Tag Archives: ACA

The CHCF Blog Californians in Individual Market Spent $2,500 Less on Care in 2015 Than Before the ACA

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http://www.chcf.org/articles/2017/04/californians-individual-market-spent-less

Average Annual Spending on Health Care by Consumers in Individual Market

Two years into the Affordable Care Act (ACA), Californians who bought health insurance on the individual market spent $2,500 less on health care compared to 2013, the year before the ACA was fully implemented, according to data from the US Census Bureau’s Current Population Survey (CPS) available on ACA 411. This decline was likely driven primarily by the premium tax credits and cost-sharing reductions provided through the ACA’s health insurance marketplaces. This progress toward making health care more affordable is at risk as federal lawmakers debate repealing or radically changing the ACA.

Californians’ Spending Decline Beats National Trends

In 2013, Californians with individual coverage spent, on average, $7,300 out of pocket on health care (defined as spending on health insurance premiums, copays, deductibles, coinsurance for services and prescription drugs). That amount fell to $4,900 in 2014, the first year the ACA health insurance marketplaces (called Covered California in California) were open for business. In 2015 average spending for those covered through the individual market continued declining to $4,800 for a total drop of $2,500 over the two-year period.

Nationally, the amount spent on health care by consumers with individual coverage dropped from $6,800 in 2013 to $5,500 in 2015, a $1,300 decline.

Average Annual Spending on Health Care by Consumers in Individual Market

Similarly, the percentage of consumers with individual coverage reporting “high-burden spending” (defined as spending more than 10% of total income on health care) fell nationally, with California seeing a steeper decline, from 42.9% in 2013 to 33.8% in 2015. Nationally, it dropped from 44.7% to 38.8% during the same period.

Percentage of Consumers in Individual Market Spending More Than 10% of Income on Health Care

For more information on national trends in high-burden spending, read this new analysis of the CPS data by the State Health Access Data Assistance Center (SHADAC). There was a small but statistically significant decline in the overall US rate of high-burden spending, with improvements also among those on Medicare and those earning less than 400% of the federal poverty level (about $47,000 a year for a single person). The brief also highlights which states saw statistically significant changes in high-burden spending among various coverage types and income levels.

 

Medical Loss Ratio: Updates and Impact

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http://bhmpc.com/2017/04/medical-loss-ratio-updates-impact/

Medical Loss RatioMedical Loss Ratio

Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. Revisiting one of the Affordable Care Act’s (ACA) metrics, Medical Loss Ratio.

As we all know, healthcare costs are skyrocketing. The US government is trying to look at healthcare spending from all angles in an effort to control costs while increasing quality. It has become a balancing act. The evolution of the American Health Care Act (AHCA) leaves open the possibilities of re-imagining a number of provisions of the ACA increasing the effectiveness of reducing costs and increasing quality. One provisios of particular interest is the Medical Loss Ratio which was supposedly designed to add efficiency, reduce waste, and control administrative costs for a currently broken healthcare system.

Medical Loss Ratio  (MLR) Rule

MLR existed long before ACA; was used to evaluate performance of managed care companies. ACA created a federal standard and modified the calculation.

The Affordable Care Act requires health insurance companies to disclose how much they spend on health care and how much they spend on administrative costs, such as salaries and marketing. If an insurance company spends less than 80% (85% in the large group market) of premium on medical care and efforts to improve the quality of care, they must refund the portion of premium that exceeded this limit. This rule is commonly known as the 80/20 rule or the Medical Loss Ratio (MLR) rule.

Modern Healthcare reports, House conservatives and outside experts doubt HHS Secretary Tom Price has legal authority to substantially revise the Affordable Care Act’s key insurance market regulations and other provisions by issuing new rules and guidance. Price could also withdraw the rule released last year that overhauled regulation of Medicaid managed care programs. If Price tries to rescind that rule, network adequacy provisions, a medical loss ratio mandate for managed care plans, and managed long-term services and supports policies would all be eliminated.

