Before physicians practice medicine independently, they receive on-the-job training as residents in teaching hospitals. These residents are vital providers of health care during their training, and many stay in the geographic area to practice after their training is completed.
Medicare pays these hospitals to offset some of the costs of training physician residents. For most hospitals, Medicare caps the number of residents it will fund per hospital based on how many residents it funded in 1996.
We found that 70% of hospitals trained more residents than Medicare funded—indicating they can train more physicians now than when these caps were set.
Read the report.
Reps. Van Drew, Smith, Pascrell, Payne and nearly 100 other House members sent a letter to HHS and the Treasury urging that their rulemaking for the No Surprises Act reflect congressional intent for a balanced process to settle payment disputes between health plans and providers.
See the letter here
Reps. Van Drew, Smith, Pascrell, Payne and nearly 100 other House members sent a letter to HHS and the Treasury urging their rulemaking for the No Surprises Act reflects congressional intent for a balanced process to settle payment disputes between health plans and providers.
Reps. Liz Cheney (R-Wyo.) and Debbie Dingell (D-Mich.) are introducing legislation today to make it easier for older adults to access telehealth services. The bill, shared first with PULSE, would codify new telehealth flexibilities for Medicare beneficiaries granted during the pandemic.
Providers would be allowed to deliver telehealth services to patients in their homes regardless of what part of the country they live in, and would permanently allow Medicare to pay for doctor’s visits via audio-only phone calls, rather than requiring a video component for every call.
Temple University Hospital lost a bid to challenge its reassignment to a lower-paid geographic area for purposes of calculating its Medicare payments because it didn’t pursue an administrative action first, the Third Circuit said.
The Medicare Act requires hospitals objecting to their operating cost reimbursements to present their claims to the Provider Reimbursement Review Board, the U.S. Court of Appeals for the Third Circuit said.
The provision works in tandem with the Social Security Act’s jurisdiction-stripping section, which precludes courts from hearing claims for reimbursement “arising under” the Medicare Act unless they’ve been through the agency’s appeals process, the court said.
Together, the provisions create a channeling requirement that operates as a “near-absolute bar” to the court’s authority to hear cases arising under the Medicare Act that haven’t first been presented to the U.S. Health and Human Services Department, the court said.
Medicare repays hospitals for certain operating costs, including wages. The wage index varies based on the geographic area to which a hospital is assigned to reflect the prevailing wages in that area.
In February 2020, Temple secured reassignment to a geographic classification that upgraded its wage index to that for New York City, thereby increasing its reimbursements.
Temple’s reclassification was supposed to be in effect from 2021 to 2023, but HHS redrew the borders and reassigned the hospital to a new, lower-paid geographic area. The hospital sued, arguing HHS improperly withdrew its New York City wage index classification.
A federal district court entered judgment for HHS. The reclassification decision deserved deference, it said.
The Third Circuit vacated the judgment and sent the case back to the district court for dismissal Monday. The federal court lacked subject matter jurisdiction because Temple hadn’t first filed its objections with the PRRB, it said.
Judge Peter J. Phipps wrote the opinion. Judges Richard L. Nygaard and Jane R. Roth joined.
Joseph D. Glazer, Princeton, N.J., represented Temple. The U.S. Department of Justice represented HHS.
The case is Temple Univ. Hosp., Inc. v. Secretary, U.S. Dep’t of Health & Human Servs., 2021 BL 230209, 3d Cir., No. 21-1293, 6/21/21.
President Joe Biden’s plan for trillions of dollars in proposed spending and tax increases is entering a procedural and political thicket in Congress that’s likely to take at least until September to clear.
If all goes according to plan for Biden and Senate Majority Leader Chuck Schumer, the Senate would pass a bipartisan infrastructure deal next month as well as a budget blueprint that sets up a vote later on a far larger bill with trillions in social spending paid for in large part by tax hikes on the wealthy and corporations. The budget bill could be passed with only Democratic votes in the Senate.
But progressive Democrats in the House and Senate say they may not back an infrastructure package that includes concessions to Republicans without a guarantee that their priorities — on climate, health care and social welfare — will be accommodated in follow-up budget legislation. At the same time, moderate Democrats like Senator Joe Manchin of West Virginia are so far refusing to commit to supporting a massive spending bill that would be passed on a party-line vote.
Here’s how the Democrats’ two-track strategy is likely to unfold:
A bipartisan group now numbering 21 senators — 11 Republicans, nine Democrats and one independent — still has to hash out the final details of their infrastructure proposal and negotiate with the White House. A sticking point is a proposal that was part of a preliminary outline to partly offset the cost by indexing the federal gasoline tax to inflation.
