Affordable Care Act Archives - Page 3 of 16 - Safety-Net Association of Pennsylvania

Safety Net Still Needed, Study Finds

Despite Affordable Care Act policies that have enabled millions of Americans to obtain health insurance, the health care safety net is still needed.
Or so concludes a new report from the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms.
For the report A Tale of Three Cities: How the Affordable Care Act is Changing the Consumer Coverage Experience in 3 Diverse Communities, researchers visited and examined conditions in Tampa, Columbus, and Richmond (Virginia), and among their conclusions was:

We still need a safety net. Safety net programs in existence before the ACA were expected to become less necessary once the ACA coverage expansions took effect. And to some extent that has indeed been the case. But what was deemed affordable under the ACA for those with income too high for Medicaid eligibility is not necessarily perceived to be affordable to the individuals enrolling in the marketplace plans, particularly when health care spending must compete with other pressing household expenses. As a result, safety net providers report that many patients who start the year with coverage return to them later in the year uninsured.

The report also found that

Safety net providers are adapting to the new coverage and health system landscape ushered in by the ACA. However, there’s not yet enough data to know whether coverage has translated to better, more affordable access to health care services.

To learn more about the report and its findings, go here to read a Center on Health Insurance Reforms blog entry on the research and go here to see the report itself.

PA Safety Net Admin2016-04-13T06:00:37+00:00April 13th, 2016|Affordable Care Act, Health care reform|Comments Off

MACPAC Unhappy With How DSH is Dished

Medicaid disproportionate share hospital payments (Medicaid DSH) are not getting to the hospitals that need them most, according to the independent agency that advises Congress and the administration on Medicaid access, payment, and care delivery issues.
In its March 2016 Report to Congress on Medicaid and CHIP, the Medicaid and CHIP Payment and Access Commission found

…little meaningful relationship between DSH allotments and three aspects of DSH payments that Congress asked us to study: 1) the relationship of state DSH allotments to data relating to changes in the number of uninsured individuals, 2) data relating to the amount and sources of hospitals’ uncompensated care costs, and 3) data identifying hospitals with high levels of uncompensated care that also provide access to essential community services for low-income, uninsured, and vulnerable populations.

MACPAC also observed that

Although early reports suggest that the coverage expansions are improving hospital finances in general, it is not yet clear how hospitals that are particularly reliant on Medicaid DSH payments are being affected.

MACPAC further maintains that

…DSH allotments and payments should be better targeted, consistent with their original statutory intent.

Noting an obstacle to such an undertaking, MACPAC

…recommends that the Secretary [of Health and Human Services] collect and report hospital-specific data on all types of Medicaid payments for all hospitals that receive them. In addition, the Secretary should collect and report data on the sources of non-federal share necessary to determine net Medicaid payment at the provider level.

Finally, MACPAC promises to continue looking into this challenge and exploring possible solutions.

In future reports on DSH payment policy, which MACPAC will include in its annual March reports to Congress, the Commission will continue to monitor the ACA’s effect on hospitals receiving DSH payments. We also plan to explore potential approaches to improving targeting of federal Medicaid DSH funding, including modifying the criteria for DSH payment eligibility, redefining uncompensated care for Medicaid DSH purposes, and rebasing states DSH allotments.

To learn more about what MACPAC had to say about Medicaid DSH and other Medicaid- and CHIP-related issues, go here to see the MACPAC report March 2016 Report to Congress on Medicaid and CHIP.

PA Safety Net Admin2016-03-21T06:00:56+00:00March 21st, 2016|Affordable Care Act, Medicaid supplemental payments|Comments Off

