The Health 202: Democrats are no longer touting the benefits of Obamacare

THE PROGNOSIS

Senate Minority Leader Chuck Schumer (D-N.Y.) (Photo by Alex Wong/Getty Images)

Congress’s official scorekeeper says Obamacare premiums will rise more slowly next year and the marketplaces will be stable in most parts of the country. But don’t expect Republicans -- or surprisingly, even Democrats -- to be doing any wild cheering.

In a dramatic shift that still leaves my head spinning, Affordable Care Act plans have lost their most ardent political defenders, as Democrats have switched from downplaying premium hikes to advertising them as the GOP's fault. And Republicans are now reticent to talk about the law at all, aware they reneged on their longstanding promises to fully repeal it.

There are still some rough times ahead for the marketplaces, partly due to Republican actions that are driving up premiums even more than they'd otherwise rise. There are also some faint signs that the marketplace situation is somewhat improving. But it's unlikely either Democrats or Republicas will be talking about the bright spots.

Yesterday morning, top officials with Blue Cross Blue Shield Association — whose insurers have the strongest presence in the ACA marketplaces — told reporters that rate hikes in 2019 should be somewhat lower than in years past. Hours later, the Congressional Budget Office offered a similar analysis, projecting the average premium for a mid-level marketplace plan will increase by about 15 percent next year, compared to an average 34 percent increase this year. The CBO expects premiums for those covered by Obamacare to increase an average of 7 percent annually between 2019 and 2028.

Top Senate Democrat Chuck Schumer reacted swiftly — but it wasn’t to applaud the slower rate increases. Instead, he said the CBO report confirms “the Trump-GOP sabotage of our health-care system is causing premiums to rise for millions of Americans — period.”

Until Donald Trump was elected president 18 months ago, Democrats were quick to defend ACA insurance plans, praising their broad coverage and noting the wide availability of subsidies to lower costs for American seeking access to health coverage. When news of big rate hikes hit over the past few years, Democrats mostly turned a blind eye, wary of criticizing President Barack Obama’s signature domestic initiative.

But no longer.

The reality is Republicans leading both chambers of Congress and the White House have acted in ways that could trigger the rise of premiums. They’ve repealed the law’s individual mandate, paving the way for healthier people to leave the marketplaces and leave sicker, more expensive patients behind. They’re working to expand leaner plans exempt from ACA coverage requirements. And they haven’t found a way to pay extra subsidies in order to defray extra plan costs for the lowest-income customers.

It's also true ACA marketplace problems existed before the GOP took power. Premium increases were so large in 2016 that many Democrats were forced to admit that some changes to the ACA were needed.

Now Democrats seem to have wholly and enthusiastically assumed the Obamacare gloom-and-doom mantle, jumping on any chances to spread negative marketplace news far and wide. They’re the ones, not Republicans, seeking to leverage the law to their advantage in the upcoming midterm elections, which will take place five days into the 2019 open enrollment season.

Yesterday, the Democratic Senatorial Campaign Committee blasted out its latest news release on what it’s terming “sabotage” by Republicans on health care. And Sen. Chris Murphy (D-Conn.) took to the Senate floor to rail against how Republicans have been approaching ACA coverage.

“Starting in January of 2017…the president, and often with the help of this Republican Congress, has engaged in a very deliberate, very purposeful campaign of sabotage to the American health-care system,” Murphy said.

Pedro Rojas holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act on February 5, 2015, in Miami. (Joe Raedle/Getty Images)

Undergirding the political messaging wars, four states have announced marketplace insurers’ initial proposed rates for the 2019 enrollment period. Average hikes range from 9 percent in Vermont to 29 percent in Virginia, according to an analysis by Charles Gaba on his website ACAsignups.net. Requests span a broad range, especially in Virginia, where CareFirst is seeking a 27 percent rate hike for its HMO plans but a 64 percent hike for its PPO plans.

“There is no average, but I think if you were to come up with an average it would be in the low teens nationwide,” Kris Haltmeyer, Blue Cross Blue Shield Association’s vice president of legislative and regulatory policy, told reporters yesterday.

There’s actually evidence that marketplace plans are regaining some profitability. Their medical loss ratios, which is the share of premiums paid out as claims, have recently started to improve and their gross margins per member are also rising, according to an analysis last week from the Kaiser Family Foundation.

But, similar to lawmakers, BCBSA officials played down signs of improvement, saying things still look deeply uncertain for their members. “Even though plans may be making a profit, that’s modest,” said Justine Handelman, senior vice president of the association’s policy office. “In most cases, about 1 to 2 percent is what you see on average across the plans.”

They’re dividing the blame for premium hikes between the high medical costs of marketplace customers, which have been a problem from the beginning, and congressional Republicans’ move to repeal the individual mandate to buy health insurance. Haltmeyer said he’s “very concerned” the Trump administration “doesn’t do anything to destabilize the market as we go toward this next enrollment period.”

“We really want to ensure there aren’t any other destabilizing changes as we go toward the next open enrollment,” Haltmeyer added.

The Blues officials said they feel the administration has made a few positive moves to assist marketplace enrollment, such as making it easier for individual insurers and brokers to directly enroll people in coverage.

But there are a slew of other actions that deeply frustrate them, most prominently the failure of Congress to reimburse insurers for the extra cost-sharing discounts or fund a reinsurance pool that helps protect insurers against heavy losses.

Since those initiatives appear dead in Congress — at least for now — Haltmeyer and Handelman said they’re hopeful states will step in and create their own reinsurance pools. So far, Alaska, Oregon and Minnesota have obtained permission from the federal government to pay for the highest-cost customers with reinsurance pools, and another three states — Oklahoma, Wisconsin and Maryland — have passed similar legislation.

“We want to see a stable market where we can make sure everyone has access to coverage, and that’s why we think it’s so important at this juncture for states to take control back,” Handelman said.

You are reading The Health 202, our must-read newsletter on health policy.

Not a regular subscriber?

AHH, OOF and OUCH

Trump boards Air Force One on Wednesday in Andrews Air Force Base, Md. (AP Photo/Evan Vucci)

AHH: Yesterday the Senate gave overwhelming approval to a massive bill expanding access for veterans to visit private doctors, sending President Trump a victory that helps cement one of his biggest campaign promises, The Post's Lisa Rein reports. The VA Mission Act, which cleared the Senate by a vote of 92 to 5 and the House by a wide margin last week, is expected to reach the president’s desk as soon as Memorial Day.

"The $55 billion package makes a five-year commitment to addressing shortcomings in the country’s largest health system, which still struggles with delays after a 2014 scandal in which VA employees were found to have fudged patient wait lists," Lisa writes. About one-third of veterans in the system now see outside doctors through a program called “Choice," but the program is fragmented and unwieldy. Doctors have complained of slow or nonexistent payments, and veterans say there’s insurmountable red tape.

"The Congressional Budget Office estimates that as a result of the VA Mission Act, an additional 640,000 veterans each year would go outside the system," Lisa writes. "The bill would require VA for the first time to negotiate a contract for veterans to seek care at private walk-in clinics, a shift now being tested in Arizona as part of a pilot program with the drugstore chain CVS."

Chief executive of USA Gymnastics Kerry Perry and CEO of USA Swimming Tim Hinchey are sworn in during a House Energy and Commerce Oversight and Investigations Subcommittee hearing on Wednesday.(JIM WATSON/AFP/Getty Images)

OOF: USA Gymnastics chief executive Kerry Perry told a House Energy and Commerce subcommittee yesterday she was “appalled and sickened by the despicable crimes of Larry Nassar” and apologized to his hundreds of victims, breaking nearly six months of silence on the issue, The Post's Liz Clarke reports.

Lawmakers used the hearing to question leaders of several leading U.S. Olympic sport organizations about their ability to protect athletes from sexual abuse. Nassar, 54, is serving an effective life sentence in prison after pleading guilty to assaulting nine girls and women in Michigan, as well as to federal child pornography crimes. Perry apologized to Nassar’s victims and vowed, “Those days are over.”

Perry took over USA Gymnastics after CEO Steve Penny resigned in March 2017, months after the initial reports of Nassar’s crimes. “In the days after Nassar’s  January sentencing hearing, the entire board of USA Gymnastics resigned after threats from the USOC to decertify the organization,” Liz notes. “A week later, after two U.S. senators called for his job, Scott Blackmun resigned after eight years as CEO of the USOC.”

(iStock)

OUCH: Here’s a stunning story from the latest in Vox's series about emergency-room billing: A man was beaten unconscious, woke up in an emergency room, checked to determine the hospital was in his health plan's network, and still ended up with a more than $7,000 bill. “I was on my iPhone lying there with a broken jaw, and I go on the Humana website and see the hospital listed,” 34-year-old Scott Kohan told Sarah Kliff. “So I figured, okay, I should be good.”

“Except he wasn’t,” Sarah writes. “While the emergency room where Kohan was seen was in his insurance network, the oral surgeon who worked in that ER was not. That’s how Kohan ended up with a $7,924 bill from the oral surgeon that his health plan declined.” When Kohan saw the bill, he called his insurance plan, which told him it was probably a clerical error and that he would just need to resubmit the claim. The resubmitted claim was denied, and the process upped the bill by $2,300.

Vox has collected more than 1,300 ER bills from readers, finding such “surprise” medical bills are quite common in emergency rooms. “The dominant storyline to emerge is what anyone who has visited an emergency room might expect: Treatment is expensive. Fees have risen sharply in the past decade. And when health insurance plans don’t pay, patients are left with burdensome bills,” Sarah writes.

AGENCY ALERT

FDA Commissioner Scott Gottlieb testifies on Capitol Hill. (AP Photo/J. Scott Applewhite)

— It's too hard for cheaper drugs known as biosimilars to get covered by insurance plans, FDA Commissioner Scott Gottlieb said yesterday at an event hosted by the Atlantic. Gottlieb warned the situation could discourage drugmakers from developing these less-expensive versions of high-cost specialty drugs, noting that few biosimilars have made it to market in recent years.

“Because the market is hard for a biosimilar to penetrate, I worry that companies are going to pull out and not develop new biosimilars,” he said.

Who's to blame? Rebate agreements between insurance plans and pharmaceutical companies, Gottlieb said. Insurers and pharmaceutical benefit managers typically want to cover drugs with higher list prices because they get a cut of the price in a rebate. The lower the list price, the smaller their rebate.

“If the health plan takes up your biosimilar then they lose all those rebates,” Gottlieb said. “Now you have to discount your biosimilar to a point where you offset the loss of the rebates to the health plan.”

OPIOID OPTICS

An addiction recovery sign stands beside a road in LaFollette, Tenn. (AP Photo/David Goldman)

— The use of involuntary commitment for drug addiction is on the rise in some states -- and lawmakers want to strengthen or establish laws that will help compel more people to seek treatment, the Associated Press reports. There are at least 35 states with measures that allow families or medical professionals to petition a judge to order someone into drug treatment if the individual could harm themselves or others, Philip Marcelo writes.

But critics of involuntary commitment, which include doctors and law enforcement officials, warn it could increase the risk of overdose for those who relapse. “Expanding civil commitment laws, critics argue, could also violate due process rights, overwhelm emergency rooms and confine people in prisonlike environments, where treatment sometimes amounts to little more than forced detox without medications to help mitigate withdrawal symptoms,” Philip writes. Researchers say there haven't been enough studies on whether such forced treatment is effective.

Even without state action, involuntary commitment for drug addiction is being used more often, the AP found. In Florida, there were more than 10,000 requests for commitment in 2016 and 2015, up from 4,000 in 2000. In Massachusetts, there were more than 6,000 forced commitments in 2016 and 2017, up from less than 3,000 in 2006. In Kentucky, there were 200 involuntary commitment orders last year, up from just five orders in 2004.

INDUSTRY RX

FDA campus in Silver Spring, Md. (AP Photo/Andrew Harnik, File)

— Drugmakers now coming under fire for potentially blocking generic competition have increased prices by double-digit percentages since 2012, a new Kaiser Health News analysis has found. These drugmakers cost Medicare and Medicaid nearly $12 billion in 2016.

The FDA recently released a public list of pharmaceutical companies accused of prohibiting generic companies from buying the drug samples needed to develop equivalent, generic medicines. KHN examined the drug companies listed by the FDA as delaying cheaper competitors and found they've raised prices and cost taxpayers more money over time.

“The FDA listed more than 50 drugs whose manufacturers have withheld or refused to sell samples, and cited 164 inquiries for help obtaining them,” KHN's Sydney Lupkin reports. “Indeed, a KHN analysis found that 47 of the drugs cost Medicare and Medicaid almost $12 billion in 2016.”

— A few more good reads from The Post and beyond:

MEDICAL MISSIVES

STATE SCAN

REPRODUCTIVE WARS

DAYBOOK

Today

• The Senate Finance Committee holds a hearing on rural health care.

Coming Up

• The Brookings Institution holds an event on medical marijuana in the United States on May 29.

SUGAR RUSH

Nicole Ellis explains the step by step process of egg freezing in episode five of The Post's original documentary series: "Should I freeze my eggs?:

Sen. Amy Klobuchar (D-Minn.) says the workplace harassment bill she introduced with Sen. Roy Blunt (R-Mo.) will change Senate culture:

From the Fact Checker: Has Trump talked to the media more than Obama?

Let's block ads! (Why?)

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/05/24/the-health-202-democrats-are-no-longer-touting-the-benefits-of-obamacare/5b058cd31b326b492dd07e53/