The Health 202: Republicans play defense on preexisting conditions

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THE PROGNOSIS

With less than a month before the midterm elections, endangered Republican lawmakers are mounting a defense against attacks they’re trying to dismantle a core element of the health-care law they fought to eliminate.

Democratic candidates on the campaign trail now regularly accuse Republicans of wanting to take away health-care protections for people with preexisting conditions. They’ve pointed to a lawsuit brought by 20 attorneys general in Republican-led states aiming to overturn the Affordable Care Act as proof the GOP wants to let such protections go down with the health-care law. That’s after Republicans whiffed in their effort to repeal and replace the ACA  last summer.

Vulnerable Republican contenders are responding to the slams by airing campaign ads saying they embrace this portion of the ACA. They’re also introducing a wave of bills in Congress they say would protect those with prior illnesses from losing access to affordable health care. But experts question the efficacy of those measures, saying they seem more designed as protection against Democratic attacks than significant policy solutions, as I helped report in a story with Colby Itkowitz this week.

In August, 10 Senate Republicans, including Sen. Dean Heller of Nevada, one of the most vulnerable GOP senators facing reelection in November, sponsored a bill to guarantee protections for patients with preexisting conditions regardless of whether the ACA is struck down in court.

The bill, spearheaded by Sen. Thom Tillis (R-N.C.), would guarantee that insurers sold plans to individuals regardless of whether they have preexisting conditions. But critics and health-policy experts contend the bill leaves a loophole that would exclude coverage for certain services associated with those conditions. For example, a person with cancer wouldn’t be denied coverage, but the insurer wouldn’t be required to cover that patient’s cancer treatments.

Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, explained the Justice Department’s argument in the Texas lawsuit that certain provisions of the ACA should be thrown out, including a “preexisting condition exclusion prohibition.”

Levitt said that such exclusions were common before Obamacare. While Tillis’s bill would restore some parts of the ACA if the Texas lawsuit is successful, it wouldn’t change rules that prohibit insurers from excluding coverage for those with prior illnesses.

“The thing about insurance regulation is it’s kind of like plumbing: A small leak becomes a big leak,” Levitt said. “Insurers would take advantage of that loophole.”

Tillis spokesman Daniel Keylin pushed back on those criticisms and said they are based on an assumed outcome of the Texas lawsuit.

Keylin said there have been “misleading and inaccurate claims made about this bill, claims that assume the courts will strike down the entirety of the Affordable Care Act in Texas versus United States.”

Keylin said the Tillis bill wasn’t meant to be “comprehensive health-care legislation,” or the “totality of Congress’s answer to the Affordable Care Act falling.”

“There is obviously no ironclad way to precisely predict how the court will rule. However, this legislation is an important preemptive step toward getting feedback, hashing out ideas, and underscoring the importance of protecting Americans with preexisting conditions,” Keylin said

He said Tillis would consider “modifications or amendments” to the measure if the court ruling goes beyond what the bill addresses.

On the House side, Rep. Steve Knight (R-Calif.), locked in a tight race in California’s 25th district, introduced a bill last month similar to Tillis’s proposal. Two other vulnerable Republican congressmen also introduced nonbinding resolutions affirming their support for protecting those with preexisting conditions, though neither contains substantive policy solutions.

Iowa Republican Rep. David Young’s resolution says regardless of what happens to the ACA, Congress should retain protections for preexisting condition. Texas Republican Rep. Pete Sessions’s resolution says states should be allowed the authority to restructure their individual health-care marketplaces, but should ensure people with preexisting conditions can access affordable coverage.

“It seems not to be politically acceptable anymore to be against protecting people with preexisting conditions,” Levitt said, pointing to all the Republican proposals. “If you look at an example, like Sen. Tillis’s bill, it shows how wide a gap there can be between a state of desire to protect people and the reality of what an actual piece of legislation does.”

For their parts, spokespeople for Young and Sessions said the congressmen’s views on protecting patients with certain conditions are not new. In a statement, Knight said he has “always advocated” for such coverage. 

“He’s always been supportive of protecting preexisting conditions going back to the [American Health Care Act]. This is just another step,” Young spokesman Cole Staudt said.  “This is not a new position for him.” 

Sessions, Young and Knight voted to repeal the ACA, though Young co-sponsored an amendment to the Republican bill that would have buffered the impact of the repeal on people with preexisting conditions. Staudt added  that Young would consider introducing  legislation in the future depending on the outcome of the Texas lawsuit.

Yet Joel Ario, managing director of Manatt Health and former director of the Health and Human Service’s Office of Health Insurance Exchanges, said any proposal that “deviates from what was originally in the ACA as a single risk pool concept is going to disadvantage people with preexisting conditions.”

