Archive for Affordable Care Act

 

CMS Introduces New Waivers

The Centers for Medicare & Medicaid Services has introduced four new “state relief and empowerment waivers” that are widely viewed as new vehicles for states to circumvent Affordable Care Act requirements to implement their own new approaches to health care.

  • Through “account-based subsidies” waivers, states may direct public subsidies into defined-contribution, consumer-directed accounts that individuals use to pay for health insurance premiums or other health care expenses.
  • “State-specific premium assistance” waivers enable states to create their own subsidy programs.
  • “Adjusted plan options” authorizes states to provide financial assistance for different types of health insurance plans, including short-term and other health insurance policies that do not meet Affordable Care Act benefits and coverage requirements.
  • “Risk stabilization strategies” waivers give states greater flexibility to implement reinsurance programs or high-risk pools.

These waiver options have been introduced not through regulations but through guidance published in the Federal Register.  States must apply for these waivers, which must meet section 1332 federal standards for  comprehensiveness, affordability, coverage, and federal deficit neutrality.

Learn more about state relief and empowerment waivers in this CMS fact sheet and this guidance that was published in the Federal Register.…

Medicaid Expansion Didn’t Hurt Access After All

The expansion of Medicaid in nearly two-thirds of the states has not affected access to care for Medicare participants in those states.

According to a new analysis by the National Bureau of Economic Research, Medicare patients had no more trouble getting timely doctors’ appointments, suffered no increase in costs, and experienced no increase in waiting times after their state expanded its Medicaid program under the Affordable Care Act.

Learn more about these findings in this Healthcare Dive report or go here for access to the National Bureau of Economic Research report “The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare.”

 …

Medicaid Expansion Helping Diabetics

The Affordable Care Act’s Medicaid expansion has led to a 40 percent increase in the number of prescriptions for diabetes medicine filled in the 30 states that expanded their Medicaid programs.

Meanwhile, there was no change in the number of diabetes-related prescriptions filled in states that did not expand their Medicaid programs.

This is considered important because it suggests that many low-income people who either could not afford their diabetes medicine or whose illness was undiagnosed are now being treated for the disease – a significant development because every diabetic who is treated for the condition represents a cost savings of $6394 a year, mostly because of fewer hospitalizations.

Learn more about how Medicaid expansion is improving the health of low-income people with diabetes and lowering health care spending in this California Healthline report or go here to see the Health Affairs study “Medicaid Eligibility Expansions May Address Gaps in Access to Diabetes Medications” on which that report is based.…

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs.

According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible.

Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it.

Despite this, the authors note, access to care did improve as a result of the Affordable Care Act’s Medicaid expansion.

Learn more about the studies, their results, and their significance by going here to see the Health Affairs report “No Association Found Between The Medicaid Primary Care Fee Bump And Physician-Reported Participation In Medicaid and here for the study “Physicians’ Participation In Medicaid Increased Only Slightly Following Expansion.”…

Hospital Government Payment Losses Could Reach $218 Billion by 2028

A recent study concluded that hospitals can expect to lose about $218 billion in federal Medicare and Medicaid payments between 2010, when the latest round of major cuts began, and 2028.

Among those cuts cited in the study, which was commissioned by the American Hospital Association and the Federation of American Hospitals, are:

  • $79 billion for DRG documentation and coding adjustments
  • $73 billion for Medicare sequestration
  • $26 billion for Medicaid disproportionate share payments (Medicaid DSH)
  • $11 billion in cuts associated with the American Taxpayer Relief Act of 2012

Other cuts came, or will be coming, through regulatory changes, the introduction of value-based payment programs, and other means.

Learn more about these cuts and their potential implications in this Healthcare Dive story.

 …