Reporting Live from Houston, Texas
I’ve been here with family for close to three weeks; it’s my sixth trip. The people are delightful, and the medical care is superb. Houston is one of the nation’s medical meccas, and the home of M D Anderson Cancer Center, probably the best place in America to get care if you have cancer.
Patients are here from all over the country; they come from every economic strata and every ethnic group; their quiet courage facing the challenges of their diseases is extraordinary and infectious. The staff, the nurses, the doctors and mid-level practitioners are utterly dedicated to their patient care mission.
Since the election, I hear lots of quiet conversations in the hospital lounges and the surrounding restaurants with patients and family members wondering what President-elect Trump will try to do to their coverage. In his campaign he said “repeal and replace” the Affordable Care Act (ACA) so that Americans would have the very best health care system in the world.
So here’s the rub; cancer care is enormously expensive. A month’s supply of certain medicines can run you $7,000 and more; a bone marrow transplant is over $200,000, and a year’s worth of care not uncommonly costs over $1 million; imagine that spread over several years of treatment. Unless you have the financial resources of President-elect Trump, how do you pay for that? Health insurance -- but only if you have it, and it covers your condition and treatment.
Under the ACA, pre-existing condition exclusions by insurance companies were banned so cancer patients can no longer be excluded from individual or employer coverage or charged higher premiums due to their cancer diagnosis or have treatments for their cancer excluded from coverage. A minimum benefits package, including doctors, hospitals and prescription drugs, was established so all the services needed by cancer patients were covered. The annual and lifetime benefits cap of some health plans were eliminated so cancer patients no longer found themselves with no coverage when their costs exceeded for example, a million dollars. And patient out of pocket expenditures were capped so that individuals were fully covered once their out of pocket on copays and deductibles reached $6250. The ACA also covered preventive and primary care to detect and treat cancer early before its spread makes the disease far less curable and treatment far more costly.
Before his election, candidate Trump said very little beyond ACA repeal, criticizing the recent premium increases in Exchange plans, shifting Medicaid into state block grants, and eliminating state restrictions on the interstate sale of health insurance. Since his election, President-elect Trump has mentioned that he wants to retain the ACA’s ban on pre-existing condition exclusions and the ACA option for adult children to stay on their parent’s plan until age 26, but has not said not much else.
Ultimately, the President, Senate and House will decide the future of America’s health system. Here is a quick summary of what Speaker Ryan and President-elect Trump have proposed on their web sites to date. Changes are proposed for Medicare, Medicaid, employment-based coverage and individual coverage; federal financing will be reduced and the costs shifted to individuals.
Medicare federal program for seniors and the disabled that covers hospitals, doctors and prescriptions.
· ACA (Affordable Care Act): Closes donut hole for prescription drug coverage and adds coverage for preventive services; reforms provider and plans’ payments; caps growth in per capita spending
· Speaker Ryan: Changes eligibility from 65 to age 67; moves to vouchers for younger Americans; repeals provider and plan payment reforms. The amount of the vouchers for each enrollee would grow consistent with the CPI, but no more. Creates Exchanges for seniors to purchase their coverage.
· President-elect Donald Trump: Repeals ACA benefit expansions and payment reforms.
Medicaid: state-federal program for the poor that covers hospitals, doctors, prescriptions and nursing home care
· ACA (Affordable Care Act): Expands coverage to all low-income persons under 138% of FPL, except the undocumented. States can decide whether and how much to expand. The federal government pays 100% of the costs of the coverage expansions, slowly declining to 90% by 2020 and thereafter.
· Ryan: Gives states a choice between a federal Medicaid block grant (state has complete flexibility as to who is covered and for what services and how much providers are paid) or a per capita cap (the growth in federal payments per person eligible for the program are capped at the growth in the CPI).
· Trump: Repeals ACA expansion and block grants the program to the states – 72 million+ Americans lose their entitlement to coverage.
Employment-based coverage (large and medium sized employers) must cover hospital, doctor and prescription services for full time employees and dependent children
· ACA: Employer mandate for large and medium sized employers to offer and pay for a portion of basic coverage for full time employees and dependent children; Cadillac benefits tax on excessively costly plans
· Ryan: Repeals employer mandate; revises Cadillac benefits tax
· Trump: Repeals employer mandate and Cadillac benefits tax
Employment-based coverage (small businesses under 50 employees may but are not required to offer coverage for hospitals, doctors and prescriptions)
· ACA: Tax credits for low wage small employers who offer coverage; purchasing pools (SHOP) and insurance underwriting reforms to assure availability and continuity of basic coverage regardless of the employee’s medical conditions.
