Health Law’s Risk Strategies Could Be Creating Reverse Robin Hood Effect
The original purpose of the obscure insurance risk adjustment was to support plans with a lot of sick patients by giving them money from ones with healthier customers. In reality, critics say, it’s not working that way. In other health law news, “concierge medicine” is no longer just for billionaires and more on what the Cadillac tax delay means.
The Washington Post: Critics Say ACA ‘Risk’ Strategies Are Having Reverse Robin Hood Effect The administration defends its approach, but critics say the “risk adjustment” program is having a reverse Robin Hood effect — taking money from some plans that are small, innovative or fast-growing, while handing windfalls to some of the industry’s most entrenched players. The goal of the practice is to help keep insurance markets stable by sharing the “risk” of sicker people and removing any incentive for plans to avoid individuals who need more medical care. Such stability is likely to encourage competition and keep overall prices lower for consumers, while its absence can undermine both and limit coverage choices — the basic principles of the law. (Goldstein, 1/13)
Kaiser Health News: Fueled By Health Law, ‘Concierge Medicine’ Reaches New Markets A growing number of primary care doctors, spurred by the federal health law and frustrations with insurance requirements, are bringing a service that generally has been considered “health care for billionaires” to middle-income, Medicaid and Medicare populations. It’s called direct primary care, modeled after “concierge” practices that have gained prominence in the past two decades. (Luthra, 1/14)
California Healthline: ‘Cadillac’ Tax Delay: A Chance To Refine or First Step To Kill It Altogether? Opponents of the Affordable Care Act’s so-called “Cadillac” tax won a major victory last month when President Obama delayed its implementation for two years via a spending package. Under the Cadillac tax, companies pay a 40% levy on the value of generous employee health plans above a certain limit. The first year of the tax calls for a $10,200 annual cap for an individual plan and a $27,500 cap family coverage. (Ackerman, 1/14)
Meanwhile, states prepare for the end of open enrollment —
The Sacramento Bee: No Health Insurance? Californians Face Tax Bite Of Up To $10,000 Per Family Sign up for health care coverage of pay the price. That’s the message from Covered California officials, who urged consumers Wednesday to sign up for Obamacare coverage by the Jan. 31 deadline or face stiff tax penalties. This year, the penalties are hitting harder, ranging from a minimum of $700 for an individual to as much as $10,000 for a family of four, depending on income. The average penalty in 2016 will be $969. That’s a 47 percent increase from last year, according to a recent analysis by the nonprofit Kaiser Family Foundation. (Buck, 1/13)
The Associated Press: MNsure Vows To Up Staffing To End Long Call-Wait Times Officials at MNsure vowed Wednesday to beef up call center staff for the final weeks of open enrollment, hoping to reverse lengthy call delays late last month that hark back to the exchange’s disastrous first year rollout. Just past a key deadline for consumers to buy insurance effective for the new year, MNsure said it is on track to meet projections for signups for the private plans that fund its budget. Open enrollment ends Jan. 31. But after focusing last year on improving its call center to soothe frustrated customers, some people still spent more than an hour waiting for help in the final week of December. (Potter, 1/13)
WBTV (Charlotte, N.C.): Woman Spends More Than 7 Hours On Hold With Blue Cross Blue Shield There’s a new song on repeat inside Stephanie Nelson’s home, but it’s not one you would expect. “That ping ping, just makes me want to punch somebody in the face,” Nelson said. Nelson is talking about the hold music that plays over and over as she waits for a representative from Blue Cross Blue Shield North Carolina to answer. … When WBTV visited Nelson Tuesday afternoon, she had been on hold for hours – nearly five to be exact – trying to work out her BCBS insurance policy that’s somehow disappeared. (Morgan, 1/14)
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations.