Vice President Pence downplays concerns over disruptions to health care – Yahoo News

NATIONAL HARBOR, Md. Vice President Mike Pence dismissed concerns Thursday about the pace of Republican plans to repeal and replace the health care law passed by Democrats under President Barack Obama, promising an orderly transition to a new system.

Despite all the fear-mongering from the left, make no mistake about it. Well have an orderly transition to a better health care system, Pence said at the annual Conservative Political Action Conference.

It was the only comment by Pence in a 20-minute speech that went beyond boilerplate rhetoric and touched on challenges facing the new administration. Nonetheless, the crowd of conservative activists greeted him with warm applause.

Pences comments came on the same day that former House Speaker John Boehner, a Republican, said Republicans would not repeal Obamacare.

All this happy talk that went on in November and December and January about repeal, repeal, repeal. I started laughing because if you pass repeal without replace, first, anything that happens is your fault. You broke it, Boehner said in a speech to the Healthcare Information and Management Systems Society in Orlando, Fla.

And so far, there does not appear to be much consensus among Republicans on how to replace Obamacare. Trump himself has made wildly contradictory comments on when new legislation would be introduced, and on what it would look like.

Just a month ago Trump promised insurance for everybody, which is at odds with the plan congressional Republicans are working on.

Concerns over changes to the health care system have sparked raucous town hall meetings around the country with Republican members of Congress.

One of the biggest obstacles to repealing Obamacare is concern over what will happen to the millions of people who have been covered under an expansion of Medicaid included in the law. Trump and House Speaker Paul Ryan, R-Wis., are in talks with governors to find a way to avoid losing coverage for those people. Trump will meet Friday at the White House to discuss the Medicaid issue with Ohio Gov. John Kasich, a Republican with whom he has clashed repeatedly.

Vice President Mike Pence speaks at the Conservative Political Action Conference. (Photo: Susan Walsh/AP)

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Vice President Pence downplays concerns over disruptions to health care – Yahoo News

Support for 2010 health care law reaches new high – Pew Research Center

With congressional Republicans discussing proposals to replace the Affordable Care Act, public support for the 2010 health carelaw has reached its highest level on record.

Currently, 54% approve of the health care law passed seven years ago by Barack Obama and Congress, while 43% disapprove, according to a national Pew Research Center survey conducted Feb. 7-12 among 1,503 adults.

Throughout the laws history, opinions about the Affordable Care Act have tended to be more negative than positive or, less frequently, divided. As recently as December, about as many approved (48%) as disapproved (47%) of the law.

The new survey finds that when those who disapprove of the law are asked about what should happen to it now, more want GOP congressional leaders to focus their efforts on modifying the law than on getting rid of it. One-in-four adults want Republican leaders to modify the law, while 17% want them to get rid of it entirely.

As in the past, there are deep partisan divisions over the health care law. Democrats overwhelmingly support the law, with 85% expressing approval. Among independents, about half (53%) approve of the health care law, while 45% disapprove. By contrast, Republicans broadly disapprove of the law (89%); just 10% express approval.

Republicans who disapprove of the health care law are divided on whether GOP congressional leaders should modify the health care law or get rid of it entirely. Nearly equal shares say Republican leaders in Congress should focus their efforts on modifying the law (42%) and focus on getting rid of it entirely (44%).

Among independents, nearly twice as many say Republican leaders should focus on modifying the law rather than scrapping it (29% vs. 15%).

Independents have grown in their support of the health care law in the past year. As was the case in December, about half (53%) now approve of the Affordable Care Act. In October, shortly before the election, 41% of independents approved of the law.

About three-quarters of Democratic-leaning independents (78%) support the health care law, little changed from December, but up 14 percentage points since October (from 64%). Opinions of Republican-leaning independents have shown less change; currently, 22% favor the law.

Democratic support for the law, which dipped in December, has increased 12 points since then (from 73% to 85%). There has been little recent change in Republicans views of the health care law.

Younger adults are more likely than older people to approve of the health care law. Today, by about two-to-one, those younger than 30 approve (65% approve vs. 31% disapprove). In October, opinion among young people was more evenly divided (51% approve vs. 45% disapprove). Since then, support also has increased among those ages 50 to 64 (52% now, 40% then).

Postgraduates continue to express broad approval of the health care law: About two-thirds (68%) approve today, which is little changed from October. Among college graduates, a majority today expresses approval of the law (58%) on par with the share who approved in December (56%), but up 10 points from before the election. In October, college graduates were divided; as many approved as disapproved (48% each).

Among whites, the educational divide is even wider. A 64% majority of white postgraduates approve of the law, equal to the share that expressed approval in October. White college graduates today have ticked up in their support for the health care law: About half (52%) currently approve, compared with 41% in October.

But among whites with some college experience or less education, a majority (62%) disapproves of the Affordable Care Act, compared with just about a third who approve (36%). In October, 30% approved of the law.

Note: Survey methodology can be found here, and topline can be found here (PDF).

Topics: Barack Obama, Domestic Affairs and Policy, Health Care, Political Issue Priorities, U.S. Political Parties

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Support for 2010 health care law reaches new high – Pew Research Center

When it comes to health care reform, innovation will matter more than politics – Michigan Radio

The Next Idea

With all the talk of reforming health care, what if we are missing the bigger picture?

What if all this emotional debate about whether to dismantle the Affordable Care Act, otherwise known as Obamacare, was a waste of time?

In 2013, I was asked to give a TED Talk in Washington, D.C. to coincide with the rollout of the Affordable Care Act. I was to follow the Surgeon General; the Director of the National Institutes of Health; and a well-known Harvard Business School professor, among others.

I immediately said, No thanks! I didnt want to be like Frank Gorshin, the impersonator who came on the Ed Sullivan Show right after the Beatles made their American debut. After some cajoling, I agreed to do the event with the stipulation that I could invite a panel of health care innovators and pretend to be Oprah.

Surprisingly, they agreed.

Top innovators from Google, AT&T, Lockheed Martin, and Qualcomm joined me in a very pleasant, non-confrontational discussion about how health care was being changed from the outside in.

We discussed the use of smart phones to perform physical exams in record time for less than $15, diagnosis of diseases like river blindness with the addition of a cheap lens attachment for handheld devices, crowdfunding the discoveries of new drugs, and using open-source informatics to create inexpensive and customized therapies, and more.

In the weeks that followed, I received a few polite but passive-aggressive emails from people I took to be seasoned physicians. The message was usually the same. You dont understand how we do things because you are not a doctor.

I also received several emails from medical students and residents. Their messages went something like this: The attending physicians in my medical center are terrified of new technology, please send help.

Finally, I received numerous inquiries from young entrepreneurs who wanted to be outside-in innovators themselves. Most of them were looking for moral support, industry connections, and large amounts of cash.

“While we are lobbying and legislating the future of health care in America, innovators are creating the products and services that will largely determine what that future looks like.”

It was clear that all three groups belonged to the same health care ecosystem but with much more eco and much less system.

What has been conspicuously absent from the discussion about reforming health care is the role innovation is playing in making it better, faster and cheaper. While we are lobbying and legislating the future of health care in America, innovators are creating the products and services that will largely determine what that future looks like.

Ideally, doctors would be leading the effort, but they are falling behind the pace of the innovators. The irony is that health care is great at developing timely new therapies but terrible at operationalizing them. Its a difficult balancing act. We expect our physicians to follow the rules so that we get predictable results. But if we dont give them room to try new things, innovators will come from somewhere else.

Over the past few years Ive been working with some of the leading medical institutions to teach students and physicians how to make innovation happen from the outside-in. The results have been promising so far, but there is much more to do before we see any real impact on the availability and affordability of health care. Its future will obviously be affected by the decisions of our elected representatives – but the ideas coming from these outside-innovators may matter more in the end.

