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Collapse of GOP bill may presage more Medicaid expansion

March 29, 2017by Robert Whitcomb in Uncategorized tagged ,

 

The collapse, for now anyway, of the Republican health-insurance bill may lead  some states where Republicans have been blocking Medicaid expansion under the Affordable Care Act for years to finally join the expansion, reports Governing Magazine.

Consider that in Kansas the legislature has voted to expand Medicaid, although hard-right Gov. Sam Brownback is expected to veto it. In Georgia, Governing reports, GOP Gov. Nathan Deal “announced that he is now open to applying for a federal waiver that would let the state expand Medicaid but with more flexibility. And in Virginia, where the Republican-dominated legislature has crushed Democratic Gov. Terry McAuliffe’s attempts to expand Medicaid, he is renewing his push.”

“The failure of Congress to replace Obamacare — at least so far — may boost long-shot bids to expand Medicaid in other states,” too, Governing reports.

“Idaho and South Dakota, for example, both toyed around with the idea of expansion but ultimately abandoned it once Trump, who promised to repeal Obamacare ‘on Day One,’ was elected. Both governors had been hopeful that something could be worked out but faced opposition from the legislature. Those efforts could be revived now that repeal isn’t on the immediate horizon.

”In Maine, the legislature had passed Medicaid expansion five times — only to be vetoed by GOP Gov. Paul LePage. This prompted residents to take matters in their own hands, and voters are set to decide the issue in November. But advocates of expansion hope the legislature will act sooner now that the ACA replacement plan collapsed.”

“Medicaid expansion has been a highly partisan issue. But the debate at the federal level has revealed that there’s more bipartisan support — among voters and policymakers — for expanding Medicaid than previously thought. Republican governors arguably scored the biggest win with the demise of {House Speaker} Paul Ryan’s plan because now they will likely take less political heat for expanding Medicaid and can claim credit for insuring more of their residents.”

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5 takeaways from the AHCA collapse

March 27, 2017by Robert Whitcomb in Uncategorized tagged , , , , , ,

 

Billy Wynne, writing in Health Affairs, presents five lessons from the failed launch of the American Health Care Act:

They are:

“Nothing is inevitable”

“There’s a difference between making a political statement and enacting real policy. The latter is invariably complex and time-consuming, creating vulnerabilities and pitfalls both known and unknown at the outset. While a cornerstone of tried and true policymaking is to leverage the ‘strategy of inevitability’—more than seven years ago, the ACA campaign itself vigorously deployed just such a strategy—the underlying premise of that strategy is always inherently false.’’

“Stakeholders matter’’

“Virtually every hospital and hospital group, every physician group, nurses, patient groups representing the young, old, disease-stricken, and disabled, and many others fervently opposed AHCA. They added analysis of AHCA’s impact on them, as governors did regarding its impact on their states. At the end of the day, this was simply a bad bill. Stakeholders figured it out and acted when it counted.’’

‘’Ultimately, on the day AHCA was originally supposed to get its final House vote, a Quinnipiac University poll came out showing only 17 percent of the public supported the bill, while 56 percent opposed it, a startling gap rarely seen in any bona fide political polling.’’

“The ACA stole most of  the good conservative ideas’’

‘’While it was lambasted by Republicans as the manifestation of a Marxist dystopia, the truth of the ACA is that it is a very moderate law. …As Health Policy Counsel to then-Finance Committee Chairman Max Baucus in the prelude to President Obama’s election, I know the pains he took to build bipartisan consensus. In 2008, he negotiated with Republican counterparts on reforming the market for small businesses, in what became the SHOP Act component of the ACA (drawing from legislation originally co-led by Republican Olympia Snowe). He convened an all-day, fully bipartisan Prepare to Launch summit to query experts and debate ideas. He released a series of white papers that laid out detailed policies he believed could gain bipartisan support (welcomed by the conservative Heritage Foundation as ‘a starting point for serious discussion’). And all of that was before President Obama was elected.”

