Litigation continues in Texas v. Azar, a lawsuit over the constitutionality of the individual mandate and, with it, the entire Affordable Care Act (ACA). This post provides a brief update on the status of the case in the district court and the Fifth Circuit Court of Appeals, as well as some new positions taken by states in the lawsuit following the midterm elections. For now, the Texas litigation is on hold pending the end of the partial government shutdown, after which the case will proceed in the Fifth Circuit.
Last year, Canadians waited a median of almost 20 weeks to receive specialist treatment after being referred by a general practitioner, according to a new report from The Fraser Institute. In practical terms, that’s the equivalent of getting a referral this week and waiting until May for treatment.
Such waits are endemic to government-run healthcare systems.
Canada’s single-payer system, which prohibits private insurance for medically necessary procedures, is a prime example of the pitfalls of total government control. Twenty weeks of waiting is bad enough. But some areas in Canada fare even worse. The median wait for treatment from a specialist following referral from a GP in New Brunswick is nearly a year.
For several months, the Trump administration has been engaged in an internal debate over the merits of allowing states to partially expand Medicaid under the terms of the Affordable Care Act (ACA). Now, after losing the House to Democratic control (and thus also losing any opportunity to repeal and replace the ACA until at least 2021), the administration is said to be ready to make a decision in favor of allowing partial Medicaid expansion to proceed under state waiver requests.
In October, the Trump administration proposed a new rule that would expand the ways employers can use health reimbursement arrangements (HRAs) to provide their employees with high-quality, low-cost health coverage. The United States Department of the Treasury estimates that once the new rules go into effect, 800,000 employers will take advantage of HRAs, which could affect coverage for more than 10 million employees.
In the wake of Republicans failing to repeal and replace Obamacare and the Democratic takeover of the House, where will the health care debate go from here?
No important health care legislation will come out of this gridlocked Congress. But the run-up to the 2020 presidential campaign will produce at least a Democratic health care plan out of the nominating process.
The Trump administration is readying guidance that could let states remodel their Medicaid programs to more closely resemble block grant proposals favored by Republicans during their failed effort to repeal the Affordable Care Act, according to people familiar with the discussions.
States would still have to adhere to certain requirements but could get far more leeway in how they design their programs, likely in exchange for some type of cap on federal funding, the people said. The guidance would lay out how states could satisfy federal requirements to get waivers to pursue the changes, they said.
The primary concerns with this model include:
Restricted access to existing medicines: The 14 countries that the Centers for Medicare & Medicaid Services (CMS) has proposed referencing in this IPI model, on average, have access to only 48 percent of the new drugs developed in the past eight years, and it took an average of 16 months after their initial global launch for those drugs to become available in those 14 countries. If the United States adopts the prices of those countries, American patients may very well face the same access restrictions as exist in those countries and lose access to existing treatment options.
Federal law might be hard to change in Washington, but in some cases, states are able to take advantage of flexibility built into federal law to develop new programs and approaches. This is true under federal Medicaid law and it is also true under the ACA, which is why CMS recently stepped up efforts to support state-specific strategies to improve their individual health insurance markets and to develop alternatives to Obamacare that better meet the needs of their residents.
In her first speech as speaker of the House, Nancy Pelosi made it clear that she knows that health care is key to why voters sent Democrats to Congress.
“Tens of thousands of public events were held, hundreds of thousands of people turned out, millions of calls were made, countless families, even sick little children — our little lobbyists, our little lobbyists — bravely came forward to tell their stories and they made a big difference,” said Pelosi, a California Democrat.