Medicare Part D Prescription Plans: What you Need to know

 

Greetings! To those of you who are current clients, thank you so much for your continued business. It’s that time of year again! Medicare’s Open Enrollment Period runs through December 7th. Most of you know, during this time, a Medicare recipient may analyze how their prescription drug usage or their current Part D Prescription Drug plan may have or will be changing for the coming calendar year.

2018 DEDUCTIBLE – INITIAL COVERAGE – GAP – CATASTROPHIC THRESHOLDS

Each year, virtually every drug plan changes something material about their coverage. It may be the premium, deductible, drug tiers, copays, or the drugs they cover or don’t cover. It could be all these things. If you don’t read your ANNUAL NOTICE OF CHANGE from your current Part D plan carrier (which you are due by September 30th each year) you could be in for some surprises with your coverage in the coming calendar year!

COMMONLY OVERLOOKED DETAILS:

a) Many people get fixated on the premium and go with the lowest. It’s easy to do. They do this without factoring in applicable deductibles and copays. My lowest premium Part D plan in 2018 is $16.70 per month. Most often, the plan with the lower premium has a higher deductible and copays, so―especially if you are using expensive brand name drugs―you end up paying more for your coverage, and drugs, overall. The same applies to the plans with no deductible.

b) While an annual deductible as high as $405 may apply before your Rx drugs are available for their copays, very often, the deductible does not apply to Tier 1 Preferred Generics and Tier 2, Non-Preferred Generics. That makes a big difference for most people. This is an example of where it pays to carefully review the plan’s SUMMARY OF BENEFITS.

c) When tempted to go with a Medicare Advantage Prescription Drug plan, keep in mind you will have to accept whatever drug coverage is tied to your Medical plan. If you are using expensive drugs, that means you may not necessarily end up with your lowest cost for your drugs. As you would when you let me identify that in the “stand-alone” Part D market.

d) As I explained in a previous post―especially when it comes to brand name drugs―it pays to always ask the pharmacist “what is this pharmacy’s lowest cost for this drug?”. Often that cash price is actually lower than your plan’s copay. In which case ― just pay cash!

Part of the service I provide my clients is running their prescription drug regimen through my a program to identify whether a superior Part D Drug plan exists for them for the coming year. My goal is to have you on a plan which results in all your prescription drugs being covered at your lowest total “out-of-pocket” (TOOP) expense. TOOP is the sum of your premium, any applicable deductible, and the copays you pay for your drugs at the pharmacy counter or through the mail. If we are fortunate enough that your current drug plan still results in meeting these objectives, you simply stay the course and let your plan roll right into 2017! If it no longer results in your lowest TOOP, I will identify the plan that is and (with your instruction) enroll you in it.

Some of you have already seen a version of this (and some of you have been preemptive) and provided me your regimen. For you, I have been working most nights and weekends since October 15th providing you 2018 plan recommendations. If you received one, you need read no further unless you are yet to request that I apply on your behalf. In which case – request the application be emailed to you or – in the case of Aetna and Humana applications – simply request I apply on your behalf with your information I have on record. Please do not apply without my involvement. Mine is a volume business, and I don’t stay in business without it going through me. Even Kenton has to eat! So your business is greatly appreciated!

To accomplish this, I need each of you (who have not already done so) to respond to this email with a list of current drugs and dosages. I am quoting each person’s plan in the order received. Remember, we have until December 7th but applying early is always better than later. So, please, forward your drug regimen, and I will quote you as soon as possible.

As to those of you with Medicare Advantage Plan, who like your coverage, you need do nothing. Just keep paying the premium and let your coverage roll right into the new year. Most of my clients have Medicare Supplement. For those whose policies are no more than two years old, you can be fairly certain it remains competitively priced, and there is little to regain in changing plans. For those of you whose policy is older than two or three years, I am volunteering to re-shop* your plan, beginning in mid-January when all my client’s Part D plans and Under Age 65 health insurance is put to bed. It is simply too much to address during the Open Enrollment Period for both Medicare and Obamacare! The government puts me in the untenable role of having to process 12 months worth of business in 8 weeks. There is no point in hiring additional help. By the time I got them trained, I would have to lay them off!

As my phones will be very busy, you may want to text me during this period if it is important you speak with me right away. My cell phone number appears below. I look forward to keeping you as a client and working to limit your medical and Medicare-related insurance expenses!

Thanks so much!
Kenton Henry
Office: 281.367.6565
Text my cell @ 713.907.7984
Http://Allplanhealthinsurance.com
Http://TheWoodlandsTXHealthInsurance.com

For the latest in health and Medicare relative news, follow my blog @ Https://HealthandMedicareInsurance.com

*Remember – because all of you are six months past your enrollment in Medicare’s Part B – it will be necessary for you to answer a series of health questions and qualify (based on your health) for a new, replacement, Medicare Supplement policy. When the time comes, I can email you sample applications so you may review those questions.

 

2018 Health Insurance Open Enrollment: Game On

Today is November 1, the first day of OPEN ENROLLMENT for Individual & Family 2018 health insurance coverage. This is not going to be my usual Op-Ed or commentary. Things are what they are for now, and I will let the numbers and the available benefits speak for themselves. We can go back to the dialogue once everyone has decided what is in their best interest for the coming year and elected a plan.

Because my phone ― and that of every agent and broker ― specializing in this market ― is going to be ringing off the hook the first few weeks, I am going to provide you some guidance to make this as easy as possible, on all of us.

Please go my quoting and application site. It has just been loaded with all your available plan options. Whether you receive a subsidy and have gone through Healthcare.gov and think you need to – or not ― you should begin here. You can get the quotes; estimate your applicable subsidy; and, seamlessly, enter into Healthcare.gov. Or, if you don’t qualify for or desire a subsidy, you may apply. If you need my assistance, you may save your work. I will see it and can pick up where you left off, to help you finish. You may email me and, if preferring to speak immediately and you cannot reach me on my desk phone, text me on my cell and I will get in touch with you, as soon as possible. If you need me immediately and cannot reach me on my desk phone, text me on my cell and I will get in touch with you, as soon as possible. My cell number is 713-907-7984. I will answer your questions and assist you in completing the process. (The voice-mail on the office line will be checked but, on the cell phone, will remain full.) It will help us both immensely if you review your options before contacting me.

CLICK HERE FOR 2018 HEALTH INSURANCE QUOTES AND PLAN OPTIONS:

https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

Here are the options I have to assist you from my quoting site:

(CLICK ON IMAGE TO ENLARGE)

Good luck and don’t hesitate to let me assist you with this year’s Open Enrollment!

D. Kenton Henry

Email: Allplanhealthinsurance.com@gmail.com

Office: 281-367-6565

Cell: 713-907-7984

https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

http://TheWoodlandsTXHealthInsurance.com

https://HealthandMedicareInsurance.com

MEDICARE CHANGES IN 2018 AND HOW THEY MAY AFFECT YOU

By D. Kenton Henry, Editor, Broker, Agent

Each year Medicare recipients and their agents and brokers prepare for upcoming changes in Medicare. This is because all changes have the potential to impact the member’s pocketbook. They may directly affect it or trickle down to the products they use to supplement Medicare.

Here is what we know is changing:

In 2017 you pay:
$1,288 Medicare deductible for each benefit period
• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $322 coinsurance per day of each benefit period
• Days 91 and beyond: $644 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
Beyond lifetime reserve days: all costs

In 2018 you will pay:
$1,316 Medicare deductible for each benefit period
• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $329 coinsurance per day of each benefit period
• Days 91 and beyond: $658 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
• Beyond lifetime reserve days: all costs

PART B DEDUCTIBLE:
The Medicare Part B deductible is $183 in 2017. It is expected to rise in 2018, but the Center For Medicaid and Medicare Services has not, and is not expected to, release that figure until closer to the end of this calendar year.

