MHA Today | July 20, 2018

July 20, 2018
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MHA Today: News for Healthcare Leaders

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July 20, 2018

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.


Herb Kuhn, MHA President & CEOOne of the most popular provisions of the Affordable Care Act allowed parents to maintain coverage for their adult children through the age of 26. Without a doubt, this helped expand coverage for young adults — especially those who might have skipped coverage otherwise — bringing more “young invincibles” into the risk pool.

Nearly a decade of rhetoric aside, one of the core goals of the ACA was to bring balance into the insurance system by building wider coverage. And, one of the tools to expand access to coverage was ensuring individuals with preexisting conditions could buy in through the marketplace. Prior to the ACA, coverage often was unavailable or cost-prohibitive, even where state high-risk pools provided a safety net.

Recent polling finds the policy of addressing pricing challenges for individuals with preexisting conditions overwhelmingly popular. A whopping 92 percent of Democrats and 79 percent of Republicans support the notion. This is a very important component of the ACA. Although popular, its future is somewhat in question.

Missouri has a significant stake in the policy.

MHA issued a report on the prevalence of preexisting conditions in Missouri.

MHA Report The researchers found that in 2015 and 2016, “More than 1.2 million individual Missourians between the ages of 18 and 64 were diagnosed with a declinable medically underwritten preexisting condition in a hospital inpatient, outpatient or emergency department setting.” This group accounts for 33.7 percent of the non-elderly population in the state and is a number higher than that reported by the Kaiser Family Foundation, which pegs Missouri’s preexisting rate at 1.09 million individuals. In addition, the 1.2 million individuals we identified were limited to those diagnosed in a hospital setting. Undoubtedly, many more declinable preexisting conditions were diagnosed in the offices of physicians and mental health professionals.

This is important because, as the report notes, until the ACA was adopted, these individuals could be priced out of the market or denied coverage altogether. Under the ACA, insurance products in the individual market could not base coverage on an individual’s health status, health history or other risk factors.

In February, a court case was filed in Texas challenging this section of the ACA. The case — supported by a 20-state coalition, including Missouri — challenges the validity of the ACA, citing the tax bill Congress adopted last year. The coalition argues that the removal of the tax penalty for not enrolling in health insurance rendered the entire law void.

The Justice Department declined to defend the government and current law against the lawsuit. But it went a step further in June, calling out that the parts of the law dealing with preexisting conditions would fall if the case is successful.

The lawsuit has not been heard and is likely years out from being adjudicated. And, many legal scholars — both conservative and liberal — have raised questions about its chances.

The suit is likely to draw additional attention in the months ahead. First, if the arguments in this case were to be upheld in lower courts, then the issue likely would land within the jurisdiction of the U.S. Supreme Court. Missouri’s airwaves are already bursting with ads about how our incumbent U.S. Senator and her challengers might vote on the nomination Judge Brett Kavanaugh, President Trump’s pick to replace Justice Kennedy. Second, the whole issue of preexisting conditions will no doubt surface and emerge as this year’s election moves forward, particularly since Missouri is a party to the suit.

Despite the heated political rhetoric, a reality check is in order. First, those who would ultimately be affected by this provision are those who buy their own insurance — the self-employed and those who don’t receive employer-based or government coverage. Only a small portion of the 1.2 million Missourians with preexisting conditions would fit into this category, but still a significant number of our fellow Missourians would be impacted. Second, whatever happens will happen in the long-term, rather than short-term. And, finally, it’s worth remembering that despite challenges to the ACA, the U.S. Supreme Court has twice upheld its constitutionality.

Coverage matters. And, it’s clear that public opinion is moving in the direction of protecting access to coverage for individuals with preexisting conditions.

If efforts to repeal the ACA have taught us anything, it is that the more Americans know about the law, the more they like it. Specifically, they like that it opened access to young adults and made insurance possible for many who had been locked outside of the system.

Ensuring Missourians with preexisting conditions have coverage is important. However, there isn’t an immediate, existential threat to coverage. We know that when individuals with preexisting conditions don’t have coverage, their outcomes suffer and costs for everyone go up.

While we can’t know what will happen with the policy, there is one thing that’s certain. Guessing about the future of the ACA is just that – guessing.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO


Herb B. Kuhn
MHA President and CEO

Regulatory News
the latest actions of agencies monitoring health care

MO HealthNet Reduces DME Reimbursement To Comply With Federal Limits

Staff Contact: Brian Kinkade

The MO HealthNet Division is reducing selected durable medical equipment reimbursement rates to comply with requirements of the 21st Century Cures Act that limits state Medicaid reimbursement to the amount that would have been paid in the aggregate for certain classes of equipment under the Medicare program. The rate decreases are effective Wednesday, Aug. 1.

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Did You Miss An Issue Of MHA Today?

July 16, 2018
CMS Releases Proposed Payment And Policy Updates To The CY 2019 Medicare Physician Fee Schedule
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National Rural Health Resource Center Announces Next SRHT Project

July 17, 2018
Missouri House Budget Committee Reviews TCD, Managed Care Contract Amendment
Federal Court Upholds Dismissal Of 340B Challenge
Opportunity Available To Participate In A Non-Expansion State Medicare DSH Appeal
Enrollment Open To Join Opioid Use Disorder ECHO
Pike County Memorial Hospital Names New CEO

July 18, 2018
UnitedHealthcare Cuts Payments For Drugs Purchased Under 340B
MO HealthNet Accepting Applications For Additional Primary Care Health Homes
Opportunity Available To Participate In A Non-Expansion State Medicare DSH Appeal

July 19, 2018
MHA Distributes Financial Indicators Analysis
Opportunity Available To Participate In A Non-Expansion State Medicare DSH Appeal
MLN Connects Provider eNews Available
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Consider This ...

Each year in the U.S., about one in six people (or 48 million) get sick from a foodborne illness. Many of these illnesses occur one by one, but some are part of outbreaks.

Source: Centers for Disease Control and Prevention