Showing posts with label Medicaid. Show all posts
Showing posts with label Medicaid. Show all posts

Sunday, August 23, 2015

JOHN KASICH’S OBAMACARE MEDICAID EXPANSION SLAMMED AT OHIO AFP EVENT


Americans for Prosperity (AFP), one of the largest conservative activist groups in the United States, held their annual “Defending the American Dream Summit” in Columbus, Ohio, this week, but the state’s Republican Governor John Kasich was not invited.

Kasich’s decision to expand Medicaid under Obamacare—a move that the U.S. Supreme Court ruled was optional and up to state discretion—is a sore subject for fiscal conservatives and led to him being, not just left out of an event held in his backyard, but attacked by several of the event’s speakers, including former Texas Gov. Rick Perry and AFP President Tim Phillips.
Obamacare critics do not like how the law allows Medicaid, originally enacted as a safety net to provide health coverage for poor mothers and children, to be expanded to cover able-bodied, working-age adults. Federal funds cover the costs of the new enrollees but will start scaling back in 2017. Moreover, states are on the hook for administrative costs for signing up the new enrollees, whose numbers have far exceeded estimates.
For fiscal conservatives, like the activists at the AFP conference, the massive spending incurred by Medicaid expansion is especially distasteful, and Kasich’s support of it is viewed as a heretical departure from conservative principles, much like the way school choice advocates view former Florida Gov. Jeb Bush’s support for Common Core.
Kasich has defended his decision to authorize Medicaid expansion in Ohio on religious grounds, a rationale that has fallen flat with conservatives. According to a report by the Cleveland Plain Dealer, when Kasich was questioned about Medicaid expansion at a California conference sponsored by the Koch brothers, AFP’s benefactors, he replied, “When I get to the pearly gates, I’m going to have an answer for what I’ve done for the poor.”
Groups like Watchdog.org, a project of the Franklin Center for Government Accountability, and the Foundation for Government Accountability have joined AFP in criticizing Kasich. Nearly half a million Ohioans signed up under Kasich’s Medicaid expansion, and the plan was already 33 percent over budget in just its first year.
According to Watchdog’s Jason Hart, Ohio’s Medicaid enrollment numbers under Obamacare now exceed 600,000 and have cost taxpayers $4.4 billion.
Phillips, the AFP President, mentioned Kasich’s Medicaid expansion when he addressed the nearly 4,o00 activists on the conference’s first day. Even though he never said Kasich’s name, the implication was clear when he vowed that they would continue to fight against Medicaid expansion: “Whether proposed by a Democrat or a Republican, we’ll continue to oppose it with all we’ve got.”
“President Obama and some Republicans want to take millions of the most vulnerable citizens and they want to throw them into a Medicaid bureaucracy where the care is substandard,” continued Phillips, as the audience cheered in agreement. “They call that compassion. We call it immoral.”
Perry also took a swipe at his fellow Republican presidential contender during his remarks on Saturday. Kasich has repeatedly claimed that the federal funds going to pay for Ohio’s Medicaid expansion “belong” to Ohioans and would be spent in other states if Ohio had not claimed them. Perry rejected this argument as “just nonsense.”
“That money doesn’t come from an endless vault of money in Washington. It is borrowed from bankers in China and children in Cleveland and Columbus,” Perry added. “Justifying Medicaid expansion on the grounds of returning federal money to your home state can only be done if you turn a blind eye to the fact that we are $18 trillion in debt.”
Avik Roy, Senior Advisor to Perry’s presidential campaign and well-regarded as a health care policy expert before joining the campaign, spoke on a well-attended panel Saturday morning on the issue of Medicaid expansion. Like Perry, Roy found Kasich’s justifications wholly unconvincing.

Thursday, August 20, 2015

Obamacare is putting a big crimp in Wal-Mart’s lucrative pharmacy business

It was not an especially good quarter for Wal-Mart, and one pain point that will continue to hurt the company is a downturn in its large in-store pharmacy business in the US. On a media call yesterday (Aug. 18), executives in part blamed the company’s reduced profit outlook on a change in the way Americans are paying for drugs.

“We are seeing less cash and more reimbursements from insurers,” CFO Charles Holley said.

In other words, the rapid fall in uninsured Americans after passage of the Affordable Care Act has led to more drugs being paid for by insurers, and fewer being paid out of pocket. That squeezes profit margins, particularly for a company like Wal-Mart with one of the biggest drug stores in the country (it brings in about $19 billion in annual revenue).

