Tag Archives: ACA

Premium support is back. What is it?

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Premium support is back. What is it?

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Click to access premium-support.pdf

A number of Republican health care policy proposals that seemed out of favor in the Obama era are now being given new life. One of these involves Medicare, the government health insurance program primarily for older Americans, and is known as premium support.

Right now, the federal government subsidizes Medicare premiums — those of the traditional program, as well as private plan alternatives that participate in Medicare Advantage. The subsidies are established so that they grow at the rate of overall per enrollee Medicare spending. No matter what Medicare costs, older Americans can be sure that the government will cover a certain percentage of it. That’s the main thing that panics fiscal conservatives, because that costs the government more each year.

Premium support could quiet that fear. Subsidies would be calculated so they don’t grow as quickly, thus protecting the federal government (that is, taxpayers) from runaway spending. There are lots of variants, but there are really two principal ideas.

Hospital leaders support keeping many elements of ACA

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http://www.revenuecycleinsights.com/news/hospital-leaders-support-keeping-many-elements-aca?mkt_tok=eyJpIjoiWWpCaU1USXhZbVEzWkRCaiIsInQiOiJURzlCeG5tb05KNjN5QU9UMGIrVFBoZkxiS3Q2WHdPZDZRNXJ0TFQzemdXdVwvS3pPa3UrcWNOQTVxanpaVW5mMFFoUzk4OXc0ejg2dSs2SkRGWHErZDlqUjlhd1dTQit3c2VBaXdGSDdPK1IzQXEwdWNNaWt6YjFRQ2xyR3JZNloifQ%3D%3D

An overwhelming majority of hospital C-suite and pharmacy executives support preserving the protections in the Affordable Care Act (ACA) for patients with preexisting conditions, according to a post-election survey.

Member-based healthcare performance improvement company Vizient conducted the survey to assess how member hospitals were reacting to the planned repeal of the ACA by the Trump administration and Republican leaders in Congress. Vizient also asked executives about their top concerns for the future as well as their priorities for 2017.

Nearly 90 percent of C-suite leaders (89.5 percent) and 96 percent of hospital pharmacy executives surveyed said the ACA’s protections for patients with preexisting conditions should be kept in place.

Other findings from the survey show:

  • 68 percent of hospital C-suite leaders and 35 percent of hospital pharmacy executives want to keep incentives for expanding Medicaid coverage
  • 56 percent of hospital executives and 46 percent of hospital pharmacy leaders want to continue subsidies to help consumers pay for insurance
  • 52 percent of hospital C-suite leaders and 39 percent of pharmacy executives want to continue value-based reimbursements.

The top three priorities for all executives this year were 1) reducing clinical variation across care delivery 2) migrating toward value-based models, and 3) the integration of existing technology systems, Vizient said.

“In reviewing the survey results, central themes come through: uncertainty and concerns about financial viability,” Byron Jobe, president and chief administrative officer for Vizient, said in a statement. “There are many open questions about the future of the ACA, and what a repeal and replacement strategy could look like. As Congress wrestles with these decisions, it’s important to ensure reimbursement levels are enough to allow hospitals to continue their mission of caring for patients in their communities. Equally important, hospitals must quickly gain a clear understanding of where health policy is heading so they can begin to prepare.”

Congress must act by March to stabilize individual markets, experts say during Senate hearing

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http://www.fiercehealthcare.com/payer/congress-must-act-by-march-to-stabilize-individual-markets-experts-say-at-senate-hearing?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTm1RM01HUTJORE15WVdRNSIsInQiOiJFd0pManZSb09vTTVCbXdwQThsTnBycFZvaEdvbmVBZUpFWU42RFlCNHpmNW81eG5vNzFGcFRWVjRodGZFRDhWTlQ1WG1OeU5CTklYaFdjSWN0OCtaWGRLU3laOU5NVGdQV3hYWE5PVUpTeXVtcnZnWFZcL040c241SnB6SytsMXYifQ%3D%3D

America’s Health Insurance Plans CEO Marilyn Tavenner testifies during Wednesday’s Senate hearing on the state of the individual marketplaces.

Expert witnesses warned lawmakers during a Senate hearing Wednesday that if they fail to ensure a stable transition while repealing and replacing the Affordable Care Act, they risk worsening the already unstable individual marketplaces.

“Insurance markets do not respond well to uncertainty,” Julie McPeak, Tennessee’s commissioner of commerce and insurance and president-elect of the National Association of Insurance Commissioners, testified at hearing held by the Senate Health, Education, Labor and Pensions Committee. “As you consider ACA reforms, it’s critical to remain transparent and to minimize surprises in our insurance system.”

For his part, Committee Chairman Sen. Lamar Alexander, R-Tenn., asked McPeak how quickly Congress needs to act in order to shore up the marketplaces enough for insurers to feel comfortable participating in 2018.

“I think you need to provide some indication to plans as quickly as possible, but March would be extremely helpful,” McPeak said, noting that insurance carriers have to file their rates by early spring. Janet Trautwein, CEO of the National Association of Health Underwriters, agreed, saying action is needed by late March at the latest.

“Right now, plans are trying to price for ‘18, and the uncertainty around cost-sharing subsidies and the tax credits would cause them to hesitate to price because we need to understand what the funding support is going to be, because that affects premiums,” America’s Health Insurance Plans President and CEO Marilyn Tavenner added.

Thus, she pointed to suggestions AHIP has previously made public, such as making full reinsurance payments for 2016, and continuing to provide premium subsidies and cost-sharing reductions through at least 2018. “Absence of this funding would further deteriorate an already unstable market and hurt the millions of consumers who depend on these programs for their coverage,” Tavenner said.

But that isn’t enough to ensure a stable and workable transition away from the ACA, Tavenner noted. Other necessary steps include recalibrating premium subsidies to encourage more young people to participate, federal risk pool funding and continuous coverage incentives.

 

Executive actions Trump could take to change the ACA

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Executive actions Trump could take to change the ACA

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The executive order President Trump signed on Friday does not have any immediate policy effect, but it does call attention to the wide range of administrative actions that a Trump administration could take to change the Affordable Care Act—all without legislation from Congress.

We’ve compiled a list of those actions. It’s not exhaustive; there is a lot more a Trump administration could do. Nor do we mean to suggest that these actions would be legal. Declining to enforce the individual mandate, in particular, would be problematic, although the Trump administration might seek cover from dubious enforcement decisions made by the Obama administration (like the “like it, keep it” fix and employer mandate delays).

Whether and which actions a Trump HHS chooses to pursue will depend on the administration’s willingness to gamble the stability—already quite fragile, in some states—of the individual market. And it will depend, too, on what Congress is willing to do through legislation. If Congress wipes out the individual mandate, for example, there’d be no need to change the rules governing hardship exemptions.

More families with employer-sponsored insurance are needing public assistance

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http://www.academyhealth.org/blog/2017-01/more-families-employer-sponsored-insurance-are-needing-public-assistance

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As employer-sponsored insurance becomes more expensive for children, public programs are picking up the slack.

The Medicaid Expansion, which was responsible for a large part of the reduction in uninsurance in the United States over the last few years, was mostly aimed at adults. This is because Medicaid has traditionally covered nearly all children in poverty for some time. The CHIP program has bolstered that coverage, so that uninsurance in children fell steadily in the 1990’s and well into the 21st century.

The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) assured that CHIP coverage would continue for some time. But even before that, trouble was brewing with respect to the coverage of children. These troubles were not in the Medicaid  program, though. Issues were arising in the employer-sponsored insurance market.

As I’ve written about in many posts here before, the cost of employer-sponsored insurance has been rising quite steadily for some time. Further, the out-of-pocket costs for such insurance have also been increasing. Deductibles, co-pays, and co-insurance – not to mention premiums – can put the cost of insurance out of reach for many employees even when it is “offered” as a benefit from their job. The costs of insurance have outpaced both income and wages for more than a decade, meaning that more and more must come out of employee’s pockets if they want to maintain coverage for themselves and their children.

 

Ex-Obamacare Chief Warns Trump’s Already Weakening The Health Care System

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http://www.huffingtonpost.com/entry/ex-obamacare-chief-warns-trumps-already-weakening-the-health-care-system_us_588bca30e4b0b065cbbc071b?utm_source=&utm_medium=email&utm_campaign=5982

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Andy Slavitt helped save Obamacare once already. He’s hoping he can do it again.

Until Inauguration Day, Slavitt had been acting administrator of the Centers for Medicare and Medicaid Services since March 2015. That agency oversees the two health programs in its name along with the Children’s Health Insurance Program and the Affordable Care Act’s health insurance exchanges. CMS, as it’s known, manages benefits for 140 million people and its $1 trillion budget is bigger than the Pentagon’s.

In the short time since Slavitt left federal service, he’s already seeing signs that President Donald Trump and the GOP Congress are dealing damage to the health care system before even repealing the Affordable Care Act. And health care executives are telling him the same thing, Slavitt said.

The Affordable Care Act first entered Slavitt’s life in the fall of 2013, when he helped lead the effort to salvage HealthCare.gov, the federal insurance exchange website, after its disastrous launch. From there, Slavitt left his position as group executive president of Optum, a unit of UnitedHealth Group, to join CMS as a senior official. President Barack Obama nominated Slavitt for the top job in July 2015 but the Senate never held a vote on him.

Now Slavitt is out of government, but he’s not abandoning the fight over the Affordable Care Act. In an interview with The Huffington Post, he argued that Trump is already undermining the law and threatening coverage for millions ― in spite of his repeated promises to ensure that all Americans would have health care under his policies.

