The Health 202: Obamacare marketplaces survived Trump’s term better than expected

“The overall impact of the Trump administration’s policies towards the marketplaces have probably been more muted than most expected — at least so far,” said Adam Gaffney, a professor at Harvard Medical School and president of Physicians for a National Health Program.

Enrollment in Healthcare.gov and the state-based marketplaces is open through Dec. 15.

People can shop for private plans, and qualify for federal subsidies if their income is between 133 percent and 400 percent of the federal poverty level.

To the concern of health-care advocates, enrollment has ticked down over the past four years, contributing to the nation’s worsening uninsured rate amid the coronavirus pandemic and fueling a growing sense among Democrats that further health restructuring is needed.

Yet by some measures, the marketplaces look healthier than ever.

Individual insurance premiums and choices have steadily improved over the past four years, despite Democrats’ insistence that the administration’s policies would destroy the marketplaces. That trend will continue in the 2021 enrollment season.

“One thing the marketplaces proved is how resilient they actually are,” said Andy Slavitt, former administrator of the Centers for Medicare and Medicaid Services under President Barack Obama.

Still, there’s a clear difference in how a Joe Biden administration would approach the ACA.

It certainly would invest more in boosting marketplace enrollment, advisers say. The Democratic nominee, if he wins tomorrow’s election, is expected to restore funds Trump scrapped to advertise the law and may push Congress to pass legislation increasing the income-based subsidies available to people. 

A Democrat-led administration may also reverse some of the changes President Trump made to the marketplaces — although Trump’s record on them is more nuanced than either party claims.

“The truth is somewhere in middle between what Republicans say and what Democrats say,” said Larry Levitt, a vice president for the Kaiser Family Foundation.

The average Obamacare customer can choose from plans offered by four to five issuers.

That’s up from an average of three to four issuers in 2020, according to data from the Centers for Medicare and Medicaid Services. Four percent of enrollees will have access to plans from just one issuer, up from 12 percent of enrollees this year.

And premiums are declining for the third straight year. The average premiums for the second-lowest-cost “silver”-level plan will be 2 percent lower next year. Average premiums for these “benchmark” plans have declined 8 percent since 2018.

“Despite the uncertainty of the pandemic and concerns about the future of the ACA, the marketplaces are strong and healthy, and premiums for high-quality, comprehensive coverage remain very affordable,” said Joshua Peck, co-founder of Get America Covered — a nonpartisan group that has worked to spread the word about the marketplaces even as the administration has cut advertising for it.

It’s a distinct shift from how things looked during the Obama administration. The first few years of the marketplaces were marked by double-digit premium increases and a steady stream of exits by insurers, as they struggled with how to price and sell insurance

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‘Obamacare’ sign-ups begin as millions more are uninsured

WASHINGTON — Millions of Americans who have lost health insurance in an economy shaken by the coronavirus can sign up for taxpayer-subsidized coverage starting Sunday.

It’s not a new COVID relief program from the government but the return of annual sign-up season under the Affordable Care Act, better known as “Obamacare.” Open enrollment lasts through Dec. 15.

The Centers for Medicare and Medicaid Services, which runs HealthCare.gov, says premiums are down slightly on average for 2021 and most people will have at least three insurers from which to pick plans. Lower-income people and even middle-class families may qualify for tax credits that can greatly reduce what they pay monthly for premiums.

But President Donald Trump, unrelenting in his opposition to President Barack Obama’s signature domestic program, is asking the Supreme Court to overturn the entire law.

Trump has been promising a much better replacement since before taking office, but never came out with his plan. The justices are scheduled to hear the case Nov. 10, and the administration is doing little to promote sign-ups, having previously slashed the program’s ad budget.

“Affordable health coverage is more essential than ever during the pandemic,” said House Speaker Nancy Pelosi, D-Calif., who’s urging people to enroll even if Trump keeps trying to do away with the law.

Hard numbers on how virus-related job losses have affected health coverage are not available because the most reliable government surveys will not be out until next year. Estimates range from 5 million to 10 million newly uninsured people. That’s on top of 26 million uninsured last year, before the pandemic, or about 8% of the U.S. population.

