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CRS — Health Benefits for Members of Congress and Certain Congressional Staff (updated)

April 16, 2014 Comments off

Health Benefits for Members of Congress and Certain Congressional Staff (PDF)
Source: Congressional Research Service (via University of North Texas Digital Library)

The federal government, as an employer, offers health benefits to its employees, including Members of Congress and congressional staff. Prior to 2014, Members and staff had access to many of the same health benefits as other federal employees. For example, Members and staff were eligible to voluntarily enroll in employer-sponsored health insurance through the Federal Employees Health Benefits Program (FEHBP), and they could choose to participate in other health benefit programs, such as the Federal Flexible Spending Account Program (FSAFEDS).

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Health Reform: Designing a Marketplace — A state-by-state comparison of Marketplace Implementation

April 16, 2014 Comments off

Health Reform: Designing a Marketplace — A state-by-state comparison of Marketplace Implementation
Source: Center on Budget and Policy Priorities

The Affordable Care Act (ACA) creates a Health Insurance Marketplace (Marketplace) in every state, which offers individuals and small businesses the opportunity to shop from an array of affordable, comprehensive health insurance plans. A state can either create and operate the Marketplace itself as a State-based Marketplace (SBM), partner with the federal government under a State Partnership Marketplace (SPM), or defer to the U.S. Department of Health and Human Services to manage a Federally-facilitated Marketplace (FFM) in the state.

In 2014, 16 states and the District of Columbia have established a State-based Marketplace for both individuals and small businesses, six states have a State Partnership Marketplace, and one state is administering a State-based SHOP Marketplace just for small businesses (with an FFM serving individuals).

The ACA provides states with significant flexibility in the design and structure of their Marketplace; hundreds of policy and operational decisions had to be addressed during the Marketplace implementation process. CBPP has evaluated SBM and SPM states across a number of these Marketplace design questions and compiled the information in this interactive tool.

CBO — Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014

April 14, 2014 Comments off

Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014
Source: Congressional Budget Office

CBO and the staff of the Joint Committee on Taxation (JCT) have updated their estimates of the budgetary effects of the provisions of the Affordable Care Act (ACA) that relate to health insurance coverage. The new estimates, which are included in CBO’s latest baseline projections, reflect CBO’s most recent economic forecast, account for administrative actions taken and regulations issued through March 2014, and incorporate new data and various modeling updates.

Relative to their previous projections made in February 2014, CBO and JCT now estimate that the ACA’s coverage provisions will result in lower net costs to the federal government: The agencies currently project a net cost of $36 billion for 2014, $5 billion less than the previous projection for the year; and $1,383 billion for the 2015–2024 period, $104 billion less than the previous projections (see the figure below).

New State-by-State Analysis: 32 Million Were Underinsured in 2012, Including 4 Million Middle-Income People; Nearly 80 Million in Total Lacked Health Insurance or Were Underinsured, Ranging from 14 Percent in Massachusetts to 38 Percent in New Mexico and Texas

April 11, 2014 Comments off

New State-by-State Analysis: 32 Million Were Underinsured in 2012, Including 4 Million Middle-Income People; Nearly 80 Million in Total Lacked Health Insurance or Were Underinsured, Ranging from 14 Percent in Massachusetts to 38 Percent in New Mexico and Texas
Source: Commonwealth Fund

Thirty-two million people under age 65 were underinsured in the U.S. in 2012, meaning they had health coverage but it provided inadequate protection against high health care costs relative to their income, a new Commonwealth Fund report finds. The first report to examine the underinsured at the state level, it finds that the rate of underinsured ranged from a low of 8 percent in New Hampshire to highs of 16 percent in Mississippi and Tennessee and 17 percent in Idaho and Utah.

Low- and middle-income families were most likely to be affected: 13 percent—4 million—of the underinsured were middle-income, earning between about $47,000 and $95,000 for a family of four, and 81 percent—26 million—were low-income, earning less than 200 percent of the federal poverty level, or under $47,000 a year for a family of four.

In addition, 47 million people were uninsured in 2012—a decline of nearly 2 million from 2010, likely due in large part to the Affordable Care Act’s early provision to expand dependent coverage for young adults.

