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ACHP in the News: ACHP President and CEO Ceci Connolly responds to 2018 payment rates for Medicare Advantage plans in Modern Healthcare, Fierce Healthcare, The Hill Extra and Politico Pulse. ACHP is pleased that Medicare Advantage rates will increase, but would like CMS to restore quality payments under the benchmark cap.
Payments to MA plans set to increase slightly
Final payment for health insurers offering Medicare Advantage plans will increase 0.45 percent on average for 2018. The average MA payment rate will increase by 2.95 percent after taking into account the way health plans code tehri members’ diagnosis.
GOP health bill could be revived
Trump Administration has been in talks with Republican lawmakers about efforts to revive an ACA repeal. A new proposal would allow states to apply for federal waivers exempting them from some health insurance mandates established under the ACA — including “essential health benefits” requiring coverage of mental-health care, substance abuse treatment, maternity care, prescription drugs and more, as well as a provision that bars insurers from charging the sick more than the healthy. If the proposal becomes law, it could make it expensive or difficult for people with pre-existing conditions to find health care coverage. Allowing insurers to vary their prices according to a person’s health was a Freedom Caucus demand last month, but it was rejected and helped stall the bill.
Cost Sharing Subsidies to Continue
The Trump administration indicated that it plans to continue the ACA’s cost-sharing subsidies while they are part of ongoing litigation. The statement could provide some clarity for insurers as they decide whether to offer plans next year on the Obamacare exchanges.
Proposed rule lowers coverage requirements
A new proposed rule would allow health plans to lower minimum coverage requirements while keeping the same medal-level, increasing out-of-pocket costs for consumers. The new rule would lower the floor of coverage by 2 percent in order to attract insurers and consumers to the exchanges and stabilize the marketplace. Insurers could offer silver-level plans that cover 66 percent of costs instead of the previous range of 68 to 72 percent and bronze-level plans for as low as 56 percent coverage.
Kansas Governor Vetoes Medicaid expansion
The Kansas House of Representatives has fallen short of overriding Governor Sam Brownback’s (R) veto of a bill to expand Medicaid by three votes. The Kansas legislature passed the bill earlier this year, despite the fact that Republicans control both houses. The bill would have expanded Medicaid coverage to an additional 150,000 low-income Kansans.Political experts claim an override of the governor’s veto would be a strong sign other states may expand Medicaid. A number of states have explored expanding Medicaid since the defeat of the Republican health care plan.
Wellmark plans to withdraw from Iowa exchanges in 2018
In response to uncertainty and instability in the health insurance landscape, Wellmark Blue Cross and Blue Shield will withdraw from Iowa’s individual health insurance market in 2018. Wellmark notes it has lost $90 million in the individual exchanges and asserts steps need to be taken to stabilize the market. Other insurers have six weeks to decide if they will operate in the individual market or raise premiums; many insurers have stated they are waiting on word from the Trump administration about the fate of cost-sharing payments before committing to participation in the market.
Markups effect hospital payments
List prices for procedures have an effect on hospital payments, according to a study by the Federal Reserve Board and the American Enterprise Institute. Every dollar added to a list price lead to an extra 15 cents payed to the hospital for patients with private insurance. The researchers also found that lists prices and markups varied greatly among hospitals.