‘’The centerpiece of the ACA became tax credits for the purchase of commercial—not government—health insurance, with a tax-driven mandate that everyone take responsibility for buying in. This had been the linchpin of numerous Republican health reform proposals prior to that time. While Medicaid expansion was also included, it took on a greater role only because that is a less costly way to expand coverage, and Democrats were utterly committed to ensuring the bill did not increase the deficit.”

‘’Other key conservative ideas were embedded in the law as well. Numerous new payment reforms were instituted to drive efficiency and lower costs; states were allowed to pool their markets (though notably none have yet); price and value transparency was instituted so consumers could compare their coverage options side-by-side; emphasis was placed on prevention and community health centers; states were free to run their own exchanges and establish their own essential health benefits; dozens of new program integrity and oversight protections were instituted.’’

“Tom Price is now the most important person in healthcare”

“While the Trump Administration has some more thinking to do before it commits to letting our health care system crash and burn, via sabotage or neglect, it certainly has that power. The locus of that power is the Department of Health and Human Services and its Secretary, former Republican Congressman Tom Price, M.D., a former orthopedic surgeon.

‘’As we have already seen, simple maneuvers like pulling publicity for HealthCare.gov and creating an aura of uncertainty can adversely impact insurance enrollment. Payment and delivery system reforms, intended to lower costs and improve quality, have been halted in their tracks. Governors have been informed that they are now freer to impose premiums and increase cost-sharing for Medicaid enrollees.

“As destabilizing as these changes are, they pale in comparison to some of the more nuclear options Secretary Price has at his disposal to wreak havoc on health care. Perhaps the foremost of these, and the one readily accessible at any moment, is the option to refrain from defending the cost-sharing subsidies.”

.

“Bipartisanship is still possible’’

“While not as expedient or gratifying to the inner ideologue inside us all, the long, frustrating work of compromise is the only viable path forward.

‘’There is a lot of lower-hanging fruit and we should give AHCA credit for bringing some of those to people’s attention. Insurers have now made clear what they think will help stabilize markets and perhaps make them more competitive, including funding risk corridor and reinsurance programs. Meanwhile, several start-up health plans are eyeing a wide array of markets where competition is limited and ripe for a lower-cost competitor. Some have faced obstacles at the state-level, undoubtedly due in part to the objections of entrenched interests. Can a Price-led HHS help open up these markets?’’

 

Insurers unlikely to recoup much of unpaid risk-corridor payments

March 22, 2017by Robert Whitcomb in Uncategorized tagged , , , , , ,

 

Sanford Health Plan,  the insurance unit of Sioux Falls, S.D., Sanford Health, has  sued the U.S. government to recoup unpaid payments under the risk-corridor program set up under the Affordable Care Act. However, they’re unlikely to get their money.
Sanford  is asking that the Feds pay nearly $9 million in overdue risk-corridor payments for 2014 and 2015. A complaint  that it filed in the U.S. Court of Federal Claims says that CMS has so far paid Sanford Health Plan only 15.1 percent of the amount that it owes.

Modern Healthcare reports that “Sanford Health Plan is the only insurer owned by a hospital system that has sued over the missing payments, which were meant to offset major losses during the first few years of ACA implementation. But it’s far from being the only provider-sponsored plan with an unpaid risk-corridor tab. Driven largely by the movement toward value-based care, many health systems entered the insurance space. Several have been successful, but the move has been difficult for many.”

In another disillusioning example, Scott & White Health Plan, run by Dallas-based Baylor Scott & White Health system, left the federal insurance marketplace this year based in part on almost $23 million in unpaid risk-corridor payments, a system spokeswoman told the news service.

Modern Healthcare reported that some insurers participating in the exchanges “never expected to receive the risk-corridor payments. They didn’t budget the payments into pricing and ended up being fine.”

“They look very smart in hindsight,”  Emily Wadhwani, a director at Fitch Ratings, told the news service.

The CMS owes insurers  about $8.3 billion to cover risk-corridor losses in 2014 and 2015.

But, the news service reports, “a victory in February for Moda Health may give insurers some hope. A federal claims judge ruled the Justice Department owes the insurer $214 million in payments as part of its participation in the program, saying the government ‘made a promise’ to insurers.”

