A look back at the week's health
policy news with a focus on ACA implementation
Welcome
to the second edition of this newsletter.
You'll note that this one is a bit different - I've taken some very
helpful feedback and shortened it considerably.
As much as I found all the articles in the last one interesting, not
everyone has the time to plow through so much content. So this week we take a more focused look at
what went on. Please continue to provide
comments and feedback, as you see, this is still very much a work in progress.
The top story this week has to be the approaching
enrollment deadline. As I write this on
Friday morning, there are a little less than 11 days to go.
Let's start with where we are now - we saw
"enrollment" hit 5 million this week: Health
law enrollment hits 5 million with 2 weeks to go. To-date I have objected to the focus on
enrollment targets, but with the approaching deadline, it's inevitable that
they will be reported and discussed. So
bowing to the inevitable I'll include them here. Note that the "consensus
definition" of enrollment has become those who selected a plan on a
marketplace (be it Federal or State).
This does not take into account how many have gone ahead with the last
step of paying their first month's premium.
Estimates vary from 75% to 90% as to how many take the final step. We won't know the answer to that one for
another couple of months.
How many of you remember
Nate Sliver? He is the blogger who came
to prominence during the last presidential election by correctly predicting 49
of 50 state results (others did even better, but he is the one who got the
coverage). This open enrollment period
seems to have led to a "new Nate Sliver" - and he thinks that
contrary to what was being forecast at the beginning of March, not only will
enrollment reach 6 million, it will blow past it to 6.2 million: This guy knew when Obamacare
enrollment would hit 5M before anyone else. Now he’s predicting 6.2M.
Regardless of the final number, it seems clear
that overall the ACA will not collapse under its own weight: Benefit Experts Agree With
Obama That ACA Has Enough Enrolled. But remember, this is really a 50 part story,
while the national figures will get the attention, each state has its own
insurance market and there will doubtless be a few that will have a tough time going
forward.
So that's where we are, and a prediction of where we're
going. But with 11 days left, how are we
going to get there? Since March madness has
begun, the only way to say it is we'll get there with a "full court
press". The Administration is using
basketball in its attempts to "stuff the basket" (ok, I'll stop now): Obamacare meets March
Madness. But not just
basketball - The President was on Ellen this week talking Scandal, House of
Cards and the ACA: President
Obama On Ellen talks ACA (sorry, that clip is just the ACA segment).
For those looking for a handy basic introduction to
enrollment, this piece is helpful: The
Sign-Up Deadline Is March 31: A Consumer Guide. And for those wondering when Ezra Klein
(formerly of Wonkblog) would resurface, here is a handy explanation of the individual
mandate including why it's needed provided by his new site: Obamacare's individual
mandate in two minutes.
Also under the category of momentous dates, Sunday
marks the fourth anniversary of the bill's signing: Obamacare
turns 4: Will anyone notice?
While it would be easy to just focus on this
open-enrollment period, time marches on.
Looking forward the Administration has released new guidance regarding
plans that will be offered for 2015: White House Tightens Health
Plan’s Standards After Consumers Complain. One of the big issues, both here in Maine and
nationally, is the "narrow networks".
As we know, while the concept isn't new they've become much more
prevalent. The new standards begin to
address them, and for further information, here is an industry based look at
the concept: Are
your networks too narrow?. When discussing networks its always worth
repeating the ramifications of going outside them: Warning: Opting Out Of Your
Insurance Plan's Provider Network Is Risky.
The Administration has also said that those sub-standard
plans that should have been cancelled last year but weren't can stick around
another two years: Obama administration wants
fewer people to get insurance cancellation notices.
Of course, in addition to
what the plans cover we also have to think about what they cost. While individuals receiving financial
assistance will be somewhat protected from rate increases (the percent of their
income they are asked to contribute don't change, so if the plan rate goes up
the subsidy will go up) long-term if the subsidies get too expensive something
will have to change. Right now, 2015
rates are anybody's guess - and everybody is guessing: The Latest Obamacare Doom
Prediction—and What to Think About It.
Looking toward next week, the Supreme Court once again
here's an ACA case. This time centered
on the birth control issue for private employers: Everything
You Need To Know About The Supreme Court Taking On Birth Control.
Shifting focus away from the ACA, the issue of health disparities
was in the news this week. Two
excellent reviews of some of the issues involved and the scope of the
problem: Income Gap, Meet the
Longevity Gap and Q&A: How States are
Tackling 'Health Disparities'.
Also some thoughts on how it needs to be addressed by the provider
community: Screening for poverty should
be included in the medical curriculum.
We'll end with a look forward. Maine's own Patent Centered Medical Home
pilot received some focus: Our View: Pilot program focuses
on health, not sick care: A team-based approach to medicine is starting to help
Mainers but needs more time to develop. This follows a few weeks of stories calling
into question the efficacy of the Medical Home concept due to a recent study
that failed to find the promised cost savings.
My take is that these pilots are still very much a work in progress. The theory is sound but we haven't yet
figured out how to make them work as well as they could. It's not a simple issue, here is a helpful
look at the issues involved: Redesign the medical home to
thrive in the real world.
Thanks
for reading!
Funded by support from
the Maine Health Access Foundation
*The title is a tribute to the BBC show, the NBC show and the amazing Tom Lehrer album "That Was The Year That Was"
