Showing posts with label AFFORDABLE CARE ACT. Show all posts
Showing posts with label AFFORDABLE CARE ACT. Show all posts

Sunday, June 28, 2015

243 CHARGED IN $712 MILLION IN MEDICARE FRAUD SCHEMES

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
June 18, 2015
National Medicare fraud takedown results in charges against 243 individuals for approximately $712 million in false billing
Most defendants charged and largest alleged loss amount in Strike Force history

WASHINGTON – Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch announced today a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulting in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings.  In addition, the Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers using its suspension authority as provided in the Affordable Care Act.  This coordinated takedown is the largest in Strike Force history, both in terms of the number of defendants charged and loss amount.

Secretary Burwell and Attorney General Lynch were joined in the announcement by FBI Director James B. Comey, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG) and Deputy Administrator and Director of CMS Center for Program Integrity Dr. Shantanu Agrawal.

The defendants are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft.  The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and pharmacy fraud.  More than 44 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.

“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement,” said Attorney General Lynch.  “The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others.  They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.  In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives.  We are prepared – and I am personally determined – to continue working with our federal, state, and local partners to bring about the vital progress that all Americans deserve.”

“This Administration is committed to fighting fraud and protecting taxpayer dollars in Medicare and Medicaid,” said Secretary Burwell. “This takedown adds to the hundreds of millions we have saved through fraud prevention since the Affordable Care Act was passed. With increased resources that have allowed the Strike Force to expand and new tools, like enhanced screening and enrollment requirements, tough new rules and sentences for criminals, and advanced predictive modeling technology, we have managed to better find and fight fraud as well as stop it before it starts.”

According to court documents, the defendants participated in alleged schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators allegedly were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $712 million in fraudulent billing.

“The people charged in this case targeted the system each of us depends on in our most vulnerable moments,” said FBI Director James Comey.  “Health care fraud is a crime that hurts all of us and each dollar taken from programs that help the sick and the suffering is one dollar too many.”

“Every day, the Criminal Division is more strategic in our approach to prosecuting Medicare Fraud,” said Assistant Attorney General Caldwell.  “We obtain and analyze billing data in real-time.  We target hot spots – areas of the country and the types of health care services where the billing data shows the potential for a high volume of fraud – and we are speeding up our investigations.  By doing this, we are increasingly able to stop schemes at the developmental stage, and to prevent them from spreading to other parts of the country.”

“Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries,” said HHS-OIG Inspector General Levinson. “Today’s takedown includes perpetrators of prescription drug fraud, home health care fraud, and personal care services fraud, three particularly harmful types of fraud plaguing our health care system. This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets.  Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.”

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  Since their inception in March 2007, Strike Force operations in nine locations have charged over 2,300 defendants who collectively have falsely billed the Medicare program for over $7 billion.

Including today’s enforcement actions, nearly 900 individuals have been charged in national takedown operations, which have involved more than $2.5 billion in fraudulent billings.  Today’s announcement marks the first time that districts outside of Strike Force locations participated in a national takedown, and they accounted for 82 defendants charged in this takedown.

*********

In Miami, a total of 73 defendants were charged with offenses relating to their participation in various fraud schemes involving approximately $263 million in false billings for home health care, mental health services, and pharmacy fraud.  In one case, administrators in a mental health center billed close to $64 million between 2006 and 2012 for purported intensive mental health treatment to beneficiaries and allegedly paid kickbacks to patient recruiters and assisted living facility owners throughout the Southern District of Florida.  Medicare paid approximately half of the claimed amount.

In Houston and McAllen, 22 individuals were charged in cases involving over $38 million in alleged fraud.  One of these defendants allegedly coached beneficiaries on what to tell doctors to make them appear eligible for Medicare services and treatments and then received payment for those who qualified. The company that paid the defendant for patients submitted close to $16 million in claims to Medicare, over $4 million of which was paid.

In Dallas, seven people were charged in connection with home health care schemes.  In one scheme, six owners and operators of a physician house call company submitted nearly $43 million in billings under the name of a single doctor, regardless of who actually provided the service. The company also significantly exaggerated the length of physician visits, often times billing for 90 minutes or more for an appointment that lasted only 15 or 20 minutes.

In Los Angeles, eight defendants were charged for their roles in schemes to defraud Medicare of approximately $66 million.  In one case, a doctor is charged with causing almost $23 million in losses to Medicare through his own fraudulent billing and referrals for DME, including over 1000 expensive power wheelchairs, and home health services that were not medically necessary and often not provided.

In Detroit, 16 defendants face charges for their alleged roles in fraud, kickback and money laundering schemes involving approximately $122 million in false claims for services that were medically unnecessary or never rendered, including home health care, physician visits, and psychotherapy, as well as pharmaceuticals that were billed by not dispensed.  Among these are three owners of a hospice service who allegedly paid kickbacks for referrals made by two doctors who defrauded Medicare Part D by issuing medically unnecessary prescriptions.

In Tampa, five individuals were charged with participating in a variety of schemes, ranging from fraudulent physical therapy billings to a scheme involving millions in physician services and tests that never occurred.  In one case, a licensed pain management physician sought reimbursement for nerve conduction studies and other services that he allegedly never performed.  Medicare paid the defendant over $1 million for these purported services.

In Brooklyn, N.Y., nine individuals were charged in two separate criminal schemes involving physical and occupational therapy.  In one case, three individuals face charges for their roles in a previously charged $50 million physical therapy scheme.  In the second case, six defendants were charged for their roles in a $8 million physical and occupational therapy scheme.

In New Orleans, 11 people were charged in connection with $110 million in home health care and psychotherapy schemes.  In one case, four individuals who operated two companies – one in Louisiana and one in California – that mass-marketed talking glucose monitors (TGMs) across the country allegedly sent TGMs to Medicare beneficiaries regardless of whether they were needed or requested.  The companies billed Medicare approximately $38 million for the devices, and Medicare paid the companies over $22 million.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG and state Medicaid Fraud Control Units.

In addition to the Strike Force, today’s enforcement actions include cases brought by the U.S. Attorney’s Offices for the Southern District of California, Southern District of Illinois, Northern District of Ohio, Western District of Kentucky, District of Maryland, District of Connecticut, District of Alaska and the Southern District of Georgia.

A complaint or indictment is merely a charge, and defendants are presumed innocent until proven guilty.

The Affordable Care Act has provided new tools and resources to fight fraud in federal health care programs. The law provides an additional $350 million for health care fraud prevention and enforcement efforts, which has allowed the Justice Department to hire more prosecutors and the Strike Force to expand from two cities to nine. It also toughens sentencing for criminal activity, enhances provider and supplier screenings and enrollment requirements, and encourages increased sharing of data across government.

