Report: Americans More Worried About Drug Costs Than Obamacare

Image: Report: Americans More Worried About Drug Costs Than Obamacare(William Thomas Cain/Getty Images)

Americans across the political spectrum overwhelmingly agree that skyrocketing prescription drug costs — not repealing Obamacare — should be the top healthcare priority for Congress and the president, something candidates seeking the White House in 2016 should consider when crafting campaign strategies, according to Politico.

Republicans are “part of the huge bipartisan majorities that back strong government measures to make drugs affordable, including requiring drug makers to release information on how they set prices (86 percent), allowing Medicare to negotiate for drugs (83 percent), capping what companies can charge for drugs to treat cancer and other life-threatening diseases (76 percent) and importing drugs from Canada (72 percent),” the website reports, citing a study released Thursday by the Kaiser Family Foundation.

In an April Kaiser foundation poll, 66 percent of Republicans wanted Washington to address the expensive and rising costs of drugs for chronically ill patients, while repealing Obamacare (60 percent) and its individual mandate (52 percent) came in as second- and third-tier priorities.

At the same time, the National Journal reported that soaring drug prices “are shaping up to be one of the next frontiers for healthcare reform in this country,” citing the findings of a Centers for Disease Control and Prevention survey that nearly half of Americans take at least one prescription drug.

“Other studies have put the number as high as 70 percent,” according to the Journal. “More than 20 percent of Americans had taken three or more prescriptions in the last 30 days, the CDC said.”

Participants in the most recent Kaiser poll said they’d like to make sure that “high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them, with three-quarters of the public (76 percent) saying this is a top priority.”

Lanhee Chen, a fellow at the Hoover Institute as well as Mitt Romney’s former health policy adviser, tells Politico that Republicans, who have set their sights on scrapping Obamacare, “are more likely to talk about drug prices as evidence of Obamacare’s failure” rather than bifurcating the issue.

“Republicans will be talking about how do we replace the ACA (Affordable Care Act) architecture,” said Chen.

There’s not universal agreement, however, about how much oxygen the candidates will expend on prescription drug prices in the run-up to 2016.

A public opinion expert at Harvard School of Public Health predicts it “is going to be very visible” and “people will be living in terror that they won’t be able to pay for this new expensive drug that they need.”

But noted conservative pollster David Merritt suggests prescription drug costs will be more of a corollary issue.

“Specific to drug costs, I think it will be secondary,” he said. “Healthcare as an issue is not going away. Obamacare is not going away. We’re still talking about life and death, but the fight will be around healthcare in general, with rising prescription drug costs as evidence of what’s wrong.”

Hillary Clinton has said she supports “a greater role for the government in driving down drug prices” but has not offered any specifics.

Vermont Sen. Bernie Sanders, a socialist who has long been a proponent of a single-payer healthcare system — in which the government funds healthcare for all Americans — has said he would like to see Medicare become an “active negotiator” in price-setting for prescription drugs, according to Politico.

Written by Melissa Clyne for Newsmax.

An Opposing View: Who Are the Uninsured Americans?

While the uninsured rate has significantly fallen in the two years after the rollout of Obamacare’s major coverage provisions, a small portion of the American population remains without health care for reasons that not even the advent of targeted outreach strategies has been able to solve, anew study has found.

The study, conducted by the Robert Johnson Wood Foundation and the Urban Institute, shows that as of March, more than half of uninsured Americans currently live in states that haven’t expanded Medicaid under the Affordable Care Act (ACA). Residents of the non-expansion states who fall in the coverage gap — with incomes that are too high the Medicaid eligibility mark but too low to qualify for subsidies — account for nearly 23 percent of Americans without coverage.

More than two-thirds of Americans without coverage do qualify for Medicaid or subsidies to help them purchase plans through insurance marketplaces. Even so, more than 60 percent of the uninsured designated affordability as their primary reason for not obtaining coverage, a data point that the Urban Institute’s Adele Shartzer describes as indicative of financial hardships burdening people across the country.

“For some patients, many of whom have less than $100 in savings, health care isn’t a priority,” Shartzer, co-author of the paper, told ThinkProgress. In the research document, titled the Health Reform Monitoring Survey, Shartzer and her colleagues note that improvements to in-person assistance of technology could help uninsured adults find affordable options and better navigate the enrollment process.

“Many people might not know about subsidies available to them so information is a solution,” Shartzer, research associate at the Urban Institute, added. “The health care law was meant to facilitate appropriate use of health care services and direct people to lower cost care that provides some financial security. A catastrophic health event can wreck your finances.”

This report comes amid renewed discussion about Obamacare among lawmakers, particularly the more than dozen GOP presidential candidates, most of whom say they’ll do away with the health care law altogether if they get elected. This week, Wisconsin Gov. Scott Walker and Florida Sen. Marco Rubio released details about how they plan to repeal and replace Obamacare if they win. Plans included the establishment of insurance across state lines, extension of tax credits to Americans of various income levels, and expanding Health Savings Accounts — ideas that analysts say wouldn’t meaningfully help the poor.

Instead, a better solution to provide covering for the remaining 10 percent of Americans could be accepting Obamacare’s optional Medicaid expansion, which has been implemented unevenlyacross the country.

However, there has been great resistance among governors in the 21 non-expansion states, partially out of a concern that they would shoulder the cost of expansion, even with the Obama administration’s assurances that their expenditures would be reimbursed through 2020. That decision has affected nearly 4 million people — many of whom hail from African American and Latino communities in the South and fall within the coverage gap.

To address this dilemma, some GOP lawmakers have developed substitutes for Medicaid expansion, using waivers through the Centers for Medicare and Medicaid Services. Arkansas, Indiana, and Iowa implemented an expansion alternative by using federal dollars to purchase private insurance for the uninsured, a move that critics say will place state legislatures in financial states since they have to reauthorize financing annually. These ongoing discussions follow decisions by lawmakers’ decisions to expand Medicaid in Alaska and Montana earlier this year, perhaps signs that other changes may happen in other states.

“Non-expansion states have been vocal about their opposition to the Affordable Care Act but situations change and states are incredibly diverse,” Shartzer said. “Lawmakers are finding other ways they can expand coverage. It’s certainly better to have expanded through an alternative mechanism than do nothing.”

But the even with insurance coverage, health issues persist for Americans struggling to make ends meet.

Single people with incomes more than triple the federal poverty level — between $30,000 and $40,000 annually — receive relatively small tax credits. People with higher incomes get nothing. Additionally, high deductible plans — a coverage option in which health care costs shift to emergencies and large-scale procedures — can place a stranglehold on individuals and families without much discretionary income. Ron Pollack, executive director of nonprofit Families USA, told the Huffington Post that those high costs often discourage people from getting insurance.

For first-time insurance holders, navigating the health care system can also be a frustrating experience. An analysis conducted by researchers at D.C.-based advocacy organization Alliance for a Just Society found that people of color contend with a dearth of primary care providers, a lack of internet access, and general confusion about health plans. Additionally, disparities exists between community health clinics in low-income neighborhoods and more affluent areas. Gary Delgado, principal investigator in the study, previously told ThinkProgress that a significant number of people in that population don’t have a “medical home” so it’s likely that they will use the emergency room instead of seeking preventative services.

Another hurdle is the high cost of treatment for chronic illnesses, which has sparked criticism of pharmaceutical drug companies. While the ACA forbids insurance companies from refusing coverage to those with preexisting conditions, providers have placed these “special medications” in a different category so patients shoulder up to 50 percent of the costs, much more than the individual and family caps on out-of-pocket payments. In recent months, attention has shifted to Hepatitis C medication, now on the market for up to $90,000. Medicare outlays for the payment of that treatment have surpassed $4.5 billion, more than 15 times the amount officials doled out on older version.

Shartzer said that that addressing these cost-related issues would make navigating the health care system a more enjoyable experience for Americans, as envisioned by the architects of the ACA.

“Access to care has been improving, but health care has been lagging behind other industries in making tools available to consumers,” she said. “There are clear gaps in health insurance care and literacy. We have to acquaint people with health care vocabulary because that can be intimidating.”

Even with these issues, a significant number of Americans do favor the ACA. More than 7 out of 10 Americans who bought new health insurance policies through exchanges last year rated their coverage as “good” or “excellent” in a Gallup poll. Amid their calls to “repeal and replace,” even Obamacare’s most ardent opponents favor many specific policies included in the legislation — including providing subsidies on a sliding scale to aid people who can’t afford insurance and forbidding the cancellation of policies when a person becomes ill.

CREDIT: AP PHOTO/CHARLES DHARAPAK

2.2M Obamacare customers hurt by this penny-wise, pound foolish choice

Brother can you spare some ObamaCareThey’re not paying now, but could pay lots more later.

Many lower-income Obamacare customers may have bought some “unaffordably cheap” health insurance plans—and are leaving significant amounts of money on the table as a result.

A new analysis found that 2.2 million people who enrolled in Obamacare in 2015 are eligible for federal aid to assist with their out-of-pocket health costs, but aren’t getting that assistance because they chose an insurance plan that does not qualify for that help. That tally represents more than 1 out of 4 of all the Obamacare customers who were eligible for such aid.

The findings by Avalere Health raise concerns that a number of those lower-income people could get stuck with health bills that they could have avoided if only they had selected a plan that might have had higher monthly premiums—but which gave them access to the federal subsidies.

“Consumers are picking plans on [Obamacare] exchanges based on premiums, rather than out-of-pocket costs,” said Avalere CEO Dan Mendelson. “As a result, some patients may be paying more than they need for care.”

“This is about a lot of low-income people leaving significant amounts of money on the table,” Mendelson said. “We know, statistically, that most of those people are going to be worse off.”

And more could be worse off in coming years. The Congressional Budget Office has estimated that during future enrollments, 3 million eligible Obamacare customers will forgo available assistance to reduce their out-of-pocket costs.

A health-care specialist helps people select insurance plans in Pasadena, California.

Getty Images
A health-care specialist helps people select insurance plans in Pasadena, California.

Under the Affordable Care Act, people whose household income is between 100 and 400 percent of the poverty level, or $11,670 to $46,680 for a single person, are eligible for federal subsidies that reduce the amount they have to pay each month in premiums for plans sold on government-run Obamacare exchanges. Most exchange customers—nearly 90 percent—receive such aid.

The ACA also offers another subsidy to act as an incentive for people to enroll in Obamacare plans. These are so-called cost-sharing reductions, and are available those who earn between 100 and 250 percent of the poverty level, or $11,670 to $29,175 for a single person.

Those subsidies reduce the amount of money that an enrollee is obligated by their plan to personally pay for eligible medical services, such as copayments, coinsurance and deductibles.

But cost-sharing reductions are available only if a person enrolls in a “silver” plan. Those cover about 70 percent of the medical costs of their customers, with the remaining share personally owed by the person. Silver plans also typically are the moderately priced offerings on an Obamacare exchange, and also are the most popular.

But if a person opts for an other plan, such as the second-most popular “bronze” plans, they cannot receive cost-sharing reductions. Bronze plans, which cover about 60 percent of medical costs of customers, tend to be both the cheapest plans on an exchange, and the ones with the highest out-of-pocket charges for enrollees.

About 5.9 million people identified in Avalere Health’s analysis are eligible for cost-sharing reduction subsidies because they enrolled in silver plans. The other 2.2 million eligible people who aren’t getting the aid did so by enrolling in other plans, primarily in the cheaper bronze plans.

Mendelson said that although the retail price of premiums for bronze plans routinely is less expensive than for silver plans, the actual dollar difference in premiums is often “not that much money” after a low-income customer’s subsidies are factored in.

“They look less expensive, even though they aren’t really,” Mendelson said.

That means that a customer’s out-of-pocket health costs can quickly eat up the difference in premium price if a person doesn’t get cost-sharing reductions, he said.

Avalere’s analysis also notes that some customers “may not be aware that CSRs are available and the benefits they offer.”

“Too many Americans shop for health insurance only on price,” Smedsrud said. “Indeed, more than half of the people who enrolled inHealthCare.gov [the federal Obamacare insurance marketplace] bought the lowest-priced plan.”

“This is an example of what I call ‘unaffordably cheap’ health insurance,” he said. “If you have pre-existing medical conditions, and expect to use your health plan, the key thing to calculate is the total family health-care spend, of which health insurance is one part, and the other is expenses not covered by your health insurance.”

“Too often, people believe that ‘next year’ is the year they won’t have out-of-pocket expenses.”

Smedsrud gave an example of how opting for a high-priced premium plan can lead to long-term savings.

“For a 30-year-old, in 2015 the difference between the average-cost bronze plan and the average-cost silver plan is about $50 a month,” he said. “But, if that person is between 200 and 250 percent of the federal poverty level, and buys a silver plan, they could save up to $1,750 by being eligible for a plan with a lower deductible and improved out-of-pocket coverage.”

“The less they make, the larger the potential savings if they use coverage health-care services.”

Back to School: Hillary Clinton’s College Plan Gets an “F”

Clinton's Student Loan PlanWASHINGTON–(BUSINESS WIRE)–After reading Hillary Clinton’s student loan plan, the fiscal policy staff at the Council for Citizens Against Government Waste (CCAGW) has given her a failing grade. While the class assignment was to write a proposal that would reform the student loan program, reduce the burden of student loans, and cut the cost of higher education, Mrs. Clinton’s financially outlandish plan would exacerbate the problem by dumping $350 billion into an already bloated system.

“on average, for a $1 increase in the subsidized-loan cap, tuitions rose by as much as 65 cents.”

