Tag Archives: Healthcare

Obamacare repeal on the ropes as pivotal Republican rebuffs Trump

U.S. Senator John McCain (R-AZ) (C) departs after the weekly Republican caucus policy luncheon at the U.S. Capitol in Washington, U.S. September 19, 2017. REUTERS/Jonathan Ernst

By Susan Cornwell and Yasmeen Abutaleb

WASHINGTON (Reuters) – U.S. Senator Susan Collins rebuffed intense lobbying from fellow Republicans and the promise of money for her state in deciding on Monday to oppose – and likely doom – her party’s last-ditch effort to repeal Obamacare.

The most moderate of Republican senators joined John McCain and Rand Paul in rejecting the bill to end Obamacare. It was a major blow for President Donald Trump who has made undoing Democratic former President Barack Obama’s signature healthcare law a top priority since the 2016 campaign and who pressured Collins in a call on Monday.

The bill’s sweeping cut in funding to Medicaid, a program for low income citizens and disabled children, was her top reason for opposing the bill, said Collins, from the state of Maine where 20 percent of the population depend on the program.

“To take a program that has been law for more than 50 years, and make those kinds of fundamental structural changes … and to do so without having in depth hearings to evaluate the impact on our most vulnerable citizens was unacceptable,” Collins said outside the Senate chambers.

She also opposed the bill for weakening protections for people with pre-existing conditions, such as asthma, cancer and diabetes.

Collins’ decision came even after the sponsors of the bill, Senators Lindsey Graham and Bill Cassidy, offered a boost in federal health care funds of 43 percent for Maine and benefits for states with other undecided senators.

Republicans have vowed to get rid of the Affordable Care Act, or Obamacare, since it was passed in 2010. While it extended health insurance to some 20 million Americans, they believe it is an unwarranted and costly government intrusion into healthcare, while also opposing taxes it imposed on the wealthy.

Republicans hold a slim 52-48 majority in the Senate and are up against a tight September 30 deadline to pass a bill with a simple majority, instead of the 60-vote threshold needed for most measures. Senate Majority Leader Mitch McConnell wanted to hold a vote this week, but it is not clear he will do so now that three senators have said they will cast “no” votes.

Graham dismissed notions that the bill was the last chance for Republicans to get rid of Obamacare and pledged to keep working on the legislation.

$1 TRILLION CUT TO MEDICAID

Democrats kept up their pressure for killing the bill. In an evening speech on the Senate floor, Senate Democratic leader Chuck Schumer said, “The Trumpcare bill would gut Medicaid, would cause millions to lose coverage, cause chaos in the marketplace.”

Schumer said once repeal of Obamacare is off the table, Democrats want to work with Republicans “to find a compromise that stabilizes markets, that lowers premiums.”

Collins and McCain, who voted against the last major repeal effort in July, have both advocated for a bipartisan solution to fixing the parts of Obamacare that do not function well.

U.S. hospital stocks were down across the board as the bill struggled. Shares of HCA Healthcare Inc and Tenet Healthcare Corp were hit particularly hard, falling 2.5 percent and 5.7 percent, respectively, on Monday.

“The Graham-Cassidy bill is looking to reduce funding for Medicaid in the longer term,” said Jefferies analyst Brian Tanquilut. “That is a benefit that we have seen improve the earnings outlooks for these hospitals.”

Collins announced her opposition shortly after the non-partisan Congressional Budget Office said that the number of people with health insurance covering high-cost medical events would be slashed by millions if it were to become law.

CBO also found that federal spending on Medicaid would be cut by about $1 trillion from 2017 to 2026 under the Graham-Cassidy proposal, and that millions of people would lose their coverage in the program, mainly from a repeal of federal funding for Obamacare’s Medicaid expansion.

The Trump administration, including Health Secretary Tom Price had lobbied her hard in recent days, Collins said.

“The president called me today, the vice president called me in Maine over the weekend, Secretary Price has called me, it would probably be a shorter list of who hasn’t called me about this bill,” she said.

