A federal audit of Maryland’s once-troubled health-insurance exchange found that the state waited too long to formally update its enrollment projections and numbers with federal grant providers, resulting in the misallocation of $28.4 million.
The inspector general for the U.S. Department of Health and Human Services recommended Friday that Maryland repay that money and properly apply for reimbursement, which could be 50 to 90 percent of the original amount. The exchange’s executive director, Carolyn A. Quattrocki, said doing so would simply be an accounting exercise, although one that could result in the state owing the government about $5 million.
Quattrocki, the exchange leader, said that the state is required to update its formula annually or when seeking more funding. The first enrollment period was a new, unknown experience, she said, so the state relied heavily on evolving instructions from federal officials. Plus, enrollment numbers were constantly changing — although publicly reported on the exchange’s Web site each month.
...the establishment of a self-sustaining marketplace is proving to be more challenging than originally expected. So far in 2015, a majority of SBMs (Colorado, Hawaii, Massachusetts, Minnesota, Rhode Island, Vermont, and Washington) are either experiencing a budget deficit or have expressed concerns about their ability to stay on budget. The SBMs [State Based Marketplace] are not alone in their budgetary worries. Even HHS has acknowledged that they are not sufficiently covering the FFM’s [Federally Facilitated Marketplace] operating costs with the 3.5% premium assessment they charge participating carriers. The President’s FY2016 budget forecasts that carrier assessments will only cover about $1.6 billion of the FFM’s $2.2 billion cost.
Modified adjusted gross income (MAGI) is the methodology adopted by the Affordable Care Act to determine eligibility for Medicaid, the Children’s Health Program (CHIP), and financial assistance in purchasing coverage through the Health Insurance Marketplaces. Policy experts and enrollment assisters have shared our concern with the Centers for Medicare and Medicaid Services (CMS) that Healthcare.gov is incorrectly counting Social Security income for some tax dependents and overstating the MAGI for those households.
If Healthcare.gov isn’t getting MAGI right, it means that eligibility is not being determined accurately in these instances. Recently, the agency confirmed the existence of a glitch, which in most cases is to the financial disadvantage of the individual or family who is enrolled in coverage.
During the 2008 financial crisis, “too big to fail” became a familiar phrase in the U.S. financial system. Now the U.S. health-care system is heading down the same path with a record number of hospital mergers and acquisitions—95 last year—some creating regional monopolies that, as in all monopolies, will likely result in higher prices from decreased competition.
Hospital consolidation, done properly in a competitive marketplace, can have positive effects. Multi-hospital conglomerates can quickly disseminate best practices and quality initiatives, for example. But competition and the choices it provides can also disappear.
Health-care conglomeration aligns with the Affordable Care Act, which created incentives for physicians and hospitals to work together in “accountable care organizations.” But an important and often forgotten prerequisite for this model is hospital competition.
Some see the dangers. In a rare move, Massachusetts Superior Court Judge Janet Sanders recently blocked Partners HealthCare—Harvard’s affiliated 10-hospital conglomerate and Massachusetts’ largest private employer—from acquiring three competitor hospitals. Judge Sanders argued that the expansion “would cement Partners’ already strong position in the health-care market and give it the ability, because of this market muscle, to exact higher prices.” This threat is even greater in rural areas where one hospital is often the only provider.
Today’s frenzy of hospital mergers and physician practice acquisitions is giving hospital systems even greater leverage to inflate opaque “charge-master” medical bills that even hospitals are sometimes unable to itemize sensibly. With no mechanism to allow free-market forces to keep prices in check, this translates into higher health-insurance deductibles and copays for insured Americans, and in the case of Medicare and Medicaid, higher taxes.
A San Bernardino, Calif., court recently held a Prime hospital, Chino Valley Medical Center, in contempt for needlessly admitting patients through the emergency room. On a national level, physician groups bought by large hospital systems are often prodded to send patients for ambulatory surgery and diagnostic procedures to the departments of their parent hospital, which may charge more than other outpatient centers the doctor might prefer.
