Trump’s HHS Nominee Holds Firm on Importance of Patient Choice

On Tuesday, the Senate Finance Committee completed a confirmation hearing for Rep. Tom Price, R-Ga., to become America’s next secretary of health and human services.

Price had previously undergone a confirmation hearing before the Senate Health, Education, Labor and Pensions Committee. Combining the two hearings, Price underwent almost eight hours of tough questioning on the Affordable Care Act, Medicare, and Medicaid, as well as questions concerning his ownership of health care stock.

In the course of that ordeal, Price reaffirmed his commitment to restoring the doctor-patient relationship in health care.

Sen. Orrin Hatch, R-Utah, praised Price for his “impeccable reputation in medicine and in Congress.” Indeed, Price is a rare breed of public servant who combines rich professional experience with a profound grasp of health policy, a complex and difficult field.

As with the first Senate hearing, this second hearing revealed stark philosophical differences between Senate Democrats and Republicans on health policy.

Price’s testimony came fast on the heels of President Donald Trump’s major executive order—a grant of administrative authority to federal agencies that will begin to pare back and rework Obamacare’s costly regulations.

Sen. Ron Wyden, D-Ore., zeroed in on the executive order, saying Americans will be worse off and that insurers fear its impact.

Congressional Republicans, including Price, introduced several replacement plans options highlighting the urgent need for congressional action.

Sen. Pat Roberts, R-Kan., said it best: “Even if Congress and the incoming administration were to do nothing, absolutely nothing, amending or repealing parts of the Affordable Care Act, the law is not working.”

While the law was supposed to enhance insurance market competition, 70 percent of U.S. counties have only one or two insurers on Obamacare exchanges. Among other glaring failures, premiums and deductibles in the individual and small group markets are skyrocketing.

Defined Contributions

Price is a longtime champion of defined contribution financing, a design in which the government makes direct payments to competing plans, including Medicare, on behalf of beneficiaries. Given this, it was inevitable that Price would receive pointed questions on Medicare reform.

Sen. Tammy Baldwin, D-Wis., announced her decision to vote against Price because he backed legislation that “would end Medicare as we know it and increase costs for seniors.”

The data show that Medicare Advantage, a system of competing comprehensive health plans, enrolls 31 percent of all Medicare patients, and Medicare Part D, the drug program, enrolls 76 percent of all Medicare enrollees. Both are financed on a defined contribution basis.

In every similar Medicare reform, traditional Medicare would be a guaranteed option for seniors. Analysis of the Congressional Budget Office projections of different versions of this reform indicates that it could result in major savings for seniors and taxpayers alike.

Sen. Robert Menendez, D-N.J., insisted, “Your answer doesn’t assuage me that in fact you are committed to Medicare as we know it today in terms of the guarantee.”

Sen. Robert Menendez, D-N.J., awaits the start of the confirmation hearing for Rep. Tom Price, R-Ga., before the Senate Committee on Finance, Jan. 24, 2017. (Photo: Ron Sachs/dpa/picture-alliance/Newscom)

Sen. Robert Menendez, D-N.J., awaits the start of the confirmation hearing for Rep. Tom Price, R-Ga., before the Senate Committee on Finance, Jan. 24, 2017. (Photo: Ron Sachs/dpa/picture-alliance/Newscom)

The Medicare guarantee is, of course, a guarantee to the Medicare benefits and services provided under traditional Medicare Parts A and B.

In virtually every major proposal to allow Medicare defined contributions—from the Breaux-Thomas proposal in the 1990s to the Wyden-Ryan proposal outlined six years ago—the government contribution would be based on competitive bidding among both private health plans and traditional Medicare to provide the traditional Medicare benefits in Parts A and B, plus protection from the costs of catastrophic illness.

In other words, the guarantee of Medicare is at the very foundation of the defined contribution proposal. It is the basic benefit floor for coverage and care for Medicare patients.

In 2016, 94 percent of private plans in the Medicare Advantage program actually bid below the cost of providing traditional Medicare.

Medicaid

The senators also gave focus to Medicaid. In responding to Sen. Claire McCaskill, D-Mo., Price elaborated:

What I believe in is a Medicaid system that’s responsive to the patients and provides the highest quality care possible. And I would respectfully suggest to you that that’s not the quality system that we currently have.

