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RWJF and National Academy of Social Insurance release report on Medicaid, Exchanges, and the individual insurance market
Posted on January 11, 2012
The Robert Wood Johnson Foundation and the National Academy of Social Insurance recently released “Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market,” which examines the practical and conceptual factors that underlie the federal/state relationship in dealing with the alignment of Medicaid and the State Health Insurance Exchange policy. The report lays out dimensions of collaboration between states and the federal government that could help establish a seamless continuum of coverage for those who may move between eligibility for Medicaid and for tax subsidies in the Exchange.
NIHCR report suggests ACA will not amply address primary care physician shortages
Posted on December 20, 2011
A report released by the National Institute for Health Care Reform (NIHCR) finds that provisions under the Affordable Care Act (ACA) to increase the number of primary care physicians may not be sufficient to meet the rising demands of medical services. Such provisions under the ACA include higher payment rates and educational loan forgiveness for primary care doctors. NIHCR urges policymakers to focus on ways to expand primary care that will yield more timely results. Such improvements could include opening the field of primary care to more non-physician providers, and improving the efficiency of existing practitioners.
RWJF report explores Exchange options for States
Posted on December 20, 2011
The Robert Wood Johnson Foundation (RWJF) released a report today that explores three ways that states can comply with the Affordable Care Act’s (ACA’s) health insurance exchange provision. First, states can establish an exchange of their own; second, states can default to a federal exchange; or third, states can create a hybrid exchange. On behalf of the National Academy of Social Insurance (NASI), the authors evaluated the considerations associated with each option to help states determine which model may work best for the unique needs of their residents. Although the underlying goals are the same in all three Exchange models, there are differences in the amount of flexibility and autonomy granted to the States with each. State Exchanges, for example, offer the greatest independence in functions like coordinating plan enrollment, eligibility, and financial management. States cede much of this autonomy with the Federal Exchange model. As its name implies, the Hybrid Exchange allows states to retain responsibility for certain core functions, while importantly, also providing an interim pathway for an eventual State Exchange. The authors conclude that regardless of the model, success can only be achieved through intensive collaboration between individual states and the U.S. Department of Health & Human Services.
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BCBS releases Health Reform Toolkit on Exchanges
Posted on December 20, 2011
This spring, as the Affordable Care Act (ACA ) celebrated its first birthday, Massachusetts commemorated five years since the implementation of its revolutionary health reform law, passed in 2006. Marking these milestones, the Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority developed the Health Reform Toolkit Series to offer insight on key health reform topics to state leaders in the process of ACA implementation. The Blue Cross Blue Shield (BCBS) of Massachusetts Foundation recently published the fourth report of the series, “Mitigating Risk in a State Health Insurance Exchange.” This toolkit focuses on the ACA’s three key strategies intended to mitigate adverse selection and stabilize health insurance premiums when insurance market reforms are implemented in 2014. These strategies are also designed to decrease health insurance plans’ economic incentives to employ tactics designed to enroll healthier persons. These three risk mitigation strategies include: 1) Risk corridors; 2) Reinsurance; and 3) Risk adjustment. By mitigating risk to health insurers, these three strategies – along with standardized product designs – work together to allow issuers to compete on quality, efficiency, and value, rather than on the basis of designing products intended to attract and enroll only the healthiest individuals.
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Commonwealth Fund’s NEJM report relates hospital admission rates and rehospitalization
Posted on December 16, 2011
In a Commonwealth Fund-supported report recently published in the New England Journal of Medicine, researchers found that U.S. regions where discharged hospital patients are readmitted at comparatively high rates are often the same regions where overall hospitalization rates are high. This relationship indicates broad, systemic problems within the U.S. health care system. The study, conducted by Arnold Epstein, M.D., Ashish Jha, M.D., and John Orav, Ph.D., examined rehospitalization rates across the country for Medicare patients with congestive heart failure and pneumonia, while also looking at how other variables, such as overall hospitalization rates, differences in patients’ coexisting conditions, quality of discharge planning, and the number of hospital beds and physicians, affected readmissions. Of all the potential causes for regional differences in readmission rates, overall hospital admission rates played the biggest role, accounting for 16 percent to 24 percent of the variation in cases of congestive heart failure and 11 percent to 20 percent for pneumonia cases. No other factor accounted for more than 6 percent of the variation.
