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More Texans May be Left Without Health Insurance After End of Open Enrollment

Open enrollment for health care under former President Barack Obama’s health care law ends Dec. 15, and while current Texas enrollment numbers are up from this time last year, new restrictions under the Trump administration may mean more uninsured Texans.

Under the Affordable Care Act, individuals who are not insured through an employer can buy plans through the federal government during the open enrollment period. In 2016, that period ran from Nov. 1 to Jan. 31 — but this year, it’s been cut in half to end Friday, Dec. 15.

While several states opted to extend the enrollment period, Texas, which runs its services through the federal healthcare.gov webpage, did not.

Texas has seen 437,919 enrollees for the 2018 plan year as of Dec. 2, according to the Centers for Medicare and Medicaid Services — a 38.8 percent increase in enrollment when compared to this time last year. But that’s not much of a comfort to organizations trying to get more people enrolled.

“We only have half as much time to enroll people,” said Melissa McChesney, an outreach coordinator at the Center for Public Policy Priorities, a left-leaning think tank. “So we would have to be doing significantly better than we are right now in order to avoid a dip in enrollment numbers overall.”

“There is concern that we will see fewer Texans enroll in the marketplace, and that’s primarily because of the shortened enrollment period, and that does mean we are likely to see a higher number of uninsured Texans for 2018,” McChesney added.

Last year, a total of 1.2 million Texans bought insurance during the enrollment period, about one-sixth of whom were automatically enrolled after not changing their coverage from the previous year, McChesney said.

Karen Pollitz, a senior fellow at the Kaiser Family Foundation, a health care nonprofit, said that in previous years enrollment has surged just before Dec. 15.

“Most people last year, in all the states, signed up by Dec. 15 even though open enrollment went all the way until the end of January because if you want coverage to begin on Jan. 1, that was the deadline,” Pollitz said.

However, shortening the window to enroll is not the only cut made by the Trump administration affecting Texans trying to buy health insurance.

The administration cut the budget for outreach and advertising by 90 percent and slashed funding to the navigator program, in which someone walks potential buyers through the process, by 60 percent. Supporters of the Affordable Care Act said these cuts have led to a decrease in awareness about the enrollment period.

Drew White, a health care policy expert at the conservative Texas Public Policy Foundation, said these restrictions were the administration’s attempts to roll back aspects of the law within their power.

“We don’t believe there is a whole lot they can do,” White said, referring to the president’s executive powers. “Congress is going to have to be the one to repeal the statutes when it comes to the regulations or to roll back the Medicaid expansion, that’s just going to be out of their purview.”

“Congress should have made good on its promise and repealed Obamacare this year as they have been promising for seven, eight years prior to that,” White said. “It’s just unfortunate because consumers are going to see their premiums and deductibles go up with fewer and fewer options as long as federal insurance regulations remain in statute.”

While it hasn’t been heavily publicized, Pollitz said there will be a special enrollment period through the end of December for people who are living in or have moved out of hurricane-affected areas. People wishing to enroll during this period will have to do so over the phone, she added.

“I think everybody, CMS [Centers for Medicare and Medicaid Services], the navigators, the other people who help folks sign up really, really want the message to be, ‘Sign up by Dec. 15. That is the best way to do it,’” Pollitz said. “Some people will need more time, or miss it, and will have this opportunity.”

In Congress, Republicans are promising to pass a new tax code by Christmas, and the current U.S. Senate plan includes a repeal of the portion of the ACA that requires all individuals to have health insurance.

The Congressional Budget Office, a nonpartisan congressional analysis organization, estimates that if the individual mandate is repealed, 13 million Americans will lose their health insurance in the next 10 years and that plans will have higher premiums as younger, healthier individuals opt to go without coverage.

McChesney said even if it’s repealed, the individual mandate would still be in effect until 2019.

“It’s important that people understand, who are considering purchasing ACA insurance right now, that they are still subject to the mandate and could potentially face a tax penalty if they go uninsured in 2018,” she said.

Disclosure: The Center for Public Policy Priorities, Kaiser Family Foundation and Texas Public Policy Foundation have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.

Read related Tribune coverage:

  • Texas is pushing the federal government for temporary funding for the Children’s Health Insurance Program while Congress fights over a permanent solution. [Full story]
  • Open enrollment for health insurance, which begins Nov. 1, will be shorter this year, and President Donald Trump has slashed funding for subsidies and outreach. [Full story]
  • Watch the video of our event in Houston on the health care landscape following Hurricane Harvey, or check out our recap below. [Full story]

Author: CLAIRE ALLBRIGHT – The Texas Tribune

Video: Cornyn – Democrats Refuse to Help Fix Health Care Mess They Created

Wednesday on the Senate floor, U.S. Senator John Cornyn (R-TX) invited his Democratic colleagues to join the effort to provide relief for the millions of Americans hurt by the Affordable Care Act.

