That Was The Week That
Was*
A look
back at the weeks health policy news with a focus on ACA implementation
Mitchell
Stein
March 14, 2014
March,
14 2014
Welcome
to the first edition of this newsletter.
As always seems to be the case these days, lots going on so let's dive
right in. We'll start with this release
of new enrollment figures and move on from there.
ENROLLMENT
In
my initial review of the enrollment data (available at the end of this document)
I noted that opponents of the law would try and make something of the drop off
in enrollment between this report and the last one. And while that's certainly happened, we've
also seen some interesting analysis saying there was no drop-off:
First
the numbers
Next, enrollment numbers as Rorschach test
But
wait, how many days were there in February?
So the numbers didn't really show a slowing of enrollment
But realistically, going to be
touch to hit 6 million by the end of March
And finally, we need to remember that these
numbers are those who have selected a plan on a marketplace, not those who've
paid their first month's premium (so not really "enrollment" numbers)
CONTINUING EFFORTS
Even before the
numbers were released with the March 31 deadline approaching the final press
had begun.
One of my favorites was the
President heading to alternative media
Which actually
seems to have helped
And of course here
in Maine, naked men get people's attention
THE REGULATIONS -
SOME CHANGE SOME DON'T
The biggest date that won't change
is the end of open enrollment - still March 31 and given how emphatically it
was stated hard to see it changing
One of the positive changes is that the cost-sharing subsidy
funding will no longer be subject to the sequester cuts (the premium subsidies
never were going to be)
And an understandable break on MLR
for insurers increased costs due to the rollout "glitches"
THE PREVIOUS NON-PARTISAN EFFORTS
ON THE DOC FIX JUST TURNED PARTISAN
The Doc-fix is the efforts to
eliminate the annual problem of Medicare's physician payment system. With health care cost inflation at historic
low, now was the time to make a permanent fix.
However the House Republican's have attached the non-partisan fix to a postponement
of the individual mandate for five years. Something they know won't get past the Senate and the President
Not to mention the negative
impacts of delaying the mandate
So
negative that the American Medical Association who has lobbied (hard) for a fix
for years rejects tying the two issues together
And a reminder how important - and problematic -
the mandate is
AND THAT'S NOT ALL CONGRESS IS UP TO
They passed three
laws this week that span the spectrum from good to unnecessary to bad. Note that it is unclear if any of these will
make it to the Senate and then the President's desk.
The potentially good one (or at least harmless one) in the
mix would allow employers to not count veterans when calculating their number
of employees. The idea is that firms
would have an incentive to hire more veterans (Hire More Heroes Act, H.R. 3474).
The unnecessary one states that volunteer firefighters and
emergency responders are not employees and so don't have to be offered health
insurance. The problem is they are
already not considered employees per the most recent Federal guidance on the
issue (Protecting Volunteer Firefighters and Emergency Responders Act, H.R.
3979).
And finally, the most troubling one would let people avoid
buying health insurance under Obamacare if they could cite a religious reason. There are many questions regarding if this is
enforceable or if it would just allow anyone to say they don't want to buy
health insurance. Note there is already
an exemption for those part of an established religion with objections making
this bill either dangerous or redundent (Equitable
Access to Care and Health (EACH) Act, H.R. 1814).
House OKs religious exemptions to having a healthcare plan
House OKs religious exemptions to having a healthcare plan
ENROLLMENT ISSUES
As
we near the end of the enrollment period, some good reminders for those who
work on these issues but great reminders for the public who does not.
Yes
you do need health insurance
And
if you don't get it, it will cost you
Understanding
what is income can be complicated
And not all
enrollment issues have been solved:
POLLS
As with the enrollment numbers, poll results can also serve as a Rorschach test.
You can take good news, like a drop in the number of uninsured
Survey: Uninsured rate drops; health law cited
For those of us who support the law, we can take a realistic look at the positives and negatives
Five takeaways from Gallup’s poll on the uninsured
But don't expect everyone to take that approach
Don’t Expect Conservative Media to Cover This New Obamacare Poll
Support continues to creep up (remember, in CNN's poll the oposition to the law includes those who say it doesn't go far enough)
CNN Poll: Support for Obamacare slightly edges up
Signs of increased support come from more than one poll with this one showing 64 percent of Americans now supporting it outright or backing small changes
Americans Stick With Obamacare as Opposition Burns Bright
MEDICARE
Mostly unrelated to the ACA but of note is that
proposed changes to Medicare prescription drug coverage were pulled back by the
administration
While the ACA mandated changes to Medicare Advantage
reimbursement continue to have an impact
For a refresher on the issue, this older item may be useful
SYSTEM REFORM
In the long run, it is reforming
the overall system that will free up the resources to provide access to all. Here is one reminder of the scope of
resources that may be reclaimed
And a reminder that change is hard
and we must constantly be on the lookout for those unintended consequences
NEW RESOURCE
And finally, our friends at the
Robert Wood Johnson Foundation have created a new website Financial Help for Health
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"
Enrollment Recap (originally
published 3/12)
To me the biggest
story around the enrollment report release yesterday was that it was not a big
story...
Doing a scan at 6 AM, it did not make the CNN front page or
Google News top stories. That said, some great coverage here in Maine
around all of your efforts (see below). And of course it wasn't
completely ignored by the national media - and you can be sure that the law's
opponents will try and make something of the drop-off in enrollment.
The
national press takes the drop-off in February to mean the Administration won't
reach the "new" goal of 6 million by the end of March. My take
is we really have no idea how busy the end of March will be.
Massachusetts saw a tremendous spike at the end of their first deadline -
but I'm leery of making any predictions based on one data point. As we
all move through the final push, please remember that while aggregate numbers
are important, every individual who signs up for coverage is one less person at
risk - and that means a lot.
And now
some numbers and links. Note that in the detailed
report released by HHS yesterday. There was basically only one number for Maine
- reflected in this chart:
Monthly Enrollment
|
Cumulative Total
|
|
Oct
|
NA
|
NA
|
Nov
|
1,741
|
1,741
|
Dec
|
11,963
|
13,704
|
Jan
|
6,807
|
20,511
|
Feb
|
4,901
|
25,412
|
Maine
health officials trying to sign up immigrants, hard-to-reach populations
More
than 25,000 Mainers have signed up for health care coverage through ACA
National
coverage:
