Daily on Healthcare: ‘Trumpcare’ plans are working

By | February 12, 2019

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‘Trumpcare’ plans are working. When the Trump administration rolled out a plan to provide a less expensive alternative to Obamacare by allowing workers and small businesses to pool together to buy insurance, Democrats charged that it was opening the door to worthless “junk” and “skinny” plans. The early evidence suggests that, on the contrary, the initiative is working out — at least for now. The alternatives, known as “association health plans,” have been covering the same benefits that Obamacare plans do, even though they are not obligated to, according to analyses by the industry publication Modern Healthcare and another by AssociationHealthPlans.com. Just like Obamacare plans, they are paying for prevention, visits to the doctor’s office and the hospital, emergency medicine, prescription drugs, maternity care, and mental healthcare. The plans are also covering people with pre-existing conditions, such as cancer or diabetes. In fact, they’re required to, an aspect of their coverage that was not well publicized, according to Kev Coleman, president of AssociationHealthPlans.com. “That’s something that was lost in the mix,” he said. At least 28 plans have launched in 13 states, according to Coleman’s analysis. Chambers of commerce, trade associations, and people who are self-employed have been enrolling.

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But is it just a honeymoon phase? Despite favorable early going, critics warn that it is only a matter of time before some unwanted pre-Obamacare practices creep back. The plans are allowed to charge people more based on age, health status, and gender. Sabrina Corlette and Kevin Lucia at the Center on Health Insurance Reforms at Georgetown University have warned that the plans offer low “teaser” rates when they first roll out but then, when it is time for people to renew their coverage, might hike prices based on how sick an enrollee is and could charge older adults more. “Because these plans lack consumer protections, plans that do cover essential health benefits could reduce coverage at some point, leaving consumers in the dark,” the pro-Obamacare advocacy group Protect Our Care said in a statement. “Fundamentally, association health plans open the door to coverage that is not comprehensive and have a long, well-documented history of fraud and abuse.” The Obama administration initially moved to limit association health plans because they suffered insolvency problems. In the years before Obamacare, hundreds of thousands of people were left holding the bag for millions of dollars in unpaid medical bills when similar plans failed. Following the Trump administration’s rules, most of the plans are being run by outside health insurers, such as UnitedHealthcare and Blue Cross Blue Shield, reducing the likelihood that they’ll become insolvent. That, too, may change over time. Outside health insurers have been allowed to run the plans since September 2018, and associations were only allowed to begin running their own plans beginning in January 2019. New associations that form cannot get started selling plans until April.

Still waiting on insurance sale across state lines. One Trump administration promise for the plans that has yet to materialize is that they will permit the sale of insurance “across state lines.” So far, only one of the plans is selling in multiple states, the farm cooperative Land O’Lakes, available in Nebraska and Minnesota. The business has said its premiums could be a third lower than those sold on the Obamacare exchange. The American Veterinary Medical Association and other groups are aiming to set up plans across state lines in the months ahead.

Utah governor scales back voter-approved Obamacare Medicaid expansion. Utah Gov. Gary Herbert signed a bill into law Monday that will roll back the Medicaid expansion to the poor under Obamacare that voters approved in November. Herbert, a Republican, said in a statement that the bill “balances Utah’s sense of compassion and frugality” and that it would provide coverage in a “meaningful, humane and sustainable way.” It provides government healthcare to people making 100 percent of the federal poverty level, rather than the 138 percent level allowed under Obamacare. 60,000 fewer people will be enrolled in Medicaid as a result. Because the bill doesn’t fit into Obamacare’s requirements, it must first be approved by the Trump administration. Federal officials have yet to allow such a “partial expansion” in any state, though both Arkansas and Massachusetts have asked for one and Georgia is preparing to unveil its own version. The Medicaid legislation includes a provision allowing the full expansion to proceed if federal officials reject the partial expansion.

Trump administration proposes rules so patients can get their medical records more easily. The administration is working to get rid of barriers on electronic health records so patients can better access their health data. Right now, healthcare facilities often block patients from getting information, charge them a fee to obtain it, or only provide paper print-outs or information on disks. Even, then the data tend to be incomplete. The administration wants to clear the way for this information to be as easily obtainable as it is in other industries, such as banking, where people can use their smartphones to access what they need. The Centers for Medicare and Medicaid Services has proposed letting patients access their information electronically without a fee and having insurers provide more information on the costs of medical services if they offer plans tied to government programs. It also suggests that hospitals send digital notifications to doctors when their patients are admitted, transferred, or discharged at a hospital, or otherwise lose Medicare funding. Most healthcare facilities use electronic records. The push for doctors and hospitals to move their data from paper to electronic records was subsidized by the federal government as part of the Obama administration’s economic stimulus package.

FDA fires off warning letter to McKesson over improperly distributed meds. The Food and Drug Administration on Tuesday sent its first warning letter under the Drug Supply Chain Security Act to distributor McKesson Corp., saying the company didn’t properly address different tampering incidents for opioids or other medications treating HIV, seizures, bipolar disorder, and high blood pressure. In one example, a customer notified McKesson that a pill container was supposed to have opioid painkillers but contained another medication instead. The medication had been swapped out when it was in McKesson’s possession, an internal investigation showed, but the FDA concluded that the company didn’t do enough to stop something similar from happening in the future. It also didn’t notify other customers about what had happened. Every company that sells and distributes drugs is by law required to have ways to investigate suspect medications. FDA officials inspected the companies practices this summer and found it failed to properly respond to notifications that there was illegitimate product in their supply chain, to quarantine and investigate suspect products, and to maintain records of investigations of suspect product and disposition of illegitimate products.

House GOP wants more work on opioids. House Republican leaders sent a letter to Democratic leaders on Monday asking for the Energy and Commerce Committee and its Health Subcommittee to get back to work on fighting the opioid crisis. They want Democrats to organize hearings that would evaluate how the bill passed last year is working and what other policies they can pursue. “While we made great strides working together last Congress, our work is far from done,” wrote Reps. Greg Walden, R-Ore., Michael Burgess, and Brett Guthrie, R-Ky.

Youth smoking soared in 2018 and the government blames e-cigarettes. The Centers for Disease Control and Prevention reported Monday that tobacco use among middle and high school students had soared by over 30 percent, an increase the agency blamed on the ongoing rise of e-cigarettes.”The skyrocketing growth of young people’s e-cigarette use over the past year threatens to erase progress made in reducing youth tobacco use,” warned CDC Director Robert Redfield. “It’s putting a new generation at risk for nicotine addiction.” In 2017, only 3.6 million youths used any type of tobacco product. In 2018, the number skyrocketed to over 4.9 million. The CDC attributed the whole increase to e-cigarettes, with 1.5 million youths picking up the habit just this last year, making e-cigarettes the tobacco of choice among nearly 80 percent of youths. Scott Gottlieb, commissioner for the Food and Drug Administration, said the rise of youth smoking will require his agency to look into further regulation of the vaping industry. “I fear this trend will continue in 2019, forcing us to make some tough decisions about the regulatory status of e-cigarettes,” he said.

Following annual physical PETA has its own imPEACHment message for Trump. The animal welfare group sent a basket of U.S.-grown peaches to the White House on Monday, urging the president to embrace a plant-based diet. People for the Ethical Treatment of Animals attached its pamphlet on becoming a vegan to the basket, along with a letter touting the benefits the lifestyle has for heart health. “I am sure you were pleased with the results of your recent physical,” wrote Ingrid Newkirk, PETA president. “However, there is still cause for concern, as you must know — so we’re sending you a basket of plump peaches to give you a warm, fuzzy feeling and hopefully help you launch a probe into an even healthier way of eating.”


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TUESDAY | Feb. 12

Feb. 11-13. Grand Hyatt. American Medical Association National Advocacy Conference. Agenda.

Feb. 11-14. Orlando. Healthcare Information and Management Systems Society annual meeting. Agenda.

10 a.m. 2358-A Rayburn. House Appropriations hearing on status of operations for the Food and Drug Administration. Live Stream.

10 a.m. 430 Dirksen. Senate Health, Education, Labor, and Pensions Committee hearing on “Managing Pain During the Opioid Crisis.” Details.

10 a.m. 1100 Longworth. House Ways and Means Committee hearing on “The Cost of Rising Prescription Drug Prices.” Details.


10:30 a.m. 2322. House Energy and Commerce hearing on “Strengthening Our Health Care System: Legislation to Reverse ACA Sabotage and Ensure Pre-Existing Conditions Protections.” Details.

2 p.m. Commonwealth Fund Teleconference on “Making Health Care Price Transparency Work for Consumers.” Details.

4 p.m. National Academy of Medicine Webinar on “Action Collaborative Countering the U.S. Opioid Epidemic.” Details.

FRIDAY | Feb. 15

1 p.m. 1789 Massachusetts Ave NW. American Enterprise Institute event on “Sense and severability: If one part of the Affordable Care Act is ruled unconstitutional, what is the proper remedy or resolution?” Details.