Category Archives: Data

Washington DC Update (2/22/17)

If you want to read the full newsletter or past issues please click here …  Washington DC Update Past Issues.

THE ADMINISTRATION

Rule on Insurance Stabilization Payments and Essential Benefits

Last week the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule, summarized in a CMS press release, to make changes intended to stabilize the individual and small group insurance markets. The proposed rule would amend standards relating to special enrollment periods, guaranteed availability, network adequacy, essential community providers, and actuarial value requirements. It also proposes to shorten the annual open enrollment period in the individual market for the 2018 plan year to about six weeks. According to an article in Axios the proposed rule seems to be viewed favorably by insurance companies, but not by some health-consumer advocates, as exemplified in a recent Families USA blog post. Comments on the proposed rule are due by 5:00 pm ET on March 7, 2017.

IRS Rule on Reporting about Insurance Coverage

As explained in a blog post from Reason, the IRS quietly made a decision to stop requiring people to fill out the line on the 1040 tax form that indicates whether the tax filer had health coverage during the tax year. This is a way of not enforcing the ACA’s “individual mandate.” See Trump’s IRS stages a stealth attack on Obamacare.

IDEA Website

As explained in an article from the Washington Post, disability and education advocates expressed concern about the disappearance of the part of the US Department of Education website (http://idea.ed.gov/) which provided information about the Individuals with Disabilities Education Act (IDEA). That website is now up again, but refers the user to a more updated version, at https://www2.ed.gov/about/offices/list/osers/osep/osep-idea.html.

IN CONGRESS

Nominations

CMS Administrator. The president has nominated Medicaid consultant Seema Verma to head the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, Medicaid, and the ACA. The Senate Finance Committee held her confirmation hearing on February 16. The most notable moment of the hearing was when Ms. Verma indicated that she thinks women should be able to purchase insurance plans that do not include maternity benefits. She also indicated that she does not support proposals to create Medicare vouchers, but does support per capita caps or block grants for Medicaid. Other topics addressed are reported in an article from USA Today. The committee accepts public comments on the nomination, due no later than March 2.

ACA Repeal and Medicaid Restructuring

On February 16, the House Republican leaders released a “policy brief” outlining their plan to repeal and replace the Affordable Care Act (ACA) AND drastically restructure the Medicaid program. (The ACA proposal starts on page 10 Medicaid proposal starts on page 14.) The document is very general, so it is difficult to assess how it would affect the access to affordable insurance.

ACA Replacement. This ACA replacement plan would: eliminate the penalty for failure to have health insurance coverage (individual mandate) and the employer mandate, provide refundable age-based (not income-based) tax credits for the purchase of insurance plans, including catastrophic plans, “enhance and expand” Health Savings Accounts, allow the sale of insurance across state lines, and provide “State Innovation Grants,” which states could use to make health care or insurance more affordable, including the creation of high-risk pools.

Notably, the policy brief does not mention how the plan might protect individuals with pre-existing conditions. But last week Rep. Greg Walden (R-OR), the Chairman of the House Energy and Commerce Committee, which has jurisdiction over Medicaid and many other health care issues, introduced the Pre-Existing Conditions Protection Act of 2017, which purportedly would prohibit group health-plan issuers from using an individual’s pre-existing conditions to determine eligibility for coverage, the services covered, or individuals’ premiums. But, as drafted, the bill does not seem to limit the premiums that can be charged for people buying insurance in the individual market.

It is difficult to assess the Ryan plan without knowing critical details, although, based on past experience, there are reasons to think that Health Savings Accounts, interstate insurance sales, and high-risk pools may not be effective in expanding coverage. House Speaker Paul Ryan said a bill would be released and committees would start to consider the legislation during the week of February 27, although it is quiet possible that date will slip.

Medicaid. The plan would cut federal Medicaid spending by imposing “per capita caps” on federal Medicaid payments to states. In other words, a state would receive a fixed amount per enrollee, varying by type of enrollee – “aged, blind and disabled, children, and adults.” States would have the option of taking a block grant instead, meaning they would get a fixed amount regardless of their population of Medicaid enrollees. Under either system, the starting amount each state would get (baseline) would be based on that state’s historical Medicaid payments, with some sort of annual inflation adjustment. This raises the politically thorny issue of how to treat the difference in historical payments between the states that took up the ACA Medicaid expansion option and those that did not. Under the plan outlined in the policy brief, the former group would eventually lose their enhanced matching payments for the expansion population, while the non-expansion States would be eligible to receive “additional temporary resources for safety net providers” during a transition period.

