Posts Tagged ‘Affordable Care Act’

National Vaccine Policies in Flux

October 5th, 2012

The next 2 years will be a time of transition for how vaccines are delivered and paid for in the US- as national policy shifts to the new order under the Affordable Care Act.  In the short-term there’ll be some transition challenges- but in the long run- it should be easier to keep up our vaccination rates. 

In a couple of weeks, the CDC will stop allowing federally purchased vaccines to be used for immunizing privately insured kids.   They’re doing this to ensure that federal vaccine only go to those who have no other options for vaccination… and to assure that all insured children are vaccinated through their insurance policy rather than taking advantage of free federally purchased vaccine. 

In the past, county public health clinics that get federally purchased vaccine through our Immunization Program have used federally purchased vaccine to ensure that any child who has not been able to access vaccine elsewhere is able to get immunized, even when the child is insured.  Because not all counties will have a mechanism to bill private insurance companies for services- some might not be fully ready to immunize privately insured children next week… meaning that insured children will need to receive all of their immunizations in their medical home.  The second policy change will be implemented mid-year 2013… when the CDC will stop allowing underinsured kids to get immunized for free with federal, except at specified locations.  “Under-insured” means that a child has insurance, but the insurance doesn’t cover one or more immunizations.  Those are the short-term challenges. 

The good news is that there’s still plenty of federal vaccine for Vaccines for Children eligible kids (including kids on AHCCCS), the uninsured and Native Americans.  The best news is that it’ll be easier to maintain high vaccination rates starting in January of 2014 because the Affordable Care Act provides for “first dollar” coverage for vaccines for all kids…  plus there’ll be fewer under-insured children.  So, the real key is to get over the 2013 hump- because beginning in January of 2014 things will get easier.

Menu Labeling & the ACA

October 4th, 2012

You might have noticed that more and more restaurants and fast food places are starting to put calorie and other nutrition information on their menus.  That’s not a coincidence or accident- they’re getting ready for the upcoming menu nutrition labeling requirements in the Affordable Care Act.  Section 4205 of the new law requires restaurants with 20 or more locations to post calorie content information for standard menu items directly on the menu and menu boards.  Vending machine operators with 20 or more machines are also required to disclose calorie content for certain items. 

This kind of upcoming nutrition clarity is a real opportunity for public health change.  Not only will the new labels give the public key information to help them make better decisions about what they buy for themselves and their families- it’ll give pause to restaurants before they label their menus- giving them an opportunity to change ingredients to lower calorie counts.  It may even spur a trend away from “super-sizes” and toward more appropriate and reasonable serving sizes.  With 32% of the calories consumed in the US tied to eating outside the home- this is an important opportunity.  

But it’ll only help if people know what to look for and how to make informed decisions with the new info.  That’s where the Arizona and national public health systems come in.  We’ll have an opportunity over the next couple of years to take advantage of this new information and maximize its utility.  A great way to get ready to use the information that is appearing on restaurant menus is to know more about what and how much you need to eat to be at your best. Check out the USDA SuperTracker to get your personalized nutrition and physical activity plan, track your foods and physical activities to see how they stack up, and  get tips to help you make healthier choices. 

For many of us, making sure that we enjoy our food, but eat less is a good first step.  Avoiding over-sized portions is another one. Check out our SNAP-Ed Champions for Change – Arizona Nutrition Network website for tips on healthy eating and active living, great videos, fun games, easy-to-make recipes, and more.

Worksite Wellness- a Critical Public Health Lever

September 21st, 2012

Chronic diseases like heart disease, cancer, stroke, and diabetes cause 70% of deaths in the US these days… absorbing 75% of the $2.5T spent on annual medical care costs.  When it comes to employee healthcare expenses- the indirect costs of poor health like absenteeism, disability, and reduced work output can be several times higher than direct medical costs.  In fact, productivity losses from health problems cost employers $1,685 per employee per year! 

One of the provisions in the Affordable Care Act includes incentives for employers to implement worksite wellness programs to help them keep their workforce healthier.  When done well (using evidence-based and best practices) worksite health programs have a 3:1 payoff.  Like the odds? 

The Affordable Care Act contains some elements that will make worksite wellness programs more common and robust over the next couple of years.  There are basically 2 kinds of worksite wellness programs.  I’ll call them Wellness and Wellness Lite.  A “Wellness Lite” program doesn’t require a participant to meet any standard related to health status to receive a reward.  For example…  a wellness program could include a gym membership or tobacco cessation program but doesn’t require participants to actually lose weight or quit smoking.  

A Wellness program requires people to meet a health status standard to get a reward.  For example- an employer could ask employees to certify that they haven’t smoked during the previous year.  Enrollees who don’t could be assessed an annual surcharge of  20% of cost of the employee’s health insurance coverage.  Rewards may be in the form of premium discounts or rebates, lower cost-sharing requirements, waiving a surcharge, etc. Under the Affordable Care Act, wellness program rewards can be as high as 30% of the cost of the employee health plan- potentially going to 50% in the future.  

Our AZ Healthy Worksites web page provides businesses with information and tools to help them develop and implement an effective worksite wellness program.  For example, the Program Design page lists the eight steps for developing, implementing, and evaluating a comprehensive worksite program.  We’ve also contracted with the Arizona Small Business Association &  Viridian Health Management to develop a new toolkit for AZ businesses.  Viridian and the Arizona Small Business Association will teach businesses how to do effective wellness programs, understand their own particular issues/data, and develop effective strategies.  In all, our contract tasks the team to train 500 AZ employers.   Finally- the CDC is jumping into the fray with a variety of resources, which you can see at their worksite wellness hub website.  

 

Women’s Services Expansion Kick In

September 20th, 2012

Several prevention-related health services will be covered without cost sharing in new health plans as of a couple of weeks ago as a result of the Affordable Care Act.  The changes are designed to help lower costs and outcomes for a variety of preventative women’s services.  Previously, some insurance companies didn’t cover some of the new preventive services, while some women had to pay deductibles or co-pays.  The new rules in the health care law requiring coverage of these services take effect at the next renewal date. 

Some of the new services include: 1) Well-woman visits; 2) Gestational diabetes screening for pregnant women; 3) Domestic violence screening and counseling; 3) Breastfeeding support, supplies, and counseling; and 4) Sexually transmitted infections and HIV counseling for sexually-active women.  The list of required services are based on recommendations from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to develop its recommendations. These preventive services will be offered without cost sharing beginning today in all new health plans.  Group health plans and issuers that have maintained grandfathered status and certain nonprofit religious organizations (like churches and schools) aren’t required to cover the new services.

Did You Get a Health Insurance Refund You Didn’t Expect?

September 13th, 2012

If you did, you can thank the Affordable Care Act.  When you buy health insurance- the percentage of your premium dollars that your insurance company spends on providing you with health care (as opposed to what it spends on administrative, overhead, and marketing) is called a “Medical Loss Ratio”.   The Affordable Care Act limits how much of your premium dollar your insurer can spend on things besides your care.  They’re supposed to give you a rebate on the portion of premium that was over the limit.  The law requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care (and efforts to improve the quality of care).  Insurers selling to large groups (usually 50 or more employees) need to spend 85% on care and quality improvement. 

The Medical Loss Ratio part of the Affordable Care Act kicked in this year.  So far, about 400,000 Arizona residents with private insurance coverage received a total of almost $28M in refunds from insurance companies.

 

Health Insurance Exchange Cost-Sharing

September 11th, 2012

The Affordable Care Act will establish health insurance exchanges in each state- providing folks (and small business employees) an additional opportunity to get health insurance coverage starting 1/1/14. The future exchanges will provide marketplaces for folks to directly compare and buy private health insurance based on price, quality, and other things. All the plans will need to cover all of the state-specific essential health benefits.

Various tiers of health insurance coverage will be available in the exchanges.  The baseline “tier” will be a minimum amount of coverage that people need to have to satisfy the federal mandate to have health insurance (or face a tax penalty).  Insurers will be required to offer plans that fit within four levels (tiers) of coverage: bronze, silver, gold, and platinum.  I posted a little more about these tiers last week

You all probably know that there’s a mandate that requires everyone to have health insurance or pay a tax penalty.  Some people will be enrolled in Medicaid and some will have their own insurance or insurance through work—  and others will get it through the health plans on the exchange.  Folks with incomes above 100% but less than 400% of the federal poverty level will receive a premium subsidy when they get insurance via the exchange.  Folks earning less than 150% of the poverty level will be subsidized via tax breaks so their premium is only 2% of their income ($50 per month for a family of four).  This report provides a graph that includes the details of the sliding scale for premium subsidies.

Platinum, Gold, Silver, and Bronze Health Plans

August 27th, 2012

The Affordable Care Act will establish various tiers of health insurance coverage beginning in 2014.  The baseline “tier” will be a minimum amount of coverage that people need to have to satisfy the federal mandate to have health insurance (or face a tax penalty).  Insurers will be required to offer plans that fit within four levels (tiers) of coverage: bronze, silver, gold, and platinum.  

The levels of coverage aren’t defined using specific deductibles, co-pays, and coinsurance- they’ll use something called  “actuarial value”.  For example, a plan with an actuarial value of 70% (referred to as a “silver” plan) means the plan will pay 70% of a standard population’s health care expenses with the enrollee paying 30% through things like deductibles, co-pays, and/or coinsurance.  The higher the actuarial value the less patient cost-sharing the plan will have on average. 

Bronze plans will have more out-of-pocket costs, and platinum plans will have least.  Bronze plans will cover 60% of enrollee costs, silver 70%, gold 80% and platinum 90%.  Young people (under 30) will be able to buy “catastrophic” plans with an even lower actuarial value.  Each plan (even catastrophic) needs to cover the state’s essential benefit package.   Insurers don’t have to offer plans in all four levels, but within the exchange all insurers must offer at least one silver and one gold plan.  You can read a lot more about actuarial value in this HHS bulletin

There are also benchmarks for premium and cost-sharing subsidies that go to lower and middle income people buying their insurance in the exchange.  I’ll cover that next week.

Essential Benefit Package 101

August 21st, 2012

The future health insurance exchange under the Affordable Care Act will need to offer an Essential Benefit Package. In fact, most health insurance plans will need to cover each state’s Essential Benefit Package starting New Year’s Day in 2014. There are 10 key service categories that future plans will need to cover- including behavioral health services. 

States need to pick a plan from a set of existing options as their “benchmark” plan- which will serve as the state-specific essential benefit package. The options to choose from include: 1) the largest plan by enrollment in any of the three largest small group insurance products in the small group market; 2) any of the largest three state employee health benefit plans by enrollment; 3) any of the largest three national federal employees health plans; or 4) the largest insured commercial non-Medicaid HMO in the State.  If the benchmark plan doesn’t include all the 10 key service categories then it needs to be supplemented. 

The due date for states to pick a benchmark plan is September 30 of this year.  If a state doesn’t want to pick a benchmark plan, the Fed’s will make the choice for them- and they intend to choose “…  the largest small group market product in the State’s small group market” which (in Arizona) is Aetna’s PPO plan.  Once a state picks the benchmark plan (or has it picked for them)- it becomes a “reference plan” for the state for a couple of years- meaning that future exchange health plans must be “substantially equal” to the benchmark plan in the scope, limitations and exclusions (e.g. visit limits). 

Obviously there’s a lot more to it than that…  and you or your Stakeholders can get a lot more in-depth info about what an Essential Health Benefit is and what it means in this document that provides an Arizona specific analysis of the issues and the various services that are covered by potential benchmark plans.

 

Health Insurance Exchanges

August 20th, 2012

The Affordable Care Act (aka health care reform) will establish health insurance exchanges in each state- providing folks (and small business employees) an opportunity to get health insurance coverage starting 1/1/14. The future exchanges will provide competitive marketplaces for folks to directly compare and buy private health insurance based on price, quality, and other things. 

The law gives states some flexibility in the design and operation of their exchange.  States can operate their own or they can let the Fed’s do it for them.  There’s also a partnership option.  The Governor kicked off a process to review the options regarding the implementation of the Act (including the exchanges) a couple of weeks ago.  Several Stakeholder meetings have already been conducted and there are more to come.  

This week, HHS’ Centers for Medicare & Medicaid Services issued their “Final Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges”.  It’s a Blueprint for states to use as part of their planning and provides guidelines for states to show how their planned exchange will offer the required range of private health insurance options.  It also outlines the process to do a “partnership” exchange.  States that want to do their own exchange need to turn in their blueprint by November 16, 2012 for their exchange to be certified in time.

Affordable Care Act Info

August 7th, 2012

Now that the Supreme Court has spoken regarding the Affordable Care Act- States have a lot more clarity around the decisions they’ll need to make and what they need to do to implement the law.  The Governor kicked off a process to review the options and engage Stakeholders for their input this week. Additional meetings are being scheduled in the coming weeks including public meetings toward the end of August and into September.  You can see the PowerPoint Presentation to Stakeholders and the AHCCCS Cost Summary on the AHCCCS website. 

Those of you that work in behavioral health (and anybody in the Agency really) should take some time to review the PowerPoint- as it provides a sketch of the background information.  There are clearly lots of decisions yet to be made- but the materials provide some interesting insight.