In the news this week: Payers continue to move toward health insurance exchanges with limited enthusiasm. Results of a study examining the effectiveness of health insurance on Medicaid recipients are inconclusive. And IPAB is going nowhere, at least for now.
Rarely does a week pass by without news about the federally mandated health insurance exchanges. As the October deadline for open enrollment inches closer, lately that news has been coming with a hefty side of doubt from insurers.
There are still some provisions of the Patient Protection and Affordable Care Act that insurers are still fighting such as age rating, but last week's big reveal from the nation's largest health plans likely got the attention of the feds because it could have implications on the price exchange participants will pay.
Insurers Walk, Don't Run Toward HIX
States, the feds, and insurers have been waiting to find out just how many insurers planned on offering products on the health insurance exchanges. According to an analysis by Reuters, despite the millions of new customers (24 million by 2016, 7 million in the first year) who will be shopping for individual policies in October, health insurance companies are not venturing too far from their comfort zones.
For example, Cigna, one of the nation's largest insurers is planning on entering a "limited" number of exchanges. Even UnitedHealthcare says it will cap the number of HIX it will participate in at 25. The other big boys in the industry echo similar stands, citing they are slow-walking to exchanges because of uncertainty about whether the exchanges will be ready in time for a quickly approaching open enrollment date of October 1.
States that already have a robust and competitive marketplace are likely to fare better than those who only have a few insurers currently covering the population.
Effectiveness of Health Insurance Still Uncertain
A study examining Oregon's Medicaid population in 2008 showed that having health insurance had little impact on the health of enrollees. Results from the first year of the study were published in 2012, but there was no definite determination made about the correlation between health and health insurance.
This time, with two years of results, the study's author, MIT economist Amy Finkelstein, was ready to point to the data with the conclusion that having health insurance is no guarantee that the health of the person covered will be better.
The study followed two groups of Medicaid patients. One group of patients was covered; the other was not. The study found what it characterized as "no significant improvements" in the health of those who were covered by Medicaid, though some healthcare analysts may argue that the increased rates of diabetes detection and management as well as lower rates of depression are significant.
Oregon's study isn't the first to point out that health insurance doesn't necessarily lead to better health. But, the study could have a chilling effect on patient engagement activities if health systems and hospitals don't believe the small improvements made are significant enough to put a dent in chronic health conditions.
As Ezra Klein, writing in the Washington Post puts it, "The problem with the Oregon study is that it doesn't help us figure out how to make health care or health insurance better."
IPAB Stalled, For Now
The Independent Payment Advisory Board, created by PPACA and detested by Congress and the healthcare industry, will not start cutting Medicare spending in 2015, as was expected. The reason is surprisingly nonpartisan and based, astonishingly, on common sense.
Essentially, the component of the law that created IPAB also has language delaying the board's authority when Medicare spending doesn't outpace the Consumer Price Index (CPI).
Since Medicare's spending has slowed in recent years —a fact lauded by Secretary of Health Kathleen Sibelius—and that pattern isn't projected to change by 2015, the chief actuary Medicare notified the Center for Medicare & Medicaid Services that the IPAB wasn't needed yet. It'll be interesting to see how temporarily this delay lasts.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.