Category Archives: Health insurance exchanges
Cynthia Crone, MNSc, APRN, CPNP, is deputy commissioner of the Arkansas Insurance Department, where she created and now leads the state’s Partnership Health Insurance Marketplace. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
Being asked to write a post about nurse leadership for National Nurses Week presents a wonderful opportunity to reflect on my nursing journey and express appreciation for the many nurses and other leaders who have played a supportive role in my development. A career in public health with an emphasis on vulnerable populations, including most recently directing efforts in Arkansas to implement the Health Insurance Marketplace, has reinforced with me the critical role nurse leaders play in the politics and policy of health care and how very important it is to foster and support community involvement and interdisciplinary collaboration by younger nurses.
I started nursing school in the mid-1970s. Nurse practitioners were just coming on the scene. After graduation I obtained certification as a pediatric nurse practitioner and traveled to 10 rural counties to hold “well child clinics.” I learned a lot from the public health nurses. I loved my job. The work helped me better understand the bio-psycho-social-spiritual art and science of nursing and the social determinants of health. Further, through interaction with nurse and other community leaders, I learned that another element—political–can’t be ignored.
Katherine Grace Carman, PhD, is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.
Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.
The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage. We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.
One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.
Sue No, RN, BSN, is a fellow in the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico (2013-2017). She is working toward her PhD in nursing with a concentration in health policy. This post is part of the “Health Care in 2014” series.
Every New Year brings New Year’s resolutions. It is a time for reflection on years past and to develop actionable changes needed for a hopeful and productive new year. Clearly 2014 is no exception. With the New Year already in full swing, I encourage people—yes, this also includes you, Generation Y—to enroll in a health insurance plan and take advantage of the Affordable Care Act’s (ACA) current and new coverage opportunities in an effort to advance our nation’s culture of health.
You might be asking yourself a few questions such as: Who is Generation Y and why are they important? I am happy to provide answers.
The largest generation, Generation Y, or Millennials, consists of young adults born between 1977 and 1994. This important demographic is key to obtaining a sustainable health care exchange system with affordable insurance plans. Healthy Millennials must enroll in the marketplace to offset the high costs acquired by the disproportionate number of Americans with high medical costs. Unfortunately, only a small number of young adults have participated in the health care exchange since open enrollment. This isn’t surprising.
Jay Himmelstein, MD, MPH, is a professor of family medicine and community health and chief health policy strategist at the Center for Health Policy and Research at the University of Massachusetts Medical School (UMMS). He serves as a senior advisor to the UMMS Office of Policy and Technology, and is a senior Fellow in health policy at NORC, University of Chicago. Himmelstein is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program, where he worked on the health staff of Senator Edward Kennedy. This post is part of the “Health Care in 2014” series.
The nation's attention has focused in recent months on the politics and challenges related to the roll-out of state and federal health insurance marketplaces created by the Affordable Care Act (ACA). Despite website technical woes, significant numbers of Americans have already gained access to affordable insurance plans through the marketplaces and other provisions of the ACA, and it appears likely that the ‘marketplace’ concept will be successful over time in connecting consumers to health insurance and significantly decreasing the ranks of uninsured.
The better functioning marketplaces currently allow consumers to: 1) determine eligibility for subsidized health insurance, 2) use basic online shopping tools to compare and purchase health insurance plans based on four different "metallic tiers" (i.e., the platinum, gold, silver, and bronze tiers), and 3) make side-to-side comparisons between these plans on features such as deductibles, out-of-pocket cost limits, and number and proximity of doctors and hospitals. A few marketplaces also offer information about plan quality, the ability to search for health care providers and hospitals associated with specific plans, and rudimentary ‘cost calculators’ which estimate the total cost of plans inclusive of premiums, deductibles, and out-of-pocket costs.
Michael Geruso, PhD, is a Robert Wood Johnson Foundation Scholar in Health Policy Research at Harvard University and an assistant professor of economics at the University of Texas at Austin. This post is part of the “Health Care in 2014” series.
2014 marks the start of coverage for those who are newly insured via the health insurance exchanges. In general, healthy behaviors and lifestyle are probably the most important inputs to health, especially for those of us free of serious chronic conditions. But for those of us who are sick, quality health care and access to drugs is crucial for health and happiness. We will soon know to what extent the health insurance exchanges have overcome their implementation problems and have connected previously uninsured Americans to health care.
When markets for health insurance work efficiently, they can deliver access to crucial health services to those who need and want them most. Unfortunately, free, unregulated markets for health insurance rarely function efficiently. The market failures in health care have long been noted by economists, most famously by Nobel Prize winner Kenneth Arrow, MA, PhD. In my view, one the most important changes that the Affordable Care Act (ACA) brings with it is an attempt to address and correct market failures via the exchanges.
Sue Birch, MBA, BSN, RN, is executive director of the Colorado Department of Health Care Policy and Financing, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2002).
Now that I have caught my breath, I wanted to share the Colorado report on Obamacare’s October 1st Birthday! Our state has decided to expand our Medicaid program and to form our own marketplace for Coloradans to shop and compare health insurance plans. These changes will help us cover many uninsured Coloradans.
In its first week, Connect for Health Colorado, our state’s health insurance marketplace, successfully attracted more than 162,941unique website visitors, had 9,658 calls and chats to the service center, and 18,174 accounts created. We think this is a strong start and know that it will take time for Coloradans who have not had insurance before to learn about their options and apply for coverage. We are working across state government to help make this happen.
At my department, Health Care Policy and Financing, Coloradans can enroll through our new modularized interoperable cloud-based system, PEAK. We had more than 9,000 applications come through this site in the first 10 days of October. It is foundational to our desire to increase new consumerism and greater client responsibility by walking through a self-enrollment process. Our website is Colorado.gov/PEAK and we have seen record traffic to the application site.
Overall, the marketplace opening went quite smoothly for Colorado—the exchange opened successfully, Medicaid began, and our technology functioned efficiently for being such a large, complex system. With the marketplace now up and running, individuals, families, and small employers can start making appointments with Health Coverage-Guides, learn about plan options, and apply for insurance when ready.
This is an exciting moment in health care history and we are proud to be working with partners across our state and our nation to provide affordable health insurance options to all residents of Colorado!
Human Capital News Roundup: Lead exposure and behavior problems, debt's impact on health, health exchange 'navigators,' and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
More Americans are dying from obesity than previously thought, according to a new study by Ryan Masters, PhD, an alumnus of the RWJF Health & Society Scholars program. In recent decades, 18 percent of deaths of Americans ages 40 to 85 can be attributed to obesity, NBC News, USA Today, and the Los Angeles Times report, which is much higher than the often cited 5-percent toll.
Pennsylvania Governor Tom Corbett last week signed a new health care law based on a plan designed by RWJF Community Health Leader Zane Gates, MD, the Philadelphia Inquirer reports. The measure will provide $4 million to community health centers in rural and underserved areas.
Children exposed to lead are nearly three times more likely to be suspended from school by the 4th grade than their non-exposed peers, according to a study co-authored by Health & Society Scholars alumna Sheryl Magzamen, PhD, MPH. “We knew that lead exposure decreases children's abilities to control their attention and behavior, but we were still surprised that exposed children were so much more likely to be suspended,” she told Science World Report.
WHYY (Philadelphia) spoke to RWJF Executive Nurse Fellows alumna Cheri Lee Rinehart, BSN, RN, about grants to train "navigators" to assist people as they purchase insurance through health exchanges. Rinehart is president of the Pennsylvania Association of Community Health Centers, one of five groups in the state that are receiving the federal funds.
Linda Wright Moore, MS, is a senior communications officer at the Robert Wood Johnson Foundation (RWJF).
The swirl of controversy and nonstop debate around the Patient Protection and Affordable Care Act (ACA) is like a play that never ends: Every time you think you’re coming to the finale, another character or plot twist crops up—and the production drags on … and on.
So it goes with the ACA: Last year, the U.S. Supreme Court ruled the new law to be mostly sound, but fudged on the state mandate to expand Medicaid just enough to keep the drama twisting and turning—and to make many poor and uninsured people ineligible for government subsidies.
Meanwhile, repeated attempts to repeal the law—at least 38 to date—have contributed to a jarring statistic: 42 percent of Americans are unaware that the ACA is the law of the land. In light of the lack of knowledge that the health reform law is the law—it’s no surprise that half of the public admits to not having enough information to understand the likely impact of the ACA on themselves and their families.
This week, the U.S. Department of Health and Human Services is rolling out a new website that provides educational tools designed to help people understand their insurance choices and select coverage that best suits their needs when open enrollment begins on October 1st. With 99 days to go until then, the new effort includes a consumer call center that will offer help to consumers in more than 100 languages. It will eventually employ 9,000 people, who will answer questions from the public 24 hours a day.
HealthCare.gov is designed to be the destination for the new Health Insurance Marketplace, also called exchanges. The new website will add functionality over the next few months so that, by October, a consumer will be able to create an account, complete an online application, and actually shop for an insurance plan.
For Spanish speakers, CuidadoDeSalud.gov offers the same information and functionality in Spanish.
Voters across the country were presented Tuesday with more than 170 ballot initiatives, many on health-related issues. Among them, according to the Initiative & Referendum Institute at the University of Southern California:
- Assisted Suicide: Voters in Massachusetts narrowly defeated a “Death with Dignity” bill.
- Health Exchanges: Missouri voters passed a measure that prohibits the state from establishing a health care exchange without legislative or voter approval.
- Home Health Care: Michigan voters struck down a proposal that would have required additional training for home health care workers and created a registry of those providers.
- Individual Mandate: Floridians defeated a measure to reject the health reform law’s requirement that individuals obtain health insurance. Voters in Alabama, Montana and Wyoming passed similar measures, which are symbolic because states cannot override federal law.
- Medical Marijuana: Measures to allow for medical use of marijuana were passed in Massachusetts and upheld in Montana, which will make them the 18th and 19th states to adopt such laws. A similar measure was rejected by voters in Arkansas.
- Medicaid Trust Fund: Voters in Louisiana approved an initiative that ensures the state Medicaid trust fund will not be used to make up for budget shortfalls.
- Reproductive Health: Florida voters defeated two ballot measures on abortion and contraceptive services: one that would have restricted the use of public funds for abortions; and one that could have been interpreted to deny women contraceptive care paid for or provided by religious individuals and organizations. Montanans approved an initiative that requires abortion providers to notify parents if a minor under age 16 seeks an abortion, with notification to take place 48 hours before the procedure.
- Tobacco: North Dakota voters approved a smoking ban in public and work places. Missouri voters rejected a tobacco tax increase that would have directed some of the revenue to health education.