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Updated: 33 weeks 2 days ago

Lack of Awareness of Health Insurance Marketplace Accounts for Low Latino Enrollment

Wed, 02/26/2014 - 4:23pm

According to new data released by the Department of Health and Human Services (HHS), Latinos—the racial and ethnic group with the highest uninsured rate in the nation—have much to gain from the Affordable Care Act. And yet, anecdotal evidence suggests that this population is not enrolling for health coverage at the level that one would expect for a group with such high numbers of uninsured.

Of the 41 million uninsured (who are also lawful U.S. residents, and thus potentially eligible for coverage under the Affordable Care Act), 10 million—25 percent of the uninsured—are Latino.

And the vast majority of Latinos—80 percent or 8.1 million—are eligible for financial assistance for plans purchased in a health insurance marketplace or for free or low-cost insurance through Medicaid or the Children’s Health Insurance Program (CHIP). 

Latinos suffer disproportionately from some chronic and serious diseases, making health coverage critical

One out of three Latinos is uninsured. At the same time, Latinos are also more likely to suffer from certain chronic and serious diseases, and they are more likely to get sicker and die from them.

For example, Latinos have among the highest diagnosis and death rates for heart disease,diabetes, andcervical cancer in the U.S. Reliable access to high quality, affordable health care is critical for increasing prevention and giving Latinos the care to effectively manage these conditions and avoid more serious complications.

Barriers to health coverage for Latinos

Anecdotal evidence points to relatively low rates of enrollment for a population with such a demonstrated need for health insurance. Here are some reasons why Latinos may not be enrolling:

  1. Lack of Medicaid expansion: HHS data find that approximately 2 million uninsured Latinos live in states that have not chosen to expand Medicaid for low-income people, and have incomes below the federal poverty level. New health coverage options may not be available to this population.
  2. Lack of awareness: Latinos are not enrolling because they simply don’t know that they can get health coverage through the health insurance marketplaces. The Commonwealth Fund found that just 49 percent of potentially eligible Latinos were aware of their state health insurance marketplace’s existence, compared to 70 percent of white and African American respondents. Enroll America found that three-quarters of Latinos are unaware of the financial help available to make insurance more affordable.
  3. Delayed release of Spanish-language materials and website: In the early days of the open enrollment period, these important resources were delayed, making it more difficult to conduct outreach in Spanish-speaking communities.
California is taking steps to increase Latino enrollment

Although good demographic data on overall Latino enrollment are not yet available for most states, there are data for California. The state (which has the highest number of uninsured Latinos), recently released data showing that Latinos make up 28 percent of enrollees so far. That’s a marked increase from December’s 18 percent enrollment number—a sign of California’s progress. But even in California, Latinos still comprise more than half of the uninsured. Recognizing that it must do a better job of getting information out to Latino communities, California has launched a new campaign to increase outreach and enrollment resources in Latino communities. If this effort is successful, it will not only increase the number of Latinos with health coverage in California, it will also provide examples of good outreach and education that can be replicated in other communities around the country.   

Now is the time to spread the word

The March 31 enrollment deadline to buy health insurance in the marketplace is fast approaching. We must move quickly to spread the word about the health coverage options that are available and the financial assistance that helps make health insurance affordable. Fortunately, there are now both English and Spanish materials available.

Health coverage resources now available for Latinos
  • Spanish speakers can visit www.cuidadodesalud.gov (the English version of the site is www.healthcare.gov). These are the federal government’s websites where shoppers can compare the health plan options in their area; fill out the single application for both coverage and financial assistance; choose the best plan for them; and get information to help them shop for and effectively use their health coverage. There’s even a Spanish chat function. In addition, they can find local organizations that are providing in-person assistance to help people enroll, including people who speak Spanish. Call 1-800-318-2596 or TY 855-889-4325 to reach the national 24/7 customer service center. The center includes Spanish-speaking representatives who are available to answer questions and help people sign up for coverage. 
  • Families USA partnered with NAACP, National Council of La Raza, and the National Urban League to create outreach materials (available in English and Spanish) designed specifically for communities of color, as well as for general audiences.
  • Families USA also offers information, tools and resources for navigators and assisters that can be useful to helpers working on enrollment.

In addition, there are Latino-focused enrollment events taking place all across the country in March. To find out if there is one near you and get involved, visit http://www.getcoveredamerica.org/national-latino-enrollment-summits/  

If we want to make a dent in Latinos’ disproportionately high rates of uninsurance and take a step closer to achieving health equity, it is important that we, as advocates and educated consumers, do everything in our power to educate and enroll as many of the 10.2 million uninsured and potentially eligible Latinos as possible.

This blog was written with the assistance of Sinsi Hernandez-Cancio and Lizette Rivera.

How The Affordable Care Act’s Risk Adjustment, Reinsurance, and Risk Corridor Provisions Protect Consumers

Wed, 02/26/2014 - 11:38am

Lately, the media have been covering three provisions—risk adjustment, reinsurance, and risk corridors—that were created by the Affordable Care Act. The new health law’s opponents have been highly critical of these provisions (risk corridors in particular), characterizing them as federal bailouts to insurance companies. Also known as the “three Rs,” these provisions allow insurance companies to manage the financial risk that they incurred when the Affordable Care Act prevented insurers from denying coverage or charging higher premiums to individuals with pre-existing conditions. Collectively, the “three Rs” seek to balance out the risk that sicker individuals bring to the insurance market as a whole. The provisions do this by redistributing funds from insurance groups (pools) that have healthier enrollees to those that have sicker individuals. And they limit significantly high profits—or losses—incurred by insurers.

Why do the “three Rs” programs exist?

Because health insurers must now accept people who are in less-than-perfect health, insurers are raising legitimate questions about how high or low to set premiums rates: should insurers set high rates, in case they end up with sicker-than-average enrollees? Or should they set low rates, hoping that healthier individuals will enroll? The first few years of the Affordable Care Act have been the hardest for insurers, as they can’t rely on past experience to help them determine rates that now include groups of individuals who may be in poor health. The “three Rs” help to balance the risks among insurance companies so that monthly premiums stay at reasonable rates.

The “three Rs” provisions also help to guarantee that insurance companies do not try to “cherry pick” by trying to attract healthier enrollees and discouraging less healthy applicants to join a plan. Reputable and competitive insurers make money by efficiently providing needed coverage. However, less reputable insurers may choose to advertise only in neighborhoods where young people are more likely to live, or on websites that young people tend to visit. These insurers may offer a gym membership as part of covered services (an attractive benefit for younger people), but then charge higher copays for certain drugs or services (those that someone in worse health might need). Some insurers also omit specialists who might tend to serve older or sicker patients (for example, geriatric specialists or oncologists) from their provider network.  

The February 2014 Congressional Budget Office’s federal budget and economic outlook update reaffirmed that the “three Rs” programs taken together are not “insurance company bailouts,” but actually help to reduce the federal budget deficit while helping lower premiums for consumers.  

What are the “three Rs”?

Risk adjustment

  • How it works: Risk adjustment collects funds from insurers in the health insurance markets that cover healthier people and redistributes those funds to plans that have sicker enrollees
  • Plans that benefit: All non-grandfathered plans in the individual and small group markets in and outside the new state marketplaces
  • Funding mechanism: Collects and redistributes funds from insurers in these markets that cover healthier people with plans that have sicker enrollees
  • Sunset date: None
  • Cost to the federal government: Zero

Reinsurance

  • How it works: Reinsurance funds are collected from individual, small and large group, and self-funded employer plans, and then redistributed to insurers in the individual market to help cover the costs of enrollees with high insurance claims.
  • Plans that benefit: All non-grandfathered plans in the individual market in and outside the new state marketplaces
  • Funding mechanism: $63 annual fee per enrollee collected from individual, small group, large group, and self-funded employer plans (in 2015 the proposed fee is $44)
  • Sunset date: 2014-2016—designed to stabilize new market during a period of transition
  • Cost to the federal government: Zero

Risk corridors

  • How it works: Risk corridors limit insurance plans’ unexpectedly high profits or significant losses.
  • Plans that benefit: Individual and small group qualified health plans (QHPs) that are sold in the new state marketplaces (and may also be sold outside the marketplaces)
  • Funding mechanism: Insurers set monthly premiums based on a predicted amount of claims. If claims are lower than predicted, the insurers reimburse the federal government. If the claims are higher, the federal government reimburses insurers for some of the money
  • Sunset date: 2014-2016—designed to help insurers who have no past years of claims experience when setting monthly premiums
  • Cost to the federal government: The Congressional Budget Office (CB0) estimates that over the three years of the program, the federal government will take in approximately $16 billion from insurers who guessed wrong and over-estimated claims but only pay out $8 billion to those with higher claims than expected in the new marketplaces. Thus, the CBO estimates that repealing the provision would increase the federal deficit by $8 billion dollars. No one should label this program an “insurance company bailout.” (See pages 114-115 of the report.)
Why are the “three Rs” important for consumers?

Insurance is supposed to be about spreading the risk among people of unpredictable and costly health problems. It’s also about spreading the cost of serious health problems over a person’s lifetime (you pay for insurance when you are young and healthy so that it’s there when you need it as you grow older or sicker).

