Healthcare

[Legacy]

QUOTE=irishroo;1902495]So the implied argument here is that insurers should accept huge losses on ACA plans because they can cover those losses with profits on other business lines? That's like saying Microsoft should still sell the Zune because they make a ton of money on software.[/QUOTE]


Wow! Just Wow!

Net income up 46% ($13.1 billion) despite losses on Obamacare, where losses were less than the year before. And this year? You'd expect that net income to improve more as they continue to make further restrictions on reimbursement, leave Obamacare in states and learn further on how to efficiently manage patient care.

Where insurers did well was in Medicare Advantage where underwriting profitability soared 279%. Under Medicare Advantage, the federal government pays companies a fixed amount each month to cover Medicare-eligible Americans. Insurers are benefiting from an influx of younger, healthier retirees, better management of enrollees' health and more favorable contracts with providers.

That's a terrific formula of staying out of high-risk, high cost pools and enrolling as many new Baby Boomers while decreasing competition delivers the leverage for more favorable contracts. 50% next year?

Just stay away from a national pool and negotiations on prices..

 

[irishroo]

Wow! Just Wow!

Net income up 46% ($13.1 billion) despite losses on Obamacare, where losses were less than the year before. And this year? You'd expect that net income to improve more as they continue to make further restrictions on reimbursement, leave Obamacare in states and learn further on how to efficiently manage patient care.

I'm not sure what the argument is here? Are you saying I'm wrong or what?

 

[Legacy]

I'm not sure what the argument is here? Are you saying I'm wrong or what?

I am admiring how profitable these health insurance companies are. Do you know how many industries that have six dominant companies can generate a 46% net income? And that's with losses on Obamacare.

They raked in $13.1 Billion. Their Individual Policy losses, which includes Obamacare, were $893 million, which would translate into another 6% gain in net income should they drop out of all of those completely. Imagine a 52% increase in their profits year over year when individuals policies' premiums and, sometimes, their deductibles are rocketing up.

In your analogy, Microsoft - if Zune is a loss - covers that loss with the prospect of making it profitable competing against other companies' products, gaining marketshare and achieving a popularity by offering a better product at lower prices. If they don't, they cut their losses and stop making Zune. Consumers are not worse off and have had their say in the marketplace. They still have options no matter what Microsoft decides to do.

In healthcare, the consumers are all of us, the competition for reasonable and affordable individual health plans is limited but also exists in a business environment that allows companies to opt out of providing service in unprofitable areas, e.g. Individual health plans including Obamacare.

Plus in health we have no alternatives to not having insurance. Or no good ones.

 

[Legacy]

Massive Movement Launched to Strip Congress of Healthcare, Over 1,000,000 Join

An Oregon man, Daniel Jimenez, has set up a petition at change.org to strip members of the US Congress of their health care coverage, with people like Paul Ryan, Mitch McConnell and President Trump working hard to strip millions of Americans of theirs. Jimenez lost his father to cancer a few years ago after he waited to long to go to the doctor because he lacked health insurance.

If the petition receives 500,000 signatures, it will be delivered to House Speaker Paul Ryan, Sen. Bernie Sanders and President Donald Trump.

As of this moment, the Petition has over 1 million signatures.

Link to Petition:
Remove health-care subsidies for Members of Congress and their families (Change.org)

At this time, under the A.C.A. (Obamacare), members of Congress, and congressional staffwere no longer eligible for the F.E.H.B.P. (Federal Employees Health Benefits Program). “Section 1312 of the Affordable Care Act requires that Members of Congress and their official staff obtain coverage by health plans created under the Affordable Care Act or coverage offered via an Affordable Insurance Exchange.”

 

[dshans]

In the interest of "fair and balanced" ...

Let the games begin!






I think that I was signator #140,208 on the petition

 

[Legacy]

Medicaid in each state with some good links:

Medicaid State Fact Sheets
(Kaiser Family Foundation) Jun 16, 2017

Medicaid and the Children’s Health Insurance Program (CHIP) provide health and long-term care coverage to more than 70 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. Medicaid is a major source of funding for hospitals, community health centers, physicians, and nursing homes. Federal policy proposals to restructure Medicaid could fundamentally change the scope and financing of the program. The two-page fact sheets provide a snapshot with key data for Medicaid in every state related to current coverage, access and financing. What percentage of people are covered by Medicaid/CHIP in your state? Click on a state or the US to download a fact sheet.

Some of the links to fact sheets:

-How has Medicaid affected coverage and access?
-Health Insurance Coverage of the Total Population
-Total Monthly Medicaid and CHIP Enrollment
-Status of State Action on the Medicaid Expansion Decision
-KFF analysis of CMS, January - March 2016 Medicaid MBES Enrollment Report, December 2016 (accessed January 2017); Louisiana Department of Health, LAD Medicaid Expansion Dashboard, accessed January 2017; North Dakota Department of --Human Services, Quarterly Budget Insight Report, July 2015-September 2016 (accessed January 2017).
-Health Insurance Coverage of Adults 19-64
-Health Insurance Coverage of the Nonelderly (0-64) with Incomes up to 200% Federal Poverty Level (FPL)
-Health Insurance Coverage of Children 0-18
-Distribution of Certified Nursing Facilities by Primary Payer Source
-Distribution of the Nonelderly with Medicaid by Family Work Status
-KFF analysis of CDC, The National Health Interview Survey (NHIS), 2015. Doctor visit among adults refers to a general doctor visit only and does not include specialty care.
-KFF, Medicaid Pocket Primer, January 3, 2017.
-KFF, Medicare and Medicaid at 50 Survey, July 17, 2015.
-How does Medicaid work and who is eligible?

-Medicaid and CHIP Income Eligibility Limits for Children as a Percent of the Federal Poverty Level
-Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level
-Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level
-Medicaid Eligibility through the Aged, Blind, Disabled Pathway

The Senate moderates (Rep), who are pushing for a slower phase-out of the Medicaid expansion that is covering low-income people in some of their states, include Susan Collins of Maine, Lisa Murkowski of Alaska, Rob Portman of Ohio and Shelley Moore Capito of West Virginia.

 

[Legacy]

One of the fact sheets from above link:

Health Insurance Coverage of the Nonelderly (0-64) with Incomes below 200% Federal Poverty Level (FPL) (KFF)

Broken down by state into different groups that are interactively sortable.

 

[Legacy]

SMALL AND LARGE BUSINESS HEALTH INSURANCE: STATE & FEDERAL ROLES (National Council of State Legislatures)

Small Business Health Care Tax Credit for Small Employers The SHOP law provisions assist small businesses and small tax-exempt organizations afford the cost of covering their employees’ health insurance. If a small business has fewer than 25 employees and provides health insurance it may qualify for a small business tax credit of up to 50 percent (up to 35 percent for non-profits) to offset the cost of insurance, starting with the 2010 federal tax year. This can make the cost of providing insurance significantly lower. Prior to 2014, the small business tax credit was 35 percent (up to 25 percent for non-profits) for qualifying businesses.

Business owners increasingly wary of GOP's Obamacare repeal-and-replace effort (CNBC)

Small businesses consistently cite health care as a critical issue. Health care is second only to "jobs and the economy" among issues that matter the most to business owners, according to the new CNBC/SurveyMonkey Small Business Survey. It's especially important to owners of businesses with between 10 and 49 employees, according to the survey. The survey also found that the cost of employee health care is among the most "critical issues" business owners face, and concern increases for firms that have 10 or more employees.

 

[Legacy]

Here are the details of Senate Republican Obamacare replacement bill

Will any medical or insurance company endorse Trumpcare?

UNVEILED: THE SECRET SENATE HEALTHCARE BILL

 

[Rogue219]

I've lowered the bar to hoping I can die on a mattress when I'm very old.

This is as The Framers, and Jesus, would have wanted. I assume anyway.

 

[Legacy]

Healthcare groups issue scathing criticism of Senate bill (The Hill)

 

[Legacy]

Ahead of health care bill release, Alaska’s senators draw speculation (Alaska Dispatch News)

As details trickled out about the thus-far secret Republican health care bill on Capitol Hill on Wednesday, the likely votes of Alaska's Republican Sens. Lisa Murkowski and Dan Sullivan continued to be a source of political speculation.

Alaskans face some of the nation's highest health care costs; the state's individual market has only one remaining insurer; and more than 33,000 additional people receive Medicaid under the state's now-expanded program. Analysis showed that the House-passed bill would do little to solve Alaska's problems, and raise premiums for many in the state at rates that far outstripped the rest of the nation.

Both senators have lamented the closed, secretive process by which Majority Leader Mitch McConnell, R-Kentucky, has managed the health care bill, without any hearings. The bill, or at least some of its details, will be released Thursday morning, and McConnell plans a vote on the legislation by the end of next week.

