Cooperating for better care.

Medicaid

Tag Archives

How to ensure Medicaid patients have enough access to specialists?

 

Michael H.  Katz, M.D.,   writes in JAMA:

“Timely access to specialists has been a longstanding concern for patients with Medicaid compared with patients who have private insurance. Thus, instituting requirements that Medicaid managed care plans adhere to timeliness and proximity standards seems like an excellent solution to a longstanding problem. However, as with so many things in health care, the issue is more complicated.”

To read his essay, please hit this link.

 


Most Americans in poll say ACA should be improved, not killed

 

By PHIL GALEWITZ

For Kaiser Health News

Move on.

That’s what most people say Congress and the Trump administration should do after the Senate failed to approve legislation in July to  revamp the Affordable Care Act, according to a survey this month.

Nearly 8 in 10 Americans say President  Trump should be trying to make the health law work, according to poll conducted by the Kaiser Family Foundation. This includes large majorities of Democrats (95 percent) as well as half of Republicans (52 percent) and President Trump’s supporters (51 percent). (Kaiser Health News is an editorially independent program of the foundation.)

Almost 6 in 10 people think the Republicans should work with Democrats to improve the health law.

Only 17 percent of the public — and 40 percent of Republicans — think the Trump administration should take steps to make the health law fail, the survey said.

Trump has threatened to end funding to insurers to cover cost-sharing subsidies that cover the out-of-pocket health expenses for millions of low-income people buying coverage on the Obamacare exchanges. Insurers say such a move would force them to leave the health law marketplaces or raise premiums. Nearly two-thirds of the public oppose the president’s negotiating tactics, the survey said.

Just 21 percent of respondents — but 49 percent of Republicans — want the GOP to continue working on a plan to repeal and replace Obamacare, the survey said.

The GOP-controlled Senate failed to pass a health bill before it left for a summer break last week. The House in May passed a bill to partially repeal the law and drastically cut Medicaid.

About 60 percent of people says that Trump and congressional Republicans are responsible for any problems with the health law. Trump has said the public will blame Democrats for any problems.

The health law is more popular than ever, with 52 percent of respondents saying they hold a favorable view of it.  There has been a 9-percentage-point increase in people who hold a favorable view since November.

Still, confusion about the law remains.

Even though only about 10 million people receive coverage through the marketplaces, about 60 percent of Americans believe that their family will be negatively affected by rising premiums in the marketplaces.

The same number of people say that insurers’ decisions not to sell insurance plans in certain marketplaces will affect everyone with insurance. Marketplace coverage affects only those buying individual insurance — not  those who get job-based plans or Medicare or Medicaid.

The poll of 1,211 adults was conducted Aug. 1- 6.The margin of sampling error is plus or minus 3 percentage points.


Court rules that Medi-Cal cut to hospitals was illegal

 

A federal appeals court has ruled that the federal government erred in approving  California’s request to temporarily cut Medi-Cal (the state’s Medicaid program) reimbursement for hospital outpatient care by 10 percent during the  Great Recession.

The ruling by a three-judge panel of the U.S. 9th Circuit Court of Appeals said the Feds can approve such cuts only if evidence shows that the aid  recipients  will  continue to have access to the same services as the general population.

California imposed the cutback  from July 2008 through February 2009.

Robert Leventhal, a lawyer who represented more than 50 hospitals in the case, told the Los Angeles Times that if the ruling stands, the state and  federal governments will have to pay back California hospitals hundreds of millions of dollars.

To read more, please hit this link.


Trump can still shrink Medicaid

By PHIL GALEWITZ

For Kaiser Health News

After the Senate fell short in its effort to repeal the Affordable Care Act, the Trump administration is poised to use its regulatory powers to accomplish what lawmakers could not: shrink Medicaid.

President Trump’s top health officials could engineer lower enrollment in the state-federal health insurance program by approving applications from several GOP-controlled states eager to control fast-rising Medicaid budgets.

Indiana, Arkansas, Kentucky, Arizona and Wisconsin are seeking the administration’s permission to require adult enrollees to work, submit to drug testing and demand that some of their poorest recipients pay monthly premiums or get barred from the program.

Maine plans to apply Tuesday. Other states would likely follow if the first ones get the go-ahead.

Josh Archambault, senior fellow for the conservative Foundation for Government Accountability, said absent congressional action on the health bill “the administration may be even more proactive in engaging with states on waivers outside of those that are already planning to do so.”

The hope, he added, is that fewer individuals will be on the program as states figure out ways “to transition able-bodied enrollees into new jobs, or higher-paying jobs.” States need to shore up the program to be able to keep meeting demands for the “truly needy,” such as children and the disabled, he added.

To Medicaid’s staunchest supporters and most vocal critics alike, the waiver requests are a way to rein in the $500 billion program that has undergone unprecedented growth the past four years and now covers 75 million people.

Waivers have often been granted in the past to broaden coverage and test new ways to deliver Medicaid care, such as through private managed-care organizations.

But critics of the new requests, which could be approved within weeks, said they could hurt those who are most in need.

The National Health Law Program “is assessing the legality of work requirements and drug testing and all avenues for challenging them, including litigation,” said Jane Perkins, the group’s legal director.

The administration has already said it favors work requirements and in March invited states to suggest new ideas.

Before taking the top job at the Centers for Medicare & Medicaid Services, Seema Verma was the architect of a Kentucky waiver request submitted last year.

Not all states are expected to seek waivers, because Medicaid enjoys wide political support in many states, particularly in the Northeast and West.

Medicaid, the nation’s largest health insurance program, has seen enrollment soar by 17 million since 2014, when Obamacare gave states more federal funding to expand coverage for adults. It’s typically states’ second-largest expense after education.

This year, Senate and House bills tried to cap federal funding to states for the first time. Since the program began in 1965, federal Medicaid funding to states has been open-ended.

Health experts say allowing the waiver requests goes beyond the executive branch’s authority to change the program without approval from Congress.

“The point of these waivers is not for states to remake the program whole-cloth on a large-scale basis,” said Sara Rosenbaum, a health-policy expert at George Washington University who chairs a Medicaid group that advises Congress.

Rosenbaum noted that states received waivers for different purposes under the Obama administration.

In Iowa, state officials won the authority to limit non-emergency transportation. Indiana received approval to charge premiums and lock out enrollees with incomes above the federal poverty level if they fell behind on paying premiums.

“Now there is concern these more extreme measures would hurt enrollees’ access to care,” Rosenbaum said.

Three states seeking waivers today are home to three key GOP players in the Senate health debate: Majority Leader Mitch McConnell (Kentucky), Sen. John McCain (Arizona) and Vice President Mike Pence (Indiana).

If states add premiums, as well as work and drug testing requirements, the result would be fewer people enrolling and staying in Medicaid, said David Machledt, senior policy analyst for the National Health Law Program.

“How does that serve the purpose of the Medicaid program and what are the limits of CMS waiver authority?” he asked.


Centene reports strong insurance-marketplace business

 

FierceHealthcare reports:

“Driven by a strong performance in its health insurance marketplace business, Centene reported better-than-expected second-quarter earnings on Tuesday—the same day Senate Republicans were poised to vote to advance legislation to repeal the Affordable Care Act.

“The insurer, which primarily specializes in Medicaid managed care, said its its profits rose to $254 million ($1.44 earnings per share) in the quarter, up from $171 million in the second quarter of 2016. Its adjusted EPS of $1.59 beat analysts’ consensus estimate of $1.30 per share, and it raised its full-year guidance by 18 cents to a range of $4.70 to $5.06 per share.

“Centene said its “strong 2017 marketplace performance” exceeded its expectations in the second quarter by $0.12 diluted earnings per share, and added that its second-quarter earnings of 17 cents per share net benefit related to risk adjustment under the ACA.

“The insurer previously said it would expand its ACA exchange presence in 2018, even as policy uncertainty has driven other insurers to exit.”

To read more, please hit this link.


Healthcare delivery, not just insurance, must be transformed

A rather simple delivery system.

— Photo by Rudiger Wolk

Beyond the sound and fury over Republican efforts to kill the Affordable Care Act, some providers are renewing calls for healthcare-delivery reform, says a piece in Health Affairs by Robert Pearl, M.D., and Norman Chenven, M.D.  They have led, respectively,  two of the nation’s highest-performing healthcare systems: Kaiser Permanente and the Austin Regional Clinic.  Dr. Pearl is chairman and Dr. Chenven vice chairman of the Council of Accountable Physician Practices.

Among their observations:

“Policymakers who are focused predominantly on how to improve the health care system by providing health insurance coverage will fail unless they simultaneously focus on transforming and modifying the delivery system; otherwise, the cost of providing that care will erode any program they create, whether coverage is provided through private insurance, Medicare, Medicaid, or another method. For this reason, we encourage the new Administration and members of Congress to consult and rely on the nation’s physician leaders, in addition to health insurance executives, to help chart the course for American health care in the future.

