In a case brought by House Republicans, a federal district judge ruled on May 12 that the cost-sharing subsidies are illegal. Congress had never explicitly appropriated those funds. The White House contends that the authority to spend the money is in the ACA statute itself. The judge didn’t buy it. Continue reading
The Affordable Care Act created many opportunities for Medicare to test new ways of paying for health care. One of the biggest and most dramatic tests is now getting underway: bundled payments for hip or knee replacement.
Unlike most Center for Medicaid and Medicare Innovation (CMMI) projects on payment and delivery reform, this one is mandatory for hospitals in 67 geographic areas designated as participants. The test began April 1 and is supposed to run for five years. Continue reading
“Across state lines.” That’s shorthand for what many GOP politicians see as part of an acceptable replacement for the Affordable Care Act.
They see the approach as reducing barriers, so insurers can base themselves in one state, but sell in other states without having to include all the coverage mandates and benefit rules in those other states. Continue reading
One premise behind the formation of accountable care organizations is that physicians and other health care providers would have financial incentives to deliver high quality care at lower costs. But research is indicating that the financial incentive may not be sufficient to foster improvements in care.
A study published in the July/August 2015 issue of the Annals of Family Medicine, noted that physicians both inside and outside of accountable care organizations (ACOs) have similar payment arrangements. They are paid a mix of salary, bonuses for productivity and a bonus equivalent to about 5 percent of total salary for delivering quality care and other factors, the researchers said. Continue reading
Here’s a story worth looking at in the states, particularly in the midst of a pretty heated campaign season: health care for those living in the United States without legal permission.
The Affordable Care Act, as you may remember, did not cover people living in the country illegally (though some conservatives insist otherwise). In fact, they can’t even buy a plan in the ACA exchanges with their own money – with no subsidy. (They can purchase insurance outside the ACA with their own money, and some who are employed do get covered through jobs, although there is some disagreement over how many.) Continue reading