Will Health Reform Law Make Premiums More Expensive or More Affordable?

Source link: http://www.pbs.org/newshour/bb/health/july-dec13/obamacare_07-18.html


President Barack Obama defended the benefits of the Affordable Care Act in a news conference, part of a broader effort to sell the law amid continuing criticism from Republicans. MIT’s Jonathan Gruber and Avik Roy of the Manhattan Institute join Jeffrey Brown to debate the cost of coverage under the health reform law.


ANALYSIS    AIR DATE: July 18, 2013

Will Health Reform Law Make Premiums More Expensive or More Affordable?



JEFFREY BROWN: Much of the public remains skeptical or unaware, an important component has been delayed, and Republicans continue their attempts to derail it.

But President Obama again today offered a strong defense of his signature health care reform law. His remarks came as deadlines approach for its implementation.

President Obama ratcheted up his campaign to sell the health care law today in a speech in the East Room of the White House.

PRESIDENT BARACK OBAMA: The Affordable Care Act is doing what it’s designed to do: deliver more choices, better benefits, a check on rising costs, and higher-quality health care.

JEFFREY BROWN: The president highlighted a relatively obscure part of the law, which he himself now regularly refers to as Obamacare, that requires insurers to spend 80 percent of premium dollars on medical care or send rebates to their customers.

BARACK OBAMA: I bet, if you took a poll, most folks wouldn’t know when that check comes in that this was because of Obamacare that they got this extra money in their pockets. But that’s what’s happening.

JEFFREY BROWN: Today’s speech was part of a broader effort to sell the law. It comes amid continuing criticism from Republicans and worry from some supporters about its implementation.

Health insurance exchanges, one of the law’s central components, begin to open Oct. 1.

BARACK OBAMA: New online marketplaces will allow consumers to go online and compare private health care insurance plans, just like you would compare over the Internet the best deal on flat-screen TVs or cars or any other product that is important to your lives. And you’re going to see competition in ways that we haven’t seen before.

JEFFREY BROWN: The president chose not to address the decision earlier this month to delay the insurance employer mandate until 2015.

Other major parts of the law, such as an individual mandate, will still take effect as scheduled.

But opponents have seized on the delay as a sign of greater problems with the law. Yesterday, the Republican-led House voted to delay the individual mandate that requires most Americans to get coverage next year or pay a penalty.

House Speaker John Boehner:

REP. JOHN BOEHNER, R-Ohio: Listen, this is about basic fairness. To say that, well, we’re going to — we’re going to relax this mandate for a year on American business, but we’re going to continue to stick it to individuals and families is strictly, and simply, unfair to the American people.

MAN: All those in favor say aye.


MAN: Those opposed, no.


JEFFREY BROWN: The House vote marked at least the 38th time that Republicans have tried to eliminate or scale back the Affordable Care Act.

Republican Representative Luke Messer of Indiana:

REP. LUKE MESSER, R-Ind.: Obamacare is not working. The American people know that. Now it seems that President Obama knows that, too. The president’s unilateral decision to violate the law and delay the employer mandate, postpone some of the law’s worst damages for businesses, fundamental fairness dictates that individuals get the same reprieve.

JEFFREY BROWN: Yesterday’s vote came on the same day New York State announced its insurance premiums on the individual market are expected to drop 50 percent.

Today, the Obama administration put out its own report on the expected cost of premiums once the new exchanges take effect. It concluded that 10 states, plus the District of Columbia, would be able to offer monthly premiums that will be 18 percent lower than initially projected by the Congressional Budget Office. Those estimates were for a lower-cost plan that would run about $320 a month for an individual.

But other states have come up with very different and higher numbers. Last week, Ohio issued its own estimate. It reported the average individual market health insurance plan would jump 88 percent next year.

The question of how much insurance will cost is a crucial one for the success of the law.

And we explore the issue further with Jonathan Gruber, an economist at the Massachusetts Institute of Technology. He worked with the administration on the health reform law and is a key architect of the Massachusetts law.

And Avik Roy, senior fellow at the Manhattan Institute, he served as Mitt Romney’s health care adviser during the 2012 presidential campaign.

Well, welcome to both of you.

Jonathan Gruber, starting as a sort of general starting point, is there a simple answer as to whether the health reform law will lower or raise premiums?

JONATHAN GRUBER, Massachusetts Institute of Technology: There’s never a simple answer with something as complicated as health care, but there’s a three-part answer.

The first part is, for most Americans who have private health insurance who get it from their large employers, nothing changes.

The second part of the answer is, for the second largest groups, those who get insurance from small employers, what they’re going to see is increased premium certainty. They won’t see their premiums jump 50 percent in the year because someone gets sick.

And on average, they are going to see rates basically stay the same. Some will go up some, some will come down some, but basically stay the same. The third group is individuals.

Now, the effect on individuals is going to vary a lot across states, because — depend on how regulated the individual market was before this law.

But what we are going to see is on average the premiums individuals face will go up, but that will be offset by the fact that the Affordable Care Act includes tax credits to cover the cost of health insurance. After you factor in tax credits, premiums will go down on average.

JEFFREY BROWN: All right, we will go through some of the details.

But first I want to ask Avik Roy the same question. The general proposition, what do you see?

