BPC Action Health Round-Up: State Flexibility, Opioids, Long-term Care, and Medicare in Health

“States” is our Country’s Middle Name…an Insightful Conversation on State Flexibility in Health Care

Much of this year’s health care debate has focused on the role of states versus the federal government, with policymakers exploring ways to increase state flexibility. So, what does state flexibility really mean in this context? How can it be used under current law, and what reforms are being discussed?  BPC dives deeper in this interesting dialogue, Can Increased State Flexibility Balance Innovation, Cost, and Coverage?, featuring Jim Capretta, Resident Fellow and Milton Friedman Chair, American Enterprise Institute; Chris Jennings, Fellow, BPC, and President, Jennings Policy Strategies; Alice Rivlin, Co-Chair, Debt Reduction Task Force, BPC, and Former Director of the Office of Management and Budget; Timothy Stoltzfus Jost, J.D., Emeritus Professor, Washington and Lee University School of Law; and Matt Salo, Executive Director, National Association of Medicaid Directors.

A few takeaways:

  • All health care is local, and states have tremendous opportunity to innovate to improve health care for their residents;
  • States have a significant amount of flexibility today, and have availed themselves of these opportunities to varying degrees. These include Social Security Act Section 1115 Medicaid waivers, and Affordable Care Act Section 1332 State Innovation waivers, Section 1333 on selling insurance across state lines, and Section 1331 on establishing a Basic Health Program;
  • There are some programmatic barriers to efficient delivery in health care, and the waiver process could be streamlined;
  • State capacity to use new flexibility could be a challenge, and it could take significant time to implement reforms.
  • State flexibility for meaningful innovation in health care requires some appropriate federal rules of the road and adequate resources.

For more on the event, see the event’s webpage, which includes a video recording of the event and related materials.

Also, check out this handy side-by-side on the current waiver authorities available to states and those under consideration in Congress.

Former Governors Offer Recommendations to President Trump’s Opioid Crisis Commission

Washington, D.C. – Former governors Mike Beebe (AR), Steve Beshear (KY), Jim Douglas (VT), Christine Gregoire (WA), and Linda Lingle (HI) outlined a set of recommendations for President Trump’s Commission on Combating Drug Addtion and the Opioid Crisis in a discussion with commission chair Gov. Chris Christie. The recommendations were also sent in a letter to the White House and to the full commission.

Their recommendations center on three main themes: curb the supply of opioids, both prescribed and illegally trafficked; support access to treatment and support recovery; and address the stigma attached to those suffering from substance use disorders by promoting evidence based policies. The governors sit on the Bipartisan Policy Center’s Governors’ Council and work together to promote bipartisan policy solutions to challenging issues facing the American public.

How Can Americans Afford Long-term Care? BPC Releases New Recommendations

Washington, D.C. – Paying for long-term care is a major financial challenge and heavy burden for many individuals and families living in the United States, often depleting their retirement savings. Each year, nearly $725 billion dollars is spent on long-term care. However, three out of four Americans over 40 are not confident they will have the financial resources to pay for needed care as they age. The Bipartisan Policy Center has released new recommendations for improving the financing and delivery of long-term care. The proposals in Financing Long-Term Services and Supports: Seeking Bipartisan Solutions in Politically Challenging Times call for improving the availability of affordable long-term care insurance (LTCI) and financing of long-term services and supports (LTSS).

Recommendations include:

  1. Private Long-Term Care Insurance: Permit penalty-free (but still taxable as income) early withdrawals from retirement savings accounts such as a 401(k) to purchase private long-term care insurance. This would help bear the costs for long-term services and supports.
  2. Medicare Respite Benefit: Allow Medicare Advantage (MA) plans and other Medicare provider organizations the flexibility to offer respite care to high-need, high-cost Medicare beneficiaries. This would apply to patients who have three or more chronic conditions and functional or cognitive impairment and are part of a person-and family-centered care plan.
  3. Beneficiary-Financed Medicare Supplemental Benefit: BPC’s new analysis suggests that Medigap and MA plans could offer an affordable LTSS benefit for older adults not eligible for Medicaid. Such a policy could result in premiums of $35 to $40 per member per month.

For more, check out BPC’s report, also featured in this Forbes article, and discussion with caregivers featuring former Senators Bill Frist and Tom Daschle.

Former Social Security Trustees Letter to the Public on the Fiscal State of Social Security and Medicare

The ex officio trustees of the Social Security and Medicare trust funds this week released their annual reports, providing an update on the financial conditions of the programs’ trust funds. Continuing the trend of recent years, the reports highlight the significant financial challenges that each program continues to face.

BPC has partnered with Charles Blahous of the Mercatus Center at George Mason University and Robert Reischauer of the Urban Institute, the most recent former public trustees for Social Security and Medicare, to provide independent analysis of the programs while the public trustee positions remain unfilled:

“The trustees’ projections remain ominous for the financial future of the programs, with serious implications for millions of current and future program beneficiaries as well as taxpaying workers. This is particularly concerning as long as there are continued delays in legislative action to shore up the programs’ financial outlooks. The reports show large projected funding shortfalls for both the Social Security and Medicare trust funds, which would require significant changes to close, even if addressed today. For Social Security alone, an immediate increase in payroll taxes from 12.40 percent to 15.16 percent, or a cut in benefits for all future beneficiaries of 20 percent would be required, for example. The corresponding payroll tax increase required for Medicare Hospital Insurance (HI) would be from 2.90 percent to 3.54 percent, or future insurance payments would need to be cut by 14 percent. Because of its unique financing structure, growing costs of the Medicare Supplementary Medical Insurance program also put pressure on the federal budget and premium paying beneficiaries. The longer legislative action to address these financing challenges is delayed, the harsher policy changes will need to be.”