5 Things Arizona: Swapna Reddy, SMAC meeting, rate setting

 

With help from Emily Viles

1. SMAC: Time to get started on 1115 waiver

The Arizona State Medicaid Advisory Committee (SMAC) held a quarterly meeting last week where a number of policy priorities, updates from AHCCCS, and administrative concerns were discussed. AHCCCS discussed the implementation of the ADES/DDD which is live this month. It also highlighted the need for “research and planning in anticipation of 1115 waiver renewal.”

The current waiver expires in October, 2021, creating some uncertainty related to the presidential election. The conversation about the waiver highlighted the need to get “up-stream” on policies, something Arizona has been a leader on compared to other states. Stakeholder work by state agencies has been seen as one of the most important factors in earning CMS approval for waivers, so the timing is good by AHCCCS to begin that work.

2. Video: US Sen. Murkowski talks impeachment

While we focus this newsletter on Arizona state health policy, sometimes news from other states stands out. Two weeks ago, Republican Senator Murkowski joined State of Reform in Anchorage to talk through her work on health care, her vote on the repeal of the ACA, and her thoughts on the impeachment process that has newly unfolded in the nation’s capital. They are worth watching, as they were some of the first comments on impeachment made by a sitting US senator in a public forum. A Senate impeachment trial could begin as early as Thanksgiving, so things are moving quickly.

“I’m also trying to think to myself ‘If this set of facts were to be in front of me, and the president were President Hillary Clinton instead of President Donald Trump, would I be viewing this in a different way?’  Because if I do, that’s wrong. I shouldn’t view what is right and what is wrong based on the political affiliation of the individual that we are considering.”

3. Q&A Swapna Reddy, ASU Health Solutions

Swapna Reddy is a Clinical Assistant Professor at Arizona State University, College of Health Solutions, where she teaches health policy. She’s also something of Arizona’s “pop health policy star” as she is often quoted by media looking for insight. So, it’s good to know what she’s tracking in Arizona health policy today.

She joined reporter Emily Viles for a look ahead to some of the policy areas legislators may want to take on in 2020. “For me, legislative actions really that focus on filling the gaps in care whether it is in the Medicaid population, the Medicaid expansion population, with children, this is critical. We are not doing well by children in Arizona. Health outcomes for children are pretty dismal here. Legislation that transcends partisanship and focuses on closing the gaps, and focus on children is key. There is not a robust enough safety net for them here in Arizona.”

4.  Video: Gretchen Jacobs, Arizona Governmental Affairs

One of the challenges facing low margin health care providers is rising wages. From child welfare to development disabilities, these providers often cover staffing with near or at-minimum wage employees. So, as the minimum wage increases, the ability for providers to cover those costs is often dependent on the legislature to add more funds to those contracts, something that often does happen.

Gretchen Jacobs is the CEO of Arizona Governmental Affairs. In this edition of “What They’re Watching,” she highlights this challenge to the state’s provider network where policy decisions both increase costs and flat-line revenue. “Now, when there is a minimum wage increase, which you think would be helpful, it has actually caused hardship because the legislature has not been able to come up with the funds to meet that increase.”

5. Is rate setting the moderate response to Medicare for All?

A recent op-ed at State of Reform from Arielle Kane, the Director of Health Care at the Progressive Policy Institute (PPI), recommends price caps over a form of Medicare for All. PPI is  aligned with centrist Democrats as was founded by Bill Clinton, among others, when he was governor of Arkansas. Their proposal would minimize provider and hospital incentives to remain out-of-network, and would cut in-network costs.

“Democrats have pushed for Medicare for All – saying that it is the only fix. But using this as a litmus test for the Democratic nomination is an oversimplification of the problem and a disservice to Americans. We [PPI] propose capping insurers’ out-of-network payment rates – starting at 200 percent and then steadily decreasing to 120 percent of Medicare rates.”

Many providers oppose rate setting, for obvious reasons. But, increasingly, the policy framework is seen as a reasonable response on cost. It’s in the federal policy discussion, and states like California and Washington implemented rate setting legislation in 2019.