PART B PREMIUMS:
COST OF LIVING ADJUSTMENT (COLA), I.e., the Social Security Income Payment Adjustment, numbers for the coming year have not been released as of yet. But it’s widely expected that there will be a COLA of around 2 percent for 2018 (as opposed to 0.3 percent for 2017, and zero percent for 2016). CMS has not yet set Part B premiums for 2018, but it’s likely that premiums will level out for all enrollees (except those with high incomes, who always pay more). This because any necessary rate change will be covered by the COLA. In other words, the increase in Part B premiums will be offset by an increase in income payments for low-income recipients.

For high-income Part B enrollees (income over $85,000 for a single individual, or $170,000 for a married couple), premiums in 2017 range from $187.50/month to $428.60/month, depending on income. They will likely rise again for 2018, but there’s another change coming that will affect some high-income Part B enrollees in 2018. As part of the Medicare payment solution that Congress enacted in 2015 to solve the “doc fix” problem, new income brackets were created to determine Part B premiums for high-income Medicare enrollees, and they’ll take effect in 2018.

The high-income brackets start at $85,001 for a single individual and $170,001 for a married couple. Enrollees with income between $85,001 and $107,000 ($170,001 and $214,000 for a married couple) won’t see any changes to their bracket.
But enrollees with income above those limits might be bumped into a higher bracket in 2018, which means their premiums could jump considerably. The highest bracket (i.e., with the highest Part B premium) will now apply to those with income above $160,000 ($320,000 for a married couple), whereas the highest bracket didn’t apply in 2017 until an enrollee’s income reached $241,000 ($428,000 for a married couple). As with the deductible, Medicare Part B premiums for 2018 have not yet been set, but slightly less wealthy Medicare enrollees will begin paying the highest prices for Medicare Part B in 2018.

Here are Medicare Part B Premiums for 2017 (based on a 2-year look-back to 2015):

If your yearly income in 2015 (for what you pay in 2017) was You pay each month (in 2017)

File individual tax return File joint tax return Married Filing Separately
$85,000 or less $170,000 or less $85,000 or less = $134
above $85,000 up to $107,000 above $170,000 up to $214,000 N/A = $187.50
above $107,000 up to $160,000 above $214,000 up to $320,000 N/A = $267.90
above $160,000 up to $214,000 above $320,000 up to $428,000 N/A = $348.30
above $214,000 above $428,000 above $129,000 = $428.60

PART D PRESCRIPTION DRUG PLANS:
The Part D Annual Deductible is $405 in 2018, up from $400 in 2017
Premiums in the State of Texas, e.g., range from a low of $16.70 to a high of $197.10
* On the positive side, the Affordable Care Act is gradually closing the donut hole -technically known as the Gap – in Medicare Part D. In 2018, enrollees will pay just 35% of the plans cost for brand-name drugs while in the donut hole, and 44% of the cost of generic drugs.

2018 PART D COVERAGE GAP STAGE:
Begins after the total yearly drug cost (including what Your plan has paid and what you have paid) reaches $3,750. After you enter the coverage gap, you pay 35% of the drug cost for covered brand-name drugs and 44% of the drug cost for covered generic drugs until your out-of-pocket costs (not including your premiums) total $5,000, which is the end of the coverage gap. Not everyone will enter the coverage gap.

2018 Catastrophic Coverage Stage:

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and mail-order) reach $5,000, you pay the greater of:

5% of the cost, or
$3.35 copay for generic drugs (including brand drugs treated as generic) and $8.35 copay for all other drugs.

 

*Tip of the 2018 Part D Open Enrollment Period:
When purchasing your prescription drugs at the pharmacy counter, always ask your pharmacist for the lowest possible cost for your drug through their pharmacy. NBC Today Show did a segment today (10.17.17) in which they revealed that many times your copay for the drug, through your insurance, is higher than the lowest cost from the pharmacy. As the photo at the top of this article depicts, sometimes the difference is quite significant. A pharmacist in Magnolia, Texas, explained that a contractual “Gag” order exists between the pharmacy and the pharmacist (or employee) which prevents the latter from disclosing this to the customer. However, once questioned, the pharmacist or employee must disclose accurate information. If the cash price is lower, by all means, pay the cash price and do not let the purchase go through your insurance.

I will keep followers of my blog apprised of, as yet, unannounced changes in Medicare as they become available. In the meantime, to those of you who are my current clients, I would like to extend a sincere thank you for your business and the confidence you have placed in me.

ASSISTANCE IN IDENTIFYING YOUR LOWEST TOTAL COST PART D DRUG PLAN:

You, and those who would consider my services may email or―for those who feel it a more secure method―may fax a list of your prescription drugs and dosages to my secure fax. (I am the only one with access to it.) I will submit your drug regimen to the quoting system which will identify the plan which covers all your drugs at the lowest total cost for the coming calendar year. The lowest-total-cost is the sum of the plan premium, any applicable deductible, and your drug costs. Whether you elect to go through me to acquire it, is at your discretion.

Please email Kenton at:
allplanhealthinsurance.com@gmail.com
or
Fax to my secure fax at:
281.367.4772

I am processing quote requests in the order received.
Thank you so much for taking the time to stay abreast of these relevant changes affecting, and so important to, Medicare recipients. I know many of you are living on fixed incomes, and keeping your costs for protecting yourself from increases in medical care, and insurance, is of vital importance to you.

 http://TheWoodlandsTXHealthInsurance.com   https://HealthandMedicareInsurance.com

Obamacare: Are All Bets Off For 2018 Open Enrollment?

By D. Kenton Henry, Editor, Broker, Agent

Last evening I began to receive texts and messages inquiring how President Trump’s executive order (EO) on Thursday, October 12th, would impact both the near and long-term future of Obamacare. Before retiring for the evening, I responded – “In the long run, dramatically. But in the short run, not so much because it will take quite awhile for the insurance industry to respond appropriately.” At that time, all I had learned was, the President ordered regulators to allow consumers to shop across state lines for health insurance along with the ability individuals of like professions, careers, and risk profiles, to band together in associations for the purpose of acquiring individual and family health insurance. Theoretically, the first would allow the consumer to shop for their best value among a far greater number of companies and plans, thus restoring competition to the market. The second would allow pooling a large number of people, and the resulting volume would lower risk to the insurance companies, thus allowing them to charge lower premiums to the members. The same principle and effect currently available to employer groups. And that was all I was aware of regarding the EO. Additionally, the EO loosens the restrictions on “Short-Term” health insurance, allowing it to serve as a viable alternative to long-term coverage for the young and/or healthy.

Today, I awakened to learn the Department of Health and Human Services announced late last night that the EO includes the cessation of federal payments for Cost-Sharing Reductions (CSRs) to insurance companies. “Immediately.” This, according to Secretary Eric Hargan and Medicare administrator, Seema Verma. And―with that―all bets are off! The Administration claims this can be done because Congress never appropriated funds for the CSRs. These funds were used to reimburse insurers for the CSRs which result in reductions in deductibles, copays, and out-of-pocket maximums for eligible individuals. However, while the insurers will lose these subsidies (amounting to $7 billion this year), they remain obligated to continue offering them to eligible customers! Eligible customers mostly include those qualifying for subsidies and electing “Silver” plans through the Marketplace, Healthcare.gov. At the very least, halting the payments could trigger a spike in premiums, at some point, for the coming year, unless Congress authorizes the money. The next payments are due around October 20th. The Congressional Budget Office estimates, without the subsidies, premiums could go up by as much as 20%. That is on top of the 15-20% average increase anticipated with the subsidies in place! Nearly 3 in 5 Healthcare.gov customers qualify for help. If you qualify for a premium subsidy, the increase will simply be paid for by your fellow taxpayers as it has the last four years. The person or family who does not qualify will have to pay for it entirely out of their own pocket. As always, it is the hard working middle class who could be hurt the most. Those who make just enough to get by, but a little too much to qualify for government assistance.

