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Affordable Care Act (ACA) - Archived

12/21/16 – McKnight’s - Dual-eligible ACO Model Could Be Jeopardized By Changes To Medicaid

By Emily Mongan

The Centers for Medicare & Medicaid Services' recently announced accountable care organization model for dual eligibles could be at risk if lawmakers overhaul the Medicaid program in the coming years. The Medicare-Medicaid Accountable Care Organization is aimed at improving care and lowering costs for beneficiaries enrolled in both Medicare and Medicaid. While one expert told McKnight's last week that the model is unlikely to disappear under the next presidential administration, changes to the Medicaid program may complicate it, according to published reports.

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12/21/16 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, December 2015 to December 2016

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12/21/16 – The Commonwealth Fund – A Long Way in a Short Time: States’ Progress on Health Care Coverage and Access, 2013-2015

By Susan L. Hayes, Sara R. Collins, David Radley, Douglas McCarthy, and Sophie Beutel

In 2013, the year before the implementation of the Affordable Care Act’s (ACA) major coverage expansions, 17 percent of the U.S. population under age 65, about 45 million people, lacked health insurance (Appendix Table 1).1 By the end of 2015, two years after implementation, the uninsured rate had declined to 11 percent, according to data recently released by the U.S. Census Bureau. In those two years, the ACA’s major health insurance reforms caused the states’ uninsured rates to shift dramatically, resulting in a new coverage map of the country.

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Click here to view the chartpack

Click here to view the appendix tables

Click here to view the press release


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12/20/16 – CHCS – Medicaid Accountable Care Organizations: State Update

Across the country, states are exploring the viability of Medicaid accountable care organizations (ACOs) that align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable. To date, 11 states have launched Medicaid ACO programs, and six more are actively pursuing them.

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12/19/16 – The Commonwealth Fund – How Much of a Factor is the Affordable Care Act in the Declining Uninsured Rate?

By Sherry Glied, Stephanie Ma and Sarah Verbofsky

Several studies have examined how the percentage of people without insurance decreased during the Affordable Care Act’s (ACA’s) first open enrollment period, which began in October 2013 and lasted through March 15 or April 15, 2014, depending on the state. Analyses uniformly show that the uninsured rate declined by roughly 4 percentage points to 6.1 percentage points during this first enrollment period, although pre- and postenrollment rates differ across studies.

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12/13/16 – Kaiser Family Foundation – What are the Implications of Repealing the Affordable Care Act for Medicare Spending and Beneficiaries?

By Juliette Cubanski, Tricia Neuman, Gretchen Jacobson, and Cristina Boccuti

The 2010 Affordable Care Act (ACA) included many provisions affecting the Medicare program and the 57 million seniors and people with disabilities who rely on Medicare for their health insurance coverage. Such provisions include reductions in the growth in Medicare payments to hospitals and other health care providers and to Medicare Advantage plans, benefit improvements, payment and delivery system reforms, higher premiums for higher-income beneficiaries, and new revenues.

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12/9/16 – CHCS - State Insights on Refining Integrated Care for Dually Eligible Beneficiaries

By Ann Mary Philip, Nancy Archibald, and Michelle Herman Soper

State Medicaid agencies have made considerable progress in implementing integrated Medicare-Medicaid programs to address the diverse needs of dually eligible individuals and better coordinate their care. Leading states are thoughtfully assessing what is and is not working, and making refinements based on their findings.  This brief, made possible by The Commonwealth Fund and The SCAN Foundation, highlights insights from states that are fine-tuning their integrated care programs. Formal evaluations of some integrated care programs are underway; however, until these results become available, the refinements made by states described in the brief — all participants in the Implementing New Systems of Integration for Dually Eligible Enrollees (INSIDE) project — can help others design their own integrated care programs to meet the beneficiary needs.

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12/8/16 – The Commonwealth Fund - The "One Care" Program at Commonwealth Care Alliance: Partnering with Medicare and Medicaid to Improve Care for Nonelderly Dual Eligibles

By Sarah Klein, Martha Hostetter, and Douglas McCarthy

Soon after completing their prison sentences for drug violations, Diane R. and Melissa H. moved into a rundown apartment in an old Massachusetts manufacturing town. There, they went back to using heroin, despite life-threatening illnesses—end-stage liver disease for Diane and HIV for Melissa. Because both women were dually eligible for Medicare and Medicaid benefits, they were able to enroll in an experimental program that allows health insurance plans to combine the capitated payments they receive from both programs to pay for a wider array of services, including substance abuse treatment. The goal of the program, called One Care: MassHealth plus Medicare, is to see whether providing comprehensive, well-coordinated care can improve outcomes and lower costs for patients like Diane and Michelle who have complex needs.

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12/07/16 – Kaiser Family Foundation – What’s at Stake in a Potential Repeal of the ACA Medicaid Expansion

President-elect Trump and Republican leaders in Congress have vowed to repeal the Affordable Care Act (ACA) and replace it with an alternative plan. There are now 32 states (including DC) that have adopted the ACA’s Medicaid expansion. While the details of a repeal-and-replace plan are not yet available to assess its impact, a new brief reveals what’s potentially at stake for Medicaid in the debate by examining the changes in health coverage and financing that have occurred since the Medicaid expansion took effect in January 2014.

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12/06/16 – The New York Times – Health Insurers List Demands if Affordable Care Act is Killed

By Reed Abelson

The nation’s health insurers, resigned to the idea that Republicans will repeal the Affordable Care Act, on Tuesday publicly outlined for the first time what the industry wants to stay in the state marketplaces, which have provided millions of Americans with insurance under the law.

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12/05/16 – Kaiser Family Foundation – New State Data: ACA Marketplace Enrollees Receiving Estimated $32.8 Billion in Tax Credits, Which Would be Eliminated Under Repeal of the ACA

New state data from the Kaiser Family Foundation estimate that 9.4 million Americans who bought health plans through Affordable Care Act marketplaces will receive a total of about $32.8 billion in premium tax credits for 2016.

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12/01/16 – Kaiser Family Foundation – After the Election, the Public Remains Sharply Divided on Future of the Affordable Care Act

Among Those Who Favor Repeal, Arguments About Loss of Coverage for Those with Pre-Exiting Conditions Can Sway Some Opinions

Many Obamacare Provisions Remain Broadly Popular Across Party Lines, But Not its Mandate

The first Kaiser Health Tracking Poll since the 2016 election finds that Americans are largely divided on the future of the Affordable Care Act even though many of the law’s major provisions remain quite popular across party lines.

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12/01/16 – Kaiser Family Foundation – Kaiser Health Tracking Poll: The Public’s Views on the ACA

The public has remained deeply divided on the health reform law since it was passed in March 2010. Click below to examine how specific groups feel about the law and how those opinions have changed or not changed over time.

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11/17/16 – Kaiser Family Foundation - Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

By Susan Baseman, Cristina Boccuti, Marilyn Moon, Shannon Griffin, and Tania Dutta

Policymakers, health care providers, and policy analysts continue to call for “delivery system reform”—changes to the way health care is provided and paid for in the United States—to address concerns about rising costs, quality of care, and inefficient spending.  The Affordable Care Act (ACA) established several initiatives to identify and test new health care payment models that focus on these issues.  Many of these ACA programs apply specifically to Medicare, the social insurance program that provides coverage to 57 million Americans age 65 and older and younger adults with permanent disabilities.

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11/09/16 – Kaiser Health News – Obamacare ‘Replacement’ Might Look Familiar

By Jay Hancock and Shefali Luthra

The Affordable Care Act transformed the medical system, expanding coverage to millions, injecting billions in tax revenue, changing insurance rules and launching ambitious experiments in quality and efficiency.

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11/04/16 – Kaiser Family Foundation – Health Coverage by Race and Ethnicity: Examining Changes Under the ACA and the Remaining Uninsured

By Samantha Artiga, Petry Ubri, Julia Foutz, and Anthony Damico

People of color historically have been more likely to be uninsured and to face more barriers accessing care than Whites, often resulting in lower use of care and worse health outcomes. The Affordable Care Act (ACA) provides an opportunity to reduce these disparities through its health coverage expansions. This brief examines changes in health coverage by race and ethnicity under the ACA and reviews characteristics of the remaining uninsured by race and ethnicity and their eligibility for ACA coverage. It is based on Kaiser Family Foundation analysis of Current Population Survey data for the nonelderly population.

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11/04/16 – CHCS – State Medicaid Managed Long-Term Services and Supports Programs: Considerations for Contracting with Medicare Advantage Dual Eligible Special Needs Plans

By Stephanie Gibbs and Alexandra Kruse

Many states are developing Medicaid managed long-term services and supports (MLTSS) programs to provide high-quality, person-centered, and cost-effective care to eligible beneficiaries in the settings of their choice. Some of these states are also seeking to better integrate care for their beneficiaries who are dually eligible for Medicare and Medicaid by contracting with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs).
 

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10/27/16 – Kaiser Family Foundation - Public Ranks Drug Costs and Sufficient Provider Networks Ahead of Affordable Care Act Changes as Health Care Priorities for Next President and Congress to Address

Most Say They Favor a “Public Option” to Compete with Private Marketplace Plans, But Views Are Malleable After Hearing Pro and Con Arguments

As the 2016 campaign nears its end, the latest Kaiser Health Tracking Poll examines the public’s view on health care priorities for the next president and Congress. Overall, Americans rank addressing high prescription drug costs and ensuring adequate provider networks in insurance plans among their top health care priorities.

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Click here to view the poll

Click here to view topline and methodology


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10/25/16 – CHCS – The Evolving Role of Charity Care: From Safety Net Medical Care to Enrollment Assistance to Addressing the Social Determinants of Health

By Maia Crawford and Melissa Parnagian

Community-based charity care programs have long offered free or low-cost medical services to the uninsured population — providing a safety net for low-income Americans who would otherwise go without needed medical care. Following the passage of the Affordable Care Act, however, many programs transitioned from providing access to basic medical services to connecting clients to health coverage. Now, many charity care programs have begun to embrace an even broader mission: working to address the social determinants of health. Charity care program efforts to address the social determinants of health fall into three main categories: (1) screening for non-medical needs and referring clients to available services; (2) supporting health literacy and bilingual understanding; and (3) promoting wellness through nutrition and fitness classes.

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Click here to view interactive map


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10/25/16 – The Commonwealth Fund – The Slowdown in Employer Insurance Cost Growth: Why Many Workers Still Feel the Pinch

By Sara R. Collins, David Radley, Munira Z. Gunja, and Sophie Beutel

Most of the conversation around health insurance costs has been focused on health plans sold through the Affordable Care Act’s marketplaces, but far more Americans get their coverage through employers. In 2015, more than half (57%) of the U.S. population under age 65, about 154 million people, had insurance through their own job or a family member’s job. In contrast, only about 10 million people are covered by a health plan purchased in the marketplaces. Contrary to early predictions that many employers would stop offering health insurance in response to the ACA’s new coverage options, there has in fact been little change in the share of the nonelderly population covered by employer plans since the law went into effect in 2010.

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Click here to view the chartpack

Click here to view the press release


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10/25/16 – Avalere – 2017 Open Enrollment Preview

2017 Exchanges Struggle to Address Challenges with Enrollment, Risk Management, and Consumer Choice

The fourth open enrollment period for the exchange market will kick off on November 1. Low enrollment, the end of risk corridor and reinsurance programs, and health plans exits will shape exchanges for the 2017 plan year. Below are critical issues that will impact consumers and the healthcare industry in the 2017 exchanges.

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10/24/16 – Kaiser Family Foundation - 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces

By Cynthia Cox, Michelle Long, Ashley Semanskee, Rabah Kamal, Gary Claxton, and Larry Levitt

Health insurance premiums on the Affordable Care Act’s marketplaces (also called exchanges) are expected to increase faster in 2017 than in previous years due to a combination of factors, including substantial losses experienced by many insurers in this market and the phasing out of the ACA’s reinsurance program. We analyzed 2017 premiums and insurer participation made available through Healthcare.gov on October 24, 2017, as well as data collected from states that run their own exchange websites. At this time, data are not available for all states; we will update as more complete information becomes available.

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Click here to view the slideshow


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10/24/16 – ASPE – Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace

The Affordable Care Act (ACA) strengthened protections for consumers who purchase coverage in the individual health insurance market. Before the Affordable Care Act, individuals could be denied health insurance coverage based on pre-existing conditions, it was difficult for consumers to make apples-to-apples comparisons among plans and premiums, and people without employer-sponsored health insurance or who were ineligible for public programs (such as
Medicare, Medicaid, and the Children’s Health Insurance Program) generally received no financial help paying for coverage. Today, the Health Insurance Marketplace gives eligible consumers options when purchasing a health plan, provides consumers with tools to compare options, and offers financial assistance in the form of advance premium tax credits that reduce the cost of health insurance to the majority of enrollees.
 
 

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10/24/16 – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, October 2015 to October 2016 

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10/21/16 – CHCS – Delivery System Reform Incentive Payment: Mapping State Programs

Delivery System Reform Incentive Payment (DSRIP) programs, authorized through federal Medicaid Section 1115 waivers, provide states with funding derived from projected savings to test cutting-edge ways to improve how care is paid for and delivered. The interactive map below provides high-level details on DSRIP and DSRIP-like programs, including those in both the implementation and application process. The information draws from CHCS’ work in the field, and may not include all details on state programs.

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Click here to view map details


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10/19/16 – Kaiser Family Foundation - The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

By Rachel Garfield and Anthony Damico

One of the major coverage provisions of the Affordable Care Act (ACA) is the expansion of Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,821 for a family of three in 20161). This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for states.

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10/18/16 – Kaiser Family Foundation - Estimates of Eligibility for ACA Coverage among the Uninsured in 2016

By Rachel Garfield, Anthony Damico, Cynthia Cox Gary Claxton, and Larry Levitt

The Affordable Care Act (ACA) extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, as of 2014, Medicaid coverage is extended to poor and near poor adults in states that have opted to expand eligibility, and tax credits are available for low and middle-income people who purchase coverage through a health insurance Marketplace. Millions of people have enrolled in these new coverage options, and the uninsured rate has dropped to the lowest level ever recorded.1 However, millions of others are still uninsured. Some remain ineligible for coverage, and others may be unaware of the availability of new coverage options or still find coverage unaffordable even with financial assistance.

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Click here to view Technical Appendix A

Click here to view Technical Appendix B

Click here to view Technical Appendix C

Click here to view Technical Appendix D


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10/18/16 – Kaiser Family Foundation - Medicaid Home and Community-Based Services Programs: 2013 Data Update

By Terrence Ng, Charlene Harrington, MaryBeth Musumeci, and Petry Ubri

As states continue to implement various aspects of the Affordable Care Act (ACA), developing and expanding home and community-based alternatives to institutional care remains a priority for many state Medicaid programs. 2013 marked the first time that home and community-based services (HCBS) accounted for a majority (51%) of national Medicaid long-term services and supports (LTSS) spending, increasing from 18 percent in 1995. The share of Medicaid LTSS spending devoted to HCBS has continued to rise, reaching 53 percent in 2014. At the same time, state Medicaid programs are operating at a time when state revenues are slowing, forcing more moderate spending growth and, as of 2016, continue to face the competing priorities of implementing the ACA’s streamlined eligibility and enrollment processes, determining whether to adopt the ACA’s Medicaid expansion, and pursuing a variety of delivery and payment system reforms.

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Click here to view the tables


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10/17/16 – Kaiser Health News – Frustration Runs Deep for Customers Forced to Change Marketplace Plans Routinely

By Jordan Rau

Andrea Schankman’s three-year relationship with her insurer, Coventry Health Care of Missouri, has been contentious, with disputes over what treatments it would pay for. Nonetheless, like other Missourians, Schankman was unnerved to receive a notice from Coventry last month informing her that her policy was not being offered in 2017.
 

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10/14/16 – Kaiser Health News – How Narrow Is It? Gov’t Begins Test of Comparison Tool for Health Plan Networks

By Michelle Andrews

The incredible shrinking provider network is nothing new in marketplace plans. One way insurers have kept premiums in check on the individual market is by reducing the number of providers available in a plan’s network. Earlier this year, the federal government said that it would introduce a tool this fall to help consumers who are shopping on HealthCare.gov gauge how narrow a plan’s provider network is compared with others in the area.

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10/14/16 – New York Times – Health Care Law’s Beneficiaries Reflect Its Strengths, and Its Faults

By Abby Goodnough and Reed Abelson

Cara Suzannah Latil is living proof that the Affordable Care Act works — but also of why a central piece of the law is in turmoil.

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10/14/16 – Kaiser Health News – Officials Warn Some Older Marketplace Customers to Switch to Medicare

By Susan Jaffe

Ever since the Affordable Care Act’s health insurance marketplaces opened for business in 2014, the Obama administration has worked hard to make sure Americans sign up. Yet officials now are telling some older people they might have too much insurance and they should cancel their marketplace policies.

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10/14/16 – CHCS – Advancing State Innovation Model Goals through Accountable Communities for Health

By Anna Spencer and Bianca Freda

Across the country, multi-stakeholder groups are using a new model to achieve the goals of a community-focused Triple Aim — improved care, reduced health care costs, and enhanced population health. These new Accountable Communities for Health (ACH) are bringing together partners from health, social service, and other sectors to improve population health and clinical-community linkages within a geographic area. Several State Innovation Models (SIM) states are testing ACH models to advance their goals and address the full range of clinical and non-clinical factors that influence health.

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10/14/16 – American Journal of Managed Care - Connected Care: Improving Outcomes for Adults with Serious Mental Illness

By James M. Schuster, MD, MBA; Suzanne M. Kinsky, MPH, PhD; Jung Y. Kim, MPH; Jane N. Kogan, PhD; Allison Hamblin, MSPH; Cara Nikolajski, MPH; and John Lovelace, MS

The number of individuals with healthcare coverage under Medicaid is expanding with full enactment of the Affordable Care Act (ACA), and the number of enrollees with serious mental illness (SMI), such as severe mood disorders and schizophrenia, who currently comprise 12.8% of those covered by Medicaid, is also increasing. Individuals with SMI have higher rates of physical illness than the general population, and healthcare systems often struggle to meet their needs. Recent efforts to improve health outcomes for this population have focused on physical and mental healthcare coordination. Under the ACA, states have options to develop new and refined solutions to address the special needs of the Medicaid population to provide care coordination, health promotion, and a connection to resources. 

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10/13/16 – The Commonwealth Fund – The ACA’s Cost-Sharing Reduction Plans: A Key to Affordable Health Coverage for Millions of U.S. Workers

By John R. Gabel, Heidi Whitmore, Matthew Green, Adrienne Call, Sam Stromberg, and Rebecca Oran

Without the cost-sharing reductions (CSRs) made available by the Affordable Care Act, health plans sold in the marketplaces may be unaffordable for many low-income people. CSRs are available to households earning between 100 percent and 250 percent of the federal poverty level that choose a silver-level marketplace plan. In 2016, about 7 million people received cost-sharing reductions that substantially lowered their deductibles, copayments, coinsurance, and out-of-pocket limits. 

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Click here to view the chartpack


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10/13/16 – Avalere – Health Insurance is a Good Buy to Protect Against Significant Financial Risk for a Range of Common Health Conditions

By Caroline F. Pearson

A new analysis from Avalere finds that consumers with a range of common health conditions could reduce their spending between $8,800 and $90,020 by purchasing insurance through the Affordable Care Act (ACA).

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10/11/16 – ICRC – Data-Driven Strategies to Analyze Opt-Outs and Engage Beneficiaries and Providers in Financial Alignment Demonstrations

On July 6, 2016, the Integrated Care Resource Center (ICRC) hosted a discussion with several states participating in the Medicare-Medicaid Financial Alignment Initiative regarding efforts to analyze “opt-out” trends in their demonstration programs. Growing enrollment in these demonstrations is a priority for these states, and they are developing increasingly sophisticated data-driven approaches to better understand disenrollment patterns and target outreach to providers and beneficiaries to prevent disenrollment.

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10/07/16 – Kaiser Family Foundation – Data Note: Effect of State Decisions on State Risk Scores

By Ashley Semanskee, Cynthia Cox and Larry Levitt

Several health insurers, including United Healthcare and Aetna, are scaling back their participation in the Affordable Care Act (ACA) health insurance marketplaces, and in some cases exiting the broader individual market, due to substantial losses in these markets. A commonly cited reason for these losses is a sicker-than-expected risk pool, meaning that on average enrollees in this market may have been sicker or higher-cost than insurers expected or priced for. There are a number of related factors that could contribute to losses for insurers in the individual and exchange markets, including competition to offer a low-cost plan and lower-than-expected benchmark premiums, changes to risk corridors payments, and some insurers having less effective cost control than their competitors.

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10/07/16 – The Commonwealth Fund – Hennepin Health: A Care Delivery Paradigm for New Medicaid Beneficiaries

By Martha Hostetter, Sarah Klein and Douglas McCarthy

Jorge’s life began spiraling out of control in 2010 when he lost his job managing a food pantry and his wife died suddenly. Soon after, he became homeless and often wandered the streets, crying uncontrollably. After another blow—his son’s death in combat in Afghanistan—a priest took him to Hennepin County Medical Center where a social worker determined he was eligible to receive services from Hennepin Health, a safety-net accountable care organization (ACO). The ACO was launched in 2012 as a Medicaid demonstration project in Hennepin County, Minnesota, to create a new model of care for Medicaid beneficiaries like Jorge who may suffer from debilitating mental health problems, chemical dependencies, and other hallmarks of poverty, trauma, and social isolation.

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10/05/16 – Avalere – Consumers Enrolling in Exchanges through Special Enrollment Periods Have Higher Costs, Lower Risk Scores, than Open Enrollment Consumers

By Elizabeth Carpenter

A new analysis from Avalere finds that individuals who enroll in exchange coverage during special enrollment periods (SEP) have higher costs and lower risk scores than open enrollment period (OEP) consumers. Specifically, 2015 SEP enrollees have 5 percent higher per-member, per-month (PMPM) costs, but risk scores that are 20 percent lower on average than those choosing a plan during the OEP. Risk scores represent a measure of predicted healthcare costs assigned as part of the risk adjustment program.

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Click here to view the complete report


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10/05/16 – The Commonwealth Fund – ACOs Holding Commercial Contracts are Larger and More Efficient than Noncommercial ACOs

By David Peiris, Madeleine Phipps-Taylor, Stephen M. Shortell, Valerie Lewis, Meredith B. Rosenthal, Carrie H. Colla, Courtney A. Stachowski, and Lee-Sien Kao

Online survey data show that accountable care organizations (ACOs) with commercial contracts outperform ACOs with public-payer contracts on selected measures of quality and process efficiency. These differences in performance are linked to variation in organizational structure, provider compensation, quality improvement activities, and management systems. The public sector can and should play a lead role in supporting and guiding the future growth of ACOs to ensure that desired quality and efficiency gains are realized.

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10/04/16 – The Commonwealth Fund - Insurance Churning Rates for Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful for Many

By Benjamin D. Sommers, Rebecca Gourevitch, Bethany Maylone, Reobert J. Blendon, & Arnold Epstein

Researchers surveyed low-income adults in Arkansas, Kentucky, and Texas in 2015 to determine how frequent changes in health insurance coverage, or “churning,” affects their care. Churning rates were found to be similar across the three states, despite their different approaches to Medicaid expansion under the Affordable Care Act (ACA). Respondents who changed health insurance coverage reported that they were more likely than those remaining in the same plan to receive low-quality medical care or to have to switch doctors. Coverage disruptions also were linked to people stopping their prescription medicines or skipping doses, and they had a negative impact on self-reported health.

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09/29/16 – The New York Times – U.S. Paid Insurers Funds Meant for Treasury, Auditors Say

By Robert Pear

Federal auditors ruled on Thursday that the Obama administration had violated the law by paying health insurance companies more than allowed under the Affordable Care Act in an effort to hold down insurance premiums.

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09/29/16 – Kaiser Family Foundation – Key Facts about the Uninsured Population

Decreasing the number of uninsured is a key goal of the Affordable Care Act (ACA), which extends Medicaid coverage to many low-income individuals in states that have expanded and provides Marketplace subsidies for individuals below 400% of poverty. The ACA’s major coverage provisions went into effect in January 2014 and have led to significant coverage gains. As of the end of 2015, the number of uninsured nonelderly Americans stood at 28.5 million, a decrease of nearly 13 million since 2013. This fact sheet describes how coverage has changed under the ACA, examines the characteristics of the uninsured population, and summarizes the access and financial implications of not having coverage.

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09/29/16 – ASPE – Affordable Care Act has Led to Historic, Widespread Increase in Health Insurance Coverage

By Kelsey Avery, Kenneth Finegold and Amelia Whitman

Historic gains in health insurance coverage have been achieved since the implementation of the Affordable Care Act (ACA). Individuals and families of all income levels, age groups, races and ethnicities, and urban and rural areas have seen substantial reductions in uninsured rates. Coverage expansion provisions of the ACA (i.e., the Health Insurance Marketplace and Medicaid expansion) and reforms in the private market, such as allowing young adults to remain on their parents’ plan until age 26 and requiring insurers to cover individuals with pre-existing health conditions, have worked in concert to reduce the national uninsured rate to a historic low of 8.6 percent. To date, 20 million individuals have gained health coverage as a result of the ACA.

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09/27/16 – Kaiser Health News – Expert Panel Recommends Expansion of Services with No Cost Sharing for Women

By Michelle Andrews

The list of preventive services that women can receive without paying anything out of pocket under the health law could grow if proposed recommendations by a group of mostly medical providers are adopted by federal officials later this year.

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Click here to view the draft recommendations


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09/25/16 – McKnight’s – One in 9 Physicians Think ACOs will Help Quality and Costs, Survey Finds

By Emily Mongan

Few physicians believe Accountable Care Organizations will live up to their expectations of increasing quality and cutting costs, a survey published Wednesday shows.

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Click here to view the full results of the survey


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09/21/16 – The Commonwealth Fund - Do Accountable Care Organizations (ACOs) Help or Hinder Primary Care Physicians’ Ability to Deliver High-Quality Care?

By Brian Schilling

Already serving tens of millions of Americans, accountable care organizations (ACOs) are likely to play an even greater role in our health care system going forward. ACOs—networks of doctors and hospitals that take on financial risk for treating a group of patients—are seen by many as critical to the effort to control costs and improve quality of care. Still, their early results have been decidedly mixed.

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09/21/16 – American Journal of Preventive Medicine - States’ Influences on Medicaid Investments to Address Patients’ Social Needs

By Laura M. Gottlieb, Andrea Quiñones-Rivera and Rishi Manchanda, Holly Wing, and Sara Ackerman

In early 2016, the Center for Medicare and Medicaid Innovation announced a 5-year multimillion-dollar grants program to test a new model of care called Accountable Health Communities, which will fund grantees to systematically identify and address the social needs of Medicare and Medicaid beneficiaries. The announcement is built on a growing body of evidence linking unmet social needs, such as food insecurity and inadequate housing, with poorer health outcomes, and reflects increased interest across the healthcare sector around addressing patients’ social needs to improve health. The Accountable Health Communities experiment will fill critical evidence gaps about the healthcare impacts of interventions at the intersection of medical care and social services.
 

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09/21/16 – Kaiser Family Foundation- CMS’s Denial of Proposed Changes to Medicaid Expansion in Ohio

In January, 2014, Ohio implemented a traditional Medicaid expansion, according to the terms set out in the Affordable Care Act.  Subsequently, the operating budget passed by the state legislature in June, 2015 required Ohio to seek specific changes to its existing expansion by applying for a Section 1115 demonstration waiver.  On June 15, 2016, the state submitted its waiver proposal, called the Healthy Ohio Program, to the Centers for Medicare and Medicaid Services (CMS), and on September 9, 2016, CMS denied the waiver application.

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09/21/16 – CHCS – Medicaid Accountable Care Organizations: State Update

Across the country, states are exploring the viability of Medicaid accountable care organizations (ACOs) that align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable. To date, 10 states have launched Medicaid ACO programs, and six more are actively pursuing them.

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09/19/16 – Kaiser Family Foundation- Proposed Changes to Medicaid Expansion in Kentucky

In January, 2014, Kentucky implemented a traditional Medicaid expansion, according to the terms set out in the Affordable Care Act.  Subsequently, Governor Bevin, who ran on a platform to end the Medicaid expansion and dismantle the State-Based Marketplace, was elected in December, 2015. Post-election, the Governor instead decided to seek a Section 1115 waiver to change the state’s traditional Medicaid expansion, and on June 22, 2016, he released his proposed waiver called Kentucky HEALTH (Helping to Engage and Achieve Long Term Health).  During an extended state level public comment period, from June 22 through August 14, 2016, the state received 1,428 comments on the waiver.  Limited changes were made to the initial proposal, and on August 24, 2016, Governor Bevin officially submitted the waiver application to the Centers for Medicare and Medicaid Services (CMS), where it is now pending.

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09/19/16 – Kaiser Health News – Health Law Expanded Coverage for Ex-Inmates, But Gaps Remain

By Jay Hancock

Insurance expansion in the early stages of the Affordable Care Act’s implementation boosted coverage for ex-prisoners but still left substantial gaps among a population with high rates of mental illness and chronic diseases such as hepatitis and diabetes, new research shows.

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09/14/16 – NAIC – NAIC Testifies Before Congress on Rising Health Insurance Costs

Remer Urges Congress to Address Problems in the Affordable Care Act

Maryland Insurance Commissioner Al Redmer, Jr. testified before Congress today on behalf of the National Association of Insurance Commissioners (NAIC). The hearing was held by the U.S. House Oversight and Government Reform Committee and examined rising health insurance premiums under the Affordable Care Act (ACA). Redmer's testimony focused on the challenges facing state health insurance exchanges.

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Click here to view Redmer's submitted testimony


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09/13/16 – U.S. Census Bureau – Health Insurance Coverage in the United States: 2015

Current Population Reports

By Jessica C. Barnett and Marina S. Vornovitsky

Health insurance is a means for financing a person’s health care expenses. While the majority of people have private health insurance, primarily through an employer, many others obtain coverage through programs offered by the government. Other individuals do not have health insurance at all (see the text box “What Is Health Insurance Coverage?”).

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09/12/16 – The Commonwealth Fund – How the ACA’s Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums

By Sherry A. Glied, Claudia Solis-Roman and Shivani Parikh

Issue: One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law’s individual mandate also protect from high health spending. Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket. Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds. Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.

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Click here to view the chartpack

Click here to view the appendix tables


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09/07/16 – Kaiser Health News – Lack of Medicaid Expansion Hurts Rural Hospitals More than Urban Facilities

By Shefali Luthrsa

It isn’t news that in rural parts of the country, people have a harder time accessing good health care. But new evidence suggests opposition to a key part of the 2010 health overhaul could be adding to the gap.

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08/28/16 – Kaiser Family Foundation – Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces

By Cynthia Cox and Ashley Semanskee

The following charts provide a preliminary picture of the potential effect insurer exits and entrants may have on competition and consumer choice in the Affordable Care Act (ACA) marketplaces. This analysis was done at the request of the Wall Street Journal. Our earlier analysis found that UnitedHealth’s absence from these markets would leave many parts of the country with fewer marketplace insurers, and that the number of counties with a single insurer would likely increase substantially if there were no new entrants. Similarly, our July analysis of insurer participation in 17 states with detailed, publicly available premium and participation data found that on average there would be fewer insurers participating in 2017 in these states than there had been in 2016 or 2015.

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08/25/16 – ASPE – The Effect of Medicaid Expansion on Marketplace Premiums 

By Aditi P. Sen and Thomas DeLeire

Since the enactment of the Affordable Care Act (ACA), health insurance coverage has dramatically increased, primarily through the establishment of Health Insurance Marketplaces (“Marketplaces”) and Medicaid expansion. These two forms of coverage have worked together to improve access to affordable and comprehensive health insurance for all Americans. As of early 2016, an estimated 20 million additional individuals have gained health coverage as a result of provisions of the ACA. 1 Additionally, as this brief estimates, the Medicaid expansion helps lower premiums for Marketplace enrollees; we estimate that Marketplace premiums are about 7 percent lower in states that expanded Medicaid compared to those that have not done so yet.

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08/24/16 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, August 2015 to August 2016 

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08/23/16 – Avalere – What are the ACA Enrollment Figures for 2016?

Recently, Avalere Worked with the Council for Affordable Health Coverage to Examine Enrollment Trends for the Affordable Care Act (ACA) – By Caroline F. Pearson - Avalere projects that 10.1 million individuals will be enrolled in an exchange plan by the end of 2016. To date, exchange enrollment has not reached original projection numbers. In March 2010, the Congressional Budget Office predicted enrollment figures for 2016 to be at 21 million.  Their projections have decreased since then- in January 2016 it was 13 million and in March 2016, it was 12 million. The Obama administration projects 10 million in enrollment for 2016. 

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08/19/16 – Avalere – Experts Predict Sharp Decline in Competition across the ACA Exchanges

Avalere Experts Predict that One-Third of the Country will have no Exchange Plan Competition in 2017, Leaving Consumers with Few Options for Coverage

By Dan Mendelson

A new analysis from Avalere finds that nearly 36 percent of exchange market rating regions may have only one participating insurance carrier offering plans for the 2017 plan year and there may be some sub-region counties where no plans are available. Nearly 55 percent of exchange market rating regions may have two or fewer carriers. To determine competition levels in the exchanges, Avalere compared carriers that offered plans in 2016 to those that have publicly announced their intentions to scale back participation or exit the exchanges in 2017 (e.g., Aetna, Humana, United, some CO-OPs). While this analysis assumes no new plans enter the market, consumer choice could improve if carriers decide to expand exchange participation.

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08/18/16 – The Commonwealth Fund – Who Are the Remaining Uninsured and Why Haven’t They Signed Up for Coverage?

Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February – April 2016

By Sara R. Collins, Munira Z. Gunja, Michelle M. Doty, and Sophie Beutel

The number of uninsured people in the United States has declined by an estimated 20 million since the Affordable Care Act went into effect in 2010. Yet, an estimated 24 million people still lack health insurance. Goal: To examine the characteristics of the remaining uninsured adults and their reasons for not enrolling in marketplace plans or Medicaid. Methods: Analysis of the Commonwealth Fund ACA Tracking Survey, February–April 2016. Key findings and conclusions: There have been notable shifts in the demographic composition of the uninsured since the law’s major coverage expansions went into effect in 2014. Latinos have become a growing share of the uninsured, rising from 29 percent in 2013 to 40 percent in 2016. Whites have become a declining share, falling from half the uninsured in 2013 to 41 percent in 2016. The uninsured are very poor: 39 percent of uninsured adults have incomes below the federal poverty level, twice the rate of their overall representation in the adult population. Of uninsured adults who are aware of the marketplaces or who have tried to enroll for coverage, the majority point to affordability concerns as a reason for not signing up.

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Click here to view the chartpack

Click here to view the press release


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08/18/16 – Kaiser Family Foundation – A Final Look: California’s Previously Uninsured after the ACA’s Third Open Enrollment Period

By Ashley Kirzinger, Bianca DiJulio, Elise Sugarman, Bryan Wu, and Mollyann Brodie

The Kaiser Family Foundation California Longitudinal Panel Survey is a series of surveys that, over time, tracked the experiences and views of a representative, randomly selected sample of Californians who were uninsured prior to the major coverage expansions under the Affordable Care Act (ACA). The initial baseline survey was conducted with a representative sample of 2,001 nonelderly uninsured Californian adults in summer 2013, prior to the ACA’s initial open enrollment period.

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Click here to view the Topline & Methodology

Click here to view the chartpack

Click here to view the attrition analysis


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08/18/16 – The Commonwealth Fund – New Commonwealth Fund Report: Latinos and People with Low Incomes Are Most Likely to Be Uninsured, Despite Significant Gains Under Affordable Care Act

Many of Remaining 24 Million Uninsured Adults Live in States Not Expanding Medicaid; Affordability, Marketplace Awareness, and ACA’s Exclusin of Undocumented Immigrants Also Play Role

Of the U.S. adult population currently without health insurance, 88 percent is Latino, makes less than $16, 243 a year, is under age 35, and/or works for a small business, according to new Commonwealth Fund survey findings. Half (51%) of the remaining uninsured live in one of the 20 states that had not yet expanded Medicaid at the time of the survey.

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08/17/16 – McKnight’s - Aetna Withdrawal Puts Spotlight Back On ACA

By Elizabeth Leis Newman

The announced withdrawal of health insurance giant Aetna from Obamacare exchanges this week has put the healthcare law back in the thicket of political debate.  Aetna announced early this week it would pull out of Affordable Care Act health insurance exchanges in close to 550 counties in 11 states, causing consternation in numerous states, particularly Texas and Arizona. But in a Huffington Post piece, reporters found evidence that Aetna would withdraw if the merger with Humana fell apart. The letter the reporters obtained, from Aetna Mark T. Bertolini Chairman and CEO, states, “if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint.”
 

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08/17/16 – Kaiser Family Foundation – Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors

By Cynthia Cox, Ashley Semanskee, Gary Claxton, and Larry Levitt

As of January 1, 2014, insurers are no longer able to deny coverage or charge higher premiums based on preexisting conditions (under rules referred to as guaranteed issue and modified community rating, respectively). These aspects of the Affordable Care Act (ACA) – along with tax credits for low and middle income people buying insurance on their own in new health insurance marketplaces – make it easier for people with preexisting conditions to gain insurance coverage. However, if not accompanied by other regulatory measures, these provisions could have unintended consequences for the insurance market. Namely, insurers may try to compete by avoiding sicker enrollees rather than by providing the best value to consumers. In addition, in the early years of market reform insurers faced uncertainty as to how to price coverage as new people (including those previously considered “uninsurable”) gained coverage, potentially leading to premium volatility. This brief explains three provisions of the ACA – risk adjustment, reinsurance, and risk corridors – that were intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform.

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08/17/16 – Kaiser Health News – People with Obamacare Plans Filled More Prescriptions, But Had Lower Costs

By Shefali Luthra

The 2010 health law was meant to expand insurance coverage so that Americans could get medical care they would otherwise go without — and not spend a fortune doing so. Though it’s still early, new evidence suggests this scenario is playing out.

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08/16/16 – Kaiser Health News – Hidden Plan Exclusions May Leave Gaps in Women’s Care, Study Finds

Buried in the fine print of many marketplace health plan documents is language that allows them to refuse to cover a range of services, many of which disproportionately affect women, a recent study found.

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08/15/16 – NAHC – Harvard Study Connects Medicaid Expansion to Improved Quality and Access to Health Care

A new study by researchers at Harvard T.H. Chan School of Public Health found that in Kentucky and Arkansas—states that have expanded Medicaid coverage under the Affordable Care Act (ACA) — low-income adults reported higher quality care and improved health compared to low-income adults in Texas, which has not expanded Medicaid coverage. The low-income adults in Kentucky and Arkansas also received more primary and preventative care and made fewer emergency departments visits. The study was published August 8, 2016 in JAMA Internal Medicine.

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08/12/16 – The New York Times – Cost, Not Choice, is Top Concern of Health Insurance Customers

By Reed Abelson

It is all about the price.  Millions of people buying insurance in the marketplaces created by the federal health care law have one feature in mind. It is not finding a favorite doctor, or even a trusted company. It is how much — or, more precisely, how little — they can pay in premiums each month.

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08/12/16 – Kaiser Family Foundation – Disparities in Health and Health Care: Five Key Questions and Answers

By Petry Ubri and Samantha Artiga

Disparities in health and health care in the United States have been a longstanding challenge resulting in some groups receiving less and lower quality health care than others and experiencing poorer health outcomes. This brief provides an introductory overview of health and health care disparities, including what disparities are and why they matter, the status of disparities today, and key efforts to address disparities, including provisions in the Affordable Care Act (ACA) and their impact on health coverage disparities.

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08/12/16 – Kaiser Family Foundation – Health Plan Enrollment in the Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries

As of June, 2016, over 370,000 beneficiaries who are dually eligible for Medicare and Medicaid were enrolled and receiving services from health plans in nine states with capitated financial alignment demonstrations. These demonstrations, jointly managed by the Centers for Medicare and Medicaid Services (CMS) and the participating states, seek to maintain or decrease costs while maintaining or improving health outcomes for this vulnerable population of seniors and non-elderly people with disabilities. This fact sheet provides a snapshot of enrollment in the demonstrations by state as of June, 2016. Enrollment numbers will continue to change as these three year demonstrations progress.

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08/12/16 – CHCS – Coordinating Access to Services for Justice-Involved Populations

By Christian Heiss, MPH, Stephen A. Somers, PhD and Mark Larson

States that expanded Medicaid coverage under the Affordable Care Act have unprecedented opportunities to connect adults released from prison or jail with needed physical and behavioral health services and social supports. This population – disproportionate­ly male, minority, and poor – suffers from high rates of mental illness and substance use disor­ders. Providing critical health services and social supports for these individuals can potentially slow the revolving door of recidivism plaguing the justice system and reduce avoidable health care costs.

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08/09/16 – McKnight’s – Medicaid Expansion Improved Care for Chronic Conditions, Study Finds

By Phil Brahm

Low-income adults in two states experienced significant improvements in care after Medicaid services were expanded as part of the Affordable Care Act, according to a recent analysis.

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08/09/16 – The New York Times - Obamacare Appears to be Making People Healthier

By Margot Sanger-Katz

Obamacare has provided health insurance to some 20 million people. But are they any better off?  This has been the central question as we’ve been watching the complex and expensive health law unfurl. We knew the law was giving people coverage, but information about whether it’s protecting people from debt or helping them become more healthy has been slower to emerge.

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08/08/16 – The Commonwealth Fund – Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

By Benjamin D. Sommers, Robert J. Blendon, Arnold M. Epstein, and John Orav

Researchers surveyed nearly 9,000 low-income adults in three states that made different choices with respect to Medicaid expansion: Kentucky, which expanded Medicaid eligibility to include more low-income adults; Arkansas, which used federal funding to purchase private plans for low-income adults; and Texas, which chose not to expand Medicaid at all. By 2015, two years after coverage expansion, low-income adults in Kentucky and Arkansas received more primary and preventive care, visited emergency departments less often, and reported better health than their counterparts in Texas.

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08/03/16 – Kaiser Health News – Obama Care Expansion a Bumpy Ride for Rural Health Clinics

By Pauline Bartolone

A network of clinics that serves low-income patients in rural Northern California is finally finding balance after being deluged with newly insured patients under the Affordable Care Act.

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08/02/16 – The Commonwealth Fund – Women’s Health Coverage Since the ACA: Improvements for Most, But Insurer Exclusions Put Many at Risk

By Dania Palanker and Karen Davenport

Issue: Since enactment of the Affordable Care Act (ACA), many more women have health insurance than before the law, in part because it prohibits insurer practices that discriminate against women. However, gaps in women’s health coverage persist. Insurers often exclude health services that women are likely to need, leaving women vulnerable to higher costs and denied claims that threaten their economic security and physical health. Goal: To uncover the types and incidence of insurer exclusions that may disproportionately affect women’s coverage.

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Click here to view Exhibit 3


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08/02/16 – Avalere – Outpatient Services are the Largest Driver of 2017 Premium Increases

Prescription Drugs are not Outsized Contributers to Rate Increases

By Caroline F. Pearson

A new analysis from Avalere shows that outpatient spending is expected to be the largest driver of premium increases in 2017. Outpatient spending accounts for 29.9 percent of 2017 rate increases and represents 27.4 percent of spending in these plans, according to 2015 allowed claims data. This finding is similar to 2016 premium trends. In previous analysis of final premiums data, Avalere found that outpatient spending accounted for 28.9 percent of premium increases—the highest across the six categories. The analysis of proposed rate filings includes data from nine states – Connecticut, Maryland, Maine, Ohio, Oregon, Rhode Island, Virginia, Vermont, and Washington.

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07/27/16 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, July 2015 to July 2016 

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07/24/16 – CHCS - Medicaid Health Homes: Implementation Update

Medicaid health homes, made possible through the Affordable Care Act, provide states with a mechanism to support better care management for people with complex health needs with the goal of improving health outcomes and curbing costs. As of July 2016, 19 states and the District of Columbia have 28 approved Medicaid health home models in operation. This fact sheet describes how states are using the health homes opportunity.

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07/22/16 – The Commonwealth Fund – Factors Affecting Health Insurance Enrollment Through the State Marketplaces: Observations on the ACA’s Third Open Enrollment Period

By Justin Giovannelli and Emily Curran

Issue: Nearly 12.7 million individuals signed up for coverage in the Affordable Care Act’s (ACA) health insurance marketplaces during the third open enrollment period, and by the end of March there were 11.1 million consumers with active coverage. States that operate their own marketplaces posted a year-to-year enrollment gain of 8.8 percent. To maintain membership and attract new consumers, the state-based marketplaces must sponsor enrollment assistance programs and conduct consumer outreach. These marketplaces relied heavily on such efforts during the third enrollment period, despite declining funding.

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07/20/16 – The Commonwealth Fund – How Has the Affordable Care Act Affected Health Insurers’ Financial Performance?

By Mark Hall and Michael J. McCue

Starting in 2014, the Affordable Care Act transformed the market for individual health insurance by changing how insurance is sold and by subsidizing coverage for millions of new purchasers. Insurers, who had no previous experience under these market conditions, competed actively but faced uncertainty in how to price their products. This issue brief uses newly available data to understand how health insurers fared financially during the ACA’s first year of full reforms. Overall, health insurers’ financial performance began to show some strain in 2014, but the ACA’s reinsurance program substantially buffered the negative effects for most insurers. Although a quarter of insurers did substantially worse than others, experience under the new market rules could improve the accuracy of pricing decisions in subsequent years.

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Click here to view the press release


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07/20/16 – CHCS – The Evolution of Charity Care Programs to Support Enrollment in Health Coverage

By Maia Crawford

In response to the Affordable Care Act’s (ACA) coverage expansions, community-based charity care programs (CCPs) across the country shifted much of their focus away from helping the uninsured access free or low-cost health services and toward helping individuals enroll in health insurance.

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07/18/16 – Kaiser Health News – Montana Medicaid Expansion By-The Numbers

By Eric Whitney

Backers of Montana’s seven-month-old Medicaid expansion say they’re pleased with the first set of financial data released this week. State figures say enrollment as of July is nearly double initial projections, at 47,399 of the 25,000 who were expected to enroll by now.

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07/14/16 – The Commonwealth Fund – Rising to the Challenge : The Commonwealth Fund Scorecard on Local Health System Performance, 2016 Edition

By David C. Radley, Douglas McCarthy, and Susan L. Hayes

The 2016 edition of The Commonwealth Fund’s Scorecard on Local Health System Performance finds continuing wide variation in health and health care across U.S. communities. In its assessment of 36 indicators of access, quality, avoidable hospital use, costs, and outcomes, we see that health care improved more than it worsened between 2011 and 2014 in nearly all 306 local areas. Gains in access to care, quality, and efficiency often corresponded to implementation of public policies, such as the Affordable Care Act, and to quality improvement collaborations. But lack of progress on many indicators suggests further efforts are needed. Notably, mortality rates were mostly unchanged, and obesity rates rose in 111 of 306 localities. Health system performance is often linked to resource availability, with areas that have a high proportion of low-income residents tending to rank lower. Exceptions to this suggest, however, that local improvement efforts can succeed despite socioeconomic challenges.

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Click here to view the full interactive report


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07/13/16 – Avalere – UPDATE: Early Analysis Finds 2017 Proposed Exchange Premiums for Low Cost Silver Plans Increasing 8 Percent on Average

Rates Vary Widely by State; Popular Low Cost Options See Smaller Increases

By Caroline F. Pearson

An updated analysis from Avalere finds 2017 premium increases continue to vary significantly by geography as more states publish their proposed rates for individual market exchange plans. Requested premium increases for average silver plans is 11 percent, but consumers can limit cost increases by selecting lower cost silver plans, which are set to increase only 8 percent. The analysis has been updated to include 14 states where complete data are available. Avalere’s previous analysis of proposed rates in nine states found similar results.

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07/07/16 - The Commonwealth Fund - Americans’ Experiences with ACA Marketplace Coverage: Affordability and Provider Network Satisfaction

Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016

By Munira Z. Gunja, Sara R. Collins, Michelle M. Doty, and Sophie Beutel

For people with low and moderate incomes, the Affordable Care Act’s tax credits have made premium costs roughly comparable to those paid by people with job-based health insurance. For those with higher incomes, the tax credits phase out, meaning that adults in marketplace plans on average have higher premium costs than those in employer plans. The law’s cost-sharing reductions are reducing deductibles. Lower-income adults in marketplace plans were less likely than higher-income adults to report having deductibles of $1,000 or more. Majorities of new marketplace enrollees and those who have changed plans since they initially obtained marketplace coverage are satisfied with the doctors participating in their plans. Overall, the majority of marketplace enrollees expressed confidence in their ability to afford care if they were to become seriously ill. This issue brief explores these and other findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016.

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07/06/16 – The Commonwealth Fund – New ACA Marketplace Findings: Subsidies for Lower-Income Enrollees Make Insurance Premium and Deductible Costs Comparable to Employer Coverage

Large Majority of Marketplace Enrollees Satisfied with Doctors Covered by Their Insurance

The Affordable Care Act’s subsidies have made health insurance premium costs in the marketplaces more affordable for lower-income enrollees and nearly comparable to costs in employer-sponsored health plans, according to a new report from The Commonwealth Fund. Sixty-six percent of marketplace enrollees with annual incomes under $30,000 reported paying either nothing or less than $125 a month for individual coverage, compared to 60 percent of people in employer plans.

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06/28/16 – CHCS – Investing in People to Build State Medicaid Capacity

By Susan Shin and Mark Larson

Medicaid agencies today are being asked to do more and more to meet the program’s increasing demands since the passage of the Affordable Care Act. States are looking to address the needs of a growing population, transition to value-based purchasing, integrate care for complex need populations, and maximize the potential of cross-agency collaboration, all within the confines of limited budgets. Few, if any, states invest in building Medicaid administrative capacity on the scale of their commercial insurance counterparts.

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06/27/16 – CHCS – ACAP Medicare-Medicaid Plans and the Financial Alignment Demonstrations: Innovations and Lessons

By Mary Philip, Alexandra Kruse and Michelle Herman Soper

More than 10 million Americans are dually eligible for Medicare and Medicaid, but due to program misalignments these beneficiaries often receive fragmented, uncoordinated care. In 2011, the Centers for Medicare & Medicaid Services (CMS) created the Financial Alignment Initiative to test new models to integrate Medicare and Medicaid for this population. Under the initiative’s capitated model demonstrations that began in 2013, CMS and states contract with Medicare-Medicaid Plans, which are responsible for the full range of covered services for dually eligible beneficiaries.

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06/24/16 – Kaiser Family Foundation - Two Year Trends in Medicaid and CHIP Enrollment Data: Findings from the CMS Performance Indicator Project

By Alexandra Gates, Robin Rudowitz, and Samantha Artiga

This brief provides an overview of recent trends in Medicaid and CHIP enrollment as of January 2016, based on data from the Centers for Medicare and Medicaid Services (CMS) produced as part of its Performance Indicator Project.1 The project was designed to provide timely data on Medicaid and CHIP eligibility and enrollment that are intended to help strengthen data-driven program management and oversight efforts at both the national and state level (an overview of the data can be found in Appendix A). They also provide insight into Medicaid and CHIP eligibility and enrollment experiences as the ACA is implemented. This brief examines data as of January 2016 to be able to look at two full years of data post implementation of the major coverage provisions in the Affordable Care Act (ACA).

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06/24/16 – The Commonwealth Fund - Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

By Carrie H. Colla, Valerie Lewis, L.S. Kao, A. J. O’Malley, C. H. Chang, and E. S. Fischer

Enrollment in Medicare accountable care organizations (ACOs) is associated with reductions in health spending as well as fewer emergency department visits and hospitalizations. This is particularly true for beneficiaries with multiple medical conditions. Following implementation of Medicare ACOs, total spending overall decreased by $136, or 1.3 percent, annually per beneficiary, and by $456, or 2 percent, for those beneficiaries with multiple conditions.

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06/22/16 – Kaiser Family Foundation  - Overview of Medicaid Per Capita Cap Proposals

By Robin Rudowitz, Rachel Garfield, and Katherine Young

The House Republican Plan (“A Better Way”) released on June 22, 2016, includes a proposal to convert federal Medicaid financing from an open-ended entitlement to a per capita allotment or a block grant (based on a state choice). This proposal is part of a larger package designed to replace the Affordable Care Act (ACA) and reduce federal spending for health care.  Often tied to deficit reduction, proposals to convert Medicaid’s financing structure to a per capita cap or block grant have been proposed before.  Such changes represent a fundamental change in the financing structure of the program with major implications for beneficiaries, providers, states and localities.

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6/21/16 – CHCS – Promising Practices to Integrate Physical and Mental Health Care for Medi-Cal Members

By Allison Hamblin, Michelle Herman Soper, and Teagan Kuruna

Effective coordination of physical and behavioral health services is critical to ensuring quality of care, particularly for low-income populations with high prevalence of chronic conditions and mental illness. Recent changes in how Medi-Cal, California’s Medicaid program, promotes access to and coordination of mental health care provide new incentives for collaboration between two historically siloed systems: MediCal managed care and county mental health. Based on lessons from implementing these changes, this brief describes promising practices to improve collaboration across systems, and to provide a more seamless experience of care for beneficiaries. These insights, while gleaned from California, can inform physical and mental health care integration in other states as well.

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06/21/16 – Kaiser Family Foundation – Trends in State Medicaid Programs: Looking Back and Looking Ahead

By Laura Snyder and Robin Rudowitz

Medicaid is the nation’s primary public health insurance program covering over 70 million Americans with low incomes. Each year, states make a range of policy changes to Medicaid to comply with new federal rules and to address an array of policy goals. Medicaid programs also operate within state budgets, requiring a constant focus on cost control that is heightened during economic downturns. For 15 years, the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA) have conducted annual surveys of Medicaid programs across the country. The National Association of Medicaid Directors (NAMD) has formally collaborated on this project since 2014.

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06/20/16 – ASPE – Impacts of the Affordable Care Act’s Medicaid Expansion on Insurance Coverage and Access to Care

The Affordable Care Act (ACA) expanded Medicaid by providing federal matching funds to cover 100 percent of the cost in states expanding coverage to nonelderly adults (ages 19 to 64) with income ≤138 percent of the federal poverty level (FPL) during 2014 to 2016. This expansion includes parents and childless adults who were previously ineligible for Medicaid coverage. To date, a total of 31 states and the District of Columbia have expanded Medicaid.

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06/20/16 – Kaiser Family Foundation – The Effects of Medicaid Expansion under the ACA: Findings from a Literature Review

By Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga

Research on the effects of Medicaid expansions under the Affordable Care Act (ACA) can help increase understanding of how the ACA has impacted coverage; access to care, utilization, and health outcomes; and various economic outcomes, including state budgets, the payer mix for hospitals and clinics, and the employment and labor market. These findings may also inform ongoing debates surrounding the Medicaid expansion. This brief summarizes findings from 61 studies of the impact of state Medicaid expansions under the ACA. It includes peer-reviewed studies as well as free-standing reports, government reports, and white papers published by research and policy organizations between January 2014 and May 2016, using data from 2014 or later. The brief only includes studies that examine impacts of the Medicaid expansion; it excludes studies on impacts of ACA coverage expansions generally (not specific to Medicaid expansion alone) and studies investigating potential effects of expansion in states that have not (or had not, at the time of the study) expanded Medicaid. In both the brief and the appendix tables, findings are separated into three broad categories: Medicaid expansion’s impact on coverage; access to care, utilization, and health outcomes; and economic outcomes.

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Click here to view the appendix


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06/19/16 – McKnight’s – Medicare ACO Savings Plummet After First Year, Study Finds

By Emily Mongan

The first full year of contracts for accountable care organizations in the Medicare Shared Savings Program led to reductions in spending, but those cuts dropped significantly in the second cohort, a new study shows.

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06/16/16 – The Commonwealth Fund – How Much Financial Protection do Marketplace Plans Provide in States Not Expanding Medicaid?

By Sophie Beutel, Minira Gunja and Sara Collins

The Affordable Care Act’s premium subsidies and cost-sharing reductions have helped to reduce out-of-pocket costs for low-income people enrolled in marketplace plans. This financial protection has been particularly important for people with incomes above 100 percent of poverty who live in states that have not expanded Medicaid. However, a key question for policymakers is how this protection compares to Medicaid. This brief analyzes a sample of silver plans offered in the largest markets in 18 states that use the federal website for marketplace enrollment and have not expanded Medicaid eligibility. It finds that marketplace enrollees at this income level in most plans analyzed are at risk of incurring premium and out-of-pocket costs that are higher than what they would pay under Medicaid. For people with significant health needs, costs are estimated to be much higher in marketplace plans than what they would be under Medicaid.

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Click here to view the press release


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06/15/16 – Kaiser Family Foundation – Analysis of 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces

By Cynthia Cox, Gary Claxton, Larry Levitt, Michelle Long, Selena Gonzales, and Nolan Sroczynski

Marketplace premiums under the Affordable Care Act (ACA), already a subject of perennial interest, have gained even more attention amid unfavorable financial results from some insurers, as well as initial reports of steep premium increases requested for 2017. Several factors will influence how premiums will change in 2017, and there is reason to believe that increases will be higher than in recent years.

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06/15/16 – AHRQ – County-Based Accountable Care Organization for Medicaid Enrollees Features Shared Risk, Electronic Data Sharing, and Various Improvement Initiatives, Leading to Lower Utilization and Costs

A county-based accountable care organization integrates medical, behavioral health, and social services with the goal of improving outcomes and reducing costs for newly enrolled Medicaid beneficiaries in Hennepin County, Minnesota. Known as Hennepin Health, the organization is a partnership of several organizations within the county government that share financial risk (a medical center, health plan, social services organization, and federally qualified health center). An assigned care coordinator works to ensure that each enrollee receives appropriate services based on his or her medical, behavioral health, and social service needs. Partners share data electronically to allow for complete information on each enrollee, and jointly implement initiatives to improve care and promote appropriate utilization. The organization has experienced a growth in enrollment over time; has reduced hospital admissions, readmissions, emergency department visits, and the costs of caring for enrollees with historically high usage; and has generated high enrollee satisfaction.

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06/15/16 – AHRQ – State-Financed, Primary Care-Led, Accountable Care Collaborative Provides Comprehensive, Coordinated Care to Medicaid Beneficiaries, Reducing Admissions, Use of Imaging Services, and Costs

Authorized by the State legislature, the Colorado Accountable Care Collaborative is a primary care–based model for delivering coordinated care to Medicaid beneficiaries. Under this initiative, the State Medicaid agency contracts with regional organizations that serve seven distinct geographic areas. These organizations, in turn, contract with and support primary care–led medical homes in coordinating and managing needed care for enrolled beneficiaries, including specialist, hospital, behavioral health, and social services. The State also contracts with an outside vendor that assists with beneficiary assignment to medical homes and with data collection, analysis, and reporting to support the regional organizations and medical homes in coordinating care and managing population health. The model uses a mixture of payment methodologies, featuring fee-for-service for medical services, capitation for care management and coordination, and financial incentives to promote quality and efficiency. The collaborative has enhanced access to coordinated care for Medicaid beneficiaries, leading to fewer admissions and readmissions, less use of high-cost imaging services, and a slowdown in the growth of emergency department visits. Collectively, these improvements have yielded an estimated $6 million in cost savings for the State.

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06/14/16 – ASPE – The Affordable Care Act: Promoting Better Health for Women

By Adelle Simmons, Jessamy Taylor, Kenneth Finegold, Robin Yabroff, Emily Gee, and Andre Chappel -The Affordable Care Act promotes better health for women through the law’s core tenets of access,
affordability, and quality. For example, the law’s provisions have expanded coverage through the Health Insurance Marketplaces and Medicaid expansions; made coverage more affordable through premium tax credits and by eliminating gender differences in premiums in the individual and small group insurance markets; and improved quality of coverage by eliminating lifetime and annual dollar limits on Essential Health Benefits and requiring coverage of recommended preventive services and maternity care. Continued implementation of the Affordable Care Act will play a significant role in promoting the health and well-being of women across the lifespan. This report is organized into three sections that describe how health care access, affordability, and quality of care have improved for women since enactment of the Affordable Care Act. 
 

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06/10/16 – Kaiser Family Foundation – ACA Coverage Expansions and Low-Income Workers

By Alanna Williamson, Larisa Antonisse, Jennifer Tolbert, Rachel Garfield, and Anthony Damico

This brief highlights low-income workers and the impact of ACA coverage expansions on this population. While low-income workers are a diverse group, unique characteristics and challenges differentiate them from their higher income counterparts.

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06/10/16 – The Commonwealth Fund – Testimony: Consumer Experiences in the ACA Marketplaces, Marketplace Stability, and Remaining Challenges to Covering the Uninsured

Invited testimony, U.S. House of Representatives, Committee on Energy and Commerce, Subcommittee on Health, Hearing on “Advancing Patient Solutions of Lower Costs and Better Care”, June 10, 2016

By Sara R. Collins

Thank you, Mr. Chairman, members of the Committee, for this invitation to testify today on the Advancing Patient Solutions of Lower Costs and Better Care. Three years after the Affordable Care Act’s major health insurance expansions went into effect, 12.7 million people are estimated to have coverage through the marketplaces and 15 million more through Medicaid. There are 20 million fewer people uninsured since the law went into effect in 2010. Yet there remains considerable controversy over how well these reforms are working for consumers and whether the marketplaces are stable and competitive. The bills under discussion in this hearing are aimed at addressing some concerns that have been raised about the marketplaces and how consumers are using their plans. In this testimony, I review current evidence about the experiences of consumers in marketplace plans and Medicaid, the competitiveness and stability of the marketplaces, and ongoing implementation challenges. I also examine three of the proposed bills and their potential implications.

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06/09/16 – Kaiser Family Foundation - Understanding Medicaid Hospital Payments and the Impact of Recent Policy Changes

By Peter Cunningham, Robin Rudowitz, Katherine Young, Rachel Garfield, and Julia Foutz

Medicaid payments to hospitals and other providers play an important role in these providers’ finances, which can affect beneficiaries’ access to care. Medicaid hospital payments include base payments set by states or health plans and supplemental payments. Estimates of overall Medicaid payment to hospitals as a share of costs vary but range from 90% to 107%. While base Medicaid payments are typically below cost, the use of supplemental payments can increase payments above costs.  Changes related to expanded coverage under the Affordable Care Act (ACA) as well as other changes related to Medicaid supplemental payments could have important implications for Medicaid payments to hospitals.  This brief provides an overview of Medicaid payments for hospitals and explores the implications of the ACA Medicaid expansion as well as payment policy changes on hospital finances.

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06/09/16 – Kaiser Family Foundation - CMS's Final Rule on Medicaid Managed Care: A Summary of Major Provisions

By Julia Paradise and MaryBeth Musumeci

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued final regulations that revise and significantly strengthen existing Medicaid managed care rules. In keeping with states’ increasingly heavy reliance on managed care programs to deliver services to Medicaid beneficiaries, including many with complex care needs, the regulatory framework and new requirements established by the final rule reflect increased federal expectations regarding fundamental aspects of states’ Medicaid managed care programs. Major goals of CMS’ in revising the regulations were to align Medicaid and CHIP managed care requirements with other major health coverage programs where appropriate; enhance the beneficiary experience of care and strengthen beneficiary protections; strengthen actuarial soundness payment provisions and program integrity; promote quality of care; and support efforts to reform the delivery systems that serve Medicaid and CHIP beneficiaries.

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06/08/16 – The Kaiser Family Foundation – 2016 Survey of Health Insurance Marketplace Assister Programs and Brokers

By Karen Pollitz, Jennifer Tolbert and Ashley Semanskee

The new system for Marketplace enrollment assistance under the Affordable Care Act (ACA) is becoming well established.  Some 5,000 Assister Programs helped consumers apply for financial assistance and select health plans for 2016 during the third Open Enrollment (OE3).  Eighty-seven percent of Programs have been in operation three years, and 7 in 10 of three year Programs report most or nearly all of their staff have also worked all three years.  Eighty-four percent of brokers certified to sell non-group Marketplace health plans this year also have worked all three Open Enrollments.  As this system of in-person help matures, important distinctions are emerging among entities which could provide opportunities to develop strategies for identifying and building on those that accomplish the most.  At the same time, substantial challenges face many Assister Programs and brokers that hinder their ability to help consumers access and successfully enroll in health coverage.

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06/08/16 – CHCS – Promising Practices to Integrate Physical and Mental Health Care for Medi-CalMembers

By Allison Hamblin, Michelle Herman Soper and Teagan Kuruna

Effective coordination of physical and behavioral health services is critical to ensuring quality of care, particularly for low-income populations with high prevalence of chronic conditions and mental illness.  Recent changes in how Medi-Cal, California’s Medicaid program, promotes access to and coordination of mental health care provide new incentives for collaboration between two historically siloed systems: MediCal managed care and county mental health. Based on lessons from implementing these changes, this brief describes promising practices to improve collaboration across systems, and to provide a more seamless experience of care for beneficiaries. These insights, while gleaned from California, can inform physical and mental health care integration in other states as well.

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06/08/16 – The Commonwealth Fund – Looking Under the Hood of the Cadillac Tax

By Sherry A. Glied and Adam Striar

One effect of the Affordable Care Act’s “Cadillac tax” (now delayed until 2020) is to undo part of the existing federal tax preference for employer-sponsored insurance. The specific features of this tax on high-cost health plans—notably, the inclusion of tax-favored savings vehicles such as health savings accounts (HSAs) in the formula for determining who is subject to the tax—are designed primarily to maximize revenue and minimize coverage disruptions, not to reduce health spending. Thus, at least initially, these savings accounts, rather than enrollee cost-sharing or other plan features, are likely to be affected most by the tax as employers act to limit their HSA contributions. Because high earners are the ones benefiting most from tax-preferred accounts, the high-cost plan tax will probably be more progressive than prior analyses have suggested, while having only a modest impact on total health spending.

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06/07/16 – Kaiser Family Foundation - Key Facts on Health and Health Care by Race and Ethnicity

By Samantha Artiga, Julia Foutz, Elizabeth Cornachione, and Rachel Garfield

Disparities in health and health care remain a persistent challenge in the United States. Disparities not only result in inequities but also limit continued improvement in quality of care and population health and result in unnecessary health care costs. Many initiatives are underway to address disparities and the Affordable Care Act (ACA) included provisions that advance efforts to reduce disparities. One key step to addressing disparities is identifying and documenting them. This information is necessary to develop and target interventions and to track progress over time. Data available to measure disparities is improving. Notably, the ACA requires all federal data collection efforts to obtain information on race, ethnicity, sex, primary language, and disability status. However, there remain gaps in data, particularly for some racial and ethnic subgroups.

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06/07/16 – OIG – Observations from Our Review of CMS’s Administration of the First Performance Year of the Pioneer Accountable Care Organization Payment Model

This memorandum offers observations based on our review of the Centers for Medicare & Medicaid Services’ (CMS) administration of the Pioneer Accountable Care Organization (ACO) Payment Model (Pioneer Model). Calendar year 2012 was the first performance year (PY1) and was the only completed year at the time of our data collection. Because our review was limited to the first year of one ACO model, we are making no formal recommendations, and our observations do not represent an overall assessment of CMS administration.
 

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06/03/16 – Avalere – CORRECTION: Early Analysis Finds 2017 Proposed Exchange Rates Exceed 2016 Increases But Vary Widely By State

Popular Low Cost Options See Smaller Increases

By Caroline F. Perason

A new analysis from Avalere finds wide geographic variation in 2017 premiums for individual insurance plans available on market exchanges. The analysis is based on proposed rate filings in nine states where complete data are available. Specifically, average proposed rate increases across all silver plans in the nine states examined range from 19 percent in Virginia to 5 percent in Washington. In 2016, 68 percent of exchange enrollees selected silver plans.  Avalere experts suggest that lower-than-expected exchange enrollment, higher healthcare costs among enrollees, and the end of the reinsurance and risk corridor programs are all likely contributors to premium growth in 2017.

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06/02/16 – The Commonwealth Fund – Promoting Value for Consumers: Comparing Individual Health Insurance Markets Inside and Outside the ACA’s Exchanges

By Michael J. McCue and Mark Hall

The new health insurance exchanges are the core of the Affordable Care Act’s (ACA) insurance reforms, but insurance markets beyond the exchanges also are affected by the reforms. This issue brief compares the markets for individual coverage on and off of the exchanges, using insurers’ most recent projections for ACA-compliant policies. In 2016, insurers expect that less than one-fifth of ACA-compliant coverage will be sold outside of the exchanges. Insurers that sell mostly through exchanges devote a greater portion of their premium dollars to medical care than do insurers selling only off of the exchanges, because exchange insurers project lower administrative costs and lower profit margins. Premium increases on exchange plans are less than those for off-exchange plans, in large part because exchange enrollment is projected to shift to closed-network plans. Finally, initial concerns that insurers might seek to segregate higher-risk subscribers on the exchanges have not been realized.

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05/31/16 – ICRC – Alternatives to Inpatient Psychiatric Services for Medicare-Medicaid Enrollees: A Case Study of Commonwealth Care Alliance

By Rebecca Sweetland Lester and James Verdier

Commonwealth Care Alliance (CCA) is one of the health plans participating in Massachusetts’ One Care demonstration under the Medicare-Medicaid Financial Alignment Initiative. The One Care demonstration began serving enrollees in October 2013. Shortly after its Medicare-Medicaid Plan began operating, CCA observed unexpectedly high behavioral health needs and high use of emergency department (ED) and inpatient psychiatric facility (IPF) services among enrollees, particularly those without connections to ongoing community based medical or behavioral health care. To address rising costs and what CCA perceived as unnecessary IPF admissions due to a lack of appropriate and available community-based crisis stabilization settings, it built on Massachusetts’ existing Medicaid behavioral health crisis stabilization services to create two new enhanced crisis stabilization units (CSUs) to: (1) provide short-term residential care for high-need patients in psychiatric crisis who could be appropriately served in a community-based setting; and (2) connect enhanced CSU patients to ongoing community-based care. Preliminary analyses suggest that the enhanced CSUs may have contributed to decreased IPF stays, ED admissions, and per-member per-month costs. Other states developing or implementing integrated care delivery approaches for the under-65 Medicare-Medicaid population can draw upon CCA’s experience to anticipate challenges they may experience and inform their own integrated program strategies.

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05/25/16 – The Commonwealth Fund – New Commonwealth Fund Survey: Most Aca Enrollees Who Have Used Their Plans Are Getting Health Care They Previously Would Have Gone Without; Wait Times For Doctor Appointments Similar To Other Insured Americans

Most Current, Comprehensive ACA Tracking Survey Finds Large Majority of ACA Marketplace and Medicaid Enrollees Say They Are Satisfied With Their Coverage

Sixty-one percent of those who have used coverage they obtained through the the Affordable Care Act (ACA) are getting health care that they would not have been able to afford or have access to previously, according to a Commonwealth Fund study out today. In addition, nearly three of five ACA enrollees who tried to find a new primary care doctor found it easy to find one, and three of five who needed to see a specialist waited two weeks or less to get an appointment. The survey, fielded between February and April of 2016, is the most recent and comprehensive look at people’s experiences with ACA marketplace and new Medicaid coverage. It is the fourth in the Commonwealth Fund’s series tracking the ACA’s progress. According to the report, Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction, 82 percent of adults with ACA marketplace coverage or Medicaid are somewhat or very satisfied with their insurance.

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05/25/16 – CHCS – Medicaid Health Homes: Implementation Update

The Affordable Care Act gives states an opportunity to improve care coordination and care management for Medicaid beneficiaries with complex needs through health homes. Health homes integrate physical and behavioral health care and long-term services and supports for high-need, high-cost Medicaid populations with the goal of improving health care quality and reducing costs. Through health homes, states seek to improve quality and reduce fragmentation of care, while leveraging enhanced federal funding (90 percent federal match for the first eight quarters).
 

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05/25/16 – The Commonwealth Fund – Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction

Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February – April 2016

By Sara R. Collins, Munira Gunja, Michelle M. Doty, and Sophie Beutel

The fourth wave of the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016, finds at the close of the third open enrollment period that the working-age adult uninsured rate stands at 12.7 percent, statistically unchanged from 2015 but significantly lower than 2014 and 2013. Uninsured rates in the past three years have fallen most steeply for low-income adults though remain higher compared to wealthier adults. ACA marketplace and Medicaid coverage is helping to end long bouts without insurance, bridge gaps when employer insurance is lost, and improve access to health care. Sixty-one percent of enrollees who had used their insurance to get care said they would not have been able to afford or access it prior to enrolling. Doctor availability and appointment wait times are similar to those reported by insured Americans overall. Majorities with marketplace or Medicaid coverage continue to be satisfied with their insurance.

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05/24/16 – Avalere – Early Analysis Finds 2017 Proposed Exchange Rates Exceed 2016 Increases but Vary Widely by State - Popular Low Cost Options See Smaller Increases

A new analysis from Avalere finds wide geographic variation in 2017 premiums for individual insurance plans available on market exchanges. The analysis is based on proposed rate filings in nine states where complete data are available. Specifically, average proposed rate increases across all silver plans in the nine states examined range from 44 percent in Vermont to 5 percent in Washington. In 2016, 68 percent of exchange enrollees selected silver plans. Avalere experts suggest that lower-than-expected exchange enrollment, higher healthcare costs among enrollees, and the end of the reinsurance and risk corridor programs are all likely contributors to premium growth in 2017.

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05/23/16 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and State, May 2015 to May 2016

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05/20/16 – Kaiser Family Foundation – Survey Finds Most Marketplace Enrollees Like Their Coverage, Though Satisfaction with Premiums and Deductibles Has Declined Since 2014

Following the Affordable Care Act’s (ACA) third open enrollment period, a new Kaiser Family Foundation survey of people who buy their own health insurance finds most marketplace enrollees give their coverage good marks, though concerns about premiums, deductibles, and other costs have risen since 2014.

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05/20/16 – Kaiser Family Foundation – Payment and Delivery System Reform in Medicare

A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

By Susan Baseman, Cristina Boccuti, Marilyn Moon, Shannon Griffin, and Tania Dutta

Policymakers, health care providers, and policy analysts continue to call for “delivery system reform”—changes to the way health care is provided and paid for in the United States—to address concerns about rising costs, quality of care, and inefficient spending.  The Affordable Care Act (ACA) established several initiatives to identify and test new health care payment models that focus on these issues.  Many of these ACA programs apply specifically to Medicare, the social insurance program that provides coverage to 55 million Americans age 65 and older and younger adults with permanent disabilities.

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05/18/16 – ASPE – Impact of the ACA on Small Businesses – Testimony Before the US Senate Committee on Small Business and Entrepreneurship 

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05/17/16 – The Commonwealth Fund – How Will Section 1115 Medicaid Expansion Demonstrations Inform Federal Policy?

By Sara Rosenbaum, Sara Schmucker, Sara Rothenberg, and Rachel Gunsalus

Section 1115 of the Social Security Act allows the U.S. Department of Health and Human Services and states to test innovations in Medicaid and other public welfare programs without formal legislative action. Six states currently operate their Medicaid expansions as demonstrations and several more are expected to seek permission to do so. While the current Medicaid expansion demonstrations vary, they share a major focus: increasing beneficiaries’ financial responsibility for the cost of coverage and care. Demonstrations include requirements that Medicaid beneficiaries pay enrollment fees and cost-sharing that exceed traditional Medicaid limits. Others propose tying beneficiaries’ financial responsibility to behavioral changes in health and wellness, while still others impose penalties for nonpayment of enrollment fees. Evaluations must consider the impact of these requirements on access, use of care, and health status, as well as the feasibility of demonstration reforms and their impact on administrative efficiency, providers, and health plans.