The Clinton plan would hand out federal tax dollars to states in exchange for “no loan” tuition at four-year universities and make two-year community colleges free. The money would come from the same source as every one of Mrs. Clinton’s new spending programs: Higher taxes on the allegedly wealthiest Americans.

According to the Federal Reserve Bank of New York, student loan debt hit an all-time high of $1.16 trillion in 2014, marking a $77 billion increase from the previous year. Upon graduating with a bachelor’s degree, the average student will owe more than $35,000 in debt, more than double the amount they owed in the early 1990s. Over the past decade, there has been a 69 percent increase in students borrowing from federal loan programs, while the federal government now provides about 71 percent of all student aid funds. More than 43 million Americans owe money on student loans.

Making more loans available at a lower cost has been a root cause of increased student debt. Tuition costs have risen by 153 percent over the last three decades for private universities and 231 percent for public universities, which is greater than price increases for food and healthcare. Increased federal subsidies for college artificially inflates the purchasing power of students, which allows universities to raise tuition and increase the demand for more subsidies. That is why the New York Fed also foundthat “on average, for a $1 increase in the subsidized-loan cap, tuitions rose by as much as 65 cents.” Mrs. Clinton also wants to expand AmeriCorps from 75,000 to 250,000 members and increase their education benefits.

CCAGW President Tom Schatz said, “Higher education costs are the result of a vicious financial cycle. Pumping more money into the system without reforms that could help mitigate and lower costs will only make the problem worse. The Clinton plan is not based in fiscal reality. Like many other proposals that she is touting on the campaign trail, it is designed to lure voters to the polls rather than solve the real issue.”

The Council for Citizens Against Government Waste is the lobbying arm of Citizens Against Government Waste, the nation’s largest nonpartisan, nonprofit organization dedicated to eliminating waste, fraud, abuse, and mismanagement in government.

Obamacare tax already affecting worker health plans

Cadillac taxFor the millions of Californians with job-based health coverage, this one’s for you.

And it’s a doozy.

Starting in 2018, a hefty — known informally as the “Cadillac tax” — will target high-cost health insurance plans offered by employers.

Don’t be fooled by the 2018 start date. Some employers are taking steps now to avoid the tax.

That means some of you soon may see your plan benefits reduced and/or “you’re going to be forced into plans that have higher deductibles, and co-pays,” says Bill Hammett, an insurance broker near San Diego who works with employers across California.

Q The Affordable Care Act seems to penalize companies that offer generous health plans as a means to attract and keep talent. Could you explain the reasoning behind the excise tax?

A The Cadillac tax is a 40 percent levy on the portion of your health coverage that exceeds certain thresholds. The Congressional Budget Office projects it will raise $87 billion over the next decade to help pay for other Obamacare benefits, such as federal tax credits for income-eligible people who buy plans on exchanges.

It also aims to encourage policies that have higher out-of-pocket costs, thus discouraging you from overusing the health care system and perhaps reducing health costs overall.

“Five-dollar co-pays disconnect us from what it costs to have health care in this country,” Hammett says.

At the same time, it will erode the long-standing tax break that employers have received for providing health insurance.

“The ACA is saying, ‘that’s nice that you want to give employees this extra benefit, but we’re not going to subsidize it above these levels’,” says Dean Forman, a Roseville broker who works primarily with Northern California employers.

The IRS has not yet issued regulations on the tax, so many details remain unresolved. But we do know that the thresholds are set at $10,200 for individual coverage and $27,500 for family coverage in 2018.

The health care benefits that are counted include:

• Your employer’s contribution to your premium.

Your share of the premium.

• Employer contributions and pre-tax employee contributions to tax-advantaged health care accounts such as flexible spending accounts (FSAs), health reimbursement accounts (HRAs) and health savings accounts (HSAs).

• Use of on-site medical clinics that provide more than minimal care.

A Towers Watson analysis in September found that about half of employers with at least 5,000 employees have benefits that would trigger the tax in 2018. By 2023, that estimate rises to 82 percent.

It won’t matter if you work in the private or public sector or at a small or large business.

“The Cadillac plan tax does not discriminate,” says Liliana Salazar, a senior vice president at Wells Fargo Insurance. “It applies to employers of all sizes.”

Among the first plans expected to be hit are generous union, corporate and public-sector plans.

Brian Marshall is superintendent of the La Mesa-Spring Valley School District near San Diego, a K-8 district with about 1,600 full-time employees.

The district won’t be able to pay the excise tax without cutting into students’ educational budget, he says.

As a result, Marshall says his only realistic choices will be to pass the tax along to employees or reduce the cost of their benefits. “That means raising co-pays, raising prescription drug costs for employees, and changing what’s covered and what’s not,” he says.

