The early story of the Affordable Care Act can be challenging to generalize sometimes because so much of it depends on decisions made at the state level — both before and during implementation of the ACA. Did states defer to a federal-run exchange, or did they set up their own? In the states that built their own insurance marketplaces, did the Web site actually work? Did they expand Medicaid programs to low-income adults? Did they temporarily let people keep their old health plans? Those decisions made across 50 states and the District of Columbia came with measurable consequences, according to new research from the Brookings Institution, published as part of the twice-annual Brookings Papers on Economic Activity.
A group of South Florida hospitals is working with a foundation to help low-income consumers pay their health insurance premiums in an effort to keep consumers covered and ensure hospitals get paid for treating them. But insurance companies say third-party payers pose a conflict of interests. The South Florida Hospital and Healthcare Association is trying to raise $5 million to donate to a foundation, which would pay the premiums for one year for 7,000 to 10,000 consumers who bought insurance under the Affordable Care Act.
An increasing number of seniors who spend time in the hospital are surprised to learn that they were not "admitted" patients -- even though they may have stayed overnight in a hospital bed and received treatment, diagnostic tests and drugs. Because they were not considered sick enough to require admission but also were not healthy enough to go home, they were kept for observation care, a type of outpatient service. The distinction between inpatient status and outpatient status matters: Seniors must have three consecutive days as admitted patients to qualify for Medicare coverage for follow-up nursing home care, and no amount of observation time counts for that three-day tally.
All of the estimated 450,000 Massachusetts residents who get health insurance through the Health Connector or MassHealth — some of whom have been in a confusing phase of temporary coverage this year — will soon begin the process of applying for coverage for 2015. If the state's new health insurance website is up and running — which the Patrick administration promises it will be — then residents will be able to beginning applying online Nov. 15. If the website still isn't working, or using a computer isn't convenient, then you'll have to fill out a paper application. Either way, you might want to keep a copy of this timeline handy through January.
It's obvious there isn't much going on in health care today, but there are a couple papers from the Brookings Institution about medical matters and geography that are worth noting. First, the think tank has found that higher Medicare spending in certain states is due to varying conditions in each location, rather than different practice styles. Louise Sheiner, a senior fellow at Brookings and author of the study, says it dispels conventional wisdom, which contends that wasteful spending on health care is due to treatment practices that vary from region to region. Sheiner says it's due more to varying conditions in certain states and their ability to pay for the resulting required medical care.
Dr. Nicole Lurie is the assistant secretary for preparedness and response at the Department of Health and Human Services (HHS), where she leads federal efforts in preventing and responding to the adverse health effects of public health emergencies and disasters. She spoke about her experiences and management philosophy with Tom Fox, a guest writer for On Leadership and vice president for leadership and innovation at the nonprofit Partnership for Public Service. Fox also heads up their Center for Government Leadership. The interview has been lightly edited for length and clarity.