November 14, 2017
Overhaul of innovation waiver process
Sens. Orrin Hatch (R-UT) and Mike Crapo (R-ID) are considering legislation that would overhaul the 1332 innovation waiver process making it easier for governors to apply for waivers without the state legislature, shortening the review time, creating templates for automatic approval and removing budget barriers. The bill also allows states to move people off the federal marketplace and into private exchanges, permits waivers that reduce financial assistance to consumers and lets states narrow the definition of the ACA’s essential health benefits. Critics worry the bill would create higher costs for consumers and that, if passed, the language in the bill would make it difficult for future administrations to end a 1332 waiver.
Ending medical expense tax could increase Medicaid spending
The House tax plan includes the elimination of the medical expense tax deduction, which has implications for tax filers and the health care system. The medical expense tax benefits taxpayers whose medical expenses are over 10 percent of their income. Many of these consumers need long-term support and use the deduction as a way to avoid enrolling in Medicaid. Eliminating the deduction could make individuals who received the assistance more likely to qualify for Medicaid, which could increase federal government spending and reliance on the program.
Medicaid expansion states vs. non-expansion states
The ACA allowed states to expand their Medicaid programs, but 18 states declined to participate in the program, foregoing tens of billions of dollars in federal aid. Avalere Health estimated that the 18 states that did not expand Medicaid could be sacrificing more than $180 billion over the next 10 years. However, the number of Medicaid expansion states could continue to grow, as voters in Maine approved a ballot measure last week and other states are slated to have expansion measures on the ballot in 2018.
States rescind retroactive health coverage for Medicaid patients
In most states, Medicaid will cover medical bills from the three months prior to enrollment. However, Arkansas, Indiana, New Hampshire and Iowa have been approved by the federal government to rescind retroactive health coverage for some Medicaid patients. State and federal officials say eliminating the retroactive coverage will encourage people to sign up for and maintain coverage when they’re healthy rather than waiting until they are sick to enroll. Consumer advocates and health care providers say the change will strap patients with large medical bills, create confusion around eligibility and leave hospitals to absorb the costs when patients can’t pay.
AMA begins efforts to help physicians utilize health data
The AMA recently launched the Integrated Health Model Initiative (IHMI), a new digital platform designed to improve, organize and share health information. This new data model will allow for information to be easily shared across health systems and deliver better-organized and more-relevant information about a patient, including social determinants of health. The AMA created the model to help physicians use the large amounts of health data they receive to improve patient outcomes.
Virtual hospitals provide care at a distance
Mercy Virtual Care Center in St. Louis is part of a growing trend of virtual hospitals, where specialists remotely care for hospital patients at a distance. The drive behind hospitals like Mercy Virtual isn’t new technology but rather new payment systems. As the industry moves away from fee-for-service, Mercy’s administrators believe they will be compensated for keeping their patients well. Mercy uses technology to sense changes in hospitalized patients, often before the patient or provider would traditionally be aware of the symptoms. By preempting symptoms rather than responding to sick patients, the hospital aims to improve outcomes at a lower cost.
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