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Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!


Doctors are on the Hill


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Today, Doctors for America is on Capitol Hill advocating for patients across the nation, as the Senate covertly and hastily rushes through a health care plan that would be devastating for millions of Americans. Physicians, nurses, medical students, and health care advocates will underscore the very real consequences of the American Health Care Act for patients, and what exactly lack of coverage means to the people they serve.
 
For so many of you, access to coverage has meant the difference between life and death for patients in your care. Healthcare providers know that coverage is good medicine. Current proposals roll back access to health care, dramatically cut Medicaid funding, and end life-saving consumer protections, jeopardizing our most vulnerable patient communities.
 
This is why your voice is critical today. Join us on social media and live-stream our press conference at 1:15PM EST.
 
Our providers will be joined by House Democratic Leader Nancy Pelosi, House Democratic Whip Steny Hoyer, Congressman Raul Ruiz, M.D. (CA-36), Congressman Ami Bera, M.D. (CA-07) and dozens of health care providers and advocates.
 
Two important actions you can take today while DFA is on the Hill:
1. Call your Senators and Representatives at (202) 224-3121 to urge them to vote NO on the American Health Care Act. Call today and every day leading up to the vote next week.
2. Share the livestream and join us on Twitter using hashtags: #PatientsOverPolitics, #ProtectOurCare and #ProtectPatients.
 
Thank you for standing in unison with us in your own communities, to send our elected officials a strong message to put patients over politics and protect our care, for the millions of Americans who have benefited from affordable, accessible, quality health coverage.
 
In solidarity,
 
Shalini Pammal
Meghana Rao
DFA Board Members

 

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Rushing toward repeal


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As we speak, the Senate is rushing to pass a bill, the American Health Care Act, that would repeal the Affordable Care Act. This reckless and hastily-written bill would cause 23 million Americans to lose their coverage and be unable to afford their care. To lawmakers, this may be an abstract number. But as physicians, we know first hand what harm this will mean for our patients.

I have been taking care of a 54 year old man for the past 2 years. He has always worked full time, but his jobs never gave him health benefits. He could not afford his medications for diabetes and hypertension and went without them for years. He got regular insurance for the first time at age 52 through the Affordable Care Act. Now, he can get the care he needs including medications, lab testing, and specialist visits. His blood sugars and blood pressure have improved. However, if the American Health Care Act passes, he would lose his coverage and go back to putting his health on the back burner. We have seen this story before and it always ends badly for our patients.

Doctors for America is leading the fight to preserve our patient’s needed coverage. We will be doing a "White Coat Fly-in" on June 22, 2017 to the U.S. Capitol to let lawmakers know that they must put patients over politics and stop the harmful American Health Care Act. 

Efforts like this and others require time, energy, and money. Lots of valuable staff time is needed to put this event together. Your donation will support our staff in making sure the Senate hears our voice.

Now is the time to stand up for your values. Please stand with us for your health and the nation’s health.

 

Sincerely,

Krishnan Narasimhan M.D

DFA Board Member

 

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Emergency White Coat Fly-In June 22nd


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The U.S. Senate has announced their plan to fast-track the American Health Care Act (AHCA), a bill which aims to repeal large portions of the Affordable Care Act. We have a short window to make an impact. This legislation is a political and moral travesty, that will not only strip health insurance from 23 million Americans and end vital consumer protections, but will also make health care increasingly unaffordable and inequitable for millions currently benefiting from life-saving coverage provided by the Affordable Care Act. 

Please join us June 22, 2017 for a White Coat Fly-in. Now, more than ever, Senators need to hear from providers and healthcare professionals who care for patients directly affected by this harmful legislation. Make your voice heard at a press event with Congressman Raul Ruiz, and then join us for meetings with key Senators. 

This is not a drill. Congress is closer than ever before to repealing the ACA. It is now or never for physician advocates to speak up. All the work we have done together to this point— our numerous phone calls and LTEs, petitions and marches— have always been in service of patients over politics. Our concerted efforts to oppose the AHCA will not only send a strong message to Congress, but will also send a strong message to our patients, that we will tirelessly fight for them and for the affordable, accessible, quality care that they deserve. 

Join us at this crucial moment to protect our patients, for whom this coverage is a lifeline. We look forward to linking arms and elevating our voices with you in Washington, D.C. on June 22nd.

 Can't attend but want to make your voice heard? Sign our open letter.

