Category Archives: Health care reform

Costs keep going up for small businesses insuring their employees

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Ideastream’s  Sarah Jane Tribble took a look at how small businesses that voluntarily cover their workers could be in for some premium shocks.

She focused on Paul Siperke, co-owner of Fat Head’s, a Cleveland brew club. It’s  a small business and, with fewer than 50 employees, there is no requirement to cover workers. But the owners do voluntarily.

And the costs keep rising – sometimes double digits, sometimes only as little as 3 percent.This year, Tribble reported, rates soared by 20 percent under the ACA, even though most of the workers are young and healthy.

She explains why: Continue reading

Similar health reform terms, but very different concepts

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Essential health benefits include maternity and newborn care.

Photo: David Castillo Dominici via FreeDigitalPhotos.net 
Essential health benefits include maternity and newborn care.

We’ve had a few members wonder whether “essential coverage” and “essential benefits” are one and the same.

They aren’t – and we’ve done a tip sheet to explain the difference in more detail.

But here’s the quick version:

If someone has minimum essential coverage it means he or she has a health plan that complies with the individual mandate. It means that there will be no penalty when 2014 taxes are filed. A lot of health plans qualify, including the exchange plans, most plans in the individual and small group market, employer-based health plans, Medicare, Medicaid.

Limited plans such as workers’ compensation or dental-only plans do not qualify as mandate-meeting minimum essential coverage.

Essential health benefits are the 10 categories of benefit s – hospitalization, prescription drugs, maternity care, etc. – that the exchange plans and the ACA-compliant off-exchange plans must cover. (After the brouhaha about plan cancellations, the administration gave states the option of extending the noncompliant plans for a few more years. They can be minimum essential coverage – but they don’t have essential health benefits.)

See the tip sheet for more explanation.

Explaining health care costs, spending in the first quarter

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Image via Wordle

Image via Wordle

So health spending is going up. Big time.

But health costs are still growing at historically slow rates.

And the Affordable Care Act gets credit for both – and neither.

Huh?

Spending and costs aren’t the same thing. Health care costs, including Medicare, have been rising very slowly for several years, way lower than the historical trends. (Although individually we may be paying more, especially if we get insurance at work and our employers are shifting costs to us through higher premiums deductibles and co-pays)

Health spending is what we’re utilizing. Maybe an MRI has only gone from $500 to $505. But if we’re buying 10 MRIs when last year we only bought eight, spending is increasing. Continue reading

Employers are tweaking benefits to control costs

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

shrinking-costsA new report from Milliman, the actuarial firm, shows employers’ health care costs rose only 5.4 percent since last year. The report also showed how employers are changing their employee benefit plans to control costs.

Here are a few highlights from the 2014 Milliman Medical Index (MMI) report:

  • The 5.4 percent rate of growth from last year to this year was the lowest annual change since Milliman produced its first MMI in 2002 and is down from 6.3 percent last year. The 5.4 percent is still higher than the rate of growth in the consumer price index (CPI). Continue reading

Health care industry reacting to overtesting, overtreatment

Carla K. Johnson

About Carla K. Johnson

Carla K. Johnson (@CarlaKJohnson) is a medical writer at The Associated Press and has covered health and medicine since 2001. She is a member of AHCJ's board of directors, serving as liaison to the association’s local chapters and leading the one in Chicago.

Photo: Carla K. Johnson Chicago Tribune reporter Julie Deardorff chats with health writer Evelyn Cunico at the May 12 event in Chicago.

Photo: Carla K. Johnson
Chicago Tribune reporter Julie Deardorff chats with health writer Evelyn Cunico at the May 12 event in Chicago.

The American health care system wastes an estimated $750 billion a year, according to the Institute of Medicine. At a recent AHCJ chapter event in Chicago, four panelists discussed one source of that waste: unnecessary tests and procedures.

Moderated and organized by AHCJ member Kevin B. O’Reilly, senior editor of CAP Today, the panel looked at the issue through the lenses of doctors, journalists, health system executives and academics.

