Posted on April 8, 2015
A new analysis by Avalere Health finds that federally-facilitated exchanges retained a higher percentage of 2014 enrollees and enrolled a higher percentage of new enrollees in 2015 than state-based exchanges. Exchanges run by the federal government reenrolled an average of 78 percent of 2014 enrollees in 2015, compared to 69 percent of 2014 enrollees in state run exchanges. Additionally, states with federal-run exchanges saw 2015 sign-ups increase by 61 percent from 2014 while state-run exchange enrollment only rose by 12 percent. According to the report, some of the higher 2015 enrollment may be attributed to technological issues with HealthCare.gov that depressed enrollment in 2014, however, Avalere contends that this alone does not explain why such significant discrepancies exist between state and federally run exchanges.
Posted on April 7, 2015
A report released by the Robert Wood Johnson Foundation (RWJF) examines Medicaid expansion in eight states- Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington, and West Virginia. Researchers found that these states are seeing large budget savings without reducing services. Savings and revenues by the end of 2015 are expected to exceed $1.8 billion across all eight states, and in Arkansas and Kentucky these savings and revenue gains are expected to offset expansion costs through 2021. The report suggests that these savings come from less state spending on programs for the uninsured, more federal dollars for newly eligible enrollees, and higher revenue from existing insurer and provider taxes. The authors contend that these findings will apply to every state that has expanded Medicaid.
Posted on March 28, 2015
The Government Accountability Office (GAO) issued a report finding that coverage of services in the selected State Children’s Health Insurance Program (CHIP) plans was generally comparable to that of the selected private qualified health plans (QHP) under the Affordable Care Act (ACA). However, GAO found notable exceptions with pediatric dental and certain enabling services, such as translation and transportation services, which were covered more frequently by CHIP plans. Selected CHIP plans and QHPs were also similar in terms of the services on which they imposed day, visit, or dollar limits, although the five selected CHIP plans generally imposed fewer limits than the selected QHPs. Additionally, GAO found that consumers’ costs for services (deductibles, copayments, coinsurance, and premiums) were almost always less in the selected CHIP plans when compared to their respective QHPs, despite the application of subsidies authorized under the ACA that reduce these costs.
Posted on March 26, 2015
The Government Accountability Office (GAO) released a new report finding that premium tax credits have likely contributed to an expansion of health insurance coverage in 2014 by significantly reducing the cost of exchange plans’ premiums for those eligible. The GAO report cited surveys finding that the uninsured rate declined significantly among households with incomes eligible for the premium subsidies. One survey found that the rate of uninsured individuals with household incomes eligible for premium tax credits fell 5.2 percentage points between September 2013 and September 2014. However, many still face challenges maintaining coverage. GAO found most nonelderly adults had access to affordable plans through their employer, Medicaid, the exchanges, or other sources as of March 2014, although about 16 percent of nonelderly adults remained uninsured.
Posted on March 9, 2015
A new Health Affairs blog examines the oral arguments in King v. Burwell, focusing on the plantiffs’ reading of the Affordable Care Act (ACA) regarding states establishing their own exchanges for the benefit of federal subsidies. Under this interpretation,the law was intended to encourage states to create their own exchange, or else receive no federal subsidy funds, which may be viewed as coercive by the Court. The blog draws parallels between the Medicaid coercion argument in NFIB v. Sebelius, where the Supreme Court ruled that requiring states to expand Medicaid under the ACA at the price of withdrawing federal funding would be unconstitutionally coercive, and the similar argument of coercion brought up in the King case. The author contends that potentially the Court will realize the deeper constitutional implications of upholding the plantiffs’ reading of the law and allow federal subsidies to continue flowing through federally facilitated exchanges.
Posted on March 4, 2015
A perspective piece published in the New England Journal of Medicine predicts potential fallout from a ruling in favor of King in the King v. Burwell case currently being decided by the Supreme Court. If the challengers prevail, the U.S. Treasury will likely have to stop issuing tax credits to users of federal exchanges. Enrollees who are unable or unwilling to pay the full cost of their insurance premiums could see their coverage terminated. The authors suggest that states could choose to set up their own exchanges and delegate some responsibilities to private contractors, in order to avoid some of the technological challenges. However, the authors also note that some states may be unwilling to set up their own exchanges, in the same way they chose not to expand Medicaid. This could lead to substantial coverage gaps for many Americans.
Posted on February 17, 2015
The Government Accountability Office (GAO) issued a report examining (1) the extent to which Medicaid enrollees have private insurance, and (2) state and CMS initiatives to improve third-party liability (TPL) efforts. GAO found that 7.6 million Medicaid enrollees (13.4 percent) had private health insurance in 2012. Additionally, the number of Medicaid enrollees with private health insurance is expected to increase with the expansion of Medicaid. To combat this issue, GAO recommends that the Centers for Medicare and Medicaid Services (CMS) routinely monitor and share across all states information regarding key TPL efforts and challenges, as well as provide guidance on state oversight of TPL efforts conducted by Medicaid managed care plans.
Posted on January 26, 2015
A new report released by the Congressional Budget Office (CBO) estimates that the coverage provisions of the Affordable Care Act (ACA) will result in $76 billion in net costs to the federal government in 2015 and $1,350 billion between 2016 and 2025. These costs come almost entirely from tax subsidies, accounting for $32 billion in 2015, and from the increase in spending from Medicaid expansions, $47 billion in 2015. CBO predicts that these costs will be offset slightly by an estimated $2 billion in penalties paid by the uninsured in 2015. This new CBO estimate of the ACA’s coverage provisions represents a 7 percent decline since their last estimate.
Posted on January 14, 2015
Consulting firm Leavitt Partners released a white paper outlining several scenarios that Congress, the states, and the administration could take should the Supreme Court rule against the administration in the King v. Burwell case. Under the first scenario Congress could amend the Affordable Care Act (ACA) in a way that establishes the subsidies were meant for all Americans regardless of who establishes the exchange. In the second proposed scenario Congress would pair a fix to the ACA with “material concessions”, such as the employer mandate or premium tax credit thresholds. In the third scenario outlined in the white paper, Congress would take no action regarding the Court’s decision, leaving it up to states to create their own contingency plans. The Leavitt white paper also suggests several fall-back ideas that may be under consideration by the administration as well as potential state reactions.
Posted on January 13, 2015
Two studies by the Robert Wood Johnson Foundation (RWJF) and the RAND Corporation came up with similar findings regarding the Supreme Court’s potential decision in the King v. Burwell case. RWJF speculates that a ruling in favor of King, eliminating subsidies in federal exchanges, would shrink the nongroup insurance market by 9.7 million nonelderly adults and increase the number of uninsured Americans by 8.2 million in 2016. The RAND study also predicts that a ruling in favor of King could cause a 47 percent increase in premiums in federally facilitated marketplaces (FFM). The implications of the court’s decision could ricochet beyond those directly losing subsidies, affecting higher income individuals and even people who obtain coverage outside of the marketplaces.