White House: Health reform hasn’t hurt jobs

The White House pushed back on Monday against allegations that health care reform is hurting jobs and the economy.

In fact, the restaurant industry—given by many critics as the prime example of a place where jobs and hours would be cut if employers had to provide health insurance—is adding jobs, said a senior administration official, who spoke on condition that he not be identified.

“Restaurants have had the fastest job growth among the industries, and even faster than what would be predicted by their sales growth,” said the official.

In addition, health care costs are slowing and by one measure, inflation in health care spending is the lowest it’s been in 49 years, says Council of Economic Advisers Chairman Alan Krueger. And to further make its point, the White House posted aTumblr page extolling the virtues of health reform.

(Read more: When doctors sell practices, prices go up)

The Obama administration has begun a full court press to sell health reform, whose main provisions are just beginning to come into effect. Republicans in Congress have been countering with hearings aimed at showing the legislation’s shortcomings, and by making a show of voting to repeal the legislation or to prevent federal funds from being used to pay for it.

“In sum, data from across the economy—covering consumers, government, and private employers—point to the same conclusion: health care cost growth has slowed,” Krueger writes in a post on the official White House blog.

“Prices for personal consumption expenditures (PCE) on health care goods and services rose just 1.1 percent over the twelve months ending in May 2013, the slowest rate of increase in nearly 50 years,” Krueger writes. PCE includes government and consumer health spending.

The senior official said the 2010 Affordable Care Act was helping bring down these costs. The law, known widely as Obamacare, has provisions to encourage hospitals to take better care of patients so they don’t end up coming back again and again for complications.

The rate of these hospital readmissions has fallen to 17.8 percent, slightly down from 19 percent in 2010, the official said.

Spending on hospital services, nursing homes, outpatient services and drugs all grew at lower rates in the time period from March 2010 to May 2013 than in previous times going back to March of 1980, the White House said.

And, the official said, the Affordable Care Act has not hurt jobs. “If the Affordable Care Act was slowing job growth, then one would expect weaker job growth in industries that currently offer health insurance to fewer employees, since these industries will be more substantially impacted by the employer mandate,” according to the official.

“In fact, since the private sector began adding jobs in February 2010, job growth in these ‘low coverage’ industries has been faster than the rest of the private sector.”

Earlier this month, the Obama administration delayed a requirement that anyone with 50 or more workers offer health insurance to any of them working full time. The requirement defines full time as 30 hours a week or more—something constructed to make sure that employers didn’t shave a few hours off full time workers’ weeks to avoid having to provide the coverage.

More from NBC News:
Obamacare won’t slash workers’ hours, report finds
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Health reform turns 3, with the hardest part yet to come

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CKE Restaurants CEO Andrew Puzder explains why he thinks the employer mandate of Obamacare should be “permanently waived.”

But many employers have threatened to cut both workers and their hours. The state of Virginia already has done so—it has capped part-time workers’ hours at 29 hours a week. State officials have said it would cost more than $100 million a year to provide them all health coverage.

Restaurants, which employ many part-time and seasonal workers, would be especially affected by the law, and some restaurant executives have told Congress they will cut hours and jobs.

“I suspect there will be some isolated instances,” the administration official said, but added there was no evidence such cases would affect the economy.

(Read moreLong-term care feared more than death)

The White House also says one of the main plans of health reform—the health insurance marketplaces where people without insurance can buy coverage—are also turning out to be less pricey than critics had warned they would be.

“In 13 states that have publicly reported premiums for 2014, the average of the lowest-cost plan is nearly 20 percent below projections based on Congressional Budget Office premiums,” Krueger blogs.

“This includes New York State, which recently announced that health insurance rates in 2014 will be at least 50 percent lower, on average, than the plans currently available in the state.”

—By Maggie Fox, NBC News


Source Link:  http://www.cnbc.com/id/100924988

ACA Likely to Deliver Bigger Bang in Rural Areas

Published: Jul 29, 2013

By David Pittman, Washington Correspondent, MedPage Today

WASHINGTON — The rural uninsured may reap a bigger benefit from the Affordable Care Act than their city-dwelling counterparts, which prompted health policy experts to call for a ramped-up campaign to publicize ACA in rural communities.