It doesn’t look as if the Trump administration will help the insurers.  House Republicans’ 123-page American Health Care Act didn’t even mention the program, which expired at the end of last year.

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Will GOP health bill cut nonprofit hospitals’ outreach to their communities?

March 16, 2017by Robert Whitcomb in Uncategorized tagged , ,

By SHAFALI LUTHRA

For Kaiser Health News

For the past six years, Mardi Chadwick has run a violence prevention program at Boston’s Brigham and Women’s Hospital. The program’s goal is to address broader, community-based health issues and social problems that make people ill or prone to repeated injury from gunshots, stabbings or environmental causes.

In Chadwick’s view, this endeavor — almost from its inception — made a big difference in nearby neighborhoods. But its profile in the eyes of hospital administrators got a boost from an Affordable Care Act provision that required nonprofit hospitals to conduct triennial assessments of local health needs and devise strategies, updated yearly, to address them. Falling short would trigger a financial penalty.

“Everyone, all of a sudden, cares about the social determinants of health,” she said. “Our expertise is being brought in. … We have a bigger seat at the table.”

But will programs like this one continue to get such attention? As the GOP-controlled Congress works to scrap Obamacare, the answer is uncertain.

Requiring this “community health needs assessment” was part of a broader package of rules included in the health law to ensure that nonprofit hospitals justify the tax exemption they receive. Another directive was that these facilities establish public, written policies about financial assistance available for medically necessary and emergency care and that they comply with limits on what patients who qualify for the aid can be charged.

These requirements add to the ongoing controversy about whether all nonprofit hospitals do enough to deserve a tax break. People on one side of the issue view the assessment rule, for instance, as an undue, unfunded burden while others say it doesn’t do enough. So far, though, the community health assessment requirement hasn’t exactly been a hot topic in the repeal-and-replace debate and was not addressed by the House Republicans’ health plan unveiled March 6.

Sen. Chuck Grassley (R.-Iowa), who has long urged that more scrutiny be applied to nonprofit hospitals’ tax status, championed the provision. His spokeswoman said he will continue to advocate that it remains in effect in whatever new health policy plans emerge. Regardless, the financial uncertainty of any overhaul of the health law could undermine some hospitals’ efforts.

The decades-old nonprofit tax status, granted by the Internal Revenue Service to institutions that meet the “community benefit” standard, spares hospitals from paying federal taxes and is collectively worth billions of dollars. Nonprofit hospitals have generally cited the uncompensated or “charity” care they provide, as well as initiatives they undertake to promote public health, as sufficient proof that they earn their tax exemption. But for-profit hospitals, which do pay taxes, cry foul, saying they make similar contributions.

The new requirements overall were meant to hold nonprofits to a higher standard — and penalize those that didn’t deliver. Under the law, hospitals that fail to complete the assessment and implementation strategy face a $50,000 fine — which can seem small next to their overall operating budgets. But down the line, the penalties can accumulate and ultimately could jeopardize their valuable tax exemption.

Meanwhile, federal data show that as recently as 2011 nonprofit hospitals targeted less than 10 percent of their operating expenses to benefit the community — this includes charity care, unreimbursed costs from Medicaid and other government programs and medical research and education. Less than 1 percent went to community health improvement services like Chadwick’s.

Advocates hoped the health law would change this. The idea was to push nonprofit hospitals to invest more in public health initiatives that do not directly earn them money — giving such programs more value on the balance sheet. But it’s hard to gauge whether that’s happened.

“You can find hospitals that have done this. But … are we seeing a real shift in the hospital community? Or are these a few hospitals that are outliers?” said Gary Young, director of the Center for Health Policy and Healthcare Research at Northeastern University. “We’ve asked them to make a sea change in how they’re doing things. And that can’t happen overnight.”

 

Part of the problem, analysts say, is that the underlying idea — reaching into the community to help people navigate the social and economic factors that can influence health — goes beyond what hospitals have traditionally viewed as their mission. Despite the potential for long-term payoff, administrators tend to focus on the immediate questions: How many beds are full? What medical services are being provided? How are they doing with their operating budget?

