Tag Archives: health care

Twenty states sue federal government, seeking end to Obamacare

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

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

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

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

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

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

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

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

(Reporting by Eric Beech in Washington)

Republicans’ push to roll back Obamacare faces crucial test

President Donald Trump (C) gathers with Vice President Mike Pence (R) and Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, May 4, 2017.

By Amanda Becker

WASHINGTON (Reuters) – A seven-year Republican effort to repeal and replace Obamacare faces a major test this week in the U.S. Senate, where lawmakers will decide whether to move forward and vote on a bill whose details and prospects are uncertain.

The Senate will decide as early as Tuesday whether to begin debating a healthcare bill. But it remained unclear over the weekend which version of the bill the senators would ultimately vote on.

President Donald Trump, after initially suggesting last week that he was fine with letting Obamacare collapse, has urged Republican senators to hash out a deal.

“Republicans have a last chance to do the right thing on Repeal & Replace after years of talking & campaigning on it,” Trump tweeted on Monday.

Republicans view former President Barack Obama’s signature 2010 health law, known as Obamacare, as a government intrusion in the healthcare market. They face pressure to make good on campaign promises to dismantle it.

But the party is divided between moderates, concerned that the Senate bill would eliminate insurance for millions of low-income Americans, and conservatives who want to see even deeper cuts to Obama’s Affordable Care Act.

The House in May passed its healthcare bill. Senate Republicans have considered two versions but have been unable to reach consensus after estimates showed they could lead to as many as 22 million fewer Americans being insured. A plan to repeal Obamacare without replacing it also ran aground.

If the Senate approves a motion to begin debating a healthcare bill, Majority Leader Mitch McConnell will determine which proposal has the most Republican support and move forward to a vote, Republicans said.

Republicans hold 52 of 100 Senate seats. McConnell can only afford to lose two Republican votes as Democrats are united in opposition.

Senator John Barrasso, a member of the Republican leadership, acknowledged on Sunday that there remained a lack of consensus among Republicans.

“Lots of members have different ideas on how it should be best amended to replace what is really a failing Obama healthcare plan,” Barrasso said on CBS’s “Face the Nation.”

The Republican effort has also been complicated by the absence of Senator John McCain, who has been diagnosed with brain cancer and is in his home state of Arizona weighing treatment options.

 

(Reporting By Amanda Becker; Additional reporting by Susan Heavey; Editing by Caren Bohan and Nick Zieminski)

 

Trump presses congressional Republicans to pass healthcare plan

By Susan Heavey and Susan Cornwell

WASHINGTON (Reuters) – President Donald Trump on Monday prodded the Republican-led U.S. Congress to pass major healthcare legislation but huge obstacles remained in the Senate as key lawmakers in his party voiced pessimism about the chances of rolling back the Obamacare law.

The House of Representatives approved its healthcare bill in May but the Senate’s version appeared to be in growing trouble as lawmakers returned to Washington from a week-long recess.

“I cannot imagine that Congress would dare to leave Washington without a beautiful new HealthCare bill fully approved and ready to go!” Trump wrote on Twitter, referring to the seven-year Republican quest to dismantle Democratic former President Barack Obama’s signature legislative achievement.

Trump appeared to be referring to the August recess that lawmakers typically take.

Senate Republican leaders have faced a revolt within their ranks, with moderate senators uneasy about the millions of Americans forecast to lose their medical insurance under the legislation and hard-line conservatives saying the bill leaves too much of Obamacare intact.

Republican Senator Pat Toomey said a new version of the legislation is expected to be released on Monday, telling the CNBC program “Squawk Box” that “there’s a shot” of getting to the 50 votes his party needs to win passage in the 100-seat Senate, with Vice President Mike Pence casting a tie-breaking vote.

Repealing and replacing the Affordable Care Act, dubbed Obamacare, was a central campaign pledge for Trump.

Obamacare expanded health insurance coverage to some 20 million people, with much of the increase due to an expansion of the Medicaid government health insurance program for the poor and disabled.

Republicans criticize the law as a costly government intrusion into the healthcare system while Democrats call the Republican legislation a giveaway to the rich that will hurt millions of the most vulnerable Americans.

“The Senate now is literally within weeks of being able to deliver on that promise to the American people,” Pence said in an interview with conservative radio host Laura Ingraham, adding there is “not yet agreement” in the Senate “but we are close.”

Some Republican lawmakers were more pessimistic, with Senator John McCain saying on Sunday the legislation is “probably going to be dead.”

