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Medicare, Medicaid, Health Reform

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Monthly Archives: April 2013

Health Care Costs: Slowdown in Growth is Because of Economy, Not Obamacare

Growth in health care spending has slowed recently.  Why?  Supporters of the Affordable Care Act (ACA) - aka Obamacare - says its due to the controversial law, although most of the ACA's provisions are yet to take effect.  However, new evidence shows that the economy is the cause of the lower rate of medical cost inflation.  Evidence also predicts...

Medicare and Medicaid Spending on Dual Eligible Populations: Analysis of Health Costs

Much of the story about rising health costs and spending has to do with relatively small groups of people with expensive health needs. For example, the Centers for Medicare and Medicaid Services (CMS) estimates Medicare beneficiaries with two or more chronic conditions accounted for 93 percent of Medicare spending in 2011, about $276 billion. Many beneficiaries with chronic conditions...

Medicare Physician Sustainable Growth Rate: Repealing SGR

For over a decade, the sustainable growth rate (SGR) has been a source of financial worry for physicians who serve Medicare patients. Medicare’s physician payment rate is based on a composite measure of the cost of care, multiplied by a factor derived from the SGR formula. Every year since 2002, the SGR has called for decreases in Medicare physician...

Medicare Payment Reform: Post-Acute Provider Reimbursement

The term “post-acute care” (PAC) covers a range of services patients receive after a hospital stay. Skilled nursing facilities, home health care agencies, long-term care hospitals, and inpatient rehabilitation hospitals all provide post-acute care. PAC providers are an important part of efforts to reduce hospital readmissions, which are a high-cost target for Medicare, Medicaid, and private health plans. Post-acute care...

Medicaid Expansion Through Health Insurance Marketplaces: Unresolved Questions

The Centers for Medicare and Medicaid Services (CMS) has answered some questions about how Arkansas’s creative plan to expand Medicaid under the Affordable Care Act (ACA). The plan, which Gov. Mike Beebe put forward, would use federal Medicaid expansion money to give premium subsidies for Medicaid beneficiaries to enroll in Qualified Health Plans (QHP) on the Health Insurance Exchanges...

Dual Eligibles and Medicare Cost Sharing: State Medicaid Payment of Medicare Premiums, Deductibles, and Co-Payments

State Medicaid programs will spend about $175 billion this year on health care for dual eligibles - low-income seniors and persons with disabilities who receive benefits from both Medicare and Medicaid.  State spending on dual eligibles falls primarily in three areas:  long term services and supports (nursing home, home health, personal care, and home and community-based services), behavioral health,...

Congress and Social Media: Use of Twitter and Facebook by Senators and Congressmen

The rise of social media has undeniably changed the way we communicate, conduct business, and go about our daily lives.  Social media services such as Twitter, Facebook, blogs, and YouTube offer rapid, easy, and efficient ways to communicate with large numbers of people.  Recognizing this, Congressmen and Senators (or tech-savvy staff members on their behalf) are using social media...

Employer Mandate and Penalties Under the Affordable Care Act: Understanding the New $130 Billion Tax

Under the new employer mandate imposed by the Affordable Care Act (ACA), employers will pay about $130 billion in penalties over the next 10 years.  The ACA employer mandate is highly complex and employers have many factors to consider. The employer mandate – called “shared responsibility” in federal law and IRS rules – imposes penalties on employers if at least...

Impact of ACA on Employer-Sponsored Insurance: Costs, Taxes, and Enrollment Effects

Employer-sponsored insurance (ESI) has been central to the U.S. health care system. The Affordable Care Act (ACA) adds many requirements and imposes many costs on employers that could change how - and if - they offer employee health care coverage.  But estimating the effect of changes to ESI is complicated. This post takes a look at estimates of the ACA’s...

Chronic Care Management: CMS Multiple Chronic Conditions Dashboard

Many new care models in both the public and private sector focus on people with chronic diseases, particularly conditions like diabetes, congestive heart failure, and hypertension. The Veterans Health Administration (VHA) Care Coordination/Home Telehealth (CCHT) pilot program serves veterans at risk of needing long term care for chronic conditions. Physician payment reform models for primary care, such as patient-centered medical...

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