“It’s a new world out there in terms of the hospital not being the center of the universe,” said Lawrence Massa, president of the Minnesota Hospital Association, the state’s hospital trade group, which has been tracking hospital response to the health assessment requirement.

Initially, they found the money nonprofit hospitals put toward “community needs” went up after the assessment requirement: from about $355 million in 2011 to $459 million in 2013, according to an analysis by the association. (The needs assessment requirement took effect in between, for the tax year starting after March 2012.) But the increase leveled off in 2014 — the most recent year for which data are available.

Massa’s conclusion: Caring for the health of people before they come into the hospital is unfamiliar territory. Not everyone took naturally to it. “We saw some communities that embraced this, and did a nice job. … In other communities, there’s been friction between public health and the acute setting — and lack of understanding.”

With continued time and sustained emphasis, that could have changed, said Sara Rosenbaum, a professor of health law and policy at George Washington University.

But now? Even if the community benefit requirements remain intact, she and others fear this accountability effort could take a hit. Repeal of the health care law is likely to create fresh financial challenges for hospitals. For instance, although the House GOP’s American Health Care Act would restore some of the uncompensated-care funding cuts hospitals absorbed under the ACA, the coverage changes proposed in Republicans’ plan could mean tens of millions more uninsured people.

That scenario, policy experts and trade groups say, would increase the amount of free care nonprofit hospitals provide, creating new budget pressures that could lead them to tamp down on efforts to promote community health work.

“We could be right back in a situation where there is a fair amount of charity care, and that could become a large component of how hospitals are justifying their nonprofit status,” said Ken Fawcett, a physician who runs a community health worker initiative at Spectrum Health in Grand Rapids, Mich.

Meanwhile, the health assessment’s impact has been evident at Boston-based Massachusetts General Hospital. There, administrators used it to devise an intervention strategy around drug abuse — partnering, for instance, with local schools and community organizations, and hiring former addicts to help patients navigate recovery.

“There’s no question the Affordable Care Act required us to bump up our game,” said Joan Quinlan, its vice president for community health. If people lose coverage, she added, hospitals will increasingly argue that’s enough reason for a tax break. It could stifle efforts to promote more substantial community benefit.

“If the ranks of the uninsured or underinsured grow, then charity care will increase. And the ability to do some of these more creative downstream efforts will be hampered,” she said. “There might be heightened awareness. But if there aren’t resources to address them, it’s going to be hard.”

 

Vt., of all places, may try some healthcare reforms pushed by GOP, too

February 27, 2017by Robert Whitcomb in Uncategorized tagged , ,

mansfield

Looking toward Mt. Mansfield, the summit of Vermont.

— Photo by K. Kemerait

Paradoxically, generally Democratic Vermont  (but now with new Republican Gov. Phil Scott) could be setting the pace for some of the healthcare reforms touted by by the Trump administration and the Republican Congress.

The Green Mountain State won got a broad federal waiver last October to redesign how its healthcare is provided and paid for. This includes  new payment systems,  a stepped-up effort to prevent unneeded treatments, cutting overall growth in the cost of services and drugs, and  more effectively dealing with such public-health problems  as opioid abuse.

The six-year initiative  follows  a failed effort under former Democratic Gov. Peter Shumlin to adopt a single-payer plan for all residents.

The hope is that the program eventually will   involve 70 percent of the state’s population, almost all of its 16 hospitals and 1,933 physicians and would include patients covered through their employment as well as those in Medicare and Medicaid.

 

Med City News noted that while the Obama administration approved the experiment it “fits the Republican mold for one way the Affordable Care Act could be replaced or significantly modified. The Trump administration and lawmakers in Congress have signaled that they want to allow states more flexibility to test ways to do what Vermont is doing — possibly even in the short-term before Republicans come to an agreement about the future of the ACA.”

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Support for ACA growing — putting GOP in bind

February 24, 2017by Robert Whitcomb in Uncategorized tagged ,

By JULIE ROVNER

For Kaiser Health News

Republican members of Congress are at home this week, with many of them getting an earful from anxious constituents about their plans to “repeal and replace” the Affordable Care Act. A poll out Friday gives those lawmakers something to be anxious about, too.

