Short Takes On News & Events

Early Results: Average 2015 Exchange Premiums Decline Slightly

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In preliminary but encouraging news for consumers and taxpayers, insurance filings show that average premiums will decline slightly next year in 16 major cities for a benchmark Obamacare plan.

Prices for a benchmark “silver” or mid-priced plan sold through the health law’s online marketplaces aren’t all moving in the same direction, however, a report from the Kaiser Family Foundation (KFF) shows. (Kaiser Health News is an editorially independent program of the foundation.) In Nashville, the premium will rise 8.7 percent, the largest increase in the study, while in Denver it will fall 15.6 percent, the largest decrease.

But overall the results, based on available filings, don’t show the double-digit percentage increases that some have anticipated for the second year of marketplace operation. On average, rates will drop 0.8 percent in the areas studied.

“If you’re the government, this is great news,” said Larry Levitt, KFF senior vice president. “Competition in the marketplaces is helping drive down the cost of the tax credit” that subsidizes coverage for lower-income consumers.

That’s because the credits are based on the cost of the second least-expensive silver plan, known as the benchmark plan. That’s the one KFF studied. The lower the benchmark-plan rates, the lower the cost to taxpayers.

For consumers, the picture is also promising — but more complicated.

The main message: shop around, says Levitt.

The fact that average premiums in selected cities are declining doesn’t mean your rates will fall. Premiums may vary significantly within states. Premiums for plans with different benefit levels — higher platinum and gold and lower bronze — may behave differently than prices for silver plans. And just because your policy was the least expensive in your area for 2014 doesn’t mean it will stay that way for 2015.

Bottom line: There is increased competition as more insurers enter the marketplaces and tune prices to attract customers. But you may need to switch plans to take advantage of that.

September 5th, 2014, 6:14 AM by Jay Hancock

Short Takes On News & Events

DC Appeals Court Agrees To Rehear Case That Could Cripple Health Law

The controversial federal court decision that threatened the future of the Affordable Care Act is no more.

The full District of Columbia Court of Appeals Thursday agreed to rehear Halbig v. Burwell, a case charging that the federal government lacks the authority to provide consumers tax credits in health insurance exchanges not run by states.

The order agreeing to hear the case technically cancels the three-judge ruling from July that found for the plaintiffs. That ruling, if upheld, could jeopardize the entire structure of the Affordable Care Act by making insurance unaffordable for millions of consumers in the 36 states where the federal government operates the exchange.

The court will hear oral arguments in the case in December. For the time being, the order also eliminates the “circuit split” that could prompt the Supreme Court to take up the case. The same day the panel from the Washington, D.C., circuit decided that tax credits are not allowed in federal exchanges, a three-judge panel from the Fourth Circuit in Richmond, Va., decided exactly the opposite.

The losers in that case, King v. Burwell, appealed the decision to the Supreme Court on July 31.

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September 4th, 2014, 11:31 AM by Julie Rovner

Health Care In The States

Five States To Get Early Access To Small Business Health Insurance Marketplace

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Businesses in five states will get an early look at the federal health insurance marketplace for small businesses, the Centers for Medicare and Medicaid announced Wednesday.

The states are Missouri, Illinois, Ohio, New Jersey and Delaware.

Businesses with fewer than 50 full-time workers in those states will be able to access the Small Business Health Options Program, or SHOP, in late October, ahead of the Nov. 15 start of open enrollment.

The five states were selected based on the agency’s analysis of state insurance markets and the availability of employee choice, among other factors, a department official said.

Employers, agents and brokers in the early access states will be able to complete eligibility applications, upload an employee roster, and view plans and pricing once they become available, the official said.

The administration delayed the SHOP implementation last year in the 36 states using the federal exchange to prioritize fixes to the insurance marketplace for individuals. However, small businesses could still purchase SHOP plans through an agent or broker using paper applications.

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September 3rd, 2014, 12:56 PM by Jordan Shapiro, The St. Louis Post-Dispatch

Health Care In The States

Victory In Mass. Health Costs May Be Temporary

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News. It can be republished for free. (details)

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to for many to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”

Why? It could be the pressure to comply with of the federal health law in its first year.

