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"content": "\u003cp>With a deadline looming, California’s health exchange and a major insurer pressed Republican leaders in Washington to clear up confusion over their commitment to key provisions of the Affordable Care Act.\u003c/p>\n\u003cp>Health insurers participating in the Covered California exchange for individuals and families must submit initial rates for 2018 on Monday. Peter Lee, the exchange’s executive director, warned in a conference call Thursday that rates could jump by more than 40 percent if the Trump administration and Republican-led Congress walk away from crucial elements of the health law.\u003c/p>\n\u003cp>In the meantime, House Republicans are looking to revive their Obamacare replacement bill and rally more support among moderate lawmakers in hopes of holding a vote soon.\u003c/p>\n\u003cp>In addition to Covered California, the chief executive of Molina Healthcare, a Long Beach-based insurer, implored Congress and the Trump administration on Thursday to act quickly to stabilize the exchange markets.\u003c/p>\n\u003cp>At issue are the continued federal funding of subsidies that reduce low-income consumers’ deductibles and copays and the enforcement of the individual mandate to purchase health coverage or pay a penalty.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Premiums in Covered California plans could increase by 42 percent, on average, if those subsidies aren’t funded and the mandate isn’t enforced, according to an analysis released Thursday by the exchange. Covered California has about 1.3 million customers.\u003c/p>\n\u003cp>Lee said it is imperative for leaders in Washington to clear up the uncertainty to avoid damaging insurance markets nationwide and hurting consumers. He said statements this week by the Trump administration that it would continue funding the cost-sharing subsidies haven’t specifically addressed whether that applies to all of 2017 or 2018.\u003c/p>\n\u003cp>“Health plans need to know now what are the rules of the road,” Lee said. “Insurers are considering their participation in the face of unprecedented uncertainty.”\u003c/p>\n\u003cp>Much of the debate this week in Washington has centered on House Republicans amending their Obamacare replacement bill, the American Health Care Act. But Lee said addressing the current market rules should be a priority ahead of crafting broader legislation.\u003c/p>\n\u003cp>Lee declined to comment on the latest legislative proposal from House Republicans, but he noted it still faces a long road ahead in Congress before it would win approval. “Health plans need to submit bids for today’s reality. Policymakers need to address that reality,” Lee said.\u003c/p>\n\u003cp>In a letter to House Speaker Paul Ryan and other congressional leaders, Molina Healthcare CEO J. Mario Molina said the cost-sharing reduction subsidies are essential for making coverage affordable for many consumers. Those subsidies cover out-of-pocket costs for exchange customers with incomes below 250 percent of the federal poverty level. They are separate from the tax credits that subsidize premium costs.\u003c/p>\n\u003cp>Without that federal funding, Molina wrote, “we will have no choice but to send a notice of default informing the government that we are dropping our contracts for their failure to pay premiums and seek to withdraw from the marketplace immediately.”\u003c/p>\n\u003cp>Molina said his company currently serves more than 1 million people through insurance exchanges in California and several other states. Molina had nearly 69,000 enrollees in Covered California as of December, state data show.\u003c/p>\n\u003cp>Anthem, California’s largest for-profit health insurer and a key player on exchanges nationally, issued a similar warning this week. During an earnings conference call on Wednesday, Anthem CEO Joseph Swedish said the insurer may exit some state exchanges or resubmit for higher rates if the fate of the cost-sharing subsidies isn’t resolved by early June.\u003c/p>\n\u003cp>Anthem has more than 310,000 customers in the California exchange, or nearly 25 percent of the market. Rival Blue Shield of California is the leader in state enrollment with 389,480, or 31 percent market share.\u003c/p>\n\u003cp>Republican leaders in Congress say they will address these concerns and move quickly to aid consumers by replacing the ACA with a plan that will reduce premiums and expand options for coverage.\u003c/p>\n\u003cp>The health law “is collapsing,” Ryan said at a news conference Thursday. “The American health care system in the individual market is in peril right now. We have a moral obligation to prevent people from getting hurt, to stop the damage from being continued.”\u003c/p>\n\u003cp>Many conservative Republicans oppose the Trump administration’s decision to continue to pay the cost-sharing subsidies, calling the subsidies unconstitutional because they lack congressional approval. House Republicans successfully sued to block the payments, but a judge put the ruling on hold while the Obama administration appealed the case. It’s not yet clear how President Donald Trump will handle that appeal.\u003c/p>\n\u003cp>Amid this political uncertainty, California Insurance Commissioner Dave Jones told insurers this week they could submit two sets of rate filings on Monday for their exchange business. One filing would reflect continued funding of cost-sharing subsidies and enforcement of the individual mandate. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With a deadline looming, California’s health exchange and a major insurer pressed Republican leaders in Washington to clear up confusion over their commitment to key provisions of the Affordable Care Act.\u003c/p>\n\u003cp>Health insurers participating in the Covered California exchange for individuals and families must submit initial rates for 2018 on Monday. Peter Lee, the exchange’s executive director, warned in a conference call Thursday that rates could jump by more than 40 percent if the Trump administration and Republican-led Congress walk away from crucial elements of the health law.\u003c/p>\n\u003cp>In the meantime, House Republicans are looking to revive their Obamacare replacement bill and rally more support among moderate lawmakers in hopes of holding a vote soon.\u003c/p>\n\u003cp>In addition to Covered California, the chief executive of Molina Healthcare, a Long Beach-based insurer, implored Congress and the Trump administration on Thursday to act quickly to stabilize the exchange markets.\u003c/p>\n\u003cp>At issue are the continued federal funding of subsidies that reduce low-income consumers’ deductibles and copays and the enforcement of the individual mandate to purchase health coverage or pay a penalty.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Premiums in Covered California plans could increase by 42 percent, on average, if those subsidies aren’t funded and the mandate isn’t enforced, according to an analysis released Thursday by the exchange. Covered California has about 1.3 million customers.\u003c/p>\n\u003cp>Lee said it is imperative for leaders in Washington to clear up the uncertainty to avoid damaging insurance markets nationwide and hurting consumers. He said statements this week by the Trump administration that it would continue funding the cost-sharing subsidies haven’t specifically addressed whether that applies to all of 2017 or 2018.\u003c/p>\n\u003cp>“Health plans need to know now what are the rules of the road,” Lee said. “Insurers are considering their participation in the face of unprecedented uncertainty.”\u003c/p>\n\u003cp>Much of the debate this week in Washington has centered on House Republicans amending their Obamacare replacement bill, the American Health Care Act. But Lee said addressing the current market rules should be a priority ahead of crafting broader legislation.\u003c/p>\n\u003cp>Lee declined to comment on the latest legislative proposal from House Republicans, but he noted it still faces a long road ahead in Congress before it would win approval. “Health plans need to submit bids for today’s reality. Policymakers need to address that reality,” Lee said.\u003c/p>\n\u003cp>In a letter to House Speaker Paul Ryan and other congressional leaders, Molina Healthcare CEO J. Mario Molina said the cost-sharing reduction subsidies are essential for making coverage affordable for many consumers. Those subsidies cover out-of-pocket costs for exchange customers with incomes below 250 percent of the federal poverty level. They are separate from the tax credits that subsidize premium costs.\u003c/p>\n\u003cp>Without that federal funding, Molina wrote, “we will have no choice but to send a notice of default informing the government that we are dropping our contracts for their failure to pay premiums and seek to withdraw from the marketplace immediately.”\u003c/p>\n\u003cp>Molina said his company currently serves more than 1 million people through insurance exchanges in California and several other states. Molina had nearly 69,000 enrollees in Covered California as of December, state data show.\u003c/p>\n\u003cp>Anthem, California’s largest for-profit health insurer and a key player on exchanges nationally, issued a similar warning this week. During an earnings conference call on Wednesday, Anthem CEO Joseph Swedish said the insurer may exit some state exchanges or resubmit for higher rates if the fate of the cost-sharing subsidies isn’t resolved by early June.\u003c/p>\n\u003cp>Anthem has more than 310,000 customers in the California exchange, or nearly 25 percent of the market. Rival Blue Shield of California is the leader in state enrollment with 389,480, or 31 percent market share.\u003c/p>\n\u003cp>Republican leaders in Congress say they will address these concerns and move quickly to aid consumers by replacing the ACA with a plan that will reduce premiums and expand options for coverage.\u003c/p>\n\u003cp>The health law “is collapsing,” Ryan said at a news conference Thursday. “The American health care system in the individual market is in peril right now. We have a moral obligation to prevent people from getting hurt, to stop the damage from being continued.”\u003c/p>\n\u003cp>Many conservative Republicans oppose the Trump administration’s decision to continue to pay the cost-sharing subsidies, calling the subsidies unconstitutional because they lack congressional approval. House Republicans successfully sued to block the payments, but a judge put the ruling on hold while the Obama administration appealed the case. It’s not yet clear how President Donald Trump will handle that appeal.\u003c/p>\n\u003cp>Amid this political uncertainty, California Insurance Commissioner Dave Jones told insurers this week they could submit two sets of rate filings on Monday for their exchange business. One filing would reflect continued funding of cost-sharing subsidies and enforcement of the individual mandate. A separate filing could assume the opposite.\u003c/p>\n\u003cp>“In light of all the actions taken by the Trump administration and House leadership to undermine the ACA, I expect that health insurers will consider filing significant rate increases for 2018,” Jones wrote in a bulletin to insurers this week.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For 2017, rates in Covered California rose by 13.2 percent, on average, statewide. The state exchange is one of the few that actively negotiates rates with insurers. Premiums for the next year usually are announced in July.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>For most of his life, Carl Goulden had near-perfect health. He and his wife, Wanda, say that changed 10 years ago. Carl remembered feeling “a lot of pain in the back, tired, fatigue, yellow eyes — a lot of jaundice.”\u003c/p>\n\u003cp>“Gray-like skin,” Wanda added. His liver wasn’t working, she explained. “It wasn’t filtering.”\u003c/p>\n\u003cp>Carl was diagnosed with hepatitis B. He is now 65 and on Medicare, but back then he had a flower shop in Littlestown, Pennsylvania, so he had been buying health insurance for his family on the market for small businesses and the self-employed.\u003c/p>\n\u003cp>The medications to manage Carl’s hepatitis cost more than $10,000 a year — and if he ever needed a liver transplant, as some people with hepatitis eventually do, the costs could be formidable. Thank goodness they had health insurance, the couple thought.\u003c/p>\n\u003cp>But then, Carl said, “the insurance renewals went way up.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After a few years, he could no longer afford to buy the coverage — more than $1,000 a month — and maintain his business. So he dropped the insurance.\u003c/p>\n\u003cp>“I was devastated,” he said, “because I didn’t know when my liver might fail.”\u003c/p>\n\u003cp>Teresa Miller, Pennsylvania’s insurance commissioner, said that steep increase in insurance rates was legal. And before the Affordable Care Act became law, a patient like Goulden might have had a hard time buying another policy. He likely would have been turned down by private insurers because he had a “pre-existing” medical condition.\u003c/p>\n\u003cp>A family like the Gouldens would “just have been out of luck,” Miller said.\u003c/p>\n\u003cp>\u003cstrong>Pennsylvania: The Wild, Wild West\u003cbr>\n\u003c/strong>\u003cbr>\nBefore the ACA, states had differing approaches to handling pre-existing conditions.\u003c/p>\n\u003cp>Pennsylvania was typical. Until the ACA mandated that insurers treat sick and healthy people equally, buying insurance seemed as lawless as the Wild West.\u003c/p>\n\u003cp>Insurers couldn’t overtly kick people off a plan if they got sick, but they could find ways to charge them much more, even those whose chronic condition wasn’t that serious — such as acne. For individuals looking to sign up in the first place, “an insurance company could simply decline to offer you insurance at all because of your pre-existing condition,” Miller said.\u003c/p>\n\u003cp>Insurers who did offer a policy to someone with a pre-existing condition might have done so with a catch — the plan could require a waiting period or might exclude treatment for that condition.\u003c/p>\n\u003cp>“So, let’s say you had diabetes, for example,” Miller said. “You might have been able to get coverage for an unexpected health care need that arose, but you’d still be on your own for any treatment and management of your diabetes.”\u003c/p>\n\u003cp>From the perspective of an insurance company, these practices were intended to prevent the sick from signing up for a health plan only when they needed costly care.\u003c/p>\n\u003cp>Pennsylvania tried to partially solve this problem by creating a scaled-back health plan, called adultBasic, for those with incomes too high to qualify for Medicaid who didn’t have any coverage. Household incomes had to be less than 200 percent of the federal poverty level, which at that time would have been $21,660 for an individual. More than 40,000 people were signed up in 2011, and nearly half a million were on the waiting list, but the plans didn’t include coverage for mental health care, prescription drugs or more than two nights in a hospital. Even so, Miller said, the strategy proved too expensive for the state.