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KHN First Edition: February 27, 2017


First Edition

Monday, February 27, 2017
Check Kaiser Health News online for the latest headlines

Today's early morning highlights from the major news organizations.

Kaiser Health News: Liberal Vermont Tests The Waters On GOP Health Care Overhaul
Steven Findlay reports: "Tiny — and very blue — Vermont could be at the leading edge of the health reforms envisioned by the Trump administration and a Republican Congress. The Green Mountain State, population around 626,000, got a broad waiver last October from the federal government to redesign how its health care is delivered and paid for. The statewide experiment aims to test new payment systems, prevent unnecessary treatments, constrain overall growth in the cost of services and drugs, and address public health problems such as opioid abuse." (Findlay, 2/27)

Kaiser Health News: Drowning In A ‘High-Risk Insurance Pool’ — At $18,000 A Year
Minnesota Public Radio's Mark Zdechlik reports: "Some Republicans looking to scrap the Affordable Care Act say monthly health insurance premiums need to be lower for the individuals who have to buy insurance on their own. One way to do that, GOP leaders say, would be to return to the use of what are called high-risk insurance pools, for people who have health problems.But critics say even some of the most successful high-risk pools that operated before the advent of Obamacare were very expensive for patients enrolled in the plans, and for the people who subsidized them — which included state taxpayers and people with employer-based health insurance." (Zdechlik, 2/27)

California Healthline: When You Don’t Speak The Same Language As Your Child’s Doctor
Ana B. Ibarra reports: "When Margarita Ruiz takes her children to the doctor’s office, she has no choice but to trust that nurses and front desk staff are translating medical orders accurately. She doesn’t speak English and her children’s pediatrician speaks very little Spanish. Ruiz, of Rosemead, Calif., said she feels grateful that staff members at the office of her children’s current doctor are usually available to translate. In the past, in a different doctor’s office, her oldest son, 14, translated for her. “It wasn’t ideal, but I didn’t have much of a choice,” said the 33-year-old homemaker. Health care experts say it is not advisable to use untrained interpreters, whether they are medical office staff members or your own family members." (Ibarra, 2/27)

The Wall Street Journal: GOP’s New Plan To Repeal Obamacare: Dare Fellow Republicans To Block Effort
Republican leaders are betting that the only way for Congress to repeal the Affordable Care Act is to set a bill in motion and gamble that fellow GOP lawmakers won’t dare to block it. Party leaders are poised to act on the strategy as early as this week, after it has become obvious they can’t craft a proposal that will carry an easy majority in either chamber. Lawmakers return to Washington Monday after a week of raucous town halls in their districts that amplified pressure on Republicans to forge ahead with their health-care plans. (Radnofsky, son and Armour, 2/27)

The Associated Press: Health Care, Supreme Court On Agenda As Congress Returns
Congress returns to Washington this week to confront dramatic decisions on health care and the Supreme Court that may help determine the course of Donald Trump's presidency. First, the president will have his say, in his maiden speech to a joint session of Congress on Tuesday night. Majority Republicans in the House and Senate will be closely watching the prime-time address for guidance, marching orders or any specifics Trump might embrace on health care or taxes, areas where some of his preferences remain a mystery. (2/27)

Politico: Leaked GOP Obamacare Replacement Shrinks Subsidies, Medicaid Expansion
A draft House Republican repeal bill would dismantle the Obamacare subsidies and scrap its Medicaid expansion, according to a copy of the proposal obtained by POLITICO. The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020. (Demko, 2/24)

The Associated Press: GOP Proposal Aims To End Insurance Mandate In 'Obamacare'
A draft Republican bill replacing President Barack Obama's health care law would end its Medicaid expansion, scrap fines on people not buying insurance and eliminate taxes on the medical industry and higher earners.Instead, it would create tax credits worth up to $4,000, allow bigger contributions to personal health savings accounts and impose a new levy on expensive health coverage some employees get at work. (2/25)

The Washington Post: House GOP Plans To Keep Some Medicaid Expansion — And Steer Money To States That Never Bought In
Congressional Republicans have been struggling for months to resolve one of the most vexing problems in their tortuous effort to replace the Affordable Care Act: What to do about the generous federal funding for states that broadened their Medicaid programs under the law, while not shortchanging the 19 states that balked at expansion? Now, as the House begins to hone details of its legislative proposal, a possible compromise has emerged. It would temporarily keep federal dollars flowing to cover almost the entire cost of the roughly 11 million Americans who have gained Medicaid coverage but would block that enhanced funding for any new participants. (Goldstein and Eilperin, 2/24)

NPR: Obamacare Rollback Bill Would Replace Subsidies With Tax Credits
The draft bill is consistent with what Republicans have been saying they want to see in place of Obamacare, says Rodney Whitlock, vice president of health policy at ML Strategies. "No surprises here," says Whitlock, who was formerly the Republican health policy director for the Senate Finance Committee. "These are all ideas Republicans have championed. Now the Congressional Budget Office will decide if they agree." (Kodjak, 2/24)

The Associated Press: Report Warns Of Gaps If Federal Health Care Dollars Are Cut
A sobering report to governors about the potential consequences of repealing the Obama-era health care law warns that federal spending cuts probably would create funding gaps for states and threaten many people with the loss of insurance coverage. (2/27)

The Washington Post: GOP Changes To Obamacare Could Cost States, Reduce Coverage, Governors Are Told
A Republican outline for replacing the Affordable Care Act (ACA) could significantly reduce the number of Americans with health insurance and potentially cost states billions of dollars over five years, according to an analysis prepared for the National Governors Association on Saturday. The 36-page document, a copy of which was obtained by The Washington Post, attempts to evaluate the impact of possible changes included in a Republican leadership plan that outlines the direction Congress could be heading in as it attempts to fulfill President Trump’s promise to repeal and replace Obamacare. (Balz, 2/25)

The Associated Press: Democrats, GOP Spar Over Medicaid Reform At Govs' Meeting
Tensions emerged Saturday between Democratic and Republican U.S. governors over a GOP-led proposal for a major overhaul to Medicaid, with Democrats saying the changes would take away people's health coverage to finance tax cuts for the wealthy. GOP governors intend to present Congress with a plan that they say would give states more flexibility to administer health coverage for poorer residents while protecting states from absorbing the costs of repealing the Affordable Care Act. Democratic governors said Saturday that their Republican counterparts were being dishonest about the effects of their plan. (2/25)

The Associated Press: GOP Governors Outline Health Care Plan, Medicaid Changes
Republican governors from seven states are calling for dramatic changes to Medicaid, which provides insurance to more than 70 million low-income Americans, as they nervously watch President Donald Trump and GOP congressional leaders move to repeal and replace the Obama-era health law.At the same time, they're telling Washington: Don't scrap the Affordable Care Act without a viable alternative. (2/24)

The Wall Street Journal: Talks Between Republican Governors Don’t Yield Agreement On Key Health-Law Issue
Governors left a closed-door meeting at the National Governors Association’s winter meeting saying they hadn’t hammered out an answer that day. “We don’t want to create unequal treatment between all the different states,” said Republican Gov. Mary Fallin of Oklahoma. “I don’t think we’ve reached a conclusion on that, other than to say it’s a priority that we find a way that we can cooperate.” (Radnofsky and Hackman, 2/26)

Politico: GOP Governors Split On Obamacare Replacement
The governors are split on whether to ask Congress to preserve the federal funding boost Obamacare made available to cover millions of additional low-income adults and broader structural changes. “We’re working through many different ideas,” said Oklahoma Gov. Mary Fallin, one of about a dozen governors trying to craft a compromise. Fallin, whose state did not expand its program, said it would be “very challenging” for her to revamp the program if Oklahoma winds up with less federal money than it currently gets. (Pradhan and Ehley, 2/25)

The Washington Post: A Divided White House Still Offers Little Guidance On Replacing Obamacare
A meeting Friday afternoon between President Trump and Ohio Gov. John Kasich, his former rival in the GOP primaries, had no set agenda. But Kasich came armed with one anyway: his hope to blunt drastic changes to the nation’s health-care system envisioned by some conservatives in Washington. Over the next 45 minutes, according to Kasich and others briefed on the session, the governor made his pitch while the president eagerly called in several top aides and then got Health and Human Services Secretary Tom Price on the phone. At one point, senior adviser Jared Kushner reminded his father-in-law that House Republicans are sketching out a different approach to providing access to coverage. “Well, I like this better,” Trump replied, according to a Kasich adviser. (Eilperin and Goldstein, 2/26)

The Wall Street Journal: John Kasich Makes Nice With Trump Amid Medicaid Push
Mr. Kasich said that a long and cordial Oval Office meeting had led him to believe the president was responsive to his arguments about how Republicans should end a bigger fight over Medicaid, the federal-state program for the poor that 14 Republican-led states including his expanded under the 2010 Affordable Care Act and 17 Republican-led states did not. He is aiming to win over Republican governors to a compromise over the future of federal funding for states that did expand this weekend. “He listened very carefully to what I have to say about it,” said Mr. Kasich, who added that he repeated his points two or three times as different people came in and out of the room, among them, Mr. Trump’s chief of staff Reince Priebus, son-in-law and senior adviser Jared Kushner, and economic adviser Gary Cohn. (Radnofsky, 2/24)

Reuters: Trump To Lay Out Healthcare Revamp Details In Speech To Congress
President Donald Trump said on Sunday he will offer details on how he would like to overhaul President Barack Obama's signature healthcare law in a speech to the U.S. Congress on Tuesday. Since they now control the White House and Congress, Republicans are under pressure to fulfill their pledge to repeal and replace the Obamacare law although they have found no easy way to do it. (Holland, 2/26)

The Wall Street Journal: Trump To Meet With Insurance Executives On Repeal Of Affordable Care Act
President Donald Trump is planning to hold a round-table meeting with health-insurance executives at the White House on Monday, according to people close to the planning, as the administration looks to encourage insurers to sign onto Republicans’ health-care overhaul efforts. The gathering is expected to focus on getting the industry leaders’ support for the GOP initiative, which would dismantle much of the Affordable Care Act and introduce several measures supported by many Republicans, including age-adjusted tax credits and expanded access to health-savings accounts. (Armour, Wilde Mathews and Hackman, 2/24)

The Wall Street Journal: Health Insurers Hope For Nothing
The specter of gridlock in Washington presents a risk for the surging stock market. For health insurers, gridlock might be exactly what investors need. President Donald Trump is set to hold a meeting with insurance executives on Monday. For most businesses, such meetings haven’t been a bad thing as the president talks up his pro-business policies. This meeting is more of a wild card. President Trump has made repealing and replacing the Affordable Care Act a top priority. On Friday he referred to the law as an “absolute and total catastrophe.” (Grant, 2/26)

The New York Times: Key Republican In Health Law’s Fate Hails From A State That Embraced It
When Representative Greg Walden of Oregon visits his expansive district, which swallows two-thirds of a very blue West Coast state, his constituents grouse amiably to their longtime Republican congressman about environmental regulations and federal lands policy. And then the conversation shifts to the Affordable Care Act and what its repeal would mean for the struggling rural workers who have long voted for Mr. Walden, and for children like 11-year-old Rocco Stone. Because of the health law, Rocco has been able to live at home, attend school and have a nearly normal life despite having autism and a rare genetic disorder. (Pear, 2/25)

The New York Times: The Adults A Medicaid Work Requirement Would Leave Behind
On a frigid morning here, Nancy Godinez was piling bread and other staples into her car outside a food pantry. She had lost her job as a custodian, her unemployment checks had run out, and her job search had proved fruitless. One thing she still had was health insurance, acquired three years ago after Arkansas’ Republican-controlled legislature agreed to expand Medicaid under the Affordable Care Act. The coverage, she said, has allowed her to get regular checkups and treatment for tendinitis in her foot. But unless she finds a new job, Ms. Godinez, 55, could be at risk of losing her insurance, too. (Goodnough, 2/25)

The Associated Press: Pre-Existing Conditions Complicate Health Care Replacement
As Republicans try to unite around a replacement for the Affordable Care Act, one of the most popular parts of the law will be among the most difficult to replace: the guarantee of health coverage for people with pre-existing conditions. The challenge of providing insurance for Americans who have no other alternative has some congressional Republicans considering whether to ask the states to reboot high-risk pools, an option with a rocky history. In the past, the pools served as insurers of last resort for people in poor health who could not get an individual policy from a commercial insurer. (Johnson and Alonso-Zaldivar, 2/25)

