Gov. Beshear: 413,000 sign up for health care in Ky.

Source Link:  http://www.whas11.com/news/local/Beshear-413000-sign-up-for-health-care-in-Ky-256208631.html

by Joe Arnold

WHAS11.com

Posted on April 22, 2014 at 1:40 PM

 

FRANKFORT, Ky. (WHAS11) — Governor Steve Beshear could hardly wait to reveal Kynect’s new totals, directing a large sign in a Capitol meeting room be turned to show the figure, 413,000 Kentuckians– about ten percent of the state’s population–have signed up for health insurance through the state exchange.

“From the beginning, I knew that Kynect would change the course of Kentucky’s history by helping hundreds of thousands of Kentucky families,” Beshear said.

Even after the federal government’s more generous introductory reimbursement rate expires in three years, Beshear says a healthier Kentucky will translate into a more prosperous Kentucky and a net positive for the state budget.

Beshear said a Price Waterhouse Cooper study projected 17,000 jobs and a $15 billion economic impact of Beshear’s embracing of the Affordable Care Act.

“Overall, this will end up from a budget standpoint as a plus over the next eight years and not a minus,” Beshear said.

“This is working,” Beshear said.  “That’s the bottom line. It’s working. We started out with 640,000 uninsured Kentuckians. It’s estimated that 75 percent of these 413,000 never had insurance before.”

David Adams, the Tea Party activist suing Beshear to stop the state based exchange, said the administration is inflating the Kynect numbers by including pending application in its enrollment totals.

“In America, we have been wildly overestimating the number of uninsured for a long time,” Adams said.

According to the state’s numbers, 330,615 Kentuckians, about 80 percent of the 413,410 new enrollees, qualify for Medicaid.

It appears that Kynect has fallen far short of projections of those who would buy private health insurance on the exchange.

According to the U.S. Centers for Medicaid and Medicare Services, Kentucky’s share of President Obama’s goal of 7 million people signing up for private health insurance through government exchanges is 220,000 people.

But, the governor’s office says 82,795 people have purchased private insurance on Kynect, or about 37 percent of that target.

The Cabinet for Health and Family Services said the numbers don’t reflect people who bought insurance outside of Kentucky’s exchange.

“We do not have the numbers of all the people that did not belong to Kynect but went directly to their health insurance company,” Audrey Tayse Haynes, the Secretary of the Cabinet for Health and Family Services, said.

 

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UPDATE 1-When Zach met Barack: pitching Obamacare online

Tue Mar 11, 2014 5:22pm EDT

(Adds White House comment, latest enrollment figures)

By Mark Felsenthal

Source Link:  http://www.reuters.com/article/2014/03/11/usa-obama-health-idUSL2N0M81YC20140311

(Reuters) – President Barack Obama took his quest to sign young people up for health insurance to an edgy comedy website on Tuesday, where he traded insults with host Zach Galifianakis while plugging his signature Obamacare health program.

Obama sat for an interview on “Between Two Ferns with Zach Galifianakis,” on the Funny or Die website. The actor, who starred in “The Hangover” films, is known for his cringe-inducing banter on the program.

Obama got the chance to urge the youth of America to get health insurance, but not until he’d been subjected to questions like “What is it like to be the last black president?” and “What should be done about North Ikea?”

The administration is stepping up efforts to increase youth participation in Obamacare, also known as the Affordable Care Act.

Youth participation is crucial to the success of the program, but U.S. government data released on Tuesday showed that while the number of people enrolled in private insurance under Obamacare reached 4.2 million, the proportion of adults aged 18-34 remained unchanged from January at 25 percent of total enrollment in private Obamacare plans.

That is well below the 38 percent that administration officials have talked about achieving to give insurers a strong mix of healthier members, whose premium payments help offset the cost of older, sicker policy holders.

Obama’s crusade to draw in young people has had help from singers Lady Gaga and John Legend, as well as sports celebrities including former basketball star Magic Johnson.

While Galifianakis, who once told an interviewer “rudeness is hilarious,” may have seemed an odd match for the president, the White House was thrilled at his ability to deliver a big audience of young people.

“Very quickly, this video went, you know, viral,” White House spokesman Jay Carney said. The segment had already been viewed 3 million times, he added.

The Funny or Die website was the top source of referrals Tuesday to healthcare.gov, the Obamacare website, Carney said.

On “Between Two Ferns,” Galifianakis did not dial back his trademark style, calling Obama a nerd and asking him if he was going to put his presidential library in his “home country” of Kenya.

The president appeared to play along gamely and tried to match Galifianakis insult for insult. “When I heard that people actually watch this show, I was pretty surprised,” Obama said.