\u003c/p>\n\u003cp>“That program was spending $13 million to $14 million a month when it was shut down,” she said.\u003c/p>\n\u003cp>\u003cstrong>California: High-Risk Pool at High Cost\u003cbr>\n\u003c/strong>\u003cbr>\nMore than 30 other states dealt with pre-existing conditions by setting up what are called high-risk pools, a separate insurance plan for individuals who couldn’t get health coverage in the private market.\u003c/p>\n\u003cp>These plans could be lifesavers for some people with conditions like cancer — which can cost tens if not hundreds of thousands of dollars to treat.\u003c/p>\n\u003cp>The experiences with high-risk pools varied, but states faced challenges, said John Bertko, an insurance actuary with the state of California. And the main problem was the high cost.\u003c/p>\n\u003cp>“The one in California, which I was associated with, limited annual services to no more than $75,000, and they had a waiting list. There was not enough money,” Bertko said. “The 20,000 people who got into it were the lucky ones. At one point in time, there were another 10,000 people on a waiting list.”\u003c/p>\n\u003cp>The pools also had catches: Premiums were expensive, as were out-of-pocket costs. And plans often excluded the coverage of pre-existing conditions for six months to a year after the patient bought the policy.\u003c/p>\n\u003cp>\u003cstrong>New Jersey: Pre-existing Conditions Covered, With A Catch\u003cbr>\n\u003c/strong>\u003cbr>\nAround that same time, across the Delaware River, the state of New Jersey was trying something different.\u003c/p>\n\u003cp>“Insurers could not take health status into account,” said Joel Cantor, director of Rutgers’ Center for State Health Policy who has been analyzing the New Jersey experience.\u003c/p>\n\u003cp>Before the ACA, New Jersey was one of just a handful of states that prohibited insurers from denying coverage to people with pre-existing conditions. Insurers also weren’t allowed to charge people significantly more for having a health issue, and the plans had to offer robust coverage of services.\u003c/p>\n\u003cp>There was a one-year waiting period for coverage of a pre-existing condition, but a larger issue became cost. The entire individual market in New Jersey became expensive for everyone, regardless of their health status, Cantor said. Because there was no mandate to have health insurance coverage, those who signed up tended to need it, and healthy people did not enroll.\u003c/p>\n\u003cp>And so, “the prices went up and up,” he said. And the premiums and enrollment “went down and down.”\u003c/p>\n\u003cp>The state tried to address this in the early 2000s by introducing a “skinny” health plan, Cantor said.\u003c/p>\n\u003cp>“By that I mean very few benefits,” he explains. “It covered very, very limited services.”\u003c/p>\n\u003cp>The plan was affordable and really popular, especially among the young and healthy people, and about 100,000 people signed up. But if a person had a health need, many costs shifted to the individual.\u003c/p>\n\u003cp>“It left people with huge financial exposure,” he said.\u003c/p>\n\u003cp>That’s, in part, why the ACA included a rule that insurance plans now must offer good benefits and be available to everybody. In exchange, insurers have the mandate and subsidies — so that everybody will buy in.\u003c/p>\n\u003cp>Cantor said these experiences point to an ongoing quandary: A small portion of people consume a big chunk of health care costs. It’s hard to predict who will cost a lot — or when.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes The Pulse, NPR and Kaiser Health News.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For most of his life, Carl Goulden had near-perfect health. He and his wife, Wanda, say that changed 10 years ago. Carl remembered feeling “a lot of pain in the back, tired, fatigue, yellow eyes — a lot of jaundice.”\u003c/p>\n\u003cp>“Gray-like skin,” Wanda added. His liver wasn’t working, she explained. “It wasn’t filtering.”\u003c/p>\n\u003cp>Carl was diagnosed with hepatitis B. He is now 65 and on Medicare, but back then he had a flower shop in Littlestown, Pennsylvania, so he had been buying health insurance for his family on the market for small businesses and the self-employed.\u003c/p>\n\u003cp>The medications to manage Carl’s hepatitis cost more than $10,000 a year — and if he ever needed a liver transplant, as some people with hepatitis eventually do, the costs could be formidable. Thank goodness they had health insurance, the couple thought.\u003c/p>\n\u003cp>But then, Carl said, “the insurance renewals went way up.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After a few years, he could no longer afford to buy the coverage — more than $1,000 a month — and maintain his business. So he dropped the insurance.\u003c/p>\n\u003cp>“I was devastated,” he said, “because I didn’t know when my liver might fail.”\u003c/p>\n\u003cp>Teresa Miller, Pennsylvania’s insurance commissioner, said that steep increase in insurance rates was legal. And before the Affordable Care Act became law, a patient like Goulden might have had a hard time buying another policy. He likely would have been turned down by private insurers because he had a “pre-existing” medical condition.\u003c/p>\n\u003cp>A family like the Gouldens would “just have been out of luck,” Miller said.\u003c/p>\n\u003cp>\u003cstrong>Pennsylvania: The Wild, Wild West\u003cbr>\n\u003c/strong>\u003cbr>\nBefore the ACA, states had differing approaches to handling pre-existing conditions.\u003c/p>\n\u003cp>Pennsylvania was typical. Until the ACA mandated that insurers treat sick and healthy people equally, buying insurance seemed as lawless as the Wild West.\u003c/p>\n\u003cp>Insurers couldn’t overtly kick people off a plan if they got sick, but they could find ways to charge them much more, even those whose chronic condition wasn’t that serious — such as acne. For individuals looking to sign up in the first place, “an insurance company could simply decline to offer you insurance at all because of your pre-existing condition,” Miller said.\u003c/p>\n\u003cp>Insurers who did offer a policy to someone with a pre-existing condition might have done so with a catch — the plan could require a waiting period or might exclude treatment for that condition.\u003c/p>\n\u003cp>“So, let’s say you had diabetes, for example,” Miller said. “You might have been able to get coverage for an unexpected health care need that arose, but you’d still be on your own for any treatment and management of your diabetes.”\u003c/p>\n\u003cp>From the perspective of an insurance company, these practices were intended to prevent the sick from signing up for a health plan only when they needed costly care.\u003c/p>\n\u003cp>Pennsylvania tried to partially solve this problem by creating a scaled-back health plan, called adultBasic, for those with incomes too high to qualify for Medicaid who didn’t have any coverage. Household incomes had to be less than 200 percent of the federal poverty level, which at that time would have been $21,660 for an individual. More than 40,000 people were signed up in 2011, and nearly half a million were on the waiting list, but the plans didn’t include coverage for mental health care, prescription drugs or more than two nights in a hospital. Even so, Miller said, the strategy proved too expensive for the state.\u003c/p>\n\u003cp>“That program was spending $13 million to $14 million a month when it was shut down,” she said.\u003c/p>\n\u003cp>\u003cstrong>California: High-Risk Pool at High Cost\u003cbr>\n\u003c/strong>\u003cbr>\nMore than 30 other states dealt with pre-existing conditions by setting up what are called high-risk pools, a separate insurance plan for individuals who couldn’t get health coverage in the private market.\u003c/p>\n\u003cp>These plans could be lifesavers for some people with conditions like cancer — which can cost tens if not hundreds of thousands of dollars to treat.\u003c/p>\n\u003cp>The experiences with high-risk pools varied, but states faced challenges, said John Bertko, an insurance actuary with the state of California. And the main problem was the high cost.\u003c/p>\n\u003cp>“The one in California, which I was associated with, limited annual services to no more than $75,000, and they had a waiting list. There was not enough money,” Bertko said. “The 20,000 people who got into it were the lucky ones. At one point in time, there were another 10,000 people on a waiting list.”\u003c/p>\n\u003cp>The pools also had catches: Premiums were expensive, as were out-of-pocket costs. And plans often excluded the coverage of pre-existing conditions for six months to a year after the patient bought the policy.\u003c/p>\n\u003cp>\u003cstrong>New Jersey: Pre-existing Conditions Covered, With A Catch\u003cbr>\n\u003c/strong>\u003cbr>\nAround that same time, across the Delaware River, the state of New Jersey was trying something different.\u003c/p>\n\u003cp>“Insurers could not take health status into account,” said Joel Cantor, director of Rutgers’ Center for State Health Policy who has been analyzing the New Jersey experience.\u003c/p>\n\u003cp>Before the ACA, New Jersey was one of just a handful of states that prohibited insurers from denying coverage to people with pre-existing conditions. Insurers also weren’t allowed to charge people significantly more for having a health issue, and the plans had to offer robust coverage of services.\u003c/p>\n\u003cp>There was a one-year waiting period for coverage of a pre-existing condition, but a larger issue became cost. The entire individual market in New Jersey became expensive for everyone, regardless of their health status, Cantor said. Because there was no mandate to have health insurance coverage, those who signed up tended to need it, and healthy people did not enroll.\u003c/p>\n\u003cp>And so, “the prices went up and up,” he said. And the premiums and enrollment “went down and down.”\u003c/p>\n\u003cp>The state tried to address this in the early 2000s by introducing a “skinny” health plan, Cantor said.\u003c/p>\n\u003cp>“By that I mean very few benefits,” he explains. “It covered very, very limited services.”\u003c/p>\n\u003cp>The plan was affordable and really popular, especially among the young and healthy people, and about 100,000 people signed up. But if a person had a health need, many costs shifted to the individual.\u003c/p>\n\u003cp>“It left people with huge financial exposure,” he said.\u003c/p>\n\u003cp>That’s, in part, why the ACA included a rule that insurance plans now must offer good benefits and be available to everybody. In exchange, insurers have the mandate and subsidies — so that everybody will buy in.\u003c/p>\n\u003cp>Cantor said these experiences point to an ongoing quandary: A small portion of people consume a big chunk of health care costs. It’s hard to predict who will cost a lot — or when.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans — up from 1 in 12 in 2000.\u003c/p>\n\u003cp>As President Donald Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal Obamacare and lower health care costs — a potentially serious job killer. It’s a dilemma: One promise could run headlong into the other.\u003c/p>\n\u003cp>“The goal of increasing jobs in health care is incompatible with the goal of keeping health care affordable,” said Harvard University economist Katherine Baicker, who sees advantages in trimming the industry’s growth. “There’s a lot of evidence we can get more bang for our buck in health care. We should be aiming for a health care system that operates more efficiently and effectively. That might mean better outcomes for patients and fewer jobs.”\u003c/p>\n\u003cp>But the country has grown increasingly dependent on the health sector to power the economy — and it will be a tough habit to break. Thirty-five percent of the nation’s job growth has come from health care since the recession hit in late 2007, the single-biggest sector for job creation.\u003c/p>\n\u003cp>Hiring rose even more as coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals, universities and companies even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job pool. Cities welcomed the development — and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Trump last year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In Morgantown, W.Va., the West Virginia University health system just opened a 10-story medical tower and hired 2,000 employees last year. In Danville, Pa., the Geisinger Health System has added more than 2,200 workers since July and is trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the UCHealth system in Colorado expanded its Fort Collins hospital and is building three hospitals in the state.\u003c/p>\n\u003cp>In cities such as Pittsburgh, Cleveland and St. Louis, health care has replaced dying industries like coal and heavy manufacturing as a primary source of new jobs. “The industry accounts for a lot of good middle-class jobs and, in many communities, it’s the single-largest employer,” said Sam Glick, a partner at the Oliver Wyman consulting firm in San Francisco. “One of the hardest decisions for the new Trump administration is how far do they push on health care costs at the expense of jobs in health care.”\u003c/p>\n\u003cp>House Republicans, with backing from Trump, took the first swipe. Their American Health Care Act sought to roll back the current health law’s Medicaid expansion and cut federal subsidies for private health insurance. The GOP plan faltered in the House, but Republican lawmakers and the Trump administration are still trying to craft a replacement for Obamacare.\u003c/p>\n\u003cp>Neither the ACA nor the latest Republican attempt at an overhaul tackle what some industry experts and economists see as a serious underlying reason for high health care costs: a system bloated by redundancy, inefficiency and a growing number of jobs far removed from patient care.\u003c/p>\n\u003cp>Labor accounts for more than half of the $3.4 trillion spent on U.S. health care, and medical professionals from health aides to nurse practitioners are in high demand. But the sheer complexity of the system also has spawned jobs for legions of data-entry clerks, revenue-cycle analysts and medical billing coders who must decipher arcane rules to mine money from human ills.\u003c/p>\n\u003cp>For every physician, there are 16 other workers in U.S. health care. And half of those 16 are in administrative and other nonclinical roles, said Bob Kocher, a former Obama administration official who worked on the Affordable Care Act. He’s now a partner at the venture capital firm Venrock in Palo Alto, Calif.\u003c/p>\n\u003cp>“I find super-expensive drugs annoying and hospital market power is a big problem,” Kocher said. “But what’s driving our health insurance premiums is that we are paying the wages of a whole bunch of people who aren’t involved in the delivery of care. Hospitals keep raising their rates to pay for all of this labor.”\u003c/p>\n\u003cp>Take medical coders. Membership in the American Academy of Professional Coders has swelled to more than 165,000, up 10,000 in the past year alone. The average salary has risen to nearly $50,000, offering a path to the American Dream.