Tag Archives: ACA

Keep Harmful Cuts in Federal Medicaid Disproportionate Share Hospital Payments at Bay

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http://www.commonwealthfund.org/publications/blog/2017/dec/harmful-cuts-in-federal-medicaid-dsh?omnicid=EALERT1329977&mid=henrykotula@yahoo.com

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  • While the ACA has had a major impact on reducing hospitals’ uncompensated care burdens, compensated care remains a challenge for many hospitals in poor communities
  • The White House and Congress have a final shot at once again ensuring that the poorest communities are not left without vital health care resources

Congress may delay a funding reduction for state Medicaid disproportionate share hospital (DSH) payments — direct, supplemental payments to hospitals serving high numbers of low-income patients — as part of end-of-year legislation. Although protecting the poorest communities from the loss of DSH funds has emerged on a short list of must-dos, final passage is far from certain. It may hinge on finding a funding strategy other than the one originally chosen by the House of Representatives — a more than $6 billion cut in critical public health funding from the Prevention and Public Health Trust Fund.

For nearly four decades, DSH payments have been a crucial part of Medicaid policy. But in light of the major gains in coverage anticipated for the poor under the Affordable Care Act’s adult Medicaid expansion, Congress scheduled a substantial reduction in federal Medicaid DSH payments beginning in 2014. Lawmakers assumed, not unreasonably, that the coverage expansions would translate into additional hospital revenue, thereby alleviating the need for as much direct DSH payment supplementation.

The relatively rosy scenario for DSH hospitals — especially those serving the poorest communities — changed dramatically in 2012 when the United States Supreme Court made Medicaid expansion optional; as of the end of 2017, nearly 3 million poor adults in 19 states continue to go without the Medicaid coverage they should be receiving.

To be sure, the ACA has had a major impact on reducing hospitals’ uncompensated care burdens. The Medicaid and CHIP Payment and Access Commission (MACPAC), which advises Congress on federal Medicaid policy, reports that between 2013 and 2014, hospital uncompensated care spending dropped by $4.6 billion, a 9 percent decrease, with the greatest declines occurring in Medicaid expansion states. But uncompensated care remains a crucial issue for many hospitals, especially those located in the poorest communities, and, in particular, hospitals serving poor communities in Medicaid nonexpansion states.

Additionally, even in Medicaid expansion states, a considerable number of low- and moderate-income adults who qualify for subsidized marketplace coverage remain uninsured. Even among those with subsidized marketplace plans whose incomes also are low enough to qualify for cost-sharing assistance (250 percent of poverty, or an annual income of about $30,000, and below), unpaid medical bills continue to add to hospitals’ uncompensated care burdens.

Should final congressional action before the holiday include a DSH cut delay, it would be the latest in a line of postponed Medicaid DSH cuts enacted by Congress over several years. Without another postponement, hospitals will lose $2 billion of the almost $12 billion federal allotment for fiscal year 2018. If this last-minute effort to stop the cuts once again as part of the spending bill does not succeed, then over 10 years, the cuts would reduce DSH payments by some $43 billion according to MACPAC.

For many reasons — the number of states that have failed to expand Medicaid; the number of Americans who continue to report that insurance coverage is unaffordable; high deductibles and other patient cost-sharing even among those with private health insurance — continuing to push back the day of reckoning on federal DSH funding reductions is a matter of high importance, not only for individual hospitals but for the communities whose health care systems these hospitals help anchor. The situation facing hospitals in nonexpansion states is especially grim; according to one estimate, failure of 19 states to implement the ACA Medicaid expansion can be expected to translate into an additional loss of $81.5 billion by 2026.

The White House and Congress have a final shot at once again ensuring that the poorest communities are not left without vital health care resources — and doing so in a way that does not pit health care against public health.

 

Can insurers sue to recover cost-sharing money?

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Can insurers sue to recover cost-sharing money?

