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House v. Burwell

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Court stays cost-sharing cut payment case

Timothy Jost writes in Health Affairs:

”{T}he Circuit Court of Appeals for the District of Columbia acceded to the request of the House of Representatives and stayed further proceedings in House v. Burwell pending further motions by the parties, due by February 21, 2017. In this case, the House of Representatives claims that government payments to insurers to reimburse them for reducing cost sharing for silver plan marketplace enrollees with incomes not exceeding 250 percent of the poverty level are illegal because Congress has not appropriated the funds for those payments.

“The ACA requires insurers to reduce cost-sharing for these enrollees and the government to reimburse them. However, the House and the Obama administration have taken different positions as to whether money has in fact been appropriated for the reimbursement payments. The lower court sided with the House.”

Mr. Jost opines:

“The reasonable course for Congress at this time is to appropriate funds to cover the cost-sharing reduction payments for 2017 (and 2018 to avoid a collapse of the marketplaces at the end of 2017), and then to negotiate with the Trump administration the withdrawal of the appeal and the vacating of the district court’s order with the administration. Until Congress appropriates these funds, the Trump administration should delay the resolution of the appeal and leave the district court’s stay of its order in place. These actions will undoubtedly be difficult for some Republicans to accept, but the alternative should be far more distasteful.”

To read the whole article, please hit this link

Deconstructing the healthcare part of Obama’s budget plan



Electron microscope view of the Zika virus.

In HealthAffairs, Timothy Jost looks at  the healthcare elements of President Obama’s proposed budget for 2017, which includes “new initiatives to increase access to mental-health care, expand opioid-abuse treatment, fight antibiotic resistance, address the Zika virus threat and fund a ‘cancer moonshot.”’

He writes: “To control Medicare spending, the budget proposal would reduce the target growth rate for Medicare enforced by the Independent Payment Advisory Board  {IPAB} to 0.5 percentage points above per-capita GDP growth. It also contains a host of Medicare payment and delivery reform proposals.”

Regarding private insurance, one proposal “would attempt to curb surprise balance bills by out-of-network providers by requiring hospitals to take steps to match patients with in-network providers and requiring physicians who regularly provide services in a hospital to accept an appropriate in-network rate as payment in full.

“Another proposal would allow HHS {Department of Health and Human Services} to develop uniform definitions and principles for standardizing medical billing and making it more transparent. Self-insured non-federal governmental plans would be prohibited from opting out of various federal consumer protection laws, such as the Mental Health Parity Law.”

Mr. Jost notes that “{T} budget request of a president in his final year of office ….is unlikely to lead to enacted legislation. Congress in unlikely to expand the authority of the IPAB or increase funding for the Medicaid expansions. But many of the expenditures identified in the budget—for the risk adjustment, reinsurance, premium tax credit, and (subject to the court decision in House v. Burwell) cost-sharing reduction payment programs—are mandated by law and are unlikely to be changed by Congress.”


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