\u003c/p>\n\u003cp>“The coding profession is a great opportunity for individuals seeking their first job, and it’s attractive to a lot of medical professionals burned out on patient care,” said Raemarie Jimenez, a vice president at the medical coding group. “There is a lot of opportunity once you’ve got a foot in the door.”\u003c/p>\n\u003cp>Some of these back-office workers wage battle every day in clinics and hospitals against an army of claims administrators filling up cubicles inside insurance companies. Overseeing it all are hundreds of corporate vice presidents drawing six-figure salaries.\u003c/p>\n\u003cp>Administrative costs in U.S. health care are the highest in the developed world, according to a January report from the Organization for Economic Cooperation and Development. More than 8 percent of U.S. health spending is tied up in administration while the average globally is 3 percent. America spent $631 for every man, woman and child on health insurance administration for 2012 compared with $54 in Japan.\u003c/p>\n\u003cp>America’s huge investment in health care and related jobs hasn’t always led to better results for patients, data show. But it has provided good-paying jobs, which is why the talk of deep cuts in federal health spending has many people concerned.\u003c/p>\n\u003cp>Linda Gonzalez, a 31-year-old mother of two, was among the thousands of enrollment counselors hired to help sign up Americans for health insurance as Obamacare rolled out in 2014. The college graduate makes more than $40,000 a year working at an AltaMed enrollment center, tucked between a Verizon Wireless store and a nail salon on a busy street in Los Angeles.\u003c/p>\n\u003cp>In her cramped cubicle, families pull up chairs and sort through pay stubs and tax returns, often relying on her to sort out enrollment glitches with Medicaid. As the sole breadwinner for her two children, ages 9 and 10, she counts on this job but isn’t sure how long it will last.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“A lot of people depend on this,” she said one recent weekday. “It’s something I do worry about.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans — up from 1 in 12 in 2000.\u003c/p>\n\u003cp>As President Donald Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal Obamacare and lower health care costs — a potentially serious job killer. It’s a dilemma: One promise could run headlong into the other.\u003c/p>\n\u003cp>“The goal of increasing jobs in health care is incompatible with the goal of keeping health care affordable,” said Harvard University economist Katherine Baicker, who sees advantages in trimming the industry’s growth. “There’s a lot of evidence we can get more bang for our buck in health care. We should be aiming for a health care system that operates more efficiently and effectively. That might mean better outcomes for patients and fewer jobs.”\u003c/p>\n\u003cp>But the country has grown increasingly dependent on the health sector to power the economy — and it will be a tough habit to break. Thirty-five percent of the nation’s job growth has come from health care since the recession hit in late 2007, the single-biggest sector for job creation.\u003c/p>\n\u003cp>Hiring rose even more as coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals, universities and companies even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job pool. Cities welcomed the development — and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Trump last year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In Morgantown, W.Va., the West Virginia University health system just opened a 10-story medical tower and hired 2,000 employees last year. In Danville, Pa., the Geisinger Health System has added more than 2,200 workers since July and is trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the UCHealth system in Colorado expanded its Fort Collins hospital and is building three hospitals in the state.\u003c/p>\n\u003cp>In cities such as Pittsburgh, Cleveland and St. Louis, health care has replaced dying industries like coal and heavy manufacturing as a primary source of new jobs. “The industry accounts for a lot of good middle-class jobs and, in many communities, it’s the single-largest employer,” said Sam Glick, a partner at the Oliver Wyman consulting firm in San Francisco. “One of the hardest decisions for the new Trump administration is how far do they push on health care costs at the expense of jobs in health care.”\u003c/p>\n\u003cp>House Republicans, with backing from Trump, took the first swipe. Their American Health Care Act sought to roll back the current health law’s Medicaid expansion and cut federal subsidies for private health insurance. The GOP plan faltered in the House, but Republican lawmakers and the Trump administration are still trying to craft a replacement for Obamacare.\u003c/p>\n\u003cp>Neither the ACA nor the latest Republican attempt at an overhaul tackle what some industry experts and economists see as a serious underlying reason for high health care costs: a system bloated by redundancy, inefficiency and a growing number of jobs far removed from patient care.\u003c/p>\n\u003cp>Labor accounts for more than half of the $3.4 trillion spent on U.S. health care, and medical professionals from health aides to nurse practitioners are in high demand. But the sheer complexity of the system also has spawned jobs for legions of data-entry clerks, revenue-cycle analysts and medical billing coders who must decipher arcane rules to mine money from human ills.\u003c/p>\n\u003cp>For every physician, there are 16 other workers in U.S. health care. And half of those 16 are in administrative and other nonclinical roles, said Bob Kocher, a former Obama administration official who worked on the Affordable Care Act. He’s now a partner at the venture capital firm Venrock in Palo Alto, Calif.\u003c/p>\n\u003cp>“I find super-expensive drugs annoying and hospital market power is a big problem,” Kocher said. “But what’s driving our health insurance premiums is that we are paying the wages of a whole bunch of people who aren’t involved in the delivery of care. Hospitals keep raising their rates to pay for all of this labor.”\u003c/p>\n\u003cp>Take medical coders. Membership in the American Academy of Professional Coders has swelled to more than 165,000, up 10,000 in the past year alone. The average salary has risen to nearly $50,000, offering a path to the American Dream.\u003c/p>\n\u003cp>“The coding profession is a great opportunity for individuals seeking their first job, and it’s attractive to a lot of medical professionals burned out on patient care,” said Raemarie Jimenez, a vice president at the medical coding group. “There is a lot of opportunity once you’ve got a foot in the door.”\u003c/p>\n\u003cp>Some of these back-office workers wage battle every day in clinics and hospitals against an army of claims administrators filling up cubicles inside insurance companies. Overseeing it all are hundreds of corporate vice presidents drawing six-figure salaries.\u003c/p>\n\u003cp>Administrative costs in U.S. health care are the highest in the developed world, according to a January report from the Organization for Economic Cooperation and Development. More than 8 percent of U.S. health spending is tied up in administration while the average globally is 3 percent. America spent $631 for every man, woman and child on health insurance administration for 2012 compared with $54 in Japan.\u003c/p>\n\u003cp>America’s huge investment in health care and related jobs hasn’t always led to better results for patients, data show. But it has provided good-paying jobs, which is why the talk of deep cuts in federal health spending has many people concerned.\u003c/p>\n\u003cp>Linda Gonzalez, a 31-year-old mother of two, was among the thousands of enrollment counselors hired to help sign up Americans for health insurance as Obamacare rolled out in 2014. The college graduate makes more than $40,000 a year working at an AltaMed enrollment center, tucked between a Verizon Wireless store and a nail salon on a busy street in Los Angeles.\u003c/p>\n\u003cp>In her cramped cubicle, families pull up chairs and sort through pay stubs and tax returns, often relying on her to sort out enrollment glitches with Medicaid. As the sole breadwinner for her two children, ages 9 and 10, she counts on this job but isn’t sure how long it will last.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>House Republicans are mulling new changes to their health care proposal, hoping to wrangle enough votes to pass a bill that would allow them to keep their campaign pledge to repeal and replace the Affordable Care Act.\u003c/p>\n\u003cp>The latest proposal allows states to make changes to the Affordable Care Act's rules governing health insurance policies and markets, in an effort to allow some states to offer stripped down policies with lower premiums.\u003c/p>\n\u003cp>The proposal represents a deal between Rep. Tom MacArthur, R., N.J., who is the head of the moderate Tuesday Group and Rep. Mark Meadows, R., N.C., who leads the far-right Freedom Caucus. The two groups could not agree on details of an earlier health care plan championed by House Speaker Paul Ryan, known as the American Health Care Act.\u003c/p>\n\u003cp>The new proposal, which was reported by Politico and The Huffington Post, is an amendment to that bill. It consists of a summary and bullet points rather than legislative language.\u003c/p>\n\u003cp>Without the full language it's unclear whether the plan could bring in enough votes to pass, says a senior House Republican aide.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The proposal retains many of the popular consumer protections of the Affordable Care Act, including ensuring that people with pre-existing medical conditions cannot be refused coverage or charged more.\u003c/p>\n\u003cp>MacArthur, on his Facebook page, said the plan \"will make coverage of pre-existing conditions sacrosanct for all Americans.\"\u003c/p>\n\u003cp>But the plan also allows states to waive those protections.\u003c/p>\n\u003cp>If states requested waivers, people with pre-existing conditions would likely be covered through state-run high-risk pools, which can be expensive for patients and for taxpayers. Many states used high-risk pools before Obamacare with limited success because they weren't adequately funded, according to a study by the Kaiser Family Foundation.\u003c/p>\n\u003cp>The plan \"would make coverage unaffordable for many older consumers and would segregate high cost consumers in coverage that would likely be inadequate,\" says Timothy Jost, an emeritus professor at Washington and Lee Law School who writes a health policy blog for Health Affairs.\u003c/p>\n\u003cp>The proposal could also cause premiums to spike for people with medical issues, according comments posted on Twitter by Topher Spiro, vice president for health policy at the left-leaning Center for American Progress. A person with diabetes could see premiums rise by about $5,600 while someone with metastatic breast cancer could be charged an additional $142,650, he says.\u003c/p>\n\u003cp>There are some protections against such premium spikes in the proposal, says Rodney Whitlock, vice president of health policy at ML Strategies who was a Republican Senate staffer when the Affordable Care Act was passed.\u003c/p>\n\u003cp>He says language that forces states to promise their changes would still protect people with pre-existing conditions, and result in lower premiums, invites people hurt by the changes to sue the state.\u003c/p>\n\u003cp>The proposal doesn't mention Medicaid at all, so it may do little to bring in support for the Republican bill. That's because the American Health Care Act was killed in part because it rolled back Medicaid coverage for millions of low-income people, something moderate Republicans opposed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I have a hard time believing that this will be acceptable to moderates in the House, much less the Senate, and will certainly be opposed by all Democrats,\" Jost says.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>House Republicans are mulling new changes to their health care proposal, hoping to wrangle enough votes to pass a bill that would allow them to keep their campaign pledge to repeal and replace the Affordable Care Act.\u003c/p>\n\u003cp>The latest proposal allows states to make changes to the Affordable Care Act's rules governing health insurance policies and markets, in an effort to allow some states to offer stripped down policies with lower premiums.\u003c/p>\n\u003cp>The proposal represents a deal between Rep. Tom MacArthur, R., N.J., who is the head of the moderate Tuesday Group and Rep. Mark Meadows, R., N.C., who leads the far-right Freedom Caucus. The two groups could not agree on details of an earlier health care plan championed by House Speaker Paul Ryan, known as the American Health Care Act.\u003c/p>\n\u003cp>The new proposal, which was reported by Politico and The Huffington Post, is an amendment to that bill. It consists of a summary and bullet points rather than legislative language.\u003c/p>\n\u003cp>Without the full language it's unclear whether the plan could bring in enough votes to pass, says a senior House Republican aide.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The proposal retains many of the popular consumer protections of the Affordable Care Act, including ensuring that people with pre-existing medical conditions cannot be refused coverage or charged more.\u003c/p>\n\u003cp>MacArthur, on his Facebook page, said the plan \"will make coverage of pre-existing conditions sacrosanct for all Americans.\"\u003c/p>\n\u003cp>But the plan also allows states to waive those protections.\u003c/p>\n\u003cp>If states requested waivers, people with pre-existing conditions would likely be covered through state-run high-risk pools, which can be expensive for patients and for taxpayers. Many states used high-risk pools before Obamacare with limited success because they weren't adequately funded, according to a study by the Kaiser Family Foundation.\u003c/p>\n\u003cp>The plan \"would make coverage unaffordable for many older consumers and would segregate high cost consumers in coverage that would likely be inadequate,\" says Timothy Jost, an emeritus professor at Washington and Lee Law School who writes a health policy blog for Health Affairs.\u003c/p>\n\u003cp>The proposal could also cause premiums to spike for people with medical issues, according comments posted on Twitter by Topher Spiro, vice president for health policy at the left-leaning Center for American Progress. A person with diabetes could see premiums rise by about $5,600 while someone with metastatic breast cancer could be charged an additional $142,650, he says.\u003c/p>\n\u003cp>There are some protections against such premium spikes in the proposal, says Rodney Whitlock, vice president of health policy at ML Strategies who was a Republican Senate staffer when the Affordable Care Act was passed.\u003c/p>\n\u003cp>He says language that forces states to promise their changes would still protect people with pre-existing conditions, and result in lower premiums, invites people hurt by the changes to sue the state.\u003c/p>\n\u003cp>The proposal doesn't mention Medicaid at all, so it may do little to bring in support for the Republican bill. That's because the American Health Care Act was killed in part because it rolled back Medicaid coverage for millions of low-income people, something moderate Republicans opposed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I have a hard time believing that this will be acceptable to moderates in the House, much less the Senate, and will certainly be opposed by all Democrats,\" Jost says.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "While Washington Fiddles, California Leaders Forge Ideas for Universal Health Care",
