Tag Archives: Medicaid

CBO’s Revised View Of Individual Mandate Reflected In Latest Forecast

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https://www.healthaffairs.org/do/10.1377/hblog20180605.966625/full/?utm_term=Read%20More%20%2526gt%3B%2526gt%3B&utm_campaign=HASU&utm_content=email&utm_source=06-10-18&utm_medium=Email&cm_mmc=Act-On%20Software-_-email-_-Health%20Affairs%20June%20Issue%3A%20Hospitals%2C%20Primary%20Care%20%2526%20More%3B%20ACA%20Round-Up%3B%20Harassment%20In%20Medicine-_-Read%20More%20%2526gt%3B%2526gt%3B

On May 23, the Congressional Budget Office (CBO) released updated projections of federal spending and tax expenditures related to supporting enrollment in health insurance, along with a new forecast of the number of Americans younger than age 65 who will have coverage or will be uninsured in the coming years.

The bottom line: The CBO continues to expect that the Affordable Care Act’s (ACA’s) markets will have relatively stable enrollment, more states will expand their Medicaid programs, and per-person health costs will rise at rates that exceed economic growth. Federal spending on subsidies for health insurance enrollment, along with tax breaks for employer coverage, will continue to grow at a rapid rate, thus intensifying pressure within the overall federal budget.

While the CBO’s new forecast looks in many ways quite similar to previous projections, the agency has revised its views on one very important aspect of its forecast—the effectiveness of the individual mandate—and also updated its forecast to reflect the effects of relevant executive decisions and proposed regulations by the Trump administration. These revisions and updates to the forecast are the primary reasons the current baseline does not differ more than it does from those issued by the CBO previously.

CBO’s Revised View Of The Individual Mandate

The most notable change in the CBO’s new forecast is the agency’s revised view of the effectiveness of the ACA’s individual mandate. During 2017, as Republicans in Congress attempted to pass legislation substantially rolling back and replacing the ACA, the CBO estimated that these efforts would dramatically increase the number of Americans going without insurance coverage. For instance, in July 2017, the CBO estimated that the version of repeal and replace assembled by Senate Majority Leader Mitch McConnell (R-KY) would have increased the number of uninsured from 28 million in 2017 to 41 million in 2018 and 50 million in 2026. There were several reasons that the McConnell proposal would have led to more people going without coverage, but the CBO specifically cited the planned repeal of the individual mandate as the most important factor.

In December, Congress repealed the penalty associated with the individual mandate as part of the sweeping individual and corporate tax reform law. At the time of enactment, the CBO estimated that the repeal would eventually lead to an increase in the number of people going without health insurance by 13 million people annually.

The CBO’s new forecast, however, places less weight on the importance of the mandate. The agency states that, for a number of reasons, it now believes that the mandate’s role in expanding coverage after 2013 is only about two-thirds of what it previously assumed. So instead of repeal adding 13 million more people to the ranks of the uninsured, the CBO now estimates the effect at slightly more than 8 million people.

The CBO cites a number of considerations for making this important revision to its forecast. Among other things, the agency is placing more emphasis on the financial reasons for expanded enrollment into coverage after 2013, such as the ACA’s subsidy structure, instead of nonfinancial factors, such as the expectation, or social norm, of insurance enrollment that the mandate was intended to create.

Summing Up 

In the aggregate, the CBO’s updated projections of health insurance enrollment and federal subsidies for coverage do not differ all that much from previous projections. What’s different are some of the assumptions. The CBO expects there will be more uninsured in the future than is the case today, but the agency does not expect a reversion back to the uninsured levels of the pre-ACA era. Furthermore, because of changes in policies set in motion by the Trump administration, there are likely to be more people enrolled in non-ACA compliant insurance plans than is the case today, and that coverage, while different, will still provide a reasonable level of financial protection to enrollees.

 

 

California’s Attorney General Vows National Fight To Defend The ACA

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https://californiahealthline.org/news/californias-attorney-general-vows-national-fight-to-defend-the-aca/

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California Attorney General Xavier Becerra pledged Friday to redouble his efforts as the Affordable Care Act’s leading defender, saying attacks by the Trump Administration threaten health care for millions of Americans.

