Tag Archives: Medicaid

Mayo Clinic faces questions over CEO’s ‘prioritized’ patients remark

Mayo Clinic is facing questions from the state of Minnesota after its CEO told employees that if patient conditions are equal, its hospitals should prioritize privately insured patients over those under government-subsidized programs such as Medicaid.

John Noseworthy’s comments were made late last year in a videotaped speech to staff but surfaced only this week after a transcript of his speech was obtained by the Star Tribune newspaper.

The Mayo Clinic has verified the transcript is accurate.

Noseworthy said in a statement that medical need will always be the top factor in scheduling an appointment.

“In an internal discussion I used the word ‘prioritized’ and I regret this has caused concerns that Mayo Clinic will not serve patients with government insurance. Nothing could be further from the truth,” he said, adding that the hospital is committed to serving patients with government insurance.

“Changing demographics, aging of Americans and budgetary pressures at state and federal government pose challenges to the fiscal sustainability in healthcare today,” he said. “While these discussions are uncomfortable, they are critical for us to be able to meet the needs of all of our patients.”

Minnesota Department of Human Services Commissioner Emily Piper said she was surprised and concerned by Noseworthy’s earlier comments and has questions about what they really mean and how Noseworthy’s directive would be carried out.

The department is looking into whether there are possible violations of civil and human rights laws.

The agency also is reviewing its contracts with Mayo Clinic to ensure the hospital is meeting its obligations to serve patients in public programs.

Last year, Noseworthy told staff that when Mayo Clinic has expertise that can’t be found elsewhere, it will always take patients, regardless of how they are paying for care.

“We’re asking. if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so . we can be financially strong at the end of the year to continue to advance our mission,” Noseworthy said in the transcript.

Mayo Clinic spokeswoman Duska Anastasijevic said the speech stressed the need to increase privately insured patients, but not at the expense of government insured patients.

Mayo Clinic said about half of the services it provides go toward those enrolled in government programs. The clinic said it provided $629.7 million in care to people in need in 2016, including $546.4 million that wasn’t covered by Medicaid or other programs for the uninsured or underinsured.

The statement said that as Mayo’s percentage of publicly funded patients has grown, to now roughly 50 percent, the health system is working to increase commercially insured patients.

“To fund its research and education mission, Mayo needs to support its commercial insurance patient numbers in order to continue to subsidize the care of patients whose insurance does not cover the cost of their care,” the statement said.

Piper said Noseworthy’s statements do not reflect routine hospital practices and she found them to be troubling.

As Human Services commissioner, Piper is focused on ensuring access to health care for those enrolled in public programs. She said providers have to follow the law and uphold agreements to provide such care. She said that in her view, nothing that is happening with the health care law on the federal level changes those requirements.

“Health insurance coverage for health insurance coverage’s sake is not the end goal,” she said. “It’s access _ that’s what’s important.”

Anastasijevic said Minnesota Medicaid patients are and will continue to be scheduled the same as patients with commercial insurance.

On Medicaid money, GOP has win-or-lose proposition for states

New England’s bucolic countryside looks much the same on either side of the Connecticut River separating Vermont from New Hampshire. But Medicaid beneficiaries are far better off in Vermont.

Vermont generously funds its Medicaid program. It provides better benefits, such as dental care, and pays doctors more than New Hampshire’s program does. That brings more doctors into the program, giving enrollees more access to care.

New Hampshire has twice Vermont’s population, but Vermont spends almost as much on Medicaid and covers more enrollees. Under the complicated formulas that set federal funding, Vermont’s substantial investment helps it capture nearly as much aid from the government as New Hampshire gets.

States’ policies differ about who or what to cover in Medicaid, and those decisions have led to historical variances in how much federal money they receive. House Republicans’ effort to shrink federal Medicaid spending would lock in the differences in a way that favors those already spending high amounts per enrollee.

“Republicans are finding out why changing Medicaid is so hard and why the easiest thing to do is to do nothing given the substantial variation in federal spending across states,” said John Holahan, a health policy expert with the nonpartisan Urban Institute.

Here’s why.

Medicaid, the national health program for low-income people that covers about 1 in 5 Americans, is 60 percent funded by the federal government and 40 percent by states. Total spending in 2015 was about $532 billion, according to the latest official data.