· Ryan: Repeals tax credits, SHOP exchanges and underwriting reforms.
· Trump: Repeals all ACA improvements for small employers
Individual coverage (for the self employed, flex workers, early retirees, students, the unemployed, the disabled and employees who are not offered coverage through the workforce) must cover hospitals, doctors and prescriptions
· ACA: Individual responsibility (mandate) to be insured, exchanges to pool individuals’ purchasing power and negotiate price, refundable tax credits to assure affordability, and insurance underwriting reforms to assure availability and continuity of basic coverage and to eliminate pre-existing coverage exclusions
· Ryan: Repeals individual mandate; replaces refundable tax credits; repeals all insurance under-writing reforms; enacts high risk pools for those with pre-existing conditions
· Trump: Repeals all ACA improvements; expands tax deductibility and tax advantaged HSAs and allows interstate sale of coverage.
Financing (federal government subsidizes Medicare, Medicaid, employer coverage and coverage for individuals earning less than 400% of FPL -- $97,000 for a family of four)
· ACA coverage expansions: Financed ½ by cuts in program reimbursements and ½ by increased taxes on the wealthy, the health plans, the drug and device industries
· Ryan: Repeals all ACA financing, but retains modified Cadillac benefits tax
· Trump: Repeals all financing for the ACA.
Over the past three years, the ACA has reduced the nation’s uninsured by about half, 20 to 25 million more Americans are now insured through the Medicaid expansions, the Exchanges, parental coverage and the employer plans. It has upgraded coverage for those with Medicare and employment-based coverage. It has assured availability, improved affordability and guaranteed renewability of individual coverage. All may lose their new coverage and the improvements in their existing coverage under the Trump and Ryan proposals; the new Medicare benefits and payment reforms could be reduced; individual entitlements to Medicaid coverage could be eliminated; tax credits to make individual coverage more affordable could be discontinued; the scope of employers’ required coverage for their full time employees and dependents could be eliminated, and insurer’s ability to make pre-existing condition exclusions for cancer and other diseases and conditions could be restored. We cannot afford to lose the important progress that has been made.
Republican leaders and President-elect Trump have indicated that repealing the ACA is among their top priorities for very quick action when the next session in Congress begins in January. However they have not yet agreed upon a replacement plan, nor have they disclosed and described it to the interested public. Patients and their family members, doctors, hospitals, boards of trustees, and health plans will need to learn what is afoot behind the closed door discussions and make their voices heard loud and clear and continuously starting now on the types of reform they prefer and those they reject.
References: http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf; Summaries of the House Republican and Trump Plans at www.luciensblog.com derived from their respective web sites.
Reporting Live from Houston, Texas
I’ve been here with family for close to three weeks; it’s my sixth trip. The people are delightful, and the medical care is superb. Houston is one of the nation’s medical meccas, and the home of M D Anderson Cancer Center, probably the best place in America to get care if you have cancer.
Patients are here from all over the country; they come from every economic strata and every ethnic group; their quiet courage facing the challenges of their diseases is extraordinary and infectious. The staff, the nurses, the doctors and mid-level practitioners are utterly dedicated to their patient care mission.
Since the election, I hear lots of quiet conversations in the hospital lounges and the surrounding restaurants with patients and family members wondering what President-elect Trump will try to do to their coverage. In his campaign he said “repeal and replace” the Affordable Care Act (ACA) so that Americans would have the very best health care system in the world.
So here’s the rub; cancer care is enormously expensive. A month’s supply of certain medicines can run you $7,000 and more; a bone marrow transplant is over $200,000, and a year’s worth of care not uncommonly costs over $1 million; imagine that spread over several years of treatment. Unless you have the financial resources of President-elect Trump, how do you pay for that? Health insurance -- but only if you have it, and it covers your condition and treatment.
