Tomorrow, Sept. 26 The Census Bureau releases2018 American Community Survey stats on health insurance coverage, economic and housing characteristics, language, educational attainment, commute to work, employment, mortgage status and rent, and income for places with populations of 65,000 or more.
Ending cost sharing reimbursements actually increased ACA enrollment, says anew study in Health Affairs. The federal government’s decision to end CSR payments seems to have increased marketplace enrollment by about 5 percent and contributed to a healthier marketplace risk pool, because of “silver loading.” Restoring CSR payments would likely reverse these effects. Health Affairs explains it well.
The 5th Circuit Court of Appeals decision in Texas v. US is due any time. The case on whether the ACA is constitutional was argued July 9. According to the Washington Post, the court says judges try to decide caseswithin two months after they are argued.Kaiser explains the lawsuit.
The Maryland Health Benefit Exchange released itsAffordability Work Group Report. The MD Exchange established an Affordability Work Group to recommend ways to reduce out of pocket costs; maximize APTCs for subsidized consumers; and maximize affordability for unsubsidized consumers. The group got data and ideas from Covered California, Families USA, and Rhode Island. The MD Health Care Commission broke out data on chronic disease (a big driver of cost) in on- and off- exchange enrollees in the individual market. Recommendations start at page 9 of the report.
MD’sEasy Enrollment Health Insurance Program lets people check a box on their state tax returns to jump-start health insurance enrollment. Maryland’s exchange will get eligibility info sent electronically from the tax return. People who qualify for Medicaid will be enrolled automatically, and the exchange will help people who qualify for private coverage enroll a plan. This program, which has broad bipartisan support, is the first of its kind in the US.
Colorado is now getting feedback and developing recommendations for a public option. Providers, insurers, consumer advocates and others have weighed in on the feasibility, scope, and design. The final policy proposal will be submitted to the state legislature by mid-November.Presentations and feedback here.
The US Census Bureau released new reports onHealth Insurance Coverage in the United States. The uninsured rate in Connecticut went from 5.5% in 2017 to 5.3% in 2018. But nationwide, this is the first year-to-year increase in the percent of uninsured since 2008-2009. Nationwide, the uninsured rate increased from 7.9% in 2017 to 8.5% in 2018. That meant 27.5 million people did not have health insurance at any point during 2018, up from 25.6 million in 2017. In 2018, 3.3% of people nationwide, or 30.8% of people with direct-purchase insurance, got their coverage through the state or federal health insurance marketplace. Between 2017 and 2018, the percentage of people covered by Medicaid decreased by 0.7 percentage points to 17.9%. The percentage of people with employment-based coverage, direct-purchase coverage, TRICARE, and VA or CHAMPVA health care did not statistically change. Employer-based insurance remained the most common source of coverage, covering 55.1% of the population for all or part of the calendar year. Seeuninsured maps by Connecticut county for 2017.
According to anAugust CMS report, Connecticut saw a 30% drop in unsubsidized enrollment from 2017 to 2018 (rank among states = 19). Unsubsidized enrollment changes ranged from an 85% drop in Iowa to a 7% gain in North Carolina. The five states experiencing the largest declines include Iowa (-85 percent), Georgia (-60 percent), Nebraska (-59 percent), Tennessee (-53 percent) and Virginia (- 51 percent).
All Medicaid expansions are not created equal: A fall 2019Brookings research paper finds that Medicaid expansion under the ACA tends to be associated with more hospital visits, primarily through ER visits for non-emergency conditions, although that finding did not hold true in Connecticut (I think).
Why People Remain Uninsured is a new report from the Commonwealth Fund. “Although the ACA has greatly expanded health insurance coverage in the U.S., some 30.4 million people are still uninsured. The Commonwealth Fund finds they are disproportionately lower income, Latino, and under age 35. The authors say the cost of insurance is a key reason why so many remain without coverage.” The report also shows that nearly half of uninsured adults may be eligible for subsidies through the marketplace or their state’s expanded Medicaid program; Northeastern states outperform the rest of the country; and men are more likely to be uninsured than women. (See also separatemap of CT's uninsured on policymap.com)
Connecticutranks1st in the nation forHealth Care Access and3rd for Health Care overall, according to US News & World Report’s “Best States” analysis. The health care ranking comprises metrics on: Health Care Access; Health Care Quality (CT ranked 14th), and Public Health (CT ranked 6th).
Covered California makes extensive OE data readily available in downloadable spreadsheets, including 9 separate tabs, that themedia share in their articles. E.g., “According to Covered California data, more than 50,000 Bay Area residents used the portal to sign up for health insurance last year.” Californiahas also started publicizing the need to prepare for itsnew individual health care mandate.
NASHP highlightedConnecticut, with Oregon, as two states that require hospitals to go further to invest in their communities. In return for billions of dollars’ worth of federal and state tax exemptions, nonprofit hospitals are required to invest in activities and services that benefit their communities. CT’s Certificate of Need process, managed by the Office of Health Strategy, requires hospitals to show in a public document how they directly tie community benefit spending to community needs — determined by the community itself — and align with CT’sState Health Improvement Plan.
Rhode Island publicized its 7th rank in the 2019 US Health Outcomes in the report released by the Commonwealth Fund. HealthSource RI was mentioned in theProJo article. Connecticut was ranked 5th in the same report.