Let’s block ads! (Why?)

Since Senate Republicans released the draft of their bill to repeal and replace the Affordable Care Act last week, many people have been wondering how the proposed changes will affect their own coverage, and their family’s: Will my pre-existing condition be covered? Will my premiums go up or down?

The bill is still a work in progress, but we’ve taken a sampling of questions from All Things Considered listeners and answered them, based on what we know now.

Q: My husband and I are both in our 50s, self-employed, and we have a daughter in college. We buy insurance through the California exchange. Our family premium is now $1,100 a month with a deductible of $6,800 per person. We have never received a subsidy.

Three months ago, I was diagnosed with breast cancer. It was early stage, and I am in treatment with no cancer remaining. We are all very active and healthy otherwise.

Here is my concern: Based on what I have read, it appears our age group stands to see the biggest jump in premium costs. Not to mention, I now have a pre-existing condition. Will our premiums rise astronomically?

— Denise Estrada, Los Angeles, Calif.

A: This is a double-barreled question on premium costs and pre-existing conditions, both major concerns to consumers.

For a person in their 50s, worries about premium increases are well-founded. Under the Affordable Care Act, insurance companies are allowed to charge older people up to three times more than young people for the same insurance policies.

The Republican health care bills in both the Senate and House would allow insurers to charge up to five times more.

That change would likely lead to cheaper health plans for younger people, but also more expensive ones for those over 50. The Kaiser Family Foundation estimates that a 60-year-old in Los Angeles County who doesn’t qualify for subsidies would see her premium rise about $2,600 a year.

As for your question about your pre-existing condition, the answer would depend on where you live. The Senate bill does preserve the pre-existing condition protections that exist under the Affordable Care Act — meaning insurance companies must offer you a policy even if you have a medical problem. But it would also allow states to ask for waivers from some federal regulations, including those that define “essential health benefits.” If a state doesn’t include cancer treatment or pharmaceutical coverage in those benefits, then insurance companies can elect not to pay for some of the care you need.

Q: My 2 1/2-year-old son has been through eight hospitalizations and is fed partly through a feeding tube. We have insurance through my husband’s employer, and our son qualified for Medicaid last November because of a program in Pennsylvania for children with chronic illnesses.

The medical bills we’ve already seen would have been catastrophic without insurance, and our out-of-pocket medical expenses were thousands of dollars a year, even with insurance, before he qualified for Medicaid. His medical care needs have been so intense that I have not been able to work this past year.

We are very worried about his future care costs without Medicaid, as well as our ability to afford insurance coverage for him if pre-existing conditions are not afforded any legal protections.

How is Trumpcare likely to affect our family?

— Emily Kane, Pittsburgh, Pa.

A: It sounds like Pennsylvania’s Medicaid program has been helpful for your child. Under the proposed law, states will have even more power to design their own Medicaid programs, so there’s no reason to think that Pennsylvania would take away a local program that it has implemented.

What might be worrisome, however, are the overall reductions to the Medicaid program. The bill turns Medicaid from an open-ended program that pays for all the care beneficiaries need, to one that caps federal spending based on the number of people enrolled. The Congressional Budget Office predicts that if the Senate bill passes, Medicaid spending would be 26 percent lower, over the next decade, than it would be under the Affordable Care Act.

Some analysts believe that over time, states will have to cut services, reduce how much they pay doctors and hospitals and make it harder to qualify for Medicaid.

Q: My wife and I are both 42, and we have two children, ages 10 and 13. We have coverage through the marketplace but do not qualify for payment assistance. In addition, my wife has rheumatoid arthritis and currently uses expensive monthly injections to treat it. Would insurance still be required to cover my wife’s arthritis treatment under the new law? And how would our premiums be affected?

— Jeremy Merrill, Cedar Park, Texas

A: As far as premiums go, it looks like yours are likely to remain about the same. The Kaiser Family Foundation estimates that for a 40-year-old in Williamson County, Texas, who doesn’t qualify for subsidies, premiums are flat under the new law.

