Making Sense of Delivery System Reform

The Affordable Care Act made a lot of changes – and improvements – to health insurance. But it was also meant to encourage changes in how health care is delivered – the care you get at the hospital, doctor’s office, pharmacy, and other places where people get health care.

Many people have frustrating experiences with health care that go beyond how it’s paid for. Maybe you can’t make an appointment without skipping work, or can’t get your prescription filled on time because of communication problems and end up skipping doses. Maybe you had to get a test done twice because re-doing it was easier than transferring your records to a new physician. Delivery system reform is meant to make the experience of getting health care better – in an ideal world, there would be seamless delivery system that lets doctors and patients focus on their health, not logistics.

HCFANY has produced a new issue brief to help consumers understand what is happening. Delivery system reform could be a great thing for everyone, but changing systems is always hard. A lot of stakeholders have learned to succeed under the status quo, and are afraid of changing how they do business. Consumers need to educate themselves about how delivery reform can benefit them and use their knowledge to encourage reform that benefits patients.

RWV Guest Blog Image UninsuredGuest blog by Lois Uttley, MPP, Director of Raising Women’s Voices-NY. Six years after the Affordable Care Act (ACA) was signed into law and three years after the ACA insurance marketplaces opened, the nation’s uninsured rate has dropped to the lowest level ever recorded. Between 2010 and 2016, the percentage of people without health insurance fell by nearly half, from 16 percent to 8.6 percent. The sharp decline is illustrated in this chart from Vox. The previous low of 9.1 percent was recorded in 2015.

The new numbers were released last week by the National Center for Health Statistics, and are based on the National Interview Survey conducted during the first quarter of 2016. The survey uncovered some important variations among population groups when it comes to health insurance. For example:

  • Only 5 percent of children 17 and younger are now uninsured. Of those, 42.1 percent had public coverage and 54.9 percent had private coverage.
  • Hispanic adults had the greatest decline in un-insurance, going from 40.6 percent in 2013 to 24.5 percent in 2016. But that reduced rate was still much higher than the 2016 rates for non-Hispanic Black (13 percent), white (8.4 percent) and Asian adults (6.7 percent).

States Fully Implementing the ACA Show Biggest Drop In Uninsured

The national survey data also reveal striking disparities between rates of un-insurance in states like New York that have fully implemented the ACA – by expanding their Medicaid programs and creating their own health insurance exchanges, or marketplaces – and those that have refused to do so because of conservative political opposition.

First, let’s look at the impact of a state’s decision to expand Medicaid. In the expansion states, the percentage of uninsured adults (ages 18 to 64) dropped by half — from 18.4 percent in 2013 to 9.2 percent in 2016. By contrast, in non-expansion states, the uninsured rate fell somewhat – from 22.7 percent in 2013 to 16.7 percent in 2016 — but still remained high.

Next, let’s look at the difference in uninsured rates between states that opened their own marketplace (or partnered with the federal government to create a marketplace) and those states that refused to do so, and instead defaulted to having a federally-run marketplace. There have been significant declines in uninsured rates in states with their own marketplaces (from 18.7 percent in 2013 to 9.1 percent in 2016) and in partnership marketplace states (from 17.9 percent in 2013 to 8.2 percent this year).

The survey found a different story in the states with federally-run marketplaces. Although even those states experience a drop in the uninsured rate (from 22 percent to 14.5 percent), the 2016 percentage of residents who remain uninsured is much higher than in the other states.






open enrollment graphic

Guest blog by Bob Cohen, Esq. Policy Director at Citizen Action of New York and Public Policy and Education Fund of New York.

Fall is almost here, which means it’s time to start thinking about open enrollment! For the fourth consecutive year, HCFANY is teaming up with the Health Education Project of NY (HEPNY) and other groups to hold outreach and enrollment summits throughout New York State. This year, we’ll also be focusing on post-enrollment challenges. We encourage navigators, certified application counselors, health advocates, community members, health providers, union members, health insurance plan representatives, and small business representatives to attend.

Over 2.5 million New Yorkers filed applied for health coverage with NY State of Health last year — a great success!

This is a great opportunity to focus on continuing issues. First, there are still many “hard-to-reach” individuals that still have not enrolled in health coverage because of issues like language barriers and lack of information even if they qualify for free or low-cost coverage through Medicaid or the Essential Plan. Second, some people are unfamiliar with many elements of how health coverage works, like deductibles and co-pays and navigating their plan’s network. Other individuals do not know what to do if they experience a problem, like medical bills that seem incorrect.

Each summit will feature a presentation on the state of outreach and enrollment by a NY State of Health representative, followed by speakers from Community Health Advocates (CHA) about how they can help consumers with post-enrollment issues, and finally presentations by the Health Care Education Project and Lois Uttley, Director of Raising Women’s Voices-New York, on health literacy. The first summit will be held on Wednesday, September 28 at the 1199SEIU in Albany from 11:00 AM to 2:00 PM. Please see the Statewide Flyer for the complete schedule of outreach and enrollment summits.

CID-NYGuest blog by Heidi Siegfried, Project Director at New Yorkers for Accessible Health Coverage (NYFAHC) and Health Policy Director, Center for Independence of the Disabled. A few days ago, Health Affairs published an article that highlighted how the non-discrimination provisions of the Affordable Care Act (ACA), Section 1557, can protect consumers against benefit designs that discriminate against people with chronic conditions or significant health needs.

New York has long prohibited denial of coverage or premium variation based on health status and the ACA now prohibits charging higher premiums or denying coverage for people with pre-existing conditions. Still, network and formulary designs can have the effect of discriminating against people with serious illnesses and disabilities.

People often overlook the fact that Section 1557 prohibits discrimination based on disability status as well as race, color, national origin, sex, and age.  HCFANY and NYFAHC submitted comments to the U.S. Department of Health and Human Services (HHS) on the proposed rules for Section 1557 in November 2015. In these comments, we asked HHS to specifically define discriminatory benefit design in the regulations implementing Section 1557 and to include all beneficiaries with chronic conditions or serious illnesses.  Although HHS did not provide a definition, they do consider benefit design discrimination on a case-by-case basis and will review complaints of disability-based discrimination. HHS also provides examples of potentially discriminatory benefit designs such as placing all HIV drugs on the highest tier.

The Health Affairs article points out that the Americans with Disabilities Act was amended to define disability as an impairment of major bodily functions such as immune system, normal cell growth, digestive, bladder, neurological, respiratory, and endocrine systems which would reach many people with chronic conditions.  Therefore, when consumers encounter discriminatory formularies, coverage limitations, or plans that exclude certain specialists, they can use Section 1557 to enforce their rights to non-discriminatory benefit design by filing complaints with the Office of Civil Rights at HHS or by challenging the plans in court.