“While there are many different ‘levers’ to pull for delivery system improvement, three are absolutely fundamental to bringing about positive change and enhancing the doctor-patient relationship: As a nation we will need to move rapidly from fee-for-service to value-based reimbursement, and from paper and stand-alone computer systems to comprehensive, integrated, and mobile electronic health records. At the same time, we will need to track quality and patient satisfaction in ways that improve clinical outcomes without overly burdening physicians. We believe that all three of these objectives can be accomplished, and that they need to be central to the approaches and legislation currently being contemplated by policymakers.”

They conclude:

“The impending crisis in health care in this country will not be averted, regardless of what happens to the Affordable Care Act, unless as a nation we move from fragmentation to integration, from volume- to value-based payment, and from paper records and stand-alone computers to interoperable and comprehensive electronic ones. If these delivery system issues are ignored in the rancorous debate about health care coverage, then no matter the outcome, the system will fail.”

To read the piece, please hit this link.


McConnell seeks to hide GOP health bill’s pain until after the mid-terms

By MICHAEL McAULIFF

For Kaiser Health News

Senate Majority Leader Mitch McConnell is well aware of the political peril of taking health benefits away from millions of voters. He also knows the danger of reneging on the pledge that helped make him the majority leader: to repeal the Affordable Care Act usually pejoratively called “Obamacare”).

Caught between those competing realities, McConnell’s bill offers a solution: go ahead and repeal Obamacare, but hide the pain for as long as possible. Some of the messaging on the bill seems nonsensical (see: the contention that $772 billion squeezed out of Medicaid isn’t a cut). But McConnell’s timetable makes perfect sense — if you are looking at the electoral calendar.

Here are a few key dates in McConnell’s “Better Care Reconciliation Act” (BCRA) that seem aimed more at providing cover for lawmakers than coverage for Americans:

2019: First major changes and cuts to the Affordable Care Act exchanges happen after the 2018 midterm cycle, allowing congressional Republicans to campaign on a “fixed” health system, even though Obamacare is still largely in place next year.

2019: States share $2 billion in grants to apply for waivers under a much looser process through this fiscal year. These waivers could allow insurers to sell skimpy plans that have low price tags but don’t take adequate care of people with preexisting conditions. None of those waivers has to go into effect, however, until after 26 Republican governors face re-election in 2018.

2020: Stabilization cash that makes the markets more predictable and fair for insurers flows through the congressional midterm cycle and the 2020 presidential cycle. Then it disappears. Medicaid expansion funds hold steady through this crucial political window, too.

2024: States enjoy their last few sips of Medicaid expansion cash at the end of 2023 — just as, perhaps, a second Republican presidential term is ending.

2025: The bill changes the formula for the entire Medicaid budget (not just the Obamacare expansion), dramatically reducing federal funding over time. That starts eight years and two presidential election cycles from now.

McConnell insists everything about the bill has been aboveboard and transparent.

“Nobody’s hiding the ball here. You’re free to ask anybody anything,” McConnell said on June 13.

But he and his working group did literally hide the bill from Democrats and most Republicans, crafting it behind closed doors until there was just a week left before his goal to secure a vote on it. (That timing was thrown off Tuesday with the announcement the vote was delayed, but the dealmaking is just beginning.)

Meanwhile, at least two policy details in the bill may obscure the effects for several years and make the health insurance markets look better almost immediately by giving insurers a more predictable, more lucrative market.

One is a stipulation that compels the federal government, for two years, to pay the cost-sharing reduction payments to insurance companies that President  Trump has threatened to end. The payments are part of the Affordable Care Act, and they flow to insurers on behalf of low-income marketplace customers to cover their out-of-pocket health expenses. Republicans had sued to stop the payments, adding considerable instability to ACA marketplaces next year. McConnell ends that uncertainty for two years.

On top of that cash infusion, the BCRA proposes a “Short-Term Stabilization Fund” that would also aim to help lower premium costs and could attract a few more insurers into counties that are sparsely covered now. It would dish out $50 billion to insurers — $15 billion per year in 2018 and 2019 and $10 billion per year in 2020 and 2021.

The money would make up for the billions that the Republican-led Congress has refused to appropriate for insurance companies under the ACA’s risk corridors program. Risk corridors aimed to offset losses for insurers whose costs were more than 103 percent of expected targets. Congress has so far paid only 12.6 cents on the dollar of those obligations and faces lawsuits from insurers that were stiffed.

In short, the two pots of money would go a long way toward addressing the instability in Obamacare created by the Republican-led Congress, but only through the next presidential cycle in 2020.

