Sunday Short Cuts

This analysis from Wall St. Cheat Sheet is pretty close to my own expectations from June 25th (right after the KvB decision was announced):

Since the Supreme Court has ensured the viability the federally-facilitated exchanges, they could be the best option for other states with problematic marketplaces. “There is no new money now to build new infrastructure, and there are no grants available to fix these systems if they’re struggling,” said Heather Howard, the director of the Princeton University program that advises states on exchange building, told the Times. “So the only path forward may be to use”

If states cede their roles to the federal government, the insurance market will begin to look different. It is a step toward centralism. Howard believes that the likely system many states will adopt the model pioneered by New Mexico, where responsibilities are split. The state picks the health care plans that will be sold on its marketplace and collect fees from insurers, while the federal government will supply the infrastructure that determines eligibility and signs up customers.

For a Southern state where President Barack Obama is deeply unpopular and Republicans dominate federal elections, Kentucky stands out for having created a well-regarded health exchange and having expanded Medicaid coverage under the Affordable Care Act. That dynamic will be put to the test in November’s gubernatorial election.

Jack Conway, the 45-year-old state attorney general, says he would continue the policies of Gov. Steve Beshear, his fellow Democrat, who has embraced the health law and made its implementation a centerpiece of his administration. Republican Matt Bevin vows to dismantle the exchange and roll back the Medicaid expansion, saying the state can’t afford them.

There's one paragraph in the middle of the article which has a contender for euphemism of the century:

“Kentuckians have a more complicated relationship with the Affordable Care Act than voters in most other states,” said D. Stephen Voss, a political-science professor at the University of Kentucky. A Marist poll in September found that while 62% of registered voters in the state had an unfavorable view of the health law, only 18% had an unfavorable impression of Kynect.

TRANSLATION: 44% of registered Kentucky voters love the Affordable Care Act, but can't stand that it was brought to them by Barack Hussein Obama. I'll let you draw your own conclusions about what that suggests.

The Daily Briefing's Dan Diamond spoke with Rob Lazerow, the Advisory Board's expert on payment reform, to understand CMS's proposal to mandate bundled payments for hip and knee replacements in 75 geographic areas.


Q: Medicare officials have announced a slew of payment reforms in recent weeks—proposals for value-based home health care, a new physician fee schedule, the Million Hearts initiative, and so on.

Rob Lazerow: That's fair—there have been a lot of Medicare proposals lately.

Q: Now, they're debuting the 'Comprehensive Care for Joint Replacement Model.' What makes this proposal especially important?Or to put it more bluntly, why should providers care?

Lazerow: Here's why: CMS is showing it's committed to integrated care delivery.

It's the first time that Medicare is proposing to make bundled payments mandatory for hospitals, doctors, and other providers in at least 75 locations, which include areas like Miami and New York City.

There have been a number of bundled payment programs in the past, and they've all been voluntary. Thousands of providers are voluntarily participating in the Bundled Payments for Care Improvement Initiative, after interest surged last summer.

This new model is very different. There's not that element of choice.

Since the King v. Burwell decision was announced, I've stated on at least three different occasions that I strongly suspect that in addition to Oregon, Nevada and Hawaii, at least 2 more state-based exchanges have a very high likelihood of making the move back to the "mothership", Healthcare.Gov, due to technical problems: Vermont and Minnesota. Here's an example of why Minnesota is sharing the top spot on the list:

The state is continuing to struggle with public health insurance renewals through the MNsure system, and officials say the problem has now grown into a backlog that includes 180,000 cases.

When renewal issues were first disclosed in May, state officials said that about 55,000 renewal cases in the Medicaid and MinnesotaCare programs were held up due to technical problems.

The backlog has contributed to problems with collecting MinnesotaCare premiums, and making sure coverage is provided only to those who qualify for the health insurance programs. State human services officials said this week that nobody has lost coverage due to delays with renewals, and announced a new plan to fix the problem.