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The Demise of Obamacare Repeal and Replace

That line appeared to be reinforced over the weekend when President Trump said, in a pre-Super Bowl interview, that the process could draw out into next year. My sense is that what Trump was talking about was the fact that the whole process, that includes implementing the replacement, could take well past 2017. Trump, never one for getting the details right, was taken literally by the press looking to write stories about how the whole process was foundering.

Speaker Paul Ryan quickly countered in his press briefing that Republicans will legislate a repeal and replace of Obamacare this year.

As I have reported to you a number of times, that process, especially the replace part, will be very difficult to achieve given the need to have at least eight Democrats onside with a complete replace bill.

Continue reading….

Anthem Chimes in on Trump’s Executive Order

On Friday, January 20, 2017, President Trump signed an executive order instructing the Secretary of
the Department of Health and Human Services (HHS) and the heads of all other federal agencies to
“exercise all authority and discretion available to them to waive, defer, grant exemptions from, or
delay the implementation of any provision or requirement” of the Affordable Care Act (ACA) that
would impose a fiscal or regulatory burden on individuals or families or any one of a number of other
stakeholders across the health care system including health insurers and purchasers of health
This Executive Order has no immediate impact on Anthem plans or our members’ benefits
and coverage. Read more:

Trump’s Executive Order on ACA and The Employer

As has been widely reported, President Trump issued an Executive Order addressing the Affordable Care Act (the “ACA”)—but many of our clients are wondering what impact it has on them and the group health plans that they sponsor for their employees, because the language of the Executive Order only speaks to minimizing the economic burden of the ACA on individuals, families, healthcare providers, health insurers, and health insurance purchasers.
By its terms, the Executive Order does not specifically address employers. Further, implementation of the Executive Order involves several practical challenges, including the fact that the heads of the agencies overseeing the ACA have not been confirmed and that the Order is to be implemented consistent with applicable law—meaning that the agencies are not supposed to disregard the ACA while repeal or replacement legislative efforts are being undertaken.
So, what’s an employer to do?

What to read more?


Fixing the ACA Law. Political Challenges Loom.

Fixing Health Insurance Reform: The Only Way Republicans Can Lower Costs is to Provide Less Coverage?

 Anna Wilde Mathews and Louise Radnofsky have a well-done story in yesterday’s Wall Street Journal. They point out that a relatively few sicker people account for most of the cost of care:

Congress has begun the work of replacing the Affordable Care Act, and that means lawmakers will soon face the thorny dilemma that confronts every effort to overhaul health insurance: Sick people are expensive to cover, and someone has to pay.

That is right.

But, this statement would seem to infer, as I have observed the general discussion about fixing Obamacare has often inferred, that there is a certain cost to health insurance and that Republicans can rearrange the deck chairs any way they want but the cost will be the same.


What I think this story, and the general discussion about how to cover people in the future is missing, is that Obamacare is so flawed that by itself it is manufacturing plan premium levels that are at least 30% to 40% higher than they need to be.

Obamacare insurance exchanges cover only about 40% of those that are subsidy eligible, when the longstanding insurance industry underwriting rule calls for 75% of an eligible group to be covered in order to have enough healthy people enrolled to pay the costs of the sick. But again it is this critical point that is being missed.

What would happen if the plans were more attractive––if people saw value in them? And, if we had 75% of the eligible group signing up as a result, what impact would that have on current premiums?

I have asked a number of health plan actuaries that hypothetical question. Hypothetical because the health plans don’t have the flexibility to rearrange the product pieces so as to make the insurance plans more attractive.

Their answer has consistently been that prices could come down at least 30% to 40% from 2018 prices. Said another way, the anti-selection load the current Obamacare exchange plans are carrying is worth at least 30% to 40%. And, that makes sense. When Obamacare launched for 2014, the carriers conservatively priced for an acceptable claim level. The reality was much higher––2018 prices are now about 30% to 40% higher after adjusting for baseline trend.

Read more click here!

How To Control American Drug Costs

Q: Many newer (as well as many older) drugs are of great value in treating many diseases. But the prices charged seem very high and rising, causing serious concern for many. Is there anything the United States can do to control these costs?
 A: We can do a lot to control drug costs, but success will take the cooperation of Congress and the legislatures, which are fundamentally in the drug industry’s pocket.

The industry lavishes money on Congress to buy that favor. Open Secrets data show that the pharmaceutical/health products sector, the most politically influential industry, gave Congress $3.3 billion in campaign contributions between 1997-2015. That largess averages out to $183 million annually over that 18-year period, or a stunning $343,000 per legislator per year. Within these dynamics, every relevant law and rule is spun to favor the interests of the drug industry over those of the American people.

In an excellent recent JAMA article on the sources of US drug pricing, Kesselheim et al. point out that influence over policy has translated into two core problems: “granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits.”

Consider Congress’ prohibition against Medicare negotiating drug prices. Millions of patients’ medications are subsidized by Medicare, which pays whatever price is demanded. It’s hard to imagine a better deal than the purchaser allowing the manufacturer to set any price, with the guarantee that the bill will be paid.

Read the full article here.