Excerpts of Sen. Cornyn’s remarks are below, and video of his remarks can be found above.

“Yesterday, we took a giant step toward delivering on our promise to the American people to provide relief from the failures of the Affordable Care Act, otherwise known as Obamacare.

“Over the last seven years, we have discussed what our solution would look like. And everybody who has been willing to participate in that conversation – sadly, not our Democratic colleagues who simply refused to do so – but every member of our conference is engaged in discussions and had input on how best to accomplish the goal of providing people affordable coverage, increased access, market stability, and better care.

“You know, we can talk about all of the details, but basically, what this boils down to is how do we provide people with access to quality, affordable health care?”

“What we’ve tried to do on this side of the aisle, and we’ve repeatedly invited our Democratic colleagues to join us because, optimally, this would be a bipartisan effort, but so far they’ve refused to participate whatsoever and really are focused solely on trying to blow up the current process.”

“I know members have a lot of ideas about how to fix the mess that Obamacare has left us, but that was precisely why it was so important for us to get on the bill yesterday, so members on both sides of the aisle can offer amendments and share their ideas.”

“Last night we began the process of considering amendments, including one from my colleague in Texas, Senator Cruz, who has a plan to provide people who choose a lower-cost premium insurance product the opportunity to do so as long as the state also requires a comprehensive plan as well. This is something ideal for many people who want an insurance safety net but don’t necessarily want their health insurance to pay for their regular medical expenses or doctor visits.”

“People keep talking about a secret process. Well, this is about as open and transparent as it gets, and everybody will have an opportunity to offer an amendment, to discuss what’s in the amendment, and to vote on it.”

NM Group Slams Obamacare Replacement Bill Ahead of Senate Debate

ALBUQUERQUE – Senate GOP leaders won’t return to Washington, D. C., until Monday to renew debate on the replacement for Obamacare. That hasn’t stopped opponents of the proposed bill from protesting, in New Mexico and cities across the country.

In Albuquerque last week, Bill Jordan with New Mexico Voices for Children – the group’s senior policy advisor and government relations officer – joined Sen. Martin Heinrich, D-N.M., at an outdoor news conference at the University of New Mexico.

According to Jordan, 300,000 New Mexico children now rely on Medicaid for health care because the state has been very successful in implementing Obamacare.

“We’ve done better than almost any state,” Jordan told the crowd, “and this bill would hurt us more than almost any other state.”

New Mexico is one of eight states with a “trigger” law to automatically undo the Obamacare Medicaid expansion if there’s any reduction in federal financial support. In order to shoulder a larger share of health-care costs for low-income residents, Jordan said the state would need to implement substantial tax increases or slash other essential state services.

He pointed out that New Mexico’s Medicaid services have already been trimmed due to the state’s 2017 budget woes. So, while other, wealthier states might be able to pick up some Medicaid costs to offset the loss of federal dollars, New Mexico isn’t one of them.

As he put it, “These are kids whose families have no other option for health care. There is nothing else. There is no other payer source.”

Jordan added that more than 70 percent of births reported in the state are paid for by Medicaid.

The Congressional Budget Office has estimated nationwide, 22 million more Americans would be without insurance in 10 years if the Senate bill is passed in its current form.

Author:  Roz Brown -Public News Service (NM)

CBO Report: 23 Million to Lose Coverage Under AHCA

AUSTIN, Texas – The Congressional Budget Office says 23 million Americans would lose their health insurance by 2026 if the American Health Care Act becomes law. Some 14 million of those 23 million would lose coverage because of plans to cut Medicaid by $884 billion.

Andy Slavitt, a senior adviser with the Bipartisan Policy Center, says states including Texas would have a hard time making up for a loss of federal Medicaid dollars.

“Kids, seniors, people with disabilities, low-income people lose their benefits,” he says. “I think we’d see hospitals have their ERs flooded again with patients who are not paying. It would obviously have a negative impact on the economy.”

The CBO predicts the uninsured rate would increase from 10 percent to close to 18 percent in the next decade. Texas already has the highest rate of uninsured people in the country.

The AHCA narrowly passed in the U.S. House earlier this month. Some Senate Republicans have promised that Medicaid recipients would be protected under the new law.

The CBO says the Republican plan could lower premiums by four to 20 percent by 2026. Slavitt notes those reductions would come at the expense of rising costs for low-income people as well as those with pre-existing conditions.

The plan also has a so-called “age tax,” which means Texans and others aged 50 to 64 would pay much higher premiums.

“Under the new law, if it were to pass, people who were in that age group would be able to be charged five times as much for insurance as younger people – in some cases, as much as $7,000 of additional costs to get covered,” he adds.

