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Cantwell: Where's the Basic Health Plan program?

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Sen. Maria Cantwell is trying to get the U.S. Department of Health and Human Services (HHS) to step up efforts to create the “Basic Health Plan” option.

Cantwell, D-Wash., asked about the status of the basic plan program today during a Senate Finance Committee hearing on the Medicare delivery system

Jonathan Blum, the director of the Center of Medicare, an arm of the Centers for Medicare & Medicaid Services (CMS), which is, in turn, an arm of HHS, talked about efforts to modernize the way Medicare pays for care.

He noted, for example, that changes in the Medicare Advantage program have increased the percentage of enrollees who are in plans that earn ratings of 4 or 5 stars on a 5-star scale to 37 percent in 2012, from 16 percent in 2009.

The gap between how much more Medicare pays for a Medicare Advantage plan enrollee and a traditional Medicare enrollee has fall to 4 percent this year, from 14 percent a few years ago, and could fall further in 2014, Blum said.

Cantwell used the hearing as an opportunity to press Blum to tell administrators at CMS to get the basic plan program going, even if the program could prove to be stiff competition for the new health insurance exchange program that states and the HHS are now setting up.

Officials and HHS and CMS want to implement the program in 2015, Blum said.

“I’m not interested in having the schedule of the date it’s going to be implemented,” Cantwell told Blum. “I’m interested in making sure the agency doesn’t thwart a more cost-effective solution to somehow ‘save the exchange.’

The drafters of the Patient Protection and Affordable Care Act of 2010 (PPACA) included Section 1331, the basic health plan provision, in an effort to offer states an alternative way to provide health coverage for residents who earn less than 200 percent of the federal poverty level but are unable to qualify for Medicaid or buy affordable employer coverage.

A state could run a basic plan itself or hire one or more commercial insurers to run a basic plan program.

The basic plans were supposed to be ready by 2014.

Cantwell argued that her state’s experience has shown that providing a basic plan would be a much more affordable way for a state to cover moderately low-income residents than sending them to the new health insurance exchange system to buy subsidized commercial coverage.

Cantwell said she can’t get anyone at CMS to “own up to the fact that states, under the law, could receive 95 percent of the [PPACA health insurance purchase] tax credits to provide cheaper care.”

“I’m interested in a commitment by the administration to live up to how the Affordable Care Act provisions says the [basic health plan program] should be implemented,” Cantwell said.

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