Guest host Barbara Bogaev leads “The Brave New World of Obamacare”

Listen to or download the Jan 2 podcast of “The Brave New World of Obamacare” on To The Point with Warren Olney.

I joined a panel of experts on exchanges, health care reform and insurance to give insights on ACA plans going into effect. To The Point tweeted key comments from each of us, including:

  • Bryce Williams, Towers Watson, @brycewatch:
    The ACA could be major boost to entrepreneurship
  • Sarah Kliff, Washington Post, @sarahkliff:
    36 hrs into Obamacare, vast majority can signon & signup w/in an hr
  • Susan Shargel, Shargel and Company
  • David Nather. Politico, @DavidNather
  • Gerald Kominski: UCLA Center for Health Policy Research, @UCLAFSPH

In the full podcast, you’ll hear comments on these points and more:

The New Year brought with it medical coverage for millions of Americans under the Affordable Care Act. On Jan 1, about two million people began to receive private health coverage through the state health exchanges or the federal website.

With one of the nation’s most sweeping changes to social policy in decades, no longer can insurers deny coverage to people with pre-existing conditions, or charge them more for their coverage than other customers. It’s also the first time they can’t legally charge women higher premiums for the same coverage as men, and the first time they can’t set a specific limit on the amount they spend on “essential health benefits” for individual policyholders.

But there are a lot of “if’s” in the implementation of Obamacare:

  • Will people be able to find a doctor who accepts their new plan?
  • Are the nation’s healthcare providers ready for the change in policy?
  • How will Obamacare shape the political climate this election year?

Click to listen in to a discussion I had with Dan Gorenstein and others on state exchanges

On December 6th, New Jersey Governor Chris Christie vetoed a bill that would have created a health insurance exchange for his state under President Barack Obama’s signature healthcare reform law. Leading up to the states’ December 14 deadline to declare whether they would run their own exchange, many have interpreted state decisions to operate their own exchanges – or not to – along political lines.

I talk about state exchanges with Dan Gorenstien in his Marketplace piece, “States must make health care decisions,” and with Alex Wayne in his Bloomberg.com article, “Insurers Face Jumbled Market With Health Exchange Rules.” But the decisions we are seeing now are much less political, than practical. Here’s why.

First, health insurance exchanges are the law of the land based on last summer’s Supreme Court decision on the constitutionality of the Patient Protection and Affordable Care Act (PPACA or ACA) and cemented by President Obama’s re-election. There will be no repeal of Obamacare. That political window has now closed.

Second, under ACA, a state can choose to have the federal government run its health insurance exchange either on an interim basis or indefinitely. So residents of New Jersey, Tennessee and other states that are leaving it to the Feds will have access to individual health plans on January 1, 2014 through a health insurance exchange. They will be covered.

Here’s why the move is practical. I know from running the nation’s largest private Medicare exchange for the last eight years that building an effective exchange does not happen overnight. It is time consuming and costly, with many moving parts.

There is the underlying technology and the crucial relationships with the health insurers that will offer plans in the exchange. There is the initial consumer outreach, education and support while consumers are evaluating and choosing plans and enrolling. There are the complex eligibility requirements that some individuals must meet to receive federal subsidies. Lastly, there is the reality that the newly insured will move between company, Medicaid and individual coverage at frequencies never before seen or managed.

Not knowing the details of what it will take to build and run an exchange or how much it will cost, Christie, Haslam and others feel it’s best to let the federal government run it for now. And they can revisit the decision in the future.

This makes practical sense. The states that will run their own exchanges from day one have been working on them for more than a year. For example, California was the first state to declare that it would run its own and appears to be further along than any other.

For New Jersey and others, at this time, it is the right move. That could change next year as more information about the success of the first state exchanges becomes known to the governor and state legislative leaders.

Governor Christie is right: This is a practical – not political – move.

Read more

For regular commentary on developments and trends in health care, technology and insurance, follow @brycewatch and @ExtendHealth on Twitter and check out www.extendhealth.com.


It’s been an insane month – lots of travel, and I haven’t had a chance to post anything lately.  The Extend Health blog just posted a great roundup of news and opinion on the Ryan-Wyden plan, which is worth a read – reprinted here in its entirety for your convenience.

Bryce

Overview:

Paul Ryan (R-WI) and Ron Wyden (D-OR) released their proposal to overhaul Medicare this week. It is not at the bill stage yet, as the authors hope to cut down on the political rhetoric and start a serious national dialogue about the future of Medicare. Ryan and Wyden have not asked the Congressional Budget Office to review their proposal yet, so it is not known how much their plan would save compared to current Medicare.

Here is a brief overview of some of the plan’s key points:

People over 55 would see no change to their benefits. They would be free to opt into a private plan when the Medicare Exchange is established in 2022.

The “premium support” system would ensure affordable coverage by empowering seniors to choose either traditional Medicare or private plans. And there would be more help for low-income seniors who need it, and less for wealthier seniors who don’t need the assistance.

Medicare plans could be purchased on an insurance exchange established by congress.

Strong consumer protection would include:

  • All participating plans would have to offer benefits that are at least equal to traditional Medicare plans.
  • Risk-adjusted premium-support payments would guarantee affordable coverage for those with the greatest health needs.
  • Plans could neither refuse coverage for pre-existing conditions, nor charge rates that discriminate based on health status.
  • CMS would oversee all plans to ensure transparency and fairness.

Competition would drive program growth. Competitive bidding would force providers to reduce costs and improve quality. Competition between private and traditional Medicare plans would incentivize both to develop better delivery models and ways to care for patients.

