In this week’s summary, you’ll find new federal regulations to address abuse of prescription pain meds, unintended consequences of ACA for those with individual coverage, ACA’s method to address the country’s embarrassing infant mortality rate, and more!
Affordable Care Act/Health Exchanges
The New York Times reports that contractors have identified the problems plaguing the federal online insurance marketplace. Repairs are so extensive, that experts predict that it will be weeks before the system operates smoothly. The Centers for Medicare and Medicaid Services have employed 55 contractors with separately designed databases and software to establish the online exchange. Internal debate continues on appointing a single information technology company to take over this role from the agency.
The Albany Times Union writes that according to New York’s health exchange executive director, Donna Frescatore, nearly 150,000 people have registered with the state’s online marketplace and thousands have enrolled. Since New York opted to run its own health marketplace, it is not affected by the problems experienced by the federal exchange.
Hundreds of thousands of people who buy their own health insurance coverage are getting cancellation notices from their current health plans, according to Kaiser Health News. This change impacts approximately 14 million people nationwide who have purchased individual, or guaranteed issue policies. Insurers claim that existing policies fall short of Affordable Care Act requirements. New policies should offer comparable coverage at comparable costs, with the help of federal subsidies. But for many consumers who like their current coverage, this change comes as an unwelcome shock.
The new health law will not result in lower costs in many rural areas, despite promises to do so through increased competition among insurers, according to the New York Times. Rural towns and counties have fewer insurance carriers. More than one-half served by the federal exchange have only one or two carriers and there is no mechanism within the exchange construction to deal with this problem.
A primary goal of the Affordable Care Act is to reduce one of the country’s most intractable and embarrassing health statistics – a high infant mortality rate that is unfitting for an advanced nation. Under the new law, pregnant women will have guaranteed access to health insurance, which up until now, has been rare. For example, individual policies do not cover pregnancy. Countries that provide universal prenatal care access have seen their infant mortality rates drop, while the rate in the United States has increased over the last four decades. Fewer than two out of three pregnant women in some states receive no prenatal care in the first trimester. Almost 12 out of 100 American births are premature, which is more than twice the rate in other developed countries. The causes of infant mortality are complex and there is no guarantee that better insurance access will resolve the problem, but it is an approach that has seemed to help in other countries.
Psychology and other mental therapy practices have historically been sole proprietor practices. The new health law will force change in this model, according to Kaiser Health News, resulting in solo practices joining large medical groups. The Affordable Care Act (ACA) and the mental health parity law of 2008 mandate mental health care coverage. Implementation of the ACA will further change what has been, in many instances a cash business, to one reimbursed by insurers.
Changes to Prescription Pain Medications
New federal regulations, expected to go into effect in 2014, are designed to curb the abuse of prescription pain medications, according to the New York Times. Changes will include limits on the number of prescriptions a patient can receive before going back to see their doctor and requiring that patients bring a prescription to a pharmacy rather than have the prescriber phone the prescription in. These regulations come despite opposition from physician, patient and pharmacy groups.
According to Avalere Health, implementation of demonstration projects for dual eligible populations (Medicare and Medicaid eligible) has slowed nationwide, but New York and 14 other states are moving forward with projects this year and in 2014. New York is implementing a capitated managed care model, which combines payment from Medicare and Medicaid for all primary, acute, behavioral health and long term care services. Some states are implementing fee for service managed care models and others are utilizing a combined approach.
Patients who visit hospitals that are part of their insurance network, are often treated by physicians and others who are not covered by their health plans, according to this article by the New York Times. Even the Affordable Care Act, which caps out of pocket costs, does not protect consumers faced with costs associated with out of network care. As a result, patients across the country are faced with huge uncovered medical bills.