Here’s What You Need to Know About Preexisting Conditions in the GOP Health Plan

Has the repeal of the ACA left you worried about all the changes potential coming to your healthcare? Take a look at this article by Glenn Kessler from the Washington Posts and find out what AHCA means for you and your healthcare.

With House Republicans prepared to take a vote Thursday on yet another version of a plan to overhaul the 2010 Affordable Care Act, attention has been especially focused on whether Obamacare’s popular prohibition against denying coverage based on preexisting medical conditions will remain in place. Republicans, from President Trump to lawmakers pushing for the bill, insist that it remains intact, just in different form. Democrats and opponents of the bill say the guarantee is gone or greatly weakened.

The reality is more nuanced and complicated, as is often the case in Washington policy debates. Despite Ryan’s tweet that people with preexisting conditions are protected, there is no guarantee that they will not face higher costs than under current law. The impact of recent tweaks to the proposed legislation is especially unclear because lawmakers are rushing ahead without an assessment by the nonpartisan Congressional Budget Office. So here’s The Fact Checker’s guide to the debate.

What’s the issue?

Before the Affordable Care Act, insurance companies could consider a person’s health status when determining premiums, sometimes making coverage unaffordable or even unavailable if a person was already sick with a problem that required expensive treatment. The ACA prohibited that, in part by requiring everyone to purchase insurance.

But that “individual mandate” was unpopular and Republicans would eliminate that requirement in their proposed American Health Care Act. As a replacement, the AHCA initially included a continuous coverage provision that boosted insurance rates by 30 percent for one year if he or she has a lapse in coverage. (We explored this interaction between the provisions earlier.)

As part of an effort to attract more votes, Republicans have added an amendment, crafted by Rep. Tom McArthur (R-N.J.), that instead allows states to seek individual waivers from the law. One possible waiver would replace the continuous coverage provision so that insurance companies for one year could consider a person’s health status when writing policies in the individual market. Another possible waiver would allow the state to replace a federal essential benefits package with a more narrowly tailored package of benefits, again limited to the individual and small-group markets.

The theory is that removing sicker people from the markets and allowing policies with skimpier options would result in lower overall premiums.

Who would be affected?

If the law passed, a person generally would not be affected unless they lived in a state that sought a waiver. Moreover, they would need to have a lapse in health coverage for longer than 63 days and they would need to have a preexisting condition. Finally, they would have to purchase insurance in the individual market – such as the health exchanges in Obamacare – that currently serves about 18 million Americans.

Someone who got their insurance from an employer – and that’s about half of Americans under 65 (155 million) – presumably would not be affected, though the CBO did project that under the initial version of the AHCA 7 million fewer people would be covered by employers than under current law by 2026.

Then, for a period of one year, a person who fell into this category would face insurance rates that could be based on their individual condition. But states that seek a waiver are required to operate a risk mitigation program or participate in what is called an invisible risk sharing program. Alaska currently has such a program that helps cover the bills for one of 33 conditions (such as HIV/AIDS or metastatic cancer). The individual with the condition still submits bills to the insurance company, which then turns around and bills the state. But then the insurance company does not consider the cost of this care as part of its calculation for premiums to other individuals in the state.

All told, the AHCA would allot $138 billion over 10 years for a variety of funds that would seek to keep premiums lower or to assist with cost-sharing. Just this week, $8 billion over five years was added to the pot to woo wavering lawmakers, with the idea that the additional funds could be used for so-called high-risk pools. Many states had such pools to help people with preexisting conditions before the ACA. But the proposal does not require a state with a waiver to set up such a pool.

What could go wrong then?

There are many uncertainties about this path. The health insurance market has a lot of churn, so many people may experience a gap in coverage of just a few months. One estimate, by the Commonwealth Fund, indicated that 30 million adults would have had such a gap in 2016, potentially exposing them to a surcharge or being placed in a high-risk pool. On top of that, the Kaiser Family Foundation estimated that 27 percent of the people in the individual market have existing conditions that would have been uninsured before the ACA.

The AHCA eliminates cost sharing and offers a stingier tax credit to defray premium costs, likely resulting in higher overall health costs that may make insurance unaffordable for many people. (The CBO projected that 24 million more people would be without health insurance than under current law by 2026.)

Then, if people get sick, they may suddenly find themselves for a year being priced on their illness if they live in a state that sought a waiver. Depending on the approach taken by a state, some people might find it difficult to keep up their coverage for a full year before they qualify for prices at the community rate.

A big question is whether the funding to cover these folks is adequate. High-risk pools were big money losers and underfunded in the pre-Obamacare days, even though many had restrictions, high premiums and waiting lists. A $5 billion federal pool, established by the ACA as a bridge to the creation of the exchanges in 2013, covered about 100,000 people but was suspended when it ran out of money.

The Center for American Progress, a left-leaning group that opposes the AHCA, produced an analysis that indicated that even with the additional $8 billion, the maximum enrollment the AHCA’s funds would cover is about 700,000 people. If just 5 percent of the people currently in the individual market ended up in high-risk pools – and all states sought a waiver – that would overwhelm the proposed funding.

Avalere Health, a consulting firm, said in an analysis that $23 billion is specifically allocated in the bill for helping people with pre-existing conditions. That would cover about 110,000 people. If states allocated all of the other available funding, that would cover 600,00 people. “Approximately 2.2 million enrollees in the individual market today have some form of pre-existing chronic condition,” the analysis said.

When states had high-risk pools, people in those pools represented just 2 percent of the non-group health insurance participants. But given the limitations of those funds, that percentage may not be a good guide for what would happen under the AHCA.

Whenever health-care laws are changed, there are unknown and unintended consequences. The current system does not take into account a person’s health status when assessing premiums. But, as a Brookings Institution analysis suggested, under the AHCA’s provisions, healthy people might have an incentive to join plans based on health status. That would leave sicker people in the community rated plans, which in turn would face higher premiums. Over time, that could make the community rating meaningless. (Update: The CBO in its revised report on the AHCA said this was quite possible for states representing about one-sixth of the U.S. population. We explored that in detail in this article.)

Another possible outcome: If the pool of money is used to pay insurance companies for the difference in costs for patients with preexisting conditions, there may be little incentive for companies to keep their prices low; the difference would be made up by U.S. taxpayers.

The Bottom Line

When it comes to health care, readers should be wary about claims that important changes in health-care coverage are without consequences and that people are “protected” – or that the changes will result in massive dislocation and turmoil. There are always winners and losers in a bill of this size. In this case, if the bill ever became law, much would depend on unknown policy decisions by individual states – and then how those decisions are implemented.

See the original article Here.