Under the ACA, pre-existing condition exclusions by insurance companies were banned so cancer patients can no longer be excluded from individual or employer coverage or charged higher premiums due to their cancer diagnosis or have treatments for their cancer excluded from coverage. A minimum benefits package, including doctors, hospitals and prescription drugs, was established so all the services needed by cancer patients were covered. The annual and lifetime benefits cap of some health plans were eliminated so cancer patients no longer found themselves with no coverage when their costs exceeded for example, a million dollars. And patient out of pocket expenditures were capped so that individuals were fully covered once their out of pocket on copays and deductibles reached $6250. The ACA also covered preventive and primary care to detect and treat cancer early before its spread makes the disease far less curable and treatment far more costly.
Before his election, candidate Trump said very little beyond ACA repeal, criticizing the recent premium increases in Exchange plans, shifting Medicaid into state block grants, and eliminating state restrictions on the interstate sale of health insurance. Since his election, President-elect Trump has mentioned that he wants to retain the ACA’s ban on pre-existing condition exclusions and the ACA option for adult children to stay on their parent’s plan until age 26, but has not said not much else.
Ultimately, the President, Senate and House will decide the future of America’s health system. Here is a quick summary of what Speaker Ryan and President-elect Trump have proposed on their web sites to date. Changes are proposed for Medicare, Medicaid, employment-based coverage and individual coverage; federal financing will be reduced and the costs shifted to individuals.
Medicare federal program for seniors and the disabled that covers hospitals, doctors and prescriptions.
· ACA (Affordable Care Act): Closes donut hole for prescription drug coverage and adds coverage for preventive services; reforms provider and plans’ payments; caps growth in per capita spending
· Speaker Ryan: Changes eligibility from 65 to age 67; moves to vouchers for younger Americans; repeals provider and plan payment reforms. The amount of the vouchers for each enrollee would grow consistent with the CPI, but no more. Creates Exchanges for seniors to purchase their coverage.
· President-elect Donald Trump: Repeals ACA benefit expansions and payment reforms.
Medicaid: state-federal program for the poor that covers hospitals, doctors, prescriptions and nursing home care
· ACA (Affordable Care Act): Expands coverage to all low-income persons under 138% of FPL, except the undocumented. States can decide whether and how much to expand. The federal government pays 100% of the costs of the coverage expansions, slowly declining to 90% by 2020 and thereafter.
· Ryan: Gives states a choice between a federal Medicaid block grant (state has complete flexibility as to who is covered and for what services and how much providers are paid) or a per capita cap (the growth in federal payments per person eligible for the program are capped at the growth in the CPI).
· Trump: Repeals ACA expansion and block grants the program to the states – 72 million+ Americans lose their entitlement to coverage.
Employment-based coverage (large and medium sized employers) must cover hospital, doctor and prescription services for full time employees and dependent children
· ACA: Employer mandate for large and medium sized employers to offer and pay for a portion of basic coverage for full time employees and dependent children; Cadillac benefits tax on excessively costly plans
· Ryan: Repeals employer mandate; revises Cadillac benefits tax
· Trump: Repeals employer mandate and Cadillac benefits tax
Employment-based coverage (small businesses under 50 employees may but are not required to offer coverage for hospitals, doctors and prescriptions)
· ACA: Tax credits for low wage small employers who offer coverage; purchasing pools (SHOP) and insurance underwriting reforms to assure availability and continuity of basic coverage regardless of the employee’s medical conditions.
· Ryan: Repeals tax credits, SHOP exchanges and underwriting reforms.
· Trump: Repeals all ACA improvements for small employers
Individual coverage (for the self employed, flex workers, early retirees, students, the unemployed, the disabled and employees who are not offered coverage through the workforce) must cover hospitals, doctors and prescriptions
· ACA: Individual responsibility (mandate) to be insured, exchanges to pool individuals’ purchasing power and negotiate price, refundable tax credits to assure affordability, and insurance underwriting reforms to assure availability and continuity of basic coverage and to eliminate pre-existing coverage exclusions
· Ryan: Repeals individual mandate; replaces refundable tax credits; repeals all insurance under-writing reforms; enacts high risk pools for those with pre-existing conditions
· Trump: Repeals all ACA improvements; expands tax deductibility and tax advantaged HSAs and allows interstate sale of coverage.
Financing (federal government subsidizes Medicare, Medicaid, employer coverage and coverage for individuals earning less than 400% of FPL -- $97,000 for a family of four)
· ACA coverage expansions: Financed ½ by cuts in program reimbursements and ½ by increased taxes on the wealthy, the health plans, the drug and device industries
· Ryan: Repeals all ACA financing, but retains modified Cadillac benefits tax
· Trump: Repeals all financing for the ACA.
