Tag Archives: Health Insurance Coverage Adequacy

Uncovered California: Community College Students’ Quest for Mental Health Services

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Uncovered California: Community College Students’ Quest for Mental Health Services

Mental Health infographic

On April 19, 35-year-old Sacramento City College student Rachel Wilson testified before the state Assembly’s higher education committee. A survivor of sexual assault and multiple suicide attempts, she described the lack of mental health support services available to her at school. Wilson was followed by an American River College professor, whose own son had killed himself while studying at a community college. The professor talked about three students who had recently committed suicide at her school, and of the lack of mental health services to help troubled individuals. When faculty members saw someone in crisis, she said, they were instructed to call campus police and have them take the student away.

“Mental illness is not a crime,” she told legislators. Then she repeated it: “Mental illness is not a crime.”

 Both women wanted the legislators to support Kevin McCarty’s (D-Sacramento) Assembly Bill 2017, which would significantly expand mental health services across California’s vast community college system.

Roughly two million Californians attend classes in one or another of the 113 community campuses dotted around the state. Surveys suggest that somewhere in the region of one in four of these students will experience a diagnosable mental health problem at some point, but approximately 40 percent of them won’t seek timely help. And too often, the institutions at which they study won’t be proactive in linking them up with vital services. As a result, they go untreated.

“Uncovered California” is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

High-Risk Pools For Uninsurable Individuals

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High-Risk Pools For Uninsurable Individuals

Figure 1: Concentration of Health Care Spending in U.S. Population, 2011

In the debate over the future of the Affordable Care Act (ACA), proposals have emerged that would repeal or weaken rules prohibiting health insurance discrimination based on health status, instead offering high-risk pools as a source of coverage for people who would be uninsurable due to pre-existing conditions.

In Congress, HR 2653 was introduced by members of the House Republican Study Committee to repeal the ACA and replace it with other changes, including state high-risk pools.  This bill would authorize $50 million for seed grants to help states establish high-risk pools, and $2.5 billion annually for 10 years to help states fund high-risk pools.  Recently, House Republicans released their proposal to replace the ACA, entitled A Better Way.  This plan would significantly modify ACA insurance market rules to provide a one-time open enrollment opportunity; thereafter, only individuals who maintain continuous coverage would be guaranteed access to insurance without regard to their health status.  This plan also would provide $25 billion over 10 years in state grants to help fund high-risk pools.  Pools would be required to cap premiums (at unspecified levels) and would be prohibited from imposing waiting lists.

For more than 35 years, many states operated high-risk pool programs to offer non-group health coverage to uninsurable residents.  The federal government also operated a temporary high-risk pool program established under the ACA to provide coverage to people with pre-existing conditions in advance of when broader insurance market changes took effect in 2014.  This issue brief reviews the history of these programs to provide context for some of the potential benefits and challenges of a high-risk pool.

The Next Big Debate in Health Care

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Source: Kaiser Family Foundation analysis of Truven Health Analytics Market Scan Commercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).

With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer.

As the chart above shows, payments toward deductibles by consumers who have insurance through large employers rose 256% from 2004 to 2014; over the same period, wages increased 32%. The chart shows what people actually paid toward their deductibles and other forms of cost-sharing, not just their exposure as deductibles climbed (which is more typically what studies and data report). Deductibles accounted for 47% of cost-sharing payments in 2014, up from 24% in 2004. During the same period some other forms of cost-sharing fell. Payments for co-pays declined by 26%. It’s no wonder that consumers say in polls that deductibles are their top health-cost concern.

Rising payments for deductibles cause people to use less health care and have played a role in the moderation we have seen in recent years in the growth of health spending. That rate of growth has begun to tick up but remains moderate by historical standards. Ever larger deductibles may dampen growth in spending but can also be a significant burden for many family budgets and a barrier to care for the chronically ill.

Presidential election: 4 things managed care should watch

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http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/presidential-election-4-things-managed-care-should-watch?GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=24082016

As the 2016 presidential election approaches, analysts and experts are advising healthcare executives to watch and monitor certain issues, such as pharmaceutical spending and healthcare reform, which will surely impact the health insurance industry. Here’s a look at what they recommend keeping a close eye on in particular.

The Fundamentally Different Goals of the Affordable Care Act and Republican ‘Replacement’ Plans

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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.

The Next Big Debate in Health Care

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http://blogs.wsj.com/washwire/2016/06/30/the-next-big-debate-in-health-care/?utm_campaign=KFF-2016-Drew-WSJ-June-30-adequacy-coverage&utm_medium=email&_hsenc=p2ANqtz–xQ5m7mTzVOQDJ-gEuLbZl7pkPEfb_Iw0ezewQc1ln7AN8seXIMO73B28qbm9dojkj8aBYyKmMoIvL46iTkyv7FWksVw&_hsmi=31195410&utm_content=31195410&utm_source=hs_email&hsCtaTracking=ed044791-0cff-437c-b853-bcb03570f762%7C6f34b697-a7d1-4d2a-b580-e9d37afa69ac

Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).

With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer.

It’s not clear whether deductibles will continue to rise as they have over the past decade. Rising cost-sharing is not employers’ preferred strategy  for containing health costs, but it’s the one they resort to when they need to quickly reduce their annual premium increase. If the economy weakens again employers will feel greater pressure to reduce their health-benefits costs, and the trend toward higher deductibles will be more likely to continue. The question of how much cost-sharing is too much, and what to do about it, could be the next big debate in health care–once the political world moves on from its focus on the ACA.