Category: Implementation

“The Supreme Court said Thursday it will decide whether private sector health care providers can force a state to raise its Medicaid reimbursement rates to keep up with the rising cost of services.
The justices agreed to hear an appeal from Idaho, which wants to overturn a lower court decision that ordered the state to increase payments.
A 2009 lawsuit argued that the state was unfairly keeping Medicaid reimbursement rates at 2006 levels despite studies showing that the cost of providing care had risen. A federal judge agreed, and the 9th U.S. Circuit Court of Appeals affirmed.”

“Kevin Counihan, the new chief executive officer of healthcare.gov, expects Obamacare will become so user-friendly that “raving fans” will emerge for the U.S. health insurance enrollment program.
Americans buying coverage for 2015 using healthcare.gov should expect an easier experience than during its troubled first year, Counihan said yesterday in his first interview since starting the job Sept. 8. While shopping will remain imperfect, “it’s night and day from last year,” he said.”

“Thousands of consumers who were granted a reprieve to keep insurance plans that don’t meet the federal health law’s standards are now learning those plans will be discontinued at year’s end, and they’ll have to choose a new policy, which may cost more.
Cancellations are in the mail to customers from Texas to Alaska in markets where insurers say the policies no longer make business sense. In some states, such as Maryland and Virginia, rules call for the plans’ discontinuations, but in many, federal rules allow the policies to continue into 2017.”

“Who’s up for the latest batch of bad Obamacare-related news?
(1) Consumers brace for the second full year of Obamacare implementation, as the average individual market premium hike clocks in at eight percent — with some rates spiking by as much as 30 percent.
(2) “Wide swings in prices,” with some experiencing “double digit increases.”(Remember what we were promised):
Insurance executives and managers of the online marketplaces are already girding for the coming open enrollment period, saying they fear it could be even more difficult than the last. One challenge facing consumers will be wide swings in prices. Some insurers are seeking double-digit price increases…”

“Last month’s launch of the Apple Watch is indicative of the big potential that companies are seeing in digital health. And the market is buying into digital health in a big way, judging by the record amount of money these firms have been raising this year.
Through the first nine months of 2014, digital health companies have raised $5 billion, almost double what they did in all of 2013, according to publicly reported data compiled by StartUp Health. The actual number of deals are on a slower pace this year, which StartUp Health says is an indication that the relatively young market is maturing.”

“One year ago, every network, every member of Congress and certainly HHS and CMS watched or tried to log into HealthCare.gov. It proved to be a long, long wait. The collective frustration at the end of the day was the site did not work.
Despite repeatedly assuring both Congressional committees and the American public that the new marketplace and this bold new experiment on shopping for government controlled health insurance was to be smooth as silk and easy as pie, the rollout was a colossal failure for the HHS Secretary and her team. Ultimately, she admitted being responsible for the ‘debacle’ but not much has been done to eliminate the problems and clean up the process. HealthCare.gov is still broken.
The rollout was a failure, but my hope is the bureaucracy has learned some lessons. Here are five things I hope we can file away as lessons learned.”

“Thousands of Americans will see their health plans cancelled before the November elections in a development that could boost critics of ObamaCare.
The Morning Consult, a Washington-based policy publication, reported that nearly 50,000 people will lose their current health coverage in the coming weeks.
The figure encompasses cancellations announced by insurance departments and providers in Kentucky, Alaska, Tennessee, New Mexico, North Carolina, Maine and Colorado.
The possible political consequences are clear in states like Kentucky, where Senate Minority Leader and leading ObamaCare critic Mitch McConnell (R-Ky.) is defending his seat against Democrat Alison Lundergan Grimes.”

“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”

“Here unedited is what I posted on September 29, 2013:
The Affordable Health Care Act’s Launch On October 1st––So How Did it Go?
Unavoidably, that will be the big question come Tuesday.
But there will be much more to it than that.
A 180-Day Open Enrollment––Not a One-Day Open Enrollment
What happens on the first day, for good or bad, will constitute only a tiny percentage of the open enrollment period. Consumers will likely visit the new websites many times before they make any decisions, and that is exactly as it should be.
Many of the health plans touted as being low-cost plans are going to be very limited access plans. It won’t be easy for consumers to compare one plan’s provider network to the other. In the best of circumstances, consumers will be confused by what is being offered for some time and will have to make a major effort to make sense of it for themselves.”