Will this break Obamacare altogether and, if so, when? What impact will it have on 2018 individual and family health insurance premiums? Rates had to be (and were) submitted to state health insurance commissioners, as required, on September 30th. Can insurance companies pull out of the market at this point? Will they? Apparently, Premium Subsidies (separate from CSRs), designed to lower premiums, per se, for qualified individuals – as well as though qualifying for tax credits upon filing – will not be affected. However, here is what the Washington Post (article below) had to say about the cessation of CSR subsidies, alone: “Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some state’ regulators directed ACA insurers to add a surcharge in case the payments were not made, but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.” In my opinion, it is too late to submit new rates for approval in time for Open Enrollment, just around the corner. But it is not too late for an insurance company to pull out of the market altogether. What options will that leave the consumer, including my clients, for coverage in 2018 and beyond?

I agree with the administration; this is their move to force the hand of Congress to reverse the policies of Obamacare, restore competition and consumer choice, to the market. It will allow elements of a free market to regulate the variables, most important of which are, benefits, choice of provider, and premium. How long it will take for this action on the part of the Trump to accomplish this, I can’t say. The Executive Order is almost certain to be challenged by state Attorney Generals and litigated in federal courts. This could take months, or more, to play out, and probably will.

I apologize that, at this point, I have more questions than answers. In the meantime, I, and, my clients have yet to learn what our 2018 health options and premiums would be (or would have been) without the ramifications of the Executive Order. Rest assured, I will be watching in earnest for the details as this situation evolves.

As always, please feel free to phone me at 281.367.6565; text me at 713.907.7984 or email me at allplanhealthinsurance.com@gmail.com. The closer we get to November 1, the more I will know. And whatever is available to you, I will have. Along with your best option. Bear in mind, “best” is a relative term.

http://TheWoodlandsTXHealthInsurance.com https://HealthandMedicareInsurance.com

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Featured article:

WASHINGTON POST
By Amy Goldstein and Juliet Eilperin By Amy Goldstein and Juliet Eilperin
Health & Science
October 13 at 9:42 AM

President Trump is throwing a bomb into the insurance marketplaces created under the Affordable Care Act, choosing to end critical payments to health insurers that help millions of lower-income Americans afford coverage. The decision coincides with an executive order on Thursday to allow alternative health plans that skirt the law’s requirements.
The White House confirmed late Thursday that it would halt federal payments for cost-sharing reductions, although a statement did not specify when. Another statement a short time later by top officials at the Health and Human Services Department said the cutoff would be immediate. The subsidies total about $7 billion this year.
Trump has threatened for months to stop the payments, which go to insurers that are required by the law to help eligible consumers afford their deductibles and other out-of-pocket expenses. But he held off while other administration officials warned him such a move would cause an implosion of the ACA marketplaces that could be blamed on Republicans, according to two individuals briefed on the decision.
Health insurers and state regulators have been in a state of high anxiety over the prospect of the marketplaces cratering because of such White House action. The fifth year’s open-enrollment season for consumers to buy coverage through ACA exchanges will start in less than three weeks, and insurers have said that stopping the cost-sharing payments would be the single greatest step the Trump administration could take to damage the marketplaces — and the law.
Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some states’ regulators directed ACA insurers to add a surcharge in case the payments were not made, but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.
A spokeswoman for America’s Health Insurance Plans, an industry trade group that has been warning for months of adverse effects if the payments ended, immediately denounced the president’s decision. “Millions of Americans rely on these benefits to afford their coverage and care,” Kristine Grow said.
And California Attorney General Xavier Becerra (D), who has been trying to preserve the payments through litigation, said the president’s action “would be sabotage.” Becerra said late Thursday that he was prepared to fight the White House. “We’ve taken the Trump Administration to court before and won, and we’re ready to do it again if necessary,” he said in a statement.
Trump’s move comes even as bipartisan negotiations continue on one Senate committee over ways to prop up the ACA marketplaces. Both Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have publicly said the payments should not end immediately, though they differ over how long these subsidies should be guaranteed.
The cost-sharing reductions — or CSRs, as they are known — have long been the subject of a political and legal seesaw. Congressional Republicans argued that the sprawling 2010 health-care law that established them does not include specific language providing appropriations to cover the government’s cost. House Republicans sued HHS over the payments during President Barack Obama’s second term. A federal court agreed that they were illegal, and the case has been pending before the U.S. Court of Appeals for the D.C. Circuit.
President Trump signed an executive order on the Affordable Care Act on Oct. 12. With the order, he directed federal agencies to rewrite regulations on selling a certain type of health insurance across state lines. President Trump signed an executive order on the Affordable Care Act on Oct. 12. (Photo: Jabin Botsford/The Washington Post)
President Trump signed an executive order on the Affordable Care Act on Oct. 12. With the order, he directed federal agencies to rewrite regulations on selling a certain type of health insurance across state lines. (The Washington Post)
“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” a statement from the White House said. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”
In a filing Friday morning, the administration informed the court that HHS had “directed that cost-sharing reduction payments be stopped because it has determined that those payments are not funded by the permanent appropriation.”
House Speaker Paul D. Ryan (R-Wis.) said in a statement that the administration was dropping its appeal of the lawsuit — something the White House did not mention in its announcement. Ryan called the move to end to the court case “a monumental affirmation of Congress’s authority and the separation of powers.”
Meanwhile, the top two congressional Democrats, House Minority Leader Nancy Pelosi (Calif.) and Senate Minority Leader Charles E. Schumer (N.Y.), excoriated the president’s decision. “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” they said in a joint statement. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.”
For months, administration officials have debated privately about what to do. The president has consistently pushed to stop the payments, according to officials and advisers who spoke on the condition of anonymity to discuss private conversations. Some top health officials within the administration, including former HHS secretary Tom Price, cautioned that this could exacerbate already escalating ACA plan premiums, these Republicans said. But some government lawyers argued that the payments were not authorized under the existing law, according to one administration official, and would be difficult to keep defending in court.
Acting HHS secretary Eric Hargan and Seema Verma, administrator of the department’s Centers for Medicare and Medicaid Services, said they were stopping the payments based on a legal opinion by Attorney General Jeff Sessions. “It has been clear for many years that Obamacare is bad policy. It is also bad law,” their statement says. “The Obama Administration unfortunately went ahead and made CSR payments to insurance companies after requesting — but never ultimately receiving — an appropriation from Congress as required by law.”
While the administration will now argue that Congress should appropriate the funds if it wants them to continue, such a proposal will face a serious hurdle on Capitol Hill. In a recent interview, Rep. Tom Cole (R-Okla.), who chairs the House Appropriations Subcommittee overseeing HHS, said it would be difficult to muster support for such a move among House conservatives.
One person familiar with the president’s decision said HHS officials and Trump’s domestic policy advisers had urged him to continue the payments at least through the end of the year.
The cost-sharing payments are separate from a different subsidy that provides federal assistance with premiums to more than four-fifths of the 10 million Americans with ACA coverage.
Word of the president’s decision came just hours after he signed the executive order intended to circumvent the ACA by making it easier for individuals and small businesses to buy alternative types of health insurance with lower prices, fewer benefits and weaker government protections.
The White House and allies portrayed the president’s move as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: fostering more coverage choices while tearing down the law’s insurance marketplaces. Until the White House’s announcement late Thursday, the executive order represented Trump’s biggest step to date to reverse the health-care policies of the Obama administration, a central promise since last year’s presidential campaign.
Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of these other kinds of coverage will have damaging ripple effects, driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s action, they say, will spark court challenges over its legality.
The most far-reaching element of the order instructs a trio of Cabinet departments to rewrite federal rules for “association health plans” — a form of insurance in which small businesses of a similar type band together through an association to negotiate health benefits. These plans have had to meet coverage requirements and consumer protections under the 2010 health-care law, but the administration is likely to exempt them from those rules and let such plans be sold from state to state without insurance licenses in each one.
In addition, the order is designed to expand the availability of short-term insurance policies, which offer limited benefits as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. The Obama administration ruled that short-term insurance may not last for more than three months; Trump wants to extend that to nearly a year.
Trump’s action also is intended to widen employers’ ability to use pretax dollars in “health re-imbursement arrangements” to help workers pay for any medical expenses, not just for health policies that meet ACA rules — another reversal of Obama policy.
In a late-morning signing ceremony in the White House’s Roosevelt Room, surrounded by supportive small-business owners, Cabinet members and a few Republicans from Capitol Hill, the president spoke in his characteristic superlatives about the effects of his action and what he called “the Obamacare nightmare.”
Trump said that Thursday’s move, which will trigger months of regulatory work by federal agencies, “is only the beginning.” He promised “even more relief and more freedom” from ACA rules. And although leading GOP lawmakers are eager to move on from their unsuccessful attempts this year to abolish central facets of the 2010 law, Trump said that “we are going to pressure Congress very strongly to finish the repeal and replace of Obamacare.”
But in an early morning tweet Friday, Trump reached out to Democrats with an appeal to somehow work together on a health-care “fix.”
“The Democrats ObamaCare is imploding,” Trump wrote. “Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!”
The executive order will fulfill a quest by conservative Republican lawmakers, especially in the House, who have tried for more than two decades to expand the availability of association health plans by allowing them to be sold, unregulated, across state lines. On the other hand, Trump’s approach conflicts with what he and GOP leaders in Congress have held out as a main health-policy goal — giving each state more discretion over matters of insurance.
Health policy experts in think tanks, academia and the health-care industry pointed out that the order’s language is fairly broad, so the ensuing fine print in agencies’ rules will determine whether the impact will be as sweeping or quick as Trump boasted — his directive will provide “millions of people with Obamacare relief,” he said.
Significant questions that remain include whether individuals will be able to join associations, a point that could raise legal issues; whether the administration will start to let association health plans count toward the ACA’s requirement that most Americans carry insurance; and whether such plans can charge higher prices to small businesses with sicker workers — or refuse to insure them.
A senior administration official, speaking to reporters on the condition of anonymity shortly before Trump signed the order, said that the policy changes it sets in motion will require agencies to follow customary procedures to write new rules and solicit public comment. That means new insurance options will not be available in time for coverage beginning in January, he said.
Among policy experts, critics warned that young and healthy people who use relatively little insurance will gravitate to association health plans because of their lower price tags. That would concentrate older and sicker customers in ACA marketplaces with spiking rates.