The White House on Friday reiterated its opposition to raising the gas tax, and some of the Democrats in the group said that piece remains in flux. The outline released last week leaves it up to Biden to offer an alternative, but Republicans have rejected raising income taxes on the wealthy or corporations. The White House last week suggested increased tax enforcement on the wealthy as an alternative, according to a White House official.
Even if a deal is hammered out, written and put on the Senate floor shortly after lawmakers return from their July 4th break, passage isn’t a slam dunk. A number of Democrats are opposed to how it would be paid for and complain that it lacks sufficient steps to address climate change. That could mean the bipartisan group and the White House will have to hunt for more Republicans in order to get the 60 votes needed to overcome a filibuster.
If the Senate passes the package, the House would then become critically important as a backstop for liberals. Representative Alexandria Ocasio-Cortez of New York said recently the House could hold up final passage of a bipartisan infrastructure package until a larger Democratic plan passes the Senate, and vote on both at approximately the same time. A similar tactic was used by Speaker Nancy Pelosi to pass the Senate version of the Affordable Care Act and an accompanying reconciliation package on the same day in March 2010.
In order to get the remainder of Biden’s $4 trillion in jobs and family proposals across the finish line, Democrats in the House and Senate will first have to pass a budget resolution that would tee up follow-on legislation with the rest of Biden’s agenda. That would allow them to fast-track the bill through the Senate with a simple majority vote — a procedural tactic known as reconciliation — bypassing any Republican effort to block it with a filibuster.
House Budget Committee Chairman John Yarmuth plans to work on a budget blueprint the week of July 12. Senate Budget Committee Chairman Bernie Sanders has not yet set a date for his committee to begin work. He told reporters last week that he wants a $6 trillion package, though several moderates have balked at that figure.
Democrats will have to agree on a limit over how much the so-called reconciliation package can add to the deficit. They will also have to agree on topline spending levels for regular appropriations and are expected to provide for an increase in the debt limit later this year as well.
It could take Democrats months to draft what is now likely to be one massive package jammed with as much of Biden’s economic agenda as they can get all 50 senators who caucus with Democrats and a House majority to approve.
But the fast-track process for bypassing filibusters is subject to arcane rules on what can be included informally ruled over by the parliamentarian. Items have to relate to the budget to qualify.
And the bill also is wide open to amendments. Senate Republicans will be able to offer changes designed to either try and split Democrats or pile up difficult votes that they plan to exploit in next year’s midterm elections. That process took a 25-hour marathon of votes when the Senate passed Biden’s $1.9 trillion coronavirus relief bill in March.
Any Democratic absence or defection in the 50-50 Senate could delay or even kill the bill. In the House, Democrats can’t afford to lose more than four votes.
Every progressive interest group and faction will be pushing to attach their favored legislation on topics as varied as curbing climate change, slicing prescription drug prices, expanding Medicare and adding a path to citizenship for unauthorized immigrants. Lobbyists for affected industries and the wealthy will be seeking carve-outs or to kill the package entirely.
And Democrats are not yet united behind Biden’s tax increases. Some want to revive the full state and local tax deduction — a pricey item that would primarily benefit the wealthy that the White House has not yet proposed — while others oppose Biden’s proposal to tax unrealized capital gains at death in excess of $1 million.
Read More: Biden Rebuff on Gas Tax Casts Doubt on Infrastructure Deal
A move to accommodate one faction’s concerns would shrink the money available for spending somewhere else.
The longer the process drags on, the closer the 2022 midterm elections, potentially making lawmakers more reluctant to take tough votes. Democrats like Schumer are wary of a repeat of the Affordable Care Act battle in 2009 and 2010, which took months longer than they hoped in part because of failed bipartisan talks, while issues like climate and immigration languished. That was followed by a massive Republican wave in the 2010 midterm elections
–With assistance from Erik Wasson and Laura Litvan.
To contact the reporter on this story:Steven T. Dennis in Washington at sdennis17@bloomberg.net
The Biden administration is giving hospitals and other providers even more time to use coronavirus relief money and apply for more.
Yet many of the larger, wealthier hospitals have been back to normal operations for months — and they posted banner profits in 2020.
Hospital admissions declined precipitously in the early months of the pandemic, as providers cut down on elective procedures and many patients stayed away for fear of the virus, but by summer 2020 they were at 90 percent of levels in previous years. By the end of last year, overall health spending was up 3.4 percent compared to 2019.
An analysis from Kaufman Hall found that hospital operating margins rose by more than 100 percent between April 2020, at the start of the pandemic, and April 2021. The report noted, however, that hospitals have seen a big increase in expenses, and margins remain thin.
Ge Bai, an expert on health-care finance at Johns Hopkins, questioned whether the extension on funding this late in the game was a good use of taxpayer money.
“Right now, the hospitals have already resumed their normal operations, and most of the hospitals are capable of overcoming short-term financial difficulty,” Bai said.
Between a faster-than-expected recovery in patient volumes and an influx in funding, some big hospital systems found themselves flush with cash during the pandemic.
HCA Healthcare, one of the nation’s largest hospital chains, finished 2020 with increased profits compared to the previous year. The health-care giant ended up returning $6 billion in relief from the government.
Other wealthy hospitals such as Baylor Scott & White Health, the largest nonprofit hospital system in Texas; Mayo Clinic; Pittsburgh’s UPMC; and NYU Langone Health all recorded hundreds of millions in surpluses, according to a Kaiser Health News report.https://30472cc52713179365a86f069617ac1b.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
A Kaufman Hall report found that with the federal funding, the hospital operating margins were 2.7 percent. Without funding, they would have been 0.3 percent.
Hospitals and other providers were told that they needed to use their coronavirus relief money by June 30, but under pressure from industry and lawmakers, the Biden administration announced earlier this month changes that will allow more time to most providers who received money after June 30, 2020.
Some providers say the extension was necessary given burdensome reporting requirements and delays from HHS in getting funds out the door.The administration is facing pressures from lawmakers to get money out quickly but also provide more oversight. The agency has yet to distribute about $24 billion from the original allocation.
HHS Secretary Xavier Becerra told Congress last month that the administration would work on ensuring “the money goes to those who need it most.”
Rick Pollack, the president of the American Hospital Association, welcomed extra time, calling the relief money a “lifeline” and pointing out that the nation’s hospitals are continuing to respond to thousands of new cases a day.
“Hospitals and health systems continue to incur expenses related to these COVID-19 cases and hospitalizations, such as ensuring an adequate workforce, acquiring equipment and supplies such as personal protective equipment, pharmaceuticals and safety equipment, administering vaccines and maintaining testing and additional screening for patients and visitors,” Pollack said.
HHS is facing scrutiny over the $178 billion relief effort, which often favored larger and wealthier providers.A February report from a congressional advisory commission found that fewer than 1 in 5 providers who accept payment from Medicaid and the Children’s Health Insurance Program, the safety-net insurance for children, but not Medicare have received relief funds. The report found that many pediatric and behavioral health providers were left out of relief funding.
Many hospitals that are smaller, poorer or more rural also face bleak financial prospects after the pandemic. Some of these struggling hospitals have been scooped up by larger, more successful hospitals over the past year. The trend worries experts and lawmakers who say that coronavirus relief to large hospitals was never meant to fuel increased hospital consolidation.
Critics point to HHS’s formula for distributing funds, especially early in the pandemic, as one reason for the uneven recovery.
The first $46 billion of relief from the Cares Act targeted funding based on patient revenue. This advantaged hospitals with a greater share of privately insured patients and hurt providers that serve large numbers of uninsured or Medicaid patients.
Experts say that HHS used this formula because it was a way to get initial funds out quickly.
“There was a lot of pressure to get money out the door, and this was the fastest way for the federal government to do that,” said Tricia Neuman, the director of the Kaiser Family Foundation’s Medicare program.
But it came with drawbacks. A Kaiser Family Foundation study found that the hospitals with the greatest share of private insurance revenue received more than double the federal relief funding compared to those where private insurance made up little of overall revenue.
While later allocations did more to target funding toward safety-net and rural hospitals, Bai points out that well-resourced hospitals and larger systems were often still at an advantage with policy teams, lawyers and other resources to apply for grants.
“Eventually we have a winner-take-all situation, meaning that if you are larger, you get more. If you’re smaller you get less,” Bai said.
The Health and Human Services Department is withdrawing a proclamation broadly calling on drugmakers to offer hotly contested price discounts for low-income health-care providers in an attempt to fend off litigation, but the agency won’t back down from fighting individual companies.
The HHS’ 2020 advisory opinion calling on pharmaceutical companies participating in the government’s 340B program to deliver drugs purchased by health centers to their contract pharmacies has been withdrawn in the “interest of avoiding confusion and unnecessary litigation,” the agency said in a June 18 court filing.
The withdrawal, however, “does not impact the ongoing efforts” to hold individual drugmakers accountable for limiting discounts, the HHS said in the filing.
The department’s rescinding of the advisory opinion follows lawsuits from drugmakers like AstraZeneca Pharma LP, Eli Lilly and Co., and Sanofi Aventis U.S. LLC that challenged the opinion, and it marks a blow to low-income health providers who allege they’re being cut off from discounts.
The HHS in Mary determined those drugmakers and others violated federal law by restricting discounts to covered entities via arrangements with contract pharmacies, and that they must immediately offer price cuts.
The HHS in Friday’s filing said this “enforcement process” functions “independently from the Opinion’s withdrawal.”