Beyond timing, the legislation’s features allow senators to make truthful arguments that disguise negative effects.

Perhaps the key claim is that the Senate bill would increase access to insurance. It might, in that insurance companies in states that waive standards would be free to offer much cheaper plans. But those plans would be cheaper because they wouldn’t cover essential health benefits or adequately cover preexisting conditions. Lower-income Americans might be able to buy a plan — possibly a $6,000 deductible for someone who makes less than $12,000 a year.

A spokesman for McConnell did not answer a request for comment. But Democrats are keenly aware of the electoral machinations in the bill.

“Everything about this legislation, from the process to the effective dates of many of the provisions, is driven by political expediency,” said Brian Fallon, a Democratic consultant and former lead spokesman for Hillary Clinton’s campaign. “Mitch McConnell only cares about getting the ‘win,’ not about the substance of the bill.”

Senate Democratic aides who spoke on background were not sure that the steps the bill takes to shore up markets for the next two elections would work when insurance companies can see what lies ahead. But they agreed the timing and short-term fixes might help McConnell twist the arms of reluctant Republican senators.

“I think it will be enormously helpful to McConnell in a room with a moderate Republican who wants to be told, ‘Hey, a lot of this stuff that’s going to happen in this bill that you’re hearing about, that’s worrisome is past your re-elect, it’s past 2018, it’s past 2020,’” one senior aide said. “‘Just vote for it, it’ll be fine, we’ll figure the rest out later.’”

Democrats said that McConnell’s hide-the-ball strategy will not work with voters, and they want Republican senators to know that before they vote.

“The polling already shows that, based on the fact that they control every aspect of government, Trump and the Republicans own everything that happens from now on in the healthcare system,” Fallon said.

Sen. Patty Murray (D.-Wash.), the top Democrat on the Health, Education, Labor and Pensions Committee who has the task of leading the arguments against the GOP bill, thinks senators will imperil their political futures if they buy McConnell’s arguments.

“Senator McConnell is doing everything he can to persuade Senate Republicans that Trumpcare won’t be devastating for the people they serve, but the facts are that Trumpcare is going to cause families to pay more, gut Medicaid, and take coverage away from millions of people,” Murray said. “Any Senate Republican who votes for Trumpcare and believes patients and families won’t hold them accountable is being sold a bill of goods.”

Still, McConnell knows how to work a legislative calendar. Expect a July full of closed-door dealmaking with reluctant senators, leading up to maximum leverage before the August recess.


Anti-ACA Texas wants Feds to renew $6.2 billion a year Medicaid deal

The Texas State Capitol.

By PHIL GALEWITZ

For Kaiser Health News

Texas rejected billions in federal aid to expand Medicaid under the Affordable Care Act, calling the program “broken.”  The leading Texas politicians opposed the ACA. But now it’s asking the Trump administration to renew a deal that’s brought the state an additional $6.2 billion a year under Medicaid to help care for the poor.

Half the money is used to help hospitals finance care for the uninsured, and the rest goes to hospitals and other providers to test regional programs to improve care and access, such as opening school-based health clinics to steer people away from expensive emergency room visits.

State officials are hoping to win a 21-month extension of an agreement that began in 2011 and will expire in December.

The Trump administration signed off on a similar pact with Florida in April, increasing extra Medicaid funds to that state from $600 million a year to $1.5 billion annually. In December, the Obama administration extended a pact with Tennessee to 2021. It is worth at least $500 million a year to the state.

Several states receive such funds but Texas’s allocation is the highest. To put Texas’ request in perspective, $6.2 billion represents more than a third of what the federal government now contributes to the state’s Medicaid program annually. Texas kicks in the balance to pay for its $29 billion Medicaid program, which covers nearly 4.8 million people.

Hospitals are counting on the cash to absorb the costs of uncompensated care, which they say has escalated even as the state’s uninsured rate fell from 20 percent in 2013 to 16 percent in 2015, according to the Kaiser Family Foundation’s estimates. (Kaiser Health News is an editorially independent program of the foundation.)

Without the money, programs and services to the poor will have to be cut, including many new clinics opened to expand access, hospitals say.

“Absent the dollars from the waiver, we would have to start to close the clinics and cut back on the manpower,” said George Masi, CEO of Harris Health System, a large public health system based in Houston.

The uninsured rate has fallen in Houston, but surrounding Harris County still has more than 1 million people without insurance.


