We Hear You: ‘No More Reasons Why Congress Can’t Totally Repeal Obamacare’

Editor’s note: Republicans’ failure to repeal Obamacare after assuming control of the White House as well as Congress registered strongly with our audience in recent days. The day after President Trump’s 100th day in office, today’s mailbag leads off with two related letters, one signed by 17 GOP and grassroots activists in Pennsylvania.—Ken McIntyre 

Dear Daily Signal: Since it was enacted into law in 2010, most Americans have opposed the Affordable Care Act, aka Obamacare. In elections since then, Republicans have campaigned on the promise of total repeal of Obamacare. We, political constituents and grassroots supporters, responded by giving Republicans the House, then the Senate, and, in 2016, the presidency.

There are no more reasons why Congress cannot totally repeal Obamacare (“What’s in the New Obamacare Deal That Could Unite Conservatives, Centrists“).

The new American Health Care Act, as it stands now, is not Obamacare repeal.  Most Americans agree, given that only 17 percent support the bill, according to a recent Quinnipiac poll.

We ask nothing more than our legislators honor their campaign promises to repeal Obamacare.

Repeal means dismantling the Title I regulatory structure in the legislation that has caused insurance premiums to skyrocket, swelled Medicaid rolls and inserted the federal government between patients and our doctors.  The 2015 repeal bill, which passed both the House and Senate, is a starting point for repealing Obamacare.

Replace means implementing free market solutions, eliminating taxpayer-funded abortions, and returning to patient-centered health care.

The House Freedom Caucus is not the problem. They are attempting to honor what the Republican Party has promised its supporters since 2010.

We, the undersigned, represent local grassroots groups whose members are your readers. We now ask that promises to us are honored: Congress must repeal Obamacare, then replace it. No more excuses.—Betty Dunkel-Hernon, for Valley Forge Patriots Republican Committee, Schuylkill Township, Pa.

Editor’s note: Also signing were Lucy Tscherne, Valley Forge Patriots; Linda Hertzog, West Chester Tea Party; Lisa Esler, Delaware County Patriots; Jane Marie Toal, Citizens for Liberty; Don Reimer, Philadelphia Tea Party Patriots; Larry Denver, president, Faith & Freedom Coalition, Pa.; Charles Beatty, vice president, Faith & Freedom Coalition, Pa.; Susan Hancock, Smart Girl Politics; Donna Ellingsen, Republican Committee, Elk Township; Linda Cleaver, Republican Committee, Londonderry Township; Marsha Spencer, Republican Committee, Lower Oxford West; Margaret Layden, Republican Committee, Tredyffin M-6; Barbara Albright, Republican Committee, West Bradford 4; Beckie Laughlin, Republican Committee, Valley North 635; Jane E. Brown, Landenberg, Pa.; Rita Misero, Coatesville, Pa.

Repeal Obamacare, Don’t Replace It

Dear Daily Signal: I don’t understand why this Republican Party is so completely unable to understand what it is Americans are asking for (“Health Care Talks Continue as Republicans Face Questions on Obamacare Repeal“). You can forward my frustrations:

I am a taxpayer with a lifelong chronic medical condition, Crohn’s disease, and I work in the medical field. You’d think I’d be ecstatic to have Obamacare, except that I’ve grown up having private insurance and for a brief time in young adulthood I was on disability/SSI.  I’ve had to sacrifice and struggle to have insurance coverage all my life.

So let me make this clear: The worst year of my life, bar none, in terms of dealing with this disease, insurance, etc., was the year I was prostrate to the federal government for my support. I vowed, never again.

Government does nothing efficiently or well. I’m sorry to burst the bubbles of our hard-working, dedicated Congress, but they cannot make anything at all work economically. At all.

Congress should repeal Obamacare completely. Why can’t Congress just set the rules, and then just let the free market solve the coverage issues by itself? Why not just let insurers offer coverage anywhere, without restrictions to certain states, and then get out of the way?

Check your (huge) egos, Congress! Let health care be handled by people who know how to manage money and who know something, anything, about health care and health insurance. Please, I’m begging you: Get out of health care.—Galen Jackson

Republicans Shrink From the Budget Battle

Dear Daily Signal: I am a very conservative person who reads a lot about current events online across seven to 10 different websites, excluding “mainstream media” sites.  I read Genevieve Woods’ commentary on congressional Republicans and couldn’t agree with her more (“Even With Republicans in Charge, Upcoming Budget Battle Looks Grim“).

The GOP is a bunch of spineless wimps who are continually outplayed by the bully “illiberals.”  The GOP doesn’t seem to have learned any lessons on strategy  from the Harry Reid/Barack Obama years.

The lessons: Get out in front of it, stick disliked legislation in a drawer someplace and forget about it.  Do not put anything forward that the president will veto. Finally, when all else fails, threaten the GOP, and if that doesn’t work, threaten them some more. Why isn’t the GOP following the Democrats’ model?

I particularly like Ms. Woods’ following recommendations, quoting from her commentary:

They should be calling the Democrats’ bluff and put forward legislation that does what they promised—reins in government spending, starts addressing America’s debt, and secures our border and national security needs.

If enough Democrats in the House and Senate don’t vote for it (such legislation requires 60 votes in the Senate), they should make it clear that they will go into every state where vulnerable Democrats are up for re-election in 2018 and tell voters there that their lawmaker was responsible for shutting down the government over liberal pet causes—such as funding for sanctuary cities and Planned Parenthood—or because he or she didn’t want to allocate funds to secure our border.

As a result of reading so much about current events, I am definitely of the opinion that Senate Majority Leader Mitch McConnell has been around too long and needs to be gone.

He doesn’t appear to be strong enough nor clever enough to lead the GOP and Senate to victory on important issues for this country.  The budget and debt ceiling are two of the really important ones.–Tracy Gore, Vancouver, Wash.

The Best Thing Trump Has Done for the Country

Dear Daily Signal: Morgan Walker’s article regarding ‘SKYPE’ reporters is excellent (“This 1 Change Trump Administration Made to White House Press Briefings Is Shaking Up the Media“). Finally, a great example of a positive spin on political news coverage.

The goal of the “mainstream media” has always been to manipulate and control the way the public thinks. It could be the most powerful force for good on the planet.  Unfortunately, it runs in the opposite direction, and is clearly the greatest threat to the Trump administration and democracy in our country.

Isn’t it ironic that the media is missing such an incredible opportunity?

Love him or hate him, perhaps the best thing President Trump has done for the country is to finally expose the biased and corrupt mainstream media for what it really is.  The “swamp,” our incredibly stupid and inept Congress, is a close second.

Please share with Ms. Walker. Also, kudos to Fred Lucas and others for continuing to investigate the George Soros conspiracy to cripple the USA from within. Glad to be a member of The Heritage Foundation.–Hank Mattox

Trustworthy News Sources a Rare Commodity

Dear Daily Signal: Your news organization, and like-minded others, should consider creating a set of standards defining acceptable practices for certification as an Associated Conservative Press Certified News Source, or similar copyrightable name (“By Choosing Trump Hater as Dinner Speaker, Mainstream Media Embraces ‘Opposition Party’ Status“).

Trustworthy news sources are a rare commodity across America for everyone, but especially for conservatives.  Someone with the resources of the Koch brothers could create a nationwide news brand on their own.

But in lieu of that, it would be helpful to have a branding device that conservatives could use to validate online media, and possibly also print and broadcast media, as reliable and accurate.  Not in the sense of dogma, but rather accurate and true by professional journalism standards.

If you think this idea is worthy of consideration, please contact your worthy peer groups for possible action.—Newell S. Jones

No Trump Voters Need Apply?

Dear Daily Signal: Having once had a mainstream media job, I prefer to remain anonymous here. Read the last paragraph of this recent New York Times ad for “a new Rio de Janeiro bureau chief, one of the most exciting and dynamic assignments in the world,” including coverage of both Brazil and Argentina:

The New York Times is an Equal Opportunity Employer and does not discriminate on the basis of an individual’s sex, age, race, color, creed, national origin, alienage, religion, marital status, pregnancy, sexual orientation or affectional preference, gender identity and expression, disability, genetic trait or predisposition, carrier status, citizenship, veteran or military status and other personal characteristics protected by law. All applications will receive consideration for employment without regard to legally protected characteristics.

Quite a laundry list.

But would The New York Times hire a Trump voter? Or do they rule out 50 percent of the U.S. population?—A Reader

Dear Daily Signal: I was very disappointed in the lead letter in your recent “We Hear You” roundup (“I’m a Sailor, a Marine, and a Transgender Woman Who Was Born This Way“). In all honesty, if we allow human beings to determine what’s acceptable in American society, we might as well neuter the Constitution because it only can be read through the eyes of biblical understanding.

John Adams stated: “Our Constitution was made only for a moral and religious People. It is wholly inadequate to the government of any other.”

What I am saying here is not my opinion or prejudice. This is historical precedent, as well as legal precedent. This is not right-wing rhetoric from the lunatic fringe. This is legal and historical fact.

By the way, The Daily Signal is wonderful. Better than reading all of the other “rags” out there. If you want good success, maintain honesty and integrity. It will reflect well on The Heritage Foundation, which has always been a refuge for honesty and truth.—Bobby G., Woodstock, Ga.

On Racial Groupings

Dear Daily Signal: Regarding Mike Gonzalez’s commentary (“There Is Time to Reverse Obama Census Proposal That Promotes Group Identity Politics“), national or regional origin and ethnicity does not constitute racial origin. It should not be used to determine the population mix in the USA.

