Health Care Delivery

For most of the spring, news on the Affordable Care Act was all about the numbers, and to much surprise enrollment surpassed the magical 7 million mark. Now, Patricia Salber, MD, and Christobel Selecky report in The American Journal of Accountable Care what having coverage means, whether it makes a difference, and what are the unanswered questions.

Managed care has an answer to what happens when previously uninsured patients suddenly gain coverage: the cost of uncompensated care falls substantially, and so do the numbers of patients showing up at hospitals and emergency rooms without insurance.

The uninsured rate among Latinos dropped sharply under the Affordable Care Act, but there were stark differences between states that have expanded Medicaid and those that have not.

Five years after the implementation of the first provisions of the Affordable Care Act and 5 months after the close of the first open enrollment period for the Health Insurance Marketplaces, we are starting to be able to measure the impact of the law.

The Affordable Care Act will save hospitals a projected $5.7 billion in uncompensated care this year, according to a report released by HHS. Roughly three-quarters of those savings are coming from Medicaid expansion states.

To optimize the impact of delivery system and payment reforms, healthcare system leaders may need to align organizational incentives with those facing frontline providers while also considering a wide range of factors that influence providers' choices.

The health insurance Marketplace will have 77 new insurers offering coverage in 2015, according to a report released by HHS. Overall, there will be a net 25% increase in the number of insurers that consumers will be able to choose from.

In 2013, lower health insurance rates saved consumers a total of $1 billion. States that enhanced their rate review programs will receive $25 million in rate review grant awards.

Since 2000, small-group health insurance premiums averaged annual increases of 5.5% nationally; however, double-digit increases were not uncommon, according to a report from the Urban Institute.

Although a majority of adults with health insurance purchased through the Affordable Care Act's marketplace said they find it easy to afford the care they need, the number of people still enrolled has dipped to 7.3 million, according to recent numbers.

Putting various branded drugs in "non-preferred" tiers and charging higher copays for them has been used for a number of years to steer consumers to use less costly medicines by giving them "skin in the game." But authors writing for The American Journal of Managed Care are alarmed by the policies of some insurers that now have designated entire classes of widely used generic drugs "non-preferred," leaving many patients without any low-cost treatment options for their diseases.

The federal government will terminate health insurance coverage under the Affordable Care Act for 115,000 individuals who failed to prove they were United States citizens or legal immigrants. Furthermore, another 363,000 people could lose their financial aid because of income reporting discrepancies.

More than 1,000 health centers in every US state and territory will receive Affordable Care Act funds to expand their primary care services, according to an announcement from Health and Human Services' Secretary Sylvia M. Burwell.

Open enrollment season is almost upon us. That will bring a test of whether the website for the federal exchange, HealthCare.gov can perform better in its second year than in its disastrous debut.

Retail health insurance marketplaces, also known as exchanges, are on the cusp of dramatically changing the health insurance business, according to a new report from PwC's Health Research Institute.

The Health Care Cost Institute and the National Academy for State Healthy Policy are launching a grant program to fund studies that will analyze how the states are implementing health reform.

Extending young adults' eligibility for health insurance on their parents' plans under an Affordable Care Act provision led to a decrease in emergency department visits.

In the largest cities in 15 states plus the District of Columbia the average insurance premiums for the second-lowest-cost silver plan will decline by 0.8% in 2015, according to an analysis from the Kaiser Family Foundation.

After vowing earlier this year to find a way to expand Medicaid to 400,000 Virginians, Democratic Governor Terry McAuliffe conceded yesterday he'd been cornered by Republicans in the Legislature determined to thwart his plans. McAuliffe yesterday unveiled a modest plan to extend Medicaid to 20,000 residents with severe mental illnesses and 5,000 children of state workers.

Transitional plans that are non-compliant may be cancelled by the insurer or barred by some states.

Yesterday's government report that healthcare spending will start rising faster after a decade of historically slow growth raises questions: Will rising numbers of insured people drive the spending? Or are healthcare costs going up on their own? The answer is likely some of each, based on a look at trends within yesterday's report and a just-released study of spending by commercial health plans, published in The American Journal of Managed Care.

The Appeals Court for the District of Columbia announced Thursday that it would re-hear Halbig v. Burwell en banc, meaning the entire panel of 11 judges will weigh in on the case. There will also be two senior judges who hear the case, but do not vote.

Maine is one of twenty-three states nationally to stay away from Medicaid Expansion.

States who refused to expand Medicaid will pay for other states that did; an investment without returns unless they participate in the expansion program.