Tag Archives: Medicaid

Donald Trump’s Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit

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http://www.commonwealthfund.org/Publications/Issue-Briefs/2016/Sep/Trump-Presidential-Health-Care-Proposal

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Issue: Republican presidential candidate Donald Trump has proposed to repeal the Affordable Care Act (ACA) and replace it with a proposal titled “Healthcare Reform to Make America Great Again.” Proposed reforms include allowing individuals to deduct the full amount of premiums for individual health plans from their federal tax returns, providing block grants to finance state Medicaid programs, and allowing insurers to sell insurance across state lines.

Goal: To assess how each of these reforms, when implemented individually, would affect insurance coverage, consumer out-of-pocket spending on health care, and the federal deficit in 2018.

Methods: RAND’s COMPARE microsimulation model.

Key findings and conclusions: The policies would increase the number of uninsured individuals by 16 million to 25 million relative to the ACA. Coverage losses disproportionately affect low-income individuals and those in poor health. Enrollees with individual market insurance would face higher out-of-pocket spending than under current law. Because the proposed reforms do not replace the ACA’s financing mechanisms, they would increase the federal deficit by $0.5 billion to $41 billion.

The Health Care Reform Proposals of Hillary Clinton and Donald Trump

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http://www.commonwealthfund.org/publications/blog/2016/trump-clinton-presidential-health-care-proposals?utm_medium=Facebook&utm_campaign=Health+Coverage&utm_source=Candidates+Blog

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As president, Hillary Clinton and Donald Trump would take the nation down distinctly different paths on health care. In this post, we summarize the health reform proposals of each candidate, and—drawing on new estimates by Christine Eibner and colleagues at RAND Health—compare the proposals’ implications for the total number of people with insurance coverage, people’s out-of-pocket health care costs, and the federal budget.

RAND’s analysis is based on publicly available health care proposals on the candidates’ websites. Where these proposals lacked sufficient clarity for modeling, RAND sought additional information from the campaigns. When answers were not forthcoming, or did not fully resolve questions, RAND made reasonable assumptions that were reviewed and critiqued by independent experts. RAND modeled only those proposals for which it had adequate detail and technical capacity.

The Starting Point

As a starting point, Clinton and Trump propose dramatically different approaches to the Affordable Care Act (ACA): Clinton would maintain the ACA and Trump would repeal it. In estimating the impact of Trump’s proposal, RAND assumes a full repeal of the law including insurance subsidies, expanded eligibility for Medicaid, and individual market reforms such as bans against preexisting condition exclusions. RAND also assumes that repeal would eliminate the ACA’s financing mechanisms such as its Medicare payment reforms and taxes on health plans and medical devices. Consequently, RAND estimates that compared to maintaining the ACA as is, repeal would cause nearly 20 million people to lose their insurance in 2018, increase average premium and out-of-pocket costs for people who buy insurance on their own, and increase the federal deficit. Trump’s repeal of the ACA would increase the federal deficit because the loss of savings from the law’s Medicare reforms and revenues from fees and taxes would be greater than savings from the elimination of insurance subsidies and the Medicaid expansion.

Why the U.S. Needs Medicaid

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http://www.commonwealthfund.org/publications/blog/2016/oct/value-of-medicaid?omnicid=EALERT1104254&mid=henrykotula@yahoo.com

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While most news stories about Medicaid focus on states’ decisions on whether to expand eligibility, the collective impact of the program on beneficiaries, health providers and systems, and state economies is rarely discussed. Given the large share of federal funds devoted to Medicaid, it’s reasonable to assume that policymakers on both sides of the aisle will be considering programmatic or financing changes for the program—or both—early in a new presidential administration. To inform that process, it’s helpful to look at the multifaceted role Medicaid plays in our health system.

When it was signed into law in 1965 as an extension of welfare, few would have anticipated Medicaid would evolve into the nation’s largest health insurer, covering nearly 73 million Americans.1 Today, Medicaid is at the center of the American health care safety net, providing benefits to adults and children otherwise unable to afford care—and helping to support and drive innovation in the hospitals and clinics that treat these patients, as well as supporting state economies.

Medicaid provides people with good insurance. While the program can vary somewhat by state, a growing body of evidence finds that Medicaid provides a comprehensive set of benefits as well as strong financial protections. A 2015 analysis of the Commonwealth Fund Biennial Health Insurance Survey suggests that people with Medicaid coverage have better access to health care services, including proven preventive care, and fewer medically related financial burdens than those who lack insurance (Exhibit 1). The same study found that Medicaid enrollees have nearly equivalent access to care as those with private coverage in many areas.

We’re closer to a publicly funded health care system than you think

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http://blog.academyhealth.org/were-closer-to-a-publicly-funded-health-care-system-than-you-think/

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Every time health care reform comes up for debate, I see people arguing about whether a publicly or privately funded system would be better. The Affordable Care Act, in an attempt to forestall this debate, decided to split the baby, and give half of its newly insured beneficiaries public insurance (Medicaid) and half private insurance (insurance exchanges). But this isn’t really true. Yes, the half of people getting expanded Medicaid are getting public insurance, but the vast majority of people getting private insurance are also getting public funds (subsidies) in order to purchase their private insurance.

In other words, even though we expanded private insurance, we’re doing it with taxpayer dollars. Overall, the reduction in the uninsured was due to mostly public spending, with relatively little private spending overall. This isn’t rare in the US health care system. A recently released policy brief from the UCLA Center for Health Policy Research, “Public Funds Account for Over 70 Percent of Health Care Spending in California“, explains this quite well.

If you just look at a simple analysis of Medicaid, Medicaid, and CHIP, you might find that about 45% (or less than half) of total US health care spending is public. But that ignores a ton of health care spending that is also paid for with public funds outside those programs. In an effort to document the different, researchers looked at health care spending in California. They included four major public funding categories:

  1. Payments for public health insurance programs (like Medicare and Medicaid)
  2. Government payments for health insurance coverage for public employees (like me at Indiana University, for instance)
  3. Tax subsidies for employer-sponsored insurance and those purchasing exchange plans who earn less than 400% of the poverty line
  4. County health care expenditures

 

Cost Control Efforts Working ‘So Far’ in MA

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http://www.healthleadersmedia.com/quality/cost-control-efforts-working-so-far-ma?spMailingID=9530189&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=1001355843&spReportId=MTAwMTM1NTg0MwS2#

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.

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.

health care expenditures 2013-2015

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

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http://www.beckershospitalreview.com/finance/aha-urges-cms-to-withdraw-medicaid-dsh-proposal.html

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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

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This is how the presidential election is shaping the ongoing drug price debate

Change Capsule Pill Filled with Word on Balls

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

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http://www.chicagotribune.com/news/sns-wp-blm-health-states-972aeae8-7a71-11e6-8064-c1ddc8a724bb-20160914-story.html

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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

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http://www.sfgate.com/business/article/Marin-hospital-could-be-first-in-state-to-allow-9216208.php

Dr. Larry Bedard poses outside of the Marin General Hospital in Greenbrae, California on Wednesday, September 7, 2016. Photo: Gabriella Angotti-Jones, The Chronicle

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.