AVIK ROY, The Manhattan Institute: So, I agree with most of John’s framework.

I would say that it’s important to understand that in the small group market and the large group market, you are still going to see insurance rates go up because insurance rates just go up every year with health care inflation, something that unfortunately the Affordable Care Act doesn’t do that much to dent.

In the individual market, he’s right that certain states will do OK because they are highly regulated already. They are regulated much the way the Affordable Care Act regulates the entire country.

But in unregulated or lightly regulated states, such as California, where today an individual who is say 40 years old can buy an insurance plan that is reasonably good for say $94 a year, they’re going to see substantial increases.

And the subsidies won’t offset increases for everyone. So, there will be a certain slice of low-income individuals who will benefit, but there’s — the majority will not.

Even if you get a partial subsidy, your rates will still go up. And if you’re not eligible for a subsidy, you get hit twice, because not only does your insurance rate goes up, but you are paying the taxes to fund subsidies that go to other people.

JEFFREY BROWN: Jonathan Gruber, respond to that. So, it’s different as opposed to what you were starting to talk about, the difference within different states.

JONATHAN GRUBER: Yes, it’s different in different states.

Look, the idea of insurance is that the healthy contribute more than they expect to get at the end of the year. The sick collect more than they contributed. And over time we are all both healthy and sick so it all evens out.

The problem is you can’t get insurance to work that way in the private market, because if you just leave the private market alone, what happens is insurance companies don’t want the sick guys, right? They’re not going to make money on them. They just want the healthy guys.

So, what they do in states like California and other states is they exclude the sick from coverage, and the healthy get very skimpy coverage. So, for instance, the $94 plan that Avik mentioned is not good coverage. It’s a plan with maybe a $10,000 deductible. These are really — or a plan which caps the benefits you can get.

What happens is states that are not regulated end up with insurance where the sick can’t get it and healthy get very skimpy plans. The result of the law will be the sick and healthy will pay same price. Plans will be more generous.

We both agree some are going to pay more. I think it’s a minority of people. By my estimates, after you factor in tax credits, about a third of those currently buying in the individual market will pay more, and about two-thirds will pay less.

JEFFREY BROWN: Avik Roy, first, I want to clarify. You said $94 a month, I think, as opposed to a year?

AVIK ROY: Ninety-four dollars a month, and that’s for a 44-year-old individual, single and childless.

JEFFREY BROWN: Let me ask you about that impact of tax credits that Jonathan Gruber was talking about. Doesn’t that offset — or to what degree does it offset any rise in premiums?

AVIK ROY: Yes, so two actuaries looked into this in the magazine “Contingencies,” which is published by the American Academy of Actuaries.

And they estimated that if you are between 20 and 30 years of age, 80 percent of people, even despite the impact of subsidies, will see increases. And for people who are 30 to 40, it’s about 30 to 40 percent of people will still see increases, despite subsidies.

So, the subsidies will have impacts for some people, but other people will see substantial rises. And here is the thing.

Jonathan had this framework where he said, well, the deal with insurance is that healthy people pay more, so that sick people can pay less. That’s one way to think of insurance.

Another way to think of insurance is the way we think of car insurance or auto insurance, which is I want to be protected. I want to protect myself if I get into a collision or my car gets stolen, but I don’t want to subsidize — I don’t want my rates to go higher because there are drunk drivers running around who are crashing their cars all the time.

So, if insurance is a bad deal for me, I have more of an incentive to drop out of the market, despite the individual mandate and some of the other factors in the law that try to dragoon people in, even though they’re being forced to subsidize people where they don’t actually benefit from the amount they’re spending on their health insurance.

JEFFREY BROWN: Well, Jonathan Gruber, feel free to respond to that, but I do want to clarify to both of you just so the audience understands, the population that we’re talking about in all of this, right? Do we agree on that, the size of the population and who is affected?


I mean, the population is — first of all, it’s those who buy individual insurance now who’s really affected. That is currently about 7 percent of the U.S. population.

Second of all — of the non-elderly population — second of all it’s the young healthy group, individuals who are not poor, which is about a third of that group.

So, we’re talking about something like maybe 2.5 percent of people in the U.S. might see rates go up, something on the order of that.

AVIK ROY: I would add something.


AVIK ROY: … which is that, if you look at the Congressional Budget Office’s estimates and you add up all the people that the Congressional Budget Office projects will be shopping for insurance on their own, either through the ACA exchanges or through other means, it adds up to about 77 million people by 2016.

So it is a substantial number of people, because it’s not just the people who buy insurance today on the individual market. It’s the people who are uninsured who should be buying insurance on the individual market, but don’t, either because they think it’s a raw deal for them or because they can’t afford it or for some other reason.

JEFFREY BROWN: And, Jonathan Gruber, now that we’re getting close, things are starting to kick in and we are getting closer to fuller implementation, what are the key uncertainties here as we try to figure out what’s going to happen? What are you looking for?

JONATHAN GRUBER: Well, I think there’s really two big sources of uncertainty.

The biggest source of uncertainty is this issue of the Medicaid expansions. State policy-makers are making absolutely short-sighted, really there’s no other word but stupid decisions not to expand their state Medicaid programs, despite the fact it’s federally financed, leaving millions of Americans without health insurance coverage, and adding confusion in implementation, because if I go to an exchange tomorrow or in January and my income is 99 percent of the poverty line, they say, sorry, you’re out of luck if you’re in Texas or Florida, because there’s no Medicaid.

