One Mom’s Fight for Her Special Needs Son in the Age of Obamacare

For Marjorie Weer and her family, the Affordable Care Act has been both a blessing and a burden.

The family of four, who live in Mount Pleasant, South Carolina, qualifies for a tax credit, and without the financial assistance, their policy would cost more than $1,200 per month.

But beyond the financial help, Weer’s experiences with Obamacare cut to the core of arguments from the health care law’s defenders for why it was implemented in the first place– and from detractors for why it should be repealed.

Weer’s oldest son, Montgomery, or Monty, was born with spina bifida, a birth defect in which the spinal cord doesn’t develop properly.

The young mother knows well that had Obamacare’s provisions not been in place when her son was born in 2014, it would’ve been extremely difficult—perhaps impossible—for the growing family to find coverage for Monty.

And because the health care law prohibits insurers from limiting how much they will pay in medical bills across the span of an insured person’s lifetime, Weer and her husband, Kevin, no longer have to worry about hitting the maximum insurers would spend on their infant’s coverage.

But even among the good that Obamacare has done for her, Weer also has been hit with the bad.

In the years since Obamacare’s implementation, insurance companies have been fleeing states such as South Carolina and narrowing their networks in an effort to rein in medical claims.

In the Palmetto State, BlueCross BlueShield of South Carolina is the only insurer selling coverage on the state’s insurance exchange.

And in the past two years, the company—like many others—narrowed its network.

Now, customers in South Carolina can see only providers located in the state.

For Weer, that means her family can go to the state’s biggest hospital, the Medical University of South Carolina, for care.

But Monty needs to go elsewhere—Boston Children’s Hospital in Massachusetts—for a medical test that will determine his neurological functioning.

And since BlueCross BlueShield of South Carolina considers any hospital outside the state to be out of network, Weer has no other choice but to fight for her son.

“In a way, we’re paying for a form of Medicaid,” Weer said, adding:

It’s not Medicaid, but you can’t leave the state for care, and you know, if the doctors that my children need were in the state, that’s great. But not everybody who has a medical license in South Carolina is the right one for for my kid.

A Trend

In an interview with The Daily Signal, Weer was quick to offer BlueCross BlueShield of South Carolina the benefit of the doubt.

The company is watching out for its long-term viability, she said, and because much of Obamacare’s enrollment population was sicker and therefore more expensive than anticipated, many insurers have responded by limiting the providers its customers can see.

According to Weer, BlueCross BlueShield of South Carolina told her that remaining in the state came with strings attached: they wouldn’t leave South Carolinians without any insurer on the exchange if they restricted their network to in-state care.

In a statement to The Daily Signal, BlueCross BlueShield of South Carolina said its decision to narrow its networks was in response to an exchange population that “uses more health care services more frequently.”

“As the only health insurer in the public exchange market in this state, there are limited avenues available to assist in keeping costs as affordable as possible,” Patti Embry-Tautenhan, assistance vice president for corporate relations at BlueCross BlueShield of South Carolina, said in an email to The Daily Signal.

“Having a nearly exclusive South Carolina-based provider network, which includes access to the state’s leading academic medical centers, is one way that we can achieve access to a wide range of multidisciplinary services while taking into account our responsibility to our other lines of business,” she said.

And what BlueCross BlueShield did isn’t exclusive to the insurer or South Carolina.

According to a recent study from Avalere, a health care consulting firm, nearly 52 percent of plans sold on the exchanges in 2014 were either a preferred provider organization (PPO) plan or a point of service (POS) plan, which have broad networks.

In 2017, the percentage of PPO or POS products offered on the exchanges dropped to 31 percent.

“That’s a pretty dramatic change, right, over the last few years,” Chris Sloan, a senior manager at Avalere, told The Daily Signal.

Sloan said that since 2014, insurers have been struggling with the cost of the enrollment population, and narrowing networks was the solution.

“One of the ways you can reduce spending or sort of control your costs is to narrow the network and cut better deals with the physicians that are actually in network so you have more preferred rates with them, and they have a higher volume [of patients] because the network is narrower,” he said.

But Sloan added, the narrowing of networks isn’t necessarily a direct consequence of Obamacare.

Health insurers were trending toward narrower networks, he said, and some were beginning to offer “tiered networks” to give consumers the option to choose between cost and access.

A cheaper plan, generally on an insurer’s first tier, would have a limited number of providers. A more expensive plan, generally the second or third tier, would have a wider network of doctors, specialists, and hospitals to choose from.

Additionally, Sloan said, narrow networks aren’t necessarily bad—for some consumers.

“Just because there are fewer doctors in networks doesn’t mean you’re getting worse care,” he said. “It can also mean you’re getting better care if you’re just focused on getting really good, quality physicians and [insurers are] steering you, by having narrow networks, toward those good physicians.”

Still, not every consumer may want to have a limited number of physicians to choose from.

“It’s too early to tell if narrow networks are good or bad for consumers,” Sloan said. “It’s a mix of both.”

The Weer family. (Photo: Marjorie Weer)

The Weer family. (Photo: Marjorie Weer)

Cleaning Up Their Mess

For Weer and her family, it’s clear that restricting coverage to doctors in-state is a bad thing.

And it’s not an issue the Weers have had to deal with in the past.

When Monty was just 4 months old, in 2014, Weer began to  take him every other weekend to see a doctor at Shriners Hospital for Children in St. Louis, Missouri, to treat his bilateral clubfeet, a condition associated with spina bifida. This went on for three months.

Monty had his own insurance plan through Aetna and also was enrolled in South Carolina’s Medicaid program via what is known as a Katie Beckett waiver.

That original insurance plan fully covered Monty’s care in St. Louis and, Weer said, she can’t remember ever having to pay for her son’s medical services after he hit his deductible.

Then, for 2016, Weer and her husband enrolled themselves, Monty, and their newborn daughter in a new plan through BlueCross BlueShield of South Carolina.

That plan allowed Monty to see doctors at Boston Children’s Hospital in Massachusetts, the top-ranked hospital in neurology and neurosurgery for pediatrics, according to U.S. News and World Report.

“They have a better test for Montgomery’s neurological needs, and so we thought, well, we’ll just transfer his care up there,” Weer said of the decision to go to Boston Children’s Hospital.

