The Latest CBO Score Of The Better Care Reconciliation Act Leaves 22 Million Uninsured by 2026
On July 20, 2017, the Senate Budget committee released the latest version of the Better Care Reconciliation Act (summary), which was sent to the Congressional Budget Office (CBO) for scoring. It is basically identical to the second BCRA draft posted on July 13, 2017 (which was not separately scored by the CBO) except that it drops the Cruz amendment and includes a couple of small changes in the Medicaid section. The July 13 draft added $70 billion in state long-term stabilization funding to the original BCRA which the Cruz amendment then shifted to the Department of Health and Human Services (HHS) to pay to insurers that o...
Source: Health Affairs Blog - July 20, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage ACA repeal and replace BCRA Source Type: blogs
CMS Releases FAQ On Its New Proxy Direct Enrollment Pathway
In May of 2017, the Centers for Medicare and Medicaid Services (CMS) announced that it intended to make a new proxy direct enrollment pathway available for HealthCare.gov enrollees for 2018. The guidance provided that direct enrollment (DE) entities would have to be audited by third-party auditors for operational readiness before they could begin offering proxy DE. On July 18, 2017, CMS released at its REGTAP.info website (registration required) a series of frequently asked questions regarding the Third Party Operational Readiness Reviews (ORRs) for the Proxy Direct Enrollment Pathway.
In response to the first FAQ, CMS sta...
Source: Health Affairs Blog - July 20, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Source Type: blogs
Is Medicaid The New ‘Third Rail?’ History Suggests It Has Been For Some Time
As President Trump and Congressional Republicans regroup following the collapse of their efforts to repeal and replace the Affordable Care Act they should look not only at what went wrong with their legislation but also past efforts to reform American health care.
While many things went wrong, the biggest stumbling block to the GOP efforts this year was the attempt to dramatically change the Medicaid program, which serves some 70 million Americans. Both the House-passed and pending Senate bills would have replaced the 52-year-old entitlement program with capped federal spending and a state-run block grant. The federal gove...
Source: Health Affairs Blog - July 20, 2017 Category: Health Management Authors: Richard Sorian Tags: Following the ACA Medicaid and CHIP ACA repeal and replace Henry Waxman Source Type: blogs
Eliminating The Medicaid Expansion May Cause More Damage Than Congress Realizes
The American Health Care Act (AHCA) and the Senate’s ill-fated Better Care Reconciliation Act (BCRA) attempted to deliver on two promises: 1) protecting patients with preexisting conditions, and 2) eliminating the Medicaid expansion. Though repeal efforts seem to have stalled for the time being, future GOP attempts to replace the ACA will undoubtedly involve the delicate task of appeasing conservative party members while maintaining provisions of the ACA that remain immensely popular with voters. While others have already discussed the failings of the proposed legislation with respect to the Medicaid expansion and preexi...
Source: Health Affairs Blog - July 20, 2017 Category: Health Management Authors: Justin Puckett and Jalpa Doshi Tags: Featured Following the ACA Medicaid and CHIP HIV/AIDS medicaid expansion states Source Type: blogs
The Obamacare Repeal Reconciliation Act: What Repeal And Delay Would Mean For Coverage, Premiums, And The Budget
Late in the day on July 19, 2017, the Senate released the Obamacare Repeal Reconciliation Act (ORRA) of 2017 (summary). The bill would repeal the Affordable Care Act’s (ACA’s) coverage provisions, but delay the repeal of the coverage provisions until 2020, presumably giving Congress time to come up with a replacement. It is virtually identical to the reconciliation bill that passed both houses of Congress in 2015, only to be vetoed by President Obama. The Congressional Budget Office (CBO) simultaneously released a cost estimate of the bill, which was very similar to the report it had offered on the 2015 bill.
The ORR...
Source: Health Affairs Blog - July 20, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage ACA repeal and replace Source Type: blogs
Health Affairs Web First: Healthy Lifestyle Prolongs Americans ’ Life Expectancy
This study, which was supported by the National Institute on Aging, will also appear in the August issue of Health Affairs. (Source: Health Affairs Blog)
Source: Health Affairs Blog - July 19, 2017 Category: Health Management Authors: Lucy Larner Tags: Elsewhere@ Health Affairs Featured Web First Source Type: blogs
From The Archives: Prices And Consumer Shopping
Welcome to “From the Archives,” an occasional Health Affairs Blog series, where we take a timely topic and delve into the literature and history, from a Health Affairs angle, of course.
The American Health Care Act and the proposed Better Care Reconciliation Act would both result in higher premiums and deductibles for many individuals in the private nongroup market according to the Congressional Budget Office. While the path forward for health reform is now somewhat unclear, the trend of higher consumer cost sharing will likely continue. Higher deductibles and cost sharing are often touted as ways for individuals...
Source: Health Affairs Blog - July 19, 2017 Category: Health Management Authors: Rachel Dolan Tags: Elsewhere@ Health Affairs Featured From the Archives shoppable health care Source Type: blogs
At It Again: Texas Continues To Undercut Access To Reproductive Health Care
Texas policymakers are once again demonstrating their contempt for reproductive health care, the health care providers who offer those services, and the women who rely on them. The state has spent years crippling a once-successful program supporting family planning and related services for low-income residents — all in service of an ideological agenda to shut out and shut down health centers that have any connection to abortion services.
Now, the state is asking the like-minded Trump administration to provide an infusion of federal funding to support its diminished program. In the process, Texas and the Trump adminis...