Becerra’s pledge came in response to an announcement from the administration Thursday that it would not defend key parts of the Affordable Care Act in court. The administration instead called on federal courts to scuttle the health law’s protection for people with preexisting medical conditions and its requirement that people buy health coverage.

Becerra accused the administration of going “AWOL.” It “has decided to abandon the hundreds of millions of people who depend on” the law, he said in an interview with California Healthline.

“It’s, simply put, an attack on the health care that millions of Americans have come to count on, and California, being the most successful state in implementing the Affordable Care Act, stands to lose perhaps more than anyone else.”

About 1.5 million Californians buy coverage through the state’s ACA exchange, Covered California, and nearly 4 million have joined Medicaid as a result of the program’s expansion under the law.

The state has been at the forefront in resisting many Trump Administration policies, including on health care and immigration.

“This is not a new experience for us under this new Trump era of having to defend Californians,” Becerra said. In the case of health care, “fortunately we have 16 other  [Democratic attorneys general] who are prepared to do it with us. ”

At issue is a lawsuit filed by 20 Republican state attorneys general on Feb. 26, which charged that Congress’ changes to the law in last year’s tax bill rendered the entire ACA unconstitutional. In the tax law, Congress repealed the penalty for people who fail to have health insurance starting in 2019.

Becerra is leading an effort by Democratic attorney generals from others states and the District of Columbia to defend the ACA against that lawsuit. In May, the court allowed them to “intervene” in the case.

 

Plan to Cut $15B in Spending Squeaks Through House

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https://www.usnews.com/news/politics/articles/2018-06-07/house-takes-up-trump-sponsored-plan-to-cut-15b-in-spending

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The House on Thursday only narrowly passed a White House plan to cut almost $15 billion in unused government money, a closer-than-expected tally on legislation that’s designed to demonstrate fiscal discipline in Washington even though it wouldn’t have much of an impact on spiraling deficits.

The measure, which passed 210-206, would take a mostly symbolic whack at government spending because it would basically eliminate leftover funding that wouldn’t have been spent anyway. The bill now goes to the Senate, where it faces long odds.

The deficit is on track to exceed $800 billion this year despite a strong economy. Republicans controlling Congress are not attempting to pass a budget this year.

The package of so-called rescissions has been embraced by GOP conservatives upset by passage in March of a $1.3 trillion catchall spending bill that they say was too bloated. More pragmatic Republicans on Capitol Hill’s powerful Appropriations panels aren’t keen on the measure since it would eliminate accounting moves they routinely use to pay for spending elsewhere.

The measure includes $4 billion in cuts to a defunct loan program designed to boost fuel-efficient, advanced-technology vehicles, rescissions of various agriculture grant programs, and cuts to conservation programs at the Department of Agriculture, among others.

While Democrats blasted the cuts, the real objection to some of them, such as $7 billion from popular Children’s Health Insurance Program funding, is that it would take that money off the table so it couldn’t be used later as it was in the earlier spending bill. The CHIP cuts wouldn’t affect enrollment in the program, which provides health care to children from low-income families that don’t qualify for Medicaid.

“Targeting CHIP for a rescission prevents Congress from reinvesting in other priorities like child and maternal health, early childhood education, biomedical research and our community health centers,” said New York Rep. Nita Lowey, the top Democrat on the Appropriations Committee.

Some GOP moderates also worry that they’re casting a difficult-to-explain vote to cut CHIP funding in the run-up to November’s midterm elections.

“I don’t think the vote’s intended for people in swing districts,” said Rep. Ryan Costello, R-Pa. Nineteen Republicans, mostly moderates, opposed the bill. No Democrats voted for it.

President Donald Trump is the first President to employ the so-called rescissions tool since the Clinton administration. The obscure process is one of the few ways around the Senate filibuster, though other parliamentary problems could await in that chamber — even if resistance from moderates and Republicans on the Appropriations Committee can be overcome.

The nonpartisan Congressional Budget Office weighed in Thursday to estimate that the measure — pushed largely by White House budget director Mick Mulvaney and No. 2 House Republican Kevin McCarthy of California — would only cut the deficit by $1.1 billion over the coming decade. That’s because most of the cuts wouldn’t affect the deficit at all since CBO doesn’t give deficit credit for cutting money that would never have been spent.

