Health Care Matters | December 13, 2024
Post Election Policy Pulse
Implementation of the No Surprises Act is in a period of instability that will carry over to the Trump Administration. With ongoing legal challenges, proposed regulations that haven’t been finalized, and whole provisions of the law that are yet to be implemented, the Trump administration could focus on four major areas of implementation in the months ahead. Read more here:
The probability of confirmation of Trump’s cabinet picks by the Senate is being closely monitored. Read insights here:
RFK Jr. Becomes Latest Troubled Trump Pick (Politico)
Rural Providers Beg Employers: No Retirees in Medicare Advantage
Rural hospitals are urging local employers to not switch retirees from traditional Medicare to Medicare Advantage plans, citing underpayment, administrative burden, and delays in care. This trend has led some hospitals to opt out of MA networks or actively encourage employers to offer traditional Medicare. Rural providers are using this opportunity to further educate employers on the impact these plans have on local health care systems, emphasizing that supporting Medicare Advantage could endanger the survival of nearby hospitals.
Read more here.
Why It Matters
The stability of rural hospitals is essential not only for providing necessary healthcare to communities but also for driving the local economy, as these hospitals are often major employers in rural areas. According to a Chartis 2023 report, the percentage of America’s rural hospitals operating in the red jumped from 43% to 50% in the last 12 months. While this issue is pervasive across the country, facilities in states without Medicaid expansion have consistently performed worse financially than their expansion state counterparts. As these institutions struggle to stay afloat, their role as key healthcare providers and economic pillars in rural communities is increasingly jeopardized, making it crucial to address these financial challenges to ensure their survival and continued contribution to local economies.
When CMS Takes Aim at the Worst Nursing Homes, It Often Misses
The Special Focus Facility (SFF) program was created in 1998 to improve the quality of care for the nation’s poorest performing nursing homes. However, due to funding cuts and staffing shortages, the program struggles to keep up with demand leading to limited improvements in quality and safety at many facilities. Even facilities who are subject to inspection and enforcement activities often regress after leaving the program. CMS and state agencies are underfunded and overwhelmed but CMS has been hesitant to take strong action. The challenge lies in balancing the need to remove underperforming facilities from Medicare and Medicaid with the risk of reducing access to care, especially in rural and underserved areas where long-term care options are limited.
Read here.
Why It Matters
Addressing the shortcomings of the SFF program is essential to prepare for future needs of an aging population. With the aging baby boomer generation, more people will require long-term care in the future. Ensuring nursing homes provide safe, high quality, effective care is crucial to meet the growing demand.
The ineffective oversight and chronic challenges in safety and quality at nursing homes contribute both to poor health outcomes of residents and to increased health care costs for both families and the system as a whole. Policy reform and increased funding for the SFF program is needed to allow it to fulfill its mission of protecting the health and wellbeing of America’s long-term care residents.
Medicaid May Face Big Cuts and Work Requirements
As Republicans prepare to control both the House and the Senate in Washington, conservative lawmakers and policy experts are discussing proposed cuts to Medicaid, potentially slashing funding for its Obamacare expansion and introducing work requirements for beneficiaries. While some lawmakers are advocating for block grants and reduced federal funding, critics are ringing the alarm that these changes will increase the financial strain on states and cause millions to lose coverage. Despite challenges, Medicaid remains in the crosshairs for the new administration’s agenda.
Read more here.
Why It Matters
As outlined in The 80 Million newsletter, there are widespread consequences of Medicaid cuts that bear consideration.
Cuts to federal Medicaid funding would shift costs to state budgets and taxpayers.
Defunding Medicaid would create a significant gap in state budgets.
Medicaid cuts would disproportionately affect children, older Americans, and individuals with disabilities.
Defunding Medicaid would harm Americans who rely on financial assistance for long-term care and community support services and their providers.
A cut to Medicaid is effectively a cut to Medicare.
Medicaid cuts would undermine behavioral health care coverage and access while the nation is in the middle of a mental health/SUD crisis.
Medicaid is a lean, efficient health coverage program; defunding it will lead to eligibility, benefits, and provider payment cuts.
Stripping states of federal Medicaid funding would negatively impact the health care workforce and state economies.
Where We Are Reading
CMS Innovation Center Releases Seventh Report to Congress
The Centers for Medicare & Medicaid Services just published the Center for Medicare and Medicaid Innovation’s 2024 Report to Congress (RTC) (PDF). This seventh report features strategic accomplishments, updates on 37 models and initiatives (including 9 newly announced models), 52 evaluations, and more activities from October 1, 2022 through September 30, 2024.
Read more about the goals and lessons learned from this work.
NAACOS Names Emily Brower Its New CEO
Coral Health Advisors congratulates Emily Brower. With this announcement, NAACOS sets an inspired course for collaboration to improve patient care, access, and cost!
Read the article here.
New VBC Resources
The Health Care Transformation Task Force released a resource overviewing the Centers for Medicare & Medicaid Services TEAM Model.
View the resource here.
