Who could lose from state health benefit limits

David Nather
Jun 15

Featured

Who could lose from state health benefit limits

The Senate health care bill is expected to allow states to relax the Affordable Care Act rules only on benefits, not on pricing as the House bill does. But that change could impact people far beyond those states, according to a new analysis by the liberal Center for American Progress — because it could lead to a return of annual and lifetime benefit limits, and not just in the states with the waivers.

The bottom line: As many as 27 million Americans could face annual limits on their coverage, and 20 million could be hit with lifetime limits, according to the analysis.

Keep reading ... words

Data: CAP analysis, 2015 American Community Survey, Centers for Medicare & Medicaid Services, 2017 Willis Towers Watson Survey; Table: Andrew Witherspoon / Axios

Why it could happen: The Affordable Care Act bans lifetime and annual limits, but only for the 10 categories of "essential health benefits" defined in the law. If a state decides that, say, prescription drugs or maternity care aren't essential benefits anymore, insurers can bring back annual and lifetime limits for them.

Why it could spread beyond those states: Large employers that operate in several states can choose which state they want to use as the basis for their benefits. So if an employer operates in 15 states, and one of them has a waiver from ACA benefit rules, it can set all of its benefits based on that state.

How the study was done: CAP based its estimates on a Willis Towers Watson survey of large employers, in which 20 percent said they'd bring back annual limits and 15 percent said they'd bring back lifetime limits if the ACA rules were repealed. It also used survey data suggesting how many people get their health insurance from large employers.

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Jonathan Swan
2 hrs ago

Featured

Trumpworld's push to get a Senate health deal

Evan Vucci / AP

Everyone is making calls — based on calculations of who's got the most leverage with certain senators down to personal relationships. President Trump, Vice President Pence, Senate Majority Leader McConnell, and officials including White House Legislative Affairs director Mark Short and Chief of Staff Reince Priebus are working the phones.

On Tuesday night the Vice President hosted a small group of very conservative senators for dinner at his residence. Mike Lee, Pat Toomey, Tom Cotton, and Ben Sasse were there. I asked a source familiar with the dinner why Toomey was there given he supported the bill, and the source told me it was wise to bring together colleagues of a similar ideological persuasion who'd come to different conclusions about the health bill.

At the Capitol, Axios' David Nather and Caitlin Owens hear only pessimism. At the White House, we hear a more optimistic read.

Nobody I've spoken to is confident about getting anything sorted by Friday. They view the real deadline as the next recess.

Mitch McConnell is in the offer-making phase. In crude terms: he's got a couple hundred billion dollars to play with and he's trying to buy off moderate Republican senators with money to fight Opioid addiction and to help out vulnerable constituents affected by the new health care plan.
The way the White House is thinking about the path to success remains the same: short-term money for moderates and long-term reforms for conservatives.
There are plenty of doomsayers, but on the inside — both inside the administration and in senior Senate offices — I'm finding a number of officials who've been skeptical all along are now quietly predicting it's going to happen.
Best encapsulation of the White Hat (optimist) thinking, from an administration source: "I think we're going to pass this. I really think they'll bribe off the moderates with opioid money and then actually move policy to shore up Mike Lee and Ted Cruz. ... If it was going to fail, McConnell would've put it on the floor. He wants people on the record — put up or shut up. He would've said: 'F--- it, let's fail now and move onto tax reform.' ... Now he's going to eat up another two weeks of floor time. He's not going to waste those weeks unless he thinks he can do this."
Best encapsulation of the Black Hat (pessimist) thinking, from a Republican close to Senate leadership: "I think the gap is too wide and they are getting zero help from POTUS."

Bottom line, from same source: "Unpopular presidents pushing unpopular proposals usually fail."

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Mike Allen
2 hrs ago

Featured

Not normal: Trump attacks half dozen companies in half a day

Alex Brandon / AP

We can't remind you, or ourselves, often enough of the through-the-looking-glass weirdness of events that cascade over us all day, every day. (Today is Day 161 of President Trump, with 1,302 left in this term).

This tweet by the president yesterday — combined with the previous day's "fake news" barrage against CNN, "the failing @nytimes & @washingtonpost," NBC, CBS and ABC — adds up to the most dangerous denigration of media since ... Nixon? Did Nixon attack six great news organizations by name in 24 hours?

A friend of ours said: "This is dictator-with-mirrored-sunglasses stuff."

Keep reading ... words

It's not normal.

The blast at Post owner (and Amazon founder Jeff Bezos) may have been prompted by a front-page story, "Unafraid of Trump, senators feel free to 'go their own way,'" that includes the line: "In private conversations on Capitol Hill, Trump is often not taken seriously."

In Brian Stelter's "Reliable Sources" newsletter last night, he pointed out: "In the past 24 hours... The White House told reporters they could cover Trump's first re-election fundraiser, but then made an abrupt change, 'closing the event to media in a break from past precedent' ... The W.H. prohibited TV cameras at the daily press briefing ... The president posted James O'Keefe's anti-CNN videos on his official @realDonaldTrump Instagram page, promoting the videos to millions of followers."

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Caitlin Owens
5 hrs ago

Featured

How the Senate health bill would change Medicaid funding

The Senate health care bill would substantially reduce federal funding for all Medicaid beneficiary groups over the next two decades compared to current law, according to an analysis by Avalere, a health care consulting firm.

Why this matters: The funding cuts could encourage states to cut benefits for enrollees, payments to providers or eligibility for the program. It also saves the federal government $772 billion over 10 years, and likely much more over 20 years.

Data: Avalere Health analysis; Note: Adult age cutoff defined by state, ranging from 19-21. Seniors are 65+; Chart: Andrew Witherspoon / Axios

What the bill does

What the bill does:

Phases out enhanced federal funding for the Affordable Care Act's Medicaid expansion.
Caps the amount of federal funding per Medicaid enrollee. This cap grows with medical inflation beginning in 2020, but in 2025 the growth rate slows to inflation, which is tighter and causes most of the steep reductions.

Go deeper: How the Senate health bill would change insurance premiums, broken down by location, age and income.

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Alayna Treene
38 mins ago

Featured

Trump gets personal with new attacks on Morning Joe hosts

President Trump's Twitter attacks got personal Thursday morning when he went after Morning Joe hosts and engaged couple Joe Scarborough and Mika Brzezinski — his old friends:

"I heard poorly rated @Morning_Joespeaks badly of me (don't watch anymore). Then how come low I.Q. Crazy Mika, along with Psycho Joe, came... to Mar-a-Lago 3 nights in a row around New Year's Eve, and insisted on joining me. She was bleeding badly from a face-lift. I said no!"

Flashback: When Joe and Mika broke the news of their engagement in a Vanity Fair interview last month, they revealed that Trump — over lunch with the couple, as well as Ivanka and Jared Kushner — offered to officiate their wedding, and recommended they hold the ceremony at Mar-a-Lago or the White House. Mika told Vanity Fair, "If it weren't Trump, it might be something to think about."

Stef W. Kight
48 mins ago

Featured

Reports: Trump routinely confuses Medicaid and Medicare

Evan Vucci / AP

A Republican Senator told the New York Times on Tuesday that President Trump gave the impression that he "did not have a grasp of some basic elements of the Senate plan" and that he was "especially confused" by the idea of opponents calling the bill "a massive tax break for the wealthy." More aides described Trump as uninterested in the particulars of health care.

"There would be times when he would describe what was clearly Medicare...but say Medicaid, and when we pointed that out, he would say, 'That's what I said, Medicare and Medicaid."

More fire quotes ... words

When asked if Trump had an understanding of the important aspects of the House and Senate health care bills, a close aide laughed and replied, "not to my knowledge."
"The president understands winning," a different official said.
Aides don't point out Trump's misunderstandings, not wanting to make him feel or look "dumb."
On Trump's campaign promises about repealing and replacing Obamacare, a former campaign aide said, "It wasn't really a policy oriented campaign—policy wasn't on our radar. The sense was, say what wins and figure out the details later."
Just as his intelligence briefings have been cut short compared to those of Obama, an official told the Daily Beast, "It is fair to say the president takes [a] similar approach to health care... [It's] 'less is more.'"

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Christopher Matthews
1 hr ago

Featured

Even Nike can't resist the Amazon revolution

Michael Noble Jr / AP

Sportswear giant Nike announced an agreement earlier this month to sell its products directly through Amazon.com, despite resisting the online retailer's entreaties for more than a decade.

The Wall Street Journal reports the decision was made after third-party sellers offering Nike products began to proliferate on the site, loosening the firm's control over pricing and distribution. Nike can't stop third-party sellers from reselling lawfully-purchased product, and following the liquidation of bankrupt Sports Authority's inventory last year, the market was flooded with Nike product that could be resold at deep discounts. Nike therefore decided to strike a deal to sell its products on Amazon in exchange for its help in stopping unauthorized third-party sales.

Why it matters: When consumers want to buy any type of product, be it electronics or apparel, an increasing share think of Amazon first.

Kia Kokalitcheva
1 hr ago

Featured

Ex-Binary Capital employee sues for alleged harassment

Binary Capital website

A female former employee at Binary Capital alleges that the VC firm tried to silence her after she quit, including alleged threats to withhold her share of the profits from successful investments (i.e., carried interest), according to a lawsuit filed in San Mateo Superior Court on Thursday.