“There is a coverage crisis happening, ” said Stan Dorn, a health policy expert now with Families USA, a liberal advocacy group. “And there are fewer resources available to help, thanks to the Trump cuts.”

Dorn worries that’s “a setup for epic failure,” and many people will remain uninsured even as states across the country are seeing alarming increases in coronavirus cases.

Administration officials say HealthCare.gov is open for business and ready to handle sign-ups online or via its call center. “We’ll be working through the upcoming open enrollment period…to ensure a smooth user experience,” CMS Administrator Seema Verma said.

More than 11 million people currently have coverage through HealthCare.gov and state-run health insurance markets offering subsidized private plans. The health law also covers another 12 million people through its Medicaid expansion, adopted by all but 12 states.

Medicaid enrollment has gone up by nearly 4 million people since March, but it’s still unclear how many laid-off workers are coping after the loss of employer coverage in the coronavirus economy.

Those who are healthy most likely have other priorities, such as finding another job. Workers who were furloughed, but not laid off, may have been able to keep their coverage. Some appear to have switched to a spouse’s plan, and those age 65 and older can get on Medicare.

The nonpartisan Kaiser Family Foundation estimates that 80% of those

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‘Obamacare’ sign-ups begin as millions more are uninsured

WASHINGTON (AP) — Millions of Americans who have lost health insurance in an economy shaken by the coronavirus can sign up for taxpayer-subsidized coverage starting Sunday.

It’s not a new COVID relief program from the government but the return of annual sign-up season under the Affordable Care Act, better known as “Obamacare.” Open enrollment lasts through Dec. 15.

The Centers for Medicare and Medicaid Services, which runs HealthCare.gov, says premiums are down slightly on average for 2021 and most people will have at least three insurers from which to pick plans. Lower-income people and even middle-class families may qualify for tax credits that can greatly reduce what they pay monthly for premiums.


But President Donald Trump, unrelenting in his opposition to President Barack Obama’s signature domestic program, is asking the Supreme Court to overturn the entire law.

Trump has been promising a much better replacement since before taking office, but never came out with his plan. The justices are scheduled to hear the case Nov. 10, and the administration is doing little to promote sign-ups, having previously slashed the program’s ad budget.

“Affordable health coverage is more essential than ever during the pandemic,” said House Speaker Nancy Pelosi, D-Calif., who’s urging people to enroll even if Trump keeps trying to do away with the law.

Hard numbers on how virus-related job losses have affected health coverage are not available because the most reliable government surveys will not be out until next year. Estimates range from 5 million to 10 million newly uninsured people. That’s on top of 26 million uninsured last year, before the pandemic, or about 8% of the U.S. population.

“There is a coverage crisis happening, ” said Stan Dorn, a health policy expert now with Families USA, a liberal advocacy group. “And there are fewer resources available to help, thanks to the Trump cuts.”

Dorn worries that’s “a setup for epic failure,” and many people will remain uninsured even as states across the country are seeing alarming increases in coronavirus cases.

Administration officials say HealthCare.gov is open for business and ready to handle sign-ups online or via its call center. “We’ll be working through the upcoming open enrollment period…to ensure a smooth user experience,” CMS Administrator Seema Verma said.

More than 11 million people currently have coverage through HealthCare.gov and state-run health insurance markets offering subsidized private plans. The health law also covers another 12 million people through its Medicaid expansion, adopted by all but 12 states.

Medicaid enrollment has gone up by nearly 4 million people since March, but it’s still unclear how many laid-off workers are coping after the loss of employer coverage in the coronavirus economy.

Those who are healthy most likely have other priorities, such as finding another job. Workers who were furloughed, but not laid off, may have been able to keep their coverage. Some appear to have switched to a spouse’s plan, and those age 65 and older can get on Medicare.