Before the major expansions of the ACA began to be implemented this year, a total of 79 million people under 65 were uninsured or underinsured, and therefore at risk for not being able to afford needed health care or for facing debt from medical bills in 2012. Nationally, nearly one of three (29%) people were uninsured or underinsured, ranging from 14 percent in Massachusetts to 36 to 38 percent in Florida, Idaho, Nevada, New Mexico, and Texas.

The Affordable Care Act’s Medicaid expansion and health insurance reforms are appropriately targeted to those Americans who are most likely to be unable to afford insurance or needed health care, according to the report, America’s Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions. Based on their incomes alone, 20 million of the underinsured in 2012, as well as 24 million of the uninsured, would qualify for Medicaid under the Affordable Care Act.

However, millions who are poor will not have any new coverage options. In states choosing not to expand Medicaid, more than 15 million underinsured and uninsured people have incomes below poverty—earning less than $23,550 a year for a family of four

Employer-sponsored benefits extended to domestic partners

April 2, 2014 Comments off

Employer-sponsored benefits extended to domestic partners
Source: Bureau of Labor Statistics

As part of compensation packages offered to employees, it is common for employers to extend certain benefits to an employee’s family members. For example, employment-based health benefits typically include insurance coverage for the family, and traditional (defined-benefit) pension plans provide survivor benefits to spouses of married employees. As employers recognize different family structures, many have adapted by offering similar benefits to employees who have varied family units. For example, employers often vary employee contributions for health benefits based on family makeup by identifying different contribution amounts for married employees with children and for single employees with children. New data provide a picture of how frequently certain benefits are extended to unmarried opposite-sex and unmarried same-sex partners. For example, 72 percent of civilian workers had access to employment-based health benefits in March 2013, with nearly all the employers extending these benefits to spouses and children, but only 32 percent of civilian workers had health benefits extended to unmarried same-sex domestic partners and 26 percent had benefits extended to unmarried opposite-sex domestic partners.

A Health Care Puzzler

April 1, 2014 Comments off

A Health Care Puzzler
Source: RAND Corporation

An American Life Panel survey finds that a lack of knowledge about health reform and health insurance is especially acute among the poor, less educated, young, and females. This presents challenges for implementation of the Affordable Care Act.

Abortion Coverage Under the Affordable Care Act: The Laws Tell Only Half the Story

March 31, 2014 Comments off

Abortion Coverage Under the Affordable Care Act: The Laws Tell Only Half the Story
Source: Guttamacher Institute
From press release:

Consumers purchasing health coverage through the marketplaces created under the Affordable Care Act (ACA) have no easy way—and often no way at all—to find out whether a health plan covers abortion care, according to a new Guttmacher analysis. The analysis lays out how this lack of transparency can be addressed by the Obama administration, which has the authority to ensure health plan issuers make such information readily available to consumers nationwide.

Who among the Uninsured Do Not Plan to Look for Health Insurance in the ACA Marketplaces?

March 27, 2014 Comments off

Who among the Uninsured Do Not Plan to Look for Health Insurance in the ACA Marketplaces?
Source: Urban Institute

New enrollment figures for both state and federal health insurance Marketplaces created by the Affordable Care Act (ACA) show that participation is picking up steam after a slow start, with data as of March 17, 2014 reflecting 5 million enrolled. But with open enrollment closing on March 31, the pace of enrollment will need to accelerate further to reach the revised target of 6 million people. Previous research suggests that the initial low levels of Marketplace enrollment were driven as much by gaps in awareness of the ACA’s coverage provisions as by the widely publicized problems with the federal website. For example, only about one-third of adults had heard some or a lot about the Marketplaces on the eve of the Marketplace rollout (Long and Goin 2014). By December 2013, about one-fifth of uninsured adults had looked at that time and another third planned to look (Blavin et al. 2014). Additional research finds that many uninsured are not looking for coverage in the Marketplaces because they are unaware that financial help is available there.

