Monday Morning Medicaid Must Reads: May 21st, 2018

Helping you consider differing viewpoints. Before it’s illegal. 


Article 1:  

Clay’s summary: ACA has gone to the gallows several times. Last time it was saved under the “its still a tax so its ok” argument. Now that the IRS made then penalty zero, that doesn’t work anymore…

Key Passage from the Article

Ignore everything you have been told by the “news” media about Texas v. United States, the lawsuit recently filed by 20 states challenging the constitutionality of Obamacare. The Fourth Estate, in its all but official role as the public relations department of the Democratic Party, has generally downplayed the suit as yet another futile attempt by fanatical Republicans bent on destroying former President Obama’s “legacy.” Following their usual playbook for reporting constitutional challenges to the “Affordable Care Act” the media briefly sneered about its merits and then, to paraphrase David Burge, “covered the story with a pillow.”

It is nonetheless an important case and it’s useful to review the basis on which the plaintiffs actually base their case against the mandate: In 2012, a majority of the Supreme Court’s justices — including Chief Justice Roberts — rejected the government’s claim that Congress could impose the individual mandate pursuant to the Commerce Clause of the Constitution. Yet Roberts held that the mandate was still constitutional because its penalty was a tax collected by the IRS to raise revenue. The plaintiffs argue that this “saving construction” evaporated when Congress reduced the penalty to zero last year. Their complaint puts it as follows:

The Patient Protection and Affordable Care Act… as recently amended, forces an unconstitutional and irrational regime onto the States and their citizens. Because this recent amendment renders legally impossible the Supreme Court’s prior saving construction of the Affordable Care Act’s core provision — the individual mandate — the Court should hold that the ACA is unlawful and enjoin its operation.

In other words, because Congress has no authority to impose the individual mandate pursuant to the Commerce Clause, and it can’t be justified as a revenue-raising device (since enactment of the Tax Cuts and Jobs Act of 2017), the mandate must be struck down.

Read it here 

Article 2:   

“State Medicaid Programs Are Seeing the Value of Telehealth at Home” Eric Wicklund, mHealthIntelligence, May 15, 2018

Clay’s summary:  This is important. The need to do hub / spoke keeps a lot of services from not happening that could happen via very simple technology (facetime, skpe, etc) in the patient’s home. Expect new rounds of billions to be blow by private equity chasing the latest MIT grad who thinks they discovered the Medicaid telehealth opportunity for the first time and can code an app.

Key Passage from the Article

In its spring 2018 update of the State Telehealth Laws and Reimbursement Policies Report, the Center for Connected Health Policy reports that 10 states have amended their telehealth policies since August 2016 to specifically make the patient’s home an originating site for Medicaid-accepted telehealth and telemedicine programs. Those states are Delaware, Colorado, Maryland, Michigan, Minnesota, Missouri, New York, Texas, Washington and Wyoming.

Meanwhile, the report notes that six states have limited the geographic requirement altogether since 2013. And 16 states have added schools to the list of approved originating sites, though some are placing restrictions on those services.

According the CCHP’s sixth annual report, some 160 telehealth-related bills have been introduced during the 2018 legislative session in 44 states, continuing a digital health trend that saw more than 200 pieces of legislation introduced during the 2017 session. But not all of those bills are supportive of new healthcare services.


Read it here




Article 3:   

“Counterpoint: Medicaid expansion study is ‘bogus’” Richard Rosen, News and Record (NC), May 18, 2018

Clay’s summary:  Lefties don’t like it when people float the idea that double Medicaid enrollments with promises of free federal magic money may put some hurt on state budgets. No way. No how. You are a TERRIBLE PERSON for even thinking it, let along examining it. Thoughtcrime! But hey – this segment is for all viewpoints so let’s run it anyway.

Key Passage from the Article

Contrary to claims that Medicaid expansion would make approximately 630,000 additional citizens eligible, most estimates are half that. Professor Hall’s data shows that enrollment “has either fallen short of or not substantially exceeded expectations.” There also is a study of 10 states that confirms providers have not been overwhelmed. Adult males have not crowded out women and children.

Since the program has been going for five years, predictions for costs rely on track records and have become progressively more accurate. No state has repealed Medicaid expansion. Governors of red states (including Arkansas, Arizona, Michigan, Nevada and Ohio) argued against repeal of the Affordable Care Act to preserve their Medicaid expansion.


Read it here