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📢 URGENT: Protect Medicaid for Millions of People with Medicare

Casey Schwarz

Senior Counsel, Education & Federal Policy

Department of Justice States Support for Total Invalidation of the Affordable Care Act

This week, the Department of Justice surprised observers by filing a short letter with the Fifth Circuit Court of Appeals indicating the Trump Administration’s agreement with a district court decision invalidating the entirety of the Affordable Care Act (ACA).

This new, more extreme position is a departure from previously stated Administration policy, which sought to strike some of the law while preserving its more popular provisions, like protections for people with pre-existing conditions, the ability for people under 26 to remain on a parent’s insurance, and prohibitions on charging older adults exorbitant amounts for coverage.

Medicare Rights Comments on 2020 Draft Rate Notice and Call Letter

Each year, the Centers for Medicare & Medicaid Services (CMS) releases a draft rate notice and call letter, which outlines rules and payment policies that will apply to Medicare Advantage plans in the upcoming plan year. Interested parties—including plans, beneficiaries, and advocates—can submit comments in response, which CMS takes into consideration when finalizing its proposal. The agency then releases a final rate notice and call letter in the spring, which contains information that plans use to submit their bids to offer Medicare Advantage and Part D plans.

Updated Federal Poverty Guidelines Announced

Each year, the Department of Health and Human Services (HHS) updates the federal poverty guidelines, which are then used to determine eligibility for programs including Medicaid, the Low Income Subsidy for Part D (LIS), and Medicare Savings Programs.

a roll of bills from which spill out pills of many colors

Medicare Announces New Model to Test Changes to Part D Payments

This week, the Centers for Medicare & Medicaid Services (CMS) )—the agency that oversees the Medicare program—announced a new model to test changes to prescription drug payments and incentives. The CMS Center for Medicare and Medicaid Innovation (CMMI) will create a voluntary, five-year model in which Part D Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MAPDs) may apply to participate.

According to CMS, the model is intended to test “new incentives for plans, patients, and providers to choose drugs with lower list prices in order to address rising federal reinsurance subsidy costs.”

Medicare Rights Responds to Proposed Changes for Medicare Advantage Plans in 2020

The Medicare Rights Center recently submitted comments in response to proposed rule changes from the Center for Medicare & Medicaid Services (CMS) pertaining to Medicare Parts C and D for 2020 and 2021. Many of the proposed rules implement changes that Congress made to the law that establishes Duals Special Needs Plans (D-SNPs). D-SNPs are special plans designed to serve the needs of people who are eligible for both Medicare and Medicaid, also known as “dual eligibles.”

CMS Proposes Changes to Protected-Class Drugs

Last week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would allow Part D and Medicare Advantage plans to use additional tools to reduce prescription drug prices. Some of these tools rely on weakening the protections for consumers who take certain medications in what are known as the “protected classes.”

Kaiser Family Foundation Analyzes Health Care Expansion Proposals

As policymakers debate next steps for expanding health insurance coverage and lowering health costs, some have introduced legislation that would broaden the role of public programs, such as Medicare and Medicaid. In light of recent characterizations of such proposals, the Kaiser Family Foundation (KFF) assessment of what these bills do (and do not do) is particularly important.

In the past two years, eight proposals were introduced, ranging from bills that would create a new national health insurance program for all U.S. residents, replacing virtually all other sources of public and private insurance (Medicaid-for-All), to more incremental approaches that would create a new public plan option, as a supplement to private sources of coverage and public programs.

Center for Medicare Advocacy Releases Analysis of Various Medicare Advantage Changes

This week, the Center for Medicare Advocacy (CMA) released an issue brief that examines the details and legal underpinnings of several proposed and upcoming changes to the Medicare Advantage (MA) program. Designed to be a resource for advocates and attorneys, CMA’s analysis combines several disparate sources of MA changes, including recently signed legislation, regulatory rulemaking, and sub-regulatory guidance. It also predicts some of the consequences of these changes on, among other things, beneficiary decision-making and informed choice. The brief outlines the changes to MA made in the Balanced Budget Act of 2018 (BBA), in the Part C and D final rule issued earlier this year, and in the Final Call Letter for 2019.

Administration Challenge to ACA’s Pre-Existing Condition Protections at Odds With Public Opinion

A federal court is considering a challenge to the Affordable Care Act’s (ACA) protections for people with pre-existing conditions that a number of state attorneys general have filed and the Trump Administration has chosen not to defend. But the public—including most Republicans—want those protections preserved. A recent Kaiser Family Foundation tracking poll finds that 72-75% of Americans say that it is “very important” to keep provisions that stop insurance companies from denying coverage or charging more based on medical history. Over 55% of Republicans said it was very important to do so. It is also the 90th time that the foundation has asked about the public’s opinion of the ACA generally, and this month 50% view the law favorably, while 40% view it unfavorably.