A look back at the week's health
policy news with a focus on ACA implementation
What an exciting week!
As a result of a late surge the Administration announced that 7.1 million
people had selected a marketplace plan during the ACA’s first open enrollment
period. That was surprising news when as
recently as the beginning of March there were questions as to if the number would
even hit 6 million (Obama Claims Victory in Push
for Insurance).
But that’s not the whole story. We need to remember there are additional
covered lives to count. We can start
with individuals under 26 who since the passage of the ACA have been able to
stay on their parent’s insurance coverage.
While we don’t have recent numbers on that group, given past data we can
estimate it at 2-3 million. We also have
to include the people who selected private insurance plans sold off the
marketplaces (Newly Enrolled, but Not
Counted by Insurance Exchanges).
That number is even more difficult to come by quickly as we’ll have to
wait for 50 very different state markets to report in, so no guess on that one
from me. And finally we also need to
remember the individuals who are newly enrolled in Medicaid. HHS announced that as of the end of February,
they estimated that number to be 3 million (Medicaid
enrollment grows by more than 3 million); we can expect that number to grow
once March data is available.
So lots of covered lives…
Once they get past that number, the first question people ask is how
many of those are newly insured? The
Urban Institute estimates that about 5.4 million individuals had gained
coverage between September 2013 (before open enrollment) and the beginning of
March. A number that should grow
substantially once the dust settles and everyone’s coverage kicks in. Of course this is not everyone who is
currently uninsured, but it is a start and for those millions of people it is a
life changing event (A
look at how many Obamacare enrollees were uninsured: 5.4 million).
These are the top-line numbers, but as we’ve
discussed before, while symbolically important, they don’t tell us everything
we want to know about how this is all working.
Specifically, no information yet on how many of these people will pay
their premium or what the risk pool looks like (age and health status). One observer notes that with this late surge,
all bets on what we thought we knew are off (Want Obamacare Answers? Get
in Line). Chances are the
millions who signed up at the last minute look nothing like those who signed up
in the preceding five months, making any projections about age and health
status just guesses.
With respect to the question of how many have/will pay their
premium, again we’ll just have to wait. Estimates
have varied widely from 80% to 95%. But
it’s important to remember that there are often good reasons why someone may
sign up and then not pay – they could have gotten a job offering benefits in
the interim or had some other change in circumstance. In fact this highlights an important aspect
of health insurance in our current system – churn. Churn is the issue of people going on and off
coverage due to life changes. Both the
private market and public programs have experienced since long before the
passage of the ACA. You can read more
about it here: Why
Some Don’t Pay Their Obamacare Premium: It’s Not What You Think.
While the numbers indicate a good beginning, groups
are already thinking about how to do better next time: Accelerating
the Affordable Care Act’s Enrollment Momentum: 10 Recommendations for Future
Enrollment Periods. And although the
next open enrollment doesn’t start until November, given the way these things
work, Insurers already calculating
2015 premiums as Obamacare kicks in.
Some would think that with the successful enrollment, the
battle over the law itself would die down – no such luck. The House passed a bill to change the
definition of full-time worker from 30 hours to 40 hours – with no hope of
passage in the Senate; it’s another public relations tool for opponents. Even though the CBO estimated that the bill
would increase the deficit by $74 billion and eliminate the employer coverage
for over 1 million individuals.
Also this week we had the Ryan budget – it repeals
all the reforms of the ACA but keeps all the Revenue (Paul Ryan’s budget makes big
Medicare changes) and an alternative to the ACA offered by Governor
Jindal which starts out by repealing the law and goes downhill from there(Jindal’s health plan starts
with a tough premise: Repeal all of Obamacare). This piece is a good overview of the partisan
nature of the discussion: 5 charts that explain the
politics of Obamacare.
Although the end of open-enrollment justifiably received
the bulk of this week’s headlines, there were several other significant health
policy related events this week:
Both nationally and here in Maine there is now
additional provider data available. On a
national basis, Medicare announced they will be posting their claims broken out
by physician (note no patient identifiable information will be available). This represents a huge victory for transparency
and comes in spite of years of efforts by the AMA to prevent the data’s release
(Medicare
to release billing data for 880K doctors).
Here in Maine we saw the release of the Patient Experience Survey data –
although this is available only on a practice specific basis (not provider
specific) thus negating some of its value (Patient experience survey
data about primary and specialty healthcare in Maine).
A “doc fix” made it through both houses of congress
and was signed by the president. Despite
the optimism of a few weeks ago, this was another one year band-aid as the deal
for a permanent fix fell apart. Although
buried in the legislation, of equal if not greater significance was the postponement
(yet again) of the implementation of ICD-10.
Although originally passed in 2009, industry lobbyists continue to say
there was just not enough time to prepare for the transition (Senate Approves ICD-10
Delay, 'Doc Fix', Obama signs bill temporarily
fixing Medicare fees). You can
read more about the ICD-10 issue here: Transitioning
to ICD-10 (Updated).
Although not always in the headlines, the work of transforming
our health care delivery system never stops, below is a sample of some of this
week’s developments that caught my eye, starting off with yet another reminder
that social services issues are an integral part of care:
- What to do when healthcare isn't enough
- Be more involved in how patients fill their prescriptions
- Mental Health Groups Split on Bill to Overhaul Care
- One example where the EMR can really make a difference in outcomes
- One in 25 patients has an infection acquired during hospital stay, CDC says
All
comments and suggestions are welcome; please let me know what you think. And as always, 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"
