Year: 2017

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1: Federal judge weighing whether Illinois must prioritize paying Medicaid bills, Chicago Tribune, Kim Geiger, 6/6/2017

Clay’s summary: IL Medicaid providers have been hung out to dry and are owed $2B. But hey expansion saves money, puppies and the environment, right? Also- Illinois budgeting and politics is a special kind of crazy.

Key Passage from the Article

 

A federal judge heard arguments Tuesday over whether Comptroller Susana Mendoza should be required to prioritize payments to some Medicaid providers among Illinois’ billions of dollars in unpaid bills that keep piling up during the state budget stalemate.

The court dispute reflects the mounting difficulty of balancing Illinois’ competing financial obligations in the midst of an ongoing political fight between Republican Gov. Bruce Rauner and Democrats who control the General Assembly.

Judge Joan Lefkow indicated in court on Tuesday that she was sympathetic to the complaints of the Medicaid patients, but that she was unlikely to go as far as telling the comptroller which bills should be set aside in order to make the payments.

 

 

Read it here 

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Article 2: How Much Will The GOP’s Medicaid Per-Capita Cap Save, If Anything? CBO Refuses To Say, Forbes, Avik Roy, 6/8/2017

Clay’s summary: Block granting Medicaid may not save anything at all – but its an important Boogeyman for leftie fear-mongers to trot out when scaring-up the masses against AHCA.

Key Passage from the Article

 

CBO identifies three provisions in the AHCA that drive the $834 billion in reduced Medicaid spending. The first is the AHCA’s repeal of Obamacare’s Medicaid expansion. The second is its repeal of Obamacare’s individual mandate, which the CBO implausibly believes will lead more than 5 million people to drop out of Medicaid. The third is the per-capita cap reform of the pre-Obamacare Medicaid program.

Remarkably, and unusually, the CBO has decided not to break out the relative effects of these three provisions onto the Medicaid reform: a silence that has led to massive confusion among states who falsely believe that their traditional Medicaid programs will be subject to massive cuts.

CBO appears to believe that it’s too complicated to tease out the impact of the AHCA’s various provisions on Medicaid, because they interact with each other. But CBO does analyses of interacting provisions all the time.

This is all we know about the CBO’s view of the impact of per-capita caps: that they will “reduce outlays.” But the essential question is: by how much?

Read it here

 

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Article 3: Michigan: Medicaid expansion producing big savings, Detroit News, Jonathan Osling, 6/5/2017 

Clay’s summary: It’s all fun and games until you have to be the one paying for it. Cue squishy savings theories to help skirt the previously agreed upon exit strategy.

Key Passage from the Article

Gov. Rick Snyder’s administration wants to broaden the equation used to calculate state savings from expanded Medicaid eligibility as it works to protect the Healthy Michigan plan from a potential demise. The 2013 Michigan law includes a trigger that would end expanded eligibility for the low-income health insurance coverage if state costs outweigh savings that result from federal funding . . . But the administration is disputing projections that the cost-savings trigger could put the program on the chopping block regardless of what happens at the federal level, arguing state savings go beyond traditional budget lines. . . “If you look at savings in uncompensated care and other savings that are out there, I don’t think that would sunset this particular plan,” Pscholka said. “I think you have to look at all the savings that are taking place with hospitals and everywhere else. That number is pretty large.”

Read it here

 

Our friends at Milliman have just released 3 new helpful analyses for the Medicaid space:

ACA Infographic- Showing how much individuals in each state benefit from exchange subsidies.  Its a pretty nifty graphic showing states in different heights based on enrollment. Also shows percentage of individuals receiving subsidies for each state, based on 2017 data. This infographic also touches on CSRs and average premiums. Its a lot of info packed into one map, and well worth the read.

ACA_CSRs Infographic-  This one gets into more specifics on the cost-sharing reduction payments you’ve seen in the news lately.

Reinsurance and High Risk Pools– This new discusses the following issues:

· Historical role of high risk pools in the pre-ACA market
· ACA’s transitional reinsurance program
· 1332 State Innovation Waivers and the development of state-run reinsurance programs
· Key considerations for high risk pools and reinsurance programs under pending healthcare reform legislation

I linked a copy above, and you can also find the original with more info on the authors here: http://us.milliman.com/insight/2017/Reinsurance-and-high-risk-pools-Past–present–and-future-role-in-the-individual-health-insurance-market/

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1: FACT CHECK: Does The Trump Budget Gut Medicaid? Daily Caller, David Sivak, 5/30/2017

Clay’s summary: Maybe the sky is not falling.

