Insurance Commons^™

Doj Withdraws Healthcare Antitrust Protections, Lance Plunkett Jd, Llm

The New York State Dental Journal

DOJ has withdrawn longstanding antitrust guidance that provided safe harbors for specific conduct in the healthcare marketplace.

Patterns Of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 And Older, 2010-2017, Yvonne Jonk Phd, Heidi O'Connor Ms, Amanda Burgess Mppm, Carly Milkowski Mph

Access / Insurance

The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their:

1. socioeconomic and health characteristics that may inform health care use;
2. trends in health care use, including use of inpatient and emergency department (ED) care; …

Dentistry And The Law: Can Dental Plan Ratings Be Defamatory?, Dan Schulte Jd

The Journal of the Michigan Dental Association

This article discusses the legal implications of dental plan ratings for dentists. If a dental plan assigns a rating to dentists and publishes it to patients without providing specific information about the rating's basis or an opportunity for dentists to contest it, legal recourse may be limited. Currently, no statutory law regulates such ratings, leaving dentists potentially vulnerable to defamatory ratings. Under Michigan law, dentists could sue for defamation, but proving the rating's falseness and the resulting loss of patients may be challenging. Federal regulation is suggested to ensure fairness, transparency, and protection for dentists subjected to involuntary ratings.

Advocacy Spotlight: Ada Lobbyist Conference Highlights Critical Advocacy Issues, Neema Katibai Jd

The Journal of the Michigan Dental Association

The ADA Lobbyist Conference highlighted crucial issues in dentistry, including Medicare reform, teledentistry, workforce concerns, and insurance challenges. State dental associations collaborated on building advocacy partnerships and shared successful grassroots engagement strategies. Medicare reform discussions focused on the ADA's opposition to Plan B inclusion and the impact of constituent outreach. State associations addressed Medicaid reform, emphasizing personal stories to convey the need for change. Teledentistry legislation and insurance company relationships were also key topics. The insights gained will shape the MDA's advocacy strategy for 2022.

Three Essays On Health Economics And Policy Evaluation, Shishir Shakya

Graduate Theses, Dissertations, and Problem Reports

This dissertation consists of three essays on the U.S. Health care policy. Each paragraph below refers to the three abstracts for the three chapters in this dissertation, respectively. I provide quantitative evidence on how much Prescription Drug Monitoring Programs (PDMPs) affects the retail opioid prescribing behaviors. Using the American Community Survey (ACS), I retrieve county-level high dimensional panel data set from 2010 to 2017. I employ three separate identification strategies: difference-in-difference, double selection post-LASSO, and spatial difference-in-difference. I compare how the retail opioid prescribing behaviors of counties, that are mandatory for prescribers to check the PDMP before prescribing controlled substances …

Chapter: “Health Law And Ethics”, Allison K. Hoffman, I. Glenn Cohen, William M. Sage

All Faculty Scholarship

Law and ethics are both essential attributes of a high-functioning health care system and powerful explainers of why the existing system is so difficult to improve. U.S. health law is not seamless; rather, it derives from multiple sources and is based on various theories that may be in tension with one another. There are state laws and federal laws, laws setting standards and laws providing funding, laws reinforcing professional prerogatives, laws furthering social goals, and laws promoting market competition. Complying with law is important, but health professionals also should understand that the legal and ethical constraints under which health systems …

The Pricing Impact Of The Decreasing Competitiveness Of The Health Insurance Market, Lauren N. Patterson

EURēCA: Exhibition of Undergraduate Research and Creative Achievement

The Affordable Care Act created the national insurance exchanges of qualified health plans to encourage a higher insured rate, larger risk pools, and lower prices for quality health coverage. Consolidation of insurers can have opposing effects. The insurers’ risk pools will grow, allowing insurers to better hedge for risk. However, consolidation decreases the prevalence of competition in the market, and past research shows that insurer consolidation decreases market competition and increases prices.

I examine how the number of plans offered in a set market, pricing components, and county health variables impact the monthly premium pricing of plans sold on the …

The Pricing Impact Of Decreasing Competitiveness Of The Health Insurance Market, Lauren N. Patterson

Chancellor’s Honors Program Projects

No abstract provided.

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Disparities In Hospital Services Utilization Among Patients With Mental Health Issues: A Statewide Example Examining Insurance Status And Race Factors From 1999-2010, Viann N. Nguyen-Feng, Hind A. Beydoun, Michael K. Mcshane, James D. Blando

Community & Environmental Health Faculty Publications

There exist many disconnects between the mental and general health care sectors. However, a goal of the Affordable Care Act (ACA) of 2010 is to change this by improving insurance access and the intersection of mental and general health care. As insurance status intersects with race, the present study examines how race, insurance status, and hospital mental health services utilization differ across groups within the state of New Jersey. The present study aims to determine trends in hospital mental health care utilization by insurance status and race from 1999 to 2010. The rate of self-pay for mental health disorders in …

Rural Implications Of Medicaid Expansion Under The Affordable Care Act, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Medicaid

In this brief, researchers from the Maine Rural Health Research Center (University of Southern Maine, Muskie School of Public Service) present findings from a SHARE-funded evaluation of the rural implications of Medicaid expansion under the ACA.

The authors examine the following issues:

• The extent to which prior public health insurance expansions have covered rural populations
• Whether rural residents who are expected to be newly eligible for Medicaid in 2014 differ from their urban counterparts
• The extent to which rural individuals might differentially benefit from the ACA Medicaid expansion in light of the expansion becoming optional
• Whether rural enrollees are likely …

Navigating The Health Care Labyrinth: Portraits Of The Socioeconomically Disadvantaged, Thomas C. Crawford Phd

Antioch University Full-Text Dissertations & Theses

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75% White that earned (primary care specialties) in …

Can Consumers Make Affordable Care Affordable? The Value Of Choice Architecture, Eric J. Johnson, Ran Hassin, Tom Baker, Allison T. Bajger, Galen Treuer

All Faculty Scholarship

Starting this October, tens of millions will be choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do …

Improving Health Outcomes For Children (Ihoc): Summary Of Pediatric Quality Measures For Children Enrolled In Mainecare Ffy 2009 - Ffy 2012, Nathaniel J. Anderson Ms, Mph, Tracey Meagher

Population Health & Health Policy

his report, authored by USM Muskie School research staff, presents the results of the 16 CHIPRA Core Measures that were collected using MaineCare claims or Vital Statistics data and reported in the State of Maine’s FFY 2012 CHIP Annual Report to the Centers for Medicare and Medicaid Services (CMS). Also included in this report are an additional three measures from the Improving Health Outcomes for Children (IHOC) project’s Master List of Pediatric Measures. In addition to presenting results in graphs and narrative, this report also provides measure definitions and background information about each measure topic.

The goal of this document …

Global Budgets, Payment Reform And Single Payer: Understanding Vemont's Health Reform, Trish Riley

Population Health & Health Policy

The Muskie School of Public Service hosted two health policy colloquia this April to promote informed discussion throughout the state regarding MaineCare coverage options under the ACA and the implications of Vermont’s move toward a single-payer system.The series, sponsored by the Muskie School Board of Visitors, offers community conversations in which experts from various disciplines and perspectives inform and engage the broader public to explore and debate critical policy issues. On April 22, community and sector leaders joined for Global Budgets, Payment Reform, and Single Payer: Understanding Vermont's Health Reform. Participants discussed Vermont's recent movie toward single payer health …

Examining Mainecare’S Coverage Options Under The Affordable Care Act, Erika C. Ziller Phd, Trish Riley

Population Health & Health Policy

The Affordable Care Act (ACA) was designed to achieve nearly universal access to health coverage in the United States—in part by standardizing Medicaid eligibility across the country so that each state’s program would cover individuals with incomes below 138% of the federal poverty level (FPL), or $15,856 for an individual and $32,499 for a family of four in 2013 (see Figure 1).i However, in June 2012, the U.S. Supreme Court determined that states could not be required to broaden Medicaid and retained the decision as a state option. States that choose to participate may do so by amending their state …

Federal Health Care Reform: An Overview, Andrew F. Coburn Phd

Population Health & Health Policy

This policy brief discusses three of the main components of the Patient Protection and Affordable Care Act (ACA), also known as "Obamacare". These components are helath insurance coverage, delivery system improvement, and cost containment. The policy brief highlights some of the provision of the law that have already been implemented and those where importnat implementation decisions will have to be made. The brief is authored by Dr. Andrew Coburn, PhD, Professor of Public Health and Director of the Population Health and Health Policy program at the USM Muskie School, and was presented at the Maine Policy Leaders Academy Health Care …

Discounted Health Insurance Premium Systems, Krupa Pravin Patel

Theses Digitization Project

The purpose of this project is to address the issue of the rising health care in the United States, specifically the issues which will arise after the implementation of Obamacare. The project provides insurance companies and the U.S. government with an approach to implementing a discounted health insurance system. This insurance system will help the people spend less for health insurance premiums by providing with the discounted premium system.

