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Matt Fiedler @mattafiedler.bsky.social · Jul 1

Full piece on the House bill is here: healthaffairs.org/content/fore.... I’ll release an updated analysis once final numbers on the Senate bill are available.

Taking Stock Of The Health Coverage Impacts Of The House Reconciliation Bill | Health Affairs Forefront

The US uninsured rate has never risen as far, as fast as it will if the House bill and other looming policy changes affecting insurance coverage take effect; the resulting increase would erase almost ...

healthaffairs.org

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Matt Fiedler @mattafiedler.bsky.social · Jul 1

What will the Senate bill mean for health coverage? We don’t yet have final CBO estimates, but it’s clear they’ll be pretty similar to the House bill. That puts the U.S. on track for an unprecedented increase in the uninsured rate that will wipe out ~3/4 of post-2013 declines.

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Matt Fiedler @mattafiedler.bsky.social · Jun 28

The Senate reconciliation bill, at least in its current form, appears likely to reduce coverage about as much as the House bill. If it becomes law, that would mean reversing most of recent years' insurance coverage gains:

bsky.app/profile/matt...

Matt Fiedler @mattafiedler.bsky.social · Jun 10

My new piece @healthaffairs.bsky.social Forefront finds that if the House bill becomes law and enhanced premium tax credits expire on schedule, the US will see an unprecedented increase in the uninsured rate, wiping out about ~3/4 of the post-2013 decline.

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Reposted by Matt Fiedler

Adrianna McIntyre @adrianna.bsky.social · Jun 26

New-to-me nugget on work requirements implementation in here:

Pinging Equifax's The Work Number — which states are likely to rely on to get recent-enough employment data — "sometimes costs over $20 per person per query"

How Medicaid Work Requirements Betray Work and Waste Money

I Oversaw Work Requirements in Michigan - Here is What I Told Congress

donmoynihan.substack.com

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Matt Fiedler @mattafiedler.bsky.social · Jun 25

Full piece is here: www.healthaffairs.org/content/fore...

Matt Fiedler @mattafiedler.bsky.social · Jun 25

Clever new piece from Kennah Watts and Jack Hoadley takes a first look at how decisions under the No Surprises Act arbitration process vary across arbitrators. Lots of interesting findings here, including that provider win rates vary a lot by arbitrator.

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Matt Fiedler @mattafiedler.bsky.social · Jun 16

From a first look at the Senate drafts, the cuts to Medicaid & the Marketplaces are similar to the House’s, maybe even a bit deeper on net. Upshot: these drafts, like the House bill, would put the US on course for an unprecedented rise in the uninsured rate.
bsky.app/profile/matt...

Matt Fiedler @mattafiedler.bsky.social · Jun 10

My new piece @healthaffairs.bsky.social Forefront finds that if the House bill becomes law and enhanced premium tax credits expire on schedule, the US will see an unprecedented increase in the uninsured rate, wiping out about ~3/4 of the post-2013 decline.

Reposted by Matt Fiedler

Matt Fiedler @mattafiedler.bsky.social · Jun 10

My new piece @healthaffairs.bsky.social Forefront finds that if the House bill becomes law and enhanced premium tax credits expire on schedule, the US will see an unprecedented increase in the uninsured rate, wiping out about ~3/4 of the post-2013 decline.

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Reposted by Matt Fiedler

Citizen Cohn / Jonathan Cohn @citizencohn.bsky.social · Jun 10

"...the US uninsured rate has never risen as far, as fast as it will if the House bill and other looming policy changes affecting insurance coverage take effect"

-- @mattafiedler.bsky.social www.healthaffairs.org/content/fore...

Taking Stock Of The Health Coverage Impacts Of The House Reconciliation Bill | Health Affairs Forefront

The US uninsured rate has never risen as far, as fast as it will if the House bill and other looming policy changes affecting insurance coverage take effect; the resulting increase would erase almost ...

www.healthaffairs.org

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Matt Fiedler @mattafiedler.bsky.social · Jun 10

Read the full piece here: www.healthaffairs.org/content/fore...

