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Obama throws support to a public option

October 21, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

President Obama has thrown his support to a  “public option” as part of fixing the Affordable Care Act  as well increasing the number of states with Medicaid expansion and  expanding enrollee tax credits. He called it all addressing the ACA’S “growing pains.”

To address uncompetitive ACA marketplaces, the president proposed creating a “public fallback plan”  — i.e., a “public option” — that would be offered with commercial insurance in  markets with too-limited competition.

He said that it is not “the time to move backwards on healthcare reform” and that “problems that may have arisen from the Affordable Care Act [are] not because government is too involved in the process. The problem is we have not reached everybody and pulled them in.”

To read a Becker’s Hospital Review story on this, please hit this link.

Experts present ideas to strengthen the ACA marketplace

October 19, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

Modern Healthcare reports that despite the gloom about the insurance market set up under the Affordable Care Act, “{H}health policy experts say there are relatively straightforward changes that would strengthen the individual insurance market. The key is getting more younger, healthier people to enroll, to offset the medical costs associated with older, sicker plan members. Experts say this could be done through toughening the mandate to buy insurance; boosting premium and cost-sharing subsidies; restoring risk protections for insurers; letting health plans charge younger people lower rates; beefing up enrollment outreach and education; and prodding people to leave their employer health plans and get covered instead through the individual market.”

To read the Modern Healthcare article, please hit this link.

California shows that the ACA can work well

October 7, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

goldengate

The Golden Gate Bridge.

For those who think that the Affordable Care Act is a disaster, California is proving that it can work well.

As the Los Angeles Times reports, “The state has recorded some of the nation’s most dramatic gains in health coverage since 2013 while building a competitive insurance marketplace that offers consumers enhanced protections from high medical bills.

“Californians, unlike people in many states, have many insurance choices. That means that even with rising premiums, the vast majority of consumers should be able to find a plan that costs them, at most, 5% more than they are paying this year.

“And all health plans being sold in the state will cap how much patients must pay for prescriptions every month and for many doctor visits.”

“California followed the blueprint. They did it right,” said Dr. J. Mario Molina, chief executive of Long Beach-based Molina Healthcare Inc., a leading national insurer that is selling marketplace plans in nine states in 2017.

“What has been lost in all the rhetoric and the politics is that the system can work,” Molina said.

To read the Los Angeles Times piece, please hit this link.

CBO report: Hospitals need to raise productivity to stave off big losses

September 12, 2016by Robert Whitcomb in Uncategorized tagged , , ,

 

brinker

Tourism statue in the Netherlands, of a nameless boy plugging a dike to stop a great flood.

A new analysis from the Congressional Budget Office (CBO) has recognized that changes in laws and regulations, prompted primarily by the ACA–notably reduced Medicare payment updates and expanded insurance coverage–can be expected to significantly impact hospitals’ future finances.

Things look tough!

The researchers noted “substantial uncertainty” around the predictions.

The CBO’s  predictions included:

If hospitals improved their productivity  only in line with the overall economy — by an average of about 0.8 percent a year through 2025, the share of hospitals with operating losses would rise to 41 percent and hospitals’ average profit margin fall to 3.3 percent.

If hospitals boosted their productivity by 0.4 percent a year, the share with operating losses would rise to  51 percent and their average profit margin fall to 1.6 percent.

If hospitals can’t increase their productivity or otherwise reduce cost growth, the share with operating losses would rise to 60 percent.

“Consequently, if those hospitals were not able to increase their productivity by enough to fully offset those reductions in payment updates or did not use those productivity gains to reduce the growth of their costs then Medicare’s payments would not keep pace with their costs of treating those patients, and profit margins for those hospitals would decline,” the  CBO researchers concluded.

To read the CBO report, please hit this link.

To read a HeathcareDIVE review 0f it, please hit this link.

Obama proposes some major ACA repair

August 30, 2016by Robert Whitcomb in Uncategorized tagged , , ,

repair

The Obama administration is planning rules changes to  try to fix some of the problems bedeviling the Affordable Care Act, especially  the flight of insurers from the exchanges set up under the ACA.

