Andy Slavitt, head of the Centers for Medicare & Medicaid Services, spoke at the J.P. Morgan health conference in San Francisco, using the opportunity to announce new initiatives, including responding to the failure of ObamaCare’s exchanges. Although sugar-coating his diagnosis, Mr. Slavitt clearly knows exchanges are in trouble.
Mr. Slavitt proposes two solutions to force more people into the exchanges. First, he will tighten up the open season for enrollment. More promising, and necessary, is a new look at risk adjustment. Slavitt promises more announcements on managing ObamaCare’s risk pool over the next few weeks.
Better risk adjustment is critical, but administrative adjustments alone will not fix the exchanges.
A new survey from payroll services giant ADP reveals that about 40% of mid-sized and large companies that are offering health coverage to workers aren’t familiar with two new ObamaCare-related forms that must be filed with the Internal Revenue Service starting this tax season.
The forms — the 1094-C and the 1095-C — are designed to track compliance with the ObamaCare rule that mid- to large-sized employers offer affordable health insurance to workers or face a fine.
The ObamaCare “risk adjustment” program was designed to support health plans with lots of sick, expensive customers by giving them money from plans with healthier customers. The goal is to help keep insurance markets stable by sharing the “risk” of sicker people and removing any incentive for plans to avoid individuals who need more medical care. Such stability is likely to encourage competition and keep overall prices lower for consumers, while its absence can undermine both and limit coverage choices—the basic principles of the law.
Yet the way the Obama administration has carried out this strategy shows another unexpected consequence of the 2010 health care law. Critics say the risk adjustment program is having a reverse Robin Hood effect—taking money from some plans that are small, innovative or fast-growing, while handing windfalls to some of the industry’s most entrenched players.
In his final State of the Union address, President Obama spent little time discussing health care programs. In sum, the president made one generic reference to Medicare, made no mention of Medicaid, and spent only about 30 seconds discussing his signature health care legislation—the Affordable Care Act—recapping its main purpose and making three claims about how it is performing.
The president claimed that the purpose of the ACA Is to ensure portability of coverage, that health care inflation has slowed, and that nearly 18 million people have gained coverage so far. He also claimed that businesses have created jobs every single month since the ACA became law. He failed to mention the nation’s greatest fiscal challenge: the unsustainability of entitlement programs.
This piece by Brian Blase aims to fill in some of the gaps.
Last week, the Department of Health and Human Services (HHS) released 2016 exchange enrollment data through the first two months of the three-month open enrollment period. Although nearly one month of open enrollment remains, the new data generally supports my previous findings. Here are seven things you should know about the new data.
1) 2016 enrollment will likely be at least ten million people below expectations when the ACA was passed
2) People with at least middle class income still largely shunning exchanges
3) Enrollees still skewing older
4) Average advance premium tax credit up 12% from last year
5) 90% of enrollees selected silver or bronze plans
6) 27% of enrollees are new sign-ups, 38% of enrollees are active reenrollees, and 33% of enrollees are automatic reenrollees
7) High auto-enrollment in states not using HealthCare.gov may lead to premium shock
Reconciliation shows repeal is possible. Now is the time to show that replacing ObamaCare is possible too. To do that, Congress should spend the next year building a framework for a patient-centered, market-based alternative that empowers individuals to control the dollars and decisions regarding their health care. Congress must use sound financing, stabilize and liberate the health care market, and make financing simpler, transparent and direct to individuals.
In a survey of non-seniors, a New York Times/Kaiser poll found about one-in-five people struggle with medical bills even though they have insurance. Among insured people who reported crushing medical debts, about three-quarters reported putting off vacations, major purchases and cutting back on household spending.
Nearly two-thirds used up all or most of their savings. Far fewer had to resort to second jobs, take on more hours or ask family members for funds (42% to 37%).
The Obama administration is promising to crack down on healthcare customers who buy coverage in between enrollment periods to lower costs. Andy Slavitt, acting head of the Centers for Medicare & Medicaid Services, acknowledged publicly for the first time Monday night that some customers are using loopholes in the enrollment sign-up periods to avoid paying healthcare premiums year-round.
He said more details about the administration’s plans will come next week, after the Jan. 31 deadline for coverage.
iMost of the people who tell you that consumerism can’t work in health care tend to work in health care themselves. But if they were doing such a great job, maybe our health care system wouldn’t be riddled with high costs, fatal medical errors, and hundreds of billions of dollars in waste and fraud.
Companies in other industries – from Wal-Mart to Trip Advisor, Amazon, and Google – have figured out ways to simplify incredibly complex systems to lower the amount of time and the cost for consumers to identify affordable, quality products. Those companies have just one thing in common: they answer to consumers.
Rather than focusing on how health care worked in the past, policymakers should encourage competition by clearing away outdated regulations that prevent savvy, tech-based entrepreneurs from empowering patients with the information they need to find the providers who deliver the best outcomes – often at a more affordable cost.
Among ObamaCare’s few popular features, even among Republicans, is the mandate to cover adult children through age 26 on the insurance plans of their parents. Although sold as a gratuity, somebody must ultimately pay. In a working paper, Gopi Shah Goda and Jay Bhattacharya of Stanford and Monica Farid of Harvard find “evidence that employees who were most affected by the mandate, namely employees at large firms, saw wage reductions of approximately $1,200 per year.”