Blog Home

Archive for the 'Children' Category




Implementing Health Reform: Beginning The Cadillac Tax Regulatory Conversation And Other ACA News (Updated)


February 24th, 2015

The Cadillac high-cost health plan excise tax, which goes into effect in 2018, is one of the last-to-be-implemented provisions of the Affordable Care Act (ACA). It was one of the most controversial provisions of the ACA, which contributed to its delayed effective date. But 2018 is now getting closer, and the Internal Revenue Services (IRS) is beginning a discussion about implementation of the Cadillac plan tax.

The Cadillac plan provision of the ACA will impose a 40 percent excise tax on the cost of employer-sponsored health plans when that cost exceeds certain thresholds. It is projected to be one of the biggest sources of revenue under the ACA; the Congressional Budget Office (CBO) in its 2015 Budget and Economic Outlook Report estimated that it would account for $149 billion in revenue between 2018 and 2225. Of this, however, only one quarter will come from the tax itself, while three quarters will come from increases in taxes on income as employers shift compensation from health benefits to taxable wages.

While the tax will affect few plans initially, it is likely to affect many more plans over time as the cost of health care continues to grow faster than inflation generally. The tax is expected to reduce health care expenditures by individuals, as it will drive employers to increase employee cost sharing as they cut the cost of coverage, and employees are likely to spend less on health care if they have to purchase it out-of-pocket rather than drawing on insurance coverage.

Read the rest of this entry »

HHS Proposed Policy On Non-Discrimination: Does It Adequately Protect Children?


February 19th, 2015

On November 26, 2014, the United States Department of Health and Human Services (HHS) published a proposed 2016 Notice of Benefits and Payment Parameters, an omnibus regulation published annually that sets “rules of the road” for the administration of federally regulated insurance plans. Among other matters, this year’s Notice contained a discussion of non-discrimination in coverage.

The concept of non-discrimination in coverage is a basic tenet health plans subject to the Affordable Care Act (ACA)’s “essential health benefit” requirements applicable to non-grandfathered health plans sold in the individual and small group markets (42 U.S.C. §18022, added by PPACA §1302). The non-discrimination standard is a watershed in U.S. law that extends the reach of prior federal civil rights laws and regulates the design, content, and administration of health insurance including Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act, Title VI and VII of the Civil Rights Act of 1964, and the Age Discrimination Act of 1975.

In accordance with its provisions, the HHS Secretary is barred from “mak[ing] coverage decisions, determin[ing] reimbursement rates, establish[ing] incentive programs, or design[ing] benefits that discriminate against individuals because of their age, disability, or expected length of life,” (42 U.S.C. §18022(b)(4)(B)). The provision further requires the Secretary to “take into account” the health needs of “diverse segments of the population including women, children, persons with disabilities, and other groups,” (42 U.S.C. §18022(b)(4)(C)).

Read the rest of this entry »

Is Bias A Source Of Unmet Needs For Medically Complex Kids?


February 2nd, 2015

A study on the “Inequities In Health Care Needs For Children With Medical Complexity,” published in the December 2014 issue of Health Affairs on children’s health, supports a suspicion I have had for some time. Children with medical complexity face the possibility of unmet health care needs simply because of who they are.

Dennis Kuo and colleagues found that children with medical complexity had higher unmet needs than children without medical complexity. The authors describe medical complexity as “children who require medical services beyond what is typically required by children with special health care needs.”

This inequity holds regardless of race, ethnicity, insurance coverage, and household income in relation to poverty level. In other words, unmet needs remain high even among those who have favorable social determinants of health care. The authors conclude that medical complexity itself may be an independent determinant of health care inequity for children.

Read the rest of this entry »

New On GrantWatch Blog


January 27th, 2015

Health Affairs GrantWatch Blog brings you news and views of what foundations are funding in health policy and health care.

