Is President Trump going to brag about pushing a big health-care button next?
If he does, keep this in mind: Any health-care buttons the president has pushed aren’t very big at all.
Yesterday the Trump administration proposed, after several delays, its promised rule to crack open the door to alternative health insurance venues for Americans who are self-employed or who work for small businesses that may not offer coverage.
The idea is to expand the availability of “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. Association health plans have been legal for years, but the proposed rule issued yesterday by the Labor Department would expand eligibility for who can participate.
If Labor finalizes the rule — after a 60-day public comment period — these association plans would be open for the first time to the self-employed. And they could be formed by businesses or groups from different industries as long as they’re in the same geographic location — or by groups within the same industry nationwide.
You could look at the new regulation as a self-soothing move by Trump as he grapples with the fact that his dearest-held campaign promise — to repeal and replace the Affordable Care Act — will probably never materialize, now that Republicans hold only a single-seat Senate majority and it’s an election year.
For Trump, expanding association plans is his latest way to claim he “solved” chaos caused by his predecessor’s much-maligned health-care law. He’s been boasting that he repealed the ACA by getting rid of its individual mandate to buy coverage – even though that’s only a single part of the sweeping health-care law and the ultimate effects of repealing the mandate are debatable.
Likewise, if you took Trump’s claims about the promise of association plans at face value, you might be expecting generous but cheap health plans to be suddenly available for millions of Americans once the rule is finalized.
“So now I have associations, I have private insurance companies coming and will sell private health-care plans to people through associations,” Trump told the New York Times in an interview last week. “That’s gonna be millions and millions of people … that were formerly in Obamacare or didn’t have insurance. Or didn’t have health care … It could be as high as 50 percent of the people.”
For Americans to participate in association plans, they would first have to be formed. It’s unclear how many small businesses and trade groups might be motivated to create them, although Labor claimed in its news release that such plans could bring coverage to up to 11 million Americans working for small businesses or sole proprietors.
“These plans would close the gap of uninsured without eliminating options available in the health-care marketplace,” the release said.
But that statement exposes another big question mark — would association health plans damage the individual health insurance market?
Skeptics of association plans say that because such plans would be exempt from most ACA regulations (although they’d still be banned from charging more for those with preexisting conditions), they’d be leaner and cheaper, and would thus siphon healthier people away from the individual marketplaces.
As the theory goes, that in turn could leave behind a sicker marketplace population, which would further drive up premiums for everyone else.
Several health policy experts described it to me this way:
The potential “winners” are middle- or upper-class consumers who can’t use federal subsidies in the marketplaces. They’re looking for cheaper coverage, so they might be drawn to association plans with lower premiums, particularly if they don’t have serious health conditions to worry about.
The potential “losers” are Americans left behind in the ACA marketplaces who find their premiums going up because everyone buying these more comprehensive plans is sicker.
Chris Hansen, president of the American Cancer Society Cancer Action Network, warned that association plans could split the health insurance market. “These products would be attractive to younger and healthier individuals,” Hansen said. “As a result, those with serious health conditions like cancer would be left paying ever-increasing premiums for comprehensive coverage.”
But let’s be clear, there’s a lot of debate over whether these predicted effects will materialize and if so, whether they would be extensive. Some comments from around the Twittersphere yesterday:
Adrianna McIntyre, health policy PhD student at Harvard and contributor to The Incidental Economist:
an association health plan is now an exchange established by a state
— Adrianna McIntyre (@onceuponA) January 4, 2018
Center on Budget and Policy Priorities’ Edwin Park:
Key point. Barring AHPs from charging higher premiums to specific employers based on health won’t stop adverse selection. AHPs can/will cherry-pick healthier firms overall in other ways, destabilizing ACA-compliant market & driving up premiums for firms w/ older & sicker workers. https://t.co/eRfIuhG0kd
— Edwin Park (@EdwinCBPP) January 4, 2018
Kaiser Family Foundation senior VP Larry Levitt:
I would expect association health plans to avoid industries with older and sicker workers, communities with higher health needs, and benefits that attract people with pre-existing conditions.
— Larry Levitt (@larry_levitt) January 4, 2018
As a reminder, here are the ACA’s 10 essential benefits, which association health plans would be exempt from under new proposed regulations. pic.twitter.com/Jz0bJ6vONZ
— Larry Levitt (@larry_levitt) January 4, 2018
We can probably say this safely: Although association health plans probably would make cheaper insurance available to people who want it, and they might undermine the ACA marketplaces (two outcomes most Republicans are pretty much fine with), they’re not going to suddenly transform the U.S. health-care system. Most people will continue getting coverage through their employer, just like before and after Obamacare was passed.
“This is not the magic bullet that is going to transform the health insurance system,” Levitt told me. “I think it’s more of an effort around the edges to move the market in a less regulatory direction.”
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AHH, OOF and OUCH
AHH: Never let it be said that The Health 202 covers only bad news. Fewer high-school teens are having sex, with substantial declines among younger students, African Americans and Hispanics, my colleague Lenny Bernstein reports. A CDC report released yesterday showed especially steep reductions in teen sex in the past two years, adding to a growing body of evidence that teenagers are engaging in fewer risky behaviors than younger people before them, including becoming pregnant, smoking cigarettes, drinking alcohol and using marijuana.
“Early initiation of sexual activity is associated with having more sexual partners, not using condoms, sexually transmitted infection and pregnancy during adolescence,” the report noted. It called the falling rate of sexual activity among 9th- and 10th-graders “especially encouraging.” The researchers said they couldn’t directly attribute the trend to any one intervention, but experts have cited several factors including access in school and online to straightforward information about sex and contraception.
By the numbers:
—In 2015, 41.2 percent of high school students reported having sexual intercourse, down from 46.8 percent in 2013.
—Among black students, 48.5 percent had sex in 2015, a steep drop from 60.6 percent in 2013 and 67.6 percent in 2005.
—Among Hispanic students, the rate of sexual intercourse fell from 49.2 percent in 2015 to 42.5 percent in 2013.
OOF: Opioid, cocaine and methamphetamine-related deaths in the United States are spiking on average, but in some Western states, deaths have actually declined or stayed the same. Drug-related deaths nationwide rose 35 percent between May 2015 and May 2017, but numbers have been stable in California while Utah and Oregon saw a 3 percent decline, and Wyoming experienced a 36 percent decline, CaliforniaHealthline reports.
Why the plateau in California? One explanation may be the highly potent and deadly synthetic opioid fentanyl has not yet saturated the market in some Western states, as it has on the East Coast and in the Midwest, reporter Pauline Bartolone writes.
Another reason could be related to public policy and available treatment. In Washington state, Pauline writes, investments in treatment, housing and employment opportunities could have diverted people from drug use and helped prevent more deaths. In California, there are needle exchange programs and distribution of naloxone, the overdose antidote.
OUCH: Later this month, the CDC plans to offer a briefing on what the federal, state and local governments are doing to prepare in case of a nuclear war, Politico reports.
“While a nuclear detonation is unlikely, it would have devastating results and there would be limited time to take critical protection steps,” says a notice about the Jan. 16 briefing posted on the agency’s website. “Despite the fear surrounding such an event, planning and preparation can lessen deaths and illness.”
The notice of course doesn’t mention recent tensions between Trump and North Korean President Kim Jong Un, but the briefing comes at a highly charged time between the two countries, as the president has tweeted threats that are alarming to experts. Mike Mullen, former chairman of the Joint Chiefs of Staff, said over the weekend the United States is closer to nuclear war with North Korea “than we have ever been.”
— Maybe put down the pot? Authorities could start prosecuting people for the possession and sale of marijuana in the eight states and District of Columbia that have legalized it, after Attorney General Jeff Sessions yesterday rescinded several Obama-era directives discouraging enforcement of federal marijuana laws.
“In a memo sent to U.S. attorneys Thursday, Sessions noted that federal law prohibits the possession and sale of marijuana, and he undid four previous Obama administration memos that advised against bringing weed prosecutions in states where it was legal to use for recreational or medical purposes,” The Washington Post’s Matt Zapotosky and Sari Horwitz report. “Sessions said prosecutors should use their own discretion — taking into consideration the department’s limited resources, the seriousness of the crime, and the deterrent effect that they could impose — in weighing whether charges were appropriate.”
“It is the mission of the Department of Justice to enforce the laws of the United States, and the previous issuance of guidance undermines the rule of law,” Sessions said in a statement. “Therefore, today’s memo on federal marijuana enforcement simply directs all U.S. Attorneys to use previously established prosecutorial principles that provide them all the necessary tools to disrupt criminal organizations, tackle the growing drug crisis, and thwart violent crime across our country.”
Sessions’s move potentially opens the door for the federal government to crack down on the burgeoning pot industry — although the impact remains to be seen — and it drew some resistance even from members of Sessions’s own party. Sen. Cory Gardner (R-Colo.) tweeted that the move “directly contradicts” previous assurances he’d gotten from Sessions and threatened to impede the nomination of Justice Department leaders in response.
Sen. Cory Gardner (R-Colo.):
This reported action directly contradicts what Attorney General Sessions told me prior to his confirmation. With no prior notice to Congress, the Justice Department has trampled on the will of the voters in CO and other states.
— Cory Gardner (@SenCoryGardner) January 4, 2018
I am prepared to take all steps necessary, including holding DOJ nominees, until the Attorney General lives up to the commitment he made to me prior to his confirmation.
— Cory Gardner (@SenCoryGardner) January 4, 2018
Sen. Cory Gardner: “I will be putting today a hold on every single nomination from the Dept. of Justice until Attorney General Jeff Sessions lives up to the commitment that he made to me” on legalized marijuana in Colorado. https://t.co/NkJuIoh4fP pic.twitter.com/GSE8N85YoP
— ABC News (@ABC) January 4, 2018
Vox’s Ezra Klein:
Senator Cory Gardner’s marijuana tweet shows how Republicans could check Trump if they wanted to: https://t.co/iAME4wL6i9
— Ezra Klein (@ezraklein) January 4, 2018
AP White House reporter Zeke Miller:
DENVER (AP) – US attorney in Colorado: No change to marijuana enforcement despite Attorney General Jeff Sessions’ shift on pot policy.
— Zeke Miller (@ZekeJMiller) January 4, 2018
Sen. Bernie Sanders (I-Vt.):
No, Attorney General Sessions. Marijuana is not the same as heroin. No one who has seriously studied the issue believes that. Quite the contrary. We should allow states the right to move toward the decriminalization of marijuana, not reverse the progress that has been made.
— Bernie Sanders (@SenSanders) January 4, 2018
Rep. Ted Lieu (D-Calif.):
Dear Attorney General Jeff Sessions and @TheJusticeDept: Let me give you a list of things more important for federal prosecutors and federal law enforcement to pursue other than marijuana:
1. Basically anything. https://t.co/ctyJui7g4c
— Ted Lieu (@tedlieu) January 4, 2018
HuffPost’s Ashley Feinberg:
i don’t have any proof of this but i believe with every fiber of my being that jeff sessions is pretty sure you ingest marijuana by injecting it
— Ashley Feinberg (@ashleyfeinberg) January 4, 2018
–Our colleague Christopher Ingraham explains why Sessions may face an uphill battle due to A) widespread support for legalizing marijuana and B) the industry’s economic clout.
To his first point: An October Gallup poll found a record 64 percent of Americans — including 51 percent of Republicans — support legalizing pot. And even if people don’t necessarily think pot should be legal, a large majority believe the federal government should stay out of state-level policies on the matter. A July Quinnipiac poll found 75 percent oppose enforcing federal laws in states where pot Is legalized.