So it’s incumbent upon you, it’s incumbent upon me, if I’m given the privilege of serving in this capacity, to work together to find the solutions that provide the highest quality of care for Medicaid patients and everybody else in this country.

Congressional Democrats’ support for Medicaid expansion is oddly paired with a very legitimate concern about racial and ethnic health care disparities.

Historically, white Americans have had proportionately greater access to private health insurance and care, while black and Hispanic Americans are disproportionately represented in Medicaid’s ranks, having less access to doctors and substandard medical outcomes compared to those enrolled in private health plans.

Alternatively, Medicaid patients should be mainstreamed into the private insurance markets, where they would get the same access to the better care enjoyed by their fellow citizens. Access to good health insurance and quality care, as Price persistently pointed out, can be a great equalizer.

Price also reminded the Senators that when it comes to Medicaid, and health care generally, Washington is often measuring the wrong thing—the amount of money taxpayers spend—when policymakers should be measuring real outcomes, such as medical care, insurance coverage, and the ability to see a doctor.

The closer decisions are left to patients, Price noted, the better it will be for patients.

At the close of the hearing, Hatch promised a prompt vote on Price’s nomination. If confirmed, Price will play a key role in renewing our health care system.

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White House: Centrist GOP Senators’ Obamacare Plan at Odds With Trump’s Vision

The White House seemed less than enthusiastic about one Senate Republican plan that would allow states to keep Obamacare, stressing President Donald Trump’s opposition to mandates that drive down competition.

On Monday, four Republican senators released the text of the Patient Freedom Act of 2017, to replace the Affordable Care Act, better known as Obamacare. The bill calls for repealing the mandates but would allow states to choose to maintain the mandates, according to the bill’s summary.

The Daily Signal asked if this legislation could fall short of Trump’s pledge during the campaign to repeal the law in its entirety.

“We’ve had these mandates requiring people to get things that has driven out competition and driven up costs,” @PressSec says.

“First and foremost, let’s get back to what his goal is: We are working with Congress, some of those conversations started last night, staff has been working on a plan to repeal and replace. His goal, first and foremost, is to make sure we give the American people a health care system that is affordable, more accessible, more doctors and more plans,” White House press secretary Sean Spicer told The Daily Signal during the press briefing.

With regards to states, Spicer focused on Trump’s opposition to mandates—which could still be in place under the GOP Senate proposal.

“How a state chooses to implement that — what I think right now is the idea that we’ve had these mandates requiring people to get things that has driven out competition and driven up costs, is not a health care system he is pleased with and wants to support the repeal of,” Spicer added.

The bill is sponsored by Republican Sens. Bill Cassidy of Louisiana, Susan Collins of Maine, Shelley Moore Capito of West Virginia, and Johnny Isakson of Georgia.

The bill summary says, “Option 1 allows the State to reinstate Title I of the ACA, including its mandates and other requirements.” In a Senate floor speech, Collings suggested states would opt against it:

Option one would allow a state to choose to continue operating insurance markets pursuant to all the rules of the Affordable Care Act … More appealing to many states, however, would be what we call the ‘better choice’ option in the Patient Freedom Act that would allow a state to waive many of the requirements of the Affordable Care Act except for vital consumer protections and still receive federal funding to help its residents purchase affordable health insurance.

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White House: Centrist GOP Senators’ Obamacare Plan at Odds With Trump’s Vision

The White House seemed less than enthusiastic about one Senate Republican plan that would allow states to keep Obamacare, stressing President Donald Trump’s opposition to mandates that drive down competition.

On Monday, four Republican senators released the text of the Patient Freedom Act of 2017, to replace the Affordable Care Act, better known as Obamacare. The bill calls for repealing the mandates but would allow states to choose to maintain the mandates, according to the bill’s summary.

The Daily Signal asked if this legislation could fall short of Trump’s pledge during the campaign to repeal the law in its entirety.

“We’ve had these mandates requiring people to get things that has driven out competition and driven up costs,” @PressSec says.

“First and foremost, let’s get back to what his goal is: We are working with Congress, some of those conversations started last night, staff has been working on a plan to repeal and replace. His goal, first and foremost, is to make sure we give the American people a health care system that is affordable, more accessible, more doctors and more plans,” White House press secretary Sean Spicer told The Daily Signal during the press briefing.

