Thanks To Efforts Of 4 Moms, Broad Institute Launches Initiative To Better Understand Food Allergies
Six years after promising a plan to “repeal and replace” the federal health law, House Republicans are finally ready to deliver.
The 37-page white paper, called “A Better Way,” includes virtually every idea on health care proposed by Republicans going back at least two decades. It would bring back “high risk pools” for people with very high medical expenses, end open-ended funding for the Medicaid program and encourage small businesses to band together to get better bargaining power in “Association Health Plans.”
What the plan does not include, however, is any idea of how much it would cost, or how it would be financed.
“It’s a framework,” a senior House Republican leadership aide said on a conference call with reporters Tuesday, with the specifics to be determined next year by congressional committees, assuming the GOP maintains its majority. He likened the document to the white paper issued just after President Barack Obama’s election by then-Senate Finance Committee Chairman Max Baucus, a Democrat. That document foreshadowed many of the key elements of the Affordable Care Act.
The plan starts with repeal of the health law and its requirements and taxes, but it would then put back many of its most popular elements: Allowing young adults to stay on their parents’ health plan to age 26; banning insurers from charging people with pre-existing health problems higher premiums; and forbidding insurers from dropping coverage if a policyholder gets sick.
It would repeal the current scheme of exchanges where consumers buy insurance and government tax credits to help moderate-income Americans pay their premiums if they don’t have an employer to help. Instead, everyone buying policies in the individual market would receive tax credits. Older people charged more by insurers would receive larger credits, though the House Republicans don’t specify how much.Use Our Content This KHN story can be republished for free (details).
But the GOP plan also would likely make insurance more expensive for older people by proposing a broader range for premiums based on age. Current premiums can vary only three-fold based on age, which is “driving out younger and healthier patients” who can’t afford them, the GOP aide said.
Under the plan, insurance companies could not charge higher rates to people with pre-existing conditions so long as they maintain continuous coverage, whether from an employer or in a policy they purchase themselves. The new high-risk pools would be available for those who have a break in coverage, or who fail to purchase during a one-time open enrollment under the plan.
The plan would get rid of most of the coverage requirements under the Medicaid program for the poor, so states could make them more or less generous than they are currently. It would also limit funding. States could opt for either a per-person cap or a block grant to spend much as they wish.
On Medicare, the proposal would encourage the existing movement of patients from the program’s traditional fee-for-service program to managed care plans, and would transition from the existing financing structure based on benefits to a controversial structure called “premium support” that puts cost-controlling responsibilities more on private insurance companies. That change has been pushed by House Speaker Paul Ryan for nearly a decade.
Backers of the existing health law were quick to criticize the GOP outline.
“Make no mistake, Ryan’s approach is not a better way forward, but a bitter path backward that returns us to the bad old days when vast swaths of Americans were left to the tender mercies of the insurance industry and could not afford needed care,” said Families USA Executive Director Ron Pollack, who pushed hard for passage of the Affordable Care Act.
“While House Republicans continue their efforts to repeal and undermine the Affordable Care Act, Democrats will work to defend the ACA so that every American has access to affordable and quality health care,” said House Minority Whip Steny Hoyer (D-Md.).
Mr. Chairman, Mr. Van Hollen, members of the Committee, I am always happy to come home to the House Budget Committee. My prepared testimony is brief. With your permission, I would like that testimony and three accompanying charts to be placed in the record.
In another sign of growing frustration with rising health costs, aerospace giant Boeing Co. has agreed to contract directly for employee benefits with a major health system in Southern California, bypassing the conventional insurance model.
The move, announced Tuesday, marks the expansion of Boeing’s direct-contracting approach, which it has already implemented in recent years in Seattle, St. Louis and Charleston, S.C.
Other large employers are also pursuing this idea in regions where they have big concentrations of workers. In some cases, they refer employees to nationally top-performing hospitals for select surgeries.
MemorialCare Health System said Chicago-based Boeing selected it from a group of bidders for the five-year contract in Southern California, where the company has roughly 37,000 employees and dependents. Financial terms weren’t disclosed.Use Our Content This story can be republished for free (details).
