A government analyst says the possibility that the Patient Protection and Affordable Care Act of 2010 (PPACA) might increase the percentage of U.S. residents who have individual commercial health coverage might not be that big of a deal.
Steven Hill, a senior economist at the Center for Financing, Access and Cost Trends — a part of the U.S. Department of Health and Huma Servces' Agency for Healthcare Reearch and Quality — make that argument in an article published in a recent issue of Inquiry, a health finance and delivery journal.
Hill looked at data from the federal government's Medical Expenditure Panel Survey for 2002 through 2007.
The conventional wisdom is that people with group coverage have much better access to health care than people with individual coverage, but the surveys seem to show that adults with individual and group coverage report similar levels of access to care, Hill says.
Today, individual plans may cost more than group coverage, use medical underwriting and put more limits on services, but PPACA rules should eliminate or reduce many of those differences and make the individual plans more like group plans, Hill says.
Individuals may report reduction in some types of access, such as access to dental care, but the gap is not necessarily statistically significant, Hill says.
The people who have individual coverage tend to be healthier than group plan enrollees, but, when they do need urgent care, they seem to be about as likely as group plan enrollees to be seen right away, and about as likely to get appointments at the desired time, Hill says.
The people with individual coverage were somewhat more likely to report being unable to get needed medical care, but, overall, only 1.7% reported being unable to get needed medical care, compared with 1.1% of the group plan enrollees, Hill says.
PAY DIRT
The Office of Inspector General (OIG) at the U.S Department of Health and Human Services has come up with an easy way to find large numbers of Medicare overpayments: Look for payments that exceed the billed charges.
OIG auditors recently did that for a Medicare outpatient services claim administrator for Wisconsin and Illinois and found that 927 of 1.547 of the greater-than-the-amount-billed payments were incorrect.
When the auditors did the same for a Medicare outpatient services claim administrator that handles New England, they found that 756 of the 1,396 greater-than-billed payments made there were incorrect.
THE PPACA SUIT
Laura Green of the Palm Beach Post is suggesting that the U.S. Supreme Court may have an easy way to avoid questions about whether the PPACA individual health coverage mandate is constitutional.
The court could avoid even considering that question for now by applying the federal Anti-Injunction Act of 1867, which prohibits plaintiffs from suing to block new federal taxes before they take effect.
If the justices use the Anti-Injunction Act to knock out the current wave of PPACA mandate constitutionality suits, they could push the need to rule on the issue back to 2015, according to legal experts Green quote.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.