'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan
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Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines
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Cheat Sheet: How Would the Republican Health Plan Affect Me?
Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals
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Her work can also be heard on NPR, \u003cem>Here & Now, \u003c/em>and PRI. Before working in audio, she taught, leading groups of students abroad. One of her favorite jobs was teaching on the Thai-Burmese border, working with immigrants and refugees.\r\n\r\nLaura has won three Northern California Area Emmys along with her Deep Look colleagues. She's won the North Gate Award for Excellence in Audio Reporting and the Gobind Behari Lal Award for a radio documentary about adults with imaginary friends. She's a fellowship junkie, completing the USC Center for Health Journalism's California Fellowship, UC Berkeley's Human Rights Fellowship and the Coro Fellowship in Public Affairs. Laura has a master’s in journalism from UC Berkeley and a master’s in education from Harvard.\r\n\r\nShe likes to eat chocolate for breakfast. She's also open to eating it all day long.","avatar":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twitter":"lauraklivans","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["editor"]},{"site":"stateofhealth","roles":["contributor","editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"Laura Klivans | KQED","description":"Reporter and Host","ogImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lklivans"},"cfeibel":{"type":"authors","id":"11314","meta":{"index":"authors_1591205172","id":"11314","found":true},"name":"Carrie Feibel","firstName":"Carrie","lastName":"Feibel","slug":"cfeibel","email":"cfeibel@KQED.org","display_author_email":false,"staff_mastheads":[],"title":"KQED Contributor","bio":"Carrie Feibel is a former health editor at KQED, where she has also reported for radio and online. Her stories have appeared on the national NPR shows \u003cem>Morning Edition\u003c/em>, \u003cem>All Things Considered\u003c/em>, and \u003cem>Here & Now\u003c/em>, and on the national website, Kaiser Health News. Her print career included stints at the \u003cem>Houston Chronicle\u003c/em>, \u003cem>The (Bergen) Record,\u003c/em> and the Associated Press in New York City. A native of St. Louis, Feibel attended Cornell University, and earned a master's in journalism from Columbia University.","avatar":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twitter":"KQEDHealth","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"stateofhealth","roles":["administrator"]}],"headData":{"title":"Carrie Feibel | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/cfeibel"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_361160":{"type":"posts","id":"stateofhealth_361160","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361160","score":null,"sort":[1506368071000]},"guestAuthors":[],"slug":"devastating-cuts-to-come-how-california-would-suffer-under-gop-health-plan","title":"'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan","publishDate":1506368071,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>State officials are sounding the alarm over a last-minute push by Republican Senators to \"replace and replace\" the Affordable Care Act. Health officials warn it's the worst proposal yet, with California set to \u003ca href=\"http://www.dhcs.ca.gov/Documents/Graham_Cassidy_Impact_Memo_DHCS_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lose billions of dollars\u003c/a>.\u003c/p>\n\u003cp>\"Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,\" said Jennifer Kent, Director of the Department of Health Care Services.\u003c/p>\n\u003cp>The two previous plans debated in Congress only partially dismantled the structures that undergird the Affordable Care Act.\u003c/p>\n\u003cp>But the new Graham-Cassidy proposal would blow up those ACA structures, and retract the money that currently pays for them, starting in 2020. After lopping off more than $200 billion from the retracted money, the federal government would use a new formula to scatter the remaining funds across the 50 states and District of Columbia.\u003c/p>\n\u003cp>Prominent losers in this scenario include states like California that eagerly embraced the Affordable Care Act. Health consulting firm Avalere \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">predicts\u003c/a> 34 states and DC would experience funding cuts, and 16 states would see an increase.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What Graham-Cassidy does, starting in 2020:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends payments\u003c/span> for Medicaid expansion, which allowed 3.8 million Californians to join Medi-Cal.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends federal subsidies\u003c/span> for private insurance coverage sold through \"Covered California,\" which cover more than one million Californians.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Removes guarantees\u003c/span> that insurance plans cannot charge higher prices to patients with pre-existing conditions to pay more for coverage, or must offer plans that include a basic suite of services, such as prescriptions, maternity care, and mental health treatment. States could opt out of many of these protections, although most experts agree that California would try to maintain them.\u003c/p>\n\u003cp>But that could be an empty promise, warns Peter Lee, executive director of Covered California. Even if California continued the protections for sick people, the insurance market could collapse as healthy people stop buying coverage when federal subsidies end.\u003c/p>\n\u003cp>\u003cstrong>California's \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\" target=\"_blank\" rel=\"noopener noreferrer\">projected losses\u003c/a>:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Number of uninsured:\u003c/span> More than 10 million Californians will lose health coverage by 2027, according to an \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Potential_Impacts_Graham-Cassidy-9-25-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">new analysis \u003c/a>by Covered California. (UC Berkeley has a \u003ca href=\"http://laborcenter.berkeley.edu/projected-health-insurance-coverage-loss-by-county-2027-under-graham-cassidy/\" target=\"_blank\" rel=\"noopener noreferrer\">breakdown\u003c/a> by Congressional district and county).\u003c/p>\n\u003cp>\u003cem>That's nearly 1 in 4 Californians under age 65, worse than pre-Obamacare levels. \u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Federal funds loss:\u003c/span> Total losses for health care in California ratchet up to $28 billion/year by 2026, then increase dramatically to $57.5 billion a year later, in 2027. That's equivalent to more than a third of all General Fund spending in California's budget.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Medi-Cal changes:\u003c/span> In addition to changes to the Affordable Care Act, the Graham-Cassidy proposal radically changes how traditional Medicaid, dating back to 1965, is funded. 14 million Californians depend on Medi-Cal coverage, and it's particularly critical for people with disabilities and residents of nursing homes.\u003c/p>\n\u003cp>California stands to lose the most money of all the states.\u003c/p>\n\u003cp>Supporters of the new plan's redistribution formulas explain that it's a matter of fairness to all states.\u003c/p>\n\u003cp>“Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts, and Maryland,\" said Senator Lindsey Graham. \"Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government.”\u003c/p>\n\u003cp>Opponents of the repeal efforts point out that California gets more money under the law because it has the largest population in the country, and because it embraced the Affordable Care Act's funding opportunities.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Other states such as Texas didn't get as much money under the ACA not because the distribution wasn't fair, but because officials in those states refused to expand Medicaid to more residents, so they didn’t pull down the federal money to pay for that. Under the new plan, Texas will get $35 billion more in federal funds by 2026.