For a nonsmoker who earns around $17,000 a year and receives federal premium assistance, for example, annual premiums equal 4 percent of income (about $700); for a similarly situated smoker, the tax credit stays the same, but the price tag for coverage nearly quadruples. Given this calculus, those who might be especially well-served by coverage—and the access to cessation services it provides—may be unable to afford it. Anecdotal reports presented at a recent national meeting of state insurance regulators indicate that, in some areas, the tobacco surcharge poses as big an obstacle to coverage access as the states that have not yet expanded eligibility for Medicaid.
Commonwealth Fund: Implementing the Affordable Care Act: State Approaches to Premium Rate Reforms in the Individual Health Insurance MarketJanuary 3, 2015
The Affordable Care Act protects people from being charged more for insurance based on factors like medical history or gender and establishes new limits on how insurers can adjust premiums for age, tobacco use, and geography.
This brief examines how states have implemented these federal reforms in their individual health insurance markets. We identify state rating standards for the first year of full implementation of reform and explore critical considerations weighed by policymakers as they determined how to adopt the law’s requirements. Most states took the opportunity to customize at least some aspect of their rating standards. Interviews with state regulators reveal that many states pursued implementation strategies intended primarily to minimize market disruption and premium shock and therefore established standards as consistent as possible with existing rules or market practice. Meanwhile, some states used the transition period to strengthen consumer protections, particularly with respect to tobacco rating.
This is the story of how a professional health economist, who knows all ins and outs of health insurance, ended up becoming involunarily uninsured as a direct result of the Affordable Care Act (ACA).
I am self-employed, and I have several significant pre-existing conditions. In other words, I’m just the sort of person who supposedly couldn’t get health insurance under the old, pre-ACA, system, and who was supposed to be able to get insurance under the new system – both for myself and my wife and children.
It turns out, neither of those is true.
Policy makers and researchers are eager to learn the effects of the Patient Protection and Affordable Care Act of 2010 (ACA) and its many provisions, but to date, they have been frustrated by the dearth of robust evidence on the ACA’s true impacts on important health care and patient outcomes (e.g., access to primary care services). The present limitations of evidence, often a consequence of delays and inconsistencies in the law’s implementation, have begun to affect policy making in the ACA’s wake.
In this article, we consider the ongoing debates among state and federal policy makers aboutwhether to extend the ACA’s so-called fee bump provision, whereby Medicaid fees for primary care services were increased to 100 percent of Medicare levels during 2013 and 2014. We describe the difficulties state Medicaid programs have experienced in implementing the fee bump as well as how the resulting evidence gap and the broader political context today shape the deliberations. To conclude, we identify policy alternatives and other factors policy makers should consider when deciding whether to extend the fee bump.
But the A.C.A. has not done as much as many had hoped it would to reduce underinsurance. In fact, it may be helping to spread it. And proposed modifications to the law, like those that would introduce a new tier of “copper” plans in addition to bronze, silver, gold and platinum, might make underinsurance worse.
This is important, because research shows that those who are underinsured are more likely to go without needed care.
In the most recent update of the Commonwealth Fund survey, conducted in September and October of this year, investigators found that 13 percent of all adults 19-64 spent more than 10 percent of their income on out-of-pocket health care costs. Poor adults were the most likely to spend this amount. More than 30 percent of nonelderly adults earning less than the poverty line spent more than 10 percent of their income on out-of-pocket costs, and 18 percent of those making between 100 percent and 200 percent of the poverty line did so. All of these people were insured.
One in three Americans say they have put off getting medical treatment that they or their family members need because of cost. Although this percentage is in line with the roughly 30% figures seen in recent years, it is among the highest readings in the 14-year history of Gallup asking the question.
More than 214,000 doctors will not participate in new plans under the Patient Protection and Affordable Care Act ACA.
According to a survey conducted this year by the Medical Group Management Association MGMA, a trade association comprised of multi-physician medical practices, “as many as 214,524 American physicians will not be participating in any ACA exchange products.” Reasons abound as to why, but, “chief among them is the fact that exchange plans are more likely to offer significantly lower reimbursement rates than private market plans, confusion among consumers about the obligations associated with high deductibles, and fear that patients will stop paying premiums and providers will be unable to recover their losses”