Forbes reports this week, “The Trump administration can start by modifying Obamacare’s “medical loss ratio” rules, which dictate how insurers must spend the money they collect in premiums. If or when the MLR requirement ends, maybe the MLR’s impact and importance remains a visible measuring stick of performance.

CNBC used MLR in this story, yesterday. “UnitedHealthcare reported medical care ratio, or the amount it spends on medical claims compared with the insurance premiums that it brings in, of 82.4 percent, an increase of 70 basis point. “We see a positive set up for peers based on a read through of the company’s better-than-expected medical loss ratio and strong Medicaid performance,” Piper Jaffray analyst Sarah James said.”

Trump Group’s Ads Bolstering GOP Obamacare Repeal Drive

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https://www.nytimes.com/aponline/2017/04/17/us/politics/ap-us-health-overhaul-ads.html?_r=0

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A pro-Trump group is airing ads in a dozen Republican-held House districts aimed at drumming up support for the White House’s wounded drive to repeal President Barack Obama’s health care law.

The $3 million campaign comes during a two-week congressional recess in which GOP lawmakers’ town hall meetings have been rocked by liberal supporters of Obama’s 2010 statute. Underscoring the challenges Republicans face, one poll showed Monday that the public trusts Democrats over the GOP on health care by their biggest margin in nearly a decade.

Leaders averted a planned House vote last month on a bill replacing much of Obama’s law with a GOP alternative because Republican divisions would have ensured its defeat. White House officials complained at the time that while conservative outside groups opposing the bill had pressured lawmakers, there was insufficient lobbying and advertising by supportive organizations.

Talks among White House officials and GOP lawmakers have continued during the break, but there have been no tangible signs that they’ve found a way to reverse what has been a damaging defeat for President Donald Trump and congressional leaders.

The TV and internet ads by America First Policies are running in districts from Arizona to Pennsylvania, the group said Monday. Some are represented by lawmakers who backed the GOP legislation, others opposed it and others hadn’t taken clear public positions.

One ad aimed at Rep. Gary Palmer, R-Ala., urges people to thank him “for standing with President Trump to repeal Obamacare now.” Palmer said after the House vote was canceled that he backed the decision to pull the bill so work on the legislation could continue.

America First Policies is run by former Trump White House and campaign staffers including Katie Walsh, who left her job as White House deputy chief of staff shortly after the leaders’ retreat from the House vote.

A poll by the nonpartisan Pew Research Center showed that by 54 percent to 35 percent, more people think Democrats do a better job than Republicans handling health care. Though the public has usually given Democrats an advantage on the issue in Pew polls, the two parties were ranked about evenly as recently as 2013.

Obamacare’s Insurers Struggle for Stability Amid Trump Threats

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https://www.bloomberg.com/politics/articles/2017-04-17/obamacare-s-insurers-struggle-for-stability-amid-trump-threats

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Obamacare is stuck in limbo, and insurers and state regulators are struggling to set their plans for what’s increasingly shaping up as a chaotic year for the health-care program.

After the failure of Republicans’ first attempt to repeal and replace the Affordable Care Act and President Donald Trump’s subsequent threats to let the program “explode,” more health insurers are threatening to pull out next year, while others may sharply raise the premiums they charge. They’ll start to declare in the next few weeks whether they’re in or out.

Marguerite Salazar, Colorado’s insurance regulator, said that her state’s carriers, which include Anthem Inc. and Cigna Corp., haven’t said they’re leaving, though they don’t want to commit either.

“That’s my biggest fear, is that we would lose carriers in the individual market,” Salazar said. “We don’t want to set up an environment that would tell them, well, maybe we don’t need to be here.”

In Washington, Insurance Commissioner Mike Kreidler pushed back by a month the date when insurers have to say what they’ll offer. He’s urging them to stay and thinks most will, but “they’re not making commitments right now.”

“They’ve got those cards and they’re holding them close,” said Kreidler, a Democrat. “Right now, there’s so much uncertainty.” The fear is that they’ll follow the lead of Aetna Inc. and Wellmark Inc., which pulled out of Iowa’s Obamacare markets this month.

