obamacare Archives - Medical Association of the State of Alabama

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Twenty States File Lawsuit against Government for the Affordable Care Act

Posted by admin on March 8, 2018

Twenty states, including Alabama, have formed a coalition to file a lawsuit against the government claiming that the Affordable Care Act is now unconstitutional.

According to the lawsuit, the states are claiming that since the GOP eliminated the tax penalty associated with the individual mandate, ObamaCare itself is no longer constitutional.

The Tax Cuts and Jobs Act, signed into law by President Donald Trump on Dec. 22, 2017, eliminated the tax penalty of the ACA, without eliminating the individual mandate itself, according to the lawsuit filed in U.S. District Court in the Northern District of Texas.

In 2012, the Supreme Court ruled 5-4 that ObamaCare’s individual mandate was constitutional because Congress has the power to levy taxes. The lawsuit points to that part of the ruling in its argument that the law is no longer constitutional.

“Following the enactment of the Tax Cuts and Jobs Act of 2017, the country is left with an individual mandate to buy health insurance that lacks any constitutional basis,” the lawsuit states. “Once the heart of the ACA — the individual mandate — is declared unconstitutional, the remainder of the ACA must also fall.”

In its current form, the ACA imposes rising costs and transfers an enormous amount of regulatory power to the federal government, according to a statement by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, who are leading the 20-state coalition lawsuit.

The lawsuit was filed by the attorneys general for the states of Wisconsin, Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Missouri, Nebraska, South Carolina, South Dakota, Tennessee, Utah, West Virginia, Texas, and by the governors of Maine and Mississippi.

The Medical Association is closely monitoring the lawsuit and will report more information as it becomes available.

Tags: ACA, constitutional, individual, lawsuit, mandate, obamacare, penalty, tax

Posted in: Legal Watch

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Judge Rejects Bid to Revive ACA Subsidies

Posted by admin on October 27, 2017

A federal judge has denied several states’ attempt to compel the Trump administration to continue paying cost-sharing reduction payments. Attorney generals from 18 states and the District of Columbia had filed a motion in the U.S. District Court seeking a temporary injunction that would reinstate the payments, which the administration decided to end earlier this month.

Judge Vince Chhabria was skeptical of the states’ argument during a hearing on the motion earlier this week, noting many states have already taken steps to diffuse the impact of CSR uncertainty. In his order denying the states’ request for a temporary injunction, Chhabria said although a federal judge did previously rule that CSR payments should end because they were not properly appropriated by Congress, in this instance, the Trump administration has the stronger legal argument. Chhabria also noted any emergency relief requested by the states would be counterproductive as state insurance regulators have been working for months to prepare for the possibility the subsidies would end.

Many states, he continued, have therefore “devised responses that give millions of lower-income people better health coverage options than they would otherwise have had.”

The Trump administration this month terminated the payments to the insurers, which help cover medical expenses for low-income Americans, as part of several moves to dismantle Obama’s signature healthcare law formally known as the Affordable Care Act. The subsidies were due to cost $7 billion this year and were estimated at $10 billion for 2018, according to congressional analysts.

Insurers have argued they do not profit from the subsidies under the Affordable Care Act, but pass them on directly to consumers to reduce deductibles, co-payments and other out-of-pocket medical expenses for low-income people. Because insurers would raise premiums on policies in the absence of the subsidies, the government would be compelled to spend more on financial assistance to low-income Americans. The Congressional Budget Office has found that a bipartisan Senate proposal to shore up Obamacare insurance marketplaces by reviving the subsidies would cut the U.S. deficit by $3.8 billion over the next decade.

Tags: ACA, cost, CSR, expense, obamacare, payment, share

Posted in: Advocacy

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Tentative Bipartisan Deal Reached to Restore CSR Payments

Posted by admin on October 20, 2017

Earlier this week, the U.S. Senate reached a bipartisan deal “in principle” to restore Obamacare cost-sharing reduction payments for two years in exchange for more state flexibility in the health care act. The proposed plan would also restore more than $100 million in funding for health care outreach.

The bipartisan bill gained momentum later in the week with 24 co-sponsors to the legislation. President Trump has suggested he was “open” to authorizing payments to insurers that help offset out-of-pocket health costs in the short term — but had not given up his goal of repealing the ACA.

