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- Bruce Bell on Why Medicare Advantage is Here to Stay
- Vern Smith on A Bad Couple Weeks for ObamaCare
- CARMEN MELCHOR on What Sequestration Could Mean to Medicare Advantage Claims Payment
- harry bailes on Medicare Advantage Showcased as the Model for Medicare Reform
- Naomi on What Sequestration Could Mean to Medicare Advantage Claims Payment
Last week’s approval of Pennsylvania’s Medicaid expansion waiver by the Centers for Medicare and Medicaid Services (CMS) may have been good medicine for ObamaCare Derangement Syndrome among Red State governors. Growing numbers are beginning to see the light and resistance to expansion is beginning to crumble like stale crackers. Expansion momentum is building in Republican-led states after Pennsylvania’s change of heart. Indiana, Tennessee, Utah and now Wyoming (!) may be next in line seeking CMS approval for their conservative-oriented expansion proposals. These custom Medicaid expansion proposals include administration by risk-bearing private health plans, increased beneficiary cost-sharing, job search requirements, and mandatory health assessments, among other conservative tenets.
Last week the Center for Medicare and Medicaid Services (CMS) announced the approval of Pennsylvania’s Healthy Pennsylvania plan to expand Medicaid coverage to more than half a million low-income people, becoming the 27th state to do so under the Affordable Care Act (ACA) and the 9th Republican governor. Read more
One of the best pieces of advice I ever got in business was to “fish where the fishes is”, and for health plan strategists it holds up. In this Golden Age of Government-sponsored Health Programs, one of the biggest fishing holes is Long-Term Services and Supports, and a new primer from KFF lays out the opportunity beautifully. And the hazards: patients who require LTSS are of course the most vulnerable and complex patients in the entire US health system, literally the final frontier for health plans and coordinated care. Huge risk, huge rewards.
The Alliance for Health Reform held a briefing on August 5, 2014 on “Navigating the Health Insurance Landscape: What’s Next for Navigators, In-Person Assisters and Brokers?”
In this Golden Age of government programs, the health plan industry has never had more exposure to the generally poor performance of pharmacy benefit managers (PBMs). Performance metrics in Medicare, Medicaid and ObamaCare are directly tied to PBM execution, and the recent track record of these companies means they are the Achille’s Heel of insurers.
House Majority Leader, Eric Cantor (R-VA) is toast. Trounced in his Richmond district by a nobody Tea Bagger Tuesday night. Cantor gave up his leadership position yesterday. Depending on where you sit politically, either the unthinkable or the inevitable happened. In fact, a Majority Leader hasn’t lost incumbency since the office was created in 1899. “The defeat of the second-ranking Republican in the House by an ill-funded, little-known tea party-backed candidate ranks as the biggest congressional upset in modern memory and will immediately generate a series of political and policy-related shock waves in Washington,” wrote Chris Cilizza of WaPo.
Medicaid is already the largest insurer on the planet, and the Affordable Care Act (ACA) is driving enrollment faster than anyone imagined. But there are headwinds in covering more Americans through Medicaid, some political, some operational. Here’s why it will continue to improve and drive expanded coverage for the uninsured — and why all insurers need to participate to remain relevant to the new American healthcare landscape.