Daily on Healthcare: New Jersey’s Obamacare enrollment slump confounds assumptions about Trump ‘sabotage’

By | December 4, 2018

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New Jersey’s Obamacare enrollment slump confounds assumptions about Trump ‘sabotage.’ Despite a full court press by the state’s Democratic government, New Jersey is in an Obamacare enrollment slump, confounding the theory that Trump administration “sabotage” is to blame for the trend of lower Obamacare enrollment. Boosters of Obamacare have pointed to a myriad of actions by President Trump that they argue have undermined enrollment, including the repeal of the individual mandate and slashing of the ad and outreach budget. New Jersey has been among the most aggressive states in trying to counteract Trump’s actions at the federal level. The state government reinstated their own individual mandate, boosted outreach spending, placed limits on enrollment in short term plans, and enacted a reinsurance program aimed at reducing premiums. Despite all these efforts, through Nov. 24, just 66,473 Garden Staters had signed up for Obamacare coverage, down 16 percent from the 79,000 reported at about the same time a year ago. Now, it’s possible that in the closing weeks enrollment will spike. It’s also possible that there was a shift this year, and more people started signing up outside the Obamacare exchange (as these numbers are only for plans purchased on the government-run exchange). But at first blush, the New Jersey numbers present a challenge to those looking for an easy explanation for the drop off in enrollment that has been observed nationally.

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Trump administration lays out healthcare wish list. The Trump administration is encouraging the expansion of Health Savings Accounts as a way to help consumers have more power in healthcare markets and reduce the cost of insurance. Senior administration officials announced the proposal among more than 50 other recommendations it put forward in a report titled “Reforming America’s Healthcare System Through Choice and Competition.” The recommendations include actions the administration could take, while others would require an act of Congress. The report, assembled by 10 different agencies and offices, centered on four areas of state and federal rules that it said “inhibit adequate choice and competition.” Authors of the report place blame for the issues the healthcare system faces in reduced choice, competition, and high prices on government regulations, saying they have “encouraged excessive third-party payment, created counterproductive barriers to entry, incentivized opaque pricing practices, skewed innovation activity, and placed restrictions on the reimbursement policies of government programs.”

Trump administration looks to take Medicaid outside the doctor’s office.  Meals delivered to the homes of patients with Type 2 diabetes. Air conditioners installed to help asthma patients breathe more easily during the summer. Uber rides provided so patients without cars can get to their doctor’s appointments. All of these ideas aren’t typically considered part of traditional medical care, but, increasingly, health insurers, hospitals, and government officials see them as ways to keep patients healthy. The alternative has long been to wait until patients get sick or need a trip to the emergency room, but doing so is costly. And now, the Trump administration is taking a closer look at social services such as healthcare.

Trump officials emphasized changes to Health Savings Accounts. Health Savings Accounts, or HSAs, can be filled with workers’ pre-tax earnings up to a limit. As with tax-deferred Individual Retirement Accounts or IRAs, the funds placed in HSAs can be invested long-term, but they also remain completely tax-free as long as they are used to pay medical expenses. Under federal law, HSAs must be paired with health insurance plans that have high deductibles, but a quirk in Obamacare’s language has made it illegal to use them with catastrophic insurance plans. Officials recommended allowing more health insurance plans to offer HSAs, allowing people to use HSAs toward the payment of their premiums, allowing people in Medicare to have them, and allowing people to contribute a greater amount of money to the plans. Under the current requirements HSAs are limited to $ 3,450 for an individual and $ 6,900 for a family. The Trump administration argues in the report that expanding HSAs will encourage patients to shop around for lower-cost healthcare. It notes that certain parts of healthcare require emergencies, but said that changes can be made to portions of the medical system that include more routine procedures, tests, and appointments.

Here’s what else made the list. Some of the other requests included giving certain types of medical providers, such as physician assistants and nurse practitioners, more leeway in the types of services they can offer, and allowing more doctors to use telehealth. It also recommends that more practices set up payment arrangements that encourage them to deliver better care at a lower price. The process for getting insurers licensed in more states should be sped up, the administration said, and doctors should be allowed to be licensed to practice in other states through telehealth. The Trump administration reiterated its desire for Congress to overhaul Obamacare, a change that isn’t likely until at least through 2020 because Democrats will control the House starting in 2019. It calls for Congress to repeal the employer mandate that obligates companies with 50 or more full-time workers provide coverage to their employees. A second part of Obamacare that blocked doctor-owned hospitals from expanding should also be repealed, officials said. (From our magazine archives in 2017: Obamacare wounds doctor-owned hospitals.)

