Archive: July 2011

UnitedHealth’s working paper examines rural health care under the ACA

Posted on July 31, 2011

“Modernizing Rural Health Care: Coverage, quality, and innovation” documents the health needs of rural populations and how well the health care system currently is and will be able respond to these needs. The paper presents data on rural health care quality, the views of people living in rural areas regarding health care delivery, and what physicians identify as major rural health challenges to overcome. The paper also addresses how Medicaid and health insurance Exchange expansion will affect the rural patient population beginning in 2014.

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GAO releases study on pre-existing condition insurance plans

Posted on July 30, 2011

The Affordable Care Act appropriated $5 billion to create the Pre-Existing Condition Insurance Plan (PCIP) program, which provides insurance for such individuals until new protections take effect in 2014. 27 states opted to run their own PCIPs, while 23 states and the District of Columbia opted to let the Department of Health and Human Services (HHS) run the PCIPs for their residents. Through their study “Pre-Existing Condition Insurance Plans: Program Features, Early Enrollment and Spending Trends, and Federal Oversight Activities,” the U.S. Government Accountability Office (GAO) examined 1) PCIP features, premiums, and criteria for demonstrating a pre-existing condition, 2) trends in PCIP enrollment and spending, including administrative costs, and 3) federal oversight activities. The GAO found that state and federally run PCIPs generally had similar cost sharing arrangements. Coverage limits were common but varied, both in terms of the benefits affected and the extent of the limits. Monthly premiums ranged considerably and were generally higher in the federally run PCIP. Enrollment and spending for state and federally run PCIPs have been significantly lower than initial projections. Spending was also lower than anticipated.

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Commonwealth Fund releases paper reporting on ACO risk-sharing payment model

Posted on July 30, 2011

The Commonwealth Fund’s paper, “Promising Payment Reform: Risk-Sharing With Accountable Care Organizations,” describes and reports on the implementation of eight private accountable care organizations (ACOs) that use, or are planning to deploy, a shared payer–provider risk payment model. The Medicare Shared Savings Program, a component of the Affordable Care Act (ACA), creates financial incentives for ACOs to provide coordinated, well-integrated, efficient care. As ACOs continue to form, payers are establishing shared-savings programs and payment methods that confer a portion of the financial risk to the provider. There is minimal evidence, however, about what sort of payment model, shared-risk or otherwise, will most appropriately support ACOs. This report summarizes research on those ACOs that include a provider risk-sharing component.

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Kaiser Family Foundation issue brief reviews states’ progress in creating health insurance Exchanges

Posted on July 30, 2011

State-based health insurance Exchanges are a key component of the Patient Protection and Affordable Care Act (ACA) of 2010, facilitating expanded access to coverage for millions of individuals and employees of small businesses. The Exchanges will enable consumers to readily compare qualified health insurance options in order to select plans that best meet their needs. Premium and cost-sharing subsidies will make health coverage more affordable for low and moderate-income individuals. In this issue brief, The Henry J. Kaiser Family Foundation reviews states’ progress to date in creating health insurance exchanges. While some states have already taken major steps toward establishing an exchange, other states have struggled to pass legislation or have opted not to begin the process of establishing one.

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NFIB survey documents ACA’s effect on small business owners

Posted on July 30, 2011

The National Federation of Independent Business (NFIB) published “Small Business and Health Insurance: One Year After Enactment of PPACA,” in order to report on small-business owner reaction to the passage of the ACA, provide current projections for the adoption and elimination of health insurance as an employee benefit, and outline expected response to market and legal changes that may develop. Health insurance remains a principal issue for small employers. It likely will remain near the top of their issue list for a long time, if not for its direct impact on its provision as an employee benefit, but for its budget and tax implications. The survey interviews 750 small employers of firms with 50 or fewer people.

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Families USA analyzes how the Basic Health Program can work for low-income consumers

Posted on July 29, 2011

Families USA’s paper, “The Basic Health Option: Will It Work for Low-Income Consumers in Your State?” reviews the concept of the Basic Health Program (BHP), discusses some potential program pitfalls, and raises key issues that can influence the direction that a BHP might take in states with varying financial and political constraints. Some key challenges highlighted in the paper of the BHP include the provision of seamless coverage and provider payment rates.

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Employer Policy Institute study discusses behavioral assumptions that will influence the share of workers covered by the employer

Posted on July 28, 2011

In “An Offer You Can’t Refuse: Estimating the Coverage Effects of the 2010 Affordable Care Act,” the Employment Policy Institute shows that the predictions of the share of workers who will keep their current employer-sponsored insurance (ESI) are quite sensitive to two behavioral assumptions. At present, 74.29% of workers have ESI. Depending on how workers and employers react to ACA implementation, that share could increase to 78.62% or decrease to 65.89%. The first behavioral assumption is to what degree firms and their workers will alter their current contracts with respect to workers’ share of the premiums. The second factor pertains to vague language of portions of the ACA. The language in doubt is whether the affordable coverage rule applies to single coverage or family coverage for workers with families.

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Update: Repeal of 1099 Reporting Requirement

Posted on July 28, 2011

Section 9006 of the Affordable Care Act (ACA) would have required businesses to issue 1099 forms for transactions over $600 with other corporations, such as vendors and suppliers. This was a significant expansion of the reporting requirements and was seen by many as a huge burden on businesses, particularly small businesses. On April 14, 2011, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 was signed into law, repealing the ACA Section 9006 reporting requirements.

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HHS issues advanced notice of changes to common rule

Posted on July 27, 2011

The U.S. Department of Health and Human Services (HHS) has issued an Advance Notice of Proposed Rulemaking (ANPRM) soliciting comments on how regulations governing human subject research might be modernized, including making changes to the Common Rule. These regulations have not been have not kept pace with advances in science and human subject research, so updates would be welcome and will apply to all human subject research funded by Affordable Care Act (ACA).

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CER board seeks public input

Posted on July 21, 2011

A new Comparative Effectiveness Research (CER) Board, established by the Affordable Care Act (ACA), is seeking public input as to what kinds of research should be performed. The ACA helped establish the Patient-Centered Outcomes Research Institute (PCORI), which will provide information to consumers to help guide their treatment decisions. PCORI is an independent body, charged with overseeing CER guidelines in the U.S.

For more information on CER, click here.

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