Tag Archives: Healthcare

Trump seeks to slash government spending in budget plan

FILE PHOTO - President Donald Trump's FY2018 budget is seen printed at the Government Publishing Office in Washington, U.S. on May 19, 2017. REUTERS/Yuri Gripas/File Photo

By Roberta Rampton

WASHINGTON (Reuters) – The White House on Tuesday will ask Republicans who control the U.S. Congress – and federal purse strings – to slash spending on healthcare and food assistance programs for the poor as they push ahead on plans to cut taxes and trim the deficit.

President Donald Trump is set to propose a raft of politically sensitive cuts in his first full budget, for the fiscal year that starts in October, a proposal that some analysts expected would be put aside by lawmakers as they craft their own budget and spending plans.

Trump, who is traveling overseas and will miss the unveiling of his plan, wants lawmakers to cut $3.6 trillion in government spending over 10 years, balancing the budget by the end of the decade, according to a preview given to reporters on Monday.

More than $800 billion would be cut from the Medicaid program for the poor and more than $192 billion from food stamps.

Republicans are under pressure to deliver on promised tax cuts, the cornerstone of the Trump administration’s pro-business economic agenda, which would cut the business tax rate to 15 percent from 35 percent, and reduce the number of personal tax brackets to three from seven.

But their policy agenda has stalled as the White House grapples with the political fallout from Trump’s firing of former FBI Director James Comey.

Comey had been leading a probe of alleged Russian meddling in the 2016 U.S. election.

Trump’s biggest savings would come from cuts to the Medicaid program made as part of a Republican healthcare bill passed by the House of Representatives.

The bill aims to gut the Obama administration’s signature 2010 Affordable Care Act, known as Obamacare, that expanded insurance coverage and the government-run Medicaid program for the poor. But it faces an uncertain future in the Senate, which is writing its own law.

The White House proposed changes that would require more childless people receiving help from the Supplemental Nutrition Assistance Program, better known as food stamps, to work.

STEEP CUTS

The plan would slash supports for farmers, impose user fees for meat inspection and sell off half the nation’s emergency oil stockpile. Another politically fraught item is a proposal for cuts to the U.S. Postal Service, a goal that has long eluded lawmakers and administrations from both political parties.

The first look at the plan came in a “skinny budget” released in March – a document that received a tepid response from Congress.

Most departments would see steep cuts, particularly the State Department and the Environmental Protection Agency.

There is some new spending. The Pentagon would get a boost, and there would be a down payment to begin building a wall on the southern border with Mexico, which was a central promise of Trump’s presidential campaign.

The budget includes $25 billion for a plan to give parents six weeks of paid leave after the birth or adoption of a child, and $200 billion to encourage state and local governments to boost spending on roads, bridges, airports and other infrastructure programs.

The plan drew immediate fire from lobby groups, including from the Committee for a Responsible Federal Budget, which said it relied on “rosy assumptions,” gimmicks and unrealistic cuts.

“While we appreciate the administration’s focus on reducing the debt, when using more realistic assumptions, the president’s budget does not add up,” Maya MacGuineas, the group’s president, said in a statement.

Trump’s plan relies on forecasts for economic growth of 3 percent a year by the end of his first term – well beyond Congressional Budget Office assumptions of 1.9 percent growth.

“That assumes a pessimism about America, about the economy, about its people, about its culture, that we’re simply refusing to accept,” White House budget director Mick Mulvaney told reporters on Monday.

(Additional reporting by Yasmeen Abutaleb, David Shepardson, Timothy Gardner, Ginger Gibson, Jason Lange and Julia Edwards Ainsley in Washington, and PJ Huffstutter in Chicago; Editing by Peter Cooney)

Global cyber attack slows but experts see risk of fresh strikes

An ambulance waits outside the emergency department at St Thomas' Hospital in central London, Britain May 12, 2017. REUTERS/Stefan Wermuth

By Jeremy Wagstaff and Eric Auchard

SINGAPORE/FRANKFURT (Reuters) – A global cyber attack described as unprecedented in scale forced a major European automaker to halt some production lines while hitting schools in China and hospitals in Indonesia on Saturday, though it appeared to die down a day after its launch.

Capitalizing on spying tools believed to have been developed by the U.S. National Security Agency, the cyber assault has infected tens of thousands of computers in nearly 100 countries, with Britain’s health system suffering the worst disruptions.

Cyber extortionists tricked victims into opening malicious malware attachments to spam emails that seemed to contain invoices, job offers, security warnings and other legitimate files.

Once inside the targeted network, so-called ransomware made use of recently revealed spy tools to silently infect other out-of-date machines without any human intervention. This, security experts said, marked an unprecedented escalation in the risk of fresh attacks spreading in the coming days and weeks.

The ransomware encrypted data on the computers, demanding payments of $300 to $600 to restore access. Researchers observed some victims paying via the digital currency bitcoin, though no one knows how much may have been transferred to extortionists because of the largely anonymous nature of such transactions.

Researchers with security software maker Avast said they had observed 126,534 ransomware infections in 99 countries, with Russia, Ukraine and Taiwan the top targets.