In the US, full retail prices paid by the uninsured are substantially inflated compared to what private insurers reimburse. Unlike the average healthcare consumer, private insurers know the market, whether generic or cheaper options are available, and they have the leverage of scale to negotiate prices.

Government programs like Medicare and Medicaid, which cover many Wal-Mart customers, are prohibited from negotiating on price with drug makers. But they are also legally required to only reimburse the drug maker a certain percentage over the average wholesale price.

Pharmacy benefit managers, which administer drug benefits for employers and insurers, have also consolidated (pdf), leaving three firms (ExpressScripts, CVS, and UnitedHealth) to cover most Americans. The bump in scale has boosted their negotiating power on drug prices.

Formerly uninsured Wal-Mart customers are also likely to be entering into lower-tier health insurance plans that don’t cover an ever-growing list of expensive drugs, instead favoring cheaper, clinically-equivalent alternatives.

Pharmacies that have overcome these changes, like CVS, have tended to focus on offering expensive and often high-margin specialty drugs that require extra service to administer (such as chemotherapy drugs and arthritis drugs).

Wal-Mart says it has no intention of selling off its pharmacy business. As for solutions, on its Aug. 18 earnings call it offered up only that it is taking a “number of actions to lessen the impact.”

Sunday, August 16, 2015

MORE STATES MOVE TO END FEDERAL FLOW OF FUNDS TO PLANNED PARENTHOOD

Despite the Obama administration’s threat against terminating federal funding of Planned Parenthood, more states are cutting Medicaid funds to the nation’s largest abortion provider following videos that have exposed top medical directors of the organization engaged in the harvesting of body parts of aborted babies for potential sale to biomedical companies.
On Friday, Arkansas Gov. Asa Hutchinson (R) directed his state Department of Human Services to terminate its Medicaid contract with Planned Parenthood, effective 30 days from a letter dated Friday, August 14, 2015, states a press release from the governor’s office.
Hutchinson said:
It is apparent that after the recent revelations on the actions of Planned Parenthood, that this organization does not represent the values of the people of our state and Arkansas is better served by terminating any and all existing contracts with them. This includes their affiliated organization, Planned Parenthood of Arkansas and Eastern Oklahoma.
I appreciate the legislature’s leadership on this important issue, especially that of Senator Eddie Joe Williams and Representative David Meeks.
Additionally, Utah Gov. Gary Herbert (R) has ordered his state’s agencies to end sending federal funds to Planned Parenthood.
According to the Idaho State Journal, Herbert said in a statement Friday that he was troubled by the recent investigative videos.
Alabama, Louisiana, and New Hampshire are also in the process of terminating Medicaid contracts with Planned Parenthood.
As more states move to end their Medicaid contracts with Planned Parenthood, StemExpress, the biomedical company that has acknowledged working with the organization in obtaining the body parts of aborted babies, has also said it will cut its tieswith Planned Parenthood.
According to the Wall Street Journal, Planned Parenthood executive vice president Dawn Laguens, said in a statement:
The federal government has made it clear that states cannot cut women off from high-quality health care at Planned Parenthood like this. It’s unlawful, unpopular, and harmful to women—and that’s why politicians who have tried to do this in other states have failed. Planned Parenthood will continue to fight on behalf of the people who count on us for high-quality healthcare across Arkansas.
In an earlier statement last week on Planned Parenthood’s website, Laguens said, “Extremists who oppose Planned Parenthood’s mission and services are making outrageous and completely false claims. They are engaged in a fraud, and other claims they’ve made have been discredited and disproven.”
Asserting that “the extremists” show “a total lack of compassion and dignity for women’s most personal medical decisions,” Laguens said the Planned Parenthood medical staff, shown in the videos in a lab separating the body parts of aborted babies, were actually engaging in “standard medical practice to review tissue to ensure the health and safety of patients…”
“Planned Parenthood’s medical providers and staff are the best in the country,” she said. “We have the highest professional standards, and we take swift action if we are ever aware of an instance where those standards aren’t being met.”
However, in April of 2013, in the midst of the trial of abortionist Kermit Gosnell – who was ultimately convicted of murdering infants born alive during abortion procedures – Breitbart News reported that Planned Parenthood Southeast Pennsylvania president and CEO Dayle Steinberg, speaking at a fundraiser, admitted that she knew what was transpiring at Gosnell’s “house of horrors,” but neither she nor her organization reported it to state health officials or others who could have stepped in.
Instead, Steinberg said Planned Parenthood left it up to women, traumatized by the horrors of Gosnell’s clinic, to report him.
“We would always encourage them to report it to the Department of Health,” she said.
With the release of the recent videos produced by Center for Medical Progress, national pro-life groups are calling out those who would continue to defend Planned Parenthood.
“We can now add harvesting baby organs without the consent of the mother to the list of ethical violations and criminal activities committed inside Planned Parenthood clinics,” said Lila Rose, president of Live Action, in a statement sent to Breitbart News. “If this was any other business there would be a rush by media and politicians for full disclosure, defunding and calls to shut down what appears to be a criminal enterprise.”
Following the most recent video in which StemExpress whistleblower Holly O’Donnell reveals details of how her former company, in conjunction with Planned Parenthood, did not obtain consent from women to take their babies’ body parts following abortion, Kristan Hawkins, president of Students for Life of America, told Breitbart News, “This is betrayal in its worst forms. This is where the war on women is taking place.”
Hawkins, whose organization coordinated the #WomenBetrayed movement and rallies at the end of July, added:
For Planned Parenthood, an organization whose only talking point is that they are there for women in their time of need, that they care about women, that they are fighting for women’s health, this particular video is a devastating reminder that behind the façade of Planned Parenthood lies a horrible group that sells women out – and sells the body parts of their babies – for money.

