As President Donald Trump and Republicans in Congress devise a plan to replace the 2010 health law, new research suggests a key component of the law helped people with chronic disease get access to health care — though, the paper notes, it still fell short in meeting their medical needs.
Research published Monday in the Annals of Internal Medicine found that the number of chronically ill Americans with insurance increased by about 5 percentage points — around 4 million people — in 2014, the first year the law required Americans to have coverage, set up marketplaces for people to buy coverage and allowed for states to expand eligibility for Medicaid, the federal-state insurance plan for low-income people. If states opted into the Medicaid expansion, people with chronic illnesses such as heart disease, diabetes, depression and asthma were more likely to see those gains.
Still, the study suggests, the law fell short in terms of guaranteeing those people could get medical treatment, see a doctor and afford medications.
The study is the first to examine how the health law affected people with these long-term diseases, which require careful and continuous management, and whose treatment drives a vast majority of the nation’s health care costs. If these people don’t get regular treatment they are especially likely to wind up needing emergency care.Use Our Content This KHN story can be republished for free (details).
“This hones in on the patients that are most dependent on having coverage and access,” said Danny McCormick, an associate professor at Harvard Medical School and senior author on the study. “Most chronic conditions require ongoing treatment. And if you don’t get it, often it results in more expensive care downstream.”
As the GOP crafts its replacement plan, those findings could indicate what elements of the law are worth keeping, and what needs to be addressed. The Medicaid expansion in particular has come under heightened scrutiny from the GOP. This past weekend, a senior aide to President Donald Trump also said the administration wants to turn control of the program over to states, which experts say could result in less funding.
The researchers say their findings suggest reversing the Medicaid expansion would pose significant problems for people with long-term illness.
They used data from the Behavioral Risk Factor Surveillance System — an annual survey jointly run by state health departments and the Centers for Disease Control and Prevention — to examine records for more than 600,000 adults with at least one chronic condition. Diseases included coronary artery disease, stroke, asthma, pulmonary disease, diabetes, depression and arthritis. They compared insurance rates in the three years and examined whether people used that insurance to see a doctor.
“There’s a clear difference between what happened for [chronically ill] individuals in states, based on how states implemented Medicaid. The Medicaid expansion was one of the strongest parts of the law,” McCormick said.
If policymakers are serious about using health dollars more efficiently, and getting better health outcomes, he added, the findings support including such an expansion in any new policy platform.
The paper builds on research suggesting people generally were more likely to get insurance if they lived in states that expanded Medicaid. States such as West Virginia, Illinois and Kentucky — which opted into the expansion — saw double-digit gains in coverage of chronically ill people.
“Medicaid expansion is one of the tools you would think of to help people with chronic conditions – and we are seeing more evidence this is the case,” said Benjamin Sommers, an associate professor of health policy and economics at Harvard’s public health school, who was not involved with this study. “The question of whether this informs [the policy] debate — it clearly should. It clearly should be relevant.”
That said, Obamacare was hardly a panacea, the researchers argue. Even after the law’s insurance changes, about 15 percent of people with chronic disease didn’t have coverage. More than one in four didn’t have a check-up in 2014. About 23 percent of people with chronic disease still had to go without doctors’ visits because of factors like cost. And those gaps were more pronounced for blacks and Hispanics. They were more likely on average to remain uninsured even after the health law took effect and to face obstacles in using new health insurance if they had it.
The paper suggests some possible causes: People didn’t understand how to use their insurance, or they had plans that required them to pay out of pocket large copays or deductibles — flat spending fees consumers have to front before coverage kicks in. Many marketplace plans were categorized as “high-deductible plans.”
“You’ve got hypertension or diabetes, and you have a very low income. It’s really hard to take your medications” without coverage and minimal cost-sharing, McCormick said. “Someone who’s insulin dependent who doesn’t get insulin? it’s going to result in an emergency room visit, or a hospital visit. There’s a large potential for downstream complications.”
But those gaps in coverage and access to care probably got smaller in the years following 2014, Sommers suggested. Other research has shown that with time, more people got insurance and learned how to use it.
“This is likely the tip of the iceberg in terms of what the Affordable Care Act was doing,” Sommers said. “It’s useful and part of a larger body of evidence making it clear access to care has improved among a range of populations.”
But, he noted, the findings do emphasize an important issue: The health law by itself did not expand health care to all Americans, or even all Americans with chronic conditions.
