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Why Geisinger’s health plan stays on the ACA exchange
Danville, Pa.-based Geisinger Health Plan has maintained a steady presence in Pennsylvania’s individual ACA exchange, despite other insurers leaving the state’s marketplace.
Over the last two years, a number of U.S. insurers decided to exit states’ ACA exchanges, citing financial losses as well as concerns regarding future stability of the individual market. Pennsylvania’s individual ACA exchange is no exception. Hartford, Conn.-based Aetna, for instance, pulled out of ACA exchanges for 2017 in 11 states, including Pennsylvania. Additionally, Minnetonka, Minn.-based UnitedHealthcare left ACA exchanges in Pennsylvania and nearly 30 other states for 2017.
Ultimately five insurers remained on Pennsylvania’s individual ACA exchange for 2017 and will remain in the market for 2018 — Geisinger Health Plan, Pittsburgh-based UPMC Health Plan, Harrisburg, Pa.-based Capital BlueCross, Philadelphia-based Independence Blue Cross and Pittsburgh-based Highmark.
Because some insurers left the state’s individual ACA exchange, Geisinger Health Plan experienced an increase in membership, says Kurt Wrobel, the plan’s CFO and chief actuary. The plan currently has 47,000 members, up from more than 30,000 in 2016. About 60 percent of the plan’s enrollment is individuals with Medicaid, Medicare or plans on the state’s individual ACA exchange.
Geisinger Health Plan also requested a rate increase for 2018 that it says is consistent with other insurers in the state. According to the Pennsylvania Department of Insurance, the five insurers that will continue selling on Pennsylvania’s individual ACA exchange for 2018 requested average statewide rate increases of 8.8 percent for individual plans.
Regarding Geisinger Health Plan’s choice to stay on the ACA exchange in Pennsylvania, Mr. Wrobel says it comes down to Geisinger’s commitment to the people of central Pennsylvania. “As a nonprofit, our primary stakeholders are the people, so with that we’re going to have a different calculation as far as our interest in staying in a program. While policy improvements are still needed, we’ve stayed in the program and we believe it’s workable as it stands now.”
One significant advantage Geisinger Health Plan has is its connection with Geisinger Health System. Geisinger Health Plan representatives said that connection allows it to develop programs such as care management programs for members, and many of the plan’s case managers work directly with physicians’ offices to provide more support and connectivity to members’ physicians.
“We think that’s a really clear differentiator. Within that, we have more robust care management systems and programs that allow us to control costs and improve outcomes, especially relative to traditional insurance companies,” Mr. Wrobel says.
As far as the future, the health plan will remain on Pennsylvania’s individual ACA exchange as long as it has a workable program.
Mr. Wrobel says Geisinger Health Plan wouldn’t rule out expanding to ACA marketplaces in other states at some point, but it’s not a high priority right now.
Overall, without the elimination of cost-sharing reductions, which help insurers subsidize the cost of coverage for low-income Americans, Mr. Wrobel believes Geisinger Health Plan could see greater stability moving forward.
“It’s our hope we can move beyond discussions, beyond all the financial issues with the program and really get to the meat of what we try to do as a health plan, which is provide cost-effective quality care,” he says. “I think we all look forward to the day when there’s sufficient stability — and that’s what we have in the Medicare and Medicaid program as well as the employer group program — where the focus is on that operational excellence of providing cost-effective quality care and we can move beyond these discussions about financial issues.”
What the Senate healthcare bill could mean for Californians
Senate leaders have released their Obamacare repeal bill, which would slash federal funding for healthcare and could leave millions of Americans uninsured.
Though the plan has not yet been analyzed by the Congressional Budget Office, it isn’t too different from the one passed by the House last month. The CBO projected the House bill would save the federal government $119 billion over the next decade, raise insurance deductibles and leave 23 million fewer Americans with health coverage.
Both bills would also undo several taxes on high-income Americans that are used to fund Obamacare.
The Affordable Care Act has had a huge impact on California, where roughly 4 million people have gained insurance and the percentage of uninsured residents has dropped more than half.
Below is a breakdown of some of the ways the Senate bill could affect healthcare coverage in California if it becomes law.
Conservative Koch Network Criticizes U.S. Senate Healthcare Bill
Officials with the conservative U.S. political network overseen by the Koch brothers say they are unhappy with the healthcare bill that may be voted on by the Senate this week and will lobby for changes to it.
At a weekend event with conservative donors, top aides to Charles Koch, the billionaire energy magnate, said the Senate bill does not go far enough to dismantle former President Barack Obama’s signature healthcare law, also known as Obamacare.
“We have been disappointed that movement has not been more dramatic toward a full repeal,” said Tim Phillips, president of Americans for Prosperity, a grassroots advocacy group backed by Charles Koch and his brother, David.
The Senate’s 142-page proposal, worked out in secret by a group led by Senate Majority Leader McConnell, aims to deliver on a central campaign promise of President Donald Trump to repeal Obamacare, which has provided coverage to 20 million Americans since its passage in 2010.
Republicans view the law, formally called the Affordable Care Act, as a costly government intrusion and say individual insurance markets created by it are collapsing.
Phillips and other aides to the Koch network told Reuters they want to see the Senate bill do more to roll back Obamacare’s expansion of the Medicaid program for poor and disabled Americans. They also contend the bill does not do enough to reform the U.S. healthcare system and cut costs.
The aides said lobbying efforts to reshape the bill are continuing ahead of a planned vote.
Similar concerns helped steer the House’s version of the bill in a more conservative direction. A primary mover of that effort, Mark Meadows, a Republican congressman from North Carolina, attended the Koch donor event.