Environmental and State-Level Regulatory Factors Affect the Incidence of Autism and Intellectual Disability

March 26, 2014 Comments off

Environmental and State-Level Regulatory Factors Affect the Incidence of Autism and Intellectual Disability
Source: PLoS Computational Biology

Many factors affect the risks for neurodevelopmental maladies such as autism spectrum disorders (ASD) and intellectual disability (ID). To compare environmental, phenotypic, socioeconomic and state-policy factors in a unified geospatial framework, we analyzed the spatial incidence patterns of ASD and ID using an insurance claims dataset covering nearly one third of the US population. Following epidemiologic evidence, we used the rate of congenital malformations of the reproductive system as a surrogate for environmental exposure of parents to unmeasured developmental risk factors, including toxins. Adjusted for gender, ethnic, socioeconomic, and geopolitical factors, the ASD incidence rates were strongly linked to population-normalized rates of congenital malformations of the reproductive system in males (an increase in ASD incidence by 283% for every percent increase in incidence of malformations, 95% CI: [91%, 576%], p<6×10−5). Such congenital malformations were barely significant for ID (94% increase, 95% CI: [1%, 250%], p = 0.0384). Other congenital malformations in males (excluding those affecting the reproductive system) appeared to significantly affect both phenotypes: 31.8% ASD rate increase (CI: [12%, 52%], p<6×10−5), and 43% ID rate increase (CI: [23%, 67%], p<6×10−5). Furthermore, the state-mandated rigor of diagnosis of ASD by a pediatrician or clinician for consideration in the special education system was predictive of a considerable decrease in ASD and ID incidence rates (98.6%, CI: [28%, 99.99%], p = 0.02475 and 99% CI: [68%, 99.99%], p = 0.00637 respectively). Thus, the observed spatial variability of both ID and ASD rates is associated with environmental and state-level regulatory factors; the magnitude of influence of compound environmental predictors was approximately three times greater than that of state-level incentives. The estimated county-level random effects exhibited marked spatial clustering, strongly indicating existence of as yet unidentified localized factors driving apparent disease incidence. Finally, we found that the rates of ASD and ID at the county level were weakly but significantly correlated (Pearson product-moment correlation 0.0589, p = 0.00101), while for females the correlation was much stronger (0.197, p<2.26×10−16).

See: Autism, intellectual disability incidence linked with environmental factors (Science Daily)

Blueprint for Approval of Affordable Health Insurance Marketplaces

March 25, 2014 Comments off

Blueprint for Approval of Affordable Health Insurance Marketplaces (PDF)
Source: U.S. Department of Health and Human Services (via Health Reform GPS)

The Affordable Care Act (ACA) establishes Affordable Health Insurance Exchanges, or “Exchanges,” also known as Health Insurance Marketplaces, or “Marketplaces” to provide individuals and small business employees access to affordable health insurance coverage beginning January 1, 2014.1 A Marketplace is an entity that both facilitates the purchase of qualified health plans (QHP) by qualified individuals and provides for the establishment of a Small Business Health Options Program (SHOP), consistent with Affordable Care Act 1311(b) and 45 CFR 155.20. Marketplaces are competitive and allow individuals and small employers to directly compare and purchase private health insurance options based on price, quality, and other factors. Marketplaces are integral to the Affordable Care Act’s goal of prohibiting discrimination against people with pre-existing conditions and insuring all Americans.

The Affordable Care Act and associated regulations provide states with significant flexibility in the design and operation of their Marketplaces to ensure states are implementing sustainable Marketplaces that best meet the needs of its population. States can choose to establish and operate a State-based Marketplace, or the Secretary of the U.S. Department of Health and Human Services (HHS) will establish and operate a Federallyfacilitated Marketplace in any state that does not elect to operate a State-based Marketplace. In a Federallyfacilitated Marketplace, the state may establish and operate a State-based SHOP Marketplace, where a state operates the SHOP Marketplace and defers responsibility for the individual Marketplace to the Federallyfacilitated Marketplace, or the state may pursue a State Partnership Marketplace, where the state may administer and operate Marketplace activities associated with consumer assistance activities. States that elect to participate in a State Partnership Marketplace will administer these functions in both the individual and the small group markets.