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05/13/16 – The Washington Post – Obama Administration: Insurers Must Provide Services Regardless of Gender Identity

By Juliet Eilperin

The Obama administration finalized a new rule Friday mandating that health insurers provide transgender patients with coverage for services and access to facilities even if those services were not traditionally covered or required by their expressed gender, as well as separate guidance calling on public schools to let transgender students access the bathrooms and facilities of their choice.

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05/13/16 – Robert Wood Johnson Foundation – ACA Implementation – Monitoring and Tracking

Children’s Coverage Climb Continues: Uninsurance and Medicaid/CHIP Eligibility and Participation Under the ACA

By Genevieve M. Kenney, Jennifer Haley, Clare Pan, Victoria Lynch, and Mathew Buettgens

Public coverage options for children have expanded dramatically over the past several decades. By 2014, before the major coverage provisions of the Affordable Care Act (ACA) were implemented, a majority of states—28 states— covered children in families with incomes up to 250 percent of the federal poverty level (FPL) or higher under Medicaid and the Children’s Health Insurance Program (CHIP), while only three states limited eligibility to children living below 200 percent of the FPL. In contrast, in 2000, shortly after the implementation of CHIP, only 11 states had eligibility levels of 250 percent of FPL or higher and 14 states had eligibility levels below 200 percent of FPL (Artiga and Cornachione 2016). Many states have also eliminated barriers to children’s Medicaid/CHIP enrollment and renewal, providing streamlined enrollment and renewal processes, greater outreach and availability of enrollment assistance, continuous enrollment, electronic data matching, and simplified verification procedures (Stephens and Artiga 2013).

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05/12/16 – The Commonwealth Fund - Changes in Consumer Cost-Sharing for Health Plans Sold in the ACA's Insurance Marketplaces, 2015 to 2016

By Jon Gabel, Matthew Green, Adrienne Call, Heidi Whitmore, Sam Stromberg, and Rebecca Oran

This brief examines changes in consumer health plan cost-sharing—deductibles, copayments, coinsurance, and out-of-pocket limits—for coverage offered in the Affordable Care Act’s marketplaces between 2015 and 2016. Three of seven measures studied rose moderately in 2016, an increase attributable in part to a shift in the mix of plans offered in the marketplaces, from plans with higher actuarial value (platinum and gold plans) to those that have less generous coverage (bronze and silver plans). Nearly 60 percent of enrollees in marketplace plans receive cost-sharing reductions as part of income-based assistance. For enrollees without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits remain considerably higher under bronze and silver plans than under employer-based plans; cost-sharing is similar in gold plans and employer plans. Marketplace plans are more likely than employer-based plans to impose a deductible for prescription drugs but no less likely to do so for primary care visits.

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05/10/16 – CHCS - Vermont’s Next Generation ACO Program Breaks New Ground in Medicaid

By Rob Houston, MBA, MPP and Jim Lloyd, JD

In April, Vermont released an RFP for its Next Generation Accountable Care Organization (Vermont Next Gen ACO) program. Under this program, Vermont plans to build on the state’s existing Medicaid ACO model, theVermont Medicaid Shared Savings Program (VMSSP), which saved $14.6M in its first year and delivered high-quality health care to more than 60,000 Medicaid enrollees across the state. Although Vermont’s Next Gen ACO is structured similarly to the Center for Medicare and Medicaid Services’ (CMS) Next Generation ACO Model (Next Gen) that serves Medicare beneficiaries, Vermont’s new ACO approach is attempting to go beyond its Medicare-inspired counterpart to make providers even more accountable for cost and patient outcomes.

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05/09/16 – Executive Insight - Alternate Payment Models

Test drive models to ensure success

By Tom Giannulli, MS, MD

The way healthcare providers get paid is changing. A combination of value-based reimbursement and direct payment models is slowly replacing fee-for-service models. To thrive in this dynamic market, physicians must look at the options, evaluate their patient panel and create a practice that can meet changing payer and patient demands. The first step is being open to change. 
 

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05/09/16 – AHIP – Factors Affecting Premiums in 2017 Individual Exchange Marketplace

The purpose of this issue brief is to describe and assess the various factors that will impact individual Exchange marketplace premiums for the 2017 plan/benefit year. Premium rates reflect many complex factors and there is significant variation in rates across states and markets. And the impact of any rate increase will depend on an individual’s income (including whether they qualify for premium tax credits), geography, age, and other factors. Moreover, the impact of any rate increase also depends on individual’s coverage preferences and options available to them.

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05/05/16 – Kaiser Family Foundation – What to Look for in 2017 ACA Marketplace Premium Changes

By Gary Claxton and Larry Levitt

Insurers are in the process of filing proposed premiums for ACA-compliant nongroup plans that will be available inside and outside of Marketplaces in 2017.

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05/04/16 – U.S. News – Here’s What Obamacare did for Mental Health

People Gained Insurance Coverage under the Health Care Law, but Access Barriers Remain

By Kimberly Leonard

People with psychological problems have been increasingly gaining health insurance coverage in recent years, but data in a study released Wednesday by the Centers for Disease Control and Prevention raise questions about whether they are also receiving medical care.

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05/04/16 – Kaiser Family Foundation – People with HIV who Gained Health Coverage under ACA are More Comfortable Navigating Insurance Two Years Later, but Problems Persist, Others Remain Uninsured

By Phil Galewitz

A new Kaiser Family Foundation report based on focus groups conducted in five states finds people living with HIV are more comfortable with navigating health insurance two years into the Affordable Care Act’s (ACA) major coverage expansions. Those in the marketplaces and Medicaid recognize their new benefits but often continue to worry about maintaining coverage and remain concerned about its affordability, and many in states without Medicaid expansion remain uninsured.

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05/04/16 – Kaiser Health News – Smokers’ Ranks Look Conspicuously Sparse in Obamacare

By Phil Galewitz

Barred from restaurants, banned on airplanes and unwelcome in workplaces across America, smokers have become accustomed to hiding their habits. So it’s no surprise many may now also be denying their habit when they buy health coverage from the federal health law’s insurance exchanges.

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05/03/16 – CHCS – Medicaid ACOs: State Activity Map

State-based Medicaid accountable care organizations (ACOs) are becoming increasingly prevalent across the country, with more and more states pursuing ACOs as a way to improve health outcomes and control costs through greater provider accountability. This interactive map offers an ongoing update of Medicaid ACO activities by state, including governance structure, scope of services, and payment model.

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05/02/16 – The Commonwealth Fund – Differing Impacts of Market Concentration on Affordable Care Act Marketplace Premiums

By Richard M. Scheffler, Daniel R. Arnold, Brent D. Fulton, and Sherry A. Glied

A new study supported by The Commonwealth Fund looks at the relationship between health care consolidation and premium prices in two state-based marketplaces. In New York, premium rates grew faster in areas with greater insurer concentration (i.e., less competition). In California, areas with less insurer competition had slower premium growth, which may be related to the state marketplace’s use of selective contracting with a limited number of plans and direct negotiations with plans on premium rates.

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05/02/16 – The Detroit News – Lawmakers Slow Medicaid Expansion in Flint

By Chad Livengood

Two months ago this week, the federal government approved Gov. Rick Snyder’s request to extend Medicaid health insurance to another 14,000 Flint children and 1,000 pregnant women who may have been exposed to toxic lead through the city’s tainted drinking water.

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4/26/16 – The Commonwealth Fund - Quality Measures at the Interface of Behavioral Health and Primary Care

By Deborah Lorber

One of the aims of the Affordable Care Act is to bridge the “silos” in health care delivery that separate behavioral and general primary care. Quality measurement will be critical to achieving this goal. But behavioral health care measures are less common than measures of general medical care, and there are even fewer measures at the interface of behavioral and medical care. Commonwealth Fund–supported researchers sought to identify existing measures that are relevant to both behavioral and general medical health.

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04/26/16 – KHN – Administration Says New Rules for Medicaid Plans Will Improve Services for Enrollees

By Jay Hancock

The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors.

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04/26/16 – Medpage Today - Medicaid Plan Networks Must Meet Standards: CMS

New Agency Rule Addresses Changing Healthcare Landscape

By Joyce Frieden

States will need to establish network adequacy standards for Medicaid managed care providers under a final rule issued Monday by the Centers for Medicare and Medicaid Services (CMS).

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04/25/16 – Kaiser Family Foundation – The Pennsylvania Health Care Landscape

As one of the most populous states in the U.S., the health and health care of Pennsylvanians have important implications for the nation at large. Pennsylvania is experiencing changes to its health care delivery and payment systems as the state expands Medicaid, provides new coverage options through the federal health insurance marketplace, and streamlines application and enrollment processes for coverage programs. This fact sheet provides an overview of population health, health coverage, and the health care delivery system in Pennsylvania in the era of health reform.

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04/25/16 - ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, April 2015 to April 2016 

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04/19/16 – Avalere – 2016 Exchange Plans Improve Access to Medicines Used to Treat Complex Diseases

By Carolyn F. Pearson

An analysis from Avalere shows that more health insurance plans offered through the Affordable Care Act exchanges are making some drugs used to treat complex diseases—such as HIV, cancer, and multiple sclerosis (MS)—more accessible to patients in 2016 than in the previous years. Specifically, plans were less likely to place all drugs in a class on the highest cost-sharing tier.

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04/18/16 – KHN – Study: Medicaid Expansion Encourages More Poor Adults To Get Health Care

By Phil Galewitz

In states that expanded Medicaid under the Affordable Care Act, low-income adults were more likely to see a doctor, stay overnight in a hospital and receive their first diagnoses of diabetes and high cholesterol, according to a study published Monday.

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04/18/16 – Kaiser Family Foundation – Analysis of UnitedHealth Group’s Premiums and Participation in ACA Marketplaces

By Cynthia Cox and Ashley Semanskee

In late 2015, amid a series of closures of relatively small co-op health plans, the nation’s largest private insurer, UnitedHealth Group, announced that it too expected losses in its Affordable Care Act (ACA) marketplace business and would reconsider its participation in the Marketplaces in the first half of 2016.  Most recently, there have been media reports that UnitedHealthcare (a subsidiary of UnitedHealth Group) would no longer participate in the Arkansas, Georgia, and Michigan exchange markets starting in 2017.  Though United is a large, established insurer in the employer-based insurance market, it has been cautious about entering the ACA marketplaces, only participating in a handful of states in 2014 before expanding its reach in 2015 and 2016.

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04/15/16 – CHCS – Integrating Behavioral Health into Medicaid Managed Care: Design and Implementation Lessons from State Innovators

By Michelle Herman Soper

Medicaid enrollees with behavioral health needs have a high prevalence of chronic conditions and are often frequent users of physical and behavioral health services. This brief, made possible by Kaiser Permanente Community Benefit, provides insights from Medicaid officials and health plan representatives in five states — Arizona, Florida, Kansas, New York and Texas — that are pursuing innovative approaches to integrate behavioral health services within a comprehensive managed care arrangement. It explores key lessons to guide state integration efforts designed to improve outcomes and reduce costs.
 
 

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4/14/16 – The Commonwealth Fund - Accountability Across the Continuum: The Participation of Postacute Care Providers in Accountable Care Organizations

By Sarah Klein

Each year, more than 40 percent of Medicare beneficiaries discharged from hospitals receive postacute care services—rehabilitation, skilled nursing, and home health care. Accountable care organizations (ACOs), which coordinate their patients’ treatment across all care settings, could play a key role in ensuring these services are appropriately used. Little is known, however, about the extent to which ACOs now engage postacute care providers in managing outcomes and costs.

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4/14/16 – The Commonwealth Fund - Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics with Performance

By Sarah Klein

With their emphasis on coordinated care management and data collection, accountable care organizations (ACOs) are especially well positioned to improve the receipt and quality of preventive care services, from vaccines and cancer screenings to health risk assessments. To assess ACOs’ progress in promoting preventive care and identify the organizational characteristics that are associated with success in this area, Commonwealth Fund–supported researchers examined first-year results of ACOs participating in the Medicare Shared Savings Program (MSSP) and Pioneer program. The study focused on two domains of preventive care: disease prevention and wellness screening.

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4/13/16 – New England Journal of Medicine - Early Performance of Accountable Care Organizations in Medicare

By J. Michael McWilliams, M.D., Ph.D., Laura A. Hatfield, Ph.D., Michael E. Chernew, Ph.D., Bruce E. Landon, M.D., M.B.A., and Aaron L. Schwartz, Ph.D.

In the Medicare Shared Savings Program (MSSP) — the largest of the Medicare accountable care organization (ACO) programs — participating provider organizations share in savings with Medicare if they keep spending for an attributed population of fee-forservice beneficiaries sufficiently below a financial benchmark. Greater shared-savings bonuses are awarded to ACOs with higher performance on a set of quality measures. Unlike ACOs in the Medicare Pioneer program, very few ACOs in the MSSP face penalties for spending in excess of benchmarks because such downside risk is not currently required.

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04/12/16 – ASPE – Health Coverage for Homeless and At-Risk Youth

Homeless and at-risk youth are likely to be eligible for health care coverage under the Affordable Care Act (often referred to as the ACA). The ACA vastly simplifies and expands access to affordable health care, including for low-income and homeless youth, and allows states to expand eligibility for Medicaid, a health care program for low-income individuals.

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04/12/16 – ASPE - Marketplace Premiums after Shopping, Switching, and Premium Tax Credits, 2015-2016

Health insurance rate information becomes available each spring as issuers file proposed rates with federal and state regulators. Rates then undergo review before being finalized in the fall, prior to the annual Health Insurance Marketplace Open Enrollment Period.  Neither the proposed nor final rates offered by any individual issuer provide a reliable basis for predicting what typical Marketplace consumers will pay in the following year. Consumers’ actual health insurance premiums will be lower because public rate review can bring down proposed increases, shopping gives all consumers a chance to find the best deal, and tax credits reduce the cost of coverage for the vast majority of Marketplace consumers. Among the roughly 85 percent of HealthCare.gov consumers with premium tax credits, the average monthly net premium increased just $4, or 4%, from 2015 to 2016.

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4/12/16 – CHCS - Overcoming Challenges in Caring for Dually Eligible Members

On April 12, 2016, Michelle Herman Soper, MHS, CHCS’ director of integrated care and Carolyn Ingram, Vice President of Public Policy at Molina Healthcare, spoke at the 13th annual World Health Care Congress. Their presentation, “Overcoming Challenges in Caring for Dual Eligible Members” discussed how payers and others can work with regulatory agencies to further Medicaid-Medicare integration, approaches to engage dually eligible individuals in care management, incorporation of social determinants of health in integrated care models, and best practices for integrated care.

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4/12/16 – CHCS -Integrating Behavioral Health into Medicaid Managed Care: Lessons from State Innovators

Medicaid enrollees with behavioral health needs have a high prevalence of chronic conditions and are often frequent users of physical and behavioral health services. More and more states are pursuing managed care models that integrate behavioral and physical health services to enhance care coordination, improve outcomes, and control costs for this high-need population. As of January 2016, 16 states currently provide or are planning to offer behavioral health services through an integrated managed care benefit — up from just a handful a few years prior. 

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04/11/16 – McKnight’s – Dual-Eligibles Demo Failing to Meet Expectations, MedPAC Says

By Emily Mangan

A demonstration program aimed at improving care for beneficiaries eligible for both Medicare and Medicaid is showing lower enrollment than expected, according to a Medicare Payment Advisory Commission staff member.

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04/07/16 – The Commonwealth Fund – Medicaid Expansion in Texas: What’s at Stake?

By Benjamin D. Sommers

Texas is one of nearly 20 states yet to expand its Medicaid program under the Affordable Care Act (ACA), and is home to the largest number of uninsured Americans of any state in the country. For many of the state’s 5 million uninsured, this decision has left them without an option for affordable health insurance. A comparison with other Southern states that have expanded Medicaid shows how this decision has left many low-income Texans less able to afford their medical bills, to pay for needed prescription drugs, and to obtain regular care for chronic conditions. These problems have been compounded by the state’s opposition to outreach and enrollment assistance for many Texans who are eligible for coverage under the ACA. Ongoing efforts from stakeholders and consumer groups to persuade state leaders to expand coverage have significant implications for the well-being of millions of low-income adults in Texas.

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04/06/16 – CHCS – State Medicaid & Public Health Collaboration to Advance the CDC’s 6/18 Initiative

The Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative: Accelerating Evidence into Action is bringing together public and private health care purchasers, payers, and providers to improve health and control health care costs. This innovative effort aims to link proven prevention activities to health coverage and delivery with a focus on six high-burden, high-cost health conditions — tobacco use, high blood pressure, health care-associated infections, asthma, unintended pregnancies, and diabetes. The “18” refers to a set of evidence-based interventions that address the six conditions.

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04/04/16 – Office of Inspector General – Opportunities for Program Improvements Related to States’ Withdrawls of Federal Medicaid Funds

The Centers for Medicare & Medicaid Services (CMS) has not issued guidance instructing States on the appropriate extent and timing of Medicaid withdrawals. Specifically, CMS has not issued guidance that clarifies the "as needed" language in 42 CFR § 430.30(d)(3) that would educate States on the application of 31 CFR part 205 in Medicaid. Such guidance and education would help prevent States from withdrawing more Medicaid funds than necessary. All three States that we audited withdrew more funds than necessary to meet immediate cash needs. At the time of our reviews, Alabama and Maryland had overdrawn more than $130 million in Medicaid funds that they had not refunded to the Federal Government. Although Illinois refunded overdrawn Medicaid funds, its withdrawals exceeded its expenditures by an average of $60 million a quarter.

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03/31/16 – Avalere – Only 33 Percent of Exchange Enrollees in 2016 Kept Their Same Plan from 2015

By Caroline F. Pearson

One third of those who enrolled in a health insurance plan on Healthcare.gov this year picked the same plan as last year, according to a new analysis from Avalere. In total, 3.2 million of the 9.6 million exchange shoppers in 2016 kept their previous plan.

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03/31/16 – CHCS – Housing Options for High-Need Dually Eligible Individuals: Health Plan of San Mateo Pilot

By Brianna Ensslin and Deborah Brodsky

Many individuals with long-term services and supports (LTSS) needs either reside in institutions or are at risk for institutionalization. Rebalancing care to provide LTSS in the community is one goal of the federal Financial Alignment Initiative for Medicare-Medicaid enrollees. This profile details the experiences of the Health Plan of San Mateo (HPSM), a participant in California’s Cal MediConnect financial alignment demonstration, as it implements a pilot program to help dually eligible individuals in nursing facilities transition back to community living and those at risk of nursing home placement to remain in the community. Lessons from this pilot may help other health plans, states, and providers develop approaches to serving dually eligible individuals with extensive LTSS needs. HPSM is a participant in Promoting Integrated Care for Dual Eligibles (PRIDE), a national initiative made possible by The Commonwealth Fund.
 

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03/30/16 – The Commonwealth Fund – Streamlining Medicaid Enrollment: The Role of the Health Insurance Marketplaces and the Impact of State Policies

By Sara Rosenbaum, Sara Schmucker and Rachel Gunsalus

In addition to expanding eligibility for Medicaid, the Affordable Care Act reformed the program’s enrollment process, with the health insurance marketplaces playing a central role in the reforms. State-based marketplaces determine Medicaid eligibility, but federal regulations give states using the federal marketplace a choice either to allow the marketplace to make Medicaid eligibility determinations or to limit its role to assessing and referring applicants to the state Medicaid agency. This issue brief examines Medicaid enrollment data and finds that states that establish their own marketplaces realize higher Medicaid enrollment. In states that use the federal marketplace, Medicaid enrollment is higher when states have the marketplace determine eligibility. These findings underscore the importance of states’ marketplace decisions regarding Medicaid enrollment.

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03/28/16 – ASPE – Benefits of Medicaid Expansion for Behavioral Health

By Judith Dey, Emily Rosenoff, Kristina West, Mir M. Ali, Sean Lynch, Chandler McClellan, Ryan Mutter, Lisa Patton, Jusith Teich, and Albert Woodward

Across the country, state and local officials are increasingly focused on improving health outcomes for people living with mental illness or substance use disorders. This brief analyzes national data on behavioral health and reviews published research focused on how Medicaid expansion under the Affordable Care Act advances the goal of improving treatment for people with behavioral health needs.

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03/24/16 – Avalere – Changing the Way Insurers are Paid Could Increase Stability in the Exchange Market and Beyond

New Avalere Report Identifies Opportunities to Refine the Risk-Adjustment Model that Could Improve the Way Affordable Care Act Plans are Paid

By Tom Kornfield

A new report by Avalere identifies opportunities to improve how health plans in the Affordable Care Act (ACA) exchanges are paid. The report comes at a time when the federal government is about to hold a meeting to discuss how the ACA marketplace plans have been paid since 2014, as well as ways the payment model could be improved. In the report, Avalere describes the importance of risk adjustment in the ACA, compares the risk adjustment model used in these markets to the models used in Medicare and Medicaid, and suggests potential modifications that could improve the model.

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3/22/16 – CHCS - Medicaid Accountable Care Organization Learning Collaborative

Medicaid accountable care organizations (ACOs) are becoming increasingly prevalent in state Medicaid delivery systems. States see ACOs as an effective way to improve patient outcomes and control costs by shifting accountability for risk and quality to providers. Since 2012, the Center for Health Care Strategies’ (CHCS) Medicaid ACO Learning Collaborative (ACO LC) has assisted 15 states in developing and launching their Medicaid ACO programs through interactions with federal and state policymakers and subject matter experts, technical assistance, and discussion of common successes and challenges in developing these initiatives. To date, five state participants have instituted Medicaid ACO programs, with more expected to launch programs in the near future.

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03/22/16 – ASPE – Health Care Spending Growth and Federal Policy

By Andre Chappel, Steven Sheingold and Nguyen Nguyen

Six years after enactment of the Affordable Care Act, the pace of health care spending growth remains a topic of keen policy interest, with recent trends subject to competing interpretations. Specifically, following a recent period of historically low growth, many expected that the sizable increase in the number of insured Americans resulting from the Affordable Care Act’s coverage expansions would temporarily increase national healthcare spending growth, while others have posited that such increases are the beginning of a return to historical patterns of higher spending growth. Similarly, analysts have questioned whether sharp increases in prescription drug spending that occurred in 2014 were a unique phenomenon tied to a breakthrough cure for a prevalent illness or something more fundamental.

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3/18/16 – CHCS - Update on Medicare-Medicaid Integration

Over 10 million individuals across the United States are eligible for both Medicare and Medicaid. These people, known as Medicare-Medicaid enrollees or dually eligible beneficiaries, often have significant health and social service needs, making them among the nation’s highest-need, highest-cost populations. As of March 2016, over two million Medicare‐Medicaid beneficiaries are enrolled in programs with the potential to better integrate care, including the financial alignment demonstrations as well as alternative models to integrate care. This fact sheet describes some of these models.

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03/17/16 – The Commonwealth Fund – How Will the Affordable Care Act’s Cost-Sharing Reductions Affect Consumers’ Out-of-Pocket Costs in 2016?

By Sara R. Collins, Munira Gunja and Sophie Beutel

Health insurers selling plans in the Affordable Care Act’s marketplaces are required to reduce cost-sharing in silver plans for low- and moderate-income people earning between 100 percent and 250 percent of the federal poverty level. In 2016, as many as 7 million Americans may have plans with these cost-sharing reductions. In the largest markets in the 38 states using the federal website for marketplace enrollment, the cost-sharing reductions substantially lower projected out-of-pocket costs for people who qualify for them. However, the degree to which consumers’ out-of-pocket spending will fall varies by plan and how much health care they use. This is because insurers use deductibles, out-of-pocket limits, and copayments in different combinations to lower cost-sharing for eligible enrollees. In 2017, marketplace insurers will have the option of offering standard plans, which may help simplify consumers’ choices and lead to more equal cost-sharing.

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03/15/16 – Kaiser Family Foundation – How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs

By Matt Warfield, Barbara DiPietro and Samantha Artiga

The Affordable Care Act (ACA) Medicaid expansion to adults closed a longstanding gap in eligibility in the 32 states, including DC, that have adopted it to date, providing a new coverage option for millions of uninsured adults. In Medicaid expansion states, many people experiencing homelessness are newly eligible for coverage since this population includes many single adults who were excluded from Medicaid prior to the expansion. Coverage is particularly important for this population given that they have poor health and intensive health care and social service needs. To further understand how the first full year of Medicaid expansion has affected patients who are homeless and the providers who care for them, this analysis uses data from the Uniform Data System (UDS) for health centers1 to examine changes in insurance coverage, revenues, and costs among Health Care for the Homeless (HCH) projects serving the homeless population. 

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03/11/16 – ASPE – Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report

For the Period: November 1, 2015 – February 1, 2016

During the third open enrollment period, the Health Insurance Marketplaces (“the Marketplaces”) continued to play an important role in fulfilling one of the Affordable Care Act’s central goals: reducing the number of uninsured Americans by providing affordable, high-quality health insurance.

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03/08/16 – ASPE – Observations on Trends in Prescription Drug Spending

The rising cost of prescription medicines is putting pressure on public and family budgets in the United States. A recent nationally-representative poll of more than 1,200 adults found that the affordability of prescription drugs tops the public’s list of priorities for the President and Congress, including “making sure that high-cost drugs are affordable to those who need them” and “government action to lower prescription drug prices”. In particular, 77 percent of adults believe that “making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them” is a top priority. 

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03/08/16 – The Commonwealth Fund – Hospitals Participating in Accountable Care Organizations Tend to Be Large and Urban, Allowing Access to Capital and Data

By Carrie H. Colla, Valerie Lewis, Emily Tierney, and David B. Muhlestein

A new study comparing accountable care organizations (ACOs) that include hospitals in their networks to those that do not finds hospitals that are in urban areas, are nonprofit, or have a relatively small share of Medicare patients are more likely to participate in ACOs than other hospitals. Whether an ACO includes hospitals does not appear to affect its capacity to manage hospital-related aspects of patient care.

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03/03/16 – ASPE – Health Insurance Coverage and the Affordable Care Act, 2010-2016

By Namrata Uberoi, Kenneth Finegold, and Emily Gee

This issue brief reviews the most recent survey and administrative information available about gains in health insurance coverage since the enactment of the Affordable Care Act (ACA) in 2010. We estimate that the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million adults through early 2016 (through February 22, 2016), a 2.4 million increase since our previous estimate in September 2015. These estimated health insurance coverage gains are shared broadly across population groups. Our estimate of a net reduction of 20.0 million uninsured adults is based on data from the National Health Interview Survey and from the Gallup-Healthways Well-Being Index. Other federal and non-governmental surveys of health insurance status show similar trends over this time period.

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03/02/16 – Kaiser Family Foundation – Outreach and Enrollment Strategies for Reaching  the Medicaid Eligible but Uninsured Population

By Samantha Artiga, Robin Rudowitz, and Jennifer Tobert

As of February 2016, a total of 31 states and the District of Columbia are moving forward with the ACA Medicaid expansion to adults. While millions of individuals have gained Medicaid coverage since initial implementation of the ACA coverage provisions in 2014, an estimated 8.8 million individuals who are eligible for coverage through Medicaid or the Children’s Health Insurance Program (CHIP) remained uninsured as of 2015.1 These include adults made newly eligible by the expansion as well as children and adults who were already eligible under pre-ACA rules but not enrolled. Reaching and enrolling these individuals into coverage will be one important component of achieving continued coverage gains moving forward. Moreover, as additional states may take up the expansion in the future, outreach and enrollment efforts will be key for achieving successful enrollment as the expansion is implemented. Keeping eligible individuals enrolled over time through successful renewals of coverage also will be important for maintaining coverage gains achieved to date.

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03/02/16 – Kaiser Family Foundation – Health Plan Enrollment in the Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries

As of February, 2016, over 377,000 beneficiaries who are dually eligible for Medicare and Medicaid were enrolled and receiving services from health plans in nine states with capitated financial alignment demonstrations. These demonstrations, jointly managed by the Centers for Medicare and Medicaid Services (CMS) and the participating states, seek to maintain or decrease costs while maintaining or improving health outcomes for this vulnerable population of seniors and non-elderly people with disabilities.  This fact sheet provides a snapshot of enrollment in the demonstrations by state as of February, 2016.  Enrollment numbers will continue to change as these three year demonstrations progress. Key facts include the following:

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03/02/16 – Kaiser Family Foundation – Where Are States Today? Medicaid and CHIP Eligibility Levels for Adults, Children, and Pregnant Women

This fact sheet provides eligibility levels for parents, other non-disabled adults, children, and pregnant women in Medicaid and CHIP as of January 2016. The findings highlight Medicaid’s expanded role for low-income adults under the Affordable Care Act (ACA) and its continued role as a primary source of coverage for children and pregnant women. State-specific data is available in Tables 1 through 3.

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03/01/16 – Kaiser Family Foundation – Medicaid Expansion Waivers: What Will We Learn?

By Robin Rudowitz, MaryBeth Musumeci, and Alexandra Gates

Six of the 32 states implementing the Affordable Care Act’s (ACA) Medicaid expansion to date have done so through Section 1115 waivers. Using these waivers, the Centers for Medicare and Medicaid Services (CMS) has approved terms that extend beyond the flexibility provided by federal law. Section 1115 waivers authorize research and demonstration projects that, in the view of the Health and Human Services (HHS) Secretary, further the purposes of the Medicaid program. The ACA implemented new requirements for these waivers, including that states must have a publicly available, approved evaluation strategy. States also must submit an annual report to HHS that describes the changes occurring under the waiver and their impact on access, quality, and outcomes. Additionally, a federal contract has been awarded to evaluate different types of Section 1115 waivers, including those related to the ACA’s Medicaid expansion. This brief examines some of the major research questions and hypotheses relevant to the federal and state evaluations of Medicaid expansion Section 1115 waivers and explores key challenges that may hamper research and evaluation efforts.

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03/01/16 – Kaiser Family Foundation – Medicaid Financial Eligibility for Seniors and People with Disabilities in 2015

By Molly O’Malley Watts, Elizabeth Cornachione, and MaryBeth Musumeci

Today, the Medicaid program provides health and long-term care coverage to nearly 70 million Americans with low incomes. They include over 6 million poor seniors and more than 10 million children and adults who qualify for Medicaid based on a disability.1 Medicaid beneficiaries with disabilities include individuals with physical conditions such as multiple sclerosis, epilepsy, and blindness; HIV/AIDS; spinal cord and traumatic brain injuries; disabling mental health conditions such as depression and schizophrenia; intellectual and developmental disabilities such as Down syndrome and autism; and other functional limitations.

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2/24/16 – CHCS - State Innovation Model – Resources for States

The federal State Innovation Model (SIM) initiative is seeking to achieve statewide multi-payer care delivery and payment reforms for roughly 80 percent of the population within participating states. Multi-payer health reform efforts, such as SIM, offer the opportunity to overcome many of the limitations associated with individual payer initiatives by focusing providers’ attention on a common set of goals and generating a critical mass of patients to make it worthwhile for providers to invest in health care delivery redesign.

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02/22/16 – OIG – HealthCare.gov: Case Study of CMS Management of the Federal Marketplace

As required by the Affordable Care Act (ACA), HealthCare.gov is the Federal website that facilitates purchase of private health insurance for consumers who reside in States that did not establish health insurance marketplaces. At its launch on October 1, 2013, and for some time after, HealthCare.gov users were met with website outages and technical malfunctions. After corrective action by CMS and contractors, HealthCare.gov performance improved and facilitated health plan enrollment for millions of consumers. The problems at launch raised concerns about the effectiveness of CMS management of the Federal Marketplace. The objective of this case study was to gain insight into CMS implementation of the Federal Marketplace, focusing primarily on HealthCare.gov.

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02/22/16 – Kaiser Family Foundation – A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP

By Robin Rudowitz, Samantha Artiga, Anthony Damico, and Rachel Garfield

The Affordable Care Act (ACA) extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, as of 2014, Medicaid coverage is extended to low-income adults up to 138% of the Federal Poverty Level (FPL) in states that have opted to expand eligibility, and tax credits are available for middle-income people who purchase coverage through a health insurance Marketplace. Millions of people have enrolled in these new coverage options, but millions of others are still uninsured. Recent analysis shows that 27% or 8.8 million of the 32.3 million non-elderly uninsured are eligible for Medicaid coverage. This issue brief provides a closer look at key characteristics of the uninsured who are eligible for Medicaid and where they live. Analysis is based on state Medicaid expansion decisions as of January 2016 which includes Louisiana’s decision to adopt the expansion. These data may help inform outreach and enrollment efforts to increase coverage gains among the eligible but uninsured population.

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02/22/16 – Kaiser Family Foundation – Payment and Delivery System Reform in Medicare

A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

By Susan Baseman, Cristina Boccuti, Marilyn Moon, Shannon Griffin, and Tania Dutta

Policymakers, health care providers, and policy analysts continue to call for “delivery system reform”—changes to the way health care is provided and paid for in the United States—to address concerns about rising costs, quality of care, and inefficient spending. The Affordable Care Act (ACA) established several initiatives to identify and test new health care payment models that focus on these issues. Many of these ACA programs apply specifically to Medicare, the social insurance program that provides coverage to 55 million Americans age 65 and older and younger adults with permanent disabilities.

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2/17/16 – LeadingAge – Perspectives On The Challenges Of Financing Long-Term Services And Supports

Recent research conducted by Urban Institute and Milliman, Inc. on behalf of LeadingAge, The SCAN Foundation, and AARP shows definitively that the nation’s current methods for financing long-term services and supports (LTSS) are unstainable, irrational, and unfair for individuals and families.  

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2/17/16 – CHCS - Delineating Responsibilities across Accountable Care Organizations and Managed Care Organizations

States introducing accountable care organization (ACO) programs into an existing Medicaid managed care environment will need to assign responsibilities between ACOs and managed care organizations (MCOs). Successful delineation of responsibilities can support ACOs and MCOs in complementing one another and being better positioned to improve care delivery for Medicaid enrollees.

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02/17/16 – Long-Term Living – Fee for Value Payment Models: Preparing for Tomorrow’s Reality

By Louis Lenzmeier

The Bundled Payments for Care Improvement Program (BPCI), part of the Patient Protection and Affordable Care Act (ACA), focuses on making a significant payment change in the industry; moving from a fee-for-service model to a fee-for-value, bundled payment, where providers are paid for a care episode. In January 2015, the Department of Health and Human Services (HHS) set definitive goals and a timetable for shifting Medicare payments from fee-for-service to fee-for-value. HHS aims to have 30 percent of reimbursements run through ACOs and bundled payment initiatives by 2016, and 50 percent by 2018.

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2/10/16 – CHCS - Program Design Considerations for Medicaid Accountable Care Organizations

By Rob Houston and Tricia McGinnis

Medicaid accountable care organizations (ACOs) are becoming increasingly prevalent throughout the United States.  Eight states have successfully launched such programs with the goal of improving health outcomes and reducing health care costs.  States are looking to this model to shift more accountability to providers through strategic monitoring of quality measures tied to alternative payment models (APMs), such as shared savings arrangements.  This brief distills key lessons from the early experiences of state Medicaid ACO programs and offers considerations for additional states designing ACO approaches.  

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2/10/16 – GAO – Changes To Funding Formula Could Improve Allocation Of Funds To States

 

Medicaid, a joint federal-state health care program for low income and medically needy individuals, is a significant component of federal and state budgets, with estimated outlays of $529 billion in fiscal year 2015. States and the federal government share in the financing of the Medicaid program, with the federal government matching state expenditures for Medicaid services on the basis of the FMAP formula. The FMAP is the percentage of expenditures for most Medicaid services that the federal government pays.

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2/10/16 – GAO – Changes To Funding Formula Could Improve Allocation Of Funds To States

Medicaid, a joint federal-state health care program for low income and medically needy individuals, is a significant component of federal and state budgets, with estimated outlays of $529 billion in fiscal year 2015. States and the federal government share in the financing of the Medicaid program, with the federal government matching state expenditures for Medicaid services on the basis of the FMAP formula. The FMAP is the percentage of expenditures for most Medicaid services that the federal government pays.

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02/10/16 – Avalere – Participation in Risk-Bearing Accountable Care Organizations Triples; CMS Proposes Rule on Medicare Shared Savings Program Benchmark Methodology

By Josh Seidman

The Centers for Medicare & Medicaid Services (CMS) announced that 121 new Medicare Accountable Care Organizations (ACOs) have joined the Medicare Shared Savings Program (MSSP) and Next Generation (Next Gen) ACO models. In addition, 147 MSSP ACOs renewed their contracts. The increase in risk-bearing ACOs and the recently released proposed benchmark rule mark CMS’ commitment to shifting from volume to value.

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02/04/16 – Kaiser Family Foundation – Health Care Spending Among Low-Income Households with and without Medicaid

By Melissa Majerol, Jennifer Tolbert and Anthony Damico

Medicaid provides coverage for over 70 million low-income families and adults.  The Affordable Care Act (ACA) sought to extend Medicaid’s reach by expanding eligibility to nonelderly adults with incomes at or below 138% of the federal poverty level (FPL) ($27,310 for a family of three in 2014).  While the Medicaid expansion was intended to be national, the 2012 Supreme Court decision effectively made it optional for states, and as of January 2016, 19 states have not adopted the expansion.

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02/04/16 – The Commonwealth Fund – Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplaces

By David Cusano and Kevin Lucia

A main goal of the Affordable Care Act is to provide Americans with access to affordable coverage in the individual market, achieved in part by promoting competition among insurers on premium price and value. One primary mechanism for meeting that goal is the establishment of new individual health insurance marketplaces where consumers can shop for, compare, and purchase plans, with subsidies if they are eligible. In this issue brief, we explore how the Affordable Care Act is influencing competition in the individual marketplaces in four states—Kansas, Nevada, Rhode Island, and Washington. Strategies include: educating consumers and providing coverage information in one place to ease decision-making; promoting competition among insurers; and ensuring a level playing field for premium rate development through the rate review process.

