Today, the Labor Department will release a final regulation expanding health plans that are free of some Obamacare rules. It's part of a broader effort by President Trump and his allies to peel away the Affordable Care Act even as it remains the law of the land.
Senior Labor officials will brief reporters this morning on a final rule on “association health plans” (AHPs), which can be formed by small businesses or trade groups banding together to sell coverage in a region, state or even nationwide. The rule is expected to exempt more of these plans from ACA requirements, including the law's 10 "essential health benefits" and its ban on allowing insurers to charge more to people with preexisting conditions.
Association plans have been around for years, but the Trump administration is expanding eligibility as a way to provide cheaper options for people to afford health insurance. The move could be characterized as sort of an “Obamacare Repeal Plan B” made up of efforts by Trump appointees to pull back on the law administratively now that Congress has failed to eliminate the ACA.
On the surface, the concept of cheaper, leaner health insurance sounds great — if you’re a young, healthy person, you could buy an association plan with narrower benefits for a smaller price tag. That’s because these plans aren’t required to cover the range of health services required under the ACA.
Trump — and many of his GOP colleagues in Congress — are anxious to finalize the rule so they can tout it before the midterm elections as a way they’re lowering health-care costs for Americans. “It’s going to be incredible,” the president said at a tax-themed event in Florida in April. “You’re going to get tremendous insurance at a very low cost.”
Per Politico reporter Dan Diamond:
Trump’s comments on the ACA today:— Dan Diamond (@ddiamond) April 16, 2018
— says the mandate repeal is “about the end of Obamacare”
— takes a shot at McCain without naming him
— says association health plans (coming soon) will have “tremendous sign-ups… you’re going to get tremendous insurance at a very low cost.” pic.twitter.com/A8w9aQcnYT
But don’t expect applause from the health-care industry once the rule comes out. In fact, there has been an overwhelmingly negative response from insurers, hospitals, clinics, doctors, nurses and patient advocates.
The L.A. Times found in a recent analysis that more than 95 percent of health-care groups that filed comments on the proposed rule expressed serious concern or opposed it. Furthermore, not even one group representing patients or the industry submitted comments in support of the association plan rule, the Times found.
“Basically anybody who knows anything about health care is opposed to these proposals,” Sandy Praeger, Kansas’s former state insurance regulator — and a Republican — told the Times. “It’s amazing.”
There’s a pretty simple reason industry hates the idea: If one side of the seesaw goes down, the other side must go up. So even though association plans might mean lower premiums for the healthy, it means the sick must cover more of their own health-care costs. And, it could further destabilize the Obamacare marketplaces by shifting the mix of enrollees toward a sicker population.
There would be a sort of domino effect as more people enroll in association health plans, according to an analysis Avalere Health released in February. The health-care consulting firm estimated that 3.2 million people could enroll in association plans over the next five years.
As these healthier folks leave the Obamacare marketplaces and small-group markets, premiums could rise 3.5 percent because it costs more to ensure those left behind, Avalere projected. And the higher premiums could prompt 130,000 to 140,000 people to drop coverage altogether within half a decade.
There is a caveat here. States have -- and will continue to have -- the ability to regulate association plans, to varying degrees. If an association plan is fully-insured (meaning it contracts with an outside insurance carrier for risk underwriting), the state has wide latitude to regulate the plan through that carrier. States have less ability to regulate self-insured association plans (meaning the plan does its own risk underwriting), but they could ban these plans from operating within their borders.
"On the critics side, they’re saying there’s no regulation -- that is far from correct," Chris Condeluci, a former Republican Senate Finance Committee staffer who now runs his own policy shop, CC Law & Policy, told me. "There is significant regulation on fully insured arrangements."
So regardless of what today's final rule says, it's likely association plans will expand somewhat but continue to vary dramatically by state on which benefits they provide and how customers' premiums are calculated.
But Republicans are desperate for something they can tout as a “win” on health care, as Democrats seize it as a top issue this election season. So expect big, bold claims from the GOP about the wonders of association plans once the final rule comes out.
Trump touted the expected regulation this month:
....We had Repeal & Replace done (and the saving to our country of one trillion dollars) except for one person, but it is getting done anyway. Individual Mandate is gone and great, less expensive plans will be announced this month. Drug prices coming down & Right to Try!— Donald J. Trump (@realDonaldTrump) June 4, 2018
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AHH: As of yesterday, artificial trans fats are banished from U.S. restaurants and grocery stores, The Post's Caitlin Dewey reports. Food makers had three years to phase out the ingredient, which the FDA ruled unsafe to eat in 2015 because of findings that these trans fats, a modified form of vegetable oil, raise “bad” cholesterol and contribute to heart disease.
But the transformation hasn’t been easy. “Some products, such as popcorn and pie crust, proved more stubborn to reinvention,” Caitlin writes. “Companies have also complained to FDA that they should be allowed to continue using trans fats in limited circumstances — such as to enhance product flavors or grease industrial baking pans.”
“FDA agreed in May to give companies one more year to find another ingredient for those purposes,” she continues. “The agency has also said that, while new products can no longer be made with trans fats, they'll give foods already on the shelves some time to cycle out of the market. But food makers and public health advocates agree that artificial trans fats are effectively no more.”
