Wednesday, January 22, 2014

"Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors

"Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors
A useful paper that covers issues I did not fully know about.  

Balt Sun: Consumers trading up for better, cheaper health insurance

Sun: Sharfstein: Risks outweigh benefits of exchange switch  

o   GOP’s sad, pathetic “replace Obamacare” plan may finally be coming Salon by Brian Beutler   

4) Measuring Quality of Care for Older Adults With Serious Illness 
An interesting article. Do not know whether they adequately address the inclusion of outcome measures, which I view as critical.  There is no discussion of this topic but perhaps such measures are encompassed in the proposed measures, hard to tell. 

5) Webinar: The Affordable Care Act's Health Insurance Marketplaces: What's the Experience So Far?

Some useful material. See especially Collins and Dash presentations.  

6) Washpost blog: Target is dropping insurance for some because of Obamacare. That could be good news for workers.

Tuesday, January 21, 2014

Medicaid signups surge in many states + more

 1) Even As Exchange Enrollment Numbers Appear Sluggish, Medicaid Expansion Sign-Ups Surge In Many States Especially West Virginia.

2) Families USA posted:
Evaluating the Consumer Window-Shopping Experience in Health Insurance Marketplace Websites: A Comparative Analysis - See
This is a good article. However, it does not include since no state uses it.  Morse's site is the most comprehensive and useful to consumers. 
Here is what I had to say about it

Morse's site is the lead article in CQ HealthBeat.  It is a  great comparison shopping site. For ACA healthplans. It was praised by Zeke Emanuel, an architect of the ACA. 
His site is the most comprehensive consumer comparison shopping site. He is not compensated for this site. It provides in one table a comparison of all plans as to premiums, deductibles, copays, subsidies, consumer report quality ratings, and links to provider networks. 
Larry Leavitt from KFF had concerns about some of the data. Turned out KFF was in error, not Morse. 

3) North Carolina Obamacare Enrollment One of Nation’s Highest

In MD: Consumers trading up for better, cheaper health insurance (Balt Sun) 

4)  WSJ: Exchanges See Little Progress on Uninsured

5) USA Today: Co-ops the underdog in health insurance marketplace

Some are doing well.

6) KHN: Cost Of Care, Diabetes Are Top Latino Health Concerns 

7) Pace of enrollment in ACA greater than Medicare Drug plans (PartD)

8) Enroll America Email 

Includes a webinar tomorrow on Key Spanish Language messages

Some useful toolkits from this group are at

Our state-by-state chart: Marketplace enrollment as a share of the marketplace eligible population

 States vary from 2% to 15%.  Maryland at 4%.

study found that 1/2 of young adults can pay less than $50/mo. Find your estimate: .

The Miami Herald's Daniel Chang, working in partnership with Kaiser Health News, reports: "As health insurance companies shift more financial responsibility onto consumers through higher deductibles, co-payments and co-insurance rates, hospital executives are feeling pressure to reveal their most closely-held secret: prices. Last week, Miami Children’s Hospital became one of the first in South Florida to give consumers more information — but not exactly the prices — they need to estimate their out-of-pocket costs, an increasingly important factor when deciding where to seek medical care" (Chang, 1/19). Read the story.


Thursday, January 16, 2014

HHS feared web contractor could harm #Obamacare

HHS feared web contractor could harm , insurers, reports:


RT : Three states are reconsidering, while one ends, contracts with maker

Governor O’Malley and Lt. Governor Brown Announce New Efforts to Assist Marylanders who had Trouble Enrolling Through Website

Sounds good, but there will still be problems with this. 

4) A Call To Arms: Support For Emergency Care Isn’t Making The Grade



Sunday, January 12, 2014

More Folks Planning to Enroll

More Americans now say they’re planning to enroll In — and many of them are healthy

Chart: Majority of people potentially eligible for insurance options are aware of the exchanges & financial help

True but only 63%. Not that great from my perspective.   

Friday, January 10, 2014

Most Uninsured Unaware Of Tax Credits

KHN: Most Uninsured Unaware Of Tax Credits, Survey Finds

2) Hospital Presumptive Medicaid Eligibility

From Health Affairs Blog: how hospitals can help enroll patients. 

 3) Observation Care Status: The High Costs Of This Fine Print

I personally experienced the hospital losing out on this type of care. I question the policy.  

4) Some tweets from Larry Leavitt, Kaiser FF

It’s halftime for open enrollment. The young and healthy will likely enroll in larger numbers in the 2nd half

Risk corridors and reinsurance act as big shock absorbers in the first 3 years to protect against a bad enrollment mix.

We’re not going to know about health mix anytime soon. Even insurers won’t know a lot when they have to set premiums for 2015

5)  NYT: Understanding New Rules That Widen Mental Health Coverage




Thursday, January 9, 2014

The ACA and the Cost Curve

1) The ACA and the cost curve

On Tuesday, the newspapers discussed an article in Health Affiars that showed that while costs had declined, there is no evidnece that the ACA is a factor.   While I agree that there is no defnitive evidence that the ACA is a factor, I think there is a very reasonable possibility that it is.  The White House agrees that the ACA is a factor. 

See for example KHN: Health Care Spending Grew At Record Slow Pace

Some provisions that could make a difference:  Pay for performance,  Hospital readmission penalties, more emphasis on accountable care organizations, other integration initiatives (e.g. in post-acute care), 80% requirement on medical underwriting, and expansion of community health centers. In Medicare: more preventive services in Medicare and closing the donut hole. The creation of the exchanges is another factor as the insurance companies are likely to have lowered costs to be competitive in the marketplaces. 

