One-Third of Doctors Consider Quitting After Passage of the ACA

Thirty-six percent of all doctors, and 45% of private practice doctors say they are more inclined to leave the medical profession because of the Affordable Care Act (ACA), according to a study by CompHealth. Fifty-one percent of doctors surveyed view the ACA unfavorably while 30% view it favorably. Physicians in private practice are most pessimistic, with 61% saying they view the law negatively. Doctors also say the following about practicing medicine after the ACA:

  • 47% say the ACA has improved access to healthcare and insurance.
  • 44% say the ACA has had a neutral effect on their patients’ quality of healthcare.
  • 76% of all doctors, and 86% of private practice doctors say they are not properly compensated by ACA reimbursements.
  • 38% say their salaries have decreased.
  • 44% spend less time with their patients.
  • 68% spend too much time entering data.
  • 59% spend too much time doing paperwork.

To cope with challenging circumstances, 40% of doctors are supplementing their income by filling in for other doctors, moonlighting, and consulting.

Survey: Access to retirement plan inspires confidence

A survey from the Employee Benefit Research Institute says 21% of people in the workforce consider themselves very confident about funding a comfortable retirement. “There is a clear dichotomy between those who have some sort of retirement plan — that is, a defined-benefit or defined-contribution plan or [an] individual retirement account ­­– and those who do not,” said Craig Copeland, senior research associate at EBRI. “Those with a retirement plan are more likely to be very confident about their financial prospects in retirement compared with those who do not have a retirement plan.” Employee Benefit News (3/24)

Major Health Insurance Changes for the New Year

Covered CA 2016 ChangesCovered California is reminding consumers and small businesses about important changes in 2016. Starting January 1, Covered California increased access to plans and providers and offered more health plans, and increased the number of benefits that are not subject to a deductible. Here is a run-down of the changes:

Most California Consumers Get New Forms for the 2015 Tax Year
This year, consumers who are insured through their employer or a government program, like Medi-Cal, will get Form 1095-B or Form 1095-C. The forms show who maintained minimum essential coverage and is not liable for the tax penalty. Consumers under Covered California will continue to get a Form 1095-A. For more information, visithttps://www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals.

The Penalty for Not Buying Affordable Insurance Is Going Up — A Lot
The IRS penalty applies to people who go without insurance when they can afford to buy it. It will increase for 2016 to at least $695 per adult and $347.50 per child under 18 or 2.5% of household income, whichever is greater. A recent study by the Henry J. Kaiser Family Foundation estimates that the average household penalty in 2016 will be $969, which is a 47% increase from 2015. For more information, visit www.taxpayeradvocate.irs.gov/estimator/isrp.

New Requirements and New Options for Many of California’s Small Businesses
Employers with more than 50 full-time-equivalent (FTE) employees must offer health insurance to employees or pay a penalty. Through 2015, this requirement applied only to businesses with more than 100 employees. Any of these employers with an employee who does not take their offer of coverage will have to pay a penalty if the employee goes on to get financial assistance to purchase coverage through Covered California. For more information, visit https://www.irs.gov/Affordable-Care-Act/Employers/ACA-Information-Center-for-Applicable-Large-Employers-ALEs.

Covered California for Small Business will expand beyond the ceiling of 50 employees to serve companies employing 100 or fewer FTE employees. For more information, visit www.CoveredCA.com/ForSmallBusiness.

Major Improvements in Choice, Access and Benefits
Covered California used its power as an active purchaser to hold down rate changes for a second year. Before the Affordable Care Act, consumers regularly experienced double-digit premium increases. For 2016, Covered California negotiated a weighted average change of 4%, which is lower than last year’s change of 4.2%. In addition, nearly 90% of Covered California enrollees get some financial assistance to help pay premiums. On average, those subsidies resulted in more than $5,200 for each household in 2014.