Here are the most recent posts:

Read the rest of this entry »

Implementing Health Reform: FAQs On Taxes And The ACA (January 24 Update)


January 13th, 2015

In the next few days, consumers who enrolled in qualified health plans through the marketplaces in 2014 will begin receiving IRS form 1095-As from the marketplaces, be they the federally facilitated marketplaces (FFMs) or state-operated marketplaces.  The form 1095-A is the form that provides individuals who have enrolled in qualified health plans through the marketplaces the information they need to fill out form 8962, which in turn is the form enrollees will need to reconcile the advance premium tax credits (APTC) they received in 2014 with the premium tax credits they were actually entitled to.  The marketplace also reports the information on the 1095-A to the IRS.

On January 12, 2015, HHS released a series of frequently asked questions about the 1095-A at its REGTAP website, which are reviewed here. This post also briefly covers other ACA-related developments.

Read the rest of this entry »

Exhibit Of The Month: Federal Health Spending On Children


January 5th, 2015

Editor’s note: This post is part of an ongoing Exhibit of the Month series.

As we begin the new year and look forward to the release of our January issue later today, we also take a look back at the “exhibit of the month” from our December thematic issue on children’s health. The exhibit, from the article, “The Scheduled Squeeze On Children’s Programs: Tracking The Implications Of Projected Federal Spending Patterns,” looks at health spending on children as a percentage of total federal spending on children from 1960 to 2013.

Read the rest of this entry »

Implementing Health Reform: Open Enrollment Progress For 2015 (Updated)


December 31st, 2014

On December 30, 2014, the Centers for Medicare and Medicaid Services released several reports on enrollment numbers covering the second marketplace enrollment period to date.  It released its first monthly ASPE (Assistant Secretary for Planning and Evaluation) report covering October 15 to November 15, 2014.   (press release here  )  The ASPE report for the first time includes some — very incomplete — information on enrollment in the state-operated exchanges.

CMS simultaneously released a snapshot report covering enrollment in the Federally Facilitated Marketplace (FFM) for the sixth week of open enrollment.

The bottom line is that the reports confirm what we all knew already: The first month of open enrollment is going much better than the early months of open enrollment last year.  As of December 26, 6,490,492 individuals had selected a plan through the FFM.  Only 96,446 selected a plan in Week 6, compared to 3.9 million in week 5, emphasizing again the importance of the December 15 deadline for January 1 coverage in driving enrollment.

Read the rest of this entry »

Narrative Matters: Child Welfare In Indian Country


December 24th, 2014

In the December Health Affairs Narrative Matters essay, a member of the Seneca Nation and a Lakota youth call for equitable child welfare for American Indians and Alaska Natives. Terry Cross’ article is freely available to all readers, or you can listen to the podcast.

In addition, Cross spoke about the issue of Native children in foster care at the recent 2014 Narrative Matters Symposium on “Vulnerable Children: Using Stories to Shine a Light on Child Health.”

Read the rest of this entry »

Narrative Matters: Shining A Light On Child Health


December 15th, 2014

Last month, a group of writers, clinicians, policy makers and other experts gathered at Airlie House in Warrenton, Virginia, for the 2014 Narrative Matters Symposium. About an hour outside the city, the scenic fall setting—rolling farm land and trees with auburn and gold leaves—was the perfect backdrop to take attendees outside of their normal day-to-day work and introduce them to others who also are deeply passionate about improving the health of vulnerable children.

The focus of this year’s symposium was “Vulnerable Children: Using Stories to Shine a Light on Child Health.” Manuel Pastor, professor of Sociology and American Studies & Ethnicity at the University of Southern California, delivered a keynote address in which he discussed the changing demographics of the United States, which by 2043 is projected to be a “majority minority” nation — driven, not by immigration itself, but by the rising number of children born in this country to immigrants. Economists have noted that inequality in the nation causes slower economic growth, Pastor pointed out, concluding that if we reduce income disparities, we are actually contributing to national prosperity.