But neither senator has pledged to withhold their vote in response to the closed process.

"Overall, I believe that we can do better for our state and our country. And I will not vote for a bill that will make things worse for Alaskans," Sullivan said Wednesday evening.

In the morning, Murkowski made clear that she is concerned about the bill's quick timeline. In an interview, the senator said that she needs enough time to determine how the bill will impact Alaskans.

Both senators have previously said that they don't want to roll back all parts of the Affordable Car Act. Both want protections to remain in place for people with pre-existing conditions and to allow young people to stay on their parents insurance. They have expressed varying degrees of support for keeping Medicaid expansion in place.

Sullivan said he has been "relentlessly" working to educate Senate leadership about the particular circumstances faced by Alaska, a small state with high costs.

To that end, Sullivan said he has focused on three main issues: stabilizing the state's individual market; making plans more affordable for Alaskans who are not currently receiving federal subsidies to offset the high cost of health insurance premiums; and finding "a sustainable and equitable path forward for Medicaid."

As Congress eyes Medicaid cuts, rising costs for elder care are on Alaska’s horizon (Alaska Dispatch News)

In Alaska, where 185,000 people were on Medicaid last month, just over 10,000 — 5.4 percent — were over the age of 65, according to Jon Sherwood, the Alaska Department of Health and Social Services' deputy commissioner in charge of Medicaid.

But Medicaid comes in for low-income people to cover what Medicare doesn't pay for — vision, dental care and long-term care.

It's the long-term care that really digs into the coffers: During the state's 2016 fiscal year, Medicaid paid for 777 people in nursing homes at a cost of $119 million. More than 6,000 adults — including but not limited to seniors — received in-home services costing more than $140 million, Sherwood said.

Currently, long-term care support — for those who are elderly and those who aren't — totals about one-third of Alaska's Medicaid budget.

Given the changing demographics, if Congress chooses to tighten available funding for Medicaid, the state could have to choose where to cut its costs, choosing between the elderly and disabled and those who can't otherwise afford insurance.

Alaska is one of 32 states that expanded Medicaid under the Affordable Care Act, to include families that make wages 138 percent of the federal poverty level. The federal poverty level is $15,060 for an individual in Alaska and increases with each additional member of a family.

Alaska has added 33,945 individuals to Medicaid through expansion. The state also faces other risk factors for increased Medicaid costs — high unemployment, high health spending per capita, and the high costs of employer-sponsored insurance premiums.

So, of those 185,000 Alaskans on Medicaid, about 34,000 were added through Medicaid expansion.

Alaska: Medicaid & CHIP (Kaiser Family Foundation)

This category provides information about the states health coverage programs for the low-income, including Medicaid and the Children's Health Insurance Program (CHIP). Includes topics such as enrollment, eligibility requirements, managed care participation, spending and federal matching amounts, and enrollment practices.

 

[IrishLax]

Why US health care costs defy common sense (opinion) - CNN.com

 

[wizards8507]

Rand Paul: Insurance should be available for $1 a day | TheHill

 

[Legacy]

Value-Based Pricing For Pharmaceuticals In The Trump Administration (Health Affairs Blog)

A New Way to Define Value in Drug Pricing (Harvard Business Review)

 

[irishroo]

Has anyone seen any study or article that looks at the potential impact of some of these proposed changes (i.e. value-based pricing) on doctors, if there is an impact at all? I ask only because I have quite a few friends either in medical school or recently graduated and the value proposition presented by medical school (you'll make really good money in 15 years, but it's going to cost you a ton in upfront tuition and opportunity costs) already seems to be on the verge on untenable, and a hit to the future earnings potential of doctors may have significant unintended consequences to doctors.

 

[Old Man Mike]

What I'd like to know (among other things) is whether the medical schools are charging the doctors-to-be far too much? We pretty much know that everything else in the system charges way too much (doctors, specialists, drug companies, etc) but where does it start? Simple Greed? Insurance Companies? Lawyers and courts?

When considering the apparently intractably fouled up state of the whole system, is there REALLY an argument for not having a POWERFUL government role in this, literally, life and death business? Aren't "market forces" and "libertarian" philosophies just "Devil take the Hindmost" in this fundamental necessity? Do we even care?

 

[wizards8507]

What I'd like to know (among other things) is whether the medical schools are charging the doctors-to-be far too much? We pretty much know that everything else in the system charges way too much (doctors, specialists, drug companies, etc) but where does it start? Simple Greed? Insurance Companies? Lawyers and courts?

