This leaves the newly uninsured with two options: If they qualify by their income, sign up for Medicaid or stay uninsured and face a penalty. Many will choose the first option. In a newly completed, as yet unpublished paper by George Washington University’s Bianca Frogner and me, we estimate that Medicaid enrollment will increase by 2%-3% annually through 2024. Yet this will not capture everyone. Many will not be eligible for the program, because either they earn more than 133% of the federal poverty level currently $11,670 for an individual, $23,850 for a family of four or their state did not expand Medicaid.Either way, there will be a significant number of uninsured Americans unwilling or unable to pay for the inflated insurance available on the exchanges and forced to pay penalties, which for 2016 and thereafter will be the greater of $695 or 2.5% of income. More will choose this option every year. By 2024, Ms. Frogner and I estimate that there will be more than 40 million uninsured, roughly 10% more than today.
Off-Exchange Plans 39 Percent to 45 Percent More Expensive than Exchange Plans | John Goodman’s Health Policy Blog | NCPA.orgJune 11, 2014
Plans sold off-exchange must offer the same essential health benefits as plans sold on the exchanges, but the primary difference between buying plans on- or off-exchange is that only on-exchange plans are eligible for government subsidies.On average the least expensive bronze plans offered by the four off-exchange insurers were 45% more expensive than the least expensive bronze plans offered on the exchanges.On average the least expensive silver plans offered by the four off-exchange insurers were 39% more expensive than the least expensive silver plans offered on the exchanges.The cheapest United Healthcare gold plan was 41% more expensive on average than the cheapest exchange gold plan, while the cheapest Assurant gold plan was 39% more expensive.
Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they’ve seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend.Experts cite many reasons: A long-standing shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won’t accept Medicaid. And poor people often can’t take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.Plus, some patients who have been uninsured for years don’t have regular doctors and are accustomed to using ERs, even though it is much more expensive.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States : May 2014 UpdateJune 4, 2014
The authors estimate that in 2014, 56 percent of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP, or subsidized marketplace coverage. In states that expanded Medicaid eligibility, 68 percent of the uninsured became eligible for assistance, compared with only 44 percent in states that did not. Because of this difference in eligibility, the ACA is projected to reduce the number of uninsured people by 56 percent in states that expanded Medicaid, compared with only 34 percent in states that did not. The authors also provide estimates of what would happen if states that have not yet expanded Medicaid were to do so.
Obamacare is the new premium support. Without a strong dose of deregulation and competition, it won’t succeed. | Morning ConsultJune 4, 2014
Regardless of whether Obamacare is “repealed and replaced” or “fixed”, the future of consumer-driven health care will be defined by how comfortably consumers operate in a market where financial pressures lead them to seek out more affordable, high quality providers—in or out of network. They won’t tolerate being left sick and told to fend for themselves with nothing but their credit cards.Real competition to lower costs and increase quality must happen quickly—by repealing the regulations and political firewalls protecting America’s health guilds from nimbler, more innovative competitors.Consider the irony: in the last election cycle, President Obama savaged Rep. Paul Ryan and Governor Romney for having the temerity to propose a premium support plan for Medicare beneficiaries, saying it would expose seniors to excessive out-of-pocket costs. Two years later, turns out Obamacare is…a premium support health insurance strategy. And a high-deductible one at that.
Early evidence suggests that emergency rooms have become busier since the Affordable Care Act expanded insurance coverage this year, despite the law’s goal of reducing unnecessary care in ERs.
Almost half of ER doctors say they are seeing more patients since key provisions of the health law took effect Jan. 1, while more than a quarter say their patient volume has remained the same, according to a survey to be released Wednesday by the American College of Emergency Physicians.
Eighty-six percent of emergency doctors expect visits to rise over the next three years, though the email survey didn’t ask the doctors why.
Democrats who designed the 2010 health law hoped it would do the opposite.
New Survey: Community Health Centers Make Substantial Gains in Health Information Technology Use, Remain Concerned About Ability to Meet Increased Demand Following ACA Coverage Expansions – The Commonwealth FundMay 21, 2014
Concerns about staffing at community health centers predate the ACA. According to the survey, 56 percent of FQHCs reported primary care physician shortages in 2013, a similar proportion as in 2009. Reports of a short supply of nurses, nurse practitioners, physician assistants, and dentists also remained relatively unchanged, with about one-third of health center leaders reporting workforce shortages in both 2009 and 2011.
via New Survey: Community Health Centers Make Substantial Gains in Health Information Technology Use, Remain Concerned About Ability to Meet Increased Demand Following ACA Coverage Expansions – The Commonwealth Fund.
It’s not just the privately insured that make better customers for physicians. Incredibly, three-quarters of all physicians received higher reimbursement rates from their uninsured patients paying out-of-pocket than from Medicaid. With fewer doctors and hospitals willing to take care of Medicaid patients, access to timely and high quality care is often compromised.
For those lower income Americans seeking subsidized coverage on the ACA’s exchanges, the story is similar. While the exchanges offer a choice of coverage, the options are dominated by “narrow network plans” that look suspiciously like Medicaid coverage. Many participants are only now discovering that their access to top physicians and hospitals is limited. In the Houston area, the renowned MD Anderson Cancer Center participates in fewer than half of the available ACA plans.
Reminder: ACA’s Out-of-Pocket Limits Differ From HSA-Qualified HDHPs Starting In 2015 – Employment and HR – United StatesMay 14, 2014
For plan years beginning in 2014, the ACA’s maximum out-of-pocket limits were tied to the out-of-pocket limits established for HDHPs. That caused some to assume that the ACA maximum out-of-pocket limits and the HDHP limit would always be the same. But they aren’t. Under the ACA, HHS is required to use a different methodology for calculating any annual adjustments than the IRS uses for HDHPs. Therefore, starting in 2015, the two limits will begin to differ as shown in the first table below.
In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.
These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.