The ca­nary in the open en­roll­ment coal mine

Modern Healthcare - - Comment | Editorial - MER­RILL GOOZNER Ed­i­tor Emer­i­tus

Sign-ups for in­di­vid­ual health plans dur­ing this year’s short­ened open-en­roll­ment sea­son are run­ning well be­low last year’s pace. The num­ber of unin­sured chil­dren is ris­ing. The share of Amer­i­cans with­out health cov­er­age will un­doubt­edly tick up next year for the first time in nearly a decade.

This du­bi­ous achieve­ment ar­rives just as the U.S. econ­omy is near­ing full em­ploy­ment. This shouldn’t be hap­pen­ing.

Em­ploy­ers that of­fer health in­sur­ance are rais­ing wages and bol­ster­ing ben­e­fits to at­tract work­ers. Peo­ple work­ing at jobs with­out ben­e­fits or in the gig econ­omy are see­ing ris­ing in­comes, which should make in­di­vid­u­ally pur­chased plans more af­ford­able.

It clearly took a lot of work by the Trump ad­min­is­tra­tion and the cur­rent Congress to un­der­mine the ex­changes where in­di­vid­ual poli­cies are sold. The ad­min­is­tra­tion re­moved in­sur­ance price sta­bi­liz­ers, ended cost-shar­ing sub­si­dies for pa­tients and slashed the bud­gets for the nav­i­ga­tors who help peo­ple sign up. It also ex­panded the avail­abil­ity of “short-term” skimpy plans, which of­fer re­as­sur­ance as long as their pur­chasers don’t get sick.

The out­go­ing Congress did its part by es­sen­tially end­ing the in­di­vid­ual man­date. Some ex­perts pre­dicted this would have lit­tle im­pact and dis­missed the Con­gres­sional Bud­get Of­fice warn­ing that 4 mil­lion fewer peo­ple would sign up on the ex­changes for 2019 be­cause of the ze­roed-out tax penalty.

It turns out the CBO may have over­es­ti­mated, but di­rec­tion­ally was spo­ton. If the cur­rent sign-up rate holds through the end of open en­roll­ment on Dec. 15, more than 2 mil­lion fewer peo­ple will choose plans on the ex­changes for 2019, about a 17% de­cline from 2018.

This will al­most en­tirely off­set the in­crease in em­ployer-based cov­er­age that one would ex­pect from an im­prov­ing econ­omy. The lat­est Cen­sus Bu­reau sur­vey showed em­ploy­ers added 2.5 mil­lion cov­ered lives in 2017, a year when em­ploy­ment gains were com­pa­ra­ble to the past year.

Next year’s unin­sured prob­lem will be ex­ac­er­bated by con­tin­u­ing ef­forts in some states to add work re­quire­ments to their ex­panded Med­i­caid pro­grams. Arkansas, which was first to im­ple­ment the new re­quire­ments, saw 12,000 peo­ple dropped from its rolls in the past three months.

It could get much worse. In a let­ter sent last month to HHS Sec­re­tary Alex Azar, the Med­i­caid and CHIP Pay­ment and Ac­cess Com­mis­sion noted over 90% of Arkansas ben­e­fi­cia­ries failed to meet cum­ber­some re­port­ing rules— even if they were work­ing.

CMS Ad­min­is­tra­tor Seema Verma promised to re­view the re­sults. But at the same time, she vowed to con­tinue the ad­min­is­tra­tion’s push for work re­quire­ments. “We re­main stead­fast in our be­lief that this pol­icy is im­por­tant for the pro­gram,” she said.

It’s poor tim­ing for ide­o­log­i­cal rigid­ity. If the econ­omy slows next year, which many economists pre­dict, the last thing you want to do is cre­ate higher hur­dles for low-in­come peo­ple need­ing Med­i­caid.

It’s not too late for health­care providers and in­sur­ers to undo some of the dam­age. To bol­ster sign-ups on the ex­changes in the last few weeks of open en­roll­ment, they can run me­dia ads and press lo­cal TV and ra­dio sta­tions to run pub­lic ser­vice an­nounce­ments. They can give emer­gency grants or as­sign per­son­nel to lo­cal nav­i­ga­tor groups, which saw 90% of their gov­ern­ment fund­ing evap­o­rate.

But the die for next year is mostly cast. Hos­pi­tal and physi­cian prac­tice fi­nance of­fi­cers need to be­gin pre­par­ing now for the com­ing fis­cal re­al­i­ties. They are al­ready see­ing their un­col­lectable bills rise due to growth of high-de­ductible plans. They should ex­pect an­other up­ward lurch in un­com­pen­sated care next year.

As mar­gins shrink, it is in­evitable that ac­tiv­ity in the health­care hir­ing hall, which has been go­ing great guns since the end of the last re­ces­sion, will slow sharply. You’d think the Trump ad­min­is­tra­tion would un­der­stand that’s not what it wants go­ing into a two-year bat­tle to win re-elec­tion. ●

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.