Selling health plans from state to state without separate licenses — the idea underlying much of the president’s order — has long been a Republican mantra. It has gained little traction in practice, however.
Half a dozen states — before the ACA was passed in 2010 as well as since then — have passed laws permitting insurers to sell health policies approved by other states. And since last year, the ACA has allowed “compacts” in which groups of states can agree that health plans licensed in any of them could be sold in the others. Under such compacts, federal health officials must make sure the plans offer at least the same benefits and are as affordable as those sold in the ACA marketplaces.
As of this summer, “no state was known to actually offer or sell such policies,” according to a report by the National Conference of State Legislatures. A main reason, experts say, is insurers’ difficulty in arranging networks of doctors and other providers of care far from their home states.

BITTER CHILL IN THE FALL AIR FOR OBAMACARE

by D. Kenton Henry, Editor, Agent, Broker

The Open Enrollment Period (OEP) when individuals and families can select and enroll in health insurance plans for the calendar year 2018 is, just around the corner, beginning, as usual, November 1. What is different this year is, the Department of Health and Human Services (DHS), which oversees Obamacare (the Patient Protection and Affordable Care Act ― ACA), has proposed ending it December 15th ― a period half as long as in all previous years. OEP historically ends January 31st. If this proposed change is effected, consumers, and agents and brokers on their behalf, will be under considerably more pressure to bind coverage during a period which has always been fraught with confusion and frustration. Expected to heighten the latter, are increasing premiums and less participation by insurance companies and providers. Increasing premiums (which have only accelerated during Obamacare) speak for themselves. Less participation by insurance companies means less competition and fewer plans from which consumers may choose. Less participation by providers means it will be even harder to find your doctor or hospital in the Health Maintenance Network (HMO) plans we Texans are forced to choose from since January 2016. Do not expect Preferred Provider Organization (PPO) plans to return for 2018. The reason behind this deliberate trend is the unstated agenda of the industry to accustom each of us to have our providers―and thereby our treatment―rationed. The stated agenda is an attempt to mitigate financial losses by the insurance companies. Those in office who would replace Obamacare, and our current insurance system, with a “Single-Payer” system have no problem, whatsoever, with this trend. This, because restrictions on providers and treatment will be inherent in any single-payer program.There are many in Washington who believe the solution to healthcare insurance is to add all of us to Medicare.Those who share in the belief the single-payer system is the solution should consider the reality that Medicare is 50 trillion is debt and predicted to be insolvent 12 years from now. (That is according to the Trump administration. Obama’s predicted it to be insolvent one year earlier, the Congressional Budget Office three years earlier) http://www.modernhealthcare.com/article/20170713/NEWS/170719951

And this is the reality with current members having paid into it their entire working careers. How do you think that is going to work when you add every other American, a great many of which are not contributing to Medicare and never have? In my mind, that will expedite the path to insolvency exponentially. Consider a true single-payer program which serves as an example: Veteran’s Administration Health Care. A beacon of mismanagement resulting in waiting lines, provider rationing, and, in many parts of the country, long travel distances for care.

To exacerbate the difficulty in predicting premiums, and budgeting accordingly, President Trump has stated he is considering withholding federal subsidies to insurance companies. Historically, these have bought down the retail premiums the consumer must pay. Here we are halfway through September, and we still do not know if Trump will do so. Now―here is the real wrench in the grist mill ― the insurance companies must submit their 2018 premiums to the State Insurance Regulators by September 30th!

“If there’s no deal on the subsidies within the next five weeks, states will have no choice but to approve rate increases that include surcharges and go with those rates for the start of open enrollment on Nov. 1. On average that would mean consumers would see an extra 20 percent price hike next year.” ― 20 August 2017, CNBC.COM

“In many ways, the die has already been cast… if nothing changes before the end of September, we’re pretty much looking at those rates being locked in for 2018,” said Wisconsin insurance commissioner Ted Nickel, who is also president of the National Association of Insurance Commissioners. ― 20 August 2017, CNBC.COM

That is 20 percent on top of general premium increases predicted to be in the 12 to 15% range.

Once again, whether you feel you need assistance in coping with these issues in electing your 2018 coverage and protecting yourself and family from the sky-rocketing cost of health care, please call me at 281.367.6565. I have been specializing in health insurance for 26 of my 31 years in insurance. I have assisted my clients in coping with Obamacare since its passage in March of 2010.

For those of you enrolled in Medicare ― Open Enrollment for election of your 2018 Part D Drug Plan begins, as usual, October 15th. Current clients should email me a list of your current drug regimen at allplanhealthinsurance.com@gmail.com. Upon receipt, I will provide you my recommendation your lowest out of pocket cost Part D plan in 2018. Those of you not currently my clients are encouraged to do the same.

http://thewoodlandstxhealthinsurance.com

https://healthandmedicareinsurance.com

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Featured articles:

Governors Tell Congress to Stabilize Individual Health Insurance Market

Michael Collins, USA TODAYPublished 1:25 p.m. ET Sept. 7, 2017 | Updated 5:45 p.m. ET Sept. 7, 2017

WASHINGTON — Governors from five states called Thursday on Congress to move quickly to stabilize the individual health insurance market and then embark on a serious effort to deal with skyrocketing health care costs.

