Category Archives: ACA

SOTU: Biden’s biggest healthcare priorities

Posted on by • Posted in Abortion, ACA, Cancer, Cancer Moonshot Initiative, Coronavirus, Health Equity, Health Inequity, Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Inflation Reduction Act, Insulin, Job Growth, Job Market, Medicaid, Medicaid Cliff, Opioid Epidemic, Payor Mix, Public Health Emergency (PHE), Unemployment • Leave a comment
https://www.advisory.com/daily-briefing/2023/02/08/sotu?utm_source=member_db&utm_medium=email&utm_campaign=2023feb08&utm_content=member_headline_final_ectake_x_x_x&elq_cid=4838956&

President Joe Biden last night highlighted several healthcare priorities during his State of the Union address, including efforts to reduce drug costs, a universal cap on insulin prices, healthcare coverage, and more.

COVID-19

In his speech, Biden acknowledged the progress the country has made with COVID-19 over the last few years.

“Two years ago, COVID had shut down our businesses, closed our schools, and robbed us of so much,” he said. “Today, COVID no longer controls our lives.”

Although Biden noted that the COVID-19 public health emergency (PHE) will come to an end soon, he said the country should remain vigilant and called for more funds from Congress to “monitor dozens of variants and support new vaccines and treatments.”

The Inflation Reduction Act

Biden highlighted several provisions of the Inflation Reduction Act (IRA), which passed last year, that aim to reduce healthcare costs for millions of Americans.

“You know, we pay more for prescription drugs than any major country on earth,” he said. “Big Pharma has been unfairly charging people hundreds of dollars — and making record profits.”

Under the IRA, Medicare is now allowed to negotiate the prices of certain prescription drugs, and out-of-pocket drug costs for Medicare beneficiaries are capped at $2,000 per year. Insulin costs for Medicare beneficiaries are also capped at $35 a month.

“Bringing down prescription drug costs doesn’t just save seniors money,” Biden said.  “It will cut the federal deficit, saving tax payers hundreds of billions of dollars on the prescription drugs the government buys for Medicare.”

Caps on insulin costs for all Americans

Although the IRA limits costs for seniors on Medicare, Biden called for the policy to be made universal for all Americans. According to a 2022 study, over 1.3 million Americans skip, delay purchasing, or ration their insulin supply due to costs.

“[T]here are millions of other Americans who are not on Medicare, including 200,000 young people with Type I diabetes who need insulin to save their lives,” Biden said. “… Let’s cap the cost of insulin at $35 a month for every American who needs it.”

With the end of the COVID-19 PHE, HHS estimates that around 15 million people will lose health benefits as states begin the process to redetermine eligibility.

The opioid crisis

Biden also addressed the ongoing opioid crisis in the United States and noted the impact of fentanyl, in particular.

“Fentanyl is killing more than 70,000 Americans a year,” he said. “Let’s launch a major surge to stop fentanyl production, sale, and trafficking, with more drug detection machines to inspect cargo and stop pills and powder at the border.”

He also highlighted efforts by to expand access to effective opioid treatments. According to a White House fact sheet, some initiatives include expanding access to naloxone and other harm reduction interventions at public health departments, removing barriers to prescribing treatments for opioid addiction, and allowing buprenorphine and methadone to be prescribed through telehealth.

Access to abortion

In his speech, Biden called on Congress to “restore” abortion rights after the U.S. Supreme Court overturned Roe v. Wade last year.

“The Vice President and I are doing everything we can to protect access to reproductive healthcare and safeguard patient privacy. But already, more than a dozen states are enforcing extreme abortion bans,” Biden said.

He also added that he will veto a national abortion ban if it happens to pass through Congress.

Progress on cancer

Biden also highlighted the Cancer Moonshot, an initiative launched last year aimed at advancing cancer treatment and prevention.

“Our goal is to cut the cancer death rate by at least 50% over the next 25 years,” Biden said. “Turn more cancers from death sentences into treatable diseases. And provide more support for patients and families.”

According to a White House fact sheet, the Cancer Moonshot has created almost 30 new federal programs, policies, and resources to help increase screening rates, reduce preventable cancers, support patients and caregivers and more.

“For the lives we can save and for the lives we have lost, let this be a truly American moment that rallies the country and the world together and proves that we can do big things,” Biden said. “… Let’s end cancer as we know it and cure some cancers once and for all.”

Healthcare coverage

Biden commended the fact that “more American have health insurance now than ever in history,” noting that 16 million people signed up for plans in the Affordable Care Act marketplace this past enrollment period.

In addition, Biden noted that a law he signed last year helped millions of Americans save $800 a year on their health insurance premiums. Currently, this benefit will only run through 2025, but Biden said that we should “make those savings permanent, and expand coverage to those left off Medicaid.”

Advisory Board’s take

Our questions about the Medicaid cliff

President Biden extolled economic optimism in the State of the Union address, touting the lowest unemployment rate in five decades. With job creation on the rise following the incredible job losses at the beginning of the COVID-19 pandemic, there is still a question of whether the economy will continue to work for those who face losing Medicaid coverage at some point in the next year.

The public health emergency (PHE) is scheduled to end on May 11. During the PHE, millions of Americans were forced into Medicaid enrollment because of job losses. Federal legislation prevented those new enrollees from losing medical insurance. As a result, the percentage of uninsured Americans remained around 8%. The safety net worked.

Starting April 1, state Medicaid plans will begin to end coverage for those who are no longer eligible. We call that the Medicaid Cliff, although operationally, it will look more like a landslide. Currently, state Medicaid regulators and health plans are still trying to figure out exactly how to manage the administrative burden of processing millions of financial eligibility records. The likely outcome is that Medicaid rolls will decrease exponentially over the course of six months to a year as eligibility is redetermined on a rolling basis.

In the marketplace, there is a false presumption that all 15 million Medicaid members will seamlessly transition to commercial or exchange health plans. However, families with a single head of household, women with children under the age of six, and families in both very rural and impoverished urban areas will be less likely to have access to commercial insurance or be able to afford federal exchange plans. Low unemployment and higher wages could put these families in the position of making too much to qualify for Medicaid, but still not making enough to afford the health plans offered by their employers (if their employer offers health insurance). Even with the expansion of Medicaid and exchange subsidies, it, is possible that the rate of uninsured families could rise.

For providers, this means the payer mix in their market will likely not return to the pre-pandemic levels. For managed care organizations with state Medicaid contracts, a loss of members means a loss of revenue. A loss of Medicaid revenue could have a negative impact on programs built to address health equity and social determinants of health (SDOH), which will ultimately impact public health indicators.

For those of us who have worked in the public health and Medicaid space, the pandemic exposed the cracks in the healthcare ecosystem to a broader audience. Discussions regarding how to address SDOH, health equity, and behavioral health gaps are now critical, commonplace components of strategic business planning for all stakeholders across our industry’s infrastructure.

But what happens when Medicaid enrollment drops, and revenues decrease? Will these discussions creep back to the “nice to have” back burners of strategic plans?

Or will we, as an industry, finish the job?

Inside the current urgent care ‘boom’

Posted on by • Posted in ACA, Association of American Medical Colleges (AAMC), Consumer Preferences, Consumerism, Convenience, Convenient Access, Primary Care, Private Equity, Urgent Care, Urgent Care Association (UCA) • Leave a comment
https://www.advisory.com/daily-briefing/2023/02/02/urgent-care-centers?utm_source=member_db&utm_medium=email&utm_campaign=2023feb02&utm_content=member_headline_finalb_x_x_x_x&elq_cid=4838956&

Urgent care centers have become increasingly popular among patients in recent years. And while the facilities may be a more convenient care option than others, experts have voiced concerns about potential downsides, Nathaniel Meyersohn writes for CNN.

What is driving the urgent care ‘boom’?

Urgent care centers have been in the United States since the 1970s, but they were widely regarded as “docs in a box,” with slow growth in their early years. Then, during the COVID-19 pandemic, demand for tests and treatments drove an increase in patients at urgent care sites around the country. According to the Urgent Care Association (UCA), patient volume at urgent care centers has increased by 60% since 2019.

As patient volumes and demand increased, growth for new urgent care centers surged. Currently, there are a record 11,150 urgent care centers in the United States, with around 7% growth annually, UCA said. Notably, this figure excludes clinics inside retail stores and freestanding EDs.

According to estimates from IBISWorld, the urgent care market will reach roughly $48 billion in revenue in 2023, a 21% increase from 2019.

“Urgent care has grown rapidly because of convenience, gaps in primary care, high costs of emergency room visits, and increased investment by health systems and private-equity groups,” Meyersohn writes.

Urgent care center growth also “highlights the crisis in the US primary care system,” Meyersohn writes, noting that the Association of American Medical Colleges said it expects a shortage of up to 55,000 primary care physicians in the next decade.

In addition, it can be difficult to book an immediate visit with a primary care provider. Urgent care sites have longer hours during the week and are open on weekends, making it easier to get an appointment. According to UCA, roughly 80% of the U.S. population is within a 10-minute drive of an urgent care center.

“There’s a need to keep up with society’s demand for quick turnaround, on-demand services that can’t be supported by underfunded primary care,” said Susan Kressly, a retired pediatrician and fellow at the American Academy of Pediatrics.

Meanwhile, health insurers and hospitals have also prioritized keeping people out of the ED. In the early 2000s, they started opening their own urgent care sites and implementing strategies to deter ED visits.

The passage of the Affordable Care Act also triggered an increase in urgent care providers, with millions of newly insured Americans accessing healthcare.

In addition, data from PitchBook suggests that private-equity and venture capital funds invested billions into deals for urgent care centers.

“If they can make it a more convenient option, there’s a lot of revenue here,” said Ateev Mehrotra, a professor of healthcare policy and medicine at Harvard Medical School who has researched urgent care clinics. “It’s not where the big bucks are in health care, but there’s a substantial number of patients.”

The increase in urgent care sites may present challenges

Many doctors, healthcare advocates, and researchers have voiced concerns at the increase in urgent care sites, noting that there are potential downsides.

“Frequent visits to urgent care sites may weaken established relationships with primary care doctors,” Meyersohn writes. “They can also lead to more fragmented care and increase overall health care spending, research shows.”

In addition, some experts have questioned the quality of care at urgent care centers, particularly how well they serve low-income communities.

In a 2018 study by Pew Charitable Trusts and CDC, researchers found that urgent care centers overprescribe antibiotics, especially those used to treat common colds, the flu, and bronchitis.

“It’s a reasonable solution for people with minor conditions that can’t wait for primary care providers,” said Vivian Ho, a health economist at Rice University. “When you need constant management of a chronic illness, you should not go there.”

Some doctors and researchers also expressed concern that patients are visiting urgent care centers instead of a primary care provider altogether.

“What you don’t want to see is people seeking a lot [of] care outside their pediatrician and decreasing their visits to their primary care provider,” said Rebecca Burns, the urgent care medical director at the Lurie Children’s Hospital of Chicago.

“There are also concerns about the oversaturation of urgent care centers in higher-income areas that have more consumers with private health care and limited access in medically underserved areas,” Meyersohn writes.

A 2016 study from the University of California at San Francisco found that urgent care centers typically do not serve rural areas, areas that have a high concentration of low-income patients, or areas that have a low concentration of privately-insured patients.

According to the researchers, this “uneven distribution may potentially exacerbate health disparities.” 

Uninsured rate fell for those historically lacking coverage

Posted on by • Posted in ACA, Health Insurance Coverage Adequacy, Medicaid, Medicaid Expansion, Public Health Emergency (PHE), Underinsured, Uninsured • Leave a comment

https://www.healthcaredive.com/news/uninsured-rate-fell-historically-lacking-coverage-hhs-repor/640488/

The national rate of uninsured people under the age of 65 fell from 11.1% in 2019 to 10.5% in 2021 as government policies aimed at increasing accessible coverage for those with lower incomes, according to an HHS report out last week.

The rate decline was highest among those who had incomes between 100% and 200% of the federal poverty level. Those in traditionally uncovered demographies, such as people who are Latino, American Indian/Alaska native and those who don’t speak English, saw larger gains in coverage.

The research comes as the Biden administration reported an 8% national uninsurance rate, a historic low, in the first quarter of last year for all Americans.

Half of the top 10 states for coverage gains expanded Medicaid under the Affordable Care Act between 2019 and 2021. The leading state, Maine, reached a 7.1% uninsured population in 2021, dropping from 10.2% in 2019. Officials shifted to a state-based exchange for the 2022 plan year.

“Many of the areas with the greatest coverage gains since 2019 had higher than average uninsured rates in 2021, suggesting progress in narrowing geographic disparities but still with substantial gaps remaining; the lack of Medicaid expansion in 11 states plays a key ongoing role in coverage disparities across states,” the report authors wrote.

The state with the largest increase in uninsured people was Alabama, which reached 12.5% in 2021 compared to 12.1% in 2019.

In addition to Medicaid expansion, other policies that helped those receive coverage include increased premium tax subsidies under the American Rescue Plan.

Also helping is the Medicaid continuous coverage provision, which has barred states from kicking people off rolls during the COVID-19 public health emergency.

That policy is set to end in April, however. Researchers have said that as many as 15 million to 18 million people could be affected.

States are taking some steps to help those eligible remain in the program. Most states plan to update enrollee mailing addresses and follow up with those people when action is recovered to maintain coverage, according to a recent Kaiser Family Foundation report.

Forty-one states said it will take up to 12 months to process renewals, KFF said.

Record-breaking 16.3M people signed up for ACA coverage

Posted on by • Posted in ACA, Health Insurance Coverage Adequacy, Medicaid, Medicaid Expansion, Public Health Emergency (PHE), Underinsured, Uninsured • Leave a comment

https://www.healthcaredive.com/news/record-breaking-people-signed-up-aca-coverage/641216/?mkt_tok=ODUwLVRBQS01MTEAAAGJjU731Jnz2OmQ49Mlkh7jVIfsWO9PQNGUgGD23jiZG76J5yFBjHCkGbM_HfYAWeZPujQSE5FV9Z068MsZ8c5kVs5X-6FfoAjcKiXxUnd6OBLk

The CMS announced Wednesday that a record-breaking 16.3 million people signed up for Affordable Care Act marketplace plans during the 2023 open enrollment season, a result of extended pandemic-era subsidies enacted by the American Rescue Plan.

Over 1.8 million more people enrolled in marketplace coverage compared to last year — a 13% increase, and the most amount of plan selections of any year since the launch of the ACA marketplace a decade ago, according to the CMS. The record-breaking enrollment numbers include 3.6 million first-time marketplace enrollees.

Enrollment comes after last year’s passage of the Inflation Reduction Act extended ACA subsidies into 2025, protecting millions of Americans from premium hikes and reflecting a broader push in policy from the Biden administration aimed at increasing healthcare insurance coverage. This month, the HHS announced that the national rate of uninsured people under the age of 65 fell from 11.1% in 2019 to 10.5% in 2021.

However, some coverage protections rely on the federal COVID-19 public health emergency status, which will expire without an extension in mid-April. Medicaid enrollment numbers are expected to drop at the end of the public health emergency, with as many as 18 million enrollees projected to lose Medicaid coverage, according to the Robert Wood Johnson Foundation.

In addition to a boost from subsidies, the CMS announced this month that it had quadrupled the number of navigators used to assist plan signups.

CMS proposes new prior authorization requirements for payers

Posted on by • Posted in ACA, Center for Medicare and Medicaid Services (CMS), Electronic Transmission, Health Policy, Health System, Hospital, Hospital Industry, Medicare, Medicare Advantage, Prior Authorization, Rev Cycle Management, Revenue Cycle • Leave a comment

https://mailchi.mp/3a7244145206/the-weekly-gist-december-9-2022?e=d1e747d2d8

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that aims to streamline the prior authorization process by requiring certain payers to establish a method for electronic transmission, shorten response time for physician requests, and provide a reason for denials. This rule replaces one proposed in December 2020 that was never finalized. 

In addition to applying to Medicaid and Affordable Care Act exchange plans, the new rule would also apply to Medicare Advantage plans, which the previous rule did not. If finalized, it will take effect in 2026.

The Gist: Managing prior authorization requests is one of providers’ greatest sources of frustration, with over 80 percent of physicians rating it as “very or extremely burdensome” in a recent Medical Group Management Association survey. 

Not only would patients would benefit from faster turnarounds, but even major payers agree that the status quo is suboptimal, and payer advocacy organization AHIP has signaled support for transmitting prior authorization requests electronically. 

The challenge for regulators will be to strike a balance that satisfies the competing interests of payers and providers—turnaround time is likely to be a sticking point—but the one good thing about a system that no one likes is that there’s plenty of room for improvement. 

Why some choose health care sharing ministries

Posted on by • Posted in ACA, Deceptive Advertising, Health Care Sharing Ministries (HCSMs), Health Insurance Coverage Adequacy, Medical Debt, Out of Pocket Expenses, Skinny Health Plans, Underinsured • Leave a comment
Why some choose health care sharing ministries

Open enrollment is upon us. While many are focused on which health insurance company has the best deal, health care sharing ministries (HCSMs) are quietly offering cheaper and less regulated alternatives to traditional coverage. Despite being an inadequate substitute, for some, they’re a welcome one.

What are HCSMs?

HCSMs are not health insurance; they are cost-sharing organizations. The idea is that members help each other directly cover medical costs. Members pay monthly contributions, similar to premiums, but can also make additional donations to cover specific bills from other members.

HCSMs are allowed to exclude pre-existing conditions from eligibility, exclude various health care services altogether, such as maternity care or contraception, and cap the lifetime financial assistance for which a member is eligible. They also do not guarantee claims will be reimbursed. (One review of HCSMs in Massachusetts found that only half of submitted claims were eligible for reimbursement.)

They are often, if not always, religiously affiliated. Members commit to a code of conduct, which may include abstaining from tobacco use and holding a traditional view of sex and marriage.

HCSMs and the Affordable Care Act

Because they are not insurance and because they are religiously affiliated, HCSMs are not regulated by the Affordable Care Act (ACA). They are not subject to minimal coverage guidelines and members are not subject to the individual mandate.

HCSMs are a notable exemption to the ACA. Supporters lobbied for the exemption based on a few reasons, including former President Obama’s promise that Americans could keep their coverage if they liked it. But the main motive was religious freedom. They argued that sharing health care costs was a “religious right and a privilege.” Congress agreed to the carveout to minimize religious opposition, and advocates lauded the decision as “Obamacare’s Silver Lining.”

The appeal of HCSMs

Some see HCSMs as a viable alternative to traditional health insurance and research suggests there may be a few reasons why.

Perhaps the most significant reason is freedom: freedom of religious expression and freedom from government oversight. The Bible encourages Christians to “bear one another’s burdens,” and HCSM members see their approach to health care costs as a fulfillment of that command. Additionally, many religious individuals oppose abortion and other medical services. As such, they may see HCSMs as a way to pay for their own health care needs without funding religiously prohibited services even indirectly.

HCSMs promote a sense of freedom beyond religion, including provider choice and less government interference. For example, members essentially pay out of pocket for health care, getting reimbursed later, so they can choose any provider that accepts self-paying patients. HCSMs also allow members to bypass “the system,” staying out of the carousel that is the heavily regulated health insurance industry.

A more tangible reason why some prefer HCSMs to traditional health insurance is thrift. Monthly contributions are typically less than monthly insurance premiums. This makes sense; HCSMs are set up to cover health care expenses after they’re accrued so upfront costs can be lower. Plus, the list of reimbursable services is often limited in exchange for even lower costs.

For healthy individuals, especially those who don’t use much health care, this kind of “low cost up front” arrangement can be enticing. But, if a member has an emergency or an extended hospital stay, or develops a chronic condition, they may be stuck with significant medical bills. Monthly contributions can also increase due to changes in health status, even common ones like weight gain.

While freedom and thrift are conscious reasons to prefer HCSMs, others may choose them due to inadequate health insurance literacy. Individuals less familiar with terms like coinsurance and deductibles may have difficulty choosing from a set of ACA-compliant health insurance plans. This difficulty likely extends to evaluating the relative costs and benefits of HCSMs.

Challenges differentiating between insurance and HCSMs may also increase when small businesses list HCSMs as a potential source of coverage for health care costs. Deceptive advertising by HCSMs and insurance brokers adds further confusion.

While HCSMs are an unregulated, risky alternative to traditional insurance coverage, some find the freedom and cost savings they provide attractive. Others don’t know of a better option and join an HCSM without understanding the potential consequences. Given that inadequate insurance coverage is associated with greater medical debt and delays in seeking necessary care, it’s important that consumers have clear, accurate information to facilitate coverage decisions.

Some red state hospitals pitch Medicaid expansion to solve rural health woes

Posted on by • Posted in ACA, Health Insurance Coverage Adequacy, Health Policy, Medicaid, Medicaid Expansion, Uncompensated Care, Underinsured, Uninsured • Leave a comment

https://www.axios.com/2022/12/08/red-state-hospitals-medicaid-expansion-rural-health-woes

Hospitals in some non-Medicaid expansion states are pitching expansion as a way to help solve the rural health crisis. But the industry is hardly speaking with one voice.

Driving the news: Facilities with fewer commercially insured patients that treat a large number of uninsured people see expansion as a potential lifeline in tough economic times.

Yes, but: Republican lawmakers in the holdout states continue to oppose enlarging their Medicaid rolls, citing higher state costs of covering a bigger population.

  • And hospital associations in North Carolina and Florida have opposed expansion plans, either out of concern about alienating key lawmakers or because the plans could bring other changes that disrupt dollars flowing to their members.

State of play: South Dakota voters approved a Medicaid expansion ballot measure this fall, leaving 11 non-expansion states.

  • Democratic governors in North Carolina and Kansas think they may be wearing down Republican opposition, Politico reports, but still face uphill battles when the new legislative sessions begin.

Zoom in: Medicaid expansion can bring dollars into a state’s health care system, even if the program pays only a fraction of the actual cost of care.

  • Numerous studies show that Medicaid expansion can have a positive financial impact on hospitals’ operating and profit margins, particularly smaller rural facilities, Robin Rudowitz, vice president at the Kaiser Family Foundation, told Axios.
  • The program could provide a reprieve for hospitals that were kept afloat in part by federal pandemic aid that’s now drying up.
  • “We have hospitals with 12 days cash on hand. We’ve lost a nursing home this year. We have seen decreased services. We’ve lost OB services in a few places, and we’ve seen over the years the decrease in mental health,” Wyoming Hospital Association vice president Josh Hannes told state lawmakers last month, per Politico.
  • Expanding Medicaid in other states has also led to a significant decline in uncompensated care costs, as well as improved states’ health outcomes, including overall mortality.

Yes, but: Medicaid expansion is not necessarily a silver bullet that will rescue every struggling facility.

  • Some state hospital associations are seeking other types of relief, from cuts in hospital bed taxes or higher reimbursements for existing Medicaid beneficiaries.

Of note: Rural, small hospitals have the most to gain from Medicaid expansion, because they serve a smaller patient populations with a larger pool of uninsured people.

  • Congress sweetened the deal for non-expansion states in the American Rescue Plan Act, with a 5% increase in the federal Medicaid Assistance Percentage for the state’s current Medicaid recipients, which lasts for two years.
  • In Texas, whose uninsured rate is the highest in the nation, hospital leaders think Medicaid expansion could help cover many in the working class whose jobs do not offer health plans.
  • “If you could get those folks coverage at a Medicaid rate it would obviously help the financial situations of (rural) hospitals, and if you could get them to a medical home you could deal with more acute medical conditions going forward,” John Hawkins, president of the Texas Hospital Association, told reporters last week.

The bottom line: While rural hospitals all over are facing headwinds, those in non-expansion states are bearing the brunt of the pain. And while there is a potential lever for those states, it doesn’t appear likely their elected officials are willing to pull it.

Many insured Americans still struggle to afford care 

Posted on by • Posted in ACA, Affordability, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, Medicaid, Medicaid Expansion, Out of Pocket Expenses, Public Health Emergency (PHE), Uncompensated Care, Underinsured, Uninsured • Leave a comment

https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

Driven by the steady progress of Medicaid expansion and pandemic-era policies to ensure access to health insurance coverage, the US uninsured rate hit an all-time low of 8 percent in early 2022. Since the Affordable Care Act passed in 2010, the US uninsured rate has been cut in half, with the largest gains coming from Medicaid expansion. 

However, using data from Commonwealth Fund, the graphic below illustrates how this noteworthy achievement is undermined by widespread underinsurance, defined as coverage that fails to protect enrollees from significant healthcare cost burdens. A recent survey of working-age adults found that eleven percent of Americans experienced a coverage gap during the year, and nearly a quarter had continuous insurance, but with inadequate coverage. 

High deductibles are a key driver of underinsurance, with average deductibles for employer-sponsored plans around $2,000 for individuals and $4,000 for families. 

Roughly half of Americans are unable to afford a $1,000 unexpected medical bill. Americans’ healthcare affordability challenges will surely worsen once the federal COVID public health emergency ends, because between 5M and 14M Medicaid recipients could lose coverage once the federal government ends the program that has guaranteed continuous Medicaid eligibility. 

