Healthcare

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This is a collaborative knowledge base; feel free to propose edits/additions that you believe are important for others to know. Contributions will be reviewed and approved based on quality and accuracy.

How You Can Resist
How You Can Resist

  • Call your member of Congress by dialing tel:844-6-RESIST and tell them to strengthen the Affordable Care Act.
  • Find out when your Senators and US Representative are holding town halls and other Upcoming Events/Opportunities. Show up and tell them to strengthen the Affordable Care Act.
  • Click here to find an organization looking for volunteers.

Updates
Recent Updates

  • 4/20/2017: Moderates and hardline conservatives, who have disagreed on AHCA since it was introduced, have found middle ground through the addition of the MacArthur Amendment. This amendment will reinstate Essential Health Benefits as the federal standard and maintain many provisions of the AHCA, such as prohibitions on discrimination based on gender and pre-existing conditions. The amendment also allows states to obtain limited waivers for Essential Health Benefits and Community Rating Rules. States must be able to prove that the purpose of the waiver is to reduce premium cost, increase health coverage or advance another benefit of health coverage. [1]
  • 4/14/2017: The Trump Administration has threatened to withhold $7 billion in cost sharing subsidies from insurers, if Democrats refuse to join healthcare talks. Democrats have promised to torpedo any bill that doesn't allocate this money as mandatory spending. [2]
  • 4/13/2017: The Trump Administration released a rule on Thursday aimed at keeping insurers in the ObamaCare marketplace. It's a sign that the Trump administration will try to keep the marketplace stable while Congress works on repealing and replacing the healthcare law. Critics have said that it wil ake it harder for any people to get insurance [3]
  • 4/12/2017: House Freedom Caucus Chairman Marl Meadows has suggested the possibility of Congress cutting their recess short to vote on an Obamacare repeal. Speaker Ryan has reportedly not ruled it out. [4]
  • 4/12/2017: President Donald Trump says he still wants Congress to pass a health care bill before turning to tax reform - an apparent reversal from last month, when he said he was ready to move on to overhauling the nation's tax code after the repeal bill collapsed. [5]
  • 4/11/2017:President Trump is set to nominate 3rd Term Congressman Tom Marino (R-PA) to the Office of National Drug Control Policy, as the nation's unofficial Drug Czar. [6]

Impact of Trumpcare Part Two
Impact of Trumpcare Part Two

Threats to the ACA
Additional Threats to the ACA by the GOP

Health and Human Services Policy and Rule Changes

Changes to Look Out For

Essential Health Benefits

  • An ACA statute lays out 10 essential health benefits that are required of each insurance plan. It is up to the Health Secretary to design how it's implemented.
    • The Obama administration largely let states decide what those essential benefits would be, but current Secretary Price could make those decisions at the federal level, requiring insurers to cover fewer services.[7]

Threats to Marketplaces

  • The Health Secretary could drop a court case [8] (U.S. House of Representatives v. Burwell, 2016)left over from the Obama administration, a move that would cut some subsidies to more than half of marketplace enrollees. [9]
  • The Health Secretary could also loosen a mandate requiring most people to have coverage or pay a penalty at tax time. [10]. The administration is pretty free to exempt large groups of people from the individual mandate via "hardship exemptions."
    • More people under these circumstances could be approved for hardships or fewer. If the administration approves more waivers, it could reduce the number of people in the marketplaces. Because of this, healthy people may start to leave in larger numbers, thus creating high-risk pools, which creates more costly coverage causing more people to drop out. [11]

Threats to Medicaid Rules

  • The Trump appointed CMS (Centers for Medicare and Medicaid Services) Administrator, Seema Verma, has the power to oversee the shape and structure of state run Medicaid programs.[12]
    • The CMS has shown some willingness to approve non-traditional programs that implement a work requirement for Medicaid benefits. Such action would kick out the low-income able bodied adults who benefit from Medicaid expansion and disqualify those same adults seeking coverage from Medicaid expansion.[13]
    • Many adults who seek out Medicaid have a disability, a felony conviction or caregiver responsibilities. A work rquirement would make Medicare a weaker safety net.[14]
  • Other potential waiver provisions could reduce Medicaid coverage and benefits including:
    • requiring premiums and health-savings account contributions, moving more people to privately managed plans, and cutting benefits like the provision of medical transportation for enrollees.[15]

Enacted Rule Changes

Market Stabilization Rule [16] [17]

  • Gives insurers more flexibility in determining the "actuarial value" of their coverage.
  • Open enrollment for next year has been shortened to six weeks, instead of three months as in previous years. (Nov. 1 to Dec. 15).
    • People who try to sign up outside of the regular enrollment season will have to prove their eligibility.
    • People who owe premiums from previous years will have to pay them before they can sign up for new coverage.
  • States will be able to determine whether insurers have enough health care providers in their networks

Pulling Obamacare ads

  • HHS and the Trump administration quickly pulled advertisements promoting Obamacare enrollment, ads that had been effective in previous years at getting young adults to sign up for coverage. [18]
    • It’s hard to say what effect that lower-than-expected enrollment will have on premiums directly, but the bigger problem could be the uncertainty it has created for insurers as they draft plans and premiums for next year.[19]
    • Any time there’s uncertainty, insurers will increase premiums more. [20]


Acts of Congress

  • The United States Congress can and has create(d) legislation that will take small bites out of the ACA. The most notable was the delay of the Cadillac tax and reducing money allocated to the Prevention and Public Health Fund. [21]
    • Such smaller changes can produce drastic downstream effects.