Opponents of the legislation are expected to hold protests in Washington, organizing sit-ins at congressional offices, holding marches and stage vigils outside Republican senators’ homes. During last week’s recess, liberal groups organized town hall meetings and protests and ran advertisements criticizing the bill.

Senate Majority Leader Mitch McConnell faces the tricky task of crafting a bill that can attract Republican moderates and hard-line conservatives in a chamber his party controls with a slim 52-48 majority.

The Senate legislation would phase out the Medicaid expansion, drastically cut federal Medicaid spending beginning in 2025, repeal most of Obamacare’s taxes, end a penalty on Americans who do not obtain insurance and overhaul Obamacare’s subsidies to help people buy insurance with tax credits.

The nonpartisan Congressional Budget Office, which assesses the impact of legislation, has estimated 22 million people would lose health insurance over the next decade under the Senate bill.

Shares of U.S. hospital companies and health insurers, which have been particularly sensitive to developments involving the healthcare legislation, were mixed in midday trading on Monday.

Among hospital stocks, Tenet Healthcare Corp edged up 0.3 percent while HCA Healthcare Inc fell 0.5 percent.

Insurer Anthem Inc inched up 0.1 percent while Centene Corp, an insurer focused on Medicaid, was flat.

The broader S&P 500 healthcare sector was off 0.1 percent, underperforming a 0.2 percent gain for the overall S&P .SPX.

(For a graphic on who’s covered under Medicaid, click http://bit.ly/2u3O2Mu)

 

(Additional reporting by Doina Chiacu; Writing by Will Dunham; Editing by Tom Brown)

 

U.N. to need $8 billion this year to help Syrians at home and abroad

By Stephanie Nebehay

GENEVA (Reuters) – The United Nations said on Tuesday it will need a total of $8 billion this year to provide life-saving assistance to millions of Syrians inside their shattered homeland and to refugees and their host communities in neighboring countries.

The first part, a $4.63 billion appeal for 5 million Syrian refugees – 70 percent of whom are women and children – was launched at a Helsinki conference. Funds will be used to provide food, rent, education and health care.

A separate appeal for an estimated $3.4 billion to fund its humanitarian operation to help 13.5 million people inside Syria after nearly six years of war, is being finalised.

“The crisis in Syria remains one of most complex, volatile and violent in the world,” U.N. humanitarian chief Stephen O’Brien told a news conference.

Attempts to end the conflict in Syria have so far failed. After two-day talks, Iran, Russia and Turkey earlier announced a trilateral mechanism to observe and ensure full compliance with a ceasefire.

“Of course we fear that it will get worse,” O’Brien said. “And even if peace was to take place from tonight, the humanitarian needs within Syria would continue for a good time to come.”

Five countries – Lebanon, Turkey, Iraq, Jordan and Egypt – host nearly 5 million Syrian refugees, a “staggering number”, with few in camps, U.N. refugee chief Filippo Grandi said.

“Even if Syrians have stopped arriving in Europe in any significant numbers, I hope that everybody realizes that the Syria refugee crisis has not gone away and continues to affect millions in host communities and continues to be a tragic situation,” he said.

It was too early to say whether any solution would lead to further displacement or people returning to their homes.

“There is uncertainty surrounding the political process, we all hope that it will move in the right direction, but we can’t tell. We’ve had disappointments in the past,” Grandi said.

Providing livelihoods and restoring basic utilities are a priority in Syria, said Helen Clark, administrator of the U.N. Development Programme (UNDP).

“Even were there to be a political settlement tomorrow, we would still be here seeking support for humanitarian relief for a country that has been brought to its knees, with 85 percent living in poverty, 50 percent in unemployment and with the severe economic and social impacts on the neighborhood.”

(Reporting by Stephanie Nebehay; Editing by Tom Miles and Raissa Kasolowsky)

Republicans in turmoil on first day of U.S. Congress in Trump era

The U.S. Capitol Building is lit at sunset in Washington, U.S.,

By Richard Cowan and Susan Cornwell

WASHINGTON (Reuters) – The Republican-led U.S. Congress began its first session of the Donald Trump era in turmoil on Tuesday as the House of Representatives backed away from a decision to defang an ethics watchdog after a public outcry, including a dressing-down from the president-elect.

With Trump set to be sworn in as president on Jan. 20, Republicans will control both the White House and Congress for the first time since 2007, and they were set to begin laying plans for enacting his agenda of cutting taxes, repealing Obamacare and rolling back financial and environmental regulations.

