The CMS rolled out new tools on Thursday to help states get approval to make changes to Medicaid such as implementing work requirements.
The CMS Administrator Seema Verma defended the administration’s push to get more states to pursue 1115 demonstration waivers even as the agency faces criticism over coverage losses due to work rules.
First, she douses progressives’ impeachment dreams in cold water, telling the Washington Post that such a divisive and drastic political step should only be taken over egregious criminality that’s “compelling and overwhelming and bipartisan.” She cagily adds, “he’s just not worth it,” a personal swipe at the president, likely deployed to placate Trump haters who will bristle at her stance. Insulting him is a little wink that she’s still ‘on the team.’ But even if the hard-Left wing of the party is willing to forgive Pelosi’s hesitant posture on impeachment, how might they react to her intense fiscal skepticism on ‘Medicare for All’ — the holy grail of the statist agenda?
Health and Human Services (HHS) Secretary Alex Azar revealed Thursday that his department is in talks with states about instituting block grants in Medicaid without congressional approval.
“We have discussions with states where they will come in and suggest ideas,” Azar said at a Senate hearing in response to questions from Sen. Bob CaseyJr. (D-Pa.). “There may be states that have asked about block granting, per capita, restructurings around especially expansion populations … It’s at their instigation.”
But he warned that how such a system would work — and who would pay for it — are big questions that have yet to be answered.
“For me, I think it’s a great opportunity for the industry to be able to expand the population that it’s coordinating care with,” Broussard said Tuesday at the Barclays Global Healthcare Conference in Miami Beach, Fla.
Surprise billing is an unexpected event that requires significant financial resources. That’s hardly a unique economic phenomenon, and the usual solution is … insurance! The unique aspect of this event, however, is that it takes place in the context of an insurance contract. What could be modified? There are really two pieces: the surprise and the bill. The former can be ameliorated by giving patients clear, up-front knowledge that they will be treated by an out-of-network provider and perhaps providing an estimate of the likely charge. That would reduce the surprise element of the phenomenon.
Legislators at both the federal and local level are trying to do something about the problem of surprise billing, what wonks often call “balance billing.” A modest, bipartisan measure proposed by state legislators in Texas would penalize emergency rooms that charge more than 200 percent above the average hospital charge for a comparable service.
A plethora of bills introduced in the U.S. Senate, including one from a group led by Sens. Michael Bennet (D., Colo.), Tom Carper (D., Del.), Bill Cassidy (R., La.), Chuck Grassley (R., Ia.), Claire McCaskill (D., Mo.), and Todd Young (R., Ind.), would limit out-of-network prices in the emergency setting to the greater of (1) the median in-network rate for a particular geographic area; or (2) 125 percent of the “average allowed amount” in a geographic area: a proxy for what hospitals charge regardless of insurer contracts.
Michigan’s new Democratic governor is attempting to reverse course on steps taken by her Republican predecessor to require childless, able-bodied beneficiaries of the Obamacare Medicaid expansion to meet work, training or community service requirements. In a February letter to the federal administrator of the program, Gov. Gretchen Whitmer called the work requirements “onerous.”
In the letter, Whitmer cited an analysis by the Manatt law firm, which predicted that Michigan’s new Medicaid work requirements would cause 61,000 to 183,000 people to lose their health coverage over the course of a year.
Doug Badger, senior fellow at the Galen Institute, says when so few individuals who were eligible for the Medicaid expansion in Arkansas re-enrolled, they made a rational decision that they were better off without the benefits.
“If you don’t report any work activity at all, after being told that this would cause you to lose benefits, that suggests that you don’t value the benefits very highly. This is consistent with research showing that Medicaid recipients receive about 20 to 40 cents of benefits for every dollar of Medicaid spending,” Badger said.
Hospital industry lobbying against health care regulatory changes paid off Thursday when the Georgia House voted against major certificate-of-need (CON) legislation by a 94-72 margin.
House Bill 198 remained alive temporarily after the chamber approved a motion to reconsider the legislation. But by late afternoon, the lead sponsor, Rep. Matt Hatchett (R-Dublin), said the bill would not be brought back up on Thursday, which was the 2019 General Assembly session’s Crossover Day.
The Trump Administration has proposed using its demonstration authority under section 1115A of the Social Security Act to test a method of reimbursement for physician-administered drugs based on prices in 14 countries. The proposal is controversial, raising constitutional questions about the agency’s authority to modify Medicare reimbursement absent congressional action, as well as objections to the use of international reference pricing. A recent paper from the Foundation for Research on Equal Opportunity (FREOPP) makes a useful contribution to this debate. The FREOPP paper recommends that the administration construct a market-based international index (MBII) that would exclude “industrialized countries with little room for market-based pricing.” This report examines the drug pricing and reimbursement policies in MBII countries and finds that these policies are generally not market-based. Secondly, it presents data showing that many drugs introduced between 2011 and 2018 are not available to consumers in MBII countries. Under the proposal advanced by the administration and that suggested by FREOPP, Medicare reimbursement for physician-administered drugs would largely be based on international reference prices in which the regulatory agency of one government sets drug prices based at least in part on those set by regulatory agencies in other countries. Importing these mutually reinforcing, centralized decisions into Medicare may reduce reimbursement for physician-administered drugs, but the new reimbursement system cannot be said to be based on market prices.
Left-wing Democrats in Congress have decided on a new version of “Medicare for All.” Turns out its going to be nothing like the Medicare program seniors are used to. What they have in mind is what we see in Canada.
Everyone (except American Indians and veterans) will be in the same system. Health care will be nominally free. Access to it will be determined by bureaucratic decision making.