Mapping the Effects of the ACA's Health Insurance Coverage Expansions
The Affordable Care Act includes several provisions that allow many individuals across the U.S. to be eligible for Medicaid or for federal tax credits to subsidize the cost of insurance. The analysis below and zip code tool estimate the share of the population in geographic areas across the U.S. who had family income up to four times the poverty level in 2010 and were either uninsured or buying coverage on their own.
Who Benefits from the Affordable Care Act Coverage Expansions?
Percentage of the Nonelderly Population With Income Up to Four Times the Poverty level
Who Were Uninsured or Purchasing Individual Coverage, 2010
Source: Kaiser Family Foundation Analysis of the IPUMS American Community Survey, 2010.
See How Many Could Benefit in Your Area
Starting in 2014, most people who are uninsured or buying individual insurance with incomes up to four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012) will be eligible for expanded coverage through Medicaid or tax credits to subsidize the cost of private insurance. See what share of the population might be helped in this way in a specific zip code.
Who Benefits From the Affordable Care Act's Coverage Expansions?
The Affordable Care Act (ACA) includes two primary mechanisms for helping people afford health coverage. Starting in 2014, people with family incomes up to 138% of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will generally be eligible for the Medicaid program. And, people buying coverage on their own in new state-based health insurance exchanges will be eligible for federal tax credits to subsidize the cost of insurance. Tax credits will be calculated on a sliding scale basis for people with family income up to four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012). (A calculator from the Kaiser Family Foundation illustrates the assistance people would be eligible for at different income levels and ages.)
The share of the population who will benefit from new Medicaid eligibility and the new health insurance tax credit will vary substantially throughout the country. We've illustrated that variation by estimating the share of the population in over 2,000 geographic areas across the U.S. who had family income up to four times the poverty level in 2010 and were either uninsured or buying coverage on their own.
On average, an estimated 17% of the non-elderly population nationwide would benefit from the Medicaid expansion and tax credits. In parts of Florida, New Mexico, Texas, Louisiana, and California, 36-40% of population could benefit. In areas of Massachusetts, Hawaii, New York, and Connecticut – states that generally have high levels of employer-provided health insurance or have already implemented reforms to make insurance more accessible and affordable – 2-4% of the non-elderly could benefit from the coverage expansions in the ACA.
These estimates are best viewed as a way of comparing what share of the population will benefit from the ACA across geographic areas, rather than as precise projections of the effects of the law. For example, some people who are currently uninsured with family incomes up to four times the poverty level may already be eligible for Medicaid but haven't enrolled and others may be ineligible due to their immigration status. Or, some may have access to employer coverage, which means that they would not be eligible for a tax credit if that employer coverage is affordable. Also, some people who are already insured with employer coverage may have incomes low enough to qualify for Medicaid, or the coverage they receive through the employer may be unaffordable, making them eligible to apply for subsidized coverage through exchanges.
In addition to the provisions that help people pay for coverage, there are other elements of the ACA that could benefit people regardless of income, such as: guaranteed access to insurance regardless of pre-existing conditions; a limit on out-of-pocket costs in all insurance plans; preventive benefits with no patient cost-sharing; and allowing parents to cover children on their insurance plans up to age 26. On the other hand, there will be some people who perceive themselves as worse off under reform, such as those who choose not to purchase coverage and must pay a penalty under the individual responsibility provision.
Methodology
This analysis was prepared by Gary Claxton, Anthony Damico, Larry Levitt, and Rachel Licata of the Kaiser Family Foundation.
The statistics shown are based on analysis of data from the 2010 American Community Survey (ACS) obtained fromIPUMS-USA. The American Community Survey is an annual nationwide survey of about 3 million people conducted by the U.S. Census Bureau that provides demographic, social, economic, and housing information at the national, state, and community levels.