Matt Fiedler @mattafiedler.bsky.social · Jun 10

If lawmakers want to change the House bill to avoid this, they’ll have to change the provisions with big coverage impacts. Notably, the bill's provider tax changes, which seem to be attracting the most ire from Senators so far, are a fairly small part of the overall picture.

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Matt Fiedler @mattafiedler.bsky.social · Jun 10

My new piece @healthaffairs.bsky.social Forefront finds that if the House bill becomes law and enhanced premium tax credits expire on schedule, the US will see an unprecedented increase in the uninsured rate, wiping out about ~3/4 of the post-2013 decline.

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Reposted by Matt Fiedler

Jacob Wallace @jacobwswallace.bsky.social · Jun 2

Ok folks, we know work requirements reduce benefits without increasing work (cc: @chloeneast.bsky.social)

But who loses benefits and what happens if work requirements are reversed?

New evidence from linked SNAP-Medicaid data and a natural experiment in CT tell a concerning story...

Thread below 👇

SNAP work requirements have biggest effect on those least able to work

Most people pushed out of SNAP in Connecticut didn’t find their way back in, even when work requirements were later reversed.

tobin.yale.edu

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Matt Fiedler @mattafiedler.bsky.social · May 27

Read the full paper here: www.nber.org/papers/w33856

Matt Fiedler @mattafiedler.bsky.social · May 27

The authors then show that fall birthdays are, correspondingly, least likely to have a doctor’s office or emergency department visit for flu (green line/dots), indicating that higher vaccination rates do indeed translate into greater protection against flu.

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Matt Fiedler @mattafiedler.bsky.social · May 27

The authors leverage the fact that kids typically have a wellness visit around their birthday. For fall birthdays, the flu vaccine is typically available at that visit, resulting in higher vaccination rates than for kids a bit older/younger, esp. around 3rd & 4th birthdays.

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Matt Fiedler @mattafiedler.bsky.social · May 27

Interesting new paper providing clear evidence that the flu vaccine is effective at reducing both office and emergency department visits for flu in kids.

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Matt Fiedler @mattafiedler.bsky.social · May 23

Second, a Twitter thread from back when CMS finalized the RADV rule explaining why CMS should audit more contracts and why that could substantially reduce risk scores and, in turn, generate significant savings:
x.com/MattAFiedler...

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Matt Fiedler @mattafiedler.bsky.social · May 23

Two other closing notes. First, while reporting of invalid diagnoses is part of why risk scores are higher in MA, more intensive coding of *valid* diagnoses is more important. Addressing coding intensity differences attributable to valid diagnoses requires tools beyond audits.

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Matt Fiedler @mattafiedler.bsky.social · May 23

#3: Litigation. The final RADV rule is already the subject of litigation, and this step will raise the stakes in that litigation considerably.
litigationtracker.law.georgetown.edu/litigation/h...

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Matt Fiedler @mattafiedler.bsky.social · May 23

In recent guidance, CMS has indicated that it intends to retain a fairly broad sampling frame, but CMS’ choices in this area also bear watching going forward.
www.cms.gov/files/docume...

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Matt Fiedler @mattafiedler.bsky.social · May 23

If CMS followed through on that, it would greatly reduce the impact of this step since the audits (and subsequent extrapolation from those audits) could only address inappropriate coding associated with the targeted sub-sample.

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Matt Fiedler @mattafiedler.bsky.social · May 23

#2: Sampling strategy. In the RADV final rule, CMS suggested that it might shift from a sampling strategy aimed at measuring the level of inappropriate coding for a contract as a whole to a strategy aimed at fairly narrow subsets of enrollees.

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Matt Fiedler @mattafiedler.bsky.social · May 23

It’s hard to assess how large sample sizes need to be without access to actual audit data. But I would not be at all surprised if CMS needs to be at the top end the 35 to 200 record sample size they envision (or beyond) for this to work well.

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Matt Fiedler @mattafiedler.bsky.social · May 23

The underadjustment will be larger when CMS' estimate of the error rate is noisier since a noisier estimate means a wider confidence interval. Thus, for audits to address overpayments due to inappropriate coding, adequate sample sizes are essential.

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