Schaeffer Initiative for Innovation in Health Policy
 
 
 

Schaeffer Initiative for Innovation in Health Policy

A partnership between the Center for Health Policy at Brookings and the Leonard D. Schaeffer Center for Health Policy & Economics, the USC Schaeffer Initiative for Innovation in Health Policy aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.

RESEARCH

Effects of the More Austere Medicaid Per Capita Cap Included in the Senate's Health Bill

Last month, we analyzed how states and the federal budget would have fared had a Medicaid per capita cap like the one envisioned in the House-passed American Health Care Act (AHCA) been implemented in the recent past. On June 22, the Senate released a “discussion draft” of their Affordable Care Act repeal bill: the Better Care Reconciliation Act of 2017 (BCRA). The BCRA also includes a Medicaid per capita cap, but that proposal differs in important ways from the one passed by the House.Read the full paper here. 

Would Price Transparency for Generic Drugs Lower Costs for Payers and Patients?
Steven Lieberman and Paul Ginsburg provide background information on generic prescription drug pricing and outline a proposed policy to generate information on actual average prices paid by retail pharmacies to acquire generic drugs. Read the full paper here

Effects of the Medicaid Per Capita Cap Included in the House-Passed American Health Care Act
Loren Adler, Matthew Fiedler, and Tim Gronniger examine how this change in Medicaid's financing structure would affect states' Medicaid programs. Read the full paper here

Making Health Care Markets Work: Competition Policy for Health Care (JAMA Viewpoint and white paper)
Many studies have examined trends towards increasing consolidation of physician practices and hospitals in the US health care system and the negative effects of decreased competition on the quality of patient care and health care costs.   JAMA Viewpoint Here and White Paper here.  A Forbes Op-Ed on the paper is here


Building a Better "Cadillac"
The excise tax on high-cost health insurance plans, a provision of the Affordable Care Act (ACA), has the potential to achieve two important goals by curbing the open-ended exclusion of employer-financed health insurance from personal income and payroll taxes. It will reduce the incentive to offer health insurance with features that permit or encourage excessive health care spending. It will also generate revenues that offset the costs of health insurance expansion. More

Solving Surprise Medical Bills
Imagine you walk into a hospital for a planned procedure, for example a knee operation to be performed by an orthopedic surgeon. Before you scheduled the surgery, you did your due diligence and confirmed that the surgeon performing the procedure participated in your insurance plan, and that the hospital where you were having the surgery was also in-network. More

How the Money Flows Under MACRA
The Medicare Access and CHIP Reauthorization Act of 2015, referred to most often as “MACRA,” set in motion a new approach to Medicare physician payment and replaced the oft-criticized Sustainable Growth Rate with two new payment schemes. In late April, the Centers for Medicare and Medicaid Services (CMS) released many proposed details surrounding the law’s implementation; however, it is important to keep in mind that the final rule is still forthcoming and may incorporate significant changes in response to public comments made on the proposed rule. More
Comments on CMS's proposed rule for implementation of MACRA provisions
The Center for Health Policy at Brookings, with support from the Schaeffer Initiative for Innovation in Health Policy, a partnership between Brookings and the University of Southern California, submitted comments on a proposed rule to the Centers for Medicare & Medicaid Services (CMS) Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. More

Health Policy Solutions Series

The Schaeffer Initiative offers the new administration and Congress solutions on reforming the Affordable Care Act and the individual health insurance market; improving competition among providers and insurers; making drug pricing more rational; modernizing the Medicare program; and addressing pressing public health challenges. Read the Series >

BLOG POSTS

How the BCRA Would Impact Enrollee Costs, According to your Age

 By: Loren Adler and Paul Ginsburg

Much attention has focused on how the recently-introduced Senate Republican health care bill – the Better Care Reconciliation Act of 2017 (BCRA) – would impact health insurance premiums, both before and after accounting for lower subsidies, and patient cost-sharing in the individual market. More

 

Sen. Cruz’s Proposed Change to Senate Health Care Bill Would Undermine Protections for Enrollees with Significant Health Care Needs
By: Matthew Fiedler

 

Senate Republicans are considering an amendment to the Better Care Reconciliation Act (BCRA) proposed by Sen. Ted Cruz that would relax a range of regulations on individual market insurance plans introduced in the Affordable Care Act (ACA).  While no formal legislative language has been introduced, Cruz’s proposal would allow insurers that offer at least one ACA-compliant plan to offer “non-compliant” plans that do not abide by ACA regulations. More


