Tag Archives: Medicaid

THE SHAMEFUL REPUBLICAN ASSAULT ON MEDICAID

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://www.newyorker.com/news/john-cassidy/the-shameful-republican-assault-on-medicaid?mbid=social_facebook

Image result for medicaid

In terms of political theatre, Donald Trump’s press conference on Thursday was the event of the week, or maybe the year. Strictly in policy terms, though, it was less important than the media briefing that Paul Ryan, the House Speaker, and other House Republican leaders held, also on Thursday, about their plans to abolish Obamacare and replace it with some version of what we might call Trumpcare, or maybe Trump/Ryancare.

There are still huge questions about what this new system will look like, and when it might be enacted. In a new seventeen-page paper, “Obamacare Repeal and Replace,” the G.O.P. lawmakers outlined proposals that are familiar from a plan that Ryan put out last year. They included expanded health savings accounts, financial aid for the establishment of high-risk pools at the state level, and the replacement of income-based subsidies to purchase individual insurance with universal tax credits.

But the paper also contained some huge gaps. It didn’t say how large the new tax credits would be, or how they and other elements of the reform would be paid for. To pay for its provisions, the 2010 Affordable Care Act levied more than a trillion dollars in tax increases over a decade. The Republican replacement will, in all likelihood, cover millions fewer people than Obamacare, but it will still have to be paid for. Ryan and his colleagues were largely silent on where the tax burden would fall.

For all this deliberate obfuscation, though, House Republicans are now being very clear about one thing: whatever legislation emerges after the Senate and the White House have weighed in, it will almost certainly roll back the Obama Administration’s expansion of Medicaid, the federal health-insurance program for poverty-stricken and low-income households. Under the outline released on Thursday, the current Medicaid system would be replaced by block grants to the states, and the extra federal money that went to Medicaid as part of the A.C.A. would gradually be removed. In effect, the Medicaid expansion would be slowly suffocated.

Top 2017 challenges healthcare executives face

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , , , • Leave a comment

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-2017-challenges-healthcare-executives-face?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=15022017

Working as a managed care executive in today’s healthcare environment is a demanding role. According to Managed Healthcare Executive’s 2016 State of the Industry Survey, challenges abound. Government requirements and mandates, such as implementing value-based reimbursement, are difficult to meet. Meanwhile, employing new technologies, such as electronic health records and data analytics, is no easy task. Pharmaceutical costs continue to rise dramatically, burdening the entire system.

The survey findings, based on 160 responses, show the biggest challenges that executives at health systems, health plans, pharmacy benefit organizations, and more anticipate next year. Here’s a closer look at the survey results, and what industry experts say organizations can do to overcome them.

GOP Considers Medicaid Reforms for Reconciliation Bill

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

https://morningconsult.com/2017/02/14/gop-considers-medicaid-reforms-reconciliation-bill/

Image result for Medicaid Reforms for Reconciliation Bill

House Republicans are weighing specific reforms to Medicaid that could be included in a reconciliation measure to overhaul the Affordable Care Act.

How to deal with the federal expansion of Medicaid under the ACA is one of the main unanswered questions as Congress works to overhaul Obamacare — one that has exposed divisions between the House’s most conservative members and GOP lawmakers from states that chose to expand the federal program for low-income Americans.

Rep. Brett Guthrie (R-Ky.), the vice chairman of the Energy and Commerce Health Subcommittee, said Tuesday that lawmakers are considering what types of reforms — specifically shifting to per capita allotments or allowing states to choose block grants — could be included in a House reconciliation bill to repeal the ACA.

“We’re going to deal with Medicaid reform in reconciliation, is kind of what was discussed. There’s no details yet,” Guthrie told reporters Tuesday after a House GOP conference meeting. Guthrie led a working group focused on Medicaid reforms in the last Congress.

Rep. Michael Burgess (R-Texas), who chairs the health subcommittee, told reporters Medicaid reform would be a discussion all week. House Majority Whip Steve Scalise’s office held a listening session Tuesday afternoon with members on Medicaid, and other committees are also gathering feedback. House Republicans are expecting to learn more information about health reform in a Thursday conference meeting focused on Obamacare.

