Sure, There’s A Health Care Deal. That Doesn’t Mean It Can Pass Thursday, Oct 19 2017 

Updated at 3:55 p.m. ET

A bipartisan coalition of 24 senators — 12 Republicans and 12 Democrats — has signed on to health care legislation to prop up the individual insurance market and keep premiums down. With the expected support of all Senate Democrats, it could have the votes to pass the chamber. But questions remain over when it might actually get a vote, as well as whether President Trump and House Republicans would bring the bill over the finish line.

“This is a first step: Improve it, and pass it sooner rather than later. Our purpose is to stabilize and then lower the cost of premiums in the individual insurance market for the year 2018 and 2019,” said Sen. Lamar Alexander, R-Tenn., on the Senate floor. Alexander and Sen. Patty Murray, D-Wash., crafted the compromise bill.

Alexander and Murray have been working on this legislation for months. Negotiations initially began after the Senate failed to pass legislation to repeal and replace Obamacare back in July.

Most Americans get health insurance through their employer or from the government. About 18 million Americans get their insurance through the individual market established by the Affordable Care Act. “They’re the ones we’re worried about; they’re the ones we’re seeking to help,” Alexander said, noting that includes about 350,000 people in his home state.

“I have to say that after seven years of intense partisanship on these issues, which would lead everyone to believe there was no hope for Republicans and Democrats to come together and work to strengthen our health care, I’m really pleased with this common ground we’ve been able to find,” Murray said on the Senate floor.

President Trump’s decision last week to end subsidies to insurance companies that were allowed under the ACA revived congressional talks. The Trump administration argued — and initial court rulings backed them up — that the payments were illegal because they had not been appropriated by Congress, which has the constitutional authority to spend the government’s money. Although the 2010 health care law required insurers to provide discounts to some low-income consumers and said the government would reimburse them, without authorizing the spending.

The Alexander-Murray proposal would appropriate those subsidies for two years, and tie them to permanent changes to the law that give states more flexibility to seek waivers from the Health and Human Services Department from the ACA’s requirements. It would also allow insurances companies to sell less comprehensive plans to all customers, not just those under age 29 as is the case under current law.

The nonpartisan Congressional Budget Office estimates that without the subsidies, premiums will go up, the deficit will rise and up to 16 million Americans could live in counties with no insurance providers at all.

“Unless they are replaced with something else temporarily, there will be chaos in this country and millions of Americans will be hurt,” Alexander warned.

Alexander said Trump has been privately encouraging of the talks, but the president cast doubts on the legislation this week by suggesting it was a “bailout” for insurance companies that he could not support. However, the bill’s sponsors counter that the legislation requires that the subsidies go directly to the consumer to keep premiums down.

The bipartisan bill has potentially critical GOP support from Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona. The trio played a defining role in the defeat of previous GOP health care bills this year. It also has the backing of Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, who have competing legislation to dismantle the ACA and replace it with a block grant system to the states.

GOP backers say the bill does not pre-empt the party’s ongoing effort to end Obamacare but rather buys time to keep working on legislation that can muster enough support to pass Congress. Conservatives have balked at Alexander-Murray as a tacit admission that Obamacare will remain the law of the land. House Speaker Paul Ryan said through a spokesman Wednesday that the speaker believes the Senate should remain focused on legislation to end Obamacare, not prop it up.

The proposal puts the GOP in a bind between the policy necessity to act to protect millions of Americans from premium hikes, and the political necessity to continue to keep up its effort to dismantle the current system. An August poll from the Kaiser Family Foundation found that 60 percent of Americans think Trump and Republicans in Congress are responsible for what happens to the ACA in the future.

Senate Majority Leader Mitch McConnell has not taken a position on the bill, but he is unlikely to bring something to the floor unless it has Trump’s support and the 60 votes needed to clear a potential filibuster, which it should if all 48 Senate Democrats support it along with the 12 Republicans who have signed on. The legislation crowds an already limited legislative calendar. It would need to become law before the end of the year when Congress needs to pass a spending bill package to keep the government running. That spending bill would be the vehicle to fund the insurance subsidies.

Along with Alexander, Collins, Murkowski, McCain, Graham and Cassidy, the additional GOP co-sponsors include Sens. Mike Rounds of South Dakota, Joni Ernst and Chuck Grassley of Iowa, Bob Corker of Tennessee, Richard Burr of North Carolina and Johnny Isakson of Georgia.

