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By Kathleen Sebelius, Secretary of Health and Human Services
Today we released our most detailed report to date about the results of the first reporting period of open enrollment in the Health Insurance Marketplace. The numbers show that interest in the Health Insurance Marketplace remains strong and the promise of quality, affordable coverage is becoming a reality for hundreds of thousands of Americans.
Between October 1 and November 2, 2013, 106,185 individuals selected plans from the Marketplace and another 975,407 applied and received an eligibility determination, but have not yet selected a plan. An additional 396,261 were determined eligible for Medicaid or the Children’s Health Insurance Program (CHIP). In total, 502,446 Americans will be positioned to have health coverage starting in 2014.
As we’ve seen in Massachusetts’s efforts to expand coverage, I expect the number of newly insured to grow substantially throughout the open enrollment period. Our efforts to improve HealthCare.gov will be critical to driving new enrollments and meeting consumer demand.
As a further indication of high consumer interest, web traffic and call center volume also continues to be very heavy. During the first reporting period, there have been over 26 million unique visitors to Marketplace websites and over 3.1 million calls to the call centers.
While we know there is still a lot of work to do to make sure every American that wants access to affordable coverage can have it, there are many encouraging takeaways from today’s report.
For the full text of the report, “Health Insurance Marketplace: November Enrollment Report,” please visit: http://aspe.hhs.gov/health/reports/2013/MarketPlaceEnrollment/rpt_enrollment.pdf
Nevada has a state supported exchange, meaning we don’t need to use the national website. We can go to our own exchange website. If you don’t have employer provided insurance and will need to enroll for insurance, VISIT THE NEVADA HEALTH LINK NOW TO APPLY today.
By Salim Zymet, Digital Advisor, Department of Health and Human Services
Enrolling just a day after the Health Insurance Marketplace opened, Daniel, a 22 year old from Orlando, Florida, is one of the millions of Americans eligible for affordable health coverage through the Health Insurance Marketplace.
Daniel says he’s “thrilled” to get coverage at the price he got it, and is relieved to be covered:
“I already had health insurance, but I just wanted to see if I could do a little bit better on the marketplace, and I did. I was able to pick a much higher quality plan, and because of my income as a student, I’ll only pay about 70 bucks a month for health insurance.”
To compare plans in your area, weigh your options, and get enrolled for coverage beginning January 1st, apply on HealthCare.gov by December 15th.
There are 4 basic ways consumers can apply for and enroll in Marketplace coverage:
- Online at HealthCare.gov;
- Over the phone by calling the 24/7 customer service center (1-800-318-2596, TTY 1-855-889-4325);
- Working with a trained person in your local community (Find Local Help); or by
- Submitting a paper application through the call center or downloading a copy at marketplace.cms.gov.
Every 4 years, HHS updates its strategic plan, which describes its work to address complex, multifaceted, and ever-evolving health and human service issues. Under the Government Performance and Results Modernization Act, Federal agencies are required to consult with the Congress and to solicit and consider the views of external parties. We welcome your input on the draft HHS Strategic Plan for FY 2014-2018. The comment period will close on October 15, 2013. Comments can be submitted from the website, or in several ways:
Fax: (202) 690-8252
U.S. Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation
Strategic Planning Team
Attn: Strategic Plan Comments
200 Independence Avenue, SW, Room 446F.8
Washington, DC 20201
- Goal 1: Strengthen Health Care
- Goal 2: Advance Scientific Knowledge and Innovation
- Goal 3: Advance the Health, Safety, and Well-Being of the American People
- Goal 4: Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs
- Appendix A: Organizational Chart
- Appendix B: Operating and Staff Divisions and Their Functions
Today, the Department of Health and Human Services (HHS) issued a memo clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives. This is the first guidance issued by HHS in response to the recent Supreme Court ruling, which held section 3 of the Defense of Marriage Act unconstitutional.
“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” said HHS Secretary Kathleen Sebelius. “Today’s announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court’s decision and to ensure that gay and lesbian married couples are treated equally under the law.”
“Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner. “Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.”
Under current law, Medicare beneficiaries enrolled in a Medicare Advantage plan are entitled to care in, among certain other skilled nursing facilities (SNFs), the SNF where their spouse resides (assuming that they have met the conditions for SNF coverage in the first place, and the SNF has agreed to the payment amounts and other terms that apply to a plan network SNF). Seniors with Medicare Advantage previously may have faced the choice of receiving coverage in a nursing home away from their same-sex spouse, or dis-enrolling from the Medicare Advantage plan which would have meant paying more out-of-pocket for care in the same nursing home as their same-sex spouse.