But if I’m 101 percent of the poverty line, I get great subsidies. I think that uncertainty, it’s going to be a problem.

The second source of uncertainty is people not really understanding the laws in place, understanding the benefits of the law. The misinformation that is being passed out is going to confuse people.

And unless people understand what the law could do for them, they might not sign up and that might limit the benefits of the law.

JEFFREY BROWN: And, Avik Roy, same question to you. What uncertainties do you see?

AVIK ROY: I would say that the biggest uncertainty is whether or not healthy and young people will sign up for insurance under the ACA exchanges.

And I think that is why you heard the president give that speech today. It wasn’t really so much for political reasons. It was because if young and healthy people don’t sign up for the exchanges, you will have a result that is a lot like the New York insurance market of today, where insurance cost $800, $900 a month for people. It’s unaffordable, because young and healthy people drop out of the market.

So, there’s a lot of concern I think among the administration and its officials that young and healthy people will see this as a raw deal — and I think correctly — and not sign up for the cross-subsidy, where they are spending a lot more for insurance to subsidize other people, where the money doesn’t benefit directly.

JEFFREY BROWN: Jonathan Gruber, just the last word on that one, on that specifically, on the young people, healthy people?

JONATHAN GRUBER: I think Avik is exactly right.

It’s critical that the young and healthy sign up. I think they will because there’s going to be low-cost insurance products available and many of them will get tax credits.

JEFFREY BROWN: All right, Jonathan Gruber and Avik Roy, thank you both very much.

AVIK ROY: Pleasure.


Speaking Out for Health Care Act, Obama Says Millions Will Get Rebates

Doug Mills/The New York Times

Obama Defends Affordable Care Act: At a White House event, President Obama spoke about how his health care law is saving Americans money.

Source Link:  http://www.nytimes.com/2013/07/19/us/politics/speaking-out-for-health-care-act-obama-says-millions-will-get-rebates.html?partner=rss&emc=rss&_r=1&

Published: July 18, 2013

WASHINGTON — President Obama, slipping back into his episodic role as a vigorous campaigner for his new health care act, said Thursday that thanks to the law, more than 8.5 million Americans are getting rebates this summer from their insurance providers.

Mr. Obama was joined by families who have benefited from a provision in the law, which requires health insurers to spend at least 80 percent of the revenue from premiums on medical care rather than on administrative costs. Insurers who fail to meet that benchmark must reimburse customers, a process that began in 2012.

“Last year, millions of Americans opened letters from their insurance companies, but instead of the usual dread that comes with getting a bill, they were pleasantly surprised with a check,” Mr. Obama said in a midday ceremony at the White House.

The checks typically amount to no more than a few hundred dollars. But the president, recounting the stories of middle-class families arrayed on the stage behind him, celebrated these modest windfalls as an early sign of the tangible benefits of the law.

For Mr. Obama, it was a high-profile return to a debate in which his voice has sometimes seemed absent. For example, he has said nothing publicly about the administration’s decision to delay for a year a part of the law dealing with employer-provided insurance.

With the Republican-controlled House of Representatives voting yet again this week to repeal the Affordable Care Act, however, he seized on new statistics that demonstrate the law is driving down premiums in New York, California and several other states.

The Department of Health and Human Services released a report Thursday asserting that in 11 states and the District of Columbia, proposed health insurance premiums for 2014 were nearly 20 percent lower than the administration had projected.

“Today’s report shows that the Affordable Care Act is working to increase transparency and competition among health insurance plans and drive premiums down,” Kathleen Sebelius, the secretary of health and human services, said in a statement.

In New York, state insurance regulators said they had approved rates for 2014 that were an average of at least 50 percent lower than those now available. Administration officials attribute much of that decline to online purchasing exchanges, set up by the law, which they say encourage more competition among insurance providers.

Thursday’s choreographed event in the East Room was intended to put the White House back on the offensive on health care, after a messy period following its decision to delay requiring employers with more than 50 employees to offer health insurance, or pay a penalty.

The delay came after heavy pressure from businesses, which said the law was too complex and cumbersome to implement on time, and it provided critics with fresh ammunition for their claim that the law is putting unfair burdens on individuals and employers.

Republicans did not let up on Thursday, claiming that the benefits extolled by Mr. Obama would be more than offset by higher costs. In some cases, they did not even wait for him to speak.

“Even though we expect the president today to tout about $500 million of these types of refunds, what he won’t say is that next year, Obamacare will impose a new sales tax on the purchase of health insurance that will cost Americans about $8 billion,” said the Senate Republican leader, Mitch McConnell of Kentucky. “That’s a 16 to 1 ratio!”

In a statement after Mr. Obama spoke, Speaker John A. Boehner said: “The picture the president paints of his health care law looks nothing like the reality facing struggling American families. They know that the law is turning out to be a train wreck.”

Mr. Obama dismissed these arguments as political gamesmanship in Washington, belied by the statistics from the states. As for the House’s latest vote to repeal the act, he said Republicans were “refighting old battles” rather than confronting the nation’s problems.