When the president was finally allowed to make his pitch about the benefits of signing up for health insurance, Galifianakis sighed, looked at his watch and said, “Is this what they mean by drones?” (Reporting By Mark Felsenthal; Editing by Nick Zieminski and Tom Brown)

You Might Pay A Lot More Than $95 For Skipping Health Insurance

March 12, 2014 3:41 AM

2014 is the first year most Americans will have to either have health insurance or face a tax penalty.

But most people who are aware of the penalty think it’s pretty small, at least for this first year. And that could turn into an expensive mistake.

“I’d say the vast majority of people I’ve dealt with really believe that the penalty is only $95, if they know about it at all,” says Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service. “And when people find out, they’re stunned. It’s much, much higher than they would expect.”

In fact, “the penalty is the maximum of either $95 or 1 percent of taxable income in 2014,” according to Linda Blumberg, a senior fellow at the Urban Institute’s Health Policy Center. “For people with higher incomes it can be much more sizable than $95.”

Blumberg says that even for people with more moderate incomes, it’s important to remember that the flat fee penalty will be assessed for every family member who lacks health coverage.

“So if it’s a two-adult household and both are uninsured, it’s twice $95; $190,” he says. “Then if there are any children in the family that are uninsured, the penalty for each of them is half of the $95.”

The flat fee penalty maxes out at $285 next year. To help people figure out what they might owe, the Tax Policy Center, jointly run by the Urban Institute and the Brookings Institution, just posted an online calculator. And Jackson Hewitt has its own “How much is my tax penalty?” worksheet.

Haile says it’s important to remember that even if most of the family has insurance, having just one uninsured member can trigger the penalty.

“If you’ve got someone who comes home to live it could cost you much more than a spare bedroom,” he says. “If you claim that child as a dependent, or could claim that child as a dependent, then you suddenly become liable for penalties if that child lacks minimum essential coverage.”

The 1 percent penalty, for those hit with that, also has a cap, but the penalty can still get pretty big. The cap is tied to the cost of the national average bronze level insurance plan. This year’s top penalty could be about $3,600 for an individual, and $11,000 for a family of four.

If you’re uninsured and earn enough to be potentially liable for penalties, you have to sign up for coverage by the end of this month in order to avoid them.

“Your only chance to buy insurance, unless you have a special qualifying event, is during this open enrollment period,” Haile says, “which makes March 31 an incredibly important date for avoiding the penalty. If you want to avoid the penalty, you need to get in and sign up for coverage now.”

That’s much different than how things were before the law’s implementation. But the Urban Institute’s Linda Blumberg says it’s due to the new rule that protects people with pre-existing health conditions.

“Now the insurance companies can’t say no, even if you’ve had serious health problems in the past, or have a serious health problem today. They can’t deny you,” she says. “And because of that, people are restricted to obtaining coverage during the open enrollment period or during some other open enrollment period where they’ve had a change in their family status or income.”

Indeed, changes to family status — a birth, divorce, or job change — will allow you to buy orchange your coverage outside the open enrollment period. And if you’re eligible for Medicaid or your kids are eligible for the Children’s Health Insurance Program, you can sign up anytime.

There are also lots of exemptions from the penalty itself, Blumberg points out, even for people who remain uninsured. The biggest is having income below the tax filing threshold.

This year that’s roughly $10,000 for a single person and $13,000 for a head of household. If you don’t have to file income taxes, you won’t have to pay a penalty. You also can get an exemption if the cheapest available insurance would cost more than 8 percent of your income, if you have unpaid medical debt, or for any of several other reasons listed on the HealthCare.gov website.

But for most people with incomes above the poverty line, time is running out to either get insurance or prepare to pay up instead.

U.S. lags behind in healthcare innovation, Sebelius says

By Jessica Zigmond 

Posted: February 27, 2014 – 3:45 pm ET

Tags: Advisory Board Co.American Recovery and Reinvestment ActCommunityHospitalsKathleen SebeliusMedicarePublic Health

http://www.modernhealthcare.com/article/20140227/NEWS/301019759/u-s-lags-behind-in-healthcare-innovation-sebelius-says?AllowView=VXQ0UnpwZTVDUGFaL1IzSkUvSHRlRU9vajAwZERlTlU=&utm_campaign=am

The federal government’s top health official Thursday gave U.S. healthcare innovation a grade of Incomplete.

“That’s really the great dichotomy of the time we’re living in,” HHS Secretary Kathleen Sebelius said. “We live in a 21st century world with a 20th century delivery system. We live in a world in which the National Cancer Institute is texting teens to convince them to quit smoking, but ask any parent how easy it is to get their kid’s immunization report from the doctor’s office.”

