This week several news outlets published stories about the great successes of the Pioneer Accountable Care Organization (ACO) demonstration project, a managed care approach explained in depth here, and the potential positive implications for Medicare. While it is understandable that many are desperate to find any sign of success deriving from the health reform law, wishful thinking doesn’t actually make the Pioneer ACO program a success. The hype surrounding the $400 million savings is overblown, and the stability of the Pioneer model should be seriously questioned before more Medicare funds are committed to a relatively untested and largely unsuccessful program.
The 2010 Affordable Care Act (ACA) health reform law established state-based health insurance exchanges to provide an individual market for qualified health insurance plans. The state exchanges sell insurance plans to any citizen, regardless of health status. Enrollees who purchase plans through an exchange can receive federal premium subsidies if their household income falls between 100 and 400 percent of the federal poverty level. This primer provides an overview of the ACA’s risk mitigation provisions that apply to individual and/or small group market plans: reinsurance, risk corridors, and risk adjustment.
Tuesday’s elections saw a major shift in the balance of Congress. However, there were relatively few actions of note amongst administrative agencies. In total, regulators published more than $260 million in compliance costs and 800,000 hours of paperwork against $225 million in benefits. Amended railroad safety standards and the implementation of Veterans Affairs (VA) reform led the week.
As summer winds down and the nation heads towards the holiday weekend, agencies found time to add more than $2.2 billion in regulatory costs and 90,000 hours of paperwork. A Dodd-Frank rulemaking accounted for the vast majority of the week’s regulatory burdens.
In a relatively modest week, regulators published $158 million in annualized costs and more than 235,000 associated paperwork burden hours; no regulation monetized possible benefits. However, the week did include notable court proceedings on the Affordable Care Act and Dodd-Frank’s fourth anniversary.
Senate confirmation hearings begin this week for Sylvia Matthews Burwell–currently the Director of the Office of Management and Budget, and the President’s pick to run the Department of Health and Human Services (HHS). Burwell would replace outgoing HHS Secretary Kathleen Sebelius, who has held the office since April 2009. Ms. Burwell should move to make HHS a more transparent, accountable organization under her leadership.
A wild week in regulatory activity resulted in a steep increase in 2014’s cost burden, but an even steeper decrease in its cumulative paperwork burden. Agencies added nearly $8 billion in total costs. Energy efficiency standards for commercial refrigerators and the Department of Education’s new “Gainful Employment” rule were the main cost drivers. Yet, largely thanks to a proposed Transportation rule, the year’s net paperwork burden fell by nearly 15 million hours.