OVERNIGHT HEALTHCARE: Medicaid proposal draws fire from insurers

The federal government on Tuesday unveiled a long-awaited regulatory package that sets national standards for Medicaid managed care and introduces the unpopular "medical loss ratio" into the program.  

The nearly 700-page rule, described by some groups as an "uber rule," contains instructions about what state Medicaid programs must do when hiring private health plans to handle long-term care for the elderly and disabled – also known as managed care.

One of the biggest proposed changes has already been introduced to government health programs via ObamaCare – the medical loss ratio.


The medical loss ratio, also known as MLR, sets the minimum amount of all premium dollars that are directly spent on healthcare. The policy, widely despised by insurers, is intended to cut overhead spending.

The proposed rule from CMS would set the medical loss ratio at 85 percent, which it described as the "industry standard" for large employers in the private health insurance market.

Jeff Myers, the president and CEO of Medicaid Health Plans, said he had "strongly encouraged CMS not to go down this route" because he said every state has already implemented some form of the medical loss ratio.

Myers, who had a dozen people still combing through the rules Tuesday evening, warned that the proposed rules could "destabilize the programs that are developed on a state level."

The Centers for Medicare and Medicare Services (CMS) is also proposing that Medicaid managed care groups align their standards with those in the private marketplace to create more uniform practices across states. Read more here.

GOP SENATORS CALL FOR OVER-THE-COUNTER BIRTH CONTROL: Sen. Cory GardnerCory Scott GardnerTariffs threaten 1.5M jobs: Study This week: House kicks off public phase of impeachment inquiry Progressive veterans group launches campaign labeling Trump as a 'national security threat' MORE (R-Colo.) is leading a new push to allow women to buy birth control without a prescription, hoping to deliver on one of the biggest promises of his freshman Senate campaign last year.

A half-dozen Senate Republicans have signed onto Gardner's bill, which would require drug companies that sell contraceptives to file an application to sell their products over the counter.

"Most other drugs with such a long history of safe and routine use are available for purchase over the counter, and contraception should join them," Gardner wrote in a statement. He said his bill would benefit women in rural and underserved areas, while also saving people money and time by "increasing competition and availability."

The Colorado Republican's push to make birth control available over-the-counter is not winning him more allies among women's reproductive health groups, however.

Groups like Planned Parenthood have opposed the idea, which they argue could drive up contraception prices.

The group has pointed to ObamaCare's contraception mandate -- requiring insurance plans to cover all FDA-approved forms of birth control -- and said that insurers may no longer cover the medication if it's not prescribed by a doctor. Read more here

HHS BOOSTS EFFORT TO FIGHT HEART DISEASE: The Department of Health and Human Services (HHS) on Tuesday announced $112 million in grants aimed at helping doctors at smaller practices fight heart disease, the leading cause of death in the U.S.

The grants will be used to create regional groups of experts who will provide assistance to smaller practices, which tend to have fewer resources than large organizations.

"By targeting smaller practices, we have a unique opportunity to reduce cardiovascular risk factors for hundreds of thousands of patients," HHS Secretary Sylvia Mathews Burwell said in a statement.

HHS says the initiative will help 5,000 primary care doctors who serve 8 million patients.

The teams of experts will give doctors coaching, as well as help with electronic medical records, a common source of complaints from doctors who consider them time-consuming and difficult to use.

The grants will go to seven regions identified as being underserved. HHS describes the targeted groups as "Native Americans in Oklahoma, Hispanics in New Mexico and Colorado, medically underserved communities in New York City and the Chicago Tri-State region, and rural communities in the Pacific Northwest, Virginia, and North Carolina." Read more here

State by state

Fistfight nearly breaks out in Texas legislature over abortion bill

GOP lawmakers in Wisconsin to fast track abortion ban after 20 weeks

Florida Senate develops new Medicaid expansion plan

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Please send tips and comments to Sarah Ferris, sferris@thehill.com, and Peter Sullivan, psullivan@thehill.com. Follow on Twitter: @thehill@sarahnferris@PeterSullivan4