Holly Humphrey, M.D., dean for medical education at the University of Chicago Pritzker School of Medicine and vice chair of the American Board of Internal Medicine Foundation’s board of trustees, discussed the foundation’s Choosing Wisely campaign. Continue reading

Use site’s data on silver plans on state, D.C. exchanges

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Want to know everything about premiums, networks, deductibles, cost-sharing and out-of-pocket limits for all 7,000-plus silver plans on exchanges in every state and Washington, D.C.? Well, now you can have it.

The Robert Wood Johnson Foundation and Breakaway Policy Strategies have created a unique dataset that you can access for free. (It can be viewed in Excel, too.) Breakaway also has done an 8-page report identifying some of the key findings in the data.

The material will let you spot national trends, see how your state is like or unlike other states, or see what variety of plans your state is offering, and what may have to change for next year. It also gives some details about what is or is not counted toward the deductible – which, as we’ve noted before, is not always straightforward.

How recent changes are leading to hidden hospital fees

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Daniel Chang

Daniel Chang wrote a piece for The Miami Herald on some of the hidden hospital fees that can take patients by surprise – and which insurers don’t necessarily cover.

These hidden fees are coming about because hospital executives have been  preparing their institutions for payment reforms  they see coming as a result of the Affordable Care Act – particularly the way the law shifts financial risk away from patients, private insurers and government payers, and to the caregivers themselves, namely hospitals, physicians and other providers.

One of the most visible ways that hospitals have been preparing for this shift is that they are buying physician practices and building new outpatient clinics and urgent care centers  to assemble teams that can practice integrated medicine and deliver care across a continuum owned and controlled by the hospital.

But as hospitals build these integrated systems and extend their geographic reach, consumers are increasingly encountering fees that are intended to support these new facilities.

Here’s what Chang learned while reporting this story.

What we know – and don’t know – about Marketplace enrollment

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

ACA-enrollmentWe posted yesterday on what we knew about enrollment as we waited for the updated HHS report – which of course then came out. … So here are a few key points:

Marketplace enrollment: It’s a bit over 8 million, as we knew. There’s no solid data on how many have paid premiums, although the insurance industry is estimating it will be about 85 percent. A small data sample – which HHS said may not be too reliable – suggested that about 87 percent of those who got subsidies were uninsured at the time they applied. But we won’t have a really good grasp on the newly insured numbers for some time, although it’s in the millions (including Medicaid and other enrollment). As we explained earlier, the numbers may fluctuate because of special enrollment (and disenrollment). Continue reading

Looking ahead to new ACA enrollment numbers

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

I keep waiting for the final official HHS report on enrollment and the state and demographic breakdowns, but since we don’t yet have it (Charles Gaba reports it should come out at 2:15 p.m. today) – let’s just recap what we do and don’t know about enrollment as of the end of April. To find out more, talk to your state insurance commissioner, exchange officials, the Medicaid office, brokers and the major insurers.

Just over 8 million in exchanges: This is the sign-up number – as critics of the law keep reminding us, not everyone has paid, or will pay. AHIP’s Karen Ignagni told me the expected rate is about 85 percent payment, 15 percent nonpayment (and no, young people are not failing to pay at way higher rates based on what we know so far). If that 15 percent figure is right, enrollment is still about 6.8 million.

Plus people will continue to go in and out of the exchanges. If you have a baby, get married or divorced, turn 65 (leaving exchange for Medicare), turn 26 (leave mom/dad’s plan for the exchange) change jobs etc etc, you can still enroll (or unenroll). The number will be in flux. There will probably be a net rise but no one is sure because it’s a new landscape.
Continue reading

Despite ‘essential’ designation, dental benefits lacking under ACA

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

State and federal policymakers should take steps to make dental benefits less costly and more widely available under the Affordable Care Act (ACA) according to a panel of experts convened by the nonprofit National Academy for State Health Policy.

While oral health advocates were heartened to see pediatric dental benefits included among the health reform law’s essential health benefits (EHB), the task of making them available on state marketplaces and getting consumers to buy them has proven to be complicated.

Dental benefits have traditionally been sold separately from other types of health insurance, and the “ACA and subsequent federal guidance treat pediatric dental benefits differently from the other EHB categories, creating unique challenges in implementing the vision of a guaranteed pediatric dental benefit,” concludes the experts’ report, released today. Continue reading