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Murray-Alexander is going nowhere. Senator Collins insists that passing the bipartisan legislation, which would restore cost-sharing payments for two years, is a condition of her vote on the pending tax bill. But she appears willing to accept airy promises that Senate leadership will make the bill a priority.

Never mind that House Republicans have no intention of passing the bill and that Democrats have ruled out cooperating if the individual mandate is repealed. Never mind, too, that the Democrats’ threat is credible: they don’t stand to gain much if the bill is passed. By and large, insurers have already adjusted to the loss of the cost-sharing subsidies.

How exactly have they adjusted? Most states instructed insurers to anticipate the withdrawal of the cost-sharing payments and to concentrate the resulting premium hikes on silver plans. Because the ACA caps the premiums that people receiving subsidies have to pay for insurance, those price spikes won’t harm most exchange customers. To the contrary, most are better off. Premium subsidies increase as the price of silver plans go up, so gold and bronze plans—whose premiums won’t increase on account of the funding cut-off—are more affordable than they otherwise would be.

In other words, “silver loading” has mitigated much of the fallout from the loss of the cost-sharing subsidies. If Congress appropriated the cost-sharing money now, it’d be a windfall for insurers. Why should Democrats throw their support behind a bill that won’t stabilize the markets and would give the Republicans cover for repealing the mandate?

* * *

If I’m right that Murray-Alexander is a dead man walking, the cost-sharing money won’t be appropriated for 2018. That, in turn, gives rise to an interesting legal question.

As I first pointed out back in 2015, insurers can sue in the Court of Federal Claims to recover their cost-sharing payments. It’s a simple lawsuit: insurers were promised some money; the federal government reneged; and the insurers want damages on account of the breach. The payment of court-ordered damages can come out of the Judgment Fund, even without an appropriation to make the payments in the normal course.

The law is clear; the lawsuit practically writes itself. Insurers should have no trouble recovering the money owed for the last months of 2017—about $1 billion. But what about the money owed for 2018 and beyond?

As a first cut, it seems that insurers should still be able to recover. In a typical breach of contract claim, the courts aim to put a non-breaching party in the same position it would have been in if the breaching party had kept its promise. Here, Congress promised to reimburse insurers for giving their low-income customers a discount on out-of-pocket payments. Insurers are still giving those customers a discount, but the government has refused to pay.

The proper measure of expectation damages, then, is the full amount of promised reimbursement. That amount will continue to accrue for every month that Congress refuses to appropriate the money. If that’s right, the question isn’t whether Congress will pay the cost-sharing payments. It’s when.

But matters may not be so simple. In measuring damages, the Court of Federal Claims will also inquire into mitigation—a principle that might be familiar to you if you’ve ever thought about breaking a lease on an apartment. Although your landlord can sue you for any rent owed for the months remaining on the lease, he also has a duty to find a new tenant. If he does, you only have to compensate your landlord for the time that the apartment was empty. The landlord has mitigated his losses.

The same principle should kick in here. Silver loading has allowed insurers to sidestep most of the harm associated with the loss of the cost-sharing subsidies. Insurers haven’t hemorrhaged customers; instead, they’ve adapted. Indeed, some insurers are better off now than they were before: as premium subsidies increase, they’ll get more customers signing up for their gold and bronze plans.

In short, insurers have mitigated a large part of their losses. Giving them the full amount of the cost-sharing money wouldn’t put them in the same position they would have been in if the federal government adhered to its promise. It would give them a windfall. Contract law doesn’t require the courts to make contracting parties even better off than they would have been in the absence of a breach.

* * *

That doesn’t mean that insurers will lose. The default rule is still that insurers should be paid what they were promised, and the onus is on the government to prove that they’ve mitigated their losses. That’s not an easy burden to discharge: it’s hard to know what the world would have looked like if the cost-sharing payments had been made, so it’s hard to know whether any given insurer is better off or worse off now that they’ve been terminated. The factual inquiries will be demanding.

