An Allegheny County Commons Pleas Court judge on Tuesday deferred ruling on a lawsuit challenging health insurer Highmark's discretion to lower payments to hospitals for certain seniors. A group of community hospitals asked Judge R. Stanton Wettick for a ruling based on a simple reading of the agreements between Highmark and the hospitals. At issue is whether Highmark was contractually allowed to reduce payments to the hospitals to reflect the vagaries of a Medicare-funded health insurance plan…
Reported by bizjournals 8 hours ago.
Ruling pending in hospitals' lawsuit against Highmark
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Health Insurer Premera Blue Cross Latest Hack Victim, 11M Consumers Affected
Just a month after tens of millions of consumers’ personal information was breached in the hack of health insurance firm Anthem, another U.S.-based insurance provider says it was the victim of a cyber attack affecting as many as 11 million customers.
King 5 News reports that Pacific Northwest-based health insurer Premera Blue Cross is working with the FBI and … [More] Reported by The Consumerist 8 hours ago.
King 5 News reports that Pacific Northwest-based health insurer Premera Blue Cross is working with the FBI and … [More] Reported by The Consumerist 8 hours ago.
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16 Million Americans Gained Health Coverage Under Obamacare
16 Million Americans Gained Health Coverage Under Obamacare16 Million Americans Gained Health Coverage Under Obamacare
Nation
Politics
Obamacare
Has Been Optimized
The U.S. Department of Health and Human Services released a report yesterday that found 16.4 million previously uninsured adults have become insured since Obamacare began enrolling in October 2013.
The rate of uninsured Americans dropped to 13.2% from 20.3% in 2012-13.
According to CNBC, "As of this month, there were about 26 million American adults without health insurance, compared to about 40 million without coverage just before the Obamacare insurance marketplaces launched in the fall of 2013."
The government's numbers are based on data from the Gallup-Healthways Well-Being Index Survey, but do not say which Americans got health coverage from expanded Medicaid, health care exchanges or employers, noted USA Today.
Not surprisingly the drop in uninsured people was very strong in the 28 states that have expanded Medicaid programs, as compared to the 22 mostly GOP-run states that refuse to do so.
Harvard University and the City University of New York found in a 2014 study that 7,000-17,000 additional deaths were likely to happen in states that refused to expand Medicaid under Obamacare, reported the Morning Call.
Sources: USA Today, CNBC, The Morning Call
Image Credit: Pete Souza
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OV in Depth: Reported by Opposing Views 8 hours ago.
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New health insurance data breach in Northwest; 11 million may be affected
A data breach may have exposed sensitive information of 11 million customers and employees of a major health insurer in the northwest United States.
Reported by L.A. Times 7 hours ago.
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Premera health insurance hack hits 11 million people
A large American insurer said Tuesday that hackers broke into its computer systems last year, exposing the data on 11 million people.
Reported by CNNMoney 6 hours ago.
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Another health insurance hack affects millions
Hackers broke into Premera, exposing sensitive personal information on 11 million people.
Reported by CNNMoney 6 hours ago.
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Another U.S. health insurance hack affects millions
Hackers broke into Premera, exposing sensitive personal information on 11 million people.
Reported by CNN.com 6 hours ago.
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Premera Blue Cross Breach May Have Exposed 11 Million Customers' Medical And Financial Data
Medical and financial data belonging to as many as 11 million Premera Blue Cross customers may have been exposed in a breach discovered on the same day as the Anthem breach, the health insurance company announced Tuesday. Premera discovered the breach on January 29, 2015. Working with both Mandiant and the FBI [...]
Reported by Forbes.com 5 hours ago.
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The Cost of Insuring Pregnant Women
Health-insurance companies have a nickname for young adults, in their twenties or thereabouts, who don’t sign up for their own health-insurance policies; they call them “young invincibles,” a term meant to suggest that many of these people forgo coverage out of a brash faith in their own youthful hardiness. The phrase started appearing more often in the press around 2009, when Congress began debating President Obama’s proposal to insure more Americans. The economics of health insurance dictate that, in order to insure large groups of people while remaining profitable, insurance companies have to attract enough healthy people to cover the costs incurred by the ill. Before the Affordable Care Act passed, insurers and some politicians argued that one of the President’s stated goals—making it easier for people with preëxisting illnesses to sign up for health insurance—would be unworkable, partly because of the young-invincible phenomenon: not enough young, healthy adults would sign up to offset the high cost of insuring the ill.
