Healthcare Triage: Republican Plans for The Affordable Care Act

Healthcare Triage: Republican Plans for The Affordable Care Act

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After campaigning for years on a plan of “repeal and replace Obamacare,” Republicans finally have the means within their grasp to make much of that possible. They control the presidency, the House, and the Senate. The filibuster still poses some potential threats to their plans, but it’s also within their means to abolish its widespread use in such a way that they could both repeal the Affordable Care Act and replace it with something of their own design.

What would that be? In contrast to what many say, there are Republican plans out there to consider. They’re the topic of this week’s Healthcare Triage.

‘Not Turning Back’: California Governor Vows To Protect State’s Health Care

http://khn.org/news/not-turning-back-california-governor-vows-to-protect-states-health-care/

Gov. Jerry Brown (Neon Tommy via flickr)

In an unusually impassioned speech, Gov. Jerry Brown vowed Tuesday to protect California’s health care gains under Obamacare against Republican attempts in Washington, D.C., to roll them back.

“More than any other state, California has embraced the Affordable Care Act,” Brown told state legislators and appointees in his annual State of the State address at California’s Capitol. “I intend to join with other Governors and Senators, and with you, to do everything we can to protect the health care of our people.”

Brown said California would not “turn back” on advances it’s made in health coverage under pressure from the new Republican administration in Washington. Under the new federal leadership, he said, the “future is uncertain and dangers abound.”

Health coverage for Californians under the Affordable Care Act “has come with tens of billions of dollars from the federal government,” said Brown. “Were any of that were to be taken away, our state budget would be directly affected, possibly even devastated.”

Leveraging an estimated nearly $20 billion federal money, health coverage has been extended to five million Californians under Obamacare, which includes federally subsidized private health plans and an expansion of eligibility for Medicaid, the program for low-income people — known in this state as Medi-Cal.

 

Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans

http://khn.org/news/block-grants-medicaid-faq/

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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 law 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.

Trump’s Health Plan Would Convert Medicaid to Block Grants, Aide Says

President Trump’s plan to replace the Affordable Care Act will propose giving each state a fixed amount of federal money in the form of a block grant to provide health care to low-income people on Medicaid, a top adviser to Mr. Trump said in an interview broadcast on Sunday.

The adviser, Kellyanne Conway, who is Mr. Trump’s White House counselor, said that converting Medicaid to a block grant would ensure that “those who are closest to the people in need will be administering” the program.

A block grant would be a radical change. Since its creation in 1965, Medicaid has been an open-ended entitlement. If more people become eligible because of a recession, or if costs go up because of the use of expensive new medicines, states receive more federal money.

If Congress decides to create block grants for Medicaid, lawmakers will face thorny questions with huge political and financial implications: How much money will each state receive? How will the initial allotments be adjusted — for population changes, for general inflation, for increases in medical prices, for the discovery of new drugs and treatments? Will the federal government require states to cover certain populations and services? Will states receive extra money if they have not expanded Medicaid eligibility under the Affordable Care Act, but decide to do so in the future?

 

 

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.