Rampaging goats and $10 million mansions: your guide to the weird world of Obamacare rhetoric

Rampaging goats and $10 million mansions: your guide to the weird world of Obamacare rhetoric

The Obamacare repeal effort is just getting underway and already the political wordplay is dizzying. On the GOP side, the rhetoric has gone from “repeal and replace” to “insurance for everybody” to “repair and rebuild.” Meanwhile, Democrats continually warn that the Republicans are trying to “rip apart our health care system.”

To help you keep pace with the debate, we’ve assembled this handy glossary of buzzwords and talking points. Enjoy.

From the Republicans:

Repair and rebuild

This is the GOP’s attempt to describe its legislative strategy for Obamacare, and an evolution of the phrase “repeal and replace.” As Politico reported Thursday, it is the mantra of Oregon Representative Greg Walden, who is leading the offensive against Obamacare in the House. It is meant to soften the GOP’s tone and suggest the replacement effort will be carefully staged and surgical. It also opens the door to delay tactics if things don’t quickly shape up in the GOP’s favor.

From the Democrats:

‘Make America Sick Again’

A play on Donald Trump’s campaign slogan, this phrase emerged in early January as Democrats held rallies to generate support for Obamacare. Judging by the nation’s $3.2 trillion tab for health care costs in 2015, a number expected to jump as high as $3.6 trillion this year, it seems clear a lot of us are pretty sick already. But you get the point.

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.

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

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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%).

Healthcare Leaders Split on Incoming Trump Administration

http://www.healthleadersmedia.com/leadership/healthcare-leaders-split-incoming-trump-administration?spMailingID=10260830&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1081571803&spReportId=MTA4MTU3MTgwMwS2#

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While 41% of executives are generally positive about the potential impact of a Trump administration, nearly as many (37%) are generally negative about the prospects. The figures regarding Tom Price at HHS and Seema Verma at CMS are similar in a HealthLeaders Media survey.

An Association Of Health Funders And The Changing Political Landscape

http://healthaffairs.org/blog/2017/01/19/an-association-of-health-funders-and-the-changing-political-landscape/

As the professional association for health foundations and corporate-giving programs, Grantmakers In Health (GIH) connects the hundreds of health funders who are spread across the American landscape, keeping them up-to-date on rapidly changing developments and providing opportunities for them to share what they’re learning and doing in their respective communities.

Times like now—when dramatic changes to the health care landscape are anticipated—accentuate the importance of this role. In 2017 it will be especially important that we help funders understand, and respond to, significant expected changes in public policies and programs that affect the communities they serve.

We will not simply be in crisis mode, however. Our concern for both informing and shaping the bigger picture of philanthropy’s health and health care priorities is ongoing.

As the year begins, the future of the Affordable Care Act (ACA) is naturally a high priority for us. Health funders are rightly anxious to understand the changes that are likely with a new Congress and presidential administration. Many grantmakers have invested for years at a national or state level to support the implementation of the ACA. They are keenly aware that rolling back the law will have consequences not only for people’s access to health care services, but also, more broadly, for jobs and state economies.

In an immediate response to these concerns, GIH has organized a series of webinars for its membership that offers the perspectives of a range of policy experts. Immediately post-election, these topics included strategies for adapting health reform–related grant making, the future of Medicaid, and the election’s implications for the State Children’s Health Insurance Program (CHIP) and other children’s coverage. Upcoming webinars will include bipartisan views of the new Trump administration’s health priorities and plans, the implications of a possible repeal of the ACA without implementing an immediate “replace” strategy, and the 2016 election’s possible effects on the health of immigrant communities.

Other ACA-related programming will include activities taking place at our annual conference in June, as well as meetings, calls with funders, and publications, including in-depth interviews about foundation strategies. Because changes to the ACA, Medicaid, and other programs will heighten the importance of state-level actions, our 2017 programming will pay special attention to elevating what funders are doing in states and sharing this information nationally.

In addition to this focus on policy changes that will affect access and coverage, we also want to identify health investment areas in which the new administration seems to be interested. We anticipate that addiction, delivery system reform, veterans’ health, and rural health will be on that list.

Gut check: Change is coming, and healthcare executives don’t necessarily think it’s a bad thing

http://www.healthcarefinancenews.com/news/gut-check-change-coming-and-healthcare-executives-dont-necessarily-think-its-bad-thing

Self-Discovery

The future of healthcare policy is a bit murky these days. President-elect Donald Trump has pledged to repeal the Affordable Care Act, and the Republican-run U.S. Congress is already fast at work to make that happen.

What’s not known, however, is what will change for the thousands of U.S. healthcare businesses that have not only adapted to the ACA but also made millions in investments in areas such as electronic health records, value-based reimbursement and reporting to align with the policies of the outgoing administration.

Healthcare Finance spoke with several executives at healthcare businesses to get their perspectives on not only the changes they expect but also their thoughts on what the healthcare sector actually needs to do to provide the best care while still safeguarding the health of its business model.

 

Private vs. public prices

http://www.academyhealth.org/blog/2017-01/private-vs-public-prices

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You probably knew that the prices private health insurers pay hospitals are higher than those of Medicare and Medicaid. But you may not have known that the gap between private and public payers used to be a lot smaller and has grown tremendously in recent years.

Using Medical Expenditure Panel Survey (MEPS) data, by payer (private health insurance, Medicare, and Medicaid) and over time (1996-2012), the chart shows average hospital payment rates (in constant dollars), adjusted for age, sex, race/ethnicity, geography, income, health conditions, charges, length-of-stay, and whether or not a surgical procedure was performed. To produce figures for the chart, the authors used this model to predict hospital payment per stay for each MEPS observation, as if they were covered by private insurance, Medicare, or Medicaid, in turn.

As is clear from the chart, adjusted, average private pay rates have always been above public rates, but were closest in 1996-2000. Back then, private rates were no more than 10% above Medicare rates. Perhaps this was the effect of managed care, which kept growth in private rates down. Those rates began to grow during the managed care backlash, until 2005. From 2005-2009, adjusted, average private hospital rates—while considerably above Medicare and Medicaid rates—held steady. Then, in 2009, they took off again. In 2012, adjusted, average private rates were about 75% higher than Medicare rates.*

Medicaid payments were about 90% of Medicare’s in most study years.

Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in Life

Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in Life

Image result for Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in LifeImage result for Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in LifeImage result for Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in Life

The recent election has caused many to question whether significant changes are about to happen to Medicaid. Repeal of the Affordable Care Act would, of course, lead to the elimination of the Medicaid expansion, which could result in significant numbers of adults losing their coverage overnight.

But even without repeal, many Republican replacement proposals also result in significant changes to Medicaid, whether it be through funding, eligibility, or benefits. So, again, let’s talk about what Medicaid does, and whether it’s long term benefits are worth it. This is Healthcare Triage News.

Top managed care trends to watch in 2017

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-managed-care-trends-watch-2017?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=13012017