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Tag Archives: gorman health group
Exchange Activity Kicks Into High Gear
Federally Facilitated Exchanges: The draft application for qualified health plans
In at least 23 states, governors are allowing a “Federal takeover” in the form of a federally facilitated exchange (FFE). Now, CMS has published the first draft of the application that health plans need to complete to become a qualified health plan (QHP) in the CMS FFE. To be sure, the exchange regulation allows individual exchanges flexibility in defining rules and operations, provided they meet the basic requirements. This flexibility applies equally to how CMS interprets its role in operating exchanges in the FFE states.
The Path to a Deal on the Fiscal Cliff
Outside the Beltway Bubble it must look like we’re about to go all Thelma & Louise off the fiscal cliff. In fact, each day the path to a deal becomes clearer, as brilliantly displayed by our friends at WaPo’s WonkBlog. The one thing that is crystal-clear: the final deal will piss off everyone.
Medicare Advantage Plans Need the “Doc Fix” More Than Docs Do
Predictably, the “Doc Fix” has become a political football in the fiscal cliff discussions here in Washington, and it continues to have huge bearing not just on physicians but Medicare Advantage plans as well. You could say MA plans need the “Doc Fix” more than docs do.
Of course they should! (But not for the reason you may think)
The New York Times reports that Hospitals fear they may bear the brunt of Medicare cuts. I should hope so! But not because they are wildly profitable at the expense of efficiency and innovation elsewhere.
What Health Care Federalism Looks Like
Insurers are beginning to grumble about the state-by-state variation in Exchange design as implementation bears down on the industry. Fierce Health Payer has a quick summary of the griping here. While I can’t blame them for their frustrations (hey, we have to figure out all 50, too!) I do wonder how they would feel about the alternative: a national exchange whose model may not adequately recognize the dramatic differences in how care is delivered by geography, demography, provider culture, et al. Just look to the Medicare Advantage program and its challenges thus far in creating a quality rating system that does not properly account for the challenges in caring for a rural population.
Supreme Court upholds Romneycare
As you have likely heard, Romneycare no, Obamacare, no, the ACA has been upheld by the Supreme Court, with Chief Justice Roberts casting the deciding vote with the liberal block. Health policy implications aside, there are some truly delicious politics here:
