Pacific Progressive

Why Premiums Will Change for People Who Now Have NonGroup Insurance

 Gary Claxton, Larry Levitt, Karen Pollitz and Anthony Damico

This article is from the Henry J. Kaiser Family Foundation 2/6/13

The federal government recently released draft regulations that address the benefits, market rules, and rating practices for nongroup coverage. Before reform, the nongroup market was widely acknowledged to be broken, with restricted access, limited benefits, high administrative costs, and frequent and large premium increases subject to inadequate oversight. Recent requests for large premium hikes for nongroup coverage in some states, at a time when the group market is experiencing very low increases, have revived concerns about current pricing practices and the effectiveness of regulatory oversight. The ACA seeks to address many of these issues, essentially remaking the nongroup market starting in 2014 by instituting new rules and a platform for increased transparency and price competition. Newly available premium and cost-sharing subsidies will vastly expand the number of people who will get coverage there. With so many changes and new participants, there understandably is a great deal of speculation about what the products will look like and how premiums in 2014 will compare to premiums in the nongroup market.

HHS Announces Coordinated Care Initiative

By Christian Torres

If the Department of Health and Human Services has its way, hundreds of physician practices will follow the money and take up a coordinated model of health care.

The Comprehensive Primary Care Initiative, announced Wednesday, will increase Medicare  payments to primary care providers who adopt a coordinated care model. A four-year demonstration, overseen by the Centers for Medicare and Medicaid Services, begins next year in several health care markets. Providers in HHS-supported accountable care organizations, which also promote coordinated care, will not be able to participate.

Coordinated care is based on teamwork among primary care doctors, specialists and other providers, with a particular focus on prevention and better managing chronic disease. HHS officials said that coordination yields both quality improvements and significant savings — primary goals of the 2010 health law this initiative stems from.

Richard Baron, director of the Seamless Care Models Group at the Center for Medicare and Medicaid Innovation, said the HHS initiative “recognizes the need to see changes in the primary care practice model, but that we first need to see changes in the payment model for primary care.”

CMS will select five to seven health care markets for its demonstration. According to Baron, CMS is looking for areas with multiple interested insurers, both public and private. These insurers will then help target and select about 75 practices in each market. Providers will be paid an extra $20 per month, on average, per Medicare beneficiary in the first two years; the funds will cover a little over 330,000 Medicare patients total. The money can be used at providers’ discretion to build up infrastructure for coordinated care, likely with increased staff, longer hours of access and electronic health records.

Florida CHIP Program ‘Treading Water’

Despite the tough economy, Florida’s Children’s Health Insurance Program added just 2,000 children in the year ended June 30, for a growth rate of less than 1 percent. Among school-age kids, the program added just 700 children.

Before last year, the Florida CHIP progam was growing by about 8 percent a year. It now has about 275,000 kids enrolled.

Rich Robleto, executive director of Florida Healthy Kids Corp., which runs the low-income health insurance program for children who don’t qualify for Medicaid, cites two factors. He said each month the CHIP program loses up to 8,000 children who transfer to Medicaid because their parents’ income fell; Medicaid added 98,000 children last year.

In addition, Robleto said, a new federal rule requires parents to provide proof they are United States citizens before children can be covered. The documention requirement caused about 10,000 kids to drop off CHIP, he said.

Florida has limited dollars to advertise the CHIP program, and Robleto said many families who lost health coverage during the economic downturn are not familiar with the government program. He said the program is trying to find both children who are eligible and have not been insured and children who have recently lost private coverage because their parents lost their jobs. Florida and two other states account for 40 percent of the 5 million children who are eligible for Medicaid or CHIP but not enrolled. The other states are California and Texas.

“It’s almost as if we are treading water,” he said.

More than 5 million children are enrolled in CHIP across the country.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. 

N.C. Insurer Invests $15M In Docs’ Health IT

by Christopher Weaver

Blue Cross and Blue Shield of North Carolina will announce today that the insurer will spend $15 million to arm as many as 750 physicians in the state with state-of-the-art electronic medical records.

Blue Cross, the dominant financier of the state’s health system with 54 percent of the insured on its rolls, stands to benefit if the electronic records help doctors practice a more efficient style of medicine. For instance, the computer can prompt doctors to do blood tests or other follow-ups with patients.

And the doctors, who all work for either free clinics or in independent small practices, get a free piece of technology they may not otherwise be able to afford. The 2009 stimulus bill makes as much as $44,000 available to each physician who successfully adopts electronic records, but those payments only begin to arrive after doctors make investments.

The Blue Cross money, on the other hand, is available upfront and will help physicians move faster than the stimulus funds, said the insurers chief executive, Brad Wilson, in an interview earlier this month. The move shows the urgency with which insurers seek ways to bring costs down, and the remaining barriers physicians face in making changes.

