Posts Tagged ‘healthcare’

Conservatives Make New Push to Repeal Affordable Care Act

June 19, 2018

Group proposes a new system that lifts national consumer protections and gives control of health care to the states

Under the conservative plan, states would receive ACA money in the form of block grants to help low-income consumers buy coverage.
Under the conservative plan, states would receive ACA money in the form of block grants to help low-income consumers buy coverage. PHOTO: ANDREW HARRER/BLOOMBERG NEWS

The Affordable Care Act should be repealed in August and replaced with a new system that lifts national consumer protections and gives control of health care to the states, according to a proposal by a conservative group set to be released Tuesday.

The proposal risks irking centrist Republicans who want to focus on other subjects. Republican leaders have said they have no appetite for another push to repeal the ACA before the November midterm elections unless such a bill clearly has the votes to pass.

Republicans faced a series of obstacles—including internal division and unified Democratic opposition—as their effort to repeal the ACA collapsed last year. There is little evidence those dynamics in Congress have changed.

Still, the proposal’s release reflects the continuing eagerness of conservatives to topple the ACA, a longtime Republican promise whose window could close if Democrats make gains in the midterms as expected.

The conservatives’ proposal would drive control of health care almost entirely to the states, reversing the ACA’s federal mandates that seek to provide basic minimum benefits and consumer protections, which Republicans argue limit people’s choice.

Under the conservative plan, states would receive ACA money in the form of block grants to help low-income consumers buy coverage. Health savings accounts, which let people set aside tax-free money for medical expenses, would be expanded. Insurers could give discounts to people who are young or maintain continuous coverage.

The proposal, which echoes provisions of a bill offered last year by Sens. Lindsey Graham (R., S.C.) and Bill Cassidy (R., La.), comes from the Health Policy Consensus Group, which includes representatives from such conservative think tanks as the Heritage Foundation, American Enterprise Institute, Galen Institute and the Manhattan Institute. The group has been meeting weekly for nine months.

The Hoover Institution on Wednesday will host a coalition of think tanks and governors, including Republican Gov. Matt Bevin of Kentucky and former GOP Sen. Rick Santorum of Pennsylvania, in Washington to discuss the proposal.

Centrist Republicans, however, haven’t been pushing a new repeal effort as part of their campaigns, especially as polls suggest the health-care issue is favoring Democrats more than in recent elections.

“Moderate Republicans are like, ‘Can’t we just let this go?’” said Simon Haeder, assistant public policy professor at West Virginia University. “It puts them in a terrible spot. They’re in a situation where if they don’t go along with them, they have to worry about making it through a primary, because these groups are well-resourced.”

Democrats face their own divisions over health care, with some liberals pushing for a sweeping “single-payer” plan and others arguing for a more limited option, such as an expansion of Medicare, that may be more palatable to centrist voters.

The block grants would be the backbone of the conservative plan. Half of the grant funding would go toward supporting the purchase of private health coverage, and half toward helping low-income Americans get coverage, although the two categories would likely overlap. The grants would ban states from using the money to fund abortions, according to the draft proposal. Medicaid expansion would also be repealed, and people on Medicaid would be able to buy private insurance coverage.

“The solution to the problem is to put program direction to states, and the federal government provides resources in a defined way,” said Yuval Levin, vice president at the Ethics and Public Policy Center. He is part of the group making the health-care proposal.

Liberals say moves to reverse the ACA, also known as Obamacare, hurt consumers by weakening or removing health coverage from many people.

“It’s just the monstrosity of Trumpcare,” House Minority Leader Nancy Pelosi (D., Calif.) said recently. “What they’re doing continues to drive up premium costs with their senseless sabotage.”

The conservative groups argue that this could be Republicans’ last chance to deliver on the eight-year GOP promise to end the ACA. That is a better electoral strategy, conservatives say, than moving toward Democratic positions or changing the subject.

The latest plan is one front of a continuing assault on the ACA by Republicans and conservatives in the aftermath of the failed previous effort to repeal it. While the Justice Department has asked a court to toss out key provisions of the health law, the 20 GOP state attorneys general in the lawsuit want the court to end the law altogether.

Some Republicans, including Sen. Ron Johnson (R., Wis.), have voiced interest in a repeal, and others have talked about passing a health-care package in coming months. Health and Human Services Secretary Alex Azar, in testimony last week, said he would work with Congress should lawmakers decide to modify or repeal the ACA.

Write to Stephanie Armour at


Google Is Training Machines to Predict When a Patient Will Die

June 18, 2018

AI advances by the ‘Medical Brain’ team could help the internet giant finally break into the health-care business

Created by illustrator Maria Chimishkyan for Bloomberg Prognosis

A woman with late-stage breast cancer came to a city hospital, fluids already flooding her lungs. She saw two doctors and got a radiology scan. The hospital’s computers read her vital signs and estimated a 9.3 percent chance she would die during her stay.

Then came Google’s turn. An new type of algorithm created by the company read up on the woman — 175,639 data points — and rendered its assessment of her death risk: 19.9 percent. She passed away in a matter of days.

The harrowing account of the unidentified woman’s death was published by Google in May in research highlighting the health-care potential of neural networks, a form of artificial intelligence software that’s particularly good at using data to automatically learn and improve. Google had created a tool that could forecast a host of patient outcomes, including how long people may stay in hospitals, their odds of re-admission and chances they will soon die.

What impressed medical experts most was Google’s ability to sift through data previously out of reach: notes buried in PDFs or scribbled on old charts. The neural net gobbled up all this unruly information then spat out predictions. And it did it far faster and more accurately than existing techniques. Google’s system even showed which records led it to conclusions.

