CMS Office of the Actuary Releases 2018-2027 Projections of National Health Expenditures
Office of the Actuary - CMS - February, 2019
CMS Office of the Actuary Releases 2018-2027 Projections of National Health ExpendituresGrowth in national health spending over the next decade remains similar from last year’s projected average annual growth of 5.5 percent
National health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027, according to a report published today by the independent Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS).
Growth in national health spending is projected to be faster than projected growth in Gross Domestic Product (GDP) by 0.8 percentage points over the same period. As a result, the report projects the health share of GDP to rise from 17.9 percent in 2017 to 19.4 percent by 2027.
The outlook for national health spending and enrollment over the next decade is expected to be driven primarily by:
- Key economic factors, such as growth in income and employment, and demographic factors, such as the baby-boom generation continuing to age from private insurance into Medicare; and
- Increases in prices for medical goods and services (projected to grow 2.5 percent over 2018-2027 compared to 1.1 percent during the period of 2014-2017).
Selected highlights in projected health insurance enrollment and national health expenditures by sector and payer include:
Health Insurance Enrollment: Net enrollment gains across all sources are generally expected to keep pace with population growth with the insured share of the population going from 90.9 percent in 2017 to 89.7 percent in 2027.
Medicare: Medicare spending growth is projected to average 7.4 percent over 2018-2027, the fastest rate among the major payers. Underlying the strong average annual Medicare spending growth are projected sustained strong enrollment growth as the baby-boomers continue to age into the program and growth in the use and intensity of covered services that is consistent with the rates observed during Medicare’s long-term history.
Medicaid: Average annual growth of 5.5 percent is projected for Medicaid spending for 2018-2027. Medicaid expansions during 2019 in Idaho, Maine, Nebraska, Utah, and Virginia are expected to result in the first acceleration in growth in spending for the program since 2014 (from 2.2 percent in 2018 to 4.8 percent in 2019). Medicaid spending growth is then projected to average 6.0 percent for 2020 through 2027 as the program’s spending patterns reflect an enrollment mix more heavily influenced by comparatively more expensive aged and disabled enrollees.
Private Health Insurance and Out-of-Pocket: For 2018-2027, private health insurance spending growth is projected to average 4.8 percent, slowest among the major payers, which is partly due to slow enrollment growth related to the baby-boomers transitioning from private coverage into Medicare. Out-of-pocket expenditures are also projected to grow at an average rate of 4.8 percent over 2018-2027 and to represent 9.8 percent of total spending by 2027 (down from 10.5 percent in 2017).
Prescription Drugs: Spending growth for prescription drugs is projected to generally accelerate over 2018-2027 (and average 5.6 percent) mostly as a result of faster utilization growth. Underlying faster growth in the utilization of prescription drugs, particularly over 2020-2027, are a number of factors including efforts on the part of employers and insurers to encourage better medication adherence among those with chronic conditions, changing pharmacotherapy guidelines, faster projected private health insurance spending growth in lagged response to higher income growth, and an expected influx of new and expensive innovative drugs into the market towards the latter stage of the period.
Hospital: Hospital spending growth is projected to average 5.6 percent for 2018-2027. This includes a projected acceleration in 2019, to 5.1 percent from 4.4 percent in 2018, reflecting the net result of faster expected growth in both Medicare (higher payment updates) and Medicaid (as a result of expansion in five states), but slower projected growth in private health insurance as enrollment declines slightly due to the repeal of the individual mandate.
Physician and Clinical Services: Physician and clinical services spending is projected to grow an average of 5.4 percent per year over 2018-2027. This includes faster growth in prices over 2020-2027 for physician and clinical services due to anticipated rising wage growth related to increased demand from the aging population.
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html
National Health Expenditure Projections, 2018–27: Economic And Demographic Trends Drive Spending And Enrollment Growth
An article about the study is also being published by Health Affairs and is available here:
Abstract
National
health expenditures are projected to grow at an average annual rate of
5.5 percent for 2018–27 and represent 19.4 percent of gross domestic
product in 2027. Following a ten-year period largely influenced by the
Great Recession and major health reform, national health spending growth
during 2018–27 is expected to be driven primarily by long-observed
demographic and economic factors fundamental to the health sector.
Prices for health care goods and services are projected to grow
2.5 percent per year, on average, for 2018–27—faster than the average
price growth experienced over the last decade—and to account for nearly
half of projected personal health care spending growth. Among the major
payers, average annual spending growth in Medicare (7.4 percent) is
expected to exceed that in Medicaid (5.5 percent) and private health
insurance (4.8 percent) over the projection period, mostly as a result
of comparatively higher projected enrollment growth. The insured share
of the population is expected to remain stable at around 90 percent
throughout the period, as net gains in health coverage from all sources
are projected to keep pace with population growth.
https://protect2.fireeye.com/url?k=529199bd-0ec4906d-5291a882-0cc47a6a52de-97641bdac742d461&u=http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05499
Universal Health Care: Is It possible in Maine?
Universal Health Care: Is it Possible in Maine? by Dr. Phil Caper and Matt Gagnon, Oct. 14, 2019
Thursday, October 31 at 2:00 pmSpeaking in Maine takes us next to Belfast for a discussion and debate about Health Care options for Maine, from Universal Health Care to Free Market options, with Dr. Phil Caper of Maine AllCare and Matt Gagnon of the Maine Heritage Policy Center.
In this discussion, Dr. Caper, advocating for universal health care, and Mr. Gagnon, promoting free-market alternatives, provide background for listeners who might have a heightened interest based on the upcoming 2020 political season.
Moderator for the talk, Jim Campbell (Board President of the Maine Freedom of Information Coalition), began by asking the speakers to define what they meant by universal health care. While both agreed in theory to the idea of covering as many people as possible, Mr. Gagnon believed calling it a human right oversimplified the question. “Health care is a fixed resource. Every question of care comes down to: how can you serve the most people?”
Dr. Caper countered with his belief that every single person should be covered, that the US is the only wealthy country in the world without universal health care. “Other countries spend half of what we do on health care, and even with all that we spend, our life expectancy keeps dropping. Are they smarter? What are the barriers to reform?” he asked, citing money in politics as a major problem.
The two speakers saw different scenarios of what would result from the State of Maine adopting universal health care, with Mr. Gagnon fearing that people would leave the state in droves because of higher taxes. He cited Vermont as a state that worked hard to create a system for universal health care, characterizing their downfall due to businesses threatening to move away because of higher government costs, necessitating higher taxes.
