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Ethics and Public Policy Center is Washington, D.C.’s premier institute dedicated to applying the Judeo-Christian moral tradition to critical issues of public policy.

Grandpa's Spells wrote:

Ethics and Public Policy Center is Washington, D.C.’s premier institute dedicated to applying the Judeo-Christian moral tradition to critical issues of public policy.

Turdacious wrote:

Grandpa's Spells wrote:

Ethics and Public Policy Center is Washington, D.C.’s premier institute dedicated to applying the Judeo-Christian moral tradition to critical issues of public policy.

Your point? They got their data from state insurance commissions.

Grandpa's Spells wrote:

Turdacious wrote:

Grandpa's Spells wrote:

Ethics and Public Policy Center is Washington, D.C.’s premier institute dedicated to applying the Judeo-Christian moral tradition to critical issues of public policy.

Your point? They got their data from state insurance commissions.

Taking propagandists' claims at face value is a recipe for getting hoodwinked.

Health Net Inc. (NYSE:HNT) says individual claim costs per enrollee are about twice as high as they used to be.

Health Net gives an early look at the effects of the Patient Protection and Affordable Care Act (PPACA) on individual major medical experience in documents filed with the California Department of Insurance.

PPACA now requires health insurers to sell individual major medical coverage without considering personal health status in decisions about whether to issue coverage, and without using health information other than age and tobacco use when pricing the coverage. In the past, California let individual health insurers use medical underwriting when issuing and pricing coverage.

Health Net asked California regulators in June for permission to raise prices on some individual medical policies sold on and off the public exchange system an average of 7.9 percent.

The company provided claims comparison data from the past for small-group coverage, but not for individual coverage. Regulators asked for historical data for the individual market. Health Net said Aug. 6, in a response, that it believes the small-group market information is more relevant, because guaranteed-issue rules took effect in the small-group market earlier.

Extracting and adjusting historical individual market data in a way that would allow for apples-to-apples comparisons with the new, PPACA-compliant products would be difficult, Health Net said. "Also," Health Net said, "our individual claims costs for the first four months under PPACA are more than double what they were prior to PPACA."

Meanwhile, in Iowa, Time Insurance Company -- a unit of Assurant Inc. (NYSE:AIX) -- has given an estimate of the impact of state and federal PPACA "grandmothering" rules in a 2015 rate filing for individual off-exchange products.

"Grandfathering rules" have let consumers and small employers keep medical coverage that was in place in March 2010, when PPACA was signed into law, even if the coverage does not comply with most PPACA provisions.

The newer "grandmothering" rules have let consumers and small employers keep some coverage that was in place before Jan. 1, 2014, even if the coverage does not comply with all of the many major PPACA provisions that took effect Jan. 1, 2014.

Time estimates its individual policy morbidity would have increased 13.4 percent by 2015 if grandmothering had not occurred. The company is estimating that, because grandmothering affected when people with older individual coverage will start buying PPACA-compliant plans, the extensions of the old, grandmothered policies will increase 2015 morbidity levels by 23.5 percent over pre-PPACA levels.

Quality of Care Reporting--Employer group health plans must provide a report annually, disclosing information of plan benefits and reimbursement structures that improve health outcomes. Though deadline for issuing regulations was Mar. 23, 2012, regulations have not yet been issued and compliance is delayed until such time.

Automatic Enrollment-- Large employers (employers with more than 200 full-time employees) must automatically enroll new employees in employers’ group health plan. Compliance is delayed until regulations are issued.

Nondiscrimination Rule-- Insured employer group health plans may not discriminate in favor of highly compensated employees. Compliance is delayed until regulations are issued.

Under [the] system [set forth by Proposition 45], intervenors are paid to challenge rate changes proposed by insurance companies, in a process that can take many months to resolve. Obamacare supporters are rightly concerned that if Proposition 45 passes, it will bollix up the fledgling health exchange's ability to negotiate rates.

Obtaining coverage information
Practices have experienced difficulty identifying patients with ACA exchange coverage and obtaining essential information related to that coverage.
• 62% of respondents reported moderate to extreme difficulty with identifying a patient that has ACA exchange coverage as opposed to traditional commercial health insurance.
• Compared to patients with traditional commercial coverage, nearly 60% of respondents indicated that for patients with ACA exchange coverage it is somewhat or much more difficult to:
• Verify patient eligibility
• Obtain cost-sharing or network information
• Obtain information about the plan’s provider network in order to facilitate referrals
“We are going to have to hire additional staff just to manage the insurance verification process.”
“Identification of ACA plans has been an administrative nightmare.”
“We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn’t so.“
Patient cost-sharing Practices are facing a number of challenges related to patient cost-sharing for ACA exchange coverage.
• 75% of respondents reported that patients with ACA exchange coverage are very or extremely likely to have high deductibles compared to patients with traditional commercial coverage.
• Practices reported significant patient confusion about the substantial cost-sharing related to many ACA exchange products, and practices are working to help patients understand the complexities of their coverage.
• Practices cited some of the main reasons for not participating with ACA exchange products were related to concerns about financial burdens from patient collections (such as burdens related to collecting high deductibles from patients and concerns about financial liability from the 90-day grace period).
“Patients have been very confused about benefits and their portion of the cost. Once the patients find out their deductible, they’ve cancelled appointments and procedures.”
“The at-risk piece of eligibility is tremendously hard to determine and explain to patients.”
“Patients don’t always understand how health insurance works, so we’ve been engaging in educational events for the community.”

