ObamaCare Watch Newsletter 4/13/18

  • The Paul Ryan Difference –
  • NJ Lawmakers Approve Health Insurance Mandate –
  • To Curb Rising Health Insurance Costs, Some States Try ‘Reinsurance Pools’ –
  • CMS Scales Back Evaluation Plans for Indiana Medicaid Waiver –
  • Budget Office Expects 34% Jump in ACA Premiums –
  • CMS Needs to Ensure Complete Accurate Data on Terminations of Coverage for Nonpayment of Premiums –
  • Insights from Monthly National Price Indices through March 2018 –
  • California Bill Would Create Health Care Price Controls –
  • Let the Market, Not Contracts, Set Price for Health Care –
  • Trump Signs Executive Order for Revamp of Federal Aid Programs –
  • Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2017 –

Leaders

The Paul Ryan Difference
The Editors
The Wall Street Journal.April 12, 2018

The retiring Speaker’s career shows the power of ideas in politics. First at the Budget Committee, then at Ways and Means. Mr. Ryan built a GOP reform consensus that became the party’s agenda. His principal triumph as Speaker is tax reform, a generational achievement that broke a bottleneck to U.S. business competitiveness and faster economic growth.Paul Ryan developed his views about an optimistic, governing conservatism in the Jack Kemp-Ronald Reagan era, and he worked in the vineyards to find his moment. His lesson about fighting for ideas that matter applies in any age.


State Actions

NJ Lawmakers Approve Health Insurance Mandate
By Michael L. Diamond
USA Today, April 12, 2018

On Thursday, New Jersey lawmakers sent to Gov. Phil Murphy (D) a bill that will require nearly all New Jerseyans to have health insurance or pay a penalty in a bid to stabilize premiums for consumers in the Obamacare marketplace. They approved another bill that would set up a reinsurance plan that would partly be paid for by the federal government and cover some of the most expensive health care claims.

To Curb Rising Health Insurance Costs, Some States Try ‘Reinsurance Pools’
By Michael Ollove
The Pew Charitable Trusts, April 9, 2018

A couple of years ago, the health insurance exchange in Minnesota was in deep trouble. Health insurance premiums for individual policies had shot up by as much as 67%, among the steepest increases in the country. Insurers were abandoning the market, leaving 116,000 Minnesotans with scant choices. The Minnesota Legislature offered a solution: a $271 million, publicly-funded reinsurance pool that would help health insurance companies pay the most expensive medical claims, thereby lowering overall insurance premiums. In its first year, 2018 premiums offered on the exchange fell by 15%.

CMS Scales Back Evaluation Plans for Indiana Medicaid Waiver
By Virgil Dickson
Modern Healthcare, April 9, 2018

The White House last Friday cleared CMS to scale back efforts to evaluate Indiana’s conservative approach to Medicaid expansion. While some think the move could prevent the agency from gathering adequate data, others say that even with a scaled-back study, the CMS could still glean pertinent information from Indiana about the impact its expansion approach has had on Medicaid beneficiaries. “Surveys were just one element and getting rid of them is not enough to make or break an evaluation” said Doug Badger, a senior fellow at the Galen Institute.


ACA Exchanges

Budget Office Expects 34% Jump in ACA Premiums
By Sam Baker
Axios, April 9, 2018

The Congressional Budget Office is anticipating a 21% jump in the cost of federal subsidies this year, driven by a 34% jump in premiums for the “benchmark” plans to which those subsidies are pegged. But after that, CBO expects a big slowdown. Federal spending on the ACA’s premium subsidies will likely grow by about 5% per year for the rest of the next decade, the budget office said, totaling more than $750 billion over ten years. The annual spending increases are mainly a result of rising health care costs.

CMS Needs to Ensure Complete Accurate Data on Terminations of Coverage for Nonpayment of Premiums
Government Accountability Office, March 9, 2018

The federal health insurance exchange allows people to enroll for insurance coverage outside of the annual open enrollment period under certain circumstances, such as losing coverage from an employer. Insurers are concerned that some people are misusing this flexibility by reenrolling after their coverage was terminated for nonpayment of premiums. Not only is this against the rules, but it undermines the stability of the exchange. CMS doesn’t collect complete data that would allow it to gauge the extent of the problem. GAO recommends gathering data on coverage terminations for nonpayment of premiums.


Health Care Prices

Insights from Monthly National Price Indices through March 2018
Altarum, April 13, 2018

According to a new brief from Altarum, health care prices have risen 2.2% since March of last year, the fastest annual growth rate since January 2012. One of the largest drivers of that price growth was hospitals. Altarum found that hospital prices have been growing annually at nearly 4%, the highest level in eight years.

California Bill Would Create Health Care Price Controls
Jonathan J. Cooper
ABC News, April 9, 2018

California’s government would set prices for hospital stays, doctor visits and other health care services under legislation introduced Monday, vastly remaking the industry in a bid to lower health care costs. The proposal, which drew swift opposition from the health care industry, comes amid a fierce debate in California as activists on the left push aggressively for a system that would provide government-funded insurance for everyone in the state.

Let the Market, Not Contracts, Set Price for Health Care
By Tom Dalzell and Sally Covington
San Francisco Chronicle, April 12, 2018

Today, California hospital markets are highly consolidated, enabling hospitals to demand rates that are 250% to 350% of Medicare allowable charges or even higher. Insurance companies go along with this because they have no product to sell without having hospitals in their networks, and insurers’ profits are a percentage of the premium (the higher the premium, the more money they make).The question now is whether employers and unions will use price-setting to stop escalating health benefit costs and their destructive, decades-long impact on family and public budgets.


Entitlement Reform

Trump Signs Executive Order for Revamp of Federal Aid Programs
By Louise Radnofsky
The Wall Street Journal, April 10, 2018

President Trump signed a broad executive order urging a revamp of federal government aid programs Tuesday, laying out broad principles for overhauling government assistance programs to require that participants who are able prove they are working or trying to find jobs. The order is primarily aimed at programs such as food stamps, housing programs, and Medicaid, which now covers 74 million people.

Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2017
HHS Office of the Inspector General, April 9, 2018

During Fiscal Year 2017, the Federal Government won or negotiated more than $2.4 billion in health care fraud judgments and settlements, and it attained additional administrative impositions in health care fraud cases and proceedings. As a result of these efforts, as well as those of preceding years, in FY 2017 $2.6 billion was returned to the Federal Government or paid to private persons. Of this $2.6 billion, the Medicare Trust Funds received transfers of approximately $1.4 billion during this period, and $406.7 million in Federal Medicaid money was similarly transferred separately to the Treasury.