Tag Archives: Department of Health and Human Services

A Push To Make Pregnancy A Qualifying Life Event

More than 50 House Democrats are asking the Obama administration to add pregnancy to the limited list of reasons women may enroll year-round in coverage on the Obamacare exchanges.

Once the second, extended enrollment period ends April 30, Americans may only sign up for marketplace coverage if they have experienced a major life event like a divorce or the birth of a child. As things stand now, pregnancy doesn’t qualify as a reason a woman could enroll in coverage outside the official signup season.

Advocates for the health law, led by the group Young Invincibles, have been pushing the administration on that front for the last month, asking it to issue a rule making pregnancy a “qualifying life event.” They’ve convinced House members to join their cause, too, led by Rep. Bonnie Watson Coleman, D-N.J.

“The Affordable Care Act has made historic progress towards ending discrimination against women in the health insurance market by requiring plans to cover maternity care…however, many women are still vulnerable,” says a letter sent Thursday to Health and Human Services Secretary Sylvia Mathews Burwell by Coleman and 54 House members.

“Special enrollment periods currently exist for qualifying life events like the birth of a child or the adoption of a child. We believe pregnancy should trigger a similar special enrollment period,” the letter says.

Nearly three dozen health advocacy groups, including the American Congress of Obstetricians and Gynecologists,also wrote to Burwell on Thursday asking for the change to be made. Young Invincibles says 50,000 people have signed a petition as well.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

New Goals Shift to Value-Based Medicare Payments

In a “historic” announcement, the Department of Health and Human Services on Monday set new goals for tying Medicare payments to quality or value through alternative payment models. The news received widespread print and online media coverage and is portrayed as an ambitious step by the Administration. Most sources also report on the generally positive response by providers, insurers and other stakeholders.

The Washington Post  (1/27, Millman) reports in its “Wonkblog” that the Obama Administration on Monday “announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.” Rather than pay more money to physicians for every procedure they perform, Medicare will also evaluate whether patients are healthier, “among other measures.” HHS Secretary Sylvia Mathews Burwell said in a press conference, “As a very large payer in the system, we believe we have a responsibility to lead.” She added, “For the first time, we’re going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system.”

USA Today  (1/27, O’Donnell) reports that HHS hopes to tie 30 percent of traditional Medicare payments to quality or value through “alternative payment models” by the end of 2016, up from 20 percent. These plans include accountable care organizations and “bundled payments,” which are groups of payments for treatments of the same issue. By the end of 2018, “HHS hopes to link 50% of payments to these arrangements.” Secretary Burwell stated, “We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement.”

Bloomberg News  (1/27, Wayne) reports that the Administration’s “historic” announcement on Monday marks “the first time the government has ever set specific goals to steer the nation away from fee-for-service payments.” According to Bloomberg, the plan would be a major transformation for hospitals, health facilities and physicians, “eventually more than doubling the reach of programs that the U.S. said has saved $417 million and that have been a model for how the government hopes to influence, and slow down, health spending.”

The Wall Street Journal  (1/27, Radnofsky, Beck, Subscription Publication) reports that the government’s ambitious goal to rework hundreds of billions of dollars in Medicare payments will likely see resistance from healthcare providers and skepticism from beneficiaries and lawmakers. Indeed, American Medical Association President Robert Wah, MD, said that while he was “encouraged” by the announcement, physicians need more flexibility in the way the payments would be administered. The AP  (1/27, Alonso-Zaldivar) adds that Dr. Wah “stopped short of an endorsement, telling reporters his group is encouraged but wants specifics.”

The Los Angeles Times  (1/27, Levey), however, reports that the “ambitious new goals” set by HHS were “broadly hailed by consumer advocates, leading medical providers and insurance industry officials.” Douglas E. Henley, chief executive of the American Academy of Family Physicians, praised the goals and hailed Monday as a “bless your heart day.” The article adds that the shift away from fee-for-service healthcare “is a central, if little recognized, goal of the Affordable Care Act.”

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Millennials Concerned of Out-of-Pocket Costs

Health plans that shift more up-front costs onto you are rapidly becoming the norm. But millennials don’t seem happy about taking on the risk, even in exchange for a lower price.

Millennials want their parents’ old health insurance plan. A new survey from Bankrate found that almost half of 18-to-29-year-olds prefer a health plan with a lower deductible and higher premiums—meaning millennials would rather pay more out of their paycheck every month and pay less when they go to the doctor. Compared to other age groups, millennials are the most likely to prefer plans with higher premiums.