Proponents of the plan argue that block-granting Medicaid funds to states would spark innovative solutions. Slavitt disagrees.

“This really is about the federal government saving money – cutting the money that they give to states for care, and then taking that money and turning around and providing a tax break to very high-income people, the insurance companies, pharmaceutical companies,” he explains.

The CBO estimates the Republican bill could cut the federal deficit by $119 billion in 10 years.

The Congressional Budget Office says 23-million Americans would lose their health insurance by 2026 if the American Health Care Act becomes law. Mark Richardson looks at who is most at risk.

Author: Mark Richardson – Public News Service (TX)

Cornyn, Cruz, Hurd, O’Rourke Comment on Passage of American Health Care Act

After Thursday’s passage of the American Health Care Act, local and statewide representatives released statements regarding the vote.

Rep. Beto O’Rouke (via Facebook)

Today I voted against the American Health Care Act (AHCA). Like the original version of the bill, which failed to garner enough support for a vote in March, AHCA seeks to replace the Affordable Care Act (ACA) with a system of tax credits and Medicaid block grants.

In the March version of the bill we knew that:

– 81,000 fewer El Pasoans would have health care

– 2.5 million fewer Texans would have health care

– 24 million fewer Americans would have health care

– Americans would see premium increases of 15–20% in 2018 and 2019

– Millions of veterans not enrolled in the VA would lose health care

– Fewer resources would be available to combat the opioid crisis

– There would be no requirement for mental health parity

– Women’s reproductive health would be defunded

The most notable changes to this version of the bill are two amendments. First, the McArthur Amendment, which allows states to determine the minimum coverage in the health care plans they offer. Currently, the ACA requires insurers to cover a host of essential health benefits like hospital stays, mental health, and maternity care. This amendment will allow insurers to consider health status when setting prices. This will directly impact patients with pre-existing conditions and older Americans who will be charged more for coverage.

The second amendment is the Upton Amendment. It adds $8 billion over 5 years to the bill to help those with pre-existing conditions pay for their insurance and health care needs. Unfortunately that is nowhere near enough and if implemented many people will soon find it difficult to pay for their health care needs.

There has been no updated analysis of this new version of the bill because it was rushed through without an official score from the Congressional Budget Office.

I voted against the bill which passed the House by a vote of 217-213. It now goes to the Senate where it meets an uncertain fate.

Rep. Will Hurd

“Since the implementation of Obamacare, I’ve told my constituents that the only meaningful metric when it comes to healthcare is actual access to quality, affordable care – not just health insurance. While the goal of Obamacare was to make healthcare more accessible and more affordable, it has done just the opposite. Likewise, while the goal of the American Health Care Act was to combat the skyrocketing premiums and outrageous deductibles millions of Americans face, it too, falls short.

“We must provide relief, but unfortunately, the American Health Care Act (AHCA) in its current form does not address the concerns of many of my constituents, including adequate protections for those with pre-existing conditions and the challenges faced by rural healthcare providers. I am unable to turn my back on these vulnerable populations because I believe we can and must do better for the American people.

“I will not support the AHCA in its current form and hope that we can continue making improvements to fix our broken healthcare system.”

Sen. John Cornyn

“Today is an important step forward in upholding our promise to give the American people relief from Obamacare,” Sen. Cornyn said. “The health care status quo is unacceptable. Premiums have skyrocketed, coverage options have disappeared, and small businesses have struggled under crushing taxes and mandates. Working alongside the Administration, making health care more affordable and accessible for all Americans will continue to be our top priority and this legislation sets us on a course to achieve that.”

Sen. Ted Cruz

“Today was an important step. I am encouraged that House Republicans were able to come together and pass a bill to repeal and replace Obamacare. The House Freedom Caucus pressed hard to reduce premiums and make health care more affordable, and their efforts, in cooperation with the entire conference, substantially improved this bill.

“Our work now goes forward in the Senate, where we should continue to improve the bill. For many weeks, I have been working closely with my Senate colleagues, from across the ideological spectrum, on consensus reforms to make health insurance more affordable. We must deliver on that promise. I am optimistic we will get the job done, and honor our commitment to provide more choices for consumers, put people in control of their healthcare, and most importantly, lower premiums.”

Texas Groups Oppose Congress’ Second Try at Health Care Bill

AUSTIN – Congress could vote on a new version of the GOP’s American Health Care Act as early as this weekend, but a group of Texas health-care advocates is strongly opposing the bill. The proposal still makes insurance more expensive for older Americans, would strip an estimated 24 million people of coverage and lead to deep cuts in Medicaid.

Adriana Kohler, senior health policy associate with Texans Care for Children, believes the Republican majority in the House has managed to make an already bad health-care bill worse.

