Tag Archives: ACA Repeal

ACA repeal makes hospitals more vulnerable to closure

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http://www.fiercehealthcare.com/healthcare/hospital-closures-aca-repeal-makes-organizations-more-vulnerable?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiTldOaE1tUXlaRFUxTlRrMyIsInQiOiJVUFpNQ0tIKzF1c1pzU0gzbVpuaTNMdE8wbHUxY09LWW1mN1hoaHJ4QnVtVzdOWUExOXNqUXhPZkxTaUUwcFpHWW9ib21QdkRxanU1TzhRMXltUUNZN2dFdVdhSnpJWWpKbTVhMGkzSmlWT3R5UDVhMTJQUXhwSlF3eXNKT1VsRyJ9

hospital hallway

Millions of insured Americans could lose health insurance coverage if Congress and the new White House administration make good on their threat to repeal the Affordable Care Act. But they aren’t the only victims.

Many hospitals could also close as a result of the legislative action and the loss of government funds and increase in uninsured Americans who need care.

And these potential closures only add to the growing problem of vanishing hospital beds, according to a Bloomberg report. Indeed, more hospitals have shifted their focus from inpatient to outpatient care for financial reasons, acquiring or opening stand-alone facilities, physician practices and retail clinics.

“It’s been a very tough environment for hospitals,” Jason McGorman, a Bloomberg Intelligence analyst, said in the piece. “They have to get into other areas and businesses to free up cash and generate better margins than inpatient care, which has become a slow-growth business.

What Could President Trump Do Through Executive Order to Dismantle the ACA?

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http://www.commonwealthfund.org/publications/blog/2017/jan/what-could-president-trump-do-through-executive-order

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The Republican House and Senate have begun the process of repealing the Affordable Care Act (ACA) through the budget reconciliation process. Enacting a budget reconciliation bill is likely to take weeks, however, and at this point it seems likely that such a bill will delay repeal of some of the most important provisions of the ACA for much longer.

In a meeting with Republican lawmakers on January 4, 2017, Vice-President-elect Mike Pence stated that the Trump administration may move much more quickly against the ACA through executive action. He told reporters that the Trump administration would begin on the first day of the administration an orderly transition process to unwind the ACA: “We’re working now on a series of executive orders that will enable that orderly transition to take place even as Congress appropriately debates alternatives to and replacements for Obamacare.”

The President and the executive departments and agencies clearly do have a great deal of power. They can exercise their authority through issuing executive orders, rules, and guidance. The executive branch of government operates programs, decides whether and how to defend or settle litigation, and exercises discretion in enforcing the law. But within our constitutional system the president and executive departments and agencies must comply with the laws and operate according to the processes laid down by law.

What can the executive do to “unwind” a law without congressional action and within the law?

States That Leaned In on the Affordable Care Act Have Much to Lose

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http://www.commonwealthfund.org/publications/blog/2017/jan/states-that-leaned-in

The Affordable Care Act (ACA) created health insurance marketplaces to make it easier for consumers to shop for and compare plan options in one place. As of December 24, 2016, over 11.5 million people had signed up for coverage through the marketplaces, and the U.S. Department of Health and Human Services projects that 13.8 million consumers will have selected a plan for 2017 by the close of this open enrollment period.

However, our new president and Congress are committed to the repeal of the ACA. Repeal could cause as many as 30 million to lose coverage, 9.3 million of whom receive federal premium assistance through the marketplaces. Nearly one-third of these enrollees reside in the 17 states that embraced the chance to set up and manage their own ACA marketplace.1  All but one of these states also expanded their Medicaid program and most incorporated the ACA’s consumer protections into their own state insurance laws, effectively adopting them as their own. These states not only embraced the ACA’s vision of improving access to affordable, quality health coverage, but also took full advantage of the flexibility for states provided under the law to design an insurance market to meet local needs.2

Within days of the ACA’s enactment, legislators, agency staff, and health care stakeholders from these states began working to develop the policy and operational infrastructure needed to build and maintain a sustainable health insurance marketplace. Doing so not only gave these states greater autonomy and flexibility to manage their insurance markets, but also allowed them to tailor public education and outreach efforts to their local population.

