New Administration, Old Approach: Trump advocates Medicaid Block Grants & ACA Repeal

 

As the shifting legislative landscape of President Trump’s first 100 days continues, two major developments emerged in the health care reform world: that the Trump administration plans to block grant the Medicaid program and that President Trump signed an initial executive order weakening the ACA.

 

From its inception in 1965 under President Lyndon Johnson until the present day, Medicaid has served as a public insurance program for low-income individuals, families, and people with certain disabilities. Unlike Medicare, which was created at the same time and is both federally funded and administered, Medicaid is a federal-state partnership program in which each individual state administers their own Medicaid program using a mixture of state and federal funds, provided that certain services and populations are covered. For the entirety of its existence, Medicaid has been an entitlement program, which means that the government is required to provide coverage for anyone who meets the eligibility rules for enrollment. This means that the amount of money being spent on a state’s Medicaid program fluctuates from year-to-year based on how many people qualify for coverage.

 

Every Republican President since Ronald Reagan has tried, and so far failed, to turn Medicaid from an entitlement program into a discretionary block grant program. Block granting Medicaid would mean the federal government would present states with a predetermined amount of money to serve their low-income and disabled residents at the beginning of each year. Most plans to block grant Medicaid would determine the amount of funding based on previous state and federal Medicaid spending in a given state, with slight changes each year to account for inflation. The states would then be allowed to determine exactly how to spend that money with many fewer requirements than in the current system. This means that if there were a recession, an unexpected disaster, disease outbreak or if general health care costs continued to rise faster than inflation, state governments would not be given extra federal funds.

 

In such a situation, states would address the health care needs of their low income and disabled residents through a variety of means, but most would reduce or eliminate covered services, restrict access to the program, or introduce higher cost-sharing mechanisms. Taken together, this would adversely affect the health and wellbeing of those in need of care. In a best case scenario, states would take on the excess costs themselves. However, this might prove difficult since many states are required to balance their budgets which might require tax increases or additional sources of revenue to meet these increased Medicaid costs. As a result, many states would choose to avoid added costs by changing the Medicaid eligibility criteria, reducing Medicaid benefits, and simply not providing care to people who are eligible. According to an analysis of a previous Republican proposal from 2012, the block granting of Medicaid could wind up dropping anywhere between 14.3 million and 20.5 million people from care.

 

It is nearly impossible to overstate how devastating Medicaid block granting would be for people living with or at risk of contracting HIV. Right now, Medicaid is the largest source of insurance coverage for people living with HIV, covering more than 40% of people with HIV who are in care. At the same time, Medicaid accounts for 30% of all federal HIV spending and when combined with state Medicaid spending, represents the 2nd biggest source of public HIV financing, trailing only Medicare. Under block grant funding, people living with HIV could bear some of the largest burdens of all impacted populations, because state governments may choose benefit designs that disproportionately affect pricey HIV medications. Given the amount of stigma regarding people living with HIV, LGBT people, and lower income populations, it is possible that some states would choose to do so. Although it may sound unlikely that a state government would discriminate against the provision of medical treatment for certain populations, it has been suggested in the past. For example homophobic legislators in Tennessee openly questioned providing funds to treat people living with AIDS due to their “bizarre lifestyle.” AIDS United strongly opposes block granting Medicaid and we urge readers to call their legislators with that message.

 

President Trump’s executive order intended to weaken the ACA may be more important for what it suggests than for what it actually accomplishes. The executive order directs federal agencies to use their current regulatory authority to “minimize the economic burden” and minimize or remove “any provision…that would impose a fiscal burden on any State, or a cost, fee, tax, penalty, or regulatory burden on an individual.” The order would also grant waivers to states that undercut the cost of consumer protections, encourage the sale of health insurance across state lines, and encourages agencies to use discretion to avoid expanding the ACA.

 

By himself, Mr. Trump doesn’t have the power to repeal or directly impede the implementation of the ACA. However, he can instruct the employees of federal agencies to begin chipping away at the law’s effectiveness. For example, the Trump administration can’t formally strike down the ACA’s individual mandate that all Americans be insured, but he can instruct the IRS to simply not fine anyone who doesn’t abide by the mandate, rendering it useless. Similarly, the executive order instructs the Department of Health and Human Services (HHS) to provide states with considerable leeway when it comes to the implementation of their health care programs and encourages HHS to accept waivers from states that would help them get around ACA regulations that they find overly restrictive.

 

On Thursday, the administration reportedly took another step to undermine the ACA. White House officials ordered the Department of Health and Human Services to halt all advertising and outreach efforts encouraging enrollment in ACA health plans purchased on the Healthcare.govmarketplace during the last days of the 2017 open enrollment period. This is significant because in previous ACA open enrollment periods, the final days were among the heaviest for signing up for health coverage. The White House action does not affect people’s ability to sign-up for coverage on the website; open enrollment ends Tuesday, Jan. 31.

 

AIDS United believes that the ACA must remain in place and that no effort to make changes, including this executive order, should attempt to repeal the law without an immediate and effective replacement in place. AIDS United will continue to provide concise analysis of the what’s happening in Washington regarding health care reform and why it should matter to people living with HIV.

 

Posted By: AIDS United, Policy Department – Friday, January 27, 2017
Search Tags: Affordable Care Act , HIV Policy

In Congress, Obamacare Replacement Plans Start To Emerge

 

Just twenty-five days into the 115th Congress, the Republican congressional majority has made significant steps to make good on campaign promises to repeal the ACA and setup President Trump for swift action on his other top priorities. Republicans kicked off a policy retreat in Philadelphia Wednesday that extends through Friday evening where they hope to hash out how to repeal and replace Obamacare.
While Republicans have had the last six years, and five-dozen attempts to overturn the ACA and plot a replacement, no clear consensus has risen on what to do following repeal. Adding to the uncertainty of how they might repeal and replace Obama’s signature law, is the assertion by President Trump that he will send his own plan to Congress, once his Health and Human Services (HHS) Secretary nominee, Tom Price is confirmed. The notion of the White House sending legislation to Congress is unnerving for many lawmakers and calls into question the separation of powers. Senator Rand Paul M.D. (R-KY), who introduced The Obamacare Replacement Act (S.222) this week, said in a statement that, “Sometimes you get ideas from the White House,” which underscores the atypical nature of President Trumps desired path toward repeal.

The Paul Replacement 

Sen. Paul’s bill has several provisions including an immediate repeal of the individual and employer mandates, the essential health benefits requirement, and other insurance mandates. Further the bill would allow unlimited deposits into Health Savings Accounts and broaden options for using those funds; allow the purchasing of insurance across state lines; and create voluntary associations for insurance pooling.

Cassidy-Collins replacement 

Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) held a press conference Monday to propose three options states could consider moving forward with health care coverage. States could either keep the Affordable Care Act (ACA) but with reduced federal funding for subsidies, switch to a different system to purchase insurance coverage, again with reduced subsidies , or go forward with an alternate plan that does not include federal assistance. The Cassidy-Collins proposal is in direct contrast to plans discussed by House and Senate leadership, which would not let the ACA continue in any form. Cassidy notes that this proposal serves as a middle-way approach that could potentially bridge Democrats’ and Republicans’ concerns. However, the Cassidy-Collins one-page compromise still needs legislative language.

Cassidy noted:
“At some point in this process, we will need a bill that can get to 60 votes. Now you can say to a blue-state senator who is invested in supporting Obamacare, ‘You can keep it, but why force it on us?’” Collins, affirms saying, “I believe most states would embrace this option, which allows states to cover the uninsured by providing a standard plan that has a high-deductible, basic pharmaceutical coverage, some preventive care and free immunizations.”

The question is, what does the rest of Congress think?

Senate Minority Leader Chuck Schumer (D-NY) described the proposal as “an empty facade that would create chaos.” Schumer wasn’t the only Democrat that predicted insurmountable challenges in the Cassidy-Collins proposal. Democratic leadership call into question the idea of giving some states the option to dismantle the current health care law and replace it with something else or nothing at all, for that matter. Conversely, Republican leadership hasn’t publicly commented much on the generality of the bill. Furthermore, Republicans have persistently supported the dismantling of the current health care law’s taxes and fees.

