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Implementing Health Reform: Basic Health Program And More ACA Litigation Results


March 10th, 2014
by Timothy Jost

On March 7, 2014, the Centers for Medicare and Medicaid Services of the Department of Health and Human Services released its final rule on the Basic Health Program (BHP). This rule finalizes a rule proposed by CMS in September of 2013, which was covered here. CMS also released its methodology for funding the BHP for 2015. Finally, CMS published, along with the Departments of Labor and Treasury, a request for information regarding the implementation of a provision of the Affordable Care Act that prohibits insurers from discriminating against providers based on their licensure or certification status.

This post will discuss these issuances, as well as a decision by the United States Court of Appeals for the District of Columbia rejecting yet one more challenge to the ACA.

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Implementing Health Reform: Extending Enrollment And Premium Deadlines; Easing Provider And Drug Transitions


December 13th, 2013
by Timothy Jost

On December 12, 2013, with twelve shopping days until Christmas and three shopping days left until exchange enrollment was supposed to close for 2013, HHS, citing “unforeseen barriers to enrollment in the Exchanges,” issued an interim-final rule entitled “Maximizing January 1, 2014 Coverage Opportunities.” The rule formally extends until December 23, 2013, the date by which individuals must enroll in the exchanges to ensure coverage for January 1, 2014, giving applicants eight additional shopping days. The rule also extends until December 31 the date by which enrollees must pay their premium to ensure coverage for January 1, while the preface encourages insurers to give enrollees even more time to pay, or to accept partial payments. The preface to the rule encourages insurers to help ensure continuity of provider coverage and availability of off-formulary drugs.

Finally, another notice, also released on December 12, extends coverage in the Pre-existing Condition Insurance Program (PCIP), which was supposed to expire on December 31, 2013, for one month.

The troubles that have afflicted the Healthcare.gov federal exchange website and many state exchanges are common knowledge. Although enrollment is going more smoothly now, millions of uninsured individuals who are eligible for advance premium tax credits that will largely cover the cost of their coverage have not yet been able to enroll. Millions of additional individuals have been unable to renew their current policies in the individual and small group market, as those policies do not meet 2014 market reform requirements. Although these individuals can purchase policies in the individual and small group market outside of the exchange, and most of them probably will, many would be able to find better deals in the exchange or qualify for premium tax credits but have not yet been able to do so.

In addition, 105,000 individuals are covered through the PCIP and a couple of hundred thousand more through state high risk pools, which were supposed to have closed at the end of 2013. These individuals desperately need coverage. The interim final rule attempts to extend the opportunities all of these individuals have to gain coverage.

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Implementing Health Reform: Website Developments And Contingencies; ACA Litigation And Guidance


October 23rd, 2013
by Timothy Jost

It is October 22, 2013, three weeks after the healthcare.gov website opened its doors. The website is still not working properly. Parts of it are working reasonably well, and a few people are getting all the way through the enrollment process. But multiple failures are still occurring throughout the system. In particular, there are serious concerns about the functioning of the “back end” of the process, where applicants are actually enrolled in qualified health plans with insurers.

The President’s frustration was demonstrated in his remarks of October 21. He noted that there are alternative pathways to eligibility — the call center and paper applications — and promised that the exchange will in the coming weeks contact people who initiated but were unable to complete the application process. He also reminded listeners that “the Affordable Care Act is not just a website.”

The President committed the full power of the federal government to making the website work. On October 22, Health and Human Services Secretary Sebelius proclaimed a “technology surge” to fix the website. She announced that HHS is bringing in Jeff Zients, who has extensive technology leadership experience in both the private and public sector, to provide management advice and counsel to the website repair project. She also stated that HHS is drawing in experts from across the government and industry “as part of a cross-functional team that is working aggressively to diagnose parts of HealthCare.gov that are experiencing problems, learn from successful states, prioritize issues, and fix them.”

The healthcare.gov website will get fixed. This is not cold fusion. It is a website, and the technology to build websites is known. But the task of matching millions of individuals to the health plan of their choice while providing financial assistance to pay for coverage is terribly complex. The marketplace securely connects four federal agencies, state governments, and dozens of insurers, and must accurately verify an enormous volume of information. It is disappointing that HHS could not have the website ready in time, and it was unwise for HHS to have launched a website that was not adequately tested. But at some point in the future, the website will be fully functional.

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The Commonwealth Fund’s WhyNotTheBest.org: Building a Platform for Health System Improvement


October 9th, 2013
 
by Anne-Marie Audet and Martha Hostetter

Development of The Commonwealth Fund’s WhyNotTheBest.org—a free tool with which to benchmark hospital performance on measures of quality and safety, outcomes, and costs—began with a question. We asked: if the U.S. health care system is not the “best in the world,” as has been amply demonstrated, what will it take to get us there?  Late […]

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We Need To Know More About Wellness Incentives


August 22nd, 2013
by Harald Schmidt

Recently, the federal government published Final Rules on wellness incentives. What’s in it for you? From next year, your employer may increase your insurance premiums by up to 50 percent of the cost of coverage if you smoke. If you’re overweight, you may look at a 30 percent surcharge. But employers may also reduce premiums by up to 30 percent for normal weight.

Will such incentives be effective health promotion tools, or merely means to shift cost to the unhealthy? Regrettably, we may never really know. This is why we need reporting of key features of all wellness programs.

Wellness incentives typically come as ‘carrots’ or ‘sticks’. In the ‘carrot’ format, they reduce net insurance costs by a certain amount, provided you engage in healthy behaviors. ‘Sticks’ impose a net-increase if you don’t.

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The BPC Health Care Reform Plan: A Response To Coulam, Feldman, and Dowd


July 30th, 2013

We commend Robert Coulam, Roger Feldman, and Bryan Dowd for bringing attention to competitive bidding in Medicare, a meaningful strategy to constrain health care costs through reducing inefficiencies in the health care system. The authors have made valuable contributions to research in this area for many years, and we welcome vigorous discussion on both the merits and strategy for implementing such a reform.

However, we believe the authors missed the mark in their recent Health Affairs Blog analysis of the Bipartisan Policy Center’s (BPC) proposal. Most notably, they failed to consider the political realities surrounding competitive bidding. In addition, they overlooked BPC’s other Medicare recommendations that are integral to the strategy for introducing competitive bidding in Medicare Advantage (MA).

In April, BPC released A Bipartisan Rx for Patient-Centered Care and System-wide Cost Containment. This was the culmination of a nearly year-long effort led by former Senate Majority Leaders Tom Daschle and Bill Frist, former Senate Budget Committee Chairman Pete Domenici, and former Director of CBO and OMB Dr. Alice Rivlin to produce a package of comprehensive, systemic reforms to achieve a higher quality, more sustainable health care system. The initiative reflected their recognition that attempts to address our nation’s health and budget challenges are too often fragmented and unproductive.

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Why Don’t the Republicans Have a Vision for Health Reform?


April 2nd, 2013
by John Goodman

In a recent Health Affairs post comparing the House Republican budget and the Senate Democratic budget, Uwe Reinhart says the contrast could not be more stark:

At least the American people now have before them the visions the two parties have for our country, especially in regard to health policy.

What are those visions? The Democratic vision he says, is that people “should have access [to health care] on roughly equal terms.” The Republican vision, by contrast, “signals to millions of low-income Americans without health insurance that they are on their own in health care.”

A Republican vision for health care? Unfortunately, there isn’t one.

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Mr. President: Make Imported Food Safe


March 26th, 2013
by Sandra Eskin

On January 4, my Pew colleagues and I applauded President Obama and the U.S. Food and Drug Administration (FDA) for releasing two sets of draft rules central to implementing the FDA Food Safety Modernization Act (FSMA), the first major update to our food safety laws in more than 70 years. The law signals a long-overdue shift in FDA’s food safety strategy. Instead of reacting to an outbreak after it occurs, the agency will focus on preventing illnesses before they happen. This emphasis on prevention should help strengthen food safety and reduce foodborne illnesses, which strike about 48 million Americans and are responsible for more than $77 billion in health-related costs each year.

The administration has taken an important step, but it must do more. Important draft regulations focused on the safety of imported foods are still awaiting release. These rules, which include the creation of a new Foreign Supplier Verification Program, are especially important since about two-thirds of fruits and vegetables and 80 percent of seafood consumed in the United States come from abroad. Overall, imports account for as much as 15 percent of all food consumed in U.S. households—and that figure is growing about 10 percent annually.

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ACA, HIV/AIDS, Oral Health, Patient Activation, & More: Foundation Blogs Round-Up


December 12th, 2012
by Lee-Lee Prina

It has been a long time since I have done a round-up of posts on other philanthropy blogs that have caught my eye, so today is the day! Other topics covered below include social determinants of health (specifically, housing), “tasksharing” in global health, and charities’ use of data. I love having the opportunity to peruse the […]

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Your (Untrained And Scared) Family Member Will Set Up Your IV Now!


November 2nd, 2012
 
by Carol Levine and Susan Reinhard

Time travel, both backward and forward, continues to be a favorite theme in popular culture. If we could travel back just 60 years or so, we would see a vastly different health care system, one geared to provide acute care, not chronic care, and one offering what today would be seen as rudimentary treatments. No one in 2012 would expect a surgeon to use techniques from that era or a doctor to prescribe medications long surpassed by more effective drugs. Yet one important area of health care and long-term care services and supports clings to outmoded terms and measures.

