Payson Roundup | by Peter Aleshire roundup editor May 9, 2017
Most Gila County residents will likely face a much harder time getting health care if the U.S. Senate adopts the Affordable Care Act Repeal the U.S. House narrowly approved last week.
KJZZ | By Will Stone | May 4, 2017
Almost all of Arizona’s Republicans threw their support behind the replacement for the Affordable Care Act, which narrowly passed the U.S. House on Thursday.
Four of Arizona’s five House Republicans voted for the American Health Care Act. Republican Rep. Andy Biggs, who represents a conservative district in the East Valley, joined Arizona's Democrats in opposing the bill.
Before the vote, Biggs criticized the legislation for not being a "clean repeal of Obamacare" and said he was disappointed that two amendments he had submitted were not adopted.
Even the state's Republican members of the House who voted for the bill struck a measured tone.
Congressman Paul Gosar, part of the far-right House Freedom Caucus, acknowledged the bill was not a full repeal, but said there were enough "conservative, time-tested" changes to this version of the AHCA to win his vote.
"Millions of Americans are drowning right now under the tidal wave of Obamacare regulations and mandates that have destroyed our entire health-care system. The American Health Care Act is a life raft to those suffering and represents a down payment towards a true market-based solution," Gosar said in a statement following the vote.
Congresswoman Martha McSally echoed those sentiments, saying she faced a "binary decision" and that the AHCA wasn't a "perfect bill."
“I will continue to work with state and local stakeholders and closely monitor this bill throughout the legislative and implementation process to ensure that my constituents have access to the care they need, that the most vulnerable are protected, and that Southern Arizona is better off in the future,” McSally said in a statement.
Congressmen David Schweikert and Trent Franks were the other Republicans from Arizona to vote yes.
The bill passed without a full analysis from the Congressional Budget Office, but some in Arizona's health-care industry say the new version of the AHCA will dramatically scale back Medicaid funding and, in the short term, cause premiums to rise for certain groups.
As written, the AHCA would allow states to apply for a waiver to what's known as the "community rating" requirement, which protected people with expensive medical conditions from being charged more than others.
"By removing that, insurance plans could charge people with pre-existing conditions significantly more to the tune where they could no longer be able to afford health insurance," Marcus Johnson of Vitalyist Health Foundation, which helps enroll people in Arizona's marketplace, said.
The AHCA allocates billions of dollars to help cover those with pre-existing conditions, but an initial analysis from Avalere Health shows that funding would not be nearly enough to cover everyone. Arizona has about 48,000 people with pre-existing conditions in its marketplace.
If Arizona pursues a waiver to establish a high-risk pool, Johnson said it's unclear whether Arizona would have the funding to cover the "demand of our aging and low-income population."
Arizona could also request exemptions from the "essential health benefits" that the ACA requires every insurance plan to include.
The Republican legislation also has major implications for Medicaid. It phases out the extra federal funding that Arizona received to expand the program.
More than 400,000 people in Arizona have joined the rolls of the state's Medicaid program since the state restored and expanded it. The new legislation keeps that enhanced funding for those already enrolled so long as they don't fall off the program, which is common among that population.
"This increases uncompensated care and forces hospitals to cost shift to commercial payers and businesses. There really isn't any free lunch in all of this," Debbie Johnston with the Arizona Hospital and Healthcare Association told KJZZ.
Johnston said the hospitals that won't be able to cost shift because of their payer mix may become financially unviable.
"We are deeply disappointed with the passage because it will jeopardize coverage for hundreds and hundreds of thousands of Arizonans," Johnston said.
"When you shift the risk and the blame from the federal government to states, it is going to make state government much more challenging with much less resources to do it," Dr. Daniel Derksen, director of the University of Arizona's Center for Rural Health, said about the changes to Medicaid.
"This isn't increasing or preserving choices. This is really reducing choices," Derksen said.
Along with rolling back the expansion, the AHCA changes Medicaid from an open-ended federal program to one that's capped. That most likely means less money for a state like Arizona, which already has a low-cost program.
Dr. Jeffrey Singer, who’s a surgeon in the Valley and a fellow at the Cato Institute, said that’s a good thing.
“By freeing states from the shackles of Washington, that money can go a lot farther. States need to be able to control their budgets because the way Medicaid is growing, it’s not leaving room for anything else,” Singer said.
In response to the vote, a spokesperson for Governor Doug Ducey emphasized that the legislation is still a work in progress:
Health policy expert Dan Derksen, MD, the Walter H. Pearce Endowed Chair and professor of public health policy and management at the University of Arizona Mel and Enid Zuckerman College of Public Health, has been appointed President of the Arizona Academy of Family Physicians (AzAFP). AzAFP’s 1,600 members include allopathic and osteopathic family physicians, family medicine residents, and medical students. It is the state chapter of the American Academy of Family Physicians with 120,000 members.