Read the rest of this entry »

Evolving Medicaid To Better Serve Children With Medically Complex Conditions


December 8th, 2014

The fragmented Medicaid system must evolve to better meet the needs of children with medically complex conditions, a growing population responsible for a high proportion of health care spending. Regional care networks and national data support are two viable tools for containing costs while improving care for our nation’s most vulnerable children.

The Case for Change

Medicaid has evolved into an essential health care payor for the nation’s children, supporting health care coverage for more than 30 million children.

The program has become particularly vital to families of children with complex medical conditions. Care for this population was not widespread when Medicaid was created nearly 50 years ago. In the early 1960s very few infants born with extreme prematurity and/or congenital conditions survived. Thanks to advances in pediatric subspecialty training and technology, the life prospects for these children have greatly improved, and Medicaid now supports an estimated 2 million children with medical complexity. This population is projected to double over the coming decade.

Read the rest of this entry »

Children’s Health: Health Affairs’ December Issue


December 8th, 2014

The December issue of Health Affairs includes a number of studies examining current threats to the health and health care of America’s children, and what can be done to meet their needs within an ever-evolving health care system. Some of the subjects covered: the role of Medicaid in reducing early-term elective deliveries; how pediatric services are covered in the state insurance Marketplaces; Medicaid spending on children with complex medical conditions; and the effect of abuse and neglect on children’s health and school engagement.

This issue of Health Affairs is supported by The W.K. Kellogg Foundation as well as by the Children’s Hospital Association, The David and Lucile Packard Foundation, Nemours, the Annie E. Casey Foundation, and The Child and Adolescent Health Measurement Initiative.

Read the rest of this entry »

Health Affairs Event Reminder: Children’s Health


December 4th, 2014

Threats to children’s health have changed dramatically over the past few generations, but America’s health care system has been slow to transform to meet children’s evolving needs. The December 2014 thematic issue of Health Affairs examines the current state of children’s health, health care delivery, and coverage.

You are invited to join us on Monday, December 8, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.  Panels will cover financing, delivery, access, and the social determinants of children’s health, and spotlight innovative programs that are making a difference.

WHEN: 
Monday, December 8, 2014
9:00 a.m. – 12:30 p.m.

WHERE: 
National Press Club
529 14th Street NW
Washington, DC, 13th Floor

REGISTER NOW!

Follow live tweets from the briefing @Health_Affairs, and join in the conversation with #HA_ChildHealth. 

See the full agenda. Among the confirmed speakers are:

Read the rest of this entry »

The Family Glitch, Other Thorny Children’s Coverage Policy Issues, And The Future Of CHIP


December 3rd, 2014

Editor’s note: For more on the topic of children’s health, stay tuned for the December issue of Health Affairs, set to be released next week.

Health Affairs’ recent policy brief on the family glitch highlights one of the key issues affecting how well children will be served in the new post Affordable Care Act (ACA) coverage landscape. Many observers thought that with the creation of health insurance marketplaces and subsidies for low-income families, there would no longer be a need for the Children’s Health Insurance Program (CHIP), which was created in 1997 to provide health coverage for uninsured low-income children.

Together with its larger sister program, Medicaid, CHIP has been quite successful in achieving this legislative goal. From 1997 to 2012, the national rate of uninsured children was cut in half from 14 to 7 percent. Yet, 7 million children still remain uninsured. The ACA, meanwhile,  was aimed primarily at reducing numbers of uninsured adults. The question now is, what policies and systems are needed to sustain and further the progress that has been made to increase rates of children’s insurance?

Read the rest of this entry »

Exhibit Of The Month: Maps Tell Powerful Stories About Children, Neighborhoods, And Possible Policy Solutions


November 25th, 2014

Editor’s note: This post is part of an ongoing “Exhibit of the Month” series. Readers who’d like to highlight other noteworthy exhibits from the same issue are encouraged to make their pitch in the comments section below.

