Colorado Will Expand Medicaid, Governor Announces
Gov. John Hickenlooper said Colorado will expand its Medicaid program as much as the federal health care law calls for, and he said the state won’t have to spend any extra money to make it happen.
The federal health overhaul law requires states to significantly expand the health care program for the poor, but when the U. S. Supreme Court ruled on the Affordable Care Act last June, it said states couldn’t be forced to take the new Medicaid money, essentially making that expansion optional.
Hickenlooper made the announcement on Thursday, the same day the Obama administration made news announcing which states will be running their own health insurance marketplaces, called exchanges. Hickenlooper said Colorado will bring a projected 161,000 people into the Medicaid program over the next ten years.
“I think this is a step towards what we’ve talked about for a couple of years now, about how do we move and make sure that we’re making Colorado the single healthiest state in America,” the governor said.
HEALTH CARE IN THE STATES
Today’s Exchange Surprise: Republican-Led Utah Gets Thumbs Up From HHS
The Obama administration’s announcement Thursday that it has given Utah a conditional okay to run its own state health insurance marketplace came as a surprise to many exchange watchers.
Utah Gov. Gary Herbert, a Republican, had resisted making major changes to the state’s existing market, which was built before passage of the health care law and is geared to small business.
“Generally, I would prefer a state-based approach if I were to have the flexibility to stay true to Utah principles,” Herbert wrote Health and Human Services Secretary Kathleen Sebelius last month asking for approval.
Acknowledging that Utah’s exchange was “atypical,” Herbert suggested it serve as “the minimum standard for all federally compliant exchanges.”
Today, the feds announced that Utah was one of seven states to gain conditional approval.
What happened? Did they cave on some of the law’s standards to bend over backwards to placate a Republican governor?
Well not exactly. At a news conference this afternoon, HHS officials said that Utah would still have to meet all of the law’s requirements to get final approval, including offering coverage for individuals, and hiring “navigators” to help consumers make decisions about what coverage to buy. They said they expected a progress report from the state no later than Feb. 1.
Plans for health insurance exchanges approved by White House for seven more states
By Sarah Kliff,
The Obama administration on Thursday approved plans by seven states to create health insurance exchanges, the new marketplaces at the heart of the Affordable Care Act.
With this final round of approvals, the White House has signed off on blueprints by 17 states and the District to operate their own exchanges in 2014, as long as they continue to meet certain benchmarks over the course of the next year.
“In all of these states, there’s more work to be done to be ready for open enrollment in October, but we believe they’ve made significant progress,” said Gary Cohen, director of the department’s Center for Consumer Information and Insurance Oversight.
Under the law, the insurance exchanges — which will be designed to work as a kind of Travelocity for individuals and small businesses wanting to buy insurance — are required to launch open enrollment on Oct. 1. By Jan. 1, consumers will be able to use federal subsidies to purchase coverage through the exchanges’ online portals.
The majority of states did not submit applications to run their own marketplace.
They now have two options. Theses states can decide to partner with the federal government, overseeing certain parts of the new exchange, or leave the entire task to the Obama administration.
States have until Feb. 15 to notify the federal government of which option they will pursue.
The administration approved four exchange applications from Republican governors — in Idaho, Nevada, New Mexico and Utah. The other three states given approval Thursday were California, Hawaii and Vermont.
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Obamacare: 5 states to watch
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States entered 2012 not knowing whether President Barack Obama’s health care law would survive. They enter 2013 facing the reality of impending deadlines and tough choices that can’t be put off much longer.
Even states that have turned down the chance to build their own exchanges — about 30 in all — have about six weeks to decide whether they want to partner with the feds on key functions. Although states don’t face a deadline to say whether they’ll expand their Medicaid programs under the Affordable Care Act, the clock is definitely ticking.
In some states, their paths are already set. In most, though, state officials will wrestle with questions about the future of their insurance markets and crunch the numbers on the ACA’s Medicaid expansion — all as the Obama administration continues to pump out guidance and rules to move implementation of the health law full speed ahead.