Key Passage from the Article

What many refer to as “cuts to Medicaid” are actually cuts to the growth of Medicaid, not the current size of the program. The Trump administration allocates more for Medicaid every year of the budget. Director of the Office of Management and Budget Mick Mulvaney calls the misconception “a classic example of how Washington speaks differently than the world back home.”

Critics counter that despite increased spending in the budget, the size of Medicaid shrinks over time as a percentage of GDP, a measure of the size of the economy, dropping from two percent today to 1.7 percent in 2027.

While this is true, when looking at the size of Medicaid as a percentage of the total budget, it remains, on average, about the same size – 9.6 percent of the total budget – compared to 2016 funding levels. For this reason, it’s misleading to characterize the savings as cuts to Medicaid.

Read it here 

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Article 2: Medicaid efficiency is needed now, more than ever The Hill, Bill Lucia 5/31/2017

Clay’s summary: New TPL legislation could help prevent improper payments when there is coverage besides Medicaid. Also, cool to see Bill Lucia publishing.

Key Passage from the Article

 

Unfortunately, some liable third parties have found loopholes in laws and regulations that shift costs to Medicaid. HR 938 aims to close these loopholes and ensure that the right party is paying the right claims. Among the key provisions in the Medicaid Third Party Liability Act that will result in Medicaid savings and efficiency are:

Prevents liable parties from denying claims due to a lack of prior authorization, thereby shifting these costs to Medicaid.
Gives Medicaid Managed Care Organizations (MCOs) the same rights as state Medicaid agencies to be the payer of last resort. This is important as nearly 70 percent of Medicaid recipients are currently enrolled in Medicaid managed care plans.
Replicates prompt payment standards routinely enforced in the commercial sector, but for Medicaid reclamation claims. These are claims for the recovery of payments made by Medicaid that are actually the responsibility of another healthcare program or liable insurer.

 

Read it here

 

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Article 3: CMS chief: Medicaid needs reform, House healthcare bill ‘outdated’, McKnights, Emily Mongan, June 1, 2017

Clay’s summary: CMS Chief Verma is strategic in her view of the current funding fights. And she knows that CBO numbers are historically garbage.

Key Passage from the Article

Verma also dismissed the Congressional Budget Office’s cost estimate for the House’s healthcare proposal, noting “CBO numbers have historically been problematic” and that her focus has turned to the Senate’s version of the legislation. The CBO report estimated the bill could cut Medicaid funding by $834 billion over ten years, and leave 23 million people without health coverage by 2026.
“I’ve been working with a lot of the senators. We want to make sure that the president’s core principles are incorporated into the final version,” Verma said. “I think what’s more important is what the Senate comes up with. Really, the House version is something that’s outdated at this point.”

Read it here

 

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Article 4: Medicaid’s Cracked Halo, Forbes, Sally Pipes, May 30, 2017

Clay’s summary: Forbes continues to write articles about Medicaid that no liberal wants to read. Or acknowledge that there is some truth to.

Key Passage from the Article

A recent issue brief from the Kaiser Family Foundation, meanwhile, concludes, “Medicaid is cost-effective.”

But the data tell a different story. Medicaid is a budget-busting program rife with waste, fraud, and abuse that doesn’t even expand access to quality care or improve health outcomes.

For starters, Medicaid’s costs are spinning out of control. In 2015, total Medicaid spending shot up almost 10 percent. Overall national health spending, by contrast, climbed only 5.8 percent. Last year, the Congressional Budget Office had to raise its projections for the 10-year cost of Medicaid by $146 billion, as per-enrollee costs came in far higher than expected.

Medicaid now accounts for 19 percent of states’ general fund spending. It’s their second-biggest budget line item, after education.

States across the country are facing budget crises this year, largely because of ballooning Medicaid costs.

Read it here

 

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Article 5: AIS Survey Data Show Significant Growth in Medicaid Managed Care, AIS Health, Lauren Kelly, April 27, 2017

 

Clay’s summary: Medicaid managed care enrollment is up and its not just because of expansion.

Key Passage from the Article

Medicaid expansion is one explanation for increases in a few states, but many Medicaid expansion programs have been in force for several years, so it is not a factor in year-over-year growth for all expansion states. Numbers are up in several non-expansion states, including those without managed care, and slight decreases are seen in both expansion and non-expansion states.

Read it here