Over the past three years, the ACA has reduced the nation’s uninsured by about half, 20 to 25 million more Americans are now insured through the Medicaid expansions, the Exchanges, parental coverage and the employer plans. It has upgraded coverage for those with Medicare and employment-based coverage. It has assured availability, improved affordability and guaranteed renewability of individual coverage. All may lose their new coverage and the improvements in their existing coverage under the Trump and Ryan proposals; the new Medicare benefits and payment reforms could be reduced; individual entitlements to Medicaid coverage could be eliminated; tax credits to make individual coverage more affordable could be discontinued; the scope of employers’ required coverage for their full time employees and dependents could be eliminated, and insurer’s ability to make pre-existing condition exclusions for cancer and other diseases and conditions could be restored.
Republican leaders and President-elect Trump have indicated that repealing the ACA is among their top priorities for very quick action when the next session in Congress begins in January. However they have not yet agreed upon a replacement plan, nor have they disclosed and described it to the interested public. Patients and their family members, doctors, hospitals, boards of trustees, and health plans will need to learn what is afoot behind the closed door discussions and make their voices heard loud and clear and continuously starting now on the types of reform they prefer and those they reject.
References: http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf; Summaries of the House Republican and Trump Plans at www.luciensblog.com derived from their respective web sites.
Reporting Live from Houston, Texas
I’ve been here with family for close to three weeks; it’s my sixth trip. The people are delightful, and the medical care is superb. Houston is one of the nation’s medical meccas, and the home of M D Anderson Cancer Center, probably the best place in America to get care if you have cancer.
Patients are here from all over the country; they come from every economic strata and every ethnic group; their quiet courage facing the challenges of their diseases is extraordinary and infectious. The staff, the nurses, the doctors and mid-level practitioners are utterly dedicated to their patient care mission.
Since the election, I hear lots of quiet conversations in the hospital lounges and the surrounding restaurants with patients and family members wondering what President-elect Trump will try to do to their coverage. In his campaign he said “repeal and replace” the Affordable Care Act (ACA) so that Americans would have the very best health care system in the world.
So here’s the rub; cancer care is enormously expensive. A month’s supply of certain medicines can run you $7,000 and more; a bone marrow transplant is over $200,000, and a year’s worth of care not uncommonly costs over $1 million; imagine that spread over several years of treatment. Unless you have the financial resources of President-elect Trump, how do you pay for that? Health insurance -- but only if you have it, and it covers your condition and treatment.
Under the ACA, pre-existing condition exclusions by insurance companies were banned so cancer patients can no longer be excluded from individual or employer coverage or charged higher premiums due to their cancer diagnosis or have treatments for their cancer excluded from coverage. A minimum benefits package, including doctors, hospitals and prescription drugs, was established so all the services needed by cancer patients were covered. The annual and lifetime benefits cap of some health plans were eliminated so cancer patients no longer found themselves with no coverage when their costs exceeded for example, a million dollars. And patient out of pocket expenditures were capped so that individuals were fully covered once their out of pocket on copays and deductibles reached $6250. The ACA also covered preventive and primary care to detect and treat cancer early before its spread makes the disease far less curable and treatment far more costly.
Before his election, candidate Trump said very little beyond ACA repeal, criticizing the recent premium increases in Exchange plans, shifting Medicaid into state block grants, and eliminating state restrictions on the interstate sale of health insurance. Since his election, President-elect Trump has mentioned that he wants to retain the ACA’s ban on pre-existing condition exclusions and the ACA option for adult children to stay on their parent’s plan until age 26, but has not said not much else.
Ultimately, the President, Senate and House will decide the future of America’s health system. Here is a quick summary of what Speaker Ryan and President-elect Trump have proposed on their web sites to date. Changes are proposed for Medicare, Medicaid, employment-based coverage and individual coverage; federal financing will be reduced and the costs shifted to individuals.
Medicare federal program for seniors and the disabled that covers hospitals, doctors and prescriptions.
