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May 2014 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

Drivers of 2015 Health Insurance Premium Changes

American Academy of Actuaries
The Affordable Care Act’s (ACA) 2014 open enrollment period for the individual health insurance market ended on March 31 and health insurers are already developing premium rates for the 2015 plan year. Insurers must submit their 2015 premiums to state and federal regulators this spring, with final approval decisions made by the fall. Open enrollment for 2015 will begin November 15. This brief outlines factors underlying premium rate setting generally and highlights the major drivers behind why 2015 premiums could differ from those in 2014. It focuses on the individual market, but considerations for the small group market are similar.

Will Premiums Skyrocket in 2015?
Urban Institute
While there may be reasons to believe that premiums will increase substantially in 2015, particularly in less competitive markets, there are even stronger reasons to believe that premium increases will be moderate, and in line with underlying cost growth. The dominant force behind the surprisingly low premiums in 2014 remains intact—the strong incentives for markets to be highly competitive, which forces insurers to set premiums aggressively to attain or retain market share. These incentives should be even stronger in 2015 with increased enrollment and a more stable risk pool.

Seeking Lower Prices Where Providers Are Consolidated: An Examination of Market and Policy Strategies
The Commonwealth Fund
Consolidation between and among hospitals and physicians can lead to improvements in efficiency and quality of care, but it also tends to raise prices for health care services. Health care purchasers and payers can counteract providers’ pricing power through various strategies, including limiting provider networks, providing tiered benefits and other point-of-service incentives to patients, and supporting the formation of physician organizations. In some cases, government regulation—like antitrust enforcement—may be necessary.

Insurance Exchanges

States May Continue to Experiment with Health Insurance Marketplaces

The Commonwealth Fund
States have several different options to take part in the Affordable Care Act's health insurance marketplaces, where people can shop for health insurance. These range from taking full responsibility for operating the marketplaces to letting the federal government run them. To help guide state decisions, the U.S. Department of Health and Human Services recently released the 2015 health insurance marketplace models for states. In their latest blog post, the Alliance for Health Reform's Sarah Dash and Georgetown University's Amy Thomas outline key deadlines and factors that states will consider when making their choices.

Information Reporting for Affordable Insurance Exchanges
Internal Revenue Service
This document contains final regulations relating to requirements for Affordable Insurance Exchanges (Exchanges) to report information on enrollments in qualified health plans, and it directs exchanges to report to the IRS and to taxpayers certain information necessary to reconcile the premium tax credit with advance credit payments and to administer the premium tax credit generally.


Medicaid and CHIP FAQs: The Basic Health Program

Centers for Medicare and Medicaid Services

This set of FAQs released by CMS provides information regarding eligibility, benefits and cost-sharing for Basic Health Program (BHP) enrollees, and additional details about BHP administration, contracting, and financing by state governments. CMS is currently developing a BHP Blueprint template, and will be making it available to states shortly.

Health Coverage and Care for Youth in the Juvenile Justice System: The Role of Medicaid and CHIP
Kaiser Family Foundation
This brief provides an overview of the health and mental health needs of girls and boys in the juvenile justice system and the role of Medicaid in addressing those needs. It focuses on the circumstances of those youth who are placed in juvenile justice residential facilities, the discontinuity of Medicaid coverage for those youth, and the options for improving coverage, continuity of care and access to needed services post-discharge, including new opportunities provided by the Affordable Care Act.

Strategic Planning

Reaching Vulnerable Populations through Health Reform

Center for Health Care Strategies, Inc.
The ACA has the potential to dramatically improve rates of health insurance coverage for low-income Americans, including many vulnerable populations. This fact sheet highlights particularly vulnerable populations that could benefit from insurance coverage, but may have trouble getting access, including: (1) racial and ethnic minority populations; (2) homeless individuals; (3) the jail-involved population; and (4) veterans.  The fact sheet outlines opportunities to connect these individuals to coverage with an eye toward the next open enrollment period.

National Healthcare Quality Report 2013

Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality (AHRQ) has released its annual report on progress and opportunities for improving health care quality and reducing health care disparities. This report focuses on national trends in the quality of health care provided to the American people and the prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors. It is important to note that the report provides a snapshot of health care prior to implementation of most coverage expansion and consumer protection provisions included in the ACA, and can serve as a baseline against which to track progress in upcoming years. This year’s report also provides expanded analyses of people with disabilities, including children with special health care needs and adults with multiple chronic conditions.

Hospital Community Benefits After the ACA: Addressing Social and Economic Factors that Shape Health

The Hilltop Institute
This is the ninth issue brief in a series released by Hilltop's Hospital Community Benefit Program. This brief continues the program's examination of state-level community benefit oversight by examining the current hospital-reported programs and initiatives that target specific social and economic factors in ten states. It also identifies standard regulatory tools and characteristics of implementation strategies used by those states that could facilitate hospital investment in activities that address social and economic determinants.

Delivery System Redesign

The Promise of Data-Driven Care

North Carolina Medical Journal
The growing adoption of electronic medical records and advances in health information technology are fueling an explosion of new health data. Expectations are high that new data resources will guide the transformation of the health care industry and positively influence population health. There have been challenges and opportunities at every turn, and progress has been slow, but mounting evidence suggests that better use of data is moving health care in the right direction.