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02/03/16 – Kaiser Family Foundation – Medicaid and Family Planning: Background and Implications of the ACA

By Usha Ranji, Yali Bair and Alina Salganicoff

Medicaid plays a primary role financing health care services and facilitating access to a broad a range of sexual and reproductive health services for millions of low-income women of childbearing age.  Today it is the single largest source of public funding for family planning services, far exceeding the funding levels of the Federal Title X family planning program.1  States have long-been required to include family planning services in their Medicaid programs, but the shifts in health care delivery and reforms brought on by the Affordable Care Act (ACA) are changing how these services are provided. While the ACA offers an opportunity to expand access to family planning services, it has challenged many family planning providers serving low-income populations to participate in changing systems of care in new ways. This brief reviews the role of Medicaid in financing and enabling access to family planning services for low-income women; discusses how states have expanded access to these services with Medicaid; and highlights future programmatic challenges in the context of the health care delivery and coverage reforms resulting from the ACA.

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02/02/16 – Kaiser Family Foundation – Women’s Health Insurance Coverage

Health insurance coverage is a critical factor in making health care affordable and accessible to women.  Among the 97.5 million women ages 19 to 64 residing in the U.S., most had some form of coverage in 2014. However, gaps in private sector and publicly-funded programs left almost one in eight women uninsured.  One of the Affordable Care Act’s (ACA’s) primary goals was to expand access to insurance coverage to reduce the number of uninsured. The law requires that nearly everyone carry health insurance, and expands access to coverage through a combination of Medicaid expansions, private insurance reforms, and premium tax credits. This factsheet reviews major sources of coverage for women residing in the U.S. in 2014, the first full year of the Affordable Care Act’s (ACA’s) major coverage expansion, and discusses the likely changes and impact of the law on women’s coverage in future years.

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02/02/16 – The Commonwealth Fund – The Affordable Care Act and the U.S. Economy – A Five-Year Perspective

By Cathy Schoen

This report provides a five-year perspective on the impact the Affordable Care Act (ACA) has had on the U.S. economy since the law’s enactment. It discusses trends in economic growth, employment, and health care costs since 2010, as well as the national experience prior to that time, and compares the recovery in the United States with that in other high-income countries.

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02/01/16 – CHCS – An Overview of Emerging State Health Care Purchasing Trends

By Tricia McGinnis and Rob Houston

This Overview of Emerging State Health Care Purchasing Trends serves as a supplement to the Medicaid Health Care Purchasing Compendium (Compendium), highlighting emerging opportunities in health care purchasing. Trends of note fall into the following categories: delivery system and payment reforms, proposed Medicaid managed care regulations, population-specific reforms, data improvements, and opportunities for federal
investment and support.
 
 

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1/28/16 – CHCS – Medicaid Health Homes: Implementation Update

Medicaid health homes, made possible through the Affordable Care Act, provide states with a mechanism to support better care management for people with complex health needs with the goal of improving health outcomes and curbing costs. As of January 2016, 19 states and the District of Columbia have 27 approved Medicaid health home models in operation. This fact sheet describes how states are using the health homes opportunity.

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1/28/16 – CHCS - Interdisciplinary Care Teams for Medicare-Medicaid Enrollees: Considerations for States

By Ann Mary Philip and Michelle Herman Soper

Interdisciplinary care teams (ICTs) are an important component of integrated care programs for Medicare-Medicaid enrollees and typically consist of the enrollee, providers, other support professionals, and family members/caregivers. These ICTs work collaboratively to develop and implement care plans to meet individuals’ medical, behavioral, long-term care, and social service needs. States developing or refining ICT requirements for integrated care programs may want to consider how prescriptive ICT requirements should be, how ICTs can better engage providers and hard-to-reach individuals, and how to measure ICT performance.

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1/28/16 – CHCS - Communicating Early Results of Integrated Care Efforts for Dually Eligible Individuals: State Approaches

By Alexandra Kruse and Anna Spencer

Many states are working in partnership with providers, health plans, and other stakeholders to transform care delivery for individuals dually eligible for Medicare and Medicaid. While there has been considerable growth in the number of individuals enrolled in integrated care models, sustaining support for integrated care and expanding its availability are continued priorities for state and federal policymakers. Demonstrating early achievements and positive beneficiary/provider experiences in new integrated care programs is essential to both maintain support from legislators, providers, and advocacy groups and increase beneficiary enrollment.

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01/28/16 – Kaiser Family Foundation – Marketplace Health Plan Options for People with HIV Under the ACA: An Approach to More Comprehensive Cost Assessment

By Lindsey Dawson and Jennifer Kates

The Affordable Care Act (ACA) has expanded access to health coverage for millions of individuals, including people with HIV.  One key expansion is the availability of new private insurance coverage through health insurance marketplaces in every state. As individuals shop for private insurance coverage in the marketplace, multiple factors go into selecting a health plan. While these factors include clinical considerations, the cost of coverage, particularly that relating to premiums, is driving much of consumer decision-making. For people with HIV, cost considerations take on added importance given their reliance on expensive antiretroviral prescription medications and the fact that cost may present a barrier to maintaining health coverage, which could adversely affect their health. Assessing premiums alone, however, may not provide an accurate measure of plan affordability and enrollees may find that they face unexpected or higher costs if premiums are used to guide plan selection in isolation. A more comprehensive assessment of the cost of coverage includes factors beyond just premiums, such as deductibles, drug costs, and out-of-pocket (OOP) maximums. Considering broader health plan costs is not only important for individuals with HIV but also for third party payers, such as the Ryan White HIV/AIDS Program, the nation’s safety net program for HIV care and treatment, which in many cases assists lower income clients with costs related to insurance coverage.

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01/26/16 – AARP Public Policy Institute – Insight on the Issues – Monitoring the Impact of Health Reform on Americans Ages 50-64:

Access to Health Care Improved during Early ACA Marketplace Implementation

By Laura Skopec, Timothy A. Waidmann, Jane Sung, and Olivia Dean
 
New data from the Urban Institute and the AARP Public Policy Institute show improvements in key measures of access to health care for 50- to 64-year-olds over the first two open enrollment periods of the Affordable Care Act (ACA). Between December 2013 and March 2015, the share of 50- to 64-year-olds with a usual source of health care other than emergency rooms increased. Concurrently, the share who reported having a problem accessing
health care decreased.
 

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1/26/16 – McKnight’s - Dual Eligible Pilots Proving Pricey, Time-Consuming for States

By Emily Mongan

Many states are finding the “nuts and bolts” of coordinating care for dual eligible beneficiaries to be more costly and time consuming than they anticipated, according to a new report. The report, completed for the Centers for Medicare & Medicaid Services by research firm RTI International, analyzed dual-eligible demonstration pilots in California, Illinois, Massachusetts, Minnesota, Ohio, Virginia and Washington. The analysis was completed in October, and released online last week.

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Click here to view the full report


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01/22/16 – Kaiser Family Foundation – New Estimates of Eligibility for ACA Coverage Among the Uninsured

By Rachel Garfield, Anthony Damico, Cynthia Cox, Gary Claxton, and Larry Levitt

The Affordable Care Act (ACA) extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, as of 2014, Medicaid coverage is extended to low-income adults in states that have opted to expand eligibility, and tax credits are available for middle-income people who purchase coverage through a health insurance Marketplace. Millions of people have enrolled in these new coverage options, but millions of others are still uninsured. Some remain ineligible for coverage, and others may be unaware of the availability of new coverage options or still find coverage unaffordable even with financial assistance.

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Click here to view the data note

Click here to view technical appendix A

Click here to view technical appendix B

Click here to view technical appendix C


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01/22/16 – MedPAC – January 2016 MedPAC and MACPAC Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid

This data book is a joint project of the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC). The data book presents information on the demographic and other personal characteristics, expenditures, and health care utilization of individuals who are dually eligible for Medicare and Medicaid coverage. Dual-eligible beneficiaries receive both Medicare and Medicaid benefits by virtue of their age or disability and low incomes. This population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy.

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01/21/16 – Kaiser Family Foundation – Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey

By Tricia Brooks, Sean Miskell, Samantha Artiga, Elizabeth Cornachione, and Alexandra Gates

January 2016 marks the end of the second full year of implementation of the Affordable Care Act’s (ACA) key coverage provisions. This 14th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies provides a point-in-time snapshot of policies as of January 2016 and identifies changes in policies that occurred during 2015. Coverage is driven by two key elements—eligibility levels determine who may qualify for coverage, and enrollment and renewal processes influence the extent to which eligible individuals are enrolled and remain enrolled over time. This report provides a detailed overview of current state policies in these areas, which have undergone significant change as a result of the ACA.

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Click here to view the news release


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01/21/16 – ASPE – Health Insurance Marketplace 2016: Average Premiums after Advance Premium Tax Credits in the 38 States Using the Healthcare.gov Eligibility and Enrollment Platform

For the Period: November 1 – December 26, 2015

From November 1 through December 26, 2015, more than 8.5 million consumers selected or were automatically enrolled in a 2016 plan through the Health Insurance Marketplaces (“the Marketplaces”) in the 38 states using the HealthCare.gov eligibility and enrollment platform. Eighty-three percent (approximately 7.1 million) of these consumers are receiving financial assistance to pay their premiums through the Marketplaces. 

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01/20/16 – Kaiser Family Foundation – Health Coverage and Care for Immigrants

By Samantha Artiga, Anthony Damico, Katherine Young, Elizabeth Cornachione, and Rachel Garfield

Immigrants, particularly those who are not citizens, historically have faced disproportionate barriers to accessing health coverage and care. The ACA offers new options to increase coverage for naturalized citizens and lawfully present immigrants, but undocumented immigrants remain ineligible for assistance. This brief provides an overview of the noncitizen immigrant population and their health coverage and access to care.

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01/20/16 – Kaiser Family Foundation – Coverage for Abortion Services in Medicaid, Marketplace Plans and Private Plans

By Alina Salganicoff, Laurie Sobel, Nisha Kurani, and Ivette Gomez

State and federal efforts to address insurance and Medicaid coverage of abortion services began soon after the 1973 Supreme Court’s Roe v Wade decision legalizing abortion and have continued to the present day. Starting in 1977, the Hyde Amendment banned the use of any federal funds for abortion, allowing only exceptions for pregnancies that endanger the life of the woman, or that result from rape or incest. The issue of abortion coverage was at the heart of many debates in the run up to the passage of the ACA and subsequently led to renewed legislative efforts at the state level to limit coverage of abortions, this time in private insurance plans. For women in the US, the extent of their abortion coverage is largely dependent on the state in which they reside, as state policies can place restrictions on both Medicaid and private insurance.

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Click here to view the news release


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1/19/16 – GAO - Medicare And Medicaid: Additional Oversight Needed of CMS's Demonstration to Coordinate the Care of Dual-Eligible Beneficiaries

Due to the flexibility that states have in designing their Financial Alignment Demonstrations, the integrated care organizations that GAO interviewed in California, Illinois, Massachusetts, Virginia, and Washington implemented care coordination for dual-eligible Medicare and Medicaid beneficiaries in a variety of ways. For example, these organizations assigned care coordinators to beneficiaries using different approaches, such as assigning them by geographic proximity to the beneficiary or to the beneficiary's primary care provider. Care coordinators also used a range of interactions with beneficiaries in order to coordinate care, including by mail, e-mail, telephone, or in person.

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Click here to view the full report


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01/14/16 – Avalere – Proposed Exchange Standardized Benefit Designs Expand First-Dollar Coverage for Services and Drugs

By Caroline F. Pearson and Elizabeth Carpenter

As the government considers rules for 2017 insurance plans offered through exchanges, a new analysis by Avalere finds that proposed 2017 benefit designs could increase coverage of certain services and drugs, while lowering out-of-pocket costs for many consumers.

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Click here to view the proposed rule


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01/11/16 – Kaiser Family Foundation – Medicaid Expansion Spending and Enrollment in Context: An Early Look at CMS Claims Data for 2014

By Laura Snyder, Katherine Young, Robin Rudowitz, and Rachel Garfield

There have been long-standing questions about the effect the Medicaid expansion would have on spending and enrollment. Preliminary data from the Medicaid Budget and Expenditure System (MBES) released by the Centers for Medicare and Medicaid Services (CMS) may provide some early insights into these questions. CMS released preliminary spending and enrollment data from the MBES that covers the period from January 2014 through December 2014. This period is of particular interest because these are the first quarters that the Medicaid expansion was in effect. During this period, 27 states including DC, had implemented the Medicaid expansion; all but two of these states – Michigan (April 1, 2014) and New Hampshire (August 15, 2014) – implemented the Medicaid expansion January 1, 2014.

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01/08/16 – Kaiser Family Foundation – Medicaid Expansion in Michigan

Michigan obtained approval from the Centers for Medicare and Medicaid Services (CMS) to implement the Affordable Care Act’s (ACA) Medicaid expansion through a Section 1115 demonstration waiver, called the “Healthy Michigan Plan.” The waiver initially was approved on December 30, 2013, and was implemented beginning April 1, 2014. On December 17, 2015, CMS approved Michigan’s waiver amendment, with new authorities to take effect in April 2018, after the expansion has been in effect for 48 months.

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01/07/16 – ASPE – Health Insurance Marketplaces 2016 Open Enrollment Period: January Report

For the period: November 1 – December 26, 2015

During the third open enrollment period, the individual market Health Insurance Marketplaces (“the Marketplaces”) continue to play an important role in fulfilling one of the Affordable Care Act’s core goals: reducing the number of uninsured Americans by providing affordable, high quality health insurance.

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01/05/16 – CHCS - Developing Capitation Rates for Medicaid Managed Long-Term Services and Supports Programs: State Considerations

By Debra Lipson, Maria Dominiak and Michelle Herman

Many states are creating or expanding Medicaid managed long-term services and supports (MLTSS) programs or Medicare-Medicaid integrated care programs in an effort to control costs and improve care quality for people who use long-term care. To accomplish these goals, MLTSS and other integrated care programs need to set capitation rates that address the diverse needs of the population served and establish incentives to promote higher quality services and more cost-effective care.

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01/05/16 – CHCS - Accountable Care Organizations: Looking Back and Moving Forward

By Rob Houston and Tricia McGinnis

Accountable care organizations (ACOs) have become increasingly prevalent in the United States. These organizations shift more accountability for health outcomes to providers and many have shown positive results for improving care and reducing costs – for Medicare, Medicaid, and commercial populations.   This brief, made possible by the Robert Wood Johnson Foundation, identifies key lessons from ACO activities across the country to date. It examines how ACOs can build upon these initial successes and informs policymakers, researchers, and foundations about key considerations to further the development of effective ACO approaches across the health care market.

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01/05/16 – The Commonwealth Fund – Both the ‘Private Option’ and Traditional Medicaid Expansions Improved Access to Care for Low-Income Adults

By Benjamin D. Sommer, Robert J. Blendon, and E. John Orav

Low-income adults in Kentucky and Arkansas, which both expanded Medicaid eligibility under the Affordable Care Act, were more likely to be insured and likely to have problems paying medical bills or affording prescriptions than low-income adults in Texas, which did not expand coverage. The Affordable Care Act (ACA) gives states the option to expand Medicaid eligibility to all adults with incomes under 138 percent of the federal poverty level (about $16,000 for an individual or $33,000 for a family of four). So far, 30 states and the District of Columbia have chosen to do so. Most have taken a traditional approach to expanding Medicaid, but several have elected the “private option”—using Medicaid funds to purchase private insurance through the federal and state marketplaces. 

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01/05/16 – Kaiser Health News – Feds Funding Effort to Tie Medical Services to Social Needs

By Julie Rovner

The federal government has announced a $157 million project to help hospitals and doctors link Medicare and Medicaid patients to needed social services that sometimes have a bigger impact on their health than medical interventions.

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12/21/15 – Kaiser Family Foundation – States with Section 1115 ACA Expansion Waivers, December 2015

This slide shows the current status of state decisions to use Section 1115 waivers to expand Medicaid. A total of 31 states including DC have adopted the ACA Medicaid expansion, including 6 states with ACA 1115 ACA expansion waivers. AZ has a pending waiver application that seeks changes to its expansion. MT and NH’s waivers will take effect on 1/1/16. PA originally expanded through a waiver but subsequently transitioned to a state plan amendment. TN and UT have debated waiver proposals which have not been approved by their state legislatures or submitted to CMS.

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12/18/15 – The Commonwealth Fund - Rethinking the Affordable Care Act’s “Cadillac Tax”: A More Equitable Way to Encourage “Chevy” Consumption

By Sarah Nowak and Christine Eibner

The Affordable Care Act’s “Cadillac tax” will apply a 40 percent excise tax on total employer health insurance premiums in excess of $10,200 for single coverage and $27,500 for family coverage, starting in 2018. Employer spending on premiums is currently excluded from income and payroll taxes. Economists argue that this encourages overconsumption of health care, favors high-income workers, and reduces federal revenue. This issue brief suggests that the Cadillac tax is a “blunt instrument” for addressing these concerns because it will affect workers on a rolling timetable, does relatively little to address the regressive nature of the current exclusion, and may penalize firms and workers for cost variation that is outside their control. Replacing the current exclusion with tax credits for employer coverage that scale inversely with income might allow for regional adjustments in health care costs and eliminate aspects of the tax exclusion that favor high-income over low-income workers.

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Click here to view the technical appendix

Click here to view the chartpack


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12/17/2015 – CHCS – Snapshot of Integrated Care Models to Serve Dually Eligible Beneficiaries

By Nancy Archibald and Alexandra Kruse

State interest in models to better integrate care for individuals dually eligible for Medicare and Medicaid continues to grow. Integrating care across service settings and funding streams can potentially improve coordination of care, increase alignment of program benefits and administration, improve beneficiary experience of care, and reduce overall costs. States are using a variety of approaches to align incentives and reduce fragmentation of care delivery across the Medicare and Medicaid programs.

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12/17/15  – Kaiser Family Foundation – Kaiser Health Tracking Poll: December 2015

By Bianca DiJulio, Jamie Firth and Mollyann Brodie

The ACA’s third open enrollment will come to a close at the end of January and the December Kaiser Health Tracking Poll finds that, at this point, only 7 percent of the uninsured correctly identify this as the deadline to enroll in coverage and 20 percent say they have been contacted by someone about signing up for coverage. When asked why they have not personally obtained health insurance this year, nearly half of the uninsured (46 percent) say they have tried to get coverage but that it was too expensive. However, slightly over half of the uninsured (55 percent) say they plan to get health insurance in the next few months.

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Click here to view the topline & methodology


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12/16/15 – ICRC – Medicare Chronic Care Management Services Payment: Implications for States Serving Dually Eligible Individuals

By Julie Stone

Medicare’s new payment to physicians and other practitioners for chronic care management provides states with an opportunity to enhance and better coordinate services for Medicare-Medicaid enrollees. This new brief from the Integrated Care Resource Center (ICRC) identifies opportunities for states and their contracting plans that serve Medicare-Medicaid enrollees to align Medicare and Medicaid coverage of care management. Such alignment could facilitate a more seamless and coordinated approach to providing the medical, behavioral, and social supports covered under both programs.

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12/15/15 – Kaiser Family Foundation – Medicaid and Long-Term Services and Supports: A Primer

By Erica L. Reaves and MaryBeth Musumeci

Medicaid is the nation’s major publicly-financed health insurance program, covering the acute and long-term services and supports (LTSS) needs of millions of low-income Americans of all ages. With limited coverage under Medicare and few affordable options in the private insurance market, Medicaid will continue to be the primary payer for a range of institutional and community-based LTSS for people needing assistance with daily self-care tasks. Advances in assistive and medical technology that allow people with disabilities to be more independent and to live longer, together with the aging of the baby boomers, will likely result in increased need for LTSS over the coming decades. To reduce unmet need and curb public health care spending growth, state and federal policymakers will be challenged to find more efficient ways to provide high quality, person-centered LTSS across service settings. This primer describes LTSS delivery and financing in the U.S., highlighting covered services and supports, types of care providers and care settings, beneficiary subpopulations, costs and financing models, quality improvement efforts, and recent LTSS reform initiatives.

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12/11/15 – National Health Policy Forum – Accountable Care Organizations in Medicaid: Learning from Leading-Edge States

Accountable care organizations (ACOs) are becoming more common in Medicaid and offer states the potential to improve the health of low-income populations while lowering health care costs. The details of these efforts vary, but common among them are changes to health care payment and delivery methods that make health care providers more accountable for the care they deliver. This Forum session featured the payment, quality measurement, and data features of Medicaid ACOs in leading-edge states, and it considered how ACOs facilitate collaboration between health care providers, public health, and social services to coordinate care and improve the health of the populations they serve.

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12/10/15 – NAHC – Urban Institute Study Advances Analysis of Federal Long-Term Care Program Models

The Urban Institute recently released a study analyzing several different models for financing long-term services and supports (LTSS) in order to meet the country’s growing need for long-term care services. The Urban Institute estimates that between 2015 and 2055, the number of older Americans with “severe LTSS needs will increase 140 percent” to a total of 15.1 million. Private insurance is not a realistic option for all income levels due to high premiums. Federal programs are also inadequate; Medicare does not cover LTSS, and while federal Medicaid provides funding to states, state eligibility requirements limit the program to individuals with disabilities and those with little financial resources.

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12/10/15 – The Commonwealth Fund – Why are Many CO-Ops Failing? How New Nonprofit Health Plans Have Responded to Market Competition

By Sabrina Corlette, Sean Miskell and Justin Giovannelli

In addition to instituting sweeping reforms designed to improve consumers’ access to affordable, comprehensive health insurance, the Affordable Care Act (ACA) created the Consumer Operated and Oriented Plan (CO-OP) Program to give consumers the option to choose a nonprofit insurer with a strong consumer focus. Of 23 CO-OPs launched, all but two have fallen short of their enrollment or profitability projections. Twelve plans have or are about to shut down, and two more have capped enrollment for 2016. The experiences of these fledgling companies reveal the many factors that limit market competition. We examined plan, pricing, and enrollment data for six CO-OPs located in Iowa and Nebraska (IA/NE), Kentucky, Maine, Maryland, Montana, and Tennessee. We supplemented this review with structured interviews of senior CO-OP executives and other experts to gain insights on the market assumptions and strategies of these new companies.

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12/9/15 – Kaiser Health News – State Obamacare Exchanges ‘Sustainable’ Without Federal Aid, Official Tells Congress

By Phil Galewitz

State insurance exchanges are healthy financially even without the federal funding that ran out this year, a top Obama administration official told a House subcommittee Tuesday.

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12/9/15 – Kaiser Family Foundation – Average Individual Mandate Penalty to Rise 47 Percent to $969 in 2016 for Uninsured People Eligible for ACA Plans

3.5 Million Could Have a Zero-Dollar Premium Contribution or Pay Less for Health Insurance than Penalty Due to Premium Subsidies; 7.1 Million Would Pay More to Get Coverage

A new analysis from the Kaiser Family Foundation finds that among uninsured people who are eligible for an Affordable Care Act marketplace plan, the average penalty for remaining without coverage in 2016 would be $969 per household – 47 percent higher than the 2015 estimated average of $661.

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Click here to view the analysis

Click here to view the issue brief


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12/9/15 – The Commonwealth Fund – Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition

By Douglas McCarthy, Davis Radley and Susan L. Hayes

The fourth Commonwealth Fund Scorecard on State Health System Performance tells a story that is both familiar and new. Echoing the past three State Scorecards, the 2015 edition finds extensive variation among states in people’s ability to access care when they need it, the quality of care they receive, and their likelihood of living a long and healthy life. However, this Scorecard—the first to measure the effects of the Affordable Care Act’s 2014 coverage expansions—also finds broad-based improvements. On most of the 42 indicators, more states improved than worsened.

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Click here for the full report

Click here to view the appendices

Click here to view the press release


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12/7/15 – Kaiser Family Foundation – Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS

By MaryBeth Musumeci

Using authority in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) has launched demonstrations that seek to improve care and control costs for people who are dually eligible for Medicare and Medicaid. Nearly 379,000 beneficiaries in nine states are enrolled in capitated models in these demonstrations as of November, 2015. Implemented beginning in July 2013, the demonstrations are changing the care delivery systems through which beneficiaries receive medical and long-term care services and the financing arrangements among CMS, the states, and providers. The demonstrations initially were approved for three years, but in July, 2015, CMS announced that states may extend their demonstrations for an additional two years. (New York’s demonstration for people with developmental disabilities (DD) is approved for four years.)

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12/3/15 – MDHHS – Michigan Announces the MI Health Link Ombudsman Program

The Michigan Department of Health and Human Services today announced that MI Health Link beneficiaries now have an additional resource for information and support through the MI Health Link Ombudsman Program which was officially operational December 1. As a requirement of Centers for Medicare and Medicaid Services (CMS), MDHHS must provide an ombudsman program for the project.
 
 

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12/2/15 – Kaiser Family Foundation – Health Center Patient Trends, Enrollment Activities, and Service Capacity: Recent Experiences in Medicaid Expansion and Non-Expansion States

By Peter Shin, Jessica Sharac, Julia Zur, Sara Rosenbaum, and Julie Paradise

In thousands of medically underserved communities across the U.S., community health centers enroll low-income people in health coverage and provide care to millions of patients. Against the backdrop of significant health center expansion over several years and a full year of expanded health coverage under the Affordable Care Act (ACA), this brief examines change between 2013 and 2014 in the volume and health coverage profile of health center patients, and health center enrollment activities and service capacity, comparing states that implemented the ACA Medicaid expansion in 2014 and states that did not expand Medicaid in 2014. The study is based on 2014 data from the federal Uniform Data System and a 2014 national survey of health centers.

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12/1/15 – Kaiser Family Foundation – One in 10 Larger Nonprofits Have Sought an ‘Accommodation’ to the ACA Contraceptive Coverage Rule, Analysis Finds

As the U.S. Supreme Court gears up to hear a new round of legal challenges to the ACA’s contraceptive coverage requirement, finds 10 percent of nonprofits with more than 1,000 employees have requested an “accommodation” to the health law’s birth control requirement.

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Click here to view the data note


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12/1/15 – Kaiser Family Foundation – Medicaid Premium Assistance Programs: What Information is Available About Benefit and Cost-Sharing Wrap-Around Coverage?

By Joan Alker, Sean Miskell, MaryBeth Musumeci, and Robin Rudowitz

States have long used Medicaid funds as premium assistance to purchase private health insurance for beneficiaries as an alternative to providing coverage directly through the state Medicaid program. States using premium assistance generally must provide wrap-around benefits and cost-sharing protections so that Medicaid beneficiaries receiving private coverage will not have access to fewer benefits or pay higher out-of-pocket costs when private coverage fails to meet Medicaid’s level of coverage or is more expensive. Some states seeking alternative ways to implement the Affordable Care Act’s (ACA) Medicaid expansion have been interested in expanding Medicaid premium assistance programs and adopting new models to purchase individual market coverage. These initiatives can be informed by an understanding of how pre-ACA premium assistance programs are working, particularly regarding wrap-around benefits and cost-sharing protections.
 

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11/25/15 – Women’s Health Issues Journal – Women, Private Health Insurance, and the Affordable Care Act

By Alina Salganicoff and Laurie Sobel

In the run up to the passage of the Affordable Care Act (ACA), many of the law’s proponents were actively engaged in advocacy that promoted the law’s benefits for women. In particular, there was much attention to the numerous provisions that addressed the long-standing inequities and discriminatory practices adopted by many private insurance plans that disproportionately disadvantaged women. These included charging women higher rates than men, while also excluding benefits important to women, such as maternity care and contraception. As we approach the end of the ACA’s third open enrollment period, it is a good time to step back and reflect what we are learning about how the private insurance reforms and expansions have affected access to coverage for women and to identify where gaps remain.

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11/20/15 – The Commonwealth Fund – How High is America’s Health Care Cost Burden? Findings from the Commonwealth Fund Health Care Affordability Tracking Survey, July – August 2015

By Sara R. Collins, Munira Gunja, Michelle M. Doty, and Sophie Beutel

One-quarter of privately insured working-age adults have high health care cost burdens relative to their incomes in 2015, according to the Commonwealth Fund Health Care Affordability Index, a comprehensive measure of consumer health care costs. This figure, which is based on a nationally representative sample of people with private insurance who are mainly covered by employer plans, is statistically unchanged from 2014. When looking specifically at adults with low incomes, more than half have high cost burdens. In addition, when privately insured adults were asked how they rated their affordability, greater shares reported their premiums and deductible costs were difficult or impossible to afford than the Index would suggest. Health plan deductibles and copayments had negative effects on many people’s willingness to get needed health care or fill prescriptions. In addition, many consumers are confused about which services are free to them and which count toward their deductible.

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Click here to view the survey questionnaire

Click here to view the press release


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11/20/15 – The Commonwealth Fund – Evaluating the Impact of Health Insurance Industry Consolidation: Learning from Experience

By Leemore S. Dafny

Research shows consolidation in the private health insurance industry leads to premium increases, even though insurers with larger local market shares generally obtain lower prices from health care providers. Additional research is needed to understand how to protect against harms and unlock benefits from scale. Data on enrollment, premiums, and costs of commercial health insurance—by insurer, plan, customer segment, and local market—would help us understand whether, when, and for whom consolidation is harmful or beneficial. Such transparency is common where there is a strong public interest and substantial public regulation, both of which characterize this vital sector.

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11/17/15 – Kaiser Family Foundation – Visualizing Health Policy: Experiences and Attitudes of Primary Care Practitioners After the ACA

Based on a survey of primary care clinicians in early 2015, this Visualizing Health Policy infographic examines the experiences and attitudes of primary care practitioners (PCPs) after the Affordable Care Act’s (ACA’s) major coverage provisions took effect in January 2014. Although most report no change in their ability to provide quality care, their opinions about the health care law are sharply divided along political party lines. Generally, primary care physicians have a more negative view of health reform’s effect on the cost of patient care, but a more positive view of the law’s impact on patient access to health care and insurance. About 6 of 10 primary care clinicians say they’re seeing more newly insured patients or patients covered by Medicaid since the ACA’s major coverage provisions took effect in January 2014. Large shares—66% of nurse practitioners and physician assistants and 50% of physicians—report that they’re currently accepting new Medicaid patients.

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11/13/15 – Kaiser Family Foundation – The Uninsured: A Primer

Key Facts about Health Insurance and the Uninsured in the Era of Health Reform

By Melissa Majerol, Vann Newkirk, and Rachel Garfield

Millions of people in the United States go without health insurance each year. Because nearly all of the elderly are insured by Medicare, most uninsured Americans are nonelderly (under age 65). A majority of the nonelderly receive their health insurance as a job benefit, but not everyone has access to or can afford this type of coverage. The Affordable Care Act (ACA), which was passed in 2010, aimed to expand coverage by providing for an expansion of Medicaid for adults with incomes at or below 138% of poverty, building on employer-based coverage, and providing premium tax credits to make private insurance more affordable for many with incomes between 100-400% of poverty.1 Most of the major coverage provisions of the ACA went into effect in 2014, and millions of people have gained coverage under the law. However, many continue to lack coverage for a variety of reasons. For example, Medicaid eligibility for adults remains limited in states that have not adopted the expansion, some people remain ineligible for financial assistance for private coverage, and some still find coverage unaffordable even with financial assistance.

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Click here to view supplemental tables


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11/13/15 – Kaiser Family Foundation – Patient Cost-Sharing Subsidies in Marketplace Plans, 2016

By Mathew Rae, Larry Levitt, Gary Claxton, Cynthia Cox, Michelle Long, and Anthony Damico

Private insurance plans typically require some form of cost sharing (also called out-of-pocket costs) when enrollees receive a health care service covered by their plan.  These expenses, which are in addition to the amount an enrollee spends on his or her monthly premium, come in a variety of forms:

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Click here to view slides


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11/13/15 – Kaiser Family Foundation – Cost-Sharing Subsidies in Federal Marketplace Plans, 2016

By Mathew Rae, Gary Claxton, Cynthia Cox, Michelle Long, and Anthony Damico

Most health plans require enrollees to pay a portion of the cost of care when they seek services, in addition to any premium that they must pay for the plan.  Plans generally have several forms of cost sharing, including deductibles, which must be paid by patients before the plan begins paying toward some or most services, and copayments or coinsurance, which must be paid by patients at the time they receive services.  A recently-published KFF brief describes the major cost sharing provisions of the bronze, silver, gold and platinum health plans available through the federal Marketplace.

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Click here to view slides


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11/13/15 – AHIP – 2015 Census of Health Savings Account – High Deductible Health Plans – November 2015

Health savings account (HSA) plans give consumers incentives to manage their own health care costs by coupling a tax-favored savings account used to pay medical expenses with a high-deductible health plan (HDHP) that meets certain requirements for deductibles and out-of-pocket expense limits. The funds in the HSA are owned by the individual and may be rolled over from year to year.

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11/13/15 – ASPE – ASPE Research Brief – November 2015

Community Action Agency Activities in Affordable Care Act Outreach and Enrollment: Insights from Case Studies

By Alana Landey and Alexander Coccia

The Patient Protection and Affordable Care Act of 2010 (ACA) put into place comprehensive health insurance reforms that are expanding health insurance coverage to millions of Americans. Through state-run or Federally-facilitated health insurance Marketplaces, consumers can compare health plans and sign up for health insurance. Middle- and low-income families can qualify for tax credits that cover a significant portion of the cost of coverage. The expanded eligibility for Medicaid in many states extends coverage to many previously uninsured Americans. The success of these reforms, however, depends on effectively identifying the uninsured, informing them of coverage options, and helping them
navigate the often complex choices involved.
 

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11/12/15 – CNBC – Obamacare Act lll: HealthCare.gov Sign-Ups Top 500K

By Dan Mangan

Only 9.5 million people to go to hit the goal.

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11/11/15 – New Census Survey Shows Continued Growth in HSA Enrollment 

Nearly 19.7 million Americans are covered by Health Savings Account (HSA)-eligible insurance plans, an increase of approximately 2 million enrollees since January 2014, according to a new census released today by America's Health Insurance Plans (AHIP).
 
 
 

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11/9/15 – Kaiser Health News – Consumer Confusion Continues in Obamacare’s Third Year

By Fred Mogul

Recording and mixing music is Vernon Thomas’ passion, but being CEO and producer of Mantree Records is not his day job. He’s an HIV outreach worker for a local county health department outside Newark, N.J. He took what was to be a full-time job in May because the gig came with health insurance – and he himself has HIV, the virus that causes AIDS.

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11/9/15 – Kaiser Family Foundation – State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligibles

This map shows the current status of the state demonstration proposals to integrate care and align financing and/or administration for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program and consequently account for a disproportionate share of spending in both programs.

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11/6/15 – Kaiser Health News - Marketplace Plans Covering Out-Of-Network Care Harder To Find

By Michelle Andrews

Health plans that offer coverage of doctors and hospitals outside the plan’s network are getting harder to find on the insurance marketplaces, according to two analyses published this week.

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Click here to view the Robert Wood Johnson Foundation analysis

Click here to view the Avalere Health analysis


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11/4/15 – Kaiser Family Foundation - State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries

This map shows the current status of the state demonstration proposals to integrate care and align financing and/or administration for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program and consequently account for a disproportionate share of spending in both programs.

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11/3/15 – Kaiser Family Foundation - Analysis of Insurer Participation in 2016 Marketplaces

By Cynthia Cox, Gary Claxton, and Larry Levitt

As Marketplace enrollees begin to shop for coverage starting in 2016, the number of insurance choices available to them is changing in some parts of the country.  In early 2015, an average of 6.1 insurer groups offered coverage in each state, up from an average of 5.0 in 2014.  Since then, some insurers have announced their exit or been required to withdraw from the Marketplaces, most notably a number of nonprofit Consumer Operated and Oriented Plans (CO-OPs) and some larger insurers like Blue Cross Blue Shield of New Mexico.  Despite these withdrawals, the Department of Health and Human Services (HHS) recently announced that the average number of issuers per state is increasing slightly in 2016 and that about 9 out of 10 returning Healthcare.gov customers will have 3 or more insurers from which to choose in 2016.

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11/3/15 – GAO – Medicaid: Improving Transparency and Accountability of Supplemental Payments and State Financing Methods

GAO has found that complete and reliable data are lacking on the tens of billions in Medicaid supplemental payments states often make, hindering transparency and oversight. In a November 2012 report, GAO found that Congress and the Centers for Medicare & Medicaid Services (CMS) have acted to improve transparency and accountability for one type of Medicaid supplemental payment known as disproportionate share hospital (DSH) payments, made for uncompensated care costs experienced by hospitals serving low-income and Medicaid patients. Since 2010, DSH payments are required to be reported to CMS and are subject to independent audits that assess their appropriateness. States also make other supplemental payments—referred to here as non-DSH payments—to hospitals and other providers that, for example, serve high-cost Medicaid beneficiaries. Gaps in oversight remained for non-DSH supplemental payments, which as of 2011 exceeded DSH in amounts paid. For example, GAO reported that 39 states made non-DSH supplemental payments to 505 hospitals that, along with regular Medicaid payments, exceeded those hospitals' total costs of providing Medicaid care by about $2.7 billion. Medicaid payments are not limited to a provider's costs for services, but GAO concluded in an April 2015 report that payments that greatly exceed costs raise questions about whether they are economical and efficient as required by law, and the extent to which they are ultimately used for Medicaid services. CMS lacks data on supplemental payments made to individual providers. Per federal internal control standards, agencies should have reliable information for decision making and reporting, and reasonable assurance that agency objectives, such as compliance with laws, are being met. In 2012, CMS officials said legislation was needed to implement non-DSH reporting and auditing requirements, and GAO suggested that Congress consider requiring CMS to provide guidance on permissible methods for calculating non-DSH payments and require state reports and audits. 