Federal funding is open-ended, which means the government guarantees states it will pay a fixed rate of their Medicaid expenses as spending rises.

Those matching rates are tied to average personal incomes and favor the lowest-income states. Mississippi has the highest Federal Matching Assistance Percentage — 76 — while 14 wealthy states, including New York and California, get the minimum 50 percent from the federal government.

But state Medicaid spending varies significantly, too, and that influences how much federal money each receives to fund its program. State policies about how generous benefits should be and how much to pay doctors and hospitals account for those differences.

GOP leaders want to give states a set amount of money each year based on the number of Medicaid enrollees they had in 2016, a formula known as per-capita caps.

A per-capita system would benefit high-spending states already receiving relatively rich allotments from the government, the Urban Institute said in a paper last September.

According to its estimates, if the system were in effect this year, Vermont would receive $6,067 per enrollee — one of the highest allotments in the country — while New Hampshire would get the least, just $3,084 per enrollee.

Per-capita caps would limit the government’s Medicaid spending because it would no longer be on the hook to help cover states’ rising costs. But caps also would shift costs and financial risks to the states and could force them to cut benefits or eligibility to manage their budgets.

“It would present a huge problem,” said Adam Fox, a spokesman for the Colorado Consumer Health Initiative, an advocacy group.

Under the GOP bill, federal Medicaid funding to states would be adjusted annually based on a state’s enrollment and medical inflation. But that would not be enough to keep up with rising Medicaid spending per enrollee, which would force states to put up more of their money or scale back the program, the nonpartisan Congressional Budget Office said March 13.

Other analyses of the GOP plan have reached the same conclusion.

Since 1999, however, the average annual growth rate in Medicaid spending per enrollee has risen more slowly than medical inflation, according to MACPAC, the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Republicans argue that overhauling federal Medicaid spending as they propose would hold down federal costs while giving states more leeway to run their programs as they see fit. “This incentive would help encourage efficiencies and accountability with taxpayer funds,” House Speaker Paul Ryan wrote last June in his white paper, A Better Way.”

Rep. Greg Walden (R-Ore.), chairman of the powerful House Energy and Commerce Committee, which has oversight of health care matters, sounded a similar note at a press conference in Washington, D.C., when the GOP plan was announced. “I think it’s really important to empower states and to put Medicaid on a budget,” he said.

But Fox argued the opposite would happen under a per-capita system — instead of gaining more control over their Medicaid programs, states would not be able to meet their needs because they’d have fewer dollars to decide how to spend, he said.

Bill Hammond, director of health policy for the nonpartisan Empire Center for Public Policy in New York, said House leaders’ decision to tie future Medicaid funding to medical inflation could help mute concerns that funding wouldn’t keep up with rising costs, but would not address the fairness issue of giving some states higher per-capita amounts than others.

“If a low-spending state decides it wants to spend more money on paying hospitals and doctors or adding more benefits, they would have a harder time doing that without breaking the federal cap,” he said.

Medicaid advocates in New Hampshire are worried because their state has few alternatives to make up for a loss in federal funding. New Hampshire lacks an income or sales tax.

“There is a tremendous amount of fear among families here as Republicans try to dismantle the ACA,” said Martha-Jean Madison, co-director of New Hampshire Family Voices.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Spring storm: Activists gathered outside Ryan’s Racine office to protest health care plan

About 250 people from Illinois and Wisconsin assembled outside House Speaker Paul Ryan’s office in Racine March 14 to demand he drop his health care repeal plan.

The demonstration took place days after the Congressional Budget Office’s analysis showed the House GOP health plan would cause 24 million Americans to lose their health coverage.

People from Fair Economy Illinois and the Jane Addams Senior Caucus joined with members of Citizen Action of Wisconsin — all People’s Action organizations — and with SEIU Healthcare Wisconsin and the Wisconsin Alliance for Retired Americans.

Protesters marched from Racine’s Monument Square on Main Street to Ryan’s office with cans of dog and cat food — the kind of lunch organizers say some seniors will have  if House Republicans pass their health plan is passed.

Outside the speaker’s office, people shared stories and fears of living without health insurance.

Reggie Griffin, of Chicago, is in his 70s and works as a home caregiver. He said he would be devastated by the defunding of Medicare because of chronic health conditions. “I want to live a life of dignity,” Griffin said, according to a news release from organizers of the protest. “There are some members of Congress, like Speaker Paul Ryan, who think I don’t deserve to live with dignity.”