Although new health innovations, discoveries and technologies are allowing Americans to live longer, healthier lives, the processes of patient experience—such as how patients manage their health, how they choose a physician and how doctors work together to create a treatment plan—have not always kept pace with new medicines, vaccines and procedures, Sebelius said in addressing attendees at the Care Innovation Summit put on by the Aspen Institute and Advisory Board Co.

The answer, Sebelius suggested, is twofold: Unlock and release the information that drives innovation; and align payment for care in a way that pays for better outcomes and innovations, rather than for more operations and hospital readmissions.

And the federal government can help by unlocking some of this information. HHS has been doing that in part through the Hospital Compare website, which allows patients to compare categories such as patient experience, average wait times and whether a hospital has medical imaging capabilities, Sebelius said.

HHS for years has collected data in a wide variety of areas, such as public healthMedicare, clinical trials and spending. But often that information was either difficult or even impossible to access, either because it was hidden behind walls that would require huge sums of money to access, or because the data were published in formats that were indecipherable, she acknowledged. In other words, Sebelius said, it was “lazy” data that had potentially valuable information.

Now, HHS is working to make that “active” data. Just recently, the department had its 1,000th data set released on HealthData.gov. In the past, Sebelius said, that information would have been available only to scientists and researchers who were willing to pay for it.

“What we’re finding is if we make data open and accessible, the private and nonprofit sectors use it to start innovating,” she said.

Sebelius shared a few success stories of healthcare providers who have seen significant changes through the use of electronic health records, including one physician in the small town of Plainville, Kan., who transferred her patient records to EHRs. After she did, she was surprised to learn that only 43% of patients in her practice over the age of 50 for whom colon cancer screenings were recommended were actually getting tested. The physician created a system in which she was notified if a patient didn’t follow through. In a year and a half, that number rose to 89%, and she is working toward 100%.

“Nationally there has been tremendous progress in the last five years from quills and clipboards to computers and keyboards,” Sebelius said. “When President Obama took office in 2009, 1 in 8 hospitals were using any kind of basic electronic record. By 2012, that number had tripled,” she said, adding that the number of doctors using EHRs is now more than 50% and on the rise.

These changes are due in large part to incentives included in the American Recovery and Reinvestment Act, she said, and emphasized that with those incentives also came the national protocols to become a meaningful user.

Looking ahead, Sebelius challenged members of the health reform community to agree that from now on, “We’ll look at innovation that is something that is happening for us and with us and by us,” she said, “rather than something happening to us.”

Follow Jessica Zigmond on Twitter: @MHjzigmond

As Deadline Nears, State Insurance Exchanges Still A Mixed Bag

February 21, 2014 3:35 AM

With a bit more than a month left for people to sign up for health insurance plans set up under the Affordable Care Act, the federal website known as HealthCare.gov finally seems to be working smoothly — in 36 states.

But what’s happening in the 14 states that are running their own exchanges?

Some are doing quite well, thank you. California, for example, said Wednesday that enrollment has already exceeded its projection for the entire enrollment period, which ends March 31.

Other states, however, are having trouble, some of it severe.

Oregon, for example, has only just gotten its website up and running this week, and it’s still not fully open to the public. Until now, Oregon had been using paper applications.

So what makes a state health exchange successful? Joel Ario, who helped launch the exchange program for the federal government and now consults for states and others working to implement the health law, says the states doing best are generally the ones doing the least — at least when it comes to their websites.

“The states that said, ‘This is complicated, we’re going to focus on the most essential issues,’ those were the states that tended to do better,” he says.

Among places in that category, according to Ario, are not just California, but also Kentucky, New York and Connecticut.

In contrast, Ario says, many of the states that are now struggling may simply have overreached.

“Unfortunately states that I once touted as the leaders — Maryland, Oregon, Minnesota,” are among those bringing up the rear, he acknowledges. “This is a complicated undertaking, and so people who tried to do too much in [the first year], I think, had some problems with that.”

Maryland and Minnesota haven’t had the same problems as Oregon, but their websites have both been worked only intermittently, and enrollment has lagged. Just as with the federal website, part of the problem has been on the information technology side.

“We’ve seen in some states that some vendors have not been able to deliver, and states have struggled with the IT implementation,” said Heather Howard, who advises states for the Robert Wood Johnson Foundation.

In Maryland, fixing the exchange has been complicated by the fact that two of its IT vendors are suing each other. Massachusetts and Vermont have both had issues with CGI, the vendor that was found responsible for most of the messy rollout of the federal site,HealthCare.gov.

