Wynne Health In Print

What the 2018 Midterm Elections Means for Health Care

The fundamental shift in the balance of power in Washington will have substantial implications for health care policymaking over the next two years. In this post, I’ll take a look at which health care issues will come to the fore of the Federal agenda due to the outcome Tuesday, as well as state expansion decisions. And it should of course be noted that, in addition to positive changes Democrats are likely to pursue over the next two years, House control will allow them to block legislation they oppose, notably further GOP efforts to repeal the Affordable Care Act (ACA)....
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The 660-Page Opioids Bill Is Now the Law. Here’s What’s in It.

Opioids killed an estimated 49,000 Americans in 2017, including nearly 2,200 Californians. They harmed many more, including children forced into the foster care system, babies born with neonatal abstinence syndrome, young adults who overdosed from dangerous new street drugs like fentanyl, and countless others who became addicted to opioids while trying to manage chronic pain. In early October, Congress overwhelmingly passed bipartisan opioid legislation, including more than $3.3 billion in authorized spending over 10 years. The Senate approved the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act (HR 6), by a vote of 98-1, while the House approved it 396-14. President Trump signed the 660-page bill into law on October 24, 2018. The legislation is an amalgamation of more than 70 bills introduced by Republicans and Democrats. The package aims to ease the epidemic by increasing access to effective treatment within Medicaid and Medicare, expanding alternative non-opioid pain management options, reducing over-prescribing, educating patients, identifying best practices that can effectively address the epidemic in the future, and more. Here are some of the key components....
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Immigrants and the New Proposed “Public Charge” Rule

On September 22, the Department of Homeland Security (DHS) released the text of highly anticipated proposed changes to “public charge” rules that could disqualify many immigrants from gaining permanent residency in the US. Public charge is the determination that evaluates whether someone is likely to become reliant on public benefits, and consequently whether he or she may enter the country or modify his or her immigration status to become a permanent resident (a “green card” holder). Historically, the determination has only considered cash benefits like Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), local General Assistance (GA) payments, and long-term care benefits. Use of benefits previously has only been examined if they were used by the immigrant themselves — not by a member of their family. The proposed rule would expand the benefits under consideration to include core safety-net programs, including health, nutrition, and housing benefits. It would change the meaning of the term public charge, redefine and expand the types of benefits considered in public charge determinations, and outline new processes for conducting what’s called the “totality of circumstances” test, the test used to examine a range of factors to determine whether an immigrant is likely to become a public charge. Last year, the government announced that it would propose changes by July 2018, but none were officially published in that timeframe. However, in the spring of 2018, the press acquired two draft versions of the proposal, enabling the policy and advocacy communities to delve into the details before the rule’s formal release. The September 22 draft was the first time the text of the proposed changes was officially released. The proposed rule is to be formally published in the Federal Register “in the coming weeks,” after which the public will have 60 days to comment. DHS will consider those comments before releasing the final rule. A companion rule regarding public charge deportability may also be pending at the Department of Justice. It is unclear when the final rule would take effect. The proposed rule solicits comments about the implementation schedule. This post provides an overview of the most important, and likely contentious, components of the proposed rule. ...
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Creating Medicare Advantage Premium Support For All, Part 5: Which Proposal Is Actually Medicare?

With the burgeoning debate around single payer, primarily oriented around "Medicare for All," CEO Billy Wynne takes a look under the hood of Sen. Bernie Sanders' "M4All" proposal and discovers it is not actually based on Medicare. He also continues his inquiry into what bona fide Medicare for All would actually look like, in this case by explaining the basics of the Medicare Advantage program, which covers 33% of Medicare enrollees this year....
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What Might Happen in Federal Health Policy Before the Midterm Elections

An in-depth guide to the key health policy issues that will dominate DC through the midterm elections....
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Here’s What the House Passed to Tackle the Opioid Crisis

A breakdown of all of the key provisions in the House-passed opioid package. From the intro: "After months of debate, the US House of Representatives passed a package of bills on June 22 addressing the opioid epidemic by a vote of 396 to 14. H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT), incorporates dozens of House bills. "Debate on a Senate package of opioid bills is in progress and the chamber is expected to take final action later this year. Both houses have much to do before a final package is adopted and sent to the President’s desk. "The House Energy and Commerce Committee published a helpful overview of the House legislation. Let’s consider the underlying provisions in seven areas: (1) medication and treatment, (2) Medicaid and the Children’s Health Insurance Program (CHIP), (3) Medicare, (4) public health, (5) community and provider education, (6) research and funding, and (7) information sharing and data tracking. Here are highlights: ..."...
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Medicare’s Hospital Outpatient Prospective Payment System Proposed Rule: Big Changes For 2019