Reported by The New Yorker 4 hours ago.
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Health insurance data breach exposes 11 million people
Unfortunately, the days of massive health care data breaches are far from over. Premera Blue Cross has revealed that hackers breached its insurance customer data starting in May 2014, potentially exposing both the financial and medical records of 11 ...
Reported by engadget 5 hours ago.
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Premera Blue Cross says data breach may affect 11 million customers
As many as 11 million customers may have been affected by a data breach at U.S. health insurance provider Premera Blue Cross, in the second large attack against the health care industry disclosed in the last two months.
Reported by ITworld 4 hours ago.
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11 Million Could Be Affected By Cyberattack On Health Insurance Company
The data breach was the second-largest ever for a health insurer and the second such incident this year.
Reported by IBTimes 4 hours ago.
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Dixon Insurance Continues Its Community Empowering Campaign, Currently Focusing On Helping A Local Man With His Fight Against Cancer
Dixon Insurance is on a mission to empower their community. Following the success of their Food Drive To Save Lives campaign, the agency has shifted their efforts to help a local man named David a.k.a. Tank, receive the help he needs to fight Cancer.
Haslet, Saginaw, Justin, TX (PRWEB) March 18, 2015
Dixon Insurance announced their new community cause earlier this month. The agency is on a mission to raise funds to help a local father in his fight against Cancer. Unfortunately, before David’s health insurance begins covering his medical costs, David needs to pay a $17,000 deductible out of his own pocket.
To launch the program, Lori Dixon, the agency’s principal, has chosen to introduce Give A Minute To Kick Cancer To The Curb. The campaign’s mission is to help a Cancer Fighter by the name of David, a.k.a. Tank, reach the $17,000 deductible needed for his insurance to kick into gear and provide support for his quickly rising medical bills, and continue receiving the medical treatment he so desperately needs. Furthermore, just to provide an idea of the high costs of Cancer treatment, did you happen to know that one minute of Chemotherapy costs $39.23?
“Cancer is a tough opponent to beat, but not an impossible one. With help, it can be conquered,” said Lori Dixon, founder of Dixon Insurance.
Each new cause showcased by the agency will feature a detailed story about its mission, on a designated donations page. To join the Dixon Insurance in supporting Give A Minute To Kick Cancer To The Curve, donors are encouraged to visit http://dixon-insurance.net/Give-a-Minute-to-Kick-Cancer-to-the-Curb_13_community_cause and share the page with their friends and family through social media and email.
With the newly launched program, Dixon Insurance takes responsibility for promoting this donations page through its many channels, to include its own database of thousands of customers, business partners, staff, neighbors and friends.
The agency also owns a monthly publication, Our Hometown magazine, which reserves a full page featuring the campaign of the chosen cause. The electronic Flipbook version of the current issue of the magazine can be accessed here: http://dixon-insurance.net/Our-Hometown-Magazine_39
More information about the agency’s initiative and services can be found at: http://dixon-insurance.net
About Dixon Insurance
As a Personal Financial Representative in Haslet, Lori Dixon knows many local families in the area. Her knowledge and understanding of the people in this community helps provide Dixon Insurance customers with an outstanding level of service. The Agency looks forward to helping families like yours protect the things that are important - family, home, car and more. Dixon Insurance can also help you prepare a strategy to achieve your financial goals. To contact Dixon Insurance, please visit http://dixon-insurance.net. Reported by PRWeb 18 hours ago.
Haslet, Saginaw, Justin, TX (PRWEB) March 18, 2015
Dixon Insurance announced their new community cause earlier this month. The agency is on a mission to raise funds to help a local father in his fight against Cancer. Unfortunately, before David’s health insurance begins covering his medical costs, David needs to pay a $17,000 deductible out of his own pocket.