Trump’s Uncertainty

Much of the uncertainty is thanks to the Trump administration, which will play a key role in deciding whether the health law’s markets collapse or survive. Industry representatives — including company executives and insurance lobby CEO Marilyn Tavenner — are scheduled to meet Tuesday with Seema Verma, the head of the Centers for Medicare and Medicaid Services, the U.S. agency that oversees the law.

Trump’s latest threat has been to stop payments that subsidize co-pays and other upfront costs for lower-income people. Without them, insurers would likely boost their premiums or drop out entirely. The administration has refused to commit to keeping the payments going.

Health insurers see April 30 as a key deadline for a decision on the cost-sharing payments. They’ll start filing with some state regulators in May to say whether or not they’ll stay in the markets.

“Everybody is still in a wait-and-see mode,” said Kristine Grow, a spokeswoman for the industry group America’s Health Insurance Plans. AHIP and other industry groups are pushing the administration to commit to making the cost-sharing payments that Trump has threatened to halt. “Plans really need certainty,” she said.

 

The GOP’s problem on health reform is they’ve spent years hiding their real position

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http://www.vox.com/policy-and-politics/2017/4/17/15325366/gop-problem-on-health-reform

The most interesting policy argument in America right now is the debate between conservatives’ real position on health care and their fake position.

The fake, but popular, position goes something like this: Conservatives think everyone deserves affordable health insurance, but they disagree with Democrats about how to get everyone covered at the best price. This was the language that surrounded Paul Ryan and Donald Trump’s Obamacare alternative — an alternative that crashed and burned when it came clear that it would lead to more people with worse (or no) health insurance and higher medical bills.

Conservatives’ real, but unpopular, position on health care is quite different, and it explains their behavior much better. Their real position is that universal coverage is a philosophically unsound goal, and that blocking Democrats from creating a universal health care system is of overriding importance. To many conservatives, it is not the government’s role to make sure everyone who wants health insurance can get it, and it would be a massive step toward socialism if that changed.

This view provided the actual justification for Ryan and Trump’s Obamacare alternative — it’s why they designed a bill that led to more people with worse (or no) health insurance and higher medical bills, but that cut taxes for the rich and shrank the government’s role in providing health care.

There was, for decades, a logic to the GOP’s dual positions: the fake but popular position was used to pursue the ends of the real but unpopular position. But in the post-Obamacare world, the chasm that has opened between conservatives’ fake and real positions has become unmanageable, and how — or whether — conservatives resolve it has become perhaps the most interesting public policy question going today.

A real conservative health care debate worth hearing

On the latest episode of Peter Robinson’s Uncommon Knowledge, Avik Roy and John Podhoretz have perhaps the most honest and bracing discussion of this I’ve heard. Podhoretz, a columnist and editor with a deep pedigree in conservative politics, begins by arguing that the passage of Obamacare, and the debate over the American Health Care Act, shows a “Rubicon” has been crossed in American politics — there is now an “almost unspoken acceptance of the idea that there should be universal coverage for health care in the United States.”

 

Medicaid expansion didn’t cause unexpected state budget problems, study finds

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http://www.beckershospitalreview.com/finance/medicaid-expansion-didn-t-cause-unexpected-state-budget-problems-study-finds.html

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A study published in Health Affairs Wednesday found the states that expanded their Medicaid programs under the ACA didn’t encounter unforeseen budget problems as a result of the expansion.

Thirty-one states and the District of Columbia have expanded their Medicaid programs under the ACA. To determine the fiscal effects of Medicaid expansion on state budgets, researchers used data from the National Association of State Budget Officers for fiscal years 2010 to 2015.

Medicaid spending increased by 11.7 percent overall in states that expanded their programs, but this spending growth was covered by federal funds. Under the ACA, the federal government paid for 100 percent of the costs for newly eligible Medicaid enrollees from 2014 through 2016 in states that expanded the program.