"title": "While Washington Fiddles, California Leaders Forge Ideas for Universal Health Care",
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"content": "\u003cp>As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.\u003c/p>\n\u003cp>Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.\u003c/p>\n\u003cp>The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.\u003c/p>\n\u003cp>But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.\u003c/p>\n\u003cp>“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.\u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">bill\u003c/a>, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.\u003c/p>\n\u003cp>\"It's the right moral thing to do,\" Lara says. \"We live in the United States of America. We live in the most powerful state in the union. It is the right thing for us to make sure that we fight to ensure that everyone has coverage.”\u003c/p>\n\u003cp>Lara’s bill contains a long \u003ca href=\"http://sd33.senate.ca.gov/news/2017-02-17-californians-healthy-california-act-seeks-one-plan-more-choice-residents\" target=\"_blank\">list of benefits \u003c/a>the statewide program would cover. Not just doctors and hospitals, but also prescriptions, vision and dental care, hospice and rehabilitative therapies, and more.\u003c/p>\n\u003cp>California Health and Human Services Secretary, \u003ca href=\"http://www.chhs.ca.gov/Pages/Secretary-Diana-S.-Dooley.aspx\" target=\"_blank\">Diana Dooley\u003c/a>, understands the appeal.\u003c/p>\n\u003cp>“I think in California there continues to be a great deal of interest and enthusiasm around single payer,\" she says. \"It is very easy to talk about and it certainly takes advantage of the anxiety people have about health insurance companies.”\u003c/p>\n\u003cp>Lara’s plan does away with premiums, deductibles, co-pays — all those pesky out-of-pocket expenses. So where would the state get the money? Past proposals – here and in states like Vermont and Colorado – have suggested new payroll taxes.\u003c/p>\n\u003cp>\"We know that single payer will be expensive,\" says Assemblyman Jim Wood, chairman of the Health Committee. \"Some estimates from a few years ago, the analysis showed $200 billion plus.\"\u003c/p>\n\u003cp>\"I believe in universal coverage and I’d love to see that happen in the future, but the devils in the details,” he added.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/317282377\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\">Roughly half of coverage\u003c/a> in California is sponsored by employers.\u003c/p>\n\u003cp>If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” Oberlander says.\u003c/p>\n\u003cp>Currently, premiums paid by both employer and employee fund private health insurance plans. Single-payer would change that: instead of paycheck deductions for premiums, workers would see new taxes on their wages to pay for the state plan. It would be controversial and disruptive, Oberlander says. \"A lot of people are satisfied with what they have.\"\u003c/p>\n\u003cp>But Lara thinks it can be done, slowly and methodically. He is traveling this week in Canada, along with Bay-Area state senators Nancy Skinner and Scott Wiener. They’ll be learning about Canadian medical care and how it’s financed.\u003c/p>\n\u003cp>Lara takes heart from the fact that Canada’s system began in just one province, and then spread to others. It did so despite resistance, over many years.\u003c/p>\n\u003cp>\"We envision California being the first state to implement a universal healthcare program, and then having that then be the model for the rest of the other states.”\u003c/p>\n\u003cp>Lara says everyone should withhold judgment until he can provide more detailed funding plans in a month or two. His goal is to get the bill at least through the Senate this year, and then push it farther forward in 2018.\u003c/p>\n\u003cp>The trade group for insurers in California does not support the single-payer idea.\u003c/p>\n\u003cp>“A single-payer system would make the quality of our health care worse, not better,” says Charles Bacchi, president and CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”\u003c/p>\n\u003cp>Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said \u003ca href=\"http://www.hoover.org/profiles/lanhee-j-chen\" target=\"_blank\">Lanhee Chen,\u003c/a> a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.\u003c/p>\n\u003cp>A single-payer system would need federal approval, essentially giving California permission to take the money meant for Medicare and Medicaid, and distribute those funds in a totally new way.\u003c/p>\n\u003cp>\"I’m not sure under what construct that could even occur,\" says \u003ca href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Jennifer Kent\u003c/a>, director of the Department of Health Care Services, which operates the state’s Medicaid program, known as Medi-Cal.\u003c/p>\n\u003cp>\"The federal government would have to essentially turn those funds over to a state,\" she says.\u003c/p>\n\u003cp>As it stands, \u003ca href=\"http://californiahealthline.org/news/single-payer-health-care-bill-to-be-introduced-in-california-senate/\">no state has a single-payer system\u003c/a>. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.\u003c/p>\n\u003cp>Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.\u003c/p>\n\u003cp>One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program \u003ca href=\"http://www.lao.ca.gov/2008/hlth/sb840/SB840_analysis.pdf\" target=\"_blank\">costing \u003c/a> $200 billion a year or more. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.\u003c/p>\n\u003cp>Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.\u003c/p>\n\u003cp>“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”\u003c/p>\n\u003cp>Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.\u003c/p>\n\u003cp>“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.\u003c/p>\n\u003cp>In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.\u003c/p>\n\u003cp>For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.\u003c/p>\n\u003cp>Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.\u003c/p>\n\u003cp>One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.\u003c/p>\n\u003cp>Newsom has acknowledged, however, that the San Francisco approach \u003ca href=\"https://www.thenation.com/article/can-california-achieve-universal-health-care-in-the-age-of-trump/\">would not necessarily work in every county\u003c/a>, and said he is open to other possibilities.\u003c/p>\n\u003cp>Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.\u003c/p>\n\u003cp>Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.\u003c/p>\n\u003cp>“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.\u003c/p>\n\u003cp>The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. \u003ca href=\"http://healthaffairs.org/blog/2017/01/24/aca-replacement-bill-from-cassidy-and-colleagues-offers-state-options-roth-hsas/\">Some Republicans\u003c/a> favor an approach in which each state decides on its own coverage system, within certain limits.\u003c/p>\n\u003cp>That could mean a retraction of coverage in some states, but in California it might open the door to a new model.\u003c/p>\n\u003cp>“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/pauline-bartolone/\">\u003cstrong>Pauline Bartolone,\u003c/strong>\u003c/a> California Healthline, and \u003cstrong>Carrie Feibel,\u003c/strong> KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.\u003c/p>\n\u003cp>Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.\u003c/p>\n\u003cp>The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.\u003c/p>\n\u003cp>But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.\u003c/p>\n\u003cp>“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.\u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">bill\u003c/a>, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.\u003c/p>\n\u003cp>\"It's the right moral thing to do,\" Lara says. \"We live in the United States of America. We live in the most powerful state in the union. It is the right thing for us to make sure that we fight to ensure that everyone has coverage.”\u003c/p>\n\u003cp>Lara’s bill contains a long \u003ca href=\"http://sd33.senate.ca.gov/news/2017-02-17-californians-healthy-california-act-seeks-one-plan-more-choice-residents\" target=\"_blank\">list of benefits \u003c/a>the statewide program would cover. Not just doctors and hospitals, but also prescriptions, vision and dental care, hospice and rehabilitative therapies, and more.\u003c/p>\n\u003cp>California Health and Human Services Secretary, \u003ca href=\"http://www.chhs.ca.gov/Pages/Secretary-Diana-S.-Dooley.aspx\" target=\"_blank\">Diana Dooley\u003c/a>, understands the appeal.\u003c/p>\n\u003cp>“I think in California there continues to be a great deal of interest and enthusiasm around single payer,\" she says. \"It is very easy to talk about and it certainly takes advantage of the anxiety people have about health insurance companies.”\u003c/p>\n\u003cp>Lara’s plan does away with premiums, deductibles, co-pays — all those pesky out-of-pocket expenses. So where would the state get the money? Past proposals – here and in states like Vermont and Colorado – have suggested new payroll taxes.\u003c/p>\n\u003cp>\"We know that single payer will be expensive,\" says Assemblyman Jim Wood, chairman of the Health Committee. \"Some estimates from a few years ago, the analysis showed $200 billion plus.\"\u003c/p>\n\u003cp>\"I believe in universal coverage and I’d love to see that happen in the future, but the devils in the details,” he added.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/317282377&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/317282377'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\">Roughly half of coverage\u003c/a> in California is sponsored by employers.\u003c/p>\n\u003cp>If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” Oberlander says.\u003c/p>\n\u003cp>Currently, premiums paid by both employer and employee fund private health insurance plans. Single-payer would change that: instead of paycheck deductions for premiums, workers would see new taxes on their wages to pay for the state plan. It would be controversial and disruptive, Oberlander says. \"A lot of people are satisfied with what they have.\"\u003c/p>\n\u003cp>But Lara thinks it can be done, slowly and methodically. He is traveling this week in Canada, along with Bay-Area state senators Nancy Skinner and Scott Wiener. They’ll be learning about Canadian medical care and how it’s financed.\u003c/p>\n\u003cp>Lara takes heart from the fact that Canada’s system began in just one province, and then spread to others. It did so despite resistance, over many years.\u003c/p>\n\u003cp>\"We envision California being the first state to implement a universal healthcare program, and then having that then be the model for the rest of the other states.”\u003c/p>\n\u003cp>Lara says everyone should withhold judgment until he can provide more detailed funding plans in a month or two. His goal is to get the bill at least through the Senate this year, and then push it farther forward in 2018.\u003c/p>\n\u003cp>The trade group for insurers in California does not support the single-payer idea.\u003c/p>\n\u003cp>“A single-payer system would make the quality of our health care worse, not better,” says Charles Bacchi, president and CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”\u003c/p>\n\u003cp>Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said \u003ca href=\"http://www.hoover.org/profiles/lanhee-j-chen\" target=\"_blank\">Lanhee Chen,\u003c/a> a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.\u003c/p>\n\u003cp>A single-payer system would need federal approval, essentially giving California permission to take the money meant for Medicare and Medicaid, and distribute those funds in a totally new way.\u003c/p>\n\u003cp>\"I’m not sure under what construct that could even occur,\" says \u003ca href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Jennifer Kent\u003c/a>, director of the Department of Health Care Services, which operates the state’s Medicaid program, known as Medi-Cal.\u003c/p>\n\u003cp>\"The federal government would have to essentially turn those funds over to a state,\" she says.\u003c/p>\n\u003cp>As it stands, \u003ca href=\"http://californiahealthline.org/news/single-payer-health-care-bill-to-be-introduced-in-california-senate/\">no state has a single-payer system\u003c/a>. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.\u003c/p>\n\u003cp>Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.\u003c/p>\n\u003cp>One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program \u003ca href=\"http://www.lao.ca.gov/2008/hlth/sb840/SB840_analysis.pdf\" target=\"_blank\">costing \u003c/a> $200 billion a year or more. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.\u003c/p>\n\u003cp>Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.\u003c/p>\n\u003cp>“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”\u003c/p>\n\u003cp>Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.\u003c/p>\n\u003cp>“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.\u003c/p>\n\u003cp>In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.\u003c/p>\n\u003cp>For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.\u003c/p>\n\u003cp>Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.\u003c/p>\n\u003cp>One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.\u003c/p>\n\u003cp>Newsom has acknowledged, however, that the San Francisco approach \u003ca href=\"https://www.thenation.com/article/can-california-achieve-universal-health-care-in-the-age-of-trump/\">would not necessarily work in every county\u003c/a>, and said he is open to other possibilities.\u003c/p>\n\u003cp>Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.\u003c/p>\n\u003cp>Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.\u003c/p>\n\u003cp>“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.\u003c/p>\n\u003cp>The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. \u003ca href=\"http://healthaffairs.org/blog/2017/01/24/aca-replacement-bill-from-cassidy-and-colleagues-offers-state-options-roth-hsas/\">Some Republicans\u003c/a> favor an approach in which each state decides on its own coverage system, within certain limits.