Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.
“Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.
“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.”
Timothy Jost is pretty sure the whole thing was a mistake.
“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said.”
“During the Patient Protection and Affordable Care Act’s first period of open enrollment October 2013 – March 2014, an estimated fourteen million people enrolled for health coverage through the new private insurance Marketplaces (8 million) and through Medicaid (6 million). To facilitate this substantial volume of enrollment and enrollment-related activities, approximately 4,400 Marketplace Assister Programs employing more than 28,000 full time-equivalent staff and volunteers served consumers nationwide. All Assister Programs were expected to help consumers understand their coverage options, apply for financial assistance, and enroll (see Appendix 1). Additional functions undertaken by many assisters included outreach and education; help with post-enrollment questions and problems; assistance with appeals of eligibility determinations; and help applying for other public benefits and services.
The emergence of Marketplace Assister Programs around the country is a significant health policy innovation. The majority of programs that were operational in 2013-14 needed to organize, launch and scale up quickly to be ready for the ACA’s first open enrollment period. Because so many programs were new or substantially expanded their scope during this first year, this period was also characterized by both the need and opportunity for widespread “learning by doing.” Several surveys conducted during or just at the close of 2013-14 Open Enrollment have already begun to assemble valuable data about: consumers’ experiences with assisters; assisters’ self-reported experiences; and best practices and lessons emerging from specific states or assister-related initiatives.1”
“Former HHS insurance oversight chief Jay Angoff has filed a lawsuit against the department for not making 2015 rate filings public, arguing the administration is not abiding by its own regulations on disclosing the information.
Responding to the lawsuit, an HHS official said the agency will publish the rate information prior to the beginning of open enrollment. HHS Spokesperson Ben Wakana told Inside Health Policy late Wednesday (Oct. 1): “We are readying the rate change information. The department is committed to providing consumers accurate information so they can make informed decisions, and therefore, before the beginning of Open Enrollment, the agency will publish final insurance rates for all 50 states.””
“The second Obamacare enrollment season could go negative — but not because of the health care law’s critics.
Obama administration allies are weighing a focus on the loathsome individual mandate and the penalties that millions of Americans could face if they don’t get covered. It would be a calculated approach to prompt sign-ups, a task that the law’s supporters expect to be more difficult, or at least more complex, than in its coverage’s inaugural year.
There are several challenges: The 2015 enrollment period is shorter, the most motivated Americans are probably already enrolled and the law is still politically unpopular. That means that even if HealthCare.gov works well — and it couldn’t be worse than last October’s meltdown — proponents are confronting a tough messaging landscape.”
“Consumers searching this fall for the best doctor covered by their new public or private insurance plan won’t get very far on a federal database designed to rate physician quality.
The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It’s so limited, health care experts say, as to be useless to many consumers.
This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament.”
“New polling data released from Independent Women’s Voice, conducted by Public Opinion Strategies among 1,000 likely voters in 43 congressional swing districts, is the most comprehensive survey yet on the likely electoral impact of the Affordable Care Act in swing states heading into the November elections.
If the elections were held today, the survey shows that Republican congressional candidates have a built-in advantage (42% – 36%) on the ballot test. Most prevalent in districts that lean Republication (43% – 33%), the GOP lead extends into pure toss-up seats (42% – 35%), and nearly disappears in districts that lean Democrat (40% – 39%).
Voters in key congressional districts are clear in their opposition to the Affordable Care Act. Disapproval of the law remains high with majority (54% – 43%) of voters in swing districts disapproving of the federal health care takeover. Strong opposition (45%) outnumbers strong support (25%) by nearly 2 to 1.”
“Finding a doctor who takes Obamacare coverage could be just as frustrating for Californians in 2015 as the health-law expansion enters its second year..
The state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state’s insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans.”
“Three Blue Cross Blue Shield plans operated by Health Care Service Corporation have decided to discontinue their “transitional” non-ACA compliant plans at the end of this year and cancellation notices will be sent to affected policyholders “shortly,” a company spokesperson tells Inside Health Policy. HCSC says the decision was made to help keep premiums for ACA plans affordable, because moving those enrollees into compliant plans will result in a more balanced mix of individuals.
Transitional plans that were on the market this year from Blue Cross Blue Shield of Texas, Blue Cross Blue Shield of New Mexico and Blue Cross Blue Shield of Oklahoma will be discontinued effective Jan. 1. One source tracking state developments said the Blues appear to be discontinuing the plans on its own volition. The Blues participated aggressively in the exchanges in the first year while many other carriers remained cautious about entering the new markets, though that is beginning to change for 2015. All of the aforementioned states are using the federal exchange for 2015 open enrollment for individual plans.”
“CMS on Tuesday goes live with a website that discloses what drug and device companies pay physicians, and the doctor lobby already is warning reporters not to misuse the data. Also this week, America’s Health Insurance Plans holds three conferences covering key health care issues, and drug-pricing policies are a hot topic with events on protected drug classes; insurance designs that encourage patients to use specialty medicines; and a briefing on the cost and value of new drugs.
The American Medical Association sent reporters a guide for appropriately handling data from the Open Payments website, which Congress created under the Physician Payments Sunshine Act. The law requires makers of drugs, devices and medical supplies to report financial relationships with physicians and teaching hospitals, and AMA worries that the public will misconstrue those relationships.
“Publicly reporting industry payments to individual physicians can imply, wrongly, that such payments are always inappropriate,” AMA warned reporters on Monday.”
“The Affordable Care Act changed the rules on how health insurance plans dealt with pre-existing conditions, outlawing the practice of turning away patients with expensive conditions or charging them a drastically higher cost for coverage. But an editorial alleges some health insurance companies operating on the new marketplaces created by Obamacare may have found a loophole that allows them to discourage sick patients from enrolling in a specific plan.
The change has to do with how drugs are categorized in health systems. From the editorial published online at the American Journal of Managed Care:
“For many years, most insurers had formularies that consisted of only three tiers: Tier 1 was for generic drugs (lowest copay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest copay). Generic drugs were automatically placed in Tier 1, thereby ensuring that patients had access to medically appropriate therapies at the lowest possible cost. In these three-tier plans, all generic drugs were de facto “preferred.” Now, however, a number of insurers have split their all-generics tier into a bottom tier consisting of “preferred” generics, and a second tier consisting of “non-preferred” generics, paralleling the similar split that one typically finds with branded products. Copays for generic drugs in the “non-preferred” tier are characteristically much higher than those for drugs in the first tier.””