\u003c/p>\n\n","blocks":[],"excerpt":"After a decade, more than 10 million Californians will lose insurance coverage as money moves to other states. ","status":"publish","parent":0,"modified":1506374897,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":650},"headData":{"title":"'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan | KQED","description":"After a decade, more than 10 million Californians will lose insurance coverage as money moves to other states. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361160 https://ww2.kqed.org/stateofhealth/?p=361160","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/09/25/devastating-cuts-to-come-how-california-would-suffer-under-gop-health-plan/","disqusTitle":"'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan","path":"/stateofhealth/361160/devastating-cuts-to-come-how-california-would-suffer-under-gop-health-plan","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>State officials are sounding the alarm over a last-minute push by Republican Senators to \"replace and replace\" the Affordable Care Act. Health officials warn it's the worst proposal yet, with California set to \u003ca href=\"http://www.dhcs.ca.gov/Documents/Graham_Cassidy_Impact_Memo_DHCS_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lose billions of dollars\u003c/a>.\u003c/p>\n\u003cp>\"Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,\" said Jennifer Kent, Director of the Department of Health Care Services.\u003c/p>\n\u003cp>The two previous plans debated in Congress only partially dismantled the structures that undergird the Affordable Care Act.\u003c/p>\n\u003cp>But the new Graham-Cassidy proposal would blow up those ACA structures, and retract the money that currently pays for them, starting in 2020. After lopping off more than $200 billion from the retracted money, the federal government would use a new formula to scatter the remaining funds across the 50 states and District of Columbia.\u003c/p>\n\u003cp>Prominent losers in this scenario include states like California that eagerly embraced the Affordable Care Act. Health consulting firm Avalere \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">predicts\u003c/a> 34 states and DC would experience funding cuts, and 16 states would see an increase.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Graham-Cassidy does, starting in 2020:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends payments\u003c/span> for Medicaid expansion, which allowed 3.8 million Californians to join Medi-Cal.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends federal subsidies\u003c/span> for private insurance coverage sold through \"Covered California,\" which cover more than one million Californians.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Removes guarantees\u003c/span> that insurance plans cannot charge higher prices to patients with pre-existing conditions to pay more for coverage, or must offer plans that include a basic suite of services, such as prescriptions, maternity care, and mental health treatment. States could opt out of many of these protections, although most experts agree that California would try to maintain them.\u003c/p>\n\u003cp>But that could be an empty promise, warns Peter Lee, executive director of Covered California. Even if California continued the protections for sick people, the insurance market could collapse as healthy people stop buying coverage when federal subsidies end.\u003c/p>\n\u003cp>\u003cstrong>California's \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\" target=\"_blank\" rel=\"noopener noreferrer\">projected losses\u003c/a>:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Number of uninsured:\u003c/span> More than 10 million Californians will lose health coverage by 2027, according to an \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Potential_Impacts_Graham-Cassidy-9-25-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">new analysis \u003c/a>by Covered California. (UC Berkeley has a \u003ca href=\"http://laborcenter.berkeley.edu/projected-health-insurance-coverage-loss-by-county-2027-under-graham-cassidy/\" target=\"_blank\" rel=\"noopener noreferrer\">breakdown\u003c/a> by Congressional district and county).\u003c/p>\n\u003cp>\u003cem>That's nearly 1 in 4 Californians under age 65, worse than pre-Obamacare levels. \u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Federal funds loss:\u003c/span> Total losses for health care in California ratchet up to $28 billion/year by 2026, then increase dramatically to $57.5 billion a year later, in 2027. That's equivalent to more than a third of all General Fund spending in California's budget.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Medi-Cal changes:\u003c/span> In addition to changes to the Affordable Care Act, the Graham-Cassidy proposal radically changes how traditional Medicaid, dating back to 1965, is funded. 14 million Californians depend on Medi-Cal coverage, and it's particularly critical for people with disabilities and residents of nursing homes.\u003c/p>\n\u003cp>California stands to lose the most money of all the states.\u003c/p>\n\u003cp>Supporters of the new plan's redistribution formulas explain that it's a matter of fairness to all states.\u003c/p>\n\u003cp>“Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts, and Maryland,\" said Senator Lindsey Graham. \"Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government.”\u003c/p>\n\u003cp>Opponents of the repeal efforts point out that California gets more money under the law because it has the largest population in the country, and because it embraced the Affordable Care Act's funding opportunities.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Other states such as Texas didn't get as much money under the ACA not because the distribution wasn't fair, but because officials in those states refused to expand Medicaid to more residents, so they didn’t pull down the federal money to pay for that. Under the new plan, Texas will get $35 billion more in federal funds by 2026.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361160/devastating-cuts-to-come-how-california-would-suffer-under-gop-health-plan","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_2808","stateofhealth_99","stateofhealth_2519","stateofhealth_3105"],"featImg":"stateofhealth_361209","label":"stateofhealth"},"stateofhealth_361137":{"type":"posts","id":"stateofhealth_361137","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361137","score":null,"sort":[1506114368000]},"guestAuthors":[],"slug":"a-tale-of-two-states-california-loses-and-texas-wins-under-gop-health-plan","title":"A Tale of Two States: California Loses and Texas Wins Under GOP Health Plan","publishDate":1506114368,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>California stands to lose billions in health care funding under the GOP’s latest plan to repeal and replace the Affordable Care Act, resulting in millions of Californians losing coverage.\u003c/p>\n\u003cp>The Graham-Cassidy legislation under discussion in the Senate would redistribute the funds now used to pay for the Affordable Care Act, effectively taking money from states that embraced all aspects of the law, like California, and redistributing it to other states, that didn't, like Texas.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains - those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, senior fellow at the \u003ca href=\"https://www.cbpp.org/\">Center on Budget and Policy Priorities\u003c/a>.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">The bill's Republican authors say redistributing the health funds is about fairness, and will give states more \"flexibility\" to redesign their own health systems.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">But health officials in California predict dire consequences if the measure were to pass.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,” top officials from the state Department of Health Care Services wrote in \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/09/graham_cassidy_impact_memo_dhcs_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis\u003c/a> released Friday. “If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs [and] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide.”\u003c/p>\n\u003cp> \u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">By 2026, California would lose $85.7 billion in federal funds, and by 2027 it would lose $138.8 billion, according to the analysis. That could cause 6.7 million Californians to lose insurance coverage, according to \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\">estimates\u003c/a> from the The UC Berkeley Labor Center.