Category Archives: Uncategorized

Taxpayers Will Pay the Price for Uncertainty Over Obamacare in 2018

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

https://www.thefiscaltimes.com/2017/08/10/Taxpayers-Will-Pay-Price-Uncertainty-Over-Obamacare-2018

The health insurance industry remains in the throes of a largely unnecessary crisis of confidence, according to an analysis released by the Kaiser Family Foundation on Thursday.

With the open enrollment period approaching for Obamacare insurance plans sold through state exchanges, Kaiser Foundation experts were able to analyze the proposals for 2018 submitted by insurance companies to 20 states and the District of Columbia — the only places where enough information is made public to allow an assessment of what health care costs would look like for an average policyholder under the insurers’ requested rate structures.

“Insurers attempting to price their plans and determine which states and counties they will service next year face a great deal of uncertainty,” the authors wrote. “They must soon sign contracts locking in their premiums for the entire year of 2018, yet Congress or the Administration could make significant changes in the coming months to the law – or its implementation – that could lead to significant losses if companies have not appropriately priced for these changes. Insurers vary in the assumptions they make regarding the individual mandate and cost-sharing subsidies and the degree to which they are factoring this uncertainty into their rate requests.”

What that means for consumers is a bit of a mixed bag. Almost all insurers are seeking rate increases, with some approaching a 50 percent jump. But the actual impact on consumers varies depending on where they buy their insurance and how much money they earn. One thing is for sure, though: The federal government, and therefore taxpayers, will be on the hook for larger subsidy payments.

Because the majority of Americans obtain health insurance through an employer-sponsored plan or from federal programs like Medicare and Medicaid, the impact of the premium increases of exchange-based policies will mean little to a large element of the population.

Of those who buy insurance on the exchanges, the overwhelming majority receive tax credits meant to keep their premium payments to a specific fraction of their annual income. The remaining 16 percent, depending on their income, receive either a smaller subsidy or no subsidy at all. It is these people who, if they live in some of the regions facing large premium increases, who will be hurt the most.

The Kaiser study gathered information from the largest city in each of the 20 states plus the District of Columbia. (Benchmark levels for tax credits are based on the second-cheapest Silver Level plan available in the largest city in a state.) They estimated the change in costs for a 40-year-old non-smoker earning $30,000 a year.

In only one state was the annual premium expected to fall in 2018: Rhode Island, which anticipates a 5 percent drop. Vermont’s premiums will remain static in 2018 if the data holds. The other 19 states can all expect increases, from a modest 3 percent in Michigan to a whopping 49 percent in Delaware.

The average increase in the data collected by Kaiser is 17 percent.

However, none of those costs would be passed on to the consumer making $30,000 a year. In fact, because of adjustments to the tax credit, he could expect to see monthly costs fall by 3 percent, to $201, next year, regardless of what premium levels do where he lives.

But somebody has to pay when premiums go up, and if it isn’t the consumer, it’s the Treasury and by extension, the taxpayer.

The change in premium payments required to keep that 40-year-old’s health insurance premium at $201 per month will increase very sharply in many states, depending greatly on how far from the premium cap a silver plan was in 2017.

In Washington State, according to Kaiser, the premium tax credit would increase 239 percent, from $31 per month to $105. In New Mexico, it would jump 183 percent, from $51 to $144. In Rhode Island it would fall 13 percent, while in Vermont it would rise a modest 2 percent. On average, though, the amount of premium payment picked up by the federal government will increase by about 63 percent in the states reviewed by Kaiser.

Perversely, as Kaiser points out, that fiscal wound is largely self-inflicted. While it is impossible to gauge just how much of this year’s rate increases are attributable to insurers being nervous about whether the federal government would slash support payments in the middle of the 2018 policy year, the answer is surely non-trivial, and the dollars are coming out of the pockets of taxpayers.

Bipartisanship is Back: Congressional Cooperation Suggests Momentum is Growing for Aging Reforms

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://altarum.org/health-policy-blog/bipartisanship-is-back

In a much-discussed early-morning vote on July 28, the U.S. Senate voted decisively to move in a different direction on health care, sending a clear signal that future reform efforts will likely have to be bipartisan. Affirmation came on August 1, when Sens. Lamar Alexander of Tennessee and Patty Murray of Washington, the Senate Health Committee’s top ranking Republican and Democrat, announced bipartisan hearings will begin this fall on possible policy solutions for American consumers and insurers participating in state exchanges.