The short-term solution would allow insurers to offer catastrophic insurance plans to consumers ages 30 and older on the exchanges, while maintaining a single-risk pool, meanwhile also making it easier for states to obtain waivers to customize health plan rules to their needs by speeding up administration approval of the waivers and allow states to copy provisions in waivers that were already approved. This could also provide a reprieve for the Affordable Care Act that would prevent 2018 premiums from increasing as much as previously predicted. However, consumers in many states will still face double-digit rate increases, and in many counties, health plans will be available from only one insurance company.

The proposed legislation would not allow states to change the essential benefits insurers are now required to offer individuals and small businesses under the ACA or let insurers discriminate against consumers with preexisting conditions for the next two years.

The Medical Association will continue to monitor the progress of this proposed legislation and is eager to work with lawmakers toward a positive solution.

Tags: ACA, cost, Insurance, obamacare, premium, reduction, share

Posted in: Advocacy

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The Medical Association Supports Replacement of ACA with Workable Health Care System

Posted by admin on July 28, 2017

The Medical Association released its 2017 Legislative Agendas earlier this year, which were developed with guidance from the House of Delegates and great contribution from our physician members who participated in the 2017 Legislative Agenda Survey. The Medical Association has continued to express support for the repeal of the Affordable Care Act and its replacement with an adequate system to protect not only physicians but their patients as well.

The U.S. Senate is engaged in deliberations on legislation to repeal and replace the Affordable Care Act. So far these debates have one thing in common – they fail to meet the basic requirements of a solid health care plan, which does not further damage an already weakened Medicaid program or make it more difficult for low and moderate-income Americans to obtain affordable health insurance.

As from the beginning, Medical Association continues to support the repeal of the Affordable Care Act and replacement with a system that:

Includes meaningful tort reforms that maintain existing state protections
Preserves employer-based health insurance
Protects coverage for patients with pre-existing conditions
Protects coverage for dependents under age 26
With proper oversight, allows the sale of health insurance across state lines
Allows for deducting individual health insurance expenses on tax returns
Increases allowed contributions to health savings accounts
Ensures access for vulnerable populations
Ensures universal, catastrophic coverage
Does not increase uncompensated care
Does not require adherence with insurance requirements until insurance reimbursement begins
Reduces administrative and regulatory burdens

The disproportionate funding model dictated by the ACA has left most states, including Alabama, sorely underfunded. Medicaid is a critical component of our health care system, covering the young and elderly. Medicaid covers more than half of Alabama births and 47 percent of our children, as well as 60 percent of Alabama’s nursing home residents. Without full funding, the Medicaid program will collapse, leaving these individuals without coverage. While uncompensated care is delivered every day in all 67 counties of this state, without Medicaid, charity care needs could skyrocket, crippling the health care delivery system and potentially placing the burden on those with private health insurance through higher premiums and co-pays.

Now’s the time to fix our broken health care system to ensure access to care for our citizens and the ability for physicians to practice medicine without overwhelming federal burdens guiding the way. The Medical Association continues to work with our Congressional Delegation during these negotiations and urges them to work together toward the passage of a viable health care solution for our residents.

Tags: ACA, congress, health, healthcare, Insurance, Medicaid, obamacare, repeal, replace

Posted in: Advocacy

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UPDATE: No Vote on Senate Health Care Bill Before July 4

Posted by admin on June 23, 2017

REVISED June 28, 2017: Although Senate Republicans had initially promised a vote on its “Better Care Reconciliation Act of 2017,” now it appears that will not be the case prior to the July 4 recess. With the release of the Congressional Budget Office report on the act, it did not appear there would be enough support to pass the legislation. While the bill is not dead, it appears that Senate Republican leaders want more time for discussion.

The Medical Association continues to review the legislation as proposed, remains in contact with Alabama’s Congressional Delegation, and is closely monitoring the legislation as it moves forward.

June 23, 2017: On Thursday, Senate Republicans released a draft of its version of their legislation intended to repeal and replace the Affordable Care Act. The 142-page “discussion draft,” called the “Better Care Reconciliation Act of 2017,” resembles the version passed by the House in May by repealing the ACA’s individual mandate and several taxes on the industry. However, the proposed legislation has several differences as well.

Pertaining to Medicaid:

Medicaid expansion is phased out from 2020 to 2024.
Medicaid’s funding structure would change to a per-capita arrangement, creating deep cuts in funding beginning in 2025.
States would be allowed to require nondisabled, nonelderly, nonpregnant participants to satisfy a work requirement for eligibility.