The monthly tracking poll from the Kaiser Family Foundation finds overall support for the health law ticked up to 48 percent in February, the highest point since shortly after it was enacted, in 2010. That was a 5-point increase since the last poll in December. (Kaiser Health News is an editorially independent project of the foundation.)

In addition, 6 in 10 people said they did not favor current GOP proposals for turning control of Medicaid, the federal-state program for low-income residents, over to the states or changing the federal funding method. More than half said Medicaid is important to them or family members.

kff-022417-medicaid_small

The increase in the law’s popularity is almost entirely due to a spike in support among independents, whose approval of the law has risen to 50 percent, compared with 39 percent unfavorable. Continuing a trend that dates to the passage of the law, the vast majority of Democrats approve of it (73 percent), while the vast majority of Republicans disapprove (74 percent).

Poll respondents are also concerned about the way Republicans say they will overhaul the measure. While they are almost evenly divided between wanting to see the law repealed (47 percent) or not repealed (48 percent), very few (18 percent) of those favoring repeal support the idea of working out replacement details later. More than half of the repeal supporters (28 percent of the sample) say the repeal and the ACA’s replacement should come simultaneously.

Interestingly, even among Republicans, fewer than a third (31 percent) favor an immediate repeal, while 48 percent support simultaneous repeal and replacement, and 16 percent don’t want the law repealed at all.

Simultaneous repeal and replacement, which is what President Trump has promised, could prove difficult since Republicans have not agreed to a plan. They are using a special budget procedure, called reconciliation, that allows them to move legislation with only a simple majority in the Senate, but that bill is limited in what it can remove from the law and what can be added to it. Other bills would likely have to overcome a filibuster by Democrats in the Senate, which requires 60 votes. Republicans currently have a 52-48 majority in that chamber.

When asked about the Republican plans to overhaul the Medicaid program, nearly two-thirds of those polled prefer the current Medicaid program to either a “block grant” that gives states more flexibility but would limit Medicaid’s currently unlimited budget, or a “per capita cap,” which would also limit spending to states but would allow federal funding to rise with enrollment increases.

Respondents also strongly favor letting states that expanded Medicaid under the Affordable Care Act continue to receive federal funding. The Supreme Court in 2012 made that expansion optional; 31 states (plus Washington, D.C.) adopted it. Eighty-four percent said letting the federal funds continue was very or somewhat important, including 69 percent of Republicans, and 80 percent of respondents in states that did not expand the program.

Republicans are counting on savings from capping Medicaid to pay for other healthcare options they are advocating.

The national telephone poll was conducted Feb. 13-19 with a sample of 1,160 adults. The margin of error is plus or minus 3 percentage points for the full sample.

Why and where the ACA succeeded in some states

February 10, 2017by Robert Whitcomb in Uncategorized tagged , ,

By STEPHANIE O’NEILL

For Kaiser Health News

Ask anyone about their healthcare and you are likely to hear about ailments, physicians, maybe costs and insurance hassles. Most people don’t go straight from “my health” to a political debate, and yet that is what our country has been embroiled in for almost a decade.

Authors of a study out  Feb. 9 tried to set aside the politics to examine how the insurance markets function and what makes or breaks them in five specific states.

Researchers from The Brookings Institution were exploring a basic idea: If the goal is to replace or repair the Affordable Care Act, then it would be good to know what worked and what failed.

“The political process at the moment is not generating a conversation about how do we create a better replacement for the Affordable Care Act,” said Alice Rivlin, senior fellow at The Brookings Institution, who spearheaded the project. “It’s a really hard problem and people with different points of view about it have got to sit down together and say, ‘How do we make it work?’”

The researchers focused on California, Florida, Michigan, North Carolina and Texas, interviewing state regulators, health providers, insurers, consumer organizations, brokers and others to understand why insurance companies chose to enter or leave markets, how state regulations affected decision making and how insurers built provider networks.

“Both parties miss what makes insurance exchanges successful,” said Micah Weinberg, president of Bay Area Council Economic Institute who led the California research team. “And it doesn’t have anything to do with red and blue states and it doesn’t have anything to do with total government control or free markets.”

Despite the political diversity of the five states, some common lessons emerged. Among them:

Health Insurance Markets Are Local

Insurer competition varied widely within states, with the most dramatic differences between urban and rural areas. The more populated regions tended to have more insurance competition and better-priced plans than rural areas.

Fewer people live in rural areas, which means there are fewer hospitals, doctors and other health professionals. As a result, insurance companies that do business in those regions have less power to negotiate prices with local providers, who are more likely to be the only game in town.

“Insurance companies don’t make money [in many rural areas] because they can’t cut a deal with the providers that will be attractive to the customers,” Rivlin said. “And there just aren’t very many customers, so it’s not obvious what to do about that.”

Republicans, including the Trump administration, have suggested that the sale of insurance policies across state lines as one way to boost competition.

But that may be easier said than done, Rivlin said.

“The insurance companies would still have to have local providers,” she said. “So a company in New York can’t easily sell in Wyoming unless it has providers lined up in Wyoming.”

Consolidation Kills Competition

Consolidation includes hospitals buying physician practices and large medical centers buying up smaller hospitals. California offers a prime example of this phenomenon. In the San Francisco Bay Area, where consolidation has reduced competition among hospitals and physician groups, consumers have fewer choices and higher premiums than those in Los Angeles, where consolidation hasn’t yet gobbled up so many providers.

More Sick People Signed Up Than Expected

Insurance companies did not have any idea who would buy policies through the exchanges in the early years. And as it turned out, a lot of those previously uninsured sick people — more than insurers and policymakers had expected —raced to get coverage.

As a result, researchers found, many plans incurred losses, with some companies reporting claims that were 50 to 100 percent greater than the premiums they collected. Making matters worse, a mechanism in the health law to reimburse companies for such losses in the early years proved inadequate. That caused a lot of them leave the marketplaces.

Under Obamacare, insurance companies could no longer deny coverage or charge higher rates to those with preexisting medical conditions. And during the first two years of the exchanges, insurers simply didn’t know how to price their policies because they’d rarely dealt with people who hadn’t been insured before, the researchers found.

In Michigan, six of 16 insurers withdrew. And in regions of Texas and North Carolina, which had between five and nine insurers, only three remained.

Some Consumers May Be “Gaming” The System

Three of the states — Florida, North Carolina and Texas — reported that generous special-enrollment rules allowed many consumers to delay enrollment into a plan until they needed healthcare. And in Michigan and North Carolina, researchers found that some people signed up for a policy, used it, then dumped it when they had received the care they needed. That ends up leaving insurers stuck with more of the tab than they’d anticipated.

“The challenge is some of the rules that were set up around the ACA made it easy to game the system, frankly,” said Lanhee Chen, a research fellow at the Hoover Institution, who was not involved in the study.

Along with tightening the rules around special enrollment periods, Chen said he’d like to see a return to high-risk pools for the sickest Americans. The idea being that removing the most costly consumers from the general risk pool will allow carriers to lower premiums for everyone else. But high-risk pools, which a majority of states operated before the ACA, are hugely expensive and don’t always work as intended, Rivlin said.

“The states have had quite a lot of experience with high-risk pools and it has not been encouraging,” she said.

A more workable solution, she said, might be found by making sure that a strong reinsurance mechanism provides payments to insurers that take on more costly customers.

Narrow Networks Appear To Be The New Normal

By the third year of the exchanges, insurers in all five states have opted to offer more narrow networks on the exchange than the plans that give access to more doctors and hospitals. These smaller networks of providers allow insurers to give more patients to participating providers in exchange for lower prices. It’s a trend that started before the Affordable Care Act became law and one that appears to be taking hold in nearly every market as insurers search for ways to keep premiums down.

The Sky May Be Falling, But Many Carriers Are Nevertheless Doing Well

Indeed, one lesser-known chapter in the Obamacare story involves those carriers that are making enough of a profit to reduce 2017 premiums.