“I recognize that there are still a lot of folks — in this town at least — who are rooting for this law to fail,” he said. “Some of them seem to think that this law is about me. It’s not. I already have really good health care.”

<img src=”http://meter-svc.nytimes.com/meter.gif”/> Source Link:  http://www.nytimes.com/2013/07/19/us/politics/speaking-out-for-health-care-act-obama-says-millions-will-get-rebates.html?partner=rss&emc=rss&_r=1&

A version of this article appeared in print on July 19, 2013, on page A14 of the New York edition with the headline: Speaking Out for Health Care Act, Obama Says Millions Will Get Rebates.

Obamacare pilot project lowers Medicare costs

By: Brett Norman
July 17, 2013 05:00 AM EDT

Source Link:  http://dyn.politico.com/printstory.cfm?uuid=81086AEB-BC65-4936-8901-F1E34EB14854

An ambitious program under the health law to change how care is paid for lost nearly a third of its participants after the first year, but not before all were able to boost the quality of care provided to patients in an experiment that some experts say holds promise to bring down health care costs in the long run.

The Centers for Medicare & Medicaid Services announced Tuesday that all 32 health care organizations had hit performance benchmarks for improving care in the Pioneer Accountable Care Organization program, and 13 had done so while substantially lowering Medicare costs. In part, that was by reducing hospitalization and rehospitalizations, CMS reported.

By health care standards, the savings claimed were relatively modest — $87.6 million in 2012. And two participants reported increasing costs by $4 million. Overall, for the 669,000 Medicare enrollees in the program, costs rose by just 0.3 percent compared with 0.8 percent for typical Medicare patients.

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“These results show that successful Pioneer ACOs have reduced costs for Medicare and improved the quality of care for their patients,” CMS Administrator Marilyn Tavenner said in a statement. “The Affordable Care Act has given us a wide range of tools to realign payment incentives in Medicare and Medicaid, and these efforts are already paying off.”

Mark McClellan, former CMS administrator under President George W. Bush and a leading accountable care expert, said the first-year performance is in line with similar undertakings in the private sector. Quality improvements typically precede savings because they can be accomplished more quickly while the savings sometime lag.

“Improving diabetes care now, you see benefits 18 months, 24 months down the road,” said McClellan, now at The Brookings Institution.

“This is a difficult journey,” he said. “It’s a marathon not a sprint, and some organizations are in a better position to do it faster, and others slower.”

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The Pioneer ACO program is among the health care law’s most aggressive experiments in improving care and cutting costs. Networks of doctors coordinate care for patients and share in both the savings they generate and — eventually — the risk of losses.

The Medicare Shared Savings Program is a risk-free version of the accountable care effort, but the share of the savings for the health care organization is also substantially smaller. Seven of the Pioneer ACOs are transitioning to that option this year, and two are opting out of the health law’s ACO programs altogether, although they may adapt their ACO investments for contracts with private insurers, Blair Childs, senior vice president for Premier healthcare alliance, said.

Presbyterian Healthcare Services in New Mexico is one of two Pioneers to drop out of the ACO program completely. The integrated health system, which also has a large health plan, faced two major challenges, according to Todd Sandman, its vice president for strategy and customer engagement. Part of the problem centered on using retrospective data, and part was that New Mexico is a “low-cost, low-reimbursement, low-health care utilization state” — putting it at a disadvantage to perform better than other Medicare providers, Sandman said.

“Frankly, what was hard for us getting out is we really do believe this is the right direction for health care providers,” Sandman said, describing the relationship with CMS as “very collaborative.”

More than 200 health care organizations are participating in the shared-savings program in addition to the Pioneer ACOs, and private insurers are employing the concept as well.

It’s one of several ideas, including bundled payments and medical homes, that are all likely to be part of reorganizing the payment model toward paying for quality, not volume, of care, McClellan said.

CMS should strike “the right balance between incentives and encouragement for change and getting participation in the program,” McClellan said. But the agency shouldn’t back off of rigorous goals — it “should continue to think of [the Pioneer ACO] program as pushing the envelope.”

Some participants had threatened to leave the program this spring over what they said was an overly ambitious set of 33 quality measures. CMS did not make the adjustments they sought. Health systems also have complained that the agency has not been fast enough in providing Medicare claims data that would help them keep track of whether their patients were filling needed prescriptions, for instance, or following up on referrals to specialists.

Jason Millman contributed to this report.


Consumer groups monitor Affordable Care Act hiring in California

Monday, July 15, 2013

SACRAMENTO, Calif. (KGO) — Consumer groups are worried about possible fraud or identity theft as California ramps up hiring for the new Affordable Care Act.

About 21,000 people are being hired to enroll Californians in the new Covered California program.

Just as the state begins implementing the federal Affordable Care Act to some 5 million uninsured Californians, Insurance Commissioner Dave Jones says not enough is being done to prevent fraud.

The Health Benefits Exchange, now known as Covered California, will start sending out thousands of enrollment counselors throughout the state in September. They will be asking for people’s personal information –like social security numbers — to sign them up for coverage.

“They can use that to perpetuate identity theft. They can also worm into your confidence and trust and sell you other insurance products and we’ve seen this time and time again where consumers get ripped off,” said Jones.

While enrollment agents will be fingerprinted and background checked, Jones would like to see them regulated like insurance brokers and agents where the bar is higher.