\u003c/p>\n\u003cp>A lot of those people are entrepreneurs or their employees. Under the Affordable Care Act in California, half a million self-employed entrepreneurs -- and a million employees who work for small businesses -- got health coverage because of the ACA, either through the expansion of Medi-Cal, or through a subsidized personal insurance plan on the state exchange, Covered California.\u003c/p>\n\u003cp>\"It would be very difficult for entrepreneurs and self employed folks to access some level of coverage,\" said Mark Herbert, California director for the \u003ca href=\"http://www.smallbusinessmajority.org/states/california\" target=\"_blank\" rel=\"noopener noreferrer\">Small Business Majority\u003c/a>. \"So it would be massively destabilizing to the ability of small employers to attract talent.\"\u003c/p>\n\u003cp>Beyond that, there would be damaging ripple effects, Herbert added: \"There's no way that you can remove those sorts of dollars out of our local communities and not see some sort of economic impact on small businesses.\"\u003c/p>\n\u003cp>Under the Graham-Cassidy bill’s redistribution formula, several states that shunned the Affordable Care Act would get more money, according to a \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> by health consulting firm Avalare.\u003c/p>\n\u003cp>Texas will get a windfall of $35 billion in health funding over the next ten years, more than any other state. State officials would get to decide how they want to spend that money. But advocates and analysts say more money for Texas doesn't necessarily guarantee an improved health care system.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“Regardless of the size of the block grant, there's just no assurance that it would translate into good coverage, or coverage that's as affordable as what we have today,” said Stacey Pogue with the \u003ca href=\"http://bettertexasblog.org/2017/09/harmful-medicaid-cutaca-repeal-bill-resurfaces-senate/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Public Policy Priorities \u003c/a>in Austin.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">Texas already has the highest number of uninsured folks, and Pogue says the state just doesn't have the infrastructure in place to expand coverage to more people. It didn't expand Medicaid in 2014, which was optional under the ACA, and the state didn't set up its own exchange, like California did with \"Covered California.\" Texans who wanted subsidized insurance plans had to use the federal exchange, healthcare.gov, which meant Texas had less flexibility when it came to regulating insurers.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“There's no planning and no thought put into, 'How would we create affordable coverage for low-income Texans?\" Pogue said, \"Unlike the 31 states that have expanded Medicaid, have done some central planning. And Texas would be starting from scratch.”\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">It would also take a lot of political will to make sure the state is actually expanding health care, Pogue added, and that motivation has been lacking among state lawmakers for years. In order to get the block grant, states would need to create a workable health infrastructure by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare statewide insurance market.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We are very concerned,” said Stacy Wilson, president of the Children's Hospital Association of Texas.\u003c/p>\n\u003cp>Wilson said this pot of money from Cassidy-Graham wouldn't solve chronic problems with Medicaid, 70 percent of which covers children. Wilson explained that's because the federal government would pay a fixed amount per person, under a per capita cap. That formula locks in how much the state gets per Medicaid enrollee, no matter how much treatment those enrollees need.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We have very low per-capita costs already, and we get locked into that forever,” Wilson said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">A conservative policy group in Texas, \u003ca href=\"https://www.texaspolicy.com/press_release/detail/tppf-statement-on-graham-cassidy-health-care-bill\" target=\"_blank\" rel=\"noopener noreferrer\">The Texas Public Policy Foundation\u003c/a>, is also not happy about the bill, but their concern is that it doesn't go far enough to repeal Obamacare.\u003c/p>\n\n","blocks":[],"excerpt":"The Graham-Cassidy bill to repeal and replace the Affordable Care Act redistributes money from states that worked hard to implement Obamacare and gives it to states that refused Obamacare funding. ","status":"publish","parent":0,"modified":1506126021,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":915},"headData":{"title":"A Tale of Two States: California Loses and Texas Wins Under GOP Health Plan | KQED","description":"The Graham-Cassidy bill to repeal and replace the Affordable Care Act redistributes money from states that worked hard to implement Obamacare and gives it to states that refused Obamacare funding. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361137 https://ww2.kqed.org/stateofhealth/?p=361137","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/09/22/a-tale-of-two-states-california-loses-and-texas-wins-under-gop-health-plan/","disqusTitle":"A Tale of Two States: California Loses and Texas Wins Under GOP Health Plan","nprByline":"\u003cstrong>April Dembosky\u003c/strong>, KQED and \u003cstrong>Ashley Lopez\u003c/strong>, KUT","path":"/stateofhealth/361137/a-tale-of-two-states-california-loses-and-texas-wins-under-gop-health-plan","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California stands to lose billions in health care funding under the GOP’s latest plan to repeal and replace the Affordable Care Act, resulting in millions of Californians losing coverage.\u003c/p>\n\u003cp>The Graham-Cassidy legislation under discussion in the Senate would redistribute the funds now used to pay for the Affordable Care Act, effectively taking money from states that embraced all aspects of the law, like California, and redistributing it to other states, that didn't, like Texas.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains - those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, senior fellow at the \u003ca href=\"https://www.cbpp.org/\">Center on Budget and Policy Priorities\u003c/a>.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">The bill's Republican authors say redistributing the health funds is about fairness, and will give states more \"flexibility\" to redesign their own health systems.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">But health officials in California predict dire consequences if the measure were to pass.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,” top officials from the state Department of Health Care Services wrote in \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/09/graham_cassidy_impact_memo_dhcs_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis\u003c/a> released Friday. “If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs [and] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide.”\u003c/p>\n\u003cp> \u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">By 2026, California would lose $85.7 billion in federal funds, and by 2027 it would lose $138.8 billion, according to the analysis. That could cause 6.7 million Californians to lose insurance coverage, according to \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\">estimates\u003c/a> from the The UC Berkeley Labor Center.\u003c/p>\n\u003cp>A lot of those people are entrepreneurs or their employees. Under the Affordable Care Act in California, half a million self-employed entrepreneurs -- and a million employees who work for small businesses -- got health coverage because of the ACA, either through the expansion of Medi-Cal, or through a subsidized personal insurance plan on the state exchange, Covered California.\u003c/p>\n\u003cp>\"It would be very difficult for entrepreneurs and self employed folks to access some level of coverage,\" said Mark Herbert, California director for the \u003ca href=\"http://www.smallbusinessmajority.org/states/california\" target=\"_blank\" rel=\"noopener noreferrer\">Small Business Majority\u003c/a>. \"So it would be massively destabilizing to the ability of small employers to attract talent.\"\u003c/p>\n\u003cp>Beyond that, there would be damaging ripple effects, Herbert added: \"There's no way that you can remove those sorts of dollars out of our local communities and not see some sort of economic impact on small businesses.