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"Other than being able to say 'We repealed Obamacare,' there was little upside to this bill," said David Howard, PhD, of Emory University, in Atlanta, in an email.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."
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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.
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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.
AzCRH Director, Dan Derksen, MD, was selected to ask a question at the CNN Town Hall with Senators John McCain and Lindsey Graham in Washington, DC on March 1, 2017.
"Senator McCain, Arizona’s done really well the last couple years - we’re in the top five for job growth, we’ve almost halved our uninsured, and we’re hoping for a Final Four appearance with the Wildcats. Go Cats!
As a family doc though I’m very concerned that some of the talk and some of the plans around capping and cutting Medicaid will just shift the risk from the federal government to States, to rural hospitals, to the physicians and the 70 million Americans who currently depend on Medicaid for coverage.
Senators how will you work to make sure that we don’t return to the days of 48 million uninsured in our country and we don’t punish cost efficient, effective states like Arizona - who responsibly run their Medicaid program - through caps and cuts in Medicaid?"
» Watch at link below (starts at 22:15 min).
Healthline News | Written by Shawn Radcliffe | Published on February 15, 2017
In recent years, many policies have chipped away at the rural health safety net that ensures that people living in remote areas still have access to healthcare.
When Terry Fulmer’s 90-year-old aunt fell and tore her shoulder ligaments, she had surgery in Albany, a two-hour drive from her home in rural upstate New York.
“Maybe she could have gotten care in a closer town. But her daughter lives in Albany so she had to go there because that’s where she recovered. She couldn’t feed herself, she couldn’t dress herself,” said Fulmer, Ph.D., R.N., F.A.A.N., president of the John A. Hartford Foundation in New York, a foundation dedicated to improving the care of older adults.
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Feb 7, 2017 -- Details the panel discussion of several rural health leaders at the annual Rural Health Care Leadership Conference. Discussion included, among other things, innovative ways rural hospitals have kept themselves afloat, the findings of the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities report, and the challenges as well as the potential of telemedicine for rural areas.
The Health Educator-Navigator position is a part-time (20 hours/wk) benefits eligible position w/ possible nights and weekends and frequent travel in Mohave, Coconino, Apache and Navajo counties.
Jan 27, 2017 Ronald Hansen and Ken Alltucker: “Arizona’s Ducey cites ‘Obamacare’ harm in seeking repeal, but law’s positives complicate issue.” The Arizona Republic | azcentral.
With more than a half-million Arizona residents gaining health coverage through the health law’s marketplace, Medicaid expansion and KidsCare restoration, fewer uninsured patients are leaving behind unpaid bills. Hospitals must assess and stabilize all patients who seek care, regardless of their ability to pay.
A statewide survey showed Arizona hospitals have significantly reduced unpaid bills since ACA coverage expansion began Jan. 1, 2014. Arizona hospitals reported uncompensated care of $395 million in fiscal year 2016, down from $746 million in 2014, according to the Arizona Hospital and Healthcare Association survey.
“The data is unequivocal on this,” said Dr. Daniel Derksen, a University of Arizona professor and director of the Center for Rural Health.
Jan 27, 2017 Lorraine Rivera: Episode 300: One Week In, Trump Sets Sights on Health Care
A look at impacts on Southern Arizona of the president-s first actions. Arizona Public Media | NPR.
Arizona is one of 31 states that expanded the Medicaid program under the Affordable Care Act. We ask how the state will respond to changes following Trump’s announced plans to “ease the burdens” on individuals and the health care industry.
Before the Affordable Care Act, 1.2 million Arizonans were without insurance. Today, it’s about 770,000. Open enrollment ends Jan. 31.
On the program:
- Christine Corieri, senior policy adviser to Gov. Doug Ducey (4:45 to 10:35)
- Dan Derksen, University of Arizona Center for Rural Health (10:45 to 17:15)
- Julia Strange, Tucson Medical Center VP of community benefit (17:15 to 27:45)