“This is a huge test for our democracy, because the Republican repeal can’t survive once the people understand it’s true implications,” said Robert Kraig, executive director for Citizen Action of Wisconsin.

“This attack on seniors and families will devastate Midwest communities. It is irresponsible and ruthless,” added Anna Marin, manager of civic engagement for the Jane Addams Senior Caucus.

One of the speakers at yesterday’s action, Tammy Wolfgram, is a small business owner from Hartland.

Before the passage of the Affordable Care Act, Wolfgram, her husband and her daughter could not find any health insurance company that would sell them coverage because all three had pre-existing conditions.

She said they struggled to afford costly insurance with high deductibles on Wisconsin’s high-risk pool.

“If ACA is repealed, I don’t know what we will do,” Wolfgram said.

A report by the Congressional Budget Office released this week shows 14 million people will lose their insurance coverage by next year and 24 million by 2026.

“Anyone who believed GOP promises that people would still have health insurance under the Republican repeal plan now know that they were lied to; they are going to be left out in the cold,” said LeeAnn Hall, co-director of People’s Action and executive committee member of Health Care for America Now.

Deciphering CBO’s estimates on the Republicans’ health bill

The Congressional Budget Office is out with its estimate of what effects the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government.

The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

Here are some of the CBO highlights:

• $337 billion reduction in the deficit. That’s CBO’s estimate over the next decade, taking into account both decreased government spending in the form of less help to individuals to purchase insurance and lower payments to states for the Medicaid program. It also includes decreased revenue from the repeal of the taxes imposed by the ACA to pay for the new benefits.

• 24 million more people without insurance in a decade. The federal budget experts estimate that people will lose insurance and that the drop will kick in quickly. In 2018, they say 14 million more people would join the ranks of the uninsured. It would reach the 24 million by 2026, when “an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

• 15 percent of Planned Parenthood clinic patients would “lose access to care.” These patients generally live in areas without other sources of medical care for low-income people. The Republican bill would cut out Medicaid funding for Planned Parenthood for a year.

• 15 to 20 percent increase in 2018 premiums, but relief would follow. Monthly costs for insurance would go up at first, due to the elimination of the requirement for most people to have insurance or else pay a tax penalty. After 2018, CBO estimates that average premiums would actually drop by 10 percent by 2026 compared to current law. That is because the lower prices for younger people would encourage more to sign up. By contrast, the law would “substantially [raise] premiums for older people.”

• 95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding. The CBO estimates that only 5 percent of enrollees in the expansion program would remain eligible for the higher federal payments by 2024, since the bill would phase out those payments to states as patients cycle in and out of eligibility.

• 14 million fewer Medicaid enrollees by 2026. That’s 17 percent fewer than projected under current law. The projection includes people who are currently eligible and would lose coverage, as well as people who might have become eligible if more states, as expected, expanded coverage under the ACA. CBO projects that is unlikely to happen now.

• $880 billion drop in federal Medicaid spending over the decade. That comes primarily by imposing, for the first time, a cap on federal contributions to the program for those with low incomes.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

 

In a liberal pocket, assisted living residents fear Obamacare’s death

From an upscale assisted living center in Seattle, 87-year-old Brendan Wall has some advice for members of Congress eager to repeal the Affordable Care Act: Slow down.

“They haven’t said what they’re going to replace it with or how they’re going to replace it,” said Wall, who taught philosophy and religion for more than 30 years.

“I think it’s a major crisis, and I hope to God they take enough time to think about it and act on it so that the thing will work.”

Wall lives at Merrill Gardens, a complex near downtown Seattle where anxiety runs high over the transition to a new administration in Washington, D.C. And while the evolving drama may not affect him directly, he and other seniors here fret about the Donald Trump administration’s vow to repeal and replace the Affordable Care Act and what it will mean for their children and grandchildren.

Wall and five other residents responded to a Kaiser Health News request for area seniors willing to share their views about health care as Trump takes over and pressure mounts on Capitol Hill to repeal the Affordable Care Act. In a news conference, Trump again called the health law “a complete and total disaster,” and said he intends to move quickly to replace it with something “far less expensive and far better,” though he offered no specifics.

