Harris Announces Medicare At Home, Expands Healthcare Agenda
Democratic presidential candidate Kamala Harris announced a new Medicare at Home initiative. She would provide home health aide and other in-home supports for seniors and the disabled in Medicare. This would extend the current scope of benefits officially from short-term home care to chronic home care. I have proposed a comprehensive long-term care program paid through Medicaid and with buy-ins by seniors.
As well, Harris wants to have hearing and vision coverage added to the traditional program.
She would pay for most of the initiatives by expanding Medicare drug price negotiations and instituting pharmacy benefit manager (PBM) reforms.
On other news, Harris is turning up the heat on Trump with a healthcare agenda. The Harris campaign thinks healthcare can be a swing issue and move undecideds to her side.
In addition, a new study in Health Affairs has found that, while Medicare Advantage (MA) extends coverage for dental, vision, and hearing care as supplemental benefits, low-income beneficiaries still face significant access barriers to these services. A survey of MA enrollees conducted in 2018 and 2019 found that 11% reported an unmet dental need, 4% had an unmet vision need and 2% had an unmet hearing need.
Additional articles: https://insidehealthpolicy.com/daily-news/harris-proposes-expanded-medicare-home-health-care-funded-new-drug-price-negotiations and https://www.beckerspayer.com/policy-updates/harris-pitches-medicare-home-care-coverage-3-notes.html and https://thehill.com/policy/healthcare/4922425-harris-adult-caregivers-medicare-benefit-at-home-care-sandwich-generation/ and https://thehill.com/policy/healthcare/4920490-harris-campaign-health-care-prioritizes/ and https://www.fiercehealthcare.com/payers/many-ma-beneficiaries-have-dental-vision-or-hearing-benefits-access-gaps-remain-study-shows
(Some articles may require a subscription.)
#longtermcare #ltss #harris #trump #election2024 #homecare #supplementalbenefits #medicareadvantage #medicare
https://www.modernhealthcare.com/politics-policy/kamala-harris-medicare-home-care-the-view
Primary Care Investment Lacking
A new article in Health Affairs Forefront blog builds a case for increased primary care investment. The authors say the United States has underinvested in primary care for decades. The U.S. spends just 5 to 7 cents of every healthcare dollar versus 12 to 15 cents per dollar in most other developed countries. The article notes that over a third of states are launching initiatives and makes the case that more needs to be done.
The authors note that research finds that increased investment in primary care leads to better quality of care, less need for hospital services, and improved patient experience. It also lowers costs. It calls for sufficient investment, prospective and predictable payments, and alignment across all lines of business.
See my blog this week on the need for a Medicare doc fix to help bolster primary care: https://www.healthcarelabyrinth.com/docs-need-rate-relief-in-medicare-program/
(Article may require a subscription.)
#primarycare #caremanagement #healthcarereform
Texas Medicaid Enjoined From New Contract Awards
A Texas judge has enjoined the state Medicaid agency from moving forward with contracts awarded in a recent Medicaid bid. A number of plans sued to stop it and the judge has found irregularities in how rules and requirements were (and were not) applied.
#texas #medicaid #managedcare
No Surprises Act Lawsuit Focuses In On Plan Non-Payment
Providers are suing Health Care Service Corporation (HCSC), a big Blue, over unpaid No Surprises Act (NSA) awards. Several federal government agencies are weighing in on the side of providers. The chief complaint here is that many plans are simply not making payments after awards. One analysis finds no payments were made 52% of the time, 49% of payments were not made within the required 30-day window, and 33% of payments were incorrect.
A federal court decided that plans are not violating the ERISA self-funding act and an appeal now is being heard in an appellate court. Providers argue courts not being able to enforce payments would endanger providers.
Three-quarters of all awards seem to be going to providers. The law is extremely slanted toward providers. While providers deserve some payments, plans not paying providers may be the only way to force some sort of compromise on the misdirected arbitration process.
#nsa #nosurprisesact #providers #healthplans
https://www.fiercehealthcare.com/payers/vocal-opposition-hcsc-arises-unpaid-surprise-billing-lawsuit
Cuban Pushing Transparency Agenda with Harris
Interesting STAT article on Kamala Harris’ interest in pharmacy benefit manager reform and transparency in the drug supply chain. Mark Cuban appears to be influencing her. The article goes through some of his reform ideas and his Cost Plus Drug Company. Cuban is a visionary entrepreneur and will remake the drug supply chain in a fundamental way.
#cuban #pbms #transparency #branddrugmakers
https://www.statnews.com/2024/10/08/mark-cuban-anti-pbm-agenda-working-with-kamala-harris
— Marc S. Ryan