The hackers, who have not come forward to claim responsibility or otherwise been identified, took advantage of a worm, or self-spreading malware, by exploiting a piece of NSA spy code known as “Eternal Blue” that was released last month by a hackers group known as the Shadow Brokers, according to researchers with several private cyber security firms.

Renault said it had halted auto production at several sites including Sandouville in northwestern France and Renault-owned Dacia plants in Romania on Saturday to prevent the spread of ransomware in its systems.

Nissan’s manufacturing plant in Sunderland, northeast England, was also affected by the cyber assault though “there has been no major impact on our business”, a spokesman for the Japanese carmaker said.German rail operator Deutsche Bahn [DBN.UL] said some electronic signs at stations announcing arrivals and departures were infected, with travelers posting pictures showing some bearing a message demanding a cash payment to restore access.

“UNPRECEDENTED” ATTACK EASES

Europol’s European Cybercrime Center said it was working closely with country investigators and private security firms to combat the threat and help victims. “The recent attack is at an unprecedented level and will require a complex international investigation to identify the culprits,” it said in a statement.

Some experts said the threat had receded for now, in part because a British-based researcher, who declined to give his name, registered a domain that he noticed the malware was trying to connect to, and so limited the worm’s spread.

“We are on a downward slope, the infections are extremely few, because the malware is not able to connect to the registered domain,” said Vikram Thakur, principal research manager at Symantec.

“The numbers are extremely low and coming down fast.”

But the attackers may yet tweak the code and restart the cycle. The researcher in Britain widely credited with foiling the ransomware’s proliferation told Reuters he had not seen any such tweaks yet, “but they will (happen).”

Researchers said the worm deployed in the latest attack, or similar tools released by Shadow Brokers, are likely to be used for fresh assaults not just with ransomware but other malware to break into firms, seize control of networks and steal data.

Finance chiefs from the Group of Seven rich countries were to commit on Saturday to joining forces to fight the growing threat of international cyber attacks, according to a draft statement of a meeting they are holding in Italy.

“Appropriate economy-wide policy responses are needed,” the ministers said in their draft statement, seen by Reuters.

HOSPITALS IN FIRING LINE

In Asia, some hospitals, schools, universities and other institutions were affected, though the full extent of the damage is not yet known because it is the weekend.

“I believe many companies have not yet noticed,” said William Saito, a cyber security adviser to Japan’s government. “Things could likely emerge on Monday” as staff return to work.

China’s information security watchdog said “a portion” of Windows systems users in the country were infected, according to a notice posted on the official Weibo page of the Beijing branch of the Public Security Bureau on Saturday. Xinhua state news agency said some secondary schools and universities were hit.

In Vietnam, Vu Ngoc Son, a director of Bkav Anti Malware, said dozens of cases of infection had been reported there, but he declined to identify any of the victims.

South Korea’s Yonhap news agency reported a university hospital had been affected, while a communications official in Indonesia said two hospitals there had been hit.

The most disruptive attacks were reported in Britain, where hospitals and clinics were forced to turn away patients after losing access to computers on Friday.

International shipper FedEx Corp said some of its Windows computers were also breached. “We are implementing remediation steps as quickly as possible,” a FedEx statement said.

Telecommunications company Telefonica was among many targets in Spain. Portugal Telecom and Telefonica Argentina both said they were also targeted.

Only a small number of U.S.-headquartered organizations were hit because the hackers appear to have begun the campaign by focusing on targets in Europe, said Thakur.

By the time they turned their attention to the United States, spam filters had identified the new threat and flagged the ransomware-laden emails as malicious, he added.

MICROSOFT BOLSTERS WINDOWS DEFENCES

Private security firms identified the ransomware as a new variant of “WannaCry” that had the ability to automatically spread across large networks by exploiting a known bug in Microsoft’s Windows operating system.

“This is one of the largest global ransomware attacks the cyber community has ever seen,” said Rich Barger, director of threat research with Splunk, one of the firms that linked WannaCry to the NSA.

The Shadow Brokers released Eternal Blue as part of a trove of hacking tools that they said belonged to the U.S. spy agency.

The attack targeted Windows computers that had not installed patches released by Microsoft in March, or older machines running software that Microsoft no longer supports and for which patches did not exist, including the 16-year-old Windows XP system, researchers said.

Microsoft said it pushed out automatic Windows updates to defend existing clients from WannaCry. It had issued a patch on March 14 to protect them from Eternal Blue. Late on Friday, Microsoft also released patches for a range of long discontinued software, including Windows XP and Windows Server 2003.

“Today our engineers added detection and protection against new malicious software known as Ransom:Win32.WannaCrypt,” Microsoft said in a statement on Friday, adding it was working with customers to provide additional assistance.

POLITICALLY SENSITIVE TIMING

The spread of the ransomware capped a week of cyber turmoil in Europe that began when hackers posted a trove of campaign documents tied to French candidate Emmanuel Macron just before a run-off vote in which he was elected president of France.