CEO Billy Wynne's breakdown of the key policy changes described in the CY19 Medicare Hospital Outpatient Prospective Payment System proposed rule....
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Creating Medicare Advantage Premium Support For All, Part 4: Financing

In this fourth installment of his Medicare Advantage Premium Support for All series, CEO Billy Wynne demonstrate that this universal coverage approach can be fully funded with current spending (i.e., no new taxes would be necessary). ...
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With Great Power Comes Great Responsibility: Medicare Advantage’s Newfound Supplemental Benefit Flexibility

The Centers for Medicare and Medicaid Services (CMS) recently made a series of interrelated policy changes to give Medicare Advantage (MA) plans more flexibility than ever to offer additional services outside of traditional Medicare. Known as supplemental benefits, these services have historically included items like dental, vision, and hearing. By allowing plans to offer an even wider and more tailored array of services, CMS expects that plans will be better positioned to attract members and meet beneficiary needs. In its announcement of rates and policies for 2019, CMS notified plans that it would expand the scope of permitted services to include things like nonskilled in-home workers, portable wheelchair ramps, and other assistive devices. CMS also issued rules that give plans the ability to target supplemental benefits at certain subsets of enrolled populations. Previously, plans were required to offer such benefits uniformly to all plan participants. Under this new category of benefits a plan could, for example, decide to offer enrollees with diabetes more frequent foot exams with lower cost-sharing. Moreover, beginning in 2020, CMS will create a third category of “chronic” supplemental benefits, allowing plans to focus services like nonemergency transportation toward individual chronically ill beneficiaries. This new category is the result of CHRONIC Act provisions enacted as part of the Bipartisan Budget Act of 2018. In sum, over the next two years, CMS will widen the scope of generally available supplemental benefits, permit benefits targeted at certain enrollee populations, and allow plans to offer a broader range of services to individual chronically ill members under certain circumstances....
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“Public Charge” Rule Would Disrupt Safety-Net Access for Some Immigrants

The Trump administration has signaled its plans to significantly alter the rule on eligibility of applicants for permanent residency and applicants intending to immigrate to the US by redefining “public charge” determinations related to the use of public benefits. This would make it harder to enter the country and reduce access to a broad range of health and human service safety-net programs for immigrants already living here, including US citizen children. The Department of Homeland Security (DHS) is developing a proposed regulation to change the requirements for ensuring that foreign nationals coming to the US do not become dependent on public assistance. In drafts of the proposed regulation that were leaked to the media this year, DHS would require a more expansive list of public benefits to be considered when immigration officials determine whether an applicant is likely to become dependent on public benefits, and thus whether they are allowed to enter the country or to change their immigration status. This proposal is currently under review at the Office of Management and Budget (OMB). After the proposal’s expected publication in July, the public will have an opportunity to comment on the proposal, and DHS must consider those comments before finalizing the regulation. It’s possible that the proposed regulation may never be published, it could be changed in response to public comments, litigation could block the final regulation from implementation, or Congress could amend the immigration law and create a new interpretation and regulations. For now, however, this is where DHS is heading. To advance the intended changes that the Department of Homeland Security is seeking, the draft regulation would alter two key definitions — “public charge” and “public benefit” — and would add a weighted system to guide how benefits are considered. Financial wealth would be weighted as positive, while use of most services, including health and human service benefits, would be weighted as negative....
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The Consumerization Of Health Care To Improve Value: Secretary Alex Azar’s “Radical” Vision

HHS Secretary Alex Azar recently laid out a four-part strategy to achieve a "radical" vision of reforming health care: giving consumers greater control over health information, encouraging price transparency, using experimental models in Medicare and Medicaid to drive value, and removing government burdens. While certain elements of the secretary’s strategy reflect important reforms, his recommendations raise questions about the desirability of a shift toward consumerization of health care and whether these changes are actually in the best interest of consumers....
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Creating Medicare Advantage Premium Support For All, Part 3: Provider Considerations

"In the first post of this series, I hypothesized that a Medicare-for-all approach that puts market-based principles at its core will have the most success not only in winning sturdy, bipartisan support but in actualizing high-quality universal coverage at lower cost. In Part 2, I explored modest benefit enhancements that would be needed to maintain the quality of coverage various populations have under existing programs, some of which were reiterated in the CAP proposal. "In this post, I will examine what a Medicare Advantage (MA)-based universal coverage regime would mean for providers, who will continue to be the heart of our system and whose decisions affect the cost and quality of our care more than anyone else’s."...
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