Tag Archive: Massachusetts

Massachusetts governor proposes Medicaid “fair share” fee on employers not providing minimum medical coverage

In order to discourage avoidable enrollment in MassHealth and slow rising costs in the state’s Medicaid program, which now accounts for nearly 40 percent of state spending, Baker has proposed in his budget a $2,000 per employee “fair share” assessment on Massachusetts employers with 11 or more full-time equivalent employees (FTE), or employees that work 35 hours per week, whose health coverage does not meet certain requirements. The Baker Administration has argued that some of the increase in MassHealth spending is driven by employed individuals enrolling in MassHealth rather than employer-sponsored insurance, and Baker’s proposal aims to reverse this trend.

Source: 2017 Health Care Policy Debates Ramp Up in Massachusetts – Lexology

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Massachusetts seeks federal OK to keep small group at 50 or fewer employees in 2016

Massachusetts has asked the federal Department of Health and Human Services to continue to allow the state to define its small group market as employers with 50 or fewer employees in 2016 as the state prepares to request a state innovation waiver application for an alternative plan for individual and small group health coverage under Section 1332 of the Patient Protection and Affordable Care Act. The law defines small employers as those employers with 100 or fewer full time equivalent (FTE) employees. However, Section 1304(b)(3) of the Affordable Care Act affords states the option – which all exercised – to set the metric at 50 or fewer employees for plan years 2014 and 2015.

Massachusetts Gov. Charles D. Baker made the request in an April 27, 2015 letter to Health and Human Services Secretary Sylvia Burwell. Baker cited the need to maintain stability in its merged individual and small group markets, citing premium rate increases for small employers under Affordable Care Act rules barring medical underwriting of small groups and the increased likelihood employers of 51 to 100 employees would opt to self insure in 2016. Both developments “will further exaggerate” instability in the state’s merged individual and small group markets and prompt Massachusetts to reconsider the continued operation of a merged market, Baker wrote.

(H/T to Elizabeth Elizabeth Osius of Manatt, Phelps & Phillips, LLP for the heads up on this development).

Baker’s letter follows a letter to Burwell earlier this year by 17 business groups and the National Association of Health Underwriters requesting the Affordable Care Act’s 2016 expansion of states’ small group health insurance market to employers of up to 100 employees be delayed until 2018. The groups warn broadening the scope of the small group market will lead to market disruption among health insurers that could limit employer coverage options as well as potentially result in premium increases.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Controlling Health Care Costs Through Limited Network Insurance Plans: Evidence from Massachusetts State Employees

We find that distance traveled falls for primary care and rises for tertiary care, although there is no evidence of a decrease in the quality of hospitals used by patients. The basic results hold even for the sickest patients, suggesting that limited network plans are saving money by directing care towards primary care and away from downstream spending. We find such savings only for those whose primary care physicians are included in limited network plans, however, suggesting that networks that are particularly restrictive on primary care access may fare less well than those that impose only stronger downstream restrictions.

via Controlling Health Care Costs Through Limited Network Insurance Plans: Evidence from Massachusetts State Employees.

 

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Gruber warns of increased tendency toward cost shifting between health and workers’ compensation systems

The trend toward less generous employer-sponsored health coverage and increased employee cost sharing has increased the exposure of the workers’ compensation system to cost shifting, warns Jonathan Gruber. Gruber was the architect of the Massachusetts Health Connector a decade ago that served as the template for the health benefit exchange and individual and small group market reforms of the Patient Protection and Affordable Care Act. Cost shifting between the two systems occurs when, for example, an employee who sustains an injury or illness over the weekend and then files a workers’ compensation claim on Monday, asserting that the injury or illness originates in the workplace.

Heightening the tendency toward cost shifting is the difference in provider access between health and workers’ compensation insurance, Gruber notes, arguing that the two forms of coverage require greater harmonization. “If the workers’ compensation system stays behind, it will have the broadest possible network and the lowest possible cost-sharing, and it’s going to have people migrating into it more and more,” Gruber said in remarks to the Workers Compensation Research Institute (WCRI) in Boston reported by the Insurance Journal.