The process of eligibility redeterminations is sure to be messy—while some Medicaid recipients will be able to turn to other coverage options, the ranks of uninsured and underinsured are likely to swell.

ACA signups top 3M since start of open enrollment, a 17% bump compared to last year

Posted on by • Posted in ACA, Center for Medicare and Medicaid Services (CMS), Dept of Health and Human Services (HHS), Health Insurance Coverage Adequacy, Inflation Reduction Act, Uncompensated Care, Underinsured, Uninsured • Leave a comment

https://www.fiercehealthcare.com/payers/aca-signups-top-3m-start-open-enrollment-17-bump-compared-last-year

Nearly 3.4 million people have signed up for 2023 Affordable Care Act insurance coverage since the start of open enrollment on Nov. 1, a record-setting pace that is a 17% boost over last year, new federal data shows. 

The signup data released Tuesday by the Centers for Medicare and Medicaid Services shows a major hike in new signups on HealthCare.gov. 

“We are off to a strong start — and we will not rest until we can connect everyone possible to healthcare coverage this enrollment season,” Department of Health and Human Services Secretary Xavier Becerra said in a statement Tuesday.

The nearly 3.4 million in signups represents activity through Nov. 19 on HealthCare.gov, which is used by residents in 33 states to pick an ACA plan, and through Nov. 12 for the 16 states and District of Columbia that run their own marketplaces.

There are 655,000 people who are new to the exchanges that picked a plan already, making up 19% of the total plan signups so far. CMS added that 2.7 million people who already have 2022 coverage renewed or selected a new plan for 2023. 

“These plan selection numbers represent a 17% increase in total plan selections over last year,” CMS said in a release. 

There is especially major growth on HealthCare.gov, which has seen 493,216 new enrollees compared to 354,137 for the same time period last year.

“Providing quality, affordable health care options remains a top priority,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “The numbers prove that our focus is in the right place.”

The new signups come as the Biden administration made new investments in expansions for marketing and outreach, including record-setting funding for the ACA navigator program. Administration officials are hoping for another robust period of signups thanks to enhanced subsidies to lower insurance costs. 

“Four out of five people will be able to find a plan for $10 or less after tax credits,” CMS said. 

The boosted tax credits were supposed to expire after this year but have been extended into 2025 by the Inflation Reduction Act.

The 2022 coverage year saw a record 14.5 million signups. The latest open enrollment for HealthCare.gov for 2023 coverage will run through Jan. 15.

Congressional control still undecided, but voters protect and expand state-level healthcare access in midterms

Posted on by • Posted in ACA, Election, Health Insurance Coverage Adequacy, Health Policy, Healthcare Reform, Medicaid Expansion, Reproductive Rights, Roe v. Wade, Underinsured, Uninsured • Leave a comment

https://mailchi.mp/cfd0577540a3/the-weekly-gist-november-11-2022?e=d1e747d2d8

While the final balance of the House and Senate are still unknown after Tuesday’s midterm elections, both chambers are expected to be narrowly divided. 

Ballot initiatives on reproductive health produced more unambiguous results, with three states—California, Michigan, and Vermont—amending their constitutions to affirm reproductive rights, and two states—Kentucky and Montana—voting down proposals that would have imposed greater legal barriers to abortion access. South Dakota became the seventh, and likely final, state to expand Medicaid via ballot initiative, making an additional 28K South Dakotans eligible for coverage, and reducing the number of states that have yet to expand Medicaid to 11.

The Gist: Democrats beat expectations, bucking historical trends in which midterm voters swing strongly against the President’s party. But healthcare did not feature prominently in voters’ choices, with this being the first election in over a decade where the state of the Affordable Care Act and protecting individuals’ access to care and coverage was not a significant choice driver. 

The fallout from the Supreme Court’s decision in June to overturn Roe v. Wade had a clear impact on voter turnout, with abortion tying inflation for voters’ top concern in exit polls. At the state level, South Dakota voters approved Medicaid expansion, where over 40 percent of the state’s uninsured adults could now gain access to coverage—another clear sign that voters, regardless of party affiliation, are behind the ACA’s expanded vision for the safety net program. 

Moving forward, a closely divided Congress is unlikely to take on significant healthcare legislation, regardless of who ultimately holds the House and Senate.