More rural residents than urban dwellers (10.7% versus 9.6%) can receive tax subsidies under the ACA to purchase private insurance and more uninsured are eligible for an expanded Medicaid program (9.9% versus 8.5%), Keith Mueller, PhD, director of the Rural Policy Research Institute’s Center for Rural Health Policy Analysis in Iowa City, said.

Educating those uninsured, rural residents about their benefits under the ACA will be vital to the 2010 health law’s success, others said at an Alliance for Health Reform briefing on rural healthcare.

“On a per person basis, we have the potential for more rural folks to benefit from this expansion than their urban counterparts,” Tom Morris, director of the Office of Rural Health Policy at the Health Resources and Services Administration, said. “The next couple of months are going to be critical in terms of getting the word out.”

However, a few obstacles stand in the way of getting those people signed up for either Medicaid or insurance subsidies, panelists at the briefing said.

For example, 30% of New Mexicans who were eligible for Medicaid even before the ACA still are not enrolled because there are barriers to doing so, Art Kaufman, MD, vice chancellor for community health sciences at the University of New Mexico Health Sciences Center in Albuquerque, said.

“You’ve heard of suppression of votes. There’s also suppression of getting people enrolled,” Kaufman said. “There are so many ways [to suppress enrollment] even a state that has accepted Medicaid [expansion] can slow the process.”

The ACA will provide coverage to those making up to 138% of the federal poverty level in states that chose to expand their programs following last summer’s landmark Supreme Court decision. While its health insurance exchanges will provide online marketplaces for the uninsured to comparison shop and purchase insurance, those making between 100% and 400% of the federal poverty level will be eligible for tax subsidies to help offset to cost of coverage.

One of the main obstacles facing the Obama administration and its advocates in their attempts to reach rural residents to tell them about expanded benefits under the ACA is political resistance to “Obamacare” in many states with large rural populations.

Their state leaders have been less willing to back programs that even would enroll or educate the public on ACA programs.

“The more we can start calling these products something else besides Obamacare, the ACA, or whatever … the better off we’re going to be,” Lisa Miller, former member of the Maine House of Representatives, said.

Meanwhile, the Department of Health and Human Services is pumping more than $150 million into community health centers and $54 million for navigator programs to help spur the enrollment process.

Miller said funds are also flowing from an unexpected source: philanthropic organizations that are funding enrollment campaigns.

© 2013 MedPage Today, LLC. All rights reserved. Use of this site constitutes acceptance of the MedPageToday.com terms of use and privacy policy. The material on this site is for informational purposes only, and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

Article Link: http://www.medpagetoday.com/Washington-Watch/Reform/40735

How to Shop Smart on New Health Exchanges: Tips on Selecting the Right Plan





Updated July 27, 2013, 11:28 p.m. ET


Millions of Americans will be shopping for their own health insurance for the first time this fall—but they will need to look closely to be sure they get the coverage that best fits their needs.

On Oct. 1, new government-backed online health-insurance marketplaces are supposed to launch in every state, sparked by the federal health law. Around seven million people are projected to buy plans there for 2014, many helped by federal subsidies, and the number is expected to swell to as many as 25 million in later years. Adding to that, some employers are considering new setups where they give workers a set sum of money to select plans in a similar type of exchange created by private companies.

Bronze or Platinum?

The health law sets many requirements aimed at standardizing plans and making them easier to compare. On the law’s public exchanges, for instance, coverage will be divided into four tiers ranging from the cheapest, “bronze,” covering around 60% of health-care expenses on average, through the priciest, “platinum,” covering 90%. There will also be limited-coverage “catastrophic” plans for people younger than 30. All plans will be expected to include certain mandated benefits such as maternity care and hospital stays, and they can’t cap annual or lifetime payouts.

Still, despite the rules, plans may vary quite a bit—giving consumers important decisions to make. “Take your time to understand the plan” you’re considering before you buy it, says Carrie McLean, director of customer service at eHealth Inc., parent of eHealthInsurance.com.

For starters, people have to pick an insurer, and in many markets, these could include new players that haven’t sold commercial plans before. The nonprofit National Committee for Quality Assurance offers “report cards” about existing health insurers at ncqa.org.

Importantly, consumers will be able to choose how they will pay out of their pockets for care. The plans will cap the out-of-pocket total for the year at $6,350 for an individual plan and $12,700 for family coverage. But a plan’s charges could come in various forms including deductibles, copayments or a percentage of the cost of certain types of services, a setup known as coinsurance.

