| “We know today that up to 80% of our health is tied to social determinants: things like housing, education, job training, transportation and access to healthy foods. Your ZIP Code can have a much greater impact on how long you live, and on your quality of life, than your genetic code. That’s why we refer to the Social Determinants of Life(SM). We are looking beyond health outcomes and leveraging our unique expertise and grassroots approach to improve life outcomes. We need to help people overcome poverty and achieve their American Dream.” | ||
| -Paul A. Tufano, Chairman and CEO, AmeriHealth Caritas |
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Summary of Projected Costs for
Medicaid Acute Care for the Nonelderly Population in 2022
Notes: A recent change in guidance from the Centers for Medicare & Medicaid Services (CMS) gives states up to 12 months to restore normal income eligibility redeterminations for Medicaid enrollees once the PHE expires, instead of just 6 months under previous rules (CMS 2021). Current CMS guidance allows a return to normal eligibility processing within 12 months of the end of the public health emergency. However, states could choose to do so more quickly. These scenarios bracket the possible changes in Medicaid enrollment after the public health emergency expires. |
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Annual Healthcare Spending
per Person, 2015-2019 1. 2019: $6,001 2. 2018: $5,832 3. 2017: $5,424 4. 2016: $5,198 5. 2015: $4,928 Source: Health Cost Institute, 2019 Health Care Cost and Utilization Report |
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2019 Health Care Cost and Utilization Report The 2019 Health Care Cost and Utilization Report presents data on health care spending, utilization, and average prices from 2015 through 2019 for individuals under the age of 65 who receive health insurance coverage through an employer. The report relies on de-identified commercial health insurance claims contributed by Aetna, Humana, and Blue Health Intelligence during this period. Health Care Cost Institute, October 2021 Health System Mergers Drive Higher Healthcare Costs, Says Trade Association Many health systems have used hospital consolidations or physician group acquisitions to grow and compete. But these actions often come at the expense of rising healthcare and insurance costs for patients, says the AHIP. It would seem obvious that the continued pandemic is driving up healthcare costs in America. But there may be other significant factors at play, including the ongoing trend of hospital consolidations, mergers, and acquisitions (M&A). HealthLeaders, October 7, 2021 Medicaid expansion closed health gaps across racial and ethnic groups Michiganders from multiple racial and ethnic backgrounds say their health has improved and they have access to regular care through a doctor’s office, after enrolling in the state’s Medicaid expansion for low-income adults, a new study finds. The improvements were especially pronounced among low-income white, Black and Latino Michiganders. Some improvements were seen among low-income members of the state’s sizable Arab-American and Chaldean population, and among those of other backgrounds. Michigan Medicine, October 4, 2021 What Will Happen to Unprecedented High Medicaid Enrollment After the Public Health Emergency? Following unprecedented Medicaid enrollment during the public health emergency, analysis projects that 15 million people could lose Medicaid coverage when the emergency declaration ends. Urban Institute, September 15, 2021 Issue Brief: Drivers of 2022 Health Insurance Premium Changes The 2022 individual and small group health insurance premium rate filing process for carriers is well underway. Actuaries generally develop proposed premiums based on their projections of medical claims and administrative costs for pools of individuals or groups with insurance. Projected medical claims reflect unit cost and utilization levels, as well as the mix and intensity of services, all of which can vary by geographic area and from one health plan to another. Risk pool composition is also important, as medical claims reflect the health status of individuals in the risk pool. American Academy of Actuaries, September 2021 |
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Kentucky, Maine, and New Mexico Launch State
Marketplaces for 2022 Coverage The Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), congratulates Kentucky, Maine, and New Mexico on successfully transitioning from HealthCare.gov to their own State-based Marketplaces for the 2022 plan year. CMS, October 4, 2021 Hospitals Confront Climate Change as Patients Sick From Floods and Fires Crowd ERs When triple-digit temperatures hit the Pacific Northwest this summer, the emergency room at Seattle’s Harborview Medical Center was ill prepared. Doctors raced to treat heat-aggravated illness in homeless people, elderly patients with chronic ailments, and overdosing narcotics users. “The magnitude of the exposure, this was so far off the charts in terms of our historical experience,” said Dr. Jeremy Hess, an emergency medicine physician and professor of environmental and occupational health sciences at the University of Washington. Kaiser Health News, October 1, 2021 Ban on ‘surprise’ medical bills on track for Jan. 1 rollout The Biden administration on Thursday put final touches on consumer protections against so-called “surprise” medical bills. The ban on charges that hit insured patients at some of life’s most vulnerable moments is on track to take effect Jan. 1, officials said. Patients will no longer have to worry about getting a huge bill following a medical crisis if the closest hospital emergency room happened to have been outside their insurance plan’s provider network. They’ll also be protected from unexpected charges if an out-of-network clinician takes part in a surgery or procedure conducted at an in-network hospital. In such situations, patients will be liable only for their in-network cost sharing amount. Associated Press, September 30, 2021 From Wellness to Resilience: AmeriHealth Caritas Announces Creation of Social Determinants of Life, Inc. AmeriHealth Caritas, a national leader in Medicaid managed care and other solutions for those most in need, announced today the creation of a new company, Social Determinants of Life, Inc. An early pioneer in addressing the health outcomes of people who are challenged by poverty and disability, AmeriHealth Caritas is now pursuing a longer-term focus on resilience and life outcomes. The Social Determinants of LifeSM category encompasses all of the social and environmental factors that engender or inhibit wellness and opportunity. Business Wire, September 28, 2021 Biden’s HHS Extends Obamacare Open Enrollment Period by 30 Days The 2022 Affordable Care Act marketplace enrollment period will increase from 45 to 75 days this year, and states will have the option to allow people with low incomes to sign up for coverage year-round, the Biden administration announced Friday. Over the objections of Obamacare marketplace insurers, a final rule by the Centers for Medicare & Medicaid Services (RIN 0938-AU60) extends the marketplace open enrollment period from Nov. 1 to Jan. 15, 2022, for states that use the HealthCare.gov website. Enrollment previously ended on Dec. 15. Bloomberg Law, September 17, 2021 CVS Caremark launches new efforts to tackle health disparities CVS Caremark, the Pharmacy Benefit Manager (PBM) of CVS Health (NYSE: CVS), today announced an expansion of its efforts to decrease health disparities among patients with certain conditions including sickle cell, HIV, and cardiovascular disease by collaborating with local partners and utilizing its unique enterprise assets. The company is increasing its investments in programs that address barriers to care and developing additional initiatives to help disadvantaged populations and alleviate inequities in the U.S. health care system. CVSHealth, September 15, 2021 HHS: ACA exchange enrollment reaches 12.2M thanks to enhanced subsidies The COVID-19 special enrollment period increased enrollment in the Affordable Care Act’s federal and state-run insurance exchanges to 12.2 million people, as signups were buoyed by boosted tax credits, new federal data shows. The Department of Health and Human Services released a report on Wednesday reporting that more than 2.8 million people signed up for coverage during the 2021 special enrollment period that ended last month. The report added that enrollment in Medicaid and the Children’s Health Insurance Program also reached more than 82.3 million people as of April. Fierce Healthcare, September 15, 2021 Census: Insured Population Holds Steady, With a Slight Shift From Private to Public Coverage Despite a pandemic-fueled recession, the number of uninsured Americans has increased only slightly since 2018, according to Census Bureau health insurance data released Tuesday. Twenty-eight million people, or 8.6% of Americans, were uninsured for all of 2020. In 2019, 8% of people were uninsured during the full year; in 2018, it was 8.5%. Kaiser Health News, September 14, 2021 |
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