By Philip Rucker and Robert Costa:
Sessions’s nomination is scheduled to be voted on Tuesday by the Senate Judiciary Committee, but his influence in the administration stretches far beyond the Justice Department. From immigration and health care to national security and trade, Sessions is the intellectual godfather of the president’s policies. His reach extends throughout the White House, with his aides and allies accelerating the president’s most dramatic moves, including the ban on refugees and citizens from seven mostly Muslim nations that has triggered fear around the globe.
The author of many of Trump’s executive orders is senior policy adviser Stephen Miller, a Sessions confidant who was mentored by him and who spent the weekend overseeing the government’s implementation of the refugee ban. The tactician turning Trump’s agenda into law is deputy chief of staff Rick Dearborn, Sessions’s longtime chief of staff in the Senate. The mastermind behind Trump’s incendiary brand of populism is chief strategist Stephen K. Bannon, who, as chairman of the Breitbart website, promoted Sessions for years.
In an email in response to a request from The Washington Post, Bannon described Sessions as “the clearinghouse for policy and philosophy” in Trump’s administration, saying he and the senator are at the center of Trump’s “pro-America movement” and the global nationalist phenomenon.
“In America and Europe, working people are reasserting their right to control their own destinies,” Bannon wrote. “Jeff Sessions has been at the forefront of this movement for years, developing populist nation-state policies that are supported by the vast and overwhelming majority of Americans, but are poorly understood by cosmopolitan elites in the media that live in a handful of our larger cities.”
The Full Story (January 30, 2017)
Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts
Friday, April 7, 2017
Friday, March 17, 2017
Washington Post: With Executive Order, Trump Tosses a ‘Bomb’ into Fragile Health Insurance Markets
By Juliet Eilperin and Sean Sullivan:
The political signal of the order, which Trump signed just hours after being sworn into office, was clear: Even before the Republican-led Congress acts to repeal the 2010 law, the new administration will move swiftly to unwind as many elements as it can on its own — elements that have changed how 20 million Americans get health coverage and what benefits insurers must offer some of their customers.
But the practical implications of Trump’s action on Friday are harder to decipher. Its language instructs all federal agencies to “waive, defer, grant exemptions from or delay” any part of the law that imposes a financial or regulatory burden on those affected by it. That would cover consumers, doctors, hospitals and other providers, as well as insurers and drug companies.
The prospect of what could flow from pulling back or eliminating administrative rules — including no longer enforcing the individual mandate, which requires Americans to get coverage or pay an annual penalty, and ending health plans’ “essential benefits” — could affect how many people sign up on the Affordable Care Act marketplaces before open enrollment ends Jan. 31 for 2017 coverage, as well as how many companies decide to participate next year.
Robert Laszewski, president of the consulting firm Health Policy and Strategy Associates, called the executive order a “bomb” lobbed into the law’s “already shaky” insurance market. Given the time it will take Republicans to fashion a replacement, he expects that federal and state insurance exchanges will continue to operate at least through 2018.
“Instead of sending a signal that there’s going to be an orderly transition, they’ve sent a signal that it’s going to be a disorderly transition,” said Laszewski, a longtime critic of the law, which is also known as Obamacare. “How does the Trump administration think this is not going to make the situation worse?” [emphasis added]
Tuesday, March 14, 2017
Washington Post: Trump Signs Executive Order That Could Effectively Gut Affordable Care Act’s Individual Mandate
By Ashley Parker and Amy Goldstein:
“Potentially the biggest effect of this order could be widespread waivers from the individual mandate, which would likely create chaos in the individual insurance market,” said Larry Levitt, senior vice president at the Kaiser Family Foundation. In addition, he said, the order suggests that insurers may have new flexibility on the benefits they must provide.
“This doesn’t grant any new powers to federal agencies, but it sends a clear signal that they should use whatever authority they have to scale back regulations and penalties. The Trump administration is looking to unwind the ACA, not necessarily waiting for Congress,” Levitt said.
The order, several paragraphs long, does not identify which of the many federal rules that exist under the ACA the new administration intends to rewrite or eliminate. In general, federal rules cannot be undone with a pen stroke but require a new rulemaking process to replace or delete them.
But in giving agencies permission to “waive, defer, grant exemptions from or delay” ACA rules, the order appears to create room for the Department of Health and Human Services to narrow or gut a set of medical benefits that the ACA compels insurers to include in health plans that they sell to individuals and small businesses.
The Full Story (January 21, 2017)
“Potentially the biggest effect of this order could be widespread waivers from the individual mandate, which would likely create chaos in the individual insurance market,” said Larry Levitt, senior vice president at the Kaiser Family Foundation. In addition, he said, the order suggests that insurers may have new flexibility on the benefits they must provide.
“This doesn’t grant any new powers to federal agencies, but it sends a clear signal that they should use whatever authority they have to scale back regulations and penalties. The Trump administration is looking to unwind the ACA, not necessarily waiting for Congress,” Levitt said.
The order, several paragraphs long, does not identify which of the many federal rules that exist under the ACA the new administration intends to rewrite or eliminate. In general, federal rules cannot be undone with a pen stroke but require a new rulemaking process to replace or delete them.
But in giving agencies permission to “waive, defer, grant exemptions from or delay” ACA rules, the order appears to create room for the Department of Health and Human Services to narrow or gut a set of medical benefits that the ACA compels insurers to include in health plans that they sell to individuals and small businesses.
The Full Story (January 21, 2017)
Thursday, February 16, 2017
Washington Post: Gun Silencers are Hard to Buy. Donald Trump Jr. and Silencer Makers Want to Change That.
By Michael S. Rosenwald:
The federal government has strictly limited the sale of firearm silencers for as long as James Bond and big-screen gangsters have used them to discreetly shoot enemies between the eyes.
Now the gun industry, which for decades has complained about the restrictions, is pursuing new legislation to make silencers easier to buy, and a key backer is Donald Trump Jr., an avid hunter and the oldest son of the president-elect, who campaigned as a friend of the gun industry.
The legislation stalled in Congress last year. But with Republicans in charge of the House and Senate and the elder Trump moving into the White House, gun rights advocates are excited about its prospects this year.
They hope to position the bill the same way this time — not as a Second Amendment issue, but as a public-health effort to safeguard the eardrums of the nation’s 55 million gun owners. They even named it the Hearing Protection Act. It would end treating silencers as the same category as machine guns and grenades, thus eliminating a $200 tax and a nine-month approval process.
“It’s about safety,” Trump Jr. explained in a September video interview with the founder of SilencerCo, a Utah silencer manufacturer. “It’s a health issue, frankly.”
The federal government has strictly limited the sale of firearm silencers for as long as James Bond and big-screen gangsters have used them to discreetly shoot enemies between the eyes.
Now the gun industry, which for decades has complained about the restrictions, is pursuing new legislation to make silencers easier to buy, and a key backer is Donald Trump Jr., an avid hunter and the oldest son of the president-elect, who campaigned as a friend of the gun industry.
The legislation stalled in Congress last year. But with Republicans in charge of the House and Senate and the elder Trump moving into the White House, gun rights advocates are excited about its prospects this year.
They hope to position the bill the same way this time — not as a Second Amendment issue, but as a public-health effort to safeguard the eardrums of the nation’s 55 million gun owners. They even named it the Hearing Protection Act. It would end treating silencers as the same category as machine guns and grenades, thus eliminating a $200 tax and a nine-month approval process.
“It’s about safety,” Trump Jr. explained in a September video interview with the founder of SilencerCo, a Utah silencer manufacturer. “It’s a health issue, frankly.”
Wednesday, February 15, 2017
Washington Post: Republicans Have no Clue How to Keep Their Promises on Obamacare
By the Post Editorial Board:
The ACA depends on private insurers participating in competitive state insurance marketplaces. Without government incentives, and with no reason to believe that their time and effort will pay off under a nebulous new policy down the road, insurers will not continue serving markets that are in any case set to disappear. To avoid a repeal-and-delay disaster, Republicans would have to pour money into Obamacare, a move they ardently opposed when the goal was fixing the program rather than tearing it down. Bottom line: Without a replacement plan passed and in place at the time of repeal, policy uncertainty will drive insurers to quit the markets and desert their patients.
Despite agitating for repeal for the past half-decade, Republicans have failed to unite around any Obamacare alternative, and they do not appear close now. Detailed proposals that have circulated among Republicans over the past several years would almost certainly result in a much skimpier system — covering fewer Americans and degrading the quality of coverage for low-income and sick people who manage to buy it.
Republicans are bumping into some awkward facts, where ideology cannot repeal basic logic. There is no health-care reform that will lower premiums, cut deductibles and increase choice all at the same time, despite President-elect Donald Trump’s rhetoric.
Moreover, an insurance-based health-care system requires pooling many people together so that premiums from healthy people offset the costs of treating the sick — and keep costs reasonable for everyone. Fiddling with regulations that compel people to buy insurance, allowing insurers more room to discriminate against older or sicker people, reducing benefits requirements — all of these could give insurers more opportunity to welcome healthy people and deter the sick, to the benefit of their pocketbooks but the detriment of society as a whole.
The Full Story (January 7, 2017)
The ACA depends on private insurers participating in competitive state insurance marketplaces. Without government incentives, and with no reason to believe that their time and effort will pay off under a nebulous new policy down the road, insurers will not continue serving markets that are in any case set to disappear. To avoid a repeal-and-delay disaster, Republicans would have to pour money into Obamacare, a move they ardently opposed when the goal was fixing the program rather than tearing it down. Bottom line: Without a replacement plan passed and in place at the time of repeal, policy uncertainty will drive insurers to quit the markets and desert their patients.
Despite agitating for repeal for the past half-decade, Republicans have failed to unite around any Obamacare alternative, and they do not appear close now. Detailed proposals that have circulated among Republicans over the past several years would almost certainly result in a much skimpier system — covering fewer Americans and degrading the quality of coverage for low-income and sick people who manage to buy it.
Republicans are bumping into some awkward facts, where ideology cannot repeal basic logic. There is no health-care reform that will lower premiums, cut deductibles and increase choice all at the same time, despite President-elect Donald Trump’s rhetoric.
Moreover, an insurance-based health-care system requires pooling many people together so that premiums from healthy people offset the costs of treating the sick — and keep costs reasonable for everyone. Fiddling with regulations that compel people to buy insurance, allowing insurers more room to discriminate against older or sicker people, reducing benefits requirements — all of these could give insurers more opportunity to welcome healthy people and deter the sick, to the benefit of their pocketbooks but the detriment of society as a whole.
The Full Story (January 7, 2017)
Tuesday, January 24, 2017
Tax Policy Center: Repealing the Affordable Care Act Would Cut Taxes For High Income Households, Raise Taxes For Many Others
By Howard Gleckman:
Repealing the Affordable Care Act would cut taxes significantly for the highest income one percent of US households, according to a new Tax Policy Center analysis. At the same time, it would raise taxes on average for low- and moderate-income households.
The ACA includes several different tax provisions. On one side of the ledger is the large refundable tax credit that subsidizes insurance premiums for many people who buy coverage on the ACA’s health exchange. On the other side: tax increases designed to both raise revenue and encourage the purchase of adequate—but not excessive--insurance. They include a penalty tax for individuals without adequate insurance, an excise tax on employers with 50 or more workers who offer insufficient coverage, and the so-called Cadillac tax on generous employer-sponsored health benefits. The law also created two extra taxes on high-income individuals--a 0.9 percent payroll surtax on earnings and a 3.8 percent tax on net investment income for individuals with incomes exceeding $200,000 ($250,000 for couples).
Overall, dumping all the ACA taxes would cut taxes by an average of $180 per household in 2017—a 0.3 increase in after-tax incomes. Of course, taxes are not the only measure of people’s well-being. A new analysis by the Urban Institute’s Health Policy Center estimates that eliminating the law without adopting a replacement could increase the number of people without insurance by more than 29 million, putting them at risk for out-of-pocket medical costs that would far exceed any tax savings.
Repealing the Affordable Care Act would cut taxes significantly for the highest income one percent of US households, according to a new Tax Policy Center analysis. At the same time, it would raise taxes on average for low- and moderate-income households.
The ACA includes several different tax provisions. On one side of the ledger is the large refundable tax credit that subsidizes insurance premiums for many people who buy coverage on the ACA’s health exchange. On the other side: tax increases designed to both raise revenue and encourage the purchase of adequate—but not excessive--insurance. They include a penalty tax for individuals without adequate insurance, an excise tax on employers with 50 or more workers who offer insufficient coverage, and the so-called Cadillac tax on generous employer-sponsored health benefits. The law also created two extra taxes on high-income individuals--a 0.9 percent payroll surtax on earnings and a 3.8 percent tax on net investment income for individuals with incomes exceeding $200,000 ($250,000 for couples).
Overall, dumping all the ACA taxes would cut taxes by an average of $180 per household in 2017—a 0.3 increase in after-tax incomes. Of course, taxes are not the only measure of people’s well-being. A new analysis by the Urban Institute’s Health Policy Center estimates that eliminating the law without adopting a replacement could increase the number of people without insurance by more than 29 million, putting them at risk for out-of-pocket medical costs that would far exceed any tax savings.
Tuesday, January 10, 2017
Talking Points Memo: Into the Obamacare Repeal Charnel House
By Josh Marshall:
Today I want to show you some hard, granular numbers on the human toll of what Republicans plan to prepare for President Trump's signature right out of the gate next month. Depending on how they go about it, we are talking about tens of millions of Americans who are about to lose their health insurance coverage. Some people might think that's a big deal. For the moment the main policy debate within the GOP is how to accomplish this and evade as much blame as possible.
* * *
Let's start with some toplines. The total number set to lose their coverage is a bit over 23 million Americans (23,134,000). Of those, 12,311,000 lose their Medicaid expansion-based coverage; 8,963,000 are exchange purchasers who benefit from significant federal subsidies; 1,390,000 are young adults under the age of 26 who are allowed to remain on their parents plans; a final 470,000 are basic health care plan enrollees in Minnesota and New York.
* * *
And here's something even more interesting, partial repeal turns out to be worse than full repeal. The Urban Institute has a new study showing something that seems paradoxical, but actually makes sense if you know the way the health insurance industry has integrated with and remade itself to operate with the ACA. Urban Institute's numbers of people who lose insurance is slightly lower than Gaba's numbers. They project 22.5 million as opposed to Gaba's 23.124. But if repeal is partial, they project an additional 7.3 million would lose their coverage. That brings the total to 29.8 million, close to 10 percent of the people in the entire country.
Why would partial repeal hurt more people than full repeal? Well, in this case partial repeal means repealing the money (the incentives) without the regulatory structure. In the words of the Urban Institute study: "The additional 7.3 million people become uninsured because of the near collapse of the nongroup insurance market." Basically you're leaving the regulations intact but removing the money that makes them possible. So everything goes haywire and you get a lot of collateral damage. Why would you do that? Simple. The rules of the Senate allow you to do that with 50 votes. It's politically easier to destroy care for an additional 7 million people.
The Full Story (December 7, 2016)
Today I want to show you some hard, granular numbers on the human toll of what Republicans plan to prepare for President Trump's signature right out of the gate next month. Depending on how they go about it, we are talking about tens of millions of Americans who are about to lose their health insurance coverage. Some people might think that's a big deal. For the moment the main policy debate within the GOP is how to accomplish this and evade as much blame as possible.
* * *
Let's start with some toplines. The total number set to lose their coverage is a bit over 23 million Americans (23,134,000). Of those, 12,311,000 lose their Medicaid expansion-based coverage; 8,963,000 are exchange purchasers who benefit from significant federal subsidies; 1,390,000 are young adults under the age of 26 who are allowed to remain on their parents plans; a final 470,000 are basic health care plan enrollees in Minnesota and New York.
* * *
And here's something even more interesting, partial repeal turns out to be worse than full repeal. The Urban Institute has a new study showing something that seems paradoxical, but actually makes sense if you know the way the health insurance industry has integrated with and remade itself to operate with the ACA. Urban Institute's numbers of people who lose insurance is slightly lower than Gaba's numbers. They project 22.5 million as opposed to Gaba's 23.124. But if repeal is partial, they project an additional 7.3 million would lose their coverage. That brings the total to 29.8 million, close to 10 percent of the people in the entire country.
