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Could Minnesota Health Reforms Foreshadow Repeal And Replace?
In the midst of the uncertainty about the Affordable Care Act, Minnesota has taken three unusual actions.
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.
Keeping Perspective During Turbulent Times
At times of dramatic change in a nation’s history, fear and anxiety can become pervasive and overwhelming. Troubling visions of authoritarianism or chaos, of political persecution, and even civil war disturb our waking thoughts and nightly dreams. It can be emotionally, almost physically, paralyzing.
As Mark Twain allegedly quipped, “history doesn’t repeat itself, but it often rhymes.” Looking for those historical rhymes can provide perspective at times of disquiet, such as this. This may be particularly true for younger members of our attentive public, who have not lived through, and emerged safely from, some of the dark periods we have experienced as a country.
America’s 241 years of nationhood have been tumultuous. Events have repeatedly challenged the viability of our democracy.
Varied as these events were, they show how frequently crises test our democracy, and how resilient it has proven over time. They also show how important it is for defenders of our freedoms to remain vigilant. No civilization—no matter how mighty or seemingly stable—is invulnerable. All decline and pass eventually from the scene. Only the values and courage of a free citizenry and its leaders assure that we will continue to confront and rise to the challenges that we will inevitably encounter.
A critical role in preserving our values and our institutions falls to nongovernmental organizations that constitute our civil society. These institutions include our churches, synagogues, and mosques, our universities, and our many charitable and philanthropic organizations. The Commonwealth Fund is one of these. As an endowed philanthropy, The Commonwealth Fund has for 99 years enjoyed the extraordinary privilege of economic independence. Currently, the Fund is dedicated to creating a high performance health system in the United States. In pursuit of that goal, it will continue to provide an independent, nonpartisan, and objective view of our health care system, and of the events and developments that may affect the health and health care of Americans.
Is 3.49 more than 3?
HHS has already submitted a proposal of new rules to OMB. [Under the proposal,] insurers would have more leeway to vary prices by age, so that premiums for the oldest customers could be 3.49 times as large as those for younger customers. Today, premiums for the old can be only three times as high as premiums for the young, which is what the Affordable Care Act stipulates. According to sources privy to HHS discussions with insurers, officials would argue that since 3.49 “rounds down” to three, the change would still comply with the statute.
This is kinda dumb. It’s also not so legal. The ACA says that “the rates” for health plans “shall not vary by more than 3 to 1 for adults.” The statute couldn’t be clearer. As I said to Jonathan: ”If I told you not to sell something for more than $3.00, and you went ahead and sold it for $3.49, then you’ve disregarded my instruction. It doesn’t matter if it rounds to $3.00. It’s more than $3.00.”
Under Chevron, agencies have lots of room to interpret ambiguous statutes. But there’s no ambiguity here. The statute says no more than 3, period. As Monty Python might say, 3.49 is right out. (Here’s where I insert the standard caveat that the administration hasn’t offered a legal argument—or any public comment, for that matter—and it’s possible I’m missing something. Also, the rule could easily be amended during OMB review.)
Debunking the Argument that the Bundled Payment for Care Improvement Program (BPCI) Contributed to Higher Procedure Volumes
Click to access BPCI_Report_Final_0.pdf
A recent study linked Medicare’s Bundled Payment for Care Improvement (BPCI) focusing on lower extremity joint replacements to lower costs of care. An accompanying editorial disputed the findings claiming that a reported rise in the volume of procedures between baseline and performance years for the intervention cohort, relative to a comparison group, indicated that total spend may have increased instead of decreasing.
Our analysis of Medicare fee-for-service data from 2010 through 2015 by hospital, for all lower extremity joint replacements in the entire United States, indicates no evidence that participation in the BPCI was responsible for any increase in the volume of procedures between baseline and performance years, thus reaffirming the original paper’s findings. We also find that trends in regional demographic and market characteristics explain the change in volume over time.
Health Sector Trend Report, January 2017
Click to access Altarum%20RWJF%20Trend%20Report%20January%202017.pdf
These reports, with funding from the Robert Wood Johnson Foundation, provide a monthly summary of key trends in health care spending, prices, utilization, and employment.
They are related to, but distinct from, the Center for Sustainable Health Spending Health Sector Economic Indicators.
The trend reports make direct use of the Quarterly Services Survey (QSS), the timeliest source of detailed, survey-based spending information for health care services, which account for more than 70% of national health spending.
Each quarter, when new QSS data are released (March, June, September, and December), we will publish an expanded version of this report with a more detailed analysis of health care services trends.
The regular monthly reports will supplement the most recent full quarterly analysis with new data on other aspects of health spending, health care prices and utilization, employment and early indications of the trends for the next quarter.
This report provides a monthly summary of key trends in U.S. health care spending, prices, utilization, and employment. The reports build on Altarum’s Health Sector Economic Indicators SM briefs (HSEI) and make direct use of the U.S. Census Bureau’s Quarterly Services Survey (QSS). When new QSS data are released (March, June, September, December), an expanded version of this report is published. Interim reports highlight noteworthy health sector trends and early indications of results for the next quarter. In this January 2017 report, spending estimates are available through November 2016, while prices and labor are available through December 2016.
Trump, GOP Lawmakers Back Off From Immediate Obamacare Repeal
There’s a moment in the Broadway musical Hamilton where George Washington says to an exasperated Alexander Hamilton: “Winning is easy, young man. Governing’s harder.”
When it comes to health care, it seems that President Trump is learning that same lesson. Trump and Republicans in Congress are struggling with how to keep their double-edged campaign promise — to repeal Obamacare without leaving millions of people without health insurance.
During the campaign, Trump promised to repeal and replace the Affordable Care Act immediately upon taking office. Last month, in an interview with The Washington Post, he said he had a replacement law “very much formulated down to the final strokes.”
But on Sunday, he dialed back those expectations in an interview with Fox News.
“It’s in the process and maybe it will take till sometime into next year, but we are certainly going to be in the process. It’s very complicated,” Trump said.
He repeated his claim that Obamacare has been “a disaster” and said his replacement would be a “wonderful plan” that would take time “statutorily” to put in place. And then he hedged the timing again.
“I would like to say by the end of the year, at least the rudiments,” he said.
Trump’s recent hesitation comes as Republicans in Congress tame their rhetoric surrounding the health care law.
Sen. Lamar Alexander, R-Tenn., chairman of the Senate health committee, said he’d like to see lawmakers make fixes to the current individual market before repealing parts of the law.
“We can repair the individual market, which is a good place to start,” Alexander said on Feb. 1.
