Department of Connecting Dots: Koch … Alaska

Two disconnected stories came across my screen yesterday so closely in time, I could not resist putting them together.  See if you agree.

Story One concerns the conservative advocacy organization, Americans for Prosperity, that is possibly the leading advocacy group in the nation fighting the Affordable Care Act/ObamaCare.  Funded by the billionaire brothers, Charles and David Koch, AFP is perhaps the leading group in the nation fighting to prevent red states from expanding their Medicaid programs to poor uninsured people.  On the other side are hospitals, physicians, insurance companies, business groups, consumers and just about everyone else except the conservative activists led by AFP and the Koch brothers’ money.

Lest you think they are starting to give up, see this from Reuters:

“If there’s one thing that exasperates Tim Phillips, the president of the conservative advocacy group Americans for Prosperity, it’s when outsiders don’t understand he’s in it for the long run.

“The group, founded by the billionaire industrialist brothers Charles and David Koch, has been around for 10 years already, and its presence is growing. Each time the number of people signed up to volunteer for AFP reaches a certain threshold in a state, AFP opens a field office there. It now has offices in 33 states, and at its national Defending the American Dream Summit on Friday and Saturday in Columbus, Ohio, Phillips joked that he was ready to accompany the handful of volunteers from Hawaii back home to do the difficult task of opening an office there.

“In an interview Saturday, Phillips made it very clear: There’s no chance AFP is going to give up on its efforts to repeal President Barack Obama’s healthcare legislation, the Affordable Care Act.

“’When I said long-term, I meant it,’ Phillips said. “We have never stopped.”

“Congress passed the healthcare legislation in 2010 and it took effect just under four years later. The Supreme Court has since ruled twice its provisions were constitutional in cases challenging it. The U.S. House of Representatives has voted many times to repeal it, but none of those efforts has made it all the way through Congress. Public opinion polls show a majority of Americans are in favor of keeping it, and Congressional Budget Office projections show it lowering government expenditures on healthcare in the future. But Phillips has a different perspective.

“’The Left has been pushing for government-run healthcare since the 1920s,’ he said. He doesn’t think AFP’s struggle will have to last that long.

“’We’re in year six of a healthcare battle.’ he said. ‘It’s may be a 10- or 12-year battle.’”

Continue reading “Department of Connecting Dots: Koch … Alaska”

Not Ready for Primetime: Republican Presidential Candidates on Health Reform

If you were among the few looking closely, you may have noticed buzz and hoopla this past week on the release of two health reform proposals from Republican presidential candidates Gov. Scott Walker (R-WI) and Sen. Marco Rubio (R-FL). Not surprisingly, while Affordable Care Act supporters were quick to criticize, ACA detractors were complimentary: “serious plans” and “the opening theme music of health policy reform for Republican presidential primary voters.”

So, how do these two plans stack up? Not well.  Here’s a handy table with which you can compare – and I’ve left nothing of out:

Category Gov. Scott Walker Sen. Marco Rubio
Title The Day One Patient Freedom Plan: My Plan to Repeal and Replace Obamacare Real Reform in the Post-Obamacare Era
ACA/Obamacare “Repeal … in its entirety” “Demand that we repeal Obamacare and replace it with a conservative solution.” (website)
Tax Credits to Purchase Health Insurance “Available to anyone without employer coverage based coverage” – the amount based on age only:

0-17: $900

18-34: $1200

35-49: $2100

50-64: $3,000

“… advanceable, refundable tax credit that all Americans can use to purchase health insurance…”
Access to Health Savings Accounts (HSAs) Anyone signing up for an HSA gets a $1000 refundable tax credit “…should be expanded.”
Sale of Health Insurance across State Lines Allow individuals to shop in any state for insurance N/A
Pre-Existing Conditions Banned for individuals who “maintain continuous creditable coverage” “Those with pre-existing conditions should have access to affordable care through mechanisms such as federal-supported, actuarially-sound and state-based high risk pools.”
State High-Risk Pools “…make it easier for states to expand these pools” See above.
Mandated Essential Health Benefits, including for Young Adults <26 “…return regulatory authority to states” N/A
Medicaid Capped state allotment for: 1. Low-income families 2. Non-disabled adults; 3. Long term services & support “… move … into a per capita system preserving funding for Medicaid’s unique populations while freeing states from Washington mandates.”
Insurance Pooling “… allow for new purchasing arrangements so farmers, small business, religious groups, individual membership associations and others could join together…” N/A
Long Term Care Insurance Deregulate the current market N/A
Medical Malpractice “… incentivize states to pass meaningful lawsuit reform…” N/A
Financing “… repeal all of ObamaCare’s $1 trillion in new taxes…” No specifics on substitute financing. N/A
Tax treatment of employer provided health insurance N/A “Glide path” downward to match the value of individual tax credits within a decade
Medicare N/A “A premium support system, empowering seniors with choice and market competition, just like Medicare Advantage and Part D already do.”

