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This Week in Health Care Reform - May 9th, 2014

As enrollment figures get parsed over, thoughts turn to lessons learned going into next year; fewer than expected have looked to be excused from the health care law’s mandate, even as HHS widens the exemption for people to do so; yet another high-ranking health official heads for the exit; Medicare Advantage continues to prove popular, despite taking up permanent residence on the chopping block; and, telehealth advances in fits and starts.


Health Care Reform

Enrollment Insights: With the announcement that more than 8 million Americans ultimately signed up for coverage on the exchanges, the Administration was able to close the books on the Affordable Care Act’s first open enrollment period.  Or, so it thought.  While the final tally exceeded original projections of just how many would sign up, it took a dramatic, last-minute surge to carry the ball across the goal line.  But, even as supporters quietly celebrated the accomplishment, opponents were quick to point out that, unless those 8 million sign-ups could be tied back to 8 million first premiums paid, those final numbers don’t provide an accurate narrative.  Accordingly, the House Energy & Commerce Committee’s Subcommittee on Oversight & Investigations convened a hearing of its own this week specifically on the issue, inviting a handful of insurers to discuss their enrollment experiences.  The hearing came on the heels of the full Committee having released a report last week claiming only two-thirds of enrollees had paid their first premiums.  Witnesses at Wednesday’s Subcommittee hearing, however, painted a different picture, attesting that as many as 90 percent of customers had, in fact, made their first payment.  As experts continue to debate the successes and failures of the rollout, and whether or not it’s working as intended, there’s no denying that there’s room for improvement heading into next year. 

Mandate Exemption:
A central component of the health care law, the individual mandate was meant to encourage full participation in the newly created health insurance exchange marketplaces.  While some have objected to the tactic as being more stick than carrot, the actuarial argument behind the provision is sound – the more enrollees in the pool, the more evenly the risk gets spread out for everyone.  Nevertheless, exemptions were quietly made available to millions of Americans looking to be excused from the mandate ahead of the open enrollment period closing last month.  Surprisingly, though, relatively few have taken the Administration up on the offer.  To date, around 77,000 families and individuals had requested exemptions; as of late last month, tens of thousands of them had been approved, with none being rejected.  And, just last week, the Centers for Medicare & Medicaid Services (CMS) announced that it was widening the exemption for people purchasing coverage off the exchange retroactive to last Thursday (May 1st).  

Another Vacancy:
The first confirmation hearing for Sylvia Mathews Burwell was held yesterday before the Senate Health, Education, Labor, & Pensions (HELP) Committee.  While opponents of the President’s signature law believed her nomination to replace outgoing Health & Human Services (HHS) Secretary Kathleen Sebelius provided them with the perfect opportunity to redirect the national conversation to what they think is wrong with the Affordable Care Act, more pragmatic observers felt her ability to perform under pressure wouldn’t really be put to the test until after she’s been confirmed.  In either case, her hearing marked the beginning of a regime change at the top of the Administration’s health care leadership team.  In addition to Secretary Sebelius’ resignation, CMS Deputy Administrator Jonathan Blum has also announced that he would be leaving his post.  And, late last week, Mike Hash added his name to the list, announcing his retirement as head of the Office of Health Reform (OHR), the HHS unit charged with overseeing implementation of the health care law. 

Medicare Advantage: Last month, ahead of CMS making final its proposed payment changes to Medicare Advantage, a good deal of coverage was devoted to the impacts that those cuts would have had on the millions of seniors and persons with disabilities currently enrolled in the popular program.  Despite the final rate notice being less than originally proposed, the changes that were ultimately enacted, when taken in combination with the cuts already imposed under the Affordable Care Act, meant that beneficiaries would, nonetheless, still be exposed to higher out-of-pocket costs, reduced benefits, and fewer choices, as more plans are forced to exit certain markets.  You’d be excused, though, if you dismissed these warnings as more political angst than what’s actually happening, especially as enrollment updates for Medicare Advantage paint a very different picture.  Already this year, the number of Medicare beneficiaries enrolled in Medicare Advantage plans reached an all-time high of nearly 16 million enrollees.  (In fact, the Congressional Budget Office (CBO) now projects that that number will reach 22 million by 2020.)  So, given that the program seems to be attracting new members at an historic rate, why all the doom-and-gloom?  While some would point to the enrollment numbers as evidence that Medicare Advantage is thriving under increasingly difficult conditions, others maintain that the program is only doing so because of the better model-of-care it embodies.  Further, as cuts to its underlying payment structure continue to chip away at the program, plans will be less able to insulate beneficiaries from feeling the impact of these cuts. 

Earlier this week, Karen DeSalvo, the National Coordinator for Health Information Technology at HHS, joined a panel of experts on connected health to talk about the intersection of technology and the enhanced delivery of health care.  The event, hosted by POLITICO and Philips, was particularly timely in light of the Federation of State Medical Boards (FSMB) having adopted a new set of guiding principles for telehealth late last month.  That policy, however, has drawn considerable opposition from patient advocates and some provider groups, who take exception to the model definition for “telemedicine” which was drafted to be intentionally aspirational to allow for the inclusion of new technologies, beyond just telephony and email.  Speaking at the event this week, DeSalvo spoke of the importance of a national embrace of these technologies (electronic health records, related systems, and devices), lest we miss out on the opportunity to vastly improve the delivery of – and access to – care in this country.  That all depends, she elaborated, on the development of a policy framework.  

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