more rigid special enrollment periods, shortening of premium grace periods are steps in the right direction, but not enough,” the analysts wrote, according to CNBC.

Anthem, which sells plans under the Blue Cross Blue Shield Brand, has a little more than 800,000 individual exchange plan customers in 14 states.

However, the insurer hasn’t been doing so hot fiscally, according to Bloomberg Intelligence. It lost approximately $374 million on individual plans in 2016. Its 2017 financial goals are moderate, and an estimated 8.6 percent of its revenue will come from individual plans.

If Anthem does decide to pull back, it could create the most significant coverage gaps in states like Colorado, Georgia, Kentucky, Missouri and Ohio, according to a New York Times report. An analysis from the Robert Wood Johnson Foundation determined an Anthem departure would leave people in almost 300 counties without an insurance carrier.

The insurer’s potential exit isn’t altogether surprising. Anthem CEO Joseph Swedish hinted at it during a call regarding fourth quarter results with Wall Street analysts. “We will make the right decisions to protect the business,” he said, according to Bloomberg. “If we can’t see stability going into 2018, with respect to either pricing, product or the overall rules of engagement, then we will begin making some very conscious decisions with respect to extracting ourselves.”

In an emailed statement to Bloomberg, Anthem said it’s working with the Trump administration “to emphasize the importance of regulatory and statutory changes in order to ensure sustainability and affordability of the individual market for consumers” and that it will “actively pursue policy changes that will help with market stabilization and achieve the common goal of making quality healthcare more affordable and accessible for all.”

Anthem’s likely departure points to a larger trend among insurers offering plans on the ACA exchanges. Earlier this year, Humana said it will completely stop offering individual plans on the exchanges in 2018. UnitedHealth Group and Aetna have also scaled back on their ACA offerings.

Photo: Hero Images, Getty Images

The top medtech stories of early 2017

  • Little or no audit preparation common device QMS problem

    By Stewart Eisenhart, Emergo Group In the second in a series of blog posts examining common problems medical device firms deal with related to quality management system audits, Emergo discusses how lack of proper internal audit preparation leads to last-minute scrambles and business headaches. Get the full story here at the Emergo Group’s blog. The […]

  • House delays vote on Trumpcare bill

    The U.S. House of Representatives today indefinitely delayed its vote on the Trumpcare legislation, which looks to begin dismantling Obamacare and replacing it with a GOP-supported framework. The Trump administration and the GOP had hoped the day would signal a significant turn for conservatives, with Trump and House Republican leaders planning the vote on the […]

  • How Phononic is upping the game on hospital refrigeration

    Solid-state heating and cooling technology company Phononic recently got its Evolve refrigerators into the new North Carolina Heart & Vascular Hospital at UNC Rex in Raleigh, N.C. UNC Rex Healthcare is using a combination of 1.8 and 5.5 CuFt Evolve refrigerators in its pharmacy, patient support areas and medicine rooms in conjunction with medication management systems, […]

  • This Trumpf laser could solve your UDI compliance problems

    Trumpf is touting a new laser and software module that enables UDI marking from a single source. Medical device makers can create corrosion-resistant marks on highly reflective materials using ultra-short pulsed lasers. By combining a marking laser with a UDI software module, Trumpf offers both components from a single source. This helps manufacturers to comply with […]

  • The stem cell ‘skin gun’ that’s aiming to disrupt wound care

    RenovaCare’s SkinGun uses a patient’s own stem cells to heal their wounds faster and more efficiently than a traditional skin graft. Pennsylvania state police officer Matthew Uram suffered severe second-degree burns to his face, right arm and leg after a friend’s bonfire got out of control. Uram was facing months of painful skin grafts, the […]

  • The stem cell therapy that could reverse hearing loss

    Frequency Therapeutics is betting that it can change the lives of millions of Americans with hearing loss through a cell therapy that triggers the body’s natural ability to heal itself. Researchers have used cells in regenerative medicine for decades – in 1931, the father of cell therapy, Paul Niehans, treated a patient with material from […]

  • Trump proposes higher FDA fees for drug, medical device FDA registrants

    By Stewart Eisenhart, Emergo Group US Food and Drug Administration user fee increases in the Trump Administration’s proposed 2018 federal budget would disproportionately impact smaller medical device companies, as these firms make up the majority of the US medical device industry. Get the full story here at the Emergo Group’s blog. The opinions expressed in […]

  • David Timmersman appointed president of Vitaldyne

    David Timmersman has been appointed president of Vitaldyne, a contract manufacturer specializing in the manufacture, assembly and packaging of medical devices and components. Timmersman assumes the position held by Mariellyn Kuske, a founder of the company who will be retiring once the transition to new leadership is complete. Mariellyn Kuske, along with her husband Mike, began Vitaldyne […]

  • 6 visual impairment breakthroughs you need to know

    About 285 million people have some form of visual impairment in the world, according to the World Health Organization. Of that number, 39 million are considered blind, and 246 million have low vision. Three-fifths of all vision impairment can be prevented or cured. Uncorrected refractive errors are one of the main causes of vision impairment in […]

  • How to make ultrasound zap tumors in a moving organ

    Researchers led by the Fraunhofer Institute for Medical Image Computing think they’ve overcome the challenges standing in the way of using ultrasound to kill cancer tumors in organs that move with breathing. Until now, health practitioners have mostly limited ultrasound to treating prostate cancer, bone metastases and uterine myoma, according to the Fraunhofer Institute (Bremen, Germany). Organs […]

  • Do patient advocacy organizations have a conflict of interest?