Hospitals, doctors and other health-care providers have been trying for years to better use stockpiles of electronic health records and other patient data. More information shared and highlighted at the right time could save lives — and at the very least help medical workers spend less time on paperwork and more time on patient care. But current methods of mining health data are costly, cumbersome and time consuming.

As much as 80 percent of the time spent on today’s predictive models goes to the “scut work” of making the data presentable, said Nigam Shah, an associate professor at Stanford University, who co-authored Google’s research paper, published in the journal Nature. Google’s approach avoids this. “You can throw in the kitchen sink and not have to worry about it,” Shah said.

Google’s next step is moving this predictive system into clinics, AI chief Jeff Dean told Bloomberg News in May. Dean’s health research unit — sometimes referred to as Medical Brain — is working on a slew of AI tools that can predict symptoms and disease with a level of accuracy that is being met with hope as well as alarm.

Inside the company, there’s a lot of excitement about the initiative. “They’ve finally found a new application for AI that has commercial promise,” one Googler says. Since Alphabet Inc.’s Google declared itself an “AI-first” company in 2016, much of its work in this area has gone to improve existing internet services. The advances coming from the Medical Brain team give Google the chance to break into a brand new market — something co-founders Larry Page and Sergey Brin have tried over and over again.

Software in health care is largely coded by hand these days. In contrast, Google’s approach, where machines learn to parse data on their own, “can just leapfrog everything else,” said Vik Bajaj, a former executive at Verily, an Alphabet health-care arm, and managing director of investment firm Foresite Capital. “They understand what problems are worth solving,” he said. “They’ve now done enough small experiments to know exactly what the fruitful directions are.”

Dean envisions the AI system steering doctors toward certain medications and diagnoses. Another Google researcher said existing models miss obvious medical events, including whether a patient had prior surgery. The person described existing hand-coded models as “an obvious, gigantic roadblock” in health care. The person asked not to be identified discussing work in progress.

For all the optimism over Google’s potential, harnessing AI to improve health-care outcomes remains a huge challenge. Other companies, notably IBM’s Watson unit, have tried to apply AI to medicine but have had limited success saving money and integrating the technology into reimbursement systems.

Google has long sought access to digital medical records, also with mixed results. For its recent research, the internet giant cut deals with the University of California, San Francisco, and the University of Chicago for 46 billion pieces of anonymous patient data. Google’s AI system created predictive models for each hospital, not one that parses data across the two, a harder problem. A solution for all hospitals would be even more challenging. Google is working to secure new partners for access to more records.

A deeper dive into health would only add to the vast amounts of information Google already has on us. “Companies like Google and other tech giants are going to have a unique, almost monopolistic, ability to capitalize on all the data we generate,” said Andrew Burt, chief privacy officer for data company Immuta. He and pediatric oncologist Samuel Volchenboum wrote a recent column arguing governments should prevent this data from becoming “the province of only a few companies,” like in online advertising where Google reigns.

Google is treading carefully when it comes to patient information, particularly as public scrutiny over data-collection rises. Last year, British regulators slapped DeepMind, another Alphabet AI lab, for testing an app that analyzed public medical records without telling patients that their information would be used like this. With the latest study, Google and its hospital partners insist their data is anonymous, secure and used with patient permission. Volchenboum said the company may have a more difficult time maintaining that data rigor if it expands to smaller hospitals and health-care networks.

Still, Volchenboum believes these algorithms could save lives and money. He hopes health records will be mixed with a sea of other stats. Eventually, AI models could include information on local weather and traffic — other factors that influence patient outcomes. “It’s almost like the hospital is an organism,” he said.

Few companies are better poised to analyze this organism than Google. The company and its Alphabet cousin, Verily, are developing devices to track far more biological signals. Even if consumers don’t take up wearable health trackers en masse, Google has plenty of other data wells to tap. It knows the weather and traffic. Google’s Android phones track things like how people walk, valuable information for measuring mental decline and some other ailments. All that could be thrown into the medical algorithmic soup.

Medical records are just part of Google’s AI health-care plans. Its Medical Brain has unfurled AI systems for radiology, ophthalmology and cardiology. They’re flirting with dermatology, too. Staff created an app for spotting malignant skin lesions; a product manager walks around the office with 15 fake tattoos on her arms to test it.

Dean, the AI boss, stresses this experimentation relies on serious medical counsel, not just curious software coders. Google is starting a new trial in India that uses its AI software to screen images of eyes for early signs of a condition called diabetic retinopathy. Before releasing it, Google had three retinal specialists furiously debate the early research results, Dean said.

Over time, Google could license these systems to clinics, or sell them through the company’s cloud-computing division as a sort of diagnostics-as-a-service. Microsoft Corp., a top cloud rival, is also working on predictive AI services. To commercialize an offering, Google would first need to get its hands on more records, which tend to vary widely across health providers. Google could buy them, but that may not sit as well with regulators or consumers. The deals with UCSF and the University of Chicago aren’t commercial.

For now, the company says it’s too early to settle on a business model. At Google’s annual developer conference in May, Lily Peng, a member of Medical Brain, walked through the team’s research outmatching humans in spotting heart disease risk. “Again,” she said. “I want to emphasize that this is really early on.”

UK Healthcare: PM Promises an additional £384 million per week into the NHS after Brexit — Also promised £20bn a year as a 70th “birthday present” for NHS

June 17, 2018

Theresa May has agreed to pour an additional £384 million per week into the NHS after Brexit – exceeding the amount mooted by the official Leave campaign and effectively locking the UK into leaving the EU.