Trump had not called Collins before the vote in July.

PROTESTERS IN WHEELCHAIRS

The Senate held its first hearing all year on the proposed Obamacare repeal on Monday, but it was immediately disrupted by protesters who forced Senate Finance Committee Chairman Orrin Hatch to postpone its start by about 15 minutes.

Police arrested 181 demonstrators, including 15 in the hearing room. The protesters, mainly from a disability rights group and many of whom were in wheelchairs, were forcibly removed one-by-one from the hearing room as they yelled, “No cuts to Medicaid, save our liberty.” The hearing eventually proceeded for about five hours, but protests could be heard outside for more than an hour.

Television talk show host Jimmy Kimmel, who had become part of the debate on U.S. healthcare legislation in May after discussing his newborn son’s heart surgery, had taken aim at the bill in recent days. On Monday he tweeted: “Thank you @SenatorCollins for putting people ahead of party. We are all in your debt.”

A new CBS poll released on Monday said that a majority of Americans, or 52 percent, disapprove of the Graham-Cassidy bill, while 20 percent approve. The poll was taken between Sept. 21 and 24.

(Reporting by Susan Cornwell and Richard Cowan; Additional reporting by Timothy Gardner, Philip Stewart, Makini Brice, Amanda Becker and Alistair Bell in Washington and Caroline Humer in New York; writing by Timothy Gardner; Editing by Bill Trott and Mary Milliken)

Anthem cuts back Obamacare coverage in Missouri to 68 counties

FILE PHOTO: The office building of health insurer Anthem in seen in Los Angeles, California February 5, 2015. REUTERS/Gus Ruelas

NEW YORK (Reuters) – U.S. health insurer Anthem Inc said on Friday that it will no longer offer Obamacare plans in 17 counties in Missouri but will remain in the bulk of the state, covering 68 counties that would not otherwise have Obamacare coverage for their residents.

Health insurers are facing an upheaval in their businesses amid growing uncertainty about healthcare legislation under President Donald Trump, who seeks to follow through on his promise to dismantle former President Barack Obama’s signature healthcare law, formally known as the Affordable Care Act.

Insurers such as UnitedHealth Group Inc, Aetna Inc and Humana Inc have exited most of the states where they sold Obamacare plans, leaving hundreds of U.S. counties at risk of losing access to private health coverage in 2018.

But other insurers, including Centene Corp, have filled those gaps, expanding into counties that had lost their coverage options.

Every U.S. county is currently projected to have at least one insurer offering Obamacare individual coverage next year. Still, 1,476 counties could have only one insurer in 2018.

(Reporting by Michael Erman; Editing by Steve Orlofsky)

Mylan, U.S. finalize $465 million EpiPen settlement

EpiPen auto-injection epinephrine pens manufactured by Mylan NV pharmaceutical company for use by severe allergy sufferers are seen in Washington, U.S. August 24, 2016. REUTERS/Jim Bourg/File Photo

By Nate Raymond

BOSTON (Reuters) – Mylan NV <MYL.O> has finalized a $465 million settlement resolving U.S. Justice Department claims it overcharged the government for its EpiPen emergency allergy treatment, which became the center of a firestorm over price increases.

The U.S. Attorney’s Office in Massachusetts on Thursday announced the accord, which was soon after criticized by some congressional members as being too easy on the drugmaker. It came 10 months after Mylan said it had reached a deal.

The settlement resolved claims that Mylan avoided higher rebates to state Medicaid programs by misclassifying EpiPen as a generic product, even though it was marketed and priced as a brand-name product.

“Taxpayers rightly expect companies like Mylan that receive payments from taxpayer-funded programs to scrupulously follow the rules,” Acting U.S. Attorney William Weinreb said in a statement.

Under the deal, Mylan did not admit wrongdoing. It will reclassify EpiPen and pay the rebate applicable to its new classification as of April 1, 2017.

