The private health insurance provisions in the Patient Protection and Affordable Care Act (P.L. 111-148, ACA, as amended) include market reforms that impose requirements on private health insurance plans. Such reforms relate to the offer, issuance, generosity, and pricing of health plans, among other requirements. ACA’s market reforms largely focus on the individual and small group health insurance markets, and in this report the reforms have been grouped by effective dates: “immediate” market reforms that become effective prior to the full implementation date of ACA, and reforms that become effective on the full implementation date (January 1, 2014)…. This report provides background information about the private health insurance market, including market segments and regulation. It describes each ACA market reform and notes any major implementation activity that has occurred (e.g., issuance of final rule from a department such as Health and Human Services). The appendices of the report provide additional information about the status of regulations relating to each reform and how the reforms apply to the different market segments and health plans…
Source: Dean Diaz, Moody’s Investors Service, Special Comment, April 4, 2012
From the press release:
The nullification of the 2010 healthcare law currently under consideration by the US Supreme Court would be a credit negative for for-profit hospital operators, says Moody’s Investors Service in a new special comment. The court is expected to announce in June its decision on the constitutionality of the reform law, which aimed to increase the number of individuals with healthcare insurance by mandating that all individuals purchase coverage.
“If the law is fully or partially repealed, for-profit hospital operators’ costs of treating patients unable to pay their bills would rise, and would limit operators’ revenue growth and profit margins and constrain cash flow,” said Dean Diaz, a Moody’s Vice President-Senior Credit Officer and author of the report. “Bad debt expense already averages over 10% of revenue of our rated for-profit hospital operators.”
Without the mandate that requires individuals to maintain healthcare coverage or face penalties, the pool of uninsured patients will likely expand, and along with increasing costs of providing healthcare services, put even more pressure on for-profit hospital operators. The biggest impact would be felt by operators of acute care for-profit hospitals, including HCA Inc. (B1 stable), Community Health Systems, Inc. (B1 negative) and Tenet Healthcare Corporation (B2 positive), says Moody’s.
Hospitals use dozens of practices to prevent hospital-acquired infections, but those facilities that employed infection preventionists who met certification requirements saw the least number of methicillin resistant Staphylococcus aureus bloodstream infections in their patients, according to a study of California hospitals with at least 100 beds.
Certification in infection control matters: Impact of infection control department characteristics and policies on rates of multidrug-resistant infections
Source: Monika Pogorzelska, Patricia W. Stone, Elaine L. Larson, AJIC: American Journal of Infection Control, Volume 40, Issue 2, March 2012
Source: Robin A. Cohen, Renee M. Gindi, and Whitney K. Kirzinger, Centers for Disease Control and Prevention, Division of Health Interview Statistics, National Center for Health Statistics, March 2012
• In the first 6 months of 2011, one in three persons was in a family experiencing financial burden of medical care. One in 5 persons was in a family having problems paying medical bills, 1 in 4 persons was in a family paying medical bills over time, and 1 in 10 persons was in a family that had medical bills they were unable to pay at all.
• Chances of being in families having problems paying medical bills, paying medical bills over time, and having medical bills that could not be paid at all, decreased with age. Almost 24% of children aged 0 – 17 years were in families having problems paying medical bills compared with 21% of adults aged 18- 64, 10% of adults aged 65- 74 , and 7% of adults aged 75 and over.
• Among persons under age 65, those who were poor and those who were near poor were more likely to be in families having problems paying medical bills and to have medical bills they were unable to pay at all than those who were not poor.
• More than one in five poor and more than one in five near poor persons under age 65 were in families that had medical bills they were unable to pay at all.
• Among adults aged 65 and over, those who were poor and those who were near poor were more than three times as likely as those who were not poor to be in families that had problems paying medical bills in the past 12 months.
– Health Insurance Coverage: Estimates From the National Health Interview Survey, January-September 2011
Source: Michael E. Martinez and Robin A. Cohen, Centers for Disease Control and Prevention, Division of Health Interview Statistics, National Center for Health Statistics, March 2012
– Selected Estimates Based on Data From the January-September 2011 National Health Interview Survey
Source: Centers for Disease Control and Prevention, Division of Health Interview Statistics, National Center for Health Statistics, March 2012
Source: Melissa McInerney & Kosali Simon, Industrial Relations: A Journal of Economy and Society, Volume 51 Issue 1, January 2012
From the abstract:
In addition to traditional forms of private and public medical insurance, two other large public programs help pay for costs associated with ill health. In 2008, Workers’ Compensation (WC) insurance provided $57.6 billion in medical care and cash benefits to employees who are injured at work or contract a work-related illness, and Social Security Disability Insurance (DI) provided $106 billion to individuals who suffer from permanent disabilities and are unable to engage in substantial gainful activity. During the 1990s, real DI outlays increased nearly 70 percent, whereas real WC cash benefit spending fell by 12 percent. There has been concern that part of this relationship between two of the nation’s largest social insurance programs may be due to individuals substituting toward DI as state WC policies tightened. We first show that this negative correlation between the national series does not hold over time within states, the level at which a causal relationship should operate. We then test for a causal effect of changes in WC enrollment on DI applications and new DI cases within states over time, using state policy (the maximum WC benefit) as an instrument for WC enrollment. Despite a strong first stage fit, we find no statistically significant evidence that WC tightening caused DI rolls to increase, although the standard errors are large enough that we cannot reject effects of substantial magnitude. We conclude it is unlikely that state WC changes were a meaningful factor in explaining the rise in DI during our study period of 1986-2001, although further study using individual level data is warranted.
Source: Susan J. Wells, HR Magazine, Vol. 57 No. 2, February 2012
Employers are linking healthy employee behaviors with lower health care premiums.
From the press release:
In the wake of the economic recession, the number of part-time workers who lack health insurance is increasing…Full-time workers are far more likely than part-time workers to be offered a health insurance benefit from their employers, which in turn affects how many are actually enrolled. In 2010, 60.1 percent of full-time workers had coverage from their own job, while 16.8 percent of part-time workers had such coverage.
From the summary:
This article from Center vice president for research Joshua Franzel and Center researcher Alex Brown advises governments to understand what has been done thus far to address OPEB liabilities so they can assess their own efforts and determine if their retiree health care programs are sustainable.
From the abstract:
Through our research we have found that women are continuously charged more for health coverage simply because they are women, and individual market health plans often exclude coverage for services that only women need, like maternity coverage. The report provides an in-depth analysis of these inequalities and explains how the Affordable Care Act explicitly removes these discriminations by 2014.
Source: John Gettens, Monika Mitra, Alexis D. Henry, and Jay Himmelstein, Inquiry,Vol. 48, No. 3, Fall 2011
From the abstract:
The Massachusetts health reform, implemented in 2006 and 2007, reduced the uninsurance rate for working-age people with disabilities by nearly half. Enrollment in Medicaid and subsidized insurance accounted for most of the gain in insurance coverage. The reduction in uninsurance was greatest among younger adults. The reform also reduced cost-related problems obtaining care; however, cost remains an obstacle, particularly among young adults with disabilities. The Massachusetts outcomes demonstrate that insurance subsidies, Medicaid expansions for low-income adults, individual insurance mandates, and enrollment initiatives can lead to substantial reductions in uninsurance and cost-related problems obtaining care among working-age people with disabilities.