Trump proposed the measure last month, but it was slow to come to a vote because some Republicans came out against it.

The White House submitted a revised package of cuts Tuesday, removing politically troublesome proposals to cut money to fight Ebola funds and to rebuild watersheds damaged by Superstorm Sandy. Trump weighed in soon after to urge Republicans to pass the plan.

It’s still unclear whether it will pass in the Senate, where pragmatic-minded Republicans are focusing on trying to get the troubled process for handling annual appropriations back on track on a bipartisan basis.

The White House and tea party lawmakers upset by the budget-busting “omnibus” bill have rallied around the plan, aiming to show that Republicans are taking on out-of-control spending.

“If this body cannot be trusted to reclaim money that will not or cannot be used for its intended purpose, can we really be trusted to save money anywhere else?” McCarthy said.

While some Democrats opposed the spending cuts as heartless, others mostly mocked the legislation.

“After spending nearly $2 trillion on tax cuts for the super-rich and blowing up the deficit, the Majority’s bill is like putting a Band-Aid on a gaping wound,” said Rep. Jim McGovern, D-Mass. “Republicans are trying to trick the American people into thinking they care about fiscal responsibility. They’re not fooling anyone.”

 

KHN’s ‘What The Health?’ Health Care Politics, Midterm Edition

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https://khn.org/news/podcast-khns-what-the-health-health-care-politics-midterm-edition/

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The 2018 midterm elections were supposed to be a referendum on President Donald Trump, not about issues such as health care. Still, voters, Democrats and, to a lesser extent, Republicans seem to be keeping health care on the front burner.

The news from Medicare’s trustees that its hospital trust fund is on shakier financial footing than it was last year, hefty premium increases being proposed in several states and activity on Medicaid expansion all take on a political tinge as the critical elections draw closer.

Also this week, an interview with Matt Eyles, president and CEO of America’s Health Insurance Plans, the health insurance industry trade group.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Ollstein of Talking Points Memo and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Outside Washington, concerns about health care accessibility and prices remain a big issue.
  • Democrats, looking toward the midterm elections in the fall, think that health care can be a potent issue for them. But many also believe that they can’t just run on complaints that the Republicans are sabotaging the Affordable Care Act. They are seeking to find a message that looks to the future.
  • Republicans see the plans by the White House to implement new regulations that allow expansion of association health plans and short-term health plans as a strong action that will thwart complaints that they haven’t fixed the ACA.
  • The states are beginning to release the initial requests from health insurers for premium increases. They vary substantially, but many appear to be partly attributed to the decision last year by Congress to repeal the penalty for people who don’t get insurance.
  • The report this week by the Medicare trustees that the hospital trust fund is closer to insolvency has ignited Democratic criticism of changes in health care law that were part of the GOP tax cut last year.
  • Arkansas has begun implementing its work requirements for healthy adults covered by the Medicaid expansion. It’s the first state to do that. But critics point out that those adults will have to register their work hours online only — and many do not have access to computers.

 

Providers argue against Medicaid rate cuts without oversight

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http://www.healthcarefinancenews.com/news/providers-argue-against-medicaid-rate-cuts-without-oversight?mkt_tok=eyJpIjoiTmpKa1pXWTVNVFkzWVRoaSIsInQiOiJNWHRUZHRjS2dlNkRPaGs2aFNZK0xBb05tS05iY2taMzBGZndmTGNWSWRubjFYVVNtOUhHb1N6VnlUVm40TGFyS3UyWitMM2ppc3VnVnM3eU03bHdFeTN4SFwvQktueldQUDd2YWN6dGJZZ0pBZ25OK0pcL2xrbDZoSWpuaitaRzhjIn0%3D

 

States with at least 85% of their Medicaid population in managed care could implement nominal payment cuts without assuring care.

Hospitals, particularly rural providers, would be hurt by a Centers for Medicare and Medicaid Services proposed rule that would force them to take lower Medicaid rates without a review of the impact of the cuts, according to comments made to CMS asking for a reconsideration of the plan.