With regards to states, Spicer focused on Trump’s opposition to mandates—which could still be in place under the GOP Senate proposal.

“How a state chooses to implement that — what I think right now is the idea that we’ve had these mandates requiring people to get things that has driven out competition and driven up costs, is not a health care system he is pleased with and wants to support the repeal of,” Spicer added.

The bill is sponsored by Republican Sens. Bill Cassidy of Louisiana, Susan Collins of Maine, Shelley Moore Capito of West Virginia, and Johnny Isakson of Georgia.

The bill summary says, “Option 1 allows the State to reinstate Title I of the ACA, including its mandates and other requirements.” In a Senate floor speech, Collings suggested states would opt against it:

Option one would allow a state to choose to continue operating insurance markets pursuant to all the rules of the Affordable Care Act … More appealing to many states, however, would be what we call the ‘better choice’ option in the Patient Freedom Act that would allow a state to waive many of the requirements of the Affordable Care Act except for vital consumer protections and still receive federal funding to help its residents purchase affordable health insurance.

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HHS Nominee Tom Price Urges Medicaid Changes to Improve Health Care

President Donald Trump’s nominee for secretary of health and human services pushed Tuesday for changes to Medicaid, telling senators the program is in need of repair.

Rep. Tom Price, R-Ga., testified before the Senate Finance Committee, where Democrats pressed him for details on Republicans’ plan to replace Obamacare. Their questions included whether that plan would roll back the health care law’s expansion of Medicaid, which made more Americans eligible.

Thirty-one states and the District of Columbia expanded eligibility for Medicaid, the federal health program for low-income Americans, under Obamacare.

The Georgia Republican offered few details on the replacement plan, but stressed that he and Trump believe the changes should be centered around patient care.

“What I believe in is a Medicaid system that is responsive to the patients, and that’s not the system we currently have,” Price said.

Trump has said he plans to reveal a health care proposal after the Senate confirms Price to head the Department of Health and Human Services, though details on the White House’s plan are sparse.

Kellyanne Conway, a senior adviser to Trump, told ABC News on Sunday that the president plans to turn Medicaid into a block grant program, under which states would receive a fixed amount of money from the federal government and decide how to use it.

Price, chairman of the House Budget Committee, previously has advocated reforming Medicaid, and his budget proposal for 2017 called for block-granting funds to the states.

But Price, an orthopedic surgeon, stopped short Tuesday of endorsing such a pathway for reform. Instead, he said the goal of any changes to Medicaid—and Obamacare—would be to give everyone the “opportunity to gain coverage” and improve Medicaid for those eligible.

“Any reform or improvement that I would envision for any portion of the Affordable Care Act would be one that would include an opportunity for individuals to gain coverage, the kind of coverage they want for high-quality health care,” he said.

Price, though, stressed that policymakers should be focused on more than the number of Americans who gain health coverage:

Just gaining coverage for individuals is an admirable goal, but it ought not be the only goal. We must have a goal in health care, especially to keep the patient at the center and realize what kind of care and coverage we’re providing for people on the ground. For people with real lives.

In response to questions from committee Democrats on the future of Medicaid, Price maintained that it’s a “vital program” in the health care system, but one with challenges.

Medicaid beneficiaries’ access to providers is limited, for example, because 1 in 3 available physicians choose not to see Medicaid patients, Price said.  Studies suggest low reimbursement rates deter physicians from seeing Medicaid patients.

“That’s a system that isn’t working for those patients, and we ought to be honest about that, and look at that, and answer the question why, and then address that,” the Georgia Republican said.

Still, Sen. Bob Menendez, D-N.J., pressed Price on the impact that reforming Medicaid would have on those currently eligible, which Menendez said would turn Medicaid, originally an entitlement program for the poor, from a “right” to a “possibility.”

“No system that the president has supported or that I supported would leave anyone without the opportunity to gain coverage,” Price responded.

If confirmed, Price will take the helm of the Department of Health and Human Services as it implements a successor to Obamacare once Congress repeals the law and passes a replacement.

Republican lawmakers already have taken the first step in rolling back the health care law. They plan to discuss the specifics regarding its repeal and a replacement plan Thursday at a joint retreat of GOP members of the House and Senate.

