Why do we need young people in the health marketplace?
Posted by on December 18, 2013 - 10:30am

As enrollment statistics in the new health insurance marketplaces start to become available, there is a growing focus on whether the enrollment of so-called “young invincibles” will be sufficient to keep insurance markets stable according to the Kaiser Family Foundation excerpted below.

Why does the age distribution of enrollees matter?

The Affordable Care Act (ACA) requires insurers in the individual market to cover anyone who wishes to enroll and restricts how insurers can vary premiums based on enrollee characteristics. Premiums cannot vary at all based on health status or gender. Premium variations based on age are limited to a ratio of three to one (meaning the premiums for a 64 year-old is three times the premium for a 21 year-old). Previously, premium variations based on age were more typically about five to one.

The limit on age rating means that, on average, older adults will be paying premiums that do not fully cover their expected medical expenses, while younger adults will be paying premiums that more than cover their expenses. For this system to work, young people need to enroll in sufficient numbers to produce a surplus in premium revenues that can be used to cross-subsidize the deficit created by the enrollment of older people. If that does not occur, premium revenues will fall short of expenses and insurers may seek to raise premiums the following year.

While enrollment in the federal and state-based marketplaces have tended to receive the most attention – and are the only enrollment statistics currently being reported – it is the age distribution across the entire individual market that matters from the perspective of the risk pool. That is because insurers are required to set premiums based on a “single risk pool” that encompasses all plans newly-purchased or renewed after January 1, 2014, both inside and outside the marketplaces.

Also, risk pooling occurs state by state, so if one state enrolls a substantial number of young adults, it will not help the insurance market in a state that is less successful.

What happens if enrollment among young adults falls short?

Because young adults will be cross-subsidizing older adults, they need to enroll in sufficient numbers for that cross-subsidy to be sufficient. If enrollment among young adults falls short, then the total amount of premiums collected by insurers will be less than the total health care expenses of enrollees plus administrative overhead and profit. And, if insurers believe that those enrollment patterns will continue into 2015, then they may raise premiums higher to compensate for the loss.

However, because premiums are still allowed to vary substantially based on age, the financial consequences of lower enrollment among young adults are not as great as conventional wisdom might suggest.

To learn more on this topic, read the full report from the Kaiser Family Foundation.

U.S. Supreme Court to review mandate to insure contraception
Posted by on November 26, 2013 - 12:33pm

The Supreme Court on Tuesday, November 26,  agreed to hear cases on whether corporations may refuse to provide insurance coverage for contraception to their workers based on the religious beliefs of the corporations’ owners.   President Obama’s health care law has exempted many religious groups from the law but did not exempt for-profit corporations because of owners' religious objections.

The National Women’s Law Center (NWLC) will be submitting a “friend of the court” brief to the Supreme Court that lays out how birth control advances the health and rights of women. Nearly 99 percent of women use contraception at some point during their reproductive years who come from a variety of religious faiths.  And currently nearly 27 million women can get free birth control without copays — a number that will increase as the health care law continues to go into effect.

Most women's organizations believe that allowing bosses to make women’s health care decisions is a dangerous precedent that could lead to companies refusing to abide by other laws that protect their employees, such as employment protections like minimum wage or equal pay. 
Sign the pledge to say all women deserve to make their own birth control decisions — no matter where they work.

 

 

 

Who should decide what birth control you use?
Posted by on November 5, 2013 - 10:30am

According to the National Women's Law Center,  "During the debate over the government shutdown, leaders in the House of Representatives passed legislation to exempt bosses from complying with the part of the Affordable Care Act, that gives women access to preventive services like birth control and well-woman visits with no co-pays or deductibles — if those employers oppose it for "religious or moral" reasons.    This means bosses could impose their religious beliefs on their employees or even block their employees' access to needed health care for vague and undefined "moral" reasons. The Senate rejected the House's plan — but this isn't the first time lawmakers have tried this trick, and it likely won't be the last."

Should your boss decide if and what birth control should be available to you through your plan???  Women need to remain vigilant as this debate continues!

Closing Racial and Ethnic Disparity Gaps for Women
Posted by on July 19, 2013 - 11:57am

For all intents and purposes, the Affordable Care Act (ACA), the President’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s Black population uninsured, more than 30 percent of Hispanics uninsured and a country still grappling with understanding and properly addressing disparities, just how far does the ACA take uninsured women in the US?

By mandating individual health insurance coverage and expanding the list of covered preventative services, ACA legislation should, theoretically, improve the quality of health care for women at a disproportionate risk of being uninsured and having low incomes. However, research has shown that having health insurance itself does not necessarily have a substantial impact if women cannot find a doctor to see them, do not have proper information about accessing resources, or are not treated in a culturally and environmentally competent manner.