Provider organizations, hospitals, the Medicaid and CHIP Payment and Access Commission, are among those asking the Centers for Medicare and Medicaid Services to rethink its proposed rule.

Comments were due this week.

CMS proposed the rule in March to allow states that have a comprehensive, risk-based Medicaid managed care enrollment that is above 85 percent of their total Medicaid population to get around network adequacy rules when implementing “nominal” rate changes.

States had raised concern over the administrative burden associated with the current requirements, particularly for states with high rates of Medicaid managed care enrollment.

For states proposing nominal cuts below 4 percent a year or 6 percent over two years, the rule amends the process for them to document whether Medicaid payments in fee-for-service systems are sufficient to enlist providers to assure access to covered care and services.

These states would be exempt from access monitoring requirements and they would not need to seek public input on the rate reductions.

America’s Essential Hospitals said, “Requiring states to ensure, through monitoring, that rate reductions do not diminish access to needed services is particularly important now, as access monitoring reviews are the only vehicle left for providers to challenge state payment rate decisions.”

The Federation of American Hospitals contends that the rule would allow for more than nominal rate changes. If finalized, FAH said, the rule would allow for an estimated 18 states to implement a rate reduction of up to 12 percent over a period of four years or 16 percent over five years, without going through requirements for ongoing monitoring of the impact of the rate changes.

This would disproportionately impact vulnerable Medicaid beneficiaries and subject providers with unsustainable rate reductions, FAH said.

Most states, even those with very high rates of managed care enrollment, often exclude certain categories of particularly vulnerable groups from managed care plans, the organization said. People with physical, mental or intellectual disabilities or who are elderly, largely get services through fee-for-service, FAH told CMS Administrator Seema Verma.

The Medicaid and CHIP Payment and Access Commission said it did not find the states’ argument of administrative burden compelling enough given the federal government’s obligations to oversee state performance and assurances related to access.

“Moreover, exceptions to reporting may introduce gaps in oversight,” MACPAC Chair Penny Thompson said. “In short, the need for states to maintain resources and tools to monitor access as an ongoing element of state program administration and decision making outweighs the limited savings states would achieve as a result of these changes.”

 

It Costs $685 Billion a Year to Subsidize U.S. Health Insurance

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https://www.bloomberg.com/news/articles/2018-05-23/it-costs-685-billion-a-year-to-subsidize-u-s-health-insurance

 

It will cost the U.S. government almost $700 billion in subsidies this year help provide Americans under age 65 with health insurance through their jobs or in government-sponsored health programs, according to a report from the nonpartisan Congressional Budget Office.

The subsidies come from four main categories. About $296 billion is federal spending on programs like Medicaid and the Children’s Health Insurance Program, which help insure low-income people. Almost as big are the tax write-offs that employers take for providing coverage to their workers. Medicare-eligible people, such as the disabled, account for $82 billion. Subsidies for Obamacare and for other individual coverage are the smallest segment, at $55 billion.

In total, the subsidies are equivalent to about 3.4 percent of the U.S. gross domestic product.

Financing Americans’ Insurance

In 2018, subsidizing health coverage will cost taxpayers almost $700 billion.

Also known as the Affordable Care Act, Obamacare reduced the number of uninsured, but 29 million people will likely go without health coverage in an average month this year, the CBO said. Thirty-five million Americans could lack coverage by 2028 as rising premiums and the elimination of the individual mandate drive more people to drop coverage.

The subsidies in the Affordable Care Act are designed to insulate people in the program from premium increases. The CBO projected that monthly premiums for a mid-range plan in the program will increase by 15 percent by 2019, and by about 7 percent annually through 2028.

One reason for the rising premiums is the actions of President Donald Trump. Last year, Trump topped funding for the cost-sharing reduction payments made to insurers under Obamacare to help Americans afford health costs.

The non-payment of those subsidies, less enforcement of a rule requiring people to have insurance and limited competition caused insurers to raise their premiums by about 34 percent in 2018, compared to 2017. That increased the cost of the subsidies to the federal government, according to the CBO.

Red states find there’s no free pass on Medicaid changes

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Red states find there’s no free pass on Medicaid changes from Trump

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Red states are getting a reality check from the Trump administration in just how conservative they can remake their Medicaid programs.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) rejected a request from Kansas to limit Medicaid eligibility to just three years.

