Tag Archives: CHIP
An Association Of Health Funders And The Changing Political Landscape
As the professional association for health foundations and corporate-giving programs, Grantmakers In Health (GIH) connects the hundreds of health funders who are spread across the American landscape, keeping them up-to-date on rapidly changing developments and providing opportunities for them to share what they’re learning and doing in their respective communities.
Times like now—when dramatic changes to the health care landscape are anticipated—accentuate the importance of this role. In 2017 it will be especially important that we help funders understand, and respond to, significant expected changes in public policies and programs that affect the communities they serve.
We will not simply be in crisis mode, however. Our concern for both informing and shaping the bigger picture of philanthropy’s health and health care priorities is ongoing.
As the year begins, the future of the Affordable Care Act (ACA) is naturally a high priority for us. Health funders are rightly anxious to understand the changes that are likely with a new Congress and presidential administration. Many grantmakers have invested for years at a national or state level to support the implementation of the ACA. They are keenly aware that rolling back the law will have consequences not only for people’s access to health care services, but also, more broadly, for jobs and state economies.
In an immediate response to these concerns, GIH has organized a series of webinars for its membership that offers the perspectives of a range of policy experts. Immediately post-election, these topics included strategies for adapting health reform–related grant making, the future of Medicaid, and the election’s implications for the State Children’s Health Insurance Program (CHIP) and other children’s coverage. Upcoming webinars will include bipartisan views of the new Trump administration’s health priorities and plans, the implications of a possible repeal of the ACA without implementing an immediate “replace” strategy, and the 2016 election’s possible effects on the health of immigrant communities.
Other ACA-related programming will include activities taking place at our annual conference in June, as well as meetings, calls with funders, and publications, including in-depth interviews about foundation strategies. Because changes to the ACA, Medicaid, and other programs will heighten the importance of state-level actions, our 2017 programming will pay special attention to elevating what funders are doing in states and sharing this information nationally.
In addition to this focus on policy changes that will affect access and coverage, we also want to identify health investment areas in which the new administration seems to be interested. We anticipate that addiction, delivery system reform, veterans’ health, and rural health will be on that list.
How will Trump change healthcare? 6 of the biggest questions answered
Throughout his campaign and in the days following the election, President-elect Donald Trump said that one of his top priorities as the commander in chief would be to repeal and replace Obamacare, a major component of the Affordable Care Act (ACA). By having a Republican president as well as the GOP holding a majority in Congress (which also support its repeal), it’s likely that this will occur, says Ashraf Shehata, MBA, advisory leader for health plans and partner of the firm’s Global Healthcare Center of Excellence, KPMG.
But how do you go about replacing Obamacare when 20 million Americans are now obtaining healthcare coverage from it?
Major changes for Medicaid coming under Trump and the GOP
http://money.cnn.com/2016/11/21/news/economy/medicaid-trump/index.html
Donald Trump likely won’t let Medicaid collapse, but he will vastly change the health insurance program for low-income Americans.
Think less federal funding, more state control, fewer participants and higher costs for those in the program.
Here’s how Medicaid works now:
Nearly 73 million Americans are on Medicaid or the related Children’s Health Insurance Program (CHIP). The programs cost $509 billion in fiscal 2015, with the federal government shouldering 62% of the bill and states paying 38%.
Most enrollees are low-income children, pregnant women, parents, the disabled and the elderly. Under Obamacare, low-income adults with incomes of up to 138% of the poverty line — $16,400 for a single person — were allowed to sign up in states that opted to expand their Medicaid programs. So far, 31 states, plus the District of Columbia, have done so, adding about 15.7 million more people to the rolls since late 2013, just before the provision took effect. (This figure includes both those newly eligible under expansion and those who always met the criteria.)
While Democrats say the program is a vital part of the safety net, Republicans have long criticized it as being bloated, inefficient and rife with fraud. They want to limit the federal government’s financial responsibility, while giving states more direct control over whom to enroll and what kind of coverage participants receive.
On the campaign trail, Trump was emphatic about having the government provide coverage to the poor, even as he vowed to dismantle Obamacare.
“You cannot let people die on the street, ok?,” he said at a CNN town hall in February. “The problem is that everybody thinks that you people, as Republicans, hate the concept of taking care of people that are really, really sick and are gonna die. We gotta take care of people that can’t take care of themselves.”
It’s Easy for Obamacare Critics to Overlook the Merits of Medicaid Expansion
At a national level, the expansion of Medicaid continues to yield benefits. Its coverage was increased, and its quality raised. Some states that have expanded Medicaid are even expecting net savings for the next few years. In states where Medicaid was expanded, hospitals had fewer uninsured visits.
Focusing on only the positives can be as misleading as focusing on only the negatives. Policy decisions, including those involving health, need to be considered in terms of trade-offs. It is true that providing Medicaid can cost the federal government, and even states, a lot of money, which can’t then be spent on other worthy pursuits. It is true that Medicaid reimburses physicians and hospitals less generously, and that it often leaves beneficiaries with fewer choices than private insurance might.
But when we look at the balance sheet for Medicaid — health benefits, financial security, societal improvements through education — it’s not hard to argue that money allocated to Medicaid is well spent.
20 Questions for President Trump
The last six and a half years have been uncharted territory in our nation’s century-long debate over health reform. For the first time the fight was about how to implement an attempt at near-universal coverage rather over what this plan should look like and what could win enough support in Congress. The Affordable Care Act (ACA) has survived major political, legislative, and legal tests, including dozens of repeal votes, two Supreme Court decisions, the 2012 presidential election, and state-level resistance.
I was outside the Supreme Court on June 25, 2015 when the King v. Burwell decision was released. I was there the moment activists switched their signs from saying “Don’t you dare take my care” to “The ACA is here to stay.” I wrote that we could finally say with some certainty that they were right, the law is here to stay. They were wrong. I was wrong.
Donald Trump’s victory throws the future of health reform into complete chaos. He will take office in January 2017 with Republican majorities in the House and Senate. President Trump, Speaker Ryan, and Senate Majority Leader McConnell have all made repeated promises to get rid of Obamacare. They will face enormous pressure to follow through with their threats of repeal. Approximately 21 million people are projected to lose insurance if they follow through with their initial proposals.
The first step to figuring out where to go from here is understanding what decisions are on the horizon. Here are my first 20 questions about health reform under the Trump administration , in no particular order:
No Matter What, Congress Will Act On Health Care Next Year
http://healthaffairs.org/blog/2016/11/07/no-matter-what-congress-will-act-on-health-care-next-year/
When Congress passed the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA) last year, House Energy and Commerce Committee Chairman Fred Upton (R-MI) said “stick a fork in it; it’s finally done.” While some elements—especially Medicare’s long-flawed Sustainable Growth Rate formula—were permanently remedied, other provisions were temporarily addressed by the bill and come due again in September or December of next year.
So, while the presidential candidates and others consider broad-based health care policies, the passage of which in the near term is dubious, there is a wide array of issues we can bank on Congress taking up, likely in one, consolidated legislative package.
Funding for the CHIP program may be the foremost among these issues, accompanied by a batch of expiring Medicare “extenders” that Congress typically addresses before they lapse. These provisions, which used to reliably hitch a ride on perennial “doc fix” legislation, are expected to travel together in a bill that, along with Food and Drug Administration user fee reauthorizations, is among a few must-pass health bills in 2017. The package will begin to take shape early in the next Congress and ideally gain focus by spring to give states lead-time for budgetary planning, especially with regard to the CHIP and Medicaid components.
Last year, Senate Democrats pushed for a four-year CHIP funding reauthorization, which would have aligned CHIP funding with the Affordable Care Act’s reauthorization of the program itself through 2019. Their efforts fell short in MACRA, although a two-year funding reauthorization keeps the program in the clear until Sept. 30, 2017.
While it’s early to predict what will be included, we anticipate the following potential items will likely be considered in this CHIP funding and Medicare extenders package:
Healthcare Triage: Medicaid has a Huge Return on Investment
As we pass the 3-year anniversary of the opening of the insurance exchanges, most news seems to focus on the private insurance people can purchase there. In recent months, many have complained about private insurers exiting the exchanges, networks being narrowed, premiums rising, and competition dwindling out of existence.
But it’s important to remember that many, if not most, of the newly insured are part of the Medicaid expansion. As of today, 19 states have still refused to participate in that program. Some cite reports and news that Medicaid offers poor quality and little choice of providers. But most seem to cite the cost of Medicaid, claiming that its growing cost will eventually bankrupt states.
Such declarations only consider one side of the equation, though. In most ways, Medicaid offers an excellent return on investment. That’s the topic of this week’s Healthcare Triage.
Donald Trump’s Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit
Issue: Republican presidential candidate Donald Trump has proposed to repeal the Affordable Care Act (ACA) and replace it with a proposal titled “Healthcare Reform to Make America Great Again.” Proposed reforms include allowing individuals to deduct the full amount of premiums for individual health plans from their federal tax returns, providing block grants to finance state Medicaid programs, and allowing insurers to sell insurance across state lines.
Goal: To assess how each of these reforms, when implemented individually, would affect insurance coverage, consumer out-of-pocket spending on health care, and the federal deficit in 2018.
Methods: RAND’s COMPARE microsimulation model.
Key findings and conclusions: The policies would increase the number of uninsured individuals by 16 million to 25 million relative to the ACA. Coverage losses disproportionately affect low-income individuals and those in poor health. Enrollees with individual market insurance would face higher out-of-pocket spending than under current law. Because the proposed reforms do not replace the ACA’s financing mechanisms, they would increase the federal deficit by $0.5 billion to $41 billion.
We’re closer to a publicly funded health care system than you think
http://blog.academyhealth.org/were-closer-to-a-publicly-funded-health-care-system-than-you-think/
Every time health care reform comes up for debate, I see people arguing about whether a publicly or privately funded system would be better. The Affordable Care Act, in an attempt to forestall this debate, decided to split the baby, and give half of its newly insured beneficiaries public insurance (Medicaid) and half private insurance (insurance exchanges). But this isn’t really true. Yes, the half of people getting expanded Medicaid are getting public insurance, but the vast majority of people getting private insurance are also getting public funds (subsidies) in order to purchase their private insurance.
In other words, even though we expanded private insurance, we’re doing it with taxpayer dollars. Overall, the reduction in the uninsured was due to mostly public spending, with relatively little private spending overall. This isn’t rare in the US health care system. A recently released policy brief from the UCLA Center for Health Policy Research, “Public Funds Account for Over 70 Percent of Health Care Spending in California“, explains this quite well.
If you just look at a simple analysis of Medicaid, Medicaid, and CHIP, you might find that about 45% (or less than half) of total US health care spending is public. But that ignores a ton of health care spending that is also paid for with public funds outside those programs. In an effort to document the different, researchers looked at health care spending in California. They included four major public funding categories:
- Payments for public health insurance programs (like Medicare and Medicaid)
- Government payments for health insurance coverage for public employees (like me at Indiana University, for instance)
- Tax subsidies for employer-sponsored insurance and those purchasing exchange plans who earn less than 400% of the poverty line
- County health care expenditures
HENRY KOTULA 