Cutting ER Visits: Harder Than Expected

The first two years of major expansion of access to health insurance under the Affordable Care Act did not produce the significant reduction in hospital ER visits that many expected.
Or so reports a new study from the Centers for Disease Control and Prevention.
According to the CDC, even though eight million people gained health insurance under the health reform law in 2013 and 2014, ER visit rates changed little.
Still, the CDC survey found some progress: visits among Medicaid patients and the uninsured fell slightly, although Medicaid patents still frequent hospital ERs more than the privately insured.
Among those who did visit the ER, many said their primary care practice was not open at the time or that the ER was the only provider to which they felt they had access to care. In addition, many who made ER return visits reported doing so because of local government reductions of behavior health services options.
Because they are located in low-income communities, Pennsylvania safety-net hospitals typically have far more ER visits than the average hospital.
Learn more about changing rates of ER visits during the first years under the Affordable Care Act in this Fierce Healthcare article or go here to see the CDC report Reasons for Emergency Room Use Among U.S. Adults Aged 18–64: National Health Interview Survey, 2013 and 2014.

PA Safety Net Admin2016-02-23T06:00:12+00:00February 23rd, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Dual Eligible Programs Show Mixed Results

The Affordable Care Act-inspired effort to find more effective ways to serve the so-called dual eligible population – mostly the disabled and low-income elderly covered by both Medicare and Medicaid – is not providing the kind of results policy-makers expected when they initiated new efforts to serve this high-cost population.
But not all of the news is bad.
On one hand, enrollment figures for those eligible to participate have not met expectations, with some of those eligible afraid they might lose their providers and some of those providers persuading their patients not to participate. In addition, some health plans that participated in the earliest efforts have withdrawn in the face of declining enrollment.
On the other hand, employing care managers to serve members has shown signs of reducing hospitalizations and Medicare costs and individuals who do participate have expressed satisfaction with the service they are receiving.
Programs that serve dually eligible individuals are of special interest to Pennsylvania safety-net hospitals because the communities they serve typically have especially large numbers of such residents.
For a closer look at the effort’s expectations, where it has succeeded, and where it has encountered challenges, see this Wall Street Journal article.

PA Safety Net Admin2015-12-30T06:00:59+00:00December 30th, 2015|Medicare, Pennsylvania Medicaid policy|Comments Off

Low-Income Workers Rejecting Health Insurance

Low-wage workers offered health insurance by their employers are largely rejecting that option, according to a report in the New York Times.
According to the Times, most of the progress in reducing the number of unemployed Americans has been made through Medicaid expansion and subsidies offered through the federal and state health exchanges. As small businesses begin to be required to offer their workers unsubsidized insurance, however, they are finding that most of their lower-wage employees are rejecting the offer. As a result, 7.5 million people last year paid the Affordable Care Act fine for failing to obtain health insurance.
A review of the profile of those who choose not to purchase employer-sponsored health insurance found that workers who earn between $15,000 and $20,000 a year purchase insurance only 37 percent of the time and that only when income rises to $45,000 does the health insurance purchase rate increase significantly.
For more information about who is and is not buying employer-sponsored health insurance and why, see this New York Times article.

PA Safety Net Admin2015-10-22T06:00:38+00:00October 22nd, 2015|Affordable Care Act|Comments Off

Increases in Medicaid Enrollment Should Slow

Growth in Medicaid enrollment, significant this year and last, should slacken in 2016, according a new Kaiser Family Foundation report.
That growth – 8.3 percent in 2014 and 13.8 percent in 2015 – should fall to approximately four percent next year. The upswing is the result of Medicaid expansion authorized by the Affordable Care Act and most of the growth was in states that expanded their Medicaid programs, although in 2015 every state experienced an increase in Medicaid enrollment.
Growth in Medicaid spending, too, is expected to decline, from 14.3 percent in 2014 and 13.9 percent in 2015 to a projected 6.9 percent in 2016.
To learn more about how, where, and why Medicaid enrollment and spending continue to grow, see this CQ HealthBeat report presented by the Commonwealth Fund.

PA Safety Net Admin2015-10-22T06:00:01+00:00October 22nd, 2015|Affordable Care Act|Comments Off

Variations on Medicaid Expansion

While most states that have taken advantage of the Affordable Care Act’s Medicaid expansion have simply expanded their existing Medicaid programs to incorporate the newly eligible, six states have taken a different path, pursuing what are known as section 1115 waivers – waivers of formal Medicaid requirements – to expand their Medicaid programs in different ways.
Typically, those different ways involve coverage modeled on private sector insurance practices, including requiring the newly eligible to choose from among approved managed care plans on the private market; the elimination of some traditional Medicaid benefits; the imposition of work requirements and higher premiums; and more.
In the new report Medicaid Expansion, The Private Option and Personal Responsibility Requirements: The Use of Section 1115 Waivers to Implement Medicaid Expansion Under the ACA, the Urban Institute takes a close look at the six states that have taken this alternative path; among the states reviewed is Pennsylvania and its now-discarded “Healthy Pennsylvania” Medicaid expansion plan. In addition, the Commonwealth Fund has published “The Promise and Pitfalls of Alternative State Approaches to Medicaid Reform,” a commentary on the efforts of the states that have followed this alternative path.

PA Safety Net Admin2015-06-17T06:00:02+00:00June 17th, 2015|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

PA Seeks to Establish Health Insurance Marketplace

In anticipation of a possible Supreme Court decision that could jeopardize the health insurance of an estimated 382,000 Pennsylvanians, the Wolf administration has applied to the federal government to establish a state-based health insurance marketplace.
The Supreme Court is currently weighing a challenge to the use by some states of the federal health insurance marketplace and the contention of litigants that the Affordable Care Act specifies that insurance subsidies would only be available through state-based exchanges. If the court rules against the federal government, the insurance of residents of states that did not establish their own exchanges and who instead obtained their insurance and federal subsidies through the federal exchange will be in jeopardy.
The move by the Wolf administration is a contingency plan and does not commit the state to developing its own exchange.
For further information about the state’s application to establish a health insurance exchange, see this Wolf administration news release.

PA Safety Net Admin2015-06-05T06:00:42+00:00June 5th, 2015|Affordable Care Act, Health care reform|Comments Off

But Does Coverage Mean Access?

More than 12 million people have joined the Medicaid rolls in the U.S. since the Affordable Care Act’s voluntary expansion of Medicaid eligibility began in January of 2014.
Historically, however, many Medicaid patients have had a difficult time finding doctors willing to serve them because in many states, Medicaid payments are so low that doctors choose not to participate in the program.
Is that still the case today? What challenges do Medicaid patients face when they need medical care?
In a new article titled “You’ve Got Medicaid – Why Can’t You See the Doctor?”, U.S. News & World Report takes a look at this issue. Find its report here.

PA Safety Net Admin2015-06-03T06:00:53+00:00June 3rd, 2015|Affordable Care Act|Comments Off

Underinsurance Remains a Problem

Twenty-three percent of American adults are uninsured, according to a new survey by the Commonwealth Fund.
Among them, 14 million had deductibles that exceeded five percent of their income while another 24 million had deductibles that fell below that threshold but had out-of-pocket health care costs – deductibles, co-insurance, co-payments, and out-of-network payments – that exceeded ten percent of their income.
The figures are for 2012 and reflected no change since 2010 but were nearly twice those found in 2003.
In addition, the survey found that the proportion of the insured with high-deductible plans has more than tripled, from three percent to 11 percent, since 2003. This is believed to reflect the proliferation of high-deductible plans in recent years – a proliferation that has increased with implementation of the Affordable Care Act and the many high-deductible plans offered through the federal exchange and state exchanges. This survey, however, did not distinguish between pre- and post-Affordable Care Act insurance policies.
Another category of the uninsured is those with income less than 200 percent of the federal poverty level whose out-of-pocket health care costs are greater than five percent of their income. Such individuals can pose a special challenge to safety-net hospitals because they often are unable to pay their co-pays, deductibles, and some of their medical costs.
For a closer look at the numbers, who is underinsured, the role of high-deductible plans in being underinsured, the effect of being underinsured on gaining access to care and addressing health problems, and more, see The Problem of Underinsurance and How Rising Deductibles Will Make it Worse, an issue brief summarizing the Commonwealth Fund survey.

PA Safety Net Admin2015-05-26T06:00:35+00:00May 26th, 2015|Affordable Care Act|Comments Off

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