To launch the program, Lori Dixon, the agency’s principal, has chosen to introduce Give A Minute To Kick Cancer To The Curb. The campaign’s mission is to help a Cancer Fighter by the name of David, a.k.a. Tank, reach the $17,000 deductible needed for his insurance to kick into gear and provide support for his quickly rising medical bills, and continue receiving the medical treatment he so desperately needs. Furthermore, just to provide an idea of the high costs of Cancer treatment, did you happen to know that one minute of Chemotherapy costs $39.23?
“Cancer is a tough opponent to beat, but not an impossible one. With help, it can be conquered,” said Lori Dixon, founder of Dixon Insurance.
Each new cause showcased by the agency will feature a detailed story about its mission, on a designated donations page. To join the Dixon Insurance in supporting Give A Minute To Kick Cancer To The Curve, donors are encouraged to visit http://dixon-insurance.net/Give-a-Minute-to-Kick-Cancer-to-the-Curb_13_community_cause and share the page with their friends and family through social media and email.
With the newly launched program, Dixon Insurance takes responsibility for promoting this donations page through its many channels, to include its own database of thousands of customers, business partners, staff, neighbors and friends.
The agency also owns a monthly publication, Our Hometown magazine, which reserves a full page featuring the campaign of the chosen cause. The electronic Flipbook version of the current issue of the magazine can be accessed here: http://dixon-insurance.net/Our-Hometown-Magazine_39
More information about the agency’s initiative and services can be found at: http://dixon-insurance.net
About Dixon Insurance
As a Personal Financial Representative in Haslet, Lori Dixon knows many local families in the area. Her knowledge and understanding of the people in this community helps provide Dixon Insurance customers with an outstanding level of service. The Agency looks forward to helping families like yours protect the things that are important - family, home, car and more. Dixon Insurance can also help you prepare a strategy to achieve your financial goals. To contact Dixon Insurance, please visit http://dixon-insurance.net. Reported by PRWeb 18 hours ago.
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Zynex Receives 42nd Pharmacy License Approval
License in Kentucky brings the total licenses to 42 states including the District of Columbia
Lone Tree, Colorado (PRWEB) March 18, 2015
Zynex, Inc. (OTCQB: ZYXI), an innovative medical technology company specializing in the manufacture and sale of non-invasive medical devices for pain management, stroke rehabilitation, neurological diagnostics, and compound pharmacy, announced today that it has received license approval from the State of Kentucky for its compound pharmacy business Pharmazy. This brings to 42 the total states, including the District of Columbia, in which the Company is licensed to provide compound pharmacy services.
Thomas Sandgaard, Zynex CEO stated: “We are pleased with the expansion of our footprint for the compound pharmacy. We are continuing to work towards licensing in the remaining states.”
About Zynex
Zynex, founded in 1996, markets and sells its own design of electrotherapy medical devices used for pain management and rehabilitation; and the company's proprietary NeuroMove device designed to help recovery of stroke and spinal cord injury patients. Zynex’s product lines are fully developed, FDA-cleared and commercially sold world-wide. Zynex also operates a non-sterile compound pharmacy providing topical and transdermal pain creams. Zynex is also developing a new blood volume monitor for use in hospitals and surgery centers.
For additional information, please visit: http://www.zynex.com
Safe Harbor Statement
Certain statements in this release are "forward-looking" and as such are subject to numerous risks and uncertainties. Actual results may vary significantly from the results expressed or implied in such statements. Factors that could cause actual results to materially differ from forward-looking statements include, but are not limited to, the need to obtain additional capital or augment our liquidity in order to continue our business, the success of our compound pharmacy and international expansion efforts, our ability to engage additional sales representatives, the success of such additional sales representatives, the need to obtain FDA clearance and CE marking of new products, the acceptance of new products as well as existing products by doctors and hospitals, larger competitors with greater financial resources, the need to keep pace with technological changes, our dependence on the reimbursement from insurance companies for products sold or rented to our customers, acceptance of our products by health insurance providers, our dependence on third party manufacturers to produce our goods on time and to our specifications, implementation of our sales strategy including a strong direct sales force, the uncertain outcome of pending material litigation and other risks described in our filings with the Securities and Exchange Commission including the “Risk Factors” section of our Annual Report on Form 10-K for the year ended December 31, 2013. Reported by PRWeb 17 hours ago.
