Uninsured at 9.1%, Census data shows
Tag Archives: Medicaid
Cost Control Efforts Working ‘So Far’ in MA
Health policy veteran Stuart Altman, PhD, is hopeful, but not optimistic, about healthcare delivery reforms and thinks hospitals will be forced to bring costs down because patients won’t tolerate any more cost shifting.
Each year, we put together a cost trend report that outlines what forces are at play in the state in terms of raising spending and we have hearings every October. We are trying to play an interesting role which is not be regulatory, but really to be in the face of the healthcare system in terms of saying, “Hey be careful. Don’t go the extra mile on in spending or pricing.”
We want to do it in a way that doesn’t destroy or even hurt the health system. In any attempt to do that, some of the forces within the health industry scream.
But, for the most part, the hospitals have been supportive of our efforts. If we were to squeeze too hard, they would react more negatively. Everyone is engaged in a very interesting balancing act. We are trying getting the system to work more efficiently… and they are trying to control costs without destroying themselves. So far it’s working.
AHA urges CMS to withdraw Medicaid DSH proposal
http://www.beckershospitalreview.com/finance/aha-urges-cms-to-withdraw-medicaid-dsh-proposal.html
Click to access 160914-cl-medicaid-dsh.pdf
The American Hospital Association submitted a letter Tuesday to CMS, asking the agency to withdraw a proposed rule to include third-party payments when calculating the hospital-specific limitation on Medicaid disproportionate share hospital payments.
In its proposal, CMS says the rule is simply a clarification on existing policy.
“Specifically, the rule would make clearer in the text of the regulation that uncompensated care costs include only those costs for Medicaid eligible individuals that remain after accounting for payments received by hospitals or on behalf of Medicaid eligible individuals, including Medicare and other third-party payments that compensate the hospitals for care furnished to such individuals,” the proposed rule states.
In the letter to CMS, the AHA argues the proposed rule is more than a clarification and actually establishes new policy. According to the AHA, CMS proposed the rule to avoid potentially unfavorable rulings in cases pending in federal court that address the DSH payment calculation.
This is how the presidential election is shaping the ongoing drug price debate
This is how the presidential election is shaping the ongoing drug price debate
In this year’s presidential campaign, health care has taken a back seat. But one issue appears to be breaking through: the rising cost of prescription drugs.
The blockbuster drugs to treat hepatitis C as well as dramatic price increases on older drugs, most recently the EpiPen allergy treatment, have combined to put the issue back on the front burner.
Democrat Hillary Clinton just issued a lengthy proposal to address what her campaign calls “unjustified price hikes for long-available drugs.” That’s in addition to a broader proposal to address high drug prices the campaign put out last fall.
Republican Donald Trump, meanwhile, has said little about health care since announcing his candidacy in 2015, but he has several times called for a change in law to allow Medicare to negotiate drug prices for the population it serves.
Here are five reasons why this issue is back — and why it is so difficult to solve.
Rich hospital, poor hospital divided by politics and a river
When hospital executive Jeanette Wojtalewicz visits CHI Health’s Mercy Council Bluffs facility across the Missouri River in Iowa, she sees the new clinics and doctors’ offices partly paid for by the state’s decision to expand Medicaid to thousands of residents.
Back on her side of the river is CHI Health’s Creighton University Medical Center in Omaha, Nebraska, a state that opposed making more low-income people eligible for the government health-insurance program. While Mercy thrives about seven miles away, Creighton is cutting 250 beds to raise efficiency amid slumping financial results.
“There’s not a big geographical difference, but because of the regulations, there are big differences in the numbers,” said Wojtalewicz, chief financial officer at CHI Health, a 15-facility, nonprofit hospital system.
President Barack Obama’s Patient Protection and Affordable Care Act is as divisive as ever six years after its passage, with Republicans including presidential candidate Donald Trump vowing to repeal it. Yet as critics focus on the legislation’s insurance mandates and penalties, the biggest impact has come from Medicaid expansion, a decision made at state level.
Marin hospital could be first in state to allow medical marijuana
http://www.sfgate.com/business/article/Marin-hospital-could-be-first-in-state-to-allow-9216208.php
If Dr. Larry Bedard has his way, Marin General Hospital would become the first acute-care medical center in California to allow patients to openly consume medical marijuana in the hospital.
