Who will treat the flood of Obamacare Medicaid patients? | NJ.com

February 8, 2015

If you want to understand Medicaid’s problems in New Jersey, just ask the Holstein men.

Justin Holstein, 39, of Ocean Township, spent a year on the government health insurance program when he was starting his own business. Long under treatment for chronic migraines, he lost all his doctors the moment he enrolled.

His new doctor said only a neurologist could renew his medication, but the insurance network’s neurologist couldn’t see him for four months, he said. That meant four months of sleepless nights battered by pain, and four months of getting through the days courtesy of the caffeine in Excedrin.

“You have a card saying you have health insurance, but if no doctors take it, it’s almost like having one of those fake IDs,” he said. “Your medication is all paid for, but if you can’t get the pills, it’s worthless.”

via Who will treat the flood of Obamacare Medicaid patients? | NJ.com.

One year after the ACA, health care that is less affordable and accessible » AEI

January 26, 2015

Last month the White House proudly announced that after completing the first year of Affordable Care Act (ACA) implementation the number of uninsured Americans is at historic lows-11.3% in the second quarter of 2014, down from 14.4% the year before. Over 10 million people enrolled for health insurance through Medicaid or an insurance exchange. But signing up for insurance does not equal access. Healthcare has to be available and affordable. The ACA did not achieve these goals in 2014 and 2015 will be worse.

Medicaid recipients have always had trouble finding care primarily because Medicaid pays physicians a fraction of private and Medicare rates. To remedy this the ACA included a federally funded two-year increase in Medicaid fees for primary care physicians up to Medicare levels. $5.6 billion was spent through June 2014. But the Urban Institute reports that it is unclear whether the increase in Medicaid primary care payment had an effect on the number of physicians accepting Medicaid patients, or on the number of Medicaid patients that physicians are willing to see. And increasing the fees of primary care physicians does not improve access to specialists-the Commonwealth Fund found that low Medicaid payment is the main barrier to specialty care. Most importantly, the primary care fee increase expired on December 31, 2014. The Urban Institute estimates this will lead to an average 42.8 % reduction in fees for primary care services. Since most states will not continue fee increases without federal funds, any increased access for Medicaid patients will not last.

via One year after the ACA, health care that is less affordable and accessible » AEI.

Insurance Premium Surcharges for Smokers May Jeopardize Access to Coverage – The Commonwealth Fund

January 15, 2015

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.

via Insurance Premium Surcharges for Smokers May Jeopardize Access to Coverage – The Commonwealth Fund.

Commonwealth Fund: Implementing the Affordable Care Act: State Approaches to Premium Rate Reforms in the Individual Health Insurance Market

January 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.

Full report.

How The Affordable Care Act Forced Me To Be Uninsured – Forbes

January 2, 2015

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.

via How The Affordable Care Act Forced Me To Be Uninsured – Forbes.

To Extend or Not to Extend the Primary Care “Fee Bump” in Medicaid?

December 5, 2014

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.

To Extend or Not to Extend the Primary Care “Fee Bump” in Medicaid?.

Underinsurance Remains Big Problem Under Obama Health Law – NYTimes.com

December 1, 2014

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.

via Underinsurance Remains Big Problem Under Obama Health Law – NYTimes.com.


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