In addition to providing new tools and resources to fight fraud, the Affordable Care Act clarified that for sentencing purposes, the loss is determined by the amount billed to Medicare and increased the sentencing guidelines for the billed amounts, which has provided a strong deterrent effect due to increased prison time, particularly in the most egregious cases.

Thursday, June 25, 2015

AFFORDABLE CARE ACT TAX CREDITS STILL AVAILABLE AFTER SUPREME COURT RULING ACCORDING TO HHS SECRETARY BURWELL'S STATEMENT

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOR IMMEDIATE RELEASE
June 25, 2015

Statement by HHS Secretary Sylvia M. Burwell on the Affordable Care Act
Today’s Supreme Court decision confirms that the Affordable Care Act’s tax credits are available to all eligible Americans no matter where they live. Americans in all 50 states and the District of Columbia can continue to rely on the security and peace of mind that come with affordable, quality health care coverage.

Over six million Americans and their families will sleep easier knowing they will still be able to afford health coverage. Millions more won’t have to worry about an upward spiral in their premiums because of today’s decision, even if they didn’t buy their insurance through the Marketplace. And the law’s financial assistance will be available in the next open enrollment so that others can benefit as well.

The Affordable Care Act is working to improve access, affordability and quality.
That is the story I hear as I travel across this country. People’s lives have been changed and even saved because they have health insurance—many for the first time. They have coverage that can keep them healthy and provide quality care when they are sick.

The Affordable Care Act also strengthens protections for almost every American with health insurance. People with pre-existing conditions can no longer be denied coverage or charged higher premiums. Critical preventive services, like immunizations and certain cancer screenings, are available at no additional cost. Since parents can keep their children on their health insurance policies up to age 26, young Americans can stay in school or find their first job without worrying about their coverage. And your health premiums can no longer be higher just because you are a woman.

I hope that this positive decision will do what the American people want us to do -- focus on the substance and turn to building on the progress we have made. They want us to move forward to provide more Americans with affordable access to quality coverage and create a health care system that improves the quality of care and spends our dollars more wisely.

Thursday, June 18, 2015

243 INDIVIDUALS CHARGED IN $712 MILLION MEDICARE FRAUD CASE

FROM:  U.S. JUSTICE DEPARTMENT
Thursday, June 18, 2015
National Medicare Fraud Takedown Results in Charges Against 243 Individuals for Approximately $712 Million in False Billing

Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulting in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings.  In addition, the Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers using its suspension authority as provided in the Affordable Care Act.  This coordinated takedown is the largest in Strike Force history, both in terms of the number of defendants charged and loss amount.  

Attorney General Lynch and Secretary Burwell were joined in the announcement by FBI Director James B. Comey, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG) and Deputy Administrator and Director of CMS Center for Program Integrity Shantanu Agrawal, M.D.

The defendants are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft.  The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and pharmacy fraud.  More than 44 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.

“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement,” said Attorney General Lynch.  “The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others.  They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.  In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives.  We are prepared – and I am personally determined – to continue working with our federal, state, and local partners to bring about the vital progress that all Americans deserve.”

“This Administration is committed to fighting fraud and protecting taxpayer dollars in Medicare and Medicaid,” said Secretary Burwell.  “This takedown adds to the hundreds of millions we have saved through fraud prevention since the Affordable Care Act was passed.  With increased resources that have allowed the Strike Force to expand and new tools, like enhanced screening and enrollment requirements, tough new rules and sentences for criminals, and advanced predictive modeling technology, we have managed to better find and fight fraud as well as stop it before it starts.”

According to court documents, the defendants participated in alleged schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators allegedly were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $712 million in fraudulent billing.

“The people charged in this case targeted the system each of us depends on in our most vulnerable moments,” said Director James Comey.  “Health care fraud is a crime that hurts all of us and each dollar taken from programs that help the sick and the suffering is one dollar too many.”

“Every day, the Criminal Division is more strategic in our approach to prosecuting Medicare Fraud,” said Assistant Attorney General Caldwell.  “We obtain and analyze billing data in real-time.  We target hot spots – areas of the country and the types of health care services where the billing data shows the potential for a high volume of fraud – and we are speeding up our investigations.  By doing this, we are increasingly able to stop schemes at the developmental stage, and to prevent them from spreading to other parts of the country.”

“Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries,” said Inspector General Levinson.  “Today’s takedown includes perpetrators of prescription drug fraud, home health care fraud, and personal care services fraud, three particularly harmful types of fraud plaguing our health care system.  This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets.  Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.”

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  Since their inception in March 2007, Strike Force operations in nine locations have charged over 2,300 defendants who collectively have falsely billed the Medicare program for over $7 billion.

Including today’s enforcement actions, nearly 900 individuals have been charged in national takedown operations, which have involved more than $2.5 billion in fraudulent billings.  Today’s announcement marks the first time that districts outside of Strike Force locations participated in a national takedown, and they accounted for 82 defendants charged in this takedown.

*********

In Miami, a total of 73 defendants were charged with offenses relating to their participation in various fraud schemes involving approximately $263 million in false billings for home health care, mental health services and pharmacy fraud.  In one case, administrators in a mental health center billed close to $64 million between 2006 and 2012 for purported intensive mental health treatment to beneficiaries and allegedly paid kickbacks to patient recruiters and assisted living facility owners throughout the Southern District of Florida.  Medicare paid approximately half of the claimed amount.

In Houston and McAllen, Texas, 22 individuals were charged in cases involving over $38 million in alleged fraud.  One of these defendants allegedly coached beneficiaries on what to tell doctors to make them appear eligible for Medicare services and treatments and then received payment for those who qualified.  The company that paid the defendant for patients submitted close to $16 million in claims to Medicare, over $4 million of which was paid.    

In Dallas, seven people were charged in connection with home health care schemes.  In one scheme, six owners and operators of a physician house call company submitted nearly $43 million in billings under the name of a single doctor, regardless of who actually provided the service.  The company also significantly exaggerated the length of physician visits, often times billing for 90 minutes or more for an appointment that lasted only 15 or 20 minutes.  

In Los Angeles, eight defendants were charged for their roles in schemes to defraud Medicare of approximately $66 million.  In one case, a doctor is charged with causing almost $23 million in losses to Medicare through his own fraudulent billing and referrals for DME, including over 1000 expensive power wheelchairs and home health services that were not medically necessary and often not provided.

In Detroit, 16 defendants face charges for their alleged roles in fraud, kickback and money laundering schemes involving approximately $122 million in false claims for services that were medically unnecessary or never rendered, including home health care, physician visits, and psychotherapy, as well as pharmaceuticals that were billed but not dispensed.  Among these are three owners of a hospice service who allegedly paid kickbacks for referrals made by two doctors who defrauded Medicare Part D by issuing medically unnecessary prescriptions.