We are quite concerned about the risk corridor assumptions plans are making this year, as we’re not sure the industry will ever receive any risk corridor payments. With no change in assumptions, we estimate the full year liability to HHS from risk corridors could exceed $1 billion. There won’t be nearly enough plan contributions to fund these requests (just one plan in our sample recorded a risk corridor payable, and it was for only $3 million), and what could soon be a Republican controlled Congress isn’t likely to appropriate additional funds. HHS intends to use 2015 risk corridor collections to fund any 2014 shortfalls, but it isn’t clear to us why health plans will suddenly start earning excess individual profits in 2015.

For background, the insurers originally assumed that HHS would fund any shortfall in the risk corridor program. However, HHS later indicated that it intended to run the program on a budget neutral basis, meaning that any payments to less profitable plans would have to come from plans earning excess individual profitability. HHS subsequently changed course, indicating that any shortfall in 2014 payments would be made up using risk corridor contributions in 2015. Of course, that assumes that
the insurers generate excess profitability on their individual business next year, which doesn’t seem too likely given the losses being incurred by many plans this year.

HHS believes the risk corridor program will be budget neutral over the three year period, but it isn’t clear how that will happen without HHS reneging on what it owes plan. HHS recognizes that the
health reform bill requires full risk corridor payments regardless of a shortfall, and HHS has suggested
it will find another source if there is a shortfall after three years, but coming up with potentially $1
billion is no easy task, made even harder if Congress turns Republican, particularly since some Republicans have derided the risk corridor program as a bailout for health insurance companies.

Hospitals and multihospital systems are acquiring medical groups and physician practices as part of a strategy to build integrated delivery systems capable of providing the full range of professional, facility, laboratory, and pharmaceutical services to affiliated patients. This consolidation may lead to greater coordination of care, less duplication of tests and treatments, a substitution of low-cost for high-cost settings where appropriate, and, as a result, lower total expenditures for care. However, this consolidation could lead to higher patient care expenditures due to preferential use of high-priced hospitals for inpatient admissions, substitution of hospital-affiliated outpatient departments for ambulatory surgery and imaging facilities, and increased prices to insurers for laboratory tests, drugs, and other ancillary services.

The policy debate about consolidation has gained new policy attention due to the financial incentives provided by the Affordable Care Act for physicians to join hospital-affiliated accountable care organizations (ACOs).

Group health care plans that do not provide coverage for hospital care will not pass the health care reform law's “minimum value” test, but the Internal Revenue Service is giving a one-year pass to existing or soon to be implemented plans excluding the coverage.

Ending months of uncertainty on the issue, the IRS on Tuesday said such plans do not provide the minimum value requirement and that regulators will shortly propose regulations to this effect.

Likely due to a flaw in a government online calculator, low-cost plans that excluded coverage for hospital services were able to pass the minimum test, benefit experts said.

That, in turn, fueled interest in the plans, which cost about half the price of more traditional plans, especially from employers who have not offered coverage and starting in 2015, faced an ACA mandate to offer coverage or be hit with a stiff financial penalty.

But in its Tuesday announcement, the IRS said plans excluding hospital coverage fail the minimum value requirement.

The IRS, in its notice, suggested that its calculator gave faulty results. The IRS, Treasury and the Department of Health and Human Services are considering whether the calculator produced “valid actuarial results.”

Still, perhaps because its own software was to blame, the IRS said employers that — prior to Nov. 4 — entered into a “binding written commitment” to offer plans excluding hospital coverage or began to enroll employees in the plans could offer the plans through the end of the next plan year.

The Hospital Readmissions Reduction Program was created by the Patient Protection and Affordable Care Act. Hospitals with excess numbers of patients returning within 30 days of discharge following treatment for heart attack, heart failure or pneumonia began having their Medicare payments docked up to 1% in fiscal 2013. That number increased to 2% in fiscal 2014.

For fiscal 2015, the fine increases to 3%, and two additional measures have been added: readmission rates for chronic obstructive pulmonary disease and total hip and total knee replacements. Adding those measures may account for the increased number of fines, experts say.

A 3% penalty could affect a hospital's entire profit margin, which provides strong incentive to keep patients from being readmitted, Pronovost said. The problem with linking fines to readmissions, however, is that the measure does not exclude factors beyond a hospital's control, such as patients' ability to afford medications or to have transportation for follow-up visits. That can ultimately create disincentives for providers and quality.