Skin color is irrelevant. We all should strive to be Americans and determine our race according to the basic four: black, Caucasian, Native American, Far Eastern/Oriental.—Cone S. Underwood

How Are We Doing?

You are doing very well.  I look forward to each new edition. Keep up the good work. And thanks.—Bill Williams

The border wall needs to be started and the national debt reversed. Still top of list.—Vtext

I’m a big fan and daily reader of The Daily Signal.  I was wondering if someone could write an article analyzing why all the Earth Day / March for Science hoopla didn’t include any outrage for the lack of the “scientific method.” It was a rigorous standard for science in the past hundreds of years, but now isn’t being followed 99 percent of the time.—Darren Richardson

Great job. I enjoy reading.—Christine Dukart 

Thank you!—Margi Wallo

Keep up the good work.—Ed Phillips 

Receiving The Daily Signal keeps me up with what is going on, not only in the U.S. but all over the world. And that, I really appreciate. The commentary is good and accurate, which is not offered on too many websites. Thanks for all the good you are doing.—Howard Shoemaker

The post We Hear You: ‘No More Reasons Why Congress Can’t Totally Repeal Obamacare’ appeared first on The Daily Signal.

We Hear You: ‘No More Reasons Why Congress Can’t Totally Repeal Obamacare’

Editor’s note: Republicans’ failure to repeal Obamacare after assuming control of the White House as well as Congress registered strongly with our audience in recent days. The day after President Trump’s 100th day in office, today’s mailbag leads off with two related letters, one signed by 17 GOP and grassroots activists in Pennsylvania.—Ken McIntyre 

Dear Daily Signal: Since it was enacted into law in 2010, most Americans have opposed the Affordable Care Act, aka Obamacare. In elections since then, Republicans have campaigned on the promise of total repeal of Obamacare. We, political constituents and grassroots supporters, responded by giving Republicans the House, then the Senate, and, in 2016, the presidency.

There are no more reasons why Congress cannot totally repeal Obamacare (“What’s in the New Obamacare Deal That Could Unite Conservatives, Centrists“).

The new American Health Care Act, as it stands now, is not Obamacare repeal.  Most Americans agree, given that only 17 percent support the bill, according to a recent Quinnipiac poll.

We ask nothing more than our legislators honor their campaign promises to repeal Obamacare.

Repeal means dismantling the Title I regulatory structure in the legislation that has caused insurance premiums to skyrocket, swelled Medicaid rolls and inserted the federal government between patients and our doctors.  The 2015 repeal bill, which passed both the House and Senate, is a starting point for repealing Obamacare.

Replace means implementing free market solutions, eliminating taxpayer-funded abortions, and returning to patient-centered health care.

The House Freedom Caucus is not the problem. They are attempting to honor what the Republican Party has promised its supporters since 2010.

We, the undersigned, represent local grassroots groups whose members are your readers. We now ask that promises to us are honored: Congress must repeal Obamacare, then replace it. No more excuses.—Betty Dunkel-Hernon, for Valley Forge Patriots Republican Committee, Schuylkill Township, Pa.

Editor’s note: Also signing were Lucy Tscherne, Valley Forge Patriots; Linda Hertzog, West Chester Tea Party; Lisa Esler, Delaware County Patriots; Jane Marie Toal, Citizens for Liberty; Don Reimer, Philadelphia Tea Party Patriots; Larry Denver, president, Faith & Freedom Coalition, Pa.; Charles Beatty, vice president, Faith & Freedom Coalition, Pa.; Susan Hancock, Smart Girl Politics; Donna Ellingsen, Republican Committee, Elk Township; Linda Cleaver, Republican Committee, Londonderry Township; Marsha Spencer, Republican Committee, Lower Oxford West; Margaret Layden, Republican Committee, Tredyffin M-6; Barbara Albright, Republican Committee, West Bradford 4; Beckie Laughlin, Republican Committee, Valley North 635; Jane E. Brown, Landenberg, Pa.; Rita Misero, Coatesville, Pa.

Repeal Obamacare, Don’t Replace It

Dear Daily Signal: I don’t understand why this Republican Party is so completely unable to understand what it is Americans are asking for (“Health Care Talks Continue as Republicans Face Questions on Obamacare Repeal“). You can forward my frustrations:

I am a taxpayer with a lifelong chronic medical condition, Crohn’s disease, and I work in the medical field. You’d think I’d be ecstatic to have Obamacare, except that I’ve grown up having private insurance and for a brief time in young adulthood I was on disability/SSI.  I’ve had to sacrifice and struggle to have insurance coverage all my life.

So let me make this clear: The worst year of my life, bar none, in terms of dealing with this disease, insurance, etc., was the year I was prostrate to the federal government for my support. I vowed, never again.

Government does nothing efficiently or well. I’m sorry to burst the bubbles of our hard-working, dedicated Congress, but they cannot make anything at all work economically. At all.

Congress should repeal Obamacare completely. Why can’t Congress just set the rules, and then just let the free market solve the coverage issues by itself? Why not just let insurers offer coverage anywhere, without restrictions to certain states, and then get out of the way?

Check your (huge) egos, Congress! Let health care be handled by people who know how to manage money and who know something, anything, about health care and health insurance. Please, I’m begging you: Get out of health care.—Galen Jackson

Republicans Shrink From the Budget Battle

Dear Daily Signal: I am a very conservative person who reads a lot about current events online across seven to 10 different websites, excluding “mainstream media” sites.  I read Genevieve Woods’ commentary on congressional Republicans and couldn’t agree with her more (“Even With Republicans in Charge, Upcoming Budget Battle Looks Grim“).

The GOP is a bunch of spineless wimps who are continually outplayed by the bully “illiberals.”  The GOP doesn’t seem to have learned any lessons on strategy  from the Harry Reid/Barack Obama years.

The lessons: Get out in front of it, stick disliked legislation in a drawer someplace and forget about it.  Do not put anything forward that the president will veto. Finally, when all else fails, threaten the GOP, and if that doesn’t work, threaten them some more. Why isn’t the GOP following the Democrats’ model?

I particularly like Ms. Woods’ following recommendations, quoting from her commentary:

They should be calling the Democrats’ bluff and put forward legislation that does what they promised—reins in government spending, starts addressing America’s debt, and secures our border and national security needs.

If enough Democrats in the House and Senate don’t vote for it (such legislation requires 60 votes in the Senate), they should make it clear that they will go into every state where vulnerable Democrats are up for re-election in 2018 and tell voters there that their lawmaker was responsible for shutting down the government over liberal pet causes—such as funding for sanctuary cities and Planned Parenthood—or because he or she didn’t want to allocate funds to secure our border.

As a result of reading so much about current events, I am definitely of the opinion that Senate Majority Leader Mitch McConnell has been around too long and needs to be gone.

He doesn’t appear to be strong enough nor clever enough to lead the GOP and Senate to victory on important issues for this country.  The budget and debt ceiling are two of the really important ones.–Tracy Gore, Vancouver, Wash.

The Best Thing Trump Has Done for the Country

Dear Daily Signal: Morgan Walker’s article regarding ‘SKYPE’ reporters is excellent (“This 1 Change Trump Administration Made to White House Press Briefings Is Shaking Up the Media“). Finally, a great example of a positive spin on political news coverage.

The goal of the “mainstream media” has always been to manipulate and control the way the public thinks. It could be the most powerful force for good on the planet.  Unfortunately, it runs in the opposite direction, and is clearly the greatest threat to the Trump administration and democracy in our country.

Isn’t it ironic that the media is missing such an incredible opportunity?

Love him or hate him, perhaps the best thing President Trump has done for the country is to finally expose the biased and corrupt mainstream media for what it really is.  The “swamp,” our incredibly stupid and inept Congress, is a close second.

Please share with Ms. Walker. Also, kudos to Fred Lucas and others for continuing to investigate the George Soros conspiracy to cripple the USA from within. Glad to be a member of The Heritage Foundation.–Hank Mattox

Trustworthy News Sources a Rare Commodity

Dear Daily Signal: Your news organization, and like-minded others, should consider creating a set of standards defining acceptable practices for certification as an Associated Conservative Press Certified News Source, or similar copyrightable name (“By Choosing Trump Hater as Dinner Speaker, Mainstream Media Embraces ‘Opposition Party’ Status“).

Trustworthy news sources are a rare commodity across America for everyone, but especially for conservatives.  Someone with the resources of the Koch brothers could create a nationwide news brand on their own.

But in lieu of that, it would be helpful to have a branding device that conservatives could use to validate online media, and possibly also print and broadcast media, as reliable and accurate.  Not in the sense of dogma, but rather accurate and true by professional journalism standards.

If you think this idea is worthy of consideration, please contact your worthy peer groups for possible action.—Newell S. Jones

No Trump Voters Need Apply?

Dear Daily Signal: Having once had a mainstream media job, I prefer to remain anonymous here. Read the last paragraph of this recent New York Times ad for “a new Rio de Janeiro bureau chief, one of the most exciting and dynamic assignments in the world,” including coverage of both Brazil and Argentina:

The New York Times is an Equal Opportunity Employer and does not discriminate on the basis of an individual’s sex, age, race, color, creed, national origin, alienage, religion, marital status, pregnancy, sexual orientation or affectional preference, gender identity and expression, disability, genetic trait or predisposition, carrier status, citizenship, veteran or military status and other personal characteristics protected by law. All applications will receive consideration for employment without regard to legally protected characteristics.