“Bringing closure to this matter is the right course of action for Mylan and our stakeholders to allow us to move forward,” Mylan Chief Executive Heather Bresch said in a statement.

The deal followed a False Claims Act whistleblower lawsuit filed by French rival Sanofi SA <SASY.PA> in 2016, two years after it first raised the matter with authorities, Weinreb’s office said.

Sanofi, which formerly marketed a rival product called Auvi-Q, will receive nearly $38.8 million as a reward from the government.

Sanofi in a statement called pursuing the matter “the right thing to do.” It has a separate antitrust lawsuit pending alleging Mylan engaged in illegal conduct to squelch competition to EpiPen.

Mylan shares rose 2.10 percent to $31.11 on the Nasdaq.

The EpiPen, which Mylan acquired in 2007, is a handheld device that treats life-threatening allergic reactions by automatically injecting a dose of epinephrine.

Mylan came under fire last year after raising the price of a pair of EpiPens to $600, from $100 in 2008, enraging consumers and putting it in the center of the ongoing U.S. debate over the high cost of prescription medicines.

Mylan has since offered its own generic version for about $300. The company announced it had reached a Justice Department settlement in October.

Some congressional members previously criticized the $465-million settlement as too small. U.S. Senator Richard Blumenthal, a Democrat from Connecticut, renewed that position on Thursday, calling it “completely insufficient.”

A U.S. Department of Health and Human Services’ Office of Inspector General analysis released in May found the U.S. government may have overpaid for EpiPens by up to $1.27 billion between 2006 and 2016.

“Absolving Mylan from a finding of wrongdoing has cleared the way for the company to pocket the money it embezzled from an American public in desperate need of lifesaving and affordable medications,” Blumenthal said in a statement.

Republican Senator Chuck Grassley of Iowa in a statement called the accord a “disappointment,” saying it “looks like the settlement amount short-changes the taxpayers.”

Mylan shares were up 0.1 at $30.50 in late trading.

 

(Reporting by Nate Raymond in Boston; Editing by Nick Zieminski)

 

End of U.S. payments to health insurers would cause premiums to rise: CBO

FILE PHOTO: A patients room is pictured at a medical center hospital in San Diego, California, U.S., April 17, 2017. REUTERS/Mike Blake

By Yasmeen Abutaleb

WASHINGTON (Reuters) – Health insurance premiums for many customers on the Obamacare individual insurance markets would be 20 percent higher in 2018 if U.S. President Donald Trump follows through on a threat to stop billions of dollars of payments to health insurers, a nonpartisan congressional office said on Tuesday.

The Congressional Budget Office also found that terminating the payments would mean that 5 percent of Americans would live in areas that do not have an insurer in the individual market in 2018. However, the agency estimated that more insurers would participate by 2020 because they will have observed how the markets work without the payments and most people would be able to purchase insurance.

The CBO’s assessment echoes concerns raised by insurers over the past several months, who have said that terminating the payments would cause premiums to rise.

Trump has repeatedly threatened to withhold the payments, called cost-sharing reductions, which amount to about $7 billion in 2017 and help cover out-of-pocket medical expenses for low-income Americans. Trump has derided the payments as a “bailout” for insurance companies.

The CBO found that the number of uninsured would be slightly higher in 2018 but slightly lower in 2020 as more insurers joined the market. It also found that premiums would be 25 percent higher by 2020, which would increase the amount of government-provided tax credits to help shield low-income people from premium increases.

Several insurers have cited the uncertainty over the payments in raising insurance premiums by double digits for 2018 or in exiting some individual insurance markets.

Anthem Inc, one of the largest remaining Obamacare insurers, earlier this month scaled back its offerings in Nevada and Georgia and blamed the moves in part on uncertainty over the payments. Blue Cross and Blue Shield of North Carolina earlier this year raised premiums by more than 20 percent, but said it would have only raised premiums by about 9 percent if Trump agreed to fund the payments.

The payments are the subject of a lawsuit brought by House Republicans against the Obama administration that alleged they were unlawful because they needed to be appropriated by Congress. A judge for the federal district court for the District of Columbia ruled in favor of the Republicans, and the Obama administration appealed the ruling.

