Class 10 – Federal laws

RE:  Comprehensive health insurance reforms

With the election of President Trump it is to be determined what will happen with Obamacare.  On May 4, 2017, the House of Representatives voted to pass the American Health Care Act of 2017 (“AHCA”), H.R. 1628.  The vote appears to be by party line, 217 Republicans voted yes, 213 Democrats voted no, and 1 person (Newhouse) did not vote.  The AHCA is intended to repeal and replace the Affordable Care Act and will now go to the Senate.  The Senate will most likely make changes to/revise the AHCA or create a new Act of its own.

Extrapolated sections from the “Summary” from Congress website regarding AHCA include the following:

Subtitle A–Patient Access to Public Health Programs

(Sec. 101) This bill amends the Patient Protection and Affordable Care Act to eliminate funding after FY2018 for the Prevention and Public Health Fund, which provides for investment in prevention and public health programs to improve health and restrain the rate of growth in health care costs. Funds that are unobligated at the end of FY2018 are rescinded.

(Sec. 103) For one year, certain federal funds may not be made available to states for payments to certain family planning providers (e.g., Planned Parenthood Federation of America).

Subtitle B–Medicaid Program Enhancement

(Sec. 111) The bill amends title XIX (Medicaid) of the Social Security Act (SSAct) to limit the state option for a participating-provider hospital to preliminarily determine an individual’s Medicaid eligibility for purposes of providing the individual with medical assistance during a presumptive eligibility period. The bill lowers, from 133% to 100% of the official poverty line, the minimum family-income threshold that a state may use to determine the Medicaid eligibility of children between the ages of 6 and 19. In addition, the bill reduces the Federal Medical Assistance Percentage (FMAP) for Medicaid home- and community-based attendant services and supports.

(Sec. 112) Beginning in 2020, the bill eliminates: (1) the enhanced FMAP for Medicaid services furnished to adult enrollees made newly eligible for Medicaid by PPACA; and (2) the expansion of Medicaid, under PPACA, to cover such enrollees. However, a state Medicaid program may continue to provide coverage, with the enhanced FMAP, to such enrollees who were enrolled prior to 2020 and do not subsequently have any break in eligibility exceeding one month. With respect to states that expanded Medicaid under PPACA, current law provides for transitional FMAP increases through 2019. The bill eliminates these increases after 2017, capping the FMAP at the 2017 level. Under current law, any alternative benefit plan offered by a state Medicaid program is required to provide specified essential health benefits. The bill eliminates this requirement beginning in 2020. (“Essential health benefits” include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, preventative and wellness services, and pediatric services.)

(Sec. 113) The bill eliminates Medicaid Disproportionate Share Hospital (DSH) payment reductions: (1) with respect to states that did not implement Medicaid expansion under PPACA, beginning in FY2018; and (2) with respect to other states, beginning in FY2020. (DSH hospitals receive additional payment under Medicaid for treating a large share of low-income patients.)

(Sec. 115) With respect to states that did not expand Medicaid coverage under PPACA, the bill: (1) with specified limitations, provides for additional federal funding for certain health care services; and (2) through 2022, increases the applicable FMAP. A non-expansion state that subsequently expands Medicaid coverage under PPACA shall become ineligible for this funding.

(Sec. 116) No less frequently than every six months, states must redetermine the eligibility of adult enrollees made newly eligible for Medicaid by PPACA. The bill temporarily increases by 5% the FMAP for expenditures that are attributable to meeting this requirement. In addition, the bill increases the civil penalty for improperly filing certain Medicaid claims related to Medicaid expansion under PPACA.

Source:  https://www.congress.gov/bill/115th-congress/house-bill/1628

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PATIENT PROTECTION AND AFFORDABLE CARE ACT (“Obamacare” or “Affordable Care Act” or “ACA”)

On March 23, 2010, President Obama signed the Affordable Care Act. On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.  The law created comprehensive health insurance reforms.