Covered California insists consumer information will be protected.

“We’re going beyond fingerprinting and background checking. I mean, there’ll be field monitors out there to make sure that the people who are taking this information are doing so in an appropriate manner,” said Covered California Spokesman Dana Howard.

Enrollment counselors will play a critical role in signing up traditionally hard-to-reach populations. Some criminal records for minor non-financial offenses maybe overlooked on applications because of their specific connections to neighborhoods.

“We also don’t want to preclude people who have paid their debt to society, who maybe are living and working in the communities now; who, you know, now finally have a chance to really redeem themselves and help their communities get covered,” said Vanessa Cajina of the Western Center on Law and Poverty.

The Health Benefits Exchange is paying more than 3,000 community organizations about $58 for each successful enrollment in the Affordable Care Act.

Training for enrollment agents begins next month.

(Copyright ©2013 KGO-TV/DT. All Rights Reserved.)


Article Link: http://abclocal.go.com/kgo/story?section=news/politics&id=9173551


California’s Obamacare Grants Will Help State Get The Word Out About Health Care Changes

Los Angeles Daily News  |  By Barbara Jones Posted: 07/11/2013 4:21 pm EDT

Funded by $37 million in state grants, four dozen diverse groups from around California — including labor unions, civil-rights advocates, medical clinics and the Los Angeles Unified School District — are preparing to launch education programs promoting Obamacare, the national health-care plan set to take effect in January.

The 48 recipients were selected from about 200 that applied for the grants, chosen for their access and ability to reach the estimated 5.3 million Californians in underserved communities who will be eligible for the subsidized or guaranteed health coverage.

“These organizations are well-established and well- known and trusted in their communities,” said Larry Hicks, a spokesman for Covered California, the state agency established to oversee a marketplace of insurance carriers. “They’ll take a more personal approach in explaining the programs and offerings through our health-insurance exchange.”

Covered California has tentatively chosen 13 commercial health plans to offer guaranteed coverage under the federal Affordable Care Act, commonly known as Obamacare. With enrollment opening Oct. 1, the agency hopes to get the outreach efforts started in the next few weeks.

“We’re taking a very targeted approach,” Hicks said. “We looked at characteristics like ethnicity, language, region and age, then partnered with organizations to reach out to those demographics.”

Cal State L.A. received $1.25 million to reach out to students at all CSU campuses, while the University of California got $1 million for its statewide campaign.

Of the $37 million total, groups serving metropolitan Los Angeles received almost $16 million. That includes the Los Angeles County Federation of Labor, which was awarded $1 million for an campaign that will extend to San Bernardino and Orange counties, and the Actors Fund, which got $435,000 to communicate with its members.

Loma Linda University Medical Center was awarded $990,000, while the San Bernardino Employment and Training Agency got $750,000. Ventura County Public Health received $700,000 to reach out to local Latino residents.

With its grant of $250,000, the nonprofit Valley Community Clinic in North Hollywood will take its message to farmers markets and athletic fields — places where working-class families often congregate — as well as state employment offices and its own waiting rooms.

“People need to know they can get coverage for themselves and for their families,” said Olga Duran, the clinic’s director of patient services. “They can have ongoing coverage with preventative care — not just acute care at an emergency room. We can get up close and personal to guide them through the process … help get them an understanding of the world they’re entering into and to facilitate that process.”

Covered California is finalizing its contract with Los Angeles Unified, which has been tapped to receive $990,000 to connect with students and families in the nation’s second-largest school district.

Dr. Kimberly Uyeda, LAUSD’s director of Student Medical Services, said information will be presented to students in the adult-ed division, which offers English-language, high school equivalency and vocational-training classes.

In addition, younger students who belong to after-school clubs with a health or medical focus will be trained and asked to convey information about the insurance-plan options to their families.

The grant money will help pay the salaries of district employees who are already working to coordinate health and social services for students. “We’ll be pulling from well-trained and skilled staff members who can really do this outreach plan,” Uyeda said.

Conservative bloggers have blasted LAUSD’s plan to use students as “messengers” for President Obama’s health-care reforms, but Uyeda insisted that any participation will be voluntary. “This is never going to be part of the curriculum or regular education,” she said. “It would never be mandatory.”

Hicks said Covered California will closely monitor the groups to ensure they’re spending the money appropriately and meeting their goals. Under guidelines for the grants, those receiving $750,000 must make contact with at least 99,000 people. A $1 million award raises that target to 132,450 people.

Covered California also plans to advertise its insurance exchange in television and radio commercials beginning later this summer, with detailed information available on its website, coveredca.com. ___

(c)2013 the Daily News (Los Angeles)

Visit the Daily News (Los Angeles) at www.dailynews.com

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Source Link:  http://www.huffingtonpost.com/2013/07/12/california-obamacare-grants_n_3580525.html?ncid=edlinkusaolp00000003

It’s not just the employer mandate: Three Obamacare delays you haven’t heard about

By Sarah Kliff, Published: July 8 at 9:52 amE-mail the writer

For many Americans, July 5 was a great day to relax, sleep off a hangover and take in a long weekend.

For the Obama administration, it was the perfect moment to release a 606-page final regulation on some of the health-care law’s most key provisions. Mostly, the rule spelled out in no short detail how the Medicaid expansion and health insurance marketplaces will work. It also included a number of delays that, up until Friday, had not been made public. The word “delay” turns up 45 times in the document.

