Americans should have no doubt about where Hillary Clinton thinks the authority in health care decisions should lie. In 1993, Hillary Clinton claimed that “we just can’t trust the American people to make those types of choices…. Government has to make those choices for people” when discussing her opposition to health savings accounts and individual choice. Underscoring her personal belief – that government knows better than individuals about what people need in their personal health care choices – candidate Clinton in 2007 planned to compose a “Health Choices Menu” of insurance plan choices that her administration would deem suitable for Americans. Naturally, she assured Americans that her menu would include “numerous, high-quality private health insurance options”. And she promised in her campaign’s announcement that the Hillary Clinton plan would be implemented “without creating new bureaucracy” and that “Americans who are satisfied with the coverage they have today can keep it.”
It is in the realm of actuarial value (AV) requirements where the law demands pointless standardization. AV measures the extent to which a policy covers the average enrollee’s medical expenses. On average, for example, a plan with an AV of 63 percent covers 63 percent of enrollees’ medical costs.
All ACA-compliant plans must fit within four “metallic” bands. A platinum plan covers around 90 percent of an enrollee’s costs, with a 2 percent tolerance in either direction. Thus, a platinum plan covers between 88 and 92 percent of costs. A less expensive gold plan covers between 78 and 82 percent of expenses. A silver plan’s AV falls between 68 and 72 percent. Finally, bronze plans cover between 58 and 62 percent.
A plan offered in 2013 can have any AV, but come January 1, 2014, all plans must fall within those four narrow metallic bands. Therefore, a plan that covers 59 percent of medical expenses is okay, because it’s within the bronze band. But a plan that covers 96 percent of expenses is unacceptable because its coverage is too generous; it is, by official rhetoric, subpar, substandard, bad insurance.
The health care law is also helping to end what could be called “entrepreneurship lock.” Simply put: prior to the ACA a person with a pre-existing condition who wanted to start her own business often had to choose between the security of employer-provided coverage or face potential discrimination in the individual market. Two business partners who wanted to leave their company to turn a new idea into a new job-creating business could be forced to shelve their entrepreneurial dream because a family member had a preexisting condition and could face sky-high rates or being shut out completely from finding insurance. Today, there is strong evidence that when affordable healthcare isn’t exclusively tied to employment, in more instances people choose to start their own companies. Now, countless Americans will have the security of affordable, quality coverage so they can focus on starting America’s next great business.
Editor’s note: if access to health insurance stimulates entrepreneurship, shouldn’t Europe be outpacing the U.S. by a considerable margin in entrepreneurial activity? I’m not aware of strong evidence that’s true: this study suggests the opposite. http://capitalism.columbia.edu/files/ccs/CCSWP9_FrydmanKhanRapaczynski.pdf
Fewer than half of states offer dental care to adult Medicaid enrollees | State Health Access Data Assistance CenterMarch 29, 2014
Fewer than half of all U.S. states offer dental care to Medicaid eligible non-elderly adults according to a study by SHADAC’s Kathleen Call and Jessie Kemmick-Pintor along with Nafisa Elmi and Pricilla Flynn of the University of Minnesota’s School of Dentistry. Even among adults living in states that offer dental benefits through Medicaid, such coverage does not ensure they will seek or access dental care.
The study authors project the effect of the ACA on patient-identified barriers to dental care based on a framework developed using data from a 2008 survey of Minnesota Medicaid enrollees with and without an annual dental visit. They project that the ACA will not reduce barriers to dental care for adult Medicaid enrollees.
Maine staved off a fiscally disastrous Medicaid expansion recently this week with a slim margin in the legislature. Though the bill to expand the program passed the Maine House of Representatives, it garnered only 97 votes; one less than the required two-thirds majority needed to override Governor LePage’s veto. It seems the Governor is the final levy against increased dependency rates in Maine, but Republican defections could soon allow Democrats to bypass the veto.
Democrats also failed to gain the two votes needed for a super majority in the Senate.
