U.S. spending deal would raise tobacco age, deny some of Trump border wall funding

By Richard Cowan and Susan Cornwell

WASHINGTON (Reuters) – Congress would raise the U.S. tobacco purchasing age to 21 and permanently repeal several of the Affordable Care Act’s (ACA) taxes under a massive government spending bill due to be released later on Monday, congressional sources said.

Republican and Democratic lawmakers hope to pass the $1.4 trillion spending bill before current government funding runs out on Saturday, to avoid a partial government shutdown and head off the kind of messy budget battle that resulted in a record 35-day interruption of government services late last year and early this year.

The legislation, worked out during weeks of negotiations between leading lawmakers and the Trump administration, denies President Donald Trump the spending increase he has sought to build his signature wall along the U.S.-Mexico border.

Most Democrats and some Republicans support a mix of improved physical barriers at the border, along with a combination of high-tech surveillance equipment and patrols by all-terrain vehicles and even horses.

They have mostly rejected Trump’s calls for at least $24 billion over the long run to build his much-touted wall, which he originally said Mexico would finance. Mexico rejected that idea. The wall’s price tag could escalate as the federal government is forced to acquire private lands for construction.

The crackdown on youth smoking, by changing the minimum age for cigarette and other tobacco purchases to 21 from the current 18, would give the Food and Drug Administration six months to develop regulations. The agency would then have three years to work with states on implementing the change.

The largest expenditures in the bill is for the Department of Defense, which would get a total of $738 billion for this year, $22 billion more than last year. It does not include “mandatory” programs, such as Social Security and Medicare, which are funded separately.

The legislation also includes $425 million in additional federal grants to help local governments prepare for the November 2020 presidential and congressional elections.

Some of the money would be used to harden infrastructure against cyber attacks following election meddling by Russia in 2016.

Negotiators settled on $7.6 billion for conducting next year’s census, which is done once every 10 years. That would be $1.4 billion more than Trump proposed.

The bill also allocates $25 million for federal gun violence research, following a decades-long suspension of such funding.

All of the money would fund government programs through Sept. 30, 2020.

The legislation would repeal several taxes originally created to help fund the ACA, popularly known as Obamacare, that had been delayed or were only intermittently in effect.

It calls for a permanent repeal of the so-called “Cadillac tax,” a 40% tax on generous health insurance plans.

It had been intended to encourage corporations to buy lower cost plans for employees but was opposed by many unions that had negotiated their health insurance plans and by businesses who said it was a benefit workers valued. The tax was delayed and never went into effect.

The spending bill would also repeal the 2.3% tax on the sale of medical devices such as catheters and pacemakers. This drew opposition from bipartisan lawmakers who said it hurt innovation at medical device companies.

Another tax to be repealed is an industry-wide health insurance fee of about 2.5% to 3% of premiums collected.

(This version of the story has been refiled to add dropped word “not” in seventh paragraph)

(Reporting by Susan Cornwell and Richard Cowan; Editing by Andy Sullivan, Chizu Nomiyama and Bill Berkrot)

U.S. government extends deadline to sign up for Obamacare insurance plans

(Reuters) – The U.S. government said on Monday the deadline for signing-up for 2020 insurance plans under the Affordable Care Act (ACA) has been extended by three days to Dec. 18 to accommodate those who experienced issues while attempting to enroll.

There were website glitches and call center delays reported on Sunday, the earlier deadline for the 2020 open enrollment, and the extension should help the final enrollment tally, said Evercore ISI analyst Michael Newshel.

“The post-Thanksgiving ramp-up in sign-ups was better than expected, and the momentum bodes well for the key final surge into the deadline this Sunday, December 15,” Newshel said in a note last week.

Last year, the number of people who signed up for 2019 health plans fell 4% to 8.5 million people from 2018, but saw a typical trend of last-minute shopping in the final week.

The Centers for Medicare and Medicaid Services runs enrollment for insurance plans created by the ACA, often called Obamacare, through the online marketplace, HealthCare.gov, for 38 states.

