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PPACA Links: 2013-07-01

Readers: Here’s the next of a series of Monday posts that are collecting what I hope are the most interesting stories of the week on the PPACA (ObamaCare). This is a huge subject to cover, so if you have additional links, please add them in comments! –lambert

In U.S., 43% of Uninsured Unaware They Must Get Coverage. Awareness higher, at 81%, among all Americans Gallup 2013-06-28

The vast majority of Americans, 81%, say they are aware of the 2010 Affordable Care Act’s (ACA’s) requirement that most Americans must carry health insurance or pay a fine. Americans who are currently uninsured — those most directly affected by this requirement — are much less likely to be aware of the provision, with 56% saying they know about it and 43% saying they are unaware. The subgroups that are less likely to be aware of the health insurance requirement are also the subgroups that are least likely to be insured, including Hispanics, blacks, young adults, and those in lower-income households. There are significant differences in familiarity by income level, with 89% of upper-income Americans, 76% of middle-income Americans, and 62% of lower-income Americans saying they are very or somewhat familiar with the law.

How much will Obamacare cost? Politico 2013-06-28

The prices that many people can expect to pay, though, may remain a mystery for a few more months. The feds, who are reviewing rates for exchange plans in more than half the states, have released limited information so far about who’s even asked to sell on federal-run insurance marketplaces, let alone what they’d like to charge. “It’s a little bit of a black box process at the moment,” [Sabrina Corlette of Georgetown University’s Health Policy Institute] said.

An Unfortunate Decision on Student Health Plan Coverage CHIR Blog 06-27-2013

This week the Administration, through a U.S. Department of Health and Human Services (HHS) final regulation and Department of Treasury guidance, concluded that if a student is enrolled in a college- or university-sponsored self-funded health plan, he or she will not be eligible for premium tax credits on the health insurance exchanges, at least for 2014. While students enrolled in such plans should not suffer penalties for not meeting the ACA’s individual responsibility requirement, they rightfully pointed out that the proposed rule exposed young people to plans that are essentially unregulated and are often very skimpy. For example, many impose annual and lifetime dollar limits and prescription drug limits, don’t fully cover preventive care, and include pre-existing condition exclusions – the very same provisions that are now prohibited under the ACA. But what’s not clear from the guidance is whether a student who enrolls in their school’s plan in August or September (and enrollment in student insurance can often be a condition of matriculation) can drop their student coverage mid-year and switch to an exchange plan.

Medicaid ‘Welcome-Mat’ Effect Of Affordable Care Act Implementation Could Be Substantial Health Affairs June 2013

The Affordable Care Act will have important impacts on state Medicaid programs, likely increasing participation among populations that are currently eligible but not enrolled. The size of this “welcome-mat” effect is of concern for two reasons. First, the eligible but uninsured constitute a substantial share of the uninsured population in some states. Second, the newly eligible population will affect states’ Medicaid caseloads and budgets. Using the Massachusetts 2006 health reforms as a case study and controlling for other factors, we found that among low-income parents who were previously eligible for Medicaid in Massachusetts, Medicaid enrollment increased by 16.3 percentage points, and Medicaid participation by those without private coverage increased by 19.4 percentage points, in comparison to a group of control states.

Nearly Half Of States Opt Not To Expand Medicaid Kaiser Health News 2013-07-01

With the fiscal year beginning in most states on July 1, many have decided whether or not to expand eligibility for adults starting on Jan. 1, 2014, as allowed by the health care law. So far, 23 states and the District of Columbia have announced they will expand eligibility. Another 22 have either said they will not expand or appear unlikely to expand on Jan. 1, while a handful remain unsettled.

A big Medicaid gap looms in Obama health care law Denver Post 2013-07-01

Nearly 2 in 3 uninsured low-income people who would qualify for subsidized coverage under President Barack Obama’s health care law may be out of luck next year because their states have not expanded Medicaid. An Associated Press analysis of figures from the Urban Institute finds a big coverage gap developing, with 9.7 million out of 15 million potentially eligible adults living in states that are refusing the expansion or are still undecided with time running short.