The advisory opinion on June 16 suffered another setback in AstraZeneca’s lawsuit. The U.S. District Court for the District of Delaware ruled that the HHS opinion was flawed and not the only way to view the law governing the 340B program.
However, the court declined to cut the advisory opinion down outright, allowing the HHS and the drugmaker to weigh in before the next move.
The HHS said it disagrees with the decision in the AstraZeneca case but is nevertheless withdrawing the opinion.
The case is Sanofi-Aventis U.S., LLC v. United States Dep’t of Health & Human Servs., D.N.J., No. 21-cv-00634, Notice 6/18/21.
To contact the reporter on this story: Ian Lopez in Washington at ilopez@bloomberglaw.com
The public option insurance plan has fallen off the national radar, despite being a major point of contention between moderates and progressives just a year ago during President Biden‘s campaign.
But rather than holding Biden’s feet to the fire on the issue, progressives are concentrating on other health care priorities, like ensuring drug pricing reform and expanded Medicare are included in a massive infrastructure package.
“Crafting a public option is much more difficult than lowering the Medicare eligibility age and expanding benefits,” said Rep. Pramila Jayapal (D-Wash.), chairwoman of the Congressional Progressive.
“That’s where we are going to focus our attention at this moment. That doesn’t mean we’ve given up on the rest of the pieces. But I do think at this moment what we can immediately do is lower the Medicare eligibility age, add benefits and address prescription drug pricing,” Jayapal said.
Biden’s time in office has been consumed primarily with responding to the coronavirus pandemic, and the window to enact other parts of his ambitious agenda, like infrastructure, is now rapidly closing.
Outside advocates and Democrats say they haven’t given up on pursuing a government-run health care plan, but there’s an acknowledgement that a lot of legislative legwork is needed on that front.
Last month, Sen. Patty Murray (D-Wash.) and Rep. Frank Pallone Jr. (D-N.J.), who are in charge of health committees in their respective chambers, announced their intention to craft a public option bill.
Their process is just getting started, and there are numerous competing ideas on what a public option should look like at the national level. Pallone and Murray asked for feedback from key stakeholder groups, as well as the general public, on some of the most basic but thorny questions.
Frederick Isasi, executive director of the liberal advocacy group Families USA, said that while a public option remains important, he wants to focus on items that might be able to pass quickly.
“The No. 1 question for us is what can we get done to move the ball forward? Our window for doing that congressionally is not very long. It’s a matter of a few more months to tee things up before we hit next year’s cycle,” Isasi said.
“The most important question is what is achievable, what is real, and significant? This is not the drawing board phase for the things that will be happening this year,” he added.
Rep. Jan Schakowsky (D-Ill.) said Democrats are largely focused on passing H.R. 3, the sweeping drug pricing bill backed by Democratic leadership.
“I think it’s definitely more a conversation about drug pricing right now than about a public option. The personnel decides, and the Speaker decides. If this is an immediate issue, it will be,” she told The Hill.
Former President Obama abandoned the public option when drafting the Affordable Care Act (ACA) in order to secure the needed votes from moderate Democrats, to the outrage of progressives.
Biden campaigned on creating a public option, touting it as a way to reduce costs without completely ending private insurance, in contrast to “Medicare for All.” The Medicare-like government insurance plan backed by Biden would be sold on ObamaCare’s marketplaces.
Biden said his proposal would cost $800 billion, as opposed to the estimated $32 trillion to enact Medicare for All.
But while the president’s $6 trillion budget unveiled last month expressed support for creating a public option, it was not included in the funding request.
“I think you have to, you have to choose your battles, and I don’t quibble with the fact that the administration made the decision to prioritize COVID relief and infrastructure. I think that’s probably the right way to go,” Sen. Chris Murphy (D-Conn.) told The Hill.
Murphy said without a push from the White House, it may be difficult to build momentum behind a public option, especially since most of the health care industry opposes any kind of government-run insurance plan.
Health care companies argue a public option would not reimburse providers enough, and would pull customers away from traditional insurance plans by offering cheaper premiums.
Still, Murphy said he thinks it would be easier to sell Americans on the benefits of a public option than it was to promote ObamaCare.https://f67e4b9973a8a8eadf7b38afca45852e.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
“The ACA was hard to understand. It was complicated. Worthwhile, but complicated. A public option — everybody should have the ability to buy a Medicare plan if they want. It’s really easy to message,” Murphy said.
Some progressives have never fully embraced a public option the way they did Medicare for All, because a public option would not abolish private insurance. Those lawmakers see expansions of health coverage as a stepping stone to Medicare for All.
House and Senate Democrats are currently eyeing a $6 trillion reconciliation proposal that would advance Biden’s infrastructure agenda and include lowering Medicare’s eligibility age to 60, broadening the program’s benefits to include vision, dental and hearing, and reducing the cost of prescription drugs.