The nonpartisan Kaiser Family Foundation estimates that 80% of

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‘Obamacare’ sign-ups begin as millions more are uninsured | St. Louis business news

Hard numbers on how virus-related job losses have affected health coverage are not available because the most reliable government surveys will not be out until next year. Estimates range from 5 million to 10 million newly uninsured people. That’s on top of 26 million uninsured last year, before the pandemic, or about 8% of the U.S. population.

“There is a coverage crisis happening, ” said Stan Dorn, a health policy expert now with Families USA, a liberal advocacy group. “And there are fewer resources available to help, thanks to the Trump cuts.”

Dorn worries that’s “a setup for epic failure,” and many people will remain uninsured even as states across the country are seeing alarming increases in coronavirus cases.

Administration officials say HealthCare.gov is open for business and ready to handle sign-ups online or via its call center. “We’ll be working through the upcoming open enrollment period…to ensure a smooth user experience,” CMS Administrator Seema Verma said.

More than 11 million people currently have coverage through HealthCare.gov and state-run health insurance markets offering subsidized private plans. The health law also covers another 12 million people through its Medicaid expansion, adopted by all but 12 states.

Medicaid enrollment has gone up by nearly 4 million people since March, but it’s still unclear how many laid-off workers are coping after the loss of employer coverage in the coronavirus economy.

Source Article

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Attacks on Obamacare threaten coverage gains among minorities

Threats to Obamacare could deal a new blow to communities of color that have been disproportionately ravaged by the coronavirus pandemic as the nation is reckoning with generations of inequity.

The Affordable Care Act’s insurance subsidies, its expansions of Medicaid eligibility and its protections for preexisting conditions have especially helped Americans of color, narrowing historic disparities in access to health insurance and affordable care. The coverage gains are among the most significant since the passage of Medicare and Medicaid and the desegregation of American hospitals more than 50 years ago.

Now, President Donald Trump is again threatening to replace the law if he’s reelected. And exactly one week after the election, the Supreme Court, with its new 6-3 conservative majority, will hear oral arguments in a case brought by conservative states seeking to overturn the entire Affordable Care Act. If the law is dismantled, the communities it aided the most stand to lose the most.

“Health care could be ripped away from millions and the numbers of uninsured Americans of color could skyrocket—aggravating the health care disparities that already exist in this country,” said Sen. Tammy Duckworth (D-Ill.). “It’s especially infuriating that this is happening in the middle of a deadly pandemic that is disproportionately devastating so many seniors, Black, Brown and Native Americans and those with pre-existing conditions.”

Between 2013, the year before the Obamacare markets opened and Medicaid expansion began, and 2018, the rate of Latinx adults without health insurance plummeted from 40 percent to 25. The uninsured rate for Black adults fell from 24 percent to 14. For white adults, it dropped from 15 percent to 9, according to the Commonwealth Fund.

“There is no doubt that the Affordable Care Act, though it left millions uninsured, narrowed the racial gap in health insurance coverage and that’s a good thing,” said Mary Bassett, the former New York City health commissioner who is now a professor at Harvard’s School of Public Health. “Having millions suddenly lose their health insurance seems very likely to have an adverse impact.”

If the health law disappeared, the Urban Institute estimated that the gaps would widen once again, almost back to 2013 levels. And that assessment was in 2019 — before the devastation wrought by the coronavirus which is exacerbating inequality, in both health and the economy overall.

Especially affected would be people of color living in one of the 38 states that expanded Medicaid, the joint federal-state health program for low-income people. Without health coverage, many would lose access to much-needed care for chronic health conditions — and become more vulnerable to serious complications from Covid-19.

Trump says he wants a health system that will give people more choice, at less cost. “It’s in court, because Obamacare is no good,” he said at his second and last debate with Democratic challenger Joe Biden.

Even the Affordable Care Act’s backers admit it was not a panacea. Health inequities, some driven by generations of systemic racism, persist. Private insurance remains out of reach

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Liz Weston: How losing Obamacare could cost you

If the Supreme Court throws out the Affordable Care Act, your finances and your future could pay the price.

THE RETURN OF PREEXISTING CONDITIONS

The Trump administration and a group of Republican attorneys general have asked that the entire law be thrown out. The Supreme Court is scheduled to hear oral arguments on Nov. 10.