When considering the apparently intractably fouled up state of the whole system, is there REALLY an argument for not having a POWERFUL government role in this, literally, life and death business? Aren't "market forces" and "libertarian" philosophies just "Devil take the Hindmost" in this fundamental necessity? Do we even care?

Except that you're perverting the end goal of a health care system. The goal of a health care system is NOT "coverage for all" or "low cost for patients," it's "positive health outcomes." That's the great myth of Obamacare. Coverage is up, but coverage isn't really a worthwhile goal if the people aren't getting any healthier.

If your goal is healthier people rather than an arbitrary "percent insured" statistic, you want freer markets and more competition.

 

[Irishize]

Massive Movement Launched to Strip Congress of Healthcare, Over 1,000,000 Join





As of this moment, the Petition has over 1 million signatures.

Link to Petition:
Remove health-care subsidies for Members of Congress and their families (Change.org)

At this time, under the A.C.A. (Obamacare), members of Congress, and congressional staffwere no longer eligible for the F.E.H.B.P. (Federal Employees Health Benefits Program). “Section 1312 of the Affordable Care Act requires that Members of Congress and their official staff obtain coverage by health plans created under the Affordable Care Act or coverage offered via an Affordable Insurance Exchange.”

What American taxpayer can't support this^.

They should adopt that into one of the requirements of serving in Congress...use the same damn health insurance your crooked ass votes for. But "They" won't b/c "They" make their own rules and vote to give themselves gold plated insurance and salary increases.

 

[Irishize]

These poor folks were able to raise enough money for a treatment in US that could possibly save their son's life. The government said "no".

Charlie Gard parents given more time to say goodbye to terminally ill son - BBC News

 

[no.1IrishFan]

Except that you're perverting the end goal of a health care system. The goal of a health care system is NOT "coverage for all" or "low cost for patients," it's "positive health outcomes." That's the great myth of Obamacare. Coverage is up, but coverage isn't really a worthwhile goal if the people aren't getting any healthier.

If your goal is healthier people rather than an arbitrary "percent insured" statistic, you want freer markets and more competition.

Healthier people generally are those who can afford regular checkups and maintenance medications instead of going to the ER when things go terribly wrong. There must also be more emphasis on how poorly people take care of themselves. If the goal isn't coverage for all, or as many as possible, you're not going to really address positive outcomes that much. Think of the body as a car that has gone many years without oil changes, new plugs/wires and tires showing steel threads. It's much harder to rectify the situation after so much neglect.

 

[Legacy]

Has anyone seen any study or article that looks at the potential impact of some of these proposed changes (i.e. value-based pricing) on doctors, if there is an impact at all? I ask only because I have quite a few friends either in medical school or recently graduated and the value proposition presented by medical school (you'll make really good money in 15 years, but it's going to cost you a ton in upfront tuition and opportunity costs) already seems to be on the verge on untenable, and a hit to the future earnings potential of doctors may have significant unintended consequences to doctors.

CMS (Centers for Medicare and Medicaid) has instituted VBP since ACA for hospitals and gradually for different diagnoses, as you may know. VBP was facilitated with the electronic medical records in hospitals, which made it easy to review documentation on admission, criteria in comparison to admission standards, and readmissions.

CMS on Value Based Programs

I do not want to think that a physician would advocate abandoning VBP models for our trillion dollar a year health care system to pay his/her med school loans or achieve an expected level of income. Experiences and attitudes differ with general care physicians vs. some specialists. Some specialists see a decrease in reimbursement because of VBP which has separated Outpatient admissions (<24 hrs) like laparoscopic appendectomies from Inpatient admissions (3 days) like bowel surgeries. CMS may come in and routinely review EMRs and deny reimbursement if appropriate. Health insurance companies generally follow the same guidelines for reimbursement. If a surgeon wants to keep an "Inpatient" patient in the hospital longer than three days, their documentation should justify each extension also according to criteria. All procedures do not now "Inpatient" with three days of reimbursement. (EMRs have also been effective in finding fraud, amounting to billions per year.) Also consider that the increase in volume, generally for non-surgical physicians, helps compensate for decreases in income that VBP may involve.

A recent UC Davis Health System study found that over the course of their lifetimes specialist physicians currently earn roughly $2.8 million more on average than primary care physicians. This gap will close under value-based purchasing as economic leverage shifts from specialists to primary care doctors. It’s more likely, however, that the incomes of medical specialists and surgeons will face downward pressure rather than primary care doctors seeing their incomes rise significantly.