“Most of the progressives believe that ultimately we should have a strengthened Medicare for All, and the steps that will get us there are the most important. And that’s why you see us prioritize the expansion of Medicare and the strengthening of Medicare,” said Rep. Ro Khanna (D-Calif.).
“Though we would vote for a public option,” Khanna added.
The public option insurance plan has fallen off the national radar, despite being a major point of contention between moderates and progressives just a year ago during President Biden’s campaign.
Congressional Democrats are hoping to pass a slew of healthcare priorities later this year aimed at expanding access to coverage and making it more affordable for patients.
There appears to be a broad agreement on the types of healthcare policies that should be in the package, like closing the Medicaid coverage gap and adding dental and vision benefits to Medicare, but details are still being ironed out by committee staff and congressional offices and nothing is certain.
The stakes are high for Democrats who view this as their last chance to accomplish major healthcare reform before the midterms, in which their majorities in the House and Senate are on the line.
“I think there is a common denominator around what people want and a growing alignment around expectations,” said Eliot Fishman, senior director of health policy at Families USA, which advises Democrats on issues like the ACA and Medicaid.
House and Senate Democrats are hoping the package will close the coverage gap in non-Medicaid expansion states, add dental and vision benefits to Medicare, permanently expand ACA subsidies to middle-income earners, lower deductibles in the marketplace, lower drug prices, expand access to home-and-community based services and address maternal mortality.
They’re likely to use reconciliation – a budget maneuver that only needs 50 votes to pass and can’t be filibustered – but for it to work, all Democrats must be on the same page – a heavy lift for the narrow House and Senate majorities.
The current thinking is Congress will pass a bipartisan bill focused on “hard” infrastructure, like roads and bridges, followed up with a Democrat-only reconciliation bill that fulfills key parts of President Biden’s so-called “jobs” and “families” plan.
“There’s no unity or consensus yet, but there is a facsimile of that – there’s an agreement of the contours of what it’s going to look like,” said Alex Lawson, executive director of Social Security Works, which works with progressive Democratic offices on issues like drug pricing and Medicare expansion. Here are some of the provisions that could end up in a reconciliation bill, which Democratic leaders hope to pass this fall.
Closing the Medicaid expansion gap
A top priority for Democrats in the House and Senate is closing the coverage gap in the 12 states that have rejected the Affordable Care Act’s Medicaid expansion.
The ACA allowed states to expand Medicaid to low-income adults making about 138% of the federal poverty level – or about $17,000 per year for an individual. It has helped insure more than 14 million people, except in states that rejected the expansion in protest of the politically controversial ACA.
“I’m convinced if you gave Texas a buck and a half, the ideological objections is such that they would not accept it,” said Rep. Lloyd Doggett (D-Texas.)
Congressional aides including Senate Finance Chairman Ron Wyden’s office are looking at several possibilities to close that coverage gap, including extending ACA subsidies to those people so they can buy insurance on the exchanges. Doggett introduced a bill that would allow localities to go around states to expand Medicaid within their jurisdictions.
“I’m just here to try to find a practical way that we can include in reconciliation that will get this job done,” Doggett said.
About 2.2 million people fall in the coverage gap, making too little to qualify for ACA subsidies to buy individual market insurance but also not qualifying for their state’s Medicaid programs, which traditionally only covers very low-income people, pregnant women and people with disabilities.
Often they go uninsured, which saddles hospitals with uncompensated care.
The last COVID-19 relief bill offered increased Medicaid funding to non-expansion states to incentivize them to expand their programs, but none have taken the bait.
Medicare expansion
Progressive Democrats also want to lower the Medicare eligibility age from 65 to 60 and add dental, vision and hearing benefits.
“That’s going to be in there,” Senate Budget Committee Chairman Bernie Sanders (I-Vt.) told reporters this week, referring to the reconciliation bill his committee must write a resolution for by July.
“To me, it is incomprehensible that in the richest country in the history of the world, that if you are 80 years of age, you may not have any teeth in your mouth to digest your food, you may not be able to hear your grandchildren speaking. We have to address that issue and we will address that issue.”
Hospitals and insurers are opposed to lowering the Medicare eligibility age, because it would result in fewer people having commercial insurance, which tends to pay providers more than public coverage. Lowering the eligibility age is most likely to fall off the radar, according to people working on reconciliation, but adding dental, vision and hearing benefits stands a better shot of passing.
Lowering drug prices
Democrats hope to pay for those added Medicare benefits through a reconciliation provision that would lower drug prices.
Senate Finance Chair Wyden is working with senators on a bill that would allow HHS to set prices for drugs covered by Medicare. Currently, the federal government is not allowed under law to interfere in private negotiations between drug makers and plan sponsors, which Democrats results in Medicare paying too much for drugs.
“I’m talking to senators, getting ready to put some ideas down on paper. That’s what you got to do when there’s a 50-50 Senate,” Wyden said this week.
The nonpartisan Congressional Budget Office (CBO) estimated a similar bill passed by the House last year that included that provision could save the government $500 billion over 10 years.
Expanding home-and-community based services
Sen. Bob Casey (D-Penn.) told Modern Healthcare “it’s the plan” to get the $400 billion for the expansion of home-and-community based expansion into reconciliation, noting that Democrats are pretty united on the issue.
The details are expected to be released in a couple of weeks, but it would likely involve giving states more funding to move people off the wait lists for those services. Because Medicaid coverage of HCBS isn’t mandatory, many states have wait lists for those services, with nearly 1 million people on it.
Expanding HCBS also has the backing of President Joe Biden.
Congress would likely tie that funding to requirements for better benefits and increased wages for caregivers, who make on average about $12 an hour and are disproportionately women of color.
More ACA subsidies and lowering deductibles
While the most recent COVID-19 relief bill extended ACA subsidies to middle-income earners, that provision expires in 2023.
The reconciliation bill is expected to permanently expand those subsidies while potentially lowering deductibles for people in the marketplace. That provision could involve expanding cost-sharing assistance or tying premium tax credits to a more comprehensive Gold plan.
“These policies enjoy support from across the ideological spectrum within the Democratic caucus and need to be a part of the discussion when the Senate considers legislation to bring down health care costs,” said a Democratic aide.
Maternal health
More than 160 members of Congress are urging House and Senate leaders to include in the reconciliation bill several provisions aimed at improving maternal health and access to coverage for new moms.
Led by Rep. Lauren Underwood (D-Ill.), the members asked the bill to extend Medicaid coverage for 1 year postpartum to new moms,
Under the law, coverage ends 60 days postpartum.
The most recently-passed COVID-19 relief bill gives states the option of extending Medicaid for a full year postpartum, but it expires in 2027 and is optional for states.
“We cannot afford to take coverage away from new moms at a time when they need it most,” the lawmakers wrote in the letter.
On Friday, June 11, HHS announced that it is extending the deadline by which hospitals and other providers that received Provider Relief Fund (PRF) payments must use their COVID-19 PRF payments. Doctors, hospitals, and other healthcare providers that received Provider Relief Fund (PRF) money after June 30, 2020, will now have 90 days to report payments received from the government’s coronavirus relief fund after the HHS extended the deadline from 30 days. The HHS Announcement also extends the amount of time providers will have to report information on the use of their PRF money.
WSC Brief – PRF Spending and Reporting Extension – 6.15.21
The U.S. health-care law known as Obamacare spent its first decade dodging a series of existential risks. By a single vote in the Senate, the law survived a repeal attempt in 2017 pushed by then-President Donald Trump. The Supreme Court shut down the latest challenge in a 7-2 decision that denied Republican states’ challenge to the law’s constitutionality. Joe Biden’s presidency could give Obamacare (more formally, the Affordable Care Act) a chance to grow beyond its initial scope. Biden pushed for the law as vice president under President Barack Obama.
Most of it, including tax subsidies to help people afford coverage and, in 39 states (including the District of Columbia), expanded eligibility for Medicaid, the U.S. health insurance program for low-income Americans. Key Obamacare consumer protections that also remain in place allow children to stay on a parent’s policy until age 26, require insurance companies to treat people with preexisting conditions equally and prohibit the imposition of annual or lifetime coverage limits.
Roughly 20 million. About half joined Medicaid as a result of the expanded eligibility. The rest found coverage by comparison-shopping among private insurers at government-run online marketplaces, where subsidies help people afford coverage. (The expanded version of Medicaid enrolls most adults earning up to 138% of the poverty line.) Even with Obamacare in place, 28.9 million Americans lacked coverage in 2019, two million more than in 2016, according to the Kaiser Family Foundation. The U.S. is an outlier among developed countries by not having universal health coverage.
Obamacare originally required all states to participate in the expanded Medicaid program; the Supreme Court, in a 2012 split ruling that upheld most of the law, struck down the requirement. The law as written also required all Americans to buy health insurance — the so-called individual mandate — at risk of a tax penalty. The Trump administration whittled away at Obamacare with executive actions, including one that cut funding for so-called navigator programs that help sign people up. A tax overhaul passed by Republicans and signed by Trump in 2017 eliminated the penalty for noncompliance, rendering the mandate moot. That paved the way for the broader constitutional challenge to the law that the Supreme Court rejected in June.