The “three Rs” work together to distribute or balance risks fairly across insurance companies so that those that end up with healthier enrollees help those that end up with sicker enrollees. It helps to keep insurance companies focused on a good product rather than a “good enrollee.” And it makes the insurance market work properly.

Opponents have particularly argued against the risk corridors. Yet ironically, many of those critics supported a similar permanent program in the Medicare Part D drug benefit law to give insurers confidence to enter a new market. The basic concept then and now is that a new insurance market is unpredictable, and therefore insurance companies tend to set monthly premiums higher to cover themselves from expenses that may or may not occur.

With the Affordable Care Act, the individual market has been transformed into a new and better functioning market—one in which pre-existing condition discrimination is prohibited, and in which new, robust premium subsidies are available to many people. Since insurers don’t really know who will enroll or how sick they will be in these new marketplaces, the risk corridors give them confidence to participate and offer lower monthly premiums in the first couple years of the Affordable Care Act’s implementation, until they have more claims experience.

An October 2013 Health Section article by The Society of Actuaries (the experts who set premiums at insurance companies) explained the need for risk corridors this way:

“….Unless you have a vintage DeLorean (with time machine capability), you were likely intimidated by the amount of uncertainty in your pricing assumptions [for quality health plans in the new individual markets]…. [the risk corridor program] provides a strong incentive for issuers to participate in the health insurance exchanges set up by the Affordable Care Act….[and] provides an incentive for issuers to manage their administrative costs optimally.”

Translation: the risk corridor program is about making health insurers operate efficiently and keeping monthly premiums low for people in a consumer-friendly, albeit very new, marketplace of individual insurance.

The Affordable Care Act’s Three Rs: Risk Adjustment, Reinsurance, and Risk Corridors

Tue, 02/25/2014 - 12:52pm

The media have been abuzz about the so-called “insurance company bailouts” in the Affordable Care Act. The new health law’s opponents have been criticizing the “Three Rs”—the risk adjustment, reinsurance, and risk corridor provisions. Most of the attacks have been focused on the risk corridor provision.

We wanted to cut through the noise and briefly explain what these provisions are and how they are financed. We’ll also explain why the risk corridor program helps lower monthly health insurance premiums for consumers.

All three provisions serve the basic goal of insurance: to fairly pool risk. Finally, the days are over when insurance companies could turn away people in less-than-perfect health. But since they now serve everyone, insurers have legitimate questions about where to set their premiums: should they set them high, in case they end up with sicker-than-average enrollees? Should they set them low, hoping to get healthier enrollees? And how can they guess where to set monthly premiums these first few years when they have never before tried to serve everyone? The three Rs help to balance the risks among insurance companies so that monthly premiums will stay reasonable for everyone.

The Three Rs provisions also help to guarantee that some nefarious insurance companies do not try to “cherry pick” by trying to attract healthier enrollees and discouraging less healthy applicants to join a plan. Reputable and competitive insurers make money by efficiently providing needed coverage, and not by cherry picking. Insurers cherry pick, for example, by only advertising in certain neighborhoods where young people are more likely to live or by advertising only on websites that young people tend to visit. Insurers can also cherry pick by offering a gym membership for example, but then having higher co-pays for certain drugs or services that a sicker person needs. Some insurers also cherry pick by omitting from their provider network some specialists, for example geriatric specialists or oncologists or other providers who serve the needs of patients with expensive health conditions.

The February 2014 Congressional Budget Office’s federal budget and economic outlook update reaffirmed that the Three R programs taken together are not “insurance company bailouts,” but they actually help to reduce the federal budget deficit while helping lower premiums for consumers.

What are the “Three Rs”?
Risk Adjustment

  • Plans that benefit: all non-grandfathered plans in the individual and small group markets in and outside the new state marketplaces
  • Funding mechanism: Collects and redistributes funds from insurers in these markets that cover healthier people with plans that have sicker enrollees
  • No sunset date
  • Cost to the federal government: Zero

Reinsurance

  • Plans that benefit: all non-grandfathered plans in the individual market in and outside the new state marketplaces 
  • Funding mechanism: $63 annual fee per enrollee collected from individual, small group, large group, and self-funded employer plans (in 2015 the proposed fee is $44)
  • These funds are then redistributed to insurers in the individual market to help cover the costs of enrollees who have very high-cost claims for medical bills. 
  • 2014-2016—designed to stabilize new market during a period of transition
  • Cost to the federal government: Zero

Risk Corridors

  • Plans that benefit: Individual and small group qualified health plans (QHPs) that are sold in the new state marketplaces (and may also be sold outside the marketplaces)
  • Basically this provision sets limits on insurance plans’ unexpectedly high profits or significant losses. 
  • Funding mechanism: Insurers set monthly premiums based on a predicted amount of claims. If claims are lower than predicted, the insurers reimburse the federal government. If the claims are higher, the federal government reimburses insurers for some of the money
  • 2014-2016—designed to help insurers who have no past years of claims experience when setting monthly premiums
  • Cost to the federal government: The Congressional Budget Office (CB0) estimates that over the three years of the program, the federal government will take in approximately $16 billion from insurers who guessed wrong and over-estimated claims but only pay out $8 billion to those with higher claims than expected in the new marketplaces. Thus, CBO estimates that repealing the provision would increase the federal deficit by $8 billion dollars. No one should label this program an “insurance company bailout.” (See pages 114-115 of the report.)

Why are the Three Rs Important for Consumers?
Insurance is supposed to be about spreading the risk among people of unpredictable and costly health problems. It’s also about spreading the cost of serious health problems over a person’s lifetime (you pay for insurance when you are young and healthy so that it’s there when you need it as you grow older or sicker).

The Three Rs work together to distribute or balance risks fairly across insurance companies so that those that end up with healthier enrollees help those that end up with sicker enrollees. It helps to keep insurance companies focused on a good product rather than a “good enrollee.” And it makes the insurance market work properly.

Opponents have particularly argued against the risk corridors. Yet ironically, many of those critics supported a similar permanent program in the Medicare Part D drug benefit law to give insurers confidence to enter a new market. The basic concept then and now is that a new insurance market is unpredictable, and therefore insurance companies tend to set monthly premiums higher to cover themselves from expenses that may or may not occur.

With the Affordable Care Act, the individual market has been transformed into a new and better functioning market—one in which pre-existing condition discrimination is prohibited, and in which new, robust premium subsidies are available to many people. Since insurers don’t really know who will enroll or how sick they will be in these new marketplaces, the risk corridors give them confidence to participate and offer lower monthly premiums in the first couple years of the Affordable Care Act’s implementation, until they have more claims experience.

An October 2013 Health Section article by The Society of Actuaries (the experts who set premiums at insurance companies) explained the need for risk corridors this way:

“….Unless you have a vintage DeLorean (with time machine capability), you were likely intimidated by the amount of uncertainty in your pricing assumptions [for quality health plans in the new individual markets]…. [the risk corridor program] provides a strong incentive for issuers to participate in the health insurance exchanges set up by the Affordable Care Act….[and] provides an incentive for issuers to manage their administrative costs optimally.”

Translation: the risk corridor program is about making health insurers operate efficiently and keeping monthly premiums low for people in a consumer-friendly, albeit very new, marketplace of individual insurance.

The Affordable Care Act is a Historic Opportunity to Advance Health Care Justice for African-Americans

Fri, 02/21/2014 - 11:09am

As we celebrate Black History Month and remember the contributions of African-Americans throughout our nation's history, it's important to also focus on the work that still lies ahead to achieve racial justice.

Decades ago, Rev. Dr. Martin Luther King said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

Despite the progress we have made, African-Americans and other people of color still struggle daily with unjust, and sometimes deadly, health care inequality.

The Affordable Care Act presents a historic opportunity to level this hazardous playing field.

African-Americans face many health disparities compared to white non-Hispanics

These disparities transcend age and gender. For example:

African-Americans are one of the communities that stand to gain the most from the Affordable Care Act

African-Americans are uninsured at a rate nearly twice that of whites. However, many are beginning to benefit from the Affordable Care Act. More than 400,000 young African-Americans have already gained coverage by remaining on their parents' plans.

As we discussed in a recent blog, 60 percent of uninsured African-Americans are eligible for lower-cost coverage either through Medicaid, CHIP, or financial assistance when purchased in the health insurance marketplace.

Getting more African-Americans covered is an essential step toward health care justice

Improving the quality of that coverage-which the Affordable Care Act does successfully-is the next step.

Many of the consumer protections included in the Affordable Care Act-such as the elimination of lifetime limits on coverage and the inability to deny coverage based on a pre-existing condition-are crucial to communities of color, whose members are more likely than average Americans to suffer from serious and chronic conditions.

The Affordable Care Act's free preventive care is a lifesaver for communities of color

The Affordable Care Act requires that new health insurance plans cover a myriad of free services, such as screening for type 2 diabetes, HIV, and depression, as well as diet and obesity counseling.

Prevention, early detection, and treatment are enormously important in illnesses like diabetes, where aggressive treatment and management can reduce serious complications like amputations, end stage renal disease, blindness, and death.

The same is true for heart disease and breast and prostate cancer, all of which are disproportionate killers of African-Americans.

Expanding Medicaid will help communities of color

The biggest challenge in many states with high numbers of African- Americans is ensuring that states expand Medicaid, which has the potential to reduce the insurance coverage disparities among many low-income people, including communities of color.