CMS Administrator Seema Verma followed up on the Kansas decision by saying the administration will not allow any states to impose lifetime limits on Medicaid.

“We’ve indicated that we would not approve lifetime limits and I think we’ve made that pretty clear to states,” Verma said last week at a Washington Post event on health care.

The Trump administration has made state innovation a priority and has promised to fast-track Medicaid waivers, especially those that will impose work requirements on beneficiaries.

Four states have been granted permission to do so — Arkansas, Kentucky, Indiana and New Hampshire — and six others have pending waivers.

States have also been allowed to impose lockout periods if beneficiaries can’t meet the work requirements and to charge higher premiums than the Obama administration allowed.

But the decision on lifetime limits marks the first time the administration completely rejected a policy favored by conservatives and shows there is no blank check for red states.

Verma never promised automatic approvals of conservative ideas, though some might have interpreted it that way, according to Jeff Myers, president and CEO of the Medicaid Health Plans of America.

He said it’s becoming clear that what the Trump administration wants is to construct policies that will make Medicaid beneficiaries self-sufficient, but that will not take away their benefits entirely.

Verma has long argued that promoting self-sufficiency is key to any changes states make to Medicaid. In explaining the decision to reject lifetime limits, Verma noted that states only temporarily suspend benefits if work requirements aren’t met.

“An individual may not comply with a requirement around cost-sharing and they could potentially lose coverage. But we want to make sure that there’s a pathway back into the program … if they’re compliant with the requirements,” Verma said last week.

Medicaid experts said officials in Kansas and other red states were mistaken if they thought they could get the Trump administration to approve changes just because they happen to be conservative.

“Contrary to some states’ expectations, there really is a waiver approval process,” said Joe Antos, a health policy expert at the American Enterprise Forum, a conservative think tank.

“Decisions will move more rapidly than they were … [but] that doesn’t mean approvals,” he said.

Matt Salo, executive director of the National Association of Medicaid Directors, said any time there’s a change in administration, states jockey to see what policies they can get approved.

“There’s a lot of pent-up interest in pursuing flexibility and changes that the Obama administration would not entertain, [but] I don’t think anyone thought it was a blank check, do whatever you want,” Salo said.

The administration has yet to make a decision on other conservative wish list policies, such as Wisconsin’s proposal for drug testing Medicaid recipients, and partial Medicaid expansion, which would let states expand coverage for only a fraction of the population and still receive full federal funding under ObamaCare.

Salo said federal officials want to make sure that any waivers they approve will survive the inevitable lawsuits that follow.

“People are pretty savvy … if you’re just going to approve something that gets torn down in the courts, you’re wasting everyone’s time,” Salo said. “The granting of a wish list that gets trounced doesn’t do any good, and even sets the agenda back somewhat. Everyone’s better off if there’s a real rationale.”

CMS recently declined to issue a decision on a request by Arkansas to roll back the eligibility levels for Medicaid beneficiaries. The agency also declined to rule on Kansas’s request to impose work requirements, which experts have speculated could be an implicit rejection of the proposals.

Unlike the other four states that have been approved, Kansas is not a Medicaid expansion state, and the administration has not approved work requirements in any nonexpansion states.

Kansas officials indicated they were still working with federal officials.

“While we will not be moving forward with lifetime caps, we are pleased that the Administration has been supportive of our efforts to include a work requirement in the 1115 waiver. This important provision will help improve outcomes and ensure that Kansans are empowered to achieve self-sufficiency,” Gov. Jeff Colyer (R) said in a statement.

 

Aetna whistle-blower put on leave after accusing CVS Caremark of $1B billing scheme

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https://www.beckershospitalreview.com/legal-regulatory-issues/aetna-whistle-blower-put-on-leave-after-accusing-cvs-caremark-of-1b-billing-scheme.html

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Aenta’s former chief Medicare actuary was placed on administrative leave after filing a whistle-blower lawsuit alleging pharmacy benefits manager CVS Caremark overbilled Medicaid and Medicare for prescription drugs, according to The Columbus Dispatch.

Here are four things to know about the lawsuit.

