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Trumps and Turns of Healthcare

Trumps And Turns Of Healthcare

Republicans abandon Trump on master repeal

While Republican leadership in the Senate has left the door slightly ajar, by and large most Republicans have turned a blind eye to President Trump’s call for finding the votes to pass a broad repeal and replace healthcare package.

Trump has asked the Senate to abolish the filibuster and attempt again to pass a bill. The problem: our Superhero John McCain (see our last two blogs) is undergoing treatment for brain cancer and the Senate still needs 50 votes to pass the bill. Two Republicans Senators (Susan Collins, R-ME, and Lisa Murkowski, R-AK) are on record opposing all recent comprehensive GOP repeal and replace measures. Still other GOP members would jump for some versions.

A hint of bipartisanship on fixing Obamacare

Could there be a bipartisan solution on Obamacare problems? Both Senators Orrin Hatch (R-UT) and Lamar Alexander (R-TN) chairmen of the two principal health committees in the upper chamber, have announced that hearings will be held in September on Obamacare’s future. On Hatch’s part, he is open to bipartisan discussions but cautioned that his committee’s principle priorities are tax reform and reauthorizing the Childrens Health Insurance Program (CHIP). Lamar Alexander and Ranking Member Patty Murray (D-WA) want to find ways to stabilize and strengthen the Exchanges. Among the ideas is funding, at least for one year, the Cost Sharing Subsidies that help lower income enrollees’ afford their out of pocket costs. A bipartisan team came together in the House to fashion a similar proposal with additional features. Additionally, in the Senate, Sen. Lindsay Graham (R-SC) has been pushing his interim solution for state block grant funds to stabilize the program, at least temporarily.

Battered by plan pullouts, a sizeable number of states will have major access issues in 2018. Virtually all states will see double-digit rate increases (as high as 43%) due to ongoing selection problems, plan risk, and uncertainty over whether President Trump will continue the subsides. Not paying subsidies over the next few weeks could shoot up premiums further for 2018 or lead to additional plan pullouts. Already, Anthem announced it would exit the vast majority of California counties where it sells both Exchange and other individual products. Molina, one of the most progressive of plans and supporters of the Exchanges, has exited two states given major losses.

It is not impossible to see a bipartisan stop-gap coming together in the Senate or even in the House. But the odds certainly are a bit long given GOP leadership’s general reticence for incrementalism and many conservatives’ opposition to anything that would prop up Obamacare. There are also other barriers to getting the right vehicle to the floor. But let’s hope wiser heads prevail in Congress and up Pennsylvania Avenue. For sure, the President can cause far-reaching, if not irreversible, damage if he acts to end subsidies in the interim.

Meanwhile, seven Democratic and six Republican Governors from diverse states came together with their own plan to fix the system. Proposals include: funding subsidies in 2017, continuing them in 2018, reintroducing the reinsurance fund that ended in 2016, and providing significant new flexibility through waivers for states to use dollars better to reduce the uninsured rates and improve coverage in their state Exchange and Medicaid programs.

States fight back on subsidies

Speaking of the subsidies, states won a major victory in a Washington, D.C. federal appeals court when they were granted status to intervene in the ongoing subsidy case. House Republicans filed the case against the Obama administration, arguing the subsidies were illegal as there is no appropriation. A lower federal court concurred. The Obama administration appealed but then left office. Trump and House Republicans put the case on hold, assuming a repeal and replace bill would pass, but it hasn’t. The administration still could pull back on the Appeal, but the 16 states (mostly Democratic controlled) could impact the future of the case, including any settlement or future actions.

The state’s attorneys general entered the suit late, but were prompted by – wait for it! – Trump’s own public statements, including Tweets, threatening to pull the funding. It is now the second time that courts have, in part, used the President’s own words to rule against him: the other time being the immigration ban.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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