November 27, 2017
Health groups look to delay ACA taxes
Industry groups are looking to repeal or delay ACA taxes by the end of the year. The end or delay of taxes on medical devices and health insurance, which were included in the ACA to help pay for coverage expansion, could be included in year-end legislation. Lawmakers in both parties oppose the taxes and have previously worked together to delay them. Health companies say the taxes harm innovation and drive up premiums.
ACA sign ups still strong, lower in third week
Overall, the rate of Americans signing up for ACA health care plans is still running ahead of last year’s numbers in states that participate in the federal insurance exchange. Between November 1-25, more than 2 million people chose plans for 2018, slightly higher than in the first four weeks of the ACA enrollment period last year. There was also an increase in the number of consumers participating in the ACA for the first time. The nonpartisan Congressional Budget Office has estimated that 11 million will enroll in 2018, up from 2017’s 10 million, even as the period for sign-ups has been cut in half to six weeks. It is possible that the higher enrollment so far reflects public understanding of the shortened sign-up season.
States prepare to shut down children’s health programs
Officials in nearly a dozen states are preparing to notify families that CHIP programs in their states may shut down by the end of 2017. States forced to end the program will need to determine whether enrolled children are eligible for Medicaid or whether their family will need to seek insurance through an ACA marketplace, which many families may not be able to afford. CHIP provides health care to nearly 9 million children and 370,000 pregnant women nationwide. Congress has not been able to agree on how to pay for the $15 billion program since the reauthorization deadline passed at the end of September.
Medicaid’s role in covering ER visits has grown
No insurance program pays more for ER visits than Medicaid, according to the Agency for Healthcare Research and Quality (AHRQ). Medicaid covered 26 million ER visits in 2006 and about 44 million visits or one-third of all emergency room visits in 2014. Medicaid’s growing role in covering ER visits is attributed to the expansion of the program as part of the ACA. The expansion of Medicaid has helped many people who were previously without insurance afford costly ER visits.
Some providers avoiding patients to keep quality scores high
Some doctors are avoiding complex cases to preserve their quality scores. Providers are concerned deaths or poor outcomes following treatment could cause Medicare or insurers to cut their payments or give them low marks in quality measures. A 2015 law ties close to 10 percent of doctors’ Medicare reimbursements to their quality scores and efficiency, causing some doctors to avoid patients who could cost them money. This unintended consequence is harming engagement between providers and patients and raising concerns about care for the sickest patients. In response to the concerns, CMS added a small bonus for doctors who treat a high number of complex patients.
Health groups band together to broaden reach
To cope with a changing health care environment and threats from companies like Amazon entering the market, many health organizations are venturing beyond their traditional lines of business to broaden their reach. For example, Aetna is in talks to combine with CVS Health to manage pharmacy benefits, and the Cleveland Clinic works with a health insurance start-up to offer individuals health plans in Ohio. These partnerships can be one-stop shops for consumers and a step toward integrated care. However, critics worry the trend of integration puts customers at a disadvantage by limiting choices and increasing costs. Under some of these arrangements, people may not be able to see doctors outside the organization’s own medical group or patients may worry that their doctor will recommend treatments that save their business partners money.
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