Before the ACA, insurers routinely used preexisting health conditions as a reason to deny coverage or charge people more. Preexisting conditions included serious ailments such as cancer or heart disease as well as more common conditions such as high cholesterol, high blood pressure, asthma, diabetes and obesity, and temporary conditions including pregnancy. Insurers denied about 1 in 5 applications for individual policies because of preexisting conditions, and some employer-provided group policies required people to wait up to a year before their preexisting conditions were covered.

President Trump signed an executive order in September announcing “a steadfast commitment to always protecting individuals with preexisting conditions,” but the order alone can’t force insurers to offer coverage if the ACA is struck down.

And America is a land of preexisting conditions. Half of adults under age 65, or up to 133 million people, had health issues that could cause them to be denied coverage or charged exorbitant premiums, according to a 2017 government analysis.

‘USE IT AND LOSE IT’ COVERAGE

Health insurance is meant to help people pay their medical expenses and avoid potentially catastrophic bills. Before Obamacare, however, using your insurance could cause you to lose it.

If someone with an individual insurance policy got sick, the insurer could scour the person’s application looking for errors. Even minor mistakes could cause the company to revoke the policy, a practice called

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How losing Obamacare could cost you

If the Supreme Court throws out the Affordable Care Act, your finances and your future could pay the price.



FILE - This undated file photo provided by NerdWallet shows Liz Weston, a columnist for personal finance website NerdWallet.com. (NerdWallet via AP, File)


© Provided by Associated Press
FILE – This undated file photo provided by NerdWallet shows Liz Weston, a columnist for personal finance website NerdWallet.com. (NerdWallet via AP, File)

Retiring early or starting a business might become too hazardous if your access to health insurance isn’t guaranteed. You might have to wait a year before preexisting conditions are covered by an employer’s plan. Young adults could be kicked off their parents’ policies. Millions of people who buy insurance through the ACA marketplaces or who now qualify for Medicaid could lose their coverage as well.

Even if you were able to keep your health insurance, you could face caps on your coverage that expose you to enormous medical bills. Preventive care and birth control could cost you more. Medicare beneficiaries could face higher premiums, deductibles and copays. Insurers could cancel your policy retroactively for even minor mistakes on your application.

In the decade since the ACA became law, many Americans have become so accustomed to the protections and savings afforded by the landmark legislation that they may not realize how much could change if Obamacare is struck down. Its effects on health care are so pervasive that nearly every American could be affected, according to the Kaiser Family Foundation, which tracks health care issues.

THE RETURN OF PREEXISTING CONDITIONS

The Trump administration and a group of Republican attorneys general have asked that the entire law be thrown out. The Supreme Court is scheduled to hear oral arguments on Nov. 10.

Before the ACA, insurers routinely used preexisting health conditions as a reason to deny coverage or charge people more. Preexisting conditions included serious ailments such as cancer or heart disease as well as more common conditions such as high cholesterol, high blood pressure, asthma, diabetes and obesity, and temporary conditions including pregnancy. Insurers denied about 1 in 5 applications for individual policies because of preexisting conditions, and some employer-provided group policies required people to wait up to a year before their preexisting conditions were covered.

Back then, many people who had health issues — or whose family members did — avoided changing jobs, starting businesses or retiring early because of the risk they couldn’t find affordable health insurance.

President Trump signed an executive order in September announcing “a steadfast commitment to always protecting individuals with preexisting conditions,” but the order alone can’t force insurers to offer coverage if the ACA is struck down.

And America is a land of preexisting conditions. Half of adults under age 65, or up to 133 million people, had health issues that could cause them to be denied coverage or charged exorbitant premiums, according to a 2017 government analysis.

‘USE IT AND LOSE IT’ COVERAGE

Video: Bill Gates says he should be paying significantly higher tax (The Independent)

Bill Gates says he should be paying significantly higher tax

UP NEXT

UP NEXT

Health insurance is meant to

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How Trump success in ending Obamacare will kill Fauci plan to conquer HIV

In his State of the Union address in February 2019, Donald Trump vowed to end the HIV epidemic by 2030.