How Would the Senate’s Health Care Bill Affect Individual Market Premiums?
By: Matthew Fielder and Loren Adler


On Monday, the Congressional Budget Office (CBO) published a comprehensive analysis of the Better Care Reconciliation Act (BCRA), Senate Republicans’ Affordable Care Act repeal legislation. While many reactions to the CBO analysis focused on how the BCRA would affect insurance coverage, the bill’s effects on individual market insurance premiums have also received considerable attention. More

Changes to State Innovation Waivers in the Senate Health Bill Undermine Coverage and Open the Door to Misuse of Federal Funds
By: Jason A. Levitis

On June 22, Senate Republicans released their much-awaited health reform bill, the Better Care Reconciliation Act of 2017 (BCRA). Much attention has rightfully focused on the bill’s myriad changes to the Medicaid program and to subsidies for the purchase of private insurance. But the legislation also makes potentially highly impactful changes to state innovation waivers, which are included in section 1332 of the Affordable Care Act (ACA). More


Like the AHCA, the Senate's Health Care Bill Could Weaken ACA Protections Against Catastrophic Costs
By: Matthew Fiedler

On Thursday, Senate Republicans unveiled the Better Care Reconciliation Act (BCRA), its Affordable Care Act (ACA) repeal bill. One provision of that legislation would greatly expand states' ability to waive a range of provisions of federal law that affect health insurance. More 

Turmoil in the Individual Market- Where it Came From and How to Fix it
Henry J. Aaron, Matthew Fielder, Paul B. Ginsburg, Loren Adler, and Alice Rivlin

In recent weeks, some health insurers have announced that they will not offer individual market coverage in 2018, while others have requested sizable premium increases. In response to this news, President Donald Trump has pronounced the individual market structure created by the Affordable Care Act (ACA) “dead.” Similarly, House Speaker Paul Ryan (R-WI) has claimed that the market is experiencing a “death spiral” reflecting fundamental flaws in the ACA’s design. These claims misdiagnose the situation. The ACA’s individual market structure — though not perfect — is sound and has succeeded in greatly expanding coverage. As 2017 began, the market was poised to leave behind the growing pains of the past few years. Then the President and Congress acted to create needless turmoil. More


To Promote Stability in Health Insurance Exchanges, End the Uncertainty Around Cost-Sharing and Other Rules
by: Erin Trish, Loren Adler, and Paul Ginsburg

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released its first set of regulations affecting the health insurance exchanges created by the Affordable Care Act (ACA) under the Trump administration. In the regulations, CMS indicated that the rule “finalizes changes that will help stabilize the individual and small group [health insurance] markets.”
While it is unclear whether the changes included in the rule will have a small positive or small negative impact on market stability, it is clear that the impact pales in comparison to the  significant instability caused by the lack of commitment from the administration (or Congress) to fund the ACA’s cost-sharing reduction subsidies or to enforce the individual mandate. More
 
by: Tim Gronniger, Matthew Fiedler, Kavita Patel, Loren Adler, and Paul B. Ginsburg

Secretary of Health and Human Services (HHS) Dr. Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma face significant decisions across a range of programs in the first half of 2017. Decisions regarding how the new Administration will approach the health insurance marketplaces rightly command the most attention, but important decisions on payment reform loom as well. More
 
by: Matthew Fiedler

One of the core functions of health insurance is to protect people against financial ruin and ensure that they get the care they need if they get seriously ill. To help ensure that insurance plans met that standard, the Affordable Care Act (ACA) required plans to limit enrollees’ annual out-of-pocket spending and barred plans from placing annual or lifetime limits on the total amount of care they would cover. More
by: Jason Doctor

Opioids provide immediate comfort to a person in pain, but result in other miseries when prescribed on a long-term basis.  Our policy towards opioids over the past two decades has had disastrous results—leading to the worst drug epidemic in U.S. history.  More
by: Loren Adler and Matthew Fielder

On Wednesday a pair of House Committees began considering Republicans’ Affordable Care Act (ACA) repeal legislation, the first formal step toward consideration of that legislation by the full House of Representatives. Congressional Budget Office (CBO) estimates of the effects of this legislation are not yet available, and it appears they will not be available until after both committees have voted on the bill. More
by: Matthew Fiedler

The Centers for Medicare and Medicaid Services (CMS) recently published final data on the number of people who used HealthCare.gov to sign up for health insurance coverage through the Affordable Care Act’s (ACA) Marketplaces during the 2017 open enrollment period. These data support two important conclusions about the state of the Marketplaces and their near-term future. More
by: Loren Adler, Mark Hall, Caitlin Brandt, Paul Ginsburg, and Steven M. Lieberman