But the moment was overshadowed by a surprise move by Republicans in the House of Representatives in a closed-door meeting late on Monday to weaken the independent Office of Congressional Ethics, which is in charge of investigating ethics accusations against lawmakers.

Trump, who campaigned on a pledge to “drain the swamp” and bring ethics reforms to Washington, was not pleased.

“With all that Congress has to work on, do they really have to make the weakening of the Independent Ethics Watchdog, as unfair as it may be, their number one act and priority,” he said on Twitter on Tuesday.

“Focus on tax reform, healthcare and so many other things of far greater importance!”

The ethics office was created in 2008 following several corruption scandals but some lawmakers have charged in recent years that it has been too quick to investigate complaints from outside partisan groups.

Lawmakers wanted to have greater control of the watchdog, and inserted changes into a broader rules package, set to pass when the House convenes on Tuesday.

Even before Trump’s tweet, many House Republicans, including top leaders, opposed the measure and worried about its ramifications. Trump’s tweet prompted an emergency meeting and a quick change of course by Republicans.

“It was taken out by unanimous consent … and the House Ethics Committee will now examine those issues,” said AshLee Strong, a spokeswoman for House Speaker Paul Ryan.

Republican members of Congress watch as they and their fellow members vote for House Speaker on the first day of the new congressional session in the House chamber at the U.S. Capitol in Washington,

Republican members of Congress watch as they and their fellow members vote for House Speaker on the first day of the new congressional session in the House chamber at the U.S. Capitol in Washington, U.S. January 3, 2017. REUTERS/Jonathan Ernst

OBAMACARE IN SIGHTS

Since his election on Nov. 8, Trump has made clear he wants to move swiftly to enact proposals he outlined during the campaign such as simplifying the tax code, slashing corporate tax rates and repealing and replacing Obama’s signature health insurance program known as Obamacare.

Republicans have long sought to dismantle Obamacare, insisting it was unworkable and hampered job growth. But they face a dilemma over how to provide health insurance for the 13.8 million people enrolled in Obamacare who could lose their coverage. The law aims to provide health insurance to economically disadvantaged people and expand coverage for others.

Trump kept up his attack on Tuesday, tweeting: “People must remember that ObamaCare just doesn’t work, and it is not affordable,” and adding, “It is lousy healthcare.”

Last month Senate Majority Leader Mitch McConnell, a Republican, said in an interview with Kentucky Educational Television that before the election, he assumed Trump did not have a chance of defeating Hillary Clinton and that Democrats would retake control of the Senate, ending any talk of repealing Obamacare.

But following Trump’s win and Republicans retaining their Senate majority, the Republicans find they have to deliver on their campaign promise, even though they have not agreed on a replacement healthcare program.

McConnell has said his top priorities for the new Congress were dealing with the “massive overregulation” he said had been a brake on the U.S. economy and making changes in the tax code to stop companies from moving jobs out of the country.

Republican lawmakers also want to curtail regulations aimed at controlling industrial emissions that contribute to climate change, and roll back banking industry reforms enacted after the near-collapse of Wall Street in 2008.

Republicans might use upcoming spending bills funding government agencies to try to kill some of those regulations. Trump also is expected to try to use his executive powers toward that end.

OBAMACARE DEFENSE

The first meeting of the 115th Congress will be full of ceremony, as the 435 members of the House of Representatives and a third of the 100-member Senate are sworn in.

Amid the celebration will be a move by House Republicans to clear the decks for Obamacare repeal.

That will come in the form of a vote on rules governing House procedures in the two-year term of the chamber. Tucked into the rules package is a move to prevent Democrats from slowing or stopping Obamacare repeal legislation because of the potential cost to the U.S. Treasury of doing so.

Leading Democrats warned of a fierce battle over Obamacare and said they planned to mobilize grassroots support for it. Obama is scheduled to meet on Wednesday with congressional Democrats to discuss strategies for fending off the Republican attacks on Obamacare.

Vice President-elect Mike Pence said he would meet on Capitol Hill on Wednesday with lawmakers about plans for replacing Obamacare and rolling back other regulations.

Trump’s Cabinet nominees were to begin meeting with senators on Tuesday ahead of Senate confirmation hearings.

The Senate also is expected to receive a Supreme Court nomination from Trump early in his term to replace conservative Justice Antonin Scalia, who died last February. Republicans refused to consider Obama’s nomination of Merrick Garland last year.