Presidential Executive Order 

As one of his first actions last Friday, Trump signed an executive order intended to minimize the economic burden of the ACA, pending its repeal. The order allows the U.S. Department of Health and Human Services (HHS) and other federal agencies to use their existing powers “to the maximum extent permitted by law” to weaken the ACA. HHS and agencies such as the IRS “were given vast discretion over key parts of the law including the individual and employer mandates,” per Pro Health Care’s Brianna Ehley. What this could mean is that it is possible to stop the individual mandate from being enforced.

In addition to President Trump’s actions, there was a congressional hearing, at which Republican members sought to expose what they perceive to be a decrease in marketplace competition and affordability. The hearing examined the “Failures of Obamacare.” There was also a hearing on theACA Individual Mandate. The hearing on the Price Nomination for HHS Secretary was also a forum for Republican senators to air their ACA-related grievances.

As HIV advocates we remain vigilant in the changing landscape and continue to seek intelligence and influence the proposed changes to our health care systems. It is imperative that the ACA not be repealed without a replacement that protects the expanded access the law has brought. We must insure vulnerable population, including people living with or at risk for HIV, are provided the access to care they deserve.

Posted By: AIDS United, Policy Department – Friday, January 27, 2017

5 Things To Know About Rep. Tom Price’s Health 

Rep. Tom Price has introduced his own alternative to the Affordable Care Act four times. The legislation provides an idea of how he might lead the Department of Health And Human Services.

Andrew Harrer/Bloomberg via Getty Images

Georgia Rep. Tom Price has been a fierce critic of the Affordable Care Act and a leading advocate of repealing and replacing the 2010 health care law.

Price, an orthopedic surgeon from the suburbs of Atlanta, introduced his own legislation to repeal and replace Obamacare in the current Congress and the three previous sessions. Price’s plan, known as the Empowering Patients First Act, was the basis for a subsequent health care proposal unveiled by House Speaker Paul Ryan, with Price’s endorsement, in June.

Price’s major complaint about the ACA is that it puts the government in the middle of the doctor-patient relationship.

“They believe the government ought to be in control of health care,” Price said in June at the American Enterprise Institute event where Ryan unveiled theRepublican proposal to replace Obamacare. “We believe that patients and doctors should be in control of health care,” Price continued. “People have coverage, but they don’t have care.”

Now that President-elect Donald Trump has tapped Price to lead the Department of Health and Human Services, here are five key planks in his own health care proposal.

  1. Price’s plan offers fixed tax credits so people can buy their own insurance on the private market. The credit starts at $1,200 a year and rises with age, but isn’t adjusted for income. Everyone receives the same credit whether they are rich or poor. People on Medicaid, Medicare, the military health plan known as Tricare, or the Veterans Affairs’ health plan could opt instead for the tax credit to buy private insurance.
  2. Price advocates for expansion of health savings accounts, which allow people to save money before taxes to pay for health care. This includes allowing people who are covered by government health programs including Medicare and the VA to contribute to health savings accounts to pay for premiums and copayments. These proposals are included in Ryan’s plan.
  3. People with existing medical conditions couldn’t be denied coverage under Price’s plan as long as they had continuous insurance for 18 months prior to selecting a new policy. If they didn’t, then they could be denied coverage for that condition for up to 18 months after buying a new plan.
  4. The Price proposal limits the amount of money companies can deduct from their taxes for employee health insurance expenses. Companies can deduct up to $20,000 for a family health insurance plan and $8,000 for an individual. The goal is to discourage companies from offering overly generous insurance benefits to their workers. Ryan’s plan proposes a cap on the employer tax deduction but doesn’t specify the level of the cap.
  5. States would get federal money to create so-called high-risk pools under Price’s plan. These are government-run health plans for people with existing medical conditions who can’t get affordable health insurance on the private market. Critics say high-risk pools have been tried in as many as 34 states and largely failed because they were routinely underfunded.

Price has said he’s not wedded to his own ideas and is open to compromise, so the final proposal to replace Obamacare is likely to be a hybrid of his ideas and those hammered out with other Republican House members and presented as Ryan’s plan.

Still, with Price on track to be at the helm of HHS, he would be the one writing the rules to implement whatever legislation is eventually passed.