Though governors may have come out strongly one way or another on implementation, most of them will have to face their first legislative sessions since the Supreme Court upheld the ACA. And even if states aren’t expanding Medicaid or setting up their own exchanges, they’ll have to confront possible changes to state laws to align with ACA requirements — or risk having the feds step in to regulate their insurance markets like never before.
Here are five of the more interesting states to watch on ACA implementation in 2013:
Link between health care spending, quality unclear
NEW YORK (Reuters Health) - Whether states, hospitals and smaller practices that spend more money on health care provide better treatment is still an open question, according to a new review of past studies.
"This is really one of the central issues we're grappling with today in health care," said Peter Hussey from the RAND Corporation in Arlington, Virginia.
The topic is especially pressing because although the United States spends more of its budget on health care than any other wealthy nation - and is spending more each year - the World Health Organization ranks its health system 37th.
According to the Kaiser Family Foundation, the U.S. spent nearly $2.6 trillion on health in 2010 - equal to just under 18 percent of the country's gross domestic product (GDP).
Hussey and his colleagues analyzed results from 61 studies that compared health care spending with outcomes on both small, hospital-wide scales and broader state-wide levels.
Some of those studies looked at whether hospitals that spent more money per patient had fewer in-hospital deaths, or if their doctors and nurses better followed guidelines. Others compared states' Medicare spending with how well their older residents were treated for a range of conditions.
"The bottom line was that no matter how you drill down into the results, at every level the results are just all over the map," Hussey told Reuters Health.
"It's totally unclear what the real relationship is."
Vermont fares well under health lawThe state ranks behind only New York and California in terms of bringing in federal grants.
The Associated Press
MONTPELIER, Vt. – When it comes to federal money to help states set up health care exchanges under the Affordable Care Act, you might expect that California would rank first and New York second.
But here's a surprise: Tiny Vermont comes in at No. 3.
An Associated Press analysis of data from the U.S. Department of Health and Human Services shows Vermont has been granted more than $158 million so far in these early stages of compliance with the federal law to help set up the new regulated health care marketplace. The new systems are scheduled to be up and running in October.
California so far has gotten about $236 million, New York about $183 million. Vermont's population of about 630,000 would make it California's fifth largest city.
"We've been very aggressive in trying to bring down federal dollars that will ensure that the assistance that Vermonters will need in making the transition to purchasing health coverage through the exchange is there," Mark Larson, commissioner of the Department of Vermont Health Access, said Friday.
Vermont also got an earlier start than many other states, some of which had held back to see if the 2010 federal health care overhaul might be struck down by the U.S. Supreme Court or turned back by a Republican victory in the 2012 presidential election, Larson said.
"Certainly, there have been a number of other states that have been waiting for the outcome of the Supreme Court ruling and waiting for the outcome of the election," he said, and have not pursued every funding opportunity that Vermont and a handful of other blue states have.
Fiscal cliff deal hits Maine hospitals; rural areas spared some cuts
Posted Jan. 04, 2013, at 8:17 p.m.
The New Year’s Day fiscal cliff deal has left Maine hospitals bracing for funding cuts and, at the same time, cheering the extension of federal programs designed to buoy rural medical centers.
Nationally, hospitals have sharply criticized the deal hammered out between Congress and the Obama administration. Hospitals won big on one hand, because the legislation averted a planned 27 percent cut in Medicare payments to doctors. But Congress had to come up with $30 billion to avoid the payment cut, and hospitals will have to pick up the tab for about half that expense over the next decade.
The scheduled pay cut, built into a 1997 deficit reduction law, forces a scramble for money each year because the formula used to fund Medicare hasn’t appropriated enough money to cover the program’s costs for about a decade. So Congress repeatedly steps in to delay, avert or shrink the pay cut in an annual ritual known as the “doc fix.”
Hospitals also helped to foot the bill for the doc fix last year, said Jeff Austin, a spokesman for the Maine Hospital Association.
“The doc fix was the biggest thing in our world, but it’s a mixed bag,” he said. “We’re glad about the doc fix but we’re upset that we were used to finance it.”