The Utility Of Trouble: Leveling The Playing Field: Giving Municipal Officials The Tools To Moderate Health Insurance Costs, Robert L. Carey

Edward J. Collins Center for Public Management Publications

According to the research, Boston could have reduced its 2010 health premiums by between 15.6 and 17.1 percent, for a savings of between $41.4 and $45.4 million by joining the state’s Group Insurance Commission, more widely known as the GIC. The City is unable to join the GIC, however, without first receiving 70% union approval, according to state law. This requirement and the associated tradeoffs involved are a major barrier to municipal participation in the GIC. Several cities and towns including Boston have called for cities and towns to have the same ability as the state to design health insurance …

Tontines For The Invincibles: Enticing Low Risks Into The Health-Insurance Pool With An Idea From Insurance History And Behavioral Economics, Tom Baker, Peter Siegelman

All Faculty Scholarship

Over one third of the uninsured adults in the U.S. below retirement age are between 19 and 29 years old. Young adults, especially men, often go without insurance, even when buying it is mandatory and sometimes even when it is a low cost employment benefit. This paper proposes a new form of health insurance targeted at this group—the “Young Invincibles”—those who (wrongly) believe that they don’t need health insurance because they won’t get sick. Our proposal offers a cash bonus to those who turn out to be right in their belief that they did not really need health insurance. The …

Controlling The Cost Of Municipal Health Insurance: Lessons From Springfield, Robert L. Carey

Edward J. Collins Center for Public Management Publications

The study finds that, by joining the Group Insurance Commission (GIC), Springfield cut increases in its health care costs an estimated $14 million to $18 million over two years. It saved an additional $5 million per year by requiring eligible municipal retirees to enroll in Medicare Part B as a precondition of receiving supplemental health coverage from the City. These two actions, together, reduced increases in the City’s health care costs an estimated 15-19% annually, on average, with savings growth each year due to compounding. Furthermore, the study estimates that if the GIC continues its past pattern of keeping its …

The Effects Of Tort Reform On Medical Malpractice Insurers’ Ultimate Losses, Patricia Born, W. Kip Viscusi, Tom Baker

All Faculty Scholarship

Whereas the literature evaluating the effect of tort reforms has focused on reported incurred losses, this paper examines the long run effects using a comprehensive sample by state of individual firms writing medical malpractice insurance from 1984-2003. The long run effects of reforms are greater than insurers' expected effects, as five year developed losses and ten year developed losses are below the initially reported incurred losses for those years following reform measures. The quantile regressions show the greatest effects of joint and several liability limits, noneconomic damages caps, and punitive damages reforms for the firms that are at the high …

The Changing Nature Of Long-Term Care In Maine, Paul Saucier, Julie Fralich

Maine Policy Review

The increase in the proportion of older adults, many with one or more chronic medical conditions, will increase the demand for long-term care. Paul Saucier and Julie Fralich discuss the socio-demographic factors affecting long-term care policy, and describe various state and federal options for providing and financing long-term care. They note that Maine’s long-term care system has so far been able to absorb considerable growth in people by serving increasing numbers in lower-cost settings. Cost sharing has been introduced, and tax policy has been changed to provide incentives for long-term care insurance. Policymakers must now consider whether the current balance …

Dirigo Health: Its Opportunities And Obstacles, Godfrey Wood

Maine Policy Review

No abstract provided.

Dirigo Health: A Small Business Perspective, Deborah Cook

Maine Policy Review

In her commentary Deborah Cook, executive director of the Maine Small Business Alliance, discusses Dirigo Health from the viewpoint of small businesses, whose employees and families, along with the self-employed, represent the largest proportion of uninsured in Maine’s population. She notes that rising costs of health care and insurance are a major threat to the viability of small businesses.

The Challenge Of Preserving And Expanding Affordable Health Care In Maine, Wendy Wolf

Maine Policy Review

Maine’s health care system is in crisis. The state’s health care expenditures represent the third highest percentage of Gross Domestic Product in the nation; state health care spending is projected to top $11 billion per year, or $8,291 per person per year, over the next seven years; businesses in Maine pay 12-23% more for coverage than the national and New England state averages; and, the state’s uninsured and vulnerable populations continue to grow. In this article, Wendy Wolf charts the rising cost of health care in Maine and the implications of these costs for all Mainers. In turn, she looks …

Dirigo Health, Sharon Anglin Treat, Michael Brennan, Ann Woloson

Maine Policy Review

Maine’s pioneering Dirigo Health program aims at reducing health care costs, improving quality, and increasing access by providing health insurance coverage to all of Maine’s currently uninsured population. State senators Sharon Treat and Michael Brennan and co-author Ann Woloson provide an overview of the components, structure and financing of the program. They discuss some of the challenges and opportunities posed in Dirigo Health’s implementation, and give an insider’s perspective on the process by which the program was enacted.

Health Care Reform In Maine: Continuing The Dialogue, Robert Keller, Neil Rolde, Peter Hayes

Maine Policy Review

No abstract provided.

The Importance Of Health Insurance Reform, Nancy Landon Kassebaum

Maine Policy Review

In her commentary, Republican Senator Nancy Kassebaum of Kansas outlines a proposed bipartisan health insurance reform act which she will introduce in the Senate next year.