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Supreme Court upholds Obamacare subsidies
U.S. News & World Report
The Supreme Court on Thursday upheld one of the main tenets of President Barack Obama's healthcare law, ruling, 6-3, that millions of Americans are entitled to keep the tax subsidies that help them afford insurance. Chief Justice John Roberts wrote the court's majority opinion and was joined by Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan.
The ruling, the second case in which the justices have decided in favor of the Affordable Care Act, preserves benefits for an estimated 6.4 million Americans and deals a crippling blow to the law's Republican opponents, who have attempted to undermine it since its passage in 2010.
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Now that SCOTUS OK'd subsidies, it's all about Medicaid expansion;
News that the U.S. Supreme Court has once again upheld the Affordable Care Act, ruling that subsidies are valid to purchase private coverage in all states no matter what government exchange an American uses, the focus on future growth will be Medicaid, the expanded program for the poor that is also a key part of the health law.
Anthem, which is attempting to purchase Cigna, has said the bulk of its growth this year as well as new business from the health law is coming from Medicaid. Earlier this year, Anthem said medical enrollment grew by 1 million members, or nearly 3 percent to 38.5 million by the end of the first quarter compared to 37.5 million at the end of 2014. "Having health care coverage is always a good thing, both for those who qualify for Medicaid and the near poor who are hovering above the poverty line," said Jeff Myers, president and CEO of MHPA. "With subsidies remaining in place for states using the federal exchange, we're happy to see the Affordable Care Act continue to help provide access to care to those previously uninsured in the private insurance marketplace."
UnitedHealth leaves insurance industry lobbying group AHIP
UnitedHealth Group Inc is planning to leave the health insurer industry's biggest trade group, America's Health Insurance Plans, or AHIP, saying it no longer represents the best interests of the company or its customers. UnitedHealth is the nation's largest health insurer, providing health coverage to about 45 million Americans. AHIP represents insurers and had a key role in negotiations and the rollout of President Barack Obama's national healthcare reform law.
Not expanding Medicaid can cost local taxpayers
The Pew Charitable Trusts
Dallas County property owners paid more than $467 million in taxes last year to Parkland Health and Hospital System, the county's only public hospital, to provide medical care to the poor and uninsured. Their tax burden likely would have been lower if the state of Texas had elected to expand Medicaid, the federal-state health insurance program for low-income people. If more low-income patients at Parkland had been covered by Medicaid, then federal and state taxpayers would have picked up more of the costs.
GOP states say Obama threatening them to expand Medicaid
Ten GOP state attorneys general on Tuesday wrote to congressional Republicans, asking for help reining in the Obama administration's alleged effort to force them to expand Medicaid under Obamacare. The letter stems from a lawsuit Florida Gov. Rick Scott filed against the Obama administration in April. In that lawsuit, Scott argued that the administration was trying to force his state to expand Medicaid under Obamacare by cutting off a separate federal program, known as the Low Income Pool (LIP), that funded care for the uninsured at hospitals in the state.
House plan to overhaul North Carolina Medicaid approved
The Associated Press via The Baltimore Sun
The House has approved its model to overhaul North Carolina's Medicaid system, contrasting starkly with a proposal incorporated in the Senate's budget. House members voted, 105-6, on Tuesday for the measure, which like the Senate's plan directs Medicaid to give a fixed amount of money to medical organizations for each patient treated. Medicaid now reimburses hospitals and doctors for every medical procedure they perform.
Florida, feds agree to extend hospital low-income pool funds
The Associated Press via The Baltimore Sun
The Obama administration and the state have reached an agreement in principle to continue funding Florida's hospital low-income pool for two more years but at a much lower cost, officials said Tuesday. Florida will receive $1 billion this year — about half of what the state has been receiving — and $600 million for 2016-2017.
The federal government must still wait until the end of a public review to issue its final ruling. The fight over the funds tore apart Florida's regular legislative session in late April and prompted Gov. Rick Scott to sue the federal government.
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Maine House endorses Medicaid expansion, but passage unlikely
Maine Public Broadcasting
After more than an hour of debate, the House voted to expand Medicaid coverage in Maine to an estimated 70,000 poor residents and generate millions in federal funds for health care providers. Westbrook Democrat Drew Gattine argued for expansion of coverage. Opponents argued the expansion is not a good long-term investment and the bill's future is uncertain. The Senate has yet to consider the measure, and Gov. Paul LePage has said he would veto any bill lawmakers passed that would expand Medicaid.
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Oklahoma Medicaid providers will not see rate cuts this year
After fervent feedback from the medical community, Oklahoma Medicaid leaders decided they will not reduce provider rates as part of the cuts they will make to balance the agency's budget. Previously, Oklahoma Health Care Authority leaders proposed cutting the amount it pays nurse practitioners and physician assistants. Under the agency's first proposal, these midlevel providers would be paid 85 percent of what the agency pays physicians — medical doctors and osteopathic physicians.
Report: New Mexico needs to curb Medicaid costs
Legislative analysts are warning that the growing price tag for providing healthcare to low-income New Mexicans will put more pressure on the state's finances going forward unless steps are taken to control costs. After a lengthy review of the state's Medicaid program, analysts with the Legislative Finance Committee found that New Mexico won't save as much money as first projected because cost-containing measures have proven difficult to implement during the program’s first year.
House, Senate Democrats push CMS to finalize Medicaid equal access rule
Inside Health Policy (Subscription required)
Democratic leaders on House and Senate health care committees are urging CMS to finish a Medicaid equal access rule from 2011 in light of the Supreme Court's decision earlier this year that providers cannot sue over inadequate Medicaid pay.
House Energy & Commerce questions CMS' Medicaid waiver approvals
Inside Health Policy (Subscription required)
Some Republicans at a House Energy & Commerce health subcommittee hearing Wednesday questioned whether CMS may be trying to coerce states into expanding Medicaid when those states look for Medicaid 1115 waiver approval and others raised concerns about the transparency, predictability and budget neutrality of the waivers in light of an earlier Government Accountability Office report.
Cancer doctors release tool to measure value of drugs
A leading group of cancer doctors on Monday released a framework for helping patients weigh the cost and benefits of cancer drugs, amid concern over rising drug prices.
The framework from the American Society of Clinical Oncology (ASCO) presents patients with a "Net Health Benefit" score that rates the added benefit a patient can expect from a treatment, factoring in the side effects. That score, which uses data from clinical trials, is then presented next to the out-of-pocket cost to patients of the drug, allowing for comparing the price and the expected benefit.
Did you miss Webinar Wednesday: 'The New Frontier: Measuring Patient Engagement and Experience' by Avalere?
View and listen to the webinar recording.
For additional information, please contact Madeline Abram, visit www.avalere.com or follow Avalere on Twitter.
For copies of other past webinars, visit here.
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July 8 Webinar Wednesday: 'Transforming Medicaid
Join Neng "Bing" Dohing, CEO of HealthCrowd, for a presentation on how macro healthcare trends are requiring a transformation in Medicaid member communications. This webinar will cover current hot topics including how to scale text messaging programs to affect HEDIS scores, using multiple modalities "in concert" to improve member experience while optimizing outreach budget, the need to move away from transactional communications, and how to make each outreach campaign better than the last. Accompanied by case studies and even comics, this webinar will be one every health plan employee can derive value from.
Philadelphia Asthma Summit set for June 26
U.S. Housing and Urban Development
The Philadelphia Asthma Summit will take place from 8 a.m. to 4 p.m. on Friday, Jun 26, at the Children's Hospital of Philadelphia. This is the fifth asthma summit that the U.S. Housing and Urban Development has hosted in collaboration with federal, state and local partners.
While each meeting is unique, the overall intent is to advance the conversation locally (state or region) around securing sustainable financing for in-home services targeting children disproportionately impacted by asthma. This Philadelphia Asthma Summit is designed to meet this intent with a specific focus on promoting the value of home-based interventions for children with poorly controlled asthma and reimbursement mechanisms for these services by healthcare insurers for children in low-income households.
Health plans participating in the meeting will hear perspectives and experiences from other health plans serving Medicaid populations. The meeting agenda includes a "Payers' Perspectives Panel" featuring Family Health Network (Barbara Hay, Retired COO), Keystone First (Dr. Lily Higgins, Medical Director) and Aetna Better Health (Dr. Guerra-Garcia, Chief Medical Officer).
Job opportunity: Vice president of marketing and sales | Chalfont, PA
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To apply, please email your resume to Adorable Harper.
Job opportunity: Senior Medicaid Strategist | Raleigh-Durham, NC
North Carolina Department of Health and Human Services
The Senior Medicaid Strategist has responsibility for the execution of the day to day activities in all efforts related to implementing Medicaid Reform for DMA. This position acts a project manager by directing internal and external resources to successfully operationalize reform policy. This individual will report directly to the DHHS Deputy Secretary for DMA.
For more details and to apply: click here.
Job opportunity: RN, manager, Clinical Health Services,
pre-authorization | Detroit
Aetna seeks an experienced RN with managed care, leadership and prior authorization expertise. Reinforces clinical philosophy, programs, policies and procedures. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Visit here and search for requisition #24937BR to learn more and apply.
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