Tag Archives: Medicaid

Prices charged by NYC area hospitals vary widely, new report says

In the New York City area, hospitals with the biggest market share tend to charge the highest prices, according to a new report from the New York State Health Foundation.

The report, prepared by Marlborough, Mass.-based Gorman Actuarial, studied pricing in three regions of the state. In downstate New York, the highest-priced facilities negotiated prices with insurers that were 2.2 to 2.7 times more than what the lowest-priced hospitals fetched.

Facilities that are part of New York-Presbyterian, Northwell Health and Montefiore Health System were consistently among the highest-priced facilities, while NYC Health + Hospitals’ facilities were all in the two lowest-priced tiers, according to the report.

The report also found that safety-net hospitals that rely mostly on Medicare and Medicaid for revenue tended to receive lower reimbursements from commercial insurers as compared with hospitals that treat few publicly insured patients.

The study’s authors received unprecedented access to contracts between hospitals and insurance companies, granted by the state Department of Financial Services, which regulates insurers. They described the hospital industry as one where higher prices don’t necessarily translate into higher-quality care, and complex contracts may hinder insurers’ ability to hold down health care spending.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Immigrants, the Poor and Minorities Gain Sharply Under Health Act

LOS ANGELES — The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates.

Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. Low-wage workers, who did not have enough clout in the labor market to demand insurance, saw sharp increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and cashiers. Minorities, who disproportionately worked in low-wage jobs, had large gains.

The health care law was one of the most bitterly contested pieces of legislation in the country’s history. It remains controversial because of its costs to both taxpayers and insurance customers. The high premiums and high deductibles of many plans still make coverage a crushing financial burden for some families.

And the law is not close to achieving the goal of universal coverage, in part because 19 states have declined to expand their Medicaid programs for the poor, an option the Supreme Court granted them in a landmark 2012 case. Nevertheless, the Times’s analysis shows that by the end of that first full year, 2014, so many low-income people gained coverage that it halted the decades-long expansion of the gap between the haves and the have-nots in the American health insurance system, a striking change at a time when disparities between rich and poor are growing in many areas.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Health spending growth rate surges to 5.3% under ACA

The Affordable Care Act expanded health coverage to millions of Americans in 2014. Because more people had insurance to pay for healthcare services, demand and spending predictably went up more quickly.

But the important question for the future remains the same: Will healthcare be able to avoid large spending spikes and move to a more sustainable payment system?

“It’s absolutely no surprise that 2014 had a higher rate of increase because of all the additional people getting coverage,” said Paul Ginsburg, a health economist at the University of Southern California. “The purpose of covering them was allowing them to use more services.”

The 5.3% annual growth rate was the highest since before the 2008 recession. More recently, the U.S. healthcare system recorded historically low growth in expenditures. Many observers believe the recession was a primary driver because the high rates of unemployment battered demand for healthcare services.

Now the tide is slowly turning, although actuaries and experts don’t expect health expenditures will return to the days of double-digit yearly growth.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

We Mapped the Uninsured. You’ll Notice a Pattern. They tend to live in the South, and they tend to be poor.

Two years into Obamacare, clear regional patterns are emerging about who has health insurance in America and who still doesn’t.

The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the Affordable Care Act’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans.

These trends emerged in an analysis we undertook with the help of two organizations that are closely monitoring the progress of the health law. Last year, we used similar data to show the substantial effects Obamacare had on reducing the number of Americans without health insurance. This year, the same groups updated their estimates of where America’s uninsured live, and the change is a lot less drastic. States that were late to expand Medicaid, including Pennsylvania and Indiana, showed substantial reductions in their uninsured residents compared with last year. In other places, the changes have been more modest. In a few — like Mississippi — things appear to have gotten worse, with fewer people having health insurance this year than last.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Truths and Myths of Obamacare

The Obamacare debate has always been rife with myths, from the infamous “death panels” to the armed IRS agents that would arrest those who don’t buy insurance (really, this was an actual myth).

But as the Affordable Care Act turns five, it appears one myth reigns above them all: the idea that the health-care law has gotten increasingly expensive over time.

A Vox poll conducted by communications firm PerryUndem shows that 42 percent of Americans think Obamacare has cost “more than expected.” Only 5 percent got the right answer: that the Affordable Care Act has actually come in under budget, costing “less than what was estimated.”

Yes, it’s really true: Obamacare has come in under budget. Twice in the past year, the Congressional Budget Office has revised downward projected spending on the Affordable Care Act. In fact, the federal government is expected to spend less on health care now than it predicted in early 2010 — and those predictions didn’t include any spending from Obamacare!

That isn’t just about Obamacare — projections on what we’ll spend on Medicare and Medicaid, the two other big federal health-care programs, went down, too. But it is pretty remarkable that health-care spending is now expected to be lower than projections made before Congress passed a massive health insurance expansion.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Healthcare Spending on an Uptick

Bloomberg News reports that a new analysis of preliminary government data by the Altarum Institute research group shows healthcare spending is on the rise again after “five years of historically slow growth.” The analysis shows “health spending increasing by 5 percent last year, compared to 3.6 percent in 2013.” If the final tally confirms the numbers, “health-care spending during 2014 would mark the biggest jump since before the recession.” The article says, however, that the jump in spending for 2014 was not unexpected, as millions “of Americans have now gained health insurance through the Affordable Care Act exchanges, expanded state Medicaid programs, and jobs created by employers.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Health Insurance and Medicaid Enrollments High

About two million New Yorkers have signed up for insurance under the Affordable Care Act, with three out of every four of them poor enough to qualify for Medicaid, according to figures released Wednesday by the Cuomo administration.

While Gov. Andrew M. Cuomo heralded the overall numbers as a sign of the success of the program, having such a large proportion on Medicaid, which is funded by the government, could impose a heavy new burden on public finances.

But insurance experts said they expected the impact of the new Medicaid enrollment to be mitigated by the greater access to health care. In other words, they said, having Medicaid coverage would give people access to primary care that could keep them from developing a chronic disease or becoming catastrophically sick and ultimately costing the system even more.

“Theoretically, could these numbers of people eventually push that Medicaid number up higher? Yes,” James R. Tallon Jr., president of the United Hospital Fund, said on Wednesday.

But, he added: “Having most people insured is the key to controlling long-term cost growth because it means you can manage care in a more effective way.”

By and large, experts said, those signing up for private insurance on the state’s Affordable Care Act health exchange are people who were priced out of the market before. The law raised the income ceiling for Medicaid eligibility in New York and other states that accepted the expansion of the program; a family of four can now earn about $33,000 and still qualify. Many people who earn too much for Medicaid can get subsidies to help them buy private insurance.

Though Republicans in Congress have criticized the public costs and tried several times to repeal the law, which was passed in 2010, President Obama has vowed to veto any attempt to overturn it.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

What’s Next for Obamacare?

A pro-Obamacare nonprofit released a road map Monday for the next steps beyond the president’s health law, including getting every state to sign up for expanded Medicaid and pushing for universal dental coverage.

The move served as a signal that President Obama’s allies don’t just want to play defense against GOP efforts to undercut Obamacare, but want to see it expanded into new areas.

Armed with twin majorities in Congress, Republicans say Obamacare has resulted in rising costs and left a bloated health care system, crippled by onerous mandates.

The GOP is weighing its best options for chipping away at the law. That includes votes to test Mr. Obama’s veto pen, or the use of a complex budget process, known as reconciliation, to show they can take a swipe at Obamacare while avoiding a Democratic filibuster in the Senate.

Use of reconciliation is limited, however, and some Republicans say that tool should only be used for reforming the tax code.

All sides in the Obamacare fight are also eyeing a Supreme Court decision, due by June, that could prevent the administration from paying subsidies in about two-thirds of the states.

If the court ruled that way, the GOP says there could be a window to try to get some big changes done in Congress.

“We’re rapidly coming to a point where we as a conference are going to have to coalesce behind some of those ideas,” Rep. Michael Burgess, Texas Republican, told The Washington Times last week as both House and Senate Republicans held a policy retreat in Hershey, Pennsylvania.

Families USA Executive Director Ron Pollack acknowledged Monday that the law is “under attack.”

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Is Our Current Insurance Model the Best Health Policy?

When the 48-year-old man from Oregon didn’t have insurance, he felt he had no place to go but the emergency room. The man, who has diabetes, went to the emergency room often when he suffered from kidney stones. “Emergency rooms, from what I understand, they can never turn you away,” he said. “I mean, you don’t have much options when you don’t have insurance.”

Then, when he enrolled in the state of Oregon’s Medicaid plan, that all changed. He started seeing doctors in their offices, and stayed away from the emergency room: “I have had five appointments with my primary, one with the diabetic because they had me go to a diabetic educator, and then an appointment with my pharmacist, and then he does a phone-in thing with me every two weeks.

His experience confirms common assumptions about how health care works. If we can just invest in preventive care, we can reduce the use of the emergency room and lower health care costs, the thinking goes. But it turns out that his experience wasn’t typical. He was part of a giant social policy experiment that randomly assigned some eligible people to get Medicaid and others to remain uninsured. Over all, the study found that people who got insurance actually used the emergency room more than their uninsured peers.

Collecting data that can trump a powerful anecdote is the value of the randomized controlled trial, says Amy Finkelstein, an M.I.T. professor and a leader of the Oregon study, which has published a series of papers, most recently on emergency room use.

That’s why this type of study — which randomly assigns some people to a new treatment and others to a placebo or an old approach — is the gold standard in evaluating the effectiveness of drugs: It can provide results that are both surprising and persuasive. But despite medical science’s long history with such studies, when it comes to the best way to design health care delivery, the randomized evaluation is still an incredibly rare approach.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The Mutual Benefit of The Government and Insurance Companies

As Americans shop in the health insurance marketplace for a second year, President Obama is depending more than ever on the insurance companies that five years ago he accused of padding profits and canceling coverage for the sick.

Those same insurers have long viewed government as an unreliable business partner that imposed taxes, fees and countless regulations and had the power to cut payment rates and cap profit margins.

But since the Affordable Care Act was enacted in 2010, the relationship between the Obama administration and insurers has evolved into a powerful, mutually beneficial partnership that has been a boon to the nation’s largest private health plans and led to a profitable surge in their Medicaid enrollment.

The insurers in turn have provided crucial support to Mr. Obama in court battles over the health care law, including a case now before the Supreme Court challenging the federal subsidies paid to insurance companies on behalf of low- and moderate-income consumers. Last fall, a unit of one of the nation’s largest insurers, UnitedHealth Group, helped the administration repair the HealthCare.gov website after it crashed in the opening days of enrollment.

“Insurers and the government have developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal Treasury to insurers each year,” said Michael F. Cannon, director of health policy studies at the libertarian Cato Institute.

So much so, in fact, that insurers may soon be on a collision course with the Republican majority in the new Congress. Insurers, often aligned with Republicans in the past, have built their business plans around the law and will strenuously resist Republican efforts to dismantle it. Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary