Tax Credits Estimated to Average $2,700 Per Family Next Year for People Who Now Buy Their Own Insurance

Americans who currently buy their own insurance through the individual market would receive tax credits averaging nearly $2,700 next year for coverage purchased through new insurance marketplaces, found a new study.

The tax credits or subsidies would cover 32 percent of the premiums on average for this group of enrollees in a so-called “silver” plan, according to the Kaiser Family Foundation analysis. .

Foundation researchers released the analysis as some states are releasing information on what premiums will be in 2014 when the Affordable Care Act’s market reforms and newly created health insurance marketplaces take effect.

The rate announcements illustrate “sticker prices” that do not reflect federal subsidies that will offset the cost of insurance for many current individual market policy holders, said the foundation based in Menlo Park, California.

“Tax subsidies are an essential part of the equation for many people who buy insurance through the new marketplaces next year,” Foundation President and CEO Drew Altman said. “They will help make coverage more affordable for low- and middle-income people.”

Under the ACA tax credits will be available to subsidize premiums for people who buy their insurance in the new marketplaces, do not have access to other affordable coverage, and have incomes between 100 percent and 400 percent of the federal poverty level (between about $11,500 and $46,000 for a single person, and $24,000 and $94,000 for a family of four).

An estimated 48 percent of people who currently have individual market coverage will be eligible for tax credits, researchers found. Tax credits among those eligible will average $5,548 per family, and subsidies will average $2,672 across all families now purchasing their own insurance, the researchers said.

Many people who are now uninsured will also be eligible for subsidies in the new marketplaces, and their tax credits will likely be higher on average since they have lower incomes than those who now buy their own coverage, the researchers said.

Using data from the Congressional Budget Office (CBO) and the federal government’s Survey of Income and Program Participation, study authors said the analysis estimates the average impact of the ACA on the individual market by quantifying how current enrollees will fare once relevant provisions of the health law are implemented.

Premium data released by states thus far suggest that the CBO premium projection is reliable, the researchers said. While subsidies and premiums will vary widely depending on each enrollee’s personal characteristics, the analysis focuses on averages to provide an indication of how much overall assistance the law will provide to people buying their own coverage today, the study authors added.

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Physicians Need To Adapt and Develop A Vision For the Future, IPA-PHO Survey Finds

The resurgence of hospitals buying physician practices, the shortage of primary care physicians, contract and reimbursement models, market consolidation and the pressure to transform primary care practices are among the key issues the leadership of the nation’s physician organizations – PHOs and IPAs are keenly concerned about.

The issues emerged from the results of the IPA -PHO Physician Organization Leadership Survey 2012 by the Managed Care Information Center (MCIC.) Continue reading

Health Systems Seen Needing New Strategies to Reorganize Delivery Models

To succeed in this new post-health reform arena, Health systems should prioritize information technology infrastructure development, information sharing, and timely distribution of information to ensure outstanding patient care, prepare for a patient-centered medical home and bundled payment system, and move toward best practice levels of care coordination, according to Health Strategies & Solutions, a Philadelphia-based consulting firm.

“The Supreme Court decision to uphold the major provisions of the ACA launches a new era in health care in the United States. Development of a robust foundation of primary care services must move to the forefront of strategic priorities for all health care providers,” the firm, with offices in a number of states, says in a white paper.

According to the firm’s white paper “Primary Care In An Era of Healthcare Reform” health care organizations that  Continue reading

SCOTUS Decision From the Payer and Provider Perspective

By Bob Jenkins

All sides of the health industry universe had ‘skin in the game’ riding on the US Supreme Court decision announced today.

“Health-Care Industry Gains Clarity” was the Wall Street Journal headline.

The upshot for the health-care industry: an influx of more than 30 million newly covered people with the means to pay for care. But there is also a cost, with an array of cutbacks to government reimbursement, new fees and taxes, and pressure to move to new payment models that boost efficiency and quality.

The court’s decision may also spark an effort to “get a bit more realistic about what can happen in the time frame” set out by the law, said Vicky Gregg, chief executive of BlueCross  BlueShield of Tennessee. Many states have stalled on implementing key provisions of the federal law, including the creation of the new marketplaces, known as exchanges, where consumers and small businesses will be able to buy health plans. http://online.wsj.com/article/SB10001424052702304441404577479042245939300.html

American College of Cardiology

“As we sort through the ramifications of this decision, it is important to remain focused on patients and overall health care delivery,” commented American College of Cardiology President William Zoghbi, MD, FACC, following the decision. “The goal should be a sustainable health care system that rewards quality and that allows physicians and their patients to determine together what is the most appropriate care. The American College of Cardiology believes a system that measures performance and rewards quality is the best way to improve public health and reduce costs.”

