Insurance Regulators Are Panicked About Obamacare’s Future

Sarah Kliff: “There is an acronym you should get ready to hear a lot in coming weeks and months: CSR. It stands for cost-sharing reductions, which the federal government pays to health insurers to lower cost sharing (things like deductibles and copays, for example) for the poorest Obamacare enrollees. Last year, the federal government paid out $7 billion through this program.”

“Long story short: The Trump administration has to decide whether it will continue to defend these CSRs — or if it will concede to the House’s case (that the administration doesn’t have authority to make these payments) and end a multibillion-dollar Obamacare funding source.”

“Insurers are desperate to know what happens to these Obamacare payments. Before deciding to enter markets or what premiums to charge they want to know if this $7 billion fund will stick around.”

Half of Americans Are Responsible for Only 3 Percent of Health Care Costs

Washington Post: “Here’s a simple reason crafting health policy is so devilishly hard: Most Americans are pretty healthy and a few are really sick.”

“The top 1 percent of health-care spenders use more resources, collectively, than the bottom 75 percent, according to a new study based on national surveys. Slice the data a different way, and the bottom half of spenders all together rack up only about 3 percent of overall health care spending — a pattern that hasn’t budged for decades. This creates a fundamental inequality in the country’s health spending that is the crux of the challenge policymakers face: They need a system that works for people who are ill, but is attractive to those who are healthy and spend little on health care.”

Climate Change Can Take a Toll on Mental Health

“Climate change is not only harmful to our physical health — it can be debilitating for our mental health as well, according to a report published Wednesday,” Jia Naqvi reports for The Washington Post.

“Severe weather events and natural disasters linked to climate change have the most dramatic impact on mental health, according to the report by the American Psychological Association and EcoAmerica: Natural disasters cause intense negative emotions in people who are exposed to them, primarily fear and grief. Anxiety, depression and unhealthy behavior are also common responses. Some people, particularly those who experience tragic events, such as the loss of a loved one or repeated exposure to extreme weather, develop post-traumatic stress disorder.”

“The weather people experience also influences their mental health, the report says. Prolonged exposure to warmer weather makes people more aggressive and diminishes cognitive functions, according to earlier studies.”

Trump Can Wound Obamacare Without the Help of Congress

Casey Quinlan: “There are a number of things the administration could do to weaken the Affordable Care Act. One would be to dramatically expand the definition of ‘hardship’ — a condition that exempts people from the individual mandate — which would depress enrollment, [Edwin] Park said.”

“The administration could also unilaterally eliminate cost-sharing reduction subsidies, which bring down the amount that low- and modest-income people on marketplace plans have to pay for their health care costs. Two years ago, House Republicans brought a lawsuit against the Obama administration arguing that these subsidies were illegal because Congress had not designated appropriations for them.”

“The administration could also drop the Obama administration’s legal defense of an ACA rule mandating contraception coverage. The U.S. Department of Justice recently requested to wait until May 1 to file another status report in ongoing litigation.”

America Is Getting Richer and Sicker

Justin Fox: “Per capita gross domestic product is much higher in the U.S. than in the other major developed economies, and no one really seems to be catching up.”

Life expectancy, on the other hand, is lower in the U.S. than in those same peer countries — and the gap has been growing.”

“In the past, one could argue that the diversity of the U.S., and its huge income disparities, helped explain the poor performance: Economically disadvantaged minority groups were dragging the average down. Recent research by Princeton University economists Anne Case and Angus Deaton, however, shows that since 1999 longevity gains have slowed most dramatically, and in some cases reversed, among white Americans.”

Why the Trumpcare Vote Could Hurt Republicans No Matter How They Vote

Caitlin Owens and Bob Herman:”…they’re left with a terrible choice: Vote against Obamacare repeal after campaigning on repeal for seven years, or vote to cover 24 million fewer people and potentially raise premiums for senior citizens. We asked more than a dozen Republicans, Democrats and health-care industry officials which is the better choice, and unsurprisingly, we came up with a mixed verdict. But there was a consensus on these points:”

  • “Neither choice is enviable.”
  • “It’s not every day — or maybe ever — that the far-right, the left and nearly every health care group are on the same page. But these three different factions all oppose the House bill. It’s mainly establishment Republicans that support it.”

Obamacare Isn’t in a ‘Death Spiral.’ (Its Replacement Probably Won’t Be Either.)

New York Times: “…the new estimates from the Congressional Budget Office contradict this long-held talking point. According to the budget office, the Obamacare markets will remain stable over the long run, if there are no significant changes. The House plan would cause near-term turmoil, it found, but the markets would eventually become stable.”

