The CMS has finalized a proposed rule to exempt more small providers from complying with MACRA. It also reversed course on plans to give providers a pass on gauging whether they are cutting costs under the Merit-based Incentive Payment System, or MIPS.

Physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year would be exempted under the rule finalized Tuesday.

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The Affordable Care Act is failing. Focused on shrinking the uninsured population, the law expanded government insurance programs and imposed considerable federal authority over U.S. health care via new mandates, regulations, and taxes. The harmful impacts of this ill-conceived approach should now be clear: Insurance premiums have skyrocketed even as deductibles rose; consumer choice on the state insurance marketplace has rapidly vanished; and for those with ACA coverage, doctor and hospital choices have narrowed dramatically. Meanwhile, consolidation across the health care sector has accelerated at a record pace, portending further harm to consumers, including higher costs in medical care.

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The upside of the failure of the Senate to pass any semblance of repealing and reforming the ACA is that it highlights three structural impediments to achieving not only health care insurance reform, but most of the Trump agenda as well: 1) Congress must realign its interests with voters’ interests; 2) The Senate must eliminate the Senate’s incumbent protection racket, where deliberation on legislation is avoided to spare Senators—of both parties—tough votes; 3) Conservatives must learn how to sell their ideas.

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The premiums for 2018 Marketplace plans were recently released to give consumers a chance to look at their plan options before open enrollment begins on November 1. Premiums are rising significantly in many counties across the country, in part due to the decision of the Trump Administration to cease payments to insurers for cost-sharing reductions. Insurer participation also declined in many areas, leaving more counties with only one insurer, which likely contributed to the high rate of premium growth.

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For some lower-income people in Obamacare, the rising premiums President Donald Trump has talked so much about will barely be felt at all. Others, particularly those with higher incomes, will feel the sharp increases when insurance sign-ups begin Wednesday.

Richard Taylor is one of the people on the wrong end. The 61-year-old, self-employed Oklahoman has meticulously tracked his medical costs since 1994. In 2013, he signed up for an Affordable Care Act plan for the law’s first year offering coverage to millions of Americans.
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Democrats are accusing the Trump Administration of “sabotaging” Obama Care by discontinuing illegal subsidies to insurers, but last week even an Obama-appointed judge in California said otherwise. The ruling deserves more public attention.

Federal Judge Vince Chhabria rejected and ridiculed a petition by 18 states to enjoin the White House from stopping cost-sharing reduction payments (CSRs) that subsidize lower copays and deductibles for consumers on the exchanges who earn less than 250% of the poverty line. “It appears initially that the Trump Administration has the stronger legal argument,” the judge noted, adding that “the emergency relief sought by the states would be counterproductive.”
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Suggestions to improve the bipartisan health care bill from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) include: 1) Increase the threshold for requiring employers to offer health benefits to 200 full-time employees from the current 50; 2) Broaden the use of tax-advantaged accounts; 3) Add a provision creating a federal reinsurance fund to help finance care for America’s most expensive patients; 4) Loosen the existing rules to encourage growth of interstate sales of health-care policies; 5) Repeal the Independent Payment Advisory Board, a panel of appointed officials that is supposed to constrain the growth of Medicare costs.

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In an odd twist, low-income people in about half of U.S. counties will now be able to get a taxpayer-subsidized ACA policy for free. The Kaiser Family Foundation found that in 1,540 counties a hypothetical 40-year-old making $25,000 a year can get a basic “bronze” plan under the ACA next year for zero monthly premium. This could become a springboard for marketing pitches by insurers as they try to sign up more consumers.

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The House and the Trump administration are asking to keep a pause on a years-long court battle over the legality of crucial ObamaCare payments to insurers, while Democratic attorneys general are seeking for the case to proceed.

In 2014, the House sued the Obama administration, arguing it was funding key payments to insurers illegally, alleging that there wasn’t a direct appropriation from Congress. The House won, and the Obama administration appealed the ruling.
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President Donald Trump called Wednesday for repealing the Obamacare individual mandate in a tax overhaul, a day before House GOP leaders planned to unveil a bill without that provision.

In a pair of tweets, Trump said: “Wouldn’t it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts for the Middle Class. The House and Senate should consider ASAP as the process of final approval moves along.”
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