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Click here to view highlights


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10/29/15 – The New York Times – Obama Administration Campaign Will Publicize Health Care Subsidies

By Robert Pear

The Obama administration on Thursday said that it would wage a national advertising campaign to counter a perception among people with low incomes that health insurance under the Affordable Care Act was not affordable.

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10/28/15 – Modern Healthcare - Medicare ACOs Get Final Waivers For Stark, Kickback Laws

By Lisa Schencker

More than three years after the launch of the Medicare shared-savings program for accountable care organizations, HHS finalized waivers that help participants avoid tripping the fraud and abuse laws that police financial relationships among physicians and hospitals. The new rule makes some tweaks but doesn't significantly change waivers to the anti-kickback statute, the physician self-referral statute known as the Stark law and the civil monetary penalties law, which many in the industry viewed as potential barriers to the payment and delivery model. The CMS and HHS' Office of Inspector General created the waivers with an interim final rule in 2011.

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10/28/15 – Kaiser Family Foundation – Estimates of Eligibility for ACA Coverage Among the Uninsured by Race and Ethnicity

By Samantha Artiga, Anthony Damico and Rachel Garfield

The Affordable Care Act (ACA) extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, as of 2014, Medicaid coverage is extended to low-income adults in states that have opted to expand eligibility, and tax credits are available for middle-income people who purchase coverage through a health insurance Marketplace. Millions of people have enrolled in these new coverage options, but millions of others are still uninsured. Some remain ineligible for coverage, and others may be unaware of the availability of new coverage options or still find coverage unaffordable even with financial assistance. 

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10/26/15 – Kaiser Family Foundation – Analysis of 2016 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

By Cynthia Cox, Selena Gonzales, Rabah Kamal, Gary Claxton, and Larry Levitt

The table below presents an update to our previous analysis of 2016 changes in premiums for the second-lowest cost (“benchmark”) silver marketplace plans in major cities in the 48 states and the District of Columbia, where we were able to find complete data on rates.

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10/26/15 – Kaiser Family Foundation – The Impact of the Coverage Gap for Adults in States not Expanding Medicaid by Race and Ethnicity

By Samantha Artiga, Anthony Damico and Rachel Garfield

People of color face longstanding and persistent disparities in accessing health coverage that contribute to greater barriers to care and poorer health outcomes. The Affordable Care Act (ACA) Medicaid expansion to adults with incomes at or below 138% of the federal poverty level (FPL) ($27,724 for a family of three in 2015) makes many uninsured adults of color newly eligible for the program, which could increase their access to care and promote greater health equity. However, in states that do not implement the Medicaid expansion, many poor adults fall into a coverage gap and will likely remain uninsured. This brief examines the impact of this coverage gap by race and ethnicity. It is based on analysis of Current Population Survey data and Medicaid eligibility rules for adults effective January 2015. (See Methods box for more information.) It finds that uninsured Black adults are more than twice as likely as White and Hispanic uninsured adults to fall into the coverage gap since a large share of this population resides in the South where many states have not adopted the Medicaid expansion. As such, the coverage gap may contribute to widening disparities in health and health care over time.

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10/23/15 – The Commonwealth Fund – A Difference-in-Difference Analysis of Changes in Quality, Utilization and Cost Following the Colorado Multi-Payer Patient-Centered Medical Home Pilot

By Erika Meredith B. Rosenthal, Shehnaz Aldina, Mark W. Friedberg, Sara J. Singer, Diana Eastman, Zhonghe Li, and Eric C. Schneider

A multipayer medical home program piloted in Colorado led to a sustained reduction in emergency department use and costs over three years, although there were no overall cost savings for practices or patients. Primary care visits also decreased. The impact on quality was mixed: cervical cancer screening rates improved, yet colon cancer screenings and hemoglobin testing for diabetes patients decreased.

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10/21/15 – Kaiser Health News – Are Medicare ACO’s Working? Experts Disagree

One of the missions of the 2010 federal health law is to slow the soaring cost of health care. A key strategy for Medicare is encouraging doctors, hospitals and other health care providers to formaccountable care organizations (ACOs) to coordinate beneficiaries’ care and provide services more efficiently. Under this experimental program, if these organizations save the government money and meet quality standards, they can be entitled to a share of the savings. Participation is voluntary.  

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10/15/15 – Kaiser Family Foundation - The Affordable Care Act Drove Record Annual Increases in Enrollment and Total Medicaid Spending Nationally in FY 2015, As Newly Eligible Adults Gained Coverage in Expansion States

High Federal Match for Adult Expansion Group Contributed to Substantially Slower State Medicaid Spending Growth in Expansion States Compared to Non-Expansion States

Survey Also Finds States Relying More on Managed Care, Undertaking Delivery System Reforms

The Affordable Care Act’s Medicaid expansion resulted in record increases in Medicaid enrollment and spending nationally in fiscal year 2015, with both rising an average of nearly 14 percent, according to the 15th annual 50-state Medicaid budget survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

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Click here to view 50-State Medicaid Budget Survey

Click here to view the Companion Report

Click here to view the Executive Summary


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10/13/15 – Kaiser Family Foundation – Nearly Half of the Uninsured, or 15.7 Million People, Are Eligible for Medicaid or Subsidized Affordable Care Act Coverage, Analysis Finds

State-Level Numbers Provide Estimates of How Many Could Be Reached During Third ACA Open Enrollment Period

Weeks away from the Affordable Care Act’s third open enrollment period, a new Kaiser Family Foundation analysis finds nearly half (49% or 15.7 million) of the 32.3 million nonelderly people in the United States without health insurance at the beginning of 2015 are eligible for Medicaid or subsidized coverage through an ACA marketplace.

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Click here to view the complete analysis

Click here to view the Technical Appendix A

Click here to view the Technical Appendix B

Click here to view the Technical Appendix C


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10/5/15 – Kaiser Family Foundation – Key Facts about the Uninsured Population

Decreasing the number of uninsured is a key goal of the Affordable Care Act (ACA), which provides Medicaid coverage to many low-income individuals in states that expand and Marketplace subsidies for individuals below 400% poverty. The ACA’s major coverage provisions went into effect in January 2014 and led to significant coverage gains. The number of uninsured nonelderly Americans in 2014 was 32 million, a decrease of nearly 9 million since 2013. This fact sheet describes trends in coverage leading up to and after the ACA expansions, examines the characteristics of the uninsured population, and summarizes the access and financial implications of not having coverage.

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10/5/15 – Avalere – New Analysis Finds Tiered and Narrow Insurance Network Products are Increasing in US Health Insurance Markets

By Mairin Brady Mancino

Network design is playing a central role in health benefit design and health policy debates. The goals of enhancing clinical quality and improving the patient experience, while lowering the total cost of care, are increasingly at the forefront of these discussions. Our latest research finds that tiered and narrow network insurance designs are becoming more prevalent, particularly, in the exchange market.

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10/1/15 – CHCS - Update on Medicare-Medicaid Integration

Nearly 10 million individuals across the United States are eligible for both Medicare and Medicaid. These people, known as Medicare-Medicaid enrollees or dually eligible beneficiaries, often have significant health and social service needs, making them among the nation’s highest-need, highest-cost populations. This fact sheet describes new opportunities open to states to better integrate care for Medicare-Medicaid enrollees.
 

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10/1/15 – Kaiser Family Foundation – Analysis of 2016 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

The chart and tables below present an updated analysis of changes in premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 13 states and the District of Columbia, where we were able to find complete data on rates for all insurers. This page will be updated as complete rate information becomes available for more states. More background can be found in our earlier analysis of 2016 rates.

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9/30/15 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, September 2014 to September 2015 

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9/30/15 – ICRC – Engaging Providers in Integrated Care Programs for Medicare-Medicaid Enrollees: Tips for States

By Sarah Barth and Michelle Herman Soper, Center for Health Care Strategies

Many states are pursuing integrated care programs, including financial alignment demonstrations, comprehensive contracts with Dual Eligible Special Needs Plans (D-SNPs), and Medicaid managed long-term services and supports (MLTSS) programs, to improve Medicare and Medicaid program alignment, service coordination, quality and cost-efficiency for Medicare-Medicaid enrollees. The success of these programs depends on engaging a broad spectrum of providers (e.g., physicians, hospitals, nursing facilities, and community based service providers) to aid program design with their feedback and participate in health plan networks. In addition, since providers are a trusted source of information for their patients, it is crucial that they support the integrated care program and are willing to encourage their patients/clients to enroll.
 

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9/30/15 – Kaiser Family Foundation – Kaiser Health Tracking Poll: The Public’s Views on the ACA

The public has remained deeply divided on the health reform law since it was passed in March 2010. Click below to examine how specific groups feel about the law and how those opinions have changed or not changed over time.

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9/25/15 – The Commonwealth Fund – Are Marketplace Plans Affordable? Consumer Perspectives from the Commonwealth Fund Affordable Care Act Tracking Survey, March – May 2015

By Sara R. Collins, Munira Gunja, Petra W. Rasmussen, Michelle M. Doty, and Sophie Beutel

Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the Affordable Care Act, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with skimpy benefit packages and high deductibles. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, indicate that the law’s tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes. At higher incomes, the phase-out of the subsidies means that adults in marketplace plans have higher premium costs than those in employer plans. Overall, larger shares of adults in marketplace plans reported deductibles of $1,000 or more, compared with those in employer plans, though these differences were narrower among low- and moderate-income adults.

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Click here to view the News Release

Click here to view the Chartpack

Click here to view the Survey Questionnaire


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9/25/15 – The Commonwealth Fund – To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance Under the Affordable Care Act While Other Have Not

By Sara R. Collins, Munira Gunja, Michelle M. Doty, and Sophie Beutel

According to the most recent Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, an estimated 25 million adults remain uninsured. To achieve the Affordable Care Act’s goal of near-universal coverage, policymakers must understand why some people are enrolling in the law’s marketplace plans or in Medicaid coverage and why others are not. This analysis of the survey finds that affordability—whether real or perceived—is playing a significant role in adults’ choice of marketplace plans and the decision whether to enroll at all. People who have gained coverage report significantly more positive experiences shopping for health plans than do those who did not enroll. Getting personal assistance—from telephone hotlines, navigators, and insurance brokers, among other sources—appears to make a critical difference in whether people gain health insurance.

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9/18/15 – Kaiser Family Foundation – Serving Low-Income Seniors Where They Live: Medicaid’s Role in Providing Community-Based Long-Term Services and Supports

By Rachel Garfield, Katherine Young, MaryBeth Musumeci, Erica L. Reaves, and Judy Kasper

Seniors managing chronic health conditions or experiencing an age-related decline in physical or cognitive functioning may need long-term services and supports (LTSS) to complete daily self-care activities (such as eating, bathing or dressing) or household activities (such as preparing meals or doing laundry). LTSS include a range of services, including adult day health care programs, home health aide services, personal care services, and case management services, among others.1 LTSS needs may be met through both paid services and unpaid services provided by friends or family members. While some people who need LTSS choose or require care based in nursing facilities, most people with LTSS needs live in the community. (See related videos on seniors with LTSS needs in Virginia and Kansas.)

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9/17/15 – The Commonwealth Fund – The Experiences of State-Run Marketplaces That Use HealthCare.gov

By Justin Giovannelli and Kevin Lucia

States have flexibility in implementing the Affordable Care Act’s health insurance marketplaces and may choose to become more (or less) involved in marketplace operations over time. Interest in new implementation approaches has increased as states seek to ensure the long-term financial stability of their exchanges and exercise local control over marketplace oversight. This brief explores the experiences of four states—Idaho, Nevada, New Mexico, and Oregon—that established their own exchanges but have operated them with support from the federal HealthCare.gov eligibility and enrollment platform. Drawing on discussions with policymakers, insurers, and brokers, we examine how these supported state-run marketplaces perform their key functions. We find that this model may offer states the ability to maximize their influence over their insurance markets, while limiting the financial risk of running an exchange.

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9/15/15 – Yahoo News - An Obamacare Change to Medicare Is Backfiring

By Millie Dent

Medicare’s attempts to hold hospitals accountable for poor quality treatment is inadvertently penalizing hospitals that take care of sicker, poorer patients, according to a new study published in JAMA Internal Medicine.  A provision in the Affordable Care Act requires Medicare to reduce payments to hospitals that have high readmission rates. The goal was to improve patient care and cut the costs of avoidable hospitalizations. Instead, the new study finds that the Obamacare change unfairly affects hospitals based on the patients they treat.

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9/14/15 – Kaiser Health News - Medicare Yet To Save Money Through Heralded Medical Payment Model

By Joran Rau and Jenny Gold

A high-profile Medicare experiment pushing doctors and hospitals to join together to operate more efficiently has yet to save the government money, with nearly half of the groups costing more than the government estimated their patients would normally cost, federal records show. The Centers for Medicare & Medicaid Services offers the lure of bonuses to health care practitioners who band together as accountable care organizations, or ACOs, to take care of patients. The financial incentives are intended to encourage these doctors, hospitals, nursing homes and other institutions to keep patients healthy rather than primarily treat illnesses, which is what Medicare payments traditionally have rewarded. ACOs that save a substantial amount get to keep a share of the savings as a bonus.

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9/10/15 – McKnight’s – Regulators Call for ACA Small Group Revision

By Emily Mongan

A changing definition of a “small group” of employees under the Affordable Care Act could lead to higher health insurance premiums for small companies, including nursing homes, experts said recently.

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9/10/15 – Kaiser Family Foundation - Analysis of 2016 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

The chart and tables below present an updated analysis of changes in premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 12 states and the District of Columbia, where we were able to find complete data on rates for all insurers. This page will be updated as complete rate information becomes available for more states. More background can be found in our earlier analysis of 2016 rates.

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9/9/15 – Kaiser Family Foundation – Preventative Services Tracker

The Affordable Care Act (ACA) requires new private health insurance plans to cover many recommended preventive services without any patient cost-sharing. For adults, the required services are recommended by the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA) based on recommendations issued by the Institute of Medicine Committee on Women’s Clinical Preventive Services.  As new recommendations are issued or updated, coverage must commence in the next plan year that begins on or after exactly one year from the recommendation’s issue date.

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Click here to view the press release

Click here to view the fact sheet


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9/9/15 – Politico – House Obamacare Lawsuit Can Move Ahead in Part

By Jennifer Haberkorn

A federal judge has ruled that a major part of the House’s lawsuit against Obamacare can proceed.

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Click here to view the federal ruling


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9/9/15 – The Commonwealth Fund – Innovations in Diabetes Care Around the World: Case Studies of Care Transformation Through Accountable Care Reforms

By Andrea Thoumi, Krishna Udayakumar, Elizabeth Drobrick, Andrea Taylor, and Mark McClellan

The rising rate of diabetes worldwide has in recent years spurred a number of innovative prevention and treatment programs focused on community-based care and information technology. Scaling up these interventions has proved difficult, however. Based on case studies conducted in the United States, Mexico, and India, researchers identified financial, organizational, and regulatory barriers to broader adoption that program leaders and policymakers are struggling to address. The authors believe a combination of new funding approaches, institutional reforms, and performance measures are necessary to spread effective advances in care and reduce the burden of diabetes and other chronic diseases.

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9/8/15 – Kaiser Family Foundation – Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS

By MaryBeth Musumeci

Using authority in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) has launched demonstrations that seek to improve care and control costs for people who are dually eligible for Medicare and Medicaid. Nearly 355,000 beneficiaries in nine states are enrolled in these demonstrations as of June, 2015. Implemented beginning in July 2013, the demonstrations are changing the care delivery systems through which beneficiaries receive medical and long-term care services and the financing arrangements among CMS, the states, and providers. The demonstrations initially were approved for three years, but in July, 2015, CMS announced that states may extend their demonstrations for an additional two years.

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9/3/15 – The Center for Public Integrity - White House Wants More Aggressive Effort On Medicare, Medicaid Billing Errors

Letter from budget director to HHS secretary says problem must be addressed in 'new and innovative ways' – By Fred Schulte - White House budget director Shaun Donovan called for a “more aggressive strategy” to thwart improper government payments to doctors, hospitals and insurance companies in a previously undisclosed letter to Health and Human Services Secretary Sylvia Mathews Burwell earlier this year. Government health care programs covering millions of Americans waste billions of tax dollars every year through these “improper” payments, Donovan said in the Feb. 26, 2015 letter.

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9/1/15 – The Detroit News - State Submits Waiver Request for Expanded Medicaid

The state of Michigan submitted a waiver request to the federal government Tuesday in the hopes that it can continue health care coverage for nearly 600,000 low-income residents under its expanded Medicaid program.

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9/1/15 – Kaiser Family Foundation – Economic and Fiscal Trends in Expansion and Non-Expansion States: What We Know Leading Up to 2014

By Laura Snyder, Robin Rudowitz and Lucy Dadayan and Don Boyd, Rockfeller Institute of Government 

Medicaid is the nation’s primary health insurance program for low-income and high-need Americans. Because of the program’s joint federal-state financing structure, Medicaid has a unique role in state budgets because it is both an expenditure item and a source of federal revenue for states. States have significant flexibility within broad federal rules to administer their Medicaid programs. Policy decisions, as well as other factors such as the economy, demographics and state tax capacity are key factors in determining the types and amounts of revenue that states collect as well as how they budget those funds across programs.

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8/26/15 – Kaiser Family Foundation – A Look at the Private Option in Arkansas

By Jocelyn Guyer, Naomi Shine, MaryBeth Musumeci, and Robin Rudowitz

In September 2013, Arkansas became the first state in the nation to receive approval from the federal government for a Section 1115 demonstration waiver to require most adults who are newly eligible for coverage through the Affordable Care Act’s Medicaid expansion to enroll in Marketplace plans. The initiative, often referred to as the “private option,” has allowed Arkansas to cover close to 220,000 Medicaid beneficiaries with commercial provider networks and strengthen its Marketplace. An additional 25,000 medically frail adults are covered through the state’s fee-for-service system, bringing to 245,000 the number of newly eligible adults covered in Arkansas as of June 30, 2015. As a result of this coverage, Arkansas has been able to drive down its uninsured rate and reduce uncompensated care costs. The future of the private option is the source of extensive discussion within Arkansas, and it continues to be watched closely by policymakers within the state and around the country. Drawing on a dozen interviews with state officials, providers, insurance carriers, and advocates, as well as early data on coverage, reduced uncompensated care costs, and other topics, this issue brief provides an initial look at implementation. Key findings include the following:

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Click here to view the News Release


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8/25/15 – Kaiser Family Foundation – How Many Employers Could be Affected by the Cadillac Plan Tax?

By Gary Claxton and Larry Levitt

As fall approaches, we can expect to hear more about how employers are adapting their health plans for 2016 open enrollments. One topic likely to garner a good deal of attention is how the Affordable Care Act’s high-cost plan tax (HCPT), sometimes called the “Cadillac plan” tax, is affecting employer decisions about their health benefits. The tax takes effect in 2018.

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Click here to view the News Release


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8/20/15 – Kaiser Family Foundation – Most Say They Can Afford Their Prescription Drugs, But One in Four Say Paying is Difficult, Including More Than Four in Ten People Who Are Sick

Large Bipartisan Majorities Support Range of Policy Changes They Believe Would Curb Drug Costs Opinion on the Affordable Care Act Remain Largely Unchanged in August

About half of Americans (54%) report currently taking a prescription drug, and a large majority of them (72%) say their prescriptions are very or somewhat easy to afford. However, about a quarter (24%) say paying for their drugs is difficult, and the share facing difficulties rises among those with low incomes (33%) or currently taking four or more prescription drugs (38%), and is highest for those in fair or poor health (43%).

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Click here to view the Kaiser Health Tracking Poll: August 2015

Click here to view Topline and Methodology


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8/18/15 – The Commonwealth Fund – Comparing Individual Health Coverage On and Off the Affordable Care Act’s Insurance Exchanges

By Michael J. McCue and Mark Hall

The new health insurance exchanges are the core of the Affordable Care Act’s (ACA) reforms, but how the law improves the nonsubsidized portion of the individual market is also important. This issue brief compares products sold on and off the exchanges to gain insight into how the ACA’s market reforms are functioning. Initial concerns that insurers might seek to enroll lower-risk customers outside the exchanges have not been realized. Instead, more-generous benefit plans, which appeal to people with health problems, constitute a greater portion of plans sold off-exchange than those sold on-exchange. Although insurers that sell mostly on the exchanges incur an additional fee, they still devote a greater portion of their premium dollars to medical care. Their projected administrative costs and profit margins are lower than are those of insurers selling only off the exchanges.

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8/12/15 – The Commonwealth Fund – Lessons from the Small Business Health Options Program

The SHOP Experience in California and Colorado

By Leif Wellington Haase, David Chase and Tim Gaudette

The Small Business Health Options Program (SHOP) got off to a slow start, with lower-than-expected enrollment and a public perception problem. This report examines California and Colorado’s small-business marketplaces, which opened on schedule in October 2013. For business owners, employee choice was the most important reason cited for considering SHOP, with ease of administration a distant second. Several owners see SHOP as a viable alternative to the private exchanges now taking root among large and midsize employers. Interviews also revealed that business owners consider insurance brokers to be an important source of enrollment assistance. Those in the insurance and policy communities perceived small-business owners to be poorly informed about available tax credits; business owners disagreed, saying the credits were simply not key to their decision to elect SHOP. Potential growth areas for SHOP include developing alternative benefit designs, contracting with Medicaid plans, and offering ancillary products, such as wellness programs.

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8/12/15 – National Business Group on Health – Health Care Benefits Cost Increases to Hold Steady in 2016, National Business Group on Health Survey Finds

Survey Shows Nearly Half of Large Employers Will Trigger “Cadillac” Excise Tax in 2018

Health care benefit cost increases at large employers are expected to hold steady in 2016, due in large part to changes employers are making to their benefit programs. At the same time, nearly half of large employers say if they don’t take additional measures to control costs, at least one of their health plans will reach the threshold that triggers the “Cadillac” excise tax under the Affordable Care Act in 2018, according to an annual survey released today by the National Business Group on Health, a non-profit association of 425 large U.S. employers.

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8/12/15 – The Detroit News - Enrollment Up in Mich. Medicaid HMOs, Individual Plans

By Karen Bouffard

Enrollment in Michigan Medicaid HMOs and individual health insurance plans tripled in 2014 as a result of the federal Affordable Care Act, according to a report released Wednesday.

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8/9/15 – McKnight’s – Senate Approves PACE Expansion Bill

By Emily Mongan

The Senate has approved a bill that would expand the Programs of All-Inclusive Care for the Elderly for testing in other populations.

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8/7/15 – Kaiser Family Foundation - Dual Eligible Demonstrations: The Beneficiary Perspective

By Laura Summer, Molly O’Malley Watts, and MaryBeth Musumeci

The financial alignment demonstrations for seniors and younger people with disabilities dually eligible forMedicare and Medicaid are joint efforts of selected states and the Centers for Medicare and Medicaid Services (CMS), designed to align benefits and financing with the goals of delivering better coordinated care and reducing costs. These three-year demonstrations are based on authority in the Affordable Care Act and were implemented beginning in July 2013.

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8/6/15 – Kaiser Family Foundation - 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers

By Karen Pollitz, Jennifer Tolbert and Rosa Ma

Now in second year, a new infrastructure of consumer assistance in health insurance continues to develop. The Affordable Care Act (ACA) provided for new publicly funded consumer assistance entities to help people on an ongoing basis as they apply for health coverage and subsidies and resolve questions and problems with their insurance once covered. Nearly all Marketplace Assistance Programs established for the first year returned this year to continue helping consumers. These assistance professionals have unique insights into how ACA implementation is progressing, what is changing and what challenges remain. How Assister Programs develop in their own right will also likely impact whether consumers can continue to get the help they need.

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Click here to view the Topline


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8/5/15 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, July 2014 to July 2015 

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8/5/15 – Providers Terminated from One State Medicaid Program Continued Participating in Other States

By Suzanne Murrin, Deputy Inspector General for Evaluation and Inspections

Prior to passage of the Patient Protection and Affordable Care Act (ACA), if a State terminated a provider’s participation in its Medicaid program, the provider could potentially participate in another State’s Medicaid program, leaving the second State’s program vulnerable to fraud, waste, or abuse committed by that provider. To prevent this from happening, the ACA requires States to terminate a provider’s participation in their respective State Medicaid programs if that provider is terminated for cause (i.e., for reasons of fraud, integrity, or quality) from another State Medicaid program. In 2014, the Office of the Inspector General (OIG) published a report that recommended improvements to address weaknesses in the Centers for Medicare & Medicaid Services (CMS) process for sharing termination information among the States. This study builds on the prior report by determining whether Medicaid providers that States reported as having been terminated for cause continued to participate in Medicaid in other States.

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8/4/15 – Kaiser Family Foundation – State Medicaid Eligibility Policies for Individuals Moving Into and Out of Incarceration

By Catherine McKee, Sarah Somers, Samantha Artiga, and Alexandra Gates

Many individuals in prisons and jails have significant physical and behavioral health care needs, but lack health insurance and regular access to care. Compared to individuals in the community, incarcerated individuals are much more likely to have chronic physical and mental health conditions, such as HIV/AIDS, a serious mental illness, or a substance abuse disorder. Despite having significant health care needs, many individuals do not receive necessary medical care during incarceration. Because the majority of individuals leaving prisons and jails do not have health insurance, they often continue to lack access to care after release.

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7/30/15 – Kaiser Family Foundation – Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender Individuals in the U.S.

By Jennifer Kates, Usha Ranji, Adara Beamesderfer, Alina Salganicoff, and Lindsey Dawson

Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity.

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7/30/15 – ASPE Issue Brief – Competition and Choice in the Health Insurance Marketplaces, 2014-2015: Impact on Premiums

By Steven Sheingold, Nguyen Nguyen and Andre Chappel

A central feature of the Affordable Care Act is the establishment of Health Insurance Marketplaces. The Marketplaces offer consumers organized platforms to shop for health insurance coverage, apply for financial assistance, and purchase coverage without any medical underwriting or premium adjustment based on pre-existing conditions. A key objective of the Marketplaces is to foster competitive environments in which consumers can choose from a number of affordable and high quality health plans. In this issue brief, we offer a progress report on the evolution of the competitive dynamics of the Marketplaces.

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7/28/15 – McKnight’s – Skilled Nursing, CCRC Spending Being Driven to New Heights – Moderately: Report

By Emily Mongan

The rapid growth of America's aging population will cause long-term care spending to continue to climb over the next 10 years, reaffirmed the latest Centers for Medicare & Medicaid Service's National Health Expenditures report.

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7/28/15 – Kaiser Family Foundation - Nearly 355,000 Dual Eligible Beneficiaries Are Enrolled in Capitated Financial Alignment Demonstrations in 9 States, as of June 2015

This chart shows enrollment in the capitated financial alignment demonstrations for beneficiaries who are eligible for both Medicare and Medicaid.  Nearly 355,000 seniors and non-elderly adults with disabilities are enrolled in these demonstrations in 9 states as of June 2015.

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7/23/15 – Kaiser Family Foundation - Proposed Rule on Medicaid Managed Care: A Summary of Major Provisions

By Julia Paradise and MaryBeth Musumeci

On June 1, 2015, the Centers for Medicare & Medicaid Services (CMS) published a Notice of Proposed Rulemaking (NPRM) to modernize federal Medicaid managed care regulations. Since the rules were last updated, in 2002, states have significantly expanded their managed care programs to include beneficiaries with more complex needs; larger geographic areas; additional services; and millions of adults newly eligible for Medicaid under the Affordable Care Act. Today, over half of all Medicaid beneficiaries are enrolled in comprehensive risk-based health plans and many also receive some services, such as behavioral health care, through limited-benefit risk-based plans.

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7/10/15 – Kaiser Family Foundation - Round 2 on the Legal Challenges to Contraceptive Coverage: Are Nonprofits “Substantially Burdened” by the “Accommodation”?

By Laurie Sobel and Alina Salganicoff

The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including Food and Drug Administration (FDA) approved prescription contraceptives and services for women. Since the implementation of the ACA contraceptive coverage requirement in 2012, over 200 corporations have filed lawsuits claiming that including coverage for contraceptives or opting for an “accommodation” from the federal government violates their religious beliefs. The legal challenges have fallen into two groups: those filed by for-profit corporations and those filed by nonprofit organizations.

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7/8/15 – Kaiser Family Foundation - Medicaid and Family Planning: Background and Implications of the ACA

By Usha Ranji, Yali Bair and Alina Salganicoff

Medicaid plays a primary role financing health care services and facilitating access to a broad a range of sexual and reproductive health services for millions of low-income women of childbearing age.  Today it is the single largest source of public funding for family planning services, far exceeding the funding levels of the Federal Title X family planning program.1  States have long-been required to include family planning services in their Medicaid programs, but the shifts in health care delivery and reforms brought on by the Affordable Care Act (ACA) are changing how these services are provided.

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6/24/15 – Kaiser Family Foundation - Analysis of 2016 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces

By Cynthia Cox, Larry Levitt, Gary Claxton, and Rosa Ma

Premium growth in the Affordable Care Act’s Health Insurance Marketplaces has been an area of significant interest, as this is one of the most tangible and measurable indicators of whether the ACA is working to keep health insurance affordable. The ACA’s rate review provision requires premium increases over ten percent to be made public. As a number of individual market insurers are requesting 2016 increases well above 10 percent, concern has been raised over the affordability of premiums in the coming year. However, these increases are not necessarily representative of the range of products from which consumers will be able to choose, and similar data is not widely available for the plans with moderate increases or decreases.

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6/24/15 – The Commonwealth Fund - How Insurers Competed in the Affordable Care Act's First Year

By Katherine Swartz, Mark Hall, and Timothy S. Jost

Prior to the Affordable Care Act (ACA), most states’ individual health insurance markets were dominated by one or two insurance carriers that had little incentive to compete by providing efficient services. Instead, they competed mainly by screening and selecting people based on their risk of incurring high medical costs. One of the ACA’s goals is to encourage carriers to participate in the health insurance marketplaces and to shift the focus from competing based on risk selection to processes that increase consumer value, like improving efficiency of services and quality of care. This issue brief focuses on six states—Arkansas, California, Connecticut, Maryland, Montana, and Texas. Based on interviews with policymakers, as well as data analysis, this brief looks at the ways carriers are competing in the new marketplaces—namely, through cost-sharing and composition of provider networks.

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6/24/15 - Commonwealth Fund - Does Medicaid Make a Difference?

Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014

By David Blumenthal, Petra W. Rasmussen, Sara R. Collins, and Michelle M. Doty

As millions of Americans gain Medicaid coverage under the Affordable Care Act, attention has focused on the access to care, quality of care, and financial protection that coverage provides. This analysis uses the Commonwealth Fund Biennial Health Insurance Survey, 2014, to explore these questions by comparing the experiences of working-age adults with private insurance who were insured all year, Medicaid beneficiaries with a full year of coverage, and those who were uninsured for some time during the year. The survey findings suggest that Medicaid coverage provides access to care that in most aspects is comparable to private insurance. Adults with Medicaid coverage reported better care experiences on most measures than those who had been uninsured during the year. Medicaid beneficiaries also seem better protected from the cost of illness than do uninsured adults, as well as those with private coverage.

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6/24/15 – CHCS - Getting Providers on Board to Improve Care for California’s Medicare-Medicaid Enrollees

On June 23, 2015, the Center for Health Care Strategies (CHCS) and Harbage Consulting held a provider summit that connected plans and providers in the Cal MediConnect Inland Empire demonstration counties of San Bernardino and Riverside. Integrated care programs such as California’s Cal MediConnectoffer a new way of aligning Medicare and Medicaid benefits and services for dually eligible individuals. These programs are new to many providers, who may have questions about how integrated programs work for their patients.

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ICRC - Monthly Enrolllment in Medicare-Medicaid Plans by Plan and by State, June 2014 to June 2015 - Technical Assistance Tool

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6/22/15 – Kaiser Family Foundation – Medicaid Delivery System and Payment Reform: A Guide to Key Terms and Concepts

Historically, most state Medicaid programs delivered and paid for services for Medicaid beneficiaries on a fee-for-service (FFS) basis, directly paying participating physicians, clinics, hospitals, and other providers a fee for each service they furnish. The FFS payment model, by definition, rewards volume, irrespective of patient health outcomes or quality of care. Also, care provided in a FFS system can often be fragmented because there is no coordinating entity, and both redundancies and gaps in patient care can result. In addition, beneficiaries are on their own in FFS systems to identify providers who participate in Medicaid and are taking new patients.

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Click here to view Mapping Medicaid Delivery System and Payment Reform to learn more about activity across states


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6/19/15 – ASPE – Outreach and Enrollment for LGBT Individuals: Promising Practices from the Field

By Tia Zeno, Katherine Warren and John Snyder

People who identify as lesbian, gay, bisexual, or transgender (LGBT) have traditionally faced challenges accessing health insurance coverage and health care. On average, LGBT individuals experience greater exposure to violence and homelessness, as well as higher rates of poverty, tobacco and substance use, psychiatric disorders, HIV infection, and cancer.1 These disparities are even more pronounced for LGBT individuals who are also members of racial and ethnic minorities and have low incomes.2 According to the 2013 National Health Interview Survey, which included measures on sexual orientation, the rate of uninsurance among lesbian, gay, or bisexual adults aged 18-64 at that time was comparable to that of the heterosexual population (19.0 percent versus 20.1 percent, respectively). However, for LGBT adults with incomes below 400 percent of the Federal Poverty Level, one in three (34 percent) were uninsured in 2013, compared to 27 percent in the general population, 3 and they were less likely to have employee sponsored insurance.4 The percentage of LGBT adults without health insurance has decreased since the Affordable Care Act's health insurance provisions took full effect at the beginning of 2014; however, significant numbers of LGBT individuals remain uninsured.5

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6/19/15 – Kaiser Family Foundation – How Does Gaining Coverage Affect People’s Lives? Access, Utilization, and Financial Security Among Newly Insured Adults

By Rachel Garfield and Katherine Young

In 2014, millions of people gained health insurance as the major coverage provisions of the Affordable Care Act (ACA) were implemented. While much attention has been paid to enrollment in new coverage options and changes in the number of uninsured over the past year, less is known about how this coverage has affected people’s lives. This report, based on the 2014 Kaiser Survey of Low-Income Americans and the ACA, aims to understand the impact that gaining coverage has had on the lives of the “newly insured” adult population. The survey of 10,502 non-elderly adults was fielded between September 2 and December 15, 2014, with the majority of interviews (70%) conducted prior to November 15, 2014 (the start of the second open enrollment period). Additional detail on the survey methods is available in the methods appendix available online.

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6/18/15 – Kaiser Family Foundation – Experiences and Attitudes of Primary CareProviders Under the First Year of ACA Coverage Expansion

A new survey from The Kaiser Family Foundation and The Commonwealth Fund asked primary care providers—physicians, nurse practitioners, and physician assistants—about their views of and experiences with the Affordable Care Act (ACA) and other changes in health care delivery and payment, as well as their thoughts on the future of primary care. In this first brief based on the survey, many providers reported seeing an increased number of patients since the coverage expansions went into effect, but not an accompanying compromise in quality of care. A large majority of primary care providers are satisfied with their medical practice, but a substantial percentage of physicians expressed pessimism about the future of primary care. Similar to the population overall, providers’ views of the ACA are divided along party lines. A second brief will report on providers’ reactions to other changes occurring in primary care delivery and payment.

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Click here to view the Survey Topline and Methodology


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6/15/15 – Kaiser Family Foundation – The ACA and People with HIV: Profiles from the Field

By Lindsey Dawson, Jennifer Kates, Tresa Undem, and Kathleen Perry

The Affordable Care Act (ACA), signed into law in 2010, has provided millions of individuals with new health insurance coverage, including thousands of people with HIV. To explore what new ACA era coverage opportunities have meant for this population, we examined the coverage and enrollment experiences of people with HIV, by conducting focus groups with HIV positive individuals in five states (California, Florida, Georgia, New York, and Texas).1 These focus groups were conducted after the end of the first open enrollment period and consisted of participants who enrolled in or attempted to enroll in private coverage through the marketplaces, those who enrolled in Medicaid as part of the expansion population, and those who remained uninsured, largely because they lived in a state that elected not to expand its Medicaid program.

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6/12/15 – The Commonwealth Fund – Large Majority of Affordable Care Act Coverage Enrollees are Satisfied with Their Insurance, People Using Plans are Getting Care They Could Not Have Afforded Before

Commonwealth Fund’s Latest ACA Tracking Survey Finds Uninsured Rate Down from 20% to 13% Since 2013; Most Newly Insured Had Lacked Coverage for at Least One Year

A large majority (86%) of people who are currently insured through the Affordable Care Act (ACA) marketplaces or newly insured in Medicaid are very or somewhat satisfied with their new health care coverage, according to a Commonwealth Fund report out today. Nearly seven in 10 (68%) adults with new coverage have used it to get health care, and of those more than three in five (62%) previously would not have been able to obtain or afford that care. 

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6/12/15 – The Commonwealth Fund – Americans’ Experiences with Marketplace and Medicaid Coverage

Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015

By Sara R. Collins, Petra W. Rasmussen, Michelle M. Doty, and Sophie Beutel

The latest Commonwealth Fund Affordable Care Act Tracking Survey finds the share of uninsured working-age adults was 13 percent in March–May 2015, compared with 20 percent just before the major coverage expansions went into effect. More than half of adults who currently have coverage either through the Affordable Care Act’s (ACA’s) marketplace plans or Medicaid expansion were uninsured prior to gaining coverage. Of those, more than 60 percent lacked coverage for one year or longer. More than six of 10 adults who used their new plans to obtain care reported they could not have afforded or accessed it previously. Majorities of people with ACA coverage who have used their plans express satisfaction with the doctors covered in their networks and are able to find physicians with relative ease. Wait times to get appointments with physicians in marketplace plans and Medicaid are comparable to those reported by other working-age adults.  

