Medicaid nearing ‘eye of the storm’ as newly unemployed look for coverage

https://www.fiercehealthcare.com/payer/medicaid-nearing-eye-storm-as-newly-unemployed-look-for-coverage?mkt_tok=eyJpIjoiTXpaa1pEa3pOVGN5T1RnMiIsInQiOiJNbUdDbys5YmFjZDh2MjB2WTd6T0ZRTUg1cGlIYnAyTjNhdzBHdnpEblpZVGxjZEpQM0xPSEFvVG9RdGJQbzdcL21KcmxGV2Vkb1RzWTQ4TnlQQlcxU1BIMXkrZEFMRWwxUDZpTGdpQVlpMVJMR01CRWFDMk1OSGpRSDlLK3RNUTEifQ%3D%3D&mrkid=959610

Medicaid nearing 'eye of the storm' as newly unemployed look for ...

As the coronavirus roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed. That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers.

The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and healthcare in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.

“Medicaid is absolutely going to be in the eye of the storm here,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “It is the backbone of our public health system, our public coverage system, and will see increased enrollment due to the economic conditions.”

Meeting those needs will require hefty investments―both in money and manpower.

Medicaid—which is run jointly by the states and federal government and covers about 70 million Americans―is already seeing early application spikes. Because insurance requests typically lag behind those for other benefits, the numbers are expected to grow in the coming months.

“We have been through recessions in the past, such as in 2009, and saw what that meant,” said Matt Salo, who heads the National Association of Medicaid Directors. “We are going to see that on steroids.”

The majority of states have expanded their Medicaid programs since 2014 to cover more low-income adults under a provision in the Affordable Care Act (ACA). That may help provide a cushion in those areas. In the 14 states that have chosen not to expand, many of the newly unemployed adults will not be eligible for coverage.

It’s possible the pandemic could change the decision-making calculus for non-expansion states, Salo said. “The pandemic is like a punch in the mouth.”

But even without expansion in those states, the Medicaid rolls could increase with more children coming into the system as their families’ finances deteriorate. Many states don’t have the resources or systems in place to meet the demand.

“It is going to hit faster and harder than we’ve ever experienced before,” Salo said.

The unique circumstances of social distancing impose new challenges for those whose jobs are to enroll people for coverage. In California, where more than a million people have filed for unemployment insurance since March 13, much of the workforce that would typically be signing people up and processing their paperwork is now working from home, which adds a layer of complexity in terms of accessing files and documents, and can inhibit communication.

“It’s going to be certainly more difficult than it was under the [2008] recession,” said Cathy Senderling-McDonald, deputy executive director for the County Welfare Directors Association of California. She said that although strides have been made in the past decade to set up better online forms and call centers, it will still be a heavy lift to get people enrolled without seeing them in person.

In some states, the challenges to the system are already noticeable.

Utah, for instance, has seen a 46% increase in applications for Medicaid. (These applications can be for individuals or families.) In March 2019, about 14,000 people applied. This March, it was more than 20,400.

“Our services are needed now more than ever,” said Muris Prses, assistant director of eligibility services for the Utah Department of Workforce Services, which processes Medicaid enrollment. The state typically takes 15 days to determine whether someone is eligible, he said, though that will increase by several days because of the surge in applicants and some staff working at home.

In Nevada, where the hotel- and casino-dominated economy has been hit particularly hard, applications for public benefits programs, including food stamps and Medicaid, skyrocketed from 200 a day in February to 2,000 in mid-March, according to the state Department of Health and Human Services. The volume of calls to a consumer hotline for Medicaid and health coverage questions is four times the regular amount.

In Ohio, the number of Medicaid applications has already exceeded what’s typical for this time of year. The state expects that figure to continue to climb.

States that haven’t yet seen the surge warned that it’s almost certainly coming. And as layoffs continue, some are already experiencing the strains on the system, including processing times that could leave people uninsured for months, while Medicaid applications process.

For 28-year-old Kristen Wolfe, of Salt Lake City, who lost her job and her employer-sponsored health insurance March 20, it’s a terrifying time.

Wolfe, who has lupus—an autoimmune disorder that requires regular doctor appointments and prescription medication―quickly applied for Medicaid. But after she filled in her details, including a zero-dollar income, she learned the decision on her eligibility could take as long as 90 days. She called the Utah Medicaid agency and, after being on hold for more than an hour, was told they did not know when she would hear back.

“With my health, it’s scary to leave things in limbo,” said Wolfe, who used her almost-expired insurance last week to order 90-day medication refills, just in case. “I am pretty confident I will qualify, but there is always the ‘What if I don’t?’”

Others have reported smoother sailing, though.

Jen Wittlin, 33—who, until recently, managed the now-closed bar in Providence, Rhode Island’s Dean Hotel―qualified for Medicaid coverage starting April 1. She was able to sign up online after waiting about half an hour on the phone to get help answering specific questions. Once she receives a check for unemployment insurance, the state will reassess her income—currently zero―to see if she still qualifies.

“It was all immediate,” she said.

In fact, she said, she is now working to help newly uninsured former colleagues also enroll in the program, using the advice the state gave her.

In California, officials are trying to reassign some employees—who are now working remotely―to help with the surge. But the system to determine Medicaid eligibility is complicated and requires time-intensive training, Senderling-McDonald said. She’s trying to rehire people who’ve retired and relying on overtime from staffers.

“It’s hard to expand this particular workforce very, very quickly by a lot,” she said. “We can’t just stick a new person in front of a computer and tell them to go. They’re going to screw everything up.”

The move away from in-office sign-ups is also a disadvantage for older people and those who speak English as a second language, two groups who frequently felt more comfortable enrolling in person, she added.

Meanwhile, increasing enrollment and the realities of the coronavirus will likely create a need for costly medical care across the population.

“What about when we start having many people who may be in the hospital, in ICUs or on ventilators?” said Maureen Corcoran, the director of Ohio’s Medicaid program. “We don’t have any specific answers yet.”

These factors will hit just as states―which will experience shrinking tax revenue because of the plunging economy—have less money to pay their share of the Medicaid tab.

“It’s all compounded,” said Lisa Watson, a deputy secretary at Pennsylvania’s Department of Human Services, which oversees Medicaid.

The federal government pays, on average, about 61% of the costs (PDF) for traditional Medicaid and about 90% of the costs for people who joined the program through the ACA expansion. The rest comes from state coffers. And, unlike the federal government, states are constitutionally required to balance their budgets. The financial squeeze could force cuts in other areas, like education, child welfare or law enforcement.

On March 18 (PDF), Congress agreed to bump up what Washington pays by 6.2 percentage points (PDF) as part of the second major stimulus bill aimed at the economic consequences of the pandemic. That will barely make a dent, Salo argued.

“The small bump is good, and we are glad it’s there, but in no way is that going to be sufficient,” he said.

 

 

 

Coronavirus exposing holes in employer insurance

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The coronavirus is exposing the holes in employer health insurance ...

A record 3.3 million people filed for unemployment in one week, in the wake of the coronavirus outbreak, but people didn’t just lose their jobs. Many also lost the health insurance that came with the job, Axios’ Bob Herman reports.

Why it matters: U.S. workers, even those who feel relatively secure in their health benefits, are a pandemic away from falling into the ranks of the uninsured.

Many of the people losing their jobs right now may not have had coverage to begin with — which would make the coronavirus-related disruption smaller, but still highlights the very large holes in this system.

  • The concern: People who get the virus but don’t have insurance are susceptible to high medical bills, or even death if they avoid or are denied treatment.

The big picture: People who lose their jobs have some options.

  • COBRA: This option allows people to keep their employer coverage for up to 18 months. However, people have to pay the full insurance premium — an average of $1,700 a month for a family plan.
  • Medicaid: State Medicaid agencies determine eligibility on current income, so this may be the easiest, lowest-cost way for people to get health coverage.
  • Affordable Care Act plans: The health care law created marketplaces for coverage, and people who lose their jobs can sign up outside the standard enrollment window.
  • Short-term plans: These stopgap plans, promoted by the Trump administration, provide some coverage but often don’t cover major hospitalizations.

 

 

 

 

KHN’s ‘What The Health?’: The Affordable Care Act Turns 10

KHN’s ‘What The Health?’: The Affordable Care Act Turns 10

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The past decade for the health law has been filled with controversy and several near-death experiences. But the law also brought health coverage to millions of Americans and laid the groundwork for a shift to a health system that pays for quality rather than quantity.

Yet the future of the law remains in doubt. Many progressive Democrats would like to scrap it in favor of a “Medicare for All” system that would be fully financed by the federal government. Republicans would still like to repeal or substantially alter it. And the Supreme Court recently accepted another case that could invalidate the law in its entirety.

In this special episode of KHN’s “What the Health?” host Julie Rovner interviews Kathleen Sebelius, who was secretary of Health and Human Services during the development, passage and implementation of the health law.

Then Rovner, Joanne Kenen of Politico and Mary Agnes Carey of Kaiser Health News, who have all covered the law from the start, discuss the ACA’s past, present and future.

Among the takeaways from this week’s podcast:

  • Although the creation of the ACA is often attributed to the Obama administration and the Democratic Congress at the time, work on a health care plan actually began well before then with small-group meetings among stakeholders, congressional hearings across the country and efforts by Sen. Ted Kennedy to galvanize interest. Much of those interactions were bipartisan and included industry leaders too.
  • Despite the vehement Republican opposition to the ACA and its many critical junctures (the death of Kennedy and his replacement by Republican Scott Brown; two tight Supreme Court decisions; and the calamitous debut of the marketplace website, among other issues), the law has proved popular. When Republicans gained control of the White House and Congress, their efforts to repeal the law helped focus consumers’ interest on the law and safeguard it.
  • How will the November election affect the law? If President Donald Trump is reelected, he is unlikely to renew the effort to repeal the law, but that doesn’t mean the assault on the law is over. Efforts to change the ACA could continue through the courts and through administrative rulemaking.
  • If a Democrat is elected, modifications to the law are generally expected to be incremental and perhaps deal with changes such as expanding the number of people getting subsidies and fix some glitches in the law.

 

 

 

Ten Years After: The ACA’s Success in Five Charts

Ten Years After: The ACA’s Success in Five Charts

 

 

 

Taking a look at the Biden healthcare plan

https://mailchi.mp/325cd862d7a7/the-weekly-gist-march-13-2020?e=d1e747d2d8

 

Now that the Democratic primary campaign has produced a clear front runner, it’s worth examining Joe Biden’s healthcare plan, which aims to expand the Affordable Care Act (ACA) by increasing access and affordability. As the graphic above highlights, former Vice President Biden has a broad—if at this point, still fairly high-level—proposal that includes a Medicare-like public option along with a variety of other ACA tweaks that aim to offer consumers more options and lower their healthcare costs.

These include allowing individuals in states without Medicaid expansion to join the pubic option premium-free, providing unlimited subsidy eligibility, and limiting drug price increases to the level of consumer inflation.

An independent analysis projects Biden’s plan would cost $2.25T and add an additional $800B to the deficit over 10 years. While large at first blush, these costs pale in comparison to Sen. Bernie Sanders’ Medicare for All plan, which would add a projected $12.95T to the deficit over the same period.

Of course, there are still many unanswered questions in Biden’s proposal, including how much consumers would pay under the public option, how much the public option plan would reimburse providers as a percentage of Medicare, and how the public option would impact competition among private insurers.

A public option offered at a significant discount has the potential to drive private plans out of business, which some project could eventually result in Medicare for All as an ultimate consequence. The devil will, as always, be in the details.

 

Winners and losers of the HHS interoperability final rule

https://www.beckershospitalreview.com/ehrs/winners-and-losers-of-the-hhs-interoperability-final-rule.html?utm_medium=email

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HHS released its much-anticipated final rules on EHR interoperability, ruling against “information blocking” tactics by EHR vendors and giving patients more control over their medical records.

The new rule will be applied over the next two years and will make patient records downloadable to smartphones using consumer apps. Overall, members of the healthcare industry applaud these efforts to make patient information more accessible to improve healthcare delivery. However, there are privacy concerns around how patient data can be used once downloaded to third-party consumer apps that weren’t addressed in the final rule.

