Overall, ACOs have been a dismal failure, VBP has had mixed results, and hospital readmission reduction programs appear to have no impact whatsoever. Yet HHS is calling for the expansion of these programs to an ambitious 90 percent of the health care sector over the next four years.
Surprisingly, despite the Medicare Advantage program’s widespread popularity and measurable success for both patients and taxpayers, Congress has repeatedly gone after this vital program with cuts that threaten its integrity and long term sustainability. Ultimately, bolstering Medicare Advantage in order to support innovative care coordination, quality patient outcomes and lower healthcare costs is a vital step for patients everywhere.
North Carolina senior citizens who choose private Medicare policies are seeing an unusual level of turmoil this year, with more than 57,000 notified their plans won’t be offered in 2015 and others seeing rates more than triple.
The upheaval involves Medicare Advantage, a program that lets people 65 and older choose private policies instead of federal health coverage. About 475,000 in North Carolina have those policies, including about 35,000 each in Mecklenburg and Wake counties.
No other state had so many people lose their current Medicare Advantage plans, according to a national tally by the Kaiser Family Foundation, a nonprofit group that tracks health trends. New York was second with just over 55,000 enrolled in canceled plans.
In last night’s U.S. Senate debate in New Hampshire between incumbent Jeanne Shaheen D. and challenger Scott Brown R., Shaheen uttered a flat-out, bald-faced lie: that Obamacare doesn’t cut Medicare spending to pay for its expansion of coverage to the uninsured. It’s a talking point that a number of Democratic Senate candidates—and their enablers in the lefty blogosphere—have been clinging to. And it’s embarrassingly dishonest.
The Medicare Trustees issued their annual report on the program’s long-term financing outlook last month, and their findings were greeted by the Obama administration as evidence that the Affordable Care Act is working. This is nonsense.
The general slowdown in health spending remains largely a phenomenon of economic conditions related to the deep recession of 2007-2009 and factors outside the realm of the ACA. Among other things, it is noteworthy that health spending growth rates have moderated across the developed world in recent years, as measured by the OECD. Even Obamacare’s most enthusiastic apologists might be sheepish about claiming the law somehow caused a global health transformation.
A close examination of the ACA’s provisions, especially those related to Medicare, also produces nothing that would lead one to expect large-scale spending moderation. The main provisions of the ACA provide substantial new subsidies for health insurance, through Medicaid and the federal and state exchanges. The Congressional Budget Office CBO estimates that these provisions will cost about $1.8 trillion over the period 2015 to 2024. The main effect of this massive increase in subsidization of insurance will be to increase demand for services and thus put upward pressure on prices and costs. This is simple economics. It may take some time for these pressures to emerge, but they will eventually emerge.
Medicare spending growth will be slow again in 2014 relative to historical standards, and some of the usual suspects are now crediting the Affordable Care Act — Obamacare — for the good news. For instance, a recent post at Vox suggests that the slowdown in Medicare spending can be attributed, in part, to the ACA’s provision penalizing hospitals for excessive readmissions of previously treated patients.
At the time of the ACA’s enactment in March 2010, the Congressional Budget Office estimated that the readmission provision would reduce Medicare spending by $0.3 billion in 2014, and only $7.1 billion over a decade. That’s about one tenth of 1 percent of total Medicare spending over that time period. There has been no information from any source since 2010 suggesting that the savings from the readmission provision has escalated into a major cost-cutting reform. In the context of overall Medicare spending, the readmissions provision is simply inconsequential.
Section 1332 of Title I of the Affordable Care Act offers to state governments the ability to waive significant portions of the ACA, including requirements related to qualified health plans, health benefit exchanges, cost sharing, and refundable tax credits. It permits state governments to obtain funding that otherwise would have gone to residents and businesses through the ACA and to use those funds to establish, beginning in 2017, an alternative health reform framework within statutory limitations. Section 1332 also permits states to apply in a coordinated fashion for waivers from Medicare, Medicaid, the Children’s Health Insurance Program, and “any other federal law relating to the provision of health care items or services.” This article reviews the statutory provisions and related regulations of this new and unprecedented state waiver authority, as well as the legislative history of section 1332. Finally, it reviews the limited activities thus far by states contemplating use of this provision and considers ways this authority may be considered for use by states in the future. Section 1332 has the potential to instigate a new, varied, and unprecedented array of state health sector innovations from both sides of the political divide over health care reform.