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Daily Archives: February 7, 2018

Bipartisan Senate Budget Deal Boosts Health Programs

In a rare show of bipartisanship for the mostly polarized 115th Congress, Republican and Democratic Senate leaders announced a two-year budget deal that would increase federal spending for defense as well as key domestic priorities, including many health programs.

Not in the deal, for which the path to the president’s desk remains unclear, is any bipartisan legislation aimed at shoring up the Affordable Care Act’s individual health insurance marketplaces. Senate Majority Leader Mitch McConnell (R-Ky.) promised Sen. Susan Collins (R-Maine) a vote on health legislation in exchange for her vote for the GOP tax bill in December. So far, that vote has not materialized.

The deal does appear to include almost every other health priority Democrats have been pushing the past several months, including two years of renewed funding for community health centers and a series of other health programs Congress failed to provide for before they technically expired last year.

€œI believe we have reached a budget deal that neither side loves but both sides can be proud of,” said Senate Minority Leader Chuck Schumer (D-N.Y.) on the Senate floor. “That’s compromise. That’s governing.”

Said McConnell, “This bill represents a significant bipartisan step forward.”

Senate leaders are still negotiating last details of the accord, including the size of a cut to the ACA’s Prevention and Public Health Fund, which would help offset the costs of this legislation.

According to documents circulating on Capitol Hill, the deal includes $6 billion in funding for treatment of mental health issues and opioid addiction, $2 billion in extra funding for the National Institutes of Health, and an additional four-year extension of the Children’s Health Insurance Program (CHIP), which builds on the six years approved by Congress last month.

In the Medicare program, the deal would accelerate the closing of the “doughnut hole” in Medicare drug coverage that requires seniors to pay thousands of dollars out-of-pocket before catastrophic coverage kicks in. It would also repeal the controversial Medicare Independent Payment Advisory Board (IPAB), which is charged with holding down Medicare spending for the federal government if it exceeds a certain level. Members have never been appointed to the board, however, and its use has not so far been triggered by Medicare spending. Both the closure of the doughnut hole and creation of the IPAB were part of the ACA.

The agreement would also fund a host of more limited health programs — some of which are known as “extenders” because they often ride along with other, larger health or spending bills.

Those programs include more than $7 billion in funding for the nationâ€s federally funded community health centers. The clinics serve 27 million low-income people and saw their funding lapse last fall — a delay advocates said had already complicated budgeting and staffing decisions for many clinics.

And in a victory for the physical therapy industry and patient advocates, the accord would permanently repeal a limit on Medicare’s coverage of physical therapy, speech-language pathology and outpatient treatment. Previously, the program capped coverage after $2,010 worth of occupational therapy and another $2,010 for speech-language therapy and physical therapy combined. But Congress had long taken action to delay those caps or provide exemptions †meaning they had never actually taken effect.

According to an analysis by the nonpartisan Congressional Budget Office, permanently repealing the caps would cost about $6.47 billion over the next decade.

Lawmakers would also forestall cuts mandated by the ACA to reduce the payments made to so-called Disproportionate Share Hospitals, which serve high rates of low-income patients. Those cuts have been delayed continuously since the law’s 2010 passage.

Limited programs are also affected. The deal would fund for five years the Maternal, Infant and Early Childhood Home Visiting Program, a program that helps guide low-income, at-risk mothers in parenting. It served about 160,000 families in fiscal year 2016.

We are relieved that there is a deal for a 5-year reauthorization of MIECHV,â said Lori Freeman, CEO of advocacy group the Association of Maternal & Child Health Programs, in an emailed statement. “States, home visitors and families have been in limbo for the past several months, and this news will bring the stability they need to continue this successful program.”

And the budget deal funds programs that encourage doctors to practice in medically underserved areas, providing just under $500 million over the next two years for the National Health Service Corps and another $363 million over two years to the Teaching Health Center Graduate Medical Education program, which places medical residents in Community Health Centers.

Kaiser Health News correspondent Emmarie Huetteman contributed to this article.

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Despite Changes That Undermined ACA Enrollment, Marketplaces ‘Remarkably Stable’

After much drama leading to this year’s open enrollment for Affordable Care Act coverage — a shorter time frame, a sharply reduced federal budget for marketing and assistance, and confusion resulting from months of repeal-and-replace debate — the final tally paints a mixed picture.

With all states now reporting, ACA plan enrollment ticked downward this year, a report out Wednesday shows, but states running their own marketplaces saw slight gains and did better than those relying on the federal exchange.

About 11.8 million Americans enrolled in 썢 coverage, down 3.7 percent from last year’s total, according to the National Academy for State Health Policy.

Open enrollment began shortly after the Trump administration sharply cut federal enrollment outreach efforts and ended a type of cost-sharing subsidy paid directly to insurers, which generally responded by raising premiums to make up for the loss.

“Despite all that, enrollment in the marketplaces across the nation was remarkably stable,” said Trish Riley, executive director of the academy, a nonprofit, non-partisan group.

Enrollment in marketplaces fully or partially run by states, for example, showed a small overall increase of 0.2 percent over the previous year, while the 34 states that rely entirely on the federal hub saw sign-ups drop by 5.3 percent, the report said.

Officials from states operating their own exchanges said their ability to make changes led to their gains.

€œWe could extend our open-enrollment period, control our marketing budget and nimbly mitigate the impact of the loss of cost-sharing subsidies [to insurers], which led to a very successful open enrollment,” said Zachary Sherman, director of Rhode Island’s state-run market.

Enrollment there is up 12 percent this year, he said, with sharp increases in the number of newly enrolled and policyholders aged 18 to 34.

California, which has the nation’s largest state market with about 1.5 million enrollees, saw a 2.3 percent drop in overall sign-ups. Covered California Director Peter Lee attributed some of that to efforts by the state to encourage off-market purchases by consumers who don’t qualify for subsidies.

Marketplace plans were more expensive than those sold outside healthcare.gov for unsubsidized consumers because California and other states asked insurers to load the premium increases stemming from Trump administration directives onto on-market plans. Those on-market price hikes were largely offset by jumps in tax credits for consumers receiving subsidies.

Despite their upbeat tone about this year’s enrollment, directors of several state marketplaces warned that 2019 looks grim.

“Just the removal of the [individual mandate penalty in Congress’ recently enacted tax overhaul] will mean premiums go up 15 percent to 30 percent or more depending on the state,” said Lee.

People who get subsidies will be largely shielded from those increases because the subsidies rise along with the premiums.

Still, the burden of higher premiums would fall on the 6 million or so people who buy their own insurance but don€™t get a federal tax credit to help them purchase coverage, according to an earlier study done by Covered California. The median income of those consumers was $ȫ,000.

The report also showed that enrollment dropped sharply in some states.

Arizona, Louisiana and West Virginia, for example, all saw enrollment falling by more than 15 percent, which may also not bode well for 2019.

Health plans are likely to raise rates there “because drops in enrollment already mean bad risk,” such as greater numbers of older or sicker members, California’s Lee warned.

Congress should act soon to mitigate those expected increases, according to the five state exchange directors who participated in a press call detailing the report’s findings, by providing funding for states to create reinsurance programs, which pay insurers for medical costs for the most expensive enrollees.

Several states, including Alaska and Minnesota, already have reinsurance programs.

Legislation to provide such funding is before Congress. While the proposals have bipartisan support €“ and the idea is endorsed by many health industry groups – the legislation faces opposition from some lawmakers who see it as a bailout for the insurance industry.

Allison O’Toole, the CEO of Minnesota’s state insurance marketplace, invited those who are skeptical to look at her state’s reinsurance program.

â€We saw it work,” said O’Toole. “Our premium rates are flat after a number of years of steep increases. We need to talk about a long term, federally financed reinsurance program if these markets are to stabilize.”

Several states, including Rhode Island, are also looking at steps they can take independent of congressional action to prepare for next year.

One idea: the use of state penalties for people who go uninsured to replace the loss of the individual mandate’s federal tax fine. Without some kind of mandate to purchase coverage, Rhode Island estimates that premiums there could rise 50 percent over three years.

œThe idea that premiums would go up at that rate is something that scares us quite a bit,” said Sherman.

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Viewpoints: Dish Up Science Instead Of Online Nutrition Myths; ‘Disastrous’ Global Gag Rule Is Harming Women Worldwide

Editorial pages focus on these health issues and others.

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Different Takes: Is It Time For Medicare For All?; All Americans Deserve Access To Affordable Health Care

Opinion writers express views on improving health care and reducing costs.

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Perspectives: CMS Takes Steps to Ensure Patients Benefit From Negotiated Discounts

Read recent commentaries about drug-cost issues.

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State Highlights: Fla. Rep. Paves Way For Coverage of HIV Drug; Rulings Strike Blow To 2 Ohio Abortion Cinics

Media outlets report on news from Florida, Ohio, Iowa, Maryland, California, New Hampshire, Colorado, New York, Virginia, Massachusetts and Texas.

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As Many Kids Have Fetal Alcohol Syndrome As Autism, Yet They Are Slipping Through Cracks

New research finds that fetal alcohol spectrum disorders affect 1.1 to 5 percent of children in the country. In other public health news: stroke treatment, untreated water, black lung, death and aging, car horns and health, and more.

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A Pacemaker For The Brain: Implant To Boost Memory Shows Promising Results

In testing, the device improved word recall by 15 percent — roughly the amount that Alzheimer’s disease steals over two and half years.

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Lack Of Diversity Among Doctors Seen As Brewing Public Health Crisis

Stat talks to a group of doctors who are traveling the country and meeting with young people of color who are interested in health career paths.

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Condition That Disrupts Sleep Responsible For Two Recent Train Crashes, Investigators Find

The Obama administration had been drafting a rule to require train operators, as well as truck and bus drivers be screened and treated for obstructive sleep apnea, but the Trump administration recently squashed it.

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