FOCUS OF THE WEEK
Texas Lawmakers Don’t Like ACA, But It Helps Pay Medicaid Tab
A provision of the ACA that calls for the federal government to cover a higher share of Texas' administrative costs will help cover $102 million of a $338 million shortfall in Medicaid costs.
Senate Punts on SGR Reform After House Passes Value-Based Incentives
The overhaul would fix the Medicare reimbursement system and align payment with CMS' current efforts to reward value-based care. For the first time, the wealthiest seniors would be asked to pay higher premiums.
Study Links Fitness Level With Lower Cancer Risk in Men
Links between cardiorespiratory fitness and cardiovascular events are well-established. More recently, researchers are turning their attention to the connections between fitness and certain cancers.
Florida Takes Another Look at Medicaid Expansion, With CMS’ Help
A deadline for the loss of federal aid for hospitals that serve the uninsured has reignited talk of expansion, and a key CMS leader said this week that the agency is willing to be "flexible."
Analysis: Half of Households With ACA Subsidy to Owe Repayment, 45% to Get Refund
The most common reasons for repayments or refunds are changes in income or family size. The law allows consumers to report these changes to the Marketplace throughout the year, but with the law being so new, most 2014 reconciliations will happen during tax filing.
Iowa Medicaid Managed Care Proposal Hits Opposition
Senators passed a bill to turn the transition over to a commission, while the state's largest newspaper called the plan a giveaway for private firms.
As ACA Nears 5-Year Mark, Opinion Still Divided But Less So
Opinion on the Affordable Care Act still breaks sharply along partisan lines, making the prospects for even technical fixes unlikely, much less a major change that might be needed in the wake of a ruling in King v. Burwell that would take away premium subsidies in states without their own exchanges.
Viewpoint Addresses Managed Care Challenge for Surgeons: Avoiding Out-of-Network Bills for Consults
Patients need transparency if another surgeon will be consulting on their procedure so there are no surprises. The authors suggest payers should extend emergency provisions to intraoperative consultations when complications arise. The movement toward bundled payments will reduce the chance for out-of-network bills, as hospitals will divide payment.
Florida Bills Would Increase Funds, Managed Care in Mental Health Delivery
Mental health advocates say Florida ranks near the bottom of states for spending on mental health. Bills introduced last week would draw down more federal Medicaid dollars to increase payments to providers, expand services, and prevent those at risk from ending up in prison. The system also has limited experience with managed care.
With New Cholesterol Drugs, Should Managed Care Brace Itself for the Next Sovaldi?
Powerful cholesterol-fighting drugs, PCSK9 inhibitors, could break new ground for payers: a higher-priced therapy could replace generic statins for patients suffering a chronic condition, perhaps for an unspecified period of time.