He pointed to Republicans’ record opposing individual pieces of Obamacare, pointing to the elimination of the individual mandate in the GOP tax overhaul:  “Anybody who voted for the mandate repeal voted against people with preexisting conditions,” he said.

Ario called GOP messaging ahead of the midterms a response to public polling that shows how important preexisting condition coverage is to voters.

“Republicans are trying to play into public support for protecting preexisting conditions,” he said, adding they’re “ignoring the fact that their previous action disadvantaged people with preexisting conditions.”

California GOP Rep. Dana Rohrabacher, who is in a heated campaign, ran an ad pointing to his eight-year-old daughter’s experience with leukemia:

AHH, OOF and OUCH

AHH: The price for the most popular of type of insurance sold on the ACA’s federal marketplaces will drop slightly next year. It’s the first time since the health plans have been sold that the rates have not gone up, our Post colleague Amy Goldstein reports.

The Centers for Medicare and Medicaid Services announced that in the 39 states that run on the federal online marketplace HealthCare.gov, the average premium for the “silver plan,” the second-lowest-cost plan, would drop by 1.5 percent for next year.

“The size of the decrease announced Tuesday is smaller than what HHS Secretary Alex Azar described in a speech last month in Nashville, where he predicted a 2 percent reduction in the average premiums in the most popular coverage,” Amy writes.

But CMS Administrator Seema Verma credited the Trump administration for creating more stability in the marketplaces with its recent policies, including the introduction of short-term health plans. “While some have publicly been accusing us of sabotage, we have been doing everything we can to mitigate the damage caused by Obamacare,” Verma told reporters on a conference call.

Amy notes that health-policy analysts “challenged the administration’s reasoning, saying that the rates for ACA health plans were driven up last year in an overreaction to the administration’s maneuvers and that prices would have been even lower for 2019 if Trump and his health-care aides had not been altering the law.”

“In particular, policy analysts cited the president’s decision a year ago to abolish a type of subsidy that the 2010 law gave insurers to buffer the expense of providing discounts to lower-income customers for their out-of-pocket costs, such as deductibles,” she adds. “In response, insurers jacked up rates. But the loss of the “cost-sharing reduction subsidies” led to larger premium subsidies for most consumers — and unexpected profits for some insurers.”

Here’s how the Kaiser Family Foundation’s Cynthia Cox put it:

OOF: Health and Human Services Secretary Alex Azar is one of as many as five candidates on the short list to replace Attorney General Jeff Sessions, assuming Sessions leaves the role this year, the Wall Street Journal’s Michael Bender reports.

Also on the list is Transportation Department general counsel Steven Bradbury; former attorney general Bill Barr, Deputy Secretary of State John Sullivan; and Janice Rogers Brown, a retired appeals court judge from the District of Columbia Circuit, Michael reports.

Azar, Bradbury and Sullivan serve in Senate-confirmed positions, meaning they could have an easier time going through another Senate confirmation process.

But Michael adds that a “person familiar with his thinking” said Azar isn’t interested in the job.

“The president has spoken openly, and often sharply, about his desire to replace Mr. Sessions and his regret over installing the former Alabama senator as the nation’s top lawyer,” he writes. “Mr. Sessions isn’t currently planning to leave, but privately has said that he anticipates he may be asked to resign, according to people familiar with the matter. The attorney general, who was the first senator to endorse Mr. Trump during the presidential campaign, has told people the request may come on the president’s Twitter feed.”

Here’s how Justice Department spokeswoman Sarah Flores responded: “This is actually the dumbest thing I’ve been asked to comment on in a while.”

OUCH: The percentage of children under 2 years old who have not received any of their recommended vaccinations has quadrupled in the past 17 years.

A pair of reports from the Centers for Disease Control and Prevention on preschool and kindergarten children’s immunization records “highlights a growing concern among health officials and clinicians about children who aren’t getting the necessary protection against vaccine-preventable disease, such as measles, whooping cough and other pediatric infectious diseases,” our Post colleague Lena H. Sun reports.

A CDC analysis of a national 2017 immunization survey found 1.3 percent of children born in 2015 had not received any recommended vaccination, up from .9 percent in 2011 and .3 percent of 19-to-35-month-olds who hadn’t been immunized when surveyed in 2001, Lena reports.

Lena notes overall, immunization rates are high and a majority of parents vaccinate their children and follow recommendations related to vaccination. But the small but increasing number of children who are not getting their vaccines is leaving them prone to disease and can pose health risks to the public.

TRUMP TEMPERATURE

— Even during an interview in which the president suggested he could work with Democrats, Trump couldn’t resist taking a shot at one issue gaining some momentum within the party and led by Vermont’s independent senator.