A study of more than 150 hospital-owned and physician-owned organizations published last October in the Journal of the American Medical Association found that patient costs are 19.8% higher for physician groups in multi-hospital systems compared with physician-owned organizations.
When the federal government sorted through the first round of clinical information it was using to reward hospitals for providing higher-quality care in December 2012, the No. 1 hospital on the list was physician-owned Treasure Valley Hospital in Boise, Idaho. Nine of the top 10 performing hospitals were physician-owned, as were 48 of the top 100.
With only 238 physician-owned hospitals in the U.S., the facilities said scoring so well on a list with more than 3,000 entries shows the doctor-owned hospitals in a very positive light. The list was released by the Centers for Medicare & Medicaid Services in December 2012 in a report on hospital value-based purchasing.
But the new information comes nearly three years after a section of the Affordable Care Act effectively banned these facilities from expanding and prohibited new majority physician-owned facilities from opening their doors.
The Affordable Care Act was supposed to create higher quality, patient choice, and lower costs. But the very hospitals that excel in all three areas according to government data are being squeezed out by the big hospital lobby and a law that is hopelessly flawed; one that is doing the complete opposite of what it promised.
Standard & Poor's Ratings Services expects the ACA risk- corridor pool to be significantly underfunded if the government enforces budget neutrality. Budget neutrality requires the pool to be funded by payments insurers make into the pool. No external funding can be allocated to it. Our study of risk-corridor receivables and payables recorded in U.S. health insurance companies' 2014 annual financial statements found that receivables insurers booked for the ACA corridor far outweigh the payables. In fact, our study indicates that the risk corridor payables are less than 10% of the receivables insurers reported in 2014. (Receivables are the amount an insurer expects to be paid from the risk corridor. Payables are the amount an insurer expects to pay into the corridor pool based on the risk-corridor formula.)
The growth in health care spending is slowing down, and one reason might be that cost sharing is rising.
The proportion of insured workers with at least a $1,000 deductible was 41 percent in 2014, quadruple that in 2006. Hidden in the numbers is the fact that increasing cost sharing for patients with chronic illnesses can backfire, causing their health care spending to go up, not down.
When patients face higher cost sharing for prescription drugs, they tend to cut back on them. That’s a finding from a recent study from the National Bureau of Economic Research by Peter Huckfeldt and colleagues, who examined employer-based health plan enrollees who use drugs to treat high cholesterol, hypertension and diabetes. They even found that patients cut their drug use when drugs were exempt from the deductible.
A 2010 study by the Harvard economist Amitabh Chandra and colleagues found that when cost sharing for physician visits and prescription drugs goes up, so does overall Medicare spending.
Geographic access to primary care facilities across the census tracts of the City of Philadelphia varies by as much as ten-fold, according to a new University of Pennsylvania study.
One of the many maps in the Penn study report released today shows six red circles around the areas of least primary care access in the city.
When researchers matched these six clusters against U.S. Census Bureau data for Philadelphia's population-by-race, they found that in three of the six areas of lowest primary care access 75% or more of the residents are African American. In a fourth, the African American population was 62%. A fifth circle in the city's Lower Northeast had a majority population of African Americans and Hispanics. The sixth circle in the city's Greater Northeast section had the lowest percentage of non-white residents but higher median age.
Major insurers in some states are proposing hefty rate boosts for plans sold under the federal health law, setting the stage for an intense debate this summer over the law’s impact.
In New Mexico, market leader Health Care Service Corp. is asking for an average jump of 51.6% in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3% increase. In Maryland, market leader CareFirst BlueCross BlueShield wants to raise rates 30.4% across its products. Moda Health, the largest insurer on the Oregon health exchange, seeks an average boost of around 25%.
All of them cite high medical costs incurred by people newly enrolled under the Affordable Care Act.
Under that law, insurers file proposed rates to their local regulator and, in most cases, to the federal government. Some states have begun making the filings public, as they prepare to review the requests in coming weeks. The federal government is due to release its rate filings in early June.
The Obama administration has posted the 2016 rate increases in excess of 10% that the Obamacare health plans are requesting.
