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RWJF and Urban reports examine coverage for vulnerable populations

Posted on June 14, 2012 | No Comments

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Every year, almost one-third of the 96 million people who will receive either Medicaid, or new subsidies to purchase insurance through an exchange, will change their source of coverage as a result of changes in their income and employment, according to a new report from the Robert Wood Johnson Foundation (RWJF) and the Urban Institute. This “churning” of people from one source of insurance coverage to another has long occurred in public programs like Medicaid and the Children’s Health Insurance Program (CHIP), but the Affordable Care Act’s (ACA) Medicaid expansion and subsidized coverage in exchanges will significantly expand its occurrence.

The authors explain how states could systematically fight churning, including through Medicaid premium assistance and the Basic Health Program. However, since such efforts can only reduce but not eliminate forced changes in coverage, the report also describes how states could limit the harm experienced by families in transition.

A second RWJF report also authored by Urban Institute researchers examines the ACA’s ability to protect all individuals who purchase insurance through the small group and nongroup markets, especially those who have many health needs, and therefore high costs. The authors say that the ACA will dramatically reduce problems in these markets by establishing benefit standards, requiring readily understandable and comparable information from plans, and prohibiting many long-standing market practices designed to avoid enrolling those with high health needs and to limit the payment of legitimate claims. However, the authors find that the proposed approach to implementing two key ACA requirements—“essential health benefits” and insurance plan actuarial value— even in combination with the law’s additional insurance protections, may not ensure that the highest-need consumers receive predictable and adequate insurance protection.

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A study released by The George Washington University finds that churning, the process of moving in and out of Medicaid in response to income fluctuations, increases hospitalizations and costs for Medicaid beneficiaries. The Continuity of Medicaid Coverage: An Update reports that individuals enrolled in Medicaid for 12 months consecutively pay on average $333/month in medical bills, while those enrolled for one month at a time pay $625/month. The study released last week was funded by the Association for Community Affiliated Plans (ACAP).
In the U.S., uninsured and low-income adults face significant health and health care inequities as compared to insured and higher-income individuals. An issue brief analyzing the Commonwealth Fund 2010 Biennial Health Insurance Survey finds that when low-income adults have access to health insurance coverage and a medical home, they are less likely to report cost-related access problems, more likely to be up-to-date with preventive screenings, and report greater satisfaction with the quality of their care. Moreover, the gaps in health care between them and higher-income populations are significantly reduced. The Affordable Care Act (ACA) includes numerous provisions that will significantly expand health insurance coverage, especially to low-income patients, as well as provisions to promote medical homes. Along with supporting the full implementation of coverage expansions, it will be important for public and private stakeholders to create opportunities that enhance access to medical homes for vulnerable populations.
The Commonwealth Fund Commission on a High Performance Health System's report "Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations" examines the continuing problems facing vulnerable populations and offers a policy framework for moving forward. The framework features three overarching strategies to close the health care divide: 1) ensure that insurance coverage affords adequate health care access and financial protection; 2) strengthen the care delivery systems serving vulnerable populations; and 3) coordinate health care delivery with other community resources, including public health services.
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.
The Centers for Medicare and Medicaid Services (CMS) of the US Department of Health and Human Services (HHS) has issued a Request for Information (RFI) on the Basic Health Program (BHP). The BHP is designed to offer an alternative pathway to coverage for low-income families, and must provide at least the same level of mimimum essential health benefits offered to other consumers through plans sold in the State's Exchange. The RFI seeks input from stakeholders on what they feel will be challenges and costs associated with the BHP, how the BHP might affect the Exchange, and innovative strategies States could use in contracting with standard health plans. For more information on the BHP, click here.
An important issue in implementing the Affordable Care Act (ACA) is how to address the needs of uninsured low-income individuals and families whose incomes exceed Medicaid eligibility levels but are less than twice the federal poverty level (about $37,000 for a family of 3 in 2011). Under the ACA, the basic approach to assisting such individuals and families is the state health insurance Exchange, which enables qualified individuals to secure coverage and provides access to premium assistance and cost-sharing subsidies aimed at making coverage and care affordable.
Provides funding for a temporary high-risk health insurance pool for individuals with pre-existing conditions.