What Would Happen If Health Care in Your State Improved? – The Commonwealth Fund

This interactive tool shows the health care gains your state could achieve by improving its performance on measures of access, quality, and health outcomes. The tool draws on data from the 2015 Commonwealth Fund Scorecard on State Health System Performance.

Source: What Would Happen If Health Care in Your State Improved? – The Commonwealth Fund

The Commonwealth Fund’s Scorecard on State Health System Performance, 2017 Edition, assessed states on more than 40 indicators of health care access, quality, costs, and outcomes. Use this interactive tool to see the gains that your state could achieve by improving its performance to the level of better-performing states, as well as the losses that would result if your state failed to sustain its performance. You can also see the impact of reaching for a goal that is even better than the current best state’s performance.

In a new To the Point post, The Commonwealth Fund’s David Radley, Douglas McCarthy, and Susan Hayes show how states can use the tool to help achieve their goals. For example, by seeing the gains made in states that have already expanded Medicaid, policymakers in Georgia or another non-expansion state can calculate the improvements in insurance coverage and access to care that are within their reach.

Revised ACA Repeal and Replace Bill Likely to Increase the Uninsured Rate and Health Insurance Costs for Many

House Republicans are close to agreeing on an amended version of the American Health Care Act, their proposed repeal and replacement of the Affordable Care Act. David Blumenthal, M.D., and Sara Collins say that, based on the summaries circulated by the media, the revised bill will significantly increase the numbers of uninsured Americans while raising insurance costs for many of the nation’s most vulnerable citizens. At the same time, the bill’s restructuring of the Medicaid program is likely to hurt state economies and enrollees.

Source: Revised ACA Repeal and Replace Bill Likely to Increase the Uninsured Rate and Health Insurance Costs for Many – The Commonwealth Fund

News outlets report that House Republicans are close to agreeing on an amended version of the American Health Care Act (AHCA), their proposed repeal and replacement of the Affordable Care Act (ACA). The all-important legislative language for the revised bill is not yet available, nor are Congressional Budget Office (CBO) projections of its effects on coverage and the budget, so any analyses are necessarily tentative.

Nevertheless, the summaries leaked to the media offer insight on the amended bill. If accurate, those summaries suggest that the revised AHCA will significantly increase the numbers of uninsured Americans, raise the cost of insurance for many of the nation’s most vulnerable citizens, and, as originally proposed in the AHCA, cut and reconfigure the Medicaid program. The new amendment specifically allows states to weaken consumer protections by, for example, permitting insurers to charge people with preexisting conditions higher premiums.

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Who Gains Under Expanded Health Savings Accounts? – The Commonwealth Fund

The U.S. House of Representatives leadership’s bill to repeal and replace the Affordable Care Act (ACA) would have significantly expanded the use of health savings accounts (HSAs), which people can use to save tax-free money to pay for certain medical expenses. This effort isn’t new and it’s not likely to go away just because a vote on the House bill, the American Health Care Act (AHCA), has been tabled. Amendments to the tax code to encourage HSAs have been a staple of Republican health care proposals, and the HSA provisions in the House legislation were introduced as a standalone bill last year.

Source: Who Gains Under Expanded Health Savings Accounts? – The Commonwealth Fund

The U.S. House of Representatives leadership’s bill to repeal and replace the Affordable Care Act (ACA) would have significantly expanded the use of health savings accounts (HSAs), which people can use to save tax-free money to pay for certain medical expenses. This effort isn’t new and it’s not likely to go away just because a vote on the House bill, the American Health Care Act (AHCA), has been tabled. Amendments to the tax code to encourage HSAs have been a staple of Republican health care proposals, and the HSA provisions in the House legislation were introduced as a standalone bill last year.

Why all the interest? HSA proponents suggest the accounts offer cost savings and give consumers freedom to spend their money how they see fit. An HSA must be paired with a high-deductible health plan (HDHP), and there is evidence that the combination of an HDHP and HSA does reduce health care spending—by leading consumers to skip care, both needed and unneeded. Yet there is little basis to conclude that HSAs expand access to care, or that the tax benefits these accounts promise reach most Americans. In practice, most financial advantages have accrued to the top 5 percent of earners, who can afford to contribute to the accounts during the year and reap larger gains at tax time.

HSAs: The Basics

HSAs were created in 2003 in legislation establishing a Medicare prescription drug benefit. They are tax-preferred savings accounts funded by consumers and sometimes their employers. Consumers can contribute to an HSA only if they are enrolled in an HDHP, which in 2017 is an individual or group health plan that has a deductible of at least $1,300 ($2,600 for a family plan). Unlike other savings vehicles established under federal law, HSAs provide what amounts to triple tax benefits: contributions are tax-deductible; account funds are invested and grow tax-free; and withdrawals are tax-exempt (if they are used for qualified medical expenses).

HSAs are far more attractive to higher-income individuals, who are more likely to have sufficient income to fund the accounts and gain a greater tax benefit than are lower-income individuals subject to lower tax rates. In 2013, tax filers with income above $200,000 were 10 times more likely to claim a tax deduction for HSA contributions than those with incomes below $50,000, and the tax-advantaged contributions these high earners made were, on average, more than twice as large. A study of HSA take-up in the group market from 2005 to 2012 found similar results and observed, perhaps unsurprisingly, that high-income households were substantially more likely to fund their HSAs fully (with their own dollars and contributions from employers) than were middle- and lower-income filers.

Enhanced HSAs on the Horizon?

The AHCA would have expanded use of HSAs by authorizing higher tax-free contributions (increasing the amount from $3,400 to $6,550 for an individual plan) and more tax-free uses for funds. The AHCA also would have cut in half the penalty for withdrawals for nonmedical expenses.