What the new plan didn’t cover, though, was the Medical University of South Carolina—the very hospital Weer is restricted to now.

In 2017, though, that all changed.

BlueCross BlueShield of South Carolina altered the design of its plans, so only hospitals located in South Carolina were considered in-network.

For Weer, it isn’t that the Medical University of South Carolina is a bad hospital, and she said Monty and her daughter will go there for care.

But for the “biggies,” Weer said it’s not the best for her son.

For one, Boston Children’s Hospital offers a more in-depth neurological test—costing $4,000 without insurance—that will determine a baseline of Monty’s nerve functioning.

Additionally, the doctors in Boston have been responsive to Weer’s inquiries, answering her emails and text messages no matter the time of day.

So after learning BlueCross BlueShield no longer would cover Monty’s medical services in Boston, Weer began working–ideally–to convince the insurer to cover Monty’s care at Boston Children’s Hospital.

“The most I resent in all of this,” Weer said, “is the time away from my kids because the people in Washington, D.C., who have no business and no knowledge about health care just decided to screw this all up and left moms like myself to clean up their mess.”

‘Well-Intentioned’

Weer’s experiences with a change in network weren’t necessarily a direct consequence of Obamacare, Avalere’s Sloan said.

But he acknowledged that issues with the health care law—specifically a lack of choice in insurers—certainly compounded the problem for consumers such as Weer.

Prior to the Affordable Care Act, Weer said, she and her husband had many insurers to choose from.

But now, since South Carolinians have only BlueCross BlueShield of South Carolina, they don’t have the option to shop around for a plan that fits their needs.

“I want to be able to take care of my kids,” Weer said, “but I need options for my special needs son.”

Policymakers cite lack of competition and choice as one of the most dire consequences of the health care law.

House Speaker Paul Ryan frequently rattles off statistics demonstrating the lack of choice consumers have on the exchanges: 1 in 3 counties nationwide have only one insurer, and 70 percent of counties have only one or two insurers.

Additionally, consumers in five states—Alabama, Alaska, Oklahoma, South Carolina, and Wyoming—have only one insurer on the exchange.

exchange-competition-map

Ryan and his fellow Republicans argue that by repealing Obamacare and replacing it, Weer and other consumers will have more options and lower costs.

“The Affordable Care Act, though incredibly well intentioned, has proven disastrous from the standpoint of rising premiums and increasingly limited choices,” Rep. Mark Sanford, R-S.C., told The Daily Signal.

In Sanford’s home state, the number of insurers selling plans on the exchange decreased from three to one in the years since Obamacare took effect. Premiums increased an average of 29 percent from 2016 to 2017.

“It’s crowding a lot of folks out,” Sanford, who is Weer’s congressman, said. “That has a real consequence for people at home who have more limited choices that may or may not fit with their health care needs.”

Last week, Sanford and Sen. Rand Paul, R-Ky., outlined their replacement for Obamacare.

Their proposal, which has the endorsement of the roughly 40-member House Freedom Caucus, relies heavily on the expansion of health savings accounts, also known as medical savings accounts, and creates a $5,000 tax credit for individuals and families who contribute to those accounts.

The Sanford-Paul bill also allows consumers who don’t receive coverage through an employer to deduct the cost of premiums from their taxable incomes, and allows individuals and families to band together through membership in an association health plan to buy insurance.

Sanford said their proposal focuses on two things: “empowering the consumer and creating a more robust marketplace.”

The South Carolina congressman said the Affordable Care Act actually “makes less expensive insurance unlawful” and deters young people from signing up for coverage.

Sanford said the health care law also allows consumers who receive a medical diagnosis to sign up for coverage the next day, which ends up costing the insurance companies money.

“It’s been really harmful to insurance companies, and their way of getting around that at times is to constrict the choice that consumers have with negative impact in terms of quality of care,” he said.

Sanford said he hopes that by enacting some of the reforms included in his proposal, more consumers, especially younger consumers, will sign up for insurance, premiums will go down, and more insurers will expand their offerings in places like South Carolina.

“I don’t think there’s a single silver bullet that will better health care,” Sanford said. “But in the aggregate if you do enough of these things, you end up with a consumer that is much more empowered relative to where they are now.”

Montgomery Weer, left, and his sister, Evangeline. (Photo: Marjorie Weer)

Montgomery Weer, left, and his sister, Evangeline. (Photo: Marjorie Weer)

A Blessing

Like many other Americans across the country who are turning up at town halls and public events for their members of Congress, Weer has been watching GOP lawmakers closely.

She wants to know how the health insurance landscape will change once Obamacare is repealed, and she’s sick of waiting for answers.

“This mama has had enough … I know this is a monster to undo, but you’ve had years to come up with something,” Weer said of a Republican plan to replacement Obamacare. “What I’ve been through, trying to navigate these waters, having a kid with spina bifida isn’t the issue. Dealing with the insurance is the hard part, and trying to keep your Christian testimony in check.”

After spending weeks bouncing among phone calls with South Carolina’s Medicaid system, Boston Children’s Hospital, and BlueCross BlueShield of South Carolina, Weer finally was able to get some concessions from the insurance company.

At first, BlueCross BlueShield of South Carolina said it would charge Weer its in-network cost for Monty’s neurological test at Boston Children’s Hospital, but none of those expenses would go toward the family’s $6,300 deductible.

Additionally, the Weers would be responsible for the balance bill—the difference between an in-network provider’s negotiated rate and the full price for a service.

Weer and her husband began to crunch the numbers, and she once again got on the phone with Boston Children’s Hospital to determine how much the test would cost with insurance, as well as how much they may have to fork over for the balance bill.

“If we’re still stuck with a $4,000 or $5,000 bill, we’re a middle class family,” she said. “That’s a big deal.”

But then, late last week, Weer’s case manager with BlueCross BlueShield of South Carolina called and said the insurance company would cover the full cost of Monty’s care at Boston Children’s Hospital.

Weer knows that things could still change, but she’s grateful her months of back-and-forth ended happily.

“Today,” she said, “I’m going to take this as a blessing.”

The post One Mom’s Fight for Her Special Needs Son in the Age of Obamacare appeared first on The Daily Signal.