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Click here to view the Survey Question Wording


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6/9/15 – The Commonwealth Fund – The Affordable Care Act and Medicare

How the Law is Changing the Program and the Challenges that Remain

By Karen Davis, Stuart Guterman and Farhan Bandeali

The aims of the Affordable Care Act (ACA) were to increase health insurance coverage for those under age 65, improve the performance of the health care delivery system, and slow cost growth. Less recognized are the provisions of the law that seek to strengthen the Medicare program.

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6/8/15 – Avalere Health - The Future Cost of Innovation: An Analysis of the Impact of Breakthrough Therapies on Government Spending

By Avalere Health LLC

Spending on pharmaceuticals grew 13.1 percent in 2014, with nearly half of this growth driven by new products launched in the last two years, primarly therapies.  While medications accounted for approximately 13 percent of healthcare spending in 2013, year-over-year drug trend between 2013 and 2014 was at its highest level since 2001. These spending trends raise questions for government programs and other payer who must balance the potential long-term budget impact on new medications with improvement in patient care.

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6/7/15 – Executive Office of the President of the United States – Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid

The Affordable Care Act has dramatically expanded access to high-quality, affordable health insurance coverage. Since the law’s major coverage provisions took effect at the start of 2014, the Nation has seen the sharpest reduction in the uninsured rate since the decade following the creation of Medicare and Medicaid in 1965, and, as depicted in Figure 1, the Nation’s uninsured rate now stands at its lowest level ever. Combining these recent gains with earlier gains after the law’s provision allowing young adults to remain on a parent’s plan until age 26 took effect, more than 16 million Americans had gained health insurance coverage as of early 2015 (ASPE 2015).

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6/5/15 – Kaiser Family Foundation – Medicaid Balancing Incentive Program: A Survey of Participating States

Prepared by Molly O’Malley Watts, Watts Health Policy and Erica L. Reaves and Mary Beth Musumeci, Kaiser Family Foundation

Eighteen states are currently participating in the Medicaid Balancing Incentive Program (BIP) to increase access to home and community-based services (HCBS) as an alternative to institutional care. Established by the Affordable Care Act, BIP authorizes $3 billion in enhanced federal funding from October 2011 through September 2015. As a condition of participation in BIP, states must implement certain structural changes and reach specific financial benchmarks by September 2015, spending at least 25 percent (1 state) or 50 percent (the remainder of states) of their total Medicaid long-term services and supports (LTSS) dollars on HCBS. During the summer of 2014, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured surveyed BIP states about basic program information, progress with implementing the BIP structural requirements, stakeholder engagement, evaluation activities, and the use of enhanced federal funds in support of other Medicaid LTSS rebalancing efforts.

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6/3/15 – Kaiser Family Foundation – Updated for 2015: Tool Displays By Locality the Share of Potential ACA Federal Marketplace Enrollees That Signed Up

An interactive tool from the Kaiser Family Foundation is now updated with 2015 data, allowing users to view on a local level the share of potential enrollees who signed up for a health plan in a federally-based marketplace under the Affordable Care Act.

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Click here to view the tool


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6/3/15 – Kaiser Family Foundation – New Analysis Details Impact on Residents in Different States if the U.S. Supreme Court Rules for Challengers in King v. Burwell

The U.S. Supreme Court is expected to rule this month in the King v. Burwell case that challenges whether low- and moderate-income Americans are eligible for subsidies to help pay for insurance if they live in states where the federal government, rather than the state, established its new insurance marketplace under the Affordable Care Act (ACA).

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Click here to view the analysis


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6/2/15 –  The Detroit News – Nearly 294K Mich. Consumers Get Health Plans

By Karen Bouffard

Nearly 294,000 or about 86 percent of Michigan consumers who enrolled for insurance at HealthCare.gov paid at least their first month’s premium and were actively covered as of March 31, according to numbers released Tuesday by the federal government.

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6/1/15 – Kaiser Family Foundation - Early Insights from Commonwealth Coordinated Care: Virginia’s Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

By Laura Summer and Jack Hoadley

Virginia is among the early states to launch a 3-year capitated financial alignment demonstration to integrate Medicare and Medicaid payments and care for beneficiaries who are dually eligible for Medicare and Medicaid. This report describes the early implementation of Virginia’s capitated demonstration, Commonwealth Coordinated Care (CCC). Findings are based on interviews conducted with a diverse group of state leaders, including representatives from state agencies; medical, behavioral health, and social services providers; consumer advocates; and health plans, involved in the design and early implementation of the CCC program. The report also includes data on enrollment in CCC to provide context for the qualitative findings.

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6/1/15 – Commonwealth Fund – Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care

By Mark W. Friedberg, Meredith B. Rosenthal, Rachel M. Werner, Kevin G. Volpp, and Eric C. Schneider

A group of physician practices that participated in a medical home intervention that included a shared-savings bonus program outperformed a comparison group of practices on clinical quality. Patients in the participating practices also had comparatively fewer hospital and emergency room visits.

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6/1/15 –  Kaiser Family Foundation – How Have Insurers Fared Under the Affordable Care Act?

By Larry Levitt, Gary Claxton and Cynthia Cox

The first full year of implementation of the Affordable Care Act (ACA) brought substantial changes to the individual insurance market. Beginning in 2014, insurers could no longer turn down applicants with pre-existing health conditions or charge them higher premiums. The so-called “individual mandate” required people to obtain coverage or pay a penalty, and federal subsidies available in the new health insurance Marketplaces made coverage more affordable for low and middle income enrollees. Overall, enrollment in the individual market grew by 46% in 2014.

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5/28/15 –  Kaiser Family Foundation – Interactive: A State-by-State Look at How the Uninsured Fare Under the ACA

The Affordable Care Act (ACA) includes coverage options for people across the income spectrum, but there are big differences in eligibility for coverage depending on whether a state expands Medicaid or not.

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Click here to view state profile fact sheets


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5/28/15 – Kaiser Family Foundation - Coverage Expansions and the Remaining Uninsured: A Look at California During Year One of ACA Implementation

By Rachel Garfield, Melissa Majerol, and Katherine Young

Under the ACA, millions of individuals have gained coverage through new provisions, effective as of January 2014, to expand Medicaid and provide premium tax credits for coverage purchased through Health Insurance Marketplaces. In California, coverage gains were substantial, with 2.7 million people gaining Medi-Cal coverage and nearly 1.7 million people determined eligible for enrollment through Covered California between October 2013 and September 2014.1 California is a bellwether state for understanding the impact of the ACA. The state’s sheer size and its high rate of uninsured prior to ACA implementation means that its experience in implementing the ACA has implications for national coverage goals. In addition, California was an early and enthusiastic adopter of the ACA; the state implemented an early Medicaid expansion through its Low-Income Health Program (LIHP) and was the first to create a state-based Marketplace.

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5/23/15 – Modern Healthcare – Will Medicare and Medicaid Predict ACA’s Future?

By Harris Meyer

While politicians debate the future of Medicare and Medicaid, few question that those programs are here to stay. It's easy to forget how controversial the idea of government healthcare programs was for most of the 20th century, and how many decades it took to enact the programs.

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5/22/15 – The Wall Street Journal – Health Insurers Seek Hefty Rate Boosts

By Louise Radnofsky

Major insurers in some states are proposing hefty rate boosts for plans sold under the federal health law, setting the stage for an intense debate this summer over the law’s impact.

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5/21/15 – Kaiser Family Foundation - Survey of Non-Group Health Insurance Enrollees, Wave 2

By Liz Hamel, Mira Norton, Larry Levitt, Gary Claxton and Mollyann Brodie

This survey reports on the views and experiences of people purchasing health insurance coverage in the non-group market. Over the past few years, the Affordable Care Act (ACA) has had a significant impact on this group, as new rules took effect that standardized coverage, guaranteed coverage for those with pre-existing conditions, and established income-based federal financial assistance to those buying insurance through new health insurance Exchanges or Marketplaces. Starting on January 1st, 2014, all coverage newly purchased either through a Marketplace or directly from an insurance company had to follow new rules under the ACA (i.e. “ACA-compliant”).

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5/20/15 – Commonwealth Fund – The Problem of Underinsurance and How Rising Deductibles Will Make it Worse

Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014

By Sara R. Collins, Petra W. Rasmussen, Sophie Beutel, and Michelle M. Doty

New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more.

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Click here to read the Chartpack

Click here to view the Tables

Click here to view the Press Release


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5/18/15 – Politico - Skyrocketing Medicaid Signups Stir Obamacare Fights

Some GOP Governors are Saying “I Told You So”

By Rachana Pradhan

Medicaid enrollment under Obamacare is skyrocketing past expectations, giving some GOP governors who oppose the program’s expansion under the health law an “I told you so” moment.

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5/15/15 – Health Affairs – Medicaid Primary Care Parity.  For 2014 and 2014, the Federal Government Raised Payment Rates to Medicaid Primary Care Providers.  Only Some States Plan to Extend the Rate Increase

Section 1202 of the Affordable Care Act (ACA) required states to raise Medicaid primary care payment rates to Medicare levels in 2013 and 2014, with the federal government paying 100 percent of the increase. This provision--often referred to as "Medicaid primary care parity" or the "Medicaid primary care fee bump"--was intended to encourage primary care physicians to participate in Medicaid, particularly in the face of an expected increase in enrollment as a result of the ACA's expansion of the program.

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5/14/15 – Kaiser Family – Early Insights from Ohio’s Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

By Molly O’Malley Watts

Ohio was the third state to launch a 3-year capitated financial alignment demonstration to integrate Medicare and Medicaid payments and care for beneficiaries who are dually eligible for Medicare and Medicaid.  Concurrently, Ohio implemented mandatory capitated managed care through separate Medicaid waiver authority.  Ohio refers to both initiatives as MyCare Ohio.  This report describes the early implementation of Ohio’s capitated Medicare-Medicaid financial alignment demonstration.  Findings are based on interviews conducted with a diverse group of state leaders, including representatives from state agencies; medical, behavioral health, and social services providers; consumer advocates; and health plans involved in the design and early implementation of the demonstration.  The report also includes data on enrollment in the demonstration to provide context for the qualitative findings.

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5/14/15 – ASPE Data Point – The Affordable Care Act is Improving Access to Preventive Services for Millions of Americans

Under the Affordable Care Act most health insurance plans (“nongrandfathered” plans) are required to provide coverage for recommended preventive health care services without cost sharing.

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5/12/15 – Kaiser Family Foundation - Early Insights from One Care: Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

By Colleen Barry, Lauren Riedel, Alisa Busch and Haiden Huskamp

Massachusetts was the first state to launch a 3-year capitated financial alignment demonstration to integrate care for beneficiaries who are dually eligible for Medicare and Medicaid – One Care – in October 2013. This report describes the early implementation of Massachusetts’ capitated demonstration.  Findings are based on interviews conducted with a diverse group of state leaders, including representatives from state agencies; medical, behavioral health, and social services providers; consumer advocates; and health plans, involved in the design and early implementation of the One Care program. The report also includes data drawn from various sources to provide context for the qualitative findings.

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5/11/15 – The Commonwealth Fund – Medicaid Benefit Designs for Newly Eligible Adults: State Approaches

By Sara Rosenbaum, Devi Mehta, Mark Dorley, Carla Hurt, Sara Rothenberg, Nancy Lopez, and Sara Ely

The Affordable Care Act gives states the option of providing less-generous Medicaid coverage to adults who become eligible through the law’s expansion of the program. Based on a review of the benefit design choices made by states that had expanded Medicaid by the end of 2014, we find that states have chosen to offer more generous coverage than what is required under federal law, either narrowing or eliminating the distinction between coverage levels for newly eligible adults and those for traditional adult beneficiaries, such as pregnant women, parents and guardians, or beneficiaries with disabilities. This suggests that states view the newly eligible beneficiaries as having the elevated health and health care needs that are common among low-income populations.

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5/11/15 – The Commonwealth Fund – Realizing Health Reform’s Potential

Medicaid Benefit Designs for Newly Eligible Adults: State Approaches

By Sara Rosenbaum, Devi Mehta, Mark Dorley, Carla Hurt, Sara Rothenberg, Nancy Lopez, and Sara Ely

The Affordable Care Act gives states the option of providing less-generous Medicaid coverage to adults who become eligible through the law’s expansion of the program. Based on a review of the benefit design choices made by states that had expanded Medicaid by the end of 2014, we find that states have chosen to offer more generous coverage than what is required under federal law, either narrowing or eliminating the distinction between coverage levels for newly eligible adults and those for traditional adult beneficiaries, such as pregnant women, parents and guardians, or beneficiaries with disabilities. This suggests that states view the newly eligible beneficiaries as having the elevated health and health care needs that are common among low-income populations.

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5/7/15 – The Commonwealth Fund – Realizing Health Reform’s Potential

The Affordable Care Act’s Payment and Delivery System Reforms; A Progress Report at Five Years

By Melinda Abrams, Rachel Nuzum, Mark Zezza, Jamie Ryan, Jordan Kizla, and Stuart Guterman

In addition to its expansion and reform of health insurance coverage, the Affordable Care Act (ACA) contains numerous provisions intended to resolve underlying problems in how health care is delivered and paid for in the United States. These provisions focus on three broad areas: testing new delivery models and spreading successful ones, encouraging the shift toward payment based on the value of care provided, and developing resources for systemwide improvement. This brief describes these reforms and, where possible, documents their initial impact at the ACA’s five-year mark. While it is still far too early to offer any kind of definitive assessment of the law’s transformation-seeking reforms, it is clear that the ACA has spurred activity in both the public and private sectors, and is contributing to momentum in states and localities across the U.S. to improve the value obtained for our health care dollars.

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5/5/15 – The Commonwealth Fund – Realizing Health Reform’s Potential

Implementing the Affordable Care Act State Regulation of Marketplace Plan Provider Networks

By Justin Giovannelli, Kevin W. Lucia and  Sabrina Corlette

Health plans with relatively narrow provider networks have generated widespread debate, mainly concerning the level of regulatory oversight necessary to ensure plans provide consumers meaningful access to care. The Affordable Care Act creates the first federal standard for network adequacy in the commercial insurance market for plans offered through the law’s insurance marketplaces. However, states continue to play a primary role in setting and enforcing network rules. This brief examines state network adequacy standards for marketplace plans in the 50 states and District of Columbia. We identify state requirements in effect at the outset of marketplace coverage, focusing on quantitative measures of network sufficiency and rules designed to ensure the delivery of accurate and timely provider directories. We then explore the extent to which those standards evolved for 2015. Though regulatory changes were limited in year one, states were most likely to act to promote network transparency and enhance oversight.

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5/4/15 – Kaiser Health News – Paying Medicaidare Enrollees To Get Checkups, Quit Smoking and Lose Weight: Will It Pay Off?

By Phil Galewitz

When Bruce Hodgins went to the doctor for a checkup in Sioux City, Iowa, he was asked to complete a lengthy survey to gauge his health risks. In return for filling it out, he saved a $10 monthly premium for his Medicaid coverage.

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4/30/15 - Kaiser Family Foundation - How Are Hospitals Faring Under the Affordable Care Act? Early Experiences from Ascension Health

By Peter Cunningham, Rachel Garfield, and Robin Rudowitz

Expanded health insurance coverage through the Affordable Care Act (ACA) is having a major impact on many of the nation’s hospitals through increases in the demand for care, increased patient revenues, and lower uncompensated care costs for the uninsured. In anticipation of higher revenues from patient care, the ACA calls for reductions in Medicaid Disproportionate Share Hospital (DSH) payments that support hospitals that serve a large number of Medicaid and uninsured patients to help cover the costs of uncompensated care. DSH cuts were scheduled to begin in 2014 but were delayed to FY2018. While many people are focusing on how these changes affect public hospitals and large urban safety net systems, many not-for-profit hospitals that have a strong tradition and mission of caring for underserved populations also may be affected. The size of the impact on specific hospitals will depend, among other factors, on whether hospitals are located in states that expanded Medicaid coverage through the ACA.

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4/29/15 – Kaiser Family – Data Note: How Has the Individual Insurance Market Grown Under the Affordable Care Act?

By Larry Levitt, Cynthia Cox and Gary Claxton

The individual (or “non-group”) insurance market has changed substantially under the Affordable Care Act (ACA). Starting in 2014, the health law put in place new rules for what types of plans can be sold, required insurance companies to guarantee access to everyone regardless of health status, and limited the factors insurers could use in setting premiums. The law also created new Health Insurance Marketplaces, where low- and moderate- income consumers without access to other affordable coverage could obtain federal tax credits to help them pay their premiums.

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4/28/15 – AHIP – Covered Populations and Premiums

By Alicia Caramenico

Health insurance premiums are not arbitrary. Each year, health insurance premiums are set based on complex factors that help estimate the costs of providing coverage to all individuals in the health insurance risk pool.

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4/22/15 – Oliver Wyman - ACO Update: A Slower Pace Of Growth In 2014

Almost 70 percent of Americans now have access to an accountable care organization for their health needs – By Niyum Ghandi - Despite well-publicized departures from Medicare’s Pioneer ACO Program, the number of accountable care organizations (ACOs) continued to rise last year, though at a slower pace than in 2013. Almost 70 percent of the U.S. population now lives in localities served by ACOs, and 44 percent live in areas served by two or more. The total number of ACOs participating in Medicare programs has increased to 426, up from 368 in January 2014 and 134 in January 2013.

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4/21/15 – Kaiser Family Foundation - Demonstrations to Improve the Coordination of Medicare and Medicaid for Dually Eligible Beneficiaries: What Prior Experience Did Health Plans and States Have with Capitated Arrangements?

By Rivka Weiser and Marsha Gold

Individuals who are dually eligible for Medicare and Medicaid (“dually eligible beneficiaries”) constitute a diverse population with extensive and varied needs for services, requiring careful coordination of the benefits covered across the two programs. The Financial Alignment Initiative was developed by the Federal Coordinated Health Care Office in the Centers for Medicare and Medicaid Services (CMS) in an effort to work with states to improve the coordination of all Medicare and Medicaid covered benefits, and enhance the care provided to dually eligible beneficiaries.

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4/21/15 – Kaiser Family Foundation – Kaiser Health Tracking Poll: April 2015

By Bianca DiJulio, Jamie Firth and Mollyann Brodie

This month’s Kaiser Health Tracking Poll finds public opinion of the Affordable Care Act (ACA) continues to be almost evenly split, with 43 percent reporting a favorable view and 42 percent reporting an unfavorable view. The share with a favorable view exceeds the share with an unfavorable view for the first time since November 2012, albeit by one percentage point, and the difference is within the survey’s margin of sampling error and is not statistically significant.  When asked about health care priorities for the President and Congress, the change that comes out on top for Democrats, Republicans and independents alike is making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them, with three-quarters of the public (76 percent) saying this should be a top priority.  Sixty percent say that government action to lower prescription drug prices should be a top priority and majorities say things like provider network protections and increased transparency related to the prices and quality of health care should be top priorities. Other than high-cost prescription drugs, Democrats, Republicans and independents have different ideas of their top priorities in health care. In terms of the availability of price and quality information, fewer than 1 in 5 say they have seen any information comparing the quality or prices for hospitals, doctors, or health insurers in the past 12 months, and fewer than 1 in 10 report using these types of information.

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4/17/15 – Kaiser Family Foundation - The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

By Rachel Garfield, Anthony Damico, Jessica Stephens and Saman Rouhani

An UpdateOne of the major coverage provisions of the 2010 Affordable Care Act (ACA) is the expansion of Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,724 for a family of three1). This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for states.

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Click here to view Technical Appendix A: Household Construction

Click here to view Technical Appendix B: Immigration Status Imputation

Click here to view Technical Appendix C: Imputation of Offer of Employer-Sponsored Insurance


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4/16/15 – Kaiser Family Foundation – Coverage of Contraceptive Services: A Review of Health Insurance Plans in Five States

By Laurie Sobel, Alina Salganicoff and Nisha Kurani

Insurance coverage of contraceptives has been the focus of legislative efforts at the state and federal level for many decades. With the passage of the Patient Protection and Affordable Care Act (ACA) came the requirement that most private plans provide coverage for women’s preventive health care, including all prescribed FDA-approved contraceptive services and supplies, without cost-sharing. Federal guidance issued on preventive services coverage requirements states that plans are permitted to apply reasonable medical management techniques to “control cost and promote efficient delivery of care.” Since the provision became effective in August 2012, there have been ongoing anecdotal reports of some women experiencing difficulties in securing no-cost coverage from their plans.

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4/13/15 – Kaiser Family Foundation - Where Are States Today? Medicaid and CHIP Eligibility Levels for Adults, Children, and Pregnant Women

This fact sheet provides an overview of eligibility levels for parents, other non-disabled adults, children, and pregnant women in Medicaid and CHIP. The data are based on eligibility levels reported by states as of January 2015, updated to reflect state Medicaid expansion decisions as of April 2015. The findings highlight Medicaid’s expanded role for low-income adults under the Affordable Care Act (ACA) and its continued role as a primary source of coverage for children and pregnant women.

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4/10/15 - The Commonwealth Fund - Health Care Coverage and Access in the Nation's Four Largest States

Results from the Commonwealth Fund Biennial Health Insurance Survey, 2014

By Petra W. Rasmussen, Sara R. Collins, Michelle M. Doty, and Sopihie Beutel

Across the country’s four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. Similarly, lower percentages of New Yorkers and Californians reported having a medical bill problem in the past 12 months or having accrued medical debt compared with Floridians and Texans. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state’s uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics.

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4/1/15 – CHCS - Exploring the Feasibility of Including Medicare-Medicaid Enrollees in Medicaid Accountable Care Organizations

By Rob Houston and Michelle Herman Soper

States and the federal government are pursuing new approaches to improve alignment and coordination between Medicare and Medicaid for dually eligible individuals. Some states are exploring Medicaid accountable care organizations (ACOs) as one potential approach to improving outcomes and reducing expenditures for these beneficiaries. However, when deciding whether to include Medicare-Medicaid enrollees in Medicaid ACO programs, states must weigh the feasibility and potential benefits against potential costs and complexities.

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3/26/15 – The Commonwealth Fund - New Report: More Than $5 Billion In Total Consumer Benefits From Affordable Care Act’s Medical Loss Ratio Provision

Review of Payment Data Finds Consumer Rebates Dropped to $325 Million in 2013, as Insurers Stepped Up Compliance with the Law

The Affordable Care Act’s medical loss ratio (MLR) provision yielded more than $5 billion in benefits to consumers from 2011 through 2013, either through the rebates that insurance companies have paid to them or through reduced health plan spending on overhead, according to a new Commonwealth Fund report. The MLR provision, which went into effect in 2011, requires insurers to spend at least 80 percent (for small-group and individual plans) or 85 percent (for large-group plans) of premiums on medical care and quality improvement.

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3/25/15 – Kaiser Family Foundation – Awaiting New Medicaid Managed Care Rules: Key Issues to Watch

By Juila Paradise and MaryBeth Musumeci

Today, more than half of all Medicaid beneficiaries are enrolled in risk-based managed care organizations (MCOs) through which they receive all or most of their care. In addition, many beneficiaries receive at least some services through prepaid health plans that provide limited benefits, such as dental or mental health care, on an at-risk basis. Not all state Medicaid programs contract with MCOs, but a large and growing number are doing so, and some states mandate that beneficiaries enroll in MCOs to receive Medicaid benefits. Many states are expanding their MCO programs to include larger geographic areas and more medically complex beneficiaries, and integrating additional services, including behavioral health care and long-term services and supports (LTSS), with physical health care. Further, states that have adopted the Affordable Care Act (ACA)’s Medicaid expansion are also relying largely on MCOs to serve the millions of newly eligible adults. In FY 2013, capitation payments to comprehensive MCOs accounted for about 28% of Medicaid spending nationally.

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3/24/15 – CHCS – Medicaid Accountable Care Organizations: State Update

Across the country, states are exploring the viability of Medicaid accountable care organizations (ACOs) that align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable. To date, eight states have launched Medicaid ACO programs, and nine more are actively pursuing them. This fact sheet from the Center for Health Care Strategies (CHCS) walks through current progress for Medicaid ACOs. It provides a definition for ACO and describes how emerging state programs are seeking to drive accountability through three key activities: (1) implementing a value-based payment structure; (2) measuring quality improvement; and (3) collecting and analyzing data. It also provides a glimpse of some early state successes.

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3/2015 – CHCS - Population Health in Medicaid Delivery System Reforms

By Maia Crawford and Tricia McGinnis

State policymakers increasingly recognize that improving health outcomes is as much about addressing the social determinants of poor health as it is about providing high-quality medical care. A number of states are testing payment models that reward good outcomes over greater volume and allow providers to invest in nonmedical interventions that improve health. Medicaid accountable care organizations (ACOs), or other ACO-like models, offer a prime opportunity to meld population health and payment and delivery system reforms.

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3/19/15 – The Commonwealth Fund - Testimony: The Affordable Care Act at Five Years

By David Blumenthal, M.D.

Thank you, Chairman Hatch, Senator Wyden, and members of the Committee, for this invitation to testify on the Affordable Care Act at five years. Research from The Commonwealth Fund and other sources demonstrate that the Affordable Care Act is helping to reduce the number of Americans who are uninsured and improving access to health care. Currently, more than 25 million people are estimated to have health insurance under the provisions of the ACA. About 11.7 million have selected a plan through the insurance marketplaces―8.8 million through the federal website healthcare.gov and 2.8 million through state-based marketplaces. An additional 10.8 million have enrolled in Medicaid or the Children’s Health Insurance Program, or CHIP. Finally, nearly 3 million more young adults are covered under their parent’s plan compared to 2010.
 
 

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3/2015 – CHCS - Health Reform’s Impact on Charity Care

By Susan Shin & Shannon McMahon

The Affordable Care Act (ACA) is changing the traditional role of charity care programs as safety net providers. The ACA’s Medicaid expansion and subsidized marketplace plans are giving millions of uninsured Americans options instead of charity care. This brief explores how four charity care programs in different states – CareLink (TX), Portico Healthnet (MN), Ingham Health Plan (MI), and Kaiser Permanente’s Charitable Health Coverage program (multiple states) – are responding to the changing health care environment. It examines their benefit packages; membership and eligibility; outreach and enrollment strategies; financial models; and new roles in providing consumer assistance.

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3/11/15 – Kaiser Family Foundation - Consumer Assets and Patient Cost Sharing

By Gary Claxton, Matthew Rae, and Nirmita Panchal

Higher cost sharing in private insurance has been credited with helping to slow the growth of health care costs in recent years. Plans with higher deductibles and other point of service costs provide health plan enrollees with incentives to make more cost conscious health care choices. For families with limited resources, however, high cost sharing can be a potential barrier to care and may lead these families to significant financial difficulties. Many current policies expose individual enrollees to thousands of dollars in cost sharing expenses and family expenses can easily top ten thousand dollars when someone becomes seriously ill.

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3/8/15 - Crain's Detroit Business - Many Michigan ACOs Saving Millions Under Medicare's Cost-Saving Plan

By Jay Greene

Many of the 15 accountable care organizations in Michigan are saving millions of dollars for the Medicare program along with passing along significant financial rewards to hundreds of participating physicians, according to several local ACO executives. Under Medicare's ACO cost containment program — begun as three-year pilot projects outlined in the Affordable Care Act of 2010 — groups of hospitals, physicians and other providers band together to coordinate care for seniors enrolled in traditional Medicare.

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3/2/15 – McKnight’s - New Medicare ACO to be Unveiled Soon

By John Hall

The government's top health insurer has announced that providers could get a first look at a new type of Medicare accountable care organization this month. It has been modeled closely after a controversial managed care program and includes new waivers for skilled nursing facilities.

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3/2/15 – McKnight’s – Controversial Medicare Auditors Group Changes Name, Website

By John Hall

A Medicare payment watchdog group saddled with huge case backlogs and heavily criticized for causing delays in resolving reimbursement issues has changed its name and location on the web.

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2/25/15 – McKnight’s – Medicaid Expansion Plans Fade in Several States

By John Hall

Several so-called “red states” are leaning toward or have outright abandoned plans to allow expansion of their Medicaid programs, bucking a nationwide groundswell of program enrollment under the president's signature healthcare reform law.

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2/25/15 – The Commonwealth Fund – How will the Affordable Care Act Affect the Use of Health Care Services?

By Sherry Glied and Stephanie Ma

In January 2014, the Affordable Care Act extended access to health insurance coverage to an estimated 30 million previously uninsured people. This issue brief provides state-level estimates of the increased demand for physician and hospital services that is expected to result from expanded access and assesses the sufficiency of the existing supply of providers to accommodate the anticipated increase in demand. We project that primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally. Increases of the magnitude likely to be generated by the Affordable Care Act will have modest effects on the demand for health services, and the existing supply of providers should be sufficient to accommodate this increased demand.  

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2/25/15 – CHCS - State Payment and Financing Models to Promote Health and Social Service Integration

By Maia Crawford and Rob Houston

States are realizing the potential benefits associated with integrating medical care and social services, and are beginning to take the first steps toward developing financing and payment models that encourage this connection. This brief, made possible by The Commonwealth Fund, reviews potential financing mechanisms to facilitate integration, with a particular focus on Medicaid. Drawing from interviews with experts across the country, it offers models ranging from one‐time seed funding for pilot projects to blended or braided financing arrangements that support comprehensive integration. The brief also highlights payment methodologies designed to influence providers to incorporate social services into their care efforts, with a focus on moving away from fee‐for‐service and toward value‐based payment strategies like global budgets.

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2/25/15 – Kaiser Family Foundation - Are Premium Subsidies Available in States with a Federally-run Marketplace? A Guide to the Supreme Court Argument in King v. Burwell

By MaryBeth Musumeci

On March 4, 2015, the Supreme Court will hear oral argument in King v. Burwell, a case challenging the availability of the Affordable Care Act’s (ACA) premium subsidies in states with a Federally-run Marketplace (including states with a Federally-facilitated Marketplace (FFM) and states with a Partnership Marketplace). In addition to expanding eligibility for Medicaid, the ACA increases access to affordable health insurance and reduces the number of uninsured by providing for the establishment of Marketplaces that offer qualified health plans and administer premium subsidies and cost-sharing reductions to make coverage affordable. 

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2/2015 – CHCS - Supporting Social Service Delivery through Medicaid Accountable Care Organizations: Early State Efforts

By Roopa Mahadevan and Rob Houston

Given the often overwhelming prevalence of social needs facing Medicaid populations, including housing, transportation, and nutrition, aligning social services and supports with health care delivery is critical. Many states recognize the connection between social determinants of health and health care utilization and outcomes, and are building the infrastructure to support social service delivery through accountable care organization (ACO) programs. This brief, made possible through support from The Commonwealth Fund, highlights the initial efforts of seven states — Colorado, Maine, Minnesota, New York,Oregon, Vermont, and Washington — that participated in CHCS’ Medicaid ACO Learning Collaborative. These states each have sought to incorporate social services into their existing or emerging Medicaid ACO models. The brief outlines key themes and considerations from these early adopters to help additional states support collaboration between ACO and social service providers.

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2/18/15 - AJMC - Predicting Nursing Home Placement Among Home- and Community-Based Services Program Participants

By Melissa A. Greiner, MS; Laura G. Qualls, MS; Isao Iwata, MD, PhD, EdM; Heidi K. White, MD; Sheila L. Molony, PhD, APRN, GNP-BC; M. Terry Sullivan, RN, MSW, MSN; Bonnie Burke, MS; Kevin A. Schulman, MD; and Soko Setoguchi, MD, DrPH

Lifetime risk of nursing home use is estimated at more than 40% and is projected to increase with greater life expectancy among Baby Boomer retirees.1 Medicaid is the primary payer of nursing home services in the United States at an average annual cost of $84,000 per beneficiary.2 In 2010, long-term care services for older patients accounted for more than one-third of state Medicaid spending.3 At a total annual cost of over $140 billion, Medicaid costs for long-term care will likely be part of ongoing discussions about state and federal deficit reduction.

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2/17/15 – Kaiser Family Foundation – The ACA and Medicaid Expansion Waivers

By Robin Rudowitz, Samantha Artiga and MaryBeth Musumeci

Under the Affordable Care Act (ACA), Medicaid plays a key role in efforts to reduce the number of uninsured by expanding eligibility to nearly all low income adults with incomes at or below 138% FPL ($16,242 per year for an individual in 2015); however, the Supreme Court ruling on the ACA’s constitutionality effectively made the expansion a state option. As of February 2015, 29 states including DC are implementing the expansion. Nearly all states (24 of 29) are implementing the expansion as set forth by law, but a limited number of states have obtained or are seeking approval through Section 1115 waivers to implement the expansion in ways that extend beyond the flexibility provided by the law. More states are discussing alternative models through waivers as a politically viable way to implement expansion in order to extend coverage and capture federal dollars.

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2/11/15 – Kaiser Family Foundation – The Cost of Care with Marketplace Coverage

By Gary Claxton, Cynthia Fox, and Mathew Rae

Private insurance plans typically require some form of cost sharing (also called out-of-pocket costs) when enrollees receive a health care service covered by their plan.  These expenses, which are in addition to the amount an enrollee spends on his or her monthly premium, come in a variety of forms.

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2/11/15 – Kaiser Family Foundation – Cost-Sharing Subsidies in Federal Marketplace Plans

By Gary Claxton and Nirmita Panchal

Most health plans require enrollees to pay a portion of the cost of care when they seek services, in addition to any premium that they must pay for the plan.  Plans generally have several forms of cost sharing, including deductibles, which must be paid by patients before the plan begins paying toward some or most services, and copayments or coinsurance, which must be paid by patients at the time they receive services.  A recently published KFF brief describes the major cost sharing provisions of the bronze, silver, gold and platinum health plans available through the federal Marketplace.

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2/8/15 – Crain’s Detroit Business – Many Michigan ACOs Saving Millions Under Medicare’s Cost Saving Plan

By Jay Greene

Many of the 15 accountable care organizations in Michigan are saving millions of dollars for the Medicare program along with passing along significant financial rewards to hundreds of participating physicians, according to several local ACO executives.  Under Medicare's ACO cost containment program — begun as three-year pilot projects outlined in the Affordable Care Act of 2010 — groups of hospitals, physicians and other providers band together to coordinate care for seniors enrolled in traditional Medicare.  If they generate sufficient savings and hit predetermined quality targets in their second contract year, the ACOs split the savings with Medicare.

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2/6/15 – Kaiser Family Foundation - State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries

This map shows the current status of the state demonstration proposals to integrate care and align financing and/or administration for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program and consequently account for a disproportionate share of spending in both programs.

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2/3/15 – CHRT - Affordable Care Act Funding: An Analysis of Grant Programs under Health Care Reform – FY2010-FY2014  

By Joshua Fangmeier, MPP, Kersten Lausch, MMP, and Marianne Udow-Phillips, MHSA 

The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010, and funds were appropriated to expand access to care, implement broad private insurance reforms, and enhance the public health infrastructure. In order to administer these new grant programs, the ACA created a number of new funding sources in the following categories: 
 
Community-based prevention: Includes a series of programs to increase investment in the public health infrastructure. The primary source of funding for these programs is from the Prevention and Public Health Fund (PPHF).
 
 

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2/2/15 – MedPAC – MedPAC Comment on CMS’s Medicare Shared Saving Program: Accountable Care Organizations Proposed Rule

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare and Medicaid Services (CMS) Medicare shared savings program: Accountable care organizations proposed rule, published in the Federal Register on December 8, 2014. The proposed rule addresses the next phase of the Medicare Shared Savings Program (MSSP). In view of their competing demands and limited resources, we especially appreciate your staff’s thoughtful approach to improving the MSSP. In this letter we comment on several issues discussed in the proposed rule, some of which we raised in our June 16, 2014 letter.1 We appreciate your staff taking up the issues that MedPAC and others have raised and their thoughtful analysis of each of these issues.

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2/2/14 – Kaiser Family Foundation - An Overview of New CMS Data on the Number of Adults Enrolled in the ACA Medicaid Expansion

By Laura Snyder, Samantha Artiga, Robin Rudowitz and Jessica Stephens

New preliminary data from the Medicaid Budget and Expenditure System (MBES) released by the Centers for Medicare and Medicaid Services (CMS) details for the first time the number of adults enrolled in Medicaid under the new Affordable Care Act (ACA) Medicaid expansion category. The data show that as of March 2014, among 48 states reporting data, 4.8 million adults out of the total 54.1 million individuals enrolled in Medicaid were in the ACA Medicaid expansion category (referred to as the VIII Group based on the section of legislation that added the expansion eligibility category). Missing from this preliminary data report are DC, North Dakota and California, which due to its size accounts for a large share of Medicaid enrollees.

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Click here to view the January - March 2014 Medicaid MBES Enrollment Report


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1/29/15 – Kaiser Family Foundation - Adults who Remained Uninsured at the End of 2014

By Rachel Garfield and Katherine Young

In January 2014, the major coverage provisions of the Affordable Care Act (ACA)—including the expansion of Medicaid eligibility and the availability of subsidized coverage through Health Insurance Marketplaces— went into effect. As the first year of new coverage under the ACA comes to a close and the end of the second open enrollment period nears, there is great interest in understanding why some people continue to lack coverage and in reaching out to the eligible uninsured. This report, based on the 2014 Kaiser Survey of Low-Income Americans and the ACA, profiles the nonelderly adult population that remained uninsured as of Fall 2014.

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1/23/15 – Kaiser Family Foundation - Federal and State Standards for "Essential Community Providers" under the ACA and Implications for Women's Health

By Cristina Jade Pena, Laurie Sobel and Alina Salganicoff 

Millions of previously uninsured Americans have gained access to health coverage through the Affordable Care Act (ACA) Marketplace plans. The provider networks of the Marketplace plans determine where enrollees can seek medical care. Many of these individuals have received their care for years from safety-net providers, such as community health centers and family planning clinics. Recognizing the important role these providers play in promoting continuity of care as people transition from being uninsured and relying on safety net clinics to private insurance, and to meet the increased demand for medical care in underserved communities, Congress established general requirements to assure that these providers have the opportunity to participate in the health plans that are offered through the Marketplaces.