Lone Tree, Colorado (PRWEB) March 18, 2015
Zynex, Inc. (OTCQB: ZYXI), an innovative medical technology company specializing in the manufacture and sale of non-invasive medical devices for pain management, stroke rehabilitation, neurological diagnostics, and compound pharmacy, announced today that it has received license approval from the State of Kentucky for its compound pharmacy business Pharmazy. This brings to 42 the total states, including the District of Columbia, in which the Company is licensed to provide compound pharmacy services.
Thomas Sandgaard, Zynex CEO stated: “We are pleased with the expansion of our footprint for the compound pharmacy. We are continuing to work towards licensing in the remaining states.”
About Zynex
Zynex, founded in 1996, markets and sells its own design of electrotherapy medical devices used for pain management and rehabilitation; and the company's proprietary NeuroMove device designed to help recovery of stroke and spinal cord injury patients. Zynex’s product lines are fully developed, FDA-cleared and commercially sold world-wide. Zynex also operates a non-sterile compound pharmacy providing topical and transdermal pain creams. Zynex is also developing a new blood volume monitor for use in hospitals and surgery centers.
For additional information, please visit: http://www.zynex.com
Safe Harbor Statement
Certain statements in this release are "forward-looking" and as such are subject to numerous risks and uncertainties. Actual results may vary significantly from the results expressed or implied in such statements. Factors that could cause actual results to materially differ from forward-looking statements include, but are not limited to, the need to obtain additional capital or augment our liquidity in order to continue our business, the success of our compound pharmacy and international expansion efforts, our ability to engage additional sales representatives, the success of such additional sales representatives, the need to obtain FDA clearance and CE marking of new products, the acceptance of new products as well as existing products by doctors and hospitals, larger competitors with greater financial resources, the need to keep pace with technological changes, our dependence on the reimbursement from insurance companies for products sold or rented to our customers, acceptance of our products by health insurance providers, our dependence on third party manufacturers to produce our goods on time and to our specifications, implementation of our sales strategy including a strong direct sales force, the uncertain outcome of pending material litigation and other risks described in our filings with the Securities and Exchange Commission including the “Risk Factors” section of our Annual Report on Form 10-K for the year ended December 31, 2013. Reported by PRWeb 17 hours ago.
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Collective Health raises $38M to grow employer health insurance business
San Mateo, Calif.-based Collective Health helps employers cut out the insurance company middleman and create their own insurance plans for employees.
Reported by VentureBeat 16 hours ago.
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An Open Letter to President Obama: The American Dream Has Failed Me
Dear President Obama,
Thank you for your service to this country. Unlike many others, I am generally pleased with your performance. There are a few things I would have done a bit differently, but I will save that for a later date. I'm here to talk to you about higher education.
I am a third-year law student at one of the most prestigious law schools in the nation. I play by the rules -- perfect attendance in the third grade, honor roll student in high school, a member of the honors fraternity in college, etc. I study. I work hard. I volunteer. I did everything I was supposed to do, and yet, in two months, I will graduate from law school with an accumulated total of over a quarter million dollars in student loans.
This May, I will take a very low paying public service legal fellowship in Washington, D.C. I am committed to and passionate about the work I will do, but I will struggle to put food on the table. I will struggle to pay my electric bill. I will struggle to pay for health insurance. I will live in a one-bedroom apartment with a roommate. I will survive. But I will struggle.
When people hear my story, they feel no sympathy. They say, "No one told you to go to law school. You chose to get a degree." These people are correct. I did choose to go to law school. I chose to go because I was promised that with determination, perseverance and hard work, I could achieve the American Dream. I was told that women and minorities are underrepresented in the legal profession, and that I could make a difference. I was told that if I ever wanted to become the president of the United States, I had to get my legal degree -- just like you.