House Speaker Paul Ryan attended the GOP senators’ policy lunch on Tuesday, and told attendees that appropriators and the authorizing committees are working out Medicaid reforms, Sen. Marco Rubio (R-Fla.) said.

In the House, proposals to transition to per capita allotment or block grants were included in the House GOP’s “Better Way” agenda, rolled out last year.

Indiana, Pence’s Home State, Seeks Federal OK To Keep Medicaid Expansion

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

http://khn.org/news/indiana-pences-home-state-seeks-federal-ok-to-keep-medicaid-expansion/

Statehouse of Indiana in Indianapolis (iStock/Getty Images Plus)

As Congress weighs repeal of the Affordable Care Act, the home state of Vice President Mike Pence Tuesday sought to keep its conservative-style Medicaid expansion under the federal health law.

Indiana applied to the Trump administration to extend a regulatory waiver and funding until Jan. 31, 2021, for its innovative package of incentives and penalties that are intended to encourage low-income Hoosiers on Medicaid to adopt healthy behaviors. Beneficiaries pay premiums, get health savings accounts and can lose their benefits if they miss payments.

Though Pence now supports the health law’s repeal, the Healthy Indiana Plan that he established in 2015 as the state’s governor has brought Medicaid coverage to more than 350,000 people. The architect of the plan was health care consultant Seema Verma, who has been nominated to head the Centers for Medicare & Medicaid Services.

Without Trump administration approval, federal money for Indiana’s expansion will run out Jan. 31, 2018. Indiana officials said the Medicaid expansion would continue even if Washington follows through on a Republican proposal to distribute federal Medicaid funds through a block grant program that would give states more flexibility in setting benefits and eligibility levels.

State officials refused to say whether the expansion would continue if Congress repealed Obamacare and eliminated funds for Medicaid expansions. If that happened, it’s unlikely states would have the money to make up for the lost federal aid.

Indiana’s effort to continue its Medicaid expansion demonstrates how states that expanded Medicaid under the Affordable Care Act — even Republican-controlled ones — are counting on additional federal dollars to pay for those expansions. It also reflects deadline pressure: They can’t wait for Congress to finish its debate over the future of the health law because they need to set budgets and programs now for next year.

According to Indiana’s request, continuing the Medicaid expansion will cost Indiana $1.5 billion but bring $8.6 billion in federal funding from 2018 to 2020.

“Indiana has built a program that is delivering real results in a responsible, efficient, and effective way,” Gov. Eric Holcomb, a Republican, said in a statement. “I look forward to maintaining the flexibility to grow this remarkably successful tool and to preserve our ability to respond to the unique needs of Hoosiers.”

Several other states including Kentucky and Ohio are considering adopting features of Indiana’s Medicaid plan.

 

Five Quick Ways HHS Secretary Tom Price Could Change The Course Of Health Policy

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

http://khn.org/news/five-quick-ways-a-new-hhs-secretary-could-change-the-course-of-health-policy/?utm_campaign=KFF-2017-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=42404172&_hsenc=p2ANqtz–5EWkVt5sjIUe_63Pbf6RTjOO_GqSTuaRBRwH_raPCxqrbMpsVfuUSNHyZm7pv8SbHa4es7RH84q1NOLCwj0m44NZyWQ&_hsmi=42404172

Image result for HHS Health Policy

After a bruising confirmation process, the Senate confirmed Rep. Tom Price, R-Ga., to head up the Department of Health and Human Services, by a 52-to-47 vote.

As secretary, Price will have significant authority to rewrite the rules for the Affordable Care Act, some of which are reportedly nearly ready to be issued.

But there is much more now within Price’s purview, as head of an agency with a budget of more than $1 trillion for the current fiscal year. He can interpret laws in different ways than his predecessors and rewrite regulations and guidance, which is how many important policies are actually carried out.

“Virtually everything people do every day is impacted by the way the Department of Health and Human Services is run,” said Matt Myers, president of the Campaign for Tobacco-Free Kids. HHS responsibilities include food and drug safety, biomedical research, disease prevention and control, as well as oversight over everything from medical laboratories to nursing homes.