As director of the Arizona Center for Rural Health (AzCRH), Derksen oversees the state Office of Rural Health, the Rural Hospital Flexibility Program, the Small Rural Hospital Improvement Program, and the AzCRH Navigator Consortium.
After graduating from the University of Arizona College of Medicine in 1984, Dr. Derksen completed his family medicine residency at the University of New Mexico where he worked as a faculty member for 25 years.
While working for Governor Susana Martinez as Director, New Mexico Office of Health Care Reform, Dr. Derksen wrote and was funded ($34.3 million) by the Centers for Medicare and Medicaid Services to establish New Mexico’s state health insurance Marketplace that currently covers over 50,000 New Mexicans.
Dr. Derksen completed a Robert Wood Johnson Health Policy Fellowship in 2008 with U.S. Senator Jeff Bingaman. He researched and drafted federal legislative provisions to improve the nation’s supply and distribution of the health workforce enacted in 2010.
As principal investigator of state, federal, private foundation, and grants in excess of $55 million over his academic career, Dr. Derksen works to improve health insurance coverage and access to high quality health care, emphasizing community-based service-learning models in rural areas.
The Kansas City Star | By Scott Canon
APRIL 03, 2017 1:36 PM
Sen. Claire McCaskill of Missouri calls for GAO report on closings of rural hospitals
Sen. Claire McCaskill, a Democrat, has called on two federal agencies for more details about support of hospitals and schools in sparsely populated areas.
The Missouri senator wrote to the Government Accountability Office seeking answers to several questions about the rate at which rural hospitals are closing, what’s driving those trends and what it means for the quality of health care in those areas. The GAO is the investigative arm of Congress.
She also called on the U.S. Department of Education for a report on how various federal policies affect rural schools.
In a letter to the GAO dated March 31 and shared with The Star on Monday, McCaskill warned that financial pressures on rural hospitals, driven partly by federal policy, pose a particular threat to health care in some parts of the country.
“In recent years,” she wrote, “the number of rural hospital closures has increased significantly and if this trend continues, such closures could have a devastating impact on my constituents and countless other Americans.”
McCaskill also noted that the Centers for Disease Control and Prevention has said people in rural areas face a heightened risk of death from heart disease, cancer, accidents, some respiratory disease and stroke — suggesting that rural hospitals fill a special need.
The senator noted that health care plays a significant economic role in many small towns.
She also cited a Kaiser Family Foundation report issued in January that warned repeal of the Affordable Care Act would signal a “death knell” for some rural hospitals.
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Why So Hard to Kill the Affordable Care Act?
GOP consensus on swift repeal proves disastrously brittle
By Shannon Firth | April 06, 2017 | Washington Correspondent, MedPage Today
WASHINGTON -- For years, Republicans vowed that if they ever got control of the White House and both houses of Congress, the Affordable Care Act would quickly end up in the trash heap. As of January 20, those pieces were firmly in place.Yet nearly 3 months later, the GOP appears no closer to enacting a repeal-and-replace bill than they were when Barack Obama was sitting in the Oval Office.
MedPage Today asked physicians and policy experts why President Obama’s signature legislation is so hard to kill and whether Republicans might give up trying.
“It seems like they are really losing steam, and risking precious political capital on health reform, without a clear consensus or compass for where they want to go,” added Daniel Derksen, MD, director of the University of Arizona Center for Rural Health.
Asked whether the latest effort at compromise giving states an additional $15 billion -- an proposed by two Freedom Caucus members Thursday -- to help them pay for sicker patients would resuscitate the bill, Derksen didn’t think so.
“As a practical matter, funding high risk pools, or variants of that strategy – don’t have great track records of success.... I don’t think this will entice entrenched extremists who wish to do away with public subsidies of health insurance and coverage entirely.”
Arizona Horizon | Arizona PBS
Airdate: March 23, 2017 at 5:30 PM, Video clip: 0min: 0sec to 12min:30sec
The U.S. House is expected to vote on the American Health Care Act, the replacement for the Affordable Care Act on Friday, March 24, 2017.
Arizona Horizon: We’ll discuss the AHCA and the vote with Dr. Daniel Derksen of the University of Arizona and Greg Vigdor, president and CEO of the Arizona Hospital and Healthcare Association.
Dan Derksen - Director of Arizona Center for Rural Health at The University of Arizona
Greg Vigdor - President and CEO of The Arizona Hospital and Healthcare Association
MEDPAGE TODAY | March 24, 2017
By Joyce Frieden (News Editor), and Shannon Firth
Washington Correspondent, MedPage Today
The House Republicans' proposal to replace the Affordable Care Act (ACA) appeared to be doomed from the start, experts said.
"Other than being able to say 'We repealed Obamacare,' there was little upside to this bill," said David Howard, PhD, of Emory University, in Atlanta, in an email. "It threatened to further destabilize the individual insurance market, and the savings to the federal government were modest. It is hard to have a coherent reform that does not address all aspects of the ACA, which is impossible in the reconciliation process."
» Continued at link below:
AzCRH Director, Dan Derksen, MD, discusses the American Health Care Act and its implications for state Medicaid programs.
The American Health Care Act fundamentally changes the financing of state Medicaid programs. It repeals Title XIX of the Social Security Act’s statutory 50% minimum federal funding of state Medicaid programs. It caps Medicaid funding to states – either as a block grant, or a per person cap.
Currently there are 74 million Americans covered by Medicaid and the Children’s Health Insurance Program (CHIP).Over half of those covered are children. Sixteen million people have been added to Medicaid and CHIP since the first open enrollment period of the Affordable Care Act in October of 2013. Eleven million were added in the 31 states expanding Medicaid.
» Watch video at the link below:
AP | Az State Wire | By BOB CHRISTIE | March 20, 2017
PHOENIX (AP) - A doubling of individual health insurance premiums in Arizona for 2017 triggered a sharp decline in Affordable Care Act signups among people who don't qualify for tax credits that offset their costs, according to a new analysis.
The review by University of Arizona health insurance expert Dr. Daniel Derksen of data released by the federal government last week shows a 23 percent decrease in enrollment by that group. Derksen's review of analysis shows the number of people buying insurance who qualify for the tax credits rose by more than 3 percent.
Overall, Arizona saw a 3.3 percent enrollment decline in marketplace plans that are a key component of former President Barack Obama's heath care law, to about 196,000 people.
The study comes as the Republican-led Congress is debating dramatic changes to the Obama-era law. Arizona, with its eye-popping premium increases, is one of President Donald Trump's most cited examples as he tries to make the case that the ACA is collapsing of its own weight.
But Derksen's research shows there are actually two simultaneous running stories about the ACA: While in Arizona some consumers who were not eligible for the law's income-based subsidies dropped coverage in the face of rising premiums, Arizonans who do get subsidies on average saw a slight decline in what they have to pay.
» Continues at link.
As part of their proposal to replace the Affordable Care Act, House Republicans are proposing to change Medicaid financing from a matching fund system to a "per-capita cap."
What exactly does that mean? Daniel Derksen, MD, director of the Center for Rural Health at the University of Arizona, in Tucson, explains the two systems in a MedPage Today exclusive video. He also outlines his concerns that changing to such a funding system may result in less Medicaid funding and poorer healthcare for Medicaid beneficiaries.
AzCRH Director, Dan Derksen, MD, explains it all in this MedPage Today video (below):
By Ken Alltucker | March 15, 2017 | The Arizona Republic | azcentral.com
Arizona could lose $46.8 million in federal public health funding over five years via a cut included in the House Republican health bill, likely forcing local health departments to reduce or cut public health programs…providing childhood immunizations, counteracting emerging public health threats such as the Zika and Ebola viruses…efforts to curb childhood lead poisoning, fight heart disease, manage diabetes, promote skin-cancer awareness and smoking cessation.
Dr. Daniel Derksen, a University of Arizona professor and director of the Arizona Center for Rural Health, said it is critical to fund public health efforts such as preventing the spread of the Zika virus. Lack of funding now could lead to higher health and fiscal costs down the road.
“When somebody has a child with microcephaly, the consequences are lifelong,” Derksen said. “It is very expensive care and has devastating consequences in terms of brain development and physical disabilities.”
Tucson News Now | Tuesday, March 7th 2017, 6:29 pm MST
By Barbara Grijalva, Reporter
Republicans rolled out their replacement for the Affordable Care Act (ACA), also known as Obamacare on Monday, March 6.
They claimed the American Health Care Act will be better and less burdensome.
President Trump said he was proud to support it and hoped it would pass quickly.
However, analysts and governors - Republican and Democrat--have their doubts about the plan being better.
Christian Science Monitor | by Francine Kiefer
The GOP's new health-care bill replaces mandates with tax credits, which would be paid even to families that don't owe taxes. But eventual reductions in Medicaid spending will leave fewer poor people covered.
MARCH 7, 2017 WASHINGTON—After seven years of promising to repeal the Affordable Care Act, Republicans are finally at the point of reckoning – unveiling a replacement plan on Monday that upends Obamacare, but will also greatly test President Trump’s ability to unify Republicans behind it.
The plan, put forward by House Republicans, generally follows GOP principles. It effectively repeals much-maligned individual and employer insurance mandates, which Republicans see as interference in personal health-care choices and markets. Instead, it provides tax credits for individuals to purchase their own policies.
It also overhauls Medicaid – federally supported health care for the poor – which many Republicans see as too costly as the federal debt approaches $20 trillion.