Calendar ’s Turn Brings New Congressional Approach To Health Reform
As congressional Republicans tried to adopt one bill after another all summer long by narrow partisan margins, they kept hearing the same message from Democrats and others: Why not try bipartisanship? Why not hold hearings, as the Democrats did in the spring and summer of 2009 leading up to the adoption of the ACA, and hear what stakeholders and experts from across the political spectrum think needs to be done to fix health care.
The Hearing Line-Up
As September begins, the Senate has scheduled a host of hearings. The Senate Health, Education, Labor, and Pensions Committee, led by Senators Lamar Alexander (R-TN) and Patty ...
Source: Health Affairs Blog - September 6, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs
Should Value Frameworks Take A ‘ Societal Perspective ’ ?
Editor’s note: One of the authors of this post, Peter Neumann, will be discussing issues related to the post at a Health Affairs September 13 event, “Understanding The Value of Innovations In Medicine.”
In 1996, the U.S. Panel on Cost-Effectiveness in Health and Medicine recommended that analysts conducting cost-effectiveness analyses (CEAs) should perform a reference case analysis, following a set of standard methodological practices to improve comparability and quality. They further recommended that such analyses assume a societal perspective, reflecting the perspective of a decision maker allocating resourc...
Source: Health Affairs Blog - September 6, 2017 Category: Health Management Authors: Peter J. Neumann and Sachin Kamal-Bahl Tags: Costs and Spending Drugs and Medical Innovation Quality 2nd Panel on Cost-Effectiveness in Health and Medicine Source Type: blogs
Getting Risk Adjustment Right Is Key Under Any Individual Market Scenario
The affordability and stability of premiums in the individual health insurance market figure prominently in the recent and ongoing debates over national health policy. Often overlooked in these debates is the role of risk adjustment and other risk-mitigation measures in promoting both objectives.
Risk adjustment is a vital tool in preventing community rating in the individual market from causing harmful risk selection against plans and insurers’ consequent risk avoidance. Effective risk adjustment lets insurers compete based on efficiency, networks, medical management, and consumer value, instead of by avoiding uncompens...
Source: Health Affairs Blog - September 6, 2017 Category: Health Management Authors: Bowen Garrett, Douglas Holtz-Eakin, Stan Dorn and Christopher Holt Tags: Costs and Spending Following the ACA Insurance and Coverage American Action Forum Center for Consumer Information and Insurance Oversight individual market risk adjustment Urban Institute Source Type: blogs
Health Affairs New Issue: Market Concentration
The September issue of Health Affairs includes a group of studies examining different aspects of health care markets: market concentration, preserving competition, and provider networks. Other September studies provide updates on Affordable Care Act (ACA) coverage.
The issue was supported in part by The Commonwealth Fund, which provided funding for the studies on market concentration.
Insurers drive down hospital and physician prices
The rapid pace of consolidation in health care markets has continued: From 1998 to 2015, there were 1,412 US hospital mergers, with 40 percent of them after 2009. To examine how provider and i...
Source: Health Affairs Blog - September 5, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs journal Source Type: blogs
The Anthem-Cigna Merger: A Post-Mortem
Editor’s Note: Watch Health Affairs for the new issue release with a special focus on market concentration at 4 pm.
On May 12, 2017, Anthem Inc. announced that it would no longer seek to acquire Cigna Corporation, putting an end to a two-year saga that reached its climax in February when US District Court Judge Amy Berman Jackson sided with the Department of Justice (DOJ), which argued that the deal violated Section 7 of the Clayton Antitrust Act. A divided panel of the Second Circuit Court of Appeals affirmed this decision in April.
The DOJ had reason to be skeptical when Anthem and Cigna announced their intention t...
