What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.
GOP Tells Governors No Firm Plans Yet on Medicaid Expansion
Governors who gathered for a meeting with congressional Republicans were told a summarized plan to repeal and replace the Affordable Care Act “does not reflect current thinking,” a senior Senate Republican said, as lawmakers remain divided over key provisions such as the Medicaid expansion. Senate Majority Whip John Cornyn (R-Texas), the chamber’s No. 2 Republican, said governors were told that a 19-page summary of how House Republicans could overhaul Obamacare was dated. Via Morning Consult.
This CEO's Small Insurance Firm Mostly Turned a Profit under Obamacare. Here's How.
Some large health insurance companies have suffered losses under the Affordable Care Act, leading to a few high-profile exits from the health exchanges. Humana is just the latest, announcing in January that it will stop offering health insurance on the Affordable Care Act exchanges at the end of 2017. But the administrators of a smaller, California-based insurer—Molina Healthcare—managed to turn a modest profit in the early years of the health law. How did they do it? Via NPR.
Advocates of Flat-Fee Primary Care See Opening in GOP’s Market-Driven Approach
Back in the day, people paid for routine primary care on their own and used insurance only when something serious came up. Some primary care doctors are betting that model can thrive again through a monthly subscription for routine care and a high-deductible insurance policy to take care of the big stuff. But the changes raise questions about whether the approach really leads to more effective and efficient health care. Via Kaiser Health News.
ACA Repeal Draft Would Revive High-Risk Pools, Kill Medicaid Expansion
A draft of a House GOP measure to repeal the Affordable Care Act would dole out $100 billion to help states provide coverage to people with pre-existing conditions in the absence of the health insurance mandate, according to a draft obtained by POLITICO. The $100 billion, which would be allotted to states over a decade, is quadruple the amount that was first proposed by House Republican leaders, but still falls short of what experts say is needed to cover the bulk of the population that has existing health conditions. The draft bill also has a continuous coverage requirement: People who drop their health plan early would be hit with a 30 percent hike in their premiums for the rest of the year. Via Morning Consult.
A Divided White House Still Offers Little Guidance on Replacing Obamacare
A meeting between President Trump and Ohio Gov. John Kasich, his former rival in the GOP primaries, had no set agenda. But Kasich came armed with one anyway: his hope to blunt drastic changes to the nation’s health-care system envisioned by some conservatives in Washington. Over the next 45 minutes, according to Kasich and others briefed on the session, the governor made his pitch while the president eagerly called in several top aides and then got Health and Human Services Secretary Tom Price on the phone. At one point, senior adviser Jared Kushner reminded his father-in-law that House Republicans are sketching out a different approach to providing access to coverage. “Well, I like this better,” Trump replied, according to a Kasich adviser. Via Washington Post.
Leaked GOP Docs Show Governors’ Health Care Demands
Republican governors are undecided on how far they want Congress to go in overhauling Medicaid, internal documents obtained by Vox show. The governors, who gathered in Washington this weekend for the National Governors Association, will be a crucial voice in the debate over repealing and replacing Obamacare. Many participated in the health law’s Medicaid expansion, which has expanded coverage to millions of Americans. Via Vox.
Experts Question GOP Approach to Pre-Existing Health Conditions
A key plank of the House GOP’s blueprint to replace the Affordable Care Act would fail to provide adequate health insurance to people with existing medical conditions without substantial state or federal funding, according to veteran health care officials and experts. A plan touted by House Speaker Paul Ryan (R-Wis.) would give Americans priced out of marketplace coverage the ability to shop for insurance in state-run high-risk pools, which are reserved for the costliest people in the health care system. Via Morning Consult.
Those Pre-Obamacare Plans Just Got another Extension
For those of you wondering what the 2018 Obamacare marketplaces will look like, we now know people with so-called "grandmothered" health plans—pre-Obamacare plans that got extended—still won't have to participate. The Centers for Medicare and Medicaid Services sent out a memo extending the transitional policies for another year, expiring by December 2018. Via Axios.
Obamacare’s Limbo Befuddles Taxpayers
Republicans’ stalled campaign to repeal the Affordable Care Act is sowing confusion among those now trying to do their taxes. Many taxpayers believe Republicans have already repealed the law, tax preparers say, and they’re surprised and upset to learn they are still subject to Obamacare’s penalty for failing to have health insurance—a charge that climbed this year to more than $2,000 per family. Via Politico.
GOP Considers Trimming Health Law's 10 Essential Benefits
As Republicans look at ways to replace or repair the Affordable Care Act, many suggest that shrinking the list of services that insurers are required to offer in individual and small group plans would reduce costs and increase flexibility. That option came to the forefront last week when Seema Verma, who is slated to run the Centers for Medicare & Medicaid Services in the Trump administration, noted at her confirmation hearing that coverage for maternity services should be optional in those health plans. Via NPR.