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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'>       <img width=623 height=151 id="Picture_x0020_1" src="cid:image009.jpg@01D2CB11.1B204D30" alt="Description: Description: Description: Description: CAL/AAEM: California Chapter of the American Academy of Emergency Medicine"><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id=content><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>May 4, 2017<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>Top 10 highlights in new AHCA bill <o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="http://www.modernhealthcare.com/article/20170504/NEWS/170509949?utm_source=modernhealthcare&utm_medium=email&utm_content=20170504-NEWS-170509949&utm_campaign=financedaily"><span style='color:#0000CC'>Modern Healthcare</span><span style='font-family:"Times New Roman",serif;color:#0000CC'><o:p></o:p></span></a></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>House Republicans plan to vote Thursday on a revised bill that seeks to eliminate provisions of the Affordable Care Act. The nonpartisan Congressional Budget Office estimates that the legislation will result in 24 million people losing their health insurance by 2026.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Here are key elements of the bill:<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>Ends the tax penalty against people without coverage.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>Ends the Medicaid expansion funding.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>Changes Medicaid from an open-ended program to one that gives states fixed amounts of money per person.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>Replaces the ACA's cost sharing subsidies based mostly on consumers' incomes and premium costs with tax credits that grow with age.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>Repeals taxes on the wealthy, insurers, drug and medical device makers.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>Consumers who let their coverage lapse for more than 63 days in a year would be charged 30% surcharges to regain insurance. This would include people with pre-existing medical conditions.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>State waivers would allow insurers to charge older customers higher premiums by as much as they'd like.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>States get $8 billion over five years to finance high-risk pools that cover those with pre-existing conditions.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>States get $130 billion over a decade to help people afford coverage.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:.5in;margin-bottom:11.25pt;margin-left:.75in;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>Keeps ACA provision that children can remain on their parents' insurance plans until age 26. <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p></div><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>May 4, 2017<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p></div><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>Fate of Obamacare now is in the Senate <o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="http://www.modernhealthcare.com/article/20170504/NEWS/170509944?utm_campaign=KHN:%20Daily%20Health%20Policy%20Report&utm_medium=email&_hsmi=51579821&_hsenc=p2ANqtz-8I5gL6CqPidjYJm4DKRz2pqIdXLC_P9RCxccgp-bHQhwaBrOs1_CiGXhUwhGLEGQ2g3vaL5ibA5BefNLalCYrMWqrZ2KZwR9VZeaU84YNPEcPy5kw&utm_source=hs_email&utm_content=51579821"><span style='color:#0000CC'>Modern Healthcare</span></a></span><span style='color:#0000CC'><o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>By Mara Lee<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The House Republicans passed the American Health Care Act with a slim majority on Thursday. The bill gives states the option of returning to a pre-Obamacare individual insurance approach of medical underwriting and high-risk pools.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The bill passed by a vote of 217-213 in the U.S. House of Representatives on Thursday afternoon, one vote over the 216-majority threshold. It is the GOP's first successful attempt to move legislation to repeal President Barack Obama's signature healthcare reform bill, the Affordable Care Act, during the Trump administration after two false starts. If it passes the Senate, the AHCA will make stark changes to the rules and regulations governing the healthcare industry for the last seven years.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>"We can continue with the status quo under Obamacare. We know what that looks like," House Speaker Paul Ryan said during debate on the AHCA Thursday afternoon. "It means even higher premiums. Even fewer choices. Even more insurers pulling out. Even more uncertainty and chaos."<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>"We can put this collapsing law behind us," he added. "End this failed experiment."<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Although the latest tweaks to the bill revolved around treatment of high-cost customers on the exchanges in an effort to win moderate votes, the ACHA's biggest impact is effectively ending the Medicaid expansion after 2020. The majority of people who have gained coverage under the ACA have obtained it through Medicaid—about 14.5 million people nationally—including 5 million who already qualified for the government health insurance but hadn't previously applied for it.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>"Rural hospitals will close, two million jobs will be destroyed across America, and all of this to give a massive tax cut to the richest in America," House Minority Leader Nancy Pelosi said. "It's Robin Hood in reverse."<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The bill would not allow expansion-eligible people who left Medicaid, even for just over a month, to return to the program. That could impact many potential Medicaid beneficiaries who work intermittently, have seasonal or part-time jobs, and cycle in and out of Medicaid as they gain or lose employer coverage or cross the earnings limit. In Connecticut, 30% of exchange customers came from or go to Medicaid in the course of a year. National studies of churn have estimated it at 25% annually.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>And starting in 2020, states would have to pay for their full share of covering the expansion population. For some states, that would be a shift from 90% funding to 50% funding. Even in Kentucky, it would be an increase in state responsibility of almost 20 percentage points.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>In Ohio, where 700,000 people have gained coverage in the expansion, the state would have to shoulder an additional $2.2 billion if that many people were still on the rolls in 2020.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Where will that money come from? In this year's budget proposal, Ohio already plans to cut Medicaid rates for nursing homes and hospitals, according to the Columbus Dispatch, because of the uncertainties around ACA repeal. Over the next two years alone, Ohio hospitals would have more than an 8% cut, or $588 million.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The seismic effect of reduced matches for the newly eligible doesn't include the impact of a per-capita cap on Medicaid. Overall, the Congressional Budget Office estimated that the bill would reduce federal spending on Medicaid by $880 billion across nine years, starting in 2017. The CBO analysis was of a previous iteration of the bill, but the new versions haven't changed the effects to Medicaid. The office also said the bill would cause 24 million people to lose their healthcare coverage.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>American Medical Association President Dr. Andrew Gurman said in a statement Wednesday that none of the amendments to the American Health Care Act would curb the "serious harm" the bill poses to patients and the healthcare delivery system.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>"Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill—that millions of Americans will lose their health insurance as a direct result of this proposal," he said.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The tweaks to the bill also didn't alter the less generous subsidy structure for older exchange customers, particularly in markets where insurance is more costly.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>There's a lot of fury around the country over the conservative healthcare reform bill, which has been expressed at Congress members' town halls and in protests. A number of Republican senators whose votes are needed for a replacement bill have said that the House version will not survive in their chamber.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>First, there are procedural issues on whether the state-waiver plan can be included and still qualify for a 51-vote majority.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>A number of Republican senators also have ideas of how to improve the bill.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Sen. John Thune (R-S.D.) told Axios that he'd like to preserve income- and age-based subsidies for customers below 250% of poverty.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Sen. Rob Portman (R-Ohio) has talked about a rolling phaseout to smooth the transition of repealing the Medicaid expansion. However, his office declined to provide details on his plan.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Jeff Wells</span></strong><span style='font-family:"Arial",sans-serif'><br>Deputy Editor, CAL/AAEM News Service<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service<br><br></span><o:p></o:p></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Contact us at: <span style='color:#0000CC'><a href="mailto:calaaem.news.service1@gmail.com"><span style='color:#0000CC'>calaaem.news.service1@gmail.com</span></a></span><br><br>For more articles, visit our <span style='color:blue'><a href="http://www.calaaem.org/news_archives.php"><span style='color:blue'>archives</span></a></span>. <br><br></span><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><a href="mailto:somcaaem@uci.edu"><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0070C0'><a href="https://maillists.uci.edu/mailman/listinfo/calaaem"><span style='color:#0070C0;text-decoration:none'> </span><span style='color:blue'>unsubscribe</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'> from this list, visit our mail server.<br><br>Copyright (C) 2015. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span> <span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0000CC'><a href="http://www.calaaem.org"><span style='color:#0000CC'>http://www.calaaem.org</span></a></span><spa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