For the individual market:

Subsidies would be based on income, not age, as included in the House version, and the subsidies will be less generous being capped at 350% of the federal poverty level.
In 2018 and 2019 $15 billion would be set aside ($10 billion in 2020 and 2021) for health insurers to “address coverage and access disruption and respond to urgent health care needs within states.”
The proposed legislation sets up a “long-term state stability and innovation program,” to be funded with $62 billion over eight years.
States will have flexibility to opt out of the ACA’s provisions regulating individual markets by tweaking existing 1332 waivers.

The Medical Association is reviewing the legislation as proposed, remains in contact with Alabama’s Congressional Delegation, and is closely monitoring the legislation as it moves forward.

Tags: ACA, affordable, obamacare, repeal, replace

Posted in: Advocacy, Health

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House Cancels ACA Repeal/Replace Vote Today

Posted by admin on March 24, 2017

UPDATED Friday, March 24 at 3 p.m.: House Republicans have stopped the vote today on the legislation to repeal and replace the Affordable Care Act amid speculation the bill did not have the 215 votes needed to pass. The decision to pull the vote came after House Speaker Paul Ryan met with President Trump at the White House. While a new vote on the legislation has not yet been announced, House leadership have indicated it could come early next week.

Friday, March 24 at 11:22 a.m.: Legislation that would repeal Obamacare and replace it with a more limited health care program for the uninsured was cleared for debate and votes on Friday in the U.S. House of Representatives by the House Rules Committee. The House voted to begin debate on the GOP’s health care plan Friday, paving the way for a cliffhanger vote late in the afternoon. The Medical Association is closely monitoring the legislation.

House Republican leaders yesterday postponed the vote to repeal and replace the Affordable Care Act fearing the lack of votes to pass the new legislation. Members of the House Freedom Caucus said they needed more changes in the bill to reduce health plan premiums or else they would vote against it.

As of Thursday afternoon, 37 House Republicans, mostly Freedom Caucus members, declared their opposition to the bill, the Washington Post reported. A handful of more moderate GOP members announced their opposition, spurred by proposed revisions that likely would further reduce Medicaid spending and coverage.

Any delay in the House vote would set back GOP plans to pass the bill in both the House and Senate before the Easter recess begins April 7. GOP leaders fear that their members will come under strong pressure to oppose the bill when they return to their districts and face constituents upset about the prospect of losing their ACA coverage.

At least a dozen Senate Republicans have expressed doubts about whether they could support the House bill in its current form. There are big uncertainties about whether provisions to change the ACA’s insurance market regulations would comply with the Senate’s budget reconciliation rules allowing legislation to pass with 51 votes.

Late Thursday the Congressional Budget Office reported that the amended version of the legislation would achieve less than half the budgetary savings of the original bill over a decade, with the same coverage losses. Federal Medicaid spending reductions would dip from $880 billion over 10 years in the original version of the proposed American Health Care Act to $839 billion. But the CBO estimated the revised bill still would result in a similar sharp decline in the number of Americans with health insurance – 14 million more uninsured in 2018 and 24 million more uninsured by 2026.

The Medical Association has been looking at the American Health Care Act from the beginning with an Alabama perspective to determine the impact of the bill on our citizens. Because of that, we have had concerns with the legislation as it was introduced. We would like to encourage more discussions by all parties to move this legislation forward.

U.S. House to Consider Medical Liability Reform Bill

Pending the outcome of the vote on AHCA, the House may consider the Medical Liability Reform Bill. The House Judiciary Committee approved H.R. 1215, the “Protecting Access to Care Act (PACA)” on Feb. 28 by a vote of 18-17. This bill is based on the California medical liability reform law and would limit noneconomic damages to a cap of $250,000, while providing unlimited economic damages. It would also give states the flexibility to increase the cap on noneconomic damages and has language protecting existing state liability reforms.

The AMA has policy in favor of limiting noneconomic damages and supports the bill. House Republican leadership considers this measure to be part of its health care reform efforts. The full House is expected to consider H.R. 1215 during the week of March 27.

Tags: obamacare, repeal, replace, trumpcare

Posted in: Advocacy

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New American Health Care Act Comes Under Fire

Posted by admin on March 8, 2017

Earlier this week, members of the House Energy and Commerce Committee released legislation as part of the House Republicans’ efforts to repeal and replace Obamacare. Although the legislation cleared its first hurdle with a lengthy, contentious markup session that began Wednesday, the House Ways and Means Committee approved the American Health Care Act. The House Energy and Commerce Committee continued debating the legislation well into Thursday. Many health care organizations are speaking out against the legislation.