Price, a Georgia physician who opposes the Affordable Care Act, abortion and funding for Planned Parenthood, among other things, could have a rapid impact without even a presidential order or an act of Congress.

Some advocates are excited by that possibility. “With Dr. Price taking the helm of American health policy, doctors and patients alike have sound reasons to hope for a welcome and long-overdue change,” Robert Moffit, a senior fellow at the conservative Heritage Foundation, said in a statement when Price’s nomination was announced.

Others are less enthusiastic. Asked about what policies Price might enact, Topher Spiro of the liberal Center for American Progress said at that time: “I don’t know if I want to brainstorm bad ideas for him to do.”

Here are five actions the new HHS secretary might take, according to advocates on both sides, that would disrupt health policies currently in force:

The Republican health-care plan the country isn’t debating

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

https://www.washingtonpost.com/opinions/the-republican-health-care-plan-the-country-isnt-debating/2017/02/09/919464e2-eee8-11e6-9662-6eedf1627882_story.html?_hsenc=p2ANqtz-_zh-MmG6tEeoYRPpXGnfQ4Br6yG61Zm_BUto5iuDDy7KmrCnce1x4mfC1IJZgA7lEGZpWUtS2wTehJJCZgUSr8nli9FQ&_hsenc=p2ANqtz-_g3ACJaUm5w_DwBb7DyuzIOw5pujA6z1qZbrcFLgKCShQytC1zSXx63-Yuh-gFk2Ivyjf6z-tWrzEpQHRkhxEck_TU4w&_hsmi=42381353&_hsmi=42404172&utm_campaign=KFF-2017-Drew-WashPost-feb10-GOPplans&utm_campaign=KFF-2017-The-Latest&utm_content=42381353&utm_content=42404172&utm_medium=email&utm_medium=email&utm_source=hs_email&utm_source=hs_email&utm_term=.ce2754889c96

With the debate about the Affordable Care Act drawing so much scrutiny, a broader Republican agenda to fundamentally change the federal role in health care is flying under the radar. It’s the most important issue in health care we are not debating.

Many Republicans in Congress want to convert Medicaid to a block-grant program and transform Medicare from a plan that guarantees care into one in which seniors would receive a set amount of money to purchase coverage. Meanwhile, Republicans would replace existing subsidies for premiums under the ACA with less generous tax credits — all while eliminating the expansion of Medicaid that enables states to cover low-income childless adults.

Taken together, these changes would amount to a fundamental rewriting of the health-care role of the federal government. They would end the entitlement nature of Medicaid and Medicare, cap future increases in federal health spending for these programs and shift much more of the risk for health costs in the future to states and consumers.

If Republicans shy away from Medicare for the time being, for fear of angering senior voters, the fulcrum for this policy shift will be the debate about converting the Medicaid program to some form of a block grant, most likely one that would cap spending on a per- enrollee basis. This would be an enormous shift. Medicaid spending exceeds half a trillion dollars , and the program represents more than half of all federal funds spent by states. Medicaid has changed dramatically from its beginnings as a program largely for women and children on welfare. It now has more than 70 million beneficiaries, and its reach is so broad that almost two-thirds of Americans say that they, a family member or a friend have been covered by Medicaid at some point.

Physician: Consequences of ACA Repeal ‘Gigantic for Us’

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

http://www.healthleadersmedia.com/physician-leaders/physician-consequences-aca-repeal-gigantic-us?spMailingID=10400909&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1100770334&spReportId=MTEwMDc3MDMzNAS2#

Image result for Physician ACA

Physician organization leaders are trying to plot business strategies for a post-ACA landscape of increased healthcare consumerism, lower reimbursement, and new partnerships.

Rolling Back the ACA’s Medicaid Expansion: What Are the Costs for States?

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://www.commonwealthfund.org/publications/blog/2017/feb/states-roll-back-aca-medicaid-expansion

Millions of people have gained health insurance coverage though the Affordable Care Act’s (ACA) Medicaid eligibility expansion, adopted by 31 states and Washington, D.C., over the past three years. Should Congress decide to eliminate or reduce federal funding for this coverage as part of ACA repeal, states that expanded will be faced with the prospect of either maintaining coverage out of their own funds or dropping the new beneficiaries from the program. Along with the loss of coverage or the creation of large budget holes, rolling back Medicaid benefits would present states with expensive and complex administrative challenges.