The theory is that a value-based care model will result in care that is less expensive, less prone to error and has better patient outcomes. Admittedly, this is still theory; it has yet to be proven in practice. But that’s the direction of change, and it’s unlikely to be reversed. A stronger, healthier healthcare system is expected to emerge, but it will not be without pain to industry participants. That’s always one of the prices to be paid for industry transformation.

(Source, 2015)

Non-hospital physicians have combined groups for more leverage in negotiations. So, marketplace competition, should these rules be abandoned, is not really an option. What are the alternatives if the only cardiologist group or surgical group in town refuses to contract? Since hospitals do not get reimbursed for an admission within thirty days for some preventable complications related to admissions, some physicians have seen those reimbursements decrease due to outcome-based criteria. (BTW, the new Health and Human Services Secretary was an orthopedic surgeon.)

Experiences and Attitudes of Primary Care Providers Under the First Year of ACA Coverage Expansion (2015)

 

[wizards8507]

Healthier people generally are those who can afford regular checkups and maintenance medications instead of going to the ER when things go terribly wrong. There must also be more emphasis on how poorly people take care of themselves. If the goal isn't coverage for all, or as many as possible, you're not going to really address positive outcomes that much. Think of the body as a car that has gone many years without oil changes, new plugs/wires and tires showing steel threads. It's much harder to rectify the situation after so much neglect.

Except the statistics don't back up anything you're saying. Someone insured under Medicaid isn't doing any more of that "oil change" stuff than someone who's uninsured.

 

[Legacy]

Except the statistics don't back up anything you're saying. Someone insured under Medicaid isn't doing any more of that "oil change" stuff than someone who's uninsured.

Source?

Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance (J. Amer Med Assoc)

Obamacare Medicaid expansion improved preventive care

 

[Legacy]

This would be a popular win for Trump where Obama failed American patients. He has promised to lower drug prices.

NIH rejects petition to override patent on pricey prostate cancer drug

Louisiana considers radical step to counter high drug prices: Federal intervention | NOLA.com

 

[Legacy]

The Kaiser Family Foundation has some great info on health care. (Home page)

That includes state health "categories and indicators". As an example, here is North Dakota's.
North Dakota: Categories and Indicators
(I'll link a few.)

(Select a category to see indicators. Results will be shown as a table or map as available.)
-Demographics and the Economy
-Health Costs & Budgets
-Health Coverage & Uninsured
-Health Insurance & Managed Care
-Health Reform
-Health Status
-HIV/AIDS
-Medicaid & CHIP
-Medicare
-Minority Health
-Providers & Service Use
-Women's Health

 

[Legacy]

DOJ’s Focus on Health Care Fraud Continues (National Law Review)

Combating health care fraud will continue to be a priority for the Jeff Sessions-led Department of Justice (DOJ).

DOJ Criminal Division’s Acting Assistant Attorney General Kenneth Blanco, in a May 18 speech at the ABA’s Institute on Health Care Fraud, said that Attorney General Jeff Sessions “feels very strongly” that “health care fraud is a priority for the Department of Justice.” Mr. Blanco called health care fraud “despicable” and said, “the investigation and prosecution of health care fraud will continue; the department will be vigorous in its pursuit of those who violate the law in this area.” Mr. Blanco continued, “I can tell you that [Attorney General Sessions] has expressed this to me personally.”

Mr. Blanco sent a strong and clear message to the audience of health care attorneys, defense counsel, compliance professionals, and relators counsel that the Justice Department’s longstanding commitment to combating health care fraud will continue. His speech appeared to be designed to address concerns that changes in emphasis in the DOJ Criminal Division towards immigration and violent crime would come at the expense of health care fraud investigations. Attorney General Sessions is committed to investigating and prosecuting health care fraud because, Mr. Blanco said, health care fraud hurts vulnerable people seeking medical care and costs the government and tax payers almost $100 billion annually.

Mr. Blanco cited three tools that the Justice Department has used for the past several years when discussing the Department’s full-court press to prosecute corporations and individuals who orchestrate and benefit from fraudulent health care schemes: (1) recent work of the Health Care Fraud Unit, a specialized unit within the Criminal Division’s Fraud Section, (2) the importance of cooperation between the Medicare Fraud Strike Forces, U.S. Attorney’s Offices, and state and federal investigative agencies, and (3) the commitment to the use of in-house, real-time data analytics to review CMS data to detect fraudulent billing and emerging fraudulent schemes. ...