The Post’s John Wagner wrote that during the “freewheeling 45-minute phone interview with the hosts of ‘Fox & Friends,” Trump was “egged on by one of the Fox hosts” regarding Sen. Bernie Sanders’s (I-Vt.) single-payer health care plan.

“If you look at Bernie’s plan, it’s a catastrophe,” Trump said, claiming that people in other countries that have similar health care systems still “come to our country when they need operations.”

The remarks during the interview follow the president’s op-ed in USA Today that asserted such an expansion of Medicare would essentially destroy the program, though as our Post colleague and fact-checker Glenn Kessler pointed out, nearly “every sentence contained a misleading statement or a falsehood.” 

— Meanwhile, Sanders responded with his own op-ed in USA Today to push back on the president’s claims.

“Given the president’s propensity to lie about almost everything, it is not surprising that Trump is grossly distorting what the Medicare for All legislation does,” Sanders wrote.

“The American people have a very clear choice in the upcoming elections,” he continued. “On one side is Donald Trump and the Republican leadership in Congress, who made throwing 32 million Americans off of health insurance their number one priority in Washington.”

AGENCY ALERT

— The Food and Drug Administration announced it has approved or tentatively approved a record 971 generic drugs this fiscal year.

That’s up from 937 final and tentative approvals for the 2017 fiscal year. The totals this year include 781 final approvals and 190 tentative approvals,”  Azar said during an interview on Fox Business Network on Thursday. This year’s total approvals included 12 percent for complex generic medications, like EpiPens.

Azar called it a “huge advance for competition and lowering drug prices.”

“Our work is not done. We’ll continue taking additional steps to help ensure patients have access to the drugs they need by making generic drug approval more efficient and predictable,” FDA Commissioner Scott Gottlieb in a statement. “We are doing this by continuing to streamline the generic drug review process to get more competitors on the market. We have found that having three or more generic competitors brings prices down more sharply than with only one or two generic competitors.”

MEDICAL MISSIVES

— When Hurricane Michael crashed into the Florida Panhandle, it sent several hospitals in the impacted areas scrambling.

Some had to close entirely and others had to evacuate some patients while keeping staff on board to help with incoming emergencies, the New York Times’s Richard Fausset, Sheri Fink and Matthew Haag report. Across the state, four hospitals and 11 nursing facilities closed due to the storm, according to the Federal Emergency Management Agency. In Georgia, 35 hospitals or nursing homes were without power or using generators.

“When a storm like Michael rapidly intensifies, leaving little advance warning, it can be difficult to organize enough specialized medical transportation and patient beds to evacuate people in time, disaster experts said,” Richard, Sheri and Matthew report. “In previous natural disasters, notoriously Hurricane Katrina, that has left hospital and nursing home patients among the most vulnerable. In the wake of Hurricane Irma last year, a dozen residents died at a Hollywood, Fla., nursing home when temperatures spiked and the facility lost air-conditioning.”

As of this morning, the storm had finally moved off the coast, leaving a trail of death and destruction from the Gulf Coast to Virginia, our Post colleagues Mark Berman, J. Freedom du Lac and Eli Rosenberg report. At least 11 people have died as a result of the storm, though officials worry that number could rise as search and rescue efforts continue.

— The number of cases of Ebola has spiked in the Congo as rebel violence in the region has hampered response efforts to the outbreak.

There have been 194 reported cases of hemorrhagic fever in two provinces in eastern Congo, The Hill’s Reid Wilson reports, an increase of 32 cases in the last week. He noted it was a “startling number for a virus that usually dies down soon after public health officials begin treating the outbreak.”

There have been 122 deaths so far related to the outbreak, and 53 people have been discharged from treatment after surviving the disease.

“Public health officials responding to the mounting outbreak are closely watching Beni, a city of about a quarter of a million residents and an important regional trading hub with ties to nearby Uganda,” Reid writes. “Of the 32 new cases identified in the last week, 26 have been in Beni. Beni has been the site of several attacks from Islamist militants based in Uganda, which have terrorized city residents and hindered response operations. Health officials had to pause their response for several days to honor a city-wide period of mourning for those killed in the most violent attacks last month.”

— And here are a few more good reads: 

HEALTH ON THE HILL

SECOND OPINION

INDUSTRY RX

OPIOID OPTICS

DAYBOOK

Coming Up

  • The American Enterprise Institute holds an event on “Nurse practitioners and America’s primary care shortage” on Oct. 15.
  • The Brookings Institution holds an event on “Crafting public policy to address the nation’s opioid epidemic” on Oct. 15.

SUGAR RUSH

Watch Kanye West’s full remarks in the Oval Office:

Late night TV hosts had a lot to say about Kanye’s meeting with Trump: 



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