The Trump administration took over the lawsuit and has so far delayed deciding whether to continue the Obama administration’s appeal or terminate the subsidies. That case became more complicated earlier this month when a U.S. appeals court allowed Democratic state attorneys general to defend the payments and have a say in the legal fight.

The administration has decided month-to-month whether to continue the payments. Its next installment is due Aug. 21.

Trump has grown increasingly frustrated as Republicans, who control the White House, Senate and House, have been unable to pass a repeal or replacement of the Affordable Care Act, former Democratic President Barack Obama’s signature domestic policy achievement. After the Senate effort failed in July, Trump tweeted days later threatening to stop the payments.

The CBO estimated the federal deficit would increase by $194 billion from 2017 through 2026 if the payments are terminated.

(Reporting by Yasmeen Abutaleb; Editing by Michele Gershberg and Chris Reese)

Anthem to exit Obamacare market in Virginia next year

FILE PHOTO: The office building of health insurer Anthem is seen in Los Angeles, California February 5, 2015. REUTERS/Gus Ruelas/File Photo

(Reuters) – U.S. health insurer Anthem Inc <ANTM.N> said on Friday it will exit Obamacare markets in Virginia and reduce its plan offerings in Washington and Scott counties and the city of Bristol next year.

The move comes nearly two weeks after President Donald Trump took aim at insurers by threatening to cut the healthcare subsidy payments that make Obamacare plans affordable, after repeatedly failing in his efforts to dismantle former President Barack Obama’s healthcare law.

Insurers are facing an upheaval in their health insurance businesses due to uncertainty over the healthcare legislation as Republican lawmakers seek to follow through on their promise to repeal and replace the Affordable Care Act.

Health insurers, such as UnitedHealth Group Inc <UNH.N>, Aetna Inc <AET.N> and Humana Inc <HUM.N>, have also exited most of the states where they used to sell plans.

The insurers have asked the government to commit to making the $8 billion in subsidy payments for 2018, saying they may raise rates or leave the individual insurance marketplace if there is too much uncertainty.

On Monday, Anthem said it would no longer offer Obamacare plans in Nevada’s state exchange and half of Georgia’s counties in 2018.

The company said on Friday it will only offer off-exchange plans in Washington and Scott counties and the city of Bristol.

Hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as health insurers consider pulling out of those markets in the coming months.

Last week, Molina Healthcare Inc <MOH.N> said it would stop selling Obamacare plans in Utah and Wisconsin.

(Reporting by Divya Grover in Bengaluru; Editing by Shounak Dasgupta)

Texas bill restricting insurance coverage for abortions nears approval

Texas bill restricting insurance coverage for abortions nears approval

By Jon Herskovitz

AUSTIN, Texas (Reuters) – A Texas bill that would restrict insurance coverage for abortions was approved by the state’s Republican-controlled House of Representatives on Wednesday, a move critics called cruel and damaging to women’s health.

The House measure would ban insurance coverage for abortions and require women who wanted coverage to purchase a supplemental plan for an abortion, the latest effort by the most-populous Republican-controlled state to place restrictions on the procedure.

If enacted, the bill would take effect on Dec. 1 and make Texas the 11th state to restrict abortion coverage in private insurance plans written in the state.

The Republican-dominated Senate has passed a similar bill, and Republican Governor Greg Abbott has shown support for the measures.

The bill’s backers say it would protect abortion opponents from subsidizing the procedure. A Democratic critic decried it as forcing people to buy “rape insurance.”

“It’s a question of economic freedom and freedom in general,” Republican Representative John Smithee, the bill’s sponsor, said in House debate on Tuesday ahead of the bill receiving preliminary approval.

The Republican sponsor of the Senate bill, Brandon Creighton, has told local media supplemental coverage would cost $12 to $80 a year

House Bill 214, which passed mostly on a party-line vote, does not offer exceptions for cases of rape or incest. Abortion rights groups are likely fight the measure in court if enacted.

