Republican dreams of repealing Obamacare lie mostly in tatters. But President Trump’s new appointee leading the nation’s health-care department has picked up the flag, announcing his first major move to back away from the law’s regulations.
Health and Human Services Secretary Alex Azar — on the job for just three weeks — shares the same goals as his predecessor, Tom Price, of easing the Affordable Care Act’s insurance regulations. But the former Eli Lilly executive appeared much more interested yesterday in proactively framing his approach to enforcement as increasing consumer choice and access, proposing an expansion of short-term insurance plans that are exempt from ACA consumer protections.
“It’s about choice, it’s about options for more individuals,” Azar told a room full of health reporters in a Tuesday morning briefing, which he promised would be just the first of many media availabilities in a marked shift from Price's shying away from the media.
“That’s the intent behind this. If it’s the right choice for those people, we would like to make it available,” Azar added.
The former pharmaceutical executive is carrying out a promise Trump made last fall, when the president announced executive actions to broaden association health plans and short-term insurance — types of coverage likely to cost less than the plans sold on the ACA marketplaces but which also cover far fewer services and don’t guarantee coverage for people with preexisting medical conditions.
Yesterday HHS proposed a rewrite of federal rules extending the time consumers can hold short-term health plans from three to 12 months, my colleague Amy Goldstein reports. The plans were originally intended to be a brief gap-filler for people between jobs or for college students taking a semester off. But the administration is attempting to redefine them as part of its strategy to help consumers bypass the ACA marketplaces, which Trump and his aides characterize as expensive failures, Amy writes.
“It’s one step in the direction of providing Americans with health insurance options that are both more affordable and more individualized for families’ circumstances,” Azar said on a conference call.
Seema Verma, administrator of the Centers for Medicare and Medicaid Services, echoed Azar’s enthusiasm about the rewrite. “While in the past these plans have been a bridge, now they can be a lifeline,” she said.
Government officials predict 100,000 to 200,000 people will opt to buy these short-term plans instead of options offered on the marketplaces, likely because those individuals were either uninsured all along or because they don't find the marketplace options affordable.
But analysts, journalists and opponents of the rules change noted these plans won't cover the full range of benefits offered by ACA and could charge people more based on their health status, gender or other factors.
From the liberal Center on Budget and Policy Priorities:
The Trump Administration proposed rules today to expand the use of short-term health plans.— Center on Budget (@CenterOnBudget) February 20, 2018
These plans offer less coverage & can deny coverage or charge higher prices to people with pre-existing conditions: https://t.co/4aRPGF8wKp
Kaiser Family Foundation VP Larry Levitt:
The expansion of short-term health insurance plans is part of a strategy to create a parallel insurance market that does not comply with the ACA's rules.— Larry Levitt (@larry_levitt) February 20, 2018
Short-term insurance plans will cherry pick healthy people, leaving ACA-compliant plans to cover a sicker pool with higher premiums.— Larry Levitt (@larry_levitt) February 20, 2018
Vox's Sarah Kliff:
Also the exact same short-term plan that would cost me $94, would only cost $77 if I were a man.— Sarah Kliff (@sarahkliff) February 20, 2018
Talking Points Memo's Alice Ollstein:
The short-term health insurance rule the Trump admin put out today also encourages companies to sell plans that don't provide mental health care as an essential health benefit https://t.co/IAF77WHJhf— Alice Ollstein (@AliceOllstein) February 20, 2018
Former CMS administrator Andy Slavitt:
BREAKING: Today Trump launched his biggest assault to the ACA, American families, and the law.— Andy Slavitt (@ASlavitt) February 20, 2018
They announced “short term plans” to compete against ACA plans and will discriminate against pre-ex conditions, not cover essential benefits, and be able to impose lifetime caps.
Former Obama administration auto czar Steven Rattner:
In an emergency, Trump’s latest swipe at ACA (extending 3-month “short-term” bare bones coverage to 1 yr) WON’T have you covered https://t.co/yJ1NZ308fK— Steven Rattner (@SteveRattner) February 20, 2018
A number of Democrats pushed back too. Sen. Bob Casey (D-Pa.):
The Administration’s health care scheme: junk insurance, higher premiums & few consumer protections. https://t.co/fDugFIVpMU— Senator Bob Casey (@SenBobCasey) February 20, 2018
It’s the opening act for Azar, in whom many Republicans are placing their hopes of shrinking the ACA’s footprint. With energy to repeal and replace President Obama’s health-care law mostly fading on Capitol Hill, the impetus to roll back parts of it lies increasingly at HHS.
Azar does appear on board -- but it’s still not entirely clear exactly how far he’ll be willing to reinterpret the law compared to his predecessor. Although Obama’s appointees stressed the law’s gains in expanding coverage to more than 20 million Americans, Azar joined Trump’s other appointees in emphasizing its shortcomings of leaving around 28 million people without insurance plans.
“I think of them as the forgotten men and women of the Affordable Care Act,” Azar said.
Azar pointed proudly to actions by HHS and Congress to walk back the ACA. He noted that lawmakers repealed the law’s individual mandate to buy health insurance in December, and last month the agency proposed a rule to expand “association health plans,” which could be formed by small businesses or trade groups banding together to sell coverage in a region, state or even nationwide.
Without providing many details, Azar spoke hopefully of the additional leeway HHS may be able to grant states in how they run their marketplaces and carry out their Medicaid programs, an approach Republicans have long held up as a way to get around ACA regulations without striking the law from the books.
“If we are not able to achieve repeal and replace, do we have enough authorities to really work with states to deliver on what we hope is affordable individual insurance for people?” Azar said.
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AHH: A major legal services program for immigrant children says HHS has pulled back an earlier order prohibiting government-funded lawyers from discussing abortion rights with minors in custody, The Post's Ann E. Marimow reports.
Earlier this month, the nonprofit Vera Institute of Justice indicated an HHS employee restricted what attorneys could say to young, pregnant detainees, telling its lawyers in an email the legal services program was at risk if attorneys answered questions about abortion rights. The instruction coincided with efforts in federal court by the head of [the Office of Refugee Resettlement] to block access to abortion procedures for undocumented teens in federal custody.
Responding to questions last week from The Post, HHS said in a statement it had “not issued a new directive on the matter of abortion.” The department declined to say whether the contract was in jeopardy if lawyers answered questions about abortion from the minors. Yesterday, an HHS spokesperson attributed the back-and-forth between the government and the nonprofit to a “miscommunication.”
OOF: The Justice Department now recommends all rape kits associated with a reported crime be submitted for DNA analysis, but there were no such national guidelines until just last year, resulting in a major and well-documented "rape kit backlog." The problem is slowly being fixed across the country as states and cities send their kits to be tested, but that means they're quietly struggling with a far more complicated challenge: What happens once the kits come back?
The Post's Jessica Contrera digs into this question in a fascinating piece, in which she spoke with numerous police investigators, researchers, prosecutors and activists in Virginia Beach about complicated questions around whether victims should be notified their kit has finally been tested or whether reminding someone of their rape -- out of the blue, years later, with no promise of a solution -- might cause them unnecessary harm.
"This dilemma would ultimately pit police, prosecutors, advocates and lawmakers against one another, making the situation far more complicated than they ever intended," Jessica writes. "Everyone wanted to do the right thing for victims; there was just no way to know what that was."
OUCH: Kenneth Frazier, the chief executive of pharmaceutical company Merck, detailed to the New York Times for the first time his public feud with Trump over his decision to leave one of the president’s business advisory councils. One of the most powerful black chief executives in the country, Frazier was the first to leave the advisory council following the president’s divisive remarks and initial failure to condemn white nationalists at protests in Charlottesville, Va. last summer.
“It was my view that to not take a stand on this would be viewed as a tacit endorsement of what had happened and what was said,” Frazier said. “I think words have consequences, and I think actions have consequences. I just felt that as a matter of my own personal conscience, I could not remain … In that moment, the president’s response was one that I felt was not in concordance with my views ... And I didn’t think they were in concordance with the views that we claim to hold as a country.”
Frazier added he had “100 percent” support from the Merck board before announcing his decision to resign. Back in August, Frazier announced the move in a statement on Twitter, and Trump quickly targeted him and Merck in follow-up posts:
Now that Ken Frazier of Merck Pharma has resigned from President's Manufacturing Council,he will have more time to LOWER RIPOFF DRUG PRICES!— Donald J. Trump (@realDonaldTrump) August 14, 2017
.@Merck Pharma is a leader in higher & higher drug prices while at the same time taking jobs out of the U.S. Bring jobs back & LOWER PRICES!— Donald J. Trump (@realDonaldTrump) August 14, 2017
--A new Washington Post-ABC News poll finds more than six in 10 Americans think President Trump and lawmakers aren't doing enough to prevent mass shootings -- and more of the public thinks better mental health care rather the Florida school shooting than more gun control. While 58 percent of adults surveyed said they believed stricter gun control laws could have prevented the massacre, 77 percent said more effective mental-health screening and treatment could have helped prevent the shooting.
Our colleagues Scott Clement and Emily Guskin report a majority of people across party lines are frustrated with Congress over its inaction. Views of the president are more divided, with eight in 10 Democrats saying Trump is not doing enough but six in 10 Republicans saying he has taken sufficient action.
Yesterday, Trump said he had signed a memo directing Attorney General Jeff Sessions to propose a regulation to ban all devices, such as “bump stocks,” that turn semiautomatic weapons into “machine guns.” Trump’s announcement comes after 17 people were killed in at a high school in Parkland, Fla last week.
--A lesbian couple is suing the Trump administration and the U.S. Conference of Catholic Bishops for denying their application to become foster parents of refugee children, the Post's Eli Rosenberg reports. Married couple Fatma Marouf and Bryn Esplin, represented by the LGBT legal group Lambda Legal, say they applied to the Catholic group to become foster parents but were denied because they were a same-sex couple. HHS has given the conference grants for its foster case program through its Office of Refugee Resettlement.
“Being denied the opportunity to foster a child because we don’t 'mirror the Holy Family’ — clearly code for being a same-sex couple — was hurtful and insulting to us,” Esplin said. “More than that, though, insisting on such a narrow, religious view of what a family must look like deprives these children of a nurturing, supportive home.”
The lawsuit argues HHS and the Catholic Conference “have discriminated and continue to discriminate impermissibly against individuals, including Plaintiffs, based on religion, their sexual orientation, their sex, and the same-sex character of their marriage, by funding the administration of services that they are on notice are being administered in a manner that disfavors same-sex relationships."
--A few more good reads from The Post and beyond:
- The West Health Institute hosts a health care costs summit.
- The Heritage Foundation holds an event on “Responding to the Transgender Moment."
- The Joint House and Senate Veterans' Affairs Committees hold a hearing on the legislative presentation of the Disabled American Veterans on March 1.
President Trump said “we must do more to protect our children” following last week's shooting:
High school students from in and around Washington D.C. staged a die-in in front of the White House:
Here's a look at four products unofficially using Trump's name: