The Latest Motion In House v. Price Has A Significant Impact On The Future Of CSR Payments

http://healthaffairs.org/blog/2017/08/01/the-latest-motion-in-house-v-price-has-a-significant-impact-on-the-future-of-csr-payments/

On August 1, 2017, the United States Court of Appeals for the District of Columbia granted the motion of the attorneys general of 17 states and the District of Columbia to intervene in House v. PriceHouse v. Price is before the D.C. Circuit on appeal from the ruling of a district court judge in favor of the House of Representatives in its lawsuit claiming that the reimbursement of insurers for reducing cost sharing for low-income qualified health plan enrollees is illegal because Congress had not appropriated funding for the payments. The judge enjoined the payments but stayed her order pending an appeal and the Obama administration in fact appealed. The states had moved to intervene, claiming that they had an interest in the action and that the Trump administration was not adequately defending their interest.

The three-judge appellate panel held first that the states had demonstrated that they had standing to intervene because they “would suffer concrete injury if the court were to grant the relief the plaintiffs seek.” The states established that a judgment for the House terminating the payments would “lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the States will have to provide health care.” This would in turn result in state-funded hospitals suffering financially when they have to cover emergency care for uninsured individuals.

The court further held that the states had established a right to intervene in the action. First, the states had established an interest in the subject matter of the lawsuit.

Second, the court held that allowing the injunction of the court below would impair the states’ rights. The court observed that the administration’s “claim that it could unilaterally suspend payments is a debated legal question, not an answer to the injury the States have evidenced. The injunction sought, which would forbid the payments at issue, would erect a roadblock to the States’ goal of either persuading or compelling the Department to make the payments.”

Third, the court held that the states had raised a sufficient doubt concerning the adequacy of the administration’s representation of their interest. The court noted that the administration had nowhere argued that it would protect the states’ interest or continue to pursue the appeal.

Fourth, the court held that the motion to intervene was timely. The states, the court held, “had filed within a reasonable time from when their doubts about adequate representation arose due to accumulating public statements by high-level officials both about a potential change in position and the Department’s joinder with the House in an effort to terminate the appeal.” The court, in short, took President Trump’s threats to terminate the cost-sharing reduction (CSR) payments seriously.

Finally, the court held that permissive intervention was also warranted in the case.

The court further ordered that the case would continue to be held in abeyance, with status reports at 90-day intervals and the next one due on October 30, 2017. With their status as parties to the case, however, the states may well next seek to get the case moving again.

The decision does not mean that the Trump administration is barred from ending the cost-sharing reduction payments. It does mean, however, that the administration cannot unilaterally stop the CSR payments, dismiss the appeal, and claim judicial imprimatur for its doing so. If the administration does stop making the payments, the states—or insurers, or possibly consumers—would be able to sue to require the payments to be made and the injunction entered by the lower court would not be as much of a “roadblock” to their prevailing. Finally, if the states ultimately convince the appellate court that the CSR funding has in fact been appropriated, the administration would be required to pay it. The decision is, therefore, a major development in the ongoing CSR saga.

TWO POWER QUESTIONS TO CLARIFY A CONFUSING FORK IN THE ROAD

Two Power Questions to Clarify A Confusing Fork in the Road

You aren’t reaching high enough if the future is known, the path is clear, and outcomes are certain. But navigating ambiguity drives most of us nuts.

All important decisions have alternatives. This is doubly true when decisions are personal.

Decisions include:

  1. Fear the other path might turn out better.
  2. Concern for hurting those negatively impacted.
  3. Anxiety about jumping from the pan into the fire. You don’t want to make things worse.
  4. Dread that new information might emerge. What if a better option appears and it’s too late?

Navigating the fork in the road:

5 considerations:

  1. Consider alternatives.
  2. Weigh pros and cons.
  3. Examine options through the lens of your strengths.
  4. Talk it over with others.
  5. Consider personal values.

2 power questions:

Some decisions are foggy even after employing the above considerations. Sometimes the more you consider, the foggier you get.

Try these two power questions if you’re still unsure after careful consideration:

  1. If both alternatives fail, which will you be glad you tried?
  2. If both alternatives succeed, which will you be glad you are doing?

Bob’s suggestions:

I just talked with Bob Hancox. He offered these suggestions if you’re at a fork in the road.

  1. If you’re stuck, ask yourself, “Whose permission are you waiting for?”
  2. If you have several alternatives, try putting them in one of three buckets. Good. Better. Best.

How do you make decisions when you’re at a fork in the road?

Republicans learn the limits of reconciliation with failed ACA repeal

https://www.brookings.edu/blog/fixgov/2017/07/28/limits-of-reconciliation-and-failed-aca-repeal/?utm_campaign=Governance%20Studies&utm_source=hs_email&utm_medium=email&utm_content=54885356

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With late night drama not often seen on the Senate floor, Republicans’ latest attempts to pass a bill repealing the Affordable Care Act failed last night, thanks in part to a divide the party’s congressional leaders, especially in the Senate, could simply not bridge.