Related: ‘Rick Scott had us on lockdown’: how Florida said no to $70m for HIV crisis

But if Trump has his way and the supreme court strikes down the Affordable Care Act (ACA), the resulting seismic disruption to the healthcare system would end that dream.

Democrats have expressed grave concern that if Amy Coney Barrett is seated on the supreme court, the conservative jurist could cast a decisive vote to destroy the ACA in the California v Texas case scheduled for oral argument starting 10 November. The Senate judiciary committee will vote on Barrett’s nomination on Thursday. A full Senate vote is expected on Monday.

The brainchild of Dr Anthony Fauci and other top brass at the Department of Health and Human Services, the ambitious Ending the HIV Epidemic: A Plan for America has received for its debut year $267m in new federal spending, largely targeted at HIV transmission hotspots across the US.



a person holding a sign: Amy Coney Barrett listens during a confirmation hearing. Photograph: Anna Moneymaker/AP


© Provided by The Guardian
Amy Coney Barrett listens during a confirmation hearing. Photograph: Anna Moneymaker/AP

The central aim of the Trump-backed plan is to improve access to antiretrovirals, given that successfully treating HIV with such medications eliminates transmission risk. For HIV-negative people, the plan promotes greater use of PrEP – a daily antiretroviral tablet that cuts the risk of HIV by more than 99% among gay and bisexual men, who are its predominant users and account for seven in 10 new infections.

Given antiretrovirals’ enormous cost, the ACA and its broadening of insurance access serves as backbone to the HIV plan, which seeks a 90% reduction by 2030 to the otherwise slowly declining or stagnant national HIV transmission rate of about 37,000 new cases annually.

“The plan is dead in the water if the ACA goes down,” said Amy Killelea, senior director of health systems and policy at Nastad, an HIV public policy non-profit.

“President Trump’s healthcare agenda, in particular his plan to get the supreme court to rule against families’ healthcare, does more to end access to HIV care than it does to end HIV,” said the Washington state senator Patty Murray.

‘Heartbreaking and morally indefensible’

Kaiser found that between 2012 and 2018, the proportion of the non-elderly HIV population lacking insurance declined from about 18% to 11%. This shift was mainly driven by the expansion of Medicaid in the states that opted under the ACA to open the program to all residents with incomes below 138% of the federal poverty level.

About 60% of non-elderly people receiving care for HIV fall into that lowest of income brackets. Forty per cent of people with HIV receive Medicaid, compared with 15% of the general population.

“Striking down the ACA would lead many people with HIV to lose insurance coverage,” said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation.

Not following the science to address HIV or Covid-19 primarily impacts

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Repeal of Obamacare Could Leave Young Cancer Patients in the Lurch | Health News

By Cara Roberts Murez, HealthDay Reporter

(HealthDay)

THURSDAY, Oct. 22, 2020 (HealthDay News) — If Obamacare, or the Affordable Care Act (ACA), is repealed, pediatric cancer patients could lose critical insurance coverage, a new study warns.

Kids with cancer often require intensive treatment and long-term follow-up to beat the disease. The ACA allows them to stay on their parents’ insurance coverage to age 26 and bans exclusion of patients with preexisting conditions.

The U.S. Supreme Court is poised to rule on the future of the ACA this fall. Researchers at the University of California, San Francisco’s Benioff Children’s Hospital and the Children’s Hospital of Philadelphia studied the potential impact of dismantling it on 18- to 25-year-old cancer patients.

“We know that even brief disruptions in insurance have been associated with harmful health consequences,” said first author Dr. Lena Winestone, of the Helen Diller Family Comprehensive Cancer Center at UCSF. “Strict adherence to chemotherapy regimens, for example, is essential for those patients with acute lymphoblastic leukemia,” the most common pediatric cancer.

Researchers tracked patients born in 1982 or later who were diagnosed with cancer between 2000 and 2015. Most had leukemia, lymphoma or tumors of the brain or spine.

