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This Week in Health Care Reform - January 17th, 2014

New polling shows it’s not just the American public that’s wary of the health care law; meanwhile, conservative angst gets misplaced; demographics paint a more complete picture of exchange marketplace enrollees; the push to protect a popular Medicare program gets launched; and, an examination of how narrow networks are in lockstep with lower premiums.


Health Care Reform

Hill Poll: Polling for the Affordable Care Act (ACA) continues to depict a populace with increasingly dyspeptic views of how the law is rolling out.  According to the latest Gallup poll released last week, disapproval of the law has risen to its highest point in over a year to 54 percent.  Also of concern, more Americans believe the ACA will ultimately make health care worse in the U.S. (48 percent) than those that believe it will make things better (35 percent).  Meanwhile, a separate survey of senior congressional aides shows that the implementation of the health care law has had a deleterious effect on morale.  In a new poll conducted by the Congressional Management Foundation, the vast majority of top staffers indicated that they were nervous about changes to their benefits (90 percent), anxious about higher costs (86 percent), and worried about access (79 percent).

Wrong Right Turn: Given the frustrations that have thus far attended the rollout of the insurance exchange marketplaces, it should come as no surprise that no small amount of angst has been ginned up as a result.  However, as legislative energies begin to target elements of the health care law designed to not only encourage participation on the exchange by insurers, but ensure that in doing so, they would not be exposed to insurmountable risk, experts warn that these politically motivated overtures are not only misdirected, but outright dangerous.  The “risk corridor” and “reinsurance” provisions were created to help insurance companies manage losses should enrollees in their plans be significantly more expensive to cover than expected.  With so many issues plaguing implementation – from the myriad glitches that prevented consumers from signing up on the exchanges to the numerous last minute changes to the law handed down by the Administration at the end of last year – this worst-case scenario is already unfolding.  But, experts caution that conservative momentum towards eliminating these provisions would, at best, divert focus from pursuing the structural changes needed to improve how the law ultimately works, or, at worst, be the first step on the road to single-payer.

Demography: Earlier this week, the Department of Health & Human Services (HHS) released the first demographic breakdown of enrollees on the state and federal insurance exchange marketplaces, providing stakeholders with a clearer picture of where exactly things stand.  By late December, nearly 2.2 million Americans had enrolled for coverage through the exchanges.  Of those, just 24 percent belonged to the target audience of 18- to 34-year olds, well below the hoped for 40 percent benchmark.  However, despite the initial pool of enrollees skewing older than expected, the Administration remains confident that, not only will enough young “invincibles” sign up before the March 31st open enrollment deadline, but, the law will work just fine given the current mix of enrollees.  Nevertheless, with fears of rising costs growing, attempts to jumpstart enrollment amongst this desired group are being rolled out.

"Seniors Are Watching": This week, the Coalition for Medicare Choices (CMC) launched its largest ever advocacy campaign, dedicated to protecting Medicare Advantage from further cuts.  The senior coalition, an initiative of America’s Health Insurance Plans (AHIP), the health insurance industry trade group, includes more than 1.5 million members across the country.  Their newest “Seniors Are Watching” campaign will look to coordinate the support of those members in an effort to remind Washington and the Centers for Medicare & Medicaid Services (CMS) that seniors are following this issue closely, while also urging decision-makers to protect this vital program from further cuts that would only weaken its ability to provide vulnerable beneficiaries with the coordinated care they’ve come to depend on.  With CMS preparing its proposed rate notice for release in late February, CMC is pledging to keep Medicare Advantage front-and-center inside the Beltway and around the country.  Visit their website to learn how you can help.

Narrow Networks, Lower Premiums: It’s no secret that the contours of health care in our country have been reshaped by the Affordable Care Act.  And, whether or not you agree with that change might have a lot to do with where you fall along the political spectrum.  But, while the kneejerk reaction may be to immediately focus on what’s gone wrong superficially, due consideration must be paid to what’s going on behind-the-scenes, and, more importantly, why something that looks bad on the surface, may in fact be good in the long-run.  One such example is the concept of “narrow networks”.  At first glance, the idea of placing limits on the doctors and hospitals available to health plan subscribers seems to fly in the face of one of the health care law’s stated promises.  Rhetoric aside, however, upon further examination, experts have begun to make the case that less choice in a health plan typically leads to lower premiums.  By only targeting providers that charge lower prices – without sacrificing proven outcomes – plans are able to bring down the costs of health care with no compromise to quality.  Additionally, by limiting their networks, insurers gain the leverage they need to keep that focus on costs and quality.  Though some believe that the ACA has caused this shift, there’s growing evidence that the law has only accelerated an existing trend – a trend, some put forth, that is characteristic of any well-functioning consumer market where a variety of choices with differing value propositions is made available at different price points.  

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