I hope that everyone who celebrates Easter or Passover had a wonderful time celebrating with family and friends and reflecting on their life and many blessings.
Building Paragon’s policy team
I am excited to announce that Paragon is growing its team. We are hiring a full-time policy analyst who will work closely with Paragon’s initiative directors in producing meaningful policy research and educational materials. For more information on the position, see here. Please share this announcement with anyone you think may be a good candidate.
Being prudent on Medicare’s telehealth coverage
The use of telehealth, which holds the promise of expanded access and improved convenience for patients, soared during the pandemic. Paragon’s state health reform book Don’t Wait for Washington: How States Can Reform Health Care Today contains recommendations for how states can ease counterproductive telehealth restrictions and make care more accessible for patients. However, the expansion of telehealth in Medicare—which increased by a factor of more than 60 between 2019 and 2020—presents a unique set of challenges. Medicare fee-for-service does not contain the necessary protections against waste, fraud, and abuse nor the necessary tools for utilization management. It’s vital that Congress does not rush into expanding telehealth in Medicare given these vulnerabilities.
Doug Holtz-Eakin, the president of American Action Forum and former director of the Congressional Budget Office (CBO), raised this concern in his April 18 newsletter. I fully support Doug’s perspective on this issue.
Doug suggests “caution about the certification of [telehealth] services, setting of payment rates, and the overall fiscal impact on Medicare and the taxpayers.” Doug offers sage advice “to introduce telehealth along with some fiscal guardrails, such as a cap on total telehealth reimbursements or a requirement that its introduction be budget neutral.” One other point worth emphasizing from Doug: let the private sector lead on setting a market-based rate for telehealth “to inform fee-for-service reimbursement rates in traditional Medicare.”
Setting the record straight on short-term insurance
While serving in the White House, I coordinated the development of a 2018 rule which expanded the allowable contract period for short-term limited-duration health insurance plans. These state-regulated plans are not subject to federal regulations, so they are often more flexible and affordable than alternative options.
Late in 2016, the Obama administration restricted the short-term plan contract period to just three months and prevented renewals. The 2018 rule reversed those restrictions—allowing people to maintain a plan for 364 days and renew that plan for up to three years.
On April 14, The Washington Post’s Health 202 published a newsletter about how the Biden Administration has yet to ban short-term plans. I was quoted in the story.
Unfortunately, the Biden administration may propose regulations that restrict short-term plans and undo the benefits of the 2018 rule. Those benefits include:
- Providing more affordable options consumers. CBO estimates that short-term plan premiums could be 60 percent lower than premiums for the lowest-priced Affordable Care Act (ACA) plans.
- Expanding overall insurance coverage. CBO estimates that the 2018 short-term plan rule would cover 700,000 people who would otherwise be uninsured.
- Helping the sick. The National Association of Insurance Commissioners was very critical of the 2016 Obama-era restrictions on short-term plans, arguing that “if the person develops a new condition while covered under the first policy, the condition would be denied as a pre-existing condition under the next short-term policy. In other words, only the healthy consumers would have coverage options available to them; unhealthy consumers would not.” Thus, the longer allowable contract period offers critical consumer protections.
Congressional oversight of $100 billion of Medicaid improper payments
The scale of Medicaid waste, fraud, abuse, and misspending epitomizes government failure. Fortunately, some members of Congress are prioritizing the issue. They wrote a letter about the growing problem to the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure on April 13. I provided this statement in support of the congressional effort:
“Across multiple administrations of both parties, CMS has failed to protect the Medicaid program and ensure that taxpayer dollars only benefit eligible enrollees. The Affordable Care Act’s expansion of the program has driven improper federal Medicaid payments to an estimated $100 billion annually. Senator Johnson and Representative Comer are taking important actions to shed light on this massive government failure and to hopefully push CMS to adopt common sense program integrity efforts.”
More on the ACA’s 12-year Anniversary
Dr. Joel Zinberg, the director of Paragon’s Initiative on Public Health and American Well-Being, appeared on C-SPAN’s “Washington Journal” on April 9 to discuss the ACA and the future of health care. Zinberg had a corresponding piece in the City Journal, “Obamacare’s Hollow Celebration.”
As Congress considers future policy changes around the ACA, it should look to real reforms that address the law’s structural problems, rather than expanding inflationary subsidies that simply paper over the law’s problems and pass higher costs to taxpayers. For more, see my National Review March 31 piece, “Reality Check: The Increasing Cost of Papering Over Obamacare’s Problems.”
All the best,
Paragon Health Institute