Ohio Health Policy Review

Insurers testing new plans that reduce cost, restrict choice of doctors, hospitals

Insurance plans have begun testing new plans with reduced premiums that limit participants’ choices of doctors or hospitals (Source: “Insurers Push Plans That Limit Choice of Doctor,” New York Times, July 18, 2010).

The plans may be especially appealing to small businesses struggling with the spiraling cost of coverage, but are also garnering interest from larger employers as well.

“What we’re seeing is a definite uptick in interest because, quite frankly, affordability is the most pressing agenda item,” said Dr. Sam Ho, the chief medical officer for UnitedHealth’s health-care plans.

Insurers anticipate that the lower-cost plans will be popular with individuals and small businesses who will purchase coverage in the insurance exchanges that will take effect in 2014.

Commonwealth report outlines key policy issues for insurance exchanges

The Commonwealth Fund released last week a report on state insurance exchanges that outlines areas of consideration for policymakers as they begin setting up state insurance exchanges.

The report, Health Insurance Exchanges and the Affordable Care Act: Key Policy Issues, describes 13 key areas for policymakers to consider.

“Health insurance exchanges are the centerpiece of the private health insurance reforms of the Affordable Care Act of 2010 (ACA),” the report states. “If they function as planned, these exchanges will expand health insurance coverage, improve the quality of such coverage and perhaps of health care itself, and reduce costs. Previous attempts at creating health insurance exchanges, however, enjoyed only mixed results.”

HPIO releases fact sheet on impact of national reform on Ohio's uninsured

As Ohio policymakers continue to implement national health reform, the Health Policy Institute of Ohio is planning to publish a series of Health Reform Fact Sheets. Over the next six months, HPIO will be releasing the short papers designed to describe the Ohio-specific impact of national reform on coverage, provider capacity, delivery system reform, information transparency, and State resources. The latest of these, finished this week, addresses Ohio’s uninsured and how they will be impacted by reform.

HPIO also has released its National Health Reform Framework — a one-page summary of implementation priorities that can be used by HPIO and others as a starting point for more detailed discussions about the challenges and opportunities related to reform.

In addition, HPIO also has created a presentation,"What Reform Means for Ohio," that describes national reform, implementation challenges, and opportunities for Ohio to improve health system performance (this presentation is ideal for strategic planning — please contact Jill Huntley at 614-224-4950 or jhuntley@healthpolicyohio.org if you are interested in scheduling Greg Moody, HPIO Interim Director, to present at your organization and/or facilitate a discussion on the impact of reform).

Ohio picks Medical Mutual to run high-risk pool

The Ohio Department of Insurance last week announced that it has chosen Medical Mutual of Ohio to operate the state’s temporary high-risk insurance pool (Source: “Medical Mutual to run state's high-risk pool,” Columbus Dispatch, June 26, 2010).

Federal reform legislation passed in March requires a high-risk pool in every state so that those with pre-existing medical conditional can purchase insurance. The pool will operate until 2014, when a state-managed insurance exchange will be established.

In its proposal, Medical Mutual, a nonprofit company, estimated that it could cover more than 5,000 Ohioans through the duration of the program, with individuals paying a standard premium for their coverage. No state funds will be used to provide this coverage.

At the same time, a new nationwide program designed to help people turned down for health coverage because of preexisting health conditions launched Thursday, which will be used by residents of the 21 states that opted against setting up a state-run high-risk pool (Source: "Obama administration unveils government health-care Web site," Washington Post, July 1, 2010)

The Obama administration unveiled on Thursday a new website, www.healthcare.gov,  where people who’ve been turned down for health coverage can go to find new options until the health-reform law’s major provisions take effect in 2014.

Ohio dependent age increase goes into effect

On Thursday unmarried Ohio adults up to age 28 were able to remain or be added to their parent’s insurance coverage (Source: “Dependent age now increased to 28 for insurance purposes,” Youngstown Vindicator, July 1, 2010).

The change, which was approved by the General Assembly last year, will work in tandem with a federal reform provision that childen up to age 26 be eligible for coverage. That provision goes into effect on Sept. 23.

The increased dependent age is expected to enable 20,000 additional young adults to obtain coverage, according to state officials.

 

Ohio Medicaid Director: Expansion this year unlikely

Although federal reform legislation enables states to expand Medicaid coverage as early as this year, Ohio Medicaid Director Tracy Plouck said the state’s tight budget makes that unlikely here (Source: “Ohio Medicaid chief says early expansion unlikely,” Associated Press, via Business Week, May 20, 2010).