My tentative sense, however, is that insurers shouldn’t be too bullish about recovery. One reason can be found in Murray-Alexander itself. As currently written, the bill would require state insurance commissioners to develop plans to provide rebates to customers and the federal government. Why? Because funding the cost-sharing payments for 2018 would otherwise give insurers a huge windfall.

Allowing insurers to recover their money in court would give them an identical windfall. The courts aren’t likely to stand for that.

 

ObamaCare mandate repeal would put pressure on states

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ObamaCare mandate repeal would put pressure on states

ObamaCare mandate repeal would put pressure on states

The expected repeal of the ObamaCare mandate to buy health insurance means that states will soon have to step in and decide whether to create their own mandates.

The requirement that everyone must purchase insurance or pay a fine is a bedrock principle of ObamaCare, but it’s also one of the most unpopular parts of the law.

GOP leaders have tried for years to find a way to repeal it, arguing that it’s an unaffordable burden on working class Americans. Now, by including a provision that eliminates the penalty in the tax bill, Republicans are on the cusp of achieving a major legislative victory.

Outside experts and supporters of ObamaCare predict chaos in the insurance markets if the tax bill passes and the mandate is repealed.

Premiums are expected to rise significantly and insurers could leave the marketplace. The Congressional Budget Office estimated that about 13 million more people would be without insurance in 10 years.

States have the power to potentially blunt the damage if they choose to enact their own mandate penalties, but even officials in the most liberal states could face a bruising political battle.

“The idea of penalizing people for not getting insurance is controversial, even in blue states,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. “The debates on reimposing the mandate are not the same as opposing Republican efforts to repeal it. It’s a different dynamic.”

Levitt noted that the idea has split Democrats in the past. For example, in the 2008 presidential campaign, Hillary Clinton’s health plan included a penalty for being uninsured, while former President Obama’s did not.

“The mandate is the most unpopular part of the Affordable Care Act, so there are political challenges in focusing a debate on just that issue,” Levitt said. “States would have to make the case that it would stabilize the market to overcome political opposition.”

There are no legal barriers if other states want to set up their own mandates, but one of the biggest obstacles is time.

If the tax bill passes as expected early next week, states will face a rapidly ticking clock to try to stabilize their health insurance markets.

“It’s faster to destroy something than to create something. For states to create a replacement infrastructure, it takes time,” said Stan Dorn, a senior fellow at the advocacy group Families USA.

Dorn said states would need to decide how much of a penalty people would pay. There would also have to be regulations about reporting requirements, and the whole package would need to pass a state legislature.

But a former Obama administration official said the administrative costs and logistics of a state-level individual mandate shouldn’t be that complicated.

“It’s something of an operational lift, but compared to what states did to implement the ACA, it’s not that hard,” said Jason Levitis, a policy expert at Yale Law School and former senior official in the Treasury Department under Obama.

Insurers have urged Congress not to repeal the federal mandate, but so far have remained quiet about state alternatives.

To date, California, Maryland and Washington, D.C., have been having public discussions about replacing the federal mandate with a state penalty.

Massachusetts has had an individual mandate on the books since 2006, when it was enacted under the law known as RomneyCare. The Massachusetts mandate is more stringent than the federal one, so other states may not want to follow that template exactly.

Earlier this year, officials in the District of Columbia recommended continuing to enforce the mandate if the federal government stopped. While it’s not the same as enacting a state-level mandate, experts said doing so would be the next logical step.

Much of the Republican opposition to ObamaCare’s individual mandate has been on a philosophical level; they don’t want the federal government imposing a financial requirement on Americans.

But advocates worry that the partisan divide will make state disparities even worse, just like with ObamaCare’s Medicaid expansion.

“The very states that tend to have the most people in need haven’t expanded Medicaid,” Dorn said. “Not all states are going to respond, and in a lot of states we’ll see premiums jump through the roof.”

Levitis said that if the individual mandate were repealed, state Republicans would face a reckoning.

“It’s been really easy over the past eight years to attack the mandate without understanding it, but now that it’s going away … state officials will be faced with a stark reality of what the market looks like without it,” Levitis said.

“One would hope it acts as a wake-up call,” he added.

 

Words banned at CDC were also banned at other HHS agencies: report

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Words banned at CDC were also banned at other HHS agencies: report

Words banned at CDC were also banned at other HHS agencies: report

Multiple agencies in the Department of Health and Human Services (HHS) have reportedly been told by the Trump administration that they cannot use certain phrases in official documents.

Officials from two HHS agencies, who asked that their names and agencies remain anonymous, told The Washington Post that they had been given a list of “forbidden” words similar to the one given to the Centers for Disease Control and Prevention (CDC).

A second HHS agency was told not to use the phrases “entitlement,” “diversity” and “vulnerable,” in documents. It was also told to use “ObamaCare” as opposed to the “Affordable Care Act” and to refer to “marketplaces,” where people purchase health insurance, as “exchanges.”

The Post’s new report builds on its Friday report that the CDC had been told it could no longer use the phrases “evidence-based” and “science-based” in documents being prepared for the 2019 budget.

The list of “forbidden” words and phrases given to policy analysts at the CDC also included “vulnerable,” “entitlement,” “diversity,” “transgender” and “fetus.”

The Health and Human Services Department has pushed back on the first report.

“The assertion that HHS has ‘banned words’ is a complete mischaracterization of discussions regarding the budget formulation process,” HHS spokesman Matt Lloyd told The Hill on Saturday.

“HHS will continue to use the best scientific evidence available to improve the health of all Americans. HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions,” the statement continued.

According to the Post, similar guidance on word choice has been issued at the State Department. Employees at the State Department have been told to call sex education “sexual risk avoidance,” which primarily refers to abstinence-only education.

The Trump administration has been repeatedly scrutinized for declining to acknowledge scientific findings, particularly related to climate change. Trump has also repeatedly expressed doubts about the scientific consensus that humans are the main cause of a warming planet. Numerous members of his administration and his appointees have also denied aspects of the scientific consensus related to global warming.

 

CDC director tells staff ‘there are no banned words,’ while not refuting report

 

 

 

 

The GOP is getting closer to passing its tax bill. Here’s what it could mean for health insurers

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https://www.fiercehealthcare.com/payer/gop-tax-reform-bill-health-insurers-individual-mandate?mkt_tok=eyJpIjoiTTJFMk1XWm1aalV4WVRsayIsInQiOiJ2STJJYW85ZmhWc0tKakYzU2VlV05Ydk5NbVNpd1orNWt0anFYUW9GcDZkTDBMSmJlTGs0XC9tNDBIT3RmMDhzdmtFazBaTWpDYm9hMVplUjhSTElrSVgreHBJd3FLXC9YaHhzMXpPR2Y4MHVNRVJqcDVvMDVzOGdGQUNIMCtobDZtIn0%3D&mrkid=959610

man counting money

The House and Senate have agreed upon a unified tax overhaul bill, putting Republicans on the fast track to pass legislation that has significant implications for the health insurance industry.

For one, the compromise tax bill will repeal the Affordable Care Act’s individual mandate penalty, Senate Majority Leader Mitch McConnell said in a statement on Wednesday. To McConnell, axing the mandate will offer “relief to low- and middle-income Americans who have struggled under an unpopular and unworkable law.”

Health insurers and the healthcare industry at large have opposed removing the key ACA provision without a viable alternative to encourage healthy consumers to buy coverage, arguing that doing so will destabilize the individual markets. Indeed, the Congressional Budget Office has estimated that repealing the mandate would increase the number of uninsured people by 13 million over the next 10 years and hike individual market premiums by 10% during most years of that decade.

