Category Archives: Health Care

State Level Progress in Implementation of Federally Facilitated Exchanges: Findings in Three Case Study States

Source: Linda J. Blumberg, Shanna Rifkin, Urban Institute, June 14, 2013

From the abstract:
This paper focuses on states’ roles in implementation of FFEs. We start by providing an overview of recent regulations issued by CCIIO that describes the possible roles both for states and the federal government in the FFEs. We then provide in-depth descriptions of each of the specific FFE options as implemented in three states-Alabama, Michigan, and Virginia-with an eye to each state’s role in developing mechanisms to carry out their new responsibilities and progress in creating relationships with the federal government in order to ensure successful implementation of the three types of federally facilitated exchanges.

Patient Protection and Affordable Care Act: Status of Federal and State Efforts to Establish Health Insurance Exchanges for Small Businesses

Source: U.S. Government Accountability Office, GAO-13-614, June 19, 2013

From the summary:
For 2014, the Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services (CMS) granted conditional approval to 18 states to establish state-based Small Business Health Options Programs, or SHOPs, and to 17 states to operate health insurance exchanges for individuals. CMS is required to operate a federally facilitated SHOP (FF-SHOP) and a federally facilitated exchange for individuals (FFE) in the remaining states. Of the 33 states with FF-SHOPs and 34 states with FFEs, 15 states are expected to assist CMS to carry out certain functions of the exchange. However, the activities that CMS plans to complete in these 15 exchanges have evolved, and CMS activities in these and other exchanges may continue to change. For example, CMS approved state roles in SHOPs and individual exchanges on the condition that they ultimately complete key activities for exchange establishment. CMS indicated that it would assume more responsibilities in these exchanges if any state did not adequately progress towards completion of all required activities.

CMS and states have made progress in establishing SHOPs, although many activities remain to be completed and some were behind schedule. CMS issued regulations and guidance necessary to establish SHOPs and took steps to establish processes and data systems necessary to operate the FF-SHOPs. Many activities remain to be completed in the core functional areas of eligibility and enrollment, plan management, and consumer assistance, and while the agency has established timelines for completion of these activities, some were behind schedule. For example, funding awards and development of a training curriculum for a key program that will provide outreach and enrollment assistance to small employers and employees have been delayed by about 2 months. Regarding states, CMS data showed that most had completed preliminary activities such as obtaining the necessary authority to operate an exchange, and many had made progress in each of the core functional areas. Many key activities remained to be completed–some scheduled for near the start of enrollment in October 2013–and, as of May 2013, states were behind schedule in completing some key activities. In particular, about 44 percent of the key activities CMS initially targeted for completion by March 31, 2013, were behind schedule, although CMS reported that it had revised many target dates and other delays were not expected to affect exchange operations.

Medical cost trend: Behind the numbers 2014

Source: PricewaterhouseCoopers, Health Research Institute, June 2013

From the summary:
Defying historical patterns—and placing added tension on the health industry—medical inflation in 2014 will dip even lower than in 2013. Aggressive and creative steps by employers, new venues and models for delivering care, and elements of the Affordable Care Act (ACA) are expected to exert continued downward pressure on the health sector.

See also:
Chart Pack

2013 Employee Benefits Research Report: An Overview of Employee Benefits Offerings in the U.S.

Source: Society for Human Resource Management (SHRM), 2013

From the abstract:
SHRM’s 2013 Employee Benefits research report provides comprehensive information about the types of benefits U.S. employers offer to their employees. In 2013, almost 300 benefits were explored, covering health care and welfare benefits, preventive health and wellness benefits, retirement savings and planning benefits, financial and compensation benefits, leave benefits, family-friendly benefits, flexible working benefits, employee programs and services, professional and career development benefits, housing and relocation benefits, and business travel benefits. The report also examines trends in employee benefits offerings over the last five years.
See also:
Press Release
Executive Summary

Spotlight on Retiree Health Care Benefits for State Employees in 2013

Source: Joshua Franzel, Center for Excellence, and Alex Brown, Center for Excellence and NASRA, June 4, 2013

Key findings:
– Health care as a portion of overall public employee wage and benefit compensation has increased from 10 percent in 2004 to 12 percent in 2012.
– Fewer state government units offer retiree health care benefits now compared to ten years ago.
– Retiree health care obligations on a per capita basis vary widely among states.
– Unfunded retiree health care liabilities are concentrated in a minority of states: of all state retiree health care unfunded liabilities, 80 percent are attributable to 12 states.
– States use a variety of methods to reduce their retiree health care costs, most commonly shifting more costs to employees and retirees.

Medicaid Expansion Under the ACA: How States Analyze the Fiscal and Economic Trade-Offs

Source: Stan Dorn, John Holahan, Caitlin Carroll, and Megan McGrath, Urban Institute, June 2013

From the Robert Wood Johnson Foundation summary:
Within the next few months, state leaders must make a decision about whether or not to expand Medicaid to residents who earn 138 percent of the federal poverty level.

A new report from the Urban Institute examines issues such as:
– The legal and policy context under which states must decide whether or not to expand Medicaid;
– The status of decision-making about Medicaid expansion; and
– How states are analyzing the fiscal effects of Medicaid expansion.

The report is based on interviews with key decision-makers in 10 states: Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia. The report found that in each state where relatively comprehensive analyses of costs and fiscal gains were conducted, the net result showed that, on balance, Medicaid expansion would yield state fiscal advantages.

Opportunities for Cost Savings in Corrections Without Sacrificing Service Quality: Inmate Health Care

Source: Philip S. Schaenman, Elizabeth Davies, Reed Jordan, Reena Chakraborty, Urban Institute, February 2013

From the abstract:
In many cities and counties, inmate health care comprises as much as a third of the cost of the corrections department. Options are presented on ways to substantially reduce the costs without reducing the quality of the care. We drew on practices of jails and prison across the nation. The approaches for cost reduction include ways to reduce demand or need for health care (e.g., screening need for hospitalization), and ways to reduce the cost per inmate when care is need (e.g. use of telemedicine.)

Overview of HHS’ proposed rule on benefits for the Medicaid Expansion population: A Step Guide for Advocates

Source: Michelle Lilienfeld, National Health Law Program (NHeLP), April 17, 2013

The Department of Health and Human Services (HHS) released a proposed rule on January 22nd addressing the benefits the Medicaid Expansion population will receive, and the interaction with the Essential Health Benefits (EHBs). This Step Guide is designed to help state advocates understand the benefit options in the proposed rule and advocacy opportunities available.

A Bipartisan Rx for Patient-Centered Care and System-wide Cost Containment

Source: Tom Daschle, Pete V. Domenici, Bill Frist and Alice M. Rivlin, Bipartisan Policy Center Health Care Cost Containment Initiative, April 18, 2013

From the summary:
High and rising health care costs consume a large and rapidly growing portion of the federal budget, crowding out investments in other crucial priorities such as education, defense and infrastructure and putting pressure on other priorities of households, businesses and governments.

This trend will only accelerate with the aging of the population and its increased dependence on federal and state financing of health care. Yet despite our high national spending, health care in the United States is uneven in quality and often wasteful, uncoordinated and inefficient. Leaders on both sides of the political aisle, and in the health and economic policy communities, recognize the urgency of improving the quality and effectiveness of care, while slowing the growth of spending. However, far too often, attempts to address our nation’s health and budget issues have been fragmented and unproductive, frequently due to partisan disagreements over how to approach these highly sensitive issues.

We, the four leaders of the Bipartisan Policy Center Health Care Cost Containment Initiative, came together to bridge this divide—to start a constructive dialogue on strengthening the U.S. health care system….

Our policies would engage both beneficiaries and providers with incentives to pursue a more coordinated, accountable, and sustainable health care system. These recommendations span four broad categories:
1. Improve and Enhance Medicare to Incent Quality and Care Coordination;
2. Reform Tax Policy and Clarify Consolidation Rules to Encourage Greater Efficiency and Competition;
3. Prioritize Quality, Prevention, and Wellness; and
4. Incent and Empower States to Improve Care and Constrain Costs Through Delivery, Payment, Workforce, and Liability Reform.

Our recommendations would improve how health care is delivered and financed in both the public and private sectors. Focusing only on federal health programs runs the risk of shifting costs to the private sector or state and local governments without achieving higher-quality care. Each policy recommendation requires trade-offs to improve care as we constrain cost growth. Though all four policy pillars are essential, the two with the most-immediate delivery and cost impact are our recommendations on Medicare policy and the federal tax exclusion for employer-sponsored health insurance (ESI). …

Trends in Health Coverage for Part-Time Workers

Source: Paul Fronstin, Employee Benefit Research Institute, EBRI Notes, Vol. 34, No. 5, May 2013

From the summary:
• The Patient Protection and Affordable Care Act of 2010 (PPACA) requires that employers with 50 or more full-time workers pay a penalty if they fail to provide health coverage to full-time workers in 2014, which has raised concern that employers may respond by cutting back on health coverage for part-time workers or by increasing the proportion of part-time workers employed.

• The recent recession has already resulted in an increased use of part-time workers: The percentage of workers employed part-time has been rising since 2007, increasing from 16.7 percent to 22.2 percent in 2011.

• Part-time workers have experienced a much larger decline in coverage than full-time workers. Between 2007 and 2011, full-time workers experienced a 2.8 percent reduction in the likelihood of having coverage from their own jobs, while part-time workers experienced a 15.7 percent decline.