Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

Generic drugs have operated under a different set of rules than brand-name drugs since 1984, when Congress passed the Drug Price Competition and Patent Term Restoration Act of 1984, or Hatch-Waxman Act. Brand-name drug manufacturers must submit extensive evidence from clinical trials to get approval from the Food and...
Communication with patients is at the heart of new primary care tools and models that improve outcomes and lower costs, such as patient-centered medical homes (PCMH) and interactive preventive health records (IPHR). Often, communication means electronic communication, and is part of efforts by Medicare, Medicaid, and private health plans to...
Here is a summary of the Medicare, Medicaid, and other health care related provisions of H.R. 8, the American Taxpayer Relief Act of 2012, as passed by House and Senate as part of the fiscal cliff negotiations.  President Obama is expected to sign the law shortly. The Congressional Budget Office (CBO)...
State Medicaid programs must increase primary care physician payment rates in 2013 and 2014 to at least 100 percent of Medicare rates.  The Medicaid-Medicare payment parity mandate is part of the Affordable Care Act (ACA). For the difference between prior rates and the necessary rate increase, states will receive a 100...
Essential health benefits (EHB) will play a fundamental role in shaping health plans after 2014. Part of the Affordable Care Act (ACA), EHBs define a baseline of 10 types of services those plans must cover, including prescription drugs, hospital services, preventive or wellness services, and chronic disease management. Qualified...
When Congress enacted the Medicare Modernization Act of 2003 (MMA), it set a spending target of about $400 billion over 10 years for the Medicare Part D drug benefit, after accounting for revenues from premiums and other sources. Seven years into the program’s life, Medicare Part D spending is...
Businesses have a big incentive to keep their employees healthy and to curb their health costs and spending. Premiums for employer-sponsored insurance for families almost doubled in the past decade, with the employer’s share of premiums increasing from $5,866 in 2002 to $11,429 in 2012. Data from the Health...
Health care quality and patient safety have become increasingly important in recent years, particularly as part of efforts to prevent wasteful spending, hospital readmissions, and medical errors. Accountable Care Organizations (ACO), health information technology (HIT), electronic health records (EHR), and new health plan reporting requirements are among the many...
Thanks to the Supreme Court’s ruling in NFIB v. Sebelius, states have a choice about whether to expand Medicaid eligibility as part of the Affordable Care Act (ACA). State Medicaid directors currently oversee a patchwork of eligibility standards, which for the most part cover low-income families and disabled people....
Fraud and abuse are common and persistent problems for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  Combined federal and state spending now exceeds $1 trillion, with fraud and abuse likely costing taxpayers well over $100 billion annually. Together with state Medicaid agencies and state attorneys general, several federal offices, such...

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