In Tampa, five individuals were charged with participating in a variety of schemes, ranging from fraudulent physical therapy billings to a scheme involving millions in physician services and tests that never occurred.  In one case, a licensed pain management physician sought reimbursement for nerve conduction studies and other services that he allegedly never performed.  Medicare paid the defendant over $1 million for these purported services.

In Brooklyn, N.Y., nine individuals were charged in two separate criminal schemes involving physical and occupational therapy.  In one case, three individuals face charges for their roles in a previously charged $50 million physical therapy scheme.  In the second case, six defendants were charged for their roles in a $8 million physical and occupational therapy scheme.

In New Orleans, 11 people were charged in connection with $110 million in home health care and psychotherapy schemes.  In one case, four individuals who operated two companies – one in Louisiana and one in California – that mass-marketed talking glucose monitors (TGMs) across the country allegedly sent TGMs to Medicare beneficiaries regardless of whether they were needed or requested.  The companies billed Medicare approximately $38 million for the devices and Medicare paid the companies over $22 million.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices of the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois and the Middle District of Florida; and agents from the FBI, HHS-OIG and state Medicaid Fraud Control Units.

In addition to the Strike Force, today’s enforcement actions include cases brought by the U.S. Attorney’s Offices of the Southern District of California, Southern District of Illinois, Northern District of Ohio, Western District of Kentucky, District of Maryland, District of Connecticut, District of Alaska and the Southern District of Georgia.

A complaint or indictment is merely a charge, and defendants are presumed innocent until proven guilty.

The Affordable Care Act has provided new tools and resources to fight fraud in federal health care programs. The law provides an additional $350 million for health care fraud prevention and enforcement efforts, which has allowed the Justice Department to hire more prosecutors and the Strike Force to expand from two cities to nine. It also toughens sentencing for criminal activity, enhances provider and supplier screenings and enrollment requirements, and encourages increased sharing of data across government.

In addition to providing new tools and resources to fight fraud, the Affordable Care Act clarified that for sentencing purposes, the loss is determined by the amount billed to Medicare and increased the sentencing guidelines for the billed amounts, which has provided a strong deterrent effect due to increased prison time, particularly in the most egregious cases.

Sunday, May 31, 2015

HHS WORKS WITH HEALTH CARE PROVIDERS TO REDUCE RISK OF HEART DISEASE AND STROKE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
May 28, 2015

New Affordable Care Act payment model seeks to reduce cardiovascular disease
Speaking today at the White House Conference on Aging regional forum in Boston, Health and Human Services Secretary Sylvia M. Burwell announced a unique opportunity for health care providers to decrease cardiovascular disease risk for tens of thousands of Medicare beneficiaries by assessing an individual patient’s risks for heart attack or stroke and working with them to reduce those risks.

Heart attacks and strokes are a leading cause of death and disability. According to the Centers for Disease Control and Prevention, about 610,000 people die of heart disease in the United States every year – accounting for one in every four deaths and costing an estimated $315.4 billion annually. The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction model proposes an innovative way of lowering those risks. Currently, providers are paid to meet specific blood pressure, cholesterol or other targets for their patients as a group. In a new approach, the Million Hearts® model will use a data-driven, widely accepted predictive modelling approach to generate personalized risk scores and modification plans for patients.

“The Million Hearts initiative is a part of our efforts to promote better care and smarter practices in our health care system,” said Secretary Burwell. “It recognizes that giving doctors more one-on-one time with their patients to prevent illness leads to better outcomes, and that greater access to health information helps empower patients to be active participants in their care.”

Beginning today, the Centers for Medicare & Medicaid Services (CMS) is accepting applications for the Million Hearts® CVD Risk Reduction model.  Health care providers who participate in the model will work with Medicare beneficiaries to determine their individual risk for a heart attack or stroke in the next ten years (for example, 25 percent). Then, providers will work with patients to identify the best approach to reduce their individual risk —for example, stopping smoking, reducing blood pressure, or taking cholesterol-lowering drugs or aspirin—and show them the benefits of each approach.  Each patient will get a personalized risk modification plan that will target their specific risk factors. Providers will be paid for reducing the absolute risk for heart disease or stroke among their high-risk patients.

The Million Hearts® CVD Risk Reduction model will operate for five years and aims to enroll over 300,000 Medicare beneficiaries and 720 diverse practices, varying in size and patient case mix; and including providers in general/family practice, general internal medicine, geriatric medicine, multi-specialty care, or cardiovascular care.

Million Hearts® is a broad national initiative to prevent one million heart attacks and strokes by 2017. Million Hearts® brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke.

Saturday, May 16, 2015

DEPT OF HEALTH AND HUMAN SERVICES SAYS 137 MILLION NOW GUARANTEED ACCESS TO FREE PREVENTIVE SERVICES

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
About 137 million individuals with private insurance are guaranteed access to free preventive services

Nationwide, about 137 million individuals, including 55 million women and 28 million children, have private health insurance that covers recommended preventive services without cost sharing, according to a new ASPE Data Point from the Department of Health and Human Services. Under the Affordable Care Act, most health plans are required to provide coverage for recommended preventive health care services without copays. Increased access to preventive services can reduce and prevent costly chronic diseases and help Americans live healthier lives. These services include but are not limited to:

* Blood pressure screening * Well-baby and well-child visits
* Obesity screening and counseling * Flu vaccination and other immunizations
* Well-woman visits * Tobacco cessation interventions
* Domestic violence screening and counseling * Vision screening for children
* Breastfeeding support and supplies * HIV screening
* FDA-approved contraceptive methods * Depression screening

“Thanks to the Affordable Care Act, millions more Americans have access to preventive services, including vaccinations, well-baby visits, and diabetes and blood pressure screenings," said Secretary Sylvia M. Burwell. “These services can substantially improve the health of families, and in some cases even save lives. We urge all individuals with health care coverage to take advantage of these services. This can make a tremendous difference in the health of Americans.”

The data released today are broken down by state, age, gender, and race and ethnicity.  Of the about 137 million individuals with access to recommended preventive services without cost sharing:

28.5 million are children, who have access to free preventive service coverage for flu vaccinations and other immunizations, vision screening, and well-baby and well-child visits.

55.6 million are women, who have access to free preventive services such as well-women visits, breastfeeding support and supplies, and recommended cancer screenings.

53.5 million are men, who have access to annual wellness visits, blood pressure screening, and cancer screenings.

And an estimated 15 million are Black, 17 million are Latino, and 8 million are Asian-Americans who have access to recommended preventive services without cost sharing.