As one of our prior blogs explained, if all states chose to expand Medicaid to those under 138 percent of the Federal Poverty Level, up to 95 percent of uninsured African-Americans would become eligible for some kind of financial assistance to pay for coverage -whether Medicaid, the Children's Health Insurance Program (CHIP), or financial assistance for insurance on the Marketplace.

We must work together to make sure the 2.2 million African-Americans and millions more of all races and ethnicities who currently fall into this Medicaid gap have a realistic opportunity to get affordable care.

Keeping Dr. King's words on health care injustice in mind, the Affordable Care Act is not just the most significant piece of health care legislation since Medicaid, but arguably the most important piece of racial justice legislation of our generation. Let us not lose sight of that as we continue to fight to protect and implement this law, and get as many people covered as we possibly can.

This blog was co-written by Kevin Oshinskie, Staff Writer, Families USA.

Consumer Assistance Programs Lose Federal Funding at Crucial Time

Thu, 02/20/2014 - 12:19pm

When consumers encounter problems with their health insurance after enrolling (many for the first time), they need access to unbiased experts to answer their questions. Although federally funded consumer assistance programs do just that, their continued funding is in peril.

How big is the problem?

Only 12 states plus the District of Columbia, the Virgin Islands, and the Northern Mariana Islands still have federally funded programs—down from 33 states plus the District of Columbia, Puerto Rico, the Virgin Islands, Guam, and American Samoa—and their grants will soon expire. This drop in funding comes at a bad time—enrollment is starting to pick up steam as consumers rush to enroll in health plans before the open enrollment window closes on March 31.

Evidence is mounting that lack of funding is causing real problems for consumers, many of whom are in new plans or still need help resolving their enrollment-related problems, a point we emphasized in Tuesday’s article in Politico.

The irony in all of this is that the Affordable Care Act specifically authorizes funding for consumer assistance programs (also called health care ombudsman programs). And though the federal government provided an initial $30 million for consumer assistance in 2010, it has not given additional funds since 2012.

How consumer assistance programs help health care consumers understand their health insurance

The Affordable Care Act charges consumer assistance programs with educating consumers about their health insurance rights and responsibilities, assisting with health insurance appeals, and helping resolve problems with premium tax credits.

The issues have a real human impact:

  • A family applies for marketplace coverage, but their enrollment is not processed quickly enough to prevent them from incurring medical expenses on their own; once they do enroll, they need help getting coverage and financial assistance for their new premiums and previously incurred expenses. 
  • A person loses her job and wants advice about whether to take COBRA or whether she can get financial assistance to buy a new plan in the health insurance marketplace. 
  • A person with multiple sclerosis wants help appealing when his health plan tells him that the medicine he needs is experimental, even though his doctor recommended this drug for his condition.
Navigators must be able to make referrals to consumer assistance programs for complex problems

Navigators (located in every state) also help consumers with health insurance enrollment and are able to help them if problems come up in the enrollment process. This help, while highly valuable, is mainly limited to assisting consumers with enrollment, and correcting problems related to the eligibility or amount of financial assistance available to consumers.

Other issues, which are sometimes more complex, are referred to consumer assistance programs. And if those programs aren’t funded, these consumer problems are not addressed.

In fact, consumer assistance programs are such an important resource that health plans are required to list them on notices to consumers about how to appeal the insurer’s decision.

Federal government should renew funding to strengthen consumer assistance programs

The Affordable Care Act does a good job outlining the responsibilities of consumer assistance programs, but not as good a job in assuring funding. The law provided $30 million of funding the first year, and authorized “further appropriations as needed.” In 2010, 33 states and the District of Columbia, Puerto Rico, the Virgin Islands, Guam, and American Samoa established or expanded consumer assistance programs with federal grants (there was little assistance for the remaining states, however). This year, only 12 states plus the District of Columbia, the Virgin Islands, and the Northern Mariana Islands continue to operate their consumer assistance programs with federal grants.

Consumer assistance programs will be critical in 2014 as enrollment continues to grow

Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society of New York, says it best: “The loss of the federal funding has been a serious problem for consumers because it’s not fair to enroll people into coverage and not have the support people really need to be able to use it. It’s a path to nowhere.”

This year, many consumers have health insurance for the first time. Many are in new health plans and are just learning how to use them. So, in addition to solving problems related to health insurance, consumer assistance programs are equally critical to helping consumers learn how to use their insurance effectively.

The Department of Health and Human Services should ensure that expert helpers are available to fill this critical component of the consumer’s experience in the health insurance marketplace.

 

Uptick in Hospital Mergers: A Doubled-Edged Sword for Consumers

Wed, 02/19/2014 - 1:45pm

 Earlier this month, a federal district court judge in Idaho examined whether a merger between a large     hospital system, St. Luke’s, and the state’s largest independent network of doctors would create monopoly conditions. This proposed merger underscores a growing trend in the health care industry: because it’s easier and more cost effective to coordinate patient care when hospitals, specialists, and primary care doctors are part of one unified system that is financially and clinically integrated, we’re seeing more hospital and provider groups merging. This isn’t surprising, as the Affordable Care Act includes a number of incentives to encourage health care providers to coordinate care between each other and across care settings. We know that, when providers work together, they improve the quality of care and health outcomes, and they may save money, too.

Mergers increase market share for hospitals and health systems and drive out competition
But here’s the concern with merging hospitals with provider groups: While integrated health systems make it easier to coordinate health care across providers, they may also drive out competition between hospitals and among specialists, and drive up prices. As hospitals and provider groups merge, the number of competing health care providers in the market shrinks. If a health system becomes so large that it has an unfair advantage in the market, it may be able to demand higher payments from health insurers. These insurers, in turn, pass these larger bills on to consumers in the form of higher monthly insurance premiums.

Idaho case spotlights the tension between hospital-led consolidation and monopoly market power
When the federal judge in Idaho reviewed the Idaho/St. Luke’s merger, he ultimately ruled against the merger on the grounds that a merger between a large hospital system, St. Luke’s, and the state’s largest independent network of doctors would create monopoly conditions in the state, thus violating federal anti-trust laws.

In his opinion, the judge noted that the merger would likely improve coordinating care and overall health outcomes in Idaho. But he decided to stop the merger because he believed that allowing it to proceed would grant the hospital system too much market power, allowing St. Luke’s to demand higher prices and harm consumers by pushing up the cost of care and health insurance. St. Luke’s is appealing the decision.

Hospital-led health system consolidation is happening more frequently 
While the trend toward the creation of more integrated health systems is not new, the rate at which mergers and acquisitions are occurring is increasing.

A recent article in the Journal of the American Medical Association analyzed this trend and found that 60 percent of hospitals are now part of a health system. Between 2007 and 2012, 432 hospital mergers and acquisition deals were announced involving 835 hospitals.

The proportion of physician practices owned by hospitals is also increasing rapidly. Between 2004 and 2011, the percentage of physician practices owned by hospitals more than doubled, rising from 24 percent to 49 percent.

Balancing integration and competition in the health care system to protect consumers
Clearly, better integrated health systems have benefits to consumers. The effective communication between providers and the seamless transitions across settings help to deliver higher quality health care and better outcomes.

These benefits must be balanced, however, with efforts to protect competition in health care markets.

The question is: Can we achieve integration and coordination across providers in ways that don’t create health systems with market power so great that they put consumers at risk?

We think the answer to this question is yes, and we will explore some of these policy options, such as incentives to promote team-based care, and the creation of tiered provider networks based on quality and cost, in posts over the coming months.

This blog was co-written by Kim Bailey, Research Director, Families USA. 

On a related note, today’s Morning Edition segment on the correlation between high premiums in the new insurance Marketplaces and provider market power highlights this issue. Listen here.  

National Youth Enrollment Day to Serve as Opportunity for Young Adults to Buy Health Insurance, Secure Peace of Mind

Fri, 02/14/2014 - 4:48pm

Meet Nathan: Nathan is a graduate student studying screenwriting, and he works as an in-home care provider for people with autism. He’s 30-years-old, and because of the Affordable Care Act, he has health insurance. Without the Affordable Care Act, that wouldn’t be possible.

Nathan makes $20,000 per year, and he is a survivor. Eight years ago, he was diagnosed with a brain tumor (that he named, “Fred”). Covered by his parents’ health insurance at the time, he was able to get the expensive treatment he needed, and he survived (“Fred” did not). Recently, he purchased a health insurance plan from the new health insurance marketplace, with a monthly premium of just more than $111 per month. He thinks that this insurance will save him $7,000 per year. With the extra money, he’ll travel, shop, and take his clients out to lunch.

Nathan is not alone—not as a cancer survivor, nor as a young adult who’s had his life altered as a result of buying health insurance in the marketplace. New data released by the US Department of Health and Human Services this week show that 3.3 million people enrolled in health insurance in a marketplace as of January 30, 2014. That includes 807,515 adults ages 18 -34. Young adult enrollment numbers grew by nearly two-thirds in January, suggesting that enrollment momentum is increasing as we get closer to March 31, 2014, the end of the first open enrollment period.

One of the questions about the Affordable Care Act has been about whether young adults will buy health insurance in large enough numbers to ensure a healthy risk pool. While some, like Nathan, have already experienced serious health issues because of fate or because of their jobs, or because of their passions (just ask the Olympic athletes in Sochi about their many injuries), most young adults are relatively healthier than are older people. So ensuring they buy health coverage remains a key goal for policymakers concerned with the long-term sustainability of health insurance exchanges and for insurers.