The researchers also found states didn’t have to take funding away from education or other programs to fund their expanded Medicaid programs.

Since the data used in the analysis was only for years during which the federal government covered up to 100 percent of the cost of expanding Medicaid, the study likely underestimates the budgetary implications of the expansion beginning in 2017. That’s because states become responsible for 5 percent of expansion costs this year, and, absent any legislative changes, will be responsible for 10 percent of costs by 2020.

 

High-Risk Pools for People with Preexisting Conditions: A Refresher Course

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http://www.commonwealthfund.org/publications/blog/2017/mar/high-risk-pools-preexisting-conditions?omnicid=1196155&mid=henrykotula@yahoo.com

During the recent effort to repeal and replace the Affordable Care Act (ACA), some members of Congress and the Trump administration seemed to be experiencing a certain nostalgia for high-risk pools, which operated in 35 states before the ACA was enacted. At a CNN Town Hall Meeting in January, Speaker of the House Paul Ryan responded to a question about coverage for people with preexisting conditions by saying:

We believe that state high-risk pools are a smart way of guaranteeing coverage for people with preexisting conditions. We had a really good one in Wisconsin. Utah had a great one . . . . What I mean when I say this is, about 8 percent of all the people under 65 have that kind of preexisting condition . . . . So, by financing state high-risk pools to guarantee people get affordable coverage when they have a preexisting condition, what you’re doing is, you’re dramatically lowering the price of insurance for everybody else. So, if we say let’s just, as taxpayers—and I agree with this—finance the coverage for those 8 percent of Americans under 65 in a condition like yours, they don’t have to be covered or paid for by their small business or their insurer who is buying the rates for the rest of the people in their insured pool, and you’d dramatically lower the price for the other 92 percent of Americans.

As high-risk pools and other changes to the ACA continue to be debated, it is critical to deconstruct statements such as these and remind ourselves of how high-risk pools really worked and how unaffordable they were. It is important to remember that high rates of uninsurance and lack of affordability for all buyers in the individual market existed before the ACA, even in states with high-risk pools. In addition, policymakers seem to substantially underestimate the number of Americans with preexisting conditions who might be forced to purchase coverage through a high-risk pool if insurers are allowed to deny coverage in the marketplace.

Reality Check

The reality is that high-risk pool coverage was prohibitively expensive and there is little evidence to suggest that the existence of such pools made coverage less costly for others in the individual insurance market. Without substantially more federal funding than currently proposed, these facts are not likely to change. People with preexisting conditions may have “access” to coverage, but most will not be able to afford it and those who can will face limited benefits and extremely high deductibles and out-of-pocket payments.

Obamacare repeal bill is the zombie GOP can’t kill — or bring back to life

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http://www.politico.com/story/2017/04/obamacare-repeal-bill-gop-zombie-237215

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Republicans in Congress for the first time are lowering expectations for how much of Obamacare they can repeal and how quickly they can do it.

As they meet constituents back home, GOP lawmakers seem trapped between the reality of their failed repeal effort and President Donald Trump’s renewed promises this week to finish off Obamacare before taking on tax reform. Vice President Mike Pence is also still trying to keep the repeal dream alive, working with conservatives on new tweaks to the stalled House bill. But even if the ultra-conservatives come on board, there’s no sign that the moderate Republicans needed to pass a bill are ready to sign on.

Those dynamics mean the Obamacare repeal effort that has helped define the Republican Party for seven years may live on in a sort of political purgatory — with no one willing to pull the plug even though there are few signs of life. The uncertainty created by that zombie state could compel health insurers to stop offering coverage in the exchanges next year, paralyze action on other legislative priorities on Capitol Hill and come back to haunt Republicans at the polls in 2018.

Lawmakers back in their districts during their first recess since the collapse of the House effort are downplaying the repeal agenda as if the rallying cry to eliminate the law “root and branch” has been pared down to some leaves. Some constituents are conveying their displeasure.

