Sabotaging the ACA

[stpioc]

Continuing to sabotage Obamacare..

President Donald Trump has not given up on the holy grail of repealing Obamacare, and on Wednesday he revealed his next move, threatening to use health insurance subsidies as a weapon to get Democrats to negotiate on reform. Trump said his administration may not have the legal authority to make cost-sharing reduction payments, in an interview with the Wall Street Journal. So-called CSR subsidies reduce out-of-pocket costs for low-income Affordable Care Act enrollees, but Republicans in Congress sued the Obama administration, saying they expenditures were not authorized under the ACA.

President Donald Trump threatens to cut Obamacare subsidies

Yea, you read this right. The President of the United States threatens to cut healthcare funding from millions simply as a negotiating ploy. This is outright blackmail, let alone sabotage. 

And then you have people who compare this to Luther King..

"Think of President Trump as the Martin Luther King of healthcare," Lord, a pro-Trump surrogate, said during an appearance on CNN.
"When I was a kid, President Kennedy did not want to introduce the civil rights bill because he said it wasn't popular, he didn't have the votes for it, etcetera. Dr. King kept putting people in the streets, in harms way, to put the pressure on so that the bill would be introduced. That's what finally worked," he continued.

Lord was referring to Trump's suggestion that his administration could stop funding cost-sharing subsidies in the individual insurance marketplaces set up by the Affordable Care Act, also known as Obamacare. These subsidies currently go to insurance companies to allow them to offer lower out-of-pocket costs to low-income Americans.

Estimates show that pulling funding would increase premiums by nearly 20% over the current projection for next year and could lead to an exodus of insurers form the exchanges.

Health policy experts have said the move would be potentially devastating for low-income people and the more than 12 million people currently enrolled in health insurance through the Obamacare exchanges. Additionally, they argue the move would effectively fulfill Trump's claims that the market is "collapsing."

Jeffrey Lord on CNN: Trump is Martin Luther King, MLK of healthcare - Business Insider

[stpioc]

And still sabotaging the ACA..

Here's a quick rundown of the changes in the CMS rule. It would:

• Limit the 2018 open enrollment period to six weeks, half the previous length: Notably, the rule said CMS and the Department of Health and Human Services would continue to spend money on outreach to encourage people to sign up. But the shorter enrollment period — going from November 1, 2017 to December 15, 2017 — will likely result in lower enrollment.
  
• Allow insurers to collect for unpaid premiums before they sign up with the same insurer the next year: The CMS release says the rule "will incentivize patients to avoid coverage lapses." It could also discourage those that have a lapse in coverage from signing up the next year, but it could help insurers recoup some of the money lost on the exchanges.
  
• Force people to provide further identification to sign up outside of the open enrollment period: In order to limit the number of people that drop coverage and only enroll when they need it, the CMS rule would force people to give more identification in order to sign up for the exchanges outside of open enrollment. This suggestion was also floated by the Obama administration.
  
• Allow insurers to determine the level of their coverage:The actuarial value of a plan is the percent of medical costs a plan would cover. The rule would allow insurers to adjust their actuarial value while still qualifying for the exchanges. In the worst case, that could mean consumers would end up with plans that cost close to the plans offered on the exchanges currently, but also cover fewer procedures.
  

Even with the changes, it is still unclear whether the Trump administration will fund cost-sharing reduction payments, which most policy analysts say is key to keeping the market from collapsing.

Trump HHS, CMS Obamacare rule change - Business Insider

[stpioc]

Americans who get their health insurance through the exchanges set up by the Affordable Care Act may have more difficulty finding a doctor next year, but it won’t necessarily have anything to do with insurers leaving the system. It could be because the Trump administration earlier this year quietly announced that it is dropping federal review of something called “network adequacy” in deference to state regulators.

When implementation of the ACA began in 2014, health care researchers immediately noticed that the insurers offering plans on the exchanges were pursuing what they called a “narrow network” strategy. That meant that they were keeping the web of care and service providers considered “in-network” as small as possible to lower costs. The law requires insurers who want to sell their policies through the exchanges to “maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance use disorder services, to assure that all services will be accessible to enrollees without unreasonable delay.”