But getting health insurance is not about the sustainability of the risk pool for the millions of young adults who have already bought or are shopping for coverage. It’s about the same peace of mind and protection against bankruptcy that drives most of us to buy insurance. Unfortunately, according to a recent survey of uninsured adults that Enroll America conducted, a shocking number of young adults still do not know that there is financial help available to make insurance more affordable. Plus, the vast majority remains unaware that March 31, 2014, is the deadline to buy coverage through a health insurance marketplace.

So how many young adults will sign up for health insurance in the marketplace in 2014? It’s still too early to say. There are 45 days left in this open enrollment period, and momentum is growing. People like Nathan are bridging the awareness gap by telling their friends, neighbors, coworkers, and family members about how the Affordable Care Act has helped them. Many, like Nathan, are sharing their stories through www.mycoveragestory.org, and every day more people are learning about their opportunity to buy health insurance, save money, and make the smart choice. It is up to all of us to keep that momentum going.

To view infographics on state youth enrollment data, click here.  

How to Improve Marketplaces to Provide Consumers with Crucial Health Insurance Information

Thu, 02/13/2014 - 10:35am

As we move into the last two months of the open enrollment period, government officials and advocates are thinking about how to better reach consumers and help them select a plan to enroll in. One way to improve the consumer experience in marketplace websites is to show consumers more information up front—information that allows them to compare and contrast plan details and financial assistance benefits—before they invest time creating personal accounts and completing an application.

What we found out about how well consumers can window-shop on marketplace websites

Families USA evaluated the window-shopping experiences of consumers in state-based marketplaces and on healthcare.gov in January. We found that in too many marketplaces, consumers don’t see important information while they are window shopping. This information can range from a list of which providers are in a network, to whether certain medicines are on the plan drug formulary. For lower-income consumers who have little disposable income to pay for doctor visits, this could mean the difference between buying a health plan or remaining uninsured.

  • Some websites fail to clearly show low-income consumers special silver-level plans that feature reduced out of pocket costs. These plans can lower or eliminate deductibles for consumers who qualify.
  • Some marketplaces have Spanish websites and materials in other languages. Others don’t.
  • Some sites have user-friendly calculators that estimate what consumers will pay in monthly premiums after they get financial help. On other websites, however, those features don’t appear until after you have created an account.

Choosing a health plan is an important decision. Without the necessary information, consumers can face  major problems down the road. They may lose access to their trusted doctor because they didn’t understand which plan the doctor was in. Or they may face higher out-of-pocket costs because they chose a plan that they didn’t quite understand.

Marketplaces should use all of the tools available to them—outreach messages, navigators and assisters, and their own websites—to educate consumers about how to choose a plan that is right for them.

How to improve the window shopping experience in health insurance marketplace websites

Some improvements to the marketplace window-shopping experience should be done as soon as possible.  For instance, marketplaces should immediately correct information about plan deductibles, and they should immediately provide links to plan provider directories and drug formularies.  Other improvements, such as creating a search tool that allows consumers to quickly find all of the plans that include their provider or cover their drug, or creating a Spanish version of the website, will take time and partnership with contractors, like IT vendors and translators. That‘s why it’s important for us to get an early start on assessing how marketplace websites can continue to become more user-friendly and provide the right information when the consumer needs it most. The best marketplace websites (such asConnecticut’s summary of a consumer’s costs in each plan, consumer-friendly link to “check if your doctor is in-network”, and links to plan quality ratings and detailed plan documents)offer terrific examples of what’s most effective for the consumer. It’s our hope that sharing these best practices will help all states adopt them, improving the consumer experience for the coming year.

How you can weigh in on improving the consumer experience for health insurance marketplace websites?

Last week, the Department of Health and Human Services (HHS) released proposed guidance that would require health plans selling in the federal marketplace to provide a direct link to provider directories and drug formularies for 2015, instead of routing consumers to a website that is potentially confusing to them. We applaud this guidance. If you live in a state with a federal or partnership marketplace, see our blog HHS Releases New Requirements for Health Plans in Federally Facilitated Marketplaces for 2015 about these, and other proposed plan requirements, that are open for comment until February 25, 2014.

You can also use other avenues to communicate with HHS about the marketplace website. For instance, when you visit healthcare.gov, use the “was this helpful” bubbles on the bottom of some pages to suggest improvements.

If you live in one of the states running its own marketplace, now is the time to talk with state administrators and your marketplace board about any improvements you want to see in your state’s health plans. You can also offer website usability suggestions to improve the consumer experience in the coming year.

Help Families USA monitor improvements. Send us your recommendations.

We are keenly interested in hearing directly from you about what improvements you would recommend for marketplace websites. We will be actively monitoring websites for improvement in 2014 and would welcome your direct input. Please contact lrivera@familiesusa.org to share any recommendations that you make to your state administrators or marketplace board.

The Facts behind Medicaid Estate Recovery

Tue, 02/11/2014 - 4:28pm

Over the last couple weeks, we’ve seen several articles that have inaccurately written about how states are recouping health care costs from the estates of individuals who were enrolled in Medicaid. These articles serve to dissuade people into not signing up for Medicaid.

However, the likelihood of Medicaid billing the estates of former Medicaid enrollees is more theoretical than real, and, if it does, there are strong consumer protections in place.

Why?

Under federal law, states are required to bill estates for the cost of an individual’s long-term care costs while on Medicaid. But recovering the costs of health services is not required by federal law, and most states simply aren’t interested in doing so because they fear the high administrative costs of collecting money from a broad Medicaid expansion population. As a case in point, only 10 states have indicated a willingness to pursue the recovery of health care costs from estates.

What is very real is the immediate financial risk of not signing up for Medicaid and consequently remaining uninsured. Someone who passes up Medicaid coverage and remains uninsured because they are concerned that the state might recoup some health care from their estate sometime in the future runs the risk of incurring large medical debts today. If that happens, creditors won’t wait until the person dies. Medical debt is the leading cause of personal bankruptcies in the U.S. And that’s a serious risk that can cause long-term financial damage to families. Someone who is currently uninsured and eligible for Medicaid should sign up for the program.

Let’s take a closer look at the facts behind what these articles are discussing:

Can Medicaid recover from estates of deceased enrollees? Since 1993, federal law has required states to recoup long-term care costs paid by Medicaid for individuals age 55 or older, after those individuals die. That’s called “estate recovery.” But federal law includes protections for family members. For example, states can’t recover costs from a deceased person’s estate during the lifetime of that person’s surviving spouse, or from a surviving child under age 21, or from a child who is blind or has a disability (regardless of age). Bottom line: these estate recovery rules have been in effect long before the Affordable Care Act (ACA)—the health law didn’t change the rules.

Why is Medicaid estate recovery suddenly being talked about? Federal law gives states the option of exercising estate recovery for people age 55 and older. Prior to Medicaid expansion, however, most people receiving Medicaid didn’t fall into this age group. But as states expand Medicaid, more people between age 55 and 65 will be enrolling in Medicaid. That means that Medicaid will be paying for health care and long-term care for this group, which will allow states to recoup the health care costs from the estates of these individuals after they die.

But remember, estate recovery rules apply, and it’s worth repeating: states can’t touch estates:

  • until the surviving spouse is also deceased
  • while a surviving child is under the age of 21
  • from a child of any age who has a disability.

Which states say they will go beyond long-term care costs? Of the states that are currently expanding Medicaid, 10 have been reported as saying that they plan to try to recover more than long-term care costs: California, Colorado, Iowa, Massachusetts, Nevada, New Jersey, New York, North Dakota, Ohio, and Rhode Island.

Is this a real cause for concern? Probably not. First, the Center for Medicare and Medicaid Services (CMS) says that it will be issuing guidance on this issue soon. That should help clarify how states should handle estate recovery for the expansion population. Second, estate recovery can cost states a lot. It is one thing to recover long-term care costs (for example, nursing home costs that Medicaid paid during the last two years of a person’s life). But it is another to try to recover health costs (for example, from the estate of a person who was on Medicaid for six month at age 58, never enrolled again, and died at age 80). That’s a lot of record-keeping and tracking.

In most cases, states probably won’t find this a worthwhile expense. That’s particularly true since they will have to send most of the money recouped to the federal government, which is paying the vast majority of the costs of the Medicaid expansion.

What can advocates do? Before investing too much on this, advocates should wait until CMS releases its guidance. After that, if more work is needed, advocates can push states to be less aggressive. Under federal law, states don’t have to recover anything beyond long-term care costs. Advocates can point out that in most cases, the administrative costs of collecting from a broad expansion population will be high. It’s also a policy that might deter some people from enrolling in Medicaid. That could end up costing the state more in uncompensated care costs today than it might theoretically recover sometime in the future.

The most important thing that advocates can do is to make sure that people who are uninsured and eligible for Medicaid understand that they should sign up. The costs of being uninsured are real and can hit someone at anytime—and can end up costing an individual’s potential heirs a lot more than the possibility that the state could maybe seek recovery from an estate, someday, years from now.

