LTC8K6

Apr 2 2015, 07:04 AM

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Oct. 1, 2015

States are allowed to shift children eligible for care under the Children's Health Insurance Program to health care plans sold on their exchanges, as long as HHS approves.

That could be interesting.

LTC8K6

Apr 2 2015, 07:00 AM

kbp

Apr 2 2015, 06:28 AM

LTC8K6

Apr 1 2015, 05:59 AM

So what happens when no one takes Medicaid patients?

[...]

The providers have the option of not taking the Medicaid patients. This lawsuit looked difficult because of that.

You'd soon end up with Medicaid patients having very few places to go for treatment.

The providers will get sued, or Obamacare will be modified so that they have to take Medicaid patients.

There is no way this administration is going to allow such a refusal, imo.

LTC

 

"Network Adequacy" is the term I was trying to remember. Medicaid and Obamacare both have requirements of a large enough network of providers to provide care in a timely manner.

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http://www.washingtonpost.com/blogs/wonkblog/wp/2015/04/01/where-romneycare-fell-short-and-what-that-could-mean-for-obamacare/

Where Romneycare fell short — and what that could mean for Obamacare

The landmark 2006 Massachusetts health-care law that inspired the federal overhaul didn't lead to a reduction in unnecessary and costly hospitalizations, and it didn't make the health-care system more fair for minority groups, according to a new study that may hold warnings for the Affordable Care Act.

Massachusetts’ uninsured rate was cut by half to 6 percent in the years immediately following the health-care law signed by then-Gov. Mitt Romney. Blacks and Hispanics, who have a harder time accessing necessary medical care, experienced the largest gains in insurance coverage under the Massachusetts law, though they still were more likely to be uninsured than whites.

The new study, published in the BMJ policy journal, examined the rates of hospitalizations for 12 medical conditions that health-care researchers say wouldn't normally require hospitalization if a patient has good access to primary care. These include hospitalizations for minor conditions like a urinary tract infection, or chronic conditions that would require repeat primary care visits over the course of a year.

[...]

Out-of-pocket costs for doctor visits and drugs may be preventing many of the newly insured from affording necessary primary care that would have otherwise kept them out of the hospital.

[...]

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https://www.youtube.com/watch?v=jwiVAPSh3IE

Keynote: HEALTH CARE REFORM: WORKING/NOT WORKING?

Is health care reform finding its footing—or fatally flawed? MIT economist and Affordable Care Act (ACA) expert Jonathan Gruber and Cato Institute Director of Health Policy Studies Michael Cannon share opposing viewpoints on the current state of reform.

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http://ebn.benefitnews.com/news/health-care-reform/cadillac-tax-likely-to-become-2016-election-issue-2746004-1.html

Cadillac tax likely to become 2016 election issue

Even five years after its enactment, the Affordable Care Act continues to draw strong opposition. And while it’s still the early days for the ACA, so far “there’s no evidence of any major disruption to the existing employer-sponsored insurance market,” said Jonathan Gruber, an MIT economist and proponent of the law, during a recent event hosted by Sun Life Financial and Bloomberg.

He attributed widespread skepticism about the law to politics, saying “there’s a continued enormous lack of understanding about what the law does that I think is a direct result of the large level of [political] opposition to it.”

And while avoiding the ACA’s Cadillac tax is front-of-mind for many benefit decision-makers, Gruber maintained the tax is only a mechanism to offset the existing discount already provided to health insurance benefits in the tax code

“Health insurance is compensation and wages are compensation. They should be taxed the same. And they’re not,” said Gruber. The result is a system that is expensive, unfair and encourages excessive consumption, he believes. “If the U.S. taxed health insurance like wages, we would raise $250 billion more a year in revenues,” he said. Moreover, “the richer you are, the bigger tax break you get because your tax rate is higher.” And, finally, he said, such as system encourages excessive consumption because people are buying health insurance with after-tax dollars.

But Michael Cannon, director of health policy studies at the Cato Institute, believes the still-on-the-horizon Cadillac tax is unlikely to remain in its current form. “A lot of employers are going to be hit by that tax, more and more over time, and more people are going to learn that promise of ‘if you like your health plan you can keep it’ was a false one,” he said.

“The question is how will Congress respond? There are going to be a lot of people who want to repeal that tax on its own, but I think a lot of proponents of the ACA will say to employers and others who want to get rid of the tax: ‘We’ll help you do that, but you have to go along with part of a broader effort to reopen the ACA and repeal parts of it.’”

The Cadillac tax, set to go into effect in 2018, is a 40% excise tax on health coverage that costs more than $10,200 for an individual or $27,500 for a family. About one-third of employers are currently at risk for triggering the tax in 2018 if they make no changes to their most costly plan, according to consulting firm Mercer’s National Survey of Employer-Sponsored Health Plans. [That "one-third" number is where it starts, but it increases tremendously over the following years.]

