Tag Archives: Healthcare

Trump faces major test as vote looms on U.S. healthcare bill

A cyclist passes the the U.S. Capitol, on the day the House is expected to vote here to repeal Obamacare in Washington, D.C., U.S., May 4, 2017. REUTERS/Kevin Lamarque

By Richard Cowan and Yasmeen Abutaleb

WASHINGTON (Reuters) – The U.S. House of Representatives was set on Thursday for a cliffhanger vote to repeal Obamacare, as Republican leaders worked to deliver President Donald Trump a win for one of his top legislative priorities.

House Republican leaders have expressed confidence the bill would pass and several party moderates who previously objected to the measure got behind it on Wednesday, giving it new momentum.

“We’re optimistic that we’ll pass it out of the House today,” Representative Mark Meadows of North Carolina, chairman of the conservative Freedom Caucus, told MSNBC’s “Morning Joe” program on Thursday.

The vote, which a House Republican aide said was due this afternoon, was expected to be close. Even if the measure passes the House, it faces daunting odds in the Senate where Republicans hold a narrower majority.

“Today is the next step in what is likely to be a very long process,” Republican Representative Michael Burgess of Texas also said on MSNBC.

Keen to score his first major legislative victory since taking office in January, Trump threw his own political capital behind the bill, meeting Burgess and other lawmakers and calling them in an effort to win their support.

Trump, whose Republican party controls both the House and Senate, is seeking to make good on his campaign promise to repeal and replace Obamacare.

Aides said he worked the phones furiously.

Wavering moderate Republicans had worried that the legislation to overhaul President Barack Obama’s 2010 signature healthcare law would leave too many people with pre-existing medical conditions unable to afford health coverage.

But the skeptical Republican lawmakers got behind the bill after meeting with Trump to float a compromise proposal expected to face unanimous Democratic opposition.

The legislation’s prospects brightened after members of the Freedom Caucus, a faction of conservative House lawmakers who played a key role in derailing the original version last month, said they could go along with the compromise.

Millions more Americans got healthcare coverage under Obamacare, but Republicans have long attacked it, seeing it as government overreach and complaining that it drives up costs.

Called the American Health Care Act, the Republican bill would repeal most Obamacare taxes, including a penalty for not buying health insurance. It would slash funding for Medicaid, the program that provides insurance for the poor, and roll back much of Medicaid’s expansion.

The latest effort comes after earlier pushes by Trump collapsed twice, underscoring the difficulty in uniting the various factions of the Republican party.

Earlier this week, prospects for the legislation appeared grim as several influential moderate Republicans said they could not support the bill, citing concerns about people with pre-existing conditions.

House Energy and Commerce Committee Chairman Representative Greg Walden of Oregon on Thursday defended the leaders’ plan to vote on the bill without a new Congressional Budget Office analysis of the costs or impact on coverage, factoring in the recent changes.

“Obviously, it’s a work in progress,” Walden, who also met with Trump on Wednesday, said in a separate MSNBC interview.

House Democrats have rejected the latest change to the Republican legislation, saying it did not go far enough toward protecting people with pre-existing conditions.

“Republicans have made Trumpcare even more dangerous and destructive than the last time they brought it to the floor,” Democratic Leader Nancy Pelosi said to her caucus in a letter late Wednesday night.

Democrats have long thought their best chance of stopping the repeal would be in the Senate, where only a few Republicans would need to defect to stop the law from moving forward.

Republican Meadows told MSNBC he expected the Senate to make changes to the bill that would improve it. The bill would then face a final vote in the House.

With the difficulties in the House, Democrats are optimistic Republicans will face a backlash from voters and could lose seats in the 2018 mid-term elections.

(Additional reporting by David Morgan, Steve Holland, Roberta Rampton, Eric Beech and Susan Heavey; Writing by Ginger Gibson; Editing by Caren Bohan and Jeffrey Benkoe)

Republicans still short of votes to pass U.S. healthcare overhaul

FILE PHOTO: A doctor checks the blood pressure of a patient in downtown Los Angeles, U.S., on July 30, 2007. REUTERS/Lucy Nicholson/File Photo

By Richard Cowan and David Morgan

WASHINGTON (Reuters) – Republicans in the U.S. House of Representatives said on Tuesday they were closer to agreeing on a reworked bill to overhaul the nation’s healthcare system but still lacked the votes to pass it, as President Donald Trump pressed lawmakers for a vote.