The boost for the health service, which the Prime Minister will set out in a speech on Monday, is intended to mark the 70th anniversary of its creation, partly by drawing on the “Brexit dividend” that will arise from the country ceasing payments to the EU.

Writing in The Sunday Telegraph, Jeremy Hunt, the Health Secretary, who campaigned for Remain during the 2016 referendum, says the Brexiteer pledge of extra funding for the NHS “can now unite us all”.

In a heavily criticised slogan, the Leave…

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Read the rest:

BBC News

NHS gets £20bn ‘birthday present’ — PM says

The NHS in England is to receive an extra £20bn a year as a 70th “birthday present”, the prime minister has said.

Theresa May is expected to detail where the additional health service funding will come from on Monday.

However, she told the BBC’s Andrew Marr Show the boost will be funded partly by a “Brexit dividend” available once the UK stops paying into the EU budget.

Labour said the government had failed to fund the NHS properly and was relying on “a hypothetical” windfall.

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In her BBC interview, Mrs May said the increase will exceed the £350m-a-week extra promised by Leave campaigners during the EU referendum campaign.

The spending plan means the £114bn-a-year budget will rise by more than 3% a year on average in the next five years.

That will mean by 2023 the budget will be £20bn a year more than it is now once inflation is taken into account.

But crucially the plan just covers front-line budgets overseen by NHS England.

About a tenth of the overall health budget is held by other bodies for things such as training and healthy lifestyle programmes, including stop smoking services and obesity prevention programmes.

The BBC understands these will be protected, but beyond that it is unclear what will happen to them.

The 2015 spending review – the last time a five-year settlement was announced – saw these budgets cut to help pay for an £8bn increase in NHS England’s budget.

The deal has been reached after a series of meetings between the chancellor and Health Secretary Jeremy Hunt and NHS England chief executive Simon Stevens in recent weeks.

They had been locked in negotiations after Prime Minister Theresa May promised there would be a long-term settlement agreed this year.

‘Superhuman efforts’

With the NHS celebrating the 70th anniversary of its creation in July, there had been a desire to see something announced before then.

Mr Hunt said this had been achieved, giving the NHS a “fitting birthday present for our most loved institution”.

He added: “It recognises the superhuman efforts made by staff over the last few years to maintain services in the face of rapidly growing demand. But it also presents a big opportunity for the NHS to write an entirely new chapter in its history.”

Labour’s shadow health secretary Jonathan Ashworth said: “Today’s announcement confirms that Theresa May has failed to give the NHS the funding it needs.”

“Labour would have invested nearly £9bn extra this year in the NHS and social care, while asking the wealthiest and big corporations to pay their fair share of tax,” he said.

Instead, he said, the government was asking patients to rely on “a hypothetical Brexit dividend”.

The announcement means extra money will also be made available for Scotland, Wales and Northern Ireland, although it will be up to the Welsh and Scottish governments to decide how that is spent.

The infamous red Brexit bus during the referendum campaign with Brexiteer Boris JohnsonImage copyright GETTY IMAGES
The PM references the controversial £350m a week claim seen on a bus used during the EU referendum campaign

Is this being paid by the Brexit dividend?

Alongside the five-year funding plan, ministers are expected to announce a new 10-year vision will be drawn up for the health service.

Details of this and how it will be carried out are expected to come in a speech by Prime Minister Theresa May on Monday.

But in her BBC interview, to be aired on Sunday, Mrs May claimed the funding boost is partly coming from a “Brexit dividend”.

“Some people may remember seeing a figure on the side of a bus a while back of £350m a week in cash,” she said.

“I can tell you that what I’m announcing will mean that in 2023-24 there will be about £600m a week, more in cash, going into the NHS.

“That will be through the Brexit dividend. The fact that we’re no longer sending vast amounts of money every year to the EU once we leave the EU.”

But Mrs May also acknowledged that “as a country” more will need to be contributed.

She did not spell out that would require tax rises, although a recent report by the Institute for Fiscal Studies said they would be needed as it was hard to imagine the money could be found from economic growth or raiding other areas of government spending.

Presentational grey line

Analysis: By Alex Forsyth, BBC Political Correspondent

It was one of the most contentious pledges of the Vote Leave campaign: a claim emblazoned on the side of the Brexit battle bus that leaving the EU would mean an extra £350m a week for the NHS.

The figure was widely discredited, but Theresa May has deliberately raised it again – suggesting this funding package will more than meet the campaign promise.

Not all of the extra NHS cash will come from the so-called Brexit dividend; there will be tax rises too. But in linking the funding to leaving the EU, the prime minister is not only trying to prove her commitment to the health service – but to Brexit as well.

That will no doubt please those in her party pushing for a clean break from Brussels; but may anger those seeking to retain close ties with the EU. The prime minister is once again walking the tightrope of divided Tory opinion.

Presentational grey line

Is this more than expected?

There has been a lot of speculation that Mr Hunt – supported by Mr Stevens – had been pushing for close to 4% a year extra.

This was the figure many in the health service had said was needed to get services back on track and to improve waiting times.

Reports have suggested the Treasury were initially offering less than 3%.

So the 3.4% average appears to be a compromise between the two camps – and is close to the 3.7% average increase the NHS has seen if you look back over the last 70 years.

Government health spending chart

The final picture is somewhat clouded by the lack of clarity about what will happen to the wider health budget.

What it does mean is that the five-year funding plan announced in 2015, which was meant to see the budget increase by £8bn above inflation by 2020, has been effectively ended two years early.

And that comes after ministers agreed in autumn 2017 to top that up by another £2.8bn.