Welcome to the hidden world of family caregivers — broadly defined as the spouses, adult children, other family members, partners, friends and neighbors who provide or manage most of the care of the growing number of noninstitutionalized people with chronic illnesses and disabilities. As our recently released AARP Public Policy Institute and United Hospital Fund report (available here and here) puts it:

Family caregivers have traditionally provided assistance with bathing, dressing, eating, and household tasks such as shopping and managing finances. While these remain critically important to the well-being of care recipients, the role of family caregivers has dramatically expanded to include performing medical/nursing tasks of the kind and complexity once provided only in hospitals.

These tasks include managing multiple medications, not just pills but injections and infusions; wound care; operating medical equipment like feeding tubes, dialysis machines, and mechanical ventilators; and using electronic monitors and other devices.

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Your Genome Belongs To You


June 8th, 2012
 
by Sharon Terry and Robert Cook-Deegan

Just four years ago, only two people in the world had their genome sequenced:  James D. Watson (co-discoverer of the structure of DNA) and J. Craig Venter (former President of the firm that mounted a private-sector rival to the Human Genome Project).  There are now many thousands of such people.  At genome meetings, scientists are […]

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Medicare Physician Payment: A Hollow Victory For The RUC


May 18th, 2012
by Brian Klepper

On May 9th, William Nickerson, Senior Judge in the Southern Maryland Federal District Court, issued a 15 page ruling against the six Augusta, GA primary care physician plaintiffs who challenged HHS’ and CMS’ longstanding relationship with the American Medical Association’s Relative Value Scale Update Committee (RUC). The opinion did not weigh the substance of the […]

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Family Caregivers: A Priority For Politicians?


October 3rd, 2011
by Sean Coffey

A posting on the Health Affairs blog earlier this year by Carol Levine asked the pointed question: “The year of the family caregiver- in what country?”  In it, she compared the “Year of the Family Caregiver” in the U.S. to the recent elections in Canada, where politicians were competing to see who could provide a […]

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Do We Need An Individual Mandate?


May 10th, 2010
by John Goodman

Should everyone be required to have health insurance? The short answer is no. There is nothing that can be achieved with a mandate to buy health insurance that cannot be better achieved by a carefully designed system of tax subsidies. Beyond that, a requirement that everyone obtain insurance (as the new health reform law dictates) […]

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Medicare Part D drug pricing


April 8th, 2010
by Kevin Outterson

Reducing Medicare Part D drug prices requires careful tools, not simply the power to negotiate

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Should We Be Able To Buy Insurance Across State Lines?


February 24th, 2010
by John Goodman

I live in Texas. Right now, the only health insurance I can buy is insurance regulated under Texas law. But if bills before Congress (most notably, one sponsored by Arizona Republican Congressman John Shadegg), are enacted, I would be able to buy insurance regulated, say, by the laws of Virginia, or the laws of Delaware, […]

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A Practical Solution For Rewarding Efficient Providers


December 23rd, 2009
 
by Charles Weller and Floyd D. Loop

We offer a practical solution to the issues that Jack Wennberg and Shannon Brownlee raised in their November 17th blog, “The Battle Over Rewarding Efficient Providers.”  We combine our experience in areas of law and patient care, respectively. American health care is in real peril of being swamped by surging costs.  President Barack Obama’s budget […]

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Massachusetts Health Reform: Employer Coverage From Employees’ Perspective


October 1st, 2009
by Health Affairs

As Congress and the Administration debate health care reform, it is instructive to look at the Massachusetts model, now in its third year. Health Affairs today released a study of workers in the Bay State who were interviewed in fall 2008 about their employer-sponsored health care coverage, following up on similar surveys in 2006 and […]

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The Public Plan: Not Worth The Risks


May 15th, 2009
by Jeff Goldsmith

One of the most controversial parts of the Obama health reform campaign platform was its pledge to create a new Medicare-like public health insurance offering that would “compete” with existing private insurance plans, and put pressure on them and on providers to hold down costs. It would do this mainly by using Medicare-like pricing leverage […]

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New Patient Safety Effort Uses Aviation Industry Model


April 13th, 2009
 
by John Iglehart and Chris Fleming

A public-private alliance known as the Commercial Aviation Safety Team (CAST) has greatly improved aviation safety. A similar alliance among health care stakeholders could reduce medication and device errors and wrong-site surgeries, renowned patient safety expert Peter Pronovost and coauthors say in an article published April 7 on the Health Affairs Web site. Pronovost is a […]

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