(Reporting by Manojna Maddipatla in Bengaluru; Editing by Shinjini Ganguli)

Trump doubles down on Obamacare fight, asks court to overturn law

FILE PHOTO - A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, U.S., October 26, 2017. REUTERS/Mike Blake

(Reuters) – U.S. President Donald Trump’s administration has stepped up its attack on the Obamacare health care law, telling a federal appeals court it agrees with a Texas judge’s ruling that the law is unconstitutional and should be struck down.

The Justice Department in a two-sentence letter to the Court of Appeals for the Fifth Circuit filed on Monday said it backed the December ruling by U.S. District Judge Reed O’Connor in Fort Worth that found the Affordable Care Act violated the U.S. Constitution because it required people to buy health insurance.

O’Connor ruled on a lawsuit brought by a coalition of 20 Republican-led states including Texas, Alabama and Florida, that said a Trump-backed change to the U.S. tax code made the law unconstitutional.

The 2010 law, seen as the signature domestic achievement of Trump’s Democratic predecessor, Barack Obama, has been a flash point of American politics since it passed, with Republicans including Trump repeatedly attempting to overturn it.

Democrats made defending the law a powerful messaging tool in the run-up to the November elections when polls showed that eight in 10 Americans wanted to defend the law’s most popular benefits including protections for insurance coverage for people with preexisting conditions. The strategy paid off and Democrats won a broad 38-seat majority in the U.S. House of Representatives.

“The Department of Justice has determined that the district court’s judgment should be affirmed,” Assistant U.S. Attorney General Joseph Hunt and other federal officials wrote in the Monday letter. They said they would file a more extensive legal briefing later.

Obamacare survived a 2012 legal challenge at the Supreme Court when a majority of justices ruled the individual mandate aspect of the program was a tax that Congress had the authority to impose.

In December, O’Connor ruled that after Trump signed a $1.5 trillion tax bill passed by Congress last year that eliminated the penalties, the individual mandate could no longer be considered constitutional.

A group of 17 mostly Democratic-led states including California and New York on Monday argued that the law was constitutional.

“The individual plaintiffs do not have standing to challenge the resulting law because they suffer no legal harm from the existence of a provision that offers them a lawful choice between buying insurance or doing nothing,” they wrote in court papers.

About 11.8 million consumers nationwide enrolled in 2018 Obamacare exchange plans, according to the U.S. government’s Centers for Medicare and Medicaid Services.

About 11.8 million consumers nationwide enrolled in 2018 Obamacare exchange plans, according to the U.S. government’s Centers for Medicare and Medicaid Services.

(Reporting by Scott Malone in Boston; Editing by Bill Trott)

Health insurers, hospital operators fall as Obamacare ruled unconstitutional

FILE PHOTO: A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, U.S., October 26, 2017. REUTERS/Mike Blake

(Reuters) – Shares of health insurers, hospitals, and healthcare companies fell in early trading on Monday, after a federal judge ruled the Affordable Care Act (ACA), also known as Obamacare, unconstitutional late last week.

The ACA, introduced by former U.S. President Barack Obama in 2010 to provide affordable healthcare to all Americans, mandates that all individuals have health insurance or pay a tax.

But on Friday, Texas District Judge Reed O’Connor agreed with a coalition of 20 states that a change in tax law last year eliminating a penalty for not having health insurance invalidated the entire Obamacare law.

Centene Corp fell 7.8 percent to $117.5, while Molina Healthcare slumped 10.1 percent to $118.4. The companies are among health insurers with exposure to ACA.

WellCare Health Plans and Anthem Inc declined 4.7 percent and 2.1 percent, respectively.

“While we are disappointed in the recent Northern District of Texas court’s ACA ruling, we recognize that this is a first step in what will be a lengthy appeals process,” Molina Healthcare said.

“Regardless, the ACA will remain in effect for 2019, and we are optimistic that it will remain in effect thereafter.”

Brokerage Evercore ISI said it expected no immediate impact from the ruling, calling it only a declaratory judgment and not an injunction.

