Will the ACA Survive the Scales of Justice Yet Again?

In late December, the U.S. Court of Appeals for the 5th Circuit struck down the individual mandate of the Affordable Care Act but ducked the central question – is the rest of the ACA valid after Congress zeroed out the tax penalty for not having health insurance?

The case was sent back to the lower court to reconsider how much of it survives; the lower court judge previously ruled the entire law unconstitutional. This move reduces the likelihood of the Supreme Court considering the case before the 2020 election, but the Democratic-led states defending the law might appeal directly to SCOTUS.

The case was brought by 18 Republican-led states and the ACA has been defended mainly by a coalition of Democratic attorneys general, as the Administration refuses to defend the law.

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More Than Medicare-for-All: Proposals to Achieve Universal Health Coverage

Since the passage of the ACA, more than 20 million Americans have gained health insurance. But the fight for affordable and accessible universal coverage continues.

Here are just some of the proposals that have been introduced in Congress:

  • The Medicare for All Act of 2019 (H.R. 1384/S.1129) would establish a national health insurance program administered by HHS.
  • The State Public Option Act (H.R. 1277/S.489) would allow states to offer residents of all incomes the option to buy into Medicaid. This option would compete with private plans on the ACA Marketplace.
  • The Medicare Buy-In & Health Care Stabilization Act of 2019 (H.R. 1346) would allow individuals aged 50 to 64 to buy into Medicare and provide some marketplace stabilization.
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All the Health Priorities in the $1.4 Trillion Spending Deal

The end of the year bipartisan spending deal will allocate $1.4 trillion in federal funding for the remainder of the fiscal year (through Sept. 30) and avoid a shutdown. The House has already passed the deal and the Senate is poised to do the same by tomorrow.

Samuel Corum for The New York Times (Source Linked)

So what health priorities made the cut for this deal?

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Back to Basics: Single Payer & Medicare-for-All

Estimates from the Urban Institute project that in 2020, the federal government will spend $732 billion on Medicare, $464 billion on Medicaid and CHIP, $60.4 billion on the health insurance marketplaces, and $27.5 billion to hospitals for uncompensated care. Households will spend $931 billion, employers will spend $955 billion, state governments will spend $285 billion on Medicaid and CHIP and $17.2 billion for uncompensated care, and providers will spend $24.1 billion.

We’re talking about an insane amount of money – honestly seems like Monopoly money to me.

Reigning in healthcare spending has to be a policy priority, it’s simply unsustainable. Medicare-for-All would shift most of the spending to the federal government, to the tune of $34 trillion over a decade.

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Congressional Committees with Health Care Jurisdiction

Health care is such a massive topic that it takes more than one Congressional committee to handle all the health-related legislation. It’s important to know which committee a bill will be referred to for any advocacy work! Speaking with committee members should be a priority.

Once a bill is introduced in the House or the Senate, it is referred to the committee with jurisdiction over the topic or program addressed in the bill. Committees then refer it to the appropriate subcommittee and conduct an evaluation of the proposed legislation. Let’s take a look at what is under the jurisdiction of the major health care committees on both sides of Capitol Hill.

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California Adopts Statewide Insurance Subsidies

Not only are the views of the California coast spectacular, but now they come with the bonus of a buffer to the rising cost of health insurance.

California will be the first state to offer state-funded tax credits for insurance purchased through Covered California, the state insurance Marketplace. The federal government offers credits as well, but many people fall into a coverage gap due to earning too much for Medicaid and the federal credit but too little to afford insurance on their own. The California credits will be paid for in part by a new tax penalty on Californians who do not have health insurance.

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Improving Quality of Care for End-Stage Renal Disease

I spent this rainy morning shadowing a pediatric nephrologist, the specialists for kidney function in kids. The number of conditions they see is vast, but each has a unique course and some can progress to renal failure, even with medical intervention.

Chronic renal failure is the result of slowly progressive kidney diseases (and it not often reversible). 1 in 3 American adults is at risk for kidney disease — the two main causes of CKD in the adult population are diabetes and high blood pressure. In kids, CKD is often associated with inherited disorders, malformations present at birth, and autoimmune diseases, to name just a few.

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$12 Billion in Risk Corridor Payments at Risk

On December 10, 2019, the Supreme Court heard oral arguments concerning $12 billion that insurers say they are owed by the federal government as part of the risk corridor program.

The risk corridor program was one of the ACA’s three premiums stabilization programs (along with risk adjustment and reinsurance). The temporary risk corridors program was designed to run from 2014 to 2016 and meant to encourage risk-averse insurers to participate in the ACA marketplaces.

Here’s how the program was set up: If a plan’s costs were lower than it’s premiums, the plan would pay a share of it’s profits to the Department of Health and Human Services (HHS). If the plan’s costs exceeded premiums received, the plan would receive a payment from HHS for it’s excess costs. Insurers entered the marketplace under the assumption these risk corridor payments would be made to cushion extreme gains and losses.

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On a Scale of Pass to Fail, Many Medical Schools Fail Students on Health Policy

The U.S. Capitol is a site of health policy discussion and legislative action.

We are in a time when physicians are increasingly speaking the language of health policy and public health — “value-based care,” “co-payment,” “social determinants of health,” “accountable care organization” — and are increasingly asked by patients to ensure that a particular treatment or procedure is covered by their insurance before moving forward. This dizzying list of health policy terms (and the responsibility of a physician to understand the lingo) just keeps growing. And there is no better time to introduce students to this world than in medical school, when they are primed for learning and not yet overwhelmed with patient care.

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Reductions in Medicare Hospital Readmissions: Real or Illusory?

Source: Lehigh Valley Hospital-Muhlenberg

Hospital readmissions pose serious risks to patients, especially to Medicare patients who are older and typically sicker than other patients. Hospital stays increase the risk of infection and medication error, put patients through physical and psychological stress (i.e. being woken up multiple times a night, falls on the way to the bathroom), and increase Medicare expenditures. Under the Hospital Readmission Reduction Program (HRRP) created by the Affordable Care Act, hospitals are penalized by Medicare if beneficiaries are readmitted (to any hospital) within 30 days of discharge. The goals of the HRRP are to:

  1. Improve care transitions
  2. Reduce the burden of readmission for Medicare beneficiaries
  3. Reduce the cost of readmissions to the taxpayer
Continue reading “Reductions in Medicare Hospital Readmissions: Real or Illusory?”