Today’s guidance clarifies that this guarantee of coverage applies equally to all married couples. The guidance specifically clarifies that this guarantee of coverage applies equally to couples who are in a legally recognized same-sex marriage, regardless of where they live.
— by Kathleen Sebelius, Secretary of Health and Human Services
The Affordable Care Act (ACA) prohibits some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans. It provides families and individuals with new protections against discriminatory rates due to pre-existing conditions, holds insurance companies accountable for how they spend your premium dollars, and prevents insurance companies from raising your insurance premium rates without accountability or transparency.
For more than a decade before the ACA health insurance premiums had risen rapidly, straining the pocketbooks of American families and businesses. Oftentimes, insurance companies were able to raise rates without explanation to consumers or public justification of their actions.
One of the provisions of the ACA is that insurance companies must now reveal the percentage of premium dollars they actually spend on health care and how much they spend on administration (e.g., salaries and marketing. Prior to ACA, this type of information was a closely held secret and insurance companies pocketed a good percentage of your premium dollars. With ACA in place, that’s no longer the case. If an insurance company spends less than 80% of premiums on medical care and quality (or less than 85% in the large employer, large group market), it must rebate the portion of premium dollars that exceeded this limit. This 80/20 rule is commonly known as the Medical Loss Ratio (MLR) rule
Rate Review in Action
The ACA brought an unprecedented level of scrutiny and transparency to health insurance rate increases by requiring insurance companies in every state to publicly justify their actions if they want to raise rates by 10% or more. Insurance companies are required to provide easy to understand information to their customers about their reasons for significant rate increases, and any unreasonable rate increases are posted online.
And it’s working. A new report released today shows that the health care law is helping to moderate premium hikes. Since this rule was implemented, the number of requests for insurance premium increases of 10% or more has dropped dramatically, from 75% to 14%. The average premium increase for all rates in 2012 was 30% below what it was in 2010. And available data suggest that this slowdown in rate increases has continued into 2013.
Moreover, when an insurer does decide to increase rates, consumers are seeing lower rate increases than what the insurers initially requested. In the review of rate requests for 10% or more, over 50% resulted in customers receiving either a lower rate increase than requested or no increase at all.
States have received $250 million in Health Insurance Rate Review Grants to help strengthen and improve their rate review processes thanks to the Affordable Care Act. Of the 44 states that received rate review grants, 40 have reported enhancements to their rate review websites. These website enhancements include searchable rate filings, new public comment options, live streaming of rate hearings, and plain language explanations of rate review and rate filings.
The Effective Rate Review program is one of many in the health care law aimed at protecting consumers. The rate review program works in conjunction with the 80/20 rule, which requires insurance companies to generally spend 80% of premiums on health care or provide rebates to their customers. Insurance companies that did not meet the 80/20 rule have provided nearly 13 million Americans with more than $1.1 billion in rebates. Americans receiving the rebate will benefit from an average rebate of $151 per household.
Additionally, today we issued a final rule that implements five key consumer protections from the Affordable Care Act, including protection against denial of health coverage because of a pre-existing condition. This rule makes the health insurance market work better for individuals, families and small businesses, and it also increases the transparency brought to rate increases by directing insurance companies in every state to file all of their rate increase requests.
For more information about the Affordable Care Act, visit http://www.healthcare.gov/index.html.
- Insurance Analysts: Obamacare to Increase Out-of-Pocket Premium Costs, Despite Lavish Subsidies (Forbes, 1/12/2013)
- Proof That Obamacare ‘Rate Shock’ Is An Ugly Insurance Company Deception (Forbes, 3/26/2013)
- Obamacare to Hike Some, Lower Other Individual Health Premiums: Sebelius (Insurance Journal, 3/27/2013)
- Some health insurance premium hikes reduced (Orange County Register, 3/7/2013)
- Insurance Companies Warn of Premium Hikes (Hispanic Business.com, 3/22/2013)
- The Hidden Cost of A Pre-Existing Condition Exclusion in the PPACA (Benefits@Work, 3/24/2013)
The Department of Health and Human Services (HHS) has finalized its regulations on a key element of health reform, the essential health benefits package. These regulations are an important step forward for expanding access to mental-health and addictions treatment in the U.S., because they require a broad range of plans to cover behavioral health services and to do so at parity with medical/surgical services. According to a new report, this means that over 62 million Americans will gain access to insurance coverage that meets parity standards. This includes 27 million uninsured Americans plus 35.5 million who have coverage that either does not cover MH/SUD or is not required to cover them at parity. Beginning in 2014, the essential benefits package will become the minimum standard of coverage that most insurance plans must meet, including plans sold on the exchanges, individual and small group plans, and Medicaid expansion plans.
Other highlights of the regulation are:
- The proposed rule includes language to assure non-discrimination in plan design, a major issue for people with chronic conditions. The rule prohibits cost-sharing structures, utilization management techniques and benefit designs that discriminate against beneficiaries based on race, age, disability status, health status, quality of life, having high health-care needs, or other characteristics. States must monitor and identify discriminatory benefit designs.
- The definition of essential benefits includes both the required preventive services outlined in the ACA as well as any state-mandated benefits (for example, autism coverage mandates) that were in effect prior to December 31, 2011.
However, HHS also left up to states’ discretion several other important decisions, including the definition of habilitative (= rehabilitation) benefits, establishment of non-discrimination standards in plan design, and the enforcement of benefit substitutions within categories. It also adopted a prescription drug policy that requires plans to cover at least one drug in every category and class of the U.S. Pharmacopoeia, an approach that could allow states to offer coverage that does not include the full range of psychiatric medications.
Given the recent report of blatant patient dumping by Southern Nevada Adult Mental Health Services, I for one am not sure leaving it up to “State” discretion to expand on and flesh out the remaining standards is all that good of an idea.
Other Available Substance Abuse & Mental Health Services Admin Reports at HHS
- OAS Methodology Reports - “[These reports address] various methodological issues concerning OAS data collection systems including: statistical techniques and theories, survey methods, sample design, survey instrument design, and objective evaluations of the reliability of collected data.”
- NSDUH Reports on Substance Abuse and Mental Health - “SAMHSA’s National Survey on Drug Use and Health (NSDUH) is the primary source of information on the prevalence, patterns, and consequences of drug and alcohol use and abuse in the general U.S. civilian non institutionalized population, age 12 and older.”
- Youth and Substance Use - These NSDUH reports discuss youth substance abuse.
- Parental, Peer and School Influences - These reports analyze information regarding parental, peer and school influences on drug abuse from the National Surveys on Drug Use & Health by SAMHSA.
- Analytic Series and Other Special Reports - “The Analytic Series addresses special topics relating to alcohol, tobacco, drug abuse, and mental health.”
- Mental Health Reports - These reports analyze information regarding mental health issues as related to drug abuse from the National Surveys on Drug Use & Health by SAMHSA.
- Violence, Suicide, & Risky Behaviors Reports - These reports provide data on suicide attempts, suicides, violence and risky behaviors as related to and influenced by drug use; data was provided by SAMHSA’s National Survey on Drug Use and Health and SAMHSA’s Drug Abuse Warning Network (DAWN).
- Reports on Depression - These reports provide information regarding depression, or related activity, and its connection to substance abuse as reported by NSDUH.
- Mental Health by Racial & Ethnic Group - These reports discuss mental health as it relates to racial and ethnic groupings.
- Homeless Reports - These reports, provided by DASIS, have information regarding homelessness admissions and substance abuse treatment.
- Katrina/Rita Areas: Substance Use and Mental Health - “[These reports present data] on substance use and mental health problems before and after Hurricanes Katrina and Rita”
- Youth & Mental Health Issues Reports - These reports provide information on mental health and substance use among youths.
- Serious Psychological Distress - These reports provide information about people suffering from serious psychological distress, its affects on mental illness and the connections that it has to substance abuse.
- Cities/Counties/Metropolitan Areas - These reports provide information regarding substance use in specific geographic areas.
|FOR IMMEDIATE RELEASE
May 22, 2012
|Contact: HHS Press Office
People in their 50s, 60s, 70s, and beyond can
save lives by becoming donors
An effort to educate adults 50 and older about the importance of registering to be organ, eye, and tissue donors was launched today in observance of Older Americans Month. The campaign was developed by the Health Resources and Services Administration (HRSA), in partnership with the Administration for Community Living’s Administration on Aging and the National Institutes of Health’s National Institute on Aging.
More than 114,000 people are on the national transplant waiting list for an organ, and more than 100 of them die each week waiting for an organ that never comes. In 2011, people 50 and older accounted for 32 percent of donors but 60 percent of the total number of transplants.
“It’s important for everyone to know any age can be the right age to be an organ, eye, and tissue donor,” said Howard K. Koh, M.D., M.P.H., assistant secretary for health at the U.S. Department of Health and Human Services. “Imagine how many more lives we could save if the majority of the more than 99 million Americans 50 years old, or older signed up to give the gift of life.”
The 50 plus campaign was developed to dispel the myth that there are age limitations for giving the gift of life through organ, eye and tissue donation or for being a transplant recipient. Adults well into their 90s have successfully donated organs, extending the lives of recipients. Campaign materials include a brochure in English and Spanish; an article; radio and print public service announcements; and web banners.
“A poll conducted of adults in the United States shows that the majority of them believe organ donation is the right thing to do, but many of those have not yet taken the next step of signing up on a donor registry,” said HRSA Administrator Mary Wakefield, Ph.D., R.N. “Together we can add to the more than 100 million people who have signed up.”
|OR IMMEDIATE RELEASE
May 15, 2012
|Contact: HHS Press Office
HHS Secretary Sebelius outlines research funding, tools for health care
providers, awareness campaign and new website
Health and Human Services Secretary Kathleen Sebelius today released an ambitious national plan to fight Alzheimer’s disease. The plan was called for in the National Alzheimer’s Project Act (NAPA), which President Obama signed into law in January 2011. The National Plan to Address Alzheimer’s Disease sets forth five goals, including the development of effective prevention and treatment approaches for Alzheimer’s disease and related dementias by 2025.
In February 2012, the administration announced that it would take immediate action to implement parts of the plan, including making additional funding available in fiscal year 2012 to support research, provider education and public awareness. Today, the Secretary announced additional specific actions, including the funding of two major clinical trials, jumpstarted by the National Institutes of Health’s (NIH) infusion of additional FY 2012 funds directed at Alzheimer’s disease; the development of new high-quality, up-to-date training and information for our nation’s clinicians; and a new public education campaign and website to help families and caregivers find the services and support they need.
To help accelerate this urgent work, the President’s proposed FY 2013 budget provides a $100 million increase for efforts to combat Alzheimer’s disease. These funds will support additional research ($80 million), improve public awareness of the disease ($4.2 million), support provider education programs ($4.0 million), invest in caregiver support ($10.5 million), and improve data collection ($1.3 million).
“These actions are the cornerstones of an historic effort to fight Alzheimer’s disease,” Secretary Sebelius said. “This is a national plan—not a federal one, because reducing the burden of Alzheimer’s will require the active engagement of both the public and private sectors.”
The plan, presented today at the Alzheimer’s Research Summit 2012: Path to Treatment and Prevention, was developed with input from experts in aging and Alzheimer’s disease issues and calls for a comprehensive, collaborative approach across federal, state, private and non-profit organizations. More than 3,600 people or organizations submitted comments on the draft plan.
As many as 5.1 million Americans have Alzheimer’s disease and that number is likely to double in the coming years. At the same time, millions of American families struggle with the physical, emotional and financial costs of caring for a loved one with Alzheimer’s disease.
The initiatives announced today include:
- Research – The funding of new research projects by the NIH will focus on key areas in which emerging technologies and new approaches in clinical testing now allow for a more comprehensive assessment of the disease. This research holds considerable promise for developing new and targeted approaches to prevention and treatment. Specifically, two major clinical trials are being funded. One is a $7.9 million effort to test an insulin nasal spray for treating Alzheimer’s disease. A second study, toward which NIH is contributing $16 million, is the first prevention trial in people at the highest risk for the disease.
- Tools for Clinicians – The Health Resources and Services Administration has awarded $2 million in funding through its geriatric education centers to provide high-quality training for doctors, nurses, and other health care providers on recognizing the signs and symptoms of Alzheimer’s disease and how to manage the disease.
- Easier access to information to support caregivers–HHS’ new website, www.alzheimers.gov, offers resources and support to those facing Alzheimer’s disease and their friends and family. The site is a gateway to reliable, comprehensive information from federal, state, and private organizations on a range of topics. Visitors to the site will find plain language information and tools to identify local resources that can help with the challenges of daily living, emotional needs, and financial issues related to dementia. Video interviews with real family caregivers explain why information is key to successful caregiving, in their own words.
- Awareness campaign – The first new television advertisement encouraging caregivers to seek information at the new website was debuted. This media campaign will be launched this summer, reaching family members and patients in need of information on Alzheimer’s disease.
Today’s announcement demonstrates the Obama administration’s continued commitment to taking action in the fight against Alzheimer’s disease.
In 2013, the National Family Caregiver Support Program will continue to provide essential services to family caregivers, including those helping loved ones with Alzheimer’s disease. This program will enable family caregivers to receive essential respite services, providing them a short break from caregiving duties, along with other essential services, such as counseling, education and support groups.
For more information on the national plan to address Alzheimer’s disease, visit: www.alzheimers.gov.