To make matters worse for state Democrats, a recent poll showed that the more Maine taxpayers find out about Medicaid expansion, the more they oppose it.
How Much Financial Assistance Are People Receiving Under the Affordable Care Act? | The Henry J. Kaiser Family FoundationMarch 29, 2014
Through the end of February, 4.2 million people had applied for and selected a plan through the marketplaces. As expected, the vast majority of enrollees (83%) have qualified for premium subsidies, since people who are not eligible for premium subsidies can buy comparable coverage with similar consumer protections outside of the marketplaces. We estimate that about 21% of those eligible for premium subsidies have applied for assistance, with significant variation across states.Using the age and tax credit eligibility of enrollees reported by the federal government, along with the marketplace premiums within each state, we estimate that 3.5 million people have qualified for a total of about $10.0 billion in annual premium subsidies, or an average of about $2,890 per person.
NCSL has just launched a new 2014 Health Reform State Legislative Database. Go directly to the online 2014 Database report, established March 25, 2014.
Search 2011, 2012 and 2013 archive legislation by state, topic, keyword, status, and/or primary sponsor. Database updates occur every other Tuesday, this also includes status updates. Click here for 2011-2012-2013 State Legislative Tracking Database
Both databases include legislation, including pending, failed and enacted bills and resolutions. The database is intended to capture state actions related to the Patient Protection and Affordable Care Act and the Health Care Education and Reconciliation Act, together referred to as the Affordable Care Act or federal health reform. Topics relate to some of the major provisions in the Affordable Care Act and include Medicaid, Access to Primary Care, Health Insurance Exchanges, Essential Health Benefits, Health Insurance Reform, Health Information Technology, Prevention and Wellness, Community Health Centers and Providers and Workforce. A separate topic, Challenges and Alternatives, covers policies that differ from the federal provisions.
County Health Rankings Show People Living in Least Healthy Counties Twice as Likely to Have Shorter Lives than People Living in Healthiest Counties – Robert Wood Johnson FoundationMarch 28, 2014
The fifth edition of the County Health Rankings released today continues to show us that where we live matters to our health. Large gaps remain between the least healthy counties and healthiest counties. For instance, the least healthy counties have twice the death rates and twice as many children living in poverty and teen births as the nation’s healthiest counties.
A collaboration between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI), the County Health Rankings allow each state to see how its counties compare on 29 factors that impact health, including smoking, high school graduation rates, unemployment, physical inactivity, and access to healthy foods. The Rankings are available at http://www.countyhealthrankings.org.
Look at our numbers (laid out in the charts below) and you’ll see why so many Millennials have Obamacare sticker shock. Someone, for example, earning $25K annually in Arizona will pay $2,424 in total monthly premiums for Obamacare (10% of their annual income) and still be stuck with a $4,000 deductible and a $5,200 cap on their out of pocket costs. The same person in Illinois will pay $3,576 in annual premiums, and in low cost Texas $2,460.
What about the same 30 year old who now earns $30,000 annually – the average salary for a pre-school teacher according to census data? In Arizona, their annual cost for carrying the Obamacare plan runs $2,772 and their deductible is $5,000. In Illinois, the same person will spend $4,092 for the same health plan, and also have a $5,000 deductible before their full health coverage kicks in.
Medicaid rolls swell as state officials resolve backlog of paper ObamaCare applications – Boston Business JournalMarch 28, 2014
At today’s Massachusetts Health Connector board meeting, Sarah Iselin, special assistant to Gov. Deval Patrick tasked with cleaning up the website mess, said that the backlog of paper applications has been eliminated. The total number of paper applications a month ago was 50,000, and the state received an additional 22,000 new paper applications since then. Many of those individuals have been placed in temporary Medicaid coverage: That transitional program has grown to 125,000 from 84,000 in just the past week. That’s because vendor CGI Corp. failed to build a working website tool to determine which people are eligible for help paying for health insurance and which are not.