Dr. Caper said Maine would attract new people by making health care premiums and co-pays disappear. Detaching employment from health care would encourage young entrepreneurs, freeing up economic growth as people become free to leave unsatisfying jobs. “We don’t need better insurance,” he said. “We need something better than insurance. Making money should not be the primary goal to health care.”
Both speakers agreed that the current system is a nightmare and that something needs to be done to clear away the inefficiencies, with Mr. Gagnon certain that nothing would happen in the short run and Dr. Caper arguing for phasing in a plan over a predetermined period of time.
Source: archives.weru.org/
https://www.mainepublic.org/post/universal-health-care-it-possible-maine
Economic Incentives Don’t Always Do What We Want Them To
By Esther Duflo and
At least since Adam Smith and his famous B’s (“It is not
from the benevolence of the butcher, the brewer, or the baker that we
expect our dinner, but from their regard to their own self-interest.”), a
fundamental premise of economics has been that financial incentives are
the primary driver of human behavior. Over the last few decades, this
faith in the power of economic incentives led policymakers in the United
States and elsewhere to focus, often with the best of intentions, on a
narrow range of “incentive-compatible” policies.
This is unfortunate, because economists have somehow managed to hide in plain sight an enormously consequential finding from their research: Financial incentives are nowhere near as powerful as they are usually assumed to be.
We see it among the rich. No one seriously believes that salary caps lead top athletes to work less hard in the United States than they do in Europe, where there is no cap. Research shows that when top tax rates go up, tax evasion increases (and people try to move), but the rich don’t work less. The famous Reagan tax cuts did raise taxable income briefly, but only because people changed what they reported to tax authorities; once this was over, the effect disappeared.
We see it among the poor. Notwithstanding talk about “welfare queens,” 40 years of evidence shows that the poor do not stop working when welfare becomes more generous. In the famous negative income tax experiments of the 1970s, participants were guaranteed a minimum income that was taxed away as they earned more, effectively taxing extra earnings at rates ranging from 30 percent to 70 percent, and yet men’s labor hours went down by less than 10 percent. More recently, when members of the Cherokee tribe started getting dividends from the casino on their land, which made them 50 percent richer on average, there was no evidence that they worked less.
This is unfortunate, because economists have somehow managed to hide in plain sight an enormously consequential finding from their research: Financial incentives are nowhere near as powerful as they are usually assumed to be.
We see it among the rich. No one seriously believes that salary caps lead top athletes to work less hard in the United States than they do in Europe, where there is no cap. Research shows that when top tax rates go up, tax evasion increases (and people try to move), but the rich don’t work less. The famous Reagan tax cuts did raise taxable income briefly, but only because people changed what they reported to tax authorities; once this was over, the effect disappeared.
We see it among the poor. Notwithstanding talk about “welfare queens,” 40 years of evidence shows that the poor do not stop working when welfare becomes more generous. In the famous negative income tax experiments of the 1970s, participants were guaranteed a minimum income that was taxed away as they earned more, effectively taxing extra earnings at rates ranging from 30 percent to 70 percent, and yet men’s labor hours went down by less than 10 percent. More recently, when members of the Cherokee tribe started getting dividends from the casino on their land, which made them 50 percent richer on average, there was no evidence that they worked less.
And
it is true of everyone else as well — tax incentives do very little.
For example, in famously “money-minded” Switzerland, when people got a
two-year tax holiday because the tax code changed, there was absolutely no change
in the labor supply. In the United States, economists have studied many
temporary changes in the tax rate or in retirement incentives, and for
the most part the impact of labor hours was minimal. Nor do people slack
off if they are guaranteed an income: The Alaska Permanent Fund, which,
since 1982, has handed out a yearly dividend of about $5,000 per
household, has had no adverse impact on employment.
On
the flip side, when jobs vanish and the local economy collapses, we
cannot count on people’s desire to seek out a better life to smooth
things out. The United States population is surprisingly immobile now.
Seven percent of the population used to move to another county every
year in the 1950s. Fewer than 4 percent did so in 2018. The decline
started in 1990 and accelerated in the mid-2000s, precisely at the time
when the industries in some regions
were hit by competition from Chinese imports. When jobs disappeared in
the counties that were producing toys, clothing or furniture, few people
looked for jobs elsewhere. Nor did they demand help to move or to
retrain — they stayed put and hoped things would improve. As a result,
one million jobs were lost and wages and purchasing power fell in those
communities, setting off a downward spiral of blight and hopelessness.
Marriage rates and fertility fell, and more children were born into
poverty.
Despite this, the faith in incentives is widely shared. We encountered this mismatch firsthand, when, in the fall of 2018, we (along with the economist Stefanie Stantcheva) conducted a survey of 10,000 Americans. We asked half of them what they thought someone should do if he or she were unemployed and a job was available 200 miles away. Sixty-two percent said the person should move. Fifty percent also said that they expected at least some people to stop working if taxes went up, and 60 percent thought that Medicaid beneficiaries are discouraged from working by the lack of a work requirement. Forty-nine percent answered yes when asked whether “many people” would stop working if there were a universal basic income of $13,000 a year with no strings attached.
Despite this, the faith in incentives is widely shared. We encountered this mismatch firsthand, when, in the fall of 2018, we (along with the economist Stefanie Stantcheva) conducted a survey of 10,000 Americans. We asked half of them what they thought someone should do if he or she were unemployed and a job was available 200 miles away. Sixty-two percent said the person should move. Fifty percent also said that they expected at least some people to stop working if taxes went up, and 60 percent thought that Medicaid beneficiaries are discouraged from working by the lack of a work requirement. Forty-nine percent answered yes when asked whether “many people” would stop working if there were a universal basic income of $13,000 a year with no strings attached.
But here is the twist: When we asked the other half of our sample the very same questions in reference to themselves, we
got very different responses. Only 52 percent said they would move for a
job, and this fell to 32 percent of those who were actually unemployed.
Seventy-two percent of them declared that an increase in taxes would
“not at all” lead them to stop working. Thirteen percent of respondents
said they would probably work less if they received Medicaid without a
work requirement; 12 percent said they would stop working if there were a
universal basic income. In other words, “Everyone else responds to
incentives, but I don’t.”
If it is not financial incentives, what else might people care about? The answer is something we know in our guts: status, dignity, social connections. Chief executives and top athletes are driven by the desire to win and be the best. The poor will walk away from social benefits if they come with being treated like a criminal. And among the middle class, the fear of losing their sense of who they are and their status in the local community can be an extraordinarily paralyzing force.
