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First Peek at PA’s Health Insurance Exchange

A new report from the U.S. Department of Health and Human Services offers a first look at the health insurance choices to be available to residents of 36 states, including Pennsylvania.
According to the report, premiums before subsidies – not yet released publicly – will average about 16 percent lower than Congressional Budget Office projections.
Across the state, Pennsylvanians will average a choice of 56 insurance plans.  The selection varies by region, with 42 choices for residents of the Philadelphia area and 36 for those who reside in Pittsburgh.Health Benefits Claim Form
The health insurance exchanges are one of the main features of the Affordable Care Act.
Rate information for the individual plans will be released next Tuesday, but monthly premiums for Pennsylvanians reportedly will be lower than the average for the 36 states for which information is available.
For more on the selection of plans, see this Pittsburgh Post-Gazette article.  For information about rates, including a chart that shows examples, see this report in the Central Penn Business Journal.
 

2013-09-26T06:00:02+00:00September 26th, 2013|Affordable Care Act|Comments Off on First Peek at PA’s Health Insurance Exchange

ACA Insurance Subsidies for 900,000 Pennsylvanians?

As many as 900,000 Pennsylvanians could be eligible on October 1 for the insurance premium subsidies that are a major part of the Affordable Care Act, according to the advocacy group Families USA.
Learn more about the subsidies, who qualifies for them, and how they work in this WHYY Newsworks article.

2013-09-24T06:00:22+00:00September 24th, 2013|Affordable Care Act|Comments Off on ACA Insurance Subsidies for 900,000 Pennsylvanians?

CMS Finalizes Medicaid DSH Cuts

The Centers for Medicare & Medicaid Services (CMS) has issued a final Medicaid disproportionate share (Medicaid DSH) regulation that cuts federal spending on Medicaid DSH $500 million in FY 2014 and $600 million in FY 2015.
The Medicaid DSH cuts were mandated by the Affordable Care Act in anticipation of every state expanding its Medicaid program.  The reform law’s Medicaid expansion mandate was later made optional by a Supreme Court ruling.
Medicaid DSH cuts will hurt all Pennsylvania safety-net hospitals, and the Safety-Net Association of Pennsylvania (SNAP) has conveyed its opposition to the cuts to CMS and also has asked members of Pennsylvania’s congressional delegation to support current legislation to delay the implementation of both Medicaid DSH and Medicare DSH cuts for two years.
While the Affordable Care Act calls for Medicaid DSH cuts through 2020, the new regulation covers only two years.  CMS has indicated that it will review its reduction methodology for future years.
Read more about the Medicaid DSH cut, why it was made, the objections to it, and future Medicaid DSH cuts in this CQ Healthbeat article presented by the Commonwealth Fund.

2013-09-20T06:00:29+00:00September 20th, 2013|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off on CMS Finalizes Medicaid DSH Cuts

More Than Better Pay Needed to Lure Docs to Medicaid

Primary care physicians want more than better reimbursement as an inducement to serve more Medicaid patients.
They also want simpler administrative procedures, faster payment, and lower costs associated with treating those patients.
These findings come from a survey of primary care physicians in Washington state.
Recruiting more primary care physicians to serve Medicaid patients is more important than ever because many states will be taking advantage of Affordable Care Act incentives to expand eligibility for their Medicaid programs.
The survey results and more can be found in the article “Physicians May Need More Than Higher Reimbursements to Expand Medicaid Participation:  Findings From Washington State,” which was published in the September 2013 edition of the journal Health Affairs.  Find that article here.

2013-09-18T06:00:34+00:00September 18th, 2013|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off on More Than Better Pay Needed to Lure Docs to Medicaid

Corbett Presents Health Care, Medicaid Proposal

Pennsylvania Governor Tom Corbett has unveiled a new “Healthy PA” proposal that includes the means through which the state would extend Medicaid coverage to approximately 520,000 additional people.
The new Medicaid recipients, instead of enrolling in the state’s traditional Medicaid program, would purchase their health insurance through the state’s health insurance exchange, a creation of the Affordable Care Act.
Funding for the new recipients would come almost entirely from the federal government, also through the Affordable Care Act.
Pennsylvania has long been one of the states that has resisted expanding its Medicaid population – a decision made optional by the Supreme Court after a challenge to the 2010 reform law’s constitutionality.
Read a summary of the Healthy PA plan, and find a link to the plan itself here, on the state’s own web site.
 

2013-09-17T06:00:26+00:00September 17th, 2013|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off on Corbett Presents Health Care, Medicaid Proposal

Reform Will Give Medicaid Population a New Look

Once the Affordable Care Act’s Medicaid expansion is implemented, the Medicaid population as a whole will be younger, whiter, healthier, and more male but also more likely to smoke and drink to excess than it is today.
That is the conclusion reached by in a new report published in the Annals of Family Medicine.
This means that spending per recipient may not be as great for new Medicaid recipients as it is for current beneficiaries and that a different patient population may need different approaches to addressing different health challenges.
Learn more about the study and its implications in the article “Potential Adult Medicaid Beneficiaries Under the Patient Protection and Affordable Care Act Compared With Current Adult Medicaid Beneficiaries, which can be found here, on the web site of the journal Annals of Family Medicine.

2013-09-13T06:00:10+00:00September 13th, 2013|Affordable Care Act, Health care reform|Comments Off on Reform Will Give Medicaid Population a New Look

Legislature to Participate in PA Medicaid Expansion Talks

The Corbett administration plans to spend the coming weeks bringing the state legislature into it Medicaid expansion deliberations.
While the administration reportedly has been working to develop a Medicaid expansion program that meets its own requirements for financial responsibility and will pass federal muster, it has been doing so largely without consulting with the state legislature, which has been in recess since early July.  While legislative approval is not needed for most aspects of Medicaid expansion, Department of Public Welfare Secretary Bev Mackereth told the Pittsburgh Post-Gazette that the administration will begin consulting with the legislature.
Medicaid expansion, originally mandated by the Affordable Care Act, was made optional for states by a Supreme Court decisions.  Only about half of the states have definitively acted to expand their programs, and while Pennsylvania officials previously expressed strong opposition to expansion, they now appear on course to unveil an expansion proposal this fall.
Read more about the administration’s latest efforts, and its intention to involve the legislature, in this Pittsburgh Post-Gazette reportHarrisburg, PA capital building.

2013-09-11T06:00:19+00:00September 11th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off on Legislature to Participate in PA Medicaid Expansion Talks

Gap in Reform Law Could Leave Many Low-Income People Uninsured

When the Supreme Court gave states discretion over whether to expand their Medicaid programs under the Affordable Care Act, it unintentionally created a gap in potential coverage options for many low-income people that may leave many of those people without affordable health insurance.
According to a new report from the Commonwealth Fund, the 2010 reform law anticipated that everyone with incomes below 133 percent of the federal poverty level would be covered by Medicaid.  Individuals and families with incomes between 133 percent and 399 percent of the federal poverty level could use new federal subsidies to help purchase private health insurance.
In states that are not expanding their Medicaid programs, people with incomes between 133 percent and 399 percent of the federal poverty level will still be able to take advantage of federal premium subsidies.  People with incomes less than 133 percent of the federal poverty level but who do not qualify for their state’s Medicaid program – qualification criteria vary from state to state – will not be eligible for the same subsidies as many who earn more than them because the reform law assumed that all such individuals would be covered by Medicaid.
According to the Commonwealth Fund, this unanticipated gap in the reform law means that as many as 42 percent of people who suffer from periodic or chronic lack of insurance and who live in states that are not expanding their Medicaid programs will not benefit in any way from Affordable Care Act insurance reforms.
Pennsylvania is one of the states in which this problem will occur because the state is not expanding its Medicaid program.  It almost certainly will require Pennsylvania’s safety-net hospitals to provide more uncompensated care than originally expected when the reform law was enacted.
Read more about the unintended consequences of the Supreme Court’s decision and the choice by some states not to expand their Medicaid programs in In States’ Hands:  How the Decision to Expand Medicaid Will Affect the Most Financially Vulnerable Americans, a new report from the Commonwealth Fund.

2013-09-09T06:00:22+00:00September 9th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off on Gap in Reform Law Could Leave Many Low-Income People Uninsured

Medicaid Expansion to Ease Hospitals’ Uncompensated Care But Not in PA

Hospitals in states that expand their Medicaid programs under provisions of the Affordable Care Act should see a reduction in their uncompensated care once people begin applying for Medicaid benefits.
That will not be happening in Pennsylvania, however, because the state is not expanding eligibility for its Medicaid program.
In states that do expand their programs, hospitals will continue to lose money serving Medicaid patients because Medicaid payments seldom cover the cost of the services hospitals provide.  Demand for Medicaid services will grow in these states, moreover, as more people become eligible for benefits and some who have not had regular access to care for years begin to use their new benefits to address long-standing medical problems.
Recent published reports suggest that the Corbett administration is working on an expansion plan, to be negotiated with the federal government, and that this plan may be revealed to the public this fall.
Michigan became the most recent state to decide to take advantage of the Affordable Care Act and expand its Medicaid program.  For a look at how Medicaid expansion will affect hospitals in that state, see this Detroit Free Press articleHospital building.
 

2013-09-04T13:40:02+00:00September 4th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off on Medicaid Expansion to Ease Hospitals’ Uncompensated Care But Not in PA

PA Inching Closer to Medicaid Expansion

Pennsylvania state officials are working on a proposal to expand Medicaid eligibility in the state as provided for in the Affordable Care Act.
But newly eligible Pennsylvanians would not participate in the state’s current Medicaid program.
Speaking to a rotary club in York, Department of Public Welfare Secretary Bev Mackereth told her audience that because the state lacks confidence in the willingness of the federal government to continue funding care for new Medicaid enrollees, the state is developing a plan to present different Medicaid options to newly eligible people.
State officials continue to negotiate the terms of such a program with the federal government and anticipate submitting their proposal to the federal government in the near future.  If approved, they do not anticipate launching such an initiative until at least January of 2015.
Read more about the state’s plans in this Calkins Media report.

2013-08-30T06:00:24+00:00August 30th, 2013|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off on PA Inching Closer to Medicaid Expansion
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