· ACA (Affordable Care Act): Closes donut hole for prescription drug coverage and adds coverage for preventive services; reforms provider and plans’ payments; caps growth in per capita spending
· Speaker Ryan: Changes eligibility from 65 to age 67; moves to vouchers for younger Americans; repeals provider and plan payment reforms. The amount of the vouchers for each enrollee would grow consistent with the CPI, but no more. Creates Exchanges for seniors to purchase their coverage.
· President-elect Donald Trump: Repeals ACA benefit expansions and payment reforms.
Medicaid: state-federal program for the poor that covers hospitals, doctors, prescriptions and nursing home care
· ACA (Affordable Care Act): Expands coverage to all low-income persons under 138% of FPL, except the undocumented. States can decide whether and how much to expand. The federal government pays 100% of the costs of the coverage expansions, slowly declining to 90% by 2020 and thereafter.
· Ryan: Gives states a choice between a federal Medicaid block grant (state has complete flexibility as to who is covered and for what services and how much providers are paid) or a per capita cap (the growth in federal payments per person eligible for the program are capped at the growth in the CPI).
· Trump: Repeals ACA expansion and block grants the program to the states – 72 million+ Americans lose their entitlement to coverage.
Employment-based coverage (large and medium sized employers) must cover hospital, doctor and prescription services for full time employees and dependent children
· ACA: Employer mandate for large and medium sized employers to offer and pay for a portion of basic coverage for full time employees and dependent children; Cadillac benefits tax on excessively costly plans
· Ryan: Repeals employer mandate; revises Cadillac benefits tax
· Trump: Repeals employer mandate and Cadillac benefits tax
Employment-based coverage (small businesses under 50 employees may but are not required to offer coverage for hospitals, doctors and prescriptions)
· ACA: Tax credits for low wage small employers who offer coverage; purchasing pools (SHOP) and insurance underwriting reforms to assure availability and continuity of basic coverage regardless of the employee’s medical conditions.
· Ryan: Repeals tax credits, SHOP exchanges and underwriting reforms.
· Trump: Repeals all ACA improvements for small employers
Individual coverage (for the self employed, flex workers, early retirees, students, the unemployed, the disabled and employees who are not offered coverage through the workforce) must cover hospitals, doctors and prescriptions
· ACA: Individual responsibility (mandate) to be insured, exchanges to pool individuals’ purchasing power and negotiate price, refundable tax credits to assure affordability, and insurance underwriting reforms to assure availability and continuity of basic coverage and to eliminate pre-existing coverage exclusions
· Ryan: Repeals individual mandate; replaces refundable tax credits; repeals all insurance under-writing reforms; enacts high risk pools for those with pre-existing conditions
· Trump: Repeals all ACA improvements; expands tax deductibility and tax advantaged HSAs and allows interstate sale of coverage.
Financing (federal government subsidizes Medicare, Medicaid, employer coverage and coverage for individuals earning less than 400% of FPL -- $97,000 for a family of four)
· ACA coverage expansions: Financed ½ by cuts in program reimbursements and ½ by increased taxes on the wealthy, the health plans, the drug and device industries
· Ryan: Repeals all ACA financing, but retains modified Cadillac benefits tax
· Trump: Repeals all financing for the ACA.
Over the past three years, the ACA has reduced the nation’s uninsured by about half, 20 to 25 million more Americans are now insured through the Medicaid expansions, the Exchanges, parental coverage and the employer plans. It has upgraded coverage for those with Medicare and employment-based coverage. It has assured availability, improved affordability and guaranteed renewability of individual coverage. All may lose their new coverage and the improvements in their existing coverage under the Trump and Ryan proposals; the new Medicare benefits and payment reforms could be reduced; individual entitlements to Medicaid coverage could be eliminated; tax credits to make individual coverage more affordable could be discontinued; the scope of employers’ required coverage for their full time employees and dependents could be eliminated, and insurer’s ability to make pre-existing condition exclusions for cancer and other diseases and conditions could be restored.
Republican leaders and President-elect Trump have indicated that repealing the ACA is among their top priorities for very quick action when the next session in Congress begins in January. However they have not yet agreed upon a replacement plan, nor have they disclosed and described it to the interested public. Patients and their family members, doctors, hospitals, boards of trustees, and health plans will need to learn what is afoot behind the closed door discussions and make their voices heard loud and clear and continuously starting now on the types of reform they prefer and those they reject.
References: http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf; Summaries of the House Republican and Trump Plans at www.luciensblog.com derived from their respective web sites.