More than 20 legislators from 16 states--many of them in key leadership positions on health or budget committees that deal with Medicaid in their home states--attended a CSG policy academy in Washington D.C. on September 21-23, 2016, to learn how states are making reforms in their Medicaid program that pursue the health "triple aim": improving the quality of care for individuals, improving the health of populations, and reducing per capita costs of health care.

Kaiser Family Foundation has posted an excellent web panel discussion on drug pricing. Representatives from Pfizer, a large international pharmaceutical company; Express Scripts, and Aetna, a major health insurance carrier, talk with Larry Levitt, a Kaiser senior vice president.

The Small Business Health Care Relief Act of 2016 (H.R.5447) was proposed by Congressman Charles Boustany (R-LA-3) to expand employer healthcare options for small businesses. Cosponsored by 22 Democrats and 37 Republicans, the legislation recently passed the House and was referred to the Senate Calendar as General Order 526.

CSG Midwest
Minnesota was an early adopter of the use of health care homes, and a five-year study of their impact shows promising results for any state looking to reduce health costs and improve patient outcomes.
“Given how much is spent for Medicaid, Medicare and dually eligible enrollees, you can create large savings and bend the cost curve,” says Douglas Wholey, a professor of health policy at the University of Minnesota and the study’s lead evaluator.

#1  Medicaid Expansion

Thirty states and the District of Columbia have expanded Medicaid eligibility to 138 percent of the federal poverty level as allowed by the Affordable Care Act, and they will be required to contribute matching funds beginning Jan. 1, 2017. This means that legislatures in those states will have to appropriate state funds during their budget sessions in 2016.  

The federal funding will decrease from covering 100 percent of the newly eligible...

As health care costs continue to rise and the future of the federal government’s Medicaid matching formula is made uncertain by the upcoming election, states are looking for innovative ways to improve health care outcomes while controlling costs. Possible solutions and promising programs were presented at the Getting More Bang for the Buck session Dec. 11 at the 2015 CSG National Conference.

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.

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.”

Last week Pennsylvania and Delaware moved toward a Plan B in case the Supreme Court rules against the Obama administration in the pending King v. Burwell lawsuit that questions whether tax subsidies can be provided in those states that did not opt to operate their own state health exchanges.

Depending on how the Supreme Court rules in King v. Burwell this summer, eight million residents of states now using the healthcare.gov exchange may lose federal insurance subsidies unless their state creates its own exchange. Some existing state exchanges have struggled with implementation over the last year. Others have been more successful.

During a CSG-East webinar on May 20th, Peter VanLoon, from Connecticut’s health insurance exchange, will describe how Access Health CT avoided most problems. Building on its success, Access Health CT is offering technical assistance and business services to states wishing to create or enhance their state-based exchange.

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