ACA Unwinding Efforts Continue

2017 saw repeated efforts to unwind the Affordable Care Act through Congressional action and  "a secret plan"  prepared early in the year that included legislative and regulatory actions aimed at eroding key components of the ACA. 
 
The effort to "scrap" the ACA continues into 2018. Just this week we see:
The Problem with Medicaid Work Requirements

Last week, CMS announced "new policy guidance for states to test community engagement [work requirements] for able-bodied adults."  Their letter  argues that work promotes good health , which is not supported by studies,  and asserts that  the change fits within the program's objectives.  Consumer Health First would assert that Medicaid is a health, and not a work, program. 

Our national partners weigh in :
  • The New York Times, also looks at the Kentucky waivers, and points to research showing that kicking people off Medicaid and delaying care can kill.
  • The Washington Post reminds us that work requirements are just one way states are looking to restrict Medicaid dollars. Other states are looking at fees, premiums, and even "lifetime caps" to limit program funding.
Science, Not Ideology, Should Drive Health Policy

Consumer Health First Board Member, Ellen Weber, Vice President for Health Initiatives at the Legal Action Center, co-authored a Maryland Matters commentary this week, arguing that for many with opioid addiction, medication assisted treatment is essential and most effective. Her commentary was in direct response to another recent commentary by former Del. Matt Mossberg, which is critical of the use of FDA approved medications to achieve sustained recovery.

The authors go on to stress that Maryland must continue to focus efforts on building an effective and robust treatment infrastructure in the state, and on increasing access to the full continuum of care for substance use disorders, as required by the Mental Health Parity and Addiction Equity Act.

JAMA Study Looks at Maryland's Global Budget System for Hospitals

This week, the Journal of the American Medical Association - Internal Medicine (JAMA) published a report,  "Changes in Health Care Use Associated with the Introduction of Hospital Global Budgets in Maryland."  For the two year period, 2014-2015, the authors found:

"no consistent changes in annual hospital stays (defined as admissions and observation stays), 30-day return hospital stays, emergency department visits, hospital outpatient department utilization, or visits with primary care physicians. Meaning, that after 2 years, Maryland's global budget program was not associated with changes in hospital or primary care use that were clearly attributable to the program."

However, the report also states that "...more time may  be needed to observe impacts of Maryland's reform on utilization." Consumer Health First would agree! Turning the health system "ship" around is no small task, but Maryland has successfully, and in one case exceeded, metrics benchmarks required in its original contract with Centers on Medicare and Medicaid Services (CMS), signed in January 2014.

That contract also required a second phase to address the total cost of care across the whole system. In December 2016, Maryland submitted two Models for CMS' consideration. One would serve as a progression plan for the All-Payer Model itself and the second would create a new Primary Care Model. Taken together, and if successfully implemented, these would address some of the issues cited in the report. Now, more than a year after those proposals were submitted, the State has agreed to a one-year extension as it awaits their approval by the Department of Health and Human Services.  In our opinion, the sooner that happens the better. 

We would like to note that CHF has been an active participant in both the design and implementation of these models. In that role, we have endeavored to ensure that the needs and interests of consumers are at the very center of this transformation of our health delivery system.  Of course, as consumer advocates, we believe that more can, and should be done, to further engage consumers and to determine what the impact is on individuals. However, we are confident that a steady hand is at the wheel of our ship and we applaud the Health Services Cost Review Commission and others who have led this important work.
Coming Up...
  • Monday, Jan. 22 - Maryland Medicaid Advisory Committee, 2:00 - 4:00 PM. Miller Senate Office Building, Education, Health and Environmental Affairs, 11 Bladen St., 4th floor, Annapolis.

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