The details: The former employee, Ann Lai, says that Binary Capital's culture was sexist, including commentary about sexual encounters, women's bodies, and inappropriate behavior toward female staff. After she resigned in May 2016, Binary Capital partner Justin Caldbeck allegedly threatened her ability to find work if she disclosed anything about her time at the firm. She quickly lost out on multiple jobs because of the firm's statements about her and her performance.

Read the lawsuit

Piling on: Lai's complaint comes a week after a report from The Information revealed that Caldbeck had been sexually harassing some female startup founders. Since then, it's also been revealed that apparel startup Stitch Fix requested in 2013 that Calbeck, at the time working for Lightspeed Venture Partners, be removed from its board after he harassed the startup's founder, though she was forced to signed a non-disparagement agreement about the situation. Over the last few days, both Caldbeck and his partner, Jonathan Teo have effectively resigned, and Binary is expected to be wound down.

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Shannon Vavra
2 hrs ago

Featured

Mining by machine: Automation hits coal industry

Anupam Nath / AP

If you want to work in coal, forget using a shovel. As Bloomberg's Tim Loh writes: "Coal…executives are starting to search for workers who can crunch gigabytes of data or use a joystick to maneuver mining vehicles hundreds of miles away."

The coal industry's workforce composition is increasingly going to be skilled workers, and overall hiring is likely to dip. As Heath Lovell, a spokesman for coal producer Alliance Resource Partners LP, puts it: "Whether coal comes back or not is not necessarily directly related to jobs," since as tech makes the industry more efficient it will be able to produce the same amount with fewer employees.

Impacts ... words

To get a sense of how successful the coal industry is going forward, look to production levels, not hiring. Remaining competitive, particularly with natural gas, likely means cutting labor.
The tech now: The machines that are likely to displace workers in the next 10 to 15 years include the longwall machine (which cuts coal in mile-long strips without many employees), joysticks to mine by remote control (with the help of videos, sensors, and positioning software), autonomous haul loaders, autonomous trucks, autonomous long-haul trains, semi-autonomous crushers and more. Read more, via the International Institute for Sustainable Development.
Likely Impacts: Accenture predicted in 2010 that employing autonomous tech in open pit mines would reduce employment by 75%. Miners, drivers, and maintainers will see more layoffs, per ComputerWorld. It is also likely that the introduction of automation will reduce fuel consumption and spending but also lost tax revenue, IISD claims.

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Axios
2 hrs ago

Featured

The iPhone went on sale 10 years ago today

Sergey Ponomarev / AP

The Economist: "No product in recent history has changed people's lives more. Without the iPhone, ride-hailing, photo-sharing, instant messaging and other essentials of modern life would be less widespread. Shorn of cumulative sales of 1.2bn devices and revenues of $1trn, Apple would not hold the crown of the world's largest listed company. Thousands of software developers would be poorer, too: the apps they have written for the smartphone make them more than $20bn annually."

The next decade: "[T]he era of stand-alone electronic devices, however slick, is coming to an end. They will increasingly become a vehicle for — and be subsidized by — services based on machine learning and other artificial-intelligence techniques. The quality of these offerings will in turn largely depend on how much data developers have access to... Although Apple's Siri was one of the first digital assistants, Google's and Amazon's offerings are now much smarter."

Jonathan Swan
2 hrs ago

Featured

The story behind Trump's Medicaid tweet

On Wednesday afternoon, President Trump tweeted a graph from his personal account showing Medicaid spending under the Republican Senate health bill.

There's a story behind that tweet: In the Oval Office on Wednesday, Marc Short, the White House Legislative Affairs director, showed Trump a piece of paper with the graph of Medicaid spending pointing up. Trump wanted to tweet it, according to a source told about the meeting.

Why it matters: The graph doesn't show the other side of the Medicaid changes: the fact that spending would go down compared to current law, which is how Senate Republicans get $772 billion in savings. That's the whole point of the new spending limits.

The strategy ... words

This is all part of a broader White House strategy: They want to change the way it's presented in the media to help sway some of the Senate Republican holdouts.

For the longest time, Republicans in all branches of government failed to frame the argument over Medicaid in terms of the Medicaid dollars going up. Some in the administration had concluded it was an argument they couldn't win. But a number of officials saw they were getting killed every day in the press, with reports of the billions being cut out of Medicaid. Some officials wanted to aggressively reframe the argument as a growth in spending — and a slowing of the growth rate under Obamacare rather than a raw "cut."
Even at this late stage, the White House believes it's crucial to change the media narrative. A number of officials believe that some crucial senators are more heavily swayed by media coverage than they are by the substance of the cuts to the Medicaid spending under the Affordable Care Act.

HHS Secretary Tom Price has been making this argument, and tweeted a similar graph of Medicaid spending on Tuesday:

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Mike Allen
2 hrs ago

Featured

Stop going to the White House press briefings

With all the legitimate gripes reporters have with this White House, perhaps the least worthy of your (or their) time and attention is the WWE-style smackdown over briefings. Every day, the White House hides or dodges. Every day, reporters protest and whine.

Here's an idea: Quit going.

Keep reading ... words

Even if the spokespeople were fully looped in, appeared on camera, and shot straight, what would you miss by blowing it off? There are transcripts and this thing called Twitter, where the rare newsy nugget will quickly appear.
Truth is, with cable and the internet, the briefings were pretty useless, even pre-Trump. Government officials are paid to make little news, and spin the best take they can. It's low-grade propaganda at best, and full-blown B.S. at worst.
You're wasting time in your day you'll never get back. For a White House reporter who doesn't work in the building, it can take a good chunk of the workday to get to the briefing, sit through it, then complain about it afterward.
Work plugged-in sources instead. It's not as if this White House is a watertight ship: Aides are remarkably candid about the hour-by-hour intrigue, infighting and strategizing.

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David Nather
2 hrs ago

Featured

No one came out of yesterday's Senate GOP meeting sounding hopeful

David J. Phillip / AP

Senate Republicans spent a whole lot of time talking about the health care bill yesterday, but not a whole lot of time reaching any deals. That makes it harder to see how they could get an agreement by Friday on a revised bill.

It didn't help when Sen. Ted Cruz said he wants to let insurers sell plans that don't have any protections for pre-existing conditions — as long as they also sell plans with that offer those protections and follow the Affordable Care Act's other insurance rules.

What we're hearing from the WH ... words

Reaction to Cruz's comment:

One Senate GOP aide told Caitlin Owens that many of the Republican senators were "surprised and pissed" because most Republican senators had already agreed not to touch the ACA's pre-existing condition protections.
Another aide summed up: "No matter how narrowly-proposed, wading into pre-ex is not just a 'No,' it's a 'Hell No' for the vast majority of the Senate GOP."
A Cruz spokesman, however, said the senator has been talking for weeks about the idea, which is part of a proposal to give consumers a choice between health plans that meet all of the ACA rules and plans that don't. He's been handing out a card that includes that pitch.

No one came out of yesterday's Senate GOP meeting sounding hopeful.

Sen. Susan Collins: "It's very difficult...I'm concerned about a number of aspects, such as coverage, Medicaid cuts, impact on premiums."
Sen. Shelley Moore Capito: "I'd like to see a [Medicaid] growth rate that matches the projected growth, or at least is close to projected growth." She also wants $45 billion in opioid treatment money over 10 years.
Sen. Rob Portman: "I'd rather see us stick to the [Medicaid] growth rates that were worked out by the House."
Sen. Rand Paul: Any tradeoff that gives more money to moderates and more deregulation to conservatives "sounds to me like a Washington deal...I'm not going to go for that."

Most of the optimism is coming from the White House. Here's how an administration source summed up the mood to Jonathan Swan last night: "I think we're going to pass this. I really think they'll bribe off the moderates with Opioid money and then actually move policy to shore up Mike Lee and Ted Cruz."

This is how it's going: Even Sen. John McCain, who hasn't been one of the most vocal holdouts, says he's not ready to vote for the bill. Since he's from Arizona, which expanded Medicaid, he wants to offer three Medicaid amendments that he's worked out with Gov. Doug Ducey.

"That has a lot to do with whether I support the bill or not," McCain told reporters as he stepped into an elevator. When asked what the amendments were, he motioned to the elevator operator to hit the button: "Basement!"

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Dan Primack
2 hrs ago

Featured

Staples being bought for $6.9 billion

Mark Lennihan / AP

Private equity firm Sycamore Partners has agreed to acquire office retailer Staples for $6.9 billion, or $10.25 per share. The move comes around one year after federal regulators prevented Staples from acquiring rival Office Depot, which soon was followed by Staples naming Shira Goodman as its new CEO. Goodman is expected to remain in place after the buyout is completed later this year.

Price talk: The $10.25 per share is higher than Staples has traded for most of the past two years, but well below its late 2014 high of $17.98 per share.

What to know: Staples is known for its bricks-and-mortar stores, but that's not necessarily where Sycamore's interest lies. Per Reuters: "Sycamore will be organizing Staples along three lines: its stronger delivery business, its weaker retail business and its business in Canada, two sources familiar with the deal said. This structure will give Sycamore the option to shed Staples' retail business in the future." Also don't be shocked if Sycamore at some point tries to revive the Staples-Office Depot merger concept, particularly now that a new Administration is in place.

Data: Money.net; Chart: Axios Visuals