Thoughts
Thought Leadership Posts
Breaking Down The MACRA Final Rule
On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) released a final rule making changes to the 2018 Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The QPP includes both the Merit-Based Incentive Program (MIPS) and Advanced Payment Models (APMs). This post explains the key policies implemented in the final rule....
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The Health Implications of Tax Reform
This post breaks down the key components of 2017 Federal tax reform and its impact on the health care sector....
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State Waivers As A National Policy Lever: The Trump Administration, Work Requirements, And Other Potential Reforms In Medicaid
As states line up to avail themselves of new flexibilities in the section 1115 Medicaid wavier process, we thought it important to examine exactly what was approved in Kentucky and Indiana, and to survey the current landscape of pending proposals in search of what other reforms may be on the horizon....
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The Arduous Road to Renewal of CHIP Funding
After months of uncertainty, on January 22, 2018, Congress passed legislation renewing long-term federal funding for the Children’s Health Insurance Program (CHIP). Nearly nine million children and 370,000 pregnant women nationwide rely on the program for health coverage. This post examines the pathway renewal of the program took through considerable delays and political controversies....
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Navigating The Section 1332 Waiver Process: For States, A Treacherous Road Ahead
In light of the mounting legislative efforts to make changes to the section 1332 waiver process, especially in the Alexander-Murray market stabilization package, and enhanced state interest in availing themselves of this opportunity, we figured it timely to provide an overview of this aspect of the Affordable Care Act (ACA), the record of how state applications have been adjudicated so far, and the prospects of change to the policy in the near term. Unfortunately, given the considerable uncertainty in both the legislative and executive branches regarding the future of these waivers, states cannot safely expend meaningful resources on developing new applications for the program at this time....
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The Alexander-Murray Market Stabilization Package: What’s In It And Where’s It Going?
They may have done it. The apocryphal bipartisan deal to “fix” Obamacare is being struck (at least by two important Senators, for now, in part …). Today, Senators Lamar Alexander of Tennessee and Patty Murray of Washington announced they are converging on an agreement on a short-term package to help stabilize the individual insurance market. Even better, the policies included would likely be somewhat successful in achieving their purported purpose...
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Senate Bill Isn’t “Better Care” for Anyone
With the release of the Senate’s “Better Care Reconciliation Act of 2017 (BCRA),” the public finally gets a glimpse of legislation crafted in utter secrecy for the past two months, and now we know why. Despite the fanfare and feigned earnestness of the upper chamber’s efforts to improve on the “mean” House-passed American Health Care Act (AHCA), the Senate bill would be disastrous for low-income families, patients with pre-existing conditions, children, and the aged, while undermining health care security for virtually everyone else....
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CBO and America’s AHCA Headache
The much-anticipated Congressional Budget Office (CBO) score of the American Health Care Act (AHCA), the GOP’s effort to dismantle the Affordable Care Act (ACA) released yesterday, indicates that the bill would cause 23 million people to become uninsured while reducing the federal deficit by $119 billion. In that sense, there is little change from their assessment of the original version of AHCA. ...
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The Bipartisan ‘Single Payer’ Solution: Medicare Advantage Premium Support For All
In my last Health Affairs Blog post, I outlined a potentially bipartisan four-step plan to move past the American Health Care Act’s (AHCA’s) disastrous framework toward a more stable, less expensive health care system. For those seeking incremental, near-term solutions, I hope those recommendations provide helpful guidance. But the AHCA’s reckless drive through the US House of Representatives has taught us something about the current status of health care politics and may have opened the window to more significant, ultimately more successful, reforms....
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