But experts say blame for failure — and credit for success — doesn’t all belong to the outside IT contractors. It’s also due in large measure to how well those contractors worked with state officials. Audrey Haynes oversees Kentucky’s largely successful exchange, Kynect. She says one key to making it work was putting the exchange in the same department that runs Medicaid.

“Anyone knows that Medicaid has to have a pretty super IT department that supports it,” she said at a recent event sponsored by the Robert Wood Johnson Foundation. “So we have a lot of experience … at bringing up large IT structures.”

And where do state exchanges go from here? Republican members of Congress from Marylandand Oregon are asking the federal government to investigate the limping exchanges in those states. That’s because both received millions of federal dollars to set up their health insurance marketplaces.

In principle, says consultant Joel Ario, figuring out what went wrong is not a bad idea. “I certainly think we want to look carefully at what happened and learn some lessons here. I don’t think anybody’s going to find any improprieties here, because they’re going to think it was all well-intentioned activity.”

And in the long run, once the states that are lagging work out their IT problems, they will probably end up, much like California, doing better than the states being run by the federal government. Heather Howard says that’s because states running their own exchanges also have more resources for consumer outreach.

“They have consumer assistance infrastructure, grants out to community-based organizations, and they’re building and doing a lot more marketing,” Howard says. “And their consumers are hearing much more about the options.”

All of which merely underscores something important about the health law that hasn’t changed: What’s available to you depends very much on where you live.

The Affordable Care Act Ensures Former Foster Youth Receive Critical Health Coverage Until Age 26

Children Now Launches Campaign to Promote Awareness and Increase Enrollment of Former Foster Youth in Medi-Cal

February 19, 2014

Source Link:  http://www.fortmilltimes.com/2014/02/19/3297938/the-affordable-care-act-ensures.html

OAKLAND, CALIF. — Children Now today announced the launch of Coveredtil26, a statewide outreach campaign to ensure all former foster youth living in California know they are now eligible for Medi-Cal coverage until age 26. Previously, Medi-Cal coverage for former foster youth ended at age 21.

Although the Affordable Care Act provision extending health coverage to former foster youth took full effect on January 1, 2014, the majority of young adults who benefit from this new provision are not yet aware of this exciting opportunity. The Coveredtil26 campaign provides advocates, youth, and stakeholders with the necessary tools to learn about this new benefit and navigate enrollment barriers.

Each year, over 20,000 youth age out of the foster care system in the United States. In California alone, between 2,700 and 5,000 youth age out of foster care every year. These vulnerable youth too often lack adequate supports to make the transition to adulthood successfully. For example, they are much less likely than their peers to have health insurance, but tend to have more health care needs due to trauma experienced during childhood.

“The Affordable Care Act’s extension of health coverage to age 26 fills a critical need for former foster youth who do not have the same option as their peers to stay on a parent’s insurance plan,” said Ted Lempert, President of Children Now. “However, it’s imperative that state and county agencies work together to ensure the processes for enrolling in coverage are easy to navigate for this vulnerable population.”

Children Now is working closely with the Department of Health Care Services, county social service agencies, and the County Welfare Directors Association (CWDA) to simplify enrollment processes for former foster youth and educate enrollment workers about this important ACA provision.

“Making sure that former foster youth can get the health care services they need and deserve is a high priority for the state,” said Anastasia Dodson, associate director of the California Department of Health Care Services, which oversees the Medi-Cal program. “We are committed to work with our county partners, other state agencies, and advocates to ensure that these youth can promptly and easily enroll in Medi-Cal coverage.”

Currently, the best way for former foster youth to enroll in coverage is to apply directly through a county social service agency office using a simple one-page form.

“Providing Medi-Cal coverage up to age 26 is one more way we recognize that many former foster youth who are transitioning into adulthood need continued support, including access to health care,” said Frank Mecca, CWDA Executive Director. “This is a great change, and our county social service agencies are diligently working to ensure eligible youth do not miss out on this opportunity.”

Former foster youth qualify for Medi-Cal coverage until age 26 if they:

 

  • Were in foster care in any state at age 18 or older,
  • Are younger than 26 years old, and
  • Live in California now.

 

Youth are eligible for Medi-Cal coverage regardless of income. Because there is no open enrollment period for Medi-Cal, former foster youth can apply any time of the year.

For more information on the extension of Medi-Cal coverage for former foster youth and the Coveredtil26 campaign visit www.coveredtil26.org.

Children Now is the leading, nonpartisan, umbrella research, policy development, and advocacy organization dedicated to promoting children’s health and education in California and creating national media policies that support child development. The organization also leads The Children’s Movement of California.

The Coveredtil26 campaign is funded by a grant from The California Wellness Foundation (TCWF). Created in 1992 as a private independent foundation, TCWF’s mission is to improve the health of the people of California by making grants for health promotion, wellness education, and disease prevention.

California Health Insurance Enrollments Rise, but Hispanics Still Lag

By IAN LOVETT

FEB. 19, 2014

Source Link: http://www.nytimes.com/2014/02/20/us/california-health-insurance-enrollments-rise-but-hispanics-still-lag.html?partner=rss&emc=rss&_r=0

LOS ANGELES — With six weeks left in the open enrollment period for insurance under President Obama’s health care law, more than 828,000 Californians have signed up for private coverage through the state’s online health care exchange, state officials announced Wednesday.

Home to about 15 percent of the nation’s uninsured, California accounted for more than 20 percent of the 3.3 million people who enrolled in plans nationwide under the new law, the Affordable Care Act, during the first four months of open enrollment. About a quarter of the state’s enrollees have been young adults, ages 18 to 34, on par with national rates.

Still, enrollment has lagged among California’s Latinos, who make up more than half of the state’s uninsured population, according to estimates by the California Health Care Almanac. Covered California, the state-run online marketplace for health insurance, did not offer applications in Spanish until the end of December, and a Spanish-language site was dogged by translation errors — just one of a string of problems with the exchange’s website.

Through the end of January, only 21 percent of the people who had enrolled identified themselves as Latino, up slightly from 18 percent at the end of 2013, according to the data released Wednesday.

Latinos in California signed up at a slightly faster rate in January, but Peter Lee, the executive director of Covered California, said the exchange still needed to improve on Latinos’ enrollment. With six weeks left of open enrollment, Covered California has begun an aggressive campaign to beef up Latino enrollment.

“From absolutely Day 1, Latino enrollment has been probably the No. 1 priority of Covered California.” Mr. Lee said. “Have we executed perfectly? No. We’re getting better as we go, and we’re seeing results right now.”

The health care exchange plans to spend $8.2 million on Spanish-language media during the first three months of this year — more than twice what was spent from October through December. In addition, more than 4,000 Spanish-speaking enrollment counselors and insurance agents have been certified in the state.

“The key element is really promoting in-person enrollment,” Mr. Lee said, adding that the state now had “an extensive ground game in place,” referring to the enrollment counselors.

The exchange had also seen a modest uptick in sign-ups among young adults, whose enrollment is considered essential to keeping insurance premiums down because they are usually healthier and need fewer costly medical services. Mr. Lee also said he expected enrollment among young people to pick up as the March 31 deadline drew nearer.

“We are constantly doing focus groups, and a lot of guys and gals are saying they’re going to wait until the 31st to sign up,” he said. “Waiting until the last minute is certainly not preferred, but it’s not unusual.”

In addition to those who signed up for Covered California health plans, nearly 900,000 people had been deemed eligible for the state’s expandedMedicaid program, known as Medi-Cal.

More than 85 percent of enrollees in Covered California plans through January were eligible for subsidies, but Covered California did not have statistics on how many of the enrollees previously had no health coverage. About 80 percent of those who had signed up for coverage had paid their first month’s premium.

http://www.nytimes.com/2014/02/20/us/california-health-insurance-enrollments-rise-but-hispanics-still-lag.html?partner=rss&emc=rss&_r=0

Outlook 2014: Affordable Care Act changes business for area health insurers and hospitals

By Shira Schoenberg, The Republican 
Follow on Twitter
on February 09, 2014 at 5:00 AM, updated February 09, 2014 at 5:10 AM

Source link: http://www.masslive.com/politics/index.ssf/2014/02/outlook_2014_affordable_care_a.html

For Massachusetts health insurers and providers, the Affordable Care Act in 2014 is about both the big picture and the little details.

In Massachusetts, unlike in some other states, the Affordable Care Act is not fundamentally changing the way health care is provided and paid for. Massachusetts already had near-universal health insurance coverage and is moving in the direction of containing costs. But the national law still requires changes. Some are in advancing concepts such as more coordinated and integrated care, pushed by new payment models in Medicare. Others are in small regulatory details, for example laws requiring insurers to fit their plans into federal categories.

“Fundamentally, we did not have to change our business model, mostly because we had the preexisting health reform program here in Massachusetts, on which the federal law was based,” said Bruce Bullen, chief operating officer of Blue Cross Blue Shield of Massachusetts. At the same time, he said, “I think people were surprised at the extent of the change that was needed to reconcile the actual rules of the federal system and the local system.”

Several insurers said the biggest changes were technical. For example, insurers had to fit all their products into four categories, based on their actuarial value, referred to as “metallic tiers.” (The actuarial value reflects the percentage of a person’s health costs the insurer is expected to pay.) That makes it easier for shoppers to compare insurance plans since a “bronze level” plan from Blue Cross Blue Shield must be comparable to a bronze plan by Health New England.

