We’re closing in on the start of the ACA’s second open enrollment season. Both Kevin Counihan, the new HealthCare.gov “CEO” within the Department of Health and Human Services, and HHS Secretary Sylvia Burwell have been speaking out a bit more about the upcoming season.
But there’s a lot they aren’t saying – or touting. Here are a few things we do – or don’t – know about what to expect by Nov. 15, the start of the three-month enrollment period: Continue reading
Hospitals across the country are merging – both with other hospitals and with other health care entities such as clinics and rehab facilities. (Those are sometimes called, respectively, horizontal and vertical integration.)
The question is whether the consolidation is creating more efficiency in the health care system, as hospitals generally argue, or whether it’s creating big monopolistic health care entities that will have more clout in negotiating with insurers and thus will lead to higher, not lower, prices.
Antitrust/ mergers and acquisitions is a topic health reporters often shy away from. But it’s important and we need to pay more attention. To help you, we just posted a tip sheet, “Getting the facts on hospital mergers and acquisitions,” based on an email-interview with Barak Richman of Duke Law School, one of the foremost experts on health care antitrust law. In addition, here are a few additional resources on the topic and some recent coverage about the issue nationally and locally.
Photo: Margot Sanger-KatzJournalists at a Sept. 18 Washington, D.C., chapter meeting heard from Tom Scully, a former CMS administrator; Stephen Zuckerman, a senior fellow at the Urban Institute; and Marilyn Werber Serafini, a former journalist now with the Alliance for Health Reform.
Open enrollment is coming again. And with millions of new people signing up for health insurance and renewing their plans come opportunities for new stories about how the Affordable Care Act is working.
Stephen Zuckerman, a senior fellow at the Urban Institute and Tom Scully, a former administrator at the Centers for Medicare and Medicaid Services who now works as a private equity investor, spoke to an AHCJ chapter meeting in Washington, D.C. about the possible stories ahead.
We wrote earlier this month about the Sept. 5 deadline for people who had signed up for ACA coverage through the federal exchange but still had some inconsistencies in the record about their citizenship or legal residency. Here’s an update:
As of early September, the Department of Health and Human Services said 310,000 people still had status questions (down from close to a million “data-matching” cases in late May). Most did get the information in and the questions resolved. But about a third did not, and that means about 115,000 people will lose coverage at the end of this month. Continue reading
Remember all those stories about people being shifted into part-time work so their employers don’t have to provide health insurance?
According to a new Urban Institute report, funded by the Robert Wood Johnson Foundation, it hasn’t happened.
If, and when, the employer mandate fully kicks in (more on that below) things could change. But the anecdotes we’ve heard about employers cutting hours because of the Affordable Care Act are just that – scattered anecdotes. (And when it does occur, it might be a result of other business conditions, not the health law). Under the ACA the definition of “full-time” work is 30 hours; anyone working 30 hours a week or more would have to be covered. The fear was that employers would cut them to, say, 28 or 29 hours, to avoid that obligation. Continue reading
The second ACA enrollment season begins Nov. 15 – after the Congressional elections. While it’s hard to imagine problems worse than last year’s rollout, there’s still plenty that can go wrong.
Kevin Counihan was just named the new CEO of HealthCare.gov – a position that incorporates the old Center for Consumer Information and Insurance Oversight (CCIIO) director job at the Centers for Medicare and Medicaid Services (CMS) and also consolidates some of the responsibility for the exchange that had been scattered throughout the Department of Health and Human Services. An old hand at health care, Counihan played a role in the Massachusetts state reform before running Connecticut’s state exchange last year. (Here’s a Connecticut Mirror piece by Arielle Levin Becker about him).
After his CMS appointment, Counihan spoke to the New York Times’s Reed Abelson and gave a preview of headaches to come. It’s hard to know how many of these problems will still feel big and threatening in November, and to what extent he’s playing a “lowering expectations” game. HHS is under new management with Secretary Sylvia Burwell and the new team would clearly benefit from some headlines that say, “Hey, it didn’t melt down.”
Last year about this time, we were reading about Covered California’s decision to require parents seeking pediatric dental coverage on the state’s new insurance exchange to buy separate stand-alone plans for their children.