Friday, August 14, 2015

OBAMA ADMINISTRATION THREATENS STATES ATTEMPTING TO DEFUND PLANNED PARENTHOOD

AP Photo/Susan Walsh

The Obama administration is threatening states attempting to defund Planned Parenthood–those trying to stop the flow of their Medicaid funds to the abortion provider–with potential violation of federal law and, ultimately, the cutting off of Medicaid funds to those states.

Following the release of investigative videos exposing Planned Parenthood’s practice of harvesting the body parts of aborted babies for potential sale to biomedical companies, Alabama, Louisiana, and New Hampshire have canceled their Medicaid contracts with Planned Parenthood, as CNSNews.com reports.
Other states are in the process of considering similar action.
In Wisconsin, for example, state Rep. André Jacque (R) is attempting to address all the layers of government funding of Planned Parenthood that are under control of his state in several pieces of legislation. While Gov. Scott Walker and the state legislature have redirected about $1 million annually from Planned Parenthood to a Women’s Health Block Grant, the abortion giant’s affiliate in Wisconsin still receives between $15 and $16 million in taxpayer money annually, mainly through Medicaid and Title X “family planning” funding.
The Centers for Medicare and Medicaid Services (CMS), which is part of the Department of Health and Human Services (HHS), has stepped in, however, reports The Wall Street Journalto warn these states that they may be in violation of federal law because, by blocking Planned Parenthood’s reception of Medicaid funds, it says women could lose access to essential preventive care, such as cancer prevention screenings.
In an HHS guidance document from 2011, the Obama administration said states are not allowed to exclude providers from Medicaid solely on the basis of the types of services they offer.
According to the WSJ report, should the states continue to block Medicaid funding to Planned Parenthood, they can request a hearing to settle the matter; however, should the conflict continue, CMS could cut Medicaid funds to the state.
Spokesmen for both Louisiana Gov. Bobby Jindal and Alabama Gov. Robert Bentley said their states are not in violation of federal law since their Medicaid contracts with Planned Parenthood give either party the right to cancel it at will with a notice period: 30 days for Louisiana and 15 days for Alabama.
The HHS guidance, however, also says that states can exclude providers from Medicaid funding if their engagement in certain criminal acts is proven, a provision that many believe is the case with the videos of Planned Parenthood’s top medical personnel discussing the sale of aborted baby organs and body parts.
“This really hasn’t been tried before,” said Casey Mattox, senior legal counsel at Alliance Defending Freedom. “Planned Parenthood has contracts with states that can be terminated for cause. In other situations the contracts were not terminated for cause.”
The Obama administration threatened to cut off Medicaid funding several years ago from Texas, when former Gov. Rick Perry redirected federal Title X funds to family planning centers in his state that are not affiliated with Planned Parenthood and other abortion providers. When Perry prohibited funding for low-income women’s health centers to go to Planned Parenthood clinics, the Obama administration argued the action was a violation of federal law and threatened to cut off Medicaid funding. Undaunted, Perry decided to fund the low-income women’s health program completely with his state’s own money.
In the wake of the release of the investigative videos by the Center for Medical Progress, White House press secretary Josh Earnest deferred to Planned Parenthood, stating the organization says it follows the highest ethical guidelines on medical research.
President Obama is a known champion of Planned Parenthood, the nation’s largest abortion provider. In April of 2013, he was the first sitting president to deliver an address to Planned Parenthood, which was founded by eugenicist and racist Margaret Sanger. He promised to stand with the organization against what he described as efforts to “turn back the clock to policies more suited to the 1950’s than the 21st Century.”
After praising the organization for its 100-year existence, Obama told Planned Parenthood, “God bless you.”
Planned Parenthood President Cecile Richards has enjoyed a close relationship with the White House from the start of Obama’s presidency. According to a report atCNSNews.com, an online record of visitors shows that Richards has visited the White House 39 times since Obama took office, beginning January 20, 2009–the day he was inaugurated.
Since then, Richards has met with Obama alone at least three times and First Lady Michelle Obama at least twice. Additionally, she met with the President and his wife together another four times. She also attended the President’s second inaugural on January 20, 2013.
Richards met with David Plouffe, former senior adviser to the president, four times and current senior adviser Valerie Jarrett five times. She has also met with many members of the Obama administration, including former White House Chief of Staff William Daley, Office of Management and Budget director Shaun Donovan, and current Chief of Staff Denis McDonough.