The result, as Bullen described it, was “everybody had a new price and everybody had a new product.”

Dave Przesiek, chief sales and marketing officer for Fallon Community Health Plan, said in the long-term, the change will probably help consumers and business owners choose plans because there will be more uniformity. In the short term, the company had to rebuild its entire portfolio of products, making some more robust and some less, and had to communicate that to customers.

There are also several new fees the Affordable Care Act imposes on insurers, which will be added to the cost of plans. Jim Kessler, vice president and general counsel at Health New England, said these add less than 5 percent to the cost of a Health New England plan.

The Affordable Care Act also changes the number of “ratings factors” – things like age or participation in a wellness plan – that insurers can use to calculate the price of premiums. This will result in lower prices for some individuals and small businesses andhigher prices for others.

One change for businesses is that the Affordable Care Act will require employers to provide “affordable” coverage, meaning it costs less than 9.5 percent of their employees’ household income. So some employers are looking for cheaper plans, including plans that limit which doctors a person can see or require patients to pay a higher deductible when they go to a more expensive hospital.

“That’s one component we’re starting to get more interest in,” Przesiek said. “Employers are saying ‘I’m concerned about the 9.5 percent. Do you have a more affordable option?'”

Also in 2014, insurers will have to put the prices of procedures at different hospitals online. Currently, insurers must provide that information by phone.

Kessler said the bottom line is, “We had to do a tremendous amount of work in 2013 to make relatively small changes in a large number of areas so the details of what we do line up with the requirements of the ACA.”

Insurers and providers also had to deal with the problems plaguing the state’s Health Connector website. The problems have resulted in errors in health insurance sign-ups and in enrollment processes that should have been done online automatically instead being done by hand using spreadsheets and multiple computer systems. This affects individuals currently buying coverage through the state’s Commonwealth Care and those signing up for the first time through the exchange for subsidized or unsubsidized plans.

“It’s going to take a lot of work to get all those many thousands of people across the Commonwealth either…re-enrolled and signed up or moved to new plan or new program or new carrier and have their coverage continue without a break,” Kessler said.

On a larger scale, the Affordable Care Act is encouraging providers to change the way care is delivered. Mark Fulco, a spokesman for Mercy Medical Center, said the Affordable Care Act implementation is the culmination of “dramatic change and transformational change that we’ve actually been undertaking for several years.”

Through new Medicare rules, the law provides incentives to move away from a fee for service model of payment toward a method of payment that essentially pays per patient, rewarding doctors who provide less expensive care for equally good outcomes.

The law creates a “Medicare Shared Savings” program, for which hospitals can voluntarily sign up by creating an “accountable care organization.” What that means is a primary care doctor works with a team of doctors to care for a population of Medicare patients. The doctors are paid for that population, rather than for each procedure. If the doctors meet quality standards and provide care below a certain cost, the savings are split between the insurer and the doctors. Although the changes only apply to Medicare, some commercial insurers are moving in the same direction. For example, Blue Cross Blue Shield pays 85 percent of its doctors through a global payment system, which it has been evolving for five years.

“Ten years ago, you were simply paid for hospital admissions and procedures and office visits, and the government or managed care payers didn’t pay an awful lot of attention to the quality of the outcome,” said Dr. Mark Keroack, president and CEO of Baystate Medical Center. “Now there are clear bonuses to be had for delivering exceptional quality and penalties to be incurred if you have below average quality or complications.”

Both Baystate Medical Center and Mercy Medical Center have partnered with other area physicians to create accountable care organizations serving seniors on Medicare. Between Medicare and similar arrangements with commercial insurers, around 60 to 70 percent of primary care patients at Baystate are in a shared savings payment arrangement, Keroack said.

“Baystate has embraced this as a philosophy,” Keroack said. “If we’re going to build this infrastructure, health records, pay case managers, bill different kinds of primary care, we might as well be doing population health for all our patients rather than just a few of them.”

There is also new federal money available through the Affordable Care Act for technology such as electronic medical records. Baystate put in place new electronic medical records both within Baystate Health and connecting to several other medical practices. Mercy Medical Center created a physical hub with a new computer software system that tracks and coordinates a patient’s care as they move through the medical system. It implemented a new electronic medical record system and an online portal where patients can view their own records. Baystate, Mercy Medical Center and Holyoke Medical Center are all connecting to the state’s new health information exchange, which allows for the sharing of medical records among providers, with a patient’s consent.