“You need to look at it and say, ‘Can I come up with it quickly?’ ” since treatments for a serious condition may soon ring up the total out-of-pocket maximum, says Karen Pollitz, a senior fellow at the nonprofit Kaiser Family Foundation. And, she warns, consumers may have to pay out the annual maximum sum twice, if they require care that stretches into more than one plan year.

Another key thing for consumers to examine is what doctors and hospitals are in a plan’s network, says Robert Krughoff, president of Consumers’ Checkbook, a nonprofit that rates health plans and medical providers on quality and cost. Exchange plans are expected to often feature limited choices of health-care providers, and who’s included may vary quite a bit.

To try to figure out if the institutions are the best in the area, consumers can look for quality assessments through resources like the website of the nonprofit Informed Patient Institute, informedpatientinstitute.org; the federal Medicare program’s Hospital Compare at medicare.gov/hospitalcompare; or Mr. Krughoff’s group’s GuideToTopDoctors.org and GuideToHospitals.org.

Limited Access

Some health maintenance organization, or HMO, plans may generally not cover out-of-network services. Plans that are labeled as preferred-provider organizations, or PPOs, may still potentially include large charges for consumers who go to hospitals and doctors outside their networks.

Consumers should also probe whether they could face barriers to accessing certain types of care, experts say. For instance, some plans may require referrals by primary-care providers before a patient sees a specialist, or may have extensive pre-authorization requirements.

Another caution: consumers who require certain prescription drugs should check if their medications are on a plan’s list of covered medicines, and how much they may have to pay to get them, experts say.

Write to Anna Wilde Mathews at anna.mathews@wsj.com

Article Link: http://online.wsj.com/article/SB10001424127887324564704578625802915036588.html?mod=googlenews_wsj

Judge denies injunction on Kentucky Medicaid expansion

Source Link:  http://www.courier-journal.com/article/20130726/PRIME07/307260115/Judge-denies-injunction-Kentucky

Mike Wynn
The Courier-Journal

FRANKFORT, KY. — A Franklin Circuit Court judge ruled Friday that expansion of Kentucky’s Medicaid program can move forward while the court considers a legal challenge from the tea party.

Gov. Steve Beshear said in May that Kentucky will add about 308,000 beneficiaries to Medicaid rolls next year under the federal Affordable Care Act, known as Obamacare.

Tea party activist David Adams has filed suit, challenging Beshear’s decision and seeking a temporary injunction to halt the expansion.

But Judge Phillip Shepherd denied the injunction Friday, reasoning that the case should conclude by October — about three months before the expansion takes effect. If the suit succeeds, relief would be available before implementation, he wrote in the three-page order.

“If the governor prevails on the merits, the injunctive relief granted at this time could cause severe hardship on the many citizens who would be eligible for expanded benefits, and such relief would create havoc for the state officials charged with implementing this policy,” Shepherd ruled.

Beshear has said expanding Medicaid will provide a windfall of federal funding and create $15.6 billion in economic benefits for the state, although critics have raised questions over costs.

Adams contends the governor does not have authority to opt into Medicaid expansion without authorization from the legislature.

But the administration argues that Medicaid is governed by regulation — rather than statute — and that Beshear has clear authority to change regulations.

Adams said Friday that Shepherd’s ruling still provides a pathway for victory in the case by allowing discovery and arguments over the constitutionality of the expansion to move forward. Shepherd also found that Adams can refile for an injunction if the case is not resolved before open enrollment begins Oct. 1.

Reporter Mike Wynn can be reached at (502) 875-5136.

What Can We Expect From the New Health Insurance Exchanges?

Posted: 07/24/2013 4:23 pm

By Sandeep Baliga and Nikhil Joshi

Huffington Post


In less than three months, the health insurance exchanges established by the Affordable Care Act will go into effect. Proponents of the law argue the exchanges will offer high-quality insurance at competitive rates for millions of consumers. Critics argue that Americans, especially those who are healthy, will balk at enrolling, causing the would-be markets to unravel.

So who is right?

Fortunately, there is a rich body of independent research that uses detailed real-world health care datasets to infer what will happen when the new insurance markets open. The studies show that well-functioning exchanges will offer lower premiums and more consumer choice.