The key point is that federal payments to states would be increasingly lower than they would under current law. In exchange for receiving less federal money, states would be given more flexibility in designing their Medicaid programs – in services and supports covered, and/or in populations served. (In the paragraph on block grants, however, the brief says that states “would be required to provide required services to the most vulnerable elderly and disabled individuals who are mandatory populations under current law.”) See 5 Key Questions: Medicaid Block Grants & Per Capita Caps (Kaiser Family Foundation). The Center for Law and Social Policy has prepared a brief on how block grants have worked (or not) in other programs.

Prospects. Many House Republicans are not ready to commit to the ACA-replacement outline released by Speaker Ryan. Furthermore, it is not clear how much support there would be for this plan in the Senate, particularly for Medicaid restructuring. Additionally, some governors will be opposed to capping Medicaid payments, since states stand to lose billions of federal dollars over time. Moreover, there will be a “formula fight” (a.k.a., “food fight”) among governors over how to treat Medicaid expansion funding in determining the baseline for future federal payments.

A new tool from the Kaiser Family Foundation allows users to compare some of the different proposals to replace the ACA.

Washington DC Update (2/15/17)

If you want to read the full newsletter or past issues please click here …  Washington DC Update Past Issues.

Greetings from Washington!

In the past week, the Senate has confirmed several Cabinet Secretaries, including the Secretary of Health and Human Services. On the House side, some reports indicate that the Republicans may be getting closer to proposing legislation to repeal the Affordable Care Act, either replacing it in a piecemeal fashion or repealing it on a delayed basis until a replacement plan is developed. On the regulatory front, the administration recently issued a new rule that will require home health agencies to be more responsive to patients and their caretakers, and may soon issue a rule to help insurers participating in ACA Exchanges.  And, if you ever have questions about health policy or terminology, you can turn to the new, online edition of The Essentials of Health Policy: A Sourcebook for Journalists and Policymakers.

THE ADMINISTRATION

Rule on Insurance Stabilization Payments and Essential Benefits?

According to Politico Pulse, a regulation to stabilize insurance companies participating in the ACA exchanges may be coming soon, since it recently was cleared by the Office of Management and Budget, an arm of the White House. The rule is expected to provide some of the measures requested by insurance companies to reduce their risk, including a tightening of special enrollment period qualifications.  According to Politico, some sources expect some modifications to the essential benefit package, too.

IN CONGRESS

Nominations

Secretary of HHS 

Despite strong Democratic opposition, Rep. Tom Price, MD (R-GA) was confirmed by the Senate last week, along a party-line vote, to be the Secretary of Health and Human Services (HHS).  Hours later he was sworn into office by Vice-President Pence.  Secretary Price has been a long-time opponent of the Affordable Care Act (ACA).  He authored a 2013 bill to repeal and replace the law, which could become a model for any administration proposal on replacement legislation. The Secretary can be followed on Twitter at @SecPriceMD.

CMS Administrator

The president has nominated Seema Verma to head the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, Medicaid and the ACA. The Senate Finance Committee will hold her confirmation hearing this week. Ms. Verma has consulted with a number of states on how to restructure their Medicaid programs under federal waivers, and developed the Indiana waiver plan under then-Governor Mike Pence. Participants in the Indiana program make contributions to special health savings accounts and can be penalized for failure to make these contributions.

ACA Repeal and Medicaid Restructuring

There are slight indications that the Republicans are moving closer to acting on their plans to “repeal and replace” the Affordable Care Act (ACA or “Obamacare”). House Republicans reportedly are meeting with the nonpartisan Congressional Budget Office (which makes the official estimate of how much a bill will cost) about the details of tax credits, high-risk pool funding, and changes to Medicaid that could be included in a repeal bill. The Hill reports that key House committees are planning to take up (“mark up”) their repeal bills by March 1, and House Speaker Paul Ryan (R-WI) has indicated that he would like the House to pass a bill by the end of March.  The legislation would take the form of a “reconciliation bill,” which would only require 51 votes in the Senate rather than the usual 60 needed to act on legislation in that chamber.

Meanwhile, Republican Senators from states that have taken up the ACA’s Medicaid expansion have begun to meet to figure out their positions on any repeal legislation.  If the Medicaid expansion part of the ACA is repealed, these states will lose many millions of federal dollars. At the same time, if the Medicaid program is restructured into a block grant or per capita cap payment system, states that did not expand Medicaid may lose out when a baseline for the block grants or caps is calculated.