There are a lot of them.
All of the federally run states have been posted and some for the state exchanges as well. Both California and New York do not have their rates on this site yet.
Some will quickly argue that many of these rate increases are subject to regulatory approval and can be rolled back. That's right. But this year the health plans have hard claim data to show the regulators and a 35% rate increase is hardly going to be rolled back to 5%.
Big rate increases like this are driven by a lot of claims experience––a lot of really lousy claim experience.
You will also notice that this list most often includes the big market share players, such as the Blues plans, in each of these states. These are the players with the best data.
That these big rate increases are coming a year before the "3Rs" reinsurance program is to end, that was supposed to subsidize the health plan's high claims experience, is not good news.
Blue Cross of Texas commented that it covered 730,833 individuals in 2014 with premium of $2.5 billion and claims totaling $2.1 billion––for a medical loss ratio of 119%. The plan further commented that, after the "3Rs" reinsurance adjustments, they lost 17% to 20% of premium in 2014––that would be more than $400 million. And, they are only asking for a 20% rate increase.
On one hand, the newly insured tend to be the most expensive clients from an insurance perspective-- claims rates (adjusted for age and medical condition) tend to drop in future years. On the other hand, these are really high loss ratios. The author has legit bona fides in the insurance industry FWIW.
Any day now, the Supreme Court will announce its decision in King v. Burwell, the latest high-stakes fight over the Affordable Care Act. If the government loses, more than 6 million residents of the 34 states that declined to establish their own health-care exchanges could lose subsidies that help them purchase insurance.
In principle, those 34 states could restore subsidies by creating their own insurance exchanges. Political leaders will certainly come under intense pressure to do so, although time is short to get an exchange up and running for 2016. Given the potential need for swift action, do the states have contingency plans in place? Could they move quickly in the wake of an adverse decision?
To investigate these questions, we undertook, with financial support from the Commonwealth Fund, a study of five states that could lose tax credits:
Florida, Michigan, New Hampshire, North Carolina and Utah.
What we found was both striking and worrisome. Dozens of interviews conducted by our research team with political leaders, agency officials and advocacy organizations in those states indicate that the states are almost completely underprepared for the Supreme Court’s decision in King.
But the bottom line is grim. The states aren’t prepared for King, and any debates over whether to create state exchanges will be turbulent and difficult. In the meantime, millions of people stand to lose their health insurance.
bennyonesix wrote:Solid work here, Turd. I am surprised BO hasn't come around to your position yet.
I'm not. Reasons 1-2336 of why the ACA is messed up is "Jeanne Lambrew still has a job with the administration." Of coarse, there are other reasons as well.
"Liberalism is arbitrarily selective in its choice of whose dignity to champion." Adrian Vermeule
More employers may be shifting to self-funded health plans, and fewer are offering full or even partial spousal coverage, as corporations redesign their benefits packages in response to the shifting health benefits landscape.
These trends were among those spotted by actuarial firm Conrad Siegel Actuaries. The firm does an annual health benefits survey; this year, 130 companies from a range of industries responded.
The biggest shift noted occurred in spousal coverage. In 2012, Conrad Siegel said, 20 percent of respondents either charged spouses for coverage or excluded them. In this year’s survey, that shot up to 47 percent.
Terry B wrote:The problem is, the program wasn't big enough. If the Republicans would have supported a proper overhaul, we wouldn't see all this mess.
Didn't this pass w/close to zero Repuglican votes? Couldn't ObamaPelosiReid have passed whatever the Dems would support?
Mao wrote:Political power grows out of the barrel of a gun. Our principle is that the Party commands the gun, and the gun must never be allowed to command the Party
Terry B wrote:The problem is, the program wasn't big enough. If the Republicans would have supported a proper overhaul, we wouldn't see all this mess.
NO Republicans voted for this*. It was a straight steamroller job by Obama & Dems. No outreach or bargaining..."Elections have consequences. (And you Repubs lost)." Deal with it.
Obamacare is 100% Obama/Democrat Party.
* https://en.wikipedia.org/wiki/Patient_P ... e_Care_Act
Wiki:
The House passed the Senate bill with a 219–212 vote on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it.
(Senate) The bill then passed, also 60–39, on December 24, 2009, with all Democrats and two independents voting for it, and all Republicans against (except Jim Bunning, who did not vote).
The best lack all conviction, while the worst
Are full of passionate intensity.
Not coincidentally, these hospitals tend to be in areas with the most expensive Medicare patients (expensive generally because they are the sickest)-- because of this, they tend to have the highest readmission rates, and get punished by Obamacare's Medicare payment policies. Obamacare was supposed to help the poor right?
"Liberalism is arbitrarily selective in its choice of whose dignity to champion." Adrian Vermeule
Center for Medicare and Medicaid Services still doesn't know what it's doing. From a recent Inspector General's report:
We determined that CMS’s internal controls (i.e., processes put in place to prevent or detect any possible substantial errors) for calculating and authorizing financial assistance payments were not effective. Specifically, we found that CMS:
relied on issuer attestations that did not ensure that advance CSR payment rates identified as outliers were appropriate,
did not have systems in place to ensure that financial assistance payments were made on behalf of confirmed enrollees and in the correct amounts,
did not have systems in place for State marketplaces to submit enrollee eligibility data for financial assistance payments, and
did not always follow its guidance for calculating advance CSR payments and does not plan to perform a timely reconciliation of these payments.
The internal control deficiencies that we identified limited CMS’s ability to make accurate payments to QHP issuers. On the basis of our sample results, we concluded that CMS’s system of internal controls could not ensure that CMS made correct financial assistance payments during the period January through April 2014.
One year after outrage about long waiting lists for health care shook the Department of Veterans Affairs, the agency is facing a new crisis: The number of veterans on waiting lists of one month or more is now 50 percent higher than it was during the height of last year’s problems, department officials say. The department is also facing a nearly $3 billion budget shortfall, which could affect care for many veterans.
The agency is considering furloughs, hiring freezes and other significant moves to reduce the gap. A proposal to address a shortage of funds for one drug — a new, more effective but more costly hepatitis C treatment — by possibly rationing new treatments among veterans and excluding certain patients who have advanced terminal diseases or suffer from a “persistent vegetative state or advanced dementia” is stirring bitter debate inside the department.
Agency officials expect to petition Congress this week to allow them to shift money into programs running short of cash. But that may place them at odds with Republican lawmakers who object to removing funds from a new program intended to allow certain veterans on waiting lists and in rural areas to choose taxpayer-paid care from private doctors outside the department’s health system.
“Something has to give,” the department’s deputy secretary, Sloan D. Gibson, said in an interview. “We can’t leave this as the status quo. We are not meeting the needs of veterans, and veterans are signaling that to us by coming in for additional care, and we can’t deliver it as timely as we want to.”
Since the waiting-list scandal broke last year, the department has broadly expanded access to care. Its doctors and nurses have handled 2.7 million more appointments than in any previous year, while authorizing 900,000 additional patients to see outside physicians. In all, agency officials say, they have increased capacity by more than seven million patient visits per year — double what they originally thought they needed to fix shortcomings.
But what was not foreseen, department leaders say, was just how much physician workloads and demand from veterans would continue to soar — by one-fifth, in fact, at some major veterans hospitals over just the past year.
Protobot wrote:The problem is, the program wasn't big enough. If the Republicans would have supported a proper overhaul, we wouldn't see all this mess.
You haven't defined a proper overhaul, and nothing I've seen suggests that one was ever on the table.
"Liberalism is arbitrarily selective in its choice of whose dignity to champion." Adrian Vermeule
Despite insurers (most likely) expecting this decision, and (most likely) knowing about the increased tax collection (because they sold the plans), they are demanding higher premiums and have the numbers to back the request up: http://irongarmx.net/phpBB2/viewtopic.p ... 00#p825677
Nothing is settled, and only fools are doing a victory lap.
"Liberalism is arbitrarily selective in its choice of whose dignity to champion." Adrian Vermeule
