Covered Clips archive
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Friday, February 16, 2018

Table of Contents

» Individual Marketplace enrollment remains stable in the face of national uncertainty
» Idaho Blue Cross jumps into controversial market for plans that bypass ACA rules
» Understanding short-term limited duration health insurance
» Trump administration: Let states decide if health plans have enough doctors
» Republicans need a nudge to lower health care costs
» Health coverage by race and ethnicity: Changes under the ACA
» Medicaid work requirements will reduce low-income families' access to care and worsen health outcomes
» No car, no care? Medicaid transportation at risk in some states
» An ER visit, a $12,000 bill--and a health insurer that wouldn't pay
» How Medicare could provide dental, vision, and hearing for beneficiaries
» Failing health of the United States

Individual Marketplace enrollment remains stable in the face of national uncertainty

The difference in enrollment between state-based marketplaces, that are charged with conducting outreach and education to promote enrollment, and the enrollment in states that rely on the federal government to promote enrollment through the federally facilitated marketplace, is even larger when comparing the changes in enrollment over the two-year period from 2016 to 2018. Over the two-year period, while the enrollment in FFM states declined by 10.5 percent — enrollment in those states that state-based marketplaces increased by 1.5 percent.

Leaders of the state-based insurance marketplaces stressed a number of reasons that allowed them to attract new customers and re-enroll existing ones including larger tax subsidies that lowered costs for millions of Americans; effective communication and targeted outreach to key populations; heightened news coverage and improved enrollment operations. These efforts combined helped SBM and SBM-FP states to overcome the national uncertainty, shortened enrollment periods in most states, dramatic reductions on marketing for FFM states, premium increases, and confusion over the availability of marketplace coverage in 2018.

Read the article.
RELATED: National ACA Marketplace signups dipped a modest 3.7 percent this year.

Idaho Blue Cross jumps into controversial market for plans that bypass ACA rules

It’s barely been two weeks since Idaho regulators said they would allow the sale of health insurance that does not meet all of the Affordable Care Act’s requirements — a controversial step some experts said would likely draw legal scrutiny and, potentially, federal fines for any insurer that jumped in. On Wednesday, Blue Cross of Idaho unveiled a menu of new health plans that break with federal health law rules in several ways, including setting premiums based on applicants’ health…
…Policy experts say that allowing lower-cost plans that don’t meet the ACA’s standards to become more widespread will pull younger and healthier people out of Obamacare, raising prices for those who remain. Supporters say that is already happening, so this simply provides more choices for people who earn too much to qualify for subsidies to help them purchase ACA coverage.

Read the article.
RELATED: Alex Azar’s first big test: Will he enforce Obamacare?

Understanding short-term limited duration health insurance

Short-term health insurance policies offer lower monthly premiums compared to ACA-compliant plans because short-term policies offer less insurance protection.  Medically underwritten policies can only be purchased by people when they are healthy.  Individuals who buy short-term policies and then develop health conditions will lose coverage when the contract ends.  Short-term policies typically do not cover essential benefits, such as prescription drugs, and often apply higher deductibles and dollar caps on coverage that are no longer allowed under ACA-compliant individual market and group health plans.  As a result, people who buy short-term policies today in order to reduce their monthly premiums take a risk that, if they do need medical care, they could be left with uncovered bills and/or find themselves “uninsurable” under such plans in the future.

Read the issue brief.
RELATED: Abortion riders: Women living in states with insurance restrictions lack abortion coverage options.

Trump administration: Let states decide if health plans have enough doctors

The Affordable Care Act required that health insurance plans sold on the marketplaces in every state maintain a sufficient number of in-network hospitals and physicians, including specialists, in their service area — essentially, that they have an adequate network of providers. Policyholders spend less to see doctors in their network. But the Trump administration last month weakened that federal oversight, potentially forcing patients to turn to more expensive providers, travel long distances for cheaper care, endure long waits for medical appointments or, critics worry, forgo care altogether….

…The rule, published in April and effective since the beginning of this year, reflects the Trump administration’s overall preference for state versus federal regulation. It shifts to states the responsibility for monitoring and enforcing network adequacy. It also doesn’t require states to use federal measures, such as limiting the time and distance patients should be expected to travel to see their providers, to determine network adequacy.

Read the article.
RELATED: Bracing for an uncertain 2018, states can apply the flexibility and innovation learned in 2017.

Republicans need a nudge to lower health care costs

Automatic enrollment counters the natural human inclinations toward myopia and inertia. Many people do not plan adequately for contingencies, either because they don’t want to or because they lack the resources to do so. Further, the natural disinclination toward taking action means some consumers will not jump through the hoops necessary to sign up for benefits even if they find what is being offered attractive…

… Automatic enrollment would work in health insurance, too. The A.C.A. has not achieved universal coverage in part because many people do not take advantage of the subsidies available to them. The Kaiser Family Foundation estimates that more than half of the uninsured, or nearly 15 million people, were eligible for subsidized coverage in 2016 but failed to enroll in a plan. Another 3.7 million people were eligible for an employer plan and yet remained uninsured.

Read the op-ed.

Health coverage by race and ethnicity: Changes under the ACA

People of color historically have been more likely to be uninsured and to face more barriers accessing care than Whites. The Affordable Care Act (ACA) health coverage expansions provided an opportunity to help reduce these disparities. This brief examines changes in health coverage under the ACA by race and ethnicity and discusses the implications for health coverage disparities. Based on Kaiser Family Foundation analysis of Current Population Survey data for the nonelderly population, it finds:

  • People of color have had larger gains in coverage compared to Whites since implementation of the ACA, helping to narrow racial and ethnic disparities in coverage.
  • Despite larger coverage gains for people of color, disparities in coverage persist, particularly for Hispanics.
  • Opportunities remain to increase coverage through enrollment of eligible but uninsured individuals in Medicaid or subsidized Marketplace coverage, but eligibility for coverage varies by race and ethnicity.
  • Progress reducing coverage disparities could be eroded by recent cuts to outreach funding, changes to Medicaid, and repeal of the individual mandate.

Read the issue brief.


Medicaid work requirements will reduce low-income families' access to care and worsen health outcomes

State proposals for Medicaid work requirements will cause many low-income adults to lose health coverage, including people who are working or are unable to work due to mental illness, opioid or other substance use disorders, or serious chronic physical conditions, but who cannot overcome various bureaucratic hurdles to document that they either meet work requirements or qualify for an exemption from them. These coverage losses will not only reduce access to care and worsen health outcomes, but will likely make it more difficult for many people to find or keep a job. Thus, Medicaid work requirements may be self-defeating on their own terms.

  • Work requirements will make it harder for most adult beneficiaries — the lion’s share of whom are already working or are ill, disabled, caregivers, or in school — to get and stay covered.
  • Work requirements are unlikely to promote employment and may be counterproductive.
  • The primary effect of work requirements will be less access to care, worse health outcomes, and less financial security.


Read the report.


No car, no care? Medicaid transportation at risk in some states

Multiple times each month, Maddie sees a team of specialists at Seattle Children’s Hospital who treat her for the condition that has left her nearly blind and deaf, with frequent seizures and life-threatening liver problems. The only way Maddie can make the trip, more than an hour each way, is through a service provided by Medicaid, the nation’s health insurance program started more than 50 years ago as a safety net for the poor.

Called non-emergency medical transportation, or NEMT, the benefit is as old as Medicaid itself. From its inception, in 1966, Medicaid has been required to transport people to and from such medical services as mental health counseling sessions, substance abuse treatment, dialysis, physical therapy, adult day care and, in Maddie’s case, visits to specialists….

…Citing runaway costs and a focus on patients taking responsibility for their health, Republicans have vowed to roll back the benefits, cut federal funding and give states more power to eliminate services they consider unaffordable. Already, states have wide leeway in how to provide and pay for the transportation. Proponents of limiting NEMT say the strategy will cut escalating costs and more closely mirror private insurance benefits, which typically don’t include transportation.


Read the article.


An ER visit, a $12,000 bill--and a health insurer that wouldn't pay

“We have a mortgage, we have bills, we have student loans,” says Cloyd, who works for the Kentucky government and has a 7-year-old daughter. “There is absolutely no way I could pay a $12,000 bill. I don’t even have $1,000 sitting around.”

Cloyd has her health insurance coverage through her husband’s job. His company uses Anthem, one of the country’s largest health insurance plans. In recent years, Anthem has begun denying coverage for emergency room visits that it deems “inappropriate” because they aren’t, in the insurance plan’s view, true emergencies. The problem: These denials are made after patients visit the ER, sometimes based on the diagnosis after seeing a doctor, not on the symptoms that sent them, like in Cloyd’s case…

…Anthem’s new policy mirrors similar recent developments in state Medicaid programs, which increasingly ask enrollees to pay a higher price for emergency room trips that the state determines to be non-urgent.


Read the article.


How Medicare could provide dental, vision, and hearing for beneficiaries

The Medicare program could offer a voluntary, supplemental insurance benefit for dental, vision, and hearing services that would begin to alleviate the unmet need for services and the financial pressure currently experienced by beneficiaries. This approach has the advantage of maximizing Medicare’s purchasing power on behalf of beneficiaries to provide affordable options for these services, specifically hearing aids. It also will simplify choice by using one benefit design and reduce administrative overhead. We calculate the total coverage costs would be $1.924 billion per year to insure an estimated 6.4 million Medicare beneficiaries, assuming a $25 per month premium and no federal subsidies. Including the low-income subsidies would cost Medicare an additional $1.052 billion per year and insure an estimated additional 2.4 million beneficiaries. As the population ages, these coverage needs will only continue to grow. If they are not addressed, the overall health of older people will suffer and the use of costly and avoidable services will increase.


Read the issue brief.
RELATED: Medicare beneficiaries’ out-of-pocket health care spending as a share of income now and projections for the future.

Failing health of the United States

A joint panel of the National Research Council and Institute of Medicine investigated the US health disadvantage in 2013. It found that Americans had poorer health in many domains, including birth outcomes, injuries, homicides, adolescent pregnancy, HIV/AIDS, obesity, diabetes, and heart disease. It also found that many factors contribute to the health disadvantage; for example, Americans are more likely to engage in unhealthy behaviors (such as heavy caloric intake, drug abuse, and firearm ownership), live in cities designed for cars rather than pedestrians or cyclists, have weaker social welfare supports, and lack universal health insurance …

…Other data are also enlightening. Over the three decades in which survival advances slowed in the US, educational performance weakened, social divides (including income inequality) widened, middle class incomes stagnated, and poverty rates exceeded those of most rich countries. The US is rich, but its wealth is not inclusive. Its social contract is weaker than in other countries—those in need have less access to social services, healthcare, or the prevention and treatment of mental illness and addiction. The “American dream” is increasingly out of reach, as social mobility declines and fewer children face a better future than their parents.

Read the report.
RELATED: Shocking drop in life expectancy shows the US is still in bad health.

Covered Clips is compiled by AACHC on behalf of Cover Arizona.

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