In 2007, then-California Gov. Arnold Schwarzenegger proposed as part of his health care overhaul (based on Gruber’s Massachusetts’s model) a “24-Hour coverage” pilot program that would have combined the medical treatment component of workers’ compensation with group health coverage. State and local government employees would obtain medical care through the same providers used in a state run managed care program for work and non-work-related health care, with an option for private employers to participate on a limited basis.

According to a report prepared that year by the California Commission on Health and Safety and Workers’ Compensation, at least 10 states adopted legislation permitting 24-hour care pilots but only two — Oregon and California – implemented them. Merging medical treatment coverage for care needs arising out either vocational or non-vocational circumstances can potentially reduce frictional costs and achieve administrative efficiencies, but has proven problematic due to various legal, institutional and cultural impediments.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Maryland mulls high risk pool fallback for individuals with exchange enrollment problems

Maryland Health Exchange Emergency Bill to be Submitted Next Week « CBS DC.

The proposed legislation would enable individuals seeking coverage through the Maryland’s health benefit exchange but whose enrollments encountered processing glitches to obtain coverage through the state’s high risk pool. According to the story, the coverage would be retroactive to January 1, 2014, when state high risk pools were to end operations under new Patient Protection and Affordable Care Act market rules barring medical underwriting for individual health plans effective that date or later.

Several other states operating their own health benefit exchanges that experienced severe problems with the launch of their web portals face a similar predicament as Maryland including Hawaii, Oregon, Minnesota, Vermont and Massachusetts.

The account also quotes Maryland Gov. Martin O’Malley as stating Maryland is considering the possibility of switching from a state-based to federal exchange either completely or in part, as well as partnering with other states.

Section 1311(f) of the Affordable Care Act authorizes the operation of “Regional or Other Interstate Exchanges” operating in more than one state, subject to the approval of the involved states and the federal Department of Health and Human Services.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Romney accuses Obama of ‘fundamental dishonesty’ on health-care law – The Washington Post

Mitt Romney stepped up his attack on President Obama’s health reform program on Sunday, accusing the president of “fundamental dishonesty” that has “undermined the foundation of his second term.”

The harsh comments from Obama’s 2012 rival follow repeated attempts by the Obama administration to liken the current measure, known as Obamacare, to the health reform law that Romney championed as Massachusetts governor.

“The president failed to learn the lesson that came from the experience of Massachusetts,” Romney said on NBC’s “Meet the Press.” His state’s efforts showed the merits of avoiding a “one-size-fits-all plan,” Romney said. “States should be able to craft their own plans.”

via Romney accuses Obama of ‘fundamental dishonesty’ on health-care law – The Washington Post.

Actually, states are able to craft their own plans under the Patient Protection and Affordable Care Act starting in 2017.  As I recently blogged, Section 1332 titled Waiver for State Innovation allows states to petition the U.S. Department of Health and Human Services to opt out of major ACA provisions including the individual and employer mandates and the requirement to have a health benefit exchange marketplace. While not intended by the Obama administration, the U.S. Supreme Court’s June 2012 ruling in NFIB v. Sebelius also gave states the option to expand Medicaid eligibility under the law.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Romney win unlikely to undo individual market reforms, exchanges

Here’s a good analysis by the Associated Press of how the Patient Protection and Affordable Care Act (PPACA) might be affected by a Romney victory in next week’s presidential election.

In public health insurance, the Medicaid expansion might be curtailed.  In commercial health coverage, payers are hoping for a repeal of the PPACA requirement they maintain minimum loss ratios of 80 percent and new tax levies on insurers.

But insurers aren’t keen on undoing the foundational political bargain of the PPACA’s individual insurance market reforms in which they must accept all applicants for coverage and individuals without other forms of public or private insurance must purchase coverage or face a tax penalty.  There’s simply too much potential new business to be had with the mandate, the AP notes, citing a PricewaterhouseCoopers projection that it and state health benefit exchanges will generate $205 billion in new premium by 2021.

Nor is a Romney administration likely to pull the plug on state health benefit exchanges given the more than $2 billion invested in them thus far in the form of federal planning and establishment grants.  Plus Romney has not publicly renounced the idea of public health insurance exchanges, a concept he innovated as governor of Massachusetts in 2006 by creating the nation’s first state run health benefit exchange, the Massachusetts Connector.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Romney says he accepts being linked to Obamacare – Yahoo! News

Speaking at a Univision forum Wednesday night, the Republican presidential nominee said that now and then Obama calls him the grandfather of Obamacare.

Romney said, “I don’t think he meant that as a compliment, but I’ll take it.” He went on to defend the Massachusetts law but says it is wrong for the federal government to take that approach.

via Romney says he accepts being linked to Obamacare – Yahoo! News.

Governor Romney was also the Godfather of former California Republican Governor Arnold Schwarzenegger’s omnibus health care reform plan in 2007-08 that was largely based on Romney’s Massachusetts reforms featuring a state health benefit exchange and an “individual mandate” that everyone have public or private health coverage.  I know because I covered “ArnoldCare” nee RomneyCare from its beginnings to inglorious collapse in the state Senate as Sacramento health care correspondent for the Bureau of National Affairs.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Ex-Obama advisers seek health care cost control – Yahoo! News

Under the proposal, the major public and private players in each state would negotiate payment rates with service providers such as hospitals. The idea is to get away from paying for each individual test and procedure. Negotiated rates could be based on an entire course of treatment. Payments would have to fit within an overall budget that could grow no faster than the average rise in wages.

The spending limits would be enforced by an independent council, but crucial details need to be spelled out. In Massachusetts, for example, budget-busting providers will be required to file plans with the state laying out how they’ll amend their spendthrift ways.

The federal government would provide grants to states interested in developing their plans.

Tanden joined a brain trust of former administration officials floating the proposal recently in the New England Journal of Medicine. The group included Peter Orszag (former budget director), John Podesta (transition director), Donald Berwick (first Medicare chief), Ezekiel Emanuel (Orszag’s health policy guru), and Joshua Sharfstein (former No. 2 at the Food and Drug Administration). Also on board was former Senate Majority Leader Tom Daschle, D-S.D., Obama’s first pick to shepherd his health care overhaul.

via Ex-Obama advisers seek health care cost control – Yahoo! News.

This item from the Associated Press dubs the initiative “Health Care Overhaul, Version 2.0,” with the goal of establishing a “first-ever budget for the nation’s $2.8-trillion health care system, through negotiated limits on public and private spending in each state.”

The proposal represents an expansion of the accountable care organization concept in the Patient Protection and Affordable Care Act’s Medicare Shared Savings Program (Section 3022 of the PPACA) beyond Medicare to encompass private payments.  It is a government led market intervention designed to shift the business model and economics of the health care industry away from the current model that rewards the provision of discrete medical procedures to an all inclusive, coordinated system of care. 

Arguably, the existing health maintenance organization (HMO) is based on the same principle.  But that hasn’t bent the so-called cost curve. The difference here is that the power of government would be brought to bear to hold down costs such as in Massachusetts. The Bay State recently enacted legislation that among other things, subjects providers to cost growth benchmarks. Those providers exceeding the benchmarks must file and implement a performance-improvement plan, with potential penalty up to $500,000 for failure to comply.  The New England Journal of Medicine has more details on the Massachusetts law here.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Massachusetts Passes Health Cost Control Bill – Kaiser Health News

The Bay State does another first in health care reform.  First with a state-based health insurance exchange and a mandate that everyone have health coverage.  Now the first state to attempt to bend the health care cost curve by force of law, albeit a paper tiger according to the story.

Here’s an excerpt from the story by WBUR and Kaiser Health News:

Under the new law, hospitals and doctors will have to cut their rate of cost growth about in half. So, instead of going up 6 to 8 percent per year, costs would only be allowed to rise 3.6 percent per year.

“No other state has tried to tie health care costs to the state’s economy,” said Massachusetts Association of Health Plans President Lora Pellegrini. “This is going to be really revolutionary and very important and I’m sure the nation’s watching.”

Michael Widmer, with the Massachusetts Taxpayers Foundation, says he thinks the health care industry will embrace the bill’s spending goals, even though they are what he considers aggressive.

“But on the other hand the legislation does not include triggers or punishments if the targets aren’t met,” he said.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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