“An estimated 30 million Americans are expected to gain health insurance through the Affordable Care Act (ACA), and a healthy and sizable workforce will be needed to meet the increased demand. The health care workforce is already facing a critical shortfall of health professionals over the next decade. The ACA breaks the promises of access and quality of care for all Americans by escalating the shortage and increasing the burden and stress on the already fragile system. The ACA’s attempts to address the shortage are unproven and limited in scope, and the significant financial investment will not produce results for years due to the training pipeline. With the ACA’s estimated 190 million hours of paperwork annually imposed on businesses and the health care industry, combined with shortages of workers, patients will be facing increasing wait times, limited access to providers, shortened time with caregivers, and decreased satisfaction.

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“Earlier today, Marilyn Tavenner of the Centers for Medicare and Medicaid Services announced that “more than 6 million Americans have signed up for coverage through the Health Insurance Marketplaces since October 1, thanks to the Affordable Care Act.” Given all of the technical problems that dogged healthcare.gov last October, this is an impressive turnaround. But it sheds little light onto the two questions most analysts are focused on. First, how many of those signing up have paid their first month’s premium, thereby activating coverage? And second: How many of those with coverage were previously uninsured? At this point, we have no definitive answers.”

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Permit employers to offer employees rewards of up to 30%, increasing to 50% if appropriate, of the cost of coverage for participating in a wellness program and meeting certain health-related standards. Establish 10-state pilot programs to permit participating states to apply similar rewards for participating in wellness programs in the individual market.

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Increase spending caps for the territories.

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Reduce states’ Medicaid Disproportionate Share Hospital (DSH) allotments.

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Expand Medicaid to all non-Medicare eligible individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL based on modified adjusted gross income (MAGI) and provides enhanced federal matching for new eligibles.

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Require Medicare Advantage plans to have medical loss ratios no lower than 85%.

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Reduce Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increase payments based on the percent of the population uninsured and the amount of uncompensated care provided.

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The Independent Payment Advisory Board, unaccountable to Congress, will be empowered to set reimbursement rates for government health programs.

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