Federal Dollars Set to Loan Funds for Health Plan Startups in States Ahead of Reform

[This article posted on February 22, 2012. It is posted within the following categories: CMS, Corporate, Healthcare Policy & The Media, via Michael Douglas, MD, MBA.]

The federal government has given opponents of the ACA another reason to gripe: it has announced the formation of loans to initiate health plans on the new exchange platform in individual states. Think of the offering has a cooperative of sorts, built for the delivery of services within an exchange. CMS intends to oversee the adoption of at least one co-op per state via this method. Of course, emergency stopgaps are in place for the recipients of loans that may have problems satisfying the terms set forth by the feds; interest rates will be typically less than 1 percent.

Naturally, the behavior of such a healthcare delivery system is a reflection of the acronym used by the ACA’s program promoting it: the Consumer Operated and Oriented Plan. Proponents of the initiative are bullish on it, as the GOP-led legislature has incrementally cut initial CMS plan estimates earmarked for this purpose. Skeptics wonder if these loan startups will carry the heft needed to compete with established private insurers in the newly formed exchange marketplace in two years. The best intentions of non-profits in this case will have to be tempered by the new reality of such competition for healthcare consumer loyalty come 2014 under the law. Should be interesting to watch. | LINK

Wisconsin Governor Backs Up Anti-Healthcare Reform Claim with Denial of Fed Funds

[This article posted on January 19, 2012. It is posted within the following categories: Healthcare Policy & The Media, Politics & The Law, via Michael Douglas, MD, MBA.]

Embattled WI governor, Scott Walker (R), issued a statement yesterday opposing the implementation of a state exchange as provisioned by the ACA — opting to defer action on the measure until the case is heard by the SCOTUS in March. In doing so, he will be returning almost $40 M in federal funding earmarked for the healthcare exchange. Whether this is earnest on his part or merely a symbolic gesture to Wisconsin GOP faithful in the wake of a pending certified recall vote on his office remains to be seen. Walker has always been against the passage of the reform law, instead focusing on efforts to deny federal assistance in doing so (states which choose this path will have to demonstrate fiscal independence on healthcare exchange creation by 1/1/13 or will be mandated a program by the feds).

Is this entire episode a game of chicken by Walker in light of his sudden vulnerability? It is, if one listens to the rhetoric from the state’s Democrats on the issue. Advocacy groups are also weighing their own disapproval of the governor’s intentions. The SOCTUS will hear testimony on the constitutionality of the reform law (notably, the mandate for coverage) over a two day period by the end of March. By the end of Februrary numerous amicus briefs will be filed by both Obama admin (DOJ) and plaintiffs (states) in the case. In spite of all the rancor surrounding this issue, it will difficult to envision striking of the mandate provision, much less the entire reform law as two lower courts have offered split decisions on the matter — prompting the SCOTUS to act quickly on a decision on the entirety of the ACA well before the election. | PDF brief from UCB Labor Center in support of the ACA’s constitutionality

Minnesota Makes Public Exchange Prototypes

[This article posted on December 6, 2011. It is posted within the following categories: Corporate, Healthcare Policy & The Media, Knowledge & Medicine, via Michael Douglas, MD, MBA.]

Are the citizens of Minnesota ready to take a look at prototype models for healthcare exchanges? The marketplace stimuli as part of reform are being unveiled today. Although it may seem early for such exposure, MN must demonstrate that it can operate an exchange as part of reform much sooner — just over a year from now, in fact. Four companies have placed demo modules up for public review. Playing around with a couple of them, I get the feel of sites that are actually consumer portals into products that resemble reservation services, only instead of purchasing a flight or hotel accomodations, I am choosing a provider which can treat certain chronic conditions more cheaply, for instance, in one organization in comparison another based upon my personal situation.

States participating in this exercise which are not able to fully integrate these virtual exchanges at the outset of reform will get fed assists. Minnesota seems ahead of the curve here, as the governor has taken a seemingly personal role in getting this state’s offerings public and implementing diligent task-force support to the process early.

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