Impacts of the ACA

Insurance Coverage by Congressional District

Preexisting Conditions by Congressional District

Benefits of the ACA

  • About 20 million people gained insurance.[22]
    • largely the result of expanding Medicaid, the federal insurance program for people with low incomes. there’s short term threats to Medicaid if it is left as is.[23]
  • The uninsured population of the US went from 16% in 2010 to 9% in 2015.[24][25]
  • 15.7 million people gained access to Medicaid.[26]

Criticisms of the ACA

  • The law mandates that all Americans have health care. If you do not, you pay a tax penalty. Some see this as a curtailment on individual liberties. The reasoning is that if only sick people buy health insurance, premiums (how much you pay for coverage) will skyrocket, as insurance companies try to make enough money to pay everyone's health care bills. If everyone, including healthy people, buys insurance, premiums will be more stable.[27]
  • The federal government is funding the Medicaid expansion for those newly eligible for coverage until 2020. After 2020, the federal government will only pay 90%, so states will be responsible for the rest.[28] There is still a significant coverage gap for people who can't receive Medicaid (see above) or exchange subsidies.
  • For many people who buy insurance on the exchanges, deductibles (the amount you have to pay yourself for your coverage before your insurance company starts paying) has increased significantly.[29][30]
  • Because of the new requirements on insurance companies, some insurance companies canceled plans that did not comply with the law, forcing people to buy plans over the exchanges.[31] Some workplaces also stopped providing insurance to their employees.
  • Some say that the law discourages healthy people from purchasing health care, which increases premiums for those who do have health care—because they are less healthy, so insurance companies must charge more so they can make sure they can cover everyone.[32][33] Premiums have definitely increased, but not for most people purchasing through the exchanges, since subsidies have also increased.[34]
  • Many large insurers are beginning to stop offering health insurance plans over the exchanges. This limits choices for people who must buy insurance over the exchanges.[35][36]
    • While there were concerns in previous years that some counties would be left without an insurer, it hasn’t yet happened. Some exchanges under duress in several states like Tennessee, where 16 counties don’t have any insurers lined up to sell on the marketplaces for 2018. The fate of the markets in those counties and a few other states depends on what Republicans in Congress do next.[37]
  • Trump has said that the ACA is "exploding," meaning mostly that premium costs are going to rapidly increase, leading to a "death spiral," in which healthy people prefer to pay the penalty rather than pay for health care. This would make premiums increase even more, making more people opt out. This has not started to happen so far, and there is no good evidence that it will.[38]
  • Some say the law does not go far enough. Millions of Americans still do not have health care, and health care purchased through the exchanges is often too expensive or does not provide high quality care. Health care is still very corporate in the US, with businesses (insurance companies) making too many health care decisions for people.[39]

Affordable Care Act

The Patient Protection and Affordable Care Act[40], usually called the Affordable Care Act or Obamacare (they are the exact same thing), is a law passed in 2010 and signed by President Obama to increase access to health care in the US. The law includes three major parts: 1) new regulations on private insurance companies that apply to employer-provided health care plans 2) a Medicaid expansion, which gave millions more people access to free government health care and 3) state health-care exchanges, which let people buy their own health insurance.[41][42][43]

People Receiving Healthcare from Employers

The law also changed some of the ways insurance companies operate. Insurance companies are no longer allowed to refuse to cover people or charge them more if they have "preexisting conditions," meaning that if you have diabetes, for example, an insurance company cannot refuse to give you insurance for only that reason.[44] Insurance companies also cannot have annual or lifetime limits on coverage, meaning they may not stop covering someone once a certain dollar limit had been reached.[45] Premiums—how much people pay for insurance—is now much more even, as insurance companies cannot increase the price for people who will have more expensive health care needs.[46]

People Receiving Healthcare from Medicaid/Medicare

The law increased Medicaid eligibility to those who earn 138% of the federal poverty limit.[47] 15.7 million people gained Medicaid under the ACA.[48] As of September, though, 19 states had not actually expanded Medicaid in their states, so not everyone who is eligible under the ACA actually has Medicaid. Such people are also not eligible for subsidies through the exchanges, because they are supposed to have Medicaid, so they are actually left without health care, in a "coverage gap."[49]

People Purchasing Healthcare Privately

Through the exchanges, which are organized by state, people who do not have another source of health care (through work, Medicare, or Medicaid, usually) can buy health care.[50] Subsidies are available to people earning less than 400% of the federal poverty level, lowering the amount they have to pay.[51]

CHIP

Children's Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.[52]

For more information about eligibility and applying for CHIP, please follow the link.

The State of Public Health

National Institutes of Health

  • The Trump Administration has proposed a 1.6 billion cut to the NIH including [53]:
    • Take $350 million from the National Science Foundation's budget
    • Cut $37 million from the Department of Energy's budget which allocates to significant science programs
    • Cut $48 million from the Environmental Protection Agency's research and development budget.
    • Cut in half the $101 million Teen Pregnancy Prevention program
    • Reduce Food and Drug Administration staff spending by $40 million
    • Cut domestic and global HIV/AIDS programs by $100 million
      • And cut the Presidential Emergency Program for AIDS Relief (PEPFAR) by $242 million
    • Completely delete the $72 million Global Health Security fund at the State Department and cut other global health programs by $90 million and $62 million for global family planning

Rural Communities

  • The Trump Administration has altered the timetable for some visa applications through the use of the travel ban. As it is being challenged in court the decision will likely to delay the arrival of new foreign doctors.[54]
    • The U.S. Citizenship and Immigration Services has temporarily suspended “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months. [55]
    • This has and will slow the flow of foreign doctors who need to fill a need in a short time period. This is starting to have huge effects on rural communities who may depend on foreign doctors to provide treatment. [56]