Source: Health Affairs Blog - September 5, 2017 Category: Health Management Authors: David Dranove Tags: Featured Insurance and Coverage Anthem Cigna Collaborative Accountable Care Innovation Source Type: blogs
ACA Round-Up: Governors Offer Individual Market Stabilization Proposals And More
On August 30, 2017, governors John Kasich of Ohio, John Hickenlooper of Colorado, and six other Republican, Democratic, and Independent governors sent a letter to the Republican and Democratic leaders of the House and Senate asking them to take immediate steps to restore stability and affordability to the individual health insurance market. The letter was sent ahead of the testimony governors are expected to offer to the Senate Health, Education, Labor, and Pensions committee on September 7.
The immediate steps recommended by the governors include:
funding cost-sharing reduction payments through 2019;
creating a temporary...
Source: Health Affairs Blog - September 1, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage budget reconciliation governors John Hickenlooper John Kasich out-of-network billing States Source Type: blogs
Forgotten Heroes: Remembering Dr. Alvin Blount, Who Helped Integrate America ’s Hospitals
Mortar rounds shook the bunker. The 8225th Mobile Army Surgical Hospital (MASH) was crammed with casualties—civilians, Americans, and KATUSAs (Korean Augmentation to US Army). The four surgical tables under the direction of its acting chief surgeon, Alvin G. Blount, often operated around the clock, doing as many as 90 surgeries during sleepless protracted engagements. Blount could shut out the mayhem and focus only on his patient’s needs, as if everything else in the world had stopped. His calm, gentle demeanor commanded respect. His was the first racially integrated MASH unit, and he was its first black chief surg...
Source: Health Affairs Blog - September 1, 2017 Category: Health Management Authors: David Barton Smith Tags: Featured Health Equity Hospitals Medicaid and CHIP Medicare Alvin G. Blount George Simkins health disparity Health Reform hospital segregation Simkins v. Cone Source Type: blogs
Insurance Commissioners And The Feds: Time For Some Relationship Counseling?
The Affordable Care Act (ACA) effectively created a shotgun marriage between state insurance regulators and the US Department of Health and Human Services who then had to provide oversight of their baby — the individual insurance market. The relationship has been complicated since the start: the insurance market has proved to be a problem child and the federal government has not been the most reliable spouse and parent recently.
Next Wednesday’s Senate Health Education, Labor, and Pension (HELP) Committee hearing, “Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: Insurance...
Source: Health Affairs Blog - September 1, 2017 Category: Health Management Authors: Christopher Koller Tags: Following the ACA Insurance and Coverage individual market Source Type: blogs
CMS Cuts ACA Advertising By 90 Percent Amid Other Cuts To Enrollment Outreach
On August 31, 2017, the Centers for Medicare and Medicaid Services (CMS) announced that it intends to cut Affordable Care Act advertising from the $100 million spent by the Obama administration in 2016 for the 2017 open enrollment period by 90 percent to about $10 million this year for the 2018 open enrollment. CMS also announced that it intends to cut navigator grants from $62.5 million in 2016 by about 40 percent to $36.8 million for 2017. It also intends to tie grants to navigator programs for 2017 to their having met enrollment goals during 2016.
The administration’s announcement must be understood in context. The Af...
Source: Health Affairs Blog - September 1, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs
Data-Driven Policy Making In An Age Of Anecdotes: What Happens When A Foundation Creates A Policy Center?
Why would a health foundation create a public policy research center?
The Healing Trust, in Nashville, Tennessee, has funded a wide variety of health-related service and advocacy organizations in Middle Tennessee. But in 2014, we asked them what additional support we could give to these organizations engaged in policy and advocacy work. One priority quickly rose to the top: timely, high-quality, and nonpartisan research and analysis on public policy issues critical to our community.
Tennessee has several prominent academic institutions with respected researchers in this field, but an independent and nonpartisan public poli...