These benefits, though, are contingent upon attracting consumers, especially those who are young and healthy, to the exchanges. A working paperby professors from Northwestern University and the University of California performs a simulation of a health insurance exchange by using data from a firm that offered each of its 9,000 employees a set of coverage options. The study finds that in a worst-case scenario, where anyone who does not see an expected gain from purchasing insurance forgoes coverage — i.e., young people — about 60 percent of people ages 25 to 30 would still benefit from purchasing a “bronze plan” at an annual (unsubsidized) price of about $2,700.

But if more young and healthy Americans sign up, a virtuous cycle occurs, with premium costs dropping, encouraging yet more young and healthy Americans to join, and so on. In the above simulation, this would cause premiums for those ages 25 to 30 to fall by more than a third.

If properly implemented, the exchanges will bring a somewhat novel feature to the health insurance market: competition. According to a 2012analysis by the American Medical Association, 70 percent of markets have little competition between private insurers.

In these “highly concentrated markets,” insurers have enough market power to set prices based not on the cost of providing insurance, but on other factors, including how much a firm purchasing insurance for its employees makes in profits.

A liquid health insurance exchange can offer much-needed competitive pressure and lower costs. According to a National Bureau of Economic Research paper, after health care reform in Massachusetts was put in place, premiums in the exchange fell more than 10 percent because of reduced insurer markups alone.

In addition to lower premiums, competition can help consumers by simply increasing choice. One analysis showed that consumers would be willing to pay increased premiums of up to almost 30 percent to include their ideal health plan in their employer’s offerings.

Well-functioning health insurance exchanges could generate benefits beyond the pool of previously uninsured individuals that join the exchanges. By providing a plausible alternative to employer-sponsored health care and ending discrimination based on pre-existing conditions, the health care law could meaningfully improve labor mobility, a critical feature of a strong economy that has been dampened since the recession.

An influential 1994 study found that a typical 38-year-old male is 25 percent less likely to change jobs if his only source of health insurance is his current job. Meanwhile, the study found that married men who are working in jobs without health insurance (e.g. as entrepreneurs) are twice as likely to seek new jobs if they have pregnant wives.

During the recession, the number of workers moving from job to job in a quarter (“job churn”) dropped by more than 20 percent, and has remained low throughout the recovery. The number of business start-ups launched each quarter also fell, and remains about 10 percent below pre-recession levels. If the health care law can, as research suggests, reduce “job lock” on the order of 25 percent, the economic benefits would be significant.

While we cannot be sure how the new markets for health insurance will work, studies based on real-world health data give us a valuable window into what may happen. The economic research indicates that well-functioning exchanges will bring much-needed competition and individual participation to a market currently characterized by high prices and little choice — and that can benefit everyone.

Sandeep Baliga is a Professor of Managerial Economics and Decision Sciences at the Kellogg School of Management. Nikhil Joshi is the Research Director at Business Forward, and former Associate Policy Director for Economics on President Obama’s re-election campaign. They are coauthors of the report, “Implementing the Affordable Care Act: The Value of Efficient Health Care Exchanges.”

Quinn signs Illinois Medicaid expansion bill

By Peter Frost Tribune reporter

11:31 a.m. CDT, July 22, 2013


Gov. Pat Quinn on Monday signed a bill that will expand Medicaid coverage to about 342,000 low-income adults in Illinois, one of the central components of President Barack Obama’s health care overhaul law.
Illinois is one of 23 states, plus the District of Columbia, that is moving forward with the Medicaid expansion, aimed to extend coverage to 17 million Americans starting in 2014. Twenty-one states have opted out of the program, which the U.S. Supreme Court deemed optional in a 2012 ruling that upheld other parts of the law.

Under the law, the federal government will pay the full cost of covering newly eligible people — including childless adults — on Medicaid from 2014 to 2016, then gradually reduce its share of the funding until it reaches 90 percent in 2020 and the years following. Illinois officials expect the federal government to contribute more than $12 billion toward the expansion between 2014 and 2020.

Now, the federal government pays an average of 57 percent of states’ Medicaid expenses.

Starting in January, Illinoisans who make up to 138 percent of the federal poverty line — about $15,860 for an individual or $32,500 for a family of four — will be eligible for the subsidized coverage.

“In the home state of President Obama, we believe access to quality health care is a fundamental right and we proudly embrace the Affordable Care Act,” Quinn said.

The law also will extend subsidies to those who make 138 to 400 percent of poverty level wages to help defray the cost of purchasing coverage on so-called health insurance marketplaces, online exchanges where individuals and small businesses can begin shopping Oct. 1 for coverage that begins in January.