Even in case of an eventual injunction, the defendants would certainly seek and most likely get a stay pending appeal, Evercore said.

Hospitals and healthcare services providers Community Health Systems, Tenet Healthcare Corp and HCA Healthcare Inc fell between 4 percent and 8 percent.

(Reporting by Manogna Maddipatla in Bengaluru)

Twenty states sue federal government, seeking end to Obamacare

FILE PHOTO: A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, U.S., October 26, 2017. REUTERS/Mike Blake/File Photo

(Reuters) – A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine.

Led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, the lawsuit said that without the individual mandate, which was eliminated as part of the Republican tax law signed by President Donald Trump in December, Obamacare was unlawful.

“The U.S. Supreme Court already admitted that an individual mandate without a tax penalty is unconstitutional,” Paxton said in a statement. “With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of Obamacare, once and for all,” he said.

The U.S. Justice Department did not immediately respond to a request for comment on whether the Trump administration would defend the law in court.

The individual mandate in Obamacare was meant to ensure a viable health insurance market by forcing younger and healthier Americans to buy coverage.

Republicans have opposed the 2010 law formally known as the Affordable Care Act, the signature domestic policy achievement of Trump’s Democratic predecessor Barack Obama, since its inception.

Paxton and Schimel, both Republicans, were joined in the lawsuit by 18 states including Arizona, Florida, Georgia, Utah and West Virginia. It was filed in U.S. District Court in the Northern District of Texas.

(Reporting by Eric Beech in Washington)

Trump administration will allow states to test Medicaid work requirements

U.S. President Donald Trump attends the Women in Healthcare panel hosted by Seema Verma (R), Administrator of the Centers for Medicare and Medicaid Services, at the White House in Washington, U.S., March 22, 2017.

By Yasmeen Abutaleb

WASHINGTON (Reuters) – The Trump administration said on Thursday it would allow states to test requiring some Medicaid recipients to work or participate in community activities such as volunteering or jobs training as a condition of eligibility for the government health insurance program for the poor.

The Centers for Medicare and Medicaid Services issued guidance making it easier for states to design and propose test programs that implement such requirements. States must propose such changes through waivers and receive federal approval.

Seema Verma, the agency’s administrator, said the policy guidance came in response to requests from at least 10 states that have proposed requiring some Medicaid recipients to work or participate in activities that may include skills training, education, job search, volunteering or caregiving. Those states include Kentucky, Maine, New Hampshire, Arizona, Indiana and Utah.

Certain Medicaid populations would be exempt from the rules, including those with disabilities, the elderly, children and pregnant women. Verma also said states would have to make “reasonable modifications” for those battling opioid addiction and other substance use disorders.

“This gives us a pathway to start approving waivers,” Verma said on a call with reporters on Wednesday. “This is about helping those individuals rise out of poverty.”

Under the 2010 Affordable Care Act, former Democratic President Barack Obama’s signature domestic policy achievement commonly known as Obamacare, 31 states expanded Medicaid to those making up to 138 percent of the federal poverty level, adding millions of people to the rolls.

Republicans have repeatedly failed to repeal and replace Obamacare, a top campaign promise of President Donald Trump. Instead, the Trump administration has sought to weaken the program through executive orders and administrative rules.

The Obama administration opposed state efforts to implement work requirements in Medicaid because it could result in fewer people having access to health insurance.

For instance, Kentucky last year proposed work requirements for able-bodied adults to get insurance and establishing new fees for all members based on income. A study found the proposal would reduce the number of residents on Medicaid by nearly 86,000 within five years, saving more than $330 million.

Republicans argue that Medicaid was created to serve the most vulnerable and has become bloated under Obamacare. Verma and other Republicans said implementing work and community engagement requirements could help improve health outcomes by connecting people with jobs and training.

(Reporting by Yasmeen Abutaleb; Editing by Peter Cooney)

Nearly 1.5 million people signed up for Obamacare plans so far: officials

Nearly 1.5 million people signed up for Obamacare plans so far: officials

WASHINGTON (Reuters) – More than 800,000 people signed up for Obamacare individual health insurance plans in the second week of open enrollment, U.S. government health officials said on Wednesday, bringing the total number of sign-ups to nearly 1.5 million so far.