The White House has been pressuring House Republicans to push ahead with legislation to repeal and replace the Affordable Care Act, commonly called Obamacare, after a first effort failed in March in a major setback for the Trump administration.

“I think it’s time now” for a healthcare vote, Trump told lawmakers at the White House on Tuesday.

But Republican leaders, including House Speaker Paul Ryan, are once again struggling to balance the concerns of moderates, who want to protect Americans with pre-existing medical conditions, with the reluctance of conservatives to make changes.

Representative Mark Meadows of North Carolina, who heads the staunchly conservative House Freedom Caucus that helped block passage of the first bill, said Republicans were still “a handful of votes away.”

Representative Tom MacArthur of New Jersey, a Republican moderate who brokered a deal that revived the healthcare legislation, said there were still some moderates in the party sitting on the fence.

“It’s close. It’s close. We’re getting there,” MacArthur said.

Lawmakers are considering a bill that would allow states to opt out of Obamacare protections for people with pre-existing medical conditions – provisions that force insurers to charge sick people and healthy people the same rates.

That is seen as a concession to the Freedom Caucus, which has endorsed the new measure. In an interview earlier this week, Trump, however, insisted the new bill would maintain protections for those with pre-existing conditions.

Republicans have long vowed to repeal Democratic former President Barack Obama’s 2010 healthcare restructuring, arguing that the law, which allowed some 20 million Americans to gain healthcare insurance, was too intrusive and expensive.

During his 2016 campaign, Trump also vowed to get rid of it.

Republicans, however, remain divided over key provisions of the bill, with some lawmakers expressing worries of a spike in the number of people without coverage, or sharp increases in insurance premiums.

“They’re still talking about possible changes. If they don’t have the votes, then they’ll have to make changes,” Representative Peter King of New York, a Republican moderate, told reporters, indicating he would likely vote for the bill.

But any tack to the center to shore up moderates’ support threatens to spur defections on the Republican right flank.

“They change it one iota, I’m out,” Representative Dave Brat of Virginia, a Freedom Caucus member, told reporters.

OPPOSITION

Adding to the pressure on Republicans is the unified opposition of Democrats, many of whom view the 2010 healthcare law as the defining domestic achievement of Obama’s presidency, as do healthcare advocates.

Ten major patient advocacy groups, including the American Heart Association and American Diabetes Association, have said they opposed the reworked healthcare bill.

Other major medical groups such as the American Medical Association have also expressed concerns over coverage losses and unaffordable insurance for those with pre-existing conditions.

If a plan passes the House, it is expected to face a tough fight in the Senate, where Republicans have a narrower majority and where some party senators have expressed misgivings about the House bill.

(Reporting by Richard Cowan, David Morgan, Steve Holland and Doina Chiacu; Writing by Paul Simao; Editing by Dan Grebler)

U.S. Republican leaders hunt for votes for healthcare bill

U.S. House Speaker Paul Ryan speaks about healthcare at his weekly press briefing on Capitol Hill in Washington, U.S, April 27, 2017. REUTERS/Yuri Gripas

By Susan Cornwell

WASHINGTON (Reuters) – House Republicans were making headway in efforts to build support for a reworked plan to overhaul the U.S. healthcare system, but have not decided when to vote, House Speaker Paul Ryan said on Thursday.

Ryan spoke as Republican leaders scoured the U.S. Capitol in search of centrist Republican backing for the amended measure after it gained the approval on Wednesday of a group of hard-right Republican conservatives who had helped to sink the original version last month.

“We’re making very good progress,” Ryan told reporters at a news conference, saying the changes endorsed by conservative Freedom Caucus Republicans on Wednesday would also appeal to moderate Republicans.

The House could vote as early as this week on the legislation, aides said, meaning it could pass the House in time for President Donald Trump’s 100th day in office on Saturday.

It remained unclear whether the amended bill could attract the 216 votes needed to pass the House, given the united Democratic opposition. Its future is further clouded in the Senate.

“We’re going to go when we have the votes,” Ryan said.