Maps and health have been powerfully intertwined since nineteenth-century British physician John Snow produced a hand-drawn map that famously showed a correlation between the locations where cholera was killing hundreds of Londoners during an 1854 epidemic and the Broad Street pump where locals unknowingly drew water contaminated with the deadly bacterium.

Fast-forward to the twenty-first century, and maps that tell compelling stories about health, policy, and place are ubiquitous. If Snow were alive today, no doubt his stethoscope would be spinning.

The power and art of mapping, geospatial analysis, and health policy research are regularly featured in Health Affairs, but never before to the extent in the journal’s November issue. Four research papers give readers five maps that depict meaningful findings about children, low-income neighborhoods, and other local characteristics that affect health and offer valuable insights for policy makers.

Read the rest of this entry »

Health Affairs December Briefing: Children’s Health


November 24th, 2014

Threats to children’s health have changed dramatically over the past few generations, but America’s health care system has been slow to transform to meet children’s evolving needs. The December 2014 thematic issue of Health Affairs examines the current state of children’s health, health care delivery, and coverage.

You are invited to join us on Monday, December 8, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.  Panels will cover financing, delivery, access, and the social determinants of children’s health, and spotlight innovative programs that are making a difference.

WHEN: 
Monday, December 8, 2014
9:00 a.m. – 12:30 p.m.

WHERE: 
National Press Club
529 14th Street NW
Washington, DC, 13th Floor

REGISTER NOW!

Follow live tweets from the briefing @Health_Affairs, and join in the conversation with #HA_ChildHealth. 

Read the rest of this entry »

Implementing Health Reform: 2016 Benefit And Payment Parameters Proposed Rule, Consumer Provisions; Hardship Exemptions


November 22nd, 2014

On November 15, 2014, the marketplaces reopened for 2015.  Anecdotal reports indicate that in most places enrollment and reenrollment are running smoothly.  But the Centers of Medicare and Medicaid Services (CMS) of the Department of Health and Human Services (HHS) is looking forward to 2016.  On November 21 CMS published its massive 2016 Notice of Benefit and Payment Parameters (BPP) Proposed Rule  with accompanying fact sheet.  It also published the draft 2016 actuarial value calculator and draft actuarial value calculator methodology for 2016.  Finally, CMS published a guidance on hardship exemptions for certain individuals.

Not to be outdone, the Department of the Treasury, Internal Revenue Service released its final regulation on Minimum Essential Coverage and other Rules Regarding the Shared Responsibility Payment for Individuals, together with a Notice regarding Individual Shared Responsibility Payment Hardship Exemptions that May be Claimed on a Federal Income Tax Return Without Obtaining a Hardship Exemption Certificate from the Marketplace and a Revenue Procedure setting out indexed adjusted percentages of income that will be used for determining the level of contributions expected of individuals before premium tax credits become available, the affordability threshold for the shared responsibility payments unaffordability exemption, and the threshold for determining whether employer coverage is affordable for purposes of determining eligibility for tax credits.

Finally, the Office of Personnel Management released a lengthy proposed rule proposing modifications in the multi-state plan program.  These rules, proposed rules, and guidances will be addressed in a series of posts over the next several days.  This post will address primarily the consumer-facing provisions of the BPP proposed rule, focusing on changes in benefits.  A second post will follow, discussing the provisions of the rule more relevant to insurers, such as proposed changes in the reinsurance, risk adjustment, and risk corridor rules.  A final post will discuss the IRS rule, which is primarily a finalization of proposals and guidances already made public, and the OPM multi-state plan rule.

Read the rest of this entry »

Social Services And Community Health: Health Affairs’ November Issue


November 3rd, 2014

The November issue of Health Affairs includes a number of studies looking at how social services and community support programs can improve the health of local residents. Other subjects covered: the potential for pay-for-performance payment models to create a market that values health, not just health care; how one safety-net accountable care organization is uniquely improving care coordination; a three-year progress report on a regional health collaborative; and more.

