March 2017
American Health Care Act of 2017 Proposed as Affordable Care Act Replacement
Update: As of March 24th, the AHCA has been officially pulled by Speaker Ryan and President Trump.
Early this month, Speaker Paul Ryan announced the American Health Care Act (AHCA) as a replacement for the current ACA. Though touted as “Obamacare 2.0”, the Congressional Budget Office estimates that 24 million Americans would lose coverage. Additionally, the new legislation would halt enrollment in Medicaid expansion by 2020, and create an per capita cap for recipients. The ACHA would provide tax credits based on age to individuals who purchase insurance and penalize individuals who do not have continuous coverage. Though the AHCA does retain some popular features of the ACA, such as the ability to stay on your parents insurance until age 26 and protections for individuals with pre-existing conditions, this bill is far from being an improved healthcare bill. It is estimated that premiums would double for many Americans, especially older Americans.
Learn more about the bill and CBO analysis here.
Call your legislators today and thank them for opposing the AHCA!
Update: As of March 24th, the AHCA has been officially pulled by Speaker Ryan and President Trump.
Early this month, Speaker Paul Ryan announced the American Health Care Act (AHCA) as a replacement for the current ACA. Though touted as “Obamacare 2.0”, the Congressional Budget Office estimates that 24 million Americans would lose coverage. Additionally, the new legislation would halt enrollment in Medicaid expansion by 2020, and create an per capita cap for recipients. The ACHA would provide tax credits based on age to individuals who purchase insurance and penalize individuals who do not have continuous coverage. Though the AHCA does retain some popular features of the ACA, such as the ability to stay on your parents insurance until age 26 and protections for individuals with pre-existing conditions, this bill is far from being an improved healthcare bill. It is estimated that premiums would double for many Americans, especially older Americans.
Learn more about the bill and CBO analysis here.
Call your legislators today and thank them for opposing the AHCA!
February 2017
Tom Price Confirmed as Secretary of Health and Human Services
On February 10th, the Senate confirmed Representative Tom Price (R-GA) as the new secretary of Health and Human Services along party lines at 52-47. An outspoken opponent of the Affordable Care Act, Price will now oversee the implementation of the ACA, Centers of Medicare and Medicaid Services, the National Institutes of Health, and the Centers for Disease Control and Prevention.
The confirmation of Secretary Price ushers in a new time of uncertainty for public health, and public health insurance policy- as Price has been a vocal supporter of converting Medicare to a voucher based system and has repeatedly mentioned his desire to defund Planned Parenthood.
On February 10th, the Senate confirmed Representative Tom Price (R-GA) as the new secretary of Health and Human Services along party lines at 52-47. An outspoken opponent of the Affordable Care Act, Price will now oversee the implementation of the ACA, Centers of Medicare and Medicaid Services, the National Institutes of Health, and the Centers for Disease Control and Prevention.
The confirmation of Secretary Price ushers in a new time of uncertainty for public health, and public health insurance policy- as Price has been a vocal supporter of converting Medicare to a voucher based system and has repeatedly mentioned his desire to defund Planned Parenthood.
December 2016
President-Elect Trump Nominates Representative Tim Price to Serve as Secretary of Health and Human Services
President-elect Donald Trump has chosen Georgia Representative and vocal Affordable Care Act opponent Tim Price to serve as the Secretary of Health and Human Services.
Rep. Price has proposed alternatives to the ACA every year since its passage in 2009, citing that he feels the current legislation interferes directly interferes with the patient-doctor relationship. Additionally, he has also stated his desire to fundamentally change the way the current Medicare and Medicaid programs operate under the Social Security Act and has proposed privatizing Medicare as an alternative to the current system.
President-elect Donald Trump has chosen Georgia Representative and vocal Affordable Care Act opponent Tim Price to serve as the Secretary of Health and Human Services.
