The pharmaceutical industry, insurers and the Obama administration all want prescription drugs to be included in determinations about whether a certain pools of patients are riskier than others.
The determinations are important because insurers who take on riskier sets of patients are eligible to receive compensation under Obamacare. Right now, those determinations are made using just medical claims.
Drug companies and insurers generally agree that prescription drugs should be included in the risk adjustment models. They currently are not.
Obamacare to date has failed miserably relative to what was originally promised regarding how many people would get covered and the number of these who would obtain their coverage through the Obamacare exchanges.
The president’s claim that “America is on a stronger footing because of the Affordable Care Act” is dubious at best. Literally no major promise made for this law has been kept and some have been broken quite egregiously.
The Medicare Advantage Value-Based Insurance Design Model kicks off Jan. 1, 2017 and will run for five years.
Value-based insurance design, or VBID, refers to health plans that waive or lower out-of-pocket costs for healthcare and prescription drugs that are proven effective for patients with chronic health conditions.
The CMS wants feedback on ways to promote quality of care and reduce cost of care for enrollees in the Medicare Advantage program.
The justices heard oral arguments in the case just last week. Now they are asking the parties to address how employees would obtain contraceptive coverage through their employer’s insurance companies without any involvement from the employer, including notifying the government, their insurer, or third-party administrator of their objection.
The parties have the opportunity to spell out for the Supreme Court how such a system could work without controlling the Little Sisters’ and other employers’ insurance plans.
According to a Blue Cross Blue Shield Association report, people who enrolled in health insurance through the ACA appear to be sick than expected. People who enrolled in individual health insurance plans after 2014 were less healthy and used more healthcare in 2014 and 2015 than those who were already enrolled in individual plans and those who receive insurance through their employer.
The report isn’t without its shortcomings. It looked only at BCBS plans, not the entire universe of Obamacare insurers. But that’s still a sizable sample. BCBS companies participate in the exchanges more than any other insurer.
Many have blamed the increase on the Affordable Care Act, which expanded health insurance coverage to millions more Americans through Medicaid — known as Medi-Cal in California — and government-run health exchanges.
Last year, a national survey of 2,099 emergency doctors by the American College of Emergency Physicians reported that 28 percent of respondents said the volume of ER patients in their hospitals “increased greatly” since the health law took effect. And 47 percent said the volume “increased slightly.”
The Bureau of Insurance hoped to stem Community Health Options’ losses, partly by ending as many as 17,000 policies, but CMS rejected the temporary plan.
Eric Cioppa, the state’s insurance regulator, wrote in the letter to CMS, his bureau “would have acted to reduce membership, increase capital and thereby better protect the remaining (co-op) members and their health care providers from the risk presented by the type of losses experienced in 2015. Because CMS’s decision has precluded my ability to act as proposed, CMS now must share responsibility for the risk of an outcome we all very much hope to avoid.”
Along with releasing end-of-the-year 2015 enrollment data for the Affordable Care Act exchanges last Friday afternoon, the Department of Health and Human Services also released data for the 2016 open enrollment period. Just like the end-of-the year 2015 enrollment data, which I discussed on Monday, a close look at the 2016 open enrollment data reveals that the ACA is significantly underperforming initial expectations.
The big story is how little has changed from 2015 to 2016. The number of 2016 exchange enrollees is up only slightly from last year, and the make-up of the risk pool—as proxied by income and age of enrollees—is virtually identical.
The Federal government wants to leave doctors and hospitals on the hook for medical bills unpaid by the failed ObamaCare co-ops.
A top official at the Centers for Medicare and Medicaid Services told Congress that the government, not medical providers, has the first right to any remaining co-op funds. This CMS policy ignores a 1993 U.S. Supreme Court decision that says the federal government is next to last in line for payment in insurance cases, and policyholders should come first.
Twelve of the 24 co-ops funded through the ACA have failed and are going through the liquidation process. At least 800,000 people have had to find other coverage after their co-op policies were cancelled.
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Hundreds of thousands of people lose subsidies under the health law, or even their policies, when they get tangled in a web of paperwork problems involving income, citizenship and taxes. Some are dealing with serious illnesses like cancer. Advocates fear the problems, if left unresolved, could undermine the nation’s historic gains in health insurance.
Coverage disruptions due to complex paperwork requirements seem commonplace in the health law’s system of subsidized private insurance, which currently covers about 12.7 million people.
The government says about 470,000 people had coverage terminated through Sept. 30 last year because of unresolved documentation issues involving citizenship and immigration. During the same time, more than 1 million households had their financial assistance “adjusted” because of income discrepancies. Advocates say “adjusted” usually means the subsidies get eliminated.