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Trump’s 100 day “plan” for healthcare

donld-trump

So… this happened.

As you might have noticed, we haven’t posted in a while. Partly that’s because we’ve been busy with other projects, but it’s also partly because there hadn’t been much happening in the world of health policy. There were a couple snags with the ACA– premiums increased by more than they had in a couple years and a couple big insurers left the exchanges– but for the most part it was running like it always has, covering more than 20 million Americans who would have been uninsured otherwise. The stalemate between Congress and the White House plus an election year meant that no new health laws were being passed. Both Trump and Clinton posted healthcare proposals on their websites during the primaries (we looked at Trump’s here, and Clinton’s here and here), and Trump like every other Republican promised to repeal Obamacare, but otherwise, healthcare got little attention during the campaign.

And then the election happened.

One of the more troubling things about Trump being elected is that we have little idea of what he’ll actually do when he’s in office. He’s promised to replace Obamacare with “something terrific,” but the proposals on his website are, for lack of a better word, a mess. Even Obamacare critics have worried about Trump’s (lack of) plan. Michael Cannon, health policy director of the libertarian Cato Institute, a man who’s been described as “Obamacare’s single most relentless antagonist,” put it this way:

“This isn’t a health reform plan. It’s a campaign operative copying and pasting a bunch of stuff from the around the web, without knowing what it means or even realizing that he’s describing current law. It shows Trump is as unserious about reforming health care as ever. He doesn’t have a plan. He has paroxysms.”

So we thought that maybe Trump’s hundred days plan would give us some more insight into how he actually plans to tackle healthcare. It did not inspire confidence.   [click to continue…]

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zika flier

We haven’t written much about Zika yet, mostly because there are already a ton of great resources explaining pretty much everything you need to know about the virus. In particular we’d recommend:

Also, Zika hasn’t sparked the same kind of public alarm that past outbreaks have, which in some ways is good, since there’s less misinformation floating around. It seems like there’s a general awareness that it’s spread primarily by mosquitos, but can also be transmitted sexually; and that the main risk is for pregnant women, because the virus can cause severe birth defects like microcephaly (although we should point out the World Health Organization estimates that only 1% of women with Zika will have a baby with birth defects). The vast majority (80%) of people who contract the Zika virus won’t show any symptoms; a minority (about 20%) will show minor symptoms like fevers, aches, headaches, and rashes; and in a very small number of cases (1 in 4,000) it can cause Guillain-Barré, a neurological condition that can sometimes lead to temporary paralysis.

However, perhaps because there hasn’t been a major public outcry, Congress has been slow to respond– even though that 1% risk to fetuses was enough for the WHO to declare a public health emergency back in January. Lawmakers on both sides of the aisle say that securing more Zika funding is critical, yet somehow Congress left for summer break without authorizing new funding. Meanwhile, the disease has arrived in the U.S.– it’s now being transmitted by mosquitos in Florida, and a baby born with a Zika-related birth defect died in Texas this week.

And so this week, we’ve seen editorials from Paul Ryan and other prominent Republicans blaming President Obama and other Democrats for blocking Zika funding. That seemed odd given that Republicans are usually the party opposed to new government spending. Turns out that in reality the GOP (1) demanded that the Obama administration use funding meant to prevent another Ebola epidemic, (2) sabotaged a Zika funding bill by adding provisions they knew Democrats wouldn’t agree to, and (3) refused to call Congress back to vote on a clean bill.  [click to continue…]

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billy madison

This has probably happened to everyone at least once in school: the deadline for a big paper or presentation was coming up and you hadn’t actually read the book or done the research. At that point, you basically had two options: (1) ask for an extension; or (2) use as many words as you could to present what little information you did have, hoping that the length would obscure the fact that you weren’t really saying anything. There’s a great example of this at the end of Billy Madison:

For six years, Republicans in Congress went the first route, asking for extension after extension on their long-awaited plan to replace Obamacare, always claiming they were going to release one “soon.” That only works for so long though, and with a presidential election coming up, they were starting to face awkward questions from voters and the media about the fate of the 20 million people who would lose coverage if the ACA were repealed.

