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

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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.

UPDATE 1-Two U.S. hospital chains dismiss Obamacare technical woes

Source Link:  http://www.reuters.com/article/2013/11/05/hospitals-reform-idUSL2N0IQ1JN20131105

Tue Nov 5, 2013 2:49pm EST

By Susan Kelly

Nov 5 (Reuters) – Two U.S. hospital operators said on Tuesday technology problems bedeviling the federal government’s online health insurance marketplace were gradually diminishing and will not stop them from pushing ahead with plans to provide care to those who sign up.

“If any company had three years’ notice about having a website functioning for a major product launch on October 1, it would have worked. It’s frustrating that it did not work,” hospital operator Tenet Healthcare Corp’s Chief Executive Trevor Fetter said in an interview with Reuters following the company’s third-quarter earnings conference call.

While the glitches that have prevented many potential health plan enrollees from signing up are disappointing, “we’re not terribly concerned about it,” Fetter said.

That is because those uninsured patients will not be able to access the new plans until January anyway, so there is still plenty of time to sign up, he said.

Fetter said problems with online access to the federal insurance exchange have been lessening, and patients can also enroll through call centers, where waiting times have been coming down. State exchanges such as the one set up in California are working much better and are offering a selection of affordable plans, he added.

“This is a really important innovation,” Fetter said. “I wouldn’t judge it by the initial performance of the federal website.”

HCA Holdings Inc Chief Executive Richard Bracken said issues with the federal website have not deterred the company from its own plans to contract with insurers to provide care to new patients.

Ninety-seven percent of HCA’s U.S. hospitals have an exchange contract with access to a bronze level insurance plan, he said. Such plans have the lowest premiums.

“We are well-positioned to participate and provide healthcare services,” Bracken said on the company’s earnings conference call.

Tenet said it has contracts with about three-quarters of all the exchange plans that are offered in its markets.

EAGER FOR PATIENTS

Hospital companies have a lot riding on the success of the insurance exchanges. Hospitals are struggling with declining admissions as many Americans have stayed away from the doctor due to lack of insurance or high deductible on their plans.

The companies expect patient admissions to grow and bad debts to decline as more patients gain insurance to pay for their care.

Tenet shares fell about 9 percent on Tuesday, to $43.96, after it provided a disappointing outlook for the fourth quarter when it released its third-quarter results on Monday.

HCA, the largest publicly owned U.S. hospital operator, was one of the only hospital chains to report a modest increase of less than 1 percent in admissions to its facilities in the third quarter. Its shares fell 2.5 percent Tuesday to $46.53.

Jefferies & Co analyst Brian Tanquilut said he believes hospitals in 2014 will benefit primarily from more people being eligible for the Medicaid health insurance program that serves the poor.

“The health reform story is intact, but near term, the volume headwinds, which have been hampering hospitals for five years, continue to persist,” he said.

 

The Health-Care Trilemma: How Obamacare is changing insurance premiums

Source Link:  http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/29/the-health-care-trilemma-how-obamacare-is-changing-insurance-premiums/

By Ezra Klein, Published: October 29 at 2:28 pmE-mail the writer

The White House’s biggest frustration right now is that Obamacare’s technical failures are obscuring its great success: Premiums are much lower than the Congressional Budget Office estimated when the law first passed.

In a new report for the liberal Center for American Progress, Topher Spiro and Jonathan Gruber quantify exactly how much lower. Spiro and Gruber find that the average individual premium in the Affordable Care Act’s insurance marketplaces was projected to be $4,700 in 2014. In fact, it’s more like $3,936 — $764, or 16 percent, lower than expected.

That’s a big deal in terms of cheaper premiums, but it’s also a big deal in terms of the budget: If the savings hold, the Affordable Care Act will cost $190 billion less than the CBO estimated over the next decade.

At the same time, people who are currently buying insurance in the individual market are moving to the Obamacare’s insurance exchanges and many are reporting that they’re seeing significantly higher premiums for very similar plans.

This almost seems like a paradox: How can premiums in Obamacare both be lower than expected and, for some people, higher than they were before?

In any conversation like this, a disclaimer is necessary. When people talk about “premiums under Obamacare,” they’re not talking about premiums for people who get insurance through their employers, or through Medicaid, or through Medicare. They’re talking about the so-called “individual market,” which serves about 5 percent of the country now, and which, if Obamacare succeeds, will serve about 10 percent of the population. So we’re talking about insurance premiums for a small minority of the population. But it’s still millions of people.

The conversation over these premiums has been confused to the point of being outright misleading. It’s become common, for instance, for the Affordable Care Act’s critics to compare prices sticker prices in the individual market to the prices in the exchanges now. Since it was routine before for a quarter of people to be turned away or quoted a higher price after revealing their health history, this isn’t just comparing apples to oranges. It’s comparing apples to oranges that many people couldn’t even buy.