Here is a brief list of a few potential winners and losers of the new rule.

 

WINNERS

Patients. Patients now have more control over their medical records and will be able to access them through third-party apps for free, which will make it easier for them to take their medical records to new providers outside of their previous provider’s system. As a result, they will have more choice in where they go for healthcare.

Hospitals and physicians. The lengthy process of trying to convert a patient’s medical records will be unnecessary. Patients will no longer need to have their medical records faxed between healthcare facilities in different networks and the rule will streamline workflow around gathering patient data to provide the best possible care. Hospitals participating in Medicare and Medicaid will also be able to send electronic notifications to other facilities or providers when a patient is admitted, transferred or discharged under its new “Coordination of Participation” rule.

App developers and health IT startups. App developers that allow patients to store their health data and medical information will have access to that data, a virtual gold mine. The federal privacy protections limiting how providers and insurers share medical records do not apply when patients transfer data to consumer apps, according to the New York Times.

Apple and Microsoft. Healthcare providers will be required to send medical data in a format that is compatible on third-party apps including Apple Health Records. Microsoft is also working to sell technology in the health sector, and the new rule will make it easier, according to CNBC.

 

LOSERS

Patients. While the rule has many benefits to patients, there is also potential for disaster. Patients who download their medical information on consumer apps may find their information shared or sold. There could also be additional security issues if those apps are hacked. Finally, some patients may become confused by their medical records and notes if the information isn’t stated clearly, causing further anxiety around their care.

Hospitals and clinics. Patient leakage may become more common if it’s easier for patients to take their medical records with them. Healthcare organizations will also need to prepare for an influx of patient data and have strong governance procedures in place as they partner with payers and other organizations to incorporate clinical data with patient-gathered data and potentially social determinants of health data.

EHR vendors. EHR companies must now adopt application programming interfaces so their systems can communicate with third-party apps. EHR companies have two years to comply and face up to $1 million per violation for engaging in “information blocking.” The new focus on interoperability may also pave the way for competitors to gain market share over the two most dominant players, Epic and Cerner.

Epic. Epic was a notable opponent to the HHS interoperability rules, citing patient privacy concerns. If forced to collaborate with other companies, Epic could potentially lose its edge over competitors, according to an op-ed written by former HHS Secretary Tommy Thompson in the Wisconsin State Journal. He contended Epic would have to “give its trade secrets away to venture capitalists, Big Tech, Silicon Valley interests and overseas competitors for little or no compensation.” Epic is also the most dominant EHR, holding 28 percent of the acute care hospital market, which could be threatened by greater interoperability. However, in response to the final rule’s release, Epic issued a statement saying that it would focus on “standards-based scope for meaningful interoperability.”

 

US Supreme Court Agrees to Review Affordable Care Act — for the Third Time

US Supreme Court Agrees to Review Affordable Care Act — for the Third Time

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The fate of the Affordable Care Act (ACA) is once again in the hands of the US Supreme Court. On March 2, the court announced that it would hear a case challenging the health law, a wide-ranging measure that “touches the lives of most Americans, from nursing mothers to people eating at chain restaurants,” wrote Reed Abelson, Abby Goodnough, and Robert Pear in the New York Times. This will be the third time the court will rule on the ACA since President Barack Obama signed it on March 23, 2010.Essential Coverage

“The justices will review a federal appeals court decision that found part of the law . . . unconstitutional and raised questions about whether the law in its entirety must fall,” reported Robert Barnes in the Washington Post. He noted that it is one of the first cases accepted for the Supreme Court term beginning October 5, which means a decision is not likely until spring or summer of 2021.

Should the court overturn the ACA, many Americans would lose the benefits afforded under the law. As Dylan Scott wrote in Vox, “everything would go: protections for preexisting conditions, subsidies that help people purchase insurance, the Medicaid expansion.”

Let’s break down each of those categories.

Protections for Preexisting Conditions

Before the ACA, people with preexisting conditions, which included common medical conditions like asthma, diabetes, and cancer, were denied health insurance or charged higher insurance premiums. Important benefits like maternity care and mental health services frequently were carved out of the benefit packages in health plans sold in the individual market — that is, outside of employer-sponsored coverage. An issue brief (PDF) by the Department of Health and Human Services estimated that up to 133 million nonelderly Americans have a preexisting condition.

As Andy Slavitt, the former administrator of the Centers for Medicare & Medicaid Services under President Obama, wrote on Twitter, examples of being charged more included “$4,270 more for asthma, $17,060 for pregnancy, and $160,510 for metastatic cancer.”

Under the ACA, insurers are no longer allowed to deny coverage or charge higher prices to people with preexisting conditions. But if the Supreme Court rules against the ACA, these protections would vanish.

Medicaid Expansion

A key provision of the ACA is expanded eligibility for enrollment in Medicaid, a federally funded state option adopted so far by 36 states and the District of Columbia. More than 12 million adults with low incomes have gained Medicaid coverage through this provision, and research comparing expansion and nonexpansion states has linked expanded Medicaid access to better health outcomes.

According to the Urban Institute, if the ACA is repealed, “the uninsurance rate across all expansion states would increase from 9% of the nonelderly under current law to 17% under repeal. In nonexpansion states, the uninsurance rate would increase from 15% of the nonelderly to 21%.” Many of the newly uninsured would be the result of losing the Medicaid coverage the ACA provided.

“The uninsured rate for Black Americans would increase from 11% to 20% without Obamacare,” Scott reported. “There would also be a dramatic spike in uninsurance among Hispanics.”

Subsidies to Help People Purchase Insurance

To expand access to affordable health insurance for those who can’t get it through their jobs, the ACA offers federal subsidies to people with low and moderate incomes who buy insurance through the ACA insurance exchanges. The subsidies take the form of premium tax credits and cost-sharing subsidies.

Approximately 9.2 million Americans receive federal subsidies, reported Abelson, Goodnough, and Pear. “On average, the subsidies covered $525 of a $612 monthly premium for customers in the 39 states that use the federal marketplace,” they wrote.

If the ACA is overturned and the subsidies are eliminated, the cost of health insurance would become unaffordable for many of those 9.2 million people, and the uninsured population would soar.

Polls Show Public Support for the ACA

According to the February 2020 KFF Health Tracking Poll, 55% of Americans say they now favor the ACA, a new high compared to approval ratings below 40% as recently as 2016. Today 85% of Democrats express favorable views of the law, compared to 53% of independents and 18% of Republicans.

Though overall support for the health law remains partisan, many of its provisions have broad bipartisan support, KFF staff wrote in Health Affairs. For instance, large majorities of Democrats (94%), independents (88%), and Republicans (77%) have a favorable view of the ACA’s health insurance exchanges, and most Democrats (80%), independents (71%), and Republicans (54%) view the Medicaid expansion favorably.

Rising Health Costs Worsen California’s Coronavirus Threat

The global spread of the novel coronavirus disease known as COVID-19 puts threats to the ACA into perspective. Despite the coverage gains made under the ACA, nearly 28 million Americans remain uninsured, and that number would rise if the law were overturned. As Chris Sloan, associate principal at the consulting firm Avalere Health, told Caitlin Owens in Axios, we “could see uninsured or underinsured patients . . . skipping necessary treatment because they believe they can’t afford it.”

“Some lawmakers are concerned that the tens of millions who are underinsured — Americans with high deductibles or limited insurance — may also be at risk of unexpected expenses as more and more people are exposed to the virus,” Reed Abelson and Sarah Kliff reported in the New York Times.

Kristof Stremikis, director of CHCF’s market analysis and insight team, wrote in a recent blog post, “In an era when the average deductible facing a working family in California now exceeds $2,700, it’s not hard to imagine how many people missed detection and treatment opportunities because they could not afford to pay for them.”

To address some of these concerns, the California Department of Insurance (PDF) and the Department of Managed Health Care (PDF) directed all commercial health plans and Medi-Cal plans to “immediately reduce cost-sharing (including, but not limited to, co-pays, deductibles, or co-insurance) to zero for all medically necessary screening and testing for COVID-19, including hospital, emergency department, urgent care, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.”

Similar policies have been announced by state regulators in Washington and New York, the San Francisco Chronicle reported.