Thursday, August 13, 2015

Under Obamacare, Uninsured Rate Fell to Lowest Level in 50 Years. Why There’s More to That Number.

Uninsured Rate Fell to Lowest Level in 50 Years
Nearly two years after Obamacare’s implementation, a new survey found that the number of uninsured Americans decreased to less than 10 percent of the population in the first three months of 2015, which is the lowest level in the survey’s 50-year history. 
However, experts say the change could be mostly attributed to the Obama administration’s expansion of Medicaid.
According to the survey from the National Center for Health Statistics, a division of the Centers for Disease Control, the number of people who were uninsured declined from 36 million in 2014 to 29 million in the first three months of 2015. Among adults between the ages of 18 and 64, the percentage of those who were uninsured dropped from 16.3 percent in 2014 to 13 percent in 2015’s first quarter.
The changes to the rate of uninsured come nearly two years after Obamacare’s implementation, which went into effect October 2013.
While the drop speaks to the mission of the health care law, Ed Haislmaier, a health policy expert, pointed to outside factors that affect the decrease in the number of uninsured Americans.
In an interview with The Daily Signal, Haislmaier, a senior research fellow in health policy at The Heritage Foundation, said that though it’s likely the Obama administration was likely “in the ballpark” for the changes in the number of uninsured, the survey had limitations.
Primarily, the government relied on answers from 26,121 respondents as opposed to an actual count, such as the number of people enrolled in health coverage, data that can be provided by health insurance companies.
“They’re trying to say how many people didn’t have coverage and extrapolate from that,” Haislmaier said.
Most notably, though, the survey failed to address an increase to the Medicaid rolls, which stemmed from Medicaid expansion created under Obamacare.
According to Haislmaier, Medicaid enrollment from January 2014 to March 2015 went from approximately 60.9 million to 71 million.

Monday, August 3, 2015

Obama’s Top Health Care Nominee Was Once Embroiled in Medical Fraud Case

Andrew Slavitt, Executive Vice President for Optum/QSSI is sworn-in to testify at a House Energy and Commerce Committee hearing on the Patient Protection and Affordable Care Act on Capitol Hill in Washington, October 24, 2013. REUTERS/Jason ReedAndy Slavitt — President Obama’s choice to manage Obamacare, Medicare and Medicaid — was linked seven years ago to a massive medical data fraud scheme that resulted in what was then the largest settlement ever by an insurance company.
If he is confirmed by the Senate, Slavitt will head the Centers for Medicare and Medicaid, which manages the federal government’s three biggest health care programs. He will manage an estimated $1 trillion in benefits that are paid to millions of doctors, patients and hospitals.
Slavitt was CEO of Ingenix, a health data analytics firm at the center of a $50 million settlement in 2009 with then-New York Attorney General Andrew Cuomo and a $350 million settlement with the American Medical Association.
Cuomo and the AMA charged that Ingenix supplied databases to insurance companies that fraudulently calculated reimbursements for out-of-network medical services provided to policyholders, according to a Daily Caller News Foundation investigation.
Ingenix was owned by UnitedHealth Group, which did not admit to any criminal wrong-doing in the settlements.
The Ingenix scandal became public in February 2008 when Cuomo filed a “notice of intent to sue” Ingenix and UnitedHealth Group for “rigged” reimbursement rates that forced patients to overpay up to 30 percent for out-of-network doctors and hospitals.
Cuomo charged that Ingenix was running a “scheme” that sought “to defraud consumers by manipulating reimbursement rates.”
The AG told reporters, “This involves fraud in the hundreds of millions of dollars, affecting thousands and thousands of families. Too many people have been hurt. It has to stop.”
It was estimated that years of data manipulation by Ingenix affected as many as 110 million Americans — about one in three patients — who used doctors, labs or hospitals that were out of their insurance network.
Cuomo, who is now New York’s Democratic governor, estimated that patients who used out-of-network providers received between 10 to 28 percent less than they were entitled to because of Ingenix’s flawed data.
The $350 million was to reimburse doctors and patients shortchanged by Slavitt’s company. The $50 million went to establish a database of physician charges to be administered independently by a university. Ingenix also agreed to shutter its entire medical data analytics department.

