October 9, 2017
Trump eyes regulatory changes to individual purchasers’ insurance options
The Trump Administration plans to implement three regulatory changes aimed at expanding insurance options for Americans who purchase insurance on their own. President Trump will order the Departments of Labor, Treasury and HHS to work together to ease restrictions on the formation of association health plans. Association plans would be required to meet certain ACA regulations—such as the ban on lifetime limits—but would be exempt from others—including essential health benefit requirements. The Administration will also lift restrictions on short-term medical insurance plans, allowing consumers to purchase plans for up to a year instead of 90 days, which is the current limit. Finally, the Administration plans to expand the use of health reimbursement accounts by allowing them to be used to purchase insurance on the individual market. The Administration says the changes are necessary to ease the regulatory burden of the ACA, but critics claim the move erodes key protections for consumers.
Trump reaches out to Democrats on ACA repeal
President Trump reached out to Senate Minority Leader Chuck Schumer (D-NY) in an attempt to craft an agreement that would repeal and replace the ACA. Schumer says he rejected the President’s offer and reiterated his commitment to repairing—rather than replacing—the health law. Schumer also emphasized any joint work on healthcare should start with a stabilization package like the one being negotiated by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA).
ACA opponents hope to use waiver program to overhaul Medicaid
Conservatives disappointed by the defeat of repeal and replace efforts are shifting their sights toward state-level implementation of health policy, particularly Medicaid. State lawmakers and officials have filed waivers with CMS that would allow them to apply conservative changes to the program, including work requirements, time limits on coverage, and lockouts for individuals who do not renew their coverage quickly enough. Conservatives believe they have an ally in Seema Verma, the head of CMS: Verma successfully used waivers to create a conservative version of Medicaid in Indiana when she ran the state’s Medicaid program. However, it’s unclear what waivers Verma will approve, and critics say many of the proposals are impermissible under existing law.
Federal judge rules against DOJ law suit
U.S. District Judge John F. Walter threw out a False Claims Act law suit brought by the Department of Justice accusing UnitedHealth Group of ignoring questionable diagnoses to boost its Medicare Advantage profits. The judge’s order allows for the DOJ to specify the allegations, but concluded the case as filed did not show intentional wrongdoing and did not prove that the government would have withheld payment if it had known of violations. The complaint was the first time the Department of Justice joined a suit regarding Medicare Advantage fraud and was an important test for False Claims Act law suits concerning risk adjustment payments.
Behavioral economics has applications for health care
Applying marketing and economic principles can help the health care industry achieve more efficient policies and lower costs. This perspective has gained attention as Richard H. Thaler was awarded the Nobel Memorial Prize in Economic Science. Thaler’s research explains how small changes in a system can have a big impact and pushed economists away from the traditional view that people are rational actors. Professor Benjamin Voyer, a L’Oreal Professor of Creativity and Marketing at ESCP Europe Business School, discusses how these findings from behavioral science can be used to influence patient behavior, including the fact that individuals value the social aspects of decision making and what is available immediately. Based on these principles, health care providers are finding success in managing chronic diseases by establishing smaller, short-term goals and comparing a patient’s progress to another cohort to motivate behavior change.
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