IHA Daily Briefing: Aug. 12

Monday, August 12, 2019
Illinois ACA Enrollment Holds Steady
Medicaid Coverage and Reduced Mortality
Study: Private Health Insurance Markets Profitable
Administration Releases Final “Public Charge” Rule
Register for IHA's HCPro Medicare Boot Camp in October   

Illinois ACA Enrollment Holds Steady
New reports released today by the Centers for Medicare & Medicaid Services (CMS) indicate that 287,625 Illinoisans had effectuated coverage (they enrolled and paid their monthly premium) through the Affordable Care Act marketplace as of February 2019 – compared to 298,348 in February of last year and to the 2018 monthly average of 278,661. Nationally, 10.6 million consumers had effectuated coverage in February, about one percent lower than at the same time last year.

CMS says the average total monthly premiums for enrollees decreased by one percent from the prior year. In Illinois, the average total monthly premium in February was $645 (the same as last year) and the average advance payment of the premium tax credit (APTC) was $524 ($534 in 2018) (87% of Illinois enrollees received APTCs).

According to CMS, people who do not qualify for APTCs are being priced out of the market, with 2.5 million unsubsidized people leaving the market from 2016 to 2018, representing a 40% drop nationally (Illinois saw a decline of 123,730 or 46%).

See the press release from CMS; Early 2019 Effectuated Enrollment Snapshot; and Trends in Subsidized and Unsubsidized Enrollment.

Medicaid Coverage and Reduced Mortality
More than 15,000 deaths between 2014 and 2017 could have been avoided if all states had expanded Medicaid under the ACA, according to a new study from the National Bureau of Economic Research.

The analysis compared changes in mortality for near-elderly adults in states with and without ACA Medicaid expansions and identified adults most likely to benefit using survey information on socioeconomic and citizenship status, and public program participation. The analysis found a 0.13 percentage point decline in annual mortality during the four-year period associated with Medicaid expansion for this population, driven by a reduction in disease-related deaths.

Assuming that the effects of Medicaid expansion in the non-expansion states would be similar to those observed in the expansion states, the authors say “failure to expand likely resulted in 15,600 additional deaths that could have been avoided if the [non-expansion] states had opted to expand coverage.”

Study: Private Health Insurance Markets Profitable
According to a new analysis by the Kaiser Family Foundation, three key private health insurance markets – Medicare Advantage, the individual market and the fully-insured group market – appear to be financially healthy and attractive to insurers.

The analysis finds that the Medicare Advantage market generates much larger gross margins per person than the individual market or fully-insured market. Private insurers achieved annual gross margins of $1,608 per person in Medicare Advantage, on average, between 2016 and 2018, about double the average gross margins in the individual market ($779) and group market ($855).

Medical loss ratios – medical expenses paid by insurers as a share of the total premiums collected – are similar across all three markets. But gross margins are higher for Medicare Advantage insurers because both medical expenses and premiums paid to Medicare Advantage plans are substantially higher, since Medicare enrollees tend to use more healthcare than people in the individual and group markets.

Medicare Advantage plans cover 22 million beneficiaries. Plans purchased by individuals and families in the individual market, including the Affordable Care Act (ACA) marketplaces in which subsidies are available to some, cover about 15 million people. The fully-insured group market for employers and their employees serves over 30 million people (although most workers are covered through self-insured employer plans).

Administration Releases Final “Public Charge” Rule
The U.S. Dept. of Homeland Security (DHS) today announced a final rule that amends DHS regulations by prescribing how the department will determine whether an immigrant is inadmissible to the U.S. based on his or her likelihood of becoming a public charge at any time in the future. Under the final rule, DHS has revised the definition of “public charge” to include more kinds of public benefits received – including Medicaid – and to mean an individual who receives one or more designated public benefits for more than 12 months, in the aggregate, within any 36-month period (such that, for instance, receipt of two benefits in one month counts as two months).

“For over a century, the public charge ground of inadmissibility has been part of our nation’s immigration laws. President Trump has delivered on his promise to the American people to enforce long-standing immigration law by defining the public charge inadmissibility ground that has been on the books for years,” said U.S. Citizenship and Immigration Services Acting Director Ken Cuccinelli. “Throughout our history, self-sufficiency has been a core tenet of the American dream. Self-reliance, industriousness, and perseverance laid the foundation of our nation and have defined generations of hardworking immigrants seeking opportunity in the United States ever since. Through the enforcement of the public charge inadmissibility law, we will promote these long-standing ideals and immigrant success.”

The rule further defines the term “public benefit” to include any cash benefits for income maintenance, Supplemental Security Income (SSI), Temporary Assistance to Needy Families (TANF), Supplemental Nutritional Assistance Program (SNAP), most forms of Medicaid and certain housing programs.

The final rule (click here) is effective 60 days after publication in the Federal Register. See a statement from President Trump here.

Register for IHA's HCPro Medicare Boot Camp in October
Is your staff prepared for the Centers for Medicare & Medicaid Services' next review?

Send them to IHA's HCPro Medicare Boot Camp®—Utilization Review Version on Oct. 29-30 to ensure they understand the latest requirements.

Held at IHA's Naperville office, this rigorous two-day program will teach participants how to:

  • Manage patient status;
  • Obtain correct Medicare reimbursement; and
  • Maintain regulatory compliance.

Medicare expert Gina Reese, Esq., RN, will share her insight from her 40-year career in healthcare and law. Reese is a certified mediator, as well as an adjunct assistant professor at the Glendale University College of Law.

This course will benefit hospital staff from multiple departments, including:

  • UR coordinators, managers, directors, committee members and physician advisors;
  • Case managers, care coordinators and nurse managers;
  • Compliance officers, auditors and staff;
  • Revenue cycle staff; and
  • Chief nursing officers.

Attendees will receive a large program book rich with information that they can refer to long after the boot camp ends. Continuing education credits are also available for this course.

Space is limited—don't wait to reserve your spot in this nationally acclaimed boot camp. A registration discount is offered for two or more attendees from the same organization. Register today.