A recent report from stop-loss carrier Sun Life Financial says that, based on an analysis of the firm's data from 2011-2014, various cancers accounted for the two costliest catastrophic conditions at 25.7% of the $2.1 billion paid to claimants. End-stage renal disease followed with 7.8% of total stop-loss claims paid.
Other costly conditions listed in the report included congenital anomalies, or conditions present at birth, premature births, congestive heart failure, cerebrovascular disease, pulmonary collapse or respiratory failure, medical and surgical complications, and septicemia. In total, the top 10 costliest conditions accounted for 52.8% of the total claims paid over the four-year period analyzed.
Just missing the over top 10: Transplants, which represented more than $41 million in stop-loss claims from 2011-2014. However, the number of claims for these procedures -- in particular, bone marrow and stem cell transplants -- has jumped in the past two years, moving them from the 10th-costliest condition in 2013 to the fifth-costliest last year.
Also noteworthy is that the number of individuals with claims of more than $1 million continued to grow. Cancer, conditions present at birth, and premature births accounted for 28% of all claims exceeding $1 million, according to the report.
Read more at Business Insurance (registration may be required).
Happy Independence Day from MedBen! In observance of the holiday, our home office will be closed on Friday, July 3 and reopen at 8:00 a.m. on Monday, July 6.
It's always our hope that during any holiday, health care claim matters are the last thing on your mind. But should a question arise while our office is closed, MedBen Access likely has the answer. Plan administrators and plan members alike can take advantage of this convenient online customer service center any time of the day or night.
To log onto MedBen Access, just go to MedBen.com and click on the "MedBen Access" link. New users will need to click on the “First time?” link in the Login box and follow the registration instructions.
MedBen Access offers a variety of useful administrative services, such as ordering ID cards, monitoring claims activity and reviewing change of information requests. Plan members can check a claim's status, review Plan Document coverage and download forms, to name just a few of the functions available.
Nor do the features end there. Members with pharmacy plans administered by PDMI will find a "My Rx" link that allows them to review their prescription drug purchases, get medication information and compare brand name drug prices with generic and therapeutic alternatives. If you offer an FSA or HRA, those participants can use MedBen Access to see their balances, claims submissions and payments by selecting the "FSA/HRA Online Inquiry" option. And MedBen WellLiving members can check their compliance with annual exams and cancer screening tests by selecting the Wellness Plan link under “My Plan.”
The entire MedBen team wishes you a safe and relaxing Independence Day!
July 31 is not only the anniversary of the creation of the federal Department of Health, Education and Welfare, it is also the date that the Department’s successor – Health and Human Services – set as the Affordable Care Act's PCORI Fee filing date.
No later than July 31, 2015, all self-funded employer health plan sponsors are required to file and pay their Patient-Centered Outcomes Research Institute (PCORI) fee. All self-funded plan sponsors are required to pay a fee based on the average number of covered lives under their eligible plans, including employees, retirees, spouses and dependents.
Self-funded plans subject to the requirements include self-funded medical benefit plans, including most non-ERISA self-funded plans and retiree-only plans. Other plans subject to the fee include self-funded HRAs and FSAs which are not integrated with a plan sponsor’s self-funded major medical plan. Dental-only, vision-only, EAP, disease management, and wellness plans are exempt.
All plan sponsors must use the IRS Form 720 dated April, 2015 to record and remit the amount due. Below is a schedule of the amount due based on your plan’s effective date.
MedBen has updated its summary of the PCORI fee filing requirement applicable to self-funded clients; clients can request a copy from their Group Service Representatives. If you have purchased PCORI reporting serivces from us, your GSRs will order reports on your behalf and e-mail them to you.
Clients who need more information about how to count covered lives under your plan or how to prepare and remit your payment, don’t hesitate to contact the MedBen Compliance Department.
The landmark Supreme Court decision to allow same-sex marriage nationwide will have a substantial impact on group health care coverage, says Kaiser Health News:
"The logic is simple. Fewer than half of employers that offer health benefits make the insurance available to same-sex partners who aren’t married. Virtually all of them offer coverage to spouses.
"By marrying partners with employer health plans, people in same-sex relationships are likely to get coverage in states that banned gay marriage until now, as well as in those that welcomed it. Thanks to rapidly shifting legal ground, 37 states recognized gay marriage before last week’s ruling, up from nine in 2012."
