Yarmuth, a Louisville Democrat, said Republicans "have set out to sabotage the law in as many ways as possible"
"The fundamental problem with the markets now is they eliminated the risk corridors that were in the original bill, original law. . . . So, I would say that is the primary problem that we've had and the most obvious fix would be to re-establish the risk corridors."
Yarmuth is referring to the 2014 omnibus spending bill that barred the Obama administration from using federal funds to make up risk corridor shortfalls. Risk corridor programs are meant to subsidize insurers who take on high-risk customers. For example, the failed Kentucky co-op was expecting $77 million in risk-corridor money, but only got $9.7 million.
Yarmuth noted that providing a public option is necessary because 33 percent of counties in the United States only have one provider offering coverage on the exchange, and one of the reasons is because not enough people live in those counties to make it "worth their while." Kentucky has 59 counties with only one provider option.
"No insurance company is going to find it worth their while to go into a market, negotiate with providers, do the marketing, find prospects for 1,000 or so customers. It's just not going to happen. So that is why we will need to have a national option for those population groups. It is really essential," he said.
Yarmuth said insurance companies have said they would increase premiums between 20 and 30 percent if the cost-sharing provisions are removed, in addition to whatever "conflationary issues there may be."
"The uncertainty is causing a great deal of problems right now because if the cost sharing reductions go away, more insurance companies will either abandon the individual market or they will raise premiums."
He said the problem is that Congress never appropriated funding for the cost sharing reductions, which cost the federal government about $7 billion a year. The House of Representatives sued the Obama administration for paying for this program even though funding wasn't approved and won, but the case now resides in the circuit court system on appeal.
Yarmuth said Democrats have asked for this appropriation to be included in the current budget that must be decided on by Friday or risk shutting down the , or at least paid for through the end of they fiscal year and "we'll vote for it."
"We said just put the appropriation of that $7 billion dollars or whatever the proportionate sum is for the remainder of this fiscal year and we'll vote for it. Because they need Democratic votes to pass anything in this budget deal."
The Obama administration paid the money out anyway and John Boenner, on behalf of the House of Representatives sued to stop the payments based on the fact that they had never been appropriated by Congress. And the lower court found for Boenner's lawsuit. The Obama administration appealed it so it is not in the circuit court system
"The worst case scenario, and this is why I'm somewhat optimistic. The worst case scenario is that the Trump administration drops the appeal if they are allowed to, the court doesn't have to allow them to drop it. But if they drop the appeal, then the lower court ruling stands. The money stops."
"Since they haven't done that yet, I'm pretty confident that they are going to continue to pay out the money at least till the lawsuit is resolved or Congress acts."
"One of the things that we have been trying to do to negotiate on the budget deal to keep the government open, which as you know this Friday we (run out of the ability to spend money if there is a government shutdown) We said just put the appropriation of that $7 billion dollars or whatever the proportionate sum is for the remainder of this fiscal year and we'll vote for it. Because they need Democratic votes to pass anything in this budget deal."
"So that is where it stands and I'm relatively optimistic that those payments will continue because if Republicans act in any way that the money goes away, there will be a causal line between their actions and the insurance companies bailing or raising rates and that line would be like in a matter of days. So there would be no confusing the fact that Republicans acted and people got hurt"
"So, I'm generally confident that we'll resolve something"
14:48
Q: Medicaid, expansion, windfall for Kentucky in a lot of ways, 400,000 in Ky. . Criticism, not flexible enough, cost too much?
Y: "There isn't a lot of flexibility in it. I don't know if that is necessarily a bad thing" . . .
"The ultimate flexibility is what the Supreme Court gave the states, which is to opt out of the Medicaid expansion"
The Waiver system allows for flexibility, likely to be approved routinely with Price and Verma in place.
"I think there is probably enough flexibility in the law through the waiver system right now"
"Some states are just mean, they are cruel and evil and they don't want to serve their people. Texas is the case in point," noting that Texas had their threshold for regular Medicaid at 30 percent of the Federal Poverty Level, which means if you made $5,000 or more a year you didn't qualify for Medicaid under their existing system.
which is one reason they didnt' expand, 30 percent of FPL to 138 percent of FPL, now that states must share cost, it would have cost them a lot of money. Unlike NY, which was already covering people up to 300 percent of the FPL.
