Supreme Court Re-Affirms Obamacare – What’s Next?

It was a stunning Supreme Court decision last Thursday. A 6 to 3 vote not only upholding insurance subsidies in states with federal exchanges but really reaffirming the Affordable Care Act.

  • Click here for an excellent NY Times analysis of what this means for Affordable Care Act in the days ahead.
  • To review all the fundamentals of the case, in laymen’s terms, to gain a better understanding of the issues, click here.
  • Hospitals and insurers are breathing a sigh of relief with the court’s decision. Click here to read their reactions.
  • The five leading health insurers— UnitedHealth, Aetna, Anthem, Cigna and Human —are involved in a complex, and so far uncertain, courtship ritual and the court decision has lit a fire under all of them. Click here and here.
  • Hospital and other health care stocks jumped higher following the court’s decision. Click here.
  • On Capitol Hill the responses were predictable but interesting nonetheless. Click here and here.

CMS Makes Changes to Its ACO Investment Model

CMS is trying to encourage more ACOs to participate in its so-called ACO investment model that it announced last fall. The program will provide upfront payment to organizations that need money to get new IT systems and other infrastructure upgrades as they get their ACO up and running. The agency says it will let ACOs that just formed in 2015 or plan to join next year apply to join the model. CMS expects to make up to $114 million available for the upfront payments. The next application period opens July 1. Click here for the CMS announcement. Click here for a good fact sheet.


Key Senator Introduces Rural Hospital Rescue Bill

U.S. Senator Charles Grassley (R-IA) introduced the Rural Emergency Acute Care Hospital (REACH) Act (S. 1648) last week to address the growing problem of rural hospital closures. The legislation establishes a new Medicare payment designation, the Rural Emergency Hospital, to sustain emergency services in rural communities. Rural Emergency Hospitals would provide emergency room and outpatient services, but not inpatient acute care. They would be reimbursed 110% of reasonable costs. The new designation is available to critical access hospitals and hospitals located in rural areas with fewer than 50 beds. The Senator’s White Paper and One-Pager summarize the bill. Click here for the full bill text.


Senate Committee OKs Extension of Rural Hospital Demo

A 5-year extension of the rural community hospital demonstration program was included in the Senate Finance Committee’s executive session last week. S. 607 – introduced by Senators Grassley (R-IA), Bennet (D-CO), Murkowski (R-AK), and Moran (R-KS) – would extend the demonstration program from 5 to 10 years. The program enables rural hospitals with fewer than 51 acute care beds to test the feasibility of cost-based reimbursement. There are currently 23 hospitals participating in the demonstration. This expansion would allow them to continue providing high quality care in rural communities. The bill text can be found here.


Senate Committee Passes 12 Health Care Bills

Last week, the Senate Finance Committee okayed 12 healthcare bills that will be considered by the Senate later this summer.. The bills address a wide range of policies – including preventing and reducing improper Medicaid and Medicare expenditures, electronic health records, rural health care, and psychiatric care. The list of bills passed out of Committee can be found here. SHC’s summary of bills can be found here.


Advocacy Group Highlights BCBS Excessive Cash Reserves

Nonprofit Blue Cross Blue Shield plans are sitting on cash reserves far above the levels required by insurance regulators, but their bankrolls have diminished slightly since Obamacare became law, according to a new study by Consumers Union. With the findings, the watchdog group is calling on regulators to take the insurers’ healthy cash reserves into consideration as they review requested 2016 rate hikes. The dominant Blue plans in some states, including Maryland, Tennessee and New Mexico, are seeking average rate hikes of more than 25 percent for individual plans. Click here for the detailed study.


NYTimes Editorial Criticizes For-Profit Hospital Charges

On the heels of a study showing that for-profit hospitals made up the largest share of 50 hospitals charging the most for their services, the New York Times last week published a hard hitting editorial against the prices charged at some for-profit hospitals. The newspaper suggested that legislation might be needed to cap the prices hospitals can charge. Click here for their editorial. Click here to read the response from the American Hospital Association.


Not Expanding Medicaid Can Cost Taxpayers More: Report

In most of the 21 states that have chosen not to expand Medicaid, residents pay more local taxes to help support hospitals that care for uninsured people. On top of that, they pay a portion of the federal taxes that help subsidize Medicaid in the 29 states and District of Columbia that did expand the program to cover more people — places where residents can expect to see lower local taxes as more people become insured. Click here for the report.


Medicaid Benefits Are Comparable To Private Health Insurance: Study

Medicaid beneficiaries and people with private health coverage fare about the same when it comes to having a regular doctor and receiving high-quality care, according to a new report from the Commonwealth Fund. The analysis, based on the Fund’s latest health insurance survey, finds that 95 percent of Medicaid beneficiaries who were covered all year of 2014 had a regular doctor, and 55 percent said they received quality care. That’s about the same share, if not slightly higher, than people with private coverage. Click here for the report.


More Than 70 Million Enrolled in Medicaid and CHIP: CMS

About 12.3 million people enrolled in Medicaid or the Children’s Health Insurance Program between Oct. 1, 2013 and April 30, 2015, increasing total enrollment in the programs by 21.3% since the start of the first open enrollment period for the Health Insurance Marketplace, according to a report released last week by CMS. More than 70.1 million people were enrolled in Medicaid or CHIP in those states as of April 30, with Medicaid expansion states showing a 28% increase and non-expansion states showing a 9% increase. Click here for details.


Study: ACA Employer Mandate Not Creating More Part-Time Employees

The Affordable Care Act’s employer mandate doesn’t appear to be driving more employees into part-time work, according to a new ADP study released last week. The findings seem to contradict a frequent criticism from the law’s opponents — that businesses will cut back workers’ hours or add more part-time employees to avoid triggering the Obamacare requirement to offer health insurance to full-time employees. Click here for the study.


Growth of “Superbugs” Focus of New Initiative; Hospitals Are the Focus

The relatively unrestrained use of antibiotics has had unexpected and dangerous consequences—breeding “superbugs” that are resistant to antibiotics and triggering infections that sicken at least 2.25 million Americans each year and kill 37,000. Consumer Reports is leading the campaign to fight against superbugs, including recommending policies that 1) Require hospitals and health-care providers to report antibiotic use and antibiotic-resistant infections and 2) Require mandatory real-time reporting by hospitals and health care providers of antibiotic-resistant outbreaks. Click here for their comprehensive report.


NIH Alternative Medicine Initiative Is Evolving: Report

In the early 1990s, Congress established an Office of Alternative Medicine within the National Institutes of Health. Seven years later, that office expanded into the National Center for Complementary and Alternative Medicine, with a $50 million budget dedicated to studying just about every treatment that didn’t involve pharmaceuticals or surgery—traditional systems like Ayurveda and acupuncture along with more esoteric things like homeopathy and energy healing. Click here for a very good report on how this effort is evolving.


Government Increases Scrutiny of Revolutionary New Lab Tests

As labs and research start-ups grow, the federal government is scrutinizing their relationships with doctors, as well as their payment and billing practices. Medicare and private insurers having increasing difficulties with paying for these tests as they multiply faster than they can be tracked. Click here for the story.