Prominent Republican Senator John McCain has warned that Rex Tillerson, Trump’s choice for secretary of state, will have to explain his relations with Russian President Vladimir Putin, who McCain has called a “thug and a murderer.”

Tillerson, who spent much of his career at Exxon Mobil Corp <XOM.N>, has been involved in business dealings in Russia and opposed U.S. sanctions against Moscow for its incursion into Crimea.

(Additional reporting by Steve Holland in Washington and Gina Cherulus in New York; Writing by Richard Cowan and Roberta Rampton; Editing by Chizu Nomiyama and Bill Trott)

McConnell will not give timeline for Obamacare replacement

U.S. Senate Majority Leader Mitch McConnell (R-KY) participates in a ceremony to unveil a portrait honoring retiring Senate Minority Leader Harry Reid (D-NV) on Capitol Hill in Washington, U.S.

By Patricia Zengerle

WASHINGTON (Reuters) – U.S. Senate Majority Leader Mitch McConnell said on Monday the Senate will move to repeal President Barack Obama’s healthcare law shortly after Jan. 1, but declined to give a timeline for a plan to replace it.

McConnell said the Senate would vote as soon as it returns from its year-end recess to repeal Obamacare. “And then we will work expeditiously to come up with a better program than current law, because current law is simply unacceptable and not sustainable,” he said.

Asked repeatedly, McConnell did not give any timeline for when the Republicans would offer their own plan. He said they would be consulting with different “stakeholders.”

Donald Trump’s election as U.S. president last month means Republicans will control the White House, Senate and House of Representatives in 2017. The new Congress goes to work on Jan. 3; Trump will be sworn in on Jan. 20.

Republicans in both the Senate and House of Representatives say they want to repeal Obamacare early in 2017.

But Republicans have not agreed on how quickly the Obamacare repeal should go into effect. A delay would give them time to work on a replacement, instead of throwing millions of Americans out of their health insurance with no substitute.

(Reporting by Patricia Zengerle; Editing by Chizu Nomiyama and Matthew Lewis)

Patients plagued by high, unexpected bills from emergency room visits

A patient waits in the hallway for a room to open up in the emergency room at Ben Taub General Hospital in Houston, Texas,

By Gene Emery

(Reuters Health) – – Two Yale economists are calling for states to end a practice that allows some doctors to surprise patients with large medical bills after visits to a hospital emergency room.

The bills appear when people show up for treatment at a hospital that’s in the patient’s insurance network but the hospital has hired doctors who are independent contractors who choose not to be part of that network.

The result: unexpected bills that average $622, according to a new analysis in the New England Journal of Medicine by Zack Cooper and Finoa Scott Morton.

They found one person who was billed an extra $19,603 after going to an emergency room where the extra costs were added in and not covered by insurance.

Even a $622 bill is daunting when nearly half of Americans can’t cover a $400 expense without borrowing money or selling assets, according to data from the Federal Reserve.

Patients “are not thinking of the bill when they need to get care and they get walloped later with a bill from a physician they didn’t know, couldn’t choose and couldn’t avoid,” Cooper told Reuters Health in a telephone interview.

“It’s roughly analogous to going out to dinner, having a decent meal, paying the bill, and eight weeks later getting a $10,000 bill from the guy who served the bread. And they threaten to send us to collection if we don’t pay,” he said.

“It isn’t just emergency care,” Cooper said. “This happens for a whole lot of other things – anesthesiologists, assistant surgeons, radiologists and laboratories. This is a vagary of how we pay for health care. But the emergency room example is particularly egregious.”

In response, the American College of Emergency Physicians (ACEP) released a statement in which its president, Dr. Rebecca Parker, complained that “the study does not discuss that insurance companies are misleading patients by selling so-called ‘affordable’ policies that cover very little until large deductibles are met – then blaming physicians for charges.”

Dr. Parker also challenged the $19,603 bill and noted that Cooper and Morton didn’t identify the insurance company supplying the data.

The two economists suggest that “the best solution would be for states to require hospitals to sell a bundled ED (emergency department) care package that includes both facility and professional fees.”

Dr. Jim Augustine, an ACEP expert on out-of-network issues, said billing used to be a package deal until the federal government demanded separate billing in the 1970s and 1980s. What has changed, he told Reuters Health by phone, is that the insurance companies have decreased what they will pay for and set up narrow networks of providers.

“Insurance companies would like to have bundled reimbursement setups because it’s advantageous for their contracting,” he said. “It’s not advantageous for the people who provide care for them.”

