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Millions of Inconsistencies In ACA Data - Health Care Edge

Millions of Inconsistencies In ACA Data 

By Sophie Novack

 

EDITOR'S NOTE: The Health Care Edge is taking a break for the July Fourth holiday. We will return on Monday, July 7.

ACCURACY LACKING: Findings from the Health and Human Services inspector general report released Tuesday--the first independent look at the largely hidden issue--show that personal details on enrollment applications for many of the 8 million who signed up through the Affordable Care Act exchanges do not match government records. The report also found the internal measures used by the federal marketplace and some state exchanges to confirm the accuracy of consumer information to be lacking. Federal officials are currently at work resolving the problem; the administration hopes to fix the majority of the cases this summer, but may have to end up using an extension.

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HHS INSPECTOR GENERAL REPORT: The federal marketplace was unable to resolve 2.6 million of the 2.9 million inconsistencies as of the first quarter of 2014, because the eligibility system from the Centers for Medicare and Medicaid Services was not yet fully operational, according to the report. (Ricardo Alonso-Zaldivar, Associated Press)

 

CDC REPORT FINDS WIDE VARIATION IN PRESCRIPTION RATES BY STATE: Nationwide, there were 82.5 prescriptions written for opioid painkillers for every 100 Americans in 2012, according to the Centers for Disease Control and Prevention report. The state with the highest rate was Alabama, with 143 painkiller prescriptions for every 100 people, while the lowest was Hawaii, with 52. (Scott Hensley, NPR)

FLORIDA PRESCRIPTION OVERDOSE DEATHS FALL FOLLOWING STRONGER REGULATION AND ENFORCEMENT: The death rate from prescription drug overdoses in the state fell by 23 percent from 2010 to 2012, and by more than half for oxycodone during the same period, according to a CDC report released Tuesday. Researchers said it was the first significant recorded drop in the U.S. since the prescription drug abuse epidemic took off more than a decade ago. The decline follows legal and regulatory changes in the state beginning in 2010. (Sabrina Tavernise, New York Times)

Insurance

A CASE AGAINST EMPLOYER-SPONSORED INSURANCE: "The [Hobby Lobby] ruling raises the question of why, uniquely in the industrialized world, Americans have for so long favored an arrangement in health insurance that endows their employers with the quasi-parental power to choose the options that employees may be granted in the market for health insurance." (Uwe E. Reinhardt, New York Times)

CONCERNS OVER PROPOSAL TO ADD 'COPPER' PLANS TO ACA MARKETPLACE: Insurance companies and some senators have suggested offering less expensive, less comprehensive "copper" plans on the ACA exchanges to encourage still-uninsured consumers to purchase plans. But some worry that this would leave consumers with unaffordable out-of-pocket costs if they actually get sick and need to use their coverage. (Michelle Andrews, Kaiser Health News)

 

Medicaid and Medicare

NEW HAMPSHIRE MEDICAID EXPANSION OFFICIALLY BEGINS: The 50,000 eligible low income residents could start applying for coverage Tuesday under the state's newly expanded program, and those accepted will begin receiving coverage August 15. Most individuals will initially join one of two Medicaid managed care plans in the state, but the state is seeking federal approval to use the federal funds to buy private coverage, aiming to shift enrollees into private marketplace plans in 2016. (Phil Galewitz, Kaiser Health News)

MEDICAID STANDOFF CONTINUES BETWEEN OKLAHOMA AND THE FEDS: Oklahoma has worked out a deal with the federal government to maintain its existing Medicaid program, Insure Oklahoma, an extra year, after it was supposed to end in 2013. CMS warned the state last year that it would have to close the program, because it does not comply with the requirements of the ACA's Medicaid expansion. (Jason Millman, Washington Post)

REPORT: MEDICAID PAYS LESS FOR DRUGS THAN OTHER FEDERAL PROGRAMS: "Medicaid pays significantly less for prescription drugs than other government healthcare programs, according to an analysis conducted by the Government Accountability Office. The healthcare program for low-income individuals paid $0.62 per unit for prescription drugs during the third quarter of 2010...By comparison, Medicare paid 32% more on average for prescription drugs and the Department of Defense paid 60% more for drug purchases." (Paul Demko, Modern Healthcare)

