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Enrollment, Coverage and the PP-ACA

12 Responses

1. Ann Miller RN MHA, on February 18, 2014 at 12:37 AM said:

   ACA – How doctors are left out

   Physicians basically know they’re going to be affected by implementation of the Affordable Care Act (ACA), but what’s harder to grasp is exactly how such changes will ultimately play out.

   But, could all this confusion about the ACA threaten a medical practice’s financial sustainability?

   http://www.medicalpracticeinsider.com/news/aca-how-doctors-are-left-out?email=MARCINKOADVISORS@MSN.COM&GroupID=90115

   Two recent studies reveal the extent of ACA bewilderment.

   Ann Miller RN MHA

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2. Ann Miller RN MHA, on February 24, 2014 at 3:43 PM said:

   Obamacare a saving grace for many baby boomers

   Aging Americans battered by the recession are flocking to the online marketplaces to buy health insurance.

   http://money.msn.com/health-and-life-insurance/article.aspx?post=fd85b5ff-8665-441d-9279-b3fc85286c7f

   As a former insurance agent; is this a surprise?

   Ann Miller RN MHA

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3. Hope R. Hetico RN MHA, on March 6, 2014 at 9:39 PM said:

   ACA Impact on Employer Benefits

   73% of employers say the Affordable Care Act is having an impact on benefits service and support and 69% report there is an impact on benefits communications.

   Source: The Prudential Insurance Company of America

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4. D. Kellus Pruitt DDS, on March 16, 2014 at 9:50 PM said:

   Obamacare Update

   Without principals, there can be no stakeholders – equal or otherwise. Am I right?

   Recently released documents from the Clinton Presidential Library reveal that Bill and Hillary’s administration was the first to discount the importance of doctors and patients by demoting them from “principals” in healthcare, to “equal stakeholders.” Even though Hillarycare was rejected, the fantasy debasement stuck.

   Yesterday, I shared the link to David Martosko’s Mail Online (UK) article which is based on the released documents: “Clinton-era White House memo from Rose Law Firm adviser: Doctors show ’emotional irrationality’ in resisting health reforms, have no ‘right’ to be over-compensated’ for treating patients.” Obama’s mounting frustration is likely to cause the current administration to similarly blame physicians for Obamacare’s shortcomings – long before President Hillary Clinton is given a second chance to piss them off.

   Two weeks ago, Martosko published a similar Mail Online article titled, “Clinton advisers admitted ‘we won’t deliver’ on ‘you can keep your health care plan’ promise – years before Obama made the same empty pledge.”

   http://www.dailymail.co.uk/news/article-2570609/Clinton-advisers-admitted-wont-deliver-health-care-plan-promise-1994-wrote-Hillarycare-scheme-amounted-hefty-tax.html

   Martosko warns Americans about other Clinton-era memos:

   – Clinton advisers knew they would be lying if they promised Americans they could keep their health care plans and their preferred doctors

   – They counseled against telling people their health care costs would go down, even though insurers would have to put $40 billion into the health system

   – ‘This is a tax, a hefty tax,’ wrote one White House strategist

   – Early on, an adviser told Hillary Clinton that she should leverage people’s love for veterans in order to muscle Republicans into voting for her health care bill

   – Hillary’s team thought members of Congress were so clueless that they needed a ‘Health Care University,’ set up by the White House, to bring them up to speed

   ——-

   Martosko: “The principal difference between Hillarycare and Obamacare was that the former relied on squeezing funds out of insurance companies, while the latter requires individuals and employers to buy their products.”

   Here are two more differences: According to the released documents, Clinton’s advisors warned the President against creating “bureaucratic burdens,” as well as using the word “mandate” when presenting Hillarycare. On the other hand, a few years later Presidents George W. Bush and Barak Obama exhibited far less shame.

   D. Kellus Pruitt DDS

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5. Jackson, on April 30, 2014 at 12:04 PM said:

   Did the ACA result in more canceled plans?

   http://healthjournalism.org/blog/2014/04/a-closer-look-did-the-aca-result-in-more-canceled-plans/

   So, let us take a closer look.

   Jackson

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6. Ann Miller RN MHA, on May 13, 2014 at 6:28 PM said:

   Employer Preparedness for the ACA

   According to the Transamerica Center for Health Studies, employers appear more informed about their companies’ options for providing health insurance than employers interviewed last year. In a 2013 benchmark study, only 37 percent of employers reported being very informed about their companies’ options for providing health insurance; in the 2014 study, 69 percent report being very informed.

   Among small businesses, the survey revealed that only six in 10 (59 percent) of those with fewer than 50 full-time equivalent employees are aware of the new Small Business Health Options Program (SHOP), compared to eight of 10 businesses overall (79 percent).

   28 percent of employers actually expect their number of employees to increase due to the ACA, compared to 15 percent that expect the number to decrease. Most employers (64 percent) plan on taking some action to comply with the ACA, with 19 percent planning to change plan options and 17 percent planning to change insurers.