So, what’s on hold? Here’s a quick summary of what the Obama administration is holding off on.

1. State-run marketplaces will not have to verify consumers’ claims that they do not receive health insurance from their employer. As Sandhya Somashekhar and I reported Friday, the health law relies partially on the federal government knowing who receives employer-sponsored insurance and who does not. Anyone who receives an affordable offer of health insurance from their employer (less than 9.5 percent of their income) does not qualify for a federal tax credit.

Initially, the federal government had told the 17 state-based marketplaces that it could handle the heavy lifting of monitoring claims by applicants that they did not receive employer-sponsored insurance. But after encountering “legislative and operational barriers,” the federal government has decided it does not have the manpower. Moreover, it will not require the states running their own marketplaces to do this check until 2015.

The upshot of this delay is that you could see some people who shouldn’t qualify for tax subsidies, because of their employer-sponsored insurance, getting them anyway. This wouldn’t be unprecedented: During the initial roll out of Medicare Part D, some seniors who should not have received low-income subsidies got them anyway.

2. The federal government will scale back oversight of what applicants say they earn. Knowing an applicant’s salary is crucial for the Affordable Care Act: Their income determines what kind of tax subsidy they receive, if they get any assistance at all.

In preliminary rules, the Center for Medicare and Medicaid Services had proposed a system where they would request more income verification data anyone who reported an income that was 10 percent lower than what federal data said they earned in the previous year. It might turn out, the discrepancy was warranted, if the applicant lost their job, for example. Or, it could also be an attempt to game the system, using a lower income to qualify for higher tax credits.

The federal government has since decided to scale back these requirements, and, in 2014, only double-check a statistically significant number of these people with large income discrepancies, rather than the entire group. Unlike the delay on employer insurance verification, this provision effects all 50 states.

This delay has lead to some speculation that consumers, in states that don’t expand Medicaid, could overreport their income in order to qualify for federal tax subsidies. This is an area I don’t yet feel versed enough to comment on (but plan to get there soon), so would suggest reading these blog posts from Avik Roy and Harold Pollack. One factor to keep in mind: The federal government does have the power to recoup tax subsidies that are too big for an individual’s given income.

3. Electronic notices for Medicaid will not be required until 2015. “We recognize that states are at different places in the development of their eligibility and enrollment systems,” CMS stated in the Friday regulation. “Technology needs to be in place to offer beneficiaries and applicants the option to receive notices electronically.” Out of concern that the technology won’t be in place, the federal government will give state Medicaid programs until 2015 to roll out electronic notices. These would include notices of what tax subsidy, for example, an individual applicant is eligible to receive.

Source Link:  http://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/08/its-not-just-the-employer-mandate-three-obamacare-delays-you-havent-heard-about/

Enrollment in Health Insurance Exchanges to Open October 1

Government News 

July 09, 2013

By Mark Moran

Beginning October 1, patients can enroll in the new Health Insurance Exchanges established by the Affordable Care Act.

Clinicians are urged to alert their patients to this important approaching date, to make them aware of this new option for health insurance coverage, and to discuss with them the possible benefits associated with this new way of accessing insurance coverage for medical care. Health insurance exchange plans offer the full range of benefits—including for psychiatric care—with no exclusions for preexisting conditions and no lifetime limits on benefit amounts.

Clinicians should note that some patients may require help in creating an account, applying for a plan, and maximizing their benefits and their cost savings.

Importantly, many low-income patients may qualify for cost savings and subsidies.

The health insurance exchanges, also known as the “marketplace,” simplify the search for health coverage by gathering together in one place all the options available within a geographic area. With one application, patients can compare plans based on price, benefits, quality, and other features important to their medical needs. Patients, families, and clinicians can also get help online, by phone, by chat, or in person.

Information about prices and benefits is written in simple language, and individuals will get a clear picture of the premiums as well as the benefits and protections to which they are entitled before enrolling.

However, health exchanges vary from state to state in how well developed they are, and some states are choosing not to participate. Some states are well into the process with established Web sites, while many others have nothing posted yet. Patients and clinicians can sign up for updates so they can be alerted for changes as state exchanges evolve.

The Centers for Medicare and Medicaid Services has established an online resource that provides individuals all the information they will need to get started at https://www.healthcare.gov/marketplace/individual. Psychiatrists and patients can find information on the plans and assistance available in their state at https://www.healthcare.gov/what-is-the-marketplace-in-my-state.


Article Link: http://psychnews.psychiatryonline.org/newsarticle.aspx?articleID=1710764

Feds relax health law income, insurance status rule for exchanges

July 08, 2013 | Crain’s Chicago Business


(Reuters) — Days after delaying health insurance requirements for employers, the Obama administration has decided to roll back requirements for new state online insurance marketplaces to verify the income and health coverage status of people who apply for subsidized coverage.

President Barack Obama’s healthcare reform law is slated to begin offering health coverage through state marketplaces, or exchanges, beginning Oct. 1. But to receive tax subsidies to help buy insurance, enrollees must have incomes ranging from 100 percent to 400 percent of the federal poverty line and not have access to affordable insurance through an employer.