Some of the estimated 137 million individuals that are guaranteed access to preventive services without cost sharing today may have had access to one or more of those services without cost sharing prior to the implementation of the Affordable Care Act. According to the Kaiser Family Foundation’s Employer Health Benefits Survey in 2012, 41 percent of all workers were covered by employer-sponsored group health plans that expanded their list of covered preventive services due to the Affordable Care Act. Based on this and available Health Insurance Marketplace data at the time, HHS previously estimated that approximately 76 million Americans – and 30 million women – received expanded coverage of one or more preventive services because of the Affordable Care Act.

Tuesday, May 5, 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES TOUTS $384 MILLION SAVINGS

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
May 4, 2015
Affordable Care Act payment model saves more than $384 million in two years, meets criteria for first-ever expansion

Pioneer ACO Model advances quality and value in health care

Today, an independent evaluation report released by the Department of Health and Human Services showed that an innovative payment model created as a pilot project by the Affordable Care Act generated substantial savings to Medicare in just two years. Additionally, the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) has certified that this patient care model is the first to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries.

The independent evaluation report for CMS found that the Pioneer Accountable Care Organization (ACO) Model generated over $384 million in savings to Medicare over its first two years – an average of approximately $300 per participating beneficiary per year – while continuing to deliver high-quality patient care. The Actuary’s certification that expansion of Pioneer ACOs would reduce net Medicare spending, coupled with Secretary Sylvia Mathews Burwell’s determination that expansion would maintain or improve patient care without limiting coverage or benefits, means that HHS will consider ways to scale the Pioneer ACO Model into other Medicare programs.

“This is a crucial milestone in our efforts to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people,” said HHS Secretary Sylvia M. Burwell. “The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier. The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.”

The Pioneer ACO Model, one of the first payment models launched by CMS, gives experienced health care organizations accountability for quality and cost outcomes for their Medicare patients. Doctors and hospitals who form Pioneer ACOs can share in savings generated for Medicare if they work to coordinate patient care, keep patients healthy and meet certain quality performance standards, or they may be required to pay a share of any losses generated.
Currently, the Pioneer ACO Model is serving more than 600,000 Medicare beneficiaries. According to today’s report, compared to their counterparts in regular fee-for-service or Medicare Advantage plans, Medicare beneficiaries who are in Pioneer ACOs, on average:

Report more timely care and better communication with their providers.
Use inpatient hospital services less and have fewer tests and procedures.
Have more follow-up visits from their providers after hospital discharge.
Pioneer ACOs are part of the innovative framework established by the Affordable Care Act to move our health care system toward one that rewards doctors based on the quality, not quantity, of care they give patients. HHS earlier this year announced the ambitious goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018. More than 3,600 payers, providers, employers, patients, states, consumer groups, consumers and other partners have registered to participate in the Health Care Payment Learning and Action Network, which was launched to help the entire health care system reach these goals.

Pioneer ACOs generated Medicare savings of $279.7 million in 2012 and $104.5 million in 2013. To date, actuarial analyses show that ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program have generated over $417 million in total program savings for Medicare. The primary analyses in the evaluation are also reported in an article published in the Journal of the American Medical Association today.

“This success demonstrates that CMS can design and test innovative payment and service delivery models that produce better outcomes for the Medicare program and beneficiaries,” added Patrick Conway, MD, the acting principal deputy administrator of CMS. “This gives CMS greater confidence in scaling elements of the model to benefit people across the nation, and we are working to determine the best strategies for embedding the lessons we have already learned from the Pioneer Model into permanent Medicare programs and our nation’s health system.”

Tuesday, April 7, 2015

SECRETARY BURWELL MEETS WITH BUSINESS LEADERS ON HEALTHCARE DELIVERY SYSTEM

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Apr 02, 2015
By: Rhette Buttle, Director, Private Sector Engagement

Earlier this month, Secretary Burwell traveled to San Francisco. During her trip, she had the opportunity to meet with private sector leaders on a myriad of issues including precision medicine, how to better transform our healthcare delivery system and implementation of the Affordable Care Act. One of those meetings was held at Rock Health with several entrepreneurs who are doing innovative work in the healthcare space, and some of whom have started businesses thanks to the Affordable Care Act.

Rock Health is a seed and early-stage venture fund that supports start-ups building the next generation of technologies transforming healthcare. During her visit, Secretary Burwell did a lot of listening, but also engaged in lively discussion focused on how the department could better support entrepreneurs and innovation. The Secretary was able to hear from leaders in the field about how we can better collaborate with innovators who seek to deliver better health care at more affordable cost; and work together to leverage data to empower consumers.

Secretary Burwell was encouraged to hear from entrepreneurs who were able to get access to quality affordable healthcare for the first time thanks to the Affordable Care Act.

Tuesday, January 27, 2015

WHITE HOUSE STATEMENT ON CBO CONFIRMATION REGARDING LOWERED DEFICITS

January 26, 2015
Statement by Principal Deputy Press Secretary Eric Schultz

The estimates released today by CBO once again confirm the progress we’ve made in bringing down deficits and expanding access to healthcare under the Affordable Care Act. Under the President’s leadership, the deficit has already been cut by about two-thirds as a share of the economy, the fastest sustained deficit reduction since World War II.

CBO’s longer-term budget and economic projections confirm the need for Congress to act to strengthen our economy for the middle class while putting our debt and deficits on a sustainable trajectory, including by making the investments that will accelerate economic growth and generate good new jobs for our workers to fill.  We look forward to discussing the President’s plan to bring middle class economics into the 21st Century and finish the job of putting our Nation on a sustainable fiscal path in more detail when the President’s FY 2016 Budget is released on Monday, February 2.

Tuesday, January 13, 2015

HHS TOUTS ACA AS MAKING "GREAT STRIDES" FOR WOMEN'S HEALTH CARE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Great Strides for Women’s Health Under the Affordable Care Act
Jan 09, 2015

By: Valerie Jarrett, Senior Advisor and Assistant to the President for Intergovernmental Affairs and Public Engagement, The White House
President Obama has said repeatedly that “when women succeed, America succeeds.”  And over the past year, millions of women have gained the security of knowing that their professional, academic, financial, and personal dreams will not be put in jeopardy if they face a health challenge.  Today, the Department of Health and Human Services (“HHS”) released a report detailing the important strides we have made in women’s health as a result of the implementation of the Affordable Care Act (“ACA”).

Up until last year, insurance companies could - and often did - charge women different premiums than men for the same coverage. As of January 1, 2014, the ACA prohibits this gender discrimination.   In part because of improved options and affordability, today’s report outlines a significant 5.5 percentage point decline in the uninsured rate among women between the ages of 18 and 64 since 2013.  And as more and more women take advantage of the Open Enrollment period that ends February 15, 2015, and sign up for affordable private health insurance, that number will continue to drop.

