Category Archives: Health Care

Under Pressure: An Update on Restrictive State Insurance Marketplace Consumer Assistance Laws

Source: Justin Giovannelli, Kevin Lucia, and Sarah Dash, Commonwealth Fund blog, October 31, 2013

To help consumers enroll in the recently opened health insurance marketplaces, the Affordable Care Act created outreach and consumer assistance positions such as “navigators,” in-person assisters, and certified application counselors. Though they are subject to uniform federal standards, in practice, these programs range widely from state to state, because of the adoption of laws and regulations in many states that make it difficult for navigators to perform their jobs, as well as differences in funding for consumer assistance for different types of marketplaces. In this post, the first of a two part-series, we will examine the new restrictions; our next post will look at the how the limited funding for outreach and education for federally facilitated marketplaces, compared with state-run or state partnership marketplaces, may be limiting consumer outreach efforts in those states.

This summer, we reported that many states with federally facilitated marketplaces had imposed requirements more stringent than the federal rules governing the navigator program. Supporters of these efforts say that more regulations are necessary to ensure that navigators are well trained and protective of consumers’ rights. However, some of the new restrictions seem likely to prevent navigators and other consumer assisters from doing the jobs they were created to do.

17 states hinder consumers from getting help in health insurance marketplaces

On the Road Again: The Dangers of Transporting Ailing Inmates

Source: Christina Mason, Tod W. Burke and Stephen S. Owen, Corrections Today, Vol. 75 no. 5, November/December 2013
(subscription required)

Every day, in communities throughout America, correctional officers, sheriff’s deputies and federal marshals must transport inmates from secure facilities to medical clinics and hospitals for treatment. Every transport is a risky venture for corrections officials, medical staff, and the public, because the possibility that the inmate may seize an opportunity to escape is ever-present. This article will examine the problems posed and the risks inherent anytime an inmate is removed from the security of a correctional institution and taken to a medical facility where proper security is difficult to maintain.

The Paitent Protection and Affordable Care Act: What Are the Facts, and Where Do We Go From Here?

Source: Viola Riggin, Corrections Today, Vol. 75 no. 5, November/December 2013
(subscription required)

…This raises several important questions: How does this act really affect the incarcerated population? How do we define “inmate” and “inmate patient” within the health insurance arena, and what rights and requirements do inmates have to access and comply with PPACA? Are they covered under the “Patient’s Bill of Rights?” The American Correctional Association’s Coalition on Correctional Health Authorities (CCHA) formed a working group to evaluate the data, understand the language of this extensive law and the provide an unbiased look into how the new mandate may affect the incarcerated population. The CCHA-PPACA working group has spent many hours assisting secretaries and directors of corrections in understanding and developing a plan for managing this new act. The following provides an outline of that work….

Access, Affordability, and Insurance Complexity Are Often Worse in the United States Compared to 10 Other Countries

Source: Cathy Schoen, Robin Osborn, David Squires, and Michelle M. Doty, Health Affairs, Vol. 32 no. 12, Published online before print November 2013
(subscription required)

From the abstract:
The United States is in the midst of the most sweeping health insurance expansions and market reforms since the enactment of Medicare and Medicaid in 1965. Our 2013 survey of the general population in eleven countries—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—found that US adults were significantly more likely than their counterparts in other countries to forgo care because of cost, to have difficulty paying for care even when insured, and to encounter time-consuming insurance complexity. Signaling the lack of timely access to primary care, adults in the United States and Canada reported long waits to be seen in primary care and high use of hospital emergency departments, compared to other countries. Perhaps not surprisingly, US adults were the most likely to endorse major reforms: Three out of four called for fundamental change or rebuilding. As US health insurance expansions unfold, the survey offers benchmarks to assess US progress from an international perspective, plus insights from other countries’ coverage-related policies.
Related:
Summary
In the Literature
Article Chartpack (PDF)
Article Chartpack (PPTX)
OECD Chartpack (PDF)
OECD Chartpack (PPTX)
Appendices

The ROC Program: Accelerated Restoration of Competency in a Jail Setting

Source: Kevin Rice, Jerry L Jennings, Journal of Correctional Health Care, online before print November 13, 2013
(subscription required)

From the abstract:
In 29 months of operation, the restoration of competency (ROC) program provided treatment services to 192 incompetent to stand trial patients in a jail setting. The ROC restored competency for 55% of the patients in an average of 57 days compared to the state hospital average of 180 days. The average cost of treatment/restoration per admission was $15,568 compared to the state hospital average of $81,000. The ROC model accelerates needed treatment for mentally ill defendants, cuts demand for costly state hospital forensic beds, and assists jails in better managing inmates with severe psychiatric disorders—yielding major cost savings and improved care. In addition to preventing readmissions and negative behavioral episodes, the ROC improved the broader forensic system by eliminating the state hospital waiting list, accelerating access to psychiatric services, promoting local access for lawyers and family, and gaining stakeholder satisfaction.

