Posts Tagged ‘Health Insurance Exchanges’

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 14th, 2016 by Patricia Donovan

The people have spoken: the future of the ACA is healthcare's most pressing concern for 2017.

The people have spoken: the future of the Affordable Care Act is healthcare’s most consuming concern for 2017.

If U.S. President-elect Donald J. Trump delivers on his campaign promises, the ‘repeal and replacement’ of the Affordable Care Act (ACA) should be an early priority for the nation’s chief executive-in-waiting.

That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the ongoing Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

“The change or replacement of Obamacare might affect us significantly, including changing our USA market priority over other markets,” contributed one respondent.

“We don’t know what ACA repeal implications will mean for us,” offered another.

Other respondents identified “changes to our government structure and the unknown impact” as well as “lack of clarity post-election” as their most pressing concerns for the year ahead.

Take the Healthcare Trends 2017 survey and receive an executive summary of the results.

Given Trump’s ambitious healthcare agenda, much is at stake for industry stakeholders. But is it possible for the incoming administration to unravel the ACA, when the public already has been exposed to many of its provisions? And if repeal is possible, how long might the process take?

Greg Mertz, managing director for Physician Strategies Group, LLC, advises healthcare organizations not to panic about the ACA’s demise. “A ‘“repeal and replace’ means that Trump admits Obamacare can’t go away. Nothing will happen quickly, and whatever happens will be less dramatic than many expect,” predicts Mertz, who points to Trump’s lack of specifics as to what might replace Obamacare as further evidence.

“House Speaker Paul Ryan, R-Wisconsin, has already put forward his plan for healthcare reform, so I would think his ideas will be a pivotal part of what eventually gets passed,” continues Mertz. “However, Congress still decides what happens, so whatever Trump proposes will be mired in hearings, staff work, and debate for at least the next year. This means that we limp along with a broken program as we argue what is better.”

Also based on Ryan’s healthcare proposals, Travis Ansel, senior manager of strategic services for Healthcare Strategy Group, is advising providers to brace for more Health Savings Account (HSA)-related payment woes. “Ryan’s plans for Medicare, which have loomed over the industry for five years, bring with them increased patient payment obligations,” Ansel explains. “Expect more and more employer-based coverages to shift to HSAs as well. We can expect payors to raise insurance premiums across the board as the Republican-led Congress unwinds the ACA.”

Ansel pointed out that major payors were forced to shift their business models and infrastructure to compete in an ACA-focused market. “The quick shift back will be a reality these payors are not prepared for and not prepared to succeed under,” he concludes.

As payor margins suffer, adds Mertz, pressure will be placed on commercial insurers to raise reimbursement to offset the gap. “Employers will howl and the feds will be pressured to control costs, especially big pharma.”

Where Mertz does expect activity is within the Health Insurance Exchanges created by the ACA. “The insurance exchanges are in trouble already, so we would expect that providers that were seeing significant numbers of exchange-insured individuals would have likely seen a drop in those numbers regardless. I think the number of uninsured will increase in the short-term, as many will decide that paying the penalty is better than paying the premium.”

As to what healthcare might look like under the Trump administration, Mertz thinks the industry will see tax credits or vouchers. “However, I seriously doubt we’ll see a government-sponsored alternative, which I think we would have seen with (the Democratic presidential nominee) former U.S. Secretary of State Hillary Clinton.”

On the provider side, Mertz expects that while physicians will see little impact, hospitals will see a rise in charity care, and no major increase in income.

For a post-election roadmap to the challenges and opportunities facing healthcare in the year ahead under GOP leadership, don’t miss Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a live webcast on Thursday, November 17 at 1:30 Eastern.

Take the Healthcare Trends 2017 survey and receive an executive summary of the results.

Infographic: Healthcare Quality in Insurance Marketplaces

August 11th, 2014 by Melanie Matthews

Under the Affordable Care Act, some health insurance marketplaces have taken steps to improve healthcare quality and delivery in their states.

A new infographic from The Commonwealth Fund examines which states and how the marketplaces are improving quality.

13 States Are Using the Health Insurance Marketplaces to Improve Quality

The new health insurance exchange marketplaces, public and private, will have a profound impact on the under- and uninsured…and will permanently alter the way health insurance is bought and sold.

AIS's Health Insurance Exchange Directory and FactbookAIS’s Health Insurance Exchange Directory and Factbook is the definitive health industry guide to health insurance exchange implementation and stakeholder strategies, with in-depth coverage of every big-dollar business issue related to the new marketplaces — including technological infrastructure, consumer support tools, benefit design, marketing, FFEs and much more.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Will Your State Run a Healthcare Exchange?