 

 

 

 

How Expanding Medicaid Saves Medicare Money

Mon, 02/10/2014 - 11:21am

A recent report from the Government Accounting Office (GAO) points to one more reason why expanding health coverage under the Affordable Health Care Act (ACA) makes good economic sense. Expanding Medicaid can eliminate gaps in the health coverage of those who eventually enroll in Medicare. This drives down Medicare’s costs because enrollees tend to enroll in the program in better health.

The report, “Medicare: Continuous Insurance before Enrollment Associated with Better Health and Lower Program Spending,” provides concrete evidence that the Affordable Care Act—which provides health coverage to more people both through the health insurance marketplace and by funding Medicaid expansion for the states that choose to take it up—can actually help preserve and strengthen Medicare.

In comparing seniors with and without health insurance prior to their enrollment in Medicare, the report findings include the following:

  • Seniors who had health insurance for six years prior to Medicare are more likely to report better health after Medicare enrollment.
  • These same seniors cost Medicare less money (35 percent lower, on average) in the first years of enrollment because they used fewer or less costly health services.
  • The savings to Medicare was an average of $2,343 per insured enrollee.
18 percent of individuals who were 55 to 64 years of age lacked health coverage

People are eligible for Medicare when they turn 65. As the report shows, having health insurance prior to enrolling in Medicare is critical to better health outcomes and lower costs per enrollee. But according to the report’s authors, in 2012, nearly 7 million individuals aged 55 to 64 lacked health insurance (about 18 percent of this age group). Why did they lack health insurance? Most are either not working, or working in lower-paid jobs that lack employer-based health insurance. These seniors struggle to meet daily expenses, have little or no money saved for retirement, and don’t want to accrue debt as they look toward the future.

What effect does lack of health coverage have on people who enroll in Medicare?

For seniors who lack health coverage prior to age 65 (when they become eligible for Medicare), many avoid or defer seeking necessary medical care because of the cost. As a result, they enter the Medicare program with untreated health problems that may have grown worse. This is essentially a pent-up demand for services.

Fortunately, the Affordable Care Act has the potential to improve this problem. How? By increasing access to health coverage through the marketplace and by funding Medicaid expansion in states that choose this option—thus extending health coverage to many more people, including the uninsured seniors whose health conditions can drive up the cost of Medicare.

Seniors with previous health coverage use health care services more effectively

An interesting counter-intuitive finding from the GAO report indicates that seniors with previous continuous coverage actually had more physician office visits after Medicare enrollment than those without prior insurance. The authors of the report suggest that this finding may indicate that, not only are these seniors in better health, but they are also accustomed to seeking medical care from a doctor’s office (where it is most effective) rather than an expensive emergency room (where it becomes more costly).

How can the Affordable Care Act strengthen Medicare?

The Affordable Care Act can strengthen Medicare by providing affordable health insurance for seniors (those with incomes up to 400 percent of the poverty level—roughly $46,000 annual income for one person) in two ways:

-        providing robust premium tax credits through the health insurance marketplace

-        funding the expansion of Medicaid in states that choose this option. For seniors with the lowest incomes, Medicaid expansion has the potential to provide quality, affordable coverage to more than 2 million people who are 55 to 64 years of age.

However, because the U.S. Supreme Court made it an option for states to expand Medicaid to everyone below 138 percent of poverty, half of the states have not yet decided to expand this program. This statistic is notable because the Affordable Care Act provides 100 percent federal funding for the first three years of expansion (and never less than 90 percent after that).

Accepting federal dollars to expand Medicaid helps ensure that every senior enters Medicare in better health and will cost the Medicare program less money as a result.

If your state has not made the decision to expand Medicaid, it is not too late. States can expand Medicaid at any time. If you care about seniors and the future of the Medicare program, urge your state’s governor and state representatives to expand Medicaid. It is a win-win for our families and our nation’s health care system.

For a 50-state map on Medicaid expansion efforts in 2014, view our recent infographic, “A 50-State Look at Medicaid Expansion: 2014.”

 

 

Reducing "Job Lock": How the Affordable Care Act Empowers Working Families

Fri, 02/07/2014 - 3:45pm

By now, many of you have either read or heard about the recent economic projections released by the Congressional Budget Office (CBO). The reaction from conservatives opposed to the provisions of the Affordable Care Act has been predictable. But plenty of journalists and policy groups consider the report an example of how the health care law is actually improving the quality of life for many Americans-most notably by giving people more freedom to make deeply personal choices about how they split their time between the things most important to them-their jobs and their families. The CBO report finds that what we know as "job lock"-the forced dependency (that many working Americans experience) to a job that doesn't allow them to make other priorities (such as taking care of a child or a disabled spouse, or even one's own health condition)-is diminishing.

Why? Because, through the Affordable Care Act's health insurance marketplaces, more working families can afford to buy insurance that is NOT tied to an employer, and they are now choosing to work in jobs with more limited hours-jobs that allow them the flexibility to take care of priorities that they were neglecting before. The report describes the number of hours worked as a reduction in the "total number of hours Americans work by the equivalent of 2.3 million full-time jobs." Many opponents of the Affordable Care Act are, predictably, casting this 2.3 million number as jobs lost. A good post outlining how the CBO refutes this claim is here. And Paul Krugman's post in the New York Times offers an articulate counterpoint to the inaccurate reporting as well.

So, it's important to read this figure as the CBO intended-not as hours lost, but as hours that working families have gained to take care of their most pressing priorities-their health and their families.

New Study from the Commonwealth Fund Finds that Forgoing Medicaid Expansion Would Cost State Residents Billions of Tax Dollars

Fri, 02/07/2014 - 11:55am

News about the benefits of expanding Medicaid just keeps coming. On December 5, 2013, the Commonwealth Fund published a study looking at the financial benefits for states that expand Medicaid under the Affordable Care Act. This new study takes a slightly different look at what Medicaid expansion could mean for state finances: It finds that states that reject the Medicaid expansion are costing their residents billions of dollars in taxes.

The report, How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion, joins the long list of studies that show how states can reap significant rewards if they expand Medicaid. For example, Medicaid expansion can improve residents' health and reduce mortality, it can reduce uncompensated care costs, and it can create jobs and business activity because of the added federal funds flowing into states.

This study uses projections for 2022, when the federal government will pay 90 percent of the costs of expansion, and states will pick up 10 percent of costs. It looks at the federal dollars flowing into states to expand Medicaid and three ways this positively affects state residents and finances.

  1. Putting Medicaid funding into context: On average, Medicaid expansion brings in about 2.35 times more federal dollars than what states would get through the highway funds program and 1.25 times more than the amount states get from federal support for defense procurement contracts.
  2. The costs of not expanding for residents: The vast majority of the Medicaid expansion will be paid for with federal funds, and those funds are raised by collecting federal taxes from residents in every state. Residents pay those federal taxes whether their state expands Medicaid or not. In states that participate in the expansion, much of that money will flow back into the state in the form of health coverage for low-income residents and payments to hospitals and other health care providers. The report looks at the federal funding states would forego if they don't expand Medicaid, adjusted to reflect the federal taxes state residents pay to fund the expansion. In every state, taxpayers would lose hundreds of millions to billions of dollars in 2022 alone.
  3. Comparing the costs of expanding Medicaid with other state efforts to bring in money: On average, the cost of the Medicaid expansion will be less than one-sixth of what states spend to attract private businesses, through costs like tax breaks.

So, what does this all mean?

  • Medicaid expansion will bring federal dollars into states at a level that's on par with programs that state politicians lobby to draw funding from.
  • In states that don't expand Medicaid, residents are paying millions, or even billions, to fund a federal program that doesn't benefit their state.
  • For less than they pay on average to attract private businesses, states can get federal funds that will provide health care for their citizens, money for hospitals and other health care providers, and jobs in the health care sector that will generate jobs and business activity in other sectors.

Above all, states that don't choose to expand Medicaid are costing their residents billions of tax dollars. And state residents should let their politicians know that's not acceptable.

HHS Releases New Requirements for Health Plans in Federally Facilitated Marketplaces for 2015

Wed, 02/05/2014 - 3:12pm

UPDATE: Families USA has now released template comments on the 2015 Letter to Issuers in the Federally Facilitated Marketplace (FFM) (the guidance discussed in this blog) for you to use in drafting your own comments. To see Families USA’s completed comments as submitted to HHS, click here.

Yesterday, the Department of Health and Human Services (HHS) released guidance to health insurers that outlines what the agency will require of health plans that want to sell health or stand-alone dental coverage in federally facilitated marketplaces (FFMs) next year. (Partnership marketplaces and federally facilitated marketplaces that conduct plan management functions may also implement these standards, although they have some flexibility in how they do so.)

The guidance letter sets the timeline under which insurers must submit proposed qualified health plans (QHPs) for federally facilitated and partnership marketplaces to be sold in 2015 (with a June 27, 2014, deadline for plans in fully federal marketplaces). It also sets standards for several health plan elements that are important to health care consumers, some of which are described below.

HHS is accepting comments on the guidance until February 25, 2014.

What does the HHS guidance require of health plans?

Provider networks and drug formularies

Direct links to provider directories and drug formularies: The guidance proposes requirements that insurers post up-to-date URLs that link directly to provider directories and drug formularies on marketplace websites. It clarifies that these links should not direct consumers to a website that requires further navigation, a login, or a search for a specific insurance product number in order to find the appropriate directory or formulary.