In 2008, you promised me I would be given an affordable education if I voted for you. Remember? In your own words: "We know that in a global economy that's more connective and more competitive that we're the party that will guarantee every American an affordable, world-class, life-long, top-notch education..." I believed you.
My story is not unique. I am the product of a broken economy and a struggling middle class whose parents make too much for them to receive a free education, yet not enough to fund the outrageous cost of higher education. We are stuck in limbo with no way out. How will we buy property when we can't afford to pay our bills? How will we pay for our children's education if we can't afford to pay for our own? It's not easy to win a race when you've started a quarter of a million paces behind.
My heart weeps for the millions of brilliant children in this world who will miss out on countless opportunities because they lack the formal training and education. Since when do we live in a country where we have to pay for success? Why didn't you tell us that the American Dream is not for all of us? You promised us you would make a difference, so make a difference. We're waiting.
Signed,
Kiara Imani Williams, future J.D. Reported by Huffington Post 15 hours ago.
Thank you for your service to this country. Unlike many others, I am generally pleased with your performance. There are a few things I would have done a bit differently, but I will save that for a later date. I'm here to talk to you about higher education.
I am a third-year law student at one of the most prestigious law schools in the nation. I play by the rules -- perfect attendance in the third grade, honor roll student in high school, a member of the honors fraternity in college, etc. I study. I work hard. I volunteer. I did everything I was supposed to do, and yet, in two months, I will graduate from law school with an accumulated total of over a quarter million dollars in student loans.
This May, I will take a very low paying public service legal fellowship in Washington, D.C. I am committed to and passionate about the work I will do, but I will struggle to put food on the table. I will struggle to pay my electric bill. I will struggle to pay for health insurance. I will live in a one-bedroom apartment with a roommate. I will survive. But I will struggle.
When people hear my story, they feel no sympathy. They say, "No one told you to go to law school. You chose to get a degree." These people are correct. I did choose to go to law school. I chose to go because I was promised that with determination, perseverance and hard work, I could achieve the American Dream. I was told that women and minorities are underrepresented in the legal profession, and that I could make a difference. I was told that if I ever wanted to become the president of the United States, I had to get my legal degree -- just like you.
In 2008, you promised me I would be given an affordable education if I voted for you. Remember? In your own words: "We know that in a global economy that's more connective and more competitive that we're the party that will guarantee every American an affordable, world-class, life-long, top-notch education..." I believed you.
My story is not unique. I am the product of a broken economy and a struggling middle class whose parents make too much for them to receive a free education, yet not enough to fund the outrageous cost of higher education. We are stuck in limbo with no way out. How will we buy property when we can't afford to pay our bills? How will we pay for our children's education if we can't afford to pay for our own? It's not easy to win a race when you've started a quarter of a million paces behind.
My heart weeps for the millions of brilliant children in this world who will miss out on countless opportunities because they lack the formal training and education. Since when do we live in a country where we have to pay for success? Why didn't you tell us that the American Dream is not for all of us? You promised us you would make a difference, so make a difference. We're waiting.
Signed,
Kiara Imani Williams, future J.D. Reported by Huffington Post 15 hours ago.
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Collective Health aims to disrupt employer-paid insurance with $38M funding
Collective Health, a startup with a plan to disrupt the employer-sponsored health insurance market, on Wednesday disclosed it has raised $38 million in two rounds of funding. The San Mateo company led by co-founder and CEO Ali Diab said it just finished raising $32 million in Series B funding led by New Enterprise Associates. It also said it raised $6 million in a previously undisclosed Series A round led by Founders Fund. Others investors include Formation 8, Redpoint Ventures, RRE Ventures, Subtraction…
Reported by bizjournals 15 hours ago.
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Hospitals stung by sharply higher patient deductibles
Sharply higher health insurance deductibles for patients are creating a new collections headache for community hospitals, which are already battered by shrinking reimbursement from insurers. High-deducible health insurance plans have become increasingly popular in recent years as employers seek relief from spiraling insurance costs, shifting a bigger share of the financial burden to employees. But even many popular, low-premium plans sold through the government online marketplace come with required…
Reported by bizjournals 15 hours ago.