Source: Health Affairs Blog - August 31, 2017 Category: Health Management Authors: Kristen Keely-Dinger and Jennifer Oldham Tags: Featured GrantWatch Health Philanthropy Health Reform Medicaid nonpartisan Policy State Health Policy Tennessee Source Type: blogs
ACA Round-Up: CDC Reports Long-Term Coverage Gains, Shorter-Term Stall; Risk Corridor Briefs Filed; And More
The Centers for Disease Control and Prevention (CDC) have released their Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January to March 2017. The survey shows that during the first three months of 2017, 500,000 fewer people were uninsured than in 2016, but 20.5 million fewer than in 2010. The former change is not statistically significant; the latter number is significant in every respect.
This pattern is repeated throughout the report. By every measure, insurance coverage improved for every group measured—children, adults, young adults, the poor, the near poor, the ...
Source: Health Affairs Blog - August 31, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage risk corridor payments uninsured rate Source Type: blogs
Are Short-Term Limited Duration Plans Bad For The Individual Market?
With the impasse in the congressional GOP’s attempts to repeal and replace the Affordable Care Act (ACA), the Trump administration has sought regulatory reforms that could improve health care choices and reduce costs for consumers. Among their options is the reversal of a recent regulation that sought to restrict the availability of short-term limited duration plans—insurance coverage exempted from the ACA’s regulations, which had previously been available for terms of up to one year. These plans have been criticized for offering poor value to consumers but also for appealing to enrollees who might otherwise sele...
Source: Health Affairs Blog - August 31, 2017 Category: Health Management Authors: Christopher Pope Tags: Following the ACA Insurance and Coverage individual market repeal and replace short-term limited duration plans Source Type: blogs
Medicaid Coverage For Residential Substance Use Disorder Treatment: Addressing The Institution For Mental Disease Exclusion Policy
This article was informed and adapted from a proprietary report created for the Medicaid Evidence-based Decisions Project (MED), a self-governing collaborative of 19 state Medicaid agencies, supported by the Center for Evidence-based Policy (the Center) at Oregon Health and Science University. The Center produces evidence and policy reports requested by the MED collaborative to help state policy makers make evidence-based decisions for improving health outcomes. For more information about MED or the Center, please call (503) 494-2182 or visit centerforevidencebasedpolicy.org.
This report was approved for publication by the...
Source: Health Affairs Blog - August 31, 2017 Category: Health Management Authors: Kelsey C. Priest, Allison W. Leof, Dennis McCarty and Valerie King Tags: Insurance and Coverage Medicaid and CHIP Population Health Institution for Mental Disease exclusion policy opioid crisis Section 1115 waiver substance use disorder substance use disorder treatment Source Type: blogs
What Medicaid Recipients And Other Low-Income Adults Think About Medicaid Work Requirements
To make the Affordable Care Act’s (ACA) Medicaid expansion more politically palatable, a number of conservative states have used 1115 Medicaid demonstration waivers to implement personal responsibility focused policies. These waivers have been used, for example, to charge Medicaid recipients premiums and to institute cost sharing above statutory limits. Under the Obama administration, four states applied for waivers to integrate work requirements into their Medicaid programs, arguing work requirements would help recipients move out of poverty and gain access to private coverage. The Obama administration denied these requ...
Source: Health Affairs Blog - August 30, 2017 Category: Health Management Authors: Jessica Greene Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Quality Kentucky HEALTH Medicaid work requirements Section 1115 Waivers Source Type: blogs
CMS Details 2018 Open Enrollment Period Procedures; Tax Court Rules APTC Must Be Repaid After Income Change
The open enrollment period for 2018 begins in a little over two months, and yet there remain a lot of unknowns about how it will proceed. In mid-July, the Centers for Medicare and Medicaid Services released a guidance stating that it would basically follow the procedures it followed in 2016 for the 2017 open enrollment period, with a few changes. On August 28, 2018, CMS released at its REGTAP.info website slides dated July 17, 2017, setting out in much greater detail the procedures it intends to follow for the 2018 open enrollment period.
As during 2017, CMS will conduct two waves of batch auto-enrollments (BARs). The firs...
Source: Health Affairs Blog - August 29, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs
