AMA Says New Health Policy Must Maintain Coverage for All Currently Covered

https://morningconsult.com/2016/11/15/ama-says-new-health-policy-must-maintain-coverage-for-all-currently-covered/?utm_source=RealClearHealth+Morning+Scan&utm_campaign=5952aea6b6-EMAIL_CAMPAIGN_2016_11_16&utm_medium=email&utm_term=0_b4baf6b587-5952aea6b6-84752421

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The American Medical Association’s House of Delegates vowed Tuesday to work with the incoming Trump administration and Congress on health care reform, but said any new reforms shouldn’t result in people losing coverage.

“A core principle is that any new reform proposal should not cause individuals currently covered to become uninsured,” the group said in a statement. “We will also advance recommendations to support the delivery of high quality patient care. Policymakers have a notable opportunity to also reduce excessive regulatory burdens that diminish physicians’ time devoted to patient care and increase costs.”

The group added that it was committed to improving health insurance so patients can access high quality and affordable care. The group released a policy framework, noting they would advocate for expanding insurance coverage and choice.

Additionally, the group says it will also advocate to make sure policies offered through insurance exchanges, Medicare Advantage and Medicaid managed care offer wide provider networks. They’re also focused on encouraging prescription drug price and cost transparency.

“The new AMA policy acknowledges the carte blanche approach to drug pricing needs to change to align with the health system’s drive for high-quality care based on value,” AMA President Andrew Gurman said in a separate statement. “This transformation should support drug prices based on overall benefit to patients compared to alternatives for treating the same condition. We need to have the full picture to assess a drug’s true value to patients and the health care system.”

 

 

 

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.

The players who are set to influence Trump on health care

The players who are set to influence Trump on health care

It’s customary in the nation’s capital to hail members of the incoming administration by telling everyone in town how close you are to them. So many in conservative Washington lobbying circles and elsewhere are busy touting their relationships with President-elect Donald Trump and his advisers.

There’s a benefit to proximity to power, especially now. At a time when nobody really knows how the Trump administration will regulate drugs and medical devices, fund scientific research, or repeal or replace the Affordable Care Act, relationships with the newcomers are viewed as critical to getting one’s issues on the table.

Donations don’t hurt, either.

Trump’s transition team is a moving train, so influencers are likely to jump aboard fast. Here’s STAT’s look at people and organizations in health care and science who are likely to have influence with a Trump presidency — and who else might benefit.

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

 

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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

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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.

Paul Ryan is determined to gut Medicare. This time he might succeed

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-medicare-ryan-20161114-story.html?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=37625118&_hsenc=p2ANqtz-8op3UbE6wkf1QHSbmlOITUvS45OW4rFAoMDUSaFiNXpSZN2Afucl6wLeww-aou9CIZqsrb3AUTqQwZmAAU0vubnznweA&_hsmi=37625118

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Bursting with the policymaking power that control of both houses of Congress and the White House gives Republicans, House Speaker Paul D. Ryan (R-Wis.) has lost no time in teeing up a favorite goal: gutting Medicare.

In an interview with Fox News Channel last Thursday, Ryan said: “Obamacare rewrote Medicare … so if you’re going to repeal and replace Obamacare, you have to address those issues as well. … What people don’t realize is that Medicare is going broke, that Medicare is going to have price controls. … So you have to deal with those issues if you’re going to repeal and replace Obamacare. Medicare has got some serious problems because of Obamacare. Those things are part of our plan to replace Obamacare.”

There’s no secret about what specifically Ryan has in mind. He intends to replace traditional Medicare, an efficient program offering guaranteed treatment and featuring rock-bottom administrative costs, with a privatized program. Seniors would get a federal voucher to help them pay premiums charged by commercial insurance plans. Ryan calls this system “premium support.”

The 1 thing about healthcare that needs to change: 4 executives weigh in

http://www.beckershospitalreview.com/hospital-management-administration/the-1-thing-about-healthcare-that-needs-to-change-4-executives-weigh-in.html

Self-Discovery

From the shift to value-based care to increased price transparency, the healthcare industry is in the midst of significant changes that are aimed at efficiently improving care. However, for that goal to be achieved, problems in the industry such as disparity in access to care and confusing billing systems still need to be addressed, according to healthcare executives.

In a panel discussion on Nov. 9 at the Becker’s 5th Annual CEO + CFO Roundtable in Chicago moderated by Rhoda Weiss, PhD, nationally recognized consultant, speaker, and author, four great minds in healthcare discussed the changes they would like to see in the industry, what gives them pride in their organizations and the issues that keep them awake at night.

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

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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.

Drug prices tug on the economy of healthcare

http://www.fiercehealthcare.com/finance/drug-prices-tug-economy-healthcare?mkt_tok=eyJpIjoiTmpjd1pURm1NR0ZqTlRWbSIsInQiOiI5MkdaMWJlaGV4dlppeWNkY1NqNTNtTFJ1MFlrcWtQQWxcL2hvYWVUK3lmNEJRT1lCVTJLQTFwdGFcL0dLWWlGMnBzbGNQbXhDdnFDVUdsdkthR3Y4UzJIVm5sT25iNHJmYWd2aGlFXC9ycVNDST0ifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

Money Pills

Drug prices continue to bedevil the economics of the U.S. healthcare system in a variety of ways.

Prescription drug prices rose 7 percent between September 2015 and September of this year, according to a new report (.pdf) from the Altarum Institute’s Center for Sustainable Healthcare Spending. No other category rose more than 2.9 percent. Hospital prices rose just 1.2 percent, although that’s up significantly from the 0.7 percent annual increase between September 2014 and September of last year.

Meanwhile, Altarum’s healthcare spending report (PDF) tells a slightly different story. Prescription drug spending rose only at a 4.5 percent annual rate between September 2015 and August of this year. That’s down from the 7.2 percent growth rate from September 2014 to 2015, and the 12.4 percent rate between August 2013 and 2014.

However, hospital spending grew at a 6.6 percent annual rate in September, up from 3.4 percent between September 2014 and 2015. That’s higher than the overall 5.5 percent growth rate.

That dovetails with forecasts that U.S. healthcare spending will reach 20 percent of the gross domestic product (GDP) by the middle of next decade. According to Altarum, it currently amounts to 18.2 percent of GDP. But another report suggested that the Affordable Care Act will actually cut healthcare spending over the long term by $2.6 trillion.

The report, which is closely read by many healthcare policy experts but gains little attention in most media circles, raised some concerns from advocacy groups.

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.