News Article | July 25, 2017
"For more than a half-century, long before the Affordable Care Act (ACA) and long before the health care debate was poisoned by partisanship, the United States has protected kids in need of healthcare," said Bill Lindsay, chairman of the board at Children's Hospital Colorado. "Senator Gardner has been an eloquent spokesman for the need to protect children on Medicaid, and now he has the opportunity to act on those principles." The Medicaid expansion in the ACA did not primarily benefit children. Now, the current version of the BCRA goes far beyond simply repealing the ACA and would actually slash longstanding coverage for children that goes back to the creation of Medicaid in 1965. Children's Colorado strongly opposes the BCRA. An Avalere analysis estimates the bill would cut kids' Medicaid funding by $43 billion over 10 years. The amendment Children's Colorado is pushing would limit the deep cuts to children's funding in the bill, though funding would still be reduced relative to current law. "We urge Senator Gardner to put forward an amendment to the BCRA to limit the bill's harm to children. Colorado's kids are counting on Cory," said Jena Hausmann, president and CEO of Children's Hospital Colorado. Editorial boards across the state – from The Gazette in Colorado Springs to the Pueblo Chieftain and The Daily Sentinel in Grand Junction-- have called on Congress to protect the essential safety net for children's medical coverage. Voters across Colorado agree. A public opinion survey by leading Republican polling firm The Tarrance Group found that, regardless of their political affiliation, 85% of Colorado voters agreed that "regardless of whether Obamacare is ultimately repealed or replaced, Congress should maintain the longstanding benefits that Medicaid has guaranteed children since 1965." Last month, a bipartisan group of 39 business, community, and political leaders sent a letter to Colorado's U.S. Senators Gardner and Michael Bennet (D – Colo.), urging them to ensure that Medicaid coverage for children is not impacted by efforts to repeal and replace the ACA. About Children's Hospital Colorado Children's Hospital Colorado (Children's Colorado) has defined and delivered pediatric health care excellence for more than 100 years. Founded in 1908, Children's Colorado is a leading pediatric network entirely devoted to the health and well-being of children. Continually acknowledged as one of the nation's outstanding pediatric hospitals by U.S. News & World Report, Children's Colorado is known for both its nationally and internationally recognized medical, research, education and advocacy programs, as well as comprehensive everyday care for kids throughout Colorado and surrounding states. Children's Colorado is the winner of the 2015 American Hospital Association-McKesson Quest for Quality Prize, and is a 2013-2017 Most Wired hospital according to Hospitals & Health Networks magazine. Children's Colorado also is recognized for excellence in nursing from the American Nurses Credentialing Centers and has been designated a Magnet® hospital since 2005. The hospital's family-centered, collaborative approach combines the nation's top pediatric doctors, nurses and researchers to pioneer new approaches to pediatric medicine. With urgent, emergency and specialty care locations throughout Metro Denver and Southern Colorado, including its campus on the Anschutz Medical Campus, Children's Colorado provides a full spectrum of pediatric specialties. For more information, visit www.childrenscolorado.org and connect with Children's Colorado on Facebook, Twitter and Pinterest. Children's Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
News Article | July 8, 2017
Senate Health Bill Could Both Boost And Undercut Mental Health Funding A little-discussed provision in the Senate health care bill is designed to boost the number of hospital beds for psychiatric care, providing a long-sought victory for mental health advocates. The provision would amend an obscure rule regarding Medicaid funding — a rule that has sharply limited the number of beds for those with schizophrenia, bipolar disorder or other mental illnesses. Yet leading advocacy groups on mental health issues say they see no reason to celebrate. That's because the Senate bill would also wring out $772 billion from Medicaid — the joint state-federal insurance program that is the single-largest provider of care for people with serious mental illness. The nonpartisan Congressional Budget Office has said that the Senate bill, drafted by Republicans as a replacement for the Affordable Care Act, would reduce overall Medicaid spending by 26 percent by 2026, and by 35 percent the following decade. The loss of those funds would devastate health care services for people with mental illness, who are some of the most vulnerable and disadvantaged people in the country, said Bethany Lilly, deputy director of policy and legal advocacy at the Bazelon Center for Mental Health Law, an advocacy group. "Medicaid is the safety net for people with serious mental illness," said Ronald Honberg, senior policy adviser at the National Alliance on Mental Illness. Without decent mental health care and support services, people who have a psychotic disorder can quickly deteriorate, Honberg said, ending up in overcrowded emergency rooms, jail and prison cells or dangerous city streets. "This bill is a prescription for making all these problems worse." Republicans who crafted the Senate bill have noted that Medicaid spending will still increase under their plan — just at a rate lower than currently projected. The Senate bill will make Medicaid spending more sustainable, said Julia Lawless, a spokeswoman for the Senate Finance Committee, one of the Senate committees that oversees health legislation. "Even before Obamacare's unprecedented Medicaid expansion," Lawless said, "the program was plagued by quality issues. States were barred from using innovative solutions to improve patient care and both federal and state Medicaid spending was growing at unprecedented, unsustainable levels." The Senate bill will reverse this course, she said, and slow the growth of Medicaid "without cutting actual benefits." The Medicaid program has traditionally refused to pay for inpatient stays in large, freestanding psychiatric facilities, making exceptions for patients under age 21 and facilities with 16 beds or fewer. The rule, which has changed little since Medicaid was created five decades ago, was aimed at preventing the federal government from paying for long-term care in psychiatric institutions. But that Medicaid rule also has contributed to a severe shortage of psychiatric beds for people in crisis, said John Snook, executive director of the Treatment Advocacy Center, a nonprofit that focuses on people with serious mental illness. Mental health advocates have called for changing the rule for decades. Last year, the Centers for Medicare & Medicaid Services eased the policy, paying for up to 15 days of inpatient hospital care for patients enrolled in Medicaid managed-care plans. But in a letter to the Medicaid program last year, the National Association of Medicaid Directors noted that some patients with mental illness or substance abuse disorders might need closer to a month of inpatient care. The current draft of the Senate bill, dubbed the Better Care Reconciliation Act, would allow states to receive federal matching Medicaid funds for up to 30 consecutive days of inpatient psychiatric hospital care, or 90 days in a year. This suggested change in Medicaid funding was included in the Republican bill because several senators have voiced concern that patients haven't had enough access to hospital care for mental illness and addiction, according to a GOP Senate aide who was authorized to speak only on condition of anonymity. The legislators involved, according to the aide, included Sen. Orrin Hatch, R-Utah, and Sen. Rob Portman, R-Ohio. Honberg said he would welcome such a change except that reducing overall Medicaid spending could force closures of rural hospitals and institutions that serve as "safety nets" — providing free care to people who are uninsured or poor. If these hospitals go out of business, Honberg said, the total number of hospital beds available to people with mental illness could shrink, not expand. Medicaid, he pointed out, pays for a wide variety of supportive services for people with schizophrenia and other serious mental illnesses — beyond doctor's visits and medications. States can use Medicaid funds to pay for case managers; transportation of patients to and from doctor's appointments; supportive housing, which helps people with serious mental illness live independently; supported employment, which provides job training and other services; and teams of professionals who assist people who need intensive, comprehensive help navigating the health system and social services. Kaiser Health News, a nonprofit health newsroom, is an editorially independent part of the Kaiser Family Foundation. Follow KHN's enterprise reporter Liz Szabo on Twitter @LizSzabo.
