Insurers are starting to calculate what to charge for health plans in 2015, reports BusinessWeek. What we know so far. Of 9 states that have submitted rates for approval, average statewide increase for Silver plans ranges from -1% (Oregon) to 16% (Indiana).
Former Health and Human Services Secretary Kathleen Sebelius acknowledged Friday that she made mistakes leading up to the rollout of the Affordable Care Act, worrying too much about whether there’d be a market for Obamacare and spending “too little time clearly on the technology side.”“I sure made some mistakes along the way in terms of focusing on some things and not on others,” she said at the Aspen Ideas Festival. Instead of confirming what she was being told about HealthCare.gov’s readiness “was actually accurate and getting enough eyes and ears on that,” she said she concentrated on the insurers, consumers and regulators who needed to come together in the health exchanges.
Employer Health Plan Sponsors: Running Harder, to Stay in Place | e21 – Economic Policies for the 21st CenturyJune 27, 2014
Highlights from a Mercer briefing in Washington earlier this month include:• Last year’s slow growth of total employee health benefits costs a 16-year low will speed up in 2014, even after employers make a number of plan changes to reduce costs• Overall private employer coverage levels will remain essentially unchanged by the ACA in the near term.• ACA-driven reductions in employee working hours are real, but more prevalent among smaller employers and particular industry sectors• Private employers consistently see the 2018 “Cadillac” tax on high-cost benefits plans as their #1 complaint and are taking a number of early steps to avoid ever paying it.
Most important, Theranos tests cost less. Its prices are often a half to a quarter of what independent labs charge, and a quarter to a 10th of what hospital labs bill, with still greater savings for expensive procedures. Such pricing represents a potential godsend for the uninsured, the insured with high deductibles, insurers, and taxpayers. The company’s prices are set to never exceed half the Medicare reimbursement rate for each procedure, a fact that, with widespread adoption, could save the nation billions. The company also posts its prices online, a seemingly obvious service to consumers, but one that is revolutionary in the notoriously opaque, arbitrary, and disingenuous world of contemporary health care pricing.
Revelations of chronic delays at Veterans Administration VA hospitals and inexcusable fraud in record keeping have spurred calls for reform of the VA system. Politicians have been eager to jump in front of cameras to declare their support for veterans. But House and Senate VA reform bills represent only tentative first steps towards empowering veterans to take ownership over their health care and hold the VA accountable.
The bigger problem is the absence of a coherent co-payment system to incentivize veterans to think through their health care decisions. Contrary to conventional wisdom, VA health care is free only to veterans with severe, service-related conditions. A byzantine co-insurance system exists in which the cost of care is linked to the severity of a veteran’s condition and the degree to which the condition is service-related. Veterans additionally receive a monthly tax-free cash payment based on the severity of their service-related health condition. The result is that veterans face perverse incentives to let their health deteriorate to the point where they can avoid copayments and receive higher monthly financial support. Reform should focus on redesigning VA co-insurance to give veterans incentives to embrace preventive care and take greater ownership over their health care decisions.
Studies show that survival rates for major cancers are better in America than they are in other developed nations. A 2012 study led by the University of Chicago’s Tomas Philipson, for instance, concluded that cancer patients diagnosed between 1995 and 1999 lived an average of 11.1 years after diagnosis in the United States, but only 9.3 years after diagnosis in Europe. America, in other words, is getting something for all that extra spending.
Pursuant to the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), a health insurance exchange has been established in each state and the District of Columbia (DC).
Exchanges are marketplaces where individuals and small businesses can “shop” for health insurance coverage. The ACA provides that states may establish their own state-based exchanges (SBEs), and as of January 2014, 14 states and DC have done so. It also directs the Department of Health and Human Services (HHS) to establish exchanges in states that do not establish SBEs, and 36 states have federally-facilitated exchanges (FFE) in 2014. In some states that have FFEs, the states carry out certain functions of the exchange; in other states, the exchange is wholly operated and administered by HHS.
The ACA provided an indefinite appropriation for HHS grants to states to support the planning and establishment of exchanges. For each fiscal year, the HHS Secretary is to determine the total amount that will be made available to each state for exchange grants. No grant may be awarded after January 1, 2015.
There are three different types of exchange grants. First, planning grants were awarded to 49 states and DC. These grants of about $1 million each were intended to provide resources to states to help them plan their health insurance exchanges. Second, there have been multiple rounds of exchange establishment grants. There are two levels of exchange establishment grants: level one establishment grants are awarded to states that have made some progress using their planning funds, and level two establishment grants are designed to provide funding to states that are farther along in the establishment of an exchange. Finally, HHS awarded seven early innovator grants to states (including one award to a consortium of New England states) to support the design and implementation of the information technology systems needed to operate the exchanges. To date, HHS has awarded a total of more than $4.8 billion to states and DC in planning, establishment, and early innovator grants.
Under the ACA, each exchange is expected to be self-sustaining beginning January 1, 2015. The law authorizes exchanges to generate funding to sustain their operations, including by assessing fees on participating health insurance issuers. To raise funds for each of the FFEs, beginning in 2014, HHS is assessing a monthly fee on each health insurance issuer that offers plans through an FFE.
The Centers for Medicare & Medicaid Services (CMS) is incurring significant administrative costs to support FFE operations. According to CMS, a total of $456 million was used to support exchange operations over the period FY2010-FY2012. In FY2013, CMS spent $1,545 million on exchange operations and estimates that it will spend $1,390 million in FY2014. The agency is relying on a mix of annual discretionary appropriations and funding from other sources for these expenditures. Those sources include expired discretionary funds from the Nonrecurring Expenses Fund, mandatory funding from the Health Insurance Reform Implementation Fund and the Prevention and Public Health Fund, and FFE user fees. CMS has budgeted $1.8 billion for exchange operations in FY2015. Most of that funding is projected to come from FFE user fees.
The data portend a vigorous debate over the “risk corridors” program, which is one of three mechanisms in the law designed to give insurers incentives to continue to participate in its exchanges even if they are at risk of significant financial losses. Some Republicans, particularly Senator Marco Rubio of Florida, Senator Jeff Sessions of Alabama and Representative Fred Upton of Michigan, have decried this program as an insurer bailout.The premise behind the risk corridors is that the financial winners in the Obamacare exchanges would compensate the financial losers such that the flow of money would make the system self-sustaining. What may not have been anticipated was what would occur if the financial losers the sicker enrollees far outpaced the financial winners the healthier ones.
The success of Obamacare always rested on getting enough “young invincibles” to enroll on the exchanges. Since the scheme bars health plans from pricing their insurance policies to the actual risk, Washington needs a lopsided share of cheaper young people paying too much in order to subsidize older people who are paying too little.
As many people expected, not enough young folks are signing up to pay the high premiums. But the structural problem could run much deeper. The young people who are enrolling also tend to have more serious and costly medical problems.
In short, Obamacare’s young enrollees aren’t invincible enough to underwrite the law’s delicate scheme.
Thursday, July 17, 2014 | 10:00 a.m. – 11:30 a.m.
AEI, Twelfth Floor 1150 Seventeenth Street, NW Washington, DC 20036
About This Event: Recent scandals at medical centers for veterans have trained a spotlight on longstanding inefficiencies within the US Department of Veterans Affairs VA. In the case of the VA’s disability system, a nearly century-old approach to wounded veterans still prevails. The widespread consensus is that the problem goes much deeper than falsified waiting lists and delayed access to care, and necessitates a global overhaul. What would a renewed vision of veteran care look like, and how should we clarify the objectives of the VA’s disability system? In the interim, what short-term reforms are practical?
Please join AEI as former VA Assistant Deputy Secretary for Policy Michael H. McLendon presents a blueprint for reform, followed by a discussion with experts in health care, disability, and public administration.