One of the district’s health plans already would trigger the excise tax and the others would trigger it “in short order,” he says, due to the quickly rising cost of heath care.

The increases to the excise tax thresholds are pegged to the Consumer Price Index, not to the rise in health care costs. As a result, more plans will hit the excise tax each year if health care inflation exceeds overall inflation.

“Health insurance companies have a tradition of jacking up our rates at two, three, four times the rate of inflation,” says Ian Lewis, research director for UNITE HERE! Local 2, a union that represents about 13,000 hotel and hospitality workers in San Francisco and San Mateo Counties.

“It’s just a matter of time before the cost of people’s health plans triggers that tax.”

There also are no adjustments for geography in the law, so plans in regions with high health costs – such as the Bay Area — will be more likely to be hit by the tax “simply because of where they’re located,” says Laurel Lucia, an ACA expert at UC Berkeley’s Center for Labor Research and Education.

Same goes for the health of your coworkers. “If someone is part of a workplace that has sicker employees, premiums are likely to be higher and the plan is more likely to be taxed,” she says.

If you work for a company that might be subject to the tax, talk to your human resources department to learn more. And don’t be surprised if you’re asked to assume a larger share of your health care costs in the next couple of years.

Businesses already are requiring workers to pay more, but the excise tax will accelerate that trend. “The Cadillac plan tax has been a catalyst to encourage employers to implement high-deductible health plans,” Salazar says.

Meanwhile, companies, unions and others are uniting to fight the tax and calling on Congress to repeal it.

Opposition to the tax crosses party lines, but getting Congress to act on anything related to Obamacare is a tall order.

Even if lawmakers decide to act, they face a daunting question:

“If you eliminate that revenue source, what would you do to cover the gap?” Salazar asks.

Questions for Emily: AskEmily@usc.edu.

The CHCF Center for Health Reporting partners with news organizations to cover California health policy.

Don’t Forget Obamacare

The opening Republican presidential debate was a spirited affair, but missing was any serious discussion of Obamacare, the domestic centerpiece of Barack Obama’s presidency. The moderators asked only two Obamacare-related questions. One elicited Donald Trump’s assertion that a government monopoly over health care “works” in Canada and “works incredibly well” in Scotland. The other prompted John Kasich to defend his decision to expand Obamacare in Ohio on the grounds that “everybody has a right to their God-given purpose.” Half of the 10 candidates (including Trump) mentioned in passing that Obamacare needs to be repealed. But no candidate even began to outline a conservative alternative.

Elephant

We hope that the candidates will soon step up to the plate in this regard. Obamacare costs a fortune at a time when we are $18.2 trillion in debt. It centralizes power and money in Washington. It declares war on doctors in private practice, who will soon go the way of the milkman unless Obamacare is repealed. It funds abortions with tax dollars. And for the first time in our nation’s history, it forces private citizens to buy a product or service of the federal government’s choosing, merely as a condition of living in the United States.

In pushing to repeal Obamacare and replace it with a conservative alternative, a candidate would be doing the American people’s bidding. A McLaughlin & Associates poll commissioned by the 2017 Project asked 1,000 likely voters (including 37 percent Democrats and only 31 percent Republicans) the following question shortly after the King v. Burwell Supreme Court decision, in which the Court ruled in favor of the Obama administration:

Which comes closest to your view of the Patient Protection and Affordable Care Act, commonly known as “Obamacare”?

1. It should remain the law of the land, either in its current form or in an amended form.

2. It should be repealed and replaced with a conservative alternative that aims to lower health costs and help people get insurance.

3. It should be repealed but not replaced with an alternative.

In response, 43 percent said Obamacare should be repealed and replaced with a conservative alternative, while an additional 12 percent said it should be repealed but not replaced. Only 38 percent said it should not be repealed. In other words, with a conservative alternative in play, likely voters support repeal by a margin of 17 points—55 to 38 percent.

It is not just any conservative alternative that can lead to full repeal. In addition to lowering costs and helping people get health insurance, a winning alternative must be designed so as to cut off the three easiest liberal lines of attack.

First, a conservative alternative must provide an answer to the problem of preexisting conditions—one that, unlike Obamacare’s, doesn’t undermine the very nature of insurance. This requires commonsense protections that allow people to do things like move from employer-based insurance to individually purchased insurance without being charged more for a “preexisting condition” that was previously covered. Similarly, when they turn 18 (or first leave their parents’ insurance) people should have a grace period of a year or so to buy insurance without being charged more for a childhood condition that might or might not have been covered under their parents’ plan.

Second, an alternative shouldn’t alter the tax treatment of the typical American’s employer-based insurance. About 170 million people have—and usually like—such insurance.

Third, a conservative alternative must provide an answer for the poor and near-poor who have become newly insured under Obamacare. This means providing refundable tax credits to all people who are not offered insurance by their employer but instead purchase it on their own. These tax credits should not be income-tested and should go directly to individuals and families—not to insurance companies, like Obamacare’s subsidies.

A conservative alternative that had its defenses in order in these three areas could then go on offense. For 70 years, the federal government has given generous tax treatment to those who get insurance through their employer, while millions of Americans have gotten no tax break for buying insurance on their own. Obamacare didn’t fix this longstanding unfairness in the tax code. A well-conceived conservative alternative would.

This contrast would highlight how burdensome Obama-care is for the middle class and the young. The typical 40-year-old making $35,000 a year without -employer-based health insurance doesn’t get a dime in taxpayer-funded Obamacare subsidies. Meanwhile, next-door, someone identically situated but receiving health insurance through an employer gets a tax break. Under the 2017 Project’s “Winning Alternative to Obamacare,” the 40-year-old without employer-based health insurance would get a $2,100 tax credit to help buy insurance—and if he or she bought insurance for less than $2,100, the difference would go into a Health Savings Account. Instead of being compelled to buy Obamacare-approved insurance through a government-run exchange, people could shop for value on the open market.

Non-income-tested tax credits would address this in-equity in the tax code and revitalize an individual insurance market that the federal government broke. Moreover, an alternative like the 2017 Project’s would not only free Americans from Obamacare’s heavy-handed mandates but would also save more than $1 trillion over a decade, while leading to more people having private health insurance than under Obamacare—according to scoring by the politically neutral Center for Health and Economy.

Obamacare must be repealed. With a well-conceived conservative alternative in play, it will be. It is up to the candidates in the 2016 field to show that they could lead us to victory on this most important domestic-policy fight.

By Jeffrey Anderson of http://www.weeklystandard.com/.

Walker teases ObamaCare replacement

scott walker

Wisconsin Gov. Scott Walker plans to unveil his replacement plan for ObamaCare next week, becoming one of the first Republican presidential candidates to dive headfirst into the healthcare debate.

In an op-ed published Friday previewing his plan, Walker pledges to eliminate healthcare mandates, expand plan options and reduce “government interference” — but includes no specifics about how to do so.

“I will soon be releasing a plan to reverse every single destructive Obamacare policy and make health care more affordable and accessible for Americans across the country. Stay tuned,” he declared in the National Review op-ed.

“My plan will be market- not government-driven, maximizing efficiency and minimizing waste,” he said. Walker will release the full plan next Tuesday following a healthcare speech in Minnesota.

Walker, who officially jumped into the race one month ago, has pledged to roll out his policy points on issues like healthcare and national security before the second GOP debate, scheduled for Sept. 16.

Out of the nearly two-dozen Republican presidential hopefuls, only Louisiana Gov. Bobby Jindal — a former federal health official — has put forward a comprehensive healthcare plan.

Despite more than 50 votes in Congress to repeal ObamaCare, Republicans have been unable to coalesce around a single replacement plan for the healthcare reform law, which is now five years old.

On the campaign trail, healthcare has received little attention after a key Supreme Court ruling upheld ObamaCare subsidies this June.

Former Florida Gov. Jeb Bush laid out some of his replacement plan in March, pledging to repeal mandates, including coverage requirements, and move toward a “consumer-directed,” “customized” system. In his model, he said any subsidies would be state-administered and any exchanges wouldn’t be “coercive.”

Billionaire businessman Donald Trump, the current GOP front-runner, told reporters earlier this month that he would repeal the law and replace it with “something terrific.”

As a governor, Walker has fiercely opposed ObamaCare. He has refused to comply with the law’s Medicaid expansion, and threatened not to save ObamaCare subsidies in his state if the court had ruled against the healthcare law this summer.

By Sarah Ferris of The Hill.

Rick Perry’s Loss Is Ted Cruz’s Gain

Former Texas Gov. Rick Perry's (left)  support among Republican voters nationally is neither wide nor deep. Meanwhile, Texas Sen. Ted Cruz is busily ascending the GOP escalator.

Former Texas Gov. Rick Perry’s (left) support among Republican voters nationally is neither wide nor deep. Meanwhile, Texas Sen. Ted Cruz is busily ascending the GOP escalator.

Joe Raedle/Getty Images

Tuesday, Rick Perry’s campaign announced it could no longer pay his staffers around the country and released them to find other work. His fundraising had dried up. It’s potentially an ignominious end to a noteworthy political career that spanned more than 30 years.