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Should pregnant women be able to sign up for 'Obamacare' coverage outside open enrollment period?
WASHINGTON -- Fifty four House members and 37 senators, all Democrats or independents, are asking the Obama administration to allow women to sign up for Affordable Care Act health insurance once they become pregnant. Currently, as is the case for health insurance...
Reported by nola.com 15 hours ago.
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The Time Is Now: Why States Need to Start Thinking About 2017 State Innovation Waivers
The Waiver for State Provision in Section 1332 of the Affordable Care Act (ACA) -- also known as the 2017 State Innovation Waiver -- provides state leaders with the opportunity to design and implement innovative and cost-saving strategies for their public health insurance programs. The waivers provide states with the incentive and means to re-imagine those programs in ways that better reflect their policy goals, state demographics, budgetary constraints and political culture.
Though 2017 may seem a ways out, the path toward achievement of such waivers is complex and involves significant policy, operational and political considerations. States should be thinking now about how to take advantage of the discretionary authority available to them, and health program innovators should be engaging in discussions about the best way to take advantage of this opportunity.
*Supporting State Innovation*
For many years, governors across the country have proposed unique, innovative and cost-effective ways to provide public health insurance coverage to their citizens, especially within their Medicaid programs. These initiatives, implemented through waivers provided from the Centers for Medicare & Medicaid Services (CMS) under Section 1115 of the Social Security Act, expand access and affordability in ways that are tailored to the unique needs of each specific state. Each time a state submits a waiver, it is proposing its own approach for how its public health insurance programs can work better. Every state has at least one of these Medicaid-related waivers and most states operate several waivers simultaneously, often with great results.
The ACA includes a provision that gives states a major incentive to design new approaches to their Medicaid program and to rethink how the federal funding that supports Medicaid, the Children's Health Insurance Program and exchange subsidies (Insurance Affordability Programs) might be more effectively spent on a state-designed program. The 2017 State Innovation Waiver provision provides states with the option to propose new designs for providing health insurance coverage to their citizens using methods that diverge from the ACA's overall plan, if they can demonstrate that they provide affordable, comprehensive coverage to at least as many people as could have been covered otherwise under the ACA -- without costing the federal government any additional money.
It's an interesting and complex challenge. A few weeks ago, I hosted a panel of some of the foremost subject matter experts on public health insurance programs as they discussed new approaches that states can take with the 2017 State Innovation Waiver for the design and operation of programs. They shared varying perspectives on approaches, illuminating both opportunities and challenges for states that pursue this path.
"Really the essence is state innovation. And it, at its core, permits state governments to use funding that would otherwise have gone to individuals and businesses to aggregate that funding to create different ways to cover people," said Krista Drobac, Partner at Sirona Strategies.
*What a 2017 State Innovation Waiver Could Provide*
The policy implications of the 2017 State Innovation Waiver are sufficiently broad to attract interest among a diverse array of states. "That's kind of the essence of the 1332," said Joel Ario, Managing Director at Manatt, Phelps & Philips, and previously the Director of the Office of Health Insurance Exchanges at the U.S. Department of Health & Human Services (HHS). "It's got bipartisan roots that allow the states to experiment."
Much of this interest focuses on how the waivers might address some of the ACA's greatest challenges, such as:
· "Churning" of individuals between primary programs as their incomes, family size and employment situation change, which can impact an individual's continuity of care and is a particular concern in states that expanded their Medicaid programs under the ACA.· Stratification of families for health insurance purposes, with some members qualifying for the exchange, and others for Medicaid or CHIP, which can lead to continuity of care difficulties within a family because of varying provider networks.· The inequity of the employee-only Employee Sponsored Insurance (ESI) affordability test, in which individuals and families with access to ESI do not qualify for exchange subsidies, except in rare situations (sometimes called the "family glitch").· The incentive for employers with disproportionate numbers of low-income employees to drop coverage because their employees can get subsidized coverage in the exchange.· Problematic technology, operations and communication links between the exchange, Medicaid and CHIP programs.· Complex rules and guidance that can prevent or inhibit states from pursuing program policies they find attractive, such as greater beneficiary financial participation and incentives for healthy behavior."This waiver is kind of the super waiver, the mega waiver, because it allows you to do so many things differently than in the past," said Dennis Smith, Managing Director at McKenna, Long & Aldridge, and formerly the Director of the Center for Medicaid and State Operations at CMS.
*Considerations for States*
Some feel that the waivers offer an opportunity for states to reintroduce policy innovation into their health insurance programs. "There are states that are out there that were working on innovation, working on areas and had policy goals for what they wanted to achieve... for those states, [with 1332] there's an opportunity to, at least in some areas, take it back and begin to innovate," said Cindy Gillespie, Senior Managing Director at McKenna, Long & Aldridge.
But, before diving into proposing a waiver, state leaders should consider the following questions:
· Should a waiver encompass each of the three primary insurance affordability programs -- Medicaid, CHIP and the exchange -- or be more limited in scope?· To what extent should the private market, including job-based benefits, be leveraged?· How can the eligibility breakpoints be re-configured to better protect continuity of care, reduce churn, and increase consumer engagement and loyalty?· How should eligibility and enrollment processes be streamlined and made more attractive to consumers?
"We want people to have coverage, and we want it to be affordable, given your circumstances in a particular state... what's the best way to do it? If it's Georgia, it's going to look different than New York City or Oklahoma. But we have those guardrails; those core principles that I think we have some national consensus around. And now we can go to work on 50 different models to achieve those goals," said Deborah Bacharach, Partner at Manatt, Phelps & Phillips.
*What's Next?*
The 2017 State Innovation Waiver is an invitation for state leaders to think boldly about how they want to help their citizens with accessing affordable health insurance. As funding for public health insurance programs becomes more complex and state leaders strive to shape programs that provide coverage for a greater number of citizens, the 2017 State Innovation Waiver may be the answer for both. It will be a journey, and a learning process, but with the end goal of achieving affordable, comprehensive and cost-effective coverage for citizens.
A state that is considering the merits of a State Innovation Waiver should begin by reviewing the federal rule that specifies the public input and transparency procedures they should follow. This 2012 rule also outlines the elements a waiver application should include, such as the ACA provisions the state intends to waive, an implementation timeline, actuarial estimates, and 10-year budget. To view this rule, please visit:this site. Reported by Huffington Post 14 hours ago.
Though 2017 may seem a ways out, the path toward achievement of such waivers is complex and involves significant policy, operational and political considerations. States should be thinking now about how to take advantage of the discretionary authority available to them, and health program innovators should be engaging in discussions about the best way to take advantage of this opportunity.
*Supporting State Innovation*
For many years, governors across the country have proposed unique, innovative and cost-effective ways to provide public health insurance coverage to their citizens, especially within their Medicaid programs. These initiatives, implemented through waivers provided from the Centers for Medicare & Medicaid Services (CMS) under Section 1115 of the Social Security Act, expand access and affordability in ways that are tailored to the unique needs of each specific state. Each time a state submits a waiver, it is proposing its own approach for how its public health insurance programs can work better. Every state has at least one of these Medicaid-related waivers and most states operate several waivers simultaneously, often with great results.
The ACA includes a provision that gives states a major incentive to design new approaches to their Medicaid program and to rethink how the federal funding that supports Medicaid, the Children's Health Insurance Program and exchange subsidies (Insurance Affordability Programs) might be more effectively spent on a state-designed program. The 2017 State Innovation Waiver provision provides states with the option to propose new designs for providing health insurance coverage to their citizens using methods that diverge from the ACA's overall plan, if they can demonstrate that they provide affordable, comprehensive coverage to at least as many people as could have been covered otherwise under the ACA -- without costing the federal government any additional money.
It's an interesting and complex challenge. A few weeks ago, I hosted a panel of some of the foremost subject matter experts on public health insurance programs as they discussed new approaches that states can take with the 2017 State Innovation Waiver for the design and operation of programs. They shared varying perspectives on approaches, illuminating both opportunities and challenges for states that pursue this path.
