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Presidential Transition Brief
– President-elect Donald Trump plans to name ExxonMobil CEO Rex Tillerson as Secretary of State.
– Reports indicate former Governor Rick Perry (R-TX) is President-elect Donald Trump’s top choice for Energy Secretary.
MedPAC recommends payment boost for doctors and hospitals
Congress should raise payment rates for hospitals and doctors reimbursed by Medicare, according to the Medicare Payment Advisory Commission (MedPAC). The commission does not recommend payment increases for ambulatory surgery centers, skilled-nursing facilities and hospices, writes Virgil Dickson of Modern Healthcare. MedPAC is also suggesting payment cuts for inpatient rehabilitation centers and home-health agencies based on the facilities’ strong profit margins. MedPAC will formally approve their recommendations in January before sending them to Congress and the Department of Health and Human Services.
Insurers warn health law changes could affect the market
In preparation for changes to the Affordable Care Act (ACA), health insurers are creating contingency plans and stepping up lobbying efforts. Health industry groups warn the wrong steps could result in an environment where insurers no longer want to participate in the individual market. Most concerning to insurers is the possibility of a quick end to the penalty for not obtaining insurance coverage and the removal of federal subsidies that offset the cost of coverage for low-income Americans, explain Anna Wilde Mathews and Louise Radnofsky at The Wall Street Journal. Priority Health CEO Joan Budden says her organization is planning for several scenarios (subscriber’s content).
Republicans betting Democrats will take hit in an ACA showdown
Republicans believe Democrats will suffer politically if they refuse to cooperate in drafting and passing a replacement bill for the Affordable Care Act (ACA). Republicans are considering repealing the ACA and phasing out the program over a period of two or three years while legislators draft a new framework for America’s health care system. While Republicans can repeal most of the ACA without Democratic support, passing a replacement law will require Democratic votes in the Senate to avoid a filibuster, according to Peter Sullivan of The Hill. Democrats assert a repeal of the ACA would be harmful for Americans, who will hold the GOP accountable.
GOP weighs options for ACA transition period amid challenges
Republican leaders have not settled on a timeframe for phasing out the Affordable Care Act (ACA) if the law is repealed. Some GOP leaders have pushed for passing a repeal of the law with a built-in transition of three years, which would give legislators time to consider a replacement plan. Hardline conservatives are advocating a quicker dismantling of the law, explains Mary Ellen McIntire of Morning Consult. House Speaker Paul Ryan (R-WI) and Rep. Tom Price (R-GA) believe a timeframe will be established after the Christmas holiday.
Quickly dismantling the law while ensuring coverage and stabilizing the markets could prove a difficult task. According to MJ Lee of CNN, challenges to a smooth transition include the large number of patients the law covers, a lack of clarity on the timing of a replacement and uncertainty around insurers defecting from the market.
New HHS secretary could bring changes to health policy
President-elect Donald Trump’s selection for Health and Human Services Secretary Rep. Tom Price (R-GA) could affect health policy without an act of Congress or a presidential order. Leaders of major agencies have authority to interpret laws and rewrite regulations, which is often how policies are carried out. Julie Rovner at Kaiser Health News describes five areas of health policy Price could alter, including coverage of birth control, changes to Medicare payments, funding for Planned Parenthood, conscience protections and tobacco regulation.
Silicon Valley backs insurance startup
A health care startup providing insurance to New Jersey residents is using data to discover potential health problems with the backing of Silicon Valley. Technology investors have injected nearly $300 million in Clover Health, which aims to improve the country’s health system through data. The insurer’s system spots anomalies, such as missed doctors’ appointments or trips to emergency room, to build health profiles on customers and stop health problems before they happen. Lizette Chapman at Bloomberg reports.
Our weekly Blog Review features insightful posts from around the web and keeps an eye on medical industry and health news via the Trend Watch. This week we review posts discussing health insurance options that sometimes harm poorer Americans. This week’s Trend Watch compiles posts analyzing pay-for-performance programs.
Insurance Plans Benefit Wealthy
The Problem with One-Size-Fits-All Health Insurance
The New York Times: The Upshot
Workers at the same company, regardless of income, have identical options for employer-sponsored health insurance. University of Michigan Law School Professor Nicholas Bagley and Health Economist Austin Frakt believe the uniformity of insurance harms low-income individuals, as employer-sponsored health coverage is subsidized more for the rich than the poor and wage cuts to account for fringe benefits affect low earners disproportionately.
Trump Plan to Increase Health Savings Accounts Should Ensure That They Do Not Only Benefit the Wealthy and Healthy
Expanding the use of health savings accounts (HSA) is a central part of President-elect Donald Trump’s health agenda. University of California San Francisco Health Economics and Health Services Research Professor Kathryn Phillips, PhD, asserts new approaches are needed for HSAs to benefit more than just the wealthy. Phillips suggests using behavioral economics to improve HSAs.
Pay for Performance
National Health Policy Shouldn’t Be Based on Flip-Flopping Science
Pay for performance has been based on now-discredited science, according to University of Pennsylvania Professor Ross Koppel, PhD, and Harvard Medical School Professor Stephen Soumerai, ScD. The authors explain research on pay for performance does not account for improvements in health care and trends occurring independently.
Watch Out, Hospitals: Medicare’s Planning to Punish You If You Misbehave
Duke University Professor Peter Ubel, M.D., feels hospital revenue could be at risk due to pay-for-performance programs. Ubel advocates for improving the programs, as many hospitals are starting to demonstrate better performance on quality metrics.