Articles on the implementation of ObamaCare.

“If you are looking for information on how Americans are engaging with the Affordable Care Act, the Census Bureau’s recently released latest annual estimates of health insurance coverage is probably not the place to look—at least for now.
The Census Bureau, which derives its information on healthcare from the Annual Social and Economic Supplement—the same survey where it asks how many toilets, computers, microwaves, etc., people have in their homes—does provide some useful insights.
It catalogues the demographic characteristics of the population based on participation in different types of health insurance coverage—government health care programs, private employer and individual plans, and the uninsured. It tells us young adults make up a disproportionate share of the uninsured and provides useful information on the relative availability of employer-sponsored coverage by industry and firm size.
But its hard numbers on enrollment and enrollment trends are not reliable for drawing “big picture” conclusions, especially regarding the ACA. Indeed, that unreliability is why this year the Census Bureau started using a new set of health coverage questions in the ASEC.”

“The uninsured rate for kids under age 18 hasn’t budged under the health law, according to a new study, even though they’re subject to the law’s requirement to have insurance just as their parents and older siblings are. Many of those children are likely eligible for coverage under Medicaid or the Children’s Health Insurance Program.
The Urban Institute’s health reform monitoring survey analyzed data on approximately 2,500 children, comparing the uninsured rate in June 2014 with the previous year, before the health insurance marketplaces opened and the individual mandate took effect. It found that rates remained statistically unchanged at just over 7 percent for both time periods.”

“Since the Affordable Care Act’s (ACA) passage, a number of lawsuits have been filed challenging various provisions of the law. The Supreme Court has decided cases about the constitutionality of the ACA’s individual mandate and Medicaid expansion as well as the applicability of the contraceptive coverage requirement to closely held for-profit corporations with religious objections. In addition, several cases challenging the availability of premium subsidies in the Federally-Facilitated Marketplace (FFM) are currently progressing through the federal courts. All of this litigation has altered, or has the potential to alter, the way in which the ACA is implemented and consequently could affect the achievement of the law’s policy goals. This issue brief examines the federal courts’ role to date in interpreting and affecting implementation of the ACA, with a focus on the provisions that seek to expand access to affordable coverage.
Court decisions about how to interpret the ACA will continue to affect the number of people who ultimately obtain affordable coverage. At present, access to Medicaid up to 138% FPL is dependent upon where people live because the Supreme Court held that implementation of the ACA’s Medicaid expansion is effectively a state option. This has resulted in a coverage gap for just over 4.5 million people with incomes too high to qualify for Medicaid but too low to qualify for Marketplace subsidies in the states that have not implemented the ACA’s Medicaid expansion to date.”

“Congress’ investigative arm said Tuesday (Sept. 16) that healthcare.gov continues to face security weaknesses, leaving the site subject to “increased and unnecessary” risk of unauthorized access, disclosure or modification of the information collected and maintained. CMS pledged to implement some of the fixes proposed by the Government Accountability Office, but GOP lawmakers used the opportunity to again blast the administration’s handling of Obamacare.
GAO recommended six ways CMS could put in place an effective information security program, and another 22 technical recommendations that could improve the effectiveness of information security controls.”

“Vermont Gov. Peter Shumlin (D) said Tuesday (Sept. 16) that the state has shut down its exchange website as it scrambles to finish operational and other improvements by Nov. 15, but the state expects the site to be “restored to full, improved operation before the start of open enrollment.”
The state made the decision to shut down the site after consulting with CMS, Shumlin said in a statement. The state also announced a number of management changes that will remove oversight of the exchange from the Department of Vermont Health Access and install Lawrence Miller, a senior advisor to the governor, as the person responsible for operational leadership of Vermont Health Connect. The Department of Vermont Health Access oversees the state’s Medicaid program.
“As all Vermonters know, we’ve had disappointment after disappointment with the Vermont Health Connect website,” Shumlin said. “I have been very frustrated that the website remains incomplete. Bringing down the site now to make improvements with our new partner Optum is the best choice to deliver a well-functioning, secure website for customers by the open enrollment period that begins Nov. 15.””