Yet, beyond the fights over “repeal and replace,” a larger issue is looming: Our health care system is not prepared to care for the age wave—which will come with a surge in need for ongoing, daily assistance. Congressional representatives from both sides of the aisle must work together to plan for burgeoning numbers of  elders and individuals with disabilities, recognizing that there are diminishing numbers of family caregivers, and that the health services and delivery system as currently configured is poorly designed to meet  long-term care needs.

Combining Forces for Better Policy

Fortunately there are stirrings of interest and activity: Rep. Ileana Ros-Lehitnen of Florida, the most senior Republican woman in the House of Representatives, joined Rep. Michelle Lujan-Grisham, a Democrat who served as Aging Secretary in New Mexico before her election to Congress, to introduce the Care Corps Demonstration Act. HR 3494 is a thoughtful measure that is designed to galvanize communities by helping them train and deploy volunteers of all ages, whose mission would be to help aging neighbors, friends, colleagues, and family members thrive in their own homes. Rep. Ros-Lehitnen’s predecessor from the 27th District of Florida was one of Congress’ best-known champions of older adults, Rep. Claude Pepper. Rep. Ros-Lehitnen announced on April 30 that she would not be running for re-election, while Rep. Lujan-Grisham has said she will run for Governor of New Mexico in 2018. Before Reps. Ros-Lehitnen and Lujan-Grisham leave Congress, they are trying to recruit supporters from across the aisle and around the country for the Act, so that it can either find its way into a “must pass” bill, or attract widespread acceptance as a standalone measure.

Here’s what the Care Corps Demonstration Act would do:

  • Invite groups to apply for Care Corps grants and administer the program locally;
  • Train volunteers to support the achievement and maintenance of the highest level of independent living (but not provide professional medical services, administrative support services, or institutional care) and deploy them to communities in need; and
  • Award Corps members living allowances and benefits, including health insurance coverage, during their volunteer period, and offer tuition assistance or loan repayment after completion of their assignment.

“It’s clear that seniors want to remain in their homes and they want control over their own health care,” Rep. Lujan-Grisham noted on introduction. “Most of all, they want to remain as independent as they can, for as long as they can. The same is true for individuals with disabilities. Care Corps will allow them to keep that independence. Unfortunately,” she added, “we’re facing high costs, along with a shortage of direct-care workers, which results in the lack of access to these important services, especially for middle class families. A national Care Corps will help build the workforce, while building intergenerational relationships that allow seniors and young people to learn from each other.”

Addressing the looming shortage of direct care workers is exactly what Rep. Bobby Scott of Virginia’s third congressional district is setting out to do. Next month, the Virginia lawmaker will introduce the Direct Creation, Advancement, and Retention of Employment (CARE) Opportunity Act (or Direct CARE Opportunity Act), which will propose to give the Department of Labor funds to establish advanced care training and mentoring programs and establish career ladders and better job opportunities, for direct care workers in up to 15 parts of the country. “Direct care workers are instrumental in supporting and assisting people across the country, particularly seniors and people with disabilities,” said Rep. Scott. “Moreover, if we invest in the direct care workforce, we invest in a rapidly growing and in-demand field. Growing the number of direct care workers is simply a win-win for investing in both the health of our communities and the jobs of tomorrow.”

PHI, a leading national organization representing and supporting direct care workers, is strongly backing Rep. Scott’s efforts: “Direct care workers are a critical part of delivering quality, person-centered long-term care, and we support this national effort to increase training, improve retention, and enhance the overall quality of jobs for this workforce,” noted Daniel R. Wilson, director of federal affairs.

Additionally, on July 27 Rep. Matt Cartwright of Pennsylvania’s 17th congressional district introduced the Improving Care for Vulnerable Older Citizens through Workforce Advancement Act. “This bill would improve both the quality of jobs for direct care workers nationwide, as well as the care they deliver, by helping to create expanded roles with sufficient training and compensation, and by helping them support people with increased complex conditions, such as Alzheimer’s and related dementias, congestive heart failure, diabetes, and other chronic conditions,”said PHI President Jodi M. Sturgeon.

Creating a System that Can Meet the Needs of Aging Americans

Together, these bills represent crucially needed investments in thinking through how to train more men and women who can serve on the frontlines of a multi-generational society in an era of mass longevity. With a majority of women now in the workforce and smaller and more scattered families quickly becoming the norm, the availability of traditional family caregivers—middle-aged women—is shrinking rapidly. This is giving rise to an urgent need to create a more flexible, community-focused workforce that is prepared to provide targeted supports in home settings on an as-needed basis to an increasing proportion of elders and individuals with disabilities.

