What’s New in Health Care Reform: April 5

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.


HHS to Continue Obamacare Payments to Insurers with Lawsuit Pending

The Trump administration indicated that it plans to continue the Affordable Care Act’s cost-sharing subsidies while they are part of ongoing litigation, one administration official said, in what may be the clearest statement on the issue so far. The precedent that the cost-sharing subdues would be funded while the lawsuit is being litigated remains the policy of the current administration, according to the official, who spoke on conditions of anonymity. Via Morning Consult.

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Trump Team Urges Skimpier Health Plans to Lure More People to Buy Insurance

Would opening the door to cheaper, skimpier marketplace plans with higher deductibles and copays attract consumers and insurers to the exchanges next year? That's what the Trump administration is betting on. In February, the administration proposed a rule that would take a bit of the shine off bronze, silver, gold, and platinum exchange plans by allowing them to provide less generous coverage while keeping the same metal level designation. But consumer advocates and insurance experts say the proposal, which is subject to finalization later this year, fails on two fronts. It doesn't address key concerns among insurers about plan design, and it might push consumers away from the exchanges because it could increase their out-of-pocket costs and reduce the amount they receive in tax credits for their health plan's premiums. Via NPR.

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Markups on Care Can Fatten Hospital Budgets—Even if Few Patients Foot the Full Bill

Few patients pay a hospital’s full price for a procedure or test. But a new study shows why those charges still matter. Economists at the Federal Reserve Board and the American Enterprise Institute found that list prices, often dismissed as meaningless by the hospital industry, are a critical gauge of which hospitals ultimately receive higher payments. An additional dollar in list price was associated with an additional 15 cents in payment to a hospital for privately insured patients, according to the study, which relies heavily on data from California. It was published in the journal Health Affairs. Via Kaiser Health News.

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Health Plans in Minnesota Saw Their Worst Year in a Decade

Minnesota health plans reported their worst financial results in a decade for 2016, with red ink flowing from both state public health insurance programs and the struggling market where individuals buy coverage for themselves. Overall, nonprofit insurers last year posted an operating loss of $687 million on nearly $25.9 billion in revenue, the Minnesota Council of Health Plans, a trade group for insurers, disclosed. Via Star Tribune.

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The Next Obamacare Battleground: Subsidies for Out-Of-Pocket Costs

Cost-sharing subsidies are different from premium tax credits, which lower the cost of monthly premiums. Only people with incomes below 250 percent of the federal poverty level—about $61,000 for a family of four this year—qualify for help with copays and deductibles. If federal reimbursements for these subsidies stop, insurers would likely respond by raising premiums to make up for the loss, explained Erin Trish, an assistant professor at the University of Southern California’s Schaeffer Center for Health Policy and Economics. Those who could be hurt the most are enrollees on the exchanges who receive very little or no premium assistance and the 750,000 people in California who purchase private insurance off the exchange. Via Kaiser Health News.

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Intraparty Tensions Boil over Amid GOP Health Care Struggles

Republican infighting is growing in the wake of the House GOP’s latest failed attempt to negotiate their bill to repeal and replace parts of Obamacare, revealing divides that threaten to stymie progress on big-ticket items even as the party controls all levers of power in Washington for the first time in more than a decade. Attempts between the hard-line conservative House Freedom Caucus and the more moderate Tuesday Group to reconcile their differences on the House GOP’s health care bill have broken down, members said. Rep. Chris Collins (R-N.Y.), a Tuesday Group member, told reporters there is an agreement among its members that outreach from the HFC has been a waste of energy. Via Morning Consult.

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No Obamacare Ceasefire in Red States

The epic collapse of the Obamacare repeal bill created an odd opportunity for 19 states that have long shunned Medicaid expansion. Billions in Obamacare cash remain on the table. And for the first time, that cash comes with a Trump administration promise to give states unprecedented flexibility to remake the program with a conservative slant—for instance, by imposing work requirements or requiring more recipients to pay premiums. Yet with few exceptions, most of the holdout states are walking away from the money and what they regard as a broken entitlement program. Some even want to shrink the program they have. Via Politico.

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More States Expanding Medicaid Could Complicate GOP’s Repeal Efforts

The GOP failure to pass an Affordable Care Act repeal bill last week has given a handful of states a new urgency to try and expand Medicaid under the law, raising the prospect of more federal spending and further difficulties scrapping the law Republicans have railed against for seven years. In recent days, Kansas state legislators have sent a bill that would expand Medicaid to Gov. Sam Brownback (R). Virginia Gov. Terry McAuliffe (D) announced a renewed push to expand the program by October. Maine voters will consider the issue on a ballot referendum this year, and Georgia’s governor suggested he would explore applying for a waiver to alter Medicaid, the Associated Press reported. Via Morning Consult.

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Obamacare Stalwart Anthem Seen Likely to Retreat for 2018

Anthem Inc. is likely to pull back from Obamacare’s individual insurance markets in a big way for next year, according to a report from analysts who said they met with the company, a move that could limit coverage options for consumers at a politically crucial time for the law. Anthem “is leaning toward exiting a high percentage of the 144 rating regions in which it currently participates,” Jefferies analysts David Windley and David Styblo said in a research note. Via Bloomberg.

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Trump’s Health Secretary Won’t Say if Administration Still Supports Obamacare Repeal

U.S. Health and Human Services Secretary Tom Price wouldn’t say whether the Trump administration still supports repeal of the Affordable Care Act, days after his party’s efforts to overhaul the law broke down. “We find ourselves right now in a position that the current system is not working,” Price said in a House subcommittee hearing, when asked repeatedly whether the administration is aiming to repeal the ACA. “We have to fix the problem.” Via Bloomberg.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.