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How to Talk About Repeal and Replace of Obamacare

It’s no secret that conservatives love numbers.

Numbers are often cited as reasons one, two, and three to change an existing law or introduce a new initiative.

Numbers matter. Numbers should be used to defend whatever policy position you take. But Americans don’t care about numbers unless they know how those numbers affect them and their family.

A numbers-heavy issue on repeat in the news cycle has been (and will continue to be) the repeal and replacement of Obamacare.

In a few days, lawmakers on Capitol Hill need to turn in their legislation to officially repeal the health care law, and people are afraid. They’ve bought into the fear-mongering expertly spun up by the mainstream media, and they don’t want to hear how numbers can save them.

So, how can you bridge this gap?

First, know that emotion and numbers aren’t mutually exclusive—a successful argument requires both.

Second, consider the possibility that numbers can be emotional if communicated properly. There’s no time like the present (this week!) to start.

Here’s how to talk to your neighbor/co-worker/friend about repeal and replace, convince them of its necessity, and not lose sight of the people affected.

Common Ground

Expressing your concern about the current state of America’s health care system and what happens if/when the law changes will go a long way to make someone want to stick around and continue the conversation.

That’s what common ground does. It lowers the defenses of the person on the other side of your conversation so you can address the actual problem.

The common ground as it relates to Obamacare is pretty easy to find: We want ALL people to have access to affordable, quality health care.

An additional piece of common ground you may want to cite is the desire to make sure those covered by Obamacare never experience a gap in their coverage.

Examples

We care about people, and health care is people-centric. Therefore, every argument you make should focus on the affected—those on Obamacare who fear losing it, those not on Obamacare who’ve experienced premium increases, etc.

If your desire is access to quality and affordable health care for all Americans, you need to prove why the current system isn’t living up to this expectation.

The Heritage Foundation laid out a few staggering statistics for 2017. A couple offensive numbers involve the high cost of deductibles:

For plans with the lowest premium costs, the so-called bronze plans, the average deductible for single coverage is $6,000 annually, while family coverage climbs to more than $12,000.

Though these numbers are shocking, you will get pushback that sounds eerily similar to the fear-mongering we hear on the news every day.

Media Myth #1: Repealing Obamacare will leave 20 million uninsured. That is a debatable (and possibly inflated) number explained more fully here. Also, those 20 million currently receive subsidies or are on Medicaid coverage. Neither of these provisions will end during or after the repeal and replace process.

Media Myth #2: If repeal happens without replacement, people currently enrolled will experience a lapse in coverage. Both the president and GOP lawmakers have said there will not be a lapse in coverage. Instead, Obamacare will likely be phased out; repeal and replace will be a process.

The truth: The 25 million who pay out of pocket but receive no subsidies and have had premium increases year after year are more at risk of losing their coverage. For example, from 2016 to 2017, the average benchmark plan premium increase was 25 percent in that year alone.

Words

Because this issue is emotional, the words you use carry more weight.

When talking to conservatives, use “Obamacare.” But when talking to liberals, use “Affordable Care Act.” There’s no point in losing your argument before you start because someone takes offense at how you refer to Obamacare/the Affordable Care Act.

A great phrase to use when talking about the current health care law is: It’s “unaffordable, unworkable, and unfair.”

And one of the best claims I’ve heard so far: “While Obamacare was designed to insure the uninsured, now Obamacare costs threaten to un-insure those who are insured.”

As supporters of Obamacare like to trot out their victims, make sure you do the same. Be a voice for and defender of those negatively impacted by Obamacare, which you can do with numbers.

Turns out, there is growing public support for repeal.

The post How to Talk About Repeal and Replace of Obamacare appeared first on The Daily Signal.

A Look at 4 of the GOP’s Obamacare Replacement Plans

As Republicans debate their strategy for repealing and replacing Obamacare, GOP lawmakers have been accused of failing to put forth a replacement plan for the health care law.

But since President Barack Obama signed the Affordable Care Act into law in 2010, Republicans in both the House and Senate have unveiled a number of proposals mapping out how the health care law would be replaced, should it be dismantled.

Most of the major plans share some key provisions: they offer tax credits to consumers, expand the use of health savings accounts, or a medical savings account, and reform Medicaid.