And so, House Republicans have moved on to the Billy Madison approach. Last week, speaker Paul Ryan released what he called “a first-time-in-six-years consensus by the Republicans in the House on what we replace Obamacare with.” At 37 pages, it’s long enough that on first glance it looks like it could be an actual alternative to the ACA; but just like Billy’s “rambling, incoherent response” was missing “anything that could be considered a rational thought,” the GOP’s rambling, incoherent health reform plan is missing, well, a plan. [click to continue…]

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Obamacare’s forgotten OTHER subsidy

aca plan comparison laptop

Back in 2013, shortly before the first Affordable Care Act plans took effect, we wrote a post about what we called Obamacare’s “other” subsidy. In it, we explained how if your income is below 250% of the poverty line (currently $29,700 for a single adult), a provision called Cost Sharing Reduction (CSR) could dramatically lower your out-of-pocket costs if you buy a Silver level plan.

At the time, it seemed like hardly anyone knew this; while we’d seen plenty of articles mentioning the ACA’s help paying for premiums, CSR was largely ignored.

Unfortunately, over the past two and a half years, not much has changed. Even as high out-of-pocket costs have become a major campaign issue, Obamacare’s CSR has gotten little coverage, meaning many people who could benefit still have no idea it exists.   [click to continue…]

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martin-omalley-medicare-plan

In our last post we talked about the wonky idea at the center of Martin O’Malley’s healthcare plan– an all payer system– and why both Hillary Clinton and Bernie Sanders should consider adopting it in their own plans.

But that’s not the only part of O’Malley’s plan that deserves a second look. In a piece for MedicareResources.org, Rob writes about his other good idea, which O’Malley calls Medicare Essential:

Originally proposed by researchers from John Hopkins University and the Commonwealth Fund, “Medicare Essential” could make Medicare simpler for enrollees, lower their premiums and out-of-pocket costs, and improve the quality of their care. It’s an idea that could strengthen Clinton’s “Medicare for More” plan or serve as a step toward Sanders’ “Medicare for All.” On top of that, it would cost the federal government nothing, making it hard for even a Republican Congress to vote no.

Go read the whole thing here!

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martin o'malley doctors

Before you ask, yes we know Martin O’Malley dropped out of the 2016 presidential race months ago.

Here’s the thing: presidential campaigns in the U.S. are way too long. The UK’s most recent national election lasted 139 days, and the last Canadian election took just 11 weeks. Meanwhile, here in the U.S., the 2016 campaign began almost two years before election day, when Ted Cruz announced his candidacy. It’s a ridiculous amount of time to focus on an election, so aside from a quick post on the first Republican debate (which, like everyone else, we watched mostly just to see the Donald Trump circus) we decided not to cover the 2016 campaign until, well… 2016.

What that meant though is that by the time we started looking at candidates’ health plans, many of them had already dropped out. In the Republican race, this wasn’t a big deal since every GOP candidate promised basically the same thing on healthcare: to repeal the Affordable Care Act and replace it with some combination of catastrophic coverage, high risk pools, selling insurance over state lines, and block-granting Medicaid.

However, on the Democratic side Martin O’Malley had an interesting proposal that none of the other candidates touched on. Even though he’s out of the race, his ideas are still worth examining, because they could improve both Clinton’s plan, which builds on the ACA, and Sander’s single-payer approach– and possibly serve as a bridge between them.   [click to continue…]

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By far the most important change for pregnant women in the Affordable Care Act was the provision saying that all health plans have to include maternity coverage as an essential health benefit. (Before Obamacare, just 12% of plans on the individual market covered pregnancies.)  But the ACA didn’t stop there– it also provided pregnant women with more choices on how to give birth, by expanding access to midwives and birth centers.

In a piece for healthinsurance.org, Rob looks at why more women are choosing to give birth outside of hospitals, and how Obamacare has helped make that choice possible. Here’s a sample:

Elizabeth Criss knows all about the stigmas attached to giving birth outside of a hospital. “When I told my husband I was being interviewed about why we chose a birth center, he said I should just quote Jim Gaffigan: ‘We’re both lazy and the hospital was soooo far … the midwife was there because we believe in witchcraft.’”

In truth though, Criss did a lot of research into different birth options, and found that for low-risk pregnancies like hers, outcomes for babies are similar at birth centers and hospitals. Also, she had reservations about how quickly hospitals turn to medical and surgical interventions, which come with their own health risks; and she knew that if something happened, the midwives at her birth center, The Midwife Center in Pittsburgh, have admitting privileges at a nearby medical center. Plus, she’d been going there for well-woman visits for years before planning to become pregnant – the atmosphere was more homey and she felt more listened to than with past doctors.

“When you’re pregnant, there’s a lot going on physically and otherwise,” says Criss. “I liked that the care was more comprehensive and whole-person centered, and they don’t treat it like you’re just a uterus.”

