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March 2015 St@teside

Health Reform Resources

SCI keeps its Federal Reform Resources webpage up-to-date with the most recent information from the states, the federal government, and health policy organizations in an effort to guide our readers through the health reform implementation process. We know there are several places to go for the latest health reform resources, and we thank you for using SCI as one of your trusted sources. Here are some of the most recent resources that can be found on our Federal Reform page:

Insurance Market Reforms

The Affordable Care Act CO-OP Program: Facing Both Barriers and Opportunities for More Competitive Health Insurance Markets

The Commonwealth Fund
The failure of the health insurance cooperative operating in Iowa and Nebraska, together with the significant financial losses experienced by most others, have raised questions about the viability of the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP) program. The program, which offers low-interest loans to co-ops, was designed to inject competition into highly concentrated markets and provide more affordable, consumer-focused alternatives to traditional insurance companies. This new blog post explains what’s behind the CO-OP program’s mixed performance so far and also points to reasons why success is still within reach.

Insurance Exchanges

Marketplace Premium Changes Throughout the United States, 2014-2015

Urban Institute
This report examines marketplace premium changes between 2014 and 2015 in all rating regions in all states and the District of Columbia. It provides premium data on the lowest-cost silver plan within each rating region for a 40-year-old individual who does not use tobacco. The report calculates that the population-weighted national average premium increase in the lowest-cost silver plan offered in each year was 2.9 percent. Increases varied considerably both across rating regions within states and across states. Data on premium increases in 40 cities and in 38 rural areas that could be separately identified also are provided.

Essential Health Benefits Update and Advocacy Opportunities
National Health Law Program
On February 20th, 2015, the Department of Health and Human Services issued the Notice of Benefit and Payment Parameters for 2016 final rule (Final Rule 2016), which among changes in other areas, finalized changes to the Essential Health Benefits (EHB) standard. This fact sheet provides an overview of existing EHB rules, changes or clarifications made to the EHB standard in the Final Rule 2016, and advocacy opportunities available.


The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States

Kaiser Family Foundation
As of March 2015, 29 states (including the District of Columbia) adopted the Medicaid expansion, though debate continues in other states. In deciding whether to implement the Medicaid expansion, the effect on state budgets has been a key issue for policy makers. This brief examines the early budget effects of expansion in three states: Connecticut, New Mexico, and Washington State. These findings are based on interviews conducted with budget officials and staff in each of the three states; the interviews focused on their state’s experiences in this early period, when the costs of those newly eligible are fully financed with federal dollars.

Strategic Planning

Integrating Health and Human Services Programs and Reaching Eligible Individuals Under the Affordable Care Act: Final Report

Urban Institute
Enacted against a background of growing public- and private-sector interest in integrating enrollment, retention, and eligibility determination for health and human services programs, the Affordable Care Act included provisions specifically calling for an expansion of such efforts, using 21st-century information technology (IT) to improve consumer experience and streamline enrollment while lowering administrative costs and protecting program integrity. This report, which summarizes a multi-faceted research project sponsored by the Assistant Secretary for Planning and Evaluation, describes integration efforts to date and explores promising strategies for the future.

Health Reform’s Impact on Charity Care
Center for Health Care Strategies, Inc.

The ACA is changing the traditional role of charity care programs as safety net providers. The ACA’s Medicaid expansion and subsidized marketplace plans are giving millions of uninsured Americans options instead of charity care. This brief explores how four charity care programs in different states – CareLink (TX), Portico Healthnet (MN), Ingham Health Plan (MI), and Kaiser Permanente’s Charitable Health Coverage program (multiple states) – are responding to the changing health care environment. It examines their benefit packages; membership and eligibility; outreach and enrollment strategies; financial models; and new roles in providing consumer assistance.

Delivery System Redesign

Building an Equitable Health Care Delivery System: Federal and State Strategies

National Academy for State Health Policy

Policymakers at the federal and state levels are working to develop strategies to address the health disparities that persist in the U.S. and promote health equity across geographic, racial/ethnic, and socioeconomic divisions. This webinar on April 2 will discuss how state and federal policymakers can strengthen their efforts to achieve health equity by coordinating with one another to align payment models, create new partnerships, and build infrastructure and data systems to reduce health disparities. State leaders from Ohio and Louisiana will describe several initiatives supporting health equity and the federal programs they are leveraging to support their efforts. An official from the Centers for Medicaid & Medicare Services (CMS) will describe federal resources available to help states advance health equity and identify opportunities for better alignment of federal and state activities.

Alternative Payment Models and the Case of Safety-Net Providers in Massachusetts

Blue Cross Blue Shield of Massachusetts Foundation

This report provides a comprehensive review of payment reform in Massachusetts and, in particular, how the changing landscape is affecting safety-net providers. Building off state-collected data that detail the adoption of alternative payment models (APMs) by payers over the course of 2012 and 2013, the report adds qualitative findings gathered from a sample of payers and providers in mid-2014. The qualitative findings focus on the variation in characteristics of Massachusetts global payment arrangements and the impact the contracts are having on safety-net providers. The report concludes with several recommendations that payers, the state, or foundations could provide to aid safety-net providers in their preparation for payment reform.