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Covered CA enrollment expected to drop as penalty ends
https://www.modbee.com/living/health-fitness/article220347880.html
Covered California’s fall enrollment period will show whether peace of mind is a motivation for people to keep their health insurance next year.
Last year, Congress passed legislation that in 2019 erases the federal tax penalty for people without coverage.
Without the threat of a penalty, Covered California, the state’s health exchange, estimates that 12 percent of its customers, or 162,000 residents, will leave the program and an additional 100,000 who purchase insurance from brokers in the state will discontinue coverage.
Affordable Care Act supporters believe there are sound reasons for the 1.4 million consumers in the program to stay insured — to protect themselves against crushing medical bills at rates subsidized by the federal government.
Almost 70,000 residents in a five-county pricing region, including Stanislaus, San Joaquin, Merced, Mariposa and Tulare counties, are covered on the exchange and 95 percent of them receive help with monthly premiums. About 18,000 are covered in Stanislaus County.
“Certainly it’s possible some will roll the dice and decide to go without coverage,” James Scullary, a Covered California spokesman, said Friday. “People generally want health insurance. They want to have that peace of mind of coverage in case of an injury or illness.”
The anticipated departure of some consumers from the pool accounts for part of an 8.7 percent average rate increase next year for Obamacare plans offered by 11 insurers in California. On average, those insurers tacked an extra 3.5 percent onto next year’s rates due to projected costs of serving a smaller, less healthy customer base when the tax penalty ends.
Individuals and families whose premiums are subsidized will see small increases because higher premiums are triggers for larger federal tax credits. It will serve to pass $250 million in additional costs to the federal government. Individuals earning between $16,754 and $48,560 a year are eligible for subsidized rates and the same applies to a family of four with income between $34,638 and $100,400 a year.
Those not eligible for subsidies will be stung by the rate increases, projected at almost 7 percent in the five-county region. A state bill to help middle-income households buy costly insurance on the individual market failed to pass this year.
The enrollment period for 2019 opened last week and runs through Jan. 15. The enrollment deadline is Dec. 15 for coverage to take effect Jan. 1.
A 40-year-old adult earning $35,000 a year can purchase a standard Silver plan for monthly costs ranging from $187 to $376, according to Covered California’s “shop and compare” online tool. Anthem Blue Cross, Kaiser Permanente, Blue Shield of California and HealthNet are the four insurance carriers offering the metal tier plans (Bronze to Platinum) in this region.
For a family of four with annual income of $62,500, monthly costs for Silver coverage will range from $254 to $625, depending on what plan is chosen. In that scenario, the two children may be eligible for free or low-cost care through the Medi-Cal program and the parents could receive extra help for co-payments.
Some residents not eligible for subsidies settle for the skimpy Bronze coverage through Covered California. A 55-year-old with $60,000 annual income will pay from $535 to $821 a month for Bronze plans next year. The cheapest Bronze HMO requires 40 percent co-pays for primary care visits and generic drugs; the annual out-of-pocket maximum is $6,000.
Citing data from Covered California’s consumer pool, Scullary said that 1.2 million customers have needed some health care and 153,000 have been protected from claims ranging from $5,000 to $50,000. Scullary said 15,000 consumers were shielded from health care costs over $50,000 and 42 people had claims in excess of $1 million.
The state exchange will promote enrollment this fall through an advertising campaign and a bus tour beginning after the November election, the spokesman said. The agency has local partners and certified brokers across the state to assist consumers with choosing suitable plans.
Covered California has a Monday-to-Saturday customer service line at 800-300-1506. Enrollment information is available at www.coveredca.com.
What’s at Stake for Health Care in Your District This Midterm Election?
What’s at Stake for Health Care in Your District This Midterm Election?
On November 6, 2018, Californians will head to the polls to vote for who will represent them in Congress. The outcome of races could have significant implications for health care in California and nationwide. Major policies at stake include the Affordable Care Act (ACA), the Medicaid program (called Medi-Cal in California), and protections for those with preexisting conditions.
What’s at stake for California?
- 1.4 million Californians purchase coverage through Covered California, the health insurance marketplace established under the ACA. Close to 90% receive federal subsidies to help them afford their premiums.
- 13.5 million Californians are covered by Medi-Cal.
- 6.7 million Californians would have lost coverage by 2027 if the last attempt by Congress to repeal the ACA and cut Medicaid (through a proposal called Graham-Cassidy) had passed. It is widely anticipated that a future attempt to repeal the ACA would be modeled after Graham-Cassidy.
- 550,000 fewer jobs would have been created in California by 2027 if Graham-Cassidy had passed.
- 16.7 million nonelderly Californians are estimated to live with a preexisting condition.
What’s at stake in your district?
Community hospitals fight for survival amid ‘precarious’ financial outlook
Many of the struggles facing hospitals and health systems are worse for community hospitals that often resort to drastic measures to keep their doors open, according to the North Bay Business Journal.
Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, called the financial situation of most community hospitals “precarious at best,” partially because of low reimbursement rates from government payers, such as those made via her state’s MediCal Medicaid program.
“There’s a host of challenges that all hospitals face, but particularly these small, independent hospitals,” said Ms. Emerson-Shea. “Some of these hospitals file bankruptcy, some shut altogether, some are able to go to local voters, and some affiliate with larger healthcare systems that have the ability to keep them open and provide them access to capital.”
Sonoma (Calif.) Valley Hospital, a 75-bed facility, has been busy this year making moves to stay afloat. his year the hospital closed its obstetrics unit, finalized an affiliation agreement with the University of California San Francisco Health and transferred ownership of its home healthcare service to Hospice by the Bay, a UCSF affiliate.
“It’s become clear that a community hospital can no longer try to be all things to all people, but must refocus on essential community needs,” said Kelly Mather, president and CEO of Sonoma Valley Hospital. “We’re all facing the same issues.”
On the Rise – Out-of-Pocket Healthcare Spending in 2017
Leveraging financial transaction data, the JPMorgan Chase Institute provides a unique cash flow view of families’ healthcare out-of-pocket spending and financial burden. In 2017 we released the first estimates of out-of-pocket healthcare spending levels and burden at the state and county level from 2013 to 2016, from our JPMorgan Chase Institute Healthcare Out-of-pocket Spending Panel (JPMCI HOSP) data asset. In this new report, we describe enhancements to, and key findings from, the updated JPMCI HOSP data asset that includes the first available estimates of 2017 healthcare out-of-pocket spending trends, as well as a first-ever look at year-over-year trends at the state and county level and for different demographic groups.
Our key findings are:
Finding 1: Year-over-year growth in out-of-pocket healthcare spending levels accelerated since 2014 to 8.5 percent in 2017. The burden of healthcare spending as a percent of take-home income ticked up slightly.
Finding 2: In 2017 high-income families experienced the fastest growth in healthcare spending, while low-income families experienced the highest growth in healthcare spending burden.
Finding 3: In 2017, families in Utah spent the most on and were the most burdened by out-of-pocket healthcare spending, while families in California saw the highest growth in spending levels.
Finding 4: Out-of-pocket healthcare spending grew the most at hospitals and ‘other’ healthcare providers and decreased at drug stores for the third consecutive year.
Arizona hospital rebrands after bankruptcy
Green Valley (Ariz.) Hospital has emerged from the bankruptcy process with a new owner and a new name, according to the Arizona Daily Star.
Green Valley Hospital entered Chapter 11 bankruptcy in early 2017 and received permission from the bankruptcy court to sell its assets. In January, Lateral GV, part of equity firm Lateral Investment Management, submitted the winning bid for the facility.
In February, the bankruptcy court approved the sale to Lateral GV, and the hospital emerged from bankruptcy in July with a new name: Santa Cruz Valley Regional Hospital.
Although the hospital exited the bankruptcy process, its financial challenges continued. Santa Cruz Valley Regional Hospital laid off 60 employees in July.
The hospital’s financial footing has stabilized over the past few months, and it is now looking to grow its workforce.
“We’re staffed and ready (for the influx in winter population) and look forward to adding more employees back in,” Santa Cruz Valley Regional Hospital CEO Kelly Adams told the Arizona Daily Star.
The hospital may also add more services in the future.
“I talk with patients every day, and they say they’re tired of going to Tucson for their healthcare,” Ms. Adams said. “This encourages us to bring more physicians in and more services.”
