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This Week in Health Care Reform - February 21st, 2014

Medicare Advantage watchers brace for impact as CMS readies its latest rate proposal; the politics of health care reform continue to exert growing influence over the legislative landscape; the exchange enrollment push targets the young; and, in this ‘year of action’, whither cooperation?


Health Care Reform

Medicare Advantage on the Brink: Medicare Advantage has been top-of-mind for a diverse and growing list of stakeholders, lawmakers, and outside watchers – not to mention the 15 million seniors and persons with disabilities that depend on the critical program for its coordinated model of care – and it’s no secret why.  With the release of its 2015 proposed rate notice (expected this afternoon – too late to be included here), the Centers for Medicare & Medicaid Services (CMS) will set the stage for further changes to Medicare Advantage, which has already shown signs of strain under CMS’ most recent round of cuts.  Last year, the agency backed off its original, and some would say, aggressive, rate proposal, but still managed to reduce payments by six percent.  That’s resulted in cost increases and benefit reductions of $30-$70 per month for seniors and the disabled with Medicare Advantage plans.  It’s estimated that further cuts along those lines would have beneficiaries experiencing additional reductions to their benefits and premium increases of as much as $900 per member for the year in 2015.  But, as mentioned, supporters of the program have not been sitting idly by.  Late last week, House Republican leaders sent the President a letter, voicing their “deep concern” over what further cuts to Medicare Advantage would do to beneficiaries.  And, on Tuesday, a bipartisan group of 40 U.S. Senators sent a letter of their own to CMS urging the agency to maintain level funding for the program, which would protect beneficiaries from “disruptive changes” next year.  While some choose to focus on the political motivations behind these recent efforts, others are more concerned about the changes to Medicare Advantage already brought to bear against those that need it most.  Keep up with the latest by visiting the Coalition for Medicare Choices

Politics and the Affordable Care Act: To categorize the implementation of the Affordable Care Act as anything but divisive would be doing a disservice to the enormous amount of political and legislative energies that have thus far attended every step of the law’s rollout.  Just shy of two months in, it’s clear that not much has changed.  In response to last week’s decision by the Administration to delay (again) the employer mandate, this week, a bill was introduced in the House that would extend similar dispensation to individuals.  Whether or not this is in keeping with Republicans’ new vision for the direction of the country is up for debate.  But, it certainly seems consistent with their messaging, particularly in regards to the sweeping health care law.  And, that’s not to say their counterparts across the aisle are rushing to its defense either.  Despite the President’s efforts to allay their concerns, Democrats have distanced themselves from the law, electing instead to focus their attention on fixing it, while simultaneously keeping it at arm’s length.

Young Targets: Already we’ve seen enrollment projections for the health care law’s new insurance exchange marketplaces revised down to 6 million (from the original 7), but now it sounds like the final tally of enrollees may fall short of even that.  In a candid conversation on Wednesday, the Vice President acknowledged that getting to 5 or 6 million enrollees, after what he described as a “shaky” start, would be an accomplishment.  While the latest enrollment figures indicate that the pace has certainly picked up, the number of young people signing up continues to disappoint.  As such, a coordinated 11th hour push targeting the young is already underway ahead of the enrollment period closing at the end of next month.

Executive Power: As mentioned, last week’s announcement by the Administration that they were delaying the employer mandate was met with more than a little partisan angst.  Unsurprising to some, given the inordinate amount of midstream changes they feel have already been made to the law.  What’s increasingly distressing experts, though, is the manner in which these course corrections seem to be handed down.  While critics argue that these changes are merely indicative of the Administration’s newfound predilection to test the limits of executive authority, it’s hard to deny that the spirit of cooperation is getting shorter and shorter shrift.  Predictably, Republicans have replied in kind, launching an investigation into the employer mandate delay.        

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