“Even with the [stimulus] incentives it’s difficult for small practices to make those upfront investments,” said Greg Griggs, the executive vice president of the North Carolina Academy of Family Physicians. To “really do it right, and use it in a meaningful manner, is still extraordinarily expensive.”

Addressing Childhood Obesity: From Public Health To Social Justice

By Jessica Marcy

Moving her hips and shaking her hands, U.S. Surgeon General Regina Benjamin danced the Cupid shuffle alongside elementary school kids to kick off the NAACP’s initiative on childhood obesity inside the Thurgood Marshall Center, where the famous civil rights lawyer stayed in Washington, D.C. while fighting for desegregation. It seemed like an appropriate backdrop to welcome NAACP’s effort to refocus discussion of childhood obesity as not strictly a public health crisis, but also a civil rights and social justice issue.

“That was fun,” Benjamin said as she took her seat. “Exercise is medicine.”

Childhood obesity, which has nearly tripled over the past three decades, impacts children from across racial groups. Yet, more than a third of black children who are obese or significantly overweight often come from communities with socio-economic conditions that hinder their ability to tackle the problem.

The NAACP held the event to release its Childhood Obesity Advocacy Manual, which they developed with CommonHealth Action, to provide tools to help local members advocate for policy changes at the local, state and federal level.

The NAACP, which also has a major initiative on HIV, hopes to use its influence as the nation’s oldest and largest civil rights organization with nearly 1,200 active local affiliates and 10,000 health educators to implement the childhood obesity plan over a two-year period. “That’s where the power of the NAACP comes in,” said Benjamin Jealous, the group’s president and CEO. “We have a volunteer network that no other organization in the black community has.”

No-Cost Birth Control Under Attack for Some Students

by Emily Crockett 

This material was created by Campus Progress.

For students at Catholic universities nationwide, the right to no-cost birth control is under attack.

The Department of Health and Human Services announced last monththat, starting next year, all new health insurance plans will be required to cover contraception and preventative women’s health care—without charging co-pays.

The announcement was a huge victory for public health and women’s rights, and has been received as a tremendously popular policy. According to a recent Reuters-National Public Radio poll, 77 percent of Americans want private insurance to cover birth control.

But a growing number of conservative groups are pushing to expand the Department of Health and Human Services’ “conscience clause,” which provides an exemption to the contraception coverage mandate for “religious employers.”

A religious employer is defined as one that:

(1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization.

Health Care Reform Benefits Causing Headache for College Republicans

This material was created by Campus Progress.

by Brian Stewart

A senior member of the College Republicans group, which sponsors chapters on campuses nationwide, said the Affordable Care Act—which has significantly helped college students—has become a tricky issue for the group.

Recent data indicates that nearly 1 million more young Americans had health insurance coverage this year than in 2009 [PDF]; officials say the increase is thanks to a provision in the act that permits students to remain on their parents’ plan until 26. That policy took effect in September 2010.

“That’s an issue that on college campuses we battle every day as College Republicans and that we get questions about,” the group’s National Co-Chairwoman Alex Smith said during a Google+ “hangout” sponsored by Fox News, according to Politico. “The candidate that will speak to specifics like that issue and others is going to be the candidate that will eventually prevail among the youth vote.”

Health care is the “No. 1” issue among college students right now, Rod Snyder, the president of Young Democrats of America, told Campus Progress.

“It’s hard to say that the people of any age group will cast their vote based on any issue, but of all the things I’d put it at the top of the list for sure,” he said. “If I were sitting in the College Republicans’ shoes, it’s a very difficult argument to make when you have all the Republican leaders in Congress and in general opposing a bill ... that has had this huge of an impact on the millennial generation. That’s a very tough position to be in, to try and defend that.”

Smith refused to elaborate on her remarks when contacted by Politico, despite an unrelated emailed statement that attacked President Obama’s economic plans, claiming young people are frustrated over the president’s “failure to create jobs that would allow us to purchase our own health coverage.”

Recently, Secretary of Health Kathleen Sebelius lauded the policy’s benefit for young Americans.

“This doesn’t just give young adults and their families peace of mind, it also gives them freedom,” Sebelius said. “It means that as they begin their careers they will be able to make career choices based on what they want to do, not on where they can get health insurance.”

Brian Stewart is a journalism network associate at Campus Progress.

Related Stories

• Officials Laud Expanded Health Insurance Coverage for Youth Under Affordable Care Act
• More Young Americans Now Have Insurance Post-Health Care Reform
• Free Birth Control Under Affordable Care Act
• Silver Screens & Cigarettes
• Kansas Closes All But One Abortion Provider

 

Federal Employee Health Premiums Announced

By Shefali S. Kulkarni

As health plan enrollment season gears up, premiums for federal employees and retirees will increase on average about 3.8 percent – less than half of the increase they saw last year.