Republicans in Congress have made repealing and replacing the Affordable Care Act, commonly known as Obamacare, a central campaign promise for seven years. Republican President Donald Trump made it a top campaign promise.

But House Republicans are not keen to repeat last month’s debacle, when their leaders acquiesced to Trump’s demand for a floor vote on the bill, only to unceremoniously yank the measure after determining it could not pass.

The Republican healthcare bill would replace Obamacare’s income-based tax credit with an age-based credit, roll back an expansion of the Medicaid government health insurance program for the poor and repeal most Obamacare taxes.

The nonpartisan Congressional Budget Office had estimated 24 million fewer people would have insurance under the original version.

The new amendment that has won over a number of conservatives, drafted by Representative Tom MacArthur, would allow states to seek federal waivers to opt out of some of the law’s provisions. That includes the highly popular provision mandating that insurers charge those with pre-existing conditions the same as healthy consumers, and that insurers cover so-called essential health benefits, such as maternity care.

Some centrists say the changes do not address their worries that the bill would hurt poor Americans in the Medicaid program. Others, including Republican Representative Dan Donovan of New York, said the loosening of protections for people with pre-existing medical conditions was a major problem.

“It’s going to cost people with pre-existing conditions even more money to have coverage … It’s something that we shouldn’t be doing,” Donovan said on CNN.

House Democrats on Thursday threatened to oppose a short-term government funding bill if the Republicans try to bring the healthcare bill to the floor this week.

Ryan brushed off this threat, even though Republicans are expected to need some Democratic votes to pass the funding bill.

House Democratic Leader Nancy Pelosi told reporters that Trump was making Republicans “walk the plank” on a healthcare bill that was “wildly unpopular.”

Ryan dismissed the idea that some Republican lawmakers’ House seats were at risk if they vote for the healthcare bill. “I think people’s seats are at risk if we don’t do what we said we would do” and repeal Obamacare, he said.

(Reporting by Susan Cornwell and Susan Heavey; Additional reporting by Amanda Becker and Will Dunham; Editing by Jeffrey Benkoe)

Trump extends program allowing some veterans to use local doctors, hospitals

U.S. President Donald Trump smiles after signing S.544, the Veterans Choice Program Extension and Improvement Act, at the White House in Washington, U.S., April 19, 2017. REUTERS/Kevin Lamarque

By Lisa Lambert

WASHINGTON (Reuters) – President Donald Trump on Wednesday moved a step closer to fulfilling his campaign promise to reform the troubled Veterans Affairs department, but some veterans groups are concerned that the administration may be working toward privatizing their healthcare.

Trump signed a law extending the pilot “Veterans Choice” program, which allows some veterans to receive healthcare from local doctors and hospitals closer to their homes than the VA’s 150 hospitals and nearly 1,000 outpatient clinics. The law eases procedures for reimbursing private providers and creates a system for sharing medical records with them.

“This new law is a good start, but there is still much work to do,” Trump said at a signing ceremony attended by VA Secretary David Shulkin and Florida Governor Rick Scott.  “We will fight each and every day to deliver the long-awaited reforms our veterans deserve.”

Trump pledged to hold a news conference next week on “all of the tremendous things that are happening at the VA and what we’ve done in terms of progress and achievement.”

Reforming the agency, rocked by a waiting-time scandal in 2014, was one of Trump’s most-repeated campaign trail promises. He has frequently suggested having the government pay outside physicians to provide veteran healthcare.

During his confirmation hearings, Shulkin said he supported overhauling the agency but did not believe in privatizing it. Still, on Tuesday the VA announced it was seeking cutting-edge treatments from the healthcare industry for brain injuries, mental health problems and chronic pain.

Extension of the “Veterans Choice” program could worry Democrats and other critics that Trump and Shulkin are inching toward sending some of the $65.6 billion the department spends annually on medical care to corporations and private businesses.

Conservatives calling for privatization say the VA provides medical services to only about 45 percent of veterans, and they point to delays and inefficiencies dogging the current system.

Some veterans groups and Democrats have warned against moving funds away from healthcare providers with expertise in injuries and illnesses unique to serving in the armed forces.

In a March report, the Government Accountability Office said veterans in the Choice program still face long wait times, mostly because cases must be referred to private contractors for scheduling.