CVS and Aetna’s $ 69B merger faces obstacles from federal judge. A $ 69 billion merger between CVS Health and Aetna may be in trouble after a federal judge voiced concerns Monday over the transaction’s anti-competitive effects. U.S. District Judge Richard Leon, who previously ruled against the federal government in its challenge to the AT&T-Time Warner merger, warned that CVS may need to keep Aetna’s assets separate as he reviews the deal, according to the Wall Street Journal. That would be problematic since the two firms have already started integration after completing the merger last week.The DOJ approved the deal between the pharmacy benefit manager and insurer in October after Aetna agreed to divest its Medicare Part D business. That proposed settlement still must be approved by Leon — who said last week he would not “rubber stamp” the agreement. CVS, Aetna and the federal government are due back in court on Dec. 18.

Trump, Democrats postpone critical spending talks. Congressional Democrats and President Trump have postponed a critical meeting about an upcoming spending deadline due to the death of President George H.W. Bush, who will lie in state in the Capitol this week. House Minority Leader Nancy Pelosi, D-Calif., and Senate Minority Leader Chuck Schumer, D-N.Y., had planned a sit-down Tuesday with Trump to discuss a deal on funding a large portion of the federal government ahead of a Dec. 7 deadline. A Senate Democratic aide said the meeting will now take place next week.

Instead House, Senate set to vote on two-week funding extension. The House and Senate are set to approve a two-week, temporary extension of federal funding that would keep the government fully operational while the two parties work out a long-term deal. Federal funding for about 25 percent of government operations is slated to run out on Dec. 7, which would be avoided under the deal. Later this week, lawmakers will vote on the legislation that would fund the government until Dec. 21. They are likely to pass it by voice vote in the House, and a congressional aide told the Washington Examiner the Senate is expected to support it. The Senate is scheduled to return to work by Thursday.

House cancels votes for week due to Bush passing. House Majority Leader Kevin McCarthy, R-Calif., announced Monday that the there will be no votes in the House until next week after Bush’s death. Votes will resume Dec. 10 at 6:30 p.m.

CDC: Polio-like illnesses seem to have peaked. The incidences of a polio-like illness that mostly affects children appear to have peaked, the Centers for Disease Control and Prevention announced Monday. The agency has confirmed 134 cases of the illness, called acute flaccid myelitis, or AFM, in 33 states. Another 165 cases have been reported to the CDC. Most cases appear to have occurred in September and October, and the CDC said it expected a decline that had been noticed in November to continue. Federal data suggest a pattern of higher infections every two years. In 2014, the CDC found 120 people had been infected, and the number dropped to 22 in 2015. The following year, it rose to 149 but then fell to 33 in 2017.

Scientists remain in the dark about the cause of AFM, but they think it may result from a viral infection. Neurological issues are often triggered by viruses, genetic conditions, or toxic chemicals in the environment.

Study on teens ready to go. Enough children have enrolled in the Adolescent Brain Cognitive Development Study, a landmark study on brain development that will follow them for a decade into young adulthood, the National Institutes of Health announced Monday. Dubbed the “ABCD study,” the information collected is aimed at helping researchers find out more about how teens develop and make choices. It evaluate impacts of screen time, impulsive decision-making, drug and alcohol use, trauma, and other factors. Scientists hope to be able to tease out genetic, social, physical, and environmental factors on a person’s life. Studies of the 11,874 children, who are now between the ages of 9 and 10, will happen at 21 research sites around the U.S. Of the total, 2,100 are twins and triplets.

California Democrats plan to extend Medicaid to illegal immigrants. A California lawmaker has pledged to re-introduce a bill that would allow adults who live in the state illegally to receive medical care paid for by the government. State Assembly member Joaquin Arambula, a Democrat and a doctor, announced the plans Monday as the legislature convened at the state capitol, according to the Los Angeles Times. Should the bill advance, California would become the first state to extend Medicaid coverage regardless of immigration status. State projections for last year’s bill found that 1.8 million people in California are uninsured and reside there illegally; roughly 1.2 million would qualify for Medi-Cal, the name of the state’s Medicaid program. The latest plan would carry an estimated price tag of $ 3 billion a year, according to California’s Legislative Analyst’s Office, which would be paid for by the state’s general fund.

