November 15, 2017
Senate tax proposal would repeal individual mandate
The latest version of the Senate tax bill includes a repeal of the ACA’s individual mandate. As of now, the House bill does not include provisions repealing the mandate. Senators are including the repeal in an effort to offset the tax plan’s $1.5 trillion in tax cuts. According to the nonpartisan CBO, repealing the individual mandate is expected to save the government $340 billion over the next 10 years, but also lead to 4 million more uninsured in 2019 and 13 million more uninsured over the next decade. The CBO also notes that, if the Senate bill is passed as written, it could trigger automatic spending cuts, including a funding cut of $25 billion for Medicare.
Risk-corridor payments reach over $12 billion
Medicare costs rising due to increase in hospital-employed physicians
According to an analysis released by Avalere, hospital acquisition of health care providers is helping drive up costs for Medicare because hospital-employed physicians performed more services in costlier hospital outpatient settings. This has resulted in up to 27 percent higher costs for Medicare and 21 percent for patients. According to the report, a 49 percent increase in hospital-employed physicians between 2012 and 2015 led to cost increases for four specific procedures in cardiology, orthopedics, and gastroentology, resulting in $3 billion increase in Medicare costs. Some payers have been pushing back on hospitals and systems that have profited off reimbursement rules that allow them to charge higher fees for services delivered in hospital off-campus facilities. CMS also recently finalized a proposal to slash what Medicare pays for are obtained at hospital-owned off-campus facilities.
EHR can impact use of social determinants of health
Medicaid work requirements
CMS Administrator Seema Verma plans to give states greater latitude in shaping the eligibility requirements and benefits packages offered by state Medicaid programs. CMS has already suggested it will allow states to implement work requirements, and Verma has also suggested she is open to allowing states to charge monthly premiums, perform drug tests, and cap how long people can receive Medicaid benefits. Verma has compared the changes to similar requirements for other federal assistance programs, such as food stamps. However, some are concerned the requirements could force millions of Americans out of the program, jeopardizing their health. Nearly 75 million people are covered by Medicaid, including 16 million added since 31 states and the District of Columbia expanded their programs under the ACA.
CMS reminding providers how to charge dual-eligible patients