The KHN story also notes that while the expectation is that most companies will cover same-sex spouses if they already offer benefits to opposite-sex spouses, the decision doesn't require them to. But refusing to do so could conceivably leave the employer open to a charge of sex discrimination.
And while the ruling has been met with widespread approval, it actually comes as something of a mixed blessing for same-sex couples who currently receive domestic-partner benefits and don't plan to get married:
"Though it is unclear what most employers will decide, some companies are likely to deliver what feels like an ultimatum, at least to some: Marry within a certain time frame, or lose your partner’s health care coverage.
"Some large employers — including Verizon, Delta Air Lines, IBM and Corning — already have. They rescinded domestic partner benefits to employees living in states where same-sex marriage was legalized and replaced it with spousal coverage."
Whenever the Supreme Court rules on a high-profile care, it invariably generates a flood of responses from politicians and pundits alike. And while yesterday's decision to allow health insurance subsidies nationwide essentially maintained the status quo, there's still plenty of opinion on what the ruling means for the future of health care reform... from the top down.
President Barack Obama, in a statement after the ruling: “After multiple challenges to this law before the Supreme Court, the Affordable Care Act is here to stay. Today is a victory for hardworking Americans all across this country, whose lives will continue to become more secure in a changing economy because of this law.”
Henry J. Aaron, Brookings: "[The Supreme Court decision] returns the debate about health care policy to the political arena where it belongs. In so doing, it brings a bit closer the time when the two parties may find it in their interest to sit down and deal with the twin realities of the Affordable Care Act: it is imperfect legislation that needs fixing, and it is decidedly here to stay."
Sen. Orrin Hatch, R-Utah: “Clever judges can find ambiguities that others aren’t able to find. [...] We’re going to have to repeal Obamacare and replace it with something better.”
Reihan Salam, Slate: "As a political matter [...] King v. Burwell would have left Obamacare’s opponents in an extremely precarious position for the simple reason that conservatives in Congress had failed to coalesce around a coherent post-King strategy in the months preceding the decision."
Stephen Stromberg, The Washington Post: There are many things Republicans could do short of a full repeal that would nevertheless undermine the law. Electing a GOP president and a GOP Congress next year would almost guarantee the death of Obamacare’s medical device tax, a source of revenue for the health-care expansion that Republicans may or may not make up with something else.
Margot Sanger-Katz, The New York Times: "Now, with the Supreme Court ensuring that every state’s consumers will have equal access to federal subsidies, it is becoming clear that more of those states will revert to a federal system for enrolling people in health insurance."
The U.S. Supreme Court today upheld, by a 6-3 vote, the nationwide tax subsidies available under the Affordable Care Act. The decision means that the subsidies to help low- and moderate-income people buy private health insurance will remain available in all 50 states.
In the matter of King v. Burwell, the petitioners' argument that the health care reform law didn't authorize subsidies in the 34 states that offer a federally-run insurance exchange hinged on six words: "An exchange established by the state." While acknowledging that "petitioners' arguments about the plain meaning ... are strong," the court's majority concluded that the subsidies are nonetheless legal.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," the court's majority said in the opinion, which was written by Chief Justice John Roberts. "The context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase."
Roberts was joined by fellow conservative Justice Anthony Kennedy and the court’s liberal Justices in the majority.
In his dissent, Justice Antonin Scalia said: "We should start calling this law SCOTUScare," an apparent reference to the fact the Supreme Court has now saved the Affordable Care Act twice. Scalia called the majority's reading of the text "quite absurd, and the court's 21 pages of explanation make it no less so."
And for an interesting bit of "what if," this Forbes article examines Republican proposals to extend the subsidies had the justices struck them down.
Here's a distressing bit of information: Based on the results of a new study, over two-thirds of the U.S. adult population are either overweight or obese.
HealthDay reports that the study, which used data from the National Health and Nutrition Examination Survey gathered between 2007 and 2012, found that about 35% of men and 37% of women are obese, while another 40% of men and 30% of women are overweight.
"This generation of Americans is the first that will have a shorter life expectancy than the previous generation, and obesity is one of the biggest contributors to this shortened life expectancy because it is driving a lot of chronic health conditions," said Lin Yang, a lead researcher of the study.
Obesity has been linked to a number of chronic health conditions, including type 2 diabetes, heart disease, certain cancers and arthritis, Yang added.
