When President Obama described the Affordable Care Act’s health-insurance exchanges in late 2013, he declared they would create “more choice, more competition, [and] real health-care security” for millions of Americans. This hasn’t panned out. Nearly three years later, choice and competition have declined, a problem that is already set to worsen in 2017.
UnitedHealth Group is the latest proof. On April 19, the company announced that it will abandon the exchanges in all but a “handful” of the 34 states in which it currently operates. This could leave up to 6 percent of the Affordable Care Act’s subscribers scrambling for new plans before year’s end.
The Centers for Medicaid and Medicare Services on Monday announced a massive update to managed care in Medicaid and the Children’s Health Insurance Program. In doing so, it attempts to bring the program in line with the changes Medicaid has undergone over the last decade. The new rule is the agency’s guideline for modernizing the low-income health care program and strengthen its quality of care.
Medicaid managed care services are offered by risk-based managed care organizations, which contract with state Medicaid programs to offer care to enrollees. Essentially, they are the private insurer alternative to traditional fee-for-service Medicaid.
CMS hasn’t issued any new regulations to the program since 2002, but a lot has changed since then. Not only has the Medicaid program itself grown under the Affordable Care Act, but now about 80 percent of Medicaid enrollees are served through managed care delivery systems, according to CMS.
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The Republican Study Committee submitted their recommendations for health reform to the House Republican Health Care Reform Task Force on Friday, pointing to several provisions of an already-introduced bill to guide its proposals.
“The Republican Study Committee has led the way on a comprehensive repeal and replace strategy for ObamaCare,” the group says of its recommendations. “Currently, the American Health Care Reform Act, H.R. 2653, is the most cosponsored ObamaCare alternative in the House. This bill relies on conservative principles and increased state flexibility to transform our top-down health care system into one that creates competition, growth and increased access for all Americans.”
The pharmaceutical industry, insurers and the Obama administration all want prescription drugs to be included in determinations about whether a certain pools of patients are riskier than others.
The determinations are important because insurers who take on riskier sets of patients are eligible to receive compensation under Obamacare. Right now, those determinations are made using just medical claims.
Drug companies and insurers generally agree that prescription drugs should be included in the risk adjustment models. They currently are not.
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Most of the remaining non-elderly uninsured people in the U.S. likely won’t gain coverage, a new study released this week suggests.
The study, from the Urban Institute says that while some higher-income people who are uninsured will surely gain coverage as the penalties for not having insurance increase, the possibility for increased coverage is actually lower among those who have higher incomes than those who are eligible for financial assistance to cover insurance.
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According to a Blue Cross Blue Shield Association report, people who enrolled in health insurance through the ACA appear to be sick than expected. People who enrolled in individual health insurance plans after 2014 were less healthy and used more healthcare in 2014 and 2015 than those who were already enrolled in individual plans and those who receive insurance through their employer.
The report isn’t without its shortcomings. It looked only at BCBS plans, not the entire universe of Obamacare insurers. But that’s still a sizable sample. BCBS companies participate in the exchanges more than any other insurer.
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The Centers for Medicare and Medicaid Services released a white paper detailing the Centers for Medicare and Medicaid’s risk adjustment model Thursday.
“CMS has implemented a risk adjustment program to mitigate the effects of risk selection on health insurance premiums for non-grandfathered plans in the individual and small group markets,” the paper concludes. “The risk adjustment program, supports market stability by pooling risk and transferring funds from plans with more low-risk (i.e., healthier and lower cost) enrollees to those plans with more high-risk (i.e., less healthy and higher cost) enrollees.”
The paper also suggests potential modifications for the 2018 and 2019 benefit years.
The Congressional Budget Office reduced the projected number of people who will enroll on the federal insurance exchanges to 12 million from 21 million in a report released Thursday.
Still, between 2017 and 2026, the CBO projects the number of insured people in the U.S. will grow from 246 million to 253 million. While the number of uninsured is expected to grow from 26 million to 28 million, the portion of uninsured people younger than 65 is expected to stay around 10 percent, according to the report.
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Voters are more likely to re-elect their representative if they voted to repeal the “Cadillac” tax, though a majority of voters say it makes no real difference in their vote, a report out today from the American Benefits Council says.
Overall, 37 percent of voters said their congressman voting to repeal the tax would make them more likely to re-elect their representative, while 16 percent said it would make them less likely to do so. Still, 47 percent said the vote made no difference. The report was released by the Alliance to Fight the 40, a coalition of groups advocating to repeal the tax on high-cost health plans.
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Kaiser Family Foundation released a survey Wednesday, which revealed among Republicans, 26 percent named Donald Trump as the candidate they most trust to represent their views on the health care, while 21 percent picked Ted Cruz. Fewer registered Republicans named John Kasich. Independents surveyed were more likely to choose either Hillary Clinton or Bernie Sanders than a Republican candidate, the report says.
Overall, the survey shows, health care is an important issue to a majority of registered voters.