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Daily Archives: January 22, 2018

CHIP Renewed For Six Years As Congress Votes To Reopen Federal Government

A brief, partial shutdown of the federal government was resolved Monday, as the Senate and House approved legislation that would keep federal dollars flowing until Feb. 8, as well as fund the Children’s Health Insurance Program for the next six years.

The legislation is awaiting President Donald Trump’s signature, expected later Monday evening.

The CHIP program, which provides coverage to children in families who earn too much to qualify for Medicaid but not enough to afford private insurance, has been bipartisan since its inception in 1997. But its renewal became a partisan bargaining chip over the past several months.

Funding for CHIP technically expired Oct. 1, although a temporary spending bill in December gave the program $2.85 billion. That was supposed to carry states through March to maintain coverage for an estimated 9 million children, but some states began to run short almost as soon as that bill passed.

The Georgetown University Center for Children and Families estimated that 24 states could face CHIP funding shortfalls by the end of January, putting an estimated 1.7 million children’s coverage at risk in 21 of those states.

Meanwhile, both houses of Congress had been at loggerheads over how to put the program on more firmer financial footing.

In October, just days after the program’s funding expired, the Senate Finance Committee approved a bipartisan five-year extension of funding by voice vote. But that bill did not include a way to pay the cost, then estimated at $8.2 billion.

In November, the House passed its own five-year funding bill for the program, but it was largely opposed by Democrats because it would have offset the CHIP funding by making cuts to Medicare and the Affordable Care Act (ACA).

Prospects for a CHIP deal brightened earlier this month when the Congressional Budget Office re-estimated how much the extension of funding for the program would cost. In a letter to Senate Finance Committee Chairman Orrin Hatch (R-Utah) on Jan. 5, CBO said changes to health care made in the tax bill would result in lowering the five-year cost of the program from $8.2 billion to $800 million — effectively a reduction of 90 percent.

The reason, explained CBO, is that the landmark tax bill passed in December eliminated the ACA’s individual mandate, which would likely drive up premiums in the individual market. Those higher premiums, in turn, would increase the federal premium subsidies for those with qualifying incomes. As a result, if kids were to lose their CHIP coverage and go onto the individual exchanges instead, the federal premium subsidies would cost more than their CHIP coverage.

Driving that point home, on Jan. 11, CBO Director Keith Hall wrote to Rep. Frank Pallone (D-N.J.) that renewing CHIP funding for 10 years rather than five would save the federal government money. “The agencies estimate that enacting such legislation would decrease the deficit by $6.0 billion over the 2018-2027 period,” the letter said.

That made it easier for Republicans to include the CHIP funding in the latest spending bill. But it infuriated Democrats, who had vowed not to vote for another short-term spending bill until Congress dealt with the issue of immigrant children brought to the country illegally by their parents.

Republicans, said Senate Minority Leader Chuck Schumer (D-N.Y.) on Sunday, “were using the 10 million kids on CHIP, holding them as hostage for the 800,000 kids who were Dreamers. Kids against kids. Innocent kids against innocent kids. Thatâ€s no way to operate in this country.”

Republicans, however, said it was the opposite — that Democrats were holding CHIP hostage by not voting for the spending bill. “There is no reason for my colleagues to pit their righteous crusade on immigration against their righteous crusade for CHIP,” said Hatch. €œThis is simply a matter of priorities.”

The CHIP renewal was not the only health-related change in the temporary spending bill. The measure also delays the collection of several unpopular taxes that raise revenues to pay for the ACA’s benefits. The taxes being delayed include ones on medical device makers, health insurers and high-benefit “Cadillac” health plans.

The bill does not, however, extend funding for Community Health Centers, another bipartisan program whose funding is running out. That will have to wait for another bill.

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In Trump’s First Year, Anti-Abortion Forces Make Strides Despite Setbacks

As a candidate, President Donald Trump promised abortion opponents four specific actions to “advance the rights of unborn children and their mothers.”

One year into his presidency, three of those items remain undone. Nevertheless, abortion opponents have made significant progress changing the direction of federal and state policies on the issue.

Indeed, on Friday, as anti-abortion protesters gathered in Washington for the 45th annual March for Life, the Trump administration announced two new policies. One is a letter to states aimed at making it easier for them to exclude Planned Parenthood facilities from their Medicaid programs; the other is a proposed regulation to allow health care providers to refuse to perform services that conflict with their “religious or moral beliefs.”

“In my administration, we will always defend the very first right in the Declaration of Independence, and that is the right to life,” Trump said in a video address from the Rose Garden to the marchers.

A vendor sells buttons during the “March for Life” on Jan. 19, 2018 in Washington, D.C. (Julie Rovner/KHN)

Marjorie Dannenfelser, president of the anti-abortion group the Susan B. Anthony List, led the Trump campaign€™s Pro-Life Coalition. The then-candidate said he was committed to “nominating pro-life justices to the U.S. Supreme Court,” which happened with the nomination and confirmation of Justice Neil Gorsuch in April.

But despite many attempts, Congress did not pass a federal ban on abortions occurring after 20 weeks, did not cut off Planned Parenthood’s federal funding and did not write into permanent law the “Hyde Amendment,” which bans most federal abortion funding but needs annual renewal.

Still, there was progress on scaling back abortion and, in some cases, access to contraception at the federal level.