One Woman’s Story About the Increasing Costs of Obamacare

When Kim Quade left her job of 17 years as a school speech pathologist outside Kansas City, Kansas, to work independently, she knew she would have to purchase her own health insurance. But, Quade says, she never anticipated the rate increases to come.

Quade, 61, says she researched options and found a decent plan for a fair price. In 2013, she changed her health insurance carrier and purchased a plan for $188 per month.

“It had a health savings account attached to it, it had a $5,000 deductible on it, but it was OK because I had money I was able to squirrel away into my health savings account,” Quade told The Daily Signal.

>>> Meet 2 Hurting Americans Who Are Ready for Congress to Repeal Obamacare

Quade says she liked this plan, in part because she believes health savings accounts are patient-centered and should be encouraged.

“It was something that I was able to take care of on my own and I was happy about it. It’s the way I was raised: You take care of yourself,” Quade says.

Mia Heck, director of the health and human services task force at the American Legislative Exchange Council, or ALEC, told The Daily Signal last month that health savings accounts can help Americans plan independently for their future.

“A health savings account (HSA) is a pre-tax medical savings account available for taxpayers who are enrolled in a high-deductible health plan,” Heck said. “The high-deductible health plan serves as catastrophic coverage, while encouraging individuals and families to save money to use toward future medical expenses. Funds deposited into an HSA are not subject to federal income tax.”

Over the years, Quade says, her situation changed drastically. In 2015, her $188 monthly premium more than doubled, to $399 per month.

She was willing to pay the increased rate, Quade says, because “I had my regular health care doctor and specialist, and I wanted to keep these people very much.”

“I didn’t want to lose them, so I bit the bullet.”

But when her monthly premium went up an additional $200, Quade says, she decided to make a change.

Quade says she and her husband reluctantly entered the federal Obamacare exchange, purchased a family plan, and stayed on it until her husband turned 65. He transferred to Medicare, and she, again, shopped for a new health insurance plan.

She says she had two goals: keep her health savings account and both of her doctors. She was able to do this at a price of $773 per month, she says, and after receiving a subsidy her monthly payment is $333–still nearly double what she was paying in 2013.

Although her original plan covered flu shots and physicals, Quade says, her policy under Obamacare covered neither for her. After a bout with pneumonia last year, she says, her insurance paid only $50 toward the cost of two X-rays.

Asked whether she experienced any improvements to her health plan under Obamacare, or noticed any benefits that weren’t available to her before, Quade simply says: “No.”

With health insurance carriers in Kansas leaving the federal exchange and some leaving the state entirely, Quade says, she was left with few options. The policy she purchased before Obamacare is no longer available, she says.

>>> Obamacare Rates Grow, Options Shrink in Kansas

“A lot of companies are leaving the states because they can’t make a profit,” Quade says. “Profit is not an evil thing, it’s how companies stay in business and make jobs for other people and produce a product.”

Amid uncertainty in Congress about the details of repealing and replacing Obamacare, Quade, who writes for the Victory Girls blog, says she believes the free market is the optimal solution for the health insurance industry.

“Less regulation, more free market,” she says. “Because companies want to do business, they would love to come back into Kansas and to other states.”

The post One Woman’s Story About the Increasing Costs of Obamacare appeared first on The Daily Signal.

Troubling New Videos Show Urgent Need to Defund Planned Parenthood

LiveAction, a non-profit organization dedicated to ending abortion and protecting the right to life, has released videos and findings that demonstrate the urgent need for Congress to defund America’s largest abortion provider, Planned Parenthood.

According to a report released in January, a LiveAction investigation revealed that “Planned Parenthood lied to the media about retraining thousands of staff” with regard to reporting sex trafficking.

Back in 2011, the organization caught Planned Parenthood on film advising an undercover investigator posing as a pimp on how to get birth control and abortions for underage prostitutes.

Planned Parenthood vowed to retrain staff and fire any employees who potentially violated abuse reporting laws. One survey found that over a quarter (29.6 percent) of survivors of trafficking visited a Planned Parenthood during their abuse.

Yet instead of training its employees to spot and report trafficking, according to Live Action’s report, Planned Parenthood trained employees how to identify undercover journalists and discern whether or not they were being recorded.

LiveAction also recently exposed Planned Parenthood’s misleading statements about the organization providing prenatal care. Specifically, Planned Parenthood President Cecile Richards claimed, “Prenatal care—these are the kinds of services that folks depend on Planned Parenthood for.”

LiveAction put this claim to the test by calling 97 Planned Parenthood facilities. It turns out that 92 of them provided no prenatal services.

As calls to defund the abortion giant have escalated in recent years, Planned Parenthood has repeatedly cited prenatal care as a vital service that women will lose access to if federal dollars are diverted to other health centers not entangled with the abortion industry.

After being exposed by LiveAction, Planned Parenthoods across the country removed references to prenatal care from their websites.

Then, at the end of January, LiveAction revealed that Planned Parenthood uses ultrasounds to determine the unborn child’s age and position in the womb for purposes of aborting the child, but refuses to provide ultrasounds to women who want to keep their babies and would like to check on their health and that of their baby.

As one Planned Parenthood staffer put bluntly on one of LiveAction’s recordings, “We only do ultrasounds if you are terminating.”

Peddling Abortion for Profit

In February, LiveAction released testimony from former Planned Parenthood employees who claimed that its facilities must hit monthly sale quotas for abortion. Planned Parenthood gave its employees incentives to meet those quotas, such as throwing pizza parties and giving paid time off.

One former employee spoke of how staff was trained “to really encourage women to choose abortion; to have it at Planned Parenthood, because it counts towards our goal.”

It’s not news that abortion is quite profitable for Planned Parenthood, and if the allegations in the testimony are true, it is grotesque that Planned Parenthood uses parties and vacation time to incentivize employees to push women toward abortion over life-affirming options.

Earlier this week, LiveAction released additional testimonials from former Planned Parenthood employees who spoke about the abortion giant’s abortion-centric business model that cut doctor-patient visit times in half and led to women being herded in the facility “like cattle.”

Managers also highlighted that despite the often-repeated myth, Planned Parenthood does not provide mammograms and offers little support to pregnant women who are going forward with a pregnancy.