Until now, the administration had proposed that exchanges verify whether new applicants receive employer-sponsored insurance benefits through random checks. It also sought to require marketplaces to verify each enrollee’s income status.

But final regulations released quietly on Friday by the Department of Health and Human Services (HHS) give 16 states and the District of Columbia, which are setting up their own exchanges, until 2015 to begin random sampling of enrollees’ employer-insurance status. The rules also allow only random – rather than comprehensive – checks on income eligibility in 2014.

The changes, which point to new technical and bureaucratic challenges at the state and federal levels, raise new questions about the how successfully Obama’s Patient Protection and Affordable Care Act will be implemented. The law is scheduled to go into effect on Jan. 1. But the administration’s latest move acknowledges that exchanges need extra time to get their verification systems in place.

Less than a week ago, the administration also announced that it would not require employers with 50 workers or more to provide insurance benefits until 2015, a one-year delay that stirred speculation about the possibility of further delays.

The regulations, contained in a 606-page HHS rule, allowed state-run exchanges to accept an enrollee’s “attestation regarding enrollment in an eligible employer-sponsored plan.” Marketplaces to be operated by the federal government in 34 states will still make random checks to verify applicant insurance status in 2014, it said.

“For income verification, for the first year of operations, we are providing (state and federal) exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification,” the rule said.

Article Link: http://www.chicagobusiness.com/article/20130708/NEWS03/130709895/feds-relax-health-law-income-insurance-status-rule-for-exchanges

Austerity takes a toll – To recover, preserve safety net programs

To recover, we need to preserve safety net programs, book co-author says

By Modern Healthcare

Posted: July 6, 2013 – 12:01 am ET

Tags: Economy, International, Policy, Public Health, Regular Feature, Research

National economic policies that impose harsh cuts on social programs, especially healthcare safety nets, can be lethal, literally. That’s the argument made by David Stuckler, a senior research leader at Oxford University, and Dr. Sanjay Basu, a Stanford University epidemiologist, in their recent book, The Body Economic: Why Austerity Kills. Their treatise is data-driven, and some of the facts they present indicate just how deadly an austere approach to dealing with an economic downturn can be. In Greece, for example, where the government has made massive spending cuts, HIV infection rates skyrocketed, suicides rose significantly and there was even an outbreak of malaria.

John D. Thomas, Modern Healthcare’s chief of editorial operations, spoke with Basu about the role of political ideology in these situations, the authors’ call for the creation of an Office of Health Responsibility and how to stop a recession from becoming an epidemic. Here is an edited excerpt:

Modern Healthcare: The International Monetary Fund, which plays a substantial role in your book, is continuing to admit that its austerity plans may have hurt more than helped in places like Greece. How does that admission make you feel and, more importantly, what should that spur the IMF to do moving forward?

Dr. Sanjay Basu: Indeed, the IMF has reversed course quite a bit not only in Greece, but in the past during the Asian crisis we saw the same thing with the IMF initially recommending austerity and then came out and gave a formal apology because the austerity created both a worse economic outcome and a worse public health outcome. From a public health perspective, what we really need to do right now is preserve safety nets for people. We have had a massive natural experiment where different countries have gone through the same recession but either underwent austerity or stimulus, and the austerity countries have done very badly in terms of public health. But there is some room for hope in preserving safety nets right now, and people are very vulnerable.

MH: How much would you say this entire story is about the weak and the powerless not having the political clout to defy these austerity measures, which are often based on political and economic ideology?

Basu: It’s a profound and sad recurring theme in the policy’s experiment. The fact of the matter is that everyone agrees the banking system and bank-based decisions created the current recession. And yet, public budgets, particularly those that support the weakest and most vulnerable, are being cut in the name of having bailed out the banks and also in being able to really try to reduce short-term deficits, although it doesn’t seem to work over the longer term.

MH: Some of your book actually sounds a bit naïve in that you argue that politics should not be ideological, but driven by data. Is a shift like this really feasible?

Basu: I think many times in history we encounter really remarkable ideologies that seem to fly in the face of data. And my responsibility as an academic is to put the peer-reviewed data out there and hope for the best in the sense that I believe strongly in democracy and informed democracy. And we do see change in the face of data even despite some pretty remarkable politics, and U.S. history is fairly optimistic in that regard.

MH: Similarly, you argue that preventive medicine pays off in the long run economically, but people have known that in this country for years and it is still not a priority.

Basu: It took a very long time for us to get even the Affordable Care Act, and we will see how well it does as it is implemented in the coming years. But certainly, while progress is slow, I do see that we have made great strides in healthcare, and the quality improvement movement has done quite a bit to make our hospitals safer. Our public health movement has done quite a bit in order to improve our continuingly improving food supply, and I do feel like we are making some progress in these regards.

MH: Your book is calling for a nonpartisan Office of Health Responsibility to analyze the impacts on public health of economic policies. What kind of responses are you getting from officials in D.C. about this initiative?

Basu: A couple of countries have implemented this, and there certainly are folks who are interested in the same kind of things here. We started a Consumer Protection Bureau in order to understand how various products are safe or unsafe for us, which is one of the reasons we have seat belts in our cars now.