Whether your insurance will cover your wife’s condition depends largely on your governor. As I explained above, states can ask for waivers from many of the Affordable Care Act’s consumer protections, including those that define what medical services insurers have to cover.

Q: My 16-year-old daughter has Crohn’s disease. She requires Remicade infusions every six weeks. Each infusion costs $20,000. I am very concerned about lifetime maximums being reinstated. Additionally, I worry that children will no longer be able to stay on their parents’ insurance policies until 26, and that pre-existing conditions will result in higher premiums, even for employer-sponsored plans.

— Amy Lowe, Dayton, Ohio

A: You only have to worry about one of those things.

The Senate bill does include the very popular provision in the Affordable Care Act that allows children to stay on their parents’ health insurance policy until they are 26.

However, there is a chance that lifetime spending limits and annual limits [to what an insurer would pay for the care of a given patient] could return. Before the Affordable Care Act, about 60 percent of employers had lifetime limits on their health plans. The section of the bill that allows states to get waivers from federal rules opens the door to those limits making a comeback — even in employer-sponsored policies.

Let’s block ads! (Why?)

Let’s block ads! (Why?)

Let’s block ads! (Why?)

Let’s block ads! (Why?)

Let’s block ads! (Why?)

Women in their 40s at average risk for breast cancer should talk to their health care provider about the risks and benefits of mammography before starting regular screening at that age, according to guidelines released Thursday by the American College of Obstetricians and Gynecologists.

The group had previously recommended annual mammograms starting at age 40. But the advice has changed to better incorporate input from the woman being screened, says physician Christopher Zahn, vice president of practice activities at ACOG. “A patient’s preferences and values need to be an important part” of the decision, he says.

Now the group says providers should offer the test when a woman enters her 40s, and that after a discussion, she may opt to start screening. If she doesn’t, she should start by age 50, ACOG says. Zahn says the guidance intentionally encompasses advice from other major groups.

The U.S. Preventive Services Task Force says women should start regular mammograms at 50, and that women in their 40s should make an individual decision about whether or not to screen. The American Cancer Society says screening should be offered starting at age 40, and outright recommends starting at 45. And the National Comprehensive Cancer Network, an alliance of major cancer centers, recommends starting at 40.

The question all these groups have wrestled with is how to balance the benefits and harms of mammography; their different recommendations reflect differences in how they interpreted and weighed the available data. “All three [schedules] are reasonable approaches to take,” says Zahn.

Mammography clearly saves lives for women over 50 and likely does so overall for women in their 40s, says Otis Brawley, chief medical officer at the American Cancer Society. But the benefits in those younger women are smaller, and they come at the cost of false alarms, unnecessary biopsies and overdiagnosis, when cancer that is detected and treated never would have threatened a woman’s health had it gone undiscovered. (The ACS says estimates of overdiagnosis vary widely, from 0 percent to 54 percent of breast cancers, in part depending on whether cases of ductal carcinoma in situ — abnormal cells that sometimes turn into cancer — are included.)

Once a woman starts mammography, she can be screened every one or two years, again after a discussion about the pros and cons of the different schedules, ACOG advises. The American Cancer Society recommends annual screening for women through age 54 and every other year for older women, with the option to continue annual tests, while USPSTF says every other year is sufficient and the network of cancer centers recommends annual screening.

A statistical model from the USPSTF finds that if 1,000 women are screened every other year from age 40 to 74, there will be eight fewer breast cancer deaths compared with no screening, 213 unnecessary breast biopsies and 21 overdiagnosed breast tumors. Meantime, if 1,000 women are screened every other year from 50 to 74, there will be seven fewer breast cancer deaths compared with no screening, 146 unnecessary biopsies and 19 overdiagnosed tumors.

Some women may decide that the small additional benefit doesn’t outweigh the increased risk of biopsy or possibly being treated for a cancer that didn’t need attention. There’s as yet no sure way to know which tumors are harmless and can be left alone. Others may choose differently. “There’s more of a respect for the individual person,” says Brawley about the new ACOG guidelines and the 2015 changes by his own organization. “You’re starting to hear, ‘Let the woman decide.’ “

“If a woman is told to get a mammogram starting at 40, it’s very reasonable to question that and ask, ‘Why? I’ve read that there are conflicting guidelines,’ ” says Deanna Attai, assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA.