Quite a laundry list.

But would The New York Times hire a Trump voter? Or do they rule out 50 percent of the U.S. population?—A Reader

Dear Daily Signal: I was very disappointed in the lead letter in your recent “We Hear You” roundup (“I’m a Sailor, a Marine, and a Transgender Woman Who Was Born This Way“). In all honesty, if we allow human beings to determine what’s acceptable in American society, we might as well neuter the Constitution because it only can be read through the eyes of biblical understanding.

John Adams stated: “Our Constitution was made only for a moral and religious People. It is wholly inadequate to the government of any other.”

What I am saying here is not my opinion or prejudice. This is historical precedent, as well as legal precedent. This is not right-wing rhetoric from the lunatic fringe. This is legal and historical fact.

By the way, The Daily Signal is wonderful. Better than reading all of the other “rags” out there. If you want good success, maintain honesty and integrity. It will reflect well on The Heritage Foundation, which has always been a refuge for honesty and truth.—Bobby G., Woodstock, Ga.

On Racial Groupings

Dear Daily Signal: Regarding Mike Gonzalez’s commentary (“There Is Time to Reverse Obama Census Proposal That Promotes Group Identity Politics“), national or regional origin and ethnicity does not constitute racial origin. It should not be used to determine the population mix in the USA.

Skin color is irrelevant. We all should strive to be Americans and determine our race according to the basic four: black, Caucasian, Native American, Far Eastern/Oriental.—Cone S. Underwood

How Are We Doing?

You are doing very well.  I look forward to each new edition. Keep up the good work. And thanks.—Bill Williams

The border wall needs to be started and the national debt reversed. Still top of list.—Vtext

I’m a big fan and daily reader of The Daily Signal.  I was wondering if someone could write an article analyzing why all the Earth Day / March for Science hoopla didn’t include any outrage for the lack of the “scientific method.” It was a rigorous standard for science in the past hundreds of years, but now isn’t being followed 99 percent of the time.—Darren Richardson

Great job. I enjoy reading.—Christine Dukart 

Thank you!—Margi Wallo

Keep up the good work.—Ed Phillips 

Receiving The Daily Signal keeps me up with what is going on, not only in the U.S. but all over the world. And that, I really appreciate. The commentary is good and accurate, which is not offered on too many websites. Thanks for all the good you are doing.—Howard Shoemaker

The post We Hear You: ‘No More Reasons Why Congress Can’t Totally Repeal Obamacare’ appeared first on The Daily Signal.

GOP Leaders Move Forward With Obamacare Repeal After Gaining Conservative Backing

For Republicans in Congress, the path to repealing and replacing Obamacare could be made more difficult by less conservative members who say a revised proposal would cause health insurance premiums to swell for sick patients.

GOP leaders were prepared to put a bill dismantling the health care law before lawmakers for a vote by Saturday, President Donald Trump’s 100th day in Congress.

But some Republicans remain wary of the new proposal, with as many as 27 lawmakers opposed to or leaning against the bill, according to The Huffington Post.

Republican leaders are working to persuade the centrist flank of the conference to back the amended proposal, called the American Health Care Act.

Republicans’ efforts to pass a bill repealing and replacing Obamacare were revived earlier this week after two leaders from the party’s centrist and conservative wings released a compromise amendment.

The amendment, crafted by Tuesday Group Co-chairman Tom MacArthur, R-N.J., and House Freedom Caucus Chairman Mark Meadows, R-N.C., would give states the option to pursue waivers to opt out of Obamacare’s regulations.

Conservatives pointed to the regulations—specifically one that mandated the services plans have to cover and a second that prevented insurers from charging sick customers more—as the reason for rising health insurance premiums.

The so-called MacArthur amendment aimed to unite Republican lawmakers behind the bill.

And indeed, the revision swayed some conservatives who initially opposed the legislation.

On Wednesday, the conservative Freedom Caucus announced its support for the revised health care bill, called the American Health Care Act. For the group to take an official position on legislation, 80 percent of its members must be in agreement.

But for some Freedom Caucus members, the revised bill still fell short of full repeal.

In a statement Thursday announcing his opposition to the legislation, Rep. Andy Biggs, R-Ariz., said support for it would mean breaking his promise to constituents to repeal Obamacare in full.

“Let’s be honest, this bill will never be a full repeal,” Biggs told The Daily Signal. “It never keeps our promise.”

Instead, the freshman lawmaker said, the waiver process created by the amendment indicated that Obamacare was left in place.

“The fact that you have to apply for a waiver—what do you think the states are asking a waiver from?” Biggs said. “They’re asking for a waiver from Obamacare. That means it remains in place.”

To win his support, the Arizona Republican said, the waiver process would need to be changed. Under Biggs’ preferred plan, states would need to notify the government that they have chosen to opt out of Obamacare’s essential health benefits requirement and community ratings rules.

Biggs also said he would like to see the legislation allow for the sale of insurance across state lines—a reform Trump repeatedly backed on the campaign trail.

“Those two things there would drive prices down and simulate, to some extent, a repeal,” he said.

In addition to continued opposition from some conservatives, House Republican leaders are also confronted with growing opposition from centrist Republicans.

Rep. Patrick Meehan, R-Pa., announced Thursday he would oppose the health care bill.

“It threatens to send premiums skyrocketing for people with pre-existing conditions,” Meehan said in a statement. “It will make coverage more expensive for older Americans as they near retirement. And it threatens essential health care benefits like doctor’s office visits, opioid addiction treatment, and emergency room care.”

Others, including Rep. Mario Diaz-Balart, R-Fla., say they are undecided. Diaz-Balart told reporters Thursday the revised proposal has “lots of red flags.”

“I’m trying to figure out how this makes the legislation better,” he said.

The Florida Republican supported the original health care bill when it was before the House Budget Committee last month.

After the Freedom Caucus announced its support for the revised legislation, many influential conservative groups followed suit, including Heritage Action for America, Club for Growth, and FreedomWorks.

With the new momentum, the White House began pushing for a vote on the bill Friday or Saturday—which would hand Trump a legislative victory by April 29, his 100th day in office.

But Republican leaders quashed that possibility Thursday night.

House Majority Leader Kevin McCarthy, R-Calif., told reporters the House would not vote on the health care bill Friday or Saturday, but said Friday leaders would bring the bill before lawmakers for a vote “as soon as possible.”

Though the House is inching closer to a vote on the health care measure, it’s unclear how long it will be before a bill repealing and replacing Obamacare lands on Trump’s desk.

House Speaker Paul Ryan said the original measure was crafted to comply with the Senate’s rules of reconciliation, the fast-track budget process Republicans are using to pass the bill.

But Senate Minority Leader Chuck Schumer, D-N.Y., says he believes the MacArthur amendment would violate those rules, which would make the bill subject to a 60-vote threshold.

Reconciliation bills pass with a simple majority, 51 votes.

“Once again, House Republicans have made their bill worse for the health of the American people in order to buy off the Freedom Caucus and other conservatives,” Matt House, Schumer’s spokesman, told the Washington Examiner. “But once again, that effort is almost certainly going to run afoul of Senate reconciliation rules, ensuring that the bill with these provisions will need 60 votes to pass.”

Senate Democrats can raise points of order to challenge provisions of a reconciliation bill they argue violates the “Byrd rule,” which ensures reconciliation bills are budgetary in nature.

Still, a House vote on the health care bill could come next week.

But Biggs warned that at this point, it’s unlikely Republicans will be able to pass a plan to mitigate premium hikes for 2018, since insurance companies are already in the initial stages of planning for next year.

For Republicans, that could make the 2018 midterm elections tricky, the Arizona Republican said.

“2018 becomes suddenly a very difficult year for Republicans to hold on to the House and Senate,” Biggs said. “I think all of us are in a tight spot.”

The post GOP Leaders Move Forward With Obamacare Repeal After Gaining Conservative Backing appeared first on The Daily Signal.

What Trump Has Done About Health Care in His First 100 Days

One of the hallmarks of President Donald Trump’s campaign was his promise to repeal and replace Obamacare. But as Trump nears his 100th day in office, he has yet to accomplish a key priority—passing legislation dismantling the Affordable Care Act.

Health policy experts say the blame for this setback lies with both Trump and Republican lawmakers. But the president’s situation also underscores the difficulty of gaining consensus within a fractured Republican Party and winning on an issue where Congress holds much of the power.

“I don’t think Republicans agree among themselves on what to replace the Affordable Care Act with,” Seth Chandler, a visiting scholar at the George Mason University’s Mercatus Center, told The Daily Signal. “I think the problem doesn’t lie so much in what Trump has done since being president. The problem is that there was a rash campaign promise made without really thinking through how it was going to be implemented.”

Trump frequently repeated his promise to repeal Obamacare on the campaign trail, where the billionaire developer said he would replace President Barack Obama’s health care law with “something terrific.”

It was a promise he further solidified in his “Contract with the American Voter, a campaign document outlining Trump’s “100-day action plan to make America great again.”

All the major GOP candidates made similar pledges, but even the president’s former advisers admit a promise to do it in 100 days was “ambitious”—although befitting Trump’s style.

“Thinking that you can get this done within the first 100 days is very Trumpian,” Ken Blackwell, the former Cincinnati mayor who led domestic policy for the Trump transition, said in a conference call with reporters Thursday. “I think we might be pleasantly surprised. He will get it done in terms of setting the framework and initiating the action to fundamentally change the way we’re dealing with one-fifth of our economy.”

Still, the president has exercised his executive authority and looked to his Cabinet, namely Health and Human Services Secretary Tom Price, to begin chipping away at Obamacare while Congress continues to debate the path forward.

The White House

On Jan. 20, his first day in office, Trump signed an executive order directing relevant agencies to waive or defer provisions of Obamacare that “impose a fiscal burden” on any state, individual, family, or other stakeholder.

In preparation for Trump’s 100th day, which falls on Saturday, the White House included that executive order in a list obtained by CNN touting the president’s “100 days of accomplishments.”

The executive order was designed to “set direction” for agencies overseeing the various provisions of Obamacare, Ed Haislmaier, who worked on health policy for Trump’s transition, said.

“That’s what executive orders are supposed to do,” Haislmaier, a senior fellow in health policy at The Heritage Foundation, told The Daily Signal. “They’re not going to get into the details of the policy, but it sets direction.”

In response to Trump’s directive, the Internal Revenue Service announced it would accept and process tax returns from taxpayers who declined to indicate whether they had health care coverage for 2016.

Typically, taxpayers have to check a box on their tax returns notifying the tax agency that they have “essential minimum coverage.” Those who do not may claim a waiver or exemption, or pay a $695 fine.

The IRS initially announced it wouldn’t process tax returns for Americans who failed to indicate whether they had insurance, were exempt, or were paying the fine.

But following Trump’s executive order, the tax agency decided to process the returns as usual.

Congress

Despite the action Trump has taken unilaterally, his promise to repeal and replace Obamacare hinges on congressional action.

So far, the president has yet to successfully shepherd a legislative package rolling back the health care law through Congress.

“Clearly there’s been a failure to pass significant legislation with respect to health care,” Chandler said. “It’s hard to say whether that’s because of some sort of political miscalculation by Trump, political miscalculation by Republican leadership, or just issues within the Republican Party.”

“But if you judge things by results, you have the right to say he hasn’t gotten done what he said he was going to get done,” he said.

Republican leaders introduced a health care bill, called the American Health Care Act, at the beginning of March. Lawmakers designed it to repeal major provisions of Obamacare—though not the whole law—and implement parts of a replacement.

Trump backed the legislation and, along with House Speaker Paul Ryan, outlined a three-step process for dismantling Obamacare—with two steps following passage of the bill.

But the legislation faced a significant setback just three weeks after it was introduced.

Conservative lawmakers in the House Freedom Caucus opposed the legislation, saying it failed to address the rising cost of health insurance premiums because it left too much of Obamacare in place.

The bill also earned the ire of centrist Republicans who worried the bill wouldn’t protect patients with pre-existing conditions and those who gained coverage under Obamacare’s Medicaid expansion.

Trump, his budget director, Mick Mulvaney—a former Freedom Caucus member himself—and Vice President Mike Pence engaged in an intense charm offensive. It involved weeks of negotiations with Freedom Caucus members and daily phone calls with Rep. Mark Meadows, R-N.C., the group’s chairman.

But ultimately—and despite threats from the president and top administration officials—the Freedom Caucus stood strong in opposing the bill.

After it became clear that not enough conservative and centrist Republicans could be swayed, Ryan and Trump decided to pull the bill March 24.

The failure frustrated Trump, who at first said he understood it was a “hard vote” for conservatives but days later took to Twitter to condemn the Freedom Caucus.

But Chandler said the real issue lies in the fact that, as Trump admitted in February, health policy is hard.

“It’s quite possible [Trump] didn’t appreciate the incredible complexities of health care,” he said.

Blackwell pointed to the welfare reform of the mid-1990s as proof that such legislative overhauls take time:

When you think about the fact that the health care system is a larger monster … to think you can get that done in 100 days as opposed to 18 months is quite ambitious. If it happens in 100 days, 180 days, 200 days, that will be remarkable.

The president can propose and Congress disposes. It’s a kabuki dance that is a real artform, and the president is showing he’s quite gifted in it.

Still, Trump hasn’t given up on pushing through legislation repealing and replacing Obamacare in the final hours of his first 100 days in office.

The House GOP’s efforts received a burst of momentum Wednesday after the Freedom Caucus announced it would support a revised version of the repeal bill.

Whether centrist Republicans back the measure, though, remains an unknown.

Still, the White House is pushing Ryan and House GOP leaders for a vote on the legislation Friday or Saturday.

If the measure were to pass the lower chamber, congressional Republicans would hand Trump a legislative victory just before the president hits Day 101.

A White House official told The Daily Signal that despite his promise to repeal and replace Obamacare within his first 100 days, the president remains committed to dismantling the “disaster known as Obamacare” and will continue working with Congress.

The Department of Health and Human Services

Price, the orthopedic surgeon and congressman from Georgia tapped by Trump as secretary of health and human services, has exercised his ability to make changes to the law through the regulatory process.

The Affordable Care Act, informally called Obamacare,  gave the head of the Department of Health and Human Services broad authority to implement and define parts of the health care law.

And Price has taken advantage of the precedent by the Obama administration.

The health agency launched a webpage devoted to keeping the public apprised of the regulatory and administrative steps it’s taking.

Included is a final rule issued last week designed to stabilize the insurance market for insurers.

Specifically, Price changed the length of Obamacare’s open enrollment period, implemented stricter verification procedures for patients to enroll in coverage during a special enrollment period, and allowed insurers to collect previously unpaid premiums before a consumer purchases new coverage from the same insurer.

Haislmaier, the Heritage health policy expert, said those on the transition team recognized that the rule stabilizing the insurance market needed to be done swiftly once the president was sworn into office.

“It was a substantial undertaking and a priority because of the situation they inherited and the timeline to complete it,” Haislmaier said, referring to the limited time the agency had before insurers began making decisions for the 2018 plan year.

In addition to the market stabilization rule, Price and Seema Verma, the new administrator of the Centers for Medicare and Medicaid Services, are reaching out directly to state governors.

Last month, Price and Verma sent a letter to governors reminding them of Section 1332 waivers, created under the Affordable Care Act. They urged the governors to pursue waivers to set up high-risk pools and state-run reinsurance programs.

High-risk pools and reinsurance programs are designed to lower costs for already-sick patients.

The two officials also sent governors a letter notifying them that the agency would consider state-led reforms to Medicaid, which include shifting benefit plan designs to include health savings accounts and requiring beneficiaries to pay insurance premiums.

“I think that’s been a good thing,” Chandler said of Price’s actions. “I don’t know if it’s enough, but it’s a step in the right direction.”

The post What Trump Has Done About Health Care in His First 100 Days appeared first on The Daily Signal.

With Support From Conservatives, House Republicans Move Closer to Obamacare Repeal Deal

Republican leaders in the House received a boost to their attempts to repeal and replace Obamacare on Wednesday as the Freedom Caucus, an influential bloc of conservatives, announced its support for a revised plan.

The group of more than 30 lawmakers said it would support a new version of the bill, called the American Health Care Act. The revision includes an amendment crafted by Freedom Caucus Chairman Mark Meadows, R-N.C., and Tuesday Group Co-chairman Tom MacArthur, R-N.J.

“The MacArthur amendment will grant states the ability to repeal cost-driving aspects of Obamacare left in place under the original [American Health Care Act],” the Freedom Caucus said in a statement. “While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower health care costs.”

For the Freedom Caucus to take an official position on legislation, its rules call for 80 percent of members to agree.

The culmination of weeks of negotiations between Meadows and MacArthur, the compromise amendment aims to unite the House’s centrist and conservative Republican wings behind the health care bill.

With their legislation, GOP lawmakers and President Donald Trump are working to fulfill a major campaign promise—to repeal and replace Obamacare.

Trump initially promised to dismantle the health care law his first day in office, but disagreement among Republican lawmakers has delayed efforts in Congress to do so.

Lawmakers received the text of the amendment last night, but a rough outline of the plan was leaked to the press last week.

The deal takes aim at regulations implemented under what President Barack Obama considered one of his major domestic achievements, the Affordable Care Act, which conservatives said caused premiums to rise dramatically.

Under the amendment, states can apply for federal waivers to opt out of Obamacare’s essential health benefits requirement, a list of 10 services that insurance plans are required to cover.

The measure leaves in place a provision of Obamacare that prohibits insurers from denying coverage to patients with preexisting conditions, but allows states to waive its community ratings rules, which ban insurers from charging sick patients more than healthy ones.

States could opt out of the community ratings rules only if they implement a program designed to minimize costs for patients with preexisting conditions, such as a high-risk pool.

High-risk pools, subsidized by the government, are insurance pools for patients with preexisting conditions.

Additionally, only patients who fail to maintain continuous coverage could be charged more by insurers.

The amendment from MacArthur and Meadows attempts to assuage the concerns of House conservatives who, along with a bloc of centrist Republicans, opposed GOP leadership’s original health care bill.

Though Republican leaders now have the support of the Freedom Caucus, it’s unclear if the revised plan will have the backing of centrist Republicans.

Members of the centrist Tuesday Group told reporters Wednesday they needed more time to look over the amendment.

The revised bill has swayed influential conservative groups, however.

Club for Growth and FreedomWorks, which both opposed the original bill, announced their support for the amendment and said they would back the bill with its addition.

