Category: Implementation

“Republicans’ strong showing in this week’s mid-term elections opens the door to more calls to repeal President Obama’s signature law, the Affordable Care Act.
And while that is all but impossible given the balance of power in the U.S. Senate, victories in Washington and at the state level could usher in other healthcare changes.”

“Fox News’ Megyn Kelly grilled House Majority Leader Kevin McCarthy, R-Calif., about whether a Republican-controlled Congress would seek to repeal Obamacare.
After repeated questions from Kelly, McCarthy said, “I would press for [a vote to repeal Obamacare] when we have ability to replace it at the same time.””

“President Reagan gauged the success of a welfare program by how quickly people were able to move off government assistance and into remunerative work. Yet President Obama, the White House, and their allies are measuring the success of Obamacare by how many people can be enrolled in their new government entitlement programs.
The president celebrated the law’s “success” in getting seven million people enrolled in Medicaid and eight million (or so) people enrolled in exchange coverage, 87 percent of whom are receiving government subsidies for their insurance. And he hopes to lure another five million people onto Obamacare programs starting with the November 15 enrollment period. There is no expectation that participation in these government programs will be a temporary boost but rather that they will become a permanent fixture in people’s lives.”

“Since enactment of the Affordable Care Act (ACA) in 2010, much of the attention in the policy community has been on modernizing Medicare’s traditional fee-for-service (FFS) program. Through Accountable Care Organizations (ACOs), larger “bundles” of payments to fee-for-service providers for episodes of care, and tests of pay-for-performance models, the hope is that the traditional Medicare model can be remade through sheer force of bureaucratic will. The stated intent is to find a way to pay for value, not volume.
These efforts may or may not bear much fruit, but, over the longer term, it’s not likely to matter much. That’s because a more important transformation of Medicare is already well underway and is occurring despite more resistance than assistance from the program’s bureaucracy. According to the 2014 Medicare Trustees’ report, enrollment in Medicare Advantage – the private plan option in Medicare — has been surging for a decade. In 2005 there were 5.8 million Medicare beneficiaries enrolled in MA plans — 13.6 percent of total enrollment in the program. Today, there are 16.2 million beneficiaries in MA plans, or 30 percent of program enrollment. (See Table IV.C1) In addition, the Medicare drug benefit, which constitutes about 12 percent of total program spending, is delivered entirely through private plans.”

“There is nothing more time consuming and expensive for a patient than undergoing extra tests or procedures during a trip to the emergency room, doctor’s office or urgent care center.
Often a physician will know exactly what a patient’s diagnosis is but will order an x-ray, CT scan, blood work or MRI to reaffirm his clinical judgment. The common rationale is to back up his opinion in case there is a lawsuit.”

“LOS ANGELES On the heels of an advertising blitz funded by health insurance companies, California voters on Tuesday tanked a proposal to give the state’s insurance commissioner veto authority over health insurance premiums.
About 60 percent of voters cast ballots against the plan to give the elected commissioner expanded authority over small group and individual health plans.”

“When the Affordable Care Act marketplace opens on Nov. 15, consumers can expect healthcare.gov to have robust technology, amped-up functions, and a shorter application form for individual plans.
What they won’t see – and likely won’t know about – are the ongoing communication problems that many on the insurance industry say continue to plague the “back-end” transfer of consumer files between the website and insurance companies.”

“Tuesday’s re-election of Republican governors in closely contested races in Florida, Georgia, Wisconsin, Maine and Kansas dims the chances of Medicaid expansion in those states.
Advocates hoping for Democratic victories in those states were disappointed by the outcomes, but Alaska, which also has a Republican incumbent, remains in play as an independent challenger holds a narrow lead going into a count of absentee ballots.
“No one would say it was a good night for the prospects of Medicaid expansion,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.”

“The Obama administration plans to close a loophole in the Affordable Care Act that allows large companies to refuse to cover in-patient hospital stays in any of their health insurance plans, according to an official involved in the internal discussions.
The official requested anonymity until the announcement is made because “the guidance that will be issued is not finalized.””

“Healthcare stakeholders and the public likely will have to wait at least another week—if not longer—to find out whether the U.S. Supreme Court will hear King v. Burwell, a case with the potential to severely disrupt implementation of the Patient Protection and Affordable Care Act.
The justices were scheduled last Friday to discuss whether to hear the case, but on Monday morning it was announced that they took no action. Shortly after that announcement, the court’s website showed that the justices had scheduled another private discussion about the case, which is called relisting.”