Tag Archives: ACA
Survey reveals 3 value-based payment trends to watch
Americans’ Experiences with ACA Marketplace Coverage: Affordability and Provider Network Satisfaction
For people with low and moderate incomes, the Affordable Care Act’s tax credits have made premium costs roughly comparable to those paid by people with job-based health insurance. For those with higher incomes, the tax credits phase out, meaning that adults in marketplace plans on average have higher premium costs than those in employer plans. The law’s cost-sharing reductions are reducing deductibles. Lower-income adults in marketplace plans were less likely than higher-income adults to report having deductibles of $1,000 or more. Majorities of new marketplace enrollees and those who have changed plans since they initially obtained marketplace coverage are satisfied with the doctors participating in their plans. Overall, the majority of marketplace enrollees expressed confidence in their ability to afford care if they were to become seriously ill. This issue brief explores these and other findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016.
Mr. Trump, Here’s Some Health Policy Advice — From a Physician
http://www.medpagetoday.com/Blogs/KevinMD/57318?xid=fb_o_
Free-market healthcare won’t last long in modern society, says Saurabh Jha, MD
Medicaid Expansion: Driving Innovation In Behavioral Health Integration
Safety-net providers in states that have accepted the federal funding available for Medicaid expansion under the Affordable Care Act (ACA) are experiencing a positive ripple effect, where increased insurance coverage rates among patients and thus greater financial security for safety-net institutions are translating into better care. We found that safety-net providers in states that expand Medicaid are delivering more services and better-coordinated care than what is available in states rejecting the expansion.
Of particular interest is the effect of Medicaid expansion on attempts to integrate behavioral health services with primary health care — long a thorny issue for safety-net providers. Research has shown that the Affordable Care Act (ACA) has increased access to behavioral health services. We present case studies from two provider systems that illustrate some of the innovative approaches that are improving the quality of behavioral health care at safety-net institutions.
The Fundamentally Different Goals of the Affordable Care Act and Republican ‘Replacement’ Plans
Rep. Pete Sessions and Sen. Bill Cassidy introduced legislation last month calling for replacing elements of the Affordable Care Act. A House task force established by SpeakerPaul Ryan is expected to follow with more health-care proposals. These Republican health plans are generally referred to as “replacements” for the ACA–in the spirit of “repeal and replace”–as though they would accomplish the same objectives in ways that conservatives prefer. But the proposals are better understood as alternatives with very different goals, trade-offs, and consequences. Whether they are “better” or “worse” depends on your perspective.
To boil down to the most basic differences: The central focus of the Affordable Care Act is expanding coverage and strengthening consumer protections in the health insurance marketplace through government regulation. By contrast, the primary objective of Republican plans is to try to reduce health-care spending by giving people incentives to purchase less costly insurance with more “skin in the game,” with the expectation that they will become more prudent consumers of health services. They also aim to reduce federal spending on Medicare and Medicaid and the federal government’s role in both programs. Elements of the ACA were designed to reduce costs, such as the law’s Medicare payment reforms, and elements of Republican plans such as tax credits aim to expand access to insurance, but the primary aims of the ACA and the Republican plans differ.
Appeals Panels Affirm Injunction Against Fixed Indemnity Regulation, Turn Back Challenge To ‘Administrative Fix’
On July 1, the D.C. Circuit decided two appeals challenging aspects of the implementation of the Affordable Care Act, accepting one challenge and rejecting the other. In Central United Life v. Burwell, a three-judge panel of the D.C. Circuit Court of Appeals affirmed a lower court injunction against a 2014 HHS regulatory prohibition on the sale of fixed indemnity insurance unless the purchaser attests that he or she already has minimum essential coverage. And in West Virginia v. HHS, a different panel of the D.C. Circuit rejected a challenge brought by the state of West Virginia to the “administrative fix” announced by HHS late in 2013. Under this arrangement, HHS deferred for 2014 enforcement of eight of the ACA’s insurance market reform requirements against existing insurance plans in the individual and small group market.
Health policy leaders to HHS: More bundled payment models, please
- The Center for American Progress (CAP) and other health policy leaders issued a joint letter to HHS Secretary Sylvia Burwell advocating further advancement in Medicare payment reform.
- The signatories seek additional mandatory bundled payment demonstrations, arguing they would show stakeholders — including hospitals, physicians, device manufacturers, skilled nursing facilities, and home healthcare agencies — that aggressive expansion is coming for bundled payments and other payment reforms.
- CAP has long advocated for Medicare to expand its most successful bundled payment models, including its Acute Care Episode demonstration project.
Health Affairs Study On Hospital Profitability Gives Us Some Important Factors To Watch Going Forward
Bai and Anderson report two profitability-related factors that reflect the effect of hospital consolidation trends: regional power and system affiliation. Regional power refers to hospitals that face less competition in their local markets, while system affiliation indicates hospitals that are part of multi-hospital systems. Both are associated with higher profitability in their study.
More and more hospitals across the country are joining systems that operate outside their local markets. This is due, in part, to the fact that antitrust regulators have limited local market mergers but have not, in general, adapted their models of hospital market competition and antitrust to address non-local mergers. As a result, hospitals in some instances are able to join systems, gain market power, and raise their prices without necessarily improving quality or service. My own research in this area (forthcoming inINQUIRY) shows that hospitals that are part of the largest multi-hospital systems in California were able to negotiate price increases that are consistently well above all other hospitals in that state.
Medicare has funding through 2028, trustees say, 2 years less than earlier thought
HENRY KOTULA 