“Mr. Ryan is right that the Obamacare market has endured hardships… But those recent woes are not the same as a death spiral, a term used to describe a complete market failure in which premiums spiral upward so only the sickest customers buy coverage.”

“For now, it looks as if the Republican plan would make the markets less stable in the short term, and possibly make them equally stable, if smaller, 10 years from now.”

The GOP’s Obamacare Replacement Is a Disaster for Some of Its Most Loyal Voters

Jeff Guo: “Grant County, Nebraska is one of the most pro-Trump places in America. In this rural community of about 700, the President won over 93 percent of the vote in the last election. But Grant County is also a place that has benefited hugely from the Affordable Care Act. In 2016, the law provided more than a quarter of its residents with tax credits to help them purchase health insurance.”

“Now, under the Republican plan to repeal and replace Obamacare, many Grant County residents would suffer steep cuts to the tax credits they’ve come to rely on. It’s a nationwide pattern: Some of the harshest consequences of the GOP’s health bill would fall on rural Republican strongholds — precisely the voters who helped elect Trump.”

“Among the counties where Trump won his biggest victories, nearly all would face deep cuts in tax credits under the Republican plan to replace Obamacare. And, in the parts of the country that would lose the most in tax credits, a majority of voters were Trump supporters.”

The Obamacare Nightmare Scenario

“The nightmare scenario for Obamacare is a meltdown of the individual health insurance market. If health insurers lose confidence as Republicans struggle with their repeal efforts — or because of the turmoil and price hikes that have already been underway — even more could withdraw, leaving Obamacare customers with nowhere to turn to keep their coverage,” Bob Herman writes for Axios.

The bottom line: Health insurers need certainty very soon about what the individual markets will look like. The market stabilization rule has assuaged some industry concerns, but the Republican replacement plan has not. Molina’s CEO told Axios the GOP plan ‘doesn’t reassure me that the marketplace is going to be more stable in the future.’ And for every insurer that leaves, ‘it raises the stakes for the next carrier to leave,’ Hempstead said.”

Environmental Hazards Kill 1.7 Million Kids Under Age 5 Each Year

“According to two new World Health Organization reports, about 1.7 million children under the age of 5 die each year because of environmental hazards. It’s the first such estimate of the child death toll from environmental causes,” Angus Chen reports for NPR.

“‘That terrible figure’ makes up about a quarter of child deaths under 5, says Dr. Maria Neira, WHO’s public health and environment department director and lead author on the reports. In addition, children can experience mental and physical developmental disorders and an increased lifelong risk for certain diseases because of exposure to pollutants.”

“These deaths are also preventable, Neira says. Policies and regulations that improve housing, sanitation, clean water and emissions often result in large benefits to children’s health, she says.”

The Largest Association of US Doctors Says Trump’s Health Care Plan Will Weaken Our Defense Against Disease Outbreak

Quartz: “The American Medical Association, the largest group of physicians in the US, sent a letter to Republicans in the House of Representatives, warning them against eliminating a key fund that’s used to prevent outbreaks in America.”

“The Republican bill to repeal and replace Obamacare will not only make health insurance more expensive for millions of Americans, it will also cut the Public Health and Prevention Fund. That means taking a 12% bite out of the US Centers for Disease Control’s budget—the part dedicated to preventing disease outbreaks and a host of other health calamities, like childhood lead poisoning.”

The Massive Tax Cuts for the Rich Inside the GOP Health-Care Plan

Washington Post: “Just two provisions in the Republican plan would allow the richest households to pay an average of nearly $200,000 less under the GOP plan, according to the nonpartisan Tax Policy Center.”

“One is 0.9 percent on taxpayers earning more than $200,000 in wages and salaries a year, or $250,000 for married couples. Those households must also pay a surcharge of 3.8 percent on income from several kinds of investments. Together, these taxes are projected to raise $346 billion over the next decade, according to the nonpartisan Congressional Budget Office.”

“At the same time, working- and middle-class households would no longer receive the same financial assistance that Democrats established to help them buy health insurance.”

Here’s How the Travel Ban Could Affect Your Health

“Here is an interesting detail about Trump’s new executive order on immigration: Thousands of America’s doctors hail from the six affected countries,” AJ Willingham writes for CNN.

“According to the Immigrant Doctors Project, headed by researchers from Harvard and MIT, more than 7,000 physicians in the US were trained in a country blacklisted under the new immigration order.”

“Cities and states in the Midwest have a high concentration of doctors whose backgrounds mean they would be affected by the new travel ban. Again, it’s not just about the doctors themselves — it’s also about the patients they treat. Other than California and New York, which top the list by population density and diversity alone, the states that rely most on physicians trained in travel ban countries are Michigan, Ohio, Illinois, Pennsylvania and Florida.”