Most of those who don’t carry coverage will face a penalty, starting next year at $95 or 1 percent of household income, whichever is greater.

In Illinois, nearly 1 million residents will be eligible for subsidized health insurance next year, under the Medicaid expansion or via tax credits through the Illinois Health Insurance Marketplace. State officials expect only about half of them to sign up.

Those eligible for subsidies will be able to chose from among up to 165 health plans offered by six insurers, according to the state, which has until the end of the month to review the offerings and recommend approval to federal regulators.

Insurers that have submitted plans for consideration are Blue Cross and Blue Shield of Illinois, Humana Inc., Aetna Inc., Coventry Health Care Inc., Land of Lincoln Health and the insurance arm of the Carle Foundation.


Copyright © 2013 Chicago Tribune Company, LLC

Local business owners preparing for Affordable Care Act mandates, despite delay

By Chloé Morrison

Published Monday, July 22nd 2013


Even though employers now have until 2015 to provide health insurance for employees under federal law, some local business leaders are doing their best to prepare for the mandate, even though they aren’t exactly sure how it will impact their businesses.

“There just seems to be so many unanswered questions,” said Mike Monen, who—along with this wife, Taylor—owns restaurants Community Pie, Urban Stack, Taco Mamacita, and Milk and Honey. “I feel like the delay is proof that some people might not be able to sustain through this type of expense. I think it proves the point that there are so many unanswered questions.”

April Wortham, market analyst with HealthLeaders-InterStudy, said that people have been confused and overwhelmed about the Affordable Care Act since it became law in 2010.

President Barack Obama’s Affordable Care Act will provide health care coverage to 30 million people.

Last summer, the Supreme Court ruled that the core of the health care reform act was constitutional. Some of the act’s requirements have already been implemented, and others will continue to be rolled out in coming years.

Because of the act, online exchanges are being created. Exchanges are where individuals and small business owners can shop for health care insurance.

Enrollment for the exchanges starts in October, and coverage will be effective in January 2014.

One of the requirements of the act is that employers who don’t already do so provide health care for their employees.

Last week, the House of Representatives voted to delay the requirement that employers provide health insurance, something Barack Obama’s administration was already doing, according to CNN.

Wortham said that—on a practical level—the delay won’t have a huge impact because the mandate impacts employers with more than 50 employees. And many employers with that many workers already offer health insurance.

According to the National Conference of State Legislatures, 98 percent of employers with more than 200 employees offer health insurance, as do 94 percent of employers with 50 to 199 employees.

But one group of businesses that is being impacted is the restaurant industry.

The Wall Street Journal recently ran an article about how some restaurant owners are starting to rely more on part-time employees in an effort to avoid the potential for higher health care costs under the federal insurance law.

But Monen, whose restaurants each have at least 50 employees, said he’s gone over details with his accountant and insurance broker and that he doesn’t think there are many good options to avoid the cost of the new mandate.

“Cutting serving or wait staff down to below 30 hours is one option, but I think that’s the most unfair thing to do,” he said. “That’s not a strategy I’ve been willing to take … We care about our employees and have always offered full-times jobs. I think that’s what everyone needs.”

And restaurants that do start cutting hours to employ more part-time workers are then forced to deal with workers who might have to work two jobs, Monen said. That brings on a new set of problems because then the employer is dealing with people who might have conflicting work schedules.

Another local restaurant owner, Mike Robinson of Fork & Pie and Brewhaus, said he already offers health insurance to employees who want it. He said he thinks that is part of creating a strong team and good work environment.

Preparing for the unknown 
Monen and Robinson are both preparing for Affordable Care Act requirements, even though there is an element of uncertainty.

“We are definitely preparing—lots of proactive meetings with our accountants and tax people,” Robinson said. “I think all my friends with small businesses are putting together a tentative game plan. It’s such a massive amount of information.”

So there are still a lot of questions that many business owners need answered.

For example, is it cheaper to just take the financial penalty instead of offering insurance? Robinson said he thought it might be.

The penalty for business owners per year is $2,000 for each full-time employee or the equivalent. So part-time employees add up and count toward the total, Wortham said.

And penalties can add up, she said.

The Chattanooga Area Chamber of Commerce will soon start working with its members to educate them on the Affordable Care Act’s requirements, said Robert Bradham, vice president of public strategies.

