While the Ohio governor is getting more attention for his efforts to keep federal funds for Medicaid expansion, he's quietly working just as hard on maintaining the momentum toward value-based care.
As he campaigned for president, Ohio Governor John Kasich said he expanded Medicaid based on a belief that he, and society, would be judged by the treatment of the poor.
These days, he’s making a different pitch—a pragmatic one to save pieces of the Affordable Care Act (ACA) that he says have worked for his state, and brought coverage to 12 million people nationwide.
The people Kasich worries about gained coverage under Medicaid expansion, which calls for the federal government to pay 90% of the cost of extending coverage to those up to 138% of the federal poverty line (FPL). This group could be left scrambling if those matching funds end abruptly. There are fears that the individual market will not be able to absorb them, and some doubt they could pay for coverage.
Kasich, a Republican who once chaired the House Budget Committee, is urging his party to keep at least some parts of the Medicaid expansion provisions, which have made it easier for the poor to pay their bills and helped many discover they had an untreated chronic condition. He’s working with Wisconsin Governor Scott Walker, Tennessee Governor Bill Haslam, and others to keep the ACA-level funding for Medicaid expansion at least at 100% of FPL, in part to make sure the state can treat all who need help amid the nation’s opioid crisis.
While this part of his crusade has received more attention in the past week, a letter sent in January to House Majority Leader Kevin McCarthy spells out Kasich's other priority—maintaining the momentum toward value-based care. As the Congress debates a replacement for the ACA, he wrote, “we need to move on to address the underlying costs that led to the current crisis, and confront the reality that too much of what we buy is of questionable value.”
Kasich’s letter highlights the bipartisan nature of support for payment reform and the shift toward value-based care, which calls for squeezing unnecessary high-cost services out of the system and expanding access to well-coordinated primary care.
The best evidence of the commitment to value-based care is the bipartisan support for the Medicare Access and CHIP Reauthorization Act, known as MACRA, which scrapped the old Sustainable Growth Rate formula and put doctors and hospitals on a course toward being paid based on quality. Kasich’s letter said the same principles must apply in Medicaid; he touted a shift to managed care that he said has reduced the growth rate and requires fewer state workers, even while adding 700,000 people to the rolls.
His letter also calls for the following:
Any transition, he wrote, must take current Medicaid enrollees’ needs into account, and “make transitions as orderly as possible.” A replacement must be shown to be “better than what individuals have now.”
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
Real-World Study Reveals Key Insights Into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Collecting SDOH Data Can Assess Risk of Medical Nonadherence, Improve HEI and Star Ratings
April 18th 2024At the Academy of Managed Care Pharmacy (AMCP) 2024 annual meeting, a panel of presenters explored changes coming to Medicare that incorporate social determinants of health (SDOH) data to improve patient and health system outcomes.
Read More
Gene and Cell Therapies Hold Potential—but How Can Payers Manage Their Costs?
April 18th 2024Presenters at the Academy of Managed Care Pharmacy (AMCP) 2024 annual meeting discussed the current promise and future potential of gene and cell therapies, as well as payer management strategies for these costly treatments.
Read More