Some observations:

First, even for a campaign document, these plans are wafer thin, raising far more questions than providing answers. Walker’s plan has just seven pages of substance, and Rubio’s is based on two short op-eds for Fox News and Politico. Continue reading “Not Ready for Primetime: Republican Presidential Candidates on Health Reform”

Creating Better Affordability in the Affordable Care Act

Every day, so many reports emerge about aspects of ObamaCare/ACA that it’s difficult to decide which ones to note. Here’s one I note today from the Urban Institute – “After King v. Burwell: Next Steps for the Affordable Care Act” written by the always perceptive Linda Blumberg and John Holahan.

The report’s basic and important message is this: though it has vastly increased health insurance security and affordability for millions of vulnerable Americans, the Affordable Care Act is not affordable enough. Knowing what we know now, the law needs better affordability for millions of Americans who need access to subsidized insurance that includes more affordable premiums and stronger cost sharing protections:

“The premium and cost-sharing structures established under the law were delineated with the intention of meeting specific budget targets that now seem overly constraining. As a result, several problems occurred. Premium tax credits are substantial, but they are still inadequate for many individuals and families, given their incomes. Similarly, many individuals with modest incomes may struggle to afford the Level of cost-sharing required in the plans for which the premium tax credits are pegged. Premium tax credits are tied to a product with cost-sharing requirements that significantly exceed the typical large employer-sponsored plan. In particular, older individuals with incomes just above the current tax credit eligibility range face high premiums relative to their incomes, and because they tend to use more medical care than do their younger counterparts, they face a total bill for premiums plus out-of-pocket spending that can be very high.”

Continue reading “Creating Better Affordability in the Affordable Care Act”

The Sounds of Silence in the Republican Debate

I had one mission last evening watching the Republican-Fox News debate among their party’s top ten presidential contenders: what, if anything, could we learn about the state of play regarding the Affordable Care Act and U.S. health policy?

What I observed: the impassioned debate about the Affordable Care Act/ACA/ObamaCare is over, even among Republicans.

Here is what I noted from the debate that referenced the ACA:

First, Ohio Governor John Kasich restated his strong support for his decision to expand Ohio’s state’s Medicaid program as enabled and financed by the ACA, invoking President Ronald Reagan as someone who “expanded Medicaid three or four times.” He emphasized Trump Kasichhow the expansion helps both Ohio’s working poor as well as the mentally ill in prisons. No apology, no retreat, and no damage or attacks from any of his rivals.

Second, asked about his prior public support for a Canadian-style single payer health care system, Donald Trump commented that “single payer works well in Canada and incredibly well in Scotland.” He said he wants a “private system without artificial lines around states” (so much for states’ rights) and opposes “insurance companies that make a fortune because they have total control of the politicians. Get rid of the artificial lines. Take care of the people who can’t take care of themselves.” Oddly, at the end of his closing statement at the very end of the program, he added, apropos of nothing: “We have to end Obamacare and make our country great again.”

Former Florida Governor Jeb Bush said he wants to “get rid of Obamacare and replace it with something that doesn’t suppress wages.” No indication of what the “something” might be.

Wisconsin Governor Scott Walker simply said he wants to “repeal Obamacare.”

That’s it. Except for Trump’s, none of the others’ closing statements mentioned the issue. Even Texas Senator Ted Cruz, in his lengthy litany of first-day-as-President actions, left executive action on the ACA off his list. Cruz, as many will recall, was the key instigator of the 2013 federal government shutdown as a final gasp to prevent implementation of the ACA’s insurance coverage expansions on January 1 2014.

The only question from the panel of three Fox news journalists relating to health reform was the one to Trump regarding his past support for single payer health insurance – more a Fox gotcha moment than a thrust into health policy.

I looked at dozens of news accounts of the program from journalists across the political spectrum. Obamacare/ACA merited no mention anywhere in the their accounts and analyses.

This is the sound of silence as the ACA disappears from the nation’s political radar screen.

Yes, U.S. health policy is becoming boring again, still a never-ending feast for the policy wonks, still a continuous hand-wringing exercise for patients and medical providers dealing with their daily challenges, and now a big nothing-burger for most Americans focused on other concerns.

On two other health related issues, we heard repeated statements of opposition to public funding for Planned Parenthood and, of course, strident statements of opposition to abortion where the focus put candidates on the defensive who are willing to allow abortion in cases of rape, incest, and to save the life of the mother.

And nothing about Ebola!

I am sure in future debates, the ACA will return and receive a higher profile. But temperatures are cooling and this program last evening was important affirmation.