“Morning Consult’s healthcare poll finds that while a majority of voters (54%) are concerned about security breaches in the health exchange websites, 52% currently believe that the information on the exchange websites is secure. Further, a plurality of voters would choose to sign up for health insurance online over a paper application or over the phone.
This poll was conducted from September 12-13, 2014, among a national sample of 2,188 registered voters. The margin of error is plus or minus 2.1 percentage points. You can see the full results here (http://bit.ly/1BMkPRm).
A majority of voters (54%) are concerned about security breaches in the health exchange websites— Interestingly, a majority of both voters who approve of President Obama and those who disapprove of the President indicate they are concerned about security breaches in the exchange websites.”

“Federal health officials said Monday that more than 100,000 immigrants who bought health-care plans through the federal insurance exchange will have their coverage cut off at the end of the month, because they failed to provide proof by the Sept. 5 deadline that their citizenship or immigration status makes them eligible for insurance on the marketplace.
Those individuals can still send in the needed information to the federal exchange and if they are found eligible, they will be able to regain coverage, officials said. They will be considered under a special category reserved for people who have experienced a major life change, such as having a baby or getting divorced or losing a job with health insurance.”

“The Obama administration bragged about its enrollment numbers in the compulsory ObamaCare system, but the lack of eligibility-confirmation systems in the exchanges may take a big bite out of those numbers shortly. Just how big a bite is anyone’s guess, however, with warnings to multiple groups that either their coverage or their subsidies may stop at any time. Last night, HHS warned that 115,000 people currently covered by ObamaCare might lose their insurance thanks to immigration issues:”

“This week exchangers could get data on enrollment in the small business exchanges operated by the federal government as Mayra Alvarez, director of CCIIO’s State Exchange Group, will testify at a House Small Business Committee hearing Thursday on SHOP exchange implementation. CMS Administrator Marilyn Tavenner will also return to the House to face the Oversight Committee on Thursday on healthcare.gov security concerns, one day after the Government Accountability Office’s planned Sept. 17 release of a report on that controversial subject.
Academics and researchers are also diving into new data out Tuesday (Sept. 16) from the Centers for Disease Control and Prevention and the U.S. Census Bureau on the number of uninsured. The CDC’s early release of data from the National Health Interview Survey found that the uninsured rate for adults ages 18 to 64 had dipped from 20.4 percent in 2013 to 18.4 percent in the first three months of 2014. The survey does not account for the late surge of enrollments toward the end of the first exchanges open enrollment period, however it is the first official government report to document the reduction in uninsured following the ACA’s coverage expansions.”

“House Ways & Means health subcommittee chair Kevin Brady (R-TX) questions HHS’ authority to settle hospitals’ appeals of denied inpatient claims and is urging HHS Secretary Sylvia Burwell to retract what he views as an “ill thought” settlement process. Brady wants Burwell to work with lawmakers to come up with a different “fair, transparent and conclusive settlement process.”
Brady wrote to Burwell Tuesday (Sept. 16) that he is dismayed by HHS’ reluctance to work with the committee on an equitable settlement process that is fully legal, adding that the “lack of engagement makes it challenging for the Congress to solve the current appeals problems and prevent similar problems in the future.”
CMS announced late last month (Aug. 29) that it will pay hospitals 68 percent of denied inpatient status claims in the appeals queue if hospitals take them out of the backlogged appeals process. The agency has been encouraging hospitals to take advantage of the settlement to “alleviate the burden of Medicare appeals on both the hospital and Medicare systems,” according to the CMS website.
Hospitals should decide whether to participate by the end of October, and CMS in a Frequently Asked Questions document released Sept. 9 says that four hospitals have already stepped forward to take the settlement offer. The document also states that this is a one-time offer from CMS.”