The right way to understand this is to think of premiums as a “trilemma” between comprehensiveness, accessibility, and affordability. Imagine this as a triangle:

premium trilemmaIn the individual market, insurance premiums depend on the balance you strike between these values. A plan could have extremely comprehensive benefits and be extremely cheap so long as it’s not open to people who are sick, or are likely to get sick. That would look like this:

trilemma firstYou could also imagine a plan that was open to all comers and very affordable — so long as it didn’t cover much. That might look like this:

affordable accessiblePrior to the Affordable Care Act, insurance in the individual market kept costs down by turning the away the sick, raising prices on the likely-to-get-sick, and offering, in many cases, pretty stingy benefits. So let’s say it was here:

insurance market nowThe Affordable Care Act makes individual market insurance both more accessible and more comprehensive. The accessibility comes from barring discrimination based on health status and limiting discrimination based on age. The comprehensiveness comes from setting minimum standards about what insurance needs to cover and what kind of limits it can set for out-of-pocket expenses, etc.

aca triangleWhat’s important to understand about this trilemma is that it means, roughly, that every change has winners and losers. Put bluntly, the Affordable Care Act’s changes are raising insurance premiums for some people who did well under the old system and lowering them for many of the people who were locked out or discriminated against.

A good example of the tradeoffs is the case of Dianne Barrette, a 56-year-old Florida woman who’s been featured in the media because her current plan will cost 10 times more under Obamacare. As Erik Wemple discovered, her old plan was health insurance in name only. It didn’t cover inpatient hospital care, it didn’t cover ambulance services, and so forth. Under Obamacare, all plans have to cover those benefits. So Barrette’s old plan was extremely affordable — $56 a month — because it covered basically nothing. Her new plan is much more expensive but also much more generous.

But it’s not all zero sum. The law pumps a trillion dollars of subsidies into the market to help people making less than 400 percent of the poverty line — which is $94,200 for a family of four — afford insurance. So now the actual premiums people are paying exist on a continuum, with some people seeing premiums increases and some people paying literally nothing at all:

subsidies aca triangleThe final factor here is increased transparency and competition among insurers — which should bring down premiums over time. Spiro and Gruber credit competition for Obamacare’s lower-than-expected premiums. We’ll see if it sticks.

So the bottom line is that Obamacare makes insurance more accessible and more comprehensive, which raises average premiums, but it adds subsidies and competitive markets, which lower premiums. Whether premiums are higher or lower for an individual person depends on their precise situation. But premiums are, in general, lower than was expected when Obamacare passed.

One thing to note about the media coverage around this is that some of the old plans in the individual market are being canceled or moved onto the exchanges at a time when the exchanges aren’t really working. So we’re hearing from people losing something but we’re not hearing much yet from the people who’re gaining insurance, or lower-priced insurance, through the law. That’s another consequence of the web site’s failures, but it’s a temporary one. There will be some losers under Obamacare, but because of the subsidies, many more winners.

Medicaid Expansion Is Set for Ohioans

Source Link:  http://www.nytimes.com/2013/10/22/us/medicaid-expansion-is-set-for-ohioans.html?_r=0&pagewanted=print

By TRIP GABRIEL

COLUMBUS, Ohio — As a Republican chairman of the House Budget Committee in the 1990s, John R. Kasich wielded a ferocious budget ax. On Monday, as Ohio’s governor, Mr. Kasich defied his party’s majorities in the state legislature to push through a multibillion dollar expansion of Medicaid under President Obama’s health care law.

By a 5-2 vote, an obscure committee, the Controlling Board, which normally oversees relatively small adjustments to the state budget, accepted $2.5 billion in extra Medicaid funds from the federal government. The money, recently approved by Medicaid administrators in Washington, will provide coverage for 275,000 Ohioans who have not been eligible for the program, the Kasich administration said.

The vote was an extraordinary — and possibly illegal, critics in Mr. Kasich’s own party said — end run by the governor around the General Assembly. Mr. Kasich, who initially declared himself an opponent of the Affordable Care Act and who has declined to set up a state online health insurance marketplace, has argued all year that his sense of Christian compassion, not to mention cool economic practicality, favored extending Medicaid to poor adults and those with disabilities who do not currently qualify.

But Republican majorities in both houses of the General Assembly blocked expansion. Opponents expressed disbelief that Washington would keep its promises under the health care law to pay almost all of the costs of expanding Medicaid, the joint federal-state health insurance program for the poor, and worried that Ohio taxpayers would have to pay.

A budget sent to the governor by the General Assembly forbade Medicaid expansion without lawmakers’ approval. Mr. Kasich vetoed that item. At least three bills to expand Medicaid have failed.