That surprised Bankrate insurance analyst Doug Whiteman. “One would assume people in this age group were not likely to get sick, so they’d choose the cheapest possible plan just to get some insurance,” he says.

In theory, millennials are perfect candidates for high-deductible plans. The conventional wisdom is that since young and healthy people tend to have very low health-care costs, they should opt for a higher deductible and keep more of their paychecks.

If, for example, you go to the doctor only for free preventive care, switching from the average employer-sponsored traditional PPO plan to the average high-deductible health plan would save a single person $229 a year in premiums, according to the Kaiser Family Foundation’s 2014 data.

Millennials shopping in the new health insurance marketplace last year didn’t want the cheapest plans either. According to the Department of Health and Human Services, more than two-thirds of 18-to-34-year-olds chose silver plans, which have mid-level premiums and deductibles. Only 4% picked catastrophic plans, the ones with the lowest premiums and out-of-pocket limits of around $6,000.

Why are millennials choosing to pay more for health care? Turns out the “young invincibles” don’t feel so invincible after all, says Christina Postolowski, health policy manager at a youth advocacy group called—as it happens—Young Invincibles. “Millennials are risk-averse and concerned about their out-of-pocket costs if something happens to them,” Postolowski says.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

New York Market Shrinking While Others Increase

Contrary to the national reports, the New York market is shrinking as carriers exit the market due to their requested rate increases being denied by the review board.

Several high-circulation outlets and beltway sources report the news of more insurers joining the marketplaces created under the Affordable Care Act. The news is seen as good for the Obama Administration and the landmark health law. Fewer outlets cover news of a precipitous drop in the number of uninsured individuals in the United States, which was announced in the same speech and also bodes well for the ACA.

The Wall Street Journal (9/23, Radnofsky, Subscription Publication) reports that, according to the Department of Health and Human Services (HHS), more insurance companies are joining the health insurance exchanges created under the Affordable Care Act. Out of the 43 states and Washington DC where insurers have formally stated their intentions, 33 will see at least one new company offer plans during the ACA’s second annual open enrollment period. In a speech before the Brookings Institution, HHS Secretary Sylvia Mathews Burwell announced the change, noting the new entries are projected to increase the total number of participating insurers by 25%, from 252 last year to 316. The department also released a report (PDF) on the new entrants.

The Washington Post (9/23, Millman) “Wonkblog” reports that Secretary Burwell used the occasion to tout the success of the landmark health law to date, saying “When you consider the law through the lens of affordability, access and quality, the evidence points to a clear conclusion: the Affordable Care Act is working.” She added, “Middle class families have more security, and many who already had insurance have better coverage.”

Fox News’ News Business Willis Report (9/23, 5:19 p.m. EDT) noted that, in addition to 77 incoming companies, “14 insurers are dropping out of the Obamacare system.”
Congressional Quarterly (9/24, Subscription Publication) reports that no state offering data so far will see a decrease in the number of insurers participating in an exchange, though 11 states will have exactly the same number as last year.
The Washington Times (9/24, Dinan) puts the latest ACA news in a broader context, citing continuing Republican opposition to the Obama Administration’s implementation of the law and uncertainties over the security and stability of healthcare.gov.

The Hill (9/24, Viebeck) reports that Burwell has been working “behind the scenes” to calm the often fiery opposition to the ACA, meeting with Republicans and emphasizing good news about the law.

Politico (9/23, Haberkorn, Norman) says the news shows the insurance industry is betting that the implementation of the ACA will continue, regardless of which party controls the Senate come January.

The New York Times (9/24, Pear, Subscription Publication) reports the numbers presented by the government “are generally consistent with reports by some insurers,” which have indicated they are “moving into additional states because they see the government-subsidized market as a business opportunity.”

For example, Reuters (9/23, Morgan, Humer) reports that UnitedHealth Group, America’s largest health insurer, plans to expand its exchange presence from a an extremely limited offering in a handful of states last year to giving consumers in most states access to its policies.

Also covering the news are the AP (9/24), CNN (9/23, Luhby), CNBC’s Power Lunch (9/23, 1:30 p.m. EDT), the Kansas Health Institute (9/23), the New Orleans Times-Picayune (9/24), the Chicago Tribune (9/23), Crain’s Chicago Business (9/23), Forbes (9/23, Japsen), The Hill (9/24, Ferris), the New York Business Journal (9/23, Robinson), the Washington Business Journal (9/24, Hoover, Subscription Publication), CNBC (9/24, Mangan), and Modern Healthcare (9/23, Demko, Subscription Publication).

Jeffrey R. Ungvary President

Jeffrey R. Ungvary