The Affordable Care Act (ACA) generally provides financial assistance, either through Medicaid eligibility or tax credits for private health insurance, to people with incomes up to 400% of the poverty level and who do not have access to public health coverage or affordable coverage through an employer-sponsored health plan. The percentages shown represent the share of people under age 65 who are in families with incomes up to 400% of federal poverty who at the time they were surveyed either (1) were not covered by public or private health insurance or (2) were covered by health insurance that they purchased directly and were not covered by any other type of public or private health insurance. Coverage by the Indian Health Service was not considered as public or private health insurance. People in institutions or who are active duty military were excluded from the analysis. Unauthorized immigrants will be ineligible for expanded Medicaid coverage and for subsidized coverage in exchanges, but the ACS does not identify the legal status of non-citizens. To account for this, we assumed that 46% of non-citizens who would otherwise be eligible for assistance would be ineligible due to their immigration status. This assumption was derived from Department of Homeland Security estimates that there were 10.8 million unauthorized immigrants in the U.S. in 2010 and 12.6 million legal permanent residents who were not citizens.
The percentages are shown by Public Use Microdata Areas (PUMA), which are statistical geographic areas defined for the tabulation and dissemination of certain census data. PUMAs are built on counties and census tracks within states and each one contains about 100,000 people. Standard errors range from 1-4% within PUMAs.
For this analysis, family income is based on the census definition of primary families, which are people within a household related to the head of the household. This differs from some other analyses produced by Kaiser and others that aggregate income by health insurance unit, which generally includes members of a nuclear family who are able to purchase health insurance as a family. Generally, using the census definition of family rather than health insurance units will result in a slightly lower estimate of the number of people who would benefit from the financial subsidies under the health reform because it produces a lower percentage of the population with incomes below or including 400% of poverty.
Health Ruling is Prompting Scams
By Elise Viebeck
Source: thehill.com
Federal trade regulators warned Friday that scam artists are using the healthcare law to ask for consumers' personal information over the phone.
The Federal Trade Commission (FTC) said that the illegal activity began after the Supreme Court ruled on June 28 to uphold the vast majority of the law.
Scam artists "say they're from the government" and use the Affordable Care Act as a hook to verify information, according to an FTC alert.
"They might have the routing number from your bank, and then use that information to get you to reveal the entire account number," the alert stated. "Or, they'll ask for your credit card or Social Security number, Medicare ID, or other personal information."
Regulators urged consumers not to give out personal or financial information after unsolicited contact from someone who says they are with the government.
"If someone who claims to be from the government calls and asks for your personal information, hang up. It's a scam," the alert stated.
Read more at the FTC site.
Joggers Rejoice!
Source: Dr. Ann Kulze
May 2012 Newsletter
Wellness Delivered Pure and Simple
In a stunning affirmation of the profound health-boosting effects of regular physical activity, European Cardiovascular researchers concluded that regular jogging can dramatically increase life expectancy. As part of the Copenhagen City Heart Study, investigators followed 19,329 adult study subjects over a period of up to 35 years. Study subjects who reported regular jogging at a "slow or average" pace were 40% less likely to die over the study period than non-joggers and increased their life expectancy by an average of 6 years. What's more, regular joggers also reported an enhanced sense of overall well-being.
Based on this evaluation, maximum survival benefits were seen in those who jogged between one to two and a half hours a week over two to three sessions. Thankfully, there are numerous types of aerobic activities that get the heart rate into this "jogging zone". According to the lead investigator, the goal is to move to the point of "feeling a little breathless, but not very breathless". (1)
Are Chubby Workers Eating You Out of Profits?
Source: https://safetydailyadvisor.blr.com
OSHA recordkeeping and reporting requirements appear straightforward, but the devil is in the details. Pound for pound, obese workers cost you plenty. Here are some facts that should disturb you.
| Which employee health issue costs employers more, obesity or smoking?