The path toward ACA repeal will not be an easy one.  There have always been many thorny policy issues to be worked out, and now there is also an increasing amount of popular opposition to repeal.  Members of Congress have, in some cases, been overtaken by constituents protesting at town-hall meetings, to the point that some Republicans fear for their safety.

Other Legislation

The FAMILY Act

On February 7, Representative Rosa DeLauro (D-CT) and Senator Kirsten Gillibrand (D-NY) reintroduced the Family And Medical Insurance Leave (FAMILY) Act. The legislation would provide up to 12 weeks of paid leave for a pregnancy, the birth or adoption of a child, to recover from a serious illness, or to care for a seriously ill family member, based on current Family and Medical Leave Act (FMLA) guidelines. Workers on leave would receive up to 66 percent wage-replacement. The cost would be paid for through small employer and employee contributions; the average worker would pay $1.50 per week. Benefits would be portable rather than tied to any one employer. Currently, H.R.1439 has 137 cosponsors and S.786 has 27, all Democrats.

MEDICAID/CHIP NEWS, INFORMATION, AND RESOURCES

CMS Tools and Information on Mental Health and Substance Use Disorder Parity and Children and Youth with Mental Health or Substance Use Disorders

CMS has published two new technical assistance documents to assist state policy makers with the implementation of mental health and substance use disorder parity requirements for Medicaid and CHIP programs. The Parity Compliance Toolkit provides technical guidance and tools for states to help them understand and perform the parity analysis for each of the requirements of the final parity rules. The Parity Implementation Roadmap provides policymakers a practical overview of how to approach parity implementation and compliance from a planning and operational perspective. The Medicaid.gov webpage on Behavioral Health provides additional information on mental health parity.

Policy Brief on Medicaid Cuts

The School Superintendents Association (AASA) has released a policy brief – In Cutting Medicaid: A Prescription to Hurt the Neediest Kids – about the potential impact of proposed changes to the Medicaid program on students with disabilities and students from low-income families.

WORTH REPEATING: Medicaid and Children with Special Health Care Needs

This issue brief from the Kaiser Family Foundation (January 31, 2017) describes children with special health care needs (CSHCN) and explains how they can become eligible for Medicaid, and describes the services for CSHCN that are covered by Medicaid and how much Medicaid spends on these services.

WORTH REPEATING: Title V and Medicaid/CHIP Interactive Worksheets

The Catalyst Center has developed two interactive worksheets that can be filled in to provide an overview of your state’s Title V program or Medicaid and Children’s Health Insurance Program (CHIP). Each worksheet includes resources to help users find and insert state-specific information to help demonstrate the importance of Title V, Medicaid and CHIP for children with special health care needs (CSHCN) in their state.

Worksheets:

The worksheets were created as companion materials to the Catalyst Center’s Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and the Children’s Health Insurance Program (CHIP)

OTHER NEWS AND INFORMATION

New Source for IDEA Information

The US Department of Education’s IDEA website is down, but the information that was on that site, including resources from the now-non-existent National Dissemination Center for Children with Disabilities (a.k.a. NICHCY) can be found on the website of the National Center for Parent Information and Resources, www.parentcenterhub.org/repository/idea.  That website also includes many other early intervention, special education, and transition resources.

New Rules on Home Health Agencies

Last month, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on the Conditions of Participation (in Medicare and Medicaid) for home health agencies. It is the first major overhaul of these rules in almost 30 years. As explained in an article from Kaiser Health News, the new rules will place many new requirements on home health agencies, some of which are intended to make the agencies more responsive to patients and their caregivers. Home health agencies also will be expected to coordinate all the services that patients receive and ensure that treatment regimens are explained clearly and in a timely fashion. The new rules are set to go into effect in July, but may be delayed as the administration reviews regulations that have been drafted or finalized but not yet implemented.

Washington DC Update (2/8/17)

If you want to read the full newsletter or past issues please click here …  Washington DC Update Past Issues.

