Ever wonder how the preparations for healthcare exchanges are proceeding? The Kaiser foundation has constructed a brief [PDF] which allows one to reasearch states’ plans in progress. To review, the establishment of healthcare exchanges by the feds under reform is meant to enable consumers to compare a selection of qualified health insurance options in order to find the plan that best meets their needs and budget — with a significant amount in taxpayer subsidies devoted to this purpose.
Among the highlights in the brief report: (1) discussion of governance of exchanges, with some states granting significant control over governance matters at the hands of the excutive branch; (2) plans by states to address conflict-of-interest issues regarding insurance plan representation within governing boards of exchanges; (3) the total amounts paid to states so far in the funding of exchange formations in their individual healthcare marketplaces; and (4) the effect of legal challenges brought forth in some states regarding the constitutionality of the insurance mandate provision of the ACA (most recently, the striking down of the state of Virginia’s challenge filed by its atty. gen.) on the formation of exchanges.
As we move closer to 2014 — the real enaction of reform — HHS is offering almost $4B under reform to create consumer-focused healthcare co-ops. Healthcare cooperatives are meant to offer a ready consumer alternative to traditional plans for coverage. Additionally, CMS[1] will be making available $600 million in loans to help start the plans along with another $3.2 billion to help keep them solvent.
As stipulated by the reform law, cooperatives must be nonprofit entities that reinvest extra revenues into either lowering premiums or improving the quality of care. Although they were originally advertized as an alternative to the public option provision (which never materialized), co-ops cannot be run by a government entity. This proviso, in effect, quells consideration that co-op funding will lead to a single-payer necessity based upon funding source.
There seems to be a neverending chorus on how Medicaid, as a payment system, fails on so many levels. Administrative hassles for short term gain multiplied many times during the average workweek for primary care physicians mired in all of the paperwork, all with no end in sight — unless the provider wishes to end the relationship, of course. Some states have made working with Medicaid beneficiaries more problematic, by lowering matching funding of the program on many levels. It seems like practically every state in the nation, except here in Minnesota, has taken a route in cutting their respective HHS budgets as a primary strategy to meet budgetary shortfalls head-on en route to a balanced result.
To curb rising Medicaid costs, about a dozen states are starting a new budget year by reducing payments to doctors, hospitals and other health care providers that treat the poor. Some health care experts say the cuts, most of which went into effect July 1 or will later this month, could add to a shortage of physicians and other providers participating in Medicaid.
With government projections of huge increases in Medicaid rolls by mid decade on the cusp of reform, insurers, policymakers, lawmakers, and healthcare systems are faced with the reality that numbers of beneficiaries will continue to add to the cost of care delivery in spite of reform. With the federal government planning to supplement spending to offset some of those costs, sky’s the limit on the share the feds will pay — increasing GOP fears of even more spending. With states’ assistance from stimulus (approx $100B) funds practically gone, it’s no surprise that of the 49 states with a budget, around half of those have met the deadline with Medicaid cuts to providers. HHS budgetary issues are on the table in Minnesota today as part of our state’s effort to balance the budget and end its government shutdown.
Consider this: With a rate approaching 30 percent, the state of Texas has the highest degree of uninsured in the country. Now consider this: It has always been known in healthcare policy circles that, if given the chance, conservative lawmakers in the state would choose to opt out of Medicaid because of what they see as a wild “unsustainability” in the federal-state program for the short term.
One of the state’s lawmakers, a Senate republican, is introducing a bill whose end result would create administrative partnerships (as presumptive methods to control healthcare costs) among health systems — a compact — that would allow the state opt-out as a feasible way of reining in the cost of healthcare delivery to the poor and uninsured in Texas. The price tag: almost half a billion dollars. While consolidating administrative redundancies to reduce costs, the bill would also have some undesirable provisions, according to healthcare advocates for Texas’s poor:
This law is more designed to set up the legal structures that will allow doctors and clinics and labs and hospitals and health plans to work together to restructure themselves in a way that they can share information and savings if they really not just keep costs down but actually improve people health outcomes. [...] The bill allows Texas to ask the federal government for permission to take its share of funding and join other states in creating a compact, a healthcare program free of federal requirements.
