Republican Senator Susan Collins criticizes secretive process of Senate health care replacement bill

The fact that there are regulations to protect people doesn't mean it is less market-based.

Some countries have a system where hospitals are owned and run by the government, and doctors and nurses are government employees. There are no medical bills to speak of, so no need for health insurance. Health care is simply provided by the government for free.

The term "market based" can be subjective in its definition. If you ask an ultra conservative to describe "market based", they will probably tell you "market based" is when you don't have government regulations and intrusions telling industries, companies, and businesses what they can or can't do. That refers to any industry, not just healthcare.

If republicans don't like (Medicare-for-all), they're definitely not going to like (VA-for-all).

I'm fine with (and in fact favor) government regulations in the marketplace to protect against abusive business practices.

a strengthened and successful Obamacare exchange where various plans have to compete against each other would be a pretty good system.

Are you opposed to the Obamacare protections/regulations?

Can you explain in what ways is it different from the current existing Obamacare? I ask the question, so that I can better understand what you are proposing.

Off hand though, I would suggest resuming subsidies, repairing the risk corridors, and in general undoing all the things that the Republicans did to sabotage Obamacare.

Beyond that, I'd say make the subsidies even stronger.

If there were a way to encourage not-for-profit insurers on the exchanges without being unduly unfair to for-profit insurers, I'd like that as well.

Although I am for all of those same things, I still believe that single-payer would ultimately be better.

I am not certain to what is a non-profit insurer.

I am not aware of such an insurer.

The rates of health insurance premium costs on the Obamacare exchanges are starting to trickle in from a few states, and early signs don’t bode well for “affordable” insurance. Democrats want to ensure Trump gets the blame.

Insurers in Virginia and Maryland recently announced they are seeking steep rate hikes on some of their Obamacare exchange plans. One company called CareFirst, which covers 15,000 people in Maryland, is proposing to raise rates by 91 percent, with premiums as high as $1,334 a month for a 40-year-old.

Senate Democrats have seized on this, and on Tuesday, they made it clear they are going to hammer the point home from now until the fall.

“When those rates go up, coverage goes down,” Senate Minority Leader Chuck Schumer told reporters Tuesday. “It’s important to remember, President Trump and congressional Republicans are fully responsible for the significantly higher premiums and millions fewer people insured.”

Other states are proposing increases that aren’t as substantial as CareFirst but will still pose a burden to people looking to get health insurance. In Virginia, rates could go up anywhere between 6.4 percent and 40 percent.

The premium increases are set to kick in October, exactly one month before the election. This could be really bad for Republicans; as the party in power, they now get blamed for everything. Plus, Trump and the GOP aren’t exactly hiding their attempts to destabilize the market. And many health insurers and policy experts agree: These rates likely wouldn’t have skyrocketed this year without the Trump administration’s meddling.

Obamacare premiums were stabilizing. Enter President Trump.

As Vox’s Dylan Scott has written about extensively, in spring 2017, rates on the Obamacare exchanges were starting to stabilize. Some insurance providers, such as UPMC Health Plan in Pennsylvania, said that while rates were going to increase, the increase would be in the single digits — about 8 percent.

Then Trump came in with the intent of making sure the system failed. He announced his administration would halt payments to health insurers, known as cost-sharing reduction subsidies, and drastically cut his administration’s budget for Obamacare outreach. The GOP repealed the individual mandate — the provision that requires every American to have insurance or pay a penalty — in its sweeping tax bill last year.

As a result, plans like UPMC are signaling their health insurance rates will likely be going up a lot more than 8 percent to compensate; rates are likely to increase upward of 40 percent. Georgia has said its premiums will be 57 percent higher than last year.

Democrats are using the words of Trump’s former top health and human services official against him; former HHS Secretary Tom Price recently said he believed axing the individual mandate would make people in the individual market sicker and drive up costs. Schumer pointed to Price’s words on Tuesday in the Senate Democrats’ press conference.

The Trump administration has repeatedly said it’s not doing any damage to the exchanges. Earlier this year, officials announced they would expand short-term insurance plans that don’t meet the ACA’s requirements, including plans that discriminate against preexisting health conditions or offer fewer services. (The conventional wisdom from the administration is that more young and healthier people would want to choose these plans.)

But as Scott reported in February, an analysis from the Urban Institute painted a bleak coverage picture with these plans available:

According to the analysis, nearly 9 million more Americans will lack minimal essential health coverage — uninsured, as far as the CBO is concerned — in 2019 and insurance premiums will increase by an average 16.4 percent across the country.

About 4.2 million would be covered by the non-ACA short-term plans — which can have annual or lifetime limits, which might cover fewer services, and which can discriminate based on health status.

The Trump administration is, in other words, overseeing a significant rollback of the historic coverage gains made under President Barack Obama and the ACA.

Insurance companies have between May 1 and July 31 to submit their proposed rates for state regulators to look at, and insurers have to let the federal government know whether they’re participating in the exchanges by September. Final rates will come out around October, right before the November midterms.

Trump and the GOP have shown every indication they’re going to try to blame this on Obama and the Democrats for passing the Affordable Care Act in the first place, but as the party in power, they’re likely to get a big share of the blame for not attempting to shore up the exchanges and further exacerbating the problem.

The ACA is fairly popular, and proposed premium hikes will come at a critical time

This is all happening right before November 2018, which should have Republicans very afraid. Democrats believe they can win based on health care; there is a very clear picture of Republicans try to repeal the Affordable Care Act in 2017, plus the Trump administration’s actions to destabilize the exchanges.

