Repair instead of repeal? Here’s what a smaller fix might look like

With Senate Republicans struggling to find votes for sweeping legislation to roll back the Affordable Care Act, several GOP lawmakers have raised the prospect of a more limited bill — passed with help from Democrats — to stabilize health insurance markets around the country.

That may be heresy for conservative Republicans who’ve spent seven years demanding the full repeal of Obamacare, as the law is often called.


Obamacare 101 is a periodic primer on the debate over repealing and replacing the Affordable Care Act »

But most patient advocates, physician groups, hospitals and even many health insurers say more-targeted fixes to insurance marketplaces make more sense than the kind of far-reaching overhaul of government health programs that Republicans have been discussing.

Why do a more limited Obamacare ‘fix’?

For one thing, it would be politically easier. More-targeted legislation also wouldn’t threaten insurance protections for tens of millions of Americans.

The political debate over the 2010 healthcare law has focused for years on what has been happening to insurance marketplaces like, which were created by the law for Americans who don’t get health insurance through work.

For a variety of reasons, the marketplaces’ first several years have been rocky.

Insurers in many states struggled to figure out how much to charge for their plans and then raised premiums substantially when customers turned out to be sicker than they expected.

And as uncertainty over the future of the markets has intensified since President Trump’s election last year, several leading national insurers have decided to stop selling plans in some states, leaving consumers in some places with few if any health plans to choose from. Trump has called Obamacare a “disaster” and “dead.”

But the marketplaces — where about 10 million Americans currently get coverage — represent a very small fraction of the U.S. healthcare system.

By contrast, more than 70 million Americans rely on Medicaid and the related Children’s Health Insurance Plan, the government safety net plans for the poor.

Altering Medicaid, as proposed under the GOP plan, would be far more disruptive. And, as congressional Republicans are learning, it is much more controversial.

But isn’t Medicaid a big problem, too?

Many conservatives have long argued the federal government can’t afford to provide so much healthcare assistance to the poor.

But Medicaid has become a vital lifeline for tens of millions of Americans. Medicaid provides assistance to more than one in three U.S. children, protects millions of Americans with disabilities and is the largest funder of nursing home care for elderly Americans, in large part because Medicare does not cover nursing homes.

Obamacare’s Medicaid expansion, which made coverage available to working-age adults in many states, is credited with driving down the nation’s uninsured rate to the lowest levels ever recorded.

And a growing body of evidence shows it is improving low-income Americans’ access to needed medical care, reducing financial strains on families and improving health.

That is why Medicaid has been fiercely defended by patient groups, doctors, nurses, educators and even some Republican governors.

What would it take to stabilize insurance markets?

Probably not that much, actually.

There is widespread agreement that the federal government must first continue funding assistance through Obamacare to low-income consumers to help offset their co-pays and deductibles.

This aid — known as cost-sharing reduction, or CSR, payments – was included in the original law.

But the payments have become a political football as Republicans argued the aid can’t be provided without an appropriation by Congress. And Trump administration officials keep threatening to cut off the payments.

Many insurers say that would be devastating, forcing them to raise premiums by double digits.

Congress could simply put an end to that uncertainty by voting to appropriate the CSR money.

Secondly, most insurance industry officials and independent experts say the federal government must create a better system to protect insurers from big losses if they are hit with very costly patients.

Such reinsurance systems are used in other insurance marketplaces such as the Medicare Part D prescription drug program and are seen as critical to stabilizing markets.

Thirdly, current and former marketplace officials say, the federal government should aggressively market and advertise to get younger, healthier people to buy health plans on the marketplaces.

This strategy has helped Covered California, that state’s marketplace, which has not been beset by some of the problems in other markets.

Finally, many experts say, federal officials likely will have to come up with additional incentives to convince health insurers to offer plans in remote, rural areas.

Some Republicans have suggested that consumers in these areas could be allowed to buy health plans that don’t meet standards set out in the current law.

Would these steps cost more money?

Yes.But both the House and Senate GOP bills to roll back Obamacare included billions of dollars to stabilize markets over the next several years.

So could Congress put that aid in a smaller healthcare bill?

That’s still unclear.

Many congressional Republicans are reluctant to spend any more money on healthcare aid, especially for a law that most have sworn to repeal.

But polls indicate that Americans now hold congressional Republicans and the Trump administration responsible for the fate of the nation’s healthcare system, including the insurance marketplaces.

That suggests that there could be a political price to pay for the GOP if the markets are not stabilized.

At the same time, Senate Democrats have signaled a willingness to work with Republicans on marketplaces fixes if GOP lawmakers agree to drop their repeal campaign.

But major hurdles remain, including demands from many GOP lawmakers that at least some of Obamacare’s provisions be repealed, such as the highly unpopular mandate requiring Americans to have health insurance.

Rather than stabilizing markets, however, eliminating the insurance requirement could lead to even more turmoil, experts say.

Repealing ObamaCare is always about tax cuts for the rich

Does moving a tax cut for the rich out of one bill and into another bill make lawmakers seem more in touch with the middle class? Senators trying to repeal the Affordable Care Act hope so. Americans should answer them with a loud “no.”

The legislation that Senate Republicans have written to repeal the ACA is one of the least popular bills in history because it cuts healthcare coverage for working people in order to finance tax cuts for the rich.

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Electronic Medical Records – Ensuring Continuity Of Patient Care

Last week, I read a story in The Star about a mother of eight who said she had a tubal ligation at one of our public hospitals after her eighth child but had two subsequent pregnancies.

Interestingly, she challenged the hospital, and according to the report, the facility said it could find no record of her being a patient despite her children being born there, as shown on their birth certificates.

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office physicians have different opinions about electronic records

A new study reports widespread agreement among physicians that maintaining electronic health records (EHRs) undermines their connection with patients. The analysis found, however, that hospital-based physicians most often decried how EHRs take time away from patient contact, while office-based physicians most often lamented that EHRs detract from the quality of their patient interactions.

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Three Ways Health Information Exchange Benefits Payers

When health payers and providers utilize health information exchange, they will make significant gains in reducing healthcare spending, reducing duplicative testing and services, and improving their use of preventive medical services, according to Dan Paoletti, CEO of Ohio Health Information Partnership at CliniSync. In an interview with, Paoletti discussed how the use of health information exchange could fill in typical gaps in care, improve care coordination, and emphasize preventive services.

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Solutions for Health Information Exchange Challenges

“Hospitals and physicians are now exchanging more electronic health information than ever before,” the Office of the National Coordinator for Health Information Technology told Congress in an annual report from early November.

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Health Information Exchange Adds Telehealth Component

An agreement between the Vermont Health Information Exchange (VHIE) and two healthcare organizations that provide telehealth services in the state now give providers connected to the statewide network access to telemonitoring data.

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HIPAA Regulations Allow for Patient Data Access

Patients being able to access their own information is an essential right under HIPAA regulations, according to the American Health Information Management Association (AHIMA). However, patient data access is often misunderstood, and individuals can be unaware of what information they are able to obtain from their provider.

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EHR Vendors Influence User’s Health Information Exchange

Are EHR vendors to blame for lacking health data interoperability and health information exchange?

Recent research published in Health Affairs suggests they may be.

According to researchers Jordan Everson and Julia Adler-Milstein, hospitals in more competitive regional EHR markets engage in less health information exchange (HIE) than those in markets where there is one dominant EHR vendor.

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