\u003c/p>\n\u003cp>That could mean a retraction of coverage in some states, but in California it might open the door to a new model.\u003c/p>\n\u003cp>“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Wearing white coats and surgical scrubs, a small group of political activists passed out pink fliers in downtown Oakland Wednesday. They wore toy stethoscopes and shiny, circular mirrors on their heads.\u003c/p>\n\u003cp>They're not really doctors, but they dressed the part to grab the attention of pedestrians and warn them about the political efforts to dismantle the Affordable Care Act. Since 2014, that law has provided five million previously uninsured Californians with coverage. The state's uninsured rate is now at a historical low of 7 percent.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/314153621\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>House Representatives, riven by political differences, have delayed a planned vote on the Republican health care bill until Friday. Their bill, the American Health Care Act (AHCA), has pushed these \u003ca href=\"https://bayresistance.org/\" target=\"_blank\">Bay Area activists\u003c/a> to get creative, and this \"Pop-Up Emergency Room\" on the sidewalk is one way of highlighting the fact that the bill would \u003cem>increase\u003c/em> the number of uninsured Americans by 24 million.\u003c/p>\n\u003cp>[gallery type=\"rectangular\" ids=\"307654,307652,307655,307649,307733\"]\u003c/p>\n\u003cp>Cindy Shamban of Berkeley wore her white coat draped over another, darker-colored coat.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"That’s part of the skit,\" she said. \"Dress up, have a little bit of fun with it, at the same time we know that we’re dealing with, you know, people’s lives.\"\u003c/p>\n\u003cp>Nearby, Monique Harris had propped a sign against her wheelchair. It read, “Losing Medi-Cal means being forced into an expensive nursing home. No more living at home.”\u003c/p>\n\u003cp>Harris has spastic cerebral palsy and is concerned about the bill's proposed funding cuts to Medi-Cal. Medi-Cal is taxpayer-funded insurance that covers low-income adults, people with disabilities, and nursing home residents.\u003c/p>\n\u003cp>\"Both me and my son receive it,\" she said. \"As well as many other people.\" Harris said Medi-Cal pays for essential equipment and treatments for her and her son. \"He has seizures and diabetes,\" she explained.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A forecast released this week by Sacramento officials estimates the adoption of the GOP-backed AHCA would blow a $6 billion hole in the California budget starting in 2020. As demand on the health system grows, the loss of federal funds to California would eventually reach $24 billion annually in 2027.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Wearing white coats and surgical scrubs, a small group of political activists passed out pink fliers in downtown Oakland Wednesday. They wore toy stethoscopes and shiny, circular mirrors on their heads.\u003c/p>\n\u003cp>They're not really doctors, but they dressed the part to grab the attention of pedestrians and warn them about the political efforts to dismantle the Affordable Care Act. Since 2014, that law has provided five million previously uninsured Californians with coverage. The state's uninsured rate is now at a historical low of 7 percent.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/314153621&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/314153621'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>House Representatives, riven by political differences, have delayed a planned vote on the Republican health care bill until Friday. Their bill, the American Health Care Act (AHCA), has pushed these \u003ca href=\"https://bayresistance.org/\" target=\"_blank\">Bay Area activists\u003c/a> to get creative, and this \"Pop-Up Emergency Room\" on the sidewalk is one way of highlighting the fact that the bill would \u003cem>increase\u003c/em> the number of uninsured Americans by 24 million.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"That’s part of the skit,\" she said. \"Dress up, have a little bit of fun with it, at the same time we know that we’re dealing with, you know, people’s lives.\"\u003c/p>\n\u003cp>Nearby, Monique Harris had propped a sign against her wheelchair. It read, “Losing Medi-Cal means being forced into an expensive nursing home. No more living at home.”\u003c/p>\n\u003cp>Harris has spastic cerebral palsy and is concerned about the bill's proposed funding cuts to Medi-Cal. Medi-Cal is taxpayer-funded insurance that covers low-income adults, people with disabilities, and nursing home residents.\u003c/p>\n\u003cp>\"Both me and my son receive it,\" she said. \"As well as many other people.\" Harris said Medi-Cal pays for essential equipment and treatments for her and her son. \"He has seizures and diabetes,\" she explained.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A forecast released this week by Sacramento officials estimates the adoption of the GOP-backed AHCA would blow a $6 billion hole in the California budget starting in 2020. As demand on the health system grows, the loss of federal funds to California would eventually reach $24 billion annually in 2027.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California would lose $24.3 billion in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to \u003ca href=\"https://www.gov.ca.gov/docs/3.21.17_AHCA_Fiscal_Analysis.pdf\" target=\"_blank\">a new state analysis\u003c/a> released Wednesday.\u003c/p>\n\u003cp>The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said. The analysis, based on internal cost, utilization and enrollment data, was sent Tuesday to the state’s secretary of Health and Human Services.\u003c/p>\n\u003cp>“It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.”\u003c/p>\n\u003cp>Although the analysis didn’t explain how the state would deal with the federal cuts, Cantwell said it would have to look at changes to eligibility, benefits or provider rates — or all three.\u003c/p>\n\u003cp>The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Medi-Cal provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million people of those became newly eligible for the publicly funded health coverage through the Affordable Care Act, helping to reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the \u003ca href=\"http://laborcenter.berkeley.edu/medi-cal-expansion-under-ahca/\" target=\"_blank\">UC Berkeley Labor Center for Education and Research\u003c/a>.\u003c/p>\n\u003cp>The public insurance program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services. The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries.\u003c/p>\n\u003cp>The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said.\u003c/p>\n\u003cp>California health officials said they estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis.\u003c/p>\n\u003cp>The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage.\u003c/p>\n\u003cp>According to the analysis, the state would face additional costs from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program.\u003c/p>\n\u003cp>A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "“It’s challenging to see how it would not … jeopardize the entire [Medicaid] program,” a top health official said.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California would lose $24.3 billion in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to \u003ca href=\"https://www.gov.ca.gov/docs/3.21.17_AHCA_Fiscal_Analysis.pdf\" target=\"_blank\">a new state analysis\u003c/a> released Wednesday.\u003c/p>\n\u003cp>The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said. The analysis, based on internal cost, utilization and enrollment data, was sent Tuesday to the state’s secretary of Health and Human Services.\u003c/p>\n\u003cp>“It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.”\u003c/p>\n\u003cp>Although the analysis didn’t explain how the state would deal with the federal cuts, Cantwell said it would have to look at changes to eligibility, benefits or provider rates — or all three.\u003c/p>\n\u003cp>The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Medi-Cal provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million people of those became newly eligible for the publicly funded health coverage through the Affordable Care Act, helping to reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the \u003ca href=\"http://laborcenter.berkeley.edu/medi-cal-expansion-under-ahca/\" target=\"_blank\">UC Berkeley Labor Center for Education and Research\u003c/a>.\u003c/p>\n\u003cp>The public insurance program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services. The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries.\u003c/p>\n\u003cp>The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said.\u003c/p>\n\u003cp>California health officials said they estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis.\u003c/p>\n\u003cp>The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage.\u003c/p>\n\u003cp>According to the analysis, the state would face additional costs from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program.\u003c/p>\n\u003cp>A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Ignored by Obamacare, Vasectomies Find a Champion in 'March Madness' Marketing",
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"content": "\u003cp>Doctors say it all started eight years ago, when a urology clinic in Oregon ran \u003ca href=\"https://www.youtube.com/watch?v=_fpfMtRIdKM\" target=\"_blank\">an ad\u003c/a> promoting the benefits of scheduling a vasectomy in March.\u003c/p>\n\u003cp>“You go in for a little snip, snip and come out with doctor's orders to sit back and watch nonstop basketball,” the voice-over promises. “If you miss out on this, you’ll end up recovering during a weekend marathon of \u003cem>Desperate Housewives\u003c/em>!”\u003c/p>\n\u003cp>Copycat ads followed. Now a \u003ca href=\"http://washington.cbslocal.com/station/106-7-the-fan/\" target=\"_blank\">sports radio show\u003c/a> in Washington, D.C., has an annual Vasectomy Madness contest, where the prize is a free vasectomy.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/313607132\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Here's how it works: Three guys come on the air to make their cases for getting snipped. The announcers ruthlessly roast them, then listeners vote on their favorite.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“All right, let's bring in our next contestant,\" a host says. \"I believe it’s Abe from Warrenton, Virginia. So tell us your story, why are you here?”\u003c/p>\n\u003cp>Abe has three kids now, ages 9, 6 and 3.\u003c/p>\n\u003cp>“Another one, surprise! Due in July,” Abe says. “I was shopping after the third for a vasectomy, and like a dope, drug my feet.”\u003c/p>\n\u003cp>There’s Mike, also expecting his fourth child -- \u003cem>also\u003c/em> a surprise.\u003c/p>\n\u003cp>“My wife and I have had enough,” he pleads. “We need help to stop the flow.”\u003c/p>\n\u003cp>And then there’s Charles.\u003c/p>\n\u003cp>“Four kids, three different women,” Charles says, inspiring a roar of jeers from the hosts.\u003c/p>\n\u003cp>Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions.\u003c/p>\n\u003cp>That may be one reason vasectomy rates are low: \u003ca href=\"https://www.cdc.gov/nchs/nsfg/key_statistics/v.htm\" target=\"_blank\">Five percent\u003c/a> of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The CDC's National Survey of Family Growth compares that to \u003ca href=\"https://www.cdc.gov/nchs/nsfg/key_statistics/s.htm#sterilizationfemale\">20 percent \u003c/a>of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive.\u003c/p>\n\u003cp>“Men are culturally the providers. It’s hard for them to seek care,” said Dr. Paul Turek, a urologist. “They don’t know how to be a patient.”\u003c/p>\n\u003cp>Turek has \u003ca href=\"http://www.theturekclinic.com/\" target=\"_blank\">clinics\u003c/a> in San Francisco and Beverly Hills. He sees an uptick in vasectomy visits during March Madness, and he’s also noticed more guys coming in together.\u003c/p>\n\u003cp>“One group came in from a tech company in a limousine,” he remembered.\u003c/p>\n\u003cp>Last year, five college buddies scheduled a group vasectomy in March. They live all over the U.S. now, and one of them had an idea to reunite in San Francisco and undergo the outpatient procedure together.\u003c/p>\n\u003cp>“I gave 'em a deal. I closed the doors,” Turek said. “We had sports TV on. They were having fun.”\u003c/p>\n\u003cp>As each guy returned to the waiting room, he was greeted with fist bumps and high-fives. Then they hobbled back to their hotel to bet on the games and yell at the television.\u003c/p>\n\u003cp>Turek made an interesting observation during that bro basketball weekend: The guys seemed to recover faster than his typical patients.\u003c/p>\n\u003cp>“They had no complaints. They were back at work sooner. They took fewer pain pills,” he said. “It was the best anesthesia, having their buddies with them.”\u003c/p>\n\u003cp>Turek gives all his vasectomy patients a certificate of honor for “uncommon bravery and meritorious performance.”\u003c/p>\n\u003cp>There is another theory about why vasectomies aren’t more popular: the cost. The Affordable Care Act requires insurers to \u003ca href=\"https://www.healthcare.gov/coverage/birth-control-benefits/\" target=\"_blank\">cover contraceptives \u003c/a>without charging out-of-pocket costs. But vasectomy wasn’t included in the rule. The procedure costs about $500, but some doctors charge up to $1,000.\u003c/p>\n\u003cp>That’s why Charles subjected himself to the free vasectomy contest at the D.C. radio station. His insurance covers a portion of the procedure, “but I'd still have to pay my deductible, which is, like, a thousand bucks.”\u003c/p>\n\u003cp>Vasectomy was overlooked in Obamacare because, under the law, birth control was considered a women’s health service.\u003c/p>\n\u003cp>“Right now the policy says to a couple: Your insurance will cover birth control without any out-of-pocket costs on your end, as long as it’s the woman who’s using it,” said \u003ca href=\"https://www.guttmacher.org/about/staff/adam-sonfield\" target=\"_blank\">Adam Sonfield\u003c/a>, senior policy manager at the \u003ca href=\"https://www.guttmacher.org/\" target=\"_blank\">Guttmacher Institute.\u003c/a>\u003c/p>\n\u003cp>Last year, 12,000 people signed a \u003ca href=\"https://www.change.org/p/health-and-human-services-cover-vasectomies-under-the-affordable-care-act\" target=\"_blank\">petition\u003c/a> asking regulators to cover vasectomy without cost sharing. Doctors’ groups even drafted language to this effect to add to the regulations, but when the Trump administration took over, it told the groups to stop trying, according to Aaron Hamlin, executive director of the \u003ca href=\"https://www.malecontraceptive.org/\" target=\"_blank\">Male Contraception Initiative.\u003c/a>\u003c/p>\n\u003cp>“The birth control benefit has been under pretty much continual political attack since the ACA was enacted,” said Sonfield.