Last year, plan costs increased an average of 7.3 percent. But an official at the federal Office of Personnel Management (OPM) said today that “lower than anticipated utilization of health care services by our enrollees and, to a lesser extent, moderation in prescription drug costs due primarily to brand name drugs coming off patent and thus greater use of generic drugs” kept health costs down and allowed the rise in premiums to moderate.

The federal government is the largest employer in the country. More than 8 million federal workers, retirees and dependents are enrolled in the Federal Employee Health Benefits program (FEHB). The plan next year will offer 206 health plan options.

According to information released by OPM today, the new rates mean that individual coverage will increase, on average, $2.32 per bi-weekly paycheck and family coverage $6.18.  However, in the most popular plan, Blue Cross and Blue Shield standard, the individual coverage premium will fall on average $0.81 and family coverage will be down $0.72 per pay period.

No significant changes in benefits were announced, but the federal government share of premiums will increase by 4 percent.

Open season, or the period when federal workers can change their coverage or sign up for new coverage, runs from Nov. 14 until Dec. 12.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

 

 

How Does This Create Jobs - 'Women Will Die Act'

Today, the House passed restrictions on abortion coverage under the Affordable Care Act.  HR 430  which brought HR 358 'Protect Life Act' to a vote, restricts the ability of women to buy insurance coverage which includes paying for abortions - if full reproductive health care for women is covered, the plan can't be included in the federal health insurance exchanges established under the Affordable Care Act.  The bill  has been called the 'Women Will Die Act' because there are loopholes that allow health care providers who object to abortion prevent transferring a woman to a medical facility that will do the procedure.  If a woman comes bleeding out from an incomplete miscarriage, she can be left to die instead of being treated.

Can anyone tell me how this creates jobs?  Why is the House, with 20 days left on the legislative calendar, moving into women's uteruses instead of moving on jobs?  

The bill will most likely die in the Senate but a significant amount of time was wasted on this bill that could be used to create jobs for Americans to get us back to work.

Who Voted for Not Creating Jobs -  Call them up and ask them how this bill creates jobs.

Dana Rohrbacher

Ed Royce

John Campbell

Gary Miller

Darrell Issa

Ken Calvert

Keeping Ballooning Tricare Costs Down Will Require More Robust Proposals - Recent Administration Plans Don’t Go Far Enough

This material was published by the Center for American Progress.

By Lawrence J. Korb

President Barack Obama’s September 19 plan to reduce the cost of some medical benefits enjoyed by military retirees and their dependents is a modest step in the right direction in programs that former Secretary of Defense Robert Gates said are simply unsustainable. But the president does not go far enough to deal with the exploding costs of health care for these people.

The administration is correct to propose an annual fee of $200 a year for the Tricare for Life Program—a program for military retirees over 65 who are eligible for Medicare—beginning in 2013. But a fee of less than $20 a month is far too low, and even if the fees increase gradually over the next decade they will save less than $700 million a year in a program that already costs approximately $11 billion, is projected to grow to at least $15 billion by 2015, and accounts for almost 50 percent of the increase in military health care costs since fiscal year 2000.

Similarly, the administration is correct to attempt to raise the co-payments that military dependents and retirees pay for brand and retail prescription drugs to make these costs closer to federal employee benefits. But this step will save only $2.1 billion a year.

These two proposals are a drop in the bucket. If they’re enacted by Congress, they will save less than $3 billion a year in the military health system, which already costs $52.5 billion, or about 10 percent of the base defense budget, and has more than doubled over the last decade.

Nearly 1 Million Young Adults Get Insurance Under Health Law

By Phil Galewitz

Nearly 1 million young adults have gained health coverage this year following the passage of the health overhaul law, which lets them stay on their parents’ insurance up to age 26, according to a federal report released today.

The report’s findings show the number of people getting coverage is running ahead of the administration’s estimate of how many young adults would become insured this year under the law. The Department of Health and Human Services had predicted 1.2 million adults age 18 to 26 would elect to stay on their parents’ policies for all of 2011. The numbers released today, which come from a household survey, are for the first three months of the year.

“This is a reminder the difference the Affordable Care Act is making in the lives of Americans,” said Kathleen Sebelius, Health and Human Services secretary. She said the provision gives young Americans the freedom to work where they want rather than taking a job merely for the health coverage. “Where would we be if the inventors of Facebook had taken a desk job just to get health insurance,” she said.

The report by the Centers for Disease Control and Prevention said the number of uninsured people aged 19 to 25 decreased from 10 million in the first quarter of 2010 to 9.1 million this year. Overall, the percentage of young adults without coverage fell from nearly 34 percent to 30.4 percent.

