Archive for Affordable Care Act


Feds Seek Input on Selling Health Insurance Across State Lines

Working to achieve an objective of reducing the cost of health insurance by encouraging the sale of health insurance policies across state lines, the Centers for Medicare & Medicaid Services has published a request for information seeking input from stakeholders and the public on how this might best be done.

According to a CMS news release, the agency seeks

… feedback on how states can take advantage of Section 1333 of the Patient Protection and Affordable Care Act, which provides for the establishment of a regulatory framework that allows two or more states to enter into a Health Care Choice Compact to facilitate the sale of health insurance coverage across state lines.  CMS is primarily looking for input on how the agency can expand access to health insurance coverage across state lines, effectively operationalize the sale of health insurance coverage across state lines, and understand the financial impacts of selling health insurance coverage across state lines.

Learn more from the CMS news release and the RFI itself.…

States Taking Different Paths to Pay for Medicaid Expansion

With the federal share of Medicaid expansion falling to 90 percent next year, states that expanded their Medicaid programs under the Affordable Care Act are now exploring new ways to raise the money to pay for the 10 percent for which they will soon by responsible.

Some are implementing hospital or insurer taxes while others are increasing existing taxes on hospitals and health insurers.  New Hampshire is directing part of the proceeds from a liquor tax for this purpose and other states have introduced cigarette taxes.  Some are charging premiums to Medicaid beneficiaries and introducing Medicaid work requirements so they can reduce overall enrollment.  Many are using money from their general revenues.

This all comes at a time when many states are finding that their budget situations have improved and are better than they have been in years.

Learn more about how states are dealing with this challenge, and whether they are finding that it is worth it, in the Washington Post article “States scramble to head off future Medicaid shortfalls.”

Medicaid Expansion: A Good Financial Decision for States?

Medicaid expansion is a good financial deal for states, according to a new analysis by The Commonwealth Fund.

At the heart of this conclusion are three primary considerations:

  • The federal government pays 90 percent of the total cost of Medicaid expansion.
  • States save money by expanding their Medicaid programs – even after paying their 10 percent share, because they shift the cost of care for some of their residents, currently paid entirely by the state, to Medicaid, for which the federal government pays 90 percent of the cost.
  • Any remaining additional state costs represent only a very small portion of expansion states’ budgets.

States that have expanded their Medicaid programs under the Affordable Care Act also appear to enjoy other benefits from their decision to expand, including new jobs in and tax revenue from the health care sector.

Learn more about why Medicaid expansion can be a good financial deal for states in the new Commonwealth Fund report “The Fiscal Case for Medicaid Expansion.”


No Medicaid Expansion=Greater Peril for Rural Hospitals

Rural hospitals located in states that did not expand their Medicaid programs, as authorized by the Affordable Care Act, are at much greater risk of closing than hospitals in states that did expand their Medicaid programs.

According to a Stateline report, most of the 100 rural hospitals that have closed since 2010 and most of the more than 600 rural hospitals that are considered to be in danger of closing now are located in states like Texas, Mississippi, and 12 others that have not expanded their Medicaid programs.

Small rural hospitals that have not closed serve large proportions of uninsured patients, some of whom would have qualified for Medicaid had their state expanded its Medicaid program, providing at least some revenue in return for the services they have provided.  Some of these hospitals, already located in areas that tend to have more low-income residents, more people without health insurance, and more people with health problems, respond to this financial challenge by closing obstetrics units and other expensive services, saving money but reducing access to care in their communities.

Learn more about the financial challenges rural hospitals face and how those challenges now jeopardize their very existence in the Stateline report …

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.…