August 12, 2014
Different eligibility criteria for different populations can also cause a churn challenge, especially for families. Most states have different Medicaid eligibility limits for children than for adults. This means that if a family’s income increases, or a child ages out of CHIP coverage, the eligibility for the parents may change, while the eligibility for the children may not. This scenario results in split families, wherein the children have one type of coverage and adults have a different type. In many states, this means understanding the details, benefits and cost structures of two types of coverage, often from different companies, in the same household.
So what can we do to safeguard consumers from these disruptions? Fortunately, states have resources in their toolkits to mitigate the impacts of churn. They can work to maintain continuity of care for individuals, and they can make sure that insurance remains affordable when people jump from one coverage source to another.
via Churn and the ACA | The Health Care Blog.
August 2, 2014
“I’ve had one doctor appointment since I got this insurance, and I had to pay $60,” Ms. Shabazz told Daniel Flynn, a counselor with the health network, the Health Federation of Philadelphia. “I don’t have $60.”Mr. Flynn spent almost two hours going over her Independence Blue Cross plan, which he explained had a “very complicated” network that grouped doctors and hospitals into three tiers. Ms. Shabazz, who has epilepsy, had not understood when she chose the plan that her doctors were in the most expensive tier.“None of that was explained when I signed up,” she said. “This is the first I’m hearing it.”
via Newly Insured by Health Law, Millions Face a Learning Curve – NYTimes.com.
July 23, 2014
In this analysis of nationally representative survey data from January 2012 through June 2014, we found a significant decline in the uninsured rate among nonelderly adults that coincided with the initial open-enrollment period under the ACA. These changes remained highly significant after adjustment for potential confounders such as employment, demographic characteristics, and income. As compared with the baseline trend, the uninsured rate declined by 5.2 percentage points by the second quarter of 2014, a 26% relative decline from the 2012–2013 period. Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, our sensitivity analyses imply a wide range from 7.3 to 17.2 million adults.
via Health Reform and Changes in Health Insurance Coverage in 2014 — NEJM.
July 22, 2014
With apologies to Mark Twain, there are lies, there are damned lies, and then there are ObamaCare statistics. Case in point is a column written by Vicki Simons touting the supposed positive effects of ObamaCare: The positive results of ACA:
— 20 million more American have access to health care than before ACA was passed.
— 8 million people have signed up for health coverage through the state and federal marketplaces; 32,000 in New Mexico.
— 4.8 million more have signed up for Medicaid coverage; 103,00 total in New Mexico. As of March 31, 2014, there were 642,489 residents enrolled in Medicaid or CHIP.
— 3 million now have coverage by staying on their parents’ plan; 26,000 in New Mexico.
Not a single one of those is accurate.
via Lies, Damned Lies, And ObamaCare Statistics – Amy Ridenour’s National Center Blog – A Conservative Blog.
July 21, 2014
The Obama administration and state insurance regulators are developing stricter standards to address the concerns of consumers who say that many health plans under the Affordable Care Act have unduly limited their choices of doctors and hospitals, leaving them with unexpected medical bills.Federal officials said the new standards would be similar to those used by the government to determine whether Medicare Advantage plans had enough doctors and hospitals in their networks. These private plans, sold by companies like UnitedHealth and Humana, provide comprehensive care to 16 million of the 54 million Medicare beneficiaries.States are free to adopt additional standards of their own, and Washington did so in late April.
via To Prevent Surprise Bills, New Health Law Rules Could Widen Insurer Networks – NYTimes.com.
July 16, 2014
Only in Washington could something that fails to hit even half of its original target be considered a gasp-inducing success. No wonder Obamacare is every bit as unpopular now as it was before the party that passed it took its initial Obamacare-induced “shellacking” four years ago.It’s time for a well-conceived conservative alternative that will fix what the government had broken even before Obamacare was passed, shift things in a conservative direction from the pre-Obamacare status quo, and lead to the full repeal of perhaps the worst legislation in American history.
via Obamacare Misses Its Target on the Uninsured by Half | The Weekly Standard.
