Tag Archive: Obamacare

Action on ACA individual market reforms successor must come in Q1 2017 to avoid messy market meltdown

Heading into this year’s elections, the individual health insurance market segment developed signs of instability as health plan issuers were pulling back their market presence for 2017 and reassessing their plans for 2018 and beyond. The election that sent Donald Trump headed to the presidency and afforded his party the opportunity to implement their stated policy to quickly repeal the Patient Protection and Affordable Care Act piled uncertainty on top of uncertainty for health plan issuers.

It’s unclear how much of the Affordable Care Act the incoming Trump administration and Congress will gut. However, it is clear that first in their sights are the individual health insurance market reforms contained in Title I of the expansive law. With these reforms first in line for the chopping block, there is no luxury of time to contemplate a gradual transition for the individual market. Congress and the new administration will have to quickly come to a consensus in the first quarter of next year.

As has been widely reported, Congress and the Trump administration could defund the bulk of the reforms using a budget reconciliation bill requiring a simple majority vote, thereby avoiding a Democratic filibuster. But that would only create more market uncertainty, crashing the old Affordable Care Act market rules before new ones could be put in place. Even more comes from the House’s successful court challenge this year of the Obama administration’s funding of out of pocket cost sharing subsidies for many lower income households buying coverage on state health benefit exchanges. It would take effect very early in the Trump administration if the administration as expected opts not to pursue an appeal, prompting health plan issuers to bail from state health benefit exchanges in 2017 and leave millions without coverage. These circumstances underscore the fact that under the Affordable Care Act, health plan market participation is voluntary. If plan issuers can’t predict their finances with any degree of certainty, all bets are off.

Health plan issuers need to begin pulling together their individual market offerings for plan year 2018 early next year. It will be difficult if not impossible for them to do so with the market rules up in the air. Lacking any certainty in the first quarter of 2017, a transition to a new scheme won’t happen in 2018. New policy will have to be nailed down in that critical first quarter. With the Affordable Care Act individual market rules well established, it’s now impossible to quickly unscramble the Obamacare omelet and turn the calendar back to 2009.

 


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. 

The states with the biggest Obamacare struggles spent years undermining the law

As insurers exit Obamacare marketplaces across the country, critics of the Affordable Care Act have redoubled claims that the health law isn’t working. Yet these same critics, many of them Republican politicians in red states, took steps over the last several years to undermine the 2010 law and fuel the current turmoil in their insurance markets. Among other things, they blocked expansion of Medicaid coverage for the poor, erected barriers to enrollment and refused to move health plans into the Obamacare marketplaces, a key step to bringing in healthier consumers.

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There are many fewer options in states whose leaders have spent years working to sabotage the law.

Source: The states with the biggest Obamacare struggles spent years undermining the law

It is inaccurate to describe red states as “sabotaging” Obamacare. The ACA is a federal-state initiative that afforded a good degree of policy latitude to the states, with that freedom vis Medicaid expansion broadened by the USSC in NFIB v. Sebelius (2012).

The real issue is there is no policy consensus among the states re health care reform notwithstanding broad agreement that reform is essential. Also, the individual market poses enormous challenges re achieving spread of risk to ensure this market segment’s long term actuarial viability. Contributing to that challenge is a culture that does not value health promoting lifestyles and regards medical care and insurance as high cost consumer commodities.

 


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. 

UnitedHeathcare’s Harken Health redefines the HMO in the age of Obamacare

AUSTELL, Ga. — UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive.With little fanfare, the nation’s largest health insurer launched an independent subsidiary in January that offers unlimited free doctor visits and 24/7 access by phone. Every member gets a personal health coach to nudge them toward their goals, such as losing weight or exercising more. Mental health counseling also is provided, as are yoga, cooking, and acupuncture classes. Services are delivered in stylish clinics with hardwood floors and faux fireplaces in their lobbies. Harken Health is available only in Chicago and Atlanta, where it covers 35,000 members who signed up this winter on the Affordable Care Act’s insurance exchanges. UnitedHealth still sells traditional plans in those cities, too.

Source: UnitedHealth wagers $65 million on ounce of primary-care prevention

This individual and small group health plan offering appears primarily aimed at boosting health literacy and appreciation for healthy lifestyles among those new to health insurance following the expansion of coverage under the Patient Protection and Affordable Care Act. Since this cohort can be frequent users of care and who because they lack pre-existing provider relationships tend to rack up costly emergency room visits for non-emergent care, Harken Health aims to reach them — and reduce ER visits — by offering unlimited primary care visits without out of pocket costs.

An apparent goal here is that by improving health literacy of its members and instilling in them an appreciation for maintaining healthy lifestyles — key health determinants — Harken Health will build a long term relationship that will pay future dividends in avoided high cost care. It’s redefining the health maintenance organization for the Obamacare era.

 


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. 

Media coverage of ACA insurance market reforms stereotypes entire demographic as chronically “sick”

In the recent past, the word “sick” used as an adjective in the medical context referred to the temporary state of an individual. Someone got sick such as with the common cold or influenza. Then they recovered. Less fortunately, they died.

Now the term “sick” is being used in media accounts in a much broader sense to refer to a permanent state of an entire demographic group. As in “sick and older” in the public dialogue over the Patient Protection and Affordable Care Act, aka Obamacare, and its individual health insurance market reforms. A recent example:

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said the industry plans to fight a tax on full-coverage plans that, while intended to pay to expand coverage and bring in more customers, may cause premiums to go up, according to insurers. They’ve also argued against more comprehensive coverage, as well as more relaxed rules about charging sick and older more money for insurance than they do young people. (Emphasis added)

Not all older people are “sick” all of the time or even most of the time. Like younger folks, they sometimes get sick and then get better. Many are quite healthy and are very aware that their bodies require more diligent maintenance in the form of health promoting and preserving lifestyles than in their more forgiving youth. Reading many media accounts, one might think everyone age 50-65 is “sick” and thus creating a major actuarial burden on individual health insurers.

 


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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