Federal Officials Weigh Iowa’s Request To Revamp Insurance Enrollment System
Iowa is seeking to move out of the federal marketplace system and set up a state-run exchange instead. State officials say that would help lower premiums, but that could come with higher out-of-pocket costs for consumers. News outlets also report on enrollment issues in Florida and Kansas.
With efforts to repeal the Affordable Care Act dead in Congress for now, a critical test for the law’s future is playing out in one small, conservative-leaning state. Iowa is anxiously waiting for the Trump administration to rule on a request that is loaded with implications for the law’s survival. If approved by the federal Centers for Medicare and Medicaid Services, it would allow the state to jettison some of Obamacare’s main features next year — its federally run insurance marketplace, its system for providing subsidies, its focus on helping poorer people afford insurance and medical care — and could open the door for other states to do the same. (Goodnough, 10/10)
Iowa Gov. Kim Reynolds said Tuesday she has requested a conversation with President Donald Trump following a news report that he instructed his top human services administrator to deny Iowa's proposal to stabilize its individual insurance market. "I haven’t spoken directly to the president," Reynolds told reporters at her weekly news conference. "I’ve asked for a conversation." The Washington Post reported last week that Trump, upon hearing of Iowa's waiver request, called the administrator overseeing the proposal and told her to reject it. (Pfannenstiel, 10/10)
The Trump administration has cut Obamacare’s advertising budget by 90 percent, shortened the enrollment period to six weeks and reduced outreach by cutting the funding for in-person navigators, who help people understand the enrollment process. (Miller, 10/10)
The Community Health Council of Wyandotte County has run ads online and on radio in past years urging uninsured people to sign up for coverage through the Affordable Care Act, often called Obamacare. But after President Donald Trump’s administration announced in August that it was slashing 90 percent of the funding for the federal government’s ACA ads this year, the group decided to start placing TV ads as well. (Marso, 10/10)
And in other news about the health law —
Encouraged by incentives in the Affordable Care Act, health care providers and insurers are trying to treat health care problems before they turn into costly health crises. Mobile clinics are an effective way to reach patients who may forgo preventive care because they can’t afford it or can’t get to a doctor’s office. ... Studies have shown the success of mobile clinics in identifying and improving previously undiagnosed conditions. A 2014 study published in The American Journal of Managed Care found that Family Van patients who were diagnosed with high blood pressure had significantly lower blood pressure on follow-up visits. That led to fewer health crises, including a 32 percent reduction in the relative risk for heart attack and a 45 percent reduction in the relative risk of stroke. (Rodd, 10/11)
Accountable-care organizations are participating more and more in risk-based contracts, but that progress has been stalled by sluggish care-delivery changes, a new survey suggests. Roughly 50% of ACOs are involved in at least one downside risk contract, such as shared savings and capitation contracts, according to a Leavitt Partners and National Association of ACOs report recently published in Health Affairs. About 47% of ACOs plan to participate in shared-savings risk-based contracts in the next year or so. (Castellucci, 10/10)
