Access to care

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.


SCOTUS agrees to hear case on Medicaid work requirements

The U.S. Supreme Court has agreed to hear a case on the Trump administration’s push for Medicaid work requirements, though the issue could be moot when President-elect Joe Biden takes office (Source: “Supreme Court to hear case on Trump's push for Medicaid work requirements,” The Hill, Dec. 5).

The Trump administration earlier this year had appealed lower court rulings that found the requirements adopted by New Hampshire and Arkansas to be unlawful. More than 18,000 people lost coverage in Arkansas due to work requirements before they were halted by a lower court.

Medicaid work requirements have been a priority for the Trump administration, though the incoming Biden administration is expected to eliminate the rules while pushing to expand access to Medicaid.


States consider options for end to extra federal Medicaid payments

 

State officials are asking the federal government for more information to help them prepare for an eventual end to increased federal funding from the first COVID-19 relief law this year (Source: “States grapple with plans for end to coronavirus public health emergency,” Roll Call, Dec. 3). 

The health emergency is set to expire Jan. 20 but will almost certainly be extended by the next administration. The question is how states will transition to normal operations.

“The issue and the challenge is that CMS, I am sure, doesn’t want to send states a signal that the public health emergency is ending, given where we are. But on the other hand, states feel like they need some indications of what to do and when to do it,” said Allison Orris, counsel with Manatt Health and a former federal health policy official.

A CMS spokesperson pointed to existing guidance to states saying that the enhanced federal funding for Medicaid — a 6.2 percentage point increase being added to states' Federal Medical Assistance Percentage rates — will stop at the end of the quarter when the public health emergency ends. The spokesperson said it’s too early to speculate on potential status changes for the health emergency, and CMS remains in constant contact with states.


Deadline for Ohio Medicaid managed care bids is today

 

Bids are due today for insurance companies that want to be a part of Ohio Medicaid’s overhaul  (Source: “Insurance company bids due today for Ohio Medicaid overhaul,” Dayton Daily News, Nov. 20).

The state is overhauling how the health insurance program for people who are disabled or have low incomes operates and picking new insurance companies as contractors to manage those insurance claims. By rebidding the contracts, the state can update the conditions for getting and spending Medicaid dollars and can re-select which insurers it trusts to meet its goals.

In 2019, Ohio paid about $17 billion to Medicaid HMOs and about 90% of the 3 million Ohioans who are covered by Medicaid get an insurance plan managed by an insurance company. These insurers get a payment per member per month and use that money to pay for their member’s health care.


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.


Ohio Medicaid enrollment spikes amid pandemic

The number of Ohioans enrolled for Medicaid coverage has increased more than 250,000 since the start of the pandemic, according to new state data (Source: “Ohio Medicaid rolls increase during pandemic,” Dayton Daily News, Oct. 29).

The state- and federally funded insurance program as of September covered 3.05 million Ohioans, with the increase primarily from covered families and children, according to the latest data reported by Ohio Department of Medicaid.

The Medicaid rolls have steadily shrunk for years as the economy improved in Ohio. But amid the disruption of the pandemic and related restrictions, many people have lost income and Ohio’s unemployment rate rose to 8.4% in September.


Study: Healthcare software algorithms inadvertently infuse racism into care

An investigation by health news website STAT News found that a common method of using analytics software to target medical services to patients is infusing racial bias into decision-making about who should receive stepped-up care (Source: “From a small town in North Carolina to big-city hospitals, how software infuses racism into U.S. health care,” STAT News, Oct. 13).

While a study published last year documented bias in the use of an algorithm in one health system, STAT found the problems arise from multiple algorithms used in hospitals across the country. The bias is not intentional, but it reinforces deeply rooted inequities in the American health care system, effectively walling off low-income Black and Hispanic patients from services that less sick white patients routinely receive.