These statistics are reflected in the individual stories and experiences of our neighbors, friends, colleagues, and loved ones.  I recently spoke with Ann C., a mother of three from Connecticut, who described to me her new appreciation for the importance of preventative care.  Last year, Ann was relieved to find a health insurance plan that she could afford by enrolling through the Marketplace.  She quickly put her new coverage to good use, and scheduled a mammogram.  The test revealed an irregularity which lead to an immediate biopsy and minor surgery.   She was diagnosed with cancer, but fortunately she had the coverage she needed in order to catch it early on and she had a method to pay for treatment.  Imagine learning such news without the ability to receive or pay for treatments. Because she caught it early, Ann is now facing a brighter, cancer-free future.

And Ann is far from alone.  One in eight women are diagnosed with breast cancer during their lifetime, and that is just one of many illnesses which both disproportionately affect women, and which can often be treated more effectively if caught early.  The ACA has increased coverage for millions of women and helped millions more remain healthy with improved access to preventive services such as mammograms, Pap smears, contraception, domestic violence screening, and other vital health services for no out-of-pocket cost.  As revealed in today’s HHS report, over 48 million women have benefitted from this expanded access to preventive care.  And because these services are available without a co-pay, women no longer need to choose between the health care they need and their other essential expenses.

Today’s report also found that the ACA has been instrumental in providing maternity benefits. 8.7 million women who purchased coverage on the individual market  have gained these crucial benefits.  The ACA also requires plans to cover maternity-related preventive services, which help increase the likelihood of a healthy and safe delivery.  With even an uncomplicated delivery costing tens of thousands of dollars, these new protections are helping curb the large expenses many women and families incur for hospital stays during pregnancy.
Today marks the last day of the Women’s Week of Action, celebrating the ACA’s accomplishments, and gearing up for the work we still have left ahead of us.  The Affordable Care Act has given millions of women peace of mind for themselves and their families. And although many women have gained coverage since last year’s Open Enrollment, there are still millions of women who have yet to sign up and gain access to these crucial services.

Sunday, September 28, 2014

HHS SAYS REPORT PROJECTS $5.7 BILLION DECREASE IN HOSPITAL UNCOMPENSATED CARE COSTS

HHS SAYS REPORT PROJECTS $5.7 BILLION DECREASE IN HOSPITAL UNCOMPENSATED CARE COSTS
FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES HHS,
FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
September 24, 2014
Contact: HHS Press Office
New report projects a $5.7 billion drop in hospitals’ uncompensated care costs because of the Affordable Care Act

Hospitals in states that have expanded Medicaid will receive about 74 percent of the total savings nationally

A report released today by the Department of Health and Human Services projects that hospitals will save $5.7 billion this year in uncompensated care costs because of the Affordable Care Act, with states that have expanded Medicaid seeing about 74 percent of the total savings nationally compared to states that have not expanded Medicaid.

For over a decade prior to the Affordable Care Act, the percentage of the American population that was uninsured had been growing steadily.  But with the significant expansion of coverage under the health care law through the Health Insurance Marketplace and Medicaid, the uninsurance rate is at historic lows.  As a result, the volume of uncompensated care provided in hospitals and emergency departments has fallen substantially in the last year, particularly in Medicaid expansion states.

“Hospitals have long been on the front lines of caring for the uninsured, who often cannot pay the full costs of their care,” said HHS Secretary M. Sylvia Burwell. “Today’s news is good for families, businesses, and taxpayers alike.  It’s yet another example of how the Affordable Care Act is working in terms of affordability, access, and quality.”

Projections from today’s report suggest that hospitals in states that have expanded Medicaid under the Affordable Care Act will see greater savings than hospitals in states that have not expanded Medicaid. Hospitals in states that have expanded Medicaid are projected to save up to $4.2 billion, which makes up about 74 percent of the total savings nationally this year.  Hospitals in states that have opted not to expand Medicaid are projected to save up to $1.5 billion this year, and which is only 26 percent of the total savings nationally.

Medicaid expansion continues to help an unprecedented number of Americans access health coverage, many for the very first time.  According to a recent report, as of July, nearly 8 million additional individuals are now enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), compared to before open enrollment in the Marketplace began in October 2013.

Because of the Affordable Care Act, states have new opportunities to expand Medicaid coverage to individuals with family incomes at or below 133 percent of the federal poverty level (generally $31,322 for a family of four in 2013). This expansion includes non-elderly adults without dependent children, who have not previously been eligible for Medicaid in most states. Twenty-eight states, including the District of Columbia have expanded Medicaid under the Affordable Care Act.

Thursday, September 25, 2014

HHS ANNOUNCES 77 NEW HEALTH INSURERS WILL ENTER MARKETPLACE IN 2015

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
New Report: Health Insurance Marketplace will have 25 percent more issuers in 2015
77 new health insurance issuers means greater choice and competition for consumers

A report released by the Department of Health and Human Services shows that consumers will have more choices as they shop for quality, affordable coverage on the Health Insurance Marketplace in 2015, because there will be a net 25 percent increase in the number of issuers offering Marketplace coverage in 2015.  In total, 77 new issuers will offer Marketplace coverage.

“When consumers have more choices, we all benefit,” said Secretary Sylvia M. Burwell.  “In terms of affordability, access, and quality, today’s news is very encouraging.  It’s a real sign that the Affordable Care Act is working.”

Today’s report examines preliminary data from 36 states run or fully supported by the federal government (Federal Marketplace) plus eight states operating State-based Marketplaces, and finds that a larger set of insurance issuers will offer plans in the Marketplaces in 2015.  Specifically:

In the 44 states for which we have data, 77 issuers will be newly offering coverage in 2015.

The Federal Marketplace states alone will have 57 more issuers in 2015; a 30 percent net increase over this year.

The eight State-based Marketplaces where data is already available will have a total of six more issuers in 2015, a ten percent net increase over this year.
Four of the 36 states in the Federal Marketplace will have at least double the number of issuers they had in 2014.

In total, 36 states of the 44 will have at least one new issuer next year.   And some of the nation’s largest insurance companies will be offering coverage in more than a dozen new states, joining the hundreds of insurance companies already participating in the Marketplace.
The report’s findings are preliminary.

Today’s report demonstrates that the Marketplace is working to increase competition and lower costs for consumers.  Previous estimates have found a correlation between greater competition and lower costs.  Specifically, an increase of one issuer in a rating area is associated with a 4 percent decline in the second-lowest cost silver plan premium, on average.  In 2014, consumers in regions with larger numbers of issuers were able to access a wider range of choices.

