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Health Care was Big in the Midterm Election, So What Happens Now? (And More)

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  1. Health Care Outstanding in Mid-Time period Elections – How will the New, Divided Congress React?
  2. Middle for Medicare Advocacy Feedback on Proposed Nursing Residence Laws and Rule
  3. Jimmo Implementation: Beneficiary Efficiently Appeals Denial of Upkeep Remedy

Health Care Outstanding in Mid-Time period Elections – How will the New, Divided Congress React?

As outcomes from this week’s mid-term elections proceed to return in, it’s clear that the Democrats will management the Home of Representatives and Republicans will retain management of the Senate in the 116th Congress that begins in January. 

In line with polling carried out earlier than and through the election, well being care was the prime situation for voters (see, e.g., CNBC, Related Press, Kaiser Health Information). As famous by Forbes, it “was the single biggest worry on the minds of the people as they cast their ballot.” It’s clear that the American individuals worth entry to high quality well being care and can maintain policymakers accountable for makes an attempt to sabotage their protection protections.

How will the new Congress react to such considerations? 


As Drew Altman, President of the Kaiser Household Basis, notes in Axios, we’ll doubtless see “two years of maneuvering but little progress on health care — unless you look beyond Washington.” Briefly, Altman states:

Democratic management of the Home stops any Republican efforts to revive their efforts to repeal and substitute the Reasonably priced Care Act, block grant Medicaid or impose a per capita cap on federal Medicaid spending. […] The identical applies to any massive modifications Republicans may need to make to Medicare. With Paul Ryan gone — the main champion of these plans — Republicans will avoid premium help or different main Medicare modifications. Solely smaller Medicare finances savers will stand any probability.

Reasonably priced Care Act

Voters overwhelmingly expressed their help for sustaining protections for these with pre-existing circumstances. Even sure candidates with a historical past of voting to repeal the Reasonably priced Care Act (ACA) started to acknowledge this, and touted how they might shield individuals with pre-existing circumstances. Nevertheless, whereas it might seem that efforts to repeal the ACA are on maintain for now, the administration and opponents of the ACA can nonetheless do a lot to undermine the regulation.

Many ACA opponents, for instance, have supported a Texas-led lawsuit to declare the ACA unconstitutional. This lawsuit would destabilize our well being care system, and deny tens of millions of shopper’s crucial well being protection. Individuals with pre-existing circumstances and people who are older and sicker can be particularly in danger. Though the president vowed to “always protect Americans with preexisting conditions” his administration determined to not defend towards the lawsuit. In reality, the Division of Justice particularly argued towards provisions that assure protection to people who find themselves older, sicker, or have pre-existing circumstances. Though voters endorsed protection for pre-existing circumstances and rejected well being care sabotage, the administration will possible proceed to behave to undermine the ACA by means of laws and different actions.


Kaiser’s Drew Altman additionally famous that the election was “a good day for Medicaid.” Poll initiatives to broaden Medicaid handed in three states (Idaho, Nebraska and Utah), and “governors elected in Kansas and Maine will now push forward Medicaid expansion.” Based on advocates, it will possible result in almost 500,000 extra individuals in these states gaining protection via the ACA’s Medicaid enlargement. Nevertheless, the Administration continues to limit entry to Medicaid via regulation and administrative motion, together with approving state waivers imposing work necessities. For instance, the day after the election, it was reported that the administration is drafting a proposed rule that may prohibit non-emergency transportation providers for Medicaid beneficiaries. With Congress deadlocked, states can take the lead and broaden Medicaid to make sure that individuals have entry to complete well being protection and also can reject pointless restrictions on eligibility.


Previous to the election, we highlighted threats to Medicare, together with some policymakers’ give attention to slicing Medicare by means of “entitlement reform.” With a cut up Congress, such efforts are much less doubtless, for the time being. It’s doubtless, nevertheless, that we’ll proceed to see dangerous coverage proposals from the Administration that, amongst different issues, reduce shopper protections and oversight of suppliers (together with nursing amenities) and Medicare Benefit plans.  The Administration may even proceed efforts to  steer individuals towards enrolling in personal Medicare Benefit plans.

It’s attainable that Congress will attempt to tackle the excessive worth of prescribed drugs, which will increase prices for the Medicare program and beneficiaries. There will even possible be discussions relating to increasing Medicare, each in the scope of what it covers (similar to including dental, listening to and imaginative and prescient) and who’s eligible to enroll.  