Saturday, August 1, 2015

[VIDEO] Obama Weekly Address, Saturday August 1, 2015


WASHINGTON, DC — In this week's address, the President celebrated the fiftieth birthdays of Medicare and Medicaid, which together have allowed millions to live longer and better lives. These programs are a promise that if we work hard, and play by the rules, we’ll be rewarded with a basic measure of dignity, security, and the freedom to live our lives as we want. Every American deserves the sense of safety and security that comes with health insurance. That’s why the President signed the Affordable Care Act, and that’s why he will continue to work to ensure that Medicare and Medicaid, programs that are fundamental to our way of life, stay strong.
The audio of the address and video of the address will be available online atwww.whitehouse.gov at 6:00 a.m. ET, August 1, 2015.



Wednesday, July 29, 2015

50 Years of Dysfunction: The Failures of Medicare and Medicaid

Fifty years ago, on July 30, 1965, President Lyndon B. Johnson signed legislation creating the nation’s two largest federal health entitlements, Medicare and Medicaid.
Medicare was created as a social insurance program for seniors and those with disabilities. It is financed primarily by payroll taxes collected during a recipients working life, and secondarily by personal and business income taxes.
Medicaid was designed as a welfare program to provide health care services to vulnerable low income groups. Medicaid is jointly financed by federal and state governments.
>>> On Thursday, the Heritage Foundation and the American Enterprise Institute are hosting an event with leading experts to reflect on the past 50 years and look ahead to the next. Details here.
Unfortunately at the age of 50, both Medicare and Medicaid continue to suffer from problems inherent to their structure and organization.
For example both programs:
  • Limit choice
  • Are overly bureaucratic and slow to change
  • Suffer from crucial gaps in coverage and inefficient pricing
  • Are plagued with losses through waste, fraud and abuse
Medicare is the largest purchaser of health care in the nation, covering roughly 55 million persons.
The Congressional Budget Office (CBO) estimates Medicare’s total annual cost at $615 billion in 2015 and it is scheduled to exceed $1 trillion by 2023.
In other words, over the next 75 years American seniors are expecting tens of trillions of dollars of Medicare benefits that are not paid for. Today, working taxpayers, mostly through business and personal income taxes, fund an estimated 86 percent of the program’s annual cost.
For Medicaid, the Centers for Medicaid and Medicare Services (CMS) Office of the Actuary estimates that Medicaid’s total (federal and state combined) spending is expected to reach $529 billion in 2015, with 68.9 million enrollees.
Fifty years later, in their July 22, 2015 memo to Senate Budget Committee staff Medicare’s Office of the Actuary reports that Medicare’s debt – the program’s long-term unfunded liability- ranges from $27.9 to $36.8 trillion.
Whether it’s the lower or higher debt number, this year’s estimates are worse than last year’s by more than a $1 trillion.
For Medicaid, cost and enrollment is expected to continue to grow, in particular due to the expansion of the program under the Affordable Care Act.
By 2023, total Medicaid spending is projected to climb to $835 billion and enrollment will near 80 million.
The President’s answer is to cut Medicare payments to medical professionals and institutions.
Under Obamacare, the Medicare Trustees warn,
“By 2040, approximately half of hospitals, 70 percent of skilled nursing facilities and 90 percent of home health agencies would have negative total facility margins, ” adding that this creates the “possibility of access and quality of care issues for Medicare beneficiaries.”
For Medicaid, access and quality of care is already a top concern.
recent CDC study found that only 68.9 percent of physicians would accept new Medicaid patients.
For the next 50 years, Congress could initiate transformative changes through a defined contribution ( “premium support”) financing in both programs, giving patients direct control over the flow of health care dollars and compelling health plans and providers to compete for patients’ dollars on a level playing field.
Intense competition among health plans and providers would stimulate innovation in benefit design and care delivery, improve patient outcomes and enhance patient satisfaction, and save serious money for both seniors and taxpayers alike.

Wednesday, July 15, 2015

Obamacare’s Enrollment Increase: Mainly Due to Medicaid Expansion

Abstract
Health insurance enrollment data show that the number of Americans with private health insurance coverage increased by a bit less than 2.5 million in the first half of 2014. While enrollment in individual market coverage grew by almost 6.3 million, 61 percent of that gain was offset by a reduction of nearly 3.8 million individuals with employer-sponsored coverage. During the same period, Medicaid enrollment increased by almost 6.1 million—principally as a result of Obamacare expanding eligibility to able-bodied, working-age adults. Consequently, 71 percent of the combined increase in health insurance coverage during the first half of 2014 was attributable to 25 states and the District of Columbia adopting the Obamacare Medicaid expansion.
W‌ith enrollment data now available for the second quarter ‌of 2014, it is possible to construct a complete picture of the changes in health insurance coverage that occurred during the initial implementation of the Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare. The data show that in the first half of 2014, private health insurance enrollment increased by a net of 2,465,586 individuals. That net figure reflects the fact that 61 percent of the gain in individual coverage was offset by a drop in employer group coverage. During the same period, Medicaid enrollment grew by 6,072,651 individuals. Thus, while a total of 8.5 million individuals gained coverage, 71 percent of that net coverage gain was attributable to the Obamacare expansion of Medicaid to able-bodied, working-age adults.
 

Changes in Private Coverage Enrollment

Health insurers file quarterly reports with state regulators, and data from those reports for the second quarter of 2014 are now available.[1] The three relevant market subsets for this analysis are (1) the individual market, (2) the fully insured employer-group market, and the (3) self-insured employer-group market.[2] Table 1 shows the changes in private health insurance enrollment during the first and second quarters of 2014, along with the net changes for the combined six-month period.
Obamacare’s initial open enrollment period began on October 1, 2013, and officially ended on March 31, 2014—though in a number of states it was extended into April to give those who had experienced problems enrolling additional time to complete the process. Because enrollment was for the 2014 plan year, the coverage for those who enrolled during the fourth quarter of 2013 took effect in the new year; thus, those individuals are included in the data for the first quarter (Q1) of 2014. The data for Q2 2014 captures enrollments that occurred during the last two months of the open enrollment period, or which were otherwise delayed due to the numerous problems experienced by the exchanges, and so did not take effect until after the end of the first quarter.
The data show that enrollment in individual market coverage increased by over 2.7 million individuals in Q1 2014 and by a further 3.5 million individuals in Q2. Thus, for the first half of 2014, enrollment in individual market coverage grew by almost 6.3 million individuals.
The second-biggest coverage change that occurred during the first half of 2014 was the decline in the number of individuals with coverage through fully insured employer group plans. Enrollment in such plans dropped by 3.8 million individuals in Q1 2014, and by nearly a million more individuals in Q2 2014. Thus, for the first half of 2014, the number of individuals with coverage through a fully insured employer group plan decreased by nearly 4.8 million.
Enrollment in self-insured employer plans modestly increased in both quarters—by 347,000 in Q1 2014, and by about 652,000 in Q2—for a net enrollment gain of a little less than one million during the first half of 2014. Consequently, the combined enrollment changes in the two segments of the employer group market during the first half of 2014 produced a net decrease of almost 3.8 million in the number of Americans covered by employer-sponsored plans.
That net reduction in employer-sponsored group coverage is explained by employers discontinuing coverage for some or all of their workers or, in some cases, individuals losing access to such coverage due to employment changes. While it is not possible to determine from the data the subsequent coverage status of individuals who lost group coverage, there are only four possibilities: (1) some obtained replacement individual-market coverage (either on or off the exchanges); (2) some enrolled in Medicaid; (3) some enrolled in other coverage for which they are eligible (such as a plan offered by their new employer, a spouse’s plan, a parent’s policy, or Medicare); and (4) some became uninsured.
 
If individuals lost group coverage, but obtained new coverage under either another employer group plan or one in the individual market, they would then be counted in the enrollment figures for those submarkets. Similarly, if individuals transitioned to Medicaid, they would be counted in the Medicaid enrollment figures reported by the Centers for Medicare and Medicaid Services (CMS).

Popular Posts