Tuesday, September 23, 2014

$99 MILLION IN GRANTS ANNOUNCED TO IMPROVE MENTAL HEALTH SERVICES FOR YOUNG PEOPLE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVIES 
September 22, 2014
Contact: SAMHSA Press Office
240-276-2130
HHS announces $99 million in new grants to improve mental health services for young people

Health and Human Services Secretary Sylvia M. Burwell announced today $99 million to train new mental health providers, help teachers and others recognize mental health issues in youth and connect them to help, and increase access to mental health services for young people. These funds were included in the President and Vice President’s Now Is the Time plan to reduce gun violence by keeping guns out of dangerous hands, increasing access to mental health services, and making schools safer.

“The Administration is committed to increasing access to mental health services to protect the health of children and communities,” said Secretary Burwell. “Today, I am pleased to announce another step the Department is taking to help ensure that our young people have access to the mental health services they need to reach their full potential.”

The Obama Administration has taken a number of steps to reduce the barriers that too often prevent people from getting the help they need for mental health and other behavioral health problems. The historic expansion of insurance coverage for mental health and substance abuse services made possible by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act will help make mental health services more affordable and accessible for tens of millions of Americans.

Today, the Department of Health and Human Services is announcing the following awards:

More than $34 million to train just over 4000 new mental health providers, including:

$30.3 million to expand the mental health workforce through 100 new grants to training programs to train new mental health and substance abuse health professionals who treat children, adolescents, and young adults with, or at risk for, a mental health or substance use disorder.

$2.7 million for 5 new grants to support youth Minority Fellowship Programs to increase access to mental health services for youth and young adults in America.
$1.6 million for 2 new grants to support addiction counselor Minority Fellowship Programs to increase access to substance abuse treatment services for youth in America.

More than $48 million to support teachers, schools and communities in recognizing and responding to mental health issues among youth, creating safe and secure schools and promoting the mental health of students in communities across the country through 120 new Project AWARE (Advancing Wellness and Resilience in Education) grants to state and local educational agencies.

$16.7 million to support 17 new Healthy Transitions grants, to improve access to treatment and support services for youth and young adults ages 16 to 25 that either have, or are at high risk of developing, a serious mental health condition.
To see the lists of award winners, visit

www.hrsa.gov/about/news/2014tables/behavioralworkforce/

http://beta.samhsa.gov/sites/default/files/fy14-grant-awards-nitt.pdf

Friday, September 12, 2014

MILLIONS OF U.S. CHILDREN NOT RECEIVING PREVENTIVE CARE SERVICES

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
Millions of children not getting recommended preventive care

Millions of infants, children and adolescents in the United States did not receive key clinical preventive services, according to a report published by the Centers for Disease Control and Prevention (CDC) in today’s Morbidity and Mortality Weekly Report (MMWR) Supplement.

Clinical preventive services are various forms of important medical or dental care that support healthy development. They are delivered by doctors, dentists, nurses and allied health providers in clinical settings. These services prevent and detect conditions and diseases in their earlier, more treatable stages, significantly reducing the risk of illness, disability, early death, and expensive medical care.
The CDC report focuses on 11 clinical preventive services: prenatal breastfeeding counseling, newborn hearing  screening and follow-up, developmental screening, lead screening, vision screening, hypertension screening, use of dental care and preventive dental services, human papillomavirus vaccination, tobacco use screening and cessation assistance, chlamydia screening and reproductive health services.

The findings offer a baseline assessment of the use of selected services prior to 2012, before or shortly after implementation of the Affordable Care Act. Sample findings include:

In 2007, parents of almost eight in 10 (79 percent) children aged 10-47 months reported that they were not asked by healthcare providers to complete a formal screen for developmental delays in the past year.

In 2009, more than half (56 percent) of children and adolescents did not visit the dentist in the past year and nearly nine of 10 (86 percent) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.
Nearly half (47 percent) of females aged 13-17 years had not received their recommended first dose of HPV vaccine in 2011.

Approximately one in three (31 percent) outpatient clinic visits made by 11-21 year-olds during 2004–2010 had no documentation of tobacco use status; eight of 10 (80 percent) of those who screened positive for tobacco use did not receive any cessation assistance.

Approximately one in four (24 percent) outpatient clinic visits for preventive care made by 3-17 year olds during 2009-2010 had no documentation of blood pressure measurement.

“We must protect the health of all children and ensure that they receive recommended screenings and services. Together, parents and the public health and healthcare communities can work to ensure that children have health insurance and receive vital preventive services,” said Stuart K. Shapira, M.D., Ph.D., chief medical officer and associate director for science in CDC’s National Center on Birth Defects and Developmental Disabilities. Increased use of clinical preventive services could improve the health of infants, children and teens and promote healthy lifestyles that will enable them to achieve their full potential.”
The report reveals large disparities in the receipt of clinical preventive services. For example, uninsured children are not as likely as insured children to receive these services and Hispanic children were less likely than non-Hispanic children to have reported vision screening.

The Affordable Care Act expands insurance coverage, access and consumer protections for the U.S. population and places a greater emphasis on prevention. Through implementation of the Affordable Care Act, new opportunities exist to promote and increase use of these valuable and vital services. This report is the second of a series of periodic reports from CDC to monitor and report on progress made in increasing the use of clinical preventive services to improve population health.

“The Affordable Care Act requires new health insurance plans to provide certain clinical preventive services at no additional cost – with no copays or deductibles," said Lorraine Yeung, M.D., M.P.H., medical epidemiologist with CDC’s National Center on Birth Defects and Developmental Disabilities. “Parents need to know that many clinical preventive services for their children, such as screening and vaccination, are available for free with many health plans.”
CDC has a long history of monitoring the use of clinical preventive services to provide public health agencies, health care providers, healthcare organizations and their partners with information needed to plan and implement programs that increase use of these services and improve the health of the U.S. population. CDC documents the potential benefits of selected clinical preventive services for infants, children and adolescents; the challenges related to their underuse; and effective collaborative strategies to improve use.

CDC is the nation's health protection agency, working 24/7 to protect America from health and safety threats, both foreign and domestic. CDC increases the health security of our nation.

Monday, August 18, 2014

SPAMMER SETTLES FTC CHARGES REGARDING FALSE INFORMATION ABOUT ACA

FROM:  FEDERAL TRADE COMMISSION 
Email Spammer Settles FTC Charges: Tricked Consumers With False Information About the Affordable Care Act

An email spammer and his company will pay $350,000 to resolve Federal Trade Commission charges that they sent deceptive emails in advance of the Affordable Care Act (ACA) roll-out, falsely claiming that consumers would be violating the law if they did not immediately click a link to enroll in health insurance.

In January 2014, the FTC filed a complaint against Yair Shalev and Kobeni Inc.,  alleging that their misrepresentations violated Section 5 of the FTC Act. It also alleged that their spam emails violated the CAN-SPAM Act by failing to provide consumers the opportunity to decline to receive future emails, and to provide a valid physical postal address. According to the complaint, the defendants’ emails led to websites with advertisements for insurance. The websites’ operators paid the defendants when consumers clicked links in the ads. Insurance companies whose ads appeared on the websites did not authorize the email messages.

The settlement order imposes a $350,000 judgment and permanently prohibits the defendants from misrepresenting material facts about any product or service, including that consumers will violate federal law if they do not select health insurance by a certain date, or that the law requires consumers to buy something. The order also bars the defendants from violating the CAN-SPAM Act, including by engaging in the violations that occurred in this action.

The Commission vote authorizing the staff to file the proposed stipulated order was 5-0.  The U.S. District Court for the Southern District of Florida entered the order on August 7, 2014.

The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them.

Friday, July 25, 2014

HHS TOUTS 10.3 MILLION NEWLY COVERED WITH HEALTH CARE

FROM:  DEPARTMENT OF HEALTH AND HUMAN SERVICES 
New Study: 10.3 million gained health coverage during the Marketplace’s first annual open enrollment period

Health and Human Services Secretary Sylvia M. Burwell announced today the release of a new study, published in the New England Journal of Medicine, estimating that 10.3 million uninsured adults gained health care coverage following the first open enrollment period in the Health Insurance Marketplace. The report examines trends in insurance before and after the open enrollment period and finds greater gains among those states that expanded their Medicaid programs under the Affordable Care Act.

“We are committed to providing every American with access to quality, affordable health services and this study reaffirms that the Affordable Care Act has set us on a path toward achieving that goal,” said Secretary Burwell. “This study also reaffirms that expanding Medicaid under the Affordable Care Act is important for coverage, as well as a good deal for states. To date, 26 states plus D.C. have moved forward with Medicaid expansion. We’re hopeful remaining states will come on board and we look forward to working closely with them.”

According to the authors’ findings, the uninsured rate for adults ages 18 to 64 fell from 21 percent in September 2013 to 16.3 percent in April 2014. After taking into account economic factors and pre-existing trends, this corresponded to a 5.2 percentage-point change, or 10.3 million adults gaining coverage. The decline in the uninsured was significant for all age, race/ethnicity, and gender groups, with the largest changes occurring among Latinos, blacks, and adults ages 18-34 – groups the Administration targeted for outreach during open enrollment.

Coverage gains were concentrated among low-income adults in states expanding Medicaid and among individuals in the income range eligible for Marketplace subsidies. The study finds a 5.1 percentage point reduction in the uninsured rate associated with Medicaid expansion, while in states that have not expanded their Medicaid programs, the change in the uninsured rate among low-income adult populations was not statistically significant.

Today’s study also looks at access to care, and finds that within the first six months of gaining coverage, more adults (approximately 4.4 million) reported having a personal doctor and fewer (approximately 5.3 million) experienced difficulties paying for medical care.

Today’s study does not include data from before 2012, as coverage was changing rapidly during this period. This means the results do not include the more than 3 million young adults who gained health insurance coverage through their parents’ plans.

The analysis builds on previous studies by reviewing a larger sample size and taking into account changes in the economy and pre-existing trends in insurance coverage. Using survey data from the Gallup-Healthways Well-Being Index for January 1, 2012, through June 30, 2014, the authors analyzed changes in the uninsured rate over time. This is also the first study to associate reductions in the uninsured rate with state-level statistics on enrollment in the Marketplaces and Medicaid under the Affordable Care Act, as described in HHS enrollment reports, and to assess the impact of the improved coverage on access to care.

HHS TOUTS $ 9 BILLION PREMIUM SAVINGS RESULTING FROM AFFORDABLE CARE ACT

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Consumers have saved a total of $9 billion on premiums
Health care law will return to families an average refund of $80 each this year

Health and Human Services Secretary Sylvia M. Burwell announced today that consumers have saved a total of $9 billion on their health insurance premiums since 2011 as a result of the Affordable Care Act.

Created through the law, the 80/20 rule, also known as the Medical Loss Ratio (MLR) rule, requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities.  If insurers spend an excessive amount on profits and red tape, they owe a refund back to consumers.

“We are pleased that the Affordable Care Act continues to provide Americans better value for their premium dollars,” said Secretary Burwell.  “We are continuing our work on building a sustainable long-term system, and provisions such as the 80/20 rule are providing Americans with immediate savings and helping to bring transparency and accountability to the insurance market over the long term.”

An HHS report released today shows that last year alone, consumers nationwide saved $3.8 billion up front on their premiums as insurance companies operated more efficiently.  Additionally, consumers nationwide will save $330 million in refunds, with 6.8 million consumers due to receive an average refund benefit of $80 per family.  This standard and other Affordable Care Act standards contributed to consumers saving approximately $4.1 billion on premiums in 2013, for a total of $9 billion in savings since the MLR program’s inception.

The report shows that since the rule took effect, more insurers year over year are meeting the 80/20 standard by spending more of the premium dollars they collect on patient care and quality, and not red tape and bonuses.

If an insurer did not spend enough premium dollars on patient care and quality improvement, they must pay refunds to consumers in one of the following ways:

a refund check in the mail;
a lump-sum reimbursement to the same account that was used to pay the premium;
a reduction in their future premiums; or
if the consumer bought insurance through their employer, their employer must provide one of the above options, or apply the refund in another manner that benefits its employees, such as more generous benefits.

The 80/20 rule, along with other standards such as the required review of proposed premium increases, is one of many reforms created under the health law helping to slow premium growth and moderate premium rates.  Combined with the savings consumers are receiving from tax credits on the Marketplace and the new market reforms, including the prohibition of pre-existing condition exclusions and charging women more for insurance than men, the 80/20 rule helps ensure every American has access to quality, affordable health insurance.

Wednesday, July 2, 2014

WHITE HOUSE REPORT ON CONSEQUENCES OF STATES NOT EXPANDING MEDICAID

FROM:   THE WHITE HOUSE 

White House Report: Missed Opportunities and the Consequences of State Decisions Not to Expand Medicaid

 Today, the Council of Economic Advisers released a report, Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid, which details the effects of state decisions regarding Medicaid expansion on access to care, financial security, overall health and well-being of residents, and state economies. 
The Affordable Care Act has expanded high‐quality, affordable health insurance coverage to millions of Americans. One important way in which the Affordable Care Act is expanding coverage is by providing generous financial support to States that opt to expand Medicaid eligibility to all non‐elderly individuals in families with incomes below 133 percent of the Federal Poverty Level.
To date, 26 States and the District of Columbia have seized this opportunity, and since the beginning of the Affordable Care Act’s first open enrollment period, 5.2 million people have gained Medicaid or Children’s Health Insurance Program (CHIP) coverage in these States, a tally that will grow in the months and years ahead as Medicaid enrollment continues. In contrast, 24 States have not yet expanded Medicaid—including many of the States that would benefit most and sometimes because State legislatures have defied even their own governors—and denied health insurance coverage to millions of their citizens. Researchers at the Urban Institute estimate that, if these States do not change course, 5.7 million people will be deprived of health insurance coverage in 2016. Meanwhile, these States will forgo billions in Federal dollars that could boost their economies.
This analysis uses the best evidence from the economics and health policy literatures to quantify several important consequences of States’ decisions not to expand Medicaid. That evidence, which is based primarily on careful analysis of the effects of past policy decisions, is necessarily an imperfect guide to the future, and the actual effects of Medicaid expansion under the Affordable Care Act could be larger or smaller than the estimates presented below. However, this evidence is clear that the consequences of States’ decisions are far‐reaching, with implications for the health and well‐being of their citizens, their economies, and the economy of the Nation as a whole.