"Some states are just not very compassionate in terms of willing to serve their constituents health care needs."
Cost?
noted Beshear's Deloitte's study that said, "We couldn't afford not to do it, not to expand, I think that answers the question"
"I understand the argument that this does become costly on state budgets, but in terms of the overall health well-being of the citizens of a particular state, and all the ancillary benefits, some of which you mentioned, job creation, reduction in uncompensated care, all those things have to be considered as part of the discussion as to whether it is affordable or not. I understand it is an imposition on state budgets, there is no getting around that, there is a cost associated with it, it is just a question of whether the offsetting benefits outweigh those cost and what Steve Beshear's report clearly indicated it was"
Q: How move forward? policies that support market driven solutions or more toward public options
Yarmuth wrote on The Hill and in Leo
19:31
"They are not going to pass their American Health Care Act or any iteration of it because they don't have the votes. They don't have the votes because the people of the Untied States said,'This is nonsense. You are not making things better. You are making the situation worse. You are hurting people.' There are going to be 24 million people, fewer people with coverage according to the CBO and on and on an on"
"So what they are finding, Republicans are finding is that there is no alternative to the Affordable Care Act, except single payer and they are not willing to go there."
"I've been challenging Republicans for a couple of years now on that very point. There is no option. If there were an option to it, other than single payer, somebody would have found it by now -- six or seven years since Republicans have been trying to repeal the Act."
"So, I don't really worry about Congress passing anything that is going to undermine the Affordable Care Act. I do worry about the administration potentially doing more to sabotage the ACT, but again there will be a causal effect and then some repercussions."
"The benefit of this debate I think that went on in March and is ongoing is that it has illustrated how difficult it is to come up with an alternative to the Affordable Care Act, that there really aren't any options to it, and that the notion that you can create a free market health care system is as I said in this piece I wrote, is like searching for a unicorn. There is absolutly no way you can do that. It doesn't exist anywhere in the world."
"A big problem that I see with Republicans attempts is, and they are showing their true colors on this, is that they don't understand the healthcare system at all and they don't really care about understanding it. They have an ideological approach to healthcare. It's Paul Ryan who wants to do everything he can to get healthcare out of the public sector. He want s to voucherize Medicare, he wants to block grant Medicaid to the states. That is his mission in life and it's based on an ideological Ann Rand philosophy and it doesn't have anything to do with health care"
Last week, Mick Mulvaney who is the new director of the OMV was on television and was asked why it was so important to get a quick action on repeal and replace . He gave three answers, and not one of them had to do with health. These are the concerns of the R party.
1. to gain political momentum
2. to make it easier to do tax reform
3. can't remember
"Fortunately, the American people are seeing through it and they understand when their health care is being jeopardized and made worse."
I think this has been a very valuable debate and will continue to be because I think it will reinforce the value of the ACA, which has a 55 percent approval rating nationally, which is a pretty dramatic change. And I think ultimately will make people understand that the only real option is single payer.
Pugel: debate has educated people about the ACA
3 goals, cover more people, bring down cost, and have stronger protections.
Dustin Pugel, research and policy associate KCEP
ACA
7 years since passed
sweeping changes, profound effect in Kentucky
Gallup uninsured rate 20 percent to 7 percent
Uncompensated care dropped 67 percent
health care sector jobs rose 13,000, while many other parts of the economy were stagnant
Early Results:
people are using more primary care, having more preventive screenings, getting routine care for their chronic conditions,
"law remains controversial"
premiums have risen, especially this past year
Although low income enrollees are shielded, still folks feeling this who earn too much for subsidies
insurers left exchanges, gone from 7 to 3 in the state
59 counties with only one insurer
"There are some problems"
Medicaid eligibility expanded, with enhanced federal matching rate, first year we pay
Republicans in charge, repeal and replace, wanted to roll back many of the protections, wanted to roll back the subsidies and change them to age based instead of income based, and other things.
"The simple answer is we could go to single payer, but that is not likely to happen anytime soon," Yarmuth said.
from Kentucky Health News http://ift.tt/2q35P1V
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