January 2, 2017 Vital Signs - Keeping Slavitt employed, why I care, inchoate uninsured

Merry Christmas, Happy New Year, Happy Kwanzaa, Hanny Hanukkah, Happy Holidays, and Happy Festivus for the Restofus! Why only one "Merry" and all the "Happys"? Time for a Congressional investigation! What are those House Benghazi and email committees doing? They must have some free time. 

There hasn't been a lot going on in healthcare over the last few months, but folks are starting to jockey for position as the stars align. First up: Repealing Obamacare!

I follow and like politics - I attribute that to having poli, sci./philosophy and JD degrees - so, these are fun times for me.

I've been wondering how the GOP was going to repeal the Patient Protection and Affordable Care Act (PPACA, aka ACA, aka Obamacare). I had some thoughts and voila, up comes a story on the GOP game plan from The New York Times which I've pasted in below.

Republicans' 4-Step Plan to Repeal the Affordable Care Act

By ROBERT PEARJAN. 4, 2017

WASHINGTON - Vice President-elect Mike Pence and the top Republicans in Congress made clear on Wednesday, more powerfully and explicitly than ever, that they are dead serious about repealing the Affordable Care Act.

How they can uproot a law deeply embedded in the nation's health care system without hurting some of the 20 million people who have gained coverage through it is not clear. Nor is it yet evident that millions of Americans with pre-existing medical conditions will be fully protected against disruptions in their health coverage.

But a determined Republican president and Congress can gut the Affordable Care Act, and do it quickly: a step-by-step health care revolution in reverse that would undo many of the changes made since the law was signed by President Obama in March 2010.

Step 1: Defang the filibuster

The Senate intends to pass a budget resolution next week that would shield repeal legislation from a Democratic filibuster. If the Senate completes its action, House Republican leaders hope that they, too, can approve a version of the budget resolution next week. Whether they can meet that goal is unclear.

The resolution contains seemingly innocuous language, instructing four committees that control health care policy - two in the Senate, two in the House - to draft legislation within their jurisdiction that would cut at least $1 billion from the deficit over 10 years. But that language has real teeth. The legislation produced to meet those instructions can pass the Senate with a simple majority - 51 votes if all senators are present - obliterating the power of the Democratic minority to block it.

Those four committees would have just a few weeks, until Jan. 27, to produce legislation repealing major provisions of the Affordable Care Act. House Republicans have some practice at this, because they have voted more than 60 times since 2011 to repeal some or all of the law.

The budget blueprint will guide Congress but will not be presented to the president for a signature or veto.

Step 2: Add the details

The committees - House Energy and Commerce, House Ways and Means, Senate Finance, and Senate Health, Education, Labor and Pensions - will quickly assemble legislation intended to eviscerate the health care law.

The repeal legislation will be in the form of a reconciliation bill, authorized by the Congressional Budget Act of 1974. Such bills can be adopted under special fast-track procedures. But Senate rules generally bar the use of those procedures for measures that have no effect on spending or revenue. So the legislation, as now conceived, would probably leave the most popular provisions of the health law intact, such as the prohibition on insurers' denying coverage to people with pre-existing conditions.

Instead, the legislation would:

■ Eliminate the tax penalties imposed on people who go without insurance and on larger employers who do not offer coverage to employees.

■ Eliminate tens of billions of dollars provided each year to states that have expanded eligibility for Medicaid.

■ Repeal subsidies for private health insurance coverage obtained through the public marketplaces known as exchanges.

It could also repeal some of the taxes and fees that help pay for the expansion of coverage under the Affordable Care Act. But some Republicans have indicated that they may want to use some of that revenue for their as-yet-undetermined plan to replace the health care law.

The 2010 law imposed taxes and fees on certain high-income people and on health insurers and manufacturers of brand-name prescription drugs and medical devices, among others. Republicans have not said for sure which taxes they will scrap and which they may keep.

Republicans say they will delay the effective date of their repeal bill to avoid disrupting coverage and to provide time for them to develop alternatives to Mr. Obama's law. They disagree over how long the delay should last, with two to four years being mentioned as possibilities.

Step 3: The new president's role

Within days of taking office, President-elect Donald J. Trump plans to announce executive actions on health care. Some may undo Obama administration policies. Others will be meant to stabilize health insurance markets and prevent them from collapsing in a vast sea of uncertainty.

"We are working on a series of executive orders that the president-elect will put into effect to ensure that there is an orderly transition, during the period after we repeal Obamacare, to a market-based health care economy," Mr. Pence said at the Capitol on Wednesday.

He did not provide details, and Trump transition aides said they had no information about the executive orders. But some options are apparent. The federal government could continue providing financial assistance to insurance companies to protect them against financial losses and to prevent consumers' premiums from soaring more than they have in the last few years.

Step 4: Find a replacement

Even as they move full speed toward gutting the existing health law, Republicans are scrambling to find a replacement. At the moment, they have no consensus.

Mr. Pence said on Wednesday that the replacement would probably encourage greater use of personal health savings accounts and make it easier for carriers to sell insurance across state lines. Also, he said, it would encourage small businesses to band together and buy insurance through "association health plans" sponsored by business and professional organizations.

Some type of subsidy or tax credit for consumers, to help defray the cost of premiums, is also likely. States would have more authority to set insurance standards, and the federal government would have less.

Mr. Trump has also endorsed the idea of state-run "high-risk pools" for people with pre-existing conditions who would otherwise have difficulty finding affordable coverage.