Beyond the workforce, there is a need for more policy analysis and research to adapt and revamp existing social insurance programs that are still organized around delivering episodic medical services, and with financing protocols that are designed to pay providers and organizations without regard to the population’s need for ongoing services across a given geographic region or community. Making this shift—from provider-centric financing models to population health models—will also require tweaking payment rules to reward comprehensive, longitudinal services that include long-term care; adjusting performance metrics to emphasize population health and incorporate key social determinants of health factors; better information technology to foster communication across multiple providers and with individuals living at home and their family caregivers; and development of ways to accurately measure need, quality, and supply of services at a community level, with the help of local leaders and experts.

There are signs that lawmakers may rise to the challenge of helping to forge solutions to these issues. In the House, an ad hoc “problem solvers caucus” has surfaced with a set of initial ideas for fixing state exchanges, and the group of roughly 40 lawmakers may continue to hold discussions about other topics. There is solid bipartisan, bicameral work being done in the Assisting Caregivers Today (ACT) caucus on long-term care issues. Parallel caucuses focusing on Alzheimer’s and other types of cognitive impairment have already made excellent contributions to development of policy on “cure” and “care.” These and other budding efforts have the capability, if further developed, to begin contributing ideas necessary to address larger-scale systems challenges in ways that can inspire and complement the work of researchers, advocates, families, providers and stakeholders.

Between now and 2030, the U.S. will change profoundly as mass longevity becomes a central dynamic. To prepare, now is the time to invest and build for long-term care, not disinvest; to map existing assets and use current programs as platforms for improving and making more efficient; and to generally acknowledge gaps and focus work on addressing common goals in a long-lived society.

In summary, evidence-based, high-value health care reform is greatly aided by congressional bipartisanship, but more is needed. To create a value-based system requires the combined efforts of many. Now that bipartisanship is breaking out, let’s get to it!

 

The ACA stability “crisis” in perspective: Premiums Spike for Some Americans

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

https://www.axios.com/the-aca-stability-crisis-in-perspective-2470990374.html

Image result for sharp premium increases?

 

The big questions about the stability of the Affordable Care Act marketplaces have focused on how fast premiums will rise, and how many plans will participate. But an equally important question, and the heart of the matter politically, is: How many people will be affected by the sharp premium increases?

The bottom line: The answer is about 6.7 million Americans who buy coverage in the non-group market in and out of the exchanges, and do not receive premium subsidies. That is a significant number of people, and an urgent policy problem requiring congressional attention and action by the administration, but it’s not a system-wide health insurance crisis. The non-group market has always been the most troubled part of the insurance system, and it was far worse before the ACA.

The breakdown:

  • 17.5 million in the non-group insurance market, including:
  • 10.3 million enrolled in the ACA exchanges
  • Approximately 7.2 million buying insurance off the exchanges
    • Most of this group buys ACA-compliant plans
    • About 1.2 million in “grandfathered” plans purchased before the ACA’s market reforms took effect

Yes, 17.5 million is a sizeable number, and what happens to their health insurance coverage and costs is important. But, to put it in perspective:

  • 156 million get their primary coverage through an employer, where premiums rose a modest 3% last year for family coverage
  • More than 74 million are covered by Medicaid and CHIP.

According to our new analysis of proposed 2018 premium changes in the exchanges, double-digit increases for benchmark silver plans are quite common, though the range across major cities is large, from a 5% decrease in Providence, R.I. to a 49% increase in Wilmington, Del.

A big reason for these increases is the uncertainty in the market surrounding Trump administration policies, especially whether they will let the $7 billion in cost-sharing reduction (CSR) subsidies flow and whether the individual mandate will be enforced.

Who’s getting hit: 84% of the enrollees in the marketplaces – about 8.7 million people – receive premium subsidies under the ACA and are insulated from these premium hikes.

However, roughly 6.7 million people — the ones who buy ACA-compliant plans inside or outside the marketplace and aren’t subsidized — will feel the full brunt of premium increases. They’ll be hit if the uncertainty is not resolved and the rates do not come down before they are finalized.

In many cases, there is as much as a 20 percentage point swing or more in rates depending on whether the CSRs are paid.

