Articles on the implementation of ObamaCare.
“Since enactment of the Affordable Care Act (ACA) in 2010, much of the attention in the policy community has been on modernizing Medicare’s traditional fee-for-service (FFS) program. Through Accountable Care Organizations (ACOs), larger “bundles” of payments to fee-for-service providers for episodes of care, and tests of pay-for-performance models, the hope is that the traditional Medicare model can be remade through sheer force of bureaucratic will. The stated intent is to find a way to pay for value, not volume.
These efforts may or may not bear much fruit, but, over the longer term, it’s not likely to matter much. That’s because a more important transformation of Medicare is already well underway and is occurring despite more resistance than assistance from the program’s bureaucracy. According to the 2014 Medicare Trustees’ report, enrollment in Medicare Advantage – the private plan option in Medicare — has been surging for a decade. In 2005 there were 5.8 million Medicare beneficiaries enrolled in MA plans — 13.6 percent of total enrollment in the program. Today, there are 16.2 million beneficiaries in MA plans, or 30 percent of program enrollment. (See Table IV.C1) In addition, the Medicare drug benefit, which constitutes about 12 percent of total program spending, is delivered entirely through private plans.”
“There is nothing more time consuming and expensive for a patient than undergoing extra tests or procedures during a trip to the emergency room, doctor’s office or urgent care center.
Often a physician will know exactly what a patient’s diagnosis is but will order an x-ray, CT scan, blood work or MRI to reaffirm his clinical judgment. The common rationale is to back up his opinion in case there is a lawsuit.”
“LOS ANGELES On the heels of an advertising blitz funded by health insurance companies, California voters on Tuesday tanked a proposal to give the state’s insurance commissioner veto authority over health insurance premiums.
About 60 percent of voters cast ballots against the plan to give the elected commissioner expanded authority over small group and individual health plans.”
“When the Affordable Care Act marketplace opens on Nov. 15, consumers can expect healthcare.gov to have robust technology, amped-up functions, and a shorter application form for individual plans.
What they won’t see – and likely won’t know about – are the ongoing communication problems that many on the insurance industry say continue to plague the “back-end” transfer of consumer files between the website and insurance companies.”
“Tuesday’s re-election of Republican governors in closely contested races in Florida, Georgia, Wisconsin, Maine and Kansas dims the chances of Medicaid expansion in those states.
Advocates hoping for Democratic victories in those states were disappointed by the outcomes, but Alaska, which also has a Republican incumbent, remains in play as an independent challenger holds a narrow lead going into a count of absentee ballots.
“No one would say it was a good night for the prospects of Medicaid expansion,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.”
“The Obama administration plans to close a loophole in the Affordable Care Act that allows large companies to refuse to cover in-patient hospital stays in any of their health insurance plans, according to an official involved in the internal discussions.
The official requested anonymity until the announcement is made because “the guidance that will be issued is not finalized.””
“Healthcare stakeholders and the public likely will have to wait at least another week—if not longer—to find out whether the U.S. Supreme Court will hear King v. Burwell, a case with the potential to severely disrupt implementation of the Patient Protection and Affordable Care Act.
The justices were scheduled last Friday to discuss whether to hear the case, but on Monday morning it was announced that they took no action. Shortly after that announcement, the court’s website showed that the justices had scheduled another private discussion about the case, which is called relisting.”
“Right now, the U.S. Supreme Court is deciding whether to hear a case that could have devastating implications for Obamacare and hundreds of thousands of people currently receiving health insurance through its exchanges.
The case, King v. Burwell, is one of several challenges based on language in the Affordable Care Act that authorizes the government to offer subsidies to people who enroll in policies sold on the health exchanges. The subsidies were introduced to make health care coverage more affordable, but the lawsuits charge that the wording of the Affordable Care Act doesn’t allow for federal subsidies.”
“WASHINGTON — The Obama administration has discovered a number of defects in the online marketplace that will offer health insurance to millions of small-business employees, but federal officials said the problems could probably be fixed before the website goes live on Nov. 15.
The website, for businesses with 50 or fewer employees, was created by the Affordable Care Act and was supposed to open Oct. 1, 2013, but officials could not meet that deadline. Since then, they have been trying to build the site.”
“The Washington Examiner’s Susan Ferrechio has a possible scoop buried in her post today on Republican efforts to peal back Obamacare after the election. Speaking of Sen. John Barrasso (R-WY), Ferrechio writes:
“Barrasso said the GOP would also take up legislation to block the Obama administration from reimbursing insurers who lose money in the healthcare exchanges.””