New Hampshire became the 26th state today to embrace the federal health law’s expanded Medicaid program, with as many as 50,000 low-income residents expected to begin signing up.
Coverage for those who enroll this month will take effect Aug. 15. Initially, most New Hampshire enrollees will join one of two Medicaid managed care plans in the state. That’s the way most other states expanded Medicaid earlier this year.
But New Hampshire officials hope that up to 10 percent of those who sign up will eventually enroll in employer plans — using federal money to subsidize that coverage.
In addition, the state plans to seek federal approval to shift most Medicaid enrollees into private insurance plans sold in the online federal marketplace beginning in 2016. Earlier this year, Arkansas and Iowa took this approach, which has become popular among Republicans because it makes use of the private insurance market.
If the federal government approves that plan, the state would shift all enrollees from Medicaid-only managed care plans to marketplace plans in 2016. The only exception would be those who can take advantage of subsidized employer-based coverage. They would remain in their employer plan, if the state deems it is less costly than a Medicaid managed care plan.
New Hampshire and other states have had an employer-subsidy option for years, though few people have used it because most poor people are not offered coverage at work, or the coverage is not as good as Medicaid, according to study by the General Accountability Office.
SEATTLE — Washington State’s health insurance exchange is looking to be an attractive marketplace for new health insurance carriers, according to an early analysis of insurer premium rate filings by McKinsey & Company.
Four new insurers have applied to sell individual policies in the state’s exchange next year, making Washington among the states with the highest number of new exchange entrants of the 12 states where preliminary 2015 rates have been filed, according to McKinsey. If insurance regulators approve the new carriers, Washington will have 12 insurers on the exchange in 2015, up from eight participating this year.
Washington’s not the only state attracting new health insurance business. Michigan also has four new exchange applicants, and five new carriers have applied in Indiana, the state so far with the highest number of new insurance carriers showing interest, according to the real-time tracking of state insurance department rate filings that McKinsey is doing.
UnitedHealthcare of Washington, Health Alliance Northwest Health Plan, and Columbia United Providers are among the new insurance exchange applicants, according to Washington State’s Office of the Insurance Commissioner.
Hutchins Coe said McKinsey hasn’t drawn conclusions about what brought new carrier interest to the state. But Washington Healthplanfinder officials said the interest shows their exchange is working.
The four largest hospitals in Alaska are facing Medicare payment penalties for the quality of their care. Providence, Alaska Regional, Alaska Native Medical Center and Fairbanks Memorial are all in the bottom 25 percent nationally for the number of infections and serious complications patients get in their hospitals, according to data analyzed by Kaiser Health News. The penalties are part of a focus on quality care that’s included in the Affordable Care Act.
Providence estimates it will lose more than $500,000 in federal payments starting in October. Fairbanks Memorial Hospital calculates its lost payments could be as much as $400,000. Both Alaska Regional and Alaska Native Medical Center estimate their penalties will cost them around $200,000. That is 1 percent of their Medicare payments.
Central line infections are one of three measures that Medicare tracked to decide which hospitals will be penalized. Central lines are IV’s inserted in veins that lead right to a patient’s heart, and infections there are serious. In 2012, Providence Alaska Medical Center in Anchorage had 17 of them in their intensive care units.
“There was no one single thing, there’s no smoking gun, ‘we were not doing x,’” said Dr. Dick Mandsager, Providence’s hospital administrator. He says the hospital had already begun to address the infections with emphasis on safety for patients with central lines. In 2013, Providence had six central line infections instead of 17.
“It’s making sure that the whole bundle of care is done every single time, all the time, regardless of how pressured you are, regardless of how many things you’ve got on your mind,” Mandsager said.
Health insurance companies in Colorado are starting to talk about their proposed premiums for 2015. State regulators on Monday released the draft prices, which the state now has 60 days to approve or deny.
Carriers generally aren’t proposing big changes in premiums for 2015, nothing that’s dramatically out of line with trends of the last several years.
“Most of the premiums are falling in a range of anything from a 10 percent decrease to a 10 percent increase. That’s where the bulk of them are sitting right now,” said Vincent Plymel, a spokesman for Colorado’s Division of Insurance.
While the proposed rates are public, they are not easy to compare to 2014 rates. Consumer advocates are digging into the data and analyzing trends. Most insurers are also talking publicly about their proposed prices.
Colorado’s dominant carrier, Kaiser Permanente, is asking for about a 7 percent premium increase, according to consumer advocates.
Health insurance premiums for people with subsidies could increase substantially in some markets – but consumers who shop around may not end up paying more, a new report out Thursday says.
Shopping around may not be as likely, however, under proposed rules also released Thursday by the Obama administration which will automatically re-enroll the vast majority of those who are signed up for plans through the online marketplaces. Automatic re-enrollments might ease the experience, but will also make it less likely consumers will check out other options.
Consumers who choose to would still be able to shop around, the administration said. And the Avalere study shows they should.
The analysis of rates filed in nine states found that as insurers battle for a share of the individual market, some plans that were the low-priced leaders this year are not the least expensive options next year.
Because subsidies through the Affordable Care Act are tied to “benchmark” plans, which are the second lowest-cost silver-tier plans in each market, even those with subsidies could see the monthly amounts they pay change. In most of the states studied, the second lowest-cost plan is changing.
“If you are a savvy buyer, you could pick a low-cost plan and probably avoid a significant rate increase,” said Caroline Pearson, vice president at Avalere. But those who do nothing may end up paying more.
A Kaiser Health News article published Sunday about upcoming hospital penalties included an analysis of Medicare data by Dr. Ashish K. Jha, a professor at the Harvard School of Public Health. This week, Jha also wrote up his own take on the data. Originally posted on his Harvard blog, Dr. Jha’s copyrighted assessment is republished below, all rights reserved:
By Ashish K. Jha
Adverse events — when bad things happen to patients because of what we as medical professionals do — are a leading cause of suffering and death in the U.S. and globally. Indeed, as I have written before, patient safety is a major issue in American healthcare, and one that has gotten far too little attention. Tens of thousands of Americans die needlessly because of preventable infections, medication errors, surgical mishaps, and so forth. As I wrote previously, according to Office of Inspector General (OIG), when an older American walks into a hospital, he or she has about a 1 in 4 chance of suffering some sort of injury during their stay. Many of these are debilitating, life-threatening, or even fatal. Things are not much better for younger Americans.
Given the magnitude of the problem, many of us have decried the surprising lack of attention and focus on this issue from policymakers. Well, things are changing – and while some of that change is good, some of it worries me. Congress, as part of the Affordable Care Act, required Centers for Medicare and Medicaid Services (CMS) to penalize hospitals that had high rates of “HACs” – Hospital Acquired Conditions. CMS has done the best it can, putting together a combination of infections (as identified through clinical surveillance and reported to the CDC) and other complications (as identified through the Patient Safety Indicators, or PSIs). PSIs are useful – they use algorithms to identify complications coded in the billing data that hospitals send to CMS. However, there are three potential problems with PSIs: hospitals vary in how hard they look for complications, they vary in how diligently they code complications, and finally, although PSIs are risk-adjusted, their risk-adjustment is not very good — and sicker patients generally have more complications.
So, HACs are imperfect — but the bottom line is, every metric is imperfect. Are HACs particularly imperfect? Are the problems with HACs worse than with other measures? I think we have some reason to be concerned.
KHN’s Julie Rovner participated in a Google Hangout with PBS NewsHour on state “right-to-try” laws, first approved in Colorado, which allow terminally ill patients to try potentially life-saving, but unapproved drugs to treat their conditions. Watch the discussion below:
The prediction, based on interviews and modeling, splits the difference between hopes that costs will stay tame and fears that they’re off to the races after having been slow since the 2008 financial crisis.
“This is not an immediate return to double-digit growth rates,” says Ben Isgur, a director in PwC’s Health Research Institute. However, he adds, “what we’re seeing for 2015 will be our first uptick in some time.”
If health plans stay unchanged, PwC sees medical costs rising by 6.8 percent in 2015, up from a projected increase of 6.5 percent this year. (PwC defines medical costs as per-capita health expenses for private insurers and large, self-insured employers. This is different from the government’s measure of health spending, which includes outlays for the government programs Medicaid and Medicare.)
But PwC doesn’t expect plans to stay the same. In a separate study, the consulting firm forecasts that employers and insurers will continue to raise deductibles and give members other incentives to mind the price of care. (The deductible is what patients pay before insurance kicks in.)
Those changes should slow growth in the total cost of care to 4.8 percent, PwC says, as greater exposure to price tags prompts workers to undergo fewer treatments and tests. (PwC expects the deceleration from 6.8 percent to 4.8 percent to come solely from changes in consumer behavior, not money employers save by shifting costs to workers.)
The penalties will ding hospitals up to 1 percent of their Medicare pay for having higher rates of patient injuries. Watch the C-SPAN video interview and listen to the NPR audio of his conversation below:
A bipartisan group of senators introduced legislation on Thursday to make Medicare take the financial status of hospital patients into account when deciding whether to punish a hospital for too many readmissions.
The bill attempts to address one of the main complaints about the readmissions program: that hospitals serving large numbers of low-income patients are more likely be penalized. Over the past two years, the federal government has reduced payments to two-thirds of the nation’s hospitals because they have high numbers of patients becoming ill and returning after being discharged. This fall the program will put as much as 3 percent of a hospital’s Medicare payments at risk and it will expand the number of conditions it bases the assessment on — currently heart attack, heart failure or pneumonia – to include chronic obstructive pulmonary disease and total hip and knee replacement.
Medicare does adjust for different levels of sickness of patients among hospitals, but it has said the Affordable Care Act, which created the program, does not give regulators the leeway to take socio-economic status into account.