More Young Americans Now Have Insurance Post-Health Care Reform

This material was created by Campus Progress.

 by Brian Stewart

Nearly half a million more young Americans had health insurance in 2010 than the previous year—a spike that health officials said “almost certainly” is a benefit of health care reform.

According to new data released by the U.S. Census Bureau on Tuesday, the increase brings the total number of insured Americans aged 18-24 to 72.8 percent, up from 70.7 percent in 2009. Those between 18 and 34 are typically the least likely to have insurance.

“Young people sometimes think they’re invincible, but it’s important for everyone to have insurance,” Secretary of Health and Human Services Kathleen Sebelius said in a statement. “One car accident, one slip in a shower, or one sudden illness can result in months or even years of health care bills that can bankrupt the average family if that son or daughter is uninsured.”

Sebelius said she expects more young Americans will continue to gain insurance coverage as the policy allowing those under 26 to remain on their parents’ plan continues to be implemented. The policy took effect on Sept. 23, 2010.

A policy brief [PDF] on the statistics says: “Given that the fraction with health coverage was stable or decreasing in other groups, the two percentage point increase in share with health coverage among 18-24 year olds almost certainly reflects the effects of the extension of dependent coverage to age 26.”

Brian Stewart is a journalism network associate at Campus Progress.

 

Stressed and Strapped: Caregivers for Friends, Relatives Suffer Emotional and Financial Strain

From UCLA Center for Health Policy Research

Family members or friends caring for aging or disabled individuals in California are under both financial and emotional strain and are likely to face even greater burdens, given recent cuts in state support for programs and services that support in-home care, write the authors of a new policy brief by the UCLA Center for Health Policy Research. 

The study looked at California's estimated 6 million–plus informal caregivers of all ages and found higher levels of serious psychological distress and negative health behaviors, such as smoking, compared with the general population. Of particular concern are an estimated 2.6 million caregivers between the ages of 45 and 64 who may be setting themselves up for an unhealthy future due to higher rates of poor health behaviors, compared with both non-caregivers in the same age range and older caregivers. 

"This is the 'sandwich generation,' the group of people struggling to meet the needs of both growing children and aging parents, often alone and while holding down full-time jobs," said Geoffrey Hoffman, the brief's lead author. "Caregivers need help, especially as baby boomers age and place even greater strains on their and their families' abilities to cope." 

Using data from the 2009 California Health Interview Survey (CHIS), the authors found that California caregivers provide an average of 20 hours of care per week for a friend or relative who can no longer do certain things for themselves, such as bathing, shopping, managing medications or paying bills. 

In Pennsylvania, It May Really Pay To Be On Medicaid

By Phil Galewitz

Pennsylvania is considering paying Medicaid recipients – in some cases as much as $200 – as an incentive to visit higher quality and lower cost hospitals and doctors.

Experts say the strategy has never been tried by other states.

Gary Alexander, the state’s Medicaid director, said his agency hopes to launch the plan by early next year in an effort to help control rising expenses in the $30 billion program.

“We are looking at a model to save hundreds of millions of dollars by steering Medicaid beneficiaries to the most cost effective settings,” Alexander told about 300 health insurance executives last week at a meeting in Washington. “To reward beneficiaries we would give them some incentive… so if the state saves $1,000 on a medical procedure we may give the beneficiary $100 or $200 as a reward.”

After his talk at a conference sponsored by the industry group America’s Health Insurance Plans, Alexander told KHN that his incentive plan would initially be targeted to the nearly 1 million Medicaid recipients still in the traditional fee-for-service Medicaid program. Later, he said, it could be expanded to the more than 1.2 million in private Medicaid managed care plans.

Alexander said he does not believe the state would need to get approval from the federal government for the incentive program, although other Medicaid officials disagree.

Report: Savings of $125B Possible for Coordinating Care of Dual Eligible

By Marilyn Werber Serafini

The federal government could save $125 billion over ten years by requiring all people who get both Medicare and Medicaid – dual eligibles – to enroll in team-based coordinated care programs, according to a report written by Emory University’s Kenneth Thorpe and funded by America’s Health Insurance Plans. States could save $34 billion, and the savings would be less at both the federal and state level if dual eligibles were allowed to opt out, Thorpe wrote.

The report comes as the deficit reduction supercommittee contemplates how to save more than $1 trillion. Health care interests, fretting over the prospect of big cuts, are beginning to point members of the committee toward proposals that would save money by creating efficiencies.

This proposal also would improve the quality of care, Thorpe writes. As of 2010, more than 9 million people were eligible for both programs, yet fewer than 2 percent were in coordinated care programs that managed all of their Medicare and Medicaid benefits.