Fundraising acumen was considered one of Perry’s strong points four years ago when he belatedly announced his run for the White House and raised $17 million in the first seven weeks of his campaign. In 2015, it’s a different story. His campaign is on the ropes and out of money. Not even Texas is solidly behind the governor this year. Jeb Bush, Ted Cruz, Rand Paul, Marco Rubio and a host of other Republican presidential candidates are successfully drilling in Texas for gushers of campaign contributions.

If this were a presidential election before Citizens United, Perry’s campaign would be finished. But his superPAC raised $17 million and so Perry’s quest for the presidency lives on.

Perry’s Opportunity and Freedom PAC has already begun setting up what is essentially a shadow campaign in Iowa and other early primary states, hiring staff and running ads. But the fact that Perry’s actual campaign has run out of money is indicative of a deeper problem also reflected in his low poll numbers: He’s got some conservative millionaires on his side, but his support among Republican voters nationally is neither wide nor deep.

His campaign is like a sick patient in the best room in the hospital with HBO on the TV. With his blood pressure (polling numbers) so low, it’s uncertain Perry’s PAC money can save him.

If the former Lone Star governor is about to change destinations and punch his ticket to the also very nice and lucrative Corporate Board of Directors Island, Texas Sen. Ted Cruz is busily ascending the up escalator to GOP Presidential Floor No. 2.

As in second place to Donald Trump in one of the latest Republican presidential polls. There have been several post-GOP-debate polls, and in the aggregate Cruz’s numbers are up. Surging 7 points in one poll, 6 in an another, Cruz along with Carly Fiorina, Rubio and Ben Carson made the debate winners’ circle.

Trump, Fiorina, Carson, Cruz. If the Democratic primary is about passing the torch from one seasoned political veteran to the next, the Republican primary has been, so far, completely the opposite — outsiders and mavericks lead the way.

The Texas senator’s political career has been defined by his repeatedly poking his finger in the eye of the Republican hierarchy in Washington, D.C. If Cruz is hated by the Senate majority leader and the speaker of the House, he is loved by the Tea Party base for sticking to his conservative guns, consequences be damned.

Ted Cruz has been campaigning heavily in the South. In Mississippi, Tea Party favorite (and failed Senate candidate) state Sen. Chris McDaniel joined Cruz’s campaign across the state as he spoke to enthusiastic and overflow crowds.

Cruz learned while running for the U.S. Senate in Texas that the key to a Republican primary victory was not to let anybody get to the right of him. In today’s GOP, it’s an excellent strategy. And unlike Trump or Carson or Rubio or Fiorina, Cruz can point to his record in the Senate to claim the conservative high ground. Tea Party Republicans know it. They applauded every time he threatened to grind the federal government to a halt. It’s part of what’s made him the most popular politician in Texas, stealing that title from Perry, the state’s longest-serving governor.

Cruz’s strategy is simple — hang in there until there are just two Republican candidates remaining and be the conservative alternative to the moderate Republican. He’s still faces long odds, but unlike Perry, Cruz is unlikely to do himself in with an “Oops” moment in a debate.

Champion debater at Princeton, editor of the Harvard Law Review, solicitor general of Texas, Cruz has argued nine times before the U.S. Supreme Court. Thinking on his feet is one of his strongest assets. Follow him on the campaign trail, and you’ll see Republican voters come away both thrilled with his conservative language and promises and surprised — amazed, in fact — at his eloquence.

As former Texas Lt. Gov. David Dewhurst discovered in 2012 in the Republican primary for the U.S. Senate, when he was expected to crush this unknown candidate, you underestimate Ted Cruz at your political peril.

By Wade Goodwyn for NPR.

Glitch in the new air traffic control computer system

Air Traffic Computer glitchFlight delays are being reported up and down the East Coast, courtesy of a glitch in the new air traffic control computer system. The system went down Saturday morning and initially affected airports in Washington, D.C., and New York. But the outage quickly spread to Baltimore and other points, causing the cancellation of more than 200 flights and leaving passengers scrambling on a busy weekend. The Washington Post describes the system affected:

ERAM stands for En Route Automation Modernization and is the computer “system that processes flight and surveillance data, provides communications and generates display data to air traffic controllers.”

ERAM is part of a larger infrastructure update called NextGen, with the rollout beginning about 18 months ago. It was designed to allow air-traffic controllers the ability to handle many more flights and to improve guidance of flights throughout the country.