Last year a congressionally mandated panel of experts found the Choice program was inefficient, but recommended establishing a community-based healthcare system that would include private doctors.

(Reporting by Lisa Lambert; Editing by David Gregorio)

Insight: Ballooning bills – More U.S. hospitals pushing patients to pay before care

FILE PHOTO: An emergency sign points to the entrance to Scripps Memorial Hospital in La Jolla, California, U.S. March 23, 2017. REUTERS/Mike Blake/File Photo

By Jilian Mincer

(Reuters) – Last year, the Henry County Health Center in Iowa started providing patients with a cost estimate along with pre-surgery medical advice.

The 25-bed rural hospital in the southwest corner of the state implemented the protocol because of mounting unpaid bills from insured patients, a group that had previously not raised red flags.

Henry County is one of hundreds of U.S. hospitals trying to cope with an unexpected consequence of the Affordable Care Act of 2010, known as Obamacare: millions more Americans have health insurance, but it requires them to spend thousands of dollars before their insurer kicks in a dime.

Since U.S. hospitals do not want to end up footing the bill, they are now experimenting with pre-payment strategies for patients, with a growing number requiring payment before scheduled care and offering no interest loans, according to interviews with more than two dozen hospitals, doctors, patients, lenders and healthcare experts.

“Most patients are appreciative that we’re telling them up front,” said David Muhs, chief financial officer for the Henry County hospital, which provides a discount for early payment. The discussion leads some patients to skip care, others to delay it or use a no interest loans available through the hospital, he said.

The ACA extended insurance to 20 million Americans, which initially helped hospitals begin to shrink debt from uninsured patients who could not pay their medical bills. But more and more, people in Obamacare plans or in employer-based health plans are choosing insurance that features low monthly payments. The trade-off is high out of pocket costs when they need care. (For a graphic, click http://tmsnrt.rs/2oCzePS)

If President Donald Trump dismantles Obamacare as promised, these plans won’t disappear. Republicans also believe high-deductible plans curb spending, and Americans faced with medical costs that rise faster than inflation and wages will look for premiums they can afford.

The trend is expected to accelerate this year because unpaid bills are creating massive bad debt for even the most prestigious medical centers. U.S. hospitals had nearly $36 billion in uncompensated care costs in 2015, according to the industry’s largest trade group, a figure that is largely made up of unpaid patient bills.

The largest publicly-traded hospital chain, HCA Holdings Inc, reported in the fourth quarter of 2016 that its ratio of bad debt to gross revenues of more than $11 billion was 7.5 percent.

One of the first to test this new payment strategy was Novant Health, headquartered in North Carolina with 14 medical centers and hundreds of outpatient and physician facilities. It saw patient debt increase when more local employers started adopting high deductible plans, including one that made its executives pay $10,000 in out-of-pocket expenses.

“To remain financially stable, we had to do something,” said April York, senior director of patient finance at Novant, whose patient default rate dropped to 12 percent from 32 percent after it started offering no interest loans through ClearBalance.

“Patients needed longer to pay. They needed a variety of options,” she said.

IMPACT ON PATIENTS

These prepayment strategies are being rolled out by hospitals across the country because the financial equation has changed so much for patients – even the insured ones.

Almost half of Americans – 45 percent – polled by the Kaiser Family Foundation said they would have difficulty paying an unexpected $500 medical bill. The average deductible this year for the least expensive of the widely used Obamacare health plans is $6,000 for an individual – an 18 percent spike since 2014 – and more than double that for a family, according to government data.

Jessica Curtis, a senior advisor at Community Catalyst, a consumer advocacy group in Boston, said the impact on patients stretches beyond personal finance.

“They delay procedures, they don’t follow advice on prescription drugs, and when they see care, they usually are for more expensive procedures because they’ve waited,” she said

Brian Sanderson, managing principal of Crowe Horwath’s healthcare services group, said communicating with patients and providing longer repayment options is a good strategy since hospital margins have shrunk, thanks to growing unpaid medical bills from consumers.

“A well informed patient is more likely to meet their obligations,” he said. “It’s just good patient relations and it helps to minimize bad debt.”

