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November 9, 2016

Where President-elect Donald Trump Stands on Six Health Care Issues

While health care was not central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.

President-elect Donald Trump has laid out different approaches to addressing these and other health care issues. Central among these is his position to fully repeal the ACA.

See where he stands on six key health policy issues.

Health Insurance Coverage Costs

The Affordable Care Act (ACA) set new standards for virtually all private health plans, including a prohibition on pre-existing condition exclusions and a requirement for private plans to extend dependent coverage to the age of 26. The law also established new marketplaces for the sale of nongroup insurance to all individuals except undocumented immigrants, and created new subsidies for nongroup coverage. New fees, taxes, and offsetting budget savings were adopted to finance ACA subsidies and reduce the deficit, including a so-called “Cadillac tax” on high-cost employer-sponsored plans. The Congressional Budget Office (CBO) estimated repeal of the ACA would increase the federal deficit by $137 – $353 billion over 10 years (2016-2025). Since enactment, the uninsured rate has fallen to 8.6% and an estimated 20 million Americans have gained coverage, while 27 million remain uninsured. Public opinion about the ACA remains divided, largely on partisan lines. Several issues have emerged in the 2016 campaign.

Donald Trump supports complete repeal of the ACA, including the individual mandate to have coverage. In lieu of requiring insurers to provide coverage to everyone regardless of health status, he would work with states to create high risk pools for individuals who have not maintained continuous coverage. In place of refundable premium tax credits, Trump would provide a tax deduction for the purchase of individual health insurance. He would promote competition between health plans by allowing insurers to sell plans across state lines; an insurer licensed under the rules of one state would be allowed to sell coverage in other states without regard to different state laws that might apply. He would promote the use of Health Savings Accounts (HSA), and specifically would allow tax-free transfer of HSAs to all heirs. Trump would also require price transparency from all hospitals, doctors, clinics and other providers so that consumers can see and shop for the best prices for health care procedures and other services.

Medicaid

Medicaid is the nation’s main public health insurance program for people with low incomes covering about 70 million Americans. Medicaid provides coverage for low income individuals and families with low or no out-of-pocket costs for care; assistance to low-income Medicare beneficiaries; coverage for long-term services and supports, and financing for safety-net hospitals, clinics and states.

Donald Trump supports a Medicaid block-grant and a repeal of the ACA (including the Medicaid expansion). He has said he would cover the low-income uninsured through Medicaid after repealing the ACA. The House Republican Plan, which is part of a larger package designed to replace the ACA and reduce federal spending for health care, would offer states a choice between a Medicaid per capita allotment or a block grant.

Medicare

Medicare is the nation’s health insurance program that provides coverage to 57 million seniors and younger adults with permanent disabilities. Four issues related to Medicare have emerged during the 2016 presidential campaign.

Donald Trump has not stated his position on the issue of Medicare program restructuring or whether to allow older adults ages 55 to 64 to buy in to Medicare. He supports repealing the ACA, which would presumably mean repealing the law’s Medicare provisions. On the issue of prescription drug costs, Trump supports allowing safe re-importation of prescription drugs from other countries.

Prescription Drugs

Prescription drugs are the third largest area of U.S. health spending, and a main driver of growth. New drugs, which require significant research and development (R&D) investments, receive a period of patent protection and market exclusivity. Following this period, the Food and Drug Administration (FDA) may approve generic drugs, which perform the same as the brand name product, often at much lower costs. The Affordable Care Act (ACA) includes a provision to fast-track approval of “biosimilars,” which are drugs that perform similarly to an existing biologic drug (one derived from living organisms). Since 2010, more new specialty drugs have been approved than traditional drugs. Unlike traditional drugs, specialty drugs (which are often biologics) require special administration (such as injection) or close observation by a physician.

Donald Trump supports allowing importation of drugs from overseas that are safe and reliable but priced lower than in the U.S. He also supports greater price transparency from all health providers, especially for medical exams and procedures performed at doctors’ offices, clinics, and hospitals, but does not specify whether this policy would also apply to retail prescription drugs, which typically are not considered services or procedures.

The Opioid Epidemic

In recent years, the use of prescription painkillers for nonmedical purposes, as well as drugs derived from opium (such as heroin), has emerged as a major public health issue. In 2013, 1 in 20 nonelderly adults used opioids for nonmedical purposes. For one in five users (almost 2 million nonelderly adults), the nonmedical use of opioids increases to the level of opioid use disorder, often referred to as abuse, dependence, or addiction. Overdose deaths involving opioids have quadrupled since 1999, with over 14,000 individuals dying from opioid overdoses in 2014, leading to what many refer to as an “opioid epidemic.” The opioid epidemic creates an estimated $55 billion annually in societal costs, such as health care expenditures, workplace costs due to lost wages and utilization of sick days, and criminal justice costs. Proposed policy actions to address the opioid epidemic include efforts to change prescribing practices to curb utilization of opioids, improve access to treatment for individuals with opioid use disorder, and enforcing drug laws to combat access, sale and use of illicit drugs.