The Wall Street Journal: Recent Warmth Toward Affordable Care Act Persists, WSJ/NBC Poll Shows
Voters’ warmer views of the Affordable Care Act held up in February, according to a new Wall Street Journal/NBC News poll, with supporters narrowly outweighing detractors for a second month. Opposition to the health law often known as Obamacare had outpolled support in every WSJ/NBC survey since the law was passed until the start of this year, when the debate began in earnest about passing repeal legislation that Republican President Donald Trump could sign. (Radnofsky, 2/24)

Los Angeles Times: With Obamacare In Jeopardy, California Considers Going It Alone With 'Single-Payer' System
th President Trump now vowing to put forward a replacement for the Affordable Care Act in March, some California politicians and healthcare advocates are once again promoting the idea of a state-run “single-payer” system that operates like Medicare. Backers say the uncertainty surrounding Trump’s promise to repeal Obamacare presents California with a chance to rethink how healthcare is delivered to its 39 million residents. (Karlamangla, 2/26)

The Washington Post: Activist Muscle Gives Obamacare A Lift
Seven years after the passage of the Affordable Care Act, Democrats seem finally to have secured a crucial element for its preservation: a robust grass-roots movement supporting it. Pro-ACA protesters attended more than 100 rallies held Saturday across the country, organized by an activist group affiliated with Sen. Bernie Sanders (I-Vt.). That followed a congressional recess week during which GOP lawmakers were confronted by defenders of the health-care law in town hall meetings across the country. Numerous Democratic officeholders also held events touting the law’s successes. (DeBonis and Weigel, 2/25)

Reuters: Anthem And Blue Crosses Loom Large In Obamacare Talks
Anthem Inc. and other U.S. health insurers complained to the White House for more than a year that they were losing money on people who waited to sign up for Obamacare coverage until they were sick. They pleaded with the Obama administration to stem their losses by tightening up on the enrolment rules. When their pleas went unmet, UnitedHealth Group Inc, Humana Inc, and Aetna Inc pulled out of most of the government subsidized health insurance market. (Humer, Abutaleb and Cornwell, 2/27)

The Associated Press: VA Data Show Low Rate Of Discipline For Drug Loss, Theft
Doctors, nurses or pharmacy staff at the Department of Veterans Affairs’ hospitals were fired or reprimanded in only a small fraction of thousands of reported cases of opioid theft and missing prescriptions since 2010, according to government data obtained by The Associated Press. About 372 VA employees were disciplined for a drug or alcohol-related issue across a network of 160 medical centers and 1,000 clinics over the last six years, according to internal figures kept by the facilities that were reported to VA’s headquarters. During that time, there were more than 11,000 reported incidents of drug loss or theft at federal hospitals — the vast majority within the VA, according to law enforcement data. Roughly translated, VA employees were disciplined in 3 percent of cases. (Yen, 2/27)

The New York Times: Gorsuch Staunchly Opposes ‘Aid In Dying.’ Does It Matter?
Ever since President Trump nominated Judge Neil M. Gorsuch to fill the empty seat on the Supreme Court, interested parties have been combing through his writings and appellate court rulings looking for signs and portents. If he’s confirmed, how might Judge Gorsuch vote on affirmative action questions? Or challenges to Roe v. Wade? But nobody has to do much head-scratching over his position on medical aid in dying. (Span, 2/24)

The Wall Street Journal: With Direct Primary Care, It’s Just Doctor And Patient
There’s no waiting room at Linnea Meyer’s tiny primary-care practice in downtown Boston. That’s because there’s rarely a wait to see her. She has only 50 patients to date and often interacts with them by text, phone or email. There’s no office staff because Dr. Meyer doesn’t charge for visits or file insurance claims. Patients pay her a monthly fee—$25 to $125, depending on age—which covers all the primary care they need. “Getting that third-party payer out of the room frees me up to focus on patient care,” says Dr. Meyer, who hopes to expand her year-old practice to 200 patients and is relying on savings until then. “This kind of practice is why I went into medicine, and that feels so good.” (Beck, 2/26)

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