Balance enrollee risk to sustain individual marketplaces, report says

http://www.fiercehealthcare.com/payer/balancing-enrollee-risk-key-to-sustainable-individual-marketplaces-report?mkt_tok=eyJpIjoiTkRGbE9XWTBNVGcwTUROaSIsInQiOiJOZEtcLzhSNHFcL3A2UGlyd2JIQWNwK2ZoRGpWcENHODJZQTlLQ1R1OVo0b3JvdUdSdkN0a0FyTzhIdHVnYVhCN0lxNHRQbW5ibEVVWjBiR0VPU2tFdXBCVmxSYWtWcWZJQ2dyOUxIRnBlNURrakpFXC93Y2xHS21RdGFybUtZZVJlViJ9&mrkid=959610&utm_medium=nl&utm_source=internal

Document titled "Patient Protection and Affordable Care Act"

Stability and sustainability in health insurance marketplaces requires a more balanced risk profile for enrollees and rules that are communicated clearly and quickly to payers, according to a new report.

The analysis (PDF), published by the American Academy of Actuaries, examined the state of insurance markets under the Affordable Care Act and noted that, while the law’s implementation did slash uninsured rates, individual marketplace enrollment was lower than anticipated and many enrollees aren’t healthy. To be most effective, the report states that more healthy people need to enroll to help offset the costs of the most ill people.

Governors voice Medicaid concerns to GOP lawmakers

http://www.fiercehealthcare.com/payer/governors-voice-medicaid-concerns-to-gop-lawmakers?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTkRGbE9XWTBNVGcwTUROaSIsInQiOiJOZEtcLzhSNHFcL3A2UGlyd2JIQWNwK2ZoRGpWcENHODJZQTlLQ1R1OVo0b3JvdUdSdkN0a0FyTzhIdHVnYVhCN0lxNHRQbW5ibEVVWjBiR0VPU2tFdXBCVmxSYWtWcWZJQ2dyOUxIRnBlNURrakpFXC93Y2xHS21RdGFybUtZZVJlViJ9

Capitol Hill

A group of governors met with congressional leaders on Thursday to express their mounting concerns about the consequences of an Affordable Care Act repeal—particularly for those who have benefited from Medicaid expansion.

The closed-door meeting included several Republican state leaders, who despite generally opposing the ACA have accepted federal funds to expand Medicaid eligibility and are wary of rolling back such coverage expansions.

Michigan Gov. Rick Snyder, for example, said after the meeting that the data show his state’s Healthy Michigan program “had a lot of success, both in terms of healthier behaviors and better outcomes helping people,” according to The Hill.

Ohio Gov. John Kasich, another Republican who attended the meeting, suggested that those who gained coverage under Medicaid expansion could instead be given either premium subsidies or tax credits to help them buy private health insurance, Reuters reports.

But Synder and Kasich have been among the more vocal governors in support of Medicaid expansion, with Kasich crediting the program for helping fund the fight against opioid abuse that is ravaging his state.

Hospitals in states that have chosen to expand Medicaid eligibility have seen reductions in their uncompensated care costs, leading some in the healthcare industry to worry about what will happen under an ACA repeal. In addition, 15.7 million more people now have Medicaid coverage than before the ACA’s major coverage provisions took effect.

Trump’s executive order on Obamacare

Trump’s executive order on Obamacare

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Some misconceptions are floating around about what the executive order does and doesn’t do. Let me try to clarify.

As I explained in a post last week, “[a]uthority to implement the ACA … is vested in the Secretaries of HHS, Treasury, and Labor—not the President. In the context of the ACA, an executive order won’t be anything more than a document containing a president’s instructions to his subordinates.”

That’s all this E.O. is. It’s a set of marching orders. It has no legal force. It changes nothing on its own.

And these marching orders are pretty vague. After pruning away the bureaucratese, the executive order tells federal agencies, especially HHS, to do everything they can:

  • To eliminate any “fiscal burden on any State” or any “cost, fee, tax, penalty, or regulatory burden” on individuals and providers.
  • To give the states more flexibility.
  • To encourage the interstate sale of health insurance.

It remains to be seen how and when these orders will be carried out. But we can make some educated guesses (most of which we could’ve made even in the absence of the executive order).

Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too

http://healthaffairs.org/blog/2017/01/11/get-health-insurance-through-your-employer-aca-repeal-will-affect-you-too/

Close-up photograph of an employee group health insurance application form.

Much of the recent attention on the future of the Affordable Care Act (ACA) has focused on the fate of the 22.5 million people likely to lose insurance through a repeal of Medicaid expansion and the loss of protections and subsidies in the individual insurance market. Overlooked in the declarations of who stands to lose under plans to “repeal and replace” the ACA are those enrolled in employer-sponsored health plans — the primary source of coverage for people under 65.

Job-based plans offered to employees and their families cover 150 million people in the United States. If the ACA is repealed, they stand to lose critical consumer protections that many have come to expect of their employer plan.

It’s easy to understand the focus on the individuals who gained access to coverage thanks to the health reform law. ACA drafters targeted most of the law’s insurance reforms at the individual and small-group markets, where consumers and employers had the greatest difficulty finding affordable, adequate coverage prior to health reform. The ACA’s market reforms made coverage available to those individuals with pre-existing conditions who couldn’t obtain coverage in the pre-ACA world, and more affordable for those low- and moderate-income families who couldn’t afford coverage on their own.

Less noticed, but no less important, the ACA also brought critical new protections to people in large employer plans. Although most large employer plans were relatively comprehensive and affordable before the ACA, some plans offered only skimpy coverage or had other barriers to accessing care, leaving individuals—particularly those with costly, chronic health conditions—with big bills and uncovered medical care. For that reason, the ACA extended several meaningful protections to employees of large businesses.

In Inaugural Speech, Trump Silent on Health Care

https://morningconsult.com/2017/01/20/in-inaugural-speech-trump-administration-silent-on-health-care/

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President Donald Trump did not mention health care in his inaugural address Friday, and the new administration’s website did not have any immediate details on its health policy.

Trump has said he would put forth his own health care plan once his nominee to lead the Department of Health and Human Services, Rep. Tom Price (R-Ga.), is confirmed and in office.

Overhauling the Affordable Care Act has been cited as the top priority for both congressional Republicans and Trump, making its absence from Friday’s speech noteworthy. House Minority Leader Nancy Pelosi wore a lapel pin that read “#ProtectOurCare” at the inauguration, an ode to the Democratic Party’s efforts to defend former President Barack Obama’s signature health care law.

It’s still not clear when Price could be confirmed as HHS secretary. He’s scheduled to testify before the Senate Finance Committee, which will vote on his nomination, Tuesday.

Trump is expected to sign executive orders related to health care in the first days of his presidency.

The Problems With ‘Repeal And Delay’

http://healthaffairs.org/blog/2017/01/03/the-problems-with-repeal-and-delay/

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Republican leaders in Congress and the incoming Trump administration have said that they plan to move quickly to repeal the Affordable Care Act (ACA) in the early weeks of 2017, with a delay in the date of when key aspects of the repeal would become effective until perhaps 2019 or 2020. This is the so-called “repeal and delay” option. They have also pledged to replace the law in separate legislation, or a series of bills, that would come later, although it is not clear what the replacement would look like or when it would pass.

We do not support this approach to repealing and replacing the ACA because it carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services, and because it is unlikely to produce a coherent reform of health care in the United States. The most likely end result of “repeal and delay” would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services.

Congress should instead roll back elements of the ACA in the same legislation that moves U.S. health care more deliberately toward a functioning marketplace that is less dependent on federal coercion and control. This approach provides the best chance of constructing a replacement plan that moves decisively in a better direction without unnecessarily creating chaos during the transition.

Universal Access And Delegation To States: Examining Two Currents In ACA Replacement Plans

http://healthaffairs.org/blog/2017/01/20/universal-access-and-delegation-to-states-examining-two-currents-in-aca-replacement-plans/

As we draw nearer to the time when the Trump administration may unveil its proposals for reforming the Affordable Care Act and the Republicans in Congress may coalesce around a single repeal and replace proposal, two ideas are surfacing that should be addressed and explored—setting a goal of “universal access” rather than “universal coverage” and shifting responsibility for ACA replacement to the states. This post looks at the challenges involved in operationalizing these concepts.