Network adequacy: For 2014, HHS is relying on state reviews or health plan accreditation to assess whether qualified health plans have adequate provider networks to serve their enrollees. For 2015, however, health plans will be required to directly submit their provider lists to HHS so it can assess whether the plans can provide access to care without unreasonable delay. In addition to these strengthened requirements, the guidance indicates that HHS is considering future federally facilitated marketplace network adequacy requirements that address factors such as a consumer’s travel time and distance to health care providers, along with a searchable provider directory for consumers.

Access to essential community providers: The guidance also strengthens standards for ensuring that essential community providers, those who serve predominantly low-income and medically underserved individuals, are sufficiently included in qualified health plan provider networks. The guidance proposes that plans in the federally facilitated marketplace must contract with at least 30 percent of the essential community providers in their service area. Plans must also make a good faith effort to contract with at least one of each type of essential community provider listed by HHS (Federally Qualified Health Centers, hospitals, Ryan White HIV/AIDS providers, etc.).

Future proposed rules on coverage transitions: The guidance shows that HHS intends to issue a future rule indicating that marketplaces may require insurers to temporarily cover non-formulary drugs or waive step therapy (which requires patients to try less expensive alternative medications before turning to more costly alternatives) or prior authorization requirements during the first 30 days of a consumer’s coverage that starts on January 1 of any year. HHS is also considering policies to ease coverage transitions for other types of care and is seeking comment on such policies.

Plan design: benefits and cost-sharing

Discriminatory benefit design: The guidance proposes a stronger federal review process in federally facilitated marketplaces to ensure that qualified health plans’ benefit designs do not discourage enrollment of people with significant health needs. This review would include an analysis to identify qualified health plans that are outliers when it comes to cost-sharing for specific benefits, as well as prior authorization and step therapy requirements for prescription drugs to identify potentially discriminatory benefit designs. It would also include review of the language that plans submit to explain covered benefits and exclusions to identify discriminatory practices.

Future proposed rules on cost-sharing for primary care: HHS is considering future rules to require all plans (or at least one plan in each metal level per insurer) to cover three primary care visits prior to a consumer meeting a deductible. HHS is encouraging insurers in federally facilitated marketplaces to adopt this policy.

Premium affordability

Premium rate review: For states that comply with federal rate review requirements, HHS will continue to largely rely on state assessments of whether proposed premiums for qualified health plans are justified. However, HHS intends to conduct new “outlier analyses” to identify premiums that are relatively high or low compared to premiums for other qualified health plans in the area and will work with states to determine if outlier plans should or should not be sold through the federally facilitated marketplace.

How can health care advocates weigh in, and how can Families USA help?

The comment period for this guidance is an important opportunity to influence the policies that will determine how consumers will fare in federally facilitated marketplace coverage in 2015. Comments should be submitted to FFEcomments@cms.hhs.gov by Tuesday, February 25. Families USA will release draft comments the week of February 10 to help others weigh in on how to ensure that marketplace plans can meet consumers’ needs. For more information, contact Claire McAndrew (cmcandrew@familiesusa.org) or Lizette Rivera (lrivera@familiesusa.org).

 

 

 

 

 

ACA Will Increase Employment Opportunities in the Health Care Workforce for Communities of Color

Wed, 02/05/2014 - 12:46pm

One aspect of the Affordable Care Act that has flown under the radar is its potential to increase employment in the health care sector for everyone, including people of color. Currently, health care employees comprise 12 percent of the labor force, making this sector the largest employer in the economy. The Affordable Care Act will only increase this share, not just because the newly insured will boost the demand for health care, but also because many who already have insurance will likely seek more preventive care than they did before.

As a result of the Affordable Care Act and demographic trends, employment in nearly all health care jobs is expected to grow drastically between now and 2020. Ensuring that people of color are able to take part in this job growth is vital both for the families and communities that benefit from this economic opportunity directly, and for the patients of color who will benefit from having more culturally competent providers.

Health care is one of the fastest growing and most recession-proof fields in the US economy. The two most numerous types of health care employees—registered nurses and home health aides—are expected to see their ranks swell 26 and 70 percent, respectively, by the end of the decade.

This is great for the economy as a whole, and given that one fourth of registered nurses and one half of home health aides are people of color, it is encouraging for minority communities as well. However, many of these employees, particularly home health aides, often receive low pay.

Therefore, it is vital that communities of color benefit from the growth in other types of health care employment as well. Physicians and pharmacists, for example, will also see increased demand for their services, and currently people of color are disproportionately less likely to hold these positions than whites.  It is crucial that people of color receive a chance to attain these more technical, higher-paying positions that require post-secondary education (college and/or training programs).

In their paper “Affordable Care Act of 2010: Creating Job Opportunities for Racially and Ethnically Diverse Populations,” Drs. Bianca Frogner and Joanne Spetz note several ways to meet this goal. First, both high schools and colleges (especially community colleges) should educate students about employment in the health care industry and provide classes to prepare them for relevant post-secondary education. Some school systems, such as Boston Public Schools, have already established these types of programs, calling them “Health Care Career Academies.” Additionally, health care employers may wish to establish on-the-job training programs, which would increase the skill level of their workers and qualify them for higher level positions.

Finally, health care employers or federal, state, and local agencies could provide tuition support to those who are training for or looking to advance their careers in health care. Employers, educators, and agencies should also work to address non-financial barriers to post-secondary education, such as difficulty accessing transportation or childcare.

The second reason to encourage diversity in the health care workforce is to build cultural competence, which is defined as the ability of systems to provide care to patients with diverse beliefs, behaviors, and values.

There are many aspects to cultural competence. At its most basic, it includes ensuring that medical professionals speak the same language as their patients, or at least that interpreters are available in situations where this is not possible. However, culturally competent care also addresses more subtle aspects of patient care. Studies have shown, for example, that African Americans are more likely to feel that they have a say in their visits when their physician is also African-American, which leads to increased patient satisfaction. Patient satisfaction, in turn, is linked to better health outcomes for certain conditions.  Therefore, cultural competence can be an important ingredient in reducing health disparities. A more diverse health care workforce is likely to be a more culturally competent one that will be better equipped to care for our increasingly diverse nation.

The Department of Health and Human Services has recently moved to address these issues, awarding $22.1 million in grants to offer low-interest student loans to students training to become nurse faculty. It also has awarded $5.2 million to improve nursing diversity, by expanding educational opportunities to those who come from disadvantaged backgrounds, including racial and ethnic minorities. This is a crucial acknowledgment of what is at stake, and hopefully, one of many forthcoming steps to encourage a diverse health care workforce.

 

Proposed New Quality Rating Systems Will Allow Consumers to Rate Health Plans in the Health Insurance Marketplaces

Mon, 02/03/2014 - 12:04pm
Families USA’s comments to the Centers for Medicare and Medicaid Services on the proposed Quality Rating System

Families USA’s comments on the new QRS system are supportive overall, though we identified areas where the measures of quality should be expanded and improved. For example, while we found that the proposed individual indicators did a good job of measuring provider performance, we recommended that additional measures of plan performance be added. Among our recommendations was inclusion of indicators that measure:
- wait time to talk to a health plan customer service representative
- accuracy and clarity of information delivered by customer service representatives
- how often claims were denied, how clearly the plan communicated the reason for the denial, and the timeliness and ease of the process for a consumer to appeal a denied claim. 

Consumers will soon have a powerful new tool that allows them to use data to measure the quality of different health plans offered in their state’s health insurance marketplace. This tool is based on the new Quality Rating System (QRS) proposed by the Centers for Medicare and Medicaid Services (CMS). It is a notable step forward in the adoption of employing consumer-friendly data transparency practices to help individuals make data-driven, informed decisions about their health care choices. In November 2013, CMS issued a notice and request for comments on the proposed framework and measures for a Quality Rating System. While the comment period on the notice has closed, health care consumer advocates should
know about this valuable new tool on the horizon.

The Quality Rating System will require insurance plans to submit data on health care quality, health outcomes, consumer satisfaction (based on an enrollee survey), and the cost of care. CMS’ proposal requires plans to report data on 42 indicators for family or individual plans and 25 indicators for child-only plans.  

Sharing this data in a consumer-friendly manner is critical to the success of the new Quality Rating System, both for consumers shopping for plans and for state marketplace administrators contracting with plans to participate in state marketplaces.

Features of a consumer-friendly Quality Rating System for health insurance plans in the marketplace:

-  displays transparent, accurate, current data on the quality and value of each plan to allow consumers to compare and contrast plan performance uniformly and easily across all plans

- creates a much-needed new data source on plan performance that allows state marketplace administrators to feature strong-performing plans and weed out poorly performing ones

-  helps state marketplace administrators create incentives (through contract requirements or bonuses)
for health plans to improve their plan’s Quality Rating System scores. To receive these incentives, health plans can introduce specific reforms that improve the quality of a health plan based on how it charges for services or how well it delivers health care to consumers.

- strengthens the ability of states to make accurate, data-driven decisions when reviewing and approving health insurance plan premium rate increase requests. States can access data on whether a plan is doing basic care coordination or employing other system improvement payment and delivery reforms to hold down costs.

- provides decision-makers with data that allow them to measure the effectiveness and quality of the health care that diverse populations are receiving, and to ensure that health care providers and plans address any disparities in how that care is being delivered.