Criss says she was happy with her experience at The Midwife Center, and she’s glad she had that option. Now, thanks to Obamacare, it’s a choice available to more women.

Go read the whole thing over at healthinsurance.org!

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trump pumpkin american flag

[This post is part of a series looking at the health plans of the presidential candidates. You can read about Bernie Sanders’ health plan here, and Hillary Clinton’s plan here and here.]

Honestly, we’re not sure what to do with Donald Trump’s health plan. On the one hand, he is the leading Republican candidate for president, and he does have an actual plan up on his website that’s about as detailed as anything Marco Rubio or John Kasich (the GOP’s “serious” candidates) have put forward.

On the other hand, Trump seems to be making up his policy positions as he goes, so who knows what the plan will look like tomorrow. Health care experts have questioned how much effort, if any, he put into it, since he doesn’t appear to have a single health policy adviser, with some of the harshest criticism coming from conservatives. For example, Michael Cannon, director of health policy studies at the libertarian Cato Institute writes:

This isn’t a health reform plan. It’s a campaign operative copying and pasting a bunch of stuff from the around the web, without knowing what it means or even realizing that he’s describing current law. It shows Trump is as unserious about reforming health care as ever. He doesn’t have a plan. He has paroxysms.

Yet for all the complaints from conservative health experts, what’s most striking about Trump’s plan/paroxysms is how similar it is to other Republican candidates’. This is a guy who told 60 Minutes, “Everybody’s got to be covered. This is an un-Republican thing for me to say… I am going to take care of everybody.” But his actual plan simply repeals Obamacare– leaving tens of millions more Americans uninsured– replacing it with almost nothing.  [click to continue…]

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hillary clinton health rally

In our look at Hillary Clinton’s health plan yesterday, we pointed out that of seven big problems that Obamacare didn’t fix, she had ignored perhaps the biggest. Despite saying that she shared Bernie Sanders’ goal of universal coverage, she hadn’t actually proposed a plan to get there. At the end of the post we said that we hoped she’d put out something more ambitious.

Well that didn’t take long. Less than hour after the post went up, we discovered that within the past day or two, Clinton has added a bunch more proposals to her campaign website, all with an eye toward expanding coverage to more of the uninsured. (For comparison, here’s what the healthcare section of her site looked like a week ago.) In addition to the things we mentioned in our last post, Clinton now says she would:

  • Enhance the premium tax credits on the ACA’s exchanges;
  • Fix the law’s “family glitch”;
  • Support new incentives to encourage all states to expand Medicaid;
  • Invest in navigators, advertising and other outreach activities to make enrollment easier;
  • Expand access to affordable health care to families regardless of immigration status; and
  • Continue to support a “public option”.

These new proposals would in fact expand coverage to more people, moving us closer to universal coverage. But how close would they actually get us?   [click to continue…]

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hillary clinton

[This is the second post in a series on the health plans of the 2016 presidential candidates. Part 1, which looked at Bernie Sanders’ health plan, is here.]

Here’s what the 2016 Democratic candidates for president agree on: They agree that healthcare in America is better since the Affordable Care Act. They also agree that there are still problems that need to be fixed, and they mostly agree on what those problems are– a list that looks pretty similar to one we made a while back:

  1. We still don’t have universal coverage;
  2. Unaffordable out-of-pocket costs;
  3. Buying and using insurance is incredibly confusing;
  4. Narrow provider networks;
  5. Price-gouging by providers;
  6. Lack of dental coverage; and
  7. Drug discrimination by insurers.

Where they differ is on how to fix them. Bernie Sanders proposes a totally new system: one single-payer plan covering everyone. As we’ve said before, it could be a great idea, potentially solving every problem on that list (and then some) all at once. Still, single-payer doesn’t automatically mean that people would be better off. For example, if we simply moved everyone into traditional Medicare, which is a single-payer plan, most people would end up with higher out-of-pocket costs, and its low reimbursement rates could force providers out of businesses. To judge any plan– single-payer or otherwise– you have to look at how it balances benefits and costs; and in Sanders’ plan those key details are a mess.

Hillary Clinton’s approach on the other hand is to build on the ACA. Clinton doesn’t provide detailed cost estimates for her proposals, but they’re all small enough changes that it’s easy to imagine how they might be paid for. In a way though, this also highlights a problem: even if all of her proposals were in place, the major issues with our health system would still remain. In other words, unlike Sanders’ plan, the numbers add up– but they don’t add up to nearly enough. [click to continue…]

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