\"\u003c/p>\n\u003cp>Under the Graham-Cassidy bill’s redistribution formula, several states that shunned the Affordable Care Act would get more money, according to a \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> by health consulting firm Avalare.\u003c/p>\n\u003cp>Texas will get a windfall of $35 billion in health funding over the next ten years, more than any other state. State officials would get to decide how they want to spend that money. But advocates and analysts say more money for Texas doesn't necessarily guarantee an improved health care system.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“Regardless of the size of the block grant, there's just no assurance that it would translate into good coverage, or coverage that's as affordable as what we have today,” said Stacey Pogue with the \u003ca href=\"http://bettertexasblog.org/2017/09/harmful-medicaid-cutaca-repeal-bill-resurfaces-senate/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Public Policy Priorities \u003c/a>in Austin.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">Texas already has the highest number of uninsured folks, and Pogue says the state just doesn't have the infrastructure in place to expand coverage to more people. It didn't expand Medicaid in 2014, which was optional under the ACA, and the state didn't set up its own exchange, like California did with \"Covered California.\" Texans who wanted subsidized insurance plans had to use the federal exchange, healthcare.gov, which meant Texas had less flexibility when it came to regulating insurers.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“There's no planning and no thought put into, 'How would we create affordable coverage for low-income Texans?\" Pogue said, \"Unlike the 31 states that have expanded Medicaid, have done some central planning. And Texas would be starting from scratch.”\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">It would also take a lot of political will to make sure the state is actually expanding health care, Pogue added, and that motivation has been lacking among state lawmakers for years. In order to get the block grant, states would need to create a workable health infrastructure by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare statewide insurance market.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We are very concerned,” said Stacy Wilson, president of the Children's Hospital Association of Texas.\u003c/p>\n\u003cp>Wilson said this pot of money from Cassidy-Graham wouldn't solve chronic problems with Medicaid, 70 percent of which covers children. Wilson explained that's because the federal government would pay a fixed amount per person, under a per capita cap. That formula locks in how much the state gets per Medicaid enrollee, no matter how much treatment those enrollees need.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We have very low per-capita costs already, and we get locked into that forever,” Wilson said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">A conservative policy group in Texas, \u003ca href=\"https://www.texaspolicy.com/press_release/detail/tppf-statement-on-graham-cassidy-health-care-bill\" target=\"_blank\" rel=\"noopener noreferrer\">The Texas Public Policy Foundation\u003c/a>, is also not happy about the bill, but their concern is that it doesn't go far enough to repeal Obamacare.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361137/a-tale-of-two-states-california-loses-and-texas-wins-under-gop-health-plan","authors":["byline_stateofhealth_361137"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_368","stateofhealth_2808","stateofhealth_3169","stateofhealth_2519","stateofhealth_365","stateofhealth_3105"],"featImg":"stateofhealth_361149","label":"stateofhealth"},"stateofhealth_360850":{"type":"posts","id":"stateofhealth_360850","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360850","score":null,"sort":[1503078231000]},"guestAuthors":[],"slug":"amid-uncertainty-over-health-care-covered-california-appeals-to-insurers-bottom-lines","title":"Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines","publishDate":1503078231,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>With ongoing uncertainty around the Affordable Care Act (ACA), the board that oversees California's health care marketplace took action to stabilize the exchange on Thursday. Their goal was to convince insurance companies to continue offering health plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee praised California's overall success as a health care marketplace, but cautioned that the exchange faces significant challenges.\u003c/p>\n\u003cp>\"We think this open enrollment’s going to be the most challenging since year one,\" Lee said. \"We’re dealing with the most federal uncertainty we’ve ever had.\"\u003c/p>\n\u003cp>Lee is referring to Congress's attempts to repeal the ACA, and the Trump administration's threats not to pay subsidies to insurance companies, as required under the health care law.\u003c/p>\n\u003cp>In the meeting, the board unanimously adopted two new resolutions they believe will maintain market stability. \u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/2017-2019%20QHP%20Issuer%20Contract%20Amendment%20Resolution%20(2017-36).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The first\u003c/a> updates contracts between Covered California and insurance companies, allowing insurers who lose money in 2018 to increase profit margins in the following three years in order to recoup losses. Alternatively, if companies make unforeseen profits because of national uncertainty, those profits would go to reducing premiums in the future.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In an email, a spokesperson for Blue Shield of California, one of the exchange's providers, said the company \"supports Covered California’s program to address the pricing uncertainty and will participate to add stability in the market.\"\u003c/p>\n\u003cp>\u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/Fiscal%20Year%202017-18%20Budget%20Revision%20(Resolution%202017-37).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The second resolution\u003c/a> increases Covered California's marketing and outreach budget by over $5 million. Marketing helps convince consumers, especially healthy ones, to sign up for plans. A mix of healthy and sick participants allows health care marketplaces to maintain lower premiums.\u003c/p>\n\u003cp>Finally, the board announced it would delay a decision about whether to further increase 2018 premiums until Sept. 30.\u003c/p>\n\u003cp>[contextly_sidebar id=\"QtimBtKZJz3HyH4ttMNqWM3dVsZyKIDx\"]\u003c/p>\n\u003cp>Those increases could be necessary to make up for the insurance companies' financial losses, if the federal government withholds subsidies designed to decrease costs for low-income consumers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The board hopes that by the end of September it will better understand what will happen to the Affordable Care Act and how that will impact California.\u003c/p>\n\n","blocks":[],"excerpt":"Covered California's board introduces two resolutions and delays a decision about rate increases.","status":"publish","parent":0,"modified":1503091746,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":364},"headData":{"title":"Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines | KQED","description":"Covered California's board introduces two resolutions and delays a decision about rate increases.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"360850 https://ww2.kqed.org/stateofhealth/?p=360850","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/18/amid-uncertainty-over-health-care-covered-california-appeals-to-insurers-bottom-lines/","disqusTitle":"Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines","path":"/stateofhealth/360850/amid-uncertainty-over-health-care-covered-california-appeals-to-insurers-bottom-lines","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>With ongoing uncertainty around the Affordable Care Act (ACA), the board that oversees California's health care marketplace took action to stabilize the exchange on Thursday. Their goal was to convince insurance companies to continue offering health plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee praised California's overall success as a health care marketplace, but cautioned that the exchange faces significant challenges.\u003c/p>\n\u003cp>\"We think this open enrollment’s going to be the most challenging since year one,\" Lee said. \"We’re dealing with the most federal uncertainty we’ve ever had.