A central aim is to rebalancing the risk pool to reduce “adverse selection” of the sickest and costliest patients on the exchanges. Among the proposed changes, as summarized by FierceHealthcare:

  • Toughening proof of eligibility for Special Enrollment Period enrollees.

  • Encouraging consumers turning 65 to shift from ACA products to Medicare ones,  thus reducing the risk profile of a demographic with higher-than-average healthcare-use rates.

  • Boosting a recent task force dedicated to ousting healthcare providers who direct patients toward ACA plans instead of Medicare and Medicaid in order to receive greater reimbursements.

  • “Creating space for insurers to creatively design their insurance products, particularly for ‘benchmark’ federally-subsidized health plans.”

  • “Restructuring how medical loss ratios are calculated.”

  • “Ending the current rule that bans insurers from entering exchange marketplaces for up to five years if they exit a marketplace.”

  • “Ascertaining whether user fees should be allocated toward outreach efforts.”

    To read a longer article on this, please hit this link.

Big insurers’ exits revive talk of Medicare for all

August 17, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

exit

As big insurers bail out of the insurance exchanges created by the Affordable Care Act, the idea of simplifying, and saving money on, the currently chaotic U.S. healthcare “system” by extending Medicare to all, or at least offering a “public option” on the exchanges, is gaining ground.

Polls suggest that a majority of the population would like Medicare for all but  the  insurance companies have a powerful lobbying and campaign-contribution operation in Washington to try to thwart that.

President Obama, pushing back against criticism of the Affordable Care Act in the wake of the insurance company exits from ACA’s insurance exchanges, has revived the idea of introducing a public, Medicare-like plan to compete with private insurers. He also has suggested that increased government subsidies could help draw more people into the ACA’s markets.

Bloomberg has noted also: “Another option is to simply give insurance companies more government money, but that would require action from a Republican Congress that would rather repeal Obamacare than fix it.”

‘There’s going to be absolutely zero interest among Republicans in bailing out Obamacare by giving it more money,”  Avik Roy, a healthcare expert who’s advised Republican presidential candidates Mitt Romney, Rick Perry and Marco Rubio on health policy, told Bloomberg.

With  such unknowns as who will control the White House and one or both houses of Congress after the November election, one would have to be very brave to make predictions.

To read the Bloomberg article on this developing story, please hit this link.

Crucial role of employers in making ACA work better

August 11, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

 

In an article in the Harvard Business Review, Robert S. Mecklenburg, M.D., medical director of the Center for Health Care Solutions at Virginia Mason Medical Center, and Lindsay A. Martin, executive director of innovation and an adviser at the Institute for Healthcare Improvement, write that large employers are key to making the Affordable Care Act work up to its potential.

They write:  {L}arge employers can play a powerful role in building on what the ACA and other initiatives have achieved to date and accelerate the positive transformation of the U.S. healthcare system.”

“Through the ACA, many new customers have been able to enter the healthcare  market, but the market remains inefficient. The ACA includes mechanisms for cost reduction that employers can build upon by contributing their purchasing power to create a complementary quality-based market to address the trillion dollars in waste that continues to burden patients, providers, and employers alike.

“Businesses as well as public sector entities can play a lead role in mitigating political hyper-partisanship and special interests by working directly with local healthcare providers to define, secure, and execute to transparent standards. Pragmatism can prevail.”

To read the article, please hit this link.

Anthem touts a Cigna takeover as good for insurance exchanges

July 28, 2016by Robert Whitcomb in Uncategorized tagged , , ,

 

Anthem, seeking to buy Cigna in the face of the opposition of the Justice Department’s Antitrust Division, argues that the deal would boost the health-insurance exchanges created by the Affordable Care Act.

Modern Healthcare opined: “The response signals Anthem will indeed litigate the case to the end even though many analysts and policy experts say the company is unlikely to win.”

Anthem said:
“At a time when large insurers are withdrawing from public exchanges, its acquisition of Cigna will significantly increase consumers’ access to the exchanges,”  Anthem, which has about 923,000 ACA exchange members, expects to lose about $300 million from that business this year but hasn’t said it will quit any markets.

The company asserted that the combined Anthem-Cigna company would enter nine new states with ACA marketplaces.

To read the Modern Healthcare article, please hit this link.

The monetary pleasures of insiders in America’s corrupt health-insurance system

July 5, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

This piece by Vatsal G. Thakkar, M.D., should be required reading for  healthcare-sector executives, clinicians and federal policymakers. It details how well-connected people, including physicians, can pull strings to get insurance coverage that ordinary people cannot.

He tells stories that “reveal an uncomfortable truth: Our health-insurance system is so broken that pulling strings — or rank — is sometimes the only way to get the coverage you think you’ve paid for.”

He continues:

“These workarounds are necessary because the healthcare system doesn’t follow any rational rules of economics, where the customer should be king.

“Economies of scale are supposed to bring costs down. But in healthcare, large hospitals are often more expensive than smaller ones because they can demand higher payments from insurance companies, which are then passed down to patients.

“In most realms, those with the least ability to pay should receive the biggest discounts. In healthcare, it is often the uninsured and indigent who receive bills with the full ‘chargemaster’ fee — the wildly inflated prices that nobody really pays — while large insurance companies get the biggest breaks.”

He discusses eloquently the lack of transparency in pricing —  an opaqueness that’s highly profitable for providers and insurers and so is likely to continue indefinitely — but bad for patients and their families. He notes:

“In a battle of dueling bureaucracies, the Supreme Court recently dealt a blow to price transparency in Vermont, where the state wished to publish a database of fees and other information. An insurance company, Liberty Mutual, objected to turning over the data on what it paid doctors and hospitals, and the Supreme Court agreed. The justices argued that, according to the ACA {Affordable Care Act} only the Department of Labor, and not individual states, had the right to collect this data. The ruling affects almost a dozen states that are pursuing similar initiatives.”

To read Dr. Thakkar’s essay, please hit this link.

The GOP’s outline of an ACA replacement

June 22, 2016by Robert Whitcomb in Uncategorized tagged , , ,

elephant

Congressional Republicans have come up with the outlines of a plan to replace the Affordable Care Act. Perhaps inevitably in an election year, the plan doesn’t tell us how it would be  financed.  But here are some important elements, as summarized by FierceHealthcare:

“The Republicans’ plan would offer everyone who doesn’t qualify for employer coverage, Medicare or Medicaid access a refundable tax credit to use in the individual market—instead of the ACA’s current policy of offering tax credits to just those of certain incomes. The credit is also age-adjusted.”

The plan would boost “’Association health plans,’ in which small business and groups such as alumni organizations and trade associations band together to offer healthcare coverage at better rates via improved bargaining power with insurers.”

“The plan would set aside at least $25 billion to fund programs that Republicans say would give financial support for those with high medical costs who find themselves priced out of coverage. Premiums for those participating in the high-risk pool would be capped, and wait lists would be prohibited.”

”A one-time open enrollment period for the uninsured, regardless of health status. If consumers who lack coverage don’t enroll in a plan during that open enrollment period, they forfeit continuous coverage protections and could face higher insurance costs in the future.”

”The sale of insurance across state lines. This often-cited GOP policy proposal …is supposed to make the insurance market more competitive and give consumers the ability to access the most affordable policies.”

”The preservation of certain ACA protections. The plan would prevent those with pre-existing conditions from being denied coverage, as well as allow individuals to stay on their parents’ insurance plan until age 26.”

”Medicaid reforms that would allow states to choose between either a per capita allotment for their programs or a block grant. States would be allowed the flexibility ‘to charge reasonable enforceable premiums’ or offer a limited benefit package. The proposal also takes several steps to ‘modernize’ the Medicaid demonstration waiver process, requiring them to be budget neutral while grandfathering in some successful waiver provisions.”

For the FierceHealthcare article on the GOP plan, please hit this link.

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