More than a dozen states have enacted various protective measures to protect patients from surprise medical bills. This post outlines why federal action is needed and recommendations on how to move forward. More
by: Neeraj Sood, Loren Adler, Paul Ginsburg, and Margaret Darling

A recent study found Medicare Fee-for-Service and Medicare Advantage patients have hospitalization and post-hospitalization costs and outcomes that are generally different. How do these outcomes translate to policy recommendations? More
 
By: Erin Trish

In order to mitigate incentives for insurance companies to avoid sicker patients, policymakers will need to include a risk adjustment program in any replacement reforms that require insurers to issue insurance to any applicant and set limits on adjusting premiums to fully reflect an enrollee's health status.More
By: Loren Adler and Paul Ginsburg

Protecting patients against catastrophic health expenses and medical bill-induced bankruptcy is often cited as the core purpose of health insurance. Yet lifetime limits on coverage and the lack of annual out-of-pocket (OOP) limits, which were commonplace in private insurance before the Affordable Care Act (ACA) banned the practices, negate this central function of insurance (traditional Medicare also lacks an annual out-of-pocket limit). More

Why repealing the ACA before replacing it won’t work, and what might
By: Alice Rivlin, Loren Adler, and Stuart Butler

With Republicans now in control of the Presidency, Senate, and House of Representatives, they have the opportunity to fulfill their repeated promise to repeal and replace the Affordable Care Act (ACA). They banded together to pass repeal alone early this year (albeit knowing it would get vetoed by the president), but no detailed consensus replacement plan has emerged.
More

Key takeaways from the final MACRA rule, plus remaining challenges
By: Kavita Patel, Margaret Darling, and Paul Ginsburg

In early November, the Centers for Medicare and Medicaid Services (CMS) published their final rule on implementation of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), providing the final word on how the law will be implemented for at least its first year.

Passed and signed into law in March-April 2015 by overwhelming bipartisan majorities in the House and Senate, MACRA was a decisive move away from the former Sustainable Growth Rate (SGR) formula that beset physicians with uncertainty surrounding cuts to Medicare rates and frustrated economists by continuously deferring cost-controlling cuts.
More

How the Department of Labor Can Help End Surprise Medical Bills

By: Mark Hall

Each year, millions of Americans seek care at a facility in their insurer’s network or with an in-network physician only to be hit with a surprise bill from an out-of-network provider involved in their care who they did not actively choose. These bills can be very large because out-of-network providers can “balance bill” the patient—meaning that the provider bills a patient for the difference between what the patient’s health insurance will pay and the provider’s “list price” (which can be very large and bears little relation to the rates they usually accept or their costs).
More

Affordable Care Act Premiums are Lower Than You Think
By: Loren Adler and Paul Ginsburg

Since the Affordable Care Act’s (ACA) health insurance marketplaces first took effect in 2014, news story after story has focused on premium increases for certain plans, in certain cities, or for certain individuals. Based on preliminary reports, premiums now appear set to rise by a substantial amount in 2017.

What these individual data points miss, however, is that average premiums in the individual market actually dropped significantly upon implementation of the ACA, according to our new analysis, even while consumers got better coverage. In other words, people are getting more for less under the ACA.
More

5 Takeaways from the 2016 Medicare Trustees Report 
By: Alice Rivlin and Loren Adler

This year’s Medicare Truste

The Center for Medicare and Medicaid Innovation (CMMI, or “the Innovation Center”) recently announced an initiative called Comprehensive Primary Care Plus (CPC+). It evolved from the Comprehensive Primary Care (CPC) initiative, which began in 2012 and runs through the end of this year. Both initiatives are designed to promote and support primary care physicians in organizing their practices to deliver comprehensive primary care services. Comprehensive Primary Care Plus has some very promising components, but also misses some compelling opportunities to further advance payment for primary care services.
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Physician payment in Medicare is changing: Three highlights in the MACRA proposed rule that providers need to know

By: Kavita Pate, Margaret Darling, Caitlin Brandt

The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) just over a year ago signaled a strong and unique bipartisan agreement to move towards value-based care, but until recently, many of the details surrounding how it would be implemented remained unknown. But last week, the Centers for Medicare and Medicaid Studies (CMS) released roughly 1,000 pages that shed more light on how physician payment will hopefully dramatically change for the better.
More