Topic: Medicaid

Will Trump and Price Pull Out the Scalpels for Star Ratings?

John Gorman

Star Ratings have driven the market in Medicare Advantage (MA) and Part D since the Affordable Care Act turned the consumer information tool into the biggest experiment in value-based payment on the planet. There’s little argument Star Ratings is working, and MA quality has improved. The program is being adopted in the ObamaCare Health Insurance Marketplace, and the Medicare Access and CHIP Reauthorization Act (MACRA) included the Quality Reporting System, or Stars for Medicaid, starting in 2019. Then Trump got elected President and appointed Tom Price the Department of Health and Human Services (HHS) Secretary. Could they pull out the scalpels for Star Ratings?

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While We Wait…How Did the ACA Fare this Open Enrollment?

Olga Walther

As the weeks go by and we continue to wait for substantive Affordable Care Act (ACA) “repeal/replace” legislation and regulations, January 31 marked the end of the 2017 Open Enrollment Period, necessitating a look into how the ACA is faring outside of the political sphere.

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Opportunities for Growth in the New Administration

Diane Hollie

“Opportunities are like sunrises. If you wait too long, you miss them.” ―William Arthur Ward 

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What Trump Could Actually Do to ObamaCare, Day One, Without Congress

John Gorman

It’s becoming clear here in DC that legislative repeal of ObamaCare may actually not happen. As many as nine GOP Senators are casting doubt on “repeal and replace” and may insist on both concurrently; only three defections are needed for repeal to be blocked. This raises the question: what could Trump do to ObamaCare himself, day one, without Congress? If you care about the coverage of 30 to 52 million Americans, the answers are scary.

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The Trump De-Regulators and Medicare Advantage

Steve Balcerzak

Hmm, you’re asking what will the Trump de-regulators do to Medicare Advantage? Given the confusion about ObamaCare non-replacement for three years and the selection of a Medicaid maven for Administrator, we haven’t heard much about Medicare Advantage and Part D. However, Trump said he wants a list of wasteful and unnecessary regulation. Even with that, we may not see a lot of actual regulatory change during 2017 in either of these programs. Changing regulations in a major way takes too much time to propose, review, and finalize anything of substance in a short period. However, there are other actions the new Administrator can take. First and foremost, de-regulators are interested in slowing the process or moderating its effects, so here are some potential actions.

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New Year. New Congress. New Administration. Same old healthcare, for now.

Olga Walther

Despite the Trump administration having yet to take office, Congress kept its promise to get the Affordable Care Act (ACA) repeal ball rolling on day one. On January 3, 2017, the first day back for Congress, the chair of the Senate’s Budget Committee introduced a budget resolution that directs several committees in both the House and Senate to begin work on the ACA repeal.  Specifically, the resolution calls for the committees to submit recommendations to reduce the deficit by $1 billion in the next decade. So what happens next?

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The New “80/20 Rule” in Government Health Programs

John Gorman

The New “80/20 Rule” in Government Programs

Everyone in health finance and policy knows the “80/20 Rule:” 20% of patients account for 80% of health expenditures. It’s also well-established that about one-third of health outcomes are determined by genetics and access to healthcare. That means two-thirds of outcomes are attributable to social determinants of health. For 2017, we need a new 80/20 rule for Medicare Advantage and Medicaid health plans and their delegates: 80% of the services we provide beneficiaries should address social determinants and make the health services we provide more effective.

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