Jeff DeGraffis a clinical professor of business administration at the University of Michigan Ross School of Business.

Jeff DeGraff’s essay on Stateside.

The Next Idea is Michigan Radios project devoted to new innovations and ideas that will change our state.

Join the conversation on Twitter or Facebook, or let us know your Next Idea here.

(Subscribe to The Next Idea podcast on iTunes, or with this RSS link.)

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When it comes to health care reform, innovation will matter more than politics – Michigan Radio

Trust the states we’ll deliver on healthcare – The Hill (blog)

Elections have consequences. Americans are reminded of that today, just as they were eight years ago.

This week, I will travel to Washington D.C. for my first National Governors Association meeting as Indianas chief executive. Ill be armed with plenty of Indiana examples to support what my colleagues from around the country already know: The greatest victories to emerge from the last decade came from the states, and they were accomplished in spite of an increasingly prescriptive and expansive federal government.

Our Healthy Indiana Plan (HIP) is now the go-to model of consumer-driven healthcare for states in the Midwest and beyond. Long before ObamaCare, Governor Mitch Daniels and his team developed this program aimed at transforming patients from passive recipients of healthcare into active participants in their health.

Later, with a looming unsustainable Medicaid expansion on the horizon, then-Governor Mike PenceMike (Michael) Richard PencePence takes victory lap at CPAC: This is our time Pence: Democrats’ Obamacare promises were ‘fake news’ Conservatives to Congress: Get moving MORE battled the federal bureaucracy in Washington for permission to grow the program responsibly and free from as many strings as possible. After two years of wading through unnecessary federal roadblocks, HIP 2.0 was born, and today 400,000 low-income Hoosiers are contributing to their healthcare costs while healthy behaviors continually improve.

HIP 2.0 members who contribute to their health care costs are more likely to seek preventative care, less likely to visit emergency rooms, and more likely to report high levels of satisfaction than those who do not. With such strong outcomes, I have petitioned the Centers for Medicare and Medicaid Services to allow Indiana to maintain HIP 2.0 and to use it as a vehicle to expand drug addiction and mental health treatment options, reduce smoking rates, and incentivize healthier behaviors.

Indianas HIP 2.0 program works because it is built by Hoosiers for Hoosiers a true skin-in-the-game approach that reflects the core values of personal responsibility and fiscal discipline intrinsic to our communities.

Our state has applied the same home-grown approach to education, empowering families to choose the best educational fit for their children whether thats a traditional public school, a quality charter school, or private school. These school choice programs garner much attention, of course, but we also have taken important steps to recruit and keep great teachers in high-need subjects and communities while increasing education funding to record levels.

There are also times Indiana has elected to replace federal funding with state funds to ease burdensome federal restrictions. Transportation is a prime example. Indiana provided $150 million in grants to local communities to pursue the projects they need most unbound by state or federal limits. Similarly, Indiana leveraged the power of public-private partnerships to complete two bridges over the Ohio River, connecting Indiana and Kentucky.

In essence, rather than adhering to a formulaic approach, our states leaders listen to families and communities to design programs flexible enough to meet the needs of Hoosiers in every part of the state. The same is true across state government in Indiana. With our affordable housing strategies, environmental permitting, workforce development and training, and so much more, we have sought every opportunity to partner with the federal government while staying true to the unique needs of our citizens.

The skepticism, and sometimes outright pushback, experienced from the federal government in the past eight years has been considerable, but states like Indiana have found solutions to their biggest problems anyway. We are committed to being as responsive as possible to the families and employers we serve, and I, like my two predecessors, understand that Washingtons one size most certainly does not fit all.

Indiana is not alone in its desire for the freedom to solve problems our own way. States are tired of unnecessary federal obstinacy against innovation and new approaches. Ignited by a decade of overreach and emboldened by a new administration eager to decentralize power, states are surging backlearning from each other and building strategies that address their needs.

In the months and years ahead, I look forward to partnering with the Trump-Pence Administration and Congress to give states the flexibility they need to act on behalf of their citizens to solve problems quickly and more effectively.

Eric Holcomb is the 51st Governor of Indiana. He is a veteran of the United States Navy, was a trusted advisor to both Governor Mitch Daniels and U.S. Senator Dan CoatsDan CoatsDNI official challenges reports of low morale in intelligence community Trust the states we’ll deliver on healthcare Trump’s pick for intel chief to get hearing next week MORE, and most recently served as Lt. Governor with then-Governor, current-Vice President Mike Pence.

The views expressed by contributors are their own and are not the views of The Hill.

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Trust the states we’ll deliver on healthcare – The Hill (blog)

2017 Health Care Heroes finalist: Barbara Terry – Cincinnati Business Courier

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2017 Health Care Heroes finalist: Barbara Terry
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2017 Health Care Heroes finalist: Barbara Terry – Cincinnati Business Courier

Why Former Tech Execs Are Leaving Google And Twitter To Start Health Care Companies – Fast Company

When Stephanie Tilenius, a former senior executive at eBay and Google, decided to start a health-coaching app, many in her network were incredulous. “Everyone thought I was crazy,” she recalls. “Some people loved that I wanted to do something to help others, but a lot socially ostracized me.”

For many entrepreneurs, the health sector offers an enticing opportunitywith strings attached. It’s an estimated $3 trillion market and is still dominated by a cadre of traditional players. But many in the technology sector have shied away from the industry after witnessing many high-profile failures and realizing that change doesn’t happen quickly. “Silicon Valley operators and investors see that health care needs better technology,” explains veteran health IT consultant Ben Rooks. “But they learn quickly that health care isn’t about radical disruption; it’s about slow evolution.”

Despite the challenges, a small but growing group of former technologists from companies like Google and Twitter are in it for the long haul. In many cases, their motivations are deeply personal: A family member lost to chronic disease, or a brush with the broken health care system. I spoke to four former tech executives about their reasons for moving into health care, the cultural differences between the two sectors, and the challenges they’ve faced along the way.

“Because patients deserve better than a seven-minute visit.”Stephanie Tilenius, former VP of commerce and payments at Google and former GM and VP at eBay and PayPal

Stephanie Tilenius started her career at e-commerce companies like eBay and PayPal, and eventually ascended the ranks to become a senior vice president at Google. But prior to joining eBay in 2001, she spent a few years at an online drugstore called PlanetRx. That early experience in health care had a lasting impact on Tilenius. When her father got sick, she felt an even stronger pull to quit her steady tech job to make an impact in the sector. “My father had multiple chronic conditions and went from doctor to doctor,” she recalls.

Stephanie Tilenius[Photo: courtesy of Vida]

These days, she is the CEO of a startup called Vida, which provides virtual care for patients with chronic ailments. Before starting the company, Tilenius reflected on her father’s need for “continuous care,” which would involve all of his care providers communicating with him and each other between office visits. Tilenius believes his heart attack could have been avoided, or at least delayed, if he had received better care than a “seven-minute visit, in which all his doctors would all just tell him to change his diet.”

Unlike many of her peers in health tech, she made a point of working closely with medical centers that were already developing clinically validated programs for treating patients with chronic disease like diabetes, depression, and hypertension. She started Vida to make these programs more accessible by shifting some of the components online, and connecting patients with virtual health coaches to inspire long-term behavioral changes.

At first, many friends and acquaintances in her network couldn’t understand why she’d leave a successful career in tech to start a health company that would likely grow and monetize at a slow pace. “People didn’t understand why I would leave a senior role and money on the table,” she says. “In Silicon Valley, it’s about hypergrowth, and if you’re not doing that, then there’s something wrong.” Likewise, many in health care were skeptical about technologists moving into their own complex sector. Tilenius believes that she’ll ultimately show her detractors on both sides that new platforms will emerge in health care, starting with mobile and cloud, and that companies like Vida will be at the forefront. Ultimately, she asks, “Don’t you want us crazy Googlers to help people by building companies and taking risks?”

“It’s a quest for purpose.”Katie Jacobs Stanton, former VP of global media for Twitter, and Othman Laraki, former VP of product management at Twitter and former product manager at Google

For Othman Laraki, the CEO of Color Genomics, the migration of technologists to health care is inevitable as the so-called “internet generation” ages and their priorities change. Laraki’s company offers a $249 test to screen people for gene mutations associated with various cancers. Laraki says he left a job in product management, in part because he learned that he is a carrier of one of these mutations. He also found through his research that those with an early awareness of their disease risks can take proactive and preventative steps. “Color started with a simple question,” he recalls. “Is this test something that could benefit my family as well as other families out there?”

The shift to health care hasn’t been easy. One of the key differences between the two sectors, he explains, is the criteria for success. “In tech, [the adage] is kind of true that ‘if you build it, they will come’,” he says. “In health care, the quality of the product is like No. 10 on the list.” Other factors are more important, such as price, privacy, patient safety, relationships with key industry stakeholders, and so on. Laraki is confident, however, that this will slowly start to change with more data flowing in health care and the trend toward consumerization.

Othman Laraki[Photo: courtesy of Color Genomics, Inc.]

In the meantime, he says that Color Genomics has been able to get an edge on its rivals, in part due to the technology background of its founders. As an example, the company started out by pricing its product in a unique way. The founders made the test affordable enough for most patients to pay out of pocket. “It was unusual, but an effective way to reach a lot of people.” Most gene-testing companies will instead choose to work with insurance companies to maximize revenue, often at the expense of its patients. By iterating continually on the product, a talent acquired at Google, Laraki says the company was also able to cut the time it took to develop a fully compliant in-house lab from the expected one year to just three months.

The response among those in the tech community to Color has been mixed. “I get a lot of, ‘That’s interesting,’ or, ‘Huh?’ says Laraki. But he and Chief Marketing Officer Katie Jacobs Stanton say that many of those same people want to get involved when they simply explain the opportunity. For Jacobs Stanton, the decision to join Color came after she watched her brother and father battle cancer. But she also had practical reasons for coming on board: “I follow the three-principal model,” she says. “Who are the people? What is the product? Could I help?” Jacobs Stanton, who is also an investor in Color, joined the company only after being convinced on all three fronts.

“I wanted to build something of everlasting value.”David Vivero, former vice president of rentals for Zillow

David Vivero recalls a not-too-distant past prior to the Affordable Care Act in which a person with a chronic medical condition, himself included, could be denied health insurance. Things may have changed on that front, but many people still feel regularly dissatisfied with their experience in health care. That prompted Vivero to start a company geared to consumers and patients (most health companies are business-to-business). “I wouldn’t say it hit me like an epiphany,” he says. “I started with an image of a single page that could be a window into an important health decision, and then it evolved.” For Vivero, another motivator came after he became a parent: “Now, having a child, I wanted to build something of everlasting value.”

Vivero’s startup Amino aims to provide transparency for patients on physician quality and price so they can make more informed decisions. One of the challenges for Vivero has been to convince veteran health technologists that there’s a route to make money through consumers, he says. Aware that many companies have tried and failed to improve transparency, some industry experts are skeptical about his chances. “The first movers tend to have arrows in their backs,” he explains.

But Vivero is convinced that technologists have a good shot at improving some aspect of the health experience if they stay humble and bring in experienced medical advisers. He says many entrepreneurs fall into the trap of eyeing the multitrillion-dollar opportunity and casting their net too wide without realizing that one sliver of the industry could be worth hundreds of millions. “When you are out there speaking with the bluster of a typical Silicon Valley entrepreneur, try to modulate it,” he advises would-be founders. “Start with empathy, and a desire to get it right for each individual user.”

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Why Former Tech Execs Are Leaving Google And Twitter To Start Health Care Companies – Fast Company

Healthcare firms plan to increase security spending | CSO Online – CSO Online

By Maria Korolov

Contributing Writer, CSO | Feb 23, 2017 5:30 AM PT

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After several high-profile breaches over the past couple of years, the healthcare industry plans to increase its spending on IT security more than other sectors.

According to a survey released this Tuesday, 81 percent of U.S. healthcare companies plan to increase security spending this year, compared to an overall industry average of 73 percent.

The spending intent is significantly higher than last year, when only 60 percent of healthcare firms planned to increase security spending.

The higher interest in improving security is likely due to a combination of increased awareness of both data breaches and risks of ransomware, as well as increased regulatory oversight, said Jim DeLorenzo, solutions marketing manager at Thales e-Security, which produced the report.

“They get increased attention as protectors of data that is so essential to everybody’s lives,” he said.

But while healthcare breaches can be very high profile and dramatic, the actual incidence rate is lower than in other industries.

Only 18 percent of global healthcare companies said they had a breach in the past 12 months, the lowest of any vertical. By comparison, 43 percent of companies in the retail sector reported that they had a breach.

Part of the reason could be that the health care records marketplace is becoming saturated. With more than 110 million healthcare records breached in 2015 alone, the medical information of nearly half of all Americans is already available on the black market.

Meanwhile, regulators are coming down harder on healthcare companies than ever before, said DeLorenzo.

The Office of Civil Rights under the Department of Health and Human Services is the agency that enforces compliance with the Health Insurance Portability and Accountability Act (HIPAA).

The regulators have previously indicated that they will be conducting more audits, and are now getting serious, he said.

“You’re actually seeing some actual penalties being assessed,” he said.

For example, earlier this month, the Children’s Medical Center of Dallas agreed to a $3.2 million settlement for ignoring security recommendations and not encrypting patient records. And the Memorial Healthcare System paid a $5.5 million settlement for its data breaches, the Department of Health and Human Services announced last week.

Compliance is the single biggest driver of U.S. healthcare security spending, said DeLorenzo.

According to the report, 57 percent of U.S. respondents said that compliance is their top spending driver — compared to just 20 percent globally.

“We’re a compliance-driven marketplace here,” he said. “Especially compared to other countries that have government-run healthcare systems.”

When it comes to allocating their spending, 69 percent of U.S. healthcare companies said that they planned to increase spending on network security. Analysis and correlation tools were in second place, with 62 percent of respondents planning to increase spending in this area.

Maria Korolov has been covering emerging technology and emerging markets for the past 20 years.

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Healthcare firms plan to increase security spending | CSO Online – CSO Online

Liberal Vermont tests the waters on GOP health care overhaul – USA TODAY

Steven Findlay, Kaiser Health News 4:41 p.m. ET Feb. 23, 2017

Phil Scott, a Republican candidate in the Vermont 2016 gubernatorial race, speaks during a forum held by the Brattleboro Area Chamber of Commerce at the American Legion in Brattleboro Vt., on June 28, 2016. (Photo: Kristopher Radder, Brattleboro Reformer, via AP)

Tiny and very blue Vermont could be at the leading edge of the health reforms envisioned by the Trump administration and a Republican Congress.

The Green Mountain State, population around 626,000, got a broad waiver last October from the federal government to redesign how its health care is delivered and paid for.The statewide experiment aims to test new payment systems, prevent unnecessary treatments, constrain overall growth in the cost of services and drugs, and address public health problems such as opioid abuse.

The six-year initiative an outgrowth of a failed attempt by Vermont a few years ago to adopt a single-payer plan for all residents could eventually encompass almost all of its 16 hospitals, 1,933 doctors and 70%of its population, including workers insured through their jobs and people covered under Medicare and Medicaid.

The Obama administration approved the experiment, but it fits the Republican mold for one way the Affordable Care Act could be replaced or significantly modified. The Trump administration and lawmakers in Congress have signaled that they want to allow states more flexibility to test ways to do what Vermont is doing possibly even in the short-term before Republicans come to an agreement about the future of the ACA.

Two Republican senators, Bill Cassidy of Louisiana and Susan Collins of Maine, introduced legislation in January that would permit individual states to design their own health reforms and keep provisions of the health law intact.

Coincidentally, the ACA contains a provision that allows states to launch such experiments starting this year, as long as they meet the ACAs overall goals for coverage expansions and consumer protections. One possible scenario, then, is that the Trump administration and Congress would agree to retain a version of that provision modified to make it easier for states to experiment, experts say.

Its a very reasonable approach, especially if it looks as if Congress cant agree on an immediate replacement plan, said Stuart Butler, a senior fellow in economics and health policy at the Brookings Institution in Washington, D.C. States have long been the laboratories for social change and policy reform, and I think many governors, Republican and Democrat, would welcome this opportunity.

Chris Jennings, a longtime health policy adviser to Bill and Hillary Clinton and Barack Obama, said Democratic states also may be amenable. Theres a long way to go on this and there are downsides for example, what would state legislatures actually do but it looks like it will be a meaningful debate.

We Want To Simplify How Things Work

Al Gobeille, Vermonts secretary of Human Services and a Republican serving under newly elected Republican Gov. Phil Scott, said the hope is that the Trump administration will preserve the states initiative.

We are doing what [the Republicans] seem to be talking about, said Gobeille, who owns a restaurant company in the state. We want to simplify how things work, with both coverage and access to care. We want to enhance competition and we want to lower cost growth even as we improve quality.

Scott and Gobeille this month announced the formal launch of the programs pilot phase. In 2017, 30,000 of the states roughly 190,000 Medicaid patients will get care, under a set budget, through an organization called OneCare Vermont. OneCares network of hospitals and doctors already provide care to about 100,000 Vermonters.

The state will give OneCare $93 million, in monthly payments, for the care of the 30,000 Medicaid patients $3,100 per person. If OneCare spends more than $93 million, the company will absorb the loss. If OneCare spends less than that amount, the company and the state share the savings.

This tests the concept of a global budget and streamlined payment which incentivizes better care, says Todd Moore, OneCares CEO. We may be a small state but we are trying a big thing. If it works, many states are likely to stand up and take notice.

Moore added that patients will be informed they are part of the program and can seek redress with the states Department of Human Services if they feel their care is stinted in any way.

In announcing the pilot program, Gov. Scott said that if its successful the experiment will be expanded in 2018 and beyond to encompass the rest of the Medicaid population, Medicare beneficiaries and people who have insurance through private employers and on their own, including through Vermont Health Connect, the states Obamacare insurance exchange. Additional hospitals, doctors and other providers would become involved, likely under the umbrella of OneCare Vermont.

Medicaid covers almost 30%of Vermont residents, Medicare covers 21%, and the rest have either private insurance, coverage through the VA or Tricare (military) or are uninsured. About 4%of Vermonters were uninsured in 2015, one of the lowest rates in the nation.

Under the terms of Vermonts contract with the Obama administration, the target for the states maximum overall cost increase in health spending would be 3.5%per year from 2018 to 2022 thats twopercentage points lower than the annual 5.6%average increase in health care spending nationally the federal government projectsbetween this year and 2025.

Success or failure will also be assessed based on population health and quality of care measures. For example, the plan calls for a reduction of substance abuse deaths by at least 10%by 2022. Likewise, the plan sets a target for not more than a 1%rise statewide in the number of people with chronic diseases such as diabetes, high blood pressure and COPD (chronic obstructive pulmonary disease). The allowance for the slight increase takes account of the states aging population.

The number of people with ready access to a primary care physician will also be evaluated, with a target of 90%of residents by 2022.

A Shift From Fee For Service

To make all this work, almost every doctor and hospital would have to join OneCare Vermont or create their own accountable care organizations, or ACOs. In these organizations, providers agree to work together to improve and coordinate care and reduce spending under a set budget.

ACOs are also set up to allow payers to gradually shift to global per-patient payment, or other simplified forms of payment, and abandon traditional fee-for-service payment. Fee-for-service payment in medicine is widely viewed as providing incentives for excessive and wasteful care, as well as fraudulent billing. Both the Affordable Care Act and a 2015 law setting up an incentive-payment system in Medicare for doctors take major steps to test whether ACOs and alternative payment systems improve the efficiency and quality of care.

Vermonts initiative builds on those efforts.

Some in Vermont are skeptical the experiment will work well, however. Paul Reiss is a family doctor in Williston and chief medical officer for HealthFirst, Vermonts largest independent practice association. HealthFirst represents (but does not own or operate) 66 doctor groups with 250 doctors, physician assistants and nurses. Reiss said the states largest hospital system the University of Vermont Medical Center dominates health care in parts of state.

We are fearful that much of a restricted pot of money will still go mostly to that company, baking in the inefficiencies of a bloated hospital budget, and not be deployed equitably to the front lines of patient care across the state, Reiss said.

The University of Vermont Medical Center vigorously denied that its budget was bloated. Moore, who is affiliated with the hospital as well as being OneCare Vermonts CEO, said: Statewide data do not confirm those assertions. The medical center is, in fact, a strong leader in ushering in a value-based system for Vermont.

Scott, in announcing the launch of the pilot phase this month, said if it does not work this year, the state would consider terminating the experiment early.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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Liberal Vermont tests the waters on GOP health care overhaul – USA TODAY

Town hall brings drama, fears on health care – Ventura County Star

The audience comes to its feet applauding someone’s comment that single-payer health coverage is the best solution. The standing-room-only crowd filled a conference room at the Camarillo Library during a town hall meeting on health care that was hosted by Rep. Julia Brownley.(Photo: KAREN QUINCY LOBERG/THE STAR)Buy Photo

More than 200 people filled every inch of a library conference room in Camarillo, standing in doorways and lined up four deep in the back.

Some carried signs to a Tuesday night town hall meeting held by U.S Rep. Julia Brownley, D-Westlake Village. Patients Over Politics, said a placard at the back of a gathering that at times became a rally for an Affordable Care Act that Republicans have pledged to repeal.

A few people wore pink cat hats.

This seems like a crowd thats all on the same page, Brownley said.

But when a different speaker asked if anyone thought their health care could improve without the system known as Obamacare, at least two people raised their hands. Then one woman, who later identified herself as a Donald Trump supporter, noted that she was a constituent of Brownleylike everyone else and asked for respect. Another audience member responded by loudly demanding the new president show people respect.

Aside from a few heated exchanges, the event revolved around concern that repealing the Affordable Care Act will mean less care.

We want greater access, not less, Brownley said.

Other speakers called for more details on the Republican plan to replace the current system.

One speaker worried that people with pre-existing health conditions could be ushered into high-risk insurance pools in which health care could cost more.

We were routinely spending $30,000 for health care, said Deborah Madden, of Westlake Village, who has a son with Type 1 diabetes, thinking of the days before the Affordable Care Act. She said the health system can be improved but worried that its elimination could hurt her son and others.

Health care is a human right, not a political issue, she said.

Dr. Kathleen Shore, of Ventura, came in her white physicians coat, complete with a stethoscope. Shes a family-practice doctor affiliated with a county-run safety net system. She worried that repeal will mean people losing coverage and care.

I can tell you story after story of people who have suffered from not having primary care, she said.