But the Cadillac tax, said Gruber, is merely a way to equalize the way wages and health insurance are taxed. “It’s essentially offsetting the existing discount in the tax code,” he said, emphasizing it’s not a new net tax. “It’s offsetting a benefit they really shouldn’t be getting in the first place.”

The intended goal of the Cadillac tax, said Gruber, “is for employers to make the most appropriate tradeoff between wages and health insurance for their employees. I think general economic theory and evidence suggests a number of employers are not doing that – they’re providing health insurance which is more generous and wages that are lower than what makes their employees the best off. ... the Cadillac tax moves them in the right direction of more appropriately having that trade-off – maybe a little bit more limited network can save a lot of costs and not really impede much the preferences of their employees.”

The Internal Revenue Service and the Department of Treasury are seeking comments about the Cadillac tax, including what constitutes employer-sponsored coverage and different approaches for determining the cost of applicable coverage. Comments are due May 15.

Gruber and Cannon agreed the Cadillac tax is likely to become an issue in the 2016 presidential election, but differed on the reasons why.
[See my notes below on the reason why!]

“It will have more of an impact on Democrat candidates. Republicans will just say ‘we hate taxes, we hate the ACA, we want to get rid of this tax,’” said Cannon, adding the Cadillac tax will affect many union plans and unions tend to support Democrats more often than they support Republicans. “There’s going to be a lot of pressure on Democrats from one of their key constituencies to do something to provide them relief from this tax.”

But Gruber believes the Republicans will face their own challenges with the Cadillac tax. “A long-standing Republican position has been to get rid of the employer tax subsidy and put them on to individuals instead. The Cadillac tax is heading in that direction,” he said. “So the question is: How does the Republican Party resolve its opposition, in some sense, to the fundamental employer system with the fact that this is the biggest thing we’ve ever done to try to get rid of something they’ve wanted to get rid of?”
[That is entirely false. The Rep's position is that what Gruber calls a "discount" should also be available to those paying for a plan thru the individual market in addition to those getting it thru the employer market. Gruber does a poor job of spinning the facts there.]

• 
  
• ...a mechanism to offset the existing discount
  ...It’s offsetting a benefit they really shouldn’t be getting in the first place
  ...providing health insurance which is more generous and wages that are lower than what makes their employees the best off
  Gruber

• 
  
• ...Health insurance is compensation and wages are compensation. They should be taxed the same. And they’re not. ...If the U.S. taxed health insurance like wages, we would raise $250 billion more a year in revenues
  Gruber

• 
  
• [untaxed health care] ...encourages excessive consumption ...a little bit more limited network can save a lot of costs
  Gruber

• 
  
• [untaxed health care] ...encourages excessive consumption ...a little bit more limited network can save a lot of costs
  Gruber

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http://www.nytimes.com/aponline/2015/04/02/business/ap-us-on-the-money-patient-advocates-qa.html

Medical Expenses: Finding Your Way With a Patient Navigator

A medical emergency leaves you with tens of thousands of dollars in unpaid hospital bills. Your health insurance company rejects coverage for an important medical test. An unexpected diagnosis requires you to find three new medical specialists.

In today's health care system, consumers are increasingly on their own when these complex -- and often costly -- medical problems arise. Primary care doctors once helped patients manage such situations, but many physicians now have 15 minutes or less for each appointment. It's in this high-pressure environment that a new industry of patient advocates -- sometimes called patient navigators -- has emerged, offering to help guide patients through knotty health situations.

Driven by an increasing number of baby boomers dealing with chronic medical problems, the field has mainly taken shape in the last 5 to 10 years, according to Professor Theresa Cronan of San Diego State University.

"People with chronic conditions use the health care system more. But the health care system has become so complex that it's really hard for people to navigate," said Cronan, who has studied the health advocacy industry.

Here are some questions and answers about these businesses and the services they offer:

WHAT DO PATIENT ADVOCATES DO?

Patient advocates are hired to help solve health care problems or help patients get the best care possible. Advocates can work for companies with hundreds of employees or operate as stand-alone consultants for a handful of clients. Some of the most common tasks health advocates work on include:

— Negotiating discounts and payment plans for large medical bills;

— Managing and filing insurance paperwork, especially appeals where companies deny coverage for expensive procedures or equipment;

— Helping patients find and schedule appointments with medical experts who specialize in rare or hard-to-treat diseases.

HOW CAN THESE BUSINESSES POTENTIALLY SAVE ME MONEY?

Many patient advocates highlight their ability to help reduce medical bills or cut through insurance red tape.

Health advocates can review patient records to spot billing errors that drive up costs. They can also coordinate care between a number of physicians, usually for patients with complex conditions, avoiding repeat billings and insurance payments.

In other cases, advocates will help patients find the best price for an expensive test or procedures. Prices for common tests, such as medical scans, can vary by hundreds or thousands of dollars, even among hospitals that are only a few miles apart, as demonstrated by payment records released by the government's Medicare program. With many patients in high-deductible insurance plans that require them to pay substantial out of pocket costs before coverage kicks in, the difference between a $300 MRI scan or a $1,300 MRI scan can be significant.

HOW MUCH DO THESE SERVICES COST?

Patient advocates typically aren't covered by insurance, so customers should expect to pay out of pocket.

Many charge an hourly rate, ranging from $50 to $250 depending on the nature of the work, their location and background. Advocates charging the highest fees usually have a medical degree. Other services may use alternative fee structures. For instance, the medical bill saver service offered by Health Advocate of Plymouth Meeting, Pennsylvania negotiates uncovered medical or dental bills of $400 or more at no upfront cost to the customer. Instead, the company takes a 25 percent cut of the recouped savings. So if the company negotiated a $10,000 medical bill down to $5,000 the company would earn a $1,250 fee. Health Advocate sells access to its bill saver service and other offerings through an annual membership fee of $25.95. About 10,000 companies also offer Health Advocate's services as a benefit to their employees.

Continue reading the main story Continue reading the main story

Continue reading the main story

WHAT QUALIFICATIONS DO PATIENT ADVOCATES NEED TO HAVE?

Currently there are no professional credentials required to be a patient advocate, so be careful about choosing a service. Several universities offer specialized courses and degrees in patient advocacy, including Sarah Lawrence College, the University of Miami and the University of Wisconsin. Such programs often combine training in medicine, health policy, economics and law. Other health advocates have backgrounds in nursing, social work, medicine and the insurance industry.

Before hiring a health advocate be sure to ask for references and information on training and experience. Customers should also receive a written contract specifying the services to be delivered and the fees.

"If you're going to get a health care advocate you're probably feeling vulnerable already, so you want to make sure you look very carefully at the organization that is going to provide these services," Cronan said.

HOW CAN I FIND A PATIENT ADVOCATE?

Academic programs like University of Wisconsin's Center for Patient Partnerships can provide contact information for graduates in the field. There are also several professional groups that offer online search tools for finding patient advocates, including:

— National Association of Healthcare Advocacy, which requires members to sign a code of ethics: http://www.nahac.com

— Alliance of Professional Health Advocates, which requires participants to have professional liability insurance: http://www.advoconnection.com/

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http://www.politico.com/story/2015/04/obamacare-health-care-cadillac-tax-116659.html

'Cadillac tax' the next big Obamacare battle

Experts say a majority of employers could eventually face the tax on health care benefits

[...]

“Capping the tax benefit for employer-sponsored health insurance, I think, is a great idea,” said Len Burman, head of the nonpartisan Tax Policy Center. “Providing an open-ended subsidy for health insurance, which encourages people to get plans that do less to restrain spending, contributes to rising health care costs. Most economists who’ve looked at health care spending have concluded that.”

The tax could eventually hit all health plans, “although you probably wouldn’t get policymakers to admit to that,” Burman siad. He added he doubts Congress will allow that to happen, saying lawmakers will come under substantial pressure to ease the tax.

It’s a big reason why Congress’ independent budget scorekeepers have said Obamacare won’t add to the deficit, and why the tax will be tough to repeal. The levy, which is projected to generate $87 billion over a decade, ramps up slowly, but is estimated to eventually produce so much money that it alone will cover the cost of providing insurance subsidies through the program’s exchanges.

“This provision is one of several in the ACA designed to promote fiscal responsibility and slow the growth of health care costs,” said White House spokeswoman Jessica Santillo.

[...]

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Instead of picking a companywide health plan, employers are increasingly giving workers financial support to choose their own from a menu of options.

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http://www.politico.com/story/2015/04/obamacare-group-slashes-staff-116790.html

Obamacare group slashes staff
Enroll America, founded by White House allies to promote health law, loses funding.

The main national organization promoting Obamacare enrollment is cutting 100 jobs amid a major retrenchment as key funders turn to other health care priorities.

It’s the beginning of the end for Enroll America, which was set up by liberal advocates of the Affordable Care Act to run a sophisticated, political-style campaign to persuade Americans to get covered. The group, led by veterans of President Barack Obama’s campaigns and administration, was never intended to last forever, but a precipitous drop in funding forced it to scale back to half of its peak size after only two seasons of Obamacare sign-up. That’s a more rapid throttling back than some of the people associated with Enroll had envisioned at the start.

The move comes as even some strong advocates of the law have lowered their coverage expectations for the first few years of the law, partly because of the resistance in many GOP-led states. With Enroll America taking a less prominent role, local community groups, health insurers, hospitals and clinics will have to pick up some of the outreach and marketing work.

[...]

Chief among the financial backers who are moving on is the Robert Wood Johnson Foundation, a major health care philanthropy that has provided nearly half of Enroll’s funding to date — $13 million in 2013 and $10 million last year. Pollack and other sources said Enroll knew in advance that RWJF was ending funding this year. Pollack said there has been some recent talk about the possibility of continuing some funding, although on a “much-diminished” basis

[...]

“It is increasingly important to support consumers by helping to make sure their coverage is of high value and makes a real contribution to their health and financial security,” Kathy Hempstead, head of coverage programs at RWJF, said in an email. She said no final decision had been made on any potential 2015 grants for Enroll.

[...]

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http://talkingpointsmemo.com/dc/obama-supreme-court-obamacare

Obama To SCOTUS: Erasing Obamacare Subsidies Would Be 'A Bad Decision'

President Barack Obama warned the Supreme Court in an interview Wednesday that a ruling to invalidate Obamacare subsidies would be "a bad decision" and result in "millions of people losing their health insurance."

Asked on CNN if he had a fallback plan, Obama said he expects the justices to decree that the Affordable Care Act statute allows health insurance tax credits in states that use the federal exchange.

"If you read the statute, it's pretty straightforward and it's pretty clear. So I'm not anticipating that the Supreme Court would make such a bad decision," he said. "If the Supreme Court made a ruling that said the folks who have federal exchanges don't get the tax credits what you'd end up seeing is millions of people losing their health insurance. And the truth is that there aren't that many options available if in fact they don't have tax credits, they can't afford to get the health insurance that's being provided out there."

[...]

• 
  
• "If you read the statute, it's pretty straightforward and it's pretty clear."
  Barry

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http://www.kitsapsun.com/news/state/federal-marketplace-more-adept-than-states-at-enrolling-customers-study-finds_67528168

Federal Marketplace More Adept Than States At Enrolling Customers, Study Finds
By: Michelle Andrews, Kaiser Health News

Despite its rocky launch, the federal health insurance exchange did better than the exchanges run by individual states at both enrolling new people in Obamacare and hanging onto previous enrollees during the 2015 open enrollment period that ended in February, according to a recent analysis.

Enrollment for 2015 on the federal exchange increased by 61 percent over 2014, to 8.8 million. On the state-based exchanges, enrollment increased 12 percent, to 2.8 million, according to the analysis by the consulting firm Avalere Health. In addition, the federal exchange re-enrolled 78 percent of its enrollees from the previous year, while the state-based exchanges re-enrolled 69 percent.

Several factors may have contributed to the disparities in enrollment and retention, says Elizabeth Carpenter, a director in the health reform practice at Avalere, which conducted the analysis based on federal enrollment data released in March for the federal and state-based exchanges.

The many website and other glitches that bedeviled the 2014 launch of healthcare.gov, the federal portal for Obamacare coverage in about three dozen states, may have contributed to its stronger enrollment showing this year, Carpenter says.

"Some folks have pointed to the technological problems with healthcare.gov, saying that there may have been people who didn't get through the enrollment process last year" because they couldn't get the website to work, Carpenter says. In 2015, instead of error messages and frozen screens, healthcare.gov functioned smoothly for the most part, even during periods of heavy use.

It may also be that the federal exchange covers more states that have a larger proportion of lower income people, Carpenter says. More than 85 percent of people who bought health insurance on the state and federal marketplaces were eligible for premium tax credits that were available to people with incomes up to 400 percent of the federal poverty level ($46,680 for an individual).

As for retention differences, it's possible that more people over-reported their income on state-based exchanges for 2014 coverage and were subsequently shifted to the Medicaid program this year. Twenty-eight states have expanded Medicaid to adults with incomes up to 138 percent of the federal poverty level (about $16,100). In those states, if someone applies for a marketplace plan, the exchange will move them into Medicaid if their income falls below that threshold.

Such shifting could make it appear that some states had lost enrollees when instead they just moved to Medicaid. Avalere didn't incorporate Medicaid eligibility shifts into its analysis.

But it's not clear why state-based exchanges would experience such shifts to a greater degree than states where the exchange is run by the federal government.

The takeaway? "The numbers underscore that significant growth year over year is not necessarily a given," Carpenter says. "The question for all exchanges is how to continue to grow over time and attract healthier enrollees."