‘Don’t forget social care’

Ian Dalton, head of NHS Improvement, a regulator in charge of monitoring performance in the health service, said: “This settlement is good news for the NHS, those who use it and those who work for it.

“It will enable the dedicated staff in our NHS to go on improving the care we can offer the patients.”

But Chris Hopson, chief executive of NHS Providers, which represents NHS trusts, said the settlement was the “minimum” that was needed.

“After almost a decade of austerity, the NHS has a lot of catching up to do.”

He also pointed out that the government needed to work out what it was going to do about social care run by councils.

Ministers have promised the system, covering care homes and help at home, will be reformed soon to ensure there is better access to services.

Niall Dickson, chief executive of the NHS Confederation, which represents healthcare organisations, said the announcement “isn’t a bonanza by any means” and that it fell short of the of the 4% extra-a-year figure an independent report had suggested was needed.

However he added: “It’s a lot better than we’ve been used to over the last few years.”

“The truth is that in spite of this welcome extra investment we will face hard choices and we need an honest debate about what the NHS can and cannot do,” he said.

Pakistan: In Praise of Our Best Healthcare

June 17, 2018

HIDDEN under the trite sound bites that the Pakistan Tehreek-i-Insaf’s political leadership thrives on, lies the story of a revolution that must be told.

PTI supporters should be disappointed that their leadership hasn’t effectively told the rest of the country about one of their biggest successes.

Few Pakistanis know that the party’s government in Khyber Pakhtunkhwa has successfully implemented a healthcare solution that is a blueprint for the rest of the country to follow.

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No, it is not the case that KP has radically outspent everyone else. In fact, all four provinces are running neck and neck in terms of health spending as a percentage of their budgets. The claim that KP’s spending priorities are somehow vastly different than Punjab’s, which only builds metros, is a fallacy that should be removed from the PTI’s rhetorical arsenal and thrown in the wreckage left by Peshawar’s bus rapid-transit project.

What should replace it is the reality of the Sehat Sahulat Programme. Because it is innovations like these that can make widespread access to decent medical care a reality in Pakistan. And that is something worth talking about.

What should replace the PTI’s rhetorical arsenal is the reality of KP’s health programme.

Sehat Sahulat is the KP government’s flagship health insurance programme. As of now, around half of the households in the province, selected for need, based on the Benazir Income Support Programme methodology, are card-carrying members.

An expansion of coverage to 70 per cent of the population is under way. The cards, known as Sehat Insaf cards, signify that the holders are covered by health insurance, with premiums paid to State Life directly by the provincial government.

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Sehat Insaf card

This insurance allows households to utilise up to Rs540,000 per year, for medical treatment and medicines, at public and private hospitals across the province. So, the poorest person in KP, sans a single rupee in hand, can be treated at the finest private hospital in Peshawar, just like any fee-paying patient.

The cherry on top? The insurance also pays patients lost wages, and in case of referrals from outside Peshawar, travelling money.

Premiums are surprisingly low. Currently, the KP government pays the insurance company just Rs1,500 a year per household covered. Well-placed sources confirm this will have to rise a bit, as the insurance company is currently losing money on the deal.

To keep costs low, and to combat fraud, there are a few caveats to the coverage. Outpatient care isn’t included, and there are rules relating to referrals that can be cumbersome. There is also a conscious attempt to prioritise utilisation of government hospitals, to allow them to generate revenue. Despite this, around 60 per cent of the fees paid in insurance claims, are paid to private hospitals.

Sehat Sahulat is a dramatic step towards equity in medical care. It replaces a system where a poor person requiring surgery had to choose between a lower survival probability at a crowded public hospital unable to cope with patient demand, and the certainty of financial ruin at a better equipped private hospital. It lessens the burden on public hospitals, raises the status of poor patients there (because they now represent a revenue source in the form of insurance payments), and enables people to afford private treatment that would previously have been unthinkable.

Alongside equity, Sehat Sahulat represents efficiency in spending healthcare resources. Such efficiency isn’t typically achieved by well-intentioned gentlemen in robes, poking at bed sheets, taste-testing food, ordering equipment purchases, and embarrassing the handful of highly qualified specialists who choose to make Pakistan their home.

If public hospitals across the country are hopelessly overcrowded, understaffed and under-equipped, then, yes, part of the reason is that budgetary allocations to healthcare must be raised.

But there is a more obvious reason — Pakistan is a poor country. To illustrate just how poor we are, consider this: even adjusting for purchasing power and price differences, every rupee earned by every person in the country wouldn’t be enough to publicly fund a healthcare system of the quality of, say, Norway ($5000+ per capita expenditure).

So, what we have must be spent efficiently. What KP’s brilliant initiative does is show what this might look like. By focusing more spending on insurance premiums, the state encourages a marketplace where entrepreneurs want to invest capital to build and equip new facilities that the government can’t afford upfront.

KP’s health-sector insiders confirm that this is well under way in the province. New private hospitals are being built at a rapid pace, to cater to demand from a newly insured patient base. This efficiently frees up the capital expense that would be required to build new facilities.

Some treatments are so expensive that no affordable insurance would cover them. For these, the state’s answer will have to remain specialised centres of excellence like the Pakistan Kidney and Liver Institute in Punjab, and the National Institute of Cardiovascular Diseases in Sindh. And for primary care, including the Lady Health Worker programmes and small health units, each province has lessons to learn from others. For everything else, look to KP.

A broad-based, sustainable insurance initiative including private hospitals is something that the federal government has also been working on. That programme, called the Prime Minister’s National Health Programme, still in the early phases of roll-out, covers just a few districts and offers far fewer benefits to beneficiaries. That the KP government has implemented its bold plan on the scale it has, in the time frame it has, is astounding.

