Tag Archives: Obamacare

Anthem to leave Ohio’s Obamacare insurance market in 2018

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

By Caroline Humer

(Reuters) – Anthem Inc, which has urged Republican lawmakers to commit to paying government subsidies for the Obamacare individual health insurance system, on Tuesday announced it would exit most of the Ohio market next year.

The high-profile health insurer, which sells Blue Cross Blue Shield plans in 14 states including New York and California, for months has said that uncertainty over the payments used to make insurance more affordable could cause it to exit markets next year.

Anthem CEO Joseph Swedish two weeks ago reiterated that the company was reviewing its participation in the individual markets that are a key piece of the Affordable Care Act, commonly called Obamacare.

Republican lawmakers and President Donald Trump have promised to repeal and replace the law, but have disagreed over the details, creating uncertainty at a time when insurers must submit plans and premium rates for 2018.

In addition, Republicans are trying to cut off these Obamacare subsidy payments in court proceedings and President Donald Trump has made conflicting statements about continuing paying them.

Insurance departments across the country have reported that insurers have submitted premium rate increases of up to 50 percent and 60 percent or even higher for 2018.

Anthem attributed the Ohio decision to volatility and uncertainty about whether the government would continue to provide cost-sharing subsidies. It said it would continue to sell Obamacare compliant plans outside of the exchange in Pike County, Ohio as well as other individual plans that were grandfathered when the law went into effect.

Anthem is the only insurer selling health insurance exchange products in all 88 Ohio counties in 2017 and the only insurer in 20 counties, according to Ohio Department of Insurance spokesman Chris Brock.

In 2018, the move would leave about 10,500 people in at least 18 counties with no insurer.

“Congressional action is needed to restore stability,” Brock said. The insurance department is looking for options for those affected, he said.

Other large health insurers have also pulled out for 2018, including Aetna Inc and Humana Inc, leaving other areas facing the possibility of no insurer.

Anthem’s decision was made as rate filings were due to the state and after discussions with the insurance department.

“States can beg and plead, but much of this is out of their hands,” said Larry Levitt, health economist at the Kaiser Family Foundation.

Anthem shares rose $1.19, or 0.64 percent, to $187.88 in early afternoon trading.

(Reporting by Caroline Humer in New York; editing by Jeffrey Benkoe and Andrew Hay)

Planned Parenthood to close four Iowa clinics after cuts

FILE PHOTO - Iowa Governor Terry Branstad arrives to testify before a Senate Foreign Relations Committee confirmation hearing on his nomination to be U.S. ambassador to China at Capitol Hill in Washington D.C., U.S. on May 2, 2017. REUTERS/Carlos Barria/File Photo

By Chris Kenning

(Reuters) – Planned Parenthood said on Thursday it would shutter four of its 12 clinics in Iowa as a result of a measure backed by Republican Governor Terry Branstad that blocks public money for family planning services to abortion providers.

Health centers in Burlington, Keokuk and Sioux City will close on June 30 and one in Quad Cities soon after as a result of losing $2 million in funds under the new measure, said Susan Allen, a spokeswoman for Planned Parenthood of the Heartland. The four clinics served 14,676 patients in the last three years, she said, including many rural and poor women.

“It will be devastating,” Allen said.

The closures marked the latest fallout from a continuing push by Republicans, including President Donald Trump, to yank funding from Planned Parenthood. Many have long opposed the organization, some on religious grounds, because its healthcare services include abortions, although it receives no federal funding for abortions, as stipulated by federal law.

The Republican-controlled U.S. House of Representatives included such a defunding measure as part of the American Health Care Act, the bill aimed at replacing Obamacare.

Iowa’s Republican-led legislature agreed in its recent budget to discontinue a federal Medicaid family planning program and replace it with a state program that bars funding to organizations that provide abortions or maintain facilities where abortions are carried out. The move cost the state about $3 million.

Texas in 2011 made a similar move that has reduced funding. A state report in 2015 found that nearly 30,000 fewer women received birth control, cancer screenings and other care as a result.

A coalition of 35 Iowa groups that oppose abortion have previously argued that funding for family planning indirectly subsidizes abortions.

“The pro-life movement is making tremendous strides in changing the hearts and minds, to return to a culture that once again respects human life,” said Ben Hammes, a spokesman for Branstad, who said there were 2,400 doctors, nurses and clinics around the state for family planning that do not provide abortions.

Planned Parenthood of the Heartland said it will continue to operate eight clinics in Iowa. They provide services including cancer screenings, birth control, STD testing and annual checkups.

