Category Archives: Health Care

Employer Wellness Incentives, the ACA, and the ADA: Reconciling Policy Objectives

Source: Kristin M. Madison, Northeastern University School of Law Research Paper No. 261-2016, October 2015

From the abstract:
Employer-based wellness programs have become increasingly common. Many large firms offer incentives for completing health-related questionnaires or undergoing biometric testing; some offer incentives for meeting targets related to biometric measures such as blood pressure or body-mass index. Over the last two decades, policy makers have both promoted and restricted incentive-based wellness programs. The 2010 Affordable Care Act (ACA) reflected both impulses: it imposed limits on the use of incentives, but signaled support for incentive-based programs by raising a previously existing ceiling on incentive magnitude. More recently, however, federal actions taken in connection with the Americans with Disabilities Act (ADA) threatened to undermine some ACA compliant, incentive-based wellness programs, eliciting protests from some employers. This essay examines the congruence of policy objectives underlying health plan regulations, the ADA, and their wellness program exceptions. While health plan regulations seek to preserve insurance affordability, regardless of health status, the ADA’s wellness program exception seeks to ensure the voluntariness of employees’ provision of information. The author argues that incentives can be compatible with voluntariness, and should therefore be permitted under the ADA, but that the ADA’s focus on voluntariness should lead to incentive regulations that are structured differently from those under the ACA.

Early Coverage, Access, Utilization, and Health Effects Associated With the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study

Source: Laura R. Wherry and Sarah Miller, Annals of Internal Medicine, Online First, April 19, 2016
(subscription required)

From the abstract:
Background: In 2014, only 26 states and the District of Columbia chose to implement the Patient Protection and Affordable Care Act (ACA) Medicaid expansions for low-income adults.

Objective: To evaluate whether the state Medicaid expansions were associated with changes in insurance coverage, access to and utilization of health care, and self-reported health. ….

Conclusion: The ACA Medicaid expansions were associated with higher rates of insurance coverage, improved quality of coverage, increased utilization of some types of health care, and higher rates of diagnosis of chronic health conditions for low-income adults. ….

Zika Virus: The Challenge for Women

Source: Jennifer Kates, Josh Michaud and Allison Valentine, Kaiser Family Foundation, Updated: April 15, 2016

The recent and rapid spread of Zika virus, a mosquito-transmitted infection, into the Americas is the latest in a series of emerging infectious diseases that pose new threats to human health. Active Zika transmission is now reported in over 20 countries in Latin America and the Caribbean, as well as several other territories, and the World Health Organization (WHO) predicts it could affect 4 million people across the Americas this year alone. On February 1 following an emergency meeting of experts, WHO declared that clusters of birth defects associated with Zika infection during pregnancy constitute a “public health emergency of international concern” requiring a stepped up, coordinated global response. In April the Centers for Disease Control and Prevention (CDC) confirmed this link.

Even before the association between Zika infection and births defects was confirmed, the Pan American Health Organization (PAHO), the CDC and other health authorities had issued guidance to pregnant women and those seeking to become pregnant to consider delaying travel to Zika-affected areas, and for those living in countries with widespread Zika transmission to avoid exposure to mosquito bites. In some countries public health authorities have gone even further, recommending that women postpone becoming pregnant for a period of time; most notably, the Minister of Health of El Salvador, a country which is experiencing a rise in suspected Zika cases, has recommended delaying pregnancy until 2018.

Such calls to postpone pregnancy raise serious issues, because many women across the region have limited access to contraceptives and other reproductive health services, experience high rates of sexual violence, and face other reproductive health decision-making barriers that can result in unintended pregnancies. In fact, some of the Zika-affected countries have among the strictest abortion laws in the world, potentially presenting women who have an unintended pregnancy with a dangerous catch-22. The United States government may have an important role to play in addressing health access and rights for women in Zika-affected countries, both through its direct health and development assets as well as its diplomatic engagement and public health expertise. To understand more about where these issues are likely to be more acute, we examine available country-level data on access to contraception, abortion policies, and the US government’s foreign assistance and global health presence in Zika-affected countries.

Women’s Health Insurance Coverage

Source: Kaiser Family Foundation, Fact Sheet, January 2016

From the summary:
Health insurance coverage is a critical factor in making health care affordable and accessible to women. Among the 97.5 million women ages 19 to 64 residing in the U.S., most had some form of coverage in 2014. However, gaps in private sector and publicly-funded programs left almost one in eight women uninsured. One of the Affordable Care Act’s (ACA’s) primary goals was to expand access to insurance coverage to reduce the number of uninsured. The law requires that nearly everyone carry health insurance, and expands access to coverage through a combination of Medicaid expansions, private insurance reforms, and premium tax credits. This factsheet reviews major sources of coverage for women residing in the U.S. in 2014, the first full year of the Affordable Care Act’s (ACA’s) major coverage expansion, and discusses the likely changes and impact of the law on women’s coverage in future years.

Why is the rich United States in such poor health?

Source: Laudan Y. Aron, Urban Institute, April 27, 2016

The original version of this post appeared in New Scientist in 2013.

Americans die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on health care. That was the startling conclusion of a major report released in 2013 by the US National Research Council (NRC) and the Institute of Medicine (IOM). Since then, evidence supporting a US “health disadvantage” has only grown, with both the Journal of the American Medical Association and the Centers for Disease Control and Prevention releasing new data in just the last several weeks. Headlines emphasizing Americans’ rising mortality rates are now common….