The view from Merrill Gardens offers a snapshot of a larger national debate about the successes and failures of President Barack Obama’s signature legislation. Its residents live in liberal King County, where less than 22 percent of voters chose Trump. But only 125 miles away, in a rural district that voted for Trump, Republican Rep. Jaime Herrera Beutler says seniors’ anxieties over repeal of the Affordable Care Act are misplaced.

“Seniors are right to be concerned about the future of ACA, but not because of congressional Republicans’ plans,” spokeswoman Amy Pennington said in an email. “The law’s fundamental flaws, phony finances and broken promises will cause it to collapse on its own — Medicaid expansion, exchanges and all.”

At Merrill Gardens, residents are more politically engaged than in many parts of the country. They avidly follow the news through local newspapers, TV, the internet and radio.

The group that showed up for an open meeting in the complex’s private dining room ranged in age from early 70s to late-80s. They included retired education, business and health professionals. Loree Wagner, a center spokeswoman, said the organizers did not ask for political affiliation.

“I find this moment especially challenging,” said Dick Kirkendall, 88, a retired University of Washington history professor who specialized in the presidency of Harry S. Truman. “I have a hard time seeing what’s ahead, a harder time than I’ve ever had. I have a harder time knowing what my president is going to do.”

Everyone in the room said they had few complaints about their existing health insurance coverage through Medicare, Medicare supplements, private pensions and Veterans Affairs programs.

But they said they fear that proposed changes — including plans to privatize Medicare and revamp Medicaid and Social Security — will mean less care for their families and the poor.

“My opinion is not to touch Medicare or Medicaid,” said Terry Doucette, 76, a former admitting department manager for a local hospital. “I mean, people are dependent upon it and there needs to be a warning time and coming together in a real thoughtful way, making everything work together, especially for the least fortunate.”

Herrera Beutler said she supports plans to protect Medicare and Social Security for seniors in the future.

In addition to Wall, Kirkendall and Doucette, the group included John Ball, 73, a former developer, Sandra Wiatr, 80, a former school nurse in the Chicago public school system and Dr. Harold Ellner, 89, a retired urologist.

Overall, they sympathized with the frustrations of those who criticized the ACA, which created online health exchanges that expanded coverage to millions, but also saw sharp rises in costs and, in some cases, limited coverage choices.

“The Obama thing had been moving out of control, particularly for middle-class people whose insurance premiums have gone up and their deductibles are unbelievable,” Wall said. “They’re out of this world. I think they had to do something.”

But they also echoed the views of a recent Kaiser Family Foundation tracking poll that found that while one in five Americans support repeal alone, three-quarters either oppose repeal entirely or want to wait until details of a replacement plan are complete. (KHN is an editorially independent program of the foundation.)

The answer is not to scrap the plan that expanded insurance to 20 million people while offering no alternative, said Ball, who only obtained regular insurance when he qualified for Medicare eight years ago. He still lives with consequences of untreated injuries, including a broken clavicle that healed badly after a rugby injury years ago.

“I’m distressed at the proposal that we chuck out the baby with the bath water,” he said. “I’ve seen the backside of no insurance and living with something you hoped wouldn’t be considered a pre-existing condition. I have a pretty strong identification with those people who didn’t have insurance and were suddenly brought into the fold of Obamacare.”

In her work as a school nurse, Wiatr saw many students with asthma whose families couldn’t afford medication inhalers to control the potentially life-threatening disease. When she managed a family practice clinic, she saw people try to cut medical costs at the expense of health.

“There were people who didn’t do lab tests, who took only half of their medication because they couldn’t afford it,” she said. “I am very upset because I think our politicians don’t have a clue how difficult it is for people to receive medication and adequate health care.”

Ellner, the urologist, worked for a local Planned Parenthood clinic after he retired and flatly said he supports a universal, single-payer health system.

“Obamacare seems to have been a way station on the way to universal health care and now it’s not only being challenged, it’s being threatened,” he said.

The situation now calls for compromise and compassion from political leaders, said Doucette. “What I want to do is simply get the hard-headed guys from both parties to meet and really want to do this instead of wanting to win,” she said. “Now, we’ll see what Trump does. He has all these ideas and he thinks everyone else is on a lower level. I would like to see them work together.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.  This report is made available by Kaiser Health News under a Creative Commons License.