On Wednesday, hackers disrupted the websites of several French media companies and aerospace giant Airbus. The hack happened four weeks before a British general election in which national security and the management of the state-run National Health Service are important issues.

Authorities in Britain have been braced for cyber attacks in the run-up to the election, as happened during last year’s U.S. election and on the eve of the French run-off vote on May 7.

But those attacks – blamed on Russia, which has repeatedly denied them – followed a different modus operandi involving penetrating the accounts of individuals and political organizations and then releasing hacked material online.

On Friday, Russia’s interior and emergencies ministries, as well as its biggest bank, Sberbank, said they were targeted by ransomware. The interior ministry said about 1,000 computers had been infected but it had localized the virus.

Although cyber extortion cases have been rising for several years, they have to date affected small- to mid-sized organizations. “Seeing a large telco like Telefonica get hit is going to get everybody worried,” said Chris Wysopal, chief technology officer with cyber security firm Veracode.

(Additional reporting by Kiyoshi Takenaka, Jim Finkle, Eric Auchard, Jose Rodriguez, Alistair Smout, Andrea Shalal, Jack Stubbs, Antonella Cinelli, Dustin Volz, Kate Holton, Andy Bruce, Michael Holden, David Milliken, Rosalba O’Brien, Julien Toyer, Tim Hepher, Luiza Ilie, Patricia Rua, Axel Bugge, Sabine Siebold and Eric Walsh, Engen Tham, Fransiska Nangoy, Soyoung Kim, Mai Nguyen; editing by Mark Heinrich)

UK government in dark over who behind cyber attack

FILE PHOTO: A National Health Service (NHS) sign is seen in the grounds of St Thomas' Hospital, in front of the Houses of Parliament in London June 7, 2011. REUTERS/Toby Melville/File Photo

LONDON (Reuters) – The British government does not yet know who was behind Friday’s global cyber attack that disrupted the country’s health system, interior minister Amber Rudd said on Saturday.

“We’re not able to tell you who’s behind the attack. That work is still ongoing,” she told BBC radio.

She said Britain’s National Cyber Security Center was working with the country’s health service to ensure the attack was contained, while the National Crime Agency was working with them to find out where it came from.

Rudd said the government did not know if the attack was directed by a foreign government.

On Friday, cyber extortionists tricked victims into opening malicious malware attachments to spam emails that appeared to contain invoices, job offers, security warnings and other legitimate files. Nearly 100 countries were impacted.

Rudd said the attack was not specifically targeted at Britain’s health service.

“(The virus) feels random in terms of where it’s gone to and where it’s been opened,” she said.

Though 45 health service organizations in England and Scotland were affected by malicious software, no patient data has been accessed or transferred, said Rudd.

The minister said lessons had to be learned from the attack.

“There will be lessons to learn … Why is it certain regions are affected more than others? Is it to do with the software? Is it to do with better IT?”

Separately on Saturday, finance chiefs from the Group of Seven rich countries will commit to join forces to fight the growing threat of international cyber attacks, according to a draft statement of a meeting they are holding in Bari, Italy.

(Reporting by James Davey; Editing by Mark Potter)

How one U.S. state is leading the charge to dismantle Obamacare

FILE PHOTO: U.S. Vice President Mike Pence, sitting with Kentucky Governor Matt Bevin (L), discusses the American Health Care Act during a meeting with local business leaders at the Harshaw-Trane Parts and Distribution Center in Louisville, Kentucky, U.S. on March 11, 2017. REUTERS/Bryan Woolston/File Photo

By Yasmeen Abutaleb and Robin Respaut

FRANKFORT, Ky./SAN FRANCISCO (Reuters) – For nearly three years, Democrats and former President Barack Obama pointed to Kentucky as one of the Affordable Care Act’s biggest success stories.

A poor, rural state that straddles the North and South, Kentucky was an early adopter of the healthcare law commonly known as Obamacare and saw one of the country’s largest drops in the uninsured rate.

Now Kentucky is poised for a new distinction: to be the first state to save money by reducing the number of people on Medicaid, the government health insurance program for the poor and disabled and a central tenet of Obamacare.

If successful, Kentucky would provide a roadmap for other states who are worried about paying an increasing share for people on Medicaid.

A new Republican health law that passed the U.S. House of Representatives on Thursday, along with state initiatives like Kentucky’s, would dramatically change the national healthcare system and cut more than $800 billion from Medicaid over the next 10 years.

The Republican bill still faces a long road ahead in the U.S. Senate and its final passage is far from assured, making initiatives like Kentucky’s all the more important.

Kentucky has proposed to lessen its financial burden before it grows by reducing the number of residents on Medicaid by nearly 86,000 within five years, saving more than $330 million in the process. (For a graphic click http://tmsnrt.rs/2on0HVK)

Kentucky’s plan also calls for new work requirements for able-bodied adults to get insurance. Plus, it would establish new fees for all members based on income and lock out some people who miss a payment or fail to re-enroll.

By following these proposed rules, Kentucky believes Medicaid enrollees will over time graduate from Medicaid to private and employer insurance plans.