Were Congress to repeal federal funding for the expansion group, coverage for these newly eligible enrollees—estimated at 11 million as of 2015—inevitably would disappear. No state is in a position to support this population without considerable federal funding. For example, were ACA Medicaid expansion funding to disappear, California would lose more than 27 percent of the total federal Medicaid funding the state is projected to receive over the 2019 to 2028 time period; federal funding would drop from $364 billion to $265 billion, a $99 billion loss.

If a repeal bill retains the Medicaid expansion but reduces federal funding for the expansion group to traditional Medicaid funding levels,1  some states might seek flexibility to roll back coverage to a lower level such as 75 percent of poverty, rather than the eligibility standard used under the expansion (138 percent of poverty). Rather than terminate insurance eligibility altogether for populations without an alternative source of coverage, states also might try to trim benefits or reduce or freeze provider payments.

But even if funding is eliminated completely, federal laws place important brakes on the process. For example, federal Medicaid rules dating back decades require states to determine if there is another basis of eligibility prior to terminating coverage. At least some of the people covered as part of the expansion population may qualify for Medicaid on other grounds such as pregnancy, being the parent of a minor child, or disability.

How Would Republican Plans for Medicaid Block Grants Actually Work?

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

How Would Republican Plans for Medicaid Block Grants Actually Work?

Image result for How Would Republican Plans for Medicaid Block Grants Actually Work?

There are only so many ways to cut Medicaid spending.

You can reduce the number of people covered. You can reduce the benefit coverage. You can also pay less for those benefits and get doctors and hospitals to accept less in reimbursement. Or you can ask beneficiaries to pay more.

None of those are attractive options, which is why Medicaid reform is so hard. Medicaid already reimburses providers at lower rates than other insurance programs. How do you reduce the number of beneficiaries when the vast majority of people covered are poor children, poor pregnant women, the disabled, and poor older people? Which of those would you cut?

Reducing benefit coverage has always been difficult because most of the spending has been on the disabled and poor older people, who need a lot of care. Beneficiaries don’t have much disposable income, so asking them to pick up more of the bill is almost impossible.

That doesn’t mean that states haven’t tried. As I’ve discussed in past columns, a number are attempting to increase cost sharing. But this isn’t really a solution because it doesn’t change overall spending much at all.

Part of the challenge lies in the way Medicaid was set up in the first place. The federal government picks up between 50 percent and 100 percent (depending on the population and the per-person income) of whatever it costs to provide health care to a state’s population. Many, if not most, Republican plans would like to change that.

They are pushing for what many refer to as a block grant program. The federal government would give a set amount of money to each state for Medicaid; it would be up to the states to spend it however they like. These block grants could be set based on overall past state needs or based on the number of beneficiaries in the state, referred to as a “per capita” block grant. Some per-capita block grants function more like “ceilings” than outright grants, allowing the state to be paid at normal Medicaid rates, but with a maximum each state could get based on the per-capita calculation.

Everything You Need to Know About Block Grants: The Heart of GOP’s Medicaid Plans

Posted on by • Posted in Uncategorized • Tagged , , , , • Leave a comment

http://www.realclearhealth.com/articles/2017/01/24/everything_you_need_to_know_about_block_grants_the_heart_of_gops_medicaid_plans_110404.html

Image result for block grant medicaid

President Donald Trump’s administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year.

It’s called “block granting.” Right now, Medicaid, which was expanded under the 2010 health reform to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —eventually translating into greater challenges in getting care for low-income people.

Block granting Medicaid is a centerpiece of health proposals supported by House Speaker Paul Ryan and Rep. Tom Price, Trump’s nominee to run the Department of Health and Human Services. This weekend, Trump adviser Kellyanne Conway emphasized the strategy as key to the administration’s health policy.

But what would this look like, and why is it so controversial? Let’s break down how this policy could play out, and its implications — both for government spending and for accessing care.

Q: How would a block grant work?