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Thought Leadership

Our wide array of published insights drive the debate in Washington.

Proposed Stark Law, Anti-Kickback Reforms Aim To Facilitate Value-Based Care

On Wednesday, October 9, the Department of Health and Human Services (HHS) announced highly anticipated proposed reforms to current regulations implementing the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute (AKS). Also addressed were related civil monetary penalties (CMPs) for inducements to beneficiaries to utilize services. HHS identified the regulations as they stand now as potential impediments to value-based purchasing arrangements for providers and suppliers participating in federal health care programs, as well as in the commercial sector....
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White House Requires Immigrants to Purchase Health Insurance

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On Friday, October 4, 2019, President Trump issued a proclamation to suspend entry of immigrants into the United States if they cannot prove that they will obtain unsubsidized health insurance coverage within 30 days of entering, or that they have the financial means to pay for any foreseeable health care costs (fact sheet). The proclamation is not yet in effect, and we anticipate legal challenges....
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A Single Public Plan Option Versus A Multiplan Approach: A Colorado Case Study

Colorado and Washington State are in the process of implementing public option programs. Other states continue to explore similar actions as well as a variety of Medicaid buy-in proposals. A core consideration states implementing these programs face is whether to allow multiple public option plans (potentially offered by multiple carriers) to any given consumer or just a single public option plan. In both forerunner states and presumably those to follow, policy makers are charged with striking a delicate balance between maximizing affordability and maintaining market stability, including in their exchanges, where such plans are likely to be offered. ...
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Medicare for All: What it Means, and Where it’s Headed

Medicare for All is the titular banner carrying the promise of comprehensive healthcare coverage for every U.S. resident and, along with it, reduced costs, improved quality, and patient-focused care. While phrases like “universal coverage” and “single-payer” have traditionally been reserved to the fringe of American politics, the idea of a single, government-run insurance plan is now taking center stage. But what does it really entail? And can we reasonably expect its fruition? We seek to provide some clarity on both questions. ...
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The Final Public Charge Rule Is Out. Here’s How It Affects Immigrants.

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The US Department of Homeland Security (DHS) has finalized significant new restrictions to reduce immigration by creating a preference for wealthy, English-speaking, insured, and educated immigrants and putting up new hurdles for impoverished immigrants and their families....
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Accelerating Primary Care Redesign: CMS’ Innovation Center Announces Five New Transformative Models

On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) announced the Primary Cares Initiative (PCI), a suite of five voluntary payment models aimed at overhauling primary care. Marking the Trump Administration’s latest investment in Medicare value-based reform, PCI focuses on the role of primary care providers as the central coordinators of patient health, with the goal of enhancing patient care while lowering overall Medicare fee-for-service (FFS) costs. Once implemented, CMS estimates that more than a quarter of all Medicare FFS beneficiaries – nearly 11 million individuals – will be included in these transformative primary care delivery models....
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A Tell-All on Telehealth: Where Is Congress Heading Next?

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The Centers for Medicare and Medicaid Services (CMS) recently enacted modest but important expansions in Medicare’s telehealth policy. Telehealth, which uses telecommunications to support virtual health care delivery to improve access to and quality of health care, is moving from promise to reality. The benefits are appealing: Patients can interact with their providers remotely, which improves access to care and can help providers manage chronic conditions from afar....
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Medicare Direct, A Blueprint For Public Option Waivers, Part 1: Introduction, Administration, And Financing

There is a reason that Medicare for All has captured the enthusiastic support of a large majority of the public: The status quo for our health care system is unsustainable economically and unforgiveable morally. An honest assessment of the probability of Congress enacting Medicare for All–related legislation, however, demonstrates it is highly unlikely in the foreseeable future. ...
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Medicare Direct, A Blueprint For Public Option Waivers, Part 2: Benefit Design, Provider Networks, And Reimbursement

In all of the discussion and debate regarding Medicare for All and public option proposals, three essential considerations often get short shrift: the benefits enrollees will receive, the network of providers they will have access to; and the rates providers will be paid for delivering these services. These elements, however, really are the guts of any meaningful initiative of this scope. ...
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Medicare Direct, A Blueprint For Public Option Waivers, Part 3: Waiver Design, Legal Authority, And Conclusion

Perhaps the greatest weakness of the Medicare for All, Medicare for More, and public option proposals issued thus far is the fact that they require Congress to pass new legislation. That is certainly true for Medicare for All, it’s true for a Medicare buy-in, and it’s likely true for federally run public options. The biggest strength of Medicare Direct, by contrast, is that it requires no such action. ...
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These Four Federal Proposals Would Have Major Health Implications for Immigrants

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The Trump administration is seeking to modify federal regulations with harmful changes that could dramatically affect immigrants’ access to health care and other public benefits and weaken the health and social safety net. These policies affect access to health coverage, food assistance, housing, protections against discrimination, and more. These proposed changes could have major consequences for the health and well-being of immigrants across the country and especially in California, which has more immigrants than any other state....
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The Drug Pricing Debate Part II: The Many Acts of Congress

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As we outlined earlier this spring, congressional action on drug pricing continues to intensify. Key committees have advanced an array of reforms, demonstrating Congress’ intent to finalize legislation this year. We aim to clarify what that might include....
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