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Issues in Health Reform

Author: rriporte

Consumer savings associated with ACA

Posted on by rriporte

The Department of Health and Social Services issued some encouraging news today for consumers about savings associated with health insurance.  “Today, the Department of Health and Human Services (HHS) announces that nationwide, 77.8 million consumers saved $3.4 billion up front on their premiums as insurance companies operated more efficiently.  Additionally, consumers nationwide will save $500 million in rebates, with 8.5 million enrollees due to receive an average rebate of around $100 per family.”

This is related to the 80/20 rule where insurance companies have to spend 80% of every dollar collected in premiums on direct patient care.  If they do not, the difference is given back to the consumers as either rebates or compensation in better future benefits.

How different states are collaborating in setting up the federally sponsored marketplaces

Posted on by rriporte

This report from the Urban Institute looks at the roles 3 states, Alabama, Michigan, and Virginia are playing in the implementation process in their states of federally-facilitated marketplaces/Exchanges. The other states, including Kansas, are not detailed but one can assume similar types of variations in style of collaboration.

The paper’s findings include:

  • Two of the three states are actively engaged in their exchange’s development, although some stakeholders noted they need more information from the government to complete the exchange and prepare themselves in a timely manner.
  • State Departments of Insurance view the regulations and their role in the exchanges as a continuation of their work pre-reform.
  • States are at different stages of readiness, Alabama for instance is lagging as a result of political/administrative hurdles the state faced and they have no plans to assist in the exchange’s development.
  • Consumer assistance programs will need to be created to help people navigate the exchange, although clearing political hurdles will be a challenge in the acquisition of federal funds to pay for such programs.

States estimates of the low income uninsured not eligible even if their home states expanded Medicaid through ACA

Posted on by rriporte

This issue brief from the SHADAC (State Health Access Data Assistance Center) of the Robert Wood Johnson Foundation details with maps and tables which states are most likely to have low income uninsured adults who even with ACA’s Medicaid expansion would remain uninsured.  Kansas is in the top tier with over 10.1%.  It is estimated that  4% of Kansas’ ~1.7 million nonelderly (less than 65) adults are either undocumented or recent legal immigrants.  Eight percent of its 391,000 low income, less than 138% of the federal poverty level ($15,856 for a single person), nonelderly adults are either undocumented or recent legal immigrants.  And about 13% of its low income uninsured nonelderly adults are either undocumented or recent legal immigrants.   The average for the US is higher at 17% because of states like California, Texas, and even some northeast states like Massachusetts and New Jersey which have higher percentages and larger populations pulling the mean upward.

More businesses due to ACA

Posted on by rriporte

Job lock has been one of resulting problems with the way Americans currently purchase health insurance.  Because the individual market is so expensive, and because many people would have pre-existing conditions that would have excluded them from purchasing a new insurance plan, many people stay at jobs they do not like.

So, with the ability to purchase insurance in the marketplace with no exclusions due to pre-existing conditions it is predicted that more people will change jobs and even pursue new entrepreneurial ventures.  This is detailed in a new report from the Robert Wood Johnson Foundation, the Urban Institute and Georgetown University’s Health Policy Institute. The number of self-employed people is expected to rise by 1.5 million — a relative increase of more than 11 percent — as a direct result of the health care overhaul.

Delaying the full implementation of the Small Business Marketplaces

Posted on by rriporte

Part of the new choices in the world of Obamacare are going to be marketplaces (SHoPs) where small businesses  can choose health plans to offer their employees.  Larger purchasing pools are expected to make the costs of offering insurance to employees of those businesses much more affordable.

Unfortunately there is going to be delay in when those SHoPs get launched.  The federal government has been mightily distracted by the unexpected task of having to set up marketplaces in over half of the states, Kansas being one of them, where Governors have decided to let the feds negotiate with state health insurance plans.

This article in the Washington Post details the specifics of what and when to expect that small business marketplace to get up and running.

