Category Archives: Uncategorized

How Accessible and Affordable were Individual Market Health Plans before the Affordable Care Act? Depends Where You Lived

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http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf434339

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Before the Affordable Care Act (ACA), the landscape of the individual market looked much different than it does today, particularly for those in less than perfect health. For the most part, what state you lived in determined how easily you could purchase a health plan, the price you would pay, and what the plan would cover. Rules for insurers in the individual market varied from state to state, but in most states, if you had a pre-existing condition, you could be denied coverage, pay more, or have coverage for your pre-existing condition excluded from your health plan. As Congress debates repeal of the ACA and its protections for people with pre-existing conditions, many policymakers have called for greater state flexibility in insurance regulation than currently exists under the ACA. It therefore is helpful to understand the range of consumer protections in the states before the ACA, and why the ACA included the insurance reforms it did. This issue brief summarizes state rules for the individual market on the eve of the Affordable Care Act.

HSAs: ‘Tax-Break Trifecta’ Or Insurance Gimmick Benefiting The Wealthy?

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HSAs: ‘Tax-Break Trifecta’ Or Insurance Gimmick Benefiting The Wealthy?

Doctor holding piggy bank

They are just three little words — “health savings accounts” — but they are generating a lot of buzz as Republicans contemplate plans to repeal and replace the Affordable Care Act.

Expanding the use of such accounts, based on a long-held conservative view that consumers should be more responsible for their health care spending, is part of almost every GOP replacement plan under consideration on Capitol Hill.

Here’s the theory behind HSAs: Making consumers bear a bigger up-front share of medical care — while making it easier to save money tax-free for those costs — will result in more judicious use of the health system that could ultimately slow rising costs.

While the details of the current proposals differ, they all generally seek to allow larger tax-free contributions to the accounts and greater flexibility on the types of medical services for which those funds can be used. Some include tax credit subsidies to help fund the accounts.

Supporters say premiums for the insurance linked to an HSA are lower, and they like HSAs’ trifecta of tax savings — no taxes on contributions, the growth of the funds in the account or on their withdrawal if spent on medical care. But skeptics note the tax break benefits wealthy people more than those with lower incomes.

Still, expect to hear a lot more about HSAs in the coming months. Here’s what you need to know:

 

Hospital Impact: No consensus in sight for the Republican ACA replacement

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capitol building above trees

Two major proposals emerged last week to replace the Affordable Care Act that differ significantly in both content and potential impact.

Clearly, both of these proposals represent initial offerings that will be modified or even replaced by others as Republican lawmakers tackle the difficult task of fixing a flawed and controversial law. The ACA offers important protections yet requires modification into a sustainable model that supports both insurance providers and those most in need of healthcare services.

Clearly the work on replacing the ACA has just begun.

Obamacare is not ‘toast.’

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https://www.healthinsurance.org/blog/2017/01/20/obamacare-is-not-toast/

"The Affordable Care Act may be headed for destruction, but I'm betting not." – Harold Pollack

Republicans have the votes – and pressure from their base – to demolish many of the ACA’s gains. Here’s why they probably won’t.

 

Counsel’s Corner: President Trump, Potential Conflicts and Health System Boards

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https://www.bna.com/counsels-corner-president-n57982083221/?utm_campaign=LEGAL_NWSLTR_Health+Care+Update_020317&utm_medium=email&utm_source=Eloqua&elqTrackId=0fe48d4501e044f0a1358b0e9518ca3d&elq=257cee302d8f4e8cae5761612eb6e82b&elqaid=7556&elqat=1&elqCampaignId=4506

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Political biases aside, the transition process for the new administration—both as to President Donald Trump and his Cabinet nominees and White House advisers—does a great service for nonprofit health systems by highlighting critical conflict-of-interest concerns. The last several weeks’ headlines provide health system general counsel with a rare opportunity to offer practical board education based on current events.

The president’s personal asset divestiture plan, announced on Jan. 11, along with the broader public scrutiny of key administration members’ business interests, present an important teaching moment on identifying, resolving and managing conflict-of-interest issues. And that’s a subject on which many health system boards could use continuing guidance, given the strictures of the duty of loyalty.

Neither the particulars of the administration’s potential conflict issues nor the details or adequacy of the president’s divestiture plan needs to be addressed here. Instead, the issues themselves provide something of a checklist that can help health system boards ensure their internal conflict-of-interest policies and processes are as fulsome as possible. Strong conflict-of-interest inquiries are critical to protect the reputation of the organization and its board members, and to sustain key business arrangements.

It is important to note that the rapid growth of health systems, the equally rapid diversification of their businesses and investment portfolios, and the expanding diversity of board members’ backgrounds in board membership significantly complicate the conflict-of-interest review process.

The “Trump Transition” conflicts checklist logically could include the following:

CONCLUSION

The landscape that encompasses the totality of the president’s family business interests and those of his Cabinet appointees—and their relationship to the ethics of government—is many layered. It nevertheless offers certain valuable analogies for the health system board—for which the duty of loyalty is sacrosanct. It isn’t all that great a leap to go from Trump’s transition issues to the conflict-of-interest policies of a nonprofit health system board. And it should be noted that the breadth of scrutiny of transition-related conflicts of interest likely hasn’t gone unnoticed by health-care industry regulators, including but not limited to state charity officials. Regulators may be far more likely than before to apply greater sensitivity to issues and relationships that may present conflict issues and their broader legal implications.

