Third Party Resources
EBRI releases issue brief regarding health plan survey
Posted on January 25, 2012
An issue brief released by the Employee Benefit Research Institute presents findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey. This study is based on an online survey of 4,703 privately insured adults ages 21–64 to provide nationally representative data regarding the growth of consumer-driven health plans (CDHPs) and high-deductible health plans (HDHPs), and the impact of these plans and consumer engagement more generally on the behavior and attitudes of adults with private health insurance coverage. Findings from this survey are compared with EBRI’s findings from earlier surveys.
EBRI reported that 7 percent of the population had a consumer-driven health plan (CDHP) in 2011, up from 5 percent from 2010. About 16 percent were enrolled…
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PCORI releases report proposing national priorities for patient-centered clinical effectiveness
Posted on January 24, 2012
The Patient-Centered Outcomes Research Institute (PCORI) proposed national priorities for patient-centered comparative clinical effectiveness in their first version of PCORI’s Research Agenda. PCORI expects to learn and update this as
we move forward. We are not specifying or prioritizing any particular condition or disease for
research, although we may do so in the future. Consistent with the criteria outlined in the Affordable Care Act (ACA), PCORI’s first research agenda looks at:
-Comparisons of Prevention, Diagnosis, and Treatment Options…
RWJF report assesses the individual mandate in a new report
Posted on January 12, 2012
Today the Robert Wood Johnson Foundation (RWJF) released a report authored by researchers from the Urban Institute called “Eliminating the Individual Mandate: Effects on Premiums, Coverage, and Uncompensated Care: Timely Analysis of Immediate Health Policy Issues.” The report examines the effect that eliminating the individual mandate—the requirement for most Americans to have health insurance or face a penalty—would have on health insurance coverage, spending, premiums and uncompensated care. Using the Urban Institute’s Health Insurance Policy Simulation Model, the researchers simulated the Affordable Care Act as enacted, as well as several alternative scenarios of health reform without the mandate.
The authors find that without the mandate:
1) Between 40 and 42 million would remain uninsured as opposed to 26 million with the mandate;
2) Private coverage would fall 11 million, covering 4 million fewer people than it would have without reform;
3) Uncompensated care spending would be much higher due to the increased number of uninsured; and
4) Individual premiums in the health benefit exchanges would increase by 10 percent in a scenario assuming high exchange participation, and by 25 percent with a low participation scenario.
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EBRI releases report on employment-based coverage of adult children to age 26
Posted on January 12, 2012
The Employee Benefit Research Institute released an article entitled “The Impact of PPACA on Employment-Based Health Coverage of Children to Age 26″ in their January volume. This report reviews the evidence as to whether the mandate to extend coverage to adult children had an effect on the percentage of young adults with coverage in late 2010 and the first half of 2011. Data from the Census Bureau’s Current Population Survey (CPS) and Survey of Income and Program Participation (SIPP) are examined, as well as data from the Center for Disease Control’s National Health Interview Survey (NHIS). The data from these three surveys suggest that the PPACA’s coverage mandate has resulted in an increase in the percentage of young adults with employment-based health coverage as a dependent.
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ACAP releases article on dual eligibles
Posted on January 12, 2012
Jane Hyatt Thorpe and Katherine Jett Hayes recently released an article funded by the Association for Communication Affiliated Plans (ACAP), “A New State Plan Option to Integrate Care and Financing for Persons Dually Eligible for Medicare and Medicaid,” which reviews barriers to clinical and financial integration in services for dual eligibles prior to passage of the ACA, identifies models used by states to integrate care through contract and waiver authorities available to CMS prior to passage of the ACA, describes two new demonstrations proposed by CMS through the Medicare-Medicaid Coordination Office and Innovation Center, and introduces a state plan option as a new model for consideration by federal and state policymakers. This new model draws on experience from existing programs and waivers to provide a permanent state plan option for a fully integrated, capitated care model that could be made available to states prior to the completion of the demonstration process begun by the Medicare-Medicaid Coordination Office and Innovation Center.
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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.
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Recent Posts
- Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–NFIB on Severability
- House approves CLASS repeal
- Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–Health Law Professors on the mandate
- Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–Solicitor General on Severability
- Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–Center for Constitutional Jurisprudence/Pacific Legal Foundation on Medicaid Expansion
- Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–AHA on the mandate
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- Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–BCBS of Mass. on the mandate