OOF: National Institutes of Health Director Francis Collins pulled the plug last week on a study meant to show the health effects of alcohol, charging that its researchers had crossed unacceptable lines in pursuing alcohol industry funding. A 165-page internal investigation of the trial shows “disturbing examples of the coziness between the scientists and their industry patrons," the New York Times’s Roni Caryn Rabin reports.
Lead investigator Kenneth Mukamal denied any contact with alcohol producers, telling NYT he had “literally no contact with the alcohol industry." But the report documented calls and lengthy memos between Mukamal and the industry, in which Mukamal appeared eager to resolve their concerns, answer their questions and suggestions, and generally sought the industry’s buy-in.
"The report documented conference calls he held with alcoholic beverage companies and lengthy memos written in response to their concerns, long before the N.I.H. even announced it would sponsor the trial," Roni writes. "Beer and liquor companies offered their own suggestions for carrying out the trial...The strategy of engagement with industry was effective. Five large beer and liquor companies eventually agreed to pick up most of the $100 million tab for the 10-year-long randomized trial."
OUCH: The acting head of the Drug Enforcement Administration told staff yesterday he is retiring, saying that running the agency as a temporary fill-in had become “increasingly challenging," the Post's Devlin Barrett reports. Robert Patterson, who has worked at the DEA for 30 years, sent an email to employees Monday afternoon saying he will retire in about two weeks.
In the email, reviewed by Devlin, Patterson says he “realized that the administrator of the DEA needs to decide and address priorities for years into the future — something which has become increasingly challenging in an acting capacity.”
"Patterson became the agency’s acting head in October, following the departure of Chuck Rosenberg, who had also served as an acting, rather than Senate-confirmed, head of the agency," Devlin writes. "Rosenberg’s departure came after months of tension between him and Attorney General Jeff Sessions over marijuana research policy and the Trump administration’s focus on pursuing the MS-13 street gang, rather than sophisticated drug cartels."
— Colleen Kraft, president of the American Academy of Pediatrics, says the president’s “zero tolerance” policy of separating families at the U.S.-Mexico border amounts to "child abuse.” Kraft weighed in during an interview with CNN yesterday amid growing fury over the policy. In the interview, she described visiting an immigration detention center.
She said the detained children develop a condition called toxic stress that normally keeps people out of danger by elevating a fight-or-flight response. But in this situation for the children, the toxic stress remains high and can inhibit brain development.
“I can’t describe to you the room I was in with the toddlers,” Kraft said. “Normally toddlers are rambunctious and running around. We had one child just screaming and crying, and the others were really silent. And this is not normal activity or brain development with these children.”
"These children have been traumatized and their trip up to the border, and the first thing that happens is you take away the one constant in their life that helps them buffer all of these horrible experiences – that’s child abuse," Kraft added.
— A new survey finds nearly half of diabetics skip their treatment because of costs. In an online poll from UpWell Heath, 45 percent of diabetics reported cutting back on treatment in 2017 for financial reasons. UpWell -- a company that provides health care for people with chronic conditions -- found more than four out of 10 respondents with diabetes said they paid more than $1,000 in out-of-pocket costs in the past year for complications related to diabetes. Another one-third of diabetics spent $100 to $500.
“Insulin is one of many essential drugs across all categories of pharmaceuticals to show substantial increases in price, the lobbying group for American physicians noted,” CBS News’s Kate Gibson reports. “The average price of insulin nearly tripled between 2002 and 2013, according to the American Diabetes Association.”
Last year, insulin costs from two manufacturers spiked 8 percent. No generic version of the drug exists, and three companies control 99 percent of the market.
— As of Monday, cigarette companies are required to have statements on their websites warning consumers about the health effects and addictive quality of their products. Yesterday was the deadline for the manufacturers to include the statements on their websites, mandated under a 2006 federal court decision, CNBC’s Amelia Lucas reports.
Philip Morris USA and its parent company Altria, as well as R.J. Reynolds Tobacco and Lorillard (now owned by Reynolds American), are the among the companies required to include the statements, which will also be available in Spanish. The statements will address smoking's health effects, its addictiveness, the lack of any benefits from cigarettes labeled "low tar" and "light," how the delivery of nicotine was enhanced by cigarette design and secondhand smoke's health effects, Amelia writes.
— A few more good reads from The Post and beyond:
- The House Homeland Security Subcommittee on Oversight and Management Efficiency holds a hearing on opioids.
- The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 340B Drug Pricing Program.
- The Senate Special Committee on Aging holds a hearing on Alzheimer’s.
- The Bipartisan Policy Center holds an event on “Introduction to CBO’s Updated Health Insurance Model."
- AHIP’s institute and expo begins on Wednesday.
- The American Medical Association holds a webinar on health literacy on Wednesday.
- The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on “Examination of the GAO Audit Series of HHS Cybersecurity” on Wednesday.
- The House Armed Services Subcommittee on Military Personnel holds a hearing on “Military Health System Reform: Pain Management” on Wednesday.
- The House Veterans Affairs Subcommittee on Health holds a hearing on VA hiring authorities, recruiting and retention on Thursday.
Trump: "The United States will not be a migrant camp:"
Attorney General Jeff Sessions defended the administration's "zero tolerance" policy of prosecuting immigrants, adding that immigrant kids are "taken care of, not put in jail:"