Bill again said to add 22 mil­lion unin­sured

Northwest Arkansas Democrat-Gazette - - FRONT PAGE - In­for­ma­tion for this ar­ti­cle was con­trib­uted by Thomas Ka­plan and Robert Pear of The New York Times and by Alan Fram, Erica Werner, An­drew Tay­lor and Carla K. John­son of The As­so­ci­ated Press.

WASHINGTON — The non­par­ti­san Con­gres­sional Bud­get Of­fice said Thurs­day that the lat­est ver­sion of a Se­nate bill to re­peal and re­place the health care law would leave 15 mil­lion people with­out health in­surance next year, ris­ing to 22 mil­lion

in 2026.

The re­port casts a shadow upon the leg­isla­tive push that Pres­i­dent Don­ald Trump is try­ing to re­vive.

The in­crease in the num­ber of people who are unin­sured was the same as the 22 mil­lion more people who would be unin­sured in 2026 un­der an ear­lier ver­sion of the bill that was an­a­lyzed in June.

The new­est score of a re­place­ment for the Pa­tient Pro­tec­tion and Af­ford­able Care Act came af­ter a marathon bar­gain­ing ses­sion Wed­nes­day night among sen­a­tors that ended in­con­clu­sively. On Wed­nes­day, the bud­get of­fice re­leased its anal­y­sis of a separate bill that would re­peal large parts of Pres­i­dent Barack Obama’s sig­na­ture health care law with­out a re­place­ment. That anal­y­sis con­cluded that such a move would in­crease the num­ber of people with­out health in­surance by 32 mil­lion in 2026.

Sen­a­tors were set to leave for the week­end Thurs­day af­ter­noon af­ter a week of fruit­less ne­go­ti­a­tions, capped by news that one of their most prom­i­nent col­leagues, Sen. John Mc­Cain, R-Ariz., has brain cancer.

The ma­jor­ity leader, Sen. Mitch McCon­nell, R-Ky.,

ap­peared de­ter­mined to force the Se­nate to vote next week on a pro­ce­dural mo­tion to be­gin de­bat­ing health care, but he still is short of the 50 votes he needs.

“Deal­ing with this is­sue is what’s right for the coun­try,” McCon­nell said. He added, “It was cer­tainly never go­ing to be easy, but we’ve come a long way and I look for­ward to con­tin­u­ing our work to­gether to fi­nally bring re­lief.”

The lat­est bud­get of­fice anal­y­sis did not take into ac­count a pro­vi­sion that would al­low in­sur­ers to of­fer low­cost, stripped-down in­surance plans, an idea that has been pushed by Sen. Ted Cruz, R-Texas, and could be crit­i­cal to win­ning the votes of Cruz and an­other con­ser­va­tive, Mike Lee of Utah.

Cruz’s pro­posal was in­cluded in a ver­sion of the bill re­leased last week, but it has been as­sailed by the in­surance in­dus­try. While the pro­vi­sion was omit­ted from the lat­est ver­sion of the bill that was re­leased Thurs­day, it re­mains un­der con­sid­er­a­tion to be part of the re­peal leg­is­la­tion, a Repub­li­can con­gres­sional aide said.

As lead­ers tested re­vi­sions that might at­tract GOP votes, one se­na­tor com­pared the process with the trade-offs law­mak­ers scorned seven years ago as top Democrats pushed Obama’s over­haul.

“It’s al­most be­com­ing a bid­ding process — let’s throw $50 bil­lion here, let’s throw $100 bil­lion there,” said Sen. Bob Corker, R-Tenn. “It’s mak­ing me un­com­fort­able right now. It’s be­gin­ning to feel a lot like how Oba­macare came to­gether.”

The bud­get of­fice re­leased its anal­y­sis as Se­nate Repub­li­cans are strug­gling to keep alive their long­time goal of re­peal­ing the Af­ford­able Care Act — and to set­tle on a strat­egy for achiev­ing that aim. But its con­clu­sions are not likely to help.