The group said in a tweet on Thursday that politicians driven more by personal beliefs than facts were hurting access to women’s health care.

“The devastation in Iowa is a sign of what could be next for the rest of the nation,” Danielle Wells, an official at Planned Parenthood Federation of America, said in an email.

(Reporting by Chris Kenning; Editing by Jonathan Oatis)

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)

White House expects vote on healthcare bill this week

FILE PHOTO: An emergency sign points to the entrance to Scripps Memorial Hospital in La Jolla, California, U.S.

WASHINGTON (Reuters) – Top White House officials said on Monday they expect the U.S. House of Representatives will vote this week to pass the Republicans’ latest plan to reform the nation’s healthcare system, even as the party’s lawmakers still appeared divided over the measure.

In interviews on CBS News on Monday, White House chief of staff Reince Priebus and White House economic adviser Gary Cohn expressed optimism the latest push to unwind former Democratic President Barack Obama’s healthcare program would succeed.

“I think it will happen this week,” Priebus said on CBS “This Morning” television program.

In a separate interview, Cohn said he expected the plan to come to the House floor for a full vote. “We’re convinced we’ve got the votes, and we’re going to keep moving on with our agenda,” he said.

U.S. President Donald Trump and fellow Republicans campaigned on a pledge to repeal and replace Obama’s health care law, also known as Obamacare, but have so far failed to unite around a plan.

A reworked proposal failed to secure enough support for a vote last week. A group of hard-line Republican conservatives backed it, but more moderate conservatives remained wary.

Republican Representative Charlie Dent, a moderate from Pennsylvania, said on Monday he still had problems with the latest version of the plan and suspected there were not enough votes to pass it now.

“Too many Americans are going to be without coverage,” Dent told MSNBC.

House Freedom Caucus chairman Jim Jordan, in several television interviews on Monday, said he expected there would be enough House Republican votes to pass the bill this week.

“This bill doesn’t get all the way there but it’s a good step and is … the best we can get out of the House right now,” Jordan told CNN.

(Reporting by Susan Heavey and Doina Chiacu; Editing by Chizu Nomiyama and Jeffrey Benkoe)

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, Republicans face tricky task of averting U.S. government shutdown

FILE PHOTO: U.S. President Donald Trump's overview of the budget priorities for Fiscal Year 2018 are displayed at the U.S. Government Publishing Office (GPO) on its release by the Office of Management and Budget (OMB) in Washington, U.S. on March 16, 2017. REUTERS/Joshua Roberts/File Photo

By Richard Cowan and David Morgan

WASHINGTON (Reuters) – President Donald Trump and his fellow Republicans who control Congress face their first major budget test next week, with the threat of a U.S. government shutdown potentially hinging on his proposed Mexican border wall as well as Obamacare funding.

With Republicans controlling the White House and both chambers of Congress, keeping the federal government operating is a basic test of their ability to govern, but their task could become even more complicated if they insist on using the spending legislation to bring about contentious policy changes.

Not only must Republicans overcome intraparty ideological divisions that stopped major healthcare legislation last month, but they will have to win over some opposition Democrats with provisions that could be distasteful to conservatives.

With the Senate reconvening on Monday and the House of Representatives on Tuesday after a two-week recess, lawmakers will have only four days to pass a spending package to keep the government open beyond April 28, when funding expires for numerous federal programs.

“I think we want to keep the government open,” Trump said on Thursday, adding he thinks Congress can pass the funding legislation and perhaps also a revamped healthcare bill.

Democratic support depends on what provisions Republicans demand in the bill. Democrats have signaled they would not cooperate if it contains money for one of Trump’s top priorities, a southwestern border wall intended to combat illegal immigration, or if it ends federal subsidies to help low-income people buy health insurance under the Affordable Care Act, known as Obamacare, which Republicans want to repeal.

Democrats also want federal funds maintained for Planned Parenthood, which many Republicans oppose because the women’s healthcare provider performs abortions. Another obstacle would be if Trump demands large defense spending increases coupled with deep cuts to domestic programs Democrats want to protect.

BALANCING ACT

Late on Thursday, leading House Democrats were voicing skepticism a deal could be reached by the deadline. In a telephone call for House Democrats, Representative Nita Lowey, the senior Democrat on the House Appropriations Committee, said: “I don’t see how we can meet that deadline” and avoid having to pass a short-term extension, according to an aide on the call.