Planned Parenthood reported almost $59 million in excess revenue for fiscal year 2015 and more than $1.4 billion in net assets. It also receives over half a billion dollars from taxpayers each year, as shown in its 2014-2015 annual report. (Curiously, Planned Parenthood has still not released its annual report for 2015-2016).

Time to Act

Congress should disqualify Planned Parenthood affiliates and other abortion providers from receiving taxpayer funds. Repealing Obamacare using language from the 2015 reconciliation measure is the best place to start.

If the reconciliation bill is crafted as it was in 2015, it would make Planned Parenthood affiliates ineligible from receiving Medicaid reimbursements for one year after the enactment of the bill. Such federal reimbursements constitute a significant portion of the roughly $500 million in government funds sent to the nation’s largest abortion provider each year and should be cut.

The ultimate solution is for Congress to pass, and the president to sign, the No Taxpayer Funding for Abortion Act.

The bill’s sponsor, Rep. Chris Smith, R N.J., explains that the legislation makes the Hyde Amendment and other current abortion funding prohibitions permanent and government-wide while ensuring that Obamacare (until it is repealed) conforms with the Hyde Amendment.

It also requires health insurance plans on Obamacare exchanges to provide full disclosure, transparency, and the prominent display of the extent to which they cover abortion so as to empower people to opt out.

Trump has committed to signing the bill into law if it reaches his desk. The bill passed in the House of Representatives the week of the 2017 March for Life, and the Senate should follow suit to finally and completely separate American taxpayers from the grisly abortion business.

The post Troubling New Videos Show Urgent Need to Defund Planned Parenthood appeared first on The Daily Signal.

GOP Leaders Release Details of Plan to Replace Obamacare

House Republican leaders mapped out their proposal for how Obamacare will be repealed and replaced in a closed-door meeting Thursday, outlining plans for Medicaid reforms and refundable tax credits for Americans.

Joined briefly by newly confirmed Health and Human Services Secretary Tom Price, House Speaker Paul Ryan, Ways and Means Committee Chairman Kevin Brady, and Energy and Commerce Committee Chairman Greg Walden presented the details to members.

The plan comes amid mounting frustration from the chamber’s conservative wing, who want to see their leaders move faster on repealing Obamacare and decided to coalesce around their own replacement plan Wednesday after discussions over potential changes to the health care system slowed.

GOP lawmakers said repeatedly they would unwind Obamacare—a promise repeated by President Donald Trump on the campaign trail—but the conference has yet to come together on which parts of the law would be repealed and how.

And members are likely to face questions on Obamacare’s future from constituents on both sides of the aisle when they head home for the Presidents Day recess.

Ryan told reporters on Thursday that upon returning to Washington at the end of the month, lawmakers would introduce the repeal and replace legislation.

However, he noted that GOP lawmakers are waiting on cost estimates from the Congressional Budget Office and Joint Committee on Taxation

“What we’re proposing is a patient-centered system where the patient designs their plan. The patient gets to decide what they want to do,” Ryan said. “The nucleus is the patient and her doctor versus the nucleus of the system being the government in Obamacare’s sake.”

According to a copy of the presentation leaders gave to Republicans that was obtained by The Daily Signal, the plan calls for Congress to pass legislation that repeals Obamacare’s taxes, individual and employer mandates, and subsidies. It also stresses that the Medicaid expansion, which loosened program eligibility requirements, would also be undone.

Then, it maps out four key components of a replacement: modernize Medicaid, use State Innovation Grants, expand health savings accounts, and provide portable, monthly tax credits.

Specifically, Americans purchasing coverage on the individual market would receive an advanceable, refundable tax credit based on age.

The plan also expands the use of health savings accounts, a policy that is the hallmark of nearly every proposal Republicans have presented over the last six years.

Brady and Walden’s replacement plan calls for an increase in the maximum contribution Americans can make to their health savings accounts. Currently, individuals can contribute $3,400 each year to a health savings account, but the Republicans’ plan would raise that limit to $6,500.

Republicans are generally in agreement on the expansion of health savings accounts and even on providing Americans some form of financial assistance, but GOP members are more divided on how to handle changes to Medicaid.

Thirty-one states and the District of Columbia expanded Medicaid, and had 100 percent of Medicaid costs for those who are newly eligible covered by the federal government from 2014 to 2016. Now, GOP senators representing some of those states have pushed for the expansion to remain in place.

But the plan put forth by House Republican leaders would repeal the Medicaid expansion and change it to either a per-capita allotment or block grant program.

The proposals provides a transition period, though not defined, for states that did expand Medicaid.

To ease the concerns of leaders from expansion states, Ryan said Walden and Sen. Orrin Hatch, a Republican from Utah who chairs the Senate Finance Committee, have been working with Republican governors discuss potential changes to the program.

The last item in the GOP’s replacement plan calls for the creation of high-risk pools, which would be funded by federal dollars allocated to the states and can be used to help those with pre-existing conditions.

Republicans plan to repeal Obamacare using a budget tool called reconciliation, which fast-tracks legislation in the Senate and allows it to pass with 51 votes.

Their plan is to start with a repeal bill that passed both chambers in 2015, but was ultimately vetoed by President Barack Obama.

GOP leaders are planning to build on the 2015 bill by including parts of Obamacare’s replacement.

Late last month, Ryan mapped out a timeline for Obamacare’s repeal, telling GOP colleagues the House would dismantle the bill in March or April.

But House conservatives are becoming frustrated with the speed leaders are moving and want to see action before then.

On Monday, the approximately 40 members of the conservative House Freedom Caucus voted unanimously to back the 2015 Obamacare repeal bill, and on Wednesday, they endorsed an Obamacare replacement plan released by Sen. Rand Paul.

The post GOP Leaders Release Details of Plan to Replace Obamacare appeared first on The Daily Signal.

GOP Leaders Release Details of Plan to Replace Obamacare

House Republican leaders mapped out their proposal for how Obamacare will be repealed and replaced in a closed-door meeting Thursday, outlining plans for Medicaid reforms and refundable tax credits for Americans.

Joined briefly by newly confirmed Health and Human Services Secretary Tom Price, House Speaker Paul Ryan, Ways and Means Committee Chairman Kevin Brady, and Energy and Commerce Committee Chairman Greg Walden presented the details to members.