Yet while the individual mandate repeal is problematic for insurers that do business on the ACA exchanges, nearly all insurance companies stand to gain from the GOP tax bill overall, according to Leerink Partners analyst Ana Gupte, Ph.D. She estimates that insurers can capture about 10% to 15% of the potential 25% upside from the legislation, subject to regulatory constraints such as medical loss ratio rules and competitive pricing constraints.

Likely the biggest gain for insurers is the fact that, per the New York Times, the compromise bill sets the corporate tax rate at 21%—significantly lower than the current rate of 35%.

Though the House and Senate have ironed out the differences in their bills, the final version still must be approved by both chambers. GOP leaders have but two votes to spare in the Senate, and will likely have to include two bipartisan measures to shore up the ACA in Congress’ year-end spending bill to win the support of Sen. Susan Collins, R-Maine.

Collins said on Wednesday that Vice President Mike Pence assured her that those measures would make it into the spending bill, according to The Hill. Yet some House conservatives have expressed opposition to the bills, which would provide funding for cost-sharing reduction payments and state-based reinsurance programs, among other provisions.

Meanwhile, the results of the headline-grabbing Senate race in Alabama have put a major crimp in Republicans’ plans to retry repealing the ACA. Once Democrat Doug Jones officially takes his seat, the GOP will have an even slimmer majority in the Senate, where the defection of a handful of moderate Republicans was already enough to kill several repeal bills earlier this year.

 

Tax Bill Threatens Our Health and Our Democracy

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http://www.chcf.org/articles/2017/12/tax-bill-threatens-our-democracy

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Earlier this month, the Senate passed legislation that would overhaul the tax code, make dramatic changes to federal health care policy, and undermine the budgets of Medicaid and Medicare, two pillars of the American health care system. The House and Senate are now trying to reconcile their two tax bills. Each passed the legislation on a party-line vote, with one Republican voting against the bill in the Senate.

Congress is now one step away from passing a tax bill that will have a profound effect on the health and well-being of Americans for a generation. No one should forget that, to get this close, the Senate rushed to approve a deeply unpopular proposal with little transparency and due diligence — and no bipartisanship. Left unchecked, these actions will harm millions of Americans — and American democracy itself.

Even though the legislation has been framed as a tax bill, it is very much a health care bill. The Senate bill would eliminate the Affordable Care Act’s individual health insurance mandate, which would lead to the destabilization of the individual health insurance market. The Congressional Budget Office (CBO) projects that this change alone would increase individual premiums by 10% a year and cause as many as 13 million Americans to join the ranks of the uninsured by the end of the next decade. In California, the uninsured population would grow by 1.7 million people. Congress may still pass separate legislation to restore some stability to the individual market, but the leading proposals are too modest to prevent much damage.

Seismic Impact

On its own, the language in the tax bills would trigger a major earthquake in the health care system, and the aftershocks of this tax bill would be just as dangerous. By eliminating more than $1 trillion of federal revenue, the administration and congressional leaders are manufacturing a budget crisis that would likely lead to automatic cuts to Medicare under federal rules. The CBO, which examined the House bill, has estimated that those cuts could be around $25 billion a year. Republican leaders have also indicated they intend to use the revenue shortfall that they are engineering with this tax bill to seek deep cuts in safety-net programs, starting with Medicaid.

This isn’t merely about what the legislation will do to health care, because it also would exacerbate inequality and worsen health disparities in this country. Under both the House and Senate bills, low- and middle-income families would pay more in taxes and have a harder time paying not just for health care, but also for food, housing, child care, education, and other basic needs. When people struggle so much to make ends meet, they suffer more from illness and die younger. And if inequality keeps getting worse, it will undermine the economic, social, and political stability upon which our nation depends.

The burden on Californians would be particularly heavy. Our families would no longer be able to deduct what they pay in state and local taxes on their federal tax returns. This change alone would take more than $112 billion a year out of the pockets of hardworking Californians — more than any other state. The fact that Californians would be paying more in federal taxes would inevitably put new pressure on our state and municipal governments to reduce their taxes. Under that scenario, it is not hard to imagine a new wave of painful state and local budget cuts.