The trouble is that so much of America’s social policy has been shaped by three principles that ignore these facts; to fix it we need to start from there.
First, most policymakers are convinced that not much needs to be done. In the fantasy world where most economic policy conversations about trade shocks and technological innovations take place, people quickly adjust to those changes — workers move smoothly from making clothes in North Carolina to folding clothes in New York or selling clothes online. But in the real world, it is unreasonable to expect markets to always deliver outcomes that are just, acceptable — or even efficient. Disruptions (because of trade, robots or anything else) provoke real suffering. A study in Pennsylvania found that when workers with long tenure got fired during mass layoffs, they were substantially more likely to die in the years immediately afterward.
Second, let’s drop the talk about “dependency” and “welfare cultures,” powerfully articulated by Ronald Reagan, and never really contested since then. (After all, it was under Bill Clinton that “welfare as we know it” was ended.) Government intervention is necessary to help people move when it makes sense, but also, sometimes, to stay in place without losing their livelihoods and their dignity. The success of the populist agenda came from casting the working class as the victims of a war waged against them and offering them the ersatz protection of various “walls.” To counter that, policymakers must acknowledge that those who struggle economically are, in a sense, society’s fallen heroes, and that we need to treat them as such.
A first idea here might be a G.I. Bill for the “veterans” of disruptions. Since 1974, the Trade Adjustment Assistance program has offered workers displaced by international trade extended unemployment benefits and up to $10,000 in education credit to help them retrain. The few people who had access to it were indeed more likely to end up in better jobs — in the 10 years after losing their jobs, workers who benefited from T.A.A. earned $50,000 more than those who did not. But as a federal program it remains minuscule — regions most affected by trade got a paltry extra 23 cents per head in T.A.A. money every year, compared with $549 in lost income.
T.A.A. could be made much more generous, both in its coverage and in the benefits it offers. Like the G.I. Bill, it could offer full tuition at public universities, up to a cap of several thousand dollars a month, and a housing stipend; in addition, there would be generous unemployment benefits, especially in the most severely affected counties. Perhaps more controversially, a second idea would be the equivalent of a Marshall Plan for the affected regions, with significant subsidies for firms to keep older workers employed.
Third, we should not be unduly scared of raising taxes to pay for these projects. There is no evidence that it would disrupt the economy. This is, of course, a touchy subject politically: The idea of raising taxes on anyone but the very rich is not popular. So we should start with raising the rates on top income and adding a wealth tax, as many have proposed. The key then would be to link the added revenue to efforts like the ones we describe above, which would serve to slowly restore the legitimacy of the government’s efforts to help those in need. This will take time, but we have to start somewhere — and soon.
https://www.nytimes.com/2019/10/26/opinion/sunday/duflo-banerjee-economic-incentives.html?
Editor's Note -
So much for pay-for-performance, and its first cousin value-based payment!!
SPC
That Beloved Hospital? It’s Driving Up Health Care Costs
by Elisabeth Rosenthal - NYT - September 1, 2019
As voters fume about the high cost of health care,
politicians have been targeting two well-deserved villains:
pharmaceutical companies, whose prices have risen more than inflation, and insurers, who pay their executives millions in salaries while raising premiums and deductibles.
But while the Democratic presidential candidates have devoted copious airtime to debating health care, many of the country’s leading health policy experts have wondered why they have given a total pass to arguably a primary culprit behind runaway medical inflation: America’s hospitals.
Data shows that hospitals are by far the biggest cost in our $3.5 trillion health care system, where spending is growing faster than gross domestic product, inflation and wage growth. Spending on hospitals represents 44 percent of personal expenses for the privately insured, according to Rand.
A report this year from researchers at Yale and other universities found that hospital prices increased a whopping 42 percent from 2007 to 2014 for inpatient care and 25 percent for outpatient care, compared with 18 percent and 6 percent for physicians.
But while the Democratic presidential candidates have devoted copious airtime to debating health care, many of the country’s leading health policy experts have wondered why they have given a total pass to arguably a primary culprit behind runaway medical inflation: America’s hospitals.
Data shows that hospitals are by far the biggest cost in our $3.5 trillion health care system, where spending is growing faster than gross domestic product, inflation and wage growth. Spending on hospitals represents 44 percent of personal expenses for the privately insured, according to Rand.
A report this year from researchers at Yale and other universities found that hospital prices increased a whopping 42 percent from 2007 to 2014 for inpatient care and 25 percent for outpatient care, compared with 18 percent and 6 percent for physicians.
So why have
politicians on both the left and right let hospitals off scot-free?
Because a web of ties binds politicians to the health care system.
Every senator, virtually every congressman and every mayor of every large city has a powerful hospital system in his or her district. And those hospitals are as politically untouchable as soybean growers in Iowa or oil producers in Texas.
As hospitals and hospital systems have consolidated, they have become the biggest employers in numerous cities and states. They have replaced manufacturing as the hometown industry in a number of rust-belt cities, including Cleveland and Pittsburgh.
Can Kamala Harris ignore the requests of Sutter Health, Kaiser Permanente, U.C.L.A. or any of the big health care systems in California? Can Elizabeth Warren ignore the needs of Partners HealthCare, Boston’s behemoth? (Bernie Sanders may be somewhat different on this front because Vermont doesn’t have any nationally ranked hospitals.)
Beyond that, hospitals are often beloved by constituents. It’s easy to get voters riled up about a drug maker in Silicon Valley or an insurer in Hartford. It’s much riskier to try to direct their venom at the place where their children were born; that employed their parents as nurses, doctors and orderlies; that sponsored local Little League teams; that was associated with their Catholic Church.
Every senator, virtually every congressman and every mayor of every large city has a powerful hospital system in his or her district. And those hospitals are as politically untouchable as soybean growers in Iowa or oil producers in Texas.
As hospitals and hospital systems have consolidated, they have become the biggest employers in numerous cities and states. They have replaced manufacturing as the hometown industry in a number of rust-belt cities, including Cleveland and Pittsburgh.
Can Kamala Harris ignore the requests of Sutter Health, Kaiser Permanente, U.C.L.A. or any of the big health care systems in California? Can Elizabeth Warren ignore the needs of Partners HealthCare, Boston’s behemoth? (Bernie Sanders may be somewhat different on this front because Vermont doesn’t have any nationally ranked hospitals.)
Beyond that, hospitals are often beloved by constituents. It’s easy to get voters riled up about a drug maker in Silicon Valley or an insurer in Hartford. It’s much riskier to try to direct their venom at the place where their children were born; that employed their parents as nurses, doctors and orderlies; that sponsored local Little League teams; that was associated with their Catholic Church.
And,
of course, there’s election money. Hospital trade groups, medical
centers and their employees are major political donors, contributing to
whichever party holds power — and often to the out-of-power party as
well. In 2018, PACs associated with the Greater New York Hospital Association,
and individuals linked to it, gave $4.5 million to the Democrats’
Senate Majority PAC and $1 million to their House Majority PAC. Its
chief lobbyist personally gave nearly a quarter of a million dollars to dozens of campaigns last year.
Senator Sanders has called on his competitors for the Democratic nomination to follow his lead and reject contributions from pharma and insurance. Can any candidate do the same for hospitals? The campaign committees of all 10 candidates participating in the upcoming Democratic debate have plentiful donations linked to the hospital and health care industry, according to Open Secrets.
But the symbiosis between hospitals and politicians operates most insidiously in the subtle fueling of each other’s interests. Zack Cooper, a health economist at Yale, and his colleagues looked at this life cycle of influence by analyzing how members of Congress voted for a Medicare provision that allowed hospitals to apply to have their government payments increased. Hospitals in districts of members who voted yea got more money than hospitals whose representatives voted nay, to the collective tune of $100 million. They used that money to hire more staff and increase payroll. They also spent millions lobbying to extend the program.
Members who voted yea in turn received a 25 percent increase in total campaign contributions and a 65 percent increase in contributions from individuals working in the health care industry in their home states. It was a win-win for both sides.
To defend their high prices, medical centers assert that they couldn’t afford to operate on Medicare payments, which are generally lower than what private insurers pay. But the argument isn’t convincing.
The cost of a hospital stay in the United States averaged $5,220 a day in 2015 — and could be as high as over $17,000, compared with $765 in Australia. In a Rand study published earlier this year, researchers calculated that hospitals treating patients with private health insurance were paid, overall, 2.4 times the Medicare rates in 2017, and nearly three times the rate for outpatient care. If the plans had paid according to Medicare’s formula, their spending would be reduced by over half.
Most economists think hospitals could do just fine with far less than they get today from private insurance.
Senator Sanders has called on his competitors for the Democratic nomination to follow his lead and reject contributions from pharma and insurance. Can any candidate do the same for hospitals? The campaign committees of all 10 candidates participating in the upcoming Democratic debate have plentiful donations linked to the hospital and health care industry, according to Open Secrets.
But the symbiosis between hospitals and politicians operates most insidiously in the subtle fueling of each other’s interests. Zack Cooper, a health economist at Yale, and his colleagues looked at this life cycle of influence by analyzing how members of Congress voted for a Medicare provision that allowed hospitals to apply to have their government payments increased. Hospitals in districts of members who voted yea got more money than hospitals whose representatives voted nay, to the collective tune of $100 million. They used that money to hire more staff and increase payroll. They also spent millions lobbying to extend the program.
Members who voted yea in turn received a 25 percent increase in total campaign contributions and a 65 percent increase in contributions from individuals working in the health care industry in their home states. It was a win-win for both sides.
To defend their high prices, medical centers assert that they couldn’t afford to operate on Medicare payments, which are generally lower than what private insurers pay. But the argument isn’t convincing.
The cost of a hospital stay in the United States averaged $5,220 a day in 2015 — and could be as high as over $17,000, compared with $765 in Australia. In a Rand study published earlier this year, researchers calculated that hospitals treating patients with private health insurance were paid, overall, 2.4 times the Medicare rates in 2017, and nearly three times the rate for outpatient care. If the plans had paid according to Medicare’s formula, their spending would be reduced by over half.
Most economists think hospitals could do just fine with far less than they get today from private insurance.
It would be unseemly for these nonprofit medical centers to make barrels of money. So when their operations generate huge surpluses — as many big medical centers do — they plow the money back into the system. They build another cancer clinic, increase C.E.O. pay, buy the newest scanner (whether it is needed or not) or install spas and Zen gardens.
Some rural hospitals are genuinely struggling. But many American hospitals have been spending capital “like water,” said Kevin Schulman a physician-economist at Stanford. The high cost of hospitals today, he said, is often a function of the cost of new infrastructure or poor management decisions. “Medicare is supposed to pay the cost of an efficient hospital,” he said. “If they’ve made bad decisions, why should we keep paying for that?”
If hospitals were paid less via regulation or genuine competition, they would look different, and they’d make different purchasing decisions about technology. But would that matter to medical results? Compared with their European counterparts, some American hospitals resemble seven-star hotels. And yet, on average, the United States doesn’t have better outcomes than other wealthy nations. By some measures — such as life expectancy and infant mortality — it scores worse than average.
As attorney general in California, Kamala Harris in 2012 initiated an antitrust investigation into hospitals’ high charges. But as a senator and presidential candidate, she has been largely silent on the issue — as have all the other candidates.
As Uwe Reinhardt, the revered Princeton health economist who died in 2017, told me, “If you want to save money, you have to pay less.” That means taking on hospital pricing.
So fine, go after drug makers and insurers. And for good measure, attack the device makers who profit from huge markups, and the pharmacy benefit managers — the middlemen who negotiate drug prices down for insurers, then keep the difference for themselves.
But with Congress returning to Washington in the coming days and a new Democratic debate less than two weeks away, our elected officials need to address the elephant in the room and tell us how they plan to rein in hospital excesses.
Elisabeth Rosenthal, a former New York Times correspondent, is the editor in chief of Kaiser Health News, the author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” and a contributing opinion writer.
https://www.nytimes.com/2019/09/01/opinion/hospital-spending.html?smid=nytcore-ios-share
Another View: Warren wise to avoid health finance trap
LTE - Portland Press Herald - October 29, 2019
The media and others have distorted the cost of Medicare for All to make it more frightening.
Re: “Another View: Warren fools no one by avoiding Medicare tax talk” (Oct. 19):I can’t blame Elizabeth Warren for being coy about how to pay for “Medicare for All.” I’ve seen little straightforward reporting about the cost of Medicare for All compared to alternatives. Instead, most coverage seems aimed at scaring people away from reasoned comparison and debate.
For example, the cost of the proposed Medicare for All is almost always presented as a 10-year number, but often does not mention the “10-year” timeframe when reporting that “scary big” number.
Secondly, media coverage almost never mentions that the current system of for-profit health insurance will cost as much or more than Medicare for All. Readers are left to infer that the quoted amounts are “in addition to” versus “instead of” the current for-profit health insurance system.