In brief, the 123-page legislation proposes to:

Eliminate the Obamacare taxes on job creators, increased premium costs, and limited options for patients and health care providers.
Eliminate the individual and employer mandate penalties.
Prohibit health insurers from denying coverage or charging more to patients based on pre-existing conditions.
Help young adults access health insurance and stabilize the marketplace by allowing dependents to continue staying on their parents’ plan until they are 26.
Establish a Patient and State Stability Fund, which provides states with $100 billion to design programs that meet the unique needs of their patient populations and help low-income Americans afford health care.
Modernize and strengthen Medicaid by transitioning to a “per capita allotment” so states can better serve the patients most in need.
Empower individuals and families to spend their health care dollars the way they want and need by enhancing and expanding Health Savings Accounts (HSAs).
Help Americans access affordable, quality health care by providing a monthly tax credit for low- and middle-income individuals and families who don’t receive insurance through work or a government program.

Although Democrats and Republicans are beginning to speak against the bill, perhaps most critical of the legislation has been the American Medical Association, which issued a letter to congressional leaders stating that it cannot support the bill.

“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” it said.

AMA President Dr. Andrew Gurman introduced the letter on the AMA’s website by stating: “We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.”

Similarly, the American Nurses Association and the American Hospital Association have expressed strong opposition to the proposed American Health Care Act citing fundamental changes in Medicare and Medicaid, which the groups argue could limit access to care while “in no way improving care.”

“It appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations,” wrote Richard Pollack, CEO and president of the American Hospital Association, in his letter to members of Congress.

The legislation does not yet have a score from the Congressional Budget Office, which could provide an estimate of the bill’s cost and impact on coverage levels. However, White House representatives have indicated a score will soon be released.

Other medical groups are expressing concern about the speed at which the bill appears to be moving.

“We are concerned that by rushing to a mark-up … in the Energy and Commerce and Ways and Means Committees, there will be insufficient time to obtain non-partisan estimates of this legislation’s impact by the Congressional Budget Office, or for medical organizations like ours and other key stakeholders in the health care community to offer substantive input on the bill,” the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists: and the American Osteopathic Association said in a joint statement.

Click here for a look at what the American Health Care Act would keep, change and/or repeal versus the ACA.

The Medical Association is closely monitoring the legislation.

Tags: ACA, healthcare, Insurance, Medicaid, obamacare

Posted in: Advocacy

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U.S. House Leaders Outline Plan to Repeal/Replace Obamacare

Posted by admin on February 17, 2017

Earlier this week, House Republican leaders presented outlines of a plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.

While GOP leaders opined that the plan would not “pull the rug out from anyone who received care under states’ Medicaid expansions,” the plan does appear to fundamentally remake Medicaid, which provides health care to more than 70 million Americans. Under the plan, Medicaid, an open-ended entitlement program designed to cover all health care needs, would be put on a budget.

The Affordable Care Act’s subsidies, which expand as incomes decline, giving poorer Americans more help, would be replaced by fixed tax credits to help people purchase insurance policies. The tax credits would increase with a person’s age, but would not vary with a person’s income. New incentives for consumers to establish savings accounts to pay medical expenses still assume that workers would have money at the end of a pay period to sock away.

The House Republican plan would also make it easier for consumers to buy health insurance from companies licensed in other states. Click here to read the plan.

The Medical Association has been vocal with concerns about changes to the health care system that could cause patients to lose access to their care and/or their insurance plans. Executive Director Mark Jackson and President-Elect Jerry Harrison, M.D., recently traveled to Washington, D.C., for a series of meetings with Alabama’s Congressional Delegation to voice the concerns of Alabama’s physicians in person.

“Dr. Harrison and I felt it was necessary to go to Washington and meet with our Congressional Delegation so they could hear our concerns about a repeal-and-replace of the current health care system,” Jackson said. “Anything that could possibly endanger our residents’ access to care needs to be given serious consideration before any action is taken. It was important for us to remind them that what they may see as dollars in a budget equate to patients in our treatment rooms here in Alabama.”

The Medical Association has released its 2017 State and Federal Legislative Agendas, developed with guidance from the House of Delegates and input from individual physician members. Click here to learn more about what issues the Medical Association supports and opposes.

Tags: ACA, obamacare, repeal, replace

Posted in: Advocacy

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