She says women should know, or ask about, the risk factors for breast cancer so they can have the screening conversation with some understanding of where they fall on the spectrum. And don’t stop the risk-reduction discussion at screening. “Ask what lifestyle or health habits can help reduce risk,” she says. (For example, research suggests exercise can cut breast cancer risk.)

On the question of when to stop routine mammograms, ACOG says screening beyond age 75 should be based on a conversation about a woman’s health status and longevity. The group also recommends against regular breast self-exams but says women should be aware of the normal feel and appearance of their breasts so they can report any changes.

Keep in mind that these recommendations are for average-risk women who are not experiencing symptoms. Many factors can increase risk, including a family history of breast or ovarian cancer and certain genetic mutations. So those women should check with their physician about when, how and how frequently they should be screened. There’s also not enough evidence to make recommendations on whether women with dense breasts should be screened differently.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She’s on Twitter: @katherinehobson

Let’s block ads! (Why?)

The Senate vote on a bill to repeal and replace the Affordable Care Act is, according to conventional wisdom, one week away.

And we still don’t know what’s in the bill.

Not having concrete information is deeply uncomfortable for a journalist like me.

But for lots of people, like those who work in the insurance industry, not knowing what’s in that bill is a bigger deal. Wednesday is a deadline of sorts for these companies. If they want to sell policies next year in states that use the federal health exchange on Healthcare.gov, they have to let Health and Human Services know their intentions.

How are they dealing?

I reached out to a couple of insurance executives and asked.

Mario Schlosser is CEO of Oscar, the insurance startup that’s betting hard on the Affordable Care Act, also known as Obamacare.

Wednesday morning, Oscar announced it’s going to keep selling individual insurance in New York in 2018, and expanding its offerings in five states – New Jersey, Ohio, California, Florida and Tennessee.

It’s a bold move, considering Congress is right now considering dismantling the Affordable Care Act markets and changing the rules governing health insurance.

“When the dust settles, the individual market will be stable, and we want to be part of getting it there,” Schlosser told me.

He agreed with President Trump that the American Health Care Act, passed by the House in May, is “mean.”

“I think that bill was mean and I think that bill would lead to loss of coverage that would be bad for pretty much everybody in the system,” he said.

Schlosser said it’s crucial for the Trump administration to stabilize the current system in preparation for any changes. That includes enforcing the individual mandate, which penalizes people who don’t buy insurance, and promising to make cost-sharing payments required under the ACA that reimburse insurers for giving extra discounts to the lowest-income customers.

If they don’t, “it would kill the market overnight.” Schlosser said.

“That would be terrible for society, it would be terrible for the whole health care system, and everybody would be worse off,” he said.

I pointed out to Schlosser that his company has a direct line to the White House. His partner and co-founder is Joshua Kushner, the brother of Jared Kushner, Trump’s son-in-law and senior adviser.

Schlosser avoided talking about that relationship and suggested he didn’t know what Trump will do.

Later, I sat down for a cup of coffee at the National Press Club with Dan Hilferty, who runs Independence Blue Cross in Philadelphia and is chairman of the board of the Blue Cross Blue Shield Association. His company sells ACA health plans in the Philadelphia area and southern New Jersey.

“I’m here in DC because of what’s happening in health care,” he said. But acknowledged he doesn’t know what’s in the Senate bill, even though the Blue plans he represents as chairman of the association insure one-third of all Americans.

Hilferty said the ACA has problems, but it did manage to bring insurance coverage to about 20 million people who didn’t have it before. That’s what he’s focused on in meetings with members of Congress.

The Congressional Budget Office says the bill passed by the House would result in 23 million fewer people having insurance coverage in 10 years, compared to current law.

