That’s A Wrap! The Affordable Care Act, One Year Later Series Comes To An End

Throughout the month of October, HMS has explored the ins and outs of the Affordable Care Act. Our The Affordable Care Act, One Year Later Series has investigated both the positive and negative aspects of the new health law. It’s been one year since the implementation. Overall, how has the ACA impacted healthcare in America? Our final post in the series will examine if the health law did, in fact, do what it was intended to do-which is reduce the number of Americans without health insurance, make health insurance more affordable, and make Americans healthier.

According to a recent New York Times article, the ACA has indeed reduced the number of Americans without health insurance.  Although a perfect measurement of the number of people affected by the law is still difficult, most private sector surveys and government reports, including a Gallup poll, The Commonwealth Fund, and a CDC survey, reach the same basic estimates. The number of uninsured Americans has been reduced by 25 percent this year-that’s eight to 11 million people. More than half of that appear to be the newly insured who have signed up for Medicaid. Others are enrolled in private health plans through the new state insurance marketplaces. Three to four million people, mostly young adults, also became newly insured through ACA provisions that kicked in. The Congressional Budget Office estimates that by 2017, approximately 26 million more Americans will become insured through the law (lower than previously estimated).

Another question we all have: Is the Affordable Care Act actually affordable? According to the Obama administration, eighty-five percent of those who signed up during enrollment period qualified for federal subsidies to help pay premiums. The subsidies are estimated to have lowered the cost by 76 percent on average. However, the law has also required insurers to provide more benefits to cover people with pre-existing conditions, subsequently causing premiums to rise for some of those who already had insurance. Others plans were canceled or were not eligible for subsidies. On a more positive note, it has also been reported that premiums may actually become lower in the next year due to spurred competition among insurers.

Lastly, has the ACA made us healthier? Most experts believe it’s still too early to know. How will the ACA fare in the long run? Only time will tell!

*You can start shopping for health insurance on Saturday, November 15. If you want coverage to start on January 1, you’ll have to buy it by December 15. If you  miss the December 15 deadline, you can buy coverage, but it will not take effect until February 1 at the earliest.


The Affordable Care Act, One Year Later: The Losers Part II

In our last post, we looked at those who have been negatively affected by the Affordable Care Act. In this post, we will continue to explore the so-called “losers” of the health law.

  1. People with incomes under 100% of the poverty line living in states that didn’t expand Medicaid. Twenty-five states didn’t expand Medicaid under the ACA. The result? More than one-third of their lowest-income residents remaining uninsured-a rate that hasn’t changed from last year (even as millions gained coverage in states that expanded Medicaid). The ACA makes Medicaid available to anyone who earns less than 138 percent of the federal poverty level, or $16,105 this year for a single person. The law also lets individuals who make between the poverty level to four times that amount get tax credits to cut the cost of private health insurance. However, anyone making less than that or nothing, gets no assistance if they live in states that didn’t expand the program.
  2. Young, healthy people with higher incomes. With new insurance policies under the ACA, younger people are facing higher rates and higher deductibles.
  3. Person whose doctor is out-of-network. Some consumers are finding it difficult to find networks that include their current doctor. People have to make the choice to stick with their current doctor and pay more for insurance or switch doctors and pay less.
  4. People who don’t want to buy insurance coverage, who will still be uninsured and will have to pay a penalty.
  5. Unauthorized immigrants who are not eligible for any part of the ACA. Also, low-income authorized immigrants who have lived in the United States for less than five years and therefore are not eligible for Medicaid.

In our last post of our ACA series, we will wrap things up by looking at the overall impact of the health law. Stay tuned!


The Affordable Care Act, One Year Series: The Losers Part I

It’s been one year since the Affordable Care Act became law. In our last posts, we explored the positive impacts of the health law. In this post, we will take a look at those who didn’t fare nearly as well.

  1. Insurance companies. Insurance companies have been particularly affected by the ACA. Due to competition in the marketplace, the companies with the lowest monthly premiums appeal the most to those shopping for healthcare. According to a recent Huffington Post report, policyholders value lower premiums more than access to a wider network of doctors. Additionally, insurers that did not comply with ACA standards, sent out cancellation notices to thousands of customers.
  2. Employers. Starting in 2015, employers with over 100 employees will be required to provide health insurance to their employees. If they do not, they will be fined a penalty.
  3. Employees with modified benefits. Some employers are changing benefits to pass on more costs to employees in the form of higher premiums and higher deductibles and some are even cutting schedules to avoid providing health insurance under the employer mandate. Furthermore, many employees who work two part-time jobs are losing out since they may not receive insurance from either employer, but make too much to qualify for subsidized insurance on the exchanges.
  4. Insurance brokers. The health law has initiated numerous new changes in regards to health insurance, making education and compliance especially important during this time. Brokers will need to keep clients abreast of specific plan changes, new fees and taxes, reporting requirements, new rules regarding enrollments, non-discrimination and other changes. Being able to assist clients through this process and ensure that they understand the law and comply with it, will be particularly challenging during this transitional period.