Why would partial repeal hurt more people than full repeal? Well, in this case partial repeal means repealing the money (the incentives) without the regulatory structure. In the words of the Urban Institute study: "The additional 7.3 million people become uninsured because of the near collapse of the nongroup insurance market." Basically you're leaving the regulations intact but removing the money that makes them possible. So everything goes haywire and you get a lot of collateral damage. Why would you do that? Simple. The rules of the Senate allow you to do that with 50 votes. It's politically easier to destroy care for an additional 7 million people.
The Full Story (December 7, 2016)
Tuesday, January 3, 2017
Urban Institute: Implications of Partial Repeal of the ACA through Reconciliation
By Linda J. Blumberg, Matthew Buettgens, and John Holahan:
Congress is now considering partial repeal of the Affordable Care Act (ACA) through the budget reconciliation process. Since only components of the law with federal budget implications can be changed through reconciliation, this approach would permit elimination of the Medicaid expansion, the federal financial assistance for Marketplace coverage (premium tax credits and cost-sharing reductions), and the individual and employer mandates; it would leave the insurance market reforms (including the nongroup market’s guaranteed issue, prohibition on preexisting condition exclusions, modified community rating, essential health benefit requirements, and actuarial value standards) in place. There is currently no consensus around alternative health policies to enact as the ACA is repealed; consequently, partial repeal via reconciliation without replacement is possible and merits analysis.
In this brief, we compare future health care coverage and government health care spending under the ACA and under passage of a reconciliation bill similar to one vetoed in January 2016. The key effects of passage of the anticipated reconciliation bill are as follows:
- The number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent). The share of nonelderly people without insurance would increase from 11 percent to 21 percent, a higher rate of uninsurance than before the ACA because of the disruption to the nongroup insurance market.
Friday, December 23, 2016
Washington Post: Trump Turns to Conservative Tacticians to Run HHS and Medicare, Medicaid
By Amy Goldstein and Elise Viebeck:
President-elect Donald Trump’s choices for health secretary and administrator of the government’s largest health insurance programs have for years pursued a sharply conservative agenda that includes redefining Medicare, placing “personal responsibility” requirements on low-
income recipients of Medicaid, and dismantling the Affordable Care Act.
If adopted, this agenda could dramatically alter access to insurance and medical services for more than 100 million Americans covered through the two entitlement programs and the ACA.
Trump has nominated Rep. Tom Price (R-Ga.) to lead the Department of Health and Human Services and health consultant Seema Verma to run the HHS agency that oversees Medicare and Medicaid. The two are master tacticians of the right-leaning health-care vision Trump adopted as central campaign themes.
The Full Story (November 29, 2016)
President-elect Donald Trump’s choices for health secretary and administrator of the government’s largest health insurance programs have for years pursued a sharply conservative agenda that includes redefining Medicare, placing “personal responsibility” requirements on low-
income recipients of Medicaid, and dismantling the Affordable Care Act.
If adopted, this agenda could dramatically alter access to insurance and medical services for more than 100 million Americans covered through the two entitlement programs and the ACA.
Trump has nominated Rep. Tom Price (R-Ga.) to lead the Department of Health and Human Services and health consultant Seema Verma to run the HHS agency that oversees Medicare and Medicaid. The two are master tacticians of the right-leaning health-care vision Trump adopted as central campaign themes.
The Full Story (November 29, 2016)
Thursday, December 22, 2016
New York Times: Tom Price, Obamacare Critic, Is Trump’s Choice for Health Secretary
From his days as a Georgia state senator, Mr. Price, now 62, has been a voice for doctors, often aligned with the positions of the American Medical Association and the Medical Association of Georgia.
He has introduced legislation that would make it easier for doctors to defend themselves against medical malpractice lawsuits and to enter into private contracts with Medicare beneficiaries. Under such contracts, doctors can, in effect, opt out of Medicare and charge more than the amounts normally allowed by the program’s rules.
He also supported legislation to bar federal funds for Planned Parenthood, saying some of its clinics had been involved in what he called “barbaric” abortion practices.
Cecile Richards, the president of the Planned Parenthood Federation of America, said that Mr. Price “poses a grave threat to women’s health” and that as health secretary he “could take women back decades.” If he had his way, she said, “millions of women could be cut off from Planned Parenthood’s preventive health services,” could lose access to free birth control under the Affordable Care Act and could again be charged more than men for the same health insurance.
The Full Story (November 28, 2016)
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