“So I would say let’s build a system that doesn’t that doesn’t push those 20 million people back to uninsured, “Hilferty said.

He says his company is focused on ensuring that whatever lawmakers do, they don’t make it harder for low-income people to get insurance.

“Frankly, we don’t care if it’s the ACA or the AHCA as long as it gives us the ability to cover more people, get them access to care and not lose money,” Hilferty said.

Like Schlosser, Hilferty is worried about what’s going to happen next year. His company has filed to sell ACA plans in the Philadelphia area. But if the Trump administration doesn’t commit to making cost-sharing payments or to enforcing the individual mandate that requires people to have insurance, his rates could go up a lot.

Either way, both companies are operating as if the ACA markets will be alive and functioning in 2018.

“I do think that in the end, reason and compassion will prevail in DC,” Schlosser said.

Let’s block ads! (Why?)

Senate Majority Leader Mitch McConnell says Republicans will release a discussion draft of their version of the health care bill on Thursday, with a vote likely next week.

Private health care talks have been underway in the Senate for weeks. McConnell tapped a 13-member working group last month to hash out senators’ differences over the House-passed American Health Care Act. McConnell’s office has since taken the lead drafting the Senate version of the party’s long-promised legislation to dismantle the Affordable Care Act.

Senate Republicans have been coy — or simply out of the loop — on the specifics in the Senate plan, but here is what we know about what might be in the bill and where it could be headed:

It Sounds A Lot Like The House Bill

After the House passed AHCA in early May, leading senators asserted that the Senate would go their own way. “We’re writing a Senate bill and not passing the House bill,” Sen. Lamar Alexander, R-Tenn., said then. “We’ll take whatever good ideas we find there that meet our goals.”

In the end, those goals appear to be aligned.

The structure of the Senate bill, as described by GOP senators and aides, appears fundamentally the same as the House-passed plan.

The Senate bill is also expected to repeal the individual mandate and all or most of the ACA’s taxes, phase out the Medicaid expansion as well as change how the Medicaid program is funded, establish a system of tax credits to help people buy insurance if they choose, and make it easier for states to opt-out of the ACA’s mandates for preexisting conditions and minimum insurance coverage mandates.

There will be changes. For instance, the Senate version is expected to include more generous tax credits to make sure older, poorer Americans don’t get hit with higher costs. Republicans are also battling over how best to remake the Medicaid program, with key vote senators like Shelley Moore Capito of West Virginia sounding skittish about Medicaid reductions.

Other Republicans are excited by the bill. Sen. John Barrasso, R-Wyo., has been one of the most vocal advocates for Obamacare repeal. “People didn’t want to have to buy this product. This is a sinking ship, people are ready to jump off,” he said Tuesday. Republicans like Barrasso see the bill as a win for the GOP and for the promises they made on the campaign trail.

“We eliminate the individual mandate. You’ll see more people as free citizens making a decision to not have Obamacare insurance, but certainly have more freedom,” Barrasso said.

The Process Stinks

“Can you say it was done openly? With transparency and accountability? Without backroom deals and struck behind closed doors? Hidden from the people? Hell no you can’t! Have you read the bill? Have you read the reconciliation bill? Have you read the manager’s amendment? Hell no you haven’t!”

That’s not Senate Minority Leader Chuck Schumer in 2017, that was former Minority Leader John Boehner in 2010 before House Democrats passed the Affordable Care Act.

Republicans vilified Democrats seven years ago for negotiating the final details of Obamacare behind closed doors. Today Senate Republicans’ response could be: We learned it from watching you.

The Senate has not held any public hearings on their health care bill (the House did), senators involved in the talks have been tight-lipped on the substance, and the public will only have a few days to see it before it gets a vote.

McConnell brushed off questions about transparency. “They’ll have plenty of time,” he told reporters Tuesday. “We’ve been discussing all the elements of this endlessly for seven years. Everybody pretty well understands it. Everybody will have adequate time to take a look at it.”

