NRHA: Rural America’s Oral Health Care Needs

National Rural Health Association

In June 2012, Vermont Senator Bernie Sanders introduced “The Comprehensive Dental Reform Act” seeking to address five main components to end the US oral health crisis. These components included: expanding coverage; creating new oral health access points; enhancing the workforce; improving education; and funding new oral health research.1 Senator Sanders’ bill has garnered support across the health care spectrum as the realistic dangers of dental disease, as well as the detrimental effects it has on both individuals personally as well as the health care system in general, continue to grow in concern for health care professionals, policymakers and citizens alike. To read the full policy brief click here

Role of Health-Law 'Navigators' Under Fire

The Wall Street Journal

May 20, 2013

Lawmakers across the country are tussling over the Obama administration's plans to create a small army of assistants to guide millions of Americans as they sign up for new health-insurance options available this fall.

Backers of the health-care overhaul face an uphill battle to spread the word about the law, in the face of consumer research that suggests most uninsured people know little about it and are skeptical about the value of health insurance generally. Some Democrats have openly worried that the administration is doing too little to make sure the enrollment process goes smoothly.

That is where the "patient navigators" are supposed to come in. But their role has come under question from Republicans who have criticized the administration's plans to educate people on the new legislation. Health and Human Services Secretary Kathleen Sebelius has already drawn fire for conversations with health-industry executives in which she encouraged them to help the nonprofit organization leading the campaign to publicize the law's benefits. Critics said that it was inappropriate for the government to turn to outside groups. Click here to read the full article. 

HCPF May At a Glance

Click here to read the full At a Glace report by the Department of Health Care Policy and Financing.

ACA still missing key regulatory details

ModernHeathcare.com

May 30, 2013

Some key regulatory details remain unanswered in the final months before the Patient Protection and Affordable Care Act's major provisions launch.

Obama administration officials have insisted that they have issued all of the major regulations for the 2010 healthcare overhaul and are now focused on implementing the law's central pillars—state health insurance exchanges and expanded Medicaid coverage—later this year. But health policy experts said they still expect important regulations implementing provisions of the law, plus a large amount of so-called subregulatory guidance.

Sam Batkins, director of regulatory policy at the conservative American Action Forum, counts 32 proposed rules that remain to be finalized, including final IRS rules on Medicare taxes and rules requiring providers to report and return Medicare overpayments within 60 days.

Other highly anticipated regulations still to come this year deal with various components of the health insurance marketplaces, experts say. Those new exchanges are expected to begin enrolling millions of private insurance subscribers in each state Oct. 1 and start providing coverage in January.

To find out what the four rules addressing various aspects of exchanges will be, read the full article here.

The Affordable Care Act: Improving Incentives for Entrepreneurship and Self-Employment

Robert Wood Johnson Foundation

May 31, 2013

Traditionally, individuals considering leaving their job to strike out on their own have worried that they may be denied health insurance coverage because they have preexisting conditions, fear losing access to a trusted physician, or are unable to afford the premiums without an employer sharing the costs. The result is that some U.S. workers feel “job lock,” being tethered to their jobs and unable to leave, even if their skills and talents no longer match their position.

New research estimates that the number of self-employed Americans will be 1.5 million higher in 2014 because of the Affordable Care Act (ACA). Beginning next year, access to high-quality, subsidized health insurance coverage will no longer be exclusively tied to employment, which could lead people to pursue their own businesses as self-employed entrepreneurs.

To find out what the ACA provisions that may encourage more people to start their own business include read the full article here.

Opinion: Spend Money on Universal Care Not Costly Exchange

Solutions

May 29, 2013

Coloradans need health care. It’s a basic human right. Yet as we get more information about Colorado’s new health insurance exchange, it seems less certain that people will get the health care they need.

The exchange, also called a marketplace, seems more complex every day. I wonder if Coloradans who need the help most will even be able to understand this new system, much less figure out how to get care.

There is a simple solution. We need universal health care, specifically a public single-payer health system that would assure all of us who need care can access it.

The complexity of implementing and understanding the reforms required under the federal Affordable Care Act (ACA) also known as Obamacare, has become more apparent in recent days. Health Care for All Colorado, the state’s leading advocacy group for a universal public single-payer system, contends that this complexity will lead not only to unnecessary confusion for patients and caregivers but also to increased costs for premiums and other administrative costs that will continue to drive the cost of health care ever higher.

Obamacare regulates health insurance companies. Find out what its major values include by reading the full article here.

Medicare Spending Variations Mostly Due To Health Differences

Kaiser Health News

May 28, 2013

The idea that uneven Medicare health care spending around the country is due to wasteful practices and overtreatment—a concept that influenced the federal health law -- takes another hit in a study published Tuesday. The paper concludes that health differences around the country explain between 75 percent and 85 percent of the cost variations. 

“People really are sicker in some parts of the country,” said Dr. Patrick Romano, one of the authors.

That’s a sour assessment for those hoping to wring large savings out of the health care system by making it more efficient. Some, such as President Barack Obama’s former budget director, Peter Orszag, assert that geographic variations in spending could mean that nearly a third of Medicare spending may be unnecessary.