Source:

Kessler G. (2017 May 4). Here's what you need to know about preexisting conditions in the GOP health plan [Web blog post]. Retrieved from address https://www.washingtonpost.com/news/fact-checker/wp/2017/05/04/heres-what-you-need-to-know-about-pre-existing-conditions-in-the-gop-health-plan/?utm_term=.bb8de3169f20


10 Things to Know about Medicaid: Setting the Facts Straight

Do you need help understanding all the aspects of Medicaid? Check out this informative article by Julia Paradise from Kaiser Family Foundation about the 10 most important things you must know when dealing with Medicaid.

Medicaid, the nation’s public health insurance program for low-income children, adults, seniors, and people with disabilities, covers 1 in 5 Americans, including many with complex and costly needs for medical care and long-term services. Most people covered by Medicaid would be uninsured or underinsured without it. The Affordable Care Act (ACA) expanded Medicaid to reach low-income adults previously excluded from the program and provided federal funding to states for the vast majority of the cost of newly eligible adults.

President Trump and other GOP leaders have called for far-reaching changes to Medicaid, including caps on federal funding for the program. In the debate about Medicaid’s future, some critics of the program have made statements that are at odds with data, research, and basic information about Medicaid. To inform policy decisions that may have significant implications for Medicaid, the low-income people it serves, and the states, this brief highlights 10 key Medicaid facts.

1.    Medicaid is a cost-effective program, providing health coverage for low-income Americans at a lower per-person cost than private insurance could.

Some say that Medicaid costs too much. Total Medicaid costs are high because Medicaid covers many people with complex needs for both health care and long-term care. Most Medicaid spending is for seniors and people with disabilities (Figure 1). Analysis shows that when the greater health needs of Medicaid enrollees are adjusted, costs per enrollee are lower in Medicaid relative to private insurance; spending per enrollee would be 25% higher if adult Medicaid beneficiaries were instead covered by employer-based insurance, largely because private insurers generally pay providers more than states do. Growth in Medicaid acute care spending per enrollee has also been low relative to other health spending benchmarks, and federal data show that Medicaid has constrained per capita spending growth more than Medicare and private insurance. States have strong financial incentives to manage Medicaid closely and ensure program integrity because they must pay a large share of Medicaid costs and must also balance their budgets. The ACA provided increased funding and new tools for both federal and state Medicaid program integrity efforts, and states continue to strengthen their operations, using data analytics and predictive modeling, expanding their program integrity activities to managed care, and making other investments.

2.    Medicaid bolsters the private insurance market by acting as a high-risk pool.

Some say that private insurance could do a better job of covering low-income people than Medicaid. Actually, Medicaid was established to provide health coverage for many uninsured people who were excluded from the private, largely employment-based health insurance system because of low income, poor health status, or disability. Over time, federal and state expansions of Medicaid have resulted in historic reductions in the share of children without coverage and, in the states adopting the ACA Medicaid expansion, sharp declines in the share of adults without coverage. Nearly 8 in 10 nonelderly, non-disabled adults are in working families and a majority are working themselves, but many work in small firms and types of industries that tend to have limited or no job-based coverage options. Among adult Medicaid enrollees who are not working, illness or disability is the main reason. By covering many of the poorest and sickest Americans, Medicaid effectively serves as a high-risk pool for the private health insurance market, taking out the highest-cost people, thereby helping to keep private insurance premiums more affordable.

Medicaid also bolsters the private insurance system by providing supplemental coverage for many privately insured children with special needs and children and adults with disabilities. Medicaid pays for therapies, dental and vision care, and other medical and long-term services and supports needed by many of these individuals but typically not covered by private insurance.

3.    Federal Medicaid matching funds support states’ ability to meet changing coverage needs, such as during economic downturns and public health emergencies.

Some argue that federal funding for Medicaid should be capped to remove states’ incentives to spend more. The availability of federal matching funds with no pre-set limit does not mean that states have no incentives to constrain spending. On the contrary, because they must spend their own dollars to claim federal matching payments, and are required by their constitutions to balance their budgets, states have a strong interest in running efficient and effective programs. State cost-cutting measures taken in hard economic times have led to lean Medicaid operations, and state Medicaid programs have been leaders in health care delivery and payment reform designed to control costs and improve care. Over 2007-2013, average annual growth in Medicaid spending per enrollee was  less than growth in private health insurance premiums – 3.1% compared to 4.6%.

The guarantee of federal matching funds at least dollar for dollar enlarges states’ financial capacity to respond to changing coverage needs. Because federal funds flow to states based on actual needs and costs, Medicaid can respond if there is an economic downturn, or medical costs rise, or there is a public health emergency such as the opioid epidemic or a natural disaster such as Hurricane Katrina. Federal payments to states adjust automatically to reflect the increased costs of the program. Capped federal funding for Medicaid would reduce federal spending, but the burden of the reductions would fall on states. The levers that states have to manage with reduced federal Medicaid funding are cuts in Medicaid eligibility and benefits, which could limit their ability to meet the health needs of their residents, respond to recessionary pressures and emerging health issues, and provide access to new but costly health care technologies, including life-saving drugs, to Medicaid beneficiaries. Federal caps would also lock in states’ historical spending patterns, constraining their flexibility to respond to changing resources and priorities.

4.    Medicaid is a major spending item in state budgets, but also the largest source of federal funds for states.

Some say that Medicaid is crowding out state spending on education and other state priorities. Medicaid is a major item in state budgets, but it is also the single largest source of federal funds for states. In FY 2015, Medicaid accounted for more than half (57%) of all federal funds states received. The federal government matches state Medicaid spending at least dollar for dollar and pays more in poorer states, and states receive an enhanced federal match – 95% in 2017 – for Medicaid expansion adults. In FY 2015, Medicaid accounted for 28% of total state spending (i.e., including state spending of federal dollars), but less than 16% of state spending of state funds – a distant second to state funds spending on K-12 education (almost 25%).

An analysis examining economic and fiscal trends in Medicaid expansion and non-expansion states found that Medicaid expansion states, which typically raise more tax revenues as a share of total taxable resources than non-expansion states, spend more per capita on both Medicaid and K-12 education. Research shows that the injection of federal Medicaid matching funds into state economies has a multiplier effect, directly benefiting the health care providers that serve Medicaid beneficiaries, and also indirectly supporting other businesses and industries (e.g., vendors), producing increased state economic activity and output as the funds flow through the system. More recent analyses find positive effects of the Medicaid expansion on multiple economic outcomes in states, including budget savings, revenue gains, and overall economic growth.

