Medicare pays between $16,500 and $33,000 for hip or knee replacements depending upon the hospital and geographic area of the country, but with a new payment program Medicare expects to save $343 over the next five years.

On Nov. 16, 2015, the Centers for Medicare & Medicaid Services announced they would begin to make bundled payments for these surgeries in 800 hospitals in 67 geographic areas under a model program over the next five years.

CSG Midwest
In 2014, the first year that many provisions in the federal Affordable Care Act began to take effect, more than 300,000 people in Minnesota still did not have health insurance. That figure amounts to 5.9 percent of the population — in a state where the rates of uninsured have been among the lowest in the nation and where Medicaid was expanded early on to cover more low-income residents.
“There is more hard work that needs to be done,” Stefan Gildemeister, program director for health economics at the Minnesota Department of Health, says about reducing the number of residents without health coverage.
The Affordable Care Act, while contributing to a rise in insurance coverage across the Midwest, has not been a cure-all. In fact, in some states, the percentage of people without coverage still hovers around the double digits, federal data for 2014 show. Who remains uninsured in this country?
According to the Kaiser Family Foundation, many of these individuals (49 percent of the total uninsured population) are eligible for some kind of financial assistance, either through state Medicaid and children’s health insurance programs or via subsidies on the newly established health care exchanges.

A ballot initiative to establish a single-payer health care system in Colorado has been approved for the Nov. 2016 ballot. Supporters turned in 158,831 signatures and after reviewing a five percent sample, the secretary of state’s office certified Initiative 20, the “State Health Care System.”

CSG Midwest
South Dakota leaders are taking steps this fall to become the Midwest’s eighth state to expand Medicaid access under the Affordable Care Act. According to the Sioux Falls Argus Leader, the planned expansion would add 48,500 residents to the public health insurance program.

The Kaiser Family Foundation released a report Oct. 13 with state by state estimates of the uninsured. Nationally, 32.3 million non-elderly persons are uninsured, but one half of that number is missing out on Medicaid or CHIP eligibility in...

On Sept. 21, news that Turing Pharmaceuticals raised the price of a 62-year-old drug by 4,000 percent overnight made headlines. The drug, Daraprim, is critical to the care of HIV and AIDS patients. The sharp rise in price from $18 to $750 per pill is part of the all-too-familiar trend of drug-price spiking in the United States and highlights concerns about the sustainability of health care.

Arizona is asking the federal government to allow it to add work requirements and lifetime eligibility limits for some adults enrolled in Medicaid, Stateline reported today. The request, which is in the form of a Section 1115 waiver request, is required under laws passed by the 2015 Arizona State Legislature. Senate Bill 1475 and Senate Bill 1092 require the governor to submit the waiver but do not link continuation of the current Medicaid expansion to the waiver’s approval. Former Gov. Jan Brewer vetoed nearly identical legislation the year before, the Arizona Daily Star reported in March 2015.

Twenty-two state legislators and one governor's health policy advisor from states gathered in Washington, D.C. on Sept. 21-23, 2015, for a CSG-led Medicaid Leadership Policy Academy. Almost 50 percent of the attendees were chairs or vice-chairs of health committees in their home states. A significant number...

State uninsured rates in 2014 ranged from a low of 3.3 percent in Massachusetts to a high of 19.1 percent in Texas. From 2013 to 2014, the uninsured rate fell in all 50 states, with Kentucky seeing the biggest gains - a drop of 5.8 percentage points.

Vermont and at least 16 other states collect health care claims data. In Gobeille v. Liberty Mutual Insurance Company the Supreme Court will decide whether the Employee Retirement Income Security Act (ERISA) preempts Vermont’s all-payers claims database (APCD) law. The State and Local Legal Center (SLLC) filed an amicus brief arguing against ERISA preemption.

ERISA applies to most health insurance plans and requires them to report detailed financial and actuarial information to the Department of Labor (DOL). ERISA preempts state laws if they “relate to” the core functions of an ERISA plan. Vermont’s APCD law seeks the following medical claims data: services provided, charges and payments for services, and demographic information about those covered.