“One of the most remarkable lies that has perpetrated in recent years in the healthcare community in America is that expanded Medicaid was working well in Kentucky,” Republican Governor Matt Bevin, who is leading the state effort, told Reuters from the governor’s mansion in Frankfort, Kentucky.

That view is in line with President Donald Trump’s administration, which has criticized Obamacare’s Medicaid expansion and urged states to pursue similar Medicaid reforms to what Kentucky is now attempting.

“If Kentucky is successful, you’ll see this spread through the more conservative-leaning states. It’s possible even a Democratic blue state could do it,” said George Huang, director and senior municipal healthcare research analyst at Wells Fargo Securities. “It’s the flexibility that some states are seeking.”

INSURING THE POOR AT A PRICE

Kentucky, a state Trump won handily last November, has been devastated by the loss of coal mining jobs and an opioid epidemic. The state sits near the bottom of health rankings for smoking rates, cancer deaths and diabetes.

“To me, morally, it was the right thing to expand Medicaid, but I had a responsibility to not to do something that would bankrupt the state,” said former Governor Steve Beshear, a Democrat, referring to the increased costs of caring for a larger population with Medicaid insurance.

More than 30 states, about a dozen of which are led by Republican governors, expanded Medicaid under Obamacare. In Kentucky, more than 400,000 people gained health insurance through the program, the highest growth rate of Medicaid coverage of any state.

Beshear commissioned independent studies by PricewaterhouseCoopers and Deloitte on the financial and health impacts of expanding Medicaid. Both studies found health and economic gains. Deloitte reported that 90,000 newly covered residents received cholesterol screening and 80,000 got preventative dental care within a year. It estimated Kentucky would see an economic boost of $30 billion and 40,000 new jobs by 2021.

Beshear’s successor, Republican Governor Bevin, was elected in 2015 on a promise to repeal and replace the healthcare law on the view that thousands of Kentuckians had unaffordable premiums and only one health insurer to choose from.

He dismissed the projections in the Beshear-commissioned studies as “preposterous,” and says the state’s share of expanded Medicaid – $74 million in 2017 and totaling $1.2 billion over five years – was too expensive and unsustainable.

“We want this to be a helping hand for people at a time when they need it, but then be able to return to the commercial marketplace,” Bevin said.

Last year, Bevin submitted the waiver to restrict Medicaid eligibility by requiring enrollees to work or volunteer at least 20 hours per week and to pay monthly premiums based on income. He’s still awaiting approval.

Bevin said he has spoken with several governors about the waiver and has had extensive conversations with Health and Human Services Secretary Tom Price about fast-tracking the approval process in order for other states to quickly adopt similar programs. Such conversations are occurring across the country in response to encouragement from the new administration to reform state Medicaid programs, said Alleigh Marre, a Health and Human Services spokeswoman.

Louisiana and Wisconsin are considering work requirements for Medicaid enrollees. The Obama administration rejected previous attempts by other states, including Ohio and Arizona, to require work programs and monthly premiums for Medicaid, historically a free program for those eligible.

“Every state is watching this to see what happens,” said Bevin of Kentucky’s waiver. “It’s the first one in the queue.”

SIGNS POINT TO “YES” FOR KENTUCKY WAIVER

The odds look good for Kentucky to get the waiver in the coming months, based on the track records of health officials that Trump named after his inauguration.

Seema Verma, the new head of the Centers for Medicare and Medicaid Services, which approves Medicaid waivers, said during congressional testimony that the agency will usher in “a new era of state flexibility and leadership.”

Verma helped craft Kentucky’s waiver, but said she will recuse herself from the approval process to avoid conflicts of interest.

She and Tom Price wrote a letter to governors in March encouraging Medicaid reforms that more closely resemble commercial insurance plans. In the letter, they suggested features such as premium fees, health savings accounts, and emergency room co-payments that encourage the use of primary care.

CMS declined to comment on Kentucky’s waiver and said it does not speculate on the process while ongoing.

Under federal law, waivers must promote Medicaid’s objective of delivering healthcare services to vulnerable populations who cannot otherwise afford them.

“Waivers have never been used to cut people from the rolls,” said Emily Parento, associate professor at the University of the Pacific’s law school and the former executive director of Kentucky’s Office of Health Policy.

But Verma’s office is encouraging changes to Medicaid that make the government program look more like private insurance policies – goals that are similar to Bevin’s in Kentucky.

“I think what will happen is that other states will look at it and go, ‘We want everything they got,’” Bevin said.

(This story has been refiled to fix spelling in paragraph 3.)

(Reporting by Yasmeen Abutaleb in Kentucky and Robin Respaut in San Francisco; Editing by Caroline Humer and Edward Tobin)

With Obamacare vote, House Republicans free to turn to tax reform

U.S. President Donald Trump (C) celebrates with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, in Washington, U.S., May 4, 2017. REUTERS/Carlos Barria

By David Morgan

WASHINGTON (Reuters) – The Republican-controlled U.S. House of Representatives plans to turn to tax reform in earnest, after concluding a lengthy healthcare debate this week with a vote to repeal and replace Obamacare.