5.    States have broad discretion in designing key aspects of their Medicaid programs.

Some say that Medicaid is federally controlled and inflexible, leaving states little room to shape their own programs. In fact, beyond federal minimum requirements for Medicaid, states have and use extensive flexibility and options to design key dimensions of their Medicaid programs. For example, they can and do elect to cover many optional services and optional groups. State Medicaid programs vary widely in terms of who is eligible, which services are covered, premiums and cost-sharing requirements, the delivery systems in which beneficiaries get care, and provider payment methods and rates. The different program design choices that states make, reflecting their particular needs, preferences, and priorities, are a large underlying factor in the wide variation in state Medicaid spending per enrollees (Figure 5). In 2011, Medicaid spending per full-benefit enrollee ranged from $4,010 in Nevada to $11,091 in Massachusetts. In addition to the flexibilities and optional state authorities provided by federal Medicaid law, states can obtain Section 1115 demonstration waivers that permit them to test and implement approaches that deviate from federal Medicaid rules if the HHS Secretary determines they advance program objectives. As of January 2017, 37 states had a total of 50 approved Section 1115 waivers.

6.    Medicaid beneficiaries have robust access to care overall, although access to certain types of specialists is an ongoing challenge for Medicaid and all payers.

Some say that access to care in Medicaid is lacking because 30% of physicians do not accept new Medicaid patients (about 70% do accept new Medicaid patients versus about 85% who accept new privately insured and Medicare patients). Taken alone, physician participation rates are a weak measure of access to care. A large body of research shows that Medicaid beneficiaries have far better access to care than the uninsured and are far less likely to postpone or go without needed care due to cost. Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance (Figure 6). Gaps in access to certain providers, especially psychiatrists, some specialists, and dentists, are ongoing challenges in Medicaid and often in the health system more broadly. Contributing factors include provider shortages, geographic maldistribution of health care providers, low Medicaid payment rates, and lack of transportation. Managed care plans, which now serve most Medicaid beneficiaries, are responsible under their contracts with states for ensuring adequate provider networks. There is no evidence that physician participation in Medicaid is declining. In a 2015 survey, 4 in 10 PCPs who accepted Medicaid reported seeing an increased number of Medicaid patients since January 2014, when the coverage expansions in the ACA took full effect. A recent analysis found no consistent evidence that increases in the share of adults with insurance at the local-area level affected access to care for adults in those areas who were already insured, including Medicaid beneficiaries.

7.    Medicaid keeps coverage and care affordable for low-income Americans.

Some say that Medicaid enrollees should pay more for their health care and have more “skin in the game” to restrain utilization. Federal law limits Medicaid premiums and cost-sharing to minimize financial barriers to coverage and care for low-income people: total out-of-pocket costs for a family are limited to 5% of the family’s income. Research shows that average spending greatly exceeds average income in low-income households, suggesting that these households accrue debt even as they earn. Therefore, even small amounts of spending on health care can crowd out other necessities or push low-income families further into debt. A family of three living at 138% FPL (the eligibility threshold for adults in Medicaid expansion states) has income of $28,180. Out-of-pocket costs totaling just 3% of their income – about $845 – would leave this family with less than $27,500 to pay for housing, utilities, food, clothing, transportation, school supplies, and other necessities. The same family living in one of the non-expansion states, where the median eligibility limit for parents is 44% FPL, would be left with about $8,700 to meet these basic costs.

Numerous studies have shown significant declines in enrollment in coverage after the implementation of new or higher premiums, as well as shorter spells of enrollment and reduced rates of renewal (Figure 7). Many who lose coverage become uninsured. Cost-sharing has been shown to lead to significant reductions in use of services, including essential and effective services like screenings and preventive care, prescription drugs, inpatient care, and other care key to health outcomes. Cost-sharing can have a particularly large impact on people with lower income and significant health care needs, as small copays add up quickly. Medicaid providers frequently report difficulty collecting cost-sharing, which effectively reduces their reimbursement; states do not collect much revenue from premiums, and state savings are largely attributable to decreased enrollment and reduced use of services – often, needed services. The Oregon Health Insurance Experiment (OHIE) showed that gaining Medicaid virtually eliminated catastrophic out-of-pocket medical spending among previously uninsured adults and reduced financial hardship. Federal action to reduce financial protections in

Medicaid would run counter to the empirical evidence that premiums and cost-sharing impede coverage and access to care, and preempt waiver initiatives underway in numerous states to further test these policies.

8.    Evidence of Medicaid’s impact on health outcomes is growing.

Some say that having Medicaid is worse than being uninsured. In fact, research shows consistently that Medicaid improves access to care for both children and adults with low income. Access to screening and preventive care in Medicaid translates into well-child care, earlier detection of health and developmental problems in children, and earlier diagnosis of cancer, diabetes, mental illness, and other chronic conditions in people of all ages. Access to primary care providers and specialists, prescription drugs, and other services improves the likelihood that Medicaid enrollees will get treatment for both their acute and chronic conditions. Expansions of Medicaid pregnant women and children have led to improved birth outcomes and child health, and there is growing evidence that Medicaid expansions to adults are associated with increased use of screening services and preventive care, prescription drugs, inpatient care, and other services key to improving health outcomes (Figure 8). The OHIE, which used a uniquely rigorous study design, found that uninsured adults who gained Medicaid coverage through a state lottery reported improved self-rated mental health and had a 30% reduction in clinically observed rates of depression relative to the comparison group of adults who remained uninsured. Medicaid also increased diabetes detection and use of diabetes medication, though the effect on control of diabetes, hypertension, and high cholesterol was not statistically significant. Research has also found that Medicaid expansions for adults were associated with significant reductions in mortality. A new study shows meaningful impacts of the Medicaid expansion on mental health for low-income parents. Some Medicaid critics, citing a small sample of observational clinical studies, have asserted that Medicaid beneficiaries have worse outcomes than the uninsured. However, a group of distinguished health services researchers commenting in a leading medical journal wrote that these studies lack a causal model explaining the observed data and, outlining numerous analytic problems with the critics’ interpretation of the findings, effectively discredited their argument.

9.    Medicaid is the primary payer for long-term care for seniors and people with disabilities.

Some assume that Medicare, the federal health insurance program for seniors and people with disabilities, covers long-term care. In fact, Medicare coverage of long-term care is extremely limited. Medicaid is essentially the only public or private insurance program that covers long-term care. Six in 10 nursing home residents are covered by Medicaid, and Medicaid’s role in providing access to community-based long-term services and supports (LTSS) for both seniors and people with disabilities is hard to overstate. The program is the largest single source of payment for long-term care, financing half of total spending in this sector, including both nursing home care and home and community-based services (HCBS) (Figure 9). Over time, states have been working to rebalance their LTSS systems by devoting a greater percentage of their long-term care spending to HCBS relative to nursing home care, and Medicaid has been instrumental in expanding access to community-based LTSS, advancing efforts to increase community integration of seniors and individuals with disabilities.