The big picture: Dealing with this uncertainty is an urgent situation, particularly since it may result in some counties having no insurers at all, as well as coverage that is unaffordable for millions of Americans. But it is far from a crisis affecting most Americans and their health insurance.

The media needs to take great care to put this problem in perspective — otherwise they could unduly alarm the public and drive people to support the wrong policy solutions. Already, most Americans wrongly believe that premium increases in the relatively small non-group market affect them. So the headline should be: “Premiums Spike for SOME Americans.”

The danger in Congress is that discussion will spread too far beyond the immediate need to stabilize the non-group market, opening up all the old wounds surrounding the ACA and producing stalemate.

Carper cast as governors’ lobbyist in health care debate

Posted on by • Posted in Uncategorized • Tagged , , , • Leave a comment

http://www.delawareonline.com/story/news/politics/2017/08/08/carper-cast-governors-lobbyist-health-care-debate/546377001/

Image result for Carper cast as governors' lobbyist in health care debate

When Sen. Tom Carper was shopping for votes to block GOP health care bills, he didn’t just turn to his fellow senators. He turned to their governors.

A self-described “recovering governor,” himself, the Delaware Democrat carried out a communications blitz – calling, texting, emailing – and made contact with up to half of them. He skipped out on a Democratic campaign retreat to make a case at the National Governors Association summer meeting in Rhode Island.

His message: The legislation will hurt your states. Put your opposition in writing so the Senate can pause, work together to stabilize the insurance exchanges, and return to “regular order,” with hearings, bipartisan amendments — and input from governors, he said.

Delaware’s senators are bullish that debate over health care will turn to fixing the Affordable Care Act after the Senate early Friday morning defeated a proposal to repeal parts of the landmark law. 7/28/17 Damian Giletto/The News Journal

“He came up and spent a morning discussing the ins and outs, the details of health care changes,” Colorado Gov. John Hickenlooper, a Democrat, said on CBS’s “Face the Nation” Sunday.

Ohio Gov. John Kasich, a Republican, speaking on the same show, said, “Tom Carper from Delaware has been unbelievable in terms of his looking at trying to solve this problem.”

Carper believed that governors’ objections would be key to blocking the GOP effort to repeal and replace Obamacare, and it turned out they were. Even Sen. John McCain of Arizona, one of three Republicans who helped sink the GOP’s last-ditch effort, repeatedly highlighted his governor’s concerns.

Senate Minority Leader Charles Schumer of New York tapped Carper to lead outreach efforts to governors in early July when Carper complained that their voices weren’t being heard. In the health care drama, where there were many players, Democrats’ casting of Carper as the lead governors’ lobbyist made sense. He’s a former NGA chairman who loves the organization (and is prone to gushing about it).

“Tom Carper was really our point person with the governors, he kind of managed it,” said Sen. Tim Kaine, a former Democratic governor of Virginia. “He played a very important role in all of this. And the governors themselves, their voices were very important.”

Several days before the NGA summer meeting, Carper learned administration officials would discuss GOP health care proposals with the governors and was alarmed to discover that no one was scheduled to present the opposing view. He wangled an invitation to speak on a closed-door panel on July 15 alongside Seema Verma, administrator of the Centers for Medicare and Medicaid Services, and Secretary of Health and Human Services Tom Price.

“(Carper) was spreading this word that we should do this together, that people shouldn’t be hurt who are not in a position of being able to help themselves,” Kasich, an opponent of the GOP health care bills, said in an interview with USA TODAY. “And it was a message of slow down and let’s get this right. At no time did he ever say we should do nothing.After that, Carper kept contact information for every governor by his side, calling them during free moments between hearings and meetings. They discussed how the legislation would impact states’ Medicaid expansions, for example, or how a straight repeal of Obamacare would impact the states.

When he couldn’t reach Arizona Gov. Doug Ducey, a Republican, he said he talked several times to his Medicaid director and to his chief of staff. He said he spoke with Kasich “a dozen times or more.”

“One night he called me and it was like 10:30 at night,” Kasich said. “He was relentless in terms of what he did. And do I think he made a difference? I have no doubt that he did. Did he switch anybody? You don’t know. Did he have some people that would have not voted for this had McCain not voted ‘no,’ I just can’t tell you. But he deserves a lot of credit for being a really good public servant, keeping in mind the people that he serves.”

Carper said his outreach efforts helped him develop trust with governors “and just to let them know if they are interested in finding a path forward, they have a number of Democratic senators… who want to find common ground.”

