This year will be the last in which uninsured Americans are forced to pay ObamaCare’s penalty for lack of coverage. The change—part of the GOP’s tax reform—comes as relief on the demand side of health insurance. Yet nothing has changed on the market’s supply side. Without additional reforms to ObamaCare’s restrictions on insurers, millions of Americans will continue to choose from a limited range of lackluster plans.
Many of the country’s top hospitals are off limits to patients covered by ObamaCare’s current plans. Take Houston’s MD Anderson Cancer Center, which was named America’s best cancer-care hospital by U.S. News & World Report in 13 of the past 16 years. The hospital’s website suggests that it takes even Medicaid, but it doesn’t accept a single private health-insurance plan sold on the individual market in Texas.
Since Blue Cross of Minnesota withdrew from the individual market in 2016, the state’s Mayo Clinic—once cited by President Obama as a model for the nation—has been off limits to Minnesotans covered by ObamaCare exchange plans. Memorial Sloan Kettering appears out of bounds for every exchange plan in New York. Both of these hospitals are open to some Medicaid patients, though Mayo’s chief executive has predicted publicly that Medicaid patients may eventually have to queue behind their privately insured peers.
Think about these developments. When Mr. Obama promised to insure the uninsured, what kind of insurance was he talking about? Most people, and maybe even the president himself, imagined it would look like a typical employer plan or a standard Blue Cross individual policy. Who imagined that the only products available would be more limited than Medicaid? Read More at The Wall Street Journal
State governments that support Obamacare are resisting efforts by the Trump administration and Congress to scale back the law, and are moving to either expand it or reinstate provisions that were rolled back.
While many red states have tried to loosen Obamacare rules or offer their residents less expensive alternatives, blue states in particular are stepping in with their own proposals. They are re-implementing policies that the Trump administration is trying to gut, or looking to go further to involve the government in health insurance.
Their ideas go beyond expanding the government-funded Medicaid program to low-income people or setting up reinsurance funds to pay for high-cost medical claims, though those proposals are on the table in several states as well. Read More at the Washington Examiner
In the wake of the Congressional Budget Office’s analysis of the Republican Senate majority’s proposal to overhaul the Affordable Care Act, an interesting argument has emerged. The millions of dollars in reduced spending on Medicaid that the Republican bill proposes aren’t actually cuts to Medicaid, because Medicaid spending still goes up.
Republicans celebrated on Thursday after successfully moving a health-care bill forward that they said would fulfill their promise to repeal President Barack Obama’s Affordable Care Act. Yet one of the bill’s most far-reaching sections is only tangentially related to repealing the law, also known as Obamacare.
The law would limit federal spending on Medicaid — the program that provides health insurance to the poor — to an index of inflation in medical prices. Since the program’s costs are increasing more rapidly than that index, over time, the government would spend hundreds of billions less on Medicaid than it would under the current system. It would be up to states to decide how to make up the difference.
A new government report shows that the average ObamaCare Medicaid expansion enrollee costs the federal government $6,366 in 2015, 49% above the per-person cost of $4,281 projected a year ago.
The surprising cost overrun is likely to result in increased scrutiny of Medicaid program expenses by Congress and could pose a risk to insurer profits in the one area of ObamaCare that has provided a reliable boost for their bottom lines.
UnitedHealth (UNH), which is pulling out of the individual health insurance exchange business in most states amid growing losses, is among companies profiting from the Medicaid expansion. Public companies vying for the Medicaid managed care business include Centene (CNC), Anthem (ANTM) and Molina (MOH).
“Government overreach” frequently sparks lively debates about the proper role of federal, state and municipal ruling bodies. A report in The Washington Examiner (online Apr. 20, by Paige Winfield Cunningham) says, “The two biggest states to reject Obamacare’s Medicaid expansion are accusing the administration of trying to force them into it.”
Texas Gov. Greg Abbott, R-Texas, recently voiced his advocacy for a lawsuit filed by Florida Gov. Rick Scott. Scott initiated the litigation against the Obama White House “over ending federal funds to pay hospitals for caring for the uninsured,” according to The Washington Examiner.
The Feds have are saying they will stop such funding unless the Sunshine State grows its Medicaid program under the auspices of the Affordable Care Act. The Examiner report additionally explains, some U.S. states have “funding pools.” These reimburse hospitals – who would otherwise receive no monies for care dispensed. Yet as Cunningham’s article points out, Medicaid expansion, “would reduce the need for such funds.”
Gov. Abbott (speaking for Florida) is quoted by Cunningham as saying, “Florida’s approach should be determined by Floridians, not coerced by federal bureaucrats.”
Aimee Picchi, in a new CBS Interactive report (online, Apr. 13) tells of The Wall Street Journal account of Stephanie Graham, whose mother joined Medicaid in 2014. This was because of the Affordable Care Act’s requirement for healthcare coverage. Without it they would wind up paying an Obamacare fine.
The CBS report describes “The Estate Recovery Law,” which permits U.S. states “to recover Medicaid costs for patients who are older than 55 when they die, although some limits apply, such as exceptions for the disabled and hardship exemptions for survivors.” Picchi’s CBS report adds, “The law is taking some newly enrolled Medicaid patients by surprise, but it’s also prompting a few states to push back on the practice.”
Doctors who treat patients on Medicaid are facing an arduous beginning to their 2015 practice years.
According to a new post on Vox by Sarah Kliff (online, Dec. 29) doctors in the category are now looking at a 42 percent reduction – in terms of Medicaid physician reimbursements. The final decline(s) in Medicare reimbursements to doctors will ultimately differ from state to state. This is due (according to Kliff’s Vox report) to each state determining and establishing its own rate of payment for primary care doctors.
California has a pattern of paying Medicaid doctors very low rates; the Affordable Care Act has increased their fees by as much as 50 percent. On the other hand, in North Carolina, as state in which two program fees were approaching identical, the rate increase was less.
Much of the Obamacare story is about discrepancies in the processing management of both personal health data, and payments. From time to time the General Accounting Office (GAO) is a source of bad news for the Affordable Care Act. A recent GAO finding continues this trend.
A report in CNS News on June 25 says Medicaid paid out $14.4 billion in what they term as “improper” payments in 2013. The report was generated by the GAO.
Federal law makes it clear that both the states and the Centers for Medicare and Medicaid Services (CMS) must guarantee the legitimacy of Medicaid. Now, an increasing segment of federal Medicaid dollars and payments are subject to being questioned.
According to the GAO, this is occurring because of a gulf between both state and federal systems controlling the integrity of managed care. In other words, CMS is going to have to assume a more predominant role in ensuring that the states are wholly responsible for the Medicaid money they both receive and handle. They’ll also have to establish clear rules accompanied by the type of support which guarantees sufficient “integrity efforts” are well in-place in managed care programs.