“All of us — Republicans, Democrats and independents — should agree that our current path is not a sustainable one,” Tennessee Gov. Bill Haslam told a Senate panel.

The governors — three Republicans and two Democrats — testified during the second of four bipartisan hearings before the Senate Health, Education, Labor and Pensions Committee.

The panel is looking for a short-term fix to stabilize the individual market after the collapse of GOP efforts to repeal and replace the Affordable Care Act, or Obamacare.

The committee’s chairman, Sen. Lamar Alexander, R-Tenn., said he hopes senators can forge a bipartisan agreement by the end of next week and pass limited legislation by the end of the month to keep prices down and make it possible for everyone in the individual market to be able to afford insurance.

Congress must act quickly. New insurance rates for 2018 must be posted on the government’s website, healthcare.gov., by Sept. 27.

At Thursday’s hearing, the committee heard from Republican Govs. Haslam, Charlie Baker of Massachusetts and Gary Herbert of Utah and Democratic Govs. Steve Bullock of Montana and John Hickenlooper of Colorado.

A key issue is the future of federal cost-sharing payments to insurers that help them provide affordable coverage for low- and moderate-income families.

President Trump has threatened to end the payments, worth about $7 billion this year.

Read more:

With Obamacare in limbo, senators look for fix to stabilize health insurance market

Trump says GOP senators ‘look like fools’ on health care, warns of ‘imploding ObamaCare’

Congress has a crucial to-do list in September: Here’s what lawmakers must accomplish

All five governors testifying Thursday urged Congress to continue the payments, echoing the pleas of state insurance commissioners who appeared before the panel a day earlier.

The governors also called for creation of a reinsurance program that would limit losses to carriers that provide coverage in the marketplace and for the federal government to give states more flexibility to design and regulate insurance plans more suited to their own needs.

“It’s time for the federal government to work with us, not against us,” said Hickenlooper, arguing that state efforts to bring down premiums have been frequently undermined.

Without the federal government’s help, trying to keep insurance affordable is “like climbing one of Colorado’s famous 14,000-foot mountains in winter without crampons,” Hickenloopper said. “It can’t be done.”

Alexander said one option for giving states flexibility would be to allow the governor or state insurance commissioner to apply for a waiver from Obamacare’s rules, instead of waiting for the state legislature to act. He also suggested a “copycat” provision so that when one state wins federal approval for a program or initiative, other states could quickly follow suit.

Senators most likely will fashion a short-term stabilization plan that includes continuing cost-sharing for a limited period of time and gives states significantly more flexibility through Obamacare’s waiver process, Alexander said.

Once a short-term fix is enacted to stabilize the individual market, lawmakers can then move quickly to focus on how to make the market vibrant in the long run, Alexander said.

“I hope we can begin to spend most of our time on the larger issue of health care costs,” he said.

Two more hearings are planned next week. The committee will hear Tuesday from various health policy experts. Health care providers and other stakeholders will appear before the panel next Thursday.

Health Insurance

If Congress doesn’t fund Obamacare subsidies next month it could get pretty complicated

  • Insurers can’t wait past a Sept. 30 deadline to set key insurance rates for next year.
  • However, the fate of key subsidy payments under the Affordable Care Act is still unknown.
  • State health insurance regulators expect that subsidies could remain in limbo past key deadlines, and are making plans for that possibility.

Bertha Coombs | @BerthaCoombs

Published 8:01 AM ET Sun, 20 Aug 2017  | Updated 4 Hours Ago CNBC.com

https://www.cnbc.com/2017/08/19/if-congress-doesnt-fund-obamacare-subsidies-it-could-get-complicated.html

State health insurance regulators have been hoping for the best when it comes to 2018 exchange enrollment, but are now bracing for the worst-case scenario — that the fate of key health insurance subsidies will remain in limbo past key deadlines next month.

“We have a way to protect consumers, but it is complicated and will cause unnecessary confusion and anxiety,” said Diana Dooley, chair of Covered California, the state’s Obamacare exchange, in a statement Friday.

California officials say they will wait until the end of September to decide whether to let insurers impose a 12.8 percent surcharge on 2018 exchange premiums to account for the potential loss of cost-reduction subsidies that reduce out-of-pocket costs for low-income enrollees.

“We are extending our deadline to give Congress time to act when they return in September,” Dooley explained. “We are heartened by the bipartisan discussion that put consumers first, but we can’t wait past Sept. 30.”

Some Republican lawmakers have proposed passing a short-term funding bill next month to authorize 2018 reimbursements for cost-reduction subsidies insurers are required to make under the Affordable Care Act.

However, if there’s no deal on the subsidies within the next five weeks, states will have no choice but to approve rate increases that include surcharges and go with those rates for the start of open enrollment on Nov. 1. On average that would mean consumers would see an extra 20 percent price hike next year.

 

“In many ways the die has already been cast… if nothing changes before the end of September, we’re pretty much looking at those rates being locked in for 2018,” said Wisconsin insurance commissioner Ted Nickel, who is also president of the National Association of Insurance Commissioners.

Pressure to act fast

State insurance commissioners, insurers and most of the major health industry groups have been urging Congressional leaders to fund the so-called cost-reduction subsidies for months, but politically it puts Republicans in a difficult spot after their failure to repeal the Affordable Care Act.

A federal judge ruled in favor of House Republicans last year, after they sued the Obama administration arguing that funding for the subsidies was never authorized by Congress. That lawsuit has been put on hold three times since last fall, and is due back in court this week.

President Donald Trump has repeatedly threatened to pull the plug on the insurer reimbursements citing the ruling, though the administration has continued to make the payments on a month-to-month basis, and will make them for August.

“What’s likely to happen is that Congress will pass some kind of interim funding, which negates the lawsuit,” said Julius Hobson, senior policy advisor at the Polsinelli law firm, adding that barring congressional authorization “it’s difficult to get a remedy that forces the government to spend the money.”

One thing that could help tip the balance for reaching a deal is the Congressional Budget Office’s report, which estimated that cutting the subsidies would increase the deficit by $194 billion over 10 years, in part because higher premium rates would result in more people qualifying for tax credits.

But Congress also has a number of key deals it has to reach next month, including raising the deficit and reaching an agreement to fund the government in order to avoid a shutdown.

What if the payments get funded after the rate hikes?

If funding for cost-reduction subsidies were approved after rates are locked in for open enrollment, consumers would not likely get relief from the price hikes right away.

“The Medical Loss Ratio that was instituted by the ACA will still be in place, meaning that consumers will be reimbursed [if] insures are not spending an 80% minimum on [health] care costs,” said Christina Cousart, senior policy associate at National Academy for State Health Policy, but she added those rebates would happen retroactively.

Some consumers might not be made whole for the premium surcharges. The higher rates would likely result in even fewer healthy unsubsidized consumers signing up for coverage. While the rate increases should be high enough to shield insurers from losses on sicker enrollees, they would not necessarily result in big rebates for consumers.

“There’s no way we can back out these higher rates that the companies put in… We’re going to have more expensive health insurance plans, we’re going to have fewer people enrolled,” said insurance industry consultant Robert Laszewski, president of Health Policy and Strategy associates.

What’s also unclear is whether consumers who receive larger tax credits would have to pay them back at tax time, if insurers do provide premium surcharge rebates.

“This is really hard to say at this point, without knowing how it will all play out — which is why we believe that the best solution is for Congress and the administration to resolve this issue now,” said Covered California spokesman James Scullary. “A resolution now eliminates the need for all of these workarounds to protect consumers.”

If Congress manages to come up with a funding deal to keep the subsidies in place, Wisconsin’s insurance commissioner says they should not stop there. He says the current problems underscore the need to give states more flexibility to stabilize their exchange markets than they have under current Obamacare rules.

“We have so little control now, so much of it is coming from the federal government through more of a central planning function rather than letting states engage in ways that best needs of their consumers,” said Nickel. “We do find ourselves in very difficult straights.”

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Changes Coming for Next Year’s Obamacare Open Enrollment Period

The Trump administration is working to make changes to the Affordable Care Act (ACA)

With the confirmation of Tom Price as Secretary of Health and Human Services, the Trump administration is already working to make changes to President Obama’s health reform law, the Affordable Care Act (ACA).

No, the promised “repeal and replace” of the ACA (also known as Obamacare) hasn’t happened yet, but Mr Price’s Department of Health and Human Services (DHS) has issued proposed guidelines that would affect consumers during 2018’s Obamacare open enrollment period.

The 2018 open enrollment period is not scheduled to begin until the fall of 2017. If the ACA is repealed, this next open enrollment period may be Obamacare’s last.

Let’s take a look at some of the proposed changes:

  • Shorter open enrollment period for 2018 – The 2018 Obamacare open enrollment period is currently scheduled to run from November 1, 2017 through January 31, 2018. DHS’s proposed change cut the duration of the the open enrollment period by half so that it runs from November 1 through December 15, 2017.
  • Some loosening of benefit requirements – The Obamacare law sets strict guidelines for “minimum essential coverage” that all major medical health insurance plans must provide. Though details are not yet available, DHS is proposing to loosen these rules somewhat, allowing insurers to offer plans with a broader range of coverage options.
  • More supporting documentation required for special enrollment periods – Outside of the nationwide open enrollment period, consumers can only purchase coverage on their own when they experience a major life change, such as marriage or divorce, or the birth or adoption of a baby, etc. A proposed revision of rules would tighten the requirements for applicants to provide documentation proving their eligibility for a special enrollment period.
  • Changes to doctor network rules – Under Obamacare, the federal government sets standards for what constitutes an adequate network of participating doctors and medical facilities for major medical plans. A proposed change from DHS would allow states to set these limits for themselves instead.
  • Collection of overdue premiums – In a move designed to discourage applicants from neglecting to pay their monthly premiums near year’s end and simply re-enrolling with the same plan for January, a proposed DHS rule would allow insurers to collect overdue premiums before extending coverage to such applicants in the next year.

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Trustees’ report says Medicare will be insolvent by 2029

Modern Healthcare

By Virgil Dickson  | July 13, 2017

The Medicare trust fund will be insolvent by 2029, the program’s trustees reported today.

 

The prediction is a year later than the 2028 date the Obama administration outlined in last year’s report. The Congressional Budget Office in January 2016 estimated the program would be solvent only until 2026.

 

Based on the new findings, the feared Independent Payment Advisory Board, which was designated by the Affordable Care Act to rein in Medicare costs if they grew faster than a set rate, will not be activated.

 

That’s likely good news as the board, called a death panel by ACA opponents, has never had to be formed. There hasn’t been the need, and some say, the willingness to expend the political capital. With midterm elections coming and possible fallout likely if Republicans repeal the ACA, this is one less possible political headache to worry about. Also of note, 2029 is 12 years longer than projected estimates before the Affordable Care Act become law.

 

However, trustees are worried doctors will exit the program anyway. The report contained new concerns about access to physicians in the coming years due to the Medicare Access and CHIP Reauthorization Act.

 

MACRA replaced the physician payment updates under the sustainable growth rate formula, which clinicians were paid under for years.

 

Under MACRA the annual physician payment update for 2017 through 2019 will be 0.5%. For 2020 through 2025, there will be no payment update, which alarmed the trustees.

 

“These amounts do not vary based on underlying economic conditions, nor are they expected to keep pace with the average rate of physician cost increases,” the report said. “Absent a change in the delivery system or level of update by subsequent legislation, access to Medicare-participating physicians may become a significant issue in the long term under current law.”

 

The new insolvency date does incorporate modest savings from the agency’s move to value-based care, including accountable care organizations. However, exact figures were not broken out.

 

“The innovations being tested under the ACA, such as bundled payments or accountable care organizations, could reduce incentives to adopt new cost-increasing technologies and could contribute to greater efforts to avoid services of limited or no value within the service bundle,” the report says.

 

Medicare Part D expenditures per enrollee are estimated to increase by an average of 6.4% annually over the next five years; that’s higher than the projected average annual rate of growth for the U.S. economy, which is 5.2 % during that period.

 

The report found that these costs are trending higher than previously predicted, particularly for specialty drugs.

 

In 2016, Medicare covered 56.8 million people and expenditures were $678.7 billion up from $647.6 billion and 55.3 million beneficiaries in 2015.

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THE FUTURE OF HEALTH INSURANCE IN 2018

Shortly after 1:30 a.m. Friday, July 28th, the U.S. Senate voted 49-51 to reject the Health Care Freedom Act (HCFA), a “skinny repeal” of the ACA. The pared-down version was attempted after previous efforts to pass a more sweeping repeal of the law have failed. Senate Majority Leader Mitch McConnell (R-KY) began floating the idea early in the week before ultimately releasing the text of the bill at 10 p.m. Thursday, just two hours before the vote. Republican Senators Susan Collins (ME), Lisa Murkowski (AK), and John McCain (AZ) joined all Democrats in voting no, while all other Republicans voted in favor. With the failure of this vote, congressional Republicans will no longer be able to use the budget reconciliation process to repeal provisions of the ACA until the next fiscal year and will instead have to move legislation under regular order that would require 60 votes for passage in the Senate. ― NAHU 7/28 (washingtonupdate@nahu.org)

Anyone who tells you they know what the next few months before health insurance OPEN ENROLLMENT  (OE)―the period during which individuals and families may apply for and obtain coverage for the coming calendar year―will produce definitively, is deluding themselves. OE is scheduled to begin November 1 and run through December 7th. At this point, the only safe prediction is the preservation of the status quo. In other words, premiums will increase another 15 to 25% minimum; there will be fewer options regarding carriers and plans and fewer in-network medical providers from which to choose. In some parts of the country, it will be even worse, with only one carrier to choose from and―in some cases ― none. Whether that will be the case in Texas remains to be seen.

Here is what we do know:

1) Premiums will increase significantly in most areas

2) In the area of Houston, one more carrier―Memorial Hermann Health Plan―has announced they are withdrawing from the market. All of their current policyholders must find replacement coverage for 2018.

3) Humana has canceled all their current individual and family plans effective July 1 and will not participate in the market in 2018. This is in addition to Aetna, Cigna’s and Unitedhealthcare’s withdrawal from the market in 2017.

4) Residents of Harris, Fort Bend, and Montgomery Counties will (hopefully) have only plans from BlueCross BlueShield of Texas, Community Health Choice, and Molina Healthcare from which to choose.

5) The only remaining network option available from the above-referenced carriers will be Health Maintenance Organization (HMO) plans where the insured individual must seek treatment within the network or have no coverage whatsoever.