“More employers are interested in moving in this direction,” said Barry Arbuckle, chief executive of the MemorialCare Health System, based in Fountain Valley, California. “It reflects the desire of these employers to participate in bending the cost curve for health care, and it allows the provider to have a more unfettered relationship with the employer and employees.”
The new health plan will be offered to Boeing workers in Southern California during open enrollment this fall alongside some existing options, including a Kaiser Permanente HMO. Coverage starts Jan. 1.
MemorialCare, a large integrated health system spanning Los Angeles and Orange counties, partnered with other hospital systems and physician groups to create a broader network.
The partners include UC Irvine Health, Torrance Memorial Health System and PIH Health.
This MemorialCare Health Alliance will include nine hospitals, about 2,400 physicians and other providers, as well as 71 surgery centers, urgent-care facilities and other freestanding clinics.
“MemorialCare and its partners have a long track record of health care leadership and innovation in Southern California, as well as a strong market presence,” Jeff White, Boeing’s director of health care strategy, said in a statement. “Creating these partnerships is one of the innovative ways we are managing our health care programs to improve quality and efficiency.”
Boeing and other self-insured employers have typically hired health insurance companies to contract with hospitals and doctors and design their employee benefits. As medical costs kept escalating, employers and health insurers often narrowed their networks to negotiate lower rates and shifted more of the costs onto workers through higher deductibles.
Direct contracting is seen as another way to potentially save money while improving care and patient satisfaction.
In these contracts, health systems usually take on the financial risk of managing the health of a large population. The provider groups are often organized as accountable care organizations, in which physicians and hospitals share the financial responsibility for coordinating care and avoiding unnecessary spending.Accountable Care Organizations, Explained
An ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending.
This MemorialCare ACO designed for Boeing must meet numerous performance measures of quality, access and savings, Arbuckle said.
The Boeing contract “allows us to earn certain incentives or, if we don’t meet certain criteria, incur a loss on that particular aspect,” Arbuckle said. “There is no incentive to keep people in the hospital and go to multiple specialists. For us, this is where health care needs to go.”
Steve Valentine, vice president and West Coast consulting leader at health-care firm Premier Inc., said MemorialCare was a logical fit for Boeing, but plenty of health systems will be competing for these types of contracts.
“Most health systems have been building up their infrastructure to do exactly this kind of relationship,” Valentine said.
MemorialCare won’t have to handle all of the administrative chores of an insurer. Boeing uses its national insurance administrator, Blue Cross and Blue Shield of Illinois, to process claims for its direct contracts.
Boeing will offer workers several incentives to choose this new provider-backed health plan in California.
Enrollees will have no copays for primary-care visits. They will get full coverage for generic drugs and the freedom to choose specialists within the network without a referral. Emergency care will be covered as in-network even if it’s received outside MemorialCare. Boeing will also offer increased contributions to workers’ health savings accounts.
In other examples, Intel Corp. contracted directly with a major health system in New Mexico, where it has several thousand employees.
Retailers Wal-Mart and Lowe’s took a different approach, striking deals with select hospitals across the country for bundled prices on specific surgeries. The companies steer workers to those hospitals.
Amid early signs that insurance premiums under Obamacare might rise significantly next year, administration officials Tuesday previewed their plans to increase enrollment in the marketplaces, particularly among young adults who have been slow to sign up.
Open enrollment starts Nov. 1 and ends Jan. 31.
For the first time, the administration said it would send letters about marketplace coverage to uninsured people and to families who paid the individual mandate penalty for not having coverage or claimed an exemption from the health law requirement that they have coverage.
About 7.9 million Americans paid a penalty for lack of coverage in 2014. The Internal Revenue Service has not disclosed how many paid the fine for lacking coverage last year.Use Our Content This KHN story can be republished for free (details).
About 45 percent of 2014 taxpayers who paid a penalty or claimed an exemption from the penalty were under age 35, according to the Health and Human Services Department.
“This new strategy…will let us directly reach millions who were recently uninsured and may appreciate the value of marketplace coverage,” HHS said.
The administration will also:
- Email people if they open an account on www.healthcare.gov but do not select a plan and pay a premium.
- Encourage insurers to contact young adults before they turn 26 and move off their parents’ health plans to tell them about marketplace coverage options. New guidance from the Department of Labor makes clear that the sponsors of employer plans are allowed to provide specific information on health insurance plans that 26-year-olds can buy on the marketplace, HHS said Tuesday. The health law allows people to stay on their parents’ health insurance until 26.