However, the picture isn't totally bleak. The proportion of obesity in kids has leveled off in recent years, suggesting that efforts to promote healthier eating and exercise for younger people is paying off. But a renewed push on better health for adults is crucial, Yang said.
“Overweight and obesity is something one can deal with as an individual, but we also need strategies for prevention at the collective level,” she said.
According to a KHN article on the study, those strategies include enhancing primary care efforts to prevent and treat obesity, changing behavior in schools and the workplace, and changing physical environments to make healthy food and exercise options more accessible.
Midsize and smaller employers are increasingly making the switch to self-funded health care coverage due in part to greater reinsurance availability, says a leading stop-loss carrier... and at MedBen, we're helping these employers benefit from the opportunity.
“Historically, there’s been some reluctance from stop-loss carriers to insure the smaller organizations that are moving to self-insured plans, as they typically don’t have sufficient claims data to use for pricing and evaluating risk,” says Brad Nieland, vice president of stop-loss at Sun Life Financial. “But stop-loss carriers now see the growth potential of the smaller-market segment, and in wanting to capitalize on it, many are finding ways to open their programs and offer competitive coverage.”
One such way that carriers can make stop-loss coverage more accessible to smaller employers is through reinsurance captive programs. MedBen introduced its first captive in January 2014, and participating employers are realizing a level of savings not available through fully-funded insurance.
Self-funding through a MedBen captive reinsurance program affords employers the opportunity to get part of their reinsurance premium back, by spreading risk among multiple groups. A portion of the collective premium is pooled into a “captive” layer owned by all participating groups -- and any funds remaining in this layer at the end of the plan year go back to the participants.
For employers who have considered self-funding but have been reluctant to make the switch from traditional insurance, a captive offers an ideal means of transition. And with MedBen as your health benefits manager, you get access to cost containment tools that can save you even more money!
Learn more about the reinsurance captive advantage by contacting MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com.
Several weeks back, we posted an article about a new Affordable Care Act regulation that would apply an "embedded" maximum out-of-pocket limit on individuals enrolled in family coverage. The rule, which applied to non-grandfathered fully-insured and self-funded health care plans, says that once the stated 2016 maximum of $6,850 for individual coverage has been reached, the individual will be then covered in full by the health plan, even if the family maximum has not yet been met.
Now, the ERISA Industry Committee, a Washington-based benefits lobbying group, is asking federal regulators to withdraw the embedded maximum requirement, arguing that there is no basis in the ACA for it:
“'Nowhere does the statute suggest that family coverage is subject to two out-of-pocket limits: an umbrella limit for aggregate costs incurred by all family members, and an embedded individual limit, equal to the self-only limit, for costs incurred by any individual member of the family,' according to the letter, signed by ERIC President and CEO Annette Guarisco Fildes and sent Wednesday to top Labor, Treasury and HHS officials.
“'The assertion that these plans are subject to the self-only limit when they provide coverage other than self-only coverage is not supported by the statute. We ask the departments to recognize that the requirement is unenforceable and to announce that it has been withdrawn,' Ms. Guarisco Fildes wrote."
Read more at Business Insurance (registration may be required).
Since the IRS announced in 2013 that flexible spending account participants could carry over up to $500 of their unused funds to the following year, many employers have added the option to their FSA plan. (About half of MedBen clients that offer FSAs currently allow it). And based on the results of a new survey, carryover acceptance will likely go higher.
In March 2015, the Employers Council on Flexible Compensation conducted a member survey regarding the carryover rule and found that:
Since the "use-it-or-lose-it" rule was a major sticking point for employee enrollment in FSAs, it's not surprising that the ability to carry over a portion of their funds would spur participation. And of course, FSAs offer additional advantages, such as enabling employees to pay for medical products and services with pre-tax dollars, and debit card convenience.
MedBen clients who are interested in adding the carryover option to their FSA plan or have questions about are welcome to contact Director of Administrative Services Sharon A. Mills at firstname.lastname@example.org. Or if you'd like to learn more about the ways an FSA can benefit your group benefits package, please contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
Regardless of how much U.S. smoking rates have dropped in the last few years, one fact remains constant: Smokers still make up a disproportionate number of adults who die from cancer.