Here is an important change this editor (who is also a health insurance broker) recently learned. Married couples who are small business owners seeking Preferred Provider Organization (PPO) coverage as a way of having access to providers and treatment―will no longer be eligible for coverage with most (if not all) small group carriers unless they had a minimum average of one W-2 employee in the previous calendar year. This new stipulation would have prevented many of my business owner clients from obtaining the group PPO health insurance they now have, had it been in effect before January 1 of 2017. A prospective client of mine whose family coverage was canceled by Humana, July 1―in the midst of cancer treatment―now finds himself denied covered access to his oncologist and hospital. It appears all ongoing medical treatment from those providers, at least through the remainder of the year, will be self-funded. If you are a small business owner considering moving to group insurance in 2108, bear this in mind and begin paying at least one employee W-2, full time, through the remainder of 2017.

Small business owners considering a move to small group coverage who can meet this eligibility requirement, please contact me for assistance in making the transition.

For individuals and families who do not have a business, or employer sponsored health insurance, I will have whatever health insurance options are available to residents of your county and will soon begin testing and certifying (as I must each fall) to market these plans for the coming calendar year. I will be able to assist you whether you qualify for a subsidy of your health insurance premium or do not. If you do, I believe it will be much easier to obtain your subsidy and health insurance through me than by dealing with the marketplace, Healthcare.gov. If you do not qualify for a one, I have a strategy for minimizing your premium while giving you access to the provider of your choice. It is not appropriate for everyone, but it has worked for many of my clients.

Please contact me at 281-367-6565; text me at 713-907-7984, or email me at allplanhealthinsurance.com@gmail.com

Though I see little reason to be optimistic for a solution to the aforementioned problems until the Patient Protection and Affordable Care Act (Obamacare) implodes entirely, and Congress is forced to unite to provide a workable solution, let’s hope enough reasonable minds prevail before it comes to that. In the meantime, I am here to assist in acquiring the best available option, as I have for the past 26 years.

―D. Kenton Henry, editor, agent, broker

http://TheWoodlandsTXHealthInsurance.com

https://healthandmedicareinsurance.com

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FEATURED ARTICLE

GOP leaders say it’s time for Senate to move on from health care

(Jenny Starrs/The Washington Post)

By Sean Sullivan By Sean Sullivan July 31 at 9:24 PM

Senate Republican leaders signaled Monday that they intend to move on from health care to other legislative priorities, even as President Trump continued to pressure lawmakers to repeal and replace the Affordable Care Act.

The discord comes amid uncertainty in the insurance industry and on Capitol Hill about what will come next after last week’s dramatic collapse of the GOP’s effort to scrap the seven-year-old landmark law. Trump on Monday threatened to end subsidies to insurers and also took aim at coverage for members of ­Congress.

But the White House insistence appears to have done little to convince congressional GOP leaders to keep trying. One after another on Monday, top GOP senators said that with no evidence of a plan that could get 50 votes, they were looking for other victories.

“We’ve had our vote, and we’re moving on to tax reform,” said Sen. John Thune (S.D.), one of Senate Majority Leader Mitch McConnell’s top lieutenants, speaking of the next big GOP legislative priority.

Sen. Roy Blunt (Mo.), another member of the Republican Senate leadership, put it this way: “I think it’s time to move on to something else. Come back to health care when we’ve had more time to get beyond the moment we’re in — see if we can’t put some wins on the board.”

McConnell did not address health care in his remarks opening Senate business on Monday afternoon. His top deputy, Sen. John Cornyn (Tex.), brushed back comments White House budget director Mick Mulvaney made on CNN on Sunday urging Republicans not to vote on anything else until voting on health care again.

“I don’t think [Mulvaney’s] got much experience in the Senate, as I recall,” said Cornyn as he made his way into the Senate chamber. “And he’s got a big job. He ought to do that job and let us do our job.”

Mulvaney was echoing what Trump tweeted Saturday: “Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill!”

On Monday, Trump tweeted: “If Obamacare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?” He was referencing subsidies that members of Congress receive to help offset their coverage costs purchased through the District’s exchanges, as required under the Affordable Care Act.

Sen. Rand Paul (R-Ky.) said Monday that based on a conversation he had with Trump, the president is considering taking executive action on health care, Reuters reported. A Paul spokesman did not immediately respond to a request for comment, and it was not clear what such an action could be. Health and Human Services Secretary Tom Price indicated over the weekend that he was considering using his regulatory authority to waive the Affordable Care Act’s mandate that all Americans buy coverage or pay a tax.

Some rank-and-file Republican lawmakers have used the collapse of repeal-and-replace to offer new fixes and improvements to health care, but there was no sign their leaders were engaged. On Monday, Price met with fellow physician Sen. Bill Cassidy (R-La.), who has proposed restructuring how federal money is distributed under the Affordable Care Act. Separately, a bipartisan group of 43 House members released details of their own plan.

“We had a productive meeting. All involved want a path forward,” said Cassidy in a statement after his White House meeting, also attended by several governors. In addition to turning over federal funds to the states, Cassidy and Sens. Lindsey O. Graham (R-S.C.) and Dean Heller (R-Nev.) have proposed repealing key mandates and a tax under the law.

But there are no signs that plan will be put to a vote any time soon. It has not been scored by the nonpartisan Congressional Budget Office. It’s unclear how many Republicans would vote for it. And McConnell is working on confirming Trump’s nominees this week.

A growing number of Republican lawmakers have raised the prospect of working with Democrats on health care. The collection of centrist House Republicans and Democrats unveiled a proposal Monday calling for revisions they said would help stabilize the individual insurance ­market.

Rep. Tom Reed (R-N.Y.), a co-chair of the centrist Republican and Democratic “Problem Solvers Caucus,” which released the plan, said he and his colleagues have been working on a draft for about three weeks, as they saw “the writing on the wall” that the Senate bill was likely to fail.

House Speaker Paul D. Ryan (R-Wis.) did not champion the plan. AshLee Strong, his press secretary, said in an email: “While the speaker appreciates members coming together to promote ideas, he remains focused on repealing and replacing Obamacare.”

Strong did not respond to a follow-up question about how that ought to happen. The House passed a sweeping rewrite of the Affordable Care Act this year, with only Republicans voting for it.

The Senate tried to pass its own version but was unable to reach an accord, even on a more modest bill that was meant to keep the talks alive in both chambers. That bill was rejected Friday when Sen. John McCain (R-Ariz.) joined two other Republicans to sink the legislation in a tension-filled vote that happened while most of the country was asleep.

In their outline, Reed and his colleagues said federal cost-sharing subsidies should be placed under congressional oversight and that mandatory funding should be assured. Now such disbursements are up to the Trump administration, which has been paying them monthly but has threatened to withhold them.

Top Democrats and Republicans warned against that.

“Right now, as insurers prepare to lock in their rates and plans for 2018, the Trump administration is dangling a massive sword of Damocles over the heads of millions of Americans — threatening to end payments the administration is supposed to make that would lower deductibles and out-of-pocket costs for so many Americans,” said Senate Minority Leader Charles E. Schumer (D-N.Y.) on the Senate floor.

Thune said he was “hopeful” the administration would keep making the payments.

After Friday’s vote, some Democrats have felt more empowered to talk about changes to the Affordable Care Act. The centrist House lawmakers want to repeal the 2.3 percent tax on medical device manufacturers and loosen the employer mandate under the Affordable Care Act. The law says companies with 50 or more full-time employees must offer coverage. They want to raise the threshold to 500.

They also said they want to create a state stability fund to reduce premiums and spur more innovation at the state level.

Getting health-care legislation backed only by Republicans to Trump’s desk by the end of August is all but impossible, even if they suddenly put aside their disagreements. The House is in recess until September. The Senate is scheduled to be in session the first two weeks of August.

The prospects of a bipartisan deal were just as doubtful, amid fierce partisanship that has gripped the Capitol in the Trump era, which has shown no signs of abating. Even those pushing for one were tempering expectations.

“We’re not stupid,” Reed said. “Those partisan swords — they’re going to be out there.”