Mr. Kasich, who has championed job creation as he prepares for a re-election campaign next year in his swing state, has argued that expanding Medicaid eligibility will be an economic booster shot, because companies will be lured to Ohio by a healthier work force. Expansion is supported by state hospitals, the County Commissioners Association of Ohio and the Ohio Chamber of Commerce.

Under the Affordable Care Act, low-income workers are to receive federal subsidies to buy insurance starting in 2014. But there is a “coverage gap” for some who earn less than the poverty level but do not currently qualify for Medicaid. The federal law allows states to expand Medicaid eligibility to people with incomes of up to 138 percent of the federal poverty level, about $15,860 for an individual. The 2012 Supreme Court decision that upheld the law also allowed states to opt out of Medicaid expansion.

With Monday’s vote, Ohio became the 25th state plus the District of Columbia to expand Medicaid, according to the Kaiser Family Foundation. Nearly a dozen Republican governors have moved to do so, despite the efforts of Congressional Republicans to “defund” the health care law. Gov. Rick Snyder of Michigan, a Republican, waged a long and finally successful fight to expand Medicaid. In Pennsylvania, Gov. Tom Corbett reversed himself and recently endorsed a Medicaid expansion plan in defiance of the State House.

Mr. Kasich, who sought the Republican presidential nomination in 2000 and is thought by some analysts to still harbor ambitions in that direction, proposed expanding Medicaid in his budget address in February. He was represented at Monday’s hearing by Greg Moody, of the Governor’s Office of Health Transformation.

The office’s Web site, makes the administration’s case for Medicaid expansion. “No matter what Ohio decides on Medicaid, health insurance premiums are going up as a result of Obamacare,” it said. “It would make a bad situation far worse if Ohio does not extend Medicaid coverage and reclaim its share of federal taxes to support jobs here in Ohio — jobs that will be created in other states with our money if Ohio does not extend coverage.”

The seven-member controlling board includes the state budget director and six senior members of the Legislature appointed by both parties. As of this weekend, the outcome of the vote seemed uncertain. But on Monday morning, House Speaker William G. Batchelder replaced two members of his party who opposed Medicaid expansion. One of the new members voted for the expansion, the other against.

Mr. Batchelder was one of 39 House Republicans who protested last week that the governor’s decision to take the matter to the Controlling Board violated state law. Speculation around the Ohio Statehouse was that Republican leaders wanted to support the governor but did not want to submit to a roll-call vote exposing their troops to reprisals by Tea Party groups staunchly opposed to the federal health care law.

Immediately after the vote, the conservative 1851 Center for Constitutional Law announced it would sue over the decision to go through the Controlling Board. Maurice Thompson, director of the center, called it a vote “of a small oligarchy” of legislators, “some of whom were switched out at the last minute for politically expedient reasons.”

Mr. Batchelder said in a statement that he replaced two members because both men were candidates to succeed him, and he did not want their competition to influence the decision.

Mr. Kasich said the vote built on efforts by his administration to improve Medicaid. His administration says it has lowered the program’s rate of increase in costs to 3.3 percent annually from almost 9 percent a year before he took office.

“Together with the General Assembly we’ve improved both the quality of care from Medicaid and its value for taxpayers,” Mr. Kasich said in a statement. “Today’s action takes another positive step in this mutual effort.”

This article has been revised to reflect the following correction:

Correction: October 23, 2013

An earlier version of this article misstated the name of the center that announced it would sue over  the Ohio legislature’s acceptance of $2.5 billion in extra Medicaid funds. It is the 1851 Center for Constitutional Law, not the Buckeye Institute.

Five Things You Don’t Know About Health-Care Reform

By 

Insurance sign-ups are just around the corner for millions of Americans under health-care reform, yet there’s still much people don’t know about this landmark legislation, particularly those changes occurring over the next decade inside hospitals, clinics, and doctors’ offices.

It’s a workforce thing. All the attention is on politics, or who will receive what benefits and where the money will come from. But the most important question is who will deliver the care and how it will be done. Most of the change will be accomplished by the health-care workforce. Transforming health care is a huge management challenge. Many clinicians and staff will have to fundamentally change their professional objectives and standards, daily routines, compensation, patient relationships, and employer relationships. The scope of health-care reform and current market pressures are unparalleled in any other industry; the re-engineering of health-care workforce roles now underway may completely change relationships between patients and clinicians in the next decade.

Biggest long-term problem: clinician shortages.An additional 30 million Americans will receive health-care coverage by the end of the decade, during a time when a further 15 million patients will become eligible for Medicare. Who will take care of all those people? By 2020, a shortage of 91,500 primary care and specialist physicians is predicted. Shortages of nurse practitioners and physician assistants, who could help fill in the gaps in primary care, also are predicted. Without enough clinicians, effective health-care reform could be stifled.

Getting paid to keep you well, rather than cure your illness. Changes in compensation for doctors and nurses will dramatically transform from quantity of work to quality of work. Until very recently, compensation and reimbursement were entirely based on the volume of patients and treatments. Now they’re beginning to reflect value-based benchmarks that will increase every year. Some of these include patient satisfaction, readmission rates, health risk assessments, and patient wellness, among other benchmarks. For hospitals, making sure patients are satisfied will become a pocketbook issue. For clinicians, careful disease management and preventive care to keep patients out of the hospital could directly affect how much they are paid.

Independent doctors’ practices are quickly fading. Physicians who hang a shingle outside a private office are becoming rarer. A recent survey showed that 55 percent of practicing physicians work for someone else, usually a hospital or a practice owned by a hospital or health system. That figure grew 8 percent in one year. Meanwhile, nearly 40 percent of physicians younger than 45 have never worked in private practice. Doctors are moving to employed positions in hospitals and health systems in search of greater stability in the rapidly changing health-care environment.

Your doctor may not be a doctor. One of the most striking changes for consumers may be team-based care, with physicians, nurse practitioners, physician assistants, psychologists, pharmacists, and others working together to improve quality of care and lower costs. If your health-care provider employs a team approach, when you make an appointment with your doctor you may instead see a nurse practitioner or physician assistant, depending on a quick assessment of your health status. In more than a dozen states, nurse practitioners can diagnose, treat, or prescribe with no physician involvement. Laws and regulations on the scope of practice for these clinicians are changing rapidly.

Health-care reform isn’t just about getting coverage for millions of people who don’t have it. It’s also about changing the way health care is delivered to reduce costs and improve patient care. Unless we can accomplish those two goals, increasing coverage will become prohibitively expensive. Transforming health-care delivery requires the active participation of America’s 16-million member health-care workforce.

Salka is President and CEO of AMN Healthcare, one of the nation’s largest health care staffing companies.

Branding Obamacare: ‘New York State of Health’

WebMD News from Kaiser Health News

By Phil Galewitz

 

Some folks like to get away, Take a holiday from the neighborhood. Hop a flight to Miami Beach or to Hollywood. But I’m takin’ a Greyhound on the Hudson River line. I’m in a New York state of mind

… er … make that “New York State of Health.”  Playing off the title of Billy Joel’s iconic 1976 song, the officials running New York’s health insurance exchange announced Tuesday that they have chosen New York State of Health as the brand name of their new onlinemarketplace.

“We wanted a name that was distinctive and unique to New York and is emotional and not just functional description,” said Leo Mamorsky, executive group account director with DDB New York  which is handling advertising  for the exchange.

In their first YouTube ad, there are scenes of Manhattan, Niagara Falls and people in rural and suburban settings. Joel’s song, though, is not on the video. Joel grew up in Hicksville, N.Y., and lives in the Hamptons.

New York is the latest state attempting to brand the new marketplaces. The marketplaces, one of the key ways the health care law extends coverage to the uninsured, open for enrollment Oct. 1, selling policies that will take effect Jan. 1. New York exchange officials announced last month that average premiums sold on the exchange would be about half the price they are today for individuals who buy their own insurance.

“In creating a name, we wanted it to be meaningful, memorable and capture the essence of what it is to be a New Yorker – that unique ‘can do’ attitude and state of mind,” said Donna Frescatore, New York  State of Health’s executive director. “We’re confident the ‘NY State of Health’ name and campaign will inspire New Yorkers who are uninsured or underinsured to explore the options and choose the plan that fits their needs.”

Despite being a fan favorite for decades, “New York State of Mind” was never a hit song and was never released as a single. Joel famously played the song at The Concert For New York City, the October 2001 benefit for the New York City Fire and Police Departments and the loved ones of first responders killed during the terrorist attack on Sept 11. He reprised that theme, playing it during his Dec. 12, 2012 concert at Madison Square Garden to raise money for victims of Hurricane Sandy, where he changed the lyrics to include places like “Breezy Point.”

New York officials said Joel was not consulted about their marketing effort. They said they had no plans to use Joel or his song in their ads.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Source Link:  http://www.webmd.com/health-insurance/ny/20130820/with-a-nod-to-billy-joel-ny-brands-obamacare-marketplace?src=RSS_PUBLIC

 

IRS website offers information about Affordable Care Act

Posted: Monday, August 19, 2013 7:07 pm

Richard Craver/Winston-Salem Journal

The Internal Revenue Service has create a website – www.irs.gov/aca — aimed at providing information about how the implementation of the federal Affordable Care Act will affect individuals, families and businesses from a tax provision perspective.

The home page has three sections, which explain the tax benefits and responsibilities for individuals and families, employers and other organizations, with links and information for each group. The site provides information about tax provisions that are in effect now and those that will go into effect in 2014 and beyond.

Topics include premium tax credits for individuals, new benefits and responsibilities for employers, and tax provisions for insurers, tax-exempt organizations and certain other business types.