What’s New in Health Care Reform: April 12

What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.


Trump Administration to Pay Health Law Subsidies Disputed by House

The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them. The statement sends a small but potentially significant signal to insurers, encouraging them to stay in the market. Via NY Times.

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Reversal: Some Republicans Now Defending Parts of Obamacare

The House’s debate over repealing Obamacare has had an unintended effect: Republicans are now defending key elements of President Obama’s health law. Many House Republicans are now defending Obamacare’s protections for people with pre-existing conditions, in the face of an effort by the conservative House Freedom Caucus to repeal them. Some Republican lawmakers are also speaking out in favor of Obamacare’s expansion of Medicaid and its mandates that insurance plans cover services such as mental health and prescription drugs. Via The Hill.

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No "Death Spiral": Insurers May Soon Profit from Obamacare Plans, Analysis Finds

In contrast to the dire pronouncements from President Trump and other Republicans, the demise of the individual insurance market seems greatly exaggerated, according to a new financial analysis released. The analysis, by Standard & Poor’s, looked at the performance of many Blue Cross plans in nearly three dozen states since President Barack Obama’s health care law took effect three years ago. It shows the insurers significantly reduced their losses last year, are likely to break even this year and that most could profit—albeit some in the single-digits—in 2018. The insurers cover more than five million people in the individual market. Via NY Times.

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GOP Health Plan Relies on Cutting Payments to Doctors, Hospitals

A Republican health-care plan to lower insurance premiums would need to cut payments to hospitals and doctors to the same level as federally-set Medicare rates and would require billions of dollars in extra government spending to meet its goals, according to an independent analysis of the policy. The Republican amendment adds what’s called the Federal Invisible Risk Sharing Program to the legislation to help appease conservatives and get the bill through the House. At a committee meeting to make the changes, one GOP congressman said it would lead to substantially lower premiums. Via Bloomberg.

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Republicans Are Using an Obscure Law to Repeal Some Obama-Era Regulations

In all, 11 regulations have been overturned using The Congressional Review Act, a heretofore obscure law passed by Congress in 1996. It allows lawmakers to overturn any regulation imposed during the final six months of the previous administration, with a simple majority vote in each chamber of Congress. It had only been used once previously, to overturn an ergonomics regulation by the Occupational Safety and Health Administration that had been approved during the Clinton administration. Via NPR.

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House GOP Amends Health Care Bill to Address Premiums

The deal House Republicans reached addresses a key problem with their alternative to the Affordable Care Act: steep premiums. The provision, which House Republicans decided to add to their Obamacare replacement bill before they face constituents during the Easter recess, is similar to a reinsurance program. It would dole out $15 billion to states over about a decade to help insurers cover the sickest people in the health care system and reduce premiums for individual health plans. But experts warn federal funding must continue beyond 10 years for the program to be successful. Via Morning Consult.

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House GOP Finds One Health Policy to Agree on, but Rift Remains

Republicans are pointing to an amendment on federal high risk pools as movement toward a health care deal, but they’re heading to their home districts without a full agreement. It’s not clear whether the proposal changes any lawmakers’ votes on the broader legislation, dubbed the American Health Care Act, a GOP bill to repeal and replace the Affordable Care Act that House leaders pulled before a floor vote two weeks ago. Via Morning Consult.

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Repeal Push Complicates State Efforts to Get Obamacare Waivers

A number of states are readying blueprints for substantial changes under an Obamacare waiver program, but a renewed push to repeal the law is complicating their plans. The Affordable Care Act’s 1332 State Innovation Waiver lets states skip some of the law’s regulations if their health care plan covers a comparable number of people without increasing the federal deficit. States can apply for the waivers starting this year. Via The Hill.

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White House Divided on Obamacare Payments

The disintegration of the latest Obamacare repeal bid in the House has thrown the health law’s fate back to a divided circle of White House advisers wrestling with whether to pay out key subsidies—or cut them off and blow up the health law. The aides have limited time to figure things out; health plans must decide in June whether to stay in Obamacare insurance markets next year or pull out. If billions of dollars of cost-sharing subsidies dry up, the plans are more likely to leave, possibly quite rapidly. Millions of people could lose their coverage—and polls show people are becoming more likely to blame health law problems on President Donald Trump than on his predecessor. Via Politico.

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Divisions among House Republicans Stall Health Care Talks, Again

House Republicans aren’t expecting to vote on a health care bill this week, and talks probably won’t resume until after a two-week recess for Easter. While there are members who say they crave agreement on health care, a deal seems unlikely while there are clear divisions within the House Republican Conference. Via Morning Consult.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.