1. Sarah Behnke, Aetna’s former chief Medicare actuary, filed the pending whistle-blower suit after her internal investigation found CVS Caremark has been allegedly overbilling the federal government for prescriptions since 2007, according to the lawsuit. Ms. Behnke accused CVS Caremark of inappropriately billing the government $1 billion-plus in fraudulent charges.

2. Aetna placed Ms. Behnke on administrative leave after the whistle-blower suit was unsealed in federal court in early April. The unsealing comes as CVS Health, the parent company of CVS Caremark, is attempting to buy Aetna for $69 billion.

3. Ms. Behnke’s lawyer told The Columbus Dispatch Aetna’s decision to place its then-Medicare actuary on administrative leave was “retaliatory and inappropriate.”

4. CVS Caremark rejected the allegations and said it will hand documents over to the court by June 1. The company said it was unaware who filed the lawsuit until after its parent put out an offer to Aetna. CVS Health spokesperson Michael DeAngelis told the publication, “We believe this complaint is without merit, and we intend to vigorously defend ourselves against these allegations.” Aetna officials declined The Columbus Dispatch‘s request for comment.

 

Americans’ Confidence in Their Ability to Pay for Health Care Is Falling

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http://www.commonwealthfund.org/publications/blog/2018/may/americans-confidence-paying-health-care-falling?omnicid=CFC1404232&mid=henrykotula@yahoo.com

President Trump is expected to soon address the nation about the rising cost of prescription drugs. But Americans are worried about more than drug prices. New findings from the Commonwealth Fund Affordable Care Act Tracking Survey show that consumers’ confidence in their ability to afford all their needed health care continues to decline.

Last week, we reported that the survey indicated a small but significant increase in the uninsured rate among working-age adults since 2016. In this post, we look at people’s views of the affordability of their health care. The Affordable Care Act Tracking Survey is a nationally representative telephone survey conducted by SSRS that tracks coverage rates among 19-to-64-year-olds, and has focused in particular on the experiences of adults who have gained coverage through the marketplaces and Medicaid. The latest wave of the survey was conducted between February and March 2018.1

Findings

Confidence in Ability to Afford Health Care Continues to Decline

In each wave of the survey, we’ve asked respondents whether they have confidence in their ability to afford health care if they were to become seriously ill. In 2018, 62.4 percent of adults said they were very or somewhat confident they could afford their health care, down from a high of nearly 70 percent in 2015 (Table 1). Only about half of people with incomes less than 250 percent of poverty ($30,150 for an individual) were confident they could afford care if they were to become very sick, down from 60 percent in 2015 and about 20 percentage points lower than the rate for adults with higher incomes. There were also significant declines in confidence among young adults, those ages 50 to 64, women, and people with health problems. Declines were significant among both Democrats and Republicans.

People in Employer Plans Have the Greatest Confidence in Their Insurance

We asked people with health insurance how confident they were that their current insurance will help them afford the health care they need this year. Majorities of adults were somewhat or very confident in their coverage; those with employer coverage were the most confident. More than half (55%) of adults insured through an employer were very confident their coverage would help them afford their care compared to 31 percent of adults with individual market coverage and 41 percent of people with Medicaid (Table 2). The least confident were adults enrolled in Medicare. Working-age adults enrolled in Medicare were the sickest among insured adults and the second-poorest after those covered by Medicaid (data not shown).2

One-Quarter of Adults Said Health Care Became Harder to Afford

We asked people whether, over the past year, their health care, including prescription drugs, had become harder for them to afford, easier to afford, or if there had been no change. The majority (66%) said there had been no change, one-quarter (24%) said it had become harder to afford, and 8 percent said it had become easier (Table 3). People with individual market coverage were significantly more likely than those with employer coverage or Medicaid to say health care had become harder to afford. About one-third of adults with deductibles of $1,000 or more said health care had become harder to afford, twice the share of those who had no deductible. About one-third of those enrolled in Medicare and 41 percent who were uninsured also reported that their health care had become harder to afford.

Only About Half of Americans Would Have Money to Pay for an Unexpected Medical Bill

Accidents and other medical emergencies can leave both uninsured and insured people with unexpected medical bills, which usually require prompt payment. We asked people if they would have the money to pay a $1,000 medical bill within 30 days in the case of an unexpected medical event. Nearly half (46%) said they would not have the money to cover such a bill in that time frame (Table 4). Women, people of color, people who are uninsured, those covered by Medicaid or Medicare, and those with incomes under 250 percent of poverty were among the most likely to say they couldn’t pay the bill.

Health Care Is Among People’s Top Four Greatest Personal Financial Concerns

Fourteen percent of adults said that health care was their biggest personal financial concern, after mortgage or rent (23%), student loans (17%), and retirement (17%) (Table 5). Those most likely to cite health care as their greatest financial concern were people who could potentially face high out-of-pocket costs because they were uninsured or had high-deductible health plans.

Policy Implications

Uninsured adults are the least confident in their ability to pay medical bills. But the risk of high out-of-pocket health care costs doesn’t end when someone enrolls in a health plan. The proliferation and growth of high-deductible health plans in both the individual and employer insurance markets is leaving people with unaffordable health care costs. Many adults enrolled in Medicare for reasons of disability or serious illness also report unease about their health care costs. An estimated 41 million insured adults have such high out-of-pocket costs and deductibles relative to their incomes that they are effectively underinsured. As this survey indicates, the nation’s health care cost burden is felt disproportionately by people with low and moderate incomes, people of color, and women.

The ACA’s reforms to the individual insurance market have doubled the number of people who now get insurance on that market to an estimated 17 million, with approximately half receiving subsidies through the ACA marketplaces. The ACA also has made it possible for people who were regularly denied coverage by insurers — older Americans and those with health problems — to get insurance. They are now entitled by law to an offer should they want to buy a plan.

But as this survey suggests, the ACA’s reforms did not fully resolve the individual market’s relatively higher costs for all those enrolled, compared to employer coverage or Medicaid. Moreover, recent actions by Congress and the Trump administration, including the repeal of the individual mandate penalty and loosened restrictions on plans that don’t comply with the ACA, are expected to exacerbate those costs for many. In the survey, people with individual market coverage are more likely than those with employer coverage or Medicaid to say that their health care, including prescription drugs, has become harder to afford in the past year. They express less confidence than those with employer coverage that their insurance will help them afford their care this year. As explained in the first post, there are a number of policy options that Congress can pursue that would improve individual market insurance’s affordability and cost protection. In the absence of bipartisan Congressional agreement on legislation, several states are currently pursuing their own solutions. But if current trends continue, the federal government will likely confront growing pressure to provide a national solution to America’s incipient health care affordability crisis.

 

 

 

 

 

‘What The Health?’ Medicaid, Privacy And Tom Price’s Return

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https://khn.org/news/podcast-khns-what-the-health-medicaid-privacy-and-tom-prices-return/

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President Donald Trump’s former New York doctor says Trump’s lawyer and private head of security “raided” his office and took the medical files relating to Trump, an act described by White House press secretary Sarah Huckabee Sanders as “standard operating procedure.” Except that’s not how the federal health privacy law is supposed to work.

Meanwhile, Seema Verma, who heads the federal agency in charge of Medicare and Medicaid, met with reporters for a wide-ranging discussion of states’ efforts to remake their Medicaid programs and the administration’s goals of encouraging people to work to help lift them out of poverty.

Plus, Robert Blendon, a professor at Harvard University’s Kennedy School of Government and its T.H. Chan School of Public Health, talks about how health issues fit into the complex politics of the 2018 midterm elections.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Alice Ollstein of Talking Points Memo and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s podcast:

  • Five states are seeking permission from federal officials to impose a lifetime limit on Medicaid eligibility. But despite the many changes the Trump administration officials have been making to Medicaid, they have shown no public interest in this yet.
  • Trump is considering regulations that would defund Planned Parenthood from the Title X Family Planning Program. Although anti-abortion groups would applaud such a move, it could backfire on the Republicans in November by energizing a wave of blue voters in the midterm elections.
  • Although former HHS Secretary Tom Price raised eyebrows this week with his comment disparaging the removal of the penalty for not having insurance, that stance is somewhat consistent with the administration’s earlier promise to find new ways to regulate the insurance markets.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.