Donald Trump has said he will stop of the flow of illegal drugs into the country by building a wall on the U.S.-Mexican border and closing shipping loopholes that allow dangerous drugs to be mailed into the U.S. He would also enhance access to addiction services, end Medicaid policies that obstruct inpatient treatment, increase first responders’ access to naloxone, lift the cap on the number of patients that providers can treat with recovery medicines, and expand incentives for state and local governments to use drug courts and mandated treatment to respond to the addiction crisis.

Reproductive Health

Reproductive health is an essential element of women’s healthcare. The Affordable Care Act (ACA) greatly expanded coverage for these services for millions of women. Access and availability of abortion services and federal payments for contraceptive providers, however, have emerged as key issues in this year’s presidential election.

Donald Trump has called for defunding Planned Parenthood if they continue to provide abortion and would redirect their funding to community health centers. He states he is pro-life but with exceptions when the pregnancy is a result of rape, incest, and life endangerment. Trump has promised to appoint pro-life justices to the Supreme Court that seek to overturn Roe v. Wade. He would also work to make the Hyde Amendment permanent law and sign the Pain-Capable Child Protection Act, legislation that would sharply limit access to later term abortions. He would also repeal the ACA, which would eliminate minimum scope of benefits standards such as maternity care in individual plans and coverage of no-cost preventive services such as contraceptives in private plans.

 

Source:  KFF.org Home / Health Reform / Where President-elect Donald Trump Stands on Six Health Care Issues

Filed Under: Medicare News

November 5, 2016

Medicare Open Enrollment Begins October 15

What is the Medicare open enrollment period?

The Medicare open enrollment period is the time during which people with Medicare can make new choices and pick plans that work best for them.

Each year, Medicare plans typically change what they cost and cover. In addition, your health-care needs may have changed over the past year. The open enrollment period is your opportunity to switch Medicare health and prescription drug plans to better suit your needs.

When does the open enrollment period start?

The Medicare open enrollment period begins on October 15 and runs through December 7. Any changes made during open enrollment are effective as of January 1, 2017.

During the open enrollment period, you can:

  • Join a Medicare Prescription Drug (Part D) Plan
  • Switch from one Part D plan to another Part D plan
  • Drop your Part D coverage altogether
  • Switch from Original Medicare to a Medicare Advantage Plan
  • Switch from a Medicare Advantage Plan to Original Medicare
  • Change from one Medicare Advantage Plan to a different Medicare Advantage Plan
  • Change from a Medicare Advantage Plan that offers prescription drug coverage to a Medicare Advantage Plan that doesn’t offer prescription drug coverage
  • Switch from a Medicare Advantage Plan that doesn’t offer prescription drug coverage to a Medicare Advantage Plan that does offer prescription drug coverage

What should you do?

Now is a good time to review your current Medicare plan. As part of the evaluation, you may want to consider several factors. For instance, are you satisfied with the coverage and level of care you’re receiving with your current plan? Are your premium costs or out-of-pocket expenses too high? Has your health changed, or do you anticipate needing medical care or treatment?

Open enrollment period is the time to determine whether your current plan will cover your treatment and what your potential out-of-pocket costs may be. If your current plan doesn’t meet your health-care needs or fit within your budget, you can switch to a plan that may work better for you.

What’s new in 2017?

The initial deductible for Part D prescription drug plans increases by $40 to $400 in 2017. Also, most Part D plans have a temporary limit on what a particular plan will cover for prescription drugs. In 2017, this gap in coverage (also called the “donut hole”) begins after you and your drug plan have spent $3,700 on covered drugs — a $390 increase over the 2016 initial coverage limit of $3,310. It ends after you have spent $4,950 out-of-pocket, after which catastrophic coverage begins. However, part of the Affordable Care Act gradually closes this gap by reducing your out-of-pocket costs for prescriptions purchased in the coverage gap. In 2017, you’ll pay 40% of the cost for brand-name drugs in the coverage gap (60% discount) and 51% (49% discount) of the cost for generic drugs in the coverage gap. Each succeeding year, out-of-pocket prescription drug costs in the coverage gap continue to decrease until 2020, when you’ll pay 25% for covered brand-name and generic drugs in the gap.

Where can you get more information?

Determining what coverage you have now and comparing it to other Medicare plans can be confusing and complicated. Pay attention to notices you receive from Medicare and from your plan, and take advantage of help available by calling 1-800-MEDICARE or by visiting the Medicare website, www.medicare.gov.

 

Source: Copyright 2006-2016 Broadridge Investor Communication Solutions, Inc. All rights reserved.