“Women and parents will be faced with the horrific decision of having to purchase ‘rape insurance’ to cover them if they are victimized,” Democratic Representative Chris Turner said in a statement. “This is not only ridiculous, but it is cruel.”

Idaho, Kansas and Oklahoma are among the 10 other states that make abortion coverage a supplement on private plans. There are 25 states with restrictions on abortion coverage in plans set up by state exchanges as part of the Affordable Care Act under former Democratic President Barack Obama, according to the Guttmacher Institute, which tracks such legislation.

“It is surprising that Texas has not done this before,” said Elizabeth Nash, senior state issues manager for Guttmacher.

The insurance measure is one of several bills concerning abortion before Texas lawmakers in a special session that runs through next week.

The Senate has already approved bills that include requiring physicians to improve notification of complications that occur during abortions and another that prohibits local governments from having contracts with abortion providers and their affiliates.

(Reporting by Jon Herskovitz; Editing by Colleen Jenkins and Lisa Shumaker)

Anthem to pare back Obamacare offerings in Nevada and Georgia

FILE PHOTO: The office building of health insurer Anthem is seen in Los Angeles, California February 5, 2015. REUTERS/Gus Ruelas/File Photo

(Reuters) – U.S. health insurer Anthem Inc <ANTM.N> said on Monday it will no longer offer Obamacare plans in Nevada’s state exchange and will stop offering the plans in nearly half of Georgia’s counties next year.

The moves come after Republican senators last month failed to repeal and replace Obamacare, former President Barack Obama’s signature healthcare reform law, creating uncertainty over how the program providing health benefits to 20 million Americans will be funded and managed in 2018.

Hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as insurers consider pulling out of those markets in the coming months.

Nevada had said in June that residents in 14 counties out of 17 in the state would not have access to qualified health plans on the state exchanges. Anthem’s decision to leave the state entirely does not increase the number of “bare counties” in the state, Nevada Insurance Commissioner Barbara Richardson said in a statement.

The insurer will still offer “catastrophic plans,” which can be purchased outside the state’s exchange and are only available to consumers under 30 years old or with a low income.

Anthem also said it will only offer Obamacare plans in 85 of Georgia’s 159 counties. It said the counties it will continue to offer the plans in are mostly rural counties that would otherwise not have health insurance coverage for their residents.

It said these changes do not impact Anthem’s Medicare Advantage, Medicaid or employer-based plans in either state.

The company said last week that it will pull out of 16 of 19 pricing regions in California in 2018 where it offered Obamacare options this year.

Anthem blamed the moves in part on uncertainty over whether the Trump administration would maintain subsidies that keep costs down.

U.S. President Donald Trump last week threatened to cut off subsidy payments that make the plans affordable for lower-income Americans and help insurers to keep premiums down, after efforts to repeal the law signed by his predecessor, President Barack Obama, failed in Congress.

Trump has repeatedly urged Republican lawmakers to keep working to undo Obama’s Affordable Care Act.

(Reporting by Michael Erman and Bill Berkrot in New York; Editing by Chizu Nomiyama and Lisa Shumaker)

Trump tells Republicans to get back on healthcare bill

U.S. President Donald Trump calls on Republican Senators to move forward and vote on a healthcare bill to replace the Affordable Care Act in the Blue Room of the White House in Washington,

By Susan Cornwell

WASHINGTON (Reuters) – U.S. President Donald Trump and members of his administration on Sunday goaded Republican senators to stick with trying to pass a healthcare bill, after the lawmakers failed spectacularly last week to muster the votes to end Obamacare.

For the second day running, the Republican president tweeted his impatience with Congress’ inability to deliver on his party’s seven-year promise to replace the Affordable Care Act, President Barack Obama’s signature healthcare bill commonly known as Obamacare. Members of his administration took to the airwaves to try to compel lawmakers to take action.

