Medicare Accountable Care Organizations (ACOs) were created by the Affordable Care Act (ACA) to improve the efficiency of the networks of hospitals and doctors that deliver services to Medicare patients and thereby lower the government’s costs. So far, however, ACOs haven’t produced any savings for the federal government. ACOs would become more efficient and innovative if they were forced to compete with the other options beneficiaries have for getting their Medicare-covered benefits.
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The White House budget for fiscal 2019 seeks major savings by repealing ObamaCare and endorsed a Senate GOP bill as the best way to do so.
“The Budget supports a two-part approach to repealing and replacing Obamacare, starting with enactment of legislation modeled closely after the Graham-Cassidy-Heller-Johnson (GCHJ) bill as soon as possible,” the White House said in its budget request.
The legislation from Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Ron Johnson (R-Wis.) and Dean Heller (R-Nev.) would replace ObamaCare with a series of block grants to states.
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House Republicans are in discussions about repealing or delaying ObamaCare’s employer mandate to offer health insurance, House Ways and Means Committee Chairman Kevin Brady (R-Texas) said Tuesday.
Brady told reporters that he has discussed the idea with Health and Human Services Secretary Alex Azar, as well as other members of the Ways and Means Committee.
“We’ve discussed that with him as well as committee members, so yeah, there is that discussion, and I’d like to see us make progress there,” Brady said.
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Idaho has a maverick plan to let insurers sell plans that don’t meet Obamacare coverage rules and patient protections to give more health insurance options to citizens who can’t afford the expensive Obamacare policies. Gov. Butch Otter issued an executive order to authorize a state-level version of the “Cruz amendment,” which Senator Ted Cruz (R-TX) offered to the Better Care Reconciliation Act during efforts to repeal the ACA last year. The amendment would have allowed insurers to offer non-ACA-compliant plans in the individual market so long as they also offered plans through the marketplace. Other conservative states are keeping a close eye on the option. HHS Secretary Alex Azar said he would closely scrutinize Idaho’s plan, but he said it was too early to know what action he might take.
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The budget deal in Congress is billed as a measure to grant stability to a government funding process that has lurched from crisis to crisis — but it is also stuffed with provisions that will broadly affect the nation’s health care system, like repealing an advisory board to curb Medicare spending and funding community health centers. Among the more significant provisions is one that would eliminate a powerful 15-member panel, known as the Independent Payment Advisory Board, created by the ACA to control the rising costs of Medicare. The board was to recommend specific savings if Medicare spending per beneficiary was projected to grow faster than certain benchmarks. Congress could have stepped in to block the recommendations, but they did not need congressional approval to take effect. The power of the board gave pause to politicians in both parties, and health care providers and some advocates for Medicare beneficiaries said it could threaten patients’ access to care.
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The congressional GOP should allow states to emulate Romneycare, by structuring ACA funds as block grants to reward states for increasing overall insurance coverage by targeting public funds to fill gaps in private insurance.
Over the past year, the Republican Congress failed to enact an attractive alternative to the Affordable Care Act, with the Congressional Budget Office estimating its various proposals as leaving between 17 and 23 million more individuals uninsured. Yet, the healthcare reform signed into law by Mitt Romney as governor of Massachusetts covered more people than under the ACA, despite spending less in public funds.
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Sen. Graham told Breitbart News, “If the reports are true that the Republican leadership is abandoning the promise to repeal Obamacare, it’s a huge mistake not only in the short term, but also the long run. There’s only unpardonable sin in politics, and that’s to stop trying to fulfill a promise.”
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President Trump’s State of the Union address left some declaring that he has “thrown in the towel” on repealing Obamacare. But conversations I’ve had with people in the Trump White House make clear that health care, including Obamacare, remains front-and-center for this administration.
Recently, I spoke with Andrew Bremberg, Director of the President’s Domestic Policy Council, about Trump’s health care agenda for 2018. His view—and his boss’s view—is that the Trump administration has done more than people appreciate on Obamacare, and on health care more broadly. On health care, Trump’s “policy direction is more robust and substantive than some people understand,” Bremberg said.
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Congressional Republicans were elected to repeal Obamacare. They may run this year as the politicians who saved it. Since late last year, GOP leaders have been planning to pump tens of billions of dollars’ worth of new federal spending into the veins of insurance companies that are hemorrhaging red ink on the Obamacare exchanges.
The transfusion is expected to be a concoction of two bills. The first, championed by Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.), would appropriate cost-sharing-reduction payments to insurers. The second, sponsored by Sens. Susan Collins (R., Maine) and Bill Nelson (D., Fla.), would give insurers an additional $10 billion (and perhaps more) in federal cash.
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Americans are among the most generous people in the world. While this nation was founded on the pursuit of a shared dream, the moral pledge of the American people has been to never leave behind our most vulnerable fellow citizens.
When we created Medicaid in 1965 as part of President Lyndon B. Johnson’s War on Poverty, we formalized that commitment and wove a fabric of care that has provided health services for seniors in need, pregnant mothers, low-income children and parents, and people with disabilities. Johnson affirmed the nation’s safety net, saying, “Our aim is not only to relieve the symptoms of poverty, but to cure it and, above all, to prevent it.”
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