Journal of Urgent Care Medicine

With Less Competition, ACA Insurers Plan Major Price Increases

With many health insurers already scaling back—or vacating—state exchanges under the Affordable Care Act (ACA, or “Obamacare”), companies that plan on continuing to offer coverage may start charging members more for the “privilege” of being insured soon. Insurance industry projections show that many states could see jumps of 20% or so, while plan members in Pennsylvania and Georgia could see premiums go up by more than a third next year. Initially, 23 health insurance co-ops …

Fewer Americans Are Uninsured—But Is ACA a Success?

The percentage of uninsured Americans dropped below 10% by the end of 2015, compared with 16% when the Affordable Care Act (ACA, or “Obamacare”) was enacted in 2010. While the Obama administration chalks that up as a “win,” ACA critics question whether patients covered under ACA-supported plans have adequate coverage. Further, insurers have complained that offering coverage through ACA’s state exchanges is not cost-effective, with UnitedHealth and Humana deciding to stop participating in many states. …

Is America’s Uninsured Problem Being Replaced by America’s Underinsured Problem?

URGENT MESSAGE: Although the Affordable Care Act has made some progress in reducing the number of Americans without any health insurance, many of the newly insured are still unable to afford routine healthcare due to plan designs that include high deductibles, copays and coinsurance. Alan A. Ayers, MBA, MAcc is Practice Management Editor of JUCM—The Journal of Urgent Care Medicine, a former member of the Board of Directors of the Urgent Care Association of America, …

Blue Cross Blue Shield: ACA Enrollees Less Healthy, More Expensive

A new report from Blue Cross Blue Shield reveals that its Affordable Care Act enrollees are sicker and more expensive than its other plan members, as a whole. In fact, they’re nearly twice as likely to be admitted to hospitals. One reason will come as no surprise to critics of the ACA, or “Obamacare:” People who were uninsured and less healthy in the first place have signed up in droves. The act requires participating insurers …

Can Cost Control Be Profitable for New-Model Insurers?

Runaway healthcare spending that amounts to 17.5% of the U.S. economy is inspiring some entrepreneurial insurers to launch new models aimed at bridging the gap between patients and health systems—instead of creating friction between those two interdependent parties, which some claim traditional insurers are doing. One, ZOOM+, is headed by a physician and owns its own neighborhood medical clinics. Another, Clover Health, raised $135 million in venture capital to build a company that sells only …

CDC: Public Exchange Coverage Up, Off-exchange Coverage Down

As public exchange coverage climbed in the third quarter of 2015, use of off-exchange private coverage dropped, according to new data from the Centers for Disease Control and Prevention. This see-saw effect seems to indicate that U.S. health carriers had more trouble holding on to enrollees in group plans and off-exchange individual policies than they did holding on to enrollees in public exchange plans. Critics of the Affordable Care Act exchange system have noted that …

Medicaid Holdouts Continue to Confound ACA Proponents

Those who herald the Affordable Care Act (ACA, or “Obamacare”) as a success continue to be vexed by the six million or so citizens who are eligible for Medicaid but simply don’t sign up for it. Perhaps that should not be surprising, however, given that most people eligible for Medicaid are exempt from having to pay a penalty for being uninsured—one of the ACA’s prime incentives for individuals to get insured—and those eligible can sign …

ACA Is Officially Repealed—Temporarily

After months of legislative back-and-forth, and as we previewed here last month, the US House of Representatives has passed new legislation that essentially repeals the Affordable Care Act (ACA, or “Obamacare”). The Senate already voted to approve the bill, called the Restoring America’s Healthcare Freedom Reconciliation Act, after implementing changes to the original version. Proponents of the new bill—which President Obama has already promised to veto—say it would cut the federal deficit by $516 billion …

What Will ACA Provisions Mean for Urgent Care in 2016?

Some urgent care operators may be starting the new year with old worries about what the Affordable Care Act, known alternately as ACA or Obamacare, means for their centers. More specifically, there is concern that the shift away from PPO, in which patients can choose any provider in their network, to more rigid HMOs—many of which require patients to have preauthorization/referral to use urgent care or pay increased steerage—could hurt the industry. Where optimists hoped …

Providing Health Insurance for Employees of Urgent Care Centers: An Obligation or Added Benefit?

URGENT MESSAGE: Five years after the passage of the Patient Protection and Affordable Care Act (PPACA)—also known as the “Affordable Care Act,” or “Obamacare”—many independent urgent care practices are still uncertain of their obligations. In addition to legal mandates, a competitive job market can make a compelling case for offering or subsidizing employee health benefits. Alan A. Ayers, MBA, MAcc is Practice Manager Editor of The Journal of Urgent Care Medicine, a member of the …