“This bill would give the option to states to take away protections for consumers, for kids, for pregnant women, for people with disabilities,” she said. “So, we strongly oppose the bill and state measures to opt into what might pass.”

The coalition, Cover Texas Now, includes advocates for children, families, patients and consumers. Kohler says the group is urging Congress to keep most parts of the current Affordable Care Act and make improvements where they’re needed.

Proponents of the changes say they’ll give states more flexibility.

Kohler says the changes proposed in the new health-care bill would make it harder for Texans who need coverage the most to get insurance.

“A new amendment to the bill would also let states strip protections for preexisting conditions,” she added. “That means insurers could discriminate and hike premiums based on your medical history.”

In her view, many of the changes would negatively affect families with kids. The bill would cut already-scarce Medicaid benefits in Texas, which Kohler says endangers both children and pregnant women.

“We urge Congress to go back to the drawing board and improve upon this plan,” said Kohler. “If you care about prenatal care or kids going to school healthy, then the Medicaid cuts for Texas in this bill are terrible news.”

President Trump has urged Congress to pass a health-care bill before his first 100 days in office are up this weekend. The original “repeal and replace” plan considered two weeks ago lacked support and was never brought up for a vote.

Author: Mark Richardson, Public News Service (TX)

NM Rally Planned for Saturday’s Health Care “Day of Action”

ALBUQUERQUE, N.M. –With the Republican Party trying to decide how to resuscitate its plan to replace the Affordable Care Act, the debate over how to fix health care in the U.S. is heating up again.

As Congress goes on another recess starting April 8, some in Albuquerque will be part of a National Day of Action to advocate for “Medicare for All.” Bob Kuning is the rally organizer in New Mexico, sponsored by the group Progressive Democrats of America. He said too many people are struggling for health care in the Land of Enchantment.

“We’re a state that has a lot of poverty and a lot of people living below poverty lines who can’t afford the ACA, let alone what the Republicans are trying to pass in the House now,” Kuning said.

He said he’s one of many people who have decided that expanding the Medicare program to cover all Americans – not just those 65 and older – is a good solution. Critics have said it would be too costly, but independent analysis of similar legislation found that 95 percent of U.S. households would pay less than the current system of insurance premiums, deductibles and co-pays.

About 12 percent of people in New Mexico are uninsured. Glenn Pearson, former president of Physicians for a National Health Program, said the failure of the American Health Care Act presents a unique opportunity for President Donald Trump to make good on campaign promises for more coverage and better benefits by moving beyond for-profit models.

“America is the only wealthy country in the world that has a free market, for-profit system,” Pearson said. “It treats health care as a commodity, like buying a TV. In every other country, health care is a human right.”

Pearson noted that the Medicare for All Act – introduced by Michigan Representative John Conyers – would provide immediate and comprehensive coverage to all Americans.

Author: Brett McPherson – Public News Service (NM)

Report: Texas Rural Health Care Faces Funding Crisis

AUSTIN, Texas – A new report warns that rural hospitals in Texas could be hit hardest under a Congressional plan to repeal and replace the Affordable Care Act.

It found that proposed funding cuts to the Medicaid program, which already is operating at a minimal level in Texas, could force many rural hospitals to close, leaving hundreds of thousands of people without reasonable access to health care.

David Pearson, director of the Texas Organization of Rural and Community Hospitals, which produced the study, said a new round of funding cuts could devastate the state’s already challenged rural health-care system.

“Continual reduction in reimbursements and available financial resources, either at the state or the federal level, have just gotten to the point where a lot of small hospitals are unsustainable,” said Pearson. “They don’t have the local tax support to make up that difference.”

According to the report, the state’s rural health-care system faces declining reimbursement rates along with rising health-care costs, and Texas already has the highest uninsured rate in the United States.

When Texas lawmakers did not expand Medicaid under the ACA, Pearson said, it put dozens of rural hospitals on the critical list.

He said 16 rural hospitals in Texas have closed since 2013, with an increasing number in financial distress. Pearson also explained that a proposed plan to fund Medicaid through block grants would only shift the financial burden of rural health care to those who can least afford it.

“Local governments and/or local tax districts already fund a large share of Medicaid,” he said. “The tax base in a rural area just isn’t large enough to be able to generate the kind of revenue that would be needed to offset that reduction.”

Pearson said when a rural hospital closes, it creates a damaging ripple effect in the local economy. He added that Texas isn’t the only state facing a rural health-care crisis.

“This really is a national crisis,” he warned. “Unfortunately, Texas leads the way as far as the number of closures, but closures across the country in rural areas are really starting to add up.”

The report, which was completed before the Republicans’ current American Health Care Act was released, was sponsored by the nonprofit Episcopal Health Foundation.

Author: Mark Richardson – Texas News Service

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