Stories about: health insurance

Study: Repeal of the individual mandate could undercut health care for youth under 26

individual mandate
Diagnosis: No insurance coverage

As the U.S. Senate takes up the proposed American Health Care Act (AHCA), a three-state study provides evidence that eliminating the individual mandate could jeopardize young adults’ health care coverage — even with laws allowing people under 26 to be covered under their parents’ plan.

Researchers led by Lauren Wisk, PhD, of the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital, analyzed insurance data from 131,542 adolescents and young adults whose family was covered by Harvard Pilgrim Health Care between January 2000 and December 2012.

“With an individual mandate, many more young adults used the dependent coverage provision, and people who were previously dropped from their parents’ plan were more likely to get back on,” Wisk reports.

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Show me the money: Reimbursement for medical innovations

medical device reimbursementDevice developers tend to focus on the FDA approval process—PMAs and 510(k) clearances—while overlooking another major challenge: getting insurers to cover the device. Before approaching investors, and certainly before doing any studies, keep payers in mind, advises Maren Anderson, president of MDA Consulting, Inc., which specializes in reimbursement planning.

In the old days, doctors prescribed, and insurers paid. Under health care reform, that’s changed, says Anderson.

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CHIP on the block: Should the Children’s Health Insurance Program continue?

chopping block CHIP
Some believe that ACA's insurance exchanges leave gaps in pediatric protection.
Funding for the federal Children’s Health Insurance Program (CHIP) will run out in 2015. Will this leave many kids without health insurance?

About 8 million children currently receive health insurance through CHIP, created in 1997 to bring coverage to children whose families earn too much to qualify for Medicaid but not enough to buy private insurance. States administer the program and receive federal matching funds to cover costs. In 2009, Congress reauthorized funding for CHIP through 2015.

What will happen to CHIP beyond 2015 is uncertain, not just because of the funding deadline but also because of changes brought on by the 2010 Affordable Care Act (ACA). Many believe that the ACA’s Medicaid enrollment incentives and expanded tax credits will add so many lower-income kids to the insurance rolls that CHIP will become unnecessary and simply go away. Others, however, say that the plans sold through the ACA’s insurance exchanges could produce gaps in coverage for children, making it crucial to keep CHIP funded.

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Affordable Care Act update: What’s next for children, hospitals, insurers?

Predictions now that healthcare exchanges are launchedIt’s been a few months since the Affordable Care Act (ACA) health exchanges opened for business, and there’s still a lot of speculation on how the bill will affect children, hospitals and insurers.

One thing that’s clear is that ACA is having some success in bringing more people into the system. In his recent State of the Union address, President Obama reported that since the federal and state health insurance exchanges opened for business on Oct. 1, 2013, 3 million citizens have enrolled in private plans and 6.3 million have been deemed eligible for Medicaid. Moreover, some health care experts believe that the Obama Administration may meet its goal of adding 7 million Americans to private insurance rolls by the March 31 enrollment deadline.

Who’s signing up for insurance through the exchanges? According to an analysis by PricewaterhouseCoopers (PwC), individual exchange members have a median age of 33 and a median income of $21,716, or 186 percent of the Federal Poverty Level. Some 91 percent are expected to be in relatively good health.

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How will health insurance exchanges affect doctors and hospitals?

Healthcare.gov button: Apply now for health coverageThe Affordable Care Act (ACA)’s health insurance exchanges opened for business on Oct. 1, and, despite website glitches and non-stop political fighting, citizens across the U.S. can now comparison shop and pick an insurance plan. Time will tell how well the exchanges will work out for consumers, employers and insurers—as well as what effect they will have on pediatricians and hospitals.

According to Wendy Warring, senior vice president, network development and strategic partnerships at Boston Children’s Hospital, the exchanges may force medical professionals to face changes in patient volume, adjustments in reimbursement rates and shifts in how employers provide benefits to insurers. Right now, she says, “people are very confused about public exchanges versus state exchanges versus private exchanges,” and opinions vary on what impact these changes will have on medical professionals.

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Pay Me Maybe: Can we get past this telemedicine barrier?

Telemedicine has the potential to transform healthcare and lower costs. A new Massachusetts law requires insurers to pay for it—but with a potential loophole.

The mandate for broader access to health care in Massachusetts has brought millions of newly insured patients into the system. At the same time, the cost of health care in Massachusetts has continued to rise, and care access issues have emerged.

This past August, Massachusetts Governor Deval Patrick signed a new law that attempts to lower costs by shifting providers away from fee-for-service payment to alternative payment models (APMs) in which they incur more financial risk, and encouraging the development of accountable care organizations (ACOs).

One provision of this law requires insurers to pay providers for services delivered remotely via “telemedicine.”

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