Sabotaging the ACA

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The Department of Justice on Monday announced that it is siding with a district court ruling that found the Affordable Care Act unconstitutional.  "The Department of Justice has determined that the district court’s judgement should be affirmed," the department said in a letter to the U.S. Court of Appeals for the Fifth Circuit. "Because the U.S. is not urging the any portion of the district court’s judgement be reversed, the government intends to file a brief on the appellees’ schedule." The DOJ’s letter in the affordable care act case in the Fifth Circuit. pic.twitter.com/VusbWx1aBM — Raffi Melkonian (@RMFifthCircuit) March 26, 2019 U.S. District Court Judge Reed O'Connor ruled in December that the Affordable Care Act's individual mandate is unconstitutional, and that therefore the rest of law is invalid.

Justice Department sides with court ruling Obamacare invalid | TheHill

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The Trump administration informed a federal appeals court on Monday night that it would no longer defend the Affordable Care Act after a judge in Texas declared that the entire law must be struck down. The judge, Reed O’Connor, is a former Republican Senate staffer with a history of striking down policies opposed by conservatives. O’Connor’s opinion is widely viewed as ridiculous, even by conservative legal scholarsand health policy experts.

Yet, while O’Connor’s opinion in Texas v. United States is likely to be reversed, either by the conservative United States Court of Appeals for the Fifth Circuit or by the Supreme Court, the Justice Department’s claim that the Affordable Care Act is unconstitutional already threatens a seemingly unrelated prosecution of a Florida health care executive on trial for allegedly committing $1 billion worth of Medicare and Medicaid fraud.

Trump just gave a huge gift to an alleged billion dollar Medicare fraudster – ThinkProgress

The silly exercise in calling the ACA unconstitutional could have a guy running a $1B fraud scheme walk, see story.

[Admin]

The repeal of ObamaCare’s individual mandate will result in 7 million more people without health insurance by 2021, according to new estimates from the Congressional Budget Office (CBO). That number is far lower than the agency’s 2017 estimate that 13 million people would be uninsured by 2027, which came as Congress was debating the GOP tax bill. The legislation, which was signed into law in December 2017, eliminated the financial penalty for Americans who don’t purchase insurance. The CBO said the effect of the repeal is partially offset by increases in coverage for other reasons, mainly because more states are projected to expand eligibility for Medicaid. Still, the CBO projected the number of people without insurance will continue to increase. In 2019, 30 million people under age 65 are projected to be uninsured, an increase from 29 million in 2018 and 28 million in 2017.

CBO: 7 million more uninsured after ObamaCare mandate repeal | TheHill

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Here are some of the results of that sabotage:

One Ohio resident paid $240 a month for health insurance that she later learned didn’t cover her knee replacement. Saddled with $48,000 in medical bills, she decided not to get the other knee replaced. “It’s been devastating to me,” said Elizabeth Belin, who lives in Columbus. The bills totaled more than her annual salary. A Kansas resident paid premiums on a policy for two years, then found out his insurance would not cover surgery for a newly diagnosed cancer. The two policyholders have filed a lawsuit in federal court against Health Insurance Innovations, based in Tampa, Fla., accusing the company of misleading them about the kind of policy they were buying.

They say they believed they were purchasing Affordable Care Act plans that include coverage guarantees. But they were sold much less comprehensive coverage that left them vulnerable to tens of thousands of dollars in unpaid medical bills, according to the lawsuit. Their complaints underscore problems with some types of cheaper health insurance alternatives that the Trump administration has expanded. Critics of the government’s decision, including the Association for Community affiliated Plans and the National Alliance on Mental Illness, are also suing the Trump administration over relaxation of rules for these plans..

Florida Company Sued Over Sales of Skimpy Health Plans - The New York Times

And this really didn't come as a surprise, here from 2017:

The drive by Senate Republicans to repeal the requirement that most Americans have health insurance is not only likely to discourage people from signing up for coverage during the current enrollment period, but also could result in higher premiums. If repeal is approved, people could opt out of buying policies because they would no longer face a tax penalty and millions could go uninsured. With the Affordable Care Act already weakened by the Trump administration, big drops in enrollment would deal yet another body blow to the law and wreak more havoc in the individual insurance market. Many consumers would likely to turn to the cheap, short-term policies that already skirt provisions of the law and may not cover pre-existing conditions or basic medical needs. “If you get rid of the mandate, you open the floodgates,” said Robert Laszewski, an industry consultant in Alexandria, Va.

Without Obamacare Mandate, ‘You Open the Floodgates’ for Skimpy Health Plans - The New York Times

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A top Trump administration health official warned against controversial changes that could undermine ObamaCare in a private memo last year that was released by House Democrats on Friday. One of the three changes was later finalized by the administration, despite the warning from Centers for Medicare and Medicaid Services Administrator Seema Verma in the memo. And the other two have not yet been proposed but remain under consideration. House Democrats said Friday the fact that the administration approved an alteration that could undermine ObamaCare over the objections of one of its own top officials shows that the Trump administration is intent on “sabotage” of the Affordable Care Act.

The August 2018 private memo to Secretary of Health and Human Services (HHS) Alex Azar shows Verma was concerned with keeping ObamaCare markets stable and preventing disruption, but on at least one front was overruled by others in the administration. The first change was a proposal to alter an index that is used to calculate how much money ObamaCare enrollees get in subsidies to help afford coverage, resulting in cuts. Verma warned in the memo that the change would cause “coverage losses, further premium increases, and market disruption.” But the administration went ahead with the change in early 2019 anyway. Administration estimates project that the move will save the government about $1 billion per year in lower subsidy payments, but will result in 70,000 people dropping coverage.