That argument rings hollow with some of his fellow Republicans. “We used to complain like hell when the Democrats ran the Affordable Care Act. Now, we’re doing the same thing,” Sen. John McCain, R-Ariz., told CNN.

“If you’re frustrated in the lack of transparency in this process, I share your frustration,” Sen. Mike Lee, R-Utah, said in a Facebook video for his constituents. Lee is a part of the 13-member working group, but he said he hasn’t seen the draft bill. “I just haven’t been able to see it yet and as far as I know the overwhelming majority of my colleagues haven’t been able to see it either.”

Failure Is An Option

McConnell has been quietly leading Republicans’ to a vote next week but that doesn’t mean it’s going to pass.

“We’re going to make every effort to pass a bill that dramatically changes the current health care law,” McConnell said when asked if he has the votes.

“I think the leader has made it pretty clear we’re going to vote, one way or another, and hopefully we’ll have 50 votes when that time comes,” Senate Republican Conference Chairman John Thune said when asked if he believed McConnell would bring a bill to the floor that didn’t have the votes to pass.

While no Republican senator has yet come out opposed the bill, McConnell has only a two-vote margin of error with many senators voicing problems with the legislation.

“If our bill comes in with greater subsidies than Obamacare, it makes it hard for conservatives to support a bill that actually has greater subsidies than Obamacare,” Sen. Rand Paul, R-Ky., told reporters in regards to the tax credits in the GOP plan. “That for me is a nonstarter.”

Conservatives like Ted Cruz of Texas and Mike Lee have Utah have been skeptical about the bill’s ability to ultimately lower premium costs for Americans. Both are seen as potential ‘no’ votes on the bill.

More moderate senators like Susan Collins of Maine and Lisa Murkowski of Alaska are also seen as potential ‘no’ votes on the other end of the spectrum.

Defeat of the House-passed bill wouldn’t necessarily end the health care debate in Congress, but it would redefine it.

Wisconsin GOP Sen. Ron Johnson hinted at what that would look like at a constituent event last Friday. “I’m not sure if we’re going to come up with 50 votes with a Republican solution. Let’s stabilize the markets and then, long-term, work with the Democrats colleagues to actually fix the healthcare system,” Johnson said.

The White House Doesn’t Love It — Yet

The White House has maintained a light tough when it comes to shaping the policies in the health care bill, but President Trump reportedly told a group of senators last week that the bill passed in the House was “mean” and he wanted the final bill to do more to help needier Americans.

On Tuesday, White House Spokesman Sean Spicer told reporters the president “wants a bill that has heart in it” but did not offer any specific policies Trump wants in the bill. Spicer also said he didn’t know if the president had seen a draft of the Senate bill.

If the Senate approves a bill next week, it still has more hurdles to go. The House either needs to pass the Senate bill as-is and send it to Trump’s desk, or the House and Senate have to go into a third round of negotiations in which both chambers would have to vote again on a final, compromise bill.

Either way, the health care debate is likely to continue into July if the Senate can pass a bill next week.

Democrats Debate How Far To Take Their Fight

Senate Democrats can’t filibuster the bill because it’s protected under special budget rules and only requires a majority vote. They’re all going to oppose it, but they can’t ultimately stop it from eventually getting an up-or-down vote.

Democrats have started a series of protests this week that could intensify as the Senate approaches that vote. They held the floor Monday evening for a series of speeches in opposition to the bill. On Tuesday, they invoked a rule to block any committee hearings from taking place that afternoon to draw attention to their opposition to the health care bill.

Outside Democratic activists associated with Indivisible are calling for Democrats to use every procedural tactic available to slow down debate. Since amendments are unlimited on a bill like this, one activist has even called on Democrats to introduce 40,000 amendments to keep the Senate on the bill through the 2018 midterms.

It’s unclear how Democrats will respond next week, but Schumer said Republicans should expect a fight. “If Republicans won’t relent and debate their health care bill in the open for the American people to see, then they shouldn’t expect business as usual in the Senate,” Schumer said in a statement.

NPR congressional reporters Scott Detrow and Geoff Bennett contributed to this report.