 

 

Filed Under: Medicare News

October 25, 2016

2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces

Health insurance premiums on the Affordable Care Act’s marketplaces (also called exchanges) are expected to increase faster in 2017 than in previous years due to a combination of factors, including substantial losses experienced by many insurers in this market and the phasing out of the ACA’s reinsurance program.

We analyzed 2017 premiums and insurer participation made available through Healthcare.gov on October 24, 2017, as well as data collected from states that run their own exchange websites. At this time, data are not available for all states; we will update as more complete information becomes available.

Changes in the Second-Lowest Silver Premium

The second-lowest silver plan is one of the most popular plan choices on the marketplace and is also the benchmark that is used to determine the amount of financial assistance individuals and families receive. The table below shows these premiums for a major city in each state with available data. (We have been reporting premiums in these cities since the launch of the ACA’s exchanges in 2014; similar analyses for 2015 and 2016 are also available.)

Across these major cities in 2016, the second-lowest silver premium for a 40-year-old non-smoker ranged from $186 per month in Albuquerque, NM to $719 in Anchorage, Alaska, before accounting for the tax credit that most enrollees in this market receive. In 2017, the second-lowest silver premium for a 40-year-old non-smoker living in these cities will range from $227 in Providence, Rhode Island to $904 in Anchorage, Alaska, before accounting for the tax credit.

Of these major cities, the places with the largest increases in the unsubsidized second-lowest silver plan were Phoenix, AZ (up 145% from $207 to $507 per month for a 40-year-old non-smoker), Birmingham, AL (up 71% from $288 to $492) and Oklahoma City, OK (up 67% from $295 to $493). Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Providence, RI (down -14% from $263 to $227 for a 40-year-old non-smoker), Indianapolis, IN (down -4% from $298 to $286) and Cleveland, OH (down -2% from $234 to $229) and increase just 1% in Little Rock, Arkansas (from $310 to $314).

Most enrollees in the marketplaces receive a tax credit to lower their premium. In most parts of the country in 2016, a 40-year-old adult making $30,000 per year would pay about $208 per month for the second-lowest-silver plan. If this person is willing to switch to whatever the new second lowest-cost silver plan is in 2017, they will pay a similar amount (the after-tax credit payment for a similar person in 2017 is $207 per month or a change of 0%). In some parts of the country (for example, in Albuquerque, NM), premiums for a 40-year-old are so low in 2016 that an enrollee making $30,000 may not have qualified for a subsidy. In these places, an increase in the benchmark silver premium may make them newly-eligible for financial assistance.

Table 1: Monthly Silver Premiums
for a 40 Year Old Non-Smoker Making $30,000 / Year
    2nd Lowest Cost Silver Before Tax Credit 2nd Lowest Cost Silver After Tax Credit
State Major City 2016 2017 % Change
from 2016
2016 2017 % Change
from 2016
Alabama Birmingham $288 $492 71% $208 $207 0%
Alaska Anchorage $719 $904 26% $164 $163 -1%
Arizona Phoenix $207 $507 145% $207 $207 0%
Arkansas Little Rock $310 $314 1% $208 $207 0%
California Los Angeles $245 $258 5% $208 $207 0%
Colorado Denver $278 $313 12% $208 $207 0%
Connecticut Hartford $318 $404 27% $208 $207 0%
Delaware Wilmington $356 $423 19% $208 $207 0%
DC Washington $244 $298 22% $208 $207 0%
Florida Miami $262 $306 17% $208 $207 0%
Georgia Atlanta $254 $286 13% $208 $207 0%
Hawaii Honolulu $262 $347 32% $179 $178 -1%
Idaho Boise $273 $348 27% $208 $207 0%
Illinois Chicago $198 $291 48% $198 $207 5%
Indiana Indianapolis $298 $286 -4% $208 $207 0%
Iowa Cedar Rapids $284 $301 6% $208 $207 0%
Kansas Wichita $248 $361 46% $208 $207 0%
Kentucky Louisville $223 $229 3% $208 $207 0%
Louisiana New Orleans $332 $373 13% $208 $207 0%
Maine Portland $288 $341 19% $208 $207 0%
Maryland Baltimore $249 $309 24% $208 $207 0%
Massachusetts Boston $250 N/A N/A $208 N/A N/A
Michigan Detroit $226 $237 5% $208 $207 0%
Minnesota Minneapolis $235 $366 55% $208 $207 0%
Mississippi Jackson $283 $352 25% $208 $207 0%
Missouri St Louis $287 $310 8% $208 $207 0%
Montana Billings $322 $425 32% $208 $207 0%
Nebraska Omaha $313 $368 18% $208 $207 0%
Nevada Las Vegas $261 $282 8% $208 $207 0%
New Hampshire Manchester $261 $267 2% $208 $207 0%
New Jersey Newark $330 $353 7% $208 $207 0%
New Mexico Albuquerque $186 $258 39% $186 $207 11%
New York New York City $369 $456 24% $208 $207 0%
North Carolina Charlotte $409 $572 40% $208 $207 0%
North Dakota Fargo $304 $331 9% $208 $207 0%
Ohio Cleveland $234 $229 -2% $208 $207 0%
Oklahoma Okla. City $295 $493 67% $208 $207 0%
Oregon Portland $261 $312 20% $208 $207 0%
Pennsylvania Philadelphia $276 $418 51% $208 $207 0%
Rhode Island Providence $263 $227 -14% $208 $207 0%
South Carolina Columbia $314 $404 29% $208 $207 0%
South Dakota Sioux Falls $309 $448 45% $208 $207 0%
Tennessee Nashville $281 $419 49% $208 $207 0%
Texas Houston $256 $288 13% $208 $207 0%
Utah Salt Lake City $244 $292 20% $208 $207 0%
Vermont Burlington $468 $492 5% $208 $207 0%
Virginia Richmond $276 $296 7% $208 $207 0%
Washington Seattle $227 N/A N/A $208 N/A N/A
West Virginia Huntington $341 $419 23% $208 $207 0%
Wisconsin Milwaukee $326 $379 16% $208 $207 0%
Wyoming Cheyenne $426 $464 9% $208 $207 0%
NOTES: In areas in which the two lowest-cost silver plans have the same premium, the next lowest-cost silver plan is used as the “second-lowest” silver plan. In some cases, a portion of the second lowest-cost silver plan is for non-essential health benefits so these values may differ from the benchmark used to determine subsidies. Data for MA and WA are not yet available.
SOURCE:  Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. For more information see  “Early Look at 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces” Jul 2016.

