Happy Monday, all. It took one travel ban to wipe Obamacare out of the news, but that's about to change thanks to some high-profile hearings on replacement ideas and Tuesday's Senate Finance Committee's confirmation vote on Tom Price. And let's not forget the big cliffhanger: Will there still be a last-minute signup surge on Tuesday as Obamacare open enrollment ends?
Please keep me in the loop if there are other things that should be on our radar. And don't forget to check out the Axios health care news stream, like Axios on Facebook and follow us on Twitter, and sign up for our health care alerts.
Will Obamacare repeal get back on track?
This week gives Republicans a chance to try to recover from last week's stumbles, which included a GOP retreat that didn't produce any clear consensus on an Obamacare replacement plan — but did produce a leaked recording of everyone arguing about it behind closed doors. There was also the Trump administration's attempt to shut down Obamacare outreach, partially dialed back on Friday so it's limited to $4 million to $5 million in TV and radio ads. (The official HealthCare.gov Twitter account is back to tweeting reminders to sign up.)
Couple of things to watch this week:
Will piecemeal work? It's clear that the House, at least, is starting with a bunch of smaller Obamacare replacement bills, with crucial details they're still working out. That's certainly the case with pre-existing conditions (see below). Republicans are trying to shut down the talk that they don't have plans, but they don't have a ton of time to work out details if they want to meet their goal of a House vote by early March.
Will Obamacare enrollment recover? There won't be a total blackout of Obamacare outreach after all, but it's not clear how much that will help the signup effort. One way or another, open enrollment is ending under an administration that's hostile to the law. The message it sent by trying to stop outreach, according to Larry Levitt of the Kaiser Family Foundation, is that it "seems more intent on accelerating the demise of the health law than on running the program effectively and keeping insurance markets stable."
Here's how the House might cover pre-existing conditions
The House Energy and Commerce Committee is probably going to take the continuous-coverage approach, which means people with pre-existing conditions will be covered as long as they have kept themselves insured. Here's the discussion draft of their bill, which the committee will talk about at a hearing Thursday. It has all of the language about requiring the coverage from insurers, but the continuous-coverage language hasn't been written yet.
Committee aides tell me that part is likely to be introduced by Rep. Susan Brooks, but the details — like how long a person would have to stay insured — are still being worked out. Their goal is to find the right incentives for people to stay insured, and to mirror employer-based coverage as closely as possible. Also still being discussed: whether to prevent insurers from charging more to people with pre-existing conditions, not just require insurers to cover them.
Other bills the committee will talk about on Thursday:
- Letting insurers vary premiums by age at a 5 to 1 margin, rather than 3 to 1 under Obamacare.
- Verifying that people who sign up outside of open enrollment are eligible to do it.
- Setting the grace periods for paying premiums to match state laws.
While you were weekending: The travel ban
There's been a lot written about how President Trump's travel ban targeting seven majority-Muslim countries has affected the health care community. But the must-read story is from Charles Ornstein of ProPublica, about a Cleveland Clinic medical intern who was turned away in New York and forced to fly back to Saudi Arabia, where she had been visiting family. The doctor, Suha Abushamma, was targeted because she had a passport from Sudan.
As of Sunday, the only comment from the Cleveland Clinic was a statement saying, "We deeply care about all of our employees and are fully committed to the safe return of those who have been affected by this action." A spokeswoman tells me the clinic's leadership — including president and CEO Toby Cosgrove, who's a Trump adviser — will start figuring out next steps today. There's also a doctor at Brooklyn's Interfaith Medical Center who's stranded in Sudan.
Lots of health care CEOs and medical researchers were tweeting harsh words about the travel ban this weekend too, including the above tweet from Brent Saunders, Allergan's president and CEO.
The catch with health savings accounts
There's a dilemma with the likely Obamacare replacement plan that Republicans haven't really grappled with, so Caitlin Owens grapples with it for them in a story this morning. They've spent a lot of time criticizing all of the sky-high deductibles under Obamacare, which is true with a lot of the plans. But as part of the replacement, Republicans want to expand the use of health savings accounts — which are tied to health plans with sky-high deductibles.
That's not an accident, because they're designed to expose people to more of the costs of their health care, which is supposed to make them more cost-conscious. But President Trump doesn't want higher out-of-pocket costs, because that's his case against Obamacare. As he put it in his ABC interview last week, "It's too expensive. It's horrible health care. It doesn't cover what you have to cover." Read Caitlin's story here.
Why insurers are nervous about next year
Even before the Trump administration pulled back on Obamacare outreach, Bob Herman notes that health insurers were feeling jittery about what could happen to the marketplaces. Some could be ready to bail if the law is repealed, with or without a replacement. To understand why, check out this report from the Urban Institute and Robert Wood Johnson Foundation, where researchers interviewed executives at 13 insurers participating in the exchanges.
The most damage could come if Republicans torpedo the individual mandate while leaving the subsidies and ban on pre-existing conditions in place. "Pulling one leg out of the stool, we crash [individual market insurers] to the ground," one insurer said. The report also noted insurers have until September to back out of the individual market for 2018, and they will do so "if there is substantial writing on the wall."
And here come the AARP Medicare ads
House Speaker Paul Ryan has admitted that he and President Trump don't see eye-to-eye on Medicare, but AARP isn't taking any chances. It's launching a TV and digital ad campaign today that highlights the clip of presidential candidate Donald Trump promising to "protect and save your Social Security and your Medicare," ending with the message: "Now it's Congress' turn." It's a seven-figure national ad buy, including a turn on the Sunday talk shows this weekend.