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September 2nd, 2014, 3:48 PM by Martha Bebinger, WBUR

Short Takes On News & Events

Indiana, Several Other States Look To Expand Medicaid Next Year

This KHN story can be republished for free. (details)

Who’s next?

With the long-awaited deal to expand Medicaid finally struck last week between Pennsylvania and the Obama administration, 27 states and the District of Columbia have adopted a key coverage plank of the Affordable Care Act. And the momentum continues to grow in Republican-led states as Tennessee and several others look to expand coverage to low-income residents in 2015.

Indiana has an expansion plan pending with the Centers for Medicare & Medicaid Services. Tennessee Gov. Bill Haslam, a Republican, said he plans to submit a plan later this year, although state Republican leaders warn it will be difficult to win legislative approval. Wyoming Gov. Matt Mead, also a Republican, said he will present an expansion plan to his legislature early next year.

Utah Gov. Gary Herbert, another Republican, is negotiating a deal with CMS, although he would also need to get such a plan past legislators. Finally, Maine lawmakers are poised to expand Medicaid if Republican Gov. Paul LePage is defeated in the November election. LePage has vetoed several bills to expand the program after they were passed by the Democrat-controlled Maine legislature. LePage trails in the latest polls.

The health law had mandated that every state expand eligibility to those making up to 138 percent of the poverty level, or about $16,100 for a single individual. But the Supreme Court’s 2012 decision effectively made the expansion voluntary for adult residents, and 23 states haven’t extended the health insurance program as a result.

Still, the Medicaid expansion program got off to a faster pace than original adoption of the program in 1966.

When Medicaid launched, just six states initially signed up: Hawaii, Illinois, Minnesota, North Dakota, Oklahoma and Pennsylvania. Twenty states followed later that year and 11 more joined in 1967.

Similarly, the Children’s Health Insurance Program started with only nine states in 1997. Another 35 states followed in 1998.

Pennsylvania’s Medicaid expansion will launch Jan. 1 to cover everyone with incomes under 138 percent of the federal poverty level. While Gov. Tom Corbett has called his expansion plan “historic” and defended his one-year delay in adding an estimated  500,000 people to the program, the  plan won’t be dramatically different than what most states are already doing.  Pennsylvania will continue to use Medicaid managed care plans for new enrollees, said Medicaid Director Leesa Allen. Insurers that have submitted bids to the state to cover newly eligible residents, including Aetna and United Healthcare, already provide Medicaid managed care to state residents.

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September 2nd, 2014, 1:21 PM by Phil Galewitz

Short Takes On News & Events

Federal Judge Blocks Texas Restriction On Abortion Clinics

This story is part of a partnership that includes Houston Public Media, NPR and Kaiser Health News. It can be republished for free. (details)

In a highly anticipated ruling, a federal judge in Austin struck down part of a Texas law that would have required all abortion clinics in the state to meet the same standards as outpatient surgical centers. The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion — all in major cities.

Judge Lee Yeakel ruled late Friday afternoon that the state’s regulation was unconstitutional and would have placed an undue burden on women, particularly on poor and rural women living in west Texas and the Rio Grande Valley.

Texas Attorney General Greg Abbott, a Republican running for governor, immediately filed an appeal with the 5th U.S. Circuit Court of Appeals. Read the rest of this entry »

August 30th, 2014, 10:18 AM by Carrie Feibel, KUHF

Short Takes On News & Events

Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County

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Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to an audit released this week.

The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required.

“The quality and integrity of investigations is impaired when surveyors’ conclusions are changed without their knowledge,” according to the audit.

The audit was the latest of several reviews showing problems with how the county Department of Public Health oversees residents’ health and safety at about 385 nursing homes. The county, the most populous in the state, contracts with the state and the federal government to inspect the facilities and to investigate complaints from residents, family members and staff.

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August 29th, 2014, 12:24 PM by Anna Gorman

Health Care In The States

In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday

This story is part of a partnership that includes Houston Public Media, NPR and Kaiser Health News. It can be republished for free. (details)

A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers.

The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions.

The laws are collectively known as TRAP laws for “Targeted Regulation of Abortion Providers.”

“They do just that,” said Rochelle Tafolla, a spokeswoman for Planned Parenthood Gulf Coast in Houston. “They ‘trap’ providers into very tight, medically unnecessary restrictions.”

