ObamaCare Watch Newsletter 4/6/18

  • A New Health-Care Debate –
  • CMS’ Plan to ‘Wind Down’ Federal Exchanges by 2020 Relies on a Big Ask from Congress –
  • Congress Needs to Rethink the ACA’s Single Risk Pool To “Stabilize” The Individual Market –
  • Timeline: Despite GOP’s Failure to Repeal Obamacare, The ACA Has Changed –
  • The Final Obamacare Tally Is In. About 400,000 Fewer People Signed Up This Year. –
  • California Commits Massive Medicaid Fraud –
  • Iowa Law Seen as Breakthrough for ObamaCare Foes –
  • Ohio Seeks First-Ever Individual Mandate Waiver –
  • MD Legislature Approves Plan to Stabilize State’s ACA Market with New Tax on Insurers –
  • California’s Path to Universal Health Care Pits Pragmatists Against Single-Payer Holdouts –
  • Doctor-Patient Relationship Compromised by Oppressive ‘Quality’ Reporting Requirements –

Obamacare’s Evolution and Impact

A New Health-Care Debate
By Yuval Levin and Ramesh Ponnuru
National Review, March 29, 2018

After years of being a central political question, health care is on the back burner. Both parties contain experts and activists who want to make major changes to health policy. But for now, both parties’ politicians are wary. A decentralizing and deregulatory approach to health policy offers a substantively and politically attractive path for Republicans. But whether it turns out to be more attractive than falling back into the role of pure critics of Democratic health reforms remains to be seen. The future of market-based health economics in America, and perhaps the political prospects of a recognizably conservative Republican party, may well depend on the answer.

CMS’ Plan to ‘Wind Down’ Federal Exchanges by 2020 Relies on a Big Ask from Congress
By Evan Sweeney
FierceHealthcare, April 5, 2018

The Centers for Medicare & Medicaid Services (CMS) plans to “wind down” support for the federal exchanges by the time open enrollment hits in 2019 and shift funding to states. For that strategy to work, the agency is relying on Congress to do something it failed to do several times last year: Pass an ACA repeal. CMS detailed its plan in a fiscal year 2019 budget justification released this week that outlines a $403 million cut to its program operations budget next year. With less funding to oversee the federal exchanges for plan year 2020, CMS would dole out grants that allow states to “assume more control of their markets and expand enrollment options.”

Congress Needs to Rethink the ACA’s Single Risk Pool To “Stabilize” The Individual Market
Joel Allumbaugh and Josh Archambault
HealthAffairs Blog, April 6, 2018

Congress has been unable to agree on “market stabilization” for the ACA, and it was left out of the recently passed omnibus. Yet, a key discussion has been missing from the conversation—the need to rethink the single risk pool in the ACA. Throwing money at the status quo will simply slow a market decline, which could leave millions with no access to affordable coverage. Splitting subsidized lives from nonsubsidized into two different risk pools could provide structural relief that allows markets to stabilize longer term.

Timeline: Despite GOP’s Failure to Repeal Obamacare, The ACA Has Changed
By Julie Rovner
Kaiser Health News, April 5, 2018

Congress in 2017 failed to “repeal and replace” the ACA. But the health law has been changed in many other ways over the past year and a half. Some changes were made by Congress, some by President Trump and his administration, and some by state officials. This piece includes a timeline of the most consequential events that have shaped the health law, from executive orders to regulatory changes.

The Final Obamacare Tally Is In: About 400,000 Fewer People Signed Up This Year.
By Abby Goodnough
The New York Times, April 3, 2018

The Trump administration said on Tuesday that 11.8 million people had signed up for health insurance through the ACA marketplaces for 2018—roughly 400,000 fewer than last year. Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the ACA through their own marketplaces, enrollment remained the same as last year.

California Commits Massive Medicaid Fraud
By David Catron
The American Spectator, April 2, 2018

The HHS Office of Inspector General has found that, by exploiting Obamacare’s expansion of the Medicaid program, California has enrolled hundreds of thousands of ineligible adults in Medicaid. Consequently, the state has bilked the federal government out of more than $1 billion in funding to which the state was not entitled. Indeed, these figures probably understate the amount of money that California officials have fraudulently extracted from the taxpayers. The OIG sampled a mere six-month period to arrive at its assessment.


State Efforts

Iowa Law Seen as Breakthrough for ObamaCare Foes
By Nathaniel Weixel
The Hill, April 3, 2018

A new law in Iowa could provide the path forward for Republican-led states that are looking for ways around ObamaCare’s rules and regulations. Iowa Gov. Kim Reynolds (R) on Monday signed a law that will allow the Iowa Farm Bureau to collaborate with Wellmark Blue Cross Blue Shield to offer self-funded “health benefit plans.” The plans would be cheaper than traditional ObamaCare plans because they wouldn’t be required to meet federal requirements.

Ohio Seeks First-Ever Individual Mandate Waiver
By Virgil Dickson
Modern Healthcare, April 3, 2018

Ohio officials have asked the Trump Administration to formally waive the ACA individual mandate that requires residents to have health insurance, making it the first state to make such a waiver request.  In its tax cut bill passed in December, Congress “zeroed out the penalty that is associated with the individual mandate … but … did not eliminate the mandate itself,” Ohio Department of Insurance Director Jillian Froment said in a March 30 letter to HHS Secretary Alex Azar. “That is why Ohio is submitting an application to waive [the mandate].”

MD Legislature Approves Plan to Stabilize State’s ACA Market with New Tax on Insurers
By Scott Dance
The Baltimore Sun, April 4, 2018

Maryland lawmakers on Wednesday finalized a bipartisan measure to collect $380 million in taxes from health insurers next year to help curtail surging premiums for 150,000 Marylanders and prevent the state’s Obamacare marketplace from a potential collapse. The legislation was a quiet, one-year compromise between the Democratic-controlled General Assembly and Republican Gov. Larry Hogan, who is expected to sign the measures.


Democrats Push Single-Payer at State Level

California’s Path to Universal Health Care Pits Pragmatists Against Single-Payer Holdouts
By Victoria Colliver
Politico, April 3, 2018

It’s the pragmatists versus the idealists in California’s latest quest for universal health care. Lawmakers and advocates are pushing for policy goals that realistically can be accomplished this year. But there’s an unrelenting camp clinging to single-payer-or-bust. California leaders are leaning toward the more incremental approach. This includes bills and budget items that would cover everything from insuring undocumented adults to preventing Medicaid work requirements and blocking the state from insurance products favored by the GOP, such as short-term, limited-duration health plans.


Quality Reporting Requirements Backfire 

Doctor-Patient Relationship Compromised by Oppressive ‘Quality’ Reporting Requirements
By Grace-Marie Turner and Carol Monaco
Forbes, April 5, 2018

Since the managed care debacle of the 1990s, billions of dollars have been spent in time and resources to improve and measure the quality of patient care. However, measuring the quality of care in the effort to improve it in a cost-efficient manner is showing evidence of being counter-productive, particularly for small physician practices and practices with complex patient populations.

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