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The 10 percent problem: Future health insurance marketplace premium increases likely to reach double digits

June 25, 2015 Comments off

The 10 percent problem: Future health insurance marketplace premium increases likely to reach double digits
Source: Deloitte

Health plans setting their premiums for the public health insurance marketplaces have faced one of the most challenging pricing scenarios in recent history. A new set of rating rules, a competitive environment, and ambiguity around enrollee populations collided to create unprecedented uncertainty.

While the Affordable Care Act (ACA) established three programs – risk adjustment, risk corridors, and reinsurance – to address some of this uncertainty, two of the programs will expire after 2016. How might these expirations and other policy levers influence health plans’ strategies for setting their marketplace premiums?
This report presents a forward-looking view for health plans participating in the marketplaces, with modeling by Deloitte Consulting LLP’s health actuarial practice estimating the effect of the risk corridors and reinsurance program expirations on health plan premiums. Among key observations:

  • Premium increases of 10 percent or more could be likely over the next three years as health plans prepare for the end of the risk corridors and reinsurance programs and try to reach or maintain profitability in 2017.
  • Certain policy levers are influencing health plans’ options for premium increases and their decisions around insurance marketplace participation. Among these are pressures to not exceed the 10 percent rate increase threshold, to offer broader networks, and to discontinue other strategies to keep prices down.
  • Health plans should consider a multi-year strategy for setting their marketplace premiums and test its execution by modeling different scenarios.

Balance Billing: How Are States Protecting Consumers from Unexpected Charges?

June 18, 2015 Comments off

Balance Billing: How Are States Protecting Consumers from Unexpected Charges?
Source: Robert Wood Johnson Foundation

States have varying policies—some have none at all—to protect consumers from unexpected bills sent by hospitals, doctors, or clinics for an amount beyond what the consumer’s insurance covers, also known as balance billing.

This analysis shows what select states are and are not doing to protect consumers from balance bills, and details instances when patients take the necessary precautions to visit a doctor or hospital that is covered by their insurance, only to have a specialist consulted during the visit who is not in the provider network of the patient’s insurance plan.

New Data and Updated Report Show Medicaid Is Expanding Insurance Coverage, with Major Benefits to States’ Citizens and Economies

June 8, 2015 Comments off

New Data and Updated Report Show Medicaid Is Expanding Insurance Coverage, with Major Benefits to States’ Citizens and Economies
Source: White House

The Affordable Care Act has dramatically expanded access to health insurance coverage. Since the law’s major coverage provisions took effect at the end of 2014, the Nation has seen the sharpest reduction in the uninsured rate since the decade following the creation of Medicare and Medicaid in 1965, and the Nation’s uninsured rate is now at its lowest level ever. Combining these recent gains with earlier gains due to the law’s provision allowing young adults to remain on a parent’s plan until age 26, more than 16 million Americans had gained health insurance coverage as of early 2015.

One important way the Affordable Care Act is expanding coverage is by providing generous financial support to States that elect to expand their Medicaid programs to cover all adults with incomes below 138 percent of the Federal poverty level. New data released this morning show that the number of people with coverage through Medicaid or the Children’s Health Insurance Program (CHIP) has risen by 12.2 million people from the start of the first open enrollment period under the Affordable Care Act through March 2015. From February to March alone, the number of people with Medicaid or CHIP coverage rose by more than 500,000 people.

New Report Reveals Violations of Affordable Care Act’s Breastfeeding Benefits

June 8, 2015 Comments off

New Report Reveals Violations of Affordable Care Act’s Breastfeeding Benefits
Source: National Women’s Law Center

A report released today by the National Women’s Law Center (NWLC) exposes at least 20 insurance companies that are violating the Affordable Care Act’s (ACA) breastfeeding benefits and identified troubling trends in insurance company compliance that are likely to be systemic nationwide. NWLC found violations that include limiting coverage of breast pump purchases and failing to have lactation counselors in network.

CRS — State Children’s Health Insurance Program: An Overview (March 20, 2015)

May 29, 2015 Comments off

State Children’s Health Insurance Program: An Overview (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The State Children’s Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance. CHIP is jointly financed by the federal government and states, and the states are responsible for administering CHIP. In FY2013, CHIP enrollment totaled 8.4 million individuals and CHIP expenditures totaled $13.2 billion.

Congress is actively discussing the future of the CHIP program because federal funding for CHIP is set to end after FY2015, even though the program is still authorized. With the current fiscal year being the final year federal CHIP funding is provided in statute, Congress’s action or inaction on the CHIP program may affect health insurance options and resulting coverage for targeted low-income children that are eligible for the current CHIP program.

Expanding coverage: How primary care physicians are accommodating the newly insured

May 21, 2015 Comments off

Expanding coverage: How primary care physicians are accommodating the newly insured
Source: Deloitte

Are there enough physicians in the US to accommodate the millions of newly insured patients? If not, how will the health care system manage its growing (and aging) patient population?

The Deloitte Center for Health Solutions 2014 Survey of US Physicians shows that 44 percent of physicians are treating more newly insured patients – an important finding for health care stakeholders and decision makers. More primary care physicians (PCPs) (56 percent) experienced an increase in the number of newly insured patients than did surgical specialists (40 percent), non-surgical specialists (38 percent), and other physicians (33 percent). Survey respondents report that this is causing longer appointment wait times and driving PCPs to work longer hours. To cope, some PCPs are adding new physicians and hiring clinical staff to help with care coordination.

Job Lock and Employer-Provided Health Insurance: Evidence from the Literature

May 20, 2015 Comments off

Job Lock and Employer-Provided Health Insurance: Evidence from the Literature
Source: AARP Public Policy Institute

This report, written by Dean Baker at the Center for Economic and Policy Research, reviews the research literature on health insurance-related “job lock”—a labor market pattern that occurs when workers are reluctant to leave a job that offers health insurance because they cannot otherwise obtain affordable insurance. Based on the research, the author concludes that the Affordable Care Act’s insurance market reforms should have substantial, positive labor market effects.

The report reviews the research on three types of job lock:

  • Workers remaining in jobs in which they are not satisfied because of the fear of not being able to get health insurance at a new job (or not being able to buy or afford it in the individual market);
  • Workers being reluctant to start a business because they do not want to lose employer-provided health insurance; and
  • Workers staying employed (or employed full time) in order to obtain employer-sponsored insurance, when they would otherwise prefer to retire or work part time.

All three types of job lock are likely to be reduced by the Affordable Care Act, resulting in important gains for workers, families, and the economy.

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