Tag Archives: Medicaid

The American Health Care Act: 10 things to know

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http://www.beckershospitalreview.com/hospital-management-administration/gop-health-bill-is-out-10-things-to-know-this-morning.html

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After years of lobbying to repeal and replace the ACA, House Republicans put forth The American Health Care Act on Monday. Here are 10 things to know about the legislation.

1. The AHCA would eliminate the ACA’s individual mandate, or requirement for American adults to enroll in health insurance. Further, the legislation eliminates the tax penalty adults faced if they were not covered. However, the concept of penalties still remains in some form: To encourage people to buy coverage, the AHCA lets insurers charge a 30 percent penalty for those who let their health plans lapse and try to buy a new policy, according to NPR.

2. The AHCA calls for Medicaid expansion to remain in effect through Jan. 1, 2020. This is different from earlier drafts of legislation, which called for an immediate reversal of Medicaid expansion. Thirty-one states, plus Washington, D.C., have opted to expand Medicaid under the ACA. By 2020, the government will “freeze” the expanded programs and restrict funding only to people who were in the program as of then — no added enrollees from that date on. States would keep getting that amount of federal aid for each Medicaid enrollee as long as the enrollee doesn’t lose eligibility for more than a month. There is also a provision in the AHCA that calls for grants of extra Medicaid provider reimbursement funds to go toward states that didn’t expand Medicaid.

3. The AHCA restructures Medicaid’s federal funding to a per-capita cap opposed to the current open-ended federal entitlement, reports Politico. States would receive capped payments based on how many people are enrolled in Medicaid. The plan also calls for more frequent eligibility testing of Medicaid enrollees.

4. The AHCA restructures Americans’ tax credits to buy health insurance. It replaces income-based subsidies under the ACA with refundable, age-based and income-capped tax credits, according to Politico. These credits increase with age, from as low as $2,000 for those under 30 or as high as $4,000 for those over 60. There would be a limit as far as credits for a single household — $14,000 — and subsidies would be eliminated over time for individuals with annual income of $75,000 and for families with annual income of $150,000, according to the report.

5. A few ACA staples roll over in the AHCA. The ACA provision related to pre-existing conditions would remain intact, meaning insurers would not be able to deny coverage or increase prices for people with such conditions, reports Reuters. Also, the AHCA retains provisions allowing adults up to age 26 to maintain coverage through their parents’ health plans, according to the report.

6. The AHCA eliminates the cap on the tax exemption for employer-sponsored insurance. Although earlier drafts of legislation capped the exemption at 90 percent of current premiums, the final version eliminated the proposal, according to Politico. The bill also gets rid of the penalty for businesses that do not offer employees health coverage.

7. The AHCA delays the effective date for the ACA’s Cadillac Tax on costly health plans from 2020 to 2025, according to The Hill. GOP lawmakers are delaying but keeping the tax to make certain their replacement plan will not increase the national deficit after a decade.

8. The AHCA bars federal Medicaid funds or federal family planning grants for Planned Parenthood clinics, according to the report. (Separate from the AHCA, the White House earlier this week extended terms for a compromise to Planned Parenthood by proposing maintained federal funding if the group agrees to discontinue providing abortions, according to ABC News.)

9. The cost of the AHCA is not yet known. The nonpartisan Congressional Budget Office has not yet scored the legislation, which means there is neither a cost estimate for the plan or how many Americans would gain or lose insurance under it.

10. What’s next? The House Ways and Means and Energy and Commerce committees are expected to review the AHCA legislation Wednesday. If the committees approve the measure, the full House could potentially act on it before April 7, according to The New York Times. The measure would then be taken up by the Senate.

Fitch: Changes to Medicaid in ACA repeal bill pose risks for hospitals

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http://www.beckershospitalreview.com/finance/fitch-changes-to-medicaid-in-aca-repeal-bill-pose-risks-for-hospitals.html

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House Republicans’ proposed ACA repeal and replacement plan, known as the American Health Care Act, calls for changes to Medicaid that expose states and hospitals to new fiscal risks, according to a Fitch Ratings report.

The AHCA would eliminate Medicaid’s entitlement structure and restructure the program’s federal funding to a per-capita cap system on Jan. 1, 2020. This change is intended to slow Medicaid spending growth. The Kaiser Commission on Medicaid and the Uninsured estimates switching to a per-capita cap system would reduce federal spending on Medicaid by $1 trillion (or 26 percent) over 10 years. This reduction would require states to make significant budgetary changes and could result in reduced reimbursement for hospitals, according to the report.

The AHCA calls for the government to freeze expanded Medicaid programs on Jan. 1, 2020, and restrict funding only to people who were enrolled in the expanded programs as of Dec. 31, 2019. Under the ACHA, states that expanded Medicaid “will be faced with a unique policy predicament of denying Medicaid access to individuals who would otherwise qualify beginning in 2020, or taking on significant costs they had anticipated would be bored largely by the federal government,” according to Fitch.