“We are actually in the process of putting together something for our members,” he said. “It’ll be later this year.”

The chamber will host educational speakers from the insurance industry to speak to area small business owners, he said.

Wortham said that part of the reasoning for the delay in the employer mandate is that there are still a lot of unanswered questions and confusion for business owners.

But the delay doesn’t mean that business owners should put off educating themselves.

“The temptation is going to be for employers—large or small—to sit back and say, ‘We’ve got another year; we can chill out,'” she said. “But I would not advise that. There is plenty that businesses still have to do, regardless of this delay. It gives them another year to figure out those questions.”

Updated @ 8:24 a.m. on 7/22/13 for clarity.


Article Link: http://www.nooga.com/162595/local-business-owners-preparing-for-affordable-care-act-mandates-despite-delay/

TN, KY are miles apart on Medicaid

By: Tom Wilemon, The Tennessean

Source Link:  http://www.wbir.com/news/article/281301/2/TN-KY-are-miles-apart-on-Medicaid

Deanna Piotrowski wound up on the wrong side of the Kentucky-Tennessee border.

She suffers from chronic conditions, cannot afford her medicine and is without health insurance. If she had settled 10 miles up the road, she would be getting Medicaid coverage.

“That’s ridiculous,” Piotrowski said. “That’s really a shame.”

Portland, Tenn., where Piotrowski lives, is not that different from Franklin, Ky., the next town up along a two-lane highway that runs past cornfields and modest homes.

Kassandra Clark says she’s lucky to live in the Kentucky town. Uncertain of prospects for health coverage at her new job, she’s grateful politicians in her state have given her a backup option.

“It shows that they care about their people, that they are there for them,” Clark said.

Kentucky has accepted federal funding from the Affordable Care Act to expand the government insurance program for the poor. Tennessee, where political opposition to “Obamacare” runs strong, has not. Kentucky is an anomaly in the South. Most Southern states have taken actionsto either block or hinder the implementation of the federal health law. Supporters of the law say it is foolhardy of politicians to refuse generous federal funding for ideological reasons, but the law’s critics say the money comes with a hefty financial hitch.

The federal government will pick up 100 percent of the costs of insuring new people brought onto state Medicaid rolls through 2016. It then phases down to a permanent 90 percent matching rate in 2020.

Joseph Smith, executive director of the Kentucky Primary Care Association, said politicians there made a pragmatic decision.

“It’s a silly decision based on ideology to refuse health care coverage to the citizens of any state,” Smith said.

Kentucky will expand coverage to an estimated 308,000 state residents with its decision.

‘We don’t have that kind of money’

But a decision about whether to expand Medicaid in Tennessee is a bit more complicated after the numbers are crunched, the state’s TennCare experience is considered and the political reality confronted. Tennessee expanded Medicaid in the 1990s, then learned it couldn’t handle the cost and had to scale back, forcing people off the program. It is a state with a larger population, which means about 100,000 more new enrollees would be eligible for its Medicaid program. And, unlike in Kentucky, Republicans are firmly in control of state government.

Fiscal responsibility matters to Republicans, said Rep. Glen Casada, who argues that Tennessee can’t afford the 10 percent match the state would have to provide beginning in 2020.

He said estimates run between $198 million and $250 million, which he believes is the closer mark. Democrats in the legislature, however, say Medicaid expansion would ultimately save the state money by lowering its cost for uncompensated care by as much as $1.6 billion.

“We’re talking probably $250 million in year four,” Casada said. “That’s a lot of money. We don’t have that kind of money just sitting around. So the question is: Do we raise taxes or what do we cut?”

And he doubts the federal government will stand by the 90 percent commitment.

“The federal government is fast approaching insolvency,” Casada said. “They cannot continue to spend money like they are spending because either the country will collapse or they will have to start cutting. The first place they are going to start cutting is the sweet deal of a 90-10 match to the states on Medicaid.”

John Graves, a Vanderbilt University professor who formerly worked for the Obama administration on health care reform, said Tennessee could protect itself from any possible future decline in matching money.

“Some other states have considered a ‘circuit breaker’ option that limits their downside risk,” Graves said. “That is, these states say they will expand for now, but if the federal government suddenly reduces its share in the future, that would immediately discontinue the expansion.”