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CMS PROPOSES PAYMENT CHANGES TO MEDICARE HOME HEALTH SERVICES: CMS has proposed strengthening eligibility requirements for home health services, setting requirements for home health agencies to demonstrate their effectiveness, and changing how much the agency pays for services, as part of CMS's plan under the ACA to reduce home health services costs and increase efficiency by 2017. The agency projects the proposed rule will save $58 million next year. (Ferdous Al-Faruque, The Hill)

Regulations

FDA TIGHTENS REGULATIONS FOR COMPOUNDING PHARMACIES: With expanded regulatory authority from the Drug Quality and Security Act passed by Congress last year, the Food and Drug Administration issued new guidance Tuesday that sets manufacturing standards, updates the list of drugs that are too risky to be altered, and outlines punitive actions it can take against companies that don't comply. (Ferdous Al-Faruque, The Hill)

NUTRITION GROUP DOES ABOUT-FACE ON SCHOOL NUTRITION REGULATIONS: The School Nutrition Association celebrated the administration's changes to school lunch requirements when they were announced in 2012, and now is leading a lobbying campaign to allow schools to opt out of the nutritional guidelines, making some former allies question the group's motivations. (Ron Nixon, New York Times)

Disease

NIH ANNOUNCES 'MYSTERY DISEASE' PROGRAM: The National Institutes of Health announced the NIH Undiagnosed Diseases Network on Tuesday, a four-year, $43 million initiative at six universities around the country to help diagnose patients with diseases that are so rare and unknown, they've been told they can't be diagnosed. (Lauren Neergaard, Associated Press)

Hobby Lobby

WHAT FORMS OF CONTRACEPTION DOES THE HOBBY LOBBY DECISION APPLY TO?: There's still a fair amount of grey area. The Supreme Court sent three cases in which Catholic businesses oppose covering any forms of birth control back to lower courts in light of the decision this week. The lower courts will have to determine whether the Supreme Court decision lifts the responsibility of these employers to cover any kinds of contraception, or whether it was limited to the IUDs and emergency contraceptives that Hobby Lobby protested. (Adrianna McIntyre, Vox)

INSURANCE ADMINISTRATORS SAY CONTRACEPTION ACCOMMODATION ISN'T WORKING: Administrators providing coverage for employees at religious-affiliated groups say the current work-around has left them with the bill, and worry the Hobby Lobby decision will worsen the problem. (Alex Wayne, Bloomberg News)

WHAT COMES NEXT FOR THE CONTRACEPTION FIGHT: Both sides are planning next steps, from lawsuits, to legislative responses, to elections. (Jaimie Fuller, Washington Post)

A LIBERAL ORGANIZATION'S RESPONSE TO THE HOBBY LOBBY RULING: In a strategy memo, experts at the Center for American Progress take a broader, more aggressive approach, arguing for amending the federal Religious Freedom Restoration Act and similar state-level laws to prevent business owners from using them "as a tool to discriminate or deny needed medical care." (Brian Beutler, New Republic)

HOW HOBBY LOBBY COULD FORCE THE COURT TO BE MORE OPEN TO CAMPAIGN FINANCE REGULATION: "Like Citizens United, the Hobby Lobby majority concluded that there is no basis for distinguishing between corporations and natural persons. But the court is much more comfortable drawing distinctions among corporations in Hobby Lobby than it was in Citizens United…As the court becomes more comfortable making nuanced determinations in the religious freedom context, it also may become more willing to make distinctions in the campaign finance context." (David Skeel, Washington Post)

ONE COMPANY HAS ALREADY STOPPED COVERING THE MORNING AFTER PILL: "On the same day as the court's decision, Rich Gimmel, owner of Atlas Machine and Supply Inc., notified his insurance provider to cancel coverage. In an interview with the Wall Street Journal, the evangelical Christian explained that he doesn't want to deny this coverage to his more than 200 employees, but he objects morally to providing funding for morning-after pills." (Philip Wegmann, The Daily Signal, The Heritage Foundation)

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Health Care Edge is one of my top resources."

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Director of Scientific Affairs, Non-profit medicial society

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