Thirdly, media coverage almost never points out that “premiums” on households and businesses to fund Medicare for All will be no more—and probably less—than “premiums and out of pockets” paid by these same households and businesses to fund the for-profit health insurance system. Characterizing the funding for single-payer as “taxes” while ignoring the simultaneous elimination of “premiums and out-of-pocket payments” invites the Norquistadors to pounce with shrieks of “She said ‘tax increase’! She said ‘tax increase’!”
Single-payer health insurance is big reform, and a legitimate option for solving a national problem. It deserves an honest comparison to the alternatives. If Elizabeth Warren could trust the media to do that, maybe she wouldn’t need to be so coy.
https://www.pressherald.com/2019/10/29/another-view-warren-wise-to-avoid-health-finance-trap/
Nurses want more security at Ellsworth hospital after multiple assaults by patients
by Bill Trotter - Bangor Daily News - October 27, 2019
Registered nurses and hospital
technicians say they want higher nurse staffing levels and
round-the-clock security where they work as part of a new contract at
Northern Light Health Maine Coast Hospital in Ellsworth.
Jennifer Nappi, a representative for Maine State Nurses
Association, said Friday that nurses want a third nurse on duty in the
emergency department during the overnight shift. She added that charge
nurses should not have patient assignments, which can hamper their
ability to assist and supervise other nurses. The nurses’ union
represents the nurses and technicians at the Ellsworth hospital.
There have been “multiple” incidents at the hospital in the
past two years in which nurses have been assaulted by patients — many of
whom are dealing with opioid withdrawal, Nappi said. She said there has
been no security presence at the hospital to assist nurses when
confrontations arise and that a plan by hospital administrators for a
limited daily security presence is insufficient.
“We want 24-hour security at the hospital,” Nappi said,
adding that some nurses at the hospital have been injured badly enough
that they have missed work, including one who quit her job shortly after
returning to work because of the lack of security for dealing with
combative patients.
The lack of round-the-clock security at the hospital “is not OK,” Nappi said.
In a statement Friday, union members at the hospital said
they are concerned for patient safety at the hospital and they want a
“fair” contract. They said they are planning to hold a vigil at 5 p.m.,
Tuesday in S.K. Whiting Park on the corner of Maine and Oak streets in
Ellsworth to draw attention to their position.
Registered nurses at the hospital have been in contract
negotiations with hospital administrators since May of this year,
according to the union. The hospital’s technicians have been trying to
negotiate their first contract with the hospital for nearly two years,
since November 2017.
Meanwhile, the hospital has been in the red in recent years,
according to financial data from the Maine Health Data Organization. In
the hospital’s fiscal year that ended Sept. 30, 2018, it raised $182.4
million in revenue but had $186.9 million in expenses, according to the hospital’s IRS tax filings.
In a statement, a hospital official said Friday that the
hospital continues to “negotiate in good faith” with the union for a
nursing employment contract and that the hospital is committed to
patient and employee safety.
“As Maine Coast frequently evaluates hospital safety, it
has recently increased security on campus to ensure that the hospital is
a safe place to give and receive care,” hospital spokesman Kelley
Columber said. “Representatives from Maine Coast Hospital will meet with
the MSNA again next month and looks forward to a successful resolution
soon.”
https://bangordailynews.com/2019/10/27/news/hancock/nurses-want-more-security-at-ellsworth-hospital-after-multiple-assaults-by-patients/?
https://bangordailynews.com/2019/10/27/news/hancock/nurses-want-more-security-at-ellsworth-hospital-after-multiple-assaults-by-patients/?
Charlie Baker’s health care bill could make a real difference
Editorial - The Boston Globe - October 26, 2019
Several
of the proposals in Baker’s bill are not new. Some items legislators
have been considering since last year’s abortive attempt to pass a
health care bill are in freestanding bills already filed this year.
There seems to be agreement, for example, that it’s time to address “surprise billing”
and limit the use of hospital facility fees. Those are the charges that
show up when a health care provider turns out to be out of network,
much to the surprise of a patient who ended up in the emergency room.
Ending the practice is overdue.
In another welcome reform, the bill would also require provider directories actually to mean what they say — to connect patients to services and clinicians that exist and will accept their insurance, not the “ghost networks” that too often make it impossible to access care, particularly mental health care. Again, similar bills were filed to make such changes this year.
The governor’s bill also aims to increase access to telemedicine for consumers by establishing a regulatory framework for those services and requiring insurers to cover them “if the same service is covered” for an in-office visit.
An especially ambitious part of Baker’s bill is an effort to reshape the delivery of services by requiring an increase in spending by hospitals and insurers of 30 percent over the next three years for primary care and behavioral health — without increasing overall spending. One astonishing fact stands out in our current system — today less than 15 percent of total medical expenses are spent on primary care and behavioral health combined, Baker said.
So, if the measure passes, health care facilities are going to have to think twice about investing capital funds in the newest MRI equipment or orthopedic center and investing more in primary care physicians, geriatric specialists, or mental health clinicians.
Which brings us to one of Baker’s other big ideas: fixing a mental health system where 50 percent of practitioners will not accept insurance — not MassHealth, not Medicare, not even private insurance. Even though the Commonwealth currently ranks number one in mental health providers available by population (1 for every 180 residents), actually seeing one is out of reach for too many residents.
Provisions in the bill to require one universal credentialing form to be used by all insurers would cut down on paperwork for behavioral health providers — something the Legislature should embrace. Anticipated rate increases (by establishing a “bottom line” for certain services) and a fairer rate system of billing for clinicians in training are also aimed at encouraging more clinicians to join the marketplace.
Some of the most controversial parts of the bill involve the governor’s attempt to control drug costs, which both the administration and legislative leaders seem to agree is a major driver of overall health care costs. One provision would extend more extensive state oversight to drugs that cost more than $50,000 per person per year — even if bought through the private market. A similar provision was added to the state budget this year but only for drugs purchased under the state’s MassHealth system. This seems a natural extension — although even that was subject to extensive lobbying by the drug industry, which remains unhappy with any attempt at price regulations.
That would, of course, make them totally apoplectic about the Baker effort to subject all drugs to a price cap of no more than inflation plus 2 percent. Call it the “Epi-Pen provision,” after the drug manufacturer everyone loves to hate. No other state has tried it — and, indeed, price caps could be a bridge too far: Lawmakers ought to subject the idea to careful scrutiny to make sure it’s not too blunt an instrument.
