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.
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
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.
Mapping Out Health Care Reform: Activity in the States
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)
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
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.
New Brief on Data Collection and Use in Health Insurance Exchanges
Source: George Washington University School of Public Health/Robert Wood Johnson Foundation
This brief, written by Taylor Burke, Lara Cartwright-Smith, and Sara Rosenbaum, discusses the new health insurance marketplaces created under the Affordable Care Act and associated structural and process-related regulations that aim to ensure the quality and value of plans sold. To qualify to be sold in these marketplaces, new plans must be certified as a “Qualified Health Plan” (QHP), meet quality accreditation standards, and implement a quality improvement strategy. These steps require the collection of information from insurers, which will result in the disclosure of information about health insurance policies, practices, cost, and quality. Learn more about QHP certification and accreditation and the impact these processes will have on the public availability of health plan performance data…
Health insurance premiums: comparing ACA exchange rates to the employer-based market (PDF)
Source: PricewaterhouseCoopers (via Health Reform GPS)
In 2014, the premiums for health plans offered on new state exchanges under the Affordable Care Act (ACA) are comparable to—and in some cases lower than—those being offered by employers with similar levels of coverage. The data suggest the new exchanges are competitive with the current insurance market and may open doors for employers as they contemplate future benefits strategies.
Contractors and HealthCare.gov: Answers to Frequently Asked Questions (PDF)
Source: Congressional Research Service (via Health Reform GPS)
The widely reported problems with the rollout of the HealthCare.gov website—the federal online health insurance portal called for by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148, as amended)—have prompted interest in the role that contractors played in developing this site. The Centers for Medicare and Medicaid Services (CMS) relied upon the services of over 50 vendors to build the site, which was reportedly largely unusable when it first became available to the public on October 1, 2013, and has been the subject of ongoing work since then.
Given HealthCare.gov’s problematic debut, questions have arisen about how CMS selected vendors to work on HealthCare.gov, and the terms of the vendors’ contractual relationships with the government. For example, some have wondered how CMS could assign work to specific vendors without engaging in “full and open competition through the use of competitive procedures”; whether there are any restrictions on agencies’ dealings with vendors that have foreign parent corporations, as some HealthCare.gov vendors do; and whether political input plays a role in the source-selection process. There have also been questions about how to obtain copies of particular contracts; vendor obligations to report performance problems to the government; modifications to existing contracts; how parties to a government contract resolve disputes; and whether the government can get its money back.
New From the GAO
Source: Government Accountability Office
1. Coal Leasing: BLM Could Enhance Appraisal Process, More Explicitly Consider Coal Exports, and Provide More Public Information. GAO-14-140, December 18.
Highlights - http://www.gao.gov/assets/660/659802.pdf
2. Federal Contracting: Commercial Item Test Program Beneficial, but Actions Needed to Mitigate Potential Risks. GAO-14-178, February 4.
Highlights - http://www.gao.gov/assets/670/660651.pdf
3. Private Health Insurance: The Range of Base Premiums for Individuals Age 19 and 64 in the Individual Market by State in January 2013. GAO-14-263R, January 31.
1. Commercial Space Launches: FAA’s Risk Assessment Process Is Not Yet Updated, by Alicia Puente Cackley, director, financial markets and community investment, before the Subcommittee on Space, House Committee on Science, Space, and Technology. GAO-14-328T, February 4.
Highlights - http://www.gao.gov/assets/670/660634.pdf
1. GAO Makes Appointment to Patient-Centered Outcomes Research Institute Governing Board, February 4.
Evaluating the “Keep Your Health Plan Fix”: Implications for the Affordable Care Act Compared to Legislative Alternatives
President Obama’s promise that Americans could keep their existing health care plans under the Affordable Care Act (ACA) has received increased scrutiny in the wake of millions of Americans having their plans cancelled. These cancellations primarily occurred in the individual or nongroup market, where individuals purchase health care plans directly from an insurer instead of through an employer. Many such plans do not meet the minimum coverage requirements of the ACA, leading insurers to send plan-cancellation notices to their enrollees.
This report describes a comparative analysis of three proposals to remedy the situation: one by the White House, another by Senator Mary Landrieu (D-LA), and a third by Representative Fred Upton (R-MI). The proposals are evaluated based on their potential impact on the ACA-compliant market and the cost and coverage of health insurance. The possibility of each proposal causing a “death spiral,” in which rising premiums and decreasing enrollment undermine the viability of the ACA-compliant market, is also addressed.
The authors find that the three proposals vary from slight to moderate impact on ACA premiums, enrollment, and federal spending, but none of them would result in the unraveling of the ACA-compliant market.
State Efforts to Promote Continuity of Coverage and Care under the Affordable Care Act
Source: Journal of Health Politics, Policy and Law
Many states have worked tirelessly over the past two years to develop health insurance exchanges and prepare for the expansion of their Medicaid programs in order to meet the requirements of the Patient Protection and Affordable Care Act. Programs to expand coverage, however, do not necessarily ensure seamlessness for many individuals who are likely to experience shifts in program eligibility due to changing circumstances (e.g., income fluctuations, family composition changes, etc.). A number of states are actively working to limit the impact of changes in program eligibility by developing policies that limit either the incidence of program eligibility changes and/or the impact those changes have on individual consumers. Various emerging state approaches take into account program history, the desire for state flexibility, and the political and operational challenges states face in developing coverage expansions that work for consumers, stakeholders, and policy makers.
Improving Mental Health and Addressing Mental Illness: Mental Health Benefits Legislation
Source: U.S. Department of Health and Human Services (Community Preventive Services Task Force)
The Community Preventive Services Task Force recommends mental health benefits legislation, particularly comprehensive parity legislation, based on sufficient evidence of effectiveness in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. There is also evidence that mental health benefits legislation is associated with increased access to care, increased diagnosis of mental health conditions, reduced prevalence of poor mental health and reduced suicide rates.
Evidence from a concurrent economic review indicates that mental health benefits expansion did not lead to any substantial increase in cost to health insurance plans, measured as a percentage of premiums.
Plans Allowing People to Keep Health Insurance Will Not Threaten New Insurance Marketplaces
Source: RAND Corporation
Plans to allow people to keep their individual health insurance policies even if they don’t meet the requirements of the federal Affordable Care Act are unlikely to send new health insurance marketplaces into a “death spiral,” according to a new RAND Corporation study.
Although three options put forward to help people keep their old plans all would cause some disruption of the risk pools that are important to the insurance exchanges, none of the changes would be severe enough to threaten their viability, according to the study.
An option adopted by President Obama to allow state insurance commissioners to decide whether to extend old insurance policies is the least disruptive of the three policies examined by the RAND report. The study predicts the president’s action will have only minimal effect on enrollment and premiums.
The most disruptive of the alternative proposals would both allow people to keep their old health plans and allow others to buy the policies as well. That option would lead to moderate price hikes and sharply lower enrollment in the new marketplaces, substantially increasing federal spending on subsidies for enrollees.
Source of Payment for the Delivery: Births in a 33-state and District of Columbia Reporting Area, 2010
Source of Payment for the Delivery: Births in a 33-state and District of Columbia Reporting Area, 2010 (PDF)
Source: National Center for Health Statistics
Private insurance was the most frequent payment source for deliveries in the birth certificate-revised reporting area in 2010 (45.8% of births), followed closely by Medicaid (44.9%), ‘‘other’’ payment sources (5.0%), and self-pay (4.4%). Similarly, NHDS data show that private insurance was the most common payment source for deliveries nationally in 2010, followed by Medicaid. Privately insured deliveries declined over the last decade, while the use of Medicaid insurance increased. Medicaid insurance of deliveries was highest for births to teenagers and for non-Hispanic black and Hispanic mothers, according to the birth certificate data. Privately insured mothers were most likely of all payment groups to receive early prenatal care and to have cesarean deliveries.
Dental Care Coverage and Use: Modeling Limitations and Opportunities (PDF)
Source: American Journal of Public Health
We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage.
We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use.
Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth.
Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.
Patient Protection and Affordable Care Act: Annual Fee on Health Insurers (PDF)
Source: Congressional Research Service (via Federation of American Scientists)
The Patient Protection and Affordable Care Act (P.L. 111-148) and the Reconciliation Act of 2010 (P.L. 111-152) impose an annual fee on certain for-profit health insurers, starting in 2014. The aggregate amount of the ACA fee, to be collected across all covered insurers, will be $8.0 billion in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017, and $14.3 billion in 2018. After 2018, the aggregate fee will be indexed to the overall rate of annual premium growth, as calculated by the Internal Revenue Service.
The annual fee will be apportioned among health insurers, based on (1) their market share and (2) their dollar value of business. The fee applies to net health care premiums written, which are defined in regulations as gross premiums from insurance sales minus refunds to enrollees under the medical loss ratio provisions of the ACA, certain commissions, and premiums ceded to reinsurers. Ceded premiums are premiums that an insurer transfers to a reinsurer, as payment for protection against defined market risks.
2014 Reporting & Disclosure Calendar for Multiemployer Plans
Source: Segal Consulting
Segal Consulting’s 2014 Reporting & Disclosure Calendar for Multiemployer Plans summarizes compliance requirements for multiemployer plans. To see a brief description of each requirement and information about such details as the plan(s) affected, filing requirements and due dates, click on any item in the gray bars below.
Hat tip: IWS Documented News