Kansas State University

search

Issues in Health Reform

Author: rriporte

How well is ACA doing getting the uninsured insured? Better than the press tells you.

Posted on by rriporte

What about all of those newly insured numbers? While it take many years to evaluate all of the impacts of ACA on insurance status, and certainly on the true impact of having insurance on health status, the numbers of newly insureds are impressive. As of January 15, 2014 there are almost 11.6 million Americans who have health insurance who did not have it before ACA. Almost 2.2 million people have enrolled for new insurance policies through the Exchanges. Almost 1.6 million have been added to state Medicaid rolls. And approximately 7.8 million young adults (under age 26 ) have already been added to their parents’ employer sponsored health insurance plans because of the ACA requirement that employer sponsored family plans expand coverage. This last group is often not cited when considering the success of ACA in getting previously uninsured people insured. Most of the articles focus on how successful the Exchanges are in getting the uninsured into those private plans. They also seem to ignore the success in getting individuals into state Medicaid programs. Almost 12 million folks newly insured has to be counted as a success for ACA accomplishing one of its major goals…to get uninsured folks insured.

Health Exchange Enrollment Picked Up in December, By HAEYOUN PARK, DEREK WATKINS and WILSON ANDREWSJAN. 13, 2014, NY Times.
http://www.nytimes.com/interactive/2014/01/13/us/state-healthcare-enrollment.html?_r=0
Covering Young Adults Under the Affordable Care Act: The Importance of Outreach and Medicaid Expansion Findings from the Commonwealth Fund, Health Insurance Tracking Survey of Young Adults, 2013
Sara R. Collins, Petra W. Rasmussen, Tracy Garber, and Michelle M. Doty, August 2013.
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2013/Aug/1701_Collins_covering_young_adults_tracking_brief_final_v4.pdf

Obamacare enrollment numbers

Posted on by rriporte

This federal report includes up to date enrollment numbers for the marketplace. While all of the numbers are extremely low (just over 100,000 enrolled through federal Exchanges), what most of the media is missing is that there are almost one million who have signed on and are no doubt taking the time to make plan choices, as good consumers would do.  AND there are ~400,000 who have been enrolled in state’s Medicaid programs.  It is interesting that about 4 times as many have been enrolled in Medicaid than in the private plans on the Exchanges.  This may suggest that the most vulnerable population is clamoring for access to health care in ways that those with a bit more resources, including the young healthy adults, are not as yet.

Delinking health insurance from the workplace

Posted on by rriporte

I’ve been speaking to one main advantage of Obamacare being the lifting of job lock, where folks get to choose to work where they want and not be afraid of being cut off from health insurance. Thomas Friedman’s opinion in the New York Times adds a particular urgency to this issue…that new jobs being creating are going to be less and less those that will come with insurance as a fringe benefit, so that the new economy dictates the need for delinking insurance from the workplace or at the least, having affordable options for workers and their families.

Job lock is lifted because now no one can be denied health insurance because of pre-existing conditions, there is place to purchase health insurance that offers large group level premiums similar to those in workplace (that’s what the Exchanges are about), and where feds operate similarly to employers by helping folks pay for those plans.  With the feds, they help those with less than 400% of the federal poverty line pay for insurance by way of the tax credits.  Employers usually paid a portion of the premium as well but rarely based on salary level of employee.

The media hype vs the truth: What about the cancellation of insurance policies

Posted on by rriporte
  • True, President Obama promised what was never possible in the individual market BUT
  • Policies were always cancelled and often at times of high medical need and expenses
  • With ACA that can no longer happen BECAUSE
  • No one can be denied health insurance
  • There are many options for insurance AND
  • The new policies are much more substantial than the ones being cancelled.  Lots of policies were almost worthless AND
  • The costs, especially with the subsidies are much more affordable for real coverage AND
  • All of the consumer protections are in place: no one can be denied a policy, no lifetime or annual limits AND
  • No more job lock.  With options for group insurance outside of working for an employer who offers insurance, options where no one can be denied a policy, people can choose to work where they want.  This is a boon for entrepreneurs who want to open their own businesses.  There is now a Marketplace Exchange where they can purchase policies in a  group rated fashion.  Imagine people leaving jobs they hate but only stayed with because they needed the insurance.  Farm wives heading back to the farm because they don’t need to work away to get insurance.  Families being able to move closer to loved one.

So the media hype that policies are being cancelled clouds the truth of the story. Yes people are scared because they are not yet aware of what their new options really are, they are afraid of change.  They are afraid of losing their doctors.  The unfortunate reality is that insurance companies have been for years changing networks of doctors annually.  One could never be certain of of which doctors were going to be in their plans from year to year.  Insurance companies negotiate with doctors and other health care providers annually to find the best fit and prices for the needs of their insured clientele.  Obamacare didn’t change that.

Time for ACA Open Enrollment: State vs Federal Exchanges

Posted on by rriporte

In the past week a new distinction in implementation success between states that had chosen to facilitate their own new insurance marketplaces (also called Exchanges) and those that did not has become apparent.  Previously much was written about how much it really did NOT matter if the Exchange was going to be run by a state or run by the feds.  After all, there were going to be marketplaces with a collection of new insurance policies for consumers to choose regardless of who was doing the facilitating.  Negotiating with the different insurance companies happened.  States have lots of policies being offered in these Exchanges.  But getting access to them online has been quite a different experience for those trying to access a state facilitated Exchange vs those accessing healthcare.gov to get to their states’ federally facilitated Exchanges.

Early on it was apparent that the burden of having the feds do it for over half of the states was going to take its toll on the administrators.  But beside that, things were going to be fairly equal.

Well, not so.  The federal website is experiencing all sorts of glitches and delays.  It is unfortunate since those who have been able to create and account and see what their states’ insurance offerings are have been satisfied. We now see evidence that running such a massive online site, with apparently outdated government type computer services, is more problematic than having states put together smaller Exchanges. Check out this article explaining the differences: http://www.nytimes.com/2013/10/09/us/politics/uninsured-find-more-success-via-health-exchanges-run-by-states.html?_r=0

Kansas families who have not been able to register or submit an application to consider a policy being offered in the Kansas Exchange can at least get a glimpse of what the premiums and tax credits might be for them in Kansas by going to insureks.org

There one enters county, household size, income, and ages of family members to be covered and a cost estimator gives expected monthly costs based on premiums and tax credits that are true to the cost of premiums in their region of Kansas.

 

Resources for the Kansas Exchange: Health insurance premiums and other options

Posted on by rriporte

There are several excellent resources available for consumers trying to make sense of what the Marketplace/Exchange in Kansas looks like.

The Kansas Insurance Department has a consumer friendly site that helps individuals and families understand the new Marketplace and offers some resources for support in making decisions.

Our colleagues at the Kansas Health Institute have a very informative map on their home page that shows what the ranges of prices for health insurance premiums through the Exchange are in Kansas.  HHS reports that the average monthly premium for a middle of the road plan in Kansas is $260/month, less than the US average of $328/month, the fifth lowest rates in the nation.

The Kansas Health Institute also has an issue brief on the Marketplace.  The brief includes

  • a summary of the 65 types of plans being offered to individuals and
  • tables showing examples of costs depending on region of state, age, and income level including the range of monthly savings for those receiving tax credits (between $100 and $1000/month depending on age and income level).

 

The role of Critical Access Hospitals for rural communities

Posted on by rriporte

With so much attention on The Affordable Care Act and the opening of the Exchanges some other issues important for the continued functioning of our health care delivery system, particularly in rural and frontier communities, is being overlooked.

A recent blog by Josh Freeman covers the role of Critical Access Hospitals for rural communities fairly completely.  Most of the blog covers the factual…how CAHs were created nationally in 1997, that Kansas has more than any other state (83), what role they play in providing health care to high risk populations (those with more occupational injuries…farmers, ranchers, loggers…and older Americans), and how a recent designation change will decrease how much money these hospitals recover from Medicare putting their existence at risk.  Freeman ends his argument with an opinion on the continued worthiness of CAHs.

These CAHs are all connected to a “supporting” hospital where their patients will be transferred to if care is not completed in 3 days.  Click here for a map of those Kansas networks.

Polls showing continued confusion for Americans about the Affordable Care Act

Posted on by rriporte

As the start date for open enrollment in the Marketplaces nears, polls find more and more confusion about what the health care law means for consumers.  It is important to remember that this initial enrollment period will be 6 months long, plenty of time for people to enroll and begin to get comfortable and informed about what the law may really mean for them.  Of interest in the polls, young adults seem more favorable to it than do older adults.  Given that Medicare beneficiaries are the least impacted population…that is, they do not need to make new decisions about their health insurance, Medicare remains…this is curious. One does wonder whether if the Medicare population could think about this as grandparents of young adults, if they would see additional benefits for those grandchildren, and peace of mind for themselves, for those youths being insured.   http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/16/two-new-polls-tell-us-americans-are-very-very-confused-about-obamacare/?wprss=rss_economy&tid=pp_widget

 

High risk groups need to learn about Marketplaces

Posted on by rriporte

Not surprisingly, one of the highest risk groups that should make it into the marketplaces are those already in state and federal high risk pools…those who were previously uninsurable anywhere else.  Believe it or not, those high risk folks too are to be added, just like everyone else, to the Marketplace with no differential rates for their pre-existing conditions.  They will get much more affordable policies in the Marketplaces…but yes, are the reason why we need so many healthy young adults in the pools as well.  Here is a study outlining the needs     report

 

Delay in employer mandate may not impact number of people insured nor costs

Posted on by rriporte

NEW STUDY by Rand verifies basic findings from Urban Institute report original July 18 posting as below, THOUGH it does point to a significant loss of federal income due to expected penalties not being collected.

“In July 2013, the Obama administration announced a one-year delay in enforcement of the Affordable Care Act’s (ACA) penalty on large employers that do not offer affordable health insurance coverage. To help policymakers understand the implications of this decision, RAND analysts employed the COMPARE microsimulation model to gauge the impact of the one-year delay of the so-called employer mandate. They found that the delay will not have a large impact on insurance coverage: Because relatively few firms and employees are affected, only 300,000 fewer people, or 0.2% of the population, will have access to insurance from their employer, and nearly all of these will get insurance from another source. However, a one-year delay in implementation of the mandate will result in $11 billion dollars less in federal inflows from employer penalties for that year. A full repeal of the employer mandate would cause revenue to fall by $149 billion over the next ten years (10% of the ACA’s spending offsets), providing substantially less money to pay for other components of the law. The bottom line: The one-year delay in the employer mandate will have relatively few consequences, primarily resulting in a relatively small one-year drop in revenue; however, a complete elimination of the mandate would have a large cumulative net cost, potentially removing a nontrivial revenue source that in turn funds the coverage provisions in the ACA.”

A report issued by the Urban Institute states that “The one-year delay in ObamaCare’s employer mandate won’t have much effect on the law’s costs nor the number of people it covers.”  The report summarizes though that a change in the individual mandate will have a significant impact.  Having a parallel delay in the implementation of the individual mandate is something currently being considered by Congressional Republications, though like their attempts at full repeal of the law, it is not destined for any traction.

The analysis in the report predicts a decline from 19% to only 15% without the individual mandate, down to 10% with the individual mandate.  Without the employer mandate this model predicts the number of uninsured to go to 10.2% uninsured rather than 10.1% with the mandate. That is, the difference with or without the employer mandate is pretty insignificant in terms of impacting the numbers of newly insured.