OVERNIGHT HEALTH: HHS says Medicaid expansion must be all or nothing

The Obama administration on Monday put the kibosh on talk of a partial Medicaid expansion under President Obama's healthcare law. Republican governors wanted to know if they could receive full federal funding for the Medicaid expansion without raising eligibility all the way to 133 percent of the federal poverty line.

That's just not possible, at least before 2017, the Health and Human Services Department said. The law says the federal government will cover the entire cost of the expansion through 2016, and it doesn't allow for a partial expansion at that rate, according to a document HHS released Monday.

“The answer is disappointing for many governors who hoped the Administration was more serious about providing states flexibility," said Mike Schrimpf, communications director for the Republican Governors Association.

Healthwatch has all the details.

Goodbye, Medicaid savings: HHS also took a big deficit-reduction option off the table Monday, saying the Obama administration no longer supports a proposal to combine the various calculations that determine how much the federal government pays for state Medicaid programs. The so-called "blended rate" would have saved the feds about $100 billion over 10 years, but mostly by shifting those costs to the states. Now that HHS is trying to coax states into the Medicaid expansion, it's not a good time to take away existing federal support. Read the Healthwatch story.

State-run exchanges: Six steps forward ... one step back.

More time: The U.S. Chamber of Commerce urged federal health officials to extend the 30-day comment period for three proposed rules on essential health benefits, insurance regulations and benefit and payment parameters for 2014. In letters to the Health and Human Services (HHS) Department, the Chamber argued that one month was not enough for businesses to respond, given the complexity of the regulations. The group also criticized for what it described as "unusual shortcuts in the proper regulatory process" when it comes to the Affordable Care Act. Read more here.

MA vs. Medicare: Republicans on the House Ways and Means Committee touted new research finding that utilization rates for emergency departments and other services were 20 to 30 percent lower for people on Medicare Advantage (MA) versus traditional Medicare. The study, published in Health Affairs, concluded that Medicare Advantage enrollees "might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare." Republican Ways and Means staff used this finding to criticize the healthcare law, which cuts MA plans. The memo also called Medicare an "uncoordinated, inefficient and severely outdated program." Read more of the study at Health Affairs.

'Replace' plan: The American Enterprise Institute released a plan for replacing the healthcare reform law if it ever gets repealed. The 59-page document from resident fellow Thomas Miller repeats a series of familiar GOP proposals, including converting Medicare to a premium-support system and block-granting Medicaid. Miller writes that the massive task of implementing the healthcare law could prove too much for health officials, creating an opening for health-law opponents to push for repeal when President Obama leaves office. Healthwatch has more on the report.

Jobs at stake: Medicaid supports about three million healthcare jobs held by women, according to a new analysis by the National Women's Law Center (NWLC). The group urged Congress to remember those jobs as it considers entitlement cuts as part of negotiations over the so-called "fiscal cliff." The NWLC report fund that women hold about 80 percent of Medicaid-supported jobs, and that the program supports the largest number of work positions in New York, California and Texas. Read more at the NWLC.

Reducing readmissions: Safety-net hospitals are 30 percent more likely to have readmission rates above the national average, meaning they are more likely to be affected by the Affordable Care Act's Hospital Readmissions Reduction Program (HRRP). This was the conclusion of a new analysis from the Commonwealth Fund, which recommended several policies hospitals might adopt to avoid high readmissions and, by extension, lower payments. Read more about the recommendations, including quality improvement initiatives and better care coronation, at Commonwealth.

Tuesday's agenda

Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin (D-Iowa) will join other leading Democrats at a press conference on preserving funding for Medicaid. Representatives from major unions and healthcare groups will also speak. 

State by state

Neb. lawmakers could override veto on Medicaid expansion

GOP legislators who pushed MinnCare under scrutiny for insurance ties

Advocates plan to pressure Haley to accept Medicaid expansion

Abortion opponents have big plans for the 2013 legislative session in Texas

Top Jindal aides used personal email to strategize on Medicaid cuts

Maine bill would let physicians decide who gets marijuana

Lobbying registrations

The WSJ Group Consulting / Labor Consultants

Nelson, Mullins, Riley & Scarborough / Cardinal Health

Reading list

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