The latest iteration of the Gallup-Healthways Well-Being Index puts the number of Americans without health insurance at 15.6 percent of the total population, down from 18 percent late last year. That number also is the lowest in nearly six years.
Editor's note: This is the first post from the Nashville Health Care Council's 2014 Leadership Health Care Delegation to Washington. Look for more content in the coming days and click here for other entries from past years' visits.
As the 2014 election season begins to heat up, nearly 100 of Nashville’s emerging health care leaders have gathered in our nation’s capital to get an inside look at the health policy discussions that will shape the mid-term elections and affect the industry throughout 2014 and beyond. During the first day of sessions at the 12th Annual Leadership Health Care Delegation to Washington, D.C., delegates heard from a slate of speakers about topics ranging from health insurance exchange enrollment to new payment and delivery models to patient engagement.
Michael Ramlet, founder and editor of digital media company “The Morning Consult,” kicked off the delegation by discussing what he predicts will be a key factor for the industry and politicians in the coming months — whether insurance exchange enrollment will reach the Obama administration’s projected goal of 7 million. With enrollment estimates now above 4 million and a new set of data expected in the weeks ahead, these figures will help determine whether the ACA can be considered effective.
However, Ramlet (pictured at right) noted that one of the biggest, yet under-reported stories of 2014 has been the number of health insurance exchange enrollees — one in five — who have failed to pay their premiums, meaning they don’t actually have coverage. And keynote speaker Dora Hughes, senior policy advisor in the government strategies group of law firm Sidley Austin (pictured), noted that there will be an estimated 5 million individuals who will not be able to get coverage because their states are not expanding Medicaid or they do not qualify for premium subsidies but still cannot afford premium costs.
The expansion of coverage under the ACA was cited as the best part of the law by a panel of policy experts, although they argued that issues such as timing of the individual mandate and the Supreme Court ruling that made state Medicaid expansion optional have created challenges across the industry.
“What keeps me up at night is coverage expansion, and that it hasn’t happened as quickly as we would have hoped,” said Mary Ella Payne, senior vice president of policy and system legislative leadership for Ascension Health. “We don’t have coverage in Tennessee with the expansion of Medicaid and…many states have not expanded coverage. Related to that are delays that we have been seeing in moving to ACA-compliant plans and delays in the marketplace for small companies.”
Tom Nickels, senior VP of federal relations for the American Hospital Association, said although insurance coverage levels are “nowhere near what we had hoped,” he expects it will take a three-year timeframe for coverage to reach desired levels through Medicaid and the exchanges.
“So I think judgment ought to be suspended at least until we get to the end of 2016,” he said.
In the meantime, Hughes noted that the Centers for Medicare and Medicaid Services’ Innovation Center is working on more than 40 models for improving care delivery in terms of cost and quality, such as accountable care organizations and bundled payments. And although there are more than 260 active ACOs around the country, reports on their effectiveness so far have been mixed.
But one thing is certain. Health care will have a leading role in the 2014 elections.
Ramlet pointed to a poll that shows independent voters evenly spit on which of the major parties they trust more on health care issues. Because of that split, what happens in the months ahead — with exchange enrollment and the perceived value of the health plans, provider experiences, and whether employers drop coverage in favor of pushing employees to exchanges — will be critical.
“There will probably be three big issues,” Ramlet said. “The economy, health care, and the third is open to debate… but health care, you can be sure, will be a major election issue.”
Photos by Keith Mellnick
State Representative Joe Armstrong of Knoxville put out the call for expanding Medicaid last week, publishing a Valentine's Day love letter to expansion on a national Democratic Party website.
Calling Medicaid expansion "one of the most important issues to face the Tennessee General Assembly in more than 20 years," Armstrong said expanding the program would benefit veterans, working class families, pregnant women and babies — and the Tennessee economy. But Gov. Bill Haslam has said Medicaid expansion would negatively impact the state, particularly when the federal funding drops from 100 to 90 percent after the first three years.
"It's all this federal money," Haslam said, as reported by The Daily News. "It will help hospitals and it will give people better health coverage. All that is true. The flip side is Medicaid already takes a huge portion of our budget. As we expand that, that will make a bigger issue. The expansion didn't prove a way to have better health outcomes. It just increased the number of people we covered."
But increased coverage is particularly relevant in health care-heavy Nashville. Hospital executives and analysts have both called Haslam's decision not to expand Medicaid purely political, saying states that have expanded coverage will see an improvement to their bottom lines.
Haslam continues to negotiate with the federal government, but maintains that the current terms of expanded Medicaid are not cost-effective for the state.
Tennessee's enrollment numbers in the federal insurance exchange jumped nearly 65 percent between Dec. 28 and Feb. 1, according to the latest report from the Department of Health and Human Services.
By the end of January, 59,705 Tennesseans had enrolled in insurance through the federal marketplace, compared to 36,250 at the end of the 2013. Find the report here.
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