Tagged Medicaid

Viewpoints: GOP Health Plan Runs Contrary To Robin Hood’s Rules By Redirecting Funding From Poor To Rich; The Town Hall Duck And Run

A selection of opinions on health care from around the country.

The Washington Post: Trump’s Toxicity Has Republicans Running Away From Their Constituents
As recent town-hall meetings of GOP Reps. Tom McClintock of Elk Grove, Jason Chaffetz of Utah, Gus Bilirakis of Florida, Diane Black of Tennessee and others turn into well-publicized tongue-lashings, their colleagues are ducking and running. … The scene is reminiscent of the tea party summer of 2009, but the energy is on the other side this time. Now, as then, the victims say the perpetrators are outsiders – Chaffetz said those who protested him included “paid” people from out of state, an echo of Nancy Pelosi’s claim of “astroturfing” – but now, as then, the anger is real. (Dana Milbank, 2/15)

Los Angeles Times: Trump Tries To Save Obamacare Exchanges While Undermining Them
With the drive to “repeal and replace” Obamacare losing steam, the Trump administration quietly moved to shore up a key feature of the healthcare law this week: the state exchanges where people shop for non-group coverage. And to its credit, Trump’s Department of Health and Human Services zeroed in on some of the factors that have led a handful of major insurers to leave the exchanges. (Jon Healey, 2/16)

Bloomberg: A Sign That Obamacare Exchanges Are Failing
Yet more bad news for Obamacare this week: Molina Healthcare lost $110 million on the exchanges last year, and the CEO told investors, “There are simply too many unknowns with the marketplace program to commit to our participation beyond 2017.” At first glance, it’s hard to see why this piece of news is worth worrying about. UnitedHealth recently projected several times those losses, and it’s a bigger player on the exchanges. Why spend so much time looking at one modest-size insurer? Because Molina is one of the companies that has been repeatedly pointed to, by virtually every health-care-policy wonk in the business, as one of the “bright spots” on the exchanges. (Megan McArdle, 2/16)

The New England Journal Of Medicine: Adjusting Risk Adjustment — Accounting For Variation In Diagnostic Intensity
In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving sicker or harder-to-treat patients and insurers aren’t penalized for covering them. For example, the private insurance companies that participate in Medicare Advantage and the Affordable Care Act (ACA) exchanges receive risk-adjusted payments from the U.S. government, with the rationale that insurers should be reimbursed more for enrollees with higher expected costs. (Amy Finkelstein, Matthew Gentzkow, Peter Hull and Heidi Williams, 2/16)

RealClear Health: A Small HSA Fix Could Produce Big Results
As Congress and the Trump administration begin laying the foundation for their replacement plan for the Affordable Care Act (ACA), their starting point should be ensuring all Americans have a ready path for enrollment in health insurance that, at a minimum, provides protection against major medical expenses. They should also promote broadened enrollment in Health Savings Accounts (HSAs) as an important means for paying for care before insurance coverage kicks in. (James C. Capretta, 2/17)

Louisville Courier-Journal: Demand For Medicaid Waivers Exceeds Funds
The “most vulnerable of our society” is a phrase that gets thrown around a lot. Politicians employ it in speeches and press releases to describe constituents who cannot take care of themselves. People with intellectual and developmental disabilities fall under this banner of protection. (Amanda Beam, 2/16)

Sacramento Bee: California Provides Model To Replace The Affordable Care Act
The new administration and Congress are under intense pressure to craft a market-based alternative to the Affordable Care Act. It won’t be easy. To achieve the financial stability required to make the market work, reformers should heed some important lessons from California. Health plans and risk-taking medical groups essentially made a “deal” with Congress to participate in the ACA. They agreed to cover applicants with pre-existing conditions without charging higher premiums in return for: an expanded individual market driven by a federal mandate that everyone buy insurance; premium and cost-sharing subsidies financed by insurers and the government; and three federal risk-mitigation programs to help stabilize the new marketplaces. (Leonard D. Schaeffer and Dana Goldman, 2/14)

Orange County Register: California Job Losses From Obamacare Repeal? Fear Not!
Obamacare was a cash cow for providers, which now argue it was a program for jobs and economic growth. They now say that repealing Obamacare will kill California jobs. That grabs any politician’s attention, but it is not true. According to a study by the UC Berkeley Labor Center, which is promoted by the California Hospital Association, “The majority (135,000) of these lost jobs would be in the health care industry, including at hospitals, doctor offices, labs, outpatient and ambulatory care centers, nursing homes, dentist offices, other health care settings and insurers. (John R. Graham, 2/16)

Cleveland Plain Dealer: Boost Funding To An Ohio Foster Care System Increasingly Burdened By The Opioid Crisis
Ohio Gov. John Kasich has been in the thick of the battle against deadly opioids, signing a bill this year to tighten restrictions on prescription opioids, speaking at conferences about heroin and even sending an Ohio Highway Patrol superintendent in April to Trumbull County after beleaguered officials there begged for help in quelling a rising tide of opioid overdoses and deaths. (2/17)

The Des Moines Register: A Second Chance To Pass Aid-In-Dying Bills
In a Gallup Poll conducted May 4-8, 2016, respondents were asked: “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it?” Sixty-nine percent of respondents answered yes. (John S. Westefeld, 2/16)

Lexington Herald Leader: Whooping Cough Making A Comeback
In the past few weeks, there have been several confirmed cases of whooping cough, also known as pertussis, in Fayette County schools and other surrounding counties. Many parents are concerned about exposure and have questions about preventing pertussis infection or recognizing symptoms. (Jessica Murray, 2/16)

The New England Journal Of Medicine: Addressing The Fentanyl Threat To Public Health
Fentanyl, a powerful synthetic opioid, poses an increasing public health threat. Low production costs encourage suppliers to “cut” heroin with the drug, particularly white powder heroin sold in the eastern United States. Fentanyl also appears as a prevalent active ingredient in counterfeit OxyContin (oxycodone) tablets. The result is that fentanyl plays a major role in rising mortality due to heroin or opioid overdose. It poses a serious overdose risk because it can rapidly suppress respiration and cause death more quickly than do other opioids. (Richard G. Frank and Harold A. Pollack, 2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Medicaid Block Grants; Job Loss And The ACA; Growing HIV Coverage

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Urban Institute: What TANF Can Teach Us About Block Granting Social Services
White House officials and congressional leaders have talked about seizing the opportunity to pass sweeping changes to federal antipoverty programs. One potential change is to give block grants of federal funds to states and allow states greater flexibility …. House Speaker Paul Ryan has long contended that expanding the block grant model to other facets of the safety net — such as Medicaid and food stamps — would afford states the flexibility to drive innovation in combating poverty. But examining the results of welfare reform after two decades presents a more cautionary tale …. Simply put, all states ended up with far fewer funds and a diminished ability to meet their residents’ needs. (Hahn and Coffey, 2/7)

The Kaiser Family Foundation: Current Flexibility In Medicaid: An Overview Of Federal Standards And State Options
This brief provides an overview of current federal standards and state options in Medicaid to help inform upcoming debates about increasing state flexibility in the program as part of efforts to restructure Medicaid financing. Today, states operate their Medicaid programs within federal standards and a wide range of state options in exchange for federal matching funds that are provided with no limit. Each state Medicaid program is unique, reflecting states’ use of existing flexibility and waiver authority to design their programs to meet their specific needs and priorities. As proposals to restructure Medicaid financing develop, it will be important to examine what additional flexibilities they would provide to states and what standards, accountability and enrollee protections would remain for states to access federal funds. (Artiga et al., 1/31)

Urban Institute/Robert Wood Johnson Foundation: Recent Evidence On The ACA And Employment: Has The ACA Been A Job Killer? 2016 Update
We find no evidence to support claims that the ACA has been a job killer. Through 2016, the ACA had little to no adverse effect on employment and usual hours worked per week. For both measures, levels in 2014, 2015, and 2016 are statistically identical to our projections based on patterns existing before 2014, the year the major provisions of the ACA went into effect. Our conclusion applies to the full sample of nonelderly persons and to subgroups of nonelderly persons based on gender and educational attainment. Levels of part-time work (29 or fewer hours per week) have fallen since 2014, but remain at somewhat higher levels than would be expected given recent declines in the unemployment rate and overall economic improvement. (Garrett, Kaestner and Gangopadhyaya, 2/16)

The Kaiser Family Foundation: Insurance Coverage Changes For People With HIV Under The ACA
This brief provides the first national estimates of changes in insurance coverage among people with HIV since the implementation of the ACA. It is based on analysis of data from the Centers for Disease Control and Prevention (CDC). We find that coverage increased significantly for people with HIV due to the ACA’s Medicaid expansion; indeed, increased Medicaid coverage in expansion states drove a nationwide increase in coverage for people with HIV. In addition, the share relying on the Ryan White HIV/AIDS Program also increased. (Kates and Dawson, 2/14)

Brookings/USC Schaeffer Center for Health Policy & Economics: Re-Balancing Medical And Social Spending To Promote Health: Increasing State Flexibility To Improve Health Through Housing
The health impacts of interventions that improve economic conditions such as household income are still the subject of considerable debate. Some economists find little support to show that public transfer payments improve health outcomes, while others argue that federal assistance frees family income to spend on better access to health care, and thereby improves population health. Some researchers have identified evidence that stressful work environments and educational disparities are social mechanisms with a deleterious impact on health, but the evidence that increased public spending targeting these mechanisms will improve health outcomes is nascent. In contrast, the research showing that expenditures that improve access to safe, affordable housing improve population health is relatively strong. (Butler, Matthew and Cabello, 2/15)

Here is a selection of news coverage of other recent research:

MedPage Today: Study: Beware The Snippy, Snarky Surgeon?
The more complaints lodged at surgeons, the more likely it was for their patients to suffer complications after going under the knife, a study found, helping explain why operators with the least favorable reviews get sued the most. Surgeons who had a history of unsolicited patient reviews — often regarding rudeness and intimidation directed at patients and other healthcare professionals alike — were tied to greater risks of: Complications for patients …. Surgical complications …. Patient readmissions. (Lou, 2/15)

Reuters: Salt Reduction Policies Cost-Effective Even Without Healthcare Savings
Government policies designed to reduce how much salt people eat may be cost-effective even without considering the potential healthcare savings, a recent study suggests. That’s because efforts to curb salt use through policies like public education and industry agreements would not cost that much relative to their potential to reduce mortality and disability, researchers estimate. (Rapaport, 2/10)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Kansas Committee Expected To Take First Vote On Medicaid Expansion Today

The issue has been swatted down repeatedly since the health law went into effect, but after moderates ousted several conservatives in last fall’s elections, a legislative panel is scheduled to vote on a measure today. The committee’s chairman, Rep. Dan Hawkins, a Wichita Republican, says it will be close. News outlets also report on Medicaid developments in Ohio, Alabama and California.

KCUR (Kansas City, Mo., Public Radio): Close Vote Expected On KanCare Expansion Bill 
Kansas lawmakers are getting ready to do something they have never done before: vote on a Medicaid expansion bill. For the past three years, conservative Republicans who controlled the Legislature refused to allow a vote on the issue. Things are different this session due to the ouster of several conservative incumbents by moderate Republican and Democratic challengers. (McLean, 2/16)

Toledo Blade: After Expansion, Medicaid Attracts More Older Men
Those enrolled in Ohio’s expanded Medicaid program in partnership with the federal Affordable Care Act turned out to be older than expected. Barbara Sears, Gov. John Kasich’s Medicaid director and former state representative from Monclova Township, said Thursday she was a little surprised to see how the population skewed older. “But when we knew we weren’t getting the younger folks into the [federal Obamacare private insurance] marketplace, we knew they probably weren’t getting into [the Medicaid expansion],” she said after speaking to the legislative Joint Medicaid Oversight Committee. (Provance, 2/16)

Modern Healthcare: Alabama Could Lose Medicaid Funding For Allegedly Rejecting Eligible Enrollees
The CMS may cut Alabama’s Medicaid funding after learning state officials reject people eligible for Medicaid coverage if they are found to have engaged in fraud or abuse but were never convicted of any criminal act. The CMS said Alabama officials also had a practice of recouping funds from these individuals. Alabama has said it is simply trying to take action against those who lie on their applications about having been previously accused of criminal activity. (Dickson, 2/16)

California Healthline: Some Immigrants, Fearful Of Political Climate, Shy Away From Medi-Cal
Some foreign-born Californians are canceling their Medi-Cal coverage or declining to enroll in the first place, citing fears of a Trump administration crackdown on immigrants. Among those dropping coverage are people in the country legally but concerned about jeopardizing family members who lack permanent legal status, according to government officials, immigration attorneys and health care advocates. (Bazar, 2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Longer Looks: A K Street Renegade; Dismantling Obamacare & Opioids In Sierra Leone

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

The Wall Street Journal: The Rise And Fall Of A K Street Renegade
Few outside Washington had ever heard of Evan Morris. Yet in the capital of wheeling and dealing, he was one of its most gifted operators. From his start as an intern in the Clinton White House, he made powerful friends and at age 27 became a top Washington lobbyist for Roche Holding AG of Switzerland, one of the world’s largest pharmaceutical companies. (Brody Mullins, 2/13)

Vox: No Limits 
Timmy Morrison was delivered by emergency C-section, weighing in at 3 pounds, 9 ounces. Doctors put him under anesthesia within a week and into surgery within a month. Parts of his stomach sometimes made their way to his lungs. Workers in the intensive care unit frequently needed to resuscitate him. He arrived seven weeks premature — but, in a way, just at the right time. (Sarah Kliff, 2/15)

The Dallas Morning News: Severely Disabled Kids’ Lives At Risk, Parents Say, As Texas Enacts Medicaid Cost-Savings Plan
Amy Pratt drove her severely disabled son, Quinten, four-plus hours to Children’s Medical Center Dallas only to learn the insurance company that Texas hired to care for him had suddenly denied payment for an important procedure, one that could potentially save the 9-year-old’s life. In El Paso, 11-year-old Rudy Smith lost most of the therapy services that helped him cope with cerebral palsy and a severe form of epilepsy, which plagues him with 50 to 100 seizures a day. His mother says she’s having trouble getting prescriptions filled, and the insurance company keeps sending her incorrect or faulty medical supplies. (J. David McSwane, 2/13)

The New York Times: Will Obamacare Really Go Under The Knife?
Six days after he was sworn in as America’s 45th president, Donald J. Trump traveled to Philadelphia to address Republican lawmakers at their annual retreat. Standing behind a lectern emblazoned with the presidential seal, Trump predicted, “This Congress is going to be the busiest Congress we’ve had in decades.” Being Trump, he could not resist ad-libbing a superlative: “Maybe ever. Maybe ever. Think of that.” (Robert Draper, 2/14)

The Atlantic: Universal Health Care And The Future Of The Affordable Care Act 
The Senate confirmed Tom Price as secretary of health and human services at 2 a.m. on Friday. After a contentious confirmation process, the Trump administration and the Republican-controlled Congress had finally installed one of the leading generals in its war on Obamacare in the department that oversees its programs. Price is a titan in the GOP camp that wants to repeal the health law, and is perhaps one of the few Republican lawmakers with both the vision and the experience needed to begin the daunting task. (Vann Newkirk, 2/14)

The New Yorker: Another Planned Parenthood Protest Showdown
In January, 1993, the New York City Council moved unanimously to erect a sign at the intersection of Bleecker and Mott streets designating the small corner on the eastern edge of the West Village as Margaret Sanger Square. The bill, introduced by Kathryn Freed, noted that Sanger had opened America’s first birth-control clinic, in Brooklyn, in 1916, and that when she was arrested and jailed on obscenity charges she had taught her fellow-inmates about contraception. Her second birth-control clinic eventually became part of Planned Parenthood in New York City, which now serves more than fifty thousand patients each year and has been headquartered at the corner of Bleecker and Mott since 1992. (Jia Tolentino, 2/13)

Vox: How Repealing Obamacare Could Splinter Neighborhoods
Sure, it was billed as a policy that would make individual people healthier — and it ended up insuring 20 million people. But it also made neighborhoods healthier. It meant communities no longer had to fight over local tax dollars to care for the uninsured. It also meant there were fewer uninsured people who felt cast out and dehumanized by their communities. It lifted up our poorest and most vulnerable neighbors. (Alvin Chang, 2/13)

Al Jazeera: Opioids: Sierra Leone’s Newest Public Health Emergency
The dark street corner would have been silent if not for the grumble of a motorbike. It was nearing midnight, but for Ibrahim Sesay – a 27-year-old motorbike taxi driver in Freetown – the evening had just begun. He pulled four small pills from his breast pocket, gulped them down without water and set off into the night. (Cooper Inveen, 2/13)      

The Wall Street Journal: Computers Turn Medical Sleuths And Identify Skin Cancer
When it comes to melanoma, early detection is a matter of life and death. But it takes a trained eye to distinguish a harmless blemish from cancer, and many people around the world lack ready access to a dermatologist.Scientists have been seeking a solution for some time. In the latest sign that they’re succeeding, researchers at Stanford University have found a way to get a computer to identify skin cancer as reliably as board-certified dermatologists can. The hope is that, eventually, scientists can get this to happen on a smartphone anywhere in the world. (Daniel Akst, 2/10)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives On The Technicalities Of Repealing, Replacing Or Repairing The Health Law

Opinion writers offer their thoughts on a range of issues related to the health insurance marketplace, Medicaid and Medicare.

RealClear Health: Welcome Back To The Medical Underwriting Circle Of Hell
All leading Republicans who are committed to repealing all or key parts of the Affordable Care Act (ACA) also emphasize their commitment to maintaining the law’s most popular part: banning pre-existing condition exclusions and medical underwriting by preserving the ACA’s (also known as Obamacare) policy of “guaranteed issue.” But the fine print in Republican proposals betrays that commitment, including legislation filed on January 26 by House Energy and Commerce Committee Chairman Greg Walden (R-OR) threatening health security for tens of millions of Americans. (John McDonough and William Seligman, 2/15)

The Washington Post: Could The Most Conservative Members Of Congress Save Obamacare?
Try to wrap your head around this possibility: the House Freedom Caucus, the most conservative members of an extremely conservative Republican majority, might be the saviors of the Affordable Care Act. How is such a thing possible? The answer is their devotion to ideological purity, which it turns out may be as disruptive a political force when the GOP is the ruling party as it was when they were the opposition. (Paul Waldman, 2/14)

St. Louis Post-Dispatch: Senators Show Fundamental Differences On Health Care
I hope many people were able to watch the debate that CNN hosted last week between U.S. Sens. Bernie Sanders and Ted Cruz. They spent over an hour fielding questions from spectators and moderators about the present and future of health care in the United States. Sen. Cruz provided a couple misleading answers and suggestions that I believe are worth clarifying. First, he stated that his primary goal in repealing the Affordable Care Act was to remove government from the equation so that health care would be back in the hands of patients and their physicians. As appealing as he makes it sound, removing government-funded insurance would hardly make a dent in the amount of autonomy patients and their physicians have over their health care. (Jonathan Mizrahi, 2/15)

Health Affairs Blog: The Future Of Essential Health Benefits
The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and Congress seek to repeal and replace the law. Essential Health Benefits, which define what health care benefits plans in the Marketplaces and certain other health plans must cover, go to the heart of what it means to have health insurance and what health care we, as a society, want to ensure people can access. (Ian Spatz and Michael Kolber, 2/14)

The Washington Post: As A Christian, I Defended Obamacare. But I Really Support Single-Payer.
A video of me questioning Rep. Diane Black (R-Tenn.) about how her party will replace the Affordable Care Act went viral last Friday. I had gone to her town hall meeting on Thursday near my home to ask what the poor and sick would do once they’re left without the law’s protections. The next night, I had the really weird experience of seeing myself on national television, and the even weirder experience of hearing and reading other people’s interpretation of my own words. My town hall question has been described as a “Christian defense of Obamacare” and “an impassioned case for the ACA’s individual mandate.” (Jessi Bohon, 2/15)

Sacramento Bee: California Provides Model To Replace The Affordable Care Act 
The new administration and Congress are under intense pressure to craft a market-based alternative to the Affordable Care Act. It won’t be easy. To achieve the financial stability required to make the market work, reformers should heed some important lessons from California. (Leonard Schaeffer and Dana Goldman, 2/14)

The Wall Street Journal: Donald Trump’s Medicaid Promise
In the midst of the tumult that now grips Washington, it is easy to forget that President Trump has yet to send Congress either a budget or a single piece of legislation. When he does, some longstanding tensions within the Republican coalition are likely to occupy center stage. (William A. Galston, 2/14)

Lincoln Journal-Star: Americans Deserve Their Medicare
AARP believes Medicare is a deal with the American people that must not be broken. That’s why we will oppose proposals in Congress to turn Medicare into a voucher system, which would drive up costs for current and future retirees and erode protections that Americans have earned through a lifetime of hard work and taxes. Unfortunately, in a short-sighted attempt to save money vouchers are being promoted on Capitol Hill as an answer to rising costs. (David Holmquist, 2/15)

The Washington Post: We Created Medicare For The Elderly. Why Not Do The Same For Children?
With all eyes focused on the nation’s health-care system, our leaders have an opportunity to put the health and future of America’s children first. Congress should consider building a tailor-made national health-care plan just for children. Just as we created Medicare for the elderly, we need an approach to pediatric health care that not only provides coverage to every child but also ensures adequate funding for essential services that meet child-specific needs. (Kurt Newman, 2/14)

The Wall Street Journal: The ObamaCare Merger Deathblow
The conceit that the five major commercial health insurers will consolidate to three seems to be dissolving, as four of those insurers called off a pair of mega-mergers on Tuesday. The immediate reasons were legal objections, but perhaps this retreat is a sign of hope for insurance markets. (2/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Central Illinois Facing Adequacy ‘Crisis’ As Hospitals Reject Medicaid Managed Care Plans

At least three hospital systems have announced plans to cut ties with Molina Healthcare, which manages the state’s Medicaid program in central Illinois, leaving tens of thousands of enrollees in a tough position. Also, legislators in Colorado begin to explore how to cover the expanding Medicaid budget.

Modern Healthcare: Central Illinois Facing Medicaid Network Adequacy ‘Crisis’
Hospitals in central Illinois are rejecting managed Medicaid plans at such a troubling rate that lawmakers are calling it a “crisis.” Decatur Memorial Hospital, Memorial Hospital System and Hospital Sisters Health System have all announced plans to cut ties with Molina Healthcare of Illinois over the last few months. The decision puts tens of thousands of patients in central Illinois in a tough position as the region’s other managed care plan, Health Alliance, exited the market last year. (Dickson, 2/14)

Denver Post: Rising Medicaid Costs Fuel Much Of Colorado Legislature’s $105 Million Spending Increase 
Colorado lawmakers are poised to approve an additional $105 million in spending for the current year, even as a budget shortfall looms. House lawmakers will begin considering a package of 18 supplemental budget bills this week as part of an annual mid-year spending adjustment to the $25.8 billion budget approved in 2016. The Senate approved the measures last week with little opposition. (Frank, 2/14)

And one Medicaid company is facing a storm of criticism over building plans —

St. Louis Post Dispatch: Clayton Rejects Centene Petition As Unconstitutional
A citizen-led initiative petition seeking to give residents a vote on large development projects is unconstitutional, violates the Clayton city charter and is “totally unworkable,” city officials said Tuesday night. …The effort was the latest to stymie Medicaid managed care company Centene’s recently approved campus expansion. It would require public votes before permits were issued to buildings in excess of 200 feet or 10 stories in height or 200,000 square feet of space. The Clayton-based health care company plans to transform a corner of downtown with a $772 million complex of office towers, a parking garage, retail space, apartments and theater. Centene says it will add 2,000 people to its existing Clayton workforce of about 1,000 employees. (Barker, 2/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Different Takes On The Complications Of Replacing Obamacare

Opinion writers offer their thoughts on the possible landmines involved in replacing or repairing the health law, including what voters have to gain and lose as well as what costs could result.

The Washington Post: Obamacare Replacement: It’s Complicated
Speaker of the House Paul D. Ryan (R-Wis.) seems to reiterate weekly that the GOP has a health-care plan to replace the Affordable Care Act. To be honest (why isn’t he?), his “A Better Way” plan provided a rough outline of health-care reform, but there are a zillion details to be determined. In addition, thanks to President Trump, the bar for a replacement has risen considerably since Ryan presented his plan. It must “have insurance for everybody,” be cheaper, be more flexible and offer better care. Oh, and Republicans promise no tax increases to pay for it. Most important, so far the Republicans have yet to converge on any single plan. And that is all before we get to the task of corralling eight Democratic senators to break a filibuster.  (Jennifer Rubin, 2/13)

Stat: A Lesson From History: Repealing The ACA Will Make Insurance Pricier
The ACA is the latest in a series of laws designed to improve an employment-based health care system that has never delivered universal coverage. The characteristics of the employment-based system coupled with the intrinsic qualities of insurance make it difficult to cover everyone. Combine that with the fact that our political process relies heavily on lobbying by insurance companies, pharmaceutical firms, the American Medical Association, and others, and curing the common cold seems more likely than “fixing” health care. (Melissa Thomasson, 2/13)

Cincinnati Enquirer: Repeal Of Obamacare Could Have High Cost
Remember the good ol’ days of U.S. health care? You know, when you could be denied insurance or charged a higher premium for a pre-existing condition, or kicked off of your health insurance plan if you got very sick. Back when there was no cap on your out-of-pocket loss …. With the repeal of Obamacare/the Affordable Care Act (ACA) a foregone conclusion, that past could become our future. And without an equivalent replacement, here’s what else you could lose. (Kimberly Kennedy, 2/13)

USA Today: Repair And Retain Obamacare: Our View
When President Obama was in office, Republicans made a mantra of their call to “repeal and replace” his signature health care program. But now that they are actually in position to do something, they’re flummoxed. They have no plan for a replacement anywhere near as robust as Obamacare. They can’t even agree on what a significant rollback would look like. So might we suggest an alternative approach? It starts by treating Obamacare the same way that a doctor would treat a patient: First, do no harm. (2/13)

USA Today: Tinkering Can’t Save Health Law: Opposing View
Many argue we should keep the Affordable Care Act intact because it has provided health insurance for more people. But to what end? Insurance under the ACA is too expensive for most to afford. Average premiums on the law’s marketplace have soared by double digits since its implementation — including an average 25% hike in 2017. Research from health care economist Stephen Parente shows there is no end in sight for substantial increases going forward. And while the law does provide subsidies, they won’t be able to keep up with these premiums. (Tim Phillips, 2/13)

Bloomberg: Here’s How Trump Will Change Obamacare
Promises made by Donald Trump and Republicans in Congress to repeal and replace the Affordable Care Act are proving to be more complicated than they sounded on the campaign trail. With reality now setting in, what’s most likely to happen? I expect to see Republicans stage a dramatic early vote to repeal, with legislation that includes only very modest steps toward replacement — and leave most of the work for later. Next, the new administration will aggressively issue waivers allowing states to experiment with different approaches, including changes to Medicaid and private insurance rules. … In other words, the repeal vote will be just for show; the waivers will do most of the heavy lifting. (Peter R. Orszag, 2/14)

RealClear Health: GOP’s Health Care Subsidies Are No Cause For Controversy
The Affordable Care Act’s (also known as Obamacare) days are numbered. Last week, both the Senate and House approved a budget resolution over the objections of the chamber’s Democrats ordering several congressional committees to draw up legislation repealing much of the law. … The GOP’s replacement contains a lot that Democrats should be able to support. (Sally C. PIpes, 2/14)

Arizona Republic: Arizona’s Medicaid Scheme Hurts Taxpayers
When state lawmakers in 2013 decided to expand Medicaid as President Obama encouraged with the Affordable Care Act, they knew their plans would require a significant tax increase. … Since then, the enrollment and costs for the program have skyrocketed above the original estimates. By the middle of 2017, state officials estimate that 650,000 Arizonans will be enrolled in the Medicaid expansion, which is roughly double the original estimates. (Naomi Lopez Bauman and Christina Sandefur, 2/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

N.H. Governor Shifts Stand To Embrace Medicaid Expansion

“There’s no doubt it’s been helpful,” Gov. Chris Sununu says in an interview with New Hampshire Public Radio. Meanwhile, Georgia’s governor signs a law that will tax hospitals and then draw down more federal funds to operate the state Medicaid program.

Atlanta Journal-Constitution: Georgia Governor Signs Hospital ‘Provider Fee’ Measure 
Georgia’s Medicaid program received a shot in the arm on Monday when Gov. Nathan Deal signed a measure into law that will avert a roughly $900 million gap in Medicaid funding. The governor signed Senate Bill 70 into law after both chambers swiftly approved the measure, which allows the Department of Community Health board to levy a hospital provider fee for another three years. (Bluestein, 2/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

A Deep Dive Into 4 GOP Talking Points On Health Care

Republicans leaders have a lengthy list of talking points about the shortcomings of the health law. Shortly before his inauguration last month, President Donald Trump said that it “is a complete and total disaster. It’s imploding as we sit.” And they can point to a host of issues, including premium increases averaging more than 20 percent this year, a drop in the number of insurers competing on the Affordable Care Act marketplaces and rising consumer discontent with high deductibles and limited doctor networks.

Yet a careful analysis of some of the GOP’s talking points show a much more nuanced situation and suggest that the political fights over the law may have contributed to some of its problems. Here is an annotated guide to four of the most common talking points Republicans have been using. 

1. The individual health insurance market is collapsing. 

— House Speaker Paul Ryan, R-Wis., on Meet the Press, Feb. 5, “the law is literally in the middle of a collapse.”

— Senate Majority Leader Mitch McConnell, R-Ky., on the Senate floor Jan. 9: “Obamacare continues to unravel at every level, leaving Americans to pick up the pieces.”

Republicans are right that the individual market that the Affordable Care Act sought to overhaul is having challenges right now. Many insurance companies left the market at the end of 2016 after losing money, which reduced choices for individuals, and five states have only a single insurer providing coverage in 2017.

But even with these challenges, the health law’s marketplaces, also called exchanges, are providing coverage to more than 10 million Americans. Some analysts say they are far from collapse.

“I have never believed the individual market was in a true death spiral,” said Joe Antos of the conservative American Enterprise Institute. A death spiral is when so many healthy people leave a market that only sick people are left and insurers cannot spread costs.

Insurance markets also vary a lot by state, said John Ayanian, head of the University of Michigan’s Institute for Healthcare Policy and Innovation. “There are a fair number of states where the exchanges are working fairly well, costs are not rising too quickly, and people have a number of choices of health plans,” he said. “There are other states where they have just one choice and prices are going up.”

At the same time, legislation written by Republicans has led to some of the trouble in exchanges. Most directly, Congress limited federal payouts to insurers who encountered higher-than-expected costs in the exchanges. Republicans called the payments “insurance company bailouts,” even though similar federal measures have been used in other markets, such as the Medicare drug plans implemented more than a decade ago.

Still, the result was that the Department of Health and Human Services was able to provide insurers with only 13 percent of the money they were promised under the law in 2015. That shortfall led directly to the implosion of most of the nonprofit co-op health plans, and some private insurers referenced the shortfalls when they pulled out of the marketplaces this year. Yet when House Energy and Commerce Committee Chairman Greg Walden, R-Ore., noted at a Feb. 2 hearing that “only five out of the original 23 insurance co-ops remain. … They tried it, it didn’t work,” he did not mention the loss of the federal payments to cover early losses. 

2. Out-of-pocket spending is too high.

— Speaker Ryan, at CNN Town Hall Jan 12: “Deductibles are so high it doesn’t even feel like you’ve got insurance anymore.”

— Senate Majority Leader McConnell (in a CNN op-ed): “It’s raising health care costs by previously unimaginable levels, and it’s hurting the very people it was intended to help.”

Out-of-pocket spending is one of voters’ top concerns when it comes to health care. The January 2017 monthly tracking poll from the Kaiser Family Foundation found 67 percent of those polled said their top health priority is “lowering the amount individuals pay for health care,” followed closely by “lowering the cost of prescription drugs” at 61 percent. (Kaiser Health News is an editorially independent project of the foundation.)

High deductibles — often in the thousands of dollars — have become part of that problem.

People who are most angry about the Affordable Care Act, said Chris Jennings, a health official in the Clinton and Obama administrations, “want deductibles lower and more benefits.”

But Republicans’ most popular proposals for replacing current individual insurance plans — cutting back on required benefits and giving more people access to tax-preferred health savings accounts — would likely increase out-of-pocket spending for those who use health services (although it would be less expensive for people who are healthy all year long).

Letting people buy more bare-bones policies “means insurance doesn’t kick in until people have very significant medical bills,” said Ayanian.

Former Obama administration health official Sherry Glied, on a panel at the National Health Policy Conference in January, asked if having a $10,000 or $20,000 deductible (as some proposals would allow) with perhaps $1,000 in a health savings account “is better than having no coverage at all? Lots of people would go bankrupt at $20,000,” particularly if they don’t have the resources to fund the HSA with their own savings. 

3. Medicaid patients can’t find doctors to treat them.

— Sen. Bill Cassidy, R-La., on the Senate floor Jan. 9: “It is the illusion of coverage without the power of access.”

— Speaker Ryan, from CNN Town Hall Jan. 12: “… so our concern is, that people on Medicaid can’t get a doctor and if you can’t get a doctor, what good is your coverage?”

Studies do suggest that low pay (each state sets its own rates) does decrease physician participation in Medicaid, and finding specialty care can be difficult in some parts of the country. But overall the academic literature shows that Medicaid patients have a far easier time, and are far more likely to obtain health care services than people with no insurance.

Benjamin Sommers of the Harvard School of Public Health, who has studied the issue, said the idea that patients with Medicaid can’t get care comes from looking overall at how many doctors and other providers accept the program’s generally lower payments and higher administrative burdens. “But that’s not the best way to study this. The best question … is when you talk to the people with coverage and ask them if they can get the care they need.”

And he said “study after study” shows that “when people get Medicaid, their access to care improves dramatically,” including greater use of primary care, preventive screening, and care of chronic conditions. “Even with some potential limitations of provider participation, patients are much better off once they get that [Medicaid] coverage,” he said. 

4. The ACA has reduced jobs.

— Tom Price, the secretary of Health and Human Services, during a confirmation hearing before the Senate Health, Education, Labor and Pensions (HELP) Committee Jan. 18: “The ACA has decreased the workforce by the equivalent of 2 million FTE’s (full time employees).”

— Senate HELP Committee Chairman Lamar Alexander, R-Tenn., on the Senate floor Jan. 9: “Across the country … employers have cut jobs to afford Obamacare costs.”

Much of this talking point stems from a report by the Congressional Budget Office in 2014 that projected the nation’s workforce would drop by about 2 million jobs due to the health law, as well as anecdotal reports about employers cutting workers hours to avoid triggering the law’s requirement that they offer health insurance.

But a careful reading of the CBO report notes that the decline they estimate would be due less to employers cutting back, and more to older workers voluntarily opting to work fewer hours — perhaps because of fears of losing their premium subsidies or their Medicaid eligibility — or retiring because they no longer had to work in order to get health insurance.

It is true that some employers cut worker hours below the 30-hour threshold to avoid the employer coverage requirement.

However, the strengthening economy, including in the health care sector, has shrunk the part-time workforce and expanded full-time employment well beyond the numbers reduced by the Affordable Care Act, according to most analysts. In fact, so many jobs have been created in the industry since the ACA became law that it is becoming a problem itself, because having such a vast chunk of the economy devoted to health care makes it harder to reduce health spending.

Categories: Cost and Quality, Insurance, Medicaid, The Health Law

Viewpoints: Drug Companies ‘Risky’ Idea; Scrapping Rule On Guns And Mental Illness Is ‘A Bad Move’

A selection of opinions on health care from around the country.

Chicago Tribune: Guns And Mental Illness: Don’t Scrap This Rule
If someone has a mental illness severe enough that he cannot work or manage his own money, should he be allowed to own a gun? In the waning weeks of his presidency, Barack Obama answered that question. Motivated by Adam Lanza’s bloody rampage at an elementary school in Newtown, Conn., that killed 20 children and six educators in 2012, Obama imposed a rule that barred gun ownership for people who qualify for Social Security disability insurance because their mental illness keeps them from working, and who cannot manage their benefits. That pool is small — just 75,000 Americans. (2/10)

The Wichita Eagle: Services For Disabled Also In Violation
Not only did federal officials determine last month that KanCare was “substantively out of compliance with federal statutes and regulations,” they determined the previous month that services for people with disabilities were also out of compliance. Yet state lawmakers had to learn about both decisions by reading about them in the newspaper. (2/12)

The Des Moines Register: Legislators Should Repay State For Cheap Health Care
Gov. Terry Branstad said in 2012 he would begin voluntarily paying 20 percent of his state-funded health insurance premiums. He encouraged other state workers, including lawmakers, to follow suit. The next year, the governor said some legislators, who had previously enjoyed premium-free health insurance, had started contributing 20 percent. But not a single lawmaker is paying that share, according to December 2016 data obtained by The Des Moines Register. And it appears they are violating state law. (2/11)

The Columbus Dispatch: More Needed To Fight Overdoses
Ohio lawmakers are asking good questions about the money that Gov. John Kasich’s proposed budget would devote to the state’s opioid epidemic and the collateral damage from it. Last week, Republican and Democrat legislators said they are concerned that the budget does not do enough. The concern is warranted. Ohio leads the nation in drug-overdose deaths, with 3,050 recorded in 2015, the most recent year with complete statistics. (2/13)

The New York Times: LSD To Cure Depression? Not So Fast
Psychedelics, the fabled enlightenment drugs of the ’60s, are making a comeback — this time as medical treatment. A recent study claimed that psilocybin, a mushroom-derived hallucinogenic, relieves anxiety and depression in people with life-threatening cancer. Anecdotal reports have said similar things about so-called microdoses of LSD. … I fear that in our desire to combat suffering, we will ignore the potential risks of these drugs, or be seduced by preliminary research that seems promising. (Richard A. Friedman, 2/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives On Obamacare And The Current State Of Health Policy Chaos, Confusion, Shifts And Opporunities

Opinion writers take stock of where things stand with the GOP’s effort to undo the health law.

San Jose Mercury News: Trump, GOP Court Health Care Chaos
Donald Trump and Republicans in Congress have one thing in common: After years of trashing Obamacare, they don’t have a clue how to craft anything better. So the president is now saying that repealing and replacing the Affordable Care Act — which he promised to do instantly when he took office — may not happen until next year. Why? Because it’s next to impossible to devise a system based on private insurers that is cheaper, covers as many Americans and provides better medical outcomes than the ACA. (2/10)

Forbes: GOP Grand Scheme On Obamacare Repeal & Tax Reform Quickly Going South
The GOP strategy on quickly repealing the Affordable Care Act and enacting tax reform that seemed to be so creative and smart when it was first revealed right after the election may soon become the prime source of legislative hell for House and Senate Republicans. Knowing that a Senate filibuster was virtually certain on ACA repeal and highly probable on tax reform, the GOP plan was to use the reconciliation process — which prevents filibusters — to pass them both. (Stan Collender, 2/12)

The Washington Post: Six Steps For The GOP To Get Its Act Together On Obamacare ‘Repeal And Replace’
The Post reports on the confirmation of Rep. Tom Price (R-Ga.) as secretary of the Department of Health and Human Services. … This is the sole development to date on the Obamacare front that could be characterized as a win for Republicans, who promised voters they’d repeal every word of the Affordable Care Act — and replace with a system that offers lower costs, more flexibility, better care and repeal of ACA-related taxes. So far, the effort has been semi-disastrous, raising questions about whether Republicans can manage to devise and agree upon a replacement that will attract the eight Democratic senators needed for cloture. Republicans would be well-advised to abide by a number of simple rules. (Jennifer Rubin, 2/10)

The Washington Post: This Remarkable Town Hall Exchange Shows How Much The Obamacare Debate Has Shifted
M.J. Lee of CNN has flagged a great moment at a town hall meeting with GOP Rep. Diane Black that has gone viral because it shows a constituent making an impassioned case for, of all things, the Affordable Care Act’s individual mandate. As some immediately pointed out, Democrats could learn from this kind of messaging. But the moment is notable for another reason, too: The answer offered by Rep. Black shows how much the debate over the health care law has shifted, in favor of the health law. (Greg Sargent, 2/10)

Stat: Trump Administration’s Plan To Tinker With Medicaid Will Be A Tricky Task
Medicaid is a highly complex program that provides vital care for a broad array of individuals. There are no easy solutions when it comes to reducing its costs. Changing Medicaid, just like reforming health care, is at best an incremental process, particularly when one considers the new populations now covered by the program as a result of the ACA, such as families in which an adult is employed but in a lower-income job. It has often been said that there are two ways to lower Medicaid costs: reduce eligibility to the program or cut the services provided. Neither are attractive options. Turning the program into block grants firmly delegates decisions on that dilemma to the states. (Gerard Vitti, 2/10)

Los Angeles Times: With Billions At Stake, A Federal Judge Just Nullified The GOP’s Most Cynical Attack On Obamacare
Moda Health, a small Oregon health insurer, just won a $214-million judgment against the federal government. Normally that wouldn’t be worth reporting, except that in awarding Moda the money, the federal judge in the case dismantled the most cynical attack on the Affordable Care Act that Congressional Republicans had devised.The issue was the ACA’s risk corridor program, which was devised to shelter insurers from unexpected losses in covering ACA customers from 2014 through 2016. To encourage insurers to enter an entirely novel market, the program aimed to balance risks by taking profits from insurers that turned out to be unexpectedly profitable and use the funds to cushion others’ losses. (Michael Hiltzik, 2/10)

Miami Herald: Affordable Healthcare A Must In Florida 
The debate about what to do with the Affordable Care Act feels overwhelming to a lot of people. Repeal. Don’t repeal. Replace. With what? What does all this uncertainty mean to us in Florida? As healthcare professionals at Florida’s largest public hospital — Jackson Health System — I and many of my colleagues are frankly terrified by the possibilities. (Martha Baker, 2/10)

Lexington Herald Leader: Health-Law Repeal Means Cuts In Autism Care
In a Jan. 6 letter to Republican representatives in Congress, Gov. Matt Bevin asked them to throw out the Affordable Care Act, saying regulation of health insurance should be given back to individual states. Bevin is advocating sending us back to the time when individuals with chronic medical conditions and disabilities had to beg legislators to get even minimal coverage for their conditions, when insurance-industry lobbyists decided what they could tolerate and then strongly encouraged legislators as to how to vote. (Wendy Wheeler-Mullins, 2/10)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Providers Warn Mass. Gov. That Plan To Cut Medicaid May Affect Home Health Services

Home health agencies say the governor’s plan to rein in Medicaid spending with a trim in reimbursements would mean that they would stop sending nurses to homes to check on patients with chronic illnesses and that would shift more people into long-term care facilities. Also, news outlets report on Medicaid developments in Kansas and New Jersey.

Boston Globe: Medicaid Cut Could Scale Back Nurses’ Visits To Patients’ Homes 
The Baker administration wants to cut how much the state pays for long-term home nursing care, a move to contain medical spending. But that may leave thousands of patients without the services they need, home health agencies warn. Leaders of several agencies said the proposed 25 percent rate cut would make it unaffordable for them to continue sending nurses to the homes of people with complex, chronic conditions like diabetes, heart disease, and schizophrenia. Patients may lose access to nursing services at home, and they could end up in nursing homes, the agencies said. (Dayla McCluskey, 2/12)

KCUR (Kansas City, Mo., Public Radio): KanCare Expansion Opponents Urge Lawmakers To Learn From Other States’ Mistakes 
The message delivered to a legislative committee Thursday by opponents of expanding Medicaid eligibility in Kansas boiled down to this: Expansion has been a disaster in the states that have enacted it, so don’t do it. Gregg Pfister, legislative relations director for the Florida-based Foundation for Government Accountability, ticked through a list of expansion states where costs and enrollment significantly exceeded projections. (McLean, 2/10)

NJ Spotlight: Audit Confirms What Patients Have Long Said: Medicaid Doctors Hard To Find 
Advocates for low-income patients have long insisted that medical care is harder to find than it looks on paper. A recent state audit seems to have proved them right, identifying numerous inaccuracies on lists of Medicaid providers that insurance companies have submitted to regulators and posted online for policy holders. In reviewing filings from recent years, State Auditor Stephen Eells — whose office is part of the nonpartisan Office of Legislative Services — discovered hundreds of situations where doctors, dentists and other specialists were not practicing at the locations listed in insurance materials provided to the state or available to patients. (Stainton, 2/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Obamacare Came To Montana Indian Country And Brought Jobs

The Affordable Care Act created new health coverage opportunities more than half a million Native Americans and Alaska Natives — and jobs have followed on its coattails.

In Montana, this is playing out at the Blackfeet Community Hospital. It’s the only hospital on the Blackfeet reservation, and has been mostly funded — and chronically underfunded — by the Indian Health Service, which has been in charge of Native American health care since its founding in the 1950s. But now, many Native Americans have been able to afford health insurance on the Obamacare exchange, and last year, Montana expanded Medicaid. Now, about one in seven reservation residents gets Medicaid.

Blackfeet Community Hospital needed to build an infrastructure to deal with the byzantine bureaucracy that comes with taking Medicaid and private insurance. The tribe’s community college started a new curriculum to help meet the growing demand for people in Indian country to process insurance claims.

Blackfeet tribal member Gerald Murray took the courses. “I got a contract before I graduated in April, and then the day of graduation in May it became permanent so I applied for it,” he said.

Murray’s experience is an example of the health care law’s transformative power in Native American communities, said Montana’s director of American Indian Health, Mary Lynn Billy-Old Coyote.

“To me, there’s opportunity there to not only build health care, but to build your entire community and build jobs,” said Billy-Old Coyote.

Unemployment on most of Montana’s Indian reservations is at least double the rest of the state. And people who are working don’t always get health insurance with their jobs. So ACA subsidies that bring down the cost of insurance premiums are a big deal, Billy-Old Coyote said. Most Montanans, Native or not, can now get policies for about $75 a month. It is a big change for the reservation communities where people are accustomed to the underfunded IHS, which often didn’t pay for care unless someone was in immediate danger of losing life or limb.

(Courtesy of Mary Lynne Billy-Old Coyote)

(Courtesy of Mary Lynne Billy-Old Coyote)

“Now you’ve got an opportunity for American Indian people to truly have access to private insurance,” she said. “You have access to greater networks of providers and specialists, and all the things we generally don’t see you have access to.”

Medicaid expansion had a lot to do with the number of health care jobs in Montana growing by 3 percent last year, according to state statistics. And schools in Montana, including tribal colleges, are offering more classes in health care fields.

At Blackfeet Community College, 23-year-old Leroy Bearmedicine is working toward certification as an emergency medical technician.

“I’d like to become a registered nurse at some point, maybe even work my way up to flight nurse — something to get the adrenaline going,” he says.

Native American leaders have seen the Affordable Care Act as a means to remedy a series of broken promises by the federal government to care for them. They now fear that promise, too, will fade. One estimate suggests Montana will lose 3,000 health care jobs if the Affordable Care Act is repealed.

This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.

Categories: Medicaid, Public Radio Partnership, Repeal And Replace Watch, Reporting Consortium, Syndicate

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Medicaid: todo lo que necesita saber sobre el financiamiento “en bloque”

La administración del presidente Donald Trump ha dejado bien claro su compromiso de rescatar la vieja estrategia republicana para gerenciar el Medicaid, el programa que ofrece cobertura de salud a personas de bajos ingresos. Es la siguiente: devolver el control a los estados y limitar el gasto anual del gobierno federal.

La forma de financiamiento se llama “subvención en bloque”. Ahora, el Medicaid, que se expandió bajo la ley de salud de 2010 para asegurar a más personas, cubre a casi 75 millones de adultos y niños. Debido a que es un derecho, todo el que califica tiene la cobertura garantizada, y los estados y el gobierno federal combinan fondos para cubrir los costos.

Los conservadores han sostenido durante mucho tiempo que el programa sería más eficiente si los estados obtuvieran una suma fija del gobierno federal y luego lo administraran como mejor les parezca. Pero otros dicen que eso significaría menos financiamiento para el programa, lo que eventualmente se traduciría en mayores desafíos para obtener atención médica para personas de bajos ingresos.

Use Nuestro Contenido

La “subvención en bloque” del Medicaid es una pieza central de las propuestas de salud apoyadas por el presidente de la Cámara de Representantes, Paul Ryan, y el representante Tom Price, quien fue confirmado como secretario del Departamento de Salud y Servicios Sociales (HHS) el 10 de febrero. La asesora de Trump Kellyanne Conway enfatizó que la estrategia es clave para la política de salud de la administración.

Pero, ¿cómo sería este proceso, y por qué es tan controversial? Vamos a desglosar cómo funcionaría esta política, y sus implicaciones para el gasto del gobierno y para el acceso de los consumidores al cuidado de salud.

¿Cómo funcionaría un financiamiento en bloque?

Hasta ahora, Trump no reveló detalles de su plan. Pero la idea básica es que los estados recibirían subvenciones federales fijas que estarían basadas en el gasto estatal y federal del Medicaid en ese estado. La subvención crecería ligeramente cada año para contabilizar la inflación, pero es posible que el costo de la salud aumente más.

Actualmente, los estados comparten el costo del Medicaid con el gobierno federal. Los más pobres pagan menos: por ejemplo, en Mississippi, el gobierno federal paga alrededor de tres cuartas partes del costo del programa, en comparación con el 50% en Massachusetts.

La financiación federal es abierta, pero a cambio, los estados deben cubrir ciertos servicios y a ciertos grupos de personas, por ejemplo, niños, mujeres embarazadas que cumplen con los criterios de ingresos y padres con hijos dependientes. Bajo una subvención en bloque, los estados tendrían más libertad para decidir quién califica, y para qué servicios.

“Va a depender de los detalles de cada propuesta de subvención, si habría ciertos beneficios que los estados tendrían que proveer”, dijo Edwin Park, vicepresidente de políticas de salud en el Center for Budget and Policy Priorities, en Washington, D.C. “Usualmente los estados tienen una flexibilidad sin casi ninguna restricción”.

¿Esto es lo mismo que el “límite per cápita”?

La subvención en bloque es ligeramente diferente de este otro modelo favorito de los conservadores. Los límites per cápita también han sido apoyados por Ryan.

Bajo estos límites, los estados también reciben una cantidad fija de dinero cada año, pero esa suma se calcula sobre la base de cuántas personas están en el programa. Ya que las subvenciones en bloque no se basan en la inscripción individual anual, el estado no necesariamente obtendría más dinero para compensar si, por ejemplo, más personas califican para el Medicaid a causa de una recesión económica. En teoría, un sistema de capitalización per cápita aumentaría la financiación. Pero si ocurre que un nuevo medicamento caro entró en el mercado, o apareció una nueva y costosa enfermedad, los presupuestos del Medicaid no cambiarían para absorber estos nuevos costos, señaló Park.

Parece que tanto demócratas como republicanos están muy acalorados con este tema. ¿Por qué es tan importante?

El sistema de subsidios en bloque es un cambio radical con respecto a cómo el Medicaid ha trabajado anteriormente. Los republicanos dicen que podría ahorrar al gobierno miles de millones de dólares. Pero otros analistas señalan que esos ahorros podrían limitar el acceso a la atención médica si la financiación se reduce. La ley de salud de 2010 instó a los estados a ampliar la elegibilidad para el Medicaid, por eso más personas enfrentarían el peso de esos recortes.

El impacto fiscal: la no partidista Oficina de Presupuesto del Congreso (CBO) estima que las recientes propuestas republicanas de subvención en bloque podrían reducir el gasto del Medicaid en un tercio en la próxima década. Los recortes empezarían siendo pequeños, creciendo a lo largo de los años.

Muchos republicanos dicen que, porque los estados tendrán una mayor flexibilidad, pueden innovar con sus programas del Medicaid.

Pero los opositores señalan que la experimentación por sí sola no compensará los presupuestos más pequeños. Las subvenciones fijas podrían significar que los estados reduzcan los beneficios u obliguen a los beneficiarios a asumir más costos compartidos.

Algunos requisitos federales son necesarios, dijo Tom Miller, experto en el conservador American Enterprise Institute. La subvención en bloque podría ser “grandiosa o un desastre”, dijo, dependiendo de cómo se implemente.

El impacto potencial es significativo. Más de 10 millones de personas que recibieron seguro a través del Obamacare están en el Medicaid y podrían verse afectadas. Esa es también la razón por la cual algunos gobernadores republicanos -en particular en estados que abrazaron la expansión del Medicaid promovida por la ley de salud- se han unido a sus compañeros demócratas para expresar sus dudas.

Si no tengo mi seguro a través del Medicaid, ¿por qué debería preocuparme?

Medicaid es un programa gubernamental importante. En 2015, representó el 17% de los gastos de salud de la nación, dinero que proviene de dólares de los contribuyentes.

Además, las 75 millones de personas cubiertas representan casi una cuarta parte de la población de los Estados Unidos. Y casi dos tercios de las personas en hogares de ancianos pagan por su cuidado usando el Medicaid, de hecho, la mayor parte del gasto del programa va a los adultos mayores y los discapacitados. Si los legisladores están tratando de ahorrar $1,000 millones en una década, es difícil ver cómo esto podría ocurrir sin afectar los beneficios de los seniors, señaló Matt Salo, director ejecutivo de la Asociación Nacional de Directores del Medicaid.

Incluso si usted no está cubierto por el Medicaid, probablemente conoce a alguien que se vería afectado por la subvención en bloque.

Rehacer la financiación del Medicaid también podría afectar los servicios que ofrecen los hospitales y su fortaleza económica. Específicamente, los hospitales y clínicas que atienden a un gran número de beneficiarios del Medicaid podrían tener que repensar sus presupuestos, qué servicios pueden proporcionar y a cuántas personas pueden emplear. Eso es importante desde el punto de vista de la atención de salud, pero también es una gran fuente de trabajo: los hospitales suelen ser grandes empleadores comunitarios.

Por último, el debate también podría establecer el tono con el que el Congreso tratará a otros programas también llamados “de derecho”, como el Medicare y el Seguro Social. El CBO estima que, salvo cualquier cambio significativo, el gasto en el Seguro Social y otros programas de salud representará alrededor del 16% de todos los bienes y servicios anuales del país -el producto interno bruto- para 2046. Un cambio exitoso en el Medicaid podría allanar el camino para cambios similares en otros programas.

¿Cuáles son las probabilidades de que esto suceda realmente?

Ahora que el partido tiene control sobre el Congreso y la Casa Blanca, los republicanos han hecho del cuidado de la salud una prioridad absoluta, incluyendo disposiciones en el nuevo presupuesto para revocar el Obamacare.

Gran parte de una propuesta de subvención en bloque podría lograrse mediante la reconciliación presupuestaria, dijeron Park y Miller. Eso significa que podría votarse sin apoyo demócrata, incluso en el Senado, ya que sólo requeriría 51 votos.

Pero sin más detalles, cualquier evaluación de las consecuencias es, en el mejor de los casos, una especulación informada.

“¿Qué significa una subvención en bloque en términos de reglas? … Nadie ha llegado lo suficientemente lejos como para decir: ‘Esto es lo que realmente significa’ ‘, dijo Salo. “Este es un territorio desconocido para muchos de nosotros”.

Mary Agnes Carey, corresponsal senior de KHN, contribuyó con este artículo.

Categories: Cost and Quality, Medicaid, Noticias En Español, Repeal And Replace Watch, States, The Health Law

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Perspectives On The Ethical Issues Surrounding The New HHS Secretary; GOP Health Policy Plans, Medicaid Reforms And What Becomes Of The Safety Net

Opinion writers offer a variety of views on the latest health policy developments.

Los Angeles Times: Trump Is Stocking His Cabinet With The Ethically Challenged. Case In Point: Tom Price
It’s bad enough that President Trump confined his Cabinet search to members of the 1%. But it’s particularly galling that his choice for secretary of the Department of Health and Human Services — an agency vital to poor and infirm Americans — may have used his congressional office to expand his personal fortune. That nominee — Rep. Tom Price (R-Ga.), an orthopedic surgeon who has served on two House committees that help shape healthcare policy — invested in more than half a dozen healthcare-industry companies even as he took steps as a legislator that benefited them. That’s a clear conflict of interest, and if Trump honestly wanted to drain the swamp of self-serving elites in Washington, he would have withdrawn Price’s nomination as soon as Price’s investing habits came to light. (2/9)

The Wall Street Journal: The GOP’s Health-Care Offensive
When Dave Hoppe recalls his first big health-care fight, one memory stands out. It was the summer of 1994, and Sen. George Mitchell, the Democratic majority leader, had canceled August recess to force a debate over his party’s health-care monster: HillaryCare. Senators weren’t happy about losing their break, remembers Mr. Hoppe, who at the time was an aide. “And yet, Republican senators were lining up in the cloakroom; they couldn’t wait to get to the floor,” he says. “They knew this issue. They’d studied it. They were better informed than Democrats about HillaryCare. There was such an esprit de corps. It was energizing.” (Kimberley A. Strassel, 2/9)

The Washington Post: The Republican Health-Care Plan The Country Isn’t Debating
With the debate about the Affordable Care Act drawing so much scrutiny, a broader Republican agenda to fundamentally change the federal role in health care is flying under the radar. It’s the most important issue in health care we are not debating. Many Republicans in Congress want to convert Medicaid to a block-grant program and transform Medicare from a plan that guarantees care into one in which seniors would receive a set amount of money to purchase coverage. Meanwhile, Republicans would replace existing subsidies for premiums under the ACA with less generous tax credits — all while eliminating the expansion of Medicaid that enables states to cover low-income childless adults. (Drew Altman, 2/9)

The Washington Post: Obamacare Repeal: Blind Men And The Elephant
Vicki Hopper, a constituent of Rep. Tom Price (R-Ga.) from Roswell, Ga., lost her job two years ago but has kept her insurance through the Obamacare exchange. She says the price is “high, but affordable” since the subsidy cuts her payment to $370 per month. On Wednesday, she met with staffers in the offices of  Sens. David Perdue (R-Ga.) and Johnny Isakson (R-Ga.). “I told them you just can’t repeal it fully,” she told me. “There’ll be chaos.” She’s convinced Republicans won’t really go through with repeal. (Jennifer Rubin, 2/9)

USA Today: Save The Health-Care Safety Net
In the debate about the fate of the Affordable Care Act, one indispensable cog in our nation’s health care system has thus far been ignored — the safety net. These are the community health centers, public hospitals, clinics and programs that never turn anyone away, regardless of the ability to pay. They provide family planning to women and primary care to public housing residents. They serve homeless families, people with TB and AIDS and hemophilia, coal miners with black lung and those in the grip of opiate addiction. (Henry A. Waxman, 2/9)

Tampa Bay Times: A Bad Medicaid Plan For Nursing Homes
Although there are still exceptions, Florida is no longer home to the flood of nursing home horror stories that Sunshine State residents heard so frequently, and from so many homes, in the early ’80s. … This may all be about to change. Earlier this month, AHCA submitted a plan to the governor and the Legislature for a new approach to nursing home Medicaid payments. The plan is intended to establish an equitable payment system that includes incentives for high-quality care, simplifies the payment process, controls costs and makes legislators’ budgeting for Medicaid spending on nursing homes more predictable. What the plan will actually do is penalize the nursing homes that for the last three decades have invested in delivering the highest quality of care possible, while rewarding homes that have remained at the bottom of the quality barrel. (Steve Bahmer, 2/9)

The Wichita Eagle: Medicaid Expansion Clears First Key Hurdle
Medicaid expansion cleared its first key hurdle this week when Wichita Rep. Dan Hawkins, the chairman of the House Health and Human Services Committee, agreed to allow a debate and committee vote next week. Committee members should heed the compelling testimony they heard and send a bill to the full House. (2/10)

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Perspectives On The GOP’s Repeal-Replace-Repair Effort And The Current State Of Play

Opinion writers offer their takes on what Republican lawmakers might do with Obamacare and the challenges it will involve.

The Washington Post: What Are Republicans Going To Do About Obamacare? ‘No Idea.’
The Obamacare repeal effort was already in unstable condition. Now its status must be downgraded to critical — and completely unserious. After years of Republican yammering about the urgent need to repeal the Affordable Care Act and months of fruitless pursuit of an alternative, President Trump now says he may not unveil a replacement this year at all. And from Capitol Hill comes new word that Republicans aren’t even talking about a plan. (Dana Milbank, 2/8)

RealClear Health: Why Is It So Hard For Republicans To Replace Obamacare?
Republicans in Congress have been attacking Obamacare and vowing to repeal it for nearly seven years, and President Trump made “repeal and replace Obamacare” a central promise of his winning campaign. Now the President and his party are in charge, but they are scrambling to craft a replacement. Why are they having such trouble? The main problem is that Republicans are a diverse bunch who opposed Obamacare for a variety of reasons. (Alice M. Rivlin, 2/9)

Milwaukee Journal Sentinel: The Great Health Care Bait-And-Switch
In the 2016 elections, conservative candidates sounded like progressives, promising they would reduce health insurance costs and expand choices for all Americans. Sen. Ron Johnson (R-Wis.) filled the airwaves with the kind of personal health care stories that used to be heard only from progressives. As Congress begins to repeal the Affordable Care Act House Speaker Paul Ryan is promising an outcome where “no one is worse off” and President Donald Trump assures us that “we’re going to have insurance for everybody.” Can we dare hope that a new age of bipartisan cooperation is before us, and that both major parties agree that everyone in America should be guaranteed quality affordable health coverage? Tragically, what we are witnessing is not a new consensus on the right to health care but one of the most audacious bait-and-switches in American history. (Robert Kraig, 2/8)

San Francisco Chronicle: Fears Of GOP Plan To ‘Repeal And Replace’ Obamacare Are Unfounded
If President Donald Trump and Republicans in Congress succeed in repealing and replacing Obamacare, 20 million Americans will lose their health insurance — or so the conventional wisdom goes. Of course, predictions about Trump have tended to be wrong. This one is no different. In fact, repealing Obamacare and replacing it with the best the GOP has to offer will likely expand access to coverage, provide a wider choice of plans and drive down the cost of insurance. On top of that, it will strengthen the incentive for healthy people to get insured. (Sally C. Pipes, 2/8)

Vox: 53% Of Republicans Don’t Know Repealing Obamacare Repeals The Medicaid Expansion
Republicans know they’ve benefited from voter confusion on this issue. It’s why Donald Trump’s health care policy could literally be to repeal Obamacare and replace it with “something terrific.” They also know that begins to end as soon as they release a real plan, and it really ends if they pass something into law. Which is why congressional Republicans are in disarray over their replacement strategy, Trump has begun making impossible promises about what will come next, and even Medicaid’s most committed opponents are admitting that slashing it is harder than they thought. (Ezra Klein, 2/8)

Forbes: Kansas Should Avoid The Medicaid Expansion Trap
The Kansas legislature has wisely rejected ObamaCare’s Medicaid expansion year after year. As a result, policymakers have protected taxpayers and the truly vulnerable from costly enrollment overruns. But now, despite a rapidly shifting health care landscape, special interest groups are once again ramping up pressure on state lawmakers to expand ObamaCare to a new class of able-bodied, mostly childless adults. Thanks to the prudence of Governor Sam Brownback and legislative leaders, Kansas is now in a position to learn from the mistakes of other states that bought into Washington’s false promises of flexibility and “free money.” They’ve also created a welfare reform model for the nation that they should build on, not diminish. (Josh Archambault, 2/8)

Bloomberg: Obamacare Exchanges Were In Big Trouble Before Trump
Healthcare.gov enrollment came in well below what was anticipated last month. After running very slightly ahead of last year’s numbers in December, January brought the news that about 400,000 fewer people had enrolled on the federal exchanges than did so in 2016. Those are scary numbers, not so much for the absolute size of the decline — it’s roughly 4 percent — but because any backwards movement is very bad news for the exchanges. (Megan McArdle, 2/8)

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State Highlights: Malloy’s Budget For Conn. Includes Deep Cuts In Health, Social Services; Wis. Legislators Skeptical Of Walker’s Health Plan For Public Employees

Outlets report on news from Connecticut, Wisconsin, Arizona, Ohio, Massachusetts, New Hampshire, Michigan, Pennsylvania, Maryland, Florida, Texas and California.

The CT Mirror: Malloy Budget Hinges On Big Labor Savings, New Revenues 
Gov. Dannel P. Malloy unveiled a $40.6 billion two-year budget Wednesday that seeks $1.5 billion in labor concessions, imposes $400 million of annual pension costs on municipalities and reorganizes the financial relationship between the state, communities and hospitals. The governor also would increase taxes by close to $200 million, scaling back income tax credits for the middle class and working poor and boosting the cigarette levy by 45 cents per pack. (Phaneuf, 2/8)

The CT Mirror: How Health Care And Medicaid Fare In Malloy’s Budget 
About 9,500 parents would lose Medicaid, fewer seniors would receive home care, mental health and substance abuse treatment providers would receive millions of dollars less from the state, and school-based health centers would see a 10 percent funding cut under the budget plan Gov. Dannel P. Malloy proposed Wednesday. The plan aims to close a budget deficit projected at nearly $1.7 billion, and many of the individual cuts drew concern from providers and advocates for health and social service programs. Still, some said the plan left them more optimistic than had previous proposals by Malloy. (Levin Becker, 2/8)

Milwaukee Journal Sentinel: Republicans Resist Walker’s Insurance Plan
Gov. Scott Walker is banking on saving $60 million in taxpayer funds over two years by changing the way public employees get health insurance, but legislators are deeply skeptical of the proposal. In the state budget he unveiled Wednesday, the governor detailed plans to shift the state to a self-insurance system to cover employee health care costs. But his fellow Republicans who control the Legislature questioned whether the state could generate the savings Walker is counting on and said the change could hurt the insurance market for individuals and small businesses. Republican legislators have resisted the proposal in the past. (Marley and Stein, 2/8)

The Wall Street Journal: Report Cites Deficiencies At Theranos Lab
Theranos Inc.’s lab in Arizona failed to ensure some patients who got potentially inaccurate diabetes test results were notified, according to a federal inspection report obtained through a public-records request. The embattled Silicon Valley company also performed patient blood-coagulation tests on a machine its staff configured improperly, according to the report and the company’s response to regulators. (Weaver, 2/8)

Milwaukee Journal Sentinel: Two More Cases Confirmed In Mumps Outbreak At Marquette University
Two more Marquette University students who live in a residence hall have been diagnosed with mumps, bringing to three the total number of cases confirmed on campus since winter break…. The newly diagnosed students are recovering at home, and the Milwaukee Health Department is following up with those known to have come into close contact with them, Smith said in the email. Mumps is a viral infection spread through coughing, sneezing, talking or occasionally through utensils and cups. It also can be spread by touching unwashed, contaminated surfaces. (Herzog, 2/8)

Arizona Republic: Gov. Doug Ducey Wants 86K Arizona Newborns A Year Tested For This Disease
Hospitals on the reservation include SCID in their newborn screenings. But outside of the Navajo Reservation, Arizona does not screen newborns for the disease, a practice Gov. Doug Ducey wants to change this year in the hopes of giving children like Ava, now 3, a chance at lifesaving treatment. Left undetected, SCID can lead to repeated infections and even death. The screening costs about $6, and Arizona is one of three states across the U.S. that do not screen for SCID. (Wingett Sanchez, 2/8)

Cleveland Plain Dealer: Toledo City Council Bans ‘Conversion Therapy’ 
City Council voted unanimously Tuesday to ban “conversion therapy,” the controversial psychological treatment that attempts to change a person’s sexual orientation or gender identity. The legislation, approved by a 12-0 vote, makes conversion therapy a fourth-degree misdemeanor with an attached fine for each offense, according to the Associated Press. (Pinckard, 2/9)

Boston Globe: OSHA Cites Brookline Psychiatric Hospital 
Workplace safety inspectors have cited Arbour-HRI, a Brookline psychiatric hospital, after discovering that front-line employees suffered broken bones and concussions during interactions with violently ill patients. The Occupational Safety and Health Administration said the hospital “has not developed and implemented adequate measures to protect employees’’ from aggressive patients. Nurses and mental health workers were punched, hit, scratched, bitten, and hit with objects including a soda bottle and wooden dresser drawer, the federal agency said. (Kowalczyk, 2/9)

NH Times Union: Hampton Nursing Facility Denies Role In Death Of Elderly Woman
A Hampton nursing facility denies that it played any role in the death of an elderly woman whose family claims died as a result of a bad hair perm.The lawyer for Oceanside Center and Oceanside Healthcare and Rehabilitation Center disputes some of the allegations made in a wrongful death suit filed late last year following the death of 89-year-old Betty Pettigrew in 2015. (Schreiber, 2/8)

Detroit Free Press: Detroit Hospitals See Hope For Heart Attacks With New Pump
Five health systems in southeastern Michigan have joined forces to save heart attack victims, using a new tiny heart pump. Since July, doctors from Henry Ford Health System, Beaumont, DMC Heart Hospital, St. Joseph Mercy Health System and St. John Providence Ascension have used Impella pumps, inserted in cardiac patients dealing with cardogenic shock, which has led to an 80% survival rate. When in cardogenic shock, patients’ heart function plummets, which leads to low blood pressure and not enough blood flowing to vital organs. (Meyer, 2/8)

The Philadelphia Inquirer/Philly.com: Money Fight Starts In North Philly Health System Bankruptcy
There is not much money to fight over in the bankruptcy of North Philadelphia Health System, which owed $24.8 million to its 30 largest unsecured creditors, according to its Dec. 30 filing. That explains the intense interest in the $692,000 that NPHS received from a New Jersey trust last Thursday. Before a hearing on the matter Wednesday in Center City, NPHS and three creditor groups reached a preliminary deal, which they detailed in U.S. Bankruptcy Judge Magdeline D. Coleman’s courtroom. (Brubaker, 2/8)

The Baltimore Sun: Center For Health Security At Hopkins Awarded $16 Million Grant
The Center for Health Security at the Johns Hopkins Bloomberg School of Public Health will study biosecurity and pandemics with the help of a $16 million grant announced Wednesday. The three-year grant from the Open Philanthropy Project will help the center study responses to serious biological risks and how technology could change those risks, improve biosafety practices, and increase awareness of biosecurity and pandemic challenges, according to the center. (Wells, 2/8)

Tampa Bay Times: Hernando Residents Tapped To Participate In National Health, Nutrition Survey 
The National Health and Nutrition Examination Survey, ongoing in Hernando County through March 8, will result in some answers to such questions and, likely, in revised national standards and recommendations regarding diet and physical and mental health. In the survey’s 55th year nationwide, this appears to be the first time Hernando County residents have been sampled, officials said. (Gray, 2/9)

Austin American Statesman: Critics Accuse UT Medical School Of Misspending Local Tax Dollars
The University of Texas Dell Medical School has spent millions of dollars on administrative and educational expenses using local tax dollars that are supposed to go only for indigent care, two activists and a former state senator charged Wednesday in remarks before UT’s governing board. The allegations echo previous complaints but were delivered with a stronger assertion of misspending and more detail. They were leveled by former state Sen. Gonzalo Barrientos of Austin and two local lawyers, Fred Lewis and Bob Ozer. (Haurwitz, 2/8)

Los Angeles Times: Southern California Gas To Pay $8.5 Million To Settle Lawsuit Over Aliso Canyon Leak
Southern California Gas Co. will pay $8.5 million to settle a lawsuit filed by air quality regulators over the Aliso Canyon gas leak and will fund a study of community health effects. The settlement with the South Coast Air Quality Management District, announced Wednesday, resolves a dispute over the months-long leak of methane from the gas company’s Aliso Canyon storage facility above the Porter Ranch neighborhood of Los Angeles. (Barboza, 2/8)

Orlando Sentinel: Orlando-Area Doctors, Patients, Growers Have Their Say On Medical Marijuana Rules
Dozens of people with ailments including cancer, chronic pain and multiple sclerosis implored the Florida Department of Health on Wednesday night to loosen the regulations for medical marijuana and allow them to get treatment faster. Voters in November approved a constitutional amendment that allows doctors to recommend full-strength marijuana for a wide variety of ailments including glaucoma, HIV, AIDS, ALS, Parkinson’s disease, Crohn’s disease and PTSD. Now the department’s Office of Compassionate Use is scrambling to figure out how to regulate the drug within the required six months of the effective date of the amendment, which was Jan. 3. (Jacobson, 2/8)

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Medicaid Managed Care Firm To Cut Reimbursements To Iowa Providers

Dozens of agencies that provide services to Medicaid enrollees with disabilities will be affected by the cuts announced by AmeriHealth Caritas, which is the largest of the three firms hired by the state to handle the Medicaid program. Managed care programs in Tennessee and California are also in the news.

Des Moines Register: Medicaid Shift: Agencies That Help Disabled Iowans Face Major Cuts
Dozens of agencies that assist thousands of Iowans with disabilities learned this week that they face significant cuts in how much they’re paid by a private company managing the state’s Medicaid program. Industry leaders said they fear some service agencies will go under because of the looming cuts from AmeriHealth Caritas. “It’s not a matter of whether we can be patient — we can’t pay our bills. You can’t pay staff with a wish,” said Linda Dunshee, executive director of Link Associates, which serves central Iowans with intellectual disabilities. (Leys, 2/8)

Nashville Tennessean: Health:Further To Aid TennCare’s Aim To Improve Member Communication
TennCare is enlisting Nashville’s health tech scene to find companies with technologies to improve communication with members. Health:Further, as part of the TennCare Innovation Program, will be using its in-house resources to find companies — whether a startup or mature firm — that can aid the managed care organizations that administer the state’s Medicaid program. The program is the first of its kind, said Marcus Whitney, CEO of Health:Further, a Nashville initiative that links startups, the established health care industry and policymakers to the disparate factors and sectors that impact health. (Fletcher, 2/8)

California Healthline: Industry Giants Anthem, Centene Among The Lowest-Rated Medicaid Plans In California
Anthem Inc. and Centene Corp., top players in the growing Medicaid managed care market nationally, run some of the lowest-quality health plans serving California’s poor population, according to state data. The two insurers combined run five of the six lowest-rated plans in the state’s Medicaid program, known as Medi-Cal. And until they improve the quality of patient care in some areas of the state, officials have placed both companies under stricter oversight. Together, the plans cover about 3 million people, or roughly 20 percent of the Medi-Cal population. (Terhune, 2/9)

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Pharmacies Thrive Selling Opioids For Depressed Small Town Pain

MANCHESTER, Ky. — This economically depressed city in the foothills of the Appalachian Mountains is an image of frozen-in-time decline: empty storefronts with faded facades, sagging power lines and aged streets with few stoplights.

But there is one type of business that seems to thrive: pharmacies.

Eleven drug stores, mostly independents, are scattered about a tiny city of 1,500 people. Many have opened in the past decade — four in the past three years. And prescription pain drugs are one of the best-selling items — the very best seller at some.

Most pharmacies here and in surrounding Clay County (population 21,000) lack the convenience-store trappings of national chains like CVS or Walgreen’s. They sell few items over the counter, focusing on prescriptions and little else.

Clay’s residents filled prescriptions for 2.2 million doses of hydrocodone and about 617,000 doses of oxycodone in the 12-month period ending last September — that’s about 150 doses for every man, woman and child. About half as many doses of each drug were reported in Allen County (population 20,640), on the Tennessee border 160 miles southwest. Even smaller quantities were used in Breckenridge (population 20,018), another central Kentucky county.

An epidemic of prescription pain-killer use and abuse has spread across the U.S. in recent years. More than 183,000 people died from overdosing on prescription opioids from 1999 to 2015, according to the Centers for Disease Control and Prevention. Nearly 2 million Americans abused or were dependent to them in 2014, the CDC has reported.

Drug manufacturers and distributors have pumped prescription opioid painkillers into rural America, in response to demand — much from it from adults who had become physically addicted. The expansion of Medicaid through the Affordable Care Act increased the percentage of Clay County residents with Medicaid and gave more of them access to free prescription drugs, including pain pills.

Though Clay County’s opioid problem long preceded the act, the improved legal access helped bring a long standing problem out from the shadows. Statistics show residents are swallowing the preferred prescription opioid more.

“Pain is big in this area,” said Daniel Gray, a pharmacist at the Family Drug Center between a Dollar General Store and a community health center in a small shopping mall.

The opioid scourge has hit rural America hardest and Clay County’s experience is a window on that harsh reality. Pain for residents comes in many forms.

pharmacist-kentucky

Drug manufacturers and distributors have pumped prescription opioid painkillers into rural America. (Phil Galewitz/KHN)

Manchester is the biggest city in the county, an area known for years as one of the nation’s unhealthiest places to live. Four in 10 residents rate their health status as being fair or poor, twice the share for the entire state population. Close to half the county is obese. The rate of diabetes is also higher than average. Eastern Kentucky has high rates of prescription drug use, not just medicine for pain, according to the state pharmacy board.

High unemployment — Clay’s 8.4 percent rate is well above both Kentucky and national averages — may contribute to the demand for painkillers. Almost 47 percent of Clay’s residents live below the poverty line and a key predictor of prescription drug abuse is social rank, said Robert Walker, a researcher at the Center on Drug and Alcohol Research at the University of Kentucky

Painkillers became more accessible through legal channels in Kentucky after eligibility for Medicaid was expanded under the Affordable Care Act in 2014. Free medications, including addictive opioid painkillers, became available to nearly 440,000 more residents who joined the Medicaid rolls. That occurred amid an epidemic of fatal overdoses involving prescription opioids in Kentucky and nationwide over the past decade. About 60 percent of Clay’s residents are on Medicaid, up from 35 percent three years ago. It is among the most highly concentrated Medicaid populations in the country.

(Phil Galewitz/KHN)

To combat drug abuse, Kentucky in 2012 passed a law to manage sales of pain drugs. (Phil Galewitz/KHN)

From 2009 to 2013, Clay already had the third highest rate of hospitalizations for pharmaceutical opioid overdoses among the state’s 120 counties. But use has accelerated for some drugs in the past three years, data shows. People become addicted to opioids after they buy drugs on the street or begin treatment for an injury, said Kenny Watts, manager of Kentucky Pain Management Services in Hazard, Ky., about 40 miles from Manchester.

Use of oxycodone (marketed as OxyContin), the county’s second-most prescribed opioid after hydrocodone rose the past three years while the use of controlled substances overall held steady, according to the state’s KASPER database, which tracks prescriptions of controlled substances. But taking Clay County’s relatively small population into account, the most recent report shows the rate of prescribed oxycodone doses filled per 1,000 residents there increased 11 percent in last year’s third quarter from the same 2013 period. A dose is a single pill.

In contrast, hydrocodone (its market names include Vicodin and Lortab) prescriptions in doses per 1,000 residents fell nearly 6 percent in 2016’s latest quarter from 2013. Oxycodone produces a high that makes it the preferred choice with those who abuse prescription painkillers and hydrocodone is the second most popular choice, research conducted in drug treatment programs has found.

To combat drug abuse, Kentucky in 2012 passed a law to manage sales of pain drugs. It required doctors and pharmacists to use a state database to find out if their patients were recently prescribed narcotics. Its purpose was to prevent patients from obtaining multiple prescriptions from different doctors.

The law also mandated that all pain clinics be licensed and gave law enforcement easier access to the drug monitoring database.

But doctors and pharmacists are ill-equipped to be enforcers. They say it is difficult to distinguish between use and abuse immediately and to overcome the large social forces beyond their control.

“Doctors are under tremendous pressure to prescribe and patients wear you down,” said Dr. Jeffrey Newswanger, an ER physician and Manchester Memorial Hospital’s chief medical officer, noting that when people feel hopeless and have little to do, they are more likely to seek help for what’s causing them pain. He said that patients frequently come to the ER seeking medicines.

“We see a lot of overdoses and have a tremendous drug problem in the area,” he said. “Whether there is any correlation between OD’s and the Medicaid expansion is hard to say. I think in general most abusers are getting their drugs from the street, not from prescriptions.”

Dr. Jeffrey Newswanger, Manchester Memorial Hospital’s chief medical officer and an emergency room physician, says doctors face great pressure from patients to prescribe pain medications. (Phil Galewitz/KHN)

Dr. Jeffrey Newswanger, Manchester Memorial Hospital’s chief medical officer and an emergency room physician, says doctors face great pressure from patients to prescribe pain medications. (Phil Galewitz/KHN)

Eldon Depew, a Manchester pharmacist for 35 years who also works at a Family Drug Center, said he recognizes the opioid abuse problem, but when he’s given a valid prescription, he fills it.

Medicaid’s expansion has not created more addicts, said Steve Shannon, executive director of the Kentucky Association of Regional Programs, which represents community mental health centers that treat substance abuse. “People who were uninsured were pretty resourceful when it came to finding drugs.”

If the ACA made cheap drugs more available, it also made treatment more accessible because it required coverage of mental health and substance abuse treatment.

County Coroner Danny Finley observed that deaths from opioid overdoses have dropped steadily — from 27 in 2011 to five last year and in 2016, just four. In last year’s third quarter, the county had the state’s 13th highest rate of doses of suboxone — a combination of buprenorphine and naloxone — that is used to treat addiction, according to the KASPER database.

Yet Manchester’s closest inpatient drug treatment facility carries a waiting list of 100 people that’s grown more than 50 percent in recent years, said Tim Cesario, director of substance abuse services at the Cumberland River Comprehensive Care Center in Corbin. The facility — with 41 beds for men and 15 for women — has been at capacity for several years, he said.

He said more people in their twenties are coming for treatment compared with an age group that was likely in its thirties and forties just a few years ago.

He attributed the trends to the increased availability of pain pills, particularly from drug dealers, and has concluded the state’s Medicaid expansion was both good and bad for those fighting the opioid epidemic.

“It did enable people to get pain pills for free if they can get someone to prescribe them but it also increased their ability to get treatment because they now had a way to pay for it,” he said. “So on one hand it’s worked against us and on another, it has worked with us.”

Elizabeth Lucas contributed to this report.

Categories: Medicaid, Pharmaceuticals, Public Health, Syndicate

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Medicaid Block Grants Advocated By GOP Could Reduce Federal Spending By $150B Over 5 Years

The analysis by consulting firm Avalere also suggests states would have to put in more money to keep the same services. In other news, efforts to overhaul the health law raise concerns about new Medicaid coverage among the homeless, Medicaid issues are on the agenda in the Kansas legislature and a doctor staffing company agrees to pay $60 million to settle allegations that it overbilled Medicaid and Medicare.

The Hill: Study: Medicaid Block Grants Would Save Feds $150 Billion
A Republican proposal to fund Medicaid through block grants could save the federal government more than $100 billion over five years, according to a new analysis released Monday. The analysis from healthcare firm Avalere Health shows that if Medicaid were funded through block grants instead of through the open-ended commitment the program receives now, the federal government would save $150 billion by 2022. Similarly, shifting to per capita caps, in which states would receive a set amount of money per beneficiary, would save $110 billion over five years. (Hellmann, 2/6)

Morning Consult: GOP Medicaid Funding Proposals Could Save $150 Billion, Analysis Finds
Republicans in Congress have proposed shifting how Medicaid works, arguing that would put states more in control of the program. … The proposal does face strong opposition, and not only from Democrats. AARP, the interest group representing senior citizens, wrote in a letter to lawmakers last week that they opposed block grants and per capita caps. Avalere’s analysis shows that under such proposals, many states would have to chip in more of the funds for Medicaid. (McIntire, 2/6)

NPR: Medicaid Expansion That Helped Homeless Is In Jeopardy
Everyone expects Congress to change the Affordable Care Act. But no one know exactly how. The uncertainty has one group of people especially concerned — the homeless. Many of these people received health coverage for the first time under Obamacare. They’re worried it will disappear. (Fessler, 2/7)

KCUR: Plan To Restore KanCare Cuts Comes With Delay 
Kansas legislators are weighing plans to restore cuts to Medicaid, but health care providers may not see the extra boost until 2018 or even 2019. The Senate’s budget committee heard testimony Monday on Senate Bill 94, which would increase a fee on HMO insurance plans to draw down federal funds and replace the cuts made to KanCare, the state’s privatized Medicaid program. The bill as written would enact the fee increase as soon as possible — even making it retroactive to the beginning of the year. But the money wouldn’t make its way to Medicaid providers until 2018. (Marso, 2/6)

KCUR: Legislators To Debate KanCare Expansion Amid Uncertainty About Obamacare Repeal 
KanCare expansion advocates say confusion in Washington, D.C., is helping their cause as they gear up for Statehouse hearings this week on an expansion bill. They say legislation sponsored by several Republican U.S. senators that would retain parts of the Affordable Care Act is evidence that some in the GOP are having second thoughts. So too is the fact that Republican governors in Indiana and Ohio are seeking approval from the Trump administration to keep their expanded programs in place. (McLean, 2/6)

Modern Healthcare: TeamHealth Will Pay $60 Million To Settle CMS Overbilling Claims 
Physician staffing giant TeamHealth Holdings will pay $60 million to settle allegations that a hospitalist services provider it acquired overcharged the CMS. IPC, a physician group practice TeamHealth purchased in 2015, allegedly encouraged its hospitalists to overbill Medicare and Medicaid, according to the U.S. Justice Department. According to the lawsuits, IPC encouraged its hospitalists to bill for their services at the highest possible levels. In some cases IPC hospitalists billed for more services in one day than could possibly have been provided in a 24-hour period. (Castellucci, 2/6)

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Viewpoints: Grading Obamacare; The Thorny Challenges Involved In Repeal

Opinion writers analyze the GOP’s fortitude in its push to dismantle the health law, as well as offer thoughts on how well Obamacare worked, what this year’s enrollment numbers mean and how to proceed with Medicaid.

The New York Times: Grading Obamacare: Successes, Failures And ‘Incompletes’
Did Obamacare work? It’s worth asking as President Trump presses his promise to repeal and replace the “disaster” of Obamacare. Ever since the Affordable Care Act was passed in 2010, it has been so contentious that it can be difficult to see beyond the partisan debate. But by looking at the many ways the law has changed health care, it’s possible to hazard some judgments. (Margot Sanger-Katz, 2/5)

The Washington Post: With No Allies, Republicans Step Away From Precipice Of Repeal
As they struggle to figure out how to deliver on the most important (and repeated) promise they made to their constituents over the last eight years — repealing and replacing the Affordable Care Act — Republicans face two sets of problems, both of which are far thornier than they imagined. The first are the policy problems, which arise from the fact that health care reform is incredibly complex (and yes, they’re just realizing that now). The second are the political problems, which may be even more challenging. (Paul Waldman, 2/3)

The Wall Street Journal: Replace ObamaCare, Don’t Rename It
So powerful is the political appeal of entitlement programs that modern democracies routinely choose bankruptcy over curtailing them. That’s even true of ObamaCare. Despite surging premiums, lagging enrollment, the growing burden on the economy, and the enduring opposition of most voters, the debate is about replacing rather than simply repealing it. (Phil Gramm, 2/2)

RealClear Health: Repealing The Affordable Care Act: Bad For The Poor, Good For The Rich
President Trump and Republican leaders in Congress have made their intention to repeal the Affordable Care Act (ACA) clear. Repealing the ACA without an immediate replacement would take health coverage away from tens of millions of Americans, remove popular protections for consumers against insurance companies, and unravel states’ individual insurance markets. And beyond these devastating impacts, the Republicans’ likely plan would also give a windfall tax cut to the highest-income Americans. At the same time, it would raise taxes significantly on millions of low- and moderate-income families due to the loss of their premium tax credits. (Brandon DeBot, 2/6)

The New York Times: Drop In Late Obamacare Enrollment Appears To Be A Trump Effect
In the waning days of this year’s Affordable Care Act sign-up period, the Trump administration declared war on the health law, releasing an executive order that could weaken its requirements and yanking advertisements and outreach off the air. Those actions appear to have made a difference. Sign-ups for health plans in the states managed by the federal government are down slightly compared with last year. About 9.2 million Americans picked an Obamacare marketplace plan for this year, according to a government report released Friday. Last year, that number was 9.6 million. (Margot Sanger-Katz, 2/3)

Health Affairs Blog: Uncertainty, Headwinds Hurt Final Marketplace Enrollment Total
On February 3, 2017, the Centers for Medicare and Medicaid Services released its final snapshot of plan selections for the fourth Healthcare.gov open enrollment period, which ended on January 31, 2017. As of that date, 9,201,805 individuals had selected plans through Healthcare.gov in the 39 states that it serves. About 3 million of these were new consumers and 6.2 million were returning consumers. (Timothy Jost, 2/5)

The Wall Street Journal: It’ll Take More Than A Band-Aid To Fix Medicaid
One of the most fraught questions in Donald Trump’s Washington is how Republicans will reform health care. No aspect of the debate over ObamaCare presents as much risk, or opportunity, as what to do with the law’s expansion of Medicaid, which gave government health insurance to millions of Americans. It won’t be easy, but President Trump and Congress have an opportunity to control Medicaid costs, improve the health of enrollees—and also win bipartisan support. (Regina Herzlinger and Richard Boxer, 2/5)

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Utah Seeks To Expand Medicaid To Cover Up To 5,000 More Low-Income Parents

The state last year asked federal officials to approve a plan to expand Medicaid to 9,000 to 11,000 Utahns but that hasn’t yet received a review. Also in the news, Indiana officials are asking the Medicaid program to not cover one form of the drug Suboxone, which is used to treat addiction, because they are concerned about its proliferation in the state’s prisons and jails, where some people use it to get high.

Salt Lake Tribune: State Officials Send Feds Medicaid Expansion Plan For Low-Income Parents
As Utah officials continue to wait for federal approval of their small-scale Medicaid expansion plan, they hope to expand coverage to some parents. Tom Hudachko, state Department of Health spokesman, said Friday that the federal Centers for Medicare and Medicaid Services (CMS) “verbally indicated” to state officials late last year that it would approve that part of the expansion, covering low-income parents with dependent children. The state has submitted a separate plan focused solely on that group. It would cover an estimated 3,000 to 5,000 low-income parents currently not covered by Medicaid, a program designed to deliver care to low-income individuals and families. (Stuckey, 2/3)

The Associated Press: Utah To Expand Medicaid To Cover More Poor Parents
The plan announced by Utah’s Department of Health would cover parents earning up to 60 percent of the federal poverty level, which is $14,760 annually for a family of four. Currently the state only covers parents earning up to 45 percent of the federal poverty level, about $11,070 a year for a four-member family. (Price, 2/3)

Indianapolis Star: Jailers Ask Medicaid To Solve ‘Big Problem’
Public safety officials are calling upon the state’s Medicaid program to cease covering an addiction drug in its film form, which they say has become the top contraband item circulating in the state’s correctional facilities. More than 100 people signed a letter to the head of Indiana’s Medicaid program requesting that the state remove the film form of Suboxone, or buprenorphine, from its formulary in the hope of preventing its proliferation inside the Indiana’s prisons and jails. (Rudavsky, 2/3)

Forbes: Opposition Mounts To Trump’s Medicaid Block Grant Idea
There is escalating opposition building across the country to an effort by the Trump White House and the Republican-led Congress to give each state a fixed block grant of federal money to pay for Medicaid coverage for poor Americans. Such an idea would be a huge change in how Medicaid is financed. Opponents say it could lead to reduced benefits if states don’t have the ability to pick up costs for new treatments or an influx of eligible patients during bad economic times that trigger job loss. Hospitals, insurers, doctors and just last week – the nation’s giant lobby for seniors – AARP, came out against Medicaid block grants. (Japsen, 2/5)

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