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Newsletter

ACA September 2019

Volume 2, Number 15
Individual and Family Health Insurance News
IN THIS ISSUE...
  
  • CMS ADOPTS STAR RATING SYSTEM FOR ON-EXCHANGE PLANS FOR 2020
  • A NEW EXPLANATION OF WHY U.S. HEALTHCARE SPENDING IS SO HIGH
  • ACA WINNING OUT OVER MEDICARE FOR ALL AMONG DEMOCRAT VOTERS
CMS ADOPTS STAR RATING SYSTEM FOR ON-EXCHANGE PLANS FOR 2020
According to an article by Robert King in the August 1 issue of Fierce Healthcare, the Trump administration will require Affordable Care Act exchange plans to display their star ratings received for quality, in a move aimed at boosting transparency.

The Centers for Medicare and Medicaid Services said on August 15 that the new requirement will apply to plans sold on the ACA’s exchanges in the 2020 coverage year. Open enrollment for 2020 begins November 1 and ends December 15. Consumers will be able to check a plan’s five-star rating on exchange websites such as Healthcare.gov.

“This addresses our strongly held commitment to equip consumers with the tools they need to find the best choice possible,” said CMS Administrator Seema Verma in a statement.

The star ratings, which rate plans on a scale of one to five, look at a series of quality factors such as network strength and customer service. CMS also has star ratings for hospitals, Medicare Advantage, Part D prescription drug plans, and nursing homes.

The decision to implement the program nationwide comes after CMS held a pilot program during the 2017 and 2018 ACA open enrollment periods. The agency displayed star ratings for plans in two states: Virginia and Wisconsin during both of those years. CMS expanded the pilot program to include Michigan, Montana and New Hampshire in the 2019 open enrollment period. According to CMS data, 84% of consumers on healthcare.gov enrolled in a three, four or five-star plan in these states for the 2019 coverage year.
A NEW EXPLANATION OF WHY U.S. HEALTHCARE SPENDING IS SO HIGH
Allison Bell has reported on the results of a RAND Corporation study on U.S. healthcare spending in the August 5 edition of Benefits Pro .
Chapin White and his RAND corporation team have come up with an explanation for why the United States spends so much more than the rest of the world on health care: private health plans pay wild prices for outpatient care.

White said RAND conducted its research in response to earlier research showing that U.S. residents get about as much health care as residents of other countries but pay much higher prices for the care, and other research showing that most of the gap is due to the high prices private health plans pay.
White’s team looked at the price gap by comparing health care facilities reimbursement data from states with good data with traditional Medicare plan reimbursement data.

The researchers found that private plan payments averaged more than 200 percent of Medicare payments for the same care at the same hospitals and that this ratio varied widely from state to state.

The ratio ranged from under 175 percent in Michigan up to more than 275 percent in Indiana-- with a median between 225 percent and 250 percent.
The researchers also found that the ratio was much higher for outpatient care than for inpatient care in most states studied. In most states, the ratio for inpatient care was around 200 percent or lower, but the ratio for outpatient care was under 250 percent in the least expensive states and over 300 percent in the most expensive states.

According to the study, two relatively easy things regulators could do to improve the price situation are to make health plans use tougher provider reimbursement agreements and, especially, to limit prices for out-of-network care.

White presented the findings to a meeting of state insurance regulators. Regulators said they want to know how much of the extra private plan spending might be the result of hospitals trying to make up for losses on Medicare patients.

Read the entire article here .
ACA WINNING OUT OVER MEDICARE FOR ALL AMONG DEMOCRAT VOTERS
According to a Kaiser Family Foundation tracking poll reported by Emmarie Huetteman in the July 30 edition of Benefits Pro , most Democrats and Democratic-leaning independents would prefer to expand the Affordable Care Act rather than replace it with a “Medicare for All” plan, according to a new tracking poll from the Kaiser Family Foundation.

The poll , released July 29, also examines opinions on a generic government-run “public option” health plan that would be available to all Americans and compete with private insurance. About two-thirds of the public said they support a public option, though more than 6 in 10 Republicans oppose it.

But the findings noted those opinions are far from set in stone. When told a   public option would help drive down prices by increasing competition in the insurance market, support rose as high as 75 percent. When told it would lead to too much government involvement in health care, though, support fell to about 4 percent.
Asked to choose between building on the ACA and replacing it with a national Medicare for All plan, 55 percent of Democrats and Democratic-leaning independents said they would expand the existing law. By comparison, 39 percent said they would prefer replacing the law with Medicare for All.

Respondents also voiced strong support for employer-based insurance, a reality likely to complicate efforts to replace the existing system.

Primary season is when most candidates trot out the proposals that appeal to their party’s more ideologically driven voters, who are kicking the tires on a slate of potential nominees. Support for Medicare for All has become a litmus test for many progressive voters as they contemplate their more than two dozen candidates.

But as the primary season wanes, the remaining candidates traditionally shift toward more incremental proposals, hoping to attract the moderate voters they may need to win the presidency.

The new KFF poll shows the public’s support for the idea of Medicare for All has dipped to about 51 percent, from 56 percent in April.
While the newest numbers show support shifting among both Republicans and Democrats, the share of Democrats who said they “strongly favor” a Medicare for All plan has dropped to 42 percent, from 54 percent in April.

Medicare for All’s slip in popularity has come as Democratic presidential candidates have shared the details of their plans and Republicans have tested out campaign messages about creeping “socialism” in the health care system, suggesting an uphill battle toward making such a plan a reality.

The poll also found strong support for some of the ACA’s key provisions (such as preventing insurers from denying coverage or charging more to those with pre-existing conditions), including among Republicans, as a challenge led by GOP state officials and endorsed by the Trump administration winds through the federal court system.
2020 Schedule
Affordable Care Act Open Enrollment
November 1, 2019 Open Enrollment begins.
December 15, 2019 is the last day to enroll for 2020 on the federal facilitated marketplace.
January 1, 2020 Coverage starts.

2020 Schedule
Medicare Annual Enrollment Period
October 1, 2019 Pre-enrollment period starts. 2020 plans can be discussed.
October 15, 2019 Enrollment starts.
December 7, 2019 is the last day to enroll for a 2020 plan.
January 1, 2020 Coverage starts.

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