But it was unclear whether the White House admonishments would have any impact on Capitol Hill, where Republicans who control both houses signaled last week that it was time to move on to other issues.

Republicans’ zeal to repeal and replace Obamacare was met with both intra-party divisions between moderates and conservatives and also the increasing approval of a law that raised the number of insured Americans by 20 million.

Polling indicates a majority of Americans are ready to move on from healthcare at this point. According to a Reuters/Ipsos poll released on Saturday, 64 percent of 1,136 people surveyed on Friday and Saturday said they wanted to keep Obamacare, either “entirely as is” or after fixing “problem areas.” That is up from 54 percent in January.

With the U.S. legislative branch spinning its wheels, the executive branch pledged to look at rewriting Obamacare regulations. Health and Human Services Secretary Tom Price told ABC’s “This Week” that he would change those regulations that drive up costs or “hurt” patients.

Price sidestepped questions about whether there were administration plans to waive Obamacare’s mandate that individuals have health insurance, saying “all things are on the table to try to help patients.”

But Price also told NBC he would implement Obamacare because it is the “law of the land.”

That Obamacare was still law clearly angered Trump, who has no major legislative accomplishments to show for his first half-year in office. “Don’t give up Republican Senators, the World is watching: Repeal Replace …” the president said in a tweet on Sunday morning.

 

NOT ‘TIME TO MOVE ON’

On Friday, Senate Republicans failed to collect enough votes to repeal even a few parts of Obamacare. That capped a week of failed Senate votes on whether to simply repeal, or repeal and replace, the 2010 law, while Trump repeatedly berated lawmakers in a late attempt to influence the legislation.

“The president will not accept those who said, quote, ‘it’s time to move on,'” Kellyanne Conway, a senior counselor to Trump, said on Fox News Sunday. Senate Majority Leader Mitch McConnell, a Republican, had made exactly that comment before dawn on Friday morning after the failed healthcare vote.

The White House budget director, Mick Mulvaney, said on Sunday lawmakers should stay in session to get something done on healthcare – even if this means postponing votes on other issues such as raising the debt ceiling.

“So yes. They need to stay. They need to work. They need to pass something,” Mulvaney said on CNN.

The House of Representatives has already gone home for its August break and the Senate is expected to do the same by mid-August.

Mulvaney also said Trump was seriously considering carrying out threats he tweeted about on Saturday, when the president said that “if a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

That tweet appeared to be referring to the approximately $8 billion in cost-sharing reduction subsidies the federal government pays to insurers to lower the price of health coverage for low-income Americans.

The Saturday tweet also appeared to be a threat to end the employer contribution for members of Congress and their staffs, who were moved from the normal federal employee healthcare benefits program onto the Obamacare insurance exchanges as part of the 2010 healthcare law.

“What he’s saying is, look, if Obamacare is hurting the American people – and it is – then why shouldn’t it hurt insurance companies and more importantly, perhaps for this discussion, members of Congress?” Mulvaney said on Sunday on CNN.

Some Republicans have said they are trying to find a way forward on healthcare. Senate Republican Susan Collins, one of three Republicans who voted against repealing parts of Obamacare on Friday, told NBC that Congress should produce a series of bills with bipartisan input on healthcare, including appropriating the cost-sharing subsidies.

The Senate has one vote scheduled when it reconvenes on Monday afternoon: whether to confirm a U.S. circuit court judge. Senate aides said they had no guidance for the agenda beyond that vote.

 

(Additional reporting by Sarah N. Lynch, Roberta Rampton, and Caren Bohan; Editing by Phil Berlowitz and Mary Milliken)

 

Hundreds of counties at risk for no Obamacare insurer in 2018

FILE PHOTO: Healthcare activists protest against the Republican healthcare bill on Capitol Hill in Washington, U.S., July 19, 2017. REUTERS/Aaron P. Bernstein

By Caroline Humer

NEW YORK (Reuters) – With Republican efforts to dismantle Obamacare in disarray, hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as insurers consider pulling out of those markets in the coming months.

