ACA Repeal is a Runaway Train

By Jill Zorn

dreamstime_xs_4843494ACA Repeal is a runaway train hurtling down the track.  Congressional leaders and President Trump are determined that it will not be derailed.

Up to a few days ago, we didn’t see it coming.  Just two weeks ago it seemed that the message, “No repeal without replace”, quite visible at town hall meetings across the country, was getting through loud and clear.  And it was.

By the time Congress returned from recess on February 27, using the process of budget reconciliation to pass a repeal bill, which would only require 51 votes in the Senate, seemed less likely.  That is because delaying passage of a replacement bill until 60 votes could be found in the Senate, was becoming politically risky.

The process had slowed down, and advocates were starting to feel that maybe, just maybe, the repeal train had been stopped, or at least slowed down.

But that is so “yesterday’s news”.  Now Republicans in Congress are frantically rushing to repeal as much of the Affordable Care Act (ACA) as they can as fast as they can.

On March 1 rumors started circulating that there was a “secret” bill, hidden in the basement, that only Republican House members and staff would be permitted to review behind closed doors.  The bill would repeal crucial pieces of the ACA but would also include a replacement plan.  Somehow, they had managed to craft a bill that would simultaneously repeal and replace the ACA and would also comply with budget reconciliation rules, so that they would only need 51 votes in the Senate to pass it.

On March 6, the American Health Care Act (AHCA) was publicly released.  Just two days later two House committees held all-night sessions to review and vote on portions of the bill.  By 4:30 am and 1:45 pm on March 9, both committees voted to advance their portions of the bill.

The two portions will be combined and sent on to the Budget Committee and for review by the Rules Committee next week.  By the week of March 20, AHCA is expected to be voted on by the full House and then sent over to the Senate.  The goal is to have the Senate approve the bill before the next recess which begins on April 10.

Meanwhile, President Trump is vowing to hold “football stadium rallies” of his followers to put pressure on Senators to vote for the plan.

A Threat to Care We Count On

For those of us who believe that all Americans should have access to quality, affordable health care and coverage, AHCA is a trainwreck of a bill.  Here are a few highlights of what it proposes:

  • Take health care away from millions of people by gutting the ACA and slashing Medicaid funding
  • Increase the cost of insurance for people as they grow older, including higher premiums, deductibles and co-pays
  • Defund Planned Parenthood
  • Threaten the long-term stability of the Medicare trust fund
  • Blow a huge hole in state budgets
  • Give massive tax cuts to the very wealthy and to drug and insurance corporations

You Can Help Stop This Trainwreck

With things moving so fast in D.C., if ever there was a time to fight, it is now.

That is why the foundation, working with other groups, has started a new campaign:  Protect Our Care CT.  The web site provides the latest information about what is going on here in Connecticut and in D.C.

Please sign up with Protect Our Care CT today to receive action alerts about upcoming events and ways to TAKE ACTION.  The time to act is NOW.


More Information about AHCA

USA Today Q and A

Sarah Kliff’s Vox Explainer

Kaiser Family Foundation summary

Health Affairs blog

CT MirrorWhat the GOP Obamacare replacement bill means for you and CT

CT Mirror: American Health Care Act:  Who gains and loses in Connecticut

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An Investment Opportunity

By Stephanye R. Clarke

investment.jpgOn September 8, 2016, the Office of Health Care Access (OHCA) rendered its final decision, allowing for the acquisition of L+M Hospital (L+M) by Yale New Haven Health System (YNHHS).

As a member of one of the communities served by L+M, I was pleasantly surprised by the conditions imposed by OHCA as part of the acquisition. As a public health professional, I was optimistic about the many ways that this acquisition might improve the health of the community. Alas, that surprise and optimism has shifted to disappointment, as I have watched the decisions play out.

Investment in Improving Community Health

A most impressive, comprehensive Community Health Assessment was completed in 2016. The process was inclusive of many community voices and should be a model for the rest of the state. The data revealed several areas of concern, and led to the development of a Health Improvement Plan that highlights three priority areas (Mental Wellbeing and Substance Abuse; Healthy Lifestyles; and Access to Care).

Per the terms of the agreement, “… the Applicants [YNHHS and L+M] shall apply no less than a 1% increase per year for the next three (3) years towards the L+MH’s community building activities in terms of dollars spent…” Community members expected that would be a significant dollar amount. Instead, we were shocked to find out that this formula resulted in amounts that would total no less than $588.74, $594.63, and $600.57.

While attending a recent public forum, I heard the independent monitor along with YNHHS’s senior VP mention a commitment to the mission and infrastructure of L+M—specifically, this phrase was used, “the investment is real, the commitment is real.”

Men holding the question what. Concept 3D illustration.

Referring to less than $600 as the “floor” commitment that will increase only on the condition that the profit margin for the hospital increases is not a reflection of a real investment or commitment to population health. It is a clear statement that the work of the collaborative and the health of the community are of little value, despite the grand statements.

Hospitals in Connecticut report being under enormous strain, citing tax policies and low Medicaid reimbursements as major causes for concern.

I would still like to see the powers-that-be put their money where their mouth is and make a real commitment to improving the health of the communities they serve.

I’ll still be watching. We all will.

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Medicaid facing threats (again) in the Governor’s Budget

By Rosana Garcia

When Governor Malloy released his budget for fiscal years 2017-2019, his proposals had cuts to health care and Medicaid/HUSKY.   It’s no secret that the state budget has a deficit of over $1.5 billion dollars next fiscal year, and the Governor’s Budget proposed a lot of cuts and reductions in services.

Tomorrow, at a public hearing in the Human Services Committee, House Bill 7040, which is a Governor’s Bill to implement his proposals, will be discussed.  Threats to Medicaid include:

  • Reducing the income eligibility for HUSKY A parents (and caregivers) from 155% of the federal poverty level (FPL), to 138% of FPL. What does that mean in real dollar terms?  Parents (and caregivers) will lose their HUSKY A coverage if they make more than:
    • $1,868 a month ($22,411 a year) for a family of 2
    • $2,348 a month ($28,180 a year) for a family of 3
    • $2,829 a month (33,948 a year) for a family of 4
  • Capping the adult dental benefit in HUSKY/Medicaid at $1,000.
  • Eliminating the Medicare Part D drug copay protection for dual eligibles (people who are on Medicaid and Medicare, who often have complex health conditions that require medications).

It’s no secret that thuninsured_ff8a8e state

Reducing eligibility in HUSKY A coverage for parents/caregivers = More uninsured people

In 2015, over 17,000 parents and caregivers who relied on the HUSKY A program with incomes over 155% of the federal poverty line were cut from the program.  In the end, only 16% of the parents who lost their benefits got coverage through Access Health CT, despite subsidies that help to pay monthly premiums.

That group of Connecticut residents who lost their coverage were in a higher income level than what is being proposed in HB 7040, which would affect an additional 9,500 people.  Let’s be clear – lowering income eligibility for HUSKY A parents and caregivers is cutting people off of coverage.  At this income level, private health coverage, even with subsidies, is unaffordable.

Other potential negative effects of reducing HUSKY A parent/caregiver eligibility include:

  • Due to the differences in income eligibility between HUSKY A children and parents/caregivers, which can cause confusion, children may not be enrolled in HUSKY A, even if they are eligible; and
  • Even if a parent/caregiver enrolls in coverage through Access Health CT, and manages to pay the monthly premiums, there are more costs associated with a private insurance plan, such as co-pays, co-insurance, and deductibles.  Dental coverage would also be an additional expense.  Those who can least afford it are burdened with higher costs that will likely prevent them from accessing care.

Cutting Medicaid eligibility and benefits reduces access

We have to remember that health care affordability isn’t just about lowering costs in the larger system – it’s also about people getting the high-quality health care they need, at a price they can afford.  For some Connecticut residents, health care coverage – and the care that comes with this coverage – is out of reach without the Medicaid program.

Yes, we need a balanced budget, but not on the backs of low-income Connecticut residents, and especially not at the cost of their health care.

 

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Report from DC: 700 advocates come together for Families USA Health Action 2017

by Rosana Garcia

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Last week, Jill Zorn and I attended the Families USA Health Action 2017 Conference in Washington, DC, to represent the Foundation, and to learn from others.

In this critical time for health care, it was inspiring to gather with almost 700 health advocates from all across the country.  Most importantly, we were all reminded what’s at stake for everyone as changes are proposed to our health care system — especially those changes that may make health insurance coverage less accessible and more expensive.

Health care is something that we all need, sooner or later.  It can mean life or death for some — and can improve our quality of life, provide good jobs, and is a cornerstone to our society.  Health care is a human right and there’s a lot on the line.

Want to know what’s at stake in Connecticut?  Check out our fact sheet: What’s at Stake in CT? How your health care could change.

I’ve gathered together my Tweets on the conference, you can check it out here in my Health Action 2017 Storify.

Families USA has posted their: Our Favorite Moments from Health Action 2017 and a Storify collection of Tweets from the conference.

You can even check out the videos from all the plenary speakers here.  I felt particularly proud of Representative Rosa DeLauro from Connecticut.  Some of my favorites included:

  • Reverend Dr. William Barber, President of the North Carolina NAACP and leader of the Moral Mondays movement, who reminded us that health care and social justice are not a left or right issue, but a moral issue
  • Dr. Atul Gawande, who told heartbreaking stories about what was at stake, and reminded us that medical care has moved from hospitals and heroics to incremental, preventive care
  • Sister Simone Campbell, Executive Director of NETWORK, who gave us four virtues for 21st century advocacy: 1) Practice a modicum of joy.  2) Holy curiosity —  Listen, really listen, to everyone’s stories.  3) Sacred gossip — When you hear stories, share them.  4) Do your part — just your part.  Trust others to do theirs.

So what can you do?

  • We’re ready to listen to your story — reach out to us on Facebook, Twitter, or email us at info@universalhealthct.org.
  • Speak up to our leaders.  In fact, Senator Blumenthal has two events this weekend:
    • Saturday February 25, 1:30 p.m. at Wilbur Cross High School, New Haven
    • Sunday, February 26, 1:00 p.m. at Central Connecticut State University, New Britain
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Congress in Recess: Tell Them YOUR Health Care Story

By Lynne Ide

blogStarting on February 18, Congress will be in recess for a week. Connecticut’s five U.S. Representatives and two U.S. Senators will be back in state and hitting the road to talk with constituents.

If you care about health care – whether it be the Affordable Care Act (ACA or Obamacare), Medicare, Medicaid/HUSKY or women’s health programs – you should know that each of these important programs are subject to elimination or drastic change if the new leadership in Washington, D.C. has its way.

Next week is a good time for you to let your voice be heard.  

Tell your U.S. Representative and your two U.S. Senators what health care means to you.

Connecticut’s Congressional delegation is supportive of the health care programs we all count on.  They are already working to protect our care, but they need us to stand with them.

They want to know your story because it will help them fight protect our care.

  • Have you or a loved one benefitted from the Affordable Care Act, Medicare, Medicaid/HUSKY or women’s health programs?  How has it helped you, and what would it mean if you lost that care?
  • Are you spending too much for prescription drugs, health insurance premiums, co-pays and deductibles?  How can Congress help people like you get the care you need at a cost you can afford?

Here are events that we know of scheduled for next week: 

(Note: Details are still being worked out for some of these events.  We will update this list on our blog as we get information from Congressional offices.)

  • The Future of Healthcare in American: A Forum on the Affordable Care Act with U.S. Representative  Joe Courtney (2nd Congressional District) Saturday, February 18  12:30 – 2 p.m. at Generations Family Health Center, 40 Mansfield Avenue, Willimantic
  • Town Hall Meeting with U.S. Representative Jim Himes (4th Congressional District)  Wednesday, February 22  6:30 p.m. at Bridgeport City Hall, 45 Lyon Terrace, Bridgeport
  • Press Conference re: Economics of ACA Repeal with U.S. Representative Rosa DeLauro (3rd Congressional District) highlighting tax breaks for the wealthy if the Affordable Care Act is repealed – Friday, February 24 10:30 a.m. at Connecticut State Medical Society, 127 Washington Avenue (East Building, 3rd floor), North Haven
  • Event with U.S. Representative John Larson (1st Congressional District) – Saturday, February 18 10:00 a.m. – noon at the Berlin Senior Center, 33 Colonial Drive, Berlin
  • Town Hall Meeting with U.S. Senator Chris Murphy Tuesday, February 21 7:30 p.m. at West Hartford Town Hall Auditorium, 50 South Main Street, West Hartford
  • General Town Hall Meeting with U.S. Senator Richard Blumenthal, Saturday February 25 1:30 p.m. at Wilbur Cross High School, New Haven and Sunday, February 26 1:00 p.m. at Central Connecticut State University, New Britain
  • Town Hall Meeting with U.S. Representative Elizabeth Esty (5th Congressional District) Sunday, March 5, 3:00-4:30 p.m. at Naugatuck Valley Community College (Mainstage Theater in the Fine Arts Center, 3rd floor), 750 Chase Parkway, Waterbury
  • Town Hall Meeting with U.S. Representative Rosa DeLauro (3rd Congressional District) Monday, March 6, 5:30 – 7:00 p.m. at Hamden Middle School, 2623 Dixwell Avenue, Hamden

You can also call your Congressperson and U.S. Senators directly: 

  • U.S. Senator Richard Blumenthal: 860-258-6940
  • U.S. Senator Chris Murphy: 860-549-8463
  • U.S. Rep. John Larson (1st CD): 860-278-8888
  • U.S. Rep. Joe Courtney (2nd CD): 860-886-0139
  • U.S. Rep. Rosa DeLauro (3rd CD): 203-562-3718
  • U.S. Rep. Jim Himes (4th CD): 203-333-6600
  • U.S. Rep. Elizabeth Esty (5th CD): 860-223-8412

There will be lots of opportunity for your advocacy and action in the coming months.  Please let us know if you want to be notified about upcoming events and let us know if there is a particular health care program you’d like to help defend.  Contact us at: info@universalhealthct.org 

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Another Victory for Connecticut Consumers: Anthem-Cigna Merger Blocked

by Jill Zorn

Plastic stamp in hand, isolated

In a victory for Connecticut consumers, the proposed Anthem-Cigna mega-merger has been blocked by U.S. District Judge Amy Jackson Berman.  This decision follows by just a few weeks the ruling of another federal judge to block the proposed Aetna-Humana merger.

While Anthem and Cigna claimed the merger would mean economies of scale, greater efficiencies and more innovation, the court found the deal would, “increase prices and reduce competition.”  In fact, the Judge was very clear that she doubted that allowing the formation of a huge monopoly that would then put pressure on provider prices would actually result in savings for consumers.

“Anthem is asking the Court to go beyond what any court has done before: to bless this merger because customers may end up paying less to healthcare providers for the services that the providers deliver even though the same customers are also likely to end up paying more for what the defendants sell… Anthem is encouraging the Court to ignore the risks posed by the proposed constriction in the health insurance industry.”

Today’s news is the culmination of a fight that Universal Health Care Foundation of Connecticut began waging, in conjunction with many allies and partners, over a year ago.

We began raising red flags about both the Aetna-Humana and Anthem-Cigna mergers in December 2015.  We quickly decided that we couldn’t do this work alone and decided to form a coalition with the Connecticut State Medical Society (CSMS) and the Connecticut Citizen Action Group (CCAG).  Working together, we were able to get the word out about the harm these mergers would cause as well as recruit other individuals and organizations to join us in opposing them.

The foundation focused on enlisting the help of other national and state-based health care advocacy groups.  One crucial professional relationship we developed was with Attorney David Balto, a consumer-oriented anti-trust lawyer, and his Coalition to Protect Patient Choice.  Other national groups that provided crucial advice and assistance included Consumers Union Healthcare Value HubFamilies USA and Universal Health Care Action Network.

Thanks to these contacts and our partnership with CSMS and CCAG, we succeeded in getting 43 groups from around the country to send a letter to the Department of Justice (DOJ) urging the DOJ to use its “expertise and enforcement power to protect people from the harm these mergers will cause.”

One major focus of our efforts was to highlight concerns about the potential conflict of interest posed by Insurance Commissioner Katharine Wade’s close ties to Cigna.  Despite these connections, the Commissioner had refused to recuse herself from presiding over the expected hearing that the Connecticut Insurance Department would hold to review the Anthem-Cigna merger.

The conflict of interest story was amplified by the persistent coverage from a national investigative journalist, David Sirota, writing for the International Business Times.  By late June, the foundation succeeded in getting over 600 people to sign our petition asking the Commissioner to resign.

As the time grew closer for DOJ to decide whether they would  oppose the mergers in court, Connecticut elected officials weighed in with their concerns, including Senator Richard Blumenthal, and State Comptroller Kevin Lembo.

Along the way, the foundation had several opportunities to speak directly with staff at the Connecticut Attorney General’s office as well as DOJ officials and express our misgivings about the mergers and the Insurance Department review process.  And we began to prepare for the public hearing that the Insurance Department would hold on the Anthem-Cigna merger.

In the end, that hearing was never held.  Instead, in July the DOJ decided to oppose both the Aetna-Humana and Anthem-Cigna mergers in court.  Attorney General George Jepsen signed on with ten other states and the District of Columbia in opposition to the Anthem-Cigna deal.

With the cases filed, we followed the trials and awaited the judges’ decisions.  Which brings us to today’s news, that the long, uphill struggle to stop these mergers has been won, at least for now.

Technically, the fight isn’t over.  Anthem has already announced they will file an appeal and we are waiting to hear what Aetna will do.

But for now, it feels good to see that the courts sided with consumers and not huge corporations, ruling to block the mergers and protect Connecticut residents from the fewer choices, job losses and higher prices they would cause.

Insurance Merger Denied-FINAL.png

 

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Trumpcare: “If You Break It, You Own It.”

By Jill Zorn

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Last week Republicans headed to a meeting in Philadelphia, aiming to reach agreement on a plan to repeal and replace the Affordable Care Act (ACA), but it seems they left Philadelphia without any clear consensus on how to proceed.  In fact, a secret recording of the meeting that was sent to the media shows that some of them are actually getting nervous about the rush to repeal the ACA:

“We’d better be sure that we’re prepared to live with the market we’ve created” with repeal, Rep. Tom McClintock said, according to the Washington Post. “That’s going to be called Trumpcare. Republicans will own that lock, stock, and barrel, and we’ll be judged in the election less than two years away.” (See this Slate article)

As John Osborn points out in this Forbes article, McClintock’s remarks are an echo of, “Colin Powell’s infamous ‘Pottery Barn rule’ uttered in the lead-up to the invasion of Iraq: if you break it, you own it.”

Part of the disarray that Republicans find themselves in, is due to the mobilization of thousands of people across the country opposing repealing the ACA without a replacement plan ready to go.  All of the calls to congress, attendance at town hall meetings and demonstrations are clearly having an impact.  There are multiple national and local groups working on this resistance effort and it’s important to keep it up.

No Agreement on Goals

as Sarah Kliff points out in Vox, is that Republicans’ lack clear policy goals, beyond dismantling the ACA.  As a result, their anti-ACA rhetoric often seems in conflict with their ACA replacement proposals.

For example, ACA critics from the right complain loudly about the high deductibles and co-pays that characterize plans available from the marketplaces, and point to them as part of the reason the ACA must be repealed.  But all Republican replacement proposals issued to-date rely to an even larger extent on health plans with high out-of-pocket costs, with less assistance with premiums.  And, if they are truly worried about affordability, why do  many of those same proposals eliminate the expansion of Medicaid to cover single adults all together?

The reality is that free market principles alone cannot maintain current coverage levels.  Here is the Forbes article, again:

“It is fascinating to observe the spectacle of politicians struggling to adhere to ideological principles that simply cannot be reconciled with the facts on the ground…Republicans despise federal government mandates and subsidies. But in their honest reflections, they know that Obamacare can’t be fixed without them and that their “replacement” plans will not meaningfully help those that cannot otherwise afford health insurance.”

Despite this lack of agreement, ACA repeal still seems to be very much on the table, and we face the very real possibility of a repeal vote without a clear replacement plan in sight.

Slow Motion Repeal

In the unlikely event that Republicans can’t quite bring themselves to pull the trigger on repeal, they are clearly implementing an alternative strategy of inaction and confusion that could have dire consequences for the ACA.

For example, insurers, like Connecticut-headquartered Aetna, continue to indicate that they view the ACA marketplaces as too risky.  The uncertainty inherent in a repeal-with-no-replace approach will only lead to greater marketplace instability and fewer insurers electing to participate in 2018 open enrollment, further weakening the program.

Another example of slow motion repeal is that the Trump administration significantly cut advertising spending in the crucial last four days of open enrollment.  Those ads were specifically aimed at younger, healthier people, needed to help stabilize the ACA risk pool.

Last week, the Trump administration issued an executive order regarding the ACA, which seems intentionally designed to sow confusion about the future of the program.

This statement by Sen. Patty Murray, reported in the February 1 edition of the on-line daily newsletter Politico Pulse, sums up the current situation:

“I want to be very clear: while my colleagues on the other side of the aisle do not have a plan, they are creating Trumpcare by sabotage.” ….”It is a broken system of chaos and uncertainty that will hurt, not help, families.”

So, even if the Republicans are not sure how to proceed, the administration is carrying out its own version of ACA repeal while millions of lives remain on the line.

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