Hospitals are doing what they can to retain patients while helping them pay medical bills that could run thousands of dollars. Many are expanding charity eligibility, and hiring companies like ClearBalance, AccessOne and Commerce Bank to provide loans to patients no matter what their credit. Most carry no interest rate for the patient, and could be extended far longer than the few months that hospitals once required before sending a bill to collections.

“People are more likely to pay a bank than a hospital,” said Mark Huebner, director of Health Services Financing at Commerce Bank, which offers its line of credit at more than 200 hospitals.

“People are aware that banks will come after them. Banks do collect on debt, and hospitals generally have been more relaxed,” he said.

Wake Forest Baptist Medical Center in North Carolina had seen its bad debt creep up in recent years as more patients saw out of pocket expenses soar, with some deductibles reaching $15,000.

“We’ve seen that many patients are unaware of the increases in their deductibles,” said CFO Chad Eckes. Wake Forest now asks for payment before non-emergency services are provided but also offers zero interest, longer repayment options.

“It’s a challenging position,” he said. “It’s a discussion no one wants to be in, and none of us enjoy.”

(Editing by Caroline Humer and Edward Tobin)

Trump talks healthcare with Republican critic on golf course

Senator Rand Paul (R-KY) speaks to an aide after playing golf with U.S. President Donald Trump at the White House in Washington, U.S., April 2, 2017. REUTERS/Joshua Roberts

By Jan Pytalski

STERLING, Va. (Reuters) – President Donald Trump golfed with a vocal Republican critic of his healthcare push on Sunday, as he insisted efforts to repeal and replace President Barack Obama’s signature healthcare law were not dead.

Senator Rand Paul and Office of Management and Budget Director Mick Mulvaney joined the president at Trump National Golf Club outside of Washington. The trio was “discussing a variety of topics, including healthcare,” said White House Deputy Press Secretary Stephanie Grisham.

The outing came hours after Trump tweeted that talks to rework the nation’s healthcare law were still under way.

“Anybody (especially Fake News media) who thinks that Repeal & Replace of ObamaCare is dead does not know the love and strength in R Party!” Trump tweeted early on Sunday.

“Talk on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck,” he added in a second message.

Republican-led efforts to replace Obama’s healthcare law were thrown into disarray 10 days ago after Republican leaders in the House of Representative had to withdraw their own legislation ahead of a vote due to insufficient support from conservative and moderate members of their own party.

Trump had worked towards the bill’s passage, but Paul had been a prominent critic and had aligned himself with the conservative House Freedom Caucus, a group that helped torpedo Trump’s first major legislative effort.

On Thursday, Trump had threatened to defeat members of the group in next year’s congressional elections if they continued to defy him.

In an interview published on Sunday by the Financial Times, Trump was adamant he wanted to get a healthcare bill passed, and said he would turn his back on the Freedom Caucus and negotiate with Democrats if that is what it took.

“If we don’t get what we want, we will make a deal with the Democrats,” he said.

(Writing by Pete Schroeder; Editing by Mary Milliken and Andrea Ricci)

Ryan opposes Trump working with Democrats on healthcare

House Speaker Paul Ryan speaks during his news conference after Republicans pulled the American Health Care Act. REUTERS/Yuri Gripas

WASHINGTON (Reuters) – U.S. House of Representatives Speaker Paul Ryan, the top Republican in Congress, said he does not want President Donald Trump to work with Democrats on new legislation for revamping the country’s health insurance system, commonly called Obamacare.

In an interview with “CBS This Morning” that will air on Thursday, Ryan said he fears the Republican Party, which failed last week to come together and agree on a healthcare overhaul, is pushing the president to the other side of the aisle so he can make good on campaign promises to redo Obamacare.

“I don’t want that to happen,” Ryan said, referring to Trump’s offer to work with Democrats.

Carrying out those reforms with Democrats is “hardly a conservative thing,” Ryan said, according to interview excerpts released on Wednesday. “I don’t want government running health care. The government shouldn’t tell you what you must do with your life, with your healthcare,” he said.

On Tuesday, Trump told senators attending a White House reception that he expected lawmakers to reach a deal “very quickly” on healthcare, but he did not offer specifics.

“I think it’s going to happen because we’ve all been promising – Democrat, Republican – we’ve all been promising that to the American people,” he said.

Trump said after the failure of the Republican plan last week that Democrats, none of whom supported the bill, would be willing to negotiate new healthcare legislation because Obamacare is destined to “explode.”