The Democratic co-sponsors joining Murray include Sens. Angus King, independent of Maine, Jeanne Shaheen and Maggie Hassan of New Hampshire, Joe Donnelly of Indiana, Amy Klobuchar and Al Franken of Minnesota, Heidi Heitkamp of North Dakota, Joe Manchin of West Virginia, Tom Carper of Delaware, Tammy Baldwin of Wisconsin and Claire McCaskill of Missouri.

Copyright 2017 NPR. To see more, visit

Draft Of Health Care Bill Addresses Trump Concerns About ‘Bailouts’ For Insurers Wednesday, Oct 18 2017 

Updated at 1:15 p.m. ET

A proposal in the Senate to help stabilize Affordable Care Act marketplaces would ensure that subsidies paid to insurance companies benefit consumers rather than padding the companies’ profits.

A draft of the bill, obtained by NPR, requires health plans to offer the subsidies as one-time or monthly rebates to consumers or they will be repaid to the federal government. The subsidies, known as cost-sharing reduction payments, are designed to reimburse insurance companies for discounts they are required to offer their customers on copayments and deductibles. President Trump has criticized the payments as a “bailout” and said last week he would cut them off.

The bipartisan bill, proposed by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., restores the payments for the rest of this year and the next two years. But the lawmakers are seeking to reassure the president that the payments will benefit consumers and not insurance companies.

Trump told reporters at the White House this morning that he was looking forward to seeing the bill.

“And if something can happen, that’s fine. But I won’t do anything to enrich the insurance companies because right now the insurance companies are being enriched. They’ve been enriched by Obamacare like nothing anybody has ever seen before. I am not going to do anything to enrich the insurance companies,” Trump said.

He had tweeted such concerns earlier on Wednesday.

A congressional GOP source tells NPR’s Susan Davis that Alexander spoke to Trump before the president tweeted out his concerns and was encouraged to keep working on the bill.  

Murray and Alexander are expected to officially release the bill with a list of bipartisan co-sponsors by Thursday. Republicans are working a number of influential senators from the moderate and conservative wings to sign on so the bill can pass the Senate.

Republican Senate leaders have indicated they will not waste limited floor time on another failed health care bill, which means the bill must be ensured 60 votes to pass.

Senate Minority Leader Chuck Schumer, D-N.Y., criticized the president at length for tempering his initial support for the deal. “This president keeps zigging and zagging so it’s impossible to govern,” Schumer said on the Senate floor Wednesday morning. “He’s totally inconsistent. For it one day, against it the next day. You can’t govern — Mr. President, you cannot govern a country, you cannot keep America great, if you don’t know what’s in the bills and you don’t have a consistent policy about them.”

Schumer said he’d had private conversations with the president in recent weeks in which they both agreed to encourage their respective senators to reach a deal.

The bill also allows states to seek waivers to create variations on the Affordable Care Act in their own states. That’s been a priority of Republican lawmakers, who argue that state-level legislators and governors better understand the needs of their citizens.

“This will give states meaningful flexibility,” Alexander said Tuesday in discussing the forthcoming bill.

The ACA allows states to apply for waivers to set up systems such as reinsurance programs that protect insurance companies from large and unexpected losses, or high-risk pools to provide coverage to the sickest patients.

But many of the state applications have been delayed or denied because of all the requirements laid out in the law.

For example, the ACA requires state legislatures to pass a law approving the waiver provisions. The new proposal would simply allow a state governor to sign off on the plan.

The bill also restores some of the federal budget for advertising and outreach for open enrollment in ACA health plans, which starts on Nov. 1. The Trump administration slashed that budget by 90 percent.

Alexander says he will seek Senate co-sponsors for the bill and then bring it to Majority Leader Mitch McConnell later this week for consideration.

NPR’s Susan Davis contributed to this report.

Full text of the bill and a summary are below.

Murray Alexander Market Stabilization Bill

Murray-Alexander Bill Summary

Copyright 2017 NPR. To see more, visit

Kentucky Group Renews Push For Higher Cigarette Tax Wednesday, Oct 18 2017 

A renewed effort to get people to quit smoking in Kentucky is launching Wednesday in Frankfort. Led by the Kentucky Chamber of Commerce, Foundation for a Healthy Kentucky and Baptist Health, at the top of the coalition’s to-do list is to raise the cigarette tax to $1.60 a pack. That’s a $1 increase over the current rate.

“The whole idea is to cut this terribly damaging smoking rate that we’ve got in Kentucky,” said Ben Chandler, chair of the newly formed Coalition for a Smoke-free Tomorrow. “We’re 70 percent above the national average, and [smoking] has tremendous economic damage.”

Generally, a 10 percent increase in the price of a pack of cigarettes could result in a 2.5 to 5 percent decline in overall smoking, according to a policy brief last month in the journal, Health Affairs. That means increasing the tax even by 6 cents could potentially mean 220,000 Kentuckians would stop smoking.

The Coalition for a Smoke-free Tomorrow estimates its proposed tobacco tax of $1.60 would raise $266 million in new state revenue each year. Kentucky’s current cigarette tax is the 43rd lowest in the nation, and even raising it to to $1.60 would put the state below the national average of $1.71 a pack.

The Kentucky Farm Bureau is a main opponent of increasing the state cigarette tax. KFB argues that increasing the tax would mean less revenues for Kentucky because smokers might go to neighboring states to buy cheaper cigarettes.

Neighboring Missouri has the lowest cigarette tax in the U.S. at 17 cents per pack. Virginia’s tax is the second lowest at 30 cents. Thirty-four states have a cigarette tax of $1 or more, including West Virginia, Ohio and Illinois.

Meanwhile, cigars, pipe tobacco, e-cigarettes and “roll-your-own tobacco” are not taxed.

But besides the additional revenue that could come from raising the tax, Chandler said there would be other benefits to the state. He said many companies don’t locate in Kentucky because of the likelihood of having many employees who smoke.

“Businesses lose money on the front end with a lack of productivity and the back end having to pay health care costs,” Chandler said.

According to the Kentucky Chamber of Commerce, companies pay $5,800 more in costs for employees who smoke versus employees who do not. The group says illnesses related to tobacco use and secondhand smoke cause 9,000 deaths each year, and cost $1.92 billion in health care expenditures. Nearly $590 million of those annual costs are covered by Medicaid, the state’s insurance program for low-income and disabled people that is funded through taxpayer dollars.

In 2014, Kentucky spent $39.2 million on tobacco control programs like the toll-free hotline, cessation classes and anti-smoking marketing. That’s almost $20 million less than the Centers for Disease Control recommends the state spend.

Chandler said the group would also like to see a statewide law to ban smoking in the workplace or indoor public places, but such a move is unlikely to get legislative approval. So instead, the group will push counties and cities to enact smoke-free laws.

Trump Pushes Obamacare To Detonation, Forges Path Away From GOP, Democrats Saturday, Oct 14 2017 

Back in March, after the first Republican legislative failure to repeal and replace the Affordable Care Act during the Trump presidency, President Trump went before cameras in the Oval Office and revealed some of his thinking when it came to the politics of health care.

“I’ve been saying for the last year and a half that the best thing we can do politically speaking is let Obamacare explode,” Trump said. “It is exploding right now.”

Experts said the ACA wasn’t “exploding,” but that it needed fixes to help incentivize insurers to stay in marketplaces.

But now, six months later, Obamacare may actually be on the road to “exploding” – catalyzed by an accelerant poured over it by President Trump. The moves he’s taken risk blowing up the individual markets by making insurance too expensive for lower- and middle-class families. Trump’s actions, however, could backfire politically, threatening to shift blame for the health care act’s shortcomings from Obama and Democrats to Trump and Republicans.

That’s something Republicans have feared and now believe will happen.

“If people lose their cost-sharing reduction payments — their subsidies — it’s going to be pretty hard to blame a former president — Barack Obama — for that,” moderate Republican Rep. Charlie Dent of Pennsylvania told NPR’s All Things Considered on Friday. “We Republicans control the House and the Senate and the White House. If there are problems, we will likely own them. It’s pretty hard to say that the former president is somehow going to be able to accept all the blame. He’s out of the game right now.”

At issue is the president’s decision to end subsidies that help offset the cost of insurance for anyone making up to three times the federal poverty level — that’s a yearly household income of $97,000 for a family of four.