According to Kaiser Health News, a study by the American Cancer Society determined that almost half of the 346,000 deaths from 12 different types of cancers in individuals 35 years of age or older in 2011 were attributable to smoking cigarettes. And while lung, bronchus, and trachea cancers were found to be the most closely associated with this habit, half of the deaths from oral cavity, esophagus, and urinary bladder cancers were attributed to smoking as well.
“The bottom line is that despite 50 years of declining smoking prevalence, almost 170,000 cancer deaths each year are still caused by smoking,” said lead author Rebecca L. Siegel.
With numbers like this, it's hardly surprising that encouraging smokers to kick the habit is one of the most effective ways to reduce health care spending. And MedBen WellLiving can help employers in this cost-saving -- and life-saving -- pursuit.
Our specialty care program identifies plan members who are at risk for diseases commonly associated with smoking, such as hypertension and heart disease, and contacts them to arrange one-on-one nurse coaching. Moreover, we will work with employers to design wellness program incentives that promote a tobacco-free lifestyle.
Quitting smoking isn't easy, but with proper support it can be done. Learn more about how MedBen WellLiving can benefit your employees, please contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Despite the fact that most people who take prescription drugs say can afford to purchase them, Americans overwhelmingly feel that the costs of such drugs are "unreasonable," a new poll finds.
The survey by the Kaiser Family Foundation found that 74% of those taking prescription drugs find the costs unreasonable, as do 72% of those not taking such drugs. More than three-quarters of the public cited drug company profits as the No. 1 reason for the high costs, followed by the expense of medical research (64%), the cost of marketing (54%) and the cost of lawsuits against pharmaceutical companies (49%).
Even so, over 75% of people who take prescription drugs say they are easy to afford, with only one in five saying they have difficulty paying for them. But about a quarter of respondents said they or a family member have not filled a prescription in the past year, while 18% have cut pills in half or skipped doses to save money, the poll found.
At MedBen, we recognize the rising costs of prescription drugs affects many of our customers -- employers and plan members alike. That's why we take multiple measures to help our clients keep their pharmacy costs as low as possible.
To begin with, MedBen offers superior Rx discount rates for brand and generic drugs. We can integrate a range of over-the-counter drugs into your prescription plan design. And we support our program with strong, useful reports and recommendations that drive groups toward good design decisions.
Moreover, many third party administrators withhold some of their clients'' rebates, typically to offset so-described “lower” administrative costs. With MedBen, you can be certain that 100% of negotiated discounts and paid rebates go back to you.
You can save money on your group's prescription plan costs. Contact MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com to learn how.
MedBen remains on schedule to meet the October 1, 2015, compliance date for conversion to ICD-10 diagnostic and procedure codes. The medical community, however, is hoping for a bit of leeway when the new system rolls out in a few months:
"Recognizing that there is no way to again delay ICD-10 implementation or just scrap it altogether, the American Medical Association (AMA) is asking the Centers for Medicare and Medicaid Services to guarantee a 'soft-landing' for the nation's physicians.
"And the AMA defines soft-landing as a 2-year grace period 'during which physicians will not be penalized for errors, mistakes, and or/malfunctions of the system.'
"Most of all, the AMA wants CMS to guarantee that the money will not stop. During the grace period the AMA wants guarantees that Medicare and Medicaid payments 'will not be withheld based on ICD-10 coding mistakes ...'.
"This latest ICD-10 policy was unanimously approved -- without additional comment -- during the House of Delegates meeting at the AMA annual meeting."
When the ICD-10 update is completed, the number of diagnosis and procedure codes used in medical billing will expand greatly, from around 18,000 in the current ICD-9 code set to about 140,000. The AMA has been an outspoken critic of the change, originally scheduled to take place in 2013 but twice delayed.
On May 26, the Departments of Health and Human Services, Labor and Treasury released a clarification as to whether or not self-funded health care plans are subject to a new Affordable Care Act regulation regarding family out-of-pocket costs. The short answer: Yes, they are.
The regulation in question, which goes into effect in 2016, applies an "embedded" maximum out-of-pocket limit on individuals enrolled in family coverage. So even though the stated 2016 out-of-pocket maximum is $6,850 for single coverage and $13,700 for family coverage before health plan coverage takes over, a family member that reaches the single coverage maximum will then be covered in full by the health plan, even if the family maximum has not yet been met.
