Tag: "health policy"

Were 43% of Exchange Enrollees Insured in 2013?

health-insuranceAs predicted, people apparently are dropping pre-existing coverage to enroll in the exchanges. Express Scripts reports that 43 percent of the enrollees in the exchange plans that it contracts with were previously enrolled in a 2013 plan that also used Express Scripts. This means that at least 43 percent of exchange enrollees had previous coverage. The actual fraction of those with previous coverage may well be higher given that a one 2013 estimate concluded that Express Scripts controlled about 40 percent of the U.S. pharmacy benefit management market.

As this blog previously reported, Express Scripts also reported that exchange enrollees used 47 percent more specialty medications, drugs that account for more than a quarter of the nation’s spending on prescription drugs. The increased medication use is not surprising given that many states moved the people in their high risk pools into the exchanges.

The Express Scripts analysis was based on a national sample of more than 650,000 pharmacy claims from approximately 423,000 people enrolled in a public health insurance exchange from January 1, 2014 to February 24, 2014.

May 20, 2014 | 30 comments | by

ObamaCare Subsidies Wrong for More Than One in Eight ObamaCare Beneficiaries

The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors…

So piles of unprocessed “proof” documents are sitting in a federal contractor’s Kentucky office, and the government continues to pay insurance subsidies that may be too generous or too meager. Administration officials do not yet know what proportion are overpayments or underpayments. Under current rules, people receiving unwarranted subsidies will be required to return the excess next year.

The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly — either too low or too high — from those on file with the Internal Revenue Service, documents show.

The government has identified these discrepancies but is stuck at the moment. Under federal rules, consumers are notified if there is a problem with their application and asked to upload or mail in pay stubs or other proof of their income. Only a fraction have done so, according to the documents. And, even when they have, the federal computer system at the heart of the insurance marketplace cannot match this proof with the application because that capability has yet to be built, according to the three individuals.

Source: Washington Post.

May 19, 2014 | 11 comments | by

Wellness Fails Again

UntitledPepsiCo is the latest large employer to report that its wellness program has a negative return on investment, returning $0.48 for every dollar invested.

A voluntary program to help people manage actual diseases returned $3.78 per dollar invested.

The authors note that the results likely overstate the return on investment because they did not include the cost of program staff or the cost of employee time.

Beginning this year, ObamaCare requires that the government spend $200 million on wellness grants for small businesses that did not have a program in place when the law passed in 2010.

May 19, 2014 | 21 comments | by

Are ObamaCare Taxes Hurting the Medical Device Industry?

ObamaCare imposed an excise tax on medical-device makers that they have been lobbying relentlessly to repeal, arguing it kills jobs. However, according to Alex Lykken of Pitchbook, an information provider that collects and analyzes data on financial deals, ObamaCare’s medical-device tax has not had an impact on venture financing of new medical device companies:

Devices & supplies financings, believe it or not, hit a 10-year high in 2012, two years after the ACA was passed and just a year before the medical device tax went into effect. It seems odd that VC firms, which look several years down the road before investing, would complete more financings and invest more capital in the industry every year right until January 2013.

There is another plausible explanation: Device makers have global markets, and investors are looking to them, not the U.S., for growth.

May 16, 2014 | 6 comments | by

Variations in Post-Acute Care Spending

A publication called “Becker’s Hospital CFO” recently ran a story based on data from a company called DataGen on “The Truth Behind Variation in Episode Payments.” The article claims it will explore “the regional variations in Medicare payments for 90-day episodes of care.” This is to prepare for the new era of bundled payments, which is supposedly right around the corner.

Toy Businessman on a Pile of MoneyIn fact, the article does two things:

  1. It completely fails to explain the regional variations it identifies, and
  2. It illustrates what a poorly thought-through idea bundling is, especially when designed by payers like Medicare.