He campaigned on a pledge to expand the program by offering a government-provided alternative to private insurance that’s known as a public option, a proposal he’s called “Bidencare.” It would be available to all Americans, including those who get their insurance through work. Low-income Americans would be automatically enrolled and, if eligible, their premiums would be free. Though he hasn’t released further details since taking office, his plan set him apart from the progressive wing of the Democratic party, which has pushed the idea of achieving universal coverage by scrapping private insurance and replacing it with “Medicare for All.”
He reopened the federal Healthcare.gov market from Feb. 15 to Aug. 15, allowing more people who are uninsured during the pandemic to sign up for health coverage. Biden’s fellow Democrats in Congress passed a $1.9 trillion Covid-19 relief package that increased Obamacare subsidies for two years and offered more money to the 12 states that haven’t expanded Medicaid if they start covering the law’s newly eligible adult population. Democrats may look to make some of those changes permanent.
Some economists worry about a “death spiral” of rising costs in the absence of a mechanism, like the individual mandate, that forces healthy Americans to get covered, since healthier people buying coverage keeps costs down for sick people. That’s one issue. Another is the limited coverage options available to Americans in rural and remote parts of the country. And in the mostly Republican-led states where elected leaders have declined to expand Medicaid eligibility, many residents fall in a coverage gap, earning just enough income that they don’t qualify for subsidies.
U.S. public opinion of the law was mostly negative from its passage in March 2010 until Trump became president and sought to repeal it, according to tracking surveys by the Kaiser Family Foundation. The threat of elimination — which failed when the late Senator John McCain of Arizona gave a memorable thumbs down in an early morning vote in 2017 — put a spotlight on popular provisions of the law, notably its prohibition on insurers charging sick people more for coverage and its list of “essential health benefits,” like hospitalization and maternity care, that must be covered. Kaiser’s tracking survey found in May that 53% of Americans viewed the law favorably, while 35% viewed it unfavorably.
The Federation for American Hospitals (FAH) on Tuesday offered three recommendations for the surprise billing rulemaking: The administration should ensure adequate stakeholder engagement, avoid policies that would create de facto benchmarks based on qualified payment amounts or advantage health plans over providers, and ensure notice and consent provisions allow exceptions for providers unable to comply.
On Friday, June 11, HHS announced that it is extending the deadline by which hospitals and other providers that received Provider Relief Fund (PRF) payments must use their COVID-19 PRF payments. Doctors, hospitals, and other healthcare providers that received Provider Relief Fund (PRF) money after June 30, 2020 will now have 90 days to report payments received from the government’s coronavirus relief fund after the HHS extended the deadline from 30 days. The HHS Announcement also extends the amount of time providers will have to report information on the use of their PRF money.
The House Appropriations Committee is slated to begin marking up its fiscal 2022 budget this week.
As President Joe Biden makes the case for democracy overseas, his agenda back home is facing major obstacles in Washington, where early progress on several key items has stalled in Congress.
Plodding negotiations and calls to drop bipartisan overtures could imperil — or even unravel — headway on infrastructure, police reform and voting rights. And a raft of revelations about former President Donald Trump’s Justice Department is threatening to draw focus on Capitol Hill elsewhere this week.Here’s where things stand in Congress:
Here’s where things stand in Congress:
The coming days will bring a better sense of where lawmakers stand on the $1.2 trillion infrastructure package that a bipartisan group of 10 senators announced last week.While the deal amounted to the most significant development yet in negotiations, the effort is already facing stiff resistance from liberal Senate Democrats eager to abandon bipartisan talks.
“Let’s face it. It’s time to move forward,” Sen. Elizabeth Warren, a Massachusetts Democrat, told CNN last week about the talks with the bipartisan group. “The Republicans have held us up long enough.”
While the group didn’t publicly reveal specifics of the agreement, several sources told CNN they crafted a package that includes:
$1.2 trillion of spending over eight years$974 billion spent over the first five yearsThe plan calls for $579 billion dollars of new spending.The spending will be focused on core, physical infrastructure.The plan will be paid for without tax hikes.
Many of the specific details still need to be ironed out.
“We’re focusing on the traditional infrastructure definition: roads, bridges, airports, seaports, waterways, highways, broadband, and I think that makes sense,” GOP Sen. Susan Collins told CBS’ “Face the Nation” on Sunday.
But many Republicans are wary that the price tag is too high, while many Democrats prefer a much more ambitious and expensive plan that they think will boost the economy, aid the climate and create jobs.
The result is a two-track path for Democrats: Party leaders say they are pursuing Biden’s massive infrastructure and social safety net package along both bipartisan and partisan lanes. Senate Majority Leader Chuck Schumer is preparing to begin the budget process next month, setting the stage for advancing a bill along straight party lines, something that can only succeed if all 50 Democrats endorse such a process known as reconciliation.Where the White House comes down on the plan will matter a lot. While many Democrats expressed concerns that their party’s negotiators were giving up too much in the talks, if the President endorses the plan, it could force many to fall in line.