Three days after Carper’s pitch at the NGA meeting, Kasich, Hickenlooper and nine other bipartisan governors who had been vocal about their concerns issued a statement opposing efforts to repeal the current system and replace it later. The statement, which Kasich said had been in the works for a while, called for governors to be included in the next steps.

“The best next step is for both parties to come together and do what we can all agree on: fix our unstable insurance markets,” they wrote.

They may be getting their wish, and so may Carper.

After the GOP’s three legislative failures, the Senate Health, Education, Labor and Pensions Committee announced it would begin hearings in September on ways to stabilize the individual health insurance market. The committee will hear from a wide range of stakeholders, including governors.

Moving forward, Carper said “the stage has been set” for better, more affordable health care coverage. Though he isn’t on the HELP Committee, he believes he can play a role in bipartisan discussions on health care.

“The key now is for the Senate to do its job,” Carper said.

The different ways your health care costs are going up

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

https://www.axios.com/the-different-ways-your-health-care-costs-are-going-up-2471186113.html

Image result for The different ways your health care costs are going up

 

We’ve spent so much time talking about Affordable Care Act costs this year that it’s easy to forget what most people are actually paying for health care — the 156 million Americans who get their health coverage through the workplace. Turns out, most of us aren’t seeing sky-high premium increases. But it’s also worth remembering that deductibles matter too — because that’s what we pay out of pocket before insurance kicks in.

Take a look at these two graphics from Axios datavisuals genius Chris Canipe. The premium increases between 2010 and 2016 weren’t that bad — they’re single digits each year, and just add up over time. But you can see some big increases in deductibles, especially in point-of-service plans and HMOs.

Why it matters: That’s a big reason why people feel their health care costs going up, because it means they’re paying more out of pocket. And when prescription drug prices rise, they’re more likely to feel it directly.

Investment firm Kohlberg Kravis Roberts closes $2.4 billion deal with Envision Healthcare, acquires Covenant Surgical Partners

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , • Leave a comment

http://www.healthcarefinancenews.com/news/investment-firm-kohlberg-kravis-roberts-closes-24-billion-deal-envision-healthcare-acquires?mkt_tok=eyJpIjoiT0RabE1UVmtZamMzTldOaCIsInQiOiJIRmpRNFJxRnFHbG9vRGV6UXZGMzZJbmZXOEZRczZRcktRb3Z4VzZHQ01UYUdoVElGRlNGVTUrRytER3FteTZSMTdXMjdjM0dlVnlrT01CS2RSNDhCa2tuRTNvbkhVMmlkU0RWQ3pvQ0lrTGVPMnkyUG8ySGJOaGhQc0FLbWUyaSJ9

Photo courtesy <a href="https://www.flickr.com/photos/cak757/15853544615"> Flickr </a>

 

Envision and WebMD deals are valued at more than $2 billion each; financial terms of Covenant deal were not disclosed.

Global investment firm Kohlberg Kravis Roberts & Co has announced they will buy Covenant Surgical Partners. Financial details were not disclosed.

Covenant buys and operates ambulatory surgery centers and physician practices, and touts 37 facilities located across 17 states.

The deal is expected to close in the third quarter of FY 2017.

The announcement comes just a day after another major, much-anticipated deal was unveiled. KKR’s Air Medical Group Holdings will merge with Envision Healthcare’s transportation subsidiary American Medical Response to form an entirely new medical transportation company, a transaction worth $2.4 billion, KKR said.

The combined company is expected to transport more than five million patients per year with air and ground ambulances across 46 states and the District of Columbia, KKR said in a statement.

Envision’s President of Ambulatory Services Randall Owen will step in as President and CEO of the new company, and when the deal is done, a new company name will be designated.

That deal is scheduled to close in the fourth quarter of 2017.

Envision Healthcare owns and operates 263 surgery centers and one surgical hospital in 35 states and the District of Columbia, with medical specialties ranging from gastroenterology to ophthalmology and orthopedics.

“The Envision leadership team conducted a robust process to review strategic alternatives for AMR. The agreement delivers on our commitment to continue the proud tradition of AMR and enables Envision to focus on its physician-centric strategy and ongoing services, including facility-based provider services, post-acute care and ambulatory surgery,” said Christopher A. Holden, Envision’s President and Chief Executive Officer.

A little more than a week ago, KKR also revealed their deal for their company Internet Brands to buy WebMD in a transaction valued at approximately $2.8 billion.  This acquisition is also expected to close in the fourth quarter of 2017.