 

 

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DFA Round Up - June 9, 2017

By Shalini Pammal
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TAKE ACTION
  • As the Senate attempts to fast-track repeal, step up and sign our petition urging the Senate not to take away coverage from millions of Americans.
  • Join us June 22nd for a White Coat Fly-in. Given the Senate's announcement that they will be fast-tracking a bill to repeal the ACA by the end of the month, we are hosting an emergency White Coat Fly-in this month instead of July. We will hold a press conference and lobby day along with Congressman Raul Ruiz (CA-36) and other provider partners, to send a strong message that Congress should not support any proposal that strips coverage from 23M Americans, and does not provide affordable, quality health care for all. The Senate is closer than ever to repeal. We need you in DC. RSVP to join us.

WEEK-AT-A-GLANCE

Senate Republicans are reportedly nearing a bill to repeal the Affordable Care Act, coalescing around a replacement plan that diverges from the House bill, in an effort to garner support from more moderate Republicans. Key GOP centrists have expressed their willingness to end federal funding for Medicaid expansion, creating an opening for more convergence within the party on this critical issue. Republican proposals would gradually phase out funding over a slower timeframe, and cap federal payments to states. The Senate bill is also poised to allow states waivers for Obamacare rules on essential health benefit requirements, but not the more popular consumer protections for pre-existing conditions. These changes have received strong pushback from conservatives, creating a similar dynamic among centrists and conservatives which had caused problems for House leadership to pass a bill. Furthermore, Republicans have included language in the bill that prohibits abortion coverage, which may be non-compliant with Senate procedural rules that only allow for budgetary changes. This has drawn fire from conservative, anti-abortion groups who have vowed opposition to any bill that does not include abortion restrictions.  President Trump has affirmed his interest in an aggressive timeline for repealing the law, with some reporting that Senate Republicans may try to vote on a bill by the end of June.

With little guidance from the administration, insurers remain uncertainabout their continuation in federal marketplaces. Anthem exited the Obamacare market in Ohio earlier this week, leaving at least 18 counties and 13,000 people without any coverage option under the program next year. An Anthem exit would in other markets would raise the number of uninsured to 300,000 across seven states. In New York, health insurers are seeking an average 16.6% premium rate increase, a substantial increase in cost for New Yorkers who do not receive help from Obamacare subsidies. Without clarity on whether cost-sharing reduction payments will continue, or whether the individual mandate requirement will be enforced, companies have requested anywhere from a 4.4% to 48.8% rate increase for Affordable Care Act plans. In the wake of the growing insurer exodus from the exchanges, Senate Republicans are concluding that cost-sharing subsidies will have to continue in order to stabilize the market, and are likely to include this in their repeal bill. Though Price has confirmed that the Department of Health and Human Services budget for the next fiscal year includes funding for the payments, it is still unclear for how long these will remain.

MEMBERS IN ACTION

Tell us about what you are up to! Email your updates and photos to DFAHQ@drsforamerica.org.

ILLINOIS

Dr. Ram Krishnamoorthi was invited by Oren Jacobsen to give a talk in Northbrook to a group that meets monthly to hear about various issues and ways to take action. He spoke about health care reform and urged attendees to speak out at this critical moment for the health of millions of patients.



NEW YORK

Dr. Bruce Rector, leader of DFA's Drug Pricing, Value, and Affordability Campaign, spoke at the Public Health Association of NYC Legislative Breakfast on drug affordability and public health.



WASHINGTON

Dr. Lisa Plymate shares that the state Health Care is a Human Right coalition created a video featuring coalition members titled, "What’s Your Plan?" You can watch it here.

FOOD TEAM

The DFA Food Team, led by Rita Nguyen, Isabel Chen and Rebecca Parad, held a Food As Health webtalk recently. The conversation focused on the many patients who struggle with food insecurity, though often don't share this struggle with their health care provider. Guest experts discussed the importance of understanding patients' food access situations and supporting them with connections to nutritious food as an important part of any treatment plan to prevent or manage illness. A campaign to address food insecurity will be launching this summer. View a recording of the webtalk here.

DRUG PRICING TEAM

Dr. Bruce Rector, a leader of the DFA Drug Pricing Team, which includes Dennis Deruelle, Justin Lowenthal, and Mark Rood, have had an impressive three wins already this year on drug affordability that DFA contributed to getting passed. An overview is below:

Maryland: At the end of the legislative session, the Legislature passed a drug pricing law intended to curb price gouging. It gives Maryland’s Attorney General the power to demand explanations from drug companies for unconscionable price increases for generic or off-patent drugs, and to administer fines. We previously wrote about how this bill should serve as a model for legislators in other states.