Now that they are out of power, Democrats are hammering home points about all the unpopular Republican policies and unveiling their own economic agenda before 2018. As Vox’s Matt Yglesias noted, it’s been hard for them to get airtime, as the country is consumed with endless Trump scandals.

Health care has already shown itself to be a powerful motivator in turning out Democrats in key special elections in Pennsylvania and Arizona. (Democrats won the former and closed margins in a Republican state in the latter.)

Per Scott:

At the macro level, Americans clearly trust Democrats more than Republicans on the issue. A Politico/Morning Consult poll from November found that 44 percent of voters trusted Democrats more, compared to 34 percent who trusted Republicans more. (USA Today and Suffolk found a similar breakdown: 43 percent trusted Democrats the most, 15 percent said they trusted Trump, and 10 percent trust Republicans in Congress — harsh numbers for the GOP any way you cut them.)

On top of that, the ACA — the Republican policy boogeyman for the past decade — has never been more popular than it is today, after withstanding a year of GOP attacks. So it should come as no surprise that Democrats are already landing substantial wins on health care in this cycle’s special elections thus far.

The Trump administration is quietly devising a plan bypassing Congress to give block grants to states for Medicaid, achieving a longstanding conservative dream of reining in spending on the health care safety net for the poor.

Three administration sources say the Trump administration is drawing up guidelines on what could be a major overhaul of Medicaid in some states. Instead of the traditional open-ended entitlement, states would get spending limits, along with more flexibility to run the low-income health program that serves nearly 75 million Americans, from poor children, to disabled people, to impoverished seniors in nursing homes.

Capping spending could mean fewer low-income people getting covered, or state-designated cutbacks in health benefits — although proponents of block grants argue that states would be able to spend the money smarter with fewer federal strings attached.

Aware of the political sensitivity, the administration has been deliberating and refining the plan for weeks, hoping to advance an idea that Republicans since the Reagan era have unsuccessfully championed in Congress against stiff opposition from Democrats and patient advocates. During the Obamacare repeal debate in 2017, Republican proposals to cap and shrink federal Medicaid spending helped galvanize public opposition, with projections showing millions would be forced off coverage.

In addition to potential legal obstacles presented by moving forward without Congress, the administration effort could face strong opposition from newly empowered House Democrats who've vowed to investigate the administration's health care moves.

The administration's plan remains a work in progress, and sources said the scope is still unclear. It's not yet known whether CMS would encourage states to seek strict block grants or softer spending caps, or if new limits could apply to all Medicaid populations — including nursing home patients — or just a smaller subset like working-age adults.

A spokesperson for CMS did not comment on the administration's plans but indicated support for the concept of block grants.

“We believe strongly in the important role that states play in fostering innovation in program design and financing,” the spokesperson said. “We also believe that only when states are held accountable to a defined budget — can the federal government finally end our practice of micromanaging every administrative process."

Republicans have sought to rein in Medicaid spending, especially as enrollment swelled under Obamacare’s expansion of the program to millions of low-income adults in recent years. CMS Administrator Seema Verma has warned increased spending on the Medicaid expansion population could force cutbacks on sicker, lower-income patients who rely on the program.

The administration wants to let states use waivers to reshape their Medicaid programs, but the effort could face legal challenges in the courts. Waivers approved by the Trump administration to allow the first-ever Medicaid work requirements for some enrollees, for example, are already being challenged in two states.

Also complicating the administration’s push: the newfound popularity of Medicaid, which has grown to cover about one in five Americans. Voters in three GOP-led states in November approved ballot measures to expand Medicaid, which has been adopted by about two-thirds of states. Newly elected Democratic governors in Kansas and Wisconsin are pushing their Republican-led legislatures to expand Medicaid this year.

Verma has been trying to insert block grant language into federal guidance for months but has encountered heave scrutiny from agency lawyers, two CMS staffers said. She mentioned interest in using her agency’s authority to pursue block grants during a meeting with state Medicaid directors in the fall but did not provide details, said two individuals who attended.

There is some precedent for the federal government capping its spending on the entitlement program. Former President George W. Bush's health department approved Medicaid spending caps in Rhode Island and Vermont that would have made the states responsible for all costs over defined limits. However, those spending caps were set so high there was never really any risk of the states blowing through them.

In recent years, governors have complained about the rising costs of Medicaid, which is eating up a bigger share of their budgets. States jointly finance the program with the federal government, which on average covers 60 percent of the cost – though the federal government typically shoulders more of the burden in poorer states. The federal government covers a much higher share of the cost for Medicaid enrollees covered by the Obamacare expansion.

An official from a conservative state, speaking on background to discuss an effort not yet public, said states would consider a block grant as long as the federal government's guidance isn't overly prescriptive.

CMS is hoping to make an announcement early this year, but it could be further delayed by legal review, which has already been slowed by the prolonged government shutdown.

Some conservative experts said the administration’s plans ultimately may be limited by Medicaid statute, which requires the federal government to match state costs. However, they say the federal government can still try to stem costs by approving program caps.

“There’s no direct provision of authority to waive the way that the federal government pays the states,” said Joe Antos of the American Enterprise Institute, a right-leaning think tank. “However, that doesn’t mean that you can’t try to have some of the effects that people that like block grants would like to see, in terms of encouraging states to be more prudent with the ways they spend the money.”