A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Archive: May 2011

Commonwealth brief addresses potential for abrupt changes in financial responsibility and gaps in health insurance coverage under ACA

Posted on May 31, 2011

The Affordable Care Act (ACA) builds on existing sources of public and private health insurance, while creating new health insurance Exchanges and subsidies. A potential disadvantage of maintaining multiple sources of health insurance is the likelihood of abrupt changes in coverage or financial responsibility when individual circumstances change. The Commonwealth Fund brief, “Realizing Health Reform’s Potential: Maintaining Coverage, Affordability, and Shared Responsibility When Income and Employment Change,” describes four policy challenges related to such abrupt changes: 1) adjusting premium and cost-sharing subsidies when incomes change; 2) coordinating eligibility for premium credits, Medicaid and the Children’s Health Insurance Program (CHIP); 3) encouraging and facilitating continuous coverage; and 4) minimizing transitions between individual and small-business exchanges. The brief outlines several policy recommendations to reduce uncertainty, simplify coverage decisions, and minimize insurance transitions. These policy change suggestions include extending coverage to the open enrollment period at the end of the year, generous treatment of income gains in correcting premium tax credits, and unifying the small-business and individual exchanges.

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National Academy for State Health Policy paper encourages FQHCs to connect with states and private practices

Posted on May 30, 2011

By forging connections between federally qualified health centers (FQHCs) and other primary care providers, states may be able to connect Medicaid beneficiaries with services needed to help them manage their health and prevent costly hospital visits. FQHCs provide a comprehensive scope of primary and preventive health care and support services and have access to federal funds. This duality gives them the expertise and resources that might be leveraged to forge symbiotic relationships with states and private practices. The collaboration could benefit FQHCs by strengthening their financial position, advance quality goals, improve staffing mix, and enhance the care continuum and services available to patients. Funded by the Commonwealth Fund and authored by the National Academy for State Health Policy, the report “Developing Federally Qualified Health Centers Into Community Networks to Improve State Primary Care Delivery Systems,” identifies states and FQHCs that are collaborating to build community networks to make medical home services available for vulnerable populations. Such collaborations offer important lessons for states to consider as they work to improve their primary care delivery system.

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CBO analyzes permanent prohibition on implementation of health reform

Posted on May 26, 2011

The Congressional Budget Office (CBO) has released a report to Congress analyzing the bugetary implications of legislation that permanently prevents the use of appropriated funds in Affordable Care Act (ACA) implementation. The analysis, submitted by CBO and the Joint Tax Commission (JCT) to Congressman Henry Waxman (D-CA) at his request, finds that the effects of a permanent prohibition on appropriated funds would largely depend on the Obama Administration’s interpretation of such a prohibition. CBO and JCT also found it difficult to measure the magnitude of effects on the deficit because any potential savings realized by reductions in spending might be offset by a significant loss in revenues resulting from the prohibition.

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HHS releases plan for retrospective rule review

Posted on May 26, 2011

The US Department of Health and Human Services (HHS) has issued a new plan aimed at improving the agency’s rulemaking and regulatory process. Pursuant to President Obama’s Executive Order 13563 of January 18, 2011, and its intent to make the nation’s overall regulatory process more transparent and less cumbersome, the HHS plan sets forth the agency’s priorities for reviewing, streamlining, and if necessary, removing existing rules and regulations.

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Medicaid Access Rule

Posted on May 26, 2011

Access to health care has been a prime focus of the Medicaid program since it’s enactment in 1965. A key aim of the Medicaid statute has been to integrate Medicaid beneficiaries into the general health care system, affording them insurance coverage that would enable them to secure care from the participating provider of their choice in a manner similar to that enjoyed by privately insured individuals and Medicare beneficiaries. It is evident, however, that despite Medicaid’s enormous achievements, access to “mainstream” medical care has remained elusive.

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CMS issues final rule on insurance rate review

Posted on May 20, 2011

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) have issued a final rule implementing Section 1003 of the Affordable Care Act (ACA), which governs disclosure and review of “unreasonable” health insurance premium rate increases. As with the previously-issued proposed rule, the final rule calls for justification by insurers to state or federal reviewers on any health insurance premium rate increase of 10% or more, beginning in September of 2011. After one year, in September 2012, the level triggering state or federal rate review and justification will be 10%, or at a state-determined level based on individual factors within that state.

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New Pioneer ACO Model Announced by CMS

Posted on May 20, 2011

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) have announced that the Center for Medicare and Medicaid Innovation (Innovation Center) will support a new type of Accountable Care Organization, called the Pioneer ACO Model. This type of ACO is designed to work in conjunction with both public and private payers and is estimated by the Medicare Chief Actuary to save up to $430 million over 3 years because of better care management and coordination.

“The Pioneer Model is an opportunity for those organizations that have already adopted significant care coordination processes to move further and faster into seamless, coordinated care by utilizing alternative payment mechanisms,” said Richard Gilfillan, M.D., director of the Innovation Center.

CMS will accept applications for Pioneer ACOs through July 18, 2011.

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NEJM article discusses how to rein in Medicare/Medicaid spending

Posted on May 19, 2011

In her New England Journal of Medicine article, “Hard Choices–Alternatives for Reining in Medicare and Medicaid Spending,” Dr. Meredith B. Rosenthal of the Harvard School of Public Health compares and contrasts the two most prominent proposals to reform health care: Paul Ryan’s “Roadmap for America’s Future” and the White House’s Affordable Care Act (ACA). She summarizes the main arguments supporting and opposing the two plans. The beauty of Ryan’s plan is that by fixing the federal government’s contribution to Medicare and Medicaid to a formula unrelated to the growth of overall health care costs, it would guarantee controlled federal spending growth. However, this would also shift financial risk to beneficiaries and state governments. The ACA alters the landscape for control federal health care spending by creating new institutions intended to facilitate progress toward reform and by directly altering payment formulas for Medicare and Medicaid. The downside of this cost savings portion of the ACA is that implementation of payment and delivery reforms is complex.

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CMS issues RFC on improving care for duals

Posted on May 16, 2011

The U.S. Department of Health and Human Services (HHS) has issued a Request for Comment (RFC) on opportunities for aligning benefits and incentives to improve overall care for individuals eligible for both Medicare and Medicaid.

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NEJM article compares and contrasts Paul Ryan’s “Roadmap for America’s Future” with the ACA

Posted on May 13, 2011

The New England Journal of Medicine’s perspective piece “Consensus and Conflict in Health System Reform–The Republican Budget Plan and the ACA” by Timothy Stoltzfus Jost, J.D., compares and contrasts Representative Paul Ryan’s (R-WI) “Roadmap for America’s Future” with the Affordable Care Act (ACA). In terms of their similarities, both plans would create a health care system in which many Americans purchase private health insurance using partially means-tested public subsidies through an exchange-based, information-rich competitive market, which is (more or less) open to all regardless of health status. Those who choose to remain uninsured would incur a penalty (or forgo a benefit), and those who purchased insurance would be responsible for significant costs. Jost also details five key differences between Roadmap and the ACA in the piece.

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