Plouck said Ohio, like many other states, is concerned about paying its share of the federal-state insurance program, even though the federal government currently pays about 74 percent of Ohio's Medicaid costs, an increased match rate written into the stimulus bill that was signed by President Obama last year. The state’s standard federal match is 63 percent.  That increased aid runs out at the end of 2010, however, and it's unclear if Congress will extend it.

States will be required to extend Medicaid eligibility in 2014, covering people with incomes up to 133 percent of the federal poverty level, or about $29,327 a year for a family of four. Also, childless adults will be covered for the first time. The federal government will pick up 100 percent of the cost for newly eligible enrollees for three years. After that, federal support gradually declines through 2020.

The state had planned on implementing an expansion of Medicaid for children from 200 percent of the federal poverty limit to 300 percent of the FPL as part of the bienium budget that was passed last July. The State's fiscal year 2010-2011 budget called for funding the expansion, and other non-health related measures, with a portion of the State's tobacco settlement dollars; however, questions as to whether the State can use this funding source remain unclear and that expansion also remains on hold.

PCP shortage looms in rural Ohio

Given the anticipated increase in newly insured Ohioans starting in 2014 because of federal health reform, the current shortage in primary care doctors in rural Ohio is likely to be exacerbated, according to officials at the American Association of Medical Colleges (Source: “Rural Ohio facing doctor shortage,” Mansfield News-Journal, May 24, 2010).

However, the AAMC’s Center for Workforce Studies director Ed Salsberg says he is optimistic that proposals in the federal Patient Protection and Affordable Care Act will, over time, increase the number of primary care providers in underserved areas of the state.

"I do expect to see that growth, but I do want to be clear that it's going to be a challenge," he said, "and a greater challenge for rural and poorer communities."

Ohio Supreme Court ruling may limit medical liability damages

A ruling by the Ohio Supreme Court earlier this month that is expected to limit damages in personal injury cases, including medical liability, is being characterized as a victory for physicians (Source: “Liability damages may be limited by Ohio ruling,” American Medical News, May 24, 2010).

The high court on May 4 ruled that defendants may submit evidence showing the amounts actually paid for a plaintiff’s medical bills, even when those costs are less than the amount originally billed. At issue is whether a defendant can request that damages be determined based on the actual amount paid by an insurance provider, which is often much lower than the total amount of the original medical bill. The difference between the two amounts is commonly know as write-offs.

"Write-offs are amounts not paid by third parties or anyone else, so permitting introduction of evidence of them allows the fact finder to determine the actual amount of medical expenses incurred as a result of the defendant's conduct," Justice Terrence O'Donnell wrote in the decision. "This result supports the traditional goal of compensatory damages -- making the plaintiff whole."

HPIO releases "A Snapshot of Ohio's Health Safety Net"

The Health Policy Institute of Ohio, through support from the HealthPath Foundation of Ohio, has released A Snapshot of Ohio's Safety Net (pdf, 71 pages, 13MB), a report on the economic downturn’s impact on safety net services in Ohio and other states’ strategies to monitor safety net change. HPIO, with support from the HealthPath Foundation of Ohio, collaborated with researchers at Wright State University to undertake the Safety Net Snapshot Project, which surveyed Ohio-based safety net providers, conducted community-level interviews and investigated other states' monitoring efforts. A fact sheet (pdf, 2 pages) of the general findings in the report is also available.

In addition, HPIO and the Ohio Association of Second Harvest Foodbanks are hosting five regional forums to discuss the status of the health care safety net in Ohio (see details below, in the left-hand column). Each forum will include a presentation of the findings of the Ohio Safety Net Snapshot Report as well as a panel of local providers to address the impact of the economic downturn and federal health reform on the safety net.

Click here for the regional forums presentation (pdf, 65 pages)

Hospitals say observation units can cut costs

Ohio hospitals are joining a national trend of expanded use of observation units, a practice they say can cut billing by a third (Source: “Hospital observation units prove efficient, cost-effective,” Columbus Dispatch, Feb. 3, 2010).

More hospitals are creating units where patients can be observed for up to 23 hours in most cases.

"A lot of patients are on the bubble -- not well enough to go home, but not sick enough for inpatient," said Janet Susi, the OSU Medical Center observation unit's clinical nurse director. "If patients don't get turned around in 23 hours, we admit them."

Added Kelly McGivern, president of insurance industy trade association the Ohio Association of Health Plans, "Being admitted is a higher standard of care than in observation; prices are higher in an admission."