New York: A new law sets an annual cap on Medicaid prescription drug spending. It aims to limit total payments to the sum of medical inflation plus 5%. If this is exceeded, it allows regulators to conduct a review that uses scientific studies and other information to determine if specific medications are overpriced in relation to their medical benefits.

Nevada just passed a bill, S.B. 539, that mandates transparency from both pharmaceutical companies and the middlemen in the drug pricing process known as pharmacy benefit managers (PBMs). PBMs are responsible for negotiating between pharmacies and insurance companies. The bill also requires that health care nonprofits disclose any contributions they receive from the pharmaceutical industry, PBMs and insurers. It was approved by the State Senate 19-2 and has been sent to the Governor’s desk; he stated he will be proud to sign it.

KEY ARTICLES 

 

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Action alert: Senate fast-tracking ACA repeal


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The Senate is moving with haste this summer to pass a bill, the American Health Care Act, that would repeal the Affordable Care Act and cause 23 million Americans to be uninsured. The next three weeks will be crucial as the leadership in the Senate has announced their intentions to pass the AHCA by the end of the month. Much of the planning about the bill is being done in secret, but reports indicate the Senate bill will look very similar to the harmful bill that passed the House.

This is a critical moment for the future of the ACA, Medicaid and our patients. Please do whatever you can to make your voice heard over the next three weeks. Below are some tools and suggested actions to aide your outreach.

Take Action:

  • Call your Senator frequently over the next three weeks: (202) 224-3121. If you get a busy signal at the DC office then call their district number. Offices keep records of the calls they get for and against legislation, which inform the way they vote. This is especially important if you live in a target state (listed below)
  • Request a meeting. Contact your Senator’s DC or district office and set up a meeting with them or their staff.
  • Sign our petition to make your voice heard. We will deliver these petitions to the Senate in the coming weeks. After you sign, share it with your friends and colleagues. 
  • RSVP for our upcoming White Coat Rally on June 22nd. This will take place before the Senate heads off for recess. Help us make sure they know where physicians stand. *Please note the change in date given the timing of the bill in the Senate.

 

Key Points:  

Ask your Senator to oppose any proposals that do the following damage to America's health care:

  • Destroy the Medicaid program as we know it by changing the structure through block grants or per capita caps.
  • Ends the Affordable Care Act's Medicaid expansion.
  • Increases the number of people without health insurance.
  • Undermines the consumer protections put in place by the Affordable Care Act, like protecting coverage for those with pre-existing conditions.

Senate Targets:

Collins (ME) 

Murkowski (AK) 

Heller (NV) 

Capito (WV) 

Flake (AZ)

Portman (OH)

Gardner (CO)

Cassidy (LA)

Toomey (PA)​

 

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Join us in DC


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Every step of the way doctors have fought for the Affordable Care Act because we believe everyone deserves the right to quality, affordable health coverage. Thanks to our efforts, millions of people are insured, patients can no longer be discriminated against because of pre-existing conditions, and Medicaid expansion has provided life-saving coverage. We can't go backward.

Right now, a bill to repeal the ACA, the American Health Care Act, has passed the house and is before the Senate. Stopping this bad bill is going to require each of us to rise up and make our voices heard. As you well know, physicians are trusted messengers on healthcare. That is why we are planning to convene doctors and medical students from across the country in Washington, DC to urge Senators not to rollback the coverage of millions of patients. Join us for a White Coat Fly-in on June 22nd in DC. 

Let’s gather in the nation's capital to urge Senators to put patients over politics. 

Can’t make it but still want to make your voice heard? Add your name to our open letter.

We hope to see you in DC! 

 

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Join us for a Food As Health Webtalk on 5/30


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As you know, the Affordable Care Act remains under serious threat. We remain committed to putting our shoulders to the wheel at this crucial moment to keep our patients covered. At the same time, DFA members said in our last survey that food insecurity was one of the most important issues for DFA to tackle for our patients. 

While we continue to tackle national health policy, we too will need to lead the charge in addressing major barriers to our patients' health -- one of which is food insecurity. Many of our patients struggle with food insecurity, though often don't share this struggle with their health care provider. Understanding patients' food access situations and supporting them with connections to nutritious food can be an important part of your treatment plan to prevent or manage illness. So join us for our upcoming webinar with leading experts in food insecurity and advocacy. 