\"\u003c/p>\n\u003cp>Lee is referring to Congress's attempts to repeal the ACA, and the Trump administration's threats not to pay subsidies to insurance companies, as required under the health care law.\u003c/p>\n\u003cp>In the meeting, the board unanimously adopted two new resolutions they believe will maintain market stability. \u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/2017-2019%20QHP%20Issuer%20Contract%20Amendment%20Resolution%20(2017-36).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The first\u003c/a> updates contracts between Covered California and insurance companies, allowing insurers who lose money in 2018 to increase profit margins in the following three years in order to recoup losses. Alternatively, if companies make unforeseen profits because of national uncertainty, those profits would go to reducing premiums in the future.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In an email, a spokesperson for Blue Shield of California, one of the exchange's providers, said the company \"supports Covered California’s program to address the pricing uncertainty and will participate to add stability in the market.\"\u003c/p>\n\u003cp>\u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/Fiscal%20Year%202017-18%20Budget%20Revision%20(Resolution%202017-37).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The second resolution\u003c/a> increases Covered California's marketing and outreach budget by over $5 million. Marketing helps convince consumers, especially healthy ones, to sign up for plans. A mix of healthy and sick participants allows health care marketplaces to maintain lower premiums.\u003c/p>\n\u003cp>Finally, the board announced it would delay a decision about whether to further increase 2018 premiums until Sept. 30.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Those increases could be necessary to make up for the insurance companies' financial losses, if the federal government withholds subsidies designed to decrease costs for low-income consumers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The board hopes that by the end of September it will better understand what will happen to the Affordable Care Act and how that will impact California.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360850/amid-uncertainty-over-health-care-covered-california-appeals-to-insurers-bottom-lines","authors":["8648"],"categories":["stateofhealth_2442","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_38","stateofhealth_368","stateofhealth_2808","stateofhealth_2519"],"featImg":"stateofhealth_16356","label":"stateofhealth"},"stateofhealth_360820":{"type":"posts","id":"stateofhealth_360820","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360820","score":null,"sort":[1502831183000]},"guestAuthors":[],"slug":"cbo-if-trump-cuts-payments-to-insurance-companies-it-will-cost-taxpayers","title":"CBO: If Trump Cuts Payments To Insurance Companies, It Will Cost Taxpayers","publishDate":1502831183,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it's going to cost him.\u003c/p>\n\u003cp>Or, more accurately, it's going to cost taxpayers — about $194 billion over 10 years.\u003c/p>\n\u003cp>The cost is \"eye-poppingly large,\" says \u003ca href=\"https://www.law.umich.edu/FacultyBio/Pages/FacultyBio.aspx?FacID=nbagley\" target=\"_blank\" rel=\"noopener noreferrer\">Nicholas Bagley\u003c/a>, a professor of health law at the University of Michigan. \"This single policy could effectively end up costing 20 percent of the entire bill of the ACA.\"\u003c/p>\n\u003cp>The deficit figure comes from the Congressional Budget Office, which on Tuesday released an \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53009-costsharingreductions.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimate\u003c/a> of the budget impact of ending what's known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they're required by law to give to low-income customers.\u003c/p>\n\u003cp>The reports also say premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>President Trump threatened repeatedly to cut off the payments, which he's called \"bailouts,\" during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, or Obamacare.\u003c/p>\n\u003cp>More recently, the president has remained mute on the topic, and insurers have been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets\" target=\"_blank\" rel=\"noopener noreferrer\">left to wonder\u003c/a> whether they will receive a check this month for the discounts they paid out in July.\u003c/p>\n\u003cp>Bagley says there's no good policy reason to cut off the payments. \"If you can cover roughly the same number of people for about $200 billion less, why wouldn't you want to do that?\" he asks.\u003c/p>\n\u003cp>Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.\u003c/p>\n\u003cp>The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.\u003c/p>\n\u003cp>Last year, about \u003ca href=\"https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-06-30.html\" target=\"_blank\" rel=\"noopener noreferrer\">85 percent\u003c/a> of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\"The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,\" says \u003ca href=\"http://www.kff.org/person/larry-levitt/\" target=\"_blank\" rel=\"noopener noreferrer\">Larry Levitt\u003c/a>, a vice president at the Kaiser Family Foundation. \"Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.\"\u003c/p>\n\u003cp>The CBO report confirms earlier analyses, including \u003ca href=\"http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/\">this one\u003c/a> by Kaiser and \u003ca href=\"http://health.oliverwyman.com/transform-care/2017/05/impact_defunding_CSR_payments.html\" target=\"_blank\" rel=\"noopener noreferrer\">this one\u003c/a> from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies \u003ca href=\"http://www.npr.org/sections/health-shots/2017/05/16/528584408/trump-refusal-to-bail-out-insurers-might-end-up-making-policies-cheaper\" target=\"_blank\" rel=\"noopener noreferrer\">cheaper\u003c/a> for some individuals.\u003c/p>\n\u003cp>Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear \"because of the substantial uncertainty about the effects of the policy on average health care costs,\" the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.\u003c/p>\n\u003cp>But the agency says insurers would come back over the next two years.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wlu.edu/faculty/emeritus-faculty/tim-jost\" target=\"_blank\" rel=\"noopener noreferrer\">Timothy Jost\u003c/a>, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.\u003c/p>\n\u003cp>He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Yost warns.\u003c/p>\n\u003cp>\"CBO assumes that things will work out rationally, and there will be a smooth landing,\" he says. \"It could be much more chaotic than that.\"\u003c/p>\n\u003cp>Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide what health plans to offer on the Obamacare exchanges and what to charge.\u003c/p>\n\u003cp>The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.\u003c/p>\n\u003cp>House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CBO+Predicts+Rise+In+Deficit+If+Trump+Cuts+Payments+To+Insurance+Companies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The Congressional Budget Office estimates that ending what's known as cost-sharing reduction payments to insurers will raise the deficit $194 billion over 10 years.","status":"publish","parent":0,"modified":1502913964,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":842},"headData":{"title":"CBO: If Trump Cuts Payments To Insurance Companies, It Will Cost Taxpayers | KQED","description":"The Congressional Budget Office estimates that ending what's known as cost-sharing reduction payments to insurers will raise the deficit $194 billion over 10 years.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"360820 https://ww2.kqed.org/stateofhealth/?p=360820","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/15/cbo-if-trump-cuts-payments-to-insurance-companies-it-will-cost-taxpayers/","disqusTitle":"CBO: If Trump Cuts Payments To Insurance Companies, It Will Cost Taxpayers","audioUrl":"http://www.kqed.org/.stream/anon/radio/tcr/2017/08/170816atcr.mp3","nprByline":"\u003ca href=\"http://www.npr.org/people/473143808/alison-kodjak\" target=\"_blank\">Alison Kodjak\u003c/a>","nprImageAgency":" Melina Mara/The Washington Post/Getty Images","nprStoryId":"543714171","nprApiLink":"http://api.npr.org/query?id=543714171&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/08/15/543714171/cbo-predicts-rise-in-deficit-if-trump-cuts-payments-to-insurance-companies?ft=nprml&f=543714171","nprRetrievedStory":"1","nprPubDate":"Tue, 15 Aug 2017 16:19:00 -0400","nprStoryDate":"Tue, 15 Aug 2017 16:14:00 -0400","nprLastModifiedDate":"Tue, 15 Aug 2017 16:19:15 -0400","path":"/stateofhealth/360820/cbo-if-trump-cuts-payments-to-insurance-companies-it-will-cost-taxpayers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it's going to cost him.