“We knew that the Affordable Care Act was going to demand improvements in better coordination of care,” Fulco said. “We said we need to implement it. We need to be ahead of the curve.”

Tim Gens, executive vice president of the Massachusetts Hospital Association, said the changes in Massachusetts are not as dramatic as in other states because Massachusetts was already working on reforming its health care system, through its 2006 health care overhaul and subsequent legislation aimed at cutting health care costs.

“The Affordable Care Act in its broad outlines mimics to a great extent what Massachusetts is trying to do,” Gens said. “The Affordable Care Act is reinforcing the path we’re on about more integrated delivery of care and payment for care that’s tied more toward outcomes and taking care of populations. It’s not just about treating people on an episodic basis, but looking at taking care of patients.”

Source link: http://www.masslive.com/politics/index.ssf/2014/02/outlook_2014_affordable_care_a.html

 

 

Work needed to close gaps in coverage for mental health, substance abuse treatment

Source Link: http://bit.ly/1bp3imn

By Paul Demko

Posted: November 8, 2013 – 2:00 pm ET

Tags: Barack Obama, Behavioral Health, Insurers, Kathleen Sebelius, Mental Health

Work needed to close gaps in coverage for mental health, substance abuse treatment

By Paul Demko, Steven Ross Johnson and Beth Kutscher

Posted: November 8, 2013 – 4:30 pm ET

 

Mental health advocates praised a long-awaited final rule issued Friday by the Obama administration requiring insurers to cover mental healthcare on the same basis as physical healthcare services. But they cautioned that more work is needed before full parity is achieved.

The final rule, issued jointly by HHS and the Treasury Department, ensures that health plans covering about 85% of the population offer the same deductibles, copayments and limits on visits for mental health services as offered for medical and surgical services.

The rule implements the provisions of the landmark 2008 Mental Health Parity and Addiction Equity Act. It takes effect July 1, 2014. It combines with the Patient Protection and Affordable Care Act to offer an unprecedented level of coverage for people with mental healthcare needs. The ACA includes mental health services among the 10 essential benefits that must be offered by all insurance plans starting in January.

The new rule applies parity requirements to intermediate levels of care in residential treatment and intensive outpatient settings. It also clarifies that parity applies to limits on geography and types of facilities in provider networks and eliminates a provision that allowed insurance companies to make exceptions based on “clinically appropriate standards of care.” Other protections in the final rule require insurers to transparently disclose the rights of plan participants.

The law and the rule do not apply to Medicare and traditional state-run Medicaid, but the administration had previously instructed state officials that their Medicaid programs should meet the 2008 parity law requirements. The law does apply to Medicaid managed-care plans, though the administration is expected to issue separate guidance for those plans, said Chuck Ingoglia, senior vice president for public policy at the National Council for Behavioral Health.

“For way too long the healthcare system has openly discriminated against Americans with behavioral health problems,”HHS Secretary Kathleen Sebelius said on a call Friday with reporters. “We are finally closing these gaps in coverage.”

“The final rule provides a crucial step forward to ensure that patients receive the benefits they deserve and are entitled to under the law,” said Dr. Jeffrey Lieberman, president of the American Psychiatric Association. “In addition to providing equal benefits for mental illness as physical illness, I am hopeful that there will be strong monitoring and enforcement at both the state and federal levels.”

The National Institute of Mental Health has estimated that 26% of American adults experience a mental disorder in any given year and that an estimated 15 million receive mental health services. While such services represent a little more than 5% of the $2.6 trillion in annual U.S. healthcare spending, insurance coverage for these services has been limited compared with coverage for physical health services. Insurers often have questioned the medical necessity of such services.

Jamison Monroe, CEO of Newport Academy, an adolescent residential treatment center for mental health and addiction disorders in California and Connecticut, said the better insurance coverage for mental health services required by the new parity rule and the Affordable Care Act will make it more attractive for healthcare providers and investors to operate mental health facilities. Experts say many areas of the country are underserved.

But providers and advocates say the rule leaves gaps and lingering questions. “The work is just beginning now,” said Ron Honberg, national director for policy and legal affairs for the National Alliance on Mental Illness, a patient advocacy group. “The specifics of parity are going to be shaped over the next few years.”

There also are concerns that state insurance commissioners will have primary responsibility for enforcing the rules on commercial insurers and that they lack the resources and the political will to do the job.

The rule would apply to nearly all private insurance plans, including employer-based, group and individual plans but not to Medicaid managed care plans, which are the largest single providers of mental healthcare. The Obama administration has already issued guidance to states on how such plans should meet parity requirements.

“The (Medicaid) guidance wasn’t as detailed as this rule is, so unless there’s some way to link that guidance with this rule, we’re not sure it’s going to be as helpful as we had hoped it would be,” Honberg said.