Food As Health: Engaging Physicians, Patients & Communities

Co-Sponsored by Feeding America

Tuesday, May 30, 2017

5PM PST/8PM EST


Then, submit your questions for our speakers and we will do our best to answer them during the call.

Deborah A. Frank MD

Deborah A. Frank serves as Boston University School of Medicine professor of Pediatrics; director, Grow Clinic for Children at Boston Medical Center (BMC); and founder and principal investigator of Children’s HealthWatch, a network of pediatric and public health researchers working to improve child health. A highly respected national authority, she has testified before both the United States and Massachusetts legislatures on the growing national problem of hunger and its effects on children. Dr. Frank also leads research funded by the National Institute on Drug Abuse on the effects of intrauterine exposure to cocaine and other substances on children’s long term development. She advocates at hearings and in the media against criminalizing addicted mothers or stigmatizing their children.

Dr. Frank has served on numerous committees and advisory boards including the Mayor’s Hunger Commission, the Massachusetts Child Hunger Initiative and the Physicians Task Force on Childhood Hunger in Massachusetts. She has received awards in recognition for her work including the 2004 Standing Ovation Award, Massachusetts Human Services Coalition; 2007 Woman of Valor Award, Jewish Funds for Justice; 2008 Woman of Justice Award, Boston Lawyer’s Weekly, and more recently in 2010 Dr. Frank received the Massachusetts Health Council Outstanding Leadership Award and the Physician Advocacy Merit Award from the Institute on Medicine as a Profession at Columbia University. Dr. Frank is the author of more than 50 papers and articles.

Hilary Seligman, MD, MAS

Hilary Seligman, MD, MAS is Associate Professor in Residence at the University of California San Francisco with a primary appointment in the Division of General Internal Medicine and a secondary appointment in the Department of Epidemiology and Biostatistics. She is also Core Faculty for UCSF’s Center for Vulnerable Populations at San Francisco General Hospital, the city’s public hospital. As a general internist, Dr. Seligman treats outpatients and inpatients at San Francisco General Hospital.

As a researcher, Dr. Seligman's work focuses on the intersection between food insecurity in the US and health, particularly the prevention and management of chronic disease. Food insecurity refers to going hungry, or being at risk of going hungry, because of the inability to afford food. As one of the nation's foremost experts on the health implications of food insecurity, Dr. Seligman uses a combination of community-based, clinic-based, and epidemiologic studies to understand the tight connections between food insecurity and ill health, and to develop and test interventions designed to improve health by increasing food access and affordability. Her research has appeared in New England Journal of Medicine, Health Affairs, Archives of Internal Medicine, and Journal of Nutrition, among others. She regularly speaks about the public health implications of food insecurity to local, regional, and national audiences. Her policy and advocacy expertise focus on federal nutrition programs (such as the Supplemental Nutrition Assistance Program, formerly known as Food Stamps), food affordability and access, and income-related drivers of food choice.

Dr. Seligman also serves on the Board of Directors for California Food Policy Advocates and the San Francisco-Marin Food Bank. She serves on the Food Security Task Force for the City and County of San Francisco.

Rita Nguyen, MD, Food As Health Moderator

Dr. Nguyen is a San Francisco Bay Area native whose interests are founded on a desire to unite the humanitarian promise of medicine with the pursuit of social justice. Her public service work has been primarily community-based and focused on addressing inequities faced by underserved communities. In terms of addressing healthcare access, Dr. Nguyen helped found Pacific Free Clinic, a Stanford-affiliated, student-run free clinic on the east side of San Jose. Her work has also encompassed physician advocacy and health policy. As a Doctors for America State Director, she led physician advocates in the greater Boston area to champion reforms that would create a better healthcare system for all, especially the most vulnerable segments of society.

At Zuckerberg San Francisco General Hospital (ZSFG), her main extra-clinical interests lie in transition in care, food environments, and physician advocacy. As Medical Director of Healthy Food Initiatives at ZSFG, she spearheaded several projects that emphasizes the importance of food and health including creating Food Pharmacies where patients can fill prescriptions for healthy diets written by their providers and a transitional meal program that partners with Project Open Hand to deliver medically tailored meals to patients discharged from ZSFG with heart failure. As an Assistant Health Officer and Chronic Disease Physician Specialist for the San Francisco Department of Public Health, she supports chronic disease and cancer prevention efforts for the City and County of San Francisco. 