The administration made myriad changes. It reinstituted and expanded the “Mexico City Policy,” which forbids funding of international aid programs that “perform or promoteâ abortion. It issued rules aimed at allowing religious-affiliated and other employers to not offer contraceptive services if they have a “religious beliefâ or “moral conviction” against them, although federal courts have blocked the new rules from being implemented. And just last week it created a new œconscience and religious freedom” division in the Department of Health and Human Services’ Office of Civil Rights. That new division is designed to enforce both existing laws protecting the rights of conscience for medical personnel as well as the new regulations.

Most important, according to many in the anti-abortion movement, the president nominated and the Senate confirmed a dozen and a half federal district court and appeals court judges who are considered likely to rule in their favor.

Abortion rights supporters concede that while the priorities on their opponents’ wish list were not accomplished, plenty still happened.

“This administration is the worst we’ve ever seen for women and families,” said Kaylie Hanson Long of NARAL Pro-Choice America in a statement. “Its attacks on reproductive freedom are relentless, under the radar, and aren’t supported by the majority of Americans who believe abortion should remain legal.”

Dannenfelser said one of the biggest changes is the number of anti-abortion advocates now working in the Department of Health and Human Services in key roles. “I can say there is more unity in this administration than there has been in any presidency on this,” she said.

Abortion opponents know their biggest obstacle is the U.S. Senate, where they don’t have the 60 votes required for most legislation. “Without making advances in the Senate, it’s going to be really tough,†said Dannenfelser.

Meanwhile, outside Washington, states continued their efforts to restrict access to abortion and family planning. States have passed 401 separate measures since Republicans took over most state legislatures in 2011, according to the Guttmacher Institute, a reproductive rights research and advocacy group.

During 2017, 19 states enacted 63 separate restrictions, said Elizabeth Nash, who tracks state legislation for Guttmacher. Among the notable laws was one in Ohio to outlaw abortions of fetuses diagnosed with Down syndrome. Arkansas and Texas passed laws to ban “dilation and evacuation” abortions, a procedure that uses suction and medical instruments to remove the fetus and is the most common procedure for abortion after the first trimester of pregnancy. Both bans have been blocked by federal courts.

Some of the new restrictions came from states that have not been active on the issue in recent years. A Wyoming law requiring ultrasounds to be offered to pregnant women seeking an abortion was that state’s first in 30 years, Nash said.

But 2017 was also notable for states seeking to widen or ensure access to abortion and other reproductive services. For example, Delaware passed a law enshrining abortion rights, while Oregon and New York require private health plans to cover abortion without patients’ cost sharing. Legislators in California, which has a long history of protecting abortion rights, have been pushing a bill that would require public universities to provide abortion pills to female students who are less than 10 weeks pregnant. The bill stalled last year, but it is being picked up again this year.

As a result, said Nash, “we are really living in a bifurcated country. The states that are progressive are looking to protect access” to abortion and contraception. “The states that are conservative are looking to restrict it.”

In other words, a nation that looks a lot like it did 45 years ago, when the Supreme Court legalized abortion nationwide in Roe v Wade.

California Healthline Reporter Ana B. Ibarra in Sacramento, Calif., contributed to this article.

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Viewpoints: A List Of Steps To Combat Opioid Crisis; What Can Go Wrong If Hospitals Get Into The Drug Business

Opinion writers from around the country express views on health care issues.

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Monday Morning Quarterbacks: Pros And Cons Of Work Requirements; What If A Doctor Won’t Help?

Editorial pages offer a variety of views on the pending debate surrounding this Medicaid policy and a range of other health care issues.

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State Highlights: ‘Pharmacy Deserts’ Plague Chicago Neighborhoods; Kansas Nursing Homes Say They’re In Crisis

Media outlets report on news from Illinois, Kansas, Texas, Minnesota, Colorado, Florida, California, Wisconsin, Ohio, Tennessee and Connecticut.

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California Lawmakers Expected To Introduce Legislation To Fortify State’s Health Exchange

“Everything they are doing at the federal level, we are doing the opposite, said state Sen. Ed Hernandez. Meanwhile in Wisconsin, Gov. Scott Walker shifts toward the center with proposal to use money to stabilize the state’s health law marketplace.

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In Rapidly Evolving Health Care Landscape, Traditional Borders Are Blurring

Hospitals’ recent decisions to start making their own drugs is just one in a long string of actions taken within the industry to break down conventional roles.

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Not All Screen Time May Be Harmful To Kids, Some Experts Begin To Consider

The standard these days is to recommend children limit time in front of screens. But there’s a difference between passive exposure and active interaction. In other public health news: transgender children, Tide Pods, gene-editing, contraceptives, cancer patients and marijuana, personalized diets based on genetics, and more.

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IV Bag Shortage In Midst Of Vicious Flu Season Exposes Flaw In Health System’s Crisis Response

A shortage of crucial supplies can lead to “potentially dangerous treatment of patients,” rising death rates and overwhelmed emergency workers and nursing facilities. Media outlets report on news of the flu out of California, Louisiana, Georgia, Minnesota and Texas, as well.

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Most People Who Overdose Don’t Die. Instead They’re Ensnared In Relentless Cycle Of Worry And Chaos.

Although the nation has been transfixed by the horrifying statistics about drug overdoses, that’s not the reality most people who are addicted to opioids are experiencing. Instead they’re caught up in a grinding, consuming and debilitating cycle of addiction.

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