Recently, I chaired a discussion at CPAC on the importance of choice in health care, and specifically health care coverage. My fellow panelists talked about government rule-making, Medicare waivers and the many problems that approaches like “Medicare for All” create — such as interposing Uncle Sam between physicians and patients. All important aspects of the health care puzzle — but nothing that hasn’t been turned over more than once in a wonky world of $5 words and inside the Beltway policy chatter.

A House panel on Wednesday sent the latest Medicaid expansion bill in the Idaho Legislature on to the House floor, but without a recommendation to pass it.

The bill — from Nampa Republican Rep. John Vander Woude — includes controversial provisions, such as a work requirement. It also requires people who are just above the poverty line to buy private health insurance plans from Idaho’s insurance exchange.

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.”

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.

Put simply, there is nothing like Medicare for All anywhere in the industrialized world. Socialized medicine proposals, like the House version introduced last month by Rep. Pramila Jayapal, (D-WA), would offer everyone living in the United States comprehensive coverage with no deductibles and no copayments. Jayapal claims, “This is not a particularly ambitious plan, in the sense that so many others have done it.” But no industrialized nation has tried anything so sweeping. Not one provides soup-to-nuts government-paid insurance that covers everything without any cost-sharing from patients. None. Even so-called single-payer systems rely on some forms of private insurance.

Other reports show Democratic leaders are not as enthusiastic as Jayapal, et al.  House Speaker Nancy Pelosi in an interview with Rolling Stone said moving to a single-payer system was the simplest way to bring about universal health care, but then noted an estimated $30 trillion cost. “That is, administratively, the simplest thing to do, but to convert to it? Thirty trillion dollars. Now, how do you pay for that?” Pelosi said.

Democrats defeated Republicans in the Obamacare repeal fight by warning that 22 million Americans would be thrown off their health insurance. They pointed to data leaked from the Congressional Budget Office.

Well, it turns out that data was completely wrong.

According to a report by the Centers for Medicare and Medicaid Services released Wednesday, the Congressional Budget Office wildly overestimated the number of people who would lose their health insurance with the repeal of the individual mandate penalty.

Critics cried sabotage when political leaders took action to repair some of the damage done by the Affordable Care Act. They saw sinister motives behind the decision by the last Congress to repeal the individual mandate and in Trump administration regulations that made more affordable health insurance options available to individuals and small groups.

But a new study by the president’s Council of Economic Advisers (CEA) finds that eliminating federal tax penalties on the uninsured and giving consumers more coverage options will provide economic benefits totaling $450 billion over the next decade.

One aspect of CMS’ price transparency initiative has received a great deal of attention recently. Our updated guidelines now require hospitals to post a list of their current “standard charges” on the internet in a machine-readable format — meaning the data can not only be read electronically but can also be imported or read into other databases. Previously, CMS required hospitals to make their standard charges available in response to an inquiry, but too often this meant making the information available only in print or a PDF that couldn’t be aggregated with other data and that wasn’t broadly available.