Trump’s action could mean premium increases of 20 percent by 2018 for people buying insurance through exchanges, the Congressional Budget Office estimates, and more than that in subsequent years. And the CBO estimates it will wind up costing — not saving — the government almost $200 billion over the next 10 years. (Bloomberg explains how.)

Trump’s decision comes after three high-profile failed GOP repeal-and-replace efforts in Congress. The White House argues the subsidies are illegal, because they are not appropriated by Congress. House Republicans sued the Obama administration hoping to stop the payments.

A court sided with the House GOP, but agreed to leave the subsidies in place until a government appeal could be heard. The Trump administration, however, decided to drop the appeal, thereby ending the payments.

In practical terms, though, this will hurt real people, many of whom are in Trump-won states. Will they accept the legal argument that the process was flawed, and Congress has to fix it, even if the man they voted for had the power to keep more money in their pockets?

Trump’s move came a day after he took yet another step to undermine Obamacare by signing an executive order allowing groups of small businesses and associations to band together to buy health insurance.

That could draw younger, healthier people away from the exchanges. It might give younger people a discount for cut-rate coverage, but it would likely drive up the price of premiums for Americans who need care.

That’s not all the Trump administration has done that could pull the rug out from under the ACA — it has also shortened the sign-up period for health care; closed the federal exchange on Sundays; and cut the budget for marketing efforts, including ending advertising to urge sign ups.

Cutting subsidies is a move long feared by health care advocates. Trump has teased doing it for months.

Back in April, he told The Wall Street Journal he was thinking about it, and perhaps revealed why:

“What I think should happen — and will happen — is the Democrats will start calling me and negotiating,” Trump told the paper.

The Journal noted that he continually came back to subsidies, and called out Democratic leaders Chuck Schumer of New York and Nancy Pelosi of California.

“Schumer should be calling me up and begging me to help him save Obamacare,” Trump said. “He should be calling me and begging me to help him save Obamacare, along with Nancy Pelosi.”

Recently, Schumer and Pelosi appeared ready to work with Trump. The president sided with them over leaders of his own party about a three-month extension on the debt ceiling, which is set to need to be raised again in early- to mid-December.

Republicans worried that he was falling into the arms of “Chuck and Nancy,” but Trump appears to be trying to carve out a third path for himself — dismissing Republicans and brow beating Democrats, hoping they will come to him on bended knee.

But Democrats have some leverage — without their votes, it will be difficult for Republicans to keep the government open or raise the debt ceiling on their own. That would risk a government shutdown and a default of U.S. debts because the country essentially couldn’t make its minimum payments.

And “Chuck and Nancy” don’t appear ready to kneel.

“Sadly, instead of working to lower health costs for Americans, it seems President Trump will singlehandedly hike Americans’ health premiums,” Schumer and Pelosi said in a joint statement. “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America. Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.”

Schumer later told reporters. “Unless our Republican colleagues act,” he said, “the American people will know exactly where to place the blame when their premiums shoot up, and when millions lose coverage.”

The message is clear, and it doesn’t sound like begging from Democrats, who are still smarting from Trump’s apparent backing away on immigration. Democrats thought they had a kind of agreement in principle on legalizing children brought to the U.S. illegally with President Trump — until he submitted a list of demands Democrats found too odious (that included the building of the border wall).

But, pointing to looming spending negotiations in December, Schumer also said with some optimism, “We’re going to have a very good opportunity to get this done in a bipartisan way, if we can’t get it done sooner.”

It now may be up to like-minded congressional Democratic and Republican negotiators to find a bipartisan solution, because it’s tough to negotiate with someone who seems unconcerned about the fallout of his decisions.

Copyright 2017 NPR. To see more, visit

How Trump Dismantling Obamacare Could Affect Kentuckians Friday, Oct 13 2017 

Jon Huffman is an actor, and doesn’t have health insurance through an employer. For the past few years, he’s bought his coverage on – and before that Kynect.

And he’s one of the millions of Americans that could ultimately be affected by President Donald Trump’s announcement Thursday that he’ll end the federal government’s payments to insurance companies to subsidize health coverage for some low- and middle-income people.