Regulations implementing the Affordable Care Act require HHS to Approve or Conditionally Approve all plan year 2015 Marketplace applications no later than June 15, 2014, for operation in 2015. States that seek HHS approval to operate a State-based Marketplace, a State-based SHOP Marketplace, or a State Partnership Marketplace for coverage years beginning after January 1, 2014, must complete and submit a Marketplace Blueprint Application that documents how its Marketplace meets, or will meet, all legal and operational requirements associated with the model it chooses to pursue. As part of its Marketplace Blueprint, a state will also demonstrate operational readiness to execute Marketplace activities.2

Navigator Resource Guide on Private Health Insurance Coverage & the Health Insurance Marketplace

March 12, 2014 Comments off

Navigator Resource Guide on Private Health Insurance Coverage & the Health Insurance Marketplace
Source: Georgetown University Center on Health Insurance Reform and Robert Wood Johnson Foundation

This guide is focused solely on the private insurance reforms of the Affordable Care Act, including the health insurance marketplaces, rating, benefit and cost standards, and premium tax credits. It is intended to supplement the Navigator training available from the U.S. Department of Health and Human Services. It is not intended to be a comprehensive, stand-alone resource for all the reforms of the Affordable Care Act.

This resource is organized into sections that address how individuals may present themselves to Navigators, based on their insurance status and coverage options.

► Section 1 covers enrollment issues for individuals, beginning with those who do not have coverage or an offer of group coverage, i.e., from an employer.

► Section 2 covers enrollment issues for individuals who have coverage or an offer of coverage—whether through an employer-sponsored plan, individual plan, high-risk pool, retiree plan, or student health plan—and want to understand their options, including eligibility for premium tax credits through the health insurance marketplace.

► Section 3 covers enrollment issues for small employers who want to understand and compare their coverage options for their employees.

► Section 4 covers post-enrollment issues, including questions that may arise as individuals use their coverage.

Information in this guide is current as of February 21, 2014. Future supplements will incorporate changes to federal rules. While we have made every effort to provide accurate information in this resource guide, navigators should contact their state’s marketplace, Department of Insurance, or Medicaid agency for guidance on specific circumstances.

CRS — Individual Mandate Under ACA

March 12, 2014 Comments off

Individual Mandate Under ACA (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Beginning in 2014, ACA requires most individuals to maintain health insurance coverage or otherwise pay a penalty. Specifically, most individuals will be required to maintain minimum essential coverage, which is a term defined in ACA and its implementing regulations and includes most private and public coverage (e.g., employer-sponsored coverage, individual coverage, Medicare, and Medicaid, among others). Some individuals will be exempt from the mandate and the penalty, while others may receive financial assistance to help them pay for the cost of health insurance coverage and the costs associated with using health care services.

Supporting the Troops: The TRICARE Quagmire

March 12, 2014 Comments off

Supporting the Troops: The TRICARE Quagmire
Source: National Center for Policy Analysis

TRICARE, the military health insurance program run by the Department of Defense, has a well-deserved reputation for inadequate quality at an exorbitant public cost. Drastic changes to this program are needed to ensure access to health care for 9.6 million active-duty service members, National Guardsmen and Reservists, retired service members (age 60 and above), survivors and their families.

Through a variety of programs, TRICARE offers three types of health care plans: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) and fee-for-service, each with different deductibles, premiums and copays.

CBO — Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act

March 6, 2014 Comments off

Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act
Source: Congressional Budget Office

CBO’s The Budget and Economic Outlook: 2014 to 2024 released a few weeks ago contained the agency’s updated estimates of the effects of the insurance coverage provisions of the Affordable Care Act (ACA). This blog post describes those revised projections of the sources of people’s insurance coverage and the net budgetary impact of those provisions, as detailed in Appendix B of the report.

The key elements of the insurance coverage provisions of the ACA that are encompassed by the estimates discussed here include the following:

  • Many individuals and families will be able to purchase subsidized insurance through exchanges operated either by the federal government or by a state government,
  • States are permitted to significantly expand eligibility for Medicaid but may decline to do so,
  • Most legal residents of the United States must either obtain health insurance or pay a penalty tax for not doing so,
  • Certain employers that decline to offer minimum health insurance coverage to their employees will be assessed penalties,
  • A federal excise tax will be imposed on some health insurance plans with high premiums, and
  • Insurers may not deny coverage to people on the basis of their health status or charge enrollees in poor health higher insurance premiums.