\u003c/p>\n\u003cp>The vasectomy battle is now moot, he added, because President Trump’s health officials want to get rid of the contraceptive mandate altogether, even for women.\u003c/p>\n\u003cp>“They are very much in danger at the moment,” Sonfield said.\u003c/p>\n\u003cp>So for now that leaves guys like Charles, Mike and Abe vying for a free March Madness vasectomy. The winner in the end?\u003c/p>\n\u003cp>Abe.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>His prize comes with a catch, though. He has to let one of the sportscasters come to his appointment, to broadcast a \"play-by-play.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Doctors say it all started eight years ago, when a urology clinic in Oregon ran \u003ca href=\"https://www.youtube.com/watch?v=_fpfMtRIdKM\" target=\"_blank\">an ad\u003c/a> promoting the benefits of scheduling a vasectomy in March.\u003c/p>\n\u003cp>“You go in for a little snip, snip and come out with doctor's orders to sit back and watch nonstop basketball,” the voice-over promises. “If you miss out on this, you’ll end up recovering during a weekend marathon of \u003cem>Desperate Housewives\u003c/em>!”\u003c/p>\n\u003cp>Copycat ads followed. Now a \u003ca href=\"http://washington.cbslocal.com/station/106-7-the-fan/\" target=\"_blank\">sports radio show\u003c/a> in Washington, D.C., has an annual Vasectomy Madness contest, where the prize is a free vasectomy.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/313607132&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/313607132'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Here's how it works: Three guys come on the air to make their cases for getting snipped. The announcers ruthlessly roast them, then listeners vote on their favorite.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“All right, let's bring in our next contestant,\" a host says. \"I believe it’s Abe from Warrenton, Virginia. So tell us your story, why are you here?”\u003c/p>\n\u003cp>Abe has three kids now, ages 9, 6 and 3.\u003c/p>\n\u003cp>“Another one, surprise! Due in July,” Abe says. “I was shopping after the third for a vasectomy, and like a dope, drug my feet.”\u003c/p>\n\u003cp>There’s Mike, also expecting his fourth child -- \u003cem>also\u003c/em> a surprise.\u003c/p>\n\u003cp>“My wife and I have had enough,” he pleads. “We need help to stop the flow.”\u003c/p>\n\u003cp>And then there’s Charles.\u003c/p>\n\u003cp>“Four kids, three different women,” Charles says, inspiring a roar of jeers from the hosts.\u003c/p>\n\u003cp>Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions.\u003c/p>\n\u003cp>That may be one reason vasectomy rates are low: \u003ca href=\"https://www.cdc.gov/nchs/nsfg/key_statistics/v.htm\" target=\"_blank\">Five percent\u003c/a> of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The CDC's National Survey of Family Growth compares that to \u003ca href=\"https://www.cdc.gov/nchs/nsfg/key_statistics/s.htm#sterilizationfemale\">20 percent \u003c/a>of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive.\u003c/p>\n\u003cp>“Men are culturally the providers. It’s hard for them to seek care,” said Dr. Paul Turek, a urologist. “They don’t know how to be a patient.”\u003c/p>\n\u003cp>Turek has \u003ca href=\"http://www.theturekclinic.com/\" target=\"_blank\">clinics\u003c/a> in San Francisco and Beverly Hills. He sees an uptick in vasectomy visits during March Madness, and he’s also noticed more guys coming in together.\u003c/p>\n\u003cp>“One group came in from a tech company in a limousine,” he remembered.\u003c/p>\n\u003cp>Last year, five college buddies scheduled a group vasectomy in March. They live all over the U.S. now, and one of them had an idea to reunite in San Francisco and undergo the outpatient procedure together.\u003c/p>\n\u003cp>“I gave 'em a deal. I closed the doors,” Turek said. “We had sports TV on. They were having fun.”\u003c/p>\n\u003cp>As each guy returned to the waiting room, he was greeted with fist bumps and high-fives. Then they hobbled back to their hotel to bet on the games and yell at the television.\u003c/p>\n\u003cp>Turek made an interesting observation during that bro basketball weekend: The guys seemed to recover faster than his typical patients.\u003c/p>\n\u003cp>“They had no complaints. They were back at work sooner. They took fewer pain pills,” he said. “It was the best anesthesia, having their buddies with them.”\u003c/p>\n\u003cp>Turek gives all his vasectomy patients a certificate of honor for “uncommon bravery and meritorious performance.”\u003c/p>\n\u003cp>There is another theory about why vasectomies aren’t more popular: the cost. The Affordable Care Act requires insurers to \u003ca href=\"https://www.healthcare.gov/coverage/birth-control-benefits/\" target=\"_blank\">cover contraceptives \u003c/a>without charging out-of-pocket costs. But vasectomy wasn’t included in the rule. The procedure costs about $500, but some doctors charge up to $1,000.\u003c/p>\n\u003cp>That’s why Charles subjected himself to the free vasectomy contest at the D.C. radio station. His insurance covers a portion of the procedure, “but I'd still have to pay my deductible, which is, like, a thousand bucks.”\u003c/p>\n\u003cp>Vasectomy was overlooked in Obamacare because, under the law, birth control was considered a women’s health service.\u003c/p>\n\u003cp>“Right now the policy says to a couple: Your insurance will cover birth control without any out-of-pocket costs on your end, as long as it’s the woman who’s using it,” said \u003ca href=\"https://www.guttmacher.org/about/staff/adam-sonfield\" target=\"_blank\">Adam Sonfield\u003c/a>, senior policy manager at the \u003ca href=\"https://www.guttmacher.org/\" target=\"_blank\">Guttmacher Institute.\u003c/a>\u003c/p>\n\u003cp>Last year, 12,000 people signed a \u003ca href=\"https://www.change.org/p/health-and-human-services-cover-vasectomies-under-the-affordable-care-act\" target=\"_blank\">petition\u003c/a> asking regulators to cover vasectomy without cost sharing. Doctors’ groups even drafted language to this effect to add to the regulations, but when the Trump administration took over, it told the groups to stop trying, according to Aaron Hamlin, executive director of the \u003ca href=\"https://www.malecontraceptive.org/\" target=\"_blank\">Male Contraception Initiative.\u003c/a>\u003c/p>\n\u003cp>“The birth control benefit has been under pretty much continual political attack since the ACA was enacted,” said Sonfield.\u003c/p>\n\u003cp>The vasectomy battle is now moot, he added, because President Trump’s health officials want to get rid of the contraceptive mandate altogether, even for women.\u003c/p>\n\u003cp>“They are very much in danger at the moment,” Sonfield said.\u003c/p>\n\u003cp>So for now that leaves guys like Charles, Mike and Abe vying for a free March Madness vasectomy. The winner in the end?\u003c/p>\n\u003cp>Abe.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>His prize comes with a catch, though. He has to let one of the sportscasters come to his appointment, to broadcast a \"play-by-play.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In her office in Zuckerberg San Francisco General Hospital, Dr. Alice Chen pulled down a blue box she keeps on top of a file cabinet. She set it on her lap and leafed through a stack of thank-you notes, until she found one from a former patient that she wanted to read aloud.\u003c/p>\n\u003cp>\"I feel enormously fortunate to have been granted such a willing and able team to support me during such a tough period,\" she read.\u003c/p>\n\u003cp>The grateful patient who wrote those words was uninsured, but was still able to get some treatment at Zuckerberg at the time. That's because Zuckerberg — and other taxpayer-funded hospitals across California —formed the medical safety net of last resort for 17 million uninsured Californians before 2014. That was the year the Affordable Care Act kicked into gear, which helped California lower that uninsured rate down to 7 percent.\u003c/p>\n\u003cp>Like many Californians in the health industry, Chen is struggling to understand the implications of the Republican health care bill, introduced last week in Congress and followed this week by sobering analyses of its effects: one from the national \u003ca href=\"https://www.cbo.gov/publication/52486\" target=\"_blank\">Congressional Budget Office\u003c/a> (CBO) and another from \u003ca href=\"http://hbex.coveredca.com/pdfs/Preliminary_Analysis_of_AHCA.pdf\" target=\"_blank\">Covered California\u003c/a>, the state's health care marketplace.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee expressed immediate concern.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We are deeply troubled by the CBO's finding that the amount of support provided for consumers to buy health insurance in 2020, under proposed legislation would be only 60 percent of what is provided under current law,\" Lee said in a press release.\u003c/p>\n\u003cp>Before the Affordable Care Act, 40 percent of patients at Zuckerberg San Francisco General were uninsured. Now it's down to 3 percent, according to hospital CEO Susan Ehrlich.\u003c/p>\n\u003cp>Many of the people who now have coverage are similar to the young woman who wrote the letter to Chen: They got insurance through the Affordable Care Act's expansion of Medi-Cal to 3.7 million additional Californians. The Republican bill jeopardizes that funding.\u003c/p>\n\u003cp>\"There’s a whole invisible group of people out there who really want insurance, want to pay their dues, but can’t afford it unless we structure the system right,\" Chen said.\u003c/p>\n\u003cp>Federico Reyes is a good example. He's a regular patient at Chen's clinic at the hospital. Among other things, he goes there to manage health issues related to having a leg amputated years ago.\u003c/p>\n\u003cp>When he lost his leg, Reyes was uninsured. He had necrotizing fasciitis, a bacterial infection that spreads quickly and kills the body's soft tissue. He said he went to another hospital but didn't receive adequate treatment because he lacked insurance. He later ended up in the emergency room at Zuckerberg S.F. General, where they amputated the leg. To this day, Reyes believes that if he had been covered at the time, the outcome of his infection would have been different.\u003c/p>\n\u003cp>Reyes is concerned about the Republican health bill, called the American Health Care Act (AHCA). He fears it will leave members of his community without proper health insurance.\u003c/p>\n\u003cp>\"All the people that got health care —and I'm speaking mostly for us poor people — it's like taking the carpet right from under our feet,\" he said. \"You hand us a piece of meat, and then you take it away from us.\"\u003c/p>\n\u003cp>Beyond concerns for patients, hospital staff members are worried about funding. Provisions of the Affordable Care Act \u003ca href=\"http://caph.org/wp-content/uploads/2017/02/sfhn-aca-final-profile.pdf\" target=\"_blank\">added\u003c/a> $125 million in revenue to the annual budget of the hospital and an affiliated network of neighborhood clinics.\u003c/p>\n\u003cp>\"If Medi-Cal expansion is capped, then some of our patients will not be insured,\" said nurse Philippa Doyle. Medi-Cal expansion provided coverage for more Californians than those traditionally included in the Medi-Cal pool. \"Because we treat everybody, then our reimbursement will go down significantly, and we won’t be able to provide resources that we are currently.\"\u003c/p>\n\u003cp>For Doyle, \"resources\" are not an abstraction. That money pays for more nurses, medical assistants and clerks to help with work flow.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Under the AHCA, public hospitals like San Francisco General are expected to lose tens of millions of dollars in government support every year.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In her office in Zuckerberg San Francisco General Hospital, Dr. Alice Chen pulled down a blue box she keeps on top of a file cabinet. She set it on her lap and leafed through a stack of thank-you notes, until she found one from a former patient that she wanted to read aloud.\u003c/p>\n\u003cp>\"I feel enormously fortunate to have been granted such a willing and able team to support me during such a tough period,\" she read.\u003c/p>\n\u003cp>The grateful patient who wrote those words was uninsured, but was still able to get some treatment at Zuckerberg at the time. That's because Zuckerberg — and other taxpayer-funded hospitals across California —formed the medical safety net of last resort for 17 million uninsured Californians before 2014. That was the year the Affordable Care Act kicked into gear, which helped California lower that uninsured rate down to 7 percent.\u003c/p>\n\u003cp>Like many Californians in the health industry, Chen is struggling to understand the implications of the Republican health care bill, introduced last week in Congress and followed this week by sobering analyses of its effects: one from the national \u003ca href=\"https://www.cbo.gov/publication/52486\" target=\"_blank\">Congressional Budget Office\u003c/a> (CBO) and another from \u003ca href=\"http://hbex.coveredca.com/pdfs/Preliminary_Analysis_of_AHCA.pdf\" target=\"_blank\">Covered California\u003c/a>, the state's health care marketplace.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee expressed immediate concern.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We are deeply troubled by the CBO's finding that the amount of support provided for consumers to buy health insurance in 2020, under proposed legislation would be only 60 percent of what is provided under current law,\" Lee said in a press release.\u003c/p>\n\u003cp>Before the Affordable Care Act, 40 percent of patients at Zuckerberg San Francisco General were uninsured. Now it's down to 3 percent, according to hospital CEO Susan Ehrlich.\u003c/p>\n\u003cp>Many of the people who now have coverage are similar to the young woman who wrote the letter to Chen: They got insurance through the Affordable Care Act's expansion of Medi-Cal to 3.7 million additional Californians. The Republican bill jeopardizes that funding.\u003c/p>\n\u003cp>\"There’s a whole invisible group of people out there who really want insurance, want to pay their dues, but can’t afford it unless we structure the system right,\" Chen said.\u003c/p>\n\u003cp>Federico Reyes is a good example. He's a regular patient at Chen's clinic at the hospital. Among other things, he goes there to manage health issues related to having a leg amputated years ago.\u003c/p>\n\u003cp>When he lost his leg, Reyes was uninsured. He had necrotizing fasciitis, a bacterial infection that spreads quickly and kills the body's soft tissue. He said he went to another hospital but didn't receive adequate treatment because he lacked insurance. He later ended up in the emergency room at Zuckerberg S.F. General, where they amputated the leg. To this day, Reyes believes that if he had been covered at the time, the outcome of his infection would have been different.\u003c/p>\n\u003cp>Reyes is concerned about the Republican health bill, called the American Health Care Act (AHCA). He fears it will leave members of his community without proper health insurance.\u003c/p>\n\u003cp>\"All the people that got health care —and I'm speaking mostly for us poor people — it's like taking the carpet right from under our feet,\" he said. \"You hand us a piece of meat, and then you take it away from us.\"\u003c/p>\n\u003cp>Beyond concerns for patients, hospital staff members are worried about funding. Provisions of the Affordable Care Act \u003ca href=\"http://caph.org/wp-content/uploads/2017/02/sfhn-aca-final-profile.pdf\" target=\"_blank\">added\u003c/a> $125 million in revenue to the annual budget of the hospital and an affiliated network of neighborhood clinics.\u003c/p>\n\u003cp>\"If Medi-Cal expansion is capped, then some of our patients will not be insured,\" said nurse Philippa Doyle. Medi-Cal expansion provided coverage for more Californians than those traditionally included in the Medi-Cal pool. \"Because we treat everybody, then our reimbursement will go down significantly, and we won’t be able to provide resources that we are currently.\"\u003c/p>\n\u003cp>For Doyle, \"resources\" are not an abstraction. That money pays for more nurses, medical assistants and clerks to help with work flow.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Under the AHCA, public hospitals like San Francisco General are expected to lose tens of millions of dollars in government support every year.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "GOP Health Proposal Would Upend Consumers’ Cost Calculations In California",