Many experts have said that repealing the health law without a clear plan to replace it could create havoc in insurance markets. Doctors, hospitals and insurance companies do not know what to expect.

Without an effective requirement for people to carry insurance, and without subsidies to buy it, supporters of the law say many healthy people would go without coverage, knowing they could obtain it if they became ill and needed it.

Democrats in Congress say they will do everything they can to thwart Republican efforts to dismantle the Affordable Care Act. They plan to dramatize their case by publicizing the experiences of people whose lives have been saved or improved by the law.

In the Senate next week, Democrats will demand votes intended to put Republicans on record against proposals that could protect consumers. Defenders of the law also hope to mobilize groups like the American Cancer Society and the American Heart Association to speak up for patients.

The Senate Democratic leader, Chuck Schumer of New York, and the House Democratic leader, Nancy Pelosi of California, are encouraging their colleagues to organize rallies around the country on Jan. 15 to oppose the Republicans' health care agenda.

And to buttress their case, Democrats are compiling statistics from the White House and from researchers at liberal-leaning groups like the Center on Budget and Policy Priorities, the Commonwealth Fund and the Urban Institute, which warn of catastrophic consequences if the law is repealed.

The actions of the GOP in the years leading up to Trump's election have been to nick and hobble Obamacare primarily by reducing the insured pool to the most expensive consumers. This is an adverse selection issue: folks who want health insurance will tend to be the same people insurance companies least want to insure: older people, folks with pre-existing conditions, working poor, etc.

The GOP has attempted to delay or get rid of the individual mandate on the state and national level. The GOP doesn't want young healthy folks in the risk pool. They were expecting that they could continue to hobble Obamacare by creating higher risk pools which in turn would increase premiums, which would irritate the Obamacare insureds, and which the GOP could then point to as evidence of a failed system. And, best of all, the GOP would be able to deny any responsibility! Fairly ingenious if a tad bit im- or a- moral.

But, hey, it's why I like politics and policy.

But with Trump's unexpected election, the GOP has had to come into the light and has to fulfill campaign promises of repealing Obamacare and replacing it with something better. And not negatively impact the newly 20mm insured. Yikes! How much fun is this?

ONWARD EVER

8 years and counting: Slavitt's pretty funny. The lobbyists are the only ones that can save Obamacare

"Slavitt, part of the outgoing Obama administration, spoke Thursday to the audience at the first MACRA MIPS/APM Summit held in Washington, and his prepared remarks were posted on the CMS blog. While he never mentioned President-elect Donald Trump by name, Slavitt said he hoped the new political climate in Washington would not reverse the progress brought about by steps such as the Affordable Care Act (ACA) and implementation of the Medicare Access and CHIP Reauthorization Act of 2015, which will change how clinicians get reimbursed under the Medicare program.

MACRA, which passed with bipartisan support from Congress, is not expected to go away under the Trump presidency, but the ACA is under attack. After almost two years as head of CMS, Slavitt will soon be out of a job as Trump has nominated Seema Verma, founder and CEO of consulting firm SVC Inc., to serve as administrator of the federal agency."

Here's the URL: https://www.fiercehealthcare.com/practices/don-t-undo-8-years-healthcare-progress-slavitt-says?

Healthcare spending $3.2T in 2015: So that's why I care about this sector. I was wondering. I'm not Mother Teresa.

"Healthcare spending in 2015 increased at a rate of 5.8%, the fastest in eight years, as more people obtained health insurance and prescription drug costs continued to rise, according to a CMS report published Friday by Health Affairs.

For the first time, the federal government accounted for the largest share of healthcare spending at 29%, mainly because of Medicaid expansion. Household spending made up 28%, private businesses were 20% and state and local governments were 17%."

Here's the URL: https://www.modernhealthcare.com/article/20161202/NEWS/161209984? 

ACA repeal will increase number of uninsured? Really? I thought that was the intent. There's no Constitutional right to healthcare. If Congress can ensure the docs that direct deposit will continue and that their cash flow will not be abated, most will take a wait and see attitude.

"Groups that represent hundreds of thousands of physicians are urging the Republican-controlled Congress not to increase the number of uninsured individuals as it moves ahead with plans to repeal the Affordable Care Act.

In a letter sent to congressional leaders Tuesday, the head of the American Medical Association (AMA), the country's largest physicians' group, urged lawmakers to proceed with caution in plans to repeal the healthcare reform law that has provided health insurance to millions of Americans.

"In considering opportunities to make coverage more affordable and accessible to all Americans, it is essential that gains in the number of Americans with health insurance coverage be maintained," wrote James L. Madara, M.D., the AMA's CEO and executive vice president. He urged policymakers to 'lay out for the American people, in reasonable detail, what will replace current policies.'"

Here's the URL: https://www.fiercehealthcare.com/practices/doctor-groups-worry-aca-repeal-will-increase-uninsured?

OBITER DICTUM

That's the standard technique of privatization: defund, make sure things don't work, people get angry, you hand it over to private capital. -  Noam Chomsky

Each generation imagines itself to be more intelligent than the one that went before it, and wiser than the one that comes after it. - George Orwell

If you can convince the lowest white man that he's better than the best colored man, he won't notice you're picking his pocket. Hell, give him somebody to look down on, and he'll even empty his pockets for you. - Lyndon Baines Johnson

Think of how stupid the average person is, and realize half of them are stupider than that. - George Carlin 

I guess the only time most people think about injustice is when it happens to them. - Charles Bukowski

See you in a few weeks.