FEEDING AMERICA, Co-Sponsor of Food As Health Campaign

Feeding America aims to feed America’s hungry through a nationwide network of member food banks and engage our country in the fight to end hunger. It is the nation’s largest domestic hunger-relief organization—a powerful and efficient network of 200 food banks across the country. As food insecurity rates hold steady at the highest levels ever, the Feeding America network of food banks has risen to meet the need. Feeding America feeds 46 million people at risk of hunger, including 12 million children and 7 million seniors. 

 

Sincerely,

Rita Nguyen, Isabel Chen & Rebecca Parad

Food As Health Leadership Team

 

ADDITIONAL LINKS: 

http://act.drsforamerica.org/go/2270?t=7&akid=1760.46553.QcaDpf

http://act.drsforamerica.org/go/2272?t=10&akid=1760.46553.QcaDpf

 

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Thank you for eight extraordinary years

By Dr. Alice Chen
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Today is my final day as Executive Director of Doctors for America. I awoke this morning with a sense of pride and gratitude for all we have done together and a sense of possibility and excitement for all that Doctors for America will do moving forward.

I came to Doctors for America over eight years ago as a newly trained internal medicine hospitalist wondering how I could stop the heartbreak of so many of my patients who were struggling to get care in a system that felt stacked against them.

My first act was simple: I signed a petition. It was the first time I signed anything as a doctor in the public sphere, but I saw that I was among thousands of colleagues who went first, so I followed. Then I got a phone call asking me to get more involved. I was touched that a stranger thought I could contribute even though I knew little about politics or advocacy. But I knew I had to do something, so I buzzed around as a happy worker bee, eager to help in whatever small ways I could.

I found myself increasingly captivated by the power I could see in the doctors and medical students who were coming out of the woodwork, peering out from our clinics and hospitals and realizing that our experiences from the trenches of patient care might help make things better. What we lacked in experience, we made up in bounds with heart and determination.

In the years since those early days, I have had the incredible honor and privilege of leading our movement of passionate, thoughtful, brave, and generous doctors and medical students across all 50 states who put their names, voices, and reputations on the line to speak up again and again on the issues that impact our patients’ lives. While I have had plenty of fears, frustrations, and self-doubt as a leader, it is this community that has always been there to buoy my spirits and keep me going.  

We have accomplished so much together. Today, over 20 million people have health care who didn’t before. Gun violence prevention is no longer a taboo subject and is seen by many as an issue of public health. Doctors for America members have become leaders in communities and nationally. Medical students just entering the profession now know that advocacy is part of our responsibility and our role as physicians. And millions of people see doctors standing up for them and feel like they matter.

Yet there is still so much to do. Even as I write, a group of Senators are working hard to find ways to repeal major provisions of the Affordable Care Act and cut Medicaid funding, throwing the care of millions into jeopardy. Women’s health is coming under attack. Congress is considering proposals that would make it easier for gun violence to happen. Immigrants and people of color - doctors and patients alike - are facing discrimination and violence. The Administration is looking to re-energize the war on drugs instead of recognizing substance use disorders as a chronic disease to be treated with compassion and evidence-based care.  Vulnerable communities worry about how they can afford healthy food and how they will care for their families if they lose their jobs or get sick.

America needs us to stand firm for the kind of country our patients deserve. America needs us to lead the way, to remind us of what matters, to demand that our leaders put patients over politics every time. I hand over the reins of Doctors for America today to our board, national and state leaders, and to all of you knowing that America needs your ideas, creativity, energy, and determination in the fights at hand and the fights ahead.

I believe even more today than ever before in the power of Doctors for America. I believe in our power to shape the world around us, especially in difficult times. How we use that power depends on you. I ask you in moments of darkness to choose light. Speak up for your patients. Reach out to support one another and recruit people to our movement. Step up as often and in as many ways as you can, and together we will build a better world.

In closing, I want to say thank you to my husband Vivek for his love and leadership and for dreaming up the idea of Doctors for America in the first place that has so enriched my life and the lives of so many others. Thank you to Milan de Vries and Nikhil Wagle for their audacity in co-founding our movement. Thank you to Doctors for America leaders and staff past and present especially our outgoing board chair Mona Mangat, our incoming board chair Scott Poppen, and our communications director Brannon Lazo. Thank you to our funders and donors, to our partner organizations, to elected officials and public servants who have stood with us, and to my family and friends who have supported and encouraged me on this journey.  

