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The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect

January 22, 2015 Comments off

The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect
Source: Commonwealth Fund

New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act’s subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014.

The Share of People with High Medical Costs Increased Prior to Implementation of the Affordable Care Act

January 22, 2015 Comments off

The Share of People with High Medical Costs Increased Prior to Implementation of the Affordable Care Act
Source: Commonwealth Fund

The percentage of Americans who spend more than 10 percent of their family income on out-of-pocket health care expenses increased to 19.2 percent in 2011, from 18.2 percent during 2007–09. Medical cost burdens were highest for people with private nongroup insurance coverage, who are among those most likely to benefit from the Affordable Care Act’s coverage expansions.

HHS OIG — Federal Marketplace: Inadequacies in Contract Planning and Procurement

January 21, 2015 Comments off

Federal Marketplace: Inadequacies in Contract Planning and Procurement
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
The Federal Marketplace at HealthCare.gov was designed to enable millions of Americans to select health insurance in a “one-stop shop” environment. A project of this magnitude and complexity required the development, integration, and operation of multiple information technology (IT) systems and Government databases. CMS acquisition planning and procurement activities were among the first steps critical to ensuring the success of this project. CMS awarded 60 contracts across 33 companies to perform this work. The troubled launch of the Federal Marketplace at HealthCare.gov in October 2013 raised a number of concerns, including questions about the adequacy of CMS’s planning and procurement efforts for this key project under the Affordable Care Act.

HOW WE DID THIS STUDY
We conducted a detailed review of documentation provided by CMS for the 60 Federal Marketplace contracts, selected 6 key contracts for indepth review, and interviewed Department of Health and Human Services (HHS) and CMS officials involved with contracting for the Federal Marketplace. We also reviewed procurement regulations, manuals, guides, and procedures provided by both HHS and CMS for acquisition planning, contractor selection, and contracting oversight processes.

WHAT WE FOUND
When awarding the Federal Marketplace contracts, CMS did not always meet contracting requirements. For example, CMS did not develop an overarching acquisition strategy for the Federal Marketplace or perform all required oversight activities. Moreover, for a project of this size and importance, CMS missed opportunities to leverage all available acquisition planning tools and contracting approaches to identify and mitigate risks. Specifically, CMS did not exercise the option to plan for a lead systems integrator to coordinate all contractors’ efforts prior to the launch of the Federal Marketplace. The complexity of the Federal Marketplace underscored the need for CMS to select the most qualified contractors. However, CMS did not perform thorough reviews of contractor past performance when awarding two key contracts. CMS also made contracting decisions that may have limited the number of acceptable proposals for much of the key Federal Marketplace work. In addition, CMS selected contract types that placed the risk of cost increases for this work solely on the Government.

WHAT WE RECOMMEND
We recommend that (1) CMS ensure that acquisition strategies are completed as required by regulation, (2) CMS assess whether to assign a lead systems integrator for complex IT projects, (3) CMS ensure that contract actions are properly documented, (4) CMS ensure that all contracts subject to oversight review requirements undergo those reviews, (5) HHS limit or eliminate regulatory exceptions to acquisition planning requirements, and (6) HHS revise its acquisition guidance to include specific standards for conducting past performance reviews. HHS and CMS concur with all of our recommendations.

The ACA’s Risk Spreading Mechanisms: A Primer on Reinsurance, Risk Corridors and Risk Adjustment

January 20, 2015 Comments off

The ACA’s Risk Spreading Mechanisms: A Primer on Reinsurance, Risk Corridors and Risk Adjustment
Source: American Action Forum

The 2010 Affordable Care Act (ACA) health reform law established state-based health insurance exchanges to provide an individual market for qualified health insurance plans. The state exchanges sell insurance plans to any citizen, regardless of health status. Enrollees who purchase plans through an exchange can receive federal premium subsidies if their household income falls between 100 and 400 percent of the federal poverty level. This primer provides an overview of the ACA’s risk mitigation provisions that apply to individual and/or small group market plans: reinsurance, risk corridors, and risk adjustment.

While the exchanges are implemented and administered by either the state or the federal government, the qualified health plans offered are sold by private insurance companies and designed to be in compliance with the ACA regulations. For insurers, offering a plan on the exchange is very different than offering a plan on the pre-ACA individual market or to a group purchaser such as a large company. For one, the issuer offering their first exchange plan in 2014 had no way of knowing the health status or previous claims history of the applicants; some exchange enrollees may have been uninsured for many years and have a long list of unmet medical needs. Secondly, the applicant must be charged the same premium as everyone else in their age band, and the oldest applicants cannot be charged more than three times the rate of the youngest. And finally, insurance companies are selling a new insurance product, with newly mandated benefits, and limits on cost-sharing, but they have no control over how many, or how few, individuals enroll.

Issuers priced their products according to their best projections. However, for the reasons listed above, uncertainty about risk pools is larger than for a mature market. In order to improve the incentives for insurers to participate, the ACA includes three risk spreading mechanisms: temporary reinsurance, temporary risk corridors, and permanent risk adjustment, all of which address potential risk pool issues by limiting the amount an insurance company can lose by participating in the marketplace. Risk adjustment is designed to spread risk among plans to prevent adverse selection, reinsurance helps plans with individuals who have unexpectedly high medical costs, and risk corridors protect both health plans and the federal government against uncertainty in pricing during the initial years of the ACA’s market reforms. These mechanisms allow insurance companies to price their products more competitively, as any significant losses will be partially offset.

Assessing Alternative Modifications to the Affordable Care Act

January 20, 2015 Comments off

Assessing Alternative Modifications to the Affordable Care Act (PDF)
Source: RAND Corporation

In this report, we use the COMPARE microsimulation model to estimate how several potential changes to the ACA, including eliminating the individual mandate, eliminating the tax credits, and combined scenarios that change these and other provisions of the act, might affect 2015 individual market premiums and overall insurance coverage. Underlying these estimates is our COMPARE-based analysis of how premiums and insurance coverage outcomes depend on young adults’ propensity to enroll in insurance coverage. We find that eliminating the ACA’s tax credits and eliminating the individual mandate both increase premiums and reduce enrollment on the individual market, as do the combined policies we examine.

MPI Releases Detailed Data Profiles of Unauthorized Immigrants and Estimates of Deferred Action Populations for Top U.S. Counties

January 16, 2015 Comments off

MPI Releases Detailed Data Profiles of Unauthorized Immigrants and Estimates of Deferred Action Populations for Top U.S. Counties
Source: Migration Policy Institute

The Migration Policy Institute (MPI) today released data profiles of unauthorized immigrants in the 94 U.S. counties with the largest such populations, including detailed information on population size, countries of origin, recency of arrival, educational enrollment and attainment, health insurance coverage, poverty levels and potential eligibility for the two deferred action programs launched by the Obama administration.

The profiles for the 94 counties, which are home to approximately two-thirds of the 11.4 million unauthorized immigrants in the United States, are the latest addition to a unique data tool that offers detailed information on this population at national and state levels, including those potentially eligible for the Deferred Action for Childhood Arrivals (DACA) program or the recently announced Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) program. Using an innovative MPI methodology that takes U.S. Census Bureau data and imputes legal status for noncitizens, the tool also provides estimates of the age, gender, parental and marital status, top languages spoken, labor force participation and home ownership rates for unauthorized immigrants.

The county profiles reveal that the top five counties with the largest populations potentially eligible for relief from deportation through DACA or DAPA — Los Angeles, CA; Harris, TX; Orange, CA; Cook, IL; and Dallas, TX — account for 1.1 million people, over one-fifth of the total potentially eligible population nationwide, which MPI estimates at 5.2 million.

CRS — Premium Tax Credits and Federal Health Insurance Exchanges: Questions and Answers (December 19, 2014)

January 14, 2015 Comments off

Premium Tax Credits and Federal Health Insurance Exchanges: Questions and Answers (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Legal challenges that may have a substantial impact on the implementation and operation of the Patient Protection and Affordable Care Act (ACA) concern whether premium tax credits are available for millions of individuals participating in federally administered health insurance exchanges. These credits, which became available in 2014, are intended to help individuals pay the premiums for private health plans offered through the insurance exchanges established under the act. In addressing who may receive this credit, ACA refers to individuals who are “enrolled in [a plan] through an exchange established by the State” under ACA. Following the issuance of IRS regulations that allow for these credits to be available in both state and federally run exchanges, lawsuits were filed claiming that the language of ACA prohibits the credits from being available to individuals who obtain coverage in federally run exchanges. The Supreme Court has decided to weigh in on this issue in King v. Burwell. While the Supreme Court has not yet set a date for oral arguments in the King case as of the date of this report, it is expected that the case will be argued sometime in March, and a decision would be rendered by the end of the Court’s term in June 2015 at the latest.

This report provides background on provisions of ACA relevant to this issue. It then answers questions concerning the legal challenges and potential implications of the Court’s decision in King.

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