Your choice of doctors in 2018 may be limited due to Trump - Business Insider

[stpioc]

Another negotiation ploy at the expense of sick Americans..

In interviews over the past week, President Donald Trump has cast doubt on whether or not his administration will fund a key provision of the Affordable Care Act that helps offset costs for insurers. The uncertainty Trump is sowing over the payments — known as cost-sharing reduction (CSR) payments — has left insurers jittery and contemplating leaving the individual insurance exchanges created by the law known as Obamacare. Trump has put CSR payments on the table in an attempt to convince Democrats to negotiate with him on his replacement plan for the ACA. But the end of the payments could mean higher premiums and a dearth of choices for insurance, experts say.

Trump, Democrats negotiate on Obamacare cost-sharing payments - Business Insider

[stpioc]

Still sabotaging..

Without clarity more insurers could leave the exchanges. The Administration is playing russian roulette with people's lives.

Health insurance executives seeking certainty on the future of federal funds that help lower-income Americans with their out-of-pocket health-care costs got no commitment that they would be paid next year in an hour-long meeting with Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), according to two insurance industry officials with knowledge of the meeting.

A CMS official confirmed that Verma “did not comment” on the payments, called cost-sharing reductions, at the meeting and told those gathered that it was a decision to be made by Congress.

Cost-sharing reductions are federal payments to insurers that help defray deductibles and co-pays for more than 7 million Americans who buy insurance through the Affordable Care Act marketplaces. In a lawsuit that has dragged on for years, the way the payments are funded has been successfully challenged in court by House Republicans. The decision was appealed by the Obama administration, and the case has been inherited by the Trump administration. The case was put on hold while Republicans tried to repeal the Affordable Care Act, and payments are being made while the lawsuit proceeds.

It has remained unclear how the issue will be resolved, and President Trump increased the uncertainty last week when he suggested in an interview with the Wall Street Journal that withholding the funds, which are projected to add up to $10 billion in 2018, could be a way to bring Democrats to the table to work together on health-care reform.

Health insurers asked the Trump administration for reassurance on Obamacare. They didn’t get it. - The Washington Post

[stpioc]

Obamacare’s biggest challenge right now has nothing to do with the flailing Republican bid to repeal and replace it. It’s President Trump’s threats to undermine obscure but important payments that help millions of Americans afford their health care. The Affordable Care Act has aided millions in purchasing private health insurance through billions of dollars of federal spending. Much of that is in the form of tax credits, which reduce the premiums that many people pay every month for their coverage.

A lesser-known piece of the law helps make health care even more affordable for lower-income people: cost-sharing reductions, or CSRs, which help make copays and deductibles cheaper for people who got insurance through Obamacare. Right now those subsidies are facing a huge threat. Trump can try to cut off those payments, which would disrupt Obamacare’s insurance markets and maybe cause them to collapse entirely.

And Trump is threatening to do just that — he could end the federal government’s defense of CSR payments in a lawsuit working its way through federal court. To counter, Democrats in Congress are now warning that the government could shut down at the end of this month if Trump and Republicans refuse to make the payments. They say they would block any spending bill that doesn’t fund the CSR subsidies.

Trump’s nuclear option on Obamacare, explained - Vox

Playing political games with the healthcare of millions..

[stpioc]

The Republicans have creates so much uncertainty and tried to sabotage the ACA in so many ways (see earlier entries in this thread) that some insurance companies are leaving the exchanges. Then they say triumphantly: "you see, it's collapsing." Apart from the fact that it works well in states where there is solid support and never mind the people with conditions that need help..

One of the ways the House bill aims to reduce costs is by letting states opt out of Obamacare insurance benefit requirements, to allow the sale of less costly plans. The Affordable Care Act's essential health benefit requirement means some people pay higher premiums for services they don't use. For insurers, that potential variability in rules adds a new level of complexity. "At this point, there's so much uncertainty. We're still talking about state waivers. It's not clear what the states are going to do as a consequence of that," said Dr. Robert Pearl, CEO of the Permanente Medical Group, a unit of Kaiser Permanente.

GOP celebrates passing health bill, but few cheers from health industry

[stpioc]

Soo, insurers are asking (but not necessarily getting) big premium hikes but one reason is the uncertainty about the cost-sharing reduction payments, which the White House is playing fast and loose with.

Maryland's insurance commissioner Al Redmer said in a statement that the proposed rates still have to go through a review process and could be adjusted before they are offered to consumers.

"It’s important to remember that these rates are what companies have requested, and not necessarily what will be approved," Redmer said. "There will be a thorough review of all the filings. As in years past, we may require changes."

Also at issue is the uncertainty of whether Obamacare's cost-sharing reduction (CSR) payments are ceased. The payments, which help defray the cost of providing low-income Americans with cheaper health insurance plans, are seen as critical to ensure the stabilization of the ACA's individual insurance markets.

Currently, the payments are appropriated by the White House rather than Congress, and President Donald Trump has threatened to end the payments. The payments are also subject to an ongoing lawsuit between the House and executive branch questioning the legality of their funding without a congressional appropriation. While the Obama administration defended the case, Trump could drop an appeal of a ruling from 2016 in which a court sided with House Republicans.

The White House has said that it will continue funding for the CSR payments but have not guaranteed they will be in place for 2018.
The uncertainty led Maryland to tell insurers that they would be able to refile their requested increases if the payments are discontinued.
In fact, in California, the insurance commission told insurers that the companies could submit plans that assumed CSRs would be paid and a set of rates assuming they went unpaid.

"I have written President Trump asking that he and his Administration stop undermining the Affordable Care Act and health insurance markets," read a letter from Dave Jones, the California insurance commissioner, to insurers filing in the state. "Health insurers are legitimately concerned that the President's actions are undermining the ACA and health insurance markets."

Most other states have set deadlines for plan submissions in June. In addition to the uncertainty regarding CSR payments, which some experts said insurers are already baking into the rate projections, Trump's administration has also issued a number of rules that could cause instability in the individual market.

A variety of insurers have already pulled out of various markets, like Aetna in Iowa and Virginia, in part due to the political uncertainty.

Maryland Obamacare health insurance rate spikes after Trump - Business Insider

[stpioc]

Some health insurance plans selling on the Obamacare marketplaces are planning steep 2018 rate increases, in part to account for the uncertainty over how the Trump administration will administer the law. The administration has been aggressively ambiguous about key policy issues, like whether it will enforce the health care law’s individual mandate or pay out insurance subsidies aimed at the lowest-income Obamacare enrollees.

In response, insurance executives tell Vox they will charge steeper rates in 2018 in order to avoid losing money. Others are quitting the marketplace altogether, saying the future just looks to uncertain to take a gamble. “We were hoping for more stability this year,” says Chet Burrell, chief executive of Carefirst, a Blue Cross Blue Shield Plan in the D.C. metro area. “But these factors have lead to instability, and the beginning of a death spiral.”

The Trump administration is making Obamacare more expensive - Vox

[stpioc]

Rep. Chris Collins (R-NY) didn’t read the American Health Care Act (AHCA), legislation to dismantle Obamacare that will result in millions of people losing access to affordable insurance, before House Republicans voted to pass it on Thursday. And he had no idea the bill would cost his state billions of federal dollars used to insure thousands of his constituents.

During a CNN appearance on Thursday, Wolf Blitzer asked Collins if he’d actually read the AHCA before voting for it.
“I will fully admit, Wolf, that I did not,” Collins said. “But I can also assure you my staff did. We have to rely on our staff… I’m very comfortable that we have a solution to the disaster called Obamacare.”
“Congressman, this legislation affects a fifth of the U.S. economy and millions and millions of Americans — don’t you think it was important to actually sit down and read, read the language of this bill?” Blitzer pushed back.
Collins replied by suggesting he was hardly the only Republican who didn’t read the bill, which was rushed through before the nonpartisan Congressional Budget Office could score it to detail its specific impact.

This is a far cry from the fall of 2010, when House Republican leaders unveiled their “Pledge to America,” which contained a “Read the Bill” promise.

House Republican didn’t know the health care bill he voted for could cost his state $3 billion