When the Affordable Care Act was passed in 2010, it was just in time for 62-year-old Huffman. He’d once had insurance through an actor’s union, but didn’t use it when he was young and healthy. But in 2013, he started feeling a sharp pain in his stomach. He held off on going to the doctor, but in 2014 finally got insurance through Kynect and saw a professional.

Courtesy Jon Huffman

Jon Huffman

“Then two months later, I was diagnosed with stage 3 colon cancer,” Huffman said. “[The insurance coverage] came just in the nick of time for me.”

One of the reasons Huffman can afford this health coverage is because of a subsidy. When he files his taxes every year, he gets money back to help him pay for his insurance. Huffman qualifies because his income is less $48,240 a year.

But in addition to these direct subsidies for people like Huffman, the federal government also gives insurance companies a chunk of money to help cover the cost of insuring people who make less than about $30,000 a year.

This money paid to the insurance companies brings down the amount enrollees have to pay every time they go to the doctor – called a copay – and the limit they have to reach before insurance kicks in – called a deductible.

And these insurance payments – called cost-sharing reductions – are what Trump is taking away. In early 2016, almost 43 percent of Kentuckians who got insurance through the federal marketplace had their deductibles and copays lowered due to the CSRs paid by the government.

Cost-Sharing Reductions

Trump has talked about stopping CSR payments for months; so much so that insurance companies factored in the loss of CSRs when they filed 2018 rate increases this summer.


Caresource, one of the two insurers left in Kentucky, initially asked the state to increase enrollees’ premiums by almost 20 percent for 2018. But they withdrew that request once it seemed likely the CSR payments would end. Now, the company plans to increase premiums by 56 percent next year.

For Huffman, the effect of all this will likely be a wash. While his monthly payment of $280 will likely increase, the federal government will have to give him a larger tax subsidy to compensate.

The people it’ll really affect will be those that don’t qualify for a subsidy because they earn too much. For a family of four, that income limit is around $98,000. For these people, monthly premiums can cost thousands of dollars.

Market Collapse

Health policy experts say eliminating the CSRs will likely lead to the people without direct subsidies leaving They could find coverage with association health plans that are cheaper but offer skimpy benefits. On Thursday, just a few hours before the announcement on CSRs, President Trump directed the federal government to find a way to create these plans.

If this happens, there would be fewer people getting insurance through the exchanges. This would mean fewer people paying those increased premiums to insurers, which could lead insurance companies to leave the market altogether. This could collapse the individual market.

This scares Jon Huffman. Colon cancer is aggressive and spreads fast. Every six months he has to go back to get checked that it’s still gone.

“All the treatment, the subsequent check-ups, is expensive,” he said. “There’s no way I could have afforded it without the [Affordable Care Act].”

But if the market altogether went away? That’d be another scenario for Huffman.

“I could lose [insurance] and not have it next year,” he said. “And if I don’t, I probably won’t get another colonoscopy. I probably wait til’ I can get Medicare before I can get more health care and keep my fingers crossed.”

But the end of CSRs isn’t likely to happen by January 1, when insurance companies’ new rates go into effect. These CSR payments are actually required in the Affordable Care Act. Several states, including Kentucky, have already said they plan to file lawsuits. That would mean years in court to determine the future of the individual market created by the Affordable Care Act.

Beshear Says He’ll Sue Trump For Cutting Obamacare Subsidies Friday, Oct 13 2017 

Kentucky Attorney General Andy Beshear says he plans to sue President Donald Trump over his plan to repeal subsidies that help people afford health insurance under Obamacare.

Trump announced Thursday that he planned to cut off the payments, which help insurers provide coverage to low-income Americans. That includes more than half of the roughly 88,000 Kentuckians who signed up for insurance through Obamacare.

“All of us will see our health care premiums increase if the federal government breaks its word,” Beshear said in a video announcement.

“Ultimately these companies are going to pass on the costs of the federal government’s broken promises to you and me.”

The subsidies help people who earn below 250 percent of the federal poverty level pay for out-of-pocket costs like deductibles and co-pays.

According to the progressive Kentucky Center for Economic Policy, just over half of Kentuckians who got insurance through the federal health exchange qualified for the subsidies during this year’s enrollment period.

Calling the payments a “bailout of insurance companies” Trump said the policy under President Obama’s administration “skirted the law to prop up a broken system.”

Trump Tweeted on Friday: “The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!”