“I take the new president at his word. He said he wants to expand coverage. He said he wants the coverage to be high-quality. He said he wants it to be affordable to Americans who have trouble affording health care,” Slavitt said. “Those are the right goals, and I think the president should start out with those goals. Now, the actions that we’ve seen so far don’t support those goals.”

Specifically, Slavitt cited the executive order Trump issued the day of his inauguration, which instructs federal agencies to “take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.”

The White House subsequently signaled this could include halting enforcement of the law’s individual mandate that most Americans obtain health coverage.

Executive actions such as these, and like the Trump administration halting television advertising for the sign-up period that ends Tuesday, threaten to destabilize the health insurance market, Slavitt. These moves signal to health insurers that enrollment will be lower this year than it could have been, and that fewer of the healthy consumers needed to offset the costs of the sick will buy coverage. Without the mandate’s tax penalty for being uninsured, some consumers will opt against buying insurance.

“It increases premiums, it will send people out of the market,” Slavitt said. “Those actions that we’ve seen haven’t gotten us on the track that we would hope and that we need to be on in a bipartisan fashion, and so I’d hope that they’re quickly corrected.”

Koch-backed group details hopes for healthcare reform

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http://thehill.com/policy/healthcare/316875-koch-backed-group-pushes-for-high-risk-pools-medicaid-freeze-in-obamacare

Koch-backed group details hopes for healthcare reform

A conservative group funded by the Koch brothers is pushing for high-risk pools and a freeze on Medicaid expansions as lawmakers try to coalesce around a replacement for ObamaCare.

Freedom Partners began circulating a memo on Capitol Hill Monday with specific reforms it thinks lawmakers should pass, including: the creation of high-risk pools at the state level to cover people with pre-existing conditions; the elimination of the ObamaCare mandate, which required everyone buy insurance or pay a penalty; and the expansion of access to health savings accounts, so people can save and pay for healthcare with pre-tax dollars.

The recommendations fall in line with what top Republicans in Congress have indicated they support.

High-risk pools offer coverage for sick people that otherwise could be denied coverage for having pre-existing conditions if ObamaCare is repealed.

California’s Uninsured: As Coverage Grows, Millions Go Without

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Click to access PDF%20CaliforniaUninsuredDec2016.pdf

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Since the implementation of the Affordable Care Act (ACA) in 2014, the uninsured rate in California dropped by nearly half, from 16% in 2013 to 9% in 2015. However, 2.9 million Californians remained uninsured.

California’s Uninsured: As Coverage Grows, Millions Go Without provides a look at the uninsured two years after full implementation of the ACA. There could be big changes in health insurance coverage ahead with the election of President Donald Trump.

Key findings include:

  • The drop in the uninsured rate was mainly due to a seven percentage point increase in individually purchased insurance coupled with a five percentage point increase in Medi-Cal enrollment.
  • One in three of California’s uninsured had annual incomes of less than $25,000. At this income level, people are potentially eligible for Medi-Cal.
  • Of the state’s remaining uninsured, one in four were age 25 to 34, one in three were noncitizens, and more than half were Latino.
  • 62% of the uninsured were employed. Of the 1.8 million uninsured workers, 44% worked in firms with fewer than 50 employees.
  • Fewer Californians cited “lack of affordability” as the main reason for going without health insurance in 2015 compared to 2014.

Price Vows ‘Access to Coverage’ Under Health Executive Order

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https://morningconsult.com/2017/01/24/hhs-nominee-vows-access-to-coverage-under-aca-executive-order/

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President Donald Trump’s nominee to be the nation’s top health official would not promise every American would get to keep their coverage under an executive order signed last week.

“What I commit to the American people is to keep patients at the center of health care, and what that means to me is making certain that every single American has access to affordable health coverage,” Rep. Tom Price (R-Ga.) told Finance Committee ranking member Sen. Ron Wyden (D-Ore.) when asked if he would commit to no one losing coverage.

The distinction between “access” to health insurance and “health coverage” appears to be a growing division between members of Congress and Trump, who vowed insurance for everyone in interviews ahead of his inauguration.

Heritage VP: Obamacare Repeal Efforts Going in ‘Wrong Direction’

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https://morningconsult.com/2017/01/26/heritage-vp-obamacare-repeal-efforts-going-wrong-direction/

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The Heritage Foundation, an influential conservative think-tank, is pushing Republicans to repeal the Affordable Care Act as quickly as possible without waiting for a replacement.

The GOP’s self-imposed Jan. 27 deadline for legislation that would repeal Obamacare is slipping by and plans for repeal are “murkier than ever” and headed in the “wrong direction” wrote James Wallner, the Heritage Foundation’s vice president for research, in the Daily Signal, a website created by Heritage.

“Given this, President Donald Trump and congressional Republicans should reiterate their commitment to the full repeal of Obamacare,” Wallner wrote. “And they need to get to work by taking the first step in the process, which should be passing legislation to repeal Obamacare as soon as possible.”