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Indicators of ACA marketplace success
An additional 1 million enrollees is a key test for the future of the Affordable Care Act (ACA). Sarah Kliff of Vox reports 2017 ACA enrollment will determine the future of the health law and suggests three additional parameters for measuring success: Americans who do not qualify for ACA tax credits must continue buying coverage; more non-exchange consumers must shift to exchange policies; and states must see positive changes in coverage or price.
Anthem’s future on exchanges depends on strong 2017
Business performance in 2017 will shape Anthem’s participation in the health care marketplace. Company leadership has stated improvements must occur over the next year, including regulatory changes to laws governing the exchanges. Anthem posted a mid-single-digit loss on exchange plans in 2016, but expects a slim profit over the next year, according to Anna Wild Mathews and Austen Ufford of The Wall Street Journal (subscriber’s content).
State ballots include health measures
Several health-related initiatives will appear on state ballots next week. Health systems want California voters to pass Proposition 52, which would permanently extend the hospital fee program for Medi-Cal, the state’s Medicaid program. In Oklahoma, two measures would reclassify certain drug violations as misdemeanors instead of felonies. The savings from fewer incarcerations would help fund job training, substance abuse treatment and mental health programs. Maria Castellucci at Modern Healthcare has the story.
Medicare to cover diabetes prevention
Medicare is taking action to prevent older Americans from developing diabetes. The federal program will start paying for preventive measures, with new benefits scheduled to start in 2018. The strategy marks a shift from treating sick beneficiaries to helping consumers stay healthy. It is the first experiment focused on averting disease and tested under the Affordable Care Act to be implemented nationwide. Amy Goldstein at the Washington Post reports.
Californians owed millions in rebates
Blue Shield of California has notified nearly a quarter of a million Californians that it owes them more than $20 million in rebates. The Affordable Care Act requires insurance companies reimburse enrollees when the insurers do not spend enough money on medical care. Pauline Bartolone from Kaiser Health News explains the rebates indicate consumers have been overcharged.
Trial for largest case of health fraud
A trial date is set for a $1 billion Medicare and Medicaid fraud scheme—the largest health fraud case in U.S. history according to the Justice Department. The Associated Press explains authorities allege a network of doctors and hospitals in South Florida referred thousands of consumers who did not qualify for services to nursing homes and assisted living facilities.
Studies of Note
In this feature, the Media Monitoring Report shares a selection of notable research studies within the health care industry.
Opioid Poisoning in Children
National Trends in Hospitalizations for Opioid Poisonings among Children and Adolescents, 1997 to 2012
October 31, 2016
Hospitalization of children and adolescents due to opioid poisoning nearly doubled between 1997 and 2012, according to researchers from the Yale School of Medicine and Veterans Affairs Connecticut Healthcare System. The greatest percent increase in hospitalizations was among the youngest age groups, toddlers and preschoolers.
Subacute Sclerosing Panencephalitis: The Devastating Measles Complication is More Common Than We Think
October 28, 2016
Kristen Wendorf, M.D., M.S., of the California Department of Public Health and colleagues find a fatal complication of measles is more common among unvaccinated children who had been infected with measles during infancy than previously thought. The researchers reviewed cases of subacute sclerosing panencephalitis, a fatal complication of measles, in California between 1998 and 2016.
Employer-Sponsored Insurance Offers: Largely Stable in 2014 Following ACA Implementation
Researchers from the University of Minnesota and Indiana University find little change in employer-sponsored health insurance before and after the implementation of the Affordable Care Act. Between 2013 and 2014, nearly all employers continued to provide health coverage consistent with their actions the previous year.
Cost of Recovery
Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction
Journal of the American Heart Association
October 14, 2016
Low-income women face higher financial hurdles to recovery after a heart attack than low-income men. A study led by Yale School of Global Health Fellow Andy Beckman finds Americans with low incomes who experience a heart attack have difficulty covering living expenses and the cost of recovery treatment and medication. Women with low incomes were more likely to be unable to afford medication.