   Source: Transamerica Center for Health Studies

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7. Ann Miller RN MHA, on July 24, 2014 at 11:24 AM said:

   Courts Issue Conflicting Rulings on Federal Insurance Subsidies

   Federal judges in Richmond, VA unanimously upheld the legality of subsidies for insurance exchanges in every state, contradicting a 2-hour-old ruling from a panel of judges in Washington. Affordable insurance for millions of low- and middle-income Americans is at stake, since experts say most people would not buy the same coverage without the subsides.

   But, neither the recent rulings will go into effect for 52 days, and at least one of them appears likely to be granted a type of appeal that would automatically stay the decisions until final outcome of the case is decided.

   It’s not clear yet whether the issue is ultimately headed for the Supreme Court, though it appears likely that legal uncertainty about the tax credits will hang over the open enrollment period for 2015 coverage.

   At issue in the cases are rules published by the IRS in 2012 that provide tax credits to buy insurance. Three judges with the 4th U.S. Circuit Court of Appeals in Richmond, VA, ruled in King v. Burwell that Congress intended to make those subsidies widely available to make insurance more affordable. That meant the IRS had a right to interpret the strict wording of the Affordable Care Act to mean all states would be eligible for tax-credits.

   Source: Joe Carlson, Modern Healthcare [7/22/14]

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8. Jackson, on September 3, 2014 at 1:14 AM said:

   Transcending Obamacare? Analyzing Avik Roy’s ACA Replacement Plan

   Avik Roy’s proposal, “Transcending Obamacare,” is the latest and most thoroughly developed conservative alternative for reforming the American health care system in the wake of the Affordable Care Act.

   Click to access mpr_17.pdf

   It is a serious proposal, and it deserves to be taken seriously.

   Jackson

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9. Major, on September 8, 2014 at 7:34 PM said:

   Five Ways ACA And Employers Shift Costs This Open Enrollment Season

   1. Unitized Pricing/Charging Per Child- Employees pay per person as opposed to the traditional individual versus family plans
   2. Narrow Networks- Control costs by limiting choices to a smaller group of medical care providers
   3. The Consumer Directed Health Plan (CDHP)- A plan with a high deductible that often comes with a contribution from the employer toward the worker’s costs
   4. The “Private Exchange”- An exchange where your employer may give you a defined amount of money to choose benefits, instead the subsidy offered under the health law
   5. Specialty Pharmacy- Specialty drugs are big ticket items for employers and such spending has jumped by double-digit percentages

   Source: Forbes

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10. Ann Miller RN MHA, on September 9, 2014 at 11:29 AM said:

    On Marketplace Risk Adjustment

    Below are links to three new papers on risk adjustment in the ACA Marketplaces. I have not read them in full, but intend to. This is an area we’ve found hard to get clarity on for some time. I hope these papers fill the void.

    1. Affordable Care Act Risk Adjustment: Overview, Context, and Challenges

    http://www.cms.gov/mmrr/Articles/A2014/MMRR2014_004_03_a02.html

    2. The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act

    http://www.cms.gov/mmrr/Articles/A2014/MMRR2014_004_03_a03.html

    3. Risk Transfer Formula for Individual and Small Group Markets Under the Affordable Care Act

    http://www.cms.gov/mmrr/Articles/A2014/MMRR2014_004_03_a04.html

    At the links, you can download the papers. They’re ungated (Your tax dollars at work.)

    Ann Miller RN MHA
    via Austin Frakt PhD

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11. Nancy Chockley PhD, on September 24, 2015 at 4:59 PM said:

    Reaching Minorities
    [Health Care Enrollment and Engagement]

    As we approach the ACA’s third open enrollment, health insurance is still far from universal for some minority groups. One in five Hispanics were uninsured last year.

    And, although coverage rates among African Americans have surged nationally, success has varied from state to state based on Medicaid expansion decisions and other factors.

    Nancy Chockley PhD

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12. Ann Miller RN MHA, on December 10, 2015 at 1:54 AM said:

    Emblem Health Boots 750 NY Doctors Thanks to ObamaCare

    Emblem Health is booting 750 doctors from its downstate network of providers effective Jan. 1 as part of ObamaCare. Fearing a precedent, the state Medical Society has called on the Cuomo administration to intervene. “They’re taking away the rights and choices from patients. This is bad for patients, bad for doctors, bad for healthcare,” said New York County Medical Society President Michael Goldstein.

    Emblem Health CEO Karen Ignagni defended the move in a letter to the state Department of Financial Services, saying the reduction covers only 2 percent of the doctors in its network. She said the insurer is implementing a payment overhaul promoted by ObamaCare and New York officials that will “improve the outcomes of our members and contribute to the creation of a better health-care system in New York.”

    In an effort to rein in costs, the new payment system provides doctors with a fixed fee per patient rather than a fee for every visit and medical test. The change requires doctors to move away from a billing system that has “rewarded volume, not value, for patients,” Ignagni said.

    Source: Carl Campanile, New York Post [12/8/15]

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