Hill Physicians Medical Group

The U.S. Supreme Court ruling is one that “clears away doubt, ” said Darryl Cardoza, CEO of Hill Physicians Medical Group, believed to be the largest IPA in the U.S.

“Over the last two years, many healthcare organizations have been working to respond to the new environment created by the reform legislation,” said  Cardoza.

“All that work has been done under a cloud of uncertainty about whether the law would be upheld. Today’s court ruling clears away that doubt. Everyone in health insurance and healthcare delivery now shares a common understanding of what’s expected.

It’s gratifying to know that millions more Americans soon will have access to care, and that doctors, hospitals, plans, employers and consumers now can work together to create more affordable care for everyone.”

AHIP

Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers, said America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni.

“As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.  The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.

“Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition.  Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”

Medicaid Health Plan Industry

“We commend the Supreme Court for keeping in place key elements of this historic legislation. MHPA and its member health plans remain committed to a strong partnership with the states and CMS to find a way to cover this population in need,” said Thomas L. Johnson, president and CEO of Medicaid Health Plans of America (MHPA).

The Medicaid health plan industry has been growing and will continue to grow as states continue to see Medicaid health plans as part of the solution to their budget woes, whether or not they participate in the expansion of Medicaid.

“We are pleased that the Medicaid drug rebate equalization policy included in the ACA remains intact. This provision that extended rebates to pharmaceuticals provided to Medicaid managed care enrollees represents a tremendous improvement in the administration of state Medicaid programs. The result will be improved care coordination and quality of care for beneficiaries enrolled in Medicaid health plans.

What the Supreme Court decision means for insurers, hospitals and drugmakers

Major health insurance stocks plummeted right after the ruling but have been edging upwards over the morning. That might reflect the market girding for the individual mandate being overturned (earlier this morning, InTrade had pegged the odds at 79 percent). That didn’t happen though – and that likely has insurance companies breathing a sigh of relief.

The big fear on the part of health insurance companies was that the individual mandate would get overturned, and people would only buy health insurance when they needed it. That would cause premiums to rise and enrollment to shrink.

Stocks of major hospital companies spiked after the Supreme Court decision, and with good reason: For decades they have been the ones who have covered the costs of providing health care to the uninsured. A federal law requires emergency rooms to provide stabilizing care to anyone whose life or bodily function may be threatened. It’s hospitals that often get stuck with that bill.

The Affordable Care Act will change that by expanding health insurance to about 30 million more Americans and making insurance companies responsible for paying their bills.

Pharmaceutical companies may be one of the industries least impacted by today’s news. About 4 percent of the industry’s revenue over the next eight years depends on the Affordable Care Act, according to the Bloomberg Government report.

Source Washing Post Wonk Blog http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/28/what-the-supreme-court-decision-means-for-insurers-hospitals-and-drugmakers/

From US News
The Unintended Consequences of the Supreme Court’s Decision

The Supreme Court settled one matter when it upheld the Patient Protection and Affordable Care Act: President Barack Obama’s landmark health reform law is constitutional and will go into effect as originally planned.  But a wide range of unintended consequences could ripple outward from the court’s historic decision.

  • Economic issues take a back seat
  • Consumers end up even more confused
  • Americans trust government even less

http://www.usnews.com/news/blogs/rick-newman/2012/06/28/the-unintended-consequences-of-the-supreme-courts-healthcare-ruling?google_editors_picks=true

Stocks of hospital companies rose sharply, and insurance companies fell immediately after the decision was announced that Americans must carry health insurance or pay a penalty.   http://www.gazette.com/articles/high-140946-ruling-care.html#ixzz1z7EGSLFi

Bob Jenkins is CEO of the Managed Care Information Center

Accountable Care Organizations – Shaking up the Medicare Reimbursement Status Quo Big Time

CMS is supposed to issue proposed regs governing ACOs this fall.

Then, expect the first ACOs to begin operating in January 2010 – just 15 months away!

We have organized an education program on ACOs this Thursday. Should be an eye opener.

Healthcare providers, hospitals, PHOs and IPAs and others, payers and even vendors need to be aware of the implications for the market and competition in the new ‘hot issue’ era of ACOs.

Hospitals, PHOs, IPAs and other physician organizations, networks or group practices need to make some quick decisions about ACOs.

If your organization is considering creating an ACO, you have no time to lose.

About the program – “Accountable Care Organizations: The Opportunities and the Risks,” a new management education audio webcast briefing, this Thursday, Sept. 30, 2010 from 1:30 PM – 2:30 PM EDT.

For details click on: http://www.healthresourcesonline.com/edu/Accountable-care-Organizations.htm