Secondly, the industry is a booming economic force. By some estimates, legal marijuana has employed between 165,000 and 230,000 workers, and generated $6.7 billion in revenue in 2016. And those sales are bringing in significant tax revenue for states with legalization. All that could be at stake with Sessions’ move to potentially crack down. And with upcoming midterm elections, it could be especially politically tricky.
— Why will Republicans probably be able to continue blocking Medicaid expansion in Virginia? Hint: It involves an artsy stoneware bowl.
In a weird conclusion to a House of Delegates race, Virginia elections officials yesterday pulled a name out of a bowl to settle a tie between Republican David Yancey and Democrat Shelly Simonds. Yancey’s name was picked, meaning Republicans may enjoy a 51-to-49 majority in the House, assuming Simonds doesn’t demand and win a recount.
“The spectacle drew national attention as an odd way to decide a highly consequential contest,” The Post’s Laura Vozzella writes. “But it might not be the last word in a saga that’s taken more turns than the clay that went into that wheel-thrown bowl, borrowed for the occasion from the Virginia Museum of Fine Arts. … As the loser of the drawing, Simonds is entitled by law to request a second recount, likely leaving the race in limbo when the General Assembly reconvenes Wednesday.”
— But if Yancey is sworn in, his party could use all its forces to block a promised effort by governor-elect Ralph Northam, a Democrat, to try again to accept the ACA’s Medicaid expansion for adults earning up to 133 percent of the federal poverty level. That’s precisely what the House of Delegates did all through outgoing Democratic Gov. Terry McAuliffe’s term.
Simonds bemoaned that possibility in a statement after the lottery took place. “There are nearly 400,000 Virginians who have been denied access to affordable health care through Medicaid expansion,” she said. “I hope our lawmakers in the House of Delegates do not leave their fate to a game of chance. I am tremendously grateful to my supporters. They will be the first to know of any next steps.”
Politico’s Dan Diamond:
The outcome of picking a canister from a bowl in Virginia today may have decided the fate of Medicaid expansion for 400,000 people. https://t.co/HiMQqyPVXN
— Dan Diamond (@ddiamond) January 4, 2018
From a National March for Truth co-organizer:
Picking a name out of a bowl in Virginia today determined the fate of Medicaid expansion for 400k people.
The vote was tied.
That was the tiebreaker.
Your. Vote. Matters. ➡️ https://t.co/nZXmrYxhWA
— Holly Figueroa O’Reilly (@AynRandPaulRyan) January 4, 2018
Center on Budget and Policy Priorities’ Jacob Leibenluft:
This sucks, but I wouldn’t give up on VA Medicaid expansion just yet. It makes that effort harder but goal must be for activism that helps flip a couple of Rs to support a very popular policy.
— Jacob Leibenluft (@jleibenluft) January 4, 2018
–A few more good reads from The Post and beyond:
HEALTH ON THE HILL
- The Senate Health, Education, Labor and Pensions Committee holds a hearing on the opioid crisis on Jan. 9.
- The House Veterans’ Affairs Subcommittee on Economic Opportunity holds a hearing on “Home Loan Churning Practices and How Veteran Homebuyers are Being Affected” on Jan. 10.
- The National Academy of Sciences holds a workshop on “The Promise of Genome Editing Tools to Advance Environmental Health Research” on Jan. 10-11.
- The House Veterans’ Affairs Subcommittees on Health and on Economic Opportunity hold a joint hearing on addressing veteran homelessness on Jan. 18.
Conservatives are taking sides in the feud between President Trump and his former chief strategist Steve Bannon:
Watch Trevor Noah talk Michael Wolff’s book “Fire and Fury,” on President Trump:
With the Golden Globes just days away, host Seth Meyers addresses how much of the show will focus on recent sexual allegations in Hollywood:
Production of “Jeopardy!” has been put on a brief hiatus while host Alex Trebek recovers from brain surgery:
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