Hospital Impact: Why preserving value-based care is vital for my health system

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http://www.fiercehealthcare.com/hospitals/hospital-impact-why-preserving-value-based-care-vital-for-my-health-system?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWm1NMVpqTmpZbVpqWldFMSIsInQiOiJVZEpvenlWYkp2QW40NE1uNnZUWlZNcWhicE1sWEZrRmd5SVwvZGx0M3hGTUNpVWN3cFwvWnNCMlpoQ25ycTlUMnhnQ0ZGWmcyem5ZdXZ1SzhsMHB3MWU2TlNuQzJkbDNjNDlTbkNVdWN2Z0wyOXB6M1NnU1MwSUs3SFR4b3ptRXlxIn0%3D

There will continue to be a lot of talk about the repeal of the Affordable Care Act over the next weeks and months. From my perspective, I am hopeful that the Trump administration and Congress will keep their focus on the payment aspects of the ACA to ensure affordability for those in need.

My health system has been delivering care under a value-based care delivery model for the last six years, and I don’t want to see that care model go away under the repeal of the law. Quite frankly, this approach to care delivery should be the model for the entire nation.

We have been making a difference in the lives of so many through an approach that provides comprehensive, interdependent care to the sickest of the sick. We started with those patients with multiple comorbidities such as heart disease, diabetes, hypertension and COPD. Through our on-campus Center for Clinical Resources, we can now address their care needs simultaneously through the efforts of physicians, nurse practitioners, nurses, pharmacists, respiratory therapists, dieticians, navigators, community health workers and care coordinators.

The model has been so successful that we are now taking the concept out to the community. We identified “hot spots” throughout our service area where patients with the highest utilization of our health system are located. We applied our high-utilizer determination criteria of three or more bedded visits within 12 months, or six or more emergency department visits with a bedded visit and readmission within 12 months, to determine these patients and their locations. We are now delivering care in homeless shelters, with senior housing, low-income housing, senior centers and churches to follow.

Our goal is to disrupt these high utilizers’ cycle of use by providing services before an ED visit becomes necessary; assisting them to address their social determinants; intervening on any behavioral health issues; introducing those in need to a community health worker who can address any ongoing social needs such as transportation to appointments; and setting them up with a primary care provider for their care going forward.

Two years ago, we introduced our first community garden, and last year our gardens grew to five additional gardens serving those in need. We anticipate the same growth with this model of taking care to the community.

If the ACA is repealed and impacts our care delivery model, programs such as these will go away, leaving the most vulnerable once again in need of the most expensive care rather than enabling us to use the Triple Aim-focused approach to their care.

1K docs, nurses urge Cleveland Clinic to cancel fundraiser at Trump resort

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http://www.fiercehealthcare.com/healthcare/1k-docs-nurses-urge-cleveland-clinic-to-cancel-fundraiser-at-trump-resort?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWm1NMVpqTmpZbVpqWldFMSIsInQiOiJVZEpvenlWYkp2QW40NE1uNnZUWlZNcWhicE1sWEZrRmd5SVwvZGx0M3hGTUNpVWN3cFwvWnNCMlpoQ25ycTlUMnhnQ0ZGWmcyem5ZdXZ1SzhsMHB3MWU2TlNuQzJkbDNjNDlTbkNVdWN2Z0wyOXB6M1NnU1MwSUs3SFR4b3ptRXlxIn0%3D

Photo: Inside the Mar-a-Lago, courtesy of The Mar-a-Lago Club website.

More than 1,100 doctors, nurses and medical students are urging the Cleveland Clinic to cancel an annual fundraiser planned at a resort owned by President Donald Trump in the wake of his executive order on immigration.

Over the last three days, 1,141 medical professionals have signed an open letter to Cleveland Clinic President and CEO Toby Cosgrove asking him to cut the perceived ties to Trump in light of the executive order that led to a first-year internal medicine resident at the organization being detained and forced to return to Saudi Arabia because her visa was issued in Sudan, one of the countries on Trump’s list

Suha Abushamma, M.D., has sued the Trump administration, CNBC reports, and a federal judge has ordered the White House to explain why she shouldn’t be allowed to return to the United States.

The ban also had a direct impact on nine patients scheduled to receive care at the Cleveland Clinic over the next 90 days.

Many of the medical professionals who signed the letter are students at Case Western Reserve University, which runs the Cleveland Clinic Lerner College of Medicine.

The letter asks Cosgrove to:

  • Reschedule the lavish fundraiser planned at Trump’s Mar-a-Lago resort in Palm Beach, Florida
  • Release a public statement that condemns the immigration ban
  • Pledge to use his power to protect Cleveland Clinic employees from deportation and allow patients to continue to receive care
  • Emphasize that Cleveland Clinic values diversity and relies on immigrants to provide medical care