That they haven’t talked about it more is shocking. The PTI would do well to change that now. And come July, each provincial government must roll the programme out in their domain.

Just as the PTI’s 100-day agenda promises — in about 10 words buried right near the end. One hopes that those supporting equity and efficiency in healthcare spending didn’t miss it.

The writer is a Lahore-based columnist and consultant with a background in finance, public and private sector strategy, and energy.

Twitter: @assadahmad

Published in Dawn, June 16th, 2018

US healthcare to provide Democrats with Trump weapon

June 11, 2018

White House efforts to undermine Obamacare sets up battle for midterm campaigns

By Barney Jopson in Brownsville 

Democrats are seeking to revive healthcare as a political weapon against Republicans ahead of elections this year after the Trump administration signalled it was ready to expand its efforts to undercut Obamacare.
Six months after Donald Trump applauded Congress for knocking out one pillar of Obamacare, his administration has said it will not seek to defend another essential component, which requires insurers to cover everyone regardless of their health.

Democrats, who are seeking to win back at least one chamber of Congress in November elections, accused the Trump administration of engaging in “sabotage” by abandoning a requirement that insurers cover people who are already unwell.

Jeff Sessions, the US attorney-general, said in a letter to Congress last week that the US justice department would argue in an existing court case that the ban on denying coverage to people with pre-existing conditions was “unconstitutional”.


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Sessions explains to Congress rationale for not defending ObamaCare
© Greg Nash


Mr Sessions acknowledged he was breaking a tradition of administrations defending the constitutionality of enacted laws. “I have concluded that this is a rare case where the proper course is to forgo defence of [the law],” he wrote.

Chuck Schumer, the top Senate Democrat, tweeted a letter he sent to Mr Trump with three other senior Democrats, which said: “Mr President, it is time to stop the sabotage. We are a country of laws and the law must be respected, defended and enforced regardless of the person occupying the Oval Office.”

The Trump administration’s move was also criticised by the health insurance industry.

Healthcare has been a contentious issue in four consecutive rounds of elections since Obamacare, formally known as the Affordable Care Act, became law in 2010.

Mr Schumer’s letter said as many as 133m Americans had pre-existing medical conditions, excluding the elderly. “Taking this position could render millions of Americans uninsurable or facing higher premiums,” the letter said.

In a nod to the midterm elections, Gerald Connolly, a Democratic member of the US House of Representatives from Virginia, told Republicans “you’ve handed us an issue we will ride into the sunset”, according to the Washington Post.

Many Republican voters have blamed Obamacare for pushing up monthly premiums for health insurance policies, as insurers seek to cover the costs of customers who are filing more claims.

During his campaign Mr Trump said he would retain protections for people with pre-existing conditions, but he has subsequently supported various Republican efforts to remove them.

Although Obamacare tends to divide Americans along partisan lines, the ban on denying coverage to people with pre-existing conditions is one of the most popular parts of the 2010 law.

Mr Sessions argued that the provision on pre-existing conditions would be unconstitutional as soon as another change to Obamacare comes into effect next year: the abolishment of a tax penalty for people who do not have health insurance.

That change, which effectively eliminated another core Obamacare requirement, was included in the tax reform bill that Republicans passed at the end of last year.

America’s Health Insurance Plans, a trade group for health insurers, said scrapping the provision on pre-existing conditions “will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states [and] cause [premium] rates to go even higher for older Americans and sicker patients”.

Mr Trump has continued trying to undo Obamacare — a key part of his predecessor’s legacy — since Republicans in Congress failed to pass new legislation to dismantle it last year.

Additional reporting by Kadhim Shubber in Washington


Sessions explains to Congress rationale for not defending ObamaCare

June 8, 2018

Attorney General Jeff Sessions sent a letter to House Speaker Paul Ryan (R-Wis.) on Thursday defending the Department of Justice’s (DOJ) rationale for not defending the Affordable Care Act, also known as ObamaCare.

“As you know, the Executive Branch has a longstanding tradition of defending the constitutionality of duly enacted statutes if reasonable arguments can be made in their defense,” Sessions wrote.

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Sessions explains to Congress rationale for not defending ObamaCare
© Greg Nash

“But not every professionally responsible argument is necessarily reasonable in this context,” he continued, adding this is “a rare case where the proper course is to forgo defense” of the law.

The department argued in court on Thursday that key components of the Obama-era law are unconstitutional, siding in large part with a challenge to the law from 20 GOP-led states.

The DOJ points to the Supreme Court’s ruling in 2012 that upheld ObamaCare’s individual mandate – that people have insurance or face a tax penalty – as constitutional under Congress’s taxing power.

After Congress repealed the mandate penalty as part of last year’s tax bill, the GOP-led states and DOJ argue the mandate itself is no longer a tax and is now invalid.

They also argue that key pre-existing condition protections cannot be separated from the mandate and should be invalidated, while the remainder of the law can stay.

Sessions’s move marks a break for the DOJ, which typically defends federal laws when they are challenged in court.

The move shows the Trump administration is not willing to defend the law, which it strongly disagrees with.

However, this is not the first time an administration has broken with precedent.

Former President Obama’s Justice Department declined to defend the Defense of Marriage Act, which defined marriage as being between a man and a woman, in 2011.