Other proposals would provide similar and sometimes greater benefits to account holders. Legislation previously authored by Health and Human Services Secretary Tom Price would increase HSA contribution limits while also making it easier to shelter those funds and other retirement savings from taxes when they are transferred to heirs. Senator Rand Paul’s (R–Ky.) ACA replacement bill would go still further, erasing the requirement that HSAs be linked to a high-deductible plan and eliminating contribution limits altogether.

There is little doubt these expansions would encourage HSA take-up. Likewise, the proposals would make HSAs even more attractive as savings and estate planning vehicles for high-income households—particularly those who earn too much to contribute to other tax-advantaged retirement accounts and those who have maxed out such contributions. At the same time, the financial services companies that manage these accounts would reap substantial benefits, too.

Looking Ahead

HSAs are already growing under current law: by 2017, nearly 21 million accounts held more than $41 billion in assets, while the cost of the program to taxpayers has steadily increased and will nearly double by 2020. The AHCA would have dramatically accelerated this trend, causing federal spending to shoot up nearly 50 percent over the first three years following enactment and by a total of more than $19 billion by 2026.

The Congressional Budget Office estimated that the AHCA would have reduced insurance coverage dramatically, especially among Americans with low incomes. Moreover, the people most likely to need assistance paying for coverage and out-of-pocket costs—those with incomes under 200 percent of poverty, or around $24,000 for a single person—are the least likely to benefit from the bill’s approach to making coverage more affordable: HSAs. Given an ACA replacement’s potential impact on federal spending and coverage, spending billions of dollars on a program that primarily helps those least likely to need assistance purchasing coverage and paying out-of-pocket costs warrants scrutiny.

Medicaid Work Requirements – Legally Suspect

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Source: Medicaid Work Requirements – Legally Suspect

Executive Summary

Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why adding a work requirement to Medicaid is “legally suspect.” They explain that currently the Medicaid Act has four requirements that an individual must meet that do not include a mandatory work requirement. “A number of courts,” Perkins and McDonald write, “have recognized that states may not ‘add additional requirements for Medicaid eligibility’ that are not set forth in the Medicaid Act.” They also note that the purpose of Medicaid is to “furnish medical assistance to low-income individuals who cannot afford the costs of medically necessary services and to furnish ‘rehabilitation and other services to help [such individuals] attain or retain capability for independence or self-care. A mandatory work requirement is not medical assistance; it is not a service provided to Medicaid beneficiaries.”

Medicaid Work Requirements – Not a Healthy Choice

Executive SummaryIn an effort to win conservative members’ support for the Affordable Care Care Act repeal bill, House Republicans have added a work requirement for Medicaid to the measure. In this issue brief, NHeLP Managing Attorney of the DC office Mara Youdelman,  Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why such work requirements “run counter to the purpose of Medicaid.” They conclude, “Work requirements would stand Medicaid’s purpose on its head by creating barriers to coverage and the pathway to health that the coverage represents.”DOWNLOAD PUBLICATION

Source: Medicaid Work Requirements – Not a Healthy Choice

Top 10 Changes to Medicaid Under House Republicans’ ACA Repeal Bill

Source: Top 10 Changes to Medicaid Under House Republicans’ ACA Repeal Bill

Executive Summary

Following the CBO score that found the House Republicans’ so-called “American Health Care Act” would cause 24 million people to lose health care coverage, NHeLP managing attorneys examine the bill’s “draconian changes” planned for Medicaid. Managing Attorney of the DC Office Mara Youdelman and Managing Attorney of the LA office Kim Lewis conclude that cutting $880 billion in federal funding and 14 million individuals off Medicaid “creates significant financial hardship for states and is devastating for low-income people everywhere. No one can afford these changes.”

With all Eyes on AHCA, House Advances 3 Bills that Could Reduce Benefits, Raise Costs for People in Employer-Based Coverage – Center on Health Insurance Reforms

With all Eyes on AHCA, House Advances 3 Bills that Could Reduce Benefits, Raise Costs for People in Employer-Based Coverage

Source: With all Eyes on AHCA, House Advances 3 Bills that Could Reduce Benefits, Raise Costs for People in Employer-Based Coverage – Center on Health Insurance Reforms

The week of March 6 was a busy one in the world of health care policy. On the Hill, legislation partially repealing the Affordable Care Act (ACA) and restructuring Medicaid was passed by two key House committees (H.R. the “American Health Care Act” or AHCA). At the Department of Health & Human Services, officials began reviewing almost 4,000 comments on the proposed ACA market stabilization rule that were received by the March 7th deadline.

Receiving far less attention was action in the House Education & Workforce Committee to advance three bills that could, if enacted, have far-reaching repercussions for people with employer-based health insurance.

Three bills that could undermine the security of employer-based coverage

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Supporting Student Success through Connecting Activities: An Info Brief Series for Community Colleges | NCWD/Youth

Source: Supporting Student Success through Connecting Activities: An Info Brief Series for Community Colleges | NCWD/Youth

Community college leaders are increasingly concerned with finding ways to better support and engage students in an effort to improve college completion rates. In order to increase their persistence and completion, many students need assistance connecting to services, activities, programs, and supports relevant to their individual needs and goals. Postsecondary institutions can play a significant role in helping students access these services, supports, and opportunities. This series of Info Briefs is designed for community colleges to raise awareness about the significance of connecting students to services and supports such as health insurance, financial assistance, housing, and transportation, and assisting them in navigating these and other services and supports relevant to their individual needs and goals. In addition, these briefs provide practical examples of how some colleges are supporting students and relevant resources for implementing connecting activities at community colleges.

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