November 28, 2017
Unsubsidized consumers hit hard by ending of CSRs
The Robert Wood Johnson Foundation has released an analysis examining how the end of CSR payments has impacted premium costs. The analysis notes that the action has not affected consumers who receive ACA subsides, but those who are ineligible for subsidy support. Ending CSR payments forced many insurers to increase premium rates for silver plans. Because the ACA subsidies are tied to the average cost of a silver plan, subsidies for low-income consumers increased when rates increased. This has helped lower the cost of bronze and gold plans for consumers who receive subsidies and offset cost increases for silver plans. However, 2 million consumers on the exchange—and an additional 5.4 million off the exchange—purchase coverage without subsidies. Using the cheapest bronze option as a benchmark, the analysis estimates the average premium increase for unsubsidized consumers is roughly 20 percent.
Congressional health care fights to watch in December
Many of the bills lawmakers are considering this month could have a profound effect on the health care industry. A comprehensive tax cut package could include provisions repealing the individual mandate, significantly impacting enrollment and premium costs, and driving additional insurers out of the individual market. Congress has yet to reauthorize CHIP funding and are also are weighing support for an opioid response and disaster relief for Puerto Rico that would include additional funding for their Medicaid program. Finally, lawmakers would like to delay certain ACA taxes that are slated to take effect in January including the medical devices tax, “Cadillac” tax and others. Given the crowded agenda, some of these provisions may go unaddressed before the end of the year, which could have larger effects on the health care industry and the nation’s health.
CHIP reauthorization making progress
Lawmakers are making progress on a compromise bill to reauthorize expired funding for CHIP and community health centers. The package would also include an extension of other Medicare programs set to expire soon and could include the Chronic Care Act to make Medicare spending more efficient. The proposed package could be attached to a short-term government spending bill early next month. Five states and Washington, DC are expected to run out of CHIP funds in the beginning of 2018 and Colorado has already notified CHIP recipients that coverage could if funding is not renewed. ACHP has sent letters to the House and Senate supporting the reauthorization of CHIP and in support of the Chronic Care Act.
California outspends federal government in marketing for ACA signups
Covered California, the state’s ACA exchange, has already spent $45 million on marketing for open enrollment, including $18 million on TV and $8 million on radio. In total, Covered California plans to spend $111.5 million on enrollment outreach for 2017-18; funds will be used to support exchange navigators, ads, staff salaries and more. California has ramped up its spending to help compensate for federal cuts to enrollment outreach. As of Nov. 14, 48,000 new customers have enrolled for ACA coverage in California, up from 39,000 in the same time period in 2016.
FCC looks to expand $400 million cap for rural health care program
The Federal Communications Commission (FCC) is seeking public comment on a proposal to increase the $400 million annual cap for the Rural Health Care Program, which provides funding for telecommunications and broadband services to rural communities to support telemedicine networks. The agency anticipates demand will likely exceed the current available funding and that an expansion would provide relief to rural healthcare providers facing funding cuts. The FCC will consider the proposal at the agency’s December 14 public meeting.
Medical community sees growing interest in street medicine
Street medicine—or treating vulnerable patients like the homeless in the field—has become a national force. More than 60 organizations across the country now perform street medicine, and are dedicated to professionalizing and expanding the movement. Advocates and practitioners are committed to legitimizing the practice as a delivery model for vulnerable populations and pressing hospitals and other organizations for more funding to help expand programs. Proponents believe treating patients where they are can help prevent the more serious conditions, ER visits or even death. Advocates acknowledge there are significant challenges to practicing street medicine—they highlight mental health as a particularly high hurdle—but believe it will become an essential tool in population health.
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