Let’s block ads! (Why?)

The Republican effort to overhaul the Affordable Care Act, or Obamacare, has led to a standoff in the Senate.

Senate Democrats on Monday night began using parliamentary maneuvers to slow Senate business as part of a coordinated protest against the GOP push to pass an Obamacare replacement bill. A small group of Republican senators has been working in private for weeks, shielding from public view the bill and the negotiations surrounding it.

In a show of frustration with what they deem the GOP’s “shameful” and “secret” legislative process, Democrats on Monday also held the Senate floor with a series of back-to-back speeches.

“If Republicans are not going to allow debate on their bill on the floor or in committee, Democrats will make opportunities to debate,” said Senate Minority Leader Chuck Schumer, speaking Monday on the Senate floor. “And these are merely the first steps we’re prepared to take in order to shine a light on the shameful Trumpcare bill and reveal to the public the GOP’s backroom deal-making.”

Liberal activists cheered on social media as Schumer forced McConnell to object to a motion to hold public hearings on the health care bill, and then pressed the Republican leader to commit to 10 hours of open debate.

Senate Democrats, in taking action Monday, are inserting themselves into a process that has excluded them by design. Democratic lawmakers are also responding to growing pressure from progressive activists who have been calling for more aggressive opposition. Members of the Democratic base have expressed concern that Republicans are moving forward with their health care bill while attention has been focused elsewhere — namely on the Russia investigations.

Some Republicans are also out of the loop

It’s not just Democrats who have been left out of the health care deliberations. Many Republican senators have seen little more than an outline and a Power Point summary of the Senate health care legislation that is being drafted.

“It’s not unusual, especially for a big bill like this. It’s okay that the drafting is happening behind closed doors,” Tommy Binion, a congressional liaison at the conservative Heritage Foundation, told NPR’s Morning Edition.

While GOP senators aren’t objecting to the process as vehemently as Democrats, a number of Republicans, including Sen. Marco Rubio, R-Fla., say the health care legislation should eventually be subject to open debate.

“If it’s an effort to rush it from a small group of people straight to the floor on an up or down vote, it’ll be a problem,” Rubio said Sunday on CNN’s State of the Union.

McConnell: “Nobody is hiding the ball here”

The Republican health care bill could be voted on as early as next week – ahead of the July 4th recess — without any committee hearings or public input. For his part, Senate Majority Leader Mitch McConnell is defending the closed health care talks.

“Nobody is hiding the ball here,” McConnell, R-Ky., told reporters last week. “There have been gazillions of hearings on this subject when [Democrats] were in the majority, when we were in the majority. We understand the issue very well and we are now coming up with a solution.”

Republicans contend the secret Senate negotiations give them time and space free from scrutiny to hash out the significant and serious differences among themselves over contentious issues, such as phasing out Medicaid expansion and determining the plan’s coverage requirements.

Democrats say the closed talks are a tacit acknowledgment by Republicans that their efforts are unpopular.

“There’s only one reason why Republicans are doing this: They’re ashamed of their bill,” said Schumer on Monday. “The Republicans are writing their health care bill under the cover of darkness because they’re ashamed of it, plain and simple.”

While the Senate is crafting its own legislation, the House-passed American Health Care Act is viewed unfavorably by a majority of Americans – 55 percent – compared with 31 percent who viewed it favorably, according to a Kaiser Family Foundation poll released in May.

What’s more, the Congressional Budget Office estimated that the House health care bill would result in 23 million fewer people with insurance in a decade, and it would leave many sicker and older Americans with much higher costs.

Republicans eager to move on from health care

Still, Senate Republicans badly want to take up other priorities such as overhauling the country’s tax code.

“We’ve been debating Obamacare’s failures and what to do about them for so many years now,” McConnell said Monday on the Senate floor. “Members are very, very familiar with this issue. Thankfully, at the end of this process, the Senate will finally have a chance to turn the page on this failed law.”

Any legislation the Senate passes would head back to the House for consideration before President Trump can sign it into law.

Let’s block ads! (Why?)