“While we’re still short of full repeal, this latest agreement would give states the chance to opt out of some of Obamacare’s costliest regulations, opening the way to greater choice and lower insurance premiums,” Club for Growth President David McIntosh said in a prepared statement. “It’s a solution we’ve supported for weeks, and the time to move forward is now.”

Heritage Action for America, the lobbying affiliate of The Heritage Foundation, backed away from its key vote against the health care bill.

In a formal statement, Mike Needham, CEO of Heritage Action, said:

To be clear, this is not full repeal and it is not what Republicans campaigned on or outlined in the Better Way agenda. The amendment does, however, represent important progress in what has been a disastrous process. Given the extreme divides in the Republican Party, allowing Texas and South Carolina to make different decisions on health insurance regulations than New York and New Jersey may be the only way forward.

Discussions over the health care bill began early last month after Republican leaders revealed their plan to repeal and replace Obamacare, a yearslong promise to voters.

Lawmakers were supposed to vote on the original legislation twice late last month. But House Speaker Paul Ryan delayed one vote then abruptly pulled the bill the next day after it became clear not enough Republicans supported it.

Conservatives, led by Meadows, continued discussions with MacArthur, Republican leaders, and the Trump administration.

GOP leaders and the White House are discussing a potential vote on the revised bill Friday, according to Axios, and the House whip team is counting votes.

Ryan, R-Wis., told reporters at a press conference earlier Wednesday that the lower chamber would vote “when we’ve got the votes.”

Still, the speaker said the MacArthur amendment “helps get us to consensus.”

“We think it’s very constructive,” Ryan said, adding:

We think the MacArthur amendment is a great way to lower premiums, give states more flexibility while protecting people with preexisting conditions. Those are the three things we want to achieve.

The post With Support From Conservatives, House Republicans Move Closer to Obamacare Repeal Deal appeared first on The Daily Signal.

House Health Care Bill Moving in the Right Direction

New developments on the American Health Care Act may finally break the legislative log-jam on the bill and make progress toward repealing and replacing Obamacare.

New Developments

Rep. Tom MacArthur, R-N.J., is proposing an amendment that would allow states to apply to the Secretary of Health and Human Services for “waivers” from Obamacare’s contentious insurance rules for a period of 10 years.

Most significantly, states could secure waivers from Obamacare’s costly “essential health benefit” requirement (the mandatory 10 categories of health benefits). Under the language of the amendment, the waivers would be virtually automatic.

Federal control over state health insurance markets has been a costly experiment. Obamacare rules have contributed in a major way to skyrocketing health insurance premiums. This is especially true for younger persons saddled with much higher insurance costs because of the law’s age-rating rules.

The overall impact has been painful. For 2017, premiums for standard plans in the exchanges have increased by an average of 25 percent, and persons in those markets have experienced shocking deductibles ($6,092 for single and $12,383 for low-cost “bronze” coverage).

Yet an estimated 25 million Americans in the individual and small group markets are ineligible for the law’s low-income subsidies.

These cost explosions have undercut competition and choice not only in the Obamacare exchanges, but also in off-exchange markets.

Indeed, in the exchanges, competition has declined to the point where in almost 70 percent of U.S. counties there are only one or two insurers offering coverage. Meanwhile, most of the remaining plans offer only narrow networks of medical professionals.

Progress

President Barack Obama and his allies in Congress should never have imposed centralized federal control over diverse state health insurance markets in the first place.

While the best solution would be to repeal that federal overreach, the proposed waiver is a significant improvement over current law. Its practical effect is to achieve a devolution of health insurance rulemaking back to the states.

The waiver approach would enable states to regain their traditional freedom in this vital area of public policy, and accommodating differences among the states would encourage experimentation and innovation in health insurance market reform.

Unfinished Business

The American Health Care Act contains a number of sound policy provisions, including a dramatic liberalization of health savings accounts, major Medicaid entitlement reform, and substantial tax reductions.

Still, the bill needs improvement.

For example, in improving protection for persons with pre-existing medical conditions in the individual market, Congress should apply the successful provisions that, prior to Obamacare, worked very well in the group market and that encourage people to maintain continuous coverage.

Likewise, the bill’s Medicaid provisions are an improvement over current law.

For able-bodied Medicaid beneficiaries, however, Congress could do even better by providing them with a “premium support” solution that would enable them to enroll in private coverage of their choice, just like their fellow citizens, and secure better access and medical outcomes.

Finally, Congress should address the central systemic driver of health care costs: the unfair, inefficient, and inequitable federal tax treatment of health insurance.

As Heritage analysts have long noted, there are a variety of ways to accomplish that goal.

In particular, rather than further delaying the effective date of Obamacare’s “Cadillac tax” on high cost employer health plans (as the House bill does) Congress should scrap that punitive and disruptive tax and instead set a simple cap on the amount of pre-tax spending on employer health benefits—as the tax code currently does for other workplace benefits.

While the House may not be able to address all of these items under a tight legislative schedule, there is no reason why the Senate cannot act effectively and expeditiously.

After seven years, the American people who voted for change have waited long enough.

The post House Health Care Bill Moving in the Right Direction appeared first on The Daily Signal.

It’s Almost Impossible to Find Out the Cost of a Medical Procedure. This Company Is Trying to Change That.

For a patient looking to see a doctor for any given medical procedure, costs often vary wildly based on the facility or physician.

Take non-surgical repair for a broken ankle.

For a 26-year-old female insured by Cigna who chooses a top-rated orthopedic surgeon in Washington, D.C., such a procedure costs $1,729.

But if she chooses another top-rated orthopedic surgeon in nearby College Park, Maryland, the procedure costs $1,199.

That’s according to a company called Amino, which mines data from billions of health insurance claims from the private and public sectors. Amino then gives patients access to information on the cost of various procedures and how much experience doctors nationwide have in those procedures.

And in the age of rising deductibles and out-of-pocket costs for health care, this Silicon Valley-based company is working to put more of such information in the hands of  patients.

An alumnus of Zillow, a real estate company that provides data on the housing market, Amino CEO David Vivero decided to start the company in 2013 based on what he personally had gone through in searching for a new insurance plan.

Because Vivero has a pre-existing condition, he realized he probably would have trouble finding a good insurance plan and a good doctor.

“I realized just having the consumer experience that health care had offered me was really frustrating,” Vivero says in an interview with The Daily Signal. “So I decided to build Amino to solve that.”

The company provides consumers with access to specifics about procedures, doctors, and costs generated by its massive database of health insurance claims from government and private-sector partners.

Users head to its website, Amino.com, and click through five screens—procedure, gender, age, location, and insurer, which is optional—before they’re presented with results for doctors based on quality and prices for more than 90 procedures.

Need a chest X-ray in the Arlington, Virginia, area?

For a 26-year-old female enrolled with UnitedHealthcare, the nation’s largest insurance provider, the procedure will cost $662 at Virginia Hospital Center, the top-billed facility.

170419_aminoembed

Need to repair a broken ankle in the Sarasota, Florida, region?

For a 48-year-old male insured by Blue Cross and Blue Shield of Florida, the procedure will cost $2,029 to see the top-rated doctor for fixing a broken ankle.

170419_aminoembed2

The website doesn’t have any ads or sponsorships, and because of this, Vivero says, he hopes Amino can offer “truth” to health care consumers.

“By committing to not taking advertisements or allowing for providers of care to bid up, we can promise the results are data-driven for consumers,” he says.

Vivero says he believes that having access to this information helps consumers make more informed choices about their health care:

Transparency can really change markets. Having an empowered consumer was really something that would really create both a competent set of choices, and also solve problems for insurance plans and providers who are now dealing with the realities of this emerging consumer class in health care.

And as deductibles on health care plans have continued to rise, leaving consumers to pay more out of their own pockets, more companies see a market for showing patients the costs of medical procedures.

“When people pay their own way, they’ll start to shop and demand prices,” Twila Brase, president of the consumer group Citizens’ Council for Health Freedom, tells The Daily Signal. “Lots of people wanted to force doctors to be transparent about their prices, but it didn’t matter until people pay their bills.”

When it first launched, Amino provided users with information on the quality of doctors featured on the site.

In October 2015, the company introduced a service allowing users to tap into its database of doctors nationwide to determine which they like based on how much experience doctors have with specific conditions and the insurance accepted. It also allows users to book an appointment.

And last year, the health care company unveiled its cost estimates, allowing patients to find the costs of 49 different services or procedures and estimate what they may have to pay based on their insurer.

Today, Amino provides cost estimates for more than 90 procedures.

“They’ve been able to finally compare and understand the prices that are available for them, which is a huge opportunity for the average consumer,” Vivero says of users.

‘The Pioneers’

As of 2015, health care spending in the United States reached $3.2 trillion, according to the federal government, and health insurance data has been used by others in the industry to build actuarial models and combat fraud.

But Vivero says his company is the first to marry access to that data with patients’ desire for transparency.

“As it relates to using this data to empower consumers to feel informed and confident in their health care choices, we feel we’re the pioneers,” Vivero says.

The company is one of several ushering in a new era of transparency in health care, fueled by higher deductibles and the increased amount patients pay out of their own pockets.

“As deductibles rise in health care, more and more decisions become the sole financial responsibility of that head of household or that individual insured member,” Vivero says. “As a result of that, the information appetite that people have has grown substantially.”

According to the Kaiser Family Foundation, the size of deductibles increased 12 percent in 2016 for consumers in the group market.

For employers with fewer than 200 employees, 65 percent of workers are in high-deductible plans, with the average deductible totaling $2,000.

In the individual market, deductibles have continued to rise as well.

According to an Avalere study of plans sold on Obamacare’s exchanges, combined deductibles—which include medical and drug deductibles—for silver-level plans jumped 20 percent from 2016 to 2017.

In 2016, for example, the average combined deductible for a silver-level plan was $3,075. In 2017, that rose to $3,703.

Though many patients began noticing a rise in deductibles after implementation of the Affordable Care Act, the Kaiser Family Foundation notes that this trend began before Obamacare was signed into law.

Still, as consumers move toward health insurance plans with lower premiums in exchange for higher deductibles, they tend to desire more information on health care services.

“Private-sector companies see an opening because people are now forced to pay cash to meet their deductibles,” Brase, of the Citizens’ Council for Health Freedom, says. “[Obamacare] has returned a cost-consciousness to a fair amount of people.”

Brase and her organization advocate a cash-based system of health care, where patients don’t have to rely on insurers to pay their bills. Removing insurers from the equation allows patients to negotiate prices directly with providers, she says.

But those with insurance, Brase says, are becoming more aware of the impact medical procedures will have on their pocketbooks:

Transparency is really important because it moves us back to true sensitivity about prices. Because of Obamacare, it forced people into paying for their own bills, [and] they then naturally gravitated toward transparency. They started asking for prices, shopped around, and went on the internet.

Brase warns that in today’s system of health care, it’s difficult to know what the “true cost” of any given procedure is, since insurance companies negotiate prices directly with providers.

That means that even within the same hospital or medical facility, costs may vary.

But the push for more transparency in the health care industry can help get patients closer to solving that puzzle, Brase says.

“It brings us closer to the true cost,” she says. “It also brings the prices down because then there’s competition between the posted costs.”

‘Nuanced Choices’

Vivero says he has heard from many Amino users who use his company’s website for different purposes.

Some report that Amino helped save “tens of thousands of dollars,” he says. Other consumers praise the company for helping to avoid misdiagnoses, since they were able to find experienced doctors to get a second opinion.

And others changed their habits of health care consumption based on the information Amino provided.

“Being able to see that information up front is incredibly empowering,” Vivero says of consumers, adding:

What they do with that is either to choose a physician, or sometimes they budget differently. Or they might decide to get that procedure done in one calendar year versus another. But at the very least, you have the information you need to make that informed choice.

To provide patients with cost estimates, Amino partnered with more than a dozen companies across the health care supply chain—health IT companies, payment processors, insurers—to compile data on patients’ health insurance claims.

That gave the company access to a trove of insurance information from the private sector.

Then, in 2014, the Centers for Medicare and Medicaid Services—the federal agency that also oversees Obamacare—named Amino a “qualified entity,” making it the first for-profit company to receive the designation. As a qualified entity, the company received claims data from Medicare Parts A, B, and D.

Amino removed all identifying information from the data it received and, with the claims, built a database with information on which doctors take which insurers, how much different procedures cost, and how much consumers will pay.

Vivero says his company now has data from more than 9 billion health insurance claims, and Amino users can book appointments online with more than 900,000 doctors and facilities.

The company recently added Amino Plus, a service for insurance companies or employers that gives members access to additional information on their insurance plans, including plan documents, network data, and the current status of their deductibles and out-of-pocket maximum fees.

“The effect of that is to drive even greater use of in-network services so that … the consumer gets fewer surprise bills and so the employer gets fewer surprise bills and out-of-network charges,” Vivero says.

In March, Amino released a study with Ipsos, a market research company, exploring Americans’ attitudes about health care costs.

The study found that 63 percent of Americans said that receiving a medical bill they can’t afford is worse than or as bad as being diagnosed with a serious illness.

Additionally, 55 percent said they received a medical bill they couldn’t afford, and 1 in 5 said they avoid high medical bills by avoiding the doctor.

Vivero says Amino’s mission is to help patients make more informed decisions that save money.

“We hope to give them the information they need to make smart choices that in the long run are better for their wallets and better for their health,” he says.

The post It’s Almost Impossible to Find Out the Cost of a Medical Procedure. This Company Is Trying to Change That. appeared first on The Daily Signal.

It’s Almost Impossible to Find Out the Cost of a Medical Procedure. This Company Is Trying to Change That.

For a patient looking to see a doctor for any given medical procedure, costs often vary wildly based on the facility or physician.

Take non-surgical repair for a broken ankle.

For a 26-year-old female insured by Cigna who chooses a top-rated orthopedic surgeon in Washington, D.C., such a procedure costs $1,729.

But if she chooses another top-rated orthopedic surgeon in nearby College Park, Maryland, the procedure costs $1,199.

That’s according to a company called Amino, which mines data from billions of health insurance claims from the private and public sectors. Amino then gives patients access to information on the cost of various procedures and how much experience doctors nationwide have in those procedures.

And in the age of rising deductibles and out-of-pocket costs for health care, this Silicon Valley-based company is working to put more of such information in the hands of  patients.

An alumnus of Zillow, a real estate company that provides data on the housing market, Amino CEO David Vivero decided to start the company in 2013 based on what he personally had gone through in searching for a new insurance plan.

Because Vivero has a pre-existing condition, he realized he probably would have trouble finding a good insurance plan and a good doctor.

“I realized just having the consumer experience that health care had offered me was really frustrating,” Vivero says in an interview with The Daily Signal. “So I decided to build Amino to solve that.”

The company provides consumers with access to specifics about procedures, doctors, and costs generated by its massive database of health insurance claims from government and private-sector partners.

Users head to its website, Amino.com, and click through five screens—procedure, gender, age, location, and insurer, which is optional—before they’re presented with results for doctors based on quality and prices for more than 90 procedures.

Need a chest X-ray in the Arlington, Virginia, area?

For a 26-year-old female enrolled with UnitedHealthcare, the nation’s largest insurance provider, the procedure will cost $662 at Virginia Hospital Center, the top-billed facility.

170419_aminoembed

Need to repair a broken ankle in the Sarasota, Florida, region?

For a 48-year-old male insured by Blue Cross and Blue Shield of Florida, the procedure will cost $2,029 to see the top-rated doctor for fixing a broken ankle.

170419_aminoembed2

The website doesn’t have any ads or sponsorships, and because of this, Vivero says, he hopes Amino can offer “truth” to health care consumers.

“By committing to not taking advertisements or allowing for providers of care to bid up, we can promise the results are data-driven for consumers,” he says.

Vivero says he believes that having access to this information helps consumers make more informed choices about their health care:

Transparency can really change markets. Having an empowered consumer was really something that would really create both a competent set of choices, and also solve problems for insurance plans and providers who are now dealing with the realities of this emerging consumer class in health care.

And as deductibles on health care plans have continued to rise, leaving consumers to pay more out of their own pockets, more companies see a market for showing patients the costs of medical procedures.

“When people pay their own way, they’ll start to shop and demand prices,” Twila Brase, president of the consumer group Citizens’ Council for Health Freedom, tells The Daily Signal. “Lots of people wanted to force doctors to be transparent about their prices, but it didn’t matter until people pay their bills.”

When it first launched, Amino provided users with information on the quality of doctors featured on the site.

In October 2015, the company introduced a service allowing users to tap into its database of doctors nationwide to determine which they like based on how much experience doctors have with specific conditions and the insurance accepted. It also allows users to book an appointment.

And last year, the health care company unveiled its cost estimates, allowing patients to find the costs of 49 different services or procedures and estimate what they may have to pay based on their insurer.

Today, Amino provides cost estimates for more than 90 procedures.

“They’ve been able to finally compare and understand the prices that are available for them, which is a huge opportunity for the average consumer,” Vivero says of users.

‘The Pioneers’

As of 2015, health care spending in the United States reached $3.2 trillion, according to the federal government, and health insurance data has been used by others in the industry to build actuarial models and combat fraud.

But Vivero says his company is the first to marry access to that data with patients’ desire for transparency.

“As it relates to using this data to empower consumers to feel informed and confident in their health care choices, we feel we’re the pioneers,” Vivero says.

The company is one of several ushering in a new era of transparency in health care, fueled by higher deductibles and the increased amount patients pay out of their own pockets.

“As deductibles rise in health care, more and more decisions become the sole financial responsibility of that head of household or that individual insured member,” Vivero says. “As a result of that, the information appetite that people have has grown substantially.”

According to the Kaiser Family Foundation, the size of deductibles increased 12 percent in 2016 for consumers in the group market.

For employers with fewer than 200 employees, 65 percent of workers are in high-deductible plans, with the average deductible totaling $2,000.

In the individual market, deductibles have continued to rise as well.

According to an Avalere study of plans sold on Obamacare’s exchanges, combined deductibles—which include medical and drug deductibles—for silver-level plans jumped 20 percent from 2016 to 2017.

In 2016, for example, the average combined deductible for a silver-level plan was $3,075. In 2017, that rose to $3,703.

Though many patients began noticing a rise in deductibles after implementation of the Affordable Care Act, the Kaiser Family Foundation notes that this trend began before Obamacare was signed into law.

Still, as consumers move toward health insurance plans with lower premiums in exchange for higher deductibles, they tend to desire more information on health care services.

“Private-sector companies see an opening because people are now forced to pay cash to meet their deductibles,” Brase, of the Citizens’ Council for Health Freedom, says. “[Obamacare] has returned a cost-consciousness to a fair amount of people.”

