Tuesday Short Cuts

This issue brief reflects lessons learned from how consumers handled the new intersections between health coverage and the tax filing process in 2015. Drawing on public data as well as Enroll America’s private survey research and outreach efforts, this issue brief examines the policy framework underpinning the linkages between taxes and health coverage, messaging considerations and opportunities, and effective partnerships to maximize enrollment. Based on this analysis, the report concludes with recommendations for policymakers and other enrollment stakeholders about how to improve the consumer experience.

Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the Affordable Care Act, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with skimpy benefit packages and high deductibles. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, indicate that the law’s tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes. At higher incomes, the phase-out of the subsidies means that adults in marketplace plans have higher premium costs than those in employer plans. Overall, larger shares of adults in marketplace plans reported deductibles of $1,000 or more, compared with those in employer plans, though these differences were narrower among low- and moderate-income adults.

The Affordable Care Act (ACA)—aka Obamacare—has been on the books for almost six years now. After its famously rocky start just two years ago this week, the ACA has become a rather remarkable success. It has reduced the ranks of the uninsured by 15.8 million since 2013. Hospital expenditures for uncompensated care have plummeted in states that embraced the ACA’s Medicaid expansion. The new law is costing the federal government markedly less than was originally projected. From a patient perspective, average premiums and premium growth are proving manageable on the new marketplaces. American medical care is better and safer than it’s ever been, in part due to incentives enacted under the ACA.

Houston workers who checked the fine print said they weren't sure whether they were joining an employee wellness program or a marketing scheme.

Last fall the city of Houston required employees to tell an online wellness company about their disease history, drug and seat belt use, blood pressure and other delicate information.

The company, hired to improve worker health and lower medical costs, could pass the data to "third party vendors acting on our behalf," according to an authorization form. The information might be posted in areas "that are reviewable to the public." It might also be "subject to re-disclosure" and "no longer protected by privacy law."

Charles Gaba and I have at different times both taken a shot at estimating how many of the private plan buyers in the ACA Marketplace would have been eligible for Medicaid had their states not refused to implement the ACA Medicaid expansion. In 2015, slightly more than half of Marketplace customers were in states that had refused the expansion.

Our estimates were based on HHS's March 2015 report of the percentage of healthcare.gov buyers whose incomes were between 100% and 150% of the Federal Poverty Level (FPL). That's a frustratingly blurry frame, since it includes both buyers who would and would not have been eligible for Medicaid in "nonexpansion" states. Buyers up to 138% FPL would have been eligible for Medicaid (as they are in "expansion" states).

Now, the Commonwealth Fund has added an  equivocal hint. I'll get to that in a minute. First, the current estimates.

Davis says there are two main aspects of “reform”. One is shifting the non-governmental half of total health care expenditures from individuals and private insurance to the taxpayers. That requires raising over $2 billion a year in some combination of new taxes. That politically impossible “reform” defeated Shumlin’s grand single  payer plan. 

The other main aspect of “reform”, he says, is “cost containment”, something that Shumlin has declared every year since he began his crusade. The goal of “cost containment” is said to be holding health expenditure increases to 3.5% a year.

The Washington Health Benefit Exchange today announced the selection of nine organizations to provide in-person assistance to Washington residents as part of theWashington Healthplanfinder customer support network.

The organizations, which include public health agencies, regional health networks and other community organizations, were chosen to help residents enroll in health insurance for the next open enrollment period, which runs from Nov. 1 through Jan. 31, 2016.

On September 25, 2015, the Centers for Medicare & Medicaid Services (CMS) awarded $110 million to 17 national, regional, or state hospital associations and health system organizations to serve as the second round of Hospital Engagement Networks. The period of performance for this second round of Hospital Engagement Networks is one year and begins in September 2015. The contracts are part of the Partnership for Patients, a nationwide public-private collaboration to keep patients from being harmed while in the hospital and heal without complication once they are discharged.  

Annual premiums for work-based coverage rose only 4% in 2015, according to the 2015 Kaiser Family Foundation/Health Research & Educational Trust survey, released Tuesday. Since 2005, premiums have grown an average of only 5% each year, compared to an 11% annual rate between 1999 and 2005.

But consumers are still shelling out a lot more than they did only a few years ago.

Hawaii’s first draft of an Affordable Care Act waiver proposal is the first of its kind in the nation.

The state is seeking public input on a waiver to harmonize its relatively progressive Prepaid Health Care Act, which passed in 1974, with the federal health care law.

The Affordable Care Act allows states some flexibility through Section 1332 “state innovation” waivers to modify coverage rules. Such waivers must keep essential mandates of the federal law and not create additional cost to the federal government.

Hawaii Health Information Corp. President and CEO Pete Sybinksy says the Affordable Care Act is "doing the right things, bringing 9 million people into coverage nationally.”

So, health care co-cops. The idea was that the administration would provide the seed capital for nonprofit insurers that would provide an alternative to traditional insurers on the exchange.  A sort of “non-public option,” if you will. This August, Robert Pear of the New York Times reported that “most of the insurance co-ops enrolled fewer people than they had predicted, and that 22 of the 23 co-ops lost money last year.” Three have already announced that they were going out of business, and recently they were joined by Health Republic of New York State, which covers more than 200,000 people through its individual and small group policies.

NOTE: As I noted when I wrote about Health Republic going belly-up last week, while 4 of the Co-Ops have indeed failed and 17 others aren't doing very well, the other 2 appear to be doing just fine for now (and at least one has expanded into a second state).

Thousands of Minnesotans who buy health insurance on their own are bracing for final word on whether their premiums will spike next year.

On Thursday, the Minnesota Department of Commerce is scheduled to release 2016 rates for shoppers who buy individual policies.

Four insurers that collectively cover most people in the market are seeking average increases of more than 20 percent each, including a proposed jump of more than 50 percent for about 179,000 people with coverage from Eagan-based Blue Cross and Blue Shield of Minnesota — the state’s largest health insurer.

NOTE: My own analysis from back in July has Minnesota looking at a weighted average requested hike of around 37%. We'll have to see what they announce as the approved hikes on Thursday...

Critics of Medicaid expansion in Virginia who reference Kentucky’s experience with federal health care reform should beware: Our success undercuts your whole opposition.

Having proved from the beginning that health care reform is both the right thing and the smart thing do, Kentucky has become the poster child for why states should expand Medicaid.

The core tenet of health care reform is helping families and saving lives. Not vague political theory, but helping people. That’s what we’re doing in Kentucky. It’s a Christian thing.

Kentuckians’ collective health has long been among the worst in the nation, ranking at the bottom in almost every health category. That’s had a negative impact on our quality of life, workforce, economy and state government finances.

Poor access to care is partly to blame. Back in 2013, we had about 640,000 people without health insurance.