"title": "GOP Health Proposal Would Upend Consumers’ Cost Calculations In California",
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"content": "\u003cp>For better or worse, Californians who aren’t insured through their employers could see major changes in their health insurance costs under a Republican replacement for the Affordable Care Act.\u003c/p>\n\u003cp>A \u003ca href=\"https://housegop.leadpages.co/healthcare/\" target=\"_blank\">House GOP proposal\u003c/a> introduced Monday would provide substantially less financial help to many consumers in higher-cost areas of California, from San Francisco to Monterey. But people in lower-cost markets like Los Angeles could fare better.\u003c/p>\n\u003cp>That’s because the Republican proposal takes a simpler, across-the-board approach to tax credits than the current law. The ACA offers a wide range of subsidies that take into account household income and the local cost of coverage. The nationwide Republican tax credits are tied just to age, starting at $2,000 per year for people under 30 and increasing to $4,000 for those over 60.\u003c/p>\n\u003cp>That doesn’t bode well for a 60-year-old in Santa Cruz. If he makes $40,000 a year, he would receive $12,836 in ACA premium subsidies to buy insurance on the state exchange for 2017, \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=R-U2DS6x8EeQhAPCLWbcVuq82ZoP3htjXhB8MWddPCaR3P3bEmXUCA..&URL=http%3a%2f%2fkff.org%2finteractive%2ftax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map%2f\" target=\"_blank\">according to an analysis\u003c/a> by the Kaiser Family Foundation. The subsidy takes into account the person’s income and the cost of insurance in the coastal town. (California Healthline is an editorially independent service of the foundation.)\u003c/p>\n\u003cp>The House’s American Health Care Act would cut that person’s assistance to $4,000, based purely on his age. A 60-year-old making $20,000 a year in the same town would be even worse off, because his low income wouldn’t be part of the calculation. He would get nearly $12,000 less under the House plan than under the current law.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the GOP’s plan could benefit younger consumers in general and particularly those in lower-priced markets of Southern California. Under current law, a 27-year-old in Los Angeles making $40,000 doesn’t get any ACA subsidy because the cost of coverage is low for someone of her income. She has to pay her entire premium.\u003c/p>\n\u003cp>But under the House plan, she would qualify for a flat $2,000 tax credit based entirely on her age.\u003c/p>\n\u003cp>The GOP plan would begin to phase out age-based tax credits when an individual’s annual income reached $75,000. The upper limit under the ACA is 400 percent of the federal poverty level or about $47,000 for an individual and more than $97,000 for a family of four.\u003c/p>\n\u003cp>Cynthia Cox, associate director of health reform and private insurance at the Kaiser Family Foundation, said any replacement plan for the ACA will create “winners and losers.”\u003c/p>\n\u003cp>She said “the people likely to gain under the ACA replacement are those who are younger, higher income and live in lower-cost areas. That might be millennials living in Los Angeles.”\u003c/p>\n\u003cp>But she said the added costs imposed on consumers in other markets could be enormous. “For a person living in Santa Cruz or another high-cost area, that is a big chunk of their income to come up with,” she said.\u003c/p>\n\u003cp>California has long had a north-south divide on medical costs. Health policy experts say the lack of competition in Northern California helps explain why health insurance premiums are, on average, about 25 percent higher compared to the southern part of the state.\u003c/p>\n\u003cp>For 2017, rates in the Covered California exchange rose by 13.2 percent, on average, statewide. But premiums in the Santa Cruz-Monterey area jumped by \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=8J6HRVhYXiQ8q6jd0etguGxJ5Cy0ftd1750eCWSgfyaR3P3bEmXUCA..&URL=http%3a%2f%2fcaliforniahealthline.org%2fnews%2fcovered-california-2017-rate-hikes-will-hit-states-central-coast-hardest%2f\" target=\"_blank\">nearly 29 percent\u003c/a>.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said ignoring income and location in issuing tax credits may force thousands of people to drop coverage.\u003c/p>\n\u003cp>“The wide variations in the health-care system across California could result in consumers in some areas being priced out of coverage,” Lee said. “The analysis of some early proposals also underscores the importance of providing financial help that is directly tied to a consumer’s income.”\u003c/p>\n\u003cp>Cox said some Republicans are purposely ignoring those geographic differences because they don’t want to reward higher-priced areas with more generous taxpayer subsidies. The hope is that lower tax credits could put pressure on insurers or medical providers to charge less.\u003c/p>\n\u003cp>Lanhee Chen, a \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=MuEfZ28KfW9Lu6GWvfsLP1pSb7IF3Zcgzj1EMKOPC-mR3P3bEmXUCA..&URL=http%3a%2f%2fkhn.org%2fnews%2ffor-conservatives-its-a-new-day-in-health-care%2f\" target=\"_blank\">conservative health-policy expert\u003c/a> and a fellow at Stanford University’s Hoover Institution, said the House Republicans’ tax-credit proposal would simplify the process and have a “positive impact on bringing down health costs over the long run.”\u003c/p>\n\u003cp>But even some critics of Obamacare think Republicans will have to alter their approach and account for differences in health costs within states and across the country.\u003c/p>\n\u003cp>“The impact will not be uniform and many parts of the country will be big losers — and not just the high-cost big cities that are traditionally Democratic areas,” said Robert Laszewski, a Virginia-based health care consultant and frequent critic of the ACA. “Many of the highest cost places are Republican strongholds. Geographic rating is as basic to health insurance 101 as anything.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "Decently paid millennials in LA might be better off than under Obamacare — but older people in pricier areas much worse.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For better or worse, Californians who aren’t insured through their employers could see major changes in their health insurance costs under a Republican replacement for the Affordable Care Act.\u003c/p>\n\u003cp>A \u003ca href=\"https://housegop.leadpages.co/healthcare/\" target=\"_blank\">House GOP proposal\u003c/a> introduced Monday would provide substantially less financial help to many consumers in higher-cost areas of California, from San Francisco to Monterey. But people in lower-cost markets like Los Angeles could fare better.\u003c/p>\n\u003cp>That’s because the Republican proposal takes a simpler, across-the-board approach to tax credits than the current law. The ACA offers a wide range of subsidies that take into account household income and the local cost of coverage. The nationwide Republican tax credits are tied just to age, starting at $2,000 per year for people under 30 and increasing to $4,000 for those over 60.\u003c/p>\n\u003cp>That doesn’t bode well for a 60-year-old in Santa Cruz. If he makes $40,000 a year, he would receive $12,836 in ACA premium subsidies to buy insurance on the state exchange for 2017, \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=R-U2DS6x8EeQhAPCLWbcVuq82ZoP3htjXhB8MWddPCaR3P3bEmXUCA..&URL=http%3a%2f%2fkff.org%2finteractive%2ftax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map%2f\" target=\"_blank\">according to an analysis\u003c/a> by the Kaiser Family Foundation. The subsidy takes into account the person’s income and the cost of insurance in the coastal town. (California Healthline is an editorially independent service of the foundation.)\u003c/p>\n\u003cp>The House’s American Health Care Act would cut that person’s assistance to $4,000, based purely on his age. A 60-year-old making $20,000 a year in the same town would be even worse off, because his low income wouldn’t be part of the calculation. He would get nearly $12,000 less under the House plan than under the current law.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the GOP’s plan could benefit younger consumers in general and particularly those in lower-priced markets of Southern California. Under current law, a 27-year-old in Los Angeles making $40,000 doesn’t get any ACA subsidy because the cost of coverage is low for someone of her income. She has to pay her entire premium.\u003c/p>\n\u003cp>But under the House plan, she would qualify for a flat $2,000 tax credit based entirely on her age.\u003c/p>\n\u003cp>The GOP plan would begin to phase out age-based tax credits when an individual’s annual income reached $75,000. The upper limit under the ACA is 400 percent of the federal poverty level or about $47,000 for an individual and more than $97,000 for a family of four.\u003c/p>\n\u003cp>Cynthia Cox, associate director of health reform and private insurance at the Kaiser Family Foundation, said any replacement plan for the ACA will create “winners and losers.”\u003c/p>\n\u003cp>She said “the people likely to gain under the ACA replacement are those who are younger, higher income and live in lower-cost areas. That might be millennials living in Los Angeles.”\u003c/p>\n\u003cp>But she said the added costs imposed on consumers in other markets could be enormous. “For a person living in Santa Cruz or another high-cost area, that is a big chunk of their income to come up with,” she said.\u003c/p>\n\u003cp>California has long had a north-south divide on medical costs. Health policy experts say the lack of competition in Northern California helps explain why health insurance premiums are, on average, about 25 percent higher compared to the southern part of the state.\u003c/p>\n\u003cp>For 2017, rates in the Covered California exchange rose by 13.2 percent, on average, statewide. But premiums in the Santa Cruz-Monterey area jumped by \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=8J6HRVhYXiQ8q6jd0etguGxJ5Cy0ftd1750eCWSgfyaR3P3bEmXUCA..&URL=http%3a%2f%2fcaliforniahealthline.org%2fnews%2fcovered-california-2017-rate-hikes-will-hit-states-central-coast-hardest%2f\" target=\"_blank\">nearly 29 percent\u003c/a>.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said ignoring income and location in issuing tax credits may force thousands of people to drop coverage.\u003c/p>\n\u003cp>“The wide variations in the health-care system across California could result in consumers in some areas being priced out of coverage,” Lee said. “The analysis of some early proposals also underscores the importance of providing financial help that is directly tied to a consumer’s income.”\u003c/p>\n\u003cp>Cox said some Republicans are purposely ignoring those geographic differences because they don’t want to reward higher-priced areas with more generous taxpayer subsidies. The hope is that lower tax credits could put pressure on insurers or medical providers to charge less.\u003c/p>\n\u003cp>Lanhee Chen, a \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=MuEfZ28KfW9Lu6GWvfsLP1pSb7IF3Zcgzj1EMKOPC-mR3P3bEmXUCA..&URL=http%3a%2f%2fkhn.org%2fnews%2ffor-conservatives-its-a-new-day-in-health-care%2f\" target=\"_blank\">conservative health-policy expert\u003c/a> and a fellow at Stanford University’s Hoover Institution, said the House Republicans’ tax-credit proposal would simplify the process and have a “positive impact on bringing down health costs over the long run.”\u003c/p>\n\u003cp>But even some critics of Obamacare think Republicans will have to alter their approach and account for differences in health costs within states and across the country.\u003c/p>\n\u003cp>“The impact will not be uniform and many parts of the country will be big losers — and not just the high-cost big cities that are traditionally Democratic areas,” said Robert Laszewski, a Virginia-based health care consultant and frequent critic of the ACA. “Many of the highest cost places are Republican strongholds. Geographic rating is as basic to health insurance 101 as anything.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies",
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"content": "\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "After weeks of internal debate, House Republicans have released their plan for the Affordable Care Act, aka Obamacare. It faces challenges from within the GOP, from interest groups — and the public.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Safety-Net Medical Center Wrestles With Specter Of ‘Repeal’",
