CMS Intends To “Wind Down” ACA Exchanges By 2020.
Fierce Healthcare (4/5, Sweeney) reports that CMS intends “to ‘wind down’ support for the federal exchanges by the time open enrollment hits in 2019 and shift funding to states.” In order for this plan “to work, the agency is relying on Congress to do something it failed to do several times last year: Pass an ACA repeal.” The article says CMS laid out “its plan in a fiscal year 2019 budget justification (PDF) released this week that outlines a $403 million cut to its program operations budget next year.” The piece adds that in February, HHS Secretary Alex Azar “said the grant program proposed under the Graham-Cassidy-Heller-Johnson bill ‘will help states stabilize their insurance market and provide for a smooth transition away from Obamacare.’”
Columnist Says ACA Remains Robust Despite GOP Efforts To Repeal It.
Max Nisen writes in a Bloomberg News (4/5) column that in spite of the Trump Administration’s “best efforts,” the ACA remains the law of the land. Nisen says CMS recently unveiled data which show only about 400,000 fewer consumers enrolled in ACA plans for this year compared to 2017. He adds, “It takes gall to trumpet the success of a program you’ve arguably set up to fail.” Nevertheless, CMS Administrator Seema Verma “tweeted on Tuesday this was the ‘most cost-effective and successful open enrollment period to date!’”
More Red States May Offer Cheaper Coverage That Does Not Meet ACA Requirements.
Modern Healthcare (4/5, Meyer, Subscription Publication) reports that other red states could emulate “Iowa and Tennessee in allowing cheaper, leaner health plans that don’t comply with Affordable Care Act rules, even though such plans could create problems in those states’ individual insurance markets, experts say.” However, “these alternative plans may find themselves in a race to the bottom as they are forced to compete with even cheaper, skimpier short-term products that the Trump administration has proposed to expand.” The article adds that the cheaper plans which states are authorizing “may have to cut benefits and adopt tougher medical underwriting practices, looking more and more like so-called junk insurance, to avoid getting stuck with sicker, costlier patients.”
Maryland Governor Signs Bills That Aims To Shore Up ACA Marketplace.
The Baltimore Sun (4/5, Dresser) reports that on Thursday, Maryland Gov. Larry Hogan (R) “signed legislation…that is expected to stave off another year of huge increases in health insurance premiums and prevent the collapse of the state’s individual health insurance markets.” The article says the bill aims “to stabilize Maryland’s insurance market for individuals and hold down expected rate increases after Congress and President Donald J. Trump took actions last year that chipped away at the Affordable Care Act.”
Signatures Submitted For California Ballot Measure To Cap Dialysis Clinic Revenue.
The San Francisco Chronicle (4/6, Wildermuth) reports that a measure to cut the costs of kidney dialysis, and to “trim the profits of the huge companies that dominate the service,” advanced closer to being added to the ballot in November when supporters submitted more than 600,000 signatures in favor of the law. The “measure would limit a clinic’s revenue to 115 percent of the average cost of dialysis treatment in the state, plus any health care improvement costs.” If passed, “clinics would be required to refund anything above that amount to either patients or the insurance companies that paid their bills.”
Public Health and Private Healthcare Systems
CMS Sets Medicare Outpatient Reimbursement Rate For Cancer Therapy.
Reuters (4/5, Beasley) reports that Medicare intends to “pay hospitals close to its standard mark-up rate for administering cell therapy Yescarta [axicabtagene ciloleucel] for cancer outpatients, who will have a co-payment of nearly $80,000, according to the Centers for Medicare & Medicaid Services.” The article says Gilead Sciences Inc, which manufactures the drug, has requested additional Medicare reimbursement for inpatients. The piece adds, “Reimbursement has been a major issue for investors because the high costs of the so-called CAR-T therapies could affect usage, especially for the Medicare population.”
Insurers Impacted By Elimination Of ACA’s CSR Payments Could Also Have Problems With Risk Adjustment Calculation, Experts Warn.
Modern Healthcare (4/5, Luthi, Subscription Publication) reports that insurers impacted by the elimination “of the Affordable Care Act’s cost-sharing reduction payments may hit a stumbling block: the law’s method for dealing with risk adjustment.” The article says this “calculation is supposed to help carriers that bear a higher share of risk in the individual market by having those that shoulder less risk make payments to offset costs.” However actuaries are warning that “it could cause more headaches” in the future.
Arizona University Employees Pushing To Exit State Health Insurance Program.
The Arizona Republic (4/5, Leingang) reports thousands of Arizona State University and University of Arizona employees are lobbying state legislators and Gov. Doug Ducey for permission “to set up their own insurance programs, something officials fear could decimate the state’s health insurance fund.” The schools are seeking “to separate from the state of Arizona’s health insurance program,” alleging “politicians for years have used university money intended for health care to balance the state budget.” The article points out that the effort could stall given that Ducey’s advisors say the state would “see a big loss…if they were to break out from the system.”
New Hampshire House Advances Bill To Reauthorize Funding For Medicaid Expansion.
The New Hampshire Union Leader (4/5, Solomon) reports that on Thursday, a proposal to reauthorize funding for Medicaid expansion which the New Hampshire Senate approved “cleared its first test in the House…as state representatives voted 222-125 to continue the government-funded health-insurance program for low-income households for another five years.” The article says funding for the program will expire at year’s end unless it is renewed. The piece adds that the bill “includes new work or community-service requirements for certain participants and conversion of the program to an HMO-style managed-care approach, instead of fee for service.”
The AP (4/5, Ramer) reports that the plan will probably “be significantly modified before facing another vote.” The article adds that the version which the House approved “would allow self-employment and seasonal work to satisfy the work requirement.”
New Hampshire Public Radio (4/5) also covers the story.
ACA Enrollment For Austin Metro Area Lower For 2018 Compared To Last Year.
The Austin (TX) American Statesman (4/5, Sechler, Subscription Publication) reports that ACA enrollment for the Austin metro area fell for 2018, totaling about 85 percent of the 2017 figure. For Texas as a whole, “enrollment came in at about 92 percent of the 2017 number, according to the federal Centers for Medicare and Medicaid Services, while nationally it came in at 97 percent of last year.” The article says some healthcare advocates believe “the strong local economy likely played a role in the Austin area’s lower sign-up percentage for 2018…because more people might have had access to health insurance through private employers.”
Kindred Health Stockholders Approve Sale To Humana.
The Louisville (KY) Courier-Journal (4/5, Costello) reports that Kindred Healthcare shareholders have approved a proposal to sell the company to a group that includes Humana, moving the deal a step closer to completion.