|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
Elizabeth Warren outlines her 100-day healthcare plan
Democratic presidential candidate Sen. Elizabeth Warren (D-MA) used Wednesday night’s debate in Atlanta to outline a new healthcare transition plan released by her campaign this week. Earlier this month the candidate provided a detailed plan to pay for “Medicare for All” (M4A), the approach to single-payer, universal coverage she favors. The plan she unveiled this week addresses the healthcare agenda for her “first 100 days”, and how she proposes to approach the rollout of M4A. She intends to use the budget reconciliation process in the Senate (assuming Democrats take control) to bypass a Republican filibuster and institute a “public option” for those over 50 to buy into an “improved Medicare program” with expanded benefits, free coverage, auto enrollment, and negotiated drug prices. A second M4A option would be made available to everyone else, free for those making under 200 percent of the federal poverty line, and with limited premiums for others. After three years, she would then put forward more comprehensive M4A legislation that eliminates private coverage and institutes a single-payer framework. Supporters of more robust M4A immediately criticized the transition plan as “backpedaling”, worried that Warren would never actually be able to implement full single-payer healthcare. If true, that puts her more in line with her moderate Democratic competitors, who have introduced similar public option plans of their own. Perhaps for that reason, discussion of M4A absorbed relatively little airtime in the latest debate, compared to earlier rounds. We continue to view M4A as more of a political rallying cry than a plausible policy outcome, but Warren’s new transition plan is as detailed as anything we’ve seen. Should she get elected, the question will be: does she expend political capital on M4A, or pursue her broader wealth-redistribution plans first? Doing both may be an impossible political lift.
North Carolina’s Medicaid overhaul is put on hold
As anticipated, North Carolina’s contentious and long-awaited Medicaid overhaul was put on indefinite hold this week, because of a disagreement between the governor and legislature over the state’s budget. A last-minute bill passed by the Republican legislature to fund the transition separately from the broader budget was vetoed by Democratic Gov. Roy Cooper. In part, the budget dispute revolves around Cooper’s desire to expand Medicaid eligibility as part of the funding plan, which the legislature refused to do. Medicaid beneficiaries have already begun to enroll in the new Medicaid managed care plans, which were slated to go into effect in February of next year. However, the lack of funding for the program has forced the state to initiate a “wind-down” process, leaving the state’s 1.6M Medicaid recipients in the traditional fee-for-service program for now. North Carolina is one of the few remaining states that has not yet moved its Medicaid recipients into private managed care coverage, and the pending overhaul was approved in 2015 by a majority Republican state legislature.
The current budget battle is another example of how the debate over Medicaid has come to dominate states’ political dynamics, as the cost burden of the coverage program consumes an ever-larger chunk of state budgets. Just across the state line, Tennessee this week formally submitted a request to the Trump administration to allow it to turn its Medicaid program into a block grant model, giving it greater flexibility over how it pays for the program. It remains unclear whether the Centers for Medicare and Medicaid Services (CMS) has the legal authority to approve such a move—a question that will surely be decided by the courts. Meanwhile, North Carolina is emerging as a proving ground not just for Medicaid transformation but for a wide variety of new approaches aimed at controlling the rising cost of care and driving innovation in care delivery. More on that below.
In the immortal words of Jerry Seinfeld…Glamour?
Coming on the heels of a flurry of announcements of policy measures to increase transparency in healthcare, new revelations regarding contracting practices at CMS may have some in Washington wishing for a little less openness. As reported this week by Politico, officials at the agency engaged public relations consultants for a $2.25M contract to provide suggestions for how to boost the profile of CMS Administrator Seema Verma, including by having her profiled by Glamour magazine and other media outlets. The story was first uncovered in March by intrepid healthcare reporter Dan Diamond (our former colleague—miss you, Dan!), best known for breaking an earlier story that led to the firing of former Health and Human Services (HHS) Secretary Tom Price. According to Diamond’s reporting, CMS paid consultants hundreds of thousands of dollars for “strategic communications” support over the course of two years, much of it aimed at crafting a publicity plan for Verma, who has played a much more visible, and political, role in advancing the administration’s healthcare agenda than her predecessors. Verma faced tough questioning about the PR contracts from Rep. Joe Kennedy (D-MA) in House oversight hearings last month, although the use of consultants was halted after Politico began reporting on them earlier this year. While Kennedy made the valid point that money spent on PR could be better spent on providing health coverage to kids, we’re willing to believe that a more thorough campaign to educate the public on policy initiatives is a worthy idea. Less clear, though, is why Verma’s personal profile seems to have been a focus of the effort. We’d rather see George Costanza and other readers of Glamour get more information on how to shop for healthcare services, or how to make smarter decisions about how to get the most out of their coverage. Or perhaps the best use of public relations dollars would be to restore funding to the Navigator program, aimed at helping individuals sign up for coverage on HealthCare.gov—especially given the lagging results of this year’s open enrollment season thus far.