    At least 83% of U.S. patient advocacy organizations receive financial support from medical device, drug and biotechnology companies, according to new research out of the University of Pennsylvania’s Department of Medical Ethics and Health Policy. The Penn research team – which included Matthew McCoy, Harald Schmidt and Ezekiel Emanuel – examined websites and annual reports for 104 organizations […]

  • What do small business owners think of the AHA, AHCA?

    Everyone has an opinion on the American Health Care Act, the new GOP plan to replace the ACA.

    A new poll from the Small Business Majority surveyed 500 small business owners from across the country on their opinions on the AHCA. The survey was conducted online between March 17 and March 20 and had a +/- 4.5 percent margin of error.

    Survey respondents came from a variety of backgrounds. Forty-eight percent were as male, while 52 percent were female. The majority of respondents (33 percent) were between the ages of 30 and 44, with the next largest proportions coming from the 45 to 54 age range (21 percent) and the 55 to 64 age range (20 percent).

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    In a tele-press conference on March 23, Small Business Majority founder and CEO John Arensmeyer discussed what prompted the poll. “We’ve been intimately involved for years talking with small business owners about the ACA,” he said. “With the proposed changes in Congress, we knew this was a huge issue for small business owners.”

    Near the beginning of the survey, respondents were asked about their existing knowledge of the ACA. Forty-eight percent of respondents admitted to only knowing “some” about the ACA. Another 24 percent said they knew “a great deal” about it, and 20 percent said they knew “not too much.” Five percent indicated they knew “nothing at all” about the ACA.

    Next, the survey questioned respondents as to whether they support or oppose the ACA. Initially, 25 percent of respondents said they strongly support the ACA, while 29 percent said they strongly oppose it.

    However, after answering a series of questions about their opinions on certain provisions of the ACA, respondents’ opinions changed slightly. Thirty-one percent said they strongly support the ACA and 24 percent said they strongly oppose it.

    The poll then added the AHCA to the mix, initially asking respondents how much they knew about it. Thirty-five percent admitted to knowing “some” about it. Another 16 percent said they knew “a great deal” about the AHCA, and 28 percent said they knew “not too much.” Eighteen percent of respondents admitted to knowing “nothing at all” about the proposed plan.

    Once again, the survey asked respondents whether they support or oppose the AHCA. Initially, 14 percent said they strongly support it and 27 percent said they strongly oppose it. After answering questions about specific provisions of the AHCA, respondents’ opinions changed. Fourteen percent of respondents said they strongly support the AHCA, and 33 percent said they strongly oppose it.

    Finally, the survey asked respondents whether they would choose the ACA or the AHCA. Thirty-nine percent of respondents were strongly in favor of choosing the ACA, and 10 percent said they would choose the ACA but weren’t as strongly for it. Meanwhile, 16 percent said they were strongly in favor of the AHCA, and 10 percent said they would choose the AHCA but weren’t as strongly for it. Interestingly, 14 percent said they’d choose neither the ACA or the AHCA.

    In a press release, the Small Business Majority noted that survey respondents were “politically diverse.” They seem to be, as 28 percent of respondents identified as Democrats, 27 percent identified as Republicans and 38 percent identified as Independents. The remaining 5 percent either indicated “other,” “don’t know” or refused to answer.

    However, it’s important to note that a contributor to Forbes and The New York Times has said the Small Business Majority is left-leaning.

    Photo: prinaka, Getty Images 

    Editor’s note: This article has been updated to reflect that the same contributor wrote in Forbes and The New York Times that the Small Business Majority is left-leaning. A spokesperson for the Small Business Majority also told MedCity that the polling firm used for the survey, Chesapeake Bay Consulting, is right-leaning.

    House GOP tosses individual mandate from ACA replacement but adds penalty for insurance lapses

    The Affordable Care Act’s tax penalty for people who opt out of health insurance is one of the most loathed parts of the law, so it is no surprise that Republicans are keen to abolish it. But the penalty, called the individual mandate, plays a vital function: nudging healthy people into the insurance markets where their premiums help pay for the cost of care for the sick. That has required Republican lawmakers to come up with an alternative.

    The GOP approach is called a “continuous coverage” penalty. It increases premiums for people who buy insurance if they have gone 63 consecutive days without a policy during the past 12 months. Their premiums would rise by 30 percent and that surcharge would last for a year. While the ACA assesses a fine for each year people don’t buy insurance, the GOP plan would punish those who decide to purchase it after not being in the market.

    Much is at stake. If this approach fails to prod enough healthy people into buying insurance, rates for everyone else in the insurance pool will rise, destabilizing promises by President Donald Trump and GOP leaders to make their Obamacare replacement more affordable. The nonpartisan Congressional Budget Office projects that millions fewer people will buy insurance if the individual mandate is repealed and replaced with a continuous coverage surcharge.

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    Why do people allow their insurance to lapse?

    Some simply can’t afford the premiums, like Sheila Swartz. She and her husband, Don, who has a heart condition, dropped their policy in December after learning monthly premiums were going to increase by about $140 to $530. “You can’t get blood out of a turnip,” said Swartz, who lives outside Nashville, Tenn., and works as a house cleaner. “If you can’t afford that premium, you can’t afford that premium.”

    This KHN story also ran on NPR. It can be republished for free (details).
    Others stop paying premiums when they lose a job or are hit with unexpected costs in other areas, such as major home or car repairs. “If you have to pay rent or health insurance, you are probably not going to choose health insurance,” said Bruce Jugan, a health insurance broker in Montebello, Calif.

    Some people try to game the system, taking the calculated risk of going without insurance until they get sick or know they need expensive medical care, such as for maternity or an elective surgery.

    Both the Affordable Care Act and the GOP proposal include a deterrent by limiting people from enrolling anytime they want. People must wait for annual enrollment periods, usually in the final weeks of the year, meaning that some people might have to wait months before getting coverage. (People still can get insurance during special enrollment periods if they lose a job, get divorced or have another specified major life change.)

    How tough is the GOP penalty compared with the individual mandate?

    Under the ACA, the average individual mandate penalty in 2015 was $442, according to the Internal Revenue Service.  The GOP penalty would vary based on cost of premiums but generally would be more expensive than paying the mandate’s penalty. A 40-year-old with annual premiums of $4,328 would pay an extra $1,298 because of the GOP surcharge.

    “It’s got teeth,” said Cheryl Damberg, a Rand Corp. economist. “In some ways, it’s a more punishing penalty, and it’s going to hit people who are least capable of financially affording it.”

    Seth Chandler, a law professor at the University of Houston Law Center who has been critical of the Affordable Care Act’s insurance markets, said he is skeptical the GOP surcharge is high enough to make people enroll. “I am concerned that the Republicans are succumbing to the same softness of heart as the Democrats succumbed too when they set the individual mandate [fine],” he said. “If you start to see insurance companies object or drop out of the markets, that’s a sign this thing is miscalculated.”

    Two conservative economists at the American Enterprise Institute, Joseph Antos and James Capretta, argue the penalty is “far too small” to be effective. “Healthy consumers are likely to take their chances,” they wrote. “With the repeal of the individual mandate, and the retention of the ACA’s insurance rules, the overall effect would be significant market turbulence, starting immediately in 2017.”

    The CBO predicts that there would be a brief increase in the number of people holding insurance in 2018, as roughly 1 million people buy coverage to avoid the surcharge. In most years afterward, however, about 2 million fewer people would buy policies, either because of the surcharge or because of the requirement they provide documentation proving they had been insured. The CBO said healthy people in particular would be more likely to avoid buying policies.

    The plan has some parallels to Medicare’s late enrollment penalty, which is applied to premiums for people who did not sign up upon turning 65. But Christopher Koller, a former Rhode Island health insurance commissioner, doubts the GOP penalty would be as effective. “Medicare is an entitlement with the force of government behind it,” said Koller, now president of the Milbank Memorial Fund, a foundation in New York that focuses on healthy populations. “You get lots of notices about what your obligations are as you approach that age.”

    What about people who can’t afford premiums?

    The GOP surcharge contains no hardship exemptions, unlike the individual mandate, which allowed people to escape paying a penalty if premiums would have eaten up too much of their income (8.16 percent in 2017).

    In 2015, 5.6 million people paid the individual mandate penalty, but another 11 million claimed a hardship exemption, according to the IRS.

    Lower-income people are going to have even more trouble buying — and keeping — coverage under the GOP plan, experts said. The ACA’s premium subsidies are based on income, and millions of people on the poorer end of the spectrum do not have to pay anything for premiums if they choose the cheapest plan. The GOP plan would offer a flat tax credit that adjusts only for age. The penalties would make some even more reluctant to buy insurance — especially if they are relatively healthy.

    “I think we would just end up with a lot more uninsured people, and they would clearly be the type of people who are less able to navigate and less able to afford insurance,” said Geoffrey Joyce, director of health policy for the University of Southern California Schaeffer Center for Health Policy & Economics.

    Republican lawmakers say their plan rightly places the responsibility on individuals. It is a view shared by some health insurance brokers like Helena Ruffin, a broker in Playa Vista, Calif. She said that a continuous coverage requirement would “limit those people who are not playing by the rules.”

    “I am favor of the penalties,” she said. “Whether or not people are going to pay attention is another story.”

    Photo: YinYang, Getty Images