In addition to covering LTSS, Medicaid also makes Medicare work for nearly 10 million poor Medicare beneficiaries (1 in 5 of all Medicare beneficiaries), known as “dual eligibles,” by helping with their Medicare premiums and out-of-pocket costs and covering vision and dental care and other benefits that Medicare does not cover. In the debate about the ACA Medicaid expansion to low-income adults, some have argued that state choices to adopt the expansion come at the cost of Medicaid’s neediest beneficiaries, but the research does not bear this out. A recent study found no evidence for the claim that Medicaid expansion leads to longer waiting lists for Medicaid HCBS waivers for seniors and people with disabilities. The study found that waiting lists for these waivers pre-date the ACA Medicaid expansion, and that there appears to be no relationship between a state’s Medicaid expansion status and changes in its HCBS waiver waiting list.

10. Medicaid is popular with the American public as well as with enrollees themselves.

Some say that Medicaid is a poor and broken program. The majority of Americans say that Medicaid is a very important program. More than half (56%) report that they, a child of theirs, or another family member or friend has been enrolled in Medicaid; the same percentage say that Medicaid is important for them and their family (Figure 10). Most Medicaid enrollees say the program is working well for the low-income people it covers and the vast majority feel well-protected financially. Focus group research has shown high levels of satisfaction with Medicaid among parents with children in the program. Two-thirds of Americans do not support caps on federal funding for Medicaid, the vast majority (84%) say that continuing federal funding for Medicaid expansion is important, and few (12%) want decreased federal spending on Medicaid.

See the original article Here.

Source:

Paradise J. (2017 May 9). 10 things to know about medicaid: setting the facts straight [Web blog post]. Retrieved from address http://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/

 


HR Pros Were Relieved When Obamacare Replacement Bill Got Pulled

Find out how HR professionals really felt about the fall of the AHCA in this great article from HR Morning by Tim Gould.

Everybody knows that the GOP’s attempt to repeal and replace Obamacare came to a rather ignominious end. But how did the HR community feel about that outcome?  

HR powerhouse Mercer addressed that question in a recent webcast, and the results were eye-opening.

Here are some stats from the webcast, which asked a couple key questions of 509 benefits pros.

On how they felt about the American Health Care Act being pulled:

  • Very relieved it didn’t pass — 24%
  • Relieved it didn’t pass — 32%
  • Very disappointed it didn’t pass — 5%
  • Disappointed it didn’t pass — 16%, and
  • No opinion — 23%.

So (utilizing our super-sharp math skills here) considerably more than half of the participants were not in favor of the AHCA, while just slightly more than one in five were disappointed it was shot down. Looks like Obamacare isn’t as deeply disliked as we’ve been led to believe — at least with benefits pros.

Mercer also asked participants to rate priorities for improving current healthcare law — using 5 as the top rating and 1 as the lowest. Those results:

  • Reduce pharmacy costs — 4.4
  • Improve price transparency for medical services/devices — 4.1
  • Stabilize individual market — 4.0
  • Maintain Medicaid funding — 4.0, and
  • Invest more in population health and health education — 3.7.

Perspective? As Beth Umland wrote on the Mercer blog, “Policymakers should view this health reform ‘reboot’ as an opportunity to partner with American businesses to drive higher quality, lower costs, and better outcomes for all Americans.”

A glance back

In case you’ve been hiding in a cave somewhere for the past several months, here’s a quick recap of the fate of the American Health Care Act.

Why did the AHCA fail, despite Republicans controlling the House, Senate and White House?

The answer starts with the fact that the GOP didn’t have the 60 seats in the Senate to avoid a filibuster by the Democrats. In other words, despite being the majority party, it didn’t have enough votes to pass a broad ACA repeal bill outright.

As a result, Senate Republicans had to use a process known as reconciliation to attempt to reshape the ACA. Reconciliation is a process that allows for the passage of budget bills with 51 votes instead of 60. So the GOP could vote on budgetary pieces of the health law, without giving the Democrats a chance to filibuster.

The problem for Republicans was reconciliation severely limited the extent to which they could reshape the law — and it’s a big reason the why American Health Care Act looked, at least to some, like “Obamacare Lite.”

Ultimately, what caused Trump and Ryan to decide to pull the bill before the House had a chance to vote on it was that so many House Republicans voiced displeasure with the bill and said they wouldn’t vote for it.

Specifically, here are some of what conservatives didn’t like about the American Health Care Act:

  • it largely left a lot of the ACA’s “entitlements” intact — like government aid for purchasing insurance
  • it didn’t do enough to curtail the ACA’s expansion of Medicaid
  • too many of the ACA’s insurance coverage mandates would remain in place
  • the Congressional Budget Office estimated that the bill would result in some 24 million Americans losing insurance within the next decade, and
  • it didn’t do enough to drive down the cost of insurance coverage in general.

See the original article Here.

Source:

Gould T. (2017 April 14). Hr pros were relieved when obamacare replacement bill got pulled Ob[Web blog post]. Retrieved from address http://www.hrmorning.com/hr-pros-were-relieved-when-obamacare-replacement-bill-got-pulled-off-the-table/


GOP Health Care Bill Would Cut About $765 Billion In Taxes Over 10 Years

The passing of the American Health Care Act means there will be a new taxes associated with healthcare. Find out in this article by Scott Horsley and see how this change in legislation will impact you.

The health care bill passed by the House on Thursday is a win for the wealthy, in terms of taxes.

While the Affordable Care Act raised taxes on the rich to subsidize health insurance for the poor, the repeal-and-replace bill passed by House Republicans would redistribute hundreds of billions of dollars in the opposite direction. It would deliver a sizable tax cut to the rich, while reducing government subsidies for Medicaid recipients and those buying coverage on the individual market.

Tax hikes reversed

The Affordable Care Act, also known as Obamacare, is funded in part through higher taxes on the rich, including a 3.8 percent tax on investment income and a 0.9 percent payroll tax. Both of these taxes apply only to people earning more than $200,000 (or couples making more than $250,000). The GOP replacement bill would eliminate these taxes, although the latest version leaves the payroll tax in place through 2023.

The House bill would also repeal the tax penalty for those who fail to buy insurance as well as various taxes on insurance companies, drug companies and medical device makers. The GOP bill also delays the so-called "Cadillac tax" on high-end insurance policies from 2020 to 2025.

All told, the bill would cut taxes by about $765 billion over the next decade.

The lion's share of the tax savings would go to the wealthy and very wealthy. According to the Tax Policy Center, the top 20 percent of earners would receive 64 percent of the savings and the top 1 percent of earners (those making more than $772,000 in 2022) would receive 40 percent of the savings.