We will keep you posted in future blogs as the Quality Rating System for plans in the new health insurance marketplaces moves forward. As we all continue our work helping consumers select the best plan for their needs; as well as encouraging state marketplaces to take a more proactive role in selecting high-value plans, controlling premiums, and driving system change; the Quality Rating System will be a powerful new tool for consumer advocates. 

Q&A with Ron Pollack: Insight into the Latest Health Insurance Marketplace Enrollment Numbers

Fri, 01/31/2014 - 4:47pm
The vast majority of people who have completed the enrollment process – 79 percent as of the end of December 2013 –have qualified for financial assistance to help pay for their health plan. This is important because it confirms what we know about the people who lack insurance: most people who are uninsured need help paying for coverage in order to buy it.

A new and widely circulated Health & Human Services report indicates that approximately 2.2 million people bought health insurance through the marketplace through the end of December, 2013 (3 million, as of late January)—the first half of the inaugural open enrollment period. These figures paint an encouraging picture of enrollment—momentum is building. A marked increase in December enrollment figures supports this, as December’s enrollment figures in state-run marketplaces were more than three times greater than the total enrollment for the previous two months. And in the federally facilitated marketplace, the figures for December were even higher—nearly eight times higher than the total enrollment for the two preceding months.

We’ve turned an important corner, and the trend points to even stronger enrollment numbers in the second half of the open enrollment period. But there is still much work to do: recent research confirms that many people who may be eligible for health coverage remain unaware of their options and, more importantly, about the financial assistance available to help them to help pay for their health care—a key boost toward affordable health care.

We sat down with Families USA Executive Director, Ron Pollack, for some insight into what the future holds for buying health insurance during the open enrollment period.

Q:           What do you think accounts for the surge in people buying health insurance in December?

A:           I’m not surprised by this. It’s reasonable to expect more people to buy coverage now that healthcare.gov has improved its operations. And it was reasonable to expect that people would take some time at the outset of open enrollment to assess their options, learn more about what is available to them, and think about which plan fit their family budget and health care needs. And, of course, the end of December was a crucial deadline for people who wanted insurance to start on January 1.

Some of the people who enrolled had received termination notices stating that their health insurance plan would be out by the end of the year. With their current health insurance plan (and let’s remember that the policies that got cancelled were substandard policies that offered poor value to consumers), this group of consumers turned to the new marketplaces. This helped them avoid a gap in coverage. Consequently, the second half of the open enrollment period will see the numbers surge even more.  These were substandard plans, such as plans that established arbitrary limits on how much the insurers would pay out in a year or a lifetime when a major illness or accident occurred. These were like Swiss cheese insurance policies, and many people upgraded their coverage before the end of the year.

But despite the fact that there was a surge in enrollment in December, we shouldn’t think that our job is done with respect to public education about the Affordable Care Act. The reason we’re not seeing more people enroll is because those who are skeptical or fearful of health insurance need to see that the new health system is different and better than the old model. When people who were uninsured tried to buy insurance in the past, they often encountered problems (cost, confusing paperwork, coverage denials because of a pre-existing condition, or coverage that was just simply too expensive). These health care consumers found that their needs weren’t being met. Now, these same people need to move past those negative experiences because, you’ve got to understand, the Affordable Care Act changes all of that.

You’ll recall that the same thing happened with Medicare Part D—the law passed in 2003 that gave Medicare recipients prescription drug coverage—when the beginning of enrollment didn’t see as many new enrollees, but picked up significantly by the end of the open enrollment period. And the same was true with Massachusetts’ health care law. Over time, enrollment increased. Data from a state-funded survey called the Massachusetts Health Insurance Survey indicate 372,000 state residents were uninsured in 2006, or 6.4 percent of the state’s population. As of 2010, Massachusetts boasted the lowest rate of uninsured people in the country.

Q:           What would you say to someone who is currently uninsured?

A:           Too many people without insurance don’t know how the financial subsidies can benefit them. If you’ve had a bad experience with your health insurance company, then you might view health insurance as unaffordable or even unattainable. It is our job to bridge that information gap. You now have the peace of mind in knowing that you can buy health insurance that is comprehensive and affordable. This insurance comes with strong protections for you that ensure that the insurance company doesn’t discriminate against you, turn you down, or fail to use your health care dollars wisely.

Also, the health system never included financial assistance (premium tax credits) to help you  buy health insurance before—that’s entirely new. Now, we have new help that makes health coverage affordable.

Q:           What significant trends have you seen in the first half of the open enrollment period?

A:           There are two important trends that I see so far. The first is that the states running their own health insurance marketplaces have seen higher enrollment numbers than those using a marketplace run by the federal government. I think that’s because these states tend to be the most interested in making the Affordable Care Act work. Therefore, because high enrollment is a critical part to success, these state-based marketplaces have made enrollment and outreach a priority—and they’re more successful at consistently reaching people.

The federal government has also given state-based marketplaces more money for outreach (such as advertising) and for enrollment navigators and assistors than federally run marketplaces. So I’d say that the advertising for state-based marketplaces has been considerably more effective because they have greater resources.

Here’s the breakdown of which states run their own marketplaces.

  • 17 states (including the District of Columbia) are running their own health insurance marketplace
  • 27 states are run by the federal marketplace (healthcare.gov)
  • 7 states are participating in partnership exchanges.

The second trend that I’m seeing is that the vast majority of people who have completed the enrollment process – 79 percent as of the end of December, 2013 –have qualified for financial assistance to help pay for their health plan. This is important because it confirms what we know about the people who lack insurance: most people who are uninsured need help paying for coverage in order to buy it. Financial assistance may ultimately be the most important factor in making enrollment successful, and we need to make sure that people know about it.

Q:           Opponents have criticized the enrollment effort for not convincing enough young adults to buy coverage, claiming that more of them need to buy into the system to make it sustainable. Is this accurate? And if so, what more needs to be done to reach this demographic?

A:           First, we need to make young adults aware that they are eligible for financial assistance (premium tax credits) in paying their monthly premiums

Second, we need to understand where these young adults are coming from. This key demographic often falls into one of three situations:

  1. They’re continuing their education
  2. They don’t have a job
  3. They’re working in an entry-level job that pays less than jobs held by people who have been employed longer

In any of these scenarios, being able to pay for health care remains the priority. Because young adults typically have the lowest incomes, the amount they’ll receive in financial assistance is the greatest. So young adults will disproportionately benefit from these health subsidies. The bottom line is to make sure they learn about availability of these substantial subsidies.

The President challenged Americans during his State of the Union speech earlier this week to help someone they know get covered. We agree that this is a priority. Worrying about getting sick and how to pay exorbitant medical bills, or struggling just to see a doctor, is no way to live. And because of important provisions in the Affordable Care Act, such as financial help for those with low incomes, you don’t have to. 

This blog was written with the assistance of Editor Talia Schmidt.

Congressional Conservatives Propose Alternative Legislation to Affordable Care Act

Wed, 01/29/2014 - 1:19pm

On Monday, three Republican senators released The Patient Choice, Affordability, Responsibility, and Empowerment Act, a proposal that would repeal the Affordable Care Act and the powerful consumer protections that exist today. Though the likelihood of its passage is slim, it nonetheless offers a comprehensive picture of how opponents of the Affordable Care Act view the way our health care system should operate.

Because the specifics of this proposal remain unclear, it is impossible to predict the exact implications of the proposed legislation. We can say, however, that it would leave a significant number of Americans without the access to health insurance they’re now provided through the Affordable Care Act.

This new proposal would also eliminate Medicaid expansion. And it would alter the traditional Medicaid system by giving block grants to states and reducing consumer protections, which could cause those beneficiaries who need Medicaid the most to lose access to their health coverage, as a recent Center on Budget and Policy Priorities report underscores.

Someone could be penniless and still not qualify for Medicaid, while states would be allowed to start adding copays and deductibles to their Medicaid programs.

Insurance companies could revert back to old ways, denying coverage to people with preexisting conditions. Women and older people, including those over age 55, could once again be charged more for health insurance in the private market. Further, states would be able to opt out of the current requirement that allows children (up to age 26) to stay on their parent's plans. Though the proposal contains a tax credit for consumers to help pay their monthly premiums, the new plan would strip middle class families who are between 300 and 400 percent of poverty of their financial assistance. Lower-income families would also lose the current financial assistance that helps them pay for deductibles and other out-of-pocket expenses. 

The legislation also curtails consumer protections. In a recent article, the Washington Post’s Sarah Kliff warns that the new plan does not contain exchanges and fails to determine a set of benefits that insurance plans must cover. The proposal lacks requirements for insurance plans to provide certain benefits that consumers expect are covered, such as maternity and mental health coverage. Often times, consumers don’t discover that these benefits are not covered until it’s too late. The plan also removes the current health care marketplaces, which are a critical factor in helping to keep rates competitive.

Finally, the proposal would be financed by taxing employer-provided insurance, but would no longer require large businesses to provide health coverage to their employees.

 

Consumers Now Have Options When It Comes to Health Insurance Plans and Carriers

Tue, 01/28/2014 - 1:44pm

Thanks to the Affordable Care Act, consumers have more options for carriers and health insurance plans through their state’s marketplace.

According to data from healthcare.gov, 34 states’ marketplaces offer plans from an average of six insurance carriers.

