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.)
It’s rate increase season, and as we head into the second ACA enrollment season, it’s hard to understand why some rates are going up, some down – sometimes in the same place.
Also, some of the rates we’re hearing about are proposals. Depending on how much regulatory oomph state insurance officials have, the rates may change.
This post give you some ideas on what to watch for and how to think about rate increases in individual states, and what questions to ask the health plans and the regulators in your state. Remember that even in states using the federal exchange, HealthCare.gov, state insurance officials still have a role.
The Alliance for Health Reform (an invaluable resource on this issue) recently held a briefing on rate changes. The full briefing (webcast, transcript, background materials, source list) can be found online here. A recent Health Affairs blog post by Christopher Koller and Sabrina Corlette provides another important resource.
Here are some key points outlined in these two resources: Continue reading
Health care costs lack transparency and are wildly variable, not just from region to region but sometimes from block to block within the same city.
It is a complex topic, with chargemaster prices, what insurers paid and what consumers pay (if anything). Then there are the administrative rules set by Medicare and Medicaid and the negotiated rates between insurers and providers.
It’s daunting, but Lisa Aliferis of KQED, Rebecca Plevin of SCPR and Jeanne Pinderof clearhealthcosts.com have teamed up to offer guidance for reporting on health care costs in this new AHCJ tip sheet.
Covering health care requires writing about the cost of care. Determining if costs are rising or falling and by how much is an integral part of the beat. After all, cost control is one of the primary concerns behind health care reform.
Mark Fendrick, M.D.
But A. Mark Fendrick, M.D., the director of the Center for Value-Based Insurance Design at the University of Michigan, suggests it’s time to shift the discussion from how much the United States spends on care to how well we spend money on health care. Focusing closely on costs leads health systems to use a one-size-fits-all approach to cost sharing, and requiring consumers to pay more for needed services may have a perverse effect of becoming a barrier to care, he explains. Conversely, VBID encourages a more clinically nuanced approach to financial incentives that involves setting consumers’ out-of-pocket costs for health care services and medications to motivate patients to do what research proves will help keep them healthy.
Fendrick will explain V-BID and the role it should play in the health care system during an AHCJ webcast, “How value-based insurance design breaks down barriers to care,” on Aug. 14, 1-1:30 pm ET.
V-BID seeks to align patients’ out-of-pocket costs, meaning their copayments, deductibles, and premium payments, with the value of health services, the center says. “This approach to designing benefit plans recognizes that different health services have different levels of value. By reducing barriers to high-value treatments (through lower costs to patients) and discouraging low-value treatments (through higher costs to patients), health systems that incorporate the concepts of V-BID can improve patient outcomes,” it says. Continue reading
The percent of premium dollars allocated to administrative costs and profit dropped in all markets since the introduction of the 80/20 rule. (Click to enlarge image.)
A new report on how health insurers are complying with the medical loss ratio rules shows insurers spent more on care delivery and less on profit and overhead in 2013 than they did in the previous two years.
The report, “Consumers Benefited From 80/20 Rule in 2013,” from the federal Department of Health and Human Services (HHS) shows that the percentage of consumers insured by companies that met or exceeded the requirements under the MLR rules has risen each year since the rules became effective in 2011. Tables accompanying the report offer some great story ideas for journalists who want to dig deeper into why insurers in their states would pay rebates to consumers rather than put those funds into care delivery.
Also called the 80/20 rules, the MLR regulations in the Affordable Care Act require insurers to spend a minimum of 80 percent of premium income on delivering care (and not on profit and overhead) in the small group and individual markets and at least 85 percent of premium income on care delivery in the large group market.
Under the MLR rules, if insurers fail to spend at least at these levels, they have to rebate the difference to consumers. Those rebates are due by Aug. 1.
“In the first three years of the MLR program, individual and employer plan enrollees received or will receive over $1.9 billion in refunds,” the HHS report said. Continue reading
Even for those of us who cover the Affordable Care Act (ACA) more or less full time, July 22 was a pretty zany day. Here’s a recap and some resources to help you going forward.
First an appeals court in Washington, D.C., ruled, 2-1 that people can’t continue to get subsidies in the federal exchanges – just on the state exchanges. Only it didn’t move to enforce that ruling – which would cut off millions receiving subsidies – because the three judges on that panel knew they didn’t necessarily have the last word. There are more legal fights to come in the case, known as Halbig v. Burwell. (It was v. Sebelius but the name was updated.)
Then, less than three hours later, another appeals court – also a panel of three judges – in Richmond, Va., issued the exact opposite ruling. They said, 3-0, that the subsidies in the federal exchange were fine. Well, maybe not fine – they thought the law was ambiguous. But even with the ambiguity, they said that the IRS had the right to interpret the law to allow the subsidies in the federal exchange. That case is known as King v. Burwell. (The IRS set the rules for the subsidies, which take the form of premium tax credits.)
The question in very simple terms is this: Did the ACA allow the subsidies through the federal exchanges? The plaintiffs argue no – and cite a specific section of the law that refers to subsidies for people enrolled “through an Exchange established by the State.” They say it’s clear as day – the subsidies are tied to state exchanges. The administration and its supporters say that’s far too narrow and literal an interpretation. The whole law is designed to expand coverage and the federal exchanges are meant to stand in when the states don’t stand up exchanges.
Now what? Continue reading