Source: Health Affairs Blog - July 18, 2017 Category: Health Management Authors: Kinsey Hasstedt and Adam Sonfield Tags: Medicaid and CHIP Public Health Quality contraceptive coverage Planned Parenthood Section 1115 Waivers Texas Women's Health Source Type: blogs
Republican ACA Replacement Effort Collapses; States Defend House v. Price Intervention Request
On July 17, 2017, Republican efforts to enact their Better Care Reconciliation Act collapsed as GOP Senators Mike Lee of Utah and Jerry Moran of Kansas announced that they would not support the legislation. Senators Rand Paul (R KY) and Susan Collins (R ME) had already announced their opposition, while Senator John McCain (R AZ) remains hospitalized in Arizona, leaving the Republican leadership at least three votes short of the 50—with Vice President Pence’s tiebreaking vote—they need to pass the bill.
Following the announcement by Senators Lee and Moran that they could not support the BCRA, Senate Majority L...
Source: Health Affairs Blog - July 18, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage ACA repeal and replace cost-sharing reduction payments Source Type: blogs
Are Section 1115 Waivers A Panacea For Draconian Medicaid Funding Reductions?
From a structural perspective, what makes the pending Medicaid legislation so extraordinary is that, without changing any of the program’s fundamental contours, both the House and Senate bills would simply superimpose arbitrary spending caps onto the statute’s federal funding contribution formula. In the near term, the loss of enhanced federal funding for the optional ACA adult expansion group would cause the most financial damage. But over the long term the true injury to Medicaid would come from holding back federal funding otherwise due under the financing agreement that has been the program’s statutory hallmark f...
Source: Health Affairs Blog - July 17, 2017 Category: Health Management Authors: Sara Rosenbaum Tags: Following the ACA Medicaid and CHIP Section 1115 Waivers Source Type: blogs
Examining Provider Bias In Health Care Through Implicit Bias Rounds
In 2015, a 27-year-old patient presented to our primary care resident practice in intractable pain, having been recently discharged from the hospital following surgery for a complex shoulder fracture. The orthopedic surgeons evaluated him the day before and scheduled a second surgery but did not adequately treat his pain. The inpatient nurse had told him he would be discharged with the oral pain regimen he had been taking for the past day or so within the hospital. But upon discharge, he found himself without those prescriptions and came to our primary care practice in severe pain. When we reviewed his inpatient record to ...
Source: Health Affairs Blog - July 17, 2017 Category: Health Management Authors: Vidya Viswanathan, Matthew Seigerman, Edward Manning and Jaya Aysola Tags: Health Equity Population Health Quality Implicit Bias Rounds implicit biases provider bias Source Type: blogs
ACA Round-Up: Medicare Trustees Report Does Not Trigger IPAB, And More
All eyes yesterday were focused on the Senate, which released significant new amendments to the Better Care Reconciliation Act. But the Senate was not the only game in town.
On July 13 the Medicare Trustees released their 2017 Medicare Trust Fund report. One of the most controversial creations of the ACA was the Independent Payment Advisory Board (IPAB). The ACA established specific target growth rates for Medicare and charged the IPAB with ensuring that Medicare expenditures stayed within these limits.
Each year the CMS Chief Actuary must make a determination as to whether the projected average Medicare growth rate for th...
Source: Health Affairs Blog - July 14, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Following the ACA Insurance and Coverage Medicare advance premium tax credits CMS cost-sharing reduction payments IPAB IRS Medicare Trustees Report Source Type: blogs
Medicaid And The Latest Version Of The BCRA: Massive Federal Funding Losses Remain
Where Medicaid is concerned, the most notable thing about the latest version of the Better Care Reconciliation Act (BCRA) is that despite the drama of the past two weeks—the flood of news coverage regarding the potential impact of the losses; mounting concerns raised by Senators from expansion and non-expansion states alike; and the massive outcry from hospitals, physicians, insurers, and health care organizations—the new iteration leaves untouched the fundamental Medicaid contours of the earlier version.
The new draft retains the federal funding bar for Planned Parenthood (§ 123) as well as the earlier versio...
Source: Health Affairs Blog - July 14, 2017 Category: Health Management Authors: Sara Rosenbaum Tags: Featured Following the ACA Medicaid and CHIP Public Health ACA repeal and replace BCRA emergency response Source Type: blogs
Senate GOP Leadership Unveils Latest Version Of Health Reform Legislation
On July 13, 2017, Senate Republican leadership released the latest version of the Better Care Reconciliation Act (summary of entire bill, including new amendment here) This post will address the private insurance sections of the amendment. A subsequent post by Sara Rosenbaum will discuss Medicaid changes.
The original draft of the BCRA was introduced on June 22, 2017. Senate Majority Leader Mitch McConnell had hoped to call a vote on the proposal before the July 4 recess. By late June, however, an unfavorable Congressional Budget Office report—which found that the bill would result in 22 million consumers losing heal...
Source: Health Affairs Blog - July 14, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Abortion association health plans catastrophic plans continuous coverage requirements Cruz Amendment health savings accounts state stability funds Source Type: blogs
In Senate Health Care Bill, A Few Hidden Surprises
A low-income person, eligible for Medicaid but not enrolled, is hit by a car or a bullet. Gravely injured, she arrives at the hospital unconscious. Thanks to expert, intensive care that lasts for days or weeks, she gradually recovers. Eventually, her health improves to the point where she can complete the paperwork needed to apply for Medicaid.
Such a hospital can be paid today, thanks to Medicaid’s “retroactive eligibility.” Even if the combination of medical problems and bureaucratic delays prevents an application from being filed and completed for several months, Medicaid will cover the care if the patient was eli...
Source: Health Affairs Blog - July 13, 2017 Category: Health Management Authors: Stan Dorn and Sara Rosenbaum Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Payment Policy Senate health bill The Better Care Reconciliation Act Source Type: blogs