Brase and her organization advocate a cash-based system of health care, where patients don’t have to rely on insurers to pay their bills. Removing insurers from the equation allows patients to negotiate prices directly with providers, she says.

But those with insurance, Brase says, are becoming more aware of the impact medical procedures will have on their pocketbooks:

Transparency is really important because it moves us back to true sensitivity about prices. Because of Obamacare, it forced people into paying for their own bills, [and] they then naturally gravitated toward transparency. They started asking for prices, shopped around, and went on the internet.

Brase warns that in today’s system of health care, it’s difficult to know what the “true cost” of any given procedure is, since insurance companies negotiate prices directly with providers.

That means that even within the same hospital or medical facility, costs may vary.

But the push for more transparency in the health care industry can help get patients closer to solving that puzzle, Brase says.

“It brings us closer to the true cost,” she says. “It also brings the prices down because then there’s competition between the posted costs.”

‘Nuanced Choices’

Vivero says he has heard from many Amino users who use his company’s website for different purposes.

Some report that Amino helped save “tens of thousands of dollars,” he says. Other consumers praise the company for helping to avoid misdiagnoses, since they were able to find experienced doctors to get a second opinion.

And others changed their habits of health care consumption based on the information Amino provided.

“Being able to see that information up front is incredibly empowering,” Vivero says of consumers, adding:

What they do with that is either to choose a physician, or sometimes they budget differently. Or they might decide to get that procedure done in one calendar year versus another. But at the very least, you have the information you need to make that informed choice.

To provide patients with cost estimates, Amino partnered with more than a dozen companies across the health care supply chain—health IT companies, payment processors, insurers—to compile data on patients’ health insurance claims.

That gave the company access to a trove of insurance information from the private sector.

Then, in 2014, the Centers for Medicare and Medicaid Services—the federal agency that also oversees Obamacare—named Amino a “qualified entity,” making it the first for-profit company to receive the designation. As a qualified entity, the company received claims data from Medicare Parts A, B, and D.

Amino removed all identifying information from the data it received and, with the claims, built a database with information on which doctors take which insurers, how much different procedures cost, and how much consumers will pay.

Vivero says his company now has data from more than 9 billion health insurance claims, and Amino users can book appointments online with more than 900,000 doctors and facilities.

The company recently added Amino Plus, a service for insurance companies or employers that gives members access to additional information on their insurance plans, including plan documents, network data, and the current status of their deductibles and out-of-pocket maximum fees.

“The effect of that is to drive even greater use of in-network services so that … the consumer gets fewer surprise bills and so the employer gets fewer surprise bills and out-of-network charges,” Vivero says.

In March, Amino released a study with Ipsos, a market research company, exploring Americans’ attitudes about health care costs.

The study found that 63 percent of Americans said that receiving a medical bill they can’t afford is worse than or as bad as being diagnosed with a serious illness.

Additionally, 55 percent said they received a medical bill they couldn’t afford, and 1 in 5 said they avoid high medical bills by avoiding the doctor.

Vivero says Amino’s mission is to help patients make more informed decisions that save money.

“We hope to give them the information they need to make smart choices that in the long run are better for their wallets and better for their health,” he says.

The post It’s Almost Impossible to Find Out the Cost of a Medical Procedure. This Company Is Trying to Change That. appeared first on The Daily Signal.

We Hear You: Obamacare and ‘Progress in Wrong Direction’

Editor’s note:  This weekend we reach deeper into the mailbag for a smattering of your views on a bunch of different issues. Let’s lead off with observations on the state of our union by Anthony Cosenza, a Defense Department veteran who teaches at Philadelphia University these days. Enjoy.—Ken McIntyre

Dear Daily Signal: This is regarding your reporting on Obamacare versus the American Health Care Act (RINOcare). I am, unfortunately, a conservative adjunct professor in the bowels of the progressive, neocommunist academe in the city of Philadelphia–a liberal, Democrat bastion. The level of student naiveté and faculty propagandizing for the neocommunist agenda is debilitating.

I also worked 40 years for the Department of Defense, paying taxes from both jobs as part of my polity contribution. I have been subsidizing the government waste factory, the politically well connected who can avoid taxes, and the “low income” people who believe they are entitled to half of what I earned in those 40 years. (Federal, state, local taxes, surcharges on utilities for nonpayers, etc., add up to about 50 percent.)

The one striking issue I have observed over the years is this construct that we should have equality of “outcomes” and not equality of “opportunity.” The scenario goes that if you are in the U.S., legally or illegally, you are entitled to what everybody else has, i.e. house, car, cell phone, free tuition, free health care,  guaranteed income (welfare) and so on.

The focus is totally on “entitlements” with no consideration for the other side of the equation–contribution.

Students believe that the only contribution people have to make is carbon dioxide (breathe) and offspring (breed). So if you breathe and breed, you are entitled to a subsidized lifestyle. We have developed a culture that Aesop warned of with the ant and grasshopper: a nation of nihilistic, free-rider, social loafers who believe they are entitled to cradle-to-grave government (taxpayer) care while having only to contribute their occasional vote to the party that promises them free stuff.

This “progressive” cultural rot affects all aspects of our political, economic, and social fabric. It was rejected during this past election by middle-class Americans who work for a living to fund this progressive cancer.

Even the immigration debate has its roots in this cultural degradation, since we have to import unskilled, uneducated labor to take jobs “Americans won’t take,” as the liberals claim. They won’t take the jobs because they don’t have to work. The social safety net funded by taxes and debt allow them to have decent, subsistence living while contributing nothing.

Hence the discussion on Obamacare and a new entitlement by expanding “free health care” (Medicaid) for “the poor.” At some point, we have to stop the “free stuff” nanny-state drug of choice for progressivism and balance the equation with some form of contribution to offset the ever-increasing scope of government entitlements.

This version of RINOcare does nothing either to stop or reverse this progressive cancer.

I ask my students to define progressivism. Of course they characterize it as “progress” toward all the value-laden, sociological fluff terms like social justice, economic equality, equal pay, open borders that, when challenged, they can’t define or conceptualize the implications.

I tell them about the skin mole I had that “progressed” to cancer. It was progress, but in the wrong direction. Progress in the wrong direction can be deadly.

I am now 65 and at the tail end of this journey, but I fear for the viability of this experiment we call the United States. This election may have been the last chance to reverse that “progress” in the wrong direction.—Anthony Cosenza

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It’s Too Easy to Spend Other People’s Money

Dear Daily Signal: The 2,000-plus pages of the Obamacare legislation include so many taxes, mandates, regulations, unelected bureaucrats, and on and on that the only way to “drain the swamp” of this horrendous, ill-conceived legislation is full and complete repeal. Where am I wrong?

House Speaker Paul Ryan’s proposed amendments “provide for the government (taxpayers) to pay all or portions of premiums to reduce premiums” (“Republicans Revive Obamacare Repeal Talks With Change to Unite Conservatives, Centrists“).

That’s simple enough, but awkwardly described in the promotion of the bill. Maybe I don’t wholly understand this.

Unfortunately, I see Ryan as a victim of the lobbyists (insurance companies and other beneficiaries of the legislation), conveniently forgetting the promise to the electorate and constituents for financial gain from lobbyists.

It should be much easier to obtain repeal of Obamacare and then replacement, rather than do both at the same time. Some effort should be to get the government out of the business of insurance and health care; the religious institutions and philanthropists will fill this responsibility, as they should.

It’s too easy to spend other people’s money and force something on the taxpayers and voters, while those doing it have no interest in the programs and are served by “other” programs they devised to cover themselves. Everyone responsible for a program should be covered by all programs devised by them for others.—Dick Matise, Dallas, Texas

Dear Daily Signal: Please help get health care reform to a good spot without blocking it. As a health care provider, the obstruction rather than construction of this bill is very frustrating.

Perfection is the enemy of pretty good.  Most Americans are thrilled with pretty good as a followup to awful.  Please get behind House Speaker Paul Ryan.—Alma Golden

‘Now I’m Struggling to Survive’

Dear Daily Signal: In Romina Boccia’s commentary on Social Security disability and those who are working, she fails to realize one thing: They will retract your disability benefits and continue doing so, and without just cause (“A Pathway to Work for Social Security Disability Beneficiaries“).

Social Security said they needed to take back my benefits, so they did. And then they took back more and more to the point where I am living on basically $400 a month, because I am working.

They don’t care, so now I’m struggling to survive. I still don’t make a lot of money. I’m still making under the sum of money they want. But they will not do anything to correct the mistake of double-docking me, and they will not hear me out.—Claire Gallo

Let’s Change Policy to Protect Unborn Children

Dear Daily Signal: Because of Roe v. Wade, more than 61 million unborn children have been killed through abortion.  In 1973, the Supreme Court declared it could not resolve “the difficult question of when life begins,” and on the basis of this unresolved question, declared a new right to abortion based on a “right of privacy.”

But only Congress can make that decision. Science is clear that human life begins at conception, when a new human person is formed.

The Life at Conception Act of 2017 (S. 231/H.R. 681) declares that unborn children are persons legally entitled to protection in the Fifth and 14th amendments to the Constitution, and will rescue millions of unborn children from dying by abortion on demand.  This bill declares that the right to life guaranteed by the Constitution is vested in each human being at all stages of life, including the moment of fertilization or cloning.

Because of the DNA schedule, we now have clear scientific evidence. This notion that we just continue to ignore the personhood of the unborn child is a violation of that unborn child’s constitutional rights to due process and equal protection under the law.

