A recent webinar examined how different providers approach the opportunities and challenges brought by the Affordable Care Act (ACA). Industry leaders in Florida, Massachusetts, Mississippi, New Jersey and Pennsylvania shared their views. Below are highlights.
ACCESS VARIES SIGNIFICANTLY STATE-BY-STATE
Each state interprets the ACA in its own way, driving provider strategy and impacting coverage, rates and costs. Massachusetts decided early on to maximize access via state health reform. Access in some other states has been more challenging, with physicians not accepting Medicaid or Federal Exchange beneficiaries. For Florida, one solution has been proactively negotiating out-of-network rates for unique services.
EARLY ADOPTER STATES SEE COST BENEFITS
Massachusetts’ early adoption of Medicaid expansion in 2006, plus coverage expansions that served as a precursor to the ACA, have seen reductions in uninsured individuals and lower costs:
- Per capita health spending growth is lower than the U.S. generally
- Expansion enabled preventative care and reduced per-member per-month costs when compared to other states
- Insurance participation is more stable than in other parts of the country
- Massachusetts’ early healthcare expansion allowed it to focus on costs and prices as far back as 2008. By 2012, its strategy focus was reducing expenditure and encouraging alternative payment methods
- In Mississippi, over 60 hospitals came together to form MississippiTrue, the first multi-provider plan in the state
- Innovations have also emerged in response to the Mississippi Telemedicine Parity Act, which mandates that all health insurance and employee benefit plans must provide remote care
UNCERTAIN STATE AND FEDERAL REIMBURSEMENT
Some states have taken pre-emptive measures to cope with a lack of clarity. For example, 53,000 Mississippi residents rely on the Federal Exchange for their health insurance. There’s uncertainty over whether Cost Sharing Reductions (CSR) will end, which could increase premiums by 25% in 2018. In response, the state has taken a number of measures:
- It’s allowed exchange providers to submit two sets of rates, one assuming CSR continues, and one assuming it doesn’t
- It has issued waivers to ensure the continuation of coverage through 2018 and to curb increases in rates for children under 14
A key challenge for providers nationwide is the uncertain outlook for the ACA. The House of Representatives passed the American Health Care Act (AHCA) to “repeal and replace” the ACA. It is estimated to achieve more than $100 billion in Medicaid reductions by 2027. Being informed and formulating strategies is now more important than ever.