Tag Archives: Health Policy

Obamacare architect’s 5 points about health care reform

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Obamacare architect’s 5 points about health care reform

Dr. Ezekiel Emanuel, M.D., Ph.D., former Chief Health Policy advisor to the Obama Administration; Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Photo credit: Courtesy of The Commonwealth Club

In a wide-ranging conversation Wednesday night at the Commonwealth Club in San Francisco, Dr. Ezekiel Emanuel, Obamacare’s main architect, talked about health care reform and the debate over President-elect Donald Trump’s pledge to repeal and replace the Affordable Care Act, which has helped insure at least 20 million more  Americans, including five million Californians.

Emanuel is still a strongly advocate of the law, saying it has contributed to keeping U.S. health care costs more under control than at any time in the last 50 years. But like many other health care experts, he acknowledges room for improvement — and hopes it can now be done a bipartisan fashion. Here are five key points he made:

1) If you abolish the mandate that everyone must have health insurance, there are few options to induce people to get covered and create a stable insurance market. You need compulsion, but Americans don’t like compulsion.

2) A possible bipartisan alternative? One possibility is for the government to automatically enroll everyone in a catastrophic coverage plan — and if someone wants more coverage, that person would pay a higher premium.

3) The two biggest mistakes made by the Obama administration and supporters of the Affordable Care Act: flawed communication and rollout. The administration should have relied more on doctors and nurses and less on politicians to explain the reform to the public because the “white coats” are trusted sources of health care information. The botched launch of HealthCare.gov, the website for the federal exchange, didn’t help.

4) The subsidies for Obamacare aren’t high enough to drive down prices for many people.

5) A bipartisan-backed health care law isn’t a dream.  The U.S. almost got nearly universal health care in the early 1970s with a plan proposed by Republican President Richard Nixon and supported by two powerful Democrats: veteran Arkansas Congressman Wilbur Mills, chairman of the House Ways and Means Committee, and Massachusetts Sen. Ted Kennedy. But scandals led to its derailment after Mills was caught with stripper Fanne Fox — and Nixon was implicated in Watergate. Democrats had hoped to regain traction on the issue after the 1974 mid-term elections, but the proposal lost momentum.

 

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.

Drug companies to face fines for overcharging 340B hospitals: 4 things to know

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http://www.beckershospitalreview.com/finance/drug-companies-to-face-fines-for-overcharging-340b-hospitals-4-things-to-know.html

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HHS’ Health Resources and Services Administration has finalized a rule that sets civil monetary penalties for drug manufactures that overcharge healthcare organizations that are part of the 340B Drug Pricing Program.

Here are four things to know about the final rule.

1. The final rule requires drug manufacturers to calculate the 340B ceiling price on a quarterly basis. The rule includes the methodology manufacturers must use when estimating the ceiling price for a newly covered outpatient drug.

2. Under the final rule, drug manufacturers that intentionally overcharge a covered hospital will face civil monetary penalties. HRSA can fine a manufacturer up to $5,000 for knowingly and intentionally overcharging a 340B hospital for drugs purchased through the program.

3. HRSA clarified that a drug manufacturer that overcharges a hospital for drugs purchased through the 340B program would not face penalties if the manufacturer made an “inadvertent, unintentional or unrecognized error in calculating the ceiling price.” A manufacturer would also be deemed not to have the requisite intent if it “acted on a reasonable interpretation of agency guidance,” or “has established alternative allocation procedures where there is an inadequate supply of product to meet market demand, as long as covered entities are able to purchase on the same terms as all other similarly situated non-340B covered entities.”

4. The final rule is effective March 6. Since the effective date falls in the middle of a quarter, HRSA said it plans to begin enforcing the requirements of the final rule at the start of the next quarter, which begins April 1.

Hospital uncompensated care costs fall to lowest level in 26 years: 4 things to know

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http://www.beckershospitalreview.com/finance/hospital-uncompensated-care-costs-fall-to-lowest-level-in-26-years-4-things-to-know.html

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From 1990 through 2015, U.S. hospitals’ uncompensated care costs totaled $704.7 billion, according to a recent American Hospital Association report.

To calculate a hospital’s uncompensated care costs, the AHA combined the hospital’s bad debt and financial assistance costs. The uncompensated care figure does not factor in Medicare or Medicaid underpayments or other contractual allowances.

Using that formula, the AHA has calculated national uncompensated care costs from 1990 through 2015.

Here are four things to know about hospital uncompensated care costs, according to the AHA report.

1. In 1990, total uncompensated care costs were $12.1 billion, representing 6 percent of total hospital expenses.

2. Although total uncompensated care costs steadily increased from 1990 to 2000, the costs consistently represented about 6 percent of total expenses. During that period, uncompensated care costs represented the smallest percent of total expenses in 1992 at 5.9 percent and the largest percent in 1999 at 6.2 percent.

3. From 2000 to 2015, national uncompensated care costs fluctuated, reaching a high of $45.9 billion in 2012, which represented 6.1 percent of total expenses.

4. In 2015, total uncompensated care costs were $35.7 billion, representing 4.2 percent of total expenses — the lowest level in 26 years.

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.

Study: In healthcare price negotiation, insurer size matters

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http://www.fiercehealthcare.com/payer/study-when-negotiating-healthcare-prices-insurer-size-matters?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiWmpCaVl6YzNZVGMzWW1VMSIsInQiOiJFOWcxQXlNRFltbXIzc2FocWNwREJpRnp6dEpLbmZORTVIb29WaTRtQ2lrYzVwQ1hjOW4rS1RMUDlNOEE1RVRJdEJoMjJYeEpNWUFjbnBiRUQ0WGhoSGpkUDQyWkQxZE1UQ3NBbFU1bjVwVm5ITjBTVUxRbmNWQ3JcLytnMlM0bnAifQ%3D%3D

Handshake

Larger health insurers are able to negotiate lower prices with providers, according to a new study. But that doesn’t necessarily mean payer consolidation is the answer to keeping healthcare costs in check.

The study, conducted by researchers from Harvard Medical School and published in the January issue of Health Affairs, examined multipayer claims data from 2014 to assess how insurers’ market power affected the rates that they were able to negotiate for office-based physician services.

The researchers found that greater market power did indeed give insurers a leg up at the negotiating table. For example, when examining rates for office visits paid to the same group of providers, they estimated that large insurers—those with market shares of 15% or more—negotiated prices that were 21% lower than prices negotiated by small insurers, or those with market shares of less than 5%.

Looking at providers of different sizes, the study also found evidence that insurers require greater market shares to negotiate lower prices from large provider groups than with smaller ones. And if providers respond to insurer mergers with greater consolidation of their own, that would boost their bargaining power and let them negotiate higher prices, the study said.