News Article | March 3, 2017
FILE - In this Jan. 24, 2017 file photo, Minnesota Gov. Mark Dayton speaks in St. Paul, Minn. Minnesota officials are bracing for billions of dollars in additional health care expenses if congressional Republicans enact a plan they're discussing to replace the Affordable Care Act, according to a draft document obtained by The Associated Press. Dayton said this week that he wants to wait and see how the federal government proceeds on health care. (AP Photo/Jim Mone File) ST. PAUL, Minn. (AP) — Minnesota officials are bracing for billions of dollars in additional health care expenses if congressional Republicans enact a plan they're discussing to replace the Affordable Care Act, according to a draft document obtained by The Associated Press. The planning document shows that the GOP proposal, a draft of which was circulated last week, would cut $1.3 billion next year from the state's low-income health care program that covers roughly one-sixth of its 5.5 million residents. By 2021, the losses would accumulate to more than $5 billion, eventually costing the state $6 billion a year starting in 2029. That analysis was prepared by the state's Department of Human Services, which runs those programs. It illustrates the uncertainty states across the nation are grappling with over how President Donald Trump and Congress will reshape the health care law championed by President Barack Obama. And it provides one of the first concrete estimates of what the emerging GOP plan would cost a state that expanded Medicaid. Some states fear that the final product will force states to choose between cutting popular health care programs for low-income residents or picking up far more of the tab. Democratic and Republican governors alike have expressed alarm about potential changes to Medicaid as members of Congress have faced backlash at town halls in their home districts. The possibility that Minnesota could be on the hook for more federal costs is weighing heavily on some state lawmakers as they start assembling a new, two-year budget. If the Medicaid changes were passed, a top Minnesota Democrat said it would undoubtedly trigger cuts to critical coverage for elderly and sick residents. "We're making promises we're not going to be able to keep," state Sen. Tony Lourey said Thursday. Minnesota is one of 31 states — plus the District of Columbia — that participated in Medicaid expansion, a marquee part of Obama's health care law that helped expand coverage to an additional 10 million low-income residents. The draft legislation would end that expansion and reduce overall spending by providing states with a fixed, annual amount per recipient in response to Republican criticism that states currently have little incentive to keep expenses under control. Minnesota Department of Human Services Commissioner Emily Piper said that was a grave mistake, calling it "code for cuts to programs for the poor, elderly, and people with disabilities." The financial hit that states may face varies drastically based on how many residents are covered on Medicaid and to what extent the federal government currently covers those costs. In a letter last week, a group of seven Republican governors urged Trump and Congress not to shift the financial burden to states. "We must ensure that people do not have the rug pulled out from under them and are not left without access to care, especially during the transition," according to a copy of the letter obtained by the AP. Minnesota and many other states covered many low-income residents before the health care overhaul, but the Medicaid expansion sent out more federal dollars and covered more people. To shift that funding back, Lynn Blewett of State Health Access Data Assistance Center at the University of Minnesota said, is "going to be very hard to go backward and get to where we were before the ACA." The Medicaid change is just one of many pieces of the evolving GOP plan to replace Obamacare. Their proposals also call to eliminate the mandate that every American buy health insurance and scrap fines on individual who don't have coverage while maintaining some of the law's most popular components, including a requirement that insurers allow young adults to remain on parental coverage until they turn 26. According to the planning document, the changes could entirely eliminate Minnesota's so-called Basic Health Plan, a supplemental program called MinnesotaCare that covers nearly 100,000 "working poor" residents. Only Minnesota and New York have implemented those plans, and coverage in both has soared since the health care law was implemented. The potential funding loss adds to turmoil in Minnesota's health care system. Lawmakers took an extraordinary measure earlier this year to offset massive premium increases for shoppers buying coverage on their own, tapping $312 million of rainy day funds to help keep down monthly rates. Democratic Gov. Mark Dayton said this week that he wants to wait and see how the federal government proceeds on health care. "To try to anticipate what they're going to do when they don't know themselves ... is really impossible," he said. Associated Press writer Steve Karnowski in Minneapolis and Ricardo Alonso-Zaldivar in Washington contributed to this report.
Shaw F.E.,Centers for Disease Control and Prevention |
Asomugha C.N.,MediCaid |
Conway P.H.,MediCaid |
Rein A.S.,Centers for Disease Control and Prevention
The Lancet | Year: 2014
The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage-and the health benefits of insurance-to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population.
