Globe: Will court ruling on the #AffordableCareAct impact #Massachusetts?

This morning’s Globe quotes Donald Berwick, MD, on the potential impact of last week’s court ruling declaring the ACA unconstitutional in Massachusetts.  Readers not yet eligible for Medicare take note.

…Massachusetts relies on billions of dollars in federal funding every year to provide coverage to lower-income residents, and the state’s health care system is deeply entwined with the federal system. So major disruptions to the federal law would extend here, several health care experts said Monday.

If the decision issued Friday were to stand, “it would be a disaster” said Dr. Donald M. Berwick, senior fellow at the Institute for Healthcare Improvement in Boston and a former administrator of Medicare and Medicaid under President Obama.

For more, see Kaiser Health News coverage of the ACA. 

Some stats from the Massachusetts Health Insurance Survey.

Figure on uninsured in MA



Health insurance premiums going down in Massachusetts for individuals? State says end of federal subsidies will “challenge” this trend.

From the Massachusetts Center for Health Information: 

PMPM: Payment per member per month

CHIA found that, overall, the individual purchaser market segment experienced decreases in average premiums (-3.4%) and cost-sharing (-8.0%) between 2015 and 2016. CHIA also found that unsubsidized plans experienced higher premium growth and larger cost-sharing increases than ConnectorCare Plan.  (State’s subsidized health insurance exchange.)

…Overall financial trends for individual purchasers were
driven, in large part, by enrollment growth in ConnectorCare plans with lower
premiums.Between 2015 and 2016, enrollment in unsubsidized individual
plans in Massachusetts increased by 6.5% to over 97,000 members, while
ConnectorCare enrollment grew by 51.4% to nearly 170,000 members

Enrollment and cost trends for individual plans purchased outside
the employer-sponsored insurance system reflect a combination of
individual purchasing decisions, population health characteristics, policy
and regulatory measures, and broader trends in health care spending.
Between 2015 and 2016, unsubsidized individual plan premiums grew
more slowly than the statewide average premium, and ConnectorCare
premiums actually decreased. For unsubsidized plan members, modest
premium growth was offset by increased cost-sharing obligations.
Members enrolled in ConnectorCare plans would have experienced higher
cost-sharing were it not for subsidies that preserved low out-of-pocket
spending. In the coming years these trends will be challenged by the
discontinuation of CSR subsidies in late 2017 and other potential changes
at the federal level. which may have a substantial effect on enrollment,
premiums, and cost-sharing for individual purchasers, depending on how
states offset these changes.

Covering health care — from DNA to ACA — is a challenge. Three reporters share insights and tips at Harvard Law #healthintheheadlines


Center for Health Law and Policy Innovation website. 




Can the states step in if the feds cut marketing $$$ for Affordable Care Act?

Your correspondent spent much of the ’90s covering health care in North Carolina. Found this while visiting family. See story below from Kaiser Health News. Probably won’t find it next visit. How the cuts will play our in Massachusetts is an unknown at this point. In the meantime, hospitals in Boston reported surpluses yesterday.

nc aca
Posted in mid-August in rural NC library

Trump Administration Whacks Millions From Budget Used To Push Obamacare

Republished with permission from Kaiser Health News

President Donald Trump has insisted for months that “Obamacare is already dead.”

His administration matched its harsh words with damaging action on Thursday — slashing millions of dollars from the government’s budget to promote the health law’s annual open enrollment season beginning in two months.

The move is likely to translate into reduced marketing and fewer navigators — trained representatives deployed by nonprofit groups that receive federal grants to help people understand health insurance options and purchase a plan. The effect could cause more confusion for consumers in an abbreviated enrollment period that is 45 days shorter than last year — running from Nov. 1 to Dec. 15.

Grants to the nonprofits that supply navigators will fall by 40 percent to $36.8 million this year and advertising will drop by 90 percent to $10 million, the Centers for Medicare & Medicaid Services said. The money will be spent in 38 states that use the government’s exchange.

Administration officials said that five years into the Affordable Care Act, most people know they need to sign up and what their options are, and that there is no evidence that more advertising leads to higher enrollment. Last year’s $100 million advertising budget was double that of 2015’s.

The administration’s announcement was denounced by prominent Democrats, former Obama administration officials and navigator organizations.

“The Trump administration is deliberately trying to sabotage our health care system,” said Senate Minority Leader Chuck Schumer (D-N.Y.).

“I can’t think what the justification is for doing this” because experience has shown people need help getting through the enrollment process, said Jodi Ray, who leads the University of South Florida’s navigator program. It has won the largest navigator award in the country for the past several years, about $5.9 million.

Ray doesn’t know what USF will get this year. Grant amounts to navigators have not been announced yet.

“It’s going to be a really big challenge and doing a lot of extra work with fewer people on the ground and doing the work in half the time,” she said.

Shelli Quenga, director of programs for the Palmetto Project in Charleston and Columbia, S.C., fears her group will have to reduce its workforce and events. Palmetto received $1 million last year.

“We will face massive cuts to our budget,” Quenga said. “I am very worried for the fate of South Carolinians who need access to impartial and unbiased information.”

Funding for 98 navigator organizations will be tied to how each performed last year relative to the enrollment goals they set for themselves. Those that didn’t meet their goals — 78 percent did not, according to CMS — will get less money this year. If an organization hit only 30 percent of its goal last year, it will receive 30 percent of last year’s funding.

That formula has some flaws, said Lori Lodes, who directed CMS’ outreach efforts in 2014 and 2015 under the Obama administration.

For one, navigators don’t get credit for every enrollment they help produce. Sometimes, consumers consult navigators about their choices and then complete their enrollment in private at home, said Lodes, who now directs the Families USA campaign called Protect Our Care.

Another problem with the formula, she said, is that it fails to recognize the large amounts of time that navigators sometimes invest in helping people who are not native English speakers or have disabilities and need more help finding suitable health plans. That could contribute to groups signing up fewer people than anticipated.

“The people that really need help come from more vulnerable populations,” Lodes said. “More vulnerable populations are not going to get the care they need.”

In a background briefing for reporters, Health and Human Services Department officials said too much money was spent in past years with too little to show for it. They cited a navigator group in one state last year that enrolled only one person in an insurance plan but received $200,000, which they said could have paid insurance premiums for 31 people in that state for the entire year.

They noted that the advertising budget doubled last year, but despite the increase, enrollment fell by 42 percent, or about 500,000 people.

But Joel Ario, a former HHS official in the Obama administration who oversaw the federal and state insurance exchanges, challenged their judgment.

The decrease resulted from the Trump administration’s decision to end advertising as 2017’s open enrollment period entered its final weeks in January, he said.

“It’s disingenuous to say that ads didn’t tie to enrollment,” Ario said.

States that run their own marketplaces are not included in the navigation program. But some of them are continuing to put resources into enrollment. California’s 2017-18 marketing budget stands in stark contrast to the federal government’s. The state is poised to spend $111.5 million advertising Obamacare, more than 10 times what CMS plans to spend in 38 states.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.