February 21, 2012
The Affordable Care Act will significantly expand health coverage opportunities through an expansion in Medicaid and the creation of new health insurance exchanges in 2014. Effective outreach and enrollment efforts will be vital for assuring the expansions translate into increased coverage. Based on a discussion with federal and state officials and experts, this KFF
report identifies key issues to consider with regard to outreach and enrollment under reform.
The discussion was part of an ongoing series of
Health Reform Roundtables that explore key issues related to implementing the expansion of Medicaid under health reform.
February 17, 2012
Last week the Obama administration released a ruling that requires all employers, including religiously affiliated organizations, to provide full contraceptive coverage in their health plans. After hearing objections about the rule, the administration relaxed the requirement for religiously affiliated employers. Below is the flood of polling that followed on the announcement of the requirement:
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FOX News covers the topic, gauging support for the requirement. Also on the survey – what do voters first mention when they discuss Mitt Romney? Check out the poll to see where the Massachusetts health reform law falls on the list.
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The Pew Research Center also tackles the issue, asking the public how much they've heard about the requirement and whether religiously affiliated institutions should be exempt from the rule.
– Taking a more general approach, the
CBS/
New York Times poll first measures support for the requirement and then measures whether the public would favor extending it to religiously affiliated employers. Americans also weigh in what on they'd like the presidential candidates to discuss (health care of course makes the cut) and which of the largest items in the federal budget – Medicare, Social Security, or defense – they'd be willing to reduce.
CNN asks Republicans which GOP presidential candidate would do the best job handling health care.
In the latest
Kaiser Health News/NPR reporting partnership, local affiliate WBUR asks Massachusetts likely voters if they like the state's health reform law and whether they see it as a precursor to the Affordable Care Act. The poll also asks voters whether they think Romney opposes the national law more because he disagrees with it in principal or more because he is trying to win the nomination.
Gallup's most recent article on health insurance coverage in America focuses on trends in employer-based health insurance.
February 16, 2012
In his latest
column, Kaiser Family Foundation president Drew Altman spotlights a Foundation analysis showing the highly variable impact that Affordable Care Act (ACA) coverage expansions will have at the local level across the country, and discusses what this might mean for reactions to the law. All previous columns are also
online. Additionally, you can subscribe to the columns and have them fed to your RSS reader
here.
February 16, 2012
A new
analysis from RAND looks at what the effect would be of eliminating the so-called “individual mandate” under the Affordable Care Act (ACA). The authors use “RAND’s Comprehensive Assessment of Reform Efforts (COMPARE) microsimulation model to predict the effects of a possible Supreme Court decision invalidating the individual mandate while keeping the other parts of the law intact,” focusing on health insurance coverage overall and insurance premiums. In contrast to other estimates, the authors “estimate the premium increase that a given individual could expect with the repeal of the individual mandate. In contrast, prior models have estimated the change in average premiums, an approach that combines the change in premium per enrollee with compositional effects, such as changes in the age and tobacco use composition of the enrolled population.” The study finds that “the elimination of the individual mandate leads to a 12.5-million-person reduction in the number of newly insured individuals and increases government spending per newly insured individual by a factor of more than two. While we find that average exchange premiums increase by approximately 9.3 percent when the individual mandate is eliminated, this finding is mostly driven by compositional effects. The increase in premiums that would be faced by any given individual is only 2.4 percent.”
February 15, 2012
A new
analysis from the Kaiser Family Foundation reveals wide variation across local communities in the share of the population that could benefit from coverage expansion in the Affordable Care Act (ACA) starting in 2014.
In parts of Florida, New Mexico, Texas, Louisiana, and California, as much as 40% of the non-elderly population could benefit from the expansion of Medicaid or through tax credits to help purchase coverage in the new health insurance exchanges. By contrast, many parts of states such as Massachusetts, Hawaii, New York and Connecticut – which already have high levels of employer-sponsored insurance or reforms that make coverage more accessible and affordable – will see as little as 2% of the population benefitting from the ACA’s coverage expansion.
The new analysis estimates the share of the non-elderly population in over 2,000 geographic areas across the U.S. who had family income up to four times the poverty level in 2010 and were either uninsured or buying coverage on their own. Starting in 2014, people with family incomes up to 138% of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will be generally eligible for the Medicaid program. People buying coverage in the new state-based health insurance exchanges will be eligible for federal subsidies to subsidize the cost of insurance if their income is below four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012).
The
analysis includes an interactive tool that allows users to enter in their zip codes and see the percentage of people in their communities who could be helped by subsidies to help pay for private insurance or eligible for Medicaid starting in 2014 under the ACA.
February 10, 2012
The
Public Religion Research Institute surveys public opinion on whether certain categories of religiously affiliated employers, such as Catholic hospitals or universities, should be required to include birth control in their health insurance coverage.
The Commonwealth Fund examines a range of issues related access to health care and insurance coverage, with a special focus on lower-income adults.
Gallup asks Americans their views on how President Barack Obama is handling health care policy.
February 9, 2012
Three new briefs from Families USA examine the details behind the idea of Accountable Care Organizations, or ACOs, new initiatives under the Affordable Care Act that, as described in the report, are “[entities] made up of health care providers that [agree] to be held accountable not just for lowering the cost of health care, but also for improving health care quality across the continuum of care, including acute care, post-acute care, long-term care, and behavioral and mental health care.” One brief
reviews how ACOs will be paid by Medicare and how quality measurements should be selected. A second brief
examines the incentive payment model behind ACOs, how initial expenditure benchmarks could be determined, and explains the minimum savings and loss rate determined by CMS. The third brief
explores how beneficiaries could be assigned to an ACO and whether the assignment will be retrospective or prospective.
February 9, 2012
The February issue of Health Affairs includes several articles on the Small Business Health Options Program (SHOP), the exchange to be established for small employers in 2014 under the ACA. Timothy Jost of the Washington and Lee University School of Law
reviews the current state of insurance market for small employers and explores how the SHOP exchange might improve coverage options. “Exchanges also potentially offer an advantage that has been missing not only from small-group but also from many large-group insurance markets: employee choice,” he writes. Even so, he concludes, “Although employee choice is attractive in theory, in practice it has proved difficult for small employers to manage, particularly during open-enrollment periods, when employees need information on multiple plans. Price continues to be the most important consideration for small businesses; choice is less important.”
Jon Kingsdale, the founding director of the Massachusetts Connector exchange, “critically examines the rationales that have been offered for a SHOP exchange,” states a short summary of his
article in the journal. “The primary reason that small businesses do not offer health insurance to their employees, he argues, is not lack of availability, because there is in fact a thriving commercial market for small-group coverage. Rather, it is cost. Unless exchanges can make a business case for their ability to bring down the cost of insurance, they will not succeed.” Another
article by research analysts at the Urban Institute “analyze[s] several key design options being considered, using the Urban Institute’s Health Insurance Policy Simulation Model: creating separate versus merged small-group and nongroup markets, eliminating age rating in these markets, removing the small-employer credit, and setting the maximum number of employees for firms in the small-group market at 50 versus 100 workers.” The authors find that “merging the small-group and nongroup markets would result in 1.7 million more people nationwide participating in the exchanges and, because of greater affordability of nongroup coverage, approximately 1.0 million more people being insured than if the risk pools were not merged.”
In another
paper, Terry Gardiner of the Small Business Majority writes about “Past and current exchanges provide valuable insights into the role exchanges can play, services they can offer, and design features that can make them successful.” In his brief, William Kramer of the Pacific Business Group on Health
touches upon whether employers will move part-time workers and retirees into the exchanges. Researchers at the Johns Hopkins School of Public Health
describe "why the Affordable Care Act could lead to favorable or adverse risk selection across plans. It reviews provisions in the act and recent proposed regulations intended to mitigate the problem of risk selection.” Finally, an
article by Mark Hall of Wake Forest University explores the issue of stop-loss coverage, “which self-funded employers rely on to protect their businesses from catastrophic medical costs incurred by one or more insured workers.” Hall argues that “Aspects of the reform law could motivate small businesses to self-insure, rather than participate in state-regulated markets either inside or outside the new health insurance exchanges. If younger or healthier groups self-insure, premiums for insured plans might rise to an extent that could seriously impair the regulated market,” and advocates for state regulation of stop-loss coverage.
February 9, 2012
The Department of Health and Human Services’ Center for Consumer Information and Insurance Oversight (CCIIO) issues
final regulations for the Summary of Benefits and Coverage (SBC) and Uniform Glossary. The SBC will detail, “in plain language, simple and consistent information about health plan benefits and coverage,” according to CCIIO. Both the SBC and the accompanying Uniform Glossary will be provided to consumers when “when shopping for coverage, enrolling in coverage, at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health plan.” The SBC also includes coverage examples which will “illustrate how a health insurance policy or plan would cover care for common benefits scenarios. Using clear standards and guidelines provided by the Center for Consumer Information and Insurance Oversight (CCIIO), plans and issuers will simulate claims processing for each scenario so consumers can see an illustration of the coverage they get for their premium dollar under a plan.” Final versions of the
SBC template and
glossary are available.
February 8, 2012
A new
report from the Urban Institute and funded by the Robert Wood Johnson Foundation provides “a status report on the Center for Medicare and Medicaid Innovation.” The Affordable Care Act “specifically charges the Innovation Center with identifying, developing, assessing, supporting, and spreading new models that might reduce expenditures under Medicare, Medicaid, or CHIP while improving or maintaining care quality,” according to the report. “The paper first defines the goals Congress envisioned for the Innovation Center and the new tools it was given, emphasizing how the enhanced authority compares with CMS’ traditional demonstration programs,” explain the authors. “Next, the paper outlines the Innovation Center’s organization and staffing, how it sets priorities and decides on funding, and its approach to altering traditional approaches to testing innovative ideas, while also seeking a much more collaborative interaction with providers, other payers, and the public.” The report also includes a list of the Innovations Center’s initiatives.