If you guessed obesity, you guessed right. A study in the Journal of Occupational and Environmental Medicine analyzed the additional costs of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007. Both obesity and smoking were associated with excess health costs. Compared to nonsmokers, average health costs were $1,275 higher for smokers. And obese people averaged an additional $1,850 more than normal-weight individuals. For those with morbid obesity, costs were up to $5,500 per year. Clearly obesity is an issue that most employers will need to deal with in the future. Americans are becoming fatter every year, and that means increasing health problems and increasing health costs. Since many of these obese people work, employers will be impacted by increasing medical costs and lost productivity. Great news! BLR's renowned Safety.BLR.com® website now has even more timesaving features. Take our no-cost site tour! Or better yet, try it at no cost or obligation for a full 2 weeks. Facts and FiguresHere are some other statistics that paint a worrisome picture: • Annual healthcare cost of obesity in the U.S. is estimated to be $147 billion per year. • Annual medical burden of obesity increased to 9.1 percent in 2006 compared to 6.5 percent in 1998. • Medical expenses for an obese employee are estimated to be 42 percent higher than for employees with a healthy weight. • Three major conditions related to obesity (heart disease, diabetes and arthritis) cost employers $220 billion annually in medical cost and lost productivity, according to CDC and MetLife research. • An American Journal of Health Behavior study showed that the annual medical cost increased from $119 for normal-weight employees to $573 for overweight employees and to $620 for obese employees. • A MetLife study found that the average absence for employee who filed an obesity-related short-term disability claim was 45 days. • A 1998 study found obesity resulted in approximately 39 million lost work days, 239 million restricted-activity days, 90 million bed days and 63 million physician visits. • Obese employees have double workers’ compensation claims, 7 times higher medical claims, and lost 10 times more working days from illness or injury compared to non-obese employees, according to the Duke University Medical Center. Who's Obese?Obesity is defined as at least 30 to 40 pounds overweight, severely obese is at least 60 pounds overweight, and morbidly obese is at least 100 pounds overweight. Obesity can increase the risk for many adverse health effects, including: · Type-2 diabetes · Hypertension · Heart failure · High cholesterol · Kidney failure · Degenerative joint disease and arthritis · Gallstones and gall bladder disease · Cancer · Lung and breathing problems (asthma) · Faster aging |
Urgent care visits to soar due to PPACA
July 6, 2012
Source: www.benefitspro.com
Urgent care visits will likely see a considerable boost due to the Supreme Court ruling on the Patient Protection and Affordable Care Act.
“Although urgent care isn’t specifically mentioned anywhere in the legislation, the open access that all urgent care centers have should make them a natural entry point for the newly insured—especially in areas where many primary care practices aren’t accepting new patients,” says Lou Ellen Horwitz, executive director of Urgent Care Association of America.
The law’s mandate targets the roughly 16 percent of uninsured Americans, equating to another 50 million Americans who could be seeking medical care, Horwitz says.
Urgent care centers, on average, see 342 patient visits per week. This equates to more than160 million patient visits each year. The Supreme Court ruling will drive an increase in volume as these new patients may see urgent cares as an alternative to the emergency room, Horwitz says.
“Fortunately, the industry continues to expand and should have capacity to accept these patients with relative ease in most areas,” she says.
There are about 9,000 urgent care centers in the country, but less “full-fledged” urgent care centers (those offering lab and x-ray, open 7 days a week), at 4,500.
New Guidelines On Obesity Treatment Herald Changes In Coverage
By Michelle Andrews
July 10, 2012
Source: Kaiser Health News
Eat less, exercise more. Simple? Yes. Easy? No. If weight loss were easy, obesity rates among adults in the United States probably wouldn't have reached the current 36 percent.
Recently revised guidelines from the U.S. Preventive Services Task Force acknowledge that fact. They recommend that clinicians screen patients for obesity, which is defined as having a body mass index of 30 or higher. Further, they say patients who meet or exceed that level should be offered or referred to "intensive, multicomponent behavioral interventions" to help them lose weight.
The revised guidelines strengthen the previous recommendations, says David Grossman, a senior investigator at Group Health Research Institute in Seattle and a member of the task force.
For the millions of people who struggle to lose weight, the new guidelines offer much-needed support. It's unclear whether employers and insurers will welcome the change, though.
Under the 2010 health-care law, new health plans and those whose benefits change enough to lose their grandfathered status must provide services recommended by the Preventive Services Task Force at no cost to members. For the 70 percent of employers that already offer weight management programs, that may mean just supplementing what they already offer, says Russell Robbins, a senior clinical consultant at Mercer, a human resources consulting firm.
But some employers are concerned they may be on the hook for ongoing treatment as employees make repeated attempts to lose weight.
"From a financial standpoint, the guidelines are pretty broad and pretty extensive," says Helen Darling, president of the National Business Group on Health, which represents the interests of large firms. "Does this mean that employers and the government will be paying for up to 26 intense visits every year for every obese person for the rest of their lives?"
An HHS official said the department is evaluating whether to issue additional guidance on the new rules.
Insurers will be working to determine how best to satisfy the recommendations, says Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group.
"I think the real question is making sure there are programs that fulfill these requirements," she says.
According to the task force, effective weight-loss programs involve 12 to 26 group or individual sessions over the course of a year that cover multiple behavioral management techniques. These may include setting weight-loss goals and strategizing about how to maintain lifestyle changes, incorporating exercise and eating a more healthful diet, and learning to address the psychological and other barriers that create roadblocks to weight loss. The task force found that people in these programs generally lost nine to 15 pounds in the first year.
The task force said there wasn't enough evidence to determine whether such interventions worked for people who were overweight but not obese.
A number of existing programs provide the kind of care that the guidelines recommend, say experts.
Weight Watchers, for example, runs 20,000 meetings a week around the country where people discuss their weight-loss challenges and successes and get pointers on losing weight and keeping it off.
At $42.95 a month for access to group meetings and online food tracking and other tools, however, it's not an option for many people with limited incomes, who make up a disproportionate share of the obese. Some employers subsidize their employees' membership in the program. Under the new guidelines, insurers and employers could be responsible for paying 100 percent of the cost.
Other programs have also been successful. Two years ago, the Centers for Disease Control and Prevention, in partnership with UnitedHealth Group and the YMCA, launched the National Diabetes Prevention Program for people at high risk for developing Type 2 diabetes.
The program is based on a study in which participants who learned to eat more healthfully and exercised at least 150 minutes a week lost 5 to 7 percent of their weight and reduced their risk of developing diabetes by 58 percent.
The program is offered by many YMCAs and other groups. It offers each participant 16 weekly group weight-loss sessions followed by six monthly sessions. It's a covered benefit for people with UnitedHealthcare or Medica insurance; others pay based on a sliding scale, says Ann Albright, director of CDC's Division of Diabetes Translation. CDC is working with Medicaid and Medicare to try to get it covered by those programs, says Albright.
John Joseph IV tipped the scales at 203 and had a BMI of 28.3 when he paid $150 to join the program at the YMCA near his Birmingham, Ala., home. In the four months since then, the 34-year-old, who runs a job-coaching business for college grads, has dropped 17 pounds.
At the weekly group meetings, he learned to count the fat grams in food and to make smarter food choices. Now he eats fewer cookies and more flounder. He started an exercise program and runs or lifts weights for 30 minutes three times a week.
"I thought, if I can do this, it will give me the infrastructure and habits so I can get to the mid-170s, which is where I want to be," he says.
Losing weight is hard, but keeping it off may be harder.
In 2009, Gayenell Magwood lost 100 pounds with the help of the weight management center at the Medical University of South Carolina in Charleston.
But after health problems curtailed her exercise routine for a few months, her weight crept up to 170, a gain of nearly 20 pounds. Magwood, 49, who lives in North Charleston and is a researcher in the College of Nursing at MUSC, went through the 15-week program all over again, at a cost of about $600. She lost the weight she had regained.
Before enrolling in the MUSC program, "I'd never once been successful with significant weight loss," she says.
House plans five-hour debate on healthcare repeal, WH warns veto
By Pete Kasperowicz
Source: thehill.com/blogs
The House will hold five hours of debate today and Wednesday on legislation that would completely repeal the 2010 healthcare law, which is being called up by Republicans in light of the Supreme Court's decision that the individual health insurance mandate is constitutional.
The House Rules Committee approved a rule late Monday setting out the lengthy debate on a bill that is expected to pass with Republican support, but very little if any Democratic support. The Repeal of Obamacare Act, H.R. 6079, was formally introduced by House Majority Leader Eric Cantor (R-Va.) on Monday.
Later Monday evening, the White House put out a statement saying President Obama would veto the bill if it were presented for his signature, something that won't happen given Senate opposition.
"The Administration strongly opposes House passage of H.R. 6079 because it would cost millions of hard-working middle class families the security of affordable health coverage and care they deserve," the statement said. "It would increase the deficit and detract from the work the Congress needs to do to focus on the economy and create jobs.
"The last thing the Congress should do is refight old political battles and take a massive step backward by repealing basic protections that provide security for the middle class, it added. "Right now, the Congress needs to work together to focus on the economy and creating jobs. Congress should act on the President's concrete plans to create an economy built to last by reducing the deficit in a balanced way and investing in education, clean energy, innovation, and infrastructure.
"If the President were presented with H.R. 6079, he would veto it."
Under the rule for the House bill, the House Committees on Education and the Workforce, Energy and Commerce, and Ways and Means will each control one hour of debate. House Committees on Budget, Judiciary and Small Business will each control 30 minutes.
Finally, Majority Leader Cantor and House Minority Leader Nancy Pelosi (D-Calif.) and/or their designees will split the last 30 minutes of debate time.
The House is expected to start work on the bill by debating and approving the rule, which will take an hour early this afternoon. A final vote on passage on the bill itself is expected Wednesday.
IFEBP survey: More than 75% of sectors will provide health coverage in 2014
By Marli D. Riggs
July 2, 2012
Source: https://eba.benefitnews.com
Despite the differing reactions among U.S. business sectors to last week’s Patient Protection and Affordable Care Act Supreme Court ruling, 77% of surveyed organizations are very likely to provide health coverage in 2014, according to a recent survey by the International Foundation of Employee Benefits Plans.Following the Supreme Court’s decision, almost half (49%) of the organizations are shifting their attention to wellness, while 32% are focusing on consumer-driven health plans, 27% will shift costs to employees and 26% will focus on value-based health care, according to The Supreme Court ACA Decision Reaction Survey.
“We’re not surprised by these findings since our recent wellness survey told us that seven in 10 U.S. employers offer wellness programs,” says Paul Hackleman, IFEBP’s health care and public employer analyst.
Overall, the results were split when respondents identified which Supreme Court decision would have been most beneficial to their organization. The data showed that 46% felt the best possible decision for their organization would have been PPACA being thrown out, while 41% said the best decision was the law being upheld. Another 12% of organizations would have liked the individual mandate overturned, but the remainder of the health care law to stay intact.
Most organizations have been keeping current with the legislative aspects of PPACA and some are already prepared for provisions in the future. Of the respondents 78% are extremely or very far along in terms of complying with current PPACA provisions, while 60% are extremely or very far along with preparing for future provisions.
Further, organizations in states that have already implemented health care exchanges are generally more satisfied with the Court’s decision (47% to 35% of respondents in states that haven’t implemented), and are more prepared with current provisions (47% to 36%) and more likely to continue coverage in 2014 (56% to 42%).
The survey was administered on June 28 to measure organizations’ reactions to the landmark decision. Responses were received from 1,122 plan administrators, trustees and organizational representatives.
Businesses won't wait for elections before implementing health law
By Sam Baker
July 9, 2012
Source: thehilll.com/blogs/healthwatch
Most businesses waited for the Supreme Court before making plans to comply with President Obama’s healthcare law — but most aren’t waiting for November to see whether the law might be repealed.
A new survey from the consulting firm Mercer found that most businesses have not begun planning for requirements that will take effect in 2014, including the mandate requiring employers to provide health benefits to most workers.
Businesses said they were holding off on implementation until they knew whether the Supreme Court would strike down the healthcare law — the same approach many Republican governors have taken. But now that the court has upheld the law, only 16 percent of the employers in Mercer’s survey said they plan to wait for November and the prospect of legislative repeal.
Mercer surveyed 4,000 businesses immediately following the high court’s decision.
The National Federation of Independent Business (NFIB), the country’s largest small-business organization, joined 26 state attorneys general in filing the legal challenge to the Affordable Care Act. Republicans consistently argue that the law will burden small employers and stifle new hiring.
But only 28 percent of the employers in Mercer’s survey said the new employer mandate will pose a “significant challenge.” The law requires many businesses to offer healthcare coverage or pay a penalty for all workers who buy coverage on their own, with help from the federal government.
“Employers with large part-time populations, such as retailers and healthcare organizations, are faced with the difficult choice of either increasing the number of employees eligible for coverage or changing their workforce strategy so that employees work fewer hours,” said David Rahill, president of Mercer’s Health and Benefits business.
The Long Arm Of The U.S. Healthcare Ruling
Source: https://www.insurancebroadcasting.com
The Supreme Court ruling to uphold the core of President Barack Obama's 2010 healthcare law has wide-ranging political and economic implications.
Here is a snap analysis of what it means for Americans, healthcare providers, insurers, the law and the presidential campaign.
How does the ruling affect the average American?
* Working families with annual household incomes up to nearly $90,000 will be able to purchase private insurance through new state insurance markets at prices subsidized according to income level, beginning in 2014. But people with household incomes of around $29,000, who qualify for coverage under the Medicaid government health insurance program for the poor, may have to wait for their respective state governments to decide whether they will join the program's huge expansion. Preventive healthcare measures including mammograms and other cancer screenings will be available without deductibles or co-pays. Adult children up to age 26 can remain on their parents' health insurance plans. Senior citizens can expect to continue receiving discounts on prescription drugs aimed at closing the Medicare coverage gap known as the "doughnut hole." Health insurers will continue to pay rebates on premiums not sufficiently targeted at healthcare services. Beginning in 2014, insurers will no longer be able to deny coverage to adults with pre-existing medical conditions and would be required to stop or curb discriminatory pricing based on gender, age and health status.
What about healthcare providers?
* The ruling removes one cloud of uncertainty over the future of healthcare reform and would help the administration's efforts to implement it fully by January 1, 2014, when the law is scheduled to go into effect. Under the decision, physicians and hospitals continue to move away from the traditional fee-for-service healthcare business model and toward more efficient systems that coordinate care. For healthcare providers, the affirmation represents millions of potential new patients, either through private plans or the government's Medicaid program for the poor. Some, however, would be under added pressure to enact more savings, which could cut into revenues. The administration still faces some fairly tall hurdles, such as establishing regulated health insurance markets in all 50 states so consumers can purchase subsidized coverage. Up until now, over a dozen states have done little or nothing to create such exchanges, partly because of the uncertainty over the fate of the law. Down the road, if Republicans succeed in taking control of the White House and the Senate in November (they already control the House of Representatives), they would likely try to repeal the law in 2013.
Where does the ruling leave health insurers?
* The health insurance industry can expect premium revenue from millions of new, healthy customers through state exchanges. But the industry will also have to operate with new consumer protections that require coverage access for people with pre-existing medical conditions and other health status issues, and mandate preventive care without customary charges.
How might the ruling influence the presidential campaign?
* This is a big victory for Obama, who has weathered years of criticism from conservatives about his reforms. The decision could energize the president and his supporters, while undercutting presumptive Republican presidential nominee Mitt Romney, who introduced similar reforms as Massachusetts governor but opposes their use as national policy. But there could be a silver lining for Republicans: the opinion could light a fire under party candidates and constituents who want a president who would repeal the law in 2013.
(Reporting by David Morgan and Lewis Krauskopf; Editing by Michele Gershberg and Will Dunham)