Primary care providers are critical for ensuring better coordinated care and better health outcomes for all Americans. To meet the health needs of Americans, the Obama Administration made recruitment, training and retention of primary care professionals a top priority.

Under the law, certain preventive services must be covered without having to pay a copayment or co-insurance or meet a deductible. This applies only when these services are delivered by a network provider.

A focus on prevention is to improve the health of Americans, and also help to reduce health care costs and improve quality of care. Through the Prevention and Public Health Fund, the Affordable Care Act works to address factors that influence health – housing, education, transportation, the availability of quality affordable food, and conditions in the workplace and the environment. By concentrating on the causes of chronic disease, the Affordable Care Act helps move the nation from a focus on sickness and disease to one based on wellness and prevention.

According to the U.S. Department of Health & Human Services, unfortunately, in too many communities today, healthy choices are neither easy nor affordable. As a result, 7 out of 10 deaths among Americans each year are from chronic diseases, and almost 1 out of every 2 adults has at least one chronic illness. Racial and ethnic minority communities experience higher rates of obesity, cancer, diabetes, and AIDS. In particular, children are increasingly vulnerable. Today, almost one in every three children in our nation is overweight or obese which predisposes them to chronic disease. The numbers are even higher in African American and Hispanic communities, where nearly 40% of the children are overweight or obese.

The Affordable Care Act’s Prevention and Public Health Fund is designed to expand and sustain the necessary capacity to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living. In FY2010, $500 million of the Fund was distributed to states and communities to boost prevention and public health efforts, improve health, enhance health care quality, and foster the next generation of primary health professionals.

Health Security Act

    Even though the Health Security Act, commonly known as the Clinton plan did not pass, the whole debate that happened during 1993 put managed care on the front page for the first time. This debate set the framework for dialogue that is going on today in Washington.

The Health Security Act attempted to create a system that would over time change the way most Americans receive health care. In this system, a group alliance of some sort would govern the type of health care people would or would not receive. Health care would be controlled by Primary Care Physician who must be approved by the alliance. This Primary Care Physician would be told what he/she can and cannot do by the alliance and by the new rules and regulations to be created. A lot of power would be given to various governing boards, governmental bureaucrats, Secretary of Health Human Services, and the National Health Board. Potentially, the National Health Board would become like a czar of U.S. healthcare. This plan, which is more than 1,000 pages long, basically defines the new health care system in the broadest of terms. It cannot be determined how the system would really work until future volumes of rules and regulations were created and made public.

It has been said that this Health Security Act failed because America was not ready to be told which doctors they can and cannot use. Doctors feared they would lose control over the decision making process involved in rendering medical care. It was claimed that quality for health care was missing in that compensation for doctors would be tied to a quota system that rewards doctors for prescribing minimal amounts of treatments and financially penalizes doctors if the amount of treatment provided is above the quota set by bureaucrats. It seemed that the health care system as proposed by Clinton would be governed by boards of people outside of the healthcare and medical industry so that the best remedy to deal with health insurance issues would probably be to contact one’s local congressman to override some bureaucrat’s health care decision. It was said that the bureaucrat’s paperwork would not contain costs but with the added procedures, approvals required under the system, costs could actually increase. Another concern was that this plan would create favored classes of individuals for better coverage as compared to most others.

The Health Security Act succeeded in getting everybody’s attention including the attention of the employer groups who were not using that much managed care. This plan was a big advertisement to get the employer groups to think about using managed care.

A study was done to examine the health care policy implications of the 1994 Congressional elections. This study looked at election day surveys to determine (1) what role did the health care issue play in voter’s choice of candidates and (2) what do voters want the new Congress to do about health care policy. It found that the candidates stands on issues were not the most important factors in determining the outcome. The candidate’s experience, character, ethics and political party were most important and that the voters top priorities for the new Congress was health care. The study found that voters wanted candidates who would support modest and incremental reform and be less supportive of major health system reform. The reasoning was because voters did not think the government would do a major health system reform right. The voters did not want a single payer system.

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