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey

Source: Tricia Brooks, Sean Miskell, Samantha Artiga, Elizabeth Cornachione, and Alexandra Gates, Kaiser Family Foundation, January 2016

From the summary:
January 2016 marks the end of the second full year of implementation of the Affordable Care Act’s (ACA) key coverage provisions. This 14th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies provides a point-in-time snapshot of policies as of January 2016 and identifies changes in policies that occurred during 2015. Coverage is driven by two key elements—eligibility levels determine who may qualify for coverage, and enrollment and renewal processes influence the extent to which eligible individuals are enrolled and remain enrolled over time. This report provides a detailed overview of current state policies in these areas, which have undergone significant change as a result of the ACA.

Together, the findings show that, during 2015, states continued to implement the major technological upgrades and streamlined enrollment and renewal processes triggered by the ACA. These changes are helping to connect eligible individuals to Medicaid coverage more quickly and easily and to keep eligible people enrolled as well as contributing to increased administrative efficiencies. However, implementation varies across states, and lingering challenges remain. The findings illustrate that the program continues to be a central source of coverage for low-income children and pregnant women nationwide and show the growth in Medicaid’s role for low-income adults through the ACA Medicaid expansion.
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The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update

Source: Rachel Garfield and Anthony Damico, Kaiser Family Foundation, Issue Brief, January 2016

From the summary:
One of the major coverage provisions of the Affordable Care Act (ACA) is the expansion of Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,724 for a family of three in 20151). This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for states.

As of January 2016, 19 states were not expanding their programs. Medicaid eligibility for adults in states not expanding their programs is quite limited: the median income limit for parents in 2016 is just 44% of poverty, or an annual income of $8,840 a year for a family of three, and in nearly all states not expanding, childless adults remain ineligible.2 Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits.

Variability and Limits of US State Laws Regulating Workplace Wellness Programs

Source: Jennifer L. Pomeranz, Andrea M. Garcia, Randy Vesprey, and Adam Davey, American Journal of Public Health, e-View Ahead of Print, April 14, 2016
(subscription required)

From the abstract:
We examined variability in state laws related to workplace wellness programs for public and private employers. We conducted legal research using LexisNexis and Westlaw to create a master list of US state laws that existed in 2014 dedicated to workplace wellness programs. The master list was then divided into laws focusing on public employers and private employers. We created 2 codebooks to describe the variables used to examine the laws. Coders used LawAtlasSM Workbench to code the laws related to workplace wellness programs.

Thirty-two states and the District of Columbia had laws related to workplace wellness programs in 2014. Sixteen states and the District of Columbia had laws dedicated to public employers, and 16 states had laws dedicated to private employers. Nine states and the District of Columbia had laws that did not specify employer type. State laws varied greatly in their methods of encouraging or shaping wellness program requirements.

Few states have comprehensive requirements or incentives to support evidence-based workplace wellness programs….
Related:
State Workplace Wellness Program Laws – Public Employers Map
Source: LawAtlas, 2016

Public and private employers are increasingly providing workplace wellness programs to support employee health, reduce costs, increase productivity, and enhance the attractiveness of the organization. Many states have adopted workplace wellness program laws that distinguish between public and private employers, and specify various requirements, such as the penalties and incentives that can be used to encourage employee participation, and tax credits that can be applied for employers that participate.
Depending on the type of program, federal or state law applies. Although a complex body of law related to federal preemption of state laws applies to workplace wellness programs, state law continues to apply to certain private employer programs and those offered by state and local governments. The existing state law varies, but the majority focus on private workplace wellness programs. This map identifies state laws dedicated to public workplace wellness programs, and the characteristics of those laws in effect in 2014.

State Workplace Wellness Program Laws – Private Employers Map
Source: LawAtlas, 2016

Public and private employers are increasingly providing workplace wellness programs to support employee health, reduce costs, increase productivity, and enhance the attractiveness of the organization. Many states have adopted workplace wellness program laws that distinguish between public and private employers, and specify various requirements, such as the penalties and incentives that can be used to encourage employee participation, and tax credits that can be applied for employers that participate.
Depending on the type of program, federal or state law applies. Although a complex body of law related to federal preemption of state laws applies to workplace wellness programs, state law continues to apply to certain private employer programs and those offered by state and local governments. The existing state law varies, but the majority focus on private workplace wellness programs. On this map, laws that did not specify employer type are grouped with laws directed at private employer programs because they likely apply to private employers in specific or limited circumstances. This map identifies state laws dedicated to private workplace wellness programs, and the characteristics of those laws in effect in 2014.

Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States

Source: Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, National Bureau of Economic Research (NBER), NBER Working Paper No. 22182, April 2016
(subscription required)

From the abstract:
The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 3.0 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those with incomes below the Medicaid eligibility threshold, non-whites, young adults, and unmarried individuals. We find some evidence that the Medicaid expansion partially crowded out private coverage among low-income individuals.

Health Care for Veterans: Answers to Frequently Asked Questions

Source: Sidath Viranga Panangala, Congressional Research Service, CRS Report, R42747, April 21, 2016

The Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA), operates the nation’s largest integrated health care delivery system, provides care to approximately 6.7 million unique veteran patients, and employs more than 311,000 full-time equivalent employees. …
This report covers the following topics:
Eligibility and Enrollment
Medical Benefits
Costs to Veterans and Insurance Collections