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1/21/15 – Kaiser Family Foundation - Abortion Coverage in Marketplace Plans, 2015

By Alina Salganicoff and Laurie Sobel

In the negotiations leading to the passage of the Affordable Care Act (ACA), abortion coverage was one of the thorniest and most controversial of many controversial issues. Along with immigrant coverage, it was one of the final issues negotiated before the House vote. Initially, the House passed the Stupak-Pitts Amendment, which would have prohibited any plans in the Marketplaces from receiving federal subsidies if they covered abortion. The final law, however, included a compromise proposed by former Senator Ben Nelson of Nebraska which allows states to ban abortion coverage on their ACA Health Insurance Marketplace and requires plans that offer abortion coverage to segregate funds, assuring that no federal funds are used for abortion coverage. After the ACA was passed, President Obama also signed an executive order to emphasize that no federal funds can be used to pay for abortion beyond the Hyde limitations.

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1/20/15 – Associated Press – Government Health Care Website Quietly Sharing Personal Data

By Ricardo Alonso-Zaldivar and Jack Gillum

 
The government's health insurance website is quietly sending consumers' personal data to private companies that specialize in advertising and analyzing Internet data for performance and marketing, The Associated Press has learned.  The scope of what is disclosed or how it might be used was not immediately clear, but it can include age, income, ZIP code, whether a person smokes, and if a person is pregnant. It can include a computer's Internet address, which can identify a person's name or address when combined with other information collected by sophisticated online marketing or advertising firms. The Obama administration says HealthCare.gov's connections to data firms were intended to help improve the consumer experience. Officials said outside firms are barred from using the data to further their own business interests.
 

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1/20/15 – The Commonwealth Fund - What's Behind Health Insurance Rate Increases? An Examination of What Insurers Reported to the Federal Government in 2013–2014

The Affordable Care Act requires health insurers to justify rate increases that are 10 percent or more for nongrandfathered plans in the individual and small-group markets. Analyzing these filings for renewals taking effect from mid-2013 through mid-2014, this brief finds that the average rate increase submitted for review was 13 percent. Insurers attributed the great bulk of these larger rate increases to routine factors such as trends in medical costs. Most insurers did not attribute any portion of these medical cost trends to factors related to the Affordable Care Act. The ACA-related factors mentioned most often were nonmedical: the new federal taxes on insurers, and the fee for the transitional reinsurance program. On average, insurers that quantified any ACA impact attributed about a third of their larger rate increases to these new ACA assessments.

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1/18/15 – Crain’s Detroit Business - Affordable Care Act Spurs Hospitals To Identify, Address Unmet Community Health Needs

By Jay Greene

Hospitals in Southeast Michigan are working to identify unmet or significant health needs in their immediate markets under new rules mandated by the Patient Protection and Affordable Care Act of 2010. One of the many little-known provisions of health care reform requires nonprofit hospitals — beginning in tax year 2012 — to conduct extensive community health needs assessment reviews in collaboration with community organizations every three years. Section 501(r) of the Internal Revenue Service code also requires hospitals to develop an implementation strategy to address those needs and report the projects and expenditures on Schedule H on the annual Form 990 to the IRS. Infant mortality reduction, obesity, cancer, diabetes, heart disease, asthma and signing up the uninsured are several community benefit projects being undertaken by nonprofit hospitals in Southeast Michigan. 

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1/15/15 – The Commonwealth Fund – New Survey: More Americans Could Get Needed Health Care and Afford to Pay Their Medical Bills in First Year of ACA Enrollment

For the First Time, Commonwealth Fund’s Biennial Health Insurance Survey Also Finds Sharp Declines in Uninsured Rates, Particularly Among Young Adults and People with Low Incomes - The number of Americans reporting they did not receive needed health care because of its cost dropped for the first time since 2003, falling from 80 million in 2012 to 66 million, according to The Commonwealth Fund’s 2014 Biennial Health Insurance Survey. And the number saying they had trouble paying their medical bills or were paying off medical debt fell from 75 million in 2012 to 64 million—the first time it declined since this question was initially asked in 2005.  The survey, discussed in the new brief, The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect, was fielded between July and December 2014 and asked respondents about their health insurance status, access to health care, and medical bill problems and debt over the previous 12 months.

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1/9/15 - MedPAC – January 2015 MedPAC and MACPAC Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid

We are pleased to announce the release of a data book: Beneficiaries Dually Eligible for Medicare and Medicaid. This joint data book is the result of an effort by MedPAC and MACPAC to create a common understanding of the characteristics of dual-eligible beneficiaries and their use of services, including demographic, expenditure, and health care utilization information. This is the second edition of this book, updated with 2010 data and new displays of 2007-2010 trends in the dually eligible population’s composition, service use, and spending.
 

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1/8/15 - The Commonwealth Fund - State Trends in the Cost of Employer Health Insurance Coverage, 2003-2013

By Cathy Schoen, David Radley and Sara R. Collins

From 2010 to 2013—the years following the implementation of the Affordable Care Act—there has been a marked slowdown in premium growth in 31 states and the District of Columbia. Yet, the costs employees and their families pay out-of-pocket for deductibles and their share of premiums continued to rise, consuming a greater share of incomes across the country. In all but a handful of states, average deductibles more than doubled over the past decade for employees working in large and small firms. Workers are paying more but getting less protective benefits. Costs are particularly high, compared with median income, in Southern and South Central states, where incomes are below the national average. Based on recent forecasts that predict an uptick in private insurance growth rates starting in 2015, securing slow cost growth for workers, families, and employers will likely require action to address rising costs of medical care services.

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Click here to view the Chartpack


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1/6/15 - Kaiser Family Foundation - Analysis of 2015 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

By Cynthia Cox, Larry Levitt, Gary Claxton, Rosa Ma and Robin Duddy-Tenbrunsel

The map and 50-state table are updates to our September analysis, which examined premium changes for the lowest-cost bronze plan and the two lowest-cost silver plans in 16 major cities. The second-lowest cost silver plan in each state is of particular interest as it acts as a benchmark that helps determine how much assistance eligible individuals can receive in the form of federal tax credits. Although premium changes vary substantially across and within states, premium changes for 2015 in general are modest when looking at the low-cost insurers in the marketplaces, where enrollment is concentrated. 

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1/5/15 - Health Affairs - The Share Of People With High Medical Costs Increased Prior To Implementation Of The Affordable Care Act

By Peter J. Cunningham

The percentage of Americans with high medical cost burdens—those who spend more than 10 percent of their family income on out-of-pocket expenses for health care—increased to 19.2 percent in 2011, after having stabilized at 18.2 percent during the Great Recession of 2007–09. The increase was driven primarily by growth in premium expenses in 2009–11 for people with employer-sponsored coverage. Out-of-pocket spending on health services, especially for prescription drugs, continued to decrease between 2007–09 and 2011. Medical cost burdens were highest for income groups most likely to benefit from the Affordable Care Act’s coverage expansions, including people with private insurance coverage. Those who purchased nongroup coverage before the implementation of the health insurance Marketplaces in 2014 spent an especially high proportion of their income on health care, and over half of these people will qualify for premium subsidies in the Marketplaces. 

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1/2015 – CHCS -  Integrated Appeals Processes for Medicare-Medicaid Enrollees: Lessons from States

By Alexandra Kruse and Ann Mary Phillip

A user-friendly appeals process that gives people an easy way to request reconsideration of coverage or payment decisions is critical to the success of person-centered, integrated care programs. Misalignments between Medicare and Medicaid appeals processes, however, pose barriers for states seeking to integrate these mechanisms in new models of care. This brief explores opportunities for states to develop an integrated appeals process, either through a Dual Eligible Special Needs Plan (D-SNP) or a financial alignment demonstration. It presents lessons from Minnesota’s D-SNP-based Senior Health Options program and the Health Plan of San Mateo’s integrated health plan on aligning appeals processes, coverage determinations, and provider payments at the health plan level. It also highlights a significant opportunity for states implementing financial alignment demonstrations to develop fully integrated appeals processes using early insights from New York’s Fully Integrated Duals Advantage program. The lessons outlined herein can inform state, health plan, and federal efforts to improve beneficiary experience in integrated programs.

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12/17/14 – Kaiser Health News - Nearly 2.5 Million Consumers Have Selected Health Plans On Federal Marketplace 

By Mary Agnes Carey 

More than 1 million people selected a health plan during the fourth week of the health law’s open enrollment and nearly 2.5 million have done so since it began Nov. 15, federal officials said Tuesday. “And this was before an extremely busy weekend,” said Andy Slavitt, principal deputy administrator of the Centers for Medicare & Medicaid Services, which oversees the federal online marketplace used by 37 states. Tuesday’s report did not include enrollment for the final three days before the Dec. 15 deadline for people to enroll if they want coverage to begin Jan. 1. Just over half of those individuals who have selected plans since the health law’s second open enrollment season began are returning customers. Enrollment in the states running their own exchanges is not yet available.
As expected, interest in healthcare.gov soared in the final days before the mid-December deadline, with 1.6 million people phoning the call center from Dec. 13 through Dec. 15, officials told reporters.
 

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12/10/14 – The Commonwealth Fund - Creating Connections: An Early Look at the Integration of Behavioral Health and Primary Care in Accountable Care Organizations

By Katherine Tierney, Aleen Saunders and Valerie Lewis

Individuals with mental illness are among the highest need, costliest patients in the U.S. health care system, yet they receive inadequate behavioral health care. Researchers have proposed various models that integrate behavioral health with primary care. These approaches have the capacity to improve patient care and outcomes in terms of both physical and behavioral health. However, implementing integration models under traditional fee-for-service payment structures presents significant challenges. Emerging payment models—like accountable care organizations (ACOs)— may allow for more coordinated care, including integrated behavioral and physical health care. ACOs are groups of providers held accountable for the quality and total cost of care of a defined patient population. Under the model, groups of providers receive modified reimbursements that offer incentives to reduce costs and improve care. This report explores how ACOs are approaching the integration of behavioral health into primary care by showcasing two models of behavioral health and primary care integration. The two ACOs vary in their approach to integration as well as in other characteristics. The first, Crystal Run Healthcare ACO, is using a combination of integration approaches, which we refer to as a colocation plus collaboration model. The goal is to improve collaboration among providers through proximity and improved information sharing. 

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12/2/14 – Modern Healthcare - Why Medicare Won't Force Penalties On ACOs That Don't Save Money

By Melanie Evans

Medicare’s accountable care contracts have proliferated fast and the program is poised to expand again. But federal officials acknowledged that it may be difficult to maintain that momentum without easing the financial risk of participating. The officials responsible for the initiative, created by the 2010 healthcare reform law, say it’s worth tweaking the structure to keep healthcare providers committed to the cause. The CMS and the hospitals and doctors that formed roughly 330 accountable care organizations in the program have wrangled since before its 2012 launch over the right balance of bonuses and penalties employed to improve quality and reduce the cost of healthcare.  Nearly all of the participants so far have chosen a track that allows them to earn bonuses if they meet cost and quality targets, with no risk of paying Medicare back if they allow costs to rise beyond benchmarks. Now the CMS will allow them to keep operating that way for another three years before wading into the riskier end of the ACO model.

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12/2014 – CHCS - Contacting Hard-to-Locate Medicare and Medicaid Members: Tips for Health Plans

By Sara Barth and Brianna Ensslin

Health plans serving individuals with significant health and social service needs, including people eligible for both Medicare and Medicaid, must be able to locate and contact members before they can effectively serve them. Unfortunately, health plans often receive inaccurate contact information for dually eligible enrollees. Additionally, contact information must be updated frequently because many Medicare‐Medicaid enrollees have unstable housing situations or use pre‐paid cell phones that run out of minutes. As a result, health plans face challenges reaching and serving members in a timely way. This brief provides tips on contacting hard‐to‐locate members from participants in PRIDE (Promoting Integrated Care for Dual Eligibles), a project made possible by The Commonwealth Fund. The participating organizations – CareSource (Ohio), Commonwealth Care Alliance (Massachusetts), Health Plan of San Mateo (California), iCare (Wisconsin), Together4Health (Illinois), UCare (Minnesota), and VNSNY CHOICE (New York) – are working to advance strategies to provide high‐quality, cost‐effective care to Medicare‐Medicaid enrollees and other high‐need populations.

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12/2014 – CHCS – Integrated Appeals Process for Medicare-Medicaid Enrollees: Lessons From States

By Alexandra Kruse and Ann Mary Philip

A user-friendly appeals process that gives individuals a simple-to-use mechanism to request reconsideration of coverage or payment decisions is critical to the success of patient-centered, integrated care programs. Misalignments between Medicare and Medicaid appeals processes, however, pose barriers for states seeking to integrate these processes in new models of care. This brief explores opportunities for states to develop an integrated appeals process, either through a Dual Eligible Special Needs Plan (D-SNP) or a financial alignment demonstration. It presents lessons from Minnesota’s D-SNP-based Senior Health Options program and the Health Plan of San Mateo’s integrated health plan on aligning appeals processes, coverage determinations, and provider payments at the health plan level. It also highlights a significant opportunity for states implementing financial alignment demonstrations to develop fully integrated appeals processes using early insights from New York’s soon-to-be launched Fully Integrated Duals Advantage program. The lessons outlined herein can inform state, health plan, and federal efforts to improve beneficiary experience in integrated programs. 

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11/24/14 – MDCH - Michigan Announces Implementation Timeline Change For MI Health Link

The Michigan Department of Community Health (MDCH) today announced a change to the implementation timeline for MI Health Link, Michigan’s demonstration project to integrate care for individuals eligible for both Medicare and Medicaid. MDCH has changed the start date from January 1 to March 1 to ensure that the program is prepared to deliver services and coordinate care. Enrollment will begin in February 2015. MDCH and the Centers for Medicare and Medicaid Services (CMS) have agreed to delay the program to ensure that the necessary care coordination models, training, provider networks and systems are adequately prepared and tested prior to the start of enrollment. “As the population served through MI Health Link includes some of the most vulnerable in Michigan, it is imperative that we are confident that our program is ready to launch prior to beginning enrollment,” said Nick Lyon, Director of the MDCH. “By launching in March, we are continuing on a responsible course to ensure that our residents will receive the best care coordination possible.”
 

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11/24/14 – Kaiser Family Foundation - The ACA and Recent Section 1115 Medicaid Demonstration Waivers

By Robin Rudowitz, Samantha Artiga and MaryBeth Musumeci 

Under the Affordable Care Act (ACA), Medicaid plays a key role in efforts to reduce the number of uninsured by expanding eligibility to nearly all low income adults with incomes at or below 138% FPL ($16,105 per year for an individual in 2014); however, the Supreme Court ruling on the ACA effectively made the expansion a state option. As of November 2014, 28 states including DC are implementing the expansion. Under flexibility provided by the ACA’s Medicaid expansion, as well as pre-existing federal Medicaid law, the Medicaid expansion is being implemented differently across states in terms of what specific benefits are provided and how those services are delivered. To date, a limited number of states have obtained or are seeking approval through Section 1115 waivers to implement the expansion in ways that extend beyond the flexibility provided by the law. However, looking ahead, more states may pursue alternative models as a politically viable way to expansion in order to extend coverage and capture federal dollars.
 

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11/19/14 – Health Affairs - International Survey Of Older Adults Finds Shortcomings In Access, Coordination, And Patient-Centered Care

By Robin Osborn, Donald Moulds, David Squires, Michelle M. Doty and Chloe Anderson

Industrialized nations face the common challenge of caring for aging populations, with rising rates of chronic disease and disability. Our 2014 computer-assisted telephone survey of the health and care experiences among 15,617 adults age sixty-five or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States has found that US older adults were sicker than their counterparts abroad. Out-of-pocket expenses posed greater problems in the United States than elsewhere. Accessing primary care and avoiding the emergency department tended to be more difficult in the United States, Canada, and Sweden than in other surveyed countries. One-fifth or more of older adults reported receiving uncoordinated care in all countries except France. US respondents were among the most likely to have discussed health-promoting behaviors with a clinician, to have a chronic care plan tailored to their daily life, and to have engaged in end-of-life care planning. Finally, in half of the countries, one-fifth or more of chronically ill adults were caregivers themselves.
 

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11/13/14 – McKnight’s - Providers, CMS At Odds Over Dual Eligible Program

By Tim Mullaney

Some nursing homes and other providers are engaging in “bad behavior” by trying to persuade people to opt-out of a managed care demonstration project, a top government official recently claimed. But a long-term care leader disputes that providers acted with bad intentions, and told McKnight's that guidance from the Centers for Medicare & Medicaid Services was lacking. Five states are conducting the demonstration projects, in which people who are eligible for both Medicare and Medicaid can elect to have their benefits administered through a managed care plan. The theory is that this will lead to more coordinated, cost-efficient care. However, providers could see reimbursements reduced under this system. For that reason, some have engaged in scare tactics to convince beneficiaries to opt out, said Melanie Bella, director of the CMS Medicare-Medicaid Coordination Office.
 

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11/4/14 – CHCS - Show Me the Integration! Where We Are and What Lies Ahead for Duals Integration?

By Carolyn Ingram 

On November 4, 2014, Carolyn Ingram, CHCS senior vice president, moderated a panel titled Show Me the Integration! Where We Are and What Lies Ahead for Duals Integration? at the National Association of Medicaid Directors’ Fall Conference. Her presentation described the opportunities for Medicare and Medicaid alignment created by the Affordable Care Act and the progress that states have made in implementing new integrated care programs using financial alignment demonstrations and Medicare Advantage Dual Eligible Special Needs Plan (D-SNPs) platforms.

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11/2014 – CHCS - Risk Stratification to Inform Care Management for Medicare-Medicaid Enrollees: State Strategies

By Brianna Ensslin and Sarah Barth 

Individuals dually eligible for Medicare and Medicaid are among the highest-need populations in either program. States integrating care for this high-need population must ensure that individuals’ health and social service support needs are addressed promptly. Stratifying Medicare-Medicaid enrollees by their level of need may help states and health plans in better prioritizing and promptly addressing care management needs to ensure high-quality, timely care. This brief, made possible through support from The Commonwealth Fund and The SCAN Foundation, describes how three states — California, Ohio, and Virginia — are requiring integrated health plans to stratify Medicare-Medicaid enrollee by their level of need within new capitated financial alignment demonstrations. It details each state’s stratification process, including the data used, risk groups, and assessment time frames. This information can help guide states implementing financial alignment demonstrations, as well as states and health plans integrating care through Dual Eligible Special Needs Plans or managed long-term services and supports programs.
 

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10/23/14 – Yahoo News - 100 Days In Michigan: U-M Team Releases New Analysis Of State's Medicaid Expansion

Results From Initial Months Could Aid Other States Still Considering Expansion

Right out of the starting gate, Michigan's expansion of health coverage for the poor and near-poor holds lessons for other states that are still on the fence about expanding their own Medicaid programs under the Affordable Care Act, a new analysis shows. In an article in the New England Journal of Medicine, a team of University of Michigan Medical School researchers publish the first analysis of the initial results from the Healthy Michigan Plan, which launched this past April. In its first 100 days, the authors write, the plan enrolled 327,912 people with incomes below or just above the poverty level – beating projections for its entire first year. Almost 80 percent of them hadn't been enrolled in other state health programs for the poor. And 36 percent of those enrolled in the first two months had used their insurance to visit a doctor or clinic by the end of the fourth month.
 

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10/8/14 – Health Affairs - Low-Income Residents In Three States View Medicaid As Equal To Or Better Than Private Coverage, Support Expansion

By Arnold M. Epstein, Benjamin D. Sommers, Yelena Kuznetsov and Robert J. Blendon

Expansion of Medicaid under the Affordable Care Act to millions of low-income adults has been controversial, yet little is known about what these Americans themselves think about Medicaid. We conducted a telephone survey in late 2013 of nearly 3,000 low-income adults in three Southern states—Arkansas, Kentucky, and Texas—that have adopted different approaches to the options for expansion. Nearly 80 percent of our sample in all three states favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Yet awareness of their state’s actual expansion plans was low. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability. While the debate over Medicaid expansion continues, support for expansion is strong among low-income adults, and the perceived quality of Medicaid coverage is high.
 

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10/6/14 – The Commonwealth Fund - The Road to Accountable Care: Building Systems for Population Health Management

This case study series describes how three diverse organizations—Health Share of Oregon, Hill Physicians Medical Group, and Marshfield Clinic—are developing accountable care systems to improve the quality and reduce the costs of care, and ultimately improve the health of populations of patients insured by Medicare, Medicaid, and commercial health plans. They employ a constellation of strategies to identify and address unmet medical needs, improve care transitions, and reduce inefficiencies and unnecessary variation in care. Care managers, outreach workers, or virtual care teams help improve outcomes for patients with complex needs that are costly to treat. Data integration and analytics are key to their efforts, although the sophistication of these capabilities varies. Two study sites have established a record of savings, while the third is still proving the potential of its approach. Their progress to date suggests that payment reforms can foster the will and accountability necessary to transform care.
 

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9/19/14 – Crain’s Detroit Business - DMC’s Michigan Pioneer ACO Earns $14 Million From Medicare

By Jay Greene

Detroit Medical Center’s Michigan Pioneer ACO earned $14 million from Medicare in its second year of operation, beating the odds as fewer than half of the other 275 accountable care organizations that launched nationally in 2012 generated enough savings to receive checks. “While we are proud of our two years of achievements working together with our patients, our physicians, our hospitals and other providers to improve access to the services that our Medicare community needs, our efforts will continue,” said DMC CEO Joe Mullany in a statement. An ACO is a group of hospitals, physicians or other health care providers that agree to manage care, share savings and improve quality for a minimum of 5,000 Medicare patients in a contract with the Centers for Medicare and Medicaid Services.
 

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9/18/14 – The Commonwealth Fund - New Commonwealth Fund Report: Most People with ACA Marketplace Health Insurance Say They Can Afford Premiums; Lower-Income Adults Report Costs Similar to Employer Coverage

In Survey, Majority of Marketplace Shoppers Rated Their Experience Fair or Poor; But Most Who Enrolled Are Happy With Their Coverage, Confident They Can Afford the Health Care They Need

Sixty-one percent of adults paying premiums for health insurance purchased through the Affordable Care Act's marketplaces are finding it very or somewhat easy to afford them, according to a new Commonwealth Fund report. Premium and cost-sharing subsidies offered through the marketplaces appear to be working: more than two-thirds of adults with low or moderate incomes (under $28,725 for an individual) paid less than $125 a month in premiums for a single marketplace policy, similar to what adults in employer plans paid. Deductibles were also comparable for adults in this income range in employer and marketplace plans. The report, Are Americans Finding Affordable Coverage in the Health Insurance Marketplaces? tracked people’s experiences shopping for affordable health insurance coverage in the marketplaces in the first open enrollment period, October 2013–June 2014. 
 

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9/7/14 – Crain’s Detroit Business - State's $8B Test To Coordinate Medicare-Medicaid Care

Goal: Savings, Quality For Medicare-Medicaid Recipients

By Jay Greene

Michigan next year will join 10 other states in a bold experiment under health care reform that will begin to manage more than $8 billion worth of care for seniors and patients with disabilities who are covered under both Medicare and Medicaid. The goal of the three-year demonstration program is to reduce costs through greater coordination of care and to improve quality and outcomes for Michigan's most chronically ill population, said Stephen Fitton, the state's Medicaid director. "The integration of Medicare and Medicaid has been at cross purposes for decades, with incentives misaligned between physical health and behavioral health," Fitton said. "We want to bring all these different domains of care together." For example, Medicare now typically covers hospital, physician, pharmacy and some short-term rehabilitation and long-term care, or nursing home, costs. Medicaid covers some medical, dental, pharmacy and the majority of long-term-care nursing home costs.
 

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9/5/14 – Kaiser Family Foundation - Analysis of 2015 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

By Cynthia Cox and Larry Levitt and Gary Claxton and Rosa Ma and Robin Duddy-Tenbrunsel

With the second open enrollment period of the health insurance marketplaces approaching, this analysis provides an initial look at premium changes for marketplace plans for individuals in 15 states and the District of Columbia that have publicly released comprehensive data on rates or rate filings for all insurers. The analysis examines premium changes for the lowest-cost bronze plan and the two lowest-cost silver plans in 16 major cities. The second-lowest cost silver plan in each state is of particular interest as it acts as a benchmark that helps determine how much assistance eligible individuals can receive in the form of federal tax credits. The findings show that in general, individuals will pay slightly less to enroll in the second-lowest cost plan in 2015 than they did in 2014, prior to the application of tax credits.
 

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8/25/14 – The Columbus Dispatch - Home-Health Workers Go Unpaid Under Ohio’s New Managed-Care Plan

Some Aren’t Getting Their Checks Because Companies Aren’t Processing Medicare, Medicaid Claims Quickly

By Rita Price

She managed to cover rent this month, but the tab for her other living expenses — even groceries — is growing. “I put everything on the credit card that could possibly go on the credit card,” said Joanie Hoffman, an independent home-health provider. “I’m going to be backtracking for a while.” Hoffman used to be paid weekly, but she said she hasn’t been receiving paychecks regularly since July 1. That’s when the state’s new managed-care plan for the elderly and younger disabled Ohioans — the “dual eligibles” who receive health coverage through Medicare and Medicaid — rolled out locally. The government generally processed claims submitted by independent workers and home-health agencies in a matter of days. Now, the bills go to Aetna Better Health of Ohio or Molina Healthcare of Ohio, the two managed-care companies for central Ohio.
 

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8/13/14 – Kaiser Family Foundation - One Year into Duals Demo Enrollment: Early Expectations Meet Reality

By MaryBeth Musumeci

July 2014 marks a year since the first beneficiaries dually eligible for Medicare and Medicaid began receiving services through one of the new financial alignment demonstrations. The demonstrations seek to maintain or decrease health care costs while maintaining or improving health outcomes for this vulnerable population of seniors and non-elderly people with significant disabilities. In 2011, CMS anticipated that the three year demonstrations would begin in 2012, and CMS has estimated that the demonstrations will serve no more than 2 million beneficiaries. To date, CMS has approved 13 demonstrations in which nearly 1.5 million beneficiaries in 12 states are eligible to enroll. As of June 2014, just over 66,000 beneficiaries were enrolled in a capitated demonstration health plan in California, Illinois, Massachusetts, Ohio, and Virginia (Exhibit 1), with enrollment to follow in other states through early 2015. 
 

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8/10/14 – The Washington Post - Health Law’s Center For Medicare And Medicaid Has Its Skeptics About Innovation

By Jay Hancock

The Affordable Care Act was supposed to mend what President Obama called a broken health-care system, but its best-known programs — online insurance and expanded Medicaid for the poor — affect a relatively small portion of Americans. A federal office you’ve probably never heard of is supposed to fix health care for everybody else. The law created the Center for Medicare and Medicaid Innovation to launch experiments in every state, changing the way doctors and hospitals are paid, building networks between caregivers and training them to intervene before chronic illness worsens. One example: George Washington University’s $1.9 million award to improve care and cut costs for at-home dialysis patients. Another: CareFirst BlueCross BlueShield’s $24 million grant to reduce unnecessary hospital visits for chronically ill Medicare patients.
 

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7/29/14 – The Commonwealth Fund - Implementing the Affordable Care Act: State Action on Quality Improvement in State-Based Marketplaces

By Sarah J. Dash, Sabrina Corlette , Amy Thomas

Under the Affordable Care Act, the health insurance marketplaces can encourage improvements in health care quality by: allowing consumers to compare plans based on quality and value, setting common quality improvement requirements for qualified health plans, and collecting quality and cost data to inform improvements. This issue brief reviews actions taken by state-based marketplaces to improve health care quality in three areas: 1) using selective contracting to drive quality and delivery system reforms; 2) informing consumers about plan quality; and 3) collecting data to inform quality improvement. Thirteen state-based marketplaces took action to promote quality improvement and delivery system reforms through their marketplaces in 2014. Although technical and operational challenges remain, marketplaces have the potential to drive systemwide changes in health care delivery.
 

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7/24/14 – The Kaiser Family Foundation - Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS

By MaryBeth Musumeci 

Using new authority in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) is launching demonstrations that seek to improve care and control costs for people who are dually eligible for Medicare and Medicaid. These three year demonstrations, implemented beginning in July 2013, are introducing changes in the care delivery systems through which beneficiaries receive medical and long-term care services. The demonstrations also are changing the financing arrangements among CMS, the states, and providers. As of July 2014, CMS has finalized memoranda of understanding (MOUs) with 12 states to implement 13 demonstrations. 
 

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7/18/14 – Journal of Health Politics, Policy and Law - Safety-Net Provider Reorganizing into an Accountable Care Organization

By Karen Hacker, Robert E. Mechanic, Palmira Santos, Douglas Thompson, Somava S. Stout, Adriana Bearse 

Under the Affordable Care Act, federal payments to safety-net providers—clinics and hospitals that primarily serve low-income and vulnerable patients—will be reduced as more people gain health insurance coverage. To manage the reduced reimbursement and the health law’s other payment reforms, some safety-net providers are embracing the patient-centered medical home and accountable care organization (ACO) models. Commonwealth Fund–supported researchers examined the experience of Cambridge Health Alliance in Massachusetts, a safety-net provider that began transforming into an ACO after the state passed its own health reform legislation in 2006. Cambridge serves nearly 100,000 patients through its network of primary care clinics, a large psychiatry department, two inpatient hospitals, three emergency departments, and affiliated specialists. 
 

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7/15/14 – The Kaiser Family Foundation - Survey of Health Insurance Marketplace Assister Programs

By Karen Pollitz and Jennifer Tolbert and Rosa Ma

The Affordable Care Act (ACA) provides for a substantial new infrastructure of consumer assistance in health insurance. All state Marketplaces are required to have Navigators and other similar Assister Programs to help consumers understand their coverage options, apply for assistance, and enroll. In addition, comprehensive State Ombudsman or Consumer Assistance Programs (CAPs) are established under the ACA to provide a full range of help – outreach and enrollment assistance as well as help with post-enrollment problems such as appealing denied claims – to all state residents in all types of group and non-group health plan coverage. Throughout the first Open Enrollment period, public attention focused on the number of people who would enroll in qualified health plans (QHPs) offered through the Marketplace and in Medicaid. People will continue to enroll in coverage throughout the year, and even more people are projected to enroll next year, but the close of Open Enrollment affords an opportunity to examine the role of Assister Programs in helping people to enroll and remain enrolled in coverage.
 

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7/12/14 – The New York Times - A Two-Page Form Spawns a Contraceptive Showdown

By Robert Pear

A two-page federal form has provoked a titanic clash between the government and many religious organizations. The form allows some religious organizations to opt out of providing contraceptive coverage, which many insurers and group health plans are required to provide under the Affordable Care Act and related rules. The opt-out sounds like a way to accommodate religious beliefs. But many religious employers like Wheaton College and the Little Sisters of the Poor are unwilling to sign the form. By signing it, they say, they would authorize their insurers or plan administrators to pay for contraceptives, including some that they believe may cause abortion. Fights over the form are playing out in dozens of courtrooms around the country. In a separate case, the Supreme Court ruled on June 30 that family-owned for-profit corporations like Hobby Lobby Stores were not required to provide insurance coverage of contraceptives to employees if the companies objected on religious grounds. The Senate planned to take up legislation to reverse that decision this week.
 

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6/30/14 – Health IT Outcomes - Medicare ACO Lessons For Medicaid

The successful deployment of Medicaid accountable care organizations will be dependent upon looking to the Medicare ACO programs underway for guidance, yet still need to be flexible in creating the new delivery systems, according to staff analysts from the Center for Strategic Health Studies.
There is growing interest in leveraging Medicare’s Pioneer accountable care organization (ACO) model to serve Medicaid beneficiaries, with the goal of creating efficiencies by standardizing approaches to accountable care across patient populations and payers. To explore the possibility of extending the model to Medicaid, CMS and CMMI began soliciting input last December on how the Pioneer ACO model might be adapted to serve Medicaid beneficiaries, including those enrolled in both Medicaid and Medicare.
 

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6/25/14 – The Commonwealth Fund - Accountable Care in the Safety Net: A Case Study of the Cambridge Health Alliance

Following passage of health care reform in Massachusetts, the Cambridge Health Alliance (CHA), a public safety-net health system, began to establish an accountable care organization in an effort to continue its mission and remain financially solvent. In examining how CHA undertook its delivery system transformation, this case study explores the organization’s four major strategies: establishing patient-centered medical homes, entering alternative payment arrangements with managed care organizations, launching complex care management, and establishing a partnership with a tertiary care institution. Workforce education and culture change were also core principles. Within two years, CHA had already received National Committee for Quality Assurance patient-centered medical home recognition for six of its primary care sites, and quality metrics demonstrate improvements in these sites compared with others. Moreover, utilization in one managed care organization is trending downward. Challenges persist, however, due in part to fiscal pressures created by state health care reform.
 

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6/17/14 – The Commonwealth Fund - Mitigating the Effects of Churning Under the Affordable Care Act: Lessons from Medicaid

By Sara Rosenbaum, Nancy Lopez, Mark Dorley, Joel Teitelbaum, Taylor Burke and Jacqueline Miller

Through a combination of three needs-based public programs—Medicaid, the Children’s Health Insurance Program, and tax credits for purchasing private plans in the new marketplaces—the Affordable Care Act can potentially ensure continuous coverage for many low- and moderate-income Americans. At the same time, half of individuals with incomes at less than twice the poverty level will experience a form of “churning” in their coverage; as changes occur in their life or work circumstances, they will need to switch among these three coverage sources. For many, churning will entail not only changes in covered benefits and cost-sharing, but also in care, owing to differences in provider networks. Strategies for mitigating churning’s effects are complex and require time to implement. For the short term, however, the experiences of 17 states with policies aimed at smoothing transitions between health plans offer lessons for ensuring care continuity.
 

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6/11/14 – Kaiser Health News - Michigan To Reward Medicaid Enrollees Who Take ‘Personal Responsibility’

By Phil Galewitz

Delayed by state lawmakers, Michigan did not expand Medicaid until the day after the federal online insurance exchange closed March 31 – a move advocates feared would undermine signups. Turns out, enrollment is exceeding expectations, which has pleased officials who seek to make the state among the first in the nation to add a heavy dose of “personal responsibility” to the federal-state entitlement program. This spring, the Wolverine state became the second after Iowa to offer lower premiums and cost sharing to recipients who agree todo a health risk assessment with their doctor every year and to commit to improve their health by taking steps such as quitting smoking or losing weight. “There is a heavy consumer engagement piece in this, both in terms of finances and skin in the game, but also in terms of healthy behaviors and really trying to find ways in which we can make the population of Michigan healthier,” Michigan Medicaid Director Stephen Fitton said in a briefing in Washington earlier this month. “We have a high obesity rate in Michigan. We don’t do very well on some broad [health] measures and we are really looking for ways to move the needle there.”
 

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6/9/14 – EHR Intelligence - Groups Urge Medicare To Widen Telemedicine Options For ACOs

By Jennifer Bresnick

The structure of Medicare reimbursements is limiting the ability of accountable care organizations (ACOs) to engage in telemedicine, say the Alliance for Connected Care (ACC) and a coalition of other telehealth advocate groups in a series of letters written to newly confirmed HHS Secretary Sylvia Mathews Burwell. In order for ACOs to take advance of the opportunities telemedicine has to offer, including increased care coordination, expanded access, and more robust patient engagement, providers need to be able to bill for their services appropriately and make the investments in telehealth infrastructure worthwhile. Medicare currently only reimburses telehealth services under limited services, points out the ACC and the Patient and Provider Group Advisory Board in their letter. Only those beneficiaries able to reach an “originating site” in an area designated as a Health Professional Shortage region or one that exists outside a Metropolitan Statistical Area can be reimbursed for remote care, leaving other Medicare patients unable to benefit from telehealth services.
 

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5/23/14 – Kaiser Family Foundation - State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries

This map shows the current status of the state demonstration proposals to integrate care and align financing and/or administration for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program and consequently account for a disproportionate share of spending in both programs. A number of states are working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to test capitated and/or managed-fee-for service models to integrate care and align financing for dual eligible beneficiaries, based on new demonstration authority in the Affordable Care Act. CMS is presently reviewing the states’ proposals to determine which will be implemented.
 

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5/16/14 – The Commonwealth Fund – New Survey: Community Health Centers Make Substantial Gains in Health Information Technology Use, Remain Concerned About Ability to Meet Increased Demand Following ACA Coverage Expansions

Use of electronic health records increased 133 percent in federally qualified health centers (FQHCs) between 2009 and 2013, according to a new Commonwealth Fund survey of health center leaders. Spurred by federal investments and financial incentives to more fully embrace health information technology (HIT), 85 percent of FQHCs reported they had achieved advanced HIT capabilities in 2013—meaning they could perform at least nine of 13 key functions, such as electronically prescribing medications. The rate in 2009 was just 30 percent. In fact, FQHCs adopted HIT at higher rates than office-based physicians, including large practices and large integrated health care systems.
 
 

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5/12/14 – The Commonwealth Fund - The Federal Medical Loss Ratio Rule: Implications for Consumers in Year 2

By Michael J. McCue and Mark A. Hall

For the past two years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in the form of medical claims or quality improvement expenses—known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2012 were $513 million, half the amount paid out in 2011, indicating greater compliance with the MLR rule. Spending on quality improvement remained low, at less than 1 percent of premiums. Insurers continued to reduce their administrative and sales costs, such as brokers’ fees, without increasing profit margins, for a total reduction in overhead of $1.4 billion. In the first two years under this regulation, total consumer benefits related to the medical loss ratio—both rebates and reduced overhead—amounted to more than $3 billion.
 