The plan comes amid mounting frustration from the chamber’s conservative wing, who want to see their leaders move faster on repealing Obamacare and decided to coalesce around their own replacement plan Wednesday after discussions over potential changes to the health care system slowed.

GOP lawmakers said repeatedly they would unwind Obamacare—a promise repeated by President Donald Trump on the campaign trail—but the conference has yet to come together on which parts of the law would be repealed and how.

And members are likely to face questions on Obamacare’s future from constituents on both sides of the aisle when they head home for the Presidents Day recess.

Ryan told reporters on Thursday that upon returning to Washington at the end of the month, lawmakers would introduce the repeal and replace legislation.

However, he noted that GOP lawmakers are waiting on cost estimates from the Congressional Budget Office and Joint Committee on Taxation

“What we’re proposing is a patient-centered system where the patient designs their plan. The patient gets to decide what they want to do,” Ryan said. “The nucleus is the patient and her doctor versus the nucleus of the system being the government in Obamacare’s sake.”

According to a copy of the presentation leaders gave to Republicans that was obtained by The Daily Signal, the plan calls for Congress to pass legislation that repeals Obamacare’s taxes, individual and employer mandates, and subsidies. It also stresses that the Medicaid expansion, which loosened program eligibility requirements, would also be undone.

Then, it maps out four key components of a replacement: modernize Medicaid, use State Innovation Grants, expand health savings accounts, and provide portable, monthly tax credits.

Specifically, Americans purchasing coverage on the individual market would receive an advanceable, refundable tax credit based on age.

The plan also expands the use of health savings accounts, a policy that is the hallmark of nearly every proposal Republicans have presented over the last six years.

Brady and Walden’s replacement plan calls for an increase in the maximum contribution Americans can make to their health savings accounts. Currently, individuals can contribute $3,400 each year to a health savings account, but the Republicans’ plan would raise that limit to $6,500.

Republicans are generally in agreement on the expansion of health savings accounts and even on providing Americans some form of financial assistance, but GOP members are more divided on how to handle changes to Medicaid.

Thirty-one states and the District of Columbia expanded Medicaid, and had 100 percent of Medicaid costs for those who are newly eligible covered by the federal government from 2014 to 2016. Now, GOP senators representing some of those states have pushed for the expansion to remain in place.

But the plan put forth by House Republican leaders would repeal the Medicaid expansion and change it to either a per-capita allotment or block grant program.

The proposals provides a transition period, though not defined, for states that did expand Medicaid.

To ease the concerns of leaders from expansion states, Ryan said Walden and Sen. Orrin Hatch, a Republican from Utah who chairs the Senate Finance Committee, have been working with Republican governors discuss potential changes to the program.

The last item in the GOP’s replacement plan calls for the creation of high-risk pools, which would be funded by federal dollars allocated to the states and can be used to help those with pre-existing conditions.

Republicans plan to repeal Obamacare using a budget tool called reconciliation, which fast-tracks legislation in the Senate and allows it to pass with 51 votes.

Their plan is to start with a repeal bill that passed both chambers in 2015, but was ultimately vetoed by President Barack Obama.

GOP leaders are planning to build on the 2015 bill by including parts of Obamacare’s replacement.

Late last month, Ryan mapped out a timeline for Obamacare’s repeal, telling GOP colleagues the House would dismantle the bill in March or April.

But House conservatives are becoming frustrated with the speed leaders are moving and want to see action before then.

On Monday, the approximately 40 members of the conservative House Freedom Caucus voted unanimously to back the 2015 Obamacare repeal bill, and on Wednesday, they endorsed an Obamacare replacement plan released by Sen. Rand Paul.

The post GOP Leaders Release Details of Plan to Replace Obamacare appeared first on The Daily Signal.

Conservatives Are Flooding Town Halls, Too. I Know, I’m One of Them.

Last week, I had the pleasure of attending a town hall event in Murfreesboro, Tennessee. Representative Diane Black spent about an hour offering her vision for congressional action and fielding questions.

As a member of the House Ways and Means Committee and acting chair of the House Budget Committee, Black has a significant role in drafting the Obamacare repeal reconciliation bill. It was no surprise the event was packed and somewhat contentious, but contrary to what the mainstream media reported, many of the constituents at the town hall wanted Obamacare repealed ASAP.

I personally came with nearly two dozen Heritage Action Sentinels all calling for repeal. Unfortunately, we were frequently drowned out by protesters from Indivisible, Planned Parenthood, and other local leftist groups that did not seek a civil conversation. They simply wanted to engage in anti-democratic practices, disrupt the conversation and erode our civic institutions.

Important conversations are needed. While Congress passed a budget resolution over a month ago to begin the reconciliation process, these two House committees have failed to write the bill.

As a Tennessean, I’m concerned House Republicans are failing to capture the momentum from the election to repeal Obamacare. The longer they wait, the more frustrated I’ve become as a Tennessee voter and Vietnam veteran.

How can I or any conservative support a Republican who fails to keep their promise?

I was eventually able to get a question at the town hall regarding the slow pace of the committees, but Black’s answer was concerning. According to her, Republicans want to move forward with caution and “get it right” the first time, even though Republicans already passed an Obamacare reconciliation repeal bill in 2015.

Nobody gets anything 100 percent right the first time. Now is the time to move forward with repealing Obamacare.

We all know this is the game politicians love to play. Some in Congress will use any excuse not to do the right thing and too often will get lost in the details. But the longer Congress waits to repeal Obamacare, the less likely it will happen.

We are already seeing this take place with new liberal activist groups, like Indivisible, gaining a following and shouting down members of Congress at town halls. Their strategy is simple and can be read on Indivisible Guides which call on liberal activists to “Stall the Trump agenda by forcing them to redirect energy away from their priorities.”

Unfortunately, Republican members of Congress are falling right into their trap.

Some Republicans want to “repair” instead of “repeal” Obamacare. Some want to pass a replacement plan first or at the same time, as if Senate Democrats will have a change of heart and vote to repeal Obamacare if Republicans play nice.

The truth is that Democrats and liberal activists groups want to delay the Obamacare repeal process indefinitely. Their intent is not to fix our broken health care system but to protect Obamacare at all costs.

Conservatives across the country, just like they did in 2009 when Obamacare was being drafted, must again show up at town halls in droves. We must remind our Republican lawmakers, our fellow citizens, and those in the media who are along for the ride of the truth:

  • Under Obamacare, millions of Americans lost their health plans.
  • Under Obamacare, millions of Americans lost their doctors.
  • Under Obamacare, premiums didn’t go down by $2,500 a year—they’ve increased by double digits every year since implementation.
  • Under Obamacare, competition and choice went down, not up. Seventy percent of U.S. counties are now left with insurer choice or a choice between only two insurers.
  • Most importantly, even if we repealed Obamacare today, all policyholders will still be covered for two years.

A good doctor knows that if a patient has an infected leg beyond recovery, the only way to save the patient is to amputate.

Republicans have a lot of work to do if they want to fix health care in America. But none of this will be possible unless step one happens first: remove the infected leg that is Obamacare.

Conservatives who gave Republicans the House, Senate, and now the White House will show up again in 2018 if they fulfill their promise to repeal Obamacare. If Republicans don’t repeal Obamacare, how can we ever trust them again?

The post Conservatives Are Flooding Town Halls, Too. I Know, I’m One of Them. appeared first on The Daily Signal.

4 Broken Obamacare Promises That Town Hall Protesters Should Remember

While the House and Senate plan to repeal and replace Obamacare, members of Congress are hosting town hall meetings with their constituents and have been greeted by hostile crowds.

These folks seem to have amnesia about Obamacare’s glaring failures.

Here’s a quick refresher on Obamacare’s top four broken promises.

1. Costs are exploding.

President Barack Obama promised that his reform proposal would cut typical family costs by $2,500 annually. That, of course, never materialized.

The typical family today pays about 35 percent of their income for health care.

The small group and individual insurance markets were hit hard by big premium increases. An eHealth report concluded that from 2013 to 2017, the average individual market premium increases were 99 percent for individuals and a jaw-dropping 140 percent for families.

Costs have also increased for those with employer-sponsored insurance, according to the Kaiser Family Foundation, from 2010 to 2016, average family premiums for employer-sponsored plans nearly increased 32 percent.

Higher premiums are not the only shock. Out-of-pocket costs in the Obamacare exchanges, particularly deductibles, have been stunning. HealthPocket analyzed that for the lowest tier bronze plans in 2017, the average deductible for an individual is $6,092 and $12,383 for a family.

2. Competition and choice are declining.

Obama told America his proposal would increase competition in the health insurance markets but that hasn’t happened either

On Tuesday, news broke that Humana will be leaving the Obamacare exchange markets next year. This was just the latest in a growing list of insurers who are jumping ship from this massive public policy failure.

Town hall audiences should take a good look at county level data. A new Heritage analysis found that Obamacare’s exchanges, in their fourth year of operation, offer Americans little health insurer choice.

The downward slide in competition means that in 2017, consumers in 70 percent of U.S. counties are left with just one or two insurer options on the exchanges. The 70 percent figure is way up from 36 percent in 2016.

3. Forget about keeping your plan.

Perhaps the most famous health care promise of all, Obama’s promise, “If you like your health care plan, you’ll be able to keep your health care plan”? In fact, there were 37 instances where Obama or a high-ranking administration official repeated that infamous promise to keep you plan and your doctor.

Rarely has there been such a disconnect between rhetoric and reality. In 2014, the first year that Obamacare was fully implemented, the Associated Press reported that there were at least 4.7 million cancelled policies across 30 states. The law’s insurance rules and mandates forced many insurers to cancel plans that people liked and wanted.

Sadly, the disruption only continued from there. For example, hundreds of thousands of people signed up for plans offered by insurers under Obamacare’s CO-OP program.

But 18 out of 23 of these federally-funded insurers have already collapsed, meaning taxpayers are highly unlikely to be repaid the more than $1.9 billion in loans they received—not to mention the thousands of CO-OP enrollees that lost their health care plans, some in the middle of the year.

Not exactly a proud moment in public policy.

4. No, you can’t necessarily keep your doctor.

Obama promised patients that they would be able to keep their doctors. For many patients, that also turned out to be untrue.

Obamacare’s rising costs, and its limited flexibility in federally fixed benefit designs, resulted in plans resorting to narrow provider networks. Narrow networks limit access to doctors and other medical professionals as a way to contain costs.

Enough is enough. For seven years, Obamacare has proved to be one giant bundle of broken promises and policy failures. Congress needs to get serious—quickly—and repeal Obamacare.

This is a crucial first step in moving America toward the patient-centered health care system our country deserves.

The post 4 Broken Obamacare Promises That Town Hall Protesters Should Remember appeared first on The Daily Signal.

Conservatives Coalesce Around New Obamacare Replacement Plan

Sen. Paul, R-Ky., and Rep. Mark Sanford, R-S.C., introduced a bill to replace Obamacare on Wednesday, increasing the pressure on GOP leaders who continue to discuss moving the law’s replacement at the same time as its repeal.

The legislation already has the full support of the House Freedom Caucus, a group of roughly 40 of the lower chamber’s conservative members. Conservatives in both the House and Senate have said they want to see repeal efforts move faster, and the lawmakers are hoping that the legislation is a turning point in the repeal-and-replace debate.

“We’re excited about the fact that it will finally be able to address many of the concerns that we’re hearing, whether it’s at townhalls or personal calls from our constituents about pre-existing conditions, about how to empower the consumer in terms of their health care choice, and ultimately drive down the price of health care,” House Freedom Caucus Chairman Mark Meadows, R-N.C., said Wednesday.

Called the Obamacare Replacement Act, the legislation shares the hallmarks of other GOP replacement plans, and Paul said it was a “consensus bill” that pulled aspects of other proposals together.

However, the lawmakers acknowledged that there are still components that Republicans disagree on, like whether a replacement should include a refundable tax credit—Paul and Sanford’s does not—and whether to keep Obamacare’s Medicaid expansion.

Paul and Sanford’s bill focuses heavily on the expansion of health savings accounts (HSAs), which are medical savings accounts. Their legislation allows consumers to contribute an unlimited amount annually to HSAs. Currently, consumers can contribute a maximum of $3,400 per year.

