Federal Healthcare Reform

Just hours before Gov. Maggie Hasan delivered her State of the State address yesterday, Senate leaders reached an agreement on Medicaid expansion.

New Hampshire held a special session in the fall of 2013 but was unable to reach an agreement to expand Medicaid, even after a Medicaid study group had recommended expansion. The House approved expansion but the Senate rejected it. 

Senate President Chuck Morse, a primary engineer of yesterday's agreement, says both parties...

Health care spending is 18 percent of the national economy so it is no wonder that big health issues face the states in 2014. The all-consuming question for states is how to contain costs. The Affordable Care Act kicks in full force in 2014 and states that haven't already decided to expand Medicaid eligibility may take up the question. The health marketplaces, while slow to start in October, were making more headway as 2014 began. Nearly 4 million (3.9) individuals had been deemed Medicaid or CHIP eligible and another 2.1 million selected private health insurance policies through the federal or state marketplaces by the end of December 2013. States will look at systems and delivery methods, including mental health, aging and professional scope of practice issues. 

CSG Director of Health Policy Debra Miller outlines the top five issues for 2014, including Medicaid expansion and cost containment, health insurance exchange implementation, building adequate mental health systems, health workforce adequacy and the aging of the baby boomers and the pressure it puts on health care systems.

After a slow start, especially for the federally run health insurance marketplace serving 36 states, nearly 365,000 Americans made it through the application process and selected a health insurance plan, according to data released by the U.S. Department of Health and Human Services Dec. 11, 2013. The number selecting a plan in November was more than double the number in October, the first month the marketplaces were operational.

Yesterday, new data was released by the U.S. Department of Health and Human Services that show over 3.6 million Americans have completed applications for health insurance coverage in the federal exchange and the state-based exchanges run by 14 states and the District of Columbia. 

Applicants who have made it to the finish line include nearly 365,000 who have selected a marketplace plan and 803,000 who have been determined eligible for Medicaid or CHIP (for children) coverage.

The federal government on Tuesday approved the Iowa plan to provide new private health insurance plus other plans from the state’s online health insurance marketplace to cover residents newly eligible for Medicaid under the Affordable Care Act option. However, according to AP reports, federal officials stopped short of approving the flexibility the Gov. Haslam requested to charge premiums. The legislature and Gov. Haslam negotiated the plan during the 2013 session.

The state’s proposal provides those with incomes up to 100 percent of poverty a state-run health plan similar to that of state employees. Those between 100 and 138 percent of poverty would get private plans sold through the marketplace and paid for with federal (and later some state) Medicaid funds.  

In the first month that Americans could go to the health insurance exchanges (or marketplaces) created under the Affordable Care Act, just over 106,000 individuals selected a health insurance plan. The state-run exchanges -- in the District of Columbia and 14 states -- have 79,391 individuals who have selected a plan, 75 percent of the national total. 

Secretary Sebelius released the numbers for the health insurance exchanges yesterday. As expected given the technical troubles that have plagued the federal government's website that covers 36 states, the numbers were small. Just over 106,000 individuals have selected a health insurance plan. The state-run exchanges -- in the District of Columbia and 14 states -- have 79,391 individuals who have selected a plan, 75 percent of the national total. 

Over 500,000 applications covering 1.5 million Americans were completed during the first month, October 1 through November 2, according to the DHHS numbers. Nearly 400,000 of those individuals were determined to be eligible for Medicaid or CHIP, more than half of them in the states with their own exchanges which have all expanded Medicaid eligibility to 138 percent of the federal poverty level. Another 326,000 will be eligible for financial assistance to make their premiums more affordable. 

Today I tuned into a rebroadcast of the Bloomberg News conversation on health exchanges and Medicaid expansion that was refreshingly void of politics. The discussion was far-reaching and speculated about changes in the nation’s health insurance system in the years ahead, rather than dwelling on the immediate problems with the rollout of the federal health insurance exchange website. It was an hour well-spent. 

New Hampshire Governor Maggie Hassan is bringing legislators back to the Capitol this week to consider Medicaid expansion in time for January 1, 2014 implementation. But first she has to convince the Senate to go along with her proposal.