- Help people pay for transportation to open enrollment events this fall where they can find help signing up. HHS has contracted with the ride-sharing service Lyft to provide discounts for those customers.
Nearly 13 million people signed up for health coverage under the Obamacare marketplaces this year. About 28 percent of them were between ages of 18 and 34. That group has the highest uninsured rate and generally enjoys the best health, which helps insurers control costs and balance the risks of covering less-healthy people.
Since the health law was fully implemented in 2014, the uninsured rate in the United States has fallen below 10 percent for the first time. In May, the rate fell to 9.1 percent, according to the Centers for Disease Control and Prevention.
Recent reports suggest health insurance premiums could increase by double-digit rates in several states in 2017. About 80 percent of marketplace enrollees are insulated from such increases by the government subsidies they receive based on their income levels.
Previously on this blog we have published articles related to developments in the refugee laws of particular countries in response to the current refugee crisis. For example, Elin wrote two posts on the refugee laws of Denmark and Sweden, and Theresa wrote a post on the European Union’s approach to the crisis. There are also a number of relevant articles on the Global Legal Monitor, which can be easily found by clicking on the “Refugees” topic.
We now also have an in-depth report on our website, titled Refugee Law and Policy in Selected Countries, that provides information on the laws and policies of twenty-two countries and the European Union regarding asylum seekers and refugees. The report was prepared by the Law Library’s foreign law research staff and is part of a growing collection of reports on important legal issues around the world.
There has been a dramatic increase in the number of refugees around the world in recent years. The refugee population of the world, which was estimated at 10.5 million in 2012, has nearly doubled in just three years. According to United Nations High Commissioner for Refugees (UNHCR) statistics, in 2015 there were around 65 million forcibly displaced persons worldwide, around 21 million of whom were refugees, of which 10 million were stateless. Over half of the 21 million refugees were children.
The UNHCR also estimates that 34,000 people around the world are forced to flee their homes every day to escape conflict or persecution. One such conflict is the Syrian civil war, which has resulted in over 4 million registered refugees in the past four years, with that number constantly increasing.
This crisis is placing pressure on the resources of host communities and has led to considerable debate about how countries should respond to the vast numbers of asylum seekers and refugees. In Lebanon, for example, a country with a population of around five million, there are more than 1.4 million registered refugees as well as a large number of unregistered Syrians in the country (estimated to be between 300,000 and 500,000). This situation is creating various pressures in the communities across the country, including overcrowded schools and clinics and soaring rent prices. Wealthier countries that are receiving refugees, albeit in smaller numbers, are also facing resource pressures. For example Sweden, which received over 160,000 asylum claimants in 2015 alone, has faced issues in providing housing for asylum seekers and refugees.
At the global level, there is discussion about how to change or strengthen current models for responding to refugee crises and the increasing burden faced by different countries. At the domestic level, a number of individual countries are applying their own refugee laws and policies in processing and supporting varied numbers of refugees. In some cases, new policies, special processes, and specific quotas have been instituted in response to the current crisis. Our report examines these developments and a number of broader issues, including the legal framework for governing the admission of refugees and handling asylum claims; the protocols and processes in place for dealing with asylum seekers arriving at the border; the refugee status determination process; public accommodations and assistance provided to refugees and asylum seekers; and integration policies (including access to employment and pathways to citizenship). It also includes a bibliography of selected recently published resources on refugee law.
The new Refugee Law and Policy report covers the following jurisdictions:Australia Brazil Canada China Denmark Egypt European Union Finland France Germany Greece Israel Italy Japan Jordan Kenya Lebanon Russian Federation Spain Sweden Switzerland Turkey United Kingdom
We often introduce our new multinational reports through this blog. Our more recent reports cover a wide range of contemporary foreign, international, and comparative law issues including counter-terrorism laws and other security measures, training related to combating human trafficking, and campaign finance laws. You can read many more reports on the Law Library’s website.
The House is slated to consider a bill tomorrow that could cause over 100,000 modest-income people to forgo health coverage and boost premiums for millions more — to pay for expanding health tax breaks that mainly benefit high-income people.