Clock ticking for states to decide on expanding criteria for Medicaid eligibility to take advantage of health reform

Posted on by rriporte


This Politico Pro article highlights the logistic issues currently facing states that have not yet decided to expand their Medicaid eligibility criteria and take advantage of the feds paying the full bill for several years.  Jason Millman also writes that for states that have not yet said yes it may be 2015 before they can tap into those monies.  Kansas is one of five states leaning toward not participating.  New York is leaning toward participating.  And the remainder have declared one way or the other.  For a good map of the current national situation click here.

By JASON MILLMAN | 5/23/13 5:09 AM EDT

“States still mired in the fight over the Obamacare Medicaid expansion are starting to give up on their first year of full funding — and it’s unclear whether they would be able to tap into the money before 2015.  Expansion remains an open question in about a dozen states after months of legislative fights. As more states continue to wrap up their budgets, some are already looking to next year’s legislative sessions as their next shot at the expansion, even amid calls for state legislatures to return for special sessions.”

“Role of Health Care Navigators Under Fire”

Posted on by rriporte

Navigators are set to be trained to help people enroll in the new marketplace of insurance plans.  As noted in this Wall Street Journal article several states are now enacting rules that are intended to protect consumers’ confidential information (e.g., social security numbers and tax info) by setting high standards (fingerprinting, licensure) of the assisters, much as insurance brokers are already.  On the surface this is certainly not a bad thing but it does create another level of barriers to assuring a smooth enrollment process this fall.

Another way of looking at this though suggests that perhaps not all is as it seems.  Extension and others who help many limited income families already have access to that confidential information (VITA sites) without any such standards.  So apparently those of limited income didn’t need the same protections of those with higher incomes.  I find this curious.

Some think the effort may be a disingenuous ploy implemented to once again make it more difficult for consumers to enroll, and to make this first year’s enrollment process go less than smoothly.  I find it important to remember that this marketplace model of health insurance that became Obamacare was originally an idea of conservative groups who did not want to see Medicare extended to all populations, or were not supportive of any of a number of other health insurance reform proposals.  A similar system has been successfully implemented in Massachusetts (when Romney was Governor there)KFF Massachusetts Health Care Refore July 2012.  And though conservative groups have clearly not be supportive of Obamacare, it is the closest to allowing the free market to continue to provide insurance, the kind of plan one would expect them to support.

Potential purchases of coverage in the Kansas Health Insurance Exchange: Who is likely in and who not?

Posted on by rriporte

The Kansas Health Institute report, “Insurance Exchange will provide many Kansas consumers with new options” estimates numbers for the state as a whole.  While more than 500,000 Kansans may consider purchasing insurance through the Exchange, only

  • 193,000 are most likely since they will qualify for tax credits/premium discounts;
  • 75,000 less likely because they don’t qualify for these;
  • 245,000 whose purchase behavior is unknown depending upon what their employers do; and
  • an additional 43,000 who will qualify for tax credits if Kansas does not expand Medicaid.  This latter population unfortunately will find insurance unaffordable even with the tax credit.

Summary from report:

2014, the Affordable Care Act’s individual mandate will require nearly all U.S. citizens to have health insurance. The health reform law also requires each state to have an online marketplace known as a health insurance exchange where people can obtain insurance.

 

This new issue brief — the eighth in a series focusing on health reform — examines which Kansans would be most likely to use a health insurance exchange.

 

Key findings of the brief include:

 

• More than 500,000 Kansans would have some reason to consider using the health insurance exchange to obtain coverage, though some are more likely to use it than others.

 

• About 1.7 million Kansans are likely to continue with the coverage they have now.

 

• The exchange will provide small employers and their workers with more options.

 

• The exchange will serve as a gateway for determining eligibility for federal tax credits as well as Medicaid and the Children’s Health Insurance Program.”

Women’s Health Quiz

Posted on by rriporte

The Kaiser Family Foundation has posted an online quiz to test your knowledge of women’s health and the effect of ACA on it.  Might be nice to use in exercises with consumers. And no, I did NOT get them all right.  There are a multitude of details in ACA and some I just haven’t learned or forget!