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Archive for Affordable Care Act

CMS Introduces New Waivers

The Centers for Medicare & Medicaid Services has introduced four new “state relief and empowerment waivers” that are widely viewed as new vehicles for states to circumvent Affordable Care Act requirements to implement their own new approaches to health care. Through “account-based subsidies” waivers, states may direct public subsidies into defined-contribution, consumer-directed accounts that individuals use to pay for health insurance premiums or other health care expenses. “State-specific premium assistance” waivers enable states to create their own subsidy programs. “Adjusted plan options” authorizes states to provide financial assistance for different types of health insurance plans, including short-term and other health insurance policies that do not meet Affordable Care Act benefits and coverage requirements. “Risk stabilization strategies” waivers give states greater … Read More

Posted in Affordable Care Act, Health care reform

Medicaid Birthing Model Improves Outcomes

A federal program to improve birth outcomes among Medicaid-covered women has produced positive results:  lower rates of pre-term births, fewer low birthweight babies, fewer C-sections, lower delivery costs, and lower first-year health care spending. The “Strong Start for Mothers and Newborns” program was a four-year initiative established by the Affordable Care Act and developed by the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Innovation to employ patient education, nutrition, exercise, preparation for childbirth, breast-feeding, and family planning rather than strictly medical interventions and was delivered through three evidence-based prenatal care models:  Birth Centers, Group Prenatal Care, and Maternity Care Homes. The program, operated in 219 separate sites in 32 states (with one in Pennsylvania), served … Read More

Posted in Affordable Care Act, Federal Medicaid issues

PA Uninsured Rate Hits All-Time Low

Pennsylvania’s uninsured rate in 2017 was 5.5 percent – the lowest on record, according to the Wolf administration. According to the Wolf administration, more than one million Pennsylvanians have obtained health insurance in recent years through the expansion of the state’s Medicaid program or improved access to insurance made possible through the Affordable Care Act. The national uninsured rate is 8.8 percent. Learn more about the decline in the number of uninsured Pennsylvanians from this news release from the governor’s office.

Posted in Affordable Care Act

Medicaid Expansion Helping Diabetics

The Affordable Care Act’s Medicaid expansion has led to a 40 percent increase in the number of prescriptions for diabetes medicine filled in the 30 states that expanded their Medicaid programs. Meanwhile, there was no change in the number of diabetes-related prescriptions filled in states that did not expand their Medicaid programs. This is considered important because it suggests that many low-income people who either could not afford their diabetes medicine or whose illness was undiagnosed are now being treated for the disease – a significant development because every diabetic who is treated for the condition represents a cost savings of $6394 a year, mostly because of fewer hospitalizations. As a Medicaid expansion state, Pennsylvania and the safety-net hospitals that … Read More

Posted in Affordable Care Act, Pennsylvania safety-net hospitals

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs. According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible. Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it. Despite this, the authors note, access to care did improve as a result of the Affordable Care Act’s Medicaid expansion. Learn more about the studies, their results, … Read More

Posted in Affordable Care Act, Federal Medicaid issues

Verdict: Medicaid Expansion Improved Care and Access

A new review of studies published since the Affordable Care Act’s Medicaid expansion has concluded that expansion improved care, access to care, and coverage in states that expanded their Medicaid programs. Among the improvements cited by studies are: greater use of primary care more preventive health visits more behavioral health care shorter hospital stays fewer avoidable hospital admissions reduced access problems reduced reliance on hospital ERs as a primary source of care improved monitoring and compliance rates for patients with diabetes and hypertension higher rates of screening for prostate cancer and Pap smears In addition, hospitals provided less uncompensated care and had better margins. Learn more in the Health Affairs study “The Effects Of Medicaid Expansion Under The ACA:  A … Read More

Posted in Affordable Care Act, Federal Medicaid issues

Helping Safety-Net Hospitals Help Their Patients

A new report published on the Health Affairs Blog describes the continuing challenges safety-net hospitals face and offers suggestions for helping them meet those challenges. The challenges, according to the report, are the virtual elimination of the Affordable Care Act’s individual health insurance mandate; the continued decline in the amount of Medicare disproportionate share hospital money (Medicare DSH) provided to safety-net hospitals; and hospital closures that shift more of the burden for caring for uninsured patients onto a smaller pool of safety-net hospitals.  The result is under-served patients and new financial risks for the hospitals that remain after some safety-net hospitals close because of the large amounts of uncompensated care those hospitals continue to provide. To address these challenges, the … Read More

Posted in Affordable Care Act, Medicare

Behavioral Risk Factor Surveillance System

A new study found that the increase in the number of insured Americans as a result of the Affordable Care Act has resulted in increased utilization of primary health care services. According to a study by the National Bureau of Economic Research, primary care utilization rose 3.8 percent, mammograms 1.5 percent, HIV tests 2.1 percent, and flu shots 1.9 percent over a three-year period.  The study suggests that preventive care increased between 17 and 50 percent. The study attributes all of the gains to improved access to private insurance and none to Medicaid expansion. These results are based on self-reported information gathered from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Learn more about these and … Read More

Posted in Affordable Care Act

ACA Improves Access to Surgical Services

The Affordable Care Act’s Medicaid expansion has improved access to surgical services for Medicaid patients. Or so says a new study published in JAMA Surgery, which reports that In this study of patients with 1 of 5 common surgical conditions, Medicaid expansion was associated with a 7.5–percentage point increase in insurance coverage at the time of hospital admission. The policy was also associated with patients obtaining care earlier in their disease course and with an increased probability of receiving optimal care for those conditions. As a result, the study found, The ACA’s Medicaid expansion was associated with increased insurance coverage and improved receipt of timely care for 5 common surgical conditions. This development is especially relevant to Pennsylvania safety-net hospitals … Read More

Posted in Affordable Care Act, Pennsylvania safety-net hospitals

The Continued Need for Medicaid DSH

While the Affordable Care Act has greatly increased the number of Americans with health insurance and reduced the demand for uncompensated care from hospitals, many hospitals still see significant numbers of uninsured patients. Some of those patients simply have not taken advantage of the health reform law’s creation of easier access to affordable insurance while others live in states that have not expanded their Medicaid programs. Hospitals that care for especially large numbers of such uninsured patients qualify for Medicaid disproportionate share hospital payments, commonly referred to as Medicaid DSH.  The purpose of these payments is to help these hospitals with the unreimbursed costs they incur caring for such patients. The Affordable Care Act calls for reducing Medicaid DSH payments … Read More

Posted in Affordable Care Act, Federal Medicaid issues, Medicaid supplemental payments
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