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Trump v. California

In this corner: Health

For basic background, start with The weigh-in: Health

Family Planning
All talk, no action—yet
It's on!
On the ropes
California wins!
Trump wins!

A bill that would have allowed Californians to buy “pro-choice” license plates—designed as a small but symbolic rebuke to President Trump and congressional Republicans—has died in an Assembly fiscal committee.

The bill had sailed through the state Senate and an Assembly policy committee, but it was among dozens of bills the Assembly Appropriations Committee blocked as the Legislature heads into its final days of the session.

Senate Bill 309’s author, Democratic Sen. Hannah Beth Jackson of Santa Barbara, said she was disappointed. “I hope to continue pursuing this effort,” she said in a statement, “because I think it is an important statement and opportunity for Californians to express their strong support for women’s reproductive healthcare.”

Her legislation would have directed the California Department of Motor Vehicles to offer a “California Trusts Women” specialty license plate if 7,500 orders were placed.

Proposed pro-choice license plate

One proposed pro-choice license plate, featuring an image by Mimi Pond

Jackson wrote the bill so that the money raised would help fund the state’s Family Planning, Access, Care and Treatment program, which helps pay for services for $1.8 million low-income Californians. But bill came with a price tag: An analysis by the Assembly Appropriations Committee estimated it would cost the up to $590,000 to create the specialized license plate, including computer programming changes, new forms and administrative costs. The state would have been reimbursed by the fees Californians would have paid to get the plate.

Earlier this year, Trump and Congressional Republicans had targeted abortion providers in their unsuccessful rewrites of the Affordable Care Act, seeking to gut federal funding to any provider that offers abortions as part of its family planning services.

More than two dozen other states offer residents a “pro-life” license plate option—an idea that has not advanced in the California Legislature given that Democrats hold super-majorities in both chambers.

California’s Obamacare exchange, Covered California, is struggling to respond to uncertainty over whether the Trump administration will continue to support the health care program.

Not only is the exchange’s board increasing its marketing effort by $5 million, but it’s also going to allow insurers to make higher profits if they lose money due to uncertainty or changes in federal policy.

“The lack of clarity and direction at the federal level continues to be a challenge,” Peter Lee, executive director of Covered California, told California Healthline. “While we are doing our best to manage a difficult situation, we hope Congress and the administration will provide clear guidance on how (they intend) to stabilize the individual insurance market.”

Covered California is gearing up to begin open enrollment Nov. 1.

President Trump had threatened to withhold the August subsidy payments for insurers that low-income members rely on. Last week, the administration said it would pay the subsidies this month—but made no promises about the future.

The board was also set to finalized premiums for 2018 last week, but now it’s put off that decision for another month. Covered California has proposed an average increase of 12.5 percent and also considered an additional surcharge of 12.4 percent on silver plans if the administration does not keep its end of the bargain.

To reach consumers and make sure they re-up their insurance or sign up for the first time, Covered California will spend $111.5 million on marketing, including  and it will radio and television spots and direct mail.

Fear that the Trump administration would make good on the presidents threats to stop payments to insurers for Obamacare has subsided, for now, after a spokesman said all August payments would be made.

The payments go to insurers to cover subsidies and out-of-pocket expenses for people enrolled in medical insurance through the Affordable Care Act.

It is estimated that the federal government will pay about $7 billion in 2017 and cover about 6 million people enrolled in the program. The funds go toward compensating insurers for providing insurance to low and moderate-income Americans and providing discounts that include co-payments and deductibles as mandated by the act. By the end of last year, 1.4 million Californians were enrolled in private insurance through Covered California, the state’s exchange that administers the Affordable Care Act.  Of those, nearly 89 percent receive federal subsidies.

The announcement is expected to help bring some stability to the markets, but experts note that the long-term prognosis is still up in the air. It’s unclear if the administration will enforce the requirement that all Americans purchase health insurance or face a fine.

Photo via Flickr

According to the Congressional Budget Office, health care insurance premiums for many Americans using Obamacare would increase 20 percent if President Trump cuts off insurer payments. Last month Trump tweeted: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

Critics of administration’s approach say Trump must commit to the program.

“This cat-and-mouse game every month has to stop,” Leslie Dach, director of the Obamacare advocacy group Protect Our Care Campaign, told CNBC. “As the nonpartisan CBO and Kaiser Family Foundation concluded in recent reports, just the threat of not making these payments has caused insurers to jack up prices next year and has injected uncertainty into the market for consumers and insurers alike.”

After the announcement that this month’s subsidies will be paid, Tennessee Republican Sen. Lamar Alexander said Congress should act to ensure that the funds will be paid through next year.

Following the Senate GOP’s dramatic late-night failure to repeal and/or replace the Affordable Care Act last week, President Trump has floated a familiar Plan B to simply “let Obamacare fail.”

Today California officials responded: “We’ll see you in court.”

This afternoon, state Attorney General Xavier Becerra joined a lawsuit against the federal government, demanding that the Trump administration commit to reimbursing insurance companies that offer plans with reduced copays and deductibles to low-income Americans under the Affordable Care Act. California joins 14 other states and the District of Columbia in the lawsuit.A health worker takes a patient's blood pressure.

Not to be outdone, California Insurance Commissioner Dave Jones also threatened to take the Trump administration to court over the subsidies. “If President Trump continues to insist on not making the cost sharing reduction payments, then I will sue the administration on behalf of consumers in the state of California,” he said at a press conference today. Jones, whose office regulates the state’s insurance markets, also announced that he had allowed health insurance companies to submit two proposed premium hikes for 2018—one with and one without the federal subsidy.

Average rates without the payment were 12.4 percent higher.

“California is not immune to the actions the president has taken destabilizing health insurance markets and we’ve seen that in the filings that have been made public today,” Jones said.

Under the Affordable Care Act, low-income Californians who are not covered by their employer or through Medicaid and who purchase mid-level “silver” plans are eligible for reduced copays and deductibles. The federal government compensates insurance companies for providing these discounts—a reimbursement estimated to cost federal taxpayers $7 billion this year.

In 2014, the House of Representatives sued the Obama Administration for making these payments without specific Congressional authorization. But as California joins this case, currently before the District of Columbia Circuit Court of Appeals, the President is also threatening to simply cut off the payments unilaterally.

Donald J. Trump on Twitter

If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!

Without the federal reimbursement, health market analysts predict that insurance companies would pull out of certain individual insurance marketplaces and raise premiums to make up the cost. The Kaiser Family Foundation, a non-partisan health policy organization based in the Bay Area, estimates that ending reimbursements would increase premiums for affected plans by 19 percent. And because Obamacare premium subsidies are tied to market rates, the foundation estimates that the policy shift would also lead to higher overall federal spending.

President Trump has argued that allowing the Affordable Care Act insurance markets to fail—and in this case, providing a helpful nudge—will force both Democrats and Republicans to negotiate a comprehensive repeal of the controversial health care program. “The subsidies must be eliminated to incentivize members of Congress to keep their promise and repeal Obamacare,” Arizona Congressman Andy Biggs said today.

On Sunday, White House counselor Kellyanne Conway told Fox News that Trump would decide on whether to carry out the payments “this week.”

Proponents of single payer healthcare in California are strategizing about what do next after the speaker of the Assembly shelved the bill, saying it lacked critical details such as how it would be funded.

“It didn’t make any sense,” said Speaker Anthony Rendon, a Democrat from Paramount. “I hope the Senate takes this chance to take the bill more seriously than they did before.”

The single-payer effort had garnered a lot of attention. Supporters hailed it as an aggressive way for California to get proactive about health care before the federal government could repeal the Affordable Care Act, popularly known as Obamacare, and replace it with a less generous Trumpcare alternative. Today the GOP-dominated U.S. Senate announced it was delaying a vote on its version until after the July 4th holiday next week.

“It was downright silly for the California Senate to approve SB 562 without an explanation of how its estimated $400 billion annual price tag—triple the state’s general-fund budget—would be covered in a way that wouldn’t hammer taxpayers and the state economy,” the San Diego Union-Tribun” wrote in an editorial.

California senators had approved the single payer bill after assurances by its Democratic authors, Los Angeles Sen. Ricardo Lara and San Diego Sen. Toni Atkins, that they would come back to them with a funding plan. That wasn’t enough for Rendon, who called the bill more of a “values” move than real public policy.

Lara and Atkins have promised to unite with supporters, including the politically potent California Nurses Association, and “do whatever it takes to stop this assault on the American people.”

“We are disappointed that the robust debate about healthcare for all that started in the California Senate will not continue in the Assembly this year. This issue is not going away, and millions of Californians are counting on their elected leaders to protect the health of their families and communities,” they said in a joint statement.

Their bill would have pooled health care money, including Medicare and Medicaid dollars, into a state fund to cover health care for all Californians. It was intended to take the place of co-pays, deductible, and premiums.

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