Behold the G.O.P. Civil War on Health Care

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As people began to digest the Republican health care plan on Tuesday, a few things became clear:

1. “This isn’t an Obamacare repeal, it’s a Medicaid repeal,” as the political writer Jonathan Allen put it.

Many Republicans have long viewed Medicaid — a health insurance program for the poor, the disabled and some elderly — with skepticism. This plan would make very large cuts to the program. The details are somewhat technical, and Edwin Park of the Center on Budget and Policy Priorities explains them. But the real-world effects will be concrete: Many people will lose coverage, and some kinds of care, if the bill becomes law.

2. Conservative policy experts hate the bill, and the criticisms come from both the far right and the center right.

Peter Suderman of Reason had an excellent frame for understanding the right’s civil war over health care: Conservatives don’t even agree on what their goals are. Making health care less expensive? Reducing the government’s role? Ensuring that the poor receive fewer subsidies?

Lacking this agreement, many Republicans have pretended that a magical health plan exists, one that would cover everyone, provide good insurance and cost less money. Wouldn’t that be nice!

 

House GOP’s Obamacare Replacement Will Make Coverage Unaffordable For Millions — Otherwise, It’s Great

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https://www.forbes.com/sites/theapothecary/2017/03/07/house-gops-obamacare-replacement-will-make-coverage-unaffordable-for-millions-otherwise-its-great/#3540ba3d37fd

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That’s not an ironic headline. Leading House Republicans have included a number of transformative and consequential reforms in their American Health Care Act, the full text of which was published Monday evening. But those reforms are overshadowed by the bill’s stubborn desire to make health insurance unaffordable for millions of Americans, and trap millions more in poverty. Can such a bill garner the near-universal Republican support it will need to pass Congress?

 

GOP releases bills to repeal and replace ObamaCare

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http://thehill.com/policy/healthcare/322609-gop-releases-bill-to-repeal-and-replace-obamacare

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Click to access AmericanHealthCareAct.pdf

Click to access AmericanHealthCareAct_WM.pdf

House Republicans on Monday unveiled their long-awaited legislation to repeal and replace ­ObamaCare, with plans to quickly push the measure through committee votes this week.

The two measures dismantle the core aspects of ­ObamaCare, including its subsidies to help people buy coverage, expansion of Medicaid, taxes and mandates for people to have insurance. The bills also dramatically restructure the Medicaid program overall by capping federal payments.

In its place, Republicans would put a new system centered on a tax credit to help people buy insurance.

House Republicans plan to take up the legislation at a breakneck pace, with two committees — Energy and Commerce and Ways and Means — scheduled to hold votes on Wednesday. A vote in the full House is expected to soon follow, within weeks.

House Ways and Means Committee Chairman Kevin Brady (R-Texas) said Monday on Fox News that he’s confident the legislation will pass with solid Republican support despite recent party infighting over the details.

“We’ve been listening very carefully to our Republican members for months now to make sure we get it right,” he said. “I am confident we are going to pass this.”

Brady noted that many of the elements of the bills have passed the House “a number of times” over the years.

Speaker Paul Ryan (R-Wis.) in a statement claimed that ­ObamaCare “is rapidly collapsing” and vowed the GOP’s plan — dubbed the American Health Care Act — will “give every American access to quality, affordable health insurance.”

Republicans acknowledge that their plan will cover fewer people, saying that unlike ­ObamaCare, they are not forcing people to buy coverage through a mandate. They say their system is less intrusive and provides people a tax credit without mandates or a range of tax increases.

But the measures face a rocky path, particularly in the Senate. Four Republican senators earlier Monday objected to an earlier version of the House plan, saying that it fails to protect ­ObamaCare’s Medicaid expansion.

Even in the House, there are objections. Conservatives in the House Freedom Caucus object that the new tax credit is a “new entitlement.” They have enough votes to kill the legislation, but it remains to be seen whether they will actually vote against a bill that dismantles the core of ­ObamaCare.

The GOP measure significantly restructures the Medicaid program, which provides coverage for around 70 million poor, disabled and elderly people, to cap federal payments.

The repeal of the Medicaid expansion and ­ObamaCare’s subsidies would not take effect until 2020, meaning current enrollees could keep their coverage this year.

Republicans would also grandfather in current Medicaid enrollees so that they can stay on the program. But once 2020 arrives, the federal government would no longer provide the extra federal funds that allow for expansion.

That plan has drawn objections from more centrist Republican senators, who want to protect the expansion and are worried about constituents losing coverage and their states losing federal funds.

The legislation would maintain ­ObamaCare’s protections for people with pre-existing conditions, who could still not be denied coverage by insurers. Instead of ­ObamaCare’s mandate, the GOP plan would seek to encourage healthy people to sign up by allowing insurers to charge people 30 percent higher premiums if a new enrollee has had a gap in coverage.