 

 

Medicaid’s Future: What Might ACA Repeal Mean?

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http://www.commonwealthfund.org/publications/issue-briefs/2017/jan/medicaids-future-aca-repeal?omnicid=EALERT1152581&mid=henrykotula@yahoo.com

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Abstract

Issue: Republicans in Congress are expected to repeal portions of the Affordable Care Act (ACA) using a fast-track process known as budget reconciliation.

Goals: This issue brief examines how repeal legislation could affect Medicaid, the nations’s health care safety net, which insured 70 million people in 2016.

Findings and Conclusions:Partial-repeal legislation that passed Congress but was vetoed by President Obama in 2016 offers some insight but new legislation could go further. It could repeal the ACA’s Medicaid eligibility expansions for adults and children but also roll back other provisions, such as simplified enrollment and improvements in long-term services and supports for beneficiaries with disabilities. Additionally, the Trump Administration could expand use of demonstration authority to introduce deeper structural changes into Medicaid, such as eligibility restrictions tied to work, required premium contributions and lock-out for nonpayment, annual enrollment periods, and coverage limits and exclusions. Together, these changes would have far-reaching implications for Medicaid’s continued role as the nation’s safety-net insurer.

The #1 thing you need to know from the 2017 JP Morgan Healthcare Conference: Follow the money

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http://www.beckershospitalreview.com/hospital-management-administration/the-1-thing-you-need-to-know-from-the-2017-jp-morgan-healthcare-conference-follow-the-money.html

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If you want to understand the future of the $3 trillion U.S. healthcare industry, the lesson of the past is to ‘follow the money.’ And no one would argue that the place to do that is the infamous JP Morgan Healthcare Conference taking place this week in San Francisco.

While there are an estimated 4,000 people attending the conference, there’s roughly another 20,000 here for ‘off the grid’ meetings in every nook and cranny you can find. It is a surreal atmosphere in the form of the top executives from more than 450 private and public companies in biotech, pharmaceutical, medical device and technology, as well as healthcare providers, payers, private equity and venture capital firms and investment banks. Simply stated, this is where medicine’s flow happens.

With that said, roughly $1 trillion or one-third of annual U.S. healthcare spend flows through hospitals and healthcare delivery systems. So, if you want to understand what’s happening now and what will happen in the future, a good place to start is in the nonprofit healthcare provider track, where CEOs and CFOs of over 20 of our nation’s largest healthcare delivery systems presented their strategic plans in rapid fire 25-minute presentations.

Together these organizations represent over $100 billion or 10 percent of that $1 trillion spend. Incredible. The average organization presenting had over $6 billion in annual revenue, 15 hospitals, close to 30,000 employees and thousands of physicians on staff. Many of the name brands in healthcare including Downers Grove, Ill.-based Advocate Health Care, Irving, Texas-based CHRISTUS Health, Cleveland Clinic, Detroit-based Henry Ford Health System, Salt Lake City-based Intermountain Healthcare, Indianapolis-based IU Health, Oakland-based Kaiser Permanente, Cincinnati-based Mercy Health, New York-Presbyterian, Chicago-based Northwestern Medicine, Northwell Health in Great Neck, N.Y., and Robert Wood Johnson Barnabas Health based in West Orange, N.J., presented along with leading children’s hospitals such as Children’s Hospital of Philadelphia and innovative physician focused models such as Marshfield Clinic in Wisconsin and Geisinger Health System in Danville, Pa.

This provided an incredibly important snapshot of both the ground level view of what’s happening in the real world today as well as the bets being placed for the future. What follows is a high-level perspective of what was shared by these prominent provider organizations.