Bon Secours’ hospital proposal in Suffolk gets an edge over Sentara’s expansion request
https://pilotonline.com/news/local/health/article_a058693e-d630-11e8-a732-eb28ce327e7d.html
In a race to build-out hospital services in the northern part of Suffolk, Bon Secours has received an edge over Sentara.
State health staff, who reviewed expansion requests from both health care systems this summer, recently provided a recommendation of conditional approval for Bon Secours. Its proposal seeks to add 18 in-patient beds and four operating rooms to a facility at the Harbour View campus.
The plan calls for a two-story, 76,000-square-foot facility on the northeast corner of Bon Secours Drive and Harbour Towne Parkway. Bon Secours executives say it’s an effort to better reach western Hampton Roads patients and establish a short-stay, surgically focused hospital.
Within days of each other, Bon Secours and Sentara filed letters to state health officials seeking permission to add or move beds to their respective northern Suffolk campuses.
Bon Secours filed its letter of intent first to apply for a “certificate of public need” to move hospital beds and a few surgery rooms from its Maryview Medical Center in downtown Portsmouth. Days later Sentara submitted a similar request for in-patient beds, operating rooms and a CT scanner at its Sentara Belleharbour campus on Route 17 Bridge Road.
That plan would involve moving beds from Sentara Obici Hospital. Hospital executives have said the shift would meet patients closer to where they are: About 14 patients at Obici each day are coming from Belleharbour, said Dr. Steve Julian, president of Obici, in a June interview.
But the Sentara project “duplicates” services already available in the district, according to the state’s review, and would contribute further to the hospital system’s market dominance. Staff recommended denial of the request, stating it could be “harmful to competition in the region.”
In a statement issued through a spokesman, Julian said Sentara was disappointed with the review but would consider next steps in the state’s certificate of public need process.
“We believe our application offered the most benefit for the least cost in a hospital-ready building already under construction,” Julian said in the statement.
The competing mini medical center proposals demonstrate how hospital systems vie for turf – and how the state tries to weigh those requests in the balance of keeping health care costs reasonable for patients.
The state health commissioner will render a final decision on the projects later this year.
Two letters of opposition against the Sentara project appear to have factored into the staff’s preference for the Bon Secours plan.
Dr. Joseph Verdirame, former president of the medical staff at Obici, wrote that, since acquiring Obici, Sentara has migrated many resources away from downtown Portsmouth and central Suffolk to Belleharbour and Sentara Norfolk General. He believes those shifts are detrimental to care in central Suffolk.
In another letter, Virginia Slocum, strategic operations planning manager at Chesapeake Regional Healthcare, said Sentara doesn’t have enough competition and that allowing it to spend more on expansion could drive “increases in health care costs” for consumers.
Repeal of ACA on Republican agenda after midterms
Repeal would end the ACA’s most popular provision, to cover those with preexisting conditions.
Republicans could try again to repeal the Affordable Care Act if they win enough seats in the midterm election this November, Senate Republican Leader Mitch McConnell said on Wednesday, according to Reuters.
WHY THIS MATTERS
Providers want to keep the ACA to minimize the cost of uncompensated care from treating individuals who have no insurance.
Insurers this year have turned around earlier losses and exits, expanding their footprint in the market and, in many cases, offering lowering premium rates for 2019.
Studies show most consumers like the ACA but remain confused about the healthcare law, with close to 80 percent unaware that open enrollment starts on November 1.
THE TREND
Republicans last year tried and failed to repeal the ACA. In another attempt to get rid of the individual and employer mandates for coverage, the GOP this summer introduced the “skinny” repeal in the Health Care Freedom Act.
On July 28, Senator John McCain cast the deciding vote when he joined two other Republican senators in voting down the skinny repeal of the ACA that the Congressional Budget Office said could result in 16 million more people becoming uninsured. Provider groups such as America’s Essential Hospitals and the American Medical Association, voiced their approval that the skinny repeal failed.
Republicans got rid of the individual and employer mandates in this year’s budget bill.
