High-Risk Pools For Uninsurable Individuals

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.

HIPAA is 20 years old. What has it meant for healthcare?

HIPAA is 20 years old. What has it meant for healthcare?

birthday cake

On Aug. 21, 1996 — 20 years ago Sunday — President Bill Clinton signed the Health Insurance Portability and Accountability Act (HIPAA) into law.

Back when bipartisanship still occasionally happened in Washington, this law, championed by then-Sens. Edward M. Kennedy (D-Massachusetts) and Nancy Kassebaum (R-Kansas) has come become to be defined by the privacy and security regulations that it enabled. Those took effect in 2002 and 2003, respectively, after the Bush administration modified rules that the Clinton administration rushed to finish before Clinton left office in January 2001.

But, as the formal name implies, HIPAA initially was known for giving people the right to “portability” of health insurance when they change jobs by limiting the ability for insurers to exclude coverage of pre-existing conditions. The complex law also led to standards for healthcare administrative transactions and a national system of provider identity codes.

HIPAA did call for a national patient identifier as well, but in 1998, Congress voted to deny the Department of Health and Human Services funding to implement a patient ID. The program still has never been funded, and the private sector has since taken it upon itself to address the issue.

So what has HIPAA accomplished in 20 years? Where has it fallen short?

Aetna’s withdrawal from Obamacare exchanges isn’t the start of a death spiral

http://www.latimes.com/opinion/editorials/la-ed-aetna-obamacare-20160817-snap-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=33162087&_hsenc=p2ANqtz-8NvJGaCD6NRfk633U9oruy0gAARfnzhUmgR73MXbgH6Kn-xnwzqWVetaFD6yxn73Itj2RU7GT3GpmmZQmhcpzETdNU6Q&_hsmi=33162087

Aetna, Inc. headquarters

Giant insurer Aetna announced this week that it was withdrawing from the Obamacare exchanges in 11 of the 15 states it had been doing business, becoming the third major insurance company to scale back its offerings dramatically in the face of heavy losses. The news led to a chorus of “I told you so’s” from critics of the 2010 healthcare law, who have long predicted that it would collapse under its own weight. But they are confusing the growing pains of a new market with the death rattle of a failing one.

It’s important to bear in mind what Obamacare, formally known as the Patient Protection and Affordable Care Act, set out to do. Over the long term, it sought to improve the quality of healthcare and rein in costs — an ambitious effort that may not yield significant results for years, if ever. In the short term, its goal was to extend insurance coverage to millions of uninsured Americans. To do so, it barred insurers from denying coverage or charging higher rates to those with preexisting conditions, required all adults to obtain coverage and offered subsidies to help poorer households pay their insurance premiums.

These changes reinvented the market for individual policies, which serves those not covered by large employer plans or government-run health programs. No longer could insurers minimize their risk by denying coverage to or gouging those with preexisting conditions. The new subsidies also attracted many previously uninsured people who had no track record to guide insurers on their needs and costs.

The result was a hotly competitive market with winners and, yes, losers. The insurance companies that have done well include those with experience serving low-income communities, as well as those in states such as California that have worked hard to bring young and healthy customers into the market. But Aetna and UnitedHealth, which announced in April that it would withdraw from almost all the Obamacare exchanges it had entered, had previously focused on serving large employers, a much less risky and volatile market.

WHY IT MATTERS: Health Care

http://bigstory.ap.org/article/a6c6a83bd9f7435ca6f79423f1240c4d/why-it-matters-health-care

About 9 in 10 Americans now have health insurance, more than at any time in history. But progress is incomplete, and the future far from certain. Millions remain uninsured. Quality is still uneven. Costs are high and trending up again. Medicare’s insolvency is two years closer, now projected in 2028. Every family has a stake.

Patients from all over the world come to America for treatment. U.S. research keeps expanding humanity’s ability to confront disease. But the U.S. still spends far more than any advanced country, and its people are not much healthier.

Obama’s progress reducing the number of uninsured may be reaching its limits. Premiums are expected to rise sharply in many communities for people covered by his namesake law, raising concerns about the future.

The health care overhaul did not solve the nation’s longstanding problem with costs. Total health spending is picking up again, underscoring that the system is financially unsustainable over the long run. Employers keep shifting costs to workers and their families.

No one can be denied coverage anymore because of a pre-existing condition, but high costs are still a barrier to access for many, including insured people facing high deductibles and copayments. Prescription drug prices — even for some generics — are another major worry.

The election offers a choice between a candidate of continuity — Clinton — and a Republican who seems to have some core beliefs about health care, but lacks a coherent plan.

If the presidential candidates do not engage the nation in debating the future of health care, it still matters.

Healthcare Coverage Reform Proposals

Click to access RyanPlanAnalysis-brief.pdf

 

Don’t Let The Talking Points Fool You: It’s All About The Risk Pool

http://healthaffairs.org/blog/2016/03/15/dont-let-the-talking-points-fool-you-its-all-about-the-risk-pool/

Insurance 2

TrumpCare Takes It On The Chin

http://khn.org/news/trumpcare-takes-it-on-the-chin/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=26990679&_hsenc=p2ANqtz–0dMdJbURVkKZogGy55ZZnzOeJhl2sqFne7r4qNo4UcBy6byjACVmLzsdkYQj0B8ETdXboygTScLgynLkPI-tCHCYMtQ&_hsmi=26990679

Republican presidential candidate Donald Trump speaks to guests during a rally at Macomb Community College on March 4, 2016 in Warren, Michigan. (Scott Olson/Getty Images)

The Pre-existing Condition: Innovative Solutions to America’s Thorniest Healthcare Challenge

http://altarum.org/health-policy-blog/the-pre-existing-condition-innovative-solutions-to-america%E2%80%99s-thorniest-healthcare-challenge

US Capitol