I got a little nostalgic for past campaigns this week when the Affordable Care Act was called “crazy.” Yes, it was from President Bill Clinton acting as a surrogate for his wife, Secretary Hillary Clinton. And, yes, he walked his comments back quickly. However, in a political season where the ACA remains the elephant in the room, the candidates seldom talk about it substantively. They should.
On Tuesday, Nov. 1, just a week before the election, the federal marketplace will begin its open enrollment period for 2017. There’s concern that marketplaces will have fewer carriers participating and a more limited set of options for consumers — at higher cost. That’s bad news for consumers, the law and the health care system.
This month’s Health Affairs includes an article on the ACA’s coverage expansions. It finds that 27 percent of individuals uninsured in 2013, who have accessed coverage through the marketplace, now have a regular source of care and use preventive services. A similar gain was found — 18 percent — for individuals who were uninsured and gained access to coverage through Medicaid.
The coverage gains aren’t what they could be if every state had expanded Medicaid or if the penalties for not purchasing in the marketplace had been higher. Nonetheless, significant progress has been made to reduce the number of uninsured Americans — by more than 20 million.
What makes this year more interesting is that Democratic nominee Hillary Clinton has a long history of working on health care expansions, including in Medicaid. Yet, her legacy includes the inability to gain consensus for a health care overhaul in the 1990s when she led her husband’s effort to expand coverage. Her running mate, Sen. Tim Kaine, hails from Virginia, a state that has been unable to craft a Medicaid expansion plan.
The Republican nominee, Donald Trump, has said that the ACA should be repealed and replaced with a “conservative” plan. His running mate, Indiana Gov. Mike Pence, was a pioneer in crafting a conservative Medicaid expansion plan for his state.
In this topsy-turvy world, the next leader will face the challenge of making the marketplace function and Medicaid expansion more equitable among the states. It’s hard to believe that the next president would be able to fully repeal the ACA with its many popular insurance reforms and significant new coverage. It would expose millions of Americans to a return to the ranks of the uninsured.
Although it’s facing tough times, the underlying philosophy of the marketplace is conservative. It finds its intellectual roots in the pre-ACA Massachusetts’ coverage expansion — sometimes called Romneycare — and in thinking that evolved from GOP options from the mid-1990s.
Perhaps more interestingly are the experiments in Medicaid expansion that have occurred since the U.S. Supreme Court’s decision to allow states to opt in or out. Where these later expansions have occurred, they generally have been built on a conservative platform and the personal responsibility among enrollees.
Clinton and Kaine have indicated that they understand the ACA needs improvement. Trump and Pence — rhetoric aside — may not have a better option than to expand the conservative innovations.
Progress towards a better health system must continue. And, as a community of providers, we must move forward on the path towards delivering better care and value for patients.
I don’t expect we’ll understand the long-term trajectory of the ACA when we wake up on Wednesday, Nov. 9.
President Clinton called the ACA crazy. In some ways, it’s hard to argue.
Let me know what you’re thinking.
P.S. — Information on the issues and candidates in Missouri are available on the Your Vote Matters section of Missouri Health Matters. Learn what the candidates for Missouri governor think about the state’s health care system and find out more about issues on the ballot.
In This Issue
Herb B. Kuhn
MHA President and CEO
Congress Voices Concern About Hospital Outpatient Payment Standards
CMS Announces Sepsis Validation Delay
CMS Announces Sepsis Validation Delay
Staff Contact: Sherry Buschjost
As a result of multiple specification updates related to the severe sepsis and septic shock measure (SEP-1), the Centers for Medicare & Medicaid Services will not score the SEP-1 measure validation for hospital inpatient quality reporting fiscal year 2018. CMS also is postponing the public reporting of the SEP-1 measure on Hospital Compare to allow continued analysis of data.
Beginning with fourth quarter 2015 data, CMS requested medical records for the SEP-1 measure from the hospitals selected for Hospital IQR Program validation. The scores for sepsis measure validation will not be used to calculate the confidence interval for the IQR validation; therefore, the validation of measure data from fourth quarter 2015, first quarter 2016 and second quarter 2016, will not impact the annual payment update of hospitals for FY 2018. Hospitals still are required to submit SEP-1 data. CMS will provide guidance on when the measure will be used for validation in future communications.
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October 6, 2016
MLN Connects Provider eNews Available
August MUR Available On HIDI Analytic Advantage®
October 5, 2016
NIH Releases Youth Suicide Prevention Plan
CMS Clarifies Coding For Advanced Care Planning
CMS Releases Final LTCF Reform Requirements
MHD Releases Behavioral Health Provider Bulletin
CMS Releases EHR Alignment Preparation Checklist For eCQM Reporting
TJC Releases Information Regarding 2017 ORYX® Performance Requirements
NCSBN Offers Free SUD Education
October 4, 2016
New Analysis Indicates 2.5 Million Could Qualify For Marketplace Tax Credits
$13.4 Million In Funding To Implement New Pediatric Quality Measures
HIDI Releases Third Quarter FFY 2016 Update To Discharge Data-Based Quality Indicators
CMS And TJC Release Supplements To Specifications Manuals
CMS Announces Availability Of IPF Reports And IPFQR Webinar
October 3, 2016
MHA Comments On The Proposed Medicare EPMs
CMS Issues Correction Notice For Medicare FFY 2017 IPPS
CMS Announces Release Of HQR 10.2
CMS Schedules IQR And EHR Incentive Program Outreach And Education Webinar