The very length and breadth of the bill will make it difficult for lawmakers to get their arms around, as House Speaker Robert DeLeo has indicated. He wasn’t unfriendly to many of its ideas, but noted that it will probably have to be dissected by several committees. Senate President Karen Spilka also seems supportive but favors a piece-by-piece approach.
The governor, a one-time CEO of one of the state’s largest insurers, seems an unlikely health care revolutionary. But who better to tackle an industry that even in this health care mecca — or perhaps especially in this health care mecca — cries out for a change in attitude and a reordering of how it cares for patients.
https://www.bostonglobe.com/opinion/editorials/2019/10/26/charlie-baker-looks-for-health-care-revolution/diuzsAcySIO17MrNZiuCmN/story.html?
The
number of such shortages has been growing, according to the report. The
shortages also are lasting longer, in some cases for years.
An analysis in the report found that two-thirds of 163 drugs in short supply in recent years were available as generics, generally at low cost. The medications were older, too, on the market for a median of almost 35 years.
But quality-control problems at manufacturing facilities were responsible for more than half of recent drug shortages, the task force also found.
The group’s proposed solutions also included new “quality ratings” that might help drug companies attract higher prices and increase market share. (Many shortages, however, occur when problems affect a company that is the sole supplier of a drug.)
The task force stopped short of suggesting greater governmental involvement in drug procurement, concluding that the shortages are likely to continue absent dramatic changes in the “broken marketplace.”
But with more people having either an ACA marketplace plan or Medicaid, the state’s uninsured rate should plummet.
Several thousand Mainers who currently have ACA insurance but qualify for Medicaid under expansion will be automatically switched to Medicaid during the Nov. 1-Dec. 15 enrollment if they haven’t already signed up for Medicaid. People who are interested in renewing or obtaining individual health insurance for 2020 can find out more information at CoverME.gov and at enroll207.com.
Those earning up to 400 percent of the federal poverty level, or $83,120 for a family of three, are eligible for subsidized ACA insurance. Seventy-four percent of Maine residents eligible for ACA insurance will be able to select a plan with a $75 or lower monthly premium, according to federal data.
Maine voters approved Medicaid expansion in 2017, but former Republican Gov. Paul LePage refused to implement it. Democratic Gov. Janet Mills implemented the expansion on her first day in office, and since then about 40,000 people have signed up for Medicaid, according to state data. Thousands more are expected to enroll in Medicaid in the coming months, including those who are switched from ACA plans to Medicaid.
Mitchell Stein, a Maine-based independent health policy analyst, said that while he doesn’t have a signup projection, he does expect fewer Mainers to sign up for ACA insurance.
“I expect ACA enrollment to go down, but for a good reason,” Stein said. Maine had roughly 70,000 people sign up for ACA coverage last year, down from a peak of 84,059 in 2016.
Although repeal efforts have so far failed, the Trump administration has taken numerous steps to weaken the ACA, including eliminating the individual mandate that required adults to sign up for insurance or pay a penalty, and slashing outreach and advertising budgets.
Nationally, since President Trump took office, ACA enrollment has declined from 12.7 million to 11.4 million. Still, despite predictions it would collapse, “the ACA is alive and well,” said Ann Woloson, executive director of Maine-based Consumers for Affordable Health Care.
Stein said Medicaid expansion means fewer people in Maine will be uninsured.
States that have refused to expand Medicaid have about double the uninsured rate of expansion states, according to the Kaiser Family Foundation. Maine’s uninsured rate before it expanded Medicaid was about 8 to 10 percent, based on estimates by three separate groups, including the U.S. Census, the Kaiser Family Foundation and Gallup.
Before Maine expanded Medicaid, those who were unable to obtain insurance through an employer – and who earned between 100 and 138 percent of the federal poverty limit, between $20,780 to $28,676 for a family of three – could purchase ACA marketplace insurance. Those enrollees were permitted to keep their ACA plans in 2019, but will be migrated to Medicaid for 2020.
Exactly how many people will be switched from an ACA plan to Medicaid is unclear, but a rough estimate from Kaiser Family Foundation state-by-state statistics shows that it probably will be about 5,000 to 9,000 people in Maine.
Stein pointed out that, especially for low-income residents, Medicaid is likely to be superior insurance.
Medicaid has zero or nominal out-of-pocket costs for patients, while ACA insurance can have co-pays, deductibles and monthly premiums. ACA premiums for low-income enrollees are low, usually about $10 to $20 per month. Some plans have zero premiums.
Rates for 2020 declined or increased slightly depending on the insurer, according to the Maine Bureau of Insurance, ranging from a decrease of 7 percent to a 0.9 percent increase. Maine has stabilized ACA rates through a reinsurance program. People who get subsidies to purchase insurance – about 85 percent of enrollees – are shielded from rate increases.
Those with ACA insurance in Maine are more likely to be older and live in rural areas, with 51 percent between the ages of 45-64, and 56 percent living in rural parts of the state, according to the federal Center for Medicare and Medicaid Services.
Meanwhile, Maine is ramping up efforts to publicize ACA open enrollment, even as the Trump administration cuts outreach efforts. Called the CoverME campaign, the effort includes the new www.CoverME.gov website, digital and television ads promoting Medicaid and the ACA, and beefed-up in-person assistance. A $750,000 grant from the Robert Wood Johnson Foundation is helping to publicize the CoverME campaign.
“For the first time in Maine, open enrollment is an opportunity for Maine people and small businesses to understand their options for affordable, high-quality coverage through both (Medicaid) and HealthCare.gov, with no coverage gaps. We look forward to launching the statewide CoverME campaign to help people in every corner of Maine get the insurance they need to live healthy lives,” Jeanne Lambrew, Maine’s health and human services commissioner, said in a statement.
Also, Maine is proposing to switch from a federally run marketplace to a state-run ACA marketplace in 2021, which would unlock an additional $2 million in federal funding for outreach efforts.
https://www.pressherald.com/2019/10/30/maine-aca-enrollment-expected-to-drop-as-medicaid-expansion-continues/
In another welcome reform, the bill would also require provider directories actually to mean what they say — to connect patients to services and clinicians that exist and will accept their insurance, not the “ghost networks” that too often make it impossible to access care, particularly mental health care. Again, similar bills were filed to make such changes this year.
The governor’s bill also aims to increase access to telemedicine for consumers by establishing a regulatory framework for those services and requiring insurers to cover them “if the same service is covered” for an in-office visit.