Joe Barton (R-Texas), a Freedom Caucus member, was confronted at a town hall meeting Tuesday by a self-described Republican who blasted the GOP for not repealing all of Obamacare on “Day One of the Trump administration.”

 

Trump Threatens Health Subsidies to Force Democrats to Bargain

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In the weeks since President Trump’s attempts to replace the Affordable Care Act collapsed, the administration has debated what to do: Try again? Shore up the insurance marketplaces? Or let the whole system collapse?

Mr. Trump has failed to get enough support from his own party, but he hopes to get the Democrats’ help by forcing them to the negotiating table with hints about the chaos he could cause.

His bargaining chip is the government subsidies paid to insurance companies so they can reduce deductibles and other out-of-pocket costs for low-income consumers — seven million people this year.

In an interview with The Wall Street Journal this week, Mr. Trump threatened to withhold the subsidy payments as a way to induce the Democrats to bargain with him.

For now, Democrats are resisting and using his maneuver against him to energize their own party. And they warn that Mr. Trump will be blamed if the insurance markets collapse and people lose coverage next year.

“Republicans are in control of government,” Senator Claire McCaskill, Democrat of Missouri, said Thursday after a town-hall-style meeting in her home state. “If they blow up what access to health care there is right now, they’re going to own it.”

The president’s tone differs from that of Republicans in Congress, who have repeatedly promised a smooth transition away from the law they call Obamacare. “We don’t want to pull the rug out from under people,” the House speaker, Paul D. Ryan, has said.

If the subsidies are interrupted, insurers say, some health plans will increase premiums and others will withdraw from the individual insurance market. That will, in turn, affect millions of other people who do not receive the subsidies.

The issue could come to a head within weeks. When the House reconvenes on April 25, the first order of business will be a spending bill to replace the current stopgap law, which expires three days later. Democrats are determined to put money for the health insurance subsidies into that bill, and some Republicans on the House and Senate Appropriations Committees are open to the idea. But ultimately, the decision will be made by Republican leaders in the two chambers.

If the spending is allowed to continue, the Congressional Budget Office estimates that the federal government will pay $135 billion in cost-sharing subsidies to insurers from 2018 to 2027.

The cloud of uncertainty swirling around the subsidies stems from a court ruling in a lawsuit that House Republicans filed against the Obama administration in 2014. Judge Rosemary M. Collyer of the Federal District Court in Washington ruled last year that spending on the subsidies “violates the Constitution” because Congress never appropriated money for them. She ordered a halt to the payments, but suspended her order to allow the government to appeal.

The Trump administration has not made clear whether it will press the appeal filed by the Obama administration. In a letter to Mr. Trump this week, the U.S. Chamber of Commerce joined the American Medical Association, the American Hospital Association and insurers in seeking “quick action” to guarantee continuation of the subsidies. Without the subsidies, they said, more people will be uninsured and unable to pay medical bills.

Democrats say they will not negotiate with Mr. Trump until he stops his drive to repeal the Affordable Care Act. “President Trump is threatening to hold hostage health care for millions of Americans, many of whom voted for him, to achieve a political goal of repeal that would take health care away from millions more,” said the Senate Democratic leader, Chuck Schumer of New York.

 

 

What Now? Healthcare or Tax Reform

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GOP wrestles with big question: What now?

Image result for healthcare or tax reformImage result for healthcare or tax reform

Republicans at both ends of Pennsylvania Avenue are facing a big question this spring: What now?

As President Trump approaches his 100-day mark at the end of this month, congressional Republicans have few accomplishments to point to and are divided over how to proceed on his two biggest priorities: healthcare and tax reform.

Congress is at the start of a two-week recess, and lawmakers say they will listen to feedback from constituents as they mull the next legislative steps of 2017. The internal debate boils down to whether they should stick to their strategy of working strictly along party lines to pass big-ticket bills or try to find common ground with Democrats, perhaps on smaller proposals.

Republicans are divided over whether to take another shot at healthcare reform, which failed in the House last month, or move on to tax reform.