Tuesday, September 13, 2016

GAO: PPACA and Medicaid are Epic Failures in Guarding Taxpayer Dollars

Full story from Allison Bell over at LifeHealthPro is absolutely worth reading, hat tip to Dr. Ryan Kennedy:
Investigators got either Medicaid coverage or the ACA exchange advanced premium tax credit premium subsidy for 17 out of 18 fake people in 2015, and they lost coverage for one when the investigator representing that fake person decided not to provide a fake Social Security number over the phone.  
Investigators got coverage approval for 15 out of 15 fake people this year, but ended up having trouble making premium payments for three of the fake people.

Monday, September 12, 2016

New California Law: Forcing Insurers to Get Doctor Lists Right

This is from Kaiser Health News
... [State Senator Ed] Hernandez, who chairs the California Senate Health Committee, is author of a newly enacted state law that aims to improve provider directories, long riddled with out-of-date and inaccurate information. 
Under the law, insurance companies — and health care providers ... must comply with new requirements to keep directories updated at least every quarter. 
The law, which took effect July 1, also provides patients with some firepower to fight surprise medical bills that result from directory errors. 
The law’s reach is broad: It applies to Covered California and private market plans, as well as Medi-Cal managed care and most job-based insurance policies. 
The inaccuracy of directories, Hernandez says, “has been and … seems to continue to be a problem that needs to be rectified.” 
Several other states, from Georgia to Maryland, have passed similar legislation or are considering doing so, says Claire McAndrew, private insurance program director for Families USA, a national health care consumer advocacy group. In some states, insurance commissioners have adopted new rules through the regulatory process. 
But California’s law “is the most comprehensive,” she says. “The level of detail in California goes beyond any other state.” Federal officials also instituted a rule this year requiring directories be updated monthly for all plans sold on the 37 state marketplaces run by the federal government. 
And they set new rules for Medicare Advantage plans, requiring that the companies contact doctors every three months and update their online directories within 30 days. A recent study in the journal Health Affairs found that provider directories for some health plans sold through Covered California and in the private market are so inaccurate that they create a “disheartening” situation for consumers trying to find doctors. 
That finding was confirmed this month when the state Department of Managed Health Care (DMHC) announced that Anthem Blue Cross and Blue Shield of California — which were previously fined for inaccuracies in their Covered California provider directories — still had “disappointing” directory problems. 
“We are optimistic and hopeful that the law … will help,” says department director Shelley Rouillard. 
Among the law’s new rules:
  • Health plans must update their printed directories at least every quarter and their online directories at least every week if providers report changes.
  • Provider directories must be posted online and be available to anyone, not just enrollees. Print directories must be available upon request.
  • The directories must “prominently” display directions for consumers who want to report inaccuracies. Upon receiving complaints, plans have 30 business days to makes changes, if necessary.
  • Providers must inform plans within five business days if they are no longer accepting new patients — or, alternately, if they will start accepting them.
  • Health plans can delay payments to providers who fail to respond to attempts to verify information.
The California law also gives consumers recourse. Let’s say you use a provider directory to find a doctor but you’re billed the out-of-network price because the directory was wrong. In that case, health plans must reimburse you the amount beyond what you would have paid to see an in-network doctor.

If you find yourself in this situation, first take your complaint to your plan, advises DMHC’s Rouillard. You will have at least 180 days from the date you received the bill to file a grievance. ...

Friday, September 9, 2016

Oof, Now Even the New York Times is Saying Obamacare Looks Like Medicaid

Hardly a ringing endorsement!

From Margaret Sanger-Katz writing at the New York Times, "Think Your Obamacare Plan Will Be Like Employer Coverage? Think Again":
[S]ix years into the health law, the reality is that a typical Obamacare plan looks more like Medicaid, only with a high deductible. The typical marketplace plan covers a small number of low-cost doctors and hospitals, and offers fewer frills than employer plans. The recent high-profile exits of many of the national insurers from markets around the country will only heighten the shift. ... 
When the first Obamacare plans were released for 2014, many experts and customers were surprised at how many featured very limited numbers of doctors and hospitals.
Three years later, and the trend has only intensified. Many of the companies providing employer-based coverage, like UnitedHealth Group, Aetna and Humana, which tended to offer broad networks, have been exiting the markets. ...

Thursday, September 8, 2016

UCLA Study: The Golden State's Healthcare is 70% Socialized

This is from California Healthline:
This year, taxpayers will cover about 70 percent of what is spent on health care in California, according to a new analysis released Wednesday by the UCLA Center for Health Policy Research.
Many people assume that the U.S. health care system is primarily supported by private dollars, such as insurance premiums from employer-based coverage, said Gerald Kominski, director of the UCLA Center for Health Policy Research and the study’s lead author.
But that’s no longer the case, at least in California — mostly because of its massive expansion of Medi-Cal, the state’s version of Medicaid, he said.
“There’s this myth that we have a mostly privately funded health care system, but we’re approaching a point in which almost three quarters of this system is funded by public money,” Kominski said. “Now a question to ask ourselves is: when do we reach the tipping point and say ‘this is essentially a public system?’”
Of $367 billion estimated to be spent on health care in the state in 2016, $260 billion will be from taxpayer money, according to the research.
Nationwide, public funds paid for about 45 percent of the country’s $3 trillion in health care expenditures in 2014 through public insurance programs such as Medicaid, Medicare and programs for low-income children, according to federal data. But that estimate may be too low — it’s probably closer to 65 percent as suggested in a separate national study, according to Kominski.
In California, Medicare and Medi-Cal alone account for roughly 47 percent of health care expenditures. ...

Wednesday, September 7, 2016

How the 2016 Presidential Election Could Impact Healthcare in America

This presidential election could bring some changes to the U.S. healthcare system.  As with all candidates in recent history, both of the two major party nominees have given lip service to controlling health care spending and reducing out-of-pocket expenses. 

Clearly, the Cadillac Tax appears to be doomed as both Hillary Clinton (D) and Donald Trump (R) support its repeal.  Even President Obama and our current congress have no desire to actually unleash that tax on Americans as evidenced by its original start date in 2018 (a full eight years after Obamacare was signed into law) and the recent delay to 2020.

The chart below provides a brief overview of each candidate’s proposed healthcare solutions:

Hillary Clinton (D)
Donald Trump (R)
PPACA (Health Reform Law)
Wants to expand PPACA
Wants to repeal PPACA
Cadillac Tax
Wants to repeal it
Wants to repeal it
Prescription Drugs
Supports elimination of tax breaks drug makers receive for direct-to-consumer advertising and supports allowing consumers to buy Rx from other countries
Supports freeing-up the market in prescription drugs with a reduction in some regulation and favors allowing consumers to buy Rx from other countries
Undocumented persons’ access to taxpayer subsidized healthcare
Would allow undocumented persons’ to buy healthcare in the PPACA Exchanges
Wants potential immigrants to prove they can pay for their own healthcare
Medicare for all
Would allow persons as young as 55 to buy into Medicare coverage
Has not stated support for this concept at this time
Coverage Across State Lines
Is open to allowing the sale of insurance policies across state lines but that is not officially part of the Democratic party platform
Would allow the sale of health insurance policies across state lines for both individuals and businesses
End of Tax Deduction Discrimination against Individuals (in favor of Businesses)
Unknown, but not currently part of the Democratic party platform
Would allow individuals who buy health insurance plans to deduct those costs, a provision that is solely reserved for businesses
Consumer Driven Healthplans (HRAs and HSAs)
Supports more transparency in healthcare but not necessarily greater use of consumer driven plans
Encourages the expansion of transparency and consumerism in healthcare via greater use of HSAs and HRAs
Would further expand Medicaid by having the federal government cover 100% of a state’s cost for such expansion over the next three years
Would not expand Medicaid, but instead would block grant federal Medicaid dollars to the states to allow them to manage each of their programs and budgets as they see fit
Expansion of PPACA “Affordability” Test for Dependents
Has expressed revisiting this issue to possibility redefine employer plan “affordability” to include some form of employer contribution for an employee’s dependents

Does not support the expansion of PPACA affordability standards for employers
Expansion of PPACA “Affordability” Test for Individuals
Would increase tax subsidies by lowering the maximum percentage of income that makes persons eligible for premium subsidies to 8.5%, from the current 9.5%
Does not support the expansion of PPACA affordability standards for individuals
Premium Price Controls
Would not empower the federal government to block or modify carrier premium increases

Of course, whether these platforms are achieved once one of the candidates is in office remains to be seen. Despite similar ambitions no president from either party has achieved goal of healthcare cost containment in modern history. At least with this chart, however, you can better understand how each candidate will attempt to tackle the problem.

Monday, September 5, 2016

Insurers Likely Lost $6 Billion in 2015 Individual Health Losses; Analysis

Ouch.  This is from Allison Bell over at LifeHealthPro:
...[B]ased on a review of statutory financial statements, ...[insurers]... lost money on individual health coverage in 41 states and the District of Columbia, and that they made money in nine states. 
Issuers in Texas, the state with the worst individual health losses, lost about $717 million, the analysts estimate. The analysts did not give premium revenue figures. ...
The analysts found 2015 Supplemental Health Care Exhibit filings for 194 companies. Of those, 133 reported losing money in the individual health market. 
The figures include both Affordable Care Act public exchange plans and off-exchange plans. 
The figures do not include retroactive adjustments the companies may have to make to reflect the cash received from or paid into the ACA reinsurance, risk adjustment and risk corridors programs. 
The analysts also estimate, based on data from statutory filings, public exchange enrollment reports and state regulators, that off-exchange policies are covering 7.5 million of the people with individual health coverage, and that ACA exchange plans are covering 12.7 million of the individual health insureds. ...