There is particular scrutiny of how Affordable Care Act programs are faring after a year in which President Donald Trump has sought to undermine Obamacare, especially after his fellow Republicans in Congress failed to pass legislation to repeal and replace the law.

More people have signed up for Obamacare plans in the first two weeks of 2018 open enrollment than in the same time period last year, and the sign-ups include about 345,000 new consumers, according to the latest figures from the U.S. Centers for Medicare and Medicaid Services.

But the Trump administration halved the 2018 open enrollment period to six weeks, slashed the Obamacare advertising budget by 90 percent and cut funding for groups that help people enroll in Obamacare insurance, so it is still unclear whether there will be the same level of participation as in years past.

The Congressional Budget Office has forecast that 11 million people will buy plans in 2018, 1 million more than were enrolled in 2017.

Republicans, who control the White House, Senate and U.S. House of Representatives, failed this summer to push through legislation to overturn the 2010 law, former Democratic President Barack Obama’s top domestic policy achievement.

Repealing Obamacare has long been a goal of Republicans and it was one of Trump’s main election campaign promises. Frustrated by inaction in Congress, the president has taken steps through executive and regulatory actions to undercut the law, and has promised to let the healthcare program “implode.”

Republicans including House Speaker Paul Ryan have said they will try again next year to repeal the law, which has extended health insurance coverage to 20 million more Americans but which has long been seen by Republicans as costly government overreach.

The Senate this week added a repeal of Obamacare’s individual mandate, the requirement that most Americans purchase health insurance or else pay a penalty, to its version of an overhaul of the U.S. tax code that is working its way through Congress.

(Reporting by Yasmeen Abutaleb; Editing by Frances Kerry)

Maine governor will not expand Medicaid, ignoring voters

Maine governor will not expand Medicaid, ignoring voters

By Gina Cherelus

(Reuters) – Maine Republican Governor Paul LePage said on Wednesday he will not expand the state’s Medicaid program under Obamacare, ignoring a ballot initiative widely backed by voters, calling it “ruinous” for the state’s budget.

Maine looked set to become the first state in the nation to expand Medicaid by popular vote.

About 60 percent of voters in Maine approved the ballot proposal in Tuesday’s election, according to the Bangor Daily News newspaper.

Republicans in Washington have failed several times to pass legislation that would dismantle former President Barack Obama’s signature healthcare law.

LePage said he will not implement the expansion until it is fully funded by the Maine legislature.

“Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget,” LePage said in a statement. “I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.”

LePage said a previous Medicaid expansion in Maine in 2002 had created $750 million in debt to hospitals and took resources away from vulnerable people.

Maine has been prominent in the nation’s healthcare debate. U.S. Senator Susan Collins, a moderate Republican from Maine, helped block her party’s efforts to repeal Obamacare. Collins did not immediately respond to a request for comment on LePage’s decision.

Maine voters were asked to approve or reject a plan to provide healthcare coverage under Medicaid for adults under age 65 with incomes at or below 138 percent of the federal poverty level, which in 2017 is about $16,000 for a single person and about $22,000 for a family of two.

If implemented, about 70,000 additional state residents would be eligible for the Medicaid program, local media reported, in addition to the roughly 268,000 people who are currently eligible.

(Reporting by Gina Cherelus in New York; Editing by Daniel Wallis and Jeffrey Benkoe)

Voters in Maine approve expansion of Medicaid under Obamacare

Voters in Maine approve expansion of Medicaid under Obamacare

By Brendan O’Brien

(Reuters) – Voters in Maine on Tuesday approved a ballot initiative to expand the state’s Medicaid program under Obamacare, sending a clear signal of support for the federal healthcare law to lawmakers in the state and Washington D.C.

The approval of the ballot question in Maine comes after Republicans in Washington failed several times over the last few months to pass legislation that would dismantle the Affordable Care Act, former President Barack Obama’s signature healthcare law.