GOP governors who turned down Medicaid money have hands out

Republican governors who turned down billions in federal dollars from an expansion of Medicaid under President Barack Obama’s health care law now have their hands out in hopes the GOP-controlled Congress comes up with a new formula to provide insurance for low-income Americans.

The other GOP governors, such as Ohio Gov. John Kasich, who agreed to expand state-run services in exchange for federal help — more than a dozen out of the 31 states — are adamant that Congress maintain the financing that has allowed them to add millions of low-income people to the health insurance rolls.

With Congress starting to consider plans for annulling and reshaping Obama’s overhaul, Republican governors and lieutenant governors from 10 states met privately for more than two hours last week with GOP members of the Senate Finance Committee and raised concerns about how lawmakers will reshape Medicaid.

“They’re worried about how it all works out,” Finance panel chairman Orrin Hatch, R-Utah, said after the session in a Senate office building.

GOP senators and governors stressed the need for giving states more flexibility to shape their Medicaid programs. That’s a change that worries Democrats, who say some states would inevitably end up covering fewer people or offering skimpier benefits.

Arkansas Gov. Asa Hutchinson said governors could find savings by being allowed to impose “work incentives” for some beneficiaries.

Kasich suggested shifting people who earn just above the poverty level from Medicaid to the online exchanges that Obama’s law created for buying coverage.

“I think they understand this is not simple and I think they know they have to get it right,” Kasich said.

A chief worry by governors was whether states that accepted extra federal money to expand Medicaid to more people would lose that extended coverage.

Sen. John Cornyn, R-Texas, said afterward that “it ain’t going to happen,” though he did not detail how.

In a letter he carried to Capitol Hill, Kasich warned that repealing Obama’s law without an alternative in place could interrupt health care coverage for hundreds of thousands in Ohio and urged he “be granted the flexibility to retain the adult Medicaid coverage expansion.”

Ohio has added roughly 700,000 recipients to the program since the law took effect in 2013.

Unlike Kasich, 19 Republican governors — including Scott Walker of Wisconsin — defied the Affordable Care Act’s mandate that states open up Medicaid to more people.

It was a major expansion of the state-federal health insurance system whose primary purpose has grown in its 52 years from backstop medical assistance for the poor to the go-to program for closing gaps in private health insurance system.

In the three years since the Affordable Care Act went into effect, Medicaid enrollment has grown by about 18 million people, to roughly 75 million, according to the federal Centers for Medicare and Medicaid Services.

Walker, seeking to win over conservative voters for his failed presidential bid, notably turned down more than $500 million for his state.

But with Republicans, backed by President-elect Donald Trump, pursuing repeal of the law, Walker and other GOP governors now are asking specifically for the Medicaid money and fewer rules for spending it.

On average, the federal government’s contribution accounts for 56 percent of a state’s Medicaid budget, making the financing terms under the health care law much more generous.

Republicans have long sought block grants or lump-sum payments for health care. The money has helped them maintain their budgets, while the relative lack of heavy regulation has allowed governors freedom to experiment with social services policy.

“Now that Barack Obama is no longer going to be at the White House, it is going to be much more palatable for Republican governors to seek additional funding,” said Ron Pollack of Families USA, a leading advocate for Obama’s law.

All Democratic governors in office when the law took effect in 2013 agreed to the expansion. Even Republican governors in 11 states agreed to expand Medicaid, some with specific waivers that still allowed them to claim the federal reimbursement.

Now, Republican leaders in states aren’t just asking for money they turned down. They’re asking to change the formula to get back what they lost.

The federal Medicaid formula is based in part on how many enrollees a state had as of 2016. By last year, Michigan, for instance, had added 630,000 recipients since accepting the Medicaid expansion.

But Medicaid in Kansas grew at a far slower rate, given Gov. Sam Brownback’s opposition to the federal law. Now, he wants Congress to change the formula to benefit his state.

If Republicans repeal health law, how will they pay for replacement?

Leading Republicans have vowed that even if they repeal most of the Affordable Care Act early in 2017, a replacement will not hurt those currently receiving benefits.

Republicans will seek to ensure that “no one is worse off,” said House Speaker Paul Ryan, R-Wis., in an interview with a Wisconsin newspaper earlier this month. “The purpose here is to bring relief to people who are suffering from Obamacare so that they can get something better.”

But that may be difficult for one big reason — Republicans have also pledged to repeal the taxes that Democrats used to pay for their health law. Without that funding, Republicans will have far less money to spend on whatever they opt for as a replacement.

“It will be hard to have comparable coverage if they start with less money,” Gail Wilensky, a health economist who ran the Medicare and Medicaid programs under President George H.W. Bush, said in an interview.

“Repealing all the ACA’s taxes as part of repeal and delay only makes a true replacement harder,” wrote Loren Adler and Paul Ginsburg of the Brookings Institution in a white paper out this week. It “would make it much more difficult to achieve a sustainable replacement plan that provides meaningful coverage without increasing deficits.”

The health law’s subsidies to individuals buying insurance and the Medicaid expansion are funded by two big pots of money.

The first is a series of taxes, including levies on individuals with incomes greater than $200,000, health insurers, makers of medical devices, brand-name drugmakers, people who use tanning salons, and employer plans that are so generous they trigger the much-maligned “Cadillac Tax.” Some of those measures have not yet taken effect.

However, the Congressional Budget Office estimated in early 2016 that repealing those provisions would reduce taxes by an estimated $1 trillion over the decade from 2016-2025.

The other big pot of money that funds the benefits in the health law comes from reductions in federal spending for Medicare (and to a lesser extent, Medicaid). Those include trims in the scheduled payments to hospitals, insurance companies and other health care providers, as well as increased premiums for higher-income Medicare beneficiaries.

CBO estimated in 2015 that cancelling the cuts would boost federal spending by $879 billion from 2016 to 2025.

The GOP, in the partial repeal bill that passed in January and was vetoed by President Barack Obama, proposed to cancel the tax increases in the health law, as well as the health premium subsidies and Medicaid expansion. But it would have kept the Medicare and Medicaid payment reductions. Because the benefits that would be repealed cost more than the revenue being lost through the repeal of the taxes, the result would have been net savings to the federal government — to the tune of about $317.5 billion over 10 years, said CBO.

But those savings — even if Republicans could find a way to apply them to a new bill — would not be enough to fund the broad expansion of coverage offered under the ACA.

If Republicans follow that playbook again, their plans for replacement could be hampered because they will still lose access to tax revenues. That means they cannot fund equivalent benefits unless they find some other source of revenue.

Some analysts fear those dollars may come from still more cuts to Medicare and Medicaid.

“Medicare and Medicaid face fundamental threats, perhaps the most since they were established in the 1960s,” said Edwin Park of the liberal Center on Budget and Policy Priorities, in a webinar last week.

Republicans in the House, however, have identified one other potential source of funding. “Our plan caps the open-ended tax break on employer-based premiums,” said their proposal, called “A Better Way.”

House Republicans say that would be preferable to the Cadillac Tax in the ACA, which is scheduled to go into effect in 2020 and taxes only the most generous plans.

But health policy analysts say ending the employer tax break could be even more controversial.

Capping the amount of health benefits that workers can accept tax-free “would reduce incentives for employers to continue to offer coverage,” said Georgetown University’s Sabrina Corlette.

James Klein, president of the American Benefits Council, which represents large employers, said they would look on such a proposal as potentially more damaging to the future of employer-provided insurance than the Cadillac Tax, which his group has lobbied hard against.

“This is not a time one wants to disrupt the employer marketplace,” said Klein in an interview. “It seems perplexing to think that if the ACA is going to be repealed, either in large part or altogether, it would be succeeded by a proposal imposing a tax on people who get health coverage from their employer.”

Wilensky said that as an economist, getting rid of the tax exclusion for employer-provided health insurance would put her “and all the other economists in seventh heaven.” Economists have argued for years that having the tax code favor benefits over cash wages encourages overly generous insurance and overuse of health services.

But at the same time, she added, “I am painfully aware of how unpopular my most favored change would be.”

Republicans will have one other option if and when they try to replace the ACA’s benefits — not paying for them at all, thus adding to the federal deficit.

While that sounds unlikely for a party dedicated to fiscal responsibility, it wouldn’t be unprecedented. In 2003 the huge Medicare prescription drug law was passed by a Republican Congress — with no specified funding to pay for the benefits.

Republished under a creative commons license via Kaiser Health News.

2016: Highs, lows and farewells

Continue reading 2016: Highs, lows and farewells