– Peter Sullivan contributed


Justice Department Won’t Defend Affordable Care Act in Lawsuit Brought by States — Health care and immigration remain two major areas of Trump’s unfinished business

June 8, 2018

Filing creates uncertainty for insurers now setting rates for 2019

The Justice Department’s decision not to defend major provisions in the Affordable Care Act was approved by President Donald Trump, according to Attorney General Jeff Sessions.
The Justice Department’s decision not to defend major provisions in the Affordable Care Act was approved by President Donald Trump, according to Attorney General Jeff Sessions. PHOTO: RICHARD B. LEVINE/NEWSCOM/ZUMA PRESS

The Justice Department won’t defend major provisions in the Affordable Care Act and is asking a federal court to strike down key elements of the law, a new blow to the health law and the stability of the individual insurance market.

The department, in a brief it filed Thursday in a lawsuit brought by 20 state attorneys general, asks the court to halt ACA protections that Republicans in Congress sought to preserve when they attempted to repeal the health law.

The provisions targeted by the Justice Department include the bans on insurers denying coverage and charging higher rates to people with pre-existing health conditions. The department is also seeking to roll back limits on how much insurers can charge people based on gender and age.

The decision to attack the ACA in this way involves a legal, political and policy gamble by the Trump administration, suggesting how much the president still wants to dismantle his predecessor’s signature health law after a failed ACA repeal effort by Republicans a year ago. The move could rattle the insurance markets and shake up the GOP message on health care months before the midterm elections.

Attorney General Jeff Sessions, in a letter to congressional leaders, said the department won’t defend the constitutionality of provisions in the ACA and the decision was made with the approval of President Donald Trump. It is highly unusual for the Justice Department not to back a federal law, though the Obama administration took a similar approach with the Defense of Marriage Act.

“Of all the things the Trump administration has done to destabilize the market, this may be the most major,” said Timothy Jost, an emeritus professor at Washington and Lee University in Lexington, Va. “What’s an insurer that is setting rates now supposed to do, because the court will not have a decision until early summer or late fall.”

The Supreme Court ruled in a landmark 2012 opinion that the health law, and specifically the requirement that Americans have health insurance, was constitutional because the penalty for not having coverage was handled by the Internal Revenue Service and fell within Congress’s taxation powers.

But Congress repealed the penalty for not having insurance last year. Republican attorneys generals are arguing in the lawsuit that the ACA and its mandate is unconstitutional now that Congress has repealed that tax-based penalty. The Justice Department agreed with that stance in its brief in asking the court to halt certain provisions of the ACA.

That case, filed in federal district court in the Northern District of Texas, focuses on the individual mandate, which is the ACA’s requirement that most people have health coverage or pay a penalty. Congressional Republicans late last year ended the penalty starting in 2019, but the requirement to have insurance technically remains. It is unenforceable without a penalty, however.

The Justice Department, in its brief, said certain ACA provisions, such as banning insurers from denying coverage to people with pre-existing conditions, are invalid as of Jan. 1 with the mandate-penalty repeal. The U.S. agreed with the plaintiffs that sections “must now be struck down as unconstitutional,” according to the Justice Department brief.

Mr. Sessions, in the letter to congressional leaders, said: “The department in the past has declined to defend a statute in cases in which the president has concluded that the statute is unconstitutional and made manifest that it should not be defended, as is the case here.”

Democrats quickly decried the move as an improper action likely to harm numerous Americans, especially those who are older and less healthy.

“Tonight, the Trump Administration took its cynical sabotage campaign of Americans’ health care to a stunning new low,” House Minority Leader Nancy Pelosi said in a statement. “Once again, Republicans are trying to destroy protections for Americans with pre-existing conditions.”

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Nancy Pelosi

Sixteen states and the District of Columbia sought to intervene in the case to defend the ACA. The court has granted their request.

The move is likely to rattle insurers who are now setting rates for 2019 based on the belief that they must abide by the ACA consumer-protection requirements. Some legal and health experts said the administration’s decision could destabilize markets.

The department didn’t say other aspects of the ACA, such as its expansion of Medicaid and its exchanges, should be halted.

University of Michigan law professor Nicholas Bagley said three Justice Department attorneys withdrew their names from the brief.

“For the administration to cast aside the ACA in a brazen political move, I’m afraid,” he said. “We don’t want the DOJ to take frivolous arguments and make it into law killers.”

For insurers, the Trump administration stance changes nothing immediately, but raises the likelihood of yet another year of far-reaching uncertainty in the ACA markets. As with other significant legal changes and threats to the ACA over the years, the court proceeding will leave insurers and, particularly, state insurance regulators in the hot seat, unsure how to proceed with decisions on pricing and plan designs.

Insurers are currently filing their rates and plans for the 2019 ACA marketplaces, based on the current rules, which require them to sell plans to all applicants and ban them from tying premiums to consumers’ health conditions. State regulators have begun reviewing the proposed rates, which are set to be completed over the next few months.

Now, insurers and state regulators will have to consider the possibility that insurers will be allowed to go back to pricing plans based on health conditions, a change that would in many ways turn back the clock to how individual coverage was sold before the ACA. It would strike down the central assumptions undergirding the filings the insurers are currently making.

Write to Stephanie Armour at

Appeared in the June 8, 2018, print edition as ‘DOJ Says It Won’t Defend Health Law.’

UK: Labour consults on plan for major National Health Service (NHS) restructuring

June 3, 2018

Shadow health secretary says party will examine how to banish privatisation and restore universal public NHS

Labour will flesh out how it would dismantle Andrew Lansley’s structural NHS reforms to bring more health provision back in-house, in a wide-ranging consultation on NHS restructuring under a future Labour government.

The shadow health secretary, Jon Ashworth, said Labour had now rejected the possibility of working within the existing structures, calling them unfit for purpose, and said the party would consult in the coming months over how it could re-establish a universally public NHS.