Pediatric dental coverage was designated as one of 10 essential benefits under the Affordable Care Act (ACA). But most dental insurance is sold separately from other kinds of health insurance, and some people supported the idea of selling pediatric dental benefits separately on the state exchange. They contended that consumers who did not want or need pediatric dental benefits should not be required to buy them.
At the same time, Covered California’s plan to offer pediatric dental coverage through stand-alone plans came as a disappointment to oral health advocates. They argued that embedding dental benefits into the health care plans for sale on the state exchange would help expand children’s access to dental care and lower the costs of the benefits by distributing the burden of paying for them across a broader group of people.
Will large hospital systems start to pressure officials in the states that have not expanded Medicaid now that their revenues have increased more than expected in the 26 states that expanded Medicaid under the Affordable Care Act?
That question seems obvious given the results of a new report (pdf) by PwC’s Health Research Institute that showed increased revenue among the nation’s five largest for-profit hospital chains in Medicaid expansion states. The PwC report shows that in states that expanded Medicaid, the five for-profit chains—Community Health Systems (CHS), HCA Holdings, LifePoint Hospitals, Tenet Healthcare and Universal Health Services (UHS)—had more insured and fewer uninsured patients in the first half of this year than they did in the first half of 2013. Hospitals in non-expansion states experienced the opposite, the consultants said. These chains run 538 hospitals in 35 states.
PwC analyzed quarterly earnings reports filed with the SEC, industry surveys and conducted interviews with hospital executives to report that the five hospital chains saw Medicaid admissions rise 10.4 percent to 32 percent since Jan. 1. At the same time, all five hospital chains reported that admissions among self-paying patients declined sharply in all states as well. Self-paying admissions dropped by 14.7 percent at CHS, by 6.6 percent at HCS, by 30.3 percent at LifePoint, by 6.5 percent at Tenet and by 9.3 percent at UHS, the report showed.
Friday is the deadline for some 350,000 people who have yet to document their citizenship/legal residency for their health insurance through the federal exchange to get the information submitted and verified or face losing insurance at the end of this month.
It would be a good time to check with health, enrollment and immigrant advocacy groups in your community to see what kind of obstacles they are facing (technical, language barriers, poor communication, confusion) and what steps they are taking to meet the deadline. The Centers for Medicare & Medicaid Services says it has been trying to reach the affected people by email, mail and telephone. Immigration advocacy groups say that the outreach has left a lot to be desired and people are having trouble getting problems sorted out. Continue reading
The post we did on Clear Health Costs got a lot of positive reaction so we asked the team involved in a John S. and James L. Knight Foundation-funded project involving two California public radio stations and the cost-tracking group to tell you more about it in their own words.
In the tip sheet, Lisa Aliferis of KQED, Rebecca Plevin from SCPR and Jeanne Pinder of clearhealthcosts.comgive you a glimpse under thehood of health care costs. “Health care costs both lack transparency and are wildly variable, not just from region to region but sometimes from block to block within the same city,” they begin.
They explain a few basics: what you pay, what insurers pay, what providers are paid, and what almost no one (except some of the uninsured) pays – the Chargemaster price. Even if you can’t build a data collection project, you can write about the variability in your community. “Put a human face on these dollar figures. Talk to people who have felt burned by the cost of a medical procedure, or confused by a huge bill. “ You might be able to find a handful of people who have had the same procedure in the same place – or the same procedure at two facilities just blocks apart in a city, or in adjacent counties in a more rural setting – and find how their experiences differed.
The “How I Did It” article by Lisa Pickoff-White, senior news interactive producer, KQED; Joel Withrow, product manager, KPCC/SCPR; and Pinder is more nitty-gritty. Your organization may not be able to do something on this scale, but it’s still worth a read to see how they approached it, what worked, and what tools they used (not just on the technical side – see the bottom of the post for other project management and collaboration tools). Facing an eight-week deadline they had to coordinate a far-flung team of journalists, data crunchers and developers scattered in Los Angeles, San Francisco, New York, Bialystok, Kiev and Tahiti. (yes, Ukraine and Tahiti.)