Employees in small businesses with up to 100 workers could use their employer’s contributions to purchase their own health insurance, and the cost of free choice options would be fully tax deductible to the employer. In addition, allowing workers to keep the same insurance when they retire would ease their transition into Medicare.

Medicare spending would be capped to GDP plus one percentage point.

Read the full report:  http://budget.house.gov/UploadedFiles/WydenRyan.pdf

 

News Roundup:

Here’s a roundup of news articles written this week about the Ryan/ Wyden proposal, with reactions and opinions from across the political spectrum.

Bloomberg BusinessWeek: Bipartisan Medicare Plan May Spur More Compromise, Ryan Says

The Washington Post: Interview with Rep. Paul Ryan

Politico: Ryan-Wyden under ‘no illusion’ their plan will pass tomorrow – Looming shutdown? W.H. says to pass a short-term CR – Essential benefits, politically speaking

Boston.com: Clipboard: The “Ryden” Medicare proposal

Chicago Tribune: White House blasts new Medicare plan by GOP’s Ryan

Reuters: Republican Ryan backs new bipartisan Medicare Plan

Forbes: Ron Wyden and Paul Ryan’s Bipartisan Plan for Health Care and Medicare Reform

The Wall Street Journal: A.M. Vitals: Ryan, Wyden to Introduce Proposal for Changing Medicare

Time: Wyden-Ryan: A Move Toward Health Care Sanity

The Washington Post: What Wyden-Ryan hath wrought

The Wall Street Journal: The Wyden-Ryan Breakthrough

Kaiser Health News: Wyden And Ryan Join Forces On New Medicare Overhaul Plan

The Hill: Paul Ryan moves away from controversial Medicare reform plan

The New York Times: Lawmakers Offer Bipartisan Plan to Overhaul Medicare

Visit Extend Health — the nation’s largest private Medicare exchange.

CMS’ Final Rule for ACOs

October 21, 2011

CMS’ final rule for Accountable Care Organizations (ACOs) is now available for download from The Office of the Federal Register. For your convenience, here’s a link directly to the PDF.

Side-by-side comparison of proposed vs. final rule for ACOs

My latest Fast Company blog post here. A new Kaiser study shows that health care premiums are skyrocketing, but as new provisions of health care reform come into effect, companies can do a lot to make their employees healthier for less money.

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Visit Extend Health — the nation’s largest private Medicare exchange.

Yesterday I spoke with Emily Chasen, writer for the Wall Street Journal CFO journal, and today she published this piece about the future of private exchanges as a mechanism for providing health care benefits to active employees. You must be a subscriber to see the whole story, but here’s a snip:

“…a corporate exchange could be a middle ground between keeping a group plan and leaving employees to  use the state exchanges. Regulations that would affect corporate exchanges are still being written, so most companies will probably want to wait for the new laws to take effect in 2014 before deciding whether to use them….According to Bryce Williams, CEO of health-care exchange operator Extend Health, such corporate exchanges could offer companies an alternative to buying group plans from a health insurer.”

Visit Extend Health — the nation’s largest private Medicare exchange.

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Earlier this year, I wrote an article for InsuranceNewsNet offering my opinion that the individual mandate provision of the Patient Protection and Affordable Care Act (PPACA) is not essential to achieving the law’s goal of ensuring that tens of millions more Americans have health care coverage.  The individual mandate provision requires all citizens to obtain health insurance by 2014 or pay a fine.

In the past 30 days, court rulings on both sides of the question of whether the individual mandate provision is constitutional makes it even more likely that the U.S. Supreme Court will review the matter sooner rather than later.

The unconstitutionally of the individual mandate has become the central argument of opponents in legal challenges to the entire law. They argue that if such a key provision is ruled unconstitutional, the entire law should be unconstitutional. It also remains unpopular with average Americans. In a new poll out last week from the Associated Press and National Constitution Center, 82% of respondents said “no” when asked, “Do you think the Federal Government should have the power to require all Americans to buy health insurance, and to pay a fine if they don’t?”

We’ll have to wait and see how the U.S. Supreme Court rules to know the fate of the provision. But my own opinion hasn’t changed. Based on our experience at Extend Health, if a health insurer offers seniors a private Medicare plan that meets their needs at a price they can afford, they will buy. This is because certain conditions for Medicare-eligible seniors exist that do not exist for all Americans. Most important, Medicare is guaranteed issue and requires standard plan designs.

Guaranteed issue means seniors cannot be denied coverage because of their health status. Standard plan design makes it possible to compare and contrast different plans from different carriers more easily. And these are exactly the conditions all uninsured Americans will experience under PPACA starting in 2014.

While I still believe that these conditions are necessary for large numbers of uninsured Americans to buy health plans without a mandate, today I would also argue they are not sufficient. In addition, the key stakeholders driving the extension of health care coverage to more Americans will need effective outreach programs to ensure that all Americans know their options, understand their eligibility for the federal subsidies that will be offered, and know where and how to purchase health plans.

A large group of these stakeholders – health insurers, health care providers, associations and health care nonprofits – took a major step in the right direction last week when they launched a nonprofit coalition with the mission of ensuring that “all Americans are enrolled in and retain health coverage.” Enroll America  will do this by working to ensure that enrollment processes are simple and streamlined and that people know where they can go to find the right information at the right time.

It’s too early to tell whether Enroll America will be successful. But the importance of its mission cannot be underestimated. While the ACA lays the foundation for insuring tens of millions more Americans with guaranteed issue and standard plan design, finishing the job will require that every American understand what’s coming, and what they can do and when.

Visit Extend Health — the nation’s largest private Medicare exchange.

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