The investigators contrasted insurance status in four age groups, including a group who turned 19 within two years of the ACA’s adoption. They were matched by cancer type, diagnosis date, demographics and treatment characteristics to patients who were two years older and, therefore, unprotected by the ACA.

They did similar comparisons with patients who were 23 to 25 years of age and between 26 and 28 when the ACA went into effect.

The average time to end of coverage was 26 months, compared to 22 months for the older group — a 15% lower risk of insurance loss. The younger patients also were more likely to retain coverage for four years — 37% versus 31%.

Winestone was senior author on a 2019 study that showed private insurance coverage may boost survival in pediatric cancer patients. In that study, 71% of patients with private insurance were alive five years after being diagnosed with bone and soft-tissue sarcomas, compared to 61% of patients with public insurance.

“Cancer survivors experience ongoing loss of income and financial burden related to their medical issues,” Winestone said in a UCSF news release. “At a time when unemployment is rising to unprecedented levels, due to the economic fallout of the pandemic, the Affordable Care Act provides a mechanism for patients to maintain access to their parents’ health insurance.”

The findings were published Oct. 22 in JCO Oncology Practice.

Copyright © 2020 HealthDay. All rights reserved.

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Biden vs. Trump: ObamaCare, access to health care in rural US impacts voters’ decisions

Kathleen Wishnick left the hustle and bustle of Sacramento for a new life in the rural deserts of Arizona more than 15 years ago.

She said her family wanted a “place in the middle of nowhere” and they found it in the small town of Arivaca, which boasts a population of about 684 people.

The peaceful setting has its perks, Wishnick told Fox News, but when it comes to health care, access is almost nonexistent.

“The roads when it rains are iffy…sometimes ambulances can’t get in… people said to us, ‘Well you won’t have any health services,’ I said well it’s just a helicopter ride away, but when it happens to you, you tend to rethink that just a little bit,” she said.

ARIZONA’S BATTLEGROUND COUNTIES START TALLYING EARLY BALLOTS

Kathleen Wishnick lives in Arivaca, Arizona, home to around 684 people. She says access to health care can be a challenge, as the nearest hospital is over an hour away (Stephanie Bennett/Fox News).

Kathleen Wishnick lives in Arivaca, Arizona, home to around 684 people. She says access to health care can be a challenge, as the nearest hospital is over an hour away (Stephanie Bennett/Fox News).

Wishnick says the town does have a clinic, but it’s only open certain days a week and has just two doctors. For more advanced procedures or to see a specialist, it involves driving to the closest hospital about an hour away.

With only days until the 2020 presidential election, the topic of health care access, insurance and affordability is front and center in Wishnick’s mind — and she is not alone.

According to the Kaiser Family Foundation, about 2.8 million Arizonans live in areas that the federal government says has a health care shortage — ranking 9th in the country overall.

“I believe everyone in Arizona and across the United States should have access to care,” Dr. Daniel Derksen, associate vice president for health sciences at the University of Arizona and director of the Arizona Center for Rural Health, told Fox News. “We are certainly spending enough as a nation and spending enough as a state to cover every single person with the care that they need, so that they get it when they need it, such as during a COVID-19 pandemic.”

Arivaca, Arizona is about 60 miles south of Tucson (Stephanie Bennett/Fox News).

Arivaca, Arizona is about 60 miles south of Tucson (Stephanie Bennett/Fox News).

THE PRESIDENTIAL ELECTION COMES DOWN TO THESE 9 STATES

Derksen said the Affordable Care Act – or ObamaCare – which former Vice President Joe Biden wants to protect and expand, is a good thing and would be harmful to rural residents to lose.

“We need to make sure that coverage is built upon not torn away … we need to build on the gains made, not throw things away and especially during a time where people really need the health care and access,” he added. “The Affordable Care Act does protect individuals from being charged more or being denied coverage or dropped from coverage once they exceed a certain amount.”

He said that about 20 million Americans could lose their health care – and more than half a million Arizonians – if provisions in the health care act went away.

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