These algorithms are running in the background of most Americans’ interaction with the health care system. They sift data on patients’ medical problems, prior health costs, medication use, lab results and other information to predict how much their care will cost in the future and inform decisions such as whether they should get extra doctor visits or other support to manage their illnesses at home. The trouble is, these data reflect long-standing racial disparities in access to care, insurance coverage, and use of services, leading the algorithms to systematically overlook the needs of people of color in ways that insurers and providers may fail to recognize.


Workers facing higher out-of-pocket costs, premiums for employer-sponsored coverage

A new survey from the Kaiser Family Foundation shows annual premiums for a family now top $21,000, and deductibles have more than doubled since 2010 (Source: “Workers With Health Insurance Face Rising Out-of-Pocket Costs,” New York Times, Oct. 8).

The high cost of health care is persisting during the pandemic, even for people who have maintained job-based insurance.

The average annual cost of a health plan covering a family rose to $21,342 in 2020, according to the latest survey by the Kaiser Family Foundation, a nonprofit group that tracks employer-based coverage. Workers paid about a quarter of the total premiums, or $5,588, on average, with their employers picking up the rest of the cost.

While premiums rose only slightly from the 2019 survey, the increase in premiums and deductibles together over the last decade has far outpaced both inflation and the growth in workers’ earnings. Since 2010, premiums have climbed 55 percent, more than double the rise in wages or inflation, according to the foundation’s analysis.


DeWine announces plan for Medicaid managed care rebidding

Gov. Mike DeWine’s administration has unveiled plans for a long-awaited overhaul of the $28 billion Medicaid health-care program covering more than 3 million Ohioans (Source: “Wellness, quality of health care for poor Ohioans centerpiece of new Medicaid approach,” Columbus Dispatch, Oct. 1).

The Ohio Department of Medicaid seeks to update its managed-care setup with a focus on population health, meeting the needs of children with complex needs and reducing administrative hurdles for patients and health-care providers.

The state invited privately operated managed-care organizations to submit applications for new managed care contracts by Nov. 20. Contracts will be awarded early next year with a new system in place in 2022. About 90% of Medicaid beneficiaries are enrolled in managed care.

Medicaid Director Maureen Corcoran said the plan is largely based on input solicited by the department from beneficiaries, physicians, hospitals and other health care providers, along with managed-care plans over the last 18 months.

The director referred to concerns with the current system which has forced some families with children in need of intensive and costly services, either in their home or residential settings, to relinquish custody so they qualify for Medicaid because they can’t afford the cost on their own.

Under the plan, Ohio Rise, so-called multi-system youth would qualify for modified eligibility requirements, allowing them to receive assistance while remaining in their family’s custody.


Study: Many children do not receive follow-up care for mental health conditions

A large new study finds that mental health care for many children in the U.S. falls far short, particularly when it comes to the follow-up treatment they receive (Source: “New research shows many children with mental health conditions don’t get follow-up care,” Stat News, Sept. 22).

The study, published Monday in Proceedings of the National Academy of Sciences, examined insurance claims from children between the ages of 10 and 17 covered by Blue Cross Blue Shield. Of the more than 2 million children included in the study, nearly one in 10 had a claim related to mental illness between 2012 and 2018.

The authors found that only 71% of the children received treatment in the 3 months that followed an initial insurance claim — but the study found that rate varied widely from one ZIP code to the next. In the best-performing ZIP codes, nearly 90% of children received follow-up care within three months of an initial insurance claim. In the worst-performing areas, only half of the children got that care.

In the past, some experts have suggested that shortages of qualified mental health providers are to blame for shortcomings in adolescent mental health care, with pediatricians often left to fill the gap. But the authors concluded that the disparities detailed in the study couldn’t be simply explained by staffing shortages.

The study found that the number of therapists in a given area is slightly associated with the chance that a child will receive follow-up treatment — but is far more closely correlated with the type of treatment a child receives. In communities where there are more psychiatrists, drug-only treatment and treatment with red flag drugs is more common. In communities with more of a supply of therapists, therapy-only treatment is more prevalent.