\u003c/p>\n\u003cp>Or, more accurately, it's going to cost taxpayers — about $194 billion over 10 years.\u003c/p>\n\u003cp>The cost is \"eye-poppingly large,\" says \u003ca href=\"https://www.law.umich.edu/FacultyBio/Pages/FacultyBio.aspx?FacID=nbagley\" target=\"_blank\" rel=\"noopener noreferrer\">Nicholas Bagley\u003c/a>, a professor of health law at the University of Michigan. \"This single policy could effectively end up costing 20 percent of the entire bill of the ACA.\"\u003c/p>\n\u003cp>The deficit figure comes from the Congressional Budget Office, which on Tuesday released an \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53009-costsharingreductions.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimate\u003c/a> of the budget impact of ending what's known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they're required by law to give to low-income customers.\u003c/p>\n\u003cp>The reports also say premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Trump threatened repeatedly to cut off the payments, which he's called \"bailouts,\" during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, or Obamacare.\u003c/p>\n\u003cp>More recently, the president has remained mute on the topic, and insurers have been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets\" target=\"_blank\" rel=\"noopener noreferrer\">left to wonder\u003c/a> whether they will receive a check this month for the discounts they paid out in July.\u003c/p>\n\u003cp>Bagley says there's no good policy reason to cut off the payments. \"If you can cover roughly the same number of people for about $200 billion less, why wouldn't you want to do that?\" he asks.\u003c/p>\n\u003cp>Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.\u003c/p>\n\u003cp>The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.\u003c/p>\n\u003cp>Last year, about \u003ca href=\"https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-06-30.html\" target=\"_blank\" rel=\"noopener noreferrer\">85 percent\u003c/a> of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\"The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,\" says \u003ca href=\"http://www.kff.org/person/larry-levitt/\" target=\"_blank\" rel=\"noopener noreferrer\">Larry Levitt\u003c/a>, a vice president at the Kaiser Family Foundation. \"Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.\"\u003c/p>\n\u003cp>The CBO report confirms earlier analyses, including \u003ca href=\"http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/\">this one\u003c/a> by Kaiser and \u003ca href=\"http://health.oliverwyman.com/transform-care/2017/05/impact_defunding_CSR_payments.html\" target=\"_blank\" rel=\"noopener noreferrer\">this one\u003c/a> from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies \u003ca href=\"http://www.npr.org/sections/health-shots/2017/05/16/528584408/trump-refusal-to-bail-out-insurers-might-end-up-making-policies-cheaper\" target=\"_blank\" rel=\"noopener noreferrer\">cheaper\u003c/a> for some individuals.\u003c/p>\n\u003cp>Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear \"because of the substantial uncertainty about the effects of the policy on average health care costs,\" the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.\u003c/p>\n\u003cp>But the agency says insurers would come back over the next two years.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wlu.edu/faculty/emeritus-faculty/tim-jost\" target=\"_blank\" rel=\"noopener noreferrer\">Timothy Jost\u003c/a>, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.\u003c/p>\n\u003cp>He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Yost warns.\u003c/p>\n\u003cp>\"CBO assumes that things will work out rationally, and there will be a smooth landing,\" he says. \"It could be much more chaotic than that.\"\u003c/p>\n\u003cp>Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide what health plans to offer on the Obamacare exchanges and what to charge.\u003c/p>\n\u003cp>The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.\u003c/p>\n\u003cp>House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CBO+Predicts+Rise+In+Deficit+If+Trump+Cuts+Payments+To+Insurance+Companies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360820/cbo-if-trump-cuts-payments-to-insurance-companies-it-will-cost-taxpayers","authors":["byline_stateofhealth_360820"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_38","stateofhealth_3155","stateofhealth_2808","stateofhealth_2519","stateofhealth_365"],"featImg":"stateofhealth_360821","label":"stateofhealth"},"news_11593208":{"type":"posts","id":"news_11593208","meta":{"index":"posts_1591205157","site":"news","id":"11593208","score":null,"sort":[1501007165000]},"guestAuthors":[],"slug":"the-senate-health-care-vote-simplified","title":"The Senate Health Care Vote, Simplified","publishDate":1501007165,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain's decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the \"failures\" of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it's still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>NPR's health and politics teams have been doing our best to shed some light on what's a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here's our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says \"nope\"?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won't get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That's \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people's health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The president called on the Senate to repeal and replace the ACA this week. Here's what they would vote on.","status":"publish","parent":0,"modified":1501022230,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":469},"headData":{"title":"The Senate Health Care Vote, Simplified | KQED","description":"The president called on the Senate to repeal and replace the ACA this week. Here's what they would vote on.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11593208 https://ww2.kqed.org/news/?p=11593208","disqusUrl":"https://ww2.kqed.org/news/2017/07/25/the-senate-health-care-vote-simplified/","disqusTitle":"The Senate Health Care Vote, Simplified","source":"NPR","sourceUrl":"www.npr.org","nprByline":"\u003cstrong>\u003ca href=\"http://www.npr.org/people/536711382/gisele-grayson\">Gisele Grayson\u003c/a>\u003c/strong>","nprImageAgency":"John Holcroft/Getty Images/Ikon Images","nprStoryId":"539051768","nprApiLink":"http://api.npr.org/query?id=539051768&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/07/24/539051768/the-senate-health-care-vote-simplified?ft=nprml&f=539051768","nprRetrievedStory":"1","nprPubDate":"Tue, 25 Jul 2017 09:26:00 -0400","nprStoryDate":"Mon, 24 Jul 2017 16:23:00 -0400","nprLastModifiedDate":"Tue, 25 Jul 2017 09:26:43 -0400","path":"/news/11593208/the-senate-health-care-vote-simplified","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain's decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the \"failures\" of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it's still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>NPR's health and politics teams have been doing our best to shed some light on what's a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here's our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says \"nope\"?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won't get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That's \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people's health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11593208/the-senate-health-care-vote-simplified","authors":["byline_news_11593208"],"programs":["news_6944","news_72"],"categories":["news_457","news_8","news_13"],"tags":["news_21167","news_21264","news_3890","news_21249","news_17286"],"featImg":"news_11593211","label":"source_news_11593208"},"news_11573069":{"type":"posts","id":"news_11573069","meta":{"index":"posts_1591205157","site":"news","id":"11573069","score":null,"sort":[1500330247000]},"guestAuthors":[],"slug":"health-care-vote-delay-gives-foes-supporters-more-time","title":"Health Care Vote Delay Gives Foes, Supporters More Time","publishDate":1500330247,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{"term":72,"site":"news"},"content":"\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain's absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama's health care law.