Pathways To Success: A New Start For Medicare’s Accountable Care Organizations
By Seema Verma HealthAffairs, Aug. 9, 2018The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would overhaul the Medicare Shared Savings Program, an ACA program under which the vast majority of Medicare’s Accountable Care Organizations (ACOs) operate. ACOs take responsibility for the total cost and quality of care for their patients, and in return receive a portion of the savings they achieve. CMS provides them with waivers to provide the regulatory relief needed to innovate. Despite the program’s intent, the program has shown increases in net spending for CMS and taxpayers. CMS Administrator Seema Verma says that, “After six years of experience, the time has come to put real ‘accountability’ in Accountable Care Organizations. Medicare cannot afford to support programs with weak incentives that do not deliver value.”
Last Thursday, the Trump administration came out with a new rule that requires hospitals to post online the prices they charge for medical procedures. This is good for Americans and moves the country closer to the administration’s vow to work towards “value-based care” or reduced costs and improved outcomes. Previously, hospitals were only required to make the information about prices available to those who asked for it.
Insurers participating in Medicare Advantage will be able to negotiate directly with drugmakers in an effort to lower the cost of prescription medications under a new policy announced by the Trump administration. The policy aims to allow Medicare Advantage plans access to the same tools as private insurers to try to lower the costs of treatments delivered in a physician’s office or hospital under Medicare Part B.The change will impact more than 20 million people enrolled in Medicare Advantage plans.
States
The Arizona Medicaid Expansion Experience: Beware the Peddlers of Cost-Shifting Claims
By Lopez Bauman, Erickson, and Sandefur
Goldwater Institute, Aug 2018As state policymakers consider expanding their Medicaid programs under the ACA, they should study the experiences of other states. One of the arguments that convinced Arizona lawmakers in 2013 to expand the program was that employers and employees were paying a “hidden healthcare tax.” According to this theory, when hospitals treat the uninsured, they pass along the unpaid treatment costs to private payers, leaving employers and employees with higher health insurance premiums. But Arizona’s Medicaid expansion did not alleviate the tax and actually made it worse. Before Medicaid was expanded, proponents in 2007 claimed that the cost shifting to private payers amounted to 14% more than hospitals’ costs. But in 2016, private payers paid 27% more than hospital costs—meaning that, three years into the Medicaid expansion, the proportion of cost shifting had actually increased.
Roughly 6.8 million of the 12.4 million Medicaid enrollees added under Obamacare’s expansion don’t work, according to the Foundation of Government Accountability. Many are capable of working, getting job training, volunteering, or providing child care. Medicaid is meant to serve as a backstop for the truly disadvantaged. It’s not supposed to be a replacement for a job. Physically able enrollees ought to work in exchange for their benefits.
In the battle over who is to blame for high prices Obamacare insurance, a new study finds that the reason is fewer insurers competing for customers, a new study finds.“Some experts have speculated that these increases are due to greater enrollment among sicker patients, the expiration of market stabilization policies, or the federal government’s discontinuation of funding for cost-sharing subsidies,” the study said. “However, these factors do not explain why some rating areas have experienced rapid premium growth, while others have experienced more modest increases.” A deeper look is needed into how more competition in the individual and small group health insurance markets could drive down premium costs.
Single Payer
Medicare for All Would Be a Fiscal Nightmare
By Charlie Katebi The Hill, Aug. 7, 2018
According to a July 30 study from the Mercatus Center at George Mason University, establishing a single-payer health care program will cost taxpayers $32 trillion over the next 10 years. The author of the report, Senior Research Strategist Charles Blahous, arrived at his estimate by forecasting the cost of Sen. Bernie Sanders’ (I-VT) Medicare For All Act. To pay for these enormous promises, the federal government would have to nearly double all the taxes it collects from individuals and corporations each year. This would cost the average American more than $18,000 in additional taxes.
Fact Check: Sanders Spins Savings in Medicare Plan
By Ricardo Alonso-Zaldivar Associated Press, Aug. 8, 2018Sen. Bernie Sanders is skimming over the facts in claiming that his “Medicare for all” plan will lead to big reductions in what Americans spend for health care. In a recent tweet, the Vermont independent insists the plan will cut $2 trillion from the nation’s health care bill.But that’s based on a scenario in which hospitals and doctors accept significantly lower payments for many patients. It’s a big asterisk, and one that Sanders fails to disclose.