Changes in Insurer Participation

As a result of losses in this market, some insurers like UnitedHealth and Aetna have announced their withdrawal from the ACA marketplaces or the individual market in some states. In 2016, the number of insurers participating in each state (grouped by parent company) ranged from 1 in Wyoming to 16 in Texas. In states that use Healthcare.gov, the average number of insurers participating in the marketplace will be 3.9 in 2017 (down from 5.4 companies per state in 2016, 5.9 in 2015 and 4.5 in 2014). Marketplace insurer participation in states using Healthcare.gov in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin.

 

Table 2: Total Number of Insurers by State, 2014 – 2017
  Total Number of Issuers in the Marketplace
State 2014 2015 2016 2017
Alabama 2 3 3 1
Alaska 2 2 2 1
Arizona 8 11 8 2
Arkansas 3 4 4 3
California 11 10 12 NA
Colorado 10 10 8 NA
Connecticut 3 4 4 NA
Delaware 2 2 2 2
DC 3 3 2 NA
Florida 8 10 7 5
Georgia 5 9 8 5
Hawaii 2 2 2 2
Idaho 4 5 5 NA
Illinois 5 8 7 5
Indiana 4 8 7 4
Iowa 4 4 4 4
Kansas 3 3 3 3
Kentucky 3 5 7 3
Louisiana 4 5 4 3
Maine 2 3 3 3
Maryland 4 5 5 NA
Massachusetts 10 10 10 NA
Michigan 9 13 11 9
Minnesota 5 4 5 NA
Mississippi 2 3 3 2
Missouri 3 6 6 4
Montana 3 4 3 3
Nebraska 4 4 4 2
Nevada 4 5 3 3
New Hampshire 1 5 5 4
New Jersey 3 5 5 2
New Mexico 4 5 4 4
New York 16 16 15 NA
North Carolina 2 3 3 2
North Dakota 3 3 3 3
Ohio 11 15 15 11
Oklahoma 4 4 2 1
Oregon 11 10 10 6
Pennsylvania 7 9 7 6
Rhode Island 2 3 3 NA
South Carolina 3 4 3 1
South Dakota 3 3 2 2
Tennessee 4 5 4 3
Texas 11 14 16 10
Utah 6 6 4 3
Vermont 2 2 2 NA
Virginia 5 6 7 9
Washington 7 9 9 NA
West Virginia 1 1 2 2
Wisconsin 13 15 16 15
Wyoming 2 2 1 1
HealthCare.gov Average 4.5 5.9 5.4 3.9
US Average 5 6.1 5.7 NA

SOURCE:  Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. For more information see  “Early Look at 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces” Jul 2016.
NOTES: Insurers are grouped by parent company or group affiliation, which we obtained from HHS Medical Loss Ratio public use files and supplemented with additional research. For 2017, the number of insurers in non-Healthcare.gov states is not yet available.

 

Source: 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health… Oct 24, 2016 | Cynthia Cox Follow @cynthiaccox on Twitter , Michelle Long, Ashley Semanskee, Rabah Kamal, Gary Claxton, and Larry Levitt Follow @larry_levitt on Twitter

Filed Under: Medicare News

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