\u003c/p>\n\u003cp>McCain's office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain's office says he'll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a \"crusty voice in Washington.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump added, \"Plus, we need his vote.\"\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain's absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail \"is with continued hard work, and that's just what we intend to do. \"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n","blocks":[],"excerpt":"Arizona Sen. John McCain's absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Obamacare.","status":"publish","parent":0,"modified":1500336683,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":300},"headData":{"title":"Health Care Vote Delay Gives Foes, Supporters More Time | KQED","description":"Arizona Sen. John McCain's absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Obamacare.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11573069 https://ww2.kqed.org/news/?p=11573069","disqusUrl":"https://ww2.kqed.org/news/2017/07/17/health-care-vote-delay-gives-foes-supporters-more-time/","disqusTitle":"Health Care Vote Delay Gives Foes, Supporters More Time","nprByline":" \u003cstrong>Alan Fram\u003cbr>Associated Press\u003c/strong>","path":"/news/11573069/health-care-vote-delay-gives-foes-supporters-more-time","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain's absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama's health care law.\u003c/p>\n\u003cp>McCain's office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain's office says he'll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a \"crusty voice in Washington.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump added, \"Plus, we need his vote.\"\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain's absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail \"is with continued hard work, and that's just what we intend to do. \"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11573069/health-care-vote-delay-gives-foes-supporters-more-time","authors":["byline_news_11573069"],"programs":["news_6944","news_72"],"categories":["news_457","news_8","news_13"],"tags":["news_683","news_21264"],"featImg":"news_11573075","label":"news_72"},"stateofhealth_353504":{"type":"posts","id":"stateofhealth_353504","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"353504","score":null,"sort":[1499897934000]},"guestAuthors":[],"slug":"cheat-sheet-how-would-the-republican-health-plan-affect-me","title":"Cheat Sheet: How Would the Republican Health Plan Affect Me?","publishDate":1499897934,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Will it change my job-based coverage? What about my pre-existing condition? Will it cover mental illness? Does it cover abortion? This searchable FAQ has answers.","status":"publish","parent":0,"modified":1499897934,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":5,"wordCount":114},"headData":{"title":"Cheat Sheet: How Would the Republican Health Plan Affect Me? | KQED","description":"Will it change my job-based coverage? What about my pre-existing condition? Will it cover mental illness? Does it cover abortion? This searchable FAQ has answers.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"353504 https://ww2.kqed.org/stateofhealth/?p=353504","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/12/cheat-sheet-how-would-the-republican-health-plan-affect-me/","disqusTitle":"Cheat Sheet: How Would the Republican Health Plan Affect Me?","nprByline":"Gisele Grayson and Nancy Shute","nprImageAgency":"NPR","nprStoryId":"535851043","nprApiLink":"http://api.npr.org/query?id=535851043&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you?ft=nprml&f=535851043","nprRetrievedStory":"1","nprPubDate":"Tue, 11 Jul 2017 12:07:00 -0400","nprStoryDate":"Mon, 10 Jul 2017 06:00:00 -0400","nprLastModifiedDate":"Tue, 11 Jul 2017 14:41:51 -0400","path":"/stateofhealth/353504/cheat-sheet-how-would-the-republican-health-plan-affect-me","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/353504/cheat-sheet-how-would-the-republican-health-plan-affect-me","authors":["byline_stateofhealth_353504"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_3120","stateofhealth_28","stateofhealth_2519","stateofhealth_365"],"featImg":"stateofhealth_353505","label":"stateofhealth"},"stateofhealth_348976":{"type":"posts","id":"stateofhealth_348976","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348976","score":null,"sort":[1498850801000]},"guestAuthors":[],"slug":"patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals","title":"Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals","publishDate":1498850801,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"After testing to see if they're at risk of disease, people fear they'll be discriminated against under proposed legislation.","status":"publish","parent":0,"modified":1498850801,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":1266},"headData":{"title":"Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals | KQED","description":"After testing to see if they're at risk of disease, people fear they'll be discriminated against under proposed legislation.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"348976 https://ww2.kqed.org/stateofhealth/?p=348976","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/30/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals/","disqusTitle":"Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals","nprByline":"\u003ca href=\"http://khn.org/news/author/charlotte-huff/\" target=\"_blank\">Charlotte Huff\u003c/a>","path":"/stateofhealth/348976/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348976/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals","authors":["byline_stateofhealth_348976"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_294","stateofhealth_3104","stateofhealth_2808","stateofhealth_2972","stateofhealth_2519","stateofhealth_3088"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_348980","label":"stateofhealth_3007"},"stateofhealth_347981":{"type":"posts","id":"stateofhealth_347981","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"347981","score":null,"sort":[1498522097000]},"guestAuthors":[],"slug":"californians-contemplate-unthinkable-choices-if-gop-health-plan-becomes-law","title":"Californians Contemplate 'Unthinkable Choices' if GOP Health Plan Becomes Law","publishDate":1498522097,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>People in the state’s health industry, from advocates to clinic directors, were left reeling by the new CBO report, which estimated the Senate Republican health plan would create an additional 22 million uninsured Americans by 2026.\u003c/p>\n\u003cp>“Nowhere are the dangers greater than in California, where our Medicaid program (Medi-Cal) covers more than one in three state residents,” said Sandra R. Hernández, president and CEO of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation.\u003c/a>\u003c/p>\n\u003cp>The Republican bill would radically cut federal funding for Medicaid, even more deeply than what was proposed in the House bill. It would also decrease subsidies for Americans who buy their own insurance on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>, but that’s a smaller group, about 1.7 million residents, compared to the 13.5 million residents covered by Medi-Cal.\u003c/p>\n\u003cp>“More Californians will likely delay or defer necessary care, and when they show up at clinics and emergency rooms, they will likely be sicker and costlier to treat,” Hernandez predicted.\u003c/p>\n\u003cp>“States, communities, and families will be forced to make unthinkable choices about providing necessary care for their loved ones,\" she added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the Senate plan, most consumers who shop for subsidized plans on Covered California would see their out-of-pocket costs rise, while also receiving less financial assistance to compensate. In San Francisco, a 60-year-old who earns $30,000 a year would be facing an out-of-pocket premium of $5,570 a year, more than double what she paid under the Affordable Care Act, according to an \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by the Kaiser Family Foundation.