As many states begin setting up new marketplaces for individuals and small businesses to buy health insurance as envisioned in the new federal health care law, Louisiana and some other states are ceding the responsibility to the federal government. President Barack Obama?s re-election on Tuesday makes clear that his signature legislation, the Affordable Care Act, is here to stay.
But what exactly it looks like will be determined by the U.S. Department of Health and Human Services, which will be issuing scores of regulations and rules in preparation for much of the law going into effect in early 2014.
Before the election, Louisiana Gov. Bobby Jindal declared he would opt out of two main components of the law: setting up a health insurance ?exchange? and expanding the Medicaid program to cover more low-income residents. While Jindal has the final word on the statewide Medicaid expansion, opting out of the exchange just shifts that responsibility to the federal health agency.
Next week is the deadline for states to tell HHS whether they will set up their own exchange, although the agency on Friday pushed back the deadline for states to actually draft a plan. Bruce Greenstein, secretary of the Louisiana Department of Health and Hospitals, declined to comment Friday on whether the state might change its position on these two key components of the federal health law. The governor?s office also did not respond to a request for comment.
Len Nichols, a health expert at George Mason University, said states that opt not to create their own exchanges are giving up the opportunity to shape the system to fit local markets. They?re also forgoing the expertise of the state insurance agency in evaluating the companies that already offer plans in the state.
?By refusing to participate, they are making it one-size-fits-all by default,? he said.
It is still unclear how many states will start their own exchanges. A Kaiser Family Foundation review found that 15 states, plus the District of Columbia, had moved forward. Another four states plan to get into ?partnerships? with the federal government, while 11 have ruled out operating an exchange. That leaves 20 states still weighing their options or not indicating what they will do.
Leaving it up to the feds means Louisiana will get a particular kind of exchange, said Jennifer Tolbert, Kaiser?s director of state health reform. While HHS hasn?t laid out exactly what it plans to do, the federal exchange will be a ?market facilitator,? which means it will allow any plan to participate as long as it meets certain requirements, she said.
Under the health care law, starting in 2014 most people will be required to have health insurance or pay a penalty. The state exchanges are meant to provide a place where individuals or small businesses can easily compare plans, with proponents also saying they hope transparency and standardized rules foster competition.
Jim Donelon, Louisiana?s insurance commissioner, said he hasn?t heard much about HHS?s plans regarding the federal exchange. Donelon, a Republican like Jindal, said the exchange was one of the concepts in the federal health law that he liked. He hoped Louisiana would choose to create its own.
In Louisiana, there isn?t much competition for health care insurance, with Blue Cross and Blue Shield of Louisiana dominating the insurance market to the extent the market is considered ?noncompetitive,? Donelon said. An October 2011 report found that in the small group market, Blue Cross claimed 80 percent of the market.
Figuring out how to foster competition is one of his greatest concerns, as the state commissioner has no authority to regulate rates for health insurance, Donelon said.
?It is a dilemma,? Donelon said. ?But I will add this: This health insurance program probably changes everything in such a dramatic fashion in the near future that we will have to wait and see.?
Some conservative health experts question the exchanges, saying the regulation they come with will stifle competition rather than spur it. In a 2010 Washington Post editorial, Robert Moffit of the conservative Heritage Foundation wrote that the Obama administration took an idea his think-tank had once embraced, but altered it beyond recognition.
?Under the president's law ? the congressionally designed exchanges are a tool imposed on the states enabling the federal government to standardize and micromanage health insurance coverage, while administering a vast and unaffordable new entitlement program,? Moffit wrote.
But others are more optimistic. Many more people will be buying health insurance in the future, which in itself should dramatically change the marketplace, said Tolbert.
?Once you have a more viable market with more covered lives, it becomes a place where more carriers, more insurers, are going to want to sell their products,? she said. For lower-income families, premium subsidies will be available, something that should make insurance affordable for more families.
The number of uninsured adults under 64 in Louisiana grew 17 percent between 2009 and 2011, from 540,490 people to 633,943 people, according to a state health department report. Because of Louisiana?s generous Medicaid benefits for poor children, the number of uninsured children in the state is relatively low.
The Urban Institute estimated that as many as 317,000 individuals would participate in Louisiana?s exchange, with more than 209,000 of them qualifying for subsidies. Subsidies will be available to those people whose incomes are up to 400 percent of the federal poverty level, or about $88,000 for a family of four.
Some of the options people will have are known, although only in broad strokes. For example, the health law requires the federal government to set up two national plans that will be available in every state. HHS is expected to release regulations for those plans soon.
In addition, non-profit ?cooperative? health insurers are getting loans from the federal government to set up new programs that will become operational in 2014.
Ochsner Health System, along with other business entities, is working on such an insurance program, called the Louisiana Health Cooperative. It received a $65 million loan from the Centers for Medicare & Medicaid Services in September.
Jim Pittman, a spokesman for the cooperative, said the program will start enrolling customers in October 2013.
?We are directed by our customers and designed to offer individuals and small businesses more affordable, consumer-friendly health insurance options,? he said.
Pittman said he was not authorized to name the other businesses involved in setting up the plan.
The federal law envisioned that people with very low incomes wouldn?t go into private insurance markets, but instead take advantage of an unprecedented expansion of Medicaid. But the U.S. Supreme Court decision this June upholding the law gave states the option to reject the Medicaid expansion, set to go into effect in 2014.
The Jindal administration has said it will do just that, saying Medicaid is too expensive and relies on a federal program state health officials consider outdated and inflexible. While the federal government would pick up the entire tab for the first three years, states would have to contribute up to 10 percent in future years.
Since the election, some have speculated that the generous nature of the Medicaid expansion ? as well as the subsidies for private insurance ? could be scaled back as lawmakers and the Obama administration look for ways to trim the federal budget.
In Louisiana, state Louisiana Democratic leaders and liberal advocacy groups are pointing to the election results and urging Jindal to change his mind. Jan Moller, director of the Louisiana Budget Project, released a statement this week noting that the decision comes at a time the state is making deep cuts to the public hospital safety net.
?Failing to expand Medicaid would leave 400,000 Louisianans out in the cold,? he said. ?And it would squander an opportunity to pump hundreds of millions of dollars into our state economy.?
The Associated Press reported that state Sen. Karen Carter Peterson, head of the state Democratic party, made similar arguments.
Leaders of New Orleans-area community clinics have said they also hope the state expands Medicaid, which would provide health insurance coverage to many of the working poor. For example, a family of three with incomes up to $25,390 would qualify for coverage.
But it is unclear whether other health-care providers will advocate for the state to change its position. On Friday, Louisiana Hospital Association president John Matessino said his organization hasn?t taken an official position.
Still, Matessino noted that under the federal law, hospitals are expecting cuts in the money they receive for treating the uninsured. Plus, the private hospitals he represents believe they are already seeing more uninsured patients in their emergency rooms as cuts at the LSU-run public hospitals are implemented.
The hospital association has generally supported expansion of health insurance coverage, Matessino noted. While the group is generally dissatisfied with the Medicaid reimbursement rates, it at least provides some compensation.
?It is better to get something than nothing,? he said.
Staff writer Lauren McGaughy contributed to this report.
Source: http://www.nola.com/health/index.ssf/2012/11/federal_government_poised_to_c.html
nick carter sister recruiting rankings san onofre paula deen birth control recall nick carter leslie carter
No comments:
Post a Comment