Maine has recently figured prominently in the nation’s debate on how to reform healthcare. U.S. Senator Susan Collins, a moderate Republican from Maine, helped block her party’s efforts to repeal Obamacare this year, which angered President Donald Trump.

Maine, which becomes the first U.S. state to approve Medicaid expansion by ballot initiative, is one of 19 states that has not expanded Medicaid under the Affordable Care Act.

About 60 percent of voters in Maine approved the ballot initiative, according to the Bangor Daily News newspaper.

Tuesday’s ballot asked Maine voters to approve or reject a plan to provide healthcare coverage under Medicaid for adults under the age of 65 with incomes at or below 138 percent of the federal poverty level, which in 2017 is about $16,000 for a single person and about $22,000 for a family of two.

The state’s Republican governor, Paul LePage, staunchly opposes expansion of federal health care insurance, vetoing legislation to do so on several occasions.

“I’ve said it before, “free” is very expensive to somebody,” LePage said in a radio address last week.

About 70,000 residents in Maine would be eligible for the state’s Medicaid program when and if state officials certify the results of the election. Lawmakers could vote to repeal or alter the referendum, much like they have recently for several citizen-initiated referendums, the Bangor Daily News reported.

“It is now the responsibility and the duty of the governor and the legislature to fully and faithfully implement this law,” the state’s Speaker of the House, Sara Gideon, said in a statement.

The Legislature’s Office of Fiscal and Program Review in Maine estimated that expansion of Medicaid would cost the state about $55 million and bring in about $525 million of federal money to the state each year, according to the Bangor Daily News.

(Reporting by Brendan O’Brien in Milwaukee; Editing by Nick Macfie)

Iowa pulls request to opt out of Obamacare requirements

Iowa pulls request to opt out of Obamacare requirements

By Susan Cornwell

(Reuters) – Iowa on Monday withdrew a request to waive some Obamacare rules to help shore up its struggling healthcare insurance market, marking a setback in efforts by Republican-governed states to sidestep requirements of the Obama-era law.

With open enrollment for the Affordable Care Act – better known as Obamacare – set to start in just over a week, the state announced it would no longer wait to hear if federal officials would approve its request aimed at cutting individual healthcare insurance premiums and widening coverage.

The withdrawal prompted a leading U.S. Senate Republican to urge Congress to approve a bipartisan fix to Obamacare, which President Donald Trump has vowed to scrap.

Iowa was viewed as a test case by some for other states that submitted similar, if far less-reaching, waivers and of how the Trump administration would respond to such requests.

Iowa Governor Kim Reynolds said the law had not been flexible enough to accommodate the state’s request.

“Ultimately, Obamacare is an inflexible law that Congress must repeal and replace,” the governor said in a statement, adding that premiums under Obamacare had increased by 110 percent for Iowans since 2013.

Iowa sought the waiver after its individual healthcare marketplace shrank to only one insurer for next year, Minnesota-based Medica.

Some of the state’s requests were similar to provisions included in Republican repeal and replace bills this year. For instance, the waiver sought to replace Obamacare’s income-based tax credits with flat age-based credits and eliminate insurer payments that Trump cut off earlier this month.

Senator Lamar Alexander, Republican of Tennessee, said the move by Iowa demonstrated the need for repairs to Obamacare that he and Democratic Senator Patty Murray have proposed aimed at stabilizing insurance markets. It would also provide states more flexibility in reshaping some parts of Obamacare.

Trump has sent mixed signals over whether he would support the bipartisan fix. Senate Majority Leader Mitch McConnell said on Sunday that he was willing to bring up the proposal for a vote but needed to know where Trump stood.

Alexander said the bipartisan repair proposal would allow the federal government to approve Iowa’s waiver.

Alexander told reporters that the Congressional Budget Office, a nonpartisan scorekeeper, would soon announce its analysis of the bipartisan repair legislation, possibly on Tuesday.

(Reporting by Susan Cornwell,; additional reporting by Yasmeen Abutaleb and Amanda Becker in Washington; Editing by Andrew Hay)