However, the original explanation of this rule was vague as to whether or not it applied only to fully-insured individual and small-group health plans, and not to large-group and self-funded plans. The new guidance removes any lingering doubt.
“The self-only maximum annual limitation on cost sharing applies to each individual, regardless of whether the individual is enrolled in self-only coverage or in coverage other than self-only. Accordingly, the self-only maximum annual limitation on cost sharing applies to an individual who is enrolled in family coverage or other coverage that is not self-only coverage under a group health plan,” the agencies said. Only grandfathered group health plans are unaffected by the rule.
The agencies also offered an example as to how the "embedded" out-of-pocket limit will work:
An employer plan has a $10,000 out-of-pocket expense limit for employees with family coverage. An employee's spouse incurs $15,000 in medical care expenses. The spouse's out-of-pocket expense will be capped at $6,850, the same cost-sharing limit that would be imposed if the individual had single coverage.
Bottom line, the embedded maximum requirement may require adjustments to your plan design. MedBen will work with clients to make the necessary changes to ensure that your plan remains in compliance with the ACA, while also helping to minimize potential cost increases caused by this new rule. As your renewal date nears, we will discuss this change with you as well as other 2016 plan design issues.
If you have questions regarding the embedded maximum requirement or any aspect of the health care reform law are welcome to contact Vice President of Compliance Caroline Fraker at firstname.lastname@example.org.
If you suffer from joint pain, it's understandable that you want a "quick fix" to the problem -- hence, the popularity of hyaluronic acid injections to soothe aching knees. But while some doctors and patients swear by their effectiveness, there's mounting evidence that such injections are, at best, placebos.
Forbes contributor Steven Salzber, who suffers from knee pain, has read the recent research about hyaluronic acid injections and isn't optimistic that relief is in sight for him:
"Just recently, Anne Rutjes, Peter Jüni and their colleagues published a very large review of the evidence on knee injections. They looked at 89 trials involving over 12,000 adults and found that in the trials that were properly controlled (blinded), hyaluronic acid injections had either no effect or a 'clinically irrelevant effect'; that is, too small a difference to matter to the patient. (They also found five unpublished trials that showed no effect at all; this is a good example of the so-called 'file drawer effect', where studies that don’t have the desired outcome are stashed away in a drawer and never published.)
"If you don’t believe Rutjes, perhaps you’ll believe the American Academy of Orthopaedic Surgeons (AAOS)... [after looking at] numerous studies, the AAOS concluded that there was no clinically meaningful benefit from these injections. This document is their official recommendation for physicians."
At the National Bundled Payment Summit in Washington, DC last week, MedBen unveiled its latest service: value based payment administration through MedBen Analytics.
For providers participating in value based payment initiatives such as the Centers for Medicare & Medicaid Services’ bundled payment care initiative or CMS’s Medicare shared savings program, MedBen Analytics will turn claims data into actionable insights necessary to improve performance. Hospitals, health systems and physician groups can benefit from this resource-conscious approach to save them time and money.
At the heart of this service is our proprietary MAPS (MedBen Analytics Payment Solutions) software. MAPS offers five customized suites for both retrospective and prospective payment models:
MAPS1: DATA RETRIEVAL AND FILE PROCESSING
Weekly and/or monthly retrieval and mapping of Medicare files for processing to the appropriate model.
MAPS2: MODEL 2 RETROSPECTIVE PROCESSING
Inpatient hospitalization, professional services, and post-acute cost processing and reporting for selected bundles on a retrospective basis. Online reporting tool.
MAPS3: MODEL 3 POST-DISCHARGE EPISODE PROCESSING
Retrospective processing including professional services, post-acute care, and readmissions for selected bundles. Reporting to highlight provider performance.
MAPS4: MODEL 4 PROSPECTIVE PROCESSING
Weekly and monthly episode processing, payment and support. Superior customer reporting, expert setup and claims processing.
MAPS 5: MEDICARE SHARED SAVINGS PROGRAM
Analytics, reporting, retrospective processing and gainshare administration.
Drawing upon 75+ years of health care and benefits administration experience, MedBen Analytics brings insightful, clear and actionable data to providers of all sizes. From implementation to completion, our payment administration team will be with you every step of the way.
Two new preventive health services have been recommended for addition to the no-cost coverage list, Kaiser News reports. Enforcement of the recommendations will take effect in 2016.
