Health Care – Page 10

President’s Latest Attempt to Destabilize Healthcare

This morning, despite ongoing bipartisan efforts to stabilize the individual insurance market following the failure of Congress to pass legislation to repeal and replace the Affordable Care Act, President Trump signed an Executive Order (EO) allowing for the creation of new association health plan (AHP) options for small employers and individuals. AHPs currently exist and are used primarily by small businesses to purchase group health coverage, but are regulated under the provisions of the ACA in the same way as coverage purchased on the individual health insurance market. Today’s EO in effect treats AHPs as large group health insurance plans and allows coverage under AHPs to be sold across state lines.

Treating AHPs in this way exempts them from important provisions covered under the ACA. As a reminder, the ACA includes provisions on insurance plans sold on the individual market which:

Require plans to cover 10 Essential Health Benefits including reproductive and maternal health services and preventive services;
Forbid insurers from charging more to individuals due to pre-existing conditions;
Limit the amount insurance companies can charge to older individuals based on age.

The American Nurses Association opposes any action – legislative or executive – which would put at risk the ability of Americans to access and receive high quality healthcare. This is particularly true when it comes to the most vulnerable Americans. It has become increasingly clear that this administration is more concerned with scoring political points and reversing gains made in healthcare than it is about actually ensuring high quality healthcare coverage for all Americans.

As a result of this EO, AHPs would be permitted to offer coverage that does not include the 10 Essential Health Benefits required to be covered under insurance plans offered through the ACA exchanges. AHPs would also be allowed to charge different prices to consumers based on age and health – including charging more for individuals with any host of pre-existing conditions.

This EO allows AHPs to sell insurance coverage which offers fewer benefits at variable prices depending on an individual’s health. This would certainly be an attractive option for someone who is young, healthy, and does not anticipate needing to use a high volume of healthcare services. The flipside is that this would have a negative impact on older adults and individuals with pre-existing conditions. The cruel irony with this plan is that these individuals would likely be stuck with plans in the individual marketplace, as they would not be able to afford the coverage offered under AHPs – which would likely not provide coverage for necessary care.

Furthermore, these insurance plans are ripe for instances of fraud, abuse, and insolvency. The Government Accountability Office in 1992 issued a report which slammed similar small business insurance arrangements and noted that they left hundreds of thousands of enrollees with millions of dollars in unpaid claims and widely failed to meet state insurance laws and regulations. The GAO report found that some plans tried to duck under state insurance regulations entirely. This type of wild, wild west approach to insurance coverage does not offer the comprehensive level of coverage at a low price that the Trump administration claims. Based on the provisions of this EO, we also expect several lawsuits to challenge this based on the legality under current federal law and on the insurance across state lines aspect.

In essence, this latest gambit by the Trump administration is another attempt to undermine the system put in place by the ACA at the expense of some of the most vulnerable Americans. Combined with the administration’s move last week to weaken the ability of Americans to access sexual and reproductive healthcare services – particularly contraceptives – covered under the ACA, this represents a significant effort to endanger the healthcare of all Americans.

We urge Congress and the Administration to continue to work toward market stabilization and to strengthen the existing system – which has resulted in coverage for tens of millions more Americans since 2014 – and to put an end to these attempts to sabotage Americans’ healthcare for political gain. ANA is committed to working with Congress and the administration on legislation and policy which aligns with our four core principles of health system transformation. This Executive Order, however, represents a major step backward from achieving those principles.

(Photo: Doug Mills/The New York Times)

Congressional Inaction Threatens Healthcare for 9 Million Vulnerable Children

With the hubbub surrounding healthcare reform, North Korea, protesting football players, and several devastating hurricanes, it is imperative that we as nurses and citizens not lose track of other important issues that also deserve our attention. For instance, on Saturday, 9 million of our most vulnerable children stand to lose their healthcare if Congress does not act.

The Children’s Health Insurance Program (CHIP) is a popular bipartisan program that was created in 1997 in order to serve children who would not otherwise have access to health insurance. Unfortunately, funding for CHIP runs out on September 30th.

Despite a reported bipartisan agreement to extend financing for this critical program, Congress has yet to take action. And time is running out: Axios reports that the situation is dire for at least three states—Minnesota, Arizona, and North Carolina—as well as the District of Columbia, all of whom would run out of CHIP funding between October and December of this year if Congress does not meet its September 30th deadline. Most other states are projected to run out of CHIP funding sometime early next year without immediate action to fund CHIP.

