Archive: October 2011

HHS releases final standards to measure health care disparities

Posted on October 31, 2011

On October 31st, The U.S. Department of Health and Human Services (HHS) released final standards to measure health care disparities based on race, ethnicity, sex, primary language, and disability status, as required by the Affordable Care Act (ACA). Making these data standards consistent will help identify significant health disparities that often exist between and within ethnic groups. For example, a study showed that the diabetes-related mortality rate for Mexican Americans (251 deaths per 100,000) and Puerto Ricans (204 deaths per 100,000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100,000). However, these data would have remained unexamined had only the umbrella terms of “Hispanic” or “Latino” been used. By adding different ethnic origins as explicit categories on all HHS-sponsored health surveys, the government hopes to better capture and track the health differences and thus target interventions more appropriately.

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Oliver Wyman report finds insurer fees will increase premiums

Posted on October 31, 2011

A new report commissioned by the insurance industry and authored by Oliver Wyman, “Estimated Premium Impacts of Annual Fees Assessed on Health Insurance Plans,” quantifies the impact of insurer fees on private and public sector coverage. According to the report, the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) have both concluded that such fees will increase insurance premiums. The analytical data presented in the report estimates that the insurer fees will increase premiums in fully insured coverage markets by an average of 1.9% to 2.3% in 2014. This translates into a $2,800 average increase in individual coverage cost, and $6,800 for a family over a 10-year period, beginning in 2014.

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UC Berkeley policy brief addresses health coverage maintenance during transitions

Posted on October 31, 2011

UC Berkeley, funded by grants from the Robert Wood Johnson Foundation and The California Endowment, recently released the brief, “The Promise of the Affordable Care Act, the Practical Realities of Implementation: Maintaining Health Coverage During Life Transitions,” which discusses seamless health coverage under the Affordable Care Act for individuals and families who lose health insurance because of a work or life transition. While outreach and education are essential for enrollment, such efforts are not sufficient to assure that those eligible will enroll in programs during these transition periods. This policy paper addresses the question, “How can implementation of the Affordable Care Act build on institutional connections and develop widespread cultural knowledge of the availability of coverage during life transitions that precipitate the loss of private coverage?”

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KCMU and HMA track Medicaid spending, coverage and policy trends in 11th annual report

Posted on October 28, 2011

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) along with Health Management Associates (HMA) recently published “Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends,” which summarizes the results from a 50-State Medicaid Budget Survey for State Fiscal Years 2011 and 2012. The report also includes background on the Medicaid program, as well as current issues facing the program including how states are preparing for the implementation of national health reform.

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House votes to include Social Security in Medicaid eligibility formula

Posted on October 28, 2011

On October 27th, the House voted 262-157 to pass H.R. 2576, a bill to strike out a “glitch” in the Affordable Care Act (ACA) that would have allowed middle-class couples to enroll in Medicaid starting in 2014. Under the ACA, before the new bill passed, the majority of Social Security benefits were not taxed, and thus not reviewed when determining Medicaid eligibility. A couple earning as $60,000 per year could have gained access to Medicaid. H.R. 2576 moves to include Social Security benefits as income when calculating modified adjusted gross income (MAGI). MAGI is used to determine Medicaid eligibility. On Tuesday, October 25th, the Obama administration publicly supported the bill.

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Health Affairs article estimates that ACA would still cover 23 million without individual mandate

Posted on October 27, 2011

Many policy gurus fear that repeal of the minimum coverage provision and corresponding penalty from the Affordable Care Act (ACA) would lead to adverse selection and thus a premium spiral. However, a recent Health Affairs article highlights other ACA provisions that would mitigate the negative repercussions of an individual mandate repeal. For example, the ACA subsidies to help people purchase coverage would restrain a premium spiral by absorbing much of the impact of premium increases. The article proffers that without the individual mandate, 7.8 million people would lose coverage, as opposed to other estimates in the 16-24 million range. In sum, the ACA would still cover 23 million people who otherwise would have been uninsured. Although the individual mandate would have important effects, the article says, perhaps it is not crucial to the successful implementation of health reform.

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Health Affairs article warns of contingencies and uncertainties under Medicaid expansion

Posted on October 27, 2011

An article recently published in Health Affairs, “Policy Makers Should Prepare For Major Uncertainties in Medicaid Enrollment, Costs, And Needs For Physicians Under Health Reform,” presents findings from a simulation model using two nationally representative data sets to estimate Medicaid eligibility, participation, and population growth. The article warns that the number of Medicaid enrollments, associated costs, and number of new physicians needed could vary hugely under Medicaid expansion. The estimated number of people enrolling in Medicaid for the first time could vary by more than 10 million when the program changes are implemented in 2014. Additionally, costs could range from anywhere between $34 billion to $98 billion per year. The new enrollments could necessitate at least 4,500 and at most 12,100 new physicians. The study results indicate that policy makers should prepare for a great deal of unpredictability associated with Affordable Care Act’s (ACA’s) Medicaid reform.

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AMA’s annual survey finds competition often sparse in commercial health insurance market

Posted on October 26, 2011

The American Medical Association recently issued the 2011 edition of “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” The survey reports that four out of five metropolitan areas in the United States lack a competitive health insurance market. Those markets are rate “highly concentrated” based on Department of Justice and Federal Trade Commission findings. In approximately half of such markets, at least one commercial health insurer had a market share of at least 50 percent. In 24 out of the 48 states covered, the two largest commercial insurers controlled a market share of 70 percent or more.

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CRS paper identifies potential issues with MAGI redefinition

Posted on October 25, 2011

The Congressional Research Service (CRS) released a paper pertaining to Congress’s moves to redefine modified adjusted gross income (MAGI) to include Social Security income. CRS cites three issues that Congress should consider if the definition of income is changed. First, because MAGI can be computed largely from federal tax return information, verification of income is streamlined. Thus, by including additional provisions, there will be increased administrative complexity involved with calculating an individual’s MAGI. Second, the original definition was developed to promote coordination between Medicaid and premium credits in the health insurance exchange. Thus, this definition change should not only apply to income definition for Medicaid, but also should apply to premium credits. Third, bill proposals have focused largely on the inclusion of Social Security benefits in MAGI for eligibility purposes. However, many other low-income programs include other types of income and asset holdings that are also excluded from MAGI.

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CMS selects 500 FQHCs for Advanced Primary Care Practice demonstration project

Posted on October 24, 2011

The Centers for Medicare and Medicaid Services (CMS) announced today that 500 Federally Qualified Health Centers (FQHCs) have been selected to participate in the Advanced Primary Care Practice demonstration project. These 500 centers will receive $42 million over three years to improve quality and coordination of health care delivery. The project is designed to evaluate the patient-centered medical home model. The goal of the model is to improve patient health and the quality of health care delivery while lowering the cost of of care. HRSA and the Center for Medicare and Medicaid Innovation Center developed the demonstration, which will be conducted from November 1, 2011 through October 31, 2014.

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