Most of all, I want to thank you for your faith in me as a leader, for all you have taught me, and for every action you take to stand up for what is right. I may be signing off as Executive Director today, but I look forward to marching alongside you in the days and years ahead to safeguard the health and wellbeing of everyone in the country we love.

Yours always,

Alice

 

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House passes ACA repeal bill

By Dr. Mona Mangat
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As we gather today for our National Leadership Conference, House Republicans have voted on a bill to repeal the Affordable Care Act. 

The bill would cause an estimated 24 million to lose coverage. It would end protections for those with pre-existing conditions, strip away essential health benefits, ration care under Medicaid and raise premiums by 20 percent. The bill would make everyone pay more -- children, young people, seniors and families. 

Simply put, House Republicans have failed our patients. But, we will not. 

The repeal bill now moves to the Senate which we have always known would be the battleground. We have a chance to stop this bad bill in the Senate if we put our shoulders to the wheel. 

Those who seek to repeal the ACA are betting you are too tired, too worn out from the previous fights to make your voices heard. We know they are wrong.

Together, we stood shoulder-to-shoulder with President Obama in the Rose Garden to urge the passage of the ACA. We spoke out across the country to connect millions with lifesaving coverage, many for the first time. We locked arms to defend the ACA against repeated attacks over the years. And, we won’t give up now.

Stand with the 24 million patients who are at risk of losing coverage by donating $24 a month to efforts to save their care.

With your generous contribution we will arm physicians with the resources they need to advocate against the repeal of the ACA.

 

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Weekly Round Up 4-28-17

By Shalini Pammal
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DFA Weekly Round Up - April 28, 2017
 
TAKE ACTION
  • Call your Representative via the Capitol switchboard at (202) 224-3121, and urge that they oppose the American Health Care Act, and any proposal that that strips healthcare from millions of Americans, guts protections for people with pre-existing conditions and ends Medicaid expansion.
  • Refer to this toolkit from our partners at the Center for American Progress Action Fund to make calls and send tweets to a targeted list of representatives who are currently undecided or have yet to publicly oppose the bill.
 
WEEK-AT-A-GLANCE
 
As the government works to avoid a federal shutdown, Republicans introduced a new amendment to their Obamacare replacement bill, breathing life into the American Health Care Act (AHCA) that was previously pulled from the House floor, and suggesting that another vote may be scheduled soon. An amendment drafted by New Jersey congressman Tom MacArthur keeps much of the AHCA in place, but allows states to eliminate major insurance regulations established by Obamacare— a provision that won endorsement from the conservative House Freedom Caucus. Along with waivers for the ban on insurers charging premiums based on consumer health, and the requirement that insurers' cover essential health benefits, the GOP amendment exempts members of Congress and their staffs to ensure that they will still be protected by such provisions.
 
Though the MacArthur amendment language has helped garner support from some conservatives, many moderate Republicans and leading healthcare and advocacy groups remain opposed to the bill, including the American Hospital Association (AHA), the American Medical Association (AMA) and the American Association of Retired Persons (AARP). The Kaiser Family Foundation also published poll findings that a majority of the public believes Trump and Republicans should work together to make the ACA work while its legislative future remains uncertain.
 
The White House also affirmed this past week that it will continue cost-sharing subsidies which are critical to the success of the Affordable Care Act marketplaces. However, it is unclear how long the White House plans to fund the cost-sharing reduction payments, leaving many insurers without the assurance necessary for their continued participation in the marketplace. Blue Cross Blue Shield insurer Anthem, among other insurers like Molina and Centene, had been pressing Congress to guarantee this crucial subsidy to help with out-of-pocket costs for low-income customers on the federal exchanges. Given the ongoing uncertainty, states are also making moves to bolster their own insurance markets, in an effort to curb big rate increases and pullbacks by insurers. Idaho, Oklahoma and Minnesota have all passed bills that allow insurers to unload some of the expense for costly consumers onto state program, using a version of reinsurance.
 
KEY ARTICLES
 
Health Affairs Blog: The MacArthur Amendment Language, Race in the Federal Exchange, and Risk Adjustment Coefficients
 
Reuters: Study says that government costs could rise $2.3 billion without Obamacare payments

Center on Budget and Policy Priorities: Amendment to House ACA repeal bill guts protections for people with pre-existing conditions
 
Vox: What the huge AHCA concession to the Freedom Caucus would actually do

 

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