NBC News reports that the computer system, years behind schedule and massively over budget, was installed in the last 18 months. Aviation Today reported in 2012 on the problems being experienced by ERAM that set back installation of the system by 3 years. The emphasis is mine. Tell me these guys didn’t help design the healthcare.gov website:

Noting Lockheed Martin’s “unique expertise” in the en route automation environment, FAA intended to award it the ERAM upgrade in 2002 as a sole source, 10-year contract. However, Raytheon protested, causing FAA to establish an inquiry that subsequently upheld the protest, with Raytheon becoming a Lockheed Martin team member when the $2.1 billion contract was finally awarded in 2003.

The inquiry report revealed, however, that neither FAA nor Lockheed Martin appeared sure how the upgrade was to be accomplished, other than it would be an “incremental decomposition,”a term that evaded clear definition.Three officials gave three different views, while FAA’s integrated product team lead for en route said she did not understand how it could be accomplished or how often one would have to go into the system at any or all of the ARTCCs to perform the incremental modifications. “There’s nothing practical about this,” the FAA integrated product team lead testified. “This is the most complex thing that the agency will ever undertake.”

Her ERAM product team lead also did not know how the “fairly complex technical task” of decomposing old software to get it to run on a new platform in a modern language might be performed. FAA did not conduct a risk assessment to examine the potential costs and benefits of incremental decomposition, nor did it know exactly what had to be incrementally decomposed, although it did acknowledge that “this will necessitate multiple transitions of deployed ERAM functionality.”

Yet, as the integrated product team lead explained, one must know what the software is in order to decompose it. Unfortunately, the Host system had been built in stages, with new functions and capabilities progressively added.

Consequently, it consisted of a set of separate hardware and software components physically interfaced together, but without a common design, infrastructure or software environment: a software “bowl of spaghetti” as both FAA’s integrated product team lead and the associate administrator for research and acquisitions described it to the inquiry.

I will agree with the project lead on this point: it’s an enormously complex system that’s bound to have a lot of bugs to work out. But don’t you get the feeling reading the above that the FAA made this more complex than it should have been? That it proceeded without a full understanding of what it wanted to accomplish? That they were riding by the seat of their pants so that errors were magnified?

The FAA’s chickens came home to roost today on the East Coast.

How Obamacare Adds $100 A Month To Your Spouse’s Coverage

Cadillac taxTo avoid the Affordable Care Act’s so-called “Cadillac tax” on rich benefit plans, companies are adding surcharges of $100 a month or more to wives and husbands of workers, hoping spouses will seek coverage elsewhere, new employer data shows.

The Cadillac tax was created as part of the Affordable Care Act largely as a way to help subsidize benefits to the uninsured under the law. Starting in 2018, employers pay a 40 percent tax on costs of health plans that are above $10,200 per individual and $27,500 for family coverage.

The idea behind the so-called “spousal surcharge” employers are implementing is to reduce the number of people an employer covers so the company can save money and avoid triggering the special excise tax for plans with high cost benefits.

“The spousal cost is wrapped into that $27,500,” Brian Marcotte, president and CEO of National Business Group on Health said in an interview last week. “If spouses have coverage elsewhere, the surcharge will get them to move to that other employer’s plan.”

National Business Group on Health shows more employers implemented surcharges on spouses of workers who can access health coverage elsewhere
National Business Group on Health shows more employers implemented surcharges on spouses of workers who can access health coverage elsewhere

The National Business Group on Health said 34 percent of its member employers next year will implement “surcharges” for spouses “who can obtain coverage through their own employer.” This is an increase from 29 percent this year.

“A handful of employers will exclude spouses altogether when coverage is available through an employer,” the business group, an association of 425 large U.S. employers including AT & T (T), Boeing (BA), CVS Health (CVS) and Wal-Mart (WMT). The survey didn’t disclose the actions of specific employers.

Benefits consultancies that work with employers say they are seeing a big increase in spousal surcharges as well. Aon Hewitt (AON) said 14 percent of employers in its 2015 health care survey have implemented or increased “specific surcharges for adult dependents with access to coverage elsewhere” and 50 percent may do the same in the next three to five years.

And Mercer, a subsidiary of Marsh & McLennan Companies (MMC) said it, too, is seeing an increase in surcharges but they tend to be implemented more by large employers than small. For example, 27 percent of companies with 20,000 or more workers required a surcharge for spouses who have other available coverage compared to 17 percent in 2010, Mercer said. By comparison, just 9 percent of employers with 500 or more workers required such a surcharge in 2014 though the percentage is rising.

The surcharge is about $100 per month on average, or $1,200 per year, according to recent surveys by the National Business Group on Health. Mercer said its data showed a similar $100 per month surcharge.