By Clive Riddle, March 24, 2017
You want more people to read everything you have to say about whichever side of the wall you’re on in the great repeal and replace debate. Or you just want to know what trendy term to search on so you can read what everyone else is saying on the subject. What hashtag to use…what hashtag to use?
We compiled a list of the hashtags surrounding the debate and had them analyzed using keyhole.co, which tracks twitter usage during the past 36 hours or so. As of noon Eastern time today, here’s what we found for twenty one selected hashtags that had surfaced the most during our research, presented in alphabetical order:
· #aca 705 posts | 2,191,075 reach
· #ahca 405 posts | 18,106,544 reach
· #BecauseOfMedicaid 500 posts | 302,037 reach
· #coveragematters 272 posts | 448,981 reach
· #fullrepeal 50 posts | 1,400,049 reach
· #healthcarebill 94 posts | 4,154,646 reach
· #healthcarereform 595 posts | 4,472,503 reach
· #IfILoseCoverage 391 posts | 1,232,293 reach
· #killthebill 729 posts | 2,153,734 reach
· #MakeAmericaSickAgain 703 posts | 935,553 reach
· #NoRepealWithoutReplace 31 posts | 28,318 reach
· #obamacare 85 posts | 43,583,728 reach
· #passthebill 704 posts | 48,210,419 reach
· #ProtectOurCare 707 posts | 2,217,826
· #readthebill 589 posts | 1,871,228 reach
· #RepealAndReplace 706 posts | 44,990,188 reach
· #ryancare 706 posts | 2,365,314 reach
· #saveaca 705 posts | 2,234,518 reach
· #SaveMedicaid 43 posts | 124,503 reach
· #SaveTheACA 711 posts | 2,061,039 reach
· #trumpcare 736 posts | 1,741,593 reach
The number of posts vs reach reflects the number of tweeters vs the number of tweetees. One tweet from @realDonaldTrump of course goes a long ways in reach.
The top ten hashtags in order of posts during this period were: #trumpcare, #killthebill, #savetheaca, #protectourcare, #repealandreplace, #ryancare, #aca, #saveaca, #passthebill, #makeamericasickagain. These were the only hashtags with 700+ posts, with a range of 703-736, so all are being used with similar frequency, and usage of other hashtags in this genre really drop off after these top ten.
With regard to reach, #passthebill, #repealandreplace, and #obamacare were the top three, each exceeding 40 million. #ahca was fourth with 18+ million. #Healthcarereform and #healthcarebill were next, each with 4+ million and it drops off from there.
A number of the hashtags (#killthebill, #passthebill) will fall out of use once the #ahca legislative debate is over, while other monikers will likely have legs for some time to come.
So pick your hashtag and start posting or browsing.
Entries in Reform & Regulatory (105)
By Clive Riddle, March 10, 2017
Don’t sweat all the granular details yet. Who
knows for certain where the political process will take this proposed Act from
Watch for the CBO “score” on the Act, which will
soon peg estimated cost and volume numbers to what’s being proposed. The CBO
score will likely shape discussions from that point forward. The portal for CBO
healthcare analysis is
Here’s two articles about the upcoming CBO score:
Obamacare replacement is hard to score, budget experts say (Washington
Nonpartisan Scorekeeper in Hot Seat for GOP’s Obamacare Repeal (Bloomberg).
Looking for a nice, quick summary of key
provisions of the Act? Check out the
Association of Health Care Journalists article by
Unpacking some key provisions of GOP’s health care bill by Joanne Kenan.
Kaiser Health News also has a succinct listing of
five key points in comparison to the ACA -
Five Ways the GOP Health Bill Would Reverse Course From the ACA by Julie
Looking for thoughtful analysis of the Act? Check
out the Timothy Jost – the oft quoted in national press expert on such matters –
in his Health Affairs Blog:
Examining The House Republican ACA Repeal And Replace Legislation.
some key opposition points from public interest groups:
AARP isn’t happy about the increased premium load older individuals would
bear in the market, or about Medicare changes. The
AHA don’t like the ultimate reductions in Medicaid and other coverages.
Families USA says the only the
Healthy and Wealthy will benefit from the bill and also take major issue
per-capita caps in Medicaid.
7. Getting too tired to read any further? Here’s six selected videos from major organizations discussing the Act.
by Clive Riddle
CMS has announced their 2017 new and renewing ACOs, so we took a somewhat deeper dive into what comprises this year’s MSSP ACO roster, along with who dropped out. For starters, though, here’s the 2017 totals including the other active ACO types (there are also 9 remaining ACOs in the non-active Pioneer model):
- MSSP - 480
- Next generation - 45
- Comprehensive ESRD (CEC) – 47
- Total: 572
52 MSSP ACOs participating in 2016 dropped out of the program for 2017. 8 of these started in 2012, 11 in 2013, 22 in 2014, 8 in 2015, 3 in 2016.
For the 480 MSSP ACOs participating in 2017, with respect their track:
- Track 1 – 438
- Track 2 – 6
- Track 3 – 36
17 of these ACOs remain in the non-active Advance Payment program. 45 of these ACOs are the AIM program, and 25 are in the SNF 3 day waiver program.
With respect to geography, when classifying the MSSP ACOs by the primary state they serve (many ACOs serve markets in more than one state), 16 states comprise over two-thirds (68%) of the total:
- FL 44 ACOs
- TX 44 ACOs
- NY 34 ACOs
- CA 25 ACOs
- MI 20 ACOs
- NJ 19 ACOs
- NC 18 ACOs
- IL 17 ACOs
- GA 15 ACOs
- IN 15 ACOs
- MD 14 ACOs
- OH 14 ACOs
- KY 13 ACOs
- VA 13 ACOs
- PA 12 ACOs
- MA 11 ACOs
With respect to their initial year joining the program, MSSPs break down as follows:
- 2012: 49 ACOs (14%)
- 2013: 63 ACOs (13%)
- 2014: 79 ACOs (16%)
- 2015: 77 ACOs (16%)
- 2016: 97 ACOs (20%)
- 2017: 99 ACOs (21%)
By Clive Riddle, December 9, 2016
CNBC called it the Obamacare Doomsday Scenario: the Urban Institute has released a 33-page brief - Implications of Partial Repeal of the ACA through Reconciliation - examining what would happen if the new congress goes forward with an ACA partial repeal with a replace to be named later – using a reconciliation bill similar to one President Obama vetoed in January 2016. Their analysis determined that “the number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent).”
The Urban Institute points out that “there is currently no consensus around alternative health policies to enact as the ACA is repealed; consequently, partial repeal via reconciliation without replacement is possible and merits analysis.” The scenario they lay out is that “Congress is now considering partial repeal of the Affordable Care Act (ACA) through the budget reconciliation process. Since only components of the law with federal budget implications can be changed through reconciliation, this approach would permit elimination of the Medicaid expansion, the federal financial assistance for Marketplace coverage (premium tax credits and cost-sharing reductions), and the individual and employer mandates; it would leave the insurance market reforms (including the nongroup market’s guaranteed issue, prohibition on preexisting condition exclusions, modified community rating, essential health benefit requirements, and actuarial value standards) in place.”
Here’s some highlights from their report of what is in store for us if the scenario takes place:
- The share of nonelderly people without insurance would increase from 11% to 21%
- 22.5 million people will become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate
- An additional 7.3 million people will become uninsured because of the near collapse of the nongroup insurance market.
- 82% of the people becoming uninsured would be in working families, and 80% of adults becoming uninsured would not have college degrees.
- 38% becoming uninsured would be ages 18 to 34, and 56% would be non-Hispanic whites.
- There would be 12.9 million fewer people with Medicaid or CHIP coverage in 2019.
- Approximately 9.3 million people who would have received tax credits for private nongroup health coverage in 2019 would no longer receive assistance.
- Federal healthcare spending would be reduced by $109 billion in 2019 and by $1.3 trillion from 2019 to 2028 because Medicaid expansion, premium tax credits, and cost-sharing assistance would be eliminated.
- State spending on Medicaid and CHIP would decrease $76 billion between 2019 and 2028.
- The newly uninsured would seek an additional $1.1 trillion in uncompensated care at the state/local level between 2019 and 2028.
- The 2016 reconciliation bill did not increase funding for uncompensated care beyond current levels.