Paige Winfield Cunningham contributed to this report

SENATE ACA REPEAL AND REPLACE UP IN THE AIR

Senate’s ACA Repeal and Replace Bill Up In Air

― op-ed by D. Kenton Henry

The passage of the Senate’s Affordable Care Act repeal and replace bill, prior to their scheduled July 4th recess, is as up in the air as the fireworks will be coinciding with that illustrious date. With five Republican and additional Democrat senators currently opposed, its passage appears tenuous at best. This, in spite of President Trump’s expressed confidence it will happen.

As a medical insurance broker the past 30 years, I have certainly have an opinion on, and a vested interest in, the passage (or failure) of the bill. The reality is, the Democrats own the current Patient and Protection Affordable Care Act (PPACA). Not one Republican voted for it. Therefore (if repeal fails), come 2018, it will be the Democrat’s law which, I believe, will result in an even greater increase in health insurance premiums we have already seen skyrocket since the Act’s passage. And be certain―we will see an even greater exodus of insurance carriers from the marketplace, leaving some counties―and possibly states―with only one carrier. Or, possibly, none. In which case, Trump and the Republicans can continue to tell the Democrats, “We told you so!”.

The problem for the Republicans is, they were elected on a platform of repeal and replace. As such, there are two ways Republicans can fail the people. The first is by not fulfilling that promise. The second―and quite possibly the larger failure― is to pass something which turns out to be an equal or greater debacle than the PPACA itself. As much as I want to see the Act replaced with something better, upon analysis, I find myself largely in agreement with Senator Rand Paul. This bill almost resembles Obamacare more than it does not. Not only does it continue subsidies based on income, but it maintains ten of the twelve mandated “essential coverage items” which forced premiums up in the first place! The primary objectives of repeal and replace were to give people more control over the coverage they purchase and reject, and to bring premiums down. To acquire just what they need and reject what they don’t, all at a lower cost. As it stands today, the Senate bill cannot accomplish either because the remaining forced mandates will force insurance companies to keep premiums high while rationalizing the subsidies allow enough people to pay them using “other people’s money”. When all is said and done, if the bill passes as is, those who don’t qualify for a subsidy will feel angry and betrayed and our twenty trillion dollar budget deficit will grow at even faster than its current, virtually criminal, rate of escalation. Couple doing away with the individual mandate to purchase and maintain coverage with allowing people to purchase it anytime of the year―in spite of the state of their health―and you have a recipe for absolute failure. Many will refrain from purchasing until they receive a dread diagnosis, then purchase the insurance to force the loss of huge medical claims on someone else! I.e., the insurance companies and those responsible insured members who pay their own premiums. If passed without restrictions on when insurance may be purchased (Open vs. Closed Enrollment), I predict this replacement will fail more quickly than Obamacare has failed.

Who will be the major losers if this bill passes as is? Those individuals who must pay their own premiums; the American taxpayer; and―when the healthy drop coverage because they are no longer forced by law to purchase it―me. Who are the major winners? Employers who will see the mandate to provide coverage for groups of 50 plus dropped, creating an incentive to hire; Medical Device companies who will see taxes on their products repealed, encouraging innovation; those individuals and families who have someone else paying all, or the majority, of their premium; and the insurance companies who continue to be subsidized and receive even greater premiums (subsidized or not) for somewhat diminished coverage. And―in the case of where a broker’s compensation is based on a percentage of premium―me.

Who knows how this will ultimately shake out. All I know is, whatever the result, it will be a mixed bag depending on your position in the equation. Stay tuned and―regardless the result―contact me at 281-267-6565. Whatever your options, unless agents and brokers fall on the chopping block, I intend to be here to assist you identifying and obtaining the option most beneficial to your physical and financial health.

https://healthandmedicareinsurance.com

http://thewoodlandstxhealthinsurance.com

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FEATURED ARTICLE:

Senate health-care draft repeals Obamacare taxes, provides bigger subsidies for low-income Americans than House bill

By Paige Winfield Cunningham By Paige Winfield Cunningham June 21

Senate leaders on Wednesday were putting the final touches on legislation that would reshape a big piece of the U.S. health-care system by dramatically rolling back Medicaid while easing the impact on Americans who stand to lose coverage under a new bill.

A discussion draft circulating Wednesday afternoon among aides and lobbyists would roll back the Affordable Care Act’s taxes, phase down its Medicaid expansion, rejigger its subsidies, give states wider latitude in opting out of its regulations and eliminate federal funding for Planned Parenthood.

The bill largely mirrors the House measure that narrowly passed last month but with some significant changes aimed at pleasing moderates. While the House legislation tied federal insurance subsidies to age, the Senate bill would link them to income, as the ACA does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill,\ but would enact deeper long-term cuts to the health-care program for low-income Americans. It also removes language restricting federally subsidized health plans from covering abortions, which may have run afoul of complex budget rules.

Senate Majority Leader Mitch McConnell (R-Ky.) intends to present the draft to wary GOP senators at a meeting Thursday morning. McConnell has vowed to hold a vote before senators go home for the July 4 recess, but he is still seeking the 50 votes necessary to pass the major legislation under arcane budget rules. A handful of senators, from conservatives to moderates, are by no means persuaded that they can vote for the emerging measure.

Aides stress that the GOP plan is likely to undergo more changes to garner the 50 votes Republicans need to pass it. Moderate senators are concerned about cutting off coverage too quickly for those who gained it under the ACA, also known as Obamacare, while conservatives don’t want to leave big parts of the ACA in place.

As a nod to conservatives, the Senate bill would give states more leeway in opting out of the ACA’s insurance regulations through expanding the use of so-called “1332” waivers already embedded within the law, according to the draft proposal. States could use the waivers to make federal subsidies available even off the marketplaces — but they couldn’t go so far as to lift ACA protections for patients with preexisting conditions.

But it may prove trickier to get moderates on board. Senate leaders are hoping the big draw for them lies in the bill’s more generous income-based approach to insurance subsidies, which closely mirror the subsidies offered under Obamacare.

Subsidies are available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, under the Senate bill, this assistance would be capped for those earning up to 350 percent — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.

The subsidies would also mirror the ACA in that they would be pegged to a benchmark insurance plan each year, ensuring that the assistance grows enough to keep coverage affordable for customers.

The Senate bill would also keep the ACA’s Medicaid expansion around for longer, gradually phasing it out over three years, starting in 2021.

Despite these shifts, moderates are likely to be turned off by how the bill cuts Medicaid more deeply than the House version. But the biggest cuts wouldn’t take effect for seven years, a time frame that could be more politically palatable for members like Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.).

Under the Senate draft, federal Medicaid spending would remain as is for three years. Then in 2021 it would be transformed from an open-ended entitlement to a system based on per capita enrollment. Starting in 2025, the measure would tie federal spending on the program to an even slower growth index, which in turn could prompt states to reduce the size of their Medicaid programs.

In a move that is likely to please conservatives, the draft also proposes repealing all of the ACA taxes except for its so-called “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

The Senate bill would also provide funding in 2018 and 2019 for extra Obamacare subsidies to insurers to cover the cost-sharing discounts they’re required to give the lowest-income patients. Insurers have been deeply concerned over whether the subsidies will continue, as the Trump administration has refused to say whether it will keep funding them in the long run.

The House had a difficult time passing its own measure after a roller-coaster attempt, with the first version being pulled before reaching the floor after House Speaker Paul D. Ryan (R-Wis.) determined he did not have the votes. House Republicans went back to the drawing board and passed their own measure — which would more quickly kill Medicaid expansion and provide less-generous federal subsidies — on May 4.

Even if the Senate measure does pass the upper chamber, it will still have to pass muster with the more conservative House before any legislation could be enacted.

Juliet Eilperin and Amy Goldstein contributed to this report.