Cooper and Morton said if physician costs were bundled with the cost of each emergency room visit, hospitals would determine what physicians would be paid and that agreement would be part of the emergency room package. There would be no surprise bills for consumers and it would preserve marketplace competition because if a doctor doesn’t like what a hospital is willing to pay for treating patients, the doctor could work at a different hospital. Hospitals would compete by offering the best rates to attract good doctors.

Under such a system, they said, “Most crucially, patients would always be protected.”

In their study, Cooper and Morton found that 22 percent of visits involved patients going to an in-network hospital emergency room staffed by out-of-network doctors.

The odds of that happening varied regionally. It was seen in 89 percent of visits in McAllen, Texas, but virtually no visits in Boulder, Colorado.

“The fact that we see places where this just doesn’t happen really tells us that this doesn’t really need to happen,” said Cooper, an assistant professor of health and economics at Yale. “There’s a lot of things that are broken in healthcare that we can’t fix or (are) really challenging. This is one that’s really big, that harms a lot of people, and that’s really easy to solve.”

SOURCE: http://bit.ly/2fXw6fT The New England Journal of Medicine, online November 16, 2016.

U.S. government says benchmark 2017 Healthcare.gov premiums up 25 percent

The federal government forms for applying for health coverage are seen at a rally held by supporters of the Affordable Care Act, widely referred to as "Obamacare", outside the Jackson-Hinds Comprehensive Health Center in Jackson, Mississippi, U.S

(Reuters) – The average premium for benchmark 2017 Obamacare insurance plans sold on Healthcare.gov rose 25 percent compared with 2016, the U.S. government said on Monday, the biggest increase since the insurance first went on sale in 2013 for the following year.

The average monthly premium for the benchmark plan is rising to $302 from $242 in 2016, the Department of Health and Human Services said. The agency attributed the large increase to insurers adjusting their premiums to reflect two years of cost data that became available.

The government provides income-based subsidies to about 85 percent of people enrolled, and those credits will increase with the higher premiums. It said 72 percent of consumers on HealthCare.gov will find plans with a premium of less than $75 per month.

Large national insurers including Aetna Inc <AET.N>, UnitedHealth Group Inc <UNH.N> and Anthem Inc <ANTM.N> have said they are losing money on the exchanges, created under President Barack Obama’s national healthcare reform law, because patient costs are higher than anticipated and enrollment is lower than forecast. Both UnitedHealth and Aetna have pulled out of the exchanges for 2017.

As a result, consumers will have fewer plans to choose from. In 2017, in five states there will be offerings from only one insurance company. The government expects average monthly 2017 enrollment of 11.4 million people, up about 1 million from 2016.

Obama acknowledged last week that the law is not working perfectly but said the problems could be fixed if lawmakers created a government-run health insurance option that would help U.S. states where there is little or no competition.

Premium increases have become fodder for the presidential race, as Republican candidate Donald Trump calls for the repeal of the Affordable Care Act if he is elected and Democrat Hillary Clinton calls for expanding it.

The news “shows why the entire program must be repealed and replaced …. Mr. Trump knows the only way to fix our nation’s failing health care system is complete and total reform,” said Trump communications adviser Jason Miller.

The government agency said the 2017 premium increase comes after two years of very low increases in the marketplace for the second-lowest cost “silver” plan, the benchmark plan used to calculate cost-sharing subsidies.

Average premiums for the silver plan increased 2 percent in 2015 and were up 7 percent in 2016, the agency said.

The figure reflects premiums on Healthcare.gov, the federally run website that sells plans for about two-thirds of the states. Including four states and the District of Columbia, which run their own insurance marketplaces, and those that have reported data, the average premium rose 22 percent, the agency said.

(Reporting by Caroline Humer in New York and Toni Clarke in Washington; Editing by Matthew Lewis and Cynthia Osterman)

UnitedHealth trims drug coverage, including Sanofi insulin

A packet of diabetes drug Lantus SoloStar passes along the production line at a manufacturing site of French drugmaker Sanofi in Frankfurt J

(Reuters) – UnitedHealth Group, the largest U.S. health insurer, will stop covering several brand-name drugs as of next year, reinforcing a trend of payers steering prescriptions to lower-priced options.

In a bulletin seeking client feedback by Sept. 28, UnitedHealth said it is changing reimbursement terms for long-acting insulins and will no longer cover Lantus, the main insulin drug sold by Sanofi.

