What’s New in Health Care Reform: Oct. 19

shutterstock_112862074-1024x683What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.


HealthCare.gov Will Add "Simple Choice" Plans in Effort to Improve Value

When the Affordable Care Act’s health insurance marketplace opens in two weeks, many consumers will have a new option for the law’s fourth open-enrollment period: standardized health plans that cover basic services without a deductible. With many health plans on the marketplace coming with deductibles in the thousands of dollars, consumers have complained that they were getting little benefit beyond coverage for catastrophic problems. The new standardized options are meant to address that concern—to ensure that “enrollees receive some upfront value for their premium dollars,” as the Obama administration said. Via NY Times.

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AHIP Head Thinks ACA Risk Programs Will Need Changes

Marilyn Tavenner, the face of private insurers, does not think Affordable Care Act exchanges are about to implode. But she does think Congress will have to make some tough decisions relatively soon about how much to buffer insurers from risk. “I do not think the exchanges are in a death spiral. I do think they’re unstable, and we have a responsibility to stabilize them,” said Tavenner, president and CEO of America’s Health Insurance Plans, in an interview with Morning Consult. “That’s on all of us.” Via Morning Consult.

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Frustration Runs Deep for Customers Forced to Change Marketplace Plans Routinely

Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. The instability, which preceded the health law, is intensifying in the fourth year of the Affordable Care Act’s marketplaces for people buying insurance directly instead of through an employer. Via Kaiser Health News.

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Are Blues’ Plans Benefitting Unfairly from Program to Offset Cost of Sicker Patients?

Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients. The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans—including Blue Shield of California—that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say. Via Kaiser Health News.

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More Than 1 Million in Obamacare to Lose Plans as Insurers Quit

A growing number of people in Obamacare are finding out their health insurance plans will disappear from the program next year, forcing them to find new coverage even as options shrink and prices rise. At least 1.4 million people in 32 states will lose the Obamacare plan they have now, according to state officials contacted by Bloomberg. That’s largely caused by Aetna Inc., UnitedHealth Group Inc., and some state or regional insurers quitting the law’s markets for individual coverage. Via Bloomberg.

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How Narrow Is It? Gov’t Begins Test of Comparison Tool for Health Plan Networks

The incredible shrinking provider network is nothing new in marketplace plans. One way insurers have kept premiums in check on the individual market is by reducing the number of providers available in a plan’s network. Earlier this year, the federal government said that it would introduce a tool this fall to help consumers who are shopping on HealthCare.gov gauge how narrow a plan’s provider network is compared with others in the area. Via Kaiser Health News.

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CMS Plotting Consumer Outreach ahead of Obamacare Sign-Ups

Obama administration officials say they’ll be more thoughtful and targeted when reaching out to Obamacare consumers as they prepare for the open enrollment period that starts next month. Department of Health and Human Services officials are finalizing their outreach plans for the sign-up period beginning Nov. 1, and leaning on what they’ve learned from past enrollments to more effectively target people who are uninsured or insured and not receiving subsidies on the exchanges when they could be. Via Morning Consult.

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Medicaid Spending and Enrollment Growth Decreased in 2016

RTotal Medicaid spending and enrollment slowed in 2016 after record increases in 2015, according to a new Kaiser Family Foundation report. Total spending growth is expected to also decrease in 2017, although the state’s share of spending is projected to increase. Spending and enrollment spiked because of coverage expansions under the Affordable Care Act. The federal government paid for 100% of expansion costs from 2014 to 2016, but states are required to pay 5% of those costs beginning in 2017, explaining the projected uptick in state spending. Via Morning Consult.

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Following Dayton’s Critique of Obamacare, Lawmakers Mull Fixes

Gov. Mark Dayton’s declaration that the federal health care overhaul is “no longer affordable” for more and more Minnesota residents could be the spark that sets off major health care changes. The Democratic governor’s remarks this week renewed calls to address rising costs in the individual market, where unexpectedly high medical claims have resulted in double-digit premium increases and has some top state officials worried that it can’t survive. Here’s a look at the issues at play and the ideas to fix them. Via WCCO.

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CMS Gets Kudos for New Medicare Payment Rule

Reaction was positive to a Centers for Medicare and Medicaid Services rule released finalizing changes to how doctors are paid through Medicare. Health provider groups said they were pleased that the agency has been, and expects to continue to be, responsive to their concerns. The changes implement a new law aimed at saving the Medicare program money by rewarding providers for high quality care. Under the rule, providers will have two paths to choose from to start shifting away from the traditional fee-for-service system. Via Morning Consult.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.