Moreover, when the number of uninsured could be decreased by more than half, but being uninsured is not equitable across racial and ethnic groups in the US, what happens to our countries most vulnerable women and children?

It has been well documented that low-income women and those without employee-sponsored insurance (ESI) are more likely to be women of color. Kaiser and US Census estimates indicate that there are significant differences in insurance rates by race and ethnicity, with national averages approximating there are almost three times as many uninsured Hispanics as Whites. In Louisiana, for example, it is believed that more than 50% of the state’s Hispanics are uninsured, while only 18% of Whites are. In the same state, it is estimated that 30% of Blacks are uninsured, reiterating just how unbalanced our country remains and how terribly far we have to go to eliminate inequalities.

Even in Massachusetts, where health reform has been a success, the number of Blacks and Hispanics that remain uninsured is two and three times that of Whites, respectively.

Although the ACA takes us a step forward in giving many of the countries uninsured woman an insurance card, the US must address what to do about probable provider shortages that will result from a lack of primary care physicians and different utilization in care between races, ethnicities and gender. We must be prepared to understand both to cultural differences in demand and pent-up demand of the previously uninsured, as well as start to really face how to deal with persistent racial and ethnic inequality in this nation that shows itself in our health care system every day.

Employer-Sponsored Insurance Beginning to Dump Spouses and Children
Posted by on April 6, 2013 - 11:51am

Two weeks ago for Forbes I wrote about some of the unintended, but positive, consequences that could result from employers dropping employer-sponsored health insurance (ESI). Following that post, many weighed in about various other consequences of such behavior from employers and what that means for health care coverage for millions of families in the US. One issue in particular caught my attention; not only because of the touching stories associated with the discussion, but because of the unique and inspiring methods some providers are utilizing to compensate for the lack of insurance coverage.

As Jodi Carroll of VoteFacts.org underscored, millions of women in the United States are reliant on their significant other,s employer to provide their family’s health insurance. Women, in particular, are disproportionately reliant on husband’s employers for coverage, with children who are also dependents.

Although positives will most likely develop in the individual market due to ESI transitions, the current and near future are exceptionally frightening for many women as employers have started down that slippery slope by excluding many dependents from future insurance coverage.

Given the recent discussion in the media, spouses and children being dropped from employer coverage is a growing concern. In the context of a bloated and dysfunctional health care system, this significant and immediate alteration in health insurance coverage could be very difficult for many households to absorb financially, particularly if their income falls just above the threshold for federal subsidies to purchase policies in the upcoming health insurance exchanges.

But, what if these mothers and children had an option that could provide them with most of the services they need, and was easily accessible and affordable.

Throughout the nation, in response to shifts in health care, many small direct health care providers are opening shop. These direct providers are able to combat many concerns through price transparency, easy access and lower costs as they establish what is basically a menu of cash only services. Further, these one-on-one scenarios improve decision-making between patient and physician and take out the need for insurance and proof of citizenship.

While many services are not available through these direct providers, a bulk of what the majority of people need are. Chronic disease management, acute care services and preventative care are all available at a face value, affordable price.

Residents in North Carolina, for example, have embraced a shining example of this new system. Access HealthCare is a direct care provider in NC with results to be impressed by. One of their diabetic female patients, and her teenage son, had lost their health insurance when her husband them, taking his ESI with him. According to her KevinMD website interview, she was working two retail jobs to fund her diabetes treatment and medical, at a cost of $5,000 a year.

However, once she found Access Healthcare, her annual costs were reduced to $450 annually and her health care results improved.

Similarly, according to Dr. Brian Forrest, founder of Access Healthcare, “a patient who normally has an 80/20 plan (like Medicare Part B) might end up having to pay 20% of their fee to see a specialist for a stress echo. If the cardiologist I use gives them an 85% discount to just pay cash up front, then the patient actually spends less out of pocket by not using their insurance.”

Although not all medical care can be preventative or primary, Dr. Forrest contends that “only about 1% of the population gets hospitalized annually. Only about 5-10% of patients that seek care at a physician office cannot get the services they need in the outpatient setting.”

For now, most of what women and children need can be found in offices like those mentioned above. However, I would still encourage citizens to purchase, at minimum, catastrophic coverage for hospitalization.

Illinois to Create "Partnership" Health Insurance Exchange
Posted by on April 2, 2013 - 11:48am

Beginning in 2013, states will begin rolling out health care insurance exchanges as required by the Affordable Care Act (ACA). To this point most legislators, policymakers and health care experts have discussed the state-based and federal insurance exchange options at length. However, there is another form of insurance exchange that states are beginning to explore, and will soon be implemented in Illinois: the “partnership”.

In the state-federal partnership, states will divide obligations with the federal government. For this partnership model there is no requirement for a 50-50 split of labor, and the states are actually more of a facade whereby the consumers (individuals and employers) merely interact with the state. The federal government, on the other hand, will essentially perform all functions of exchange management except customer service and/or plan management. Moreover, states have the choice to run either one or both of those functions. According to former head of insurance exchange planning at HHS Joel Ario, “States that choose this option are ceding the more technical aspects of exchange activity to the federal government but can retain control
 of insurer oversight and consumer assistance.”

In the state-federal partnership model, the federal government will operate everything from consumer eligibility and enrollment to financial management and risk corridors. This essentially means that the federal government will take on most responsibility for the exchange, while granting states many of the perks they would receive if they had created a state-based exchange.

To date, only a few states have revealed that they intend to participate in a state-federal exchange. Here in Illinois, Governor Pat Quinn announced intention to run a partnership exchange in July of 2012. Since that announcement, the state has already received $39 million for the state, and this sum does not include monies issued for Medicaid expansion.

Currently, the Department of Health and Human Services (HHS) has written very little about this vague “partnership,” leaving many in Illinois wondering exactly what the collaboration will look like and how consumers will respond. The only known is that beginning in 2013, Illinois will embark down a new path for getting health care insurance to its citizens, and that will be facilitated through an exchange.

How well do you understand the Affordable Care Act: Take the Test
Posted by on March 24, 2013 - 9:44am

As the three-year anniversary of the Affordable Care Act approaches, the Kaiser Family Foundation has updated its interactive quiz that allows users to test their knowledge about what’s in – and what's not in – the health reform law.

Quiz takers can compare their health reform knowledge to that of their friends by sharing their quiz results on Facebook and Twitter. The quiz also includes links to more information about specific provisions of the law.   There's a lot posturing and misunderstanding out there so take the quiz and see how informed you are.  I got 9 out of 10, not bad.   Let us know how you do.

Long-acting contraceptives use may increase under ACA
Posted by on March 14, 2013 - 1:27pm

Even though they're more effective at preventing pregnancy than most other forms of contraception, long-acting birth-control methods such as intrauterine devices and hormonal implants have been a tough sell for women, especially younger ones. But changes in health-care laws and the introduction of the first new IUD in 12 years may make these methods more attractive. Increased interest in the devices could benefit younger women because of their high rates of unintended pregnancy, according to experts in women's reproductive health.

IUDs and the hormonal implant -- a matchstick-sized rod that is inserted under the skin of the arm that releases pregnancy-preventing hormones for up to three years -- generally cost between $400 and $1,000. The steep upfront cost has deterred many women from trying them, women's health advocates say, even though they are cost-effective in the long run compared with other methods, because they last far longer.

Under the Affordable Care Act, new plans or those that lose their grandfathered status are required to provide a range of preventive benefits, including birth control, without patient cost-sharing. Yet even when insurance is covering the cost of the device and insertion, some plans may require women to pick up related expenses, such as lab charges.

 Long-acting reversible contraceptives (LARCs) require no effort once they're put into place, so they can be an appealing birth-control option for teens and young women, whose rates of unintended pregnancy are highest, experts say.

Across all age groups, nearly half of pregnancies are unintended, but younger women's rates are significantly higher, according to a 2011 study from the Guttmacher Institute, a reproductive health research organization. Eighty-two percent of pregnancies among 15- to 19-year-olds were unintended in 2006, and 64 percent of those among young women age 20 to 24 were unintended, the study found.

Although the use of LARCs has more than doubled in recent years, it is a small part of the contraceptive market. Among women who use birth control, 8.5 percent of women used one of those methods in 2009, according to the Guttmacher Institute. The use of LARCs by teenagers was significantly lower at 4.5 percent, while 8.3 percent of 20- to 24-year-olds chose this type of contraception.

In October, the American College of Obstetricians and Gynecologists reiterated its strong support for the use of LARCs in young women.

Yet many young women are unaware that long-acting methods could be good options for them, in part because their doctors may be reluctant to prescribe them, experts say. That is partly the legacy of the Dalkon Shield, an IUD that was introduced in the 1970s whose serious defects caused pain, bleeding, perforations in the uterus and sterility among some users. The problems led to litigation  that resulted in nearly $3 billion in payments to more than 200,000 women.

In addition, providers may hesitate because there's a slightly higher risk that younger women will expel the device, experts say.