Some experts, reacting to the new numbers, warn it may be time to re-evaluate the program, which has added new measures and increased penalties. Recent studies and leading safety experts point to the need to consider socio-economic factors, which they say cause hospitals in poor communities to be disproportionately penalized.

Others note that if only 769 of more than 3,370 hospitals are avoiding fines, perhaps the measures are not achieving their desired goals of improving care.

“What it suggests to me is that this isn't really as strong a signal for quality of care,” said Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine. “It looks like it's becoming a mechanism to reduce payment rather than improve quality.”

Nine of the 39 hospitals receiving the maximum penalty are in Kentucky. Forty counties in Kentucky are considered to have “persistent poverty,” meaning 20% or more of their residents have fallen below the poverty line over the past three decades, according to the U.S. Census Bureau's American Community Survey.

Seven of the nine hospitals that received the maximum fine in that state were in persistent-poverty counties, and three received the maximum fine all three years.

Stand-alone community hospitals may be unable to prevent readmissions despite the use of comprehensive, evidence-based intervention components that are within their control. Better collaboration between hospitals and community-based providers is needed to ensure continuity of care for discharged patients.

But probably the most widely touted reason given for why obstinate Republican governors will be able to take Obamacare down is a legal theory pushed by conservative scholars like Michael Cannon, the health policy director at the libertarian Cato Institute. It goes like this: Congress only intended the subsidies and tax credits that help consumers buy health insurance to be available through state-created, not federally created, exchanges. If these benefits aren't available in states with federally run exchanges, the argument goes, then other key components of the law, like the requirement that employers offer health insurance, and that most people must buy insurance, also fall apart in those states.

Jonathan Gruber, who helped write former presidential candidate Mitt Romney's Massachusetts health care law as well as the Affordable Care Act, calls this theory a "screwy interpretation" of the law. "It's nutty. It's stupid," he says. And beyond that, "it's essentially unprecedented in our democracy. This was law democratically enacted, challenged in the Supreme Court, and passed the test, and now [Republicans] are trying again. They're desperate."

Pinky wrote:Gruber needs to stop being honest when cameras are on.

But in fairness to him, he is right. The bill passed because no one, including more of the representatives voting on it, understood what it said. I don't doubt that most members of Congress who voted for the bill intended to give subsidies to people in states without their own exchanges, but it's also clear that denial of subsidies to people in those states was intentionally written into the bill. Overall, the good ideas in the ACA are probably less popular than the bad ones.

Healthcare is simply not a setting in which reasonable reform will be popular.

I think that this comes to the master strategy of the Republican party, which is to confuse people enough about the law so that they don’t understand that the subsidies they’re getting is because of the law. It goes back to the old Jimmy Kimmel bit where he asked people if they liked Obamacare and they said no, but they asked people if they liked the Affordable Care Act and they said yes.

“The Affordable Care Act was publicly debated over the course of 14 months, with dozens of Congressional hearings, and countless town halls, speeches, and debates,” White House spokeswoman Jessica Santillo said in a statement. “The tax credits in the law that help millions of middle class Americans afford coverage were no secret, and in fact were central to the legislation. Not only do we disagree with [Gruber’s] comments, they’re simply not true.”

An administration official who spoke on the condition of anonymity sought to play down Gruber’s role in developing the law, noting that he “did not work in the White House.”

Since the beginning of 2010, 43 rural hospitals — with a total of more than 1,500 beds — have closed, according to data from the North Carolina Rural Health Research Program. The pace of closures has quickened: from 3 in 2010 to 13 in 2013, and 12 already this year. Georgia alone has lost five rural hospitals since 2012, and at least six more are teetering on the brink of collapse. Each of the state's closed hospitals served about 10,000 people — a lot for remaining area hospitals to absorb.

The Affordable Care Act was designed to improve access to health care for all Americans and will give them another chance at getting health insurance during open enrollment starting this Saturday. But critics say the ACA is also accelerating the demise of rural outposts that cater to many of society's most vulnerable. These hospitals treat some of the sickest and poorest patients — those least aware of how to stay healthy. Hospital officials contend that the law's penalties for having to re-admit patients soon after they're released are impossible to avoid and create a crushing burden.

David Burge ‏@iowahawkblog

Nancy Pelosi knows exactly who didn't write the bill she never read.

In 2015, employees will pay 55% more for health insurance premiums and out-of-pocket medical bills than they did in 2010, according to a report Thursday from human resources company Aon Hewitt.

The average worker with employer-sponsored health insurance will pay about $2,664, or nearly 24% of the total cost of their plan next year. Five years ago, employees paid $1,835, which worked out to 22.3% of the total premium payment.

What's more, employees will pay an average of $2,487 in out-of-pocket costs, such as copayments, coinsurance and deductibles next year. That's nearly double what employees paid in 2009, when those costs amounted to $1,276.

T>1200 wrote:Just wanted to check in to see if Turd had shot himself yet.