But differences emerge in the nitty gritty details of each proposal, including whether tax credits are based on age or income, where to cap the tax exclusion on employer-sponsored coverage, and whether to turn Medicaid into a block grant program or per capita allotment.

House and Senate Republicans, along with President Donald Trump, are meeting in Philadelphia, Pennsylvania, on Thursday and Friday for their annual retreat, where House Speaker Paul Ryan, R-Wis., said earlier this month lawmakers will have a “full, exhausting” conversation on their plan for repealing and replacing Obamacare.

Already, there are at least four plans crafted to replace the law. On Monday, Republican Sens. Bill Cassidy of Louisiana and Susan Collins of Maine introduced another proposal ahead of this week’s GOP gathering.

While the other major Republican proposals repeal all of Obamacare, the Cassidy-Collins plan repeals only the health care law’s mandates, like the individual and employer mandates; maintains its subsidies and taxes; and allows states that like Obamacare to keep Obamacare.

In addition to the Cassidy-Collins plan, The Daily Signal examined proposals offered by Ryan and the Republican conference; Rep. Tom Price, R-Ga., who Trump nominated for secretary of health and human services; the Republican Study Committee; and Sen. Richard Burr of North Carolina, Sen. Orrin Hatch of Utah, and Rep. Fred Upton of Michigan.

See how these Obamacare replacement plans stack up.

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8 Reasons Why Obamacare Should Be Repealed

As the debate over repealing Obamacare intensifies, it’s important to remember the law’s most glaring failures.

Here are eight:

1) Costs

Despite repeated promises of premium reductions, Obamacare has delivered major increases.

In the employer-sponsored market, costs continue to increase. According to the Kaiser Family Foundation, average family premiums for employer-sponsored plans have increased almost 32 percent from 2010-2016.

In the individual market, where the bulk of Obamacare’s new rules and regulations have taken effect, the average nationwide premium increase has been 99 percent for individuals and 140 percent for families from 2013-2017, according to an eHealth report.

Deductibles keep rising, too, especially for Obamacare exchange plans. According to an analysis by HealthPocket, the average deductible for a bronze plan in 2017 is $6,092 for an individual and $12,383 for a family. The average silver plan deductible for an individual is $3,572 and $7,474 for a family.

2) Choice and Competition

Relative to the individual market prior to the law’s implementation, insurer competition has always been limited on Obamacare’s exchanges. However, competition has continued to decline, with 2017 being the worst year yet.

Forthcoming Heritage Foundation research finds that 70 percent of U.S. counties have only one or two insurers offering coverage on the exchange in 2017.

3) Exchange Enrollment

The Obama administration estimated that the average monthly effectuated enrollment in the exchanges was 10.4 million people in 2016. This is significantly below original projections from the Congressional Budget Office, which estimated that 21 million people would be getting their coverage through the law’s government-run exchanges in 2016.

According to the IRS, in 2015, 12.7 million taxpayers claimed one or more exemptions from Obamacare’s mandate to purchase coverage and another 6.5 million taxpayers paid the penalty rather than sign up for coverage.

4) Exchange Websites

The federal government sent nearly $5 billion to states to set up their own health insurance exchanges. Despite the ample funding, the vast majority of states either didn’t want to set up their own, or tried and failed.

In 2017, only 11 states and the District of Columbia run their own exchange. The remaining 39 states use HealthCare.gov, which cost taxpayers at least an estimated $800 million to build. Recall that HealthCare.gov was only able to enroll six people on its launch date, Oct. 1, 2013.

5) If You Like Your Plan, but the Government Doesn’t, You Can’t Keep It

When Obamacare’s insurance rules and mandates took full effect in 2014, insurers were forced to cancel existing plans that didn’t comply with the new standards. A tally put together by the Associated Press shows that there were at least 4.7 million plan cancelations across 30 states.

6) Collapsed Co-Op Program

Obamacare provided for the creation of 23 new nonprofit health insurers through the Consumer Operated and Oriented Plan program. These insurers launched in 2014, using $2.4 billion in taxpayer-funded “loans.” Shortly thereafter, they began to collapse like dominos.

Some of the closures happened during the plan year, significantly disrupting coverage and the market. Thus far, 18 out of 23 have gone under, resulting in a combined $1.9 billion in government loans that taxpayers are highly unlikely to ever be repaid.

