Efforts have been made over the past several decades to achieve meaningful health reform. The number “three” figures prominently in such attempts. One version focuses on: increasing access to health care, improving quality, and reducing costs. Pursuing any one of these aims often has the unwanted outcome of making it difficult to realize the other two. Another version based on the number three is known as the Triple Aim, which consists of improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care.
Worth noting is that it occasionally proves challenging at times to obtain a clear picture of what is transpiring when reports from different sources present conflicting information. As an illustration, the U.S. Census Bureau earlier this month indicated that the uninsured rate from 2016-2017 remained statistically unchanged, while private polling data suggest an increased uninsured rate of 1-2 percent. Meanwhile, the most recent attempt of a comprehensive nature to make improvements in the realm of health care is represented by the Patient Protection and Affordable Care Act (usually referred to as the ACA or Obamacare) that became law in 2010. Since then, several policy initiatives of a more incremental nature have been proposed. Recent examples are described on this page of each issue of TRENDS, along with updates as they occur. Some developments that continue to materialize are discussed below.
Medicaid Work Requirements
Many individuals who previously did not have health insurance were able to obtain coverage when the federal-state Medicaid program was expanded to include them. Some states currently are planning to add work requirements for able-bodied adults who receive coverage. Michigan recently submitted a waiver application that would require enrollees in the age bracket 19-62 either to work, attend job-training, or volunteer at least 80 hours per month to retain coverage. If approved, the proposal will become effective in 2020 and may affect as many as 540,000 beneficiaries. Because of 12 possible exemptions that would apply to particular groups, such as family caretakers and pregnant women, the actual number may prove to be lower. If the waiver application is approved, Michigan is in line to become the fifth state to be able to impose work requirements. Utah and Wisconsin are among some other states that also are seeking waiver approvals.
Exploring The Fate Of Short-Term, Limited-Duration Health Insurance Plans
The Trump Administration was successful in having a final rule issued on August 1, 2018 to help individuals struggling to afford health coverage find new, more affordable options. The rule allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than three months. Such coverage now can cover an initial period of less than 12 months, and taking into account any extensions, a maximum duration of no longer than 36 months in total. A case filed in mid-September 2018 in Washington, DC is aimed at stopping the expansion of short-term health plans because opponents view them as not requiring provision of the same essential health benefits as ACA-compliant plans and possibly jeopardizing the ability of individuals with pre-existing conditions to find coverage. In contrast, proponents believe that short-term, limited-duration insurance will benefit: individuals who are between jobs, students taking time off from school, and middle-class families without access to subsidized ACA plans. Compared to the federal final rule, Oklahoma released guidance on September 7, 2018 to limit the sale of short-term, limited-duration plans to six months.
Medicare Savings Achieved By Accountable Care Organizations (ACOs)
An estimate from the Center for Medicare & Medicaid Services (CMS) indicates that Medicare ACOs underperformed during the first few years of implementation, generating a gross savings of $954 million. This estimate is contested by a report commissioned by the National Association of Accountable Care Organizations (NAACOS), which claims that the Medicare Shared Savings Program (MSSP) produced more than $1.84 billion in gross savings between 2013 and 2015. According to NAACOS, as of January 2018, there are 561 Medicare ACOs serving more than 12.3 million beneficiaries with hundreds more commercial and Medicaid ACOs serving millions of additional patients.
More Articles from TRENDS September 2018
FULFILLING A QUEST FOR PATIENT-CENTERED CARE
Patient-centered care is an important aspect of service delivery, but more efforts are needed to achieve its full potential. Read More
PRESIDENT’S CORNER—ASAHP MEMBER FOCUS
Charles Gulas, Dean of the Walker College of Health Professions at Maryville University of Saint Louis, is featured in this issue of TRENDS. Read More
FISCAL YEAR 2019 FUNDING PICTURE BRIGHTENS
For the first time in 15 years, Congress manages to complete a funding package for health and education prior to the start of the next fiscal year on October 1. Read More
HEALTH REFORM DEVELOPMENTS
Some states seek workforce requirements for certain Medicaid recipients, a challenge is mounted to stop an expansion of short-term health insurance plans, and savings are produced by accountable care organizations. Read More
DEVELOPMENTS IN HIGHER EDUCATION
Opponents respond to a Trump Administration proposal to rescind gainful employment regulations, representatives of various interest groups testify at a U.S. Department of Education hearing on accreditation, and Congress increases appropriations for education programs. Read More
QUICK STAT (SHORT, TIMELY, AND TOPICAL)
Prevalence Of Chronic Pain And High-Impact Chronic Pain Among Adults—United States
Daily Use Of Marijuana Among Non-College Young Adults
Micromotor Pills As A Dynamic Oral Delivery Platform
Using Biomimicry To Develop Solutions For Human Health Problems Read More
AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY
Creating A Policy Environment To Address Social Determinants Of Health
Population Health: Translation Of Research To Policy
Achieving Rural Health Equity And Well-Being: Proceedings Of A Workshop Read More