The Obamacare Replacement Act also creates a $5,000 tax credit for those who contribute to a HSA, and prohibits consumers from using the money in their accounts to pay for elective abortions.

Under Paul and Sanford’s bill, consumers who don’t receive insurance through their employers can deduct the cost of premiums from their taxable incomes, which serves to equalize the tax treatment for individuals and employers.

Additionally, the legislation allows individuals and small businesses to band together through membership in an Association Health Plan to buy health insurance. Paul and Sanford said these pooling mechanisms will decrease costs for consumers.

The bill also allows insurance companies to sell policies across state lines and eliminates Obamacare’s Essential Health Benefits mandate, which is a list of services insurance plans are required to cover without cost-sharing.

A major question that has emerged during the debate over Obamacare replacement plans is whether any new proposal will require insurers to provide coverage to consumers with pre-existing conditions, as the Affordable Care Act did.

Sanford and Paul’s plan would preserve that protection, so long as those with pre-existing conditions maintain continuous coverage.

Conservatives are beginning to grow antsy over the lack of progress on Obamacare’s repeal.

On Monday night, the House Freedom Caucus unanimously voted to support legislation undoing the health care law that passed the House and the Senate in 2015, a move that could force Republican leaders to use that bill as the floor for future repeal bills or risk losing the group’s support.

The 2015 bill repealed the individual and employer mandates, ended the subsidies and Medicaid expansion, and rolled back all of the law’s taxes.

Both Paul and Sanford have said that the 2015 bill should be the starting point for negotiations on which parts of Obamacare to unwind, and the conservatives are urging House leadership to advance repeal of the health care law at a faster rate than they currently are moving.

“This is a big, big day for conservative Republicans,” Paul told reporters Thursday. “We owe this to the conservatives around the country who elected us to repeal, to completely repeal Obamacare. But I think if you’re going to completely repeal something, you should replace it.”

The post Conservatives Coalesce Around New Obamacare Replacement Plan appeared first on The Daily Signal.

House Conservatives Draw Hard Line on Obamacare Repeal Bill

Conservatives in the House are drawing a hard line with party leadership on what legislation repealing Obamacare they’ll support and making it clear they won’t accept anything less than a bill dismantling the health care law that passed last year.

“The commitment for Republicans in 2010, 2012, 2014, 2016 has been repeal and replace, not repeal and renege, and repeal means that it’s a repeal,” Rep. Warren Davidson, R-Ohio, told reporters at a monthly event on Capitol Hill on Tuesday. “There are no Affordable Care Act plans. There’s no ‘if you like your Obamacare you can keep your Obamacare’ in the Republican commitment.”

“It should carry today, and that’s a question for the Senate if somehow there’s a lack of will to do what they’ve already done,” he continued.

Republicans are currently in the midst of debating which parts of Obamacare should be repealed, with conservatives splitting from more moderate members of the party.

On Monday night, the roughly 40-member House Freedom Caucus unanimously voted to back a plan to bring a 2015 bill repealing major parts of Obamacare before members again for a vote.

That legislation repealed the individual and employer mandates, the law’s taxes, subsidies, and Medicaid expansion. It also stripped the government of its authority to run the exchanges, and defunded Planned Parenthood.

The repeal bill crafted in 2015 passed both the House and the Senate, but President Barack Obama vetoed it.

But with Republicans now in control of the White House, conservatives are emboldening their colleagues—many of whom voted in favor of the 2015 bill—to put that same legislation on President Donald Trump’s desk.

And they’re not going easy on their fellow Republicans.

“Members of Congress are scared all the time,” Rep. Raúl Labrador, R-Idaho, told reporters. “They need to actually just lean in, move forward, and do what they told the American people they were going to do.”

Conservatives like Labrador have long maintained the position that they must repeal as much of Obamacare as possible—a campaign promise they say has resonated with voters since the 2010 midterm elections.

But now, some of their colleagues are approaching an undoing of the law with trepidation and are opting for repairing, not repealing, the law.

“When you hear about [the Cassidy-Collins bill], when you hear about repair, when you hear about not getting rid of all the taxes, when you hear about not defunding Planned Parenthood, it sort of makes you wonder [if they’re backing away from repeal],” Rep. Jim Jordan, R-Ohio, told The Daily Signal.

Members of the Freedom Caucus have met with some of their Senate colleagues like Sen. Bill Cassidy of Louisiana to discuss Obamacare’s repeal, and Jordan said their appeal to those who want to unwind less than what the 2015 bill did is simple.

“You done voted on it,” he said. “Everyone voted on it, so let’s at least do that.”

Rep. Mark Meadows, a Republican from North Carolina who now leads the Freedom Caucus, echoed Jordan’s statements.

“To suggest that we can pass it in 2015 and that it’s more difficult to do it in 2017 makes for a very difficult argument for anyone on why they’ve changed their position and were willing to vote for it then and aren’t willing to vote for it now,” Meadows said.

For Republican members who may be waffling on Obamacare repeal, turning to instead repair the law, Labrador had a warning.

“Something that Republicans need to be concerned about is if we’re just going to repeal Obamacare with ‘Obamacare lite,’ then it begs the question: Were we just against Obamacare because it was proposed by Democrats? And if that’s our position, then we’re very hypocritical. Then we really were just taking a political position, not a policy-based position,” he said.

“If we’re going to come back with something that does exactly the same thing as Obamacare but change a couple of things, and just call it Trumpcare or Ryancare, then what was our fight about for the last six years?” Labrador continued.

At a press conference Tuesday morning, House Speaker Paul Ryan and members of the GOP leadership team reaffirmed their commitment to repealing, not repairing, Obamacare, but there are still major differences among Republicans in the House and Senate on what to undo and what to include in the repeal bill.

While conservatives are looking to the 2015 bill to serve as a starting point for negotiations, Republican senators like Cassidy and Susan Collins of Maine believe Congress should wait to repeal Obamacare’s taxes, which were included in the previous legislation.

Additionally, Republican leaders have said they want to include parts of a replacement—tax credits, expansion of health savings accounts, and creation of high-risk pools—in the legislation repealing the bill.

Last week, though, Sen. Mike Lee, R-Utah, said grouping the two together is a “horrible idea.”

Members of the Freedom Caucus, however, haven’t explicitly ruled out including aspects of a replacement in a repeal bill, so long as the 2015 legislation serves as the starting point for negotiations.