In Congress, we expect that the majority party’s choices about what to work on and how to work on it will be guided, in large part, by their desire to maintain and grow their majority in the future. As the process went on over the past several months, it became increasingly clear that, for the current GOP leadership, what they thought was best for the party’s collective fortunes was adopting something that they could credibly claim “repeals Obamacare.” After all, doing so has been one of their central campaign promises since the law was adopted in 2010—and what helped account for some of their electoral success since that time. The content of the narrow bill to which Senate Republicans retreated in an attempt to keep the process moving reflects this priority, in that it contained symbolic provisions that would be easy for voters to understand as “Obamacare repeal” should the bill have ultimately become law. Chief among these provisions was the repeal of the requirement that individuals purchase health insurance, known as the individual mandate. This provision is among the law’s best known and the change in the Senate bill would have been easy for voters to understand. Under Obamacare, they were required to do something; under the Republican bill, they would not have been.

At the end of the day, however, individual Senate Republicans concluded that even if leaders had judged that “repealing Obamacare” was in the best interests of the party collectively, they could not support the different proposals drafted to actually get there. This was perhaps most true of Senators Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), who opposed beginning debate and all three alternative proposals considered this week. There were also, however, 11 other senators who voted no on at least one of the alternatives offered this week. While some of those votes may have been strategic, as members knew that the proposal would not ultimately be enacted, they do help illustrate the persistent divides within the Republican Party about the best way to proceed on health policy. In an era of high party polarization and a well-sorted electorate, this kind of cross-pressuring, where what’s good for the party is not necessarily good for the individual member, is less common than it once was. But as the experience of the last few months suggests, those situations can still and do arise.

While the choice by Republicans to pursue their collective goal of “repealing Obamacare” through the fast-track budget reconciliation process meant that Senate Majority Leader Mitch McConnell (R-Ky.) only needed to find 50 votes, it also constrained his task in important ways. The rules of the budget process, including the Byrd Rule, place restrictions on the content of reconciliation bills and amendments to them. While it can be difficult to know exactly how these rules shape a particular piece of legislation, one consequence of them is that leadership does not necessarily have as much room to maneuver in terms of deal-making as they might have on other bills. What’s more, by turning to a process that did not require the support of any Democrats to move forward, Republicans could not rely on the opposition of the other party as a useful foil while they sought to build a winning coalition. Instead, all attention was focused on the party’s internal conflicts and inability to reach agreement—a task made harder by the presence of a same-party president without the policy expertise or interest to help broker the necessary deals. Special legislative procedures that prevent filibusters, in sum, can help majority parties get legislative wins, but only if the party agrees internally on the policy particulars of what that win should look like.

As an agenda item, health care generally and Obamacare specifically aren’t going anywhere any time soon. The Children’s Health Insurance Program, which covered about 9 million children in 2016, needs to be reauthorized by the end of September, and uncertainty about the continued payment of certain subsidies for some Obamacare enrollees on the individual marketplace remains. But with a range of other major issues needing action in the coming weeks—including spending bills and the debt ceiling—Republicans appear ready to move on from their legislative pursuit of their biggest collective goal of recent years.

29 hospital, health system outlook and credit rating actions in July

http://www.beckershospitalreview.com/finance/29-hospital-health-system-outlook-and-credit-rating-actions-in-july.html

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Brigham and Women’s may extend buyout offer beyond initial 1,600 employees

http://www.beckershospitalreview.com/hospital-management-administration/brigham-and-women-s-may-extend-buyout-offer-beyond-initial-1-600-employees.html

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Boston-based Brigham and Women’s Hospital may ask more employees to voluntarily leave their jobs just three months after offering buyouts to 1,600 employees, according to The Boston Globe.

“We are considering a respectful way to minimize any potential involuntary reduction in force by inviting some employees who may wish to leave the Brigham to voluntarily separate from the organization,” the hospital said in a statement to The Boston Globe. “When we announced the voluntary retirement opportunity in April, we indicated that additional reductions in force would likely be necessary.”

When Brigham and Women’s announced the buyout offer in April, the organization said it is profitable but facing pressure amid shrinking payments from government and commercial insurers and growing labor costs. Buyouts were only offered to employees age 60 or older. The offer includes one year of base pay and health insurance for up to 20 months.

About 45 percent of those eligible have applied for the buyout, according to The Boston Globe.

A hospital spokesperson told The Boston Globe the hospital hasn’t decided how many and which employees to extend the buyout offer to.

Brigham and Women’s is owned by Boston-based Partners HealthCare and has approximately 18,000 employees.

Fitch: Failed ACA replacement efforts add to healthcare sector uncertainty

http://www.beckershospitalreview.com/finance/fitch-failed-aca-replacement-efforts-add-to-healthcare-sector-uncertainty.html

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As ACA repeal and replace efforts stall, significant uncertainty remains surrounding how federal policy will affect nonprofit healthcare organizations, leading to a negative sector outlook for healthcare, according to Fitch Ratings.

The uncertainty and negative outlook comes as the Trump administration looks for ways to weaken the ACA even if the health reform law is not repealed.

Nonprofit hospitals experienced declines in uncompensated care under the ACA because of an increase in healthcare coverage due to Medicaid expansion, rollout of healthcare exchanges and allowing children to stay on their parent’s health insurance plan until age 26.

While repeal efforts cause uncertainty for hospitals, current discussions regarding a bipartisan healthcare bill could be beneficial for nonprofit hospitals. A bipartisan effort could potentially reduce the insurance premium price hikes, according to Fitch.

55 hospital transactions and partnerships in July

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/55-hospital-transactions-and-partnerships-in-july.html

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