Rep. Price has proposed alternatives to the ACA every year since its passage in 2009, citing that he feels the current legislation interferes directly interferes with the patient-doctor relationship. Additionally, he has also stated his desire to fundamentally change the way the current Medicare and Medicaid programs operate under the Social Security Act and has proposed privatizing Medicare as an alternative to the current system.
November 2016
CMS Releases New Rule for Medicare Quality Payment Program (MACRA)
In May 2016, CMS proposed a new rule creating a Medicare Quality Payment Program (MACRA) to move towards a value based payment system aimed to improve the quality of services paid for by the program.
The payment system was finalized last month and provides physicians and other health care providers to choose between two options to optimize quality and ensure more patient centered care to allow for a smoother transition away from traditional fee for service payment programs already in place.
In May 2016, CMS proposed a new rule creating a Medicare Quality Payment Program (MACRA) to move towards a value based payment system aimed to improve the quality of services paid for by the program.
The payment system was finalized last month and provides physicians and other health care providers to choose between two options to optimize quality and ensure more patient centered care to allow for a smoother transition away from traditional fee for service payment programs already in place.
August 2016
Aetna Leaves Affordable Care Act Marketplace Exchanges
In early August, the third largest health insurer in the United States, Aetna announced that it will be leaving most Marketplace exchanges. It is not the only major insurer reporting losses due to the ACA, as United HealthCare and Humana have also scaled back their Marketplace offerings for similar reasons.
This move comes after the United States Department of Justice moved to block the acquisition of Humana by Aetna, citing that such it and the proposed Anthem-Cigna merger would decrease the insurance options available to the public and create three giant insurance companies in control in the process. This will have no effect on the Marketplaces in states which already did not have Aetna, but will leave those looking towards it in other states lacking an additional option.
In early August, the third largest health insurer in the United States, Aetna announced that it will be leaving most Marketplace exchanges. It is not the only major insurer reporting losses due to the ACA, as United HealthCare and Humana have also scaled back their Marketplace offerings for similar reasons.
This move comes after the United States Department of Justice moved to block the acquisition of Humana by Aetna, citing that such it and the proposed Anthem-Cigna merger would decrease the insurance options available to the public and create three giant insurance companies in control in the process. This will have no effect on the Marketplaces in states which already did not have Aetna, but will leave those looking towards it in other states lacking an additional option.
May 2016
States Achieve Medicaid Expansion (SAME) Act of 2016 Proposes Extending Federal Funding Offer to States Which Have Not Expanded Services
On April 13th, U.S. Senators Mark R. Warner (D-VA) and Debbie Stabenow (D-MI) of the Senate Finance Committee introduced the SAME Act of 2016. This act would give states that chose to expand Medicaid after the 2014 deadline set through Affordable Care Act the same amount of matching funding as the states who expanded before the deadline.
The authors of this legislation believe that increasing the federal match rate for the 19 states who have not expanded Medicaid will act as an incentive, resulting in increased access to care and benefits for those who would be newly eligible.
On April 13th, U.S. Senators Mark R. Warner (D-VA) and Debbie Stabenow (D-MI) of the Senate Finance Committee introduced the SAME Act of 2016. This act would give states that chose to expand Medicaid after the 2014 deadline set through Affordable Care Act the same amount of matching funding as the states who expanded before the deadline.
The authors of this legislation believe that increasing the federal match rate for the 19 states who have not expanded Medicaid will act as an incentive, resulting in increased access to care and benefits for those who would be newly eligible.
Proposed Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCAP) Act of 2016 to Help Curb Out of Pocket Drug Costs
RxCAP would put Medicare in line with other health insurance plans who are protected by the cost sharing caps put in place by the Affordable Care Act. This cap means that seniors enrolled in Medicare would not be responsible to pay more than $7,500 a year on medications. It is estimated that more than 2.5 million beneficiaries have paid for drug therapies and treatments above this amount last year alone.
If RxCAP passes and becomes a law, it could increase access to important quality-of-life enhancing drugs for seniors, a historically low-income population.
RxCAP would put Medicare in line with other health insurance plans who are protected by the cost sharing caps put in place by the Affordable Care Act. This cap means that seniors enrolled in Medicare would not be responsible to pay more than $7,500 a year on medications. It is estimated that more than 2.5 million beneficiaries have paid for drug therapies and treatments above this amount last year alone.
If RxCAP passes and becomes a law, it could increase access to important quality-of-life enhancing drugs for seniors, a historically low-income population.
April 2016
Centers for Medicaid and Medicare Services Issues Notice of Benefit Payment Parameters for the 2017 Healthcare Marketplace
The Centers for Medicaid and Medicare Services (CMS) has released a rule detailing minimum requirements for health insurance plans sold in the marketplace and dates for open enrollment periods from 2017 onward. This rule encourages insurers to offer standardized plans covering more health services before a plan's deductible is met. This would make general health services more affordable and easier to obtain within the marketplace. Additionally, CMS has mandated that from 2017 and onward, plans will be labeled as “basic”, “standard”, or “broad” so that consumers are better aware of the full range of services that will be available to them.
The Centers for Medicaid and Medicare Services (CMS) has released a rule detailing minimum requirements for health insurance plans sold in the marketplace and dates for open enrollment periods from 2017 onward. This rule encourages insurers to offer standardized plans covering more health services before a plan's deductible is met. This would make general health services more affordable and easier to obtain within the marketplace. Additionally, CMS has mandated that from 2017 and onward, plans will be labeled as “basic”, “standard”, or “broad” so that consumers are better aware of the full range of services that will be available to them.
January 2016
Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015
The House of Representatives recently revised and passed a budget reconciliation bill on January 6th, 2016. The H.R. 3762: Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 could repeal major provisions in the Affordable Care Act.
This bill would:
The House of Representatives recently revised and passed a budget reconciliation bill on January 6th, 2016. The H.R. 3762: Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 could repeal major provisions in the Affordable Care Act.
This bill would:
- Restrict the federal government from operating health care exchanges
- Eliminate the Prevention and Public Health Fund
- Phase out funding for subsidies to help lower and middle-income individuals afford insurance through the health care exchanges
- Eliminate tax penalties for individuals who do not purchase health insurance and employers with 50 or more employees who do not provide insurance plans
- Eliminate taxes on medical devices and the so-called “Cadillac tax” on the most expensive health care plans
- Phase out an expansion of Medicaid over a two-year period
- End federal funding to Planned Parenthood for one year by prohibiting Medicaid reimbursements for Planned Parenthood services. Instead, the bill would increase funding for a community health program.
November 2015
The Women’s Public Health and Safety Act will amend Medicaid to modify the requirements for a state plan for medical assistance. Currently, any individual that requires medical assistance may receive services from any entity, institution, agency or person qualified to do so. Under this new bill, states will be able to choose whether or not to deny services provided by certain entities to eligible individuals based on the individual’s or entity’s involvement with abortions.
By limiting services from any health care providers who offers abortions, this act would limit a range of other family planning and women’s health resources to Medicaid receiving individuals.
Introduced: 9/11/15 Passed by House: 9/29/15
By limiting services from any health care providers who offers abortions, this act would limit a range of other family planning and women’s health resources to Medicaid receiving individuals.
Introduced: 9/11/15 Passed by House: 9/29/15
October 2015
Medicaid Expansion 2015
In states that have expansion packages, Medicaid coverage will be available for adults based on income alone compared to non-expansion states in which income, household size, disability, family status, and other factors affect eligibility. Expansion of Medicaid now allows people with annual incomes below 138% of the federal poverty level health care coverage regardless of other factors. This population typically consists of low-income able-bodied parents, low-income adults without children, and many low-income individuals with chronic mental illnesses and/or disabilities who struggle to maintain well-paid jobs but did not meet previous disability standards for Medicaid.
According to the Medicaid Enrollment & Spending Growth report released by the Kaiser Commission on Medicaid and the Uninsured, enrollment increased across all 50 states and the District of Columbia by an average 13.8% in the 2015 fiscal year. The 31 states that opted to expand Medicaid under the Affordable Care Act saw an average 18% increase in enrollment and in spending within 2015, the first full year of the expansion. Some financial analysts have equated the Medicaid enrollment spikes to those normally seen in tough economic times.
Find out more about Medicaid Expansion and what it means for you!
In states that have expansion packages, Medicaid coverage will be available for adults based on income alone compared to non-expansion states in which income, household size, disability, family status, and other factors affect eligibility. Expansion of Medicaid now allows people with annual incomes below 138% of the federal poverty level health care coverage regardless of other factors. This population typically consists of low-income able-bodied parents, low-income adults without children, and many low-income individuals with chronic mental illnesses and/or disabilities who struggle to maintain well-paid jobs but did not meet previous disability standards for Medicaid.
According to the Medicaid Enrollment & Spending Growth report released by the Kaiser Commission on Medicaid and the Uninsured, enrollment increased across all 50 states and the District of Columbia by an average 13.8% in the 2015 fiscal year. The 31 states that opted to expand Medicaid under the Affordable Care Act saw an average 18% increase in enrollment and in spending within 2015, the first full year of the expansion. Some financial analysts have equated the Medicaid enrollment spikes to those normally seen in tough economic times.
Find out more about Medicaid Expansion and what it means for you!
Pennsylvania House of Representatives Proposes Bill to Regulate Unfair Practices of PBMs
Pharmacy Benefit Managers (PBMs) are in charge of processing and paying prescription drug claims and act as liaisons between payers and pharmacies. These PBMs manage pharmacy benefits for nearly 95% of Americans. In Pennsylvania, PBMs do not have to register with any state entity. Because of this lack of accountability, there is no standard for determining the maximum allowable costs (MACs) of products and many PBMs engage in unfair auditing practices. MACs establish the unit price for the products sold to pharmacies. Lack of regulation of MACs means that PBMs can set and alter prices for drugs as they choose, resulting in high costs to pharmacies and in turn, patients.
The Pennsylvania House of Representatives has proposed two bills, HB946 and HB947, that would alleviate these disparities. The first bill would require all PBMs to register with the Department of Health and provide pharmacies with how MACs are determined and established to increase accountability. The second bill would create the Pharmacy Audit Integrity Act, which would regulate auditing practices among pharmacies. PBMs would be required to provide sufficient notice to pharmacies prior to audits, and only audits that follow Federal and Commonwealth of Pennsylvania procedures can be conducted. Increased monitoring and strict enforcement of these laws will ensure that drug costs will be lowered to the public, making it more accessible for people to receive the medication they require for temporary and chronic health conditions.
Pharmacy Benefit Managers (PBMs) are in charge of processing and paying prescription drug claims and act as liaisons between payers and pharmacies. These PBMs manage pharmacy benefits for nearly 95% of Americans. In Pennsylvania, PBMs do not have to register with any state entity. Because of this lack of accountability, there is no standard for determining the maximum allowable costs (MACs) of products and many PBMs engage in unfair auditing practices. MACs establish the unit price for the products sold to pharmacies. Lack of regulation of MACs means that PBMs can set and alter prices for drugs as they choose, resulting in high costs to pharmacies and in turn, patients.
The Pennsylvania House of Representatives has proposed two bills, HB946 and HB947, that would alleviate these disparities. The first bill would require all PBMs to register with the Department of Health and provide pharmacies with how MACs are determined and established to increase accountability. The second bill would create the Pharmacy Audit Integrity Act, which would regulate auditing practices among pharmacies. PBMs would be required to provide sufficient notice to pharmacies prior to audits, and only audits that follow Federal and Commonwealth of Pennsylvania procedures can be conducted. Increased monitoring and strict enforcement of these laws will ensure that drug costs will be lowered to the public, making it more accessible for people to receive the medication they require for temporary and chronic health conditions.