Providers denounce Senate GOP leaders’ healthcare bill

 

Leaders of the hospital sector and other major healthcare groups have denounced the Senate Republican leadership’s  Affordable Care Act repeal bill as  little or no improvement over the House bill, which  providers have criticized as imperiling the health of millions of patients.

Rick Pollack, president and CEO of the American Hospital Association, said of the”Better Care Reconciliation Act of 2017”:

“Unfortunately, the draft bill under discussion in the Senate moves in the opposite direction {from protecting coverage}, particularly for our most vulnerable patients. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.”

Bruce Siegel, M.D., president and CEO of America’s Essential Hospitals, said: “For the hospitals that protect millions of Americans and their communities—our essential hospitals—this bill might even accelerate decisions by some to reduce services or close their doors.”

“The Senate healthcare bill released today is just as bad as the version passed by the House of Representatives last month and is a threat to the health of America,” said George Benjamin, M.D., executive director of the American Public Health Association. He asserted that  Senate Republicans had committed “legislative malpractice.”

David O. Barbe, M.D., president of the American Medical Association, chimed in with:

“The AMA is reviewing the Senate health system reform legislation, guided by our key objectives that people who are currently insured should not lose their coverage and that Medicaid, CHIP and other safety-net programs should be adequately funded. The AMA strongly opposes Medicaid spending caps, and we have grave concern with a formula that will not cover needed care for vulnerable patients.”

And  Bernard J. Tyson, chairman and CEO of Kaiser Permanente, said:  “First, we need to cover more people, not fewer people.” He suggested   a three-part test to determine what healthcare progress ought to look like: Does it achieve wider  access, affordability and better outcomes?

Centers for Medicare & Medicaid Administrator Seema Verma, a Trump appointee, not surprisingly, praised the bill.

“I appreciate the work of the Senate as they continue to make progress fixing the crisis in healthcare that has resulted from Obamacare. Skyrocketing premiums, rising costs and fewer choices have caused too many Americans to drop their insurance coverage. Today, Obamacare is in a death spiral and millions of Americans are being negatively impacted as a result. They are trapped by mandates that force them to purchase insurance they don’t want and can’t afford.” {The term “Obamacare” is usually used by Republicans as a derogatory term for the Affordable Care Act, the law’s official name.}

“The Senate proposal is built on putting patients first and in charge of their healthcare decisions, bringing down the cost of coverage and expanding choices. Congress must act now to achieve the president’s goal to make sure all Americans have access to quality, affordable coverage.”

.


Penn. looks at the hospital superuser challenge

 

In a report whose  substance would probably be  roughly replicated in other states, a Pennsylvania state panel reports that 3 percent of hospitalized patients in Pennsylvania consume a huge proportion of healthcare resources and at a huge total cost: about $1.25 billion a year.

These “superusers” — patients with five or more hospital admissions per year— accounted for 10 percent of all hospital payments in 2016, according to a new report (PDF) by the Pennsylvania Health Care Cost Containment Council (PHC4). They account for 12 percent of hospital admissions and 15 percent of hospital days.

Eighty percent of those payments were for Medicare and/or Medicaid patients.

The three biggest reasons for superusers’ frequent hospital stays were sepsis, heart failure and mental-health disorders. The last, of course, tend to be linked with other ailments. Consider the higher than average incidence of alcoholism, drug addiction and smoking by mentally ill people “medicating” themselves. These pathologies, of course cause many other ailments, especially various cancers and heart and circulatory ailments. And then there are the traffic and other accidents associated with addiction.

Still, there was a ray of good news: The number of superusers dropped  to 21,968 in 2016  from 24,045 in 2012.

Robert Shipp III, vice president for population health strategies for the Hospital and Health System Association of Pennsylvania, told The Philadelphia Inquirer that Keystone State hospitals  have moved to address the superuser problem by, for example advising such patients to visit their primary-care provider, not a hospital, for follow-up care. And increasingly nurses and pharmacists are checking up on patients by phone and visiting them at home.

FierceHealthcare commented:

“Organizations across the country have tried to tackle the problem of high-cost superusers. When the University of Illinois Hospital noticed that its most frequent superusers were chronically homeless patients, it launched an initiative to provide them with furnished apartments and support services. The organization’s $250,000 investment in the program has resulted in a 35% drop in monthly hospital visits and a 40% decrease in the annual cost of their care.”

To read the Pennsylvania panel’s report, please hit this link.

To read The Philadelphia Inquirer’s story, please hit this link.

To read FierceHealthcare’s comment, please hit this link.


Page 1 of 23123...Last

Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, Mass