The Affordable Care Act, One Year Later Series: The Winners Part II

The Affordable Care Act, One Year Later Series: The Winners Part II will continue exploring the ways in which the ACA is working.

  1. Premiums in the marketplaces aren’t rising quickly and more insurers are     joining the marketplaces to compete. Many opponents of the ACA have argued that only older and sicker people are signing up for coverage, and that carriers would increase premiums or abandon marketplaces. However, multiple studies have shown that premiums inside marketplaces are barely rising. In fact, even within states, there is a lot variation. The HHS announced that participation in the marketplaces will actually increase next year.
  2. Employer premiums aren’t rising. Most working-age Americans are insured through their employers. And although critics said employer premiums would skyrocket, this hasn’t been the case. A Kaiser/HRET Survey of Employer-Sponsored Health Benefits found that employer premiums rose by just 3 percent. However, because coverage can still be expensive, employers have asked employees to pay more in out-of-pocket costs.
  3. Overall health costs are rising at historically low rates. When measuring the cost of healthcare, economists mostly care about national health expenditures-what the U.S. spends on medical care through both private and public insurance, as well as through individual out-of-pocket costs. According to the latest projections from CMS, it’s been rising very slowly.
  4. The net effect on the budget has been to reduce the deficit. The ACA calls for new spending since the government now has to underwrite the costs of both the expanded Medicaid program and subsidies for people buying health insurance. With every dollar in new spending, there is also one dollar in either new revenue or new spending cuts. According to the Congressional Budget Office (CBO), the net effect is to reduce the deficit. Additionally, according to the Committee for a Responsible Federal Budget, the total bill for federal healthcare programs is likely to be lower than predicted when the ACA first became law.

Stay tuned to the HMS Affordable Care Act, One Year Later Series to find out who the ACA losers are.

Click here to see our last post.

The Affordable Care Act, One Year Later Series: The Winners Part I

The Affordable Care Act isn’t too popular with the American public. In the latest tracking poll from the Kaiser Family Foundation, 47 percent of respondents said they view the law unfavorably, while 35 percent said they view it favorably. These numbers should not be surprising as the figures are similar to what other surveys have found.

Although the ACA has flaws, the data tells a different story-that if you focus on the big picture, it’s working exactly as it should.  Below are a few reasons explaining how it’s working:

  1. More people have health insurance. The primary goal of the ACA was to gain coverage for the uninsured and we now have evidence that it has done exactly that. According to a series of surveys from independent research organizations, including the Commonwealth Fund, Gallup, the Rand Corporation and the Urban Institute, the number of people without insurance decreased by 10 to 12 million. Hospitals are also reporting seeing fewer and fewer uninsured patients.
  2. People who are getting health insurance are better off. Two recent studies show that that people who have health insurance are better off. The first study was a major study of Medicaid, based on data from Oregon. Researchers determined that people who got health insurance from the program were significantly less likely to experience financial distress and more likely to report better mental health. Another study, using data from Massachussetts and its expansion of health insurance, found improvements in economic security, mental health, and physical health.  A survey from the Commonwealth Fund found that 60 percent of people who got new coverage on the marketplaces had used their insurance to pay for services and 62 percent said they could not have paid for such care previously.
  3. Winners outnumber the losers in the new marketplaces. Although the website got off to a rough start, it was the plan cancellations and raised premiums that caused the most problems. However, the new law provides tax credits which, in most cases, offset part or all of the increase for most people and reduces the price of coverage for people who once paid higher rates because they were older or in poor health. Overall, people paid less for their insurance in 2014 than in 2013. The best evidence comes from the Kaiser Foundation; of those people, 46 percent of respondents said they were paying less, 39 percent said they were paying more, and 15 percent said they paid the same. A Commonwealth Survey found that 68 percent of people buying marketplace plans rated them at “good” or better.


HMS Kicks Off The Affordable Care Act, One Year Later Series

This week, HMS Healthcare Management Solutions, Inc. will kick off our new blog series, The Affordable Care Act, One Year Later. The ACA has represented the most significant regulatory overhaul of the U.S. healthcare system since the 1960’s. Initially created to increase the quality and affordability of health insurance by lowering the uninsured rate and expanding public and private insurance coverage, the ACA has been making steady progress since its implementation. Although it did get off to a shaky start (to say the least), the ACA’s provisions are finally beginning to take ahold to change the landscape of healthcare-one that puts demands on healthcare providers and payers for efficiency, quality and transparency.

Stay tuned to the HMS blog as we investigate the effects of the ACA one year since its launch.