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.

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.”

WHITE HOUSE VIDEO: THE AFFORDABLE CARE ACT: 5 YEARS LATER

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.

HHS TOUTS ACA SAVINGS OF $372 MILLION AND IMPROVED CARE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

September 16, 2014

New Affordable Care Act tools and payment models deliver $372 million in savings, improve care

Pioneer ACO Model and Medicare Shared Savings Program ACOs part of plan to improve care and lower health costs across the health system

The Centers for Medicare & Medicaid Services (CMS) today issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have improved patient care and produced hundreds of millions of dollars in savings for the program.

In addition to providing more Americans with access to quality, affordable health care, the Affordable Care Act encourages doctors, hospitals and other health care providers to work together to better coordinate care and keep people healthy rather than treat them when they are sick, which also helps to reduce health care costs. ACOs are one example of the innovative ways to improve care and reduce costs.  In an ACO, providers who join these groups become eligible to share savings with Medicare when they deliver that care more efficiently.

ACOs in the Pioneer ACO Model and Medicare Shared Savings Program (Shared Savings Program) generated over $372 million in total program savings for Medicare ACOs.  The encouraging news comes from preliminary quality and financial results from the second year of performance for 23 Pioneer ACOs, and final results from the first year of performance for 220 Shared Savings Program ACOs.

Meanwhile, the ACOs outperformed published benchmarks for quality and patient experience last year and improved significantly on almost all measures of quality and patient experience this year. (Please see the accompanying fact sheet for additional details.)

“We all have a stake in improving the quality of care we receive, while spending our dollars more wisely,” Health and Human Services Secretary Sylvia M. Burwell said.  “It’s good for businesses, for our middle class, and for our country's global competitiveness.  That’s why at HHS we are committed to partnering across sectors to make progress."

This news comes as historically slow growth in health care costs is continuing.  Health care prices are rising at their lowest rates in nearly 50 years, Medicare spending per beneficiary is currently falling outright, and, according to a major annual survey released last week, employer premiums for family coverage grew just 3.0 percent in 2014, tied with 2010 for the lowest on record back to 1999.

Since passage of the Affordable Care Act, more than 360 Medicare ACOs have been established in 47 states, serving over 5.6 million Americans with Medicare.  Medicare ACOs are groups of providers and suppliers of services that work together to coordinate care for the Medicare fee-for-service (FFS) beneficiaries they serve and achieve program goals.

ACOs represent one part of a comprehensive series of initiatives and programs in the Affordable Care Act that are designed to lower costs and improve care by advancing three key strategies for improving care while investing dollars more wisely: incentives, tools, and information.

Incentives
We are interested in advancing efforts to strengthen incentives to reward higher value care rather than higher volume of care.  The Center for Medicare and Medicaid Innovation, created by the Affordable Care Act, is testing new models of care in two of the biggest health insurance plans in the world – Medicare and Medicaid.  One example is ACOs, where groups of health care providers receive a financial incentive for coordinating care delivery.  As we announced today, they are already seeing success.  By working with state and private partners, we can drive more improvement through supporting payment models that reward higher quality care.

Tools
We recognize that giving providers and states the tools and capacity for change in the health care delivery system is crucial to the success of these efforts.  The HHS Office of the National Coordinator for Health Information Technology and CMS are managing $27 billion in funding from the American Recovery and Reinvestment Act of 2009 and other sources to promote the adoption of electronic health records (EHR) in hospitals and doctor’s offices.  More than 75 percent of eligible health care professionals, and over 90 percent of eligible hospitals, have already qualified for EHR incentive payments for using certified EHR technology to meet the objectives and measures of the program.

And HHS is providing technical assistance and grants in areas such as practice design and transformation, supporting states in leveraging state-wide alignment towards value in health spending, and recruiting and training a world-class health care workforce.

Information
The more we empower doctors and patients with information, the better choices they are able to make about their care.  HHS has set out to improve the flow of information for consumers, providers, and payers by, for example, releasing more Medicare data, and supporting the ability of health information technology systems to talk to each other for patients’ benefit.

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.

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.

PRESIDENT OBAMA'S REMARKS AT HOUSE DEMOCRATIC ISSUES CONFERENCE

FROM:  THE WHITE HOUSE 

Remarks by the President at House Democratic Issues Conference

Hyatt Regency Chesapeake Bay
Cambridge, Maryland

10:43 A.M. EST

THE PRESIDENT:  Thank you.  Thank you, guys.  (Applause.)  Thank you.  Everybody, have a seat.  Thank you so much.  (Applause.)  Well, it is good to see you.  Joe, thank you for the wonderful introduction.  Let me be the first to say, Happy Valentine’s Day to our fearless leader, Nancy Pelosi.  (Applause.)  Paul will hopefully get you more than just a thank-you.

To Steny, to Jim, Xavier, Steve Israel -- who’s doing an extraordinary job under very difficult circumstances -- (applause) -- Debbie Wasserman Shultz, who is putting in more miles than just about anybody I know -- (applause) -- and all of you.  It’s great to see you. 

We just saw each other at the White House fairly recently, so I'm not going to give a long speech here.  I want to spend most of my time answering some more questions.  But let me just make a couple observations since we saw each other.  First of all, I stated in our State of the Union that the single most important thing we have to do -- not just as a party, but as a country -- is make sure that there’s opportunity for every single person; that we are focused every single day in this town -- or in Washington -- on making sure that if you're willing to work hard, if you're willing to take responsibility, that you can get ahead.  It doesn’t matter where you live, what circumstances you were born into, what you look like, who you love, you should be able to make it here in America.

And as I said at the State of the Union, I want to work with Congress to make that happen, but I'm not going to wait, because there’s too much to do.  (Applause.)  And America does not believe in standing still.  America insists on moving forward.

We laid out some very specific ways that we can move the country forward, breaking them down into a few categories:  Number one, creating more good jobs that pay good wages.  Number two, making sure that folks are trained to fill those good jobs. Number three, making sure that our kids have the best education  in the world.  And number four, making sure that hard work pays off, that people aren’t poor if they’re working full-time, that they have some semblance of retirement security, that they can count on health care if, heaven forbid, something happens to them.

And already, just in the last couple of weeks, we’ve put forward a range of executive actions that are going to make a difference.  So, yesterday, for example, I had a chance to be with a group of minimum wage workers for federal contractors -- these are folks who are washing dishes, or cleaning clothes on military bases or facilities -- and sometimes the debates on Capitol Hill get so abstract, and to be next to folks -- the average age, by the way, 35.  These aren’t teenagers, these are folks who are looking after families and trying to raise kids.  And to see what it would mean to them for us to have a federal minimum wage of $10.10 an hour, and how much relief that would give them, and how committed they were to the American Dream and getting ahead and just hoping that somebody was standing up for them -- it reminded me of why I'm a Democrat.  (Applause.)  and it reminded me of why I'm so proud of this caucus, because you're standing up on behalf of them.

And so we signed the executive order -- these folks are going to get a raise.  And what I said yesterday is that now it's time for Congress to act because America deserves a raise.  (Applause.)

I pointed out yesterday, as I pointed out at the State of the Union, that the majority of low-wage workers are women, which is why we're going to keep on pushing to make sure that we have equal pay for equal work -- (applause) -- and we have sensible family policies.  Because as I said at the State of the Union, when women succeed America succeeds.  I still believe that.  (Applause.)

We've traveled to manufacturing plants up in Wisconsin to talk about how we can continue to accelerate advanced manufacturing and technology in this country.  And we've got some great possibilities to create hubs that keep us on the cutting-edge.  We've signed executive orders to advance the kind of job training that is going to help people train for the jobs that actually exist and link up businesses with our community colleges. 

We've already through executive action set up a new retirement account, MyRA, that allows folks to get a starter retirement, because a whole lot of people don’t have 401(k)s to save. 

Across the board, we’re moving.  But as I said at the State of the Union, and I want to repeat today, we can get a whole lot more done if we’ve got Congress working with us.  And this caucus has shown time and time again under the most difficult circumstances the kind of courage and unity and discipline that has made me very, very proud.

And I was just talking to Nancy before I came out here.  The fact that we are no longer going to see, I believe, anybody try to hold our government hostage and threaten the full faith and credit of the United States of America in order to contract policy concessions, the fact that we were able to pass a clean debt limit is just one example of why when you guys are unified, you guys stick together, this country is better off.  And I could not be more thankful and more appreciative and prouder of what you’re doing.  (Applause.)

Just a couple of more points.  Number one, you’ve seen reports over the last couple of days that we actually slightly exceeded our targets for ACA signups and enrollments this past month, in the month of January.  (Applause.)  We now have well over 3.5 million people who have signed up and are getting insurance through the marketplaces for the first time.  That does not count the close to 7 million folks who have signed up for Medicaid because of the law that you passed, or the 3 million young people who are staying on their parents’ plans.  We’re starting to see data already that the uninsured rate is coming down.  We are going to keep on pushing on this to make sure that here in America, everybody can enjoy the kind of financial security and peace of mind that good quality health insurance provides.  (Applause.)

And I just want to say thank you for all of you hanging in there tough on an issue that I think 10 years from now, five years from now, we’re going to look back and say this was a monumental achievement that could not have happened had it not been for this caucus.
 
And, finally, there are some big things that we have to do that I cannot do through executive action where we have to get Congress and where the American people are on our side.  A federal minimum wage law is one of them.  Another, though, is making sure that we’ve got a smart immigration policy in this country that grows our economy -- (applause) -- gets people out of the shadows, makes sure that our businesses are thriving.  That’s got to be a top priority.  We’re going to have to keep on working on that.
 
And I believe, frankly, that there are folks on the other side of the aisle who genuinely want to see this done, but they’re worried and they’re scared about the political blowback. And, look, everybody here is an elected official and we can all appreciate the maneuverings that take place, particularly in an election year.  But when it comes to immigration reform, we have to remind ourselves that there are people behind the statistics, that there are lives that are being impacted -- that punting and putting things off for another year, another two years, another three years, it hurts people.  It hurts our economy.  It hurts families.
 
And part of what I’d like to think makes us Democrats is not simply some abstract ideological set of beliefs, but the fact that we’re reminded every single day that we’re here to help a whole bunch of folks out there -- our neighbors, our friends, our communities -- who are struggling still and need our help.  And they’re counting on us.  The good thing is they’ve got some outstanding members of Congress who are willing to fight for them regardless of the political cost, starting with your leader Nancy Pelosi. 

I’m grateful for you.  And I’m looking forward to making sure that this year we keep on making progress even if we continue to get a little resistance from the other side.  The American people know that we could be breaking out if Washington gets its act together, and it’s important for us to lead that process. 

Thank you very much.  (Applause.)