Archive: February 2013

Census Bureau report finds drop in employer-sponsored health coverage

Posted on February 27, 2013

According to a U.S. Census Bureau report released this morning, the rate of individuals with employer-sponsored health coverage dropped from 64.4 percent in 1996 to 55.1 percent in 2011. Among the employed population aged 18 to 64, 68.2 percent received health insurance through their own employer or another person’s employer. In addition, 34.7 percent of individuals who did not work received coverage through employment-based health insurance and 43.3 percent of individuals with family incomes less than 138 percent of the federal poverty level were employed by firms offering health benefits.

The Census Bureau report uses data from the Survey of Income and Program Participation (SIPP) to examine the characteristics of people with employer-provided health insurance coverage as well as characteristics of employers that offer health insurance.

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GAO report finds ACA cost controls not enough to account for increased spending

Posted on February 27, 2013

The Government Accountability Office (GAO) yesterday released a report on the long-term costs of the Affordable Care Act (ACA). The report found that the long-term fiscal outlook depends largely on whether elements in the ACA designed to control cost growth are sustained. As federal health care spending is expected to continue growing faster than the economy over the next 75 years, the federal budget is on an unsustainable path, even with ACA measures intended to curb cost growth. Yesterday, at a Senate Budget Committee hearing, ranking member Jeff Sessions (R-Alabama), said the report showed the ACA will increase the deficit by $6.2 trillion over the next 75 years.

ACA cost curbing provisions include reduced payments from Medicare and Medicaid, the creation of a 15-member Independent Payment Advisory Board to make recommendations to reduce Medicare costs, and new taxes to pay for the health care expansion.

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Update: Basic Health Program FAQs

Posted on February 27, 2013

On February 6, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a new series of ACA-related Frequently Asked Questions (FAQs). The first two questions address the Basic Health Program (BHP). As described in an earlier Implementation Brief, the BHP was included in the ACA as a special state coverage option for low-income families and individuals. In answer to the question “When will the Basic Health Program be operational?”, CMS replied that the agency does not intend to propose implementing rules until sometime in 2013 and furthermore, that final rules will not be issued until 2014. The status of the Basic Health Program emerged as one of the subjects of a Senate Finance Committee’s ACA oversight hearing on February 14, 2013, during which Senator Maria Cantwell (D-WA), who sponsored the legislative amendment creating the BHP, questioned CCIIO Director Gary Cohen on the timing of BHP guidance.

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DOL publishes whisteblower interim final rule

Posted on February 23, 2013

The Department of Labor (DOL) yesterday published an interim final rule that would provide regulations governing the employee protection (whistleblower) provision of section 1558 of the Affordable Care Act (ACA). The provision provides protections to employees of health insurance issuers or other employers who may have been subject to retaliation for reporting potential violations of the law’s consumer protections or affordability assistance provisions. This interim rule establishes procedures and time frames for the handling of retaliation complaints under section 18C.

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Dartmouth study identifies problems with risk-adjustment methods

Posted on February 22, 2013

In a study led by the Dartmouth Atlas Project and The Dartmouth Institute for Health Policy & Clinical Practice, researchers raise questions regarding the risk adjustment that Medicare and others apply to insurance claims data in an effort to make effective comparisons about the performance of doctors and hospitals and to credit providers for treating patients who are sicker than average. The study examines commonly used risk-adjustment methods and finds that regions and hospitals with more physician visits, referrals, tests, and imaging can make some patient populations appear to be sicker than others when they are not. As a result, these regions and providers with more diagnoses receive higher reimbursements.

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HHS publishes market and rate review rule

Posted on February 22, 2013

The U.S. Department of Health and Human Services (HHS) today published a final rule regarding Insurance Market Rules and Rate Review. The rule addresses guaranteed coverage and premium rating standards under the Affordable Care Act (ACA). The rule includes five key consumer protections, including fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans. Of note with regard to the ACA’s age rating bands, HHS cannot slowly phase-in the 3:1 band, meaning that next year, insurers can only charge older people three times as much as younger people due to their age. In addition to age, insurers will be able to base premiums on tobacco use, family size, and geography when selling to individuals and small businesses. The new rule applies to individual and small group markets both in and out of the Exchanges, except for some grandfathered plans. The regulations requires insurance companies to report on all rate increases, as opposed to those over 10 percent.

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ASPE report finds reduction in premium rate increases

Posted on February 22, 2013

According to a report published today by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), a division of the U.S. Department of Health and Human Services (HHS), evidence suggests that the ACA has contributed to a reduction in the rate of increase in premiums in the individual market since 2010. These numbers are based on data collected from the 15 states that publicly post all requests for rate increases in the individual market. The proportion of rate filings in which the requested increase was 10 percent or more declined from 75 percent in 2010 to 34 percent in 2012. Available data for 2013 suggest that this pattern of slower premium growth has been maintained so far in 2013, with only 14 percent of requested rates at 10 percent or more. In addition, the average premium increase in 2012 was 30 percent below that in 2010.

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CMS publishes bulletin on MAGI-based eligibility verification plans

Posted on February 21, 2013

Today the Centers for Medicare & Medicaid Services (CMS) published an Informational Bulletin to provide information to state Medicaid and CHIP agencies on the verification plans required for both Medicaid and Children’s Health Insurance Program (CHIP) eligibility, the MAGI-based (Modified Adjusted Gross Income) Eligibility Verification Plan Template, and a review of the final verification regulations.

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CCIIO releases FAQ on state plan management

Posted on February 21, 2013

According to a Frequently Asked Questions (FAQ) guidance posted by the Center for Consumer Information and Insurance Oversight (CCIIO), states can determine whether health insurance plans qualify for the online health insurance exchange markets and conduct other plan management activities without submitting a “blueprint” application to the Department of Health and Human Services (HHS). The blueprints are applications that must be submitted to HHS in order for states to operate state-based exchanges or to participate in a state partnership exchange under the Affordable Care Act (ACA).

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OIG finds most states on track to comply with ACA technical demands

Posted on February 21, 2013

According to a report published by the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), 35 States reported that they anticipate implementing streamlined eligibility and enrollment systems, streamlined application forms, and data sharing and matching by January 1, 2014, as mandated under section 1413 of the Affordable Care Act (ACA). However, the report also describes challenges reported by States, such as implementing the requirements by the target date and upgrading outdated eligibility and enrollment systems. The report details various funding issues related to implementing needed changes. According to the paper, States also reported needing information and guidance, particularly on the Secretary’s application form, the planned Federal data services hub, and the calculation of Modified Adjusted Gross Income (MAGI). The OIG report concluded that the Centers for Medicare & Medicaid Services (CMS) should continue to provide guidance to States as they prepare to implement the streamlined eligibility and enrollment systems.

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