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Health of the Union 2018

One of the weird things about Donald Trump’s State of the Union speech was how much he sounded like a normal president– ignore the parts about the wall and MS-13 and the digs at kneeling NFL players and you could easily picture an alternate universe where a President Mitt Romney or a President Jeb Bush was giving the same speech.

Partly that’s just the nature of the State of the Union– it’s a laundry list of policy accomplishments/goals, and for all the talk of Trump being an “outsider” candidate, his actual policies are generic Republican stuff– but it was also partly in how he defended those policies.

We’ve probably fact-checked hundreds of statements about healthcare from politicians on both sides of the aisle, and it’s actually pretty rare to catch them straight up lying. They say things that are false all the time, but they typically do that by starting with a grain of truth and then spinning it wildly out of context. So for example, during the 2012 campaign Mitt Romney claimed that Obamacare “robbed” $716 billion from Medicare– in truth Obamacare didn’t take any money out of Medicare, it simply lowered the reimbursement rates that would be paid to hospitals, insurers, and other providers, saving $716 billion. Or to give an example from the other side, there’s President Obama’s “if you like your plan, you can keep it” claim. It’s true that the Obamacare contained a provision that exempted pre-ACA plans from the ACA’s rules, but there was nothing in the law to prevent insurers from canceling those old plans, and many did.

President Trump is different. From the size of his inauguration crowd to the ratings of his State of the Union, Trump’s tells lies that don’t contain even a grain of truth– and he does it constantly. However, in the State of the Union, at least on healthcare, he spun and mislead like a normal politician. Here’s how…   [click to continue…]


Passing an extension of funding for the Children’s Health Insurance Program (CHIP) should have been one of the easiest things Congress could possibly do on healthcare.

The CHIP program, which covers 9 million kids nationwide, is wildly popular: a poll from the nonpartisan Kaiser Family Foundation in November found that reauthorizing CHIP funding topped the American public’s list of priorities for Congress and President Trump:

The vast majority of politicians on both sides of the aisle support CHIP– or at least say they do. As always, there are disagreements between the parties about how to pay for it, but finding the money shouldn’t be that hard, since CHIP doesn’t cost all that much. In 2016, spending on CHIP was about $13.6 billion, or less than half a percent of the $3.3 trillion spent on health care last year in the U.S. (By comparison, we spent $672.1 billion on Medicare in 2016.)

CHIP also works really well– in 1996, the year before the program was introduced, the uninsured rate among children was 15%; by 2015 it was down to under 4.5%. And according to a survey of research on the impact of CHIP by the Kaiser Family Foundation, “A vast literature documents much greater access to care among children covered by Medicaid and CHIP relative to uninsured children.”

Yet somehow, Congress let CHIP funding expire in September, putting the health of millions of kids at risk– it then it took 114 days and a government shutdown before they finally acted. Why did it take so long? Good question…   [click to continue…]


Earlier this year, we heard one of the hosts of a popular political podcast start using a new qualifier: “in Trump-adjusted terms.” She mostly used it to describe how she was feeling on a given day– “I’m fine (in Trump-adjusted terms)”– but it works in all sorts of situations. A boring week (in Trump-adjusted terms) would be one where the President of the United States doesn’t edge us closer to nuclear war with an unstable dictator on Twitter. A successful meeting (in Trump-adjusted terms) is one in which he doesn’t accidentally reveal classified intelligence to a foreign adversary or ask racist questions about immigration.

It’s also a good way to think about the state of American healthcare in 2017. For those of us who believe that everyone in this country should have access to affordable healthcare, the raw numbers are disappointing:

Still though, if you had told us that a year into the Trump administration the vast majority of the ACA would still be standing and covering almost as many people as it had in 2016, we would have been relieved. In other words, 2017 was a pretty good year for the ACA… in Trump-adjusted terms. Here are three reasons why.   [click to continue…]


Procrastinator’s guide to getting covered in 2018

It’s been a bumpy road for the Affordable Care Act in 2017, but the law is still standing: Republicans’ efforts to “repeal and replace” it fell apart over the summer, and the recent election of Senator Doug Jones in Alabama, means that they’re unlikely to try again in 2018.

With repeal off the table, the Trump administration instead seems set on doing everything in it’s power to make the law work less well. Perhaps as part of that effort they drastically shortened the open enrollment period where anyone can sign up for Obamacare. Last year, you had until January 31 to sign up for a 2017 plan; this year, TODAY (Dec. 15) is the last day to buy a plan for 2018 in most states.

However, as long as you’re “in line” (that is, in the process of trying to buy a plan) by midnight tonight you can still get coverage. Also, a number of states have extended their deadlines, so even if you’re reading this after December 15, it’s still worth logging onto healthcare.gov to check. Plus if your income is low enough you and your family might qualify for Medicaid, and you can enroll in that an any time.

And for those of you in a rush to pick a plan before the deadline, here’s a bunch of helpful information to help you make it through quickly! [click to continue…]


If we’ve learned one thing over the past few months, it’s to stop making predictions about what Congress will do next. Like the killer in a horror movie, every time we thought Obamacare repeal bill was dead– when Paul Ryan gave up on a House vote back in March; when at least three Senators announced their opposition to every public version of the bill– it always somehow managed to come crawling back. And when it looked like a version might actually pass last month, John McCain swooped in at the last minute to put the final stake in its heart.

Or so we thought. We’ve been hearing rumblings that some Republican senators are pushing for another repeal vote. However, others– even more shockingly– are pushing for bipartisan bill to help fix the ACA. Let’s take a closer (but prediction free) look at the two options. [click to continue…]


By now we’re sure you’ve heard that Senate Republicans failed to pass a health bill in July, with the deciding vote cast by John McCain in a dramatic, late-night session. (In a healthcare bloggers’ nightmare, Senate Republicans managed to schedule the vote while I was on a camping trip, and when I got back we had to switch web servers and couldn’t upload anything.) Now that the smoke has cleared somewhat, we thought it would be helpful to take a look back at what exactly happened– not to mention how completely insane the process was– and what it means for healthcare moving forward.  [click to continue…]


Man, it’s been a crazy week for the Senate health bill. Last Thursday, GOP leaders released a new version, which included an amendment from Senator Cruz that was supposed to make the bill more acceptable to conservatives. By Monday, enough conservative Senators were opposed that the bill was dead, and the backup plan of repealing Obamacare without a replacement collapsed the next day. Shortly after that, McConnell announced that he was scheduling a vote on healthcare for next week.

Confused? You’re not alone. Even Republican senators still don’t know which Obamacare repeal and/or replacement bills they’ll be voting on. To try and make at least some sense of how we got here, here’s a day-by-day recap of the week’s biggest news. [click to continue…]


Our last post looked at how the Senate health bill would be particularly bad for older Americans, but that’s definitely not the only group the bill would disproportionately harm. The bill (which was written by 13 men) also manages to reduce access to every type of reproductive healthcare for women: not only does it make it harder for women to access birth control or terminate a pregnancy, it also makes it much harder for women who are pregnant to get maternity care.   [click to continue…]


One of the Dave’s I know is an older American who could see his premiums skyrocket thanks to the GOP health plan.

The Congressional Budget Office released its score of the Senate health bill yesterday, and as I read it, I kept thinking back to a comment we received earlier this year, from a reader named Dave.

In March of 2016, Dave lost his job and with it his health coverage; he later found another much lower paying job without benefits (“hey I’m 63, glad to be working at all,” he writes); he bought coverage through the marketplace, where he says that Obamacare’s advanced tax credits “reduced my monthly premiums substantially.”So at first this sounded like was an “Obamacare is working great” story. However, when he did his 2016 taxes, it looked like an end-of-year bonus would push his total income above the cutoff to qualify for the ACA’s tax credits and he’d have to pay them all back. Understandably, he wasn’t happy:

This arbitrary number seems crazy, you go 1 dollar over it and owe thousands back to the IRS. Instead of some kind of sliding scale where if you go above certain limits you start losing the advanced credits but not owe a huge chunk for exceeding by a few dollars. The idiots that wrote and approved this plan, our representatives, OBVIOUSLY didn’t consider the poor schlub middle-class guy with a family of 4 paying 2 college tuition bills, food, mortgage and every other everyday bill, somehow cannot afford a 1700 health insurance bill while earning a certain amount, but go over that amount by a dollar and now he can afford it???, Frigging’ insanity, can’t wait for Trump and the Republican congress to replace this disastrous govt run nightmare.

Now, for most people, the Affordable Care Act does mean affordable premiums. The law’s tax credits lower premiums for people making less than 400% of the poverty line; and if you’re a younger person (i.e. under 40) making more than that, your premiums will still be affordable, because insurance companies charge young people less. But if you’re an older person and your income is too high to qualify for tax credits? You could end up paying more than 25% of your income for health insurance.

This is one of the Affordable Care Act’s biggest flaws, and Dave is right that Congress should fix it. But here’s the thing: the health plan that Trump and the Republican Congress are trying to pass would make things much, much worse.   [click to continue…]


After reading the health bill that the Senate released yesterday, we were wondering how exactly Republicans would argue for this bill. It has massive cuts to Medicaid, increased costs for the sick and older Americans, higher deductibles, waivers letting states opt out of the ACA’s insurance protections… in fact, we didn’t see anything that the majority of Americans would support aside from maybe the repeal of the individual mandate.

Then we saw Pennsylvania Senator Pat Toomey’s op-ed in the Philadelphia Inquirer: apparently the strategy is to mislead constituents about what the Senate bill actually does. So much of the Senator’s op-ed was wrong or misleading that we decided to address it point-by-point.   [click to continue…]