Benefit Changes for the 2016 coverage year:

  • The majority of Bronze plan consumers now get three office visits a year to a primary care provider or specialist with no deductible. Other needed services, such as lab tests and rehabilitation, will not be subject to a deductible.
  • Covered California’s Silver plan will combine copay and coinsurance into a single product. Every doctor visit, lab test, and prescription will not be subject to a deductible in this single product. Consumers with chronic conditions will be protected by a cap on specialty drugs. The vast majority of consumers will see their specialty drugs capped at $250 per month, per prescription. Plus, because of Covered California’s standard benefit design, the caps must be offered by every health insurance plan in the individual market and by all plans offered by the exchange. For more information, visit http://news.CoveredCA.com/2015/05/covered-california-board-protects.html.
  • Adult dental coverage is now offered as an add-on.
  • 6% of Covered California consumers will be able to choose from at least three health insurance companies thanks to the addition of two new health insurance companies — UnitedHealthcare Benefits Plan of California and Oscar Health Plan of California as well as the expansion of Blue Shield of California and Health Net.
  • More than 90% of hospitals (general acute centers as designated by the California Office of Statewide Health Planning and Development) in California will be available through at least one health insurance company, and 74% will be available through three or more companies.

 Medi-Cal Coverage for Undocumented Children

  • Medi-Cal will be expanded to all children regardless of their immigration status. The new law goes into effect in May 2016.

Health Care Improvements for All Californians
Starting July 1, health plans must publish and maintain printed and online provider directories. Health plans must maintain accurate provider directories, including routine updates. For more information, visithttp://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137.

A new state law will require health plans and insurers to implement formula-tier requirements and cost-sharing caps similar to products offered through Covered California. Assembly Bill 339 requires plans and insurers to have formularies that do not discourage the enrollment of people with certain health conditions. It also sets requirements regarding access to in-network retail pharmacies, standardized formularies, and coverage for certain single-tablet HIV and AIDS treatments. For more information, visithttp://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB339.

Medicaid and CHIP Beat Private Plans in Access to Pediatric Preventive Care

Children with Medicaid or the Children’s Health Insurance Program (CHIP) have greater access to preventive care than do children with private insurance, according to a survey by PolicyLab at the Children’s Hospital of Philadelphia. David Rubin, MD, MSCE, of PolicyLab suggests requiring private plans on the exchanges to match Medicaid’s mandatory benefit and cost-sharing provisions. He noted that some new insurance plans in the commercial market are tiering specialty providers as out-of-network, which blocks access for children with special healthcare needs.

Seventy-eight percent of caregivers of children with Medicaid and CHIP say the insurance always meets their needs compared to 73% of caregivers of children with private insurance. Eighty-eight percent of children with Medicaid or CHIP had access to preventive medical care compared to 83% of children with private insurance. Eighty percent of children with Medicaid have access to dental care compared to 77% of children CHIP and 73% of children with private insurance.

Getting specialty care is a challenge for children in all coverage types, with as many as one in four having difficulty seeing a specialist. However, these challenges are greatest for children with CHIP (28%) and for privately insured children with special health care needs (29%). Seventy-seven percent of caregivers of children with private insurance have out-of-pocket costs compared to 38% of those with CHIP, and 26% of those with Medicaid.

Addressing Disparities in Pediatric Care

With its dense care network, California has the potential to improve healthcare access for publicly insured children. The state could improve access by providing incentives for providers to accept these patients. In contrast, states, such as Mississippi, would not generate the same improvement since access for privately insured children is also lacking, according to an analysis by Georgia Tech.