Help for the poor reduced

Over time, the GOP bill would limit the federal contribution to Medicaid, while shifting control of the program to states. Depending on what happens to costs, states may be forced to provide skimpier coverage, reduce their Medicaid rolls, or both. The Congressional Budget Office estimated that an earlier version of the bill would leave about 14 million fewer people covered by Medicaid by 2026. (The House voted on the current bill without an updated CBO report.)

CBO also anticipated fewer people would buy insurance through the individual market. With no tax penalty for going without coverage, some people would voluntarily stop buying insurance. Others would find coverage prohibitively expensive, as a result of changing rules governing insurance pricing and subsidies.

The GOP bill would allow insurance companies to charge older customers up to five times more than younger customers — up from a maximum 3-to-1 ratio under the current health law. The maximum subsidy for older customers in the GOP plan, however, is only twice what is offered to the young.

The bill also allows insurance companies to offer more bare-bones policies. As a result, young, healthy people could find more affordable coverage options. But older, sicker people would likely have to pay more.

In addition, because the subsidies offered in the Republican plan don't vary with local insurance prices the way subsidies do in Obamacare, residents of high-cost, rural areas would also suffer. That could include a large number of Trump voters.

See the original article Here.

Source:

Horsley (2017 May 4). GOP health care bill would cut about $765 billion in taxes over 10 years [Web blog post]. Retrieved from address http://www.npr.org/2017/05/04/526923181/gop-health-care-bill-would-cut-about-765-billion-in-taxes-over-10-years


An Employer’s Guide to Navigating the ACA’s Strong Headwinds

Great article from our partner, United Benefit Advisors (UBA) by Michael Weiskirch.

One might describe the series of events leading to the death of the American Health Care Act (Congress’s bill to repeal and replace the Affordable Care Act) as something like a ballistic missile exploding at launch. The Patient Protection and Affordable Care Act (ACA) repeal debate began nearly a decade ago with former President Barack Obama’s first day in office and reemerged as a serious topic during the 2016 presidential election. Even following the retraction of the House bill, repeal of the ACA remains a possibility as the politicians consider alternatives to the recent bill. The possibility of pending legislation has caused some clients to question the need to complete their obligation for ACA reporting on a timely basis this year. The legislative process has produced a great deal of uncertainty which is one thing employers do not like, especially during the busy year end.

While the “repeal and replace” activity is continuing, it is imperative that employers and their brokers put their noses to the grindstone to fulfill all required reporting requirements. To accomplish this, employers will need brokers that can effectively guide them through this tumultuous season. We recommend that employers ask their brokers about their strategies for

  • Implementing the employer shared responsibility reporting
  • Sending all necessary forms to the employer’s employees
  • Submitting the employer’s reporting to the IRS
  • Closing out the employer’s 2016 filing season

Employers should also inquire about any additional support that the broker provides. They should provide many of the services that we at Health Cost Manager provide to our clients: They should apprise their clients of the latest legislative updates through regular email communication and informational webinars. Brokers should also bring in experts in the field that have interacted with key stakeholders in Washington. And most important, they should remain available during this uncertain period to answer any questions or concerns from clients.

We know employers would prefer not to have to comply with these reporting obligations – many have directly told us so. We understand this requires additional work on their part to gather information for the reporting and increased compliance responsibility. Knowing how stressful the reporting season can be for employers, brokers should go out of their way to help their clients feel confident that they can steer through the reporting process smoothly. The broker’s role should be to take as much of the burden off the employer’s shoulders as possible to enable them to reach compliance in the most expedient manner possible. Sometimes this involves stepping in to solve data or other technical issues, or answering a compliance-related question that helps the client make important decisions. It’s all part of helping employers navigate through the ACA’s strong headwinds during these uncertain times.

Audit-proof your company with UBA’s latest white paper: Don’t Roll the Dice on Department of Labor Audits. This free resource offers valuable information about how to prepare for an audit, the best way to acclimate staff to the audit process, and the most important elements of complying with requests.

See the original article Here.

Source:

Weiskirch M. (2017 April 13). An employer's guide to navigating the ACA's strong headwinds [Web blog post]. Retrieved from address http://blog.ubabenefits.com/an-employers-guide-to-navigating-the-acas-strong-headwinds


Data Note: Medicaid’s Role in Providing Access to Preventive Care for Adults

Medicaid has played a large role in the life of many Americans. By using federal money low-income Americans are able to receive healthcare. Take a look at this article by Kaiser Family Foundation and see how Medicaid's dollars are spent to help provide low-income Americans with healthcare.

Medicaid, the nation’s public health insurance program for people with low income, covers 74 million Americans today, including millions of low-income adults. The Affordable Care Act (ACA) expanded Medicaid to nonelderly adults with income up to 138% of the federal poverty level (FPL), and, in the 32 states (including DC) that implemented the expansion, more than 11 million adults have gained Medicaid as a result. Chronic illness is prevalent in the adult Medicaid population. Preventive care, including immunizations and regular screenings that permit early detection and treatment of chronic conditions, improves the prospects for better health outcomes. This Data Note focuses on Medicaid’s role in providing access to preventive care for low-income adults.

WHY IS PREVENTIVE CARE FOR ADULT MEDICAID ENROLLEES IMPORTANT?

Adults in Medicaid have high rates of preventable and controllable conditions. Nearly one-third (30%) of non-elderly adult Medicaid beneficiaries report that they are in only fair or poor health – roughly double the percentage of low-income privately insured and uninsured adults who report fair or poor  health (Figure 1). Medicaid adults also have significantly higher rates of chronic conditions and risky health behaviors that may be amenable to preventive care. One in 10 adult enrollees has a diagnosed mental illness; 7 in 10 are overweight or obese, and almost 1 in 3 smoke tobacco.

Preventive care can reduce disease and avoidable use of high-cost services. Increased access to screening for diabetes, cancer, depression, and o ther chronic conditions, and counseling to address behavioral risk factors, have the potential to reduce disease and prevent exacerbations of conditions that can be medically managed. Improved health may reduce the use of avoidable hospital and other high-cost care, and reduce Medicaid spending. For example, smoking can cause heart disease and other chronic illnesses that one study estimated may be responsible for more than $75 billion in Medicaid costs. Medicaid coverage of smoking cessation services, including quit lines and medications, has the potential to mitigate both the health and cost impacts of smoking. Obesity, a major driver of preventable chronic illness and health care costs, affects about two-thirds of low-income adults. Findings from one study indicate that severe obesity in adults cost state Medicaid programs almost $8 billion in 2013, suggesting that “effective treatment for severe obesity should be part of each state’s strategy to mitigate rising obesity-related costs.”

