Making Democracy Work

Health Care Committee

Advocating for Health Care

Healthcare Updates

March ILR -

Health & Human Services Rule Changes for Patient Protection and Affordable Care Act (ACA) - Secretary Tom Price (HHS) has proposed the following rule changes. While Congress approves any ACA repeal, repair, or replacement, federal agencies may adopt rule changes without congressional oversight. Proposed rule changes have a 90-day comment period. The comment period for these changes ends as ILR goes to press: "Y

  • The new Open Enrollment 5 (OE5) time period is shorter, November 1st- December 15th. "Y

  • Pre-enrollment verification would be required for consumers who want to enroll in a plan through a Special Enrollment Period (SEP). They would have 30 days to document proof of their qualifying life change event (i.e., marriage) to effectuate coverage. "Y

  • The rule would allow an insurer to avoid enrolling a person whose coverage was terminated for non-payment of premiums in the past year, unless that person pays back-premiums he or she owes the insurer.

Watch your email box and future ILR for proposed HHS rule changes on which you may wish to comment.

Health insurance company mergers have been blocked for now, an action intended to keep competition among plans. Federal level changes face uncertainty, which has resulted in insurance companies possibly withdrawing plans from the marketplace in 2018. Proposals include marketing across state lines. The challenge is that each state has differing rules governing insurance. Whose regulations would prevail? National Public Radio (NPR) reports that Eastern states who have made this effort have found it unsatisfactory for consumers.

New Secretary of Health and Human Services - Georgia 6th District US Representative Tom Price was confirmed as Secretary of HHS on Feb 10, 2017. Secretary Price is an orthopedic physician and has served in government for the past 21 years. The Senate confirmation debate for Secretary Price, Republican of Georgia, focused as much on his ethics and investments, particularly in the pharmaceutical industry, as on his health policy views. Democrats also denounced his desire to rein in the growth of Medicare and Medicaid by making fundamental changes to the programs, which insure more than 100 million Americans. (NY TIMES, Feb 2017).

Repeal of the Patient Protection and Affordable Care Act (ACA) was part of the 2016 Republican Party platform and one of the first matters taken up by Congress in January, 2017.

Pharmaceutical Industry - Although prescription prices are continually rising, The GOBOLDLY media campaign focuses the publicˇ¦s attention on scientists great work to bring new, life-saving drugs to market. (GOBOLDLY ad ). The lobbying group for the pharmaceutical industry is PhRMA. Its campaign is intended to justify higher costs for their products without discussion of CEO salaries and industry bottom-line profits. While we celebrate the healing possibilities brought by decades of expensive research, consumers must keep their perspective on the role of lobbyists and their influence on government officials.

Medicaid - Both federal and state proposals for Medicaid funding would move toward block grants. Specific amounts of money would be granted to states for Medicaid programs. Rather than funding based on a stateˇ¦s health spending needs, a set amount of money is allocated. States would use their own funding mechanisms if Medicaid costs exceed the grant amount. A state legislature could also choose to cut services or eligibility for thousands of people.

Missouriˇ¦s Medicaid program is MO Health Net. Senate Bill 28 is currently brought forward, which would allow the Joint Committee on Public Assistance to make funding decisions. This is not an elected committee, but it would make final decisions for Missourians.

Prescription Drug Monitoring Program - Missouri is moving ahead with a Prescription Drug Monitoring Program (PDMP). SCS/SB 314 and 340 are being discussed with reconciliations. This act establishes the Narcotics Control Act addressing concerns about opioid addictions. A floor vote may be scheduled soon.

Advocates Watchful But Ask: "Replace before Repeal"

February ILR -

Congressional maneuvers have begun the dismantling of the Patient Protection and Affordable Care Act (ACA/Obamacare). Their first steps include attacks through the budget and appropriations process. No money, no care.

We anticipate additional tactics. Will the appointment of Dr. Tom Price as head of Health and Human Services become a reality? What rule changes would weaken consumer protections? Please know that contacting your US Senators and Congressional Representatives may be the best defense.

There are several areas of concern beyond dismantling ACA. Would stem cell research move forward? would opioid addiction treatment be allowed? Medical trials could be thwarted. Fear may prevent immigrants from seeking medical treatment.

Seldom considered is the importance of the Secretary of Agriculture in directing the general health of our population. This department regulates food program for low income people. They include Supplemental Nutrition Assistance Program (SNAP - food stamps) and Women, Infant and Children (WIC) programs. Recipient numbers have been reduced over the years, but the latest numbers suggest 44 million people benefit from the program. WIC serves pregnant women and infants (up to 5 years of age). According to Kaiser Health News, 53% of all US born infants benefit from this program. Sonny Perdue, former Georgia Governor, has been suggested for this cabinet appointment.

Take a look at Missouri. The Senate Committee for Seniors, Families and Children is reviewing possibilities through SB 28. Advocates are testifying against this proposal and would like tot see this stay in committee hearings rather than go to the floor of the Senate - and further. It is subject to change as it goes through the legislative process.

This proposal suggests the legislature would also approach financial squeezes to make fewer and fewer Medicaid recipients able to pay for health care. MO HEALTH NET is our state Medicaid program. Federal Block Grants would limit the shared finances currently at approximately a 60/40 split of Federal vs State money. Some legislators also suggest amounts received should be capped which ultimately would affect ALL those receiving MO Health Net benefits.

Remain watchful. Speak to issues. Ask questions of our elected officials. "Complacency is not an option," read one of the signs at the Women's March on January 21. Our League members are powerful and watchful as citizens.

Dianne Modrell, Chrm Health Care Committee