September 4th, 2013 by Jackie Lyons

Every state must offer a healthcare insurance exchange by January 2014, under the Affordable Care Act.

The Centers for Disease Control estimated there were 48.2 million people without insurance in 2011, according to a new infographic from Face the Facts USA. The infographic describes how many individuals will be insured through healthcare exchanges, health plans that must be offered and assistance that will be available.

State Run Healthcare Exchange

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: Next-Generation Insurance Benefit Design and Marketing.

Healthcare Business Week in Review: Health Insurance Exchanges, Navigators, Medication Adherence

August 30th, 2013 by Cheryl Miller

Contrary to popular opinion, young adults between the ages of 19 and 26 do not think they’re immortal and do think they need health insurance. In fact, according to a study from The Commonwealth Fund, if members of this population don’t have health insurance, it’s because they can’t afford it.

Nearly half of the 15 million young adults enrolled in a parent’s health plan last year most likely would not have been eligible for coverage without the health reform law’s dependent coverage provision.

The survey also found that only 27 percent of young adults were aware of the state health insurance marketplaces launching October 1. The demographic that would benefit most from these marketplaces are those without coverage and those from low- or middle-income households, or, those least likely to be aware of them.

But these young adults, and all other adults, can seek out help through a coterie of navigators funded by the HHS. The agency has granted $67 million to 105 applicants in federally run and state partnership marketplaces, for navigators trained to help Americans who need assistance in shopping for and enrolling in plans in the health insurance marketplaces beginning this fall.

Health information navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new HIEs, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program (CHIP). Funding was available to eligible private and public groups and the self-employed who met certain standards to promote effectiveness, diversity, and program integrity, HHS officials say.

If all the health reform changes have made Americans’ blood pressure soar, there is help: a large scale study from Kaiser Permanente found that single pill combinations and consistent follow-ups with hypertension patients helped improve the rate of blood pressure control by nearly twice as much. Through one of the largest community-based hypertension programs in the nation, Kaiser Permanente Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009, helping to reduce the risk of stroke and heart attack for patients.

And speaking of soaring, accountable care organizations are flooding the healthcare landscape; with the number of public and private ACOs nearing 500, participants and pundits alike are looking more closely at the model’s structure, challenges and benefits.

How is your organization participating in ACOs? Take HIN’s third annual survey on ACOs by September 6, 2013 and receive a FREE executive summary of the compiled results.

Women’s Health Must be Priority for States’ Health Exchanges

March 13th, 2013 by Cheryl Miller

Women are finally getting the respect they deserve.

According to a new report from the George Washington University School of Public Health and Health Services (SPHHS), women’s health issues are key to the health of the nation and should be a major consideration when policymakers design and set up new insurance exchanges. And states need to maintain transparency so women can know up front what their coverage includes, including enrollment processes, scope of benefits, out of pocket charges and exemptions, so they can best provide for themselves and their families.

Transparency is also key to HHS’s aggessive list of health information technology (HIT) goals for 2013. Among them: at least 50 percent of physician offices will be using EHRs, and a majority will use electronic exchange among providers, ensuring that patients’ health information will be accessible wherever they access care. These goals are considered crucial to reducing healthcare costs and improving care quality, HHS officials say.

Increased access is behind a new primary care medical home (PCMH) certification from the Joint Commission. Designed for hospitals and critical access hospitals that have ambulatory care services that include primary care services offered by clinicians, the certification is considered beneficial to patients because it provides them increased access to the clinician and interdisciplinary team, and care from other clinicians and facilities is tracked and coordinated and regulated by evidence-based treatment protocols.

And increased virtual access is welcome to the majority of consumers, says a new Cisco Customer Experience Report recently released at the Healthcare Information and Management Systems Society (HIMSS) Conference.

Consumers and healthcare decision-makers across the globe were surveyed on sharing personal health data, participating in in-person medical consultation versus remote care and using technology to make recommendations on personal health. Results showed that the majority of Americans favored the increase of technology and remote care.

Three-quarters of consumers find access to care more important than face-to-face contact with their clinician, and are comfortable with the use of technology for medical interaction. The bottom line: consumers will overlook cost, convenience and travel, in order to be treated at a perceived leading healthcare provider to gain access to trusted care and expertise.

And don’t forget to take our new online survey on care transitions in 2013. Describe how your organization strategizes care transitions and you’ll receive a free executive summary of survey results once it is compiled.

These stories and more in this week’s issue of the Healthcare Business Weekly Update.