This is the web version of VoxCare, a daily newsletter from Vox on the latest twists and turns in America’s health care debate. Like what you’re reading? Sign up to get VoxCare in your inbox here.
New York takes steps to safeguard Obamacare
New York is sending a clear message to its health insurance plans: Stick with Obamacare's insurance marketplace — or else.
The state announced Monday that it will bar insurers who quit the marketplace from bidding for future contracts with New York health programs. That's a big deal: 6.4 million New Yorkers have Medicaid coverage, making those contracts lucrative opportunities that health plans won't want to miss out on.
"These aggressive actions will make certain that no matter what happens in Congress, the people of New York will not have to worry about losing access to the quality medical care they need and deserve," New York Gov. Andrew Cuomo said in a statement.
New York already has a competitive marketplace, so it's not clear how much this step will matter. The state hasn't had trouble attracting insurers to its marketplace in the way other states have. Every New York county had at least two plans signed up to sell coverage in 2017, according to data from the Robert Wood Johnson Foundation. The New York metro area had especially robust competition, which you can see in the map below.
:format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/8634679/NY_2017_providers.125253.png)
This type of provision would be a lot more meaningful in a place like Missouri or Iowa, two marketplaces badly in need of more competition. New York isn't likely to struggle with empty Obamacare counties regardless.
New York isn't the first state to tether Medicaid contracts to marketplace participation. As VoxCare readers may remember, Nevada has a similar regulation on the books. That state gives preference to health insurance plans that want Medicaid contracts if they also sell on the state marketplace.
The provision seems to have been successful in convincing two additional health plans to participate in the Nevada Obamacare marketplace. Medicaid is a lucrative enough program, it seems, that states can use it as a lure to bring insurance plans into other smaller programs like the marketplace.
How do you automatically enroll millions into health insurance? Here are a few ideas.
For months now, Republican legislators and health policy wonks have kicked around a novel idea to increase health coverage: automatically enrolling millions of uninsured Americans into low-cost insurance plans.
I wrote a long story about automatic enrollment a few weeks ago, and one of the biggest questions I got from readers was: How does it actually work? How do you find the uninsured people? How do you let them know they have coverage?
In Health Affairs, conservative health policy experts Lanhee Chen and Jim Capretta dive into all of these details. They argue that the IRS should act as the hub for identifying the uninsured:
The foundation for an effective automatic enrollment program is data on income and insurance enrollment. Fortunately, the ACA already established a process for collecting and compiling this data in the federal income tax system to determine compliance with the law’s individual mandate. The IRS’ data can be repurposed for identifying households eligible for automatic enrollment into insurance.
Other parties (states, employers) should be brought into a process of maintaining and updating this database. States, for instance, can collect data on insurance enrollment through driver’s license, car registration, and tax collection systems, which could then be used to verify, cross-check, and update the federal database. Insurers should also be able to verify the government’s data with their own.
Chen and Capretta also outline how long it would take to build such a system. They estimate that the earliest possible date to start automatic enrollment would be in mid-2020. If you're keeping up with the American Health Care Act debate, this is certainly a piece worth going through and considering.
Chart of the Day
Medicaid patients have longer wait times in states with lower reimbursement rates
:format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/8634691/F2.large.130440.jpg)
Medicaid patients wait slightly longer to see the doctor. A new Health Affairs study finds that the median wait time for an outpatient visit is 4.1 minutes for patients with private insurance, compared to 4.6 minutes for those with Medicaid. Wait times are also longer in states with lower Medicaid reimbursement rates.
Euphemism of the Day
He raised both his middle fingers and explained, using colorful language, that anyone criticizing Mylan, including its employees, ought to go copulate with themselves.
This comes from New York Times reporter Charles Duhigg's excellent inside account of how the drug manufacturer Mylan thought about its massive EpiPen price hikes.
Kliff’s Notes
Your daily top health care reads, with research help from Caitlin Davis
Today's top news
- "Senate works to pass Obamacare repeal bill before August recess": “This week, Senate lawmakers will begin asking to see details on how Senate GOP leaders hope to write a measure that can attract at least 50 Republican votes. 'It's difficult to know what to expect,' said Michael Cannon, director of health policy studies at the CATO Institute, a libertarian think tank. It's also hard to predict when to expect a draft bill.” —Susan Ferrechio, Washington Examiner
- "Pence: Congress is "working around the clock" to repeal ACA": “Vice President Mike Pence is still an optimist about the Senate's prospects for getting a health care deal. In Iowa this afternoon, he declared that Congress is 'working around the clock' to produce a bill to repeal the Affordable Care Act, and called on the Senate to pass a bill this summer. He said Iowa is 'facing a health care crisis' under Obamacare, citing the withdrawals of Wellmark and Aetna from the ACA marketplace and the possibility that Medica might pull out, too.” —David Nather, Axios
- "Trump to host fundraiser for New Jersey ally in health care": “President Donald Trump will be hosting a fundraiser at his New Jersey golf club for the Republican lawmaker who helped revive the GOP health care overhaul. The invitation, obtained by The Associated Press on Sunday, says the Republican president and Rep. Tom MacArthur of southern New Jersey's 3rd District will host the June 11 event at Trump National Golf Club in Bedminster.” —Associated Press
- "Health Care in Iowa Shows Peril for Both Political Parties": “As Republicans in the U.S. Senate return to Washington on Monday and turn to drafting their legislation to repeal much of the ACA, Iowa displays the stakes for individual states and the senators who represent them. Both Mr. [Chuck] Grassley and Sen. Joni Ernst, his fellow Iowa Republican, suggested recently that a full repeal was unlikely, given Republicans’ 52-48 Senate majority and rules in the chamber limiting what sorts of bills can pass with only 51 votes rather than 60.” —Kristina Peterson and Stephanie Armour, Wall Street Journal
- "Predicting which Texas insurance carrier might enter Tennessee": “The Tennessean recently reported that Tennessee’s insurance commissioner, Julie Mix McPeak, said that a Texas health insurer was considering entering a metro Tennessee market in 2018. This news could give health insurance consumers in Nashville, Memphis or Chattanooga more choices than initially expected.” —Alex Tolbert, USA Today
Longer reads and analysis
- "In Texas, Abstinence-Only Programs May Contribute To Teen Pregnancies": “Studies show access to contraception is key to reducing the teen pregnancy rate. And according to the National Campaign to Prevent Teen Pregnancy, teen pregnancies in Texas cost the state $1.1 billion each year. [CEO of the Texas Campaign to Prevent Teen Pregnancy] Gwen Daverth says the costs are due to lost wages and an increased reliance on social services.” —Lauren Silverman, NPR
- "Insurance companies duck Obamacare repeal fight": “The lobby has lost influence and is now struggling to mount a unified front against Republican efforts to push through an Obamacare replacement. At the same time, the Trump administration has ignored their pleas to stabilize Obamacare’s exchanges in the short term, which could send the wobbly insurance marketplaces crashing before the GOP agrees on a health care plan.” —Paul Demko, Politico
- "How a single-payer health plan would look in California": “Many questions about the proposal, including the most pressing — how it would be paid for — remain unanswered. But the measure would upend the health care network in the state, drastically reducing the role of private insurance companies and scrapping the need for consumers to pay premiums, deductibles and co-pays.” —Catherine Ho, San Francisco Chronicle
Join the conversation
Are you an Obamacare enrollee interested in what happens next? Join our Facebook community for conversation and updates.