"Really the essence is state innovation. And it, at its core, permits state governments to use funding that would otherwise have gone to individuals and businesses to aggregate that funding to create different ways to cover people," said Krista Drobac, Partner at Sirona Strategies.
*What a 2017 State Innovation Waiver Could Provide*
The policy implications of the 2017 State Innovation Waiver are sufficiently broad to attract interest among a diverse array of states. "That's kind of the essence of the 1332," said Joel Ario, Managing Director at Manatt, Phelps & Philips, and previously the Director of the Office of Health Insurance Exchanges at the U.S. Department of Health & Human Services (HHS). "It's got bipartisan roots that allow the states to experiment."
Much of this interest focuses on how the waivers might address some of the ACA's greatest challenges, such as:
· "Churning" of individuals between primary programs as their incomes, family size and employment situation change, which can impact an individual's continuity of care and is a particular concern in states that expanded their Medicaid programs under the ACA.· Stratification of families for health insurance purposes, with some members qualifying for the exchange, and others for Medicaid or CHIP, which can lead to continuity of care difficulties within a family because of varying provider networks.· The inequity of the employee-only Employee Sponsored Insurance (ESI) affordability test, in which individuals and families with access to ESI do not qualify for exchange subsidies, except in rare situations (sometimes called the "family glitch").· The incentive for employers with disproportionate numbers of low-income employees to drop coverage because their employees can get subsidized coverage in the exchange.· Problematic technology, operations and communication links between the exchange, Medicaid and CHIP programs.· Complex rules and guidance that can prevent or inhibit states from pursuing program policies they find attractive, such as greater beneficiary financial participation and incentives for healthy behavior."This waiver is kind of the super waiver, the mega waiver, because it allows you to do so many things differently than in the past," said Dennis Smith, Managing Director at McKenna, Long & Aldridge, and formerly the Director of the Center for Medicaid and State Operations at CMS.
*Considerations for States*
Some feel that the waivers offer an opportunity for states to reintroduce policy innovation into their health insurance programs. "There are states that are out there that were working on innovation, working on areas and had policy goals for what they wanted to achieve... for those states, [with 1332] there's an opportunity to, at least in some areas, take it back and begin to innovate," said Cindy Gillespie, Senior Managing Director at McKenna, Long & Aldridge.
But, before diving into proposing a waiver, state leaders should consider the following questions:
· Should a waiver encompass each of the three primary insurance affordability programs -- Medicaid, CHIP and the exchange -- or be more limited in scope?· To what extent should the private market, including job-based benefits, be leveraged?· How can the eligibility breakpoints be re-configured to better protect continuity of care, reduce churn, and increase consumer engagement and loyalty?· How should eligibility and enrollment processes be streamlined and made more attractive to consumers?
"We want people to have coverage, and we want it to be affordable, given your circumstances in a particular state... what's the best way to do it? If it's Georgia, it's going to look different than New York City or Oklahoma. But we have those guardrails; those core principles that I think we have some national consensus around. And now we can go to work on 50 different models to achieve those goals," said Deborah Bacharach, Partner at Manatt, Phelps & Phillips.
*What's Next?*
The 2017 State Innovation Waiver is an invitation for state leaders to think boldly about how they want to help their citizens with accessing affordable health insurance. As funding for public health insurance programs becomes more complex and state leaders strive to shape programs that provide coverage for a greater number of citizens, the 2017 State Innovation Waiver may be the answer for both. It will be a journey, and a learning process, but with the end goal of achieving affordable, comprehensive and cost-effective coverage for citizens.
A state that is considering the merits of a State Innovation Waiver should begin by reviewing the federal rule that specifies the public input and transparency procedures they should follow. This 2012 rule also outlines the elements a waiver application should include, such as the ACA provisions the state intends to waive, an implementation timeline, actuarial estimates, and 10-year budget. To view this rule, please visit:this site. Reported by Huffington Post 14 hours ago.
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