It’s time we recognize the Supreme Court is not the Supreme Being, and change policy to be pro-life and protect children instead of rip up their body parts and sell them like they’re parts to a Buick.

Nothing in this bill shall be construed to require prosecution of any woman for the death of her unborn child. I urge Americans to contact their senators and representatives and ask them to cosponsor and cast their vote for the Life at Conception Act of 2017.—John Gibson, Lake Jackson, Texas

Why We Don’t Have a Totalitarian State

Dear Daily Signal: I totally disagree with Steven Bucci’s conclusion in his commentary, “Who to Blame for the Latest WikiLeaks Dump: Manning and Snowden.”

Bradley Manning and Edward Snowden had nothing to do with the latest leaks, and Mr. Bucci acknowledged that fact but still blamed them. It is like blaming God for sins.

God gifted all his creation with free will, and it is up to individuals to use it. The latest leaks were a service because the “leakers” saw a danger in the way the CIA was operating and exposed it.

It is only through leaks that we don’t have a totalitarian state. The government doesn’t have a right to spy on Americans without a court order, and the FISA courts seem bent on approving any government request.

I disapprove of the actions of Manning, but I approve of Snowden’s actions because he exposed the National Security Agency’s collection of data from all Americans. The metadata collected allows the NSA to request the content if it doesn’t already have it. The metadata is dangerous because it can lead to a totalitarian state.

Wikileaks is a service that allows a look into a federal agency that is spying on Americans and is a danger to a free society. The CIA put the whole country in danger because they didn’t protect its hack programs. Mr. Bucci should be more outraged that the CIA was allowed to spy on anyone, even Americans. It apparently didn’t have to request a court order for any operations.

Now any hacker can overthrow the country by knocking out our power grid, or take down any senator, representative, Supreme Court justice, or president. Congress needs to look at and remedy this situation, fast.—Fred Minook

How Low We’ve Sunk in Surrendering Liberties

Dear Daily Signal: The fact that Sweet Cakes by Melissa is requesting that the Oregon government give its blessing to the bakery owners’ refusal to serve clients on religious grounds shows how low we’ve sunk in surrendering our freedoms and liberties (“Bakers Accused of Hate Get Emotional Day in Court“).

Requiring government approval for religious actions is no different from requiring government approval for anything else. Whom a business chooses to serve as clients belongs to the business alone for its own reasons and nobody else’s.  That’s what private property rights are all about.

Instead of tying up the courts and wasting taxpayer money, same-sex couples denied service should quit whining and simply take their business elsewhere.  It’s that simple.

The state of Oregon’s intervention in this matter is a waste of taxpayer money. The state government needs to butt out and use its resources for legitimate needs, instead of frivolous matters such as this.—Stephen V. Gilmore, Charlotte, N.C.

Siding With Buckley on Legalizing Pot

Dear Daily Signal: Cully Stimson’s commentary about stepping up federal law enforcement against marijuana laws is in direct opposition to The Heritage Foundation’s support for limited government, individual freedom, and states rights (“How Trump’s DOJ Can Start Enforcing Federal Marijuana Law“).

I side with the late William F. Buckley on the issue of legalizing marijuana. It originally was banned for racist reasons, and whether it is harmful or not doesn’t matter. Its prohibition doesn’t stop anyone who wants to take it, but it hurts all of us with all of the unintended consequences like financing gang violence and terrorism.—Jeff Goldstein

Don’t Let Outsiders Disrupt Town Halls

Dear Daily Signal: Thank you for allowing us to watch Rep. Dave Brat’s town hall meeting online (“How One Congressman Handles a Rowdy Town Hall Meeting“). A suggestion you may be able to circulate is for attendance of a town hall meeting to be restricted to the constituents of the member of Congress putting it on.

All attendees should be required to show ID indicating residency within the district. Only those who are verified constituents should be allowed in. Others may be allowed to join in “overflow” areas where their disruptions will not infringe on the rights of the true constituents to communicate with their representative.—Jerry Dundalk, Iron Mountain, Mich.

‘Quite the Chameleon’

Dear Daily Signal: Seems to me that Mike Gonzalez is somewhat disingenuous in his presentation of the very matter he is commenting on (“Trump Should End Government Funding of NPR’s Biased News“).

On the one hand, Gonzalez speaks of the “why” and on the other hand lauds the overall greatness of program offerings and the powerful support base of the entities he innocuously proposes be unfunded of taxpayer dollars. He seems quite the chameleon.—Darryl Szymanski, Sheridan, Wyo.

How Are We Doing?

Thank all of you for the prodigious work you perform on a daily basis, in the ongoing work of factual education on seminal issues of the time.—Robert Powell, Oregon City, Ore.

You all need a proofreader.  Too many mistakes.—Kathy Hilliard

My first read of The Daily Signal: Enjoyed it and it was not of length to be dreaded as something to daily check up on, as some are. Still solidly informative.—Charles Davis

I like your coverage of events. Calm, collected, and terse.—Jan Miller

I like this format. Thank you.-—Pat B.

I learn way more about what is happening in the news @dailysignal than any fictional major news channel.—Jay Schreffler

So appreciative of you! Am grateful for the accuracy in your information. You are a blessing to the citizens of our country. Good work.—Benedicta Harris

The post We Hear You: Obamacare and ‘Progress in Wrong Direction’ appeared first on The Daily Signal.

What’s in the New Obamacare Deal That Could Unite Conservatives, Centrists

Conservative and centrist Republicans in the House are working on a deal that some say could unite the two factions and attract enough votes to pass the stalled bill to repeal and replace Obamacare.

But amid increased pressure from the White House to move forward with the plan to unravel the 2010 health care law, some conservatives have questions about the changes.

News of the deal comes as President Donald Trump nears his 100th day in office, and just days before lawmakers return to Washington, D.C., to hash out the details of a bill funding the government.

Brokered by Tuesday Group co-chairman Tom MacArthur, R-N.J., and House Freedom Caucus chairman Mark Meadows, R-N.C., the “MacArthur Amendment” offers concessions to the centrist and conservative wings of the GOP, which opposed the House GOP’s bill for different reasons.

“I’m optimistic that we will have a bill that accomplishes all the goals that so many of us have campaigned on, promised, and yet the work’s not done,” Meadows told the Asheville (N.C.) Citizen-Times.

According to a draft of the amendment obtained by Politico, the plan allows states to apply for “limited waivers” to opt out of Obamacare insurance mandates—a change designed to address conservatives’ concerns with the legislation.

Under the waivers, states could eliminate a requirement mandating the services that insurance plans must offer—the essential health benefits requirement—and another prohibiting insurers from charging patients more based on health status—known as community rating rules.

To receive the waiver, though, states must set up a high-risk insurance pool or participate in the federal high-risk pool. High-risk pools are insurance pools for patients with preexisting conditions subsidized by the government.

States also must prove, according to the document published by Politico, that “the purpose of the requested waiver is to reduce premium costs, increase the number of persons with health care coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with preexisting medical conditions.”

The second part of the deal, which seeks to sway centrist Republicans, keeps some Obamacare regulations in place that have grown in popularity over the years, including the ban on insurers from discriminating against patients with preexisting conditions.

The proposed changes from Meadows and MacArthur attempt to reconcile the differences between conservatives in the House Freedom Caucus and centrist Republicans.

Both factions revolted against leadership’s original health care bill, called the American Health Care Act, but for differing reasons. House Speaker Paul Ryan pulled the bill from the floor March 24 for lack of votes to pass it.

Conservatives said the plan didn’t combat the rising cost of premiums, while centrists worried sick patients would be deprived of access to affordable, quality health insurance.

Though the amendment seeks to bring Republicans closer to the 216 votes needed for the health care bill to pass, members have yet to see the legislative text.

A vote next week—occurring at the same time Congress debates a government spending bill—would give lawmakers little time to read the plan.

“My first instinct is that if you don’t give me time to read something, there’s probably something there that I’m not going to like, and that’s why you’re rushing it through,” Rep. Andy Biggs, R-Ariz., told The Daily Signal. “I prefer that you give us time to read it.”

Biggs, a member of the Freedom Caucus, said he still has questions about the plan, which resembles an offer put forth by Vice President Mike Pence before Republicans departed for their home districts for Easter recess.

“As what I’d like to call a new federalist, I don’t think that states should be having to clamor and jump through whatever hoops the federal government insists upon in order to make the decisions for their citizens,” Biggs said, referring to the waiver process. “I happen to like and respect [HHS Secretary] Tom Price immensely, but that doesn’t mean the next person will share that same approbation from me. [States] are going to be reliant on whoever that is, even under a Republican regime. That’s a problem.”

According to the Huffington Post, Republican leadership in the House and Senate continue to review the amendment.

But the White House is pushing for the House to vote on the newly revised plan next week, and Republicans are expected to discuss the path forward on a conference call Saturday.

During an interview with Fox News on Wednesday night, White House press secretary Sean Spicer said there’s a “potential” that Republicans revive their efforts to repeal Obamacare before Trump’s 100th day in office, April 29.

“I know that our team has continued to work with members of the House in particular to see if there’s a way forward,” Spicer said. “And fortunately for us, I think the appetite to really get this done continues to grow.”

Ryan, too, said his conference continues to make progress on a plan. During a speech in London on Wednesday, the speaker said Republicans are “very close” to agreeing on a bill that can pass the lower chamber.

The post What’s in the New Obamacare Deal That Could Unite Conservatives, Centrists appeared first on The Daily Signal.