Each of these carriers provides a range of health insurance plans. These plan choices will give people the flexibility to a find a health plan that meets their needs. Finding providers, prescriptions, and pricing is much easier now. Plus, most of these states offer at least four carrier options.

Choosing the right health coverage category and getting financial help to pay for a plan

Plans with similar levels of care are organized into four categories (also known as metal levels): bronze, silver, gold, and platinum.

And if you need financial help, visit your state’s marketplace website to compare health plans and see if you qualify for financial help to pay less out-of-pocket.

If you qualify for financial help to reduce your monthly payment (also called a premium), you can use this toward buying a plan in any metal level.

Certain financial assistance requires choosing a silver plan

If you qualify for extra financial assistance to lower costs for health care services, such as copays, coinsurance, or deductibles, you must choose any silver plan in the marketplace to take get this extra help.

In each of these 34 states, there are at least four different silver plans offered. And on average, these states offer 26 different silver plans. With such a wide variety, states are hoping to meet the needs of as many residents as possible in one plan or another.

The Affordable Care Act brings freedom and flexibility in choosing the right health plan

Given what we know about economics, offering consumers more choices typically means greater competition in the marketplace, which often leads to lower prices. Offering these options should allow consumers to find a plan in which they can keep their doctor if they want or receive their medication without worry.

The Affordable Care Act was designed to promote the freedom of choice and flexibility in shopping for health coverage.

 

 

Consumers Now Have Options When It Comes to Health Insurance Plans and Carriers

Tue, 01/28/2014 - 1:44pm

Thanks to the Affordable Care Act, consumers have more options for carriers and health insurance plans through their state’s marketplace.

According to data from healthcare.gov, 34 states’ marketplaces offer plans from an average of six insurance carriers.

Each of these carriers provides a range of health insurance plans. These plan choices will give people the flexibility to a find a health plan that meets their needs. Finding providers, prescriptions, and pricing is much easier now. Plus, most of these states offer at least four carrier options.

Choosing the right health coverage category and getting financial help to pay for a plan

Plans with similar levels of care are organized into four categories (also known as metal levels): bronze, silver, gold, and platinum.

And if you need financial help, visit your state’s marketplace website to compare health plans and see if you qualify for financial help to pay less out-of-pocket.

If you qualify for financial help to reduce your monthly payment (also called a premium), you can use this toward buying a plan in any metal level.

Certain financial assistance requires choosing a silver plan

If you qualify for extra financial assistance to lower costs for health care services, such as copays, coinsurance, or deductibles, you must choose any silver plan in the marketplace to take get this extra help.

In each of these 34 states, there are at least four different silver plans offered. And on average, these states offer 26 different silver plans. With such a wide variety, states are hoping to meet the needs of as many residents as possible in one plan or another.

The Affordable Care Act brings freedom and flexibility in choosing the right health plan

Given what we know about economics, offering consumers more choices typically means greater competition in the marketplace, which often leads to lower prices. Offering these options should allow consumers to find a plan in which they can keep their doctor if they want or receive their medication without worry.

The Affordable Care Act was designed to promote the freedom of choice and flexibility in shopping for health coverage.

 

 

Live from Health Action 2014...Saturday 1/25/14

Sat, 01/25/2014 - 12:11pm

From: Talia Schmidt
2:30pm 

Looking Forward plenary

The ballroom is buzzing as colleagues and friends come together for the closing of Health Action 2014. Business cards are exchanged, phone numbers given out, hugs distributed freely and frequently.

Families USA’s executive director Ron Pollack invites Texas State Senator Leticia Van de Putte to the stage for some closing remarks.

Van de Putte shares her gratitude to all the health advocates in the room for devoting three days of their time to engaging in the discussions here at Health Action 2014.

She pauses to relay her favorite Martin Luther King Jr. quote:

“Life’s most persistent and urgent question is ‘what are you doing for others?" 

“You in this room have answered it,” Van de Putte says. “You, everyday, are doing for others. It’s what motivates me in my work.”

She firmly believes in leaving the next generation a little bit better off.  This is why she was so triumphant when the Supreme Court decided that every person deserves health care and upheld the Affordable Care Act.

Van de Putte, who has six children, proudly shares that all of them have jobs. And health care.

Too many families are burdened with financial worries. But with the Affordable Care Act, these families receive something—a peace of mind—that cannot be taken away from them.

And it’s the health care advocates fighting for affordability and reaching those families that are responsible.

She encouraged staying strong against those oppose health reform. In Texas, she says, opponents tried to raise the costs for navigators and assisters helping with enrollment.

But it’s the work of advocates that keep her going.

“We’re so proud of the work you have done, and we know we have a lot of work to do,” Van de Putte says. “Especially those that have chosen not to expand Medicaid.”

“The decision not to expand Medicaid was a terrible business decision on the part of our state. We said no to $4 billion. That’s why we have members of the Chamber of Commerce now begging us to expand Medicaid.”

Van de Putte leaves us with the notion that everything comes back to health care. It’s imperative that we continue in our fight to preserve this right for all American consumers.

“What we do know,” Van de Putte says, “is that health and health care is the bedrock of any family’s success.” 

From: Talia Schmidt
9:05am

Saturday morning's Health Action 2014 conference kicks off with a discussion about digital strategy and social media.

"What is this thing called digital strategy?" asks Families USA's moderator Carla Uriona. "It's simply to communicate."

Sharing a message, engaging, and pursuing a call to action is a timeless thing; it hasn't changed.

Susannah Fox of Pew Internet and American Life Project has studied the effects of social media on health care. She uses data in grant proposals to convince people to start using social media.

In preparation for this workshop, Fox admits she started the conversation on Twitter a week ago, soliciting ways that different demographics view social media. More than 1,200 people engaged in the conversation.

Younger audiences are on social media platforms like Twitter and Facebook, which remains the most dominant form of social media today.

Fox prefers Twitter. "It's like taking a twirl on stage, and hoping somebody's going to see it."

What else we learned from Susannah Fox:

  • Instagram works well for information best expressed visually.
  • YouTube swamps Facebook. As WiFi and broadband take over, people are sharing videos more and more. "It's very popular for young people, but there's an opportunity for all users."
  • Slideshare is best when you have a lot of information to share.
  • Tumblr, a very visual platform, is an incredibly participatory platform. "To me social media is as much a listening tool as anything else." Fox shared Planned Parenthood's Tumbl, which serves as a Q&A for readers.

Regina Holliday begins her presentation and within seconds, the audience learns what a bundle of energy she is.

When her husband was diagnosed with kidney cancer in 2009, he was transferred to five facilities in just 12 weeks. Throughout the process, Holliday was amazed by the lack of organization in hospitals regarding their electronic records.

The medical facilities told Holliday that copies of her husband's records would cost $.73 per page and would only be available after a 21-day wait.

A short time later, her husband died. Holliday had requested her husband's medical records so she could research his condition and care. She also hoped that they could make informed decisions together. She never had the chance.

Holliday threw herself into her art. She grew frustrated when people said art is just for children or a way of expressing yourself. While it certainly can be, Holliday uses her art for a greater good: for patient advocacy.

She uses it to raise awareness about important health care issues in America.

Her first community art project stemmed from $500 in paint supplies, a wall that was donated to her, and a ladder from her church. She painted a mural underscoring the importance of why patients must have access to data.

It instantly got picked up on Twitter and soon, ABC, NBC and eventually, the British Medical Journal. 

"You realize you're not just drawing on a wall," Holliday says with unparalleled fervor. "You're doing it on the internet."

You can see her masterpiece, "73 Cents," at 5001 Connecticut Avenue.

Holliday values the medium of murals because they're permanent. "You can't tell a wall to shut up."

She has also painted about hygiene practices in hospitals that would potentially reduce the rate of Clostridium difficile, also known as C-Diff. She finds inspiration for her work from data online.

And it doesn't end there. Holliday got the idea that greeting card companies should make hospice cards. She started a "TweetChat" that even TedMed joined, until finally, a greeting card company called her to tell her they loved her idea.

Last but not least, Holliday founded a flashmob called The Walking Gallery, a group of people who comes together to "wear our stories on our backs." The members wear jackets or doctor's lab coats painted with the story of a patient or an element of medical advocacy.

While she's a health advocate, Holliday primarily considers herself a health policy activist. Everything she does, she says, is to make policies more patient-centered.

The Walking Gallery doesn't make money; it's a movement. But Holliday walks with pride and brought together an extraordinary community of health advocates.

Lawrence Swiader knows it's a tough act to follow. He works for the National Campaign to Prevent Teen and Unplanned Pregnancy and helps run the Bedsider program to rebrand birth control.

Bedsider's mission is to take the fear and mystery out of birth control. It seeks to reduce the proportion of unplanned pregnancy by 20% by 2020.

"We try to make our content social and engageable and shareable," says Swaider.

Swiader knows talking about birth control can be sticky at times, which is why he hopes people will take to social media to engage in a lively conversation sharing stories and facts.

When it comes down to it, this panel certainly empowers you to engage in social media and share your stories, hard as it might be, with the world. Our personal tragedies and triumphs can inspire us to get involved in a community that needs us to stand up for health care.

Holliday looks out at the crowd with a heartfelt smile worth more than a thousand words.

But, she offers some words to live by anyways.

"People's stories are just as important as data."