But even as Republicans predicted that tax reform would succeed before year-end, lawmakers encountered new uncertainties about what a final tax package might contain, as well as doubts about whether Republicans will be able to enact reforms without Democratic help.

President Donald Trump and Republicans in Congress have pledged to complete the biggest tax reform since 1986, when President Ronald Reagan was in office, before the end of 2017. But they face an uphill battle, mainly over policy differences within their own ranks.

Thursday’s 217-213 House vote on healthcare legislation raised confidence in the Republican-controlled chamber’s ability to move major legislation after two earlier pushes ended in failure.

But to move forward on tax reform, the House, Senate and Trump administration must agree on where to set tax rates, how to pay for cuts and whether the final package should add to the deficit or pay for itself, all areas where common ground may be hard to find.

A plan to enact reforms without Democratic support will also require Republicans to pass a 2018 budget authorizing the parliamentary process known as reconciliation. But a new budget agreement poses a daunting task given Republican opposition to Trump demands for deep domestic spending cuts.

“That may prove to be one, if not the most difficult votes of the tax reform process,” Jonathan Traub, a managing principal at the consulting firm Deloitte Tax LLP.

Meanwhile, the need to reach agreement between the House, Senate and White House will likely delay introduction of a tax reform bill, which had been expected in early June.

But Republicans say it will ultimately make it easier to enact reforms before the end of the year.

The House Ways and Means Committee, which will unveil the initial tax bill, is still aiming for a revenue-neutral package that raises $2.4 trillion for tax cuts through a new border adjustment tax and elimination of business deductions for net interest payments, both controversial measures.

Panel chairman Kevin Brady told reporters that revenue neutrality is necessary to ensure bold, permanent changes to tax policy that can drive economic growth.

“That’s the argument and the case we’re going to make to the Senate and the Trump administration,” he said.

But Representative Mark Meadows, who chairs the conservative Freedom Caucus that helped block Trump’s first healthcare bill,

voiced opposition to a revenue neutral approach.

“If it’s revenue neutral, you’re not really lowering taxes. You’re shifting the burden,” Meadows told reporters.

The Trump tax plan unveiled last week calls for steep tax cuts financed by government revenues that officials say will result from higher growth. Some fear the plan could add trillions of dollars to the deficit if growth does not materialize.

Meadows said tax cuts should be offset by cuts to entitlement programs including Social Security and Medicare, which Trump has promised not to touch.

(Editing by Alistair Bell)

Trump faces major test as vote looms on U.S. healthcare bill

A cyclist passes the the U.S. Capitol, on the day the House is expected to vote here to repeal Obamacare in Washington, D.C., U.S., May 4, 2017. REUTERS/Kevin Lamarque

By Richard Cowan and Yasmeen Abutaleb

WASHINGTON (Reuters) – The U.S. House of Representatives was set on Thursday for a cliffhanger vote to repeal Obamacare, as Republican leaders worked to deliver President Donald Trump a win for one of his top legislative priorities.

House Republican leaders have expressed confidence the bill would pass and several party moderates who previously objected to the measure got behind it on Wednesday, giving it new momentum.

“We’re optimistic that we’ll pass it out of the House today,” Representative Mark Meadows of North Carolina, chairman of the conservative Freedom Caucus, told MSNBC’s “Morning Joe” program on Thursday.

The vote, which a House Republican aide said was due this afternoon, was expected to be close. Even if the measure passes the House, it faces daunting odds in the Senate where Republicans hold a narrower majority.

“Today is the next step in what is likely to be a very long process,” Republican Representative Michael Burgess of Texas also said on MSNBC.

Keen to score his first major legislative victory since taking office in January, Trump threw his own political capital behind the bill, meeting Burgess and other lawmakers and calling them in an effort to win their support.

Trump, whose Republican party controls both the House and Senate, is seeking to make good on his campaign promise to repeal and replace Obamacare.

Aides said he worked the phones furiously.

Wavering moderate Republicans had worried that the legislation to overhaul President Barack Obama’s 2010 signature healthcare law would leave too many people with pre-existing medical conditions unable to afford health coverage.

But the skeptical Republican lawmakers got behind the bill after meeting with Trump to float a compromise proposal expected to face unanimous Democratic opposition.

The legislation’s prospects brightened after members of the Freedom Caucus, a faction of conservative House lawmakers who played a key role in derailing the original version last month, said they could go along with the compromise.

Millions more Americans got healthcare coverage under Obamacare, but Republicans have long attacked it, seeing it as government overreach and complaining that it drives up costs.

Called the American Health Care Act, the Republican bill would repeal most Obamacare taxes, including a penalty for not buying health insurance. It would slash funding for Medicaid, the program that provides insurance for the poor, and roll back much of Medicaid’s expansion.

The latest effort comes after earlier pushes by Trump collapsed twice, underscoring the difficulty in uniting the various factions of the Republican party.

Earlier this week, prospects for the legislation appeared grim as several influential moderate Republicans said they could not support the bill, citing concerns about people with pre-existing conditions.

House Energy and Commerce Committee Chairman Representative Greg Walden of Oregon on Thursday defended the leaders’ plan to vote on the bill without a new Congressional Budget Office analysis of the costs or impact on coverage, factoring in the recent changes.

“Obviously, it’s a work in progress,” Walden, who also met with Trump on Wednesday, said in a separate MSNBC interview.

House Democrats have rejected the latest change to the Republican legislation, saying it did not go far enough toward protecting people with pre-existing conditions.

“Republicans have made Trumpcare even more dangerous and destructive than the last time they brought it to the floor,” Democratic Leader Nancy Pelosi said to her caucus in a letter late Wednesday night.

Democrats have long thought their best chance of stopping the repeal would be in the Senate, where only a few Republicans would need to defect to stop the law from moving forward.

Republican Meadows told MSNBC he expected the Senate to make changes to the bill that would improve it. The bill would then face a final vote in the House.

With the difficulties in the House, Democrats are optimistic Republicans will face a backlash from voters and could lose seats in the 2018 mid-term elections.

(Additional reporting by David Morgan, Steve Holland, Roberta Rampton, Eric Beech and Susan Heavey; Writing by Ginger Gibson; Editing by Caren Bohan and Jeffrey Benkoe)

Republicans still short of votes to pass U.S. healthcare overhaul

FILE PHOTO: A doctor checks the blood pressure of a patient in downtown Los Angeles, U.S., on July 30, 2007. REUTERS/Lucy Nicholson/File Photo

By Richard Cowan and David Morgan

WASHINGTON (Reuters) – Republicans in the U.S. House of Representatives said on Tuesday they were closer to agreeing on a reworked bill to overhaul the nation’s healthcare system but still lacked the votes to pass it, as President Donald Trump pressed lawmakers for a vote.

The White House has been pressuring House Republicans to push ahead with legislation to repeal and replace the Affordable Care Act, commonly called Obamacare, after a first effort failed in March in a major setback for the Trump administration.

“I think it’s time now” for a healthcare vote, Trump told lawmakers at the White House on Tuesday.

But Republican leaders, including House Speaker Paul Ryan, are once again struggling to balance the concerns of moderates, who want to protect Americans with pre-existing medical conditions, with the reluctance of conservatives to make changes.

Representative Mark Meadows of North Carolina, who heads the staunchly conservative House Freedom Caucus that helped block passage of the first bill, said Republicans were still “a handful of votes away.”

Representative Tom MacArthur of New Jersey, a Republican moderate who brokered a deal that revived the healthcare legislation, said there were still some moderates in the party sitting on the fence.

“It’s close. It’s close. We’re getting there,” MacArthur said.

Lawmakers are considering a bill that would allow states to opt out of Obamacare protections for people with pre-existing medical conditions – provisions that force insurers to charge sick people and healthy people the same rates.

That is seen as a concession to the Freedom Caucus, which has endorsed the new measure. In an interview earlier this week, Trump, however, insisted the new bill would maintain protections for those with pre-existing conditions.

Republicans have long vowed to repeal Democratic former President Barack Obama’s 2010 healthcare restructuring, arguing that the law, which allowed some 20 million Americans to gain healthcare insurance, was too intrusive and expensive.

During his 2016 campaign, Trump also vowed to get rid of it.

Republicans, however, remain divided over key provisions of the bill, with some lawmakers expressing worries of a spike in the number of people without coverage, or sharp increases in insurance premiums.

“They’re still talking about possible changes. If they don’t have the votes, then they’ll have to make changes,” Representative Peter King of New York, a Republican moderate, told reporters, indicating he would likely vote for the bill.

But any tack to the center to shore up moderates’ support threatens to spur defections on the Republican right flank.

“They change it one iota, I’m out,” Representative Dave Brat of Virginia, a Freedom Caucus member, told reporters.

OPPOSITION

Adding to the pressure on Republicans is the unified opposition of Democrats, many of whom view the 2010 healthcare law as the defining domestic achievement of Obama’s presidency, as do healthcare advocates.

Ten major patient advocacy groups, including the American Heart Association and American Diabetes Association, have said they opposed the reworked healthcare bill.

Other major medical groups such as the American Medical Association have also expressed concerns over coverage losses and unaffordable insurance for those with pre-existing conditions.

If a plan passes the House, it is expected to face a tough fight in the Senate, where Republicans have a narrower majority and where some party senators have expressed misgivings about the House bill.

(Reporting by Richard Cowan, David Morgan, Steve Holland and Doina Chiacu; Writing by Paul Simao; Editing by Dan Grebler)

U.S. Republican leaders hunt for votes for healthcare bill

U.S. House Speaker Paul Ryan speaks about healthcare at his weekly press briefing on Capitol Hill in Washington, U.S, April 27, 2017. REUTERS/Yuri Gripas

By Susan Cornwell

WASHINGTON (Reuters) – House Republicans were making headway in efforts to build support for a reworked plan to overhaul the U.S. healthcare system, but have not decided when to vote, House Speaker Paul Ryan said on Thursday.

Ryan spoke as Republican leaders scoured the U.S. Capitol in search of centrist Republican backing for the amended measure after it gained the approval on Wednesday of a group of hard-right Republican conservatives who had helped to sink the original version last month.

“We’re making very good progress,” Ryan told reporters at a news conference, saying the changes endorsed by conservative Freedom Caucus Republicans on Wednesday would also appeal to moderate Republicans.

The House could vote as early as this week on the legislation, aides said, meaning it could pass the House in time for President Donald Trump’s 100th day in office on Saturday.

It remained unclear whether the amended bill could attract the 216 votes needed to pass the House, given the united Democratic opposition. Its future is further clouded in the Senate.

“We’re going to go when we have the votes,” Ryan said.

Republicans in Congress have made repealing and replacing the Affordable Care Act, commonly known as Obamacare, a central campaign promise for seven years. Republican President Donald Trump made it a top campaign promise.

But House Republicans are not keen to repeat last month’s debacle, when their leaders acquiesced to Trump’s demand for a floor vote on the bill, only to unceremoniously yank the measure after determining it could not pass.

The Republican healthcare bill would replace Obamacare’s income-based tax credit with an age-based credit, roll back an expansion of the Medicaid government health insurance program for the poor and repeal most Obamacare taxes.

The nonpartisan Congressional Budget Office had estimated 24 million fewer people would have insurance under the original version.

The new amendment that has won over a number of conservatives, drafted by Representative Tom MacArthur, would allow states to seek federal waivers to opt out of some of the law’s provisions. That includes the highly popular provision mandating that insurers charge those with pre-existing conditions the same as healthy consumers, and that insurers cover so-called essential health benefits, such as maternity care.

Some centrists say the changes do not address their worries that the bill would hurt poor Americans in the Medicaid program. Others, including Republican Representative Dan Donovan of New York, said the loosening of protections for people with pre-existing medical conditions was a major problem.

“It’s going to cost people with pre-existing conditions even more money to have coverage … It’s something that we shouldn’t be doing,” Donovan said on CNN.

House Democrats on Thursday threatened to oppose a short-term government funding bill if the Republicans try to bring the healthcare bill to the floor this week.

Ryan brushed off this threat, even though Republicans are expected to need some Democratic votes to pass the funding bill.

House Democratic Leader Nancy Pelosi told reporters that Trump was making Republicans “walk the plank” on a healthcare bill that was “wildly unpopular.”

Ryan dismissed the idea that some Republican lawmakers’ House seats were at risk if they vote for the healthcare bill. “I think people’s seats are at risk if we don’t do what we said we would do” and repeal Obamacare, he said.

(Reporting by Susan Cornwell and Susan Heavey; Additional reporting by Amanda Becker and Will Dunham; Editing by Jeffrey Benkoe)

Trump extends program allowing some veterans to use local doctors, hospitals

U.S. President Donald Trump smiles after signing S.544, the Veterans Choice Program Extension and Improvement Act, at the White House in Washington, U.S., April 19, 2017. REUTERS/Kevin Lamarque

By Lisa Lambert

WASHINGTON (Reuters) – President Donald Trump on Wednesday moved a step closer to fulfilling his campaign promise to reform the troubled Veterans Affairs department, but some veterans groups are concerned that the administration may be working toward privatizing their healthcare.

Trump signed a law extending the pilot “Veterans Choice” program, which allows some veterans to receive healthcare from local doctors and hospitals closer to their homes than the VA’s 150 hospitals and nearly 1,000 outpatient clinics. The law eases procedures for reimbursing private providers and creates a system for sharing medical records with them.

“This new law is a good start, but there is still much work to do,” Trump said at a signing ceremony attended by VA Secretary David Shulkin and Florida Governor Rick Scott.  “We will fight each and every day to deliver the long-awaited reforms our veterans deserve.”

Trump pledged to hold a news conference next week on “all of the tremendous things that are happening at the VA and what we’ve done in terms of progress and achievement.”

Reforming the agency, rocked by a waiting-time scandal in 2014, was one of Trump’s most-repeated campaign trail promises. He has frequently suggested having the government pay outside physicians to provide veteran healthcare.

During his confirmation hearings, Shulkin said he supported overhauling the agency but did not believe in privatizing it. Still, on Tuesday the VA announced it was seeking cutting-edge treatments from the healthcare industry for brain injuries, mental health problems and chronic pain.

Extension of the “Veterans Choice” program could worry Democrats and other critics that Trump and Shulkin are inching toward sending some of the $65.6 billion the department spends annually on medical care to corporations and private businesses.

Conservatives calling for privatization say the VA provides medical services to only about 45 percent of veterans, and they point to delays and inefficiencies dogging the current system.

Some veterans groups and Democrats have warned against moving funds away from healthcare providers with expertise in injuries and illnesses unique to serving in the armed forces.

In a March report, the Government Accountability Office said veterans in the Choice program still face long wait times, mostly because cases must be referred to private contractors for scheduling.

Last year a congressionally mandated panel of experts found the Choice program was inefficient, but recommended establishing a community-based healthcare system that would include private doctors.