An especially ambitious part of Baker’s bill is an effort to reshape the delivery of services by requiring an increase in spending by hospitals and insurers of 30 percent over the next three years for primary care and behavioral health — without increasing overall spending. One astonishing fact stands out in our current system — today less than 15 percent of total medical expenses are spent on primary care and behavioral health combined, Baker said.
So, if the measure passes, health care facilities are going to have to think twice about investing capital funds in the newest MRI equipment or orthopedic center and investing more in primary care physicians, geriatric specialists, or mental health clinicians.
Which brings us to one of Baker’s other big ideas: fixing a mental health system where 50 percent of practitioners will not accept insurance — not MassHealth, not Medicare, not even private insurance. Even though the Commonwealth currently ranks number one in mental health providers available by population (1 for every 180 residents), actually seeing one is out of reach for too many residents.
Provisions in the bill to require one universal credentialing form to be used by all insurers would cut down on paperwork for behavioral health providers — something the Legislature should embrace. Anticipated rate increases (by establishing a “bottom line” for certain services) and a fairer rate system of billing for clinicians in training are also aimed at encouraging more clinicians to join the marketplace.
Some of the most controversial parts of the bill involve the governor’s attempt to control drug costs, which both the administration and legislative leaders seem to agree is a major driver of overall health care costs. One provision would extend more extensive state oversight to drugs that cost more than $50,000 per person per year — even if bought through the private market. A similar provision was added to the state budget this year but only for drugs purchased under the state’s MassHealth system. This seems a natural extension — although even that was subject to extensive lobbying by the drug industry, which remains unhappy with any attempt at price regulations.
That would, of course, make them totally apoplectic about the Baker effort to subject all drugs to a price cap of no more than inflation plus 2 percent. Call it the “Epi-Pen provision,” after the drug manufacturer everyone loves to hate. No other state has tried it — and, indeed, price caps could be a bridge too far: Lawmakers ought to subject the idea to careful scrutiny to make sure it’s not too blunt an instrument.
The very length and breadth of the bill will make it difficult for lawmakers to get their arms around, as House Speaker Robert DeLeo has indicated. He wasn’t unfriendly to many of its ideas, but noted that it will probably have to be dissected by several committees. Senate President Karen Spilka also seems supportive but favors a piece-by-piece approach.
The governor, a one-time CEO of one of the state’s largest insurers, seems an unlikely health care revolutionary. But who better to tackle an industry that even in this health care mecca — or perhaps especially in this health care mecca — cries out for a change in attitude and a reordering of how it cares for patients.
https://www.bostonglobe.com/opinion/editorials/2019/10/26/charlie-baker-looks-for-health-care-revolution/diuzsAcySIO17MrNZiuCmN/story.html?
U.S. Blames Drug Shortages on Low Prices and a ‘Broken Marketplace’
by Roni Caryn Rabin - NYT - October 29, 2019
Chronic drug shortages that threaten patient care are
caused by rock-bottom prices for older generic medicines and a health
care marketplace that doesn’t run on the rules of supply and demand,
among other factors, according to a federal report published on Tuesday.
The report, the work of a task force led by the Food and Drug Administration and comprising representatives from various federal agencies, recommended that buyers like hospitals consider paying higher prices for older generic drugs.
Paying more would encourage drug companies to prioritize drugs like vincristine, a critical cancer medicine for children that now sells for just $8 a vial. To the consternation of cancer specialists, supplies of the drug recently have been scarce.
Cancer drugs are not the only medications in short supply. At any given time in the United States, there are shortages of well over 100 drugs, including many used for anesthesia, palliative care and septic shock, as well as vaccines and medical supplies like sterile water.
The report, the work of a task force led by the Food and Drug Administration and comprising representatives from various federal agencies, recommended that buyers like hospitals consider paying higher prices for older generic drugs.
Paying more would encourage drug companies to prioritize drugs like vincristine, a critical cancer medicine for children that now sells for just $8 a vial. To the consternation of cancer specialists, supplies of the drug recently have been scarce.
Cancer drugs are not the only medications in short supply. At any given time in the United States, there are shortages of well over 100 drugs, including many used for anesthesia, palliative care and septic shock, as well as vaccines and medical supplies like sterile water.
An analysis in the report found that two-thirds of 163 drugs in short supply in recent years were available as generics, generally at low cost. The medications were older, too, on the market for a median of almost 35 years.
But quality-control problems at manufacturing facilities were responsible for more than half of recent drug shortages, the task force also found.
The group’s proposed solutions also included new “quality ratings” that might help drug companies attract higher prices and increase market share. (Many shortages, however, occur when problems affect a company that is the sole supplier of a drug.)
The task force stopped short of suggesting greater governmental involvement in drug procurement, concluding that the shortages are likely to continue absent dramatic changes in the “broken marketplace.”
That was a disappointment to doctors on the front lines of care, especially those treating children with cancer.
“The government has previously stepped into the marketplace to assist the ailing automotive industry, Wall Street and the insurance companies,” said Dr. Yoram Unguru, who treats children with cancer at the Herman and Walter Samuelson Children’s Hospital at Sinai in Baltimore.
“Why not do the same for our ailing health care system, specifically the manner in which lifesaving medications are manufactured and distributed?”
Essential medications should be viewed as “critical infrastructure, not unlike public utilities such as electricity and water,” Dr. Unguru added. Preventable cancer drug shortages “are unacceptable and ethically unjustifiable,” he said.
A shortage of a generic cancer drug, vincristine, has panicked parents in recent weeks and sent doctors scrambling to secure supplies. Vincristine is the backbone of treatment for many childhood cancers and is critical in the treatment of acute lymphoblastic leukemia, the most common childhood cancer.
But the solutions proposed in the federal report, if put in place, may not have any impact in the near term, said Dr. Peter C. Adamson, chair of the Children’s Oncology Group, and “fall short in ensuring that today’s children with cancer will not continue to be placed at risk.”
A spokeswoman for Pfizer, the sole supplier of vincristine in the United States, said that the company believed deliveries would meet patient needs through the end of the year, and that the company expected to fully recover from the shortage by January.
“In terms of filling orders, it depends on the date of the order, the level of customer inventory and the exact customer need,” the spokeswoman said. “We are doing all we can to make sure no patient misses a single dose.”
https://www.nytimes.com/2019/10/29/health/drug-shortages-generics.html
Editor's Note: =
One way to solve the critical shortage of generic drugs would be for the government take over the task of manufacturing and distributing them. Wonder why that wasn't mentioned in this "government" report? Maybe it's too sensible.