This issue of Health Affairs is supported by The Kresge Foundation, the Robert Wood Johnson Foundation, and the Annie E. Casey Foundation. It will be discussed at a Wednesday, November 5 briefing at the National Press Club in Washington, DC.

Read the rest of this entry »

Health Affairs Web First: CHIP Eligibility Finds Decrease In Uninsurance In Some States


September 24th, 2014

As part of the 2009 reauthorization of the Children’s Health Insurance Program (CHIP), states were provided with new resources and options to help reduce uninsurance rates among children. These included: expanded eligibility guidelines; simplified enrollment and renewal procedures; and funding for outreach campaigns. Fifteen states chose to raise their CHIP income eligibility thresholds.

In one of the first studies to analyze the impact of these recent CHIP expansions on the program’s enrollment, published today as a Web First by Health Affairs, authors Ian Goldstein, Deliana Kostova, Jennifer Foltz, and Genevieve Kenney found that “expansion states” saw a 1.1-percentage-point reduction in uninsurance among newly eligible children, cutting this group’s uninsurance rate by nearly 15 percent. The study also discovered that public coverage increased by 2.9 percentage points, revealing a shift among some of these families away from private insurance, and found variable effects across states.

Read the rest of this entry »

Pediatric Asthma: An Opportunity In Payment Reform And Public Health


September 18th, 2014

Editor’s note: The post is informed by a case study, the third in a series made possible through the Merkin Initiative on Physician Payment Reform and Clinical Leadership, a special project to develop clinician leadership in health care delivery and financing reform. The case study will be presented on Wednesday, September 24 using a “MEDTalk” format featuring live story-telling and knowledge-sharing from patients, providers, and policymakers. 

The Clinical Challenge: A Chronic, but Manageable Illness

Asthma affects 7 million children – more than 10 percent of kids in the U.S. – and is the most common chronic childhood disease. Yet even with high levels of insurance coverage, 46 percent of pediatric patients have uncontrolled asthma. There are substantial gaps in appropriate prescribing and adherence to effective medications. In addition, a multitude of non-medical issues influence a child’s ability to control their asthma: low parental health literacy, poor quality housing, and environmental triggers such as pests, mold, and cleaning chemicals. As a result 800,000 kids visit the emergency department (ED) for asthma each year.

In 2007 (the latest year which data are available) the U.S. spent over $56 billion on asthma care, of which nearly $27 billion was spent on pediatric asthma. Medicaid is the primary payer for pediatric asthma related hospitalizations with 55 percent of the market. Better control may also mean lower medical costs, due to reductions in ED visits, admissions, and other health care utilization – patients with poorly controlled severe asthma cost nearly $5,000 more per patient per year compared to average pediatric asthmatic costs.

Read the rest of this entry »

A First Look At How The Affordable Care Act Is Affecting Coverage Among Parents And Children


September 9th, 2014

Following the implementation of the major coverage provisions of the Affordable Care Act (ACA) in 2014, the question arises: “How is the health law affecting uninsured children and their families?” Today, the Urban Institute released two new briefs using the Health Reform Monitoring Survey (HRMS) to begin to answer that question.

The bottom line is that between September 2013 and June of 2014, coverage increased for parents, particularly in states that have expanded Medicaid under the ACA, but no coverage changes were yet apparent for children. This early look suggests that the ACA is contributing to coverage gains for parents, which in turn should be beneficial to both them and their children.

Children’s Coverage

The report on children’s coverage from The Urban Institute and the Georgetown University Center for Children and Families found that the uninsured rate for children remained at historically low levels—close to 7 percent—but did not decline further for children under age 18 between September 2013 and June 2014. However, this national snapshot does not capture all of the fluctuations in children’s coverage that may be occurring across the country in particular states; we will have to wait for data from federal sources to have a definitive assessment of how coverage is changing at the state level.

Read the rest of this entry »

Click here to email us a new post.