"title": "A Safety-Net Medical Center Wrestles With Specter Of ‘Repeal’",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>SAN MATEO — Little surprises Lynda Sutherland, who has been a licensed vocational nurse for 35 years at San Mateo Medical Center. But in the past few years, Sutherland said, she’s been surprised by what’s missing: the patients who used to return again and again to the public hospital for the same ailments.\u003c/p>\n\u003cp>“They’re just not coming back,” she said.\u003c/p>\n\u003cp>Spurred by the Affordable Care Act (ACA), medical centers like this one have overhauled the way they deliver care in an effort to keep patients healthier and out of hospital beds. They have connected newly insured patients with primary care doctors in outpatient clinics, helped them manage chronic diseases and tried to reduce their reliance on emergency rooms for routine care.\u003c/p>\n\u003cp>Now, with President Donald Trump and congressional Republicans pledging to repeal Obamacare, such hospitals fear the gains they have made could be lost or diminished. In particular, they worry that if patients lose health insurance, their revenue will fall — to the detriment of the patients, the hospital staff and the community.\u003c/p>\n\u003cp>“It would be felt on a daily basis,” said Erin O’Malley, director of policy for America’s Essential Hospitals, a nationwide association of nearly 300 hospitals that serve low-income patients. “Our mission will not be changing, but the challenges will be mounting … especially if we have a ‘repeal’ without a comparable ‘replace.’ ”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The California Hospital Association sent a letter Feb. 8 to California’s congressional delegation on behalf of hundreds of hospitals and health systems, saying that repealing the Affordable Care Act without replacing it “would upend the financial stability of hospitals and their patients.”\u003c/p>\n\u003cp>The association wrote that it was particularly concerned about proposals that would reduce federal dollars for Medicaid, which was significantly expanded under the 2010 health law to include low-income childless adults. The association also expressed concern about dismantling the changes hospitals have made to promote the quality of care over the quantity. For instance, as a result of new financial penalties under Medicare, many hospitals invested in changes to ensure they weren’t readmitting patients too soon after discharge.\u003c/p>\n\u003cp>Although all hospitals would be affected if the health law were repealed, public and safety-net facilities such as San Mateo Medical Center would suffer more, said Gerald Kominski, director of the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>“The Affordable Care Act has certainly stabilized the financial situation of safety-net providers,” he said. “If we roll back the ACA completely and don’t have a replacement plan that specifically improves funding for safety-net providers, then those hospitals are going to become more vulnerable again.”\u003c/p>\n\u003cp>Across the nation, hospitals that serve the poor have raised similar concerns. A recent analysis by America’s Essential Hospitals showed that hospitals could lose more than $40 billion in funding from 2018 to 2026 if the law is repealed.\u003c/p>\n\u003cp> Over the past several years, safety-net hospitals like San Mateo Medical Center have worked to help patients better manage their chronic diseases and reduce their reliance on emergency rooms for routine care. Administrators worry if the Affordable Care Act is repealed, they will lose revenue and be unable to focus as much on prevention. (Anna Gorman/KHN)\u003c/p>\n\u003cp>Republicans have put forward several proposals that worry hospital administrators. Among them are Medicaid block grants, which could result in less funding for beneficiaries, and withdrawal of federal support for insurance exchanges.\u003c/p>\n\u003cp>About 72,000 patients are seen annually at the county-run San Mateo Medical Center, which includes the hospital and nine outpatient clinics. Before the health law took effect, 48 percent of patients were uninsured and 31 percent were on Medi-Cal, the state’s version of Medicaid. Now, 17 percent are uninsured and 57 percent have Medi-Cal.\u003c/p>\n\u003cp>“If Medicaid rolls back … not only does the revenue disappear, but then people will delay care, get sicker and then costs will go up,” said Chester Kunnappilly, CEO of the medical center.\u003c/p>\n\u003cp>The hospital and clinics receive $166 million annually in Medi-Cal revenue — which makes up about 60 percent of the total budget. At least $50 million would be at risk with a repeal of the ACA, Kunnappilly said.\u003c/p>\n\u003cp>“People will lose their jobs, and it becomes this vicious cycle,” he said. “How many people we can take care of continues to shrink because the teams get smaller.”\u003c/p>\n\u003cp> Michael Asip enrolled in expanded Medi-Cal under the Affordable Care Act before switching to Medicare when he turned 65 last year. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the San Mateo Medical Center. “I’m the poster boy for the safety net,” he said. (Anna Gorman/KHN)\u003c/p>\n\u003cp>San Mateo Medical Center made numerous changes over the past few years to catch patients before they became seriously ill. For example, it created teams of outpatient providers — including pharmacists, medical assistants and social workers — to coordinate care. It began reminding patients when they needed to get mammograms and other preventive tests. They expanded substance abuse and mental health treatment, which was required to be covered under the law.\u003c/p>\n\u003cp>In addition, the medical center sent patients with urgent needs to “express care” so they wouldn’t have to go to the emergency room or wait to see their doctor. Hospital administrators changed the discharge process, sending some patients home with the medications they needed and even dispatching staff to visit others after release.\u003c/p>\n\u003cp>Dramatic changes were made by safety-net hospitals elsewhere in response to the ACA. In Los Angeles County, for example, a computer system was developed to the ensure less duplication of care and better monitoring of patients, and patients were assigned to clinics that served as their medical “homes.”\u003c/p>\n\u003cp>“The ACA provided the economic incentive to do what should have been done anyway,” said Mitch Katz, director of the Los Angeles County health department. “It won’t go back to the way it was done before.”\u003c/p>\n\u003cp>On a recent day at the San Mateo Medical Center, Marla Muniz, a 46-year-old waitress from San Mateo, came to a clinic at the medical center for a physical and treatment for worsening pain in her shoulders and arm. She has Medi-Cal now, because of the program’s expansion, after going years without health insurance.\u003c/p>\n\u003cp>“I am scared they are going to take away my Medi-Cal,” she said. “If I had a good job that paid well, it wouldn’t matter. But I don’t. And I have a lot of pain. I have more and more pain every day.”\u003c/p>\n\u003cp>Another patient, Michael Asip, was there to see one of his physicians. He’d enrolled in expanded Medi-Cal before turning 65, then switched to Medicare. Long uninsured, he had gone months without seeing a doctor even after a heart attack. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the medical center.\u003c/p>\n\u003cp>Sumita Kalra, a physician at a primary care clinic, said she has seen numerous patients like Muniz and Asip who put off health care for years. When they finally got coverage through the ACA, some were diagnosed with diabetes, cancer and other serious diseases.\u003c/p>\n\u003cp>Now “we can catch those ticking time bombs before something worse happens,” Kalra said.\u003c/p>\n\u003cp>Louise Rogers, chief of the San Mateo County Health System, said that kind of change, fostered by the ACA, should not be reversed.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We don’t want to see a turning back of the clock,” she said.\u003c/p>\n\n",
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"excerpt": "San Mateo Medical Center is among hundreds of hospitals in California and across the country that serve low-income patients, and fear the gains they have made under the Affordable Care Act could be lost. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SAN MATEO — Little surprises Lynda Sutherland, who has been a licensed vocational nurse for 35 years at San Mateo Medical Center. But in the past few years, Sutherland said, she’s been surprised by what’s missing: the patients who used to return again and again to the public hospital for the same ailments.\u003c/p>\n\u003cp>“They’re just not coming back,” she said.\u003c/p>\n\u003cp>Spurred by the Affordable Care Act (ACA), medical centers like this one have overhauled the way they deliver care in an effort to keep patients healthier and out of hospital beds. They have connected newly insured patients with primary care doctors in outpatient clinics, helped them manage chronic diseases and tried to reduce their reliance on emergency rooms for routine care.\u003c/p>\n\u003cp>Now, with President Donald Trump and congressional Republicans pledging to repeal Obamacare, such hospitals fear the gains they have made could be lost or diminished. In particular, they worry that if patients lose health insurance, their revenue will fall — to the detriment of the patients, the hospital staff and the community.\u003c/p>\n\u003cp>“It would be felt on a daily basis,” said Erin O’Malley, director of policy for America’s Essential Hospitals, a nationwide association of nearly 300 hospitals that serve low-income patients. “Our mission will not be changing, but the challenges will be mounting … especially if we have a ‘repeal’ without a comparable ‘replace.’ ”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The California Hospital Association sent a letter Feb. 8 to California’s congressional delegation on behalf of hundreds of hospitals and health systems, saying that repealing the Affordable Care Act without replacing it “would upend the financial stability of hospitals and their patients.”\u003c/p>\n\u003cp>The association wrote that it was particularly concerned about proposals that would reduce federal dollars for Medicaid, which was significantly expanded under the 2010 health law to include low-income childless adults. The association also expressed concern about dismantling the changes hospitals have made to promote the quality of care over the quantity. For instance, as a result of new financial penalties under Medicare, many hospitals invested in changes to ensure they weren’t readmitting patients too soon after discharge.\u003c/p>\n\u003cp>Although all hospitals would be affected if the health law were repealed, public and safety-net facilities such as San Mateo Medical Center would suffer more, said Gerald Kominski, director of the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>“The Affordable Care Act has certainly stabilized the financial situation of safety-net providers,” he said. “If we roll back the ACA completely and don’t have a replacement plan that specifically improves funding for safety-net providers, then those hospitals are going to become more vulnerable again.”\u003c/p>\n\u003cp>Across the nation, hospitals that serve the poor have raised similar concerns. A recent analysis by America’s Essential Hospitals showed that hospitals could lose more than $40 billion in funding from 2018 to 2026 if the law is repealed.\u003c/p>\n\u003cp> Over the past several years, safety-net hospitals like San Mateo Medical Center have worked to help patients better manage their chronic diseases and reduce their reliance on emergency rooms for routine care. Administrators worry if the Affordable Care Act is repealed, they will lose revenue and be unable to focus as much on prevention. (Anna Gorman/KHN)\u003c/p>\n\u003cp>Republicans have put forward several proposals that worry hospital administrators. Among them are Medicaid block grants, which could result in less funding for beneficiaries, and withdrawal of federal support for insurance exchanges.\u003c/p>\n\u003cp>About 72,000 patients are seen annually at the county-run San Mateo Medical Center, which includes the hospital and nine outpatient clinics. Before the health law took effect, 48 percent of patients were uninsured and 31 percent were on Medi-Cal, the state’s version of Medicaid. Now, 17 percent are uninsured and 57 percent have Medi-Cal.\u003c/p>\n\u003cp>“If Medicaid rolls back … not only does the revenue disappear, but then people will delay care, get sicker and then costs will go up,” said Chester Kunnappilly, CEO of the medical center.\u003c/p>\n\u003cp>The hospital and clinics receive $166 million annually in Medi-Cal revenue — which makes up about 60 percent of the total budget. At least $50 million would be at risk with a repeal of the ACA, Kunnappilly said.\u003c/p>\n\u003cp>“People will lose their jobs, and it becomes this vicious cycle,” he said. “How many people we can take care of continues to shrink because the teams get smaller.”\u003c/p>\n\u003cp> Michael Asip enrolled in expanded Medi-Cal under the Affordable Care Act before switching to Medicare when he turned 65 last year. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the San Mateo Medical Center. “I’m the poster boy for the safety net,” he said. (Anna Gorman/KHN)\u003c/p>\n\u003cp>San Mateo Medical Center made numerous changes over the past few years to catch patients before they became seriously ill. For example, it created teams of outpatient providers — including pharmacists, medical assistants and social workers — to coordinate care. It began reminding patients when they needed to get mammograms and other preventive tests. They expanded substance abuse and mental health treatment, which was required to be covered under the law.\u003c/p>\n\u003cp>In addition, the medical center sent patients with urgent needs to “express care” so they wouldn’t have to go to the emergency room or wait to see their doctor. Hospital administrators changed the discharge process, sending some patients home with the medications they needed and even dispatching staff to visit others after release.\u003c/p>\n\u003cp>Dramatic changes were made by safety-net hospitals elsewhere in response to the ACA. In Los Angeles County, for example, a computer system was developed to the ensure less duplication of care and better monitoring of patients, and patients were assigned to clinics that served as their medical “homes.”\u003c/p>\n\u003cp>“The ACA provided the economic incentive to do what should have been done anyway,” said Mitch Katz, director of the Los Angeles County health department. “It won’t go back to the way it was done before.”\u003c/p>\n\u003cp>On a recent day at the San Mateo Medical Center, Marla Muniz, a 46-year-old waitress from San Mateo, came to a clinic at the medical center for a physical and treatment for worsening pain in her shoulders and arm. She has Medi-Cal now, because of the program’s expansion, after going years without health insurance.\u003c/p>\n\u003cp>“I am scared they are going to take away my Medi-Cal,” she said. “If I had a good job that paid well, it wouldn’t matter. But I don’t. And I have a lot of pain. I have more and more pain every day.”\u003c/p>\n\u003cp>Another patient, Michael Asip, was there to see one of his physicians. He’d enrolled in expanded Medi-Cal before turning 65, then switched to Medicare. Long uninsured, he had gone months without seeing a doctor even after a heart attack. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the medical center.\u003c/p>\n\u003cp>Sumita Kalra, a physician at a primary care clinic, said she has seen numerous patients like Muniz and Asip who put off health care for years. 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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"onourwatch": {
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
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"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
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