“The Affordable Care Act is not a universal coverage law. It’s a huge expansion for coverage but still left 20 to 30 million uninsured,” he said. “Even for those with coverage, some are still experiencing challenges.”
Trump has not yet offered his plan but said universal coverage will be part of his health care plan — although aides have since walked back on that claim. Meanwhile, an analysis this month by the nonpartisan Congressional Budget Office suggested that the repeal plan offered last year by Republicans eventually would increase the uninsured population by as many as 32 million.
As Cabinet nominee Tom Price faces a Senate confirmation hearing Tuesday, a newly released trove of documents sheds further light on how he interacted as a congressman with the Centers for Medicare and Medicaid, the massive agency he may soon oversee.
Letters provided by CMS after an open records request show that the Health and Human Services pick has repeatedly stepped up in favor of drug firms, device manufacturers and higher physician payments, leading some experts to question whether he would be a reliable advocate for the public’s health.
The documents reveal additional instances where Price, a doctor from Georgia, set aside his priority of budget discipline in favor of special medical interests, including by sending a letter endorsing a medical procedure that Medicare later decided not to pay for, pointing to weak evidence that it helped patients get better.
“He’s clearly shown in this case and in other ways allegiance to the corporate interest, but not to the patient interest,” said Diana Zuckerman, president of the National Center for Health Research, a nonpartisan think tank that has studied medical device safety.This KHN story also ran in The Daily Beast. It can be republished for free (details).
Price aligned with pharmaceutical firms in one letter, criticizing a policy meant to steer doctors away from the costliest drugs. He also sided with physicians who balked at a move to cut their pay for epidural pain relief injections.
A spokesman for the Trump transition, Phillip Blando, said Price has “always brought a compassion and commitment” to caring for patients and his public service as a lawmaker.
“Any suggestion that his motivations for public service have been anything other than seeking to improve the lives of the American people is simply wrong,” Blando said in a statement.
On Wednesday, Democratic lawmakers pressed the Republican congressman on his investments and elicited few details on the congressman’s plans for replacing Obamacare during a four-hour Senate health committee hearing.
Pointed questions came from Sen. Patty Murray, D-Washington, who grilled Price about his investment in an Australian drug company, Innate Immunotherapeutics. Price bought stock cheaper than what was offered on the open market, according to a Kaiser Health News report cited in the hearing.
Newly released documents show that in August, Price signed a letter to Medicare criticizing the use of “step therapy” in the drug program for seniors. The policy encourages doctors to first prescribe low-cost, established drugs and determine if they’re working before going to newer, more expensive options. In the letter, Price and eight other lawmakers said the program should remain flexible enough that it does not “take prescribing power out of the hands of physicians.”
Julie Donohue, co-director of the University of Pittsburgh Center for Pharmaceutical Policy and Prescribing, said Medicare’s use of step therapy is one of the few tools it has to contain soaring drug costs.
“Unfortunately, unfettered choice of medicines … leads to higher drug spending and higher cost for taxpayers, so you have to strike the right balance,” Donohue said.
Another letter in 2013 would have helped major pharmaceutical firms by reducing the reports they must file on educational materials they hand out to doctors. Price and 22 other lawmakers wanted to relieve the companies from reporting what they spend giving doctors journal article reprints or textbook chapters. At the time, Medicare declined to make a change.Related Stories
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Dr. Adriane Fugh-Berman, a physician and Georgetown University professor who studies drug industry relations with doctors, said the disclosure is important since such materials handed out to doctors are often vetted and controlled by drug companies, and then are used as promotional materials by sales teams.
A proposal similar to the 2013 letter recently emerged as a flashpoint before the 21st Century Cures Act passed in December. Then, Sen. Charles Grassley threatened to hold up the bill over a provision exempting drug firms from reporting on the handouts, as well as another stream of funding, continuing education to doctors.
“With taxpayers and patients paying billions of dollars for prescription drugs and medical devices, and prices exploding, disclosure of company payments to doctors makes more sense than ever,” Grassley said in a November statement, spurring the provision to be dropped.
Another letter shows Price endorsing a medical procedure before it was proven to help patients.
In a 2012 letter, Price urged Medicare officials to assign a payment code for a new procedure meant to relieve a condition associated with lower back pain. Price’s letter notes that the procedure was pioneered by a California company called Vertos Medical that sells the device used to perform the spinal operation.
“We have spoken with providers unaffiliated with Vertos who … have confirmed that this is a significant therapy that we need to advance,” according to the letter signed by Price and Dr. Bill Cassidy, a Republican Louisiana senator who is also a physician.
Lobbying records show that Vertos spent $70,000 on lobbying in 2012, the same year Price and Cassidy sent the letter. Lobbying records do not show whether Vertos reached Price. Vertos and its lobbyist, Jeffrey J. Kimbell & Associates, did not respond to requests for comment.
The doctors’ request to Medicare, though, did not achieve the desired outcome. Medicare officials later examined research saying the procedure had helped patients, but issued a decision refusing to pay for it, citing “weak studies, questions about missing information, questions about adverse events and conflicts of interest.”
The Medicare decision says “the evidence does not support a conclusion of improved health outcomes for our Medicare beneficiaries.”
Price waded in with the Congressional Doctors Caucus in early 2014 over another controversial medical procedure. He and seven other lawmakers signed a letter complaining about a Medicare pay cut to doctors who perform epidural pain-relief injections on patients’ spines.
The letter also came after researchers began to question whether the side-effects of the spinal injections — including nerve damage, paralysis and strokes — were worth the short-term pain relief benefit, according to a report in the journal Surgical Neurology International.
Medicare responded to lawmakers’ concerns over the proposed pay cut, saying it was the result of an analysis comparing doctor pay rates to the amount of time the services take to perform. Medicare ultimately reduced the scope of the pay cut, though, after heavy lobbying by pain physicians and lawmakers.
Murray and other Senate Democrats have called for a House ethics inquiry into Price. Public Citizen, a nonprofit government accountability group, also filed a complaint with the Securities and Exchange Commission.
“After this week’s hearing, I’m afraid we have more questions than answers about Congressman Price’s stock trades and the kind of information he had when they were made,” Murray told reporters Thursday. “I remain deeply disappointed that Republicans brushed aside these serious concerns and decided to hold his nomination hearing anyway.”
Lawmakers have recently called for an investigation into Price’s purchase of six pharmaceutical company stocks in March, weeks before he led a bipartisan effort to quash a policy change that would have hurt the companies’ bottom line. In last week’s hearing, Price said his stockbroker made the purchases without his knowledge.
HOUSTON — Donning a protective gown, rubber gloves and a face mask, Dayna Gurley looks like she’s heading into surgery. But Gurley is a medical social worker charged with figuring out why her client, a man who uses more health care services than almost anyone else in Houston, has been in three different hospitals in the last month.
The patient, who asked not to be identified, has chronic massive ulcers, AIDS and auditory hallucinations. He rents a cot in another person’s home but is more often homeless, with no family to help him.
“It’s almost like self-sabotage,” Gurley said about her many attempts to steady her client’s life. “We get really close to an important doctor’s appointment or getting him connected with stable housing, and his impulsiveness gets in the way of that.”
Patients like the Houston man are health care’s so-called “super-utilizers”— people with complex problems who frequent emergency rooms for ailments more aptly handled by primary care doctors and social workers. They cost public and private insurers dearly — making up just five percent of the U.S. population, but accounting for 50 percent of health care spending.
As health care costs continue to rise, hospitals and doctors are trying to figure out how to find these patients and get to the root of their problems.
An effort to do just that started in New Jersey’s poorest city, Camden, more than a decade ago. Inspired by the way police departments mapped crime data to detect “hot spots,” family physician Dr. Jeffrey Brenner dug into ambulance records and emergency department data to show how high-cost patients were shuttling between city hospitals.
“In America, we’re medicalizing social problems and we’re criminalizing social problems, and we’re wasting huge amounts of public resources,” Brenner said. “We have the wrong tools to solve the wrong problem.”
To steer patients away from expensive emergency care and push health systems to change the way they do business, the Affordable Care Act funds programs called Accountable Care Organizations. These are networks of hospitals, physicians and others who team up to improve care, lower costs and reap the savings.
Brenner’s team at the Camden Coalition includes Latonya Oliver and Bill Nice, social workers who seek out patients like Peter Bowser in local neighborhoods. Bowser was once homeless and went to the emergency department nearly 30 times in one year.
But after Oliver and Nice helped get a permanent roof over his head, Bowser’s trips to the ER all but stopped.
“I think you’d prefer to spend your time here than in the hospital any day of the week,” Nice said to Bowser on a recent afternoon, gathered at the kitchen table in his tidy apartment.
This high touch, data-driven approach has yielded big savings. ER visits for the first group of patients dropped by 40 percent, cutting monthly hospital bills from $1.2 million dollars to $500,000.
Since then, Brenner has sought to spread the model around the country. One example is the Patient Care Intervention Center in Houston, a sprawling city desperate to aid its sickest and most isolated patients.
While the more than 100 hospitals here typically know their own super-utilizers, they had no way of knowing the top users across the entire city.This KHN story also ran on PBS NewsHour. It can be republished for free (details).
Tackling that problem took unprecedented planning among typically disjointed city and county agencies, hospitals and nonprofits. Now, many of the hospitals in Houston and the fire department pool their data and send it to Kallol Mahata, a former oil industry IT engineer with the patient care intervention center who combines it into one database.
Mahata and Dr. David Buck, the group’s founder, help to identify patients at the top of the list—the outliers of the outliers.
Teams are dispatched to parks and neighborhoods to find the patients.
Firefighters and paramedics like Thomas Pierrel often know these residents from 911 calls. But this time, their mission is different: to encourage them to enroll in the volunteer program.
Inside one super-utilizer’s threadbare home, Pierrel makes his pitch. “We go with you to your doctors, we make appointments, we find specialists. We try to maximize the resources that you have,” he tells the prospective client.
The results of these intensive interventions can be stunning.
Timmy Williams was dying when Dayna Gurley found him.
He was holed up at home and reeling from untreated HIV that had progressed to AIDS. He couldn’t take care of his young son and cycled through Houston’s hospitals.
“When we first met Timmy, he was very hard to engage,” Gurley recalled. “We knew that he probably was not taking any of his medication, and he was very skinny.”
She arranged for a home aide to care for Williams seven days a week, got his apartment cleaned and the lights turned back on.
Now, Williams’ HIV is undetectable and his health — and life — have been steadied.
In the two years since Houston’s Patient Care Intervention Center has been up and running, costs for those in the program have gone down 83 percent and hospital visits by 70 percent.
But it can be difficult to keep these programs moving. Often insurance companies and government payers reap those savings, rather than hospitals. Buck and Dayna Gurley were once banned from a Houston hospital whose executives feared losing money if their high-cost patients stopped showing up.
“Nobody wants to take ownership of any of it,” said Buck, his voice bristling with frustration. “The people just want ownership of what they have authority over, and that’s really the issue: each of these areas are little fiefdoms.”
Back in Camden, even Brenner is less optimistic than he once was. His office now overflows with pillows and kitchenware for clients the Camden Coalition is trying to place in housing. And he thinks homelessness and entrenched financial interests in health care are the biggest barriers.
“I think this is going to take a lot longer than I ever imagined,” he said. “I think we’re in a 20-year arc of recalibrating and rethinking what is health and what’s health care? What’s the purpose of our health care system? What are we trying to accomplish?”
But Brenner still believes these intensive efforts are the best way to help patients like Timmy Williams. He’s now healthy enough to make his way around the city on his own, says Gurley, and her super-utilizer team did more than rescue him from his darkest days.
“I had to put it in my head that no one is going do it for me,” he said. “I have to do it for myself. I have to step out and do it myself.”
At home now with his son, his illness no longer gets in the way of being the father he wants to be.
But it’s unclear how these efforts will be affected by a Trump administration, which along with congressional Republicans wants to repeal the health law.
PBS NewsHour producer Jason Kane contributed to this report.
Paula Wilson has seen some tough times in her 23 years as the CEO of Valley Community Healthcare, a clinic that provides care for the poor in North Hollywood, Calif. But nothing was quite like Nov. 9, the day after the U.S. elections, when walking around the office “was like coming into a funeral,” she said.
Her staff worried that a repeal of the Affordable Care Act, long promised by Republicans, would obliterate their jobs. Patients fretted it would jeopardize their care.
Nearly a third of the clinic’s 25,000 patients were newcomers, many of them recently covered through the expansion of Medi-Cal ushered in by the Affordable Care Act. Thanks to the expansion, Valley Community Healthcare had been growing rapidly, opening one new site, adding on to others, and offering patients new dental and mental health services.
What would happen if this new source of financial support were taken away?
Wilson didn’t have an answer that day, and she still doesn’t. But she’s hanging on to a cautious hope. “Pretty much that whole first week was getting a grip and assuring people: We’ve been here 46 years and we’re not going anywhere,” she said. “We’ve fought the fight before, and we’ll do it again.”
In the absence of details about the impact and timing of a possible ACA repeal, Wilson’s brand of determination is all community clinics can count on for now.Use Our Content This story can be republished for free (details).