Fewer people have access to workplace retirement plans

Research shows that 53% of workers ages 25 to 64 had access to a workplace retirement plan in 2011, down from 61% in 1999. The downward trend most likely has continued recently, the study notes. Many boomer households will likely have to get by on only Social Security benefits. Money magazine (4/8)

Experts Predict A Big Boost in Access to Mental Health Drugs

Doctors and managed care organizations anticipate increased demand for drugs that treat major depression, bipolar disorder, and schizophrenia, according to a survey by Decision Resources Group. The demand for these drugs will rise thanks to Medicaid expansion in 24 states and affordable coverage through the exchanges. Doctors expect to see 30% more patients with these conditions. Managed care organizations say that drug formularies in the exchanges are the same or compare favorably to those of traditional group health plans. While there are many generic drugs to treat these behavioral health conditions, managed-care organizations offer favorable tier placement to brands they believe offer superior efficacy, safety, and tolerability. Branded behavioral drugs, such as Brintellix, Saphris, and Fanapt are excluded less often from exchange plans than from commercial group plans. Abilify will launch generically in 2015, which is expected to increase utilization, especially in Medicaid plans and in managed-care plans that offer higher payments for physicians with high generic prescribing rates. Narrow provider networks in the exchanges are expected to drive many patients to visit primary care doctors for  behavioral conditions. Compared to psychiatrists, these generalists are not as familiar with the newer branded drugs, and they welcome information about pharmaceutical companies’ patient assist programs. Doctors overwhelmingly support patient assistant programs. They say that patients will still need drug coupons when they face high deductibles or formulary exclusions through an exchange plan. For more information visit www.DecisionResourcesGroup.com.

State Budget Expands Access to Health Care

Gov. Jerry Brown signed a state-spending plan for the coming fiscal year, which expands Medi-Cal to an additional 1.4 million low-income Californians. In doing so, the state is adopting an optional provision of the federal Affordable Care Act.

The budget leverages private funds from The California Endowment and federal matching grants providing $53 million for Obamacare outreach and enrollment assistance at no additional cost to California taxpayers. This funding will provide $28 million in private and federal money to support enrollment for up to 450,000 Medi-Cal applicants. It will provide $25 million for Medi-Cal outreach and enrollment grants targeting mixed-status families, the homeless, school-age children, and other vulnerable populations.

In the short term, fiscal savings would far outweigh the non-federal costs of providing health care to the expansion population, according to a statement by the California Legislative Analyst’s office (LAO). LAO said, “After a decade, when the enhanced federal matching rate is reduced from 100% to 90%, we estimate that overall savings to the state as a whole (state and local governments) would likely continue to outweigh costs…We believe the policy merits of the expansion and the fiscal benefits that are likely to accrue to the state as a whole outweigh the costs and potential fiscal risks. We recommend the state adopt the optional expansion.  We also find that the state is in a better position than the counties to effectively organize and coordinate the delivery of health services to the newly eligible population — potentially resulting in improved health outcomes and administrative efficiencies. As a practical matter, we also believe the state is better positioned than the counties to successfully implement an expansion by January 1, 2014. We recommend the Legislature adopt a state-based expansion, shifting the fiscal and programmatic responsibility of providing health care to the expansion population from counties to the state.”

DMHC Fines Kaiser Over Access to Mental Health Services

The California Department of Managed Health Care (DMHC) issued a $4 million fine against Kaiser for not providing enough access to mental health services. DMHC Director Brent Barnhart, said, “The Department’s actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them.” DMHC says that Kaiser does not do the following:
• Make sure that quality assurance systems accurately track, measure, and monitor the accessibility and availability of providers.
• Monitor its provider network to ensure that appointments are offered within regulatory timeframes.
• Provide effective action to improve care where deficiencies are identified.
• Provide accurate and understandable mental health education materials, including information about  the availability and optimal use of the plan’s mental health care services.

The plan’s mental health educational materials, including frequently-asked-question  sheets, Website postings, and new patient presentations included inaccurate information that could dissuade an enrollee from pursuing medically necessary care. The DMHC also found examples of member materials that, while consistent with the law, did not convey coverage in language understandable to the average member.

The DMHC will conduct a follow-up survey in October to make sure that Kaiser has corrected the deficiencies and is complying with the law. The full survey report can be found here:http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bh031813.pdf.

Last Updated 10/09/2019

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