The article defines four types of episodes that are likely candidates for bundled payment. These all start with an inpatient admission followed by post-acute care treatment –

  1. Acute Myocardial Infarction (AMI)
  2. Congestive Heart Failure (CHF)
  3. Pneumonia
  4. Major joint replacement

Read More » »

May 15, 2014 | 9 comments | by

Hospital Price Transparency: More Toothless Regulation

The Administration continues to promulgate ineffective regulations that are supposed to help patients understand how much money they owe their hospital. Here is this month’s proposed rule updating the hospital Inpatient Provider Payment Services (IPPS) schedule for 2015:

Hospitals are responsible for establishing their charges and are in the best position to determine the exact manner and method by which to make those charges available to the public. Therefore, we are providing hospitals with the flexibility to determine how they make a list of their standard charges public. Our guidelines…are that hospitals either make public a list of their standard charges (whether that be the charge master itself or in another form of their choice), or their policies for allowing the public to view a list of those charges in response to an inquiry.

It is hard to imagine how this is going induce hospitals to present good-faith charges to patients, whether they are insured or not. A better solution would rely on common law, not federal regulation.

May 15, 2014 | 6 comments | by

By Shunning the Exchanges, Republican Governors Helped Taxpayers and Helped Make ObamaCare Work Better

A new report, by former Missouri Insurance Commissioner Jay Angoff, shows that states in which governors and/or legislators resisted ObamaCare, and whose Attorneys-General challenged its constitutionality, had the lowest cost-per-enrollee:

56456

States which established their own ObamaCare exchanges cost much more to enroll people. The worst, Hawaii, cost $23,899 per enrollee. The “best” of the state-based exchanges is California’s, which cost $758 per enrollee. For all states with their own exchanges, the average cost was $1,503 per enrollee.

If heavily populated Republican states, like Texas and Florida, had established their own exchanges that cost the same as California’s, the bill to federal taxpayers would have been $15 million higher than it was. If they had set up exchanges that cost the same as the average state-based exchange, the tab would have been $30 million higher.

May 15, 2014 | 9 comments | by

Urban Institute: Kill the Employer Mandate

Caduceus with First-aid KitA new report from the Urban Institute urges the end of the employer mandate. The mandate has little effect on coverage: 251.1 million people would have health insurance if the employer mandate is fully implemented, versus 250.9 million if it were repealed. However, the mandate hurts low-income workers, by influencing some employer to cut back both hours and headcount:

Creating arbitrary thresholds (e.g., potential penalties for firms of 50 or more workers not providing coverage for employees typically working 30 or more hours per week) for financial requirements will change the employment decisions in some firms, and at least some workers will be adversely affected by them.

(Linda Blumberg, John Holahan, & Matthew Buettgens, Why Not Just Eliminate The Employer Mandate?)

May 14, 2014 | 8 comments | by

Update: Federal Taxpayers Have Spent $655 Million on Three State Exchanges That Have Shut Down

Here’s the list:

Maryland                 $171,013,111

Massachusetts        $179,036,455

Oregon                    $305,206,587

Total                       $655,256,153

(Phil Kerpen, The Federalist). See previous posts here and here.

May 14, 2014 | 7 comments | by

PwC: Even ObamaCare’s Gold Exchange Plans Cost Less than Employer-Based Coverage

health-insurancePricewaterhouseCoopers’ Health Research Institute has just published another piece of research suggesting that many employers will be dropping health benefits and dumping employees into ObamaCare’s health-insurance exchanges. Employer-sponsored health plans pay about 85 percent of healthcare costs with the remainder paid by the employee. In other words, the average employer-based plan falls between the gold (80%) and platinum (90%) levels created under the 2010 law. Comparing premiums for plans offered on ObamaCare exchanges across the country:

Across the board, at every level, average exchange premiums are lower than this year’s average premiums for employer sponsored coverage. The average median premium for gold plans is 8% lower than the national average employer premium. When examining the average of the lowest premiums for gold plans the gap is 27 percent.

In 2014 health insurance plans offered on the ACA’s 51 new exchanges are on average, comparable to, or lower priced than, similar employer-based plans. In addition, most exchange shoppers have a wider variety of plans than the typical employer-based offering. The tradeoff may come in provider choice.

(PwC Health Research Institute, Health Insurance Premiums: Comparing ACA Exchange Rates to The Employer-Based Market)

May 14, 2014 | 11 comments | by
« Previous Page — Next Page »