Nurses know that this is unacceptable. We can all agree that America’s children are our most precious and valuable resource—simply put, leaving 9 million American children without healthcare is immoral and wrong. Moreover, it would be bad policy. As the Children’s Hospital Association puts it, “healthy children grow up to become healthy adults, and CHIP helps ensure that the children covered by the program are able to reach their full potential.”

The American Nurses Association agrees. The evidence shows that children with access to CHIP experience improved health outcomes, reductions in avoidable hospitalizations, and lower child mortality, all of which reduce overall healthcare costs. CHIP recipients are also more likely to attend school and graduate from college, and less likely to cause their parents to miss time at work.

Bottom line: CHIP translates into gains with “positive implications for both individual economic well-being and overall economic productivity.” In short, it’s a no-brainer.

It’s time for Congress to act now, before funding runs out for this common-sense program. Our children deserve no less.

Senate Republican Healthcare Push Ends in Defeat (Again)

Senate Majority Leader Mitch McConnell (R-KY) has chosen not to hold a vote on the Graham-Cassidy-Heller-Johnson bill to repeal and replace the Affordable Care Act. With a September 30^th deadline to pass healthcare legislation with a simple majority of votes, opposition from at least 3 members of the 52-member Republican caucus, united Democratic opposition, and no viable alternative plan, the Senate Republican push to repeal and replace the ACA is effectively dead (for now).

The American Nurses Association would like to express its immense gratitude to all of our members, constituent and state nursing associations, organizational affiliates, and partner advocacy groups for all of your work in helping to defeat this latest attempt to gut the American healthcare system. Your calls, emails, and letters to your elected officials, as well as your physical presence at rallies and hearings, ratcheted up the pressure on these officials and made it known loud and clear that this legislation would have had an enormously adverse impact on the ability of your patients to receive high quality healthcare.

Quite simply, the Graham-Cassidy-Heller-Johnson bill was bad public policy. Its provisions would have: ripped away coverage from Americans receiving care under Medicaid expansion and limited federal funding for the Medicaid program overall; eroded protections for individuals with pre-existing conditions; made it easier for states to remove the 10 Essential Health Benefits requirements; slashed federal funding for healthcare services; defunded the Prevention and Public Health Fund; and defunded Planned Parenthood for one year. The non-partisan Congressional Budget Office, in the very limited time it had to do an analysis, concluded that millions of Americans would have lost their healthcare coverage under this bill. In addition, many experts noted that states would have had only two years to implement drastically different healthcare systems with no federal support to speak of – a nearly impossible task.

ANA would also like to offer our tremendous thanks to the members of Congress who opposed the Graham-Cassidy bill. In particular, the 48-member Democratic caucus once again showed its grit and resolve by standing united against this bill in favor of the best interests of its constituents. ANA would also like to thank Sen. Susan Collins (R-ME) and Sen. John McCain (R-AZ) for demonstrating their resolve in the face of tremendous pressure from their caucus to pass repeal and replace legislation. These senators should be commended for putting the best interests of their constituents ahead of their party and standing opposed to this legislation.

As we have seen before, the failure of one repeal and replace proposal does not automatically mean that the healthcare system is safe. It is very likely that the Trump administration will continue to undermine the ACA through regulatory and other policy measures; we have already seen this in their assaults on value-based purchasing regulations, their brinksmanship with respect to cost-sharing reduction payments, and their refusal to undertake a robust ACA enrollment strategy crucial to connecting Americans with individual health insurance coverage. Senate Republicans are also already discussing language for the FY 2019 budget which would allow them to once again use reconciliation to repeal and replace the ACA.

ANA believes that the current healthcare system created by the ACA can and should be improved upon. However, any healthcare reform proposals should be done in a bipartisan manner, through regular order, and should offer pragmatic solutions to real problems faced by Americans. Of immediate importance are the reauthorization of the Children’s Health Insurance Program (CHIP) – which runs out of funding on September 30^th – the stabilization of the individual insurance market, which received several bipartisan hearings in the Senate Health, Education, Labor, and Pensions Committee, and the implementation of a robust enrollment campaign for the ACA’s individual insurance market. These issues are straightforward, would advance ANA’s principles of health system transformation, and, most importantly, ensure that more Americans are able to receive high-quality healthcare.

The fight over healthcare reform is not over. While another repeal and replace bill has gone down to defeat, there will be further attempts to undermine the gains realized under the ACA. For these reasons, we urge you to continue to press your elected officials – local, state, and federal – to commit to ensuring healthcare reform in alignment with ANA’s principles of health system transformation. For now, however, let’s take a deep breath and celebrate stepping back from the brink of what would have been a disastrous transformation of the healthcare system.