The Texas law that passed in 2013 requires doctors who perform abortions to first obtain admitting privileges at a hospital within 30 miles. Many clinics, especially rural ones, found it difficult to comply with that rule by the November deadline. The number of Texas clinics that perform abortions has dropped from 41 to 20.

Now the law’s final rule requires doctors’ offices to meet the standards of ambulatory surgical centers, including an array of rules that govern hallway widths, the presence of showers and lockers, heating and cooling specifications. The rules also require conformance with other construction codes that can cost millions of dollars.

The rule goes into effect on Labor Day, unless federal Judge Lee Yeakel of the Western district in Austin issues an injunction to stop it. He is expected to issue a decision by Friday. If he stops the surgery center rule, Texas Attorney General Greg Abbott could quickly appeal to reinstate it.

One Houston doctor, who asked not to be identified because he fears being targeted by abortion protestors, says he will have to stop providing abortions if the final rule goes into effect. Read the rest of this entry »

August 28th, 2014, 3:24 PM by Carrie Feibel, KUHF

Short Takes On News & Events

Urgent Care Centers Opening For People With Mental lllness

LOS ANGELES, Calif. — Hoping to keep more people with mental illness out of jails and emergency rooms, county health officials opened a mental health urgent care center Wednesday in South Los Angeles.

The goal of The Martin Luther King, Jr. Mental Health Urgent Care Center is to stabilize and treat people in immediate crisis while connecting them to ongoing care. Run by Exodus Recovery, it will be open 24 hours a day, seven days a week and can serve up to 16 adults and six adolescents. During their stay of up to one day, patients will undergo a psychiatric evaluation, receive on-the-spot care such as counseling and medication and be referred for longer-term treatment.

The center can take people in severe crisis and expects many will be brought in by police and paramedics, said Connie Dinh, vice president of nursing services for Exodus. But she said it cannot accept people who are incoherent, extremely aggressive or need emergency medical attention. They will still need to be treated at hospitals or inpatient psychiatric facilities.

Staff will be able to place people on 72-hour psychiatric holds if they are a danger to themselves or others.

Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go, experts and advocates said. In Los Angeles County, four such centers have opened and several more are planned.

L.A. County’s mental health director Marvin Southard said the centers are a more effective way to care for many patients with mental illness and are less disruptive to hospitals. And county Supervisor Mark Ridley-Thomas, who led the effort to open the center, said they are “more humane” and a smarter approach.

Hospitals statewide saw a 47 percent increase in encounters with patients with mental health needs between 2006 and 2011, compared to a 14 percent increase in all patients, according to the California Hospital Association. Mental health urgent care centers can help relieve the burden on emergency departments, get patients the care they need and reduce health care costs, said Sheree Kruckenberg, vice president of behavioral health at the association.

“As we are trying to bend the cost curve, to me this is a slam dunk,” she said.

Ron Honberg, policy director for the National Alliance on Mental Illness, said that the centers are a great place to respond to crises, but the centers are “just one piece in a more complicated puzzle” and people need to be linked to community services.

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August 28th, 2014, 5:00 AM by Anna Gorman

Short Takes On News & Events

CBO Projects Lower Medicare and Medicaid Costs

Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday.

Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast.

Despite the long-term projected drop, federal spending for major health care programs will jump this year by $67 billion — or about 9 percent —  the agency estimated.  The largest increase will be for Medicaid, which is projected to grow by $40 billion, or 15 percent. Most of this short-term increase is attributable to the Affordable Care Act, including its Medicaid expansion and the financial assistance to help people purchase health insurance.

More than half of the states and the District of Columbia have opted for the health law’s Medicaid expansion. Subsidies to help eligible individuals purchase health on the law’s online marketplaces, or exchanges, and related expenses (mostly grants to states to establish exchanges) would total $17 billion this year, according to CBO.

CBO and the Joint Committee on Taxation’s projections of outlays and revenues arising from the health law’s provisions related to health insurance coverage have not changed substantially since the spring for 2014 or over the 2015–2024 period, according to CBO.

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August 27th, 2014, 3:35 PM by Mary Agnes Carey