September 14, 2017
Proposed legislation could jeopardize stabilization bill
Despite support from state officials, consumer advocates and health care experts, the bipartisan push by HELP Committee Chairman Lamar Alexander (R-TN) and Patty Murray (D-WA) to stabilize the health insurance markets is threatened by the introduction of two partisan bills, including a single-payer proposal and an ACA replacement bill.
The Alexander and Murray bill would authorize CSR payments to insurers and give states increased flexibility under the ACA. Tennessee’s regulator, Republican Julie McPeak, last week said ensuring CSRs is “the single most important issue” to stabilizing markets and several Senators have expressed interest in reinsurance programs.
In the House, the “Problem Solvers Caucus” has also put out a bipartisan plan, similar to the HELP Committee proposal, to stabilize the ACA markets. The group met yesterday with President Trump to discuss the proposal, where the President indicated that he is open to a bipartisan stabilization plan.
Cassidy, Graham unveil details to replace ACA
More details are available on the Graham-Cassidy proposal to repeal and replace the ACA. The bill would give states $1 trillion in block grants to design their own coverage systems. Under the bill, each state would receive a federal block grant replacing ACA premium subsidies, CSR payments and Medicaid expansion funding. States could also waive essential health benefits. Federal funding to states to expand Medicaid to low-income adults would end in 2020. The Center on Budget and Policy Priorities found that the 20 states facing the largest percentage of funding cuts would see reductions ranging from 35 to 50 percent. The funding cuts could lead to fewer benefits for consumers, higher premiums and coverage losses.
Administration working to loosen ACA rules
The Administration is beginning to look at ways to rollback regulations around the ACA without Congress, including ending mandatory programs, slowing the transition to a system that pays doctors based on quality and reversing a rule that prevents nursing homes from forcing residents to sign away their right to sue. The effort has raised alarms among patient advocates and policy experts, who fear it could erase several years of gains aimed at modernizing the health care system and tipping the balance of power away from providers and toward patients.
Single-payer health plan introduced in the Senate
Yesterday, Sen. Bernie Sanders (I-VT) rolled out his “Medicare for All” proposal that would expand Medicare coverage and eliminate deductibles, copays and premiums. The proposal would extend insurance to all Americans over four years by lowering the eligibility age for Medicare. Private insurance companies would not be a part of the Medicare system under this plan. Currently there is no exact plan for how to pay for this proposal. Upwards of 15 Democrats are now co-sponsoring the bill.
American Medical Association panel may hold too much clout over physician pay
CMS is set to approve almost every 2018 payment proposal made by an American Medical Association panel, known as the RUC, which recommends how much Medicare should pay for specific services. Some experts say that RUC determinations on Medicare payouts are more focused on giving favorable rates to expensive procedures instead of encouraging primary care and preventive care. CMS pays out around $100 billion a year for physician services.
Mulit-payer models prove successful
Providers are finding success with CMS’s Comprehensive Primary Care Initiative, which emphasizes preventive screenings and follow-ups. One provider who was accepted into the initiative found her practice had an overall improvement in quality of care and a reduction of average monthly costs by about 40 percent. Providers are hopeful these success stories will spur CMS to introduce additional multi-payer models.
Emergency room visits hit peak during ACA implementation
Visits to emergency rooms hit an all-time high of 141 million in 2014, the same year ACA insurance expansion was implemented. The new CDC data contradict the opinion of many policy experts who predicted that ER visits would decline as insurance coverage expanded. Some analysts say the high ER use could stem from newly insured people becoming familiar with the health care process.
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