(Reporting by Lisa Lambert and Eric Beech; Editing by Leslie Adler)

Trump tells lawmakers he expects deal ‘very quickly’ on healthcare

U.S. President Donald Trump and First Lady Melania Trump host a reception for Senators and their spouses at the East Room of the White House in Washington, U.S., March 28, 2017. REUTERS/Carlos Barria

WASHINGTON (Reuters) – U.S. President Donald Trump told a group of senators on Tuesday that he expected lawmakers would be able to reach a deal on healthcare, without offering specifics on how they would do it or what had changed since a healthcare reform bill was pulled last week for insufficient support.

“I have no doubt that that’s going to happen very quickly,” Trump said at a bipartisan reception held for senators and their spouses at the White House.

“I think it’s going to happen because we’ve all been promising – Democrat, Republican – we’ve all been promising that to the American people,” he said.

A Republican plan backed by Trump to overhaul the U.S. healthcare system was pulled on Friday after it failed to garner enough support to pass the Republican-controlled House of Representatives.

Trump, a Republican, did not mention that failure at the reception nor did he offer specifics on how he planned for lawmakers to reach a consensus on a healthcare bill that would repeal and replace the Affordable Care Act, familiarly known as Obamacare.

Trump told lawmakers at the reception that he would be talking about infrastructure and investing in the military, without offering a time frame or details.

“Hopefully, it will start being bipartisan, because everybody really wants the same thing. We want greatness for this country that we love,” he said.

(Reporting by Ayesha Rascoe; Editing by Leslie Adler, Toni Reinhold)

How Republicans can hobble Obamacare even without repeal

People march in a "Save Obamacare" rally in Los Angeles.

By Julie Steenhuysen

CHICAGO (Reuters) – Republicans may have failed to overthrow Obamacare this week, but there are plenty of ways they can chip away at it.

The Trump administration has already begun using its regulatory authority to water down less prominent aspects of the 2010 healthcare law.

Earlier this week, newly confirmed Health and Human Services Secretary Tom Price stalled the rollout of mandatory Medicare payment reform programs for heart attack treatment, bypass surgery and joint replacements finalized by the Obama administration in December.

The delays offer a glimpse at how President Donald Trump can use his administrative power to undercut aspects of the Affordable Care Act (ACA), including the insurance exchanges and Medicaid expansion that Republicans had sought to overturn.

The Republicans’ failure to repeal Obamacare, at least for now, means it remains federal law. Price’s power resides in how to interpret that law, and which programs to emphasize and fund.

Hospitals and physician groups have been counting on support from Medicare – the federal insurance program for the elderly and disabled – to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost.

The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018. Although he has voiced general support for innovative payment programs, Price has been a loud critic of mandatory federal programs that dictate how doctors should deliver healthcare.

Providers such as Dr. Richard Gilfillan, chief executive of Trinity Healthcare, a $15.9 billion Catholic health system, say they will press on with these alternative payment plans with or without the government’s blessing. But they have been actively lobbying Trump officials for support, according to interviews with more than a dozen hospital executives, physicians and policy experts.

Without the backing of Medicare, the biggest payer in the U.S. healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway U.S. healthcare spending.

Price “can’t change the legislation, but of course he’s supposed to implement it. He could impact it,” said John Rother, chief executive of the National Coalition on Health Care, a broad alliance of healthcare stakeholders that has been lobbying the new administration for support of value-based care.

The move Friday to pull the Republican bill only reinforces the risk to the existing law, which Trump said on Friday “will soon explode.”

“It seems that the Trump Administration now faces a choice whether to actively undermine the ACA or reshape it administratively,” Larry Levitt, senior vice president at Kaiser Family Foundation, wrote on Twitter.

“The ACA marketplaces weren’t collapsing, but they could be made to collapse through administrative actions,” he added.

NEW PAYMENT PLANS AT RISK

The United States spends $3 trillion a year on healthcare – more by far than 10 other wealthy countries – yet has the lowest life expectancy and the highest infant mortality rate, according to a 2013 Commonwealth Fund report.

Health costs have soared thanks in part to the traditional way doctors and hospitals get paid, namely by receiving a fee for each service they provide. So the more advanced imaging tests a doctor orders or pricey procedures they perform, the more money he or she makes, regardless of whether the patient’s health improves.

“We have a completely broken economy in healthcare,” said Blair Childs, senior vice president at hospital purchasing group Premier Inc. “Literally, all of the incentives in fee-for-service are for higher cost.”

Alternative payment models are designed to remove incentives that reward overtreatment of patients. Private insurers are on board, with Aetna Inc, Anthem Inc, UnitedHealth Group and most Blue Cross insurers announcing plans to shift half of their reimbursement to alternative payment models to control costs.

To promote the shift to alternative payments, the ACA created an incubator program at the Centers for Medicare Medicaid Services (CMS). The CMS innovation center is funded by $10 billion over 10 years to test payment schemes aimed at improving quality and cutting the cost of care.

The Obama administration’s decision to make some of these payment programs mandatory has drawn the ire of Price, a former U.S. senator and orthopedic surgeon. In response to a mandatory payment program for joint replacements last September, for example, Price charged that the CMS innovation center was “experimenting with Americans’ health.”

In his January 17 confirmation, Price said he was a “strong supporter of innovation,” but said he believed the CMS innovation center “has gotten a bit off track.”

TRUMP SETS WHEELS IN MOTION ON DAY 1

President Trump has already signed an executive order directing the HHS to begin unraveling Obamacare. In the early hours of his presidency, Trump directed government agencies to freeze regulations and take steps to weaken the healthcare law.

The order directed departments to “waive, defer, grant exemptions from, or delay the implementation” of provisions that imposed fiscal burdens on states, companies or individuals. These moves were meant to minimize the costs and regulatory burdens imposed on states, private entities and individuals.

David Cutler, the Harvard health economist who helped the Obama Administration shape the ACA, said Price could do all sorts of things to undermine the law.

“If he wants to blow it up, he can,” Cutler said in an email. But if they do, he added, “they alone will own the failure.”

(Editing by Edward Tobin)

House speaker tells Trump healthcare bill lacks votes: CNN

U.S. House Energy and Commerce Committee Chairman Representative Greg Walden (R-OR) (center L, at table) and Ways and Means Committee Chairman Representative Kevin Brady (R-TX) (center R, at table) testify at an early-morning Rules Committee hearing as Congress considers health care legislation to repeal Obamacare at the U.S. Capitol in Washington, U.S., March 24, 2017. REUTERS/Jonathan Ernst

By Richard Cowan and Dustin Volz

WASHINGTON (Reuters) – Republicans in Congress said they lacked the votes needed for passage of their U.S. healthcare system overhaul and a key committee chairman came out in opposition after Donald Trump demanded a vote on Friday in a gamble that could hobble his presidency.

Amid a chaotic scramble for votes, House of Representatives Speaker Paul Ryan, who has championed the bill, met with Trump at the White House. Ryan told the president there were not enough votes to pass the plan, U.S. media reported.

The showdown on the House floor follows Trump’s decision to cut off negotiations to shore up support inside his own party, with moderates and the most conservative lawmakers balking. On Thursday night he had issued an ultimatum that lawmakers pass the legislation that has his backing or keep in place the Obamacare law that Republicans have sought to dismantle since it was enacted seven years ago.

“We’ll see what happens,” Trump said at the White House, adding that Ryan should keep his job regardless of the outcome.

The White House said the vote was set for about 3:30 p.m. (1930 GMT) on Friday on the bill to replace Democratic former President Barack Obama’s signature domestic policy achievement, the 2010 Affordable Care Act, widely known as Obamacare.

“There’s nobody that objectively can look at this effort and say the president didn’t do every single thing he possibly could with this team to get every vote possible,” White House spokesman Sean Spicer told reporters.

Republicans control Congress and the White House but have deep divisions over the first major legislative test since Trump became president on Jan. 20.

In a blow to the bill’s prospects, House Appropriations Committee Chairman Rodney Frelinghuysen announced his opposition, expressing concern about reductions in coverage under the Medicaid insurance program for the poor and the retraction of “essential” health benefits that insurers must cover.

“We need to get this right for all Americans,” Frelinghuysen said.

Representative Rodney Davis, a member of the House Republican team trying to win passage, said the bill was short of the needed votes, and White House budget director Mick Mulvaney added it was unclear if enough support was present.