“About half the insurers are making a ton of money on [the exchanges] and that’s how markets work,” Weinberg said. “The idea that there should be winners and losers in a particular marketplace is something that Republicans should certainly feel comfortable with.”

Medicaid Managed Care Plans Come Out Winners

Researchers found that regional insurers that originally went into business to care for those with Medicaid — the health insurance for the poor and disabled — are filling gaps after insurers fled in many markets. Molina Health in California, WellCare in Florida, Community Health Choice in Texas, “appear to have thrived in the ACA marketplace environment,” the study said.

Rivlin said the success of these plans is likely due to their experience caring for a low-income, often very sick population. They already had well-established networks of local providers that allow them to provide care at a lower cost. As 2017 premiums skyrocketed, consumers became more willing to enroll in these more affordable, lesser-known plans.

California Leads The Pack

In the Golden State, which fully embraced all things Affordable Care Act, competition remained stable with 11 insurers offering coverage and only one — UnitedHealth — dropped out completely. And 2017’s average premium increases, while about 13 percent, were about half of the national average.

Part of California’s success, Weinberg said, is due to its hands-on approach in deciding which insurers may join the market. And it got involved in negotiating the price of plans, which helped keep a lid on premiums, compared to other states.

This story is part of a partnership that includes NPR and Kaiser Health News.

GOP said to mull 4 ACA replacement provisions

February 9, 2017by Robert Whitcomb in Uncategorized tagged , , , , ,

dump

Politico reports that congressional Republicans Republicans and  Trump administration officials  “are scrambling to get Obamacare repeal efforts back on track by stuffing as much of a replacement policy as possible into a repeal bill.”

Four Affordable Care Act replacement measures are reportedly being considered.

The changes would include expanding Health Savings Accounts, enacting high-risk health-insurance pools, revising Medicaid and authorizing tax credits to help people buy insurance policies.

The idea is to  win over Republicans who have been insisting that repeal and replace be taken up simultaneously. Their ambivalence has been fueled in part by fear of voter anger if the GOP kills some popular parts of the ACA.

Politico reported that “replacement policies would be rolled into a measure repealing the 2010 healthcare law, which will be taken up and passed under an expedited process only requiring 51 votes for passage in the Senate. It’s still unclear whether the Senate parliamentarian will allow the replacement pieces to be inserted into the bill. But if she signs off, the policies could provide reassurance to GOP lawmakers eager to make good on longstanding vows to scrap the health law who want to vote on some replacement policy at the same time.”

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Minn. reforms could presage ACA repeal and replacement

February 7, 2017by Robert Whitcomb in Uncategorized tagged , , , , ,

By MARK ZDECHIK

Via Kaiser Health News

What’s going to happen to the federal health law? The quick answer is no one knows. But in the midst of the uncertainty about the Affordable Care Act, states still must govern their insurance markets. Most have been muddling through with the 2017 status quo, but Minnesota is a special case, taking three unusual actions that are worth a closer look.

Last month, Minnesota:

  • Passed a one-time bailout for some consumers in the individual insurance market dealing with skyrocketing premiums.
  • Rejected an attempt to let insurers offer cheaper, bare-bones coverage.
  • Laid the groundwork for a sort of homegrown “public option” insurance plan.

Here’s more on each item.

The Bailout

Faced with some of the country’s highest hikes on premiums in the individual market — 50 to 67 percent, on average — Minnesota lawmakers passed a bailout for people who earn too much to qualify for the Affordable Care Act’s federal tax credit. The $300 million law will cut monthly 2017 premiums by 25 percent for about 125,000 Minnesotans.

Democratic Gov. Mark Dayton backed the measure since October when he called the ACA “no longer affordable to increasing numbers of people.” But passage wasn’t assured as both houses of Minnesota’s legislature are controlled by Republicans.

It is thought to be the second time a state has offered up state tax dollars to stabilize an insurance marketplace created by the ACA. (Alaska came up with a $55 million bailout for insurers in 2016.)

