MHA Today | August 19, 2016

August 19, 2016

MHA Today: News for Healthcare Leaders

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Herb Kuhn, MHA President & CEO Earlier this week, Aetna announced that it would not be offering marketplace health insurance plans in three-quarters of the states it served in 2016. The departure follows the announcement earlier this summer by UnitedHealthcare to exit numerous states’ marketplaces. Currently, both insurers offer plans in Missouri, but will not in 2017.

Some are saying Aetna’s departure is the death rattle of the Affordable Care Act’s individual marketplace. That’s probably histrionics. What is more likely is that Aetna’s actions are symptomatic of fundamental changes that must be made in both the individual marketplace and in the nation’s larger health insurance system.

Both Aetna and UnitedHealthcare have argued that their decision to leave markets are based on significant losses in the individual marketplace. That’s imaginable. The two insurers are not alone in arguing the point — every major participant in the state’s marketplace has requested a rate increase for 2017, with some requests exceeding 30 percent.

For the 2017 Missouri marketplace, the exits signal coming turmoil. Next year, there will be fewer carriers and fewer plan options. Moreover, some of these plans will be narrow networks, which will significantly limit provider choice for consumers.

The Aetna announcement follows recent news that the U.S. Department of Justice is suing to block the proposed mergers of Aetna and Humana, and Anthem and Cigna. The mergers would make matters worse. If the mergers were allowed, and Aetna and UnitedHealthcare remained outside of the Missouri marketplace, only Anthem and Blue Cross and Blue Shield of Kansas City would remain. Since they are both part of the same system, they do not compete in rating areas.

A single insurer in the marketplace would result in the disappearance of competition. The consequence would be a massive transfer of market power — a very bad situation for providers and consumers.

That doesn’t have to happen.

Two insightful columns appeared in USA TODAY on Wednesday. First, the paper’s Editorial Board urged all stakeholders to collaboratively work on solutions to problems with the ACA, rather than capitalize on the politics. Second, Marilyn Tavenner, former Centers for Medicare & Medicaid Services’ Administrator and current President of America’s Health Insurance Plans, suggested action was needed to re-evaluate risk corridors that are driving the rate spikes.

If rate increases and departure from the marketplace are symptoms, there’s a strong possibility that insufficient risk adjustment and unexpected costs are the disease. In fact, it makes sense that a large population of the previously uninsured are likely to have pent-up demand for services and chronic conditions that will take time to manage. The CMS actuary recently identified that a similar cost problem was occurring in Medicaid expansion states.

We can’t know what will happen in November or how that will shape the system. Nonetheless, it’s clear that the marketplace is in peril. Whether there’s a will to recognize and treat the disease, or whether we’ll continue to address symptoms as they arise, is the fundamental question.

Let me know what you think.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Seeks Information About Steering Patients To Higher Payment Health Plans
CMWF Finds ACA Disparities Remain
Louisiana Hospital Employee Assistance Fund Accepting Donations

Regulatory News
the latest actions of agencies monitoring health care

CMS Seeks Information About Steering Patients To Higher Payment Health Plans

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released a request for information regarding concerns about health care providers steering people who are eligible for, or receiving, Medicare and/or Medicaid benefits to an individual market plan for the purpose of obtaining higher payment rates. CMS also sent letters to Medicare dialysis facilities announcing the RFI. CMS stated that it is considering “potential regulatory and operational options to prohibit or limit premium payments and routine waiver of cost sharing for qualified health plans by health care providers, revisions to Medicare and Medicaid provider enrollment rules, the imposition of civil monetary penalties for individuals that fail to provide correct information about consumers enrolling in a plan, and potential charges that would allow issuers to limit their payment to health care providers to Medicare-based amounts for particular services and items of care.” The document is scheduled to be released Tuesday, Aug. 23, and comments will be due by 4 p.m. 30 days after publication in the Federal Register.

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Quality and Population Health

CMWF Finds ACA Disparities Remain

Staff Contact: Leslie Porth

Recent Commonwealth Fund findings reveal that in the three years since the Affordable Care Act’s health insurance marketplaces opened and states began to expand Medicaid eligibility, uninsured rates among Latinos and African Americans have significantly declined. Still, Latinos are more likely than any other racial or ethnic group to lack health coverage.

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Louisiana Hospital Employee Assistance Fund Accepting Donations

Staff Contact: Mary Becker

The Louisiana Hospital Association has established the Louisiana Hospital Employee Assistance Fund to provide support to hospital employees affected by the devastating floods that swept through the area. LHA estimates that more than 5,000 hospital employees suffered significant property loss to their homes. Click here to contribute to this effort.

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Did You Miss An Issue Of MHA Today?

August 18, 2016
Deloitte Issues Health Policy Brief On Evolving Landscape Of Telehealth
Hospira Issues Voluntary Nationwide Recall
CMS Releases New Prescription Drug Cost Data
MLN Connects Provider eNews Available
The Academies Explore Community Approaches To Disaster Risk Reduction

August 17, 2016
MHA Distributes Analysis For Proposed CY 2017 Medicare Outpatient PPS
AHA Issues Compendium Of Appropriate Use Toolkits

August 16, 2016
CMS Solicits Comments On MOON Through Sept. 1
CMS Schedules Education Session On IPPS Quality Reporting
Mercy Hospital Washington Names New President

August 15, 2016
HIDI Releases First Quarter 2016 VBP Payments Model
CDC Issues Proposed Rules On Quarantine Standards
CMS Updates Appendix J And Exhibit 355
TJC Announces Pioneers In Quality Program Education Session
CMS Schedules IRF And LTCH Public Quality Reporting Webinar
CDC Researchers Identify Neonatal Abstinence Syndrome Variation Among States
HRSA Offers COPD Webinar

Consider This ...

Nearly one in every five Medicare dollars is spent on people with Alzheimer’s and other dementias. Unless the current trend changes, in 2050, it will be one in every three dollars.

Source: Alzheimer’s Readiness Project