A project of the Galen Institute

Issue: "Social Impact"

Top Health Stories of the Summer

Jonathan Easley
Morning Consult
Tue, 2014-09-02
"From Halbig to Sovaldi, this summer was a busy one for health policy and politics. We’ve made it easy to catch up, collecting all of the top stories you clicked on over the past few months. Together, they tell a story about the state of healthcare in the U.S., and offer clues as to where things may be headed when Congress returns in the fall. Among them: The political battle over Obmacare has become more complicated for Republicans since the government cleaned up the Healthcare.gov mess, and with midterm elections around the corner, the focus will be on how much either party continues to attack or ignore the law. There are policy, legal and business matters to be settled as well – the employer mandate is under attack from the left and the right, the courts have been a wildcard for the health law to this point and could continue to be so, and employers and employees are finding themselves wading through the on-the-ground impacts of the law.

23 states still haven’t expanded Medicaid. Which could be next?

Jason Millman
The Washington Post
Tue, 2014-09-02
"Thursday's announcement that Pennsylvania will expand its Medicaid program brings the country one state closer to the original expansion outlined under Obamacare. But because of the Supreme Court's 2012 decision making the expansion a voluntary program, there are still 23 states that haven't expanded public health insurance to all of their low-income residents. The expansion in Pennsylvania will add about 500,000 low-income to adults to the Medicaid rolls. According to numbers from the Kaiser Family Foundation, about 281,000 of those people were falling into what's known as the "coverage gap"— people who don't qualify for Medicaid but also don't get subsidies for purchasing insurance on their own, either. About 4.5 million people across the country fall into this coverage gap, according to Kaiser."

Hispanics: A Growing Force in the New Health Economy

Sarah Haflett
The Morning Consult
Tue, 2014-09-02
"When the Affordable Care Act’s insurance exchanges reopen enrollment this fall, many companies will look to tap the growing prominence of Hispanic consumers. Healthcare companies that use technology wisely and partner with brands already familiar to Hispanics will have the advantage in reaching the nation’s fastest-growing demographic group. Although the US Hispanic pocketbook packs a punch–$1.2 trillion in purchasing power in 2013, more than any other ethnic group1 –the health industry has yet to win the Hispanic consumer and their dollar. More than 10 million Hispanics could gain health insurance coverage under the ACA through Medicaid expansion and the marketplaces, which are entering year two. Yet, Hispanics only accounted for 7.4%–about 400,000–of more than 5 million enrollees in the federal marketplaces last year.2,3 For businesses aiming to succeed in the new health economy, Hispanics represent unparalleled growth opportunities.

Will Obamacare’s Political Toxicity Hamper Future Reforms?

Ben Domenech
The Morning Consult
Tue, 2014-09-02
"The widely accepted view among policymakers in Washington, D.C. is that even if President Obama’s health care law is currently more unpopular than ever, by the time 2016 rolls around, it will be an immovable object, impossible to wholly repeal. In past columns for The Morning Consult, I have argued this is an incomplete picture of the politics of the issue, one which underestimates the Republican base’s dedication to repeal, and the necessity of Republican candidates to respond to that desire. You could assume that the continued unpopularity of Obamacare would play to Republicans’ advantage within the battle over health care policy, and that’s certainly correct at the moment. The fact that a Democratic Senator touting his support for Obamacare (albeit without naming which law he voted for) is national news is an indication of that.

Is the Republican fight against Medicaid expansion over?

Justin Green
The Examiner
Tue, 2014-09-02
"The Republican fight against Medicaid expansion is far from over, but there are fewer opponents than there used to be. The expansion of the government health insurance program was originally supposed to be mandatory under the Affordable Care Act, but the Supreme Court made it optional as part of a landmark decision on the law in June of 2012. In the wake of the decision, Republican governors flocked to announce they were declining to expand coverage. As of 2014, 19 states — 18 of which are led by Republican governors — have declined outright to expand coverage, but some former holdouts are beginning to come to terms with expansion. This week, Pennsylvania formally agreed to terms with federal regulators, raising the number of states that have expanded coverage for low-income residents under Obamacare to 27. Pennsylvania is the ninth state led by a Republican governor to expand Medicaid.:"

Narrow Networks Bill Passes Floor Vote

David Gorn, California Healthline
Fri, 2014-08-29
"The Assembly this week approved a bill to limit narrow networks in California's health plans. The legislation already passed a Senate vote and is expected to get concurrence today on the Senate floor and move to the governor's desk for final approval. SB 964 by Sen. Ed Hernandez (D-West Covina) directs the Department of Managed Health Care to develop standardized methodologies for health insurers to file required annual reports on timeliness compliance, and requires DMHC to review and post findings on those reports. It also eliminates an exemption on Medi-Cal managed care plan audits and requires DMHC to coordinate those plans' surveys, as well. "I introduced the bill in response to complaints we’ve heard about inadequate networks in the Medi-Cal program, as well as at Covered California," Hernandez said.

Cover Oregon turnaround consultant's bills grew to $600,000-plus as exchange obstacles multiplied

Nick Budnick,The Oregonian
Fri, 2014-08-29
"The price tag of the Cover Oregon health insurance exchange fiasco continues to grow. As Clyde Hamstreet, the corporate turnaround expert hired to lead Cover Oregon in April, wraps up his work he leaves behind a stabilized agency – and a hefty bill. Initially signed to a $100,000 contract, Hamstreet ended up staying longer than expected, with two associates joining him at Cover Oregon after Gov. John Kitzhaber essentially forced out three top officials there in a public display of house-cleaning. Through July, Hamstreet has billed $598,699 on an amended $750,00 contract. He hasn't submitted his August invoice. He says the price tag was driven by the exchange's increasing needs, as his firm stayed longer and did more than initially planned. "We didn't do this job to make a lot of money off the state," he said Thursday. "Our philosophy was to try and help get the boat righted and try to help clean things up and basically help the state. ...

As many as 1 in 5 exchange enrollees affected by technical problems, staff concedes

Carol Ostrom, Seattle Times
Fri, 2014-08-29
"A lack of transparency in describing and fixing technical problems became an issue in Thursday’s Washington Health Benefit Exchange Board meeting. Board member Bill Hinkle grew testy at what he said was mutual staff back-patting and excuses for the problems still plaguing thousands of accounts. “C’mon you guys, let’s quit blowing smoke here,” Hinkle said. “I’m tired of patting people on the back….We’re not doing great yet.” Board member Teresa Mosqueda pressed staff for numbers of enrollees affected by technical problems. “We really need to have the data in front of us to manage some of these issues,” she said.

Reform Update: Facing ACA mandates, insurers diversify into technology

Beth Kutscher
Modern Healthcare
Fri, 2014-08-29
"Health insurance companies, now required to spend the lion's share of premium revenue on patient care, are looking for higher investment returns elsewhere. As a result, they're increasingly putting money into technology ventures where they expect to realize higher returns. The medical-loss ratio standard under the Patient Protection and Affordable Care Act requires insurers to spend at least 80% of what they earn from premiums on patient care and related quality improvements. No more than 20% can be used for administrative, marketing and business expenses. The requirement is as high as 85% for large group plans. Tied to that, insurers are trying to maximize their investment returns while also investing in businesses that are exempt from the 80/20 rule. Technology operations check off both those boxes for them. "That's been a catalyst for a substantial amount of investment,” said Joshua Kaye, a Miami-based partner at law firm DLA Piper. “We're really seeing it on a national scale.

Beware Of Higher Charges If You Go To An Out-Of-Network Emergency Room

Michelle Andrews
Kaiser Health News
Fri, 2014-08-29
"When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network. (Plans that are grandfathered under the law don’t have to abide by these provisions.) That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect.

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