Nov 22, 2017

Axios Vitals

Good morning … Vitals will be off the rest of this week. Console yourselves with some stuffing and mashed potatoes, and I'll see you again Monday. Happy Thanksgiving.

Higher premiums would cancel out some people's tax cuts

The Senate's proposed tax overhaul would repeal the Affordable Care Act's individual mandate permanently, and provide individual tax cuts temporarily.

Once those tax cuts expire, just about everyone on the individual insurance market will face higher health insurance costs without a tax cut to help pay for it. And even in the short term, some people's tax cuts would effectively be erased by the higher premiums they'd face without the individual mandate.

Threat level: As my colleague Caitlin Owens reports this morning, based on an analysis from the Commonwealth Fund, the biggest burden here would fall on people who buy insurance on their own, but don't get subsidies to help cover their premiums.

  • Those subsidies help insulate low-income consumers from premium hikes, but the people who don't get them will be on the hook for all of the added costs that come with repealing the individual mandate — and that would eat up a lot of the extra money they'd be keeping because of the bill's tax cuts.
​Many families can't afford even moderate deductibles

A lot of low-income families can't afford even a moderate deductible, yet deductibles continue to rise in almost all forms of insurance, Kaiser Family Foundation president Drew Altman writes in his latest Axios column.

  • Roughly 40% of all non-elderly households don't have enough liquid assets to cover a high deductible ($3,000 for an individual or $6,000 for a family).
  • Among families whose income makes them eligible for the ACA's premium subsidies, 60% don't have enough liquid assets to cover a high deductible and 44% couldn't cover the deductible for a mid-range plan ($1,500 for an individual or $3,000 for a family).

Why it matters: High deductibles are everywhere, and they're only getting higher. Many ACA plans have relatively big deductibles and Republicans' alternatives would push them higher. They've been getting bigger and bigger in employer plans, too.

  • "For many families, even if they have insurance, any significant illness could wipe out all their savings, making impossible to fix a broken car to get to work, or pay for school, or make a rent or mortgage payment," Altman says.
​Medicaid and CHIP now cover almost 75 million people

Enrollment in Medicaid and the Children's Health Insurance Program is up nearly 30% under the ACA, according to new data from the Centers for Medicare & Medicaid Services. The two programs now cover almost 75 million people — about 16 million more than they covered in 2013, before the ACA's coverage expansion took effect.

Between the lines: The ACA's Medicaid expansion is part of the equation here, but not the whole story.

  • Total enrollment has risen by 38% in expansion states and 12% in non-expansion states.
  • That's largely due to Medicaid's "woodworking" effect: All the attention in prior years surrounding open enrollment and Medicaid expansion has prompted people who were already eligible for the program, but had never signed up, to explore their options.

Quick take: This is a big part of the reason repeal-and-replace is so difficult politically. Republicans' proposals not only would have ended the Medicaid expansion, but made deep cuts to the underlying program. That's always going to end up costing a lot of people their health care coverage — and that's always going to make at least some lawmakers nervous.

​Mulvaney's face time with the health care industry

Mick Mulvaney, the director of the Office of Management and Budget, holds a lot of power when it comes to federal regulations. And the health care industry certainly has his ear, based on meeting records obtained by ProPublica and the transparency advocacy group Property of the People.

Here are just some of the health care executives Mulvaney has met with since he started earlier this year:

  • Blue Cross Blue Shield Association CEO Scott Serota (several times)
  • UnitedHealth Group CEO Stephen Hemsley
  • CVS Health CEO Larry Merlo
  • Mylan CEO Heather Bresch
  • NantHealth CEO Patrick Soon-Shiong
  • Independence Blue Cross CEO Dan Hilferty
  • PhRMA's board of directors

Go deeper: Mulvaney met with two CEOs of large home health companies the week before Medicare released a favorable rule for the home health industry.

Be smart: There's nothing inherently scandalous about regulatory officials meeting with the industries their regulations affect. But that's why the Obama administration had made these visitor records public: to give the public at least some sense of who had a seat at the table.

​1 Thanksgiving thing: Turkey doesn't make you sleepy

Everyone loves a smartypants at Thanksgiving, so when your relatives claim they're tired from all that turkey — it's the tryptophan! — let them know that they are WRONG.

It wouldn't be Thanksgiving without re-upping health economist Aaron Carroll's definitive tryptophan takedown. The gist:

  • Turkey doesn't have that much tryptophan.
  • Tryptophan is hard to absorb on a full stomach.
  • If you're tired after Thanksgiving dinner, it's probably because of you just ate an enormous quantity of food, and/or drank a lot of wine (and/or physically exhausted yourself trying to change the subject away from politics).

Antagonize your friends and family: Make them watch Carroll's explainer on your tiny smartphone screen when all they want to do is take a nap.

Happy Thanksgiving! Let me know what you'll be watching next week: