With the election less than three weeks away, states officials, congressmen, health care providers and insurers continue to tread water as they wait for the answers the election will provide. Congressional Republicans sent letters to Secretary Sebelius pointing to the wastefulness in the design of the Electronic Health Record incentive program – a program that if Romney were elected and there was Republican support in Congress would probably be eliminated anyway. States hired consultants to determine whether they should run their own exchanges or expand their Medicaid programs – issues that might be moot if Republicans sweep the November elections. And state officials, providers and insurers drag their feet in following through with Affordable Care Act deadlines and requirements – inaction that will require them to work overtime after the election to meet deadlines if the political status quo remains.
AT THE AGENCIES
CMS announced that 11 Medicare Advantage plans received five-star rankings for 2013, up from nine plans in 2012. Star rankings determine whether a plan receives a CMS bonus, which helps counteract some of the Medicare Advantage reimbursement cuts under the Affordable Care Act.
According to a report from the Kaiser Commission on Medicaid and the Uninsured, 26 states submitted proposals this past spring to CMS to reform how they care for dual eligibles. Dual eligible patients are those who receive health care coverage through both Medicare and Medicaid. The Kaiser report says that 18 states will test the capitation model, five states will test the managed fee for service model and three state will test both.
IN THE STATES
States continue to work to make a decision about whether to expand their Medicaid eligibility pursuant to the Affordable Care Act. The list develops every day, but here is an update on where things stand now: Florida, Georgia, Louisiana, Mississippi, South Carolina and Texas have rejected the Medicaid expansion. Arkansas, California, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Rhode Island, Vermont and Washington are expanding. The rest are still undecided.
Idaho is paying $195,000 to two consulting firms – Leavitt Partners and Milliman – to explore the option of expanding Medicaid coverage.
On Wednesday (10/17), Pennsylvania's Insurance Commissioner Michael Consedine said that the state would most likely not have a state-run health insurance exchange up and running by January 2014. Consedine's comments suggested that the state might opt for the federally run exchange at first and consider switching to a state-run exchange at a later time.
On Tuesday (10/16), the Michigan Senate Insurance Committee passed two bills related to an overhaul of Blue Cross Blue Shield of Michigan. Michigan Blue gets special tax and regulatory treatment because it agrees to provide health coverage for residents with pre-existing conditions. Because the Affordable Care Act prohibits health insurers from taking health status into account starting in 2014, the state seeks to end Michigan Blue's tax-exempt status and change it from a charitable trust to a customer-owned nonprofit.
ON THE HILL
Sens. John Thune (R-S.D.), Tom Coburn (R-Okla.), Richard Burr (R-N.C.) and Pat Roberts (R-Kan.) sent a letter to HHS Sec. Sebelius requesting a meeting with staff members from CMS and HHS' Office of the National Coordinator for Health Information Technology to discuss the EHR incentive program. The letter asks whether the use of taxpayer-subsidized EHRs increases the use of diagnostic tests instead of reducing them and whether some health care providers received subsidies for EHR systems that were established before the adoption of the new standards. The senators’ letter follows one from House Republicans, which called for HHS to halt the meaningful-use incentive payments to providers. This letter argued to Sec. Sebelius that nearly $10 billion in federal dollars had been wasted because the Stage 2 Meaningful Use program rules are actually weaker than the Stage 1 rules from three years earlier.
Senate Minority Leader Mitch McConnell (R-Ky.) said at a town hall meeting to medical professionals that he did not see a way of repealing the Affordable Care Act if President Obama wins reelection.
IN THE ELECTION
At the second presidential debate on Tuesday (10/16), there was less focus on health care than in the first debate.
The Romney team is out with a new mailer in Virginia that vows to protect health care 'choice.' The brochure says that Romney would give states and patients more freedom and flexibility over their health care.
To view our compilation of recent health care reform implementation news, click here.