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5/12/14 – The Commonwealth Fund - The Federal Medical Loss Ratio Rule: Implications for Consumers in Year 2

By Michael J. McCue and Mark A. Hall

For the past two years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in the form of medical claims or quality improvement expenses—known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2012 were $513 million, half the amount paid out in 2011, indicating greater compliance with the MLR rule. Spending on quality improvement remained low, at less than 1 percent of premiums. Insurers continued to reduce their administrative and sales costs, such as brokers’ fees, without increasing profit margins, for a total reduction in overhead of $1.4 billion. In the first two years under this regulation, total consumer benefits related to the medical loss ratio—both rebates and reduced overhead—amounted to more than $3 billion.
 

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5/9/14 – Kaiser Family Foundation - Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS

By MaryBeth Musumeci

This issue brief compares demonstration programs in California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Virginia, and Washington state that are introducing changes in the care delivery systems through which people who are dually eligible for Medicare and Medicaid receive services, as well as changing the payment approach and financing arrangements among the Centers for Medicare and Medicaid Services, the states and providers.
 

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5/9/14 – Kaiser Family Foundation - Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS

By MaryBeth Musumeci

This issue brief compares demonstration programs in California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Virginia, and Washington state that are introducing changes in the care delivery systems through which people who are dually eligible for Medicare and Medicaid receive services, as well as changing the payment approach and financing arrangements among the Centers for Medicare and Medicaid Services, the states and providers.
 

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4/24/14 – Kaiser Health News - Most States To Rely On Federal Website For 2015 Enrollment

By Phil Galewitz

Only two of the 36 states that relied on the federal insurance exchange this year -- Idaho and New Mexico -- plan to set up their own online marketplaces in time for the next open enrollment beginning Nov. 15. Both those states had moved to run their own exchanges last year but couldn't get them working in time for the 2014 enrollment season so they used the federal exchange instead. No other states have announced similar plans and analysts say none is likely to be able to develop a detailed plan before the deadline in a little more than five weeks. Election-year politics, tight deadlines and problems with health insurance exchanges in Oregon, Maryland and Hawaii dampened the interest of lawmakers in other states to form their own exchanges, despite the millions in federal funding that would be available under the Affordable Care Act. 
 

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4/21/14 – Science Daily - Patient Care Patterns Studied In Medicare Accountable Care Organizations

A third of Medicare beneficiaries assigned to accountable care organizations (ACOs) in 2010 or 2011 were not assigned to the same ACO in both years and much of the specialty care received was provided outside the patients' assigned ACO, suggesting challenges to achieving organizational accountability in Medicare. ACOs are intended to foster greater accountability in the traditional fee-for-service Medicare program by rewarding participating health care provider groups that achieve slower spending growth and high quality care. But unrestricted choice of health care providers is maintained for Medicare beneficiaries and that could weaken incentives and undermine ACO efforts to manage care. Medicare beneficiaries are not required to pick a primary care physician so Medicare uses utilization rates to assign patients to ACOs.
 

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4/18/14 – Modern Healthcare - Give ACOs a Break, AHA tells CMS Innovation Center

By Melanie Evans

The American Hospital Association is lobbying the CMS Innovation Center to make it easier for accountable care organizations to earn Medicare bonuses and delay potential penalties as the agency looks to expand the initiative. In a letter to Dr. Patrick Conway, the Innovation Center's acting director, the AHA said that financial risks outweighed the potential bonuses for hospitals under the Medicare shared-savings program, the accountable care initiative created under the Patient Protection and Affordable Care Act. “The No. 1 way to increase participation in ACO programs is to modify the shared-savings determination to ensure that more ACOs are able to receive a bonus—and a larger bonus—so that they can continue to invest in the program.”
 

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4/17/14 – Modern Healthcare – ACA Enrollment Tops 8 Million, Obama Says

By Paul Demko

Enrollment in health plans sold on Obamacare's insurance exchanges has reached 8 million, and 35% of those who signed up through HealthCare.gov are under the age of 35, President Barack Obama said Thursday. The Patient Protection and Affordable Care Act “is now covering more people at less cost than most would have predicted a few months ago,” the president said in a White House news briefing. Obama also held a meeting Thursday at the White House with several health insurance executives, including Karen Ignagni, president and CEO of the trade group America’s Health Insurance Plans, and Dr. Martin Hickey, CEO of New Mexico Health Connections and chair of the National Alliance of State Health Co-ops. “Certainly every insurer that was in the room with the president said the horse is out of the barn,” Hickey said. “We’re just trying to figure out how to re-saddle it for 2015.” 
 

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4/14/14 – Modern Healthcare – ACA Cost Estimate Cut By $104B Over Next Decade

Obamacare is expected to cost $104 billion less than previously anticipated for the period 2015-24, according to a new analysis (PDF) by the Congressional Budget Office. That's in part because premiums on plans purchased through the state and federal exchanges are expected to be lower than prior estimates. That spells lower federal subsidies for individual who make up to 400% of the federal poverty threshold. The lower-than-expected premiums can be attributed to narrower networks and more care restrictions on exchange plans than on many employer-offered plans, the CBO said.
 

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4/7/14 – Yahoo News - Survey Confirms Gains In Health Insurance Sign-Ups 

By Ricardo Alonso-Zaldivar 

A growing share of Americans got health insurance as sign-up season for President Barack Obama's health care law came to a close last month, a major survey released Monday has found. The Gallup-Healthways Well-Being Index provides independent validation for White House claims that the law is expanding access, particularly for working people with no coverage on the job. But the improvement, while substantial, doesn't appear as large as some of the numbers claimed by the law's supporters. Gallup found that the share of adults without health insurance shrank from 17.1 percent at the end of last year to 15.6 percent for the first three months of 2014. The decline of 1.5 percentage points would translate roughly to more than 3.5 million people gaining coverage. The trend accelerated as the March 31 enrollment deadline loomed.
 

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4/3/14 – Kaiser Family Foundation - State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries 

This map shows the current status of the state demonstration proposals to integrate care and align financing and/or administration for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program and consequently account for a disproportionate share of spending in both programs.
 

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3/26/14 – HealthAffairs - Adults In The Income Range For The Affordable Care Act’s Medicaid Expansion Are Healthier Than Pre-ACA Enrollees

By Steven C. Hill, Salam Abdus, Julie L. Hudson and Thomas M. Selden

The Affordable Care Act (ACA) has dramatically increased the number of low-income nonelderly adults eligible for Medicaid. Starting in 2014, states can elect to cover individuals and families with modified adjusted gross incomes below a threshold of 133 percent of federal poverty guidelines, with a 5 percent income disregard. We used simulation methods and data from the Medical Expenditure Panel Survey to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACA’s Medicaid expansion and thus newly eligible for coverage. Although differences in health across the groups were not large, both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees. Twenty-five states have opted not to use the ACA to expand Medicaid eligibility. If these states reverse their decisions, their Medicaid programs might not enroll a population that is sicker than their pre-ACA enrollees. By expanding Medicaid eligibility, states could provide coverage to millions of healthier adults as well as to millions who have chronic conditions and who need care.
 

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3/24/14 – The Commonwealth Fund - Assessing Care Integration for Dual-Eligible Beneficiaries: A Review of Quality Measures Chosen by States in the Financial Alignment Initiative 

By Sabiha Zainulbhai, Lee Goldberg, J.D., M.A., Weiwen Ng, M.P.H., and Anne H. Montgomery, M.S. 

Caring for the 9 million low-income elderly or disabled adults who are eligible for full benefits under both Medicare and Medicaid can be extremely costly. As part of the federal Financial Alignment Initiative, states have the opportunity to test care models for dual-eligibles that integrate acute care, behavioral health and mental health services, and long-term services and supports, with the goals of enhancing access to services, improving care quality, containing costs, and reducing administrative barriers. One of the challenges in designing these demonstrations is choosing and applying measures that accurately track changes in quality over time—essential for the rapid identification of effective innovations. This brief reviews the quality measures chosen by eight demonstration states as of December 2013. The authors find that while some quality domains are well represented, others are not. Quality-of-life measures are notably lacking, as are informative, standardized measures of long-term services and supports.
 

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3/17/14 – Kaiser Family Foundation - Sizing Up Exchange Market Competition

The individual health insurance market historically has been highly concentrated, with only modest competition in most states. At the time the Affordable Care Act (ACA) was signed into law in 2010, a single insurer had at least half of the individual market in 30 states and the District of Columbia. While a dominant insurer may be able to negotiate lower rates from hospitals and physicians, without significant competitors or regulatory oversight, there is no guarantee that those savings would be passed along to consumers. Health insurance exchanges (also called marketplaces) are intended to promote price competition in the individual and small group insurance markets through greater transparency. 
 

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3/12/14 – Reuters - Sebelius Says No Obamacare Mandate Delay, Enrollment Extension 

There will be no delay in the penalty most Americans face under President Barack Obama's healthcare reform law if they fail to obtain health coverage this year, U.S. Health and Human Services Secretary Kathleen Sebelius said on Wednesday. Sebelius also said there would be no postponement of this month's deadline for enrolling in coverage through new private health insurance marketplaces or the Medicaid program for the poor. "No, sir," was Sebelius' categorical answer when asked about both prospects by Representative Kevin Brady of Texas at a hearing of the House of Representatives Ways and Means Committee.
 

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3/11/14 – Modern Healthcare –Exchange Enrollment Tops 4.2 Million Through February, But Pace Slackens 

By Paul Demko 

Nearly 950,000 Americans selected a health insurance plan through the state and federal exchanges in February. That brought the total to 4.2 million with one month left in the open enrollment period. Enrollments decreased by just over 200,000—or 18%—from January, when more than 1.1 million individuals enrolled in commercial plans. But federal officials expressed optimism that there will be another surge as the March 31 deadline for enrollment approaches. Most people who don't have coverage at that point will face a fine of $95 or 1% of their income, whichever is greater. In 2006, the Obama administration noted, more than 1 million individuals signed up for plans in the final week of the initial enrollment period for the Medicare prescription drug program. In addition, nearly a quarter of federal employees who opted to change their health benefits in 2012 did so during the last two days of the enrollment period. 
 

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3/11/14 – Healthcare IT News – Health Insurance Giant Inks ACO Deal 

By Erin McCann

One of the nation's largest healthcare insurance providers today announced it was going forward with an accountable care agreement that would deliver higher quality care to some 28,000 people. Hartford, Conn.-based Aetna inked a deal Tuesday with Atlantic Health System in northern New Jersey to partner with the health system's existing ACO that was established back in 2012. Officials say Aetna members who use the Atlantic ACO and Centers of Excellence will experience more coordinated care, particularly patients with chronic or complex conditions, and will also benefit from the improved flow of information to treating physicians in the Atlantic ACO.
 

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3/5/14 – Bloomberg - Obama Said to Allow Two-Year Renewal for Old Health Plans 

By Alex Wayne

Americans who kept health plans that don’t comply with Obamacare requirements will be able to renew those policies for two more years, according to a person familiar with the matter. The Obama administration, which has been deliberating the issue since November, is expected to announce today the extension of the health plans, said the person, who asked not to be identified because the decision wasn’t yet public.
 

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3/4/14 – The Kaiser Family Foundation - State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries 

This map shows the current status of the state demonstration proposals to integrate care and align financing and/or administration for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program and consequently account for a disproportionate share of spending in both programs.
 

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2/27/14 – Modern Healthcare - Reform Update: Republicans At Odds Over How To 'Fix' ACA

By Paul Demko

Republicans face a fundamental predicament in proposing alternatives to Obamacare: How do you put forth a substantive proposal that doesn't first require repealing the Patient Protection and Affordable Care Act? The law's interlocking pieces make it difficult to tinker around the edges. Most notably, it's difficult to incorporate popular provisions of the law such as the ban on discriminating against individuals with pre-existing conditions that Republicans say they want to keep, while simultaneously scrapping its more controversial provisions such as the individual mandate to acquire insurance coverage. Plus, Republicans have been unable to unify behind a single plan to replace the ACA. One of the major conflict points has been whether to limit the tax exclusion that individuals receive for employer-based coverage. Doing so would help pay for subsidies for individuals who currently lack coverage, but many conservatives view the elimination of the exclusion as a verboten tax hike.
 

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2/13/14 – Bloomberg Businessweek - Paying Doctors to Shun Hospitals

By John Tozzi

In an attempt to tame growing Medicare costs, the Affordable Care Act encourages doctors and hospitals to form groups called accountable care organizations, or ACOs. The idea is to get doctors, hospitals, nursing homes, and other providers to work together to treat Medicare patients. They’re supposed to avoid unneeded or redundant procedures and emphasize preventive care and chronic-disease management. These alliances typically invest in electronic health records to track patient treatments and hire social workers to make sure patients take their medication and don’t miss checkups. In exchange for lowering Medicare’s bills, ACOs get to keep a portion of the savings. Three years into the voluntary program, 367 groups of health-care providers nationwide have formed ACOs. They’re responsible for 5.3 million Medicare patients, or about one in eight people on the federal insurance program for Americans 65 and older.
 

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2/10/14 – Yahoo News - New Blow For Obama Health Law 

President Barack Obama's health care law suffered a new blow Monday, as his administration delayed a key component requiring small businesses to provide insurance to employees or face a fine. The decision was the latest glitch to Obama's signature domestic achievement which has been plagued by political attacks and a disastrous debut for a sign-up website. Department of Treasury officials writing rules for the Affordable Care Act decided that business with fewer than 100 workers but more than 50 would have an extra year -- until 2016 to offer health care to employees or face a fine. The requirement, known as the employer mandate had already been put off by one year. "While about 96 percent of employers are not subject to the employer responsibility provision, for those employers that are, we will continue to make the compliance process simpler and easier to navigate," said Assistant Secretary for Tax Policy Mark Mazur.
 

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2/8/14 – Pioneer Press - Budget Model Uncertain For State Health Exchanges 

By Patrick Condon 

The 14 states running their own health insurance marketplaces had all their startup costs footed by the federal government, but they're supposed to pay for themselves starting next year under the federal health care reform law. In several states, it's not clear whether it will work out that way. Projected enrollments are lower than expected, meaning the insurance surcharges designed to sustain the exchanges might not generate enough revenue in the years ahead without significant changes in the financing model. Officials in some states are stashing away federal grant money to continue paying for operations beyond the January 2015 target date for financial self-sufficiency. Others are contemplating staffing cuts or boosting insurance surcharges. To date, the 14 states operating their own exchanges, plus the District of Columbia, have received nearly $3.8 billion to start and operate their health insurance exchanges, according to a state-by-state tally by The Associated Press.
 

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1/18/14 – National Senior Citizens Law Center - Is It Working? Recommendations for Measuring Rebalancing in Dual Eligible Demonstrations and MLTSS Waivers 

A growing number of states are shifting the responsibility for providing long-term services and supports (LTSS) for seniors and persons with disabilities to managed care organizations (MCOs). Some states are making this transition through the Financial Alignment Demonstrations (known as the dual eligible demonstrations) overseen by the Medicare-Medicaid Coordination Office. Others are using Medicaid waiver authority under Sections 1115, 1115A, or 1915(b)/(c). States and the Centers for Medicare and Medicaid Services (CMS) have indicated that one goal of shifting to a managed care delivery model is to rebalance public spending on LTSS by increasing access to home and community-based services (HCBS). This is a goal that has been widely embraced by beneficiaries and their advocates. Increasing access to HCBS should lead to more people receiving the services and support they need at home and in the community instead of in more costly institutional settings. As more seniors and people with disabilities remain integrated in their communities and avoid institutional placements, Medicare and Medicaid costs will decrease.
 

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1/17/14 - The Wall Street Journal - Exchanges See Little Progress on Uninsured 

Early Estimates Suggest That Majority of Sign-Ups Already Had Health Plans 

By Christopher Weaver & Anna Wilde Mathews 

Early signals suggest the majority of the 2.2 million people who sought to enroll in private insurance through new marketplaces through Dec. 28 were previously covered elsewhere, raising questions about how swiftly this part of the health overhaul will be able to make a significant dent in the number of uninsured. Insurers, brokers and consultants estimate at least two-thirds of those consumers previously bought their own coverage or were enrolled in employer-backed plans. The data, based on surveys of enrollees, are preliminary. But insurers say the tally of newly insured consumers is falling short of their expectations, a worrying trend for an industry looking to the law to expand the ranks of its customers.
 

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1/10/14 – Milbank Memorial Fund - Improvements in Health Status after Massachusetts Health Care Reform 

By Philip J. Van Der Wees, Alan M. Zaslavsky & John Z. Ayanian 

The key provisions of Massachusetts’s 2006 health care reform law were an individual mandate to obtain health insurance if affordable, expanded Medicaid coverage for children and long-term unemployed adults, subsidized health insurance for low and middle-income residents, and a health insurance exchange to help higher-income residents obtain unsubsidized insurance. Approximately 400,000 Massachusetts residents have obtained coverage since this health care reform. With nearly 98% of residents now insured, Massachusetts has the highest rate of insurance of any state in the county, although the affordability of health care remains a substantial concern. The absolute gain in health insurance coverage was greatest for socioeconomically disadvantaged groups, even though racial and ethnic disparities in access to health care in Massachusetts persist. In addition, low-income people receive less screening for cancer and cardiovascular disease.
 

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1/2/14 – The Kaiser Family Foundation - State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries 

This map shows the current status of the state demonstration proposals to integrate care and align financing and/or administration for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program and consequently account for a disproportionate share of spending in both programs.
 
 

 


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12/18/13 – MedPAC – Data Book: Beneficiaries Dually Eligible For Medicare and Medicaid 

This data book is a joint project of the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC). The data book presents information on the demographic and other personal characteristics, expenditures, and health care utilization of individuals who are dually eligible for Medicare and Medicaid coverage. Dual-eligible beneficiaries receive both Medicare and Medicaid benefits by virtue of their age or disability and low incomes. This population is diverse and includes individuals with multiple chronic conditions, physical disabilities, cognitive impairments such as dementia, developmental disabilities, mental illness, and difficulties with activities of daily living. It also includes some individuals who are relatively healthy. For dual-eligible beneficiaries, Medicare is the primary payer of primary, acute, and post-acute care services covered by that program. Medicaid provides varying levels of assistance with Medicare premiums and cost sharing and, for many beneficiaries, also provides services not covered by Medicare, such as long-term services and supports (LTSS). Full-benefit dual-eligible beneficiaries receive the full range of Medicaid benefits offered in a given state. For partial-benefit dual-eligible beneficiaries, Medicaid pays Medicare premiums and may also pay the cost sharing for Medicare services.
 

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12/10/13 – The National Bureau of Economic Research - Is This Time Different? The Slowdown in Healthcare Spending 

By Amitabh Chandra, Jonathan Holmes, Jonathan Skinner 

Why have health care costs moderated in the last decade? Some have suggested the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) can take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly in the Medicare population. A more difficult question is: Will this slowdown continue? Here we are more pessimistic, and not entirely because a similar (and temporary) slowdown occurred in the early 1990s. The primary determinant of long-term growth is the continued development of expensive technology, and there is little evidence of a permanent slowdown in the technology pipeline.
 

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12/5/13 - The Commonwealth Fund - How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion 

By Sherry Glied, Ph.D., and Stephanie Ma 

Following the Supreme Court's decision in 2012, state officials are now deciding whether to expand their Medicaid programs under the Affordable Care Act. While the states' costs of participating in the Medicaid expansion have been at the forefront of this discussion, the expansion has much larger implications for the flow of federal funds going to the states. This issue brief examines how participating in the Medicaid expansion will affect the movement of federal funds to each state. States that choose to participate in the expansion will experience a more positive net flow of federal funds than will states that choose not to participate. In addition to providing valuable health insurance benefits to low-income state residents, and steady sources of financing to state health care providers, the Medicaid expansion will be an important source of new federal funds for states.
 

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12/3/13 – The Kaiser Family Foundation - State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries 

This map shows the current status of the state demonstration proposals to integrate care and align financing and/or administration for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program and consequently account for a disproportionate share of spending in both programs. A number of states are working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to test capitated and/or managed-fee-for service models to integrate care and align financing for dual eligible beneficiaries, based on new demonstration authority in the Affordable Care Act.
 

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11/26/13 – CHCS - The Balancing Act: Integrating Medicaid Accountable Care Organizations into a Managed Care Environment

By Tricia McGinnis, Rob Houston, and Deborah Brown, Center for Health Care Strategies

 
Accountable care organizations (ACOs) are rapidly gaining a foothold across the country as a way to improve health care quality and control rising costs. States can facilitate Medicaid ACO model adoption by complementing the existing managed care infrastructure and clearly defining ACO and managed care organization responsibilities and performance expectations. This new brief from the Center for Health Care Strategies can help guide state Medicaid agencies in successfully implementing ACOs within a managed care environment. It is a product of Advancing Accountable Care Organizations in Medicaid: A Learning Collaborative, which was made possible by The Commonwealth Fund and the Massachusetts Medicaid Policy Institute, a program of the Blue Cross Blue Shield of Massachusetts Foundation. Through the learning collaborative, ACO innovators from seven states - Maine, Massachusetts, Minnesota, New Jersey, Oregon, Texas, and Vermont - have gathered to accelerate ACO program development and address key issues.
 

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11/25/13 – The Seattle Post - Washington State To Try Dual Medicaid-Medicare Program

In a demonstration project, the state will combine Medicaid and Medicare services for people who qualify for both. The move is expected to prevent duplication of services and save money. - Washington state’s Medicaid program that gives free health insurance to poor and disabled people is working with the federal government on an experiment that is expected to save taxpayer dollars and improve services. The new program would combine Medicaid with Medicare, which is the federal health insurance for older Americans. Some elderly and disabled people qualify for both federal programs, and services for these so-called “dual eligibles” have long been among the most costly provided by the state. The demonstration project announced Monday would enable the programs to work together to serve this subset of people.
 

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11/21/13 – The Commonwealth Fund - Better Care at Lower Cost: Is It Possible?

By Deborah Lorber

Even if you’re not an expert on health care or the Affordable Care Act, you’ve probably heard that the costs of care in the United States are high—really high. Maybe you’ve even heard that the U.S. spends more on health care than any other country. But what does it mean? Why does it happen? And can we do anything about it? For starters, the $2.9 trillion we spend annually on health care—a whopping $9,200 per person—isn’t necessarily buying us the best care or ensuring good health. In fact, not only does the U.S. fare worse in terms of infant mortality and life expectancy than other developed nations, it also tops the list for deaths that are considered preventable with timely and appropriate treatment. What’s more, a hospital stay or common diagnostic tests, like MRIs, cost many times more in the U.S. than in countries like Germany or Japan.

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11/14/13 NBC News - Obama Says People 'Deserve Detter', Gives Extra Year For Health Insurance

By Maggie Fox

President Barack Obama announced a fix to the vexing problem of canceled health insurance policies Thursday, saying insurers don’t have to cancel plans next year just because of the Affordable Care Act. Insurers can continue the plans for 2014 on two conditions — they have to tell people what their plans don’t cover, and they have to let people know they do have the option of going onto the health insurance exchanges to buy new plans with federal government subsidies and perhaps go onto Medicaid.
 

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11/12/13 – Forbes - Do Premiums Differ In States With A State-Based Exchange Versus Federal Exchange Under ObamaCare?

By Josh Archambault & Sam Cappellanti

Democrats in red states have started to push the argument that if their state had just set up a state-based exchange under the Affordable Care Act (ACA), then premiums wouldn’t be so high. However, a quick review of premium data derived from a recent American Action Forum study should put that argument to rest for good. Whether an exchange is state-based or federally run makes little difference to the end result of premiums – the Federal government ultimately retains veto power over all decisions and no state is immune from the regulatory tsunami that is emerging from Washington.
 

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11/11/13 – Dallasnews - Private Exchanges May Be The 401(K) Of Health Plans

By Mitchell Schnurman

HealthCare.gov is floundering, but private health exchanges are alive and well and winning converts. And they may bring a major change to benefits in corporate America. Dozens of companies have joined private exchanges, including Walgreen, Petco, Kinder Morgan and Sears. This year, more than 1 million workers are expected to select health insurance this way. By 2017, the number could reach 20 million, if employers save enough money and workers prefer more choices, one expert predicts. Private exchanges are driven by the same ideas behind HealthCare.gov, although they appear to be rolling out smoothly. Companies pay a fixed amount, workers pick a plan for their budget, and a roster of insurers usually competes on costs.
 
 

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11/5/13 – The Kaiser Family Foundation - State-by-State Estimates of the Number of People Eligible for Premium Tax Credits Under the Affordable Care Act

Key provisions of the 2010 Affordable Care Act (ACA) create new Marketplaces for people who purchase insurance directly and provide new premium tax credits to help people with low or moderate incomes afford that coverage. We estimate that about 17 million people who are now uninsured or who buy insurance on their own (“nongroup purchasers”) will be eligible for premium tax credits in 2014. This issue brief provides national and state estimates for tax credit eligibility for people in these groups. We also estimate that about 29 million people nationally could look to new Marketplaces as a place to purchase coverage.
 

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11/1/13 – Yahoo Finance - How Obama Overlooked 10 Million Americans Who Could Lose Health Insurance

By Rick Newman

We may now know what the most devastating statement of Barack Obama’s presidency is going to be: “If you like it, you can keep it.” Obama has said that repeatedly about people who have health insurance as of January 1, 2014, when the major provisions of the Affordable Care Act go into effect. Yet insurers have been canceling hundreds of thousands of policies because their terms don’t comply with new requirements of the health-reform law. That makes Obama look like he was either fibbing or didn’t know the ramifications of his own law. And it comes on top of humiliating snafus at Healthcare.gov, the website that’s supposed to make it easy to sign up for Obamacare but has been plagued by recurring outages even a month after going live on October 1. (On Wednesday Secretary of Health and Human Services Kathleen Sebelius apologized for the "miserably frustrating" tech snafus during a Capitol Hill hearing.)
 

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10/29/13 – Associated Press - Medicare Chief Apologizes For 'Obamacare' Woes

By Ricardo Alonso-Zaldivar And Stephen Ohlemacher

Stressing that improvements are happening daily, the senior Obama official closest to the administration's malfunctioning health care website apologized Tuesday for problems that have kept Americans from successfully signing up for coverage. "I want to apologize to you that the website has not worked as well as it should," Medicare chief Marilyn Tavenner said as she began her testimony before the House Ways and Means Committee. It was the most direct mea culpa yet from a top administration official. The first senior official to publicly answer questions from lawmakers, Tavenner is being grilled not only on what went wrong with HealthCare.gov, but also whether lawmakers can trust promises that things will be running efficiently by the end of November.
 
 

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10/23/2013: Kaiser Family Foundation - The Uninsured: A Primer – Key Facts about Health Insurance on the Eve of Coverage Expansions

This comprehensive primer provides a profile of the uninsured population, including demographics and an explanation of why they lack coverage. It also reviews the consequences of not having coverage and examines differences in uninsured rates between different groups of individuals. With Affordable Care Act coverage expansions on the horizon, this document also summarizes how the uninsured population may be impacted by these changes.
 
 

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10/23/13 – Kaiser Family Foundation - The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

The expansion of Medicaid eligibility to nearly all low-income adults is a core component of the coverage provisions in the 2010 Affordable Care Act (ACA). The ACA Medicaid expansion provides a link between new private coverage options available through either Health Insurance Marketplaces or employers and the existing Medicaid program, which previously had many gaps in coverage for adults. Historically, Medicaid eligibility generally was restricted to low income individuals in a specified category, such as children, their parents, the aged, or individuals with disabilities. In most states, adults without dependent children were not eligible for Medicaid. Further, eligibility levels for parents were generally set very low and varied greatly across states. As a result, only 30% of poor nonelderly adults had Medicaid coverage in 2012, compared to 70% of poor children, and uninsured rates for poor adults (42%) were well over twice the national average (18%).
 

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10/10/13 – The Detroit News - Health Markets Rollout Panned

Only 7% Say Launch Went Extremely Well, According To Poll

By Nancy Benac & Jennifer Agiesta 

The debut of the government’s health insurance marketplaces drew a huge audience — and underwhelming reviews. Just 7 percent of Americans say the rollout of the health exchanges has gone extremely well or very well, according to an AP-GfK poll. The reaction was somewhat better among supporters of the new health care law, but still middling: 19 percent said the rollout went extremely well or very well. Among the uninsured — a key audience for the health exchanges — 42 percent said they didn’t know enough to judge how well the rollout had gone, suggesting an ongoing lack of awareness about the program in its early days. Despite the bumpy rollout, plenty of Americans are giving the system a try.
 

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10/9/13 – The Washington Post - Some Say Health-Care Site’s Problems Highlight Flawed Federal IT Policies

By Craig Timberg and Lena H. Sun

Problems with the federal government’s new health-care Web site have attracted legions of armchair analysts who speak of its problems with “virtualization” and “load testing.” Yet increasingly, they are saying the root cause is not simply a matter of flawed computer code but rather the government’s habit of buying outdated, costly and buggy technology. The U.S. government spends more than $80 billion a year for information-technology services, yet the resulting systems typically take years to build and often are cumbersome when they launch. While the error messages, long waits and other problems with www.healthcare.gov have been spotlighted by the high-profile nature of its launch and unexpectedly heavy demands on the system, such glitches are common, say those who argue for a nimbler procurement system.
 

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10/1/13 – Forbes - 4 Ways New Exchanges Will Radically Alter Health Insurance

By Robert Pearl, M.D.

When the next phase of the Affordable Care Act (ACA) kicks into gear January 1, 2014, each state will be required to offer its residents access to health care insurance through an online marketplace, often referred to as a “health insurance exchange.” These exchanges are now open for business today, Oct. 1, 2013, allowing individuals to sign up online, by phone or in-person, with health insurance coverage starting next year. Until now, buying health insurance has been a daunting task for most individuals and small businesses. But purchasing health insurance through exchanges will more closely resemble booking a vacation on Expedia or Orbitz. People using this vehicle to enroll will see lots of options, common features among the offerings, and greater transparency around price, quality and consumer ratings.
 

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10/1/13 – The Commonwealth Fund - Establishing a Coalition to Pursue Accountable Care in the Safety Net: A Case Study of the FQHC Urban Health Network

By Karen E. Schoenherr, Aricca D. Van Citters, Kathleen L. Carluzzo, Savannah Bergquist, Elliott S. Fisher, and Valerie A. Lewis

The Federally Qualified Health Center Urban Health Network is a coalition of 10 federally qualified health centers (FQHCs) in the Minneapolis–St. Paul area that pursued an accountable care organization (ACO) through a Medicaid demonstration project with Minnesota. Under the ACO model, the coalition has assumed responsibility for the total cost and quality of care delivered for an assigned patient population. This case study explores: the state context under which the ACO contract emerged; origins of the coalition; the members’ motivations to participate; strategies and processes established to work toward cost and quality benchmarks; challenges faced in pursuing accountable care; and the organizational strengths that facilitated the health centers’ shift from competition to collaboration. The keys to the coalition’s success include a committed leadership team focused around a singular purpose; the partnership with its administrative services partner; and the diversity of programs, services, and experiences among the 10 FQHCs.
 

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5/3/13 – MedPage Today - Medicare: Cost-Cutters on Hold

By David Pittman, Washington Correspondent, MedPage Today
Published: May 03, 2013

WASHINGTON -- A Medicare cost-cutting board created by the Affordable Care Act (ACA) -- the subject of much criticism from the medical community and supporters of the law as a whole -- won't have an impact on the program until at least 2016, a top Medicare official said this week.

The Independent Payment Advisory Board (IPAB) was to form later this year or early next to recommend ways to scale back Medicare spending beginning in 2015.

However, the trigger for its formation -- the growth of Medicare spending topping the growth of overall inflation and inflation on medical goods and services -- failed to hit that target, Paul Spitalnic, acting chief actuary for the Centers for Medicare and Medicaid Services (CMS), wrote in a letter dated Tuesday.

Spitalnic pegged the 5-year average of Medicare spending at 1.15% -- well below its trigger target of 3.03%. That means the first possible year IPAB could impact healthcare is 2016. The 1.15% figure is the average growth from 2011 to 2015.

The ACA created the IPAB as a back-stop to curbing federal spending on Medicare. If spending topped a pre-specified target, the 15-member board would draft ways to cut spending. The savings would equal however much it would take to fall below the spending target.

Congress would have to either vote as a super-majority to overrule the cuts or come up with its own alternatives equal to those IPAB cuts. If Congress failed to act, the cuts would take place.

But IPAB has drawn heated debate because its unelected members can draft changes to Medicare that can take effect with little to no congressional oversight or outside comment. Critics say the board could lead to "rationing" of care.

However, the ACA mandates that IPAB "cannot propose any recommendation to 'ration' care, raise revenues, increase beneficiary premiums or cost-sharing, restrict benefits, or alter rules for Medicare eligibility," according to a Health Affairs brief on the IPAB published last year. In addition, the IPAB is limited by the ACA as to how much it can cut from the Medicare budget: 1% of total Medicare outlays in 2016, 1.25% in 2017, and 1.5% in 2018 and thereafter, the brief stated.

This week's news of the delay in launching IPAB will do little to quiet IPAB critics because the possibility for the board still exists -- albeit a year later than first possible, said Paul N. Van de Water, senior fellow at the liberal Center on Budget and Policy Priorities in Washington, where he specializes in Medicare, Social Security, and health coverage issues.

"The folks who have been the strongest opponents of IPAB are unlikely to change their view," he told MedPage Today in a phone interview.

Van de Water said Medicare's low spending is not terribly surprising and was predicted around the ACA's passage by leading health economists. Even then, "IPAB was never intended to be the first line of defense in controlling healthcare costs," he added.

If it were to spring into action in the next year, IPAB has a long way to go to become reality. President Obama has yet to appoint a single member to IPAB, and members have to be confirmed by the Senate. But even if there is no IPAB, the Secretary of Health and Human Services would still have the power to enact similar cost controls, critics said.

The Republican-controlled House of Representatives -- including Republicans and some Democrats who voted for the ACA -- has voted several times in the last 2 years to repeal the IPAB, an opposition that doesn't appear to be letting up any time soon. The Democratic-controlled Senate has been unable or unwilling to pass an IPAB repeal.

The Healthcare Leadership Council in Washington recently submitted a letter to members of Congress signed by more than 500 medical groups opposing the board. Several national medical societies, including the American Medical Association, signed the letter.

The American Hospital Association and the drug company trade group Pharmaceutical Research and Manufacturers of America have also opposed the board.

The Healthcare Leadership Council still strongly opposes the IPAB even after this week's news that it won't spring into action until 2016 at the earliest.

"A lemon of a car doesn't suddenly become a beautifully running machine just because it's sitting in the garage," Executive Vice President Michael Freeman told MedPage Today in an email. "IPAB shouldn't continue to exist as a false security blanket against Medicare spending escalation, when the focus should be on actual program reforms that can achieve greater cost-efficiency without undermining access and quality."

Physicians may have a greater reason to fear the IPAB because hospital payments are exempt from cuts in the short term, leaving the board with fewer options to trim spending.

"Because hospitals had already agreed to restraints on growth in their payments as part of the financing of the Affordable Care Act, they lobbied for and obtained protection from any additional hospital payment cuts proposed by IPAB until 2018," the Health Affairs brief noted.

Another complaint is that the board only has power to create savings in a single year rather than the long term.

"The result will be that IPAB has less leeway to propose major health care delivery system reforms that could take years to play out, because such reforms would be unlikely to produce 'scoreable' one-year savings," the Health Affairs brief stated.


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5/2/13 – Kaiser Family Foundation - State Decisions for Creating Health Insurance Exchanges and Expanding Medicaid, as of May 2, 2013


State Decisions on Health Insurance Exchanges and the Medicaid Expansion, as of May 9, 2013

18 States have declared State-based Exchanges; 7 are planning for Partnership Exchanges and 26 are defaulting to Federal Exchanges. 


Click here for more


 


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3/21/13 – AHIP - Estimated Impact Of 2014 Proposed Reductions To Medicare Advantage – Maps And Charts

By Glenn Giese, FSA, MAAA & Chris Carlson, FSA, MAAA

On Friday, February 15, 2013, the Centers for Medicare & Medicaid Services (“CMS”) released the Advance Notice of Methodological Changes for Calendar Year 2014 Medicare Advantage (“MA”) Capitation Rates and Part C and Part D Payment Policies (the “2014 Advance Notice”). The Notice calls for significant reductions to Medicare Advantage Organizations (“MAOs”). Coupled with the reductions already being implemented pursuant to the Affordable Care Act (“ACA”), indications are the changes described in the 2014 Advance Notice will have adverse effect on MAOs and Medicare beneficiaries in 2014 and beyond. America’s Health Insurance Plans (“AHIP”) engaged the Actuarial Practice of Oliver Wyman to review the 2014 Advance Notice. In a report released on February 26, 2013 titled, “Proposed Changes to 2014 Medicare Advantage Payment Methodology and the Effect on Medicare Advantage Organizations and Beneficiaries,” Oliver Wyman estimated the combined effect of the changes included in the ACA and those proposed in the Advance Notice could necessitate benefit reductions and premium increases of $50 to $90 per member per month (“PMPM”).
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3/2013 – Health Affairs - Survey Of 5 European Countries Suggests That More Elements Of Patient-Centered Medical Homes Could Improve Primary Care

By Marjan Faber, Gerlienke Voerman, Antje Erler, Tina Eriksson, Richard Baker, Jan De Lepeleire, Richard Grol and Jako Burgers

The patient-centered medical home is a US model for comprehensive care. This model features a personal physician or registered nurse who is augmented by a proactive team and information technology. Such a model could prove useful for advanced European systems as they strive to improve primary care, particularly for chronically ill patients. We surveyed 6,428 chronically ill patients and 152 primary care providers in five European countries to assess aspects of the patient-centered medical home. Although most patients reported that they had a personal physician and no problems in contacting the practice after hours, for example, other aspects of the patient-centered medical home, such as provision of written self-management support to patients, were not as widespread. We conclude that despite strong organizational structures, European primary care systems need additional efforts to recognize chronically ill patients as partners in care and can embrace patient-centered medical homes to improve care for European patients.

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