ACA Repeal and Medicaid Restructuring

ACA

The Republicans in Congress are still trying to figure out how to move forward with their plans to “repeal and replace” the Affordable Care Act (ACA or “Obamacare”), or even to “repair” it, a term some have adopted recently. There have been a number of hearings on issues and bills related to amending the law, but a comprehensive plan has not yet emerged. In a Sunday interview with Bill O’Reilly, the president said he thought it might take until next year to figure out a way to replace the ACA, but House leaders are still talking about moving legislation – at least to enact a delayed repeal – this spring. Yet, a number of Members of Congress have said they would not support repealing of the ACA without simultaneously enacting a law to replace it. Moreover, the uncertainty of a repeal law with a delayed effective date – to give Congress time to develop an ACA alternative – could drive insurance companies away from participating in the exchanges. Therefore, there have been talks with insurance companies about ways to ensure their stability during the delay period or the transition to a new plan. See the New York Times article “G.O.P. Campaign to Repeal Obamacare Stalls on the Details.” 

As reported in the past, the president and many congressional Republicans have indicated that they will continue policies to protect consumers with pre-existing conditions, but at the same time do away with the requirement that everyone have insurance (the “individual mandate”). These two aims that are generally considered incompatible given the need to have an insurance pool that includes a number of healthy people, some of whom would forego insurance if not required to have it. A proposed solution to this dilemma is to require people to have continuous coverage in order to be protected from pre-existing condition exclusions. In fact, the chairman of the relevant House committee recently unveiled and held a hearing on continuous-coverage legislation and other ideas for replacing the ACA. See the op-ed Repealing Obamacare and Rebuilding Our Health Care System by Chairman Greg Walden (R-OR) and Health Subcommittee Chairman Michael Burgess (R-TX). Rep. Frank Pallone (D-NJ), Ranking Democrat on the committee, among others, assert that a continuous-coverage requirement will not provide adequate protection, however, and that the Walden bill would permit insurers to charge higher premiums for those with pre-existing conditions.

Information for states on the impact of ACA repeal:

Medicaid

Last week, subcommittees of the House Energy and Commerce Committee held two hearings about the Medicaid program. On January 31, the Subcommittee on Oversight and Investigations held a hearing on “Medicaid Oversight: Existing Problems and Ways to Strengthen the Program” (links to testimony and Republican staff background memo). A witness who oversaw Medicaid and CHIP in the Clinton administration (Tim Westmoreland) testified: “Rather than further supporting constructive State and Federal efforts to ensure that every dollar is well spent, these proposals would slash and cap Federal funding not just for the bad actors but for the good guys who are acting on behalf of people who are eligible and in need. Reduced, capped Federal funding does nothing to improve program integrity. But it does put coverage at risk for low-income Americans and shifts the costs for the most expensive services to States, localities, providers, and charities.”

On February 1, the Subcommittee on Health held a hearing on “Strengthening Medicaid and Prioritizing the Most Vulnerable” (links to testimony and Republican staff background memo). For opposing opinions on the impact of the bills discussed at the hearing, see this op-ed from the bills’ sponsors, and this critique from the President and CEO of the Children’s Mental Health Network.

Resources related to Medicaid proposals:

Alternative Approaches to Medicaid Financing: Choice of Design Elements in Alternative Financing Proposals, from MACPAC

MEDICAID/CHIP NEWS, INFORMATION, AND RESOURCES

Medicaid and Children with Special Health Care Needs

This issue brief from the Kaiser Family Foundation (January 31, 2017) describes children with special health care needs (CSHCN) and explains how they can become eligible for Medicaid, and describes the services for CSHCN that are covered by Medicaid and how much Medicaid spends on these services.

Title V and Medicaid/CHIP Interactive Worksheets

The Catalyst Center has developed two interactive worksheets that can be filled in to provide an overview of your state’s Title V program or Medicaid and Children’s Health Insurance Program (CHIP). Each worksheet includes resources to help users find and insert state-specific information to help demonstrate the importance of Title V, Medicaid and CHIP for children with special health care needs (CSHCN) in their state.

Worksheets:

The worksheets were created as companion materials to the Catalyst Center’s Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and the Children’s Health Insurance Program (CHIP).

Medicaid Waivers Targeting Children With Autism Spectrum Disorder Reduce The Need For Parents To Stop Working

This article from the journal Health Affairs found that Increases in the Medicaid home and community-based services waiver cost limit and enrollment limit significantly reduced the likelihood that a parent had to stop working, although the results varied considerably by household income level.

Current Flexibility in Medicaid: An Overview of Federal Standards and State Options

This issue brief from the Kaiser Family Foundation provides an overview of current federal standards and state options in Medicaid and how states have responded to these options in four key areas: eligibility, benefits, premiums and cost sharing, and provider payments and delivery systems.