Archive for August, 2019


ACA Has Reduced Insurance Disparities

The Affordable Care Act is responsible for a major reduction in the disparity of insurance status among racial and ethnic minorities.

According to a new Commonwealth Fund analysis,

All U.S. racial and ethnic groups saw comparable, proportionate declines in uninsured rates…  However, because uninsured rates started off much higher among Hispanic and black non-Hispanic adults than among white non-Hispanic adults, the coverage gap between blacks and whites declined from 11.0 percentage points in 2013 to 5.3 percentage points in 2017. Likewise, the coverage gap between Hispanics and non-Hispanic whites dropped from 25.4 points to 16.6 points.

Learn more about specific differences among racial and ethnic groups, differences based on residence in Medicaid expansion states and non-expansion states, and differences in securing public or private health insurance in the Commonwealth Fund study “Did the Affordable Care Act Reduce Racial and Ethnic Disparities in Health Insurance Coverage?”

Uninsured Rate Rose in 2017

The rate of uninsured Americans rose in 2017, the first such increase since implementation of the Affordable Care Act.

According to a new Urban Institute study,

The increasing uninsurance rate between 2016 and 2017 was driven by losses of private nongroup coverage, such as that purchased in the health insurance marketplaces, and decreases in Medicaid and Children’s Health Insurance Program (CHIP) coverage (-0.4 percentage points each).

In addition,

Overall, coverage losses were concentrated in the 19 states that did not expand Medicaid eligibility under the Affordable Care Act by July 1, 2017…Between 2016 and 2017, uninsurance held stable in Medicaid expansion states but increased by 0.5 percentage points in nonexpansion states.

The study also noted that these declines occurred at a time when the economy was considered strong, incomes were rising, and more employers were sponsoring insurance coverage.

Learn more about where and why the number of uninsured people rose in 2017 in the Urban Institute report “Health Insurance Coverage Declined for Nonelderly Americans Between 2016 and 2017, Primarily in States That Did Not Expand Medicaid.”

Medicaid Rolls Could Include Too Many People in Some States

Some states appear to have more Medicaid participants than they do individuals who meet the program’s income eligibility requirements.

Or so suggests a new study from the National Bureau of Economic Research.

According to the study, an analysis of nine states that expanded their Medicaid program under the Affordable Care Act found 800,000 more Medicaid participants than it did individuals who meet Medicaid’s income eligibility criteria.

The study acknowledges that the actual numbers may not be as great because some people qualify for Medicaid based on disabilities and factors other than income.

Learn more in the National Bureau of Economic Research report “Medicaid Coverage across the Income Distribution under the Affordable Care Act.”

Stakeholders Respond to CMS “Patients Over Paperwork” RFI

More than 400 stakeholders responded to the federal government’s request for ideas to reduce the administrative burden associated with serving publicly insured patients.

The request was disseminated via a Centers for Medicare & Medicaid Services request for information that was part of the agency’s “Patients over Paperwork” initiative.  Among the groups that responded were the American Hospital Association, The American Association of Colleges of Nursing, the Critical Access Hospital Coalition, the Coalition of Long-Term Acute-Care Hospitals, the National Rural Association of Rural Health Clinics, the American Academy of Ophthalmology, the American Academy of Family Physicians, the American Hospital Association, and others.

Among the suggestions they offered were reconsideration of quality  metrics, changes in the merit-based incentive payment system (MIPS), the inclusion of social determinants of health in quality metrics, changes in star rating systems, greater efficiency in prior authorization processes, changes in interoperability requirements, and others.

Learn more about who submitted comments in response to this RFI and what they proposed in their comments in the Healthcare Dive article “CMS says it wants to cut paperwork. Providers have ideas.”

Surprise Medical Billing Problem Growing Worse

Insured patients are getting more surprise medical bills, and more expensive surprise medical bills, even as Congress attempts to tackle this problem.

According to a new study, 42.8 percent of emergency department patients now receive surprise medical bills for out-of-network services, up from 32.3 percent in 2010, with those surprise bills rising from a mean of $220 in 2010 to $628 in 2016.

Patients experience similar frustrations with inpatient visits, with surprise bills for out-of-network services arriving in the mailboxes of 42 percent of patients in 2016, up from 26.3 percent in 2010.  Those surprise bills rose from a mean of $804 in 2010 to $2040 in 2016.

The most common reason for a surprise medical bill?  Ambulance service, with more than 85 percent of patients who arrive at a hospital emergency department via ambulance receiving a surprise bill and more than 81 percent of patients served on an inpatient basis who use ambulances receiving such bills.

Learn more about how the surprise medical bill problem continues to grow, despite state and federal efforts to address it, in the JAMA Internal Medicine study “Assessment of Out-of-Network Billing for Privately Insured Patients Receiving Care in In-Network Hospitals.”