Haslam’s plan

Gov. Bill Haslam has been trying to find a way for Tennessee to use the federal money for a state-tailored plan that would prevent a repeat of the prior TennCare expansion, when thousands of people were added to the rolls and quickly racked up medical bills. Haslam favors a plan similar to a private insurance model, in which shared costs curb the overuse of benefits. Instead of expanding TennCare rolls, the money would be used to help poor people buy private insurance, with some co-payments on medical visits and procedures. Adults on TennCare currently have co-pays only for prescriptions.

Haslam’s path is a difficult one. He has to get his plan past the Obama administration and then before the Republican-controlled state legislature.

Arkansas Gov. Mike Beebe, a Democrat, got the Republican legislature in his state to pass an expansion plan that has some similarities to what Haslam has proposed. Federal officials are working toward approving it as a demonstration project. Under the plan, the state would use federal money as “premium assistance” to buy private coverage for people eligible for Medicaid.

Kentucky Gov. Steve Beshear, also a Democrat, envisions Medicaid expansion in his state as a job creator, not a financial drain. He projects expansion will have a $15.6 billion economic impact and create nearly 17,000 jobs between 2014 and 2021.

Hospitals will take hit

The problem with boiling down the Affordable Care Act to any kernel of fiscal certainty is that the recipes differ, according to whoever is mixing the numbers.

However, one certainty is that hospitals in Tennessee will lose money without some form of Medicaid expansion. The federal law reduces special payments to hospitals that treat a disproportionate share of the poor and uninsured. Those patients were supposed to gain coverage in every state through Medicaid expansion. The law had language that would have effectively forced states to expand coverage by cutting off Medicaid funding to those that refused. But the U.S. Supreme Court struck down that portion of the law.

Vanderbilt University Medical Center, which provides more care to the uninsured than any other hospital in the region, announced last week that it is cutting expenses and eliminating jobs. The Tennessee Hospital Association has warned that small rural hospitals might be forced to close without some type of Medicaid expansion.

Renard Murray, the regional administrator for the Centers for Medicare and Medicaid Services (CMS), said there is no deadline for Tennessee to make a decision.

“That option is always on the table for a state,” Murray said, noting that when Medicaid was first created in the 1960s, some states delayed offering the optional program.

“But after several years, several decades have passed, every state now has a Medicaid program,” Murray said. “Medicaid expansion is no different.”

Kentucky is the only one of the eight states in CMS region 4that has agreed to expand its Medicaid program. Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee have not.

2 women, 2 scenarios

Piotrowski, who moved to Portland, Tenn., from Michigan this summer, knows little about Tennessee politics. She does know she can’t afford her medicine. A doctor in Michigan who had treated her family for generations charged her only $30 a visit and gave her drug samples for hypertension, diabetes and depression.

She left that medical arrangement and came to Tennessee so her children would have better job opportunities and live in a place with less crime. She applied for TennCare coverage and got denied.

She is trying to connect with community health centers and faith-based clinics in the area that treat people regardless of their ability to pay.

“Everything else in Tennessee I love,” Piotrowski said. “I really was disillusioned. I know there’s a lot of people that are worse off than me, but my health issues could be serious.”

Up the road in Franklin, Ky., Ashley Austin, a part-time job juggler without health insurance, smiled as she helped children with the Boys and Girls Club sell vegetables they had raised at the farmers’ market.

“I also work at Hobby Lobby,” she said. “If we are a part-time employee, our hours got cut because they do not want to provide insurance for us.”

Austin had been on her mother’s plan until she lost her job. But come Jan. 1, she’ll have health insurance because she lives in Kentucky.

Contact Tom Wilemon at 615-726-5961 or twilemon@tennessean.com.


Source Link:  http://www.wbir.com/news/article/281301/2/TN-KY-are-miles-apart-on-Medicaid

Minorities & The ACA: What The Affordable Care Act Means For Minorities

July 18, 2013 11:16 AM | Examiner.com


The Affordable Care Act (ACA) will affect the health care of every American in some form as it continues to be implemented. The law’s intended effects are particularly targeted on certain groups. For example, the ACA creates a new Office of Minority Health to address disease prevention, health promotion, risk reduction, healthier lifestyle choices, use of health care services and barriers to health care. Some of the largest minority groups in America include African Americans, Hispanics, American Indians, Alaska Natives, Asian Americans, Native Hawaiians and Pacific Islanders.