Their conclusions are based on the wide differences in spending, which in 2011 rangedfrom an average of $14,085 per Medicare beneficiary in Miami, to $5,563 per beneficiary in Honolulu, even after Medicare’s cost of living and other regional adjustments — but not health status — were taken into account.

The new study comes as advisors to the government consider whether regional differences are a useful tool to reduce health spending. An Institute of Medicine panel is preparing a report on whether Congress should pay less to hospitals and doctors in areas where there is heavy use of medical services, and more in regions where spending is lower. That report is due out this summer, but an interim version indicated that the panel was opposed to the idea. Read more here. 

Premium Assistance in Medicaid

Robert Wood Johnson Foundation

June 6, 2013

States have proposed using expansion funds to buy private coverage for Medicaid beneficiaries through the new health insurance exchanges.

Nearly a year after the Supreme Court’s June 2012 decision declaring the Affordable Care Act’s (ACA) Medicaid expansion optional, states continue to grapple with whether or not to pursue the option for newly eligible populations. Although the Medicaid expansion accounted for about half the total number of people projected to gain coverage under the ACA, many states, to date, have declined to expand Medicaid or are learning toward rejecting the option because of cost and political concerns. But the long-term consequences of denying the Medicaid expansion, especially large coverage gaps for millions of low-income people, are also prompting some states to consider novel alternatives for extending Medicaid under the ACA.

One approach that has piqued states’ interest is using the additional federal funds as “premium assistance” for eligible Medicaid beneficiaries to purchase private coverage through the law’s new health insurance exchanges.

It remains to be seen how many states will pursue the premium assistance approach in order to move their Medicaid rolls to the private exchanges. While the option appeals greatly to conservative leaders looking to reduce the role of government in healthcare, many details must still be negotiated. Advocates speculate that exchanges may offer more efficient cost sharing, greater competition, reduced fraud, less churning, higher reimbursement rates and better provider networks. However, not all of the states choosing premium assistance will see all of these benefits. Alternatively, the cost to an individual state may be higher than traditional Medicaid.

This policy brief examines a range of policy issues surrounding premium assistance using Medicaid expansion funds, and next steps for states.

Long-term care a looming crisis, but Colorado takes an important step

Solutions
June 10, 2013

Both Colorado and the United States face a crisis over long-term care for our aging population. (Baby boomers, this means you.)

In a few years, an unparalleled demographic shift will begin to place unprecedented demands on both our health care and long-term-care systems. When this shift reaches its peak in 2030, 61 million Americans will be between 66 and 84 years old. In that same year, 9 million people will be older than age 84.

As for Colorado, the number of households aged 65+ will increase by 123 percent between 2010 and 2030.

If we are to successfully manage the health care needs of our aging population, we need to pursue options that will cost less, protect people’s assets and life savings, keep people in their homes for as long as possible, and help to reduce the financial and emotional stress on family caregivers. The longer we wait to develop a strategy, the more costly those options will be and the more difficult they will be to implement.To read the full article click here.

Tom Morris Testifies on the Hill

Tom Morris, Associate Administrator at the Federal Office of Rural Health Policy (FORHP), testified before the U.S. Senate on May 23rd at a hearing on Improving Federal Health Care in Rural America: Developing the Workforce and Building Partnerships. Speaking before the Committee on Homeland Security and Governmental Affairs, Morris gave an overview of FORHP, its history and its current programs, and discussed the “Improving Rural Health Care Initiative,” which has four key areas of focus, including moving toward a more evidence-based approach in rural programs. Click here to download his testimony.

Affordable Care Act and CMS Funding

As part of the Affordable Care Act, federal dollars have been designated for “navigators” (people or organizations that will help explain the health law’s new programs). CMS is offering approximately $54 Million and HRSA is offering approximately $150 million in funds for navigators. The CMS money will go to contractors (for-profit or non-profit entities); the HRSA money is going exclusively to FQHCs. In addition, in May CMS announced that it will make another one billion dollars available for innovative healthcare reform/delivery initiatives. Click here for more info.

Federal Budget and Sequestration

The House and Senate have both approved Budget Resolutions for the first time in several years, according to Bill Finerfrock, NOSORH legislative liaison. “While this is generally good news, the impact of this is a mixed bag,” Finerfrock said. “Although the Senate and House have both adopted Budget Resolutions, the spending levels approved by the respective bodies are very different. Within the next few weeks, the House and Senate Appropriations Committees will determine the top line allocations for all appropriations. NOSORH will provide members with an alert once the allocations levels are announced.

Revised Metropolitan Designation

Because the Office of Management and Budget has revised its Metropolitan and Micropolitan statistical areas (see the February 28th OMB Bulletin), there are 104 counties that were changed from nonmetropolitan to metropolitan. This could have an important impact on the 44 Critical Access Hospitals located in those counties, which could lose their CAH status and have to transition to PPS payments. In addition, because of this revision, dozens of formerly rural counties may lose their telehealth Medicare benefits.