The big policy news from this last week was that the Center for Medicare and Medicaid Services (CMS) released the so-called “final rule” on the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA.
What is MACRA, you ask? And what is a “final rule”? Well, you may remember intermittent debates, fights, and panics a few years ago about the Sustainable Growth Rate, and Medicare reimbursement formula that always threatened to drastically cut doctors’ pay under Medicare, except for the fact that Congress kept “temporarily” delaying it for years. MACRA is the replacement – no huge cuts to doctors’ pay immediately, but it does put into place a new regime of cost-controlling strategies linked to holding physicians accountable to a range of quality-of-care measures. The final rule finalized, ahem, the exact cadre of payment incentives, deductions, and implementation time frames that constitute MACRA. Health Affairs summarizes here.
“As an initial sign they hit the target, key Members of Congress have already weighed in applauding the Rule. Here’s a tip: when Members applaud a regulation like this so quickly, two things are going on: 1) they are taking a solid helping of credit for changes the agency has made; and 2) they are putting affected stakeholders on notice that they have an uphill battle in securing new changes soon. Read: this is as good as it’s going to get.”
Continue reading Health Policy Updates: October 22 2016
Given the problems that the ACA/Obamacare has faced, were there any realistic alternatives at the time the law was passed, that would have done any better? Megan McArdle, writing at Bloomberg, thinks yes. Specifically, focus on the simple expansion of Medicaid to support low-income Americans rather than trying to set up the complex Exchange infrastructure.
“Here’s my radical plan: If the Obamacare exchanges are going to result in, at best, people being able to buy Medicaid-style plans with limited choices and benefits, then why not just eliminate the middleman and give them … Medicaid?”
Continue reading Health Policy Updates: September 3 2016
A large part of the ACA/Obamacare was to expand Medicaid; many (though not all) states elected to do so. New data out this week in JAMA Internal Medicine suggests that patients are benefiting. Compared to states that did not expand Medicaid, previously uninsured patients who have now gained access to Medicaid coverage do better on many metrics, including better access to outpatient care, increased diabetes screening, and reduced non-compliance due to cost.
The Oregon Medicaid experiment from a few years ago left Medicaid skeptics with some reason to be agnostic as to whether Medicaid actually improves people’s health. These data lessen the foundation for such skepticism, and should thus should help move the conversation forward. Continue reading Health Policy Updates: August 14 2016
I’m a week behind in sending this link out, but Sarah Kliff at Vox had a great post on “narrow networks,” an effective (if unpopular) strategy used by health care insurance companies to hold down costs and premiums. Insurance companies can lower costs and improve the experience for everyone by restricting their provider networks to the lowest-cost providers in each geographical region…but consumers are often surprised not to see their doctor or favorite big-name hospital on the list.
“So this, then, is Oscar’s coming pitch: less choice of where to get care but a much better, more seamless experience once you’re getting care…Oscar plans to work especially closely with doctors in these systems to eliminate the frequent hassles of obtaining care. Patients with Oscar will be able to see doctors’ schedules, for example, and make appointments on the insurance plan’s website and app.” Continue reading Health Policy Updates: August 7 2016
Last week in one of the pieces I included, I mentioned being confused by conflicting reports regarding the increasing prices of insurance plans on the ACA exchanges. This week, there is a Vox.com story that helps to explain the issue, and how it is easy to come away with mixed messages.
“I’ve spent the past few days talking to experts about what to expect from Obamacare rates in 2016. And they do expect premiums to rise faster this year, largely because health-care costs are going up faster, too. But they caution against reading too much into the little information currently available — and they don’t expect the huge rate increases making headlines now to be the norm.”
Continue reading Health Policy Updates: July 19 2015