The insurer said Basaglar, a cheaper biosimilar insulin sold by Eli Lilly would be covered as “Tier 1,” meaning the lowest out-of-pocket costs for members. Levemir, produced by Novo Nordisk, will move from Tier 1 to Tier 2.

CVS Health made a similar move last month to drop Lantus in favor of Lilly’s new biosimilar.

Analysts at Jefferies said the sales impact of the United exclusion should be less than that from the CVS move, because the United plan covers around 15 million people while CVS covers 19 million.

Sanofi shares fell more than 1 percent on Thursday after the news but had recovered by 1200 GMT, while Novo was down 1.3 percent.

Sanofi reaffirmed its sales expectations despite the latest exclusion. A spokeswoman said the company was still targeting a decline in diabetes drug sales of 4 to 8 percent a year until 2018.

“We are disappointed with the decision. For Sanofi, it is a pity not to leave doctors a choice,” she said. “We had anticipated this kind of decision but we are holding discussions with other organisations in the United States to have them keep Lantus on their lists.”

Biosimilars are cheaper copies of protein-based biotech drugs such as Lantus, which are no longer protected by patents. They cannot be precisely replicated like conventional chemical drugs but have been shown to be equivalent in terms of efficacy and side effects.

United also said it will exclude from coverage Amgen’s white blood cell-boosting drug Neupogen, in favor of Zarxio, a biosimilar sold by Novartis.

UnitedHealth last year bought Catamaran for $12.8 billion, making it the nation’s No. 3 pharmacy benefit manager after Express Scripts Holding and Caremark, which is owned by CVS.

(Reporting by Deena Beasley, Ben Hirschler and Noelle Mennella; Editing by Ruth Pitchford and Elaine Hardcastle)

UnitedHealth sees further losses for Obamacare insurance

The logo of Down Jones Industrial Average stock market index listed company UnitedHealthcare is shown in Cypress, California

By Caroline Humer

(Reuters) – UnitedHealth Group Inc is still losing money on the individual insurance business created under U.S. President Barack Obama’s national healthcare reform law due to customers’ high medical costs, the company said on Tuesday.

The largest U.S. health insurer said that it was booking $200 million in losses in the second quarter to cover higher-than-anticipated use of medical services by customers this year. UnitedHealth and other insurers have blamed those costs for their losses from the exchange business.

The company said it expected the program, often called Obamacare, to reduce 2016 earnings by about $850 million, up from $475 million in 2015.

Next year, it will exit most of the two dozen states where it sells individual insurance on the exchanges but still has plans to sell in Nevada, New York and Virginia.

“We do not expect any meaningful financial exposure on 2017 business from the three or fewer exchange markets where we currently plan to remain,” Chief Executive Officer Stephen Hemsley said on a conference call with analysts to discuss second-quarter financial results.

Individual exchange customers this year have more severe chronic conditions, such as diabetes, chronic obstructive pulmonary disease and HIV, and attrition has been lower than expected, UnitedHealth said. It expects to end 2016 with 750,000 exchange members.

The company said its other businesses, including pharmacy benefit management and the technology and consulting divisions, were strong, and it reported higher-than-expected earnings and revenue for the second quarter.

UnitedHealth, which also sells employer-based insurance as well as Medicare and Medicaid, raised the low end of its full-year profit outlook to $7.80 per share from $7.75 and kept the high end at $7.95.

Shares of UnitedHealth were up 0.5 percent at $141.42. It is the only large insurer not involved in any of the major consolidation deals under review by antitrust regulators.

Other insurers were off slightly on the announcement but lost ground after a report that antitrust regulators were planning to block their deals. Aetna Inc was off 3.6 percent at $114.90, while Anthem Inc fell 2.9 percent to $131.11. Cigna Corp was down 2.3 percent at $130.02 and Humana Inc gave up 5.3 percent to $151.10.

Mizuho analyst Sheryl Skolnick said UnitedHealth’s Obamacare business could further weigh on 2016 profit, given that more members have stayed on than expected and will have higher expenses during the second half.

“They have tried as much as they can… to take as much of the losses as they can,” Skolnick said.

Revenue from the company’s Optum business, which manages drug benefits and offers healthcare data analytics services, rose 51.5 percent to $20.6 billion from a year earlier.

Net earnings rose to $1.75 billion, or $1.81 per share, from $1.59 billion, or $1.64 per share, a year earlier.

(Reporting by Caroline Humer in New York and Amrutha Penumudi in Bengaluru; Editing by Lisa Von Ahn)