Top Trump health official warned against controversial ObamaCare changes in private memo | TheHill

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The sabotage is working:

The uninsured rate is rising for the first time since ObamaCare passed, two recent studies show, alarming advocates who fear the problem could get worse.  Data from the Centers for Disease Control and Prevention released in July show there were 2.1 million more uninsured people between 2016 and 2018. And a study from the Urban Institute this month, using Census Bureau data, found 700,000 more uninsured people just between 2016 and 2017.  The increase is especially noteworthy given the strong economy, signaling the uninsured rate will rise even higher if the economy worsens and people start losing the coverage they get at their jobs.

Advocates sound alarm as uninsured rate rises under Trump | TheHill

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Watch out, older Americans and people with disabilities! President Trump just announced a plan to give corporate health insurers more control over your health care. His new executive order calls for “market-based” pricing, which would drive up costs for everyone with Medicare, eviscerate traditional Medicare, and steer more people into for-profit “Medicare Advantage” plans. Seema Verma, the Trump appointee who heads the Centers for Medicare and Medicaid Services (CMS), may not have warned Trump about the slew of government audits revealing that many Medicare Advantage plans pose “an imminent and serious risk to the health of… enrollees.” They also overcharge taxpayers to the tune of $10 billion a year. In the last few years alone, CMS’ limited audits have highlighted major issues with Medicare Advantage plans. Reports from the Department of Health and Human Services Office of the Inspector General (OIG) and Government Accountability Office (GAO) have underscored these issues. They have recommended that CMS increase its oversight of Medicare Advantage plans and its enforcement efforts..

Trump just launched a stealth attack on seniors’ health care – Alternet.org

• And sabotaging Medicare..
  

[Admin]

During the 2016 election, Donald Trump promised to repeal and replace the Affordable Care Act. Congressional Republicans tried to make good on this promise in 2017, before a Senate vote effectively killed the effort. In the wake of that failed attempt, Republican states challenged the law’s constitutionality in court, an effort encouraged and aided by the Trump administration.

But with 2020 elections looming, the Trump administration and state-level Republicans have seemingly lost their appetites for slashing and burning the landmark health care legislation. In briefs filed Friday to the Supreme Court in a lawsuit that seeks to overturn the law in its entirety, the US Department of Justice and a separate group of Republican state attorneys general both asked the court not to take on the case this year.

The case carries heavy implications for the US health care system, and for the 2020 elections as well. Should the Republican plaintiffs succeed in getting the ACA struck down, the Urban Institute estimates that about 20 million people in the US will lose their health insurance. And the result of a Supreme Court ruling could have stark effects on both Democratic and Republican pitches to voters ahead of November’s elections.

Trump administration wants the Supreme Court to wait on Obamacare ruling - Vox

• Amazing stuff, sabotage by stealth..
  
• If 20M people lose their coverage, this will cause thousands of avoidable deaths and untold other misery like medical bankruptcies.
  

[Admin]

Plans for block grants of Medicaid are decades old Republican plans to cut Medicaid and are now serious proposals from the Trump government. But VP Mike Pence pretends not to know them and doesn't agree with basic facts:

As Vox’s Dylan Scott explained, enacting block grants, a long-held goal of ideological conservatives, “would fundamentally change how the program is financed” and ultimately result in funding cuts and less coverage:

Medicaid would no longer pay whatever is necessary to provide medical care to the people in or near poverty who qualify for its benefits. Instead, spending would be limited in states that got a waiver from the federal government, and they could impose cuts on benefits.

Davidson told Vox that block-granting Medicaid has been part of mainstream Republican thinking about health care for decades, so he doesn’t buy that Pence was as ignorant about his administration’s new plan as he seemed to be. (The White House didn’t immediately respond to a request for comment.) “I think he was not expecting to be pressed on that, and didn’t have his talking points prepared, so he retreated back to his safe space,” Davidson said. “I believe he understands exactly what his administration is doing.”

Watch: Pence tries to defend Medicaid cuts during exchange with doctor - Vox

• Watch the accompanying videos recording the conversation between a doctor and Pence.
  

[Admin]

As a health policy expert, I find the vision brought forward by the Trump administration deeply concerning. Cuts to virtually all important health-related programs bode ill for nations future. To make things worse, ancillary programs that are crucial for good health are also on the chopping block. To be sure, most of the proposed damage will find it hard to pass muster with Congress. Yet given the nation’s ever-growing debt Congress may soon be amenable to rolling back the nation’s health safety net. 

Rolling back the ACA and the safety net. To no one’s surprise, some of the biggest cuts in the proposed budget focus on health care programs. The budget document uses a number of terms to disguise its true intentions. Yet a closer look indicates that terms like “rightsizing government,” “advancing the President’s health reform vision,” “modernizing Medicaid and the Children’s Health Insurance Program,” and “reforming welfare programs” all come down to the same end result: cuts to the safety net.

One of the main targets remains the Affordable Care Act, or ACA. In 2017, after several failed attempts to repeal and replace the ACA, the Trump administration has scaled back its open hostility. Instead of asking directly to repeal the ACA, this year’s budget proposal calls for initiatives to “advance the president’s health reform vision,” by cutting more than half a trillion dollars from the budget.

These initiatives come on top of actions the Trump administration has already taken to roll back the Affordable Care Act, including the repeal of the individual mandate penalty, severely limiting outreach and enrollment efforts, and creating a parallel insurance market by expanding the roles of short-term, limited duration and association health plans.

What the Trump budget says about the administration's health priorities

• Much more in the article, cuts to Medicaid, Medicare, Food stamps, etc.