7) Dumping Millions Into Medicaid

Instead of reforming the over-stretched and unsustainable Medicaid program, Obamacare has dumped millions more people into it. After the first two years of Obamacare, an additional 11.8 million people were enrolled in the Medicaid program.

The law’s expansion is projected to add $969 billion in new Medicaid spending over the next decade, adding to existing Medicaid spending for a total federal cost of $3.8 trillion from 2017-2028.

8) Restricted Access to Providers

Obamacare’s increased costs have prompted narrow network plans to flourish on the exchanges—an unpleasant surprise for patients that desire broad access to providers. The Robert Wood Johnson Foundation measured network size for plans sold in the 2014 exchanges, finding:

Fourty-one percent of networks are small or x-small: 11 percent of networks are x-small, meaning they include less than 10 percent of office-based practicing physicians in the area and another 30 percent are small, including between 10 percent and 25 percent of physicians. At the other end of the spectrum, 11 percent are x-large, which we define as networks including more than 60 percent of physicians.

For all these reasons and many more, Congress should repeal Obamacare as soon as possible to clear the way for health care reform that actually works for Americans.

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Relief Is on the Way: What Trump’s Obamacare Executive Order Will Do

A newly inaugurated President Donald Trump rang the opening bell for what will be a multi-step process to repeal and replace the Affordable Care Act, or Obamacare, as he signed an executive order on Friday directing his subordinates to:

exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.

While it is true that that Congress will need to enact legislation to address Obamacare’s major components, the Trump administration can immediately begin to pare back and rework the law’s numerous and detailed regulations. In large part, that is because the law itself granted the executive branch considerable discretionary authority to fill in the details through regulation. Those details can now be changed by a new administration, and this executive order makes doing exactly that the official policy of the Trump administration.

As to the substance, the new president’s clear directive is for his appointees to focus on minimizing the damaging effects of the law. That constitutes a sharp change in direction from the one taken by the Obama administration.

The implementation approach taken by the Obama administration was essentially to try to increase subsidized enrollment heedless of any resulting costs or disruptions to either the public or private sectors. This executive order signals that the Trump administration’s first order of business for Obamacare will instead be to minimize those costs and disruptions.


That will be particularly welcome news for those who faced loss of their coverage and doctors and escalating premiums and deductibles, but received no offsetting Obamacare subsidies. Their lived experience of Obamacare as “all pain, no gain” was a major factor explaining not only the law’s persistent unpopularity but also why voters in sequential elections handed Republicans control of first the House, then the Senate, and finally the White House.

As for the mechanics, the new administration’s actions to implement this executive order in the coming weeks will reflect considerations of both effect and timing. The Trump administration is likely to prioritize those changes that will have the biggest and most immediate effects—such as ones that can help stabilize the unsubsidized individual and small employer health insurance markets and head off any repeat in 2018 of the massive increases in premiums announced last fall for 2017.

What is little appreciated, even by Washington policymakers, is that while subsidized Obamacare enrollment has been slowing, the damage the law is doing to unsubsidized markets has been accelerating. For instance, while insurers exiting Obamacare’s subsidized exchanges was widely reported last fall, less attention was paid to the more disturbing news that a number of insurers were also exiting the unsubsidized individual and small employer health insurance markets as a result of Obamacare.

The administrative actions called for in this executive order can help to shore up those non-exchange markets.

Furthermore, the Trump administration acting (wherever possible) to quickly rollback Obamacare’s voluminous and detailed regulations will support and encourage Congressional efforts to advance repeal and replace legislation; signal a new direction for health reform to insurers, providers, employers, and other stakeholders; and offer consumers tangible evidence that relief is on the way.

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Trump Signs Executive Order Curbing Obamacare

Hours after taking the oath of office, President Donald Trump followed up on his campaign pledge to try to start chipping away at Obamacare, and curb federal regulations.

Trump signed an executive order on Friday evening from the Oval Office “to ease the burden of Obamacare as we transition to repeal and replace,” White House press secretary Sean Spicer told reporters Friday.

The new president’s goal is to repeal the Affordable Care Act, better known as Obamacare, which will require congressional actions.