Health Affairs | Year: 2013
The Affordable Care Act established the Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models. The goal is to reduce program expenditures while preserving or improving the quality of care provided to beneficiaries of Medicare, Medicaid, and the Children's Health Insurance Program. Central to the success of the Innovation Center is a new, rapid-cycle approach to evaluation. This article describes that approach-setting forth how the Rapid Cycle Evaluation Group aims to deliver frequent feedback to providers in support of continuous quality improvement, while rigorously evaluating the outcomes of each model tested. This article also describes the relationship between the group's work and that of the Office of the Actuary at the Centers for Medicare and Medicaid Services, which plays a central role in the assessment of new models. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.
Current Opinion in Organ Transplantation | Year: 2013
PURPOSE OF REVIEW: This article conveys early findings with respect to changes in patient and graft survival since Centers for Medicare & Medicaid Services (CMS) regulations for Medicare coverage of solid organ transplantation became effective on 28 June 2007. RECENT FINDINGS: Programmes cited by CMS for subpar outcomes have strong incentives to improve performance and have risen to the challenge. Adult kidney programmes that entered into System Improvement Agreements or were approved for mitigating factors by CMS, for which there is a 2-year postsurvey tracking period (Nâ€Š= â€Š15), improved their standardized mortality ratio (SMR) for 1-year posttransplant patient survival from 2.05 to 1.17 on average. Volume in some of those programmes tended to decline, whereas national volume increased. Nationally, average donor risk across U.S. adult kidney transplant programmes increased approximately 6% from CY2001 through CY2010. Average recipient risk also increased. Despite increased risk profiles, national survival rates for all organ types continued to increase from 2007 through 2010. SUMMARY: People who receive transplants from programmes cited by CMS for subpar outcomes tend to have much improved prospects for posttransplant survival. Individuals waitlisted in those programmes may face lower odds of receiving a transplant, at least temporarily, due to the tendency of such programmes to reduce volume as they regroup to improve their outcomes. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Annals of Family Medicine | Year: 2012
Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide.
Preventing chronic disease | Year: 2013
The increase in chronic health conditions among Medicare beneficiaries has implications for the Medicare system. The objective of this study was to use the US Department of Health and Human Services Strategic Framework on multiple chronic conditions as a basis to examine the prevalence of multiple chronic conditions among Medicare beneficiaries. We analyzed Centers for Medicare and Medicaid Services administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program in 2010. We included approximately 31 million Medicare beneficiaries and examined 15 chronic conditions. A beneficiary was considered to have a chronic condition if a Medicare claim indicated that the beneficiary received a service or treatment for the condition. We defined the prevalence of multiple chronic conditions as having 2 or more chronic conditions. Overall, 68.4% of Medicare beneficiaries had 2 or more chronic conditions and 36.4% had 4 or more chronic conditions. The prevalence of multiple chronic conditions increased with age and was more prevalent among women than men across all age groups. Non-Hispanic black and Hispanic women had the highest prevalence of 4 or more chronic conditions, whereas Asian or Pacific Islander men and women, in general, had the lowest. The prevalence of multiple chronic conditions among the Medicare fee-for-service population varies across demographic groups. Multiple chronic conditions appear to be more prevalent among women, particularly non-Hispanic black and Hispanic women, and among beneficiaries eligible for both Medicare and Medicaid benefits. Our findings can help public health researchers target prevention and management strategies to improve care and reduce costs for people with multiple chronic conditions.
Health Affairs | Year: 2011
Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and standalone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered. © 2011 Project HOPE-The People-to-People Health Foundation, Inc.
Hartman M.,MediCaid |
Martin A.B.,MediCaid |
Lassman D.,MediCaid |
Catlin A.,National Health Statistics Group
Health Affairs | Year: 2015
In 2013 US health care spending increased 3.6 percent to $2.9 trillion, or 9,255 per person. The share of gross domestic product devoted to health care spending has remained at 17.4 percent since 2009. Health care spending decelerated 0.5 percentage point in 2013, compared to 2012, as a result of slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care also contributed to the low overall increase. © 2014 Project HOPE-The People-to-People Health Foundation, Inc.