Republicans, newly empowered by Donald Trump’s ascendance to the White House, have made clear they plan to repeal large parts of the landmark health care law in short order. The timing of any replacement is still uncertain, though political pressure has been growing recently for any void left by a repeal to be quickly filled with a new plan. For the time being, however, consumers are unlikely to see big changes in their health care.
Community clinics are key providers of primary care services for the poor. CaliforniaHealth+ Advocates, which represents the state’s clinics, estimates that they serve 6.2 million Californians — an increase of more than a million in less than five years. Today, more than 3.5 million community clinic patients are covered by Medi-Cal, California’s version of Medicaid, the federal health insurance program for people with low incomes.
More than half of patients who signed up for Medi-Cal after the advent of the ACA have gotten their primary care at community clinics, according to a December 2015 report by the California Health Care Foundation. (California Healthline is an editorially independent service of the California Health Care Foundation.)
Historically supported by Democrats and Republicans alike, community clinics worked hard to implement Obamacare reforms, and they benefited as a result. Many, like Valley Community Healthcare, helped enroll patients and expanded their services, taking advantage of special ACA funding that enabled them to improve their facilities and systems of care.
The same scenario has played out nationwide at many of 1,400 federally backed community health centers — a type of community clinic — according to two studies published recently in the journal Health Affairs.
One of the studies, which used data from 2012 to 2015 to track visits to community health centers, showed that in states that adopted the Medicaid expansion, the centers saw more patient visits, including those for mental health treatment, and lower rates of uninsured patients — a financial boon for clinics that typically operate on thin margins.
The second study, which examined data from 2011 to 2014, found that in the Medicaid expansion states, patients were more likely to receive asthma treatment when it was needed, have their body mass index assessed, get pap smears and keep their blood pressure relatively stable.
Proponents of the health reform law in California had hoped the expansion of community clinics would provide primary care for more patients, thus reducing expensive emergency room visits at safety-net hospitals.
“Health centers have been the poster child of positively embracing the ACA. They’ve gone along with everything,” said Blue Shield of California Foundation CEO Peter Long, whose organization supports the clinics. But without clarity about where funding will come from in the future, or how much of it there will be, it’s possible that clinics will “go into hunker-down mode,” he added. That could mean limiting hours, reinstating waiting lists for new patients and cutting promising new programs.
Implementing Obamacare “put a lot of stress on their systems,” Long said. “To unwind it would be equally hard.”
Wilson and other clinic CEOs say they’re trying to anticipate worst-case scenarios and plan accordingly, but that’s hard when Congress hasn’t specified what changes it is planning, or when to expect them.
“Right now it’s all crystal ball gazing,” said Steven Wallace, associate director of the UCLA Center for Health Policy Research. “‘Repeal and replace’ is a great slogan, but ‘replace’ is really hard to figure out.”
Community clinic leaders say they’re focusing on several funding challenges. First is a potential rollback of the ACA’s Medicaid expansion program, which extended new coverage to about 20 million people in the U.S., including more than 5 million in California, said Carmela Castellano-Garcia, CEO of CaliforniaHealth+ Advocates.
Some also worry that shifting Medicaid to a block grant system, an idea President Trump has endorsed, would result in cuts to services; or that Congress could decline to reauthorize “330 funding” — an additional $5 billion community clinics receive each year from the federal government. That stream of federal dollars is set to expire in September 2017.
That funding, in addition to payments from the Medi-Cal expansion, allowed the Los Angeles Christian Health Centers to add medical, mental health, dental and case management staff and open two new sites.
The clinic, headquartered on Skid Row in downtown Los Angeles, also launched a fundraising campaign to revamp and enlarge its flagship facility. But CEO Dr. Lisa Abdishoo now worries that some financial assumptions made in planning the expansion may no longer apply now that Trump has been sworn in. “We’re trying not to panic, but now we have to question the sustainability of some of the growth,” she said.
Health care advocates have advised community clinics that they may need to “look at 2009 levels” to plan for post-ACA operations, Abdishoo said. That year, Los Angeles Christian Health Centers served 6,600 patients a year, compared to 10,000 today.
Jane Garcia, CEO of La Clínica De La Raza, a 32-site clinic network in Alameda, Contra Costa and Solano Counties, said her organization could lose ground on hard-fought cost reductions if people’s insurance is taken away and they revert to their old behavior of seeking care only when they are very sick.
“Patients who don’t have coverage hesitate to come in and see the doctor, and they hesitate to seek preventive care,” Garcia said. “That’s the kind of thing that was starting to have an impact on bending the curve on cost reduction.”
ACA-related grants allowed La Clínica’s health centers to improve case management and collaborate more effectively with partners such as Sutter Health, which also saved money by reducing the number of patients seeking primary care in emergency rooms. La Clínica would probably have to cut such administrative efforts were the ACA repealed, Garcia said.
Pamela Richardson, a 60-year-old patient of Valley Community Healthcare who suffers from an iron absorption disorder called hereditary hemochromatosis, was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.
Once Richardson was covered, she got long-delayed primary care, which revealed that she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have pap smears,” she said. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”
Wilson, Castellano-Garcia and others said they plan to make precisely that case — that community clinics represent a good value — once state and federal officials begin mulling an ACA replacement in earnest.
A November 2016 study in the American Journal of Public Health showed that Medicaid spending was 24 percent lower for patients who received a majority of their primary care from federally qualified health centers — a type of community clinic — than for patients who got care in other settings. The savings extended across all services, the study’s authors reported.
In rural Shasta County, where a majority voted for Trump, one in three people has Medi-Cal coverage. Dean Germano, CEO of Shasta Community Health in Redding, said he has already launched conversations with staffers of Republican U.S. Rep. Doug LaMalfa, whom he considers “a friend of the health centers.”
“Our mission is to make people like him realize what [repeal] will mean for people on the ground,” Germano said. “If the system goes through a major shock, what would happen to jobs? It would have a major impact on rural communities.”
Another clinic CEO, Kim Wyard of Northeast Valley Health Corporation in San Fernando, said she takes heart because Congress will have to do something to replace what it is taking away. Just blowing everything up isn’t an option, she said.
“We need a safety net, and if more patients are uninsured, we’ll need it more,” Wyard said. “We’re cost-effective,” she added. “Our new president wrote ‘The Art of the Deal.’ He likes a deal. I don’t think there’s a better deal than health centers.”
Shefali Luthra contributed to this report.
Nationwide, the wholesale infant sleep industry is worth more than $325 million a year, according to figures reported by companies to the Juvenile Products Manufacturers Association. Jenny Gold’s story on the industry aired on Marketplace on Jan. 16.
Repealing and replacing the Affordable Care Act has been considered the new Trump administration’s top priority. But you wouldn’t know that from the new president’s earliest actions.
President Donald Trump’s brief inaugural address mentioned many of the issues he raised repeatedly on the campaign trail — jobs, immigration and trade policy. But there was not even a brief mention of his plans to improve health care.
The new White House website was similarly silent on anything health related. Under the “issues” section it includes energy, foreign policy, jobs, the military, law enforcement and trade. But no health section.
The website for the Department of Health and Human Services, however, while scrubbed of any outgoing Obama administration personnel, still features ways to sign up for coverage under the Affordable Care Act. Open enrollment continues until the end of the month.
Trump voters in Washington for the inauguration didn’t seem fazed by the lack of attention to the issue, however.Use Our Content This KHN story can be republished for free (details).
“I believe he’s going to make a difference when he changes Obamacare into something new and better,” said Kim Traffanstedt of Plant City, Fla. “With all the ideas they’ve been working on now for a while, it’s going to make a difference to a lot of people.”
“I think there is a specific plan, he just hasn’t revealed it yet,” said Kathy Bohn of Bloomington, Ill.
As recently as last week, Trump told The Washington Post that he was putting finishing touches on a health plan that would guarantee “insurance for everybody.”
Those comments, however, were quickly walked back by staff. Meanwhile, progress on the nomination of Trump’s choice to lead HHS, Rep. Tom Price, R-Ga., has been slowed by allegations of conflicts of interest involving his ownership of stocks in health companies while he served on congressional committees overseeing health issues.
Congress has already taken the first step toward overhauling the Affordable Care Act. Both the House and Senate passed a budget resolution that orders committees to begin writing bills that would eliminate portions of the law that directly affect the budget.
But even while that bill (which has yet to be written) could pass the Senate with a 51-vote majority, Republicans have only 52 seats in the Senate and more than a half dozen senators have expressed reservations about repealing the law without an immediate replacement.
House and Senate Republicans are scheduled to discuss the matter in more depth next week at their retreat in Philadelphia. Trump and Vice President Mike Pence are scheduled to attend.
Kaiser Health News reporter Rachel Bluth contributed to this article.