3. Medicaid expansion efforts
Another state-level topic to watch in 2018 is Medicaid expansion efforts. “The 2017 election proved that a ballot initiative to expand Medicaid in a red state can be successful,” Day says. Maine passed such a ballot initiative by a sizable margin. Additionally, other Republican states have expanded Medicaid. Some states such as Utah and Idaho are looking into ballot initiatives for the next election.
Currently, 18 states have not expanded Medicaid. If these states did so, 4.5 million uninsured adults would be eligible for Medicaid, Day says. This would allow more people to benefit from the ACA, which could make it harder to repeal.
4. Easing Stark Law restrictions
The introduction of bipartisan legislation on November 1 in the House and Senate designed to expand eligibility for waivers to allow providers to better coordinate care in ways currently prohibited by Medicare’s Stark Law, which restricts a provider from referring patients to an entity that the provider has a financial relationship with, is another possible area of legislative action. Cate McCanless, policy director, Brownstein Hyatt Farber Schreck, a law and lobbying firm, reports that CMS, along with the House Ways and Means and Senate Finance committees, has indicated interest in more permanent relief from the restrictions of the Stark Law.
“The legislation would open the door for providers to better align financial incentives to coordinate care along the care episode that achieves both positive patient outcomes and financial savings in a value-based payment model,” McCanless says. “Its introduction signals interest by the Hill to provide CMS with the regulatory flexibility needed to expand exceptions to the Stark Law that have precluded care coordination efforts in the Medicare program.”
With healthcare reform hitting lots of hurdles this year, it will be interesting to see how legislation in 2018 unfolds.