“Potentially the biggest effect of this order could be widespread waivers from the individual mandate,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, told The Washington Post. Currently, individuals who do not have health insurance and do not qualify for an exemption must pay a $695 annual fee or up to 2.5 percent of annual household income.

“They’re very aware of the fact that the first job is to prevent the Affordable Care Act from doing more damage than it’s already done,” says Ed Haislmaier, a senior research fellow in health care policy at The Heritage Foundation. “As we saw with the premium increases in the fall, people who are buying individual or small employer coverage without a subsidy are getting hammered.”

Haislmaier cautioned, however, that the executive order is “the beginning of the process.” The order states that it’s the goal of the administration to repeal the law, but:

In the meantime, pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.

The order mentions several times, “To the maximum extent permitted by law,” and continues:

[T]he heads of all other executive departments and agencies … with authorities and responsibilities under the act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act that would impose a fiscal burden on any state or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.

Democrats have argued that gutting the law that mandates individuals buy health insurance and employers provide it would leave millions uninsured. Republicans say the mandate has been overly burdensome.

Obamacare has seen an increase of about 14 million insured, based largely on Medicaid expansion. The law requires individuals to buy insurance and employers to provide it.

However, the Obama administration admitted that health care premiums increased by an average of 25 percent across 39 states in October. Further, 33 states have fewer insurers offering coverage on Obamacare in 2017 than in 2016. Only one state, Virginia, gained insurers. Five states have one insurer, while 13 have just two. One-third of all U.S. counties will have just one insurer.

White House chief of staff Reince Priebus sent a memo titled “Regulatory Freeze Pending Review” to block all pending regulations under review but not yet in the Federal Register.

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HHS Pick Tom Price Pledges to Meet ‘Needs of All’ After Obamacare Repeal

Rep. Tom Price, who is President-elect Donald Trump’s pick to lead the Department of Health and Human Services, countered Democrats’ claims about the consequences of repealing Obamacare, telling senators that “nobody’s interested in pulling the rug out from under anybody.”

Price, R-Ga., appeared Wednesday before the Senate Health, Education, Labor and Pensions Committee in a courtesy hearing where he fielded questions on his plans for the health care system once Congress repeals Obamacare.

“The last thing we want to do is go from a Democratic health care system to a Republican health care system,” Price said early on. “We want to go to an American health care system that recognizes the needs of all.”

On Tuesday, four days after Trump is sworn in, Price will go before the Senate Finance Committee, which will vote on confirming his nomination.

As secretary of the Department of Health and Human Services, or HHS, Price would be responsible for overseeing repeal of the health care law and implementing its replacement—a plan congressional Republicans have yet to unveil.

Congress took a crucial step toward repealing Obamacare last week, but Democrats and some Republicans raised concerns about the repeal process, especially regarding Americans who gained health coverage under the law.

Price, a former chairman of the House Budget Committee, signaled to committee Chairman Lamar Alexander, R-Tenn., that the law would be repealed piece by piece, but stressed he didn’t want to pull “the rug out from under anybody.”

“I think there’s been a lot of talk about individuals losing health coverage,” Price told the committee. “That is not our goal, nor is it our desire nor is it our plan.”

Among concerns expressed by Senate Democrats was whether Americans with pre-existing conditions would be able to purchase coverage once Obamacare is repealed.

Price offered few details on the replacement plan the Trump administration will put forth. But his own proposal requires insurers to provide coverage to consumers with pre-existing conditions if the individual has had coverage for at least 18 months.

Price’s proposal also calls for creation of high-risk pools, designed to help those with pre-existing conditions find affordable insurance. The Georgia Republican reiterated his support for that before the Senate panel.

Trump, in an interview published Sunday, told The Washington Post his replacement plan would provide “insurance for everybody.” The president-elect walked back his comment, however, in an interview Tuesday with Axios.

When asked about Trump’s comments, Price said he shared the president-elect’s goal of providing “insurance for everybody,” but focused specifically on expanding access.

“What I’m committed to is making sure every single American has access to coverage they want and making sure Americans can purchase that coverage,” he said.

Price also fielded questions from Democrats about his stock trades involving health care companies over the past four years.

Senate Democrats, some of whom also own health care stock, alleged that Price unethically traded certain stocks. Price maintained that he had no knowledge of the stocks purchased, since a broker manages his investment portfolio.

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