June 24, 2014
“Is the new law effective in reducing the number of uninsured? Yes, but so far not very,” he says.
Key questions include: How many actually have enrolled?How many of those were previously uninsured? How has Obamacare affected the overall pool of uninsured? What percentage of eligible people have signed up? What’s the cost?
via Obamacare’s Exchanges Fall Well Short of Enrollment Target.
June 18, 2014
Nearly half of ER doctors responding to an April poll by the American College of Emergency Physicians said they are already seeing an increase in patients because of the health care law, and 86 percent said they expect visits to increase over the next three years.But it’s way too soon to make claims about the impact of the health law, other observers say. “Every time I read about somebody talking about the impact of the Affordable Care Act on behavior and patient volume in the emergency department it makes me cringe,” says James Scheulen, who directs ER services for the five hospitals in the Johns Hopkins University health system. He says ER use was on the rise before the health law anyway, so teasing out the effects of the ACA will be hard. At Hopkins, there’s been no uptick in volume this year compared to the last three months of 2013, he adds.“Lengthy waits in ERs has always been a constant,” says Harvard School of Public Health Professor John McDonough. “So it’s risky to generalize without real data.” Statistics have to be considered carefully, he adds, pointing to reported increases by Massachusetts physicians in waiting times for appointments after the state’s 2006 coverage law. The data “is actually quite suspect because it’s based on a volunteer survey of physicians and always gets a pathetically poor response rate.”
via Emergency Rooms See Longer Waits From Health Law : Roll Call Policy.
June 11, 2014
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 In a newly completed, as yet unpublished paper by George Washington University’s Bianca Frogner and me, we estimate that Medicaid enrollment will increase by 2%-3% annually through 2024.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.
via Stephen T. Parente: The Short Unhappy Life of ObamaCare – WSJ.
June 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.
via Off-Exchange Plans 39 Percent to 45 Percent More Expensive than Exchange Plans | John Goodman’s Health Policy Blog | NCPA.org.
June 9, 2014
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.
via More patients flocking to ERs under Obamacare.
June 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.
via Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States : May 2014 Update.
June 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.
via Obamacare is the new premium support. Without a strong dose of deregulation and competition, it won’t succeed. | Morning Consult.
May 21, 2014
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.
via ER Visits Rise Despite Health Law – WSJ.com.
May 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.
May 20, 2014
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.
via Better healthcare for the poor | TheHill.