The bud­get of­fice did have good news about the lat­est ver­sion’s fis­cal im­pact: It would re­duce fed­eral bud­get deficits by $420 bil­lion over 10 years, about $100 bil­lion more than an ear­lier ver­sion of the leg­is­la­tion. The change re­sulted mainly from the fact that Se­nate lead­ers de­cided to keep two taxes on high-in­come people that would have been elim­i­nated by the pre­vi­ous ver­sion of the Se­nate bill.

The lat­est ver­sion of the Se­nate bill would in­crease av­er­age in­surance pre­mi­ums by 20 per­cent next year, the bud­get of­fice es­ti­mates, but it would re­duce pre­mi­ums af­ter 2019, so that in 2026 pre­mi­ums for a typ­i­cal “bench­mark plan” would be 25 per­cent lower than un­der cur­rent law.

Still, one of the main rea­sons for the lower pre­mi­ums is that the typ­i­cal in­surance plan would, ac­cord­ing to the bud­get of­fice, “pay for a smaller share of the to­tal cost of cov­ered ben­e­fits.” In other words, out-of-pocket ex­penses from de­ductibles and co-pay­ments would grow.

More­over, the bud­get of­fice said, even though av­er­age pre­mi­ums for a stan­dard bench­mark plan would de­cline af­ter 2019, many older people would face sub­stan­tial in­creases in pre­mi­ums.

For ex­am­ple, it said, the net pre­mium — af­ter tax cred­its — for a mi­dlevel “sil­ver plan” for a 64-year-old per­son with an­nual in­come of $26,500 would be $5,500 a year in 2026, or more than three times the amount pro­jected un­der cur­rent law.

The anal­y­sis de­tailed huge changes that the bill would im­pose on Med­i­caid, the health care pro­gram for low-in­come people and the dis­abled. In 2026, it said, 15 mil­lion fewer people would be en­rolled in Med­i­caid, com­pared with en­roll­ment ex­pected un­der cur­rent law, and fed­eral Med­i­caid spend­ing would be 26 per­cent lower.

The Se­nate bill, like the re­peal bill passed by the House in May, would put an­nual caps on fed­eral Med­i­caid spend­ing and would roll back the ex­pan­sion of eligibility au­tho­rized by the cur­rent health care law.

Se­nate Repub­li­can lead­ers in June rolled out a bill to re­peal and re­place the health law, hop­ing to fi­nally de­liver on their prom­ise to dis­man­tle the ex­ist­ing law. But since then, McCon­nell has come up short in try­ing to mar­shal the sup­port to push a ver­sion of his leg­is­la­tion through the cham­ber.

This week, af­ter his lat­est ef­fort to pass a bill col­lapsed, McCon­nell laid out a new ap­proach — re­peal­ing the health law with­out im­me­di­ately pro­vid­ing a re­place­ment — and pledged to hold a vote to be­gin de­bate on health care next week.

But on Wed­nes­day, Trump urged sen­a­tors to pro­vide a re­place­ment to go with a re­peal of the health law, re­viv­ing the ef­fort to re­vise McCon­nell’s bill that ear­lier in the week seemed dead as Repub­li­can sen­a­tors re­nounced their sup­port, sink­ing their ma­jor­ity.


In a re­lated de­vel­op­ment, Trump’s ad­min­is­tra­tion has ended Af­ford­able Care Act con­tracts that pro­vided as­sis­tance at li­braries, busi­nesses and ur­ban neigh­bor­hoods in 18 cities, mean­ing shop­pers on the in­surance ex­changes will have fewer places to turn for help sign­ing up for cov­er­age.

Com­mu­nity groups say the move, an­nounced to them by con­trac­tors last week, will make it even more dif­fi­cult to en­roll the unin­sured and help people al­ready cov­ered re-en­roll or shop for a new pol­icy. That’s al­ready a con­cern be­cause of con­sumer con­fu­sion stem­ming from the po­lit­i­cal wran­gling in Washington and a shorter en­roll­ment pe­riod. People will have 45 days to shop for 2018 cov­er­age, start­ing Nov. 1 and end­ing Dec. 15. In pre­vi­ous years, they had twice that much time.