As we have now said elsewhere, the Middle urges policymakers to increase providers and protection equally for all Medicare beneficiaries, not simply subsets reminiscent of solely these in personal MA plans. For instance, an out-of-pocket cap must be added to the conventional Medicare program as exists in MA. Rights to buy Medigap supplemental insurance coverage insurance policies must be expanded to individuals beneath 65, and embrace extra ongoing entry for all in order to offer really significant decisions for Medicare beneficiaries. Each cost and protection must be equalized between MA and conventional Medicare in order that the scales will not be irreversibly tipped in favor of privatization. 


Whereas a divided Congress possible forestalls main well being care-related laws in the close to time period, Medicare, Medicaid and the Reasonably priced Care Act stay underneath menace from the Administration. We encourage Congress to do its obligation to carry out strong oversight of those packages. The lives of tens of millions of individuals throughout the nation rely upon it.

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Middle for Medicare Advocacy Feedback on Proposed Nursing Residence Laws and Rule

Laws to Scale back Rehospitalizations Fails to Reply Questions About Resident Protections

The Decreasing Pointless Senior Hospitalizations (RUSH) Act of 2018 (H.R. 6502) would permit sure medical teams to offer telehealth and on-site first responder providers to nursing house residents in an try to scale back rehospitalizations. Though the objective of decreasing pointless and inappropriate rehospitalizations is commendable, the RUSH Act leaves far too many questions unanswered for nursing house residents, together with:

  • Will the HHS Secretary make sure that first responders don’t substitute present nursing employees?
  • Will the Secretary certify that these outdoors corporations and their staff should not have a document of offering poor care to residents?
  • Will the Secretary be sure that residents aren’t being inappropriately stored at the nursing residence to extend income?
  • Will nursing house operators be allowed to have an possession curiosity in these outdoors corporations?

The Middle for Medicare Advocacy, Lengthy Time period Care Group Coalition (LTCCC), California Advocates for Nursing House Reform (CANHR), and Nationwide Shopper Voice for High quality Lengthy-Time period Care (Shopper Voice) despatched a letter opposing the RUSH Act to the invoice’s sponsor and cosponsors.

Division of Labor’s Proposed Rule Would Permit Minors to Independently Function Harmful Resident Hoists

The Division of Labor has issued a discover of proposed rulemaking (NPRM) that might overturn a prohibition towards permitting 16 and 17 year-olds to independently function power-driven resident hoists and carry for nursing house residents. Beneath the present coverage, these minors can solely function hoisting or lifting units underneath the supervision of educated grownup employees members. The Division’s proposal to roll again this resident safety conflicts with the Nationwide Institute for Occupational Security and Health’s (NIOSH) discovering that these minors “cannot safely operate power-driven hoists to lift or transfer patients by themselves…”

To learn the Middle for Medicare Advocacy’s and the Lengthy Time period Care Group Coalition’s (LTCCC) feedback opposing the Division’s proposed rule, please go to: http://www.medicareadvocacy.org/wp-content/uploads/2018/11/LTCCC-CMA_RIN-1235-AA22.pdf

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Jimmo Implementation: Beneficiary Efficiently Appeals Denial of Upkeep Remedy

Regardless of the Jimmo case’s affirmation that Medicare protection of a keep in a talented nursing facility (SNF) is acceptable to take care of a resident’s practical standing, when the nursing or remedy providers have to be offered by knowledgeable nurse or therapist, SNFs and managed care plans regularly proceed to disclaim medically crucial protection.  Expedited appeals to maintain Medicare-covered providers in place require the resident/household to attraction to the High quality Enchancment Group (QIO) by midday the day after they obtain a denial discover.  Gathering medical help from the resident’s main care doctor or different related doctor is usually troublesome beneath such strict time deadlines.  Whereas medical help is useful and ought to be sought, households could possibly persuade the QIO to proceed protection, with cautious documentation of what occurred at the SNF.

The daughter of a resident just lately despatched the Middle for Medicare Advocacy copies of the two letters she wrote to the QIO, each of which efficiently persuaded Livanta to order the managed care plan to proceed Medicare-covered care. The daughter described in element how her mom had made clear progress throughout her restricted keep; the absence of a “communicated care plan” or invitation to take part in a care planning assembly for her mom; the insufficient quantity of remedy offered by the SNF; prejudgment by the managed care plan to restrict protection, based mostly on the resident’s dementia; and Jimmo. 

Ordering continued care, Livanta wrote, in the second profitable attraction: “A review of the received medical records shows that the patient was admitted to the Skilled Nursing Facility (SNF) for rehabilitation following an acute care hospital stay for treatment of acute stroke.  There is no sufficient documentation that the patient is ready for discharge from skilled services and the patient still requires daily skilled therapy services to maintain function or prevent decline.  Termination of SNF services is not appropriate at this time.”

Copies of the redacted letters and Livanta determination can be found.

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