Bare-Bones Coverage

A failed amendment to the Minnesota legislation sought to strip dozens of so-called “essential benefits” from health plans with the expectation that slimmed-down coverage would cost less.

Republican State Rep. Steve Drazkowski, who offered the amendment, said he was trying to eliminate the current, “government-controlled, one-size-fits-all, dictating set of mandates.

“What we’re doing is trying to create an environment that, if and when the ACA goes away, that Minnesotans will have the freedoms they need in order to start to bring some free-market competition, some free-market ingenuity and innovation into the health insurance market,” he said.

The laundry list of benefits that consumers could choose to have covered or not under Drazkowski’s amendment included maternity care, diabetes treatment and mental health care among many others. Some items on the list are very specific: Lyme disease, prostate cancer screenings, outpatient surgery.

Dayton and other Democrats opposed the amendment and it dropped out of the final legislation.

Still, it caught the eye of Minnesota native Andy Slavitt, who is the former administrator of the Centers for Medicare & Medicaid Services, which oversee the health law marketplaces. Slavitt, who tweeted about the amendment, said it is a cautionary tale about high-deductible catastrophic

 

Still, it caught the eye of Minnesota native Andy Slavitt, who is the former administrator of the Centers for Medicare & Medicaid Services, which oversee the health law marketplaces. Slavitt, who tweeted about the amendment, said it is a cautionary tale about high-deductible catastrophic plans that cover little or no basic care.

Democratic Gov. Mark Dayton backed the measure since October when he called the ACA “no longer affordable to increasing numbers of people.” But passage wasn’t assured as both houses of Minnesota’s legislature are controlled by Republicans.

It is thought to be the second time a state has offered up state tax dollars to stabilize an insurance marketplace created by the ACA. (Alaska came up with a $55 million bailout for insurers in 2016.)

Bare-Bones Coverage

A failed amendment to the Minnesota legislation sought to strip dozens of so-called “essential benefits” from health plans with the expectation that slimmed-down coverage would cost less.

Republican State Rep. Steve Drazkowski, who offered the amendment, said he was trying to eliminate the current, “government-controlled, one-size-fits-all, dictating set of mandates.

“What we’re doing is trying to create an environment that, if and when the ACA goes away, that Minnesotans will have the freedoms they need in order to start to bring some free-market competition, some free-market ingenuity and innovation into the health insurance market,” he said.

The laundry list of benefits that consumers could choose to have covered or not under Drazkowski’s amendment included maternity care, diabetes treatment and mental health care among many others. Some items on the list are very specific: Lyme disease, prostate cancer screenings, outpatient surgery.

Dayton and other Democrats opposed the amendment and it dropped out of the final legislation.

Still, it caught the eye of Minnesota native Andy Slavitt, who is the former administrator of the Centers for Medicare & Medicaid Services, which oversee the health law marketplaces. Slavitt, who tweeted about the amendment, said it is a cautionary tale about high-deductible catastrophic plans that cover little or no basic care.

ACA repeal could kill innovative programs at hospitals

January 30, 2017by Robert Whitcomb in Uncategorized tagged , , , , , , , , , , , ,

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The Republicans’ promise to repeal the Affordable Care Act not only threatens to deprive millions of people of their health insurance; it could drive many hospitals deep into debt and destroy innovative programs created by the ACA aimed at  improving patient care.

Timothy Ferris, M.D., an internist and medical director of the Mass General Physicians Organization, told FierceHealthcare that he worries that the “progress we’ve made over the past five years would be threatened.”

He said that  includes programs through the Accountable Care Organization (ACO) at Massachusetts General Hospital, including experiments with video consultations and home hospitalization.

Dennis Keefe, head of Care New England, in Rhode Island, told NPR that he is concerned about the future for Integra, an ACO that includes primary- care physicians, specialists, urgent-care and after-hour providers, clinics, laboratories and inpatient facilities.

Hospitals and healthcare systems that have spent the last six years trying to create new value-based, patient-centered models as part of the ACA.  And so 120 organizations sent a letter to President  Trump and Vice President Pence urging them to not roll back progress they have made.

To read more, please hit this link.

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