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Topic: Policy & Health Reform
With the failed Affordable Care Act (ACA) repeal effort, senators packed their bags and headed off for August recess. Their return will be met with a significantly packed healthcare agenda: Children’s Health Insurance Program (CHIP) Reauthorization, ACA Stabilization Bill, Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, as well as last ditch efforts to repeal the ACA through bills that have yet to be voted on such as Graham-Cassidy.
Forty-nine Democrats and three Republicans delivered a blow to Affordable Care Act (ACA) repeal efforts last week by voting against what was then seen as the final effort to pass a bill through the Senate. Already this week, talks have ramped up of both a new repeal effort as well as bipartisan efforts to force through a “market stabilization bill.” Despite the focus on possible repeal legislation, the administration already holds one powerful card in their hand – the use of 1332 waivers – that could provide an avenue for healthcare reform through state action.
Reauthorization for the Children’s Health Insurance Program (CHIP) lurks behind Washington’s focus on the Affordable Care Act (ACA) repeal and replace efforts. But the battle may be as contentious, and the added factor of a September 30th deadline makes stakeholders worry.
During the presidential campaign, Donald Trump highlighted the need to address rising drug costs, stating the drug industry was “getting away with murder.” Several recent high-price drug increases for HIV/AIDS drugs, hepatitis C drugs, and the EpiPen®, among others, have also raised Congressional, state, and public concern about the issue. During the campaign, Trump discussed allowing re-importation of cheaper drugs or allowing the government to negotiate drug prices as ways to lower prices.
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.
In a word, it’s trouble. Let me count the ways.
Top of mind is the Medicaid overhaul. Block Granting Medicaid has been the Holy Grail on the Republican side since Reagan. And why not: the Department of Health and Human Services (HHS) wants to download the risk to the states. Whether it is the per capita limits required by law or the optional Hobson’s Choice of the block grant for the entire population, it means one thing. Pain. States have to balance their budgets, unlike Uncle Sam who has that bottomless checkbook.