7 Policy Changes America Needs So People Can Work and Have Kids

Source: Stew Friedman, Harvard Business Review, HBR Blog Network, November 11, 2013

We are in the midst of a revolution in gender roles, both at work and at home. And when it comes to having children, the outlook is very different for those embarking on adulthood’s journey now than it was for the men and women who graduated a generation ago. I recently published research from the Wharton Work/Life Integration Project, comparing Wharton’s Classes of 1992 and 2012. One of the more surprising findings is that the rate of Wharton graduates who plan to have children has dropped by about half over the past 20 years. …

…My research, and that of others, increasingly points to the fact that the thwarting of young people’s aspirations is the result of external pressures that make having both a successful career and a child seem impossible. Our current capacity to meet this challenge is cause for very serious concern. But there is no one solution; partial answers must come from various quarters. Here are seven ideas for action in social and educational policy, based on my own research — described in Baby Bust: New Choices for Men and Women in Work and Family — and what others have learned:

1. Provide World-Class Child Care….
2. Make Family Leave Universally Available….
3. Revise the Education Calendar….
4. Support Portable Health Care….
5. Relieve Students of Burdensome Debt….
6. Display a Variety of Role Models and Career Paths….
7. Require Public Service….

Fiscal Federalism: A Marriage of Money

Source: Anne Stauffer, Capitol Ideas, November/December 2013

The relationship between federal and state finances is complex, not well understood and vital to almost every aspect of Americans’ lives. Federal and state tax dollars jointly support schools, roads, health care, public safety and other key programs. This partnership, however, is under pressure from the enormous fiscal challenges of the past several years and the ongoing fiscal uncertainty at the federal level. An informed conversation using real data on the state impact of federal policies could help policymakers make the tough choices required to put all levels of government on a path to fiscal stability.

A dialogue is critical because federal and state finances are closely intertwined. Federal grants for health care, education, transportation and other programs make up roughly a third of state budgets, ranging from 24 percent in Alaska to 49 percent in Mississippi in 2011, the last year for which complete data are available.

Beyond that, total federal spending levels in states—on grants, contracts, salaries and direct payments to individuals for programs such as Social Security—are significant relative to the states’ overall economies, equivalent to between 12 percent of state gross domestic product in Delaware to 36 percent of state GDP in New Mexico, in 2010. In addition, many state-level fiscal policies piggyback on federal policies. …
Related:
Health Care and Federalism – Medicaid Expansion Decisions: Federalism, Politics or Both?
Source: Debra Miller, Capitol Ideas, November/December 2013

States More Reliant on Federal Dollars
Source: Capitol Ideas, November/December 2013

Special Investigation: How Insurers Are Hiding Obamacare Benefits From Customers

Source: Dylan Scott, Talking Points Memo, November 4, 2013

….Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies’ own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces — which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.

The extreme lengths to which some insurance companies are going to hold on to existing customers at higher price, as the Affordable Care Act fundamentally re-orders the individual insurance market, has caught the attention of state insurance regulators.

The insurance companies argue that it’s simply capitalism at work. But regulators don’t see it that way. By warning customers that their health insurance plans are being canceled as a result of Obamacare and urging them to secure new insurance plans before the Obamacare launched on Oct. 1, these insurers put their customers at risk of enrolling in plans that were not as good or as affordable as what they could buy on the marketplaces…..

Taking the leap

Source: Jennifer Grzeskowiak, American City & County, Vol. 128 no. 10, October 2013

Local governments move forward, despite debates over the Affordable Care Act. … Yet despite the uncertainty, many cities and counties have embraced their role as leaders in the community and are making sure they’re ready to help enroll and serve residents while determining what the ACA might mean for their own internal operations…