“The President appreciates the Senators’ work to advance critical investments we need to create good jobs, prepare for our clean energy future, and compete in the global economy,” White House spokesman Andrew Bates said in a statement last week.
House Speaker Nancy Pelosi, for her part, said Sunday she’s “very pleased” that a deal was reached, but she warned the proposal might be a tough sell to the House Democratic Caucus if more isn’t included.
“I do think that it is predicated on an infrastructure that is of the last century. We have to be thinking in a more forward way. We must build back better. So if this is something that can be agreed upon, I don’t know how we can possibly sell it … to our caucus unless we know there is more to come,” she told CNN’s Dana Bash on “State of the Union.”Policing overhaul talks up against the clock
Deliberations over a broad policing reform bill remain stalled on a number of key issues as negotiators race to meet their deadline for an agreement before the end of June, when a two-week July Fourth recess begins.
GOP Sen. Tim Scott of South Carolina, the top Republican negotiator, described to CNN last week how in addition to resolving the stark differences over qualified immunity — which deals with whether individual officers could be sued for wrongdoing as Democrats want but Republicans reject — there are still challenges in combining the Democrats’ House-passed George Floyd Justice in Policing Act with the Senate Republicans’ JUSTICE Act.
“It’s a little more complicated than just the top four or five issues that we’ve been covering, because the devil in the details of the actual body of the pieces of legislation are complicated and there are very big differences,” he said.
Asked by CNN why the talks, which have stretched on for many weeks, are taking so long, Scott said combining the two very large bills is proving to be complicated. “Have you read the two bills? They’re long,” he said. “So, I don’t mean that to be sarcastic. In all honesty, comparing the two bills, and then coming to a solution on the two sides is really hard.”Sen. Cory Booker, the key Senate Democratic negotiator, agreed Thursday that there’s “a lot of work to be done” but maintained that the parties can still reach an agreement by the end of the month.
“I think we are days, but that could be 30 days or 25 days, who knows, and there’s a lot of work to be done in a very short period of time,” the New Jersey Democrat told reporters, when asked whether the negotiators are days away or far from reaching a deal.
Pressed on whether he’s concerned about some progressive organizations not wanting a compromise on qualified immunity, Booker said, “I’m going to get the best deal we can possibly get, and if it’s not making substantive and meaningful reform that will, you know, create more transparent policing, more accountable policing and potentially save lives then I don’t think there’s any reason to do it.”
Supporters of the George Floyd Justice in Policing Act say it would boost police accountability and help eradicate racial bias in policing.
While Biden has said he supports the bill, some leaders say if Congress won’t act, they want to see the White House reviving Obama-era panels to review policing practices and investigating police agencies in more cities. Other civil rights activists, however, say the nation needs police reform legislation more than anything and they are hopeful that Congress will pass it and Biden will sign it.
Progressive groups move to pressure Senate on voting rights
While Schumer has said he will put the For the People Act (or S 1) — a sweeping election and voting rights package — on the floor this month, the legislation currently doesn’t have the votes to advance.
The broad package, which was passed by the House in March, would bar states from limiting voting by mail, would require prepaid postage on absentee ballots and would mandate voter registration on the same day as the election. It also effectively would overturn voter ID laws by requiring states to allow voters to submit sworn statements in lieu of identification.
The bill’s proponents are expected to hammer out changes to the roughly 800-page bill to make it more palatable to all members of their caucus and address the concerns of local election officials.
The current version, for instance, mandates 15 consecutive days of early voting with polls open at least 10 hours a day. But Sen. Amy Klobuchar of Minnesota, one of the Democrats guiding the measure through the Senate, has sought to exempt jurisdictions with fewer than 3,000 registered voters and those that mail ballots to all voters, following feedback from election officials.
Democratic Sen. Joe Manchin of West Virginia is the only Democrat who is not a co-sponsor of the original legislation, but other Democrats have expressed concerns with the current draft of the bill in private meetings.“I believe that partisan voting legislation will des
troy the already weakening binds of our democracy, and for that reason, I will vote against the For the People Act. Furthermore, I will not vote to weaken or eliminate the filibuster,” Manchin wrote in an op-ed published in the Charleston Gazette-Mail last week.
Activists say they are preparing for a range of outcomes, including an all-out drive against the filibuster during the senators’ July Fourth recess, if the bill falters in the Senate later this month.
The showdown in the chamber will play out as more GOP-controlled states move ahead with limits on voting, inspired by former President Donald Trump’s unfounded claims that voter fraud contributed to his White House loss in 2020.
As of late last month, 14 states had enacted at least 22 laws restricting ballot access since the 2020 election, according to the Brennan Center for Justice at New York University School of Law, with an additional 61 bills advancing through legislatures in 18 states.
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