Some people said they see it as an­other at­tempt to un­der­mine the health law’s mar­ket­places by a pres­i­dent who has sug­gested he should let the Af­ford­able Care Act fail. The ad­min­is­tra­tion ear­lier this year pulled paid ad­ver­tis­ing for the sign-up web­site health­care. gov, prompt­ing an in­quiry by a fed­eral in­spec­tor gen­eral into that de­ci­sion and whether it hurt sign-ups.

Now in­sur­ers and ad­vo­cates are con­cerned that the ad­min­is­tra­tion could fur­ther desta­bi­lize the mar­ket­places where people shop for cov­er­age by not pro­mot­ing them or not en­forc­ing the man­date com­pelling people to get cov­er­age. The ad­min­is­tra­tion has al­ready threat­ened to with­hold pay­ments to in­sur­ers to help people af­ford care, which would prompt in­sur­ers to sharply in­crease prices.

“There’s a clear pat­tern of the ad­min­is­tra­tion try­ing to un­der­mine and sab­o­tage the Af­ford­able Care Act,” said Elizabeth Ha­gan, as­so­ciate di­rec­tor of cov­er­age ini­tia­tives for the lib­eral ad­vo­cacy group Fam­i­lies USA. “It’s not let­ting the law fail, it’s mak­ing the law fail.”

Two com­pa­nies — McLean, Va.-based Cog­nosante LLC and Falls Church, Va.-based CSRA Inc. — will no longer help with the signups, af­ter Cen­ters for Medi­care and Med­i­caid Ser­vices of­fi­cials de­cided not to re­new a fi­nal op­tion year of the ven­dors’ con­tracts. The con­tracts, awarded in 2013, were never meant to be long term, Cen­ters for Medi­care and Med­i­caid Ser­vices spokesman Jane Nor­ris said in an email.

“These con­tracts were in­tended to help CMS pro­vide tem­po­rary, in-per­son en­roll­ment sup­port dur­ing the early years” of the ex­changes, Nor­ris said. Other fed­er­ally funded help with en­roll­ment will con­tinue, she said, in­clud­ing a year-round call cen­ter and grant-funded nav­i­ga­tor pro­grams. The ex­ist­ing pro­gram is “ro­bust” and “we have the on-the-ground re­sources nec­es­sary” in key cities, Nor­ris said.

But com­mu­nity ad­vo­cates ex­pected the ven­dors’ help for at least an­other year. “It has our heads spin­ning about how to meet the needs in com­mu­ni­ties,” said Inna Ru­bin of United Way of Metro Chicago, who helps run an Illi­nois health ac­cess coali­tion.

CSRA’s cur­rent $12.8 mil­lion con­tract ex­pires Aug. 29. Cog­nosante’s $9.6 mil­lion con­tract ex­pires the same date.

To­gether, they as­sisted 14,500 en­roll­ments, far less than 1 per­cent of the 9.2 mil­lion people who signed up through health­, the in­surance mar­ket­place serv­ing most states. But some ad­vo­cates said the groups fo­cused on the healthy, young adults needed to keep the in­surance mar­kets sta­ble and prices down.

Dur­ing the most re­cent open-en­roll­ment pe­riod, they op­er­ated in the Texas cities of Dal­las, Hous­ton, San An­to­nio, Austin, McAllen and El Paso; the Florida cities of Miami, Tampa and Or­lando; At­lanta; north­ern New Jer­sey; Phoenix; Philadelphia; Indianapolis; New Or­leans; Char­lotte, N.C.; Cleve­land; and Chicago.

The in­surance ex­changes, ac­cessed by cus­tomers through the fed­eral health­care. gov or state-run sites, are a way for people to com­pare and shop for in­surance cov­er­age. The health law in­cluded grant money for com­mu­nity or­ga­ni­za­tions to train people to help con­sumers ap­ply for cov­er­age, an­swer ques­tions and ex­plain dif­fer­ences be­tween the in­surance poli­cies of­fered.


Se­nate Ma­jor­ity Leader Mitch McCon­nell heads into the Se­nate cham­ber on Thurs­day. “Deal­ing with [the health care bill] is what’s right for the coun­try,” he said.

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