Topic: Medicaid

ObamaCare Derangement Syndrome Fades, Medicaid Expands.

John Gorman

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.

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PA’s Corbett is Latest GOP Governor to Take Medicaid Expansion. Will Others?

John Gorman

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

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Health Plan Strategists: Fish Where the Fishes Is — in LTSS

John Gorman

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.

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Navigators, In-Person Assisters and Brokers

Jean LeMasurier

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?”

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PBMs are the Health Plan Industry’s Achilles Heel

John Gorman

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.

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Tuesday Night’s Primary Elections Were Huge. Here’s What They Mean for Our Industry.

John Gorman

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.

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The Status of Medicaid Expansion, and Why It Will Keep Getting Better

John Gorman

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.

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