(Reporting by Lisa Lambert; Editing by David Gregorio)

Insight: Ballooning bills – More U.S. hospitals pushing patients to pay before care

FILE PHOTO: An emergency sign points to the entrance to Scripps Memorial Hospital in La Jolla, California, U.S. March 23, 2017. REUTERS/Mike Blake/File Photo

By Jilian Mincer

(Reuters) – Last year, the Henry County Health Center in Iowa started providing patients with a cost estimate along with pre-surgery medical advice.

The 25-bed rural hospital in the southwest corner of the state implemented the protocol because of mounting unpaid bills from insured patients, a group that had previously not raised red flags.

Henry County is one of hundreds of U.S. hospitals trying to cope with an unexpected consequence of the Affordable Care Act of 2010, known as Obamacare: millions more Americans have health insurance, but it requires them to spend thousands of dollars before their insurer kicks in a dime.

Since U.S. hospitals do not want to end up footing the bill, they are now experimenting with pre-payment strategies for patients, with a growing number requiring payment before scheduled care and offering no interest loans, according to interviews with more than two dozen hospitals, doctors, patients, lenders and healthcare experts.

“Most patients are appreciative that we’re telling them up front,” said David Muhs, chief financial officer for the Henry County hospital, which provides a discount for early payment. The discussion leads some patients to skip care, others to delay it or use a no interest loans available through the hospital, he said.

The ACA extended insurance to 20 million Americans, which initially helped hospitals begin to shrink debt from uninsured patients who could not pay their medical bills. But more and more, people in Obamacare plans or in employer-based health plans are choosing insurance that features low monthly payments. The trade-off is high out of pocket costs when they need care. (For a graphic, click http://tmsnrt.rs/2oCzePS)

If President Donald Trump dismantles Obamacare as promised, these plans won’t disappear. Republicans also believe high-deductible plans curb spending, and Americans faced with medical costs that rise faster than inflation and wages will look for premiums they can afford.

The trend is expected to accelerate this year because unpaid bills are creating massive bad debt for even the most prestigious medical centers. U.S. hospitals had nearly $36 billion in uncompensated care costs in 2015, according to the industry’s largest trade group, a figure that is largely made up of unpaid patient bills.

The largest publicly-traded hospital chain, HCA Holdings Inc, reported in the fourth quarter of 2016 that its ratio of bad debt to gross revenues of more than $11 billion was 7.5 percent.

One of the first to test this new payment strategy was Novant Health, headquartered in North Carolina with 14 medical centers and hundreds of outpatient and physician facilities. It saw patient debt increase when more local employers started adopting high deductible plans, including one that made its executives pay $10,000 in out-of-pocket expenses.

“To remain financially stable, we had to do something,” said April York, senior director of patient finance at Novant, whose patient default rate dropped to 12 percent from 32 percent after it started offering no interest loans through ClearBalance.

“Patients needed longer to pay. They needed a variety of options,” she said.

IMPACT ON PATIENTS

These prepayment strategies are being rolled out by hospitals across the country because the financial equation has changed so much for patients – even the insured ones.

Almost half of Americans – 45 percent – polled by the Kaiser Family Foundation said they would have difficulty paying an unexpected $500 medical bill. The average deductible this year for the least expensive of the widely used Obamacare health plans is $6,000 for an individual – an 18 percent spike since 2014 – and more than double that for a family, according to government data.

Jessica Curtis, a senior advisor at Community Catalyst, a consumer advocacy group in Boston, said the impact on patients stretches beyond personal finance.

“They delay procedures, they don’t follow advice on prescription drugs, and when they see care, they usually are for more expensive procedures because they’ve waited,” she said

Brian Sanderson, managing principal of Crowe Horwath’s healthcare services group, said communicating with patients and providing longer repayment options is a good strategy since hospital margins have shrunk, thanks to growing unpaid medical bills from consumers.

“A well informed patient is more likely to meet their obligations,” he said. “It’s just good patient relations and it helps to minimize bad debt.”

Hospitals are doing what they can to retain patients while helping them pay medical bills that could run thousands of dollars. Many are expanding charity eligibility, and hiring companies like ClearBalance, AccessOne and Commerce Bank to provide loans to patients no matter what their credit. Most carry no interest rate for the patient, and could be extended far longer than the few months that hospitals once required before sending a bill to collections.

“People are more likely to pay a bank than a hospital,” said Mark Huebner, director of Health Services Financing at Commerce Bank, which offers its line of credit at more than 200 hospitals.

“People are aware that banks will come after them. Banks do collect on debt, and hospitals generally have been more relaxed,” he said.

Wake Forest Baptist Medical Center in North Carolina had seen its bad debt creep up in recent years as more patients saw out of pocket expenses soar, with some deductibles reaching $15,000.

“We’ve seen that many patients are unaware of the increases in their deductibles,” said CFO Chad Eckes. Wake Forest now asks for payment before non-emergency services are provided but also offers zero interest, longer repayment options.

“It’s a challenging position,” he said. “It’s a discussion no one wants to be in, and none of us enjoy.”

(Editing by Caroline Humer and Edward Tobin)