ACA/health reform

Federal lawsuit could end ACA free preventive services

A federal lawsuit heard in Texas last month could upend or even eliminate the preventive care requirement in the Affordable Care Act (Source: “Lawsuit Could End Free Preventive Health Checkups,” Pew Stateline, Aug. 9).

A group of patients and employers are arguing that the requirement is unconstitutional. The federal judge hearing the case, Reed O’Connor of the U.S. District Court for the Northern District of Texas, in 2018 struck down the Affordable Care Act as unconstitutional, only to be overturned by the U.S. Supreme Court in 2021.

According to a July report by the Urban Institute, a nonprofit research organization, health plans now cover more than 100 preventive health services with no out-of-pocket cost to patients. Among them are screening and counseling for alcohol misuse and obesity, screenings for blood pressure and depression, and immunizations.

Eliminating the preventive care mandate, many health policy analysts agree, could have far-reaching and dramatic effects, potentially causing millions of patients to put off or neglect health screenings that could detect diseases early. More than 60 professional medical organizations, including the American Medical Association, published a joint statement last month warning of a dire impact of striking down the provision.


Graphic of the week

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HPIO analysis of Ohio Medicaid data has found that the state share of spending on the Medicaid program has risen at a slower rate than the federal share over the past decade (see graphic above).

Since SFY 2011, total Medicaid spending in Ohio (including state and federal funding) has increased about 80% from $17.6 billion in SFY 2011 to $31.7 billion in SFY 2021. During that time, the federal share of Ohio Medicaid spending grew by 87%, while the state share grew by 63%.
 
The graphic is included in HPIO's fact sheet that was released in April, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic.”


Uninsured rate drops for all races in Ohio, with biggest reduction among Asian and Black Ohioans

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Click for larger version


The percent of Ohioans who are uninsured dropped by almost half from 12.3% to 6.4% between 2011 and 2019 (see graphic above).

Every race saw a drop in the percent of uninsured, with the percentage of Asian and Black Ohioans dropping most dramatically compared to other groups. Despite these gains in access, however, Ohioans of color are still more likely to be uninsured than white Ohioans.

Much of the drop in Ohio’s uninsured population is attributable to the state’s 2014 decision to expand Medicaid eligibility as part of the Affordable Care Act. In HPIO’s 2021 Health Value Dashboard, Ohio ranked seventh out of the 50 states and the District of Columbia for access to care — the first time Ohio has ranked in the top quartile on any Health Value Dashboard domain.

While access is clearly a bright spot for the state, the Dashboard found that Ohio’s population health outcomes remain poor. Access to care is critical, particularly for Ohioans with serious health conditions. But the Dashboard and national research shows that health is shaped by many factors, including social, economic and physical environments.

This April, HPIO is creating a series of data graphics in recognition of National Minority Health Month


Study: Many who attempted suicide can’t find mental health care

A new study has found that although suicide attempts in the United States have increased substantially over the last decade, the number of people who had recently attempted suicide and said they were not receiving mental health services has remained constant at about 40 percent (Source: “Survey of Americans Who Attempted Suicide Finds Many Aren’t Getting Care," New York Times, Jan. 19).

The study, published in JAMA Psychiatry on Wednesday, traces a rise in the incidence of suicide attempts, defined as “self-reported attempts to kill one’s self in the last 12 months,” from 2008 to 2019. During that period, the incidence rose to 564 in every 100,000 adults from 481.­ Among the major findings was that there was no significant change in the use of mental health services by people who had tried suicide, despite the passage of the Affordable Care Act in 2010 and receding stigma around mental health care.

The Affordable Care Act, which took effect fully in 2014, required all health plans to cover mental health and substance abuse services, and also sharply reduced the number of uninsured people in the U.S. Still, many respondents to the survey in the new report said the cost of mental health care was prohibitive; others said they were uncertain where to go for treatment or had no transportation.

Dr. Paul Nestadt, an assistant professor of psychology at Johns Hopkins who has researched the epidemiology of suicide but was not involved in the study, said the new data points, once again, to the scarcity of psychiatric beds or mental health professionals who take insurance, factors that have prevented medical science from bringing down the country’s suicide rates.

“The bottom line is, our treatments really work,” he said. “But people have to be able to access care. When they can’t, they’re left with less choices.”


Ohio to push for reinstatement of Medicaid work requirement

Ohio will appeal a move by the Biden administration to rescind federal approval of a work requirement that the state wants to use to determine Medicaid eligibility, Gov. Mike DeWine announced Thursday (Source: “Ohio seeks to reinstate Medicaid work requirement in appeal to Biden administration move,” Columbus Dispatch, Sept. 9).