The problem of health disparities

Before the ACA was passed, minorities tended to suffer from what is commonly called “health disparities,” which is simply one way of saying that minorities tended to suffer more from health issues than the majority population. For example, the 2010 Census Bureau report found that minorities tend to have lower infant mortality rates, and also have lower life expectancy than Whites.

More specifically, look at the following 2010 statistics from the Office of Minority Health for the 43.8 million African Americans (14 percent of the overall population) living in the United States:

  • 44 percent of African Americans in comparison to 62 percent of non-Hispanic Whites used employer-sponsored health insurance.
  • 28 percent of African Americans in comparison to 11 percent of non-Hispanic Whites relied on Medicaid, public health insurance.
  • 20.8 percent of African Americans in comparison to 11.7 percent of non-Hispanic Whites were uninsured.
  • In 2009, the death rate for African Americans was higher than Whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS and homicide.

The statistics are also glaring for the 52 million Hispanics (approximately 16.7 percent of the population) who live in the United States:

  • Hispanics have the lowest insured rates of any racial or ethnic group; just 39.6 percent of Mexicans are insured, 51.6 percent of Puerto Ricans, 51.6 percent of Cubans and 46.4 percent of other Hispanic and Latino groups.
  •  In 2010, 30.7 percent of the Hispanic population was not covered by health insurance, as compared to 11.7 percent of the non-Hispanic White population.
  •  Hispanics have higher rates of obesity than non-Hispanic Whites.
  • The rate of low birth weight infants is lower for the total Hispanic population in comparison to non-Hispanic Whites.
  •  Puerto Ricans have a low birth weight rate that is 60 percent higher than the rate for non-Hispanic Whites.
  • Also Puerto Ricans also suffer disproportionately from asthma, HIV/AIDS and infant mortality.
  • Mexican-Americans suffer disproportionately from diabetes.

According to the Office of Minority Health, these health disparities are caused by a number of factors, with economics being one of the leading factors. For example, 26.6 percent of Hispanics, in comparison to 14.9 percent of non-Hispanic Whites, work within service occupations, and those occupations tend to not provide health benefits. The unemployment rate for African Americans was twice as high as the unemployment rate for Non-Hispanic Whites, according to the 2010 Census Bureau report.

The ACA attempts to address these health disparities in a number of ways.



Before the problem can appropriately be solved it must first be fully understood. To that end, Congress funded the National Institute on Minority Health and Health Disparities with $831 million for scientific research on how to improve minority health and eliminate health disparities.


Expansion of Medicaid

Since many minority groups tend to suffer from higher levels of poverty, they also tend to rely more on programs such as Medicaid. Medicaid covers nearly 40 percent of African-American and Latino children. The ACA expands coverage in 2014 up to 133 percent above the poverty level. Nearly half of the current group of uninsured people would qualify for Medicaid under this new criteria.


Community health centers

The ACA provides $11 billion in funding to double the number of patients that are provided primary and preventative services by community health centers. In 2009, 34 percent of health center patients were Hispanic or Latino and 28 percent were African American.


Employer mandate

In addition, the ACA will attempt to expand employer-provided health insurance coverage to many minorities who work in lower-paying jobs. Under the law, employers with more than 50 employees will have to pay a fine if any of their employees receive a premium credit for purchasing their own insurance because they were not offered insurance from their employer.



Minorities have historically suffered from worst health outcomes in the United States due to a number of factors. The ACA attempts to expand health insurance coverage for minorities and improve overall health through research, public programs and mandated private insurance.


[1] http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=7
[2] http://www.ncsl.org/documents/health/HDandACA.pdf
[3] http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8016-02.pdf


Ryan Witt is a freelance writer covering all things St. Louis Cardinals. His work can be found on Examiner.com.


Article Link: http://sacramento.cbslocal.com/2013/07/18/minorities-the-aca/


Health Insurance Changes Coming Your Way Under the Affordable Care Act

The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act

2014 is coming–are you ready for Obamacare? Join the YouToons as they walk through the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, when major parts of the Affordable Care Act, also known as “Obamacare,” go into effect.

This cartoon was written and produced by the Kaiser Family Foundation. Charlie Gibson, former anchor of ABC’s World News with Charlie Gibson and a member of the Foundation’s Board of Trustees, narrated the video. Creative production and animation was provided by Free Range Studios.

http://youtu.be/JZkk6ueZt-U | #HCR #affordablecareact #uninsured #medicaid #exchange #ACA #healthcarereform