- SPC
“The government has previously stepped into the marketplace to assist the ailing automotive industry, Wall Street and the insurance companies,” said Dr. Yoram Unguru, who treats children with cancer at the Herman and Walter Samuelson Children’s Hospital at Sinai in Baltimore.
“Why not do the same for our ailing health care system, specifically the manner in which lifesaving medications are manufactured and distributed?”
Essential medications should be viewed as “critical infrastructure, not unlike public utilities such as electricity and water,” Dr. Unguru added. Preventable cancer drug shortages “are unacceptable and ethically unjustifiable,” he said.
A shortage of a generic cancer drug, vincristine, has panicked parents in recent weeks and sent doctors scrambling to secure supplies. Vincristine is the backbone of treatment for many childhood cancers and is critical in the treatment of acute lymphoblastic leukemia, the most common childhood cancer.
But the solutions proposed in the federal report, if put in place, may not have any impact in the near term, said Dr. Peter C. Adamson, chair of the Children’s Oncology Group, and “fall short in ensuring that today’s children with cancer will not continue to be placed at risk.”
A spokeswoman for Pfizer, the sole supplier of vincristine in the United States, said that the company believed deliveries would meet patient needs through the end of the year, and that the company expected to fully recover from the shortage by January.
“In terms of filling orders, it depends on the date of the order, the level of customer inventory and the exact customer need,” the spokeswoman said. “We are doing all we can to make sure no patient misses a single dose.”
https://www.nytimes.com/2019/10/29/health/drug-shortages-generics.html
Editor's Note: =
One way to solve the critical shortage of generic drugs would be for the government take over the task of manufacturing and distributing them. Wonder why that wasn't mentioned in this "government" report? Maybe it's too sensible.
- SPC
Maine ACA enrollment expected to drop as state continues its Medicaid expansion
by Joe Lawlor - October 30, 2019
Open enrollment for the Affordable Care Act marketplace begins Friday, and Maine’s Medicaid expansion will likely contribute to a decline in 2020 signups for ACA coverage, experts say.But with more people having either an ACA marketplace plan or Medicaid, the state’s uninsured rate should plummet.
Several thousand Mainers who currently have ACA insurance but qualify for Medicaid under expansion will be automatically switched to Medicaid during the Nov. 1-Dec. 15 enrollment if they haven’t already signed up for Medicaid. People who are interested in renewing or obtaining individual health insurance for 2020 can find out more information at CoverME.gov and at enroll207.com.
Those earning up to 400 percent of the federal poverty level, or $83,120 for a family of three, are eligible for subsidized ACA insurance. Seventy-four percent of Maine residents eligible for ACA insurance will be able to select a plan with a $75 or lower monthly premium, according to federal data.
Maine voters approved Medicaid expansion in 2017, but former Republican Gov. Paul LePage refused to implement it. Democratic Gov. Janet Mills implemented the expansion on her first day in office, and since then about 40,000 people have signed up for Medicaid, according to state data. Thousands more are expected to enroll in Medicaid in the coming months, including those who are switched from ACA plans to Medicaid.
Mitchell Stein, a Maine-based independent health policy analyst, said that while he doesn’t have a signup projection, he does expect fewer Mainers to sign up for ACA insurance.
“I expect ACA enrollment to go down, but for a good reason,” Stein said. Maine had roughly 70,000 people sign up for ACA coverage last year, down from a peak of 84,059 in 2016.
Although repeal efforts have so far failed, the Trump administration has taken numerous steps to weaken the ACA, including eliminating the individual mandate that required adults to sign up for insurance or pay a penalty, and slashing outreach and advertising budgets.
Nationally, since President Trump took office, ACA enrollment has declined from 12.7 million to 11.4 million. Still, despite predictions it would collapse, “the ACA is alive and well,” said Ann Woloson, executive director of Maine-based Consumers for Affordable Health Care.
Stein said Medicaid expansion means fewer people in Maine will be uninsured.
States that have refused to expand Medicaid have about double the uninsured rate of expansion states, according to the Kaiser Family Foundation. Maine’s uninsured rate before it expanded Medicaid was about 8 to 10 percent, based on estimates by three separate groups, including the U.S. Census, the Kaiser Family Foundation and Gallup.
Before Maine expanded Medicaid, those who were unable to obtain insurance through an employer – and who earned between 100 and 138 percent of the federal poverty limit, between $20,780 to $28,676 for a family of three – could purchase ACA marketplace insurance. Those enrollees were permitted to keep their ACA plans in 2019, but will be migrated to Medicaid for 2020.
Exactly how many people will be switched from an ACA plan to Medicaid is unclear, but a rough estimate from Kaiser Family Foundation state-by-state statistics shows that it probably will be about 5,000 to 9,000 people in Maine.
Stein pointed out that, especially for low-income residents, Medicaid is likely to be superior insurance.
Medicaid has zero or nominal out-of-pocket costs for patients, while ACA insurance can have co-pays, deductibles and monthly premiums. ACA premiums for low-income enrollees are low, usually about $10 to $20 per month. Some plans have zero premiums.
Rates for 2020 declined or increased slightly depending on the insurer, according to the Maine Bureau of Insurance, ranging from a decrease of 7 percent to a 0.9 percent increase. Maine has stabilized ACA rates through a reinsurance program. People who get subsidies to purchase insurance – about 85 percent of enrollees – are shielded from rate increases.
Those with ACA insurance in Maine are more likely to be older and live in rural areas, with 51 percent between the ages of 45-64, and 56 percent living in rural parts of the state, according to the federal Center for Medicare and Medicaid Services.
Meanwhile, Maine is ramping up efforts to publicize ACA open enrollment, even as the Trump administration cuts outreach efforts. Called the CoverME campaign, the effort includes the new www.CoverME.gov website, digital and television ads promoting Medicaid and the ACA, and beefed-up in-person assistance. A $750,000 grant from the Robert Wood Johnson Foundation is helping to publicize the CoverME campaign.
“For the first time in Maine, open enrollment is an opportunity for Maine people and small businesses to understand their options for affordable, high-quality coverage through both (Medicaid) and HealthCare.gov, with no coverage gaps. We look forward to launching the statewide CoverME campaign to help people in every corner of Maine get the insurance they need to live healthy lives,” Jeanne Lambrew, Maine’s health and human services commissioner, said in a statement.
Also, Maine is proposing to switch from a federally run marketplace to a state-run ACA marketplace in 2021, which would unlock an additional $2 million in federal funding for outreach efforts.
https://www.pressherald.com/2019/10/30/maine-aca-enrollment-expected-to-drop-as-medicaid-expansion-continues/