The Congressional Budget Office estimated that eliminating the subsidies would result in premiums rising 20 percent in 2018 and lead more insurers to stop offering plans in parts of the country.

Democrats have accused Trump of sabotaging the law, though Beshear said the lawsuit “isn’t about the president at all.”

“It’s about Kentuckians deserving health care that they can afford and the federal government keeping its word,” Beshear said.

“In the end, this action is going to harm them. It doesn’t matter if they’re a Democrat or Republican, it doesn’t matter who they voted for, they deserve affordable health care.”

Beshear will be joining Democratic attorneys general from California, Massachusetts and Connecticut who are also planning to sue Trump over the move.

In a conference call, the officials said they plan to file the lawsuit in federal court in California.

Arguing that Trump violated provisions in the Affordable Care Act and the Administrative Procedures Act, the attorneys general are attempting to block Trump’s move and force the administration to continue making payments while the lawsuit is pending.

Poll: while Trump moves to dismantle ACA, public favors repair Friday, Oct 13 2017 

By Jordan Rau | Kaiser Health News In a poll conducted before President Trump’s Thursday announcement of unilateral changes to the Affordable Care Act, 71 percent of people surveyed by the Kaiser Family Foundation, said that they preferred the administration try to make the law work rather than to hasten replacement by encouraging its failure. […]

Trump Says He’ll Sign Order To Expand Health Insurance Options Tuesday, Oct 10 2017 

President Trump is poised to sign an executive order that he says will make it easier for people to join together as a group and buy health insurance from any state.

The president tweeted about his plans on Tuesday morning.

“Since Congress can’t get its act together on HealthCare, I will be using the power of the pen to give great HealthCare to many people — FAST,” he wrote.

The order would direct government agencies with jurisdiction over health insurance to find ways to allow consumers and small businesses to create associations to buy health coverage, according to The Wall Street Journal, which cited an unnamed Trump administration official.

Proponents of the move say that association health plans, which could be offered by trade groups, chambers of commerce or groups of small businesses, would not be bound by Affordable Care Act regulations that require insurance policies to cover everyone, no matter their health status, and to cover a specific set of benefits.

Conservatives have long advocated for these kinds of plans because they say they will boost competition and lower premiums. Kentucky Sen. Rand Paul argued for them on NPR’s All Things Considered in September.

“We believe that previous administrations have defined the law too narrowly, and under a new definition, there will be a wider expansion of AHPs, which will greatly lower costs to the consumer and provide more health insurance options,” Rand’s communications director Sergio Gor said in an email to NPR on Tuesday.

But health industry analysts say that if the policies don’t have to follow ACA rules, they would likely draw healthier people out of the traditional insurance market with the lure of low-premium policies that offer few benefits. That would leave the Obamacare markets with a sicker, more expensive population and could drive their premiums higher.

“If the executive order is as expansive as it sounds and association plans are allowed to cherry-pick healthy people, it could truly cause the individual insurance market under the ACA to collapse, leaving people with pre-existing conditions without access to affordable coverage,” says Larry Levitt, senior vice president of the Kaiser Family Foundation.

But he says exempting insurance plans from the ACA rules through regulation would be difficult.

“They would have to twist current laws into a pretzel to allow both individuals and small businesses to get insurance through associations exempt from the ACA’s rules and operating across state lines,” Levitt says.

Joseph Antos, a health policy scholar at the conservative American Enterprise Institute, agrees. “Trying to exempt these new associations from ACA rules that apply to all other plans doesn’t strike me as something that’s going to stand up in federal court,” Antos says.

Insurance markets are defined by local populations and local hospital networks, Antos says. There’s no reason to believe that an association of people spread across many states would be able to negotiate better deals with health care providers than insurance companies already do.

Health insurers have long opposed the idea, saying it will drive premiums higher for many consumers. “Association health plans would fragment and destabilize the small group market, resulting in higher premiums for many small businesses,” the National Association of Insurance Commissioners said in a position paper on its website.

Insurance premiums are based on the health status of the people who are included in the group being covered. Under the Affordable Care Act, those groups are defined by geography — everyone of the same age group in the same region pays the same premium for similar coverage.

Allowing some people to pull out of that group and buy less generous insurance could split the market between healthy people who don’t need much care and sicker people who use more. And that would drive up costs for those sicker people.