The second-ranking House Democrat, Representative Steny Hoyer, told his fellow Democrats that they should only support such a short-term measure if a deal on long-term bill is reached and only finishing touches remained, the aide said.

Republican leaders face a familiar balancing act: satisfying the party’s most conservative members while not alienating its moderates.

Rules in the 100-seat Senate mean Trump’s party also would need the support of at least eight Democrats even if the Republicans remain unified, giving the opposition party leverage. House Republican leaders would need some Democratic votes if the most conservative lawmakers object to the bill, as they did to the healthcare plan championed by Speaker Paul Ryan.

With congressional elections looming next year, Republicans acknowledge the stakes are high.

“Even our most recalcitrant members understand that if you shut down the government while you’re running it and you control the House and the Senate, you can’t blame anybody but yourself,” said Representative Tom Cole, a senior House Appropriations Committee Republican.

White House budget director Mick Mulvaney said the Trump administration was willing to talk to Democrats about funding for Obamacare subsidies in exchange for their agreement to include some Trump priorities such as the wall, the defense hike and more money for immigration enforcement.

“It is ripe for some type of negotiated agreement that gives the president some of his priorities and Democrats some of their priorities. So we think we’ve opened the door for that,” Mulvaney said.

Democrats reacted negatively.

“Everything had been moving smoothly until the administration moved in with a heavy hand. Not only are Democrats opposed to the wall, there is significant Republican opposition as well,” said Matt House, a spokesman for Senate Democratic leader Chuck Schumer.

FURLOUGH ‘LADY LIBERTY?’

The government was last forced to close in October 2013, when Republican Senator Ted Cruz and some of the most conservative House Republicans engineered a 17-day shutdown in an unsuccessful quest to kill Democratic former President Barack Obama’s healthcare law.

“These kind of bills can’t pass without a reasonable number of the party of the minority in the Senate, and we are optimistic we will be able to work all that out,” Senate Majority Leader Mitch McConnell said at the start of the spring recess.

A deal is needed because Congress was unable to approve funding for the entire 2017 fiscal year that ends in September and has relied on stop-gap spending legislation.

Congress has passed no major legislation since Trump took office in January, and he has ambitious hopes for major tax-cut legislation, infrastructure spending and other bills.

With the difficulty passing a bill with so many divisive elements, lawmakers next week might need to buy time by passing a short-term bill lasting possibly one to three weeks, maintaining current spending levels.

“That would be a setback: not catastrophic, but not a good thing, and a sign that you can’t govern,” Cole said.

A federal closure would shutter National Park Service destinations like the Statue of Liberty, Yellowstone and the Grand Canyon. Government medical research would be suspended. Thousands of federal workers would be furloughed with thousands more working without pay until the shutdown ends, including homeland security personnel. Some veterans benefits could be suspended.

Time would stand still in the U.S. Capitol with nobody on duty to wind the 200-year-old “Ohio Clock” just outside the Senate chamber.

(Reporting by Richard Cowan and David Morgan; Editing by Kevin Drawbaugh and Will Dunham)

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)

Ryan opposes Trump working with Democrats on healthcare

House Speaker Paul Ryan speaks during his news conference after Republicans pulled the American Health Care Act. REUTERS/Yuri Gripas

WASHINGTON (Reuters) – U.S. House of Representatives Speaker Paul Ryan, the top Republican in Congress, said he does not want President Donald Trump to work with Democrats on new legislation for revamping the country’s health insurance system, commonly called Obamacare.

In an interview with “CBS This Morning” that will air on Thursday, Ryan said he fears the Republican Party, which failed last week to come together and agree on a healthcare overhaul, is pushing the president to the other side of the aisle so he can make good on campaign promises to redo Obamacare.

“I don’t want that to happen,” Ryan said, referring to Trump’s offer to work with Democrats.

Carrying out those reforms with Democrats is “hardly a conservative thing,” Ryan said, according to interview excerpts released on Wednesday. “I don’t want government running health care. The government shouldn’t tell you what you must do with your life, with your healthcare,” he said.

On Tuesday, Trump told senators attending a White House reception that he expected lawmakers to reach a deal “very quickly” on healthcare, but he did not offer specifics.

“I think it’s going to happen because we’ve all been promising – Democrat, Republican – we’ve all been promising that to the American people,” he said.

Trump said after the failure of the Republican plan last week that Democrats, none of whom supported the bill, would be willing to negotiate new healthcare legislation because Obamacare is destined to “explode.”

(Reporting by Lisa Lambert and Eric Beech; Editing by Leslie Adler)