Still, conservatives in both chambers are in agreement that the 2015 plan should serve as the floor for the upcoming repeal legislation, and the comments from the lawmakers put further pressure on Republican leaders.

If House leadership puts a bill before its members that repeals less of Obamacare than the 2015 legislation did, then members of the Freedom Caucus said they’ll oppose it.

The repeal bill in the House needs 218 votes to pass, and without the support of the more than 40 members of the group, the legislation fails.

Similarly, GOP Sens. Ted Cruz of Texas, Marco Rubio of Florida, and Lee sent a letter to Senate leaders last month notifying them that the same 2015 legislation should be used as the floor for future repeal legislation.

Sen. Rand Paul, R-Ky., echoed that statement Tuesday, telling Axios that the 2015 bill should be “the minimum that we do … no less.”

The GOP holds 52 seats in the Senate, and Republicans can’t lose more than two votes on the reconciliation bill, which passes with 51 votes.

If Senate leaders put a bill repealing less of Obamacare than the last bill did, they could lose the support of Paul, Rubio, Cruz, and Lee, which would kill the bill.

The post House Conservatives Draw Hard Line on Obamacare Repeal Bill appeared first on The Daily Signal.

We Hear You: From Obamacare to Affordability and Choice for Consumers

Editor’s note: We’re hearing from so many enthusiastic members of The Daily Signal’s audience that we decided to begin running some of your correspondence. Here’s a batch on the topic of Obamacare.  You’ll find our address at the bottom.—Ken McIntyre

Dear Daily Signal: Thank you for Elizabeth Fender’s data-filled article on the Obamacare approval ratings over time. I appreciate your truthful reporting of the facts, and your citing the specific data and your sources (“Obamacare May Soon Be Over. Here’s What Americans Have Thought of the Law Since 2010”).

In addition to the reasons you cite for Obamacare’s low approval ratings (narrow networks, high and rising health care premiums), there are several others.

These include religious liberty violations: the contraceptives mandate on employers by the Department of Health and Human Services (source of two Supreme Court challenges and hundreds of lawsuits); abortion and Planned Parenthood funding; Independent Payment Advisory Board “death panels” (someone wouldn’t be able to use his own money to save his own life); and the government’s definition of “religious entity.” Last but not least is the Supreme Court ruling on gay marriage, which affects administration of health care benefits.

The Obamacare regulations seem to have completely ignored the serious comments advising the government to stop, slow down, make major changes. The contraceptives mandate and transgender mandate are huge mistakes, ignoring the science that shows that the premises upon which these mandates are based are faulty.

I am hopeful the Trump administration will work more collaboratively with key stakeholders in our health care system, including Catholic health care providers. The larger Judeo-Christian health care delivery system deserves to be treated as the large stakeholder that it is.

As the new administration moves into office and into power, we still can attempt to be peacemakers. We can honor the goal of the Affordable Care Act—to create a health care system that provides affordable care and expands access. This is a worthy goal.

People who have preexisting conditions need to have some form of health care insurance. Theoretically, there should not be an “uninsurable” person. These are some of the areas where insurance companies can focus to create new products and services. I believe they would respond appropriately. My experience with the industry supports the fact that they have far more goodness than they are given credit for.

We can honor one administration for their work as we move forward with the next administration’s agenda—as determined by the voters who put them there. —Kathleen Goryl

Making News Personal

Dear Daily Signal: I just read your piece about Obamacare and its effect on an owner of an International House of Pancakes franchise (“Obamacare a Factor in IHOP Owner’s Decision to Sell His 16 Restaurants”). Your mentioning Utica, N.Y., jumped out at me. I live just north of Utica in Remsen, home of Olympic luger Erin Hamlin.

I loved your piece because it made the news very personal. So much of the debate on health care is numbers about “millions of people covered.” This showed what happened to an employer who was trying to do right by his employees, not to a number of people.

Thank you for mentioning Utica. —Jane White

Sorting Out Plans to Replace Obamacare 

Dear Daily Signal: I think that there is merit to each of the Obamacare replacement plans, and lawmakers need to sort it out and commit to one (“A Look at 4 of the GOP’s Obamacare Replacement Plans”).

However, I have never favored health care support for grown people age 21 and up. Why should taxpayers support these adults and/or subsidize their parents who choose to do so? —David Cromer

Choosing Between Mortgage and Health Premiums

Dear Daily Signal: I’m writing about the repeal of Obamacare and its consequences (“What Happens for Consumers After Congress Repeals Obamacare”). My son is paying over $1,200 per month for family health insurance plan, and he has lost his primary job.

His family can’t qualify for subsidies because they still make too much with part-time jobs. But they will have trouble between choosing to pay the mortgage or health premiums. He’s no congressman!—Susan Peed

Obamacare Doesn’t Protect Patients

Dear Daily Signal: I know from personal experience that the Affordable Care and Patient Protection Act doesn’t contain enough to protect patients. Obamacare should have included where to file comments, suggestions, and complaints about your care. This would help pinpoint what and where the problems are. I find filing with the state to be useless.

My five-day nightmare stay at a hospital revealed what I consider serious problems. I had requested my hospital records three different times within a half-year, but the hospital claimed the records were not complete. After the two-year limitation to sue them, they finally gave me my “records.”

The records were not what I expected. There was no timeline of services provided, treatments, doctors’ assessments, medications, or the amounts. Being sued by the hospital for unpaid bills (some for services I didn’t request), I requested my records from the hospital lawyers. They sent me a list of the charges instead.

I was shocked at the number of drugs I was given—over 40, eight of which were for pain. I was given eight doses of morphine in a four-day period. All of those drugs and the amounts should have been in my records in a timeline, along with things like blood pressure and temperature checks.

Medical records in a timeline would help keep communications open between doctors and nurses, reduce unnecessary treatments and services, help keep the patient from being overmedicated, and give patients and health insurance companies better oversight. Do you know what’s in your medical records?  —Gary Kujat

Want to sound off regarding our coverage? Write to The Daily Signal via letters@dailysignal.com. All letters are subject to editing for length, clarity, and style.

The post We Hear You: From Obamacare to Affordability and Choice for Consumers appeared first on The Daily Signal.