The party is committing for the first time to a wholesale restructure of the health service. Overhauling NHS structures have traditionally been politically risky. The former Conservative health secretary Lansley generated controversy when he introduced sweeping reforms in his 2012 Health and Social Care Act.

The reforms saw primary care trusts disbanded and new clinical commissioning groups buying and providing local healthcare services, with NHS contracts opened to the voluntary and private sectors.

Ashworth said Labour would consult on how to undo those reforms. “In the past Labour has said it would work within existing structures,” Ashworth said.

“But these structures are not fit for purpose, over the coming months I want to consult on how we move to an NHS based on partnership and planning where privatisation is banished and we restore a universal public NHS.

“It’s my intention that the next Labour government should bring forward legislation to reinstate the NHS, so that the fragmented structure and Health and Social Care Act will be swept away under the next Labour government.”

Ashworth said the arguments about the future of the NHS, as it approached its 70th birthday, should not only focus on more investment, but on structural failures.

“The truth is the Health and Social Care Act combined with Thatcher’s internal market have led to billions wasted, greater privatisation and fragmentation,” he said.

“And yet the delivery of healthcare in the future where whole person care is the expectation depends on greater collaboration and integration at a local level of social care, primary and community care, mental health services in partnership with the acute sector.”

The Nuffield Trust said Labour should tread cautiously in embarking upon a radical restructure. The health thinktank’s senior fellow Helen Buckingham said: “Nobody would say that the current NHS structure is ideal, but reorganising the health service from Whitehall brings its own set of risks, as we have seen all too often.

“It is easy to underestimate the disruption caused by changes which often take years, and to overestimate the actual difference that they make to staff and patients at the front line. Labour must carefully consider the cost and the benefits of any further reshuffling of health service structures, and proceed with caution.”

The outsourcing of a number of NHS services has come under scrutiny in recent months. Last month, a National Audit Office report found that the outsourcing of primary care support services to Capita had put patients at risk and that Capita was incentivised through the contract to close existing services to minimise its losses. The NAO said the arrangement had led to widespread failure of service delivery.

May is expected to announce an increase for the NHS budget for the next few years to coincide with the health service’s 70th birthday in July, and is under pressure from some cabinet ministers including the health secretary, Jeremy Hunt, to commit to around 4%-a-year increases for the rest of the parliament.

The chancellor, Philip Hammond, has argued for only a modest increase, given the state of public finances, and has argued in favour of capping the annual increase at 2.5%.


Gaza health crisis escalates after weeks of Hamas protests — “The whole Gaza is a sinking ship.”

June 1, 2018

Gaza has been on the brink of collapse after weeks of violence have left more than 13,000 Palestinians wounded, overwhelming an already disastrously weak health system, the Red Cross warned yesterday.

The International Committee of the Red Cross (ICRC) is sending two teams of war surgeons to Gaza and setting up a surgical unit in the enclave’s main hospital to treat heavy casualties from clashes between Israeli forces and Palestinians.

Since protests on the Gaza-Israel border began on March 30, Israeli troops have killed 115 Palestinians and wounded more than 13,000 people, including 3,600 by live ammunition, Robert Mardini, ICRC’s director for the Near and Middle East, said in a news conference in Geneva. Mardini’s comments came as this week also saw the most intense flare-up of hostilities between Palestinian militants and Israel since the 2014 Gaza war.

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Palestinian militants launch a mortar — FILE photo

“The recent demonstrations and violence that took place along the Gaza border since the end of March have triggered a health crisis of unprecedented magnitude in this part of the world,” Mardini said.

The ICRC will set up a 50-bed surgical unit at Al-Shifa hospital, Gaza’s largest. “Our priority now clearly is to help gunshot wound victims. Imagine, 1,350 people with complex cases who will need three to five operations each, a total of 4,000 surgeries, half of which will be carried out by ICRC teams,” he said. “I think such a caseload would overwhelm any health system in the world, including in Geneva.”

 Palestinian protesters gather in Khan Younis, in the southern Gaza Strip.
Palestinian “protester” on the Gaza side of Israel’s border fence

The six-month surge of medical expertise, drugs and equipment will speed the long road to recovery and relieve an overwhelmed health care system, he said.

Since 2007, the Gaza Strip has groaned under a crippling Israeli and Egyptian blockade that has gutted its economy and deprived its roughly 2 million inhabitants of many vital commodities, including food, fuel and medicine. In the long-embargoed enclave, the humanitarian situation has gotten worse each day. The strip was heavily battered in July-August 2014 in a war between Israel and Hamas that killed more than 2,200 Palestinians and 73 people on the Israeli side. Its problems are exacerbated by a decade-old Israeli blockade. The ICRC has appealed to donors for a $5.3-million budget extension to fund a new 50-bed surgical unit in the Al-Shifa Hospital, medical supplies and other additional assistance.

That comes on top of its annual budget for its work across Israel and the Palestinian territories of around $49 million, far less than half of which is funded. But while Mardini voiced hope the boost in aid would help, he cautioned that it was far from a permanent fix for Gaza which has sky-high unemployment, limited supplies of electricity and clean water, and a sanitation system unable to cope. “The whole Gaza is a sinking ship,” he said. And while health workers are focused squarely on “saving lives and limbs,” other health services, for instance during child birth or to respond to a heart attack, are suffering, he said.

As Trump Starts Talking Heathcare Again, Is There Solace from The UK’s National Health Service (NHS)?

May 31, 2018

Deficit for NHS trusts in England double the amount planned

HospitalImage copyright PA

NHS trusts in England have reported a combined financial deficit that was nearly twice the amount planned.