But expulsion is a problem more likely associated with the size of the uterus, which is not necessarily related to a patient's age, says Tina Raine-Bennett, research director at the Women's Health Research Institute at Kaiser Permanente Northern California and chairwoman of the ACOG committee that released the revised opinion on LARCs. "Expulsion is only a problem if it goes unrecognized." (Kaiser Health News is not affiliated with Kaiser Permanente.)

The new IUD Skyla became available in mid-February. It is made by Bayer, the same company that makes Mirena, another IUD sold in the United States. Unlike Mirena, which is recommended for women who have had a child, Skyla has no such restrictions (nor does ParaGard, the third type of IUD sold here). Mirena is currently the subject of numerous lawsuits alleging some complications, such as device dislocation and expulsion.

Skyla is slightly smaller than the other two IUDs on the market and is designed to protect against pregnancy for up to three years, a shorter time frame than the others.

This shorter time frame may make Skyla more attractive to younger women who think they may want to get pregnant relatively soon, some experts say, although any IUD can be removed at any time.

"More providers are spreading the word that it's okay, and more young women are demanding it," says Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Written by

By Michelle Andrews

Feb 18, 2013

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

Illinois makes progress on health insurance marketplace
Posted by on February 25, 2013 - 7:36am

During a visit with Illinois Governor Pat Quinn on February 13,  Health and Human Services (HHS) Secretary Kathleen Sebelius announced that Illinois has been conditionally approved to operate a State Partnership Marketplace (Exchange), which will be ready for open enrollment in October 2013. This partnership will allow Illinois to make key decisions and tailor the marketplace to local needs and market conditions.

“I applaud efforts by Illinois to build a new health insurance marketplace,” Secretary Sebelius said.  “Working together, we will be ready in eight months when residents of Illinois will be able to use the new marketplace to easily purchase quality, affordable health insurance plans.”

“Here in the home state of President Barack Obama, we are forging ahead to make the promise of the Affordable Care Act a reality,” Governor Quinn said. “Access to decent health care is a fundamental right. Hundreds of thousands of people in Illinois will gain quality health coverage through the Health Insurance Marketplace. They will also gain the peace of mind that comes from knowing that the care will be there if they need it. We are going to be working very hard between now and October 1st to educate the people of our state about the health care coverage options they will have through the Marketplace, thanks to President Obama's leadership.”

With today’s conditional approval of Illinois, twenty states and the District of Columbia have been conditionally approved to partially or fully run a marketplace – with the remaining states having until Feb. 15, 2013, to apply for a State Partnership Marketplace.

Because of the Affordable Care Act, consumers and small businesses will, beginning next January, have access to a new marketplace, where they can access quality, affordable private health plans.  These comprehensive health plans will ensure consumers have the same kinds of insurance choices as members of Congress, and will not be able to be denied coverage because of a pre-existing condition.

Consumers in every state will be able to buy insurance from qualified health plans directly through these marketplaces and may be eligible for tax credits and cost sharing assistance to help pay for their health insurance and out of pocket costs.

For more information on the new health insurance marketplace, visit:
www.healthcare.gov/marketplace/

Health Care Reform Update: In Maps and Charts!
Posted by on November 28, 2012 - 11:45am

The re-election of President Obama ensured that the Affordable Care Act  will move forward in 2013. In the coming months and years American’s will see a series of sweeping changes that begin with state-level action for health care reform, impacting millions of American women.

However, with each passing day it seems that more and more states and policymakers are changing their minds about what the respective plans are for the future.

Within the first few weeks of 2013 states must make decisions about whether they will set up a health insurance exchange, what essential health benefits must be covered by insurance plans in their region, and whether the states will expand their Medicaid programs.

Due to the number of health reform changes coming, the complexity of these issues and regulations and the huge impact on women’s health, it is easy for anyone to fall behind. Even health policy experts see changes every day that alter our analysis and projected outcomes. To help sort through the chaos, a few experts have created tables, maps and blogs to help the rest of us out.

* A broad range of policy changes (in an easy to understand chart!) can be found on the new State Reform website. This website is a state-based online network that frequently updates the avowed intentions of each state.

* For visual people, the best new source for information is the ProPublica website which has created “The Outlook of ObamaCare in Two Maps” being widely circulated and the Wright on Health blog where writers (including myself) keep readers updated on changes weekly.

* The Kaiser Family Foundation has also created an entire tab on their website devoted to diagrams and updates on health reform. The search function within this tab further makes it easy to find exactly which issue of change one wants to see in visual form.

* More information on federal government extensions being granted to states and insurance plans can be located on the Department of Health and Human Services website.

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