So, follow the money…and here’s the Top 10 Trends shaping how that money is flowing:

Five Republican senators aim to delay ACA repeal

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http://www.fiercehealthcare.com/payer/five-republican-senators-aim-to-delay-aca-repeal?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiWmpCaVl6YzNZVGMzWW1VMSIsInQiOiJFOWcxQXlNRFltbXIzc2FocWNwREJpRnp6dEpLbmZORTVIb29WaTRtQ2lrYzVwQ1hjOW4rS1RMUDlNOEE1RVRJdEJoMjJYeEpNWUFjbnBiRUQ0WGhoSGpkUDQyWkQxZE1UQ3NBbFU1bjVwVm5ITjBTVUxRbmNWQ3JcLytnMlM0bnAifQ%3D%3D

The Senate side of the United States Capitol in Washington, D.C.

With Republican leadership charging ahead despite growing concerns about a hasty repeal of the Affordable Care Act, a group of GOP senators has introduced a measure intended to draw out the repeal process.

The amendment, introduced by Republican Sens. Bob Corker, Rob Portman, Susan Collins, Bill Cassidy and Lisa Murkowski, would extend the deadline for congressional committees to write an ACA repeal bill from Jan. 27 to March 3.

The Senate is expected to vote this week on a resolution that would set the stage for repealing key provisions of the law through budget reconciliation.

President-elect Donald Trump hasn’t officially indicated a position on a repeal timeline, but top Trump aide Reince Priebus and Kentucky Sen. Rand Paul have both indicated that he would support a simultaneous repeal and replacement, FierceHealthPayer has reported.

ACA repeal: Why healthcare lobbies are unusually quiet as Congress acts

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http://www.fiercehealthcare.com/healthcare/aca-repeal-why-healthcare-lobbies-are-unusually-quiet-as-congress-acts?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiWmpCaVl6YzNZVGMzWW1VMSIsInQiOiJFOWcxQXlNRFltbXIzc2FocWNwREJpRnp6dEpLbmZORTVIb29WaTRtQ2lrYzVwQ1hjOW4rS1RMUDlNOEE1RVRJdEJoMjJYeEpNWUFjbnBiRUQ0WGhoSGpkUDQyWkQxZE1UQ3NBbFU1bjVwVm5ITjBTVUxRbmNWQ3JcLytnMlM0bnAifQ%3D%3D

congress

A fast-track repeal and replacement of the Affordable Care Act will lead to widespread chaos and millions of Americans losing health insurance coverage. But many healthcare executives and lobbyists haven’t put up much of a fuss for fear of getting on the “wrong side” of the new White House administration.

Republicans are acting quickly to overturn President Barack Obama’s landmark legislation, but The New York Times reported that the strongest message lobbyists have sent to lawmakers was a demand for the repeal of an annual fee that health insurance companies must pay to expand coverage under the law.

While not all healthcare groups are keeping quiet—the American Medical Association, for instance, has urged lawmakers to be cautious with their plans to repeal—industry groups that helped create the Affordable Care Act in 2010 are keeping a low profile, according to the publication.

Many healthcare execs “don’t want to get on the wrong side of the new administration or the Republican majority in Congress,” Kenneth E. Raske,  president of the Greater New York Hospital Association, told the NYT.

So instead of trying to stop the repeal, many lobbyists aim to help shape the replacement of it.

Part of the reason for the muted response, the publication noted, is that many of these same people were taken by surprise by the election of Donald Trump because they expected Hillary Clinton to win.

One person who is in a particularly awkward position, the NYT writes, is Marilyn B. Tavenner, chief executive of America’s Health Insurance Plans, the leading lobby for insurers. She worked for the Obama administration for years and led the work on the Affordable Care Act.

She has urged that Congress maintain subsidies for low- and moderate-income individuals through at least 2019 and eliminate the tax on insurers.