\u003c/p>\n\u003cp>But a 27-year-old in San Francisco making $40,000 a year would see premiums decrease by 12 percent.\u003c/p>\n\u003cp>In general, older consumers would pay more under the Senate plan, because the bill allows insurers to charge them five times as much as younger people, but also because the subsidy they get decreases by almost $1,000 a year.\u003c/p>\n\u003cp>When it comes to the impacts on Medi-Cal, which covers the lower-income residents, people with disabilities, and many seniors, rural California would bear the brunt, said Doreen Bradshaw, executive director of a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of health clinics in northern California.\u003c/p>\n\u003cp>“If you look at a map, 44 out of 58 counties in California are rural,” she said. “We need to maintain [Medicaid] for rural America. This has the potential to be very devastating.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The state’s rural counties provide food, timber, and water for the rest of California and the rest of the country. Bradshaw said cutting health care for rural California workers would have a negative ripple effect on the national economy.\u003c/p>\n\n","blocks":[],"excerpt":"Congressional Budget Office report predicts 15 million more uninsured in U.S. next year, and 22 million in a decade. ","status":"publish","parent":0,"modified":1498524414,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":448},"headData":{"title":"Californians Contemplate 'Unthinkable Choices' if GOP Health Plan Becomes Law | KQED","description":"Congressional Budget Office report predicts 15 million more uninsured in U.S. next year, and 22 million in a decade. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"347981 https://ww2.kqed.org/stateofhealth/?p=347981","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/26/californians-contemplate-unthinkable-choices-if-gop-health-plan-becomes-law/","disqusTitle":"Californians Contemplate 'Unthinkable Choices' if GOP Health Plan Becomes Law","path":"/stateofhealth/347981/californians-contemplate-unthinkable-choices-if-gop-health-plan-becomes-law","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>People in the state’s health industry, from advocates to clinic directors, were left reeling by the new CBO report, which estimated the Senate Republican health plan would create an additional 22 million uninsured Americans by 2026.\u003c/p>\n\u003cp>“Nowhere are the dangers greater than in California, where our Medicaid program (Medi-Cal) covers more than one in three state residents,” said Sandra R. Hernández, president and CEO of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation.\u003c/a>\u003c/p>\n\u003cp>The Republican bill would radically cut federal funding for Medicaid, even more deeply than what was proposed in the House bill. It would also decrease subsidies for Americans who buy their own insurance on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>, but that’s a smaller group, about 1.7 million residents, compared to the 13.5 million residents covered by Medi-Cal.\u003c/p>\n\u003cp>“More Californians will likely delay or defer necessary care, and when they show up at clinics and emergency rooms, they will likely be sicker and costlier to treat,” Hernandez predicted.\u003c/p>\n\u003cp>“States, communities, and families will be forced to make unthinkable choices about providing necessary care for their loved ones,\" she added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the Senate plan, most consumers who shop for subsidized plans on Covered California would see their out-of-pocket costs rise, while also receiving less financial assistance to compensate. In San Francisco, a 60-year-old who earns $30,000 a year would be facing an out-of-pocket premium of $5,570 a year, more than double what she paid under the Affordable Care Act, according to an \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by the Kaiser Family Foundation.\u003c/p>\n\u003cp>But a 27-year-old in San Francisco making $40,000 a year would see premiums decrease by 12 percent.\u003c/p>\n\u003cp>In general, older consumers would pay more under the Senate plan, because the bill allows insurers to charge them five times as much as younger people, but also because the subsidy they get decreases by almost $1,000 a year.\u003c/p>\n\u003cp>When it comes to the impacts on Medi-Cal, which covers the lower-income residents, people with disabilities, and many seniors, rural California would bear the brunt, said Doreen Bradshaw, executive director of a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of health clinics in northern California.\u003c/p>\n\u003cp>“If you look at a map, 44 out of 58 counties in California are rural,” she said. “We need to maintain [Medicaid] for rural America. This has the potential to be very devastating.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The state’s rural counties provide food, timber, and water for the rest of California and the rest of the country. Bradshaw said cutting health care for rural California workers would have a negative ripple effect on the national economy.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/347981/californians-contemplate-unthinkable-choices-if-gop-health-plan-becomes-law","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_3120","stateofhealth_3119","stateofhealth_2808","stateofhealth_2519","stateofhealth_365","stateofhealth_3118"],"featImg":"stateofhealth_346838","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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You ask the questions. You decide what Bay Curious investigates. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us","airtime":"SUN 2pm-3pm, MON 12am-1am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png","officialWebsiteLink":"https://www.wnycstudios.org/shows/otm","meta":{"site":"news","source":"wnyc"},"link":"/radio/program/on-the-media","subscribe":{"apple":"https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2","tuneIn":"https://tunein.com/radio/On-the-Media-p69/","rss":"http://feeds.wnyc.org/onthemedia"}},"our-body-politic":{"id":"our-body-politic","title":"Our Body Politic","info":"Presented by KQED, KCRW and KPCC, and created and hosted by award-winning journalist Farai Chideya, Our Body Politic is unapologetically centered on reporting on not just how women of color experience the major political events of today, but how they’re impacting those very issues.","airtime":"SAT 6pm-7pm, SUN 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Our-Body-Politic-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://our-body-politic.simplecast.com/","meta":{"site":"news","source":"kcrw"},"link":"/radio/program/our-body-politic","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/our-body-politic/id1533069868","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9feGFQaHMxcw","spotify":"https://open.spotify.com/show/4ApAiLT1kV153TttWAmqmc","rss":"https://feeds.simplecast.com/_xaPhs1s","tuneIn":"https://tunein.com/podcasts/News--Politics-Podcasts/Our-Body-Politic-p1369211/"}},"pbs-newshour":{"id":"pbs-newshour","title":"PBS NewsHour","info":"Analysis, background reports and updates from the PBS NewsHour putting today's news in context.","airtime":"MON-FRI 3pm-4pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.pbs.org/newshour/","meta":{"site":"news","source":"pbs"},"link":"/radio/program/pbs-newshour","subscribe":{"apple":"https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2","tuneIn":"https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/","rss":"https://www.pbs.org/newshour/feeds/rss/podcasts/show"}},"perspectives":{"id":"perspectives","title":"Perspectives","tagline":"KQED's series of of daily listener commentaries since 1991","info":"KQED's series of of daily listener commentaries since 1991.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Perspectives-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/perspectives/","meta":{"site":"radio","source":"kqed","order":"15"},"link":"/perspectives","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/id73801135","npr":"https://www.npr.org/podcasts/432309616/perspectives","rss":"https://ww2.kqed.org/perspectives/category/perspectives/feed/","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"}},"planet-money":{"id":"planet-money","title":"Planet Money","info":"The economy explained. 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