New report on health reform implementation: How to ensure access to coverage is maintained
Modifications to current policies could help ensure that health insurance coverage and subsidies provided under the Affordable Care Act remain stable even through major life changes, according to a new Commonwealth Fund report released today. At least 34 million people will gain new coverage under the law, and the report's authors say that it will be important to ensure that life changes like fluctuations in income and job transitions don't cause abrupt changes in people's health insurance coverage or financial responsibilities for their premiums or care. Uncertainty about how life changes could affect their health insurance and premium costs might lead people to delay signing up for coverage through the exchanges and Medicaid, and could cause people who have received premium subsidies to have to pay money back if their incomes are higher than expected.
"The Affordable Care Act will ensure universal access to affordable coverage and provide a single point of entry for people to qualify for help in paying for health insurance," said lead author Pamela Farley Short, a professor at Penn State University's Department of Health Policy and Administration. "To minimize gaps and churning in health insurance, however, it will be critical that federal and state policymakers implementing the law make sure that it is simple for people to sign up for, pay for, and keep their coverage when their lives change. This will also help reduce administrative costs to federal and state governments."
According to the report, Realizing Health Reform's Potential: Maintaining Coverage, Affordability, and Shared Responsibility When Income and Employment Change, people could experience coverage gaps or changes in financial responsibility for a number of reasons:
- How premium subsidies are calculated: Since premium tax credits are based on income from prior year tax returns, people with income changes might receive too much or too little in subsidy, and then face an unexpected bill or, conversely, become eligible for more subsidy. Recent legislation increased the amount that people would have to pay back if their income rose above their prior year returns.
- Movement between Medicaid and subsidized private coverage in the exchanges: People with incomes near the Medicaid eligibility threshold often experience changes in income that could cause them to shift between Medicaid and the subsidized private insurance obtained through state insurance exchanges. Additional complexity could be caused if Medicaid and the state exchanges assess people's eligibility for the programs over different time frames (a few months vs. a year).
- Movement between individual and small business exchanges: There is likely to be a lot of movement between individual and small business health insurance exchanges in states that create both, as people experience changes in their employment status. This movement could lead to gaps in coverage for families who would have to switch plans and pay different premiums when they move between the exchanges for small employers and individuals. In addition, the increased turnover caused by maintaining separate exchanges will increase enrollment and disenrollment costs.
- Full-year coverage. Making coverage choices valid for one year, instead of requiring that people select new coverage with every life change could make a significant dent in the administrative burdens and complexity that might otherwise result from life changes.
- Internal Revenue Service (IRS) alerts. Requiring the IRS to send alerts to people whose income, and therefore their eligibility for premium credits, has changed over the course of the year could help people better plan for changing financial responsibilities.
- Decision-making support for consumers. Providing support to help people look at "what-if" scenarios could help them see how life changes would affect their premium costs and subsidies as they select their health insurance plans for the coming year.
- Coordinated eligibility determination. Coordinating the systems that determine people's eligibility for Medicaid, the Children's Health Insurance Plan, and subsidies for health insurance premiums could ease confusion and make it easier for people to move between the programs.
- Combined small business and individual exchanges. Making the exchanges as large as possible, by drawing individuals and small businesses into a unified exchange, would reduce administrative costs for insurers and for states, and make for an easier transition for people who leave jobs at small businesses and need individual health insurance plans.
"The promise of The Affordable Care Act is that, for the first time ever, all Americans will have access to affordable, comprehensive health insurance, with far more information about their benefits and out-of-pocket costs," said Commonwealth Fund President Karen Davis. "However, in order to reach health reform's full potential, policymakers must take care to implement the law in a way that will take the guesswork and uncertainty out of people's health insurance decisions."
More information: The report, co-authored by Katherine Swartz from Harvard University and Namrata Uberoi and Deborah Graefe from Penn State, is available at www.commonwealthfu… overage.aspx
Provided by Commonwealth Fund
- 30 million women to benefit from health reform law Jul 30, 2010 | not rated yet | 0
- New study: Health reform to make health insurance affordable for nearly all families Apr 27, 2011 | not rated yet | 0
- Insurance plan penalizes smokers, obese Oct 23, 2006 | not rated yet | 0
- New report: Employer health insurance premiums increased 41 percent from 2003 to 2009 Dec 02, 2010 | not rated yet | 0
- New report: How will the affordable care act affect 15 million uninsured young adults? Oct 08, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
The gap between life expectancy in patients with a mental illness and the general population has widened since 1985 and efforts to reduce this gap should focus on improving physical health, suggest researchers in a paper ...
Health 11 hours ago | not rated yet | 0
Failure to use linked electronic health records may lead to biased estimates of heart attack incidence and outcome, warn researchers in a paper published in BMJ today.
Health 11 hours ago | 5 / 5 (1) | 0
Dietary advice on added sugar is damaging our health, warns a cardiologist in BMJ today. Dr. Aseem Malhotra believes that "not only has this advice been manipulated by the food industry for profit but it is actually a risk ...
Health 11 hours ago | 5 / 5 (4) | 0
(HealthDay)—In 2008 to 2010, the prevalence of key health behaviors among U.S. adults varied, with about one in five adults current smokers and 62.1 percent overweight or obese, according to a report presented ...
Health 13 hours ago | 5 / 5 (1) | 0
(HealthDay)—The overall health of Americans isn't improving much, with about six in 10 people either overweight or obese and large numbers engaging in unhealthy behaviors like smoking, heavy drinking or ...
Health 13 hours ago | not rated yet | 0
Is it permissible to harm one to save many? Those who tend to say "yes" when faced with this classic dilemma are likely to be deficient in a specific kind of empathy, according to a report published in the scientific journal ...
33 minutes ago | not rated yet | 0 |
Phthalates: Study links chemicals widely found in plastics, processed food to elevated blood pressure in children, teens
Plastic additives known as phthalates (pronounced THAL-ates) are odorless, colorless and just about everywhere: They turn up in flooring, plastic cups, beach balls, plastic wrap, intravenous tubing and—according to the ...
1 hour ago | not rated yet | 1 |
(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...
18 hours ago | 4.2 / 5 (5) | 0 |
(Medical Xpress)—Despite spending billions of dollars on research and development, drug companies have been unable to come up with effective treatments for dementia and Alzheimer's Disease (AD). Now, A. ...
16 hours ago | 4.9 / 5 (14) | 0 |
Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.
18 hours ago | 4.6 / 5 (7) | 0 |
Activating an enzyme known to play a role in the anti-aging benefits of calorie restriction delays the loss of brain cells and preserves cognitive function in mice, according to a study published in the May ...
12 hours ago | 5 / 5 (4) | 0 |