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CBO — How Initiatives to Reduce Fraud in Federal Health Care Programs Affect the Budget

October 22, 2014 Comments off

How Initiatives to Reduce Fraud in Federal Health Care Programs Affect the Budget
Source: Congressional Budget Office

Observers often cite fraud as an important contributor to high health care spending, particularly in federal programs. This report describes how CBO estimates the budgetary effects of legislative proposals to reduce fraud in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), and how those estimates are used in the Congressional budget process.

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Implementing The ACA: Medicaid Spending & Enrollment Growth For FY 2014 And FY 2015

October 16, 2014 Comments off

Implementing The ACA: Medicaid Spending & Enrollment Growth For FY 2014 And FY 2015 (PDF)
Source: Kaiser Family Foundation

Medicaid spending and enrollment growth are affected by both the economy and policy decisions determining who is covered under the program, the services provided and payments for care. For more than a decade, economic conditions, including two major recessions, were the primary driver of changes in Medicaid spending and enrollment. In FY 2014 and in budgets adopted for FY 2015, enrollment and spending have grown with implementation of the major coverage provisions in the Affordable Care Act (ACA), including the federally financed Medicaid expansion. This report provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2014 and 2015 (FY 2014 and FY 2015) and an overview of Medicaid financing. Findings are based on interviews and data provided by state Medicaid directors as part of the 14th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) with Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth and compare expansion and non-expansion states.

What’s In and What’s Out? Medicare Advantage Market Entries and Exits for 2015

October 15, 2014 Comments off

What’s In and What’s Out? Medicare Advantage Market Entries and Exits for 2015 (PDF)
Source: Kaiser Family Foundation

During the debate over the Affordable Care Act (ACA), some questioned whether the Medicare Advantage market would shrink in response to the reductions in payments to Medicare Advantage plans included in the ACA,1 expressing concern that plans would exit markets across the country, leading to a drop in enrollment, similar to what occurred after the Balanced Budget Act of 1997 (BBA97).2 Since 2010, enrollment has far exceeded expectations, increasing by nearly 5 million beneficiaries, continuing a steady upward climb that started a decade ago.3 Between 2010 and 2014, the total number of plans has declined modestly, but beneficiaries in 2014 still had the option to choose among 18 Medicare Advantage plans, on average.

Medicare Advantage plans enter and exit markets for a number of reasons related to business strategies, local market conditions, and profitability. When Medicare Advantage plans make a decision to exit markets, beneficiaries have the option to switch to another Medicare Advantage plan offered in their area or get coverage under traditional Medicare. If they choose traditional Medicare following termination of their plan, they have a special open enrollment period for Medigap policies. In this sense, traditional Medicare serves as a back-up for beneficiaries affected by Medicare Advantage plans terminations.

This Data Note examines the availability of plans nationwide and by state in 2015, and changes in plan availability since 2011. It documents the number and share of Medicare Advantage enrollees affected by plan withdrawals each year, the characteristics of plans that will be entering the market and characteristics of those exiting the market in 2015, and also assesses the potential implications of these changes for Medicare Advantage enrollees. While the availability of Medicare Advantage plans varies within states by county, this Data Note compares plan participation at the state-level to provide a snapshot of changes in the Medicare Advantage market in 2015. Plans that consolidate (withdraw from the certain counties, but remain in others) are counted among the exiting plans for areas where they will no longer offer plans in 2015. The analysis excludes group Medicare Advantage plans, Special Needs Plans (SNPs) and other plans not available for general enrollment.

See also: Medicare Part D: A First Look At Plan Offerings In 2015 (PDF)

In States That Don’t Expand Medicaid, Who Gets New Coverage Assistance Under the ACA and Who Doesn’t?

October 14, 2014 Comments off

In States That Don’t Expand Medicaid, Who Gets New Coverage Assistance Under the ACA and Who Doesn’t? (PDF)
Source: Robert Wood Johnson Foundation

In states not expanding Medicaid, 6.3 million uninsured adults who could have qualified for Medicaid are instead ineligible, while 5.9 million other uninsured adults qualify for subsidized, private insurance. We compare these two groups and find the following:

Median income for such ineligible adults is 35 percent below poverty. For eligible adults, it is 175 percent of the federal poverty level. In dollars, median incomes are under $800 a month for the ineligible uninsured and over $2,000 a month for eligible adults. As a result:

  • Only 28.0 percent of uninsured black adults qualify for help paying for health coverage while fully 42.7 percent are ineligible because of nonexpansion. By contrast, more uninsured whites qualify (36.0 percent) than not (32.7 percent).
  • More uninsured women are ineligible than eligible (33.2 percent vs. 27.8 percent). Slightly more uninsured men qualify (30.9 percent) than not (29.7 percent).
  • Uninsured adults who are Hispanic, under age 25, or have at most a high school degree are more likely to be ineligible than eligible. The opposite is true for uninsured adults ages 45 to 64 or with at least some college education.

Uninsured adults ineligible for coverage assistance because of nonexpansion include 4.4 million with a high school degree or less, 3.1 million women, 1.6 million blacks, 1.5 million under age 25, and 1.3 million Latinos.

These contrasts involve coverage assistance that the ACA made available for the first time. However, before the ACA, nonexpansion states already provided Medicaid to 6.5 million adults, and 1.8 million uninsured adults were eligible for Medicaid but not enrolled.

The National Coalition on Health Care Releases Inaugural Congressional Report Card: 113th Congress Fails to Make the Grade on Health Care Costs

October 13, 2014 Comments off

The National Coalition on Health Care Releases Inaugural Congressional Report Card: 113th Congress Fails to Make the Grade on Health Care Costs
Source: National Coalition on Health Care

Today, the National Coalition on Health Care (NCHC) released “Health Costs and the American Family: A Report Card on the 113th Congress,” finding that despite strong bipartisan efforts, this Congress has yet to make the grade in curbing health care costs.

The seven-page report card grades actions taken by the 113 Congress in three areas of health policy where common-ground, bipartisan solutions were possible: modernizing physician payment and SGR repeal, price and quality transparency, and strengthening Medicare. The report card concludes that Congress has so far failed to make meaningful progress toward greater health care affordability.

2015 Medicare Part B premiums and deductibles to remain the same as last two years

October 10, 2014 Comments off

2015 Medicare Part B premiums and deductibles to remain the same as last two years
Source: HHS Centers for Medicare and Medicaid Services

Secretary of Health and Human Services Sylvia Burwell announced today that next year’s standard Medicare Part B monthly premium and deductible will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. For the approximately 49 million Americans enrolled in Medicare Part B, premiums and deductibles will remain unchanged in 2015 at $104.90 and $147, respectively. This leaves more of seniors’ cost of living adjustment from Social Security in their pockets.

New From the GAO

October 6, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Medicaid: Information on Inmate Eligibility and Federal Costs for Allowable Services. GAO-14-752R, September 5.
http://www.gao.gov/products/GAO-14-752R

2. Private Health Insurance: The Range of Base Premiums in the Individual Market by County in January 2013. GAO-14-772R, September 5.
http://www.gao.gov/products/GAO-14-772R

3. Troubled Asset Relief Program: Treasury Could Better Analyze Data to Improve Oversight of Servicers’ Practices. GAO-15-5, October 6.
http://www.gao.gov/products/GAO-15-5
Highlights – http://www.gao.gov/assets/670/666386.pdf

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