Similarly, Iceland looks at how its various fiscal and economic policies affect public health. We want economic growth because ultimately it will lead to better livelihoods a lot of the time, but we don’t want to pursue economic growth at any cost—that compromises the quality of our cities and our family lives and our own health. So we need to kind of recalibrate and realize what the means are and what the end is in terms of the public health discourse.

MH: The 2009 American Recovery and Reinvestment Act is running out. What are the ramifications if the government doesn’t reverse that trend?

Basu: It is a little too early for us to know what the impact is of the sequester, for example, or the end of the stimulus at this point. But in terms of the public health data, we already see another natural experiment taking place between states that have responded by using the stimulus to really help bolster social safety nets and those that haven’t.

And so we see the states that have really bolstered their safety net experience have much better public health outcomes already. I would expect that to continue unless we reverse course in terms of our austerity experiment.

MH: You write that “just a few key decisions … can stop a recession from turning into an epidemic.” What are the most important of those key decisions?

Basu: I think the first one is to be careful when experimenting with people, and the reason I say that is, austerity—especially in Europe—has been basically a massive experiment in a sense and one that’s failed. And, as a physician, I have the mantra “first do no harm,” so when massively adjusting budget cuts through indiscriminant cutting, which is what austerity is, you are really playing with people’s lives, and we have to be much more cautious about that. But there is also very good peer-reviewed evidence about which programs seem to work really well to protect health during hard times and even have economic stimulus side effects or cost savings. For example, active labor market programs, which are a group of programs that help people get back to work relatively quickly by working with both the newly unemployed and their former employers seemed to, as a side effect, reduce alcoholism, suicides and a number of other public health bad outcomes.

MH: What are your thoughts on the limited federal funding available to promote the aspects of the healthcare reform law that increase access to healthcare?

Basu: It is remarkable, and the politics of this are certainly very clear. I think there is quite a separation between those who study healthcare and what actually gets implemented, and there are so many of my colleagues working very hard to try to improve the manner in which things are budgeted. I am hopeful that being more open about this process and revealing to folks what’s really going on is going to help get a little bit more sensible in budgeting.
Read more: Austertity takes toll on public health, book co-author says | Modern Healthcare http://www.modernhealthcare.com/article/20130706/MAGAZINE/307069972#ixzz2YTzk3aDC

HHS Launches Health Insurance Exchange Campaign: Educational Efforts Aim to Help Enroll

Revamped website, call center and other educational efforts aim to help enroll 7 million people in state HIEs within six months.



Ken Terry
| June 25, 2013 12:15 PM


In an effort to get the word out to individuals and small businesses that will be eligible to buy health insurance through the new state health insurance exchanges starting in October, the Department of Health and Human Services (HHS) has launched a health reform outreach campaign that includes a 24-hour call center with a toll-free number and a revamped Healthcare.gov website.

Between October and March, HHS hopes to enroll 7 million people in the health plans that will compete for business in the state insurance exchanges. By 2022, the number of enrollees is expected to swell to 24 million, according to the Congressional Budget Office.

If the insurance exchanges meet the projection for this year, noted Kaiser Health News, it would be the biggest open enrollment season in the history of health insurance. But to get there, HHS and its partners will have to overcome widespread ignorance among the uninsured about the state insurance exchanges.

To help address these challenges, HHS has transformed Healthcare.gov into an educational site that provides general information about the insurance exchanges and the Affordable Care Act. Starting October 1, eligible individuals and firms with up to 100 employees will be able to purchase insurance, in whatever state they live or do business, through Healthcare.gov.

According to a news release, “Key features of the website, based on consumer research and online commercial best practices, include integration of social media, sharable content and engagement destinations for consumers to get more information. The site will also launch with Web chat functionality to support additional consumer inquiries.”

The website is designed so that consumers can access it from mobile devices as well as desktops and laptops. In addition, HHS is providing an application programming interface (API) so that developers can insert some of the site’s contents in their own applications.

Meanwhile, an equally big health IT story is playing out behind the scenes. The Centers for Medicare and Medicaid Services (CMS) — a unit of HHS — and some states are scrambling to assemble the health IT infrastructure that will be needed when the exchanges open for business on October 1. In 34 states, the feds are building the exchanges because the states either declined to participate or agreed to help CMS carry out only some of the exchange operations. Among these functions, a new GAO report says, are eligibility and enrollment, plan management, and consumer assistance.

At the center of this huge enterprise will be a CMS data hub. “To support consumer-eligibility determinations, for example, CMS is developing a data hub that will provide electronic, near real-time access to federal data, as well as provide access to state and third-party data sources needed to verify consumer-eligibility information,” GAO noted. “While CMS has met project schedules, several critical tasks, such as final testing with federal and state partners, remain to be completed.”

The report further describes the work that has been done on this data hub, including external testing of the link between CMS and the Internal Revenue Service. Information from the IRS and other sources will determine whether people buying insurance on the state exchanges are eligible for federal subsidies.

Explaining how this will work, GAO says, “CMS has also begun to test capabilities to establish connection and exchange data with other federal agencies and the state agencies that provide information needed to determine applicants’ eligibility to enroll in a QHP [qualified health plan] or for income-based financial subsidies, such as advance premium tax credits and cost-sharing assistance, Medicaid or CHIP.”

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Article Link: http://www.informationweek.com/healthcare/policy/hhs-launches-health-insurance-exchange-c/240157268