Tag Archives: NY Health Benefit Exchange

Failed Co-ops Add Ammunition to G.O.P. War on Health Law

New York is not alone in failed co-ops.

Washington — The financial failure of more than half the nonprofit health insurance companies created under the Affordable Care Act has handed Republicans a new weapon in their campaign against the health law, thrown the Obama administration on the defensive once again and left more than a half-million consumers in the cold.

“Any start-up faces the inherent risks of building a business from the ground up,” Dr. Mandy Cohen, the chief operating officer at the Centers for Medicare and Medicaid Services, told Congress on Tuesday at a contentious hearing of the House Ways and Means Subcommittee on Health. “As with any new set of business ventures, some co-ops have succeeded while others have encountered more challenges.”

So far, 12 of the 23 nonprofit insurance plans created as a result of President Obama’s signature domestic achievement have announced — voluntarily or under pressure from federal and state regulators — that they will not offer coverage next year. The most recent announcement came on Tuesday, just hours before the House hearing, when Consumers Mutual Insurance of Michigan posted a notice on its website saying it will not sell health plans in 2016 on the insurance marketplace.

New Yorkers were dismayed to receive notices over the weekend saying insurance policies from their co-op, Health Republic Insurance of New York, “will not be available after Nov. 30.” With more than 155,000 members, the New York insurer was the largest of the co-ops.

To read the full story, 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

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

ACA Rates for 2015 Did Not Rise

The Hill    (12/22, Viebeck) reports that insurance premiums for ACA exchange plans “did not rise on the whole for 2015, though 10 states saw double-digit increases, according to a new analysis.” Researchers at the University of Chicago found that the average monthly premium for benchmark exchange plans went unchanged from 2014 to 2015, while the average deductible rose by 1 percent. The study, “released by the Commonwealth Fund, called the trend ‘unprecedented’ in the individual health insurance market, where premiums rose an average of 10 percent or more per year prior to the passage of the healthcare reform law.” The analysis stated that the three most important contributors to the stability of marketplace premiums were “an increase in the number of participating insurance carriers; the design of the marketplaces; and the risk stabilization programs for participating insurers.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Court Rules: No Subsidies for Individuals for Health Insurance

A federal appeals court has ruled the Obama administration cannot subsidize insurance premiums for nearly 7 million Americans, dealing a serious blow to the Affordable Care Act (this does not impact state funded exchanges like New York and Connecticut). The ruling sets up an almost-certain appeal to the U.S. Supreme Court.

Two judges with the D.C. Circuit Court of Appeals in Washington ruled Tuesday that the text of the reform law clearly forbids income-tax subsidies to go to low- and middle-income Americans who use one of the 34 federally run insurance exchanges. The tax subsidies have been flowing since the beginning of the year, based on a 2012 interpretation of the law by the IRS.

The actual text of the law says the sliding-scale tax credits are only available for coverage purchased “though an exchange established by the state,” which only 16 states did. IRS officials had claimed the imprecise wording of the law contradicted Congress’ overall intent to expand insurance coverage as widely as possible. But that argument did not win the day Tuesday.

“Because we conclude that the ACA unambiguously restricts the section 36B subsidy to insurance purchased on Exchanges “established by the State,” we reverse the district court and vacate the IRS’s regulation,” the two-member majority wrote.

The ruling was the second dose of bad news for the Democrat-passed reform law this summer. Last month, the Supreme Court dealt a major symbolic blow to the law by ruling in Burwell v. Hobby Lobby Stores that the administration could not force the owners of closely held corporations to defy religious objections and cover contraceptives in their employees’ insurance plans. The ruling prompted new legislation to ensure contraceptives are covered without cost for millions of women, but the future of that proposal is far from certain.

Tuesdays ruling poses a much greater financial threat to the law’s internal function, but the decision was not altogether surprising.

During oral arguments in March, the judges seemed to be split along the partisan lines that eventually became the 2-1 vote on Tuesday, with Republican-appointed judges Thomas Griffith and A. Raymond Randolph voting for the plaintiffs and Democrat-appointed judge Harry Edwards siding with Obama’s IRS.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The Obama Adminstration Setting Standards for Health Plan Networks

The Obama administration and state insurance regulators are developing stricter standards to address the concerns of consumers who say that many health plans under the Affordable Care Act have unduly limited their choices of doctors and hospitals (mostly individual, not group plans), leaving them with unexpected medical bills. Carriers are looking to further stratify their networks in their 2015 plan offerings, so plans are available at numerous price-points to attract consumers with varying needs.

Federal officials said the new standards would be similar to those used by the government to determine whether Medicare Advantage plans had enough doctors and hospitals in their networks. These private plans, sold by companies like UnitedHealth and Humana, provide comprehensive care to 16 million of the 54 million Medicare beneficiaries.

States are free to adopt additional standards of their own, and Washington did so in late April.

“I heard from many consumers who were upset to find their health plan no longer included their trusted doctor or hospital,” said Mike Kreidler, the insurance commissioner of Washington State. “Some people discovered this only after they had enrolled.”

Mr. Kreidler said the new standards were needed to deal with “an emerging trend toward narrower networks of medical providers.”

If a network is viewed as inadequate, patients may need to seek care from doctors outside the network, incurring thousands of dollars in costs not covered by insurance.

New York adopted a law this year to protect consumers against such “surprise medical bills.” Before treatment, doctors must tell patients what insurance they accept. If an insurer does not have a doctor with the expertise to treat a patient’s problem, the patient can go to providers outside the network at no additional cost.

The National Association of Insurance Commissioners, representing state officials, is updating its 18-year-old model law to add new consumer protections, after finding that some insurers tried to cut costs by excluding children’s hospitals and academic medical centers. Cancer treatment centers say they, too, have been excluded from many health plan networks.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Doubt Conjured by Slow Enrollment of Small Group to The Shop

Article from Bloomberg states, “Enrollment in Obamacare health plans for small businesses is off to a slow start, leaving in doubt whether the U.S. program can attract enough customers to satisfy insurers.”

To read more, click here.

Jeffrey R. Ungvary

Jeffrey R. Ungvary

President

 

The Confusion for Insurance Hikes

A common question we hear from our clients is “why are insurance rates going up.” Back in October 2013, we blogged about this burning question; here’s a link to our post to as a refresher.

Three months later, The New York Times reports, people signing up through the Affordable Care Act’s marketplaces tend to be older, officials said Monday, a demographic mix that could cause premiums to rise in the future if the pattern persists. You can read the entire article here.

As a reminder, the cost of health care (and the underlying insurance rates) increase due to four primary reasons:

• Better technology (CAT scan vs. X-ray)
• Aging population (life expectancy in 1900 was 40; today we’re more than double that)
• Defensive medicine (Google any ailment and a doctor has to test and treat you for it)
• Increased use of pharmaceuticals (doesn’t there seem to be a pill for everything?)
• Couple these four factors with a poorer risk pool and health insurance rates are going to rise at a faster rate.

Unfortunately, we will not see insurance rates going down anytime soon in the group marketplace and the anomaly of rates dropping in the individual market was due to new and more plans being offered in New York. However, to balance out the costs, there needs to be a variety of healthy people of all ages enrolling in the Exchange.

Jeffrey R. Ungvary

Jeffrey R. Ungvary

President

A Look Back on 2013’s Road to Health Care

Although the Federal Exchange had a lot of hiccups and fumbles, New York hit the mark just right. Take a look back on 2013, with NY1’s Health in Review, here.

Jeffrey R. Ungvary

 

Jeffrey R. Ungvary

President

One More Option for Those with Canceled Plans or Seeking Coverage

If you’re facing financial hardship, you now have the option to either purchase a catastrophic plan or avoid the requirement to have health coverage.

The Washington Post states:

“The rule change was issued in a bulletin from the Department of Health and Human Services. It is the second major response by the Obama administration to a public and political furor that erupted in the fall when several million people who bought their own insurance began to receive notices that their policies were being canceled because they fell short of new benefit standards. The cancellations prompted complaints that President Obama had reneged on an oft-repeated promise that, under the Affordable Care Act, people who like their health plans could keep them.”

To sum up today’s announcement, if you received a cancellation notice from your insurance and the plans through the federal and state marketplaces are too expensive, you can claim hardship and be exempt of needing insurance or opt to buy a catastrophic coverage.

To read the rest of the article, click here.

Jeffrey R. Ungvary

 

Jeffrey R. Ungvary

President