Filling the need for trusted information on national health issues…

Why Trump’s Dealmaking Model Doesn’t Fit Health Care Policy

In this column as an Axios contributor, Drew Altman discusses President Trump’s threat to withhold cost sharing subsidies and questions whether his approach to deal making can bridge health care’s partisan and ideological divide. “Health policy is not like real estate,” he says.

Column/Op-Ed Read Post

A Warning From the Polls About Letting Obamacare “Explode”

In this column for Axios, Drew Altman sees a warning for the Trump administration and Republicans in the latest Kaiser Tracking Poll: the more they do to undermine the Affordable Care Act marketplaces the more the public is likely to hold them, and not the Democrats, accountable for the problems with the law.

Column/Op-Ed Read Post

Don’t Expect Medicaid Work Requirements to Make a Big Difference

Under the Trump Administration, some Republican governors may look to move their Medicaid programs in a more conservative direction. In his latest column for Axios, Drew Altman discusses the arguments about Medicaid “work requirements” and why few people are likely to be affected by them in practice.

Column/Op-Ed Read Post

Why Deductibles Would Rise Under the GOP Health Care Plan

This inaugural Drew Altman column for Axios examines how the GOP House bill would impact deductibles for people who buy insurance in the non-group market. A KFF analysis for the column shows deductibles in a typical non-group plan would be about $1550 higher under the American Health Care Act compared to the Affordable Care Act.

Column/Op-Ed Read Post

The Republican Health-care Plan the Country Isn’t Debating

In this Washington Post op-ed, Drew Altman discusses how Republicans’ ideas to change Medicaid and Medicare and repeal the Affordable Care Act would fundamentally change the federal role in health, calling it: the biggest change in health we are NOT debating.

Column/Op-Ed Read Post

High-Risk Pools as Fallback for High-Cost Patients Require New Rules

In this Wall Street Journal Think Tank column, Drew Altman examines how Republicans would “split the risk pools” between the healthier and the sick in their Affordable Care Act replacement plans, using state high risk pools as a fallback for higher cost patients, and examines the steps that would be necessary to make them effective based on prior experience in the states.

Column/Op-Ed Read Post
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In this column as an Axios contributor, Drew Altman discusses President Trump's threat to withhold cost sharing subsidies and questions whether his approach to deal making can bridge health care's partisan and ideological divide. "Health policy is not like real estate," he says.
[post_title] => Why Trump's Dealmaking Model Doesn't Fit Health Care Policy [post_excerpt] => In this column as an Axios contributor, Drew Altman discusses President Trump's threat to withhold cost sharing subsidies and questions whether his approach to deal making can bridge health care's partisan and ideological divide. "Health policy is not like real estate," he says. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => why-trumps-dealmaking-model-doesnt-fit-health-care-policy [to_ping] => [pinged] => [post_modified] => 2017-04-20 06:45:45 [post_modified_gmt] => 2017-04-20 10:45:45 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=214458 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 213743 [post_author] => 36621681 [post_date] => 2017-04-07 06:37:28 [post_date_gmt] => 2017-04-07 10:37:28 [post_content] =>
In this column for Axios, Drew Altman sees a warning for the Trump administration and Republicans in the latest Kaiser Tracking Poll: the more they do to undermine the Affordable Care Act marketplaces the more the public is likely to hold them, and not the Democrats, accountable for the problems with the law.
[post_title] => A Warning From the Polls About Letting Obamacare "Explode" [post_excerpt] => In this column for Axios, Drew Altman sees a warning for the Trump administration and Republicans in the latest Kaiser Tracking Poll: the more they do to undermine the Affordable Care Act marketplaces the more the public is likely to hold them, and not the Democrats, accountable for the problems with the law. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => a-warning-from-the-polls-about-letting-obamacare-explode [to_ping] => [pinged] => [post_modified] => 2017-04-07 06:37:28 [post_modified_gmt] => 2017-04-07 10:37:28 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=213743 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 213282 [post_author] => 71503784 [post_date] => 2017-04-03 06:24:56 [post_date_gmt] => 2017-04-03 10:24:56 [post_content] =>
Under the Trump Administration, some Republican governors may look to move their Medicaid programs in a more conservative direction. In his latest column for Axios, Drew Altman discusses the arguments about Medicaid “work requirements” and why few people are likely to be affected by them in practice.
[post_title] => Don't Expect Medicaid Work Requirements to Make a Big Difference [post_excerpt] => Under the Trump Administration, some Republican governors may look to move their Medicaid programs in a more conservative direction. In his latest column for Axios, Drew Altman discusses the arguments about Medicaid “work requirements” and why few people are likely to be affected by them in practice. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => dont-expect-medicaid-work-requirements-to-make-a-big-difference [to_ping] => [pinged] => [post_modified] => 2017-04-06 11:26:53 [post_modified_gmt] => 2017-04-06 15:26:53 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=213282 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 212370 [post_author] => 36621681 [post_date] => 2017-03-22 06:55:08 [post_date_gmt] => 2017-03-22 10:55:08 [post_content] =>
This was originally published as an Axios column on March 22, 2017. Health care is complicated, as the president has discovered. But here is one thing that is not so complicated: if people have modest means and limited tax credits, and coverage is expensive, they will mostly buy health plans with lower premiums — and high deductibles. This is what is likely to happen under the GOP health care bill, the American Health Care Act. Only people who need more health care will stretch for more generous coverage. If that happens, those health plans will draw too many sick people, causing insurance companies to stop offering them for fear of losing money. That would leave mostly the low-premium, high-deductible plans.
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Data: Kaiser Family Foundation analysis; Chart: Andrew Witherspoon / Axios
As the chart shows, the average deductible for a typical plan in the non-group market under the GOP plan would be about $1,550 higher in 2017 than it would have been under the Affordable Care Act, based on our analysis for this column. Most of the debate has been about what would happen to premiums — but for consumers, it's total out-of-pocket costs that matter. Under the Affordable Care Act, the low-premium, high-deductible health plans are called "bronze" plans — so think of this as the "bronzification" of the non-group market. The result: premiums may be lower in some cases, but deductibles will go up. That is based on the Congressional Budget Office's conclusion that the AHCA will result in health plans covering a lower share of patients' medical expenses. They'd have an average actuarial value across plans of 65% — meaning insurers would cover 65% of medical expenses on average for its enrollees — compared with the current market under the ACA, which has an average actuarial value of 72%. The drop would be due to consumers gravitating to lower premium plans, insurers increasingly offering only those plans, and the elimination of the cost sharing subsidies the ACA provided to insurers. That could change now that the House is adding a reserve fund of as much as $85 billion to beef up the tax credits for older customers, but it depends on what the Senate does with the money. President Trump said his plan to replace Obamacare would have "lower numbers, [and] much lower deductibles." When advocates of the AHCA talk about expanding choice of lower cost plans, keep in mind that they are focusing on the premiums, not the overall costs to consumers. But insurance market dynamics, the CBO, and now this new analysis suggest that those out-of-pocket costs will go up for many consumers buying their own insurance, particularly people who need more health care services.
[post_title] => Why Deductibles Would Rise Under the GOP Health Care Plan [post_excerpt] => This inaugural Drew Altman column for Axios examines how the GOP House bill would impact deductibles for people who buy insurance in the non-group market. A KFF analysis for the column shows deductibles in a typical non-group plan would be about $1550 higher under the American Health Care Act compared to the Affordable Care Act. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => why-deductibles-would-rise-under-the-gop-health-care-plan [to_ping] => [pinged] => [post_modified] => 2017-03-27 11:16:42 [post_modified_gmt] => 2017-03-27 15:16:42 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=212370 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 208742 [post_author] => 36621681 [post_date] => 2017-02-09 21:37:13 [post_date_gmt] => 2017-02-10 02:37:13 [post_content] =>
In an op-ed for The Washington Post, Drew Altman discusses how Republicans' ideas to change Medicaid and Medicare and repeal the Affordable Care Act would fundamentally change the federal role in health, calling it: the biggest change in health we are NOT debating.
[post_title] => The Republican Health-care Plan the Country Isn’t Debating [post_excerpt] => In this Washington Post op-ed, Drew Altman discusses how Republicans' ideas to change Medicaid and Medicare and repeal the Affordable Care Act would fundamentally change the federal role in health, calling it: the biggest change in health we are NOT debating. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-republican-health-care-plan-the-country-isnt-debating [to_ping] => [pinged] => [post_modified] => 2017-02-10 11:10:30 [post_modified_gmt] => 2017-02-10 16:10:30 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=208742 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 206797 [post_author] => 36621681 [post_date] => 2017-01-23 13:13:41 [post_date_gmt] => 2017-01-23 18:13:41 [post_content] =>
This was published as a Wall Street Journal Think Tank column on January 23, 2017.
Republicans see high-risk pools run by states playing a central role in their Affordable Care Act replacement plans as a fallback option for sick people who do not have insurance or lose coverage. Based on experience in the states, it’s clear that these pools will need to operate differently and be funded much more fully than they have been in the past if the sickest people who fall through the cracks are to be protected. Under the ACA, there is a single risk pool in each state for the non-group insurance market in which healthier people–who may themselves be sick someday–pay more to offset the costs of sicker people who are guaranteed coverage and comprehensive benefits. Embodied in Republican replacement plans is a very different idea of how the market should work. They would split the risk pools, giving healthier people the option of choosing less costly insurance plans–generally with high deductibles and savings accounts–with more limited benefits packages that they feel fit their needs. Separate arrangements would then be made for sick people who may not be able to keep their current coverage, with the state high-risk pools as their primary fallback option. The health law signed by former President Barack Obama has set a high bar for protecting the sick and people with pre-existing conditions but uses its individual mandate to help accomplish that, a provision Republicans intend to eliminate. While details of the Republican replacement plans aren’t known, the number of people who could be uninsured or have a gap in coverage and need “last resort” insurance could be substantial. We do know that every two years, about 32 million people with coverage lose it and have a gap in coverage. Almost 30% of the nonelderly population has conditions that would have left them uninsurable before the ACA, and about half of Americans report that they, or a family member, have a pre-existing condition. Before the passage of the ACA, 35 states operated high-risk pools for people in the non-group market who could not get standard coverage. The performance of these pools was so anemic that their total enrollment across these states peaked at 226,615 in 2011. Perhaps surprisingly, nearly all of them excluded coverage for pre-existing conditions for a period of time–usually six months to 12 months–while providing other coverage for the enrollee. If this seems counterintuitive to you, join the club; wasn’t coverage for pre-existing conditions the main point? The vast majority of the high-risk pools in the states also imposed lifetime dollar limits on covered services ranging from $1 million to $2 million, totals easily exceeded by someone with a serious illness.
Most plans chosen by enrollees had high deductibles and most pools offered plans with premiums one and a half to two times higher than the rates generally offered in the non-group market. A few states discounted premiums for people with more modest incomes. Premiums did not cover costs in the state risk pools, with a combined shortfall of over $1.2 billion in 2011, and some states capped enrollment. Due in part to the spotty performance of the state risk pools, the ACA established a separate national high-risk pool program called the Federal Pre-Existing Condition Insurance Program (PCIP) to cover uninsurable people until the ACA’s insurance reforms kicked in in 2014. The federal high-risk pool did not exclude coverage of pre-existing conditions and charged more typical premiums despite serving sicker people. But only 100,000 enrolled in it, and it also experienced a shortfall of about $2 billion in its last year of operation, 2013. Among the GOP’s ACA replacement plans, Rep. Tom Price, now President Donald Trump’s nominee to lead the Department of Health and Human Services, has proposed $3 billion over three years for state high-risk pools and incentives for states that hold premiums under two times standard rates. The Ryan Better Way plan in the House proposes $25 billion but does not specify a time period for the funding. Past experience shows that any strategy to split the risk pool into the healthier and the sick and set up state high-risk pools as the fallback for high-cost patients who lose coverage will require new rules that protect people with pre-existing conditions immediately when their coverage starts, eliminate lifetime caps, and have adequate funding if policies are to be affordable and the large losses are to be avoided.
[post_title] => High-Risk Pools as Fallback for High-Cost Patients Require New Rules [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman examines how Republicans would “split the risk pools” between the healthier and the sick in their Affordable Care Act replacement plans, using state high risk pools as a fallback for higher cost patients, and examines the steps that would be necessary to make them effective based on prior experience in the states. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => high-risk-pools-as-fallback-for-high-cost-patients-require-new-rules [to_ping] => [pinged] => [post_modified] => 2017-02-14 16:29:36 [post_modified_gmt] => 2017-02-14 21:29:36 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=206797 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 214458 [post_author] => 36621681 [post_date] => 2017-04-20 06:45:45 [post_date_gmt] => 2017-04-20 10:45:45 [post_content] =>
In this column as an Axios contributor, Drew Altman discusses President Trump's threat to withhold cost sharing subsidies and questions whether his approach to deal making can bridge health care's partisan and ideological divide. "Health policy is not like real estate," he says.
[post_title] => Why Trump's Dealmaking Model Doesn't Fit Health Care Policy [post_excerpt] => In this column as an Axios contributor, Drew Altman discusses President Trump's threat to withhold cost sharing subsidies and questions whether his approach to deal making can bridge health care's partisan and ideological divide. "Health policy is not like real estate," he says. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => why-trumps-dealmaking-model-doesnt-fit-health-care-policy [to_ping] => [pinged] => [post_modified] => 2017-04-20 06:45:45 [post_modified_gmt] => 2017-04-20 10:45:45 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=214458 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 163 [max_num_pages] => 28 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 527f98ad71f537bc9897743f2fc1d168 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )

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