Uninsured rate in California drops to record low, CDC estimates -AND- House Releases ACA Repeal, Replace Bill That Transforms Medicaid

Fri Mar 10 21:08:24 PST 2017

February 14, 2017

Uninsured rate in California drops to record low, CDC estimates 

<http://www.sfgate.com/business/article/Uninsured-rate-in-California-drops-t
o-record-low-10932662.php> SF Gate

By Catherine Ho

The percentage of Californians without health insurance fell to a record low
7.1 percent in 2016, according to estimates released by the Centers for
Disease Control on Tuesday.

The figure represents just a 1 percentage point drop from 2015, but is down
significantly from the 17 percent uninsured rate in 2013, before the
Affordable Care Act was implemented.

Similarly, the percentage of Americans without health insurance dropped
slightly from 9.1 percent in 2015 to 8.8 percent in 2016.

The estimates, from the CDC's National Center for Health Statistics, are
based on data for the first nine months of 2016 that was collected from
about 73,000 people in 38 states.

California was the only state among the 38 in the report that showed a
significant decrease in its uninsured rate for adults between 18 and 64 -
dropping from 11 percent to 9 percent.

California officials welcomed the news as a sign that structures created by
the Affordable Care Act, the federal health care law that expanded health
care coverage to roughly 20 million Americans, are working.

"Covered California is proud to be part of the effort that is helping
millions of people get the coverage and care they need," Executive Director
Peter Lee said in a statement.

California is considered one of the most successful states in expanding
health care coverage for its residents under the health care law, which is
also known as Obamacare. The state has dramatically expanded its Medicaid
program, Medi-Cal, adding nearly 4 million newly eligible low-income people
since 2014.

Covered California, the insurance exchange through which low-income
residents and other individuals can buy insurance using federal subsidies,
is growing and expects to hit 1.5 million people in 2017, up from 1.3
million in 2016.

The law's expansion of Medicaid and its other provisions - such as
prohibiting insurers from denying patients coverage because of pre-existing
conditions - are driving down the uninsured rate, said Cynthia Cox, an
associate director at the Kaiser Family Foundation who researches the health
law's effect on private insurers and enrollees.

"There's no question the (Affordable Care Act) is driving down the uninsured
rate," she said. "We've seen the uninsured rate fall every year since the
law went into effect. The progress has slowed a bit, in the first couple
years there was significant progress and now it's more or less plateaued.
But it's still continuing to fall."

President Trump and congressional Republicans are vowing to repeal the law,
but they have yet to coalesce around a plan to replace it. On Tuesday, Trump
renewed his promise to repeal and replace, saying in a tweet, "Obamacare
continues to fail."

March 6, 2017

House Releases ACA Repeal, Replace Bill That Transforms Medicaid

<http://www.medscape.com/viewarticle/876718?nlid=113272_3901&src=wnl_newsalr
t_170306_MSCPEDIT&uac=116715AZ&impID=1303030&faf=1> Medscape

By Robert Lowes

The Medicaid program, almost 52 years old, would undergo drastic changes in
a much-anticipated House Republican bill to repeal and replace the
Affordable Care Act (ACA) that was released today.

Called the American Health Care Act, the bill would repeal the ACA's
expansion of Medicaid eligibility and the extra federal match dollars that
come with it by December 31, 2019. But in a concession to the 31 states
that chose to expand their Medicaid programs, the bill would preserve the
extra federal funding after 2019 for beneficiaries who had enrolled under
ACA expansion beforehand, and who do not have a break in eligibility for
more than 1 month thereafter.

As revealed in a leaked draft last month, the bill also would convert
open-ended federal contributions to state Medicaid programs into a fixed,
per-capita cap.  Congressional Democrats oppose this new formula, saying
that it would underfund state programs, forcing them to kick beneficiaries
off the rolls, trim benefits, and cut reimbursement to physicians and
hospitals.

Giving states more control of their Medicaid programs is another feature of
the bill. It would erase the ACA requirement that state Medicaid plans
provide the same essential benefits as those mandated for private health
plans sold on the ACA exchanges.

Cadillac Tax Postponed Until 2025

The American Health Care Act makes one significant departure from the draft
version leaked in February. That version called for taxing generous
employer-sponsored health plans just as the ACA does with its so-called
Cadillac tax, scheduled to take effect in 2020. The bill released today does
not create a new tax on employer-sponsored health plans, but instead delays
the ACA's Cadillac tax until 2025.

The rest of the bill largely preserves the provisions first revealed in the
leaked draft. The American Health Care Act would:

-       Give Americans refundable tax credits ranging from $2000 to $4000 a
year per individual, based on age, to buy private health coverage.  They are
capped at $14,000 for a family. In a change from the draft version, tax
credits begin to shrink once annual income surpasses $75,000 ($150,000 for
joint tax filers).

-       Repeal the penalty for individuals who do not obtain coverage.

-       Prohibit, as the ACA does, insurers from denying coverage to
individuals with pre-existing conditions, or charging them more.

-       Preserve the ACA provision that allows young adults to remain on
their parents' plan until age 26.

-       Eliminate ACA taxes on such things as medical devices, prescription
drugs, over-the-counter medications, and certain health insurers.

-       Allow individuals and families to almost double the amount they can
contribute to health savings accounts, and give them more flexibility in
spending those dollars.

-       Give states $100 billion worth of grants over 10 years to set up
high-risk insurance pools for individuals with costly, pre-existing
conditions; reduce out-of-pocket expenses; promote access to preventive
services; and otherwise make healthcare more affordable.

The House Energy and Commerce Committee has scheduled a so-called markup
session this Wednesday to discuss portions of the bill under its
jurisdiction, consider amendments, and vote on sending it to the House
floor. The House Ways and Means Committee will mark up the rest of the bill
the same day. In January, the House and Senate, both controlled by
Republicans, passed legislation that would allow this ACA repeal-and-replace
measure to sidestep a Democratic filibuster in the Senate and pass in  that
chamber with only 51 votes.

Jeff Wells
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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