But Trump has long said the cost of insurance has risen too much under the ACA and that he wants to see people have more choices, including the choice to buy insurance with fewer benefits.

The order, which is expected later this week, would begin to fulfill Trump’s promise during his campaign to allow people to buy insurance “across state lines,” a goal that many conservatives say will boost competition. Insurance markets are currently regulated at the state level, and consumers can only buy policies that are approved in their state.

Trump said in the Oval Office on Tuesday that he’ll be “signing something probably this week that’s going to go a long way to be able to help a lot of the people who have been hurt on the health care. “They’ll be able to buy, they’ll be able to cross state lines and they’ll get great competitive health care and it will cost the United States nothing,” the president said.

Antos of AEI disagrees.

“I don’t see any real impact here.”

Copyright 2017 NPR. To see more, visit

Trump Guts Requirement That Employer Health Plans Pay For Birth Control Friday, Oct 6 2017 

The Trump administration is rolling back the Obama-era requirement that employer-provided health insurance policies cover birth control methods at no cost to women.

According to senior officials with the Department of Health and Human Services, the goal of the new rule is to allow any company or nonprofit group to exclude the coverage for contraception if it has a religious or moral objection.

“This provides an exemption and it’s a limited one,” said Roger Severino, director of the HHS Office of Civil Rights. “We should have space for organizations to live out their religious identity and not face discrimination.”

He said he expects most companies will continue to provide coverage for birth control and that the changes will only affect a tiny percentage of U.S. women. The new rules are being published Friday in the Federal Register and go into effect immediately.

But some health policy analysts say the new rule creates a huge opening that lets any employer claim an exemption, leaving their female workers to pay the full cost of any birth control out of pocket.

“It is a huge loophole for any employer that does not want to provide birth control coverage to their employees,” says Dania Palanker, a professor at Georgetown’s Center on Health Insurance Reform.

The change fulfills a promise Trump made in May to the Catholic religious order The Little Sisters of the Poor in a ceremony in the White House Rose Garden. The nuns had sued the Obama administration over the birth control requirement.

The Affordable Care Act requires employer-provided health insurance policies to include coverage for preventive health care. After the law passed, HHS used its regulatory authority to specify what has to be included in those preventive services, and birth control, including “all Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.”

But the policy was controversial from the start.

Several companies and religious groups sued, saying the rule infringed on their religious freedom.

The Obama administration created an exemption for churches, and allowed other “religious employers” to opt out by notifying the government. When they did so, the administration would arrange with their insurance companies to provide the coverage directly, without the employers’ involvement.

But the Little Sisters of the Poor weren’t happy with that workaround and sued.

The group’s case, and a second one involving private businesses including the Hobby Lobby chain of craft stores, went to the Supreme Court.

The court ruled in favor of Hobby Lobby in 2014, saying privately held companies could object on religious grounds. And then, last year, the court issued a split ruling in the Little Sisters case, saying the government shouldn’t fine the nuns, but also ordering the two sides to work out an arrangement that accommodates their religious beliefs.

Before a deal was reached, Donald Trump became president.

At the Rose Garden ceremony in May, he told the Little Sisters of the Poor that he planned to change the rules. “You’re long ordeal will soon be over,” he promised.

Under the new rule, women who work for Hobby Lobby or the religious group may no longer have access to birth control coverage through the Obama-era workaround. A Hobby Lobby spokesman said the company would have no comment on Friday, and the Little Sisters of the Poor didn’t respond to NPR’s emails seeking comment.

Hobby Lobby’s founder and CEO David Green told reporters in 2013, “Our family is now being forced to choose between following the laws of the land that we love or maintaining the religious beliefs that have made our business successful and have supported our family and thousands of our employees and their families.”

HHS officials said they don’t expect many companies to seek waivers. They said the group seeking waivers will likely be limited to those approximately 200 companies and nonprofits that have already sued.

But Palanker says the impact could be a lot bigger. There are a lot of large private companies, she says, whose owners may hold strong religious beliefs but did not want the publicity and expense of suing the federal government.

Hobby Lobby has 32,000 employees.

“A lot of women will retain birth control coverage,” Palanker says, “but there will be a lot of women who will lose that coverage.”

That means they’ll find themselves paying out of pocket. A one-month’s supply of birth control pills can cost anywhere from $4 to $55 or more, according to

Longer-acting contraception, like an IUD, can cost more than $1,000, says Sarah Lipton-Lubet, a vice-president of the National Partnership for Women and Families. She says the new rule is a tool for discrimination against women.

“Women shouldn’t be denied access to basic health care based on their employers’ religious beliefs,” she says. “We all have the right to our religious beliefs. But the way that this rule treats religion is really an excuse to discriminate.”

HHS officials say they also plan more stringent enforcement of a provision in the Affordable Care Act that prohibits federal subsidies from being used for insurance policies that cover abortion. The agency will issue guidelines for insurers today on how they have to charge women who want abortion coverage at least $12 a year more for such a policy, and they have to keep that money in a separate fund to be used only to pay for abortions.

The Trump administration’s rule is likely to face its own legal challenges from groups that favor contraception.

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In Wake Of Las Vegas, Louisville Hospitals Say They’re Prepared For Mass Shooting Thursday, Oct 5 2017 

Keith Miller briskly walks down a bare, white hallway, through swinging doors and into what could be a emergency room movie set.

Here, he said, patients would be operated on if there were a bottleneck in the actual operating room caused by too many patients – like in the case of a mass shooting like what happened in Las Vegas this week.

“The types of injuries you’re talking about responding to in a mass casualty event are the types of injuries we see here every day, it’s just that there are substantially more of them,” said Miller, a trauma surgeon at University of Louisville Hospital. “So when it comes to preparing for something like this, it’s always in the back of your head.”

Not only is University of Louisville Hospital the only Level 1 adult trauma center in Louisville—it’s the only Level 1 trauma center in a 70-county area spreading south into Kentucky and north into Indiana. The “Level 1” designation indicates the facility is capable of providing the highest level of surgical care for trauma patients, and University of Louisville Hospital is staffed 24/7 to deal with traumatic injuries–everything from car accidents to workplace explosions.

And in the event there’s a mass shooting or any large-scale disaster in the region, this sterile space would quickly be filled with patients, and extend into a nearby hallway and other areas.

Kentucky Hospital Association

Level 1 trauma centers are equipped to handle major trauma, like gun shot wounds. Level 2, 3 and 4 trauma centers have fewer capabilities.

In Kentucky, hospitals and first responders have contingency plans if something were to happen. The people with the most traumatic of injuries – like a gunshot, knife wound or severe burn – would go to University Hospital. If children are involved, they’d go to Norton Children’s Hospital downtown, where there’s a Level 1 trauma center for kids. And Miller said other hospitals in the area would take on patients with less severe injuries.

“This isn’t a single hospital response to this [a mass shooting or other disaster] – this is a community-wide, and a regional, sometimes state-wide approach,” Miller said.

University Hospital and Norton’s Children each have their own playbooks for what would happen if a disaster occurred. And though these plans haven’t been tested at the magnitude of what happened in Las Vegas, both emergency departments get practice.

Sometimes that practice comes with disasters that involve multiple casualties, like when tornadoes tore through southern Indiana and parts of Kentucky in 2012, killing 35 people. Miller said that was the last time he remembers the emergency department really being taxed beyond the usual daily traumas.

But the playbook is also used every day on routine injuries.

“You can scale it as big as you want, or as big as you want,” said University Hospital Emergency Manager Joshua Goss.

Miller added that both hospitals have times when they put more staff on call.

“There’s no doubt that the day of Derby, Thunder over Louisville, that’s it’s more at the forefront of our minds, where we may all have to be here very quickly,” Miller said.

At Norton Children’s—the region’s Level 1 pediatric trauma center—attending trauma physician Keith Cross said in case of a disaster, the mode his staff would go into is a more intense version of what they already do.

“It’s kind of like Clark Kent and Superman. You’re not Superman all the time, you can’t live that way, but sometimes you switch into that mode, and that’s what you do when there’s a mass casualty event,” said Cross. “And you have to have a staff that’s trained to in how to switch to that mode temporarily.”

Cross said the daily practice in dealing with small-scale traumas is important to help his staff prepare for the worst. Plan, practice the plan, and in case of a disaster, they’re ready.

Featured photo: Keith Miller (left) and Joshua Goss of University of Louisville Hospital.

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