Tracking Medicaid Expansion Decisions: A Closer Look at Legislative Activity StateReforum 2013-06-27 (chart)

This revised chart includes additional details on key elements of Medicaid expansion bills that have been introduced in state legislatures, such as proposals to provide coverage to the expansion population through qualified health plans on the exchange, special requirements related to cost sharing or care delivery, or options allowing a state to discontinue participation in the expansion.

5 messaging challenges for Obamacare Politico

The Supreme Court made the law even more confusing for the poor by deciding Medicaid expansion is optional for states. In some states, poor people will get benefits from expanded Medicaid — and in others they’ll get nothing. Even more confounding — the below-the-poverty line Medicaid population can’t tap into the subsidies in the health insurance exchanges, but people who are just few rungs up the income ladder can get that financial help.

Wisconsin Experience Indicates That Expanding Public Insurance To Low-Income Childless Adults Has Health Care Impacts Health Affairs June 2013

In 2009 Wisconsin created a new public insurance program for low-income uninsured childless adults. We analyzed administrative claims data spanning 2008 and 2009 using a case-crossover study design on a population of 9,619 Wisconsin residents with very low incomes who were automatically enrolled in this program in January 2009. In the twelve months following enrollment in public insurance, outpatient visits for the study population increased 29 percent, and emergency department visits increased 46 percent. Inpatient hospitalizations declined 59 percent, and preventable hospitalizations fell 48 percent.

Study: ObamaCare rule covering 930K young adults The Hill 2013-07-01

More than 930,000 young adults have health insurance thanks to an ObamaCare rule making them eligible for coverage on their parents’ plans, according to a new study. The report found that gaining coverage under the mandate did not affect the probability of employment, but it was associated with fewer work hours.

Hospitals Threaten Obamacare Savings by Exiting Program Bloomberg 2013-06-29

Almost a third of 32 hospitals and health systems involved in an experiment aimed at changing the way medical providers are paid may exit the program, a potential threat to the Affordable Care Act’s ambitious cost-saving goals. Medicare’s “Pioneer” program is designed to save money by more efficiently managing care for patients with chronic diseases, such as diabetes and dementia. The providers agreed to a three-year plan to forgo traditional fee-for-service payments, where hospitals charge for every procedure, and instead get a fixed monthly stipend for individual patients. Begun in January 2012, Pioneer is one of several programs involving 252 providers created under the law to experiment with new payment models. Nine Pioneer members have told the U.S. they may exit, said Brian Cook, a Centers for Medicare and Medicaid Services spokesman. At least four may join other accountable-care programs that carry less financial risk, he said.

Affordable Care Act multistate program not sparking competition Politico 2013-06-24

The Affordable Care Act calls for the federal government to contract with two multistate plans — and one has to be a nonprofit. They have to be available in at least 31 states next year, although they don’t necessarily have to be available in every community in a state at the outset. Within four years, they have to be available nationwide. Having failed to get a government-run public option, backers wanted at least one nationwide, nonprofit alternative to compete with the standard commercial plans. So far, only Blue Cross Blue Shield has publicly declared that it will offer multistate plans. But the Blues already provide coverage in all 50 states, and the early indications are that their multistate plans will basically be clones of the standard plans they’ll be selling anyway in any given state. That means consumers won’t really be getting anything new.

Thousands Of Mississippi Consumers May Not Be Offered Insurance Subsidies Kaiser Health News 2013-07-29

Tens of thousands of uninsured residents in the poorest and most rural parts of Mississippi may be unable to get subsidies to buy health coverage when a new online marketplace opens this fall because private insurers are avoiding a wide swath of the state. No insurer is offering to sell plans through the federal health law’s marketplaces in 36 of the state’s 82 counties, including some of the poorest parts of the Delta region, said Mississippi Insurance Commissioner Mike Chaney. As a result, 54,000 people who may qualify for subsidized coverage would be unable to get it, estimates the Center for Mississippi Health Policy, a nonpartisan research group.

Will New Laws in States with Federally Run Health Insurance Marketplaces Hinder Outreach? The Commonwealth Fund 2013-07-01

To date, 18 states with federally facilitated exchanges (including state-partnership exchanges) have enacted, or are currently considering, legislation that imposes state-specific requirements on navigators. Of these, 12—Arkansas, Florida, Georgia, Indiana, Iowa, Maine, Montana, Nebraska, Ohio, Tennessee, Texas, Virginia, and Wisconsin—have already passed such legislation. (Utah—which adopted a bifurcated approach in which the federal government will operate the individual exchange and the state will operate the small-business exchange—also enacted navigator legislation.) An additional five states—Illinois, Michigan, Missouri, North Carolina, and Pennsylvania—are currently considering pending legislation or have sent such legislation to the governor to be signed. Most of the bills require a navigator to obtain state licensure or approval before operating in the state. Many also establish training requirements, require criminal background checks, and authorize disciplinary measures against navigators. Some bills also subject navigators to existing insurance law (such as privacy and unfair trade practices standards) or require navigators to secure financial protection against wrongdoing.

Local Officials Asked to Help on Health Law Times 2013-06-29

The White House is recruiting mayors, county commissioners and other local officials to promote and carry out President Obama’s health care law in states like Florida and Texas, where governors are hostile to it. “We may assign some of our staff to sit with folks at computers and help them through the whole process,”[Dr. Thomas L. Schlenker, the public health director in San Antonio] said. “It will be complicated. It will be confusing. But for the people who get connected to insurance, we are convinced it will do a lot of good.”

Latino Enrollment Key To Success Of Health Law Marketplaces Kaiser Health News 2013-06-23

Just as Latinos were crucial to President Barack Obama’s re-election success in 2012, they are now key to the success of his health law. And the administration is doing everything it can to make sure that Latinos, like the Velandias, enroll. Latinos make up 17 percent of the total U.S. population, but 32 percent of the nation’s uninsured. They’re also more likely to be young – nearly half of Hispanics are under the age of 26. That’s important for the insurance pools because young and healthy people need fewer medical services and insurance companies can use their premiums to help subsidize coverage for older or sicker patients. On a recent trip to California, Obama highlighted a successful outreach campaign targeting Latinos that he says should be replicated in other states. As part of that effort, Hispanic media groups Univision, Telemundo and ImpreMedia (which publishes La Opinion, La Prensa and El Diario, among other news outlets) deploy a broad campaign on television, radio, mobile platforms and the web, which the administration says could reach nearly 100 percent of Hispanic families in California. The effort is being funded by the California Endowment, a Los Angeles-based foundation that has pledged $225 million to help with outreach in the state.

NFL Indicates It Will Not Participate In Obamacare Campaign Sports Business Daily

NFL VP/Communications Brian McCarthy on Friday in an e-mail wrote that the league “has ‘no plans’ to work with the Obama administration in educating the public about the president’s controversial health care reform,” commonly referred to as Obamacare, according to Ashley Killough of CNN.com. McCarthy added that the league has “responded to letters they received from members of Congress.” He said the NFL has had “no substantive contact with the administration about” the prospective campaign.

Hardship? No penalty, but no insurance Don McCann, PNHP 2013-07-01

The Affordable Care Act (ACA) requires that individuals who fail to enroll in a qualified health plan (QHP) be required to make a shared responsibility payment (a financial penalty for being uninsured). There are several exemptions that allow the penalty to be waived, and one of these is “individuals who experience a hardship.” Of the exemptions, hardship is perhaps the most compelling. But think about that. These are individuals who have the greatest need to have the security of health care coverage, yet, instead of establishing measures that would bring them under the insurance umbrella, they are being left bare – exposed to greater financial hardship and greater barriers to health care access. Is this the best that we can do for these people – waive a financial penalty for the sin of being uninsured – a penalty that they couldn’t pay anyway?

Feds Release More Obamacare Guidelines Pallet Enterprise 2013-07-01 (handy decision tree chart for business)

For companies that are unsure how to prepare for new health care rules and penalties set to take effect next year, the Pallet Enterprise previously published the Obamacare Decision Tree to assist with answering common questions and provide a good picture of where they stand and what strategies to consider in the April 2013 issue.

Hacking HIPAA Health Blawg 06-24-2013

Right now we have the worst of all worlds with regards to patient privacy in healthcare. Patients are frequently subject to sub-standard security and privacy practices AND healthcare innovators are unable to deliver solutions that would be useful to patients because their technical approaches are uncomfortably novel for health care bureaucrats. Patients end up getting poor security and no innovation, the worst of all options. This problem is going to get worse before it gets better, since the new Omnibus HIPAA Rule will make cloud hosting of health care projects untenable very soon.