Colorado enrollment outpaces last year. More than 46,000 Coloradans selected health plan through Connect for Health Colorado in November, a 6 percent increase from the same time last year, according to new data released by the state Monday. This stands in contrast to the federal exchange, which has fallen behind in its signups, the latest federal data show.

15 percent of doctors use telemedicine. That’s according to a survey from the American Medical Association, the nation’s largest doctor group. AMA found that 15 percent of doctors use telemedicine for patient interactions, such as for following up with them or helping them manage chronic illnesses, while 11 percent use it to consult with other doctors. The percentages varied by specialty. At 39.5 percent, radiologists were most likely to use the technology with patients, while 27.8 percent of psychiatrists used it, followed by 24.1 percent of cardiologists. The AMA study surveyed 3,500 physicians for the study.

Stephen Colbert gives open enrollment a shout-out. Late-night host Stephen Colbert re-tweeted a tweet from former CMS Administrator Andy Slavitt saying that enrollment in the Obamacare marketplaces had fallen behind. “Well then, let’s help with that marketing! Retweet this, y’all!” Colbert wrote. Slavitt, who has become an Obamacare advocate since leaving his post, had in his tweet lamented the drop in enrollment so far and said that people wouldn’t know the deadline was Dec. 15.

No, Alexandria Ocasio-Cortez, ‘Medicare for all’ cannot be mostly financed by eliminating Pentagon fraud. Incoming member of Congress Alexandria Ocasio-Cortez made an embarrassing error over the weekend, in which she suggested that roughly two-thirds of the $ 32 trillion projected cost of extending Medicare coverage to everybody could be paid for simply by targeting Pentagon fraud. In reality, her math was egregiously off. Click here to see why.

RUNDOWN

Gallup Government favored to ensure healthcare, but not deliver it

The Hill Study: Emergency medical services take 10 percent longer to get to poor neighborhoods

Washington Post U.S.-China fentanyl pact is not expected to produce immediate results

The Sun Oregon is close to becoming the first US state to legalise magic mushrooms

Miami Herald Florida gets federal approval to trim retroactive eligibility for Medicaid
Associated Press Report estimates new costs of Medicaid expansion in Montana

Bloomberg The opioid epidemic’s first corporate casualty may be a drugmaker that helped fuel the crisis

TUESDAY | Dec. 4

House and Senate in session.

Dec. 3-5. Renaissance Washington. Conference on the Science of Dissemination and Implementation in Health. Details.

Dec. 4-5. Health Resources and Services Administration meeting on infant mortality. Details.

Dec. 4-5. Food and Drug Administration meeting on “Circulatory System Devices Panel of the Medical Devices Advisory Committee.” Details.

Noon. 121 Cannon. Rare Disease Legislative Advocates and the Rare Disease Congressional Caucus co-chairs briefing on “The Diagnostic Odyssey.” Details.

12:20 p.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Health and Human Services Secretary Alex Azar to speak on “Health care that matters: Real choices for real competition.” Details.

WEDNESDAY | Dec. 5

Dec. 5-7. Chicago. National Center for Complex Health and Social Needs conference on “Putting Care at the Center.” Details.

10 a.m. 122 Cannon. IBM and HealthITNow discussion on interoperability in healthcare. Details.

10:15 a.m. Rayburn 2322. House Energy and Commerce hearing on “Examining the Availability of SAFE Kits at Hospitals in the United States.” Details.

3 p.m. 1301 K St NW. Washington Post event on opioid addiction with Surgeon General Jerome Adams and New York City Mayor Bill DeBlasio. Details.

THURSDAY | Dec. 6

Dec. 6-7. 1300 Pennsylvania Ave. NW. Medicare Payment Advisory Commission public meeting. Details.

8:30 a.m. 750 1st St. NE. Mental Health Liaison Group 2019 Annual Meeting. Registration.

9:30 a.m. 1225 I St. NW. “Bipartisan Leadership in Healthcare: CHRONIC Care Act of 2018.” Details.

10 a.m. 2154 Rayburn. Subcommittee on Healthcare, Benefits, and Administrative Rules and Subcommittee on Government Operations joint hearing on “Exploring Alternatives to Fetal Tissue Research.” Details.

FRIDAY | Dec. 7

Noon. Dirksen G-50. Alliance for Health Policy Congressional Briefing on Aging in America. Details.  

TUESDAY | Dec. 11

2:30 p.m.1225 I St. NW> Bipartisan Policy Center event on “Financing the Public Health Infrastructure.” Details.

Healthcare