Medicare

President Biden, Vice-President Harris, Speaker Pelosi

As expected, the healthcare section of President Biden's first address to a joint session of Congress (technically not a State of the Union, but close enough) included a call for making the subsidies expanded under the American Rescue Plan permanent as part of the American Families Plan.

Also as expected, he did not call for other major healthcare reform priorities to be baked into the #AmFamPlan.

He did, however, spend significant time calling for those other priorities to be passed separately from the AFP...considerably more than he did on the subsidies themselves.

Before I get into the proposed healthcare policies: Early on in the speech, Biden gave a shout-out to his Administration for the success of the current, ongoing COVID Special Enrollment Period:

Protect Our Care Logo

This morning, healthcare reform advocacy organization Protect Our Care held a webinar in which they went over the results of a new national survey of 1,200 Americans conducted a couple of weeks ago called, simply enough, "Next Steps on Healthcare: What Voters Want".

For the most part, none of the results are terribly surprising:

  • Lowering the cost of healthcare and expanding affordable health insurance coverage is a top priority for a large majority of voters.
  • There's strong support across the board for three major healthcare proposals:
    • Lowering the cost of health insurance for people who purchase coverage on their own
    • Giving Medicare the power to negotiate with drug companies for lower prices
    • Giving low-income Americans who are uninsured the opportunity to obtain health insurance at little or no cost

Several of the questions were more about the framing of the issues--that is, which specific types of messaging work best.

The Biden Administration's first major bill was, of course, the American Rescue Plan, which actually consisted of perhaps a dozen smaller bills which were debated and passed out of a bunch of different House/Senate committees individually before being merged together into the larger package bill.

The next major legislative effort in the works is supposed to be an even larger omnibus infrastructure bill, broken into two major sections: "The American Jobs Plan" and "The American Families Plan". The "Jobs Plan" is supposed to include so-called "hard infrastructure". Here's the summary of the major bullets according to the White House website:

This is mostly an updated version of a post from last week, but there's some important new (potential) developments. Via Amy Lotven of Inside Health Policy:

The White House is expected to roll out the health care priorities for its two-part infrastructure package sometime this Spring, and the health piece potentially could move separately now that the Senate parliamentarian has agreed Democrats have another shot passing their priorities through a simple majority. While there appears to be consensus that the bill will expand, or make permanent, the Affordable Care Act tax credits from the American Rescue Plan, other policies are less clear and will likely depend on the amount of offsets lawmakers can glean from drug-pricing measures.

via Amy Lotven and John Wilkerson of Inside Health Policy:

Pelosi: Drug Pricing May Pay For Health Care Pieces Of Infrastructure Bill

House Speaker Nancy Pelosi (D-CA) said everything is on the table for the next legislative package that is expected to focus on infrastructure improvements and include health care provisions like a permanent increase to the Affordable Care Act tax credits — and she said the package likely will be paid for by tackling prescription drug prices.

...Pelosi said including House Democrats’ drug pricing bill, H.R.3, would pay for $500 billion of the cost of the infrastructure bill, part of which could be used to boost ACA tax credits and make ACA coverage more affordable. The savings also could also be used for other health-related efforts, she said. For example, House Energy & Commerce Chair Frank Pallone (D-NJ) has been working with Rep. Jim Clyburn (D-SC) to expand community health centers and to improve broadband services, which would support telehealth.

 

Not much to add to this. Via RawStory:

At a town hall meeting on Fox News Thursday, President Donald Trump acknowledged that his administration intends to cut Social Security and Medicare.

“We — when these trade deals kick in, you know this economy is the best economy we’ve ever had. It’s nothing to what it’s going to be when the trade deals kick in,” said Trump.

“But if you don’t cut something in entitlements, you’ll never really deal with that,” said the questioner.

“We’ll be cutting, but we’re also going to have growth like you’ve never had before,” said Trump.

Ah. Just what you want in the middle of a reelection campaign and a deadly pandemic outbreak.

video clip originally captured by Pod Save America.

Oh yeah...there's also this:

Four days ago, from Trump Administration Centers for Medicare & Medicaid Administrator, Seema Verma:

No, the Trump administration is not cutting Medicaid. https://t.co/bk5uMMKof4

— Administrator Seema Verma (@SeemaCMS) February 6, 2020

(sigh) Honestly not sure why I'm bothering posting this. Anyone who doesn't understand that the only promises Trump keeps are the racist, xenophobic, homophobic, misogynistic, antisemitic and corrupt ones by this point is either a complete idiot or willfully ignorant:

The Trump administration wants to slash billions of dollars in federal support from Medicaid, food stamps and other safety net programs for the poor, while largely sparing the Medicare program that benefits seniors.

On the one hand, this isn't nearly as big of a technical disaster as the HealthCare.Gov launch was in 2013, I admit.

On the other hand, only 8 million people enrolled in ACA exchange plans in the first 2013-2014 Open Enrollment Period, whereas nearly 60 million are enrolled in Medicare.

via the House Energy & Commerce Committee via email:

Bipartisan House Leaders Raise Medicare Plan Finder Concerns

  • Committee Leaders Urge CMS to Open Special Enrollment Period for Beneficiaries Who Used Plan Finder to Make Enrollment Decisions

Washington, D.C. – Bipartisan House health leaders sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma expressing concerns over reports that the Medicare Plan Finder was confusing, generated incorrect results, and inadvertently led beneficiaries to select plans with lower premiums but higher overall costs.

Believe me, I was certain that I had finally gotten this year's Medical Loss Ratio (MLR) rebate project out of my system. I really was.

However, there was one other MLR-related issue which I've wondered about for years: The ACA requires that carriers who sell policies in the Individual and Small Group markets spend at least 80% of the premium revenue on actual medical claims (limiting them to a 20% gross margin), and 85% on the Large Group market (limiting them to 15% gross).

That accounts for around 165 million people, give or take...roughly 50% of the total U.S. population...but what about the other private (or at least semi-private) insurance markets? I'm referring, of course, to privately-administered Medicare and Medicaid plans...aka Medicare Advantage and Managed Care Organizations (MCOs).

A couple of weeks ago I wrote an extensive piece laying out what seemed, at first glance, to be a bona fide state-level Public Option bill quietly working its way through the Washington State legislature:

Democrats in Olympia push through governor’s 'green' agenda and public healthcare coverage bills

...Another key item on the governor’s agenda is the so-called “public option” socialized health care coverage measure, SB 5526. This bill would create subsidized state-funded public health plans managed by regulated insurance companies. It would require the State Insurance Commissioner and the Health Care Authority to set up the socialized plans by 2021.

,,,These plans would be available through the state’s health care exchange to all residents, but the state would pay subsidies to individuals with incomes of up to five times the poverty level. Premiums would be limited to no more than ten percent of adjusted gross income, and payments to doctors and other health care providers would be restricted to Medicare-level limits.

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