Patients wouldn’t be allowed to smoke it, since smoking is prohibited. But Bedard, a retired emergency physician at Marin General who now serves on the Marin Healthcare District board, says he knows of no other legally prescribed drug that cannot openly be used by patients in a hospital.
“I know that it happens that it’s being used in the hospital, but it’s ‘don’t ask, don’t tell,’” Bedard said. “It’s kind of wink-and-nod medicine.”
The doctor is taking steps toward bringing it out into the open by introducing a resolution at Tuesday’s board meeting for Marin Healthcare District, which governs Marin General. The resolution, if approved, would direct the hospital’s administrative and medical staff to review and research the clinical and legal implications of using medical marijuana in the hospital and report back to the board.
Bedard initially planned to introduce a resolution to allow patient use in the hospital but stepped back from that last month after the Drug Enforcement Agency declined to remove marijuana from its list of dangerous drugs, keeping it in the same category as such drugs as heroin and LSD.
$2 cigarette tax hike: Doctors and hospitals fight tobacco industry
http://www.sacbee.com/news/politics-government/capitol-alert/article101382077.html
Doctors have long argued that low reimbursement rates are undermining the Medi-Cal system. While more Californians are seeking treatment, the state hasn’t done enough to increase funding to provide care, Corcoran said. Reimbursement rates are not up to par with the cost of practice, making it difficult for physicians to accept Medi-Cal patients, he said.
“It is a broken system,” Corcoran said. “Physicians want to be able to take care of patients. There’s not a lack of desire or a lack of willingness. It’s whether you can actually sustain a practice for all of your patients and provide that level of care that areas need and deserve.”
Medi-Cal is expected to balloon to 14.1 million patients in the current budget year, nearly double the number of Californians using the government-funded health care program four years ago, according to the state. Officials attribute the increase to the federal health care overhaul that expanded subsidized insurance. With a shortage of Medi-Cal doctors, advocates say patients in rural areas and other pockets of the state lack adequate access to care.
During budget talks, the Brown administration has pushed back against the need for rate increases. The administration pointed out that struggling providers can request reimbursement in full and questioned whether higher rates will result in better care.
How the ACA’s Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums
Abstract
Issue: One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law’s individual mandate also protect from high health spending.
Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket.
Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds.
Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.
States that resisted the ACA face the biggest hurdles in 2017
States that are set to experience reduced competition in their health insurance exchanges also appear to be the ones that were unwilling to lay the groundwork to create a robust marketplace.
The issues that many states are now facing regarding consumer choice and premium pricingwere predicated by resistance from Republican politicians, who failed to expand Medicaid or conduct the necessary outreach to enroll healthy individuals into marketplace plans, according to the Los Angeles Times. In fact, eight of the nine states that have the fewest plan options next year refused to expand Medicaid and failed to engage in outreach.
“It’s the same basic lesson I tell my kids,” Joel Ario, a former insurance commissioner in Oregon and Pennsylvania, told the newspaper. “If you put the work into something, you will get results. If you just sit on the sidelines and complain, you shouldn’t be surprised if things don’t work out.”
Without Medicaid expansion, Texas hospitals left holding the bag
http://www.fiercehealthcare.com/finance/without-medicaid-expansion-texas-hospitals-left-holding-bag
Should Texas ever decide to expand Medicaid eligibility under the Affordable Care Act, its hospitals would be spared about $358 million a year in costs tied to uncompensated care, a new study has found.
The research was conducted by the Florida-based consulting firm Health Management Associates on behalf of the Texas Health and Human Services Commission, The Dallas Morning News has reported. The report was not immediately available online.
If Medicaid were expanded, about 9 percent of the approximately $4 billion a year Texas’ hospitals spend on uncompensated care could be saved, the newspaper reported. Health Management Associates (HMA) predicted about 668,000 Texans out of the 1.1 million eligible for Medicaid coverage would enroll if eligibility were expanded.
But, quoting the report, the newspaper said that Texas lawmakers are not inclined to expand Medicaid anytime soon.
HENRY KOTULA 