- If Congress partially repeals the ACA with a reconciliation bill like that vetoed in January 2016 and eliminates the individual and employer mandates immediately, in the midst of an already established plan year, insurers would suffer substantial financial losses (about $3 billion); the number of uninsured would increase right away (by 4.3 million people); at least some insurers would leave the nongroup market midyear.
by Clive Riddle, December 2, 2016
What shall be the fate of value-based care initiatives in the wake of a new administration’s zeal to slash away at all thing Affordable Care Act? The following article: Focus on Value to Survive, Maybe Flourish, for Next Four Years, recently appeared in the Inaugural issue of Value-Based Payment News, Russell Jackson, editor:
The quadrennial change of who’s who in the nation’s capital generally brings with it a shift in focus at the federal regulatory agencies and a reboot of the dynamic between the White House and the Capitol. But despite the magnitude of change that could reverberate throughout the national-level political apparatus this time around, experts pretty much agree that the value- and quality- and other payment reform-related programs – the Medicare Access and CHIP Reauthorization Act included – will likely continue in much their current form, albeit, in some cases, under different names and with, in all likelihood, different, and surprising, claims of original ownership.
Don’t be surprised, in other words, if a newly named Centers for Medicare and Medicaid Innovation turns out to have been the new president’s idea all along. Here’s a sampling of what the policy experts have been telling the press about value-based healthcare programs for the next four years.
“Premier Senior Vice President Blair Childs says Republicans strongly support Accountable Care Organizations. ‘They first ran the ACO demonstrations under the Bush Administration,’ he said by email. ‘They are envisioned in MACRA, of which the Republicans are strong supporters.’”
== ‘Republicans Expected to Spare ACOs, Other Demos from ACA Repeal;’ http://insidehealthpolicy.com/
“Ian Spatz, a senior advisor at Manatt Health, said there is no reason to think Republicans would reverse the trend toward providers sharing risk. He said ACOs and other demonstrations that move away from the fee-for-service system are not partisan. However, Spatz said it’s likely that Republicans will place restrictions on CMMI, such as prohibiting mandatory demonstrations, and they might change the Centers’ name.”
== same article
Gilberg, senior vice president of government affairs for the Medical Group Management Association, said they are advising members to continue preparation for MACRA. ‘We don’t see that that is going to be repealed. It was bipartisan, nearly a unanimous vote.’”
== ‘MACRA will move forward largely untouched when Trump steps in, experts say;’ http://www.healthcarefinancenews.com/news/macra-will-move-forward-largely-untouched-when-trump-steps-experts-say
“Christopher Kerns, managing director at The Advisory Board, said, ‘MACRA is not in trouble, but mechanisms by which they control spending could change.’ Kerns said there might be a shift away from ACOs as a principal driver of controlling spending, and more toward bundled payments or price controls, cuts or other forms of utilization control in the form of reduction in reimbursement for different kinds of services.”
== same article
“The American Academy of Family Physicians said [it doesn’t] believe MACRA as a whole is in any real danger of repeal. ‘The election of Mr. Trump will have a limited impact on the MACRA law in the short-term,’ said AAFP President John Meigs Jr. ‘Looking forward, this law was supported by 91% of Congress. Based on the bipartisan support, it is difficult to see how there would be any fundamental changes under the Trump Administration.’”
== same article
“’This is a movement that’s happening independent of the ACA, or parallel to it,’ said David Jones, an assistant professor of health law, policy and management at Boston University’s School of Public Health. ‘It’s very unclear when they say they’re going to repeal ObamaCare whether they’re even thinking about things like CMMI or to shift away from things like fee-for-service.’”
== ‘Will value-based payment initiatives continue under Trump?;’ http://www.modernhealthcare.com/article/20161111/MAGAZINE/161109907
On the other hand …
“House Budget Chair Rep. Tom Price (R-GA) has had CMMI in his sights for a while now, and Sen. Orrin Hatch (R-UT) is no big fan. Both claim the center lacks accountability and hasn’t shown clear results. They may try to eliminate mandatory CMMI payment models and could seek to legally trim its sails.”
== ‘CMS CMMI, ONC and AHRQ preparing to take hits;’ https://www.g2xchange.com/statics/cms-cmmi-onc-and-ahrq-preparing-to-take-hits
You can request a sample copy of Value-Based Payment News by going here: http://valuebasedpaymentnews.com/sample.html