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- Sharon Willliams on A New Source of Capital for Star Ratings and Clinical Innovations
- William on Will Trump and Price Pull Out the Scalpels for Star Ratings?
- Bobby on January Release of the Draft MMG – Perfect Timing
- Pam Lassila on Best Practices and Common Conditions of Audit Preparation
- Capitol Hill Healthcare Update | Gorman Health Group Blog on What Trump Could Actually Do to ObamaCare, Day One, Without Congress
The Voice of John Gorman
I am continually amazed by how many health plans in Medicare Advantage (MA) and Medicaid still cling to restrictive, “Dr. No”’90’s-style managed care practices like pre-authorizations, referrals, and concurrent review. With massive policy changes looming in Medicaid, and the influence of Star Ratings in MA greater than ever, health plans may soon have a gun to their heads: evolve medical management from restrictive to supportive, or die.
After six weeks of intensely secret negotiations, the “Better Care Reconciliation Act of 2017” (BCRA) is out, and it’s much worse than the House’s AHCA. The story remains the same: worsening benefit cuts for the poor to provide a tax cut for the rich. After Trump called it “mean,” and literally every healthcare organization has rallied against it, the hoped-for moderating influence of the august upper body of the U.S. Congress is gone. TrumpCare is still mean.
By now I’m sure you’ve seen the Congressional Budget Office (CBO) assessment of TrumpCare/the American Health Care Act (AHCA) and its topline findings: 23 million would lose coverage, it cuts $1.1 TRILLION in coverage assistance to low-income Americans, it would increase premiums for those age 50-64 by more than 850%, all while providing a massive tax cut to the wealthy and various healthcare industries like device manufacturers.
While headlines rage in DC about Trump’s leaks to Russian spies visiting the White House last week, the Senate’s sausage factory grinds away on TrumpCare. You’ll recall following House passage of the American Health Care Act (AHCA), the Senate essentially declared it DOA in the upper chamber and started over. Health plans are in the middle of bid development for the ObamaCare Marketplace and for Medicare Advantage and Part D, so timing and details matter.