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CRS — Medicare Advantage (MA)–Proposed Benchmark Update and Other Adjustments for CY2016: In Brief (February 25, 2015)

March 5, 2015 Comments off

Medicare Advantage (MA)–Proposed Benchmark Update and Other Adjustments for CY2016: In Brief (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Medicare Advantage (Part C or MA) is an alternative way for Medicare beneficiaries to receive covered benefits. Under MA, private health plans are paid a per-person monthly amount to provide all Medicare-covered benefits (except hospice) to beneficiaries who enroll in their plan. Unlike under original Medicare, where providers are paid for each item or service provided to a beneficiary, the same capitated monthly payment is made to an MA plan regardless of how many or few services a beneficiary actually uses. The plan is at-risk if costs for all of its enrollees exceed program payments and beneficiary cost sharing; conversely, in general, the plan can retain savings if aggregate enrollee costs are less than program payments and cost sharing.

This report provides a brief background on how MA payments are determined through a comparison of a plan’s estimated cost (bid) and the maximum amount Medicare will pay a plan (benchmark). The report then discusses how the calculation of the benchmark (or maximum possible payment) has changed with the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended), and related administrative action. The report then describes some of the provisions in the Advance Notice of Methodological Changes for CY2016, which would either adjust the benchmarks or make other adjustments, some of which are statutorily specified and some of which are at the discretion of the Secretary. The report concludes with answers to a few questions on the CY2016 MA payments.

Many Aspects of the Affordable Care Act Would Not Be Affected by King v. Burwell, CRS Insights (March 3, 2015)

March 5, 2015 Comments off

Many Aspects of the Affordable Care Act Would Not Be Affected by King v. Burwell, CRS Insights (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The U.S. Supreme Court is preparing to hear oral arguments on March 4, 2015, in the King v. Burwell case where the court is to examine whether or not the statutory language of the Patient Protection and Affordable Care Act (ACA) allows the IRS to make premium tax credits available to residents of states that declined to establish health insurance exchanges. For a more detailed examination of the issues at stake in King v. Burwell, see CRS Report R43833, Premium Tax Credits and Federal Health Insurance Exchanges: Questions and Answers.

The outcome of this case may have significant implications for the future of the private health insurance expansion provisions contained in the ACA. However, what has garnered less attention is the fact that the ACA established numerous programs and policies that operate independently of the premium tax credit regime and would remain current law absent any further action by Congress. This Insight highlights some of the key public health and health services-related issues and programs that would remain in effect. A discussion of other ACA provisions that would not be affected by King v. Burwell—including changes to Medicare, Medicaid, and the State Children’s Health Insurance Program, as well as some of the private insurance changes (e.g., guaranteed issue and renewal of coverage)—is beyond the scope of this document. In addition, indirect effects such as potential impact of the case on safety net providers are not addressed. For a detailed overview of many of the non-health insurance expansion related provisions of the ACA, see CRS Report 41278, Public Health, Workforce, Quality,
and Related Provisions in ACA: Summary and Timeline.

Patient Responses to Incentives in Consumer-directed Health Plans: Evidence from Pharmaceuticals

February 26, 2015 Comments off

Patient Responses to Incentives in Consumer-directed Health Plans: Evidence from Pharmaceuticals
Source: National Bureau of Economic Research

Prior studies suggest that consumer-directed health plans (CDHPs) -characterized by high deductibles and health care accounts- reduce health costs, but there is concern that enrollees indiscriminately reduce use of low-value services (e.g., unnecessary emergency department use) and high-value services (e.g., preventive care). We investigate how CDHP enrollees change use of pharmaceuticals for chronic diseases. We compare two large firms where nearly all employees were switched to CDHPs to firms with conventional health insurance plans. In the first firm’s CDHP, pharmaceuticals were subject to the deductible, while in the second firm pharmaceuticals were exempt. Employees in the first firm shifted the timing of drug purchases to periods with lower cost sharing and were more likely to use lower-cost drugs, but the largest effect of the CDHP was to reduce utilization. Employees in the second firm also reduced utilization, but did not shift the timing or use of low cost drugs.

State-Level Trends in Employer-Sponsored Health Insurance: A State-by-State Analysis

February 23, 2015 Comments off

State-Level Trends in Employer-Sponsored Health Insurance: A State-by-State Analysis (PDF)
Source: Robert Wood Johnson Foundation

The Affordable Care Act (ACA) includes provisions to improve access to affordable health insurance, including access to employer sponsored insurance (ESI). However, concerns have been raised that the ACA could have unintended consequences that would cause declines in ESI. To provide a baseline for understanding the impacts of the ACA on ESI, this report examines and compares trends during two time periods: a period before and including the recession (2004/2005 to 2008/2009), and a period including and since the recession (2008/2009 to 2012/2013). While the majority of non- elderly Americans with health insurance are covered by employer-sponsored insurance (ESI), the percentage of the U.S. population with ESI has been declining for more than a decade — a trend that accelerated during the time of the Great Recession (December 2007 to June 2009).

Racial/Ethnic Differences in Uninsurance Rates under the ACA

February 18, 2015 Comments off

Racial/Ethnic Differences in Uninsurance Rates under the ACA
Source: Urban Institute

This report is the first state-level projection of ACA coverage gains for racial/ethnic groups. Absent ACA coverage provisions, Latinos, blacks, and American Indian/Alaska Natives are overrepresented among the uninsured. With the ACA and current state Medicaid expansion decisions, uninsurance rates are projected to fall for each racial/ethnic group, narrowing coverage differences between whites and each minority group, except for blacks. If all states were to expand their Medicaid programs, we project that uninsurance rates would fall further for all racial/ethnic groups, with blacks experiencing a marked reduction. Effective outreach can further reduce uninsurance rates for all racial/ethnic groups.

Does Health Care Reform Support Self-Employment?

February 17, 2015 Comments off

Does Health Care Reform Support Self-Employment? (PDF)
Source: Federal Reserve Bank of Kansas City

Health insurance access can influence individuals’ labor market decisions. Some economists argue employer-provided health insurance may have deterred entrepreneurship, as self-employed individuals may have faced difficulties in obtaining coverage. As the Patient Protection and Affordable Care Act (PPACA) is gradually implemented, the reform might affect individuals’ decisions to become or remain self-employed.

Tüzemen and Becker examine a similar reform, the Massachusetts Health Care Reform Act, as a case study for the PPACA. They find the uninsured rate declined in Massachusetts following the reform for working-age individuals in general and for the self-employed in particular. Additionally, the self-employment share stayed flat in the state while declining in the rest of the nation. The authors conclude the reform may have supported self-employment in Massachusetts, and suggest the PPACA might have similar effects on the national self-employment share.

How Does Enrollment of Young Invincibles Affect Premiums in the ACA Individual Market?

February 9, 2015 Comments off

How Does Enrollment of Young Invincibles Affect Premiums in the ACA Individual Market?
Source: RAND Corporation

The individual health insurance market involves people buying coverage directly from an insurance company. The ACA established online marketplaces (also known as exchanges) for people to buy insurance in this market. Collectively, the individual market includes non-employer plans offered both on and off of the exchanges.

To keep health insurance affordable in this market, insurers need to spread risk across a broad pool of enrollees, including younger, healthier people, to offset the costs of older, sicker people. Some have theorized that low enrollment among younger, healthier populations could cause insurers to raise premiums, which in turn could price increasing numbers of buyers out of the market, leading ultimately to a market collapse. Does the affordability of premiums in the individual market under the Affordable Care Act (ACA) depend on a given level of young adult enrollment? Will premiums spike if young adult enrollment declines?

To address these questions, a RAND team used the COMPARE microsimulation model to estimate the effects of changes in young adult enrollment in the individual market on premium prices.

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