The Trump Administration also introduced a less expensive alternative to ACA plans in allowing consumers to buy short-term limited duration plans that offer coverage for up to a year and can be extended for three years. The short-term plans are not mandated by law, as are ACA plans, to cover pre-existing conditions and offer essential benefits.
THEIR TAKE
Republicans have long promised to end the ACA because they say it’s not working.
OUR TAKE
Republicans have been chipping away at Obamacare and the government has drastically cut funds to promote it, but at the same time, the Department of Health and Human Services has helped to stabilize the market. Most significantly, it has allowed insurers to silver load plans to apply full premium increases to silver plans in the ACA to make up for the loss of cost-sharing reduction payments that were eliminated by President Trump. Since nine out of 10 consumers get tax subsidies for buying plans, this move was essentially subsidized by the federal government.
Even if the GOP retains its majority this November, repeal of the ACA will be an uphill battle. It would end the ACA’s most popular provision to cover those with preexisting conditions.
President Trump tweeted on Friday his support of protecting those who have preexisting conditioins saying. “All Republicans support people with pre-existing conditions, and if they don’t, they will after I speak to them. I am in total support. Also, Democrats will destroy your Medicare, and I will keep it healthy and well!”
CMS announces new waiver flexibility in ACA market
States will have the ability to allow individuals to use ACA subsidies when buying short-term limited duration plans.
States are getting new flexibility in waivers to the Affordable Care Act, including being able to target ACA subsidies for individuals who want to buy short-term, limited duration plans, Centers for Medicare and Medicaid Services Administrator Seema Verma said today.
What is not flexible is protecting access to coverage to those with pre-existing conditions.
Verma gave no specifics on the types of waivers that will be considered, but said the agency was preparing to release a series of waiver concepts. More specifics are expected to be released in the coming weeks.
The policy goes into effect today but is expected to impact states next year, for the 2020 plan year.
IMPACT
The effect of the waivers will likely not be known until next year.
But the allowance of short-term insurance as an ACA alternative could have a more immediate effect as consumers choose plans during open enrollment starting November 1.
The Trump Administration this year extended the length of short-term plans from three months to one year, with an extension allowed for up to three years. Because these plans would not be obligated to cover the essential benefits mandated under the ACA, premiums are expected to be lower.
Opponents have said this would cause an exodus of healthy consumers from the traditional ACA market and rising prices for those left behind.
THE TREND
CMS has been taking credit for stabilizing the ACA market and lowering premiums through the use of waivers and by easing regulations.
For instance, reinsurance waivers have helped reduce premium costs, CMS said. To date, CMS has approved eight state waivers, and all but one have been a reinsurance waiver for states to develop high-risk pools to help pay the cost of high claims.
The reason for the lack of other approved waivers is due to the previous Administration limiting the types of state waiver proposals that the government would approve, CMS said.
The new Section 1332 waivers, called state relief and empowerment waivers, will allow states to “get out from under onerous rules of Obamacare,” Verma said.
WHAT ELSE YOU NEED TO KNOW
Under Section 1332 of the ACA, states can waive certain provisions of the law as long as the new state waiver plan meets specific criteria, or “guardrails,” that help guarantee people retain access to coverage that is at least as comprehensive and affordable as without the waiver; covers as many individuals; and is deficit neutral to the federal government.
The new waivers should aim to provide increased access to affordable private market coverage; encourage sustainable spending growth; foster state innovation; support and empower those in need; and promote consumer-driven healthcare, CMS said.
ON THE RECORD
“Now, states will have a clearer sense of how they can take the lead on making available more insurance options, within the bounds of the Affordable Care Act, that are fiscally sustainable, private sector-driven, and consumer-friendly,” said Health and Human Services Secretary Alex Azar.
“The Trump Administration inherited a health insurance market with skyrocketing premiums and dwindling choices,” said CMS Administrator Seema Verma. “Under the president’s leadership, the Administration recently announced average premiums will decline on the federal exchange for the first time and more insurers will return to offer increased choices.
“But our work isn’t done. Premiums are still much too high and choice is still too limited. This is a new day — this is a new approach to empower states to provide relief. States know much better than the federal government how their markets work. With today’s announcement, we are making sure that they have the ability to adopt innovative strategies to reduce costs for Americans, while providing higher quality options.”
HENRY KOTULA 