What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid?

http://www.commonwealthfund.org/publications/issue-briefs/2016/nov/medicaid-block-grants

ABSTRACT

Issue: President-elect Trump and some in Congress have called for establishing absolute limits on the federal government’s spending on Medicaid, not only for the population covered through the Affordable Care Act’s eligibility expansion but for the program overall. Such a change would effectively reverse a 50-year trend of expanding Medicaid in order to protect the most vulnerable Americans.

Goal: To explore the two most common proposals for reengineering federal funding of Medicaid: block grants that set limits on total annual spending regardless of enrollment, and caps that limit average spending per enrollee.

Methods: Review of existing policy proposals and other documents.

Key findings and conclusions: Current proposals for dramatically reducing federal spending on Medicaid would achieve this goal by creating fixed-funding formulas divorced from the actual costs of providing care. As such, they would create funding gaps for states to either absorb or, more likely, offset through new limits placed on their programs. As a result, block-granting Medicaid or instituting “per capita caps” would most likely reduce the number of Americans eligible for Medicaid and narrow coverage for remaining enrollees. The latter approach would, however, allow for population growth, though its desirability to the new president and Congress is unclear. The full extent of funding and benefit reductions is as yet unknown.

What’s going to happen with House v. Burwell?

What’s going to happen with House v. Burwell?

Image result for house vs burwell

I’m getting a lot of head-scratching questions about the lawsuit, which is now pending at the D.C. Circuit. Let me see if I can help.

As I see it, there are two distinct questions in play:

  1. Does President Trump want to stop making cost-sharing payments on Day One, leading to the immediate collapse of the individual insurance market in many states? Or does he want to keep making the payments during a transition period?
  2. What approach will the Trump administration take to the litigation?

Value-based care will likely continue under Trump

http://www.fiercehealthcare.com/finance/value-based-care-will-likely-continue-under-trump-administration?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWVRsaVpESTVOVGN5TW1ZeCIsInQiOiJ4SUR1VG42K1ltRHorVmE5QUgwZ1A5ZGJMMjhDZ1g0Um4rczVTZVVFMHBGYkVZQjVKTGlBekduM005OEVuTklVdmdyMmNOakx2NVNYOTh3TVpNV0ZHXC9ydndRSTZDMTIrNEw0QlVTb2J6V0E9In0%3D

Doctor talking to senior patient and her husband

Despite President-elect Donald Trump’s campaign promises to repeal the Affordable Care Act, industry experts say value-based care initiatives will likely continue under the new White House administration.

Healthcare finance takes the spotlight

Although it’s likely that certain aspects of the ACA will change, demand for value-based care will not go away, write NewYork-Presbyterian Hospital’s Emme L. Deland, senior vice president and chief strategy officer, and Jonathan Gordon, director of NYP Ventures, in a post for NEJM Catalyst.

“At the moment, it seems likely that healthcare financing will get more attention than healthcare delivery under the new administration,” they write.

François de Brantes, executive director for the Health Care Incentives Improvement Institute, agrees, writing in a separate post for NEJM Catalyst that the bipartisan Medicare Access and CHIP Reauthorization Act will help fuel the movement away from fee-for-service payments.

Expect Medicaid to Change, but Not Shrivel, Under Donald Trump

The expansion of Medicaid, a central pillar of the Affordable Care Act, faces immense uncertainty next year, with President-elect Donald J. Trump and top Republicans in Congress embracing proposals that could leave millions of poorer Americans without health insurance and jeopardize a major element of President Obama’s legacy.

But influential figures in surprising quarters of the new administration might balk at a broad rollback of Medicaid’s reach, favoring new conditions for access to the government insurance program for the poor but not wholesale cutbacks.

Mike Pence, the vice president-elect, is proud of the Medicaid expansion he engineered as governor of Indiana, one of 31 states that expanded eligibility under the Affordable Care Act. The Indiana program has conservative features that emphasize “personal responsibility” and require Medicaid beneficiaries to make monthly contributions to savings accounts earmarked for health care.

Another Trump adviser, Gov. Chris Christie of New Jersey, hails the expansion of Medicaid in his state, saying more than half a million people are receiving “more and better health care.” The federal government pays the full cost for newly eligible beneficiaries from 2014 through 2016 and at least 90 percent of the costs in later years under the health law.

It is hard to overstate the importance of Medicaid, which insures 77 million people, pays for more than half of all births in some states, covers about two-thirds of nursing home residents and provides treatment for many people addicted to opioids. Spending on Medicaid, by the federal government and states combined, exceeds $500 billion a year.

Of the 20 million people who have gained coverage under the Affordable Care Act, officials estimate, 12 million are insured by Medicaid — with few of the problems that have plagued the new insurance exchanges, or marketplaces.

But change is coming. In his campaign manifesto, Mr. Trump said Congress must repeal the Affordable Care Act and give each state a lump sum of federal money — a block grant — for Medicaid. Congress passed legislation in January to repeal the health law and roll back its Medicaid expansion. Mr. Obama vetoed the measure, but Speaker Paul D. Ryan of Wisconsin has vowed to put similar legislation on a Republican president’s desk.

Keeping tabs on a potential ACA repeal: Three questions to watch

https://www.brookings.edu/blog/fixgov/2016/11/15/keeping-tabs-on-a-potential-aca-repeal-three-questions-to-watch/?utm_campaign=Brookings+Brief&utm_source=hs_email&utm_medium=email&utm_content=37671114

 

Image result for Healthcare Reform

In the days since the surprise election of Donald Trump to the presidency, substantial attention has been paid to the possibility that congressional Republicans will take advantage of a Republican president’s pen to repeal all or part of the Affordable Care Act, possibly as soon as January. Doing so will almost certainly involve a special budgetary process known as budget reconciliation, which, thanks to a limit on time for debate, eliminates the possibility of a filibuster. Reconciliation and other similar procedures for limiting debate in the Senate (which I’ve written on elsewhere) are often described as “arcane,” and certainly, the coming weeks are likely to bring several procedural twists, likely with big policy implications, worth watching. Given the centrality of the law’s repeal to Republican messaging—the House has voted on repeal more than 60 times—the political implications of the foregoing debate are large as well. Here are three key questions I’ll be watching for the answers to as the debate unfolds, as they’ll tell us much about the both the policy and political implications of Republicans’ repeal efforts.

Ryan now has the muscle to phase out Medicare — within months

http://www.sfgate.com/politics/article/Ryan-now-has-the-muscle-to-phase-out-Medicare-10613139.php?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=37625118&_hsenc=p2ANqtz-8__03zRw-gu7XJrwOBmO6XYdGObArnMQTK9_dRrTgDh69s7q3OUq53AcYCfr9bwrtHj5mbLYOPIBBdQVoE_yCtdZWBTg&_hsmi=37625118

Image result for Ryan now has the muscle to phase out Medicare — within months

House Speaker Paul Ryan’s plan to phase out Medicare is nothing new. But now, under a Trump presidency and with both houses of Congress in Republican hands, it looks like he could finally make it happen, possibly within months.

Back in 2011, as a U.S. representative for Wisconsin’s 1st Congressional District, Ryan floated a plan to turn Medicare into a “premium support” program. The “premium support” would be a payment that would let you buy insurance from private insurers. But you won’t get full coverage.

As Josh Marshall acidly noted Sunday in a blog for TPM, “In any case, rather than Medicare you’ll have insurance from an insurance company, which everybody should love because haven’t you heard from your parents and grandparents how bummed they were when they had to give up their private insurance for Medicare?

“You’ll hear lots of people calling this ‘reform’ and other catchwords. But Medicare is a single payer, universal health care system. Replacing it with private insurance means getting rid of it. Even calling it ‘privatization’ masks what is really afoot.”

On Fox News Special Report on Thursday, Ryan was asked about entitlement reform. His answer:

“You have to remember, when Obamacare became Obamacare, Obamacare rewrote Medicare, rewrote Medicaid. If you are going to repeal and replace Obamacare, you have to address those issues as well. What a lot of folks don’t realize is this 21-person board called the IPAP is about to kick in with price controls on Medicare. What people don’t realize is because of Obamacare, Medicare is going broke, Medicare is going to have price controls because of Obamacare, Medicaid is in fiscal straits. You have to deal with those issues if you are going to repeal and replace Obamacare. Medicare has serious problems [because of] Obamacare. Those are part of our plan.”

Marshall says that’s false, and Ryan knows it. Instead of putting Medicare under deeper financial stress, the Affordable Care Act has had the opposite effect and actually extended Medicare’s solvency by over 10 years, he says.

According to Medicare’s trustees, the “Part A” trust fund — the costliest component of Medicare, covering hospitalization — is set to become insolvent in 2028. In 2009, before the passage of the Affordable Care Act, it was projected that fund would go broke in 2017.

Hospital executives’ 12 most pressing post-election questions, answered

http://www.beckershospitalreview.com/hospital-management-administration/hospital-executives-12-most-pressing-post-election-questions-answered.html

Image result for key health policy issues

https://www.advisory.com/Research/Health-Care-Advisory-Board/Expert-Insights/2016/2016-Election-12-Questions-Every-Executive-Should-Be-Asking

In a stunning upset, Donald Trump took the stage early yesterday morning to claim victory as the next president of the United States while Republicans celebrated retaining control of both the House and the Senate.

While the outcome of the election has long been expected to have a far-reaching impact across a number of policy areas, the Republican sweep of Congress and White House could result in profound changes in health policy after a hard-fought election on both sides of the aisle.

Although the exact implications of the race will become more apparent in the coming days and weeks, we expect Republicans to emphasize the election results as a mandate for change and use the opportunity to pursue significant new initiatives.

So what can providers expect from a Trump administration and a GOP Congress? Let’s take a look at what’s potentially in store for Medicare, Medicaid, and the private insurance market—and what those changes mean for provider strategy—by looking at the most common questions I’ve already received following the election.

California Dreamin’ in a post-Trump healthcare world

http://www.fiercehealthcare.com/finance/suddenly-it-s-much-darker-california-dreaming-may-be-one-silver-lining?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTmpjd1pURm1NR0ZqTlRWbSIsInQiOiI5MkdaMWJlaGV4dlppeWNkY1NqNTNtTFJ1MFlrcWtQQWxcL2hvYWVUK3lmNEJRT1lCVTJLQTFwdGFcL0dLWWlGMnBzbGNQbXhDdnFDVUdsdkthR3Y4UzJIVm5sT25iNHJmYWd2aGlFXC9ycVNDST0ifQ%3D%3D

California flag and American flag

The consensus among policymakers and observers: Not good.

“At risk is insurance coverage for literally millions of Americans,” said Anthony Wright, executive director of the advocacy group Health Access California.

Jim Lott, who teaches healthcare policy at USC and Cal State Long Beach and was the longtime executive vice president of the Hospital Association of Southern California, noted that even if parts of the law are preserved the way Trump suggests, it would still be imperiled.

“If you don’t have an employer mandate and an individual mandate, the market would self-destruct,” Lott said. “It will create havoc.”

Barcellona, an attorney by training, concurred with Lott. “The law matters and these federal programs are conditioned on the act being implemented in a certain way,” he said.

Barcellona also brought up a consequence that would be utterly disastrous for millions of middle-class Americans: If the ACA is eliminated in the middle of a calendar year, it could put them on the hook for repaying billions of dollars in premium tax credits.

Donald Trump is about to face a rude awakening over Obamacare

https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donald-trump-is-beginning-to-face-a-rude-awakening-over-obamacare/?utm_source=RealClearHealth+Morning+Scan&utm_campaign=c672ab1b84-EMAIL_CAMPAIGN_2016_11_12&utm_medium=email&utm_term=0_b4baf6b587-c672ab1b84-84752421

After reiterating his promise to repeal and replace the Affordable Care Act, President-elect Donald Trump has indicated that he may keep two of the law’s most popular provisions. One is straightforward enough — children up to age 26 being allowed to stay on their parents’ plan. The other — preventing insurance companies from denying coverage because of preexisting conditions — offers a perfect illustration of why Trump and most of the other Republicans critics of Obamacare don’t understand the health insurance market.

Let’s say that in the beautiful new world of “repeal and replace,” insurers are required to sell you insurance despite the fact that your kid has a brain tumor. Insurance companies know what to do with that. Their actuaries can calculate that kids with brain tumors typically require (I’m making this number up) about $200,000 a year in medical care. So they’ll offer to sell you a policy at an annual premium of $240,000.

At this point your response will probably be that such an outcome is not fair. When the law says insurance companies can’t discriminate on the basis for preexisting conditions, surely what it means is that they have to charge roughly the same price for health insurance, irrespective of your preexisting condition. In the language of insurance, that’s called “guaranteed issue at community rates.”

Unfortunately, in the states that have tried guaranteed issues at community rates, the insurance markets have collapsed. That’s because if you guarantee everyone the right to buy health insurance at community rates, then some consumers will game the system. The young and healthy ones won’t buy any health insurance at all — they’ll go without until they are diagnosed with diabetes or a brain tumor or get hit by a truck crossing the street. And when that happens, they will immediately call up Aetna or Anthem and exercise their right to buy health insurance at the low community rate, irrespective of their medical condition. It won’t be long before insurance companies begin losing a ton of money and are forced either to raise premiums through the roof or stop writing policies altogether.

Here’s why Trump is already waffling on Obamacare

https://www.washingtonpost.com/posteverything/wp/2016/11/12/heres-why-trump-is-already-waffling-on-obamacare/

President-elect Donald Trump is already signaling that he might backpedal on his promise to repeal the Affordable Care Act, telling the Wall Street Journal Friday that he’d consider hanging onto popular Obamacare provisions such as “the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.”

His apparent reluctance to scrap the entire ACA is understandable. In the long run, waffling on repeal will probably be less painful than causing a health-care catastrophe. Trump capitalized on Republicans’ long dislike of the Affordable Care Act by focusing on news, in the last weeks of the campaign, that premiums would increase sharply for many Americans purchasing insurance through its exchanges. But he didn’t promise a pared-down health-care regime. He promised to repeal and replace Obamacare with a plan that would cover everyone, offer more choice and cost less.

It was a populist approach to health care that wasn’t new. Sixteen years ago, in “The America We Deserve,” he wrote: “I’m a conservative on most issues, but a liberal on this one,” an appeal that didn’t hurt candidate Trump. But President Trump is likely to find the issue challenging. Repeal requires only the will of Congress. Replacement is subject to the laws of economics and mathematics, which aren’t on his side.

In the campaign, Trump proposed replacing the Affordable Care Act with a tax deduction for individuals who pay for health insurance out of pocket. Like all tax deductions, such a deduction is worth more to people with higher tax rates. But most of those who would be left without coverage by an ACA repeal are lower-income individuals with tax rates that are already low. Thus, the benefit they’d receive from a deduction doesn’t come close to the financial hit they would experience from an ACA repeal. Independent estimates suggest repeal would cause about 20 million people to lose coverage, only one-quarter of whom would purchase insurance with the deduction. The rest wouldn’t be able to afford it.