It’s a Start

The Centers for Medicare & Medicaid Services has been instructed by President Donald Trump to adjust its rules to allow the States to adjust their own rules to require work for Medicaid payments.

This is a very good start.  There are two remaining steps, though.  The funds transferred to the States in support of Medicaid need to be converted to block grants with no strings attached.  Each State knows its own medical support needs far better than does the Federal government.

The Veteran’s Choice Program

This is a program that would give veterans the option of going to a private sector doctor in lieu of playing the delay wait game at a Veterans Administration facility, after the veteran has jumped through the requisite VA hoops.  After a political tussle in Congress over increasing/renewing its funding, some additional money was provided.  That additional funding was necessitated because

its popularity depleted the allocated funds more quickly than anticipated. Patient visits through the program increased more than 30% in the first quarter of fiscal year 2017, according to the VA.

Death Panels?

The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group.

Because sometimes readmission is necessary for quality care—whether that readmission was driven by later complications, by too-soon original discharge in the Medicare (which is to say Government) pressure to hold down costs first, or by some other factor—but that Government pressure to push the patient out the door also pushes against the patient’s return.  Even when necessary.

Obamacare Subsidies

Recall that under Obamacare, health coverage plan providers are required to subsidize low-income Americans (who, under Obamacare, are required to buy the plans regardless of need for the plans on offer or ability to pay the vig for them) for their costs in buying those health coverage plans.  Recall further that the Obama administration paid those plan providers monies to reimburse them for those government-mandated subsidy payouts.  Recall also that Congress never appropriated any funds for the purpose of making those payments to the plan providers.  Finally, recall that a DC District court ruled those payments to the health plan providers illegal—because Congress had not appropriated any funds for the purpose.  Then the Trump administration ceased those payments to the health plan providers.

Health Plan Providers Are Concerned

These providers, which surprisingly The Wall Street Journal misapprehends as insurers, are bracing for a drop in enrollment in the ongoing health plan provision program “turmoil.”  There’s this key passage in the article at the link:

[M]any firms say they expect to lose consumers who will bear the full brunt of the rate increases—those who aren’t eligible for the health law’s premium subsidies, which help enrollees with annual incomes of less than around $48,000.

Health Plan Coverage and Contraception

The Wall Street Journal has noted that the Trump administration has taken regulatory action to reduce, if not eliminate (the Supreme Court still has to do its job vis-à-vis a Little Sisters of the Poor case, as does Congress legislatively, contra a short handful of Republicans who prefer Obamacare intact over any step toward getting rid of it), the requirement that health plan providers provide contraception to women at no cost to those women coverees and do so regardless of any question of conscience or religious tenet.

Naturally, Progressive-Democrats and the Left generally have their collective panties in a wedgie over that.  However, they carefully ignore certain inconvenient facts.

Two Health Insurance Markets?

The Wall Street Journal has misunderstood the situation and the proposal [emphasis added].

President Donald Trump’s executive order on health insurance, the most significant step so far to put his stamp on health policy, is designed to give more options to healthy consumers. It also could divide the insurance market in two.

What Trump is purportedly going to do with his Executive Order is

  • instruct[] federal agencies to loosen rules on health plans that the administration says have driven up premiums and reduced insurance offerings

The Not Good Enough Legacy

Here are some stats regarding Obamacare’s impact on our poor, courtesy of The Wall Street Journal.

More than one in three of taxed [via the individual mandate penalty] households earned less than $25,000, which is roughly the federal poverty line for a family of four.

And

More than 75% of penalized households made less than $50,000 and nine in 10 earned less than $75,000.

And

Fewer families paid the tax in 2015 than in 2014, yet government revenues increased to more than $3 billion from about $1.7 billion, as the financial punishment for lacking coverage increased.

Some Thoughts on Graham-Cassidy

These are…triggered…by Thursday’s Wall Street Journal piece on how the Graham-Cassidy Plan Would Change Health Coverage.

The Congressional Budget Office has said that, without a rule requiring insurers to charge all customers comparable premiums, health plans could become prohibitively expensive for some people with pre-existing conditions.

The plans wouldn’t be insurance plans, either, since the premiums wouldn’t have anything to do with the risk being transferred.  The plans would be welfare plans.

Separately, states could also waive a requirement that insurers provide a set of medical benefits like mental-health services and prescription-drug coverage. If those benefits aren’t required, people with costly medical conditions could have difficulty buying insurance with the relevant services or medications.

Medicare for All

Senator Bernie Sanders (I, VT) is beating that drum, again, and has support from some Progressive-Democratic Party Senators.

The health proposal, dubbed Medicare for all, would offer the same suite of medical benefits required for some insurance plans under the Affordable Care Act and eliminate most out-of-pocket costs. Mr Sanders argues that although taxes would likely rise to support the new system, families would save money by no longer needing to purchase health coverage. The government, he says, could also secure lower prices for medical services.