July 9, 2014
The CMS is planning to conduct its first nationwide research effort to answer the question of whether adult Medicaid beneficiaries can find providers, and if factors such as being in managed Medicaid versus a fee-for-service offering aid or hurt the search. What it’s likely to find, according to interviews conducted with state Medicaid officials and medical society officials in 20 states, is a mixed picture overshadowed by general concerns that reimbursement rates remain too low to entice many doctors to accept new Medicaid patients.
Many states already conduct such surveys annually, but the CMS’ aim is to standardize the collection and analysis of data from state to state. The survey will begin this fall, with the goal of reaching roughly 29,000 adult Medicaid enrollees from each state for a total sample size of approximately 1.5 million, according to a bulletin circulated to state officials.
via Healthcare Reform Update: Can Medicaid beneficiaries find a doctor? The CMS wants to know | Modern Healthcare.
July 7, 2014
In two years, the ACA’s structural problems will lead to substantial premium increases. Once that happens, North Carolinians will likely leave the insurance market in droves. They’ll have little choice – they won’t be able to afford health insurance because federal subsidies won’t keep up with the rapid price increases. Within a decade, this could swell the ranks of the state’s uninsured by 57 percent.This isn’t baseless speculation. I reached this conclusion by using a peer-reviewed economic model published in several health journals. It was funded by both private and government sources, including the Department of Health and Human Services, and has been cited by multiple Supreme Court justices in ACA-related rulings.But why won’t this happen until 2017? Because that’s the year the Affordable Care Act goes into full effect and certain temporary provisions begin to sunset. The changes will affect all plans sold for 2017 and beyond.
via Future of Obamacare bleak for North Carolinians | Other Views | NewsObserver.com.
July 2, 2014
This paper explores the effects of public health insurance expansions on hospitals’ decisions to adopt medical technology. Specifically, we test whether the expansion of Medicaid eligibility for pregnant women during the 1980s and 1990s affects hospitals’ decisions to adopt neonatal intensive care units NICUs. While the Medicaid expansion provided new insurance to a substantial number of pregnant women, prior literature also finds that some newly insured women would otherwise have been covered by more generously reimbursed private sources. This leads to a theoretically ambiguous net effect of Medicaid expansion on a hospital’s incentive to invest in technology. Using American Hospital Association data, we find that on average, Medicaid expansion has no statistically significant effect on NICU adoption. However, we find that in geographic areas where more of the newly Medicaid-insured may have come from the privately insured population, Medicaid expansion slows NICU adoption. This holds true particularly when Medicaid payment rates are very low relative to private payment rates. This finding is consistent with prior evidence on reduced NICU adoption from increased managed-care penetration. We conclude by providing suggestive evidence on the health impacts of this deceleration of NICU diffusion, and by discussing the policy implications of our work for insurance expansions associated with the Affordable Care Act.
via Public Health Insurance Expansions and Hospital Technology Adoption.
June 25, 2014
An eHealth analysis of fixed-benefit indemnity plans offered through the company’s website reports an average monthly premium of $112.98 for fixed-benefit indemnity plans. The coverage offered through fixed-benefit indemnity health insurance products may be summarized by the following:Fixed-benefit indemnity medical plans provide set benefits, typically in the form of a cash payout, to help cover services such as doctor’s visits, urgent care, x-rays, prescription drugs in some cases, and certain hospital expenses.
These products typically do not require policy holders to meet an annual deductible, but will not provide coverage beyond specified caps. Lifetime coverage limits may also apply.Benefits are typically paid directly to the policy holder who may then apply that amount to cover a portion of his or her medical expenses.
According to guidelines issued by the Centers for Medicare and Medicaid Services, fixed-benefit indemnity plans will no longer be available for purchase as a stand-alone product beginning in 2015, which means that consumers will only be able to purchase fixed-benefit indemnity plans to supplement their major medical coverage.
via eHealth Offers Fixed-Benefit Indemnity Plans for Consumers Who Want Additional Coverage Options Outside of Open Enrollment.