The ACA also made other changes to rules governing health insurance coverage that are not listed here.

Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012

February 28, 2014 Comments off

Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012 (PDF)
Source: National Center for Health Statistics

This report presents detailed tables from the 2012 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, education, current employment status, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates (frequencies and percentages) are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions.

Report to Congress on the impact on premiums for individuals and families with employer-sponsored health insurance from the guaranteed issue, guaranteed renewal, and fair health insurance premiums provisions of the Affordable Care Act

February 25, 2014 Comments off

Report to Congress on the impact on premiums for individuals and families with employer-sponsored health insurance from the guaranteed issue, guaranteed renewal, and fair health insurance premiums provisions of the Affordable Care Act (PDF)
Source: U.S. Department of Health and Human Services, Center for Medicare & Medicaid Services (via Health Reform GPS)

Before the premium rating provision of the ACA took effect, firms with employees who had better than average health risks would typically pay lower premiums, and therefore, they were more likely to be the firms that offer health insurance. As a result, most of people with coverage in the small group market have premium rates that are below average. Based on our review of the available research and discussions with several actuarial experts14, we have estimated that roughly 65 percent of small employers offering health insurance coverage have premium rates that are below average.

Once the new premium rating requirements go into effect, it is anticipated that the small employers that offer health insurance coverage to their employees and their families would have average premium rates. Therefore, we are estimating that 65 percent of the small firms are expected to experience increases in their premium rates while the remaining 35 percent are anticipated to have rate reductions. The individuals and families that receive health insurance coverage from their small employer generally contribute a portion of the premium. For this analysis, if the employer premium increases, it is assumed that the employee contribution will rise as well.

Potential Effects of the Affordable Care Act on Income Inequality

February 20, 2014 Comments off

Potential Effects of the Affordable Care Act on Income Inequality
Source: Brookings Institution

The Affordable Care Act (ACA) will improve the well-being and incomes of Americans in the bottom fifth of the income distribution. Under our broadest and most comprehensive income measure we project that incomes in the bottom one-fifth of the distribution will increase almost 6%; those in the bottom one-tenth of the distribution will rise more than 7%. These estimated gains represent averages. Most people already have insurance coverage that will be left largely unaffected by reform. Those who gain subsidized insurance will see bigger percentage gains in their income.

Mapping Out Health Care Reform: Activity in the States

February 20, 2014 Comments off

Mapping Out Health Care Reform: Activity in the States
Source: Deloitte

How many individuals have selected a plan on the health insurance exchanges? What decisions are states making around Medicaid expansion? How many medical insurance carriers are competing in states’ individual markets in 2014? Check out these maps to find out.

National Association of State Mental Health Program Directors Resource Management Guide: Impacts of the Affordable Care Act on Coverage for Uninsured People with Behavioral Health Conditions (2013)

February 18, 2014 Comments off

NASMHPD Resource Management Guide: Impacts of the Affordable Care Act on Coverage for Uninsured People with Behavioral Health Conditions (2013)
Source: National Association of State Mental Health Program Directors

Click on your state to access state-specific data on the number of uninsured people with behavioral health disorders who are eligible for health insurance under the ACA, the projected use rates for behavioral health services, and characteristics of the newly insured population.

CBO — Frequently Asked Questions About CBO’s Estimates of the Labor Market Effects of the Affordable Care Act

February 10, 2014 Comments off

Frequently Asked Questions About CBO’s Estimates of the Labor Market Effects of the Affordable Care Act
Source: Congressional Budget Office

Last week CBO released its latest report on the outlook for the budget and the economy; we also released a companion report that takes a closer look at the slow recovery of the labor market. The budget and economic projections presented in those reports include an updated analysis of the effects of the Affordable Care Act (ACA) on labor markets, which we explain in Appendix C of the report on the outlook. That analysis has attracted a great deal of attention and raised several questions. In this blog posting, we try to answer a few of the questions we have been asked.

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