The U.S. Preventive Services Task Force has recommended Hepatitis B screening for adolescents and adults at high risk for infection, and low-dose aspirin use for pregnant women who are at high risk for preeclampsia, a condition characterized by an abrupt increase in blood pressure that can lead to serious complications for the woman and baby.
The task force, a nonpartisan group of medical experts, also issued a recommendation for gestational diabetes screening after 24 weeks in asymptomatic pregnant women, which is already covered at no charge by most health plans.
Under the Affordable Care Act, preventive care services given an "A" or "B" recommendation by the task force must be covered by non-grandfathered health plans without charging participants. (The A or B grade is based on the certainty regarding the service's net benefit.) A complete list of recommendations is available at the USPSTF website.
MedBen clients who have any questions regarding no-cost preventive health services are welcome to contact Vice President of Compliance Caroline Fraker at email@example.com.
Summer means sunshine, cookouts... and of course, home safety. Unintentional injuries are the fifth leading cause of death in the United States, and 48% of them occur in the home. But simple common sense measures, such as keeping a tidy space with unexposed cords, medications, and toys, will help to prevent in-home injuries.
Equally important, every home should be equipped with smoke and gas detection alarms. Carbon monoxide and other gases are silent threats, both odorless and colorless. Installing devices that test air quality to detect dangerous smoke or chemicals that are present is the only sure way to protect your home. So, always ensure these alarms are in working order by changing the batteries twice annually and testing the alarms every month.
Make sure your family is prepared and has a plan of action if an in-home alarm sounds. For fires, make sure your family is aware of all exit points. Educate your children on the proper ways to exit a house during a fire, such as staying low to the ground and how to “stop, drop, and roll.” And always have a designated meeting spot away from the scene.
Being precautious and prepared is the best way to make your family and home safe. For more information on how to protect your household from trouble, visit your local fire department.
A recent study demonstrates how preventive care can potentially benefit an individual in multiple ways. According to researchers at the University of Michigan, earlier screening, diagnosis and treatment of type 2 diabetes may also decrease the risk of cardiovascular problems.
Reuters Health reports that the research team analyzed data from a European diabetes study in which people age 40 to 69 without known diabetes were screened and treated for the condition. In that study, some participants who tested positive were treated intensively while others were treated routinely, and the researchers found no difference in cardiovascular outcomes or death five years later.
The researchers then translated the study data into a computer model to estimate what may have happened over the same five year period if they had not been screened, and their diabetes diagnoses had been delayed by three or six years.
If screening was delayed by three years, the researchers estimated that about 11% of people would likely experience a heart problem within five years, compared to about 8% when screening wasn't delayed. If screening was delayed by six years, they estimated that about 13% of participants would experience a heart problem over the five years.
While acknowledging that a computer model isn't as reliable as real-world results -- which, in this case, would be all but impossible to replicate -- the numbers do suggest the usefulness of regular preventive care. The sooner a chronic condition is diagnosed, the better the odds of successfully treating the condition -- and ultimately reducing the risk of other chronic conditions to boot.
MedBen WellLiving promotes preventive care as a key component of a healthier and more productive workplace. To learn more about how our "family doctor first" approach can benefit your business, we invite you to contact Vice President of Sales & Makreting Brian Fargus at firstname.lastname@example.org.
If you're wondering why the Republican-led houses of Congress haven't yet made a full-court press to repeal the Affordable Care Act, Rachael Bade and Jennifer Haberkorn explain the reasons behind the delay:
"Repealing the law 'root and branch' is probably out of the question, the chamber’s parliamentarian is hinting, because some parts of Obamacare don’t affect the federal budget. That’s a must in order to use the obscure procedure known in Senate parlance as reconciliation, which allows lawmakers to avoid the 60-vote filibuster hurdle and pass bills on a simple majority vote.
"That’s not the GOP’s only problem. Under those rules any Obamacare repeal has to reduce — not increase — the deficit. So Republicans will have to pick and choose which parts of the Affordable Care Act they most want to ditch.
"'The message came out loud and clear that total repeal won’t work,' said Tom Miller, a health care policy expert at the right-of-center American Enterprise Institute, referring to private conversations on the Hill about what can and can’t be done.
"That means Republicans will probably have to go through the ACA provision by provision and strike only policies that have a direct cost to Uncle Sam, what’s known on the Hill as a 'Byrd rule scrub" or 'Byrd bath.'”