Republican senators failed this week to repeal and replace Obamacare, former President Barack Obama’s signature healthcare reform law, creating new uncertainty over how the program providing health benefits to 20 million Americans will be funded and managed in 2018.

In response, Republican President Donald Trump on Friday again suggested that his administration would let the Obamacare program “implode.” He has weakened enforcement of the law’s requirement for individuals to buy insurance, threatened to cut off funding and sought to change plan benefits through regulations.

Anthem Inc, Cigna Corp, Health Care Service Corp and Molina Healthcare, four of the biggest health insurers selling Obamacare plans, said they are weighing whether to pull out of more markets for 2018 rather than face financial losses. They have until Sept. 27 to finalize their plans.

So far, 40 U.S. counties are expected to have no insurer offering individual coverage next year, but that number could rise by the hundreds, according to U.S. government data, Kaiser Family Foundation analysis and insurer disclosures. More than 1,300 counties, primarily in 15 states, currently have only one insurer participating in 2018. Anthem and HCSC are the last man standing in one-third of those counties and states – putting those areas in particular at risk.

“Right now the number of counties at immediate risk of having no insurers in 2018 is small, but it could easily grow significantly if a couple major insurers decide to exit,” Larry Levitt, health economist at the Kaiser Family Foundation, said.

Many insurers have been waiting for an answer from Trump or lawmakers on whether they will continue to fund $8 billion in annual government subsidies. Without assurances, many insurers plan to raise rates an additional 20 percent by an Aug. 16 deadline for premium prices. Others say that the many unknowns will make the business too risky.

The last-minute drama has left millions of Americans questioning whether they will have medical coverage next year.

Julie Grady, a 59-year-old small business owner in Carson City, Nevada, is currently covered by Blue Cross Blue Shield of Nevada, part of Anthem, which has already decided to leave the exchanges in her county and most of the state. Carson City will have no insurer on the exchanges next year.

Grady’s pays a reduced premium of $70 per month and a deductible under $1,000 for her plan, which is part of the Affordable Care Act, commonly called Obamacare. Grady is looking at being uninsured, as she was before the law.

“I would have to go without health insurance,” she said. “I would just stay healthy, hike, eat well. I’d be in trouble if something catastrophic happened. I would lose everything.”

ANTHEM CONSIDERING 2018 PLANS

Anthem, the second-largest U.S. health insurer, sells Blue Cross Blue Shield plans in 14 states. It has already decided to pull out of most individual markets in Nevada, Ohio, Indiana and Wisconsin in 2018. Earlier this week, Chief Executive Officer Joe Swedish said he was still weighing 2018 participation in its other states.

In states like Colorado, Georgia, Kentucky, Missouri, and Virginia, Anthem sells plans in more than 250 counties where it is the only insurer, and they could be left “bare” next year, according to government data.

Health Care Services Corp is a Blue Cross Blue Shield licensee in five states and is the only Obamacare individual insurer in more than 90 Texas counties, more than 75 Oklahoma counties, and half a dozen Illinois counties. It confirmed on Friday that it has submitted products for its five states but is still weighing next year.

“We’re working through the regulatory filing process and hope to fully participate…in 2018, however no final decisions have been made,” HCSC spokeswoman Kristen Cunningham said.

Molina, which has more than 1 million members in Obamacare plans, and Cigna, with more than 250,000 participants, have said they need more certainty from the government to decide on 2018 participation and would weigh their decisions up until the late September deadline.

State insurance regulators have worked hard in recent months to replace insurers who have left. In Nevada, for instance, Centene Corp and Aetna Inc entered in some counties that Anthem left after the insurance commissioner said he would favor these insurers for its Medicaid contract bids.

But they are unlikely to find replacements for new dropouts in these final weeks, particularly if the Trump administration signals it won’t fund $8 billion in subsidies for out-of-pocket medical costs.

“There is almost no chance they would step in to participate,” said Kurt Wrobel, a fellow at the Society of Actuaries and chief financial officer of the Geisinger Health Plan in Pennsylvania.

Some insurers say they will likely just raise rates and hope it works. Blue Cross Blue Shield of Michigan filed two sets of rates with the state department of insurance, one up to 32 percent higher if the fate of subsidies remains unclear.

“We don’t have any plans to pull out,” said Rick Notter, director of the individual business at BCBS Michigan. “But it would certainly help to have more certainty around what the market holds.”

(Additional reporting by Jilian Mincer; Editing by Michele Gershberg and Cynthia Osterman)

Senate poised for healthcare showdown

Senate Majority Leader Mitch McConnell, accompanied by Senator John Cornyn (R-TX) and Senator John Barrasso (R-WY), speaks with reporters following the successful vote to open debate on a health care bill on Capitol Hill in Washington, U.S., July 25, 2017. REUTERS/Aaron P. Bernstein

By Amanda Becker and Yasmeen Abutaleb

WASHINGTON (Reuters) – U.S. Senate Republicans begin their final push on Thursday to unravel Obamacare, seeking to wrap up their seven-year offensive against former Democratic President Barack Obama’s signature healthcare law that extended insurance coverage to millions.

Republicans leaders hope a pared-down “skinny” bill that repeals several key Obamacare provisions can gain enough support to pass after several attempts at broader legislation failed to win approval earlier this week.

The skinny bill’s details will be released at some point on Thursday, before the Senate embarks on a marathon voting session that could extend into Friday morning. The legislation is expected to eliminate mandates requiring individuals and employers to obtain or provide health insurance, and abolish a tax on medical device manufacturers.

The effort comes after a chaotic two-month push by Senate Republicans to pass their version of legislation that made it out of the Republican-controlled House of Representatives in May.

Members of the party, including President Donald Trump, campaigned on a pledge to repeal and replace what they say is a failing law that allows the government to intrude in people’s healthcare decisions.

Republicans were optimistic about the skinny bill’s chances of receiving at least 50 votes in the Senate where they hold a 52-48 majority.

Senator John Cornyn, the chamber’s No. 2 Republican, said the bill, once approved, would go to a special negotiating committee of lawmakers from both chambers that would reconcile the House and Senate versions into a single piece of legislation.

Republican leaders had tapped a group to craft legislation largely behind closed doors, exposing rifts within the party. While conservatives said the group’s proposals did not go far enough, moderates said they could not support measures estimated to deprive tens of millions of health insurance.

The Senate voted 55-45 on Wednesday against a simple repeal of Obamacare, which would have provided a two-year delay so Congress could work out a replacement. Seven Republicans opposed the bill. On Tuesday, senators rejected the repeal-and-replace plan Republicans had been working on since May.

Senate Majority Leader Mitch McConnell can lose only two Republican votes to pass healthcare legislation. Even then, he would have to call on Vice President Mike Pence to cast a tie-breaking vote as head of the Senate. Democrats are united in opposition.

GOVERNORS SEEK INVOLVEMENT

A bipartisan group of 10 governors urged senators in a letter on Wednesday to start over and use a drafting process that includes governors from both parties. Governors of Nevada, Ohio, Louisiana, Pennsylvania and Colorado were among those who signed the letter, all of whose states have Republican senators.

The Congressional Budget Office, a nonpartisan research agency, estimated on Wednesday that a combination of provisions that might go into the skinny bill would lead to 16 million people losing their health coverage by 2026.

It had earlier estimated that the two other bills rejected by the Senate this week would have led to 22 million to 32 million people losing their health insurance by 2026.

Senate Democratic leader Chuck Schumer criticized Republican leaders for crafting a “yet-to-be-disclosed final bill” in secret.

“We don’t know if skinny repeal is going to be their final bill, but if it is, the CBO says it would cause costs to go up, and millions to lose insurance,” Schumer said on the Senate floor.

(Additional reporting by Susan Cornwell, Richard Cowan and David Morgan; Writing by Lisa Lambert; Editing by Peter Cooney)