Implementing Health Reform: Increasing Medicaid Payments for Primary Care Physicians

Timothy Jost

Posted 5/10/12 on the Health Affairs Blog

On May 9, 2012, the Center for Medicare and Medicaid Services released proposed regulations to implement section 1202 of the Health Care and Education Reform Act of 2010. Section 1202 increases Medicaid payments made to primary care physicians for primary care services during the years 2013 and 2014 to Medicare payment rates, with the additional cost covered by the federal government.

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The Self-Care Economy: OTC Medicines in the U.S. Deliver Value to the Health System

Jane Sarasohn-Kahn

Posted 2/7/12 on Health Populi

U.S. health consumers’ purchase and use of over-the-counter medicines (OTCs) generate $102 billion worth of value to the health system every year. Half of this value accrues to employers who sponsor health insurance for their workforce; 25% goes to government payers (e.g., Medicare, Medicaid); and, 25% returns to self-insured and uninsured people.

For every $1 spent on OTCs, $6.50 is saved by the U.S. health system, shown by the chart.

For millions of health consumers, OTCs substitute for a visit to a doctor’s office: most cost-savings generated by OTC use are in saved costs of not visiting a clinician, as discussed inThe Value of OTC Medicine to the United States, published by the Consumer Healthcare Products Association in January 2012.

Continue reading “The Self-Care Economy: OTC Medicines in the U.S. Deliver Value to the Health System”

Health Reform Briefs: The Minimum-Coverage Requirement And Other Issues

Timothy Jost

Posted 1/07/12 on The Health Affairs Blog

©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

As every reader knows, the Supreme Court has agreed to consider challenges that have been brought to the constitutionality of two provisions of the Affordable Care Act (ACA) by twenty-six states, the National Federation of Independent Businesses, and individual plaintiffs.  The Court has scheduled the case for five and a half hours of oral arguments in late March.  It will probably decide the case early in the summer.

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Better Than Printing Money

Paul Levy

Posted 12/22/11 on Not Running A Hospital

John McDonough, one of the health care experts in Massachusetts, writes on his blog about the three-year renewal of the state’s Medicaid waiver.  John presents a history of the waiver and notes that it provides the “green glue,” i.e., the infusion of federal cash, that makes possible the health care reform process approved by this state several years ago.

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High Court to Review ACA’s Minimum Coverage Requirement, Medicaid Expansion

Timothy Jost

Posted 11/14/11 on the Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

Today, November 14, 2011, the Supreme Court decided to review a decision of the Eleventh Circuit Court of Appeals striking down the minimum coverage requirement of the Affordable Care Act (ACA) as unconstitutional.  The case will probably be argued before the Court in March and decided in the early summer.

Procedurally, the Court “granted certiorari.”  This means that it agreed to review certain questions raised by the certiorari petitions presented by the various parties in the Florida case, including the plaintiffs who challenged the constitutionality of the Affordable Care Act — 26 states, the National Federation of Independent Business, and two private individuals — and the federal government, which defended the Act’s constitutionality.  The Eleventh Circuit had ruled against the federal government on the question of whether the minimum coverage requirement of the ACA is constitutional, but had ruled against the plaintiffs on all other issues.

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Supreme Court Goes Beyond Individual Mandate

Merrill Goozner

Posted 11/14/11 on Gooz News

The Supreme Court, as expected, will consider the constitutionality of the individual mandate in health care reform. But as Tim Jost, a Washington and Lee University professor of law, noted today on theHealth Affairs blog, the high court will also hear arguments on the constitutionality of using Medicaid to expand insurance coverage to people earning up to 138 percent of the poverty line. States are challenging this mandate under what the attorneys general in the 26 states challenging the law call “the coercion theory.” Noted Jost:

The coercion theory calls into question a multitude of federal government programs.  Many federal programs, and not just health care programs, operate through conditional grants to the states.  Were the Supreme Court to hold that the Medicaid expansions are unconstitutional, it would open every one of these programs to judicial challenge.  New programs, or changes in existing programs, could be tied up for years as litigation proceeded.  Such as decision could pose a much greater threat to the power of Congress to address national problems than might a decision holding that Congress exceeded its authority under the Commerce Clause in enacting the individual mandate. It would be a truly radical decision.

I don’t know that this cases yet rises to the level of a Dred Scott decision for the 21st century. But its framing by the states challenging the law has all the hallmarks of the southern states that challenged the 1964 civil rights act, claiming states had the right to nullify federal laws that prohibited local laws condoning segregation, impeding voting and the like. The stakes in this spat over the individual mandate have suddenly grown significantly larger.

Get Ready for Big Changes in Provider Reimbursement

Joe Paduda

First posted 8/2/11 on Managed Care Matters

Get ready for big changes in provider reimbursement

Now that the debt limit deal is done, the hard stuff starts. While there’s been a lot of focus on the Pentagon budget and lack of revenue increases, the real heavy lifting will come when the super-committee convenes to figure out how to save the next $1.2 trillion. And their focus will be on Medicare, Medicaid, and provider reimbursement.

Because that’s where the ‘super-committee’ is going to have to find a big chunk of the additional savings required by the deal.

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