Peter Orszag and several others have written well on this.  See
previous posts

Deceleration in Health Spending - full article

Obamacare may be causing a slowdown in health spending

See also:
Health Care Reform: Views From The Hospital Executive Suite   Hospital Execs predict savings from ACA.  

 2)  Commonwealth: New Survey Finds Rise in Visits to Insurance Marketplaces Since October; Many Shoppers Young, Healthy

Some useful results.  Encouraging as younger people showed interest in ACA. 

3) WSJ Health News (@WSJhealth) 8 Jan 14:

Massachusetts Wastes Third of Health Spending, Report Says

4) KHN: Supplemental Plans Raise Medicare Costs 22 Percent 

Need to read entire article as there is a debate in it. 

5) KHN: More Insurers Extend Premium Payment Deadlines  

6) KHN: As Workers' Insurance Costs Rise, Bosses (Sometimes Wrongly) Blame Obamacare  

7)  Fight To Cut Health Costs Depends On States

The States can play a role but can only contribute part of the answer.  

8) New One-stop Rating Site for California Consumers

see also KHN article 

Monday, January 6, 2014

ACA Status: My perspective

I do not have any profound insights about the ACA at this juncture.  I will just share my thoughts for what they are worth.

I first want to note, as previously stated, the ACA accomplished major changes from the start.  For instance, as of 2011: 
  •   young adults under 26 could enroll in their parent’s insurance policy
  • children could no longer be excluded for pre-existing conditions.
  • the Medicare prescription drug doughnut hole was reduced
  • preventive care services were expanded under Medicare.

Now to the major phase of the ACA, the expansion of the Medicaid program and the creation of the health insurance exchanges or marketplaces, which started this past October.  I share the frustrations of many with the myriad problems of the Federal and State marketplaces.  The computer problems have been very troubling and frustrating.  It appears that the worst of the problems are over but we are not home free as problems continue.  It is also noted that similar programs, like the Medicare prescription drug program, also had start-up problems. Whether or not we reach the goals for this first year, many millions will have enrolled in the private insurance and Medicaid plans and their costs will be significantly reduced.  Costs will not have been reduced for all, but apparently for most.  In subsequent years, many many more will enroll in these programs. 

Like others, I am optimistic that many additional states will embrace the Medicaid expansions in the coming years. 

As others have noted, the rate of inflation for health care costs has significantly declined.  It is not clear whether the ACA has been a factor but there is a reasonable possibility that it has.  And there are additional provisions in the law that will continue to contribute to reductions in the cost curve.

I have a few regrets, which are: 
  •  that I could not get adequate attention to Steve Morse’s website which is the most comprehensive consumer shopping comparison site.  I had Zeke Emanuel endorse it in an editorial, Congressional Quarterly and Hearst Newspapers highlight it, and the Capital Region Connector use it, but it is not used widely.
  • my efforts to engage a number of organizations to comprehensively mobilize enrollee recruitment efforts at the State level have so far not been very successful
  • several of my other suggestions have not had an impact, but a few have.

I am also very pleased that I was able to organize and provide assistance at a number of enrollment fairs, which got some media attention.

To those who say we should have had single payor, my answer is that Baucus and his staff, who were the under-appreciated architects of the ACA, pulled off a most brilliant move.  It was the best compromise that could have been achieved given the politics of this country.  Many European countries that have national health insurance do not have single payor systems either.  Perhaps somewhere down the road, single payor will be achievable but not in the near future.  Keep in mind, Presidents for 100 years have tried to enact reform without success. Obama deserves credit for having learned the lessons from the Clintons by letting Congress take the lead and only being a cheerleader and lobbyist with some key input. 

In summary, while I have concerns, I remain optimistic that the ACA will be a major success.  Nevertheless, there is much work to be done and I hope that more of us can join together to ensure the best outcome.  Please let me know if you are willing to help with the ACA. 

Sunday, January 5, 2014

First days of coverage seemed to go smoothly.

1) 3 Jan
Compared to the first days of Obamacare enrollment, the first days of coverage seemed to go smoothly. What's next?   I wonder how accurate this statement is given that folks may not have tried using the system yet.  

Why neither the White House nor Republicans are very comfortable with Obamacare's biggest coverage success: Medicaid 

Chart: How does patient access to a doctor or nurse when care is needed compare across countries?   I hope it improves with the ACA.  Hard to predict given the expected shortages of providers.

Friday, January 3, 2014

State leaders embrace Medicaid expansion

Sun: State leaders embrace Medicaid expansion  
Glad to see progress in Maryland. 

 2) KHN: Six Things That May Move Public Perception Of Obamacare 


2014 = Obamacare ad blitz. Millions of $ in pro-enrollment ads in Q1, followed by the midterms.

Health insurance comes to Skid Row. My KHN and NPR colleagues take a look.

Lots of very interesting articles in this issue.   

4 in 10 uninsured Black adults who could qualify for Medicaid fall into coverage gap – read more in our brief   These are the States that did not expand Medicaid.  

Wednesday, January 1, 2014

The start of full coverage under the ACA.

Ezra Klein @ezraklein 
Everything you need to know about life under Obamacare

From Here are some tips on using your new coverage. 


[Health Affairs Blog] Implementing Health Reform: The Risk Pool, Contraceptive Coverage Litigation, And Other Developments  Useful discussion of a number of issues by Timothy Jost.  


THIS is why we fought for 5 years to pass and protect the Affordable Care Act:

Well done video by OFA.