October 16, 2017
Legal impact of Trump’s action on CSRs
A ruling last spring that said it was unconstitutional to make federal cost-sharing reduction (CSR) payments without an explicit appropriation from Congress partially fueled Trumps decision to stop paying as much as $7 billion this year to insurers in exchange for holding down out-of-pocket expenses for millions of Americans. But it also opens the door to lawsuits initiated by Congress over the specifics of how the executive branch spends tax dollars. In addition, 18 states and DC filed a lawsuit challenging the administration’s move to end the payments, saying the sudden move wasn’t explained properly and unconstitutionally disregarded mandatory spending.
Hill deal necessary to restore payments
It’s been reported that Trump will oppose any congressional efforts to reinstate CSR payments unless he gets something in return, such as a deal to repeal and replace the ACA or funding for his pledged border wall. This puts more pressure on HELP Committee leaders Senators Lamar Alexander (R-TN) and Patty Murray (D-WA.) who have been working on a bipartisan, short-term deal to extend the subsidies and stabilize the market. Alexander and Murray are set to resume their negotiations this week. A new Kaiser Family Foundation survey found that by better than 2-1, Americans said they would rather that Trump and Congress work to stabilize the marketplaces rather than continue to try to repeal and replace the current law.
Pro-Trump states most affected by his CSR decision
Trump’s move to end the ACA provision benefiting roughly 6 million Americans helps fulfill a campaign promise, but also risks harming some of the very people who helped him win the presidency. Nearly 70 percent of those benefiting from CSRs live in states Trump won. The number underscores the political risk for Trump and his party, which could end up owning the blame for increased costs and chaos in the insurance marketplace. This map shows a breakdown of who receives CSRs and how Congressional districts voted in the November 2016 elections.
Department of Justice drops lawsuit against UnitedHealth
The Department of Justice has dropped a lawsuit accusing UnitedHealth Group, Inc. of submitting false claims to get inflated Medicare payouts. U.S. District Judge John Walter in Los Angeles ruled that the lawsuit failed to identify any UnitedHealth officers who signed documents vouching for data submitted to the Medicare Advantage program, or that any of them knew they were signing off on false information. DOJ declined to comment, but a second lawsuit by the government, accusing UnitedHealth of obtaining over $1 billion of Medicare payouts it was not entitled to, is pending. The dismissal is a setback for the DOJ. Its complaint marked the first time that the government had intervened in a whistleblower-led FCA suit alleging Medicare Advantage fraud.
AHA report on community benefits may be flawed
The American Hospital Association released a report saying that the benefits that not-for-profit hospitals provide to their local communities far outweigh foregone federal tax revenue. But some experts say the report has flaws and omissions that exaggerate hospitals’ community roles and understate the power of their tax exemptions – including that the AHA did not account for significant property tax breaks and used older data from 2013 that did not reflect the ACA’s coverage expansion. In addition, calculating shortfalls from Medicare as a community benefit also raises a red flag. The AHA report follows a July Politico investigation examining how hospitals have cut back on charity care since the ACA but still reap major financial benefits by not paying federal, state and local taxes.
Head of Veterans Affairs interviews for HHS post
David Shulkin, the current U.S. Secretary of Veterans Affairs was interviewed by the White House for Secretary of HHS, according to sources familiar with the meetings. Shulkin is one of a number of leading contenders for the position. Other potential candidates include Seema Verma, CMS Administrator and FDA Commissioner Scott Gottlieb.
Racial gaps in care for developmentally delayed kids
African American and Hispanic children with developmental delays are less likely to receive early intervention services than white children, according to a new study published in Pediatrics. The study consisted of interviews conducted with African American and Hispanic mothers. Information gathered from the interviews shows that most of these mothers were skeptical of a doctor’s findings and relied on advice from social circles, or were provided with limited or conflicting information, so they didn’t know whether or not to pursue early intervention services. Researchers suggested that understanding why parents don’t seek early interventions for their children could help improve methods for identifying and supporting children.
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