Repeal-and-Delay Would Make Budget Neutrality for ACA Replacement Difficult

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http://www.commonwealthfund.org/publications/blog/2017/jan/repeal-and-delay-budget-neutrality-aca-replacement?omnicid=EALERT1152052&mid=henrykotula@yahoo.com

As Congress considers options to repeal and replace the Affordable Care Act (ACA), it will need to confront how the federal budget scoring process can affect the fate of legislation. The Congressional Budget Office (CBO) is required to produce a “score,” or budget estimate, for most bills approved by a full committee in both the House of Representatives and the Senate. Each score represents CBO’s best estimate of the 10-year impact of legislation on the federal deficit. Bills scored as deficit-increasing may be difficult to pass given certain statutory and procedural rules intended to prevent new legislation from increasing the federal deficit.

Under the plans currently being discussed, repeal of the ACA’s coverage expansions may be delayed for two to three years to avoid immediately ending coverage for the 20 million people who became newly insured through the ACA.1 Another rationale for the potential delay is to allow Congress time to coalesce around a single replacement policy. Yet the repeal-and-delay approach could also set up a budgetary cliff by taking credit for the savings and leaving the costs of any replacement for future legislation.

CBO evaluates legislation relative to a baseline that reflects existing law. Under a repeal-and-delay approach, Congress would partially repeal the ACA in 2017 using budget reconciliation, a process that allows expedited consideration of legislation that affects the federal deficit. To do so, the House and the Senate would need to pass a budget resolution requiring Congress to reconcile the budget to achieve specific changes to revenues or spending. (So far, the Senate has passed such a resolution.) Congress could then repeal provisions of the ACA that directly affect the federal budget, including federal funding for Medicaid expansion and marketplace tax credits, with a simple majority of votes, avoiding the potential of a filibuster in the Senate.

With this approach, lawmakers would be able to act quickly and decisively on a key promise made by president-elect Donald Trump, namely to repeal the ACA within the first 100 days after taking office. But disagreement among lawmakers about appropriate replacements for the ACA could cause disruption for insurers and health care providers, who would face uncertain regulatory and marketplace environments.

Moreover, the repeal-and-delay approach could make it difficult for any replacement legislation to be budget neutral. In a score of a previous partial repeal bill, H.R. 3762, CBO projected that repealing the coverage provisions in the ACA would reduce federal spending by $1.4 trillion between 2016 and 2025. Once repealed, the savings associated with eliminating the ACA’s coverage expansions would be part of current law and hence the baseline budget. This means that a future replacement bill could be scored as deficit-increasing, even if it cost less than $1.4 trillion.

S&P issues stable outlook for nonprofit healthcare despite looming ACA repeal

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http://www.beckershospitalreview.com/finance/s-p-issues-stable-outlook-for-nonprofit-healthcare-despite-looming-aca-repeal.html

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S&P Global Ratings‘ outlook on the nonprofit healthcare sector is stable in 2017, despite the sector facing a likely repeal of the ACA.

Although S&P’s ratings and financial medians support its outlook on the sector, the rating agency may change its outlook in the near future.

“…we see a growing potential for credit quality deterioration based on the latest results from some providers, and the possibility the outlook could turn negative after the new administration and Congress are sworn in, given their intention to drastically alter the ACA and many long-term legislative tenets of the overall healthcare delivery system,” said Kevin Holloran, an S&P Global Ratings credit analyst.

Even without any major legislative changes, many hospitals are facing renewed expense, revenue and volume pressures, as the initial positive effects of Medicaid expansion have ended. S&P said there has recently been an increase in the number of providers with weaker financial and operating performance.

“We believe the sector peaked in 2016 from a financial and operating metric perspective, although change is evolving slowly and is based on existing legislative healthcare framework,” said S&P.

The rating agency emphasized that 2017 is not all doom and gloom for the nonprofit healthcare sector.

“Continued implementation of fundamental operational improvement initiatives and strategies…should continue to provide financial flexibility under any type of payment system,” said S&P.

Two other major rating agencies, Moody’s Investors Service and Fitch Ratings, have also issued stable outlooks for the nonprofit healthcare sector in 2017.