Senate panel divided on length of Obamacare stabilization funding, state flexibility


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Senate panel divided on length of Obamacare stabilization funding, state flexibility  A handful of governors urged U.S. senators on Thursday to help Obamacare customers by injecting billions of dollars in federal funding into the market, but were divided over the longevity of such support and how much authority states should have in crafting their own healthcare plans. They stressed from the outset of a Health, Education, Labor and Pensions Committee hearing that they believed it was necessary for Congress to appropriate cost-sharing reduction subsidies. Utah Gov. Gary Herbert, a Republican, said he wasn’t a fan of the CSR payments but that insurers needed predictability. Montana Gov. Steve Bullock, a Democrat, called for three years of funding for the subsidies, even though HELP Committee Chairman Sen. Lamar Alexander, R-Tenn., has called for one year and Democrats who are willing to appropriate the funds have called for two. Additional divisions emerged over whether governors felt Obamacare created too many restrictions for states, and whether a stabilization package should address them. A proposal that has been pushed by Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, and Dean Heller of Nevada would take roughly $500 billion in revenue from Obamacare and hand it to states to craft their own plans. While some Republicans have suggested it may be a vehicle for seeking again to undo portions of Obamacare, Cassidy raised it during the hearing Thursday to gauge how governors felt about it. Massachusetts Gov. Charlie Baker, a centrist Republican, said he would not support such a proposal, saying that it would hurt Medicaid and cut money from states. He did, however, say that he would like states to have more flexibility when it came to benefits that health insurance companies are required to provide in their plans. “We support essential health benefits, but it’s a challenge to stay within strict federal standards,” he said. He also supported allowing states to come up with their own ways for nudging people to get health insurance, including through letting states decide whether to enact an auto-enrollment plan that would place people into catastrophic plans paid for through tax credits. Herbert noted his state of Utah was different from Massachusetts and had younger residents, and urged senators to allow states to lead on healthcare. “Give us that opportunity and we will solve much more efficiently and effectively,” he said.

Repeal or suspension of health insurance tax will not make it into the stabilization package Alexander has stressed the need to focus on a bill that would have narrow provisions, and said during Thursday’s hearing that it was unlikely the committee would look to repeal the health insurance tax, because they had limited time to make up the revenue elsewhere. Suspending or repealing the provision has been a major lobbying effort for insurers or small businesses, who say that it could reduce premiums by as much as five percent. “There’s no way we come up with $145 billion in 10 days,” Alexander said.

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Some Republicans plot last-minute push for Obamacare repeal Key Republican senators plan to reveal an update of their Obamacare repeal bill on Monday in the hopes of getting a vote on it by the end of the month. Republican Sens. Bill Cassidy of Louisiana, Lindsey Graham of South Carolina, and Dean Heller of Nevada are proposing to block grant all federal healthcare dollars for the Medicaid expansion to states, along with funds equalling the value of Obamacare tax credits. The proposal has emerged as the only Obamacare repeal bill left standing after the Senate narrowly voted down a “skinny” repeal bill in late July. Cassidy said the senators hope to reveal a new version of the bill on Monday and then send it to be scored by the nonpartisan Congressional Budget Office in hopes of getting a score that would allow for a vote by the end of the month, when the current fiscal year ends and the reconciliation language allowing Republicans to pass a bill with 51 votes expires.

But Trump appears ready to move on from healthcare President Trump criticized congressional Republicans on Friday for failing to rescind Obamacare even though the GOP controls the Senate, and urged them to move quickly on tax reform now that the debt ceiling issue has been put on hold. Republicans, sorry, but I’ve been hearing about Repeal & Replace for 7 years, didn’t happen! Even worse, the Senate Filibuster Rule will….” Trump tweeted Friday morning. “…never allow the Republicans to pass even great legislation. 8 Dems control – will rarely get 60 (vs. 51) votes. It is a Repub Death Wish! “Republicans must start the Tax Reform/Tax Cut legislation ASAP. Don’t wait until the end of September. Needed now more than ever. Hurry!,” he wrote.

Hatch, Wyden signal long Senate reauthorization for child insurance program Sen. Orrin Hatch, R-Utah, told reporters he would be in favor of extending the Children’s Health Insurance Program for five years in a move sure to please Democrats and program supporters. The statement came after a hearing of the Senate Finance Committee, which Hatch chairs, on the fate of CHIP, which needs to be reauthorized by the end of this month. Several witnesses at the hearing said that the program should to be reauthorized for five years to provide more certainty for families and states. “It’s my bill, so sure. I have no problem with that,” Hatch told reporters in response to a question of whether he was open to a five-year reauthorization. Senate Finance Committee Ranking Member Ron Wyden, D-Ore., said that he wanted to get the “longest possible extension and the most generous funding possible.” The federal government is projected to spend $17.4 billion for CHIP for federal fiscal year 2018, which starts on Oct. 1. Wyden neglected to say if he only wanted a five-year extension, which was a recommendation from MACPAC. “I am gonna talk to a chairman about it,” he said.  Experts at the Senate Finance hearing urged for a longer reauthorization period beyond just two years. “It dampens innovation and probably limits state investment when the future is so uncertain,” said Linda Nablo, chief deputy director for Virginia’s Department of Medical Assistance Services.

New documents trigger questions about special treatment for Congress under Obamacare An influential Obamacare opponent who was the architect of a Supreme Court challenge that threatened to unravel the law is raising questions over whether the District of Columbia’s health exchange looked the other way so that employees of Congress and others could illegally enroll in a program meant to cover small businesses. Michael Cannon, the director of health policy studies at the libertarian Cato Institute, said that his latest findings indicate cause for a Department of Justice investigation that he believes could lead to criminal charges. The root of his argument, alongside John Malcolm, a legal expert at the conservative Heritage Foundation and former deputy assistant attorney general in the Department of Justice’s Criminal Division, rests on documents Cato and the conservative Judicial Watch obtained under the Freedom of Information Act. Cannon and Malcolm wrote about their concerns in a Washington Examiner opinion piece published Tuesday. One of the documents is a letter from official at the D.C. Health Benefit Exchange Authority saying that no one was denied coverage through the district’s small business exchange, even though it was possible to fill out incorrect information. This raises questions, Cannon said, about whether anyone has improperly received coverage. Nicholas Bagley, an administrative law expert and professor at the University of Michigan School of Law who is sympathetic to Obamacare, has been critical of Cannon and Malcolm’s argument. Bagley said he didn’t think that the case would go anywhere. “The Justice Department has enough on its plate investigating cases where there’s hard evidence that a crime occurred,” he said. “It shouldn’t – and won’t – devote its resources to investigating the hypothetical possibility that someone, somewhere might have received federal benefits they weren’t entitled to.”

Kasich, Hickenlooper defend state flexibility on Obamacare Ohio Gov. John Kasich on Friday said that some of the essential health benefits that had been set up under Obamacare were too limiting to customers, proposing that someone have the option to buy a plan that excludes maternity coverage while explaining his decision to mandate autism coverage in his state. Kasich, a Republican, was appearing in a panel in Washington alongside Colorado Gov. John Hickenlooper, a Democrat with whom he has been working on an Obamacare stabilization plan to lower the costs of premiums and give customers more choices for health insurance plans. Kasich cited the example of a healthy 23-year-old patient, whom he said might want the opportunity to purchase coverage that excludes maternity care, in favor of a catastrophic plan that boosts health savings accounts.  “Why do you have to give them maternity coverage if they don’t want it?” he asked in a discussion hosted by the conservative American Enterprise Institute and the liberal Center for American Progress.  “What I’m suggesting is you get choice,” he said later during the panel. “But there has to be some sense of the core benefits.”  He later pointed to his signature on a bill in Ohio that mandated private health insurance cover the screening, diagnosis and treatment of autism spectrum disorder, saying he believed it was necessary. He also raised the possibility of allowing states in future years to move healthy people who make between 100 and 138 percent of the federal poverty level from Medicaid into private health insurance coverage. Hickenlooper cited the individual mandate as another example where states could have more flexibility, as long as they have some other mechanism for encouraging young and healthy people to sign up for coverage, and proposed that waivers be approved faster.  

Virginia left with empty Obamacare counties More than 70,000 Virginians are facing the prospect of having no insurer that will offer them Obamacare coverage for next year. The news surfaced after roughly two weeks had passed showing every U.S. county in the country had at least one health insurer selling Obamacare plans. Insurer Optima Health, which said in August that it would offer coverage in every nearly county in Virginia, reversed its decision on Thursday. The company announced that, rather than expand, it instead would reduce participation from the 35 counties it offered plans in this year. Optima will keep the Hampton Roads and Harrisonburg markets and enter the Charlottesville area, Halifax County, and Mecklenburg County. The move leaves 63 Virginia “bare” counties. “The decisions we made were challenging ones given the recent changes and ambiguities in the marketplace,” Michael Dudley, Optima president and CEO, said in a statement. “Our most recent filing with the state reflects these dynamic changes, as would be expected in these circumstances.” Optima is offering plans only in counties where its healthcare company, Sentara Healthcare, has doctors and hospitals doing business, and said it will allow the company to “better manage chronic conditions to keep members healthy.”

Prosecutors want Shkreli behind bars for controversial Facebook post about Hillary Clinton Federal prosecutors are requesting a judge lift Martin Shkreli’s bail and send him to jail, after the “Pharmo Bro” posted an intimidating message online directed at Hillary Clinton on Facebook. The court motion filed in New York on Thursday show federal prosecutors calling on a judge to remove Shkreli’s $5 million bond and place him behind bars for dangerous public conduct. In a Facebook post, Shkerli wrote that people should “try to grab a hair” from Clinton during her upcoming book tour. “Will pay $5,000 per hair obtained from Hillary Clinton after the sequence matches. Good luck, patrollers,” he wrote. The post was deleted. Prosecutors say this incident among others “demonstrates that he cannot meet his post-trial burden to show, by clear and convincing evidence, that he does not pose a danger to the community.” Shkreli took to Facebook to respond to the backlash from his controversial statement about Clinton and said it was a joke. “Lol Hillary Clinton’s presumptive agents are hard at work. It was just a prank, bro! But still, lock HER up. Spend your resources investigating her, not me!!” he posted on Facebook on Thursday. He also responded to the prosecutors’ request by posting on Facebook, “F— the government.”

West Virginia drop charges against journalist who tried to ask Price questions on Obamacare Charles Miller, the prosecuting attorney for Kanawha County, this week notified the attorneys of reporter Dan Heyman, who works for Public News Service, that the state is dismissing charges it brought against him for his conduct in May at the West Virginia state capitol. “The state has determined, after a careful review of the facts, that Mr. Heyman’s conduct, while it may have been aggressive journalism, was not unlawful and did not violate the law with which he was charged, that is, willfully disrupting a state governmental process or meeting,” the prosecutor said in a statement. Heyman was asking questions of Health and Human Services Secretary Tom Price regarding the bill Congress was negotiating to repeal and replace portions of Obamacare.

Teen pot use hits new low amid turmoil for legalization backers A major national survey has found people under 18 are using marijuana at the lowest rate since 1994, welcome news to legalization supporters facing a setback in Congress and a potential threat from the executive branch.Hours before the results were posted online, House leaders blocked a floor vote on an amendment adopted since 2014 protecting state medical pot programs, as requested by Attorney General Jeff Sessions, a cannabis reform foe re-entering President Trump’s good graces after strained summer relations. The results of the National Survey on Drug Use and Health show 6.5 percent of Americans ages 12-17 used marijuana in the past month in 2016, as compared with 7 percent in 2015 and 7.4 percent in 2014, the year the nation’s first recreational pot stores opened in Colorado and Washington.

RUNDOWN

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Bloomberg Don’t Yelp your doctor. Study finds ratings are all wrong.

Columbia Journalism Review Under Trump, health reporters confront an information blockade

 

Calendar

FRIDAY | Sept. 8

Sept. 7-10. Washington Marriott Marquis. 901 Massachusetts Ave NW. U.S. Conference on AIDS. Agenda.

Sept. 7-8. Ronald Reagan Building. 1300 Pennsylvania Avenue NW. Medicare Payment Advisory Commission public meeting. Details.

Sept. 7-9. Denver. Catholic Medical Association annual education conference. Schedule.

Noon. G50 Dirksen. Alliance for Health Policy discussion on “Stabilizing the Individual Market in Uncertain Times.” Details.

SUNDAY | Sept. 10

Sept. 10-12. Swissôtel, 323 East Upper Wacker Drive. Chicago. Eighth International Congress on Peer Review and Scientific Publication. Details.

MONDAY | Sept. 11

Sept. 11-13. Hogan Lovells. 555 13th Street NW. Food is Medicine Coalition National Symposium.

TUESDAY | Sept. 12

Sept. 12-13. Marriott Wardman Park. 2660 Woodley Rd. NW. 2017 Association for Accessible Medicines Biosimilars Council Conference. Includes keynote by CMS Administrator Seema Verma. Agenda.

8 a.m. Newseum. 555 Pennsylvania Avenue. Discussion hosted by The Hill on “Turning Genes into Medicine: Reimagining Our Healthcare System.” Details.

10 a.m. 420 Dirksen. The Senate Health, Education, Labor and Pensions Committee will hold a third  hearing on stabilizing the Obamacare exchanges, with discussions on state flexibility. Details.

10 a.m. 215 Dirksen. Senate Finance Committee hearing on “Health Care: Issues Impacting Cost and Coverage.” Details.

11 a.m. 562 Dirksen. Homeland Security and Governmental Affairs Committee Minority roundtable on opioid sales and marketing.

2:30 p.m. Brookings. 1775 Massachusetts Ave. NW. Event on “Inclusive School Environments: Improving Outcomes for Students With and Without Disabilities.” Details.

WEDNESDAY | Sept. 13

8 a.m. AJAX. 1011 4th Street NW. Event hosted by The Hill on “America’s Opioid Epidemic: Search for Solutions” with Sen. Rob Portman, R-Ohio, and Rep. Paul Tonko, D-N.Y. Details.

9 a.m. 529 14th Street NW. National Press Club. Event on “Understanding the Value of Innovation in Medicine.” Details.

9:30 a.m. Blue Cross Blue Shield Association. 1310 G St. NW. Event on “Breakfast With The Blues: BCBS Medical Officers To Discuss Efforts In Fighting The Opioid Crisis.”

THURSDAY | Sept. 14

1:30 p.m. Alliance for Health Policy Webinar on “New Administration, New Approach to Medicaid Waivers?” Details.

FRIDAY | Sept. 15

Sept. 15-19. Chicago. American Academy of Pediatrics conference. Schedule.

8 a.m. Newseum. 555 Pennsylvania Ave NW. Atlantic forum on “Children and Cancer.” Details.

Noon. 325 Russell. Alliance for Health Policy event on “Chronic Pain & Opioid Addiction: The Role of Integrated Care.” Details.

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Senate panel divided on length of Obamacare stabilization funding, state flexibility

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