Meadows, chairman of the conservative Freedom Caucus in the House, said he is prepared to support the Senate bill if it clears that chamber, a sign that quick action to land the legislation on Trump’s desk is possible.
However, Meadows said the Senate version of the bill would need to be amended to allow insurers who sell plans on Obamacare’s insurance exchanges to offer less-expensive plans that do not comply with that law’s coverage requirements.
Republican Senator Ted Cruz of Texas, who currently opposes the Senate bill, has offered an amendment along those lines. Cruz attended the Koch event here, as did Senators Jeff Flake of Arizona and Ben Sasse of Nebraska, who remain undecided.
Meadows also seeks an amendment that would allow some consumers who have private health savings accounts to deduct the cost of insurance premiums from their taxes.
Senate leaders have set a goal of passing the healthcare measure by the end of this week, ahead of the July 4 congressional recess, which would then send it back to the House.
If the Senate passes legislation this week that is palatable to the House, Meadows said it is conceivable the House could pass that version and choose to forgo a formal conference committee that would reconcile the Senate and House bills. That, he said, could result in sending the bill to Trump’s desk for his signature before the recess.
Getting a vote by the end of the week could be difficult.
Five Senate Republicans, including Cruz, have publicly voiced their opposition to the current Senate draft. No Senate Democrats are expected to back it, which means McConnell cannot afford to lose more than two Senate Republicans.
As a sign of the Koch network’s influence, Phillips said his organization is prepared to spend as much as $400 million before next year’s congressional elections to advocate for the network’s conservative causes.
How Medicaid Works, and Who It Covers
One of the biggest flash points in the debate over Republican legislation to repeal and replace the Affordable Care Act is the future of Medicaid. Here are some basic facts about the 52-year-old program.
What is Medicaid?
It’s a public health insurance program largely for low-income people, though some middle-class disabled and elderly people also qualify. States and the federal government share the cost.
Whom does Medicaid cover?
■ Nearly one in five Americans, 74 million people, are on Medicaid.
■ Federal law guarantees Medicaid coverage to pregnant women, children, elderly and disabled people under certain income levels.
■ It covers more than a third of the nation’s children and pays for half of all births.
■ It also covers almost two-thirds of nursing home residents, including many who are middle class and spent of all their savings on care before becoming eligible.
States also have the option of covering other groups, like children and pregnant women whose household incomes are higher than the federal thresholds, or young adults up to age 26 who were once in foster care.
■ The Affordable Care Act allowed a new optional group: any adults with income up to 138 percent of the poverty level, which would be $16,643 for an individual this year. Thirty-one states now offer Medicaid to this group.
When was it created?
■ In 1965, as part of President Lyndon B. Johnson’s “Great Society.”
■ There was little political debate; the bigger fight was over creating Medicare, the program to cover the elderly, which Medicaid is often confused with.
Is Medicaid an entitlement
program?
Yes. Anyone who meets the eligibility rules has a right to Medicaid coverage, and for now, states are guaranteed open-ended financial support from the federal government.
How much does it cost?
■ Medicaid cost $553 billion in fiscal year 2016. Of that amount, $348.9 billion came from the federal government; the states paid $204.5 billion.
■ Medicaid accounts for 9 percent of federal domestic spending. For states, it is the biggest source of federal funding and the second-largest budget item, behind education.
The biggest costs in Medicaid are for the elderly and the disabled, often because of long-term care in nursing homes.
■ Washington pays 50 to 75 percent of Medicaid costs for most eligible groups, with poor states receiving more money.
■ Under the Affordable Care Act, the federal government initially covered all of the costs for the roughly 11 million people insured under the law’s expansion of Medicaid, who are largely adults without disabilities.
■ Under the law, Washington picks up 95 percent of state costs for the expansion of Medicaid this year, whittling down to 90 percent in 2020.
What changes are in store?
■ Both the House and Senate health bills would fundamentally change the way the federal government pays its share of Medicaid costs, setting a per-person limit on spending that would adjust annually for inflation.
■ The bills would also effectively end the Medicaid expansion, by sharply reducing how much the federal government pays for that population starting in 2020.
■ The result of these changes, according to independent analyses, would be major reductions in federal Medicaid spending over time.
■ Enrollment would drop, too, according to the nonpartisan Congressional Budget Office, with states making it harder to qualify for the program and getting rid of certain benefits to make up for tightened federal spending.
What Keeps Healthcare Finance Executives Up at Night?
Cartoon – What about Business
Cartoon – The Goal of this Meeting
Cartoon – Budget Meeting with the CFO
What happens when the federal government eliminates health coverage? Lessons from the past
After much secrecy and no public deliberation, Senate Republicans finalized release their “draft” repeal and replace bill for the Affordable Care Act on June 22. Unquestionably, the released “draft” will not be the final version.
Amendments and a potential, albeit not necessary, conference committee are likely to make some adjustments. However, both the House version – American Health Care Act (AHCA) – and the Senate’s Better Care Reconciliation Act (BCRA) will significantly reduce coverage for millions of Americans and reshape insurance for virtually everyone. The Congressional Budget Office (CBO) is expected to provide final numbers early the week of June 26.
If successful, the repeal and replacement of the Affordable Care Act would be in rare company. Even though the U.S. has been slower than any other Western country to develop a safety net, the U.S. has rarely taken back benefits once they have been bestowed on its citizenry. Indeed, only a small number of significant cases come to mind.
My academic work has analyzed the evolution of the American health care system including those rare instances. I believe historical precedents can provide insights for the current debate.