Precision Medicine Has Bipartisan Support, Proponents Assure Amid Trump Administration Transition

https://360dx.com/cancer/precision-medicine-has-bipartisan-support-proponents-assure-amid-trump-administration?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=1

Precision Medicine2

At a cocktail reception in Boston last week ahead of an annual meeting on personalized medicine, attendees milled around not talking about the latest advances in genomics or the challenges of companion diagnostics development. They were too preoccupied with the impact of the Presidential elections the week before.

Will the new administration value genomics research and personalized medicine projects going on around the country that depend on government funding? How will a change in administration and priorities impact projects such as the Precision Medicine Initiative (PMI) and the Cancer Moonshot? Who will head up the US Department of Health and Human Services, the National Institutes of Health, and the US Food and Drug Administration? And will these new government officials continue efforts of the last administration to advance data sharing, privacy protections, and integrated systems critical for the implementation of personalized medicine?

 

Oregon policy center says health industry should fill budget gap

http://www.bizjournals.com/portland/news/2017/01/19/oregon-policy-center-says-health-industry-should.html

Hospitals should pay more to help fill a budget gap in the Oregon Health Plan, the Oregon Center for Public Policy argues.

Since the Oregon health care industry has benefited from the Affordable Care Act, it should chip in more to fill a looming hole in the Medicaid budget, a new report from the Oregon Center for Public Policy concludes.

The report by policy analyst Janet Bauer says Medicaid is a “great deal” for Oregon. It triggers a multi-billion dollar investment by the federal government into the state’s economy. Federal funds cover 75 percent of the Oregon Health Plan in the 2017-19 biennium.

But the health plan is facing an $882 million budget shortfall starting later this year, as the federal government contribution to the Medicaid expansion population dwindles.

The Center for Public Policy is calling on the state to increase the existing tax on hospital revenue, reinstate a tax on managed care organizations and consider new taxes on other types of health care providers.

“The Affordable Care Act, and the Medicaid expansion in particular, have proved to be a boon for much of the health care industry,” Bauer said in the report. “Net patient revenues at Oregon hospitals have increased sharply since the time major federal reforms came into effect. Meanwhile, hospitals’ charity care — a justification for their nonprofit status — has plummeted because many more Oregonians are able to pay for hospital care through newly-acquired insurance.”

Gov. Kate Brown’s proposed budget includes a hike in the hospital tax and reinstatement of a tax on health insurers.

Andy Davidson, president and CEO of the Oregon Association of Hospitals and Health Systems, said hospitals have a history of helping Medicaid fill budget gaps, back to the inception of the original hospital tax program in 2003.

ACA Changes Favored 2 to 1 by Healthcare Leaders Over Repeal and Replace

http://www.healthleadersmedia.com/leadership/aca-changes-favored-2-1-healthcare-leaders-over-repeal-and-replace

Image result for aca repeal

As the Trump administration officially begins later this week, a new HealthLeaders Media survey shows that healthcare industry leaders support changes to the existing law rather than replacing it. Two-thirds of respondents (66%) say the best option for the healthcare industry regarding the Patient Protection and Affordable Care Act is to make some changes but otherwise retain it.

At the opposite ends of the spectrum, 27% favor full repeal and replacement, while only 7% of respondents say keep it as it is, indicating the extent of dissatisfaction with the PPACA.

Interestingly, a greater share of health systems (78%) than hospitals (66%) and physician organizations (65%) favor making some changes to the PPACA.

On the other hand, a greater share of hospitals (28%) and physician organizations (27%) than health systems (17%) prefer full repeal and replacement. This is perhaps an indication that health systems are less able than other providers to accept full repeal and replacement because of their greater complexity as organizations.

Among the 66% of respondents who say that the best option for the PPACA is to make some changes, the top three changes they advocate are adding a public health insurance option (61%), eliminating the excise tax on high-cost employer health benefit plans (‘Cadillac tax’) (50%), and eliminating the individual mandate and noncompliance penalty (37%).

The two changes receiving the fewest responses are eliminating Medicaid expansion (10%) and abandoning the focus on value-based care and reimbursement (16%).