The need to ensure that individual autonomy is considered and respected near the end of life is rapidly increasing. Every single day, over 10,000 baby boomers turn 65 years old and gain Medicare eligibility. Between 2010 and 2050 the number of Americans on Medicare will double to 84 million, octogenarians will quadruple to 8 million, and the ratio of potential caregivers to Americans over 80 years old will dive from 7-to-1 in 2010, to 4-to-1 in 2030 Though we are fortunate that medical science has been able to extend the number of years a Medicare beneficiary is expected to live by about 300 percent, Americans have not changed how they talk about and plan the final stages of life.
The American Action Forum (AAF) recently assessed the plausible effects of a ruling for the plaintiffs in the Supreme Court case, King v Burwell, concerning the legality of subsidies in the federally-run health insurance exchanges implemented under the Affordable Care Act (ACA). One outcome of such a ruling would be that medium and large employers in the 37 states with federal exchanges would no longer be burdened with the ACA’s employer mandate. The employer mandate requires all employers with 100 or more “full-time” workers (50 or more effective 2016) to provide their employees with health insurance. AAF previously assessed the labor market effects of the mandate and other regulations, finding that they have already reduced employment and weekly pay. To make matters worse, the ACA defines “full-time” as working 30 or more hours per week, which is nowhere close to reality in today’s labor market. As a result, all employers with 100 or more workers this year and 50 or more next year must be conscious of all their workers’ hours if they wish to avoid the employer mandate.
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.
Even in the face of Monday’s snow day, regulators found time to publish more than $4.5 billion in total costs and nearly 3 million paperwork burden hours. Total published rulemaking costs in 2014 are now well past $10 billion.
This morning, President Obama released his proposed budget for fiscal year (FY) 2015, which provides useful insights into the administration’s policy priorities.