Vice President Mike Pence, a former House member and influential among Republican lawmakers, postponed a planned trip to Arkansas and Tennessee to help secure passage.

“I’m still optimistic,” Spicer said. “I feel like we’re continuing to work hard. But at the end of the day you can’t force somebody to do something.”

Trump and House Republican leaders cannot afford to lose many votes in their own party because Democrats are unified in opposition, saying the bill would take away medical insurance from millions of Americans and leave the more-than-$3 trillion U.S. healthcare system in disarray.

Republican supporters said the plan would achieve their goal of rolling back the government’s “nanny state” role in healthcare.

FOREHEAD TATTOO

House Democratic leader Nancy Pelosi said, “What’s happening today is a lose-lose situation for the Republicans. It’s a lose-lose for the American people, that’s for sure. But the people who vote for this will have this vote tattooed to their foreheads as they go forward.”

Failure of the measure would call into question Trump’s ability to get other key parts of his agenda, including tax cuts and a boost in infrastructure spending, through a Congress controlled by his own party.

“If it doesn’t pass, this issue is dead,” Republican Representative Mario Diaz-Balart, a bill supporter, said of Republican healthcare legislation. “This is the one shot.”

Even if the legislation passes in the House, it faces an uncertain future in the Senate, where Republicans have expressed misgivings.

Healthcare was the first major test of how Trump, a real estate magnate who touted his deal-making prowess in the 2016 presidential campaign, would work with Congress. Days of negotiations led to some changes in the bill but failed to produce a consensus deal.

U.S. stocks were mixed on Friday in early afternoon trading, having pared earlier gains, while U.S. treasuries were mostly higher.

Leading Republicans had taken to the House floor to make their case to pass the bill and implored conservatives to seize the opportunity to make good on the party’s long promise to get rid of Obamacare.

‘ONLY OUR FIRST STEP’

“Today we are faced with a stark choice,” said Republican Diane Black, who heads the Budget Committee. “While no legislation is perfect, this bill does accomplish some important reforms.”

Black called the bill “only our first step.”

Trump added on Twitter, “This is finally your chance for a great plan!”

Democratic Representative Debbie Wasserman Schultz, a breast cancer survivor, called the bill “an immoral piece of legislation” that would gut medical coverage and patient protections.

A Quinnipiac University poll released on Thursday found 56 percent of U.S. voters opposed the House bill, with only 17 percent supporting it. Quinnipiac said its poll had a margin of error of plus or minus 3 percentage points.

Replacing Obama’s signature health care plan was a key campaign pledge for Trump and Republicans, who view it as overly intrusive and expensive.

Obamacare boosted the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies. About 20 million Americans gained insurance coverage through the law.

The nonpartisan Congressional Budget Office said under the Republican legislation 14 million people would lose medical coverage by next year and more than 24 million would be uninsured in 2026.

The House plan would rescind a range of taxes created by Obamacare, end a penalty on people who refuse to obtain health insurance, end Obamacare’s income-based subsidies to help people buy insurance while creating less-generous age-based tax credits

It also would end Obamacare’s expansion of the Medicaid state-federal insurance program for the poor, cut future federal Medicaid funding and let states impose work requirements on some Medicaid recipients.

House leaders agreed to a series of last-minute changes to try to win over disgruntled conservatives, including ending the Obamacare requirement that insurers cover certain “essential benefits” such as maternity care, mental health services and prescription drug coverage.

The House and Senate had hoped to deliver a new healthcare bill to Trump by April 8, when Congress is scheduled to begin a two-week spring break.

Click on the links below for related graphics:

Graphic on Obamacare and Republican healthcare bill (http://tmsnrt.rs/2n0ZMKf)

Graphic on shifting positions in the U.S. Senate on Republican healthcare bill (http://tmsnrt.rs/2mUE4Xf)

Graphic on poll on Americans’ views of the Republican healthcare bill (http://tmsnrt.rs/2n7f3e4)

(Additional reporting by Susan Heavey, Susan Cornwell, Jeff Mason, David Morgan, David Lawder, Amanda Becker, and Doina Chiacu; Writing by Will Dunham; Editing by Bernadette Baum and Bill Trott)