The rule builds on a federal law that Congress passed in 1996 requiring parity in lifetime and annual benefit limits for mental health coverage. HHS received more than 5,400 public comments on its draft rule. President Barack Obama had promised that the rule would be issued this year. It was among 23 executive actions that his administration outlined to address gaps in mental healthcare highlighted in the wake of the mass shooting last December in Newtown, Conn. There is bipartisan agreement that better and more accessible mental healthcare services are needed to help prevent such incidents.

“This is another important step in building the foundation for ensuring that people have appropriate and adequate mental health and addiction coverage compared to what they have on the medical side of things,” said Mark Covall, president of the National Association of Psychiatric Health Systems.

Policy experts praised the final rules for providing greater guidance in several important areas. For instance, they make clear that insurers will be required to cover what are typically called “intermediate services.” That could include residential treatment or intensive outpatient care. “That’s a big step toward leveling the playing field and making sure that people who have this coverage are getting all the services that they need,” Covall said.

In addition, the final rule provides more explicit instructions for insurers on what information they must disclose to subscribers about whether treatment is covered and under what conditions.

How The Affordable Care Act Pays For Insurance Subsidies

November 07, 2013 2:57 AM

The new health care law will provide around $1 trillion in subsidies to low- and middle-income Americans over the next decade to help them pay for health insurance.

Johanna Humbert of Galien, Mich., was pleasantly surprised to discover that she qualifies for an insurance subsidy, since her current plan is being canceled. Humbert makes about $30,000 a year, so she’ll get a subsidy of about $300 a month. The new plan is similar to her current one, but it will cost $250 — about half of what she pays now.

But where will the money come from to pay for subsidies like these?

On his show last Friday, liberal comedian Bill Maher called the Affordable Care Act a “Robin Hood” plan. “It does take from the rich to make better the poor,” he said.

You can certainly make a case for that, says economist Joseph Antos of the American Enterprise Institute. “In a general sense, the rich, of course, subsidize the poor. The rich pay more income taxes,” he says. “So, yes, absolutely, that’s how subsidies are supposed to work.”

So if you’re a low-income person getting a tax credit from the U.S. Treasury to subsidize your health care, a big chunk of that credit is coming from taxes paid by the well-off.

The Cost Of Subsidies

But the authors of the Affordable Care Act didn’t want the subsidies to become a drain on the Treasury and add to the deficits. So they included provisions designed to offset the cost of the subsidies.

MIT economist Jonathan Gruber, who helped develop the law, says about half the costs are offset by projected savings in Medicare payments to insurers and hospitals. Another quarter is offset by added taxes on medical-device makers and drug companies.

“The other source of revenue is a tax increase on the wealthiest Americans,” he says. “Those families with incomes above $250,000 a year will now have to pay more in Medicare payroll taxes.”

Those provisions actually make the bill a net positive for the federal budget, according to the nonpartisan Congressional Budget Office. By the CBO’s accounting, Obamacare will produce a surplus. Gruber says the law will “actually lower the deficit by about $100 billion over the next decade and by $1 trillion in the decade after.”

However, many Republicans have expressed skepticism about those findings.

New Policy, New Marketplace

The subsidies do mean some low-income people will pay almost nothing for insurance, while higher-income people will pay the full market price.

Dentist Aaron McLemore of Louisville, Ky., makes more than $100,000 a year, and doesn’t qualify for any subsidy on the Obamacare exchange. The 31-year-old’s current policy is being canceled. A new policy from the exchange will more than double his monthly premium and boost his annual deductible to $7,000.

His higher costs aren’t subsidizing lower-income policy holders, whose subsidy has already been paid by the government. But he is providing a subsidy in another way: The Affordable Care Act requires him to buy a policy with features he doesn’t need.

“Seeing as I’m a single male with no kids or dependents, and I’m paying for pediatric dental care and maternity care, it doesn’t make a whole lot of sense to me,” McLemore says.

What Obamacare is doing is moving McLemore out of the individual market — where people are sorted by age and health history and scope of coverage — to a market more like the traditional, employer-based group policy, in which young and old workers get the same coverage and pay the same premium.

Gruber, the MIT economist, says that model reflects the basic idea of insurance.

“The notion of insurance is we’re protected against risk,” he says. “What that means is that [during] a period of time when we’re healthy, we pay more in premiums than we collect in benefits. In those periods of time we’re sick — and we all go through them — we collect more in benefits than we pay in premiums.”

Young, healthy people subsidize older people, who are more likely to be sick. Of course, most of those younger folks will eventually become old folks and experience the same benefit.