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May 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 Reform

Regulation of Student Health Plans Under Federal and State Law: An Overview
State Health Reform Assistance Network
In March of 2012, the U.S. Department of Health and Human Services issued a regulation defining student health plans as individual health insurance under federal law. As a result, they are now subject to the same consumer protections afforded to all those covered by individual health insurance set forth in the Public Health Service Act, as amended by the Affordable Care Act (ACA). This issue brief examines student health plans, which cover over 1 million students, and investigates the interplay between federal and state regulation with regard to these plans.

Insurance Exchanges

Survey of Non-Group Health Insurance Enrollees, Wave 2
Kaiser Family Foundation
This survey reports on the views and experiences of people purchasing health insurance coverage in the non-group market. Over the past few years, the ACA has had a significant impact on this group, as new rules took effect that standardized coverage, guaranteed coverage for those with pre-existing conditions, and established income-based federal financial assistance to those buying insurance through new health insurance Exchanges or Marketplaces. Starting on January 1, 2014, all coverage newly purchased either through a Marketplace or directly from an insurance company had to follow new rules under the ACA (i.e. “ACA-compliant”).

Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care
Families USA
Approximately 14.1 million previously uninsured Americans gained health insurance between the beginning of open enrollment in October 2013 and March 4, 2015. Some of the greatest declines in uninsured rates were for lower- and middle-income consumers, including those eligible for tax credits to help pay their premiums for plans in the health insurance marketplaces. But simply having health insurance is no guarantee that consumers can afford to pay for health care. Unfortunately, this study shows that, for many Americans with non-group coverage, deductibles and other out-of-pocket costs are prohibitively high, and are associated with many of these insured consumers forgoing needed health care.


Medicaid Expansion Is Producing Large Gains in Health Coverage and Saving States Money
Center on Budget and Policy Priorities
In the short time since states have been able to expand Medicaid to low-income adults under health reform, a clear divide has emerged between states that have expanded Medicaid and those that have not. Since the major coverage provisions of the ACA took effect in 2014, insurance coverage rates have improved across the country, but the gains are far greater in the states that have expanded Medicaid. As a result, hospitals in expansion states are treating fewer uninsured patients, and the amount of uncompensated care they are providing is declining steeply. Moreover, contrary to critics' claims that Medicaid expansion is financially unsustainable for states, there is increasing evidence that expansion has saved states money, and these savings are expected to grow over time.

Proposed Rule: Mechanized Claims Processing and Information Retrieval Systems for Medicaid
U.S. Department of Health and Human Services
This proposed rule would extend enhanced funding for Medicaid eligibility systems as part of a state’s mechanized claims processing system, and would update conditions and standards for such systems, including adding to and updating current Medicaid Management Information Systems (MMIS) conditions and standards. These changes would allow states to improve customer service and support the dynamic nature of Medicaid eligibility, enrollment, and delivery systems. Comments on this proposed rule are due by June 15, 2015.

Strategic Planning

The Problem of Underinsurance and How Rising Deductibles Will Make It Worse
The Commonwealth Fund
New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half of underinsured adults reported problems with medical bills or debt and more than two of five reported not getting needed care because of cost.

The Robert Wood Johnson Foundation’s Plan Choice Challenge: Winning Tools and Considerations for States
State Health Reform Assistance Network and the National Academy for State Health Policy
The Robert Wood Johnson Foundation’s “Plan Choice Challenge” was a recent competition facilitated by Health 2.0 to spur the development of innovative technology applications that better support consumers as they shop for and purchase health insurance. This webinar featured background on the challenge from Health 2.0, an overview of the winning apps, and insights into what states should consider as they explore plan selection tools. States had a chance to ask questions of the vendors who developed the winning applications—Consumers’ CHECKBOOK (first place), Stride Health (second place) and Clear Health Analytics (third place).

State Models for Health Care Cost Measurement: A Policy and Operational Framework
Milbank Memorial Fund
Dollars spent on health care are dollars not available for other uses. Understanding the rate at which costs are growing—and the growth rate the economy can bear—is important for the financial health of any state. This report looks at total cost of care measurement activities in four states and the policy priorities in each state that are driving the activity. It examines the questions these states had to ask and in determining total cost of care measurement—where data come from, what to count, how to count—and how they answered them.

Delivery System Redesign

The Affordable Care Act at Five Years: How the Law is Changing the Delivery of Care in the U.S.
The Commonwealth Fund
In the five years since the ACA was passed, the nation's attention has shifted from the law's insurance market reforms and the bumpy rollout of to the success of the marketplaces in covering millions of previously uninsured Americans. Far less attention has been paid to the parts of "Obamacare" that target problems with how health care is delivered and paid for, many of which become apparent when people receive their insurance card and seek out care.