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Supporters of the Affordable Care Act (ACA) won another huge battle against TrumpCare this week, but the war rages on. The threat will continue to loom until Trump is removed from office, Democrats retake the House or Senate, or the Senate provides him a win with a bipartisan market stabilization bill in the wake of the stinging defeat of Graham-Cassidy, his third failure to repeal the ACA.
Congress is in recess, and, for now, the Affordable Care Act (ACA) fight is on hold, at least legislatively. This is not so, however, for states and the Centers for Medicare & Medicaid Services (CMS). While the rejection of ACA repeal proposals under which Medicaid would face significant cuts was seen as a major win for the program and the underserved communities, the fight goes on as states look to make changes through 1115 waivers and wait for the outcome of the Children’s Health Insurance Program (CHIP) funding reauthorization. Discussed below is some of the recent impactful waiver activity.
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.
The reintroduction of the bipartisan “Stabilize Medicaid and CHIP Coverage Act of 2017” in the House (Green, D-Texas, and Barton, R-Texas) and the Senate (Brown, D-Ohio) provides 12 months of continuous eligibility to Medicaid and Children’s Health Insurance Program (CHIP) enrollees, mitigating the effect of what is known as “churn” for enrollees and health plans. “Churn” affects millions of enrollees who are disenrolled from Medicaid or CHIP due to changes in income or paperwork, despite being otherwise eligible.
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.