The irony is that California actually has the power to stop this runaway train. If the entire California congressional delegation worked together to protect their constituents, and if they were united and strong, they could prevent many — if not all — of the worst provisions in the tax bills from becoming law.

This moment is a test of leadership. Nothing less than the health of our people — and our democracy — are at stake.

Actuaries warn of premium increases from repealing ObamaCare mandate

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Actuaries warn of premium increases from repealing ObamaCare mandate

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A group of insurance experts is warning Congress against repealing ObamaCare’s individual mandate, saying the move would raise premiums and could cause insurers to drop out of the market.

The American Academy of Actuaries wrote to congressional leaders on Tuesday saying that “eliminating the individual mandate would lead to premium increases.”

The Republican tax-reform bill which is nearing completion in Congress would repeal the ObamaCare mandate that people have health insurance or pay a fine.

Republicans argue the measure included in the Senate-passed bill is tax relief by removing a penalty for low-income people who choose not to buy insurance.

The actuaries warn that repealing the mandate would harm the health insurance market by removing an incentive for healthy people to enroll and balance out the costs of the sick.

The insurance experts also say that a measure pushed by Sen. Susan Collins (R-Maine), intended to help offset the premium increases from repealing the mandate, would not be enough to make up the difference.

That bill, sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray(D-Wash.), would fund key ObamaCare payments known as cost-sharing reductions. The actuaries say the payments “would not offset premium increases due to an elimination of the mandate.”

The letter says additional measures — such as funding to bring down premiums known as “reinsurance,” which Collins has also proposed — could help, though. Some experts say more funding than is currently proposed would be needed.

The instability from repealing the mandate also could lead some insurers to drop out of markets altogether, the actuaries warn, potentially leaving some people with no insurance options.

“Insurers would likely reconsider their future participation in the market,” the actuaries write. “This could lead to severe market disruption and loss of coverage among individual market enrollees.”

 

 

Why Do People Hate Obamacare, Anyway?

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https://khn.org/news/why-do-people-hate-obamacare-anyway/

The Affordable Care Act, aka “Obamacare,” has roiled America since the day it was signed into law in 2010. From the start, the public was almost evenly divided between those who supported it and those who opposed it.

They still are. The November monthly tracking poll from the Kaiser Family Foundation found that 50 percent of those polled had a favorable view of the health law, while 46 percent viewed it unfavorably. Partisan politics drives the split. Eighty percent of Democrats were supportive in November, while 81 percent of Republicans were strongly negative. (Kaiser Health News is an editorially independent program of the foundation.)

That helps explain why Republicans are working to repeal a key element of the health law in the tax bill Congress is negotiating. The requirement that most Americans have health insurance or pay a tax penalty — the so-called individual mandate — is by far the most unpopular provision of the law, particularly among Republicans.

Still, while partisanship is a major reason why some people hate the health law, it’s far from the only one. Here are four more: 

Ideology

Conservatives and libertarians strongly object to the federal government becoming ever more involved in the nation’s health care system. While the refrain that the ACA represented a “government takeover” of health care was a significant exaggeration, the law did insinuate the government significantly further in its funding and oversight of health care.

Adding to that was the unhappiness with the ACA’s individual mandate. Although the idea was originally suggested by Republicans in the late 1980s, the GOP had mostly backed away from it over the years (with the notable exception of Massachusetts Gov. Mitt Romney, who supported that state’s health overhaul in 2006).

But conservatives are not alone in opposing the ACA on ideological grounds. Many liberals don’t like the law, either. They think it does not go far enough toward a fully government-run system and gives too much power to private insurance companies. 

Lack Of Knowledge

A big part of why people don’t like the health law is that they don’t understand what it does or how it works. Some of that is because health care is complicated.

Even some of the main arguments made by the law’s supporters are not well understood. For example, the health law is responsible for some 20 million Americans gaining health insurance. Yet in 2016, when the uninsured rate hit an all-time low, only one-quarter of respondents to the Kaiser tracking poll knew that. A little under half thought the rate had remained unchanged, and 21 percent thought the rate had risen to an all-time high.

But some misperceptions follow intentional fabrications or exaggerations of the law’s impact. Many people came to believe (incorrectly) that the law would create “death panels” to decide the fate of seniors on Medicare, which became PolitiFact’s “Lie of the Year” in 2009. Other outlandish and untrue claims about the law included the idea that it would require people to be microchipped, that it would create a “private army” for President Barack Obama and that it would require hospitals to fire obese employees.

Even the derisive nickname “Obamacare” fed the confusion. In a now-famous skit by comedian Jimmy Kimmel, people on the street expressed a strong preference for the Affordable Care Act over Obamacare — unaware that they were the same thing. 

Confusing The Health Law With The Rest Of The Health System

Once the ACA became law, basically everything bad that happened in health care was attributed to it. This is the famous “you broke it, you bought it” problem — the law became the scapegoat for any number of problems in the health care system, regardless of whether they predated its enactment.

For example, rising prices for prescription drugs has been a problem for years. But the ACA did not seek to address that, except for one provision that sought to facilitate generic copies of some of the most expensive biologic medications.

Also, before the ACA, some insurers stopped offering plans in the individual market, while others raised premiums dramatically and often would not cover care at high-cost providers like teaching hospitals. 

Some People Actually Are Worse Off

The ACA did create some losers. Healthy people who managed to buy individual health insurance before the law’s passage have seen their premiums and out-of-pocket costs soar as insurers have raised prices to accommodate sicker people who had been largely shut out of coverage. Among those hardest hit are people who earn just slightly too much to qualify for federal premium subsidies, particularly early retirees and people in their 50s and early 60s who are self-employed.

Many of those people would have been helped if Democrats had been able to pass some of their original ideas for the ACA, including a “public option” plan run by the government, or a “Medicare buy-in” that would have given people age 55 and older the option of purchasing Medicare coverage before the normal eligibility age of 65. Both were rejected by more conservative Democrats in the Senate.

Some people found themselves in a “coverage gap” after the Supreme Court in 2012 ruled that the ACA requirement for states to expand Medicaid had to be optional. That meant people with incomes under the poverty line but still too high to qualify for Medicaid in their states have no affordable program available.

Others were forced to give up coverage that they liked, even if it did not offer many benefits, or were angry because their doctors and hospitals were no longer in their insurers’ networks. Obama’s promise that “if you like your health plan you can keep it” was PolitiFact’s “Lie of the Year” for 2013.

However, even some of those consumers have seen benefits from the law, although they might not realize it, like required rebates from insurers who charge too much for administrative costs.

But it is human nature for people who feel wronged to complain loudly, while people who are satisfied merely go on with their lives. In the end, that is why it seems so many more people hate Obamacare than actually do.

 

Consumer-directed health plans enrollment up but costs are not coming down, RAND finds

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http://www.healthcarefinancenews.com/news/consumer-directed-health-plans-enrollment-costs-are-not-coming-down-rand-finds?mkt_id=1526895&mkt_tok=eyJpIjoiWm1NeVpXWmtNall4WTJWbCIsInQiOiJDV1RRSkR0bFhQOGpsaDlib0hldGUrdEVoK0ttS2Q1VXBQQldYaFhFeXRaYW4xRE9ZXC9rU1gxd0QwdlFtbCtPYWR5d3QwK0hHTlEwb0NKSnkrd2pcL0J1NCtOTklqc2hyZ1ArWDZRY2E5RjBoXC80NG8xaVhzT1kyV3Z1N0tIUnRCeCJ9

 

Even though high-deductible insurance options could save patients thousands of dollars every year, most people are not shopping around.