Attorney General Dave Yost filed a notice of appeal with the Centers for Medicare & Medicaid Services weeks after the agency withdrew its approval for the "community engagement" requirement. The measure would require all new adult group beneficiaries under 50 years old to complete 80 hours per month of employment, education or job skills training.   

Federal officials approved Ohio's requirement under former President Trump in 2019, but the COVID-19 pandemic prevented it from going into effect this year. DeWine and other Republicans say it's necessary to encourage self-sufficiency and relieve the burden on taxpayers.


Biden administration revokes permission for Ohio Medicaid work requirements

The federal Centers for Medicare and Medicaid Services told the Ohio Department of Medicaid this week that it cannot proceed with its plans to require some people on the health coverage program to work to keep their coverage (Source: “Biden administration nixes Ohio’s Medicaid work requirements,” Cleveland Plain Dealer, Aug. 11).

In a 23-page letter, sent to the state on Tuesday, CMS says that work requirements do not “ promote the statutory objectives of Medicaid” because they would likely result in thousands of people losing coverage.

This is a change from the administration of former President Donald Trump, which had approved the state’s work requirements program in 2019. The Ohio Department of Medicaid was directed to submit a work requirement program by the Ohio General Assembly in the 2017 budget bill.

Work requirements were supposed to begin Jan. 1, but were postponed because of the coronavirus pandemic.


ACA, Medicaid expansion reduce income inequality, study finds

Coverage gains made and subsidies offered under the Affordable Care Act reduced income inequality by more than 10% in 2019, according to a new study (Source: “ACA's coverage gains decreased income inequality: study,” Fierce Healthcare, Jan. 7).

The study from the left-leaning think tank Urban Institute, backed by the Robert Wood Johnson Foundation and published in Health Affairs, found that for a typical person in the bottom 10th percentile of income, those who enrolled in a plan under the ACA saw their incomes increase by an average of 18.8%.

In states that expanded Medicaid, their incomes rose by an average of 22%, the study found. The study also found that coverage gains led to reductions in income inequality within and between age and racial groups.


Supreme Court justices signal likely support for keeping ACA

Statements made by Supreme Court justices during the latest challenge to the Affordable Care Act indicate that the law is likely to be upheld (Source: “‘Obamacare’ likely to survive, high court arguments indicate,” Associated Press, Nov. 10).

Meeting remotely a week after the election and in the midst of a pandemic that has closed their courtroom, the justices on Tuesday took on the latest Republican challenge to the Obama-era health care law, with three appointees of President Donald Trump, an outspoken critic of the law, among them.

But at least one of those Trump appointees, Justice Brett Kavanaugh, seemed likely to vote to leave the bulk of the law intact, even if he were to find the law’s now-toothless individual mandate that everyone obtain health insurance to be unconstitutional.

“It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the act in place,” Kavanaugh said.

Chief Justice John Roberts, who wrote two earlier opinions preserving the law, stated similar views, and the court’s three liberal justices are almost certain to vote to uphold the law in its entirety. That presumably would form a majority by joining a decision to cut away only the mandate, which now has no financial penalty attached to it. Congress zeroed out the penalty in 2017, but left the rest of the law untouched.


Medicaid facing unprecedented strains amid pandemic, unemployment surge

As COVID-19 roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed (Source: “Medicaid Nearing ‘Eye of The Storm’ As Newly Unemployed Look For Coverage,” Kaiser Health News, April 3, 2020).

That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers. The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and health care in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.


Insurance premiums to spike in 2021 because of COVID-19, report forecasts

The cost of COVID-19 testing and treatment is likely to squeeze U.S. health insurers' profits, which could lead to higher premiums in 2021 (Source: “COVID-19 could prompt higher 2021 insurance premiums, benefit cuts,” Modern Healthcare, March 23, 2020).

A new report from Covered California, the state's Affordable Care Act marketplace, projected that commercial insurers and employers across the United States could face a $34 billion to $251 billion bill for coronavirus testing and treatment this year. Their best estimate is $103 billion.

Absent any federal action, those costs could prompt commercial health insurers to increase premiums between 4% to 40% in 2021 to make up for increased medical claims and stay solvent, according to the report.

The report by Covered California's chief actuary John Bertko focuses on costs for the commercially insured, which includes about 170 million Americans who receive coverage through their jobs and the individual market. It doesn't address the separate and likely significant costs to Medicare, Medicaid or other public programs, though Bertko said those costs would be "huge."