Wednesday, May 24th 2017, 9:54 pm Thursday, May 25th 2017, 8:53 am MST
TUCSON, AZ | Tucson News Now KOLD 13
More than 23 million Americans could be uninsured by 2026 if the GOP health bill goes through.
That statistic was released Wednesday, May 24, by the Congressional Budget Office.
Eric and Risa Cline are worried it could hurt their family. The Tucson couple purchased health insurance through the Affordable Care Act.
Right now, they pay about $500 a month for themselves and their three children, but they are worried that since Eric has a pre-existing condition, the price will go up.
“We won’t be able to afford it at all,” Risa said. “I don’t even know how we’re surviving now, to be honest.”
Eric is recovering from an aneurysm and has endured two brain surgeries since 2015. He needs continuing treatment.
“My whole left side was paralyzed, I had big speech issues,” he said.
Republicans supporting this bill say it would save the government $119 billion.
However, Dr. Daniel Derksen, U of A Professor of Public Health Policy argues that the long-term costs will be passed on in other ways.
“All you’re doing is shifting the cost of health care for that population to hospitals, to nurses, to physicians that take care of people regardless of their ability to pay,” he said.
Tucson News Now | Wednesday, May 24, 2017, 8:45 pm
The National Rural Health Association (NRHA) honored Copper Queen Community Hospital (CQCH) CEO, James Dickson earlier this month with the 2017 Louis Gorin Award for Outstanding Lifetime Achievement in Rural Health Care.
Award recipients are selected based on their creativity, unselfishness, compassion and cooperative attitude in seeking ways to make lasting contributions to rural health care.
“It is a rare opportunity for someone to be able to serve and help the community like I have for over 18 years, ” said James Dickson, “I would like to thank my staff, Board of Directors, and Physicians for believing in the vision and being able to provide access to primary healthcare in medically underserved communities.”
Jim Dickson, has an unwavering commitment to providing rural southern Arizonans with accessible, affordable, high-quality health care. His efforts brought state-of-the-art care to southern Arizona through renovation and expansion of the hospital and RHC diagnostic and treatment services.
Dickson has achieved this through innovative and unparalleled collaborations with major health care systems in Arizona using telemedicine for sophisticated diagnostic and specialty care in Cochise County, saving residents the expense and travel to Tucson or Phoenix for services.
In addition to his work in health care, Dickson identifies and addresses unmet community needs, creating the first library for middle school students in Bisbee and offering scholarships to Cochise County high school graduates for training to land well-paying local jobs.
“Jim Dickson’s work at the CQCH critical access hospital and affiliated RHCs, and most recently, to create one of the state’s first rural freestanding emergency departments (ED) at the Douglas Medical Complex, underscores his unwavering commitment to providing rural southern Arizonans with accessible, affordable, high quality health care.” stated Daniel Derksen, MD from the Arizona Center for Rural Health at The University of Arizona.
“For 20 years, Jim has led health care improvements in Cochise County that spans over 6,200 sq. miles, has a pop. density of 20 persons/sq.mi., and 17 percent poverty rate. For comparison, Connecticut is smaller at 5,500 sq.mi., has a pop. density of 650 persons/sq.mi. and 10.7 percent poverty rate.
His efforts brought state-of-the-art care to southern Arizona through renovation and expansion of the hospital and RHC diagnostic and treatment services.
He does this through innovative and unparalleled collaborations with major health care systems in Arizona using telemedicine for sophisticated diagnostic and specialty care in Cochise County, saving residents the expense and travel to Tucson or Phoenix for services.”
Summary: The AHCA cuts $1.5 trillion dollars in federal funding over 10 years by slashing state Medicaid (-$830B), eliminating Marketplace subsidies (-$665B) to individuals and families, and causing 23 million Americans to become uninsured over 10 years. The President’s budget cuts $2 trillion dollars in health spending over 10 years, disproportionately affecting low-income, elderly and rural Americans.
The American Health Care Act (AHCA) was passed by the U.S. House of Representatives on May 4, 2017 by a vote of 217 to 213. The Congressional Budget Office posted its costs and coverage estimates of that bill on 05/24/20171. If passed by the Senate then signed by the President, the CBO estimates it would:
- Increase U.S. uninsured by 14 million in year 2018, and 23 million uninsured by year 2026.
- Increase the uninsured total to 51 million Americans by year 2026, versus 28 million who would lack insurance in 2026 under the current Affordable Care Act (ACA) law.
- Decrease by almost $1.5 trillion dollars the federal funding of health coverage over 10 years (2017-2026) by cutting Medicaid funding to states ($830 billion) and eliminating ($665 billion) in marketplace subsidies to help low-income Americans buy health plans (page 39 CBO Report1).
- Disproportionately affect the frail elderly, blind, disabled and rural Medicaid enrollees.
- Cut by $830 billion dollars over 10 years in federal Medicaid funding to states, resulting in 14 million fewer Medicaid enrollees by 2026.
- Reduce by $665 billion dollars over 10 years in federal subsidies to help individuals buy health insurance (also known as the nongroup or individual health insurance market) by eliminating in year 2020 the ACA’s refundable tax credits and cost sharing reductions. These would be replaced by $275 billion in tax credits for nongroup insurance in year 2020.
- Allow insurers in 2018 to charge older enrollers five times more than younger enrollees, versus three times more under current law.
- Allow insurers to impose a 30% charge to individuals who did not maintain continuous coverage.
- Allow states to waive the Affordable Care Act’s consumer protections and thereby stop requiring insurers to include the 10 essential health benefits (such as preventive services, newborn care, and maternity coverage), and allow insurers to go back to charging people more for pre-existing conditions (eliminates the community rating) if a person had not maintained continuous coverage.
- Appropriate $8 billion dollars per year in 2018 in funding for states that obtain a waiver for a Patient and State Stability Fund starting in 2018 for those with pre-existing conditions.
- Provide $15 billion in funding to states choosing to waive the ACA requirements for community rating and essential health benefits for maternity coverage, newborn care, prevention, treatment, or recovery services for people with mental and/or substance use disorders.
- $610 billion in federal Medicaid funding to states. It is not clear how this relates to AHCA cuts.
- $193 billion for the Supplemental Nutrition Assistance Program (SNAP, aka food stamps).
- $72 billion in Supplemental Security Income (SSI) disability.
- $21 billion in Temporary Aid to Needy Families (TANF).
- $87 billion for the National Institutes of Health
- $18 billion for the Centers for Disease Control and Prevention
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.
Recent events in Washington have ensured that in 2019, MIPS will take approximately $199 million from underperforming clinicians and redistribute the funds to providers above the performance threshold. For many, joining a value-based payment program is one way to help ensure you are on the positive side of the funds redistribution while improving the care of your patients.
The below white paper is designed to help navigate rural healthcare providers, in making the transition to value-based care. It can be trickier for providers working in less populated areas than for their urban counterparts. Smaller population bases and tighter operating budgets make it difficult to justify the money needed to transition from fee-for-service to value-based care. Therefore, decisions need to be carefully made in order to know the facts surrounding an ACO and understanding how it will benefit your community.
CPSI, in partnership with Caravan Health, has put together a white paper that discusses ACOs and where they currently sit in the healthcare landscape. It drills down into rural healthcare organizations and the unique position they are in, as well as the challenges and advantages associated with rural providers. Click the button below to download, "Navigating the ACO Landscape - A Rural Perspective." This white paper will help to learn how to improve your financial performance and your ability to remain independent and sustainable while improving the health of your friends, family and neighbors.
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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):