An increasingly popular form of health insurance touted for its money-saving potential has not reduced spending on unnecessary medical services, a new study shows.

Researchers from the USC Schaeffer Center for Health Policy and Economics and the RAND Corp. found that consumer-directed, high-deductible health plans have little or no effect on curbing spending on 26 services that medical professional and industry groups have deemed “low value.”

The researchers compared patient spending on unnecessary medical services, such as an MRI for lower back pain or imaging for an uncomplicated headache, before and after they switched from a traditional insurance plan to a consumer-directed health plan — a form of high-deductible insurance.

The study, published in The American Journal of Managed Care, is the latest of several to indicate that high-deductible plans are falling short of their promises of significant savings.
Recent work by researchers at USC Schaeffer Center, the USC Price School of Public Policy and the USC School of Pharmacy have found that most consumers on high-deductible plans are not comparing prices to find the best deals on services or on prescription drugs, even though the research indicates that some patients could potentially save hundreds or thousands of dollars per year.

Unnecessary services add up to an estimated $750 billion in wasteful healthcare spending each year, according to the National Academy of Sciences. Examples of the unnecessary services in the list of 26 that the researchers tracked were T3 testing for hypothyroidism, a spinal injection for low-back pain and stress testing for stable coronary artery disease.

Patients on consumer-directed health plans share more costs for their care than patients on traditional plans as they pay a higher deductible. With the high-deductible plan, a patient can open a pre-taxed healthcare savings account and use it to pay for out-of-pocket medical services. This type of plan is often pitched as way to give consumers more skin in the game, presuming they will shop and compare prices for services or skip unnecessary care and therefore spend less.

Enrollment in these plans has risen dramatically in the last decade, with a nearly seven-fold increase. Only about 4 percent of Americans with employer-sponsored insurance were on a consumer-directed health plan in 2005, compared to about 30 percent today. The vast majority of individuals who obtained insurance under the Affordable Care Act are on consumer-directed health plans.

Patients are reducing their spending overall, but not for low-value services in particular — and medical providers also often lack incentives to curb spending on these services, which are frequently ineffective.

The study focused on 26 common, low-value services from various sources, including the Choosing Wisely campaign, national guidelines, peer-reviewed literature and professional consensus. Launched in 2012 by the American Board of Internal Medicine Foundation to raise awareness about unnecessary services, the Choosing Wisely campaign has compiled recommendations from more than 70 medical professional and specialty societies identifying common and wasteful medical tests, treatments and procedures whose use should be questioned or avoided.

While spending on unnecessary services did not significantly change after a patient switched plans, the high-deductible plan did result in an average, annual $231 decrease on outpatient spending.

Actuaries: Alexander-Murray won’t offset mandate repeal

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The American Academy of Actuaries is throwing some cold water on Republicans’ claims that they’ll offset the damage from repealing the ACA’s individual mandate by restoring funding for the law’s cost-sharing subsidies.

  • “While making cost-sharing reduction reimbursements to insurers … would offset premium increases due to the prior termination of those payments, it would not offset premium increases due to an elimination of the mandate,” the actuaries wrote in a letter yesterday.
  • This should not come as a surprise. This is hardly the first time nonpartisan experts have said the move to restore cost-sharing payments — a bill sponsored by Sens. Lamar Alexander and Patty Murray — would not make up for the effects of repealing the mandate. They are separate things.

The big question: Does Collins believe this analysis, and does she care? Collins has made two ACA-related demands — a vote on Alexander-Murray, and a vote to establish a new reinsurance fund — in return for her vote to repeal the individual mandate.

  • Plenty of experts have said Alexander-Murray wouldn’t do much.
  • Reinsurance would.
  • But it’s not clear either proposal can pass the House. If one of them can, it’s probably Alexander-Murray.
  • That leaves a distinct possibility that insurance markets will not actually see the stabilizing effects Collins is bargaining for.

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