It’s obvious that a federal opt-out is an impossiblity in the Obama administration, but it does open up the possibility for upping the ante in the reform debate via the anti-spending advocacy of the state’s current governor — who just happens to be considering seriously a run for the White House in 2012. | LINK
The issue may not be as salient or controversial as the discussion on whether to back the mandate provision in the PPACA during its annual policy meeting … but MedPAC, be warned; the AMA is staking out its position on proposed cuts in reimbursements for ambulatory imaging studies. Seen as another healthcare tax and spend mechanism in the primary care delivery sector by the payment commission, the AMA has marshaled the apparent bipartisan support of the main congressional regulator of payment activities of CMS — the House Energy and Commerce Subcommittee on Health — in fighting the proposed cuts.
The American Medical Association is circulating a draft letter to Congress urging lawmakers to reject Medicare payment proposals aimed at cutting back the use of imaging services. [...] The letter argues that the recommendations ‘could have a number of unintended consequences, including reducing payments to primary care physicians and driving more services out of physician offices and into more expensive hospital settings.’
The use of imaging and proposed cuts on that use would present a major problem for primary care as a discipline. In a medical specialty already beset by incremental government nickle-and-diming among those practices which continue to see beneficiaries, the curtailing of such use simply to take a slash-and-burn approach in penalizing all MA plans in the name of cost containment does nothing to increase care quality and everything to discourage continued healthcare access. | LINK
President Obama has issued policy guidance on the extension of healthcare benefits under Medicaid for gay couples.
Under the new guidance, dated June 10, states have the option to allow healthy partners in a same-sex relationship to keep their homes while their partners are receiving support for long-term care under Medicaid, such as care in a nursing home.
This is significant, because, as the article states, states have the ability to seize property to pay for overdue medical charges once a beneficiary’s ability to pay is exhausted. The presence of a spouse in a married relationship living on that property would prevent liens and seizures from taking place, allowing Medicaid benefits to kick in. The same-sex partner living in the home would abort any power the state would have in realizing payments under those alternative conditions for beneficiaries receiving long term care services.
The current economic crisis that is afflicting many states, including Minnesota, renders no amount of negotiation trivial (or, even civil at times, for that matter) and is gripping many states in political gridlock. With a Democrat chief executive and a Repub controlled legislature, Minnesota is no exception. One of the state’s largest agencies — the Dept. of Human Services — is receiving the lions share of scrutiny as it is a major source of govt spending. It follows that, with the gridlock in St. Paul, a shutdown could be looming; that could have an enormous effect on state subsidized health care spending.
Not all healthcare entities in the state are bracing for the worst in the current legislative impasse amid a $5B budget deficit. Hospitals in Minnesota are proud to trumpet their contributions to a growing, if sputtering, economy.
In all, the state’s 148 hospitals generated $27.2 billion and created 214,108 jobs in 2009, according to the most recent data available from the Minnesota Department of Employment and Economic Development, which ran the numbers for the Hospital Association.
Hospitals in Minnesota, especially those in rural areas, may be huge economic drivers of activity, but the spending on healthcare — in the acute care setting — will always outpace the cost of care delivered in a strictly preventative sense. Including safety nets, which were created to attend to those with limited access to healthcare resources, many hospitals still account for heavy spending — eventually encroaching on the need for public matching funds to offset explosive growth in the cost of delivery. In troubled economic times, a balance is needed between spending in both the public and private sectors to ensure continued healthcare delivery in a fiscally sound fashion, not a reckless one. Apparently DHS leaders, reps from the MN Hosp. Assn., Governor Dayton, and lawmakers will be meeting to discuss their philosophical approaches to this glaring issue next week. | LINK
The latest news from the Medicare front has nothing to do with the latest Paul Ryan salvo against the entitlement. It’s the overall health of the program that has eyes concerned. Five years sooner than expected — that’s how quickly the feds say that funds are being consumed. According to trustees, the earlier deficit projections are the result of the poor economy, resulting in decreased collections from payroll taxes; continued current rates of Medicare spending without the influence of reform; and fraud.
Don’t let those trustees’ predictions fool you. I, and many others who closely watch developments like these within the realm of health policy, believe that the outlook for Medicare is more grim because those original projections assume cuts in reimbursements to doctors that Congress has usually already applied as a matter of course, and overall cost savings are usually difficult to predict, regardless. As a result, Medicare legislation needs scrutiny — and fast. The longer lawmakers sit on numbers like these, they’ll have to apply emergency stopgaps no one wants — huge tax increases[1] or program cuts — to save the program. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