WHAT PREVENTIVE SERVICES DOES MEDICAID COVER FOR ADULTS?

Coverage of most adult preventive services has historically been optional for states. Medicaid coverage of preventive services for children has long been strong, as states must cover comprehensive preventive services at no cost for children in Medicaid under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. In contrast, historically, coverage of adult preventive care has been largely optional for states, with some exceptions – states must cover pregnancy-related care and family planning services without cost-sharing. In addition, within federal guidelines, states can charge adults cost-sharing for preventive services.

The ACA expanded coverage of adult preventive care. An important thrust of the ACA was an emphasis on preventive care. In particular, the ACA included recommended preventive services without patient cost-sharing as one of the 10 “essential health benefits” (EHBs) that most health plans are now required to cover. The required preventive services are based on the recommendations of independent, expert clinical panels and include, for adults: 1) screening and counseling services (e.g., cancer screening, diet counseling); 2) routine immunizations; and 3) preventive services for women. The EHB requirement applies to Medicaid benefits for adults who are newly eligible due to the ACA expansion, but not “traditional” Medicaid adults, for whom most preventive services are optional for states and can require cost-sharing within federal guidelines. To incentivize states to cover the EHB preventive services for all Medicaid adults, the ACA provided for a one percentage point increase in the federal Medicaid match rate for these services in states that opt to cover all of them without cost-sharing.

Selected EHB-required preventive services for adults:

All adults

  • Immunizations
  • Cancer screening
  • Diabetes screening
  • Depression screening
  • Obesity screening and counseling
  • Tobacco screening and smoking cessation services

Women

  • Well-woman visits to get recommended services for women
  • Breast and cervical cancer screening
  • Domestic and interpersonal violence screening and counseling
  • Osteoporosis screening
  • Breastfeeding support, counseling, and supplies for pregnant and nursing women
  • Expanded tobacco intervention for pregnant women

Most state Medicaid programs covered many adult preventive services before the ACA took effect. A 2014 study found that most state Medicaid programs covered all EHB-required adult preventive services in 2013, although some had cost-sharing charges. At the same time, another study found that documented state coverage policies in effect prior to the ACA did not always correspond precisely with the EHB requirements for preventive care, indicating there was room for improvement. Eight states – California, Minnesota, Nevada, New Hampshire, New Jersey, New York, Oklahoma, and West Virginia – have opted to cover the recommended adult preventive services without cost-sharing for all Medicaid adults. Seven of these states implemented the Medicaid expansion to low-income adults.

HOW DO ADULTS WITH MEDICAID FARE IN ACCESSING PREVENTIVE CARE?

Nearly all adults with Medicaid have a usual place where they get routine or preventive care. One measure of Medicaid’s effectiveness is the extent to which beneficiaries have a usual source of care, which opens the door to the health care system, including preventive care. Over 90% of adults with Medicaid report having a usual place of care – the same as the percentage of low-income privately insured adults with a usual place, and significantly exceeding the share of low-income uninsured adults who do (Figure 2). Adults with Medicaid are also significantly more likely than adults in the other two groups to have had a primary care visit and a mental health visit in the past year. Research shows that people with a usual source of care have better outcomes and that having a primary care physician as the usual source of care increases the likelihood of receiving appropriate care.

Medicaid is as effective as private insurance at connecting low-income adults with recommended clinical preventive services. The percentage of Medicaid adults who report receiving recommended clinical preventive services is at least as high as the percentage of low-income privately insured adults receiving these services (Figure 3). In fact, Medicaid adults are significantly more likely than the privately insured to report a blood pressure check (84% versus 79%) and a cholesterol check (60% versus 56%). Medicaid adults do significantly better than the uninsured on every measure of preventive care. Notably, the share of low-income adults who report receiving recommended cancer screenings is no more than about half, pointing to a need for increased investment and effort to improve access to these services as well as public education about their importance.

The major health risks and costs posed by overweight/obesity and smoking point to a need for more focus on patient counseling, including in Medicaid. As mentioned earlier, 70% of Medicaid adults are overweight or obese and nearly one-third smoke, somewhat higher rates than those for low-income privately insured adults (65% and 18% respectively). Both obesity and smoking are risk factors for preventable chronic diseases, including cancer, that increase morbidity and mortality as well as health care costs. The share of overweight/obese adults and adult smokers in Medicaid who report being counseled by their provider on diet (38%) or smoking (63%), while similar to the share for privately insured adults, highlights an important gap in preventive care and a need for more investment and effort (Figure 4).

WHAT IMPACT HAS THE MEDICAID EXPANSION HAD ON ACCESS TO PREVENTIVE CARE FOR LOW-INCOME ADULTS?

A large and growing body of studies demonstrate that Medicaid eligibility expansions can improve access to primary and preventive care. Research shows that Medicaid expansion is associated with increased visits to primary care providers and increased diagnosis of diabetes and high cholesterol, as well as increased screening for diabetes, and reduced rates of skipped medication due to cost. The Oregon Health Insurance Experiment provides strong evidence of increases in screening and medication use for depression and declines in self-reported and clinically observed depression among previously uninsured adults who randomly won a limited number of Medicaid “slots” through a state lottery. The expansion also led to increases in diabetes screening and medication use among the adults who gained Medicaid compared to those who remained uninsured. A focused study of health center patients in Oregon found increases in screening for obesity, blood pressure, smoking, and chlamydia, as well as increased rates of mammograms, Pap tests, and lipid testing for adults in the Medicaid group. The pre-ACA expansion of Medicaid in Massachusetts was associated with an increase in hospital utilization, as would be expected, but hospitalizations for preventable conditions fell.

LOOKING AHEAD

Because Medicaid plays a large role in covering low-income adults and adult Medicaid enrollees are at elevated risk for preventable or treatable chronic conditions, ensuring access to preventive care and boosting utilization of these services among Medicaid adults is important to the national goal of improving population health while lowering health care costs. Medicaid expansion states have put preventive care within affordable reach of millions of previously low-income adults. State coverage of recommended preventive services without cost-sharing for all Medicaid adults would lower financial barriers to these services for many more of the nation’s poorest and sickest adults, increasing early detection and treatment of health conditions and risky behaviors, a necessary step to improve health outcomes and long-term trends in Medicaid costs. The House-passed American Health Care Act (AHCA) would both terminate enhanced federal funding for the Medicaid expansion to low-income adults and repeal the federal EHB requirements for Medicaid adults, threatening large losses of Medicaid coverage for adults as well as retrenchment in covered benefits, including preventive care for adults.

See the original article Here.

Source:

Ku L., Paradise J., Thompson V. (2017 May 17). Data note: medicaid's role in providing access to preventive care for adults [Web blog post]. Retrieved from address http://www.kff.org/medicaid/issue-brief/data-note-medicaids-role-in-providing-access-to-preventive-care-for-adults/?utm_campaign=KFF-2016-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=52163695&_hsenc=p2ANqtz-_gq9UyDH_SyF_QUp6ExHuNpYp6ykLD7jGDmfelAPRlt4oaEFavzA8qUl9kjpfPDmmJd0VguBWPyhfkRGAzAiJl9iQmcA&_hsmi=52163695


Employers and the ACA – It’s Status Quo for Now

With the passing of the AHCA, the ACA is now the norm for employers' healthcare. Find out what employers need to know about ACA and how it will affect them in the future in this interesting article from Think Hr by Laura Kerekes.

The Trump administration’s effort to repeal and replace the Affordable Care Act (ACA) through legislation failed last month when House Republicans were unable to push their proposal forward. The proposed bill, called the American Health Care Act, would have eliminated most of the ACA’s taxes and fees on health plans along with removing penalties on large employers that did not offer coverage to their full-time workers. It is unclear whether Congressional leaders will make another attempt to legislate major changes in the ACA this year. Meanwhile, federal agencies under President Trump’s direction may begin to take steps to revise regulations that do not require changes in law.

The situation certainly has caused some confusion among employers, so it is important to note that, as of now, nothing has changed. The ACA’s existing rules for group health plans, required notices, and employer reporting duties remain in effect. Applicable large employers (ALEs), generally entities that employed an average of 50 or more full-time-equivalent employees in the prior year, are still subject to the ACA’s employer mandate or so-called “play or pay” rules.

As a reminder, here is a brief summary of the key ACA provisions that require action by employers:

Notices:

  • Employer Exchange Notice: Provide to all employees within 14 days of hire.
  • Summary of Benefits and Coverage (SBC): For group medical plan, provide SBC to eligible employees at enrollment and upon request.

Health Plan Fees:

  • Patient-Centered Outcomes Research Institute (PCORI): For self-funded group health plans, pay small annual fee by July 31 based on prior year’s average participant count.
  • Transitional Reinsurance Program (TRP): For self-funded plans that provided minimum value in 2016, annual fee was due by January 15, 2017 (or by January 15 and November 15, 2017 if paying in two installments).

Reporting:

  • W-2 Reporting: Report total cost of each employee’s health coverage on Form W-2 (box 12). This is informational only and has no tax consequences. (Employers that filed fewer than 250 Form W-2s for prior year are exempt.)
  • Forms 1094 and 1095: ALEs only: Report coverage offer information on all full-time employees. Self-funded employers only (regardless of size): Report enrollment information on all covered persons.

Employer Mandate (“Play or Pay”): ALEs only. To avoid the risk of penalties, determine whether each employee meets the ACA definition of full-time employee and, if so, offer affordable minimum value coverage on a timely basis.

In summary, employers are advised to continue to comply with all ACA requirements based on the current rules.

On a related note, the ACA imposes several requirements on group health plans, whether provided through insurance or self-funded by the employer. Insured plans also are subject to the insurance laws of the state in which the policy is issued. In many cases, provisions matching the ACA are now embedded in state insurance laws. So future changes in the ACA, if any, may not apply to group medical policies automatically. Depending on the state and the type of change, additional legislation at the state level may be needed to enact the change.

See the original article Here.

Source:

Kerekes L. (2017 April 14). Employers and the ACA - it's status quo for now [Web blog post]. Retrieved from address https://www.thinkhr.com/blog/hr/employers-and-the-aca-its-status-quo-for-now/


Workers Might See Employer Health Coverage Disappear Under New GOP AHCA

Do you receive your healthcare through an employer? Then take a look at this article from Benefits Pro about how the passing of the AHCA will affect employees who get their healthcare through an employer by Marlene Y. Satter.

It’s not just individuals without employer health coverage who could lose big under the newly revised version of the Republicans’ American Health Care Act.

People who get health coverage from their jobs could be left swinging in the wind, too—in fact, as many as half of all such employees could be affected.

That’s according to an Alternet report that says an amendment added to the bill currently being considered by the House of Representatives would allow insurers in states that get waivers from regulations put in place by the Affordable Care Act to deny coverage for 10 types of health services—including maternity care, prescription drugs, mental health treatment and hospitalization.

An MSNBC report points out that “because the Republican-led House is scrambling to pass a bill without scrutiny or serious consideration,” the last-minute amendment’s full effects aren’t even known, since “[t]his is precisely the sort of detail that would’ve come to light much sooner if Republicans were following the American legislative process. In fact, this may not even be the intended goal of the GOP policy.”

While the ACA prohibits employer-based plans from imposing annual limits on coverage and bare lifetime caps on 10 essential benefits, the Obama administration did loosen those restrictions back in 2011, saying that employers could instead choose to follow another state’s required benefits.

What the new Republican take on the AHCA does is push that further—a lot further—by allowing large employers to pick the benefit requirements for any state. That would let them limit coverage on such costly types of care as mental health and substance abuse services.

In a Wall Street Journal report, Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services under President Barack Obama, is quoted saying, “It’s huge. They’re creating a backdoor way to gut employer plans, too.”

The changes to employer-based plans would hit anyone not insured by Medicare or by small-business plans, because the bill includes cuts to Medicaid and changes to the individual market as well.

A report from the Brookings Institution points out that “One of the core functions of health insurance is to protect people against financial ruin and ensure that they get the care they need if they get seriously ill.” The ACA pushed insurance plans to meet that standard, it says, by requiring them to “limit enrollees’ annual out-of-pocket spending and [bar] plans from placing annual or lifetime limits on the total amount of care they would cover.”

However, while those protections against catastrophic costs “apply to almost all private insurance plans, including the plans held by the roughly 156 million people who get their coverage through an employer,” the Brookings report says, the amendment to the Republican bill “could jeopardize those protections—not just for people with individual market plans, but also for those with employer coverage.”

How? By modifying “the ‘essential health benefit’ standards that govern what types of services must be covered by individual and small group market insurance plans. The intent of the amendment is reportedly to eliminate the federal benefit standards that currently exist and instead allow each state to define its own list of essential health benefits.”

And then, with employers allowed to pick and choose which state’s regulations they’d like to follow, a loophole the size of the Capitol building would not only allow “states will set essential health benefit standards that are considerably laxer than those that are in place under the ACA,” says the report, but “large employers may have the option to pick which state’s essential health benefits requirements they wish to abide by for the purposes of these provisions.”

The result? “[T]his would likely have the effect of virtually eliminating the catastrophic protections with respect to large employers since employers could choose to pick whichever state set the laxest standards. The same outcome would be likely to occur for all private insurance policies,” the report continues, “if insurers were permitted to sell plans across state lines, as the Administration has suggested enacting through separate legislation.”

While the actual effect of the amendment is unclear, the Brookings report concludes, “there is strong reason to believe that, in practice, the definition of essential health benefits that applied to the catastrophic protections would be far weaker under the House proposal than under current law, seriously undermining these protections. These potential adverse effects on people with employer coverage, in addition to the potentially damaging effects of such changes on the individual health insurance market, are thus an important reason that policymakers should be wary of the House proposal with respect to essential health benefits.”

See the original article Here.

Source:

Satter M. (2017 May 4). Workers might see employer health coverage disappear under new GOP AHCA [Web blog post]. Retrieved from address http://www.benefitspro.com/2017/05/04/workers-might-see-employer-health-coverage-disappe?page_all=1


3 Aspects of the GOP Healthcare Plan that Demand Employers’ Attention

The House of Representatives last week passed the American Health Care Act (AHCA) bill to begin the process of repealing the ACA. Find out what this new legislation means for employers in the great article from Employee Benefits Adviser by Daniel N. Kuperstein.

The extremely emotional journey to repeal (more appropriately, to “change”) the Affordable Care Act reached a significant milestone this week: The Republican-led House of Representatives passed an updated version of the American Health Care Act. While more than 75% of the provisions of the ACA remain intact, the AHCA gutted or delayed several of the ACA’s taxes on employers, insurers and individuals.

So what does this mean for employers?

First off, it’s important to remember that this new bill is not law just yet. The House version of the bill now heads to the Senate, where there’s no guarantee that it will pass in its current form; the margin for victory is much slimmer there. Only three “no” votes by Senate Republicans could defeat the bill, and both moderate and conservative Republican lawmakers in the Senate have expressed concerns about the bill. In other words, employers don’t have to do anything just yet, but it’s still beneficial to understand the major changes that could be coming down the pike.

As employers know from working over the last seven years to implement provisions of the ACA, there will be a million tiny details to work through if the AHCA becomes law.

But for now, we see three major aspects that demand employers’ attention.

There will be more emphasis on health savings accounts
Under the AHCA, health savings accounts will likely become far more popular — and more useful. The HSA contribution limits for employers and individuals are essentially doubled. Additionally, HSAs will be able to reimburse over-the-counter medications and allow spouses to make catch-up contributions to the same HSA. Of course, with this added flexibility comes increased responsibility — there will be a greater need for employees to understand their insurance.

There will be more flexibility in choosing a benchmark plan
For larger employers not in the small group market, the AHCA creates an opportunity to choose a benchmark plan that offers a significantly lower level of benefits to employees.

Currently, the ACA provides that employer-sponsored self-insured health plans, fully-insured large group health plans, and grandfathered health plans are not required to offer EHBs. However, these plans are prohibited from imposing annual and lifetime dollar limits on any EHBs they do offer. For purposes of determining which benefits are EHBs subject to the annual and lifetime dollar limits, the ACA currently permits employers sponsoring these types of plans to define their EHBs using any state benchmark plan. In other words, employers are not bound by the essential health benefits mandated by their state and can pick from another state’s list of required benefits.

Under the AHCA, we may see a big change to how the rules on annual and lifetime limits work. Notably, nothing in the AHCA would prohibit employers from choosing a state benchmark plan from a state that had obtained an AHCA waiver, which would allow the state to put annual and lifetime limits on its EHBs. This means that, if one state decides to waive these EHB requirements, many employers could decide to use that lower-standard plan as their benchmark plan. Of course, while choosing such a benchmark plan may benefit an organization by lowering its costs, such a move may have a negative impact on its ability to recruit and retain the best talent.

There will be a greater need to help employees make smart benefits decisions
The most important aspect of this for employers is to understand the trend in health insurance, which is undeniably moving in the direction of consumerism.

The driving philosophy behind this new Republican plan is to place more responsibility on individuals. However, this doesn’t mean employers can throw a party and simply wish their workers “good luck” — employers need to think at a macro level about what’s good for business. In a tightening labor market in which so many talented people consider themselves free agents, smart employers will focus on helping employees to make smart decisions about their health insurance.

See the original article Here.

Source:

Kuperstein D. (2017 May 5). 3 aspects of the GOP healthcare plan that demand employers attention [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/opinion/3-aspects-of-the-gop-healthcare-plan-that-demand-employers-attention


Medicaid Family Planning and Maternity Care Services: The Current Landscape

Find out about the current landscape of Medicaid and how the repeal ACA will impact certain aspects of Medicaid in this great article by Kaiser Family Foundation.

As the Trump Administration and Congress weigh major changes to Medicaid and programs that fund reproductive health care, new analyses from the Kaiser Family Foundation highlight the current state of coverage and challenges for family planning, pregnancy, and perinatal services in the Medicaid program that provides coverage for millions of low-income women across the nation.

  • The inclusion of maternity care as an essential health benefit has been the focus of a recent policy debate over the future of the Affordable Care Act. For nearly half of births in the U.S., Medicaid picks up the tab. A new survey of state-level maternity care policies under Medicaid finds that all surveyed states covered prenatal visits, but benefits such as genetic counseling, parenting and newborn education services, and home visits were not covered in some states. Similarly, all states included hospitalization benefits, but not all paid for deliveries in birth centers or at home.
  • Over half of states have established limited scope family planning programs under Medicaid. A case study analysis of Medicaid family planning programs in six states (AL, CA, CN, IL, MO, and VA) conducted in the summer of 2016 uncovered opportunities to improve enrollment in family planning programs; identified the importance of these programs for women who have difficulty affording premiums; and documented challenges faced by family planning clinics under Medicaid. Some ACA Medicaid expansion states are reconsidering the need for a separate family planning program under Medicaid, but most have maintained them.
  • Three quarters of reproductive age women on Medicaid are enrolled in managed care arrangements. A new analysis explores the experiences and perspectives of leaders of Medicaid Managed Care Organizations (MCOs) and finds that MCOs rely heavily on safety net clinics including community health centers and family planning clinics such as Planned Parenthood to provide in-network family planning services to their members. MCO leaders identified churning in enrollment, the high costs of stocking IUDs and implants, and global hospital payment methodologies for maternity care as potential barriers to certain family planning services.

See the original article Here.

Source:

Author (2017 April 27). Medicaid family planning and maternity care services: the current landscape [Web blog post]. Retrieved from address http://www.kff.org/womens-health-policy/press-release/medicaid-family-planning-and-maternity-care-services-the-current-landscape/