GAO compares PCIP implementation with CHIP
Posted on December 15, 2011
The U.S. Government Accountability Office (GAO) has issued a report comparing the early stages of the federal Pre-Existing Condition Insurance Plan (PCIP) with the Children’s Health Insurance Program (CHIP). The federal PCIP was authorized by the Affordable Care Act (ACA), and is intended to provide insurance for individuals with previously existing medical conditions who have been unable to obtain health insurance coverage for at least 6 months. GAO was tasked by the Senate with comparing early enrollment and implementation across both PCIP and CHIP. GAO found that like CHIP, enrollment in PCIP was slow in the beginning, but increased over time. GAO also found that enrollment in PCIP was generally lower in States that had high risk pools than in States that did not.
For more information on pre-existing conditions, click here.
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U.S. trumps other countries in health care spending again
Posted on November 23, 2011
The Organization for Economic Co-operation and Development recently released the 6th annual Health at a Glance report. The OECD paper shows that the United States is number one in health spending even though Americans have a lower rate of doctor visits and hospitalizations than most of the other 34 member countries. The United States spent approximately $7,960 per person on health care in 2009. This rate was about 2.5 times the average per capita health care cost in the other countries studied.
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RWJF releases summary documenting that public health interventions lead to health care cost savings
Posted on November 16, 2011
The Affordable Care Act (ACA) created the Prevention and Public Health Fund, a 10-year, $15 billion commitment to support programs, medical screenings, and research related to public health and prevention. This national commitment to investment in preventing disease before it occurs is in line with evidence from a variety of recent reports and studies indicating that strategic investments in proven, community-based prevention programs could result in significant U.S. health care cost savings and overall economic cost savings. The Robert Wood Johnson Brief, “Return Investments in Public Health: A Summary of Groundbreaking Research Studies,” summarizes the findings and recommendations from four major studies released between 2008 and 2011.
CRS issues report regarding presidential power over the ACA
Posted on November 15, 2011
On November 14, 2011, the Congressional Research Service issued a memorandum regarding the extent to which a President, through use of an executive order or other administrative actions, could impact provisions under the Affordable Care Act (ACA). The report confirms that while the President would be able to alter certain regulations, a “President would not appear to be able to issue an executive order halting an agency from promulgating a rule that is statutorily required by PPACA, as such an action would conflict with an explicit congressional mandate…” CRS examined the issue for Republican Senator Tom Coburn of Oklahoma, finding that federal courts would frown upon any attempt to undo White House legislation.
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GAO recommends automatic increases in FMAP
Posted on November 10, 2011
A recent Government Accountability Office (GAO) report introduces a prototype formula to provide states with temporary Medicaid assistance during national economic downturn. Once a threshold number of states–26 in the GAO formula–demonstrate a sustained decrease in their employment-to-population ratio, temporary increases to the Federal Medical Assistance Percentage (FMAP) will be automatically triggered under the GAO plan. This assistance will end when fewer than the threshold number of states show a decline in the ratio. Targeted state assistance would be calculated based on 1) increases in unemployment, as a proxy for changes in Medicaid enrollment; and 2) reductions in total wages and salaries, as a proxy for changes in states’ revenues. Such assistance would facilitate state budget planning, provide states with greater fiscal stability, and better align federal assistance with the magnitude of the economic downturn’s effect on individual states.
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- Contraception Coverage under the ACA’s Preventive Services Coverage Requirements, and Employer Implementation: An Update posted on April 20, 2012
- Update: Essential Health Benefits FAQs posted on May 9, 2012
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- State Health Insurance Exchange Navigators posted on February 28, 2011
- Update on the Final Rule: Standards Related to Reinsurance, Risk Corridors and Risk Adjustment posted on April 4, 2012
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