Repeal Without Replace: Senate Starts Undoing Obamacare With No Replacement

In the wee hours of the morning on Thursday, the Senate took the important first step toward repealing the Affordable Care Act, narrowly approving a budget resolution that lays the groundwork for the undoing of much of President Obama’s signature health care law. The 51-48 vote fell almost entirely along party lines, with Senator Rand Paul (R-KY) being the only Republican to vote against the resolution and no Democrats voting for it. Having passed in the Senate, the budget resolution has been transferred over to the House where it could be voted on as early as this Friday or later, depending on how successful Speaker Ryan is at bringing together an often-fractured House GOP.

If the House passes the Senate resolution, reconciliation instructions will be sent out to the Senate Finance Committee; the Senate Health, Education, Labor and Pensions Committee; and to the House Ways and Means and Energy and Commerce committees. These instructions are designed to get the committees to report legislation that would reduce the federal deficit by at least $1 billion over the next decade. In practice the legislation will be used to repeal certain aspects of the ACA with only a 51-vote majority in the Senate and without having to face the risk of being filibustered by Democrats. This means that the GOP will be able to repeal major provisions of the ACA that affect the federal budget and will have to introduce other legislation to repeal the other provisions, including those that reform health insurance practices.
For people living with or at risk of contracting HIV, the changes that could be made through this reconciliation process will be immense and potentially deadly. Through reconciliation, Congress will be able to repeal the individual mandate to buy coverage, take away the ACA’s insurance premium subsidies and, perhaps worst of all, roll back Medicaid expansion. Medicaid is the single largest source of insurance coverage for people living with HIV, covering more than 40% of all people with HIV who are in care. Add to that the fact that Medicaid expansion by itself was responsible for putting an addition 14 million Americans on health insurance, and it is not hard to understand just how much of an impact this reconciliation process could have on the HIV community.

The Senate vote on the budget resolution was the climax of nearly 7 hours of rapid-fire voting known as “vote-a-rama”, a tradition whereby Senators—in this case, mostly Democrats—are allowed to propose roll call votes on amendments to a budget resolution in quick succession with the aim of getting their colleagues on the record with votes concerning politically volatile issues. On Wednesday night, Democrats put forth a number of amendments regarding some of the popular aspects of Obamacare as both an act of defiance and a way to put pro-repeal Senators on-the-record for the elimination of well received ACA provisions.

For their part, Republicans in the Senate chose in most instances to vote as a unified block even when such a vote went against the wishes of their constituencies. Over the course of the evening, the Senate rejected 19 different amendments along party lines, many of which would have served to protect access to quality, affordable health care for all Americans. Of particular interest to people living with or at risk for contracting HIV were amendments put forth by Senate Democrats aimed at preventing health insurers from discriminating against people based on pre-existing conditions, allowing children to stay on their parents’ health insurance until the age of 26, prohibiting insurers from denying health insurance or raising rates on women because of their gender, and not making any cuts to Medicaid funding. None of these amendments were accepted, but they did provide good indication of what aspects of the ACA would be vulnerable under a full ACA repeal.

Perhaps the most important vote of the night—aside from the final approval of the budget resolution—was one that didn’t happen at all. An amendment put forth by Senator Bob Corker (R-TN) and four other GOP Senators that would have extended the January 27th deadline to come up with repeal legislation by an additional 5 weeks was withdrawn late on Wednesday night. The amendment was initially brought up by Senator Corker and some of his Republican colleagues in light of legitimate fears that their party would not have a replacement plan in place when they repealed the ACA. And, while nothing happened over the course of the evening that would have given Senator Corker and his amendment’s supporters reason to believe a replacement plan was any nearer than before, they would all go on to vote in favor of the budget resolution at the end of the night, continuing down a path of repeal without replacement.

Most of America had long since gone to sleep and likely won’t remember when or exactly how it happened, but history with certainly note that, if the Affordable Care Act is indeed dismantled, that Congress began to do so when no one was watching.

Upcoming Support Group Meeting at Site #2

Cordially invites you to an
Evening Dinner
Amongst Friends

Wednesday, January 18th, 2017

 

Topic:  Work it out!

 

Presented by – Alison Ruby

 

Sponsor by – Merrick Pharmaceutical

 

5:00pm – 5:30pm Dinner

5:30pm – 6:30pm Presentation

6:30pm – 7:00pm – Rap Up!     

 

upcomingsupportgroupevent