Another man called for a single-payer health care system. His request drew a standing ovation.

Deborah Baber Savalla wore a hoodie emblazoned with the name, Trump. At one point, she told the crowd she didnt feel welcome, leading another person to tell her she wasnt. Another person then came to offer Savalla a hug.

After the meeting, Savalla said she came looking for information.

I truly wanted to know what her position was, she said of Brownley.


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The congresswoman told the crowd she was willing to consider proposals presented by Republicans but drew a line at reverting to the way things were before the Affordable Care Act.

Im not open to going backward, she said. Im interested in going forward.

Nancy Gomez of the advocacy groupHealth Access Californiaurged people to contact friends and family members and ask them to reach out to Republicans in Congress.

We can slow down this train wreck, she said.

Paula Roady, 63, of Camarillo, came with a sign that read, Yay ACA, and noted that organizers should have booked a bigger room.

She came to listen but also to send a message to the new president.

Were going to be involved now in resisting this new administration, she said.

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Town hall brings drama, fears on health care – Ventura County Star

A right to healthcare belongs in our Constitution – The Hill (blog)

After eight years attacking the Affordable Care Act, Congressional Republicans are facing a tough reality: ending this landmark law means millions of Americans will lose health coverage.

My Democratic colleagues in the House and Senate are committed to protecting Americans health care, safeguarding the Affordable Care Acts historic progress, and finding tangible improvements to make care more affordable.

I believe health care is a fundamental right, which is why I introduced the America’s Right to Health Care Amendment.

This proposed amendment to our Constitution is simple and straight-forward: As a nation, we must act to guarantee every American affordable, quality health care.

According to recent polling from the Pew Research Center, more than 60 percent of Americans agree that providing health coverage to all Americans is the federal government’s responsibility.

While my amendment enshrines that principle into our Constitution, we have already made tremendous progress under the Affordable Care Act towards meeting that federal responsibility.

The uninsured rate is at its lowest in history. People who never before had access to health coverage, because they had a pre-existing condition like diabetes or heart disease, are now able to get the care they need. I hear often from people who are alive today because of this law.

Health coverage has also become more equitable and comprehensive. Women can no longer be charged more than men for our basic health care — and access to family planning must be covered. Young adults are able to stay on their family’s plan until age 26. No one has to pay a co-pay for recommended preventive and wellness care.

An end to annual and lifetime limits means that people who face a devastating diagnosis like cancer no longer have to worry about their insurance companies stopping payment for their care.

Of course, there are some things we need to fix about the Affordable Care Act, including addressing high premiums in the individual market and reining in out-of-control prescription drug costs.

Under the Americas Right to Health Care Amendment the federal government must find common-sense solutions to high out-of-pocket costs instead of simply adding to insurance and drug companies profits.

More than just safeguarding our progress and mandating solutions, the amendment also makes clear that universal access to health care is essential to the strength of the nation. More than 14 million people have gained health coverage in the 32 states that expanded Medicaid. For many, this means getting the care they need to fully participate in the workforce.

That is good for them and their families, good for businesses, and good for our entire society. Even Republican governors have embraced increased access to health care under the Affordable Care Act because of its benefits to state economies.

Despite the broad public agreement that all Americans must have access to health care, I am a realist. This Republican Congress is more interested in catering to big drug and insurance companies than in considering proposals like my amendment.

But the America’s Right to Health Care Amendment lays down a critical marker by which we can judge Congressional Republicans’ health care proposals.

Do Congressional Republicans want to expand coverage to more Americans or do they want take it away from our families? Does the Republican majority support access to high-quality care or do they want to make it easier for insurance companies to deny care? Does the GOP favor or oppose important consumer protections that save lives?

So far, the answer from Republicans is clear: they want to go backwards and give big drug and insurance companies more control over our health care system. Thats just plain wrong.

Every American deserves to have affordable, quality health care. By coming together, standing up, and speaking out, we can make access to health care a fundamental right for all Americans.

Rep. Betty McCollum represents Minnesotas 4th District in the United States House of Representatives.

The views expressed by this author are their own and are not the views of The Hill.

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A right to healthcare belongs in our Constitution – The Hill (blog)

National briefs: Trump may have health care plans – Pittsburgh Post-Gazette

WASHINGTON The White House declined Wednesday to rule out that President Donald Trump will push his own plan to replace the Affordable Care Act, rather than pursue one course with congressional Republicans.

When asked if there will be a single White House-congressional GOP plan, White House press secretary Sean Spicer left open the door that the president might roll out his own plan no matter what lawmakers do. Minutes later, Mr. Spicer referred to the presidents plan when discussing how the administration intends to achieve one of its top campaign goals.

On Capitol Hill, since Mr. Trump was elected and the party kept the House and Senate, Republican lawmakers have celebrated an era of unified GOP governance. Mr. Spicers comments suggest the party lacks a unified approach to how to dismantle the health care law and replace it.

Shutting down stereotypes

WASHINGTON The Supreme Court on Wednesday firmly rejected the use of racial stereotypes when deciding the proper sentence for a convicted criminal, reopening the case of a black man who was condemned to death after his Texas jury was told African-Americans are statistically more likely than whites to commit violent crimes.

Our laws punish people for what they do, not for who they are, Chief Justice John G. Roberts Jr. said in the courtroom.

The 6-2 decision faulted Texas authorities and judges for refusing to give a new sentencing hearing to Duane Buck, a Houston man convicted of shooting and killing his ex-girlfriend and her new boyfriend in 1995.

Ex-sports doctor charged

LANSING, Mich. A Michigan sports doctor who treated elite female U.S. gymnasts was charged Wednesday with sexually assaulting nine girls, including some too reluctant to speak up about the alleged abuse years ago because he was considered a god.

Roughly two dozen charges were filed against Larry Nassar, the first criminal cases related to his work at Michigan State University where he was the preferred doctor for gymnasts in the region who had back or hip injuries. Hes also being sued by dozens of women and girls, including 2000 Olympian Jamie Dantzscher, who described the assaults on 60 Minutes Sunday.

Child care help suspended

WASHINGTON Major U.S. Army bases at Fort Knox, Ky., and Wiesbaden, Germany, are shutting down child care and education services for military families due to President Donald Trumps hiring freeze on federal workers.

Emily Bewley, whose family is stationed at the U.S. Army Garrison in Wiesbaden, was signing out the youngest of her four children from preschool on Tuesday when she found out that the program would be suspended in six days.

Families at the Fort Knox base were sent a letter Feb. 17 announcing that part-day child development centers on the base would be suspended, and no new children would be enrolled. The hourly child care program is also being suspended. Parents were given 10 days notice.

The extent to which the hiring freeze will affect child care programs at other military bases was unclear.

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National briefs: Trump may have health care plans – Pittsburgh Post-Gazette

Sen. Dan Sullivan talks health care with Alaska business leaders as protesters rally outside – Alaska Dispatch News

Alaska Dispatch News
Sen. Dan Sullivan talks health care with Alaska business leaders as protesters rally outside
Alaska Dispatch News
The protest was organized by the Alaska affiliate of "Protect Our Care," a national group pushing to protect the Affordable Care Act, said organizer Andre Horton. Organizing for Action and the Alaska Nurses Association also coordinated the rally, he said.

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Sen. Dan Sullivan talks health care with Alaska business leaders as protesters rally outside – Alaska Dispatch News

Healthcare Groups Ask HHS Chief Price for Regulatory Relief – Medscape

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Healthcare Groups Ask HHS Chief Price for Regulatory Relief – Medscape

Trump: Healthcare plan coming in March – The Hill

President Trump saidWednesdaythat he expects a healthcare plan to come forward as soon as next month.

Maybe mid to early March well be submitting something that I think people will be very impressed by, Trump told reporters, according to a pool report.

It remains unclear whether Trump is referring to a plan that the White House would release on its own, which could throw off congressional efforts, or simply a joint plan with lawmakers introduced in Congress.

House committees are looking to mark up legislation in early March.

Pressed by The Associated Presson Mondayon whether the ObamaCare replacement plan would come from the White House, chief of staff Reince Priebus said, We dont work in a vacuum.

Furthermore, Republican senators who hosted Health and Human Services Secretary Tom Price earlier this month said his message was that the administration wants to work with lawmakers on the replacement plan.

The details of the Republican replacement plan remain unclear. House Republicans last week circulated an outline, though, with elements like a tax credit to help people afford coverage.

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Trump: Healthcare plan coming in March – The Hill

"Right to shop" bill looks to incentivize cheaper health care – Columbia Missourian

JEFFERSON CITY Health care is a lucrative business for hospitals, doctors and insurance providers. Why not patients?

That would be one result of a set of bills proposed by Rep. Keith Frederick, R-Rolla, that would make Missouri one of a handful of “right to shop” states in the country.

“Right to shop” laws aim to incentivize patients to find cheaper health care. Patients could compare costs and select a cheaper provider, and insurance companies would be required to split the difference between the initial estimate and the cheaper alternative with the patient.

“This bill would require that insurance companies share the savings with the citizens,” Frederick said.

To use an example given by Frederick during the hearing, if an insurance company planned to shell out $2,000 to a patient and the patient found a doctor who would perform the procedure for $1,000, the insurance company would cut a check for $500 to the patient.

Frederick proposed two similar bills, one focused on current and retired state employees, the other focused on all other Missouri residents.

Patients would be able to find information on cost estimates for procedures by going to the insurance providers website because the bill requires the companies to maintain payment information publicly.

Insurance companies would have to pay patients regardless of whether the service provider was in their network.

Frederick said he first heard of a similar proposal from the Foundation for Government Accountability, a think tank based in Florida, while attending a conference in Chicago.

“Ive been a big fan of transparency,because Ive observed over the years that patients have a hard time finding out what the cost of a health-care service is before they consume it,” he said.

“Its kind of like going to the car dealership and he tells you, ‘Buy it, take it home, park it in your garage, and next week well tell you how much you spent.'”

One lobbyist, Jim Gwinner, spoke in favor of the proposals, but a number of lobbyists representing hospital and insurance organizations spoke out strongly against the measures.

Shannon Cooper, a lobbyist with the Missouri Insurance Coalition, said “right to shop” laws would incentivize cheaper health care too much, leading to lower-quality standards.

“When there is a cash incentive out there, some people will be driven to the lowest-cost provider. They wont take into consideration a positive outcome,” he said. “Theyll just think ‘Hey, I might get a check if I go down the street and let somebody do the procedure on me that I dont know and Ive never heard of.'”

Frederick was undeterred.

“I would just ask the committeenot (at the hearing),” he said. “People that are not here are patients, your constituents, consumers of health care. They dont have lobbyists.”

Supervising editor is Mark Horvit.

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"Right to shop" bill looks to incentivize cheaper health care – Columbia Missourian

‘Medicare for All’ Only Way for Trump to Keep Healthcare Promises – Common Dreams

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'Medicare for All' Only Way for Trump to Keep Healthcare Promises
Common Dreams
But "single-payer reform could," write the co-founders of Physicians for a National Healthcare Program (PNHP). "Such reform would replace the current welter of insurance plans with a single, public plan covering everyone for all medically necessary

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‘Medicare for All’ Only Way for Trump to Keep Healthcare Promises – Common Dreams

Truth Test: Does Coffman have a plan to fix healthcare? – 9NEWS.com

Brandon Rittiman, KUSA 7:08 PM. MST February 21, 2017

(Photo: American Action Network)

KUSA – While we haven’t seen a concrete plan from Republicans to replace Obamacare, the replacement is already getting rave reviews — at least in TV ads supporting GOP members of Congress.

The “American Action Network,” which doesn’t disclose its donors, is running one such ad in Colorado.

It’s technically an issue ad, suggesting you call Congressman Mike Coffman to give him an “attaboy” for working on healthcare.

CLAIM: Our healthcare system isn’t working. Mike Coffman has a plan to fix it. VERDICT: Overstatement

Mike Coffman doesn’t have a plan to replace Obamacare, but his staff points out he “does have some very specific principles that he expects to see included in the plan to replace the Affordable Care Act.”

That is not the kind of thing you’d write if the plan was actually done.

In fairness to Coffman, this isn’t an ad *he* made.

But he is meant to benefit from it.

And if the ad is a bit over-the-top in singing Coffman’s praises about changing healthcare laws– well, at least he’s got plenty of company.

This same ad is running claiming that several other congressional Republicans also have plans in TV ads running in other states.

Theres also a generic version that simply promises Republicans have a plan.

And the group cut versions of the ad with the same visuals, but with scary music and a more somber voiceoverattacking Democrats who supported Obamacare.

So the key message here is that whatever Republicans come up with, the American Action Network group thinks it’s gonna be great.

CLAIM: [Obamacare has led to] rising premiums and deductibles. VERDICT: True, but needs context

It’s true premiums and deductibles have increased since Obamacare, but this needs a little context: premiums and deductibles were also increasing before Obamacare.

CLAIM: [Obamacare has led to] Washington intruding between doctors and patients. VERDICT: Too vague to test

Without a more specific claim, this is too vague for us to factcheck.

One could argue this has been the case for more than a century– since the first time Congress passed a law on healthcare.

CLAIM: [Obamacare has led to] expensive mandates that destroy jobs. VERDICT: Fair

While the ad-makers can point to a study from their own think tank, we can look at more neutral sources to find evidence to support this claim.

The New York fed surveyed companies and found roughly one in five cutting jobs in the service and manufacturing sectors in response to Obamacare.

There’s also evidence a relatively small number of workers were dialed back to part time due to the A-C-A.

Despite all that, it’s worth pointing out that the national jobs reports have been steadily improving with the broader economic recovery.

The idea that we can experience job growth and the idea that healthcare policy might cause some companies to dial back on their hiring plans are not mutually exclusive.


The ad goes on to make several promises about what will be in the new plan, which does overlap with what congressman Coffman’s office told us he wants to see.

Many of the promises in the ad mirror policies already enacted by Obamacare, such as addressing pre-existing conditions, tax credits to help people buy insurance, and targeting small businesses to pool their resources.

Coffmans office told us he wants to keep the changes Obamacare made for pre-existing conditions, the ability for parents to keep children on their plans until age 26, and maintaining coverage for people who gained it under the ACAincluding the Medicaid expansion, which has been criticized by some of Coffmans fellow Republicans.

In any case, we’ve seen some G-O-P proposals to replace Obamacare, but since they haven’t settled on one we can’t really fact check those promises yet.


And that gets us to the bottom line: this ad is glossing over the fact Republicans have yet to unite behind a plan on healthcare in an effort to make you think it’s going to be awesome, no matter what plan they end up with.

( 2017 KUSA)

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Truth Test: Does Coffman have a plan to fix healthcare? – 9NEWS.com

Want to live longer? Move to a country with universal health care, study finds – The Mercury News

LONDON While most people born in rich countries will live longer by 2030 with women in South Korea projected to reach nearly 91 Americans will continue to have one of the lowest life expectancies of any developed country, a new study predicts.

Scientists once thought an average life expectancy beyond 90 was impossible but medical advances combined with improved social programs are continuing to break barriers, including in countries where many people already live well into old age, according to the studys lead researcher, Majid Ezzati of Imperial College London.

I can imagine that there is a limit, but we are still very far from it, he said.

Ezzati estimated that people would eventually survive on average to at least 110 or 120 years. The longevity of South Korean women estimated in 2030 is due largely to investments in universal health care, he said. South Korea also led the list for men.

Its basically the opposite of what were doing in the West, where theres a lot of austerity and inequality, he said.

Ezzati and his co-authors used death and longevity trends to estimate life expectancy in 35 developed countries. The calculation is for a baby born in 2030. The study was published online Tuesday in the journal Lancet.

Women were ahead of men in all countries. Behind South Korea, women in France, Japan, Spain and Switzerland were projected to live until 88. For South Korea men, life expectancy is expected to reach 84. Next were Australia, Switzerland, Canada and the Netherlands at nearly 84.

At the bottom of the list: Macedonia for women at nearly 78, and Serbia for men at about 73.

While some genetic factors might explain the longevity in certain countries, social and environmental factors were probably more important, Ezzati said.

The study estimated that the U.S., which already lags behind other developed countries, will fall even further behind by 2030, when men and women are projected to live to 80 and 83. American women will fall to 27th out of 35 countries, from their current ranking of 25, and men will fall from 23rd to 26th.

The researchers note that among rich countries, the U.S. has the highest maternal and child death rates, homicide rate and is the only high-income country without comprehensive health care. The researchers also predicted how much longer 65 year olds in 2030 would live; they guessed that among men, those in Canada would live the longest, surviving another 23 years. Among 65-year-old women in 2030, they estimated that South Koreans would live the longest, another 28 years.

In an accompanying commentary, Ailiana Santosa of Umea University in Sweden wrote that the projections raise crucial issues about which strategies are needed to tackle worsening inequality problems.

Achieving universal health coverage is worthy, plausible and needs to be continued, she said.

The study was paid for by the U.K. Medical Research Council and the U.S. Environmental Protection Agency.

Originally posted here:

Want to live longer? Move to a country with universal health care, study finds – The Mercury News

The Republican Health Care Plan: Do the Promises Add Up? – Knowledge@Wharton

Health insurance reform will be high on the agenda as the U.S. House of Representatives reassembles after Presidents Day. Cutting through the high-decibel pitches from supporters and critics of the Affordable Care Act (ACA), experts discern a leaner alternative taking shape.

A Republican policy brief notes that under the ACA, or Obamacare, premiums have risen an average of 25% this past year and that nearly a third of all U.S. counties have uncompetitive markets with only one insurer offering plans. It faults the Medicaid program for being too bloated and rendered less effective by fraud, waste, poor oversight and by being misdirected at able-bodied people instead of more vulnerable sections of the population.

The Republican plan put forth last week offers an alternative, promising lower costs, more choices and flexibility for employers in the plans they may offer and also for individuals, who would be able to buy insurance across state lines and also obtain coverage regardless of age, income or pre-existing medical conditions.

Highlights of the Republican plan include: portable, monthly tax credits that can be used towards buying insurance, and that are not tied to employers or to a government-mandated program. Individuals can use the credits to shop for health insurance plans across state lines. It includes a measure to expand Health Savings Accounts (HSAs), which would offer more freedom for contributions by individuals and their spouses, and more flexibility in terms how they spend their savings.

It promises Medicaid reform by empowering states to design their own plans and by putting the program on a tighter budget, something critics read to mean sharp cuts in federal funding with block grants to states to run Medicaid, many of whom would want to make cuts overall. The policy brief offers no details as yet, but that is because the Congressional budget office is reviewing the plan. The latest proposals are based on House speaker Paul Ryans plan that he unveiled last year.

The biggest detail is the little question of money, said Robert Field, Wharton lecturer and professor of law and health management at Drexel University. He referred specifically to a proposal to grant tax credits based on age instead of income: How big they will be everyones expecting they will be less generous than under Obamacare. Age-based tax credits would replace the ACA feature where subsidies kept pace with premium increases so that employees could continue to afford them. Delinking those subsidies from income criteria and linking them with age changes those protections.

Katherine Hempstead, senior advisor to the executive vice president at the Robert Wood Johnson Foundation, pointed to what she described as two semi-contradictory things going on at once. On one hand, the motivation in changing the age rating could allow insurers to charge more for older people and charge less for younger people, she said. At the same time, subsidies for older people are aimed making health insurance more affordable to them, she added.

Do the taxpayers want to be moderately generous to many or highly generous to a few? Mark Pauly

The hope then is that policies for younger people would be affordable enough, and the take-up rates of people buying those policies would improve, said Hempstead. But she didnt expect the Republican alternative to pan out exactly that way. Many people suspect that the lower-income part of the market is going to drop out, she noted. That is going to have huge implications for the risk pool if that happens. I dont know how affordable these policies will be for anybody.

Field and Hempstead discussed the pros and cons of the Republican health care proposals on the Knowledge@Wharton show on Wharton Business Radio on SiriusXM channel 111. (Listen to the podcast at the top of this page.)

Age vs. Income

At first glance, the move to link subsidies to age and not income seems the right approach. The reason to have subsidies independent of income is to avoid the relatively high implicit tax on income of Obamacare recipients when your subsidy goes down as your income goes up, said Mark Pauly, Wharton professor of health care management, and business economics and public policy. He noted that the implicit tax rates were above 100% for some groups.

However, making the subsidy a flat amount regardless of income at a level that still provides adequate help to lower-income people could have adverse effects, according to Pauly. It means very high additional taxes which also discourage work effort of everyone, not just the 3% of the population buying in exchanges, he said. Or you can set the subsidy low which keeps taxes down but will leave more low income people uninsured. That situation would arise because the premium those low income people would have to pay will be much more than the average amount they would have to pay if they were uninsured and received charity care, he explained.

So they have a serious dilemma, Pauly noted. Do the taxpayers want to be moderately generous to many or highly generous [in a targeted way] to a few? And probably the credits will be claimed more by the reasonably well-off rather than the lower-income people who will stay out.

Removing tax exemptions for employer-sponsored plans will be more efficient because then there will be neutral incentive for people getting insurance through their job or in the individual market, said Pauly. He did not expect large firms with good benefits departments to change their policies, but it may cause some smaller firms to switch to paying more cash wages and having workers buy their insurance as individuals. He noted that individual insurance is administratively about five times costlier by than large group insurance.

Hempstead noted that the absence of penalties for not buying health insurance would not help increase take-up rates, either. If subsidies are based solely on age and not on income, you will have lower-income younger people particularly those who are 26 or 27 years old who have just moved on from their parents policies who will not be able to afford [coverage] and we will lose them from the market, she said. She saw an inherent unfairness in lower-income younger people not getting much in the way of subsidies, while older people who are quite wealthy would qualify for them.

According to Hempstead, the Republican plan is much less redistributive than the ACA is, especially as it relates to deepening risk pools to gain more efficient pricing. The market is very heavily juiced with public money, she said. If you pull a lot of that public money out, there will be consequences. Such a scenario would also bring up anti-poverty issues, she added.

An End to Employer-sponsored Coverage?

Moves to remove tax exemptions for people in employer-sponsored plans face opposition from unions and employers who use health insurance as an incentive in recruiting, but many on both sides of the political aisle see those bringing longer-term gains. The idea is that people would get more of their compensation in the form of wages and less in the form of health insurance benefits, said Hempstead. That would lead people to ultimately chart a course away from employer-sponsored insurance which after all is just an historical artifact that a lot of people have gotten used to, but there is no particular reason that your employer should be taking out your health insurance for you.

If there are a lot of really dire projections about people getting thrown out of coverage and about affordability issues, its not going to be simple. Katherine Hempstead

Hempstead pointed to arguments that reducing those tax exemptions would eventually help create a much larger and more vibrant individual market. She thought that scenario would also solve problems in making risk pools more efficient. But other people are naturally very wary about that, including large employers who see it as a major recruitment strategy and are uncomfortable about transitioning to a phase where they are not the providers of those benefits.

Field characterized that proposal as just the Cadillac tax from the ACA in another name. Under the so-called Cadillac tax that is set to take effect in 2020, insurers will have to pay an annual 40% excise tax on high-end employer-sponsored plans that have annual premiums exceeding $10,200 for individuals or $27,500 for a family. The idea is to make it less attractive to give overly generous plans which encourage people to over-use medical services, he said. [The Republicans] are taking something from Obamacare that amounts in a way to a tax increase and firing the shots in terms of making it into policy.

Hempstead noted that there is a lot of bipartisan support and empathy for this, adding that she, too, agreed with it. I thought the Cadillac tax was a move in the right direction, even if there were some other ways it could be modified.

Will Wages Really Increase?

However, employees worry that the removal of the tax exemption for their health insurance premiums may not be replaced fully by higher wages, Hempstead said. Another concern is whether they would be able to find good alternative products if they were to lose coverage from their employers. In any event, she noted that many people see the push towards employees buying their own health insurance as inevitable, although [it] isnt going to be an overnight change. She pointed to some moves already underway in the direction of direct-to-consumer markets, such as with the Medicare Advantage plans and the growth of private exchanges.

Field was skeptical about how the transition to a removal of the tax exemptions would protect employee wages. If employers stop [offering health coverage] and say they will give employees the money rather than the health insurance, would it be a one-for-one exchange? he asked. Would they give you all of the money they would have given the insurance company? I think the answer is no, but how much of it would they give you? Would workers actually see an increase in their paychecks?

Employees would be worse off in that any wage increase would be taxable, which means they would have less money on hand to buy their health insurance, Field noted. That could have the effect of leaving policies less generous than earlier. It would have a profound effect on the structure of health finance and health care provisions because the flow of money would change.

It is imperative to have a well-functioning health insurance market for those changes to work, said Field. If that is where we are going, then we better have a pretty vibrant individual market, he argued. Whatever they do to change those markets better hold up, because we are throwing people into them and if they cant buy policies there, where are they going to go?

Getting Medicaid Right

Money is again central to the plans to reform Medicaid, said Field. He noted that the Trump administration could provide states block grants to manage that program, perhaps on a per-capita basis. If they do that with enough money, maybe the system will be better, because states could innovate more, he said. If they do that without enough money, which is what the critics fear, this could be a major cutback and could lead to a lot of people losing their health coverage.

The outcomes of a badly run Medicaid program could be serious, according to Field and Hempstead. Field notes that Medicaid is unloved; everyone likes to take hits at it, but it is the backbone of our safety net hospitals, of our pediatric hospitals. Its influence is beneath most peoples radar, but its throughout the system, so if you tinker with it, a lot of harm can be done. Hempstead noted that Medicaid is the single-biggest category with 72 million people enrolled in it. Its a huge lifeline for a lot of providers and [has] widely different beneficiary groups, she said. [They are] kids, pregnant women and healthy adults, but also some very sick people, the aged and disabled.

If there is a way to provide more coverage for less money, then [Trump has] got a brand new business line, even better than resorts and hotels. Robert Field

A policy of caps on per-capita funding for Medicaid must consider how appropriate it is for groups with varying per-capita expenditures, and how those patient populations grow over time, Hempstead said. You can think about some really bad scenarios, especially for the very vulnerable populations of the aged and disabled, and also some huge shifting of burdens on family caregivers as the programs run out of money, she added. She noted that many states expanded their Medicaid offerings in recent years to fix deficiencies. Now you can imagine a lot of transitions that wont necessarily bode well for vulnerable people.

The Road Ahead

Health insurance costs could also be tamed by people adopting healthier lifestyles, Field said. He noted that the ACA included provisions to encourage prevention, including making preventive services available with no co-pays or deductibles. It also fostered innovation in payment models. For example, providers get incentives where they are rewarded more for the health of their population than for the number of services that they provide.

But achieving all that is not easy, Field said. How do you change behavior? Were not going to shut down McDonalds, were not going to outlaw cigarettes, and were not going to force you to go to the gym, he explained. There are limits to how far the nanny state can go. Additionally, even if people make those lifestyle changes, it would take 20, 30 or 40 years before their effects are seen on the health care system, he added.

More on the immediate horizon, Hempstead said there is no certainty that the Republican proposals would become reality. Its not clear there are the votes for this, she added. If there are a lot of really dire projections about people getting thrown out of coverage and about affordability issues, its not going to be simple. Field said he expected heated debates in the town hall meetings over the proposals. A lot of people now are scared and angry that they will lose their health coverage, and that will have a big effect on what Congress ends up doing.

Field, too, is not sure the Trump administration will find a way to make the various disparate objectives of the new plan coalesce into a workable alternative. If [Trump] has a magic formula, then that is amazing, he said. If there is a way to provide more coverage for less money, then hes got a brand new business line, even better than resorts and hotels. If he can do it, great, but [it is] just a little bit dubious. Added Hempstead: Were taking public money out of the market, which is not going to bode well for people that get coverage and for the markets to really thrive.

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The Republican Health Care Plan: Do the Promises Add Up? – Knowledge@Wharton

France’s Fillon mellows on health care reform – POLITICO.eu

French presidential candidate Franois Fillon | Lionel Bonaventure/AFP via Getty Images

Embattled center-right candidate waters down policy proposals.

By Natalie Huet

2/21/17, 1:09 PM CET

Updated 2/21/17, 9:40 PM CET

Frances beleaguered Franois Fillon sought to win back voters Tuesday by promising free glasses, hearing aids and dentures.

The center-right presidential candidate had been widely expected to win the election in May until he tripped on plans to slash health spending, and on a major scandal over payments to his wife and children.

Eager to regain the ground that polls suggest hemay have lost to far-right leader Marine Le Pen and independent candidate Emmanuel Macron, Fillon has now seriously softened his pitch for health care reform.

There is no question of touching public health insurance, even less privatizing it or lowering its coverage, Fillon tolda conference hosted by the Mutualit Franaise, the French federation of non-profit complementary health insurers.

Fillonplans to fully reimburse eyeglasses for children starting this year, he told Le Parisien newspaper and to negotiate a new deal with private health insurers to better cover hearing aids and dental implants. The aim isto bring household out-of-pocket costs for these productsas close as possible to zero by 2022, he said.

Former economy minister Macron, who has yet to unveil a detailed campaign manifesto, was quick to point out that he had been the first candidate to promisefull reimbursement of glasses, hearing aids and dental implants in the next five years.

Theyve been telling me, you dont have a platform but somehow it gets copied, he quipped.

Macron also wantstoinvest 5 billion in over-stretched hospitals whileboosting prevention and access to primary doctors. By relying more on outpatient care,heforesees15 billion in spending cuts over five years.

Fillon initially came under fire this fall over his radical plan to limit public health insurance to serious and chronic diseases. By Christmas, he had backpedaled on the proposal, deleted it from his website and took his whole health care reform back to the drawing board.

The former prime minister still plans to slash 20 billion in health care costs over five years by focusing on efficiency gains, capping health spending growth at 2 percent per year and ensuring patients have better access to primary care doctorsso they dont rush to hospitals to seek care.

But hesought to show he was far from caricatures and open-minded about how to make Frances generous health care system more sustainable. If elected, he said he plans to call a major conventionat the end of the year to discussits future with all the stakeholders concerned.

This article has been updated.


France’s Fillon mellows on health care reform – POLITICO.eu