The legislation also repeals nearly all of the taxes created by ­ObamaCare, including the medical device tax and health insurance tax, starting in 2018. The bills scrap a controversial Republican proposal in earlier drafts that would have started taxing some employer-sponsored health insurance.

To ensure that the legislation passes muster under special budgetary rules, it keeps ­ObamaCare’s “Cadillac tax” on generous plans after 2025. That provision, which could prove controversial, will help ensure that the measure does not add to the federal deficit in that decade.

For New Medicaid Patients, The Doctor Is In (Generally). But You May Have To Wait.

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http://khn.org/news/for-new-medicaid-patients-the-doctor-is-in-generally-but-you-may-have-to-wait/

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More than 14 million adults have enrolled in Medicaid since the health law passed, and that has caused some hand-wringing over whether there would be enough primary care providers to meet the demand. But a study out this week suggests that the newly insured people are generally able to get timely appointments for primary care.

For the study, which was published online in JAMA Internal Medicine, trained field workers posing as new Medicaid or privately insured patients called physician practices in 10 states and requested a new-patient appointment for either a checkup or newly diagnosed high blood pressure. They recorded whether they were able to get an appointment and how soon it could be scheduled.

The states in the study — Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas — represented a mix of states that expanded Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level (about $16,600) and those that haven’t done so. An initial round of fieldworker calls to more than 9,700 practices was made in 2012 and 2013, before most states had expanded Medicaid coverage, followed by a second round of calls to more than 7,300 practices in 2016.

Over the time periods studied, appointment availability improved for Medicaid callers by 5.4 percentage points, while it stayed stable for privately insured callers (though Medicaid callers still had a tougher time getting appointments in general).

But, during the second study period, callers from both groups were less likely to be able to schedule an appointment within a week. The proportion of Medicaid callers who waited a week or less decreased by 6.7 percentage points, to 49.1 percent; the share of those who said they were privately insured who waited a week or less declined by 4.1 percentage points, to 52.7 percent.

“Some of these offices were getting a little more full,” said Daniel Polsky, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania and the study’s lead author. “One way doctors were making room for more patients was that instead of making an appointment in a week’s time, some were making it in two weeks.”

There are many factors that may have contributed to the ability of primary care providers to absorb more patients, including increased funding for federally qualified health centers and the growth of retail clinics, among others.

The study should ease concerns that the health law will exacerbate the shortage of primary care providers, Polsky said, though there may still be regional challenges accessing care.

“It’s still true that fewer doctors are willing to see Medicaid patients than are willing to see commercial patients,” he said. “But if you have Medicaid, your access to doctors is still good.”

 

Trump Outlines 5 Principles for Healthcare Reform

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http://www.healthcaredive.com/news/trump-outlines-5-principles-for-healthcare-reform/437171/

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Five takeaways from the leaked Republican bill to repeal Obamacare

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http://www.pbs.org/newshour/rundown/5-takeaways-leaked-republican-bill-repeal-obamacare/

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A formal draft of the House Republican plan to repeal and replace the Affordable Care Act leaked out on Friday.

The final version is likely to be different — how much different, it’s hard to say. The draft obtained by Politico is dated two weeks ago, and rumors have been swirling here that Republicans received an unfavorable analysis from the Congressional Budget Office, the official scorekeepers on the cost and coverage implications of legislation.

But this is nonetheless an important milestone — real legislative text, prepared with an eye toward the complex parliamentary procedures needed to pass ACA repeal with only Republican votes, and presumably with the endorsement of House leadership.

Much attention will be paid to the proposed tax credits offered for people to buy health insurance and the changes to the tax treatment of employer-based insurance. Here are five provisions with big implications for health and medicine.

 

Medicaid’s Role: What’s at Stake Under a Block Grant or Per Capita Cap?

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Medicaid’s Role: What’s at Stake Under a Block Grant or Per Capita Cap?

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A new video slideshow from the Kaiser Family Foundation explains how Medicaid works now and what is at stake as policymakers in Washington consider converting program financing to a block grant or per capita cap.

The 3-minute video describes how Medicaid is financed under current law, whom it covers and how spending is distributed across various groups of enrollees, including children, adults, seniors, and people with disabilities. It shows, for instance, that although seniors and people with disabilities comprise about a quarter of Medicaid enrollees, they account for nearly two-thirds of Medicaid spending because they have more complex health needs and therefore higher per person costs.

Proposals to convert Medicaid to a block grant or per capita cap financing could reduce federal Medicaid spending over time and be tied to increased flexibility for states in how they run their Medicaid programs. However, the video slideshow also explains how such proposals may shift costs to states, beneficiaries and providers, as well as limit states’ ability to respond to changes in medical costs and/or demand for Medicaid.