Also, From: Acting Assistant Attorney General Kenneth A. Blanco of the Criminal Division Speaks at the American Bar Association 27th Annual Institute on Health Care Fraud
Fort Lauderdale, FL ~ Thursday, May 18, 2017

The Centers for Medicare & Medicaid Services (CMS) estimate that the total health care spending in the United States in 2015 reached $3.2 trillion, or 17.8 percent of the gross domestic product. That is eye-popping in my view.

and,

Since its inception in March 2007, the Medicare Fraud Strike Force has charged nearly 3,200 defendants who have collectively billed the Medicare program for more than $11 billion. To give you a sense of how this looks during a shorter timeframe: between the beginning of 2016 and February of this year, the Medicare Strike Force program, the Health Care Fraud Unit, and partner U.S. Attorney’s Offices, charged 482 individuals with a total loss amount of nearly $2.8 billion. During this period, 180 defendants were convicted, and the Medicare Fraud Strike Force reached resolutions totaling $512 million paid to U.S. and state authorities. These resolutions vary in amounts from thousands of dollars to one corporate resolution resulting in a U.S. penalty of $144 million.

I cannot overemphasize the importance of the cooperative partnerships between the Strike Forces, U.S. Attorney’s Offices, and several investigative agencies. Let me give you an example of the kind of results we have achieved by working hand-in-hand. Last year, the Criminal Division organized the largest national health care fraud takedown in history, both in terms of individuals charged and the loss amount. This nationwide sweep was led by the Medicare Fraud Strike Force with the collaboration of 36 U.S. Attorney’s Offices and the largest number ever of participating Medicaid Fraud Control Units (MFCUs). This effort resulted in charges against 301 individuals, including 60 doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare and Medicaid fraud schemes involving approximately $900 million in false billings. This example drives home our commitment, capabilities, our nimbleness and our level of coordination.

 

[Legacy]

How Republicans can save their health care legacy (Brookings Inst) by Alice M. Rivlin

 

[Legacy]

Sessions to Unveil Health-Care Fraud Crackdown This Week, Sources Say (Bloomberg)

In what is described as a nationwide sweep with hundreds of arrests being carried out across the U.S., the Justice Department is cracking down on fraudulent claims made to some of the nation’s biggest insurers, said one of the people. People who run drug addiction treatment centers that have filed bogus claims and those who have filed reimbursement claims for drugs they then sell illegally are among those to be charged, the person said.

Arrests will be carried out in cities including Miami, Chicago, Detroit and Los Angeles, the person said. Scores of arrests are expected in southern Florida, which is home to hundreds of residential drug addiction treatment centers, said the person. Federal prosecutors, some of whom have been working on cases for a year or more, were directed to accelerate their efforts in time for this month’s operation, the person said. The Government Accountability Office did an investigation and found last year that the sign-up process for the Affordable Care Act exchanges was "vulnerable to fraud."

 

[Legacy]

Surprise. Trump administration gives Obamacare a boost in Alaska (Alaska Dispatch News)

No company will ever make a profit selling health insurance to Alaskans stricken with lung cancer, brain cancer, sickle cell anemia, hemophilia, multiple sclerosis, end-stage renal disease, cystic fibrosis, Lou Gehrig's disease, AIDS, leukemia, quadriplegic cerebral palsy, chronic hepatitis, Parkinson's and other torments.

There are 33 costly conditions, now spelled out in state regulation, that make up the tale of horror at the center of the individual health insurance dilemma in Alaska. But an Obamacare improvement is at hand from an unlikely source — the Trump administration.

The underlying problem is that insuring sick people is never going to be profitable in a high-cost state with a small population. "In short, there are not enough healthy members in Alaska's individual market to offset the cost of members with very high medical costs," as Premera put it in 2014.

At one time, the only option for victims of serious diseases who were not on Medicare or did not have decent health care coverage through an employer or a spouse was to spend every dime fighting to stay alive.

There were high-risk insurance pools, including one in Alaska that had about 500 people who paid high premiums, deductibles and faced lifetime limits on total medical expenses. In 2012, a 60-year-old could buy a plan with a $10,000 deductible for $737 a month.

Today, the individual market has morphed into a high-priced pool for those who make too much to qualify for subsidies. A 60-year-old earning about $60,000 a year pays close to $2,000 a month. But a 60-year-old who earns about $55,000 pays $444 a month because of subsidies, according to the Kaiser Family Foundation insurance calculator....