When the Affordable Care Act (ACA) was being crafted, it was almost as if the designers thought that they were developing a relatively static system. They would simply cover the lowest-income individuals with Medicaid, make available subsidized private plans for moderately-low-income individuals, and then use individual and employer mandates, under threat of penalty, to force the rest of the uninsured into private plans. Although a limited amount of churning in and out of various plans and programs was expected, what they did not seem to understand was how unstable these categories actually are. The churning is massive.
The Affordable Care Act provides a 90 day grace period during which health care coverage through exchange plans is continued before insurers can cancel the plans for non-payment of premiums. However, the insurers must pay claims for only the first 30 days, whereas providers are not allow to collect from the patient during the remaining 60 days. After 90 days of nonpayment of premiums, the patient can be retroactively billed, though collection can be difficult since most of these patients do not have enough funds to pay their premiums, much less their health care bills.
The Effect of Malpractice Reform on Emergency Department Care By Daniel A. Waxman, M.D., Ph.D., Michael D. Greenberg, J.D., Ph.D., M. Susan Ridgely, J.D., Arthur L. Kellermann, M.D., M.P.H., and Paul Heaton, Ph.D. The New England Journal of Medicine, October 16, 2014 Emergency department care has been a particular focus of a new generation of […]
Implementation of the Affordable Care Act: Cross-Cutting Issues: Six-State Case Study on Network Adequacy By Sabrina Corlette, Kevin Lucia, and Sandy Ahn Urban Institute, September 2014 During the transition to new health plans and new marketplaces under the Affordable Care Act (ACA), many insurers revamped their approach to network design, and many now offer narrower […]
Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015 By Vernon K. Smith, Kathleen Gifford, Eileen Ellis, Robin Rudowitz and Laura Snyder Kaiser Family Foundation, October 14, 2014 Primary Care Payments The ACA included a provision to increase Medicaid payment […]
Privately Insured in America: Opinions on Health Care Costs and Coverage The Associated Press-NORC Center for Public Affairs Research, October 2014 A significant minority of those with private health insurance, including those covered by high-deductible health plans (HDHPs), are greatly impacted by the out-of-pocket cost of health care—they are concerned with the uncertainty of major […]
Reference Pricing: A Small Piece of the Health Care Price and Quality Puzzle By Chapin White, Megan Eguchi National Institute for Health Care Reform, NIHCR Research Brief No. 18, October 2014 As purchasers seek strategies to reduce high health care provider prices, interest in reference pricing—or capping payment for a particular medical service—has grown significantly. […]
Low-Income Residents In Three States View Medicaid As Equal To Or Better Than Private Coverage, Support Expansion By Arnold M. Epstein, Benjamin D. Sommers, Yelena Kuznetsov and Robert J. Blendon Health Affairs, October 8, 2014 (online) Abstract Expansion of Medicaid under the Affordable Care Act to millions of low-income adults has been controversial, yet little […]
Income Inequality and Rising Health-Care Costs By Mark J. Warshawsky and Andrew G. Biggs The Wall Street Journal, October 6, 2014 A new Kaiser Family Foundation survey reports that health-insurance premiums rose by a “modest” 3% in 2013. Even more modest, however, was the 2.3% growth of workers’ earnings last year. These figures merely illustrate […]
An Interview With George Halvorson: The Kaiser Permanente Renaissance, And Health Reform’s Unfinished Business By Jeff Goldsmith Health Affairs Blog, September 30, 2014 Kaiser (Permanente) surprised the health plan community by announcing in March 2002 the selection of a non-physician, George Halvorson, as its new CEO. During his twelve year tenure as CEO, Halvorson not […]
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