Monday, June 30, 2014

HHS TOUTS ACA FOR EXPANDED COVERAGE IN PRIVATE HEALTH INSURANCE PLANS

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Affordable Care Act helps 76 million Americans with private coverage access free preventive services
Women save nearly $500 million on oral contraception out-of-pocket costs

Health and Human Services (HHS) Secretary Sylvia Burwell announced today that about 76 million Americans in private health insurance plans are newly eligible to receive expanded coverage for one or more recommended preventive health care services, such as a mammogram or flu shot, with cost sharing, because of the Affordable Care Act. The new data were released in a report from HHS today.

Under the Affordable Care Act most health plans must cover a set of recommended preventive services like screening tests and immunizations at no out-of-pocket cost to consumers. This includes Marketplace private insurance plans.

“Today’s findings are just one more indicator that the Affordable Care Act is delivering impact for millions of people nationwide,” said Secretary Burwell. “Seventy-six million is more than just a number.  For millions of Americans, it means no longer having to put off a mammogram for an extra year. Or it means catching a problem early enough that it’s treatable.”

Today’s data are broken down across states, age, race and ethnic group.  For example, the report finds that approximately 30 million more women are now eligible to receive coverage for the recommended preventive services with no out-of-pocket costs.  Altogether, a total of 48.5 million women are estimated to benefit from free preventive services.  Covered preventive services for women include well-woman visits, screening for gestational diabetes, domestic violence screening and counseling, and FDA-approved prescription contraception with no cost-sharing.

Recent evidence from the IMS Institute for Healthcare Informatics (IMS) shows that an additional 24.4 million prescriptions for oral contraceptives were dispensed with no co-pays in 2013 compared to 2012, translating to an estimated $483.3 million reduction in out-of-pocket spending by women.

Of the 76 million Americans with expanded access to free preventive services:

18.6 million are children receiving expanded preventive services coverage for immunization vaccines for children from birth to age 18; vision screening; hearing screening for newborns; behavioral assessments; obesity screening; and height, weight, and body mass index measurements.

29.7 million are women receiving expanded preventive services coverage for cervical cancer screening, mammograms for women over 40, recommended immunizations, healthy diet counseling for women at higher risk for chronic disease and obesity screening and counseling; cholesterol and blood pressure screening; screening for HIV; depression screening; and tobacco-use screening; well-woman visits, screening for gestational diabetes, domestic violence screening and counseling, and FDA-approved contraception with no cost sharing.
28.1 million are men receiving expanded preventive services coverage for recommended immunizations such as flu shots, colorectal cancer screening for adults over 50, healthy diet counseling for those at higher risk for chronic disease, obesity screening and counseling, cholesterol and blood pressure screening, screening for HIV, depression screening, and tobacco-use screening.

Saturday, April 12, 2014

PRESIDENT OBAMA'S WEEKLY ADDRESS FOR APRIL 12, 2014

FROM:  THE WHITE HOUSE 

Weekly Address: Ensuring Equal Pay for Equal Work

WASHINGTON, DC – In this week’s address, the President underscored the importance of ensuring equal pay for equal work and highlighted the steps his Administration has taken to expand opportunity and narrow the pay gap that exists between men and women. Just this week – on Equal Pay Day – the President took action to increase transparency and make it easier to recognize pay discrimination. Women make up half of America’s workforce, and are increasingly the primary-breadwinners in American families. Ensuring that women are paid fairly is a commonsense step to grow our economy.  That is why the President again called on Republicans in Congress to support the Paycheck Fairness Act and stop blocking progress that would benefit women – because when women succeed, America succeeds.

Remarks of President Barack Obama
Weekly Address
The White House
April 12, 2014

Hi, everybody.  Earlier this week was Equal Pay Day.  It marks the extra time the average woman has to work into a new year to earn what a man earned the year before.  You see, the average woman who works full-time in America earns less than a man – even when she’s in the same profession and has the same education. 
That's wrong.  In 2014, it’s an embarrassment. Women deserve equal pay for equal work.
This is an economic issue that affects all of us.  Women make up about half our workforce.  And more and more, they’re our families’ main breadwinners.  So it’s good for everyone when women are paid fairly.  That’s why, this week, I took action to prohibit more businesses from punishing workers who discuss their salaries – because more pay transparency makes it easier to spot pay discrimination.  And I hope more business leaders will take up this cause.
But equal pay is just one part of an economic agenda for women.
Most lower-wage workers in America are women.  So I’ve taken executive action to require federal contractors to pay their federally-funded employees at least ten dollars and ten cents an hour.  I ordered a review of our nation’s overtime rules, to give more workers the chance to earn the overtime pay they deserve.  Thanks to the Affordable Care Act, tens of millions of women are now guaranteed free preventive care like mammograms and contraceptive care, and the days when you could be charged more just for being a woman are over for good.  Across the country, we’re bringing Americans together to help us make sure that a woman can have a baby without sacrificing her job, or take a day off to care for a sick child or parent without hitting hardship.  It’s time to do away with workplace policies that belong in a “Mad Men” episode, and give every woman the opportunity she deserves.
Here’s the problem, though.  On issues that would benefit millions of women, Republicans in Congress have blocked progress at every turn. Just this week, Senate Republicans blocked the Paycheck Fairness Act, commonsense legislation that would help more women win equal pay for equal work.  House Republicans won’t vote to raise the minimum wage or extend unemployment insurance for women out of work through no fault of their own.  The budget they passed this week would force deep cuts to investments that overwhelmingly benefit women and children – like Medicaid, food stamps, and college grants.  And of course, they’re trying to repeal the Affordable Care Act for the fiftieth or so time, which would take away vital benefits and protections from millions of women.
I’m going to keep fighting to make sure that doesn’t happen.  Because we do better when our economy grows for everybody, not just a few.  And when women succeed, America succeeds.  Thanks, and have a great weekend.

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