Maine hospitals, which employ about half the state’s doctors, expect to lose roughly $40 million over the next decade to pay for the doc fix, Austin said. That money will be part of $10.5 billion nationally that the federal government is recouping over the next few years for past Medicare overbilling by hospitals stemming from bill coding practices.
Hospitals maintain that they have not been overpaid.
Maine hospitals will be largely spared in coming years from another planned cut under the fiscal cliff deal that reduces Medicaid payments to hospitals that serve a high proportion of poor, uninsured patients, Austin said. About a decade ago, Maine decided to funnel that federal money into the MaineCare program to provide health insurance to a greater number of residents, rather than pay hospitals directly, he said.
“That doesn’t hit Maine hospitals like it does in other parts of the country,” Austin said.
Obamacare — why having everyone insured matters
Everyone is so upset about Obamacare, and being required to have health insurance. How many people actually do not have health insurance? And what difference will it make, forcing them to have health insurance anyway? I have health insurance myself, but I don’t see why I should care about other people having it.
Independent Yankee
Dear Independent Yankee,
In 2011, approximately 48 million people under age 65 had no health insurance. This translates to about 18 percent of the people under age 65. (The vast majority of Americans over age 65 have Medicare, though almost 700,000 of the elderly also had no insurance. Not everyone qualifies for Medicare.)
Under the Affordable Care Act (health reform), the percentage of people uninsured should go down by more than half. The difference it will make to the people who get health insurance could be significant. Some uninsured people have put off getting care, because they can’t afford it. Ninety percent of the uninsured are in households earning less than 400% of the Federal Poverty Limit. Affording even simple medical care is difficult for these people. For others, having health insurance won’t change much: even with an insurance card, they won’t get medical care.
The real issue is when uninsured people get a major illness and cannot pay their medical bills. Their costs are ultimately paid by everyone else who either has insurance or pays for their care.
Behind fiscal cliff deal, a hospital finance fight
Posted Jan. 04, 2013, at 9:26 a.m.
After Congress’ fiscal cliff deal this week dug into hospitals’ pockets to avert a drop in Medicare payments to physicians, industry associations screamed. The president of the American Hospital Association said the reductions — nearly $15 billion over a decade — “will make it harder for patients to access the care they need.” The president of the Federation of American Hospitals also said patients would suffer because lawmakers had decided to “rob hospital Peter to pay for fiscal cliff Paul.”
Will hospitals be hobbled by Congress’ latest cuts? The answer may lie in a long-running dispute about whether Medicare has been overpaying hospitals for the past few years.
In late 2007, the Centers for Medicare & Medicaid Services (CMS) changed the way hospitals submit bills for Medicare patients. Its new system created 749 categories to allow hospitals to describe the illness level of their patients more specifically. The goal was to make sure that a hospital treating a person who has pneumonia and other illnesses, such as diabetes, for instance, would be paid more than a hospital treating an otherwise robust patient with pneumonia.
But the change raised a concern, said Paul Matsui, executive director of The Advisory Board Co., a Washington consulting firm. Medicare officials “knew right from the get-go there was going to be some incentive to put more codes on the claims, make sure you have all the different complications and” other illnesses, Matsui said. “They knew that was going to look like a rise” in the severity of the patients’ conditions, he said.
So Medicare proposed cutting its payment levels to counterbalance the likely change in billing. But the hospitals dissuaded the government from cutting rates, disputing the inevitability that coding would creep up.
After several years, CMS examined billing trends and determined that hospital patients suddenly were deemed sicker and warranted higher payments. The Medicare Payment Advisory Commission, or MedPAC, an independent agency that advises Congress, wrote in 2010 that the initial concerns about excess payments were correct and said the “improved coding increased payments by $6.9 billion over 2008 and 2009.”
Congress allowed Medicare to recover $6 billion of these overpayments through 2009, but last spring MedPAC estimated hospitals had received $11 billion in overpayments between 2010 and 2012, which Medicare was not empowered to get back.
The fiscal cliff legislation changed that, giving Medicare the power to recoup $10.5 billion of those overpayments over the next few years. The money will go toward putting off $30 billion in scheduled cuts in payments to doctors who treat Medicare patients.
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