There was a deficit of £960m in the last financial year compared with the £496m they had planned for, the regulator NHS Improvement said.

Acute hospitals were largely responsible, mainly because of increased patient demand, it said.

All other providers, including ambulance and mental health trusts, had collectively underspent, it added.

The latest reported deficit is reached after taking account of extra financial support provided by the government.

Therefore, the Nuffield Trust think tank argued that the true underlying figure was much worse, as the finances had to be patched up with one-off savings and emergency extra cash.

Senior policy analyst Sally Gainsbury said: “Given the huge pressures on NHS providers, it is not at all surprising that the reported deficit for 2017-18 is £960m.

“As we have previously warned, there is a widening gap between what we are asking the NHS to do and what we are funding it to do.”

Chris Hopson, chief executive of NHS Providers which represents various services, said a 5% annual increase in NHS funding is needed to match European levels of care.

He told BBC Radio 4’s Today: “Everywhere you look you get a sense of the NHS under real pressure.”

He said his proposed funding increase equates to an extra 9p on income tax or 7% on VAT, adding: “We need to be realistic about what the nation can afford.”

‘Substantial money’

Janet Davies, chief executive and general secretary of the Royal College of Nursing, said: “Theresa May and Philip Hammond cannot allow this financial knife-edge to continue.

“Whether the chancellor announces the extra funding in time for the NHS anniversary this summer or waits until the autumn Budget, it must be both substantial and genuinely new money.”

The report also highlighted that more than 2,600 patients were waiting longer than 12 months for non-urgent treatment in March – a 75% increase over the year before.

And half of the nation’s 10 “best performing” accident and emergency departments were unable to meet waiting time standards in January, February and March, according to the latest quarterly performance figures.

‘Incredible resilience’

NHS Improvement said acute hospitals had faced a surge in demand within A&E, particularly over the winter months. Some also spent more to cover vacancies and sickness absence.

It pointed out that 156 of the 234 trusts finished the year either reaching or exceeding their financial targets.

Chief executive Ian Dalton added: “Despite epic challenges, NHS staff up and down the country displayed incredible resilience and saw more patients than ever before within four hours.

“More than two-thirds of providers ended the year on budget or better than planned. Given rising demand and record vacancies, this is an important achievement.”

Ministers have promised a new long-term financial plan for the NHS, which is expected within weeks.

In March, Prime Minister Theresa May said she wanted to get away from annual “cash top-ups” and would come up with a blueprint later this year to allow the NHS “to plan for the future”.



NHS report reveals sharp rise in waiting times for care

Quarterly performance figures from the NHS provider sector show more than 2,600 people have waited over a year for treatment.

Newcastle, UK - February 10, 2016: The NHS (National Health Service) logo on an entrance sign for the Royal Victoria Infirmary, a teaching hospital which includes an accident and emergency department...Part of an NHS hospital entrance sign in Newcastle, England.
Image:The NHS Mandate states that 95% of patients attending A&E should be seen within four hours

There has been a sharp rise in the number of patients who have waited more than a year for NHS care in England, according to a new report.

The latest quarterly performance figures of the NHS provider sector show more than 2,600 people have waited over a year for treatment.

The figures from NHS Improvement also reveal half of the nation’s “best performing” A&E departments are unable to meet waiting time standards.

The NHS Mandate states that 95% of patients attending A&E should be seen within four hours.

But only five A&E departments managed to meet the 95% target during January, February and March, and half of the 10 “best performing” units didn’t even meet the four hour target.

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More than five million people attended A&E during January, February and March – which led to more than 1.1 million hospital admissions.

Meanwhile, the NHS provider sector ended the financial year with a deficit of £960m – £464m more than the target set for the year.

The report also highlights that NHS providers in England did not meet targets for diagnostic tests, referral to treatment times and some cancer care targets.

The document, which covers the “most challenging winter periods that the NHS has had”, shows that at the end of March 2018, 2,647 patients were waiting over a year for treatment compared to 1,513 the previous year.

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Image:NHS providers in England did not meet targets for diagnostic tests

It also is a “large increase” from the 2,179 waiting in February 2018, the report says.

The report also highlights that the NHS provider sector ended the year with a “challenging level of vacancies” of more than 92,000 posts.

But NHS Improvement argued that the figures show NHS staff displayed “incredible resilience” in meeting demand during a “challenging year for the NHS”.

It said that the NHS as a whole has “broadly achieved financial balance for the year” after NHS England provisionally reported that it had managed a £955m underspend for the commissioning of healthcare services in 2017/18.

Ian Dalton, chief executive of NHS Improvement, said: “Hundreds of thousands more patients have been to A&Es this year but the NHS did not buckle under the pressure.

:: Britons believe NHS is in decline, says Sky Data poll

“Despite epic challenges, NHS staff up and down the country displayed incredible resilience and saw more patients than ever before within four hours,” he said.

“More than two thirds of providers ended the year on budget or better than planned. Given rising demand and record vacancies, this is an important achievement.”

Janet Davies, chief executive and general secretary of the Royal College of Nursing, warned that Prime Minister Theresa May and Chancellor Philip Hammond “cannot allow this financial knife-edge to continue”, adding that the health service needs “genuinely new money”.

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A Department of Health and Social Care spokesman said: “The Prime Minister and Jeremy Hunt have committed to a long-term plan with a sustainable multi-year settlement for the NHS to help it manage growing patient demand, which will be agreed with NHS leaders, clinicians, and health experts.

“It is testament to the hard work and dedication of staff that despite ever rising demand and significant winter pressures, 277,150 more patients were seen within four hours in A&E in 17-18 compared 16-17, and the majority of trusts’ finances are in good order.”